Principles, Models, and Ethics of Assistive Technology

Assistive technology Act of 1998 definiteion

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

Assistive technology WHO definition

any product, instrument, equipment, or technology adapted or specifically designed for improving functioning of a disabled person

Examples of AT

• mobility devices

• positioning devices

• communication aides

• electronic aids to daily living

• low-tech activity specific devices

• sensory tech

• cognitive aids

• prosthetics/orthotics

AT looks to ____ the disabling influence of many environments

reduce

____ occurs at the intersection of the person and the context in which they live

disability

AT service delivery principles

• process is person-centered not AT centered

• Outcome is enablement of participation in desired activities

  • services are provided in a sustainable manner

AT service delivery team

• OT

• setting dependent

• Polgar and Cook approaches AT from a generalist POV

Technology that is developed without the input of consumers is ____ likely to be adopted for its intended use

less

Evidence informed process

1. includes steps to identify tech that is most appropriate for the user

2. provides necessary training and support for initial and ongoing use of the technology

3. adequately evaluate the outcome of the tech

4. funders typically require evidence that supports specific outcomes of at use before purchasing

Sustainability

• providing AT products and services in a manner that ensures people who need them have access in a timely and continuing manner

• can involve development and establishment of AT services

• providing tech that can be maintained and repaired using local knowledge, tech, and materials

technologies are becoming more _____

pervasive

distribution of AT is often through ____

funding

what becomes a concern with AT?

privacy

ethical process of principles including beneficence and nonmaleficence

• AT’s purpose to benefit the consumer

  • AT must not harm the consumer

ethical process of principles including social justice

• accessibility of AT services for all who require it

• 1/10 people have access to the AT they need for everyday activities (WHO)

• Lack of access to AT keeps some people with disabilities in poverty

ethical process of principles including distributive justice

• inequities occur at the intersection of the person with a disability and the context in which he or she lives

• advocates for an equitable distribution of resources

autonomy

right to self-determination and freedom from unnecessary constraints, interference, or loss of privacy

Use of AT can imply weakness or less ability however AT that is based on mainstream technologies can decrease the _____

stigma

Abandonment or discontinuance of AT is sometimes due to _____

stigma

The Human Activity Assistive Technology (HAAT) Model

• Cook and Hussey, 1995

• Describes someone (human) doing something (activity) in a context using AT

• Emphasis of the model is on the person engaged in an activity within chosen environments

HAAT activity component

• self care, work, volunteer, education, leisure

• person may engage in multiple activities concurrently

• engagement in activity is dynamic

• assists in understanding of tasks in which the user of AT participates

• what does the user do with AT?

• Does the activity involve other people?

HAAT human component

• includes user’s abilities in motor, sensory, cognitive, and affective areas

• initial and ongoing assessments of these abilities

• Is change in ability expected to occur?

• Roles and experience with technology need to be considered

HAAT context component

• context is used in contrast to environment

  • physical context

  • social context

  • cultural context

  • institutional context

complexity of AT

• low-tech

• mid-tech

• high-tech

HAAT AT component

• enabler for a human doing an activity in context

  • human/technology interface

  • processor

  • environmental interface

  • activity output

low tech AT

• simple

• low maintenance

• limited/no electronics

mid tech AT

• some maintenance

• some training

• more electronics

high tech

• complex electronics

• more training

• more maintenance

examples of low/no tech AT

• pencil grip

• adapted books

• slant board

• color coding

• read to out loud

• note taker

• picture schedule

examples of mid-tech AT

• word prediction

• text to speech

• speech to text

• spell checkers

• adapted toys

• organizers

• e-books

examples of high-tech AT

• computers/laptops

• smartpens

• smartphone

• apps over $100

• joystick access

hard technology

• refers to tangible device

• computer hardware, AAC device, hearing aid, mobility device

soft technology

• less tangible aspects that support the use of a device

• includes other people written or auditory material

how to apply HAAT model to AT

• product and research development

• product usability studies

• client assessment

• outcome evaluation

preparatory studies should be done prior to _____ design

product

_____ _____ of individuals with disabilities are critical parts of AT research and development process

lived experiences

usability

how well the user is able to access the device’s functionality

key features of usability

• learnability

• efficiency

• memorability

• errors

• satisfaction

• ease of use

Clinical assessment in AT

1. identification of need to be addressed by AT use

2. assessment of key aspects

3. synthesis of assessment results

4. device recommendation

5. formal and informal assessments

6. may include procurement of funding

OTs use AT as an intervention to

improve client’s performance, enable participation, maintain their meaningful engagement in occupation

OT scope of practice within AT

• evaluating AT needs

• developing and implementing intervention plans that incorporate AT to support occupational performance

• training clients, caregivers, and team members on use of AT

• coordinating services and resources for teams

• advocating reimbursement and funding for AT devices and services

• engaging in outcome measurement and scholarly work that builds evidence for the use of AT in OT services

what does intervention look like with AT?

the OT designs, fabricates, applies, modifies, and provides training with various forms of AT and tools as part of the intervention process to promote participation in occupation and enable access