17:12:43 Hello, thank you for having me here today.
17:12:46 My name is Carrie polar ski, and I'm a rehabilitation psychologist at the University of Michigan.
17:12:54 I served as the chief psychologist, for the spinal cord injury and complex medical rehabilitation units.
17:13:02 I also provide outpatient services, and help facilitate the Michigan medicines spinal cord injury virtual peer support group, my roles with disability advocacy have included work with them the American Psychological Association committee on disability
17:13:21 issues in psychology, serving a term from 2013 to 2015, and then again more recently in 2020.
17:13:30 Within the APA division of rehabilitation psychology. I helped to establish and co chair, a special interest group of psychologists with disabilities, which is currently the disability identity committee.
17:13:43 I serve as vice chair on the executive board for our local Center for Independent Living. And lastly, I proudly identify as having a physical disability.
17:13:52 And if you would meet me in person, you would see that I utilize a power scooter for mobility in the community.
17:14:01 It is this background. That brings me here today to talk about spinal cord injury clinical care and advocating for Disability Justice, during a pandemic.
17:14:15 My goals are to discuss some of the unique considerations for individuals with spinal cord injury and their care, identify ways to adjust care to meet physical and mental health needs during a pandemic.
17:14:26 And then lastly, identify action steps for advocacy and supporting Disability Justice
17:14:34 in a break the unique considerations down into a few categories. First is general care. Early in the pandemic services were reduced across the board to essential services and care needs so that people can isolate and stay home to limit contact for individuals
17:14:52 with spinal cord injuries reductions in routine care could have been even more challenging as they may often have received care on a more regular basis.
17:15:02 Furthermore, reductions and limited access to personal protective equipment, medical supplies, and medications were experienced by many, but compared to the general population.
17:15:15 Those with spinal cord injuries, may be more likely to need these supplies, and therefore we're disproportionately affected reductions and access to caregivers, or home care services.
17:15:30 Further impacted those with spinal cord injuries.
17:15:33 And all of these things combined likely increased fear and seeking services that were available, or even basic needs.
17:15:43 There's also increased vulnerability. For those with disabilities or spinal cord injuries, whether they resided in institutional setting or at home. They were unable to self isolate maintain the six feet distance between them and others, and sometimes
17:16:00 even difficulty wearing a mask.
17:16:03 Because of their, their disability, as well as their needs to have more contacts for their health care, and having people in and out, and increase contact with others.
17:16:16 The risks associated for those with spinal cord injuries. If they contract a coven 19 were awesome much greater because oftentimes they were already immuno compromised had greater risks associated with respiratory infections, and may have complications
17:16:33 with Mr delayed diagnosis, for reasons that their spinal cord injury may have masked or hidden, those concerns. If they had problems with temperature regulation or respiratory problems, missing symptoms of fevers, or cough that were early warning signs
17:16:51 of needing to be tested for covert 19.
17:16:56 Acute Care Services inpatient rehabilitation, or also impacted hospitals were overrun and there are bench shortages. Ultimately, needing to use some of the rehab services to help with those acute medical needs.
17:17:12 And so the result could be shorter inpatient rehabilitation admissions limited visitors and people being a lot of the hospital, reduced family or caregiver training.
17:17:25 Certainly, reduced care contact as already discussed by Tom therapists were limited and unable to provide homie valuations.
17:17:35 And then ultimately, patients discharge home with fewer follow up services and increase isolation, all of these things, resulting in a compound and stress and a negative impact on physical and mental health.
17:17:51 So in order to think about some of the adjustments that were needed.
17:17:56 It was gradually that some routine care services were able to be reestablished. And in that process.
17:18:04 A combination of determining services that needed to be in person, versus those that could be done, virtually took place, so that people can start to receive the care they needed in terms of inpatient rehabilitation.
17:18:17 Many adjustments were made that included virtual services.
17:18:23 Initially, rehabilitation psychology services were provided via telephone or using a tablet, with the support of rehab engineering. To set up those technology services and help connect the provider with a patient virtual services for included for the
17:18:42 educational group to include family in training, and also to connect patients with peer support.
17:18:50 Similarly on outpatient level, physical, mental health services and peer support resumed in many ways, utilizing virtual platforms.
17:19:04 In terms of covert care much needed to be learned. And oftentimes, advocacy for the needs of individuals with disabilities. If they needed to go to the hospital to receive Kovac care.
17:19:18 Many of our acute therapists, were called to serve in the coven care capacity. And there was a lot that was learned by including physical medicine and rehabilitation providers, physicians and psychologists to address the needs of those experiencing the
17:19:37 difficulties with isolation and needing to maintain their physical health, while receiving Copa care.
17:19:47 There were some pros and cons with many of these virtual transitions, many services, did not need to resume in person, which was a positive, and many can reach broader audiences.
17:19:59 So our support groups were now able to be received by people that wouldn't normally be able to travel to our local area, which was a definitely a positive.
17:20:10 But there's also many drawbacks of not having actual contact with people. And that many exists in health inequities were exacerbated by individuals who didn't have good use of technology, access to technology or connectivity, were further isolated and
17:20:28 limited in their services.
17:20:34 I worked along with several others, Erin Andrews, Kara Ayers Kathleen brown and Dana done to write an article titled nobody is expendable medical rationing and Disability Justice during the coven 19 pandemic.
17:20:50 And this article highlighted concerns with medical rationing and medical discrimination.
17:20:59 Medical rationing is the allocation of scarce resources, which necessarily entails holding potential beneficial treatments from some individuals because there's not enough supply to go around.
17:21:12 Medical discrimination takes place when there's discrimination or division of healthcare, which is based on disability, or even perceived quality of life.
17:21:21 And so that is disproportionately affecting, some people.
17:21:25 Early in the pandemic crisis care standards and triage protocols, a merge, that works Presley biased against disabled people, and included things like recommendations to reallocate ventilators from current users to meet the acute need for ventilators,
17:21:43 and many of these identify discriminations had to be addressed the Office of Health and Human Services opened investigations and warn against possible violations of Americans with Disabilities Act,
17:22:01 disability, activists and medical emphasis had to advocate for crisis triage protocols that did not unfairly disadvantage disabled people, some of the recommendations included things like focusing on near term prognosis, rather than subjective assessments
17:22:20 of longer term.
17:22:22 Longer term prognosis, or subjective determinations of quality of life.
17:22:28 Furthermore, encouraging health care facilities to make sure to adopt a transparent process to reduce bias, and decision making, procedures and processes.
17:22:41 It's also very important to recognize the advocacy should not fall, only on the individual with a disability or their support system, healthcare professionals must advocate in their communities and their health care systems.
17:22:55 Just a few ways to advocate and things to think about. Include making sure to advocate for Accessible education communication and sharing of information so that there are sign language interpreters closed captioning.
17:23:09 It is written in a way that is understandable also making sure that testing and vaccination sites are accessible.