Environments Midterm

Construction Principles

Increase the area of force applied (wider straps and longer orthoses are more comfortable, 2/3rd of forearm Rolled and smooth edges reduce pressure Cornersshouldbe rounded Contourincreases strength Conform to body segments Lengthofforearmorthosis to 2/3rd or 3/4th Contour to forearm 1⁄2 of forearm width

Control Functions

-Discreet - on off switch for light, TV -Continuous - dimmer switch on light, volume control of TV -Other examples of discreet - telephone memory dialer, channels on TV - although these seem continuous- each is a distinct choice.

Collateral ligaments

MP's must be flexed, IP's extended for maximal healing of ligaments

Bony Landmarks

Lateral and Medial Epicondyles Humerus Olecranon Process of Ulna Styloid Process of Ulna Styloid Process of Radius Pisiform CMC Joint Base of Thumb Metacarpal Heads PIP Joints (hourglass deformities and nodes) DIP joints (same as PIP)

Classification by functional purpose- restriction

Limit motion after nerve injury Limit motion after tendon injury Limit motion after bone/ligament injury Provide joint stability and alignment Assist in functional use of the hand

Ulnar nerve injury

Loss of power grasp- especially ulnar side of hand- intrinsic muscles Claw Deformity- Ulnar side of hand Loss of sensation ulnar side of palm, ulnar half of ring finger and little finger

Telephone control

Low tech solutions -mouthsticks, head pointers -speaker phone -mechanical switch to lift or push down on telephone answer/hang up switch/device -gooseneck phone headset holders -operator assisted calls

Products and technology:

The natural or human-made products or systems of products, equipment, and technology in a person's immediate environment that are gathered, created, produced, or manufactured.

objective

The student will provide the design, fabrication, and instruction; in the application, fitting, and training of an orthosis for a patient to improve his/her function, and discuss the scientific principles of the biomechanics, physics and kinesiology of which it was based....

Support and relationships:

People or animals that provide practical physical or emotional support, nurturing, protection, assistance, and connections to other persons, in their home, place of work, or school or at play or in other aspects of daily occupations.

SHARPEN YOUR CRITICAL ANALYSIS OF DESIGN AND FABRICATION

Clinical Reasoning Questions post design and fabrication Did this orthosis achieve the intended purpose? Are the included joints positioned optimally? Can my client don/doff this orthosis easily Is this an aesthetically pleasing orthosis? What would I change about this orthosis? Does this need to be changed immediately? NEXT TIME I make this orthosis, what would I do differently?

transmission methods

Remote Control - absence of hard wiring between control interface and device to be controlled -use of house wiring and modules to control lights, TV. two codes are sent by a transmitter to identify device and function. -up to 256 devices can be controlled in this manner with this type of system -only binary functions are possible- off, on -can be disrupted by interference, not work when multiple circuits flow through same wiring system -most out of date because of wireless networking, cell phones, etc.

Classification by functional purpose- mobilization

Remodel scar tissue Elongate soft tissue contractures Increase PROM Re-align joints or ligaments Substitute for weak or absent motion Maintain fracture alignment while allowing motion Provide resistance for exercise

Hand based

Short thumb spica splint C bar splint (modified for function, stretching of web space, rest) Finger immobilization splint (any finger including palmarbar.

Studies on EADL use

Top four reasons for recommending EADL -empowerment of client -improvement of QOL -increase access to call systems -decrease need for attendant care (Holme et al., 1997) Major reasons EADL not recommended -lack of funding -high cost -unavailability of equipment for trials -lack of knowledge about EADL's on the part of the practitioner (Holme et al., 1997) Many of these barriers have been removed in 2020 (e.g. Alexa)

Electronic Powered Feeder

Try the feeder and see what you think are the pro's and con's to this technology (IN LAB) -unable to use UEs, wonderful example of an EADL for feeding

Mobilization is to

Used as a tx modality Controlled tension -dynamic -static progressive -serial static Remodeling scar and DCT -Lengthen soft tissue contracture -Substitute for weak or absent mm -Provide resistance exercise -Maintain fx alignment and joint mobility

radial nerve injury

Wrist drop Loss of extrinsic finger extension Loss of thumb extension

Maintaining proper alignment

Wrist radial or ulnar deviation (generally neutral is best) Proximal Palmar Arch Distal Palmar Arch Longitudinal arch Dual Obliquity of the hand (the hand should be splinted lower and shorter on the ulnar side)

X10 and ZWave

X 10 has been around since 1975. Radio Shack provides inexpensive control modules that work through home wiring and radio frequency transmission. You need a control unit and modules that plug into the lamp, appliance, or other device that you wish to control.

Extensor Mechanism

You need both intrinsics and extrinsics to fully extend fingers - lateral bands can slide volar or dorsal

Z-Wave

Z-Wave is a wireless communications protocol designed for home automation, specifically to remotely control applications in residential and light commercial environments. The technology uses a low-power RF radio embedded or retrofitted into home electronics devices and systems, such as lighting, residential access control, entertainment systems and household appliances. (wikipedia)

Orthosis definition

a well fitted device, from a medical professional, to modify function

Proximal Arch

at level of the carpometacarpal joint, relatively fixed, keystone is the Capitate. -MCP

Distal Arch

at the level of the metacarpophalangeal joints, relatively mobile PIP

Longitudinal Arch

best understood by following the 3rd digit Arch deepens with flexion and flattens with extension of the fingers

Pulleys and ligaments supporting flexor tendons

gliding is needed to prevent adhesions

Traction

intended for fx reduction, orthoses can provide joint alignment but usually have surgical component

Infrared Elevator Control

key fab

Programmable Controllers

codes are stored in the controller that are appropriate to a range of appliances. More flexible and able to control more appliances than trainable Computer software can be used to convert computer into programmable controller

Flip Lite Page Turner

electronic, turns pages for you

Tobii Dynavox I Series

eye gaze control

Group Item Scan

switch selects group and then the particular itemwithin the group ABCDE FGHIJ KLMNO FIRST SWITCH SELECTS GROUP OF LETTERS. HITTING THE SWITCH AGAIN SELECTS THE PARTICULAR LETTER DESIRED WITHIN THE GROUP -ex: scan to first group, scan through letters to pick one you want, select switch to choose

Other materials

padding, strapping, and velcro

ulnar nerve compression

slide 29: can present in multiple different ways i. Three ulnar nerve neuropathies ii. Restrictive ulnar nerve orthosis iii. Pay attention to atrophy (top pic good, nice and pink) (bottom 2 are atrophied) iv. All treated uniquely

