Posts Tagged Telehealth
In-home rehabilitation, using a telehealth system and supervised by licensed occupational/physical therapists, is an effective means of improving arm motor status in stroke survivors, according to findings presented by University of California, Irvine neurologist Steven C. Cramer, MD, at the recent 2018 European Stroke Organisation Conference in Gothenburg, Sweden.
“Motor deficits are a major contributor to post-stroke disability, and we know that occupational and physical therapy improve patient outcomes in a supervised rehabilitation program,” said Cramer, a professor of neurology in the UCI School of Medicine. “Since many patients receive suboptimal therapy doses for reasons that include cost, availability, and difficulty with travel, we wanted to determine whether a comprehensive in-home telehealth therapy program could be as effective as in-clinic rehabilitation.”
In a study conducted at 11 U.S. sites, 124 stroke survivors underwent six weeks of intensive arm motor therapy, with half receiving traditional supervised in-clinic therapy and half undergoing an in-home rehabilitation program supervised via a videoconferenced telemedicine system.
Subjects were on average 61 years old, 4.5 months post-stroke, and had moderate arm motor deficits at study entry. When examined 30 days after the end of therapy, subjects in the in-clinic group improved by 8.4 points on the Fugl-Meyer scale, which measures arm motor status and ranges from 0 to 66, with higher numbers being better. Subjects in the telerehab group improved by 7.9 points, a difference that was not statistically significant.
“The current findings support the utility of a computer-based system in the home, used under the supervision of a licensed therapist, to provide clinically meaningful rehab therapy,” Cramer said. “Future applications might examine longer-term treatment, pair home-based telerehab with long-term dosing of a restorative drug, treat other neurological domains affected by stroke (such as language, memory, or gait), or expand the home treatment system to build out a smart home for stroke recovery.”
He said that the demand for rehabilitation services will likely increase, due to an aging population and increased stroke survival as a result of better access to advanced acute care. Telehealth, defined as the delivery of health-related services and information via telecommunication technologies, can potentially address this growing unmet need.
“We reasoned that telerehabilitation is ideally suited to efficiently provide a large dose of useful rehab therapy after stroke,” said Cramer, whose research team is part of the NIH StrokeNet consortium.
This research builds on the findings of a pilot study of 12 patients with late subacute stroke and arm-motor deficits who were provided 28 days of home-based telerehab program. The results, published in November 2017 in the journal Neurorehabilitation and Neural Repair, found that patient compliance was excellent (97.9%) and participants experienced significant arm-motor gains (Fugl-Meyer scale increase of 4.8 points). The study also found that patients did not need any additional computer skills training due to the design of the telerehab system.
“Getting patients to remain engaged and comply with therapy is a key measure of success of any rehabilitation program,” Cramer said. “Greater gains are associated with therapy that is challenging, motivating, accompanied by appropriate feedback, interesting and relevant. Telerehab achieves this because therapy is provided through games, provides user feedback, can be adjusted based on individual needs, is easy to use—and is fun.”
This study was supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development as well as the National Institute of Neurological Disorders and Stroke (grant U01 NS091951), the NIH StrokeNet Clinical Trials Network, the 11 US enrollment sites, the research team at the primary study site at the University of California, Irvine, and the patients and families who participated.
Purpose: This abstract reports a qualitative study on a home-based stroke telerehabilitation system. The telerehabilitation system delivers treatment sessions in the form of daily guided rehabilitation games, exercises, and stroke education at the patient’s home. Therapists examine patients then establish regular videoconferences with them via the system to discuss their progress, provide feedback, and adjust treatment. The aims of this study were to investigate patients’ general impressions about the benefits of and barriers to using the telerehabilitation system at home.
Methods: We used a qualitative study design that involved in-depth semi-structured interviews with 10 participants who had completed a 6-week intervention using the telerehabilitation system. Thematic analysis was conducted using the grounded theory approach.
