Telerehabilitation
Encyclopedia
Telerehabilitation is the delivery of rehabilitation
services over telecommunication networks and the internet. Most types of services fall into two categories: clinical assessment (the patient’s functional abilities in his or her environment), and clinical therapy. Some fields of rehabilitation practice that have explored telerehabilitation are: neuropsychology
, speech-language pathology, audiology
, occupational therapy
, and physical therapy
. Telerehabilitation can deliver therapy to people who cannot travel to a clinic
because the patient has a disability
or because of travel time. Telerehabilitation also allows experts in rehabilitation to engage in a clinical consultation at a distance.
Most telerehabilitation is highly visual. As of 2006 the most commonly used modalities are via webcam
s, videoconferencing
, phone lines, videophone
s and webpages containing rich Internet applications. The visual nature of telerehabilitation technology limits the types of rehabilitation services that can be provided. It is most widely used for neuropsychological rehabilitation; fitting of rehabilitation equipment such as wheelchair
s, braces or artificial limbs; and in speech-language pathology. Rich internet applications for neuropsychological rehabilitation (aka cognitive rehabilitation) of cognitive impairment (from many etiologies) was first introduced in 2001. This endeavor has recently (2006) expanded as a teletherapy application for cognitive skills enhancement programs for school children. Tele-audiology
(hearing assessments) is a growing application. As of 2006, telerehabilitation in the practice of occupational therapy and physical therapy are very limited, perhaps because these two disciplines are more “hands on”.
Two important areas of telerehabilitation research are (1) demonstrating equivalence of assessment and therapy to in-person assessment and therapy, and (2) building new data collection systems to digitize information that a therapist can use in practice. Ground-breaking research in telehaptics (the sense of touch) and virtual reality may broaden the scope of telerehabilitation practice, in the future.
In the United States, the National Institute on Disability and Rehabilitation Research
's (NIDRR) http://www.ed.gov/about/offices/list/osers/nidrr/index.html?src=mr supports research and the development of telerehabilitation. NIDRR's grantees include the "Rehabilitation Engineering and Research Center" (RERC) at the University of Pittsburgh
, the Rehabilitation Institute of Chicago
, the State University of New York at Buffalo, and the National Rehabilitation Hospital in Washington DC. Other federal funders of research are the Veterans Administration, the Health Services Research Administration in the US Department of Health and Human Services, and the Department of Defense. Outside the United States, excellent research is conducted in Australia and Europe.
As of 2006, only a few health insurers in the United States will reimburse for telerehabilitation services. If the research shows that tele-assessments and tele-therapy are equivalent to clinical encounters, it is more likely that insurers and Medicare
will cover telerehabilitation services.
and telemedicine
since the 1950s. The Department of Defense
(DoD) and the National Aeronautics and Space Administration (NASA) spearheaded the technology in the United States
during the Vietnam War
and the space program; both agencies continue to fund advances in telemedicine
.
Three early adopters of telemedicine were state penitentiary systems, rural health care systems, and the radiology
profession. Telemedicine makes business sense for the states because they do not have to pay for security escorts to have a prison
er receive care outside the prison.
Rural telemedicine in the United States is heavily subsidized through federal agency grants
for telecommunications operations. Most of this funding comes through the Health Services Research Administration and the Department of Commerce. Some state universities have obtained state funding to operate tele-clinics in rural areas. As of 2006, few (if any) of these programs are known to financially break-even, mostly because the Medicare program for people over age 65 (the largest payer) is very restrictive about paying for telehealth.
In contrast, the Veterans Administration
is relatively active in using telemedicine for people with disabilities. There are several programs that provide annual physical exams or monitoring and consultation for veterans with spinal cord injuries. Similarly, some state Medicaid
programs (for poor people and people with disabilities) have pilot programs using telecommunications to connect rural practitioners with subspecialty therapists. A few school district
s in Oklahoma
and Hawaii
offer school-based rehabilitation therapy using therapy assistants who are directed by a remote therapist. The National Rehabilitation Hospital
in Washington DC and Sister Kenny Rehabilitation Institute
in Minneapolis provided assessment and evaluations to patients living in Guam
and American Samoa
. Cases included post-stroke
, post-polio, autism
, and wheel-chair fitting.
