OTA 206 - Assistive Technology

Assistive Technology Within Occupational Therapy Practice

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

Rehabilitation Technology

“Those technologies that are intended to restore an individual to a previous level of function following the onset of pathology.”

Rehabilitation Technology is used

• therapy setting

• trained professionals

• over a short period of time

• technologies are discontinued

Central to Occupational Therapy is….

• The belief that active engagement in meaningful activity supports the health and well-being of the individual

• Individuals who have functional limitations may require assistance to participate in their selected occupations when remediation is no longer an option.

to “assist“ is to

“help, aide, or support“

“ASSISTIVE TECHNOLOGIES” are those technologies that

“assist” a person with a disability in performing tasks.

Because Assistive Technologies are not expected to change the basic ability of the user,

AT has different design considerations

It is expected that AT will:

• Be used over prolonged periods of time

• By individuals with limited training

• By individuals with possibly limited cognitive capacity

The biggest difference between Rehabilitative and Assistive Technology is…

• At the end of the rehabilitation process, the patient no longer uses rehabilitation technologies

  • Rehabilitative technologies remain in the clinic

• But, the patient may have just completed training in the use of AT

  • AT goes home with the patient

Universal Design

• “If devices are designed to meet the needs of people with a wide range of abilities, they will be more useable of all users, with or without disabilities.”

  • A relatively new category of technology

  • Universal Design has the potential to make AT obsolete!

assistive technology =

compensatory

rehabilitative technology =

restorative

Human Interface Assessment Model

• Detailed look at the skills & abilities of humans in areas of motor, process & communication/interaction

• If demands of a task do not exceed ability- no AT needed

• If demands of a task exceed ability- cannot perform task as able bodied people can AT devices bridge gap between demands & abilities?

Occupational Therapy Practice Framework:

“Activity analysis addresses the typical demands of an activity, the range of skills involved in its performance, and the various cultural meanings that might be ascribed to it. . . Occupation-based activity analysis places the person in the foreground. It takes into account the particular person’s interests, goals, abilities, and contexts, as well as the demands of the activity itself. These considerations shape the practitioner’s efforts to help the . . . person reach his/her goals.”

OTA role when teaching AT…consider

1. Can the client control technology- does it make demands beyond their ability (too complex/difficult)?

2. Does it meet the client’s needs?

3. Ability of client to perform task that AT was recommended

4. Careful match between sensory, cognitive & motor abilities of user – input/output capabilities of technology

5. A person’s ability to use a device sometimes overshadows the tasks for which it was intended

Three categories of Electronic Assistive Technology

1. Electronic Aids to Daily Living (EADL)

2. Alternative and Augmented Communications (AACs)

3. General computer applications

1st Category: Electronic Aids to Daily Living (EADL)

• Devices that control electrical devices in the patient’s immediate environment

EADL applies to the control of:

• Lighting and temperature, opening key locks

• Televisions, radios, DVD players, telephones, and toys

EADL systems are characterized by the degree and type of control that they provide the user:

1. Power switching

2. Feature Control

3. Subsumed devices

Power Switching

• ….various technologies to “switch” power to electrical devices in environment

• …OT teaches how to operate the control of the device

• …Which control goes to which device

  • Evaluate the client when rested and also when fatigued

Goals/Advantages of Power Switching

• Client can operate the controls

• Client can recognize which control operates which light or appliance

• Client can turn device on/off at will

• Client can control devices throughout the day (energy level)

Feature Control

• home EADL remote

  • More than just on-and-off controls; allows for changing the volume, radio/tv stations, dim the lights, fan speed, etc

Aspects of Feature Control

• Feature control refers to what in the environment can/is controlled by the direct control (remote), or voice activation unit (Alexa, Siri, Google)

• Infrared remotes cannot reach a device in another room; hence why the integration of apps and voice controls have increased

Subsumed Devices

• The concept of subsumed devices is independent devices have been rolled into a single multipurpose device

• i.e. smartphones are not just for telephone use

  • -can watch movies, text, use apps, navigate, etc.

2nd Category: Augmented & Alternative Communication

• AAC- Augmented & Alternative Communication technology

• AAC is defined as “the use of technology to allow communication in ways that an able-bodied individual would be able to accomplish without assistance”

Augmented & Alternative Communication devices are appropriate for individuals who:

1. have difficulty in understanding language

2. have difficulty formulating messages

3. have difficulty in motor control or muscle tone

Augmentative

systems that supplement communication by voice and gestures between people

Alternative

systems that replace communication by voice or gestures between people

Low tech → high tech (letter board ←→ dynovax)

• Meets communication needs of a person

• Able to meet basic needs of interaction

Low Tech AAC

• critical communication

• stylus to point communication board

• Dynavox

3rd Category: Computer Access

• Computers are an AT for individuals with a wide range of disabilities because the computer allows them to perform tasks for which they have no alternative method.

