Is Telerehabilitation Effective?

To determine the usefulness of telerehabilitation David Hailey etal of the School of Information Systems and Technology, University of Wollongong, Australia reviewed the evidence on the effectiveness of various telerehabilitation (TR) applications. The survey included reports on rehabilitation for any disability, except drug or alcohol addiction or mental health conditions. Considered were all kinds of telecommunications technology for TR. Both study performance and study design were considered . The results were judged on whether each TR application had been successful, whether the results were clinically significant, and whether it was necessary to gather further data to establish whether the application was suitable for routine use. There were 61 scientifically credible studies that reported patient outcomes. Administrative changes were identified through computerized literature searches on 5 databases. Twelve clinical categories were included in the studies. The ones dealing with neurological or cardiac rehabilitation were in the majority. Thirty-one of the studies (51%) were of good or high quality. The study results showed that 71% of the TR applications were successful, 18% were unsuccessful and 11% were unclear as to their status. The outcomes for 51% of the applications seemed to be clinically significant. The poorer-quality studies tended to have outcomes that were worse than those from high- or good-quality studies. The surveyors judged that further study was required for 62% of the TR applications and preferable for 23%. Their conclusion was that TR shows promise in many fields, but evidence of benefit and impact on routine rehabilitation programs is still somewhat limited. There is still a need for more detailed, better-quality studies and for studies on the use of TR in general routine care. One of the areas of success in telerehabilitation is in the use of the TUTOR system. The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR are designed to give intensive rehabilitation exercises to those that have had a spinal cord/brain injury, stroke, Parkinson’s disease, MS, CP, Radial and Ulnar nerve injuries as well as other upper and lower limb surgeries or injuries. The TUTOR system uses sophisticated software that provides a customized exercise program for the individual patient. Many times the patient lives too far from a rehabilitation clinic or has improved to the point where he no longer needs to be seen in a regular clinic. In those cases the TUTORs have an excellent rehabilitation system in place for the therapist to instruct the patient remotely. Currently in use in leading U.S. and European hospitals the TUTORs are fully certified by the FDA and CE. See WWW.MEDITOUCH.CO.IL for further information.

New Stroke Rehabilitation Device May Join Others Already In Use

Victoria University, New Zealand, masters student in engineering, Abigail Rajendran, 23, designed a stroke rehabilitation device and is working to market it. Rajendran believes that stroke patients will be able to rehabilitate themselves from home with the new device. With the device strapped on to a patient’s hand the goal is to exercise it in an opening and closing motion. A connected computer game activates at the same time and keeps both sides of the brain working. Once the patient regains the strength and can do the motion himself, he can increase the resistance with a special liquid contained in the device. Rajendran says that until now, stroke patients had to rely on expensive and large rehabilitation equipment only found in hospitals. However this device could be used regularly at home. Funding for a prototype has been provided by the Science and Innovation Ministry. Few, if any, home rehabilitation instruments are available for people recovering from strokes and new technology has to be made available according to Chief executive Sunil Vather. Apparently New Zealand stroke patients get only a few hours of therapy if they’re lucky and this device may afford them many more hours. Miss Rajendran will present her idea in Singapore later this month, and in Brisbane in October. The device may be ready for use in about a year. Apparently unknown to Miss Rajendran and her associates such physical therapy solutions already exist and are being used successfully in many leading U.S. and European and other hospitals and clinics. The physical therapy products known as the HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR have been devised to allow intensive exercises to stroke victims as well as those afflicted with disabling Parkinson’s, MS, CP, brain/spinal cord injuries and other upper and lower limb paresis. The TUTORs are comfortable ergonomically designed gloves and braces that are attached to the affected areas of the body and then connected to a computer that has dedicated software in the form of games. These games are played with the active initiation of the patient himself and the results are recorded and evaluated by physical therapists who then design a specific exercise program for that patient. Since many patients have improved to the point where they no longer need hospitalization they and others who live too far from a rehabilitation clinic can avail themselves of the TUTORs at home through the use of telerehabilitation. In addition the TUTOR system is one of the most cost effective physical therapy products on the market today and they are small in relation to hospital based large equipment. The TUTORs are fully certified by the FDA and CE. See WWW.MEDITOUCH.CO.IL for more information.

