1 THE ROLES OF MEDICAL REHABILITATION PROFESSIONALS Rory A. Cooper, PhD Rosemarie Cooper, MPT,ATP Brad E. Dicianno, MD,
2 AT-Service Delivery Model Center For Assistive Technology Mission Services Service Delivery Model (Medical Home) Clinician Task Force (Team Approach) Outcome Measures Research ( Virtual Coach) Assistive Technology Centers of Excellence
3 Center For Assistive Technology Mission The mission of CAT is to enhance the ability of people with disabilities to fulfill life goals through the coordination and provision of appropriate assistive technology services.
4 Center For Assistive Technology Services wheelchair seating and positioning personal mobility systems augmentative communication devices (speech output devices) audiology services, aural rehabilitation, assistive listening and alerting devices, and hearing aid dispensing specialized computer equipment and software, such as adaptive keyboards, monitors, and voice programs ergonomic workstation design environmental control units for work, school, or home recreational devices, such as cycles and skis consultation on vehicle modifications and related adaptive equipment adaptive driving evaluation and training environmental accessibility and recommendations for home modifications
5 AT Takes a Team Effort! Physical Medicine & Rehabilitation Rehabilitation Nursing Speech Language Pathology Occupational Therapy Physical Therapy Recreation Therapy Rehabilitation Engineering Blind Rehabilitation Specialist Counseling Psychology Neuropsychology Social Work/Case Manager Prosthetist/Orthotist Prosthetic Purchasing
6 The chief team member is. The client The design and application of the AT Service Delivery starts out with the introduction of the client to the AT Assessment team and empowering the client to be an active decision- making member of that team. One stop visit AT Service Home
7 AT- Service Delivery Process (Good Practices) Screening In-depth evaluation and client education Final specifications Documentation Fittings Delivery Training Follow-up/Outcomes
8 AT- Service Delivery Process (Good Practices) Assessment by a knowledgeable & trained clinician face-to-face evaluation The individual s medical history; Physical abilities and needs; Functional abilities and needs; Seating and positioning abilities and needs; Home accessibility; Currently used assistive devices; and Environmental considerations
9 AT- Service Delivery Process Trial of Demonstration Equipment Client education Discussion of options Review of goals Compromises/Optimization Home trials Consensus and final decisions
10 AT Team Physical therapists provide services that help restore function, improve mobility, relieve pain, and prevent or limit permanent physical disabilities of patients suffering from injuries or disease. Occupational therapists (OTs) evaluate people s abilities to perform the everyday tasks they need to do (toileting, dressing); are required to do (data entry, tool and die machine repair, change diapers); or want to do (play cards). When task performance is too difficult, painful, or cannot be accomplished at all, occupational therapists modify or simplify the tasks; adapt tools, objects, or environments; or match technologies to people s needs and preferences enabling more independent, safe, and adequate task performance.
11 AT Team Physiatrists are the team leaders of care during rehabilitation, directing a rehabilitation care plan that includes several other team members. Some of the types of problems that a physiatrist may treat are skin breakdown, obesity, bowel and bladder problems, musculoskeletal, back, and nerve injuries, chronic pain, and spasticity. Physiatrists also guide prescriptions for orthotics, prosthetics, mobility devices and assistive technology
12 AT Team A speech language pathologist deals with the prevention, diagnosis, and treatment of a wide range of primarily expressive communication disorders, including the identification, diagnosis, and rehabilitation of speech, language, and swallowing dysfunction. The goal of augmentative and alternative communication (AAC) intervention is to optimize the communication of individuals with significant communication disorders 3. AAC assistive technology provides a viable rehabilitation solution to assist individuals who cannot speak to achieve maximum potential.
