Thursday, September 12, 2013

Touch Therapy for Stroke Treatment

Extol the smartphones! They are capable to introduce cost-effective and timely care in stroke evaluation, thus enabling physicians to save the lives of millions, say studies from America and Japan

Ria Lakshman V | cd news

Recent clinical trials have demonstrated the effectiveness of telecommunication in the treatment of diseases. It enables the sophisticated satellite technology to broadcast consultations between a healthcare professional and patient through videoconferencing equipment. Although the technology fastens the treatments, several studies highlight its defects such as the lack of reliable connections, high cost factor and the fear of malpractices. However, for diseases like stroke where time plays a significant role in treatment, telecommunication outweighs its demerits.

Stroke is a disease that kills six million people worldwide, according to the World Heart Foundation. It disables another five million every year. Therefore, a rapid, available-at-any-time consultation between the patient and the stroke specialist is of great importance in deciding optimal treatment. The more neurons die, the chances of death is higher. 

 Recently, the usage of telemedicine in treatment of stroke, dubbed as ‘telestroke’ is gaining popularity among the physicians, especially in Europe and United States. American Heart Association (AHA)/American Stroke Association guidelines already permit the usage of high-quality video conferencing for telestroke consultation by a remote stroke specialist when the in-person stroke specialist is not available in the hospital. The method is efficient, but several barriers hinder the treatment. Firstly, it is time-consuming to set up and establish a video conferencing device. Secondly, hospitals require heavy cost for acquiring, installing and maintaining telemedicine communication systems. Finally, the neurologist or the stroke care specialist who is oceans apart require a desktop or laptop computer to access the images, which further delays the treatment.

Smartphone for stroke evaluation

Dr. Bart Demaerschalk MD, the director of Mayo Clinic and Telestroke program and his team of doctors have now cropped up a more feasible solution to the troubles – the usage of smartphones for the telestroke evaluation. The smartphones are the most widely carried portable communication device of the day and most of the physicians use them too. They offer a wide range of possibilities in employing for treatments, especially when coupled with prevalent healthcare applications. The app stores have a plethora of video conferencing and teleradiology applications available to facilitate telestroke consultation. The use of videophones cut the costs for establishing video conferencing devices of telestroke evaluation by an order of magnitude. It also expedites the time taken to set up and consult the patient.

In the study 'Smartphone teleradiology application is successfully incorporated into a Telestroke network environment' conducted by Dr. Demaerschalk explored the possibilities of the smartphones (specifically Apple iPhone 4) by developing a Resolution MD (ResMD) mobile application. This application provides a complete telemedicine solution to the mobile devices, providing instant access to 2D and 3D image visualization of scans on smartphones. The neurologists found that the CT brain scans of the patients on iOS device were accurate to 100 percent in detecting intraparenchymal hemorrhage and it also showed 98-99 percent accuracy in detecting early acute parenchymal ischemic change.

The study, which was published in Circulation: Cardiovascular Quality and Outcomes, the AHA journal evaluated 53 patients presented at Yuma Regional Medical Centre with acute stroke. The scan results were simultaneously reviewed by radiologists and telestroke specialists with smartphones, followed by an independent adjudication panel of stroke neurologists. The results were remarkably good that it showed smartphones can be used anytime and anywhere, particularly in rural hospitals where there is no immediate access to neurological care.As a progression, Dr. Demaerschalk and his team also analyzed the satisfaction of physicians on high quality video conferencing using FaceTime application of Apple iPhone 4 in another study titled 'Reliability of Real-Time Video Smartphone for Assessing National Institutes of Health Stroke Scale Scores in Acute Stroke Patients'. The results demonstrated iPhone 4 as a reliable tool for stroke telemedicine, rating higher acceptance and satisfaction among the physicians. Being a first-of-its-kind study in the sector, both the studies are revolutionary and explored an untapped segment in the medical device sector.

First-class Image App
In addition to Mr. Demaerschalk’s researches, there are studies from Japan that developed systems to exchange diagnostic images and clinical management information. The study “A New Support System Using a Mobile Device (Smartphone) for Diagnostic Image Display and Treatment of Stroke” by Hiroyuki Takao, MD, an instructor of Jikei University School of Medicine in Tokyo and his colleagues developed a system to efficiently manage stroke diagnosis and the subsequent treatment, thereby reducing extra work hours, making physicians efficient even when away from hospitals. Designated as iStroke, the system comprises of a transmitting server and a receiver phone. iStroke comes with several useful functions in stroke management system.

The system facilitates stroke call function or the facility to alert the medical staffs about an expected admission of an acute stroke case. Incorporated with a time-bar function for monitoring patient, the system allows physicians to view both static and video images in real-time. Tweeting facility to fellow specialists to exchange opinions further enhances the system. On the whole, i-Stroke offers a complete solution to acute stroke management by encouraging swift reaction in treatment of stroke.

Limitations of the system

Perhaps, the system of videophones may limit the autonomy of the vascular neurologists. Under the system, it is the medical assistant who captures the images and sometimes, it could be challenging for the assistant to simultaneously conduct and record an examination. Also, the procedure demands a photographic talent for the assistant who captures the images, the knowledge of the angles, lighting, acoustics and background. Another possible disadvantage is psychological, the deterioration of the physician-patient relationship and rapport, especially because the patient interacts only with the medical aide and not with the neurologist directly.

However, on comparison with the parameters such as accuracy, specificity, sensitivity, cost-effectiveness, installation cost, accurate decision-making, time efficiency, rate of technical complications, patient privacy and security features, the above said limitations can be ruled out to certain extent.


When the studies in the field of telestroke evaluation are coupled together, the real-time smartphone neurological examinations and teleradiology assessments appear to be promising for the vascular neurologists. A single mobile health tool will enable them to actively conduct full telestroke and teleradiology assessments necessary for a complete virtual stroke consultation in a remote environment. Besides offering a real-time treatment for the patients, the introduction of smartphone and tablets to telemedicine may significantly overcome the cost barrier that prevents the hospitals from expansion of telestroke network.

This article was written for Color Doppler magazine, September 2013 issue -

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