Introduction to Assistive Technology

Assistive Technology- What is it?

There are two parts to the definition

• Device

  • 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

  • a device could be defined as AT for one person, but not another (e.g., an elevator isn’t an AT for me, but it would be an AT for someone who uses a wheelchair)

• Service

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

Definitions Non-federal

“For most people, technology makes things easier; for people with disabilities, however, technology makes things possible.”

Classifications of AT

1. Assistive vs. Rehabilitative or Educational Technologies

   1. assistive= helping someone to do something; compensatory

      1. e.g., communication device helps someone to communicate

   2. rehabilitative= helps to improve a function that’s been lost; improving

   3. educational= used primarily for education

      1. e.g., to write a paper, to complete a chemistry experiment

   4. all funded by different organizations, so it’s important to use these different terms

2. High Tech vs. Low Tech

   1. high-tech is usually

      1. electronic, expensive, requires batteries/charging/etc., requires maintenance, requires background of how to use

      2. people ~like~ these tech better

   2. low-tech is usually

      1. not electronic, cheaper, doesn’t require batteries/charging/etc., easier to use

      2. usually better for helping people in ~most~ situations

3. Hard vs. soft technologies

   1. hard

      1. the pieces required to create the technology

      2. e.g., the software

   2. soft

      1. the people creating the technology

      2. e.g., OTs

4. Minimal (orthoses) vs. Maximal (prostheses)

   1. minimal= technology provides some assistance or augments the ability to perform a task (than what you might have been able to)

      1. e.g., Grammarly just to check spelling and grammar

   2. maximal= technology takes over the entire task or a majority of it

      1. e.g., wheelchair usage by someone who can’t walk

5. General vs. specific technologies

   1. general= can be used across a wide range of tasks

      1. e.g., cushion for posture can be used on a bed, chair, floor, etc.

   2. specific= can only be used for 1 purpose

      1. e.g., communication device is soley for improving communication

6. Custom vs. Commercial

   1. custom= customizing something for a client

      1. e.g., our adaptive devices

   2. commercial

      1. e.g., at Walgreens, CVS

7. ***Appliances vs. Tools

   1. appliances= needs no experience

      1. e.g., put your glasses on —> you see

      2. e.g., plug-in appliance —> it works

   2. tools= require specific expertise/training in order to use

      1. e.g., wheelchair, communication device, certain types of driving equipment

What is an Appliance?

• Technology that involves no expertise

• eg., you just plug it in!

What is a Tool?

Technology that involves expertise

Service Providers (the organization) of Assistive Technology: Who are They? + requirements to get certified

1. Rehabilitation therapists

2. Assistive technology certified professionals (Certified ATP through RESNA: Rehabilitation Engineering and Assistive Technology Society of North America)

   1. Education: Bachelor’s or Associate’s in Rehabilitation Science OR non-rehabilitation field)

   2. Work Experience (# of years and FTE (full-time equivalent))

   3. Examination (4-hour multiple choice)

   4. Renewed annually

3. Vendors

4. The AT consumer, family, and friends

AT within OT Practice

• different settings is AT practiced in

• Delivered in a variety of settings

  • hospitals,

  • rehab centers,

  • SNF,

  • outpatient,

  • HHA,

  • schools,

  • work sites and

  • communities

• Delivered in a variety of roles (primary therapist, team member, consultant)

• Broad range of services (evaluation, recommendation, justification, advocacy, funding, fabrication, customization, training, integration, and follow-up)

• “When a person is unable to participate in meaningful activities or occupations, assistive technology may be used as a support”

• “The intent is to use technology as a tool to optimize the individual’s participation in areas of occupation”

Service Delivery Settings of AT

• Rehabilitation Settings

• University Based

• State Agency Programs

• Private Practice

• Durable Medical Equipment Suppliers

• Veterans Administration

• Local Affiliate of a National Nonprofit Disability

• Volunteer Programs

Service Delivery Models

• Medical

  • patient-focused (i.e., clients are actually referred ot as “patients”);

  • medical necessity;

  • insurance reimbursement;

  • DME (Durable Medical Equipment)

• Educational

  • student-focused (e.g., writing aids);

  • FAPE/IEP;

  • school budget;

  • must be left in the school/cannot take it home (e.g., school iPad), as the state/school system pays for it

• Vocational rehabilitation

  • worker focused

  • vocational need

  • federal/state funds

  • e.g., driving controls

    • can be modified up to $100

• Consumer-direct

  • consumer-focused;

  • personal choice;

  • personal funds (pay for whatever they need out of pocket; insurance doesn’t cover);

  • ECUs (Environmental Control Unit- device that allows people with disabilities to control electronic devices and appliances in their environment through alternative input methods like switches or voice commands)

AT Service-Delivery Process (steps)

1. Referral and Intake

2. Initial Evaluation

3. Recommendation and Report

4. Implementation

5. Follow-up

6. Follow-along

Legislations affecting AT

• Rehabilitation Act of 1973

• Individuals with Disabilities Education Act of 1997

• Assistive Technology Act of 1998

• Developmental Disabilities Assistance and Bill of Rights Act

• Americans with Disabilities Act of 1990

  • only targets clients with developmental disabilities

    • e.g., making sure they can go to school, get a job, and live independently

  • prohibits discrimination against people with disabilities

  • lots of problems, but a great 1st step in the right direction

• Medicaid

  • income-based; can qualify if you are in poverty

  • largest funding for AT

• Medicare

  • age-based

  • last resort- should not be the first place you go to; only if nowhere else meets your needs

Low or No Tech: Do Not Dismiss the Importance!

dollar-store/home-made stuff <3

• Laptrays, adapted desks

• Typing aids, splints

• Book holders, 3-ring binders, slant boards

• Built-up handles, grips, Crayon TwistUps, etc.

• Reachers, mouth sticks, and head/chin pointers

• Handheld magnifiers

• Raised line paper, writing guides

• Homemade devices! Client or therapist!

Look for Non-AT Choices-

Choosing items for ease of use with limited hand function

e.g., flip top squeeze toothpaste, hand mixer, soap pump

Specific AT that OTs might primarily work with

• Assist in seating and positioning and ECU integration

• Switch access

• Mounting

• Writing assistance tools and software

• But as an OT gains more expertise in AT, the roles between service providers blend

Goal Setting

Must focus on activity; what the client wants to be able to do!

• it is not all about the device- but the activity!