Assistive Technology: Providing Independence for Individuals with Disabilities

Barbara E. Berry, PhD RN Susan Ignash, RN CRRN

Key words assistive technology, disability, functional capabilities,

rehabilitation

Despite improvements in technology and health care, the number of people with disabilities, and the complexity of needs that they and their families experience, continue to in- crease. In response to these needs, specialized technology has been developed that helps people with disabilities to be- come more independent and more involved in the activities in their homes, schools, and communities. However; many individuals with disabilities, their family members, and many rehabilitation service providers are not aware of the avail- ability, use ox and benefits afforded by assistive technology devices. Furthel; many providers have not received the pre- service academic preparation required to provide services and support to their clients. Preparation includes acquiring the knowledge and skills needed for evaluation of client needs, making appropriate assistive technology recommen- dations, and developing advocacy skills such as writing let-

ters of necessity that justify funding for assistive technology devices. This article provides information about these issues and suggests that further information is available through continuing education courses as well as articles in the refer- ence list and other sources cited in the accompanying tables.

Barbara E. Berry is the director of nursing at the University of Miami, Mailman Center for Child Development, School of Medicine, Departtnent of Pediatrics in Miami, FL. Susan lgnash is the Registered Nurse Care Coordinator for the State of Florida Children's Medical Services Brain and Spinal Cord Injury Program in Miami, FL. Address corre- spondence to Barbara E. Berry, University of Miami, Mail- man Center for Child Development, 1611 NW 12 Avenue, Room 4022, Miami, FL 33136 or e-mail bberry@med. tniami. edu.

Despite improvements in technology and health care, the number of individuals with disabilities and the complexity of needs they and their families experience continue to increase. In response to these needs, specialized technology has been de- veloped that helps people with disabilities to become more in- dependent and more involved in the activities in their homes, schools, and communities. Therefore, the purpose of this arti- cle is to provide information about the availability, use, and ben- efits of assistive technology, and to discuss the advocacy skills that are related to writing letters of necessity and obtaining fund- ing for assistive technology devices.

The benefits of assistive technology were demonstrated in the results of a survey of people with disabilities by The Na- tional Council on Disability (1993). The survey found that near- ly 75% of school-age children who used assistive technology were able to remain in a regular classroom and 45% were able to reduce their use of school-related services. The survey also found that approximately 65% of the respondents who were of working-age and who used assistive technology were able to reduce their dependence on family members; 38% were able to reduce their dependence on paid assistance. Finally, approxi- mately 90% of the employed people with disabilities reported that assistive technology enabled them to work faster or better, 67% reported that assistive technology helped them to obtain em- ployment, and 83% reported that they earned more money after obtaining the assistive device.

Thus, assistive technology not only benefits infants and chil- dren with disabilities who are able to participate in home and school activities, but also benefits caregivers and school per- sonnel by reducing the time spent giving personal assistance and increasing the time available for other activities and duties. The benefits extend even to communities, when more people are able to participate in the workforce and thus rely less on gov- ernment assistance. Congress first recognized these benefits in 1988 when it passed the Technology-Related Assistance for In- dividuals with Disabilities Act (PL 100-407/the Tech Act), and in 1990 when it passed the Americans with Disabilities Act (PL 101-238/ADA). In addition, the intent of Congress to integrate young children and students with disabilities into society through assistive technology was made clear when it incorporated the Tech Act definition of assistive technology into the Individuals with Disabilities Education Act Amendments of 1991 (PL 102- 1 19/IDEA). To extend the benefits of assistive technology to people with disabilities across the lifespan, Congress in 1992 reauthorized the Rehabilitation Act (PL 102-5691the Rehab Act) and referred to the ADA and the Tech Act for definitions of as- sistive technology and rehabilitative services (Cook & Hussey, 2001; Galvin & Scherer, 1996).

What is assistive technology? United States Public Law (PL) 100-407 (the Tech Act) de-

fines assistive technology as "any item, piece of equipment, or

6 Rehabilitation Nursing Volume 28, Number 1 JanuarylFebruary 2003

product system whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities.” Assistive technology devices optimize function by enhancing residual capacities (such as the use of an orthotic splint); by re- placing missing parts (such as the use of a prosthetic limb); by providing an alternative means of function (such as the use of an augmentative or alternative communication device); and by minimizing environmental barriers (such as the use of wheel- chair ramps).

