Assessment Tools for Your AT Toolbox

Report
Assessment Tools for Your
AT Toolbox
Presented by the OT PSG at RESNA 2013
You say Evaluation, I say
Assessment
Who’s right?
It depends!
What do you say?
According to
http://www.thefreedictionary.com
/
e•val•u•a•tion (ɪˌvæl yuˈeɪ ʃən)
n.1. an act or instance of evaluating or appraising.
2. a diagnosis or diagnostic study of a physical or
mental condition.
the making of a judgment about the amount, number,
or value of something
According to
http://www.thefreedictionary.com
/
as·sess·ment (-ssmnt)n.1. The act of assessing;
appraisal.
2. An amount assessed, as for taxation.
the evaluation or estimation of the nature, quality, or
ability of someone or something:
Toe-may-toe or Toe-mah-toe
Functionally, assessment is the measurement of what is
there.
Evaluation includes making judgments about what is
there, and what is needed
Assessment ?
Let’s call these the tools we put in our toolbox –
assessment tools
and evaluation the determination of which AT best
meets the needs of this particular client
According to the Assistive
Technology Act of 2004, P.L. 108364
Evaluation is part of AT service
“the evaluation of the assistive technology needs of an individual
with a disability, including a functional evaluation of the impact
of the provision of appropriate assistive technology and
appropriate services to the individual in the customary
environment of the individual.”
RESNA Fundamentals Course
states
Assistive Technology Provision: Assessment – Develop
an understanding of the general assessment process
and principles.
Regardless of what we call it, using
a systematic approach is critical
Why?
The story of Lenny
Using a conceptual practice model
to guide your evaluation
Back to definitions
How do we define AT
ASSISTIVE TECHNOLOGY DEVICE.—The term
‘assistive technology device’ means any item, piece of
equipment, or product system, whether acquired
commercially, modified, or customized, that is used to
increase, maintain, or improve functional capabilities
of individuals with disabilities.
Enabling a person with a disability
to do something, somewhere
Specifically, the person is able to do things with the
technology that able-bodied people can do without it
Conceptual models help us to operationalize these
elements of the definition.
Conceptual Practice Models
International Classification of Function
(ICF) – World Health Organization
Matching Persons with Technology
(MPT) – Dr. Marcia Scherer
Student Environment Tasks and Tools
(SETT)– Dr Joy Zabala
Human Activity Assistive Technology
(HAAT)– Cook & Hussey
Human Interface Assessment
(HIA)– Anson
International Classification of
Function
(ICF)
Matching Persons with
Technology (MPT)
The characteristics, needs and preferences of each
individual user
The characteristics of the milieu, i.e. the physical and
attitudinal environment in which the AT device will be
used
The characteristics of the AT devices
The SETT Framework
Environment
Task
Tools
Student
www.JoyZabala.com
The HAAT Model
Evaluation includes:
The Human
The Activity
The Assistive Technology being considered
These are all embedded in the environment where the
activity is performed
Human Interface Assessment
Human Interface Assessment
The activity and environment make demands on the
individual
The individual brings a level of skills and abilities to
the task
Human Interface Assessment
Human Interface Assessment
When the demands of the task are less than the
intrinsic skills and abilities of the individual, no
assistive technology is required
This does not mean that the individual does not have
functional limitations, only that, for this task, in this
environment, no restrictions exist
In another environment, or another task in this
environment, AT might be required
Human Interface Assessment
Human Interface Assessment
When there is an imbalance between the skills and
abilities of the human and the demands of the
environment, AT can be used to bridge the gap,
enabling function
Human Interface Assessment
These conceptual models tell us
what to consider
Environment
Task
Tools
Person
The Assessment Tools in our
Toolbox
What to include is the question
How do you do it?
A Parable of Tools
A Parable of Tools
There are a wide range of wrench manufacturers, of a
wide range of prices
Craftsman (Sears)
S&K
KD Tools
Kobalt
Most include life-time warrantees, and easy
replacement
A Parable of Tools
Drive by almost any mechanics shop, though, and one
image is seen:
A Parable of Tools
Why is this one brand so common?
Snap-on wenches are a bit thinner than other brands,
while as strong
They will reach into tight spaces just a bit better
Because the tools fit the usage better, they make the job
of the mechanic just a bit easier
A Parable of Tools
For our AT Toolbox, we want assessment tools that
most closely meet the needs of the assessor, that reach
into tighter spaces, and give us more complete
information
What To Assess and How:
Best Practice Guidelines
Quality Indicators for Assessment of Assistive Technology
Needs
Assistive technology devices and services are considered for all
students with disabilities regardless of type or severity of
disability.
During the development of an individualized educational
program, every IEP team consistently uses a collaborative
decision-making process that supports systematic
consideration of each student’s possible need for assistive
technology devices and services.
IEP team members have the collective knowledge and skills
needed to make informed assistive technology decisions and
seek assistance when needed.
Best Practice Guidelines
Decisions regarding the need for assistive technology devices
and services are based on the student’s IEP goals and
objectives, access to curricular and extracurricular activities,
and progress in the general education curriculum.
