Living in a small country town, John, a 49-year-old owner of a hardware store, found that his capacity to return to his everyday life was significantly restricted following his stroke. John's aphasia and difficulties with walking, balance, and the use of his right arm and hand made it impossible for him to manage his hardware business unassisted. Access to the in-person rehabilitation services at the tertiary hospital where he was managed when he had his stroke was difficult due to distance, his physical and communication difficulties, and his need to continue to work. However, on discharge from the center-based rehabilitation unit, John transitioned to the hospital's home-based telerehabilitation program that enabled him to continue to access physical therapy, speech pathology, occupational therapy, psychology, and social work services. Using specialty telerehabilitation software on his iPad, John's rehabilitation team could assess his progress, provide interventions to maximize his function and independence, modify and progress his physical and speech exercise regimen, and provide education and support from a distance. These services were critical for John to remain in his community and support his family.
Telerehabilitation, “the delivery of rehabilitation services by information and communication technologies” 1 at a distance, offers a plausible alternative or supplement to center-based rehabilitation services. For patients with conditions associated with stroke, head and spinal injury, progressive neurological disorders, musculoskeletal disorders, and respiratory and cardiac disease, long-term rehabilitation is often required to restore function, regain everyday skills, and maintain an acceptable quality of life. The ease of access and timely intervention facilitated by telerehabilitation promotes a client-centered approach along a continuum of care.
Although “telerehabilitation” is the umbrella term adopted to denote technology-enabled rehabilitation and is used by some professional groups, 2 there is diversity in terminology across disciplines. For example, the broader term of “telepractice” is used by speech-language pathologists, 3,4 “telehealth” is used by the American Physical Therapy Association, 5 and other terms have been used to denote a specific discipline such as “telepsychology.” 6
NATURE OF TELEREHABILITATION
Telerehabilitation is distinctly different from conventional telemedicine consultations with respect to the range of health professionals involved, the frequency and type of interactions that occur with a single patient, the service settings, and the variety and utility of technologies that may be used across the continuum of care. A broad range of health professionals, including physical therapists, occupational therapists, speech-language pathologists, psychologists, audiologists, teachers, rehabilitation engineers, dieticians, rehabilitation physicians, and nurses, can be involved in telerehabilitation. 1 The services that can be provided via telerehabilitation are extensive and include education to the patient and family, counseling, assessment, intervention, ongoing monitoring, and offline self-management programs. 1 Interdisciplinary rehabilitation can also be supported by telerehabilitation through multipoint real-time videoconferencing.
The types of interactions between the client and health professional in telerehabilitation consist of a variety of intervention schedules and different types of exchanges, activities, and technologies. These include intensive and distributed ...