An Assistive Technology Program: Meeting the Unmet Needs of People with Disabilities

1. An Assistive Technology Program: Meeting the Unmet Needs of People with Disabilities CSUN Conference 2010 Holly A. Cohen, OTR/L, ATP Nandita Singh, MPH,OTR/L Steve VanLew, MS, OT/L

2. Goals: AT and Our Program at NYU Gather an understanding of our program and how it came about Quality of Life and Assistive Technology What is it and how does AT affect QOL PIADS How do we use outcome studies Case Studies Questions???

3. Who are we? The History of Our Institution

4. Rusk Institute of Rehabilitation Medicine Rehabilitation hospital affiliated with NYU Langone Medical Center in New York City Howard A. Rusk – Founding Father of Rehabilitation Medicine

5. Occupational Therapy Services at Rusk Adults and Pediatrics Inpatients: 80 beds 20,000 visits per year Outpatients: 8,500 visits per year Acute Care: 670 beds 12,000 visits per year

6. OT Staffing Director of OT/PT Associate Director of OT 6 Supervisors 6 Clinical Specialists 41 OTR’s 3 COTA’s 4 Support Staff

7. What is Assistive Technology? • “Any item, piece of equipment or product system, whether acquired commercially, modified or customized, that is used to increase, maintain or improve the functional capabilities of individuals with disabilities”

8. Examples of AT • Computer screen readers • Alternative computer access hardware and software • Keyboards • Mice • Monitor • ECUs • SGD or AAC • Glasses • Walkers, canes, etc.

9. The AT Program at NYU Rusk • 2004 - Outpatient Occupational Therapy Department • 2005 - 16 patients seen for Assistive Technology • 2009- 150 adults seen for Outpatient Assistive Technology - Over 50 inpatient and pediatric consults

10. Main Areas of Focus: • Computer access • Hardware, software, and switch interfacing • Speech Generating Devices or AAC • Text to speech software, voice amplifiers, telephone adaptations, and any other technology to enhance an individuals communication • Environmental Control Units • Leisure tasks such as gaming units, photography, etc.

11. Service Delivery: • Program is lead by Occupational Therapy Clinical Specialist in Assistive Technology • Individuals are evaluated based on an occupational therapy practice domain including: • Activity demands • Performance skills • Performance patterns • Client factors • Context and environment

12. Patients are seen through evaluation, delivery, and implementation of technology prescribed • Patients trial various forms of technology to meet their goals prior to prescription

13. Types of Patients Seen: • SCI • CVA • ALS • MD • MS • CP • Impairments of fine and gross motor control skills • Work related injuries • TBI or other cognitive impairments • Neuropathy • Repetitive stress injuries

14. How Are We Unique? • Most assistive technologies are not covered by insurance companies • The service at NYU is grant funded. This enables us to provide equipment to individuals that could otherwise not afford to purchase it themselves • All individuals receive necessary equipment regardless of reimbursement

15. Our Grant: • Initially applied for Helen Hoffritz Grant Fund in 2005 • Goal was to receive money to provide technology to our patients • Since 2005, we have received money annually • In 2010 double amount of money provided than 2005

16. Meeting Communication Needs: • All individuals are seen collaboratively with both the AT and SLP departments • Two programs work together • Evaluation • Letter of justification • Training of all communication technology • True collaborative approach

17. The Mentorship Program: • Educational program for staff interested in assistive technology • Ten week program with staff/senior occupational therapist • AT education • Service delivery • Documentation and goal writing • Involves supervised treatment of referred AT patients

18. The Mentorship Program: • Goal is for participants to assist with patient care • Expansion across the board in all services • Currently building a basic competency for staff on all levels for Assistive Technology

19. Providing Novel Technology: • The Rusk Institute has a collaboration with the Interactive Telecommunications Program (ITP)at NYU and the NYU Occupational Therapy Department at New York University

20. Providing Novel Technology: ITP 2 year graduate program located in the Tisch School of the Artswhose mission is to explore the imaginative use of communications technologies Occupational Therapy Program at NYUoffers both entry level and post professional education

21. OT and ITP: Goals: To create technology for individuals with disabilities when “off the shelf” is not sufficient Facilitates students, clinicians, and professors to work together to meet the needs of clients with disabilities

22. OT and ITP: • 2003: Collaborative class given for OT and ITP students; “Developing Assistive Technology” • Awarded funding through University Curricular Challenge Fund Grant • 2005: Continued participation in education between OT’s and ITP program • Development of Assistive Technology Lab through Nathan Cummings Foundation Grant

23. OT and ITP: • 2007: Worked with ITP students within Assistive Technology classes to tailor and critique their projects • 2008: “Design for One” created in ITP department. Goal to develop technology for individuals that didn’t fit “off the shelf” options

