Combined Sections Meeting 2010 San Diego, CA Feb. 17-20, 2010 Carla Sabus , PT, PhD

1. TEACHING IN AN E-LEARNING AGE: Using a Virtual Environment to Facilitate Authentic, Interdisciplinary Instruction of Home Assessment Combined Sections Meeting 2010 San Diego, CA Feb. 17-20, 2010 Carla Sabus, PT, PhD csabus@kumc.edu Patricia Kluding, PT, PhD pkluding@kumc.edu

2. Welcome to the University of Kansas Medical Center Virtual World

3. Theme Objectives • Recognize available resources that can be utilized to develop virtual environments. • Evaluate the educational utility of virtual environments in physical therapy education. • Appreciate levels of student involvement and participation using virtual environments. • Recognize the value of technology as vehicles for interdisciplinary collaboration and instructional technology research.

4. Technology is just a tool. In terms of getting the kids working together and motivating them, the teacher is the most important. Bill Gates

5. Learning Objectives • Students will formulate patient-centered environmental recommendations through an interdisciplinary, collaborative effort. • Students will appreciate the influence of contextual factors including patient values, patient roles, and environmental barriers on optimal physical function. • Students will evaluate recommendations to appreciate unintended consequences of environmental modifications. • Students will develop a home-based physical therapy plan of care.

6. Instructional Challenges • KUMC PT & OT student curriculum includes skills development in home evaluation and recommendations • Former learning experiences have not: • Demonstrated before and after home modifications for a specific home and client • Allowed students to evaluate recommendations and consider unintended consequences of changes • Allowed interdisciplinary collaboration that is typical of home assessment • Reinforced a patient-centered approach

9. Instructional Opportunity • Virtual environment under development by the Teaching and Learning Technology (TLT) department at KUMC. TLT pursuing multiple applications for virtual environment. • Parallel content coverage by 1st year OT and DPT students in Fall semester. • PTRS case-based curriculum approach

10. The ICF: A Conceptual Framework for Home Assessment Activity limitation is problems in activity that occur as a result of an interaction between a health condition and the context in which the person exists. Functioning & Disability • Body Functions and Structures • Activities • Participation Contextual Factors • Environmental • Personal

11. Appreciating Environment and Personal Factors Why do they have two microwaves and which do they really use?

12. Microwave A • Older • Fewer Buttons • Fewer Functions • Lower Wattage

13. Microwave B • Newer • More Functions • More Buttons • Greater Wattage • Received as a Gift

14. Microwave A

15. Microwave B

16. Why do they have two and which do they really use? • Family gave them the new one • Older one is the one they really use • Lower watts doesn’t blow a fuse in the mobile home • Fewer buttons, less error • Mostly used to heat up stuff made by a caregiver

17. Patient Values Home & Objects Have Meaning • Objects selected by the person create permanence in the intimate life • Objects make up the person’s identity • Household objects reflect as well as shape the pattern of the owner’s self

18. Physical Context • Context: “a variety of interrelated conditions within and surrounding the client that influence performance” • Physical context • Built environment • Natural Environment

19. Lawton’s Ecological Model Lawton & Nahemow, 1973

20. Background • Second life • Platform for 3-D Virtual reality • Estimated 2 million users • Used as a grounds for research and education Mason, 2007; Martinez, Martinez, & Warkentin, 2007; Polvinen, 2007; Schmidt, Kinzer, & Greenbaum, 2007 • Provides options to simulate real-world type experiences Dede, Clark, Ketelhut, Nelson, & Bowman, 2005

21. Second Life and Health Education • Allows consequences and evaluation of solutions/interventions • Allows simulation of clinical situations and patient/client interaction that cannot be feasibly created in the classroom setting • Multiple applications of KUMC Island in Second Life • Nurse Anesthesia • Nursing Health Informatics • Physical Therapy and Occupational Therapy

