The Assistive Technology Partnership Newsletter, Issue 3, 2009

Article 1: Technical Assistance; On-site Assessments

Assistive Technology Partnership’s advanced model of services focuses on adapting services to meet the functional needs of individuals, rather than fitting individuals into categories of age, disability or income. This approach helps to support consumers or agencies (such as schools) as they look to make informed decisions about assistive technologies, which results in appropriate services and assures more persons with disabilities that are getting technology are using it.

The Nebraska Assistive Technology Partnership (ATP) began in 1989 with the objective to develop, implement, and evaluate model systems for the delivery of assistive technology devices and services to persons with disabilities throughout the state. During the first several years of operation, ATP’s primary focus was on awareness (networking with peers, providing information on acquiring and using assistive technology, and connecting individuals to the partnership). In 1991, ATP established a working model of services (information and referral, awareness, technical assistance, and funding) that would come together over the course of five successive years. By 1992, ATP began providing technical assistance at demonstration centers across the state. More than information, this service afforded individuals the opportunity to experiment with various technologies before purchasing them. This service also meant that technology recommendations were being made, while a two-way conversation regarding individual abilities and goals was taking place between a technology expert (technology specialist) and the individual with the disability. Come 1996 ATP services evolved to include on-site assessments, which included the same services received from technical assistance with the exception of the location. During an on-site assessment, a technology specialist meets with the individual with a disability in the setting where they are requesting the use of assistive devices (ie. home, school, work or community). When the technology specialist completes an assessment on-site he/she can take into consideration a plethora of information about the consumer’s environment.

For Example:

• Noise levels can play a part in determining whether or not speech to text software may be a good solution.
• Understanding the role of the consumer’s family or caregivers helps to zero in on or forego certain options for successful transfers to the toilet, shower, bed or car, etc.
• Seeing an individual complete a task helps to put into perspective a consumers current abilities, understand the method they use to complete the task, and pinpoint where solutions are needed.
• Taking into account a consumer’s physical stature, their physical environment, and how it affects a task performance, aids in finding the most appropriate and cost-effective solution/modification.
• A school’s staff level of awareness, knowledge and support available for certain assistive technologies can impact the recommendation of which device should be purchased for a student.

An independent assessment provided by the technology specialist for ATP can curtail recommendations based on vendor product availability or cookie cutter approaches that expect one solution to fit all and are key to high consumer equipment utilization success rates.
ATP’s follow up surveys indicate that 96.5% of consumers are utilizing and benefiting from their assistive technology (AT) and home modifications. The 3.5%, which represents consumers who are not using the equipment, is primarily due to minor repairs or adjustments that are needed to the device, the death of the individual, or relocation of the individual due to illness. Equipment is retrieved when possible from the 3.5% of individuals no longer using their devices and entered into the inventory for recycling to benefit other consumers.
National abandonment rates are much higher without the inclusion of assessment services for assistive technology. National studies have found that 50% of assistive technology given to people was not used. Other studies find that approximately 37% of devices paid for by insurance were abandoned by consumers.

Article 2: Meet ATP Consumers

Larry

Meet Larry Cole, a 62-year-old contractor from O’Neill. In 2008, while working on the job, Larry fell down an open stairwell and injured his spinal cord. Larry spent months at Madonna Rehabilitation Hospital and Quality Living, Inc. to begin the process of learning how to live with his disability. During this time, Larry also began working with ATP to modify his two-story home. In order to have independent access to and from his home, a ramp was constructed in the garage, and plans were made to add an accessible bathroom on the main floor. In addition, Larry is working with ATP and Vocational Rehabilitation (VR) to achieve his goal of running his business from home.

Jody

Jody Daniels, a 56-year-old double amputee from Bellwood, began working with ATP in 2004. Since that time, ATP has helped Jody with van and home modifications. During the summer of 2009 Jody borrowed a 12’ portable ramp from AT4ALL to gain access to her sister, Sandra (Sandy) Larsen’s home, while Sandy was on hospice. Jody said there was no alternative to the borrowed ramp she utilized, as her attendant is no longer able to lift her up and down stairs. To Jody, this ramp meant she was able to spend quality time with a sister 14 years her senior, and it meant the world to her to finally get to know Sandy.

