ASSISTIVE TECH: OT METHODS

SETT Framework

"SETT" = 1. Students (What are the students needs & abilities?) 2. Environment (What are the students educational environments?) 3. Tasks (What activities take place in the expectations?) 4. Tools (What accommodations, strategies and solutions should be considered?) - Guides teams seeking to identify supports and services for students with disabilities - Used primarily in educational setting - Team approach for collaborative decision-making regarding AT 1. Student-centered 2. Environmentally useful 3. Tasks-focused

Discrete or continuous appliance

(TV, VCR, CD, cassette tape control) - IR remote transmission

Switch Control

(any device requiring one or two switches) - hardwiring IR link to the switch box (smart plug) - switch (relay) output from EADLs

Momentary control of appliances

(door opener, drapery control) - Powerline transmission - RF remote transmission

Binary latched control of appliances

(lights, radio, on and off only) - Powerline transmission - RF transmission to smart plug

AT legislation: IDEA/IDEAIA

- 1975 - ensures a free, appropriate public education for children with disabilities - AT language added * Section 300.5 assistive technology * Section 300.6 assistive technology service (includes evaluation, functional eval, selecting, designing, fitting, customizing, adapting, applying, maintaining, repairing, or replacing AT device, coordinating using over therapies, interventions or services w/ AT devices such as those associated w/ existing education/rehab plans & programs. Training, or technical assistance provided for professionals, individuals, employer, or if appropriate family included.) - AT must be considered and documented and students individualized education plan (IEP)

AT legislation: AT Act

- 1998 later revised 2004 - increase access, availability, and funding for AT through national and state initiatives 1. Title I: State grants 2. Title II: National programs - provide support to states to build capacity to address AT needs for individuals with disabilities - requires state AT programs to serve individual of ALL ages with disabilities in ALL environments - includes all type of assistive technology

2015 Disability status report for USA

- 54 million Americans living w/ a disability - result of interaction between person and their environmental barriers - 65 yrs or older has highest disability rate (Top 6 reported disabilities) 1. Visual 2. Hearing 3. Ambulatory 4. Cognitive 5. Self-care 6. Independent living

Occupational therapy code of ethics

- AOTA, 1977 * Core values to guide members toward ethical courses of action in professional and volunteer roles *Six principles 1. Beneficence 2. Non-Maleficence 3. Autonomy 4. Justice 5. Veracity 6. Fidelity *Seven core values 1. Altruism 2. Equality 3. Freedom 4. Justice 5. Dignity 6. Truth 7. Prudence

AT & Occupational Performance

- AT device can help ENHANCE or IMPROVE a clients functioning, participation and overall quality of life. OT domain: " achieving health, well-being, and participation in life through engagement in occupation". - Occupational performance is the act of doing and accomplishing an activity or task through an action

AT and privacy

- Accessibility privacy is when the person is physically left alone and free from intrusion in their physical space - Decisional privacy is freedom to make personal choices and decisions - Informational privacy is control over ones personal information

Assistive Technology Legislation

- Americans with Disabilities Act (ADA) - Rehabilitation Act (Rehab Act) - Assistive Technology Act (AT Act) - Individuals with Disabilities Education Act (IDEA)

OT & AT: Intervention

- Create/Promote: doesn't assume disability is present or that any aspect would interfere with performance. - Establish/restore: augment that process and our approach will be designed to change the client variables that are impacting their occupational performance in a negative manner - Maintain: help with those who might have degenerative conditions (RA, muscular dystrophy) that's losing functioning and we want to maintain where they are at, ease burden and workload of independence - Modify: compensate or adapt, adapt the task or tool that is being used. Prevent: further impairment due to overuse or overexertion. Prevent any further damage or loss of functioning

AT legislation: ADA

- Disability defined as mental or physical limit that affects one or more major life activities, record/history of impairment, or a person who is perceived by other as having an impairment. - Applied to US Congress - Person must have a relationship or a association with the person that has the disability - DOES NOT list specifically name all impairments covered - Prohibits discrimination on the basis of disability 1. Title 1: Employment (employers or religious entities w/ 15 or more employees) 2. Title II: State/Local government agencies & public transportation 3. Title III: Public accommodations 4. Title IV: Telecommunications

EDAL recommendations

- Empowerment of client - Improvement of client quality of life - Reduce need for attendant (caregiver) care - Provide access to attendant call systems and other devices in environment

Ethical issues in AT

- Ethics Constructed norms - Professional ethics Code of values and norms that guide practical decisions

AT Frameworks & models

- Human Activity Assistive Technology Model (HAAT) - SETT Framework - OCTOPUS Framework

Primary reason EADLs are NOT recommended...

