Assistive Tech Final

How to support the needs of your AAC user

- Augmented communicators describe a 'good' communication partner as patient, motivated, interested, and comfortable with all methods of communication - Sometimes communication partners underrate their abilities, shout at them as though they are deaf, over enunciate, and/or talk to others instead of addressing them directly

classification of robots (1992) still remains in 2020

- service - industrial - professional service - personal service - assistive, socially assistive and socially interactive

what do you think? is it cheating or leveling the playing field for someone that has an impairment?

Individual with motor and/or sensory impairment - Outcome = is the activity being completed - Mobility = does individual get from point A to point B successfully with AT device? (walker, wheelchair, etc.) Individual with cognitive impairment - Outcome = name all 50 states - Memorization = does individual name all stated successfully with AT? (search engine)

Robots for feeding

OBi

human variables

Often impacted as a result of cognitive impairment - Memory - Attention - Information processing - Problem solving - Organization - Perception - Orientation - Emotional regulation

seating and participation function

The primary purpose of a seating device is to maximize a person's ability to function in all activities across all performance areas. ​ ​ There are three distinct areas of seating interventions, each serving a particular user need: ​ 1. seating for postural control ​ 2. seating for tissue integrity ​ 3. seating for comfort ​

critical element to consider

Time - To set up - To design or modify - To obtain correct CAD software and filaments - To run the 3 D printer - To allow for cool down of both the nozzle and the printing bed but you do not need to own a 3D printer to use 3D printing

Jaco assistive arm (2 and 3 point grasp)

$30,000-$35,000 - Grasping a bottle - Grasping a bottle at ground level to table height - Pushing buttons (computer, elevator and appliances) - Tissues out of box - Taking a straw from a container to another container - Pouring between container

what do AT tools for cognitive augmentation look like?

- AT as a cognitive prosthesis (extends cognitive ability) (reminders, alarms, spellcheck) - the distinction between educational vs. assistive tech is more blurred when looking at tools for cognitive disabilities such as LD - should we be compensating and removing a barrier or remediating a skill

The primary function of an activity matrix for the implementation of assistive technology is to:

A. Minimize costs. B. Match the activity to technology to the responsible team members. C. Decrease abandonment. D. For ethical technology utilization. B and C were accepted

The following cultural context variable may support the use of an AT tool for manipulation or an EADL: a. Use and availability of mainstream tools for manipulation b. Integration of technology in a home c. Portability d. Funding

A. use and availability of mainstream tools for manipulation Remember what constitutes a context variable

Cases Mild Cognitive Impairment

Adult - 30-year-old post TBI, 3 years ago - Ability to read and write severely affected, language and ability to communicate - Poor time management, forgets to complete daily tasks including taking his meds - Has been seeking out technologies to live more independently and remove barriers to daily living - Main concern is forgetfulness, and the impact reading and writing has had on his ability to create reminders

types of AAC: High-Tech

Electronic speech generating devices that permit the storage and retrieval of messages. dedicated devices or tablets with apps, price is much higher, lamp words for life, wearable devices such as larger apple watches - dynavox - school is obligated to cover cost of AAC device or other AT devices but if child moves or graduates, the device belongs to the school - parents can choose to use insurance so they own the device but school will help parents acquire it, can only get one device every 5 years - always give user largest selection set even if they do not know the vocabulary yet. this way they learn the vocab in the correct spot and the vocab never moves, better for motor planning

go baby go

National - Originated at the University of Delaware​ - Provides modified ride-on cars to children 0-3 (or older of smaller size) who experience limited mobility​ - Cost to modify a car is ~$200​ --Switch to turn car on​ --Firefly Go To seat​ --Seating supports​ --Steering modifications​ - Enables children to engage in independent and volitional environmental exploration​ CT - Many organizations involved at the CT level:​ - QU PT (and now OT)!​ - CCSU engineering department​ - CT 0-3​ - Local High Schools​ - CCMC Therapists​ - Follow up on Fb and Instagram​

wheelchair standards

Standards can provide manufacturing guidance to ensure product quality​ International Standards Organization (ISO) and RESNA have published overlapping and comparable standards for:​ - Manual wheelchairs​ - Power wheelchairs​ - Seating systems​ - Wheelchair use during transportation​ ​ Examples of standards covered by both ISO and RESNA:​ - Determination of overall dimensions/mass/turning space​ - Determination of coefficient of friction on test surfaces​ - Wheelchairs used as seats in motor vehicles​ - Determination of efficiency of brakes​ - Testing power and control systems for electric wheelchairs​ ​ Standards are voluntary but there are strong motivations to adhere​ - Ex) VA has purchasing requirements for wheelchairs and could impact compliance with standards by adopting them and not creating their own​

