The Beginner's Guide to Telehealth and Telerehabilitation for Low Vision

Is it difficult for you to travel to the nearest low vision clinic or private agency for vision rehabilitation therapy services? Do you find the cost, effort and stress of travel outweighs the benefits?

As health care services turn to videoconferencing, telemedicine and remote counseling, the logical next step would be to consider the effectiveness of a similar model applied to rehabilitation. 

In the last five years, the rehabilitation sector has seen an influx of research evaluating the impact and need of remote, video-based evaluation and follow-up. In this Beginner's Guide we will look closely at recent research in the fields of low vision and related therapy outcomes. Let's get up to speed. 

What is telerehabilitation?

"Telerehabilitation refers to the delivery of rehabilitation services via information and communication technologies (Brennan 2011). Clinically, this term encompasses a range of rehabilitation services that include assessment, monitoring, prevention, intervention, supervision, education, consultation, and counseling (Bittner, et al. 2015)."

It is an approach to rehabilitation that utilizes modern technology to reach people who otherwise wouldn't be able to attend therapeutic sessions. It seeks to break down the barriers that people in rural communities, or people with limited travel options, face when seeking help for their functional vision. 

Winters, J. (2002). Telerehabilitation research: Emerging opportunities.  Annual Review of Biomedical Engineering,   4 , 287-320.

Winters, J. (2002). Telerehabilitation research: Emerging opportunities. Annual Review of Biomedical Engineering, 4, 287-320.

How is telehealth and telerehabilitation applied in the medical sector and different therapies? 

Medically

Perhaps, like me, you first realized that you could access a medical doctor remotely via your health insurance app. I was SHOCKED to learn that I could get a prescription for sinusitis from my living room, in less than 20 minutes. eVisit, an online telemedicine company, offers us beginners a great overview of how telemedicine came to be. Read their Ultimate Guide here. 

"Telemedicine refers to the use of information technologies and electronic communications to provide remote clinical services to patients. The digital transmission of medical imaging, remote medical diagnosis and evaluations, and video consultations with specialists are all examples of telemedicine (eVisit)." 

Other Therapies

Occupational Therapy

Telerehabilitation, as defined by the American Occupational Therapy Association (AOTA) position paper, is the clinical application of consultative, preventative, diagnostic, and therapeutic services via two-way interactive telecommunication technology (Wakeford, Whitman, White, & Schmeler, 2005).

The Canadian Association of Occupational Therapists (CAOT) also has a position statement about tele-occupational therapy. CAOT recognizes the ongoing development of tele-occupational therapy, which will promote opportunities for effective, efficient, and accessible occupational therapy services, education and resources to all Canadians (Schmeler, et al. 2015).

Vocational Rehabilitation and Counseling

The Commission on Rehabilitation Counselor Certification (CRCC)  has published significant revision to the ethics code that contains new practice guidelines regarding the use of technology in assessment and distance counseling (Schmeler, et al. 2015).

The new code outlines that rehabilitation counselors are held to the same level of expected behavior as defined by the ethics code regardless of the technology used or its application. It offers practice guidelines on issues related to problematic use of the Internet, privacy, confidentiality and security (Schmeler, et al. 2015).

Speech Language Pathology 

ASHA uses the term “telepractice” to refer to “the application of telecommunications technology to deliver professional services at a distance” (American Speech-Language-Hearing Association, 2005). Since 1998, ASHA has studied the potential impact of telepractice on speech-language pathologists (SLPs) and audiologists and the individuals they serve (Schmeler, et al. 2015).

Physical Therapy

American Physical Therapy Association (APTA) has released a Board of Directors Position on telehealth. There are also articles explaining how physical therapists are using telehealth to overcome barriers of distance and time (Schmeler, et al. 2015). 

Winters, J. (2002). Telerehabilitation research: Emerging opportunities.  Annual Review of Biomedical Engineering,   4 , 287-320.

Winters, J. (2002). Telerehabilitation research: Emerging opportunities. Annual Review of Biomedical Engineering, 4, 287-320.

