ASSISTIVE TECHNOLOGY MIDTERM
** please add or take away anything you think is necessary. no promises this will be everything on the
exam or if I hit all the points, but I tried my best :) **
ETHICS
● Constructed norms of internal consistency regarding what is right and what is wrong
● 5 types:
○ AUTONOMY → the right to self-determination and freedom from unnecessary
constraints or interference without the loss of privacy
○ JUSTICE/DISTRIBUTIVE JUSTICE → distributive justice: principles designed to
guide the allocation of the capabilities, benefits and burdens of economic activity
■ What should we consider regarding people in poverty when it comes to
distributive justice?
● Have problems with converting income to capabilities, especially if they
have a disability
● Less likely to attend school, which limits potential earnings
● More likely to earn a lower income
● Heightened risks for acquiring a disability as a result of living conditions
-- food insecurity, unsafe housing, lack of medical care, lack of clean
water & sanitation, and unsafe work, lack of access to medical care and
rehab
■ What should we consider regarding medical necessity when it comes to
distributive justice?
● That technology is prescribed by therapeutic need only, not by social
needs for employment, education, or relationships
○ The problem with this is: independence and function are
often not related to medical necessity
○ FIDELITY → requires clinical practice in AT carried out with honesty, integrity, and
trustworthy behavior
○ BENEFICENCE → actions intended to benefit the good of other persons
○ NONMALEFICENCE → do not harm
●
Major ethical concerns are beneficence and nonmaleficence more than autonomy.
Technology can potentially take over some decision making but provide benefit and no harm
PATERNALISM → lack of ability to give informed consent: assumes that safety is more important than
freedom of choice. This takes away autonomy
● Ex: putting a surveillance camera on someone with ID to make sure they are safe, but it takes
away that choice for the client
TYPES OF AT
●
HARD TECHNOLOGY → actual, tangible device
○ Hardware, AAC device, hearing aid, or a mobility device, w/c
■ Readily available components that can be purchased and assembled into AT
systems
○ Human/Technology Interface (HTI) → several roles -- boundary between the user and the
AT
■ Electronic devices, control interface (joystick, keyboard)
○ Environmental sensor → detects energy in various forms
■ Light sensors - camera
■ Sound sensors - microphones
■ Motion sensors - accelerometers
■ Location sensors - GPS
○ Processor or mechanism -- alters the input from the HTI.
■ Processor = electronic (cell phone/computer)
■ Mechanism = the rope on a sock aid or the part that pulls on a reacher
○ Activity outputs -- relevant to chosen to activity
●
SOFT TECHNOLOGY → less tangible
○ Other people, written or auditory materials, and computer software, instruction how to
use a service
○ Human areas of decision making, strategies, training, concept formation, and
service delivery
■ Adjustments to a w/c to affect comfort, safety, and performance
■ Training of the user to successfully use the hard technology
■ Information on how to use cell phones
■ Assessment to determine the specific needs of an individual and to match ATs to
those needs
○ Any service that directly assists an individual with a disability in the selection,
acquisition or use of an AT device
■ Evaluating needs and skills for AT
■ Acquiring AT
■ Selecting, designing, repairing, and fabricating AT systems
■ Coordinating services with other therapist
■ Training both individuals with disabilities and those working with them to use
effectively
○ Human areas of decision making, strategies, and concept formation applied to service
delivery in proper assessment, system or device selection, and fitting or setup
○ Provided:
■ Directly through people
■ Written manuals, tip sheets, and other documents
■ Electronic (websites online help)
●
HIGH TECHNOLOGY → expensive and/or complex
○ Devices that are expensive, often complex, and difficult to obtain and difficult to make.
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LOW TECHNOLOGY → simple to use and obtain
○ Simple to use, easy to produce, and easy to obtain.
ALWAYS THE BEST MOVE TO FIND SOMETHING THAT IS THE MOST SIMPLE
AND MOST ACCESSIBLE TO USE
Possible combinations of types of tech?
