Telerehabilitation

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Telerehabilitation

• American Telemedicine Association
• Telerehabilitation SIG
• 2006

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Table of Contents

• Goals/Alignment with ATA Goals
• Leadership Membership
• Status of Specialty Area
• Technologies
• Standards
• Business Models/ Use cases
• Outreach Program
• Courses/Education (online)
• Inter-SIG Collaboration

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Goals/Alignment with ATA Goals

• SIG Goals
• Promote access to rehab services through
  telehealth
• Serve as an information resource on
  evidence-based outcomes and reimbursement
• Build membership

4
Leadership

• SIG Co-chairs 2006-2007
• Janet Brown, MA CCC-SLP
• American Speech-Language-Hearing Association
• jbrown_at_asha.org
• David Brennan, MBE
• Senior Research Engineer
• National Rehabilitation Hospital
• David.M.Brennan_at_medstar.net

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SIG Members

• assistive technologists
• educators
• neuropsychologists
• occupational therapists
• physical therapists
• rehabilitation engineers
• rehabilitation nurses and physicians
• speech-language pathologists
• telehealth and disability policy specialists

6
Status of Telerehabilitation

• Potential for growth in SLP
• Shortages and access issues stimulate demand
• Growth is limited by reimbursement
• Current work is usually grant-funded using
  existing telehealth resources

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Literature

• Telerehab bibliography available on SIG page
• Largest number of published studies are in
  speech-language pathology with different
  populations and disorders
• Cognitive-communication impairments, voice
  disorders, stuttering, motor speech, swallowing
  Stroke rehab
• PT, OT
• States reimbursing through Medicaid

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Literature Results

• Overall, studies to date support comparability of
  telehealth to face-to-face services, and positive
  patient satisfaction
• Studies tend to have small subject sizes, and are
  non-randomized
• Need for studies that evaluate clinical outcomes,
  cost-effectiveness, patient/clinician satisfaction

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Literature From Other Groups

• Professional associations policy documents on
  telehealth posted on SIG page
• American Occupational Therapy Association
• American Speech-Language-Hearing Association

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Technologies

• Telerehab utilizes a wide range of both
  interactive and store-and-forward technologies
• For many telerehab interactions, ultra
  high-resolution image/video is not required
• Both high and low bandwidth videoconferencing
  tools can be utilized
• Depends upon the clinical/technical requirements
  of the telerehab encounter

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Technologies

• Sensor data can be used to augment audio/video
  signals
• Biosignals
• Kinematic and kinetic sensors (e.g. angles,
  forces)
• Audiometric tools
• Data sharing allows clients and clinicians to
  work interactively on shared materials

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Standards

• Given the range of professions and applications
  that can be used, there are no specific technical
  standards for delivery of telerehabilitation
  services
• Professional associations policy documents
  provide guidance as to patient selection,
  provider competencies, and ethics

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Business Model/Use cases

• Home care
• Telehealth not reimbursable as a visit but can
  help with staff utilization
• Visiting Nurse Service of NY (SLP)
• Satellite clinics in telehealth networks
• St. Alexius in Bismarck, ND provides SLP services
  to satellites in rural areas
• School contracts
• Shortage of SLPs
• INTEGRIS Health, Oklahoma City, OK and others
  providing school services via contract

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Business Model/Reimbursement

• Medicare currently does not recognize rehab
  professionals as eligible providers of rehab
  servicesongoing advocacy to change policy
• http//www.atmeda.org/news/policy_issues/policy_is
  sues.htmhandbook
• Medicaid reimburses in some states
• Private health insurers have been lobbied to
  provide coverage for some telerehab services
• BC/BS of North Dakota reimburses SLP services?

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Outreach Program

• Presentations/posters at annual meeting
• Internet presence
• ATA SIG page
• Wikipedia
• Collaborations with professional organizations

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Inter-SIG Collaboration

• Plan to confer or collaborate with Home Telecare
  and Human Factors SIGs