Transcript Title

VA-PRC AT
Overview &
Contract Update
‘Deep Dive’ Assistive Technology
Institute
Mark R. Schmeler, PhD, OTR/L, ATP,
Richard M. Schein, PhD, MPH,
Carmen DiGiovine, PhD, ATP, RET &
Andi Saptono, PhD
University of Pittsburgh
September 11-12, 2012
Palo Alto, CA
Goal
Support VA, VA Clinicians, Veterans, &
active-duty military personnel
through the appropriate application
of Assistive Technology
Overview
3-Year Systematic Plan with 13 Unique Milestones
• Needs Assessment
• Development Plans
– Physical space
– Personnel
– Training/CE
– Demo Equipment
– Practice Guidelines
– Documentation
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Outcome Management
AT Intervention
Device Reviews
Information
Infrastructure
• CARF
• Build Upon Existing
Programs
Definition of Assistive Technology
• Any item, piece of equipment or product system
whether acquired commercially off the shelf,
modified, or customized that is used to increase or
improve functional capabilities of individuals with
disabilities.
(Assistive Technology Act, 1998, PL 105-394, S.2432)
– Low/high tech solutions
– Function in a variety of environments (home, work,
classroom, & community)
– Engage in meaningful activities (activities of daily living,
play, learn, interact socially, work, travel...)
– Achieve independence
AT Service Areas
• Wheeled Mobility & Seating Equipment
• Augmentative and Alternative Communication Devices
• Cognitive Orthotics & Learning Technologies
– Now called Electronic Cognitive Devices
• Electronic Aids to Daily Living (EADLs)
• Adapted Computer Access
• Adapted Driving & Vehicle Modifications
• Adapted Sports & Recreation Equipment
Milestones 1, 2, & 3
• Milestone 1: Initialize Project
– May 5, 2009 at the Denver VA Medical Center
– May 13-14, 2009 Kick-Off Meeting in Richmond, VA
• Milestone 2 & 3: Develop Design and Work Plans
– Needs Assessment
– Facility Resources
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Identify Current AT Services and Core Areas
Capacities and Preference with Outcome Tools
Resources
Continuing Education
Milestone 2- Design Plan
‘Ingredients’
Personnel:
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AT Manager/Coordinator
Medical Oversight
Rehabilitation Engineer and/or Technician
Rehab Therapists (OT, PT, KT, SLP, & RT)
Neuro/Rehabilitation Counseling
Prosthetics & Sensory Aids Service
Representative
• Administrative Support
Milestone 2- Design Plan
‘Ingredients’
Space – room size, use of multi-function and hybrid
spaces, patient and staff flow, access to storage
• *Defining Assistive Technology Lab - “A dedicated
space that includes a variety of state of the art products, devices and
equipment that may enable patients with disabilities to accomplish
daily living tasks, assist them in communication, education, work or
recreation activities, in essence, help them achieve greater
independence and enhance their quality of life.”
• *Outlining - “1000 NSF (93.0 NSM). Provide one per each
Outpatient Unit authorized. Includes displays and
educational/treatment modules for various assistive devices and
technology.”
*VA Space Planning Criteria for a Polytrauma Rehabilitation
Center (August 2008 SEPS Version 2.0, Chapter 111)
Milestone 2- Design Plan
‘Ingredients’
Space Allocations
• Open Space – gross motor (i.e. wheeled
mobility and sports recreation)
• Quiet Space – small enclosed treatment areas
• Storage – organization among facility engineers
• ‘Lending Library’ – loaner devices clinical trials
• ADL Apartment – various ADL/EADL
equipment
• Adaptive Driving – simulator evaluation/training
Design & Work Plans
Milestone 5 - Education
RESNA ATP Exam Preparation & Training
10+ Certified Assistive Technology Professionals (ATPs)
within the PRCs. Additional VA clinicians are preparing to
take the ATP exam within year three.
Exam study resources remain open with online/on-demand
RESNA Exam Review Course which has also been provided
at no cost to PRC clinicians on an as needed basis but can
be made available to additional personnel.
Milestone 5 - Education
Virtual AT Grand Rounds
• Quarterly Webcasts during three year period
– 12 recorded (available www.rstce.pitt.edu)
– CEU’s available at no cost to PRC clinicians
Topics
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Electronic Cognitive Devices
Electronic Aides to Daily Living
Augmentative & Alternative Communication
Wound Management
Spasticity Management
Rehabilitation Engineering
Driving Rehabilitation
Social Networking & Ethical Considerations
Ex: Virtual AT Grand Round
Milestone 5 - Education
Assistive Technology Institutes
• May 18 – 20, 2010 Pittsburgh, PA
– 40 VA clinicians from various sites attended: 18 VA-PRC; 19 VAPNS; 3 VACO
• May 3 – 5, 2011 Pittsburgh, PA
– 23 VA clinicians from various sites attended: 18 VA-PRC; 2 PNS;
3 VACO.
• February 22 – 24, 2012 Richmond, VA
– 53 healthcare professionals (47 in-person and 6 via telehealth)
from various sites attended
• September 11 – 12, 2012 Palo Alto, CA
*Future AT Institutes are being planned at other PRCs
Milestones 6
Standardized AT Procedures
– Standards of Practice
• VA Clinical Practice Guidelines
• National Standards (RESNA, AOTA, etc.)