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 The Catholic University of America
, both located in Washington, DC; the Sister Kenny Rehabilitation Institute in Minnesota; and the East Carolina University
in North Carolina
. Some of this early research work, and its motivation, is reviewed in Winters (2002). The State of Science Conference held in 2002 convened most of military and civilian clinicians, engineers, and government officials interested in using telecommunications as a modality for rehabilitation assessment and therapy; a summary is provided in Rosen, Winters & Lauderdale (2002). The conference was attended by the incoming president of the American Telemedicine Association
(ATA). This led to an invitation by ATA to the conference attendees to form a special interest group on telerehabilitation. NIDRR funded the second 5-year RERC on telerehabilitation in 2004, awarding it to the University of Pittsburgh. This RERC was renewed in 2010.
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 Journal of Telemedicine and Telecare that explored how telemedicine can become a profitable business for hospitals. They argue that telerehabilitation should be expanded so that people with disabilities and people in pain (perhaps after hip-replacement surgery or people with arthritis
) can get the rehabilitative therapy they need. It is unethical to limit paymente for telerehabilitation services only to patients in rural areas.
Research in telerehabilitation is in its infancy, with only a handful of equivalence trials. As of 2006, most peer-reviewed research in telemedicine are case reports of pilot programs or new equipment. 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 far head of occupational therapy and physical therapy in demonstrating equivalence over various types of telecommunications equipment.
, voice disorders, speech disorders in children, and swallowing dysfunction. The technology involved in these applications has ranged from the simple telephone (Plain Old Telephone System – POTS) to the use of dedicated Internet-based videoconferencing systems.
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 laserdisc
over the telephone and a closed-circuit
television system to assess speech and language disorders (Wertz et al, 1987), and a satellite-based videoconferencing system to assess patients in rural areas (Duffy, Werven & Aronson, 1997). More recent applications have involved the use of sophisticated Internet-based videoconferencing systems with dedicated software which enable the assessment of language disorders (Georgeadis, Brennan, Barker, & Baron, 2004, Brennan, Georgeadis, Baron & Barker, 2004) and the assessment and treatment of motor speech disorders (Hill, Theodoros, Russell, Cahill, Ward, Clark, 2006; Theodoros, Constantinescu, Russell, Ward, Wilson & Wootton, in press) following brain impairment and Parkinson's disease
. Collectively, these studies have revealed positive treatment outcomes, while assessment and diagnoses have been found to be comparable to face-to-face evaluations.
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 Lidcombe program to children who stutter have utilized the telephone in conjunction with offline video recordings to successfully treat several children. Overall, the parents and children responded positively to the program delivered at a distant. Using a high speed videoconferencing system link, Sicotte, Lehoux, Fortier-Blanc and Leblanc (2003) assessed and treated six children and adolescents with a positive reduction in the frequency of dysfluency that was maintained six months later. In addition, a videoconferencing platform has been used successfully to provide follow-up treatment to an adult who had previously received intensive therapy (Kully, 200).
Reports of telerehabilitation applications in paediatric speech and language disorders are sparse. A recent Australian pilot study has investigated the feasibility of an Internet-based assessment of speech disorder in six children (Waite, Cahill, Theodoros, Russell, Busuttin, in press). High levels of agreement between the online and face-to-face clinicians for single-word articulation, speech intelligibility, and oro-motor tasks were obtained suggesting that the Internet-based protocol had the potential to be a reliable method for assessing paediatric speech disorders.
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 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.
Physical medicine and rehabilitation
Physical medicine and rehabilitation , physiatry or rehabilitation medicine, is a branch of medicine that aims to enhance and restore functional ability and quality of life to those with physical impairments or disabilities. A physician having completed training in this field is referred to as a...
services over telecommunication networks and the internet. Most types of services fall into two categories: clinical assessment (the patient’s functional abilities in his or her environment), and clinical therapy. Some fields of rehabilitation practice that have explored telerehabilitation are: neuropsychology
Neuropsychology
Neuropsychology studies the structure and function of the brain related to specific psychological processes and behaviors. The term neuropsychology has been applied to lesion studies in humans and animals. It has also been applied to efforts to record electrical activity from individual cells in...