Evolution of assistive technology Stone age: Fred broke his leg on a hunting expedition. Plas-

ter casts had not been invented, so he used a stick to help him walk, leaving him with a limp when his leg healed. As Fred’s wife, Wilma, grew older she could no longer hear as well. She discovered that an empty animal horn made voices louder (Cook & Hussey, 2001). .

Civil War: Wood and leather limb prostheses with pelvic at- tachment bands were replaced by suction socket attachments. Hearing aids were invented, but were bulky and had much low- er fidelity than today’s hearing aids (Cook & Hussey, 2001).

Twentieth century: Evolution in health care and technolo- gy saves lives (battle line hospitals, emergency medical trans- portation, intensive care units, advanced treatments, antibiotics, and other medications), but also leaves large numbers of people to live their lives with a disability or chronic illness. Creativity by individuals (some of whom have disabilities themselves), and the evolution of electronics (computer chips of reduced size, re- duced cost, and increased capabilities resulting in synthesized speech, robotic aids, graphics) result in the development of as- sistive technology devices.

Characterization of assistive technology devices

Assistive technology devices can be characterized as low- tech and high tech. Low tech devices are simple to make and easy to obtain. An example is the pencil-and-paper communi- cation boards. High tech devices are expensive, more difficult to make, and are sometimes harder to obtain. Examples are com- puters, environmental control units, and computerized wheel- chair controls. Assistive technology devices can be designed to either increase an individual’s physical functioning, or to reduce the environmental factors that prevent the achievement of personal goals. (See Table 1 for examples of assistive technology devices and appropriate Internet sites for more information.)

Implications for practice As people with disabilities, and their advocates, have become

aware of the possibilities afforded by assistive technology, they have successfully pursued major litigation and legislation that addresses the need for MedicaidMedicare and insurance cov- erage. Although many people with disabilities and their family members are uninformed about assistive technology devices, others are learning about these devices through catalogues and fairs. However, they often lack the knowledge that is needed to select, order, and obtain funding for appropriate devices. In

addition, the increasing number of people with disabilities who could benefit from assistive technology greatly outnumber the assistive technology providers who have the knowledge and skills necessary to provide appropriate assistive technology and related services. Moreover, many rehabilitation service providers have not received the preservice preparation required for pro- viding services and support to people with disabilities (Hakes, 1991; Snell, 1990). This preparation should include those ad- vocacy skills related to writing letters of necessity and obtain- ing funding for assistive technology devices.

As members of the healthcare team, rehabilitation nurses are often the care coordinators for people with disabilities. Thus, they are in an important position to advocate for their clients concerning the benefits of assistive technology, and to partici- pate in the process of acquiring technology devices. As advo- cates, rehabilitation nurses should be able to suggest appropri- ate professionals who can evaluate and follow-up on the use of the devices. Nurses should also be concerned with creative ways in which to fund the devices. Low tech items such as pencil-and- paper communication boards can often be selected by the user without assistance. However, a professionally trained rehabili- tation specialist must be involved in the evaluation, selection, purchase, training, and follow-up processes involved in acquir- ing high tech devices. Rehabilitation nurses must know who the rehabilitation specialists in the community are who have been trained to provide assistive technology services (for instance, physical and occupational therapists, computer specialists, speech and language pathologists, therapeutic recreation therapists, and rehabilitation engineers). When insurance, Medicaid, or Medicare will not fund a particular device, nurses must be able to suggest possible funding sources in the community, such as service clubs (e.g., Lions, Elks, and Shriners), or businesses. In addition, nurses must be aware of loan programs and programs that provide assistance in the acquisition of used assistive tech- nology devices, which are often available through community agencies. Networking within the community with groups that promote independence will provide a wealth of information about how to access assistive technology services.

Information that may help in acquiring technology is pro- vided in Tables 2,3,4, and 5. Tables 2 and 3 provide examples of terminology and methods that can be used to demonstrate to funding sources such as MedicaidMedicare and insurance com- panies the necessity and medical justification for funding assis- tive technology devices.

