Bridging the Gap Between Consumer and Products in Rehabilitation MedicineOccupational TherapistThe Transdisciplinary TeamExpectations of Assistive TechnologyExpectations of Assistive TechnologyExpectations of Assistive TechnologyExpectations of Assistive TechnologyExpectations of Assistive TechnologyExpectations of Assistive TechnologyLevels of Assistive Technology: Some Practical, Working DefinitionsLevels of Assistive Technology: Some Practical, Working ConceptsLevels of Assistive Technology: Some Practical, Working ConceptsLevels of Assistive Technology: Some Practical, Working ConceptsA Continuum of Considerationsfor Assistive Technologyfor the Mechanics of WritingEquipment SuitabilitySteps Needed to Issue an Assistive DeviceInstruction in the Use of the Assistive DeviceReinforcementWho pays?Other Factors Associated with Non-use of Assistive DevicesAccess to Equipment and Rehabilitation Services1Bridging the Gap Between Consumer and Products in Rehabilitation MedicineDeborah E. Kenney, MS OTR/LRehabilitation R&D Center - Veterans Affairs Palo Alto HCSDepartment of Functional Restoration - Stanford University2Occupational Therapist¾Assisting people people who are unable to function independently or are not functioning as independently as possible in the areas of daily living, work, play and leisure.¾Independence is increased through functional activities that are meaningful to the individual. ¾Occupational Therapists treat the whole person!3The Transdisciplinary TeamComputer Engineer Social WorkersFamily/Tutor/Caregiver Occupational Therapist Rehabilitation Counselor Speech-Language Pathologist Assistive Technology Specialist ProsthetistsService Coordinator Medical ConsultantsFabrication/Adaptation Tech Teachers/Special EducatorsTraining Coordinator AT Equipment VendorsAudiologists Hearing Device SpecialistNurse Practitioners Physical Therapists4Expectations of Assistive Technologyz Will allow the individual to:¾Discharge to home¾Return to independent activities of daily living5Expectations of Assistive Technologyz Will allow the individual to:¾Discharge to home¾Return to independent activities of daily livingMobility6Expectations of Assistive Technologyz Will allow the individual to:¾Discharge to home¾Return to independent activities of daily living MobilitySelf Care7Expectations of Assistive Technologyz Will allow the individual to:¾Discharge to home¾Return to independent activities of daily livingMobilitySelf CareCommunication8Expectations of Assistive Technologyz Will allow the individual to:¾Discharge to home¾Return to independent activities of daily livingMobilitySelf CareCommunication Leisure9Expectations of Assistive Technologyz Will allow the individual to:¾Discharge to home¾Return to independent activities of daily livingMobilitySelf CareCommunication LeisureVocation10Levels of Assistive Technology: Some Practical, Working Definitions¾Assistive technology devices can be classified by levels of technology and life skill areas.¾Devices can also be classified by the level of technical training that the user requires to implement the equipment.11Levels of Assistive Technology: Some Practical, Working ConceptsLow Technology Devices¾Equipment that is easy to use and do not require electrical power. May require a short training period.¾Strategies, methods and/or techniques that rely primarily on user's ability to move or utilize various body parts in modified wayFinger spellingKnocking on a door Scooting up/down steps12Levels of Assistive Technology: Some Practical, Working ConceptsElementary Technology Devices¾Include most battery-operated devices. User requires a moderate training period.¾Relatively simple materials and equipment commonly found in living and work space. Off-the-shelf or inexpensive.Basic wheelchair/walkerBuilt-up penModified faucet handleModified eating utensils13Levels of Assistive Technology: Some Practical, Working ConceptsHigh Technology Devices¾Include complex and programmable equipment. User requires specific training in order for the user to take full advantage of their capabilities.¾User integrated with complex electronic, mechanical or hydraulictechnologies to accomplish user’s purpose. Typically expensive.Voice operated ECUElectric liftsModified car/van controlsMotorized wheelchair14A Continuum of Considerationsfor Assistive Technologyfor the Mechanics of WritingRegular pen or pencilPencil or pen with adapted gripAdapted paper (e.g. raised line, highlighted lines)Voice Recognition softwareSlant board to create slanted writing surfaceTypewriterPortable note taker that interfaces with computerComputer with word processing softwareWord prediction/abbreviation expansion software for efficiency(Adapted by ATTO from WATI, 1998)15Equipment Suitability¾Age¾Gender¾Perception of self¾Culture¾Support¾Pre prescription home visit16Steps Needed to Issue an Assistive Device¾Selection of a device for an activity¾Site and method of instruction¾Time to introduce device during hospitalization¾Reinforcement of its use¾Written justification to insurance company17Instruction in the Use of the Assistive Device¾Repetition is key¾Types of instruction:demonstrationpracticing actual skills in hospital environmentwrittenvideo18ReinforcementTransition of skills to community/home environmentFollow-upSupport groupsRefresher training may be necessary19Who pays?OUserOInsurancePrivatemanaged carefee-for-servicesMedicareOVA20Other Factors Associated with Non-use of Assistive DevicesOToo many devices!OChange in habits to make ADLs easier21Access to Equipment and Rehabilitation Services(Bingham and Beatty, 2003)>50% needed assistive equipment in last 12 months30% were unable to get needed equipment40% needed rehabilitation services in last 3 months>50% did not receive those