, speech-language pathology, audiology
Audiology
Audiology is the branch of science that studies hearing, balance, and related disorders. Its practitioners, who treat those with hearing loss and proactively prevent related damage are audiologists. Employing various testing strategies Audiology (from Latin , "to hear"; and from Greek , -logia) is...
, occupational therapy
Occupational therapy
Occupational therapy is a discipline that aims to promote health by enabling people to perform meaningful and purposeful activities. Occupational therapists work with individuals who suffer from a mentally, physically, developmentally, and/or emotionally disabling condition by utilizing treatments...
, and physical therapy
Physical therapy
Physical therapy , often abbreviated PT, is a health care profession. Physical therapy is concerned with identifying and maximizing quality of life and movement potential within the spheres of promotion, prevention, diagnosis, treatment/intervention,and rehabilitation...
. Telerehabilitation can deliver therapy to people who cannot travel to a clinic
Clinic
A clinic is a health care facility that is primarily devoted to the care of outpatients...
because the patient has a disability
Disability
A disability may be physical, cognitive, mental, sensory, emotional, developmental or some combination of these.Many people would rather be referred to as a person with a disability instead of handicapped...
or because of travel time. Telerehabilitation also allows experts in rehabilitation to engage in a clinical consultation at a distance.
Most telerehabilitation is highly visual. As of 2006 the most commonly used modalities are via webcam
Webcam
A webcam is a video camera that feeds its images in real time to a computer or computer network, often via USB, ethernet, or Wi-Fi.Their most popular use is the establishment of video links, permitting computers to act as videophones or videoconference stations. This common use as a video camera...
s, videoconferencing
Videoconferencing
Videoconferencing is the conduct of a videoconference by a set of telecommunication technologies which allow two or more locations to interact via two-way video and audio transmissions simultaneously...
, phone lines, videophone
Videophone
A videophone is a telephone with a video screen, and is capable of full duplex video and audio transmissions for communication between people in real-time...
s and webpages containing rich Internet applications. The visual nature of telerehabilitation technology limits the types of rehabilitation services that can be provided. It is most widely used for neuropsychological rehabilitation; fitting of rehabilitation equipment such as wheelchair
Wheelchair
A wheelchair is a chair with wheels, designed to be a replacement for walking. The device comes in variations where it is propelled by motors or by the seated occupant turning the rear wheels by hand. Often there are handles behind the seat for someone else to do the pushing...
s, braces or artificial limbs; and in speech-language pathology. Rich internet applications for neuropsychological rehabilitation (aka cognitive rehabilitation) of cognitive impairment (from many etiologies) was first introduced in 2001. This endeavor has recently (2006) expanded as a teletherapy application for cognitive skills enhancement programs for school children. Tele-audiology
Tele-audiology
Tele-audiology is the utilization of telehealth to provide audiological services and may include the full scope of audiological practice.This term was first used by Dr. Gregg Givens in 1999 in reference to a system being developed at East Carolina University in North Carolina, USA...
(hearing assessments) is a growing application. As of 2006, telerehabilitation in the practice of occupational therapy and physical therapy are very limited, perhaps because these two disciplines are more “hands on”.
Two important areas of telerehabilitation research are (1) demonstrating equivalence of assessment and therapy to in-person assessment and therapy, and (2) building new data collection systems to digitize information that a therapist can use in practice. Ground-breaking research in telehaptics (the sense of touch) and virtual reality may broaden the scope of telerehabilitation practice, in the future.
In the United States, the National Institute on Disability and Rehabilitation Research
National Institute on Disability and Rehabilitation Research
National Institute on Disability and Rehabilitation Research is a United States governmental institution that provides leadership and support for a comprehensive program of research related to the rehabilitation of individuals with disabilities...
