The use of telerehabilitation in assistive technology.

Abstract

Telerehabilitation is an evolving technology designed to assist rehabilitation practitioners and caregivers in delivering rehabilitative services to consumers at a remote site. In its simplistic form, it is a way of providing patient information between rehabilitation practitioners who are physically separated from patient. It offers an ideal tool to promote this sharing of information and help in managing patients with chronic health diseases and persons with disabilities. Telerehabilitation involves telecommunications applications and other information technologies that promote independence and improve quality of life for persons with disabilities. For a person with a disability, access to appropriate assistive technology (AT) can mean a more independent, productive life. Selecting assistive technology is usually not so simple. Finding the "best fit" between person, environment, and technology is a multi-step process. Poorly chosen equipment may be of little help to the user, or even end up unused in a closet. The paper begins with a general overview of key issues related to telerehabilitation. It further discusses the legal and ethical issues in telerehabilitation. The types of technologies used in telerehabilitation, assistive technology, human factors related to assistive technology and barriers and advantages of telerehabilitation have also been talked about.

Telerehabilitation is that part of all of telehealth practice that allows the delivery of medical rehabilitative services at a distance, using modern information technologies. Telehealth is the application of computer, communication, and information technologies to improve the access to and the quality of healthcare assistance. While incorporating the health management aspects of telehealth, telerehabilitation also utilizes telecommunication technologies to improve access to rehabilitation services that support independent services for persons with disabilities. This definition of telerehabilitation covers a broad range of services such as communications, health management, education, environmental control, and community access. New wireless technologies are making it possible to provide portable devices that support the same health monitoring, communication, and information resources associated with telerehabilitation in the home. It may be as simple as two professionals discussing a case over the telephone, or as sophisticated as using satellite technology to broadcast a consultation between providers at facilities in two countries, using videoconferencing equipment. The first is used daily by most rehabilitation professionals, and the latter is used by the military and some large medical centers (Brown, 2001).

Telerehabilitation should be extended beyond the home into the community. Applying wireless technologies will allow persons with disabilities that may otherwise have kept them home bound--to move independently in the community. Wireless communication, videoconferencing, and the Internet have made telerehabilitation a reality. Applications are as vast and exciting as the technology they employ (Meloro, 2001). It is important to remember that it is not new rehabilitation or new types of rehabilitation care management systems, but rather new technology that is being incorporated into rehabilitative services. Incorporation of technology is not unique--in fact, the development and use of new technology and equipment in rehabilitation is common. What is different, however, is that the communication technology that enables telerehabilitation has the potential to impact all general and subspecialty areas in rehabilitation and eventually all people (Viegas & Dunn 1998).

Tele is the Greek root word meaning "far off" or as Webster's defines it, "distant, remote, whence, from, or to a distance" (Guralnik, 1967). Just as telephone means sound (phone) across distance, telerehabilitation is rehabilitation across distance. The specific technology will change, and the networks used will evolve and expand. The process by which people communicate and interact and the extent to which people communicate and interact and the extent to which communication takes place are changing quickly and continually. It is telerehabilitation technology that will enable rehabilitation practitioners to do what they have always done, making it available to more people. Telerehabilitation involves new, multidisciplinary ways of working and can bring rehabilitation directly to common people. It is a huge new field of endeavor and one in which many of the waters are uncharted. Uncertainty and challenge coexist with excitement in developing telerehabilitation. Not only have we many unknowns in telerehabilitation, what is known changes all the time--new facts are learned and old concepts discounted. It should be properly introduced and based on evidence of effectiveness. Achieving these goals requires that communication channels develop between the different disciplines involved in delivering telerehabilitation services (Darkins & Cary 2000).

Legal and Ethical Issues

The development and use of new technology or new applications of existing technology have legal and ethical implications that arise subsequent to the use of such technology. Often, these legal and ethical implications themselves are not new but rendered so because their context may be new or changed. This is the case in telerehabilitation, in which the use of "electronic information and communications technology to provide and support care when distance separates the participants" alters the context in which services are provided (Viegas & Dunn 1998).