DIY in the maker movement: 3D printing

Three-dimensional printing is a form of additive manufacturing technology where a three-dimensional object is made through laying down successive layers of materials (Mishra 2014). Three-dimensional printing uses various materials including plastic, metal, ceramic, or living cells in layers to produce a 3D object. (skin grafts, small organs, bones)

robot assisted instruction (movia)

unpredictability of social response of a human being makes children with ASD more engaged with a robot

Who is AAC for? appropriate for anyone desiring to communicate or their is a barrier to communicate

*There are no prerequisite skills, symbol acquisition levels, age requirements, or cognitive level to using AAC People with complex communication needs who are/have: - Physically involved but cognitively able - Multiply involved with unknown cognitive abilities - Physically able but motor speech or language delayed - Pre-verbal or emergent-verbal - On the autism spectrum - Developmentally delayed - Exhibiting behavior disorders related to inability to communicate effectively - Severe speech sound production difficulties AND students who have difficulty accessing their curriculum in the absence of AAC support

What is AAC?

- "The supplementation or replacement of natural speech and/or writing with a variety of symbols, strategies, and techniques" (Lloyd, Fuller & Arvidson, 1997). - Augmentative (in addition to) and Alternative (replaces) Communication - Communication is the most foundational activity of daily living (WHO, 2011) - A set of tools and strategies that an individual uses to solve every day communicative challenges (ISAAC).

opportunities

- 3D printing is still a relatively new concept and further research, analysis, knowledge and promotion needs to occur in order to reap all benefits that this advanced technology has to offer (Ganesan, B. Al- Jumaily, A & Luximon, A., 2016) - OTs can collaborate with professions including physical therapists, engineers, teachers, doctors, technicians and various other professionals. One of the most imperative members of the team when working with 3D technology is the consumer or the client (Kane, Hurst, Buehler, Carrington & Williams, 2014). - Although widely unknown, occupational therapists can bring awareness towards the benefits, advantages and affordability of 3D printing. One area in which this can be done is with prosthesis. At present, prostheses are highly expensive and range from $5000 to $10,000 for an upper extremity prosthesis. With the use of a 3D printer, the cost of a prostheses may be less than $1,000 (Silva, Rand, Cancel, Chen, Kathirithamby & Stern, 2015). - 3D printing can also have a break through in the school setting. Special education in particular is believed to be one area in which 3D printing can have a major impact. (Buehler, Kane, & Hurst, 2014). - Occupational therapist can work with teachers that are involved in STEM (science, technology, engineering and math) to offer more hands-on information and learning for students. - Occupational therapists also have a unique understanding of universal design and universal design of learning. Through implementation of 3D printed products in the classroom, there is the potential for all students to have the opportunity to learn in the best way possible for the individual (Buehler, Kane, & Hurst, 2014).

uncle nathan case

- 52 years old - Diagnosed with ALS at age 48. He was very healthy and active and first noticed something was off when he was shoveling the driveway and had trouble moving his hands. - Lives with his wife and their 16-year-old daughter in Terryville, CT. He has two older sons (late 20's) who live out of state and visit when they can. He has two young grandsons. Supportive family, his 4 sisters and 2 brothers frequently visit, and his parents visit every other week. - Reasons for eye gazing system- primarily communication (slurred speech and difficult to understand), has no hand function for typing or other fine motor tasks, wanted to be more independent and this system allows him to "speak", shop online, listen to music and watch TV without assistance from others

SMART wheelchairs

- A SMART Wheelchair is either a standard power wheelchair with a computer and sensors or a mobile robot base with a seat attached ​ - Useful for users who have low vision, motor impairments, or cognitive impairments ​ - Typically provide two functions (1) collision avoidance (sensors that detect an obstacle in the path of the wheelchair) and (2) navigation (sensors guide chair)​ - Comes in shared control system, which wheelchair controls are shared between user and computer, or autonomous control, in which computer has full control of the chair​ Benefits of SMART wheelchairs​ - Relieves weight from bottom in a tilted position​ - Can get through hinged door​ - Stops on command​ - Different body position options (e.g. cushions, head rest)​ ​ Not available on the commercial market ​ - Only exists in research setting​ - Anticipated to be available for clients in the near future ​

Examples of Mid- Tech Tools for Severe Cognitive Disabilities

- Alarms - Digital vs. analog watches/clocks - Electronic reminder systems - Electronic pill boxes

FIRST ROBOT FOR SOCIAL INTERACTION: KHAMIS, KAMEL & SALICHS (2007)

- An autonomous robot whose attitudes and behaviors take into account the interests of the human - Make take the physical form of a "person" - User interface (review that term from user control presentations) is how the user communicates with the robot - User should have immediate, perceptible results and continuous control over all actions of the robot - Robot should respond to voice, gesture, and touch Robot has a service response interface for continual monitoring of what the human wants - Greatest potential in when there is an adaptive interface-meaning that the robot can learn from patterning or practicing a movement pattern with human assistance BUT then perform that movement independently to support the user. See Orbi video later in slide deck.

