伊犁州2007年安全生產(chǎn)目標(biāo)管理責(zé)任書(shū) 28

This

lecture

is

designed

to

introduce

you

to

the

main

features

and

concepts

that

we

currently

understand

about

TeleRehabilitation.1.

Overview

ofTelemedicine

and

TeleRehabilitation2.

Technologies

and

nomenclature3.

Report

on

local

findings4.

Future

developments5.

Opportunity

for

interactive

web

based

discussionTeleRehabilitation

OverviewandBeijing

ConferenceOctober

2001Preliminary

ResultsNigel

Shapcott,

M.Sc.,

A.T.P.Departmentof

Rehab

Science

and

Technology,University

of

PittsburghandCenter

for

Assistive

TechnologyUPMC

Health

SystemTraditionally

we

acknowledge

our

main

funding

sources

for

the

work

that

we

carry

out.

In

our

case

we

have

received

funding

froma

number

ofdifferent

sources

and

throughout

our

work

have

received

help

of

loaned

equipment

and

free

expertise

frommany

others.Institutional

AcknowledgementsBeijing

ConferenceOctober

2001n

US

Dept.of

Agriculture

SBIR

I

and

II.n

Center

for

Excellence

in

RuralMedicallyUnderserved

Areas,

PA.n

Veteran’s

Affairs

Rehab

Research

&Development

Servicen

Dept

of

Rehab

Science

&

Technologyat

the

University

of

Pittsburghn

UPMC

Center

for

Assistive

Tech.n

UPMC

Spinal

Injury

Centern

HERL

VA

Medical

Center

PittsburghTraditionally

we

acknowledge

our

main

funding

sources

for

the

work

that

we

carry

out.

In

our

case

we

have

received

funding

froma

number

ofdifferent

sources

and

throughout

our

work

have

received

help

of

loaned

equipment

and

free

expertise

frommany

others.People

AcknowledgementsBeijing

ConferenceOctober

2001n

Michael

Boninger

MDn

Laura

Cohen

PTn

Rory

Cooper

PhDn

Rosi

Cooper

PTn

Shirley

Fitzgerald

PhDn

Mark

Schmeler

OTn

Tricia

Thorman

OTTeamworkTwo

groups

are

loosely

defined

as

the

TeleRehab

“experts”

or

specialists

and

those

at

TeleRehab

personnel

“rural”

sites.

However

it

is

veryimportant

to

understand

that

in

order

for

the

client

to

receive

the

best

care

the

“expert”

and

the

ruralindividuals

are

members

of

a

teameach

ofwhomhas

different

and

equallypertinent

information

vital

to

a

good

outcome.ConstituenciesIt

is

generally

assumed

that

the

two

groups

would

be

split

as

indicated

in

the

slide,

but

it

may

well

be

that

there

is

considerable

overlap,

dependingon

local

resource

issues.

That

is,

in

aparticular

health

care

system,

who

are

the

health

care

providers

visiting

clients

in

their

homes

or

places

ofwork.TeleRehab-

How

we

see

itAssistive

TechnologyPractitionerAssistive

TechnologySupplierRegistered

NurseCertified

Orthotist

or

ProsthetistOTR,

PTPhysiatristExpert

HubNon

Specialist

OTR

or

PTCOTAorPTARTS

TechnicianLPNOrthotistor

ProsthetistVisiting

NurseRural

SiteVisual

and

Audio

EvaluationTransfer

of

Eval

DataPressure/DimensionalDelivery

of

various

Rehabilitation

interventions

remotely:wheelchairs,

wound

care,

follow

up,

training

etc.Beijing

ConferenceOctober

2001The

major

issues

revolving

around

the

need

can

be

summarized

simply

as

distances,

lack

of

local

expertise,

high

costof

delivery

in

rural

areas.The

problems

of

deliveryof

Rehabilitation

Service

provision

in

rural

areas

parallels

the

deliveryof

health

care

to

rural

areas

where

the

proportionof

people

with

chronic

illnesses

is

higher

and

the

means

to

pay

for

themis

reduced

services

(Witherspoon,

Johnston,

&

Wasem,

1993).

