A mobile telemedicine system for remote consultation in cases of acute stroke

Abstract

A mobile telemedicine system, capable of transmitting video and audio simultaneously, was designed for consulting acute stroke patients remotely. It could use a wireless local area network (e.g. inside the hospital) or a mobile phone network (e.g. outside the hospital). When initiating a call, the sending unit chose a suitable encoding profile based on the measured data throughput, in order to allocate appropriate bit rates for video and audio transmission. The system was tested using a portable digital assistant (PDA) type phone and smart phone as receiving units. Video and audio recordings were made from five patients (two normal and three stroke patients) and then transmitted at different rates. Subjectively, both video and audio qualities improved as the data throughput increased. The physical findings, including facial droop, arm drift and abnormal speech, were observed remotely by four specialists according to the Cincinnati Pre-hospital Stroke Scale guideline. A comparison between the face-to-face method and the mobile telemedicine method showed that there were no discrepancies at bit rates of more than 400 kbit/s. We conclude that specialists could generally conduct remote consultations for stroke patients either using a public mobile network or a wireless LAN.

Reliability of Prehospital Real-Time Cellular Video Phone in Assessing the Simplified National Institutes of Health Stroke Scale in Patients With Acute Stroke

“…35 The application of NIHSS in its original 1,7,13,14,[17][18][19][20][21][22][23][24] or modified format 8,9,19,30 -32 in evaluating patients with acute stroke has been validated by neurologists, 7,8,10 nonneurologist physicians, 2,4,11 trainees, 12 nurse coordinators, 2,4,10,11,37,38 and emergency medical technicians. 32,39 Studies have confirmed the benefits of telemedicine application of NIHSS in the prehospital setting, 19,20,31,32,40 aiming to decrease ischemic time and facilitate the use of thrombolytic.…”

Teleneurology: is it really at a distance?

“…Technological advances are rapidly upcoming, particularly with mobile devices [60][61][62] like personal digital assistants (PDAs) and smart phones, systematic evaluation of which will be of considerable interest.…”

“…The reliability of administering stroke severity scales, particularly the NIHSS, remotely is well established [25,62]. This has been in both the acute [69] and sub-acute [70] setting in stroke and can be performed reliably even by telemedicine naïve examiners [71].…”

Mobile Videoconferencing Apps for Telemedicine

“…7 Eleven studies had more than one teleconsultation involving physicians or other health providers. [8][9][10][11][12][13][14][15][16][17][18] They included, for example, studies of 3G cellular networks with transmissions of 64 kilobits/s (Kbps) for cardiopulmonary resuscitation assistance with and without video, 8 video with multiplexed 3G networks (combining multiple 3G data streams into a single signal) to achieve transmissions of 125-150 Kbps from moving ambulances to transmit endotracheal intubations and ultrasound, 9 and video telestroke consultations with land line transmissions over 700 Kbps and 3G wireless transmissions as low as 128 Kbps. 10 Overall, the studies suggest that there may be lower boundary transmission rates below which the data transmitted become unusable.…”

“…[10][11][12][13] One stroke study identified a lower threshold of 400 Kbps, 14 whereas an echocardiogram study's lower threshold was 200 Kbps. 15 The only study documenting transmission while moving found that maintaining transmission while switching between cell towers was an issue. 9 The results of these studies are highly variable, and the number of cases in many studies was low (under 10 in four studies 11,12,14,15 and only 20 in another 13 ).…”