Telepractice as a service model in speech and language therapy has significantly grown in Germany since the pandemic. However, the implementation is not yet satisfactory. The Hybrid and Interactive Speech and Language Therapy after Stroke project (HiSSS) aimed to provide a complex therapy platform that would integrate both synchronous and asynchronous therapeutic elements for the first time in Germany. This study aimed to evaluate the usability of an early-stage platform by involving people with speech and/or language impairment and speech and language therapists in the development process to ensure that the system was tailored to their needs. Structured observation and a focus group were used in an exploratory usability workshop. Participants provided feedback on facilitators and barriers, suggestions for improvement, training needs, and support while using the platform. The results of the exploratory usability workshop showed that both end user groups would be interested in a future use of the HiSSS platform.
Background: Ensuring equitable access to effective interventions for people with Parkinson’s disease (PD) remains a global challenge. Although dance and multimodal exercise improve motor and non-motor symptoms, no randomized controlled trial has compared their feasibility, safety, and participants’ perceptions when delivered online in a group-based format. Methods: This randomized controlled feasibility trial allocated participants to a dance or multimodal exercise group incorporating music. Interventions were delivered via videoconference twice weekly for 12 weeks. Feasibility and safety were assessed through adherence, attendance, technological barriers, and adverse events. Participant perceptions were evaluated post-intervention using study-specific structured interviews. Results: Seventy-five participants were enrolled (dance: n = 40; multimodal exercise: n = 35), predominantly women, with mild-to-moderate PD (Hoehn & Yahr Scale 1.0–3.0). Both interventions were feasible and safe, with high adherence (82.5–85.7%), moderate attendance, and no adverse events with similar participants’ perceptions across the groups. Conclusions: Group-based online dance and multimodal exercise are feasible, safe, and well accepted for people with mild-to-moderate PD, supporting their use as telerehabilitation options in clinical practice.
Telehealth is a broad term used to describe the use of electronic or digital information and communications technologies (ICT) to deliver clinical healthcare, patient and professional health-related education, and public health and health administration. More recently, the term digital health has emerged to refer to the use of digital technologies as tools and systems that contribute to improving healthcare outcomes (i.e., artificial intelligence and machine learning, digital therapeutics, mHealth, remote patient monitoring, remote therapeutic monitoring, wearable devices, and other health analytics and information software systems). These technologies enhance the efficiency of health care delivery through the broad use of information and communication technologies (ICT) and in some commercial applications include telehealth. This document is a revision of the American Telemedicine Association's (ATA) "Principles for delivering Telerehabilitation Services" (2017) and reflects the current utilization of telerehabilitation services. Its purpose is to inform and assist practitioners in providing effective and secure telerehabilitation services that are based on client needs, current empirical evidence, and available technologies. Rehabilitation professionals, in conjunction with professional associations and other organizations are encouraged to use this document as a resource for developing discipline-specific standards, guidelines, and practice requirements. This guide is not intended to replace the primary practitioner's clinical decision-making about the appropriate course of healthcare for any client.
Autistic children may need additional support to manage daily activities compared with their peers. Telehealth occupation-based coaching (OBC) may help them participate in daily activities and develop related skills. Although telehealth OBC is feasible and acceptable to caregivers, its acceptability to children remains unknown. This phenomenological study explored the lived experiences of seven children who completed dyadic, telehealth OBC with their caregivers. We conducted semi-structured interviews and thematic analysis to understand their perspectives on intervention acceptability. Three themes emerged: (1) I want to be included and heard in coaching calls, (2) I can learn to participate in coaching, and (3) I like coaching because I met my goals. Findings suggest that dyadic, telehealth OBC is acceptable to children because it supports their inclusion, fosters self-efficacy in coaching, and contributes to perceived improvements in daily activities. Findings also provide preliminary evidence that this approach can promote child engagement and self-determination.
Despite the recent surge in the use of telerehabilitation (TR) for neurological disorders, there is a lack of TR programs tailored to persons with Parkinson’s disease (PwPD), particularly in low-resource settings. To address this gap, we aimed to develop a tele-assisted home exercise program for improving balance and functional mobility in PwPD (TELEPORT-PD). An e-Delphi process was conducted with an international, interprofessional team of experts involved in rehabilitation of PwPD. A comprehensive pool of exercises was compiled and evaluated across three rounds of e-Delphi process. Out of 473 exercises pooled from literature and experts, 99 exercises entered the e-Delphi process after deduplication and were categorized under six domains. After consensus, the final program included 42 exercises along with dosage, progression, and safety considerations. The TELEPORT-PD protocol developed through an international, e-Delphi consensus could be adapted for its use in low-resource settings worldwide.
