Telerehabilitation for Stroke Survivors

Stroke is a type of blood vessel disorders in the brain that causes major disability in adults. Based on data from the National Institute of Health Research and Development, Indonesian Ministry of Health (Balitbangkes Kemenkes) in 2014, stroke is the leading cause of death in Indonesia. Stroke survivors have a tendency to experience movement and body function disorders which include conditions of immobility which, if not prevented, can interfere with the functioning of the body's systems, such as: decreased function of the musculoskeletal system, infections, decreased cardiovascular endurance and increased the risk of falls. It is needed professional treatment in improving or maintaining movement and body function in stroke patients.

Physiotherapy as a profession that plays a role in the movement and body function has a role in: prevention and promotion of health, curative (treatment), and rehabilitation. The treatment that has been given so far still emphasizes direct contact with patients. It is only patient who have direct access will get the treatment. Patients who are in the rural area or lack of physiotherapy professionals have less opportunity to access this health service. In addition, the current corona pandemic condition creates limited access to health services and limits the number of patients who are mobile while in health care, thus making conditions for stroke patients who need services cannot be handled properly.

A systematic review and meta-analysis study published at the Stroke and Cardiovascular Disease Journal in 2015 explains the effectiveness of the telerehabilitation approach in stroke patients. This study included 1,025 study participants. Telerehabilitation is defined as a rehabilitation service using communication media to obtain health services from professionals (such as telephone, video call, and audio-conference) to provide physiotherapy care processes which include: history taking (examination and measurement), intervention / therapy services, and evaluation patient related to movements and body functions.

This study included samples with stroke diagnosis with age over 18 years, rehabilitation procedures that included (telemedicine, telecommunications media, and telephone intervention programs, video-conferencing, robot-assisted rehabilitation, virtual and augmented reality therapy). The study was conducted for 4 weeks. The results of this meta-analysis show that conventional rehabilitation (face-to-face) has the same effect as telerehabilitation in improving the ability to carry out daily activities (such as bathing, feeding, dressing) and motor function in post-stroke.

Telerehabilitation methods that can be applied are various. It is also needed cooperation with other family members in terms of assistance/help patients if they cannot move independently. Physiotherapy services that can be provided include the examination procedure before the start of therapy (through online chat or video conference sessions). In addition, intervention procedures can be through training directions through video conferences, educational videos, or training postures and activities outside of the bed (sitting, standing, and walking) to the level of activity by involving interaction with people and the environment at home.

There have been no studies show that the application of telerehabilitation has more significant benefits than conventional therapy. This is because aspects of sensory-motor stimulation are directly needed for post-stroke patients. In addition, the application of telerehabilitation also has disadvantages such as good stability of internet signal connection which is needed and the application methods in acute stroke patients who need more strict monitoring, cannot be applied yet. However, in the face of the current pandemic, the therapeutic process directly requires security such as procedures for using personal protective equipment, and others. Thus, the application of telerehabilitation can be an alternative to provide therapeutic services for post-stroke patients in the current pandemic era.