Largedistances

meanlong

travel

times

increasingcosts

associated

withany

service

deliveryand

the

time

of

travel

consumes

valuable

time

skilledprofessionals

could

be

using

to

provide

services.TeleRehab-

The

Needu

Resources

and

Distancesu

Not

enough

skilled

peopleu

Large

numbers

of

underservedu

Too

many

milesu

Earlier

dischargeu

Mortality

ratesu

Disability

ratesu

ATApprox

200

milesPennsylvania-

West/CentralBeijing

ConferenceOctober

2001The

potential

of

modernlow

cost

technologies

as

tools

in

the

deliveryof

Assistive

technology

have

been

discussed

(Shapcott,

1994).

An

exampleof

the

technologyof

the

time

was

shown,

the

AT&Tvideo

phone-

this

was

little

better

than

an

ordinary

phone

call

in

getting

information

to

aremote

party

because

of

small

picture

size,

low

resolution

and

slowframe

rates.New

low

cost

POTS

based

video

conferencing

technologies

are

appearing

rapidly.

These

are

based

around

low

cost

digital

video

chips

andsophisticated

video

compression

techniques.

These

can

cost

little

as

approximately

$400

(US)

for

each

unit.

See

picture

below.

The

units

consistof

a

camera

and

all

required

electronics

in

a

small

box

and

are

relatively

easy

to

use.

These

systems

are

now

able

to

transmit

and

receivereasonable

video

images

and

are

being

further

developed

to

accept

RS232

computer

inputs

whichhave

the

potential

of

enablingthe

transmissionof

accompanying

electronic

data.TeleRehab-

Why

Are

We

Using

TelephoneBased

Systems

Now?u

AT&T,

top

picture

1994

($1500)poor

performanceu

ViaTV,1998u

1998,

same

widespreadinfrastructure

(POTS)-

betterperformance

with

lower

costse.g.

ViaTV,

Starviewu

New

units

cost

$300

+Beijing

ConferenceOctober

2001Potential

Benefits

of

TeleRehabBeijing

ConferenceOctober

2001u

Better

access

to

health

care

for

thoseliving

outside

metropolitan

areasu

Fewer

trips

to

clinics

and

hospitals

forboth

patients

and

cliniciansu

More

specialists

can

take

part

in

anevaluationu

Follow-up

with

clients

after

dischargeThis

lecture

is

designed

to

introduce

you

to

the

main

features

and

concepts

that

we

currently

understand

about

TeleRehabilitation.1.

Overview

ofTelemedicine

and

TeleRehabilitation2.

Technologies

and

nomenclature3.

Report

on

local

findings4.

Future

developments5.

Opportunity

for

interactive

web

based

discussionTeleRehabilitation

-Part

II-

Technologies

and

NomenclatureBeijing

ConferenceOctober

2001Bandwidthcan

be

imagined

as

beinganalogous

to

the

internal

diameter

of

a

water

pipe,

the

larger

the

diameter

the

more

water

will

flow-

thus

thelarger

the

bandwidth

the

more

data

canflow

and

in

this

case,

the

better

the

video.Compression

isa

mathematical

technique

used

in

the

software

and

hardware

which

uses

"tricks"

to

squeeze

better

qualityvideo

for

a

particularavailable

bandwidth.Technologies

listed

here

are

asof

1999

and

by

observation

change

on

a

3-6

month

cycle

with

new

technologies

appearing

and

old

ones

fadingout.

As

time

passes

some

of

the

older

technologies

repackaged

an

reappearing

at

more

advantageous

times.BANDWIDTH-

(Rate

of

Information)

Available/Developing

TechnologiesBeijing

ConferenceOctober

2001u

Hard

wired-T/4

Fiber

optic

Lines-

highu

Hard

wired-ISDN

Digital

Phone

Lines-

mediumu

Hard

wired-POTS-

Plain

Old

Telephone

Service-

lowu

Hard

wired-Cable-

medium/highu

Hard

wired-

Power

Utilities-

notknownu

Hard

wired-

*DSL

Technologies-

medium/highu

Wireless-

Cell

Phone

3G-

medium/highu

Wireless-

2

Way

Satellite

(0.5m)-

medium/highConnection

Technologies-

SummaryBeijing

ConferenceOctober

2001u

Rapid

changes

in

theseu

Huge

potential

marketu

Rural

areas

likely

to

be

last

in

lineu

Bandwidth

will

increaseu

Video

quality

willimproveu

Data

capability

will

be

further

developedThis

lecture

is

designed

to

introduce

you

to

the

main

features

and

concepts

that

we

currently

understand

about

TeleRehabilitation.1.

