Telerehabilitation Technologies Research Articles

Telerehabilitation Technologies: Accessibility and Usability

In the fields of telehealth and telemedicine, phone and/or video technologies are key to the successful provision of services such as remote monitoring and visits. How do these technologies affect service accessibility, effectiveness, quality, and usefulness when applied to rehabilitation services in the field of telerehabilitation? To answer this question, we provide a overview of the complex network of available technologies and discuss how they link to rehabilitation applications, services, and practices as well as to the telerehabilitation end-user.This white paper will first present the numerous professional considerations that shape the use of technology in rehabilitation service and set it somewhat apart from telemedicine. It will then provide an overview of concepts essential to usability analysis; present a summary of various telerehabilitation technologies and their strengths and limitations, and consider how the technologies interface with end users’ clinical needs for service accessibility, effectiveness, quality, and usefulness. The paper will highlight a conceptual framework (including task analyses and usability issues) that underlies a functional match between telerehabilitation technologies, clinical applications, and end-usercapabilities for telerehabilitation purposes. Finally, we will discuss pragmatic issues related to user integration of telerehabilitation technology versus traditional face-to-face approaches.Key Words: Remote, Technology, Usability, Accessibility, Decision Factors, Decision Support.

Quantitative Assessment of ADL: A Pilot Study of Upper Extremity Reaching Tasks

Effective telerehabilitation technologies enable patients with certain physiological disabilities to engage in rehabilitative exercises for performing Activities of Daily Living (ADLs). Therefore, training and assessment scenarios for the performance of ADLs are vital for the promotion for telerehabilitation. In this paper we investigate quantitatively and automatically assessing patient’s kinematic ability to perform functional upper extremity reaching tasks. The shape of the movement trajectory and the instantaneous acceleration of kinematically crucial body parts, such as wrists, are used to compute the approximate entropy of the motions to represent stability (smoothness) in addition to the duration of the activity. Computer simulations were conducted to illustrate the consistency, sensitivity and robustness of the proposed method. A preliminary experiment with kinematic data captured from healthy subjects mimicking a reaching task with dyskinesia showed a high degree of correlation (Cohen’s kappa 0.85 withp<0.05) between a human observer and the proposed automatic classification tool in terms of assigning the datasets to various levels to represent the subjects’ kinematic abilities to perform reaching tasks. This study supported the use of Microsoft Kinect to quantitatively evaluate the ability of individuals with involuntary movements to perform an upper extremity reaching task.

Feasibility of Telerehabilitation Implementation as a Novel Experience in Rehabilitation Academic Centers and Affiliated Clinics in Tehran: Assessment of Rehabilitation Professionals' Attitudes.

Introduction. This study aimed to assess rehabilitation professionals' attitude toward implementation and application of telerehabilitation technology as a novel study in rehabilitation academic centers and affiliated clinics in Tehran. Methods. It was a descriptive cross-sectional study. To collect data, a researcher-designed questionnaire was developed. 141 rehabilitation experts participated in the study. Results. A majority of faculty members (78%) and clinicians (89.7%) either were in “definite agreement” or “somewhat agreed” with implementation and application of this technology, which demonstrates an overall positive attitude. Discussion. Based on the positive attitudes of the majority of participants toward implementation and application of this technology and their preferences in offering different telerehabilitation services, it seems that there is an appropriate and desirable acceptance and administrative culture to implement this technology among rehabilitation experts in Tehran. It is thus expected that implementation and application of this technology will be a promising experience in rehabilitation academic centers and affiliate clinics in Tehran.

School-based telerehabilitation in occupational therapy: using telerehabilitation technologies to promote improvements in student performance.

This article discusses the use of telerehabilitation technologies in occupational therapy for school-based practice. Telerehabilitation, for the purpose of this program, included the implementation of occupational therapy services via two-way interactive videoconferencing technology. The subjects included in this pilot program were children, ages 6 to 11 years, who attended an online charter school and had difficulties in the areas of fine motor and/or visual motor skills which impacted success with handwriting. Each participant completed a virtual evaluation and six 30-minute intervention sessions. The Print Tool™ Assessment was used to determine progress pre- and post-program. A learning coach/student satisfaction survey was given at the end of the program to determine participant satisfaction. Outcomes revealed improvements in handwriting performance for most students who participated in the program and high satisfaction rates reported by all participants.

Lessons learned in pilot testing specialty consultations to benefit individuals with lower limb loss.

