1、Beijing Conference October 2001Nigel Shapcott,M.Sc.,A.T.P.翻译：王季军，审校：王珏翻译：王季军，审校：王珏 博士博士匹慈堡大学健康与康复科学学院康复科学与技术系匹慈堡大学健康与康复科学学院康复科学与技术系匹慈堡大学医学院健康系统辅助技术中心匹慈堡大学医学院健康系统辅助技术中心Beijing Conference October 2001US Dept.of Agriculture SBIR I and II.Center for Excellence in Rural Medically Underserved Areas,PA.Vet
2、erans Affairs Rehab Research&Development ServiceDept of Rehab Science&Technology at the University of PittsburghUPMC Center for Assistive Tech.UPMC Spinal Injury CenterHERL VA Medical Center PittsburghBeijing Conference October 2001 Michael Boninger MD Laura Cohen PT Rory Cooper PhD Rosi Cooper PT S
3、hirley Fitzgerald PhD Mark Schmeler OT Tricia Thorman OTBeijing Conference October 2001Beijing Conference October 2001传输评价数据传输评价数据压力压力/空间数据空间数据辅助技术从业人员辅助技术厂商注册护士认证矫形及修复专家OTR,PT理疗医师基于图像与声音的评价基于图像与声音的评价专家中心专家中心非专业 OTR or PTCOTA or PTARTS 技师LPN矫形或修复专家上门服务护士乡村站点乡村站点远程传输各种影响康复的因素远程传输各种影响康复的因素：轮椅轮椅，创伤护理创伤
4、护理，治疗跟踪治疗跟踪，培训等培训等。Beijing Conference October 2001 资源与距离资源与距离没有足够的熟练人员没有足够的熟练人员大量的服务不周大量的服务不周过于遥远过于遥远病人过早出院病人过早出院死亡率死亡率伤残率伤残率帮助技术帮助技术大约大约 200 英哩英哩宾州宾州-西部西部/中心中心Beijing Conference October 2001Beijing Conference October 2001 为居住在大城市外的人提供为居住在大城市外的人提供更方便的健康监护更方便的健康监护 缩短病人与医师到诊所和医缩短病人与医师到诊所和医院的路程院的路程 更多专
5、家可参与到诊断评价更多专家可参与到诊断评价 对出院病人实现疗效随访跟对出院病人实现疗效随访跟踪踪Beijing Conference October 2001Beijing Conference October 2001Beijing Conference October 2001Beijing Conference October 2001Beijing Conference October 2001 Beijing Conference October 2001目标与方法目标与方法为使用有线电话传输声、光信号来进行辅助技术远程处方服务的电视会议系统建立评价其可靠性与局限性的科学基础。确定在
6、由于地理、交通、经费原因而不能提供良好服务的社区中，增加辅助技术的处方服务能力的潜力。用远程康复系统对患者所需轮椅或座位进行评价，并与现场康复评价的结果相比较。Beijing Conference October 2001研究问题研究问题有经验的临床医师用远程康复技术和已定义的操作协议能否：可靠地确定远程康复流程对特殊病人是否合适而安全？可靠地、在细节水平上提供关于所需轮椅精确决定？可靠地获取关于病史与体检结果的准确评估？Beijing Conference October 2001 评估评估面谈-从标准信息表获得病人信息以组成“模 型患 者”；与患者面谈确定灵活的目标、目标的合适性、诊断以及
7、身体健康状况的任何变化。坐垫评价-由临床医师亲自进行运动测量评价或通过远程康复系统由临床医师指导助手进行评价。坐垫评价的目标是建立被动和主动的上、下肢运动范围、任何病理移动方式、坐姿和移动技术、脊椎定向，及与运动和其它目标相关的功能性能力。测量-临床医师或其助手用数据收集表要求记录线性或角度测量结果。Beijing Conference October 2001 20 个测试者作为“模型患者”4 个评价者交叉学习2 个本地2 个现场In Person(IP)2 个远程康复(TR)数据采集协定的细节（表格）4 个临床医师(2 OT,2 PT)9 个“助手”培训远程康复评价移动ROM尺寸测量Bei
8、jing Conference October 2001荣军医疗中心Highland Drive匹慈堡匹慈堡大学医疗中心辅助技术中心匹慈堡Beijing Conference October 2001CAT TRCAT IPVA IPVA TR临床医师 1 评价临床医师2 评价临床医师3 评价临床医师4 评价第 1 天第 2 天两次评价间两次评价间 隔隔 三到七天三到七天Beijing Conference October 2001数据收集数据收集:由一个物理治疗师、一个统计员、二个职业治疗师、二个理疗师、一个康复工程师组成的小组设计一系列综合数据统计表。这些表用于记录患者的特征、患者的环境及
9、处方细节。它们是在对一系列已有表格及“图森辅助技术计划”的工作框架进行分析总结后建立起来的。Beijing Conference October 2001IN T A K E FO R M#1(Sim ulated T elephone Interview)PA ST M E D IC A L H IST O R Y:Please tell m e your nam e,SS#,address and phone num ber.1)N am e _ 2)SS#_ 3)A ddress_ 4)Phone _ 5.Please tell m e w hat your m ain diagnose
10、s are:(1)_(2)_(3)_ 6.Is your condition is stable,im proving or deteriorating:(1)Stable (2)D eterioration anticipated (3)Im provem ent anticipated Page 1 of 7 Beijing Conference October 2001INTAKE FORM#2-Wheelchair Information-To be completed by inspection and withheld from clinicians WHEELCHAIR SPEC
