1、TeleRehabilitation Overview and Preliminary Results Nigel Shapcott, M.Sc., A.T.P.Department of Rehab Science and Technology, University of Pittsburgh and Center for Assistive TechnologyUPMC Health SystemInstitutional AcknowledgementsUS Dept.of Agriculture SBIR I and II.Center for Excellence in Rural

2、 Medically Underserved Areas, PA.Veterans Affairs Rehab Research & Development ServiceDept of Rehab Science & Technology at the University of PittsburghUPMC Center for Assistive Tech.UPMC Spinal Injury CenterHERL VA Medical Center PittsburghPeople Acknowledgements Michael Boninger MD Laura Cohen PT

3、Rory Cooper PhD Rosi Cooper PT Shirley Fitzgerald PhD Mark Schmeler OT Tricia Thorman OTTeleRehab- How we see it Transfer of Eval DataPressure/DimensionalAssistive Technology PractitionerAssistive Technology SupplierRegistered NurseCertified Orthotist or ProsthetistOTR, PTPhysiatristVisual and Audio

4、 EvaluationExpert HubNon Specialist OTR or PTCOTA or PTARTS TechnicianLPNOrthotist or ProsthetistVisiting NurseRural SiteDelivery of various Rehabilitation interventions remotely: wheelchairs, wound care, follow up, training etc.TeleRehab- The NeedResources and DistancesNot enough skilled peopleLarg

5、e numbers of underservedToo many milesEarlier dischargeMortality ratesDisability ratesATApprox 200 milesPennsylvania- West/CentralTeleRehab- Why Are We Using Telephone Based Systems Now?AT&T, top picture 1994 ($1500) poor performanceViaTV, 19981998, same widespread infrastructure (POTS)- better perf

6、ormance with lower costs e.g. ViaTV, StarviewNew units cost $300 +Potential Benefits of TeleRehabBetter access to health care for those living outside metropolitan areasFewer trips to clinics and hospitals for both patients and cliniciansMore specialists can take part in an evaluationFollow-up with

7、clients after dischargeTeleRehabilitation -Part II- Technologies and Nomenclature BANDWIDTH- (Rate of Information)Available/Developing TechnologiesHard wired-T/4 Fiber optic Lines- highHard wired-ISDN Digital Phone Lines- mediumHard wired-POTS- Plain Old Telephone Service- lowHard wired-Cable- mediu

8、m/highHard wired- Power Utilities- not knownHard wired- *DSL Technologies- medium/highWireless- Cell Phone 3G- medium/highWireless- 2 Way Satellite (0.5m)- medium/highConnection Technologies-SummaryRapid changes in theseHuge potential marketRural areas likely to be last in lineBandwidth will increas

9、eVideo quality will improveData capability will be further developedTeleRehabilitation -Part III- Results Clinical IssuesInjury- Handover of responsibilityTransferROMTrainingQualifications at both endsSpecialized training requirementsRecognition of current limitsNo feel (ROM)Tremors (not picked up)M

10、ore quantitative tools needed (Pressure etc)Multiple view issues Efficacy of Wheelchair System Prescription Using POTS TeleRehabAims and Methodto establish a scientific basis for the reliable use and limits of video conferencing for remote prescription of Assistive Technology using POTS lines to tra

11、nsmit and receive the audio and video signals. to determine the potential of increasing the availability of AT prescription services to communities, underserved due to geographical and/or transportation and/or financial barriers.TeleRehab (TR) systems are used to evaluate individuals for their wheel

12、chair & seating needs and compared to the findings of In Person (IP) evaluations. Efficacy of Wheelchair System Prescription Using POTS TeleRehabRESEARCH QUESTIONSCan experienced Clinicians using TR technologies, with defined operational protocols:1. Reliably determine if the TR process is appropria

13、te and safe for a specific individual? 2. Reliably provide accurate decisions regarding the need for a wheelchair, at a detailed level? 3. Reliably obtain accurate assessments of medical history and physical examination? Efficacy of Wheelchair System Prescription Using POTS TeleRehabAssessment/Evalu

14、ationInterview- with the Model Patient consists of access to information from a standard information sheet; and an interactive session determining mobility goals, appropriateness of these goals, diagnosis, any changes in condition. Mat evaluation- a physical motor and measurement evaluation either c

15、arried out by the Clinician in the face-to-face situation or under the guidance of the Clinician by the Assistant via TR. The purpose of the mat evaluation is to establish passive and active ROM, of the upper and lower extremities, any pathological movement patterns, sitting and transfer skills, spi

