Bridging the Gap Between Research and Practice: Acute Intermittent Hypoxia Kendall King OTD | Doctor of Occupational Therapy | Huntington University

Project Description

Acute intermittent hypoxia is a treatment in which patients undergo brief periods of breathing at low oxygen levels. This treatment has been known to create a response of spinal motor plasticity resulting in improvements in respiratory and non-respiratory functions. As we know, patients who have undergone neurophysiological traumas are left in states of depleted motor and sensory function. Research shows that the use of acute intermittent hypoxia is a beneficial treatment to be applied to patients with spinal cord injuries in order to improve physical function. Research has also shown that the synergistic use of AIH treatment and task-specific training has improved overall function among members of this population.

The purpose of this project is to facilitate the use of intermittent hypoxia as a treatment modality option for those recovering from spinal cord injuries and other various neurological traumas. My intent is to educate practitioners on the efficacy of this treatment option in order to advocate for its use in rehabilitation settings within the Parkview system. My plan is to educate and advocate to current practitioners on this treatment through the development of educational resources, such as handouts, info graphs, and furthermore disseminating a comprehensive presentation on AIH to be presented to the inpatient rehabilitation therapists (OT/PT) at Parkview Randalia Fort Wayne.

Needs Assessment

The student created and disseminated an online survey to be sent out to Parkview Randalia inpatient and outpatient OT/PT rehabilitation practitioners to gather baseline understanding of AIH treatment. Recipients of the survey were given exactly one week to complete the survey.

Respondents had the choice to answer “yes” or “no” to gauge if they had ever heard of the treatment. Following this, if answered “yes” to question of “have you ever heard of acute intermittent hypoxia treat?” Respondents explained their understanding in a short answer.

Of the respondents, 85..7% of respondents answered to never hearing what acute intermittent hypoxia treatment is, and 100% had answered “no” to whether they had ever used the system of not. However, 100% of the respondents answered “yes” to wanting to learn more about the acute intermittent hypoxia treatment system.

Prioritization of Needs: Lack of awareness of AIH treatment among Parkview neuro-rehabilitation practitioners.

Why does the need persist?

Acute intermittent hypoxia is a supplemental modality that produces various proliferating benefits to the human body that can aid in the rehabilitation process of an individual suffering from neurological trauma and deficits. Results are seen very quickly when AIH is used in conjunction with occupational therapy and/or physical therapy. The topic of AIH is widely researched. However, therapists do not widely practice it. Advocacy for this modality is needed to increase its usage and improve the neurorehabilitation process.

Avoiding the rehab potential for the neuro population where improvements can be made will result in:

• Failing to serve the neurorehabilitation population
• Failing to educate current practitioners on the topic of AIH to incorporate into their current practice

Literature Review

Acute intermittent hypoxia (AIH) is a modality in which patients undergo brief periods of low inspiration levels of oxygen. This treatment is known to create a response of spinal motor plasticity resulting in improved respiratory and non-respiratory functions. As we know, patients who have undergone a spinal cord injury reside in states of depleted motor and sensory function. Research shows that acute intermittent hypoxia is a beneficial treatment for patients with spinal cord injuries to improve physical function.

Among spinal cord injury patients, studies have shown that AIH is most effective when paired with a motor activity. This pairing facilitates the increase in spinal plasticity.

Research shows that exposure to brief periods of hypoxia facilitates the release of serotonin among serotonergic neurons in various parts of the spinal cord. Previous research on anesthetized cats shows that a large amount of serotonin is released within the brain, as well as during AIH administration. Furthermore, evidence shows that serotonin is also released within the caudal raphe spinal cord region, as shown by research on anesthetized rats.

Areas of Focus

• Advocacy
• Education
• Clinical Practice

Target Population

Primary Site

Parkview Randalia in Fort Waye, Indiana.

While at this site, the student completed observation hours, alongside the project expert mentor, physical therapists, and occupational therapists. This site supported this project by providing the student with clinical experience and various resources to support this project

Mission Statement

Advocate to local rehabilitation facilities about the benefits of using AIH during the recovery of patients in the neurorehabilitation population, in order to maximize the progress gained during treatment sessions with the use of AIH products.

Project Leader

Kendall King, OTD

The duties of the project leader were to engage evaluation plan with the bi-weekly consultations with faculty mentor and expert mentor. The student is also required to communicate project needs and access to mentored practice setting.

• Meet all outcome measures by deadlines
• Produce doctoral level deliverables
• Stay organized
• Meet with expert mentor and faculty mentor bi-weekly
• Remain mindful of ethical considerations throughput project

Mentors

Expert Mentor: Justin Shaffer, DPT

The expert mentor may assist and monitor the student with design of capstone project individualized goals/objectives prior to signing the learning contract. The expert mentor worked in conjunction with the student, DCC, and the faculty mentor to finalize the student's individualized learning contract to demonstrate the synthesis and application of knowledge gained. The expert mentor reviewed the mission/vision statement, purpose, goals/objectives, and deliverables, and monitored successful completion through the formalized evaluation mechanisms. Prior to beginning the DCE, the expert mentor may be instrumental in the completion of an MOU between the University and a project site. Any additional requirements from the project site or Human Resources need to be communicated to the student.