Rehabilitation Nursing Volume 28, Number I January/February 2003 7

Assistive Technology

Online Resources Adapted Toys and Games

For more examples and information about toys and games for chil- dren with disabilities:

http://~vww.ablenetinc.corn Ablenet, Inc. This site answers questions, provides resources, and

discusses prices of assistive technology products for children. http://www. rjcooper. coin R. J. Cooper and Associates. Switches and toys, software and hard-

http://~vww.un~maine.edu/-sped/Switch%20Toys/swichtoy. htni Center for Assistive Technology Switch Activated Toys. This is a

site sponsored by University of Maine at Farmington that pro- vides a description of switch-operated toys.

ware for people with special needs.

http://www.enablingdevices.conl/ Enabling Devices. This site provides information about toys for

children with special needs. http://www. tjhusa. con1 TFH (USA) Ltd. This site describes adapted toys for children. http://www.acliievableconcepts.coni.arr/cards. htm Achievable Concepts. This site provides information about adapted

cards and games for people with disabilities.

Background Early childhood development occurs as a consequence of dy-

namic transactions between children and their environments. For instance, reaching for and exploring objects results in a height- ened sensitivity to objects, an increase in goal-oriented behavior, increased self-confidence, and the expression of positive and negative emotions. These actions, in turn, increase parental ex- pectations of their young children, as well as new patterns of communication. All children need opportunities to make choices, manipulate objects, express curiosity, solve problems, and inter- act with others.

Toys and games, such as battery operated toys for use with a single switch, and adapted non-mechanical toys and game boards expand opportunities for young children with disabilities to inter- act with the world and promote integration into society at an ear- lier age. Many regular toys can be adapted for a child with a.dis- ability through the use of switches. Switches provide a way to operate battery operated toys, radios, televisions, tape players, and games. Switches can be activated by many parts of the body, including hand, thigh, or head movement, eyebrow wiggle, tongue pressure, eye glance. The possibilities are endless (Burkhart, 1980; Cook & Hussey, 2001; Galvin & Scherer, 1996; Goossens & Crain, 1992).

Aids for Daily Living For more examples and information about aids for daily living: http://~vww.sanimonspreston.com Sammons Preston. This site describes assistive technology devices

for activities of daily living. http://www. carecraft. co. nz/ Care Craft. This site describes assistive technology products for the

http://ww,v.ncniedical. corn North Coast Medical. This site describes assistive technology

products for activities of daily living. http://www. family village. wisc.edrr/mall. htm Family Village. This accessibility shopping mall includes re-

elderly.

sources for adaptive products and assistive technology.

Daily living technology includes devices that provide func- tional solutions for accomplishing everyday tasks in all the envi- ronments in which they are needed, including home maintenance (such as food preparation), interpersonal relationships (such as communication and child care), and personal care (such as eat- ing, dressing, and toileting) (Cook & Hussey, 2001; Galvin & Scherer, 1996).

Examples of devices that assist in performance of home main- tenance include devices for food preparation such as cadjar openers; one-handed vegetable scrapers; bowls with suction cup bottoms for stability when stirring; cutting boards that stabilize food being cut; modified handles for knives, spoons, and other utensils.

Examples of devices for household chores include: gripping cuffs or extended handles for brooms and mops; key holder; reachers for obtaining articles from shelves.

Examples of devices that assist in performance of personal care include dressing and toileting aids; adapted button hooks for single-handed use; zipper pulls, trouser pulls, and aids for putting on socks or hose; adapted shavers; back brushes; washcloth hold- ers.

Examples of devices for food and drink consumption include: modified handles; spoodfork combinations; plates and bowls with suction cups for stability while eating; plates and bowls with enlarged rims for scooping; electric feeders; cups with snorkel lids to suck fluids.

'Web sites provided for these examples were current at the time of publication. However, due to the ephemeral nature of Web sites, continued availability s not guaranteed.

8 Rehabilitation Nursing Volume 28, Number 1 JanuarylFebruary 2003

Online Resources

Wheelchairs and Mobility Aids For more examples and information about wheelchairs and mo-

bility aids: http://www.curbcut coin Curbcut. This site provides resources for people in wheelchairs. http://www.achievabIeconcepts. corn Achievable Concepts. This site provides information about

mobility products for adults and children with disabilities, in- cluding Mountain Buggy and scooter.

http://www.pridemobility.com/ Pride Mobility Products. This site features assistive equipment

to help the geriatric population stay active and independent. http:/hww.arnericanwheeIchairs.corn American Wheelchairs. This site provides information about new

and used manual and electric wheelchairs.