types of AAC: low-tech

- Any AAC system that does not require a power source - May have a unique communication system through symbols (see text page 403 for examples): PCS, Rebus, PIC and others may be more common in different cultures and countries. - OTs often use picture exchange for ADLs and work. pen and paper, dry erase board, pictures, no power source, wearable low tech devices such as bracelets

Examples of High- Tech Tools for Mild Cognitive Disabilities

- Computer access - Word prediction/word completion - Text to speech - Voice recognition - Reading pen - Pulse pen - Conceptualization software/organizational software - Electronic calendars/reminders/alarms

Software Considerations

- Cura LulzBot Edition is free and the recommended software for the Lulzbot Taz 6. This software prepares the files for printing and allows the user to control the operation of the LulzBot 3D printer. - When purchasing a 3 D printer look for one that has supportive software for operations - Look for software that allows for the use of 360 degree imagining for objects to be scanned and then sent to printer. - E.g Scanner and Structure at: https://structure.io/

Examples of Mid- Tech Tools for Mild Cognitive Disabilities

- Digital reminders - Digital schedules - Hand-held spell checkers - Electronic pill boxes - Electronic books - Calculators/talking calculators/money calculators - Portable word processors

Filaments- the plastics

- Filaments must be compatible with your printer; your printer nozzle; and the template for the 3 D model you want to print - Filaments have different density, can have a core materials such a wood or metal, and the type of filament MUST be selected before each printing of a 3 D model to ensure proper heat - The type of filament will also contribute to the length of time to make a 3 D model - In working with a human being, the filament should be checked for sharp areas; possible allergic reactions; skin sensitivities, and possible movement of the printed item near the eyes or mouth.

splints can be manufactured by 3D printers

- In a study about forearm splint compliance, it was found that noncompliance could be attributed to complexity of the splint, aesthetics, pressure on bony prominences and uncomfortable to wear (Sandford, Barlow & Lewis, 2008). - Using a 3D printed splint can allow for compliance by the client because the printed product is made specific to the client with smooth, soft edges, appropriate and necessary ventilation, increased comfort and fit (Ganesan, Al-Jumaily, & Luximon, 2016) - 3D printers can manufacture and produce pieces of adaptive equipment that are necessary environmental modifications that a client needs (AOTA, 2014). - Examples include, but are not limited to, built-up utensils, glass holders, and grip holders for various everyday objects such as keys, pencils or glassware (Ganesan, Al-Jumaily, & Luximon, 2016) - The products of a 3D printer allow for improved grasp, ease in reaching, assistance with maintaining grasp and easy release.

promoting self determination

- Infer preferences - Provide means to communicate - Make observations when presenting objects - Consider all communicative intents to determine preference - Record free time spent with activities - - Consult with family, friends - Include client in decision making process (person centered planning)

obstacles

- Nanoparticles that can be inhaled when the printer is in use. There are different types of filament that can be used. In one study, it was found that one kind, acrylonitrile-butadiene-styrene (ABS), released about 33-38 times higher of a concentration of particles than its counterpart, the polylactic acid (PLA) filament (Yoon, 2016). - A good 3D printer can cost anywhere between $250- if you're going as basic as they can get to $6,500, to over $10,000 if you want high-end products to come out of your printer or if they get specialized like a dental 3D printer. In addition, you have the costs of the filament which range depending on the kind you choose. - Selecting appropriate 3 D models to make and asking the question: can this be made in a faster-safer-more effective manner?

VALDES, KHOSHNAM, NEVA & MENON (2020). JOURNAL OF NEUROENGINEERING AND REHABILITATION

- Need for robots to "recall" proprioceptive and kinesthetic action in order to replicate a functional movement pattern - A robot that can be manually taken through a functional pattern such as how to scoop food and bring it to the user's mouth will have the greatest potential for self care - The robot needs to have some type of proprioceptive and haptic memory, again see the Obi video later in the presentation for such a tool on the market

Examples of Low- Tech Tools for Mild Cognitive Disabilities

- Number lines/graph paper - Modified writing paper - Pocket reminders on paper - List of frequently misspelled words - Printed daily schedule - Highlighters - Modified text

roles of OT in AAC

- Positioning (often with PT) - Determination of direct or indirect body part access points (often with PT) - Determination of the developmental level of the person for cognition and perception (with educator, SLP, psychologist, social work) - Trial the AAC with all team members across all environments - Contribute vocabulary ideas (words and phrases) for all domains of occupation - Ensure that the system/tools can be used across all environmental considerations.

