Technology in Rehabilitation: Ethical and Curricular Implications for Physical Therapist Education

Abstract

Background and Purpose. In recent years, the development of assistive technologies in rehabilitation has outpaced considered ethical reflection about their application. The use of assistive technologies raises both ethical issues and values conflicts in terms of education, accessibility, and patient/client preferred values, beliefs, and goals. The purpose of this position paper is two fold: (1) to discuss the various aspects of assistive technology (AT) in terms of patient/client care, ethics and values conflicts, and influential factors, and (2) examine curricular implications and applications with patient/client care in physical therapy professional education. Position and Rationale. Due to the many factors influencing AT use, clinicians and students need to think carefully and deeply about the interface of certain technologies for patients/clients with chronic conditions. The ethical principles of autonomy, social justice, and the phenomenological meaning of AT for patients/clients and their families must be taken into account by rehabilitation professionals. With recent technological advances of AT, the authors consider the need for faculty to explore, within the curricula, the ethical implications of technological applications for patient/client care and the integration of AT into PT education programs. Discussion and Conclusions. Several national organizations and governmental agencies have begun to address the numerous aspects of AT utility, access, and denial. Emerging clinical research continues to promote the clinical and environmental impact of AT for provider care and patient/client rehabilitation. Yet, in the 21st century, not all AT access is equal or desired in patient/client populations. As educators prepare health care providers for the 21st century in the United States, the time has come to re-examine implications of contemporary AT for physical therapy education, focusing on the issues of ethical and social justice. The authors address the need for expanded interprofessional collaboration to ensure the full spectrum of ethical use and safe application of assistive technology in patient/client rehabilitation. Keywords: Ethics, Physical therapy education, Assistive technology, Interprofessional education. BACKGROUND AND PURPOSE Introduction The Winter 201 1 special issue of the Journal of Physical Therapy Education reminds us how assistive technologies have helped patients with disabilities gain more independence and improve quality of life. Assistive technology (AT) is denned as devices and product systems that assist persons with disabilities with the performance of therapy, daily tasks, and activities 1(p59) (see Appendix for a guide to acronyms). Technologies range from no technologies (no tech) to low-level technologies (low tech) to highly complex technologies (high tech). High tech has evolved in recent years to include robotics,2 telemedicine,3 virtual reality,4 computer interface brain waves,5 deep brain stimulation,6 and implantation of microchips to assist in both recovery and improved function in individuals with disabilities.7 Assistive technology compliance and use is influenced by a combination of (Figure) social, economic, ethical, and cultural factors. Rehabilitation providers should be aware of these many influences, including how their own values guide and influence patients/ clients and caregivers in complex decisions regarding the utility of AT. As technology becomes more complex, so do the ethical issues associated with AT use. Rehabilitation professionals and educators must consider ethical issues and socio-cultural factors associated with AT. The complexity of high tech requires rehabilitation educators to carefully instruct future rehabilitation professionals how to critically assess ethical issues associated with AT and AT decision-making. Purpose The purpose of this position paper is two-fold. First, we explore the associated ethics, agencies, and guidelines related to AT. …