ArmTutor Assists in Enhanced Rehabilitation following Arthrodesis Surgery

In a study of Poliomyelitis in children which can cause paralysis of shoulder girdle muscles leading to a flail shoulder, Joshua D. Miller, MD et al, in the Journal of Pediatric Orthopaedics:, September 2011 - Volume 31 - Issue 6 - p 679–682, stated that shoulder arthrodesis is indicated as a possible treatment for these children in order to stabilize the shoulder. This retrospective study reviewed all shoulder arthrodesis surgeries owing to complications of polio performed at a major medical institution between 1981 and 1996 to assess position of fusion, radiographic evidence of fusion, complications, and patient satisfaction., Methods: A review of medical records identified 11 patients undergoing 13 shoulder arthrodesis procedures, with a mean age of 14.7 years at the time of the procedure. Internal fixation was achieved with large cancellous screws in 8 patients and a Dynamic Compression Plate (DCP) plate in 5 procedures. Average follow-up period was 41 months. Eight patients were placed into a spica cast and 5 used a sling postoperatively., The results showed that shoulder arthrodesis surgery in this cohort resulted in an average position of fusion with 42.3 degrees of abduction, 23.8 degrees of flexion, and 26.2 degrees of internal rotation. Twelve of the 13 procedures assessed for radiographic union demonstrated fusion. The most common complications were malrotation and nonunion. Of the 13 procedures, 2 underwent humeral osteotomies for malrotation, and 1 with 6.5 mm cancellous screws required revision with a DCP plate owing to nonunion. Six patients underwent hardware removal, 3 of which were specifically owing to complaints of painful hardware. At final follow-up, no patient reported pain and all expressed satisfaction with their results and improved shoulder function after repair.His conclusion was that this study is the largest series of shoulder arthrodesis surgeries for treatment of patients with a flail shoulder from polio to date, providing a more thorough analysis of its efficacy as an indicated treatment., The ArmTutor together with its sister devices (HandTutor, LegTutor, 3DTutor) has proven very effective in improving range of motion of shoulders and elbows following surgery, disease or trauma. The innovative device is an electronic brace connected to a computer with dedicated software. It allows for repetitive exercises to the affected joint with augmented feedback. Currently used in leading U.S. and foreign hospitals the system can be administered by a physical therapist or the patient himself. It is available for children as well as adults and can be used together with tele rehabilitation.

American Society for Quality (ASQ) advises the implementation of Telemedicine, remote monitoring systems and telerehabiliation programs

The American Society for Quality (ASQ) conducted an online poll with 475 U.S. healthcare quality professionals who are part of the ASQ quality community http://bit.ly/jivNXB. The report states that healthcare quality will be most impacted by shortages of clinicians including occupational and physical therapists both in the acute and sub acute and outpatients settings. One of the solutions proposed to allow healthcare organizations to prevent these shortage-related quality issues is the implementation of Telemedicine, remote monitoring systems and telerehabilitation programs.
The HandTutor and ArmTutor systems are used to give tele-rehabilitation world wide to children with arm and hand movement impairments and to supplement tradition occupational and physical therapy. The LegTutor system allows for patients to undertake a supervised and motivating exercise program for the knee and hip in their own homes following orthopedic trauma, disease and surgery.

American Telemedicine Association (ATA) asks Medicare to pay for telehealth services given by physical therapists, occupational therapists, and speech

In a letter sent to Dr. Donald M. Berwick Administrator for the Centers for Medicare and Medicaid Services (CMS) the American Telemedicine Association wants Medicare to waive the restrictions on telehealth payments so that telehealth services http://bit.ly/iC4pwm . This will mean that tele-medicine and telerehabilitation can be treated like any other form of care. As Administrator, Dr. Berwick oversees the Medicare, Medicaid, and Children’s Health Insurance Program (CHIP). Together, these programs provide care to nearly one in three Americans.
An important change will be the removal of Medicare restrictions on paying physical therapists, occupational therapists, and speech-language pathologists for telehealth services. The ATA contends that lifting this and the location-based prohibition would open up home-based telerehabilitation, which the group called "an important service for beneficiaries from whom going to therapy is a major barrier."

HandTutor system increases the dose of exercise training in order to improve functional hand movement ability

In the April edition of Neurorehabilitation and Neural Repair http://bit.ly/gXjd8x Dr. Anthony Rudd Consultant Physician in Stroke Medicine St. Thomas' Hospital London and Professor of Stroke Medicine King's College London discuss a study looking to find the optimum Dose–Response of Mobilisation and Tactile Stimulation Therapy for the Upper Extremity Early After Stroke. The group state that Physical therapy doses may need to be higher than provided in current clinical practice, especially for patients with severe paresis.
The HandTutor system allows the patient to undertake motivating and challenging active intensive exercise practice. It is suitable for patients with severe movement impairments as well as patients that need to improve their fine motor movement ability. The HandTutor system is used in acute, sub acute and outpatient treatments. The HandTutor system is also used by the patient at home and can be supported by telerehabilitation. This allows for an optimum and higher dose of exercise training.

HandTutor system allows for hands on therapy through tele-rehabilitation

In the February issue of Journal of Rehabilitation Medicine http://bit.ly/ev4mth Dr. Nancye M. Peel and her group from Centre for Research in Geriatric Medicine The University of Queensland discuss the implementation of telerehabilitation in older people. The barriers that need to be overcome include patient limitations, staff issues and the logistics of implementing the system. They comment that tele-rehabilitation is challenging because of the complexity of cases, with many requiring “hands-on” therapy.
The HandTutor system uses dedicated rehabilitation software that allows the virtual functional exercise tasks to be tailored to the patients movement ability. The tasks have been designed by physical and occupational therapists and are motivating to a wide range of patients sensory, motor and cognitive ability age and neurological or orthopedic indications.