Dona D. Anderson

Dona@DonaAnderson.com

Dominican Univers i ty o f Cal i forn ia

3/26/2013

HEALTH PROMOTION & COMMUNITY

REINTEGRATION:

HOOKED ON TELEHEALTH

COMMUNITY-DWELLING PERSONS

LIVING WITH SCI

AND/OR OTHER DISABILITIES

or

HEALTH

PROMOTION

THROUGH

BROADBAND

ACCESS

“…access to information and

communications technologies

and systems is one element that

will enable persons with

disabilities to participate fully in

all aspects of life.”

- -United Nations Convention on the Rights of

Persons with Disabilities

“..for people with disabilities,

broadband is a flexible and

adaptable tool that is being

used to deliver affordable,

convenient, and effective

services, and that enables a

range of social, economic, and

health-related benefit.”

VIRTUAL

ABILITIES

FOR

PERSONS

WITH

DISABILITIES

Report commissioned by

the U.S. Chamber of Commerce 2009

EMBRACE

CHANGE

THROUGH

BROADBAND

ACCESS

“We are living in a time of rapid

and unpredictable change.

Advances in knowledge and

technology have made our lives

more interconnected and

complex.”

- -J im Hinojosa,

2007 Eleanor Clarke Slagle Lecture

“Becoming Innovators in an Era of Hyperchange”

AOTA:

TELEHEALTH: A DELIVERY

MODEL WITHIN

OCCUPATIONAL

THERAPY

TELEHEALTH

TELEREHABILITATION TELEMEDICINE

eHEALTH

Telehealth:

An emerging service delivery model for occupational therapy that uses information and communication technologies to deliver evaluative, consultative, preventative, and therapeutic services to clients who are in a different location than the practitioner.

Telerehabilitation:

The application of communication and information technologies for delivery services by all ied health professionals (e.g. occupational therapy practitioners, physical therapy practitioners, speech-language pathologists, audiologists).

BRINGING

THERAPY

TO WHERE

PEOPLE

LIVE,

WORK,

AND PLAY…

Cason, 2012 in OT Practice

• Creates a level playing field – the great equalizer,

internet is blind to disability

• Provides convenient & cost-effective means to

communicate with friends, family.. anyone.

• Provides means to complete academic degrees

and certifications– Universities and MOOC

• 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

BROADBAND:A

TECHNOLOGY

TO TRANSFORM

OUR

FUTURE

GOING

MOBILE

TO GET

HOOKED IN

TO

TELEHEALTH

INTERNET

USE

AND

CELLPHONE

OWNERSHIP

TRENDS:

2009-2012

CONNECT 2 COMPETE

Section 716:

Communications

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

CLOSING THE DIGITAL

DIVIDE

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

(PatientsLikeMe, Trusera)

Support groups (DailyStrength, Rareshare)

Health social bookmarking (PeerClip)

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, v ir tual

communities (Second Life)

WEB 2.0

APPROACH

TO

PROMOTING

HEALTH

REALTIME

VIDEO

TECHNOLOGY:

CENTRALIZED

EXPERTISE

REMOTE

AIDES or

GENERALISTS

TELEREHABILITATION:

“FACE-TO-FACE”

OCCUPATIONAL THERAPY Conduct remote evaluations, assessments, and

interventions using real-time video technology for

Home evaluations

Wheelchair assessments

Neurological assessments

COPM assessments

Lower-limb amputation care

Pressure ulcer management

Assistive technology training in clients‟ home context

Delivery of home exercise program with haptic (touch-

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-based

arm rehabilitation regimen 62 year old man, >3 years post -stroke.

Two Logitech BuddyCams used over Skype

connection. OT instructed patient in functional

performance of ADL activities using NMES in

naturalistic home setting

Pre- and Post- intervention 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.

