OT672 Assistive Technology

Hierarchy of AT Selection?

-"Low to high tech" (arrow goes from "adapt" downward to "design" where the arrow point is) -Adapt the activity or task (start here; better if person doesn't need to buy something) -Select a device that is commercially available for persons without disabilities -Select commercially available rehabilitation products in innovative ways -Combine commercially available rehabilitation products in innovative ways -Modify existing commercially available rehabilitation products -Design and create a new device for a specific individual

See picture, fixed or flexible?

-Central line going straight into some artery that can get direct access for medication into the blood; this is for MS; YOU WILL NOT KNOW FIXED OR FLEXED UNTIL YOU PUT THEM IN SUPINE/gravity eliminated; assessment: trunk flexion: compression of lungs & diaphragm cannot expand, head is to the left for he is trying to achieve midline; he's getting scoliatic curve because pelvis is out of line

Principles to Universal Design? (7)

-PRINCIPLE ONE: Equitable Use The design is useful and marketable to people with diverse abilities. -PRINCIPLE TWO: Flexibility in Use The design accommodates a wide range of individual preferences and abilities. -PRINCIPLE THREE: Simple and Intuitive Use Use of the design is easy to understand, regardless of the user's experience, knowledge, language skills, or current concentration level. -PRINCIPLE FOUR: Perceptible Information The design communicates necessary information effectively to the user, regardless of ambient conditions or the user's sensory abilities. -PRINCIPLE FIVE: Tolerance for Error The design minimizes hazards and the adverse consequences of accidental or unintended actions. -PRINCIPLE SIX: Low Physical Effort The design can be used efficiently and comfortably and with a minimum of fatigue. -PRINCIPLE SEVEN: Size and Space for Approach and Use Appropriate size and space is provided for approach, reach, manipulation, and use, regardless of user's body size, posture, or mobility.

Where is the HAAT model? Where is the human? Look at their different contexts they need to participate in and looking at different equipment they may need? Need to write justification statement for walkers and w/c's to get them paid for. This grid will teach you how to write justification statements (Back of Notecards)

-Rose example: -Human is in the impairment: Due to ______ impairment___, Rose requires this. Activity in activity and AT in device. Helpful to close statement with Rose requires a ___ to increase bra donning to MODIFIED independence due to decreased use of coordination and hand strength to increase independence in ADLs

What is AT? o A. Switch-operated iPad o B. Robotic arm for stroke rehab (RESTORE so NO) o C. Sock Aide o D. Exercise Bike (RESTORE CV FUNCTION so NO) o E. Wheelchair o F. All of the above o G. A, C and E

-Used for compensation and adaptation

Macular Degeneration?

-center vision loss

Cataracts?

-general blurriness; will flicker in pupil

Glaucoma?

-peripheral vision loss

Fitting the Seating System: -Width: Measure width of hips (do this in sitting; measure width of either side of femur): add ___1___ -This is not a hard rule and the context of the user needs to be considered! -Depth: Measure sacrum (consider all other cushioning, etc.) to popliteal (back of knee): ___2___ Height- Measure popliteal to bottom of shoes (this is height of w/c): -LE propeller (use heal strike to walk along)? ___3___ -UE propeller (use UE to propel)? ___4___

1. 1 inch on either side (prevents shearing and gives room to go) 2. Subtract 2 inches (prevents rubbing on back of knee and gives some pressure relief and prevents back of LE sheering 3. Subtract cushion height (i.e. if it is a 2 inch cushion, then will subtract 2 inches from w/c height) 4. Add 2-3 inches to w/c height so they are able to clear and not hit bottom of their footplates

Considering the Visual Field: -P. 320, Figure 13-4; normal range 70 - 104 -Put axis on top of persons head, move moveable arm out into persons visual field; yes a pole with a red dot and when they can see the dot measure the angle -Lower left black image is called a tangent screen: bring visual tracking device closer and closer and have patient tell you when they see it -Most high tech is parameter in optomistris office you set you head in there -Color vision limit is up to ___1___ -Measuring the visual field -___2___ is color that has the most peripheral vision for someone's eyes; can be in the farthest field or vision; ___3___ has the least

