Telerehabilitation allows for the delivery of cognitive training post traumatic brain injury. Writing in Brain Injury, 05/01/2013 Ng EMW et al. from Toronto Rehabilitation Institute, University Health Network , Toronto, ON look at the delivery of the Cognitive Orientation to daily Occupational Performance approach (CO-OP) in a telerehabilitation format. Using the Outcome measures included the Canadian Occupational Performance Measure, the Mayo-Portland Adaptability Inventory-4 Participation Index, and the Dysexecutive Questionnaire the group conclude that Telerehabilitation can be used for addressing executive dysfunction after traumatic brain injury and may help promote community integration of individuals living with TBI.
Posts Tagged ‘Telerehabilitation’
Published in JAMA Neurol. 2013 Mar Dr. Ray Dorsey, Associate Professor of Neurology, Director of the Movement Disorders Center, Johns Hopkins University concludes that web-based videoconferencing and telemedicine for the provision of specialty care at home is feasible, effective and provides value to patients, and may offer similar clinical benefit to that of in-person care in Parkinson Disease (PD). This indicates that telemedicine is feasible for other movement Disorders and neurodegenerative Diseases.
What are the models of PT and OT licensure portability in the USA
1. Mutual Recognition Compacts — This model is similar to being able to use a driver’s license issued in one’s own state in other states that have a legal agreement with this state.
2. Expedited License— This is a uniform application and credential verification that is stored and sent to the state that the license is required for.
3. Limited License— this will grant a license to an OT or PT in each state that will be limited in scope to the practice of telehealth across state lines.
4. National License— The OT and PT profession will be administered at the national level and based on a universal standard.
5. Federal Pre-emption— the federal government will grant licensure for inter-state practice of telerehabilitation.
Telemedicine is described as the delivery of healthcare services – diagnosis, consultation or treatment, through the use of interactive audio, video or other electronic media. Ready access to telecommunications technology is therefore transforming the delivery of care. This is why the following US states are planning to in introduce legislation that will make tele rehabilitation reimbursed:
Writing in the January edition of the BMJ Dr Salisbury – professor of primary healthcare and his colleagues Dr. Hall – lead for outpatient physiotherapy and Dr.Foster – professor of musculoskeletal health in primary care show that telephone assessment and advice services for patients with musculoskeletal problems is as clinically effective as usual care and provides faster access to physiotherapy. Therefore tele rehabilitation has the potential of providing timely access to physiotherapy (a problem in the National Health Service (NHS). In the UK General practitioners refer about 1.23 million patients for physiotherapy each year in the U.K. The referrals are mostly for lower limb, back, upper limb and cervical pain, respectively.
Arriving at the University Medical Center in Salt Lake City all the way from South Africa, the helicopter carrying Jeremy Clark landed noisily. Jeremy, a 23 year old college graduate had been on a Mormon religious mission for just a few weeks when he woke one morning to find that his legs were completely paralyzed. Doctors in S.A. were unable to find anything wrong with him medically.
Also not speaking made his examination process in Utah more difficult. Doctors were determined to get to the bottom of the problem and arranged for various tests to be performed. It was necessary to rule out diseases such as multiple sclerosis (ms); myasthenia gravis, a neuromuscular autoimmune disease that causes varying degrees of muscle weakness; Guillain-Barré syndrome, an acute condition associated with progressive muscle weakness and paralysis and stroke. A lumbar puncture to collect fluid from around the brain and inside the spinal cord had to be done to rule out infection.
Then a full medical examination was conducted. Jeremy was a healthy and physically fit young man and his heart, lungs, abdomen, neurological exam, muscle tone all acted in a normal fashion. He was able to move his head, neck and arms without a problem but his legs would not move at all. More surprising was the fact that tapping his legs with a rubber hammer showed that there was no damage to the nerve path between muscles and spinal cord.
A stroke was ruled out as that usually would have affected only one side of the body. A discussion with Jeremy’s parents ruled out drug use or mental health problems. A doctor involved in the case was wondering whether Jeremy was ”faking” his symptoms and finally the staff psychiatrist was called in for an evaluation.
After another neurological exam the psychiatrist came up with a diagnosis of ”conversion disorder”. He explained that conversion disorder is an unusual psychological state with symptoms that resemble a neurological disorder or another medical condition. It usually begins abruptly and begins with a mental conflict or emotional crisis. Then it “converts” to a physical problem that prevents the patient from being involved in the activity that was causing him stress. There are a relatively small number of cases reported per 100,000 people and it is more common in women. Beginning at almost any age it usually occurs between the ages of 11 and 35. Aside from paralysis it can also cause amnesia, blindness, motor tics and other ”symptoms”.Usually the disorder will disappear spontaneously after 2 weeks of hospitalization and in some cases a physical illness is discovered later.
Jeremy was told about his condition, reassured that there was no physical disability and that he would recover very soon. After further routine questioning Jeremy broke down and and stated that he could not continue with the mission he was sent on. He didn’t like talking about religion with people. He was reluctant to come home because he thought he would let his parents or God down . This caused him enormous stress. The doctor informed him that no one could force him to go back. The situation was explained to his parents who agreed to get involved in his therapy sessions and rehabilitation. Within days Jeremy was walking the halls and was discharged from the hospital after making a complete recovery from the paralysis.
When a disease or surgery causes an incomplete paralysis of a limb or joint the most effective physical therapy solution should be found. Fortunately, a recent innovation has created the TUTOR system of products known as the HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR. The TUTOR system was developed to allow intensive exercise practice to those who have incurred a stroke, brain/spinal cord injury, MS, CP, knee/hip surgery or other type of upper or lower limb disabling event.
The TUTORs consist of ergonomically comfortable gloves or braces that are strategically placed and contain sensors connected to sophisticated exercise game programs. Physical or occupational therapists record and monitor the progress made and then design a specific exercise regimen for that patient. The TUTOR system is now in use in leading U.S. and European hospitals and clinics. Fully certified by the FDA and CE they are available for use at home through telerehabilitation and can be used by adults and children from the age of 5 and up. See WWW.MEDITOUCH.CO.IL for further information.