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Pilot Program at Memphis VA Promises Patients Greater Autonomy after Spinal-Cord Injuries

by U.S. Medicine

March 12, 2012

By Annette M. Boyle

MEMPHIS, TN — A pilot program in Memphis is bringing VA closer to meeting what perhaps is the greatest desire for its 42,000 veterans with spinal-cord injuries and disorders: more control of their environment.

This month, VA Memphis will roll out the “autonoME” environmental control unit (ECU) from Accessibility Services Inc., which will enable that spinal-cord unit’s 60 patients to do things such as adjust their beds, call a nurse, use the Internet, select music and make phone calls, even if they can only move their eyes.

spinal_cordwheelchair1.jpg

As one of the winning programs in the 2011 competition, the environmental-control pilot received funding through the VA Employee Innovation initiative.

According to Charles Brown, director of the VHA Innovation Program, the equipment being tested in Memphis is much more sophisticated than current controls. “Because the equipment can be calibrated for facial recognition, a patient can actually activate and read e-mail, select a TV channel, play a game or select an educational review, just by eye movement,” he said. “If they can just raise their eyebrows, it can track that.”

“We wanted to give our patients more control. Our spinal-cord patients have gone and fought for our country and come back with these terrible injuries. It’s a terrible thing to lie on the bed and not be able to control any aspect of your surroundings. It’s just not good care,” added Sheena House, chief bio-medical engineer at the Memphis VA Medical Center. For five years, House had sought a way to enable veterans with severe spinal cord injuries (SCI) to better control their environment.

While some sophisticated equipment existed for home use, no manufacturer had tackled the challenges of hospitals using different types of beds, a variety of televisions and a range of patient capabilities, according to House. “We had contacted a number of vendors, and no one was willing to tackle the challenges in a hospital environment. We had decided to just get better cabling to make our existing units work more efficiently. The Tampa VA Spinal Cord Unit referred us to Accessibility Services for the cabling, but when they saw our true need, they did everything that we wanted and more.”

The autonoME units offer a variety of ways for SCI patients to interact with the system, including voice activation, sip-and-puff straw usage, head-tracking, eye-pupil movement and single/dual switches. For those with more capability, the devices also have touchscreens.           “Sheena wanted a system that allowed vets to control their environment. We thought we could enable them to compute with the same equipment. The unit we developed collaboratively withAssistive Technology Solutions, AM Communications and the Memphis VA allows patients to make adjustments in the room and also get online, send e-mails, use Skype, access Kindle readers and play simple games like chess and solitaire. If they are nonvocal, an integrated augmentative communications device allows them to talk to their physicians, family and friends. The unit takes them into the 21st century,” says Fred Thompson, commercial relations manager at Accessibility Services, based in Florida.


Sample autonoME screen. – Photo courtesy of Accessibility Services Inc.

House and Cathlene Wall, a biomedical equipment support specialist at the Memphis VA, talked to patients and nurses to determine patient needs, identify current challenges and work with the development team to create a device that would work with existing equipment and constraints. Most importantly, the team “wanted to give patients a sense of independence during their stay in the hospital. Controlling our surrounding is so basic for us, but it’s a huge thing for them. It’s also a big safety issue here. We want them to be able to call the nurses when they need to. The device restores some of the independence and control they used to have and lost through their injuries,” House explained.

Pilot Program at Memphis VA Promises Patients Greater Autonomy after Spinal-Cord Injuries

At the same time, the Memphis VA team expects the units to enable nursing staff to spend more time providing clinical care, rather than changing television channels and adjusting beds. For other clinical staff, the augmentative communications technology might lead to a higher level of care and more targeted counseling.

“Once we had a product that we thought could work, we put in the proposal with the innovations program to receive grant money to try to implement it here,” said House. “It’s never been implemented anywhere else before — we’re the first hospital in the public or private sector that has a device like this.”

The need resonated with VHA employees, who voted for the program in the Innovation selection process, and among national leaders.

“We’re looking forward to making advances in this area for our returning servicemembers,” Brown said. “It’s very critical that we take care of those that are in such great need. We’re excited about the possibility that this innovation can increase the ability for those veterans that are severely disabled to be able to communicate with the real world.”

Interest in the autonoME unit has been significant within the VA and beyond. Thompson has shown the device at a number of fairs, which generated calls from several VA Spinal Cord Units. Private hospitals and the Paralyzed Veterans of America also have been eager to learn more about the system, he said.

“I promised [House] that the Memphis VA would be the first. Others will have to wait until we have this program up and running,” Thompson noted.

In addition to seeing the units in place in the 24 VA Spinal Injury centers around the country, the team is keen to enable veterans to use autonoME devices once they go home. In the Memphis Spinal Cord Unit, about 40 beds are used by patients who come in for a week for annual evaluations. The rest of the units are devoted to veterans who may stay substantially longer.

“We have around five ventilated patients who are may be here for a year or two and others who may stay six months,” said Prabhakaran Nambiar, MD, clinical lead for the project and chief of the Memphis VA Spinal Cord Injury service. “Quality-of-life issues are very important for these patients. This equipment enables them to do most of the things they would like to do in life. We would like to develop it so the unit could also be fitted onto wheelchairs, so they would have the same abilities when mobile,” whether at the VA or elsewhere. Regardless of how long they are in the unit, patients “can get better and return home, so we would like to get some of these things adapted so they can have the same equipment,” Nambiar said.

“Our goal is to make the transition as seamless as possible for the patients,” added House. “They come in, they use the equipment, they become used to it, they understand how it functions, and then we send them home with it so that they have the same access there as well. Accessibility Services is waiting for us to work out the details with some of our prosthetics and the details of training.”

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