Assistive Technology and Functional Outcomes Following Spinal Cord Injury
Abstract
Background: Assistive technology (AT) helps people with physical disabilities, such as spinal cord injury (SCI), compensate for functional limitations such as fine hand and finger movement. Many AT systems have been developed to enable individuals with physical disabilities to use computers and smartphones more easily. AT includes aides such as voice recognition software, sip-and-puff devices, mouth sticks, head devices, adapted mouse controls, and specialized wrist or arm devices. Unfortunately, access to having and using many of these devices for people with SCI can be difficult because of financial constraints that limit the ability to purchase the devices and/or Internet service, as well as functional impairments that make controlling the device difficult. Research problem: Although AT, specifically computer and smartphone equipment and the hardware and software devices that make these more usable, is routinely prescribed for individuals with tetraplegia while they are in rehabilitation programs, we have limited evidence about the impact of AT on functional outcomes, such as employment and community reintegration, or the impact on psychosocial outcomes, such as self-efficacy or quality of life. The aims of this study will be addressed through both a qualitative and quantitative methodology. We will conduct focus groups to examine barriers to or facilitators of AT access and use from the perspective of individuals with tetraplegia and how these barriers/facilitators impact functional and psychosocial outcomes. We will then survey approximately 300 individuals with tetraplegia (150 Veterans and 150 civilians) to identify variations in use of AT across insurance providers and socioeconomic status. We will also assess the relationship between AT use and productivity (employment/school) in Veterans and civilians with tetraplegia. We will determine if those who have access to and use AT have higher rates of paid employment than those without access to or use of AT. Finally, we will assess the relationship between AT and psychosocial outcomes (e.g., mood, self-efficacy) in Veterans and civilians with tetraplegia. Study design: The proposed study will employ a mixed-methods approach to achieve the specific aims. To develop an in-depth understanding of the barriers and facilitators to AT access and utilization, semi-structured focus groups of 5 to 7 participants per group will be conducted at a U.S. Department of Veterans Affairs (VA) medical center in the midwestern United States and at a private, non-profit rehabilitation hospital in the western United States. We will then collect data from 150 participants from each of the two study sites via telephone interviews. In addition to demographic and injury-related information, data will be collected on the psychosocial impact of assistive devices, productivity (i.e., employment, school work), mood, self-efficacy, quality of life, perceived manageability of needs, and societal participation. Impact: We anticipate that the findings from this study will help guide the development of future interventions that assess the impact of AT on employment, mood, and community integration for Veterans with tetraplegia. Additionally, the information generated from this study will be critical to inform future policy, clinical practice, and reimbursement standards for AT for both Veterans and civilians with SCI. Military relevance: There are an estimated 100,000 American Veterans with spinal cord injury or disease. The incidence of SCI has increased significantly and is expected to continue to rise with modernized combat and the use of unconventional war tactics. Veterans with SCI who desire to return to school or the workforce will require access to AT. This study will identify barriers that Veterans encounter when attempting to gain access to AT and help formulate interventions or policy change to enhance access.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Oct 29, 2018
- Source ID
- W81XWH1810806
Entities
People
- Kimberley Monden
Organizations
- Craig Hospital
- United States Army