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Amy C. Nau, Jacqueline Fisher; TelerehA Tele-Rehabiltation Pilot Study for Artificial Vision Devices. Invest. Ophthalmol. Vis. Sci. 2012;53(14):333.
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© ARVO (1962-2015); The Authors (2016-present)
The BrainPort™ (Wicab, Madison WI) pairs a camera to an electrode display which rests on the tongue. The device improves orientation and mobility for the blind by providing information about the proximal environment. Like all blind skills, practice is required to attain proficiency, but a lack of trained therapists, geographic and financial barriers are issues that must be overcome. Without a rehabilitation infrastructure to support long term training, rates of abandonment are likely to be high for artificial vision devices. Creative methods to overcome this deficiency must be urgently explored. The Rehabilitation Engineering Research Center at the University of Pittsburgh has developed a secure telerehabilitation portal termed Visyter. The purpose of this pilot study was to: 1) develop a year long rehabilitation protocol for advanced BrainPort training using existing Visyter infrastructure 2) determine the barriers to tele-rehabilitation in a blind cohort and 3) deploy a smartphone application allowing a sighted person to assist with training at home.
3 adult, male blind subjects were enrolled in this pilot study. Baseline psychophysical and mobility tests used in previous BrainPort studies were conducted on day 1 and again after approximately 15 hours of training at the UPMC Eye Center. Upon completion, subjects were sent home with a BrainPort, a Droid smartphone (Verizon) allowing a sighted person to directly view images displayed on the tongue, a camera and a speaker. The clinical interactions between the subject and therapist consisted of increasingly advanced skills and homework tasks covered during 30 minute sessions for 6 months. Subjects used their own computers with a high speed internet connection. Our primary outcome measure included development of a prototype tele-rehab conference capability.
We successfully deployed the Visyter software program to all subjects. Barriers included the need for a sighted person to assist with hardware and software set up, and ideally be present for training sessions. Computers with high speed internet access are needed. All subjects and therapists felt the portal was useful and the smartphone application to be very helpful. All subjects and therapists felt the interaction was as productive as face to face interaction.
This study showed that telerehabilitation represents a feasible strategy to overcome the barriers to successful long term rehabilitation with artificial vision devices. Future studies will explore use of smartphone cameras to allow for remote mobility training in outdoor settings as well as to investigate use of tele-rehabilitation portals for low vision populations.
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