Telerehabilitation (or e-rehabilitation is the delivery of rehabilitation services over telecommunication networks and the internet. Telerehabilitation allows patients to interact with providers remotely and can be used both to assess patients and to deliver therapy. Fields of medicine that utilize telerehabilitation include: physical therapy, occupational therapy, speech-language pathology, audiology, and psychology. Therapy sessions can be individual or community-based. Types of therapy available include motor training exercises, speech therapy, virtual reality, robotic therapy, goal setting, and group exercise.
Commonly used modalities include webcams, videoconferencing, phone lines, videophones and webpages containing rich Internet applications. The visual nature of telerehabilitation technology limits the types of rehabilitation services that can be provided. Telerehabilitation is therefore often combined with other modalities such as in-person therapy.
Important areas of telerehabilitation research include the investigation of new and emerging rehabilitation modalities as well as comparisons between telerehabilitation and in-person therapy in terms of patient functional outcomes, cost, patient satisfaction, and compliance.
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 extend coverage to certain telerehabilitation services as was the case during the pandemic (see also Occupational Therapy).
Technologies
Plain old telephone service (POTS) with videophones/phones in telerehabilitation There are several types of connections used with real time exchanges. Plain old telephone service (POTS) uses standard analog telephone lines. Videophones are used with POTS lines and include a camera, display screen, and telephone. 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 television as a screen. Videotelephony/Videotelephony in telerehabilitation The use of improved quality video-assisted telecommunication devices, such as videoconferencing, webcams and telepresence to assist in treatments. Virtual reality/Virtual reality in telerehabilitation Virtual reality in telerehabilitation is one of the newest tools available in that area. This computer technology allows the development of three-dimensional virtual environments. 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 intelligence/Artificial intelligence in telerehabilitation Wireless technology/Wireless technology in telerehabilitation PDAs/PDA in telerehabilitation Mobile telephony/Mobile telephony in telerehabilitation Electronic medical records/Electronic medical record telerehabilitation Mobile apps/Mobile apps telerehabilitation Rehabilitation Robotics with telerehabilitation integrated into the therapeutic intervention (e.g., teleevaluation, telesupport, telemonitoring)
Clinical applications
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, stuttering, 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, the treatment of language disorders, and the assessment and treatment of motor speech disorders following brain impairment and Parkinson's disease. Speech and language therapy can also be effectively delivered via video for people with aphasia. 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 has been considerable research into the assessment and treatment of dysphagia via telerehabilitation, including cost analyses, leading to the establishment of sustainable telerehabilitation services.
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.
Occupational therapy Occupational Therapy Practitioners (OTP), work with people across the lifespan in order to facilitate independence, establish or rehabilitate roles, habits and routines. Occupational Therapy can be administered through means of telehealth, and since telehealth is often being performed in the clients' own environment, carry-over and efficacy of interventions is often increased. There are many types of occupational therapy intervention that can be provided through telehealth. Many positive outcomes have been reported across multiple intervention areas including: motor learning/relearning, ADL/IADL retraining (following CVA, TBI, Cancer, joint replacement, etc), functional cognitive training, home modification assessments, vision rehabilitation, pediatric therapies and family training. It is safe to consider telehealth as an emerging practice area for OTPs with evidence of efficacy mounting from various areas of practice.
Following the COVID-19 Pandemic, Medicare and many private insurance companies swiftly adopted Telehealth as a reimbursable option for provision of occupational therapy services, although Telehealth has been used for many years prior especially in rural areas. As the public health emergency is due to expire, many advocates of telehealth are working towards establishing more permanent measures to protect telehealth as a reimbursed service. The American Occupational Therapy Association (AOTA) and World Federation of Occupational Therapists (WFOT) are both in support of Telehealth as a means to provide care. Most importantly, OTPs themselves are in support of making telehealth a permanent option for service delivery. Telehealth is a promising adjunct to in-person treatment for persons receiving occupational therapy services.
Physical therapy For individuals with shoulder pain specifically, research shows that telerehabilitation can be just as effective as in-person physical therapy. Effective interventions given in telerehabilitation for shoulder pain include exercises for shoulder mobility and strength. In addition, it has been found that telerehabilitation, especially for long term treatment such as chronic shoulder pain, is cost and time effective compared to in person therapy. However, one drawback is that manual therapy and the use of modalities, which are important parts in treatment of shoulder pain, are not possible.
Types of Physical rehabilitation therapies delivered through telerehabilitation include strengthening exercises, motor retraining, goal setting, virtual reality, robotic therapy, community-therapy.