Recognizing and understanding customer needs is a critical part of any product design process. Rehabilitation is a fairly mature field, yet one where most current clinical assessments and therapeutic interventions do not make use of telecommunications technologies. Can (and should) this change? And if so, how? Are there unmet needs? What would be the impact in service delivery infrastructure?

These are important questions. We know that the "value-added" of tools of telehealth rests with the potential for minimizing the barrier of distance, both of patients to healthcare services and of researchers to subject populations. It would seems that such enhanced access opens up new possibilities for discovering and implementing optimized intervention strategies across the continuum of care.  This could include various stages of the rehabilitative plan of care, including timely assessment and But technology must be appropriate. Addressing this question is difficult, though as seen from the Workshop on Homecare Technologies for the 21st century, there are those out there who feel that such change is needed.

We will revisit this issue throughout this class. At this stage, of value is to first understand where potential needs (and markets) are, models of telehealth, and what

Integrated into these is a focus on telehomecare from within a rehabilitation context, which had been an area of active research, which was a key focus of a workshop coordinated by this author on Home Care Technologies for the 21^st Century (8,9).  

Many target populations are currently under study. For instance, at the RERC on Telerehabilitaiton's State of the Science on Telerehabilitation that was sponsored by the RERC on Telerehabilitation and the American Telemedicine Association (ATA) and brought together roughly 80 clinical researchers, engineering scientists and human factors specialists, results were reported for studies of:

• caregivers of persons post-stroke,
• remote assessment of individuals with or at risk for pressure ulcers,
• teleconsultations related to prosthetics/orthotics,
• social/vocational training for autistic persons,
• neurocognitive telecounseling for brain injured persons,
• virtual reality for stroke and orthopedic patients,
• therapeutic play for children in neurological impairments, and
• home telesupport for older adults with chronic health challenges (e.g., cardiopulmonary).  

It is broadly believed that there is considerable potential for telerehabilitation applications to expand, especially on the premise of the emerging consumer-centered model as the foundation for a "reengineered" 21^st-century healthcare system. In closing remarks at the conference, the president of ATA suggested that telerehabilitation provided a vehicle for bringing a greater degree of scientific inquiry to the field of telehealth (11).  In addition to natural ties to human-technology interfaces and user-centered engineering, there is the reality that roughly 50 million Americans currently live with a level of functional impairment that impacts on their ability to perform daily activities, many also with a chronic health disease.  While most do not receive special rehabilitative services, each year millions receive some form of therapeutic intervention, ranging from over 3 hours per day of therapy while an inpatient within a comprehensive rehabilitation hospital to management and some therapy within a skill nursing facility to outpatient therapy to home visits.  Access to services is often a challenge, as is access by researchers to larger subject populations.  The opportunities for telerehabilitation are real.  The tools available for intervention may have an impact on the strategy, and this review is motivated by the expectation that advances in telecommunications and information technologies will help minimize the barrier of distance in the delivery of rehabilitative services, and have great potential to improve future intervention strategies.

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