Banjo splint can be used for traction

slide 34

Example of 90 degree pull for dynamic splints to improve force and apply proper pressure to improve motion

slide 37

levers with splinting

slide 50 a. All orthoses have a lever b. Resisting ability for patient to flex c. Palmar component because wrist is heavy (may be from high tone) d. Long forearm piece creates balance

Significant structures

Arches -Longitudinal -Distal Transverse -Proximal transverse

how orthoses are named

Articular -crosses one or more joints Non-Articular Location-describe body part / joints Direction- position of the joint Intent-immobilize, restrict, or mobilize Circumferential Gutter Radial Ulnar Volar Dorsal Anterior Posterior

Pros and Cons: High Resistance to Stretch

Can form parts of orthosis Can 'man-handle' o Material often warmer to touch, edges do not typically finish as nicely, bulky for finger joints, not as contoured b. High = manhandled easier, not for a finger (too bulky)

Pros and Cons: Low Resist to Stretch

Conforms, minimal handling, easy to roll edges Edges finish smooth o Difficult to work with, hard to control, MUST handle gently o Does not reheat well a. Low = drapeable moldable (lots of finger prints, handle gently)

Follow up questions

Is the client wearing the orthosis the recommended times? If no, why not? Does client note any problem areas or skin irritation? If yes, where specifically? What are my proposed solutions for addressing the problem area? Which one will work best, and which is most feasible? Is this orthosis meeting the intended purpose? If no, why NOT? What can I change to achieve the goal(s) of this orthosis? ALWAYS FOLLOW UP! -take a look every following session if needed

TOOLS

Leather punch Heat gun Scissors Utility knife Tongs / spatula Wire bender Mesh net Solvent Cold spray Tape measure Ace wrap (Splint) form pan Drill Drummel a. Tongs to lift out b. Wire bender for add on c. Mesh net bottom of tub d. Goniometer to measure proper angles

ELEMENTS OF WELL DESIGNED ORTHOSIS

Maintains Normal Arches Retains normal joint axis of motion Permits balanced function of unaffected mm Provides most PRACTICAL prehension pattern Optimal Stability with Maximum mobility Frees palmar surface of hand or fingertip

Resistance of material

Minimum resistance to stretch -Min-moderate resistance Moderate resistance -Mod-maximum resistance Maximum resistance a. Keep it simple/basic, only the most material needed for the job at hand (cost effective, light weight, etc.) b. Max for resting hand c. Mod for talor d. Min = poly form e. How drapable, loose, easy to stretch out, etc. = min mod max f. High memory = maintains pattern g. 30 seconds for max materials to heat up (mod = 3-5 min)

Principles for splinting

PROVIDE CONTOUR ELIMINATE FRICTION AVOID SHEAR STESS CONSIDER RECIPROCAL FORCES USE OPTIMAL ROTATIONAL FORCES CONSIDER PASSIVE MOBILITY OF SUCCESSIVE JOINTS CONSIDER THE TORQUE EFFECT ON A JOINT

Materials: Useful handling characteristics

Resistance to stretch Memory Working time

Materials cont...

Thickness- 1/16th" 3/32nd" 1/8th" Available colors Latex free Shrinkage Temperature 150-160 F Perforations Shelf life Precuts Rigidity of material Cost Packaging

Pros and Cons: Memory

great to refit and reheat; able to redo o More difficult to roll edge o Shrinks as cools, tight? o Difficult to do portions of

What is assistive technology?

"Refers to a broad range of devices, services, strategies, and practices that are conceived and applied to ameliorate the problems faced by individuals who have disabilities"

Social Environments

"availability and expectations of significant individuals such as a spouse, friends, caregivers. Also includes larger groups that are influential in establishing norms, role expectations, and social routines"

general purpose

(robotic arm)

How do you think temporal aspects affect adjustment to disability?

-Blind from birth vs. blind from car accident vs. slowly deteriorating vision? -Congenital amputee vs. amputee from diabetes vs. amputee from electrical accident? -Teenager who becomes quadriplegic from car accident vs. teenager with muscular dystrophy -Teenager hit by drunk driver vs. teenager who was driving drunk

Electronic Telephone Controllers

-Can be plugged into telephone -Can be plugged into phone line directly and by-pass telephone -can directly answer phone without picking up handset/headset -uses features common to many phones such as memory dialing, repeat calling, -Computer software available to do dialing from computer workstation

Characteristics of a good splint

-Even thickness -Aesthetically pleasing -No rough spots or rough edges -Durable (no weak fusions, weakly applied velcro) -No distal migration -Contoured to maximize strength -Fits correctly to allow movement or fully immobilize joints (anatomical landmarks can be seen- no client complaints about fit) -Arches of hand and other anatomical considerations are properly addressed

Restriction is to

-Limit motion after nerve injury or repair -Limit motion after tendon repair -Limit motion after surgical repair -Assist in functional use of the hand

To insure prompt services...

-Minimize fitting...once, twice, strap...adjust -Instruct with care, wearing schedule, precautions while working with orthosis-Instruct with care of skin and care of orthosis -Always try to improve your design and your skills -Rolling edges will increase area of contact, less pressure, at fingers and thumb -Use elastic bandage (Ace wrap) apply or position under hand or arm during fabrication-Use good body mechanics, get comfortable, and don't lean, twist or reach -Use gravity whenever possible, lay patient supine on mat if needed-Inform nurse, family member and/or patient of info -Use padding on bony prominences, then remove -Use old socks for liners, add padding, moleskin -Recycle, reuse and reduce.....

Immobilization is to

-Reduce tone -Decrease contracture -Block or transfer power of movement -Increase Functional use of the hand -Prevent Deformity -Maintain tissue length -Protect Healing Structures -Protect joint alignment -Maintain fx alignment -Allow Tissue Growth or Remodeling

Examples of technology

-Reachers -Head Pointers, Mouthsticks, -Adaptive Feeding Aids -Devices with Extended Handles -Devices with Built up Grip -Devices with Modified Grip for writing, dressing, gardening, leisure -adaptive equipment (i.e., dressing or feeding aids, etc.) -sometimes use to augment EADL (i.e., using a mouth stick to click a button on the EADL)

Precautions for splinting

-Temperature sensitivity poor autonomic nervous system regulation of temperature (burns) -poor skin integrity-geriatric population -Pain or swelling -poor compliance/cooperation -hand sensitivity (hypersensitivity vs. insensate) -vascular insufficiency -Wounds (especially poor wound healing or scarring) -poor fitting splint -Pressure areas (do not cause them) educate client about them. (red spots that do not go away after 20 minutes would be a bad thing) -Rash, other skin reactions -Properties of splint materials- eg. they will melt in a hot car or on the beach -You are not responsible for home made modifications done by clients or family!

