The resources on this page have been collected for use by stroke care and rehabilitation professionals to provide telehealth services due to COVID-19 isolation or social distancing.
- This web page contains links to information and materials and other content that might assist health professionals work and consult remotely with people with stroke, and with people with stroke who may have been discharged prior to completing their full rehabilitation programs.
- The linked information, materials and other content on this web page has not been created, produced or endorsed by the Stroke Foundation.
- The linked information, materials and other content on this web page is not intended to replace a health professional’s own professional judgement and decision-making.
- The Stroke Foundation shall not bear any liability for reliance by any user on the linked information, materials and other content on this web page.
Medicare item numbers
COVID-19 Telehealth MBS items can now be claimed. See the list at the bottom of the linked news item, or the Australian Government’s fact sheet on Temporary Telehealth Bulk-Billed Items for COVID-19. The government has confirmed that existing face-to-face attendance items under the MBS can be used to deliver telehealth consultations by the following allied health professionals:
- Aboriginal and Torres Strait Islander health workers and health practitioners
- occupational therapists
- social workers.
For more information, see the government’s Frequently asked questions (PDF).
Synapse Medical has a free blog that answers questions about COVID-19 numbers. FAQs are also available, and questions can be posted.
Communication tools for people with aphasia
Accessible healthcare communication materials and resources may be needed by people with aphasia and/or cognitive difficulties. The Centre for Research Excellence in Aphasia Rehabilitation and Recovery have put together a repository of materials, including in languages other than English, and they will continue to update it. Open either the PDF or the Excel document to find all the links. Key information includes:
- General public health information about COVID-19
- Pictographics relating to COVID-19, to support communication
- Supported communication training for health professionals, to enhance their communication with people with aphasia
- Wellbeing, peer support and social connection
- Adapting aphasia assessments
- Technology and telerehabilitation, with aphasia-friendly resources for using web-based platforms.
As healthcare professionals transition to telerehabilitation, it may seem too challenging to include people with aphasia. However, it is absolutely possible and should be promoted.
General telehealth guides and tips
Guide to using telehealth for clinicians during COVID-19 (PDF), a 4-page guide document with instructions on how to set up and run a successful telerehab session, with links to guidelines and tips on effective communication.
Centre of Research Excellence (CRE) in Telehealth, based at the University of Queensland. Highlights include:
- What is Telehealth, with a series of videos describing what it is and gives examples of how it is done
- Policy Digest, which covers a myriad of policy documents from guidelines to codes to conduct to standards to resource packages. It really is comprehensive and worth a look.
NSW Agency for Clinical Innovation’s telehealth website, updated daily with useful resources including:
- Telehealth for patients, carers and other providers, with Resources for patients (4 min. video with subtitles) about how to link to a telehealth provider (note this is specific to NSW Health); and Telehealth etiquette for patients and carers (2 min. read).
- Local contacts and training for clinicians, with an email template for a telehealth clinic appointment, and a clinician script to introduce patients to a telehealth appointment.
NeoRehab telerehabilitation platform eHAB, designed specifically for allied health telerehab services. It contains tools for measurement, data capture, interactive media capabilities, and can do multi-point calls – all of which are often necessary for rehabilitation services. The platform has the necessary security features that health services demand. Training in how to use eHAB is available. The designer of this system, Prof. Trevor Russell, is happy to support teams to get set up with the system. Contact email@example.com
Video consultation guide for GP practices, a blog post that includes tips for high quality consultations, but is mostly COVID-19 diagnosis related. There is also a PDF document you can scroll through without having to download, which gives references for telehealth effectiveness.
Australian Physiotherapy Association’s webinar series on telehealth is freely available, with a Q&A about how to make a rapid transition. Additionally, the Australian Physiotherapy Neurology Group has a Facebook group you can request to join, where lots of members are sharing ideas and resources. You do not need to be an APA member, but you do need to be a physio and it may take a day or two for the moderator to get you linked in.
Australian Physiotherapy Association’s guidelines on the use of telehealth in response to COVID-19 (PDF, 33 pages) have also been released. These guidelines include practical tips and considerations around privacy, safety and ethics.
