1. 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

2. or

3. HEALTH
“…access to information and PROMOTION
THROUGH
communications technologies BROADBAND
and systems is one element that ACCESS
will enable persons with
disabilities to participate fully in
all aspects of life.”
--United Nations Convention on the Rights of
Persons with Disabilities

4. “..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

5. EMBRACE
“We are living in a time of rapid CHANGE
and unpredictable change. THROUGH
BROADBAND
Advances in knowledge and ACCESS
technology have made our lives
more interconnected and
complex.”
--Jim Hinojosa,
2007 Eleanor Clarke Slagle Lecture
“Becoming Innovator s in an Era of Hyperchange”

6. AOTA:
TELEHEALTH TELEHEALTH:
A DELIVERY
MODEL WITHIN
OCCUPATIONAL
THERAPY
TELEREHABILITATION TELEMEDICINE
eHEALTH

7. 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

8. • 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

9. GOING
MOBILE
TO GET
HOOKED IN
TO
TELEHEALTH

10. INTERNET
USE
AND
CELLPHONE
OWNERSHIP
TRENDS:
2009-2012

11. Section 716:
Communications
CONNECT 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

12. CLOSING THE DIGITAL
DIVIDE

13. 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

14.  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)

15. 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

16. CASE STUDY: remotely-based
arm 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 satisfaction
Hermann, et al. (2010) AJOT, 64, 73-81.

17. HOW WILL
RANCHO
PROMOTE
DIGITAL
LITERACY
FOR HEALTH
PROMOTION
eHealth AND
Rancho Los Amigos National
COMMUNIT Y
Rehabilitation Center
INTEGRATION
??
Telerehabilitation
Telemedicine

18.  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 fer's_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

19. The End
Not a perfect world, real or virtual…..

20. 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