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OTs role in work and industry is to aid and facilitate individuals to engage and reengage in work activities (AOTA, 2022). This includes prevention of injury, transitional return to work programs, and remediated, compensatory, and adaptive solutions to return to work (AOTA, 2012).

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OTs Role when working with children and youth is to help facilitate participation in occupations and activities and to improve functional abilities and participation in ADLs, play, and leisure (Laverdure & Beisbier, 2021). When considering children and youth, occupational engagement can help with development of motor, social, cognitive, and vocational skills (Laverdure & Beisbier, 2021).

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1. Video camera or phone for video modeling
2. Virtual Reality
3. Video Games
4. Speech Generating Devices
5. Sensory aids (hearing aids; speech as auditory reading substitute)
(Cook et al., 2020; Laverdure & Beisbier, 2021)

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Using Virtual Reality to Help Kids with Autism | Freethink Superhuman

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1. Built up Utensils
2. Pencil Grip
3. Fidget spinner/Squishy Balls
4. Visual Schedule
5. Communication Card

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http://www.pekdadvocacy.com/assistive-technology/assistive-technology-children/

Laverdure, P. & Beisbier, S. (2021). Occupation- and Activity-Based Interventions to Improve Performance of Activities of Daily Living, Play, and Leisure for Children and Youth Ages 5 to 21: A Systematic Review. Am J Occup Ther, 75(1), 7501205050p1–7501205050p24. doi: https://doi.org/10.5014/ajot.2021.039560

Cook, A. M., Polgar, J. M., & Encarnacao. (2020). Assistive technologies: principles & practice (5th ed.). Elsevier.

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Top 5 Funding Resources for Assistive Technology for Children with Physical Disabilities | Pennsylvania Assistive Technology Foundation

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When someone calls us looking for help getting their assistive technology (AT), one of the first questions we ask is whether they are enrolled in a waiver – that is,... [ Read Top 5 Funding Resources for Assistive Technology for Children with Physical Disabilities ]

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1. Fitness Desk
2. Dragon dictation software
3. Smart Clothing (Hard hat/vest with sensors, GPS, etc.)
4. Virtual/Augmented Reality construction training
5. Mechanical Lifts

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Improving construction worker safety with wearable sensors

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1. Laptop stand
2. Lumbar support cushion
3. Alternative keyboard
4. Safety Goggles
5. Non-slip tread tapes for traction on slick surfaces

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https://www.osha.gov/ergonomics

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6925745/

Ambegaonkar, R. (2022). How technology is making construction safer. https://www.ny-engineers.com/blog/how-technology-is-making-construction-safer

American Occupational Therapy Association. (2022). Special Interest Sections: work and industry. https://www.aota.org/community/special-interest-sections/work-and-industry

American Occupational Therapy Association. (2012). Fact sheet: Occupational therapy services at the workplace: transitional return-to-work programs. https://www.aota.org/-/media/Corporate/Files/AboutOT/Professionals/WhatIsOT/WI/Facts/Transitional.pdf

Luke, A. (2021). High- & Low-Tech Tools of the Trades. https://www.constructionbusinessowner.com /equipment-maintenance/high-low-tech-tools-trades

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Overview

Prevention of Musculoskeletal Disorders in the Workplace

Musculoskeletal disorders (MSDs) affect the muscles, nerves, blood vessels, ligaments and tendons. Workers in many different industries and occupations can be exposed to risk factors at work, such as lifting heavy items, bending, reaching overhead, pushing and pulling heavy loads, working in awkward body postures and performing the same or similar tasks repetitively. Exposure to these known risk factors for MSDs increases a worker's risk of injury.

Work-related MSDs can be prevented. Ergonomics --- fitting a job to a person --- helps lessen muscle fatigue, increases productivity and reduces the number and severity of work-related MSDs.

Impact of MSDs in the Workplace

Work-related MSDs are among the most frequently reported causes of lost or restricted work time.

A Process for Protecting Workers

Employers are responsible for providing a safe and healthful workplace for their workers. In the workplace, the number and severity of MSDs resulting from physical overexertion, and their associated costs, can be substantially reduced by applying ergonomic principles.

Implementing an ergonomic process is effective in reducing the risk of developing MSDs in high-risk industries as diverse as construction, food processing, firefighting, office jobs, healthcare, transportation and warehousing. The following are important elements of an ergonomic process:

Provide Management Support - A strong commitment by management is critical to the overall success of an ergonomic process. Management should define clear goals and objectives for the ergonomic process, discuss them with their workers, assign responsibilities to designated staff members, and communicate clearly with the workforce.

Involve Workers - A participatory ergonomic approach, where workers are directly involved in worksite assessments, solution development and implementation is the essence of a successful ergonomic process. Workers can:

Identify and provide important information about hazards in their workplaces.

Assist in the ergonomic process by voicing their concerns and suggestions for reducing exposure to risk factors and by evaluating the changes made as a result of an ergonomic assessment.

Provide Training - Training is an important element in the ergonomic process. It ensures that workers are aware of ergonomics and its benefits, become informed about ergonomics related concerns in the workplace, and understand the importance of reporting early symptoms of MSDs.

Identify Problems - An important step in the ergonomic process is to identify and assess ergonomic problems in the workplace before they result in MSDs.

Encourage Early Reporting of MSD Symptoms - Early reporting can accelerate the job assessment and improvement process, helping to prevent or reduce the progression of symptoms, the development of serious injuries, and subsequent lost-time claims.

Implement Solutions to Control Hazards - There are many possible solutions that can be implemented to reduce, control or eliminate workplace MSDs.

Evaluate Progress - Established evaluation and corrective action procedures are required to periodically assess the effectiveness of the ergonomic process and to ensure its continuous improvement and long-term success. As an ergonomic process is first developing, assessments should include determining whether goals set for the ergonomic process have been met and determining the success of the implemented ergonomic solutions.

