W. Glinkowski 1,2,6, K. Mąkosa 3,6, M. Wasilewska 5, K. Marasek 4, A. Górecki 1 Internet based telerehabilitation videoconferencing

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1 W. Glinkowski 1,2,6, K. Mąkosa 3,6, M. Wasilewska 5, K. Marasek 4, A. Górecki 1 Internet based telerehabilitation videoconferencing Chair and Department of Orthopedics and Traumatology of Locomotor System, μ Center of Excellence TeleOrto, Medical University of Warsaw Department of Anatomy, Center of Biostructure, Medical University of Warsaw Entropia.pl Multimedia Department, Polish Japanese Institute of Information Technology, Warsaw Medical University of Warsaw (MS student) Polish Telemedicine Society

2 Introduction Rehabilitation therapies teach people with musculoskeletal disorders how to compensate or regain function. There are some difficulties to establish telerehabilitation therapy as access to IT device, computer skills, etc. Example: During winter, particularly strong and cold, many patients disappeared from out patient rehabilitation centers.

3 Introduction Physiotherapist appearing on the computer screen or mobile device display seems to be a very attractive opportunity for many patients. Certainly, some of rehabilitation sessions require direct physiotherapist presence but in other session dominates supervising role of the physiotherapist. The remote sessions may run utilizing teleconsultation network.

4 Introduction Therapies are provided over a relatively long period of time to improve the patientʹs endurance and strength. Telerehabilitation holds great promise also for institutionalized patients who have provided these therapies at a setting which is under medical (nurses, nursing assistants) control (a nearby ambulatory clinic, the nursing home, etc.).

5 Introduction The aim of the study was to evaluate how patients would be able to attend telerehabilitation sessions. Would they have the good will to try it, or be technically prepared. What are patients expectations concerning telerehabilitation. Finally, we performed already a few sessions of telerehabilitation utilizing originally developed application for Internet based telerehabilitation.

6 Telerehabilitation logging web page

7 Telerehabilitation web page

8 MDA / GPRS / WiFi

9 Internet based telerehabilitation videoconferencing Two research approaches were undertaken during the study. The one was to review consecutive patients in out patient orthopedic clinic about their attitude to telerehabilitation. The second was to test the quality of available technologies in use for telerehabilitation sessions.

10 Internet based telerehabilitation videoconferencing A selected group of patients was instructed how to use the application. All those patients were familiar with personal computer use and how to browse an internet. The Macromedia Flash Server connects both sides of videoconferencing system. Currently, two way system of communication allows the patient to follow the therapist instructions and direct inspection of exercises by the therapist utilizing web cameras.

11 Internet based telerehabilitation videoconferencing We have tested usefulness of desktops, laptops and WLAN connected personal digital assistants and Flash Player operating mobile phones to create patients terminal.

12 Results Two hundred patients (117 females, 83 males) were asked about their preparedness for telerehabilitation. Their average age was 53 years (15 83). Only 30 declared e mail address. More than half of the group declared an easy access to PC (54, 5%), but only 3 have had web camera. The popularity of mobile phones could be noted recently. Seventy six and half percent of our patients were mobile phone users.

13 Results Almost 40% of patients were determined to use internet based telerehabilitation. All of those attempts to telerehabilitation (desktops, laptops and WLAN connected personal digital assistants and Flash Player operating mobile phones) were evaluated positively by both kinds of users. They confirmed some obstacles and inconveniencies previously premised.

14 Conclusions We conclude that use of telerehabilitation via internet may significantly improve the process of function regaining with additional possibilities for joining leading physician during such sessions. Remotely controlled rehabilitation may also overcome patient s absence in outpatient offices during bad weather conditions and also to reach the most distant patients.