Assistive Technology Service Provision Research Articles

Guidelines for assistive technology service provision – A scoping review

Purpose: Despite the high unmet need for effective AT provision, multiple service delivery models across different countries, and a shortage of personnel trained in this field, no widely useable and accepted Assistive Technology (AT) service provision guidelines currently exist. This review aims to provide an overview of the literature regarding AT service provision guidelines to inform the development of globally useable AT provision guidance, aligned with contemporary global initiatives to improve access to AT. Materials and Methods: The rapid scoping review method used a two-tiered approach to identifying relevant publications: (1) systematic search of academic databases (Medline, CINAHL, SCOPUS, and Google Scholar); (2) consultation with international AT organisations and experts. The search was conducted in March 2023 with no date limitations. Analysis was guided by the TIDE-funded HEART research on quality AT provision and service delivery processes in Europe, as well as the WHO-GATE 5 P framework for strengthening access to AT. Results: 35 publications were identified from various countries, and directed at differing assistive products, personnel, and provision contexts. No established guidelines for AT service provision currently exist. However, despite the variety in contexts, the range of assistive products and the range of stakeholders to whom guidelines are directed, several key service delivery steps were identified that may form part of such guidelines. Conclusions: This review offers a strong starting point for developing guidance for AT provision to meet global needs. Careful consideration of vocabulary, process, and application to the diversity of assistive products is recommended in systematizing globally applicable guidance.

IMPROVING REHABILITATION OUTCOMES FOR PEOPLE AGING WITH LONG-TERM HAND IMPAIRMENTS

Abstract Despite the importance of hand and upper extremity function in ADL performance and successful aging-in-place, contextual and engaging in-home rehabilitation interventions that promote use, feedback of progress, and long-term monitoring of changes in functional ability among individuals with chronic upper limb deficits are lacking. This presentation will present the findings from three TechSAge pilot projects focused on the use of technology to support in-home rehabilitation for individuals aging with long-term upper extremity disabilities. DigiHand, is a smartphone-based application combined with sensor-embedded objects used in daily activities (e.g., coffee cup) that enables users to self-manage their own rehabilitation, obtain feedback on progress to refine movements, and allow remote monitoring by therapists. Similarly, KeyStroke is an in-home piano training mobile app that provides engaging music exercises to promote long-term rehabilitation and therapists’ monitoring of progress of stroke survivors. Finally, 3DP for AT is generating design requirements to support the development of an open-source software tool that would allow assistive technology service providers, who are novice users of 3D printers, to create and fabricate highly customized 3D-printed assistive devices that are more durable, aesthetic, and will better meet the unique needs of people aging with long-term hand impairments.

The Measurement of Experience and Satisfaction with Public Provision of Assistive Technology Services for Workers with Disabilities in Korea

The Korean government has been providing AT services for workers with disabilities and is increasing its provision every year. However, there are request for improvement from individuals with disabilities regarding service process, eligibility, and quality of services. In response to those requests, this study was created to more accurately identify the process to be improved and to collect opinions from workers with disabilities for improvement of public AT services. The survey consisted of respondents' demographic information, experiences with the public AT service process, and opinions on improving public AT service. The request to participate in the survey was conducted for 3 weeks, and the responses of 158 disabled workers were used for analysis. This study used descriptive statistics and analysis of variance and planned follow-up testing in case a significant difference was found. The results indicated a low satisfaction with early stages of AT service process, such as information acquisition. Respondents also hoped that the application process would be changed to be simpler and more direct to take into account workers with disabilities, and that the provision of assistive devices would be expanded and diversified. The government is leading positive changes in line with the needs of workers with disabilities identified in this study. In the future, it is necessary to gradually expand the application eligibility for public AT services and to improve service system and provide government support for them.

Unmasking Experiences of OTs Providing High-Tech Assistive Technology Services

Abstract Date Presented 03/31/2022 This study examines the transformation of OT generalists into experts in the provision of Assistive Technology Services (ATS). It sheds light on the adaptive strategies that OTs adopt while overcoming occupational and environmental barriers in the workplace and seeking to gain expertise. It also has recommendations from the experts in the field to better prepare entry-level OTs to provide ATS in the current climate. Primary Author and Speaker: Katherine Selby McDowell Additional Authors and Speakers: Karen Aranha

Promoting regional coherence and cohesion amidst multiple assistive technology initiatives in Africa.