Note: An ergonomic process uses the principles of a safety and health program to address MSD hazards. Such a process should be viewed as an ongoing function that is incorporated into the daily operations, rather than as an individual project.
OSHA NIOSH High Risk Occupations for MSDs

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Ergonomics - Overview | Occupational Safety and Health Administration

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Overview Prevention of Musculoskeletal Disorders in the Workplace Musculoskeletal disorders (MSDs) affect the muscles, nerves, blood vessels, ligaments and tendons. Workers in many different industries and occupations can be exposed to risk factors at work, such as lifting heavy items, bending, reaching overhead, pushing and pulling heavy loads, working in awkward body postures and performing the same or similar tasks repetitively.

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OTs role in health and wellness is health promotion in the context of the individual, including assessment and interventions of people, environments, and activities, so that they may participate and maintain participation in daily and desired occupations while maximizing their quality of life (AOTA, 2015).

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OTs Role in mental health includes promotion, intervention, and prevention of mental health challenges that may impact an individual's occupational performance (AOTA, 2022).

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1. EndeavorRX: Prescription Video Games
2. Ellipsis: voice/speech pattern detection
3. Virtual Reality Technology
4. NightWare for nightmare management
5. CalmiGo for anxiety/stress management

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How the NightWare Watch Helps PTSD Survivors | The Henry Ford’s Innovation Nation

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1. Journal
2. Free meditation apps
3. Pocket Stone
4. Weighted vest
5. Planner/Calendar

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Mental health is important. Use these bullet journal spreads to track your moods, feelings to take control of your mental well-being.

Keeping up with your mental health is a great way to promote whole-body wellness. This includes tracking your moods, and everyday habits to get an overall glimpse of your daily, weekly, and monthly health.

You can use your bullet journal to do this in a creative, positive, colorful, and enjoyable way. If you don't own a journal yet, here is a good quality dotted journal that you can start with.

1. Compliment Keeper

Remind yourself how awesome you are! Prepare a page you can call whatever you like, such as "compliment jar' or 'go you!'

Each day or week list the ways you've gone above and beyond to make your life great! This can be as simple as having a great day at work to finally hitting that five miles on the treadmill.

Celebrating our little accomplishments can give us the motivation to keep heading towards the bigger ones!

2. Mini Mood Tracker

Keeping up with your wellness starts with the moods and emotions you feel every day. Use a simple mood tracker with a pictorial key to keep up.

Use a two-page simple spread, or other easy spreads if you're not super artistic, to create a calendar for the month with easy-to-read boxes.

Create a key using easy, basic drawings. It might make you smile to draw little faces for each mood!

You can also use stickers like stars of different colors, like the ones here, to denote your different moods each day.

Decorate the page as you desire.

3. Love Yourself Log

Many people don't take the time to love themselves. Loving yourself is the key to wellness and positive life.

And look how amazing you are! You deserve love!

When you love yourself, you can then love others. There are little things you can do throughout the month to show yourself love.

This can be as simple as taking a nap when you're tired of taking a break to do some yoga or meditation. Keep up with your self-love by filling up a 'bucket' with different-colored balls to represent each self-love act.

4. Gratitude List

One of the things we usually take for granted is the good things in our lives when it's so much easier (and a force of habit) to focus on what's wrong when we get overwhelmed.

This beautiful, pretty-in-pink layout serves up love with an easy-to-use spread that lets you list the things you're most grateful for each month.

Use the colors you love and doodle designs that bring you joy!

5. Attack Your Anxiety

Millions of people suffer from anxiety, and anxiety attacks are very common. When you're having an anxiety attack, you can feel scared, emotional, and out of control.

Dedicate a page or layout to your bullet journal with ideas to help you with your anxiety. Whether you have used techniques like grounding or other therapeutic ideas, sometimes it can help you see them right in front of you.

This makes it easy to glance at your favorite ways to calm down during a panicky moment or anxiety attack. Use calming colors on these pages or favorite images.

Check out these mood trackers to understand your emotions better.

6. Today is a Good Day

What are your ingredients for the perfect day? Does it start with your favorite kind of coffee?

Do you style your hair a certain way or wear a favorite outfit? Maybe you relax and unwind at home or spend the morning exercising and listening to music.

It's important for your mental health to focus on the positive aspects of everyday life, so make a list of every component of your best day to gear you up for a great one!

7. Tracking Triggers

You may have a health condition like allergies or chronic pain. Or, you may be monitoring triggers that turn your moods on and off.

Whatever you're tracking, it makes sense to keep a chart in your journal that lets you identify things that trigger your symptoms and what the resulting symptoms are for each month.

Whether you suffer from a mental or physical illness, it can be helpful to pinpoint what your triggers are that cause you to feel bad so you can avoid them, especially if you're already feeling lousy.

8. Helpful Habits

There are so many habit tracking bullet journal layouts. The habit tracker pictured is a great start, especially if you're new to journaling and a bit overwhelmed by complex layouts.

You can use a grid journal like the one here to make it easier to make squares and add each habit in calendar form to the page.

Tracking your habits is an excellent way to start new ones ( exercising, eating well, getting more sleep) or leaving bad ones in the dust (spending too much money, not focusing on gratitude).

Grab a few pretty markers like the ones here and doodle to add your own personality to the page!

9. Self-Care Spread

How do you take care of your physical and mental health? There are many ways to do this.

It could mean getting extra sleep or saying no to evening plans and relaxing at home instead. Self-care isn't just physical; it's mental too, such as skipping a late night of work and picking up a book instead.

Make a collage of images or drawings that inspire you and a list format box with each day of the week.

Your goal is to add a list of self-care actions and check off how many days you do one - hopefully, every day you're practicing self-care!

10. Watercolor Brush Bujo

Using Tombow watercolor brushes like the ones you can find here is one way many people enjoy customizing their bullet journals. You can use this design for fancy headers on any page.

