Telerehabilitation Applications for Cognitive and Vocational Rehabilitation

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Hugh Hood
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3/29/11 Telerehabilitation Applications for Cognitive and Vocational

and Rehabilitation Sciences Department of Rehabilitation Science and

Rehabilitation Engineering Research Center (RERC) on

Assistive Technology and Cognitive Rehabilitation.

1 3/29/11 Telerehabilitation Applications for Cognitive and Vocational Rehabilitation Michael McCue, PhD, April 1, 2011 School of Health and Rehabilitation Sciences Department of Rehabilitation Science and Technology Collaborators, Affiliations and Acknowledgments Rehabilitation Engineering Research Center (RERC) on Telerehabilitation, NIDRR, # H133E Interagency Agreement for Assistive Technology and Cognitive Rehabilitation. Contract funded by Pennsylvania OVR ASERT Regional Center on Autism. Pennsylvania Department of Public Welfare. 1

2 Tele-Continuum (Parmanto & Saptono, 2008) Evidence for Telerehabilitation Practice General emphasis has been on equivalence or noninferiority with face to face/traditional services Efforts to document equivalent or reduced costs: client travel time clinician time Satisfaction and usability 2

3 Extending the Model: Naturalistic Rehabilitation Evidence for in-vivo home and work-based rehabilitation widespread: Behavioral interventions for anxiety, pain, and phobias Supported Employment Stroke rehabilitation ICF encourages exploration of contextual factors in environment Rehabilitation Considerations In defining process and outcomes, what works for telemedicine may not work for telerehabilitation... 3

4 Rehabilitation Characteristics Encounters with professionals are often repetitive, with established relationships Client need for services often escalates as recovery continues Needs and problems often most evident out in the community (shopping, at work) rather than in clinical settings Rehab prescribes and enables clients to practice extensively between sessions in real-life activities Rehabilitation Characteristics Multitude of professional disciplines Need for carryover of clinical evaluations and recommendations from one service network/ team to another Coupled with stubborn and chronic poor employment rates, evidence points to need for new and expanded models of communitybased and vocational rehabilitation 4

5 Contextual Factors in Rehabilitation Limited or difficulty generalizing from clinic to natural environment place and train model of supported employment Use of strategies in environment to facilitate employment success Assistive technology Cognitive rehabilitation Adjustment to disability counseling Contextual Factors in Rehabilitation Rehab process requires: Education about injury/disability Detail about the environment Spontaneous compensatory strategies tried out in everyday life Increasing self-awareness and incorporating new info about self 5

6 Contextual Factors Complex follow-up needs, often escalating over time: Emotional Psychosocial Family/relationship issues Return to work issues Return to home community, making faceto-face follow-up difficult or impossible Contextual Factors: Conducting TR Obtain info about environment (pictures, sounds) Implement real-time therapy while individual faces environmental problems ( in vivo ) Provide education and feedback at pace tolerable to individual Provide system of tracking progress/changes Anticipate long-term case management and system carryover needs 6

7 TR Applied to Vocational Rehabilitation Samples of TR in the VR Field (Summit Group Survey) Clinical Research and Demonstration Projects University of Pittsburgh Summit Group* Informal Survey of Telerehabilitation in VR Common for state agencies to utilize VC and other technologies for staffing, training and administration Several state VR agencies support and promote TR for consultation (Oregon, Virginia, WWRC) Many state VR agencies implement client services via TR - deaf and interpreter services (e.g., South Dakota, Maryland, Oregon) *Region 8 TACE; NCRTM; Utah VR 7

Summit Group Survey Selected states identified direct client services via TR Montana: client counseling sessions WWRC: AAC training, NP test interpretation Oregon: Client-counselor follow-along using

8 Summit Group Survey Selected states identified direct client services via TR Montana: client counseling sessions WWRC: AAC training, NP test interpretation Oregon: Client-counselor follow-along using text messaging Nebraska: Researching ipad for client services RTC Rural Telecommunications and Individuals with Disability Illustrations of Telerehabilitation Applications in Vocational Rehabilitation 8

