Mauritius calling: medical care and neurorehabilitation needs in an oceanic idyll.

The tropical island of Mauritius, located off the coast of Southern Africa, has greatly improved its health care system, especially for frontline services and procedures such as cardiac surgery. But the post-acute neurorehabilitation care is still problematic, much to the detriment of disabled patients, their families, and Mauritian society overall. Comparisons with neurorehabilitation care in the United Kingdom suggest the scale of the problem in terms of uncoordinated medical teams, limited follow-ups, lack of expertise, and cultural stigma. This article assesses the needs of the neurologic rehabilitation segment in Mauritian health care and submits a set of policy recommendations addressing what medical professionals, hospitals, government officials, and other organizations can do to improve the neurologic rehabilitation infrastructure for Mauritian patients.

Functional and clinical outcomes of telemedicine in patients with spinal cord injury.

OBJECTIVE: To compare the 6-month outcomes of telerehabilitation intervention with those of standard care for spinal cord injury (SCI). DESIGN: Multicenter randomized controlled trial. SETTING: Home, nursing, or unspecialized hospital care provided after discharge from a spinal cord unit. PARTICIPANTS: Adult patients with nonprogressive, complete, or incomplete SCI discharged for the first time from the spinal cord unit to their homes (Belgium and Italy) or to their homes or another facility (England). INTERVENTIONS: All patients received the standard care they would have normally received after discharge from the spinal cord unit. In addition, patients in the telemedicine group received 8 telemedicine weekly sessions in the first 2 months, followed by biweekly telemedicine sessions for 4 months. MAIN OUTCOME MEASURES: Functional status at 6 months, clinical complications during the postdischarge period, and patient satisfaction. RESULTS: No significant differences in the occurrence of clinical complications were found between the study groups. A higher improvement of functional scores in the telemedicine group was found only at the Italian site: FIM total score 3.38+/-4.43 (controls) versus 7.69+/-6.88 (telemedicine group), FIM motor score 3.24+/-4.38 (controls) versus 7.55+/-7.00 (telemedicine group; P<.05). Items contributing to this difference were grooming, dressing upper body, dressing lower body, and bed/chair/wheelchair transfer. Higher satisfaction with care was reported by patients in the telemedicine group across all sites. CONCLUSIONS: Our study provides some of the first quantitative evidence, based on results from 1 site, that telerehabilitation may offer benefits to patients discharged from a spinal cord unit compared with standard care in terms of functional improvement. Further research is warranted to confirm or disprove this finding.

Using telemedicine to provide post-discharge support for patients with spinal cord injuries.

We are conducting a randomized controlled trial of telemedicine with patients with spinal cord injuries in their own homes. Internet videoconferencing is used at a bandwidth of 128 kbit/s. Data collection began in March 2004. Twelve patients had entered the study by August 2004, but none had completed it. Preliminary results in one case suggest that telemedicine provided various benefits: (1) the patient received advice he would probably not have solicited; (2) it enabled an expert to view the entry site of a pin in the patient's halo brace, to determine whether the general practitioner should be contacted to arrange a swab; (3) it made it easier for the interviewer to understand family interactions during the session. Telemedicine offers an additional tool in the care of geographically widespread outpatients.