1. VA-PRC AT Overview & Contract Update Mark R. Schmeler, PhD, OTR/L, ATP, Richard M. Schein, PhD, MPH, Carmen DiGiovine, PhD, ATP, RET & Andi Saptono, PhD University of Pittsburgh September 11-12, 2012 Palo Alto, CA ‘Deep Dive’ Assistive Technology Institute

2. Goal Support VA, VA Clinicians, Veterans, & active-duty military personnel through the appropriate application of Assistive Technology

3. 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

4. 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

5. 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

6. 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

7. 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’

8. 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.” Milestone 2- Design Plan ‘Ingredients’ *VA Space Planning Criteria for a Polytrauma Rehabilitation Center (August 2008 SEPS Version 2.0, Chapter 111)

9. 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 Milestone 2- Design Plan ‘Ingredients’

10. Design & Work Plans

11. 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

12. Virtual AT Grand Rounds Quarterly Webcasts during three year period –12 recorded (available www.rstce.pitt.edu)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

13. Ex: Virtual AT Grand Round

14. Assistive Technology Institutes May 18 – 20, 2010 Pittsburgh, PA –40 VA clinicians from various sites attended: 18 VA-PRC; 19 VA- PNS; 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 Milestone 5 - Education

17. 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

18. 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

20. University of Pittsburgh-Bakery Square/Research Office connected by Ethernet Cable Richmond PRC connected by patient wireless with docking face- to-face camera Palo Alto PRC connected by Verizon 4G wireless & remote camera controls University of Pittsburgh-Main Campus connected by Ethernet Cable with only audio accessed

21. 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

22. Milestone 8 Examples of Devices Evaluated (N=27) -iTouch- Read & Write Gold -Live Scribe Pen- Proloquo2Go ipad App -Hand Cycle- Chat PC Silk AAC -Quartet EADL- Lingraphica Comp Acc -Dynavox Xpress AAC- Predictable iPad App -DynaWrite AAC- iPad and iPad2 -Microsoft Voice Recognition- Kurzweil -Mount N Mover- Saje Powerhouse EADL -Up Band by Jawbone- Primo! by Possum

23. Ex: Apple iPad Review

24. 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

25. Milestone 9 - Outcomes –Identify AT Outcome Measurement Tools PIADS, QUEST, FMA, NOMS-FCM –Test Tools –Develop Outcome Data Collection Procedures –Data Analysis Models

26. “3DR” 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

27. 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

29. AT Outcomes Database System

30. Data Output Examples

31. ToolTime 1Time 2Time 3Total *FMA8017097 **QUEST207534264 ***PIADS95130108 Total382834469

33. 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

34. 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

35. 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 ‘4G’ 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 VA- wide level Milestone 13 – ICAT

36. Specific user name and password required for authentication & access to www.pratclinic.pitt.eduwww.pratclinic.pitt.edu Currently being implemented at the five VA- Polytrauma Rehabilitation Centers and various other VA PNS & PSCT sites

38. AT Templates & Coverage Policies

39. AT Device Reviews

40. AT Online Education

41. Questions? Mark R. Schmeler - schmeler@pitt.eduschmeler@pitt.edu Richard M. Schein - rms35@pitt.edurms35@pitt.edu Carmen DiGiovine – carmen.digiovine@osumc.educarmen.digiovine@osumc.edu Andi Saptono - ans38@pitt.eduans38@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