TeleHealth and TeleRehabilitation

Telehealth delivers health consultations using telecommunication and technology which may be in the form of telephone or video conferencing.  It can also involve the computerised monitoring of vital signs, ECG, etc.  It has been a medium for health consultation for a while.

It is the only accessible mode of health service delivery for people living in rural and remote regions or those who are simply unable to get out of their home requiring specialised consultations.  However, with the rise of Covid19, it may be a mode of choice for service delivery to those who are elderly, immunosuppress.

Technology has improved at such a rapid rate that we are now able to accomplish a lot more remotely.  Examples in our day-to-day practice include being able to monitor compliance to home program using a smartphone App, send personalised videos of exercises demonstrated by the clients themselves, set up the monitoring of wandering dementia clients’ for their family, online consultations, etc.

Being a team that delivers many hands-on therapy services including physiotherapy, massage therapy and podiatry, it can be difficult for therapists to conceive how that online consultation or telerehabilitation could work.

I spoke to a speech pathologist who has extensive telehealth experience through working for the UQ telehealth service and these are her comments.

  • “There is increasing evidence being published every day regarding its effectiveness.”
  • “We need to be flexible about the way things are done.”
  • “I have experienced great effectiveness in my clientele.”
  • “Sometimes the lens may be flipped, and it may be hard for you to work out what is the client’s left or right side.”

 


 

Covid19 in Australia – a change in service delivery

Dated 13/3/20

telehealth coronavirus

Growing up in Hong Kong in the 80s, I have vivid memories of restaurants preparing ducks in an alley next to an industrial wastewater drain, hawker stalls selling pre-cooked food that is left out in the open, spitting in the open is not uncommon…    Since SARS in early 2000, Hong Kong has become a hypervigilant cleanliness conscious city, wearing a mask is an accepted norm, sneezing and coughing in public is frowned upon….

Here in Australia, the rise of Covid19 may be a wake-up call for some of us who have previously been less vigilant about hand hygiene, not always getting the flu vaccination, or soldiering on to work even when we are feeling unwell.  With more prominent people being infected including world-renowned Australian classical music composer, Brett Dean, and our Minister for Home Affairs, Peter Dutton, it is understandable that people are prompted to panic buy masks, toilet rolls, rice and pasta!

Locally as a therapy team, apart from joking about running out of toilet rolls at home, we have had to consider seriously about providing services differently.  And without even promoting it, in the last 2 weeks, we have completed more online consultations than in the last 10 years put together.  This is likely to be on the increase.

 


 

What do you need to deliver online consultation or telerehabilitation?

telehealth video conference on tablet with speech therapist

One doesn’t need a state of the art telecommunication technology to have online consultation or telerehabilitation.  It can be as simple as having a telephone line and speaking to your therapist.  Your experienced therapists will ask you key questions to enable you to describe your issues.  Appropriate advice may be rendered through a good interview.  I have recently attended an NDIS review meeting with the local area coordinator, NDIS support coordinator and the participant at his residential home, while his nominee dialled in.

If you are more tech-savvy, you can consider doing video calls with your therapist.  Face-time, video calls on WhatsApp and skype are all free as long as you are connected to the internet.  These applications also allow you to connect with 2 or more remotely located people/professionals.

As a therapy team, we have recently started using Zoom for online consultations and telerehabilitation because it allows video conferencing with multiple people and screen sharing.   You can run Zoom via a desktop or a mobile device.  For example, we have been working with the son of an NDIS participant who has early onset dementia through this medium of consultation.  Screen sharing and video touring of the home have all been handy tools.  As such, the therapist is able to work with the son on setting a consistent routine, refining the use of appropriate verbal and non-verbal cues and environmental prompts that can be implemented by the support worker with the objective that the support worker may be like a “trainer” for the participant rather than a replacement to her loss of independent function.

Another example was the setting up of an online Speech Pathology consultation with a lady who was concerned that she may be exposed to possible infections because she was assisted by a personal hygiene carer who had a runny nose and was sneezing.

