Assistive Technology

Disability

Socially Constructed phenomenon that results from barriers present in the environment. Barriers can be physical, social, political, and attitudinal.

WHO’s ICF Model of Disability

disability results from interaction between an person and their environment. Disability is possible in all experiences and is the responsibility of all.

Prevalence of Disability in the US

27% of adults

Prevalence of Disability Globally

16% of adults

Prevalence of all types of disability in the US

12.8% cognition

 12.1% mobility

7.2% independent living

6.1% hearing

4.8% vision

3.6% self-care

How can poverty increase risk of disability?

malnutrition, inadequate access to education and healthcare, unsafe working conditions, pollution, sanitation, access to safe water

Assistive Technology

Any item, piece of equipment, or product system whether acquired commercially of the shelf, modified, or customized that is used to increase, maintain, or improve functional capability of individuals with disabilities.

Any service that directly assists an individual with a disability in the selection, acquisition, or use of an assistive technology device.

Strategy to reduce disabling influence of environments. Includes devices and services.

5 activities for AT

1. communication

2. cognition

3. mobility

4. manipulation

5. vision

5 principles of AT

1. client-centered

2. outcome

3. evidence-informed

4. ethical

5. sustainable

Client-centered AT

Using the process of meeting the needs of the user when engaging in relevant activities across necessary contexts

NOT about fitting the person to the technology

We want high rates of adoption

Desired outcome of AT

enablement of participation in desired activities

Device becomes an extension of the person

To achieve the desired outcome, we must understand what the person wants, needs, and is expected to do

3 Facets of Evidence-Informed AT…

1. Identifies technology that’s most appropriate for the user

2. Provides necessary training and support

3. Evaluates the outcome of the technology

Ethical principles in AT

beneficence

non-maleficence

social justice

distributive justice

beneficence

being responsive to the needs of others

non-maleficence

avoid causing harm, educate clients on devices

social justice

fair division of resources, opportunities, and privileges in society

Distributive Justice

fair allocation of resources, benefits, and burdens among members of a society

Sustainable AT

Provide services in a timely manner and in a way that they can be used continuously - depends on economy and resources

Human-Activity-Assistive Technology (HAAT) Model

describes someone doing something in a context using AT; evolved parallel to the ICF model

Dynamic nature of the model reminds us that these elements interact and influence each other, and the degree of influence changes.

4 aims of ICF Model

Framework for describing and organizing information on disability to:

1. To provide a scientific basis for understanding and studying health and health-related states, outcomes, determinants, and changes in health status and functioning

2. To establish a common language for describing health and health-related states to improve communication between different users – healthcare workers, researchers, policy-makers, and the public, including people with disabilities

3. To permit comparison of data across countries, healthcare disciplines, services, and time

4. To provide a systematic coding scheme for health information systems

Main 3 elements of CMOP-E

Person - includes spiritual

Environment

Occupation

Main 3 elements of PEO-P

1. person - includes spiritual

2. environment

3. occupation

Main 4 elements of HAAT model

1. human - includes novice/expert

2. context

3. activity - cognition, communication, manipulation, mobility

4. assistive technology - the enabler for humans doing activities in context

4 components of assistive technology

1. human technology interface (HTI)

2. processor

3. environmental sensory

4. activity output = result

Is abandonment of devices a greater problem for publicly or privately funded devices?

publicly

4 primary applications of the HAAT model

1. product research and development - preparatory studies and lived experiences

2. product utility vs usability

3. client assessments

4. outcome evaluations - short and long term

utility

how well the device meets the intended function

usability and its 6 components

how well the user can access the device’s functionality. Includes 6 components:

1. learnability

2. efficiency

3. memorability

4. errors - incorrect actions the user makes or actions that are omitted that limit or prevent a device from functioning as intended

5. satisfaction

6. ease of use

learnability

Part of usability. All functions of the device are easily learned. also, effectiveness of soft technologies to support learning.

efficiency

Part of usability. The user meets the intended goals of device use in a reasonable amount of time with minimal frustration and effort

Memorability

Part of usability. How the device is used can be easily remembered, particularly when a function has not been used over a long period of time. EX: programming a particular function on a smart phone. When the programming process is easily retained or retrieved from memory, this aspect of usability is satisfied.