's (NIDRR) http://www.ed.gov/about/offices/list/osers/nidrr/index.html?src=mr supports research and the development of telerehabilitation. NIDRR's grantees include the "Rehabilitation Engineering and Research Center" (RERC) at the University of Pittsburgh
University of Pittsburgh
The University of Pittsburgh, commonly referred to as Pitt, is a state-related research university located in Pittsburgh, Pennsylvania, United States. Founded as Pittsburgh Academy in 1787 on what was then the American frontier, Pitt is one of the oldest continuously chartered institutions of...
, the Rehabilitation Institute of Chicago
Rehabilitation Institute of Chicago
The Rehabilitation Institute of Chicago , ranked the "#1 Rehabilitation in America" by U.S. News & World Report every year since 1991 is a rehabilitation hospital located in Chicago, Illinois, United States. It also operates a network of alliance hospitals and outpatient and day rehabilitation...
, the State University of New York at Buffalo, and the National Rehabilitation Hospital in Washington DC. Other federal funders of research are the Veterans Administration, the Health Services Research Administration in the US Department of Health and Human Services, and the Department of Defense. Outside the United States, excellent research is conducted in Australia and Europe.
As of 2006, only a few health insurers in the United States will reimburse for telerehabilitation services. If the research shows that tele-assessments and tele-therapy are equivalent to clinical encounters, it is more likely that insurers and Medicare
Medicare (United States)
Medicare is a social insurance program administered by the United States government, providing health insurance coverage to people who are aged 65 and over; to those who are under 65 and are permanently physically disabled or who have a congenital physical disability; or to those who meet other...
will cover telerehabilitation services.
History
In 1999, D.M. Angaran published “Telemedicine and Telepharmacy: Current Status and Future Implications” in the American Journal of Health-System Pharmacy. He provided a comprehensive history of telecommunications, the internetInternet
The Internet is a global system of interconnected computer networks that use the standard Internet protocol suite to serve billions of users worldwide...
and telemedicine
Telemedicine
Telemedicine is the use of telecommunication and information technologies in order to provide clinical health care at a distance. It helps eliminate distance barriers and can improve access to medical services that would often not be consistently available in distant rural communities...
since the 1950s. The Department of Defense
United States Department of Defense
The United States Department of Defense is the U.S...
(DoD) and the National Aeronautics and Space Administration (NASA) spearheaded the technology in the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
during the Vietnam War
Vietnam War
The Vietnam War was a Cold War-era military conflict that occurred in Vietnam, Laos, and Cambodia from 1 November 1955 to the fall of Saigon on 30 April 1975. This war followed the First Indochina War and was fought between North Vietnam, supported by its communist allies, and the government of...
and the space program; both agencies continue to fund advances in telemedicine
Telemedicine
Telemedicine is the use of telecommunication and information technologies in order to provide clinical health care at a distance. It helps eliminate distance barriers and can improve access to medical services that would often not be consistently available in distant rural communities...
.
Three early adopters of telemedicine were state penitentiary systems, rural health care systems, and the radiology
Radiology
Radiology is a medical specialty that employs the use of imaging to both diagnose and treat disease visualized within the human body. Radiologists use an array of imaging technologies to diagnose or treat diseases...
profession. Telemedicine makes business sense for the states because they do not have to pay for security escorts to have a prison
Prison
A prison is a place in which people are physically confined and, usually, deprived of a range of personal freedoms. Imprisonment or incarceration is a legal penalty that may be imposed by the state for the commission of a crime...
er receive care outside the prison.
Rural telemedicine in the United States is heavily subsidized through federal agency grants
Grant (money)
Grants are funds disbursed by one party , often a Government Department, Corporation, Foundation or Trust, to a recipient, often a nonprofit entity, educational institution, business or an individual. In order to receive a grant, some form of "Grant Writing" often referred to as either a proposal...
for telecommunications operations. Most of this funding comes through the Health Services Research Administration and the Department of Commerce. Some state universities have obtained state funding to operate tele-clinics in rural areas. As of 2006, few (if any) of these programs are known to financially break-even, mostly because the Medicare program for people over age 65 (the largest payer) is very restrictive about paying for telehealth.
