What is AT and  how can it  be of benefit 

We are in the age of technology.   We would have a hard time just making it through the day without technology and how it assists us in our daily tasks. 

Assisitve technology is just the applied use of technology.  Eye glasses and contacts, remote controls, wheel chairs, cordless phones, hearing aides, E-mail, TTY phones, closed captioning TV are just a few examples of how we employ technology to make our daily functioning easier. 

As therapists, we are concerned with functioning in life rolls. The tasks that can easily be taken for granted by many individuals (using a phone, TV, dressing, cooking, eating, walking,  talking, driving a car…etc.) can also be suddenly disrupted by fate.

I call this program practical assistive technology.  I chose this term because what we practice at the St. Ambrose University assistive technology lab. Our budget is not large and yet we supply the community with long-term loans of equipment ranging from simple tilt boxes to environment controls.  I have also found that if a patient is to stick with a piece of technology it should address their specific needs and not just what is available.  Also, this can be much less expensive.  The total amount of material in our environmental control units is less and $500.  Our total hip warning boxes have less than four dollars of materials.

If we limit ourselves to just what is available off the shelf or out of a catalog then we are really just limiting how well we can help our patients.

I like to think of the education process as an individual gathering tools and skills to use in their professional life.  The greater the number of unique tools and skills a person has in their professional tool box will allow a person to help a greater variety of patients. One of my favorite tools that has helped a wide variety of individuals is assistive technology. 

What is Assistive Technology?

 These definitions also appear in the Tech Act Legislation (P.L.100-407) which has been adopted in the Individuals with Disabilities Education Act (IDEA). IDEA defines an assistive technology device as:

 ...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. [20 U.S.C. Chapter 33, Section 1401 (25)]. 

This definition is broad and includes a range of devices from low technology to high technology items as well as software. Under IDEA the legal definition of assistive technology services is:

...any service that directly assists an individual with a disability in the selection, acquisition, or use of an assistive technology

device.[20 U.S.C. Chapter 33, Section 1401 (26)] 

Specifically, assistive technology services include:  the evaluation of the needs of an individual with a disability, including a functional evaluation of the individual in the individuals customary environment; purchasing, leasing, or otherwise providing for the acquisition of assistive technology devices by individuals with disabilities; selecting, designing, fitting, customizing, adapting, applying, maintaining, repairing, or replacing of assistive technology services; coordinating and using other therapies, interventions, or services with assistive technology devices, such as those associated with existing education and rehabilitation plans and programs; training or technical assistance for an individual with disabilities, or, where appropriate, the family of an individual with     disabilities; and training or technical assistance for professionals (including individuals providing education and rehabilitation services), employers, or other individuals who provide services to, employ, or are otherwise substantially involved in the major life functions of individuals with disabilities.  

Assistive Technology -- technology for more independent, productive and enjoyable living -- can be simple or complex. It includes, Velcro, adapted clothing and toys, computers, seating systems powered mobility, augmentative communication devices, special switches, assisted listening devices, visual aids, memory prosthetics, and thousands of other commercially available or adapted items. These technology solutions improve an individual's ability to learn, compete, work and interact with family and friends. People use assistive technology to achieve greater independence and to enhance the quality of their lives. Services, such as evaluations, training, or trial use of new equipment are also examples of assistive technology.

Categories of Assistive Technology

Aids for Daily Living: 

Self help aids for use in activities such as eating, bathing, cooking, dressing, toileting, home maintenance, etc. 

Augmentative or Alternative Communication (AAC): 

Electronic and non-electronic devices that provide a means for expressive and receptive communication for persons with limited or no speech. I have recorded a message for several patients that can be played by the phone asking for help that give all the salient information for a individual to call for help but has limited speaking skills. 

Computer Accessibility 

Input and output devices (voice input, Braille), alternate access aids (headsticks, light pointers), key board masks or large key keyboards, adapted mice, switches, special software, etc. that enable persons with disabilities to use a computer. This category includes speech recognition software. There is help built into many OS to assist with coordination or visual limitations i.e.; sticky keys and high contrast screens built into windows. HOW: click start, settings, control panel and then double click accessibility options.) 

Environmental Control Systems:

Devices that enable someone with limited coordination or mobility to control various appliances, i.e. telephones, TV, VCR, Cable, Lights, and Fans in their room, home or other surroundings. Home automation is a very hot topic right now. There are many web sites to assist , train, and sell you need items. Home automation is much cheaper than you think and easily used right off the shelf to provide the assist needed to increase ours patients functioning!  See X-10.com or smarthome.com

Home/Worksite Modifications:

Adaptations in the home, worksite or other area (ramps, home elevators, wheelchair accessible showers) that remove or reduce physical barriers for an individual with a disability. Simply removing throw rugs is a good start to any individual with limited mobility.

Prosthetics and Orthotics:

Myoelectric prosthetics or other orthotic aids (splints, braces, etc.). There are also prosthetics to assist with cognitive limitations or deficits, including audio tapes, digital recorders, electronic memos, and pagers (that function as prompts or reminders).  

Seating and Positioning:

Accommodations to a wheelchair or other seating systems to provide greater body stability, trunk/head support and an upright posture, to increase functioning. Moble arm supports to assist with arm movements by assisting with weak muscles. High tech inserts and cushions that assist in reducing  pressure on the skin's surface. 

Aids for Vision Impaired:

Visual aids for specific populations including magnifiers, Braille or speech output devices, large print screens, closed circuit television for magnifying documents, etc.  Magna-glide is a great help for diabetics  

Aids for Hearing Impaired:

Aids for specific populations including assistive listening devices (infrared, FM loop systems), hearing aids, TTYs, visual (lights flash when the telephone rings) and tactile alerting systems,  etc. (did you know you can have your computer flash a part of the screen instead of beeping- see accessibility options in the control panel page. HOW: click start, settings, control panel and then double click accessibility options.) 

Wheelchairs/Mobility Aids:

Manual and electric wheelchairs, Addable inputs such as sip and puff controllers, head switches and programmable controllers that can filter out tremors or ataxic movements with joystick controllers.

 Vehicle Modifications:

Adaptive driving aids, low-strength power assists,  hand controls, micro-switches, wheelchair and other lifts, modified vans, or other motor vehicles used for personal transportation

Many time assistive technology is not always apparent. I once used a small vice grip pliers mounted on a board (for stability) for a patient of mine to assist with opening up his accu-check strips. I remember the feedback of his diabetic trainer saying how proud he was that he was still independent with his diabetic tasks. The point is, it is not just the high tech that is the most important, but how any device can be used to assist a patient!

The Impact & Benefit of Assistive Technology 

A preliminary study (National Council on Disability, 1993) surveyed 136 individuals with disabilities to evaluate the costs and benefits associated with the use of different kinds of technology-related assistance. The individuals were from four age groups and the results indicate a significant impact of AT on many aspects of the respondents lives, including: the majority of infants with disabilities benefited by having fewer health problems because of AT; nearly 75% of school age children were able to remain in a regular classroom, and 45 % were able to reduce their use of school-related services; 65% of working-age persons were able to reduce dependence on family members, 58% were able to reduce dependence on paid assistance, and 37% were able to increase earnings Among elderly persons, 80% were able to reduce dependence on others, half were able to reduce dependency on paid persons, and half were able to avoid entering a nursing home. These results indicate that the issue becomes not how can we afford effective AT, but what costs are involved if it is not provided.