13 AT Team An audiologist deals primarily with receptive communication disorders, especially the prevention, identification, and measurement of hearing loss and the rehabilitation of individuals with hearing impairments, as well as the assessment of balance disorders. Assistive Devices: Devices to Enhance Hearing Ability Signaling and Alerting Devices
14 AT Team Rehabilitation counseling is a process whereby the counselor works collaboratively with an individual with a disability to understand existing problems, barriers, and potentials in order to facilitate the client s effective use of personal and environmental resources for personal, social, career, and community adjustment. OVR
15 AT Team Rehabilitation Engineering: Rehabilitation technology means the systematic application of technologies, engineering methodologies, or scientific principles to meet the needs of, and address the barriers confronted by, individuals with disabilities in areas that include education, rehabilitation, employment, transportation, independent living, and recreation. The term includes rehabilitation engineering, assistive technology devices, and assistive technology services. Assistive Technology Supplier (ATP Credentialed)
16 Implementation of Outcome Measures The Need Locating the appropriate tool Integration into assessment Acceptance by clinicians
17 The SmartWheel is a Quantitative Tool The SmartWheel provides data such as: Average force it takes to propel a wheelchair Length of each push on the handrim How often the person is pushing How smooth the person is pushing
18 The Importance of Quantitative Data Bolsters funding justification: Medical Insurance and Vocational Rehab Provides data to support equipment decisions Client education Feedback to promote training (e.g., push technique) Provides visit-to-visit data to track client outcomes Database and knowledge base creation
19 Functioning Everyday with a Wheelchair (FEW) (Mills, et al, 2007) www. few.pitt.edu 1. Durability, Reliability 2. Comfort 3. Health Needs 4. Operate 5. Reach 6. Transfers 7. Personal Care 8. Indoor Mobility 9. Outdoor Mobility 10. Transport
21 Timed Up & Go (TUG)Test Sit in Arm Chair Get up & walk 3 meters Turn around, come back & sit down <10 seconds = normal <20 seconds = good mobility, can go out alone, mobile without a gait aid <30 seconds= problems, cannot go outside alone, requires a gait aid Podsiadio & Richardson, seconds = high risk for falling Shumway-Cook, Brauer& Woolcott, 2000)
22 Research Example: Virtual Coach Collaboration between the University of Pittsburgh and Carnegie Mellon University: Started from a CMU-computer engineering class project: U-Pitt Clinician gave lectures about: Introduction to Power Seat Functions (PSFs) Concerns and considerations from clinical observation
23 Development of Virtual Coach Technologists to observe clinician-client relationship More specific questions were developed: How can we enhance the use of PSFs and provide appropriate feedback? How can we verify whether the user understand clinical recommendations and comply with them? Are there any technologies currently on the market that could be applied?
24 Virtual Seating Coach (VSC) Functions: Monitor and Record Power seat function and wheelchair usage Interaction with VSC Remind Pressure relief Usage safety Report For clinicians Conventional power wheelchair Current: instrumented system Future: add-on system
25 Virtual Seating Coach (VSC) User can personalize display effects Desktop page
27 Assistive Technology Centers of Excellence Partnership between the VHA and Academic community (University of Pittsburgh) Established 4 COE across VA In-person evaluation and training Telemedicine evaluation and consultation Teleconference and in-person training of staff Assist with establishing AT expertise in each of 22 VISNs In-person evaluation and training AT resources available to all Veterans
28 Integrated System Polytrauma Centers (now 5!) Regional referral centers Polytrauma Network Sites (22) VISN level referral sites Polytrauma Support Clinics (85) Facility level teams Polytrauma Points of Contact (43) Referral and care coordination
29 Polytrauma Rehabilitation Centers Regional referral centers for veterans and active duty service members with TBI and polytrauma Patients with high degree of medical complexity and varied patterns of disabling injuries Full range of acute comprehensive medical and rehabilitative services
30 Polytrauma Rehabilitation Centers Tampa, FL Richmond, VA Minneapolis, MN Palo Alto, CA
33 Military Culture Dealing with the loss of brothers in combat Transferred to the PRCs, which limits communicating with and support of their comrades Wish to return to combat with their comrades Young and technologically savvy Incorporation of military culture as a motivational tool and effects on rehab
34 Family Support Integral member of the rehab team for goal formation and patient support/motivation Families have high expectations and understandably want the latest advances and state of the art technology for their loved one Families live together on campus. They are very aware of everybody s care, therapy and receipt of technology Family involvement facilitates improved education and carryover of newly learned skills
35 Teams Involve more people, thus affording more resources, ideas, and energy than would an individual. Provide multiple perspectives on how to meet a need or reach a goal, thus devising several alternatives for each situation. C. G. Wilkes in John C. Maxwell, Equipping 101. Thomas Nelson Publishers, Nashville, 2003.p.5-6 ; Shortell & Kaluzny, Health Care Management Organization Design and Behavior. Thomson DelMar Learning, US, 2006, Chapters 6 8.
