Telerehabilitation
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Telerehabilitation (or e-rehabilitation
Commonly used modalities include
Important areas of telerehabilitation research include the investigation of new and emerging rehabilitation modalities as well as comparisons between telerehabilitation and in-person therapy in terms of patient functional outcomes, cost, patient satisfaction, and compliance.
As of 2006, only a few health insurers in the United States will
Technologies
- videophones/phones in telerehabilitation
- There are several types of connections used with real time exchanges. Plain old telephone service (POTS) uses standard analog telephone lines. Videophones are used with POTS lines and include a camera, display screen, and telephone. Videophones use telephone lines that are available in most homes, so are easy to set up; however small display screens make them problematic for individuals with vision problems. This can be solved by using a large screen or television as a screen.
- Videotelephony/Videotelephony in telerehabilitation
- The use of improved quality video-assisted telecommunication devices, such as videoconferencing, webcams and telepresenceto assist in treatments.
- The use of improved quality video-assisted telecommunication devices, such as
- Virtual reality/Virtual reality in telerehabilitation
- Virtual reality in telerehabilitation is one of the newest tools available in that area. This computer technology allows the development of three-dimensional virtual environments.
- Motion technology/Motion technology in telerehabilitation
- Web-based approaches/Web-based approaches in telerehabilitation
- Applications that run over the internet, just as if they were installed in your computer (called Rich Internet Applications), represent a new direction in software development. A person subscribes to the website rather than purchase the software. Any updates or changes to the software system are instantly available to all subscribers. The applications can be accessed from any location where one has access to an internet connected computer. Likewise, a patient's data is accessible from where ever the therapist is located. Neither the application nor the patient's data is tied to one computer.
- Sensors and body monitoring/Sensors and body monitoring in telerehabilitation
- Haptic technology/Haptic technology in telerehabilitation
- Artificial intelligence/Artificial intelligence in telerehabilitation
- Wireless technology/Wireless technology in telerehabilitation
- PDAs/PDA in telerehabilitation
- Mobile telephony/Mobile telephony in telerehabilitation
- Electronic medical records/Electronic medical record telerehabilitation
- Mobile apps/Mobile apps telerehabilitation
- Rehabilitation Robotics with telerehabilitation integrated into the therapeutic intervention (e.g., teleevaluation, telesupport, telemonitoring)
Clinical applications
Speech-language pathology
The clinical services provided by
Early applications to assess and treat acquired adult speech and language disorders involved the use of the telephone to treat patients with aphasia and motor speech disorders (Vaughan, 1976, Wertz, et al., 1987), a computer controlled video
The treatment of stuttering has been adapted to a telerehabilitation environment with notable success. Two Australian studies (Harrison, Wilson & Onslow, 1999; Wilson, Onslow & Lincoln, 2004) involving the distance delivery of the
Reports of telerehabilitation applications in
Voice therapy across a variety of types of voice disorders has been shown to be effectively delivered via a telerehabilitation application. Mashima et al. (2003) using PC based videoconferencing and speech analysis software compared 23 patients treated online with 28 persons treated face-to-face. The authors reported positive post treatment results with no significant difference in measures between the traditional and videoconferencing group, suggesting that the majority of traditional voice therapy techniques can be applied to distance treatment.
Although obvious limitations exist, telerehabilitation applications for the assessment of swallowing function have also been used with success. Lalor, Brown and Cranfield (2000) were able to obtain an initial assessment of the nature and extent of swallowing dysfunction in an adult via a videoconferencing link although a more complete evaluation was restricted due to the inability to physically determine the degree of laryngeal movement. A more sophisticated telerehabilitation application for the assessment of swallowing was developed by Perlman and Witthawaskul (2002) who described the use of real-time videofluoroscopic examination via the Internet. This system enabled the capture and display of images in real-time with only a three to five second delay. There has been considerable research into the assessment and treatment of dysphagia via telerehabilitation, including cost analyses, leading to the establishment of sustainable telerehabilitation services.[29][30][31][32][33][34][35][36][37][38][39][40][41][42]
There continues to be a need for ongoing research to develop and validate the use of telerehabilitation applications in speech-language pathology in a greater number and variety of adult and paediatric communication and swallowing disorders.
Occupational therapy
Occupational Therapy Practitioners (OTP), work with people across the lifespan in order to facilitate independence, establish or rehabilitate roles, habits and routines. Occupational Therapy can be administered through means of telehealth, and since telehealth is often being performed in the clients' own environment, carry-over and efficacy of interventions is often increased. There are many types of occupational therapy intervention that can be provided through telehealth. Many positive outcomes have been reported across multiple intervention areas including: motor learning/relearning,[43] ADL/IADL retraining (following CVA, TBI, Cancer,[44] joint replacement, etc), functional cognitive training,[45] home modification assessments,[46] vision rehabilitation,[47] pediatric therapies[48] and family training. It is safe to consider telehealth as an emerging practice area for OTPs with evidence of efficacy mounting from various areas of practice.
Following the COVID-19 Pandemic, Medicare and many private insurance companies swiftly adopted Telehealth as a reimbursable option for provision of occupational therapy services, although Telehealth has been used for many years prior especially in rural areas. As the public health emergency is due to expire, many advocates of telehealth are working towards establishing more permanent measures to protect telehealth as a reimbursed service. The American Occupational Therapy Association (AOTA) and World Federation of Occupational Therapists (WFOT) are both in support of Telehealth as a means to provide care. Most importantly, OTPs themselves are in support of making telehealth a permanent option for service delivery.[49] Telehealth is a promising adjunct to in-person treatment for persons receiving occupational therapy services.