Register for free UTS telepractice webinars for rapid transition during COVID-19. SPROUTS Clinic (Speech Pathology Reaching Out at UTS) is not just reaching out to speech pathologists during COVID-19 – they’re reaching out to all disciplines, health professionals, schools and health services caught up in the disruption to allied health services. The webinar is held fortnightly through April/May 2020 depending on demand, to support services Australia-wide in their rapid transition to implementing telehealth-related telepractice. Clinicians in other countries are welcome to attend, but time zones are made to suit UTS staff living in Sydney and NSW, Australia. The examples provided relate to speech pathology but can be easily applied to learning across any health discipline. Webinars will not be recorded. The main benefit in attending is the active learning model enabling engagement and interaction between the participants and with the teachers.
For novice clinicians, the Stroke Training and Awareness Resources (STARS) website includes 19 e-learning resources to support key competencies in stroke care.
Online panel discussion: COVID19 & digital technology: the roles, relevance & risks of using telehealth in a crisis (90 min). Dr Norman Swan talks to Prof Trish Greenhalgh, Dr Amandeep Hansra, Dr Neale Fong, Karrie Long and Dr Daniel Stefanski about their experience of using telehealth.
Free webinar: The role of Telehealth in curbing the COVID-19 Epidemic. Five expert panellists will share practical strategies for health professionals, including lessons from their own journeys and insights to how COVID-19 might change the way we use technology to deliver healthcare in the long-term. Register now for the webinar on Thursday 23 April 2020, 12–1 pm AEST.
Virtual conference 24 April 2020 – From the Frontlines: A Covid-19 Special Event (CPD points apply). The Australian Institute of Digital Health has brought together local and international professionals to discuss the critical role of technology innovation, data innovation, telehealth and virtual care. Attend live on Friday 24 April, or register and get access to watch the conference later, as well as get a month’s access to Digital Health TV – a collection of hundreds of videos and presentations about telehealth and digital healthcare innovation.
Bridges Self Management team have collated some of their evidence-based resources for self management. As they say, “if there was ever a time for good self-management support, it is now.”
Stroke Tele-Etiquette by Victorian Stroke Telemedicine (VST) Service, a short (2 min 15 sec) video on the most important concepts to consider when using telemedicine for clinical consultations: Environment; Technology; Appearance and Communication (ETAC).
iWalkAssess app from the University of Toronto provides instructions and tools to facilitate measuring walking speed and a 6-minute walk test. It includes automatic comparison to normative data and functions for goal setting. It is not designed for use via telehealth, but could possibly be adapted and may be a useful tool for novice clinicians.
How to administer the Montreal Cognitive Assessment (MoCA), via phone or telehealth. Score sheets can be downloaded from www.mocatest.org
Remote Administration Guidelines for the NIH Toolbox®: Response to COVID-19. From the United States National Institutes of Health (NIH), the Toolbox is a comprehensive set of neuro-behavioral measurements that quickly assess cognitive, emotional, sensory, and motor functions from the convenience of an iPad.
Telepractice Dysphagia Assessment Service is an e-learning program for establishing and conducting adult clinical swallowing evaluations via telepractice. it has separate packages for Speech Pathology Managers implementing telepractice services, and for training clinical speech pathologists and healthcare support workers. The model of care described in this program was developed, tested and validated through research conducted by the Centre for Research in Telerehabilitation at The University of Queensland, and the Speech Pathology & Audiology Department at The Royal Brisbane & Women’s Hospital.
To access the Telepractice Dysphagia Assessment Service as a non-QHealth clinican, you first need to register for the iLearn website following the instructions in iLearn user help for external (PDF). Once your registration is processed, log into iLearn, go to the Course Catalogue, and search for “Telepractice”. Click on the link for the course (AHPOQ-R) Telepractice Dysphagia Assessment Service.
Therapy tools and resources
In addition to other resources below, physiotherapyexercises.com has a range of exercises on file that can be prescribed using a mobile option – and it’s free. There is a link to a 9-min video “how to guide” for the mobile version – look for “New Mobile Functionality” on the home page. It is also available in several different languages.
Setting up safe and effective home exercises (PDF), a 3-page guide including photos.
REPS Recovery Exercises app consists of video-guided, post-stroke exercise programs, including TASK. The aim of TASK is to help people after stroke to exercise at home, on an ongoing basis. People can practice everyday tasks, such as sitting, standing, stepping and standing up. It was designed to improve and/or maintain strength and mobility, as well as encourage people after stroke to be more physically active. TASK is also available as a web-based program.