36 Deep Dive Assistive Technology Institute for VA Clinicians Pittsburgh, PA 2010 & 2011
37 Deep Dive Assistive Technology Institute for VA Clinicians Pittsburgh, PA 2010 & 2011
The following excerpt has been taken from the Christopher & Dana Reeve Foundation Paralysis Resource Center website. http://www.christopherreeve.org/site/c.mtkzkgmwkwg/b.4453457/k.a4cb/overview How_to_Pick_a_Rehab.htm
Patient Guide New Hanover Health Network Coastal Rehabilitation Services Welcome This guide book is designed to provide you with information regarding the programs, treatment and care provided by Coastal
REHABILITATION CONCEPTUAL FRAMEWORK February 13 th, 2012 Interprofessional Practice Health Professions Strategy and Practice Rehabilitation Conceptual Framework - I Executive Summary The Rehabilitation
Amputation Rehabilitation Center AT MossRehab Since 1959, MossRehab has provided our patients with a breadth of clinical expertise unrivaled in the region. Within our extensive system you ll find: Experienced
COUNCIL OF EUROPE COMMITTEE OF MINISTERS RECOMMENDATION No. R (92) 6 OF THE COMMITTEE OF MINISTERS TO MEMBER STATES ON A COHERENT POLICY FOR PEOPLE WITH DISABILITIES (Adopted by the Committee of Ministers
Recovering After a Stroke: A Patient and Family Guide Consumer Guide Number 16 AHCPR Publication No. 95-0664: May 1995 US Agency for HealthCare Research and Quality Purpose of This Booklet This booklet
NHS National Institute for Clinical Excellence Guidance on Cancer Services Improving Supportive and Palliative Care for Adults with Cancer The Manual Improving Supportive and Palliative Care for Adults
How to Choose the Mobility Device that is Right for You A guide for people with ms managing major changes Jason (cover photo), diagnosed in 2005. Kim (top), diagnosed in 1986. John (second from top), diagnosed
The MAURITIUS RESEARCH COUNCIL NNEEDS ASSESSMENT ON NEUROLOGICAL REHABILITATION SERVICES IN MAURITIUS Report Mauritius Research Council, February 2012 ACKNOWLEDGEMENTS This study was carried out in collaboration
C6 CONSUMER GUIDE: EXPECTED OUTCOMES SPINAL CORD MEDICINE Expected Outcomes: What You Should Know A Guide for People with C6 Spinal Cord Injury Administrative and financial support provided by Paralyzed
Clinical Practice Guidelines for Quality Palliative Care SECOND EDITION Clinical Practice Guidelines for Quality Palliative Care SECOND EDITION Publisher National Consensus Project for Quality Palliative
BSRM Standards for Rehabilitation Services Mapped on to the National Service Framework for Long-Term Conditions British Society of Rehabilitation Medicine C/o Royal College of Physicians, 11 St Andrews
ACUTE INPATIENT REHABILITATION: MEETING THE NEEDS OF THE TRAUMA PATIENT St. Mary Rehabilitation Hospital Goals for today s presentation: Admission 1. Clarify the inpatient rehabilitation admissions process.
Careers Nova Scotia High Opportunity Career Options in Nova Scotia 2014-2015 careers.novascotia.ca Acknowledgements A special note of thanks is extended to the professional associations, employers, trade
PART I General Concepts and Principles of Rehabilitation Nursing Chapter 1 Overview of Rehabilitation Kristen L. Mauk Learning Objectives At the end of this chapter, the reader will be able to Define rehabilitation.
Guidelines for Care: Person-centred care of people with dementia living in care homes FRAMEWORK January 2011 You matter because you are you and you matter to the last moment of your life. We will do all
The Falls Management Program: A Quality Improvement Initiative for Nursing Facilities Authors: Jo A. Taylor, R.N., M.P.H. Patricia Parmelee, Ph.D. Holly Brown, M.S.N., A.P.R.N.-B.C. Joseph Ouslander, M.D.
Michigan Administrative Rules for Special Education (MARSE) Supplemented With Selected MARSE (September 2013) (July 2010) Michigan Department of Education, Office of Special Education Published October
Joint Commissioning Panel for Mental Health www.jcpmh.info Guidance for commissioners of rehabilitation services for people with complex mental health needs 1 Guidance for commissioners of rehabilitation
The Doctor Thinks It s FTD. Now What? A Guide for Managing a New Diagnosis The doctor thinks it s FTD. Now what? Table of Contents The Association for Frontotemporal Degeneration (AFTD) is a non-profit
The National Multiple Sclerosis Society One thing people with MS can count on. KIDS GET MS TOO: Questions and Answers A Publication of the Multiple Sclerosis Society of Canada and the National Multiple
High expectations for all Supporting the introduction of the Children and Families Act 2014 p2 High expectations for all Foreword Hello, I am very pleased to be able to introduce this High Expectations