Results: Participants mostly reported positive experiences with the telerehabilitation system. Benefits included observed improvements in limb functions and provision of an outlet for mental tension and anxiety. They mainly valued the following four merits of the system: engaging game experience, flexibility in time and location in using the system, having the therapists accountable, and having less burden on caregivers. In particular, all participants rated highly their experience using the videoconference capability, which provided a channel for therapists to observe, correct, and provide feedback and encouragement to patients. Most patients expressed that they established a personal connection with the therapist through use of the telerehabilitation system. By doing so, they felt less isolated and more positive and connected. Finally, communicating with therapists three times a week also held patients accountable for completing the exercises. Barriers to system use were all logistics-related, such as the lack of physical space at home, which impeded effective use, and poor internet connection at home.
Conclusions: The telerehabilitation system studied provides patients with home-based access to games, exercises, education, and therapists. Based on participants’ qualitative feedback, it is a promising tool to deliver stroke rehabilitation therapies effectively and remotely to patients at home.
[ARTICLE] A Cloud-Based Virtual Reality App for a Novel Telemindfulness Service: Rationale, Design and Feasibility Evaluation – Full Text
Background: Worldwide, there has been a marked increase in stress and anxiety, also among patients with traumatic brain injury (TBI). Access to psychology services is limited, with some estimates suggesting that over 50% of sufferers are not accessing the existing services available to them for reasons such as inconvenience, embarrassment, or stigmatization concerns around mental health. Health service providers have increasingly been turning to drug-free therapies, such as mindfulness programs, as complementary treatments.
Objective: Virtual reality (VR) as a new delivery method for meditation-based stress and anxiety reduction therapy offers configurable environments and privacy protection. Our objective was to design a serious learning-meditation environment and to test the feasibility of the developed telemindfulness approach based on cloud technologies.
Methods: We developed a cloud-based system, which consisted of a Web interface for the mindfulness instructor and remote clients, who had 3D VR headsets. The mindfulness instructor could communicate over the Web interface with the participants using the headset. Additionally, the Web app enabled group sessions in virtual rooms, 360-degree videos, and real interactions or standalone meditation. The mindfulness program was designed as an 8-week Mindfulness-Based Stress Reduction course specifically for the developed virtual environments. The program was tested with four employees and four patients with TBI. The effects were measured with psychometric tests, the Mindful Attention Awareness Scale (MAAS) and the Satisfaction With Life Scale (SWLS). Patients also carried out the Mini-Mental State Examination (MMSE). An additional objective evaluation has also been carried out by tracking head motion. Additionally, the power spectrum analyses of similar tasks between sessions were tested.
Results: The patients achieved a higher level of life satisfaction during the study (SWLS: mean 23.0, SD 1.8 vs mean 18.3, SD 3.9) and a slight increase of the MAAS score (mean 3.4, SD 0.6 vs mean 3.3, SD 0.4). Particular insight into the MAAS items revealed that one patient had a lower MAAS score (mean 2.3). Employees showed high MAAS scores (mean 4.3, SD 0.7) and although their SWLS dropped to mean 26, their SWLS was still high (mean 27.3, SD 2.8). The power spectrum showed that the employees had a considerable reduction in high-frequency movements less than 0.34 Hz, particularly with the 360-degree video. As expected, the patients demonstrated a gradual decrease of high-frequency movements while sitting during the mindfulness practices in the virtual environment.
Conclusions: With such a small sample size, it is too early to make any specific conclusions, but the presented results may accelerate the use of innovative technologies and challenge new ideas in research and development in the field of mindfulness/telemindfulness.
Attention impairment has often been considered a hallmark of mental illness. Attention training is an important part of meditation, and has proven to augment the ability to sustain attention . Mindfulness as a meditation tool has an important role in psychology, self-awareness, and well-being. The authors Brown and Ryan [ ] reported that mindfulness over time was related to a reduction in variable mood and stress in patients with cancer. Mindfulness is an internationally recognized therapy that teaches self-awareness, maintaining own thoughts, sensations, feelings, emotions, and appreciation of your living environment [ ]. The mindfulness meditation technique may help patients manage potentially negative outcomes and improve well-being by controlling unselfconsciousness (thoughts on failure). Avoiding problems associated with the future, focusing on the present, being “now,” and controlling the tracking of time may, in addition to well-being, lead to mindfulness. A person who can achieve such an active and open attention state can control thoughts from a distance, free to judge whether they are good or not [ ]. In this context, mindfulness can also be considered an important tool for managing anxiety and stress in patients [ ]. Kabat-Zinn [ ] designed an 8-week meditation course, Mindfulness-Based Stress Reduction, which provides 2 hours of meditation in a group with additional homework. Mindfulness-Based Stress Reduction has demonstrated that awareness of the mind, unconscious thoughts, feelings, and other emotions positively affect major physiological processes and thus decreases the level of stress-related disorders [ – ].