TR Employment Supports Mobile and Internet Applications Modalities Used During 15 Week Study 14 12 10 Face-to Face Training Phone Text

Supports Sensors Collect information about what the person is doing

9 TR Employment Supports Mobile and Internet Applications Modalities Used During 15 Week Study Face-to Face Training Phone Text Messaging Instant Messaging Correspondence Frequency Week Experimental TR Job Coaching Supports Sensors Collect information about what the person is doing Machine Learning Software Identify a physical movement (e.g. flipping a hamburger) Cueing Software Deliver a cue if the physical movement is not correct for this step in the task (or offer praise) Remote Job Coach Support 9

10 Accuracy Matrix Sensors Action Flipping Picking Placing Pressing Salting Flipping Picking Placing Pressing Salting 94.12% 3.32% 1.04% 1.07% 0.45% 5.56% 91.09% 0.40% 2.95% 0.00% 1.75% 0.75% 95.75% 0.30% 1.45% 7.02% 5.98% 3.51% 81.92% 1.56% 1.88% 0.00% 6.35% 1.30% 90.48% Developing an Infrastructure for TR Applications in the VR Setting A telerehabilitation portal enables ongoing real time, secure collaboration across program staff in different locations. The portal includes multiple features to emulate clinical workflow (e.g., medical records, progress notes, program materials, calendars, referral database, program evaluation and EBP tracking). Incorporates VISyTER technology for integrated HD video conferencing (morning rounds, clinical assessment, counseling, consultation, staffings) 10

11 3/29/11 Portal to Facilitate VR State Operated Rehabilitation Center (HGAC - Johnstown) Research protocols for remote autism (ADOS) and neuropsychological testing (usability, reliability and validity of remote standardized psychometric assessments) 11

Cognitive and Vocational Rehabilitation Mobile TR Applications Remote Cognitive Rehabilitation (16 week ecologically oriented

asynchronous contact with therapist via portal/mobile tablet device) Remote Job Coaching (8 week trial of mobile job supports

record Clinical Workflow Calendar Imbedded automated test protocols Test Stimuli White board response capability SMS text chat

12 Cognitive and Vocational Rehabilitation Mobile TR Applications Remote Cognitive Rehabilitation (16 week ecologically oriented memory rehabilitation program incorporating everyday demands and applications; structured protocol, homework, synchronous and asynchronous contact with therapist via portal/mobile tablet device) Remote Job Coaching (8 week trial of mobile job supports including synchronous and asynchronous interactions with coach) Portal Features TeleNP TeleCR TeleJC Interactive Video Medical record Clinical Workflow Calendar Imbedded automated test protocols Test Stimuli White board response capability SMS text chat Customizable data collection forms Task guidance videos Therapeutic scripts (e.g., problem solving) Bibliotherapy resources Database/AV capture 12

CBA - Self- evaluajon Work schedule Problem solving script Video task guidance library Worksite daily task list Live interacjve video with coach Camera for recording/ forwarding to coach SMS text

rigorously researched, therefore underutilized and untested TR already recognized as a tool to address rural accessibility TR enables extension and expansion of services beyond clinic, face to face

13 CBA - Self- evaluajon Work schedule Problem solving script Video task guidance library Worksite daily task list Live interacjve video with coach Camera for recording/ forwarding to coach SMS text chat with coach Mobile Device Applications Link to JAN accommodajons TR Challenge for Vocational Rehabilitation Community based rehabilitation, including VR, has traditionally been under funded, less rigorously researched, therefore underutilized and untested TR already recognized as a tool to address rural accessibility TR enables extension and expansion of services beyond clinic, face to face models; consistent with rehabilitation model of intervening in natural environment Interventions that promote and result in employment and self-management are examples of the extension and expansion of services Need new models for expanding TR applications to VR Encourage support for Model demonstrations, University- State VR collaborations, Industry-VR collaborations 13

14 Contact Information Michael McCue, PhD 14

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