A collaborative approach to the telerehabilitation of patients with hand impairments

Telehealth systems represent an ICT solution for delivering health services to the patients from a distance (Patient to Doctor/Doctor to Patient systems, P2D and D2P) or facilitating the consultation between the health professionals (Doctor to Doctor systems, D2D). Whether P2D/D2P systems aim at defining an interaction between the two involved figures crossing the boundaries of the hospital, D2D systems foster a professional interaction between physicians, typically for a second opinion or for a collaborative approach to the treatment. In this paper we present a collaborative extension of a system for telerehabilitation (patent pending), belonging to the P2D category, in order to include also some D2D features. The proposed extension promotes a collaborative scenario involving several actors with different roles and privileges on the system: the patient, the physiotherapist, the physiatrist, a consulting specialist and the administrator. All the involved figures interact through the telehealth system thanks to an expressly designed software infrastructure. The main P2D information How is ensured by the telerehabilitation kit, able to record and send over the internet the statistics on the main performance parameters extracted during the home rehabilitation sessions. Beyond the administrator, the system enables the interactions between the other figures (D2D) in order to propose, validate and comment possible rehabilitation protocol modifications in response to the performance trend of the patient, taking into account the possible effect of different systemic treatments the patient is subjected to. The design of such a collaborative framework descends from an engineering analysis of the experience gained in the context of the ongoing experimental trials about hand rehabilitation of rheumatic patients with the P2D system.