Anxiety and stress disorders can be related to pressure at work, incurable diseases, or neuromuscular disorders, such as Parkinson disease, light traumatic brain injury (TBI), multiple sclerosis, or other diseases of the muscular or central nervous system. Deficits in executive functions, memory, and learning are often documented after TBI. In addition, at least half of those suffering from TBI experience chronic pain and/or sleep disorders, depression, and substance abuse .
A review of the literature shows that neural systems are modifiable networks and changes in the neural structure can occur in adults as a result of training . The study reported on anatomical magnetic resonance imaging (MRI) images from 16 healthy meditation-naïve participants who underwent the 8-week mindfulness program [ ]. The results obtained before and after the program suggested that participation in a Mindfulness-Based Stress Reduction course was associated with changes in gray matter concentration in the regions of the brain involved in learning and memory processes, emotion regulation, self-referential processing, and perspective taking.
Early rehabilitation in the acute and subacute phase may be a critical period and a key to effective rehabilitation, especially in TBI . A significant drawback is that patients often stay in hospital for a limited time and are soon discharged for recovery at home. Afterward they can visit an outpatients’ clinic. Patients residing close may find the outpatient service convenient, but it could be very inconvenient for those who are in need of ongoing care, are dependent on public transport, or in the worst case do not have access to transport at all. Consequently, external factors such as travel fatigue may hinder the effectiveness of the therapy and, in some, may even increase anxiety and stress. In addition, modern diseases caused by stress and anxiety in the workplace are on the increase, but access to treatment and therapy is usually not possible during working hours [ ].
Innovative technologies can ensure real-time communication and data recording/sharing over long distances, even within larger groups of participants . Nowadays, privacy, data security, shyness, and pride are among the most frequent reasons to avoid therapy if a mental disease or neuromuscular disorder is related to work or social status [ ].
Some patients prefer to remain anonymous and do not want to reveal their problems, even to colleagues. The sense of “total immersion” created by virtual reality (VR) is an emerging technology that may entirely replace mainstream videoconferencing techniques . These technologies may fulfill patient expectations [ ] regarding anonymity and enhance presence [ ]. Patients can hide their identify using an avatar and their voices can be disguised. Psychologists and other experts may observe the kinematic changes in motion patterns, gestures, face mimics, and other measurable features [ ]. If there is a group, the VR avatars can be synchronized and controlled in real time, using cloud-based technologies. The operator can form groups, deliver individual or group tasks, or lead a private conversation with selected participants. We have developed a technology that is available for home and workplace use, called Realizing Collaborative Virtual Reality for Well-being and Self-Healing (ReCoVR), for which the VR headset is coupled with a mobile phone. The only requirement is a connection to Wi-Fi/4G Internet, plus communication with the cloud server allows remote interaction with other users residing thousands of miles away.