- Hard/high
- Hard/low
- Soft/high
- Soft/low
AMERICANS WITH DISABILITIES ACT OF 1990 (ADA)
● Civil rights law that is intended to protect against discrimination based on disability
● It applies to all qualifying privates employers (employers with 15 or more employees), all state
and local government programs, including the public schools, and all places of public
accommodation, including non-religiously controlled colleges and universities and test agencies
● ADA disabilities include both mental and physical medical conditions
● Prohibits discrimination of the basis of disability
● Most significant disability rights legislation in U.S. history
INDIVIDUALS WITH DISABILITIES EDUCATION ACT 2004 (IDEA)
● This was formerly known as the Education of All Handicapped Children Act
● Guaranteeing right to “free and appropriate education”
● Emphasizes mainstreaming and least restrictive environment
● Reauthorizes and improves programs in areas of transition and assistive technology
● AT devices covered so that students can access their education
● 6 main elements of IDEA
○ IEP (individualized Education Program)
■ A written statement of the educational program designed to meet a child’s
individual needs. (has goals for child and how to help them meet goals)
■ All children that receive special education have to have an IEP
○ FAPE (Free & Appropriate Education)
○ LRE (Least Restrictive Environment)
○ Appropriate Evaluation
○ Parent & Teacher Participation
○ Procedural safeguards
AMERICANS WITH DISABILITIES ACT AMENDMENT ACT 2008
● Disability: has a physical or mental impairment which substantially limits one or more
major life activities
● Expanded the definition of major life activities to include:
○ Eating
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Sleeping
Walking
Standing
Lifting, bending
Reading
Concentrating
Thinking
Communicating
Bodily functions
SECTION 504
● “No otherwise qualified individual with a disability in the U.S. shall, solely by reason of his
or her disability, be excluded from the participation in, be denied the benefits of, or be
subjected to discrimination under any program or activity receiving Federal financial
assistance”
● The section 504 regulations require a school district to provide a “free appropriate public
education” (FAPE) to each qualified student with a disability who is in the schools district
jurisdiction, regardless of the nature or severity of the disability.
● Under Section 504, FAPE consists of the provision of regular or special education and related
aids and services designed to meet the students individual educational needs as adequately as the
needs of nondisabled students are met.
● AT to be provided by states in vocational rehabilitation and IPEs (individualized plans for
employment)
● Section 508 -- electronics and IT developed and used by government is accessible to people with
disabilities (websites, hardware, and software)
ACTIVITY ANALYSIS
● Foundational skill of OT for decades
● Hierarchical task analysis may produce a flowchart that depicts the process of doing an activity,
showing different paths resulting from difference choices made
● Provides a narrative of steps
● Understand the performance of an activity
● Understand how a specific person or group completes an activity
● Analyze function AT has in activity
THE HUMAN ACTIVITY ASSISTIVE TECHNOLOGY MODEL (HAAT)
● Describes someone FIRST doing something in a context, THEN using AT
● Emphasis is on the person engaging in an activity within chosen environments
● Prevents the AT from assuming prime importance with the technology meeting the needs of
the persons rather than the result of the person adapting to the technology
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○ AT = enabler & catalyst
Transactional in nature → like foundational models, considers the influence of the interaction
on a variety of elements and variables on occupational performance
4 components of the HAAT model
1. Activity
■ Execution of tasks & participation in life situations
■ Discussing individual activities is convenient and useful in planning therapeutic
measures, but usually many tasks are being completed at once. Engagement is
dynamic and flowing between activities at any given time
■ Activity output → action that is replaced or augmented by an assistive device,
includes:
● Communication
● Cognitive abilities
● Manipulation
● Mobility
2. Human
■ Abilities in motor, sensory, cognitive, and affective areas (analysis to determine
these abilities necessary in initial eval, assessment, and outcome eval)
■ Also consider the user’s role and their motivation to use AT & engage in activity
■ Crucial to recommendation of AT
■ Think lifespan: will abilities change over time? Improve? Decline?
3. Context
■ Physical
● Built & natural terrain with respect to accessibility
● What will person need to do in these spaces, visual info in space,
environmental mods, and safety for those with disability
● Parameters: Noise, light, temp, weather, sound
■ Social
● Direct → circle of friends concept -- 5 circles. AT varies in each social
context
○ Lifelong social patterns (immediate family)
○ Close friends (know your secrets)
○ Acquaintances (classmates, co-workers, neighbors)
○ Paid workers (Dr, OT, plumber, etc)
○ Occasional but unfamiliar interactions
● Indirect → physically present in context but separated from others often
exert power in context
○ EX: president of a company, school principal, politicians, policy
makers, administrators
■ Cultural
● Beliefs, rituals, values (will AT be accepted?)
