<s>
Telerehabilitation	B-Application
(	O
or	O
e-rehabilitation	B-Application
is	O
the	O
delivery	O
of	O
rehabilitation	O
services	O
over	O
telecommunication	O
networks	O
and	O
the	O
internet	O
.	O
</s>
<s>
Telerehabilitation	B-Application
allows	O
patients	O
to	O
interact	O
with	O
providers	O
remotely	O
and	O
can	O
be	O
used	O
both	O
to	O
assess	O
patients	O
and	O
to	O
deliver	O
therapy	O
.	O
</s>
<s>
Fields	O
of	O
medicine	O
that	O
utilize	O
telerehabilitation	B-Application
include	O
:	O
physical	O
therapy	O
,	O
occupational	O
therapy	O
,	O
speech-language	O
pathology	O
,	O
audiology	O
,	O
and	O
psychology	O
.	O
</s>
<s>
Types	O
of	O
therapy	O
available	O
include	O
motor	O
training	O
exercises	O
,	O
speech	O
therapy	O
,	O
virtual	B-Application
reality	I-Application
,	O
robotic	O
therapy	O
,	O
goal	O
setting	O
,	O
and	O
group	O
exercise	O
.	O
</s>
<s>
Commonly	O
used	O
modalities	O
include	O
webcams	B-Protocol
,	O
videoconferencing	B-Application
,	O
phone	O
lines	O
,	O
videophones	B-Application
and	O
webpages	O
containing	O
rich	B-Application
Internet	I-Application
applications	I-Application
.	O
</s>
<s>
The	O
visual	O
nature	O
of	O
telerehabilitation	B-Application
technology	O
limits	O
the	O
types	O
of	O
rehabilitation	O
services	O
that	O
can	O
be	O
provided	O
.	O
</s>
<s>
Telerehabilitation	B-Application
is	O
therefore	O
often	O
combined	O
with	O
other	O
modalities	O
such	O
as	O
in-person	O
therapy	O
.	O
</s>
<s>
Important	O
areas	O
of	O
telerehabilitation	B-Application
research	O
include	O
the	O
investigation	O
of	O
new	O
and	O
emerging	O
rehabilitation	O
modalities	O
as	O
well	O
as	O
comparisons	O
between	O
telerehabilitation	B-Application
and	O
in-person	O
therapy	O
in	O
terms	O
of	O
patient	O
functional	O
outcomes	O
,	O
cost	O
,	O
patient	O
satisfaction	O
,	O
and	O
compliance	O
.	O
</s>
<s>
As	O
of	O
2006	O
,	O
only	O
a	O
few	O
health	O
insurers	O
in	O
the	O
United	O
States	O
will	O
reimburse	O
for	O
telerehabilitation	B-Application
services	O
.	O
</s>
<s>
If	O
the	O
research	O
shows	O
that	O
tele-assessments	O
and	O
tele-therapy	O
are	O
equivalent	O
to	O
clinical	O
encounters	O
,	O
it	O
is	O
more	O
likely	O
that	O
insurers	O
and	O
Medicare	O
will	O
cover	O
telerehabilitation	B-Application
services	O
.	O
</s>
<s>
Angaran	O
published	O
"	O
Telemedicine	B-Application
and	O
Telepharmacy	O
:	O
Current	O
Status	O
and	O
Future	O
Implications	O
"	O
in	O
the	O
American	O
Journal	O
of	O
Health-System	O
Pharmacy	O
.	O
</s>
<s>
He	O
provided	O
a	O
comprehensive	O
history	O
of	O
telecommunications	O
,	O
the	O
internet	O
and	O
telemedicine	B-Application
since	O
the	O
1950s	O
.	O
</s>
<s>
The	O
Department	O
of	O
Defense	O
(	O
DoD	O
)	O
and	O
the	O
National	O
Aeronautics	O
and	O
Space	O
Administration	O
(	O
NASA	O
)	O
spearheaded	O
the	O
technology	O
in	O
the	O
United	O
States	O
during	O
the	O
Vietnam	O
War	O
and	O
the	O
space	O
program	O
;	O
both	O
agencies	O
continue	O
to	O
fund	O
advances	O
in	O
telemedicine	B-Application
.	O
</s>
<s>
Three	O
early	O
adopters	O
of	O
telemedicine	B-Application
were	O
state	O
penitentiary	O
systems	O
,	O
rural	O
health	O
care	O
systems	O
,	O
and	O
the	O
radiology	O
profession	O
.	O
</s>
<s>
Telemedicine	B-Application
makes	O
business	O
sense	O
