OT 620 Quiz Four
6 outcomes of EADLs to be evaluated
1. identification of control sites and control interfaces 2. determination of cognitive abilities related to understanding EADL operation 3. listing of EADL functions desired (priority order) 4. evaluation of the consumer's motivation to use electronic environmental control 5. a listing of other electronic devices that the consumer uses 6. identification of environments EADLs will be used
4 Reasons to NOT recommend an EADL
1. lack of funding 2. high cost 3. unavailability of EADLs for trial 4. lack of EADL knowledge by the OT
Low technology: Special purpose aids
1. lengthening a handle or reducing the reach required 2. modifying the handle of a utensil for easier grasp and manipulation 3. converting two-handed tasks to one-handed ones 4. amplifying the force that a consumer can generate with their hands For one specific task
Transportation: Social context
2 aspects: - Societal view of community mobility as a right for all individuals - Perception of older drivers by members of society
Robotic Aids
Are intended to assist individuals with manipulation and are a natural alternative manipulation device for people with disabilities - Assistive robots - Physically assistive robots (PARs) - Socially assistive robots (SARs)
How far away should the driver be from steering wheel?
At least 10 inches
Mobile assistive robots
Two types wheelchair mounted and mounted on a mobile base that is controllable by the user Both are designed to serve as a general purpose manipulative aid for people with severe UE limitations
Vehicle Access: Van Modifications
Typically involve provision of a ramp for access and a tie-down system to secure a wheelchair
Cognition skills: Memory
Drawing on past knowledge to use it in the present. (Encoding, storage, ST/LT, etc. )
Occupant Protection
Structures present in vehicle (seatbelts and airbags), and those added to vehicle (child or w/c restraints), that contribute to the protection of vehicle occupants
Types of tie-down manufacture frame
- 4 point straps - Docking systems
Assessment of cognition for AT devices
- AOTA occupational profile - COPM: leisure, performance, school activities identified - AOTA framework in non-standardized way - MOCA, mini mental, EFPT, clock drawing
Manipulative aids are categorized in what 4 ways
- Alternative: Different method to do task - Augmentative: Assistance to do task "normally" - Special Purpose: Only for one task - General purpose: Two or more tasks
Cognitive skills that can be aided by AT devices
- Attention - Calculation - Emotion - Experience of self - Planning - Time management - Memory
Skills to analyze: Knowledge organization
- Categorization - Sorting - Sequencing - Mental Representation: declarative (knowing that), procedural (knowing how)
Assistive technology for children: Vehicle seats
- Child reaches 80 lbs and is at least 4ft 9in tall
Assistive technology for children: Booster seats
- Children over 40lbs - These seats properly assist in seatbelt placement
Location/Size of controls and seatbelt consideration with transportation: Vehicle Selection
- Controls: Are there physical or visual implications that are impairing the use of controls? is ROM the problem? - Seatbelt: Can they reach, fasten, and unfasten
Mechanical Assist
- Different hand controls previously mentioned - or providing lever arm that affords mechanical advantage: magnifies force applied by user
Three key activities for technology as it relates to transportation
- Driving - Vehicle accessibility - Occupant protection
Two types of learning
- General: Basic - specific learning: going to depend on level of ability to understand general learning (mathematics, reading, writing)
4 point straps
- Has for separate straps that attach to the wheelchair to hold in place
Skills to analyze: Problem Solving
- Identify problem - Judgment - Decision making - Reasoning (deductive & inductive) - Planning - Evaluation - Generalization & T/F
Vehicle accessibility
- Ingress (Get in) - Egress (Get out) - Consider for both public and private transport - you cannot use it if you cannot get in or out
Assessment for use of manipulation aids
- Initial assessment - Collaboration - Assessment of the clients manipulation
Assistive technology for children: Rear facing infant seats
- Intended for Birth-12 months or 22lbs - Infants younger than 12m do not have sufficient head control and their bones are not yet developed to withstand minor crash. - Not intended to be left in the vehicle usually, rather child is transported in infant seat between destinations.