How can it be applied to Vision Rehabilitation Therapy?

"Delivering low vision rehabilitation services remotely via telemedicine has the potential to help people with vision loss maintain function and activities of daily living as well as social and psychological well-being (Bittner, et al. 2015)."

Although VRT telerehabilitation hasn't hit the mainstream yet, pockets of investigation are emerging.

AERBVI and ACVREP have not released positions on telehealth or rehabilitation at the time of this blog post, however the Journal of Visual Impairment and Blindness published the most recent study in 2016 entitled, Steps to Offering Low Vision Rehabilitation Services Through Clinical Video Telehealth. Spearheaded by the VA Buffalo VISIOR pilot clinic, they came to the following conclusions: 

"The increase in low vision clinical care at the Buffalo VA VISOR clinic, because of the addition of low vision telehealth clinics, has shown the effectiveness of access by helping more partially sighted and legally blind patients who could not schedule comprehensive low vision rehabilitation services in an outpatient or inpatient setting (Ihrig 2016)."

"Clinical video telehealth currently allows low vision rehabilitation with low vision optometrists and blind rehabilitation therapists in a manner that is timely and without the need for the patient to travel long distances to receive services (Ihrig 2016)."

How does telerehabilitation compare to in-person therapy?

In an exciting new comparative study by Baycrest Center for Geriatric Care, professionals evaluated the effectiveness of telerehabilitation strategies, and held up the results to the success of in-person therapies. Here is what they found:

"Telerehabilitation helps healthcare professionals reach more patients in need, but some worry it doesn't offer the same quality of care as in-person treatment. This isn't the case, according to recent research by Baycrest.

The study, published in the journal Aphasiology, found that patients who accessed speech language therapy over the Internet saw large improvements to their communication abilities that were similar to those of patients doing in-person therapy.

This finding encourages greater adoption of telerehabilitation to treat patients living in remote communities who are recovering from post-stroke communication disorders as a way to improve the use of limited healthcare resources (Baycrest Centre for Geriatric Care 2017)."

What is the future outlook for telehealth and telerehabilitation for low vision? 

Looking back at the Buffalo VA VISOR pilot telerehabilitation clinic, they found that most patients responded positively:

"Specifically regarding telehealth, patients noted they appreciate the low vision clinical video telehealth clinic because it allowed them to receive services they would not otherwise be able to access (Ihrig 2016)."

Overcoming the barriers of immediate intervention, transportation, geographical location, and access to VRT services, help ensure that the future of telerehabilitation is expansive. Although it is still in it's infancy, distance-based assessments, consultation and therapeutic interventions promise to broaden the availability of specialized therapies to those individuals who require support in overcoming these barriers. 


References

Baycrest Centre for Geriatric Care. (2017, July 20). Similar improvements between speech language therapy delivered online and in-personScienceDaily. Retrieved August 4, 2017 from www.sciencedaily.com/releases/2017/07/170720142332.htm

Bittner, A. K., Wykstra, S. L., Yoshinaga, P. D., & Li, T. (2015). Telerehabilitation for people with low vision. The Cochrane Database of Systematic Reviews8, CD011019. http://doi.org/10.1002/14651858.CD011019.pub2

eVisit: The Ultimate Guide to Telemedicine. https://evisit.com/what-is-telemedicine/

Ihrig, C. (2016). Steps to offering low vision rehabilitation services through clinical video telehealth. Journal of Visual Impairment & Blindness (Online), 110(6), 441. Retrieved from https://search-proquest-com.proxy.wexler.hunter.cuny.edu/docview/1847926465?accountid=27495

Schmeler, M., Schein, R., McCue, M., & Betz, K. (2015). Telerehabilitation and Clinical Applications: Research, Opportunities, and Challenges. International Journal of Telerehabilitation, 0, 12-24. doi:https://doi.org/10.5195/ijt.2008.701

Winters, J. (2002). Telerehabilitation research: Emerging opportunities. Annual Review of Biomedical Engineering, 4, 287-320.