22. Instructional Development • Planning KUMC Isle • Fit-to-build vs Build-to-fit • Time • Resources • Computer/Internet standards (systems requirements: http://secondlife.com/support/system-requirements/?lang=en-US) • User training/tutorials • Instructional planning • Interdisciplinary curriculum planning • Structuring learning activity, assignment, and assessment

23. Development Process • Spring 2008 • Acquisition of KUMC Island within Second Life • Development of KUMC virtual OR and retirement home • Initial planning for PT/OT department use of Second Life • Summer 2008 • Construction of virtual townhouses (original and solution house) • Instructional planning • Research proposal, grant funding, Human Subjects approval (exempt) • Fall 2008 • Instructor-guided home assessment with interdisciplinary student groups • Summer 2009 • Data analysis, review of outcomes, revision goals and instructional methods • Introduction of optional virtual environment assignment for 3rd year students • Fall 2009 • Student immersion in virtual environment for home assessment and sharing group recommendations for 1st year students • Home environment incorporated in course for 3rd year students

24. Week 1 Content coverage (lecture) Tour of virtual home environment Interdisciplinary group completion of assignment Identify environmental challenges and assets Write 3 patient goals related to home function Prioritize 3 environment recommendations to support goal Week 3 Group presentation of goals and recommendations Tour of solution virtual home environment Interdisciplinary group completion of follow-up assignment Evaluate recommendations and any unintended consequences Revise patient goals and reprioritize recommendations as needed Consider recommendations within a $500.00 budget constraint Individual reflection statements Week 5 Final group assignment and individual reflections due Web-based survey invitation (open 4 weeks with reminders) 1st Year Student Instruction - 2008

25. 1st Year Student Instructional Development • Fall 2008 Instructors provided the virtual environment tour. Instructors also directed the tour of the home with modifications. • Fall 2009 Each student accessed the virtual environment through individual avatars. Students independently viewed the group recommendations and toured the home with modifications. Students met outside of scheduled class time to make revisions to recommendations within budgetary constraints. Testing the Threshold of Technology Tolerance and Self-directed Interdisciplinary Learning

26. 3rd Year Student Instruction • Embedded in final neurologic rehabilitation course • Individual activity • Assignment introduced in syllabus, with links and instructions on course website • At student request, 1 hour of class time used to review assignment: • Technology liaison gave overview of procedures • Brief tour of virtual world • Q and A

27. Dee Rigles • Older, retired adult with history of DM with retinopathy, nephropathy, and peripheral neuropathy • Afternoon caretaker for 2 school-aged grandchildren • Diminishing participation due to impairments • General health and wellness considerations

28. Home Tour

29. Anticipated Outcomes • Greater value of interdisciplinary collaboration • Expect differences in Second Life learning experiences between • In class gr0up activity • Individual immersion activity

30. Assignment Quality (compared to home assessment of student’s own home environment with a paper patient) Recommendations within the Virtual Environment were • More Specific • More Patient Centered • More Individualized • More Contextual • More Creative

31. Capturing Educational Outcomes • Technological Aspects • 87.5% (n=28) enjoyed the virtual learning environment • 93.8% (n=30) found the virtual environment was NOT a distraction to learning • 21.9% (n=7) report feeling dizzy

32. Capturing Education Outcomes • Interdisciplinary Interaction • 84.4% (n=27) found the interdisciplinary activity was helpful to learning   • 84.4% (n=27) found the interdisciplinary interaction helped with decision making

33. Second Life use in the future • 90% (n=29) agreed they could apply learning to actual home assessment • 43.8% (n=14) thought they would like to use Second Life in another class

34. Student Feedback - 2008

35. Student Feedback - 2009

36. Reflection Themes - 2008 • Reflect on the learning process • Divergent viewpoints between disciplines • Novelty of the experience • Patient-centered approach • Identify knowledge gaps • Expense/Reimbursement • Practical aspects – feasibility, contractors • Considerations of patient values when making recommendations • Reflect on your role in the group process • Interdisciplinary role: professional identity, expertise of discipline • Unique perspectives on the interaction of home environment on patient function • Understanding perception of self and viewpoints by others

37. 3rd year Student Assignment • Modifications to assignment • Detail on balance assessment in case description • Prioritized problem list and plan for home-based PT • Reflection • Did this assignment help you 1) develop a patient-focused intervention, 2) understand home assessment for safety and function, 3) develop a home program of exercise that considers the home environment as a factor • Recommendations for this assignment in future?