Primary Driving Controls
- Its used to stop, go and steer - Modifications available to assist with: - main grip on wheel - access to pedals - control over vehicle with the hands and arm only when LEs not available
2 primary types of pedal adaptions
- Left foot accelerator - Pedal Extensions
Primary controls: Weak UE
- Mechanical Assist - Power Assist
Transportation: Institutional Context
- Occupant protection is always #1 - Legislation and standards related to crash testing - Legislation and policy related to license to drive
4 designs of hand controls for accelerator or break
- Push-pull - Push-twist - Push-right-angle-pull - Push tilt
Skills to analyze: Information Processing/orientation
- Quantitative - Temporal - Visuospatial - Personal
Transportation Visual/perceptual impairment considerations
- Significant limitation - Visual Field - age-related changes - Accommodation issues - Contrast between figure ground
Skills to analyze: Memory
- Storage (Short Term or Long Term) - Encoding - Retrieval: Recognition, recall
Transportation Cognitive impairment considerations
- Think safety - Impulsive behaviors - Memory, Judgement or executive functions - Mild cognitive impairment/dementia
Assistive technology for children: Forward facing infant seats
- Used longer term. - Accommodate children 40 lbs and 40inches. - PROPER INSTALL=CRITICAL
Physical context to consider with transportation: Vehicle Selection
- Vehicle access - Vehicle aspects - Are you using vehicle seat or W/C - Location and size or primary and secondary controls -Seatbelt and airbag design
Skills to analyze: Attention
- Vigilance - Search - Selective - Divided
Ingress/Egress consideration with transportation: Vehicle Selection
- Want to assess drivers seat and passenger seat - Seat height getting in (can add handybar) - Want to consider door weight and test in controlled conditions before outside
context: describe social/cultural context
- acceptance enables occupations - influence of others in the environment can impact use of manipulation aids (family, friends, coworkers, etc.) - use of robots are widely accepted in health setting already - ergonomically designed devices will be expanded as the population ages - cultural shift: access of EADLs for individuals with disabilities will be increased as they continue to integrate into their daily lives
Skills to analyze in occupational performance
- attention - perception - memory - information processing / orientation - knowledge organization - problem solving - language - learning
Driving
- being in control of and moving a vehicle, traveling under ones own direction or having at ones disposal" - Primary and secondary
Population SAR is useful for
- children with autism spectrum disorder - elderly individuals who require companionship - allowing users to stay connected with family and friends
Assessment: Rehabilitation
- clients may be learning how to engage in many more activities and may have regained some motor functions - clients will have greater mobility and may be learning to use a powered wheelchair to enable more independence - they may also have more opportunities to learn how to use EADLs for more complex functions such as a telephone
Driving Evaluations: Clinical
- cognition - physical - visual - perceptual
Major parts of EADLs
- control interface/input device (keyboard) - user display: provides feedback (screen) - selection method: how users indicate their choice (direct or scanning) - output distribution: translates selection into a form of control of the device
Principles of assistive robots
- degrees of freedom: each joint of a robot represents a degree of freedom and these determine the position in space - levels of autonomy: assistive robots are typically at a midrange of autonomy - configuration: some robots are flexible and others are designed for specific application
Mouth sticks and head pointers
- direct manipulation and controlled by head movements - can also be used for sliding objects, dialing a phone, typing, and turning off lights
Transportation musculoskeletal and neurological impairment considerations
- direct relation to motor impairments= has potential to impact occupation protection and driving issues - Unable to sit independently: Typically not able to use OEM seatbelt as it does not provide enough support - Joint Contractures: May not have joint mobility to be seated in vehicle
EADL: Types of controls
- discrete control: turn appliance on/off, binary - continuous control: results in successively greater or smaller degrees of output
Assessment: community
- focus of EADLs is to use them in the home to enable engagement in daily activities - home environment provides the opportunity to determine the requirements for EADLs in a stable environment and how it needs to be integrated into the user's life
context: describe institutional context
- funding impacts access of EADLs and robotics - high cost is a major barrier - some insurances may cover the cost and some individuals may meet specific criteria (ex. veterans)
Reachers
- handle grip used to control jaws of reacher to grasp an object - manipulation = squeeze with whole hand, pistol grip with all fingers, or trigger with index finger - can be used to manipulate objects such as: food, cooking utensils, office items, recreational, and leisure objects - useful activities such as: dressing, hygiene, self care, and household activities
Physical Context: describe electronic aids to daily living (EADLs)
- high technology devices - use can be limited due to context (ex. ambient noise and lighting)
Power Assist
- hydraulic, pneumatic assist or electrical power systems - add servomotor that apply force to brake and accelerator: recent developments - use joystick (pull back for acceleration, forward for brake)
3 aspects physical context
- low tech - high tech - electronic aids to daily living (EADLs)
EADL: Switch Outputs
- momentary control: active only as long as the switch is pressed and useful for continuous functions - latched control: a switch closure is turned on by the first activation and off by the next activation and useful for turning on an appliance - single switch: activation of a complete control cycle (ex. garage door)
Low technology: General purpose aids
- mouth sticks - head pointers - Reacher For more than one tasks
Assistive technology for cognition
- recorders - word completion / prediction - information retrieval - time management - prompting / cueing - stimuli control (auditory - noise reduction, visual field, media representation) - language tools - alternative output / input
activity: gross motor and fine motor functions of the upper extremities are used to participate in activities such as...
