At USAHS, we pride ourselves on our culture of innovation and our faculty’s disciplined, creative experimentation with new ideas and technologies. During the Fall 2020 trimester, assistant professor Jennie DiGrado, OTD, OTR/L, C/NDT, led occupational therapy students from our San Marcos, California, campus in a pilot project that used robotics as a way to connect virtually with patients.
Dr. DiGrado teaches Clinical Applications in Gerontology, a required course for both the Master of Occupational Therapy (MOT) and the Doctor of Occupational Therapy (OTD) programs. In normal times, students in the course do onsite fieldwork at locations including La Fuente, a skilled nursing facility in nearby Vista. But when COVID-19 shutdowns meant that students could not enter the facility, Dr. DiGrado wanted to continue engaging with the residents to ease their sense of isolation. And she needed to brainstorm virtual fieldwork alternatives so her students could get the hours they need to advance toward graduation.
Dr. DiGrado took her conundrum and some preliminary ideas to the University’s Innovation Steering Committee (ISC), led by Maria Puzziferro, PhD (Dean of Digital Learning and Innovation) and Dr. Elisabeth McGee, DPT, MOT, OTR/L. Drs. Puzziferro and McGee suggested that students use the Double robot to communicate with residents of La Fuente. “It was a great idea,” Dr. DiGrado says. The ISC approved this concept as a pilot project and granted funding to make it happen.
The Robot Provides a Human Analog in Virtual Times
All USAHS campuses are equipped with one telepresence robot from Double Robotics. The Double robots enable a remote healthcare worker to communicate with a patient through a moveable robot equipped with an iPad. In this case, the occupational therapy students would be able to maneuver the robot to interact with individual residents of La Fuente. The residents would see the student’s face on the iPad, a close analog to a human presence.
For technical help, Dr. DiGrado collaborated with Jarid Grier and Victoria Wolfe, clinical simulations experts who manage the San Marcos Center for Innovative Clinical Practice (CICP). Exploring options for compliance with HIPAA (for patient privacy) and FERPA (for student privacy), Grier and Wolfe discovered they could generate a one-time link on the robot so that a session could not be reused. They also figured out how six people (five students plus Dr. DiGrado) could log on to the robot at one time.
Meanwhile, the resident would see only one face—that of the student who was controlling the robot. In training sessions, groups of students practiced logging into the system and moving the robots. “A lot of students were a bit intimidated at first,” Grier says. “But when they saw how easy it was, they did a complete 180 in their attitude.”
The robot relies on strong WiFi connections, so USAHS IT staff spoke with La Fuente IT staff to plan the best locations for patient interactions to avoid signal drop. La Fuente named their robot “Wall-E” after the robot in the Pixar movie, and Wall-E is housed at La Fuente.
Easing Isolation Through Group Creative Activities
As part of their fieldwork experience, each student had a chance to plan a group activity for the residents, determine how to grade the activity for group participants with varying levels of cognitive abilities, and use the Double robot technology to facilitate a group session with the participants. In the process, students also practiced communicating with the interprofessional team at La Fuente.
Third-term OTD student Cortney Yap facilitated a session just before Halloween. She led a conversation where participants shared their favorite Halloween memories. Her group of five students also guided participants in playing “I Spy” and making skeleton masks. “Working with the Double robot was really cool,” Yap says. “It was more personal being able to move ourselves [via the robot] throughout the room instead of relying on a worker to position and reposition a computer screen.” In other sessions, participants danced to Michael Jackson’s “Thriller,” painted pumpkins, made holiday-themed crafts and played several different games.
“With the robot, you can be right next to the client,” says Dr. DiGrado. “You can look over their shoulder at their art and move between each person. It feels like you’re there.” Students learned not to roll Wall-E too much (because it’s distracting and the WiFi can drop), but to focus on rotating the tablet to make sure it was at eye level with the group participants.
Many of La Fuente’s residents had been feeling isolated. Since the pandemic began, they’ve had limited ability to leave their rooms and engage in activities that would normally be scheduled at the facility. Many have been unable to see family members or friends for months. “They were grateful for this connection,” Dr. DiGrado says. “The La Fuente staff was grateful as well. And the students loved it. They said it was an extremely valuable experience for them.”
In a survey of students in this course, 97.3% agreed that this project gave them a good understanding of telemedicine and how it works. 92.9% felt comfortable using the technology. One student wrote, “This fieldwork experience has proven to me that there are solutions to environmental and contextual barriers of older adults. I am so humbled to have had this opportunity to work with a few residents at La Fuente. This is a session I will never forget.”
This program is continuing through the Spring trimester. There is also potential for continued growth of using the Double robot post-COVID: For example, the robot could go into clients’ homes, so that students could gain insight into the living environment and make suggestions about improvements. Students could also use the Double robot to conduct occupational profiles with clients in other facilities and to collaborate with facility staff.
“It was great being able to work with technology that might become more popular as telehealth continues to grow in our profession,” Yap says. “It is definitely an adjustment to switch from in-person therapy to telehealth, but I’m so thankful to be introduced to it during school so that I am prepared in the future.”
About Our Entry-Level Occupational Therapy Programs
The University of St. Augustine for Health Sciences (USAHS) offers hands-on Master of Occupational Therapy (MOT) and Doctor of Occupational Therapy (OTD) degrees. Join a collaborative cohort of peers who learn under the mentorship of expert faculty-practitioners. Practice with mock patients in our state-of-the-art simulation centers and learn anatomy with our high-tech tools. Prepare for clinical practice with patients across the lifespan, as well as advanced roles in research, practice leadership, and policymaking. Residential (online/weekday labs) and Flex (online/weekend labs) paths are available.