Unit 1

Assistive Tech (AT)

fills the gap between performance skills and performance demands

• any item, piece of equipment, or system (commercially off the shelf, modified, or customized) that is used to increase or maintain functional capacities of individuals with disabilities

AT vs. Rehabilitation Tech

Examples:

RT: functional electrical stimulation

AT: button hook, power mobility device, eye tracking software, reacher, hearing aids, screen reader/speech to text software 

Both: exoskeleton, virtual reality

RT aka Therapeutic Use of Technology (TUT):

• Remedial approach with graded activity focused on improving occupational performance 

• Task-oriented, high repetition and intensity

• Ex: physical agent modalities, ultrasound, diathermy, paraffin

Same tech may function as RT/TUT or AT depending on intervention goal

Match the right tech to the right person

Low-Tech AT

• Simple tech

• Typically no power source

• Easy to understand and use

• No specialized training

• Low cost

• Ex: large print books, handheld magnifiers, pencil grips, non-slip mats

Mid-Tech AT

• Increased complexity ot specialized systems of device

• usually user-friendly and customizable

• minimal training

• typically requires electronic or battery power source

• moderate cost

• decreased level of clinical reasoning and creativity

• Ex: calculator, audio books, electronic calendars, voice memo, basic communication devices

High-tech AT

• advanced and specialized systems/devices

• usually complex and computerized

• cutting-edge solutions

• significant training and ongoing support

• larger financial investment

• clinical reasoning driven by systems and protocols

• Ex: speech-generating device, voice-recognition software, computer-access aids with eye-tracking tech, advanced prosthetics, smart home system

Models: International Classification of Functioning, Disability, and Health (ICF)

• ICF tells us where the problem is, does not tell us what factor we should consider when making AT decision

  • too broad, need an OT specific model

Human Activity Assistive Technology Model (HAAT)

• influenced by PEOP and CMOP-E

• helps understand how AT interacts with person, environment, and activity

Activity- execution of task, tasks that a person needs/wants to do

• cognitive, physical, sensory, perceptual, communicative, and affective requirements for activity

Human- motor, sensory, cognitive, and affective abilities; motivation; novice vs. expert

Context- physical, cultural, social, institutional

AT- human-technology interface (HTI)- how the user controls the AT system and receive feedback

• environmental sensor- light sensors (cameras), sound sensors (microphones), motion sensors, and location sensors (GPS)

• processor

• activity output

Shortcoming- does not tell us where to start or how to solve the problem

Person-Environment-Occupation-Performance Model (PEOP)

client-centered, top-down, based on ICF

Person (intrinsic factor)- physiological, cognitive, spiritual, neuro-behavior, psychological

Environment (extrinsic factor)- social support, social and economic system, culture and values, built environment/technology, natural environment

Occupation- activities, tasks, roles

Performance- actual act of doing

• helps identify barriers and facilitators to occupational performance

• can use AT to remove barriers and improve performance

Shortcomings: no associated assessment tool and no direct outcome measure; challenge of weighting the different factors, not centered around AT (one of many environmental factors)

Canadian Model of Occupational Performance-Engagement (CMOP-E)

client-centered, top-down

Spirituality- essence of self, gives determination and meaning

Affective- social and emotional functions

Physical- sensory, motor, and sensorimotor functions

Cognitive- metal functions, perception, concentration, memory, comprehension, judgement, reasoning

Occupation- self-care, productivity, leisure

Environment- physical, social, cultural, institutional

Engagement- person/occupation/environment fit, occupational performance, occupational engagement

• designed to evaluate the level of difficulty and satisfaction with occupational performance, focus on identifying meaningful occupations

• goal is to promote occupational engagement

• can use AT to improve performance and satisfaction with occupations

Shortcoming: not specific to AT

Pro: comes with COPM outcome measure

Matching Person and Technology Model (MPT)

organizational framework to assess and recommend successful use of a variety of AT

Student, Environment, Tasks, and Tools Model (SETT)

student-based tool to use when deciding what tools and strategies work

• promote collaborative decision-making in all phases of AT service design and delivery

• focus on understanding student’s: abilities and challenges, interests and preferences, communication/physical/sensory/cognitive needs, strategies and supports, academic and social goals

tools- devices, services, and strategies a student needs to succeed

• tools should not be decided until the IEP team examines SET factors

Quality Indicators of AT (QIAT)

collaborative self-assessment conducted by a group of stakeholders

• goal is for service providers and school districts to evaluate current practice and create plans to improve

consideration of AT needs, assessment of AT needs, AT in the IEP, AT implementation, evaluation of effectiveness, AT in transition, administrative support for AT, AT professional dev

outcome measure that is scored on a 5-point Likert scale

TAKE HOME MESSAGE

Universal Design

enables and empowers a diverse population by improving human performance, health/wellness, and social participation

• usable by all people, to the greatest extent possible, without need for adaptation or specialized design

• equitable use, flexibility in use, perceptible info, tolerance for error, low phyical effort, size and space for approach and use

Equitable Use

useful and marketable to people with diverse abilities

• same means for all users

• avoid segregating or stigmatized

• provisions for privacy, security, and safety for all

• design is appealing to all

Flexibility in use

design accommodates a wide range of individual preferences and abilities

• choice in methods of use

• accommodates R or L handed use

• facilitates user’s accuracy and precision

• adaptability to user’s pace

Simple and Intuitive to Use

easy to understand, regardless of user’s experience, knowledge, language skills, or current concentration level

• eliminate complexity

• consistent with expectations and intuition

• accommodate wide range of literacy and language

• provide effective prompting and feedback

Perceptible Info

design communicate’s info effectively to the user, regardless of ambient conditions or user’s sensory abilities

• different modes for redundant presentation of essential info

• maximize legibility

• provide compatibility with a variety of techniques or devices used by people with sensory limitations

Tolerance for Error

design minimized hazards and adverse consequences of accidental or unintended actions

• provide warnings of hazards and errors

• provide fail safe features

• discourage unconscious action in tasks that require vigilance

Low Physical Effort

design can be used efficiently and comfortable and with a minimum of fatigue

• maintain neutral body position

• use reasonable operating forces

• minimize repetitive actions

• minimize sustained physical effort

Size and Space for Approach and Use

appropriate size and space is provided for approach, reach, manipulation, and use regardless of user’s body size, posture, or mobility

• clear line of sight to important elements for seated and standing users

• make reach to all component comfortable for seated/standing users

• accommodate variations in hand and grip size

• adequate space for use of assistive devices or personal assistance

Ergonomics

designing and arranging things people use so that the people and things interact most efficiently and safely

• prevent discomfort and injuries caused by work

• fitting workstation and tools to employees

• common ergonomic injuries: carpal tunnel, epicondylitis, tenosynovitis, muscle strain, tendinitis, trigger finger, low back pain

• ergonomic risk factors: repetition, forceful exertions, awkward postures, holding a position without movement, localized constant pressure

Principles of Ergonomics

• work in neutral postures

• reduce excessive force

• keep everything in reach

• work at proper height

• reduce excessive motions

• minimize fatigue and static load

• minimize pressure points

• provide clearance

• move, exercise, stretch

• maintain a comfortable environment