1. A Philosophy and Practical Applications Presentation
Promoting Independence and FUNction with ADL and Communication Equipment
A Philosophy and Practical Applications Presentation

2. Objectives 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“

3. 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

4. What is Adaptive Technology?
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

5. What is “appropriate technology?”
From Disabled Village Children, Hesperian Foundation Publications

6. Appropriate Technology
Jaipur leg
Rubber, wood, aluminum
Estimated $28.00-$40.00 cost
Hotchkiss wheelchair
bike parts
Mine action informaiton center- James Madison University in Virginia

7. It’s All About Participation
Unique to individual Needs, Wants, and Circumstances
“Functional and Fun”

8. Standing wheelchairs

9. Cultural relevance

10. 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

11. "She can't/We didn't because..."
Bad models of disability
Perpetual infant/Little Innocent Angel
Sick role/invalid "Medical Necessity"
Geriatric/Terminal
Low expectations
Dependency, limited or no autonomy
Top (or only) priorities become safety, protection, ease and convenience for caregiver

12. ADLs - Eating Ataxia – bigger, heavier utensils
Reduced dexterity – swivel and/or bent spoon

13. Winsford feeders Cheek switch to scoop and present food
Need some head control
Hands-free

14. Food preparation

15. 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

16. 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

17. Gadget Tolerance = Independence

18. 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
Still slower
Hands free use possible
Different style of proofreading – spellcheck won’t work
Adaptive keyboards, alternative mouse access
Small for weaker or lower arm mobility
Larger for less accurate hand use
Trackball, HeadMouse, MouseKeys
aboutonehandtyping.com
Or…

19. Writing and typing
Writing bird, typing stick (or use pencil, eraser end down in cuff)
Don’t underestimate two or even single finger typing

21. 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

22. 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
EASI at RIT

23. 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

24. Alternative – Augmentative
Prerequisites vs Participation
Interdisciplinary evaluation mandatory
Rx “therapy units as needed”
Stress medical, not peer communication
Different choices for ambulatory vs w/c with tray user
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
Literate English vs special language vs pictures
Need for support, upgrades (college level)

25. The McDonald’s Shake Story

26. The Strawberry Shake Story

27. Resources Arkansas Easter Seals Society
ICAN Increasing Capabilities Access Network
International Society for Augmentative and Alternative Communication
RESNA
Prentke-Romich and other AAC companies
John Halloran