In this example, a trigger tracker has been made to track fibromyalgia symptoms and what things cause flares. This is a great idea for anyone who has a chronic illness or a mental illness such as anxiety.

Not only are watercolors pretty to look at, but any kind of painting can be very therapeutic! Don't worry if you're not a professional artist, either.

You don't have to impress anyone; this journal is just for you!

11. Healing Health

This easy list layout offers some solutions for enhancing mental health, especially if you find yourself having one of those days. This could mean hopping in a hot tub full of bubbles (aaaah!), taking a walk, or creating a cute craft!

Whatever ways you like to keep your brain from burning out, list them in this mental health first aid kit layout!

The author used Tombow markers like the ones here, which are popular choices for journals since the colors are so beautiful, and they are so much fun to use.

Pick your favorite colors, add an inspirational quote, or simply paint a pretty drawing that will make you smile.

12. A Habit of Gratitude

Negativity can do a number on your mental health. Did you know it's much easier to be negative than positive?

Let's turn that around in 2020 and focus on everything that's great in your life, and you know there are so many awesome things to celebrate!

Do a two-page spread for each month with a calendar on one page along with drawings and doodles that are bright, colorful, and engaging.

On the opposite page, list everything you're grateful for that month! It can be as simple as lunch with your mom or finding a lost earring to something bigger like a new job or apartment.

13. Your Majesty

You are a queen. And, you deserve to be treated like one!

If nobody else is doing it, why aren't you? This cute layout takes patterned washi tape like the kind you can find here and gives the pages a distinct and decorative edging.

In the boxes, list the things you can do to care for your body, mind, and heart. These can vary from eating healthy and exercising to listening to music and taking a break from the internet.

Try using Koi coloring brush pens like the ones found here to add lots of fresh color to your self-care pages and meaningful doodles that you love.

14. Mindfulness Moments

Part of mental health wellness is being mindful, which is a big part of focusing on your habits, activities, and how you can improve your daily life.

Devote a double-page layout to mindfulness. You can list the things that you like to do to have more positive life experiences.

Make the lists easy to read, use bright colors, and add a couple of your favorite mindfulness activities and quotes you can reference when you need to.

15. Anxiety Layout

When you have anxiety, you'll find that getting to the bottom of what triggers your panic may help you avoid stress altogether.

Make a chart that starts with the date, what your mood was when you felt anxious, and what you feel like actually triggered your anxiety.

Then, you could try some different self-care solutions to see what the outcome is and what your thoughts are. This could prove really helpful to you!

Use watercolors, markers, stickers, or whatever makes you happy and calm on the pages.

16. Colorful Calm

Doodling adds dimension to this layout that can help you relieve the burden of your anxiety. Create small bright images of the things you do to help you when you feel nervous, like listening to music, watching movies, or going outside to enjoy nature.

On the following page, make boxes for each aspect of self-care: your body, your mind, heart, soul, etc. Make these lists a bit more detailed than the drawings.

These can be a great reference when you're feeling overwhelmed, and multiple colors can be soothing to see when you're having a tough day!

17. Depression Data

Sometimes when you have a mood disorder, tracking your moods, sleep, activities, and other daily habits can help you see what actually contributes to anxiety and depression.

This can be in the form of a user-friendly chart. You can write the days in and color-coded squares to keep up with everything using the colors of the key to represent each mood or activity.

Glancing at this layout can give you some much-needed mental health answers, especially when combined with your other habit trackers like spending, health, and other things that can all contribute to depression and anxiety.

18. Positive Pens

Get creative with keeping up with the things you're grateful for by drawing photos of horizontal pens of different colors.

Each pen represents something in your life you are grateful for. You can make a list a day, or just add items throughout the month as you think of them.

When you're feeling down and having a bad day, reflect on your life and how much you have to be grateful for!

It can improve your perspective.

19. Panic Response

For people who suffer from panic and anxiety, sometimes it can seem like there's no way to control it. That's not true, though!

You can get a handle on your health by keeping a log of the things you've noticed always have a positive effect on you when you feel anxious and panic-stricken.

Do a double-page spread with little lists of the ways you can alleviate panic. These can range from creative expression to sharing a chat with your best friend.

On the opposite page share some tips for crisis mode - when you feel like you can't breathe. Meditation, taking deep breaths, and grounding techniques are just a few things to focus on.

Feeling better?

20. Happy Hints

Sometimes we get in a rut and need a visual reminder of the things we can do to feel more positive and fulfilled at the moment.

Use blank pages or grid pages to doodle things that you know will have a positive effect on you, like sunshine, hydration, and focusing on the small things even on days when it seems hard.

Bright colors soothe the soul!

Conclusion

Are you enjoying any of these bullet journal ideas? Which mental health spread are you going to try next?

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Mental health is important. Use these bullet journal spreads to track your moods, feelings to take control of your mental well-being. Keeping up with your mental health is a great way to promote whole-body wellness. This includes tracking your moods, and everyday habits to get an overall glimpse of your daily, weekly, and monthly health.

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https://www.explorevr.org/sites/explorevr.org/files/files/AT%20MH%20Part%201%20FINAL.pdf

https://www.explorevr.org/sites/explorevr.org/files/files/AT%20MH%20Part%202%20FINAL.pdf

American Occupational Therapy Association. (2022). Special Interest Sections: Mental Health. https://www.aota.org/community/special-interest-sections/mental-health

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OT providers work with aging adults and caregivers to promote productive aging including promotion of health and quality of life and facilitation of participation in meaningful occupations (AOTA, 2016).

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1. Whoop 4.0 fitness band
2. QardioArm Wireless Smart Blood Pressure Monitor
3. Treadmill/Stationary Bicycle
4. Electric Toothbrush
5. Voice-Activated Pill Dispenser

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The future of wellness: Connected and customized

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1. Medical Alert Systems
2. Robot Vacuum
3. Smart Lighting and Appliances
4. Elevating Reclining Chair
5. Remote monitoring systems

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Smart Home Technology For Elderly Care | Products and Usage

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1. Grab bars
2. Button hook
3. Personal Hygiene Aid
4. Reacher
5. Versa Frame

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1. Medication planner/Pill box
2. Food journal
3. Resistance Bands/Home Exercise Program
4. LED lights
5. Leisure tools (balls/jump rope/gardening tools etc.)