- self care - household maintenance - care for others - work - social participation - leisure
Considerations for one UE or prosthetic arm/impaired hand
- steering devices attach directly to wheel or bar that goes across the wheel - EX. palm grip, tri-pin, form-grip, V grip, spinner knob, amputee ring - zero effort steering mechanism - reduced wheel diameter
Physical Context: High Text
- usually fixed in a single location, complex, higher cost, and may restrict use for others - limited to home of client
Physical context: Low Tech
- usually portable, low cost, useful for multiple devices, and easy to "tuck away" - common in homes, school, and work environments - EX. reaching devices, built-up handles
EADL Selection methods
- voice recognition - single or dual switch - touch screen - integrated with other controls (augmentative, alternative communication, and many others)
Vehicle Access: Van Modifications considerations
- width of chair for movement (in vehicle / and inside) - height of chair for head clearance - length of chair for turning radius, front rigging, and the need for reclined position as this will increase the length of the chair
Transmission methods
-direct connection - house wiring - infrared - radio frequency transmission
Functions of EADLS
1. Environmental regulation 2. Information acquisition 3. Safety/security 4. Communication
4 reasons for recommending an EADL
1. empowerment of the client 2. improvement in the client's quality of life 3. increased access to call systems 4. decreased need for attendant care
Functions of EADLS: Environmental Regulation
allows user to adjust temperature, lighting, and some pressure relief devices
Assessment: Acute care
clients are experiencing a sudden change and loss in ability to engage in daily activities-EADLs can be used for necessary activities such as call bell for nursing assistance and controlling a TV
Transmission methods: Direct connection
controlled devices be physically close together (telephone lines, intercom systems, and bed controls)
Socially Assistive Robots (SARs)
create close and effective interaction with a human user for the purpose of giving assistance - provides assistance to human users through nonphysical social interaction - the robots have sensors that are able to perceive and interact with their environment
Assessments for driving
decision when recommending to regulatory body is difficult 1. knowledge that removing a person drivers license results in withdrawal social activities and depression 2. the concern that this conclusion is based on sound assessment procedures
Secondary driving controls: Knobs
for operating secondary controls may not be within reach, but can be adapted by adding extensions or different shaped control or by relocation
Docking systems
have a bracket that is secured to vehicle floor and a component that is fixed to the lower portion of the wheelchair that couples with a bracket
Compensation vs. Remediation
in your mind as the OT, think:do we care how the function/occupation is completed as long as the activity is successfully completed?
Transmission methods: Infraed
infrared light transmission is the medium and is used for binary discrete and continuous types of control (remotes)
Cognition skills: Knowledge representation
of facts, objects and skills. Ex: Mental Representation: declarative, procedural. Grouping:- Categorization, sorting, sequencing.
Cognition skills: Problem Solving
process for which the goal is to overcome obstacles obstructing a path or solution
Physically assistive robots (PARs)
provide assistance with manipulation of object
Assessment: Collaboration
required from the patient, clinician, and family to determine the potential wants and needs of the client that must be addressed by the technology
How is acceleration accomplished
rotating, pulling back, or pulling down to the steering column
Cognition skills: Language
system of communication objects, concepts, emotion, and through the systematic use of sounds, graphics, gestures and symbols
describe assistive robots
the human is the operator to enhance the user's ability to manipulate objects and function independently
Skills to analyze: Learning
the process by which knowledge, skills, or attitudes are acquired. can be obtained through study, experience, and teaching
Assessment: Initial assessment
to determine the individual's needs, especially in the context of daily living
Transmission methods: Radio frequency transmission
use of radio frequency waves as the link between distribution and control unit and the control interface, the controlled appliances or both (garage door openers, bluetooth, wifi, and phones)
Functions of EADLS: Communication
use of the telephone, intercom systems, and attendant calls (ex. alexa)
Functions of EADLS: Information acquisition
used to control audio-visual equipment, electric page turners, etc.
Functions of EADLS: Safety/Security
used to control audio-visual equipment, electric page turners, etc.
Transmission methods: House wiring
uses household wiring to carry short-wave radio frequency signals to devices that need to be controlled (plugged right into the outlet)
Assessment: Assessment of the clients manipulation
will provide information on the client's performance in these areas and degree of support needed
Where is the best place for a car seat
In the center rear seat next best is the seat on passenger side.
Cognition skills: Perception
Interpretation of sensations from environmental stimuli
Cognition skills: Orientation
Knowing and ascertaining one's relation to self, to others, to time and to one's surroundings.
Cognition skills: Attention
Link btw the limited amt of info that is manipulated mentally and the amt. of info available through the senses, stored memories, and other cog. processes
Hand control for accelerator or break
Mechanical linkage connected to each pedal, a control handle, and associated connecting hardware
Secondary driving controls
Needed for safe operation of a vehicle - Turn signals, parking breaks, lights, horn, temp control, and wipers - May add a control panel which can contain all these functions which can replace the standard controls
Primary driving activities
acceleration, deceleration, stopping and steering
Secondary driving activities
activation of turn signals, parking break, lights, entertainment, nav, temp and turning on/off.
