Using Contextually Based Technology in Occupational Therapy



Robert Ferguson, OTRL, and Douglas Rakoski, MA, OTR/L, ATP feel that when we consider technology, our ideas of it can range from using a computer to robotics. Working with stroke survivors, they want occupational therapy practitioners to be aware that even the simplest technology can help clients achieve their therapeutic goals.
Ferguson and Rakoski prefer using technology in stroke rehabilitation by breaking down tasks and incorporating them into therapeutic interventions and that occupational therapy should be the driving force in using technology in rehabilitation.
 “Technology is pervasive in our daily lives”, say Ferguson and Rakoski. It’s used daily from young children to  74-year-old women who never used a computer  and now are on it every day.  Most people don’t realize how many repetitions are required to access and use  user-friendly and intuitive technology such as smartphones, computers and tablets.  This fact allows therapists an opportunity to provide an occupationally based treatment which can be modified and adapted  to facilitate cognitive, motor  and perceptual abilities.
Using technology with a stroke survivor as an example.
One patient had a hard time being able to reach behind to do toilet hygiene. Rakoski and Ferguson said “we can use the computer to do that,” and of course everyone laughed at him. But if the task is broken down the client has to be able to internally rotate and reach behind. They brought up a card game on the computer that the client liked, where he touched the screen to move the cursor, but to do a left click, they took a switch and  safety-pinned it to the back of his pants. So he’s doing the same motion, but he’s doing a high number of repetitions so he can practice the movement to be able to reach. They broke down the functional task into components and utilized the same tasks while the client is playing a game or doing an activity.
Ferguson continues: While the client was doing that, I’m using the same hands-on handling techniques that I would normally use in the clinic, but  with the technology to facilitate that movement. It gives us hundreds of repetitions and we’re able to replicate it.
Ferguson was asked why he thinks occupational therapy practitioners struggle to find ways that link stroke intervention approaches to the client’s participation in meaningful occupations?
He responded that many common everyday activities don’t normally have enough repetitions inherent to the demands of the activities. As a result, therapists  tend to use  objects like rings or blocks   that can provide repetition, but they lack context. Unfortunately even when a treatment approach uses  contextually appropriate objects for the activities, when the treatment occurs outside of a natural environment they are still practiced out of context. We normally work in a hospital and it therefore makes it difficult to  link many activities contextually. Some people have tried to use functional kits, which are more appropriate, but they are difficult to adapt to challenge the patient as they continue to progress. Technology can contextually be used  anywhere. You can decide how the technology interaction is to be completed and it becomes an intricate part of the activity. Patients seem love it and they find it easy to relate it to their  goals.
Rakoski describes his favorite technology that helps with post stroke interventions.
He likes an ”emerging movement”—whether it’s finger extension, wrist or elbow —it’s such a small movement that it’s not really functional. You aren’t able to get dressed or  take care of yourself, but it’s still an emerging movement.  The client can see that, “Wow, I’m moving my finger, even if just by a few degrees, but I’m activating that switch, which is driving the computer to do an activity or  play a game.” Even though it’s not completely functional, the patient begins to get  to see that there is some movement. The stronger they get the more they can be challenged. So even though it’s not  a favorite piece of equipment, it gets the client who functionally cannot use that movement, to   see that it translates into some  activity.
Rakoski was asked what he would want all occupational therapists to know about using technology in stroke rehabilitation?
He answered that it isn’t necessary to have a large expensive piece of equipment. Sometimes it’s just a simple touch screen or  switch. A lot of it boils down to  creativity.  Basically it’s setting up the computer to allow the client to interact in a meaningful occupation—it could be a hunting  or fishing card game—but you’re working on a high number of movements and repetitions. You’re engaging the patient which makes him work harder and longer. He will also  have less fatigue and less pain. It basically depends on the therapist‘s creativity.
Ferguson stated that technology is all over the place today and is so much a part of everyone’s lives. Almost everyone uses some technology every day. However, even folks who don’t use a lot of technology like to come into the computer lab. They are interested in seeing  what they can do and what the connection is to  what they want to be able to do.
The TUTOR system (HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR) is a recently developed state of the art technological advance in rebuilding muscles and limb movement following stroke, head/brain injuries, Parkinson’s disease, CP, MS and other upper or lower limb surgeries or diseases. Physical as well as occupational therapists administer intensive exercises through this innovative physical therapy product.
Consisting of ergonomically designed and comfortable gloves and braces the TUTORs contain sensors  connected to exclusive computerized games. The therapists then monitor the results and customize an exercise program for that particular patient. The TUTOR system implements an impairment based rehabilitation program with augmented feedback and encourages motor learning.
Currently in use in leading U.S. and European hospitals and clinics the TUTORs are fully certified by the FDA and CE.
They are available for children from the age of 5 as well as adults and can be used in the patient’s home through telerehabilitation.
See WWW.MEDITOUCH.CO.IL for further information.



One response to this post.

  1. Digital games are an excellent field of application to explore the pros and cons of
    interacting with physiological sensors, because the consequence of failure are less
    severe than in critical computing systems,Biofeedback Game is very famous on socity. where life or death depends on the right
    algorithm. This is one of the reasons why physiological computing and psychophysiological
    game evaluation have become so popular in the game user research community. So, what
    applications of physiological sensors have we seen in the past and which ones are we
    likely to see in the future?


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