Telerehabilitation technologies enable the delivery of rehabilitation services from providers to people with disabilities as well as specialty care consultations. This article discusses the barriers experienced when planning and pilot testing a telerehabilitation multi-site specialty consultation for specialists in their medical centers, and the lessons learned. The barriers included integration and participation, coordination across organizational units, and privacy and information security. Lessons learned included the need for collaboration across multiple departments, telerehabilitation equipment back-ups, and anonymous and private communication protocols. Despite delays resulting from coordination at multiple levels of a national organization, we developed a program plan and successfully implemented a pilot test of the southeast region program. Specialty consultation using telerehabilitation delivery methods requires identifying provider preferences for technological features. Lessons learned could inform development of outpatient telerehabilitation for patients with amputations and studies of patients and providers involved in telerehabilitation.

Clinical Telerehabilitation: Applications for Physiatrists

Telemedicine offers an innovative approach to increase access to rehabilitation medicine services for patients who live in areas where physiatrists are scarce or absent. This article reviews the current status of telerehabilitation services delivered through real-time videoconferencing to provide support, assessment, and interventions to individuals with impairments or disabilities. A literature review demonstrates various uses of telerehabilitation by physical therapists, occupational therapists, speech and language pathologists, audiologists, recreational therapists, neuropsychologists, nurses, other physician specialists, and physiatrists. We also provide more in-depth examples of 2 current programs that involve physiatrists: One furnishes telerehabilitation services to adult stroke survivors, and the other addresses the special health care needs of children with developmental disabilities. We discuss the benefits of using telemedicine via real-time videoconferencing to care for individuals with disabilities, outline the challenges of successfully implementing a physiatric telerehabilitation program, and finish with a list of potential applications for physiatrists interested in incorporating telemedicine into their practice. Further investigation of the use of telehealth technologies to deliver physiatric services, care coordination, and education is needed. We recommend that our professional societies develop and publish guidelines to facilitate development and use of telerehabilitation technologies to increase access to physiatric services.

Ten years of telerehabilitation: A literature overview of technologies and clinical applications

This paper aims at delivering a structured overview of telerehabilitation literature by analysing the entire set of articles under the search terms "telerehabilitation" or "tele-rehabilitation" to portray "state of the art" ten years after the publication of the first scientific article on the topic. A structured study has been conducted by considering all those articles containing the word "telerehabilitation" or "tele-rehabilitation". Medline, Embase, Cochrane, UK Centre for Reviews and Dissemination, Canadian Agency for Drugs and Technologies in Health databases have been interrogated for articles between 1998 and 2008. 146 scientific articles were found. 56 articles focus on patient treatment, 23 are reviews, 3 are to be considered as both patient treatment papers and reviews, 53 are either technical reports, system descriptions or analyses of new approaches; 8 are general discussion on telerehabilitation. The present paper draw the scenario of the first ten years of telerehabilitation, focussing on clinical applications and technologies. Basically, it confirms the lack of comprehensive studies providing evidence for supporting decision and policy-makers in adopting telerehabilitation technologies in the clinical practice. An overall lack of standardisation in the used terminology also results from the analysis of keywords, which is typical of quite recent fields of application.

Telerehabilitation mediated physiotherapy assessment of ankle disorders

Musculoskeletal injuries are the most common source of chronic pain and disability. The ankle joint is the most common of these injuries and without adequate rehabilitation function can be severely impaired. Access to physiotherapy rehabilitation services can be limited due to geographical remoteness and a shortage of services in rural and remote areas. Telerehabilitation is a potential solution to bridge this service delivery gap. The aim of this study was to determine the criterion validity and reliability of conducting a remote musculoskeletal assessment of the ankle joint complex using telerehabilitation technologies compared with a face-to-face assessment. This study utilized a repeated measures design to assess 15 subjects (mean age 24.5, SD 10.8 years) presenting with ankle pain. Conventional face-to-face assessments were compared with assessments performed via a telerehabilitation system. A similar agreement of 93.3% in patho-anatomical diagnosis and an 80% exact agreement (chi(2) = 4.267; p < 0.04) in primary systems diagnosis was found between face-to-face and telerehabilitation assessments. Clinical observations were found to have very strong agreement (k = 0.92) for categorical data and significant agreement (93.3% agreement; chi(2) = 234.4; p < 0.001) for binary data. A high level of inter- and intrarater reliability was found for the telerehabilitation assessments. This study demonstrates the criterion validity and reliability of remote musculoskeletal assessments of the ankle joint complex using telerehabilitation.

Telerehabilitation technologies: accessibility and usability.