● Perceptions of time & space
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Independence vs autonomy
Causality of life situations (some cultures view disability as a
punishment)
Institutional
● Legislation -○ Rehabilitation Act of 1973 (amended 86, 92, 93)
■ Reasonable accommodations
■ Section 504 prohibits discimrination
■ AT to be provided by states in vocational rehabilitation
and IPEs (individualized plans for employment)
■ Section 508 -- electronics and IT developed and used by
government is accessible to people with disabilities (this
includes websites, hardware, software)
○ Americans with Disabilities Act 1990 (ADA)
■ Prohibits discimrination of the basis of disability
○ Disabilities Education Act 2004 (IDEA)
■ FAPE: free and appropriate public education
■ IEPs
■ AT devices covered so that students can access their
education
○ Assistive Technology Act of 1998
■ Funding allocated for states to invest in technologies,
microloans, other “capacity strengthening” measures for
people with disabilities
● Funding Regulations/Policies
○ Policies establish who is eligible for what devices, and who are
the gatekeepers of funding
● Medicaid
○ LARGEST funding source for AT in the US
■ Income-based / means-tested program
■ States responsible for who-gets-what, how, and when
● Medicare
○ Another major funding source
○ Vocabulary is within medial model for AT; DME or prosthetics
○ Covers OT, PT, speech services
○ 4 groups: 65+, disability met under SSA, disabled children of
people also disabled/dead/retired at 65+, people with end stage
renal disease
4. AT
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AT = enabler
4 aspects of AT in HAAT
● human/technology interface (HTI): portion of AT with which the user
interacts
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Processor/Mechanism: translates information and forces received from
the human into signals that are used to control the activity output
● Environmental interface: components that detects input from the
environment (e.g. sound, light), and converts it to a useable form
● Activity output: action that is replaced or augmented by an assistive
device, includes communication, cognition, manipulation and mobility.
■ Continuum of mainstream tech → commercially available AT → custom AT
4 applications of the HAAT Model
○ Product research (specific needs & why)
○ Product usability studies
○ Client assessment
○ Outcome evaluation
INFLUENCES ON HAAT: ECOLOGICAL MODELS
● CANADIAN MODEL OF OCCUPATIONAL PERFORMANCE AND ENABLEMENT
(CMOP-E)
○ Does not explicitly ID AT
○ Delineates clinician roles in client-therapist relationship
● PERSON-ENVIRONMENT-OCCUPATION-PERFORMANCE (PEOP)
○ AT considered within “environment” (like ICF)
○ Top-down approach to enabling participation & occupational performance
● Similarities
○ Environmental barriers & enablers = facilitates occupation or limit it
○ Occupation = bridge between person & environment
○ Both linked to ICF
■ See fig 1 .2 below (also can be found in textbook)
INFLUENCES ON HAAT: ICF
● International classification of functioning, disability, and health:
○ Two relevant aims:
■ Provide basis for research on health and its determinants
■ Establish a common language that will foster effective communication across
different users
○ AT listed “products and technology of the environmental factor”
○ Environment & AT considered external to user - problematic (because our environment is
not just external, a person who is using it is taking it with them and becomes a part of
them)
● Context, social context, cultural context, institutional context -- legislation and regulations and
policies and function
PRINCIPLES OF AT SERVICE DELIVERY
● Person centered
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Outcome = participation in desired activities
Evidence-informed process → do the products you are using have evidence of its necessity and
ethical
Ethical
○ Beneficence
○ Nonmaleficence
○ Social Justice
○ Distributive Justice
Sustainable -- they will keep using them even after therapy is over
UNIVERSAL DESIGN (UD)
● “The design of products and environments to be usable by all people, to the greatest extent
possible, without the need for adaptation or specialized design.
