Biomedical Engineering Reference
In-Depth Information
Since its primordial application, the two main drivers of telemedicine were, firstly, the
chance to reach underserved users to provide sanitary services, as in the case of rural areas
or people living in adverse climatic conditions, and, second, the chance to exploit ICT to
propose innovative solutions for the organization of sanitary services in terms of efficacy
and efficiency. Nowadays, several studies demonstrate the chance to reach large popula-
tions of users, even in large areas, as well as the chance to manage information efficiently
among different professional profiles (Balch and Tichenor 1997; Balch et al. 2006). Recently,
an increasing number of projects have proposed the direct involvement of “informed”
users in the exploitation of telemedicine services, going on to redefine the relationships
between agents of the sanitary services.
Literature reviews, carried out analyzing pilot telemedicine experiences, demonstrated
that only a small amount of them were producing actual benefits with respect to traditional
approaches. However, it is important to note that most of these studies were developed
without updated technologies and in some cases without the availability of traditional
alternatives (Strode et al. 1999; Whitten et al. 2002). What is emerging is the need to carry
out telemedicine applications, including “cost-effectiveness” evaluations (in comparison
with traditional services), as an integral part of service design and analysis.
An important issue involving users and professionals is the problem related to the treat-
ment and management of privacy data. From a technical point of view, three main key
points are to be highlighted: confidentiality (granting access only to authorized agents),
integrity (no modification of user data), and availability (related to rights to access data).
At present, some tentative designs of shared standards have been considered to reach
interoperability among systems and applications, saving the need to design and exploit
autonomously designed telemedicine services.
16.3.2 Telerehabilitation
In the general framework of telemedicine applications, more recently telerehabilitation has
been developed: hence, a number of practical applications are already available supported
by the technological achievements of the last decade (1999-2010). These applications are
designed for distance rehabilitation by means of ICT as the media to transmit therapy data
(Lathan et al. 1999). The main driver for these applications compared with traditional sys-
tems was the chance to supply rehabilitation to users living in rural areas (Torsney 2003):
Remote access is allowing the users to access sanitary services (Hauber et al. 2002).
Another benefit of telerehabilitation is the prolonging of the rehabilitative time at home,
considering that, in some cases, intensive rehabilitation can ensure an effective recovery
from the impairment. The chance to extend the rehabilitative activities can also be useful
in the chronic phase, when the “lowering” of the function can also be caused by the “not-
used” condition (Taub et al. 2000).
Telerehabilitation has a large number of applications
with different complexities (from a simple telephone teleconsultation to distance operated
rehab exercise monitoring).
16.3.3 The nu!reha Platform
The platform represents the final realization resulting from an intense experimental
period in which concept design has been explored (Scattareggia et al. 2004; Zampolini
et al. 2007; Huijgen et al. 2008 ). The main idea is to supply personalized exercises for
execution at home by users in a distant, monitored manner. The system has been designed
to be a main application of part of the neurological rehabilitation service as an extension