Errors

Part of usability. Incorrect actions the user makes or actions that are omitted that limit or prevent a device from functioning as intended. Important that errors can be recognized, that the effect of an error is minimal, that feedback is given to signal an error is made, and that the user can repair an error made.

Satisfaction

Part of usability user has a positive experience when using the device

Ease of Use

Part of usability. A device must be simple to use. Minimizing the

number of steps required to generate the desired output.

Name 3 models for AT assessment and service delivery

1. HAAT

2. Matching Person and Technology (MPT)

3. Comprehensive Assistive Technology (CAT)

accessibility

capability of a device to allow use by individuals with disabilitiesa

assistive technology

broad range of devices, services, strategies, and practices that are conceived and applied to ameliorate the problems faced by people with disabilities

Body structures and functions

the components of the ICF that identify physiological functions of body systems, including mental and cognitive functions

Context

portion of the HAAT model that describes the influence of physical, social, cultural, and institutional environments or contexts on the access to, service delivery, and use of AT

Distributive justice

principles designed to guide the allocation of the benefits and burdens of economic activity

Ethics

a formal code of conduct that guides behavior in different situations; includes a professional code of ethics

Everyday technology

pervasive technology that facilitates everyday tasks and activities – remote controls, microwave ovens, smartphone apps

Evidence-informed

practice and service delivery that’s informed by clinical and research evidence

Free and appropriate public education

right to an education of every child with a disability; established under the US individuals with disabilities education act (IDEA

High technology devices

devices that are expensive, often complex, difficult to obtain, and difficult to make

Impairment

any loss or abnormality of psychological, physical, or anatomical structure of function

Low technology devices

devices that are simple to use, easy to produce, and easy to obtain

Technology Options

Any item, piece of equipment, or product system whether acquired commercially off the shelf, modified, or customized that is used to increase, maintain, or improve functional capabilities of individuals with disabilities

Telephones were originally used for what population?

Hard of Hearing

Mainstream AT

Closed captioning

Voice recognition

On-screen keyboards

Speech synthesis

Digitized speech

Word prediction

Screen enlargement

Wearables

Universal Design

design of products and environments to be usable by all people to the greatest extent possible, without the need for adaptation or specialized design

7 Components of Universal Design

1. Cost

2. Flexibility

3. Simple

4. Tolerance for error

5. Low effort

6. Size and space

7. Information

Examples of Mainstream public building accomodations

Sidewalk curb cuts

Automatic Doors

Lower buttons on elevators

Enlarged bathroom stalls

Commercially available devices

devices that don’t increase the cost of the product, they are already manufactured with specialized features

EX:

computers, smart phones with apps, smart watches, cars with blind spot monitoring or push-to-start, vegetable peelers, suction items

higher tech: wheelchairs, scooters, seating systems, speech generating devices, switch controls.

modified adapted commercial technology: low vision, cognition, and functional limitations

Hard technology

refers to the actual, tangible device, such as computer hardware, an AAC device, a Braille reader, or a mobility device

soft technology

less tangible aspects that support the use of a device

• including other people, written or auditory materials, and computer software

• involve decision making, strategies, training, concept formation, and service delivery that are used in R&D, when making a product recommendation, and activities involved when learning to use the device

4 aspects of Assistive Technology (according to HAAT model)

1. human technology interface

2. processor

3. environmental sensor

4. activity output

human technology interface

forms the boundary between the human and the AT. 2-way interaction.

Processor

 links the HTI and the activity output. Translates information and forces received from the human into signals that are used to control the activity output. Interprets and formats external data from the environmental sensor so they can reach the user via HTI.

environmental sensor

detects external environmental data

activity output

cognition, communication, manipulation, or mobility

activity analysis questions

1. why?

2. how? - independent or dependent

3. temporal aspects? - frequency? time required for independent completion? time required for assisted completion?

4. where?

5. what other activities does this support?

What 5 body functions should an OT assess when doing an activity analysis for AT?

1. hearing

2. vision

3. cognition

4. neuromuscular

5. voice

What are the differences between how novices and experts interact with technology?

Experts take more risks.

Experts stretch the way a device is used.

Experts use less-conscious effort to control AT.

occupational performance

physical, sensory, cognitive, communication, and affective. Habitual tasks can be done without much conscious attention.

