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

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This material is based upon work supported by the National Institute of Food and Agriculture, U.S. Department of Agriculture,
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This material is based upon work supported by the National Institute of Food and Agriculture, U.S. Department of Agriculture,
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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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. Assistive Technology Devices
… range from highly complex technology to simple
adjustments that can make life more dignified,
remove barriers and change lives.
16

17. The DOD’s Computer/Electronic Accommodations Program (CAP)
http://www.cap.mil/Default.aspx
17

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

20. 20

21. 21

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. Screen Magnifiers vs. Readers
Magnifiers
Readers
• MAGic
• JAWS
• ZoomText
• Window-Eyes
• Supernova
• HAL
23

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. 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. 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. Simple devices can make
a big difference
27

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. Alternate Mice
• Trackball
• Head Controlled (Camera Mice)
• Joystick
• Touch Pads
• Touch Screens
29

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. 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. 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. 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. 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. Environmental Adaptations
•
•
•
•
•
Ramp
Wide doorways, door sill removal
Stair lift, elevator
Grab bar
Aisle width,
furniture layout
35

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. 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. 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. 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. 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. www.resna.org
41

42. 42

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. 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. 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. 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. Clearly we have a problem.
What do we do?
47

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. 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. 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. 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. 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. Find Out What the User Wants
•
•
•
•
Get the information
Organize the information
Use the information
Revise the information
53

54. A successful outcome begins early with choosing
the most appropriate AT for a person.
How can we best do that?
54

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. 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

58. This is the Matching Person
& Technology Process
MT
P
58

59. MT
P
59

60. MPT Assessment Process
MPT
Model
60

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. 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. 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