Week 2 Assistive Technology Service Delivery and Clinical Reasoning

Assistive technology = service delivery

devices are _______

services enable _________

outcomes define _______

tools, participation, success

All AT decisions must consider…

Human

Activity

Assistive technology

Context

AT focuses on…

participation

functional outcomes

strengths over deficits

access over remediation

AT works alongside…

skill remediation

environmental modification

task adaptation

education and training

What is the process of AT service delivery?

Initiation

Assessment

Solution selection

Equipment selection

Authorization

Implementation

Management and follow-up

initiation phase-

referral

a problem in functioning has been identified

assessment phase-

occupational profile

OT evaluation to formulate the need

solution selection phase-

POC

equipment trials and recommendations

equipment selection phase-

choosing/selecting specific equipment

authorization phase-

funding source

ordering device(s)

implementation phase-

delivery to consumer

fitting and training for use by consumer

management and follow-up phase-

maintenance and repair

follow up (evaluating the effects on function)

what are some key things to note when it comes to the AT service delivery process?

AT service delivery is not linear; movement between steps is expected

when it comes to AT service delivery, _________ is part of best practice; it is not optional but expected

re-evaluation

what are clinical reasoning questions you must answer when receiving a referral indicating a client needs an AT?

what occupation(s) is disrupted?

why is participation limited?

what matters most to the client

what does participation look like to them?

what occupations are non-negotiable

before recommending an AT, ask yourself;

can i explain why this supports occupation?

can i justify it to the client?

can i justify it to a funder?

can i adapt it if it stops working?

when does AT assessment occur?

AT intake

during trials

during training

AT follow-up

across the lifespan

what are contexts you need to analyze when provide AT delivery services?

physical; home, school, work

social; caregivers, peers, support

cultural; values, expectations

institutional; policies, funding, rules

temporal; disease progression, routines

what are different types of reasoning you can use during the AT delivery process?

procedural

interactive

conditional

ethical

pragmatic

procedural reasoning-

focuses on what to do and in what order

ensures the AT process is systematic, defensible, and compliant

interactive reasoning-

centers on understanding the client as a person

considers motivation, preferences, habits, identity, and lived experience to build trust and supports client buy-in

conditional reasoning-

integrates past, present, and future

anticipates changes in condition, environment, or roles; supporting flexibility and adaptability of AT

pragmatic reasoning-

accounts for real-world constraints to ensure realistic implementation; funding limits, time, access, policies, caregiver availability, and service delivery contexts

ethical reasoning-

guides decisions related to fairness, access, autonomy, safety, and professional responsibility

what is feature matching?

a clinical reasoning process in which the OT identifies the functional features required for occupational participation and align those features with the client’s abilities, needs, preferences, and contexts

feature matching prioritizes _________ first and then identifies ________ characteristics

occupation, technology

when doing feature matching we want to focus on…

access methods

cognitive demands

physical requirements

environmental compatibility

we do not match people to devices, we match ____________ needs to _________ features

occupational, functional

access method-

how the user physically or cognitively initiates, controls, or interacts with AT to perform a task

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 versus sequences

continuous vs. discrete access-

sustained control versus brief activation

cognitive access-

mental effort required to understand, remember, and operate

feedback type-

how AT communicates information back to the user to confirm actions, guide performance, or support learning during task completion

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-

how much movement, force, or control variability a device allows

precision-

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

high precision demand-

a task that requires selecting small targets or performing exact movements demands

when is a high precision demand AT inappropriate?

if the client has tremors or reduced fine motor control

low precision, high range-

tasks that involve large, general movements

flexibility-

the extent to which AT can be adjusted, customized, or adapted to accommodate changes in the user, the occupation, or the context over time

high flexibility-

a solution that allows adjustments in positioning, sensitivity, or mode of use can be graded as abilities change or as the task becomes more complex

low flexibility-

a solution designed for a single task with minimal adjustability may limit participation when routines change or when the client’s abilities fluctuate

protability-

how easily AT can be transported, positioned, and used across different environments and contexts

high portability-

a solution that is lightweight, compact, and quick to deploy supports spontaneous participation and use across settings

low portability-

a solution that is bulky, requires extensive setup, or depends on a fixed environment may limit use to a single location

aesthetics-

how AT looks, feels, and aligns with a user’s personal identity, preferences, and social contexts

appearance, size, sound, visibility, and perceived stigma

device characteristics to evaluate-

access method

feedback type

range and precision

flexibility

portability

aesthetics

why is a trial device important?

predict real-world performance

identify barriers early

support funding justification

reduce abandonment risk

trials should include….

real tasks

real environments

observation and client feedback

Errors in AT practice-

device-first thinking

poor feature match

inadequate trials

insufficient training

missing follow-up

Common reasons for AT abandonment-

context mismatch

cognitive overload

psychosocial factors

changing needs

support breakdonw

Ethical issues in AT-

access inequity

autonomy conflicts

safety vs. independence

resource stewardship

informed consent

Measuring outcomes

AT outcome tools- QUEST, PIADS, FIATS

AT funding considerations-

public programs

private insurance

community sources, eligibility criteria

documentation requirements

AT implementation includes…

client training

caregiver training

environmental setup

documentation and education

AT follow-up addresses…

changing needs

fit and usability over time

continued occupational engagement

prevention of abandonment

Common pitfalls in AT practice; follow-up related-

device-first thinking

skipping trials

ignoring context

limited follow-up