FUNCTIONAL IMPACT OF ASSISTIVE TECHNOLOGY ON PEOPLE WITH HEMIPLEGIA FROM STROKE

Noralyn C. Davel, OTR and Roger O. Smith, Ph.D., OTR, FAOTA University of Wisconsin- Milwaukee

Abstract

The use of assistive technology is a traditional treatment approach of occupational therapists working with patients in rehabilitation. The range of assistive technology used in rehabilitation is vast, from "low tech" long handled sponges to "high tech" wheelchairs and communication devices. While the use of assistive technology with patients with stroke is widely accepted, it has not been substantiated by research in functional outcomes. The OT FACT computerized documentation program was used to collect data on individuals with stroke on an inpatient rehabilitation unit. Data were collected for each patient unit at admission, at discharge and at a two to three month follow-up call. Independent variables included demographics, Functional Independence Measure (FIM) and the use of assistive technology devices. Results of the study demonstrate the effectiveness of OT FACT in data collection and demonstrate the change in functional outcomes of patients with stroke using assistive technology.

Background

The use of assistive technology for people with disabilities has become a powerful medium for facilitating independence and personal productivity. The assistive technology field has always relied on the good intentions of funding agencies (such as medical assistance and medical insurance companies) to pay for devices for the people who will benefit from assistive technologies. While the lack of data and scientific evidence to support the use of assistive technology has always been a problem, the common sense approach has usually been adequate. Recently however, public funding systems have been instituting more fiscal restraint. Consequently, more empirical data are necessary to justify the expenditures of assistive technology devices and services that can range from a few dollars to many tens of thousands of dollars. Superficially, documenting the usefulness of assistive technology seems to be as simple as recording how well it works. Assistive technology suppliers and service providers have not found this to be so easy. The reason for the difficulty is two-fold. First, virtually no instruments have been created to measure the impact of assistive technology. Second, it is not even certain what constructs best measure the effectiveness of assistive technology. An instrument designed to truly measure assistive technology as defined in federal law (widely) must be extremely flexible and encompassing. Data collection instruments have traditionally been much more specific. OT FACT (Smith, 1992), available from the American Occupational Therapy Association is a computerized, comprehensive, functional assessment that is being tested here as an outcome measurement tool. The national Center for Health Statistics cites that over 34 million civilian non-institutionalized Americans are limited in their activity due to long-term disability. An additional 2 million are residing in long-term care facilitates. A large percentage of these individuals use assistive technology devices. Studies have found that some populations of disability use an average of more than six devices. As health care dollars become more rationed, decisions will increasingly be made between allocating dollars for therapy and rehabilitation of people with disabilities or for compensatory interventions such as the use of assistive technologies. Figure 1 shows common approaches used in rehabilitation of which assistive technology is shown as a key area of practice.

Research Question

Does assistive technology intervention as provided by occupational therapy practitioners improve the functional outcome of individuals with stroke?

Methods

The study is structured as a simple repeated measures multi-variate design. The independent variable includes a number of demographic variables, Functional Independence Measure (FIM) and the use of assistive technology devices. Assistive technologies were listed from the Abledata categories (DOS Abledata, 1992). Please refer to figure two for examples from the assistive technology list. Five in-patient unit field sites are involved. Dependent variables are observed at three points in time: admission to the rehabilitation unit, at discharge from the unit and at a two to three month follow-up. Dependent variable data are all collected with an intra-class correlational analysis for the reliability assessment. The OT FACT documentation software used for data collection. OT FACT elicits the subjective judgments of raters and qualifies the judgments through a branching questioning structure called Trichotomous Tailored Sub-Branching Scoring. This study collected the Environment Free data (performance across functional areas without assistive technology) and Environment assisted data (with technology). The use of double scoring procedures at discharge allows for teasing out the use of assistive technologies. The therapists/data collectors also collect the independent variable data.

Figure Two:  Assistive Technology examples

Results

Preliminary data demonstrates the significance of using assistive technology in the outcomes of patients with stroke. A case example, "GS," a 66 year old male who suffered a left cerebral vascular accident, had 17% improvement in his OT FACT score in Activities of Performance: personal care activities. (See figure three.) His intrinsic improvement in rehabilitation was 57%, adding the use of assistive technologies, and his improvement increased to 70%. Figure four shows the changes in the activities of daily living levels, comparing initial assessment scores with discharge "environment free" and discharge "environment adjusted" scores. The data collected on assistive technologies used by "GS" included: tub bench, grab bars, suction toothbrush, velcro, one-handed insulin draw, easy open bottles, and small based quad cane. Data collection continues at the five research sites.

Discussion

The preliminary data indicate that the use of assistive technologies does appear to make a difference in the functional outcomes of patients with stroke. The technologies that are most used by stroke patients appear to be the "low tech" items such as grab bars, adapted toothbrushes and canes. This study is a follow-up to Smith's (1993) Assessing the impact of assistive technology using OT FACT version 2.0. As predicted, OT FACT demonstrates success in its usefulness as an outcomes measurement tool for a stroke population. Current interest in measurement includes frequency measures and quality of life indices, including self-satisfaction issues. OT FACT has the flexibility in its design to measure self-satisfaction, to allow for cooperative patient-therapist goal setting and to tailor the outcome indicator specific to the population.

Figure Three: General Levels

Figure Four: Activities of Performance Levels

References DOS Abledata. (1992). [Computer program]. Madison, WI: Trace Research & Development Center.

Smith, R. O. (1987). Using the occupational therapy comprehensive functional assessment (OTCFA) to evaluate the efficacy of technological intervention in rehabilitation. Proceedings of RESNA '87, the 1987 RESNA Conference, 341-343. Washington, DC: RESNA.

Smith, R. O. (1992). OT FACT Software and Operation Manual. Rockville, MD: American Occupational Therapy Association.

Smith, R. O. (1993). Assessing the impact of assistive technology using OT FACT Version 2.0. Proceedings of RESNA '93, the 1993 RESNA Conference, Arlington, VA: RESNA.

Smith, R. O., Benge, M., Hall, M. (1994). Technology for Self-Care. In C. Christiansen (Ed.) Ways of Living: Self-Care Strategies for Special Needs pp.379-422, Rockville, MD: American Occupational Therapy Association.

Acknowledgments This research is supported by a grant from the Graduate School at the University of Wisconsin-Milwaukee.

Address Roger O. Smith, Ph.D., OTR, FAOTA. Occupational Therapy Program, Department of Health Sciences University of Wisconsin-Milwaukee P.O.Box 413 Milwaukee, WI 53201-0413 (414)229-4713