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An Assistive Technology Program: Meeting the Unmet Needs of People with Disabilities. CSUN Conference 2010 Holly A. Cohen, OTR/L, ATP Nandita Singh, MPH,OTR/L Steve VanLew, MS, OT/L. Goals:. AT and Our Program at NYU Gather an understanding of our program and how it came about

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An Assistive Technology Program: Meeting the Unmet Needs of People with Disabilities

CSUN Conference 2010

Holly A. Cohen, OTR/L, ATP

Nandita Singh, MPH,OTR/L

Steve VanLew, MS, OT/L


AT and Our Program at NYU

Gather an understanding of our program and how it came about

Quality of Life and Assistive Technology

What is it and how does AT affect QOL


How do we use outcome studies

Case Studies


who are we
Who are we?

The History of

Our Institution

rusk institute of rehabilitation medicine
Rusk Institute of Rehabilitation Medicine

Rehabilitation hospital affiliated with NYU Langone Medical Center in New York City

Howard A. Rusk – Founding Father of Rehabilitation Medicine

occupational therapy services at rusk
Occupational Therapy Services at Rusk

Adults and Pediatrics


80 beds

20,000 visits per year


8,500 visits per year

Acute Care:

670 beds

12,000 visits per year

ot staffing
OT Staffing

Director of OT/PT

Associate Director of OT

6 Supervisors

6 Clinical Specialists

41 OTR’s

3 COTA’s

4 Support Staff

what is assistive technology
What is Assistive Technology?
  • “Any item, piece of equipment or product system, whether acquired commercially, modified or customized, that is used to increase, maintain or improve the functional capabilities of individuals with disabilities”
examples of at
Examples of AT
  • Computer screen readers
  • Alternative computer access hardware and software
    • Keyboards
    • Mice
    • Monitor
  • ECUs
  • SGD or AAC
  • Glasses
  • Walkers, canes, etc.
the at program at nyu rusk
The AT Program at NYU Rusk
  • 2004 - Outpatient Occupational Therapy Department
  • 2005 - 16 patients seen for Assistive Technology
  • 2009- 150 adults seen for Outpatient Assistive


- Over 50 inpatient and pediatric consults

main areas of focus
Main Areas of Focus:
  • Computer access
    • Hardware, software, and switch interfacing
  • Speech Generating Devices or AAC
    • Text to speech software, voice amplifiers, telephone adaptations, and any other technology to enhance an individuals communication
  • Environmental Control Units
    • Leisure tasks such as gaming units, photography, etc.
service delivery
Service Delivery:
  • Program is lead by Occupational Therapy Clinical Specialist in Assistive Technology
  • Individuals are evaluated based on an occupational therapy practice domain including:
    • Activity demands
    • Performance skills
    • Performance patterns
    • Client factors
    • Context and environment
Patients are seen through evaluation, delivery, and implementation of technology prescribed
  • Patients trial various forms of technology to meet their goals prior to prescription
types of patients seen
Types of Patients Seen:
  • SCI
  • CVA
  • ALS
  • MD
  • MS
  • CP
  • Impairments of fine and gross motor control skills
  • Work related injuries
  • TBI or other cognitive impairments
  • Neuropathy
  • Repetitive stress injuries
how are we unique
How Are We Unique?
  • Most assistive technologies are not covered by insurance companies
  • The service at NYU is grant funded. This enables us to provide equipment to individuals that could otherwise not afford to purchase it themselves
  • All individuals receive necessary equipment regardless of reimbursement
our grant
Our Grant:
  • Initially applied for Helen Hoffritz Grant Fund in 2005
  • Goal was to receive money to provide technology to our patients
  • Since 2005, we have received money annually
    • In 2010 double amount of money provided than 2005
meeting communication needs
Meeting Communication Needs:
  • All individuals are seen collaboratively with both the AT and SLP departments
  • Two programs work together
    • Evaluation
    • Letter of justification
    • Training of all communication technology
  • True collaborative approach
the mentorship program
The Mentorship Program:
  • Educational program for staff interested in assistive technology
  • Ten week program with staff/senior occupational therapist
    • AT education
    • Service delivery
    • Documentation and goal writing
  • Involves supervised treatment of referred AT patients
the mentorship program1
The Mentorship Program:
  • Goal is for participants to assist with patient care
    • Expansion across the board in all services
  • Currently building a basic competency for staff on all levels for Assistive Technology
providing novel technology
Providing Novel Technology:
  • The Rusk Institute has a collaboration with the Interactive Telecommunications Program (ITP)at NYU and the NYU Occupational Therapy Department at New York University
providing novel technology1
Providing Novel Technology:


