Occupational Therapy and VENTure
Occupational therapists have a central role within the multidisciplinary team that
work with individuals who have suffered a high level spinal cord injury and are subsequently
dependent on mechanical ventilation. As a team member occupational therapists will
focus on maintaining joint integrity of the upper extremities from the shoulder to
the digits. This is done by applying passive range of motion exercises and arranging
for a home exercise program for the family to carry over after they leave their long
term hospital care. Occupational therapist can fabricate splinting devices for positioning
and prevention of joint contractures. A communication method or device can be created
to allow for expression of the client’s needs. Occupational therapists play a key
role in wheel chair management with implementation of mobilization devices and appropriate
equipment for positioning and sizing, such as control units, custom seating systems
and head supports. Cognitive and visual perceptual training can be done for those
who have suffered a possible traumatic brain injury with their spinal cord injury.
Obtaining durable medical equipment for discharge from long term care to within the
home, such as bath and shower commodes, hoya lifts, and air mattresses to avoid pressure
sores. Devices can be installed on the wheel chair that will enable mobilization of
the chair or for possible access to the use of computers and keyboards, such as voice
activated programs or joy sticks that are controlled with the tongue.
The Venture Think Tank has allowed the opportunity for an occupational therapist to
work on their team. This organization is in the process of creating advocacy policies
that will address the needs of individuals who use ventilators for survival. Various
aspects of technology are being researched with the idea of creating a system that
will allow for better communication to outside industries and companies that are detrimental
to the survival of this population during catastrophic times. An occupational therapist
can help in taking a role as an advocate for this population; implementing the devices
so that they are accessible and ergonomically situated and positioned on their chairs;
and assist in reaching out to the community in encouraging awareness of priorities
for this population.
Physical Therapy and VENTure
Susan Miale, PT, DPT, PCS, Stony Brook University
Physical therapists (PTs) work directly with patients who are dependent on mechanical
ventilation in various settings across the lifespan. PTs in the hospital setting work
with the multidisciplinary team to mobilize patients on mechanical ventilation and
assist in weaning from the ventilator as appropriate. PTs assist with positioning,
handling, and developmental stimulation of pre-term infants on mechanical ventilation
in the neonatal intensive care unit. PTs help improve functional mobility, strength,
flexibility, physical fitness, and quality of life of children and adolescents who
are dependent on mechanical ventilation through various therapeutic handling techniques,
therapeutic exercise, play-based interventions, use of adaptive equipment, and patient
and family education. For adults, PTs provide manual therapy, strengthening exercises,
postural and balance activities and functional mobility training to improve overall
function and quality of life. PTs also perform airway clearance and respiratory muscle
training for both children and adults as appropriate. Most importantly, PTs act as
an advocate for their patients to ensure that they have the highest quality of life
possible.
The VENTure Think Tank has afforded physical therapists the opportunity to advocate
for patients dependent on mechanical ventilation in a much more global way. PTs work
with the team to brainstorm about social policies and procedures that will ensure
and enhance the quality of life of this population. PTs possess knowledge of body
systems and how these systems can be impacted by adverse events like disease, disability,
stress, and environmental factors. PTs also use their specific skill set to provide
information about how certain strategies can impact this population in terms of physical
abilities and overall functional mobility. For example, PTs have provided information
regarding the need to minimize exposure to airborne pathogens in the event of an emergency
evacuation because of the risk of airway compromise and decline in respiratory muscle
function.
Respiratory Therapy and VENTure
Respiratory therapists are health care professionals whose responsibilities include
patient assessment, disease management, diagnostic evaluation, disease management,
patient and family education, heart and lung rehabilitation and care of patients with
deficiencies and abnormalities involving the heart and lung systems. Their scope of
practice involves the use of physician prescribed protocols and the use of technology
to treat patients with heart and lung diseases in hospitals, medical clinics, physician's
office, nursing homes, heart and lung rehabilitation facilities and home care. Their
responsibilities can include the interpretation of physiological data such as arterial
blood gases, sleep studies, pulmonary function testing, caring for patients on life
supporting mechanical ventilation, the administration of medications, monitoring lung
and heart function, providing therapy to patients with sleep disorders such as obstructive
sleep apnea, providing rehabilitation for patients with lung and heart disorders,
treating patients with medical gases such as oxygen therapy for heart and lung diseases.
The role of the respiratory therapist in participating in the VENTure Think Tank Project
at Stony Brook University School of Health Technology and Management is to provide
the necessary clinical skills and expertise to help with carrying out this project.
The primary area of responsibility includes topics on chronic mechanical ventilation
management, hemodynamic monitoring, EKG interpretations, treatment of cardiac arrhythmias,
cardiopulmonary pathologies and cardiopulmonary pharmacology. The respiratory therapist
should be able to promote a clear understanding of the fundamental differences and
uniquely compromised position that ventilator-dependent paralyzed individual's experience.
The respiratory therapist will help to influence policy and develop technology that
helps resolve many issues surrounding ventilator-dependent individuals who have sustained
the need for long-term ventilator care. Finally, the respiratory therapist should
become a strong advocate for the ventilator-dependent individual by helping to promote
a clear understanding of the disease process, medical therapies in treating the individual
and to make the public aware of the concerns of this community. Along with other healthcare
professionals we must educate the public concerning this community of ventilator-dependent
individuals and explain to the public how extraordinarily gifted these individuals
can be if given the chance.
Complex Rehab Equipment and VENTure
J. Gregg Blanchard, ATP, CRTS; Hudson Seating and Mobility
The wheelchair and support system for ventilator client . Specialized seating allows
for proper posture, head control, allows for independent movement and communication.
Considerations are made on what limitations have to be overcome in order to fulfill
the needs of the individual. Access to drive control, independent seating functions,
computer access and environmental control are all part of the picture. A compact,
integrated, fully functioning system that fits the users environment is the goal of
the assistive technology professional.
Gregg is a seating and mobility specialist who has been supplying complex rehab to Long island and the New York metropolitan areas for decades. His knowledge and experience have been a valuable asset. As an ATP (Assistive Technology Professional), Gregg analyzies the needs of consumers with disabilities, assists in the selection of appropriate assistive technology for the consumer’s needs, and provides training in the use of the selected device(s).
