Telerehabilitation is that part of all of telehealth practice that allows the delivery of medical rehabilitative services at a distance, using modern information technologies. Typically this involves image or data in addition to voice.
The National Rehabilitation Hospital in Washington, DC has begun clinical initiatives in this area, in particular, international health delivery. For instance, with telerehabilitation, patients from the diplomatic core or other international groups can take our services with them when they go home. Increasingly, healthcare providers are starting to get wired to their former patients. It's an extraordinarily interesting challenge to anybody interested in instrumentation, electronic communications, and design of technology for human users—so-called human factors engineering
There are three facets to telerehabilitation. First, there is training and counseling. Somebody has gone back to his or her community; but still requires frequent access to professional care. Telerehabilitation affords the clinician the opportunity to better understand the patient's home environment and community situation. Presumably, this will allow better advice, teaching, and training. This can become quite interactive. For instance, if a patient is having trouble transferring to a shower chair, a camera can be trained on a demonstration area of the hospital and the patient can get a refresher course without having to go back to the hospital. The second facet is assessment and monitoring of a person's condition. This should allow the clinician to follow the patient for a longer and optimal period of time than protocol might currently allow if clinical follow up were the only option. Finally, telerehabilitation can be used as a therapy delivery system.
This third facet may be the most daunting and challenging aspect of telerehabilitation. For example, a thorough physical therapist will maintain that unless they can actually get his or her hands under the patient's butt, they cannot assess whether their seating system is properly designed. The question becomes is it possible to find a remote way to deliver the same thorough and appropriate seating design. With complex assistive technology, it may be possible to assess, from a remote location, what problems are occurring. This would be much like a mechanic doing an electronic diagnostic test on a car, only from a central location, with the "car" staying in the owner's garage.
Another way to consider telerehabilitation is point of delivery. There are two possibilities. On a macro level, telerehabilitation attempts to bring the comprehensive expert services of a large urban rehabilitation hospital to places where such care is not available, most notably in rural areas. After the acute rehabilitation care, a patient transfers to a local clinic, closer and more convenient to their home and community. Through telerehabiliation, original caregivers can follow and consult with local clinics where is may not be practical to have the level of expertise required for post rehabilitative care available on site. In this sense, the patient's care is enhanced through a community rehabilitation effort without having to travel what may amount to several hundred miles in some cases.
The other possibility is delivery of service at home. Research in telerehabilitation strives to determine what care can be delivered at home, where a person's life is centered. The challenge is to put complex technologies into a home setting with little or no technical support. At the same time, these technologies have to meet extremely high standards of reliability, ease of use, and ease of learning. For instance, computers may not be particularly friendly to people with cognitive disabilities. Or, patients and/or caregivers may have "technophobia".
It is important to distinguish between telerehabilitation and tele-enhancement of independent living. The former delivers medical rehabilitation services. The later focuses on the general enhancement of a person's life, along with their family and loved ones.
real time. Others, such as data collection based on daily exercise can be stored and reviewed remotely once a week or as otherwise appropriate. It's important to recognize that not all rehab applications are real-time.
Finally, not all telerehabilitation is patient oriented. Continuing medical education conducted over the Internet and other long distance learning networks are also part of telehealth.
The reasons to develop telerehabilitation capacities are many. The concern most often expressed is loss of the personal factor—the hands on the touch, the glint in the eye, the smell of the patient. However, in rural settings where comprehensive rehab services are scarce, the alternative may well be no service at all. Even in urban settings, immobility due to disability and poor transportation infrastructure can make three blocks as unrealistic as 200 miles. In addition, it is no secret that health care facilities are pressured to shorten patient's length of stay. Follow up care through telerehabilitation may provide a needed solution to maintaining quality care.
Telerehabilitation also stands to enhance quality of care. It should provide better continuity of care. It may also create more patient tailored rehabilitation to fit a persons environment and lifestyle. Ultimately, the availability of telerehabilitation services, may allow persons to remain at home rather than transfering to a nursing facility.
There is also a strong potential for reduced cost. Intuitively, it would seem remote care would save on travel, either for providers or for patients. If geographic scope of care can be expanded through the use of physician assistants with the consultation of more precise expertise given from a central location, the need for large hospitals with their large overhead costs may be diminished. Then there is possible prevention of expensive secondary medical consequences. Telerehabilitation may make follow up care that would otherwise be unavailable possible and consequently reduce the incidence and/or the severity of common medical consequences such as decubitus ulcers. With Multiple Sclerosis and its many symptoms, this would seem a reasonable argument and, hopefully, a cause to investigate further for verification and, if true, implementation.
Although telerehabilitation offers infinite possibilities to enhance care while reducing costs, there are few places where it is in place and able to be tested. As the NIDRR-Funded Center in Telerehabilitation, the role for the National Rehabilitation Hospital is to extend an invitation to anyone who wants to work with these new clinical initiatives, who can bring something to the table, and who can get something from this research. The Veterans Health Administration has a marvelous nationwide physical infrastructure in place and is a potential pool of data. NRH encourages practitioners both with VA and other health care facilities to get in touch with us and explore this exciting area.
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