Aids for Seating and Positioning For more examples and information about aids for seating and positioning: http://www. blvd. com/Pediatric-Products Disability Resource Center. This site features pediatric products such as adaptive positioning, seating, headgear, mobility, and rehabilitation technology. hnp/!. blvdcomlPediarric_Products/Positioning-~-Sea~g-~u~i~ The Boulevard. This site provides information about positioning & seating equipment products specifically developed to aid in the healthy development of young children with a disability.

Aids for People with Hearing Impairments For more examples and information about aids for people with hearing impairments: http://www. lssgroup.com/ LS & S Group Incorporated. This site has a catalog of items for people who are hearing impaired. http://azhearing. corn Arizona Hearing Online Company. This site offers a big selection of amplified telephones for people with hearing impairments. http://www.auditechusa.com/ Auditech. This site provides a catalog of devices for people with hearing impairments. http://www.deajiech~orce9.co. UW Assistive Living Devices. This site provides a catalog of devices for people with hearing impairments. http://www.seniorshops.com/seniorshops/hearbetter. html Senior Shops. This site provides a catalog of devices for people who are hearing impaired.

Background

Providing mobility for young children is especially important because according to developmental theory, learning is entirely dependent on children’s actions on the world. Mobility enhances the visual information that children receive, heightens sensitivity to objects and events beyond the arm’s reach, promotes goal- oriented behavior, and increases control over the environment.

For older children and adults, mobility provides a way to do many things, including learning, interacting with others, engag- ing in play and recreational activities, making a living, and es- caping from life threatening situations.

Mobility aids include: wheelchairs, walkers, bicycles, tricycles, and scooters. Mobility promotes integration into society and is an essential component toward achieving competence and indepen- dence (Cook & Hussey, 2001; Furumasu,l997; Galvin & Scher- er, 1996).

Individualized modifications to a wheelchair or other seating sys- tems improve stability and seating posture, provide trunk or head support (or both), and reduce pressure on the skin surface (Cook & Hussey, 2001; Galvin & Scherer, 1996). Examples include cush- ions, solid supports, seat belts, and recline or tilt options.

Assistive technology for people with hearing impairments and deafness can generally be classified as either communication de- vices or alerting devices, using sound, light, and/or vibration (Cook & Hussey, 2001; Galvin & Scherer, 1996; Stach, 1998).

Examples of communication devices that aid a person with a hearing impairment include: hearing aids (such as conventional, cochlear implants, and tactile vocoders); entertainment aids (such as closed captioned televisions), and lip reading aids (such as a mi- crophone that is worn on a lapel or in a pocket to detect speech and is analyzed by an electronic analyzer worn in eyeglass frames); telephone aids (such as amplifiers built into the telephone; TDD (telephone devices for the deaf) in which outgoing messages are typed (and can be converted to Braille if the telephone operator is blind), and return messages are relayed by pulsations in the receiv- er or by typed messages (which can be converted to Braille).

Examples of alerting devices that aid the person with a hearing impairment include: flashing lights specific for door bells, smoke alarms, and nursery alarms; silent alarms which transmit to a wrist receiver; tactile alarm clocks (under the pillow, for exam- ple); visual automobile alarms for detecting noise (such as sirens, honking, railroad crossing alarms).

‘Web sites provided for these examples were current at the time of publication. However, due to the ephemeral nature of Web sites, continued availability s not guaranteed.

Rehabilitation Nursing Volume 28, Number 1 JanuaryFebruary 2003 9

Assistive Technology

Online Resources

Aids for People with Vision Impairments For more examples and information about aids for people with vi- sion impairments: http://www. freedomsci. com/ Freedom Scientific. Products and newsletter for people with sen- sory and learning disabilities. http://www. netas. cod-ddots/ Dancing Dots Music Technology. This site describes the GOOD- FEEL@ Braille Music Translator http://www.sighted.com Sighted Electronics, Inc. This company has more than 17 years of experience with adaptive aids for visually impaired and blind people. http://www.envisionamerica.com/grindex. html Envision America. This site describes devices for people with vi- sion impairments. http://www. telesensory. corn/ Telesensory. This site describes products for people with low vision. http://www.eschenbach. com/ Eschenback Optik Company. This site describes devices for peo- ple with vision impairments. http://www. independentliving.com/ Independent Living Aids. This site provides a catalog of devices for people with vision impairments.