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OT providers aid in client-centered remediation, help to facilitate adaptive techniques and/or compensatory strategies in order to maximize occupational participation and functional abilities within the individual's appropriate context and environment (AOTA, 2020).

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https://aspe.hhs.gov/reports/assistive-technology-frail-elderly-introduction-overview-0

American Occupational Therapy Association. (2016). Occupational therapy’s distinct value: productive aging. https://www.aota.org/-/media/Corporate/Files/Practice/Aging/Distinct-Value-Productive-Aging.pdf

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Robert Elliot

University of Pennsylvania

August 15, 1991 Revised April 28, 1992

PDF Version (19 PDF pages)

This report was prepared under contract between HHS's Office of Family, Community and Long-Term Care Policy (now DALTCP) and the University of Pennsylvania. For additional information about this subject, you can visit the DALTCP home page at http://aspe.hhs.gov/_/office_specific/daltcp.cfm or contact the office at HHS/ASPE/DALTCP, Room 424E, H.H. Humphrey Building, 200 Independence Avenue, S.W., Washington, D.C. 20201. The e-mail address is: webmaster.DALTCP@hhs.gov. The Project Officer was Robert Clark.

I. INTRODUCTION

Long term care refers to a wide range of medical, social and personal care services needed by individuals who are functionally impaired. The elderly, persons aged 65 and over, are the primary users of long term care.

In 1985, there were about 5.5 million functionally disabled elderly living in the community and an additional 1.3 million in nursing homes. By the year 2020, each of these figures is projected to almost double to 10.1 million and 2.5 million respectively (Manton, 1989). Long term care has emerged as a significant health and social policy issue.

Long term care, particularly nursing home care, is expensive. In an era of large federal deficits, it consumes a large fraction of Medicare and Medicaid expenditures. The elderly, whether functionally impaired or not, prefer to live independently in their own homes for as long as possible. The problem is to find ways to control rising costs while enabling the frail elderly to live as independently as possible.

One promising solution is assistive technology.

II. AN ALTERNATIVE TO HUMAN HELP

Long term care for the frail elderly has been provided predominantly by other people who help with daily activities such as preparing and eating meals, bathing, grooming and getting around. These aides often make the difference between an individual's ability to live at home in the community (with help) and the need to move to a more restrictive residential setting.

Due to the shrinking pool of direct service workers and the enlarging pool of elderly individuals who want to stay independent in the community, researchers, caregivers, family members and elderly individuals themselves are looking for new solutions. They are exploring strategies that reach beyond human assistance; they are looking closely at assistive technology.

"Assistive technology," according to the Technology Related Assistance Act of 1988 (P.L.100-407), is any item, piece of equipment, or set of products that helps a person with a disability to increase or improve his/her functional capabilities.
Ida P. provides and example of how technological assistance can make the difference between dependence and functional independence. At age 85, Ida is energetic and sharp, but she is unable to walk more than a few steps due to increasingly severe arthritis. She is unable to go in nd out of her second floor apartment alone. With intensive, daily human assistance, she can continue to live independently; she would need someone to shop and run other errands, and possibly to move her up and down the stairs. Alternatively, she can move to a facility where someone will prepare meals for her and staff will move her around. A third option, assistive technology, in the form of a one time purchase of a wheelchair and a stair climbing seat, can make the difference between dependence and functional independence for Ida. To this vibrant member of the community, the choice is obvious.
Assistive technology can allow a person with disabilities to function more independently, thus gaining self respect and greater acceptance in mainstream society. In addition, policymakers are becoming aware that assistive technology makes good fiscal sense. It has the potential to reduce the need for expensive human help and intensive informal care.

This paper offers an overview of assistive technology and P.L.100-407, and explores: (a) the potential of assistive technology to substitute for human assistance; (b) barriers to general acceptance of assistive technology; (c) advantages and disadvantages of assistive technology; (d) financing assistive technology; (e) research gaps; and (f) policy considerations concerning assistive technology.

III. THE "TECH ACT" OF 1988

The field of assistive technology was given a significant push in 1988, both in terms of funding and public policy recognition.

Congress enacted the Technology Related Assistance Act of 1988 (P.L.100-407) to expand the availability of assistive technology services and devices to people with disabilities. The law, which was authorized for five years, contains two sections.

Title I authorizes the Secretary of Education to implement a program of grants to states to develop comprehensive statewide programs of technological assistance. Each state can receive between $500,000 and $1 million for the first two years. In the third year, the maximum amount rises to $1.5 million.

Title II authorizes Programs of National Significance, research intended to help states develop their own service delivery systems. Additionally, Title II includes training and public awareness projects that provide new training opportunities. Extra funds from this section can be used to educate individuals about the benefits of training people to use new devices.

IV. EXAMPLES OF ASSISTIVE TECHNOLOGY

In 1985, there were over 18,000 devices to aid the functionally impaired elderly (U.S. Office of Technology Assessment, 1985). There are considerably more today. These devices are not all sophisticated computerized systems. They range in price and complexity from a $3 modified eating utensil to a $25,000 reading machine for a blind person to a multi-hundred thousand dollar communication voice simulator.

Many are not designed as assistive devices for people with disabilities, but to make life easier for anyone--for instance, a sound sensitive light switch. With the plethora of assistive devices on the market, an entire house can be renovated to enable a functionally impaired person to carry out his or her daily life independently.

In the kitchen, eating and cooking utensils can be fitted with oversized handles for easier gripping. This "assistive device" can enable an 85 year old with arthritic fingers and hands (lie Ida P.) to continue to prepare meals for herself.

