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Therapeutic Use of Technology: Case-based Clinical Reasoning with Everyday Technology

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Therapeutic Use of Technology: Case-based Clinical Reasoning with Everyday Technology

  1. 1. Therapeutic Use of Technology: Case-based Clinical Reasoning with Everyday Technology Douglas Rakoski, OTD, OTR/L, ATP @Polish_Prinz_II Robert Ferguson, MHS, OTR/L @robferguson_OT
  2. 2. 2 Learning Objectives 1. Describe the therapeutic use of technology as it relates to their practice. 2. Relate considerations for the therapeutic use of technology to the various aspects of clinical reasoning. 3. Analyze the different aspects of clinical reasoning and synthesize them into appropriate technology-based treatment. 4. Integrate the therapeutic use of technology into practice using a clinical reasoning process.
  3. 3. 3 Lead the Way OT
  4. 4. 4 Traditional Methods Meet Technologically Innovative Interventions “Where’s the robot?”
  5. 5. 5 TECH SPECTRUM http://www.sodahead.com/entertainment/do-you-know-who-rosie-the-robot- is-from-the-jetsons/question-710073/?link=ibaf&q=&esrc=s http://www.pcworld.idg.com.au/slideshow/418869 /pictures-ipad-mania-around-world/?image=13
  6. 6. 6 UMICH TECH …. NOW
  7. 7. 7 UMICH TECH…..THEN & NOW
  8. 8. 8 What is the effectiveness of Virtual Reality in increasing upper extremity motor control of people who are Stroke Survivors? • Fluet, G. G., & Deutsch, J. E. (2013). Virtual reality for sensorimotor rehabilitation post-stroke: The promise and current state of the field. Current Physical Medicine and Rehabilitation Reports, 1(1), 9-20. • Kwon, J., Park, M., Yoon, I., & Park, S. (2012). Effects of virtual reality on upper extremity function and activities of daily living performance in acute stroke: A double-blind randomized clinical trial. Neurorehabilitation, 31(4), 379-385. doi:10.3233/NRE-2012-00807 • Lee, D., Lee, M., Lee, K., & Song, C. (2014). Asymmetric training using virtual reality reflection equipment and the enhancement of upper limb function in stroke patients: A randomized controlled trial. Journal of Stroke and Cerebrovascular Diseases. Advance online publication. doi:10.1016/j.jstrokecerebrovasdis.2013.11.006
  9. 9. 9 What is the effectiveness of Virtual Reality in increasing upper extremity motor control of people who are Stroke Survivors? • Rand, D., Givon, N., Weingarden, H., Nota, A., & Zeilig, G. (2014). Eliciting upper extremity purposeful movements using video games: A comparison with traditional therapy for stroke rehabilitation. Neurorehabilitation and Neural Repair. Advance online publication. doi:10.1177/1545968314521008 • Sin, H., & Lee, G. (2013). Additional virtual reality training using xbox kinect in stroke survivors with hemiplegia. American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists, 92(10), 871-880. doi:10.1097/PHM.0b013e3182a38e40 • Laver, K. E., George, S., Thomas, S., Deutsch, J. E., & Crotty, M. (2011). Virtual reality for stroke rehabilitation. The Cochrane Database of Systematic Reviews, (9), CD008349. doi:10.1002/14651858.CD008349.pub2
  10. 10. 10 LIMITATIONS of VR • Duration of therapy for VR group was twice that of the conventional therapy group, therefore total time of therapy could confound results (Sin & Lee , 2013, Level I). • More time may be required for the effectiveness of the VR program to transfer to actual ADL performance due to the game- based program (Rand et al., 2014, Level I). • Small sample size and relatively short intervention period. Outcome measure assessed only the short-term effect of VR and conventional therapy (Kwon et al., 2012, Level I). • No standardized interventions across the studies and hardware interfaces differed between the studies (Fluet & Deutsch, 2013, Level I).
  11. 11. 11 The clinical and community-based practice of OT: • Virtual reality should be utilized as an adjunct to traditional OT. • Virtual reality environments, activities, and games should be selected that create emergent motivation in the client to enhance engagement in purposeful movements. • Therapists need to evaluate virtual activities prior to the intervention to ensure that software addresses the purposeful movements desired for real world tasks. • OT practitioners should examine the client’s motivation of using virtual reality versus real world tasks or use virtual reality for specific movements that impact actual performance components.
  12. 12. 12 “KNOBOLOGY”
  13. 13. 13 Casey Christy, MA, ATC, CSCS
  14. 14. 14 Casey Christy, MA, ATC, CSCS
  15. 15. 15 Casey Christy, MA, ATC, CSCS
