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Group 1 – Ian Swain, Geraldine Mann, Diane Whitham, Ann-Marie Hughes

Group 1 – Ian Swain, Geraldine Mann, Diane Whitham, Ann-Marie Hughes. What is an AT -Assistive equipment for which a rehabilitation programme is set up to provide, establish and manage maintenance.

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Group 1 – Ian Swain, Geraldine Mann, Diane Whitham, Ann-Marie Hughes

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  1. Group 1 – Ian Swain, Geraldine Mann, Diane Whitham, Ann-Marie Hughes

  2. What is an AT -Assistive equipment for which a rehabilitation programme is set up to provide, establish and manage maintenance. -Products aimed at having a rehabilitative effect not a simple device to achieve a given function. -To improve motor control and have a ‘carry over’ effect not just an ‘orthotic’ effect. Dynamic Orthotics -Lycra -CCD -Saebo flex & similar products -(Multiple effects) -ROM -Biomech reducing impairment Reduce Spasticity BoTox Robots -Reduce impairment – shoulder and elbow -Movement, strength FES -Reduced Spasticity – muscle strength Biofeedback – muscle control C Mitt - Increase usage

  3. Complimentary • Sub divide into Hand & Arm • Different effects • Only Dynamic Orthotics can be a mutually exclusive group • The rest all stand on their own • CMIT • - May use with other ATs at the same time • 4. Sequential • - Use 1 early rehabilitation • - Use 2 ongoing • - Short term i.e. daily

  4. Hand Acute Sub-acute Chronic A B C 4/52 4/52 – 6/12 > 6/12 Arm A B C 4/52 4/52 – 6/12 > 6/12 Severity - Based on MRC scales? - Measure – MRC - Jebsen - ARAT - Fugl-Myer - Spasticity Produce Matrix on each AT. A. -Treatment duration and frequency -Inherent cost -Acceptability Hand Movement Key AW 23 Beds (Rehab) 60% Complex Strokes 2 professions 51/7 length of stay ≈ 60-70 p.a. 600 new CVA p.a. 1/3 inpatient >1/12 What ?

  5. Group 2 – Damian Jenkinson, Duncan Wood, Sara Demain, David Turner

  6. WP1 Current Practice WP2 Literature Review WP3 Barriers to use Cost – indicative only AT: Delete or Alter rank PT Generated criteria – Non prescriptive ? Informing decision -? ‘outcomes’ AT1 AT2 WP3 Design WP4 Document Decisions Using results from trial – into practice. -ED population, cost, access… WT/EXT PCT, DH, Steering group Year 2 RPT

  7. Defining AT PRODUCT SERVICE ‘Enabling Independence’ ‘Learning’ ADL Broadens Exclusion Criteria? (Specific Task) ? Recovery

  8. WP2 a -Clinical Effectiveness b c ‘Outcomes’ -Meta-Analysis Authors -Indicative Outcomes to Health Econ/QUALI e.g. persons delivering Tx - Population (for example)

  9. Group 3 – Anand Pandyan, Gabrielle McHugh, Paul Chappell, Caroline Ellis-Hill

  10. What is AT • Effect should not be transient (e.g. spoon, wheelchair) [Assistive Device] • Active vs Passive

  11. WP1 – current NHS practice WP2 – literature review (current ongoing research) WP3 – User needs & views (Patient, Clinicians & Budget holders) WP3 are practical issues with respect to UL AT… WP1 what are they doing and why (w.r.t. UL) What can be done for the “WP1-Why” from WP2 and how does that match with “WP3-want” Consensus way forward (taking on board other ongoing research) How to select

  12. Model WP1 WP2 WP3

  13. Design AT2 AT1 AT1 AT1 AT2 AT2 AT1

  14. Group 4 – Jane Burridge, Garth Johnson, Sybil Farmer

  15. Questions Suppliers input & moderated by evidence WP2 Evidence Who with? How long for? Who with? ATs for RCT Cost How much How measure? When

  16. Evidence for efficacy WP2 = strongest WP1 + WP3 = less strong Impairments (Various) Measures Functions QOL WP3 = Strongest WP1 Acceptability Baseline for comparison

  17. WP2 Include prevalence and co-variance Prevalence of Problem function Sample for RCT Impairment Spasticity Weakness Motor control Contracting Co-variance?

  18. Typical PT Weight the factor Impairments Percentage of patients with that problem Weakness User Preferences Cost Strength of each interaction

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