- Lack of external funding + high cost of devices - Limited availability of different type of devices - Limited knowledge of available devices - Limited opportunities to trial devices

EADLs Assessment Outcome

- Listing of EDAL functions desired in priority order - Listing other electronic devices that a client uses - Identification of the environment in which EADL will be used - Determination of cognitive abilities related to EADL operation - Evaluation of clients motivation to use EADLs - Identification of control sites and control interfaces

Technology

- Mobile devices 1. tablets 2. phones 3. wearables - Computer/laptops - Switches - environmental control - Seating & mobility - Driving - ADLs - Other

AT Options: Mid & High Tech

- More complex electronics - Costly - Require training - May be highly customizable Eye gaze systems, head control mice, complex switches, bio-physiological interfaces such as myoelectric prostheses, prostheses, high-end seating, empowered mobility devices, hearing and vision aids, and environmental control units.

Human Activity Assistive Technology Model (HAAT) continued...

- Process of doing something - Functional result of human performance - Necessary for human existence Principles of HAAT 1. Product research & development 2. Usability 3. Clinical assessment 4. Outcome evaluation

AT legislation: Rehab Act 1973

- Replaces the Vocational rehab act 1. Section 504 - reasonable accommodations 2. AT in vocational rehab - Rehabilitation engineering - vocational rehabilitation services - individualized written rehabilitation programs - individualized plans for employment 3. Section 508 -access to electronic office equipment - accessible electronic or information technology

AT Options: No & Low Tech

- Simple tools and adaptations - Often readily available - Inexpensive - Require little training Builds up handles, dressing devices, reachers, pencil grips, adaptive cutting boards, grab bars, tubs/shower chairs, wireless keyboards, adaptations and modifications to computers (key guards/adaptive keyboards), and simple adaptive seating (ball chair/seat cushion).

Occupations

- engaging in occupations should have meaning, purpose & value to the individual. 1. ADLs 2. IADLs 3. Rest/sleep 4. Education/work 5. Play/leisure 6. Social participation

Distinct value of occupational therapy & AT

- improve health and quality of life through facilitating participation and engagement and occupations - client centered focused on function, aim to achieve positive outcomes and cost effective

Two types of switch controls available on most EADLs...

- momentary control: switch closure is active only as long as the switch is pressed. The output remains active only while the control interface is activated (I.e., a switched pressed) - latched control: A switch closure is turned on by the first activation and off by the next activation, and it toggles between these two states with each activation. Can be useful when turning on an appliance such as light or radio or when sustained switch activation is difficult for the user.

OT & AT: ADLs, IADLs, rest and sleep

1. AT recommendation 2. OTs as makers - Adapting tools - 3-D printing to create AT *developing AT To address client occupational performance challenges

Occupations: ADLs

1. Activities of daily living - self-care activities' - Basic activities of daily living (BADLs), personal activities of daily living (PADLs) 2. Include: - dressing, feeding, eating/swallowing, bathing/showering, personal hygiene and grooming, toileting and toilet hygiene, functional mobility, sexual activity and personal device care

Occupational performance: Sleep Assessment

1. Children and adolescents: - sleep disturbance scale for children (SDSC) - children's sleep habits questionnaire (CSHQ) - children's sleep wake scale - adolescence sleep hygiene scale 2. Adults - PROMIS Sleep disturbance - level 2 - sleep disturbance — adult (PROMIS — sleep disturbance — short form) - Pittsburgh sleep quality index (PSQI) - Consensus sleep diary - Insomnia severity index

Occupations: Defined

1. Daily life activities: - individuals, groups and populations - wants, need, expected to do 2. Client-centered - personal identity - sense of competence - value and meaning 3. Human aspects - doing, being, becoming, belonging

Application of ethical concepts in OT

1. Determine the nature of the situation: - Ethical distress (the appropriate next step is obvious) - ethical dilemma (the next step is not so obvious) 2. Assess - Who is involved? - What additional information is needed to move forward? - Separate facts from assumptions 3. Consider alternative action and probable consequence 4. Which items from the code of ethics can guide you 5. Consider other ethical principles and add additional resources 6. Make a decision that you can ethically defend and carry out 7. Reflect and assess the outcome

Fundamental approaches to sensory aids

1. Environmental interface: detects the sensory data that the human cannot obtain through their own sensory system 2. Information processor - environmental interface signal is fed to an information processor to amplify the signal - dependent on the type of sensory aid 3. User display: portrays the sensory information for the human user

