Telemedicine implementations often remain in the pilot phase and do not succeed in scaling-up to robust products that are used in daily practice. We conducted a qualitative literature review of 45 conference papers describing telemedicine interventions in order to identify determinants that had influenced their implementation. The identified determinants, which would influence the future implementation of telemedicine interventions, can be classified into five major categories: (1) Technology, (2) Acceptance, (3) Financing, (4) Organization and (5) Policy and Legislation. Each category contains determinants that are relevant to different stakeholders in different domains. We propose a layered implementation model in which the primary focus on individual determinants changes throughout the development life cycle of the telemedicine implementation. For success, a visionary approach is required from the multidisciplinary stakeholders, which goes beyond tackling specific issues in a particular development phase. Thus the right philosophy is: 'start small, think big'.

Abstract-User acceptance of myoelectric forearm prostheses is currently low. Awkward control, lack of feedback, and difficult training are cited as primary reasons. Recently, researchers have focused on exploiting the new possibilities offered by advancements in prosthetic technology. Alternatively, researchers could focus on prosthesis acceptance by developing functional requirements based on activities users are likely to perform. In this article, we describe the process of determining such requirements and then the application of these requirements to evaluating the state of the art in myoelectric forearm prosthesis research. As part of a needs assessment, a workshop was organized involving clinicians (representing end users), academics, and engineers. The resulting needs included an increased number of functions, lower reaction and execution times, and intuitiveness of both control and feedback systems. Reviewing the state of the art of research in the main prosthetic subsystems (electromyographic [EMG] sensing, control, and feedback) showed that modern research prototypes only partly fulfill the requirements. We found that focus should be on validating EMG-sensing results with patients, improving simultaneous control of wrist movements and grasps, deriving optimal parameters for force and position feedback, and taking into account the psychophysical aspects of feedback, such as intensity perception and spatial acuity.

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This pilot study shows the potential of the telerehabilitation intervention: compliance with the activity coach was high, which directly related to an improvement in activity levels.

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The term spasticity is inconsistently defined and this inconsistency will need to be resolved. Often, the measures used did not correspond to the clinical features of spasticity that were defined within a paper (i.e. internal validity was compromised). There is need to ensure that this lack of congruence is addressed in future research.

The isolated contributions of motor unit recruitment and firing rate variations to the median frequency of the electromyogram's power density spectrum were determined. Orderly stimulation of the cat gastrocnemius motor units via nerve electrodes gave rise to linearly increasing median frequency regardless of the action potential firing rate of the active motor units. Increase in the discharge rate of all the motor units resulted in nearly constant median frequency. It was concluded that the increasing average conduction velocity during motor unit recruitment is the major contributor to variations in the electromyogram median frequency. The possibility of using the median frequency as the index to identify the recruitment control strategies employed by various muscles during increasing force contraction is suggested.

Objective-Evidence for effective management of shoulder impingement is limited. The present study aimed to quantify the clinical, neurophysiological, and biomechanical effects of a scapular motor control retraining for young individuals with shoulder impingement signs.Method-Sixteen adults with shoulder impingement signs (mean age 22 ± 1.6 years) underwent the intervention and 16 healthy participants (24.8 ± 3.1years) provided reference data. Shoulder function and pain were assessed using the Shoulder Pain and Disability Index (SPADI) and other questionnaires. Electromyography (EMG) and 3-dimensional motion analysis was used to record muscle activation and kinematic data during arm elevation to 90° and lowering in three planes. Patients were assessed pre and post a 10-week motor control based intervention, utilising scapular orientation retraining.Results-Pre-intervention, patients reported pain and reduced function compared to the healthy participants (SPADI in patients 20 ± 9.2; healthy 0±0). Post-intervention the SPADI scores reduced significantly (p<0.001) by a mean of 10 points (±4). EMG showed delayed onset and early termination of serratus anterior and lower trapezius muscle activity pre-intervention, which improved significantly post-intervention (p<0.05-0.01). Pre-intervention, patients exhibited on average 4.6-7.4° less posterior tilt, which was significantly less in two arm elevation planes (p<0.05) than healthy participants. Post-intervention, upward rotation and posterior tilt increased significantly (p<0.05) during two arm movements, approaching the healthy values.Conclusions-A 10 week motor control intervention for shoulder impingement increased function and reduced pain. Recovery mechanisms were indicated by changes in muscle recruitment and scapular kinematics. The efficacy of the intervention requires further examined in a randomised control trial.