Group 1 – Ian Swain, Geraldine Mann, Diane Whitham, Ann-Marie Hughes

What is an AT -Assistive equipment for which a rehabilitation programme is set up to provide, establish and manage maintenance. -Products aimed at having a rehabilitative effect not a simple device to achieve a given function. -To improve motor control and have a ‘carry over’ effect not just an ‘orthotic’ effect. Dynamic Orthotics -Lycra -CCD -Saebo flex & similar products -(Multiple effects) -ROM-Biomech reducing impairment Reduce Spasticity BoTox Robots -Reduce impairment – shoulder and elbow -Movement, strength FES -Reduced Spasticity – muscle strength Biofeedback – muscle control C Mitt - Increase usage

Complimentary 1.Sub divide into Hand & Arm 2.Different effects -Only Dynamic Orthotics can be a mutually exclusive group -The rest all stand on their own 3. CMIT - May use with other ATs at the same time 4. Sequential - Use 1 early rehabilitation - Use 2 ongoing - Short term i.e. daily

Hand Acute Sub-acute Chronic A B C 4/52 4/52 – 6/12 > 6/12 Arm A B C 4/52 4/52 – 6/12 > 6/12 Severity - Based on MRC scales? - Measure – MRC - Jebsen - ARAT - Fugl-Myer - Spasticity Produce Matrix on each AT. A. -Treatment duration and frequency -Inherent cost -Acceptability Hand Movement Key What ? AW 23 Beds (Rehab) 60% Complex Strokes 2 professions 51/7 length of stay ≈ p.a. 600 new CVA p.a. 1/3 inpatient >1/12

Group 2 – Damian Jenkinson, Duncan Wood, Sara Demain, David Turner

WP1 Current Practice WP2 Literature Review WP3 Barriers to use ? Informing decision -? ‘outcomes’ Using results from trial – into practice. -ED population, cost, access… WP4 Design AT2AT1 Cost – indicative only AT: Delete or Alter rank PT Generated criteria – Non prescriptive WP3 Document Decisions Year 2 RPT WT/EXT PCT, DH, Steering group

Defining AT PRODUCT SERVICE ‘Enabling Independence’‘Learning’ ADL Broadens Exclusion Criteria? (Specific Task) ? Recovery

WP2 a -Clinical Effectiveness b c ‘Outcomes’ -Meta-Analysis Authors -Indicative Outcomes to Health Econ/QUALI e.g. persons delivering Tx - Population (for example)

Group 3 – Anand Pandyan, Gabrielle McHugh, Paul Chappell, Caroline Ellis-Hill

What is AT Effect should not be transient (e.g. spoon, wheelchair) [Assistive Device] Active vs Passive

How to select WP1 – current NHS practice WP2 – literature review (current ongoing research) WP3 – User needs & views (Patient, Clinicians & Budget holders) WP3 are practical issues with respect to UL AT… WP1 what are they doing and why (w.r.t. UL) What can be done for the “WP1-Why” from WP2 and how does that match with “WP3-want” Consensus way forward (taking on board other ongoing research)

WP2 Model WP1WP3

Design AT1 AT2 AT1 AT2

Group 4 – Jane Burridge, Garth Johnson, Sybil Farmer

ATs for RCT Questions Suppliers input & moderated by evidence Who with? How long for? How much When Cost How measure? WP2 Evidence

Evidence for efficacy WP2 = strongest WP1 + WP3 = less strong Impairments (Various) Functions QOL Measures Acceptability Baseline for comparison WP3 = Strongest WP1

WP2 Include prevalence and co-variance Prevalence of Problem function Impairment Spasticity Weakness Motor control Contracting Co-variance? Sample for RCT

Typical PT AT1 (CIMT) AT2 (FES) AT3 (ROBOT) Impairments Weakness User Preferences Cost Weight the factor Percentage of patients with that problem Strength of each interaction