Augmentative and/or Alternative Communication Aids For more examples and information about augmentative andor alternative communication aids: http://www.adaptivation.com/ Adaptivation, Inc. This is a resource for a variety of assistive technology needs. http://www.dynavoxsys.com DynaVox Systems, a division of Sunrise Medical Inc. This site provides advanced augmentative communication solutions to thousands of people with speech, language, learning and physical disabilities from around the world. http://www.prentrom.com/index. html Prentke Romich Company. This site offers a variety of communi- cation products in this online store. (http://www. words-plrcs.com) Words +. This site features state-of-the-art products that truly “unlock the person” by providing communication and computer access products. http://www.zygo-usaxom Zygo Industries, Inc. This site features high-tech, yet easy to use augmentative communication systems for profoundly physically disabled people.

Background

include devices for all degrees of vision loss that affect the indi- vidual’s ability to perform the usual tasks of daily life. Products for people who are blind or visually impaired are designed to provide access to information, ensure safe travel, and assist with activities of daily living (Cook & Hussey, 2001; Galvin & Scher- er, 1996; Freeman & Randall, 1997).

Examples of devices to provide access to information for peo- ple with a vision impairment include magnification aids (optical and nonoptical), such as: handheld magnifiers; stand magnifiers (some with built-in lights); prisms of special lenses built into glasses to extend visual field; telescopes worn on the head or held in the hand; enlarged print books and enlarged print com- puter screens; high intensity lamps; high contrast colors on print.

Other examples of devices to provide access to information for people with a vision impairment include electronic aids, such as: closed circuit television devices (CCTV) which increase image size; automatic reading of text (text to speech or text to Braille); talking books, newspapers, magazines on cassette tapes or diskettes.

Examples of devices to ensure safe travel include: canes; laser or sensor canes; wheelchair-mounted sensory aides.

Examples of devices to assist with activities of daily living in- clude: voice output or Braille operating appliances; talking wrist watches; paper money readers.

Aids for people who are blind or who have visual impairments

People without speech andor writing impairments have com- munication techniques that include speech as well as gestures, fa- cial expressions, telephones, computers, handwriting. People with limited andor no speech often have physical disabilities that require the use of other communication techniques. Some of these techniques can be described as unaided communication be- cause they require the use of the person’s own body, such as pointing, pantomime, manual signing, and finger spelling.

Augmentative and alternative communication techniques (AAC) describe devices that require something other than the person’s own body to provide a means for expressive and/or re- ceptive communication, such as a pen or pencil, a letter or pic- ture communication board, a typewriter, or an electronic commu- nication device with speech output (Beukelman & Mirenda, 1992; Cook & Hussey, 2001; Galvin & Scherer, 1996; Yorkston, 1992).

*Web sites provided for these examples were current at the time of publication. However, due to the ephemeral nature of Web sites, continued availability ,s not guaranteed.

10 Rehabilitation Nursing Volume 28, Number 1 JanuaryFebruary 2003

Online Resources Aids for Computer Use

For more examples and information about aids for computer use: htrp://wrvw.apple.coriJedrrcafior~I Z/disability Apple Computer. This site has information on computer access solutions for people with disabilities. hrip://wvw. fashinccorn TASH Inc. This site features a variety of access devices. hffp://~vww.at-cenfer.corri Virtual Assistive Technology Center. This site provides informa- tion on free and inexpensive software helping people with dis- abilities to use computers. hrfp://www.syriapseadapfive. cord Synapse Adaptive. Speech Recognition & adaptive technologies for people with disabilities.

Aids to Enhance Education For more examples and information about aids to enhance educa- tion: liffp://~v~vw.donjohnsfon.cordcatalog/cafalog. hfrn Don Johnston Incorporated This site provides solutions for students who struggle with reading and writing and for students with disabilities. Iiffp://~vww.farnilyvillage.~visc.edrc/educafioiJaf. h f t d Assistive Technology for Students with Disabilities. This site provides information related to assistive technology that will en- able students to benefit from educational programs. htfp://~v~vw.alphasmart.com Alphasmart. Features affordable and effective technology solu- tions for the education market. hrtp://~vw~v.assisfivefech.com Assistive Technology, Inc. This site provides innovative solutions to help people with learning, communication, and access difficul- ties lead more independent and productive lives.

