eHealth: health-related info and educational resources – health literacy Web sites and repositories, videos, apps
Hooked on Telehealth for Occupational Therapy
HEALTH PROMOTION & COMMUNITY REINTEGRATION: HOOKED ON TELEHEALTH COMMUNITY-DWELLING PERSONS LIVING WITH SCI AND/OR OTHER DISABILITIES Dona D. Anderson Dona@DonaAnderson.com D o m i ni c a n U n i v e r s i t y o f C a l i fo r n i a 3 / 2 6 / 2 01 3
HEALTH“…access to information and PROMOTION THROUGHcommunications technologies BROADBANDand systems is one element that ACCESSwill enable persons withdisabilities to participate fully inall aspects of life.” --United Nations Convention on the Rights of Persons with Disabilities
“..for people with disabilities, broadband is a flexible and VIRTUAL ABILITIES adaptable tool that is being FOR used to deliver affordable, PERSONS convenient, and effective WITH DISABILITIES services, and that enables a range of social, economic, and health-related benefit.” Report commissioned by the U.S. Chamber of Commerce 2009
EMBRACE“We are living in a time of rapid CHANGEand unpredictable change. THROUGH BROADBANDAdvances in knowledge and ACCESStechnology have made our livesmore interconnected andcomplex.” --Jim Hinojosa, 2007 Eleanor Clarke Slagle Lecture“Becoming Innovator s in an Era of Hyperchange”
AOTA: TELEHEALTH TELEHEALTH: A DELIVERY MODEL WITHIN OCCUPATIONAL THERAPYTELEREHABILITATION TELEMEDICINE eHEALTH
Telehealth: BRINGING THERAPY An emerging service delivery model for TO WHERE occupational therapy that uses information and communication technologies to deliver PEOPLE evaluative, consultative, preventative, and LIVE, therapeutic services to clients who are in a WORK, different location than the practitioner. AND PLAY…Telerehabilitation: The application of communication and information technologies for delivery services by allied health professionals (e.g. occupational therapy practitioners, physical therapy practitioners, speech -language pathologists, audiologists). Cason, 2012 in OT Practice
• Creates a level playing field – the great equalizer, internet is blind to disability BROADBAND:• Provides convenient & cost-effective means to A communicate with friends, family.. anyone. TECHNOLOGY• Provides means to complete academic degrees TO TRANSFORM and certifications– Universities and MOOC OUR FUTURE• Creates a number of economic opportunities (telecommuting/ small business creation• Enables individuals to gather medical knowledge, explore grant opportunities, join forums, blogs, connect with people with similar interests and needs through social networking• Facilitates videoconferencing for real-time remote rehabilitation• Manifests a virtual space to be more… than a person with a disability
Section 716: CommunicationsCONNECT 2 COMPETE and Video Accessibility Act Of 2010 Federal Communications Commission (FCC) is committed to rapid deployment of and universal access to broadband services for all Americans. New low-cost family PCs Redemtech, Microsoft; Morgan Stanley to develop a microcredit program to pay for upfront costs Digital Literacy Best Buy, Microsoft, America‟s Public Libraries, FCC) Grassroots Effort nonprofit and grassroots organizations committed to spread the word about Connect to Compete Leadership and Implementation Kelley Dunne (CEO of One Economy) will lead this new nonprofit initiative Connect2Compete.org
WEB 2.0 DESIGN: A dynamic and interactive eHealth resource• Webcast instructional videos to bridge the literacy gap, with embedded post-video knowledge quizzes for instant feedback• “Ted” talks produced by innovative clinicians with opportunity for interactive blog postings• Testimonials and podcasts of patients, peer mentors with an interactive chat function• Virtual interactive support groups at regularly scheduled times for development of mutual trust and continuity• Educational courses with opportunity for questions & answers at end of lecture using GoToMeeting-type software technology• Survey monkeys available with prize incentives for participation
Health wikis (Medpedia) Health-focused social network sites WEB 2.0 (PatientsLikeMe, Trusera) APPROACH Suppor t groups (DailyStrength, Rareshare) TO Health social bookmarking (PeerClip) PROMOTING HEALTH Electronic Health repositories (CureTogether) Disease mapping via data mining (Google Flu Trends) Twitter (Flu Tweets, HealthMap, SickCity) Health video-sharing websites and podcasts (icyou.com, facingdisability.com, ClubPushrim) Health-focused blogs Health topic-based groups, vir tual communities (Second Life)
TELEREHABILITATION: “FACE-TO-FACE” REALTIME OCCUPATIONAL THERAPY VIDEO Conduct remote evaluations, assessments, and TECHNOLOGY: interventions using real-time video technology for Home evaluations Wheelchair assessments CENTRALIZED Neurological assessments EXPERTISE COPM assessments Lower-limb amputation care REMOTE Pressure ulcer management Assistive technology training in clients‟ home context AIDES or Delivery of home exercise program with haptic (touch- GENERALISTS sensitive) control interface Virtual treatment session with client using FES Deploy new technologies using virtual reality Caregiver training for ROM and strength training Home modifications to increase mobility safety Vocational education
CASE STUDY: remotely-basedarm rehabilitation regimen 62 year old man, >3 year s post -stroke. Two Logitech BuddyCams used over Skype connection. OT instructed patient in functional per formance of ADL activities using NMES in naturalistic home setting Pre- and Post-inter vention assessments: COPM, Fugl-Meyer, Action Research Arm Test Results were significant positive outcomes in motor proficiency and patient satisfactionHermann, et al. (2010) AJOT, 64, 73-81.
