Telerehabilitation! Is it time to rethink Neurorehabilitation services in Pakistan?

Abstract

Telemedicine also known as Telehealth is a mean to support healthcare by using communication technology when there is distance between the participants.1 The healthcare system changed after the COVID-19 pandemic which expanded telehealth. Telerehabilitation has however been used as an adjunct to the in-person care instead of completely replacing it.2 For both medicine and surgery, the technologies used for telemedicine have recently gained popularity. Telemedicine has become a source of diagnosis and treatment by the use of telecommunication in remote areas. It helps people living in areas with shortage of medical facilities have an access to healthcare. Although arguments have been raised regarding in-person limitation, patient satisfaction and reduced quality of healthcare, there are various studies that have proved to be contrary.3 Telerehabilitation has been efficient in dealing with various neurological disorders including Parkinson's disease (PD). The characteristics of neurological diseases like progression, mobility concerns and unequal distribution of qualified and trained healthcare professionals makes an in-person session difficult.1 Some conditions other than parkinsonism, dementia, epilepsy and headache have also been replaced by telerehabilitation. Saporta et al (2020) proposed a tele-approach model for patients having neuromuscular conditions. The MRC score for strength was assessed through performance of specific tasks and sensory evaluation was done using cotton swabs or pin after guiding the caregivers. Adequate caregiver training can also be utilized for examination of other signs including balance, gait and cerebellar tasks. Repetitive virtual activities to evaluate fatigue can be performed to assess specific diseases like Myasthenia Gravis. Scales like inflammatory Rasch-built Overall Disability Scale (i-RODS) and ONLS can be used to measure upper and lower limb disability through daily life tasks that have been limited by the neurological conditions, they help in quantifying the disease.4 According to a study conducted by Alessandro et al (2019), telerehabilitation along with other techniques caused functional and psychological improvements in a patient of facial palsy.5 According to a systematic review by Asma Alonazi (2021) children having restricted access to physical therapy specially during Covid-19 and having conditions like autism, cerebral palsy, neuromuscular diseases, neurodevelopmental disorders etc benefitted from telerehabilitation.6 Telerehabilitation requires creative physical therapy approaches that have been used manually until now. It is a hope for better healthcare facilities in the areas of Pakistan where physical therapy is hard to reach through professionals. Although there is more to explore in telerehabilitation, it is worth applying, it will help in keeping rehabilitative services from saturating in certain areas of the country. References: • Demartini B, Bombieri F, Goeta D, Gambini O, Ricciardi L, Tinazzi M. A physical therapy programme for functional motor symptoms: a telemedicine pilot study. Parkinsonism & Related Disorders. 2020;76:108-11. • Tenforde AS, Borgstrom H, Polich G, Steere H, Davis IS, Cotton K, et al. Outpatient physical, occupational, and speech therapy synchronous telemedicine: a survey study of patient satisfaction with virtual visits during the COVID-19 pandemic. American journal of physical medicine & rehabilitation. 2020. • Piche J, Butt BB, Ahmady A, Patel R, Aleem I. Physical examination of the spine using telemedicine: a systematic review. Global Spine Journal. 2021;11(7):1142-7. • Spina E, Trojsi F, Tozza S, Iovino A, Iodice R, Passaniti C, et al. How to manage with telemedicine people with neuromuscular diseases? Neurological Sciences. 2021;42(9):3553-9. • de Sire A, Marotta N, Agostini F, Drago Ferrante V, Demeco A, Ferrillo M, et al. A telerehabilitation approach to chronic facial paralysis in the COVID-19 pandemic scenario: what role for electromyography assessment? Journal of Personalized Medicine. 2022;12(3):497. • Alonazi A. Effectiveness and acceptability of telerehabilitation in physical therapy during COVID-19 in children: findings of a systematic review. Children. 2021;8(12):1101.