Managing Patient Factors in the Assessment of Swallowing via Telerehabilitation

Undoubtedly, the identification of patient suitability for a telerehabilitation assessment should be carried out on a case-by-case basis. However, at present there is minimal discussion of how telerehabilitation systems can accommodate and adapt to various patient factors, which may pose challenges to successful service delivery. The current study examines a subgroup of 10 patients who underwent an online assessment of their swallowing difficulties. Although all assessments were completed successfully; there were certain patient factors, which complicated the delivery of the online assessment session. The paper presents a discussion of the main patient factors observed in this cohort including the presence of speech and/or voice disorders, hearing impairment, dyskinesia, and behavioural and/or emotional issues and examines how the assessment session, the telerehabilitation system, and the staff involved were manipulated to accommodate these patient factors. In order for telerehabilitation systems to be more widely incorporated into routine clinical care, systems need to have the flexibility and design capabilities to adjust and accommodate for patients with varying levels of function and physical and psychological comorbidities. 1. Introduction Telerehabilitation services often involve intensive, detail-oriented, and interactive assessments. Hence it is accepted that patients are ideally served by systems and technology designed to optimise high quality visual and audio during a real-time interaction [1]. It is, however, equally important that any telerehabilitation system or service is designed to be sensitive to and accommodate the needs of the end user [2, 3]. Optimising both the equipment technology and the adaptability/usability of the system helps to ensure the development of systems and services that function well and are sufficiently flexible to adapt to patients with various levels of capability. The use of telerehabilitation to conduct clinical assessments of dysphagia is an area of practice which is currently still in its infancy. Hence the system requirements necessary to optimise capabilities for both the user and the patient during online assessments of swallowing are still being established. Initial work by Lalor et al. [4] described the use of a videoconferencing system with fixed cameras to conduct an assessment of swallowing and language for a remote patient with global aphasia and severe dysphagia. Although session objectives were able to be met, the researchers reported facing multiple difficulties during the assessment, which were