Telerehabilitation technology offers hope away from the clinic

October 09, 2012 Eric Wicklund, Editor, mHIMSS

Matthew Slattery's days are measured in tiny increments -- the blink of an eye, the shrug of a shoulder, the movement of an arm. And while the 14-year-old youth slowly recovers at home from a horrific traffic accident, those movements are watched by trained specialists at a clinic miles away and across the Atlantic in Israel.

From his home in Cockeysville, Md., Matthew's movements are captured by body sensors developed by MediTouch, an Israel-based developer of telerehabilitation solutions, and monitored by specialists at the Kennedy Krieger Institute in Baltimore, some 30 minutes away. The MediTouch software is integrated with remote viewing software from TeamViewer, enabling physicians at Kennedy Krieger to measure Matthew's progress and communicate with his father Ed, who in turn can communicate with MediTouch officials half a world away.

"We're all a team in this, " says Ed. "He can now pick up a pencil with his right hand. That means a lot."

Mobile body sensors like those developed by MediTouch, which launched in 2004 and brought its first product – the HandTutor – to market in 2008, hold great promise for the physical rehabilitation market, which sees millions of dollars spent each year on transportation and hospitalization costs that could otherwise be avoided if patients could exercise and be monitored in the comfort of their own homes. In addition, the sensors could not only help specialists chart and modify exercise routines for their patients, but also track vital signs and other physiological data that would help detect health concerns before they develop into medical issues, saving untold dollars in medical treatments and hospitalization costs.

"One of the trends of physical rehabilitation is getting that rehabilitation away from the clinic and into the home environment," says Alan Waterman, international sales manager for MediTouch. "There are so many benefits to that, both clinical and economic, some of which you can't even measure. … Also, you need to document the sessions and record the results, and by providing a platform you can offer immediate feedback. … The results are dramatic.

Matthew, his older brother Peter and his mother Susan were headed back from a family reunion in Cleveland in August of 2010 when a tractor-trailer slammed into the back of their car as they slowed for traffic. Susan was killed almost instantly, Peter was badly injured but stable, and Matthew lost 80 percent of his blood. He spent close to eight months in a hospital, enduring several brain surgeries, and was all but immobile upon being discharged.

"You have to understand, this kid should not be alive," says Ed, 56, who retired shortly thereafter to take care of his son. "He was a lump. He couldn't talk. He could barely move his index finger."

A little research led Ed to MediTouch, and Matthew was fitted for the HandTutor, a specially designed glove that acts like a computer mouse and connects the user with interactive games downloaded on the family's home computer. Waterman says the games are very basic, designed so that users have to repeat flexion and extension movements, isolating as very specific motion.

"This isn't like a Wii," says Ed, who adds that Matthew underwent six weeks of training at Kennedy Krieger so that his personalized regimen could be developed by MediTouch. "We tried to use the Wii and the Xbox, but (Matthew's) wheelchair screwed it up. They're not designed for rehab, for the things that Matthew has to do."

Matthew began with exercises targeting his shoulder, then his arm, then his hand, down to his fingers. The process is customized to take into account his range of motion and his progress.

"Just picking up a cup requires several muscle groups (and) joints," Waterman points out. "All of them need to be trained to work together."

Meanwhile, the process is captured through an online computer connection facilitated by TeamViewer. Much more cost-effective than a closed-circuit system with a webcam, the online link enables therapists at the Kennedy Krieger Institute to monitor, measure and adjust Matthew's exercises and stay in touch with the family. It also allows Ed to chat with Waterman.

"Alan can actually take control of my computer if he needs to," Ed says.

"TeamViewer brings much needed therapy to immobile patients," says Jennifer Hayes, part of Tampa, Fkla.-based TeamViwer's technical sales team. "Psychiatrists and therapists alike have begun to take notice of the wide variety of uses that TeamViewer brings to the teletherapy table. Therapy and group sessions can now be conducted with patients who are either not able nor comfortable leaving their home. This allows the patient to receive the needed benefits of a group social interaction and obtain therapy with one-on-one sessions from the comfort of their home."

According to Hayes, sessions are conducted using video streaming and Voice over IP (VoIP), creating an effortless and inviting option for patients who may not be tech-savvy or comfortable with traditional remote access setup.

"Additionally, there is no added cost to the patient to use the technology, assuming they already have a computer and web cam," she said. "The video session allows for real-time interaction with their fellow group members and/or therapists creating an environment as if they were sitting in a room together. Through this technology, immobile patients receive the much needed interaction that they might not otherwise receive. Additionally, as the sessions are conducted from their home, it provides unmatched privacy and comfort which increases the motivation and willingness of the patients to actually participate."

In 2011, MediTouch introduced the ArmTutor and the LegTutor, as well as the 3DTutor, a wireless sensor that can be attached to several parts of the body to work in conjunction with the other systems. (Matthew is working with that now.) Each iteration offers more hope for those suffering from physical rehab issues, be they accident victims, stroke survivors, wounded warriors or those with chronic conditions.

Waterman envisions hundreds of thousands of people who would normally have to travel to a clinic or extend their stay in a hospital, instead rehabbing at home, through their computer, while being monitored in real-time by specialists.

For Ed and Matthew, the results hit closer to home, in the simple act of picking up a pencil – one small, carefully and intricately measured step in what everyone hopes will be a long and continually rewarding journey.