Overview

ofTelemedicine

and

TeleRehabilitation2.

Technologies

and

nomenclature3.

Report

on

local

findings4.

Future

developments5.

Opportunity

for

interactive

web

based

discussionTeleRehabilitation

-

Part

III-

ResultsBeijing

ConferenceOctober

2001Clinical

IssuesBeijing

ConferenceOctober

2001u

Injury-Handoverof

responsibilityn

Transfern

ROMu

Trainingn

Qualifications

at

both

endsn

Specialized

training

requirementsu

Recognition

of

current

limitsn

No

feel

(ROM)n

Tremors

(not

pickedup)n

More

quantitative

tools

needed

(Pressure

etc)n

Multiple

view

issuesEfficacy

of

Wheelchair

System

Prescription

Using

POTS

TeleRehabBeijing

ConferenceOctober

2001u

Aims

and

Methodn

to

establish

a

scientific

basis

for

the

reliable

use

andof

video

conferencing

for

remote

prescription

of

AssistTechnology

using

POTS

lines

to

transmit

and

receive

theaudio

and

video

signals.n

to

determine

the

potential

of

increasing

the

availabiliAT

prescription

services

to

communities,

underserved

duto

geographical

and/or

transportation

and/or

financialbarriers.n

TeleRehab

(TR)

systems

are

used

to

evaluate

individuals

for

their

wheelchair

&

seating

needs

and

compared

to

the

findings

of

In

Person

(IP)

evaluations.Efficacy

of

Wheelchair

System

Prescription

Using

POTS

TeleRehabBeijing

ConferenceOctober

2001u

RESEARCH

QUESTIONSu

Can

experienced

Clinicians

using

TR

technologies,

withdefined

operational

protocols:u

1.

Reliably

determine

if

the

TR

process

is

appropriate

andsafe

for

a

specific

individual?u

2.

Reliably

provide

accurate

decisions

regarding

the

needfor

a

wheelchair,

at

a

detailed

level?u

3.

Reliably

obtain

accurate

assessments

of

medical

historand

physical

examination?Efficacy

of

Wheelchair

System

Prescription

Using

POTS

TeleRehabBeijing

ConferenceOctober

2001u

Assessment/Evaluationn

Interview-

with

the

"Model

Patient"

consists

of

access

to

informatifrom

a

standard

information

sheet;

and

an

interactive

sessiondetermining

mobility

goals,

appropriateness

of

these

goals,

diagnoany

changes

in

condition.n

Mat

evaluation-

a

physical

motor

and

measurement

evaluation

eithercarried

out

by

the

Clinician

in

the

face-to-face

situation

or

underguidance

of

the

Clinician

by

the

Assistant

via

TR.

The

purpose

of

themat

evaluation

is

to

establish

passive

and

active

ROM,

of

the

upperand

lower

extremities,

any

pathological

movement

patterns,

sittingandtransfer

skills,

spinal

orientation,andfunctional

abilitiesto

mobility

and

other

goals.n

Measurement-

the

Clinician

or

Assistant

record

linear

and

angularmeasurements

as

required

by

the

data

collection

form

and

setting.Efficacy

of

Wheelchair

System

Prescription

Using

POTS

TeleRehabBeijing

ConferenceOctober

2001u

20

subjects

acting

as

“model

patients”u

4

evaluations/subjectn

Crossover

studyv

2

Locationsv

2

In

Person

(IP)v

2

TeleRehab

(TR)n

Detailed

Protocol

Data

Collection

(Forms)n

4

Clinicians

(2

OT,

2

PT)u

9

“Assistants”