BackgroundAppropriate provision of assistive technology services (ATS) and products are a global health issue and essential for achieving the Sustainable Development Goals (SDGs). The Sixth African Network for Evidence-to-Action on Disability (AfriNEAD) conference included a workshop on collaboration, cohesion and coherence in ATS delivery in Africa.ObjectiveThis article aimed to summarise the workshop proceedings and to provide some recommendations on how coherence and cohesion can be facilitated in assistive technology services in Africa.MethodA round table and small group discussions on assistive technology were facilitated in the virtual space of the AfriNEAD conference. Organisations and role players in ATS and products in Africa participated as keynote speakers, round table members and in small group discussions.ResultsThere was consensus amongst participants that cohesive collaboration must be facilitated. They further agreed that users must be central to future action. There are local, national and regional initiatives, but none of these have grown into an African assistive technology platform. World Health Organization (WHO) Africa can bring partners together and facilitate creation, officialisation and operationalising of a continental assistive technology platform, through building on the existing initiatives. The AfriNEAD disability research country working groups can act as in-country coordinating bodies for ATS and afford a possibility of a structured approach to assistive technology research.ConclusionIt is time to break away from Western institutionalised biomedical ways of providing ATS in Africa. Africans must develop coherent, cohesive ATS driven by empowered users who build on Africa’s strengths and addresses the continents’ unique needs.

“Unknown world of wheelchairs” A mixed methods study exploring experiences of wheelchair and seating assistive technology provision for people with spinal cord injury in an Irish context

Aim This study explores people living with spinal cord injury (SCI) experiences and perspectives of wheelchair and seating assistive technology service provision within an Irish context. There are few studies that examine the process of wheelchair and seating provision and the connection between satisfaction, performance, and participation. Method This mixed methods study explores participant experiences in two parts. Part one presents a thematic analysis of eight in-depth semi-structured interviews with wheelchair service users living with SCI. Part two presents the results content and frequency analysis of an on-line survey of wheelchair service user’s experience and satisfaction with wheelchair and seating service provision from respondents with SCI (n = 117) taken from a larger national survey from respondents with various diagnoses (n = 273). Results Findings from the interviews and survey revealed the meaning of wheelchair and seating assistive technology provision as essential to life following SCI. Barriers within the provision system such as wait times and funding were found to impede people’s rights and freedom from initial assessment through to follow up, maintenance and repair. Conclusions The current implementation of wheelchair and seating assistive technology provision as described in this paper impacts the ability of individuals living with an SCI to participate as equal members of society. A review of wheelchair provision is essential to optimize access to services for appropriate wheelchairs. IMPLICATIONS FOR REHABILITATION As a basic human right, appropriate wheelchair and seating assistive technology provision facilitates people’s optimal independence, health and well-being, social engagement, and participation in everyday life. The development of adequate wheelchair services should be a priority area for individuals with SCI who use wheelchair and seating assistive technology. National wheelchair and seating assistive technology provision policies in alignment with internationally developed best practice guidelines to provide equal access to services which include assessment, delivery, training, maintenance, and follow-up are essential.

Ethics and assistive technology: Potential issues for AT service providers

ABSTRACT The purpose of this article is to report on the results of a survey intended to explore Assistive Technology Professionals’ (ATPs’) perceptions of what constitutes an ethical dilemma and their perceived confidence in addressing such issues. This study implemented an exploratory-descriptive design. A total of 214 ATPs responded to the ATP Ethics Survey. Findings suggest that most of the ATPs participants of this study reported having received ethics education. In addition, results indicated that defining what constitutes an ethical dilemma, particularly related to client/patient issues, and defining an ethical decision-making process are areas that warrant more education and development. While the results of this study only represent the self-reported experiences of those 214 ATPs that answered this survey, these suggest that there is a need for professionals in the AT area to further explore and discuss the impact of ethical situations in their practice. Further studies should continue to explore ethics training and decision-making processes in the provision of assistive technology services. Such explorations and subsequent training should be conducted in collaboration with professional organizations and their respective leadership.

