the BRAIN - Shepherd Center

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AssistiveTechnologyFeature Photo by Gary Meek Edge with appropriate Shepherd patients to see how it can help them and then determine if it’s an affordable solution for them. Results elsewhere indicate there is reason to be optimistic, John notes. Eyegaze Edge appears to be a promising piece of technology for improving patients’ quality of life and restoring some of their independence. Eye Control Shepherd’s Assistive Technology Center evaluates vision-based communication and control system for patients who cannot speak. By Bill Sanders Shepherd Center patient Julius Singleton struggled a bit the first time he stared at a computer screen and tried to type out his name, using nothing but his eyes. But, with a little practice using a vision-based communication and control technology called Eyegaze Edge, Julius, a college professor from Burnsville, W.Va., made progress. “This technology has the potential to transform the lives of quadriplegics whose high-level injuries make it difficult for them to speak and communicate,” says John Anschutz, director of the Assistive Technology Center at Shepherd Center. The technology, developed by LC Technologies Inc., gives users numerous functions including: speech generation, environmental control (lights, appliances), typing, and running both mouse- and keyboardcontrolled applications on the company’s Edge screen. Also, the Edge can serve as a keyboard and mouse interface for a user’s own computer. Users make selections by looking at boxes or “keys” displayed on the Edge screen. The system uses a pupil-center/corneal-reflection method to determine where a user is looking on the screen. An infrared-sensitive video camera, mounted beneath the system’s screen, takes 60 pictures per second of the user’s eye. The Edge calculates the person’s gazepoint (i.e., the coordinates of where he is looking on the screen) based on the relative positions of the pupil center and corneal reflection within the video image of the eye. The technology isn’t new to the market, but it’s new to Shepherd Center and its patient population. Ruth Fierman, an occupational therapist in the Assistive Technology Center, is testing the Eyegaze If Ruth determines there is potential for the Eyegaze Edge system to be a good match for a patient, one of Shepherd’s speech and language pathology therapists determines if the system will provide efficient communication for the patient. As a technology demonstration with Julius shows, Eyegaze requires practice. Users must learn how to focus on a letter or statement, such as “I am thirsty,” for the right amount of time. “It can be intimidating until you are familiar with it,” John says. “Once they get the hang of it, though, they want us to speed it up.” Physicians expect Julius to regain his voice, but some other high-level quadriplegics do not regain that function. And if they are unable to use a mouse stick in their mouth, they have virtually no ability to communicate, John notes. So Eyegaze Edge appears to be a promising technology for improving patients’ quality of life and restoring some of their independence. “If someone can’t communicate at all, it is amazingly frustrating for that person,” John explains. “So, once we finish evaluating the Eyegaze Edge system we have at Shepherd now, we hope to get some funding through grants to help more people. The price of these units has come down from about $18,000 to $9,000, so we hope, in time, that we can get them into some homes of people who need them.” Above: Ruth Fierman, center, an occupational therapist in Shepherd Center's Assistive Technology Center (ATC), evaluates whether the Eyegaze Edge system is appropriate for quadriplegics who have lost use of their voice. John Anschutz, manager of the ATC, assists with a demonstration for patient Julius Singleton of Burnsville, W. Va. Photo by Gary Meek 1 4 Spinal Column w w w. s h e p h e r d . o r g
OutreachFeature Building Professional Relationships Shepherd Center emphasizes outreach to referring facilities and physicians. By Kayla Eubanks The Shepherd Center Marketing and Public Relations departments have teamed up to create a special outreach plan to the hundreds of referring facilities and physicians who work with the hospital each year. To build better relationships and improve communications, the team created new strategies to effectively communicate news at Shepherd and update referring physicians on how their patients are doing in rehabilitation, explains Mitch Fillhaber, vice president of marketing and managed care. The goal is to improve access to Shepherd Center physicians for the trauma physicians and neurosurgeons who initiate life-saving interventions at the facilities that refer patients to Shepherd. Fillhaber outlines the details of the plan: MD-to-MD Communication As part of the new plan, Shepherd Center doctors call referring physicians to provide insight into their patient’s transition and rehabilitation plan following admission. Although most physicians already call the referring hospital or physician once a patient has arrived, Shepherd created an internal standard to ensure that this happens regularly. If a patient is admitted to the ICU, the admitting physician will contact the referring physician within 24 hours to confirm the patient arrived. The physician also will provide information on the patient’s medical status and immediate plan of care. If a patient is admitted on a Friday, the referring physician will be contacted by Monday. For acute rehabilitation patients, the standard is to call the referring physician within 24 hours of the first team meeting, which is typically held during the patient’s first week at Shepherd. Team meetings involve the patient’s physician, case manager, therapists and nurses. The team discusses the patient’s plan of care, including anticipated therapies and any medical issues the patient may be having. Referring physicians will be told the medical status, care plan and anticipated length of stay. Enhancing Discharge Summaries Another way Shepherd Center is intent on improving its direct communication with outside physicians is through enhanced Above: Shepherd Center physicians, including Medical Director Donald Peck Leslie, M.D., call referring physicians to provide insight into their patient’s transition and rehabilitation plan following admission. information in its discharge summaries. The hospital’s 13 admissions liaisons have been meeting with referring physicians from trauma centers to determine what additional information would be beneficial for them to have in anticipation of serving patients upon their return to the community. New Newsletters Shepherd Center also will be expanding its physician publications to include two new newsletters that will complement Consulting Physician, a newsletter the hospital started earlier this year. The two new bi-annual newsletters include one written for neurosurgeons and trauma physicians and the other for physiatrists. The newsletters provide information on hospital practices, ICU processes, research trials, continuing education opportunities and more. The first issue of Consulting Physician is available at www.shepherd.org/ publications. The others are under development. Photo and Video Updates A great way to understand Shepherd Center practices is to see firsthand how a patient is improving. For a visual update, referring facilities can receive a photo or video of their former patient. Photos are taken during therapy sessions to demonstrate something the patient is working to improve, such as lifting their arms or writing their name. The photos also give the patient an opportunity to say thank you to the referring team. Video updates include recorded messages from the patient, his or her physician and sometimes even family members. It shows the patient in multiple therapy sessions and tells the story of their recovery since arriving at Shepherd. The admissions team can take these to referring hospitals when they visit to show physicians and case managers how their prior referrals improved. Photo by Gary Meek Fall 2009 1 5
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