Andi Saptono

VISYTER: Versatile and Integrated System for Telerehabilitation

The versatile and integrated system for telerehabilitation (VISYTER) is a software platform for developing various telerehabilitation applications. VISYTER has been designed to take into account the environments and requirements of rehabilitation services. The requirements considered in the platform design include minimal equipment beyond what is available in many rehabilitation settings, minimal maintenance, and ease of setup and operation. In addition, the platform has been designed to be able to adjust to different bandwidths, ranging from the very fast new generation of Internet to residential broadband connections. VISYTER is a secure integrated system that combines high-quality videoconferencing with access to electronic health records and other key tools in telerehabilitation such as stimuli presentation, remote multiple camera control, remote control of the display screen, and an eye contact teleprompter. The software platform is suitable for supporting low-volume services to homes, yet scalable to support high-volume enterprise-wide telehealth services. The VISYTER system has been used to develop a number of telerehabilitation applications, including a remote wheelchair prescription, adult autistic assessments, and international physical therapy teleconsultations. An evaluation of VISYTER for delivering a remote wheelchair prescription was conducted on 48 participants. Results of the evaluation indicate a high level of satisfaction from patients with the use of VISYTER. The versatility and cost-effectiveness of the platform has the potential for a wide range of telerehabilitation applications and potentially may lower the technical and economic barriers of telemedicine adoption.

Telerehabilitation Wheeled Mobility and Seating Assessments Compared With In Person

OBJECTIVE To evaluate the equivalency of wheeled mobility and seating assessments delivered under 2 conditions: in person (IP) at a local clinic and via Telerehabilitation at remotely located clinics. DESIGN The study used a prospective, multicenter controlled nonrandomized design to investigate wheeled mobility and seating assessments. SETTING Five wheelchair clinics in Western Pennsylvania. PARTICIPANTS Participants (N=98) in need of new wheeled mobility and seating were recruited and consented for IP assessments at the Center for Assistive Technology (n=50) and Telerehabilitation (n=48) assessments at remotely located clinics. INTERVENTIONS The telerehabilitation condition used a custom videoconferencing system to connect a wheeled mobility and seating expert at the University of Pittsburghs Rehabilitation Engineering Research Center on Telerehabilitation to a remote clinic. MAIN OUTCOME MEASURES Study findings were based on the level of function the participants showed with their new wheeled mobility and seating devices as measured by using the Functioning Everyday with a Wheelchair (FEW) outcome tool. RESULTS The results revealed no significant differences between the FEW pretest average or item scores for the 2 conditions or the FEW posttest average or item scores except for the FEW transportation item. The average FEW and FEW item scores reached the established clinically relevant pretest-posttest difference of 1.85, and the change scores were significantly different. The difference between FEW means based on posttest confidence intervals indicated that telerehabilitation was equally effective as IP rehabilitation. CONCLUSIONS An expert practitioner located at least 125 miles away from each of the remote sites used a secured videoconferencing system to consult from a geographic distance on wheeled mobility and seating evaluations via telerehabilitation. Compared with participants receiving standard IP care, the telerehabilitation treatment condition was equally effective on all but 1 outcome.

An Integrated Telehealth System for Remote Administration of an Adult Autism Assessment

We developed a telehealth system to administer an autism assessment remotely. The remote assessment system integrates videoconferencing, stimuli presentation, recording, image and video presentation, and electronic assessment scoring into an intuitive software platform. This is an advancement over existing technologies used in telemental health, which currently require several devices. The number of children, adolescents, and adults with autism spectrum disorders (ASDs) has increased dramatically over the past 20 years and is expected to continue to increase in coming years. In general, there are not many clinicians trained in either the diagnosis or treatment of adults with ASD. Given the number of adults with autism in need, a remote assessment system can potentially provide a solution to the lack of trained clinicians. The goal is to make the remote assessment system as close to face-to-face assessment as possible, yet versatile enough to support deployment in underserved areas. The primary challenge to achieving this goal is that the assessment requires social interaction that appears natural and fluid, so the remote system needs to be able to support fluid natural interaction. For this study we developed components to support this type of interaction and integrated these components into a system capable of supporting the entire autistic assessment protocol. We then implemented the system and evaluated the system on real patients. The results suggest that we have achieved our goal in developing a system with high-quality interaction that is easy to use.

Development of a Service Delivery Protocol Used for Remote Wheelchair Consultation via Telerehabilitation

The purpose of this paper is to explain the development, methodology, and implementation of an assistive technology (AT) service delivery protocol using a telerehabilitation consultation model for evaluation of remote wheelchair prescriptions. The provision of wheeled mobility and seating interventions can be complex when considering people with intricate seating and positioning needs, environmental factors, and wide array of product interventions. The availability of qualified practitioners with specialty expertise in this area is limited, especially outside of urban areas. Therefore, people are potentially isolated from rehabilitation services due to geography or physical limitations. A repeated measure study design is used to evaluate the service delivery protocol measured by the effectiveness of wheeled mobility and seating interventions provided in a remote location by a generalist occupational and/or physical therapy practitioner with consultation from an expert therapist via interactive teleconferencing. Effectiveness is measured by magnitude of change and scored by pre and post scores of the Functioning Everyday with a Wheelchair (FEW) outcome measure tool. Two model programs have been specified and are currently implementing the service delivery protocol. The live interaction has enabled remote therapists the ability to exchange personal and health information to experts in the field from an urban facility. The impact of this service delivery protocol will be augmented as it is to be launched and replicated in three additional sites. Telerehabilitation is a new field that can only be measured by its long-term impact; however, its success can be looked at by its development and implementation into everyday clinical service delivery.