16、nal orientation, and functional abilities related to mobility and other goals. Measurement- the Clinician or Assistant record linear and angular measurements as required by the data collection form and setting. Efficacy of Wheelchair System Prescription Using POTS TeleRehab20 subjects acting as “mod

17、el patients4 evaluations/subject Crossover study2 Locations2 In Person (IP)2 TeleRehab (TR)Detailed Protocol Data Collection (Forms)4 Clinicians (2 OT, 2 PT)9 “Assistants TrainedTeleRehab evaluationTransferROMDimensions2 Locations2 LocationsVA Medical Center- Highland DrivePittsburghUPMCCenter for A

18、ssistive TechnologyPittsburghExperimental Schematic CAT TRCAT IPVA IPVA TRClinician 1 evaluationClinician 2 evaluationClinician 3 evaluationClinician 4 evaluationDAY 1DAY 23-7 DAY DELAYBETWEEN SESSIONSEfficacy of Wheelchair System Prescription Using POTS TeleRehabData Collection: - A team consisting

19、 of a Physiatrist; Statistician, 2 OTs; 2 PTs and a Rehabilitation Engineer have developed comprehensive data collection forms to record information on the characteristics of the Model Patient their environment; and the details of the prescription. The forms were derived over a series of iterations

20、and reviews from a collection of existing in house forms and the work of the Assistive Technology Program in Tucson . Data Collection- Form 1Data Collection- Form 2Data Collection- Form 3Data Collection- Form 3Data Collection- Form 4Preliminary Estimations (9 of 20 subjects)Qu. 1. Further evaluation

21、Multi- rater Kappa, 4 clinicians, 0.464 & p=0.07Multi- rater Kappa 3 clinicians, 0.615 & p=0.03TP vs IP Kappa 0.615, p=013simple agreement 90%(Weighted Kappa issue)Preliminary Estimations (9 of 20 subjects)Question. Wheelchair TypeManual Wheelchair- simple agreement 100% (n=4)Powered Wheelchair- sim

22、ple agreement 100% (n=4)Scooter- simple agreement 100% (n=1)Preliminary Estimations (9 of 20 subjects)Question. Wheelchair FeaturesManual Wheelchair: (folding, rigid, TIS, recline)-simple agreement 75% Powered Wheelchair Features: (recline, TIS)- simple agreement 94%Powered Wheelchair Drive: (front,

23、 rear, mid)- simple agreement 69% Scooter: ( 3 or 4 wheeled)- simple agreement 50% Preliminary Estimations (9 of 20 subjects)Question. Seating DimensionsOverall Seat width: (18)- simple agreement 61% Overall seat width In Person : (18)- simple agreement 66%Overall Seat length: (18)- simple agreement

24、 75% Overall seat length In Person : (18)- simple agreement 44%Preliminary Estimations (9 of 20 subjects)Question. Seating/Cushion FeaturesCushion Supports: (medial thigh, lateral thigh, medial hip)- simple agreement 86% Cushion customization required : (yes, no)- simple agreement 86%Cushion pressur

25、e relief required: (yes, no)- simple agreement 78% Preliminary Estimations (9 of 20 subjects)Question. Seating/Backrest FeaturesBack Lateral Supports: (left, none)- simple agreement 83% Back Lateral Supports: (right, none)- simple agreement 83% Back customization required : (yes, no)- simple agreeme

26、nt 80%Preliminary Estimations (9 of 20 subjects)Question. Headrest and ArmrestHeadrest required: (yes, no)- simple agreement 94% Armrest required: (yes, no)- simple agreement 94% Preliminary Estimations (9 of 20 subjects)Conclusions:Simple to set up and useGood quality audio is essentialExperienced

27、clinicians required Linear measurement results diabolical- supports rationel for simple measurement rigs (Logan et al 1998)TeleRehabilitation -Part IV- Future Technical Issues TeleRehab- Future NeedsData Acquisition with videoPressureDimensionalData Acquisition with videoWound CareTeleRehab- Future

28、NeedsTeleRehab- Future NeedsData Acquisition with videoTemperatureData Acquisition with videoShearHumidityTeleRehab- Future NeedsData Acquisition with videoData GloveTeleRehabilitation -Future Service Delivery ISDN or Other High Bandwidth SystemsHigh bandwidth link to center in Texas followed up wit

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