Aids to Enhance Recreation and Leisure For more examples and information about aids to enhance recre- ation and leisure: hrtp://www.achievableconcepfs.cotn Achievable Concepts. This site provides information about adapt- ed cards and games for people with disabilities. http://www. familyvillage. wisc.edu/recreaf.hfrn Family Village Recreation and Leisure Center. This site provides information about sports, cooking, mobility (including strollers), gardening, reading, audio and video.

Background The computer provides a means of participating in activities

that would otherwise not be available to people with disabilities. For example, special software has been written to allow people who are blind to use the computer to read, people with cognitive impairments to use the computer to supplement or enhance their memory, and people who have hearing deficits to use the comput- er to communicate over telephones. In addition, there are special devices that enable people with disabilities to use a computer. These include: access aids, such as switches and head pointers; input devices such as modified or alternative keyboards; and out- put devices such as voice or Braille (Cook & Hussey, 2001; Calvin & Scherer, 1996; Hawking, 1994; Lazzaro, 1998).

Assistive technology devices enable people of all ages with dis- abilities to benefit from educational programs. They include: com- puters; software; modified desks; writing aids; paper holders; page turners; book holders; modifications of the learning environ- ment (Flippo, Inge, & Barcus, 1995; Lewis, 1993).

Devices and modifications that enable persons to participate in recreational activities using adapted sports equipment include: beeping balls for people with visual impairments; adapted skis for water skiing or snow skiing for people with physical impairments; adapted bowling alleys for people with physical impairments; adapted fishing equipment for people with various disabilities. Devices and modifications which enable persons to participate in leisure activities include: Braille or large print playing cards and books; books on tape; board games; adapted gardening tools (Calvin & Scherer, 1996; Clark & Chadwick 1992). .

'Web sites provided for these examples were current at the time of publication. However, due to the ephemeral nature of Web sites, continued availability IS not guaranteed.

Rehabilitation Nursing Volume 28, Number 1 JanuaryEebruary 2003 11

Assistive Technology

Online Resources

For more examples and information about home and workshop modifications: http://~v~v~~~.riccess-by-desigii.coril/nccess~rodircts~~rorlircts.litrii Access by Design. This site describes accessible design and building products and provides resources including employment, travel, equipment, sports, and recreation. http://www. ergoweb.coni ErgoWeb. This site offers volumes of useful ergonomics informa- tion including instructional materials, standards and guidelines, news and products. http://wwiv. horiieriiods. org/ National Resource Center for Home Modification. This site de- scribes home modification for the elderly.

Home and Worksite Modifications

Environmental Control Systems For more examples and information about environmental control systems: http://~v,vw.qtiusa. coiii Quartet Technology, Inc. This is a vendor for Environmental Control Units. Iittp://w~vw.mokoa.org/ecir.htrii Home AutomationEnvironmental Controlfilectronic Aids for Daily Living (EADL). This site offers assistance to persons with disabilities to find products for home automation, environmental control and independence.

Vehicle Modifications For more examples and information about driving aids and vehi- cle modifications: litrp://~vww.fniiiilyvillnge. wisc. eddA T/Drivirig.htrii Family Village. This site contains information related to assistive technology, including products related to driving adaptations. hrtp://~v~vw.,vlieelchair-getaw~i)~s. coiid Wheelchair Getaways. This nationwide rental agency offers vans that are wheelchair-accessible. http://www. blvd.conl/Accessible-Veliicles/Reiitals The Boulevard. This nationwide site features wheelchair accessi- ble vehicles, vans and minivans with wheelchair lifts and adap- tive driving equipment for rent. http://wwiv.ci.chi. il. its/CorisrriiierServices/rv/lcliair~~eliic~les.liti~il Wheelchair accessible taxicabs. One free phone call can put someone in touch with every taxicab company that operates wheelchair accessible cabs. ht~p://~vw~v.ciccessi6lcvciris.corir/ Accessible Vans of America. This is a vendor for accessible transportation options for people with disabilities, including wheelchair van rentals, preowned wheelchair van sales and other transportation needs.

