1. Therapeutic Use of Technology:
Case-based Clinical Reasoning
with Everyday Technology
Douglas Rakoski, OTD, OTR/L, ATP
@Polish_Prinz_II
Robert Ferguson, MHS, OTR/L
@robferguson_OT

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Learning Objectives
1. Describe the therapeutic use of technology
as it relates to their practice.
2. Relate considerations for the therapeutic
use of technology to the various aspects of
clinical reasoning.
3. Analyze the different aspects of clinical
reasoning and synthesize them into
appropriate technology-based treatment.
4. Integrate the therapeutic use of technology
into practice using a clinical reasoning
process.

3. 3
Lead the Way
OT

4. 4
Traditional Methods Meet
Technologically Innovative
Interventions
“Where’s the robot?”

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TECH SPECTRUM
http://www.sodahead.com/entertainment/do-you-know-who-rosie-the-robot-
is-from-the-jetsons/question-710073/?link=ibaf&q=&esrc=s
http://www.pcworld.idg.com.au/slideshow/418869
/pictures-ipad-mania-around-world/?image=13

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UMICH TECH …. NOW

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UMICH TECH…..THEN & NOW

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What is the effectiveness of Virtual Reality in
increasing upper extremity motor control of
people who are Stroke Survivors?
• Fluet, G. G., & Deutsch, J. E. (2013). Virtual reality for sensorimotor
rehabilitation post-stroke: The promise and current state of the field.
Current Physical Medicine and Rehabilitation Reports, 1(1), 9-20.
• Kwon, J., Park, M., Yoon, I., & Park, S. (2012). Effects of virtual
reality on upper extremity function and activities of daily living
performance in acute stroke: A double-blind randomized clinical trial.
Neurorehabilitation, 31(4), 379-385. doi:10.3233/NRE-2012-00807
• Lee, D., Lee, M., Lee, K., & Song, C. (2014). Asymmetric training
using virtual reality reflection equipment and the enhancement of
upper limb function in stroke patients: A randomized controlled trial.
Journal of Stroke and Cerebrovascular Diseases. Advance online
publication. doi:10.1016/j.jstrokecerebrovasdis.2013.11.006

9. 9
What is the effectiveness of Virtual Reality in
increasing upper extremity motor control of
people who are Stroke Survivors?
• Rand, D., Givon, N., Weingarden, H., Nota, A., & Zeilig, G. (2014).
Eliciting upper extremity purposeful movements using video games:
A comparison with traditional therapy for stroke rehabilitation.
Neurorehabilitation and Neural Repair. Advance online publication.
doi:10.1177/1545968314521008
• Sin, H., & Lee, G. (2013). Additional virtual reality training using xbox
kinect in stroke survivors with hemiplegia. American Journal of
Physical Medicine & Rehabilitation / Association of Academic
Physiatrists, 92(10), 871-880. doi:10.1097/PHM.0b013e3182a38e40
• Laver, K. E., George, S., Thomas, S., Deutsch, J. E., & Crotty, M.
(2011). Virtual reality for stroke rehabilitation. The Cochrane
Database of Systematic Reviews, (9), CD008349.
doi:10.1002/14651858.CD008349.pub2

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LIMITATIONS of VR
• Duration of therapy for VR group was twice that of the
conventional therapy group, therefore total time of therapy could
confound results (Sin & Lee , 2013, Level I).
• More time may be required for the effectiveness of the VR
program to transfer to actual ADL performance due to the game-
based program (Rand et al., 2014, Level I).
• Small sample size and relatively short intervention period.
Outcome measure assessed only the short-term effect of VR and
conventional therapy (Kwon et al., 2012, Level I).
• No standardized interventions across the studies and
hardware interfaces differed between the studies (Fluet &
Deutsch, 2013, Level I).

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The clinical and community-based
practice of OT:
• Virtual reality should be utilized as an adjunct to traditional
OT.
• Virtual reality environments, activities, and games should be
selected that create emergent motivation in the client to
enhance engagement in purposeful movements.
• Therapists need to evaluate virtual activities prior to the
intervention to ensure that software addresses the purposeful
movements desired for real world tasks.
• OT practitioners should examine the client’s motivation of
using virtual reality versus real world tasks or use virtual
reality for specific movements that impact actual
performance components.