Clock Yourself app is for balance training. It contains five stages that introduce progressively complex activities to train balance – very good for high-level balance exercises and dual tasking. Cost $1.99
AMOUNT trial patient instructions (PDF). This trial used readily available technology (e.g. Wii Fit, Xbox Kinect) and rehab technology (e.g. fysiogaming, Stepping tiles). The 14-page patient instructions are clear and aphasia-friendly, with clear instructions on using iPads as well as the trial-specific apps and FitBits. The AMOUNT trial protocol (DOCX) includes instructions and clinical decision-making guides.
Balance exercise ideas for home programs (PDF), a useful 5-page list from StrokeEd.
Tracking physical activity using devices (PDF), a 9-page document with instructions for using a range of common apps and devices, such as FitBit, Garmin, MapMyWalk and others.
Recovery of upper limb function and Walking learning modules on InformMe were created and reviewed by stroke, occupational therapy and physiotherapy experts. They contain practical advice for therapists when assessing and planning treatment for upper limb recovery and walking after stroke.
Clinician’s guide to task training for stroke survivors – the aim of this program is to help you review rehabilitation techniques with a focus on task-specific training.
HEALTH HUB LIVE is hosted daily at 12.30 pm on Facebook by the team at St Vincent’s Private Hospital Sydney. These sessions guide people through daily prehabilitation exercises that can be done at home, as well as important health and wellness information to support people through COVID-19.
ViaTherapy app is designed as a decision tree for prescribing evidence-based arm exercises for people after stroke. It could be particularly useful for novice clinicians, or those with less experience in stroke. Easy to use on a mobile or PC interface.
GRASP program, with therapist Instructor manuals, participant manuals, and exercise log sheet and the target board are all available to download for free once you have registered at the website. GRASP is graded in three levels, dependent on the level of arm movement the person has. The program is available in both hospital and at home versions.
PUSH arm exercise program was originally designed and implemented at Bankstown-Lidcombe Hospital, Stroke Unit. The program is based on evidence regarding arm training and dosage. There is currently no specific evidence validating the PUSH program. PUSH is suitable for stroke survivors with limited movement in their affected arm.
See the Accessible healthcare communication materials and resources from the CRE in Aphasia Rehabilitation and Recovery linked above. The full contents are described at the top of this page, but they include information on adapting aphasia assessments, and aphasia-friendly resources for using web-based platforms.
Speech Pathology Australia has a telepractice web page, which is accessible to their members only. The telepractice FAQ page has additional information which may help speech pathology clinicians to set up telepractice services (e.g., videos on practicalities of telepractice), and information on funding streams. These web pages will be updated regularly as new resources become available.
thiswayup.org.au has online courses available for chronic pain and a range of mental health conditions. All courses are free until 30 April 2020.
Vision and perception
Read-Right program for hemianopic alexia: This online program, developed by the team at UCL Queen Square Institute of Neurology, is a practice-based therapy that aims to improve reading speeds in people with hemianopic alexia, a reading disorder related to a visual impairment (hemianopia) usually caused by a stroke or brain injury. The main part of the therapy involves reading scrolling text. The program includes in-built tests of visual fields, reading speed and visual search. Program participants are able to select from a wide range of reading materials including classic novels, current newspapers and popular novels (such as Harry Potter). The program is free for the first 7 days then at a cost of 5 GBP per month (approx $10 AUD).
Eye Search program for visual scanning: Free online therapy for patients with visual search problems (hemianopia or visual neglect) caused by stroke or brain injury, developed by the team at UCL Queen Square Institute of Neurology. It is behavioural therapy designed to improve patients’ speed and accuracy when finding objects through an online game that focuses on visual scanning and the training of the parts of the brain that control eye movements. Each level of the game then becomes increasingly difficult.
PAVING the Path to Wellness™: Emergency Response Edition, a free, 6-week virtual program for patients who are recovering from brain injury and stroke and don’t have the funds to pay for this rehabilitation. The program includes a wellness toolkit for building a healthy mindset through lifestyle changes such as creating a wholesome diet and exercise plan, learning how to enjoy regular sleep patterns, identifying important goals, finding meaning and purpose, and forming powerful personal connections. With funding from brain injury charity SameYou, Spaulding Rehabilitation Hospital will accommodate 150 free places on their program, on a first come, first served basis. See eligibility requirements and registration guidelines in the link.
TIME (Together In Movement through Exercise) Program information (PDF). There are exercise and wellness videos for people with mobility challenges and lots of seated options.
