Kudritzki Virginia, Howard Ileana M
Rehabilitation Care Services, VA Puget Sound Healthcare System, Seattle, WA, United States.
Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States.
Front Neurol. 2023 Jul 26;14:1238916. doi: 10.3389/fneur.2023.1238916. eCollection 2023.
The Veterans Health Administration (VHA) has served as a leader in the implementation of telerehabilitation technologies and continues to expand utilization of non-traditional patient encounters to better serve a geographically and demographically diverse population. Amyotrophic Lateral Sclerosis (ALS) is a progressive neurodegenerative disease impacting Veterans at a higher rate than the civilian population and associated with high levels of disability and limited access to subspecialized care. There is growing evidence supporting exercise-based interventions as an independent or adjunctive treatment to maintain or restore function for this patient population; many of these interventions can be delivered remotely by telehealth. The recent advancements in disease-modifying therapies for neuromuscular disorders will likely increase the importance of rehabilitation interventions to maximize functional outcomes. Here, we review the evidence for specific exercise interventions in ALS and the evidence for telehealth-based exercise in neuromuscular disorders. We then use this existing literature to propose a framework for telehealth delivery of these treatments, including feasible exercise interventions and remote outcome measures, recommended peripheral devices, and an example of a current remote group exercise program offered through VHA.
退伍军人健康管理局（VHA）一直是远程康复技术实施的领导者，并继续扩大对非传统患者诊疗方式的利用，以更好地服务地域和人口构成多样的人群。肌萎缩侧索硬化症（ALS）是一种进行性神经退行性疾病，影响退伍军人的比例高于普通人群，且与高度残疾和获得专科护理的机会有限相关。越来越多的证据支持以运动为基础的干预措施作为维持或恢复该患者群体功能的独立或辅助治疗方法；其中许多干预措施可通过远程医疗远程提供。神经肌肉疾病疾病修饰疗法的最新进展可能会增加康复干预措施对于最大化功能结局的重要性。在此，我们回顾了ALS中特定运动干预措施的证据以及神经肌肉疾病中基于远程医疗的运动的证据。然后，我们利用现有文献提出一个这些治疗的远程医疗提供框架，包括可行的运动干预措施和远程结局指标、推荐的周边设备，以及一个目前通过VHA提供的远程团体运动项目示例。