  16. 16. 16 Technology Inspiring Creativity • Mentorship: Facilitate staff to enhance their knowledge and skills while using technology • Research: Assist staff in finding solutions in regards to technique, equipment, or software. Clinicians' with case loads do not have this time and may abandon technology due to time investments. • Resources: Pursue and advocate for new technologies that allow clinicians to be on the cutting edge of "Therapeutic Use of Technology".
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  18. 18. 18 “OT GENIUS” - Dr. Suzanne Peloquin abcnews.go.com
  19. 19. 19 A COMPLEX PLAN
  20. 20. 20 Person-Environment-Occupation Model of Occupational Performance
  21. 21. 21
  22. 22. 22 Human Interface Assessment
  23. 23. 23 Therapeutic Use of Technology
  24. 24. 24 “Therapeutic use of Technology” • Utilizing available technology to accomplish therapeutic goals of vision, cognitive, or motor recovery during occupational therapy intervention.
  25. 25. 25 Everyday Technologies
  26. 26. 26 Clinical Reasoning with Therapeutic Technology • Blending: – Clinical Knowledge – Device capabilities – Providing a dynamic “just right challenge” Burke.org markpascua.com
  27. 27. 27 http://mlblogselisha06.wordpress.com/tag/justin-moeneau/
  28. 28. 28 OT Process ( AOTA, 2014)
  29. 29. Linking Therapy to Computer Activity
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  34. 34. 35
  35. 35. 36 Peggy
  36. 36. 37 Michael
  37. 37. 38
  38. 38. 39
  39. 39. 40
  40. 40. 41
  41. 41. 42 Hospicio
  42. 42. 43 Therapeutic benefits of the Wii Fit
  43. 43. 44 Creatively Challenging Balance
  44. 44. 45 X-Box Kinnect Jaycehallshow.com
  45. 45. 46*Thank you Amanda Carr
  46. 46. 47 The Sharpbrains Checklist •Based on Scientific Research? •Measurable Claims and Benefits? •Ensures Cross-Training? •Is it Exercise – or Entertainment? •Good Fit for the Client? http://www.sharpbrains.com/blog/2007/08/16/brain-training-games-and-games/
  47. 47. 48 5 C’s • Complexity • Cost • Comprehension • Clinical Reasoning • Creativity
  48. 48. 49 Clinical Reasoning - Positioning - Device features - System Settings - Software - Device features - System Settings PROTOCOLS LOW TECH HI TECH
  49. 49. 50 Clinical Reasoning Creativity LOW TECH HI TECH “OT GENIUS”
  50. 50. 51
  51. 51. Therapeutic Use of Technology Clinical Reasoning Process Case Studies; Susan and Nancy
  52. 52. 53 For you social media users, you may take pictures… But only of my “good” side https://www.facebook.com/DwayneJohnson/photos/pb.406433779383.-2207520000.1420823006./10152751291789384/?type=3&theater
  53. 53. 54 Why is Knowing About My Clinical Reasoning Process Important?
  54. 54. 55
  55. 55. 56
  56. 56. Narrative Reasoning
  57. 57. Narrative Reasoning 58
  58. 58. ScientificReasoning 59
  59. 59. 60 Diagnostic Reasoning
  60. 60. Ethical Reasoning
  61. 61. Pragmatic Reasoning
  62. 62. Generalization Reasoning
  63. 63. Procedural Reasoning Procedural and Interactive Reasoning
  64. 64. Interactive Reasoning
  65. 65. Conditional Reasoning
  66. 66. 67 Conditional Reasoning
  67. 67. 68 Susan’s Case Continued From Your Handout
  68. 68. 69
  69. 69. 70
  70. 70. 71 Nurse Nancy • 67 year old ICU nurse and a self-proclaimed technophobe. Was planning on learning to be more involved with online entertainment for leisure and social media to keep in touch with her children and grandchildren. • She loves spending time with family, being outdoors, working as a nurse, reading and she finds particular enjoyment in cleaning house. • One month before retiring, she was involved in a car accident. Had cervical fractures and a R sub-arachnoid hemorrhage. Both were addressed surgically and she had limited residual impairment. • Suffered a L parietal ischemic stroke the day before she was to go home. • Her resultant R hemiparesis, apraxia, and mild expressive aphasia, coupled with her orthopedic surgical restrictions limited her ability to safely care for her basic self-care needs nor her participation in her reported meaningful activities. • Could minimally open her hand if she used tenodesis. Difficulty stabilizing her trunk and scapula during attempts to use her R UE in functional activity. At the time of her admission to rehab, she was displaying the development of learned non-use. She has a supportive family with both her children providing legal and functional support.
  71. 71. 72 Task-Oriented Bilateral Isokinematic Training
  72. 72. 73
  73. 73. 74 Working on Washing Dishes?
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  79. 79. 80 Summary View
  80. 80. 81 Oh, got it…
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  85. 85. 86
  86. 86. 87 Technology and Occupation: Imagining the Future
  87. 87. 88 Q&A

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