Demands for rehabilitation services, particularly in-home care and ... and cameras is provided with custom software developed specifically for the purpose.
Improving Telerehabilitation Technology to Challenge Chronic Disease Management Michel Tousignant, Simon Brière, Mathieu Hamel, and Catherine Pagé Chair of telerehabilitation Research Centre on Aging, Sherbrooke Geriatric University Institute, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec {michel.tousignant,simon.briere,mathieu.hamel2, catherine.page}@usherbrooke.ca
Abstract. Demands for rehabilitation services, particularly in-home care and outpatient clinics, are increasing and are difficult to meet. In-home telerehabilitation is growing as a complement or alternative to face-to-face therapy. The technological aspect of telerehabilitation is in constant evolution and is central to a high quality and efficient way for rehabilitation delivery. The aim of this presentation is to demonstrate technological innovations used “inhome” with the telerehabilitation platform over the years (generations 1 and 2 of the technological infrastructure). The improvements made from the first to the second generation partly implied the use of external sensors to allow a real time follow-up of clinical parameters. These changes have permitted research and new studies to target new populations for teletreatment. Keywords: Telerehabilitation, Technological environment, Platform.
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Introduction
In-home telerehabilitation, defined as the provision of remote rehabilitation services to individuals with persistent and significant disabilities via information technologies and telecommunications in their home [1], is growing as a complementary or alternative intervention to traditional face-to-face therapy for in-home care and outpatient services. The rationale for in-home telerehabilitation is to expand and facilitate the delivery of rehabilitation services to people who cannot access them due to either a shortage of health care professionals or a lack of access to services, long waiting lists for home care services or problems getting to and from the clinic [2]. Contrary to teleconsultation which provides diagnosis and evaluation services, clinical care services provided via in-home telerehabilitation encompass active treatment and follow-up [3]. To ensure the quality of the rehabilitation and allow this novel method to deliver accessible services to as many populations as needed, with either acute or chronic diseases, the technological environments should be in constant evolution. The main purpose of this presentation is to show technological innovations used inhome with the telerehabilitation platform in order to consider physiological parameters in the teletreatment of chronic obstructive pulmonary disease (COPD). M. Donnelly et al. (Eds.): ICOST 2012, LNCS 7251, pp. 238–241, 2012. © Springer-Verlag Berlin Heidelberg 2012
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Technological Infrastructure for Telerehabilitation Services
2.1
The First Generation of the Technological Infrastructure: Dealing With Acute Diseases
Based on experience from the past 10 years, a telerehabilitation platform was developed to deal with post-surgery patients (post-arthroplasty) who returned home after short-term hospitalization stays and needed rehabilitation in a short delay [4-6]. While being similar in many ways, two different systems were used to provide telerehabilitation services: an “in-home” system and a clinician system. The telerehabilitation platform for both systems is illustrated in Fig 1. The core of these systems is a videoconferencing system (Tandberg 550 MXP), which uses a h.264 video codec and integrates a pan-tilt-zoom (PTZ) wide angle camera combined with an omnidirectional microphone. The system is mounted over a 20-inch LCD screen, which displays the video received from the other end. Audio is played using external speakers placed on both sides of the screen. Video and audio data were encrypted and transmitted over a residential high-speed internet connection, allowing communication over a maximum bandwidth of 512 kbps in both directions. The system was also resilient to packet loss and ensured that audio and video were correctly synchronized.
Fig. 1. First generation telerehabilitation systems. Components of both systems are: A) videoconferencing system, B) LCD screen, C) router and modem connecting to the internet, D) clinician computer and screen display.
On the clinician’s side, a similar videoconference and network setup are used. However, since the clinician needs to have control over the session and cameras, a dual display computer replaces the LCD screen used at home. The control of sessions and cameras is provided with custom software developed specifically for the purpose of conducting such sessions. The platform was developed to ensure that interactions between clinicians and clients during the telerehabilitation sessions were not impeded by technology, but facilitated with user-friendly interfaces such as providing an intuitive control on both PTZ cameras (home, clinician), as described in Fig 2.
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Fig. 2. Camera control. The camera control is entirely done with a mouse. On a click, the camera centers on that point. In A), the users select an area with the mouse and release the mouse button. The camera moves and centers on the area shown in B.
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Second Generation of Technological Infrastructure: Dealing with Chronic Diseases
The first generation system was efficient in providing teletreatment to a population with acute diseases. However, teletreatment of chronic diseases such as COPD requires the follow-up of some clinical parameters in real time : oxygen saturation and heart rate. In order to allow connection of such external sensors, the LCD screen used in the first generation system was replaced with a 25.5-inch Touchsmart embedded computer. Sensory data is received and processed by the in-home computer, displayed on the patient’s screen and sent over the Internet connection, providing a real-time display of the sensors to the clinician. The second generation of the telerehabilitation platform and software interface for both systems are illustrated in Fig 3. Currently, only an oxymeter is used with COPD patients, but the addition of an in-home computer allows the connection of other sensors such as respiratory belts, instrumented soles and inertial measurement units that could provide further information such as respiratory frequency, center of pressure and anatomical angles. Bandwidth used by these sensors varies according to their number, type and sampling rate. The oxymeter is currently sampled at 1 Hz and uses under 0.1 kbps, making it negligible compared to video bandwidth. The patient can also use the system during offline sessions to complete exercises or to watch informative presentations on COPD using a touch screen.
Fig. 3. Second Generation of the Telerehabilitation Platform. Components of both systems are: A) videoconferencing system, B) embedded computer with a touch screen, C) microphone and speakers, D) video and sensors display.
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This second generation is already used in actual teletreatments. In fact, results of a pilot study on COPD is now published [7]. The main conclusion is that teletreatment seems to be a practical way, both clinically and technically, to dispense rehabilitation services for patients with COPD.
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Conclusion
The research has shown that the use of a residential Internet connection is sufficient for in-home teletreatment considering the new possibilities offered by the second generation of the telerehabilitation platform. The use of external sensors, like the oxymeter, is promising and did not add any additional constraints. They seem to be appreciated by both the clinicians and the patients. Although more complex and a bit difficult to move, the use of a computer on the patient’s side of the platform increased the possibility to follow by live transmission some physiological parameters essential for patients at risk of acute problems during the teletreatment sessions. In the future, other sensors will be incorporated in the platform depending on the populations and clinical needs (ergocycle, blood pressure, range of motion and force measurement).
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