Trainedn

TeleRehab

evaluationn

Transfern

ROMn

Dimensions2

Locationsu

22

LLooccaattiioonnssVAMedicalCenter-HighlandDrivePittsburghBeijing

ConferenceOctober

2001UPMCCenter

forAssistiveTechnologyPittsburghExperimental

SchematicCAT

TRCAT

IPVA

IPVA

TRClinician

1evaluationClinician

2evaluationClinician

3evaluationClinician

4evaluationDAY

1DAY

23-7

DAY

DELAY

BETWEEN

SESSIONSBeijing

ConferenceOctober

2001Efficacy

of

Wheelchair

System

Prescription

Using

POTS

TeleRehabBeijing

ConferenceOctober

2001u

Data

Collection:

-

A

team

consisting

of

a

Physiatrist;Statistician,2

OTs;

2

PTs

and

a

Rehabilitation

Engineer

hdeveloped

comprehensive

data

collection

forms

to

recordinformation

on

the

characteristics

of

the

Model

Patient

thenvironment;

and

the

details

of

the

prescription.

The

formwere

derived

over

a

series

of

iterations

and

reviews

from

acollection

of

existing

in

house

forms

and

the

work

of

theAssistive

Technology

Program

in

Tucson

.Data

Collection-

Form

1Beijing

ConferenceOctober

2001Data

Collection-

Form

2Beijing

ConferenceOctober

2001Data

Collection-

Form

3Beijing

ConferenceOctober

2001Data

Collection-

Form

3Beijing

ConferenceOctober

2001Data

Collection-

Form

4Beijing

ConferenceOctober

2001Preliminary

Estimations

(9

of

20

subjects)Beijing

ConferenceOctober

2001n

Qu.

1.

Further

evaluationv

Multi-

rater

Kappa,

4

clinicians,

0.464

&

p=0.07

v

Multi-

rater

Kappa

3

clinicians,

0.615

&

p=0.03

v

TP

vs

IP

Kappa

0.615,

p=013v

simple

agreement

90%v

(WeightedKappa

issue)Preliminary

Estimations

(9

of

20

subjects)Beijing

ConferenceOctober

2001n

Question.

Wheelchair

Typev

Manual

Wheelchair-

simple

agreement

100%

(n=4)

v

Powered

Wheelchair-simpleagreement

100%

(n=4)v

Scooter-

simple

agreement

100%

(n=1)Preliminary

Estimations

(9

of

20

subjects)Beijing

ConferenceOctober

2001n

Question.

Wheelchair

Featuresv

Manual

Wheelchair:

(folding,

rigid,

TIS,

recline)-simpleagreement

75%simplesimplesimplev

PoweredWheelchairFeatures:

(recline,

TIS)-agreement

94%v

Powered

Wheelchair

Drive:

(front,

rear,

mid)-agreement

69%v

Scooter:

(

3or

4

wheeled)-agreement

50%Preliminary

Estimations

(9

of

20

subjects)Beijing

ConferenceOctober

2001n

Question.

Seating

Dimensionsv

Overall

Seat

width:

(<16”,

16”,

18”,

>18”)-simple

agreement

61%v

Overall

seat

widthIn

Person

:

(<16”,

16”,

18”,>18”)-

simple

agreement

66%v

Overall

Seat

length:

(<16”,

16”,

18”,

>18”)-simple

agreement

75%v

Overall

seat

lengthInPerson

:

(<16”,

16”,

18”,>18”)-

simple

agreement

44%Preliminary

Estimations

(9

of

20

subjects)Beijing

ConferenceOctober

2001n

Question.

Seating/Cushion

Featuresv

Cushion

Supports:

(medial

thigh,

lateral

thigh,

medial

hip)-simple

agreement

86%simplesimplev

Cushion

customization

required:

(yes,

no)-agreement

86%v

Cushion

pressure

relief

required:

(yes,

no)-agreement

78%Preliminary

Estimations

(9

of

20

subjects)Beijing

ConferenceOctober

2001simplesimplen

Question.