EADL

-What's with that? ECU is what I learned -Electronic Aids to Daily Living has replaced what used to be called Environmental Control Units -Too much confusion with air conditioners and furnaces using old term -New term more accurately reflects the functional result of the device

EADL: Electronic Aids for Daily Living

-can control your whole home with AT

Virtual keyboard

-click on letters with mouse or fingers -on the screen

Transmission Methods: Radio Frequency Transmission

-examples - garage door openers, portable telephones -can be transmitted across solid objects -is more susceptible to interference and lack of privacy

Transmission Methods: Ultrasound

-limited to four to eight channels -transmission can be blocked by solid objects -can work for continuous control functions

Community use of EADL's

-needs for EADL in rank order communication security/health recreation household tasks employment education telephone television room lights emergency signal door computer

Meaning of Environments

-physical environment -social environment •"External physical and social environments that surround the client and in which the client's daily life occupations occur"

Large Key Prog - ZygoIndustries

-prevents you from accidently hitting another button (good for those with a tremor)

Transmission Methods: Infrared

-works for all types of control functions -also requires direct line of site between control and device -often do not work well in bright light

OT Process

1) Referral 2) Screening 3) Assessment 4) Intervention Plan 5) Intervention 6) Discharge Plan 7) Discharge 8) Follow-Up -similar to AT process

AT process

1) Referral & Intake 2) Initial Evaluation 3) Trial 4) Recommendations 5) Write Proposal 6) Implementation 7) Follow-Up 8) Follow Along Review of OT theory and process -evaluate anything (individual, fit of technology, etc.) (look at personal factors before insisting technology use) -trial = see what works best for the client (comfort, functionality, etc.) (not always possible to have proper technology readily available) -proposals are VERY complex, have to be written in a way they are fundable -follow-up = did you get the tech, any questions, has anything changed to where this is no longer fitting for you, etc. -follow along = call them every 6 months (functional changes, equipment breaks, etc.)

Check for pressure after 15-20 minutes 10 major sites to check

1. Head of the ulna 2. Dorsal MCP joints 3. Dorsum proximal phalanx 4. Base of thenar eminence 5. Palmar fingertips 6. Center of the palm 7. Proximal end of orthosis 8. Web space of thumb 9. Volar thumb IP joint 10. Radial styloid

The objectives for orthotic intervention

immobilization mobilization restriction

Splint definition

immobilizes straight (for safe transport) casting term

Case Review: Dequervain's tenosynovitis

62 y/o female, with OA, DM and weakness in right thumb and radial wrist; she describes pain with wringing out washcloth, and is unable to open pill bottles and cut her food with right hand. Therapist examines and notes a positive Finklestein's test, and CMC OA with positive grind test of the base of the right thumb. She is very active with babysitting her granddaughter, volunteering at church, and she states her hands are always cold. She does not want surgery or injections at this time. Her physician refers her for a thumb orthosis.

About the UE

8 CARPAL BONES 14 PHALANGES5 METACARPALS RADIUS ULNA HUMERUS

axis of motion

A stable line that does not move when the bones of a joint move in relation to one another. slide 48 i. Flexion or extension, 90 degree pull, no friction or sheer

Transmission Methods: Voice Recognition!!

Alexa etc.

What is Adaptive Access

Alternate Access: •Keyboard -Layout -Size -Virtual •Mouse -Styles -Alternate •Switch Rate Enhancement: •Word completion •Word Prediction •Abbreviation- Expansion Combination •Voice recognition -touch screen = virtual keyboard -mouse can fit to individual

Natural environment and human-made changes to environment

Animate and inanimate elements of the natural or physical environment and components of that environment that have been modified by people, as well as characteristics of human populations within that environment. Engagement in human occupation influences the natural environment, and changes to human behavior can help protect the environment

Forearm based

Anti-spasticity cone splint Anti-spasticity ball splint

definition of assistive technology

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. 1) Includes commercial, modified, and customized devices 2) Emphasizes functional outcomes of individual with disabilities 3) Emphasis on an individual basis

Assitive technology service

Any service that directly assists an individual with a disability in the selection, acquisition, or use of an assistive technology device 1) Evaluating needs and skills for assistive technology 2) Acquisition of AT 3) Selecting, designing, repairing, and fabricating assistive technology systems 4) Coordinating services with other therapies 5) Training both individual with disabilities and those working with them to use the technologies effectively

Why Z-Wave

As all controllers and appliances are connected to the same mains wiring system, X10 is able to determine which device to direct a control signal to, by using a 'house code' and a 'unit code'. The house code was intended to allow adjacent houses to use X10 without interfering with each other - there's always a risk that houses in the same neighborhood share a connection to the power distribution system, therefore signals can 'bleed' from one to another, which wouldn't be a good thing! Finally, X10 can control up to 256 devices, which sound a fair number - but its competitor, Z-Wave, can control an unlimited number of lights and appliances. (http://www.vesternet.com/resources/technology-comparison/x10-vs-z-wave)

Funding

BVR - Veteran's Administration Not covered under Medicare, or most private insurances Is covered if included in AAC device ECU/EADL integrated controller should be ordered with the new wheelchair-then it is covered. Usually out of pocket expense Grants are available through a variety of sources to help fund AT-check local Independent Living Center Can be borrowed through some equipment loan programs

Commercial splints

Benefits- -Can be more comfortable -Can be more cost effective -Quicker -Can be more durable Cons -Can cause problems if it does not fit right -Can be unable to be adjusted -Can be less durable- unsuitable for dirty or high stress environments

need to know anatomy

Bones Muscles Ligaments Nerves

Anatomy

Bony landmarks and other anatomical landmarks related to splinting Nerve injuries and functional problems requiring splinting Arthritis related problems requiring splinting Orthopedic conditions and splinting Splinting for spasticity Positioning of splints related to wound healing and functional recovery

When creating a splint

Consider... -the arch systems -Skin creases -Bony prominences -Edema -Sensibility and Vascularity

EADLs process

Control Interface - switch or switches, joystick, head mounted device, optical pointer, eye gaze User Display - LCD (liquid crystal display), LED (light emitting diode) , Computer Screen Selection Method - Output Distribution Block -selection method + ODB = processor -user display ex: something showing on the screen to show that I clicked "9" (feedback) -output = actually does what function you told it to do

dynamic hand based dorsal finger orthosis

slide 10

Places of nerve impingement

Cubital tunnel Dorsal radial side of forearm (superficial radial nerve) Carpal Tunnel (watch out for splinting in extremes of wrist extension or flexion) Guyon's canal (ulnar nerve proximal palm ulnar side of hand)

improve effectiveness

Design Function Choice of materials, strapping, and other parts Patient comfort Cosmetic Appearance a. Fitting = decrease time, be straight forward, ensure they can put it on themselves and function b. Rolling edges will allow decreased pressure

Evaluation Cont...