Background: Artificial intelligence is expanding into telemedicine and telerehabilitation, yet significant privacy and security concerns persist. Scope: To synthesize empirical evidence on privacy and security approaches in health care, particularly those relevant to distributed home care. Methodology: A systematic review identified 80 studies (2019 to 2025), and Latent Dirichlet Allocation (LDA) topic modeling characterized the privacy and security themes. Results: Sixty-six studies addressed privacy, only seventeen addressed security, and three studies addressed both. LDA identified four themes: patient data privacy, federated learning for medical imaging, encrypted training and secure computation, and healthcare data governance. Most studies emphasized privacy-preserving approaches, like federated learning, encryption, and differential privacy. Almost half were conducted outside healthcare environments, limiting insight into real teleclinical and telerehabilitation workflow. Conclusion: Securing healthcare AI will require a multi‑layered governance framework, broader global representation, and integration of privacy and security protections into routine clinical workflows.
This study investigated the feasibility of delivering Semantic Feature Analysis (SFA) within a fully immersive virtual reality (VR) environment for adults with normal cognitive aging (NCA) and communication disorders (CSD). The scope included short-term semantic feature training, baseline assessments, and evaluation of engagement and acceptability. Thirty-five adults (11-younger, 11-older, and 13-CSD) completed a two-phase protocol involving standardized SFA and VR-delivered SFA (VRSFA) across five tasks: picture naming, associative matching, common feature identification, semantic feature questions, and integrated SFA training. Participants completed cognitive and language assessments pre- and post-intervention, with qualitative feedback gathered through thematic analysis. Quantitative data were analyzed using non-parametric tests to assess group differences and task effects. Findings indicate that immersive VR is a feasible, engaging, and promising approach for delivering evidence-based semantic-feature training for individuals with typical and impaired cognitive communication profiles. Results support continued exploration of VR as a scalable and accessible rehabilitation modality in speech-language pathology.
The increased utilization of telehealth services necessitates systematic evaluation of patients’ experiences with technologies, tools, and interventions adapted for the remote delivery of rehabilitation programs. This study examined the usability of Zoom™ as a telehealth platform for delivering a virtual fall-risk screening program in older adults. A convenience sample of community-dwelling older adults participated in a single virtual fall-risk screening session conducted via Zoom. Following the session, participants completed the 9-item System Usability Scale (SUS). Thirty participants (mean age = 71.47 years, SD = 5.97) completed the study. The mean SUS score was 76.30 (95% CI [71.47, 82.03]), exceeding the established benchmark of 68 for average usability and approaching the threshold of 80, indicative of excellent usability. Subscale analysis demonstrated that scores for perceived complexity, ease of use, and user confidence exceeded benchmark values, whereas learnability yielded more variable results. Overall, Zoom demonstrated good usability for virtual fall-risk screening in older adults. Participants reported that the platform was easy to use and facilitated confidence, supporting its suitability for remote telerehabilitation screening and intervention delivery.
Hand tendon injuries require a long rehabilitation process. Telerehabilitation may offer advantages in terms of accessibility, time, and cost. Accordingly, this study aimed to determine the efficacy of telerehabilitation in individuals who underwent hand tendon surgery. This randomized controlled study comprised two groups: a home program group and a telerehabilitation group. While the control group continued their routine treatment and home program, the intervention group’s home program was monitored via telerehabilitation three times per week for six weeks. Outcomes were assessed using the Visual Analog Scale (VAS) for pain, a baseline hydraulic hand dynamometer for gross grip strength, a Lafayette hydraulic pinch meter for fine grip strength, the Nine-Hole Peg Test for dexterity, and the Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) questionnaire for functional status. The findings indicated that telerehabilitation had positive effects on activities of daily living and overall functionality.