● Design for all -- in Europe
● Commercial products are designed with UD in mind -- accessible features are built in for all
● Migration of features from ATs contributes to UD
● Still need for specialty AT
○ Combo = modular systems - minstreamt tech and form it to the person
■ Ex: a chromebook with an adaptive keyboard
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Principles of Universal Design
○ Equitable use
○ Flexibility in use
○ Simple and intuitive use -- easy to understand
○ Perceptible information
○ Tolerance for error - an error is made or use the wrong way it will not be hazardous, and
still fxn if used the wrong way
○ Low physical effort
○ Size and space for approach and use - regardless of someone size or physical look it can
accommodate a wide range of people
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Mixed two concepts:
○ Different people have different skills and abilities
■ Flexible interfaces that use different sensory, cognitive, and physical modalities
○ Different people have different needs and desires
■ Multimodal platforms that have many features and flexible configurations,
customize through software apps
AMBIENT ENVIRONMENTS → network based connectivity in which every electronic device used on
a regular basis has both computing power and is linked to other devices through local networks or the
internet
What leads to abandonment of AT?
- Stigma
AT FUNDING SOURCES
● Public Funding → medicare, medicaid, public schools, state AT loan programs
● Private Funding → private health insurance
● Alternative sources → Kiwanis, United Way, rotary, church groups, workers comp, non-profits,
educational foundations, used equipment databases, etc.
Which type of allocation technique most closely relates to OT?
- Flexible allocation → user/client varies participation based on many things and gets to consider
needs in different contexts. Capabilities change based on human skills, context, and changing
activities -- AT must meet these dynamic needs
MODELS OF DISABILITY IN REHABILITATION
● TRADITIONAL MODEL OF DISABILITY
○ Based on cultural traditions and religiously-determined knowledge, views and practices
■ Also known as the Religious/Moral Model of Disability
■ https://www.copower.org/models-of-disability/177-religiousmoral-model-ofdisability.html
■ Can lead to both positive and negative attitudes, but most often resulted in
dreadful treatment of PWDs due to associating disability with past sins
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MEDICAL MODEL
○ Scientific values of evidence and authority, but often identifies the “problem” as located
within the individuals with a disability;
○ Focus is on impairment, not the whole person
■ ICIDH, 1980
○ Focus on achieving a cure, or return to ‘NORMAL’
○ Authority lies with highly retrained professional and is based on an Expert/Professional
Model of Disability
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SOCIAL MODEL OF DISABILITY
○ This framework is based on knowledge, from the life experience, values, perspectives,
and priorities of PEOPLE with DISABILITIES
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Disability is seen as part of a continuum of human variation or the result of
discriminatory policies, practices, research, and education
■ PWDs are the authorities/experts and ADVOCATES with regard to their
perceived situations and self-defined goals
INTEGRATIVE MODEL OF DISABILITY
○ Broad knowledge base ranging from medicine to the experience of PWDs
○ Addresses limitations in following just the Medical Model or just the Social Model
■ ICF (WHO, 2001)
■ Broadens the basic medical model by assessing Activity, Participation, and
Contextual Factors
BIOPSYCHOSOCIAL -- INTEGRATIVE MODEL → recognized the complex interaction of
biological, psychological, and social factors
PLISSIT
● P → Permission (or explicit permission)
○ “I’d like to ask you about your sexual health today. I ask all of my clients about this topic
as it is a part of our whole health approach to care”
● LI → Limited Information
○ Known facts, terminology, normalizing
○ Can be a powerful moment to give patients information within their comfort level (do not
negate your influence)
● SS → Specific Suggestions
○ “I would avoid using oil based lube with condoms”
● IT → Intensive Therapy
○ Sensate focus, identity issues, infidelity, paraphilias
○ Salient around sexual trauma survivors (body will constrict at the mere thought of
penetration)
WHO (2010) SEXUAL HEALTH RIGHTS
● Rights critical to the realization of sexual health include the right to. . .
○ Equality and nondiscrimination
○ Be free from torture or to cruel, inhumane or degrading treatment or punishment
○ Privacy
○ The highest attainable standard of health (including sexual health) and social security
○ Marry and to found a family and enter into marriage with the free and full consent of the
intending spouses, and to equality in and at the dissolution of marriage.
○ Decide the number and spacing of one’s children
○ Information as well as education
○ Freedom of opinion and expression
○
Effective remedy for violation of fundamental rights