Another kitchen-related assistive device is an automatic feeder, controlled by a chin switch or and hand/foot switch, so that people who cannot hold eating utensils due to tremor or spasticity of the hands and arms can feed themselves.

Assistive devices are frequently found in the bathroom. Grab bars around the tub are easily installed and help prevent falls. Shower benches, bathtub lifts and a door on the bathtub not only alleviate some need for human assistance, but make it easier to shower and reduce the risk of slipping.

In the bedroom, ceiling poles around the bed can make it easier to get in and out of bed. Bedside controls for lights and other appliances increase the ability of mobility impaired people to control the lighting, temperature or other conditions of their home without getting out of bed.

For the functionally impaired elderly living in multi-level housing, wheelchair lifts and stair-climbs allow for full access and mobility throughout the house. Individuals with hearing impairments can benefit from a simple blinking light instead of a doorbell. Large handled combs and brushes and velcro fasteners for clothing help people with limited manual fine motor abilities.

These are but a few of the many devices available. New assistive devices that range considerably in price, technical sophistication, quality and suitability are constantly appearing on the market.

V. ROBOTS: A GLIMPSE AT THE 21ST CENTURY

Robotics is an emerging field that could benefit people with cognitive impairments as well as those with physical disabilities. For people in the former group, a robot could remind the person when to do certain daily activities, such as eat, bathe, or go to bed. It could also monitor the individual's safety and contact others when help is needed.

For example, falls are the most common cause of severe injury or accidental death among the elderly. A robot that could recognize when a person has fallen could automatically "beep" a pager or telephone for help. Robots that perform simple tasks, such as reminding a person that the stove or iron is on, could reduce the incidence of serious accidents.

Two of the most difficult tasks for elderly individuals with physical impairments are sitting down and standing up. A robot that could assist with these actions would be very valuable, and could possibly substitute for human assistance.

VI. CAN ASSISTIVE DEVICES SUBSTITUTE FOR HUMAN HELP?

Will assistive devices be able to replace human assistance? Due to technological advances, devices have been able to substitute for human assistance in some cases. However, for most people, assistive devices supplement human help. In the end, the answer to the question depends on which segment of the heterogeneous elderly population is being discussed.

The functionally impaired elderly fall into three broad categories.
THE MILDLY IMPAIRED
The first group includes about 1.4 million people who have relatively mild impairments, such as mild arthritis, and can generally get by without help from other people.

Within this group, assistive devices can be a great boon, even substituting for help that would otherwise have to be provided by another person. Examples include an elderly person with arthritis, who, with modified pot handles and knives, can cook for himself, and a person who can shower using a grab bar and shower seat.
THE MODERATELY IMPAIRED
The second category includes persons with moderate impairments, those who are functionally impaired in one or two activities of daily living. An example is an individual with arthritis plus the loss of leg movement. For people in this group, assistive devices tend to supplement informal or formal home care.

For those in this second group, while the assistive devices do take some of the burden off of the home care provider, they may not be able to make the person completely independent. For example, a stair-climb may allow a disabled elderly person to move independently among floors; however, the person may not be able to toilet independently, and would still require human help.
THE SEVERELY IMPAIRED
The third category of the impaired elderly currently makes little use of assistive technology. This group includes approximately 2.5 million people with multiple health problems and severe functional limitations. Often these individuals cannot perform three or more activities of daily living. Such persons may have severe cognitive impairments, as well as several physical impairments such as loss of arm and hand movement.

The remarkable adaptations of assistive technology to the needs of younger disabled persons (such as quadriplegics) plus anticipated advances in miniaturization of devices, computers and communications may open new possibilities for the use of assistive technology by the severely impaired elderly.

VII. BARRIERS TO ACCEPTANCE

Despite the availability of thousands of devices designed to enhance life for the functionally impaired elderly, assistive technology has not been fully successful in the geriatric marketplace (RESNA, 1990:100).

Experts attribute this to four factors: (a) inadequate training and orientation for the elderly consumer; (b) inappropriate match of assistive device to the person's need; (c) unwieldy designs; and (d) failure to realize that assistive technology involves more than just giving a person a device.
INADEQUATE TRAINING
Caregivers report that older people appear to have a great deal of hesitancy to use new technology. Until recently, researchers attributed this apprehension to a decreased ability to learn in the elderly. However, recent studies show that the elderly do indeed retain their ability to learn, but may require unique training approaches (RESNA, 1990:100).

The way the new technology is taught has a critical impact on the elderly individual's comprehension and on the success of the person's use of the device. (RESNA, 1990:100) Researchers and trainers have found the following teaching guidelines to be helpful.

1. Caregivers and instructors must have a positive, realistic attitude. Negative attitudes and unrealistic goals can result in frustration by the consumer and ultimate rejection of the device.

2. The instructor should be well known, or at least familiar, to the elderly person. This familiarity will increase the person's level of trust and willingness to experiment with the new device. The training should occur in the individual's home, as people comprehend more under comfortable circumstances than in an unfamiliar place. At home, an individual can be much more at ease and is better able to focus on the training.

3. The instructor must allow sufficient time to permit a series of short, repetitive training sessions to reinforce the material. Older persons can learn new technologies, particularly if the instructional process takes into account their age and frailty. Since frail older persons tire more easily than the young, instructional sessions should be shorter. Frequent, careful, properly spaced repetition of steps can reinforce the learning of skills needed to operate assistive devices.

4. The instructor must emphasize to the elderly individual how valuable the assistive technology will be, and how much it will contribute to the person's independence. If the individual feels that the technology is not critical to his or her independence, there will be less incentive to use it.

5. The technology must be explained to the family members and caregivers in addition to the elderly person. To overcome many of the early concerns and problems, it is critical that everybody who participates regularly in caring for the elderly individual understand (and not fear) the device.

