VIDEOCONFERENCING - a new way of presenting reports

by Bjorn Lofterod Chief Consultant, Section for Child Neurology, Rikshospitalet University Hospital , Oslo , Norwa

The first clinical motion lab in Norway was established at our hospital as late as January 2002. Since then we have had an increasing demand for gait analysis from all over Norway . In the first year we performed 60 analyses and this year we will carry out approximately 150 analyses. Our staff is expanding and we have a multidisciplinary approach. The team consists of physiotherapists, orthotists and physicians (a child specialist neurologist and an orthopaedic surgeon). They all work part-time in the laboratory. We use a six-camera Vicon 612 system and two AMTI force plates. So far we have been very satisfied with the system and support. In the near future we hope to supplement our resources with a video vector system and equipment for evaluating oxygen consumption.

From the start we have focused on a close co-operation with the referring clinicians. We believe this is vital in order to give the patient the best advice. Hence it makes the physicians generally more aware of the importance of gait analysis as part of their treatment plan.

The movement analysis team. From left: Terje Terjesen (orthopaedic surgeon); Ann-Britt Huse (cpo); Bjorn Lofterod (child specialist neurologist); Reidun Jahnsen (physiotherapist); Monica Johannessen (physiotherapist); Ingrid Skaaret (cpo).

Our ideology is that the result will not be better than the weakest link in the chain. The team in the laboratory therefore tries to take responsibility for the whole chain and to secure any weak part. To achieve this aim good communication between the professionals that take part in the treatment is necessary.

We make team conclusions. However, final conclusions are always made in co-operation with the referring specialists, as they know the patient best and have good knowledge of the rehabilitation resources in the country. All the patients have a follow up post-treatment analysis. In order to evaluate our recommendations and results we are very much concerned that the patient follows the treatment plan outlined, including appropriate training and use of orthosis. Among patients receiving surgery we now know (through our own study of this subject) that the surgeons follow the preoperative gait analysis recommendations in more than 90% of the cases.

Our ambition to play a major role in the patient’s treatment plans has many challenges, such as the effective communication of our recommendations. So far we have communicated these recommendations to the referring specialists at regular meetings, which we call conclusion seminars. During these meetings the team presents the patient and analysis as displayed in a Polygon report. In the first two years we always had the seminars at our hospital. During that period we experienced inconsistency in attendance, and sometimes we found that the most important persons of the local rehabilitation team could not find time to meet. There may be many reasons for inconsistency in attendance, but for Norway high travelling expenses and unstable weather conditions mean a lot. The country has only 4.8 million people, but is very long and narrow and it takes about three hours to travel by air from the north to the south.

In order to achieve our goal concerning a close co-operation with the referring specialists we had to look for another way of organizing some of the conclusion seminars. It turned out that all the co-operating hospitals had a videoconference system, but like us they hardly ever made use of it. Now, two years later, we have good experience in organizing gait analysis conclusion seminars by videoconferencing with hospitals all over Norway . One definite advantage is that it allows more people to take part, as there are no travelling expenses to fund. The referring specialist can involve colleagues and local members of the multidisciplinary team in the discussion. No travelling time means that all involved can make their day more efficient, and it is also easier to find time to suit everyone when you are not depending on public transport. All these factors ensure a better attendance, and hopefully a better final result for the patient. When the attendance improves more professionals learn about the possibilities and restrictions of gait analysis. This may in future lead to a better selection of high priority patients.

A view of the movement analysis laboratory with a subject under test.

Before each meeting we send our Polygon report as a Word document by e-mail so all participants are prepared for the subsequent discussion. We and our colleagues at the other end have two screens. On one screen we can see the team from the other hospital (and vice versa), and on the other screen we present the patient by using an ordinary Polygon report. Details and future treatment are discussed before a joint conclusion is drawn. We use about 30 minutes for each patient presented and usually have two to three patients presented at each meeting. We use a Tandberg Videoconferencing System, but we believe there are also other high quality products on the market.

One disadvantage is that the screen is smaller than the screen we use when we present the reports at our hospital. This may blur the text in the report. The picture may also sometimes appear a bit unclear, but this is usually a question of adjusting the system. Sound is rarely a problem. Videoconferencing will of course never be the same as having your colleagues in the same room, but it is close to it and the organization is very convenient as a means of connecting specialist services.

There is a good co-operation between the motion labs in the Nordic countries ( Denmark , Finland , Sweden and Norway ). Three years ago we formed the Nordic Vicon User Group. The group meets twice a year for professional and social networking. A result from this teamwork is a Nordic normal reference database. As far as I know we are the only team in the group up to now that use videoconferencing in our clinical work. But future multicenter studies between the four countries may be a perfect challenge for more active use of videoconferencing with less attendant travel expenses. We may also be able to establish joint discussions and consult each other concerning difficult cases using this useful method.