1. Assistive Technology and Adaptive Computing Overview
George Gober
Assistive Technology Associate
Research Department
Methodist Rehabilitation Center

2. Methodist Rehabilitation Center
Objectives
Define Assistive Technology and associated terminology
Introduce the IEP process
Identify categories of AT with examples of equipment
Introduce training opportunities and certifications
Provide info regarding AT resources
A vision of the future of AT
Methodist Rehabilitation Center

3. What is Assistive Technology?
The Individuals with Disabilities Education Act
IDEA ‘97 (Public Law ) mandates the provision of assistive technology and offers clear definitions of assistive technology devices and services.
Methodist Rehabilitation Center

4. Assistive Technology Devices
Definition
Assistive Technology Devices
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 the functional capabilities of children with disabilities. (Section 300.5)
Most of the common complications Persons who are chronically sick, aged, or disabled are particularly susceptible to the adverse effects of immobility.
Methodist Rehabilitation Center

5. Assistive Technology Services
Definition
Assistive Technology Services
Any service that directly assists an individual with a disability in the selection, acquisition, or use of an assistive technology device. (Section 300.5)
Evaluating
Providing devices
Selecting, Designing, Customizing
Maintaining, Repairing
Coordinating
Training/Technical Assistance –student, family and school service providers
Most of the common complications Persons who are chronically sick, aged, or disabled are particularly susceptible to the adverse effects of immobility.
Methodist Rehabilitation Center

6. IEP Team Student, Parents Assistive Technology Specialist
Special Education Teacher
General Education Teacher
Occupational Therapist, Speech and Language Pathologist, Physical Therapist,
School Administrator
School Psychologist
Virchow’s Triad
Vessel damage
Blood hypercoagulability
Stasis
The incidence of DVT after stroke without prophylaxis is 23 to 75%. The development of DVT has been correlated to the degree of lower extremity paralysis and ambulatory status.
Mechanical measures and pharmacologic prophylaxis.

7. Methodist Rehabilitation Center
AT support for IEP
Positioning
Physical access for learning tools/computers
Writing (Physical and Composition)
Math
Reading
Learning/Studying
Organization
Communication
Specific sensory deficits
Aids for Daily Living
Muscle weakness is the functional consequence of muscle atrophy. Loss of strength is rapid after the 1st day of immobilization and tends to reach its maximum 10 to 14 days later.
The rate of muscle weight loss during bedrest is slow during the 1st 1 to 2 days, but becomes rapid thereafter. By 10 days approaches 50% of muscle weight loss with muscle protein synthesis decreasing to 50% of baseline at 14 days of immobilization.
Loss of strength and atrophy is more prominent in the legs than the arms. Loss of endurance: unexercised muscle demonstrates a reduction of ATP & glycogen storage and rapid depletion after resumption of activity. Resistive leg exercises can maintain muscle protein synthesis.
Healthy subjects on prolonged bedrest develop shortening of musculature of back and legs, especially those muscles that cross the hip and knee joints. Neurologically impaired individual with weakness and/or spasticity develops the same except at an accelerated rate.
Prevention: proper positioning in bed, resting splints, ROM exercises, early mobilization and ambulation
Treatment: PROM with terminal stretch, heat, progressive dynamic splinting and casting, pain management
Back pain: due to tightness of back & hamstring muscles and/or weakness of back and abdominal muscles
Methodist Rehabilitation Center

8. Methodist Rehabilitation Center
Positioning
During lengthy periods of bedrest, there’s a progressive decline in blood volume: reduction of 13% by day 4 and maximum reduction of 15% by day 14. There’s a decrease in cardiac output due to decrease in blood pressure and decreased secretion of antidiuretic hormone. Over about 2 to 4 weeks RBC mass decreases and Hct begins to drop. The plasma volume decreases more that the RBC mass resulting in and increased blood viscosity.
Normally upon laying down 500ml of blood shifts to the thorax. After several days of bed rest, if a healthy person stands up from supine, the usual shift of 500 ml from the thorax into the legs causes blood pooling due to impaired venous return. In healthy people, adaptation to upright position may be completely lost after 3 weeks bed rest. To restore the normal postural cardiovascular response, it can take 2 to 72 days.
The resting pulse rate is relative to a person’s cardiac efficiency. During periods of bedrest the resting pulse rate increases approximately 1 bpm every 2 days. Between 26 to 72 days of continued activity is needed until the resting pulse returns to baseline after 3 weeks of bedrest.
Prevention: early mobilization, ROM exercises, strengthening exercises (supine & upright), abdominal strengthening, isotonic/isometric exercises of legs, support garments
Methodist Rehabilitation Center