Daily roles and activities Goals for technology Types and location of electronics to be controlled. Physical evaluation/Access -Vision -Motor control -Cognition Technical Support in the home

Radial gutter splint

DeQuervains, ulnar collateral ligament tear, CMC Arthritis slide 49

Classification by body parts

Digit and thumb based- stack splint for mallet finger Hand based- short thumb opposition splint Forearm based- wrist cock-up splint Arm based- volar elbow extension splint, sugar tong splint

Modes of Access: Selection Method

Direct •All choices are presented at 1 time •User identifies a target and goes straight to it (example- typing on computer keyboard) •Requires refined, controlled movement and is more difficult of the 2 •Cognitively more intuitive and easier Indirect •Intermediary steps involved •All of choices are not presented at one time •Cognitively more demanding •Scanning -Linear - abcdefg etc. -Circular - arrow scans around circle and switch select (pic on slide 50) -indirect ex: mores code -linear = scan straight across a line -circular = scan in a circle

OTPF 4th Edition: Environmental Factors

Environmental factors make up the physical, social, and attitudinal environment in which people live and conduct their lives. Human interaction with the environment is a requirement of life. Environmental factors include the natural environment and human-made changes to the environment, products and technology, support and relationships, attitudes, and services, systems, and policies

position of function

EXAMPLE OF IMMOBILIZATION ORTHOSIS

ASSISTED EXTENSION WITH FLEXION BLOCK - MCP JOINT EDC

EXAMPLE OF MOBILIZATION ORTHOSIS slide 37

HAND BASED FIGURE-8 (anti-claw)

EXAMPLE OF RESTRICTION ORTHOSIS a. Better extension at PIP b. Prevention of joint contracture at PIP c. Assists in function

Orthotic devices

Easily adjusted Quickly constructed Fitted early after trauma Efficient and adequate in support Simple and direct design Light in weight Pleasing to the eye Free of pressure areas Comfortable Securely strapped

Arm based

Elbow positioning splint Humeral fracture brace Sugar tong splint

Initial Evaluation and Big Picture

Evaluate •Person •Occupation •Environment Intervention •Adaptive Movement Strategies •Assistive Devices •Home Modifications •Training Follow-Up

Trainable controllers

Example - controller that can be used for VCR and TV - you must put in codes to let the controller know what type of TV you are using, when to switch from controlling TV to controlling VCR etc.

Keyboard Short cuts

F1 --> Brings up help ctrl + p --> Brings up print box ctrl + n --> "new" alt + f --> Opens "File" menu Winlogo + f --> Opens "Find" Winlogo + m --> Minimizes all open windows

Physics Principals Important for Splinting

Force principles- pressure, torque, shear Traction and compression Levers 90 degree pull and proper alignment for dynamic splints

No death grip!

Handle gently- AVOID TROP POUSSE....... Albrecht Fabri's collected writings appear as a book titled "Der schmutzige Daumen" (The dirty thumb). Here is a translation of the central section of it, giving some of Fabri's central thoughts about aesthetics: "Well", D. said, "everything A. is writing is a little bit what is called trop poussé in French. He has worked a little moment too long on all of these things; and this moment has sufficed to drive out of it what gives life to a work. I call that the dirty thumb, you just can't define it."

Splint Intent

Immobilization- no movement of the joint being splinted- example- resting pan splint Mobilization- encourages or allows joint movement without restrictions- can be serial static or dynamic - example- dynamic MP extension splint Restriction- restricts certain movements but allows other movements to maximize function while encouraging healing and preventing injury.- example- flexor tendon injury dorsal wrist hand splint- blocks complete extension, allows passive finger flexion.

Computer Access Assessment Feature Match Process

Individual (Needs •Abilities •Expectations) --> Technology (Interface/Input •Processing •Output •Other Properties) -what the individual does = eye gaze, talking, typing, etc. -processing = what the computer does, determines the output based on the input -output = result

Traction and Compression

It is difficult to design a splint that provides traction. You must be able to grab the distal portion of the body part and pull in direct opposite direction from the proximal portion to achieve traction. An example of this would be attaching a hook to the fingernail and pulling the fingers in a straight line with all joints extended to apply traction to the DIP, PIP and MP joint. Compression would be pulling the joint together and is also difficult to achieve with splinting. Compression also is a negative effect when splint straps are too tight and compress the nerves, arteries, and soft tissues too tightly- causing reduced circulation to the area, and increased compressive force to the soft tissues.

JAWS

Job Access With Speech •World's most popular screen reader •Developed for computer users whose vision loss prevents them from seeing screen content or navigating with a mouse •provides speech and Braille output -For those who are completely blind, reads EVERYTHING

Chubon

Keyboard designed for one finger typists or mouthstick users -picture on slide 64

Largest Rate Limiting Factor of you as a therapist is ?????????????????????

Lack of training! -this is more current advancements with this profession Others -cost (now going down as these products become more acceptable) -availability

Median Nerve injuries

Median Nerve Injury Loss of opposition Loss of 3 jaw pinch Loss of sensation to medial palm and thumb, index, middle, and half of ring finger Ape Hand Deformity

Levers

Most splints are a first class lever - the fulcrum is located at the joint and the splint works to move the distal segment into extension or flexion. Make sure that both the proximal portion and distal of the splint are long enough to reduce pressure when applying the force of the lever arms to the joint being positioned or dynamically pulled into flexion or extension. The general principle is to cover as much of the tissue as possible without immobilizing a body part that does not need to be immobilized.

Volar Plates

Need to heal in slight flexion- but careful- not too long or they will heal in shortened position

Hospital Bed based EADLs

Nurse Call Button!!!! -chin mounted found to be most effective in early stages of SCI. Why? Other ideas for Hospitals -television, radio control -bed controls -medication controls (morphine pump)

Contexts Vs Environments

OTPF 4 Context is a broad construct defined as the environmental and personal factors specific to each client (person, group, population) that influence engagement and participation in occupations. Context affects client's access to occupations and the quality of and satisfaction with performance (WHO, 2008). -environmental factors and personal factors Environmental factors are aspects of the physical, social, and attitudinal surroundings in which people live and conduct their lives. Environmental factors influence functioning and disability and have positive aspects (facilitators) or negative aspects (barriers/hinderances) -natural environment and human-made changes to the environment -products and technology (natural or human-made) -support and relationships (people or animals) -attitudes (observable evidence of customs, practices, ideologies, values, norms, factual beliefs, and religious beliefs held by people other than the client) -services, systems, and policies Personal factors are the unique features of a person that are not part of a health condition or health state that constitute the particular background of the person's life and living. Personal factors are internal influences affecting functioning and disability and are not considered positive or negative, but rather reflect the essence of a person - "who they are"

Attitudes:

Observable consequences of customs, practices, ideologies, values, norms, factual beliefs, and religious beliefs (attitudes of those external to the person, not of the person themselves).

