Tele-rehabilitation therapy may be a future intervention alternative to assist the recovery of patients suffering from various brain injuries. Preliminary research suggests that information and communication technologies may be used to deliver rehabilitation therapy to patients living at home. The results of this study suggest that the lack of physical interaction between patient and therapist does not hamper motor learning for people with mild/intermediate arm impairments.

Background: Because of a lack of rehabilitative facilities and resources, patients may be discharged from the hospital early while still requiring further rehab services. With recent advances in communications technologies, this need may be met as new methods to deliver rehabilitation services in the home are becoming a reality. Tele-rehabilitation has the potential to assist people in the community without the need for in person treatment by physical therapists and/or other similarly trained professionals. Potential benefits to the health care system include the ability to provide a prolonged therapy to patients, to support patient reintegration to community living, and possibly maximizing the use of health care resources. The purpose of this study was to explore the potential of using telerehabilitation to assist people in home settings.

Methods: Five patients suffering from mild/intermediate arm motor impairments due to an ischaemic stroke participated in this study. Patients with cognitive impairment were excluded from the study. The tele-rehabilitation system comprised of two workstations, one located in the patient's home and the other at the rehabilitation hospital. Therapists were able to monitor participants completing tasks/exercises using video-conferencing equipment. The participants received training on how to use the telerehabilitation system prior to the start of the study.

The virtual reality (VR) tele-therapy consisted of a therapist demonstrating a series of simple arm movements (e.g., pouring water from a glass, using a hammer, and turning around the centre of a doughnut) and the participant attempting to replicate the motion. Both the therapist's and participant's movements were recorded using a magnetic receiver and transformed into a virtual image that changed position in response to arm movement. During the performance, participants were able to see their arm trajectory in addition to the therapist's recorded arm trajectory. The therapist provided information about task correctness to patient using the video-conferencing system.

The participants completed 1 hour of VR tele-therapy each day, five days per week, for a period of four weeks at home. Two standardized scales were used to assess the motor deficit and monitor active daily living function changes both before and after the VR tele-therapy.

Findings: The average age was 53 years with a mean average of 12.8 months of residual symptoms from their stroke. All five participants completed the study and indicated they were satisfied with the telerehabilitation system. After treatment, trajectories of the participants' affected arm become more coherent and linear (i.e., smooth) as if executed with a healthy arm. Participants demonstrated improved impairment level but did not demonstrate improved function in the arm, probably because the participants may have adapted to functioning without the compromised arm prior to enrolling in the study.

Conclusions: Even though additional research is required to address and explore many additional issues, tele-rehabilitation may be a future intervention that could be used to people requiring therapy. This study suggests that the lack of physical interaction between patient and therapist does not hamper motor re-learning. Potential use of this system could allow patients in rural or distant location to access therapy services from their homes. Another possible use may include the distribution of pre-recorded therapy regimen to people suffering from mild neurological symptoms, freeing up rehabilitation therapists to spend more time with people with more serious conditions.

Reference: Maglaveras N, Koutkias V. "Motor tele-rehabilitation in post-stroke patients". Medical Informatics & The Internet in Medicine, 2004; 29, 119-125.

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