Four functions of EADLs

1. Environmental regulation: temperature, lighting, some pressure relief devices 2. Information acquisition: Controls audiovisual equipment, electrically powered page turners, other electric devices 3. Safety/security: notify users that someone is at their home/apartment allow them to see that individual remotely through camera and remotely unlock & lock. Detect an emergency or contact service in case of emergency 4. Communication: include the use of a telephone to both place and receive a call, intercom system such as those to identify visitors at the front door, attendant calls

AT for vision

1. HAAT model - 2 primary intrinsic enabler's of the human are sensory and perception - impairments and either of these functions will require the use of sensory aids 2. Sensory aids - level of impairment is critical for use - Sufficient residual function in primary system - input is augmented to make it more useful to the person Ex: magnifying glass - insufficient residual function in primary system - sensory aid must use alternative sensory pathways Ex: Braille (touch)

Performance patterns include

1. Habits (specific automatic behaviors that can be useful dominating or impoverished) 2. Routines (establish sequences of occupation that provide a structure of daily life) 3. Roles (set behaviors expected by society and shaped by context and culture) 4. Rituals (symbolic actions with spiritual, cultural or social meaning) - All can either support or hinder occupational performance

Human Activity Assistive Technology Model (HAAT)

1. Human - Motor - Sensory - Cognitive - Affective l - Novice/expert *assessed initially & on going* 2. Context - Physical: natural environment that's support and hinder participation - Social: friends family, teachers, etc - Cultural: beliefs, rituals, and values - Institutional: legislation & funding * the access to service delivery & use of technology* 3. Activity - Cognition - Communication - Manipulation - Mobility *any execution of task that a person needs or wants to engage in. Includes temporal aspect of length and frequency of participation.*

Occupations: IADLs

1. Instrumental activities of daily living - support home and community life - often more complex than ADLs 2. Include: - care of others, care of pets, child rearing, communication management, driving and community mobility, financial management, health management and maintenance, home establishment and management, meal preparation and cleanup, religious/spirituality, safety/emergency, shopping

Performance skills include

1. Motor Skills 2. Process Skills 3. Social Interaction Skills - Client demonstrated abilities - Goal directed actions that are observable a small units of engagement and daily life occupations. They are learned and developed overtime situated and specific environment and contexts.

Occupations: Rest and Sleep

1. Rest/sleep - activities for restoration - support healthy, active occupational engagement 2. Include: - rest, sleep preparation, and sleep participation

Training & education AT device

1. Teach client basic functions of the device 2. Start simple, build to complex 3. Ensure success 4. Select meaningful activity 5. Work towards clients goals 6. Use informal evaluation's too

Client factors include

1. Values, Beliefs, and Spirituality (perceptions/motivations) 2. Body Functions (physiological functions of various body systems, such as their mental, sensory, neuromuscular, muscular, cardiovascular, respiratory, voice, etc.) 3. Body Structures (anatomical parts of the bodies such as organs, limbs, and their components that support body functions.) - That influence clients performance and occupations

Universal design principles

1. equitable use 2. flexibility in use 3. simple and intuitive use 4. perceptible information 5. tolerance for error 6. low physical effort 7. size and space for approach and use

Electrically powered page turners

A book holder and mouth stick or other reading material and mechanically turn the pages when a switch or switches are pressed by the user. Limitations: Book set up and properly position for both visual and physical access. Requires high degree of head control and ability to hold a mouth stick. A mechanical head pointer illuminates the last requirement but there is still limitations of access. Fatigue often limits the ability to use these devices for a length of time. Audiobooks are readily available and provide an alternative to physically manipulating pages

Non-maleficence

AT service delivery includes adequate education and training in the proper use and maintenance of the technology to comply with the principles Not causing harm to others directly or through avoidance of action that risk harming others At can be inherently harmful if improperly applied

Term remote control

Absence of physical attachment among various components. Occurs between the output unit and the appliances it controls.

Single switch

Activation may be used to initiate a control function that is completely automatically Ex: Remote garage door opener, open/close doors

Beneficence

Acts of mercy,kindness, and charity All forms of action intended to benefit or promote the good of others

Assistive Technology device

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

Assistive Technology Service

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

HIT & the selection method are provided through...