Background Structural adaptations and fabrications in the home or worksite

remove or reduce physical barriers for people with disabilities. Ex- amples include: ramps; lifts; wider doorways; bathroom modifica- tions (Calvin & Scherer, 1996; Mace, 1991; Welch, 1998).

Electronic systems enable people with limited mobility to con- trol devices such as appliances, electronic aids, and security sys- tems in their homes, worksites, or other settings through the use of devices similar to TV controllers (Cook & Hussey, 2001).

Adapted driving aids such as hand controls, lifts, and modified vans or other motor vehicles are used for personal transportation (Calvin & Scherer, 1996).

'Web sites provided for these examples were current at the time of publication. However, due to the ephemeral nature of Web sites, continued availability s not guaranteed.

12 Rehabilitation Nursing Volume 28, Number 1 JanuaryIFebruary 2003

1. For persons at home, assistive technology may allow them to be left alone, decreasing the need for home health or per- sonal care services.

2. For persons in day treatment programs, assistive technology may enable them to gain the skills required to enter a voca- tional rehabilitation program or even competitive employ- ment.

3. A person.with cerebral palsy may require a power chair and a communication device to prevent the frustration of not being able to move or communicate.

1. Demonstrate that the disabilities of a person with cerebral palsy or similar condition are medical problems and that the use of technology would have a therapeutic effect on the client by reducing his or her emotional and psychological frustration.

2. Demonstrate that a speech prosthesis can be a motivational factor to increase the client’s ability to communicate with others, enabling the person to communicate health needs and his or her contained anger and emotional frustration. (Remember that a prosthesis replaces a missing or nonfunc- tioning body function or part, therefore, a communication device replaces nonfunctioning speech.)

3. Demonstrate how the device will help the client to secure a job or remain employed (if the client is employable).

Table 4 provides a case study of a fictitious child with cere- bral palsy who needed a specific communication device. Table 5 is an example of a letter of necessity written by the child’s physician.

The following Web sites offer comprehensive information about advocating for people with disabilities, and about train- ing rehabilitation professionals in evaluating and providing as- sistive technology devices.

American Occupational Therapy Association: www.aota. org/nonmembers/area3 California State University Center on Disabilities: www. csun.edu/cod Rehabilitation Engineering and Assistive Technology Society of North America: www.resna.org/prodev/index. html Research Institute for Assistive and Training Technolo- gies: www.nasdse.org/riatt.htm University of Miami, Mailman Center for Child Develop- ment: http://pediatrics.med.miami.edu/OnlineCrs.htm

In 1993, Maria Jarvis*, a single parent, was pregnant with her fourth child in 6 years. Johnny was born on May 13. Soon after Ms. Jarvis took Johnny home from the hospital, she knew something was wrong.

The doctors eventually diagnosed Johnny as having cerebral palsy and referred him to an Early Intervention Program. As a result, he was placed in a therapeutic day care setting where he received physical, occupational, and speech therapy. Ms. Jarvis was referred to the Florida Department of Health Children’s Medical Services (CMS), where a nurse care coor- dinator worked with her to develop a plan of care for Johnny and to coordinate his many health care appointments.

Ms. Jarvis attended Johnny’s therapy sessions once a month to learn how to work with him at home. In addition, the CMS nurse care coordinator made home visits to supply her with in- formation about cerebral palsy and answer questions about his care and medications to ensure that Ms. Jarvis was following Johnny’s therapeutic schedule for medications, stimulation, and range of motion exercises.

At 3 years of age, Johnny was transitioned from the Early Intervention Program to the public school Exceptional Educa- tion Program. His therapies were all continued with recom- mendations from the speech-language pathologist for intensive therapy, with an emphasis on interventions for verbal apraxia and evaluation for possible augmentative communication de- vice use. All the testing and evaluations confirmed the diagno- sis of verbal apraxia. Various communication methods were attempted both at school and at home.

At 9 years of age, it was determined that Johnny could ef- fectively use a specific type of communication device that was recommended by the augmentative communication specialist. The CMS nurse care coordinator collected the various reports from therapists, including all the testing used to determine the diagnosis, the different methods of communication that had been attempted, and trials with the communication device. These were submitted with the request of the primary physi- cian to provide a letter of necessity for justifying funding the device.

Note: Table 5 is tlre pliysicioir Is letter of riecessity for jitstifyirig the firridirig of /he corrrrrriiriicariori device for Jolir~rry. Notice that /lie thera- py evolimtions ore ari iriregrnlpart of the letter. *Narries cirefictitiorrs arid irsed orily to provide exoriiples.