This cloud-based app is used for interaction and communication between a mindfulness expert and participants. Each participant uses a commercially available mobile phone and a simple head-mounted VR headset to join the mindfulness session in the virtual environment (VE). Our main objectives were to design a suitable mindfulness protocol based on Mindfulness-Based Stress Reduction, with tasks in the VE with 360-degree videos, and to test the feasibility of the developed mindfulness/telemindfulness app in a real environment. Additionally, we analyzed head movements during mindfulness sessions to stimulate further initiatives in this research space. […]
The science and practice of telehealth have undergone rapid growth in recent years. A search of the Web of Science for the term ‘telehealth’ would have returned only two papers in 1995, compared with 104 papers in 2000, and 5069 papers in June 2017. This exponential growth is also evident in the number of randomised, controlled trials and systematic reviews indexed in the Physiotherapy Evidence Database with ‘telehealth’ in the title, rising from 10 records in 2008 to 70 records in 2017. These papers span the breadth of physiotherapy practice, with particularly strong representation from musculoskeletal and cardiorespiratory physiotherapy (Figure 1). High-quality randomised, controlled trials that support the benefits of telehealth interventions in many physiotherapy subdisciplines have been published over recent years. These have included telephysiotherapy interventions for chronic knee pain,1 non-specific low back pain,2 chronic obstructive pulmonary disease (COPD),3 heart disease,4 breast cancer,5 joint arthroplasty,6 and urinary incontinence.7Many of these studies have demonstrated significantly better clinical outcomes than usual care that did not include physiotherapy, including improved exercise capacity, better physical function, reduced symptoms and enhanced health-related quality of life.
Telephysiotherapy can take many different forms, with the components driven by the goals of treatment. Videoconferencing provides direct contact between patients and physiotherapists, either one-to-one1 or in a virtual group setting.3 For some telephysiotherapy programs (eg, pulmonary rehabilitation, stroke rehabilitation) it may be necessary to perform a limited number of home visits, in order to perform assessments or provide instruction in the use of equipment.3, 8 However, some telephysiotherapy programs are delivered entirely from a distance, without ever meeting the patient in person, including notable examples of successful treatment of stress urinary incontinence using email support7 and a mobile app.9 Telephysiotherapy programs may include remote monitoring of physiological signals, such as pulse rate, oxygen saturation, electrocardiograms (ECG), and joint range of movement, in specific populations such as cardiorespiratory or orthopaedic disease.4, 10, 11Whilst some telephysiotherapy models require specially designed equipment,6, 11 others have achieved similarly successful outcomes with off-the-shelf consumer devices and software.1, 3 The ubiquitous nature of the smartphone provides new opportunities for telephysiotherapy, including: physical activity monitoring; sound and light cues to set exercise intensity and duration; real-time feedback on exercise performance; and text messaging to provide exercise advice or progression.10, 12 Simple web-based diaries can be used to record exercise and provide feedback.12 Didactic or interactive education programs can also be provided.1 In some populations it may be possible to automate aspects of a telephysiotherapy program to provide efficient and effective care to large patient populations, for instance using internet platforms that provide automated goal setting and feedback in conjunction with a pedometer for patients with non-specific low back pain.2
The increase in our capacity to deliver physiotherapy at a distance using telehealth has occurred at the same time that ‘hands-on’ physiotherapy techniques have become less important for some health conditions. For example, electrotherapy is no longer recommended for routine treatment of low back pain,13 whereas exercise therapy is an important component of care.14 Interventions designed to increase physical activity and physical fitness now have an important role in physiotherapy management for numerous clinical groups and across the lifespan, recognising the critical impact of these factors on long-term health outcomes.15 Many of these interventions, which typically involve goal setting, exercise prescription and self-management training, do not require hands-on therapy and are highly amenable to telephysiotherapy.
Despite the potential for telehealth to increase the capacity of the health system and deliver better health outcomes, there has been relatively slow uptake in practice. Enthusiasm has been tempered by the lack of clinically relevant benefits seen in some large-scale randomised trials involving people with chronic diseases such as heart failure and COPD;16, 17, 18 however, these trials relied heavily on telemonitoring of physiology and symptoms, rather than on delivery of therapy. Remote monitoring has not delivered consistent benefits over usual care, perhaps because it is difficult to maintain long-term adherence with monitoring, or the difficulty in identifying meaningful changes in monitored variables. Trials in telephysiotherapy, which typically involve delivering a treatment from a remote location, have generally been more successful, producing similar results to interventions that are delivered face to face. For instance, in 205 patients who had undergone knee arthroplasty, in-home rehabilitation delivered by videoconference demonstrated equivalent outcomes for pain, stiffness and function when compared with face-to-face rehabilitation.6 Similarly, in 152 people with heart failure, cardiac rehabilitation with exercise prompts and ECG monitoring transmitted via a mobile phone produced similar benefits to a traditional outpatient cardiac rehabilitation program.10 A key feature of these successful telephysiotherapy interventions is that they delivered treatments of known effectiveness in a different way, using technology to reach patients who are located away from healthcare facilities. […]
eRehabilitation™: The future of rehab!