In contrast, the Veterans Administration
United States Department of Veterans Affairs
The United States Department of Veterans Affairs is a government-run military veteran benefit system with Cabinet-level status. It is the United States government’s second largest department, after the United States Department of Defense...
is relatively active in using telemedicine for people with disabilities. There are several programs that provide annual physical exams or monitoring and consultation for veterans with spinal cord injuries. Similarly, some state Medicaid
Medicaid
Medicaid is the United States health program for certain people and families with low incomes and resources. It is a means-tested program that is jointly funded by the state and federal governments, and is managed by the states. People served by Medicaid are U.S. citizens or legal permanent...
programs (for poor people and people with disabilities) have pilot programs using telecommunications to connect rural practitioners with subspecialty therapists. A few school district
School district
School districts are a form of special-purpose district which serves to operate the local public primary and secondary schools.-United States:...
s in Oklahoma
Oklahoma
Oklahoma is a state located in the South Central region of the United States of America. With an estimated 3,751,351 residents as of the 2010 census and a land area of 68,667 square miles , Oklahoma is the 28th most populous and 20th-largest state...
and Hawaii
Hawaii
Hawaii is the newest of the 50 U.S. states , and is the only U.S. state made up entirely of islands. It is the northernmost island group in Polynesia, occupying most of an archipelago in the central Pacific Ocean, southwest of the continental United States, southeast of Japan, and northeast of...
offer school-based rehabilitation therapy using therapy assistants who are directed by a remote therapist. The National Rehabilitation Hospital
National Rehabilitation Hospital
The National Rehabilitation Hospital is located in Washington, D.C., and specializes in treating persons with physical disabilities, including spinal cord injury, brain injury, stroke, arthritis, amputation, multiple sclerosis, post-polio syndrome, orthopedic, and other neurological conditions.The...
in Washington DC and Sister Kenny Rehabilitation Institute
Sister Kenny Rehabilitation Institute
The Sister Kenny Rehabilitation Institute, located at 28th Street and Chicago Avenue in Minneapolis, is the leading rehabilitation provider in the region. The Institute is named after Sister Elizabeth Kenny, an Australian woman trained in nursing — the title “Sister” is used in British countries to...
in Minneapolis provided assessment and evaluations to patients living in Guam
Guam
Guam is an organized, unincorporated territory of the United States located in the western Pacific Ocean. It is one of five U.S. territories with an established civilian government. Guam is listed as one of 16 Non-Self-Governing Territories by the Special Committee on Decolonization of the United...
and American Samoa
American Samoa
American Samoa is an unincorporated territory of the United States located in the South Pacific Ocean, southeast of the sovereign state of Samoa...
. Cases included post-stroke
Stroke
A stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...
, post-polio, autism
Autism
Autism is a disorder of neural development characterized by impaired social interaction and communication, and by restricted and repetitive behavior. These signs all begin before a child is three years old. Autism affects information processing in the brain by altering how nerve cells and their...
, and wheel-chair fitting.
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 The Catholic University of America
The Catholic University of America
The Catholic University of America is a private university located in Washington, D.C. in the United States. It is a pontifical university of the Catholic Church in the United States and the only institution of higher education founded by the U.S. Catholic bishops...
, both located in Washington, DC; the Sister Kenny Rehabilitation Institute in Minnesota; and the East Carolina University
East Carolina University
East Carolina University is a public, coeducational, engaged doctoral/research university located in Greenville, North Carolina, United States. Named East Carolina University by statute and commonly known as ECU or East Carolina, the university is the largest institution of higher learning in...
in North Carolina
North Carolina
North Carolina is a state located in the southeastern United States. The state borders South Carolina and Georgia to the south, Tennessee to the west and Virginia to the north. North Carolina contains 100 counties. Its capital is Raleigh, and its largest city is Charlotte...
. Some of this early research work, and its motivation, is reviewed in Winters (2002). The State of Science Conference held in 2002 convened most of military and civilian clinicians, engineers, and government officials interested in using telecommunications as a modality for rehabilitation assessment and therapy; a summary is provided in Rosen, Winters & Lauderdale (2002). The conference was attended by the incoming president of the American Telemedicine Association
American Telemedicine Association
American Telemedicine Association , established in 1993 as a non-profit organization, ATA goal is to promote access to medical care for consumers and health professionals via telecommunications technology...