2 year graduate program located in the Tisch School of the Artswhose mission is to explore the imaginative use of communications technologies

Occupational Therapy Program at NYUoffers both entry level and post professional education

ot and itp
OT and ITP:


To create technology for individuals with disabilities when “off the shelf” is not sufficient

Facilitates students, clinicians, and professors to work together to meet the needs of clients with disabilities

ot and itp1
OT and ITP:
  • 2003: Collaborative class given for OT and ITP students; “Developing Assistive Technology”
    • Awarded funding through University Curricular Challenge Fund Grant
  • 2005: Continued participation in education between OT’s and ITP program
    • Development of Assistive Technology Lab through Nathan Cummings Foundation Grant
ot and itp2
OT and ITP:
  • 2007: Worked with ITP students within Assistive Technology classes to tailor and critique their projects
  • 2008: “Design for One” created in ITP department. Goal to develop technology for individuals that didn’t fit “off the shelf” options
ot and itp3
OT and ITP:
  • 2010: Continued involvement with ITP students and development through the “Developing Assistive Technology” class
why does this work
Why Does This Work?
  • Exposes artists, designers, technology developers to individuals with disabilities
    • Expanding their appreciation of how their craft can make an impact on someone’s life, possibly developing their career paths
  • Reinforces the importance of creative outlets for people with disabilities
community outreach
Community Outreach:
  • OT/ATP provides in-servicing to local organizations and facilities
    • Local rehabilitation hospitals
    • Vocational rehabilitation
    • Pediatric organizations
    • Support groups
    • Participation in community events
  • Goal is to educate about AT and how it can assist their clientele
what s next
What’s Next?

Expansion - goal is to utilize trained staff to assist with patient care and service delivery

Community outreach - address AT needs in various settings

Continued Collaboration - with NYU Occupational Therapy Program and ITP for continued education and development of technology