One thing we know for certain is that the future of rehab is inseparable from the Internet. To be client–centred, we have to go where our clients are … and our clients are everywhere, throughout the community and all over the Internet. The growth and complexity of knowledge, research and evidence for best practices in health mirrors the growth of the Internet and its tools to disseminate information, to provide forums for eclectic interactions and informative discussions. Our clients are aptly at this intersection – they are at the centre and we need to meet them there. This intersection is a magical place; it‘s on fire with prolific activity.
We are the benefactors of a modern revolution: the intersection of advances in technology, creative interfaces and evidence-based therapies are taking healthcare to levels only dreamed of. “The motive behind the use of this technology is to maintain the essential qualities of the health-care interaction, while improving access by overcoming barriers such as economics, culture, climate, and geography,” (Rees, 2004).
Telehealth has been touted as the most significant contribution to health-care delivery systems of the future (Bashshur, 1997). eRehabilitation™, a component of telehealth, is a cutting-edge, yet flourishing means of delivering rehabilitation, psychological & mental health services.
At Brainworks, we have developed eRehabilitation™ as a comprehensive treatment platform that uses interactive audio, video, or data communications to provide rehabilitation services at a distance.
Does eRehabilitation™ work?
Absolutely – eRehabilitation™ is Evidence-Based: there is a growing literature base that demonstrates the efficacy of these interactive, online modalities.
There are several areas for which online guided therapy based on CBT could be regarded as empirically-supported (Andersson, 2009), including panic disorder, social anxiety disorder, posttraumatic stress disorder (PTSD), and mild to moderate depression. progress. Carlbring et al. (2005) found equivalent outcomes of individual face-to-face CBT and Internet CBT for panic disorder. In a trial on depression (Spek, Nyklıcek, et al., 2007) found no differences between live group treatment and Internet CBT.
A recent study by Matsura et al. (2002) investigated the interrater reliability of videoconferencing compared with face-to-face assessment interviews. Perfect agreement was obtained between both interviewing conditions. Glueckauf et al. (2002) assessed the effects of videoconferencing-based counselling compared with counselling using a speakerphone, and conventional, face-to-face counselling. The counselling was provided to 22 rural teenagers with epilepsy. All treatment conditions were associated with similar outcomes, including significant reductions in problem severity and frequency.
Day and Schneider (2002) conducted a comprehensive and methodologically sound study evaluating the delivery of brief CBT via videoconferencing. A sample of 80 clients with concerns ranging from weight concerns to personality disorders were randomly assigned to one of three treatment groups (face-to-face, two-way audio, or two-way video) or a waiting list control group. No significant differences were found between treatment groups across outcome measures and all three groups were significantly superior to the no-treatment group.
A number of studies have demonstrated the benefits of conducting assessments via the Internet. These include: ease of administration, collecting data, communicating findings to clients, cost efficiency, reaching disabled persons and those that live in the rural areas (EmmelKamp, 2005; Fischer & Freid, 2001; Naus, Phillip, & Samsi 2009;).
References available upon request. Please contact us for more information and literature to support your referral!
Source: How It All Works – Brainworks
Telehealth offers a solution to assist delivery of occupational therapy (OT) services for hand therapy in rural and remote locations. However, there is currently no evidence to validate this service model. The aim of this study was to examine the validity of clinical decisions made during hand therapy sessions conducted via telehealth compared to a traditional clinical model (TCM) assessment, and explore patient and clinician satisfaction.
Eighteen patients referred for hand therapy to a rural/remote hospital-based outpatient service were assessed simultaneously via telehealth and a TCM assessment. An allied health assistant supported data collection at the patient end. Hand function was assessed using a range of objective measures, subjective scales and patient reported information. Minimal level of percent exact agreement (PEA) between the telehealth OT (T-OT) and the TCM-OT was set at ≥80%.
