Remote Wheelchair Selection: Supporting Wheeled Mobility and Seating Device Stakeholder's Decision in Telerehabilitation

Introduction

Telerehabilitation (TR) is a rehabilitation environment, in which the use of telecommunications technology provides rehabilitation and long-term support to people with disabilities in geographically-remote regions. Current wheelchair selection and evaluation processes are based on in-person assessment often not available to patients in underserved or rural areas due to lack of expertise by clinicians in wheeled mobility and seating (WMS) interventions. To improve current rehabilitation processes, technologists and clinicians have investigated the use of advanced telecommunications and information technologies as a way of bridging the geographic distance between individuals with specialized medical needs living in remote areas and the source of specialty care (Winters 2002 and Zampolini et al. 2008).

The National Institute on Disability and Rehabilitation Research (NIDRR) of U.S. Department of Education funds the Rehabilitation Engineering Research Center on Telerehabilitation (RERC-TR). Since December 2004, the RERC-TR at the University of Pittsburgh (www.rerctr.pitt.edu) serves people with disabilities by researching and developing methods, systems, and technology that support remote delivery of rehabilitation and home health services for people who have limited local access to comprehensive medical rehabilitation outpatient and community-based services. Research and development activities within RERC-TR are in the areas of TR infrastructure and architecture, TR clinical assessment modeling, teleassessment for the promotion of communication function in children with disabilities, remote wheeled mobility assessment, behavioral monitoring and job coaching in vocational rehabilitation, and remote accessibility assessment of the built environment.

WMS interventions have been considered one of the most important assistive technology devices in the field of rehabilitation. The expertise in WMS interventions is a core requirement of the current wheelchair selection and evaluation process. However, this expertise is often not available to patients in rural and/or underserved areas. Today's technology in WMS offers many choices, and makes it challenging to find the most appropriate device. In the last few years, the Centers for Medicare and Medicaid Services (CMS) have focused on ensuring the appropriate prescription of mobility equipment to its beneficiaries. As a result, Medicare issued new coding guidelines and coverage policies for power mobility devices (PMDs). This chapter reviews the current research works related to TR, wheelchair coverage policy issues, and decision support to improve TR practices. Finally, it introduces Remote Wheelchair Selection Advisor (RWS-A), a decision support system for clinicians, suppliers, and patients with mobility impairments to assist with the selection of an appropriate PMD. This system is from the project, titled “Evaluation of Remote Wheelchair Prescription” of the RERC-TR at the University of Pittsburgh. In conclusion, we discuss lessons learned from a focus group regarding the user acceptance and future direction of research on RWS-A.