New Technology Brings Back “House Calls”

Imagine the Telerehab system in development at the Houston VA Medical Center as a way of beaming “house calls” into veterans’ homes.

The hospital’s technologist, John Wright, and rehabilitation engineer, Tom Krouskop, created the Telerehab system for just that purpose - to create “house calls” without doctor or patient travel.

Computers are the backbone of the Telerehab system, carrying information through the telephone wires from home to office. Cameras extend vision, transmitting pictures from home to office and back again. Speaker and cellular phones let the doctor and patient talk to each other. And finally, a hand-held temperature sensor partially replaces the sense of touch for the doctor who might be miles away.

But all these gadgets don’t work by themselves. Houston VA researchers are examining ways to turn the system into a valuable part of a veteran’s medical care. Health science specialist, and associate physical medicine and rehabilitation associate professor at Baylor College of Medicine, Diana Rintala, Ph.D., and rehabilitation specialist Trilok Monga, M.D., who is also a physical medicine and rehabilitation professor at Baylor, are evaluating Telerehab’s usefulness and determining the impact it could have on a veteran’s health.

Veterans most likely to benefit from Telerehab, Rintala said, are those at risk of amputation due to chronic unhealed wounds. These veterans attend a special clinic at the hospital, the Preservation Amputation Care and Treatment, or PACT, program.

Veterans in PACT face real challenges in the healing process, Monga said.

“Conditions like diabetes and peripheral vascular disease interfere with healing. Leg wounds develop easily and heal slowly, needing numerous follow-up visits and specialized care,” he said.

Many veterans have long commutes to get to the hospital, he added.

“Fatiguing journeys are detrimental to an already difficult process of healing. Amputation wounds also need special follow-up care, requiring multiple visits,” Monga said.

Recently, veterans attending the PACT clinic were asked to help test Telerehab. They were first taken into the Telerehab laboratory, where a camera and a computer were set up, just as they might be in a veteran’s home. Then, in another section of the hospital, a physician examined the wound by talking with the patient over a speakerphone and asking questions. The same expert then walked down to the laboratory to inspect the wound in person, to see if his or her diagnosis matched his or her original rating.Early results have been promising. In most cases, the diagnosis was the same. Additional testing was done in veterans’ homes. All the tests went well, Rintala said, but many more questions remain.

“For now, participating veterans from the PACT program have the hope that Telerehab ‘house calls’ will save their energy for healing,” she said.

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©2006 Texas Medical Center

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