Faculty Mentor: Jill Linder, OTR

A faculty mentor with expertise in the student's focus area will provide ongoing mentorship to ensure the student's adherence to the learning contract throughout the duration of the DCE, thus remaining compliant with the 2018 ACOTE Standards. The faculty mentor worked in conjunction with the student, DCC, and the expert mentor to finalize the student's individualized learning contract to demonstrate the synthesis and application of knowledge gained. The faculty mentor reviewed the mission/vision statement, purpose, goals/objectives, and deliverables, and monitored successful completion through the formalized evaluation mechanisms. During the DCE, the faculty mentor consultations within the evaluation plan should involve discussion on various issues/barriers encountered during the planning and/or implementation of the experience.

Outcomes

• The student will disseminate needs assessment on AIH treatment use among neurorehabilitation therapists at Capstone site, through the creation and completion of an inventory survey.
• The student will complete observation hours and compile educational resources to increase awareness and education about the treatment.
• The student will present on the risks and benefits of the AIH approach through the presentation and dissemination of information to practitioners to advocate for this treatment option.
• The student will write a grant manuscript appropriate for the securing funds for AIH programming within the community.

Deliverables

• Parkview knowledge inventory survey
• Parkview AIH Needs Assessment for primary site for knowledge of AIH modality
• Budgetary plan for AIH system acquisition for primary site location
• Best practice educational handout for practitioners to be given out during presentation
• Acute intermittent hypoxia educational handout for Parkview Randalia Inpatient Rehabilitation floor
• Best practice clinical infograph
• Grant manuscript
• Comprehensive presentation for primary capstone site

Deliverable #1: Parkview Knowledge Inventory Survey

Deliverable #2: Parkview AIH Needs Assessment

Deliverable #3: Budgetary Plan

Advocacy

To advocate for the implementation of the acute intermittent hypoxia system within the Parkview Randalia Rehabilitation Unit, a comprehensive presentation was created to be presented to the physical and occupational therapists on this floor. This presentation summarizes the components of the system, risks, benefits, best practice guidelines, and overall efficacy of the modality use.

Education

In order to educate the rehabilitation practitioners at Parkview Randalia on the efficacy of the acute intermittent hypoxia modality, the student created an educational handout to be placed in each office on the inpatient rehabilitation floor. The student also created a best practice guideline infographic to educate practitioners on how acute intermittent hypoxia could be used within a therapy session. Lastly, the student created a best practice guideline handout to be disseminated during the student's presentation.

Clinical Practice

Along with the observation hours completed, the student utilized the information gained at Parkview Randalia and The Shirley Ryan Ability Lab to create a best practice guideline infograph to educate practitioners on how to appropriately incorporate acute intermittent hypoxia into a therapy session.

Reflection

This Capstone experience encouraged and facilitated personal and professional growth for myself. I was able to implement and improve my interprofessional communication skills by having the opportunity to communicate with various healthcare professionals on the inpatient rehabilitation unit at Parkview. Through this experience, I had the opportunity to not only advocate for the implementation of the acute intermittent hypoxia modality, but I was able to advocate for myself as a future occupational therapist and doctoral student in many ways.

Impact on OT

• Education: By educating practitioners on the efficacy of the use of the acute intermittent hypoxia modality, rehabilitative therapists at Parkview Randalia are able to increase their knowledge base in order to maximize the potential of services provided at Parkview Randalia.
• Advocacy: Through education, the acute intermittent hypoxia modality is being advocated for. The more practitioners know about this modality, the further the potential for use grows.
• Through the clinical practice element of this project, I was able to build strong interprofessional relationships. Engaging with practitioners of other professions on a daily basis gave me the opportunity to work on and improve my interprofessional communication skills.

Future Initiatives

Future initiatives for this project include:

• Acquisition of the AIH system for the primary capstone site
• Begin research with the AIH system
• Gaining recognition and approval of the system as formal treatment.

The research potential for the AIH system is limitless. While existing literature supports the use of this system with those recovering from SCI; gaps remain as to what other conditions could receive benefit from the use of AIH treatment. Once Parkview can secure necessary funds, and is able to purchase the AIH system, they will be able to begin research using this modality. My hope for the future is for another Capstone student to continue this project and help guide research with this system, in hopes to officially have AIH modality use recognized as a formal treatment. If this goal is reached, there is no limit to the amount of individuals that can be helped. Recognition of this system would allow expansion of the rehabilitation services offered at Parkview Randalia, and other rehabilitation hospitals across the country. Further, benefiting the medical community immensely.

References

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