Self-efficacy

personal sense of how well one can perform an activity in an anticipated situation

Motivation

from internal and external sources can promote higher occupational performance

Self determination

affects whether someone can perceive themselves as capable of engaging in an activity and completing it with a degree of competence.

the opportunity to make a choice on how and when daily functions are carried out.

Occupational satisfaction

perceived level of performance. The ability to choose the occupation and control the context results in greater satisfaction. Changes in skill level can affect satisfaction! Social and cultural contexts impact satisfaction

Occupational engagement

the degree to which a person is engaged with or involved in a particular occupation. Interest is linked with engagement.

Co-occupation

an occupation in which 2 or more people are involved and cannot be done by one person alone

Operational competence

ability to use AT for its intended purpose

Strategic competence

more subtle elements of using an AT device – soft technology

Social competence

for certain technology, knowing when things are appropriate or not appropriate. EX: with speech AT, knowing when certain words are appropriate and when they are not

Linguistic competence

AT devices sometimes require an increase in vocabulary to explain how they work and what they do

Context in the HAAT model

where the human carries out activities; can determine factors in whether the person successfully uses an AT system.

Microenvironment

closest, most intimate environments in which a person functions – home, school, or work. The person and their abilities are known, rules are defined, and rules/expectations are understood.

Meso environment

environments where a person functions less frequently. Includes community centers, shopping malls, and churches.

Macroenvironment

broader social and cultural contexts that impose a legislative and moral behavioral framework on the person

Physical context

physical attributes of the environment that enable, hinder, or affect performance of daily activities, either with or without AT. Limits individuals with disabilities from occupational engagement because they can’t access places, materials, or people to do so.

wayfinding, physical safety, temperature, light and sound

Potential modifications to the physical environment

declutter

signs with braille

signs with high contrast

signs that are simple to understand

Light’s 4 competencies in his model of human activity

1. occupational competence

2. strategic competence

3. social competence

4. linguistic competence

institutional context

larger organizations within a society that are responsible for policies, decision-making, and procedures. Funding at a state or provincial level. Policies at more local levels, such as municipalities, school boards, healthcare institutions, or other community agencies.

Rehabilitation Act of 1973

• Established reasonable accommodation

• Amendments make provisions for AT! require that each state include provisions for AT within its vocational rehabilitation. Requires provisions AT in IEP as needed.

• Section 504: nondiscrimination based on disability for federally funded programs

• Section 508: ensure access to electronic office equipment for for federal employees.

ADA - 1990

• Prohibits discrimination based on disability in employment, state and local government, public accommodations, commercial facilities, transportation, and telecommunications.

• Title I: employment = reasonable accommodations for employees, including AT.

• Title II: state and local government agencies + transportation = equal opportunity to benefit from all services and programs

• Title III: public accommodations ** does not mention AT

• Title IV: telecommunications = phone and TV access for people with hearing and speech disabilities

·       *Requires common carriers to have interstate and intrastate telecommunications relay services 24/7 which allows callers to communicate if they have disabilities

IDEA

§  FAPE = Free and Appropriate Public Education

§  IEP = individualized education plan

§  1997 amendment is what included AT!

·       Now, devices from sensory aids to AAC devices to specialized computers have been used to provide access to kids

·       Lack of local services or lack of funds is NOT a sufficient reason to deny services or devices justified in the IEP.

·       If the IEP goals are not met, or if there are differences over what should be include, a fair hearing process may be pursued.

Assistive Technology Act of 1998

§  Supports states’ capacity to address AT

§  Supports investment in technology

§  Supports microloans for AT

§  Title 1: state grant programs

§  Title 2: national activities

§  Title 3: alternative financing mechanisms

§  **primary change: repeal of the provision that allows the law to expire annually.

**applies to all 50 states!

Medicaid

Established in 1965

Primary goal: provide medical assistance to people in need and to furnish them with rehabilitation and other services to help them “attain or retain capability for self care"

Largest funding source for AT.

Income-based eligibility.

Person must be eligible for medicaid, request device, and demonstrate need.

United Nations Conventions on the Rights of Persons with Disabilities

2006

Identifies ethe rights of people with disabilities and the obligations of states parties to the convention to promote, protect, and ensure those rights.

