Telerehabilitation in spinal cord injury persons: a novel approach

The care of a spinal cord injury (SCI) person constitutes a great challenge for the provider: SCI persons are mobility impaired, and they are prone to develop multiple comorbidities such as diabetes mellitus, hypertension, obesity, bladder infections, wounds, and depression. Furthermore, disease manifestations can be misleading depending on the level of injury. The utilization of telemedicine to monitor patients and deliver care has opened a new horizon for SCI persons. Several telehealth programs are now in use to monitor pressure ulcers and postdischarge rehabilitation in SCI persons. To answer the need for a more comprehensive approach to the multifaceted manifestation of SCI at the James J. Peters VAMC, we have started a customized telerehabilitation program. The program monitors the most common comorbidities of SCI, it is instrumental in the reintegration of the SCI person in the community, it offers individualized in-home rehabilitation programs, it addresses safety issues, and it offers counseling, weight reduction, and maintenance plans. A team of SCI specialists-including an internist, a registered nurse, a physical therapist, a nutritionist, a psychologist, and a recreational therapist-are available for weekly meetings with the patients. The programs are tailored to the patients' needs and agreed upon by both parties. Both messaging devices and video monitors are utilized. An interdisciplinary template is used to record assessments and plans. Preliminary results are encouraging; coordination of the team and relative poor technology are some of the obstacles we have identified. Further evaluation is necessary to determine cost effectiveness.