Valerie

Valerie Mackins, a 53-year-old quadriplegic from Omaha, was shot in the neck when she was just 21-years-old. Valerie currently lives in an apartment with her daughter. In 2001, Valerie requested a phone for communication and emergency purposes (when her daughter is out). She has many doctors’ appointments throughout each month, and it was critical for Valerie to have a safe and independent way to communicate with her doctors. A hands free phone with voice activation, sip and puff switch, and a mounting system was put in place, and with minor adjustments and replacements over the years, this device continues to meet Valerie’s needs.

Edna

In May of 2009, 84-year old Edna Loveless came to the ATP office to request a basket for her walker. Due to the nature of Edna’s request, the funding coordinator suggested that AT4ALL would be the best resource for Edna. A technology specialist talked with Edna about her needs. With the AT4ALL resource, the technology specialist was able to secure a cart on wheels with handles for free that would allow Edna to transport water, meals and other items from her kitchen to her front room. The technology specialist was also able to provide Edna with a toilet riser (also from AT4ALL) that was appropriate for her height.

Article 3: Interview with technology specialists

How important is a consumer’s contribution to the success of a project?
Generally speaking, there is much better acceptance of AT if the consumer feels they were involved in the process, demonstrations, trials, etc. Several ways a consumer can contribute are: 1) review plans and decide if it will work for you, 2) discuss the plan with your landlord if there is one, 3) promptly return all paperwork, 4) help to identify local contractors, and 5) notify staff of any changes in their status, such as change of wheelchair, loss of function, plans to move, etc.

Can AT benefit more than the individual with a disability?
AT can benefit and impact many. Immediately, it can benefit the consumer, their caregiver and family, and teachers or employers as the consumer is now more independent with a task than prior to AT.

What is appropriate technology?
An appropriate accommodation is one which gives a consumer equal access to (not necessarily better access to) something they formally could not access without an accommodation. In some situations more then one system may resolve the barrier. For instance, the “Mercedes” solution and the “Pinto” solution. As technology specialists we do not recommend the Mercedes solution just because it is more expensive, faster, or has extra features, if the “Pinto” solution meets the consumers needs. For example a student in a post secondary setting with solely handwriting limitations may be able to use a portable word processor (the Pinto) or a laptop (the Mercedes) to create written text for assignments in class. However, if both solutions meet the keyboarding and spell checking needs of the student the word processor is appropriate for the current needs. Should the student have or develop physical access needs that would require specialty hardware or software the laptop would be considered, as the word processor no longer meets their needs.

Does one solution work for all?
• No. Each individual has different needs. An example would be a person that uses a walker to help with mobility and a person that needs to use a wheelchair. The person using a walker will have a more difficult time in going up and down a ramp compared to the person using a wheelchair.

• Design the plan to fit the individual, not the individual to fit the plan.

Is determining AT needs only done once?
• Determining assistive technology needs is a process since technology advances quickly, individual needs change as their environments change, and people become more aware of their strengths and limitations as they mature.

• Usually this would be the ideal situation, unfortunately, human abilities are in constant fluctuation (usually declining).

Do people with disabilities always need expensive or high-tech devices?
• For some consumers the best solutions are low-tech, no-tech. Even with some high-tech solutions, consumers have low-tech backup systems. For example some consumers who use a power chair prefer to have a manual chair as a backup for the times when the batteries do not charge properly or the chair needs to go in for repair so they are still mobile.

• Sometimes this is necessary, and unfortunately sometimes this equipment can become outdated rather quickly as technology advances. There is some truth in this as many devices are shockingly expensive, these items aren’t mainstream products and are expensive to design, develop, promote, etc. However, the word “always” has no real truthful basis.

Have you ever created or customized a device that could not be found through a manufacturer?
I worked with a woman who acquired a brain injury that resulted in her left hand to mimic every movement she made with her right hand. Together, we discovered weighting her left hand would slow the mimic enough that she was able to complete some functional tasks. She also did not like to wear aerobic weights all the time, so I made weighted bracelets for her to wear which were more discrete. In addition, she was scared to shave her right underarm, so I made an extra long razor for her since the commercial ones from an aids for daily living catalog were too heavy.