– Documentation & Electronic Templates
• developed generic AT documentation template based on World
Health Organization International classification of Function,
Disability, & Health (ICF) as well as other common practices
associated with AT such as PSAS Guidelines
• Other templates have been created for AT areas: AAC, ECD, &
computer access
Milestones 7
Consultation Services
– Quarterly In-Person/On-Site Visits
• Assist with program development, outcome
measurement, continuing education, lap set-up,
installation of AT equipment, evaluation/assessment
– Telementoring & Teleconsultation via VISYTER
• Versatile Integrated System for Telerehabilitation
University of
Pittsburgh-Bakery
Square/Research
Office connected by
Ethernet Cable
Richmond PRC
connected by
patient wireless
with docking faceto-face camera
University of
Pittsburgh-Main
Campus connected
by Ethernet Cable
with only audio
accessed
Palo Alto PRC
connected by
Verizon 4G wireless
& remote camera
controls
Milestone 8
Evaluation of AT Devices
– Develop AT Evaluation Model
• 17 review criteria (Examples: affordability,
compatability, durability, effectiveness, operability,
learnability)
– Conduct 22 AT Product Evaluations
• First 6 Reviews by UPitt
• Next 6 reviews by 1 PRC Site with feedback from UPitt
• Next 10 reviews done independently by PRC Site
– Disseminate Updates via Portal
Milestone 8
Examples of Devices Evaluated (N=27)
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iTouch
Live Scribe Pen
Hand Cycle
Quartet EADL
Dynavox Xpress AAC
DynaWrite AAC
Microsoft Voice Recognition
Mount N Mover
Up Band by Jawbone
- Read & Write Gold
- Proloquo2Go ipad App
- Chat PC Silk AAC
- Lingraphica Comp Acc
- Predictable iPad App
- iPad and iPad2
- Kurzweil
- Saje Powerhouse EADL
- Primo! by Possum
Ex: Apple iPad Review
Milestone 9 - Outcomes
Challenges
• Limited resources, skills, time constraints
• Low disability sample sizes
• Administrative burdens
Strategies
• Assess & pilot established tools
• Develop collective database
• Build on past experience & research literature
Milestone 9 - Outcomes
– Identify AT Outcome Measurement Tools
• PIADS, QUEST, FMA, NOMS-FCM
– Test Tools
– Develop Outcome Data Collection Procedures
– Data Analysis Models
“3DR” Approach
• Design – understand challenge & solutions to
meet the requirements
• Develop – bring design with user as the center
of process (i.e. intuitive, user friendly)
• Deploy – efficiency for the end user to access
• Refine – customizing and adjusting solution to
accommodate service
Current Progress
• Database/Registry developed & deployed
• Online surveys and forms
• Advanced reporting system
– real-time reports, filtering options for tables, graphs,
comparison by demographics, devices
• Accessible anytime and anywhere
• Tracking client progress
• Data stored in secure location
AT Outcomes Database System
Data Output Examples
Tool
Time 1
Time 2
Time 3
Total
*FMA
80
17
0
97
**QUEST
207
53
4
264
***PIADS
95
13
0
108
382
83
4
469
Total
AT Categories by PRC Site
0
0
0
Recreation
4
0
1
Mobility
66
16
0
1
0
0
Learning Technology
0
0
EADL
0
Computer Access
Minneapolis
3
Tampa
6
7
Richmond
9
Palo Alto
13
12
18
13
20
Cognitive Device
0
AAC
6
0
9
10
20
20
30
40
50
60
70
Milestone 12 - CARF
– CARF AT Accreditation Built Into Design Plan
– 13 Standards Serve as Road Map and Program
Development
– Mock CARF AT Surveys at 4 PRCs
• Tampa initial survey January 2011
– OFFICIALLY CARF ACCREDITED!!
• Palo Alto initial survey June 2011
• Richmond initial survey early September 2012
Milestone 13 – ICAT
• Integrated Clinician AT Workbench
– Internet-based Informatics Infrastructure
– Interlink Multiple Resources Into Single Portal
• Standardized Documentation Templates
• Guidelines & Coverage Policies
• AT Device Reviews
• Outcomes Management
• Online / On-Demand Educational Service
• Question & Answer Forum
• Telementoring & Teleconsultation
Milestone 13 – ICAT
• Assisted with Executive Decision memo to each of
the four PRC ISO’s detailing appropriateness to
contract for external Internet Service Providers for
internet access
• Availability of ‘4G’ wireless and access to funds for
computer equipment based on specification
• With assistance from EES, unblocked UPitt’s
continuing education website for access on a VAwide level
Milestone 13 – ICAT
• Specific user name and password required for
authentication & access to www.pratclinic.pitt.edu
• Currently being implemented at the five VAPolytrauma Rehabilitation Centers and various
other VA PNS & PSCT sites
AT Templates & Coverage Policies
AT Device Reviews
AT Online Education
Questions?
Mark R. Schmeler - [email protected]
Richard M. Schein - [email protected]
Carmen DiGiovine – [email protected]
Andi Saptono - [email protected]
Acknowledgement: VA-PRC Personnel & PRAT Team
Supported by the Veterans Administration
Assistance and Advisory Services for Polytrauma
Rehabilitation Center Assistive Technology Labs
VA-791-08-RP-0058