for	O
the	O
states	O
because	O
they	O
do	O
not	O
have	O
to	O
pay	O
for	O
security	O
escorts	O
to	O
have	O
a	O
prisoner	O
receive	O
care	O
outside	O
the	O
prison	O
.	O
</s>
<s>
Rural	O
telemedicine	B-Application
in	O
the	O
United	O
States	O
is	O
heavily	O
subsidized	O
through	O
federal	O
agency	O
grants	O
for	O
telecommunications	O
operations	O
.	O
</s>
<s>
In	O
contrast	O
,	O
the	O
Veterans	O
Administration	O
is	O
relatively	O
active	O
in	O
using	O
telemedicine	B-Application
for	O
people	O
with	O
disabilities	O
.	O
</s>
<s>
An	O
argument	O
can	O
be	O
made	O
that	O
"	O
telerehabilitation	B-Application
"	O
began	O
in	O
1998	O
when	O
NIDRR	O
funded	O
the	O
first	O
RERC	O
on	O
tele-rehabilitation	B-Application
.	O
</s>
<s>
The	O
conference	O
was	O
attended	O
by	O
the	O
incoming	O
president	O
of	O
the	O
American	O
Telemedicine	B-Application
Association	O
(	O
ATA	O
)	O
.	O
</s>
<s>
This	O
led	O
to	O
an	O
invitation	O
by	O
ATA	O
to	O
the	O
conference	O
attendees	O
to	O
form	O
a	O
special	O
interest	O
group	O
on	O
telerehabilitation	B-Application
.	O
</s>
<s>
NIDRR	O
funded	O
the	O
second	O
5-year	O
RERC	O
on	O
telerehabilitation	B-Application
in	O
2004	O
,	O
awarding	O
it	O
to	O
the	O
University	O
of	O
Pittsburgh	O
.	O
</s>
<s>
In	O
2001	O
,	O
O	O
.	O
Bracy	O
,	O
a	O
neuropsychologist	O
,	O
introduced	O
the	O
first	O
web	O
based	O
,	O
rich	B-Application
internet	I-Application
application	I-Application
,	O
for	O
the	O
telerehabilitation	B-Application
presentation	O
of	O
cognitive	O
rehabilitation	O
therapy	O
.	O
</s>
<s>
Palsbo	O
published	O
an	O
article	O
in	O
the	O
Journal	O
of	O
Telemedicine	B-Application
and	O
Telecare	O
that	O
explored	O
how	O
telemedicine	B-Application
can	O
become	O
a	O
profitable	O
business	O
for	O
hospitals	O
.	O
</s>
<s>
They	O
argue	O
that	O
telerehabilitation	B-Application
should	O
be	O
expanded	O
so	O
that	O
people	O
with	O
disabilities	O
and	O
people	O
in	O
pain	O
(	O
perhaps	O
after	O
hip-replacement	O
surgery	O
or	O
people	O
with	O
arthritis	O
)	O
can	O
get	O
the	O
rehabilitative	O
therapy	O
they	O
need	O
.	O
</s>
<s>
It	O
is	O
unethical	O
to	O
limit	O
payments	O
for	O
telerehabilitation	B-Application
services	O
only	O
to	O
patients	O
in	O
rural	O
areas	O
.	O
</s>
<s>
Research	O
in	O
telerehabilitation	B-Application
is	O
in	O
its	O
infancy	O
,	O
with	O
only	O
a	O
handful	O
of	O
equivalence	O
trials	O
.	O
</s>
<s>
As	O
of	O
2006	O
,	O
most	O
peer-reviewed	O
research	O
in	O
telemedicine	B-Application
are	O
case	O
reports	O
of	O
pilot	O
programs	O
or	O
new	O
equipment	O
.	O
</s>
<s>
Rehabilitation	O
researchers	O
need	O
to	O
conduct	O
many	O
more	O
controlled	O
experiments	O
and	O
present	O
the	O
evidence	O
to	O
clinicians	O
(	O
and	O
payers	O
)	O
that	O
telerehabilitation	B-Application
is	O
clinically	O
effective	O
.	O
</s>
<s>
Plain	O
old	O
telephone	O
service	O
(	O
POTS	O
)	O
uses	O
standard	O
analog	B-Protocol
telephone	O
lines	O
.	O
</s>
<s>
Videophones	B-Application
are	O
used	O
with	O
POTS	O
lines	O
and	O
include	O
a	O
camera	O
,	O
display	B-Device
screen	I-Device
,	O
and	O
telephone	O
.	O
</s>
<s>
Videophones	B-Application
use	O
telephone	O
lines	O
that	O
are	O
available	O
in	O
most	O
homes	O
,	O
so	O
are	O
easy	O
to	O
set	O
up	O
;	O
however	O