INAPPROPRIATE MATCH
While quality training is fundamental to help elderly people accept and use assistive devices, choosing equipment that matches the person's needs is another key to success. The misapplication of technology can be both costly and time consuming.

People often overlook the importance of purchasing the equipment that best fits a person's needs. In addition, case managers are often not trained to understand assistive devices and help elderly people choose and use the right ones. The result can be that an elderly individual never learns the full capabilities of a device and misses out on some of its potential benefits.

Certain devices may be purchased more frequently because they are the ones case managers, consumers or caregivers know about. One way to remedy this problem is to educate caregivers on how to assess a person's need for assistive technology and help a person choose the right devices.

Matching an individual's needs and abilities with appropriate equipment requires a solid knowledge of physical needs assessment techniques and a strong background in the constantly changing field of available technology.
UNWIELDY EQUIPMENT
Many observers suspect that one reason elderly individuals are reluctant to use some assistive devices has to do with the design of the equipment. One stigma is that the device will detract from the person's appearance (RESNA, 1990:101). Many devices appear bulky or cumbersome; consequently, elderly people reject them.

A new approach to design, with ample consideration for aesthetics, can help address this problem. One way to make designs more appealing and suitable is to encourage input into the design of assistive devices from people with disabilities.
MORE THAN A PIECE OF EQUIPMENT
Individuals can often be given a new piece of equipment, a pair of glasses for example, and taught to use it relatively quickly. More frequently, however, the concept of "assistive devices" encompasses ongoing technological support services, like training and maintenance.

This broader concept of assistive technology may not mesh well with the traditional service delivery system, which is geared toward cure, closure or some other fixed goal. Difficulties may crop up when it is time to provide and pay for maintenance or replacement of equipment. Policymakers need to be aware of the ongoing costs of many devices; equipment is not always a "one shot" solution.

VIII. ADVANTAGES OF ASSISTIVE TECHNOLOGY

Assistive technology offers a number of advantages to those who are in a position to use it.
SAVING MONEY AND IMPROVING LIFE QUALITY
Assistive devices have the potential to save money and improve the quality of life for many elderly disabled individuals. The U.S. Office of Technology Assessment (1985) noted that, for some individuals, assistive devices can delay or prevent institutionalization, resulting in enormous personal and financial savings.
HELPING PEOPLE REMAIN FUNCTIONALLY INDEPENDENT
The range of assistive devices available today can allow elderly individuals to remain functionally independent in their communities, with fewer in-home services. Reducing the need for formal home care services could put a dent in the $44 billion spent annually on long term care for the elderly (Under Secretary's Task Force Report on Long-Term Care; 1991:3-3--DRAFT).

The benefits of assistive devices go beyond cash savings. Most important, with the help of assistive technology, many elderly disabled people can remain independent for a longer time. Assistive devices are instrumental for many people to perform activities of daily living.

Without assistive technology, the estimates of elderly persons with disabilities rise substantially. Using assistive devices, approximately 725,000 people can bathe independently, and close to 1.4 million can use the bathroom without human help. Under Secretary's Task Force Report on Long Term Care; 1991:2-16,17--DRAFT). Even simple technology, like velcro closures on clothing, could enable people to dress themselves, alleviating the need for some help from others.
INSTITUTIONS CAN SAVE MONEY
Institutions that serve the elderly can also save money when they use assistive devices properly. With greater use of assistive devices, some observers speculate that nursing facilities and other residential settings can either reduce staff, or use existing staff more productively, and thereby cut operating costs and increase efficiency.
BENEFITS TO CAREGIVERS
Assistive devices benefit caregivers as well as elderly individuals. Over one-third of all informal caregivers are over age 65, and many are themselves disabled (U.S. Senate, 1990:21) While informal caregivers are generally unpaid, the care they provide is definitely not "free."

They often provide care under stressful circumstances (e.g., they are sick themselves, the service they provide degrades their own health, they have to cut back on their own social lives, etc.). (Under Secretary's Task Force Report on Long Term Care; 1991; 2-25--DRAFT).

More widespread use of assistive devices could alleviate some of the need (and demand) for informal care. Consequently, assistive devices could take some of the pressure off of informal caregivers. Preliminary analyses of the 1989 National Long Term Care Survey indicate that the use of assistive technology is increasing while rates of informal caregiving are declining.

IX. DISADVANTAGES OF ASSISTIVE DEVICES

Although elderly individuals with functional impairments can realize tremendous benefits from assistive devices, technology brings with it problems and disadvantages too. Many of the problems result from mismatches between individual needs and assistive devices. What works beautifully for one person, may be a dismal failure for another, due to unique characteristics of the people involved.
PERSONS WITH MULTIPLE IMPAIRMENTS
Many assistive devices are designed on the premise that they can compensate for a person's impaired ability. However, when an elderly person has more than one impairment, the ability to use the device may be impaired as well.

Consequently, certain assistive devices may not be as effective for people with multiple ADL impairments. Finding the appropriate device for an individual with a particular set of impairments can be time-consuming if one lacks broad knowledge of the market (Office of Technology Assessment, 1985:215).

Alice T. is 82 years old and has severe osteoporosis and a respiratory problem. She would like to use crutches to help her get around, but her respiratory problem impairs her stamina. While the device would be quite helpful to her if she had only one problem, her multiple disabilities make it difficult to use the crutches. A more complex (and costly) assistive device like a motorized wheelchair may be needed.
PROBLEMS FOR PERSONS WITH COGNITIVE IMPAIRMENTS
For cognitively impaired people, assistive devices can be difficult to understand and use correctly. Cognitive impairments are estimated to affect about half of the nursing facility population and about one-fifth of community long term care recipients (U.S. Office of Technology Assessment, 1985:215).

Potential users of assistive devices need to be evaluated for their cognitive abilities to use the devices. Confusion and reasoning difficulties can restrict a person's ability to get the most out of technology. In addition, memory-impaired persons may forget where they put an assistive device or forget its purpose and how to use it.