Lessons learnt from the ExDose Trial (DOCX 41 KB). Some helpful tips from Margaret Galloway that emerged during a study of a telehealth-delivered exercise program aimed at increasing cardiorespiratory fitness for people after stroke.
ESSA (Exercise and Sports Science Australia) video webinars from exercise physiologists about ‘taking your clinic online’, ‘telehealth in practice’ and ‘how to deliver telehealth: a case study”. (See the “Resources section” at bottom of page). Note: these examples are not stroke specific.
Hacks for exercising after stroke, a 13 min presentation by Dr Sarah Valkenborghs aimed at inspiring stroke survivors, but which includes useful tips for exercising for people with significant mobility issues.
Aerobic exercise after stroke (PDF), from the Canadian Partnership For Stroke Recovery. This guide for stroke survivors addresses the benefits of aerobic exercise, who should participate, why they should participate, how to get started and what’s involved. It also includes a sample program and tips on how to monitor exercise intensity. The accompanying Clinician’s guide (PDF) includes key messages, elements and considerations of an aerobic program, addressing barriers and outcome measures.
EnableMe podcast with physiotherapist Dr Natalie Fini (18 min) to help stroke survivors learn about physical activity and exercise following stroke.
Clock Yourself app is a training tool for patients developed by physiotherapist Meg Lowry. It progressively increases tasks for people and works on improving balance and reaction times.
Free “Senior Strong” workouts from the Body Project. This is a commercial company, but the workouts are freely available on YouTube and via the links below. The workouts were designed in conjunction with a nursing professor from the UK. They include older adults demonstrating as well as the fitness instructor. Instructors are engaging, with lots of talking but clear visual demonstrations. Some use dumbbell weights, which can be substituted with cans of beans or other household items. All (apart from the standing balance one) demonstrate sitting and standing options.
- 18 min ‘mobility’ workout – focus on stretching and gentle movements
- 24 min cardiovascular workout – Level 1
- 24 min cardiovascular workout – Level 2
- 24 min cardiovascular workout – Level 3
- 23 min resistance workout – Level 1
- 30 min resistance workout – Level 2
- 34 min resistance workout – Level 3
- 34 min circuit (cardiovascular and resistance training) – Level 2
- 34 min circuit (cardiovascular and resistance training) – Level 1
- 17 min workout focused on standing balance – only suitable for people with good balance
- 13 min boxing workout. May be difficult for people with a hemiplegic arm
- 27 min high repetition resistance workout. Can do without weights
- 26 min standing Pilates workout – only suitable for people with good balance
- 11 min workout for the abdominals – in chair or standing, no floor work
- 24 min walking cardiovascular workout. Includes some quick side-stepping work. Still includes seated options for all exercises.
Relevant research papers
Safety and feasibility of telehealth delivered exercise (fitness) training. For full text contact Margaret Galloway, Margaret.Galloway@newcastle.edu.au
Hassett L, van den Berg M, Lindley RI, Crotty M, McCluskey A, van der Ploeg HP, Smith ST, Schurr K, Howard K, Hackett ML, Killington M, Bongers B, Togher L, Treacy D, Dorsch S, Wong S, Scrivener K, Chagpar S, Weber H, Pinheiro M, Heritier S, Sherrington C (2020). Digitally enabled aged care and neurological rehabilitation to enhance outcomes with Activity and MObility UsiNg Technology (AMOUNT) in Australia: A randomised controlled trial. PLoS Med. 2020 Feb 18;17(2):e1003029. doi: 10.1371/journal.pmed.1003029. eCollection 2020 Feb.
Laver KE, Adey-Wakeling Z, Crotty M, Lannin NA, George S, Sherrington C (2020). Telerehabilitation services for stroke. Cochrane Database Syst Rev. 2020 Jan 31;1:CD010255. doi: 10.1002/14651858.CD010255.pub3.
Bagot K, Moloczij N, Arthurson L, Hair C, Hancock S, Bladin CF, Cadilhac DA (2020). Nurses’ role in implementing and sustaining acute telemedicine: a mixed-methods, pre-post design using an extended technology acceptance model. J Nurs Scholarsh. 2020 Jan;52(1):34-46. doi: 10.1111/jnu.12509. Epub 2019 Sep 11.