8 Principles:

1. Respect for dignity

2. Non-discrimination

3. Full participation

4. Respect for difference

5. Equality of opportunity

6. Accessibility

7. Equality between men and women

8. Respect for evolving capacities

WHO Global Disability Action Plan

2014-2021

Aims to contribute to achieving optimal health, funcitoning, well-being, and human rights for all people with disabilities

• Moving barriers and improving access

• Strengthen and extend rehabilitation, habilitation, AT, and support services

• Strengthening relevant and internationally comparable data to support research

Convention on the Rights of the Child

** Most widely and rapidly ratified human rights treaty in history, but the US is the only country that has NOT ratified this human rights treaty

Article 2 = nondiscrimination

Article 3 = best interests of the child

Article 6 = right to life, survival, and development

Article 12 = right to be heard

Madrid International Plan of Action on Aging

o   Signed by 159 governments but is not legally binding, implementation is voluntary

o   Adopts a human rights approach, older adults are active agents – NOT PASSIVE beneficiaries of humanitarian and development action

o   Lists actions aimed at the maintenance of maximum functional capacity throughout life

Sustainable Development Goal Ideas

o   Initially, did not specifically mention disability, however, it was realized it isn’t possible to achieve these goals without considering disability issues.

o   In 2008, UN urged states to consider the rights and well-being of people with disabilities

o   Ongoing process with technological improvements and the average life expectancy increasingO

Original 8 Sustainable Development Goals in 2000

1. eradicate extreme poverty and hunger

2. achieve universal primary education

3. promote gender equality and empower women

4. reduce child mortality

5. improve maternal health

6. combat HIV/AIDS, malaria, and other diseases

7. ensure environmental sustainability

   1. global partnership for development

Updated 17 Sustainable Development Goals in 2015

1. end poverty in all forms everywhere

2. end hunger, achieve food security, and improved nutrition and promote sustainable agriculture

3. ensure healthy lives and promote well-being for all at all ages

4. ensure inclusive and equitable quality education and promote lifelong learning for all

5. achieve gender equality and empower all women and girls

6. ensure availability and sustainable management of water and sanitation for all

7. ensure access to affordable, reliable, sustainable, and modern energy for all

8. promote sustained, inclusive, and sustainable economic growth, full and productive employment, and decent work for all

9. build resilient infrastructure, promote inclusive and sustainable industrialization, and foster innovation

10. reduce inequality within and among countries

11. make cities and human settlements inclusive, safe, resilient, and sustainable

12. ensure sustainable consumption and production patterns

13. take urgent action to combat climate change and its impacts

14. conserve and sustainably use the oceans, seas, and marine resources for sustainable development

15. protect, restore, and promote sustainable use of terrestrial ecosystems, sustainably manage forests, combat desertification, and halt and reverse land degradation and halt biodiversity loss

16. promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable, and inclusive institutions at all levels

17. strengthen the means of implementation and revitalize the global partnership for sustainable development

Community-Based Rehabilitation

• Bottom-up approach to development involving communities.

• Believe “a community-based approach helps to ensure that development reaches the poor and marginalized, and facilitates more inclusive, realistic, and sustainable initiative”.

• best for low/middle-income countries

• main objective: reduce poverty by improving access to health, education, and livelihood opportunities for people with disabilities

poverty is a _______ AND _______ of disability

cause AND consequence

Early Childhood Intervention

• ECI is so important!

• ECI concerns: efficacy, effectiveness, and cost-justification of intervention.

• ECI Challenges:

  • 1) reaching all populations that can benefit

  • 2) ensuring quality in equal standards of provision

  • 3) respecting the rights and needs of children and families - family-focused care.

Employment

• Employment rates are significantly lower and unemployment rates are significantly higher among individuals with disabilities

• Factors that contribute:

  • Physical barriers to moving from home to work

  • Accessing education

  • Cultural barriers

  • Attitudinal barriers

  • Misconceptions

Education

• Children with disabilities are less-likely to start school and have lower retention and promotion rates

• Convention on the Rights of Persons with Disabilities: urges all parties to remove barriers and provide reasonable accommodation and support services, ensuring that children with disabilities are included in the general education system and not separated in special schools

• Several barriers to education of children with disabilities still exist. System-wide problems and school problems!