Seating/Backrest

Featuresv

Back

Lateral

Supports:

(left,

none)-agreement

83%v

Back

Lateral

Supports:

(right,

none)-agreement

83%v

Back

customization

required

:

(yes,

no)-simple

agreement

80%Preliminary

Estimations

(9

of

20

subjects)Beijing

ConferenceOctober

2001n

Question.

Headrest

and

Armrestv

Headrest

required:

(yes,

no)-simple

agreement

94%v

Armrest

required:

(yes,

no)-simple

agreement

94%Preliminary

Estimations

(9

of

20

subjects)Beijing

ConferenceOctober

2001n

Conclusions:v

Simple

to

set

up

and

usev

Good

quality

audio

is

essentialv

Experienced

clinicians

requiredv

Linear

measurement

results

diabolical-

supportsrationel

for

simple

measurement

rigs

(Logan

et

al1998)This

lecture

is

designed

to

introduce

you

to

the

main

features

and

concepts

that

we

currently

understand

about

TeleRehabilitation.1.

Overview

ofTelemedicine

and

TeleRehabilitation2.

Technologies

and

nomenclature3.

Report

on

local

findings4.

Future

developments5.

Opportunity

for

interactive

web

based

discussionTeleRehabilitation

-Part

IV-

Future

Technical

IssuesBeijing

ConferenceOctober

2001TeleRehab-

Future

Needsu

Data

Acquisition

with

videon

Pressuren

DimensionalBeijing

ConferenceOctober

2001u

Data

Acquisition

with

videon

Wound

CareTeleRehab-

Future

NeedsBeijing

ConferenceOctober

2001TeleRehab-

Future

Needsu

Data

Acquisition

with

videon

TemperatureBeijing

ConferenceOctober

2001u

Data

Acquisition

with

videon

Shearn

HumidityBeijing

ConferenceOctober

2001TeleRehab-

Future

Needsu

Data

Acquisition

with

videon

Data

GloveBeijing

ConferenceOctober

2001This

lecture

is

designed

to

introduce

you

to

the

main

features

and

concepts

that

we

currently

understand

about

TeleRehabilitation.1.

Overview

ofTelemedicine

and

TeleRehabilitation2.

Technologies

and

nomenclature3.

Report

on

local

findings4.

Future

developments5.

Opportunity

for

interactive

web

based

discussionTeleRehabilitation

-Future

Service

Delivery

ISDN

or

Other

High

Bandwidth

SystemsHigh

bandwidth

link

to

center

in

Texas

followedup

with

POTS

link

into

home.

TeleRehab

servicesare

limited

by

funding

to

special

cases

anddemonstrations

at

this

time.Beijing

ConferenceOctober

2001N-)JF#CWyLuwqhnd>:7%3S@*HO!DXzTQsioekaBeijing

ConferenceOctober

2001IYE$9(L+1~5;tRwUA9j0`4.8cmptRxVBY$I(M=2<;Ef5O#G%J)N@3>7^akeo+isQwTzXD!H*dnhqLuSyWC0`4.8cmfpjtRxVBZE$I(M=2<6;9dnhrPuSyWC#G&K)N@3~7^bkeoisQwUAXD!H*L4.8c1mgqjtRxVBZ%I(M=2<6:+9F>90`3>7^blfpiRxVAYE$I(M=2~5;AYE$I(L+1~;950`.7^blfpjtRw4UTzXC#G&K-0`3>7^blfpjsQwUAYE$I*L+1a59cmgqOuSyVB@%J)N=2<6:akeohrPvTzXD!G&K-;~0-K&G#CWyTvPrhnd>7^bl3foisQwUAYE!H*L+1~5.8cmgqOuRxVBZF%J)M=2<6:FkdnhrPvZ%ngqOuSyWCJsioekd:63@Nv>K*H!DXazT-FQ)Z0`4.8cfpjtRxBYE$I(M=2<;V9m5fpjtRxVAYE$I(M=2~5;`904.8clN3>7^blfoisQwUKYD!H*L+1~5.8cmg-OtRxVB@nZF%J(M=2<6:akdnhrPvTzWC#G&qdAhrPvSyWC#G&K-

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