Richard M. Schein

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.

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.

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.

The Voice of the Consumer: A Survey of Veterans and Other Users of Assistive Technology

Introduction A total of 3.6 million Americans and over 250,000 veterans use wheelchairs. The need for advancements in mobility-assistive technologies is continually growing due to advances in medicine and rehabilitation that preserve and prolong the lives of people with disabilities, increases in the senior population, and increases in the number of veterans and civilians involved in conflict situations. The purpose of this study is to survey a large sample of veterans and other consumers with disabilities who use mobility-assistive technologies to identify priorities for future research and development. Materials and Methods This survey asked participants to provide opinions on the importance of developing various mobility-assistive technologies and to rank the importance of certain technologies. Participants were also asked to provide open-ended comments and suggestions. Results A total of 1,022 individuals, including 500 veterans, from 49 states within the USA and Puerto Rico completed the survey. The average age of respondents was 54.3 yr, and they represented both new and experienced users of mobility-assistive technologies. The largest diagnostic group was spinal cord injury (SCI) (N = 491, 48.0%). Several themes on critical areas of research emerged from the open-ended questions, which generated a total of 1,199 comments. Conclusion This survey revealed several themes for future research and development. Advanced wheelchair design, smart device applications, human-machine interfaces, and assistive robotics and intelligent systems emerged as priorities. Survey results also demonstrated the importance for researchers to understand the effects of policy and cost on translational research and to be involved in educating both consumers and providers.

The future of the provision process for mobility assistive technology: a survey of providers

Abstract Purpose: The purpose of this study was to evaluate the opinions of providers of mobility assistive technologies to help inform a research agenda and set priorities. Materials and methods: This survey study was anonymous and gathered opinions of individuals who participate in the process to provide wheelchairs and other assistive technologies to clients. Participants were asked to rank the importance of developing various technologies and rank items against each other in terms of order of importance. Participants were also asked to respond to several open-ended questions or statements. Results: A total of 161 providers from 35 states within the USA consented to participation and completed the survey. Conclusions: This survey revealed themes of advanced wheelchair design, assistive robotics and intelligent systems, human machine interfaces and smart device applications. It also outlined priorities for researchers to provide continuing education to clients and providers. These themes will be used to develop research and development priorities. Implications for Rehabilitation • Research in advanced wheelchair design is needed to facilitate travel and environmental access with wheelchairs and to develop alternative power sources for wheelchairs.• New assistive robotics and intelligent systems are needed to help wheelchairs overcome obstacles or self-adjust, assist wheelchair navigation in the community, assist caregivers and transfers, and aid ambulation.• Innovations in human machine interfaces may help advance the control of mobility devices and robots with the brain, eye movements, facial gesture recognition or other systems.• Development of new smart devices is needed for better control of the environment, monitoring activity and promoting healthy behaviours.

Poster 40 Seat Elevator Procurement and its Association with Functional Mobility

Group 1, n1⁄4 236, patients who were ambulating less than 150 feet at admission to inpatient rehabilitation. Group 2, n1⁄455, patientswhowere ambulating over 150 feet at admission to inpatient rehabilitation. Interventions: Anticoagulation Therapy. Main Outcome Measures: VTE outcomes, discharge destination, and FIM gait gains. Results: A total of 295 patients admitted one year were identified through admission medical records met the inclusion criteria of this study and became subjects of this investigation. Group 1 (ambulation less than150 feet) mean age was 71.38 years (SD1⁄413.77) and sex distribution was 49% male / 51% female. Group 2 (ambulation greater than 150 feet) mean age was 69.4 years (SD1⁄414.2 years) and sex distribution was 53% male / 47% female. Group 1, 64% (151/236) were on anticoagulation VTE prophylactic treatment as compared to Group 2 at 44% (24/55) and differences between the two groups were significant (x1⁄49.04, P1⁄4.01). Incidence of VTE for Group 1 was 2.5% (6/236) and for Group 2 was 0% (differences between the two groups was nonsignificant, X1⁄41.479, P1⁄4.477). FIM gait gains for Group 11⁄4 2.28 (SD1⁄41.55) and Group 21⁄41.35 (SD1⁄4.77) and differences in FIM gait gains were significant (t1⁄46.401, P1⁄4.0001). Discharge destination for Group 1 to home1⁄452.1%, SNF1⁄435.5%, acute care1⁄412.4% and for Group 2 to home1⁄490.7%, SNF1⁄47.4%, acute care1⁄41.9% (3 x 2 x21⁄431.61, P1⁄4.0001). Conclusions: These results suggest that, as expected, patients with lower mobility scores were more likely to be anticoagulated. Anticoagulation does not appear to negatively impact FIM gait gains and may in fact be associated with greater gains in FIM gait scores. In spite of lower initial mobility, incidence of VTE and discharge destination were similar between the two groups. Level of Evidence: Level III