wheelchair training peds

- Prerequisite required: Motivation ​ - Responsibility of therapist, family, and caregivers to promote safety of use​ - 3 phases of wheelchair use: Exploration (child explores movement) > play (promotes exploration) > functional use ​ - Practice time and quality learning is key ​- General tips: Minimal instructions, simple and consistent vocabulary, allow for processing time, trial and error, large/quiet environments ​ - Verbal cues: Stop & go while child moves and re-direction cues​ - When providing cues: Say "come over here" rather than giving the direction to further test their knowledge​ - Progress environment as skills improve​ - Virtual reality training is emerging practice (gym, home, forest)​ - Course progression: Wide straight pathways > 90 degree turns > curves ​- Clinicians must provide training so others can support mobility training & supervise​ - Ensuring proper positioning & ensuring appropriate driving methods are being used​ - Behavioral issues should be addressed the same you would a typical student when possible​ - Recommended training games: Stop & Go (for safety), Follow the leader (directional concepts), obstacle courses (safety/directional) ​​

examples of low tech tools for severe cognitive disabilities

- Schedules - Lists (symbols, test, pictures) - Visual support systems - Color coding systems - Low tech activity analysis systems - Counting/measuring systems - Stimuli reduction systems - Flow charts - Microwave button shields - Headphones (noise reduction)

Kinova dynamic arm support

- Uses the wheelchair's power supply - Suitable for both left- and right-handed users - Highly adjustable to user arm strength and morphology - Follows the natural movement of the user's arm Each arm supports up to 4.5 kg (10 lb) KINOVA

applications in OT

- When looking at the Occupational Therapy Practice Framework, the relationship between - 3D printing and occupational therapy can be noted (American Occupational Therapy Association [AOTA], 2020). 3D printing can allow for a client to better participate in an occupation-based intervention (AOTA, 2020). - Occupational therapists are responsible for educating clients on the use/purpose of the product from 3D printing which will allow the client more optimal occupational performance and occupational balance. - Stabilizes, positions, bends, grips, manipulates, moves, lifts are a few of the performance skills that can be attained through a 3D printed product (AOTA, 2020). - Various types of adaptive equipment can be printed that are client specific and target a specific motor function which allows the client to have success when participating in their daily occupations (AOTA, 2014; Ganesan, Al- Jumaily, & Luximon, 2016).

what is the maker movement?

- a global community of inventors, designers, engineers, artists, programmers, hackers, tinkerers, craftsmen and DIYers - focuses on a perennial curiosity "about how they could do it better the next time" - believes in the basics of the traditional design cycle: reiteration, trying, reflecting, asking if it meets the purpose, and making it better and more functional - does this sound like OT?

time-space-safety

- cool down period - ventilation (need to use in well ventilated room because of any gases emitted during the printing) - age (must be 18 years or older, if not it requires adult supervision) - burn hazard (the nozzle and heater block should never be touched before turning off the heat and allowing time to cool down) - cool down can take up to 20 minutes - don't touch plastic items right after they are printed- allow cool down period - heated bed and stepper motors also need cool down time as they heat up during the printing process - electric shock hazard (internal power supply can cause shock at any time, do not open that part) - fire hazard (don't place flammable objects near printer, can cause fire) - pinch hazard (be careful not to put fingers, clothing, or hair near the belts, pulleys, or gears as they may get caught in the machine

circles of communication in our daily life

- partners and family - friends real, face to face, and virtual - acquaintances in shops, on streets, in environments - unfamiliar people such as on phone in health care communication may change based on communication partner, make sure they have a range of full vocabulary

Examples of High-Tech Tools for Severe Cognitive Disabilities

- smart phones - jitterbug phone - applications - smart homes (home monitoring systems for gas controls, doors, windows) - GPS tracking systems - simplified media presentation - word prediction (language retrieval) - tools for concept organization/decision making (inspiration)

SHERIDEN'S LEVEL OF ROBOTIC AUTONOMY (2000)

1. Computer offers no assistance, human does it all. 2. Computer offers a complete set of action alternatives 3.Computer narrows selection to a few choices 4. Computer offers a single action 5. Computer allows human limited time to veto before automatic execution. 6.Computer informs human after automatic execution IF human requests 7.Computer executes automatically then informs human 8. Computer decides everything and acts automatically Yikes!

activity categories specific to communication

1.Receiving communication a. Via spoken b. Via nonverbal c. Via sign language d. Via written 2. Production of communication a. speaking b. body language c. written 3. Conversation and communication devices

compare basics of robotics

1992 - Robots should do no harm - Robots should assist in the life functions desirable by a person or family - Robots should increase freedom to engage in social activities without a burden on care givers or families or professional assistants - Most complicated need are those movements which have angular degrees of freedom: wrist deviation and forearm rotation 2020 - basic areas of robot care - Engine for cognitive development children - Manipulation for self care - Social connections - Fetching-carrying-presenting objects to user - Do no harm - Assist with activities in a manner that allows a person to have more typical interactions with others

