Telerehabilitation Clinical and Vocational Applications for Assistive Technology: Research, Opportunities, and Challenges

Rehabilitation service providers in rural or underserved areas are often challenged in meeting the needs of their complex patients due to limited resources in their geographical area. Recruitment and retention of the rural clinical workforce are beset by the ongoing problems associated with limited continuing education opportunities, professional isolation, and the challenges inherent in coordinating rural community healthcare. People with disabilities who live in rural communities also face challenges accessing healthcare. Traveling long distances to a specialty clinic for necessary expertise may be troublesome due to inadequate or unavailable transportation, disability specific limitations, and financial limitations. Distance and lack of access are just two threats to quality of care that now being addressed by the use of videoconferencing, information exchange, and other telecommunication technologies that facilitate telerehabilitation. This white paper illustrates and summarizes clinical and vocational applications of telerehabilitation. We provide definitions related to the fields of telemedicine, telehealth, and telerehabilitation, and consider the impetus for telerehabilitation. We review the telerehabilitation literature for assistive technology applications; pressure ulcer prevention; virtual reality applications; speech-language pathology applications; seating and wheeled mobility applications; vocational rehabilitation applications; and cost effectiveness. We then discuss external telerehabilitation influencers, such as the positions of professional organizations. Finally, we summarize clinical and policy issues in a limited context appropriate to the scope of this paper. Keywords: Telerehabilitation, Telehealth, Telemedicine, Telepractic

Some Reflections on Designing Effective Social Telerehabilitation Services for Older Adults

The share of the population aged 65 years and over is increasing in every EU Member State, candidate country, and EFTA Member State. WHO/Europe has established a Subnetwork on Healthy Ageing within the European Healthy Cities Network and provides guidance to Member States in developing profiles of healthy ageing, since, given the increasing number of older adults, maintaining their health status is a crucial issue.  This article, which is part of the Latvian national scientific program VPP INOSOCTEREHI, focuses on the issues related to the design, implementation, and assessment of user interfaces that can maximize usability in social telerehabilitation systems for older adult users. This is a very real challenge, since older adults don’t form a homogeneous class. Investigating older adults’ skills and their attitudes towards the perceived usefulness of computer applications could be helpful in identifying some sub-sets of older adult users and their typical behaviours

Telerehabilitation: Policy Issues and Research Tools

The importance of public policy as a complementary framework for telehealth, telemedicine, and by association telerehabilitation, has been recognized by a number of experts. The purpose of this paper is to review literature on telerehabilitation (TR) policy and research methodology issues in order to report on the current state of the science and make recommendations about future research needs. An extensive literature search was implemented using search terms grouped into main topics of telerehabilitation, policy, population of users, and policy specific issues such as cost and reimbursement. The availability of rigorous and valid evidence-based cost studies emerged as a major challenge to the field. Existing cost studies provided evidence that telehomecare may be a promising application area for TR. Cost studies also indicated that telepsychiatry is a promising telepractice area. The literature did not reference the International Classification on Functioning, Disability and Health (ICF). Rigorous and comprehensive TR assessment and evaluation tools for outcome studies are tantamount to generating confidence among providers, payers, clinicians and end users. In order to evaluate consumer satisfaction and participation, assessment criteria must include medical, functional and quality of life items such as assistive technology and environmental factors. Keywords: Telerehabilitation, Telehomecare, Telepsychiatry, Telepractic

An engineering approach to business model experimentation – an online investment research startup case study

Every organization needs a viable business model. Strikingly, most of current literature is focused on business model design, whereas there is almost no attention for business model validation and implementation and related business model experimentation. The goal of the research as described in this paper is to develop a business model engineering tool for supporting business model management as a continuous design, validation and implementation cycle. The tool is applied to an online investment research startup in roll out and market phase. This paper describes the research as performed in a case study setting by focusing on the design, implementation and evaluation of the business model engineering tool. We also analyze the actual implementation and usage of the business model tool by the online investment research startup by focusing on the most critical actions related to actual business model implementation – i.e. actions with so-called ‘Lollapalooza tendencies’

Insight into the Digital Health System of Ukraine (eHealth): Trends, Definitions, Standards, and Legislative Revisions

