Teleneurology

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Teleneurology describes the use of telecommunication methods to diagnose or treat neurological diseases . This is mainly done in the area of ​​emergency care, but there are also applications in chronic neurological diseases. Ultimately, local or temporal gaps between the practitioner and the patient are bridged.

Acute neurology

The first applications of telemedicine in neurology were in the treatment of acute strokes . Neurological expertise in this area was provided by experienced neurologists in appropriate centers for clinics without the appropriate facilities via video conference . This made it possible to enable modern stroke therapy including thrombolysis even in clinics without the presence of appropriate specialists. In practice, the patient in such a smaller clinic was examined jointly by the doctors on site and an experienced neurologist connected via video conference and a computer tomography was carried out. Thereafter, the treatment was recommended according to the current scientific status and carried out on site without delay by transporting the patient (transfer). Relocation may only be necessary in individual cases, e.g. B. with a larger vascular occlusion ( thrombectomy ).

In order to guarantee treatment in accordance with the most modern standards, monitoring units (beds equipped with monitoring of vital functions) were created in the clinics, the requirements of which are based on a stroke unit . This also includes the inclusion of the therapy methods practiced ( speech therapy , physiotherapy , occupational therapy ). In order to guarantee this overall concept, specialized stroke networks were developed, the principles of which include regular training for all those involved in treatment and quality assurance measures. Further requirements are:

As part of a scientific study, the TEMPiS network was able to prove for the first time that the treatment of acute stroke with this concept is equivalent to that in a stroke unit. As a result, it was therefore possible to settle these services through a special OPS (8-98.b) to the health insurance companies, whereby the service can be financed. A number of other stroke networks developed in the (e.g. state of Bavaria: STENO, NEVAS, TESAURUS, TRANSIT).

Teleneurology is currently being expanded to include other acute neurological diseases, in particular its use in dizziness, epilepsy, meningitis and encephalitis as well as neuro-traumatological diseases is being investigated.

Apparatus and technical equipment

From a technical point of view, teleneurology represents a video conference technology adapted for medicine, with which a remote assessment of patients takes place via video transmission and support of the doctors working on site in the care of the patients. The digital audio and video data are encrypted and transmitted over the IT network of the participating hospitals and over broadband internet connections.

After a connection has been established from a workstation, the teleneurologist controls a mobile recording unit on the patient's bed. The systems essentially consist of a camera and microphone as input devices and a screen and loudspeakers as output devices. In medical applications, CT or MRT images are transmitted to the teleneurologist's workstation.

Mobile stroke unit

A further acceleration of the therapy in acute strokes can only be achieved if the necessary prerequisites (computed tomography and neurologist) are brought to the patient. This requires an ambulance specially equipped with a CT, and the ambulance must also be a neurologist. This concept was first put into practice in Homburg in 2008 (Mobile Stroke Unit), initially the CT was transported in an additional truck. This means that the decision for thrombolysis or transfer to a specialized hospital for thrombectomy can be made directly at the patient's home. This concept is currently offered very predominantly in large cities. However, it would be particularly important for rural areas with correspondingly long transport routes to the next stroke unit. It is precisely there that it is difficult to establish itself due to the very high personnel requirements.

Chronic diseases

Teleneurology has proven itself here for the treatment of patients with Parkinson's syndromes. The patient is instructed by a computer system to carry out the examination according to a specialized movement scale (UPDRS). This is recorded on video (possibly several times a day), which a specialized neurologist then assesses at a time of his choosing. This means that the medication doses can be adjusted throughout the day in order to optimize the patient's mobility. This can save the patient a hospital stay.

Special consultation hours

In a broader sense, special consultation hours (e.g. for epilepsy, headaches, etc.) can also be counted as part of teleneurology. The availability of the specialists v. a. improved for patients with long journeys.

Neurological rehabilitation

With telerehabilitation, therapeutic offers can also be made more easily available. There have been studies on the therapy of speech disorders, and occupational therapy is also conceivable. Physiotherapeutic concepts have so far been v. a. evaluated in the cardiological field. There are now commercial providers for this.

literature

  • Claus Schwing, Teleradiology: Comprehensive stroke diagnosis possible with CT, trends in medical technology, KU special No. 31 - 10/2005, Baumann Fachverlage, pp. 19–22

Web links

Individual evidence

  1. ↑ HJ Audebert, J. Schenkel, PU Heuschmann, R. Haberl, U. Bogdahn (Writing Committee of the TEMPiS Group): Effects of the implementation of a telemedical stroke network: the telemedic pilot project for integrative stroke care (TEMPiS) in Bavaria , Germany. Lancet Neurology 2006; 5: 742-748
  2. ↑ OPS code 8-98 at dimdi.de [1]
  3. ^ Bavarian State Ministry of Health and Care : Stroke Networks , accessed on November 11, 2015
  4. ↑ "Tele-Schwindel" at TEMPiS.de [2]
  5. ↑ Indications in the ANNOTeM network [3]
  6. ↑ Mobile Stroke Unit worldwide [4]
  7. ↑ Medical video observation in Parkinson's disease [5]
  8. ↑ "Synchronous Teletherapy" [6]
  9. ↑ Teletherapy for aphasia after a stroke [7]
  10. ↑ EvoCare [8]
  11. ↑ Caspar-Health.com [9]