ATs for seating

3 distinct areas of seating interventions: seating for postural control, seating for tissue integrity, and seating for comfort. ​ - Planar cushion: Appropriate for individuals who require min. support or who do not use a seating system for a long period of time. Designed from flat blocks of foam. ​ - Contour cushion: Beneficial for individuals to support postural management or those at risk for developing pressure ulcers. Curved surfaces that closely match the shape of the individual's body. Support and control increased as the degree of contour is increased. ​ - Custom contoured cushion: Provides the greatest amount of body contact and most support that is shaped and customized to the client's body. Disadvantage of this cushion is the limitation of varying positions; thus, client is in a fixed static position. ​ - Prefabricated backs: Appropriate for individuals with paraplegia and C4 and C6 quadriplegia for postural control support. They can be adjusted to the client's trunk control, head support, and mobility. ​

outcomes for seating

3 main outcomes of seating include the effect of pelvic stabilization, effect of seated support surface on reach, and efficacy of pressure redistribution cushions:​ 1. Pelvic Stabilization​ - Important to start with the pelvis when considering seating to promote stability and functionality when seated​ - Two options: lap belt and a rigid pelvic stabilizer​ - Studies have found that rigid pelvic stabilizers had better functional outcomes for wheelchair users when measured by the COPM​ 2. Reach​ - Seating and positioning can affect an individual's ability to reach.​ - Seat cushions can improve dynamic stability during reaching tasks​ - Studies have found that contour foam cushions have shown to be most effective in providing stability to support reach.​ 3. Pressure Redistribution Cushions​ - Lower incidence of IT and sacral pressure ulcers with use of pressure redistribution cushions in general. No one cushion is more effective at reducing this.​ - Viscous fluid cushions lessen interface shear stress​ - Material of cushion can affect heat dissipation.​

HAAT applied to enabling mobility

Activity: Personal Mobility - the ability to move oneself from one place to another (in, around, outside, or between buildings, within home or community)​ - Within mobility devices: passenger or driver (of transportation vehicle including wheelchair) ​ - Foundational activity for other skills/activities such as activities needing to transport to another location ​ - Consider level of independence/ability when using and maneuvering mobility devices, and use schedule (full time versus as intermittent need)​ Human:​ - common diagnoses resulting in mobility impairments include stroke, CP, Guillain-Barre syndrome, Huntington's chorea, TBI, muscular dystrophy, Parkinson's disease, poliomyelitis, SCI, spina bifida, MS, orthopedic and rheumatological conditions, diabetes, cardiorespiratory conditions, and obesity- impairments and strengths of the client determine the type of WC​ - mobility needs differ across the lifespan; early mobility is important for children to experience movement within the environment and literature supports the use of powered mobility; older adults may depend on another person to push the wheelchair depending on the user​ Contextual Factors: ​ - Physical contexts - context in which the device is used influences client's ability to use device, and what device is recommended. Will the device be used indoors or outdoors? How accessible are the environments? Width of doorways, floor surfaces, bathroom layout and structure should be considered.​ Social contexts - family members, peers, others in the social environment influence choice. Peers with experience using mobility devices can be a great source of information​ Cultural Contexts - values related to cultural and societal inclusivity, availability of technology, and access to technology. Cultural values will influence nature of the device (if inclusivity is valued, they will seek a device that enables community participation​ Institutional Contexts - regulations and policies of specific institutions influence the device choice. These contexts include funding, requirements for stability of client and conditions, restrictions on where the device can be used, and requirements of client performance. Future needs and current implications should also be considered ​

why obi- why self feeding is so important to a user

Besides the nutritional benefits of eating what are the other values? - Control over environment? - Choice? - Social participation? - Allowing for typical family interactions - Is the money worth the function? - Kevin uses a switch-joystick to operate - William uses a single switch

In the assistive technology service delivery process you should obtain funding approval in all of the following except: A. Referral. B. Initial Evaluation. C. Recommendations. D. Follow along.

C. Recommendations

interprofessional collaboration

Communication is embedded in all activities all day. Requires a true IP team with the lead most often the Speech and Language Pathologist

power control interfaces

Control interface: what a person uses to direct movement of a powered wheelchair ​ Two Control Distinctions:​ 1. Proportional w/ continuous joystick​ - 360-degree directionality​ - Speed of wheelchair can be controlled ​ - The greater the joystick displacement, the faster the chair moves​ 2. Nonproportional w/ discrete joystick OR switch​ - Activated in 1 direction at a time, no diagonal or circle movements ​ - Uses only 1 selected speed​ - To change direction, user must release control in one direction and activate it in direction of change ​ Multiple Control Interfaces ​ - Joystick (T-bar, extended, U-shaped, sphere, etc.)​ - Switches​ - Touch Drive 2 control interface- bottom picture ​ - Sip & Puff- top left picture​ - Various Head Control Systems- top right picture​ - Indirect selection using scanning​

fundamentals to consider of the tool

Degrees of Freedom (DOF): how many variables are required to determine position of tool in space. How many degrees of freedom does a human wrist have (3 name them) Each joint of a robot gives a degree of freedom. If an assistive robot is on a stand then it will have additional degrees of freedom.