9. Physical Access to Computers

10. Writing Low-tech writing aids High-tech software assists example:
Co:Writer from Don Johnston

11. Math Visually enhanced calculator Talking calculator
Talking scientific calculator

12. Reading Low-tech solutions High-tech hardware
Text-to-Speech and Scan-and-Read
software
(OCR)

13. Learning / Studying Internet High-tech software solutions
Example: WYNN from Freedom Scientific

14. Organization Bar code identification Braille tags
Watches with reminders
Software assists…signals, reminders, scheduling programs
Hand held recorders

15. Communication Low-tech communication board
AAC: Alternative and Augmentative Communication
Independent devices and computer based software

16. Sensory Deficits Hearing Vision Alerts, signals
Assistive Listening Device (ALD)
Personal FM
Induction Loop
Captioning
Vision
Magnifiers
Readers
CCTV
Braille

17. Aids for Daily Living Special handles for classroom utensils
Special switches
Reachers
Chalkboard options
Special toilet needs

18. Methodist Rehabilitation Center
Major Categories of AT
Aids for Daily Living
Communication
Computing
Mobility, Seating and Positioning, & Adapted Transportation
Sensory Aids
During lengthy periods of bedrest, there’s a progressive decline in blood volume: reduction of 13% by day 4 and maximum reduction of 15% by day 14. There’s a decrease in cardiac output due to decrease in blood pressure and decreased secretion of antidiuretic hormone. Over about 2 to 4 weeks RBC mass decreases and Hct begins to drop. The plasma volume decreases more that the RBC mass resulting in and increased blood viscosity.
Normally upon laying down 500ml of blood shifts to the thorax. After several days of bed rest, if a healthy person stands up from supine, the usual shift of 500 ml from the thorax into the legs causes blood pooling due to impaired venous return. In healthy people, adaptation to upright position may be completely lost after 3 weeks bed rest. To restore the normal postural cardiovascular response, it can take 2 to 72 days.
The resting pulse rate is relative to a person’s cardiac efficiency. During periods of bedrest the resting pulse rate increases approximately 1 bpm every 2 days. Between 26 to 72 days of continued activity is needed until the resting pulse returns to baseline after 3 weeks of bedrest.
Prevention: early mobilization, ROM exercises, strengthening exercises (supine & upright), abdominal strengthening, isotonic/isometric exercises of legs, support garments
Methodist Rehabilitation Center

19. Aids for Daily Living Home accommodations
Utensils and tools
Lifts, elevators, ramps
Bathroom assists
Home modifications
Workplace or school accommodations
Special workstations
Ergonomic equipment

20. Utensils and Tools Low Tech
Eating Implements
Kitchen Utensils
Tools
Modification types
Straps
Weights
Ergonomic handles

21. Utensils and Tools High Tech
Assistive feeding machines
Barcode scanners for grocery items

22. Communication AAC: Alternative and Augmentative Communication
Digital Speech
Recorded speech
Independent devices
Computer based software

23. Computers Input Devices Output Devices Ergonomics Keystroke Reduction
Accessibility Issues

24. Mobility Support canes White canes Walkers Manual wheelchairs Scooters
Power wheelchairs

25. Sensory Aids Hearing Vision Alarms, alerts TTY Phones (TDD) Captioning
Talking Devices
Bar Code organization
Magnifiers

26. AT Certifications
Assistive Technology assessments typically performed by a PT or an OT
RESNA :
Assistive Technology Practitioner (ATP)
Assistive Technology Supplier (ATS)
ATACP (online from CalState Northridge)
Assistive Technology Applications Certificate Program
Certificate in Assistive Technology
Graduate programs in BioMedical Engineering

27. The Future of Assistive Technology
Universal Design
Moore’s Law
Convergent Technologies
Emerging Technologies
Virtual Reality
Neuroprosthetics