A survey of assistive technology service providers in the USA

This study investigates perspectives of assistive technology service (ATS) providers regarding their education and training, interdisciplinary standards of practice, use of a common language framework, funding policies, utilization of evidence and outcomes measurement. A survey underpinned by AT legislations and established guidelines for practice was completed by 318 certified AT providers. More than 30% of the providers reported their education and training as inadequate to fulfil four of the seven primary roles of ATS. Nearly 90% of providers expressed awareness of the International Classification of Functioning, Disability and Health (ICF) domains for interdisciplinary communication. However, only 45% felt that they could effectively utilize the ICF in their documentation. About 75% of the providers acknowledged the lack of a recognized standard for the provision of services. Prevailing inadequacies in funding were negatively impacting the quality of ATS, as expressed by 88% of respondents. Translation of evidence to practice was identified as a major challenge by 41% of service providers. Providers were predominantly documenting outcomes through informal interviews (54%) or non-standard instruments (26%). Findings support the need for strengthening professional curriculum, pre-service and in-service training and an established standard to support effective, interdisciplinary AT services and data collection to support public policy decisions.Implications for RehabilitationThis study validates the need to strengthen education and training of AT service providers by enhancing professional curriculum as well as their engagement in pre-service and in-service training activities.This study draws attention to health care funding policies and practices that critically impact the quality of AT services.This study signifies the need for an established interdisciplinary standard among AT professionals to support effective communication, service coordination and outcomes measurement.

Assessing service delivery systems for assistive technology in Brazil using HEART study quality indicators

BACKGROUND: Recently in Brazil, there has been investment and improvements in the service delivery system for assistive technology provision. However, there is little documentation of this process, or evidence that users are being involved appropriately. OBJECTIVE: To understand how assistive technology service provision currently functions in Belo Horizonte city, Brazil, in order to provide context-specific interventions and recommendations to improve services. METHOD: Qualitative research design, including visits to key institutions and semi-structured interviews with key stakeholders. Interview questions were divided with two purposes: 1) Exploratory, aiming to understand present service functioning; 2) Evaluative, aiming to assess staff difficulties in applying existing best practice. RESULTS: Assistive Technology services in Belo Horizonte fall under the `medical model' definition of the service delivery system developed by AAATE. It was also found that staff lack training and knowledge support to assess user requirements and to involve them during the decision-making process. Additionally, there is no follow-up stage after the device is delivered. CONCLUSIONS: The study clearly defines the service provision function and the staff difficulties at Belo Horizonte city, providing information for further studies.

A centre for provision of assistive technology services in Singapore

Traditionally, persons with acquired disabilities in Singapore receive rehabilitation services at Rehabilitation Centres or Community Hospitals. They would be prescribed activities of daily living aids and mobility aids to improve their independence in their day-to-day activities. Assistive Technology (AT) devices were not considered as a part of rehabilitation as therapists lacked the knowledge and resources in prescribing appropriate technological solutions to their clients. The services of the Specialised Assistive Technology Centre (ATC) at the Society for the Physically Disabled (SPD) have changed this perspective and greatly improved service provision and awareness. This article highlights the role of occupational therapists in the provision of AT to complement rehabilitation therapy services for persons with disabilities and in improving rehabilitation outcomes related to AT usage for this population.

Assistive technologies after stroke: self-management or fending for yourself? A focus group study

BackgroundAssistive Technologies, defined as “electrical or mechanical devices designed to help people recover movement” have demonstrated clinical benefits in upper-limb stroke rehabilitation. Stroke services are becoming community-based and more reliant on self-management approaches. Assistive technologies could become important tools within self-management, however, in practice, few people currently use assistive technologies. This study investigated patients’, family caregivers and health professionals’ experiences and perceptions of stroke upper-limb rehabilitation and assistive technology use and identified the barriers and facilitators to their use in supporting stroke self-management.MethodsA three-day exhibition of assistive technologies was attended by 204 patients, family caregivers/friends and health professionals. Four focus groups were conducted with people purposively sampled from exhibition attendees. They included i) people with stroke who had used assistive technologies (n = 5), ii) people with stroke who had not used assistive technologies (n = 6), iii) family caregivers (n = 5) and iv) health professionals (n = 6). The audio-taped focus groups were facilitated by a moderator and observer. All participants were asked to discuss experiences, strengths, weaknesses, barriers and facilitators to using assistive technologies. Following transcription, data were analysed using thematic analysis.ResultsAll respondents thought assistive technologies had the potential to support self-management but that this opportunity was currently unrealised. All respondents considered assistive technologies could provide a home-based solution to the need for high intensity upper-limb rehabilitation. All stakeholders also reported significant barriers to assistive technology use, related to i) device design ii) access to assistive technology information and iii) access to assistive technology provision. The lack of and need for a coordinated system for assistive technology provision was apparent. A circular limitation of lack of evidence in clinical settings, lack of funded provision, lack of health professional knowledge about assistive technologies and confidence in prescribing them leading to lack of assistive technology service provision meant that often patients either received no assistive technologies or they and/or their family caregivers liaised directly with manufacturers without any independent expert advice.ConclusionsConsiderable systemic barriers to realising the potential of assistive technologies in upper-limb stroke rehabilitation were reported. Attention needs to be paid to increasing evidence of assistive technology effectiveness and develop clinical service provision. Device manufacturers, researchers, health professionals, service funders and people with stroke and family caregivers need to work creatively and collaboratively to develop new funding models, improve device design and increase knowledge and training in assistive technology use.