small	O
display	O
screens	O
make	O
them	O
problematic	O
for	O
individuals	O
with	O
vision	O
problems	O
.	O
</s>
<s>
The	O
use	O
of	O
improved	O
quality	O
video-assisted	O
telecommunication	O
devices	O
,	O
such	O
as	O
videoconferencing	B-Application
,	O
webcams	B-Protocol
and	O
telepresence	B-Application
to	O
assist	O
in	O
treatments	O
.	O
</s>
<s>
Virtual	B-Application
reality	I-Application
in	I-Application
telerehabilitation	I-Application
is	O
one	O
of	O
the	O
newest	O
tools	O
available	O
in	O
that	O
area	O
.	O
</s>
<s>
This	O
computer	O
technology	O
allows	O
the	O
development	O
of	O
three-dimensional	O
virtual	B-Application
environments	I-Application
.	O
</s>
<s>
Applications	O
that	O
run	O
over	O
the	O
internet	O
,	O
just	O
as	O
if	O
they	O
were	O
installed	O
in	O
your	O
computer	O
(	O
called	O
Rich	B-Application
Internet	I-Application
Applications	I-Application
)	O
,	O
represent	O
a	O
new	O
direction	O
in	O
software	O
development	O
.	O
</s>
<s>
The	O
clinical	O
services	O
provided	O
by	O
speech-language	O
pathology	O
readily	O
lend	O
themselves	O
to	O
telerehabilitation	B-Application
applications	O
due	O
to	O
the	O
emphasis	O
on	O
auditory	O
and	O
visual	O
communicative	O
interaction	O
between	O
the	O
client	O
and	O
the	O
clinician	O
.	O
</s>
<s>
As	O
a	O
result	O
,	O
the	O
number	O
of	O
telerehabilitation	B-Application
applications	O
in	O
speech-language	O
pathology	O
tend	O
to	O
outnumber	O
those	O
in	O
other	O
allied	O
health	O
professions	O
.	O
</s>
<s>
The	O
technology	O
involved	O
in	O
these	O
applications	O
has	O
ranged	O
from	O
the	O
simple	O
telephone	O
(	O
Plain	O
Old	O
Telephone	O
System	O
–	O
POTS	O
)	O
to	O
the	O
use	O
of	O
dedicated	O
Internet-based	O
videoconferencing	B-Application
systems	O
.	O
</s>
<s>
Early	O
applications	O
to	O
assess	O
and	O
treat	O
acquired	O
adult	O
speech	O
and	O
language	O
disorders	O
involved	O
the	O
use	O
of	O
the	O
telephone	O
to	O
treat	O
patients	O
with	O
aphasia	O
and	O
motor	O
speech	O
disorders	O
(	O
Vaughan	O
,	O
1976	O
,	O
Wertz	O
,	O
et	O
al.	O
,	O
1987	O
)	O
,	O
a	O
computer	O
controlled	O
video	O
laserdisc	O
over	O
the	O
telephone	O
and	O
a	O
closed-circuit	O
television	O
system	O
to	O
assess	O
speech	O
and	O
language	O
disorders	O
(	O
Wertz	O
et	O
al.	O
,	O
1987	O
)	O
,	O
and	O
a	O
satellite-based	O
videoconferencing	B-Application
system	O
to	O
assess	O
patients	O
in	O
rural	O
areas	O
(	O
Duffy	O
,	O
Werven	O
&	O
Aronson	O
,	O
1997	O
)	O
.	O
</s>
<s>
More	O
recent	O
applications	O
have	O
involved	O
the	O
use	O
of	O
sophisticated	O
Internet-based	O
videoconferencing	B-Application
systems	O
with	O
dedicated	O
software	O
which	O
enable	O
the	O
assessment	O
of	O
language	O
disorders	O
,	O
the	O
treatment	O
of	O
language	O
disorders	O
,	O
and	O
the	O
assessment	O
and	O
treatment	O
of	O
motor	O
speech	O
disorders	O
(	O
Hill	O
,	O
Theodoros	O
,	O
Russell	O
,	O
Cahill	O
,	O
Ward	O
,	O
Clark	O
,	O
2006	O
;	O
Theodoros	O
,	O
Constantinescu	O
,	O
Russell	O
,	O
Ward	O
,	O
Wilson	O
&	O
Wootton	O
,	O
in	O
press	O
)	O
following	O
brain	O
impairment	O
and	O
Parkinson	O
's	O
disease	O
.	O
</s>
<s>
The	O
treatment	O
of	O
stuttering	O
has	O
been	O
adapted	O
to	O
a	O
telerehabilitation	B-Application
environment	O
with	O
notable	O
