Tele-rehabilitation through interactive video endorsement

The THRIVE Video-conferencing Platform is composed of a purpose-designed PC-based set-top-box which is meant to be connected to a TV monitor and to a communication line (ADSL or ISDN). The Platform comprises the following items: - 1 Central Unit (Set-top-box); - 1 Webcam; - 1 microphone with noise and echo cancellation; - 1 remote controller; - 1 USB electronic security key; - 1 Audio/Video television connection cable and the relative SCART adapter; - 1 Power cable; - 2 audio interconnection cables; - untwisted cable to connect to the ISDN socket or to the ADSL modem; - 1 system reference manual; For the Platform to work, a colour TV monitor equipped with an A/V or SCART connector is required. The Video-conferencing Platform is powered by a software which is specifically designed to allow operation by people with limited manual skills and which allows the sending and storing of video messages.

Quality of life (QoL) is both the ultimate goal of rehabilitation following a spinal cord injury (SCI) and a key outcome to be used in determining the effectiveness of rehabilitation programmes [K. Whalley Hammell]. - However many QoL instruments used in research about SCI patients have not been validated for this particular group of individuals (in terms of reliability, validity and sensitivity), or include inappropriate or questionable items. - After a systematic literature review we decided to use the WHOQoL 100, a general health related quality of life (HRQoL) instrument, developed by an international research group promoted by the World Health Organisation. - In THRIVE WHOQoL 100 has been systematically applied to assess QoL among SCI patients. This has shown that QoL always declines after discharge from a Spinal Unit, although scores on spirituality proved to be better among subjects assigned to the 'Telemedicine' rather than the 'Control' Group in all the three sites participating in the trials. - The findings of the THRIVE project highlighted as the time after discharge is particularly critical: SCI patients can feel abandoned and frail. Telemedicine can have an important role of clinical, psychological and social support.

Physiotherapy and ergotherapy have an important role in the multidisciplinary care for spinal cord injured patients to prevent complications and chronic disease and to restore activities of daily life and occupational skills in patients with impaired mobility. Therapies are highly specialized and address patient mobility using wheelchairs, prostheses and domotic home equipment. Therapists must be trained in specialized Spinal Units to deliver this type of care which is often unavailable where patients live. THRIVE has developed a tele-rehabilitation protocol in which all aspects of physiotherapy and ergotherapy were integrated to ensure that patients can be followed also after their discharge from the spinal cord unit. Protocol efficacy was demonstrated by comparing a selection of predefined outcomes in patients who received tele-rehabilitation and patients who received only standard homecare in a randomised controlled trial. The protocol was validated and adapted after the feedback from the participating physiotherapists and ergotherapists. THRIVE has provided evidence that physiotherapy and ergotherapy for spinal cord patients can be successfully integrated in a tele-rehabilitation program. The THRIVE therapy protocol is ready to be used by interested health institutions and offers, when used together with the THRIVE medical and nursing protocols, new possibilities for the care of patients with spinal cord injury.

Medical care for spinal cord injured patients requires a collaborative effort of various medical specialities such as internal medicine, neurology, neurosurgery, psychiatry, physiatrics, orthopaedics, dermatology and urology. Specialised Spinal Units deliver this type of care which is expensive and limited to the first months after injury. There is a need to extend spinal unit care to the home of patients in order to reduce patient's length of stay in Spinal Units and to improve the quality of care after discharge. THRIVE has created a tele-rehabilitation protocol in which all aspects of medical care were integrated to ensure effective detection of medical complications over time and to start therapeutic action when needed. Protocol efficacy has been demonstrated by comparing a selection of predefined medical outcomes in patients who received tele-rehabilitation and patients who received only standard home care in a randomised controlled trial. The protocol has been validated and adapted after the feedback from medical specialists, patients and caregivers. THRIVE has provided the proof of concept that telemedicine can be successfully applied to spinal cord injured patients. The THRIVE protocol is ready to be used by interested health institutions and offers new possibilities for the in-home care of patients with spinal cord injury.

Nursing care for spinal cord injured patients requires specialized nursing skills for an effective management of bladder and bowel dysfunction, care of pressure ulcers and also to deal with the frequently associated psychological difficulties. Specialized Spinal Units deliver this type of care which is expensive and limited to the first months after injury. There is a need to extend spinal unit care to the home of patients in order to reduce patient's length of stay in Spinal Units. THRIVE has created a tele-rehabilitation protocol in which all aspects of nursing are integrated to ensure effective nursing assistance over time. Protocol efficacy has been demonstrated by comparing a selection of predefined medical outcomes in patients who received tele-rehabilitation and patients who received only standard homecare in a randomised controlled trial. The protocol has been validated and adapted after the feedback from the participating nurses, patients and caregivers. THRIVE has provided evidence that nursing for spinal cord patients can be successfully integrated in a tele-rehabilitation program. The THRIVE nursing protocol is ready to be used by interested health institutions and offers, together with the THRIVE medical and therapy protocols, new possibilities for the care of patients with spinal cord injury.

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