TeleRehab 2.0 uses wearable sensors, cameras and custom motion-capture software to collect data from patients in remote communities, which is then sent to specialists in urban centres to provide accurate assessments. (Photo: Codie McLachlan)
The human touch of a high-tech University of Alberta project is starting to be felt by rural Alberta physiotherapy patients on the road to recovery.
The specialized assessments made possible through a telehealth project that began last summer are moving patients in small communities to tears of relief as they get the help they need.
“There’s so much gratitude,” said Emily Armstrong, co-ordinator for Tele-Rehab 2.0, a research project from the Faculty of Rehabilitation Medicine that remotely connects rehabilitation medicine specialists in Edmonton with clinicians and their patients in rural clinics, continuing-care homes and health-care centres.
“We had a client crying because she was so happy that we were able to give her this service she wouldn’t have been able to access otherwise,” Armstrong said.
“When we finished the treatment session, under her mask she was smiling from ear to ear. The improvement was like night and day. Tele-Rehab 2.0 offers them so much support on an emotional level. The patients see their doctors or physiotherapists engaging with the specialists, trying to help them live life better, and they are so relieved to actually be heard.”
Virtual consultations for complex problems
The project helps balance the scales for rural Albertans who may not have access to the specialized assessments they need because they face the costs and inconvenience of a 400-kilometre drive, missed days of work and an overnight hotel room, said Martin Ferguson-Pell, a professor in the Faculty of Rehabilitation Medicine and primary investigator on the project.
“We realized it was particularly important to provide access to complex assessments for rural patients by connecting a specialist clinician in a hub location to the patient and a generalist clinician based in the rural setting.”
The virtual consultations let specialists offer expertise for patients dealing with complicated problems, such as a shoulder injury that isn’t getting better, said Armstrong.
“You would bring in someone with more knowledge of shoulder pathology or who has more experience treating shoulders so that you can get some different ideas for treatment.”
The technology is also being welcomed by doctors, physiotherapists and other clinicians—particularly new ones—who may not have the special training required to assess and treat certain conditions.
“They’re receiving mentorship and support in handling complex cases.”
Since the project’s launch last July, 30 clients have received multiple specialized assessments to develop rehabilitation plans that help them recover and cope with their conditions, with 20 more on the waiting list. The hope is to get more funding to scale up the program to meet growing demand, said Ferguson-Pell.
Created in the U of A’s Rehabilitation Robotics Lab, Tele-Rehab 2.0 currently focuses on people experiencing shoulder pain, hip and knee replacements, and vertigo and balance issues. It also offers services for wheelchair users who need seating assessments, and recently added the capacity for falls risk assessment.
The pilot project, funded by Alberta Innovates, currently serves patients in the Peace River, Grande Prairie, Jasper and Pincher Creek areas, and recently expanded into continuing-care facilities in Edson, Hinton and Grande Cache, thanks to support from Employment and Social Development Canada through the United Way Covid-19 Emergency Community Support Fund.
Increasing role for telehealth
Being able to serve vulnerable seniors in long-term care during the pandemic makes Tele-Rehab 2.0—and the whole idea of telehealth—increasingly relevant, Ferguson-Pell noted.
“The seniors in those facilities are really nervous about going to a traditional clinic for an in-person assessment. We are able to keep them in their bubble and still get them the clinical assessment they need, without the risk of contracting COVID.
“The pandemic has suddenly caused everyone to realize we need to use this type of technology, and we’ve shown we can do it as well as in-person, and our clinicians are happy. They’re telling us the outcomes they are getting with their patients are as good as if it was in person.”
The technology used in Tele-Rehab 2.0 is constantly being refined by the companies partnering on the project, he noted. “We are pioneering their technology in virtual health.”
New enhancements being used to help patients include a telepresence robot created by Double Robotics with zoom-in vision to study patient expression during assessment and surgical wound healing, infrared video goggles from Vestibular First to help diagnose balance issues, and software from Kinetisense, an Alberta startup company that helps analyze gait and sit-stand strength.
All contribute to objective measurements that will allow for better tracking of patient progress and support additional consultations, Ferguson-Pell said.
“In time, these measurements will generate data to provide benchmarks for patient progress tracking and shared decision-making. The measurements and recordings we take should also help to reduce the need for multiple in-person assessments by different specialists.”
Beyond its cutting-edge use of technology, Tele-Rehab 2.0 is also paving the way for how to deliver that tool, with the team working out the bugs along the way, he added.
“The heavy lifting is really how you get the technology to work in a realistic clinical setting. Is the camera going to fit into the patient assessment room? It’s got to work out of the box and that can be hard to do. We’ve never had signposts to follow before for tele-rehab, so we’ve had to develop the pathways, and that can be shared with other clinics so they can do it too.”
Ultimately, he hopes to see these technologies and processes in routine use across Alberta and beyond. He would also like to expand the range of services offered to rural Albertans to ensure they have access to the best health care possible.
“We’ve made the commitment that we are going to make this work in real-life practice in Alberta.”
The Tele-Rehab 2.0 team is part of the U of A’s SMART Network. Funding support is provided by Alberta Innovates through the Pfizer-Alberta Collaboration in Health grant, by Employment and Social Development Canada through the United Way COVID-19 Emergency Community Support Fund, by the Alberta Health Services Bone and Joint Health Strategic Clinical Network and by a Rural Health Professions Action Plan grant.