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The previous sections set up a framework for studying the rehabilitative plan of care from an optimization framework.
Telehealth relaxes some of the constraints imposed by the infrastructure, and thereby expands the solution space. In principle, the addition of such alternative tools should, if used wisely, only improve care. By eliminating distance as a barrier, telehealth tools add possibilities for more timely access to assessment information, support services, and treatment. For instance, telecommunications tools in the home can provide alternatives to the conventional model of outpatient and home visit services – typically limited to weekly encounters of fixed duration.
By addressing the barrier of distance, telecommunications technologies open up new possibilities for optimzing service delivery across the rehabilitation continuum of care:
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New tools for timely assessment and/or therapeutic intervention
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Such use can affect both planning and delivery of services, and optimum use of "feedback"
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Such use can help address need for objective measures with greater ecological validity.
To the engineer, the rehabilitative care model this is a sampled data system, as shown by the switches in the previous figure, in which the switch is “left open” for long periods. When such feedback is not available, the best plan that is possible is an open-loop, feed-forward control; the worst is no control at all. Even if control is ongoing without feedback, the “control space” (the set of possible interventions) is reduced since some interventions require a practitioner. Thus, the current standard algorithm and its implementation are nonideal for optimizing health-related outcomes. It also appears suboptimal with regard to costs, benefits and other practical financial outcomes; when benefits are only sampled sporadically, cost is likely to be higher than it needs to be. Thus telerehabilitation tools can provide more timely assessments, as well as the potential for more timely interventions.
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Optiming Rehab Plan of Care - Roles for Telerehab