(ATA). This led to an invitation by ATA to the conference attendees to form a special interest group on telerehabilitation. NIDRR funded the second 5-year RERC on telerehabilitation in 2004, awarding it to the University of Pittsburgh. This RERC was renewed in 2010.
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 Journal of Telemedicine and Telecare that explored how telemedicine can become a profitable business for hospitals. They argue that telerehabilitation should be expanded so that people with disabilities and people in pain (perhaps after hip-replacement surgery or people with arthritis
Arthritis
Arthritis is a form of joint disorder that involves inflammation of one or more joints....
) can get the rehabilitative therapy they need. It is unethical to limit paymente for telerehabilitation services only to patients in rural areas.
Research in telerehabilitation is in its infancy, with only a handful of equivalence trials. As of 2006, most peer-reviewed research in telemedicine are case reports of pilot programs or new equipment. 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 far head of occupational therapy and physical therapy in demonstrating equivalence over various types of telecommunications equipment.
Technologies
- Plain old telephone servicePlain old telephone servicePlain old telephone service is the voice-grade telephone service that remains the basic form of residential and small business service connection to the telephone network in many parts of the world....
(POTS) with videophoneVideophoneA videophone is a telephone with a video screen, and is capable of full duplex video and audio transmissions for communication between people in real-time...
s/Phones in telerehabilitation- There are several types of connections used with real time exchanges. Plain old telephone service (POTS) uses standard analogAnalog transmissionAnalog transmission is a transmission method of conveying voice, data, image, signal or video information using a continuous signal which varies in amplitude, phase, or some other property in proportion to that of a variable...
telephone lineTelephone lineA telephone line or telephone circuit is a single-user circuit on a telephone communication system...
s. Videophones are used with POTS lines and include a cameraCameraA camera is a device that records and stores images. These images may be still photographs or moving images such as videos or movies. The term camera comes from the camera obscura , an early mechanism for projecting images...
, display screenDisplay deviceA display device is an output device for presentation of information in visual or tactile form...
, and telephoneTelephoneThe telephone , colloquially referred to as a phone, is a telecommunications device that transmits and receives sounds, usually the human voice. Telephones are a point-to-point communication system whose most basic function is to allow two people separated by large distances to talk to each other...
. 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 televisionTelevisionTelevision is a telecommunication medium for transmitting and receiving moving images that can be monochrome or colored, with accompanying sound...
as a screen.
- There are several types of connections used with real time exchanges. Plain old telephone service (POTS) uses standard analog
- VideotelephonyVideotelephonyVideotelephony comprises the technologies for the reception and transmission of audio-video signals by users at different locations, for communication between people in real-time....
/Videotelephony in telerehabilitation- The use of improved quality video-assisted telecommunication devices, such as videoconferencingVideoconferencingVideoconferencing is the conduct of a videoconference by a set of telecommunication technologies which allow two or more locations to interact via two-way video and audio transmissions simultaneously...
, webcamWebcamA webcam is a video camera that feeds its images in real time to a computer or computer network, often via USB, ethernet, or Wi-Fi.Their most popular use is the establishment of video links, permitting computers to act as videophones or videoconference stations. This common use as a video camera...
s and telepresenceTelepresenceTelepresence refers to a set of technologies which allow a person to feel as if they were present, to give the appearance of being present, or to have an effect, via telerobotics, at a place other than their true location....
to assist in treatments.
- The use of improved quality video-assisted telecommunication devices, such as videoconferencing
- Virtual realityVirtual realityVirtual reality , also known as virtuality, is a term that applies to computer-simulated environments that can simulate physical presence in places in the real world, as well as in imaginary worlds...
/Virtual reality in telerehabilitationVirtual reality in telerehabilitationVirtual reality in telerehabilitation is a method used first in the training of musculoskeletal patients using asynchronous patient data uploading, and an internet video link. Subsequently, therapists using virtual reality-based telerehabilitation prescribe exercise routines via the web which are...
