2004 Conference Proceedings

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COMPUTERS: A THERAPEUTIC TOOL FOR OCCUPATION-BASED ACTIVITIES

Presenters/Authors:

Barbara Phillips, MS OTR/L ATP
Rancho Los Amigos National Rehabilitation Center
7601 East Imperial Highway
Downey, CA 90242
Phone: 562-401-6805
Email: Bphillips@dhs.co.la.ca.us

Bobbi Jean Tanberg, COTA
Rancho Los Amigos National Rehabilitation Center
7601 East Imperial Highway
Downey, CA 90242
Phone: 562-401-6810
Email: Btanberg@dhs.co.la.ca.us

The Center for Applied Rehabilitation Technology (CART) at Rancho Los Amigos National Rehabilitation Center provides assistive technology services to individuals with physical disabilities. The CART team performs evaluations, makes recommendations and teaches individuals and their families how to use assistive technology. The team provides services to both inpatients and outpatients.

In 2002, the staff at CART received a grant to fund a computer lab for the inpatients at Rancho. Initially the intention of the lab was to bring computer services to patients on the inpatient unit, rather than having them travel to a separate building for services. What has evolved is a full range of therapeutic interventions and services. A Certified Occupational Therapy Assistant and an OT student professional worker staff the lab on a part-time basis. The technology is also supported part time by a technology specialist, an OTR and a speech pathology assistant.

In the past, only individuals with prior computer experience or patients who could solely rely on technology to enhance their quality of life (high level spinal injuries) were referred to the technology center for computer access assessments. Now, almost any patient can receive therapy using the computer and alternative access methods as a functional tool. The computer is used as the tool, but the focus is on the activity. The individual can be pursuing a passion such as reading a newspaper in their native language, while working in increasing their shoulder range of motion or hand coordination. Their attention is on the activity but the input method is adjusted to focus on the physical and cognitive therapeutic goals.

For example, one woman with a muscle disease that left her strong distally and weak proximally was able to work on her shoulder strength by playing a game of solitaire. The mouse speed was slowed down and the therapist lined up 3 mouse pads forcing her to extend her shoulder the full range of motion while she played her game. This allowed her to functionally participate in an occupation that was interesting and motivating for her while improving the strength in her shoulder.

Another example is a 65-year-old retired nurse who had sustained an injury that left her with a C1 level tetraplegia. Her passion was reading novels and she had never used a computer before. She tried books on tape, but did not enjoy them. She was very depressed and was generally not interested in using adaptive equipment or assistive technology. Her husband, a physician, researched and was interested in purchasing an electric page turner to allow her to return to reading books independently. A demonstration of an electric page-turner was provided, with disappointing results. It was through a session in the Computer Therapy Lab that she was able to independently read a book using an on-line book service (www.bookshare.org) and a single switch with her tongue. Her husband immediately registered for the program and began downloading books to their computer at home.

After suffering a stroke and being placed in a nursing home for 2 years, another patient was seen in the computer lab. Prior to her injury, she was a telemarketer and used the computer at work. Her stroke left her severely ataxic and she had not used a computer since onset. After her evaluation, she was able to access the computer independently once again. Her family supported her goals and purchased a new computer for her to use in her home upon discharge from the rehabilitation facility.

As part of the grant, additional equipment was purchased and placed into a loan library. For patients who are expected to make further physical gains, equipment that will meet their present needs but is not necessarily a long term solution, is available for them to borrow for a 1-3 month period. After that period, they are evaluated at CART, the outpatient technology center, and final computer access recommendations are made.

Case studies of individuals with different physical disabilities including SCI, TBI, CVA and muscle diseases will demonstrate the wide variety of uses for the computer as a therapeutic tool. Individuals who participate in the lab are surveyed regarding the effectiveness of services and equipment they received. Results from this survey will be shared.

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