AAC: Access Important to return to direct and indirect access methods for consideration

Direct selection - Pointing with physical contact • Finger• Stylus• Mouthstick - Pointing without physical contact • Eyegaze • Lightpointer • Headmouse - Symbol pickup and exchange Indirect selection - Scanning with single or dual switches - Directed scanning • joystick

What leads to successful AAC use?

Frequent, consistent use in a variety of settings (e.g., school, home, community) to discuss motivating topics. Aided language stimulation (Goosens & Crain, 1986): - Provide user with a model of the system in use - Allow user to see AAC symbols in everyday situations - Suggest to the user that the system is an acceptable means of communication communication partner should also use communication device

FIRST PRESENTATION OF ROBOTS FOR USE IN OCCUPATIONS: 1987

Glass, K. & Ha;;, K. (1987) Occupational therapist' views about the use of robotic aids for people with disabilities. American Journal of Occupational Therapy, 41(11), 745-747. - Prosthetic workstations - Brushing teeth, feeding, using a phone - High cost and general distrust of the tools - High potential for improving dignity and self control

AT Tools for Severe Cognitive Disabilities

Goal of AT for individuals with severe cognitive impairments is to: - Simplify - Offer repetition - Offer consistency - Offer multiple modalities

the basics to get started:

Hardware: Printer takes a filament of plastic and melts it at a specific point to create whatever object is place in the program.3D Model → Put into specific hardware's printer software → Printer will create that out of plastic Software: prepares the 3 D printer for printer and controls the operation of the printer - Software to run the printer will run 3 D models that are written for or compatible with your printer - Software that allows you to design and develop templates for printer: CAD software know your machine

additional questions

How can you improve independent cooking skills in a group home for individuals with ID? - How can you use low tech to support measuring? - How can you use AT to support independent microwave cooking? - How can you use AT to support use of electronics for an individual with ID and limited UE use? - How can you make recipes accessible?

HAAT and seating

Human demographics: -Age​ -Gender​ -Marital Status​ -Education level​ -Employment status ​ -School attendance ​ -Time since onset​ Human factors/body structures/function: -Co-morbidities​ -SCI​ -Degree of severity​ -Weight status ​ -Skin moisture ​ Activity factors: - How we are seated affects our ability to complete activities. Appropriate seating factors: stable base, proper biomechanical position, comfortable. Factors that can influence proper biomechanical seated position are lifting and carrying objects in hand, fine hand use, and hand and arm use. These factors can combine to help perform occupations (eating a meal, writing or using a computer at home, driving, sewing, providing care, feeding a child)​ Contextual components: Physical --> seating height, arm rests, cushion, footrests, back rest, wheel of seats​ -temperature ambient temperature gels components of cushions. The semifluid material altered= reduced amount of cushioning​ -exposure to sunlight: degrades foam if left exposed to sunlight such as during situations when custom built seat cushion is left uncovered before final fitting​ -moisture: foam degrades when it gets wet​ Social --> multiple individuals can use the seating system such as family, caregivers and school personnel​ -User needs instruction on weight, complexity of the seating system, and maintenance​ -Proper body mechanics--> users and caregivers needs to be educated on proper body mechanics on lifting and carrying the seating system due to its heavy nature​ -Proper maintenance--> Users and caregivers should be educated on proper maintenance of the system due to the special properties of the materials used for the seating to prevent misuse​ ​Institutional --> funding is a key institutional consideration ​

video illustrations of low-tech

PECS: picture exchange communication system for children with autism. Note the team members: teacher, behavior specialist, psychologist. E Tran Board for an adult as a low-tech solution for an adult who also uses high tech

Cases Severe Cognitive Impairment

Pediatric - 18-year-old female with ID - Currently enrolled in a vocation program at her local high school - Able to complete basic ADL's (bathing, dressing, grooming) independently - Weaknesses: Memory for new skills, initiation of tasks, easily overstimulated, decision making, counting - Strengths: Personable, very social, strong desire to work, desire to move around community independently - Current job opening: Counting and packing binder clips (12 large/box, 20 small/box); Job opening available both at a constructive workshop or in a small factory Adult case - 86-year-old female has lived in her current home for over 35 years. Her husband is recently deceased and her daughter lives nearby. - Recent difficulty remembering things, experiencing some confusion (has had a few TIA's a few years back) - Her daughter helps out as often as possible - Confusion and memory have resulted in leaving gas cooker on but not lit on several occasions

feature matching for seating

Primary seating need (postural control, tissue integrity, comfort) can be assessed to determine best seating features required for the individual client ​ Trial different alternatives of positioning and observe whether they have beneficial or adverse effects on the person's ability to control interfaces ​ - Trial the seating features in their natural environment to see if it will work long term​ - Easier to document need and obtain funding for these devices​ Assess the ability to complete functional skills with the device ​ Main concern: Does the simulated seating system meets the goals identified during the needs assessment? ​ Example questions for feature matching:​ - Does this system meet the user's goals and needs?​ - Does this system provide stability and allow for maximal performance in functional activities?​ - Is this system durable to meet their needs for a reasonable period of time?​ - Is the seating system flexible to meet the user's changing needs? Ex: can it grow with the client over time/change height/size, etc.​ - Are there resources available to ensure proper maintenance?​ - Can the user or a third-party payer finance the cost?​