Matrix

One switch activates scan down columns and then across rows. Second switch selects item. -quicker than having to scan across one line to move down to the next -picture on slide 52

Principles

PRESSURE = TOTAL FORCE / AREA OF FORCE APPLICATION INCREASE THE AREA OF FORCE APPLICATION TO REDUCE PRESSURE

Evaluation Process

Physical Abilities? Can the person use a control interface? What kind? Augmentative Communication Device in use? Can it be used to control EADL devices? Cognition? -ability to learn new tasks -ability to integrate new skills with old activities Motivation? Functional Capacities? Lifestyle? Employment Status? Specific Tasks to be Accomplished? Realistic Expectations Daily Routine? Accessibility of Residence? Attendant Care Available? Existence of other Assistive Technologies Funding

Computer Access: Seating and Positioning

Posture and Positioning -person -keyboard -in a functional position, where the effector organ can access the input device in an ergonomic and healthy way (90 90 90)

Pressure

Pressure = force / area Critical teaching points - larger straps, larger coverage of surfaces with splint material will increase area and decrease pressure on any given area. -Efforts to eliminate or reduce pressure over bony prominences, areas that are healing, and areas that are prone to pressure sores (e.g. skin affected by continued use of steroids, healing burns, edematous areas) will result in a better outcome and a happier client!! -Too much force applied to an area in dynamic splinting can cause problems such as swelling, pain, and micro tears to soft tissues, ligaments, or bones. The general rule is a prolonged tension over time is superior in improving motion.

Credentialing

RESNA •Assistive technology practitioner (ATP) •Professional background in engineering, OT, PT, recreation therapy, special education, speech pathology, or vocational rehab counseling •Rehab Engineering Technologist (RET) www.resna.org National registry of Rehabilitation Technology Suppliers •Certified Rehab Technology Supplier CRTS www.nrrts.org **Important to have knowledge and skills in AT & familiarity with the scope of the AT industry -RESNA certification (AOTA controversy, should one be certified to prescribe high end w/c) -NRRTS = certified suppliers

Positioning Considerations

Resting position Functional position Healing and scar management considerations- protective position

anatomical positioning: intrinsic plus splinting position

Safe Position

Services, systems and policies:

Services that provide benefits, structured programs and operations, in various sectors of society, designed to meet the needs of persons, groups and populations.

Alignment of the wrist

Slight ulnar deviation of wrist Dinner fork deformity- needs correction surgically!! Scaphoid! - Thumb must be included to rest or protect scaphoid Zig Zag deformity- wrist radially deviated, MP's ulnarly deviated- Splint in opposite directions to correct, properly position.

Transverse Carpal Ligament

Splint wrist in neutral to minimize compression of median nerve

Digital splints

Stack splint (mallet finger) PIP figure 8 splints for boutonniere or swan neck deformity Long finger splint (immobilizes PIP and DIP, can be volar, dorsal, or circumferential Serpentine splint for thumb IP lateral instability

Splint designs

Static- no moving parts- purpose is to immobilize Serial static- no moving parts- splint is designed to apply forces to increase motion with no moving parts Dynamic-moving parts with some kind ofoptimal force applied to assist movement or to allow movement

Objectives

Students will review anatomical principles related to splinting Students will identify physics principals related to splinting Students will identify classifications of splints Students will name various splints and associate purposes of these splints for individuals with arthritis, orthopedic, and neurological conditions Students will indentify precautions for splints Students will identify splint construction principles

Classification by functional purpose- immobilization

Symptom relief Protect and position for edema Maximize functional use Maintain tissue length Protect healing structures Protect healing fracture Improve joint alignment Block or transfer power of movement Reduce muscle tone or contracture

Temporal Context

Temporal context includes stage of life, time of day or year, duration or rhythm of activity, and history

Tendon Sheaths

Tendinitis

Canadian Source Reports These Funding Options

The following are funding possible sources for EADL: -Insurance companies -Self pay -WSIB -Charity organizations, e.g., Ontario March of Dimes, President's Choice Children Charity, Easter Seals -Diagnosis specific organizations e.g., MS Society, OFCP, MDAC, ALS society -Service clubs such as Lion's Clubs, Rotary Clubs

Evaluate the Occupation

To do what you want to do •The occupations one performs during the course of the day while engaging in: -Work -Play -Leisure -do you want this technology to accomplish 1 thing, or multiple things (universal function)

Torque

Torque (or tortion) is a rotary force very similar to pressure When you are pulling a portion of an extremity in a rotational direction (such as using a sugar tong splint to improve supination) the force applied is torque. In general- do not apply force in rotation when you want to apply the force in flexion or extension. An example of this would be pulling a middle phalanx into extension- be careful that the angle of pull is at 90 degrees and is in direct alignment with the joint so you do not apply rotational force to the extremity you wish to pull into extension.

Critical ligaments and tendons

Transverse Carpal Ligament- CTS Network of carpal ligaments- malalignment of wrist Pulleys and cruciate/annular ligaments for flexor tendons Volar Plate- Palmar ligaments Collateral ligaments Tendon sheaths- DeQuervains, Flexor tendon sheaths, extensor tendon sheaths Extensor mechanism- intrinsic plus position for intrinsic weakness

What kind of splint would you supply female with?

VOLAR FOREARM BASED THUMB EXTENSION Wrist included -radial extension Fingers/IP joint mobilized Light weight perforated material Well padded Stockinet liner APL EPB immob 3 wide straps -like the picture except the thumb is covered

Occupational Therapy Performance Contexts

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Technologies that Aid Manipulation and Control of the Environment

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Assistive Technology

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Fundamentals of Splinting for Occupational Therapists

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ORTHOTIC FABRICATION

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Electrically Powered Page Turner

What does the book say about pro's and con's to these devices? -needs set-up -success lies in consistency to grab page of various textures, sizes and thicknesses of books. -https://www.pageflip.com/products/lite -not as pertinent today because a lot of people don't read books as much (more electronic books)

Forearm based

Volar or dorsal wrist immobilization splints (wrist cock-up, palmar bar, clam shell) Radial gutter (with thumb spica) Long thumb spica (immobilizes entire wrist) Dorsal wrist hand immobilization Resting pan splint- variations for functional, protective positioning

Follow-Up

What should happen immediately after delivery?

