A professional’s guide to assistive technology
by Anthony Yuill
The provision of assistive technology has long been a central component of occupational therapy, and is key to minimising barriers to function and promoting the independence of clients.
Therapists at The OT Practice benefit from years of cumulative clinical experience with assistive technology, informed by up-to-date knowledge of published literature related to its use. Our OT’s have a proven track record of success in the assessment, recommendation and implementation of assistive technology solutions for a variety of clients of all ages. This guide avoids prescribing any single procedure however, but instead provides an overview to assist professionals in understanding and implementing assistive technology.
What is assistive technology?
According to a report by the Royal Commission on Long Term Care (1999), assistive technology refers to “any device or system that allows an individual to perform a task that they would otherwise be unable to do, or increases the ease and safety with which the task can be performed” 1.
It is therefore an umbrella term that includes a wide range of assistive, adaptive or rehabilitative devices, as well as the expertise whereby these devices may be selected, sourced and used, all with the aim of improving clients’ independence and quality of life.
Assistive technology is sometimes associated with, but is not identical to, what in health and social care settings are termed telehealth, telemedicine or telecare. These refer to systems of communication between an individual and their healthcare team, examples of which include remote monitoring of diabetic patients, falls-detection systems, dementia care or alarm systems. Wherever such communication systems assist the client in performing a task of some kind, they too may be said to fall within the definition of assistive technology.
Not all technologies however are assistive in the strict sense used by occupational therapists. Mobile phones and tablet devices, for example, commonly include as part of their standard functionality the ability to schedule reminders, which for many clients may be a great assistance as aids to memory. Nonetheless, while an excellent use of everyday technology, in the absence of customized hardware or software we would not normally refer to such devices and their applications as assistive technology in the technical sense.
Conversely, a device as straightforward as a sock aid would, for example, fall within the definition on account of its specialised purpose. But the most significant recent development in the technology arena has, of course, been the rapid development of digital communication. Thus occupational therapists may sometimes use the phrase assistive technology in a narrower sense, to refer to those devices which make use of new digital technologies in ways that would not have been possible even ten years ago.
Types of assistive technology
Although our purpose here is not to catalogue the enormous range of assistive technology now available, an awareness of their broad categories of operation is helpful when assessing their suitability.
One important distinction is between those technologies that require active engagement from a client and those that do not, the selection of each being specific to an individual’s aptitude and their attitude to the technology:
- Active-client technologies require the individual to take some action to operate the technology. Examples include operating voice-recognition software, eye gaze systems or the use of rehabilitative applications on a computer or tablet device.
- Passive-client technologies do not require conscious interaction from the client. Examples include movement-activated lighting or a falls-detection system.
Another distinction, relevant to the consideration of whether a technology is likely to be practical and cost-effective in the longer term, is between those that require only a one-time set-up and those that are linked to support services on an ongoing basis:
- Stand-alone technologies, once set up, will continue to work in a determinate way. Examples include a speaking clock or specialized kitchen utensils.
- Support-service linked technologies link to responders or support systems, whether the communication is initiated actively by the client, remotely or automatically. Most telecare systems are examples of support-service linked technologies.
How should occupational therapists approach assistive technology?
Occupational therapists frequently use Activity Analysis to consider the tools and equipment necessary for clients to engage in a specific activity. Following an assessment, if everyday equipment is not suited to an individual’s abilities then the therapist will consider either modifications to it or else wholly specialized devices; in other words, they will consider assistive technology.
Some examples of the numerous products and services that occupational therapists might recommend include, but are not limited to, the following:
- Mobility aids, such as wheelchairs, walkers, crutches or prosthetic devices
- Hand/grab rails positioned in key places around the home or workplace
- Toileting or bathing/showering aids
- Customized cooking equipment
- Computer or other electrical devices that maximise cognition and act as aids to memory
- Hearing aids
- Eye-gaze systems
- Environmental control systems
- Voice recognition software, screen readers or enlargement applications
- Automatic page-turners, book holders or pencil/pen grips
- Ramps, specialist lighting or automatic door openers in community buildings and businesses
But being aware of the range of alternatives is only one part of the therapist’s task; it is in making the choice between them that their expertise and judgement is irreplaceable. Just as the right choice of technology can prove invaluable in promoting function and independence, so long-term use of inappropriate devices can impair these and, instead, prolong or deepen dependence on family, friends or formal care. The consequences of poor choices can therefore be costly, as well as disappointing for clients and case managers.
