Equipment Part II: Developmental Motor, ADL, and Communication

Promoting Independence and
FUNction with ADL and
Communication Equipment
A Philosophy and Practical
Applications Presentation
By being familiar with what is available
 And putting up with a mess of philosophical and
historical material from Dr. Stefans, AGAIN…
 You will become able to set expectations, select
and encourage use of effective technologies for
specific situations and disabling conditions
 Overcoming all barriers with persuasive
examples and justifications
“Narrative Research“
As a physiatrist you can increase the quality of life for people with
physical disabilities by helping them reach goals which they desire and
are achievable. To do all of this, you must be able to establish rapport
so that you can identify and prioritize goals. Then you teach the patient
and the family to acquire the knowledge and skills which will promote
achievement of goals and adaptation to disability.
As a physiatrist be sensitive, askable, flexible, negotiable, creative,
enthusiastic, and sincere. Understand your own values, attitudes, limits,
and strengths in order to help others without imposing upon them.
Place a high value on humanness. Acknowledge discomfort and pain
including your own. Carry a low burden of guilt or envy for the
circumstances of other people. Lastly, trust people to accept
responsibility for themselves.
- Theodore M. Cole M.D., as Chairman, PM&R Department,
University of Michigan, Ann Arbor
What is Adaptive
Assistive technology (AT) is any kind of device
or tool that helps people learn, work,
communicate and live more independently.
AT can be very simple and inexpensive, like a modified
knife and fork, or it can be very sophisticated and
costly, like a computerized speech device.
- Arkansas ICAN website
What is “appropriate
From Disabled Village Children,
Hesperian Foundation Publications
Appropriate Technology
Jaipur leg
Rubber, wood, aluminum
Estimated $28.00-$40.00 cost
Hotchkiss wheelchair
bike parts
It’s All About
Unique to individual Needs, Wants,
and Circumstances
“Functional and Fun”
Standing wheelchairs
Cultural relevance
Going potty
Not necessary to wait
for walking and talking
 Support feet, trunk if
needed, reduce size of
hole to reduce fear of
falling in
 How important is it to be
out of diapers? –
Cindy’s story
"She can't/We didn't because..."
Bad models of disability
Perpetual infant/Little Innocent Angel
Sick role/invalid "Medical Necessity"
Low expectations
 Dependency, limited or no autonomy
 Top (or only) priorities become safety, protection,
ease and convenience for caregiver
ADLs - Eating
Ataxia – bigger, heavier utensils
 Reduced dexterity – swivel and/or bent spoon
Winsford feeders
Cheek switch to
scoop and
present food
 Need some
head control
 Hands-free
Food preparation
So, who dresses you?
46 year old with C6 quadriplegia does not want
to stay at world famous rehab center longer to
learn dressing skills
 12 year old girl starting to have conflict with mom
over clothing choices
It’s OK to get your adaptive
technology at Wal-Mart when…
Regular car seat OK for moderate limitations in
trunk control, check weight/height limits
 They start selling I-Pads and you can afford one
 It’s just what you need and costs a lot less
Gadget Tolerance = Independence
I want to get my son a voice activated
computer to use at school!
Simple handwriting replacement – consider
portable keyboard instead (AlphaSmart/QuickPad)
 Voice recognition continues to improve
Adaptive keyboards, alternative mouse access
Still slower
Hands free use possible
Different style of proofreading – spellcheck won’t work
Small for weaker or lower arm mobility
Larger for less accurate hand use
Trackball, HeadMouse, MouseKeys
Writing and typing
Writing bird, typing stick (or use pencil, eraser
end down in cuff)
 Don’t underestimate two or even single finger
Motor, sensory, or cognitive issues
Tactile mouse for blind person experimental
Need keystroke navigation
Screen reader = text to speech
 KE:NX – reads what you have written
 Magnification software, large monitors
 Scanning access – severe motor issues
Low efficiency
Compensate with word prediction
Web Accessibility
PDF is no longer “Pain, Despair and Frustration”
 Flash is the new PDF
 Section 508
Alt text
Captions and transcripts
Think about screenreaders
AAC - PM&R/Physician Roles
Identify potential
 Document medical necessity
 Write Rx, make referrals
 Guide selection – PECS vs Liberator
 Reassure and educate re process and outcomes
Appropriate expectations of appropriate technology
Let kids tell bad jokes in clinic
Learning cause and effect
Alternative – Augmentative
Prerequisites vs Participation
Interdisciplinary evaluation mandatory
Verbal communication may increase
Signing increases Language
Communicate more than basic needs or yes/no to
familiar caregivers
May interface with computer (or be a computer)
Training and programming issues
Rx “therapy units as needed”
Stress medical, not peer communication
Different choices for ambulatory vs w/c with tray user
Literate English vs special language vs pictures
Need for support, upgrades (college level)
The McDonald’s Shake Story
The Strawberry Shake Story
Arkansas Easter Seals Society
ICAN Increasing Capabilities Access Network
Prentke-Romich and other AAC companies
International Society for Augmentative and Alternative
John Halloran

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