quality of life qol and assistive technology
Quality of Life (QOL) and Assistive Technology
  • An assistive technology device should promote good QOL for the user to the extent to which it makes the user feel competent, confident, and motivated to exploit life’s possibilities (Jutai & Campbell, 2002)
  • Assistive technology is an extension of the external physical environment
qol continued
QOL continued:
  • Example:
    • If an individual with quadriplegia wanted to use a computer to pay their bills online
      • Level of performance skills would greatly influence the exact type of devices required to facilitate independence
      • The change in QOL is of engagement of computer occupations can only be measured from the perspective of the individual
  • QOL is a subjective and theoretical construct
the piads
  • Psychological Impact of Assistive Devices Scale
  • A 26-item, self-report questionnaire
  • It has established psychometric properties, internal consistency, test-retest reliability, and construct validity (Jutai & Day, 2002)
  • Describes user experiences along three dimensions
    • Confidence, adaptability, self esteem
  • When participating in the PIADS, all patients first “fill out” the background information form
  • This form is technology specific
  • Nine questions long
    • Amount of time using technology
    • Method of access
    • Level importance technology is to daily life, 1-5
the piads scoring
The PIADS, Scoring:
  • The rating scale is from -3 to +3
    • -3 meaning decreases
    • +3 meaning increases
  • Zero denotes neutrality of no change
  • It can be used to assess the impact of any assistive device, prosthesis or medical procedure
  • Can be used with people of all ages and abilities
how do we use the piads
How Do We Use the PIADS?
  • We use the PIADS to assess the effects of assistive devices
    • Quality of life
    • Functional independence
    • Well-being
  • All patients that received equipment participate in a PIADS survey
    • Regardless of payer source and type of technology
the piads1
  • It is completed six months following completion of service
  • Administered by Occupational Therapists
  • Through the use of the PIADS, we hope to ascertain if the provision of technology is truly enhancing the three dimensions of focus.
the data
The Data:
  • 82% reported increased in satisfaction
  • 85% increased independence
  • 82%increased self esteem
  • 82%increased quality of life
  • 88%increased happiness
  • 59%decreased embarrassment
  • 65%decreased frustration
what are we doing with the data
What Are We Doing With The Data?
  • The results of the PIADS are provided to the grant fund in order to obtain annual funding
  • Use of data to obtain additional funding, other than grant that we have now
  • Plans to utilize PIADS for research purposes
case study 1 a g
Case Study #1 - A.G.:
  • 42 year old male with a primary diagnosis of C2 SCI as a result of a motorcycle accident (10/2004)
  • Prior to his MVA, AG worked as an air conditioner installer
  • He lived with his girlfriend; his two young children lived nearby
a g continued
A.G. Continued:
  • Following injury, AG resided in a LTC facility for three years
    • He was dependent for all self care needs, including a ventilator at all times
  • In 2007, AG received a phrenic nerve stimulator, enabling him to return to home with 24 hour care
    • Also provided with power wheelchair, independent with use of sip and puff controls
a g continued1
A.G. Continued:
  • A.G. was referred to the Assistive Technology Service at the NYU/Rusk Institute
  • His goals were to:
    • “Do more for myself”
    • “Go to school so I can get a job with computers”
a g continued2
A.G. continued:
  • Following AT evaluation A.G. was introduced to options for:
    • Light control
    • TV and all other IR control
    • Computer access
a g s prescription
A.G.’s Prescription:
  • After an extensive trial period, A.G. was given:
    • Computer access skills:
      • Head mouse, software for on screen keyboard and dwell click software
      • Dragon Naturally Speaking
      • Laptop was mounted to wheelchair
  • Following training on all equipment, A.G. was independent with computer access and was able to enroll in continuing education classes on web design
a g s prescription1
A.G’s Prescription:
  • Software was installed on A.G.’s computer for environmental controls
    • Lights
    • TV
    • DVD
    • Stereo
  • A.G. was now independent for IR and other home controls
  • All of A.G.’s goals were met
  • He was able to transition from dependent to independent in many areas in his daily life
  • All of A.G.’s technology was provided from the Helen Hoffritz Grant Fund
  • 55 year old female with a primary diagnosis of ALS (diagnosed 18 months prior to referral)
  • C.P. had been experiencing a consistent decline in speech and functional status since her diagnosis
    • Non ambulatory, maximal assist for all self care skills
    • Limited bilateral upper extremity function
  • Her goal for assistive technology was “to have a way to communicate to people so they can understand”

Following an extensive evaluation it was determined that C.P. would benefit from a SGD for communication in all settings

The SGD would include environmental controls for increased independence in her home

SGD would need to be mounted to her wheelchair for access

  • SGD obtained could be accessed in several ways
  • C.P. was trained on all access methods appropriate for her, primarily relying on eye gaze
  • C.P.’s aide was independent with manipulation of the mount
  • Device obtained also worked as a Windows based computer
  • C.P. uses environmental controls through device to independently access lights, TV, and DVD player
Following training of device, C.P. is now independent with speech to both familiar and unfamiliar listeners
  • She was able to independently use device to call her daughter
  • Independent with control over devices in her home
  • All goals were met
  • The use of assistive technology can have profound impact for individuals with disabilities
  • Our Assistive Technology program at the Rusk Institute of Rehabilitation Medicine serves allindividuals with disabilities regardless of their ability to afford the technologies
  • Continue use of the PIADS with plans to submit for IRB approval
  • American Occupational Therapy Association. (2008). Occupational Therapy Practice Framework: Domain and process (2nd ed.). American Journal of Occupational Therapy, 62, 625-683.
  • Day, H., Jutai, J., Campbell, K. A. (2002). Development of a scale to measure the psychosocial impact of assistive devices: lessons learned and the road ahead. Disability and Rehabilitation, 24, 31-37.
  • Jutai, J. & Day, H. (2002). Psychosocial Impact of Assistive Devices. Technology and Disability, 14, 107-111.
  • Renwick, R., Brown, I. & Raphael, D. (1994). Quality of life: linking a conceptual approach to service provision. Journal of Developmental Disabilities, 3, 32-44.
  • Wilcock, A. A. & Townsend, E. A. (2008). Occupational Justice. In E. B. Crepeau, E.S. Cohn, & B. B. Schell (Eds.). Willard and Spackman’s Occupational Therapy (11th ed., pp. 192-199). Baltimore: Lippincott Williams & Wilkins.

Thank you!Holly A. Cohen, OTR/L, ATPNYU Langone Medical CenterRusk