Simple Adaptations (FREE)

Windows Control Panel-Ease of Access •Keyboard -Sticky Keys -Filter Keys -Mouse Keys •Appearance •Narrator •IOS - Universal access •Keybord -Sticky Keys -Slow Keys •Mouse/Trackpad •Hearing •Seeing -what adaptations come free with the computer -sticky keys = need to use one hand to type, so these hold down the key for you -filter keys = helpful for a tremor, only type one letter rather than a bunch when held down -mouse keys = use mouse instead of keypad -narrator reads the screen for you -change appearance of keyboard for those with visual deficits/perceptual deficits

Functional Position

Wrist 45 degrees extension, MP's 45 degrees flexion, IP's 30 degrees flexion, thumb opposed and flexed

MECHANICAL PRINCIPLES: example with silver ring

a. Silver ring prevents extension, but applies a lot of pressure (would not apply to patient with sensitive skin or extreme contractures like the next slide) -would not apply a silver ring to someone with a severe swan neck deformity

Robots

approximately 150,000 individuals in US could benefit from Assistive Robot -Fixed workstations (on table) -Mobile robots at home, work, school either attached to wheelchair or driven via a mobile base -Robots specifically designed to meet educational needs of children. studies showed an increase in attention and motivation among students using robot vs. computer games or switch toys.

special purpose

designed for only one task (electronic feeder)

alternative

different method for completing the task

Discharge

follow the plan

Compression glove

for edema

Protective position

for healing of fractures, burns on dorsum of hand Wrist 30 degrees extension, MP's 90 degrees flexion, IP's fully extended, thumb fully abducted and extended. slide 23

Torque

instead of flexion or extension force, care is needed not to twist, or apply force in a rotational direction, especially dynamic orthosis

line of pull

look at slide 47 don't want to pull it less that 90 degress or else it troques the joint

Tight ligaments or torn ligaments

need surgical correction or long termsplinting to align wrist during healing

anatomical positioning is important

position of function (slide 30) vs position of rest (picture)

augmentative

provides assistance todo the task in a normal manner

Compression

pulling the joint together is difficult to achieve with orthoses... with soft tissues, avoid nerve, arterial, muscle compression

Findings from some studies on EADL's

staff and residents report benefits of EADL's in institutional settings -feelings of increased self worth and independence, more privacy among residents; staff reported relieved of extra duties and saved time -training critical!!! -residents with access to EADL's 3 times as likely to independently access the environment Community use of EADL's characteristics of EADL's valued by high level quadriplegics -visual and auditory selection displays overall size and appearance (does it fit into a home?) -confidential use of telephone during phone calls -direct access to dialing phone reliability Community use of EADL's -men use them more than women -exposure to them early in hospital stay increases use -funding and availability -employment status -non-users spend more time in passive recreation like watching tv vs. traveling, participating in education. -users employ more assistive devices in general -users perform more tasks independently -the earlier the EADL is introduced, the better (i.e., in the hospital room)

Brace definition

to hold in alignment (like teeth)

Frohment's Sign

ulnar nerve injury test

Resting Position

wrist 30 degrees extension, MP's 30 degrees flexion, IP's 10 to 20 degrees flexion, thumb partially abducted and MP/IP slightly flexed.

other alternate keyboards

•Enlarged -Big Keys •Mini -enlarged good for visual deficits (also brightly colored, simple font) -mini for those with decreased ROM or those typing with one finger

follow-up

•Especially necessary when AT is involved

Developmental Stage

•"A stage or phase of maturation" •based upon developmental theory -Stages and behaviors are sequential and expected at certain ages -normative data are used to compare individuals to "average" or expected performance -naturalistic studies becoming popular (to explain development as seen in more usual habitats and settings)

Cultural Environments

•"Customs, beliefs, activity patterns, behavior standards, and expectations accepted by the society of which one is a member. Includes laws, political aspects, and personal rights, opportunities for education, employment, and economic support"

Physical Environment

•"nonhuman aspects of contexts; includes accessibility to and performance within environments having natural terrain, animals, plants, buildings, furniture, objects, tools, or devices" -rehabilitation engineering, environmental studies, ergonomics, architecture, geography, urban planning, social sciences all study the physical environment from unique and overlapping aspects

Life Cycle Phase

•"place in important life phases such as career style, parenting style, or educational process" •involvement of the person in social roles and life tasks that are common for persons of that age and social status in the culture •based upon Major Life Events - work, family life, physical development, and significant others

Disability Status

•"place in the continuum of disability, such as acuteness of injury, chronicity of disability, or terminal nature of illness" •how recent is the problem? •what is the expected duration of the disability (short term, permanent)? •is it degenerative or is recovery possible? •did it begin at childbirth or late in life?

Webster's Definition

•"to weave together" •"a view of the whole situation, background, or environment relevant to some happening or personality, including its location in both time and space" •The environmental context is at least as powerful a determinant of the lives and functioning of persons with disabilities as the person's individual impairments

AT assessment team

•1) Consumer & Family/Caretaker •2) Seating and Positioning Specialist •3) Interface Specialist •4) Augmentative Communication Specialist •5) Special Educator/Educator •6) Rehabilitation Engineer •7) Funding Specialist •8) Rehabilitation technology supplier -a lot easier to use If you are seated properly -interface ex = want to have switches power your technology -SLP = collaborate with them when there is a communication issue (ID simple or complex tech based on cog, function/abilities determine how they can work this technology) -proper positioning of technology for optimal use -special educator if they need to use it in the classroom (ID needs of student and abilities of teacher) -engineers = creative and creations -funding specialist, collaborate with SW -tech supplier knows the market (new products)

Assessment

•A registered OTR shall assess an individual's performance areas, components, and contexts

Intervention Plan

•Formulate an intervention plan based on the results from your assessment Shall include: •Strengths & weaknesses •Estimate rehab potential •ID measurable LTG & STG •Collaborate with client and significant others •Collaborate with appropriate other (community) resources •Choose the best time and duration of treatment •ID re-evaluation plan •ID discharge plan

Evaluate: The Person

•Goals & Expectations •Interest/Motivation •Abilities •Limitations

Control Interface

•Hardware by which the human in the AT system operates or controls a device •Also referred to as input device •Ranges from 1 to infinite number of independent inputs or signals, defined as input domain

Continuum

•AT vs. Rehabilitative/Educational Technology •Low Tech vs. High Tech •Hard Tech vs. Soft Tech •Appliances vs. Tools •Minimal vs. Maximal -Orthosis -Prosthesis •General vs. Specific •Commercial vs. Modified vs. Custom -rehabilitative tech. ex: electronic/weight machine that gave you resistive exercise passively (you are trying to increase ROM/strength) -assistive tech = it will help you do an area of occupation, but not necessarily going to make your functioning (ROM, strength, etc.) better -low tech ex: sock aid -high tech = ease of use and complexity and cost considered (usually a lot of electronics involved) -hard tech = equipment (ex: w/c, computer, etc.) -soft tech = brain power (ex: my training I will provide) -appliance ex: toaster -tool requires skill to use (ex: portable circular saw, have to have expertise on how to use it appropriately/safely) -minimal ex = reacher -maximal ex = power chair -orthosis and prothesis can be minimal or maximal -general = population -specific = individual

Static Display AAC Devices

•Ablenet Quick Talker •7 Level Communicator •Tech Talk/Speak •Tobii S32

Evaluate: The Environment

•Accessibility -Physical environment -Safety issues •Home Modification

Implementation

•After you have received funding approval •Order the equipment •Receive the equipment •Set up the equipment •Train the consumer and caregivers -training = set up and use

Proximal Scale Physical Environments

•Architectural barriers for the home •ADL assessments •Negotiability Rating Scale - is the home functional with adaptive equipment? •Value of appearance over function?