Provision of assistive technology services method (ATSM) according to evidence-based information and knowledge management

Purpose. This article develops a standardised method for assistive technology service (ATS) provision and a logical basis for research to improve health care quality. The method is ‘interoperable’ across disabilities, disciplines, assistive technology devices and ATSs.Background. Absence of a standardised and interoperable method for ATS provision results in ineffective communication between providers, manufacturers, researchers, policy-makers and individuals with disabilities (IWD), a fragmented service delivery system, inefficient resource allocation and sub-optimal outcomes.Objectives. Synthesise a standardised, interoperable AT service method (ATSM) fully consistent with key guidelines, systems, models and Federal legislation. Express the ATSM using common and unambiguous language.Results. Guidelines, systems, models and Federal legislation relevant to ATS provision are reviewed. These include the RESNA Guidelines for Knowledge and Skills for Provision of Assistive Technology Products and Services (RESNA Guidelines), IMPACT2 model, international classification of functioning, disability and health (ICF) and AT device classification (ATDC). Federal legislation includes the Assistive Technology Act of 2004, Americans with Disabilities Act of 2008 and Social Security Act. Based on these findings, the ATSM is synthesised and translated into common and accessible language.Conclusion. ATSM usage will improve communication between stakeholders, service delivery coherence, resource allocation and intervention outcomes.

Assistive Technology use in the working environment and the roles of assistive technology service providers

Assistive Technology use in the working environment and the roles of assistive technology service providers

Ethics and assistive technology service provision

A review of ethical issues that arise in assistive technology service provision suggests that in order to provide effective assistive technology-related services, rehabilitation professionals need to take into account a variety of ethical considerations inherent in consumer-responsive service provision.

Characteristics of assistive technology service delivery models: stakeholder perspectives and preferences

Purpose. The purpose of this study was to identify the key characteristics of an assistive technology service delivery model preferred by the various stakeholders in Manitoba, Canada.Methods. A descriptive, exploratory approach consistent with qualitative research design was used to explore this issue. Three focus groups were held using a semi-structured interview guide and a hypothetical case study to guide the discussion. Eighteen adults participated in the study, each representing one of three groups of stakeholders (assistive technology service providers, funders and users). Interviews were audiotaped, transcribed and analysed using an inductive process to develop categories and themes.Results. Three primary themes emerged from the data: the user of assistive technology is a unique individual; a decision-making process exists; and, assistive technology devices and services are complex. Based on the study results, recommendations for the delivery of assistive technology services are outlined.Conclusions. The results of this study may be useful for developing funding guidelines, supporting the importance of assistive technology in enabling meaningful activities, and examining current delivery of services in different contexts.

Technology and transition: tools for success

The Technology and Transition project has established a collaborative model for providing and coordinating assistive computer technology (ACT) services to students with disabilities to support the transition process. The model addresses areas mandated by federal legislation including: (a) support for the role of occupational therapy in secondary settings and in the transition process; (b) provision of assistive technology services to students with disabilities in these settings; and (c) facilitation of successful transition outcomes for students with disabilities. The Technology and Transition model has 4 interrelated components: (a) ACT service delivery including evaluation, student training in the use of devices, and coordination of ACT with the technology used in the school; (b) the provision of ACT devices through a Lending Library, a key component of the model. Seventy-four percent of the participants borrowed equipment from the library; (c) an education component including a website providing transition related materials and resources and a summer training program in which students learn computer literacy skills; and (d) working with school personnel to facilitate coordination and collaboration between the student, family, school personnel, employers, and adult service providers. Occupational therapists have the skills and expertise vital in facilitating the successful transition of students with disabilities from secondary education to adult settings and have been instrumental in the development and implementation of the Technology and Transition model. Preliminary results indicate successful outcomes. Twenty seven students have participated in the project to date; 12 are in college and two are in job training programs with ACT in place, two withdrew from the project and the remaining students continue in secondary education with ACT from the lending library.