information on restraints

Restraints= "Any manual method or physical or mechanical device, material or equipment attached or adjacent to the resident's body that the individual cannot remove easily which restricts freedom of movement or normal access to one's body." (CMS, 2011). ​ Guidelines within institutional settings: - Use the least restrictive device ​ - Reassessed frequently for agitation and continuation of use​ - Remove periodically​ - Follow facility guidelines for documentation of use​ - Follow physicians' orders for continued use ​ Care plan: - Reposition client frequently to decrease risk of pressure ulcers​ - Perform skin checks regularly​ - Perform ROM exercises daily ​ - Ensure restraint is not limiting ADL participation​ - Ensure ongoing assessment and monitoring occur​ Additional strategies: - Assess if the emotional behavior is due to environmental factors that may be changed so the individual does not need restraints (triggered by another person, potential to fall out of bed)​ - Be aware of own emotions when interacting with the client ​ - Use positioning alarm to be aware if client tries to climb out of bed​ - Enhance exercise programs ​ - Ensure that staff is familiar with the client​ - Ensure the client is comfortable in bed while having the restraints on ​

assessment components for wheeled mobility

Seating Assessment for powered mobility is the same process​ Focus on Human and Context Factors as they relate to powered mobility​ - Human: current living situation, existing technology, diagnosis, cognition, growth, weight/size, measurements​ - Activity: Start with activities in which the person wishes to engage using the mobility technology which device best meets the users needs in the activities​ Context: ​ Physical - Visit the physical context is possible, interview with assessment instrument; include questions about transportation​ Social - who and how they will influence use (caregivers, employers, school personnel)​ Institutional - policies/practices, funding should be known before making a recommendation​

Wheelchair classifications

Standard wheelchairs: folding steel chairs with limited adjustment (seat width and depth), heaviest of manual w/c, not useful for LT use (require a lot of energy to propel) ​ ​ Lightweight, lightweight high strength: weigh less than standard, similar features but more flexibility in seat width/back height, lower seat to floor height, user can propel with feet​ ​ Ultra-lightweight: substantially lighter than standard, retains folding frame & lower seat to floor height, appropriate for those who use manual w/c as primary mobility ​ ​ Rigid sport ultra-lightweight: rigid frame with quick release rear wheels and backs may allow folding for transfer and storage of chair (in a vehicle)​ DME Power Mobility Devices: ​ - include scooters and standard power wheelchairs​ - Meets all basic power WC needs (many rule outs)​ Group 1: Used for short to moderate distances at level surfaces ​ Client's will benefit:​ - No postural abnormalities​ - No risk of pressure injury​ - No power seat functions required​ - Appropriate for basic seating without added stability or skin protection​ - Narrower turning radius​ Group 2: characterized by captain's seat​ - Improves ability to participate in ADLS at home​ - Have single and multipower seating ​ - Tilt/recline system available​ - Client's will benefit​ - Poor postural stability or transfers​ - Access is unavailable at home for scooter​ - Able to safely operate power WC or caregiver willing to operate​ - Do not use if dependent on chair for pressure relief​ Complex Rehabilitation Technology (CRT): ​ - Different from DME; medically necessary configured power/manual mobility device that requires evaluation, fitting, and specific adjustment by MD, OT, PT, and ATP (must be skilled and experienced)​ - Common diagnoses: congenital disorder, progressive/degenerative disease, tonal abnormality, trauma, or someone who uses w/c as primary mobility every day/sits in the chair for a longtime​ - Need specific dimensions for client comfort and optimizing position for function ​ - Also includes adaptive seating and alternative positioning​

AT and promoting self determination

Strategies for self-directed learning - Antecedent cue regulation (visual/auditory cues) - Self-instruction - talking out loud prior to performing/self-talk - Self -monitoring - Observe and record own performance - Self-evaluation - compare the behavior being monitored with desired goal - Self-reinforcement - provide reinforcement upon successful completion of a task

self determination

Taking control and responsibility for one's life. - Best Practice in special education - Should be promoting self-determination across settings - If using client centered practice, we should be aligned with self-determination

AT for cognitive augmentation

Technologies to assist individuals with cognitive impairments congenital vs acquired conditions - ID, LD, ASD, ADHD, CP - CVA, TBI, dementia, MS mild cognitive impairments vs. severe cognitive impairments

