Rehabilitation to cope and work around a significant physical disorder can be a trying process at the best of times. However, typically, the health service does not operate under the best of times. Months of progress by both patient and practitioner can be wiped out almost overnight by caseload restructuring, or facility reappropriation.

Frustration mounts on both sides when patients are unable to see specialists because mobility difficulties conflict with the clinic building's capabilities, and the practitioner is unable to make regular home visits because of travel costs or time constraints.

Telerehabilitation - rehabilitation conducted via remote link, as a variation on telepresence, would seem to be a good answer. In fact it is a good, and frequently used treatment method for mental disorders. Yet, for physical disorders, without the communications technology in place on both sides to properly mediate, it has not occurred save in isolated instances.

Yet, progress is being made. Australia, with its our widely dispersed population and rural and remote communities, is the ideal location to begin pioneering this type of treatment, and so it is unsurprising that this area would be interested in such work, more swiftly than other areas.

the telerehabilitation research unit of the University of Queensland is conducting the first clinical studies of telerehabilitation.One study, uses speech pathology service provision as a guinea pig, the other uses physical therapy.

Speech Telerehabilitation

The choice of speech makes a great deal of sense as speech defects require a minimum of special equipment to handle on a remote basis. The graduate in charge, Dr Anne Hill, works with speech pathology professionally, making the choice of field somewhat more obvious.

"Having worked clinically with people living with an acquired neurogenic communication disorder, I saw how frustrating it was for both the person with the communication disorder and the clinician if access to these services was restricted due to issues of caseload, distance or mobility issues," she said. "This form of service delivery may help alleviate some of the access problems experienced by those living in rural and remote areas, as well as the metropolitan population restricted by mobility issues."

She led a study even though she was already convinced of the benefits, in order to provide empirical data that could be used to assay funding and assist other efforts to telerehabilitate. The study assessed 86 patients with various speech and language disorders, such as dysarthria, aphasia and apraxia of speech.

Each participant was also assessed using the traditional face-to-face method, allowing Dr Hill to gather comparative data and measure the validity and reliability of remote assessment.

"Two speech pathologists conducted simultaneous rating of the face-to-face and telerehabilitation assessment of the participants," she said. "One of the two speech pathologists was randomly assigned to lead the assessment, either in the telerehabilitation environment or the face-to-face environment, while the other speech pathologist became a silent scorer of the assessment in the alternative environment.

"This methodology allowed for the direct comparison between the telerehabilitation and face-to-face assessments, which is important in the development of evidence-based guidelines.

"Telerehabilitation has the potential to address the major issues of service delivery in future decades, such as resolving inequities in access to rehabilitation services and meeting the increased demand for services due to an expanding ageing population.

"Furthermore, telerehabilitation holds some promise for the further development of community-based chronic disease/disorder management protocols and providing cost-effective, functionally appropriate, high quality rehabilitation to all.

"The introduction of telerehabilitation to the profession of speech-language pathology unlocks an exciting new era of research which blends clinical and technological innovation to better understand and serve those living with a communication disorder.

"Future research will be limited only by our imagination in applying evolving technology to rehabilitation."

Custom designed videoconferencing software is used, which al;lows for high baud, 128kb/sec speech transfer, with considerable additional libraries on the clinician's end, analysing speech flow in real-time. The patients are currently provided with a mid-spec PC if they do not possess one. If they do possess such, certain elements of the study call for a touch-screen system which is provided, as such systems are currently not standard on home units.

Physical Therapy Telerehabilitation

The same basic tools are used in the PT studies. Patients are provided with a mid-end PC, with a usb port. A variety of physiotherapy devices, including the ePAED, an 'an electronic portable anthropometric evaluation device' otherwise known as a small digital camera with additional processing capability (specialist palm pc), can be plugged into the USB port, then controlled via teleoperation, by the clinician, with them instructing the patient or a patient's family member, how to hold the device, and recording the shape and girth of various physical attributes of the patient with it.

The telerehabilitation functions less like a standard physical therapy session, and more as a check-up on progress. Photos taken in real-time, with clinician supervision via videoconferencing, have been previously proven by the research unit, to be as accurate as vernier calliper measurements, once the photos are run through image enhancement and 3D extrusion processes on the clinician's end. This also occurs in real-time, thanks to a high end clinician workstation.

References

Telerehabilitation Research Unit - The University of Queensland

Speech Pathology assessment

Speech disorders can be treated from a distance

ePAED foot assessment in adults

ePAED measurement of plagiocephaly

ePAED measurements of static joint angles

Offline References

Hill, A., Theodoros, D., Russell, T., & Ward, E. (2008). Using telerehabilitation to assess apraxia of speech in adults, International Journal of Disorders of Communication, iFirst, 1-17.