Community Scale Physical Environments

•Architectural barriers in the community (curb ramps, railings, height of water fountain, etc) •How far individuals travel within the community or outside the community(are there adequate rest stops between sites?)

Societal Scale Social Environments

•Attitudes toward individuals with disabilities by persons in society •Acceptance of individuals with disability •Attitudes related to type of disability including psychiatric disorders and criminal record

Selection techniques for Scanning

•Automatic - hit the switch, the software scans across the choices until you hit the switch again •Inverse scanning - hold the switch down until you get to the selection you want. Let up on the switch when you reach the item you want to select •Directed scanning - user activates to select the direction of the scan, vertical or horizontal. Then device scans selection set sequentially, hit switch again to make selection -Step scanning - hit the switch each time you want to move to the next item. Hit a second switch to select the item -automatic = hit switch once, software scans until you hit it again -inverse = keep holding until you want to let go -direct = every time I hit the switch it will move one space over -multiple switches = one in one direction, one in the other, one to select and item, etc.

Computer Access: Keyboarding

•Basic Skill •Alternative to handwriting •Mouse alternative -blind = keyboard use only (cannot use mouse) (ex: use ctrl-C to copy)

Proximal Scale Cultural Environments

•Clinical Reasoning Studies (clinical settings) •Classroom Behavior •Work Environments

Getting Started: Assessment

•Compass -Measures typing speed and mouse functions •Computer Access Evaluation Forms -See folder in Blackboard -are there assessments available that are software driven on the computer? -mouse functions = clicking right or left, movement of the mouse across the screen, etc.

Discharge (Transition) Plan

•Compile a discharge (transition) plan •Location •Resources (referral?) •Training •Equipment needs

Write a Proposal

•Consult a funding specialist •Write it up! •Submit it!

more on context in the OTPF

•Context affects a person's access to occupations and influences the quality of and satisfaction with performance •Context is the broad concept that encompasses two components: Environmental factors, and Personal factors.

OTPF definition of context

•Context is the construct that constitutes the complete make-up of a person's life as well as the common and divergent factors that constitute groups and populations. The context within which engagement and participation in occupations occurs is specific to each person's unique context.

Examples of contexts

•Cultural •Personal •Physical •Social •Temporal •Virtual

Immediate Scale Cultural Environments

•Culture of the Family •Caregivers of Individuals with Disabilities

Referral and Intake

•Determine if technology is a good match between you and your consumer •Can you provide adequate services?

Input Domain May be either Discrete or Continuous

•Discrete- each location has a fixed value representing a distinct result, with no intermediate steps. •Continuous - inputs are ongoing/continuous with several intermediate steps and an infinite number of values -discrete ex: I type "f" on the keyboard and it gives me an "m" -continuous = goes until it is physically stopped

Voice Recognition

•Dragon Naturally Speaking •Windows Speech Recognition •IOS and Mac Voice Control -dependence on voice recognition = use "Dragon Dictate" (control with commands and reads words aloud)

Immediate Scale Social Environments

•Dyads - couples, mother-daughter, father-son,

Preventing Typing Injuries

•Elbows about 90 degrees •Wrists straight •Feet supported •Back Straight •Take frequent breaks

Meaning of contexts

•Elements within and surrounding a client that are often less tangible than physical and social environments, but exert a strong influence on performance •OT Practice Framework: a variety of interrelated conditions within and surrounding the client that influence performance...cultural, personal, temporal, and virtual

Community Scale Social Environments

•Encompasses wider distances than particular settings such as a home •Social Support - amount of instrumental and emotional assistance available from a variety of sources •use of community services, recreational services, various kinds of employment

Societal Scale Cultural Environments

•Historical Reviews of treatment of individuals with a disability by societies •Comparative studies of various cultures •Models of how to deal with individuals with disabilities -medical, social pathology, supercrip, business, civil rights/ minority model, legal model, cultural pluralism model, consumer model

AAC - Dynamic Display-Consumer

•I Pad/I Touch -Multitude of apps •Android Tablets -Saltilo Silk -Saltillo Nova Chat •Tobii Tablet -what functions do they need to do = determines device -want to play games = buy an Ipad -have work to do = other devices are more efficient

Funding for assistive technology

•IDEA / Public Schools •VA Hospitals •Vocational Rehab •Workers Compensation •Personal •Donation / Sponsor •Medicaid Waiver -some schools are required to provide it (HAS to be on the IEP) -these are places that MIGHT support you

Intervention

•Implement the plan you created •Modify plan as needed or as adjustments become necessary

Typing Vs. Writing

•Keyboarding speed relates to handwriting legibility and handwriting speed •On average, 6th graders keyboard faster than they write -Key - 14.9 WPM Ave. (6.2-33.9) -Write - 10.9 WPM Ave. •Adults 26 Wpm handwriting (Freeman, 1954)

Access Evaluation: Cognitive Evaluation

•Look at language skills •Categorization •Sequencing •Matching •Being able to socially communicate •Being able to understand (receptive) •Motor speech skills •Being able to recognize symbols •Syntax

Trial Period

•Make friends with a vendor! •A trial evaluation using "loaner" equipment •The system should be matched to the consumer rather than forcing the consumer to match the system -vendors are the best (lend equipment out for trials) -match the system to the person, rather than use of a general piece of technology and have the person live with it

Recommendations

•Make recommendations based on: -Performance during the trial period -The abilities and disabilities of the consumer and the characteristics of potential assistive devices

Societal Level Physical Environment

•National or Global standards for Architectural Barriers •Universal Access Guidelines

physical environment

•Natural (geographic terrain, plants) and built (buildings, furniture) surroundings in which daily life occupations occur •Can either support or present barriers to participation in meaningful occupations

Access Methods

•Need to find the best body part that has the best agility, speed, & size -Effector organ •What is the best effector organ for w/c control? -HANDS -effector organ = finger, palm, elbow, etc. (how will I access the input device)

From the Initial Evaluation...