Background: Despite the growing use of telehealth in stroke rehabilitation, it remains unclear whether online assessments can match the accuracy of in-person evaluations. Purpose: To investigate the safety and reliability of tele-assessment using the 360 Degree Turn Test in individuals with chronic stroke under controlled conditions. Methods: Twenty-five individuals with chronic stroke were assessed both in person and via synchronous tele-assessment with a 24–48-hour interval. Online assessments were conducted via video call by a trained physiotherapist. One month later, the same physiotherapist and a second physiotherapist scored the recorded assessments asynchronously. Results: There was a high level of agreement between in-person and tele-assessment (ICC > 0.90). Tele-assessment demonstrated excellent intra- and inter-rater reliability. However, participants took significantly longer to complete the test during tele-assessment (p < 0.05). No adverse events were observed. Conclusion: Tele-assessment using the 360 Degree Turn Test demonstrated high reliability and appeared to be safe under the specific conditions tested (i.e., chronic participants, caregiver presence, and controlled environment). However, performance outcomes obtained via tele-assessment may not be directly comparable to in-person assessments in longitudinal follow-up.
Two complementary editorials are presented by two IJT editors. The first editorial reflects upon aspects of the relationship between Artificial Intelligence (AI) and telerehabilitation and points out that current AI terminology, in which AI is employed as "an umbrella term" can be imprecise and confusing. The second editorial observes that telerehabilitation is now entering a new stage of development in which digital health, computer science, artificial intelligence, and rehabilitation medicine are becoming increasingly integrated. The future use of Human Digital Twins as dynamic, patient-centered digital representations will enable individualized assessment, rehabilitation planning, monitoring of patient trajectories, and decision support across distributed care environments.
The implementation of machine learning techniques enables the analysis of large data corpora to differentiate response patterns based on exercise parameters, providing insights for implementing efficient telerehabilitation of reading skills. In this study, we applied unsupervised machine learning methods to investigate rehabilitation training trajectories in response to a self-adaptive teleintervention of reading decoding. We analyzed data from 6,692 children and adolescents using the Reading Trainer app for at least two months. Using K-means clustering, we identified eight distinct learning curve patterns, subsequently categorized as No-responders, Partial Responders, and High Responders based on the differences between initial and final reading performance. Multinomial regression analysis showed that younger children with greater initial difficulties and those who completed a higher number of in-session exercises during treatment were more likely to be classified as High Responders. These findings provide crucial insights to predict responses to reading intervention and help in personalizing telerehabilitation strategies.
Introduction: Pelvic floor dysfunctions (PFD) are common during pregnancy, and the metabolic stress of Gestational Diabetes Mellitus (GDM) may exacerbate this condition. Supervised muscle training is an option that might be effective for treating PFD. This study aimed to evaluate the effects of a semi-supervised exercise program, delivered via telerehabilitation, on pelvic floor function in pregnant women with GDM. Methods: A randomized, controlled, blinded clinical trial was conducted with participants allocated into an Exercise Group (EG; n=20) and a Control Group (CG; n=20). The EG performed an exercise protocol (aerobic, global strength, and pelvic floor muscle–specific training) for 10–20 weeks, with telemonitoring via smartphone. The CG received educational booklets. Pelvic floor muscle function, PFD symptoms and impacts, and sexual function were assessed before and after the intervention. Perceived global improvement was measured at the end of the study. Results: Although no between-group differences were observed post-intervention for the overall sample, the stratified analysis of participants with urinary incontinence (UI) revealed a significant time-by-group interaction for the International Consultation on Incontinence Questionnaire–Short Form (ICIQ-SF) (p = 0.007). Among women with UI, post-intervention between groups comparisons indicated mean differences of 4.07 (IC95%: 1.03;7.11) for the ICIQ-SF, 14.51 (IC95%: 1.26;27.76) for the UDI, and 2.68 (IC95%: -19.21;24.57) for the UIQ. In this subgroup, the EG demonstrated a numeric significant reduction in urinary discomfort and a protective effect against worsening UI severity compared with the CG. Conclusion: A semi-supervised telerehabilitation program appears to be effective in reducing and preventing the progression of urinary symptoms in pregnant women with GDM and pre-existing urinary incontinence.
The Lung Transplant GO (LTGO) randomized controlled trial evaluated the efficacy of a telerehabilitation behavioral exercise program after lung transplantation compared to enhanced usual care (EUC). We hypothesized that the LTGO treatment condition would show significantly greater improvements in change scores from baseline to 3 and 6 months for outcomes of physical function, physical activity, and blood pressure control compared to the EUC condition. The sample included 88 lung transplant recipients (LTRs) randomized 1:1 to either LTGO or EUC. No statistically significant differences in change scores for physical function, physical activity, and blood pressure control were found between treatment groups at 3 and 6 months. While no statistically significant difference in outcomes were found between groups, null findings are not uncommon. These findings and the discussion of post-trial considerations are important for the design of future trials to inform the field of telerehabilitation.