Augmentative & alternative communications (AAC) device Ex: powered wheelchair controller or a computer

5 types of ethical principles

Autonomy Fidelity Beneficence Justice Non-Maleficence Veracity

EADLs Assessment

Begins in determining the clients needs in the context of daily living demands Human capabilities are then assessed 1. Manipulation skills - eye tracking/blinking 2. Cognition Canadian occupational performance measure (COPM) 1. Identify key areas in which client wants/needs to engage in Sensory function - vision, audition, and touch perception evaluated for the role in the HTI

Power line control - X10 and insteon

Communication among devices using home automation can be implemented using powerlines. Distribution and control unit is plugged into standard electrical outlet and each appliance is to be controlled is plugged into a module, which is them plugged into the house wiring plug. Digital control signals are transmitted over the house wiring from the distribution control to individual plans modules. Two codes are sent the first coat identifies the device to be controlled, and the second select the function to be performed. X 10 appliance control it was designed for the use of general population and consequently it's common and inexpensive Advantages: how is Ryan transmission are there no modification is needed to the home electrical system and technology is relatively inexpensive. Disadvantage: lack of privacy, possible interference between systems on the same electrical power system resulting in unreliable performance, the inability to transmit when multiple circuits are being used for the wiring system, the lack of portability.

Assistive Technology

Devices, services, strategies, and practices that are conceived and applied to ameliorate the problem faced by individuals who have disabilities

Transmission methods EADLs

Direct connection, house wiring (X10), infrared light transmission, a radio frequency transmission.

Direct connection EADLs

Direct wiring requires that the control device be physically close together or necessitates the installation of special wiring just for the EADL. Ex: telephone lines, intercom systems, bed control, nurse car, and external speakers. Benefits : increased reliability and control of device is not suitable for remote control methods. Disadvantage: is tethered to what it controls

AT for rest/sleep: sleep preparation and participation

Dream tent Position and transfer aids Mattress toppers Lights, sounds and scents Rails Sleep safe bed Hospital bed

Single-Device Binary Control EADLs

EADLs that control only one appliance, cost is low and significant increase in independence, useful for developing motor control Both have momentary unlatch modes and include a timer to activate appliances for a preset number of seconds Ex: radio/light

Justice

Fairness in individual, interpersonal, organizational, and social contexts - Distributive justice Normative principles designed to guide the allocation of the benefits and burdens of economic activity Principles

Fidelity

Faithful, loyal,honest, and trustworthy behavior Honor your agreements To be treated with respect

Acute care and rehabilitation contextual implications

If client has experienced a sudden change in ability to engage in ADLs. The client has limited physical abilities and in case of SCI, no longer knows what their body can do or how to control their environment. In the acute phase, post trauma the response to the EADL will vary in the device may be rejected because the client needs time to adjust to his altered function and to recognize how technology can enhance that function. Early introduction of a device to someone with a progressive disease allows the opportunity to concentrate on being proficient with the use of the device rather than attempting to both learn how to use the device and adapt to loss of function at same time. Rehabilitation context, it's typically learning how to engage in many more activities and may have regained some other function. The setting is more likely template professionals with EADL expertise who will be involved in assessment, recommendation, set up, and training of technology.

Controlled device

Is connected to the output distribution component either directly (i.e, hard-wired) or via a remote (wireless) link

EADLs Considerations of context

Is important when considering high tech devices - Physical aspects of light and sound can affect technologies

Human compnent

Low vision vs blind Low vision Still able to use vision system just reduced Blind

Voice assistant/smart speakers

Most common Amazon echo, google home, Apple home, Alexa Taking phone calls, playing music, answering questions, and connecting to third-party smart plugs through Wi-Fi. Individuals whose disability prevent speech can use voice assistants Through their augmentative & alternative communication (AAC) system.

Informed consent for AT device

Nature of treatment Benefits Risk Alternatives Opportunities for questions

Community context

Once returning to community or their own homes. Provide opportunity to determine the requirements for EADLs and how technology is needed to be integrated into users daily life

AT & common conditions

Orthopedic Spinal cord CVA Parkinson's Muscular dystrophy Sleep disorders

Principles of AT

Person centered Outcome is enablement Evidence-informed Ethical process Sustainable manner

AT for ADLs: Mealtime

Primarily for eating, self-feeding and drinking - "built-up handle" (universal) - "Lift ware" primarily with patients with tremors such as Parkinson's disease - "plate guard": challenges with scooping -

home automation systems

Provide control over many home appliances including coffee makers, thermostats, door locks, motion sensors, smart plugs and switches and cameras for monitoring. Main principle is to embed intelligence and connectivity and all devices to communicate with each other and be controlled from a central point

