Definitions

The formal definition of assistive technology (AT), according to the federal government, is as follows: “Any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase or improve functional capabilities of individuals with disabilities.”^* The important thing to remember about this definition is the fact that anything that helps a person be more functional is considered AT. The term assistive technology naturally makes one think that AT has to be commercially manufactured and expensive; however, this is not always the case. Also formally defined in the law is the term assistive technology services (AT services). This term includes “any service that directly assists an individual with a disability in the selection, acquisition, or use of an assistive technology device.”^** The inclusion of a service component is particularly important to occupational therapy (OT) practitioners, and this suggests that those who framed this legislation realized an important truth: Eequipment alone is not enough; professional services are also required for the evaluation of AT and the training for its use.

Why should we consider the use of AT in the care of individuals with disabilities? A brief look at the World Health Organization’s distinction of the terms health condition, activity limitations, and participation restrictions illustrate the importance of AT. Let us say that a child is born without his upper extremities (health condition), and so he is unable to perform basic activities of daily living (activity limitation) (the World Health Organization Web site: http://apps.who.int/classifications/icfbrowser/, accessed September 23, 2009). If this child is prevented from participating in a local drawing class because of this health condition or activity limitation, then his participation has been restricted. AT addresses the health condition aspect of the individual and minimizes activity limitations because when an aid or device that will allow the individual to meet the goal of drawing is identified, he or she can assume his or her role in society (e.g., a young child who wants to draw) and the health condition is thereby minimized.

Assistive technology team

Interdisciplinary teamwork is considered the cornerstone of effective rehabilitation.² The need for teamwork is particularly crucial as it relates to the use of AT. The disciplines represented as part of the assistive technology team (AT team) may vary according to the needs of the client and health condition or body functions (Box 26-1). For example, a physical therapist provides important information about gross motor strength and function as well as positioning for function and mobility. The occupational therapist gives valuable input relative to fine motor function, participation in activities of daily living (ADLs) and positioning for access. The speech–language pathologist is concerned with overall communication ability as well as specific strengths and abilities related to language comprehension and language expression. The user, and his or her parents, guardians, or caregivers, are always the central members of the team and should be involved in all aspects of equipment decision making and/or implementation. Additional team members could include a rehabilitation engineer charged with designing or fabricating aids or devices, an equipment vendor who provides medical equipment supplies and a teacher concerned with using technology to assist a student in meeting his or her educational potential and achieving educational goals. Regardless of which professionals make up an individual team, it is the responsibility of each AT team to work together to decide what technology will be of benefit to an individual user, how it will be used, how equipment will be maintained, and how the impact of the technology will be measured.⁴

Role of the cota

AT services vary depending on the setting and the experience of the individuals comprising the AT team. As such, the role of the certified occupational therapist (COTA) will also vary according to setting and experience. The registered occupational therapist (OTR) and the COTA are important members of the AT evaluation and service provision team.

At one time or another, the OTR and the COTA may be involved in securing necessary funding for AT, supervising the use of equipment, measuring outcomes related to equipment use, and equipment fabrication and/or adaptation. Additional roles of the COTA could include client and family education and instruction in the use of AT as well as education and instruction for other team members such as regular and special educators and classroom assistants.

Characteristics of assistive technology

The term assistive technology is used to describe a broad array of assistive aids and devices that include, but are not limited to, aids for daily living, seating and positioning aids, communication aids and devices, environmental control units, aids for persons with visual impairments, and assistive listening devices. As a group, these technologies share common characteristics, which are important to understand in delivering quality AT services (Table 26-1). First, and most important, is a solid understanding of the distinction between “assistive technology” and rehabilitative, educational, or medical technology.⁵ The term assistive technology should only be used to refer to aids and devices that are used daily to complete a given task. The terms rehabilitative or educational technology should be used when referring to the use of technology as only one aspect of an overall rehabilitation or education program. Medical technology refers to the use of technology to support or improve life functions. The following case study illustrates why this distinction is so important.

Recall that our definition of AT emphasizes function, not disability. Since Marissa has to work very hard to activate the toy and this is only one of many activities she is engaged in to increase independent head control, the use of the toy and switch would be considered rehabilitative technology.

You might still be confused as to why this distinction is so important. Consider that in the scenario with Tyronne, our goal is to make technology easy to access. But, in the second scenario, with Marissa, the technology is actually hard to access, since we are challenging her to move in ways that are not easy for her. We would certainly not want an individual to work as hard as Marissa if our goal was daily, independent play! This distinction is important for more practical reasons as well. For example, the use of AT daily (as in the case of Tyronne) or temporarily (as in the case of Marissa) has a direct impact on considerations of durability, cost, and operational difficulty. If we are going to use a device for the development of a particular skill, we would not want to spend large amounts of money or consider an option that would require a significant amount of lead time to achieve operational competence. Instead, we would limit our options to an aid or device that was relatively inexpensive and easy to learn. This distinction between assistive and rehabilitative or educational technology is also very important for setting technology-related goals as well as gauging our expectations for technology use (i.e., whether we expect AT to be used daily or over a long period of time).

Another characteristic of AT is that it can be categorized as low technology or high technology.⁵ This distinction is somewhat self-explanatory. Low technology is easy to obtain, easy to use, and of relatively low cost. In contrast, high technology is more difficult to obtain, requires greater skill to use, and is frequently more costly. We consider these factors when weighing options for individual users. For example, if we are working with an individual who we know to be “technophobic,” then we would probably want to keep our AT options toward the low technology end. At the same time, we do not want to make AT decisions simply based on the fact that someone enjoys and is comfortable with technology. This author’s motto is simple: Never buy a Jaguar when a Volkswagen will do! To be safe, we should always make sure that our decisions about technology are based on the goals and abilities of the client.⁷

The final characteristic of AT that we need to discuss is the distinction between assistive technology tools and assistive technology appliances.⁵ The term assistive appliance includes any aid or device that provides benefit to the user with little to no training or development of skill. This could include items such as eyeglasses or orthotics. An assistive tool, on the other hand, requires the development of skill in order for it to be of value to the user. Examples of assistive tools include feeding machines, communication aids and devices, and mobility aids. This distinction is especially important when speaking with users and caregivers about their expectations of AT. A good example is the selection of a communication aid or device. Too often, there are misconceptions that if we “just find the right thing,” the user will be able to communicate instantaneously. It is important for everyone to be clear about the fact that any communication aid or device is an assistive tool and, as such, requires a certain degree of training before it can be of benefit to the user.

Assistive technology myths and realities

In their book on assistive technology, Jan Galvin and Marcia Scherer describe a number of myths and realities with respect to AT, many of which are important to share before moving forward.⁷ As already mentioned, AT does not need to be expensive or complicated. A simple pad and pencil can be the perfect communication aid. Moreover, keep in mind that people with the same disability do not necessarily require the same devices. For example, the same wheelchair is not recommended for every person needing one! It is especially important to keep in mind that “assessment,” as it relates to AT, is an ongoing process. It is simply not possible to know everything about an individual user in the course of three or even four encounters. Additionally, as users develop and improve their skills as a result of intervention, reassessment of AT needs is warranted. We will discuss this further when we talk about the assessment process. Lastly, it is important to be open to multiple sources of information when it comes to AT. The field of AT is changing at a remarkably rapid pace, and it is very difficult for any single professional to be familiar with everything that is available. Consequently, consumers, family members and even vendors can provide us with valuable input about appropriate technology for individual users.