The Basics of Telehealth Assessment and Treatment

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Practice using different platforms:

Tele-Rehabilitation requires a strong platform that offers competent technical and technological services. They may fall under the following categories

Video conferencing: This is on a continuous online platform that permits dynamic interaction between the client and therapist. This may include platforms like skype, zoom, google duo, watssapp cal etc

Image transfer: This includes transfer of select images for the purpose of treatment.

Data transfer: This includes transfer of information through non image or vdieo methods like emialing medical records, exercise plans etc

Technical support practice

• Technical support needed for a consultation includes
• Audio conference equipment
• Video conference equipment
• Computer networking (Wans and LANs)
• Broadband networks
• Satellite television which provide interaction

More information on these technical aspects of dealing with a teleconsultation is given in the page, Practical considerations in Telehealth

Recommendations for Consultations:

It is always considered better to conduct mock consultations to evaluate any technical glitches that may occur and evaluate network strength

Before the Consultation	Consider a pre call questionnaire (Self rating like in case of VAS or Body chart) Ask the client if they would like a partner or family member to be present during the consultation Schedule the consultation based on whom you need to see on a priority basis(Clinical triaging in telehealth) Confirm if a video graphic consultation is clinically appropriate Use a room that is private and well lit Make sure the patients phone number is ready, in case the video graphic link gives trouble Keep the patients clinical records ready and preferably on another screen Prior to the session test the technology , if it is works as its supposed to.
Start of the consultation	Always initiate the consultation by calling the patient Check the connectivity and clarity by asking the subject of he/ can see or hear. A formal introduction to the patient is a must A verbal consent must be taken from the client before the commencement of the assessment procedures It is always better to look at the camera for the client to make eye contact and restore the subjects faith in you In case there are other consultants in the room they need to be introduced to the client
The consultation	Maintain written records as you would for a face-to -face consultation. Be aware that the video communication is slightly different in comparison to their In case you are preoccupied, making notes or reading medical records, let the patient know
Closing the consultaion	Summarize key points, incase something went wrong technically this would really help Clarify any doubts the patient might have Confirm i the patient is happy with the video method of telehealth Remind the client not to stop his routine medication in case of any co morbidities present Say goodbye and close the call
After the consultation	Update the records Schedule referrals or follow up appointments Make sure the exercises, if promised in the form of an email are sent Prompt follow up email needs to be sent, summarizing the necessary features of the teleconsultation Face to face appointments in case necessary must be scheduled

Consultations:

The consultant or therapist must always be prepared. The therapist must develop a list of the questions that will have be asked. The key examination points including active movements, passive movements and special tests must be organised to optimize best utilization of the session time. Identify if any of the assessment procedures may require assistance by a family member.

To rely on observatory findings may be challenging as additional questions instead of your observation skills

Examination:

Safety is priority: Before we venture into the technicalities of this section it is important to understand that safety f the client is and must be the prime concern of every therapist. In the unlikely event that something goes wrong, a therapist must be able to reach out to the patient or have a system in place

Camera placement: The placement must give a good view of the client. This can be done by a few trial placement areas tried out in the subjects vicinity (EG: on a table ,adjusting the tilt of the laptop or placing the ipad on a stand that is aligned to give a good view of the client a he/she performs what is asked of him/her.

Adaptations for examinations:

Adaptations for usual tests.

Instruct patients how to do ROM, with How and order of the tests and patient movements

Teach patients to perform the exercise:- There are multiple ways to teach a patient a particular exercise and continually monitor as it is done in a face to face rehabilitation session. These methods can be followed with family members assisting whenever required

• Prerecorded video
• Online video demonstration
• Display of visual feedback
• Video conferencing
• Sensors embedded in task devices if they are available can track and relay information to the therapist
• Family member to assist if needed like with passive ROM

Tests that are not safe to perform. Replace with another test or additional questioning or rather in-person.

1. Exclude all reg flags
3. Rationale if a referral is necessary
4. identifying a support network of seniors or experts in the field who can advice and assist at any stage required. This channel needs to be active and the clinicians must be able to contact , as an when necessary
5. The contact details shouldn't be kept confidential, it would even be recommended to get seperate lines and contact ids for this purpose, after the consultation the numbers must be deleted or stored only i the official records

Always maintain the records of the patients

Reduce the amount of identifiable patient details that you share digitally

Assessment needs:

Empowerment of the patient

Individually tailored

Not recommended to assess:

Assessing high risk patient or patients with potentially high risk conditions

Patients with internal examination including any pelvic area examination

Coniditions or comorbidities affecting the ability to us technology including delusion, anxieties about using tecnology

Deaf and dumb individuals, may be difficulat , however the use of assitive technolgy may aid the process

Recommendations to the Organizers

Telehealth networks must be establishes, preferably standardized software or systems

Consulting and refereeing sites must be made available , probably like a smaller unit for immediate consultation when required

Standardized, goal oriented and time driven protocols must be in place for the efficient delivery of rehabilitation services specially in he acute phase

Continuing education and mock simulation conditions are suggested to continually train and update professionals offering services

Telerehablitation includes one mode of communication. In fact to optimize results and to evaluate adherence , multiple modes of of communication may be necessary, like video conferencing, telephone, desktop video phones, messaging devices, online chat sessions, video recordings, email.

Patient guide:

1. Decide what type of a consultation you would like or need (telephone consultation works well if a video isn't necessary). Video consultations are more reassuring due to the visual feedback.
2. Ensure your details last updated at the hospital are your current details (email id, phone number). locate a quite place, with good connectivity to the internet. test the device you will be using prior to the consultation. Make sure the Physical therapist has your credential details to know it is you and to respond timely. Login to the connection a few minutes prior to the consultation
3. During the process of the consultation, you can look at the screen, it isn't mandatory to look at the camera as this may be difficult. Any questions that require verification can be clarified. If the connection is disrupted in between , reconnect the call
4. Make sure to follow u on anything you have agreed to.

Evidences:

• Stroke rehabilitation: Quality of life, activities of daily living and upper limb function improved in the same capacity as that of face to face rehabilitation. No adverse events reported with the practice of telerehablitation,