Trainable or programmable devices

Remote controllers that utilize either IR or RF typically are designed for operation with only one appliance (TV, DVD player). Helps reduce number of boats can be set up to work with any appliance. This device operate by storing the control code for any specific appliance function (on/off). Trainable controller: specific appliance in sending the specific function code (TV ON) then stores code for feature use Programmable control: have codes for many appliances permanently stored in them All functions of the individual appliance controllers can be stored and one master controller and a person can control all the devices through this single master control. Advantages: only one user interface description, diverse URC technologies can be supported, including connection via desktop and laptop computers, as well as mobile technologies like smart phones and tablets

Continuous control

Results in successively greater or smaller amounts of output among an infinite number of possible out-puts. Ex: opening and closing draperies, controlling volume on the TV or radio, and dimming or brightening lights.

discrete control

Simply turn the appliance on/off or open/close a door. Also referred as a binary since there are only two possible states Ex: involves selection of a single event from a 10 minute number of possible events such as selection of a TV channel or a pre-stored telephone number

Control Interface

The hardware (e.g., keyboard, joystick, single or multiple switches) by which the user operates an assistive technology system or controls a device

Human Technology Interface (HTI)

The hardware and software through which the user interacts with any technology (computer keyboard, postural support systems, displays) Control interface in user display constitute

Factors influence use of EADLs

Training and ongoing support Device reliability Device trial period User identified application of device - As opposed to therapist identification of application

Is it possible to have remote links between the control interface & the processor...

Typically use Bluetooth

Universal remote Console (URC)

Universal remote standard provides a versatile user interface description for devices and services, called a user interface socket to which any URC can connect Ex: cell phone and wireless computer networks

Radio frequency transmission EADLs

Usahs radio frequency waves is the link between the distribution and control unit and the control interface, the controlled appliances or both. Ex: Remote control garage door opener's and mobile phones, wi-Fi, Bluetooth, ZigBee (Low power consumption and long range of operation) Advantage: is not black buy common household materials, and the true mission can be over a relatively long distance throughout a home or a yard Disadvantage: possible interface from other devices or the lack of privacy

Selection Methods EDALs

Used with EADL's include direct selection, scanning, directed scanning, and coded access. - Direct selection occurs when a user of the system can choose any output directly Ex: controlling a room light, fan, or a radio on/off control may have one control interface (possibly a key on a small keyboard or speak recognition) - Scanning access: then the keyboard may be replaced by scanning panel and each of the three items to be controlled has a corresponding light. When the light of the device to be activated comes on, the user activate a control interface to select the item - Code access: Such as Morse code can be used for each of the three output devices. Do user enters a series of dad's and dashes corresponding to numerical code required to activate the desired appliance.

infrared transmission EADLs

Using infrared light transmission as the medium. This method is the most common in the control of home electronics (tv set, cable, DVD, CD PLAYER). Discrete and continuous types of controls Advantages: no installation costs (compared to hardwiring) and ease of portability Disadvantages: Signal, because it is a light wave, can be blocked by many materials and a direct line of sight between the transmitter and receiver is greatly required

Manipulation

What we do with upper extremities Clients with little to no manipulation skill may not be able to use low tech AT device it may benefit the use of EADLs

Factors that DO NOT influence EADLs

When any of the perviously stated factors are not met Client becomes overly dependent on caregiver to accomplish task that can be solved by EDAL use. - As Its we encourage independence - Decrease caregiver burn out

Occupational performance: ADLs and IADLs assessment

When considering an assessment: 1. Age 2. Condition 3. Occupational performance impairment Ex: Ashers occupational therapy assessment tool, occupational therapy assessment for older adults

Internet of Things

describes a system in which everyday objects are connected to the internet and in turn are able to communicate information throughout an interconnected system

EADLs (electronic aids to daily living)

devices used to control electrical devices in the clients environment Environmental control systems (ECS) and environmental control units (ECU)

OCTOPUS Framework

occupations, client, technology, opportunities, purchasing, utility, settings - Ongoing collaborative approach for collaborative decision making regarding AT 1. Comprehensive approach for assessment and intervention 2. Occupation based 3. Functional 4. Interdisciplinary 5. Lifespan

Autonomy

right of self determination Freedom of action and choice

AT for rest/sleep: Rest

wedges Rollers and bolsters Mat Side-lyer Recliner Bean bag Chill out chair

Morality vs. Ethics

• Morality: Our ability to understand the difference between right and wrong. The goodness or badness of human character • Ethics: Moral principles that govern a persons behavior or ability to make the right choices