success	O
.	O
</s>
<s>
Using	O
a	O
high	O
speed	O
videoconferencing	B-Application
system	O
link	O
,	O
Sicotte	O
,	O
Lehoux	O
,	O
Fortier-Blanc	O
and	O
Leblanc	O
(	O
2003	O
)	O
assessed	O
and	O
treated	O
six	O
children	O
and	O
adolescents	O
with	O
a	O
positive	O
reduction	O
in	O
the	O
frequency	O
of	O
dysfluency	O
that	O
was	O
maintained	O
six	O
months	O
later	O
.	O
</s>
<s>
In	O
addition	O
,	O
a	O
videoconferencing	B-Application
platform	O
has	O
been	O
used	O
successfully	O
to	O
provide	O
follow-up	O
treatment	O
to	O
an	O
adult	O
who	O
had	O
previously	O
received	O
intensive	O
therapy	O
(	O
Kully	O
,	O
200	O
)	O
.	O
</s>
<s>
Reports	O
of	O
telerehabilitation	B-Application
applications	O
in	O
paediatric	O
speech	O
and	O
language	O
disorders	O
are	O
sparse	O
.	O
</s>
<s>
Voice	O
therapy	O
across	O
a	O
variety	O
of	O
types	O
of	O
voice	O
disorders	O
has	O
been	O
shown	O
to	O
be	O
effectively	O
delivered	O
via	O
a	O
telerehabilitation	B-Application
application	O
.	O
</s>
<s>
(	O
2003	O
)	O
using	O
PC	O
based	O
videoconferencing	B-Application
and	O
speech	O
analysis	O
software	O
compared	O
23	O
patients	O
treated	O
online	O
with	O
28	O
persons	O
treated	O
face-to-face	O
.	O
</s>
<s>
The	O
authors	O
reported	O
positive	O
post	O
treatment	O
results	O
with	O
no	O
significant	O
difference	O
in	O
measures	O
between	O
the	O
traditional	O
and	O
videoconferencing	B-Application
group	O
,	O
suggesting	O
that	O
the	O
majority	O
of	O
traditional	O
voice	O
therapy	O
techniques	O
can	O
be	O
applied	O
to	O
distance	O
treatment	O
.	O
</s>
<s>
Although	O
obvious	O
limitations	O
exist	O
,	O
telerehabilitation	B-Application
applications	O
for	O
the	O
assessment	O
of	O
swallowing	O
function	O
have	O
also	O
been	O
used	O
with	O
success	O
.	O
</s>
<s>
Lalor	O
,	O
Brown	O
and	O
Cranfield	O
(	O
2000	O
)	O
were	O
able	O
to	O
obtain	O
an	O
initial	O
assessment	O
of	O
the	O
nature	O
and	O
extent	O
of	O
swallowing	O
dysfunction	O
in	O
an	O
adult	O
via	O
a	O
videoconferencing	B-Application
link	O
although	O
a	O
more	O
complete	O
evaluation	O
was	O
restricted	O
due	O
to	O
the	O
inability	O
to	O
physically	O
determine	O
the	O
degree	O
of	O
laryngeal	O
movement	O
.	O
</s>
<s>
A	O
more	O
sophisticated	O
telerehabilitation	B-Application
application	O
for	O
the	O
assessment	O
of	O
swallowing	O
was	O
developed	O
by	O
Perlman	O
and	O
Witthawaskul	O
(	O
2002	O
)	O
who	O
described	O
the	O
use	O
of	O
real-time	O
videofluoroscopic	O
examination	O
via	O
the	O
Internet	O
.	O
</s>
<s>
There	O
has	O
been	O
considerable	O
research	O
into	O
the	O
assessment	O
and	O
treatment	O
of	O
dysphagia	O
via	O
telerehabilitation	B-Application
,	O
including	O
cost	O
analyses	O
,	O
leading	O
to	O
the	O
establishment	O
of	O
sustainable	O
telerehabilitation	B-Application
services	O
.	O
</s>
<s>
There	O
continues	O
to	O
be	O
a	O
need	O
for	O
ongoing	O
research	O
to	O
develop	O
and	O
validate	O
the	O
use	O
of	O
telerehabilitation	B-Application
applications	O
in	O
speech-language	O
pathology	O
in	O
a	O
greater	O
number	O
and	O
variety	O
of	O
adult	O
and	O
paediatric	O
communication	O
and	O
swallowing	O
disorders	O
.	O
</s>
<s>
Types	O
of	O
Physical	O
rehabilitation	O
therapies	O
delivered	O
through	O
telerehabilitation	B-Application
include	O
