Abstract—Physical rehabilitation positively affects clinical outcomes in multiple sclerosis (MS) however it is limited by delivery modes, cost and distance. Telemedicine approaches can potentially facilitate home- based rehabilitation however they were not systematically implemented for patients with MS. We developed a Home Automated Telemanagement (HAT) system for computer-guided management of patients with MS providing individualized instruction and monitoring of physical therapy exercise at patient homes. The HAT home unit runs on a netbook in the patient’s home connected to a remote server via internet. The system questions the patient on their condition, gives detailed step by step exercise instructions, records their daily exercise log, and informs and quizzes the patient on their knowledge of multiple sclerosis. The exercise log is transmitted to the remote HAT server where it is analyzed using decision support algorithms to facilitate MS management. The exercise logs are available on-line for review by patient providers. Patient exercise regimen is determined by their physical therapist and can be updated on-line, keeping a personalized approach to disease management while taking advantage of the convenience the technology supplies. This telemanagement system has been successfully designed and implemented to optimize the care of patients with multiple sclerosis. Keywords-telerehabilitation; eHealth; multiple sclerosis I. INTRODUCTION Multiple sclerosis (MS) is a chronic debilitating disease of the central nervous system that may result in significant damage of the neuromuscular system, vision, and affective and cognitive functions [1]. Approximately 400,000 persons in the United States have MS [2]. Lifelong rehabilitation measures, along with medication treatment, are the major components of patient management [3–4]. Physical exercises positively affect patients’ quality of life and their functional capacities [5–6]. Poor adherence to rehabilitation, limited patient education, and access to specialized care can be barriers to treatment [7–8]. Removing those barriers is an important step towards improving patient care for multiple sclerosis. Current technology allows for remote information transfer in a variety of circumstances. Information can be easily transferred to and from a person’s home through the existing telephone and internet infrastructures. Our goal was to design a telemanagement system for patient use in MS. This paper reports the success of design and implementation of the Home Automated Telemanagement (HAT) software in patients with MS. We describe the software and hardware used, website design, and overall interactions of the HAT system design. II. SYSTEM DESIGN The HAT system is based on Wagner’s model of chronic disease care [9]. The HAT system supports the major components of this model including patient self-care, tailored education and counseling, individualized treatment plan, guideline-concordant decision support, comprehensive patient provider communication, and multidisciplinary care coordination [10-12]. Using this model, the HAT system has been successfully implemented and tested in various health conditions [13-17]. The HAT system consists of home unit, HAT server and clinician unit [18]. The previous applications utilized laptops, PDA, IVR, and cell phones for patient home units [19-22]. The HAT system for MS takes advantage of the current technology to provide patients with a convenient treatment plan and exercise regimen as well as enforcing adherence to rehabilitation through more frequent monitoring. The home unit was developed using Visual Basic and runs on netbooks with Windows operating systems. Visual Basic is a programming language and development environment from Microsoft derived from the BASIC programming language. The language allows for quick development and has extended Microsoft Windows functionality for more complex projects. Visual Basic is also well supported by older operating systems, making it ideal for projects utilizing less expensive computers with limited system resources. The patient home unit sends patient self-report information via internet to a HAT server running Windows 2008. A server running Internet Information Services (IIS) collects the patient’s data and integrates it into a website to be accessed by the patient’s physician and physical therapist. IIS is one of the most widely used web servers and provides a stable and widely compatible system for receiving and editing patient information. The webpage was developed using Microsoft’s .NET framework. This is a framework for developing dynamic websites which offers extensive built-in functionality and is supported by most browsers. The patient home unit allows a patient to run a self-test and exercise program which asks the patient a series of symptom questions, instructs them on exercise routines, Designing Physical Telerehabilitation System for Patients with Multiple Sclerosis Joseph Finkelstein, Jeffrey Wood Chronic Disease Informatics Program, Johns Hopkins University Baltimore, USA jfinkel9@jhmi.edu 68 Copyright (c) IARIA, 2012. ISBN: 978-1-61208-179-3 eTELEMED 2012 : The Fourth International Conference on eHealth, Telemedicine, and Social Medicine