Ethical considerations: recommendations for best practice
Ethical principles are what align occupational therapists’ professional conduct to the ultimate purpose of their vocation, namely the wellbeing of clients. Therapists will therefore have a proper regard at all times for the standards of professional practice identified by professional and regulatory bodies.
The Social Care Institute for Excellence (2010) has put forward four ethical principles to be addressed when considering a solution for a client that uses assistive technology2:
- Autonomy - whether or not a technology promotes choice in their everyday life
- Beneficience - whether or not a technology promotes their broader wellbeing
- Non-maleficience - whether or not a technology entails a significant risk of harm
- Justice - whether or not the costs of a technology are justified by its potential benefit
Common barriers to the success of a technology include lack of understanding of the equipment, a concern that its use requires skills beyond an individual’s capabilities, and the fear that it may replace valued existing services - especially human contact. Moreover, it may be more important in some cases to address the root causes of a problem rather than alleviate its consequences through the use of technology: before suggesting a fall-detector system for an older client, for example, a therapist should look at the causes of these falls and whether a simpler solution might lower the risk of their occurrence.
At this stage therefore, here are some of the specific questions that a therapist will want to ask. Other than being necessary in their own right, explicit consideration of a client’s full circumstances is also likely to be essential in securing any funding that may be required3:
- Does the proposed technology address the client’s specific needs, making the most of the abilities they already possess and maximising independence?
- Can it be easily incorporated into the routine of their everyday life?
- Are there limitations of space or other environmental factors (such as limited internet access) that would prevent an otherwise suitable technology from being a practical choice?
- Will the proposed technology remain suitable given the likely progress of a client’s condition and possible changes to their degree of impairment?
Examples:
- A raised toilet seat with handrails may appear ideal for a client with reduced movement in the pelvic region. But, if reduced movement is due to brittle or otherwise weak bones, these may not be suitable if strength in the hands and wrist later deteriorates.
- An eye-gaze environmental control system may maximise a client’s independence at the time it is installed, but if the client spends periods of time in respite or has a journey of in-patient rehabilitation ahead of them then this independence and control is significantly reduced again unless the technology can be transported. Timing and routine are important considerations for all technology, but especially the more expensive solutions.
- A manually-propelled wheelchair for a client with MS may be useable at the time of assessment, but an electric wheelchair or scooter may be more appropriate if their condition is progressing rapidly.
- Is the client likely to embrace the technology, or be resistant to it?
- Might use of the technology actually lead to the client feeling marginalized or unfairly discriminated against, for example by their privacy being compromised?
- Is the technology likely to have an impact on the client’s family?
- Will a training session be necessary to assist the client in using the technology, and should post-installation visits be arranged to monitor their progress with it?
- Is the proposed technology cost-effective in this context, or is there a simpler, cheaper technique that would work just as effectively?
- Would human contact and intervention be preferable to the use of assistive technology, which should support and not replace personal care?
##Conclusion##
In this guide we have examined the purpose of assistive technology and some examples of its use, along with its importance to occupational therapy. We have also presented the kinds of questions that practitioners will naturally want to ask before making a recommendation so as to exploit its advantages while avoiding costly mistakes.
In the digital age it is particularly important to place assistive technology at the centre of the “tool-box” of expertise and solutions that occupational therapists offer their clients. We encourage all our therapists to remain informed of developments in this technology and to be innovative in its use.
If you would like to discuss further the way in which assistive technology can improve the lives of your clients, please contact one of our dedicated Client Managers at The OT Practice on 01628 857 144.
Useful Links
COT Hot Topic – www.cot.co.uk
Smart Thinking – www.smartthinking.ukideas.com
Telecare Aware – www.telecareaware.com
Living Made Easy – www.livingmadeeasy.org.uk
AbilityNet – www.abilitynet.co.uk
1 Cowan, D. and Turner-Smith, A. (1999), The role of assistive technology in alternative models of care for older people, in Tinker, A. and et al (eds) Royal Commission on Long Term Care (Research Volume 2)
2 Social Care Institute for Excellence (2010), At a Glance, 24: Ethical issues in the use of telecare
3 For further details, you may wish to search Research and Development Work Relating to Assistive Technology at www.gov.uk