•Needs Identification -Performance areas •Skills Identification -Performance components •Consider Device Characteristics **Cognition is more rate limiting factor when compared with physical -skills = have to have high cog level of functioning to understand/remember all the functions of the technology to work it properly -people will throw the equipment away if it is constantly breaking or doesn't fill its purpose

Voice Recognition Issues

•Not for classroom or public places use •Rate less than advertised for most people •High cognitive requirement •Correction of errors important •Accuracy increases with use •Voice stress precaution

Access Evaluation: Physical Evaluation

•Obtain ______ •Identify _______________ •Evaluate __________________ -Measure ROM, _______ -Select ____________ •Perform __________________ -Non-computer -Computer

Personal Context

•Personal context refers to demographic features of the individual, such as age, gender, socioeconomic status, and educational level, that are not part of a health condition

Keyboarding Guidelines

•PreK -K -Guided keyboard exploration , alphabet and numbers •Grade 1 - Keyboard layout, function keys (return, space bar) and software tool bar •Grade 2 - type one handed •Grade 3 - learn 2 handed typing - 10 words per minute •Grade 4 - Concentration on speed - faster than handwriting •Grade 5 - Goal 25 gross words per minute •Grade 6 - Goal 30 words per minute -concentrate on accuracy. •Middle School - 30-40 words per minute •High school - 40-60 words per minute

social environment

•Presence, expectations, and relationships of persons, groups, and populations

Keyboard Layouts

•QWERTY (classic) •ABC •Custom •Dvorak •Chubon

Referral

•Receive information about a potential client from a health-care professional, family member, or from the client

Follow Along

•Regular contact with consumer •**Essential portion of the AT delivery system!! •Consumers are dynamic •Their AT devices should also be congruently dynamic

Screening

•Review the information and determine if your services can adequately serve their need

ZoomText

•Screen Enhancement (Magnification) •ZoomText is a stand-alone piece of software designed for visually impaired people.

Assitive technology includes

•Seating and Positioning •Computer Access •Environmental Controls or EADL •Augmentive or Alternative Communication •Visual Impairment technologies •Assistive Listening •Organizational Assistants •Writing Adaptations •Robotics -it is difficult to be an expert in all of these areas of assistive technology

Consideration for Splinting- Construction Principles

•Skin Integrity •Subcutaneous fascia •Edema •Neurovascular supply •Sensation-if impaired skin checks important- dynamic splinting schedules may need modification •Pressure/Bony Prominences •Friction from splint migration •Decide purpose of splint and confer with client •Decide design of splint and confer with client •Construct pattern •Check pattern for fit and refine if necessary •Decide upon materials- organize work space and collect all tools and materials needed •Cut and heat or heat and cut splint material •Mold and evaluate fit •Finish edges and re-fit as needed •Apply straps, padding, accessories •Educate client and caregivers about splint goals, precautions, wearing schedule •Provide follow-up contact information •Document what you did!!

Proximal Scale Social Environments

•Social Roles - student / teacher, family interactions and functioning, •Social climate of a group •Work Environment Scale •Ethnography

Mouse Clicks/Modes of Selection

•Switch •Dwell •Voice •Puff & sip •Blink (with eye gaze only) -dwell = look at the item you want for 3 seconds to select it (head-controlled mice or eye gaze) -Jouse = use of chin or tongue to control mouse -blink = clicks on what you want with a blink

Examples of Virtual Context Issues in OT

•Telehealth •Older therapists adjusting to use of technology for note writing, communication •Facebook, Social Media •Too much virtual context? What are some adverse consequences to being on line all day?

Dvorak Keyboard

•The Dvorak keyboard is an ergonomic alternative to the layout commonly found on typewriters and computers known as "Qwerty". The Qwerty keyboard was designed in the 1870s to accommodate the slow mechanical movement of early typewriters. When it was designed, touch typing literally hadn't even been thought of yet! It's hardly an efficient design for today's use. -increase typing speed with this type of keyboard -practical perspective = community keyboards are not this layout

Access

•The point of contact between the person and AT •Where body part interacts/touches with AT Things to consider when selecting the best access method: •Speed •Accuracy •Control •Reliability •Endurance -if I have a bad tremor, my accuracy to type an 'M' on the keyboard will be rough -reliability (how long will the technology last)

Examples of Immediate Scale Physical Environments

•Tool use •Work simulators •Assistive technology •Fine Motor Task Assessment •Ergonomics of computer workstation

Alternate Mouse

•Touch window Hands Free •SmartNav •Tracker Pro •Headmouse Extreme Mouth •Jouse •Quad Joy •Power Wheelchair controls •Eye Gaze -Tobii PC Eye -tracker = head control -PCI = eye gaze control of computer

Mouse Styles

•Trackball •Touch pad •Joystick •Switch Activated Joystick (SAM) -trackball for tennis elbow (use of fingers, don't have to slide mouse around) -joystick more wrist and finger movement

Environmental Contexts

•Where occupational performance takes place and consists of: -Physical components -Social components -Cultural components •Virtually all human experiences have all three components addressed at some level

Rate Enhancement

•Word Completion -User selects desired word by entering its code •Word Prediction -Offer a menu of words based on previous words entered •Abbreviation - Expansion -OMG --> Oh my gosh! -ASAP --> As soon as possible KNOW DIFFERENCE (on exam) -word completion = type in part of the word, and a suggestion comes up you can click to increase typing speed -word prediction = what is the next word you want after typing one word

Integrated System: Eye Gaze Systems

•i12 or i15 w/C-Eye Quick Glance •Eye Max by Dynavox •Forbes Commlink

Do you really need a computer?

•iPad or other Tablet •Portable word processors -Alpha Smart •Apple/ Mac or PC? •Desktop or Laptop? •AAC system -ipad/tablet is more portable -people have preferences on operating systems -apple is better as far as accessibility features than android

construction principles

•strive for good cosmetic fit •consider the DX when applying splint: (dorsal vs. volar vs. radial vs. clam shell/bi-valve) •use equipment appropriate to material •round corners •smooth edges •analyze mechanical principles (also with strap placement) •stabilize joint surfaces •provide ventilation prn •use padding appropriately

Virtual Context

•virtual context refers to interactions that occur in simulated, real-time, or near-time situations absent of physical contact. The virtual context is becoming increasingly important for clients as well as occupational therapy practitioners and other health care providers. Clients may require access to and the ability to use technology such as cell or smartphones, computers or tablets, and videogame consoles to carry out their daily routines and occupations.