Telerehabilitation is the application of telecommunication technology to provide distant support, assessment and intervention to individuals with disabilities (Ricker et al., 2002). It is not a new idea, but it really wasn’t until the last few years that technology supporting efficient visual and auditory communication between parties on either end of the camera has become widely available.
Thousands of people per year participate in medical telehealth visits currently. In many cases, this method is preferred by the doctor as well as the patient for not only convenience, but also to reduce the risk of patient
exposure to infectious disease while in the doctor waiting room. Of course this is for certain types of visits, which tend to be more straightforward, like a UTI or a sore throat.
The potential to apply telerehabilitation in the assessment, treatment and management of rural or underserved populations of people with disabilities, has been of interest to clinicians and researchers for many years. While there is an encouraging body of research to support the use of Telerehabilitation as a tool in the field of Complex Rehab Technology (CRT), specifically seating and mobility, acceptance and integration into practice and public policy has been somewhat limited.
The Immediate Need
There is a very specific reason to consider telerehab for the CRT population at this time. The onset of the Covid-19 pandemic has accelerated the need and the potential for adoption of a remote service delivery model for CRT in unprecedented ways.
CRT products are, by definition, medically necessary for individuals who require them and are therefore urgent in nature for the client.
The prescriptive process requires seamless collaboration between an interdisciplinary team of professionals including a Physician, Physical or Occupational Therapist and a Rehabilitation Technology Professional. Delaying or restricting access to these products or related services could be catastrophic, in terms of physical health, functional and mental health of an individual with a mobility impairment. Disruption of traditional service delivery models has many CRT professionals wondering how to collaborate remotely for the purpose of meeting the needs of the CRT consumer.
Telerehabilitation for CRT
Conceptually, the evaluation and fitting processes should remain consistent with established clinical best practice. Regardless of who is physically present with the client, the clinician maintains the responsibility of guiding and documenting the evaluation process, while the supplier’s role is to assist in the appropriate measurement, selection and fitting of equipment.
In speaking to clinical teams around the country who are engaging in remote evaluations, they suggest approaching it “like any other evaluation”. Roles do not change. A thorough screening of the client prior to evaluation, to gauge whether or not the client is appropriate for a remote evaluation is also suggested.
Highly complex clients cannot be thoroughly evaluated in this manner, although an evaluation could be initiated and followed up by a hands-on interaction at a later date.
The interview portion of the evaluation should largely remain unchanged from what is typical of a live client interaction.
The primary difference occurs in the capturing of objective measures when the clinician is remote and the Rehabilitation Technology Professional is present with client. Typical tests and measures may need to be captured in atypical ways.
The defined scope of practice of the Rehabilitation Technology Professional in this scenario, would prohibit the traditional execution of some tests and measures such as those grading strength or spasticity. While not necessarily as precise, much of this information can be adequately captured by the experienced clinician, through the guided remote observation of functional performance. For example, the therapist can ask the client to move their upper extremities through specific movements to observe active range of movement relative to an activity such as propelling a manual wheelchair. Again, this is not for every client and is not a replacement for hands on for more complex individuals.
Fitting and Problem Solving After the Fitting
Remote interactions with clients can extend the reach of the clinical team beyond what has typically been possible. One team in a Midwest seating clinic has been doing grant-based fittings and follow-up to fittings for a couple of years. They have stated that this allows them to have “eyes on” for clients who are far away, or for whom coming back to clinic poses a hardship. Additionally, other clinicians have stated that it offers them a unique opportunity to observe and record function within the client’s own environments.
The collective dogma of the CRT community is being challenged in terms of how to adapt to the disruption in our “traditional” service and delivery model in the face of a global pandemic. CRT services are critical to the population that requires them.
Telerehabilitation offers one promising solution in the short-term, and an intriguing array of possibilities, to potentially impact our model in the future.
If you have questions about telerehabilitation in CRT contact firstname.lastname@example.org
Barlow IG, Liu L,Sekulic A. Wheelchair seating assessment and intervention: A comparison between telerehabilitation and face-to-face service. International Journal of Telerehabilitation. 2009;1(1): 17-28. Doi: 10.5195/ijt.2009868
Ricker J, Rosenthal M, Garay E, DeLuca J, Germain A, Abraham-Fuchs K, et al. Telerehabilitation needs: A survey of persons with acquired brain injury. The Journal of Head Trauma Rehabilitation. 2002;17(3):242–250.
Schein, Richard Michael (2009) Evaluation of a Telerehabilitation Consultation Model for Remote Wheelchair Prescription. Doctoral Dissertation, University of Pittsburgh (Unpublished)
Schmeler MR, Schein RM, McCue M, Betz K. Telerehabilitation clinical and vocational applications for assistive technology: research, opportunities, and challenges. Int J Telerehabil. 2009;1(1):59–72. Published 2009 Sep 4. doi:10.5195/ijt.2009.6014
About the Author
Eric Grieb, OTR/L/ATP received his Bachelor of Science in Occupational Therapy from Colorado State University in 1992. He has worked in the clinical subspecialty of Seating and Wheeled Mobility for the last 27 years; both as an Occupational Therapist and as a supplier of Complex Rehabilitation Technology. Over the span of his 17 year career with Numotion Eric has filled the roles of ATP, Director of Clinical Education, Director of ATP Development Vice President of Sales and Vice President of Commercial Development. In these roles he has worked to develop and deliver an array of innovative, educational and sales imperatives.
About the Author
Susan Johnson Taylor, OTR/L Susan Johnson Taylor is an occupational therapist who has been practicing in the field of seating and wheeled mobility for 39 years primarily in the Chicago area at the Rehabilitation Institute of Chicago Wheelchair and Seating Center (now the Shirley Ryan Ability Lab). Susan has published and presented nationally and internationally and has consulted on product development for a variety of manufacturers. Susan is both a member and fellow with RESNA. She is currently a member of the Resna/ANSI Wheelchair Standards Committee and the Clinician’s Task Force. She is a Certified member of the International Society of Wheelchair Professionals. Susan joined the Numotion in 2015 and is the Director of Training and Education.