Assistive Technology Assessment Handbook

Stefano Federici, Marcia Scherer, Stefano Federici, Marcia Scherer

• Publisher: CRC Press
• Year: 2017
• ISBN:
  9781351230889
• Edition: 2
• Topic: Médecine
• Subtopic: Théorie, pratique et référence de la médecine

Assistive Technology Assessment Handbook, Second Edition, proposes an international ideal model for the assistive technology assessment process, outlining how this model can be applied in practice to re-conceptualize the phases of an assistive technology delivery system according to the biopsychosocial model of disability. The model provides reference guidelines for evidence-based practice, guiding both public and private centers that wish to compare, evaluate, and improve their ability to match a person with the correct technology model. This second edition also offers a contribution to the Global Cooperation on Assistive Technology (GATE) initiative, whose activities are strongly focused on the assistive products service delivery model. Organized into three parts, the handbook: gives readers a toolkit for performing assessments; describes the roles of the assessment team members, among them the new profession of psychotechnologist; and reviews technologies for rehabilitation and independent living, including brain–computer interfaces, exoskeletons, and technologies for music therapy. Edited by Stefano Federici and Marcia J. Scherer, this cross-cultural handbook includes contributions from leading experts across five continents, offering a framework for future practice and research.

Section II

Assessment Professionals

Working on the Multidisciplinary Team

Marcia J. Scherer and Stefano Federici

Contents

II.1Introduction

II.1.1Treating Developmental Disabilities

II.1.2Treating Degenerative Disabilities

II.1.3Treating an Acquired Disability

II.2Presentation of the Chapters of Section II

II.3Conclusion

References

II.1 Introduction

How disability is diagnosed and treated differs according to age at onset and type of disability. Developmental disabilities, which occur in infancy and childhood, are typically diagnosed after behavioral and maturational anomalies are observed and are then confirmed medically. Acquired disability can occur at any time in the life span, and treatment is often initiated in a hospital emergency room. Disability associated with a degenerative condition, typically associated with advanced age, is generally managed by primary care physicians, neurologists, gerontologists, and family members.

II.1.1 Treating Developmental Disabilities

Developmental disabilities such as Down Syndrome or cerebral palsy cannot be “cured”. However, interventions applied as early as possible can make a great deal of difference in current and future functioning. Orthopedic and neurological impairments can be surgically corrected or medically managed. Often, children with developmental disabilities undergo many treatments during their initial development with the goal of strengthening or extending the use of existing capabilities (Scherer, 2005). All disabilities can be greatly helped with advances in technology.

The goal today is to help children with developmental disabilities to participate in life by playing with other children, attending school and being a valued member of the family and community. This requires that the right blend of technologies, supports, and accommodations are provided in light of the student’s needs and strengths (Scherer, 2005). In-school interventions may include physical and occupational therapy, speech therapy, and the administration of medications that control seizures, relax muscle spasms, and alleviate pain. This may also include braces and other orthotic devices, communication aids such as computers with voice output, and a wide variety of additional products designed to minimize functional limitations and allow the achievement of academic goals and participation in the full academic curriculum and school activities.

Although students with developmental disabilities have educational and physical challenges, their potential is unlimited. The key is to identify abilities and strengths and strengthen them while managing limitations and match students with the opportunities and supports necessary to achieve lives of productivity and quality.

II.1.2 Treating Degenerative Disabilities

The situation is somewhat different at the other end of the life span for those individuals who have a degenerative cause of disability. Until recently, when an aging person was observed putting things in the wrong places and then forgetting where they put them, not performing personal care activities, and saying and doing inappropriate things, then that individual likely moved in with adult children or other relatives to be cared for and monitored. That still occurs today, but just as frequently the individual’s primary care physician may recommend the family to consider assisted living or a nursing home.

In some manner, we have situations the reverse of what they were traditionally. The families of infants and children with developmental disabilities now assume a major portion of caregiving because placing their child in an institution would be viewed by today’s society as acting irresponsibly. At the same time, options for caregivers of aging persons with dementia increasingly include placement in specialized facilities that, in spite of efforts to lower the staff–patient ratio and create an attractive and homey atmosphere, are institutions for all practical purposes.

II.1.3 Treating an Acquired Disability

Once the person is stabilized medically, they may receive medical rehabilitation designed to strengthen the remaining capabilities and compensate for those that have been lost. Psychosocial issues (financial, family, housing, or school/work) are viewed with the objective of returning the individual to prior roles and community participation (Scherer, 2012).

Rehabilitation centers can be embedded within a larger medical center or in a freestanding rehabilitation facility. Rehabilitation encompasses not only the therapy provided but also everything else that occurs on the unit including nursing care, monitoring of behavior, nutritional assessment and planning, and non-pharmacological strategies and techniques employed to foster the optimal environment for recovery. As a result, the therapy for patients occurs 24 hours per day on the unit and provides the opportunity to carry over treatment, strategies, and training all day long and observe the recovery process more closely to adjust to a patient’s needs more effectively. Even the physical structure and environment of the unit itself is often used for facilitating the management of patients. For instance, limiting the points of access onto and off the unit often deters patients from wandering into unsafe areas. Additionally, low stimulation settings help decrease agitation and irritability. All of these aspects of management facilitate recovery and help minimize the use of medications and their side effects.

Clinical information, the results of laboratory testing, as well as imaging, all aid in the determination of disability. The evaluations performed by occupational and physical therapists, speech language pathologists, psychologists, and so on are equally important. Information from a variety of standardized assessments and tests are used to help determine and guide treatment planning from acute care to community (re)integration.

Outcome measures used for determining the effectiveness of medical interventions and rehabilitation continue to focus primarily on changes over time in body functions and structures. Moreover, when quality of life is addressed, it is apt to be limited to health-related quality of life (e.g., Maas et al., 2010). A recent study reported, however, that health-related quality of life measures are predominantly measures of function that results “in a bias against people with long-standing functional limitations not related to current health” (Hall, Krahn, Horner-Johnson, and Lamb, 2011, p. 98).

As stated by Wilson (2006), improved methods of evaluating rehabilitation that relinquish the dependence on traditional outcome measures that frequently fail to identify the real needs of patients and families are required. It remains the case that considerably less attention is provided to the following:

•The lifestyle and daily routines, preferences, and goals of individuals with disability and their family members

•A person’s predisposition to benefit from some interventions over others

•The match of expectations of benefit with realization of benefit from the chosen interventions

•Social and environmental factors impacting benefit

True to a biopsychosocial approach, rehabilitation should begin with an understanding of the current physical, cognitive, emotional/behavioral, and psychosocial functioning of the individual. This requires a rehabilitation team comprised of individuals from the diverse areas of specialty including neuropsychology, rehabilitation psychology, psychiatry, occupational therapy, speech language pathology, social work, and vocational rehabilitation counseling. Specialists in sensory loss, such as a...