The IEP team gathers and analyzes data about the student,
customary environments, educational goals, and tasks when
considering a student’s need for assistive technology devices
and services.
When assistive technology is needed, the IEP team explores a
range of assistive technology devices, services, and other
supports that address identified needs.
The assistive technology consideration process and results are
documented in the IEP and include a rationale for the
decision and supporting evidence.
Assessment Tools
There are NO assessment tools that are reliable and
valid!
There are tools that are reliable and valid for specific
applications.
It is important that tools be used as they are designed to
be.
It is important that tools be used where they are
designed to be.
Client Centered
Critical to include the client/consumer in the decision
making process.
Every Client is unique
Decreases abandonment
What to Assess
Virtually all of the models agree that the assessment
must include:
The task
The person
The environment
The AT being recommended
The Task
This is nothing more than an activity analysis, which
OTs have been doing since the birth of our profession
What physical skills are required for the task?
Strength, ROM, dexterity, postures, endurance
What sensory skills are required for the task?
Sight, sound, touch, smell, taste, temperature
What cognitive skills are required for the task?
Concentration, vigilance, reaction time, sensory
integration
The Person
Most of the information required is included in a
traditional evaluation
Strength, ROM, endurance, bilateral tasks, etc.
Vision, sound, proprioception, kinesthesia, touch are
standard
Smell, taste, color spectrum might require specialized
testing
Cognition, executive function, memory, computation,
etc.
The Environment
On a basic level, is the environment ADA compliant?
Keep in mind that this is minimal accessibility, and can
be used to identify environmental barriers, but is not
enough for school or work access
Environmental conditions include:
Lighting levels and colors
Sound levels of important and background sounds
Frequencies of sounds that are important to the job
Temperature and temperature range
Humidity
Smells and chemical exposures
The Assistive Technology
First, compare the skills and abilities of the individual with
the demands of the task and restrictions of the environment
Does the AT operate within the constraints of the
environment?
Does the AT amplify or support the functions needed for
the task?
Can the AT be perceived and controlled by the individual?
Is the AT acceptable to the individual?
Infusing Conceptual Models
into Practice
Same tools
New Look
Exploring Roles
Maximizing goals
Rehabilitative and Educational
Technologies
“Depending on the client’s contexts, rehabilitation and
educational technologies have the role of remediation,
restoration, or acquisition of foundational skills.”
- Cook & Polgar, 2008
Occupational Technology
“Studying the development and maintenance of wellness
and social health in persons with disabilities in a
technologically changing society”
- Breines & Pellerito, 2003
Emergent motivation
“experience a new or previously unengaging activity as
intrinsically motivating if we once find flow in it. The
motivation to persist in or return to the activity arises out of
the experience itself. The flow experience is thus a force for
expansion in relation to the individual’s goal and interest
structure, as well as for growth of skills in relation to an
existing interest”
- Nakamura & Csikszentmihaly, 2002
The virtual context allows clients to discover
alternate ways of achieving goals.
EXPLORING ROLES /
MAXIMIZING GOALS
P
R
E
P
A
R
A
T
I
O
N
Patient interests/Roles/Meaningful
Activity
Exploring Software/Apps for desired
Virtual Context
(Task Anaylsis)
Isolating Software/Apps that contain
features/settings to facilitate client goals
(Task Anaylsis)
Occupational Goal
Performance demands of occupation
(Task Anaylsis)
Isolation of desired Movement/Vision
Process/Cognitive Strategy
EXPLORING ROLES /
MAXIMIZING GOALS
F
A
C
I
L
T
A
T
I
O
N
Positioning of client to facilitate
motor/vision/cognitive
strategies
Monitor client participation for
maximal engagement
Monitor client participation for
desired motor/vision/cognitive
strategies
Selection and positioning of
equipment to isolate motor
movement or facilitate
participation in
vision/cognitive activity
Introduction of software to
enhance client participation
Flemings Tracks of Clinical
Thinking
The procedural reasoning strategy was used when the
therapist thought about the person's physical ailments
and what procedures were appropriate to alleviate
them.
Interactive reasoning was used to help the therapist
interact with and understand the person better.
Conditional reasoning, a complex form of social
reasoning, was used to help the patient in the difficult
process of reconstructing a life now permanently
changed by injury or disease.
Questions to ask
Standardized vs. Non standardized tools
How can we assess the impact of the provision of
appropriate assistive technology ?
Formal vs. Informal procedures
How do you do it?
Group discussion
Resources for assessment tools
ID-AT-Assessments (Informational Database of
Assistive Technology Assessments)
AbleData.com
WHODAS 2.0
Rehabilitation Measures Database
The Boston Rehabilitation Outcomes Center
ADA CAT
Resources for assessment tools
Frameworks, models and taxonomies
http://www.r2d2.uwm.edu/atoms/archive/technicalrep
orts/fieldscans/fs7/tr-fs-taxonomiesmodelsresource.html
AT Assessments
http://www.r2d2.uwm.edu/atoms/idata/

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