Q&A With Rob Ferguson and Doug Rakoski: Using Technology With Stroke Interventions
By Stephanie Yamkovenko
When we think about technology, our ideas of it can range from robotics to using a computer. Working with stroke survivors, Robert Ferguson, OTRL, and Douglas Rakoski, MA, OTR/L, ATP, want occupational therapy practitioners to know that even the simplest technology can help clients meet their therapeutic goals.
Are you an occupational therapy practitioner working with clients with stroke? You can learn in-depth information about stroke rehabilitation from the leading experts at AOTA's Specialty Conference—Adults with Stroke and earn up to 13 contact hours. November 30 to December 1 in Baltimore, Maryland.
|Ferguson and Rakoski use technology in stroke rehabilitation by breaking down tasks and incorporating it into therapeutic interventions, and they will be presenting on the topic at the upcoming 2012 AOTA Specialty Conference—Adults with Stroke. AOTA talked to the two presenters about technology and how occupational therapy should be the driving force in using technology in rehabilitation.
AOTA: Your presentation at the Stroke Conference is about traditional stroke rehabilitation methods meeting technological interventions—why do you think technology enhances traditional methods of stroke rehabilitation?
Ferguson: Technology is pervasive in our daily lives. It's used daily from young children to my 74-year-old mother, for example, who never used a computer until about 10 years ago and now she's on it every day and I can't get her off of Facebook. Most people don't realize how many repetitions are required to access and use even user-friendly and intuitive technology such as computers, tablets, and smartphones. Interestingly, this fact allows therapists the opportunity to provide an occupationally based treatment that can be modified and adapted in ways to facilitate motor, cognitive, and perceptual abilities.
AOTA: Can you give an example of how you would use technology with a stroke survivor?
Rakoski: One patient had a hard time being able to reach behind to do toilet hygiene. I said "we can use the computer to do that," and of course everyone laughed at me. But if you break down the task, the client has to be able to internally rotate and reach behind. We 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, we took a switch and we 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. We're breaking down the functional task into components and utilizing the same tasks while the client is playing a game or doing an activity.
Ferguson: While the client was doing that, I'm using the same hands-on handling techniques that I would normally use in the clinic, but I am using that with the technology to facilitate that movement. It gives us hundreds of repetitions and we're able to replicate it.
AOTA: Why do you think occupational therapy practitioners struggle to find ways to link stroke intervention approaches to a client's participation in meaningful occupations?
Ferguson: Many common everyday activities don't have enough repetitions inherent to the demands of the activities. As a result, therapists may tend to use random objects like blocks or rings that can provide repetition, but they don't provide context. Unfortunately even when a treatment approach uses the recommended contextually appropriate objects for the activities, when the treatment occurs outside of a natural environment they are still practiced out of context. We work in a hospital and it makes it difficult to contextually link many activities. People have attempted to use functional kits, and those are more appropriate, but they are hard to adapt to challenge the patient as they progress. Technology can contextually be used almost anywhere. You can set up how the technology interaction is to be completed and it becomes an inherent part of the activity. Patients love it and they find it easy to relate it to their overall goals.
AOTA: Describe your favorite technology that helps with interventions after stroke.
Rakoski: My favorite thing is if there's an emerging movement—be it wrist, elbow, or finger extension—it's such a small movement that it's not truly functional. You wouldn't be able to get dressed or be able to take care of yourself, but it's still an emerging movement. We can set up on the computer to just use that movement and the client can see that, "oh my gosh, I am moving my finger, even if just by a few degrees, but I am activating that switch, which is driving the computer to play a game or do an activity." Even though it's not completely functional, we're beginning to get them to see that there is movement. As they get stronger, we can challenge them more and more. So it's not really a favorite piece of equipment, but it's getting the client who functionally cannot use that movement, but in the computer lab they are seeing that it translates into some kind of activity.
AOTA: What do you want all occupational therapy practitioners to know about using technology in stroke rehabilitation?
|Picture above: The client pictured was preparing for floor play and crawling with her infant and at the beginning of the session, she was unable to maintain weight bearing without facilitation and assistance. Ferguson and Rakoski used an intervention utilizing neurodevelopmental treatment and massed intensive practice within the context of a task-oriented computer activity. The client is required to maintain weight bearing on a parallel switch in order to activate the touchscreen, and she completed over 30 minutes of dynamic weight bearing and completed more than 200 repetitions without facilitation.
You don't need to have a large expensive piece of equipment. Much of what we do is fairly low tech, just a simple touch screen or a switch. A lot of it comes down to your creativity. You're basically setting up the computer to have the client interact in a meaningful occupation—it could be a card game, hunting game, or fishing game—but you're working on a high number of repetitions and movement. You're getting the client engaged, which makes them work harder and longer. They have less fatigue and less pain. It doesn't have to be an expensive interface—it comes down to your creativity.
Ferguson: With technology being so pervasive, it's so much a part of our day. There aren't too many people who don't use technology. But even folks who don't use technology want to come into the computer lab. It's really interesting when they see what they can do and how it connects with what they want to be able to do, they come in.
AOTA: Why should occupational therapy practitioners attend the Stroke Specialty Conference?
Ferguson: It provides a great opportunity for focused learning experiences and to network with specialists in stroke rehabilitation.
Get information about Ferguson and Rakoski's session and register for the 2012 AOTA Specialty Conference—Adults with Stroke here.
Stephanie Yamkovenko is AOTA's staff writer.