Physical therapy
Types of Physical rehabilitation therapies delivered through telerehabilitation include strengthening exercises, motor retraining, goal setting, virtual reality, robotic therapy, community-therapy.
Motor strengthening exercises are the most commonly implemented modality. In motor training exercises, a provider guides a patient through performing different motions and activities in order to regain strength and function. Motor training through telerehabilitation has consistently been shown to produce equivalent functional outcomes compared with in-person therapy. However, many patients require in-person therapy initially before transitioning to telerehabilitation.
Goal setting has been used in remote areas where cost and provider availability prohibit access to physical therapy. Patients work with a therapist to set personal goals and track their progress through sessions. Goal setting telerehabilitation has been shown to produce increased patient satisfaction and improvement in activities of daily living compared with a control group receiving no therapy.
Virtual reality therapy involves the use of a sensor to detect movement and a virtual environment displayed on either a screen or headset. Patients perform therapeutic movements that correspond to tasks within the virtual environment. This provides an immersive environment for the patient and allows computerized monitoring of patient progress. Studies that compared virtual reality with motor training exercises have shown equal or better outcomes with virtual reality.
Robotic therapy typically involves the use of hand and foot strengthening robots which provide resistance training and assist the patient with performing movements. Robotic devices can also obtain precise data on patient movements and usage statistics and transmit them to providers for evaluation. Robotic therapy has even been combined with virtual reality telerehabilitation to create a virtual environment which responds to robotic movements. Robotic telerehabilitation studies have shown patient improvement from baseline but equivalent functional outcomes compared with motor training exercises.
Community therapy is used to deliver education and therapy to patients remotely, either through group exercise sessions or through kiosks. Community therapy tends to have lower patient compliance than individualized therapy, but can deliver similar results if appropriately utilized.[1]
Chronic respiratory disease
Telerehabilitation for chronic respiratory disease
The latest evidence suggests that primary pulmonary rehabilitation and maintenance rehabilitation delivered through telerehabilitation for people with chronic respiratory disease reaches outcomes similar to centre-based rehabilitation.[50] While there are no safety issues identified, the findings are based on evidence limited by a small number of studies.[50]
Cardiovascular disease
Telerehabilitation for cardiovascular disease
A systematic review of ten studies to measure the effectiveness of telerehabilitation as a means to reach "cardiac rehabilitation" has shown to be considered as an effective and appropriate measure to increase participation in underdeveloped areas.[51] The issue noted in the review was the technical drawbacks of broadband and limited internet connectivity, which limited the participation of willing participants of the study.[51] Addressing this technological gap could help showcase the potential impact of telerehabilitation on cardiac rehabilitation accessibility and participation as well as person-centered, health, and economic outcomes.[51]
Stroke survivors
Telerehabilitation for stroke survivors
In a 2018 systematic review of 15 studies it was found that there were no significant differences in given tests and measures between telerehabilitation and control groups when it came to post stroke care.[52] This was supported through tests such as Barthel Index , Berg Balance Scale , Fugl-Meyer Upper Extremity , and Stroke Impact Scale.[52] Furthermore, the study goes on to conclude that “Telerehabilitation can be a suitable alternative to usual rehabilitation care in post stroke care especially in remote or underserved areas. Larger studies are needed to evaluate the health-related quality of life and cost-effectiveness with the ongoing improvements in telerehabilitation networks.”[52]
Standards and training requirements
- Telerehabilitation standards
- Reimbursement policies/Reimbursement in telerehabilitation
- Legislative activities/Legislative activities in telerehabilitation
- privacy issues/Ethics and privacy issues in telerehabilitation
- Clinical and technology training issues
History
In 1999, D.M. Angaran published "Telemedicine and Telepharmacy: Current Status and Future Implications" in the
Three early adopters of telemedicine were
In contrast, the
An argument can be made that "telerehabilitation" began in 1998 when NIDRR funded the first RERC on tele-rehabilitation. It was awarded to a consortium of biomedical engineering departments at the National Rehabilitation Hospital and
In 2001, O. Bracy, a neuropsychologist, introduced the first web based, rich internet application, for the telerehabilitation presentation of cognitive rehabilitation therapy. This system first provides the subscriber clinician with an economical means of treating their own patients over the internet. Secondly, the system then provides, directly to the patient, the therapy prescription set up and controlled by the member clinician. All applications and response data are transported via the internet in real time. The patient can login to do their therapy from home, the library or anywhere they have access to an internet computer. In 2006, this system formed the basis of a new system designed as a cognitive skills enhancement program for school children. Individual children or whole classrooms can participate in this program over the internet.
In 2006, M.J. McCue and S.E. Palsbo published an article in the
Research in telerehabilitation has evolved beyond its infancy, with many studies, but most are demonstration projects of smaller size. Rehabilitation researchers need to conduct many more controlled experiments and present the evidence to clinicians (and payers) that telerehabilitation is clinically effective. The discipline of speech-language pathology is ahead of occupational therapy and physical therapy in demonstrating equivalence over various types of telecommunications equipment. One area with dozens of research studies that often involve a telerehabilitation component relates to home telesupported neurorehabilitation therapy for stroke survivors (see sections on Physical Therapy, Stroke Survivors). These employ a suite of interactive goal-directed tasks, tunable by a therapist, that make use of simple robots or devices using game ports (e.g., Feng and Winters, 2007[56]).
Related organizations
- American Telemedicine Association (ATA)
- American Speech-Language-Hearing Association(ASHA)
- National Institute on Disability and Rehabilitation Research (NIDRR)
- Rehabilitation Engineering and Assistive Technology Society of North America (RESNA)
- Special Interest Group on Telerehabilitation (SIGOT)
See also
References
- ^ a b
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External links
- Telerehabilitation at Curlie