AT Service Delivery and Clinical Reasoning (draft)

AT is a service delivery ______

process

AT is a ______, not a ______

service, device

If a device is working from a tech standpoint, but not being used, is it successful?

No

All AT decisions must consider

human, activity, assistive technology, context

Ignoring any component of the HAAT model _______ abandonment risk

increases

AT is ______, not rehabilitative

enabling

AT focuses on what?

• participation

• functional outcomes

• strengths over deficits

• access over remediation

AT works alongside

• skill remediation

• environmental modification

• task adaptation

• education and training

AT service delivery process

1. initiation

2. assessment

3. solution selection

4. equipment selection

5. authorization

6. implementation

7. management and follow up

initiation phase of AT

• referral

• a problem in functioning has been identified

assessment phase of AT

• occupational profile

• OT eval to formulate the need

solution selection phase of AT

• plan of care

• equipment trials and recommendations

equipment selection phase of AT

choosing and selecting specific equipment

authorization phase of AT

• funding source

• ordering device/s

implementation phase of AT

• delivery to consumer

• fitting and training for use by consumer

management and follow up of AT

• maintenance and repair

• follow up (evaluating the effects on function)

AT service delivery is not _____

linear, movement between steps is expected

_________ is part of best practice

re-evaluation

If a device doesn’t work, the question is not “what went wrong?” but

“what did we learn, and what do we adjust?”

A referral does not equal a _______

solution

OT clinical reasoning questions

1. what occupation is disrupted?

2. why is participation limited?

3. what matters most to the client?

AT is being considered to support _____ _____, not convenience alone

occupational participation

Before recommending AT, ask yourself…

1. can i explain why this supports occupation

2. can i justify it to the client

3. can i justify it to a funder

4. can i adapt it if it stops working

feature matching

clinical reasoning process in which OTs identify the functional features required for occupational participation and systematically align those features with the client’s abilities, needs, preferences, and contexts, rather than selecting a device based on diagnosis, availability, or familiarity

feature matching prioritizes ______ first, then identifies technology characteristics that support access, efficiency, safety, and sustained use

occupation

evaluation and feature matching, focus on

• access methods

• cognitive demands

• physical requirements

• environmental compatibility

we do not match people to devices, we match ______ needs to _____ features

occupational, functional

why trial devices?

• predict real-world performance

• identify barriers early

• support funding justification

• reduce abandonment risk

Trials should include

• real tasks

• real environments (when possible)

• observation + client feedback

Errors in AT practice

• device-first thinking

• poor feature match

• inadequate trials

• insufficient training

• missing follow-up

reasons for abandonment

• context mismatch

• cognitive overload

• psychosocial factors

• changing needs

• support breakdown

ethical issues in AT

• access inequity

• autonomy conflicts

• safety vs. independence

• resource stewardship

• informed consent

common AT outcome tools

• QUEST

• PIADS

• FIATS

funding considerations

• public programs

• private insurance

• community sources

• eligibility criteria

• documentation requirements

implementation includes

• client training

• caregiver training

• environmental setup

• documentation and education

common pitfalls in AT practice

follow-up addresses:

• device-first thinking

• skipping trials

• ignoring context

• limited follow-up

Device characteristics

• access method

• feedback type

• range & precision

• flexibility

• portability

• aesthetics

OT clinical reasoning questions regarding eval and feature matching

1. what features reduce effort or barriers?

2. What features may increase frustration or fatigue?

3. what skills are required to use this technology?

make sure features match ______ ______ and client abilities

occupational demands

Direct access

using hands, fingers, or another body part directly

Indirect or alternative access

scanning, switch-based access, or mediated input

Single-step vs multi step access

one action verses sequences

continuous vs discrete access

sustained control versus brief activation

cognitive access

mental effort required to understand, remember, and operate

visual feedback

lights, symbols, text, color changes

auditory feedback

tones, verbal cues, sounds

tactile/haptic feedback

vibration, pressure, movement

multimodal feedback

combination of visual, auditory, and tactile

range refers to how much ______, force, or control variability a device allows

movement

Precision refers to how ______ and consistently a user can control that movement or input

accurately

Together, _____ and ____ determine whether a user can perform an activity efficiently, safely, and without excessive effort

range and precision

flexibility refers to the extent to which AT can be _______, customized, or ______ to accommodate changes in the user, the occupation, or the context over time

adjusted, adapted