Telestroke in Stroke Survivors

Abstract

Stroke is a high-frequency disorder placing a significant burden on the health care systems, being the foremost cause of complex chronic disability in adults. Devising systems that can enhance the prevention of stroke recurrence is an important priority and challenge in both the developed and the developing world. The potential for recurrent stroke can be substantially reduced by effective management of vascular risk factors. Telestroke is a tool with potential application to improve risk management of stroke survivors. Lack of acknowledgment of existing practices as well as lack of awareness of potential financial barriers to diffusion of telestroke can lead to limited implementation. Telestroke offers service providers the opportunity to access large numbers of stroke survivors targeting secondary prevention. The ideal ‘telestroke model’ provides service support, education for the patient and caregiver, as well as integration of specialist and primary care services. Effective use of technological advances, with adequate recognition of the importance of human interaction in the long-term management of a largely elderly population of stroke survivors is challenging but possible. Telestroke should be systems- and not technology-driven. Barriers in the implementation of telestroke have been identified as insufficient planning of IT infrastructure, lack of long-term vision for sustainability, a lack of contextual perspective as well as poor communication across domains. Future telestroke models should provide effective action in an integrated model of care recognizing and involving all existing players and practices.

Teleneurology: is it really at a distance?

“…In addition to thrombolysis, telestroke has been successfully implemented in follow-up care [17] and was compared favourably to conventional stroke unit care in order to reduce length of hospital stay, facilitate quick access to initial brain imaging, rehabilitation assessments and investigations like carotid ultrasound [10].…”

“…The latter would be more replicable in teleneurology [35]. The IC-ARUSS project in Australia and the TEMPiS network in Bavaria have used telemedicine for risk factor management and follow-up of depressive symptoms in stroke survivors who returned to the community [17,36]. Conceivably, a telemedicine setup can be used for provision of ongoing follow-up care for neurological patients, including monitoring of therapy [37] and assessing functional status, mobility and risk of falls [38].…”

“…In addition, with horizontal networking, telemedicine could become a very useful tool for patient recruitment into non-acute clinical trials. Telemedicine networks may help establish large cohorts of patients with neurological disorders providing opportunities for clinical research into morbidity and quality of life [17,36]. It could, potentially, enhance recruitment of patients with rare neurological disorders into investigative and treatment trials.…”

“…Limited availability of neurological expertise coupled with the need for rapid assessment and treatment in this situation, turned attention to telemedicine as a potential solution. In several neurological disorders, effectiveness of web-based systems has been demonstrated in patient evaluation [12][13][14] as well provision of rehabilitation, follow-up care and counseling [15][16][17][18][19].…”

Telehealth Stroke Education for Rural Elderly Virginians

“…5 Efforts to decrease the incidence of stroke include stroke education, as stroke education has been shown to reduce vascular risk factors. [6][7][8][9][10][11][12] Stroke education via telehealth can provide rural communities access to preventative education and to experts that are often missing in the rural communities. There is a need to determine whether telehealth stroke education is feasible, whether it is comparable to in-person education in regards to satisfaction, and whether it is effective in increasing knowledge of stroke.…”