Video Exercises & Collaboration

Some exercises are really simple for patients to understand and providing VHI printed instructions is sufficient.  However, I find more complex exercises very difficult for patients to retain after leaving the clinic as they show me incorrect demonstrations on the next visit.  Strategies I've used is asking how the patient wants the instructions written down so they can remember their way.

I've tinkered with the idea of just video recording what I would like them to do so they can refer to that visual feedback to help with learning.  Today, it is still hard to share video of patients as file sizes are large and cannot be emailed easily.  Although most patients have an email address, having them sign up for video sharing services can be a hassle in order for them to see videos.  Providing them with a flash drive of their exercises can be difficult as they can be easily lost or not work correctly with the patient's computer.  At our pro bono clinic at UND, my partner and I decided to utilize Dropbox in order to share videos of our client performing exercises.  We could easily record a video with a tablet or smartphone and upload it directly to Dropbox.  Sharing on Dropbox is a breeze and only people with the URL it provides have access to the video.  We also used goo.gl to shorten the URL to make it typing it in the patients home device much more simple.  The beautiful thing about Dropbox is videos play nicely within a browser without having to download any files and works nicely on most smart phone devices.

There are other services such as Google Drive and Box that are capable of easy cloud sharing, but I'm sure you have heard all the hacking that has been going on in the news recently.  Also these services have risks for not complying with HIPAA currently as discussed on this website.  I plan on further discussing drawbacks such as HIPAA and data theft in a future post.

Although these may not be ideally used in the clinic for patients, I have found these to be marvelous for collaborating with classmates and colleagues.  We can share files, modify them, and see previous versions of files which was super helpful especially for group presentations.  Plus if you have the service installed on your computer, anything you edit within the service folder changes automatically online for everyone.  Using Google Drive had other services too such as Google Hangouts.  We could all simultaneously video chat for free and share real time of our computer monitor screen.  The beautiful thing about Google services is it can all be done from a browser without having to download and install any software (although these do work best using Google Chrome).  FaceTime and Skype are other video chatting alternatives.

Other Exercise/HEP Services (I also plan on comparing these services more later on):

• You could simply record a patient with your phone/tablet camera and email it to them
• WebExercises
• Physiotec
• Perfect Fit
• HEP2go - HEP2go has been a very awesome service I have been using on my 3rd clinical set I will be discussing more in the future due to how versatile it is for being a free service.

All the videos you record can be referred back to in order to assess if patients have improved and they love to see that they have made improvements as well.

Orthopedic Testing Apps

The other day I had a friend ask myself and a classmate of mine to check out his shoulder.  He reported getting pushed into the boards during hockey and his shoulder was sore as a result of it.  When we arrived we observed him holding his shoulder close to his arm in a self splinting fashion and had him remove his shirt to examine it.  There were no asymmetries or visible separations but he had a very tender joint AC joint to palpation.  In Exam & Eval we have not been instructed on any AC joint tests so I got out my iPhone and used an orthopedic testing app called Core - Clinical Orthopedic Exam.  It instructed me on how to perform the cross over test and even provided video (all videos can be found on there youtube channel).  We ended up getting a positive test and we looked up instructions on how to make a sling for our friend since we did not have any handy at this website and instructed him as to ice periodically.  Since our friend is an engineer student he was curious about what we thought his injury was so I used Zygote Body to educate him on the AC joint.  A few days later he reported he was feeling better as well as confirming his injury with imaging that he did have a grade I AC joint sprain.

On another note there is an iPad app by 3D4Medical with plenty of orthopedic education animations and 3D models called Orthopedic Patient Education.  I have yet to try it but I will most likely get it when it goes on sale.

Aslo my classmates and I had a very brief moment in an NSC 2014 video at 0:52!

Some of My Favorite Apps

3D4Medical makes some really awesome apps for patient education or to use as a studying tool.  My favorite app created by them is Muscle System Pro III as it was incredibly helpful when I took anatomy to visualize structures 3-dimensionally and to see individual muscle movement.  I found the joint specific apps like Shoulder Pro III to be helpful in educating patients on rotator cuff repairs as viewing arthroscopic images is not really intuitive to patients.  There are multiple surgical and pathology videos for many of the joints in the body that 3D4Medical has.

Zygote 3D Anatomy Atlas & Dissection Lab is a fantastic anatomy app and even has a free website called www.zygotebody.com (the website is best used in Google Chrome).  This particular app is a little more challenging to use but is super versatile.  Structures can be made transparent or removed altogether and there is even a cross section mode you can put in any plane.  I find that helpful to see the course of nerves and vessels.  I also love to use this when educating patients in the clinic to get the exact view of the structure I want instead of relying on the posters/books available in clinic.

Using Coach's Eye to assess and educate patients is spectacular.  When I started doing gait analysis in school it was incredible to record someone ambulating and then slow down the motion in order to picture the gait cycle and the deviations from normal.  My clinical instructor used this app as a visual feedback tool to help patients learn correct motions by recording the patient doing the exercise incorrectly and then doing a side by side comparison of the correct movement.

The beautiful thing about these apps is that they can be displayed to a larger TV by using Apple TV for iPhone/iPad/Mac users or Chrome Cast for Android users so patients don't have to stare at a substantially smaller phone screen.