- Virtual reality in telerehabilitation is one of the newest tools available in that area. This computer technology allows the development of three-dimensionalThree-dimensional spaceThree-dimensional space is a geometric 3-parameters model of the physical universe in which we live. These three dimensions are commonly called length, width, and depth , although any three directions can be chosen, provided that they do not lie in the same plane.In physics and mathematics, a...
virtual environments.
- Virtual reality in telerehabilitation is one of the newest tools available in that area. This computer technology allows the development of three-dimensional
- 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 intelligenceArtificial intelligenceArtificial intelligence is the intelligence of machines and the branch of computer science that aims to create it. AI textbooks define the field as "the study and design of intelligent agents" where an intelligent agent is a system that perceives its environment and takes actions that maximize its...
/Artificial intelligence in telerehabilitation - Wireless technology/Wireless technology in telerehabilitation
- PDAsPersonal digital assistantA personal digital assistant , also known as a palmtop computer, or personal data assistant, is a mobile device that functions as a personal information manager. Current PDAs often have the ability to connect to the Internet...
/PDA in telerehabilitation - Mobile telephonyMobile telephonyMobile telephony is the provision of telephone services to phones which may move around freely rather than stay fixed in one location. Mobile phones connect to a terrestrial cellular network of base stations , whereas satellite phones connect to orbiting satellites...
/Mobile telephony in telerehabilitation - Electronic medical recordElectronic medical recordAn electronic medical record is a computerized medical record created in an organization that delivers care, such as a hospital or physician's office...
s/Electronic medical record telerehabilitation
Clinical applications of telerehabilitation
- Review of telerehabilitation research on clinical populations
- Professional to professional (clinic to clinic applications)
- TelehealthTelehealthTelehealth is the delivery of health-related services and information via telecommunications technologies. Telehealth could be as simple as two health professionals discussing a case over the telephone or as sophisticated as doing robotic surgery between facilities at different ends of the...
– Information accessInformation accessInformation access is a term used to describe an area of research at the intersection of informatics, Information Science, Information Security, Language Technology, Computer Science, and library science.... - Clinical approaches
- Assessment
- Monitoring
- Intervention
- Telesupervision (of licensed assistants)
- Telementoring
- Tele-education
- Telementoring
Speech-language pathology
The clinical services provided by speech-language pathology readily lend themselves to telerehabilitation applications due to the emphasis on auditory and visual communicative interaction between the client and the clinician. As a result, the number of telerehabilitation applications in speech-language pathology tend to outnumber those in other allied health professions. To date, applications have been developed to assess and/or treat acquired adult speech and language disorders, stutteringStuttering
Stuttering , also known as stammering , is a speech disorder in which the flow of speech is disrupted by involuntary repetitions and prolongations of sounds, syllables, words or phrases, and involuntary silent pauses or blocks in which the stutterer is unable to produce sounds...
, voice disorders, speech disorders in children, and swallowing dysfunction. The technology involved in these applications has ranged from the simple telephone (Plain Old Telephone System – POTS) to the use of dedicated Internet-based videoconferencing systems.
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 laserdisc
Laserdisc
LaserDisc was a home video format and the first commercial optical disc storage medium. Initially licensed, sold, and marketed as MCA DiscoVision in North America in 1978, the technology was previously referred to interally as Optical Videodisc System, Reflective Optical Videodisc, Laser Optical...
over the telephone and a closed-circuit
Closed-circuit television
Closed-circuit television is the use of video cameras to transmit a signal to a specific place, on a limited set of monitors....
television system to assess speech and language disorders (Wertz et al, 1987), and a satellite-based videoconferencing system to assess patients in rural areas (Duffy, Werven & Aronson, 1997). More recent applications have involved the use of sophisticated Internet-based videoconferencing systems with dedicated software which enable the assessment of language disorders (Georgeadis, Brennan, Barker, & Baron, 2004, Brennan, Georgeadis, Baron & Barker, 2004) and the assessment and treatment of motor speech disorders (Hill, Theodoros, Russell, Cahill, Ward, Clark, 2006; Theodoros, Constantinescu, Russell, Ward, Wilson & Wootton, in press) following brain impairment and Parkinson's disease
Parkinson's disease
Parkinson's disease is a degenerative disorder of the central nervous system...