HOW WILL RANCHO PROMOTE DIGITAL LITERACY FOR HEALTH PROMOTION eHealth ANDRancho Los Amigos National COMMUNIT YRehabilitation Center INTEGRATION ?? Telerehabilitation Telemedicine
Patient registration to include email address and question: do you have internet access at home? y/n –> data collection on number of Rancho patients using internet A FEW Automated sof tware with text message reminder RANDOM of scheduled appoint to decrease # of “no THOUGHTS shows” Discuss internet access in therapy sessions – vast knowledge reser voir and social connectivity for patients who are physically isolated but need not be vir tually isolated Proactive use of iPad video technology: brain injur y and the Jim Schaef fer stor y http://www.biausa.org/_blog/Personal_Stories/ post/Jim_Schaef fers_Stor y / family researched online and found info on Motor Trephine Syndrome = videotaped their dad‟s symptoms which prompted neurosurgeon to explore fur ther Occupational therapists to embrace broadband and assist to narrow the digital divide for their patients – grant money, direct patients to internet, to Rancho website for health promotion information
The EndNot a perfect world, real or virtual…..
REFERENCES A m e r i c a n O c c u p a t i o n a l T h e r a p y A s s o c i a t i o n . ( 2 0 0 8 ) . O c c u p a t i o n a l t h e r a p y p r a c t i c e f r a m e w o r k : D o m a i n a n d p r o c e s s ( 2 nd e d . ) . American Journal of Occupational Therapy, 62, 625-683. American Occupational Therapy Association. (2010). Telerehabilitation. American Journal of Occupational Therapy, 6 (Supple.), S92-S102. doi: 10.5014/ajot.2010.64S92-64S102 Anneken, V., Hanssen-Doose, A., Hirschfeld, S., Scheuer, T., & Thietje, R. (2010). Influence of physical exercise on quality of life in individuals with spinal cord injury. Spinal Cord, 48, 393-399. Baldassare, M., Bonner, D., Petek, S., & Shrestha, J. (2012). Just the facts: California‟s digital divide. Retrieved from http://www.ppic.org/content/pubs/jtf/JTF_DigitalDivideJTF.pdf California School Health Centers Association. (2013). Increasing web access with Comcast. Retrieved from http://www.schoolhealthcenters.org/homepage -posts/comcast partnership/ Cason, J. (2012). An introduction to telehealth as a service delivery model within occupational therapy. OT Practice, 17(7), CE1-CE7. Davidson, C. M., & Santorelli, M. J. (2009). A report to the U.S. Chamber of Commerce: The impact of broadband on people with disabilities. The Advanced Communications Law & Policy Institute of New York Law School , 1- 75. Federal Communications Commission. (2011). FCC takes critical steps to bring advanced Communications services to those with disabilities. Retrieved from http://transition.fcc.gov/cgb/dro/cvaa.html . Hermann, V. H., Herzog, M., Jordan, R., Hofherr, M., Levine, P., & Page, S. J. (2010). Telerehabilitation and electrical stimulation: An occupation-based, client-centered stroke intervention. American Journal of Occupational Therapy, 64, 73-81. Horrigan, J., & Rainie, L. (2006). When facing a tough decision, 60 million Americans now seek the internet„s help: The internet„s growing role in life„s major moments. Retrieved from http://pewresearch.org/pubs/19/when -facing-a-tough- decision-60-million-americans now-seek-the-internets-help H o u s i n g A u t h o r i t y o f L o s A n g e l e s . ( 2 0 1 1 ) . B r i d g i n g t h e d i g i t a l d i v i d e : 2 0 0 th r e s i d e n t r e c e i v e s computer at Jordan Downs. Retrieved from http://www.hacla.org/the-200th-r/ Internetsociety. (2012). Internet accessibility: Internet use by persons with disabilities. Retrieved from http://www.internetsociety.org/doc/internet -accessibility-internet-use persons-disabilities-moving-forward Lidal, I.B., Veenstra, M., Hjeltnes, N., & Biering -Sorensen, F. (2008). Health-related quality of life in persons with long- standing spinal cord injury. Spinal Cord, 46, 710-715. Metzger, M. J., & Flanagan, A. J. (2011). Using Web 2.0 technologies to enhance evidence based medical information. Journal of Health Communication, 16, 45-58. doi: 10.1080/10810730.2011.589881 Sarhan, F., & Cummings, P. (2008). Health promotion for people with spinal cord injury: Improving quality of life, British Journal of Neuroscience Nursing, 4 (8), 374-380. Scelza, W. M., Kirshblum, S. C., Wuermser, L., Ho, C.H., Pribe, M. M., & Chiodo, A. E. (2007). Spinal cord injury medicine. 4. Community reintegration after spinal cord injury. Archives of Physical Medicine and Rehabilitation, 88(1), S71-S75. Smith, B. M., LaVela, S. I., & Weaver, F. M. (2008). Health -related quality of life forveterans with spinal cord injury. Spinal Cord, 46, 507-512. doi:10.1038/sc.2008.2
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