24. OT and ITP: • 2010: Continued involvement with ITP students and development through the “Developing Assistive Technology” class

25. Why Does This Work? • Exposes artists, designers, technology developers to individuals with disabilities • Expanding their appreciation of how their craft can make an impact on someone’s life, possibly developing their career paths • Reinforces the importance of creative outlets for people with disabilities

26. Community Outreach: • OT/ATP provides in-servicing to local organizations and facilities • Local rehabilitation hospitals • Vocational rehabilitation • Pediatric organizations • Support groups • Participation in community events • Goal is to educate about AT and how it can assist their clientele

27. What’s Next? Expansion - goal is to utilize trained staff to assist with patient care and service delivery Community outreach - address AT needs in various settings Continued Collaboration - with NYU Occupational Therapy Program and ITP for continued education and development of technology

28. Quality of Life and Assistive Technology

29. Quality of Life (QOL) and Assistive Technology • An assistive technology device should promote good QOL for the user to the extent to which it makes the user feel competent, confident, and motivated to exploit life’s possibilities (Jutai & Campbell, 2002) • Assistive technology is an extension of the external physical environment

30. QOL continued: • Example: • If an individual with quadriplegia wanted to use a computer to pay their bills online • Level of performance skills would greatly influence the exact type of devices required to facilitate independence • The change in QOL is of engagement of computer occupations can only be measured from the perspective of the individual • QOL is a subjective and theoretical construct

31. The PIADS: • Psychological Impact of Assistive Devices Scale • A 26-item, self-report questionnaire • It has established psychometric properties, internal consistency, test-retest reliability, and construct validity (Jutai & Day, 2002) • Describes user experiences along three dimensions • Confidence, adaptability, self esteem

32. PIADS: • When participating in the PIADS, all patients first “fill out” the background information form • This form is technology specific • Nine questions long • Amount of time using technology • Method of access • Level importance technology is to daily life, 1-5

33. Background Form:

34. The PIADS, Scoring: • The rating scale is from -3 to +3 • -3 meaning decreases • +3 meaning increases • Zero denotes neutrality of no change • It can be used to assess the impact of any assistive device, prosthesis or medical procedure • Can be used with people of all ages and abilities

36. How Do We Use the PIADS? • We use the PIADS to assess the effects of assistive devices • Quality of life • Functional independence • Well-being • All patients that received equipment participate in a PIADS survey • Regardless of payer source and type of technology

37. The PIADS: • It is completed six months following completion of service • Administered by Occupational Therapists • Through the use of the PIADS, we hope to ascertain if the provision of technology is truly enhancing the three dimensions of focus.

38. The Data: • 82% reported increased in satisfaction • 85% increased independence • 82%increased self esteem • 82%increased quality of life • 88%increased happiness • 59%decreased embarrassment • 65%decreased frustration

39. What Are We Doing With The Data? • The results of the PIADS are provided to the grant fund in order to obtain annual funding • Use of data to obtain additional funding, other than grant that we have now • Plans to utilize PIADS for research purposes

40. Case Study #1

41. Case Study #1 - A.G.: • 42 year old male with a primary diagnosis of C2 SCI as a result of a motorcycle accident (10/2004) • Prior to his MVA, AG worked as an air conditioner installer • He lived with his girlfriend; his two young children lived nearby

42. A.G. Continued: • Following injury, AG resided in a LTC facility for three years • He was dependent for all self care needs, including a ventilator at all times • In 2007, AG received a phrenic nerve stimulator, enabling him to return to home with 24 hour care • Also provided with power wheelchair, independent with use of sip and puff controls

43. A.G. Continued: • A.G. was referred to the Assistive Technology Service at the NYU/Rusk Institute • His goals were to: • “Do more for myself” • “Go to school so I can get a job with computers”

44. A.G. continued: • Following AT evaluation A.G. was introduced to options for: • Light control • TV and all other IR control • Computer access

45. A.G.’s Prescription: • After an extensive trial period, A.G. was given: • Computer access skills: • Head mouse, software for on screen keyboard and dwell click software • Dragon Naturally Speaking • Laptop was mounted to wheelchair • Following training on all equipment, A.G. was independent with computer access and was able to enroll in continuing education classes on web design

47. A.G’s Prescription: • Software was installed on A.G.’s computer for environmental controls • Lights • TV • DVD • Stereo • A.G. was now independent for IR and other home controls

49. A.G.: • All of A.G.’s goals were met • He was able to transition from dependent to independent in many areas in his daily life • All of A.G.’s technology was provided from the Helen Hoffritz Grant Fund

50. Case Study #2