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“KNOBOLOGY”

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Casey Christy, MA, ATC, CSCS

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Casey Christy, MA, ATC, CSCS

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Casey Christy, MA, ATC, CSCS

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Technology Inspiring
Creativity
• Mentorship: Facilitate staff to enhance their
knowledge and skills while using technology
• Research: Assist staff in finding solutions in
regards to technique, equipment, or software.
Clinicians' with case loads do not have this
time and may abandon technology due to
time investments.
• Resources: Pursue and advocate for
new technologies that allow clinicians to be on
the cutting edge of "Therapeutic Use of
Technology".

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“OT GENIUS”
- Dr. Suzanne Peloquin
abcnews.go.com

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A COMPLEX PLAN

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Person-Environment-Occupation
Model of Occupational
Performance

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Human Interface Assessment

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Therapeutic Use of Technology

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“Therapeutic use of
Technology”
• Utilizing available technology to
accomplish therapeutic goals of
vision, cognitive, or motor
recovery during occupational
therapy intervention.

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Everyday Technologies

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Clinical Reasoning with
Therapeutic Technology
• Blending:
– Clinical Knowledge
– Device capabilities
– Providing a dynamic “just right
challenge”
Burke.org markpascua.com

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http://mlblogselisha06.wordpress.com/tag/justin-moeneau/

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OT Process ( AOTA, 2014)

29. Linking Therapy
to
Computer Activity

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Peggy

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Michael

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Hospicio

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Therapeutic benefits of the
Wii Fit

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Creatively Challenging
Balance

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X-Box Kinnect
Jaycehallshow.com

46. 46*Thank you Amanda Carr

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The Sharpbrains Checklist
•Based on Scientific Research?
•Measurable Claims and Benefits?
•Ensures Cross-Training?
•Is it Exercise – or Entertainment?
•Good Fit for the Client?
http://www.sharpbrains.com/blog/2007/08/16/brain-training-games-and-games/

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5 C’s
• Complexity
• Cost
• Comprehension
• Clinical Reasoning
• Creativity

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Clinical Reasoning
- Positioning
- Device features
- System Settings
- Software
- Device
features
- System
Settings
PROTOCOLS
LOW
TECH
HI
TECH

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Clinical Reasoning
Creativity
LOW
TECH
HI
TECH
“OT GENIUS”

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52. Therapeutic Use of
Technology
Clinical Reasoning Process Case Studies;
Susan and Nancy

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For you social media users, you
may take pictures…
But only of my “good” side
https://www.facebook.com/DwayneJohnson/photos/pb.406433779383.-2207520000.1420823006./10152751291789384/?type=3&theater

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Why is Knowing About My Clinical
Reasoning Process Important?

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57. Narrative Reasoning

58. Narrative Reasoning 58

59. ScientificReasoning
59

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Diagnostic Reasoning

61. Ethical Reasoning

62. Pragmatic Reasoning

63. Generalization Reasoning

64. Procedural Reasoning
Procedural and Interactive Reasoning

65. Interactive Reasoning

66. Conditional Reasoning

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Conditional Reasoning

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Susan’s Case Continued
From Your Handout

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Nurse Nancy
• 67 year old ICU nurse and a self-proclaimed technophobe. Was planning
on learning to be more involved with online entertainment for leisure
and social media to keep in touch with her children and grandchildren.
• She loves spending time with family, being outdoors, working as a
nurse, reading and she finds particular enjoyment in cleaning house.
• One month before retiring, she was involved in a car accident. Had
cervical fractures and a R sub-arachnoid hemorrhage. Both were
addressed surgically and she had limited residual impairment.
• Suffered a L parietal ischemic stroke the day before she was to go
home.
• Her resultant R hemiparesis, apraxia, and mild expressive aphasia,
coupled with her orthopedic surgical restrictions limited her ability to
safely care for her basic self-care needs nor her participation in her
reported meaningful activities.
• Could minimally open her hand if she used tenodesis. Difficulty
stabilizing her trunk and scapula during attempts to use her R UE in
functional activity. At the time of her admission to rehab, she was
displaying the development of learned non-use. She has a supportive
family with both her children providing legal and functional support.

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Task-Oriented Bilateral
Isokinematic Training

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Working on Washing Dishes?

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Summary View

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Oh, got it…

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Technology and Occupation:
Imagining the Future

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Q&A