• Can augment attention/thinking skills with cognitive limitations

• Can monitor & enhance attention to task

• Can be used to enhance language learning & temporal processing skills

• Used to change text to assist with reading

Guidelines for Computer Access

• Aware of cause and effect relationships

• Attention span of at least 3 minutes

• Attempts to follow simple instructions

• Can communicate yes/no

• Experience with other devices

• Letter/number recognition

• Physical exploration of the environment

• Motivation

Control Technologies

• Input adaptations

• Output adaptations

• Performance enhancements

Input Adaptations

• Physical keyboards

• Virtual input techniques

• Pointing systems

• Switch Encoding inputs

• Speech input

• Scanning input

alt keyboard:

Dvorak layout

physical keyboards

• key guard

• braille

virtual keyboards

• touch screens

• virtual keyboards

adapted keyboarding - pointing system

• head wand

• mouth sticks

switch encoding devices

• tongue mouse

• tongue drive system

speech inputs

• Type by voice/not always best choice for some (Speech recognition requires consistency)

• Requires intense training & use

• User needs cognitive skills

• Must be able to find misrecognized words & correct them if error is made

• Also be intrusive & lacks privacy

scanning inputs

• The control interface presents options to the user in a sequential manner, signaling agreement once the correct choice is selected

• May first offer groups of choices when group is chosen than offers items in the group sequentially

• Allows selection with limited physical effort

• Energy expenditure is small

• Time expenditure is large

Scanning Inputs Methods

• Breath Activated

  • This sensor detects the airflow and translates it into commands for scrolling through content on a screen, such as web pages or documents.

Rate Enhancement

May increase info transmitted by each selection when a person with disability is unable to make selections as quickly

Language can be expressed in one of 3 ways:

1. Letter by letter spelling (not efficient)

2. Word Prediction

3. Compression/Expansion (abbreviations)

(Output Options) - Adaptations of the output of technology are based on sensory modalities of :

• Vision (the assumption is that the person has near normal visual acuity)

• Hearing

• Tactile sensation

Output options

EADL’s use display panels and lighted icons to show the current status of the devices

Output

• tactile adaptations

• refreshable braille

Visual Output Adaptations

• Contrast between background and foreground colors

• Image size

  • Screen enlargement programs

  • Magnifier screens for computer screen

Speech Output Options are useful in two cases:

1. when it replaces voice for a person with a disability

2. when the user is not able to use vision to access the technology

Other thoughts…

• Mobile arm support

• Wrist support

• Uncontrolled movement problems may need to be restricted (athetoid CP, ataxia)

• Placement of switch should not interfere with ADLs

• Should be able to activate with little body movement

• Permanently mounted devices are favorable vs. those mounted on person

• Commercially available preferred over “homemade”

Assistive technology

• technologies that "assist" a person with a disability in performing tasks.

• Not expected to change the basic ability of the user

• Used over a prolonged period of time by individuals with limited training and who possibly have limited cognitive capacity

REHABILITATION TECHNOLOGY

Those technologies that are intended to restore an individual to a previous level of function following the onset of pathology

Universal Design

• A relatively new category of technology

• Basic concept:

  • "If devices are designed to meet the needs of people with a wide range of abilities, they will be more useable of all users, with or without disabilities."

• Has the potential to make AT obsolete!

Rehabilitation Technology

Used in a therapy setting by trained professionals over a short period of time and then discontinued.

Human Interface Assessment Model

Detailed look at the skills & abilities of humans in areas of motor, process & communication/interaction

Key difference between assistive technology and rehabilitative technology

Assistive is compensatory and rehabilitative is restorative

EADL means what

Electronic Aids to Daily Living

AAC means what

Alternative and Augmented Communications

EADLs

• Devices that control electrical devices in the patients immediate environment.

• Examples: lighting, temperature, opening key locks, televisions, radios, dvd, telephones, and toys

Levels of EADL systems

• Power switching

• Feature control

• Subsumed devices

Power Switching

• various technologies to "switch" power to electrical devices in environment

• OT teaches how to operate the control of the device

  Which control goes to which device

• Evaluate the client when rested and also when fatigued

Feature Control

Feature control refers to what in the environment can/is controlled by the direct control (remote), or voice activation unit (Alexa, Siri, Google)

Subsumed Devices

• have been rolled into a single multipurpose device

  • i.e. smartphones are not just for telephone use
    -can watch movies, text, use apps, navigate, etc

AAC- Augmented & Alternative Communication technology

• "the use of technology to allow communication in ways that an able-bodied individuals would be able to accomplish without assistance.

• seen in those who have difficulty understanding language and difficulty in formulating messages

Different between augmentative and alternative

• Augmentative supplements communication by voice and gestures between people

• Alternative replaces communication by voice or gestures between people

Input Adaptations

• Physical keyboards

• Virtual input techniques

• Pointing systems

• Switch Encoding inputs

• Speech input

• Scanning input

Speech Output Options are useful in two cases:

1. When it replaces voice for a person with a disability

2. When the user is not able to use vision to access the technology