Accessibility Transformation Gateway

We developed a transcoder gateway that is designed to transform any website on the fly and to adapt the website to the users preference and limitations. The gateway applies accessibility rules during transformation to lift accessibility barriers from a webpage. We report both the results of a pilot study and a usability study of visually-impaired users utilizing the gateways.

Evaluation of a Telerehabilitation System for Community-Based Rehabilitation

The use of web-based portals, while increasing in popularity in the fields of medicine and research, are rarely reported on in community-based rehabilitation programs. A program within the Pennsylvania Office of Vocational Rehabilitation’s Hiram G. Andrews Center, the Cognitive Skills Enhancement Program (CSEP), sought to enhance organization of program and participant information and communication between part- and full-time employees, supervisors and consultants. A telerehabilitation system was developed consisting of (1) a web-based portal to support a variety of clinical activities, and (2) the Versatile Integrated System for Telerehabilitation (VISYTER) video-conferencing system to support the collaboration and delivery of rehabilitation services remotely. This descriptive evaluation examines the usability of the telerehabilitation system incorporating both the portal and VISYTER. Telerehabilitation system users include CSEP staff members from three geographical locations and employed by two institutions. The IBM After-Scenario Questionnaire (ASQ) and Post-Study System Usability Questionnaire (PSSUQ), the Telehealth Usability Questionnaire (TUQ), and two demographic surveys were administered to gather both objective and subjective information. Results showed generally high levels of usability. Users commented that the telerehabilitation system improved communication, increased access to information, improved speed of completing tasks, and had an appealing interface. Areas where users would like to see improvements, including ease of accessing/editing documents and searching for information, are discussed.

Telerehabilitation assessment using the Functioning Everyday with a Wheelchair-Capacity instrument

This study explored the interrater reliability between a generalist practitioner administering the Functioning Everyday with a Wheelchair-Capacity (FEW-C) in person (IP) and a remote expert practitioner observing via telerehabilitation (TR) from more than 100 miles away. Each of the 46 participants was simultaneously rated by both the IP and TR practitioner, who were masked to each others results. The IP-TR raters demonstrated excellent interrater reliability, with an intraclass correlation coefficient of 0.91 for the total FEW-C and 0.96, 0.88, and 0.90 for the constructs of independence, safety, and quality, respectively. Internal consistency (Cronbach alpha) was 0.94 for the total FEW-C tool and 0.91, 0.83, and 0.82 for independence, safety, and quality, respectively, indicating good internal consistency without redundancy. Using TR and the FEW-C, an expert practitioner more than 100 miles away was able to accurately assess the functional mobility needs of clients being assessed for new wheeled mobility devices.

Secure Telemonitoring System for Delivering Telerehabilitation Therapy to Enhance Children’s Communication Function to Home

A secure telemonitoring system was developed to transform CosmoBot system, a stand-alone speech-language therapy software, into a telerehabilitation system. The CosmoBot system is a motivating, computer-based play character designed to enhance childrens communication skills and stimulate verbal interaction during the remediation of speech and language disorders. The CosmoBot system consists of the Mission Control human interface device and Cosmos Play and Learn software featuring a robot character named Cosmo that targets educational goals for children aged 3-5 years. The secure telemonitoring infrastructure links a distant speech-language therapist and child/parents at home or school settings. The result is a telerehabilitation system that allows a speech-language therapist to monitor childrens activities at home while providing feedback and therapy materials remotely. We have developed the means for telerehabilitation of communication skills that can be implemented in childrens home settings. The architecture allows the therapist to remotely monitor the children after completion of the therapy session and to provide feedback for the following session.

Transcoding Biomedical Information Resources for Mobile Handhelds

We developed a transcoder gateway that transforms web pages on the fly. The transcoder adapts the pages to the limitation of the users device, especially the small screen of PDAs and smart phones. We developed novel template-matching algorithms to detect the structure of a webpage and to match the structure with a known template in the template library. Transformation rules such as summarization can then be applied to the template to make reading full-text documents in small screen devices more usable. Our current project focuses on transcoding full-text biomedical information resources (such as full-text biomedical journals) to support mobile healthcare professionals.

The VISYTER Telerehabilitation System for Globalizing Physical Therapy Consultation: Issues and Challenges for Telehealth Implementation

Background and Purpose. There are substantive issues to address in physical therapist education programs facing obstacles related to faculty funding for educational endeavors, identification of optimal pedagogies, and consideration of global and national health concerns. Educational technologies may serve as tools to expand the delivery of high‐quality, efficient health care education to address current, evolving, and future needs of physical therapist students and the patients they will serve. The purpose of this case report is to describe the Versatile and Integrated System for Telerehabilitation (VISYTER) and its use for physical therapy telehealth consultation in an international setting, as well as its use to measure patient satisfaction and explore provider perspectives on the experience. Case Description. Three pediatric patients, 1 male and 2 females, with a mean age of 5 years (SD=3), and located in Mexico, participated in a telehealth session with academic and clinical faculty in the United States using the VISYTER telerehabilitation system. A patient satisfaction survey and user perspectives were collected and analyzed. Key themes were identified from semi‐structured interviews with patients, family members, and health care providers. Outcomes. Patient satisfaction was high for utilizing the VISYTER telerehabilitation system. A key theme was that technology‐assisted collaboration between the health care team members and patients may further education, research, and practice in Mexico and the United States. Discussion and Conclusion. Several challenges must be addressed when considering telehealth implementation internationally. Overall, the VISYTER telerehabilitation software, using lowbandwidth Internet connections (384 kbps) and aggressive compression with low resolution (320 x 240), allowed for a stable telehealth physical therapy consultation between Mexico to the United States.