Purpose. This article aims to provide an in-depth examination of the digital health system of Ukraine, focusing on the emerging trends, precise definitions, established standards, and recent legislative revisions that shape the practice and implementation of eHealth solutions within the country. Background. The digital health landscape in Ukraine has witnessed significant transformations, especially in the wake of the COVID-19 pandemic and subsequent military conflicts. These events have catalyzed the expansion of telemedicine services, leading to innovative approaches in healthcare delivery. The national strategy underscores the necessity for human-centric and accessible telemedicine, reinforced by technological neutrality, and harmonization with global standards. Methods. A review of the current literature, national strategies, and legal documents was conducted, alongside an analysis of data usage and service provision patterns in various Ukrainian regions. Participation in the "Science for Safety and Sustainable Development of Ukraine" competition facilitated project initiatives like the development of a cloud-based platform for patient-centered telerehabilitation for oncology patients. Findings. The utilization of telemedicine has significantly increased in conflict-affected regions, demonstrating the need for, and the effective deployment of, digital health strategies under crisis conditions. Private health facilities and entrepreneurs have been pivotal in the provision of telemedicine services. Legislative efforts have been geared toward framing telemedicine as an integral component of the national eHealth system, ensuring interoperability, and aligning with international standards and the Internet of Medical Things (IoMT). Interpretation. The findings underscore the resilience and adaptability of the Ukrainian healthcare system in the face of adversity. There is a clear trend towards a more integrated, patient-focused, and technologically advanced healthcare model, aligning with international trends and prioritizing public health goals over private profits. This progress, however, is contingent upon continuous development, investment in technological infrastructure, and legislative support to sustain and advance digital health initiatives

Development of an Integrated Telerehabilitation Information Management System to Support Remote Wheelchair Prescription

Information technology (IT) is central in providing Telerehabilitation (TR), which enables people with disabilities access to limited number of qualified practitioners with specialty expertise, especially at rural areas. Prior to 2008, most TR utilized non-integrated IT systems to provide its basic infrastructure. Using this approach, data management has to be done manually over multiple non-integrated systems, increasing the possibility of outdated or missing data. An integrated system that is open, flexible, extensible, and cost-effective was designed and developed as a solution to mitigate this problem. The work described in this dissertation elaborates the process of developing such system, called the Versatile and Integrated System for Telerehabilitation (VISYTER). VISYTER was intended to become a platform that is capable of delivering any TR, and was first used to support Remote Wheelchair Prescription (RWP), a TR effort to support clinicians in rural Pennsylvania to prescribe wheeled mobility and seating devices. The development process of VISYTER consisted of three main phases: identification and verification of requirements, validation, and evaluation. The requirement identification and verification phase involved a group of expert clinicians from RWP with the purpose of identifying the requirement of the system to support RWP: a system that can provide real-time teleconsultation and documentation support for prescribing a wheeled mobility intervention. Validation studies were conducted with help from ten individuals, including physicians, clinicians, and suppliers participated to validate VISYTER in their workplaces. All participants agreed that VISYTER can be used to properly support both the teleconsultation and documentation phase of RWP. Afterward, the usability of VISYTER was evaluated through a comparison study with a commonly utilized videoconferencing system in TR, POLYCOM. Twenty-six clinicians participated in a counterbalanced experimental study to measure the difference in usability for completing client assessment tasks using both systems. The study found VISYTER to be more efficient and less prone to error when compared to POLYCOM. Based on these findings, the study concluded that an integrated system could improve the usability TR delivery when compared to non-integrated systems approach

A wireless posture monitoring system for personalized home-based rehabilitation

We live in an aging society, an issue that will be exacerbated in the coming decades, due to low birth rates and increasing life expectancy. With the decline in physical and cognitive functions with age, it is of the utmost importance to maintain regular physical activity, in order to preserve an individual’s mobility, motor capabilities and coordination. Within this context, this paper describes the development of a wireless sensor network and its application in a human motion capture system based on wearable inertial and magnetic sensors. The goal is to enable, through continuous real-time monitoring, the creation of a personalized home-based rehabilitation system for the elderly population and/or injured people. Within this system, the user can benefit from an assisted mode, in which their movements can be compared to a reference motion model of the same movements, resulting in visual feedback alerts given by the application. This motion model can be created previously, in a ‘learning phase’, under supervision of a caregiver.Project “AAL4ALL”, co-financed by the European Community Fund FEDER through COMPETE – Programa Operacional Factores de Competitividade (POFC). This work is funded by FEDER funds through the COMPETE 2020 Programme and National Funds through FCT - Portuguese Foundation for Science and Technology under the projects UID/CTM/50025/2013 and UID/EEA/04436/2013.info:eu-repo/semantics/publishedVersio