11、IFICS:1.Is a wheelchair used?(0)No (1)Yes Is the primary wheelchair manually propelled?(0)No (1)Yes Wheelchair type?(1)Standard(2)Light weight(3)Ultra light weight Page 1 of 5 Beijing Conference October 2001 SUPINE EVALUATION Pelvic Mobility 1.Is Anterior Posterior Pelvic tilt a problem?(1)No(Neutra
12、l Achieved,Flexible)(2)Yes Anterior and Posterior (1)Fixed (2)Neutral not Achieved(3)Anteriorly Tilted (4)Posteriorly Tilted 2.Is pelvic rotation a problem?(0)No(Neutral Achieved,Flexible)(1)Yes Page 8 of 17 Beijing Conference October 2001Beijing Conference October 2001FORM#4-RECOMMENDATIONS 1.Shoul
13、d the person be seen again for a more in depth evaluation,or should they be referred elsewhere?Explanatory note:In this context this question assumes that if a prescription is determined to be safe to continue remotely then a wheelchair would be made available for a trial at some later time and the
14、NO box would be checked.If it is not safe to continue for any reason then the YES box should be checked.(1)NO (2)YES Confidence in Answer Low confidence 1 2 3 4 5 Certain 2.Primary Wheelchair Type(result of this evaluation)2.1 Manual-self propelled (1)NO (2)YES Confidence in Answer Low confidence 1
15、2 3 4 5 Certain Frame Type Check Boxes to indicate choices of features(1)Folding frame (2)Rigid Frame (3)TIS (4)Recline Page 1 of 7 Beijing Conference October 2001问题问题 1：进一步评价：进一步评价多人评价 Kappa,4 clinicians,0.464&p=0.07多人评价 Kappa，3 clinicians,0.615&p=0.03远程康复评价与 现场评价：Kappa 0.615,p=013simple agreement
16、90%(Weighted Kappa issue)Beijing Conference October 2001问题问题2：轮椅类型轮椅类型手动轮椅-simple agreement 100%(n=4)电动轮椅-simple agreement 100%(n=4)小型摩托-simple agreement 100%(n=1)Beijing Conference October 2001问题问题3：轮椅特征轮椅特征手动轮椅:(折叠式,固定式,TIS,可躺式)-simple agreement 75%电动轮椅特征:(可躺式,TIS)-simple agreement 94%电动轮椅驱动:(前驱,后
17、驱,中间驱动)-simple agreement 69%小型摩托:(3 轮或 4轮)-simple agreement 50%Beijing Conference October 2001问题问题4：座位尺寸座位尺寸座宽:(18英吋)-simple agreement 61%依据患者的座位总宽度:(18英吋)-simple agreement 66%座长:(18英吋)-simple agreement 75%依据患者的座位总长度:(18英吋)-simple agreement 44%Beijing Conference October 2001问题问题5：座位的坐垫特征座位的坐垫特征支撑座垫:
18、(大腿中部,大腿侧部,臀部)-simple agreement 86%要求专用座垫:(是,否)-simple agreement 86%要求减压座垫:(是,否)-simple agreement 78%Beijing Conference October 2001问题问题6：座位的靠背特征座位的靠背特征靠背侧部支撑:(左侧,无)-simple agreement 83%靠背侧部支撑:(右侧,无)-simple agreement 83%要求专用靠背:(是,否)-simple agreement 80%Beijing Conference October 2001问题问题7：头靠与扶手头靠与扶手
19、要求头靠:(是,否)-simple agreement 94%要求扶手:(是,否)-simple agreement 94%Beijing Conference October 2001结论结论:易于建立与使用必须有高质量的音频信号要求专业的临床医师长度测量结果太粗糙-要考虑更换简易测量工具(Logan等 1998)Beijing Conference October 2001Beijing Conference October 2001Beijing Conference October 2001Beijing Conference October 2001Beijing Conference October 2001Beijing Conference October 2001Beijing Conference October 2001宽带系统联接到德克萨斯州的中心，以有线电话接入用户家。目前，由于缺乏基金支持，远程康复服务被局限于用在特殊病例或演示方面。