Summary This article has provided information related to availability,

use, and benefits of assistive technology, plus the skills need- ed to write the letters of necessity that are required to obtain funding for assistive technology devices. It is suggested that this information be included in the cumculum of preservice and continuing educational programs for rehabilitation personnel. Finally, it is recommended that all healthcare professionals in the field of rehabilitation acquire the knowledge, advocacy, and

Rehabilitation Nursing Volume 28, Number I JanuaryFebruary 2003 13

Assist ive Tech no1 og y

TO WHOM IT MAY CONCERN: RE: Johnny Jarvis* Date of Birth May 13, 1993

I am writing as the physician for Johnny Jarvis, now 9 years old, in support of his obtaining the communication device rec- ommended by the Augmentative Communication Specialist. Johnny has been a patient of mine since June 29, 1994. His medical diagnoses are cerebral palsy with verbal apraxia. At- tached are reports of diagnostic tests and methods supporting this diagnosis.

cate through normal vocalization and this will continue to be the case in the future. Obviously, there are many reasons that he needs to have some way to communicate with the outside world, these include but are not limited topersonal needs and school participation. There is ample evidence that he possesses the cognitive abilities to communicate, but because of his clini- cal disability, he lacks the physical ability to speak. In addition, from a medical point of view, it is exceedingly difficult to manage him without any way to have direct communication with him.

Johnny ‘s condition makes it impossible for him to communi-

The prognosis that Johnny will be able to generate functional communication as a result of the ability to use the communica- tion device is excellent (according to the Augmentative Com- munication Specialist). Attached are reports which support this prognosis, describe the features of the recommended device, and describe how the device will match Johnny’s abilities and limitations.

In summary, the modern medical management of individuals who have cerebral palsy with verbal apraxia is generally con- sidered to include augmentative communication assistance as an integral part of the program. I strongly urge that this device be funded for the above reasons. If you have questions, please feel free to contact me.

Sincerely,

M. Martin, M. D.* Enclosures

*Names arejictitioirs and used only to provide exarnples.

sKills that are necessary to ensure people with disabilities greater independence and a better quality of life through assistive technology.

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Freeman, P., & Randall, J. (1997). Art and practice of low-vision. Woburn, MA: Buttenvorth & Heineman.

Furumasu, J. ( 1 997). Pediatric powered niobility: Developmental perspec- tives, technical issues, clinical approaches. Arlington, VA: Rehabilita- tion Engineering and Assistive Technology Society of North America.

Galvin, J.C. & Scherer, M.J. (1996). Evalimting, selecting. and using ap- propriate assistive technology. Gaithersburg, MD: Aspen Publishers.

Goossens, C., & Crain, S . S . (1992). Ut ng switch interfaces with chil- dren who are severely physically challenged. Austin, T X : Por-Ed.

Hakes, A. (1991). Competencies related to the identification, screening, as- sessment. and family services coordination for professions serving vul- nerable infnnts, toddlers, and their families. Tallahassee, F L The Flori- da Consortium of Newborn Intervention Programs.

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The National Council on Disability. (1993). Study on thefinancing of assis- five technology devices and services for individuals: Report to the Pres- ident and the Congress of the United States. Retrieved March 3, 2001, from http://ncd.gov/newsroom/publications/assistive.html.

Welch, P. (1998). Strategies for teaching irniversal design. Boston: Adap- tive Environments.

Yorkston, K.M. (1992) Augnientative coniinunication in the medical set- ting. Tucson, A Z Communication Skill Builders.

Continuing education articles discuss current trends and issues affecting reha-

cation offering (code number RNC-205) bilitation nursing. This continuing edu-

will provide 1 contact hour to those who

cation form on page 40. This independent study offering is appropriate for till rehabilitation nurses. By reading this artic1e;the learner will achieve the following objectives: 1. Define the term “assistive technology.’’ 2. Discuss the benefits of assistive technology for indi-

viduals with special needs. 3. Use the appropriate terminology when writing letters

of necessity that are required to obtain funding for as- sistive devices.

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read this article and complete the appli- %,,roo

14 Rehabilitation Nursing Volume 28, Number 1 JanuaryFebruary 2003