1. 60 degrees 2. Blue 3. Green

-65% of persons who become blind do so after the age of ___1___ -why would they not want to learn Braille? ♣ Often due to diabetes (also have decreased sensation...), vision loss, would not want to learn a new language, crystalized memory lolol. -___2___is the primary method for information storage and retrieval for persons who are blind (audio books, auditory reading machines with OCR)

1. 65 2. Auditory Method

Visual Impairment: ___1___: is ability of ciliary muscles to adjust lens, normal is 10 cm away at age of 20 -When ciliary muscles don't work as well with age ___2___ they don't bend as well -Usually 20 year old can read with object ___3___ away -50 years old cannot accommodate ___4___ -Visual field, normal is _0cm center, 70 to 140? What? LOOK UP!_____ to ________

1. Accommodation 2. presbyopia 3. 10 cm 4. <30 cm 5.

Classifications of Cushions: -___1___: individual cells (all tough way to L); have person sit in it; supposed to be able to stick two fingers in it, if you cant blow it up more ; less stable, used with high level SCI, but have seatbelt, etc. -___2___: maid from Jay Company; a step down; more planar (flat); "well" is gel filled on the bottom part in the back -___3___: combined as foam contour for femurs and open well gel in the back

1. Air filled (ROHO) 2. Viscoelastic fluid (gel) 3. Hybrid cushions

Characterization of AT (same language from all professionals): -____1____: do NOT require skill/training i.e. keyguards, eyeglasses -____2____: think skill (required)) i.e. joystick, long cane, hemi-keyboard

1. Appliances 2. Tools

Evaluation Principles for Seating: -Postural Control: -What is the control in sitting? ___1___

1. BALANCE (fair GOOD is a hands free sitter, top level; next one down is hands depent sitter NOT a fair balance (fair, then hands dependent sitter, then lowest is propped sitter (with 2 hands, still cant always sit and requires external support))

Biomechanical Principles: -___1___ is the study of body position and movement -___2___ is the study of motion -Linear movement is if all body parts ___3___ i.e. in a car or power w/c all body parts move together -Rotational movement is through ____4___ i.e. have folcroms, levers, thru rotational movements -Force is anything that acts on a body, occurring in ___5___ i.e. sitting on w/c cushion there's a force down and a force up to allow bony promincences to push into it

1. Biomechanics 2. Kinematics 3. MOVE TOGETHER IN THE SAME DIRECTION 4. Angles 5. Equal and opposite action reaction pairs

Blind vs. Low Vision: (p. 315) ___1___: you are using a different sensory pathway for visual; vision is no longer primary source i.e. using tactile or auditory ___2___: still use visual system as primary source

1. Blind 2. Low vision

Severe visual loss->___1___ -Alternative sensory system is required, such as Braille -Tactile substitutions and auditory substitutions -3 major issues identified: ___2-4___

1. Blindness 2. Access to printed reading material 3. Orientation and mobility 4. Access to computers and the internet

Framework for AT: WHO ICF: -___1____ (body structures and functions) -____2____ (activities-execution of tasks, and participation-involvement in life situations) The environment and personal factors: -____3____ that modify health and health-related states -AT is in environmental elements classification, related to ADLs, mobility, communication, religion/spirituality, education, employment, culture, recreation, and sport

1. Body factors 2. Individual and Societal elements 3. Contextual factors

Captioning: -All televisions produced today must have closed caption capabilities, and all ___1___are required to provide closed captioning for all new programming released after ___2___ -___3___ is remote or real-time where a stenographer listens and enters text, which is transmitted and read by the deaf individual

1. Broadcasters 2. 1998 3. Computer Assisted Real Time Transcription (CART)

Aids for auditory Impairments: -Hearing aids: all sound frequencies cannot be amplified, it would be unnatural -Cochlear implants: used when cochlea is damaged. As long as the ___1___ is intact, stimulation is provided by implanted ___2___

1. CN 8 2. ELECTRODE

Evaluation Principles for Seating: -Understand HAAT Model -What activities/occupations will the client perform in the seating system? Can they go out to the community, what can they do in the w/c that they couldn't do prior -Use ___1___ to identify key occupations

1. COPM

Properties of Materials of Seating Systems: -___1___: how dense it is, more weight=more dense=more firm -___2___: how much emersion you need when someone sits down i.e. do you needit to sink to encompass the ischials, or do you want the support -___3___: related too much to stiffness; wont allows someone to push ischials forward into PPT -___4___: how cushion can get back into shape i.e. if have gel cushion have to physically move cushion back bc has low resiliency -___5___: how quickly it'll soften during impact i.e. gel is LEAST amount of dampening

1. Density 2. Stiffness 3. Sliding Resistance 4. Resilience 5. Dampening

Other vision problems? (2)

1. Diabetic Retinopathy 2. Congenital Blindness

Memory: -Many use ___1___ for notes, or portable note takers or personal organizers -Storage of data in computer memory and flash memory, or direct transfer of data from a PC <-> portable reader

1. Digital Recordings

Selection methods? (2)

1. Direct selection 2. Indirect selection

___1___: i.e. (making choice to hit a "K") (what we do everyday) -Indicates choice by using voice, finger, eye, or other body movement -Most difficult method physically because it requires ___2___ -___3___ demand required (bc u have selection set in front of u) -https://www.youtube.com/watch?v=J6-fP8xQKFM -looking to point at eye / laser is DIRECT bc no switch.

1. Direct selection 2. controlled movement 3. low cognitive

Context: -Shift toward "participation" to describe disability after 1999 -Difficulties viewed as a result from limitations in the social and physical environments -"Problem in the environment" or ___1___ in contexts -Four contexts: ____2-5____ -Where have you seen this before?

1. External Influences 2. Physical 3. Social 4. Cultural 5. Institutional

Evaluation Principles: -___1___: permanent and can't be moved; not tone but due to bone structure; could be i.e. due to rod in spine from sacrum (fixed) 3 up to L3; this will adjust how you make your gravitational changes; CANT CORRECT THIS -ex: pelvis->spine -Seating system should _ALWAYS BE BUILT AROUND THE DEFORMITY (cant i.e. give them cushion to give them a more neutral alignment, NOT restoring or treating, just ADAPTING) -___2___: muscles can be stretched and JOINT CAN MOVE -Seating system can correct a FLEXIBLE DEFORMITY (RESTORATIVE)

1. FIXED SCI 2. FLEXIBLE SCI

Assistive Listening Devices: -____1___ & ___2___ radio transmitted -Under ADA, large meeting rooms (churches, lecture rooms) must be equipped with ___3___ -These are: ___4-6___

1. FM 2. INFRARED 3. ASSISTIVE LISTENING DEVICES (ALD's) 4. HARD-WIRED JACKS-wired jacks for plugged in earphones 5. FM or infrared transmitter-RECEIVER setups 6. Typical for classroom instruction

Trunk: -Chest/shoulder straps to prevent ___1___ trunk flexion

1. Forward

Types of AT: -____1____: seating systems, control interfaces, computers) vs. - ____2____: only specific to one function or person ♣ ____3____ (can order out of a catalog or drug store) to ____4____ (i.e. person with scoliois custom seating) ♣ ____5____ Design (design for all) ♣ ____6____ you modify the device via foam handle ♣ ____7____ i.e. foam in place seating system

1. General Application 2. Specific Application 3. Commercial Technology 4. Custom Technology 5. Universal 6. Modified Devices 7. Custom Devices

____1____: (only theory and framework to know for this class) -Please use this model when justifying your clinical reasoning in your case studies and projects -Human operating the device (physical, cognitive, and emotional elements) -activity categorized in the performance area, -Assistive technology ____2____ and ____3____ enablers -Contexts of use of the AT.

1. HAAT Model 2. INTRINSIC 3. EXTRINSIC

Hearing loss: -In aging, there is usually a greater hearing loss in ___1___ -"Hard of hearing:" augmentation of existing pathways include hearing aids, ____????___________, or assistive listening devices (ALDs) -Deafness uses alternate sensory pathways: sign language or lip reading. OR COCHLEAR IMPLANTS (CN ___2___)

1. HIGHER frequencies rather than lower frequencies; so talk deeper when talking to older individuals 2. CN 8, vestibulochoclear

Control Sites: -___1-6___ (MEMORIZE) -Fine motor control of hand is preferred, then head then switches of the shoulder/elbow, then leg/foot -Use of the arm or leg is less desirable because these are used for gross movements, however, the foot is possible for typing -https://www.youtube.com/watch?v=Ht0SaiVqY6Q

1. Hand/finger (top_most precise) 2. Head (bc smaller musculature movements in neck) 3. Eye 4. Arm/Leg 5. Foot 6. Mouth (bottom of arrow; MEMORIZE this arrow)

Characterization of AT (same language from all professionals): -____1____: anything that is tangible, you can pick up/a tool -____2____: i.e. computer program, can't pick up, not tangible

1. Hard Technology 2. Soft Technology

Characterization of AT (same language from all professionals): -____1____: Expensive, difficult to make, hard to obtain; more expensive, difficult to make/obtain i.e. custom devices, speech generating devices -____2____: Inexpensive, simple to make, easy to obtain *Can be relative to person using it i.e. iPhone may not be high tech to us but to 80-year-old would be

1. High Tech 2. Low Tech

Auditory Impairments -Auditory threshold are amplitude (___1___) and frequency (___2___) is the wave -Amplitude is in ___3___ and minimal for hearing is ___4___ -Frequency of human hearing is ___5___ -___6___ is the intensity (amplitude) + frequency combo of the two is what audiologist tests -______????______ determines hearing and type of loss

1. How TALL, the wave; how loud it is coming out; measured in db 2. how WIDE; measured in Hz; shorter the wave the higher the Hz 3. dB 4. 20 dB 5. up to 20,000 Hz (dog whistle is 25,000 to 50,000 Hz) 6. "Threshold"

Restorative vs. Adaptive: Restorative: -Guy is positioned on an ___1___ wedge, it's putting pelvis in APT, if go into sacral sit will just slide off so OT must be I front, use dicem for his hands, facilitates then SPINAL EXTENSION and SCAPULAR RETRATION (bc of APT) -Seating systems are built to ___2___ -Use "LR" or "facilitation" -This cushion is ___3___ and is contoured to help put into neutral pelvic tilt (cushion pic) -Can use wedge cushions to put pelvis ___4___ -If you make front casters ___5___ and back wheels ___6___ creates a tilt

1. INVERTED 2. RESTORE 3. Honeycomb made of gel 4. Back 5. Higher 6. Lower

Constructing Seating Systems: -Trunk -May require ___1___ supports can help accommodate a ___2___ that may continuously press more and morel ♣ Lower on trunk ⟶ ___3___ ♣ Higher on trunk ⟶ ___4___

1. Lateral 2. FLEXIBLE SCI 3. LESS control 4. GREATER control *For picture, one point on pelvis (push into neutral at obliquity but opp side), one in the middle and one higher in thoracic to counteract forces

Principles for Seating for Postural Control: -Look at Trunk -Upright trunk if flexible -Consider spinal deformities -___1___: APT -___2___: PPT -___3___: Lateral flexion -Also look at secondary curves of head maintaining CG and rotation causing compression of chest wall

1. Lordosis 2. Kyphosis 3. Scoliosis

Types of AT: -____1____: ENHANCE FUNCTION i.e. can't reach but give them reacher to enhance reach vs. -____2____: replace function i.e. person with no speech will use speech generating device

1. Minimal Technology 2. Maximal Technology

Design and Construction of Seating Systems: -Planar = use as flat as they can tolerate -Appropriate when ___1___ is needed -___1___:for LE and pelvis vs. -___2___: do this with wind-swept deformity i.e. a beading system to make custom cushion

1. Minimal support 2. Standard contoured 3. Custom contoured

Seating systems are ___1___ but supposed to be safe and comfortable

1. NOT restorative

Principles for Seating for Postural Control: -Pelvis: want ___1___ and ___2___ (slight anterior tilt provides increased posture, brings us into more spinal extension, scapula retracts and scapular retraction, and neck neutral/extension) -Result is ___3___ -Key point of control: ___4___ -Want ~90° hip flexion to inhibit ___5___ -Consider tight hamstrings: hamstrings originate in the ischium; tight hamstrings PPT and cant stretch out hamstrings

1. Neutral 2. Slight APT 3. Spinal Extension 4. Pelvis 5. Extensor hip ? (ASK JEN :))

Fundamental Approaches: -Low vision augments (i.e. increases/maximize function we already have) visual pathway, many times due to acuity, use alternative methods to increase what individual can see -Categories of Magnification ___1___: i.e. eye glasses, hand held devices ___2___: i.e. altering environment like using large print, contrast ___3___: i.e. with glaucoma & presbyopia Try ___4___: glasses, magnification, then managing environment, filters or contrast on screens, then high-tech closed circuit -Visual field augmentations include widened lenses

1. OPTICAL AIDS 2. NON-OPTICAL AIDS 3. ELECTRONIC AIDS 4. low to high tech

HAAT Model: Human- -____1____: how a person changes and adapts their engagement in activity in response to environmental demands and changes in their own abilities -Follow ____2____ of the OTPF (AOTA, 2008) to understand the human's abilities -____3____ can be strategies to replace AT -___4____ (prescribed ways) vs. ____5_____ (takes risks) with the technology i.e. using w/c to do stairs

1. Occupational Competence 2. CLIENT FACTORS 3. Soft technologies 4. NOVICE 5. EXPERT

Classifications of Cushions: -Foam: inexpensive, lightweight, good envelopment (molds to you), but may trap heat, will wear out -Also, viscoelastic foam or flexible matrix -___1___: use this if possibility for recovery; gives more air and circulation vs. -___2___: helpful for cleaning purposes

1. Open cell 2. Closed cell

Principles for Seating for Postural Control: -It all starts with the ___1___! ALWAYS SUPPORT THIS FIRST -Think ___2___ -Seating to enable movement, NOT ___3___ -LE's should be in ___4___ -Trunk midline and upright -Head midline with neutral neck (not flexed) -Shoulders neutral with elbows at 90 degrees (may use custom arm rests)

1. PELVIS 2. Proximal stabilization 3. Restrict environment 4. NEUTRAL (90-90-90)

Building the seating system: -Start with a ___1___surface (put this in w/c; you an put dense foam in w/c too) -With swing (i.e. dip) w/c putting hips in IR adduction... NOT neutral

1. PLANAR

Seating for w/c Comfort: -Wheelchair users who have sitting discomfort i.e. ALS, MS,elderly & Low back pain -Do NOT use "for comfort" but "increasing sitting tolerance" for 8 hours with XYZ seat cushion -___1___= FLAT; use as flat of surface as person can tolerate when minimal support I needed -Avoid this language, "comfort" is not paid for by thirty party funding -Difficult to objectively measure

1. PLANAR

Principles of Seating for Postural Control: -It all starts with the pelvis! (neutral mostly with some APT) -Angle of seat -___1___ support -Contours to support pelvis in ___2___ position -Consider pelvic belt (not seatbelt) only for pelvic support, not as a restraint, only at ___3___ -Also consider seat depth and foot rest height

1. PROXIMAL 2. NEUTRAL 3. 45-90 degrees

Principles of Seating for Postural Control: -___1___: if one pelvis side is higher than the other, corresponds to LOWER PELVIS -Named for the side that is ___2___ -Often seen with pelvic rotation -Sometimes "1" results in ___3___ (FIXED!) (this is combo of pelvis rotation and pelvic obliquity) -Often fixed and painful, so seating system should be designed to ___4___rather than correct

1. Pelvic Obliquity 2. LOWER 3. WIND-SWEPT DEFORMITY 4. ACCOMODATE

Overview of Seating Interventions: -Seating for ___1___ i.e. CVA, SCI because they have abnormal muscle tone -Seating for ___2___ i.e. weight bearing on bony prominences i.e. SCI, MS, CP, ALS, elderly -Seating for __3__;but this word is not covered by insurance you have to be more creative getting up for fall risk, can they sit for prolonged seating i.e. for class or work can they sustain posture without pain, workday hours or education hours vs. for comfort; want to say number of hours they will tolerate upright sitting *See Box 9-2 for documentation hints* (AT Book)

1. Postural Control 2. Pressure redistribution 3. Comfort

Evaluation principles: -Sitting: ___1___ and ____2____ together (pelvis, spine and scapula) -Skeletal Deformities (see pictures later :))

1. ROM 2. Skeletal alignment

Alerting devices (KEY IS ___1___): -i.e. this is why fire alarms are blinking too

1. SAFETY

Mobile Devices: -Many deaf individuals rely on ___1___ -People who are deaf that want to use their cell phone as a TTY will require an adapter and an application that provides ___2___

1. SMS/MOBILE MESSAGING/texting 2. TTY functionality (an adaptor)

Built-in computer adaptations: -___1___displays captions for speech and sounds to indicate activities i.e. if something makes a sounds should be able to turn it off -Multimedia information must be provided on transcripts or captions -Do you see challenges with this?

1. SPOKEN DIALOUGE

Evaluation principles for seating: -Human factors: (HAAT Model) -Evaluation of physical skills on mat in __1___ because a lot of the time the people are very fatigued and making them sit up and down they will get fatigued easier; YOU ARE CONSERVING THEIR energy -You will then move up to ___2___ -Musculoskeletal factors -Supine: -Mobility of the ___3___ without any sort of gravity on it first i.e. how flexible is it, or is it completely fixed and cant move or stretch out in any way -Range of motion of EVERYTHING

1. SUPINE FIRST 2. UNSUPPORTED SITTING 3. Supine

Consider Pressure Ulcers: -Consider bony prominences: ___1-3___ -This is a sacral wound in pic i.e. if on feeding tube head of bed is up at 45 then that shearing force because they pull you up patient slides down

1. Sacram 2. Coccyx 3. Ischials

CONTROL INTERFACE (INPUT DEVICE, HARDWARE): -Switches, joystick, keyboard -Signal is sent to a processor (hardware) -Feedback to a display i.e. screen gives you FB -Processed into the activity output -Example: joystick signal programed as UP signal is transformed to forward movement -___1___: group of items available from which choices are made (keyboard is over 100 choices) -Could be ___2-4___ -Depends on communication, mobility, manipulation, cognition.

1. Selection set 2. Visual 3. Auditory 4. Tactile

Mobility and Orientation Aids: -Orientation: "location in relation to the environment" -5 Approaches: ___1-5___ *Guide should be in front of blind person -According to the text, due to ___6___, it takes 6-12 weeks to develop cane proficiency

1. Sighted guide (a person) 2. Guide dogs 3. Long cane 4. Electronic aides (designed as supplement) 5. Orientation and navigation systems 6. ECHO LOCATION

___1___: -This is for extreme pelvis problems -This is supposed to go UNDER ASIS i.e. like a roller coaster belt

1. Sub-ASIS bar

Telephone Access: -___1___are electronic visual telephones -They use a keypad and visual display -Good for people who need to make a call to someone who does not have a ___2___ -Sign language communication rate is comparable to human speech... what technology can two sign language users use? ___3___

1. TTY TELATYPE; FIRST TXT MSGERS ON LANDLINES has keyboard on a visual display 2. TTY OPERATOR is provided by the telephone company 3. SKYPE

Sensory substitutions: -Tactile: ___1___ is used by blind-deaf individuals, or use "finger spelling" -Can you think of other tactile methods for the hard of hearing? -Fitbit i.e. vibration; off the shelf devices that have built in vibration -Helen Keller said that persons who are blind are cut off from things, and those who are deaf are cut off from people -Visual: speech therapy for deaf individuals see ___2___; try and get -Visual: alarms, what else? i.e. light and sounds; things with two sensory pathway components -___3___ is a major universal design goal for assistive devices that use visual substitution

1. Tadoma method 2. WAVES OF A WORD 3. Speech-to-text conversion

Biomechanics Principles: Types of Forces: -___1___: pulling apart -___2___: pushing together -___3___: parallel/sliding forces (watch during seating/lateral transfers over) -___4___: measured in force per unit area, in U.S. normally inches -Want ___5___. If it is over 80 mmHg, then need an intervention (so orange, red and some yellow means intervention) --> See pressure mapping picture of male leaning on his RIGHT ISCHIAL (pic in mmHg)

1. Tension 2. Compression 3. Shearing 4. Pressure 5. Less than 80 mmHg

Trunk: -___1___ may eliminate the effects of gravity (i.e. kyphosis), especially on head control -Consider vision, eating, use of tray, and social engagement may be compromised

1. Tilt-in-space

Evaluation Principles for Seating: -What is the response to positional changes? ____1____ or the ___2___ in various positions -For paraplegic want footplate to be high so don't slide out and want to maintain neutral/PPT? -Only minimal amount of external support should be used ___3___

1. Tilted Pelvis 2. LE 3. LRE

AT is client-centered: -Consumer: -____1____: is the consumer using the device outside of the clinic? -Want to avoid technology abandonment i.e. this is the device someone needs but not what the consumer may want/afford/use -Consumer delivery settings: rehab, university, state, private, suppliers, VA (only reimburse of adaptive driving/mobility), non-profits, volunteer programs -Delivery: clinic vs. telerehab growing -Research -Review "Code of Ethics"

1. True test

___1___: o Any tool that can make life easier o Increasing independence for people with disabilities o Want sophisticated device for human to make limbs their own o Normalcy: some people feel normal while others were vulnerable i.e. change battery so part of them

1. What is AT?

Visual Impairment: -Based on ___1___: how well eyes can focus on an image -Perfect vision you can see at 20 meters/feet when normal people can see at 20; at 10/20 you have to stand at 10 feet to see what people see at 20 feet -Blindness is worse than ___2___ -Low vision/severe visual impairment is better than or equal to: ___3___ -"visually impaired" person has difficulty seeing an image at 10 feet, person must stand at ___4 ?? (ask jen)___ feet to see the same image; person can still visually read

1. acuity 2. 3/60 or 1/20 (so stand at one foot or less to see what other people see at 20 feet) (MEMORIZE RATIO) 3. 3/60 (4/60 is severly impaired); person can still visually read; still using visual pathway 4. ??

Reading Aids: Braille is defined by Grades 1, 2 & 3: ♣ Grade 1: ___1___ ♣ Grade 2: ___2____ ♣ Grade 3: ___3____ -Limitations include ___4 & 5___but can be overcome with refreshable Braille display electronic -65% of persons who become blind do so after the age of ___6___ why would they not want to learn Braille? ♣ Often due to diabetes (also have decreased sensation...), vision loss, would not want to learn a new language, crystalized memory lolol. o _____Auditory method_____________ is the primary method for information storage and retrieval for persons who are blind (audio books, auditory reading machines with OCR)

1. all the words spelled out all the way; every character 2. words are abbreviations 3. a symbol 4. it's heavy 5. requires more paper

Magnification Aids: -Optical aides (___1___), nonoptical aids (___2___), and electronic aides (___3___) Rules: -Use colors that differ as little as possible in lightness (perceived intensity) -Avoid colors from ends of the spectrum -Avoid white or gray with any color of the same lightness -Avoid colors adjacent to each other in the color spectrum -Avoid pastels for low vision

1. handheld 2.ENVIRONMENTAL (large print) 3. CCTV- Closed circuit TV; closed to person who is using the image, it is not broadcast

CONNECTING THE USER TO THE TECHNOLOGY: -Human/technology interface elements -Control interface: ___1___ -Selection set -Selection method

1. hardware processor

HUMAN/TECHNOLOGY INTERFACE: -Boundary between the human and the AT across which information is exchanged -How the ___1___controls the ___2___ -Universal access control interface? ♣ Keyboard ♣ Mouse ♣ What else?

1. human 2. device

Try devices ____1____ tech: -Don't want to recommend something expensive and hard to obtain if something lower would work) -Example on other side :)

1. low first to high tech last

Constructing Seating Systems: -Consider pressure ulcers -Occur due to application of external pressure and the normal flow of blood and oxygen to tissue is reduced -Factors include myriad: ___1-8___

1. nutrition 2. infection 3. climate (i.e. hot and wet are worse bc moisture) 4. sitting psture (want out of PPT/sacral sitting) 5. age, 6. body type (thin & frail more), 7. mobility 8. transfer techniques (i.e. lateral trasnfers bc cause sheering forces)

*In Guillian Barre system is proximal weakness and even though Rose isn't vent dependent; diaphragm is affected so will have respiratory weakness!; just because at one period person has 4/5 trunk strength doesn't mean they can sustain that posture for 8 hours

:)

High tech electronic aides: -https://www.youtube.com/watch?v=khv9LnKBDK4 -Adaptations to tech in routine?

:)

Mobility & Orientation Aids: -Electronic aides https://www.youtube.com/watch?v=NjEghGEExEQ Navigation aides (Like talking GPS): -Keeps track of the user's current location -Find a way around and through environments -Successfully find and follow a safe walking path to the destination -Provide information about the salient features of the environment -Speech cues and environmental descriptions -GPS-based -Blind people still have need for spatial mapping in their brain. They don't know what like i.e. a mile is but can use "tactile town" to find out -Robotic canes? http://www.nibib.nih.gov/news-events/newsroom/nih-funds-development-novel-robots-assist-people-disabilities-aid-doctors-0 Emerging aids: -Ultrasonic Range Finder with Haptic Feedback called The Bat Hat http://hackedgadgets.com/2013/12/04/ultrasonic-range-finder-with-haptic-feedback-called-the-bat-hat/ -Smart care: http://www.pbs.org/newshour/bb/smart-cane-may-help-visually-impaired-navigate-terrain/ -Robotic sighted guides: http://www.engineeringtv.com/video/Baxter-Robot-Helping-Blind-Peop -iBeacon: bringing GPS indoors: http://bestofwhatsnew.popsci.com/apple-ibeacon -Visual aids for self care, work, leisure Pay attention in the lab video, how the speaker completes these occupations (clothes matching, cooking, leisure, work, low or high tech aides)?

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Start for lecture 2: Seating & Positioning

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AT Legislations: -Rehabilitation Act of 1973 (Amended) -Americans with Disabilities Act of 1990 (ADA) key! -Individuals with Disabilities Education Act, Amendments of 2004 (IDEA) key! -Assistive Technology Act of 1998 -Funding: Medicare vs. Medicaid

Facts :)

Rose's Information: -Motor coordination: -Measured on 9-hole peg test. How would you report this clinically? -If it's not in the case study, use your imagination (pt goals, address, insurance... etc) -Trunk control: Is this a hands-free sitter or hands-dependent sitter?

Finish :)

Computer Adaptations: -Lab video: computer use explanations -Blind https://www.youtube.com/watch?v=UzffnbBex6c -Uses screen readers like Narrator, JAWS -Or refreshable Braille displays -Some people may have embossers printers -Low vision https://www.youtube.com/watch?v=VBeu01ztoZE -Lab: trialing low vision built-ins

check out the videos :)