Ukraine's current rehabilitation and healthcare challenges have catalyzed a national push toward scalable, AI-enabled digital health solutions. This Letter reports on a joint initiative of I.Ya. Horbachevsky Ternopil National Medical University, and the V.M. Glushkov Institute of Cybernetics of the National Academy of Sciences of Ukraine to operationalize the human digital twin (HDT) concept within a tele-diagnostic (TD) & artificial intelligence (AI) platform for telerehabilitation and digital education. The Letter delineates how HDTs, understood as continuously updated virtual representations of individual patients, are coupled with AI agents to support remote patient monitoring, decision-support, and personalized rehabilitation trajectories. Beyond clinical care, these HDTs function as virtual patients for simulation-based training and in-silico experimentation, enabling students, residents, and multidisciplinary teams to rehearse diagnostic and therapeutic strategies without risk to real patients. By integrating sensor-derived data, AI-driven expert systems, and web-based learning environments, the TD+AI platform exemplifies how resource-constrained settings can effectively employ HDT technologies to converge digital health and digital education. The Letter concludes by highlighting opportunities for international collaboration to co-develop, validate, and scale such HDT-centered telerehabilitation ecosystems.
Multi-Modality Aphasia Therapy (M-MAT) is a cost-effective group intervention for post stroke aphasia. M-MAT was recently adapted for telerehabilitation but has not yet been tested. This pilot study aimed to investigate the feasibility, acceptability, and preliminary signs of efficacy, providing 30 hours of M-MAT Tele to three groups of three people with chronic aphasia. Participants were grouped according to aphasia severity. Clinical outcomes were assessed at three timepoints. Feasibility and acceptability were assessed through a range of trial measures including recruitment, adherence, treatment fidelity and overall participant ratings. Recruitment targets were achieved, with nine participants receiving a median 24.4h of the prescribed dose. Therapy integrity and adherence were high (94%), effect sizes favoured positive clinical change, and acceptability was strong based on participant and therapist feedback. Minor protocol/software changes were recommended. This pilot study showed that M-MAT Tele was acceptable and feasible to participants and therapists, with positive preliminary outcomes.
Despite the growing use of telehealth in stroke rehabilitation, it remains unclear whether online assessments (i.e., tele-assessment) can match the accuracy of in-person evaluations. Given the high prevalence of stroke and its significant impact on mobility, precise assessment is essential. This study evaluated the reliability and safety of a tele-assessment protocol for mobility and balance in individuals with chronic stroke, using the OMPEPE guideline. Twenty-five participants underwent in-person and synchronous tele-assessment (Timed Up and Go, Five Times Sit-to-Stand, and Functional Reach tests) within 24 to 48 hours. One month later, the same physiotherapist and a second investigator independently scored asynchronous video recordings. Results showed strong agreement between online and in-person assessments, with excellent intra- and inter-rater reliability (ICC > 0.90). Most participants had moderate to severe motor impairment. These findings suggest that tele-assessment is a reliable and safe approach when systematically planned, providing an effective solution for monitoring individuals with chronic stroke conditions when in-person healthcare is not feasible.
Background:Persons with Parkinson's disease (PwPD) require ongoing rehabilitation to maintain independence, but traditional center-based and unsupervised home programs have limitations in accessibility and adherence. Home-based telerehabilitation (TR) offers a promising alternative by enabling remote delivery of exercise interventions. Objective:To evaluate the effect of home-based TR on balance, functional mobility, and quality of life in PwPD. Methods:A comprehensive electronic search was conducted across PubMed, CINAHL, Embase, OvidSP, ProQuest, Scopus, Web of Science, Cochrane CENTRAL, and PEDro databases. Interventional studies on exercise-centric home-based TR for PwPD with either balance, functional mobility, or quality of life as outcomes were included. Results:A total of 37 studies were included in this systematic review, of which 13 were eligible for meta-analysis. The meta-analysis revealed small but significant improvements in balance (SMD = 0.25; 95% CI: 0.04 to 0.45; p = 0.02). and functional mobility (SMD = -0.28; 95% CI: -0.52 to -0.05; p = 0.02). However, no significant effect was observed for quality of life (SMD = -0.08; 95% CI: -0.25 to 0.09; p = 0.35). Conclusion:Home-based TR is effective for improving balance and functional mobility in PwPD, although, its effect on quality of life is unclear which warrants further research.