strengthening	O
exercises	O
,	O
motor	O
retraining	O
,	O
goal	O
setting	O
,	O
virtual	B-Application
reality	I-Application
,	O
robotic	O
therapy	O
,	O
community-therapy	O
.	O
</s>
<s>
Motor	O
training	O
through	O
telerehabilitation	B-Application
has	O
consistently	O
been	O
shown	O
to	O
produce	O
equivalent	O
functional	O
outcomes	O
compared	O
with	O
in-person	O
therapy	O
.	O
</s>
<s>
However	O
,	O
many	O
patients	O
require	O
in-person	O
therapy	O
initially	O
before	O
transitioning	O
to	O
telerehabilitation	B-Application
.	O
</s>
<s>
Goal	O
setting	O
telerehabilitation	B-Application
has	O
been	O
shown	O
to	O
produce	O
increased	O
patient	O
satisfaction	O
and	O
improvement	O
in	O
activities	O
of	O
daily	O
living	O
compared	O
with	O
a	O
control	O
group	O
receiving	O
no	O
therapy	O
.	O
</s>
<s>
Virtual	B-Application
reality	I-Application
therapy	O
involves	O
the	O
use	O
of	O
a	O
sensor	O
to	O
detect	O
movement	O
and	O
a	O
virtual	O
environment	O
displayed	O
on	O
either	O
a	O
screen	O
or	O
headset	O
.	O
</s>
<s>
Studies	O
that	O
compared	O
virtual	B-Application
reality	I-Application
with	O
motor	O
training	O
exercises	O
have	O
shown	O
equal	O
or	O
better	O
outcomes	O
with	O
virtual	B-Application
reality	I-Application
.	O
</s>
<s>
Robotic	O
therapy	O
has	O
even	O
been	O
combined	O
with	O
virtual	B-Application
reality	I-Application
telerehabilitation	B-Application
to	O
create	O
a	O
virtual	O
environment	O
which	O
responds	O
to	O
robotic	O
movements	O
.	O
</s>
<s>
Robotic	O
telerehabilitation	B-Application
studies	O
have	O
shown	O
patient	O
improvement	O
from	O
baseline	O
but	O
equivalent	O
functional	O
outcomes	O
compared	O
with	O
motor	O
training	O
exercises	O
.	O
</s>
<s>
The	O
latest	O
evidence	O
suggests	O
that	O
primary	O
pulmonary	O
rehabilitation	O
and	O
maintenance	O
rehabilitation	O
delivered	O
through	O
telerehabilitation	B-Application
for	O
people	O
with	O
chronic	O
respiratory	O
disease	O
reaches	O
outcomes	O
similar	O
to	O
centre-based	O
rehabilitation	O
.	O
</s>
<s>
A	O
systematic	O
review	O
of	O
ten	O
studies	O
to	O
measure	O
the	O
effectiveness	O
of	O
telerehabilitation	B-Application
as	O
a	O
means	O
to	O
reach	O
"	O
cardiac	O
rehabilitation	O
"	O
has	O
shown	O
to	O
be	O
considered	O
as	O
an	O
effective	O
and	O
appropriate	O
measure	O
to	O
increase	O
participation	O
in	O
underdeveloped	O
areas	O
.	O
</s>
<s>
Addressing	O
this	O
technological	O
gap	O
could	O
help	O
showcase	O
the	O
potential	O
impact	O
of	O
telerehabilitation	B-Application
on	O
cardiac	O
rehabilitation	O
accessibility	O
and	O
participation	O
as	O
well	O
as	O
person-centered	O
,	O
health	O
,	O
and	O
economic	O
outcomes	O
.	O
</s>
<s>
In	O
a	O
2018	O
systematic	O
review	O
of	O
15	O
studies	O
it	O
was	O
found	O
that	O
there	O
were	O
no	O
significant	O
differences	O
in	O
given	O
tests	O
and	O
measures	O
between	O
telerehabilitation	B-Application
and	O
control	O
groups	O
when	O
it	O
came	O
to	O
post	O
stroke	O
care	O
.	O
</s>
<s>
Furthermore	O
,	O
the	O
study	O
goes	O
on	O
to	O
conclude	O
that	O
“	O
Telerehabilitation	B-Application
can	O
be	O
a	O
suitable	O
alternative	O
to	O
usual	O
rehabilitation	O
care	O
in	O
post	O
stroke	O
care	O
especially	O
in	O
remote	O
or	O
underserved	O
areas	O
.	O
</s>