In the fields of telehealth and telemedicine, phone and/or video technologies are key to the successful provision of services such as remote monitoring and visits. How do these technologies affect service accessibility, effectiveness, quality, and usefulness when applied to rehabilitation services in the field of telerehabilitation? To answer this question, we provide a overview of the complex network of available technologies and discuss how they link to rehabilitation applications, services, and practices as well as to the telerehabilitation end-user. This white paper will first present the numerous professional considerations that shape the use of technology in telerehabilitation service and set it somewhat apart from telemedicine. It will then provide an overview of concepts essential to usability analysis; present a summary of various telerehabilitation technologies and their strengths and limitations, and consider how the technologies interface with end users' clinical needs for service accessibility, effectiveness, quality, and usefulness. The paper will highlight a conceptual framework (including task analyses and usability issues) that underlies a functional match between telerehabilitation technologies, clinical applications, and end-user capabilities for telerehabilitation purposes. Finally, we will discuss pragmatic issues related to user integration of telerehabilitation technology versus traditional face-to-face approaches.

The effects of aphasia severity on the ability to assess language disorders via telerehabilitation

Background: Telerehabilitation is the remote delivery of rehabilitation services via information technology and telecommunication systems. There have been a number of recent studies that have used video conferencing to assess language skills in people with aphasia. These studies have highlighted the possibility that severity of impairment and aetiology may have an effect on the administration of telerehabilitation language assessment protocols. Furthermore, anecdotal accounts of difficulties in administering language assessment via telerehabilitation also demonstrate the need for research into the effects of severity of aphasia. It is important that the effects of severity of aphasia are determined as part of the overall evidence base for telerehabilitation language assessment protocols. Aims: To investigate the influence of severity of aphasia on the ability to assess acquired aphasia via telerehabilitation methods. Methods & Procedures: A total of 32 participants with an acquired aphasia were assessed simultaneously via telerehabilitation and face‐to‐face methods on the Boston Diagnostic Aphasia Examination 3rd Edition Short Form (BDAE‐3) and the Boston Naming Test (BNT) (2nd Edition Short Form). A custom‐built telerehabilitation system developed at the University of Queensland enabled real‐time telerehabilitation assessment over a 128 kbit/s Internet connection. Participants were grouped according to their severity level. Data analysis was conducted on the differences in scores from the two assessors. Outcomes & Results: Results revealed that severity of aphasia did not greatly influence the accuracy of the telerehabilitation assessment for the majority of the BDAE‐3 clusters. However, severity of aphasia appeared to affect the ability to assess naming and paraphasia via telerehabilitation methods. Post‐hoc analysis revealed that the scores given in the face‐to‐face and telerehabilitation environments were comparable within each severity level. Conclusions: Results suggest that severity of aphasia may influence the ability to assess some language parameters via telerehabilitation. Further research should use larger sample sizes to confirm these results and to refine the telerehabilitation technology to enable these parameters to be adequately assessed. Additionally, clinician satisfaction with telerehabilitation assessment should be qualitatively researched so as to widen clinician acceptance of this method.

Human factors in the development and implementation of telerehabilitation systems

Telemedicine services must be designed and implemented with the users in mind. When conducting telerehabilitation, factors such as age, education and technology experience must be taken into account. In addition, telerehabilitation must also accommodate a range of potential patient impairments, including deficits in language, cognition, motor function, vision and voice. Telerehabilitation technology and treatment environments should adhere to universal design standards so as to be accessible, efficient, usable and understandable to all. This will result in improved access to a wider range of telerehabilitation services that will facilitate and enhance the rehabilitative treatment and recovery of people living with varying levels of injury, impairment and disability.

Telerehabilitation for a baby's abnormal foot correction

Telemedicine now finds itself at a crossroads and the robotic use over distance for medical diagnosis and treatment has now become a reality. Many kinds of medical deformity on patients at a remote location can be corrected in a non-surgical way, by using robotic medical assistive devices, under telerehabilitation technology. The present work gives an overview of telerehabilitation, along with its application. The paper follows the main characteristics of telerehabilitations. Finally, a conceptual telerehabilitation model for the correction of a clubfoot deformity in newborn babies is presented. This model gives a clear indication that the proposed model can be implemented in real life, to give a standard method for better health care of the child and hence to society.

Development of a teletechnology protocol for in-home rehabilitation

Our ability to provide in-home rehabilitation is limited by distance and available personnel. We may be able to meet some rehabilitation needs with videoconferencing technology. This article describes the feasibility of teletechnology for delivering multifactorial, in-home rehabilitation interventions to community-dwelling adults recently prescribed a mobility aid. We used standard telephone lines to provide two-way video and audio interaction. The interventions included prescription of and/or training in functionally based exercises, home-hazard assessment, assistive technology, environmental modifications, and adaptive strategies. Patients were evaluated in three transfer and three mobility tasks, and appropriate treatment was provided over the course of four visits. To date, 13 of the 14 subjects enrolled in the rehabilitation study have completed all four visits (56 visits total). Equipment-related problems were most common early in the study, particularly on the initial visit to a subject's house. We identified (mean +/- standard deviation [SD]) 13.1 +/- 7.9 mobility/self-care problems per subject and made 12.5 +/- 8.3 recommendations per subject to address those problems. At 6-week follow-up, 60.1 percent of our recommendations had been implemented. The greatest number of problems was identified for tub transfers (mean +/- SD = 3.4 +/- 1.4), the greatest number of recommendations was made for toilet transfers (mean +/- SD = 3.1 +/- 3.4), and the most frequently implemented recommendations were for transition between locations. Overall, our results show promise that both the telerehabilitation technology and intervention procedures are feasible.

