Assistive Technology Clinical Outcomes Research Management System (AT-CORMS) Tool Utilizing the International Classification of Functioning (ICF) Cognitive AT Outcomes Research INDIVIDUAL Abilities & Skills Resources ROLE Or SETTING BARRIERS Individual Cognition Sensory Physical External Psychosocial Contextual Fiscal ACTIVITY Requires: Learning Communication Mobility ACTIVE PARTICIPATIONNO BARRIERS LIMITED/NO PARTICIPATION BARRIER REDUCTION THROUGH ASSISTIVE TECHNOLOGY ACTIVE PARTICIPATION ENHANCED QUALITY Of LIFE X Existing Body of Knowledge Effective Constructs Best Practices Assistive Technology Assessment and Intervention Resources Barrier Reduction Through Assistive Technology Figure 1. Structure of the ICF. (*with permission) With the advent of the World Health Organization’s International Classification of Impairments, Activities, and Participation (ICIDH-2) [7], a conceptual framework for measuring the impact of assistive technology devices and services across multiple disciplines and individualized modalities was realized. Of particular importance to us is that this model moved away from a ‘consequence of disease’ classification (1980 version) [8] to a ‘components of health’ classification. This provides for  A scientific basis for understanding and studying health and health-related states, outcomes and determinants;  Establishment of a common language for describing health and health-related states in order to improve communication between different users;  Comparison of data across countries, health care disciplines, services and time; and,  a systematic coding scheme for health information systems (ICIDH-2, December 2000). [7] Classification of disability (e.g., by the World Health Organization), as originally constructed, related underlying pathological processes, the resulting impairments, the impact on specific aspects of function, overall disability, and handicap or difficulty participating in societal roles. As conceptual frameworks evolved, the importance of environmental and social factors became increasingly apparent [9]. The most recent formulation of this process, the International Classification of Function, Disability, and Health (ICF) describes how people live with their health condition [7 ]. The emphasis shifts, in this model, from the impact of disabling conditions on function to a focus on participation of individuals with specific disabling conditions in society. Terminology and research perspectives must therefore shift from a focus on disease and disability to a focus on enabling the individual to maximize his or her potential in the home, community, and society Figure 2. Schematic representing the ICF Classification of Function and Ability The new ICF framework recognizes that difficulties with body structure, activity, and participation are not linearly related to a particular health condition. Rather, an underlying health condition may contribute at several levels related to function, activity, and participation. Several important concepts emerged from this reconceptualization [8]: Signs and symptoms of health conditions are not necessarily directly related to the underlying health condition. Rather, a dynamic interplay occurs among body systems/ impairments, activities/activity limitations, and participation/participation restriction. A dynamic and reciprocal relationship exists, encompassing person-environment interactions of health conditions (function and disability) and contextual factors (Fig.1.). Preventive strategies are important in limiting the downward cycle of impairments, activity limitations and participation. These strategies include: primary prevention to reduce the possibility of further disablement, secondary prevention to limit/reverse the impairment influence on function and the development of secondary conditions, and tertiary prevention to reduce disadvantages associated with the health condition and promote opportunities for full participation. Key Components of Plan Outcomes research in the field of assistive technology (AT) is critically necessary to facilitate marketing decisions, enhance accountability, and augment our knowledge base. Outcomes research has the potential to facilitate evidence- based practice; enable better decision-making by consumers, their families and clinicians and improve the quality of life and independence of persons with disabilities. Dependable information regarding which devices work and for which people under which real-life circumstances is also indispensable for charting future research and development aimed at improving existing, emerging and new technologies. Assistive technology outcomes research is also needed to understand and implement effective solutions for consumers and to justify third party payments. The purpose of this application is to further the ongoing development of a secure, HIPAA (Health Insurance Privacy and Accountability Act of 1996) compliant, multi- site, assistive technology outcomes system called the Assistive Technology Clinical Outcomes Research Management System (AT-CORMS) and to fully test new features and functionality in multi-site clinical settings in preparation for a large scale clinical outcomes trial. Depiction of Broad Plan for Analytical Conceptual Model AT-CORMS Process Principal Investigator: Cathy Bodine PhD,CCC-SLP, University of Colorado at Denver and Health Sciences Center, Department of Physical Medicine and Rehabilitation