I feel passionate about digital assistive technology, and I don’t think it has to do with the fact that I work with younger clients (well, maybe a little). As an OT, for many years I have seen the different a well-chosen piece of equipment can do to assist a person access a meaningful daily activity. For me, digital assistive technology is just a step further from this concept: it is fast, versatile and motivating to a wide range of people from different backgrounds, interests and ages. More importantly, it has quickly developed a range of accessible options for people with disabilities and it can work excellently as a means to an end (i.e. environmental control).
Professionals from every field have rapidly acknowledged the value that technology offers to their clients; however, OTs frequently decide that they lack expertise or that it may be other profession’s remit to deal with these issues. Additionally, OTs already have knowledge of important underlying skills, such as how to improve positioning, arm and hand function, visual-perception, etc., all of which play an essential role when deciding the type of technology to prescribe.
At the end of the day, one Ipad-size does (NOT) fit all!
It can also feel daunting to dig deeper in this area, since there are currently so many choices and the technology changes fast, at times to attract further consumers but frequently to improve its functionality and resolve glitches.
So here is a quick guide to restore confidence on our skills and encourage the use of digital assistive technology in our day-to-day practice:
- Address Postural Needs: This should be the first thing to consider before further assessment is carried out. In most cases, the person will need to accurately use their hands or other body parts to access technology: your job is to make them as stable and comfortable as possible, so don’t hesitate to use appropriate chairs, work surfaces, footrests, cushions, angled desktops, wrist supports, etc.
Then comes deciding on a position for the system: this also needs to be stable and in the same place, as we don’t want to change the demands of the task every time for the user. Appropriate placing or fixed mounting of the equipment will maximise physical access to the system tried. Once a successful set up has been agreed, another job is to convince everyone not to alter it, to achieve consistency and ease of access in the long run. Use permanent markers and take pictures of the person using their system in the right set-up, then ensure this information is shared with all involved, including the client.
- Assess physical abilities and reliable movement patterns: as OTs, it is second nature to us to measure underlying capacities (i.e. muscle tone, range of movement, joint laxity, type of grasps, bilateral coordination, finger dexterity, etc.); but what we really need to know here are the effortless, consistent and reliable movements that will enable accurate access to a technology system. Look at the wider picture here: have a look at the ways in which the person moves and interacts with other motivating objects in a familiar situation. The hands are always the preferred (and often easier) option, but at times we may need to consider other body parts, if they are more reliable or require less effort from the user (i.e. head, knee, eyes, etc).
- Consider sensory needs: such as visual impairments, visual perception difficulties, auditory loss, additional sensory processing needs, etc. These will all change the way of accessing technology. Fortunately, many operating systems and websites currently offer different accessibility options targeted to sensory impaired users. Specialist software should only be considered after the ‘accessibility options’ from an operating system have been unsuccessful to facilitate access.
- Before meeting the user, find out first the type of communication and literacy level of the user: verbal, written, pictures, gestures/ Makaton, BSL, symbols, picture grids, etc. Consult and involve an SLT if the main purpose of the equipment will be communicative. The level of literacy of the user may rule out options solely based on written language.
- Involve other people: It’s never a one-person job! Other professionals around the client will provide invaluable information for your assessments (e.g. teacher, SLT, psychologist, personal assistants/ carers, etc), and the family and the user’s views should be paramount. In the end, the user’s choices must always prevail; we are just facilitators offering the best matches to them.
- Function of equipment: in consultation with the user and the family/carers/education staff, determine what aims are to be achieved by introducing a new piece of equipment: recording of work in class, communication, gaming, environmental control, etc. It is also in the interest of the student to limit the number of devices. Multi-purpose devices or compatibility between devices should always be encouraged first, where possible (i.e. tablet PC to record academic work, with adequate voice output for communication purposes).
- Training, Trials and inclusion in real life: It is essential to check what has been tried in the past already when choosing a new system to trial. The person’s natural environment is always preferable to carry out any assessments and trials in, to detect further difficulties that may prevent access to the system. If there is quite a high cost implication, try to get the company to do a short term loan or use their ‘returns’ policy if unsuitable after a trial.
Support is crucial after provision: ensure everybody is trained and has sufficient knowledge of the system (but don’t bombard them with too much information). Identify and agree with the user and support staff the times of the day when the equipment can be used to ensure full integration in their routines, rather than an extra chore that everybody forgets after a while.
Generally speaking, if a person appears to have a delay or a difficulty in activity participation or communication, technology should be introduced as early as possible in that person’s life. Most children, young people and adults already have access to technology round the clock as part of their school, work and leisure routines. Many older adults are already introducing it in their lives to ensure participation in meaningful activities such as talking to relatives on Skype, selecting a favourite large print book on their e-reader or reminding themselves of their medication using phone alarms.
It is an OT’s responsibility (in conjunction with other relevant professionals) to carry out a client-centred assessment of AT needs, to prescribe appropriate resources and initiate onward specialist referrals for all clients requiring AT to enhance their participation in relevant daily activities. An occupational therapist is a ‘core professional’ that has an essential contribution to this type of assessments, but further skill development may be required in this area, to match existing professional skills with the advantages of new and emerging technologies.