Telerehabilitation Position Paper

Though the use of telerehabilitation technologies is expanding quickly as a viable method of service delivery for many practitioners within the field of health care, there remain issues of efficacy, cost, reimbursement, legal and ethical ramifications, and practitioner competence. There is a significant need for occupational therapy practitioners to document, research, and publish on the efficacy of consultation, intervention, and follow-up services provided using telerehabilitation technologies. Further investigation of the use of telehealth technologies in professional development and supervision is needed to clarify effectiveness and efficiency, as demand for services, particularly in rural areas, threatens to exceed services available. Occupational therapy practitioners using telerehabilitation methods must adhere to the AOTA Occupational Therapy Code of Ethics (AOTA, 2000), maintain the AOTA Standards of Practice (AOTA, 2005), and comply with state regulations, ensuring both their proficiencies as practitioners and the well being of their clients.

The economics of telerehabilitation.

This paper is an analysis of the economics of physical telerehabilitation, at home, in the clinic, and at work. This study was a precursor to generating a business case for manufacturing telerehabilitation systems. Pilot studies were performed and structured interviews conducted with providers, payers, patients, and employers. The data obtained were analyzed, in conjunction with published data, to understand the economics with respect to parameters such as lost opportunity costs at work, faster rehabilitation, and cost savings to patients, providers, payers, and employers. The results showed that telerehabilitation has a positive business case with respect to all the stakeholders. The ability to quantify and analyze data from patients remotely is convenient and economical to providers. Patients benefit by getting back to their normal activities faster, both at home as well as work. Telerehabilitation at work allows employees to be treated at work without having to take time to go to a clinic. Lost opportunity costs for employers are minimized when workers return to work faster and are treated onsite. The ability to measure progress quantitatively is beneficial for patients, providers, payers, and employers. Additionally, malingering can be detected and eradicated using telerehabilitation. Proper application of appropriate telerehabilitation technologies makes eminent economical sense. There is a strong business case for the application of telerehabilitation, onsite, in large corporations and therefore is profitable to medical device manufacturers.

The Economics of Telerehabilitation

This paper is an analysis of the economics of physical telerehabilitation, at home, in the clinic, and at work. This study was a precursor to generating a business case for manufacturing telerehabilitation systems. Pilot studies were performed and structured interviews conducted with providers, payers, patients, and employers. The data obtained were analyzed, in conjunction with published data, to understand the economics with respect to parameters such as lost opportunity costs at work, faster rehabilitation, and cost savings to patients, providers, payers, and employers. The results showed that telerehabilitation has a positive business case with respect to all the stakeholders. The ability to quantify and analyze data from patients remotely is convenient and economical to providers. Patients benefit by getting back to their normal activities faster, both at home as well as work. Telerehabilitation at work allows employees to be treated at work without having to take time to go to a clinic. Lost opportunity costs for employers are minimized when workers return to work faster and are treated onsite. The ability to measure progress quantitatively is beneficial for patients, providers, payers, and employers. Additionally, malingering can be detected and eradicated using telerehabilitation. Proper application of appropriate telerehabilitation technologies makes eminent economical sense. There is a strong business case for the application of telerehabilitation, onsite, in large corporations and therefore is profitable to medical device manufacturers.

Telerehabilitation needs: a survey of persons with acquired brain injury.

To survey individuals with acquired brain injury to assess multiple facets of interest, access, and familiarity necessary to implement new telerehabilitation technologies. Anonymous mail survey. Community. Seventy-one respondents to a survey. These individuals had experienced acquired brain injury (predominantly severe traumatic brain injury [TBI]) and were living in the community. Surveys were mailed by a state chapter of the Brain Injury Association to a random selection of members with acquired brain injury. Survey designed specifically for this investigation. The survey responses indicate that there is great interest in the possibility of accessing telerehabilitative services among individuals with acquired brain injury. In particular, there was strong interest expressed in services that could be used to assist with problems in memory, attention, problem-solving, and activities of daily living. Telemedicine, and more specifically telerehabilitation, holds great promise as an adjunct to traditional clinical service delivery. Little research in this area has been applied, however, to individuals with acquired brain injuries. Although on the surface, telerehabilitation seems to be an appropriate assessment and treatment modality for individuals with brain injury, it will only succeed if those individuals have the interest-and the access-necessary to use new and evolving technologies.