VAPRC AT Overview Contract Update Deep Dive Assistive

VA-PRC AT Overview & Contract Update ‘Deep Dive’ Assistive Technology Institute Mark R. Schmeler, Ph. D, OTR/L, ATP, Richard M. Schein, Ph. D, MPH, Carmen Di. Giovine, Ph. D, ATP, RET & Andi Saptono, Ph. D 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 • • 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 • • Identify Current AT Services and Core Areas Capacities and Preference with Outcome Tools Resources Continuing Education

Milestone 2 - Design Plan ‘Ingredients’ Personnel: • • • 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 – – – – 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 face-to -face camera University of Pittsburgh-Main Campus connected by Ethernet Cable with only audio accessed Palo Alto PRC connected by Verizon 4 G 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) - i. Touch Live Scribe Pen Hand Cycle Quartet EADL Dynavox Xpress AAC Dyna. Write AAC Microsoft Voice Recognition Mount N Mover Up Band by Jawbone - Read & Write Gold - Proloquo 2 Go ipad App - Chat PC Silk AAC - Lingraphica Comp Acc - Predictable i. Pad App - i. Pad and i. Pad 2 - Kurzweil - Saje Powerhouse EADL - Primo! by Possum

Ex: Apple i. Pad 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

“ 3 DR” 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 Richmond 7 9 Palo Alto 13 12 18 13 20 Cognitive Device 0 AAC 6 0 9 20 10 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 ‘ 4 G’ 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 - schmeler@pitt. edu Richard M. Schein - rms 35@pitt. edu Carmen Di. Giovine – carmen. digiovine@osumc. edu Andi Saptono - ans 38@pitt. edu 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