HOW WILL

RANCHO

PROMOTE

DIGITAL

LITERACY

FOR HEALTH

PROMOTION AND

COMMUNITY

INTEGRATION

??

eHealth

TelemedicineTelerehabilitation

Rancho Los Amigos National

Rehabilitation Center

Patient registration to include email address and question: do you have internet access at home? y/n –> data col lection on number of Rancho patients using internet

Automated sof tware with text message reminder of scheduled appoint to decrease # of “no shows”

Discuss internet access in therapy sessions –vast knowledge reservoir and social connectivity for patients who are physically isolated but need not be vir tually isolated

Proactive use of iPad video technology: brain injury and the Jim Schaef fer story http://www.biausa.org/_blog/Personal_Stories/post/Jim_Schaef fer's_Story/ 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

A FEW

RANDOM

THOUGHTS

The End

Not a perfect world, real or virtual…..

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 n d e d . ) . A m e r i c a n J o u r n a l o f O c c u p a t i o n a l T h e r a p y , 6 2 , 6 2 5 - 6 8 3 .

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 1 0 ) . T e l e r e h a b i l i t a t i o n . A m e r i c a n J o u r n a l o f O c c u p a t i o n a l T h e r a p y , 6 ( S u p p l e . ) , S 9 2 - S 1 0 2 .

d o i : 1 0 . 5 0 1 4 / a j o t . 2 0 1 0 . 6 4 S 9 2 - 6 4 S 1 0 2

A n n e k e n , V . , H a n s s e n - D o o s e , A . , H i r s c h f e l d , S . , S c h e u e r , T . , & T h i e t j e , R . ( 2 0 1 0 ) . I n f l u e n c e o f p h y s i c a l e x e r c i s e o n q u a l i t y o f l i f e i n i n d i v i d u a l s w i t h s p i n a l c o r d i n j u r y . S p i n a l C o r d , 4 8 , 3 9 3 - 3 9 9 .

B a l d a s s a r e , M . , B o n n e r , D . , P e t e k , S . , & S h r e s t h a , J . ( 2 0 1 2 ) . J u s t t h e f a c t s : C a l i f o r n i a ‟ s d i g i t a l d i v i d e . R e t r i e v e d f r o m h t t p : / / w w w . p p i c . o r g / c o n t e n t / p u b s / j t f / J T F _ D i g i t a l D i v i d e J T F . p d f

C a l i f o r n i a S c h o o l H e a l t h C e n t e r s A s s o c i a t i o n . ( 2 0 1 3 ) . I n c r e a s i n g w e b a c c e s s w i t h C o m c a s t . R e t r i e v e d f r o m h t t p : / / w w w . s c h o o l h e a l t h c e n t e r s . o r g / h o m e p a g e - p o s t s / c o m c a s t p a r t n e r s h i p /

C a s o n , J . ( 2 0 1 2 ) . A n i n t r o d u c t i o n t o t e l e h e a l t h a s a s e r v i c e d e l i v e r y m o d e l w i t h i n o c c u p a t i o n a l t h e r a p y . O T P r a c t i c e , 1 7 ( 7 ) , C E 1 - C E 7 .

D a v i d s o n , C . M . , & S a n t o r e l l i , M . J . ( 2 0 0 9 ) . A r e p o r t t o t h e U . S . C h a m b e r o f C o m m e r c e : T h e i m p a c t o f b r o a d b a n d o n p e o p l e w i t h d i s a b i l i t i e s . T h e A d v a n c e d C o m m u n i c a t i o n s L a w & P o l i c y I n s t i t u t e o f N e w Y o r k L a w S c h o o l , 1 -7 5 .

F e d e r a l C o m m u n i c a t i o n s C o m m i s s i o n . ( 2 0 1 1 ) . F C C t a k e s c r i t i c a l s t e p s t o b r i n g a d v a n c e d

C o m m u n i c a t i o n s s e r v i c e s t o t h o s e w i t h d i s a b i l i t i e s . R e t r i e v e d f r o m h t t p : / / t r a n s i t i o n . f c c . g o v / c g b / d r o / c v a a . h t m l .

H e r m a n n , V . H . , H e r z o g , M . , J o r d a n , R . , H o f h e r r , M . , L e v i n e , P . , & P a g e , S . J . ( 2 0 1 0 ) . T e l e r e h a b i l i t a t i o n a n d e l e c t r i c a l s t i m u l a t i o n : A n o c c u p a t i o n - b a s e d , c l i e n t - c e n t e r e d s t r o k e i n t e r v e n t i o n . A m e r i c a n J o u r n a l o f O c c u p a t i o n a l T h e r a p y , 6 4 , 7 3 - 8 1 .

