Forty to fifty million people in the European Union suffer from some kind of motor disability, a number which represents 10 to 13 percent of the entire population. The Rehabilitation Departments of the University Hospital at the "Vrije Universiteit" (AZVU) in Amsterdam and at the Roessingh Research and Development (RRD) Institute in Enschede work together in a telemedicine pilot project to assess the value of a multimedia movement analysis and advanced telecommunications platform in everyday clinical practice. Via this teleconsultation initiative, physicians are able to support each other in choosing the right treatment for a particular patient. The medical pilot study forms part of the overall MESH-project, which deals with the implementation of all sorts of Multimedia services on the Electronic Super Highway. MESH is funded by the Dutch Ministry of Economic Affairs.
For the MESH-project as a whole, a consortium of five industrial and research groups is responsible, comprising Lucent Technologies, KPN Telecom, SURFnet as the Internet-provider, the Telematics Institute, and the Centre for Telematics and Information Technology (CTIT) of the University in Twente. The teleconsultation pilot study has been separately financed by the Dutch Ministry of Health, Welfare and Sports and started in January 1998. Between June and October 1998, two physicians at Roessingh and the VU Hospital have exchanged discussions on nearly 40 patient cases via a high performance video-conferencing platform and by means of a large bandwidth Asynchronous Transfer Mode (ATM) communication link with a minimum data transfer speed of 5 Mb/s.
In the movement analysis laboratory of the RRD or AZVU department, the patient receives a full examination which results in a multimedia dataset of digitized videorecordings with electromyographic (EMG) and ground reaction force signals. This data is completed with the patient's medical history and clinical tests. Before the actual teleconsultation session takes place, the file first is being transmitted to the physician at the remote site for study. Both the RRD and AZVU locations dispose of an integrated MESH platform with a shared document viewing system for interactive use. During the session, the physicians apply a customized version of SYBAR, a multimedia system for human motion analysis, which allows real time synchronized viewing of the movement disorder data at both sites.
Especially in rehabilitation treatment for motor disabled persons, the video-conferencing facility has proven to be extremely useful. A verbal description of movement disorder is quite impossible without using subjective terms. As a result, unambiguous information about patient movement patterns cannot be transferred via telephone, e-mail or fax, since only visual data can avoid any possible misunderstanding in communication between physicians. The real time video and audio connections within the MESH platform facilitate the process of medical decision making although the remote consultant has no personal contact with the patient. The major advantage however of using teleconsultation consists in the cost-effective moving of information instead of patients.
The medical MESH pilot study has tested the teleconsultation facility within two different modalities. In the formal setting, the multimedia dataset has been generated in a standardized and protocolled hospital environment with high quality equipment, in which patient contact is established on a short term basis. This kind of High Structure-Low Volume (HSLV) scenario has been used in the MESH-project to select the most efficient treatment for children with a walking disability due to Cerebral Palsy (CP). The informal setting uses datasets with vague and indefinite information, which is often subjectively gathered. In this case, the teleconsultation session is applied in a Low Structure-High Volume (LSHV) scenario, which has served in MESH to advise the most useful orthosis for adult patients suffering from movement disorder due to a Cerebro-Vascular Accident (CVA) as well as for children with CP and Spina Bifida.
The project partners anticipate that teleconsultation soon will find its way in three specific domains, provided that the participating health professionals and hospital institutions are ready to introduce the necessary adjustments in currently existing clinical routine procedures. The geographical distance of rehabilitation facilities with specific expertise no longer plays any role for teleconsultation in rare patient cases. Second, health care delivery spreads its wings beyond the boundaries of the institutions and becomes much more patient-centred with shared responsibilities between the hospital physician and the general practitioner. Third, the use of teleconsultation will stimulate the introduction of new treatment methods and rehabilitation equipment. For more information on this project, we refer to the MESH home page.