1. Chapter 22 Assistive Technology by Debra Young, MEd, OTR/L, SCEM, ATP, CAPS

2. Learning Objectives (cont.)
After studying this chapter, readers should be able to (cont.):
Summarize assistive technology legislation as it relates to occupational therapy practice.
Apply assistive technology models to occupational therapy practice to guide the use of assistive technology as a preparatory method to support occupational performance.

3. Learning Objectives (cont.)
After studying this chapter, readers should be able to (cont.):
Explain the assistive technology assessment process to feature match match assistive technology to client needs to support occupational performance.
Be aware of assistive technology supports that maximize fit and support client occupational performance with the targeted outcome of client carryover of use.

4. History of Assistive Technology (cont.)
Use of assistive tools to complete daily tasks goes back thousands of years.
Tools adapted to help others with special needs in society.

5. History of Assistive Technology (cont.)
Tools meant for those with special needs became part of mainstream society.
Tools continue to be developed, used, and integrated into daily routines.

6. Assistive Technology Legislation (cont.)
1975—Individuals with Disabilities Education Act
Required individualized education programs
These determine and specify assistive technology (AT).
1988—Fair Housing Amendment Act
Reasonable accommodations to private and common living spaces
Architectural access assistive technology

7. Assistive Technology Legislation (cont.)
1988—Hearing Aid Compatibility Act (HAC)
Telephones hearing aid compatible
1990—Television Decoder Circuitry Act
Closed captioning
1990—Americans with Disabilities Act (ADA)
AT falls under reasonable accommodations.

8. Assistive Technology Legislation (cont.)
1996—Telecommunications Act amended
Telecommunications equipment and services accessible and usable
1998—Section 508 of Rehabilitation Act
Electronic and information technology developed, maintained, procured, or used by the Federal government accessible to people with disabilities

9. Assistive Technology Legislation (cont.)
1998—Technology-Related Assistance for Individuals with Disabilities Act (Tech Act)
Provided funding to states
1998—Workforce Investment Act
1998—Carl D. Perkins Vocational and Technical Education Act Amendment

10. Assistive Technology (cont.)
First defined in Federal law in Individuals with Disabilities Education Act (IDEA)
Delineation between:
AT device
AT services

11. Assistive Technology (cont.)
AT used concurrently with occupations to support daily occupational performance
High-tech to low-tech devices
Examples: pencil grip, complex environmental system to manage households

12. Assistive Technology (cont.)
Team approach best for some categories
Example: Augmentative and alternative communication
Collaborate or refer to OT practitioner with specialized training in an area of AT
Example: Adaptive driving

13. Assistive Technology (cont.)
Figure 22.1 An example of an augmentative communication device

14. Assistive Technology Models
International Classification of Functioning
Disability and Health
Person–Environment–Occupation
Human Activity Assistive Technology Model

15. International Classification of Functioning, Disability, and Health (cont.)
Published 2001 by the WHO
Individual and population health framework

16. International Classification of Functioning, Disability, and Health (cont.)
Framework classifies individuals based on :
Body functions
Body structures
Activities and participation
Environmental factors
Personal factors

17. Person–Environment–Occupation Model (cont.)
Law and colleagues, 1996
Transactive framework and approach

18. Person–Environment–Occupation Model (cont.)
Analyzes the dynamic and interdependent relationship between the:
Person
Environment
His/her occupations and roles
Looks at the individual holistically

19. Person–Environment–Occupation Model (cont.)
Series of intrinsic factors
Environment:
Participation impacted by extrinsic characteristics of the environment in which it occurs

20. Person–Environment–Occupation Model (cont.)
Self-directed meaningful tasks and activities
Occupational performance and participation:
Outcome of the interaction of the person, environment, and occupation
Three concentric circles that dynamically interact with one another over time and overlap

21. Person–Environment–Occupation Model (cont.)
Figure 22.5 Person–Environment–Occupation Model (PEOM)

22. Human Activity Assistive Technology Model (cont.)
Cook and Hussey
Developed using the foundations of:
ICF
Canadian Model of Occupational Performance and Enablement
PEOP
Human Performance Model

23. Human Activity Assistive Technology Model (cont.)
Four components:
Human
Intrinsic enabler
AT component
Extrinsic enabler
Context
Where activity is performed
Activity
Determined by an individual’s life roles

24. Human Activity Assistive Technology Model (cont.)
Figure 22.6 The HAAT Model

25. Assessment (cont.)
AT used as part of a treatment session in preparation or concurrently with occupations and activities to support daily occupational performance.
Considering AT use is one part of occupational therapy process.

26. Assessment (cont.)
Other parts:
Occupational profile
Activity analysis
Analysis of occupational performance
Intervention process
AT may be used

27. Human Factors (cont.)
Client factors and performance skills have significant impact on the success or failure of AT interventions.
Up to 75% of success in AT is attributable to human factors.
Thorough occupational profile and knowledge of technology device aids required.