Power propelled drive wheels

The location of the drive wheel can largely impact how the wheelchair drives and maneuvers in different environments; therefore, it is important to always consider the individual's primary environments when determining drive wheel placement.​ CRT Front-Wheel Drive Wheelchair: Drive wheels meet obstacles first for a smooth transition between surfaces, Increased wheel traction, LEs can be positioned further back in the chair, easily navigates corners, can get directly under counter tops for ease of use. ​ - Benefits: Drive wheels meet obstacles first for a smooth transition between surfaces, Increased wheel traction, LEs can be positioned further back in the chair, easily navigates corners, can get directly under counter tops for ease of use.​ CRT Mid-Wheel Drive Wheelchair: Drive wheel is under the user, two casters in front, two casters behind. ​ - Benefits: Tightest turning radius, easily navigates turns, base most intuitive because of center of gravity, casters provide stability​ Rear-Wheel Drive Wheelchair: Drive wheels at the rear, two front casters, original power wheelchair configuration​ - Stable anterior base, directional stability allows wheelchair to track straight naturally, good outdoor performance. ​

wheelchair training adults

Training in mobility occurs before and after the delivery of the final wheelchair. A trial period should precede final wheelchair recommendations. ​ Basic Skills Taught During Training Include:​ - Maintenance of wheelchair by the user- keeping chair clean, tires properly inflated, brakes adjusted, ensuring chair is inspected on a regular basis​ - Maneuvering wheelchair indoors, in and around tight spaces, over various surfaces ​ Advanced Skills Taught During Training Include:​ - Relieving weight from buttocks and adjusting position in the chair ​ - Moving through a hinged door​ - Positioning and operating controllers for power wheelchairs​ - Turning while moving backwards​ - Propulsion while on an incline​ - Level changes​ - Performance of a wheelie and wheelie skills​ Wheelchair Skills Program is a training program which teaches basic and advanced mobility skills. - assessed through the Wheelchair Skills Test ​ Other factors include motivation, cognitive and physical abilities, and environmental factors. ​

self advocacy

actively promoting and supporting oneself or others (individuals, organizations, or populations), requires an understanding of strengths and needs, identification of goals, knowledge of legal rights and responsibilities, and communicating these aspects to others.

manual and power specialized bases

manual bases: Strollers​ - Umbrella folding with a sling seat: Does not provided good sitting support but folds easily for storage in a vehicle​ - Full-sized units with solid seats​ ​- Stroller bases resemble standard strollers in appearance, which can be appealing to parents.​ - One disadvantage of the stroller is that the child or adult is often in a reclined position, which may limit his or her ability to carry out functional tasks​ ​ Transport wheelchairs​ - Designed for occasional use, to transport patients in short term situations​ - Ex: airports, hospital, malls​ - Typically have upholstery seating and 4 small wheel​ - They do not have any adjustability​ - Lightweight, durable, maintenance free​ Geriatric Clients ​ - Age related disabilities (arthritis, osteoporosis etc.) contribute to reduced muscle strength and range of motion, and age-related visual changes often occur as well. ​ - Center of gravity ratio of the client to the axis of the drive wheel provides optimal stability and mobility balance​ - Access to the drive wheels and hand rims that are inclusive of their strength and ROM of UE ​ Bariatric Clients (BMI >30)​ - Larger frames to accommodate large size (typical wc have max capacity of 300 lbs, the larger ones are either 600 or 1000 lbs). ​ Power bases: ​Scooters​ - The propelling structure of the scooter includes the drive train, the tires, the tiller, and the battery. Scooters with a front-wheel drive do better on level terrain and are more maneuverable. In rear-wheel drive scooters, the rider's weight is positioned over the motor so there is better traction and more power. These scooters are better able to handle inclines and uneven or rough terrain and therefor are preferable for outdoor use. Some of the advantages of the scooters are that they are lighter in weight, can be disassembled for transportation, are easy to maneuver, and are less costly than other power wheelchairs. The primary disadvantage of scooters is that they do not provide flexibility in control interfaces. The user needs to have a fair amount of trunk and UE control to operate the tiller of the scooter. The seat of the scooter does not provide adequate postural support for clients. ​ Power assist mechanisms​ - For individuals who do not want a powered wheelchair have shoulder pain when propelling manual wheelchair​ - When the user applies force above a preset level to the hand rims, a motor engages to help to propel chair.​ - Magicwheels: similar concept, offers 2 gears like a bicycle to assist the client.​ ​ Smart Wheelchairs: ​ either a standard power wc as to which a computer and collection of sensors have been added for a mobile robot based to which a seat has been attached ​

obi

must be able to chew and swallow and lean forward (neck mobility) to bite the food off of the spoon, as well as cognitive ability to understand the machine - diner is in control of the experience, activates switches to move spoon to desired food, deliver food, and bring spoon back to plate miscellaneous DME, not automatically approved, most of the time insurance initially denies it, they are approved on appeal - medicare will not cover it, medicaid and private pay sometimes will after the appeal

Types of AAC: Mid-Tech

requires a source of power; often used to encourage early communication skills; has more vocabulary than low tech systems - simple and easy to use - switches - big mack communicator for toy selection and play - go talk devices, italk2, small wearable mid tech devices such as watch