38. 3rd year Student Assignment • [Recommended home modifications] • Problem list and plan for PT • Reflection comments

39. Unique Treatment Strategies • Balance activities: • Using environment • kitchen island • carpet/tile surfaces • seated reach on couch/bed • open doors • Reach for household items • cupboards • move magnets on fridge • objects on floor • books in living room • Head turn while walk in kitchen/hallway • Obstacle course with dog toys

40. Unique Treatment Strategies • Endurance training • Walk pathway from kitchen to living room • Use inside/outside stairs for exercise • Play fetch with dog • Play with grandkids • Simon Says • Wii • Play with legos or make bead necklace

41. Unique Treatment Strategies • Safety education: • Kitchen – stove / coffee pot • Rearrange items to within reach (kitchen / bathroom) • Practice getting into/out of tub • Food prep: • List of healthy, inexpensive, easy to prepare items / cookbook • Practice in therapy to assess deficits • Include daughter/grandkids • Social: • Host pot luck for family / friends with a cello concert!

42. Student Reflection: Positives • “It was nice to see the equipment/objects in her home for exercises” • “Good to touch on the idea of home evals again after our first year in PT school” • “This assignment helped me to think as a home health PT and use a critical, detail-oriented eye to find potential problems in the home” • “I had to modify several of my initial treatment ideas once I saw the actual home environment” • “I am new to Second Life and I was pleasantly surprised at how user-friendly it was”

43. Student Reflection: Negatives • “I don’t think many real homes look like this – on my home health rotation many homes were split level, crammed full of 40 years worth of stuff, wobbly handrails, etc” • “A lot of work to install the program, create an avatar, and getting access to the isle for the project” • “Challenging to upload to my home computer”; “Would prefer to have software more available on campus computers” • “It would be better to see a depiction of the patient and how she moves in her home”; “A more complex patient or including a follow up component would improve this assignment” • “This assignment would be improved by doing it in an actual home”

44. Both Positive and Negative … • “Second Life is an amazing program that can do a lot! … but it can be so involved that it distracted me from the actual assignment”

45. Take Home Message • Students enjoyed using Second Life. • Students felt they benefited from interdisciplinary interaction. • Educational programs can use similar technology in building new curriculum. • Capture student outcomes when introducing an novel instructional strategy.

46. Future plans • Embedded information/prompts • Integration of clinical simulations with electronic health record • Expand interdisciplinary collaboration • Observation of patient’s interaction with environment

47. http://secondlife.com/

48. Questions, Ideas, and Discussion

49. References www.secondlife.com Antonacci. D. M., & Modaress, N. (2005). Second life: The educational possibilities of a massively multiplayer virtual world (MMVW). Paper presented at the EDUCAUSE Southwest Regional Conference, Austin, Texas. Conklin, M. S. (2005). 101 uses for second life in the college classroom. Retrieved Jan. 3, 2010. Dede, C., Clarke, J., Ketelhut, D., Nelson, B., & Bowman, C. (2005). Fostering motivation, learning, and transfer in multi-user virtual environments. Paper presented at the Annual Conference of American Educational Research Association (AERA), Montreal, Canada Lawton MP. Competence, environmental press, and the adaptation of older people. In: Lawton MT, Windley PG, Byerts TO, ed. Aging and the Environment. New York, NY: Springer, 1982: 33-59. Tomey KM, Sowers MR. Assessment of physical functioning; a conceptual model encompassing environmental factors and individual compensation strategies. Physical Therapy. 2009; 89:705-714.

50. Acknowledgements • Aging in Place • Dory Sabata, OTD, OTR/L, SCEM • KUMC Teaching and Learning Technology Department • Tennille Fincham • Stephanie Gerald • Dave Antonacci