Advances in microprocessor technology may overcome some of these limitations. Computerized systems of reminding or cuing the cognitively impaired on the location and use of assistive devices appear feasible. More research in this area is needed.
NEGATIVE SOCIETAL ATTITUDES
There exists a bias in American society against rehabilitation of the elderly. Many people accept "the stereotyped view that deterioration is inevitable" (Office of Technology Assessment, 1985:216). Rehabilitation of older people has not been a priority.

Sociologists attribute this bias to the fact that many elderly persons are no longer in the workforce; as a result their contributions are not adequately valued and investments in improving their functional abilities may be judged as not worth the cost. Evaluating the rehabilitation potential of the elderly is difficult, since so few are offered the opportunity (Kane, Kane and Arnold, 1983).

X. WHO PAYS FOR ASSISTIVE DEVICES?

None of the four major sources of health care funding for the elderly (Medicare, Medicaid, private insurance and out-of-pocket payment) offer comprehensive coverage for assistive technology. However, the Department of Veterans' Affairs (DVA) and some new private financing arrangements may offer new options to pay for assistive devices. In this section, each of the public and private funding alternatives are briefly described.
MEDICARE
The Medicare Part B program will pay up to 80% of the cost of assistive technology as long as the devices meet the Medicare definition of "durable medical equipment" (DME). Medicare policies define durable medical equipment as items that are "primarily and customarily used to serve a medical purpose, and generally are not useful to a person in the absence of illness or injury" (U.S. House of Representatives, 1991; 154).

Many assistive devices, such as electric garage door openers, microwave ovens, and golf carts, were designed for the fully mobile, independent adult. Medicare does not cover most of this type of items.
MEDICAID
Medicaid may pay for assistive devices if a person meets the eligibility requirements for the program. However, since Medicaid covers only 13.5% of the elderly population, it is not a viable financing option for most older citizens. (Under Secretary's Task Force Report on Long Term Care, 1991:3-5--DRAFT). In addition, there is considerable variation among state Medicaid programs in their coverage of assistive devices. Consequently, individuals are forced to look elsewhere for financial assistance, most notably to the private sector.
DEPARTMENT OF VETERANS' AFFAIRS
The Department of Veterans' Affairs purchases more assistive devices for individuals with disabilities than most other agencies. In addition to buying millions of dollars worth of hearing and seeing aids and wheelchairs, the DVA also buys automobile/van adaptive aids, patient lifts, hospital beds and other medical equipment. It also offers a clothing allowance benefit to replace clothing that is ruined when using assistive devices.

Although a person must be eligible to receive DVA benefits, DVA is considered by many to be a model payment system. It has a very systematized structure to pay for its large volume of equipment purchases. It uses enormous amounts of resources to educate and train clinical personnel in the use of assistive devices.

Furthermore, it supports and extensive staff of equipment procurement specialists. DVA also invests in research and development, evaluation, promulgation of standards, and development of procurement guidelines for assistive devices. (Reeb, 1989:1)

The DVA payment system is quite comprehensive, compared to other third party payment systems. The program covers traditional medical equipment such as artificial limbs and wheelchairs, as well as products that typically fall outside the medical bailiwick, such as automobile and home modifications.
PRIVATE PAYMENT SYSTEMS
Two common methods of private health care funding are payments made directly by consumers ("out of pocket payments") and private insurance. For less costly devices, such as modified eating utensils and simple object grabbers, out of pocket payment is reasonable. However, more complex equipment, such as electric wheelchairs, are often unaffordable to the average disabled elderly individual. For these major purchases, people often turn to private insurance.

A key problem with private insurance policies is that they frequently won't pay for off the shelf products, even when the products are effective and less stigmatizing. According to RESNA, "if an in-home device looks desirable or useful to an able-bodied person, or if it looks like a luxury or convenience to a completely functional person, funding will be denied." (RESNA, 1990:458)

Two alternative methods of paying for assistive devices are assistive financing and subsidy financing. Assistive financing, or loan guarantee, involves a partnership between a private financial institution and another organization interested in underwriting credit financing to targeted populations. This type of financing allows people to pool costs and risks.

Historically, banks have been hesitant to make loans for assistive devices to elderly people because the applicants generally have limited financial resources and the equipment would have minimal resale value. With assistive financing, an interested third party assumes some of the repayment obligation, thus reducing the bank's risk.

Assistive financing has two major benefits. First, since it requires consumers to contribute to the cost of the product, it encourages them to use it more effectively. Second, it taps funding from the extensive resources of the private credit industry.

Although assistive financing systems are still evolving, many successful programs are already underway. In 1988, the Mitarai/Canon Optacon Financing Program began extending low interest loans to eligible applicants for the purchase of the Optacon II, a reading device for the blind (Reeb, 1989:7).

Subsidy programs are a second alternative for financing assistive devices. These programs provide equipment at reduced cost or for free. The subsidy may be in the form of a grant, a rebate, or a discount. It may target specific products, or an entire product line.

Subsidy programs promote broader distribution and encourage people to use devices they might not otherwise consider. Many private and nonprofit organizations, such as Associated Services for the Blind and United Cerebral Palsy Association of Western New York, have developed specific subsidy programs.

XI. MUCH TO LEARN: RESEARCH NEEDS

In the emerging, evolving field of assistive technology, there are several gaps in the research. First, studies need to be undertaken to determine the costs and benefits of assistive devices compared to human assistance. It is possible that despite the high cost of certain assistive devices, the ultimate costs may be lower than ongoing human assistance.

The field needs empirical research to determine the effect of the use of assistive technology on other types of services. In addition, the benefits in terms of increased independence and quality of life need to be measured.

The field also needs to undertake more research on better ways to get out information on assistive technology. Research should be undertaken to determine the most effective ways to inform professionals, families and consumers about new devices, the best ways to use them, and ways to pay for them.

