Telerehabilitation to treat Physical Disorder
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.
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.
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.
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.
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.