Bagot KL, Moloczij N, Barclay-Moss K, Vu M, Bladin CF, Cadilhac DA (2020). Sustainable implementation of innovative, technology-based health care practices: A qualitative case study from stroke telemedicine. J Telemed Telecare. 2020 Jan-Feb;26(1-2):79-91. doi: 10.1177/1357633X18792380. Epub 2018 Sep 7.
Galloway M, Marsden D, Callister R, Erikson K, Nilsson M, English C (2019). The feasibility of a telehealth exercise program aimed at increasing cardiorespiratory fitness for people after stroke. International Journal of Telerehabilitation 11(2); 9-28. doi:10.5195/ijt.2019.6290
Caughlin S, Mehta S, Corriveau H, Eng JJ, Eskes G, Kairy D, Meltzer J, Sakakibara BM, Teasell R (2019). Implementing telerehabilitation after stroke: lessons learned from Canadian trials. Telemed J E Health. 2019 Sep 9. doi: 10.1089/tmj.2019.0097.
Maddison R, Rawstorn JC, Stewart RAH, Benatar J, Whittaker R, Rolleston A, Jiang Y, Gao L, Moodie M, Warren I, Meads A, Gant N (2018). Effects and costs of real-time cardiac telerehabilitation: randomised controlled non-inferiority trial. Heart. 2019 Jan;105(2):122-129. doi: 10.1136/heartjnl-2018-313189. Epub 2018 Aug 27.
Hamilton C, McCluskey A, Hassett L, Killington M, Lovarini M (2018). Patient and therapist experiences of using affordable feedback-based technology in rehabilitation: a qualitative study nested in a randomized controlled trial. Clin Rehabil. 2018 Sep;32(9):1258-1270. doi: 10.1177/0269215518771820. Epub 2018 Apr 26.
Bagot KL, Cadilhac DA, Kim J, Vu M, Savage M, Bolitho L, Howlett G, Rabl J, Dewey HM, Hand PJ, Denisenko S, Donnan GA, Bladin CF; Victorian Stroke Telemedicine Programme Consortium (2017). Transitioning from a single-site pilot project to a state-wide regional telehealth service: The experience from the Victorian Stroke Telemedicine programme. J Telemed Telecare. 2017 Dec;23(10):850-855. doi: 10.1177/1357633X17734004.
Bagot KL, Cadilhac DA, Bladin CF et al (2017). Integrating acute stroke telemedicine consultations into specialists’ usual practice: a qualitative analysis comparing the experience of Australia and the United Kingdom. BMC Health Serv Res 17, 751 (2017). https://doi.org/10.1186/s12913-017-2694-1
Laver KE1, Lange B, George S, Deutsch JE, Saposnik G, Crotty M (2017). Virtual reality for stroke rehabilitation. Cochrane Database of Systematic Reviews 2017, Issue 11. Art. No.: CD008349. DOI: 10.1002/14651858.CD008349.pub4.
Bagot KL, Bladin CF, Vu M, Kim J, Hand PJ, Campbell B, Walker A, Donnan GA, Dewey HM, Cadilhac DA; VST collaborators (2016). Exploring the benefits of a stroke telemedicine programme: An organisational and societal perspective. J Telemed Telecare. 2016 Dec;22(8):489-494.
Chen J, Jin W, Zhang XX, Xu W, Liu XN, Ren CC (2015). Telerehabilitation approaches for stroke patients: systematic review and meta-analysis of randomized controlled trials. J Stroke Cerebrovasc Dis. 2015 Dec;24(12):2660-8. doi: 10.1016/j.jstrokecerebrovasdis.2015.09.014. Epub 2015 Oct 23.
Clark RA, Conway A, Poulsen V, Keech W, Tirimacco R, Tideman P (2015). Alternative models of cardiac rehabilitation: a systematic review. Eur J Prev Cardiol. 2015 Jan;22(1):35-74. doi: 10.1177/2047487313501093. Epub 2013 Aug 13.
Crotty M, Killington M, van den Berg M, Morris C, Taylor A, Carati C (2014). Telerehabilitation for older people using off-the-shelf applications: acceptability and feasibility. J Telemed Telecare. 2014 Oct;20(7):370-6. doi: 10.1177/1357633X14552382.
PubMed search for systematic reviews on telerehab for stroke (free to access). On 26/3/20 there were 14 hits.
Evidence to guide telehealth physiotherapy. The Physiotherapy Evidence Database (PEDro) has compiled a list of systematic reviews of tele-physiotherapy published in the last 5 years.