Physicians and case managers, especially, need to have ready access to information about assistive devices and how to use them. It is likely that with more and better information, disabled elderly individuals would be able to select more appropriate equipment and use it properly.

Finally, the prices of assistive devices need to be explored. For instance, there are many inexpensive assistive devices that could be very useful to certain disabled elderly individuals. These devices need to be identified and cataloged. Furthermore, research should be undertaken to figure out how to make expensive devices more affordable to elderly individuals.

XII. POLICY CONSIDERATIONS

In this writer's opinion, the goal of public policy regarding assistive technology should be that functionally disabled elderly individuals receive the most appropriate mix of active help, standby help and assistive technology to overcome or compensate for their limitations and live as independently as possible.

Policymakers should understand that a single form of technology is often not the only answer for a certain functional limitation, nor is it always economically or medically advisable to substitute devices for human help. Other approaches, such as personal assistance, learning new skills, and adapting to a new environment can be equally or more beneficial.

To increase the development and application of assistive technology, policymakers must focus on four issues.

1. Public policy needs to make assistive technology more affordable and accessible. If assistive technology is to reach its maximum potential, disabled elderly people will have to be able to afford it. Policymakers could make a significant contribution by focusing on helping middle class individuals buy assistive devices--these individuals are too wealthy to qualify for many public programs, yet too poor to afford the devices out-of-pocket.

In addition, there is a vital need to develop a comprehensive reimbursement plan that can avoid fragmentation and allow for service packages that combine human assistance and assistive devices.

2. Information on assistive devices must be more available. Often devices are not used, or the wrong devices are used because of poorly trained clinicians who lack access to up to date information. Policymakers should especially focus on getting information out to people who have direct contact with disabled elderly individuals who are poor and living in isolated areas.

3. Policy should not be based solely on economic factors. Policymakers should avoid creating situations in which a person purchases a specific device simply because it is subsidized, even though it may not be the best fit for the circumstances. This policy concern relates to both information dissemination and financing.

Observers have noted that existing policy reimburses for a relatively narrow range of available equipment. This can lead to inequitable resource allocations and inhibit individuals' ability to select the best combination of options for community living. An additional concern is that advocates for specific types of assistive devices that are not reimbursed will be quite active in trying to get their services recognized.

4. Functionally impaired individuals should have the opportunity to participate in deciding which type of device they will use and decisions should never be considered final. The decision should be made after a thorough assessment, and should be reversible if the individual discovers that the device is not the best match for their skills, impairment or motivation level. In addition, the choice should take into account that the most beneficial situation for a person may include a combination of assistive devices plus human help; under current policies, people may be forced to choose one or the other.

XIII. CONCLUSION: NEED FOR COORDINATION

In this writer's opinion, the major barrier to assistive technology is the severe fragmentation of the community service delivery system and its financing structures. Several agencies provide assistive devices, or counseling or training on how to use them, or financing for them, but there is not a smoothly coordinated system.

Although some people can get some devices and receive support to use them properly, the delivery system appears to be rife with confusion in coverage policies, gaps in service, and an overall lack of continuity. While P.L.100-407 was welcomed in the field, it also contributed to the confusion and lack of coordination among public and private systems.

The highly divided financial support system fails to encourage the development of coordinated services that could provide access to appropriate assistive devices. The U.S. is quite advanced technologically; unfortunately, due to the lack of coordination in the service system, disabled elderly individuals do not reap the maximum benefits from this level of sophistication.

While the Technology Related Assistance for Individuals with Disabilities Act is a step in the right direction, its ultimate success will lie in its ability to serve as a foundation, upon which we build an entire, coordinated delivery system.

REFERENCES

Breuer, J. A Handbook of Assistive Devices for the Handicapped Elderly: New Help for Independent Living. The Hayworth Press, Inc., New York, NY, 1982.

Fernie, G. "Robotics-A Commentary from the Perspective of Applications in Geriatrics." Interactive Robotic Aids-One Option for Independent Living: An International Perspective, New York, NY, 1986.

Forbes, W. "The Evaluation of Assistive Devices." Rehabilitation Digest, Fall 1990.

Kane, R.L., R.A. Kane, and S.B. Arnold. "Prevention in the Elderly: Risk Factors," paper prepared for the Conference on Health Promotion and Disease Prevention for Children and the Elderly. Foundation for Health Services Research, September 16, 1983.

Levine, R. and L. Gitlin. "Home Adaptations for Persons with Chronic Disabilities: An Education Model." The American Journal of Occupational Therapy, April 1990.

Manton, K.G. "Epidemiological, Demographic and Social Correlates of Disability Among the Elderly." The Milbank Quarterly, 67:2, 13-58. [ http://aspe.hhs.gov/daltcp/reports/epdemes.htm]

Office of Special Education and Rehabilitation Services. Summary of Existing Legislation Affecting Persons with Disabilities. Clearinghouse on the Handicapped, Publication No. E-88-22014, Washington, DC, August 1988.

Office of the Assistant Secretary for Planning and Evaluation. "The Long-Term Care Population and Its Use of Services," draft, December 1990.

Reeb, K., Jr. "Assistive Financing for Assistive Devices: Loan Guarantees for Purchase of Products by Persons with Disabilities." Electronic Industries Foundation Rehabilitation Engineering Center, Washington, DC, January 1989.

RESNA. Assistive Technology Sourcebook. Resna Press Publishers, Washington, DC, 1990.

Under Secretary's Task Force on Long-Term Care. Long-Term Care of the Elderly: The Financing Challenge for the Nineties and the Twenty-First Century, February 15, 1991.

U.S. House of Representatives, Committee on Ways and Means. 1991 Green Book: Overview of Entitlement Programs. U.S. Government Printing Office, Washington, DC, 1991.

U.S. Office of Technology Assessment. Technology and Aging in America, Washington, DC, June 1985.

U.S. Office of Technology Assessment. Technology and Handicapped People, Washington, DC, May 1982.

U.S. