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Military Caregiving: Assistive Technology Devices

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WHAT YOU NEED TO KNOW ABOUT ASSISTIVE TECHNOLOGY BUT DIDN'T KNOW WHO TO ASK

From wheelchairs to hearing aids, memory supports to speech devices, assistive technology (AT) solutions have long been a staple for supporting the functioning of individuals with disabilities, especially wounded service members. However, there can be barriers to successful implementation of an assistive technology solution. Research has shown that the most important way to reduce this non-use or abandonment rate is to know how to find the available AT resources, involve the service member in selecting the AT, and to use a systematic process for assessing both the warrior’s needs and preferences. The most effective support may be personal assistance, strategies, or technologies—most commonly, a combination of these.

This webinar will present ways to be informed of the variety of available AT and the use of a systematic process to match the service member with the most appropriate solution for his or her enhanced functioning and well-being.

Join via https://learn.extension.org/events/1297

Published in: Education, Technology
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Military Caregiving: Assistive Technology Devices

  1. 1. A few days after the presentation, we will send an evaluation and links to an archive and resources. We appreciate your feedback. To receive these emails, please enter your email address in the chat box before we start the recording. All chat will be recorded and archived. This material is based upon work supported by the National Institute of Food and Agriculture, U.S. Department of Agriculture, and the Office of Family Policy, Children and Youth, U.S. Department of Defense under Award Numbers 2010-48869-20685 and 2012-48755-20306.
  2. 2. www.eXtension.org/militaryfamilies facebook.com/militaryfamilies blogs.eXtension.org/militaryfamilies twitter.com/MilFamLN bit.ly/MFLNwebinars To receive notifications of future webinars and other learning opportunities from the Military Families Learning Network, sign up for the Military Families Learning Network Email Mailing list at: http://bit.ly/MFLNlist This material is based upon work supported by the National Institute of Food and Agriculture, U.S. Department of Agriculture, and the Office of Family Policy, Children and Youth, U.S. Department of Defense under Award Numbers. 2010-48869-20685 and 2012-48755-20306.
  3. 3. *MFLN Military Caregiving has applied for 1 CE credit from the National Association of Social Work (NASW). For those interested in receiving NASW credit please send your name, the name of the agency you are associated with and the state in which you reside to woundedwarrior@ag.tamu.edu. This material is based upon work supported by the National Institute of Food and Agriculture, U.S. Department of Agriculture, and the Office of Family Policy, Children and Youth, U.S. Department of Defense under Award Numbers. 2010-48869-20685 and 2012-48755-20306.
  4. 4. What You Need to Know About Assistive Technology But Didn’t Know Who to Ask Marcia Scherer, Ph.D. 12 December 2013 Military Families Learning Network Webinar 4
  5. 5. Marcia Scherer, Ph.D. • President of the Institute for Matching Person & Technology • Professor of Physical Medicine and Rehabilitation, University of Rochester Medical Center • Project Director, Burton Blatt Institute, Syracuse University 5
  6. 6. Learning Objectives 1) Define assistive and cognitive support technologies 2) List 3 key resources for locating relevant products and local resources 3) Discuss a process for identifying the AT needs of veterans with a variety of disabilities 6
  7. 7. What are we talking about? • Assistive technology (AT) – generally defined internationally as: Any item, piece of equipment or product systems, whether acquired commercially, off the shelf, modified or customized, that is used to increase, maintain or improve functional capabilities of individuals with disabilities. • Cognitive Support Technologies – a class of AT designed to help with memory, attention, concentration, and so on. Scherer MJ. (2012). Assistive Technologies and Other Supports for People with Brain Impairment. New York: Springer Publishing Co. 7
  8. 8. Assistive Technology • A formal, legal definition of assistive technology was first published in the Technology-Related Assistance for Individuals with Disabilities Act of 1988 (The Tech Act). This act was amended in 1994; in 1998, it was repealed and replaced with the Assistive Technology Act of 1998 ("AT Act"). Throughout, the original definition of assistive technology remained consistent. – “Any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities." • This definition focuses on functional capabilities and not participation and contribution. 8
  9. 9. International Organization for Standardization classification (ISO 9999) definition: • “An assistive product is any product (including devices, equipment, instruments and software) especially produced or generally available, used by or for persons with disability – for participation – to protect, support, train, measure or substitute for body functions/structures and activities, or – to prevent impairments, activity limitations or participation restrictions” 9
  10. 10. In both definitions, AT covers • Products especially produced to compensate for a disability as well as • Those commercially available products with the purpose of serving users in general, that is, mainstream or everyday technology. Whether a product should be viewed as AT or not, is defined by the purpose for use, that is, whether it meets a need related to a disability. 10
  11. 11. Service Members use a Combination of: • Personal Assistance • Strategies • Everyday Technologies – Wristwatch, Smartphone • Specialized Technologies • E-pill alarm watch, jitterbug phone Photo Source: National Center for Telehealth & Technology 11
  12. 12. Because… The individualized needs of the consumer are so specific that a generalized AT device often does not help and a specialized AT device often is too complicated for easy use. 12
  13. 13. Sample Resources for Information on Apps for Smartphones (e.g., iPhone and Google Android phones) and Tablet Computers (e.g., iPad) • Tools, Apps and Resources for TBI: – http://accesstechnews.wordpress.com/2011/02/09/tools-apps-and-resources-fortbi/ • There's an App for That-iPod:iPad 101 – The PACER Center’s Simon Technology Center (STC) focuses on making technology more accessible to children and adults with disabilities. – www.pacer.org/stc/pubs/AllAboutAppsforEducationHandout.pdf • iPad Assistive Technology/Disability Round-Up: – http://atmac.org/ipad-assistive-technology-disability-round-up • iPhone, iPad Apps for Special Education Organized by Category: – http://www.scribd.com/doc/24470331/iPhone-iPad-and-iPod-touch-Apps-forSpecial-Education Scherer MJ. (2012). Assistive Technologies and Other Supports for People with Brain Impairment. New York: Springer Publishing Co. 13
  14. 14. Advantages of everyday technologies – User appears like everyone else, even “cool.” – They are usually less expensive than specialized technologies. – Because they are cheaper than specialized technologies, they make an effective back-up or secondary device. Disadvantages of everyday technologies – They most likely will not be paid for by health insurance or Centers for Medicare & Medicaid Services (CMS), which administers Medicaid, Medicare, and the Children's Health Insurance Program. The rationale is that they are not exclusive to medical needs. – They are made for the “average user’ and not those with individual, particular needs. Scherer MJ. (2012). Assistive Technologies and Other Supports for People with Brain Impairment. New York: Springer Publishing Co. 14
  15. 15. Because… The individualized needs of the consumer are so specific that a generalized AT device often does not help and a specialized AT device often is too complicated for easy use. 15
  16. 16. Assistive Technology Devices … range from highly complex technology to simple adjustments that can make life more dignified, remove barriers and change lives. 16
  17. 17. The DOD’s Computer/Electronic Accommodations Program (CAP) http://www.cap.mil/Default.aspx 17
  18. 18. What is www.AbleData.com? • Comprehensive information source for assistive technology: – www.abledata.com • Database of assistive technology with almost 40,000 assistive products. • Product categories by intended function classified in 20 areas. 18
  19. 19. 19
  20. 20. 20
  21. 21. 21
  22. 22. ISO 9999 – Class 22 Assistive products for communication and information ISO 9999 – Class12.39 Assistive products for orientation ICF - e125 – Products and technology for communication • Blind and Low Vision – Products for people with visual disabilities. – Major Categories: Computers, Educational Aids, Health Care, Information Storage, Kitchen Aids, Labeling, Magnification, Office Equipment, Orientation and Mobility, Reading, Recreation, Sensors, Telephones, Time, Tools, Travel, Typing, Writing (Braille). • Deaf And Hard of Hearing – Products for people with hearing disabilities. – Major Categories: Amplification, Driving, Hearing Aids, Recreational Electronics, Sign Language, Signal Switches, Speech Training, Telephones, Time. • Deaf Blind – Products for people who are both deaf and blind. 22
  23. 23. Screen Magnifiers vs. Readers Magnifiers Readers • MAGic • JAWS • ZoomText • Window-Eyes • Supernova • HAL 23
  24. 24. Assistive Listening Devices • Two types: – personal use (PocketTalkers) – group use (conference room systems) • Primary purpose: – Amplification and concentration of sound • Goal: – make desired sound stand out from the background noise 24
  25. 25. ISO 9999 – Class 09 Assistive products for personal care and protection ISO 9999 – Class 15 Assistive products for housekeeping ICF - e115 - Products and technology for personal use in daily living • Aids for Daily Living – Products to aid in activities of daily living. – Major Categories: Bathing, Carrying, Child Care, Clothing, Dispenser Aids, Dressing, Drinking, Feeding, Grooming/Hygiene, Handle Padding, Health Care, Holding, Reaching, Time, Smoking, Toileting, Transfer. • Housekeeping – Products to that assist in cooking, cleaning, and other household activities as well as adapted appliances. – Major Categories: Food Preparation, Housekeeping General, Cleaning, Ironing, Laundry, Shopping. 25
  26. 26. ISO 9999 – Class 09 Assistive products for personal care and protection ISO 9999 – Class 15 Assistive products for housekeeping ICF - e115 - Products and technology for personal use in daily living • Computers – Products to allow people with disabilities to use desktop and laptop computers and other kinds of information technology. – Major Categories: Software, Hardware, Computer Accessories. • Controls – Products that provide people with disabilities with the ability to start, stop or adjust electric or electronic devices. – Major Categories: Environmental Controls, Control Switches. 26
  27. 27. Simple devices can make a big difference 27
  28. 28. Computer Input Standard – – – – – Keyboard Mouse Joystick Voice Touch screen Adapted – Modifications to keyboard, mouse – Alternate keyboards – Alternate mouse input – Hands-free input 28
  29. 29. Alternate Mice • Trackball • Head Controlled (Camera Mice) • Joystick • Touch Pads • Touch Screens 29
  30. 30. ICF - e120 - Products and technology for personal indoor and outdoor mobility and transportation ISO 9999 – Class 12 Assistive products for personal mobility [does not include public transit] • Walking – Products to aid people with disabilities who are able to walk or stand with assistance. – Major Categories: Canes, Crutches, Standing, Walkers. • Wheeled Mobility – Products and accessories that enable people with mobility disabilities to move freely indoors and outdoors. – Major Categories: Wheelchairs (Manual, Sport, and Powered), Wheelchair Alternatives (Scooters), Wheelchair Accessories, Carts, Transporters, Stretchers. 30
  31. 31. ICF - e120 - Products and technology for personal indoor and outdoor mobility and transportation ISO 9999 – Class 12 Assistive products for personal mobility [does not include public transit] • Seating – Products that assist people to sit comfortably and safely. – Major Categories: Seating Systems, Cushions, Therapeutic Seats. • Transportation – Products to enable people with disabilities to drive or ride in cars, vans, trucks and buses. – Major Categories: Mass Transit Vehicles and Facilities, Vehicles, Vehicle Accessories. 31
  32. 32. Mobility Devices - Manual • Walking – Crutches – Walkers – Fit with milieu is important Photo Source: DVIDS (Marine) • Manual wheelchair – – – – Folding Standing Ultralight Sports Photo Source: DVIDS (Air Force) 32
  33. 33. Mobility Devices - Power Includes Wheelchairs, Scooters – Seating system + mobility base – Positioning features: tilt, recline, elevation Drive Controls – – – – Hand (joystick) Breath (sip/puff) Head (switch array) Switch (any body part) Photo Source: DVIDS (Marine) 33
  34. 34. ISO 9999 – class 18 Furnishings and adaptations to homes and other premises ISO 9999 – class 24 Assistive products for environmental improvement and assessment ICF - e150 - Design, construction and building products and technology of buildings for public use ICF - e155 - Design, construction and building products and technology of buildings for private use • Environmental Adaptations – Products that make the built environment more accessible. – Major Categories: Indoor Environment, Furniture, Outdoor Environment, Vertical Accessibility, Houses, Specialties, Lighting, Signs. • Safety and Security – Products to protect health and home. – Major Categories: Alarm and Security Systems, Child Proof Devices, Electric Cords, Lights, Locks. 34
  35. 35. Environmental Adaptations • • • • • Ramp Wide doorways, door sill removal Stair lift, elevator Grab bar Aisle width, furniture layout 35
  36. 36. Impaired Mental Capabilities • Memory – Short or long term, recall and recognition • Perception – Attention, discriminating sensory input • Problem Solving – Recognizing the problem, implementing solutions and evaluation Photo Source: Defense Imagery • Concepts – Generalizing, skill development 36
  37. 37. But so far… • Palm Pilots (for memory cueing), • Automated pill-boxes (for taking medications on schedule), • Many products for way-finding or orientation…have had disappointing success. • Why??? 37
  38. 38. FACT Fewer than 25 percent of people with disabilities who could be helped by assistive technology are using it. – Alliance for Technology Access 38
  39. 39. AT Devices • In spite of all the availability of about 40,000 specialized products, and even more everyday technologies … • On average, almost 1/3 of them are unused or discarded. This represents waste in… – $$$ – Therapist/provider time and more We need to reduce inappropriate use and non-use! 39
  40. 40. Difficulties Encountered in Choosing & Using Technology • Bewildering array of options/Devices are often complex • Fragmented information & service system • Limited understanding of resources & options • Decision making is complex & involves compromises • Lack of follow-up & training on AT use • Limited funding 40
  41. 41. www.resna.org 41
  42. 42. 42
