Models of Practice. Lecture 7. A successful outcome begins with choosing the most appropriate AT for a person. How can we best do that?.
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Matching people with assistive technology is complex because people’s expectations of and reactions to technologies are complex. Reactions are highly
Scherer M. J. (2005). Assistive technology in
education for students who are hard of hearing or deaf. Handbook of special education technology research and practice. Knowledge by Design. (2005). Whitefish Bay, WI.
Sometimes the evaluation people’s expectations of and reactions to technologies are complex. Reactions are highly
is driven by a request for a
specific piece of equipment.
In these instances, the focus
is on the equipment, and
the student’s problem is
Kurtz J. (2003). Assistive technology in schools: how do we make it work? OT Practice. Aug 18; 8 (15), 16-20.
Cultural and Financial Priorities
Legislation & Policy
Attitudes of Key Others
and Device Selection
* Family/Friends & Significant Others
Trialling, Use and Realization of Benefit
Functional ATD Need
Knowledge and Information
Personal Preferences and Priorities
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.
Ensure good outcomes for individuals
Provide evidence for successful practices
Augment AT knowledge base
Document need to funding and policy makers
to make informed choices
to monitor how well solutions meet their goals, preference and ongoing requirements
to enable them to direct the process in order to optimize their utilization on the solution.
An integratedapproach which utilizes a range of mechanisms to provide consumers with adequate information
Context people’s expectations of and reactions to technologies are complex. Reactions are highly
Functioning & Disability
Body Functions &
QOL people’s expectations of and reactions to technologies are complex. Reactions are highly
Individual people’s expectations of and reactions to technologies are complex. Reactions are highly
Influences on Activities & Participation
It is no longer sufficient to show we have improved a person’s functioning. We must show we have enhanced
•AT is often provided as part of a number of interventions and it is therefore difficult to ascertain the degree to which the AT is responsible for the outcome
•Difficult to define the expected outcomes
•Consumer diversity and individualization makes comparisons difficult
Jutai J & Day H. (2002). Psychosocial Impact of Assistive Device Scale (PIADS). Technology and Disability, 14, 107-111].
+ Good psychometric properties after a slow start (contact lens and eyeglasses use)
Demers, L., Weiss-Lambrou, R., & Ska, R. (1997). Quebec User Evaluation of Satisfaction with assistive Technology (QUEST): A new outcome measure. In S. Sprigle (Ed.), Proceedings of the RESNA 97 Annual Conference (pp. 94-96). Arlington (VA): RESNA Press.
Scherer, M.J. (1989). The Assistive Technology Device Predisposition Assessment (ATD PA) Consumer Form. Webster, NY: The Institute for Matching Person & Technology, Inc.
ATDPA Section A: Abilities ICF Classification: Body Functions (b)
1. Seeingb210 Seeing functions
2. Hearingb230 Hearing functions
3. Speechb3 Voice and speech functions
4. Understanding,rememberingb144 Memory; b164 higher level cognitive
functions; b1670 reception of language
5. Physical strength/staminab730, b735, b740 Muscle functions
6. Lower body useb760 Control of voluntary movement functions
7. Grasping and use of fingersb760 Control of voluntary movement functions
8. Upper body useb760 Control of voluntary movement functions
9. Mobilityb770 Gait pattern functions
ATDPA Section B. Well-Being, QOL ICF Classification: Activities & Participation (d)
10. Personal care, household activitiesd5 Self-care; d630, d640 Household tasks
11. Physical comfort & well-beingb280 (pain)
12. Overall healthb4, b5, b6, b8
13. Freedom to go wherever desiredd4 Mobility; d460 Moving around in different locations, d470, Using transportation; d475 Driving
14. Participation in desired activitiesd2 General tasks & demands; d9 Community, social &
15. Educational attainmentd810-d839 Education
16. Employment status/potentiald840-d859 Work and employment
17. Family relationshipsd760, e310 Family relationships
18. Close, intimate relationshipsd770 Intimate relationships, e320Friends
19. Autonomy, self-determinationd177 Making decisions
20. Fitting in, belongingd7 Interpersonal interactions, d910 Community life
21. Emotional well-beingb152 Emotional functions;d240 Handling stress and
other psychological demands
ATDPA Section C: Psychosocial factors ICF Classification: Contextual Factors
Attitudes and support from family, Support from family (e310, 410),
friendsSupport from friends (e320,420)
Temperament Personal, Temperament & personality (b126)
Mood Emotional functions (b152)
Autonomy and self-determination Making decisions(d177), Higher cognitive functions (b164), Attitudes (e4)
Self-esteem Personal, Emotional functions (b152)
Readiness for technology use Incentive to act (b1301), Forming an opinion
ATDPA Section D. Device MatchICF: Products & Technology Matching (e115-e145)
Help achieve goals General tasks and demands (d2)
Improve QOL All Activities & Participation (d), Energy (b130), Sleep (b134),
Emotional functions (b152)
Knows how to use Learning and applying knowledge (d1), Support (training) from
health professionals (e355)
Secure with use Psychomotor function (b147), Emotional functions (b152)
Fits with routine Carrying out daily routine (d230)
Capabilities for use Specific mental functions (b140-bb180), Neuromusculoskeletal &
movement –related functions (b7)
Supports for use Support and relationships (e3)
Will physically fit Moving around using equipment (d465), Domestic life (d6), Community life (d910), etc.
Comfort – family Emotional function (b152), family attitudes (e410)
Comfort – friends Emotional function (b152), friends attitudes (e420)
Comfort - school/work Emotional function (b152), peer attitudes (e425)
Comfort - communityEmotional function (b152), stranger attitudes (e445)
+ Good psychometric properties. Predictive of a match.
+ Useful when evaluating a person’s device expectations and realization of benefit with a specific device.
+ Computerized scoring and interpretations available
– Requires a commitment of at least 45 minutes to complete (longer if other forms are also used such as History of Support use) and to involving the consumer in the process
– Many professionals are uncomfortable with asking consumers personal questions.
de Jonge, D., Scherer, M & Rodger, S. (2006)
Assistive Technology in the WorkplaceSt Louis, Mosby.
Scherer, M. J. (2005). Living in the State of Stuck: How Assistive Technology Impacts the Lives of People with Disabilities, Fourth Edition. Cambridge, MA: Brookline Books.
+ Allows the client to reassess their performance on the identified tasks at various intervals
+ Very individualized
– Requires considerable time
– Not focused on AT
+ Enables issues to be prioritised and the baseline performance to then be compared with performance following acquisition of the device
– Assesses activities and not participation
– Requires consumers to be able to identify their problems
– Has not been used extensively in outcome studies.
COMPASS is a software program to measures computer performance (input, navigation and output). Provides quantitative data regarding reaction time, typing speed, number of errors.
The Siva Cost Analysis Instrument (SCAI) detail/compares costs of technology interventions.
Assessment of Life Habits (LIFE-H) questionnaire available in two forms: a 69- item screening tool to identify areas of life where participation in limited and a 240-item in-depth assessment across 12 domains: nutrition, residence, responsibility, fitness, personal care, communication, interpersonal relations, mobility, community, education, employment and recreation.
Other measures of participation have been developed for wheelchair users, community activities (AM-PAC/PM-PAC is not an AT outcome measure),
Evidence based practice is how Clinicians/researchers objectively provide evidence through scientific means on the outcome (positive and/or negative) of their intervention/s with their client group/s
Why we need evidence based Practice.
Clinical result measures
Quality of Life
YesPerspectives of Different Stakeholders: Importance of Various Outcome DimensionsDeRuyter 98