H o r r i g a n , J . , & R a i n i e , L . ( 2 0 0 6 ) . W h e n f a c i n g a t o u g h d e c i s i o n , 6 0 m i l l i o n A m e r i c a n s n o w s e e k t h e i n t e r n e t „ s h e l p : T h e i n t e r n e t „ s g r o w i n g r o l e i n l i f e „ s m a j o r m o m e n t s . R e t r i e v e d f r o m h t t p : / / p e w r e s e a r c h . o r g / p u b s / 1 9 / w h e n - f a c i n g - a - t o u g h -d e c i s i o n - 6 0 - m i l l i o n - a m e r i c a n s n o w - s e e k - t h e - i n t e r n e t s - h e l p

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 t h r e s i d e n t r e c e i v e s c o m p u t e r a t J o r d a n D o w n s . R e t r i e v e d f r o m h t t p : / / w w w . h a c l a . o r g / t h e - 2 0 0 t h - r /

I n t e r n e t s o c i e t y . ( 2 0 1 2 ) . I n t e r n e t a c c e s s i b i l i t y : I n t e r n e t u s e b y p e r s o n s w i t h d i s a b i l i t i e s . R e t r i e v e d f r o m h t t p : / / w w w . i n t e r n e t s o c i e t y . o r g / d o c / i n t e r n e t - a c c e s s i b i l i t y - i n t e r n e t - u s e p e r s o n s - d i s a b i l i t i e s - m o v i n g - f o r w a r d

L i d a l , I . B . , V e e n s t r a , M . , H j e l t n e s , N . , & B i e r i n g - S o r e n s e n , F . ( 2 0 0 8 ) . H e a l t h - r e l a t e d q u a l i t y o f l i f e i n p e r s o n s w i t h l o n g -s t a n d i n g s p i n a l c o r d i n j u r y . S p i n a l C o r d , 4 6 , 7 1 0 - 7 1 5 .

M e t z g e r , M . J . , & F l a n a g a n , A . J . ( 2 0 1 1 ) . U s i n g W e b 2 . 0 t e c h n o l o g i e s t o e n h a n c e e v i d e n c e b a s e d m e d i c a l i n f o r m a t i o n . J o u r n a l o f H e a l t h C o m m u n i c a t i o n , 1 6 , 4 5 - 5 8 .

d o i : 1 0 . 1 0 8 0 / 1 0 8 1 0 7 3 0 . 2 0 1 1 . 5 8 9 8 8 1

S a r h a n , F . , & C u m m i n g s , P . ( 2 0 0 8 ) . H e a l t h p r o m o t i o n f o r p e o p l e w i t h s p i n a l c o r d i n j u r y : I m p r o v i n g q u a l i t y o f l i f e , B r i t i s h J o u r n a l o f N e u r o s c i e n c e N u r s i n g , 4 ( 8 ) , 3 7 4 - 3 8 0 .

S c e l z a , W . M . , K i r s h b l u m , S . C . , W u e r m s e r , L . , H o , C . H . , P r i b e , M . M . , & C h i o d o , A . E . ( 2 0 0 7 ) . S p i n a l c o r d i n j u r y m e d i c i n e . 4 . C o m m u n i t y r e i n t e g r a t i o n a f t e r s p i n a l c o r d i n j u r y . A r c h i v e s o f P h y s i c a l M e d i c i n e a n d R e h a b i l i t a t i o n , 8 8 ( 1 ) , S 7 1 - S 7 5 .

S m i t h , B . M . , L a V e l a , S . I . , & W e a v e r , F . M . ( 2 0 0 8 ) . H e a l t h - r e l a t e d q u a l i t y o f l i f e f o r v e t e r a n s w i t h s p i n a l c o r d i n j u r y . S p i n a l C o r d , 4 6 , 5 0 7 - 5 1 2 . d o i : 1 0 . 1 0 3 8 / s c . 2 0 0 8 . 2

REFERENCES