  43. 43. Technology Non-Use : 30-50% • Information about repair and maintenance • Environmental obstacles • Whether the device was seen as effective, reliable, durable, comfortable and easy to use by the user • Social acceptability of the device • Degree to which the device heightens visibility of disability • ‘Hassle index’ functional gain vs. degree of hassle 43
  44. 44. Technology Non-Use : 30-50% • Change in the priorities or needs of the user • Performance of the device • Consumer involvement in device selection • Motivation to use the device or do the task • Continued availability of the device • Access to meaningful training 44
  45. 45. Technology is an important resource, but… Too often we see device non-use. It usually arises from…a poor match of person and technology! 45
  46. 46. SO… – It’s NOT about the product or the device. – It IS about its usefulness, its value. It’s about its MATCH TO THE PERSON, not vice versa. 46
  47. 47. Clearly we have a problem. What do we do? 47
  48. 48. Assistive Technology Service “Any service that directly assists an individual with a disability in the selection, acquisition, or use of an assistive technology device” (Title 29, Chapter 31, 3002(a)) Photo Source: DOD Flickr 48
  49. 49. Address Personal Factors & Get an Evaluation • All but the simplest technology requires an evaluation early in the process of selecting interventions and devices • No one better for this than rehabilitation psychologists Photo Source: Fort Hood Sentinel 49
  50. 50. Questions Professionals Have : • User’s goals and expectations • User comfort and experience with AT • What the user tried that worked out well • What the user tried that did NOT work out well • The desirability of a no-tech, low tech or high tech intervention Photo Source: DVIDS (Army) 50
  51. 51. Question Service Member Has: How can I be helped to… • Feel more self-confident • Be independent, autonomous • Participate as I wish in a variety of roles and activities • Achieve a high quality of life and sense of well-being Photo Source: Air Force Flickr 51
  52. 52. Questions Both Consumers AND Providers Have: • How can I know the technology resources that are available and have confidence in my knowledge of available products and their features? • How can I follow a systematic process to ensure a good match of person and most appropriate technology? 52
  53. 53. Find Out What the User Wants • • • • Get the information Organize the information Use the information Revise the information 53
  54. 54. A successful outcome begins early with choosing the most appropriate AT for a person. How can we best do that? 54
  55. 55. MPT is a G.O.O.D. Assessment Process • Gets the information needed for AT selection. • Organizes the information in a standard way. • Operationalizes steps in the process of matching person with desired technology supports. • Documents and standardizes questions for following-up to assess effectiveness. 55
  56. 56. Environmental Factors • • • • Availability of Products Affordability of Products Availability of appropriate professionals Opportunities and services Experiences: • Handling challenges • Health system • Technologies Expectations of Benefit Personal Preferences and Priorities Social and Economic Priorities Legislation & Policies Attitudes of Family/Friends & Key Others Support from Family/Friends & Key Others Support DecisionMaking & Selection Personal Factors Knowledge and Information • • • • Assessment of Functional Need Provider Person with Disability Objective Need Device Comparison & Trial use • Device ratings • Desired device Assessment of Predisposition Subjective Need, incl: •Task doworthiness • AT useworthiness modifications • Training needs/desires • Written plan Follow-Up  Use  Realization of benefit  Enhanced performance of activities  Enhanced participation  Subjective wellbeing Adapted from Scherer, M., Jutai, J., Fuhrer, M., Demers, L. & DeRuyter, F. (2007). A framework for modeling the selection of assistive technology devices (ATDs). Disability and Rehabilitation: Assistive Technology, 2(1), 1-8. 56
  57. 57. 57
  58. 58. This is the Matching Person & Technology Process MT P 58
  59. 59. MT P 59
  60. 60. MPT Assessment Process MPT Model 60
  61. 61. MPT Process & Portfolio of Assessments • Step 1: Initial Worksheet • Step 2: History of Support Use • Step 3: Specific technology matching (assistive, educational, workplace technologies and more) • Step 4: Identification of factors that may indicate problems with acceptance of the technology or realization of benefit from use • Step 5: Identification of intervention strategies • Step 6: Action plan and documentation • Step 7: Follow-up 61
  62. 62. Acknowledgements The MPT materials have been developed through support from: • • • • • National Science Foundation National Institutes of Health Centers for Disease Control and Prevention National Institute for Disability and Rehabilitation Research As well as funding from Europe 62
  63. 63. Disability and Rehabilitation: Assistive Technology Official Journal of the International Society of Physical and Rehabilitation Medicine (ISPRM) Published By: Informa Healthcare Frequency: 6 online issues per year Print ISSN: 1748-3107 Online ISSN: 1748-3115 63

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