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Telehealth is a broad term used to describe the use of electronic or digital information and communications technologies to support clinical healthcare, patient and professional health related education, and public health and health administration. Telerehabilitation refers to the delivery of rehabilitation and habilitation services via information and communication technologies (ICT), also commonly referred to as” telehealth” technologies. Telerehabilitation services can include evaluation, assessment, monitoring, prevention, intervention, supervision, education, consultation, and coaching. Telerehabilitation services can be deployed across all patient populations and multiple healthcare settings including clinics, homes, schools, or community-based worksites. This document was adapted from the American Telemedicine Association’s (ATA) “A Blueprint for Telerehabilitation Guidelines” (2010) and reflects the current utilization of telerehabilitation services. It was developed collaboratively by members of the ATA Telerehabilitation Special Interest Group, with input and guidance from other practitioners in the field, strategic stakeholders, and ATA staff. Its purpose is to inform and assist practitioners in providing effective and secure 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.Keywords: American Telemedicine Association, Habilitation, Rehabilitation, Telehealth, Telepractice

“America’s high schools are obsolete […] designed 50 years ago to meet the needs of another age.” – Bill Gates, National Governors’ Conference, 2005. Obsolete and designed for another time—the same could be said for our existing health care system, treatment approaches, and service delivery models. The emergence of outcome-based payment by Accountable Care Organizations, severe restrictions in funding, and limited or absent insurance coverage for voice treatment are powerful drivers for more effective voice therapy treatment. Findings reported from the Voice and Swallowing Center of Maine support significant cost reductions to payers when telepractice is used in voice treatment (Towey, 2012a). This article describes three distinct applications of voice telepractice that expands conventional thinking about voice therapy and voice therapy telepractice. It is believed these presented cases are the first published examples that demonstrate the efficacy of voice telepractice to: (1) assess and fit a device for a laryngectomee; (2) complete virtual musculoskeletal assessment of a voice patient; and (3) provide virtual simultaneous co-treatment in voice therapy.

This Brief Communication represents an analysis of the cost savings to MaineCare (also referred to as Medicaid) directly attributable to service provided via speech therapy telepractice. Seven female (primarily adolescent) MaineCare patients consecutively referred to Waldo County General Hospital (WCGH) with suspected diagnosis of Vocal Cord Dysfunction (VCD) were treated by speech therapy telepractice. Outcome data demonstrated a first month cost savings of $2376.72. The analysis additionally projected thousands of dollars of potential savings each month in reduced medical costs for this patient group as a result of successful treatment via speech therapy telepractice. The study suggests that without access to speech therapy telepractice for patients with VCD, the ongoing medical costs to MaineCare will be ongoing and significant.

We investigated the underlying genetic defect in an immunodeficient patient who presented with recurrent bacterial infections in his late twenties and demonstrated a transcriptional defect in major histocompatibility complex (MHC) class II regulation. Transient heterokaryon analysis implicated functional loss of CIITA, the MHC class II transactivator protein, and in support of this MHC class II antigen expression was restored by stable transfection with the wild-type molecule. A single amino acid substitution, phenylalanine to serine, in the COOH-terminal portion of the CIITA sequence correlated with reduced transcription of both classical (HLA-DP, -DQ, and -DR) and nonclassical (HLA-DM and -DO) class II genes. The long survival of the patient, although remarkable, was not associated with partial CIITA function as evidenced by residual MHC class II expression. These data define at high resolution a region of CIITA that is essential for function in both professional and nonprofessional antigen presenting cells and which could potentially constitute a target for therapeutic intervention by novel factors with a propensity to downregulate MHC class II antigen expression.

Much of speech therapy involves the clinician guiding the therapeutic process (e.g., presenting stimuli and eliciting client responses); however, this Brief Communication describes a different approach to speech therapy delivery. Clinicians at Waldo County General Hospital (WCGH) use high definition audio and video to engage clients in telepractice using interactive web-based virtual environments. This technology enables clients and their clinicians to co-create salient treatment activities using authentic materials captured via digital cameras, video and/or curricular materials. Both therapists and clients manipulate the materials and interact online in real-time. The web-based technology engenders highly personalized and engaging activities, such that clients’ interactions with these high interest tasks often continue well beyond the therapy sessions.

For more than 30 years, speech therapy telepractice has been recognized as an effective substitute when no therapist was available. This chapter describes a speech therapy telepractice model that can provide treatment better than traditional methods and is not restricted to patients living in areas without qualified professionals. Using web-hosted applications, telepractice can be provided securely and effectively on virtually any computer, smart phone, or tablet at low cost to the therapist and no cost to the patient. This chapter provides the information necessary to develop an effective speech telepractice program, including low-cost/no-cost telepractice video connections and digital treatment materials and use of Web 2.0 approaches to enhance treatment and competencies required for effective speech therapy telepractice.

Regulation of both IFN-γ inducible and constitutive MHC class II gene transcription is under the control of CIITA. This master regulator is synthesised in the cytosol and must translocate to the nucleus in order to activate class II gene transcription. Here, we demonstrate that, in a patient deficient in MHC class II gene expression, a single missense mutation results in sequestration of CIITA within the cytosol. The mutation is situated in a region that bears homology to the β strand domain of ribonuclease inhibitor-like leucine-rich repeat (LRR) motifs. Deletion and mutagenesis analysis suggest that structural integrity of this region is required for efficient nuclear localisation. Importantly, we show that in the absence of amino terminal domains, the carboxy terminal LRR region is sufficient to efficiently target GFP chimeric proteins to the nucleus. CIITA therefore encodes multiple domains that can, in isolation, efficiently target to the nuclear compartment.

In this study, the acoustic output from three sonoporation drug delivery ultrasound systems, namely Sonidel SP100 were characterised using an acoustic radiation force balance. Delivery of nucleic acid to a target tissue as a form of gene therapy is an important means of treating a variety of disorders, for example cardiovascular disease. One method of this type of treatment utilises ultrasound to stimulate cell membrane permeabilisation (sonoporation) for the purpose of transferring nucleic acids into cells. This approach offers advantages over competing technologies such as viral vectors, primarily as a result of its relatively non-invasive nature. However, the ultrasound sonoporation systems used to produce this permeability of the cell need to be fully characterised in order to provide the most effective treatment. Therefore, in this study acoustic output measurements were made for three SP 100 ultrasound systems and the output obtained from each system were compared to determine whether each of the three systems had similar performance. An absorbing target acoustic radiation force balance was used to obtain these measurements, the resolution of this system was 1 mN. The results from each system operating in continuous mode were compared using a t-test and the results were found to be similar at a significance level of p