. Collectively, these studies have revealed positive treatment outcomes, while assessment and diagnoses have been found to be comparable to face-to-face evaluations.
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 Lidcombe program to children who stutter have utilized the telephone in conjunction with offline video recordings to successfully treat several children. Overall, the parents and children responded positively to the program delivered at a distant. Using a high speed videoconferencing system link, Sicotte, Lehoux, Fortier-Blanc and Leblanc (2003) assessed and treated six children and adolescents with a positive reduction in the frequency of dysfluency that was maintained six months later. In addition, a videoconferencing platform has been used successfully to provide follow-up treatment to an adult who had previously received intensive therapy (Kully, 200).
Reports of telerehabilitation applications in paediatric speech and language disorders are sparse. A recent Australian pilot study has investigated the feasibility of an Internet-based assessment of speech disorder in six children (Waite, Cahill, Theodoros, Russell, Busuttin, in press). High levels of agreement between the online and face-to-face clinicians for single-word articulation, speech intelligibility, and oro-motor tasks were obtained suggesting that the Internet-based protocol had the potential to be a reliable method for assessing paediatric speech disorders.
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
Larynx
The larynx , commonly called the voice box, is an organ in the neck of amphibians, reptiles and mammals involved in breathing, sound production, and protecting the trachea against food aspiration. It manipulates pitch and volume...
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 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.
Disciplines and therapies
-
- Speech-language pathology
- Audiology
- Physical therapy
- Occupational therapy
- PsychologyPsychologyPsychology is the study of the mind and behavior. Its immediate goal is to understand individuals and groups by both establishing general principles and researching specific cases. For many, the ultimate goal of psychology is to benefit society...
- NursingNursingNursing is a healthcare profession focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life from conception to death....
- Social workSocial workSocial Work is a professional and academic discipline that seeks to improve the quality of life and wellbeing of an individual, group, or community by intervening through research, policy, community organizing, direct practice, and teaching on behalf of those afflicted with poverty or any real or...
- Rehabilitation counselingRehabilitation counselingRehabilitation Counseling is focused on helping people who have disabilities achieve their personal, career, and independent living goals through a counseling process...
/Vocational rehabilitation
Standards and training requirements
- Telerehabilitation standards
- ReimbursementReimbursementReimbursement is the act of compensating someone for an expense . Often, a person is reimbursed for out-of-pocket expenses when the person incurs those expenses through employment or in an account of carrying out the duties for another party or member....
policies/Reimbursement in telerehabilitation - Legislative activitiesLegislationLegislation is law which has been promulgated by a legislature or other governing body, or the process of making it...
/Legislative activities in telerehabilitation - EthicsEthicsEthics, also known as moral philosophy, is a branch of philosophy that addresses questions about morality—that is, concepts such as good and evil, right and wrong, virtue and vice, justice and crime, etc.Major branches of ethics include:...
and privacy issues/Ethics and privacy issues in telerehabilitation - Clinical and technology training issues
Related organizations
- American Telemedicine AssociationAmerican Telemedicine AssociationAmerican Telemedicine Association , established in 1993 as a non-profit organization, ATA goal is to promote access to medical care for consumers and health professionals via telecommunications technology...
(ATA) - American Speech-Language-Hearing AssociationAmerican Speech-Language-Hearing AssociationThe American Speech–Language–Hearing Association is a professional association for speech–language pathologists, audiologists, and speech, language, and hearing scientists in the United States and internationally...
(ASHA) - Association of Telehealth Service ProvidersAssociation of Telehealth Service ProvidersAssociation of Telehealth Service Providers is an international membership-based trade non-profit organization dedicated to improving health care through growth of the telehealth industry and promoting the use of telecommunications in healthcare. Its main activities are advocacy, education...
(ATSP) - National Institute on Disability and Rehabilitation Research (NIDRR)
- Rehabilitation Engineering and Assistive Technology Society of North AmericaRehabilitation Engineering and Assistive Technology Society of North AmericaRehabilitation Engineering and Assistive Technology Society of North America is an interdisciplinary association of people with a common interest in technology and disability...
(RESNA) - Special Interest Group on Telerehabilitation (SIGOT)