Level of agreement for all objective measures (dynamometer and pinch gauge reading, goniometer flexion and extension, circumference in millimetres) ranged between 82% and 100% PEA. High agreement (>80% PEA) was also obtained for judgements of scar and general limb function, exercise compliance, pain severity and sensitivity location, activities of daily living and global ratings of change (GROC) scores. There was 100% PEA for overall recommendations. Minimal technical issues were experienced. Patient and clinician satisfaction was high.
Clinical decisions made via telehealth were comparable to the TCM and consumers were satisfied with telehealth as a service option. Telehealth offers the potential to improve access to hand therapy services for rural and remote patients.
[WEB SITE] Silver Linings: Remote rehab – Telehealth helps seniors recover in rural areas – New Hampshire
Melly said the use of Jintronix at the New Jewish Home has resulted in a 60 percent reduction in rehospitalizations of these patients.
“The more engaged the patient is, the better their outcome is,” Melly said.
At the center, Melly said you will see others in the rehabilitation room or patient’s families gather around to cheer on the patient as they go for soccer goals or reach the pinnacle of a rock climb.
“How much fun is that?” she said.
On this day, Brown scored a 6 out of 6 in soccer and 5 out of 6 in skiing. When he leaves the facility, Brown said he plans on buying a Wii videogame console to keep up with his therapy.
“It’s something I can do at home,” he said.
Evin said Jintronix is actually safer than a Wii for people like Brown because the program is tailored to the patient and the patient’s progress is monitored by their health team and tracked.
Bartels said there is “a lot of activity” in the field of telerehabilitation and there are other similar programs in development. He points to the future in sensors.
At Northeastern University, researchers are studying the use of sensors in ceilings to track a person’s movement, their gait, and their level of exercise. He said a person’s gait tells a lot about a person’s health. He said it’s one thing to watch a person walk across the room once for the doctor – it’s another thing to watch a person walk 50 times back and forth a day between the bedroom and the kitchen.
“A slower gait may mean an infection or something with medication and side effects or they’re depressed,” Bartels said.
At the Dartmouth Institute they are using sensors to monitor overweight elders.
Melly said she expects the New Jewish Home to be using more of this type of technology in the future.
“It’s the case of technology finally catching up with the medical needs,” she said.
Silver Linings is a continuing Union Leader/Sunday news report focusing on the issues of New Hampshire’s aging population and seeking out solutions. Union Leader reporter Gretchen Grosky would like to hear from readers about issues related to aging. She can be reached at email@example.com or (603) 206-7739. See more at www.unionleader.com/aging.
[SLIDESHOW/PDF] Successes and Barrier of Implementing Telehealth Models of Rehabilitation with Children and Adults – The Ohio State University
- Understand the terminology related to telehealth/ telerehabilitation
Describe evidence-based clinical applications of telehealth in OT
Discuss how the use of telehealth technologies may contribute to a world of health and well being
[Abstract] A Telehealth Approach to Caregiver Self-Management Following Traumatic Brain Injury: A Randomized Controlled Trial
Design: Parallel group, randomized controlled trial with blinded outcome assessment.
Setting: General community.
Participants: A total of 153 caregivers (mean age = 49.7 years; 82% female; 54% spouses/partners, 35% parents) of persons with moderate to severe TBI who received acute and/or rehabilitation care at a level I trauma center. Eighty-two percent of participants were evaluated at 6-month follow-up.
Intervention: Individualized education and mentored problem-solving intervention focused on caregivers’ primary concerns delivered via up to 10 telephone calls at 2-week intervals.
Main Outcome Measures: Composite of Bakas Caregiving Outcomes Scale (BCOS) and Brief Symptom Inventory (BSI-18) at 6 months post-TBI survivor discharge. Secondary measures included the Brief COPE.
Results: Caregivers in the treatment arm scored higher on the BCOS-BSI composite (P = .032), with more active coping (P = .020) and less emotional venting (P = .028) as measured by the Brief COPE.
Conclusions: An individualized education and mentored problem-solving approach delivered via telephone in the first few months following community discharge of the TBI survivor resulted in better caregiver outcomes than usual care. Consideration should be given to using this approach to augment the limited support typically offered to caregivers.