Individuals with disabilities using the Internet: a tool for information and communication

The Internet is available 24 hours per day and offers a wealth of information via web sites, mailing lists and other resources for individuals with disabilities. These individuals can use the Internet as a tool to gain information related to their disabilities, assistive technology, employment, lei sure activities, public policy and more. This article will describe some of the sites on these topics that may be of particular interest to individuals with disabilities, their family members and assistive technology service providers. This article provides the reader with a summary of the resources available regarding disability-related information on the Internet.

Rehabilitation engineering training for the future: influence of trends in academics, technology, and health reform.

A perspective is offered on rehabilitation engineering educational strategies, with a focus on the bachelor's and master's levels. Ongoing changes in engineering education are summarized, especially as related to the integration of design and computers throughout the curriculum; most positively affect rehabilitation engineering training. The challenge of identifying long-term "niches" for rehabilitation engineers within a changing rehabilitation service delivery process is addressed. Five key training components are identified and developed: core science and engineering knowledge, synthesized open-ended problem-solving skill development, hands-on design experience, rehabilitation breadth exposure, and a clinical internship. Two unique abilities are identified that help demarcate the engineer from other providers: open-ended problem-solving skills that include quantitative analysis when appropriate, and objective quantitative evaluation of human performance. Educational strategies for developing these abilities are addressed. Finally, a case is made for training "hybrid" engineers/therapists, in particular bachelor-level engineers who go directly to graduate school to become certified orthotists/prosthetists or physical/occupational therapists, pass the RESNA-sponsored assistive technology service provision exam along the way, then later in life obtain a professional engineer's license and an engineering master's degree.

Addressing Assistive Technology Needs in Special Education

Assistive technology is critical to maximize the functional skills of the person with a physical disability at home, work, and school. As assistive devices become increasingly complex and expensive and more options are available, the need for an assistive technology specialist is enhanced. Recent regulations and advances in technology are affecting the type, quality, and comprehensiveness of assistive technology service provision and need for assistive technology specialists. The occupational therapist's role as an assistive technology specialist is illustrated in an example of an assistive technology program within a special education setting.

Job roles of assistive technology service providers in the United States.

The purpose of this study was to identify empirically the roles of assistive technology service providers in the United States. Via factor analysis, the following six job roles were identified: (a) Device Selection and Maintenance Activities, (b) Environmental Modification Activities, (c) Dissemination of Information on Assistive Technology Activities, (d) Evaluation of Suitability of Assistive Device Activities, (e) Administration Activities, and (f) Product Development Activities. The identified roles can provide a potential guide for the development of education or training curricula for assistive technology service providers. Those job role categories can be considered to be required areas of knowledge in a curriculum for assistive technology specialists. The identified roles can also be utilized to help define the profession of assistive technology. That definition could help guide the development of eligibility criterion and examination content for a credentialing programme for qualified assistive technology service providers in the future. A clear description of the job of assistive technology service providers can help administrators create needed positions within service delivery organizations such as state department of rehabilitation services and a rehabilitation hospital. The results could be valuable to the administrators responsible for setting job role criteria for assistive technology service providers. Such criteria are necessary for making effective hiring and employee evaluation decisions. In addition, the results can provide other professionals who utilize assistive technology services with an accurate picture of the services available from assistive technology service providers. When professionals on a rehabilitation team know what to expect of each other, clients are better served. Thus a better understanding of the roles of assistive technology service providers can contribute to better utilization of their services by a multidisciplinary team. This would in turn increase the chances of assistive technology services being offered to clients. Replication of the present study is encouraged to verify the obtained results. A future study should also focus on examining the roles of assistive technology service providers by directly observing their daily work activities. The task inventory used in the present study (ATTI) might be utilized to help guide such observations.