28. Human Factors (cont.)
King 10 essential factors that relate to use or abandonment of AT:
Continuum
Transparent (easy to understand and use)
Opaque (not intuitive and person needs to be taught to use)

29. Human Factors (cont.)
Baker’s Basic Ergonomic Equation, adapted by King for occupational therapy:
Likelihood of success (S) = M/(P+C+L+T)
M = Motivation
P = Physical effort
C = Cognitive effort
T = Time involved

30. Human/Technology Interface (cont.)
Human–technology interface is essential to consider.
Interaction between user and AT device or system includes:
How the user will operate a device (input)
Feedback device provides (output)

31. Human/Technology Interface (cont.)
Cook and Miller Polgar (2014)—three elements of human/technology interface:
Control interface
Hardware person uses to control a device
Selection set
Items from which choices are made
Selection methods
Direct selection
Indirect selection

32. Transmission Methods (cont.)
Refers to systems that require a signal for the device to be controlled
Need to be considered for determination and recommendation of Electronic Aids for Daily Living (EADLs)
Devices that enable a person to control elements within an environment

33. Transmission Methods (cont.)
Potential considerations to meet a client’s needs (cont.):
If the system uses direct wiring and/or X-10 house wiring, what is the backup in case of a power outage?
Can the device be used in the needed environment or does the transmission preclude this?
Does the device require line of sight for the signal to be sent and received?

34. Transmission Methods (cont.)
Potential considerations to meet a client’s needs (cont.):
What is the range the device will transmit a signal?
Is there any concern for signal interference?
Is there limited Internet availability or transmission concern secondary to living in rural environments?

35. Assistive Technology Assessments
Variety of assessment approaches used by OTs
Common to all are:
Feature matching a device to a client’s needs to maximize occupational performance
Ensure successful carryover of use

36. Movement, Control Site, Input Method, Position, and Targeting Assessment (cont.)
Systematic motor access assessment:
Five major components:
Movement
Control site
Input method
Positioning
Targeting

37. Movement, Control Site, Input Method, Position, and Targeting Assessment (cont.)
Other considerations:
Overall response
Accuracy of overall method
Reliability
Overall quality

38. Movement, Control Site, Input Method, Position, and Targeting Assessment (cont.)
Goal:
Assess motor access options for AT use
Make recommendations of best possible access method
Accuracy of overall method/methods

39. Movement, Control Site, Input Method, Position, and Targeting Assessment (cont.)
Assessment gathers data on at least two to three MSIPT components:
Provides evidence to support recommendations

40. Matching Person and Technology (cont.)
Individualized approach
Identifies characteristics that lead to AT device adoption or abandonment

41. Matching Person and Technology (cont.)
Three main components:
Milieu
The environments in which the person uses the technology
Person
The individual’s characteristics and preferences
Technology
The technology’s functions and features

42. Matching Person and Technology (cont.)
Assessment process is a series of self-checklist and questionnaire assessment forms.

43. Student Environment Tasks Tools (cont.)
Use to aid the process of:
Gathering
Organizing
Analyzing data to find appropriate AT

44. Student Environment Tasks Tools (cont.)
Student factor:
Analyzes what does the student need to do
Evaluates what are the student’s current abilities and limitations

45. Student Environment Tasks Tools (cont.)
Environment factor:
Analyzes all aspects of the environment needed to complete an educational task
Tasks factor
Probes further into what activities take place in the environment
Evaluates how difficult they may be for the student

46. Student Environment Tasks Tools (cont.)
Determined after considering the other factors
Low-tech or high-tech

47. Student Environment Tasks Tools (cont.)
Figure SETT Framework

48. Intervention
Process includes:
Preparing the intervention plan
Implementing the plan
Reviewing the plan

49. Intervention Plan (cont.)
Directs the actions of OT practitioners
Describes selected occupational therapy approaches
Describes types of interventions used in reaching the client’s identified outcomes

50. Intervention Plan (cont.)
In addition to client factors and performance skills, also need to match features to the client’s individual needs and abilities.
Ideal system is flexible and adapt to client needs over time.

51. Intervention Plan (cont.)
Questions to ask (cont.):
What are the user’s goals?
What are the user’s values and beliefs regarding AT?
What are the user’s functional capabilities?

52. Intervention Plan (cont.)
Questions to ask (cont.):
What is the user’s cognitive status?
What type of feedback does the user need?
What position(s) will the user be in?

53. Intervention Implementation (cont.)
Process of putting the intervention plan into action.
Client trial in specified environment with OT practitioner present:
Determines if worth purchasing
Every State Tech Act program has an AT loan program.

54. Intervention Implementation (cont.)
Educate and train all people who will come in contact with the device/system:
Client
Caregivers
Staff

55. Intervention Review
Does the data from the trials show success as relates to targeted outcome/outcomes?
Which AT device/system trialed best meets client’s needs?
If none, determine the underlying reasons.

56. Funding (cont.)
How AT device/system funded is individualized.
Based on:
Who is the user
Where the user is receiving services
What AT is being used
In what environment

57. Funding (cont.)
Sources of funding:
School district
Medicaid
Medicare
Private insurance
Vocational rehabilitation program
Self-pay

58. Certification (cont.)
Ethical responsibility of OTs and OTAs to stay up to date on knowledge and techniques related to services provided.

59. Certification (cont.)
Two certifications available to OTs:
AOTA
Specialty Certification in Environmental Modifications (SCEM)
Rehabilitation Engineering and Assistive Technology Society of North America (RESNA)
Assistive Technology Professional (ATP)