 


 

What may be the pros and cons of telerehabilitation or online consultation?

telerehabilitation - woman doing stretching

There are some obvious restrictions for My Rehab Team therapists when operating online.  For instance, it is pretty difficult to do a massage, manage someone’s toenails, check someone’s tongue mobility and swallowing ability, listen to someone’s chest through live video or phone calls.  There are also copyright clinical tools for Speech Pathology that can not be shared electronically when being used.

Despite these, there are lots of things one can do online.  Being a more novel mode of service delivery, one does need to think outside of the box.  For example, it is possible to deliver a vast amount of traditional dietetics and speech interventions online.

As for an occupational therapist, it is possible to do a live tour of a home through a video live and photos.  For the physiotherapist or podiatrist, someone’s gait may be even better observed through a video recording which allows replay and slow motion.  A majority of education and advice may be provided through video or phone conferencing as well.

In terms of the technicalities, having a good internet connection is essential if you are using an internet-based method.   Some conferencing programs are most stable than others, giving better video resolution and clearer sound.  Zoom, for example, is the most popular one being used today for this reason.

When doing video conferencing, there are little quirks that are worthy of note as well.  Someone, please tell me why, sometimes, the screen is flipped so that left and right are swapped around!  It gets confusing with left and right on video anyway.  What about people who hate seeing themselves on the screen?  I just found out that Zoom allows people to touch up their appearance when conferencing online.  I hope that health professionals are not so self-conscious to go to that level of ridiculousness.

Fun facts aside, it is totally possible to share lots of online resources through the share screen or sending a link to watch a youtube video demonstration.  The sky is the limit when it comes to resources to provide our clients through an online channel and being able to run through these resources live to ensure effective appropriation by the client.

 


 

Frequently Asked Questions

It is amazingly easy to complete a Functional Capacity assessment online. The initial interview can be done via telephone or video consultation with the client and/or relevant others.

Client’s care support can assist in providing relevant video, photos, and measurements to enable us to do the assessment as if we have visited them.  A video conference also allows the therapist a dynamic view of the layout of the home.

Ideas for therapy and assistive technology solutions may be illustrated through shared videos and photos.

Yes

Send a request through our website or shoot us an email or give us a call.

Yes.

We take Credit Card and Direct Debit payment.

Sorry, we don’t deliver a weekend service.

No.

If you are using online programs, yes. However, you may opt to have telephone consultations which is no.

You can use a computer or a smart device or simply a phone.

As long as you wish.

Yes, there are copious amount to show efficacy.

This depends on what interventions are required. You can discuss this directly with your therapist. Language training, dietetics consultation, gait training, cognitive training, subjective part of vestibular assessment, even exercise training can all be conducted online.

No, your therapist will set up the call and send you a link that you can use. You are advised to be ready 10 minutes before the consultation so that if there are any connections concerns, the therapist will call you on your phone to resolve these or conduct the consultation on the phone instead.

Yes. This is because our therapists are always on the road. To conduct an online consultation, they will still need to travel back to the office.

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Telerehabilitation after a stroke?

Cochrane collaboration has recently reviewed 22 studies involving nearly 2000 people after a stroke and compared the therapeutic outcome of those who received telerehabilitation versus face-to-face therapy versus no therapy.  The therapy interventions were aimed at improving arm function, the ability to walk, and providing counselling support for people upon leaving the hospital after a stroke.  It was found that there was low to moderate quality evidence to support that telerehabilitation is more or similarly effective to face-to-face therapy.

Telerehabilitation has not been shown to be inferior to face-to-face therapy.  There are no serious adverse effects caused by telerehabilitation.  Telerehabilitation is an emerging field that requires more research to enable the drawing of a more definitive conclusion.

 


 

My Rehab Team provides telerehabilitation for stroke in disciplines including Physiotherapy, Occupational Therapy and Speech Pathology. If you would like to find out more please call us on 1300 469 734 or email us.

Reference:
Laver, E.L., Adey-Wakeling, Z., Crotty, M., Lannin, N.A., George, S., Sherrington, C. (2020) ‘Telerehabilitation services for stroke.’,  Cochrane Database of Systematic Reviews.  https://www.cochrane.org/CD010255/STROKE_telerehabilitation-services-stroke