Feasibility of NIH stroke scale evaluation and telestroke use via an interactive high-vision videoconferencing system

Abstract

Background and purpose: There are clear differences in the outcome between regions with respect to the rate of thrombolytic use for acute ischemic stroke. On the basis of this assumption, Telestroke has been proposed as a specialized remote treatment technology for stroke. We put together a single-hub singlespoke network and investigated the concordance rate for remote evaluation of neurological findings as well as technical issues, such as time required for evaluation and envisaging the use of tissue plasminogen activator (tPA) injection therapy. Methods: We calculated the National Institutes of Health Stroke Scale (NIHSS) scores for 15 healthy individuals simultaneously by remote examination and face-to-face examination and evaluated the time required for measurements. Next, we calculated the NIHSS scores for 15 subacute stroke patients simultaneously by remote examination and face-to-face examination, and evaluated the measurement errors and concordance rate. We also investigated camera positioning and time taken to establish communication for patients within 3 h of onset. Results: Time required for NIHSS score measurements was significantly longer by using Telestroke, at an average of 2 min 41 s. The average error in the scores was only 0.73 points, but the occurrence of errors was possible especially with patients who had difficulty in understanding the instructions required for examination because of aphasia. For score measurements, the camera should be placed 150-170 cm directly above the subjects' head, and the appropriate time to start remote examination support is by establishing communication after computed tomography (CT) scanning. Conclusions: tPA injection by remote medical support using an interactive videoconferencing system is feasible.

A trial case of medical treatment for primary headache using telemedicine

“…In terms of legislation, telemedicine was previously prohibited under Article 20 of the Medical Practitioners Act, which states that “No medical or dental practitioner shall provide medical care without personally performing a face-to-face examination, and telemedicine shall be performed only in a manner that complements face-to-face medical care.” However, the practice of telemedicine was legalized in December 1997 following issuance of a notification by the Ministry of Labour, Health and Welfare stating that “The practice of telemedicine does not directly infringe on Article 20 of the Medical Practitioners Act provided that it can be used to obtain useful information on the patient's physical or mental condition to the extent that it can be used as an alternative to face-to-face medical treatment even if it is not equivalent.” Indications for telemedicine were rapidly expanded in March 2011 to allow mainly doctor-to-patient treatments of chronic-stage patients who are receiving ongoing therapy and whose recent condition has been stable. These changes have led to the use of telemedicine not only in-home care situations but also on a trial basis in hyperacute stroke patients [ 19 – 22 ] in a doctor-to-patient with doctor setting.…”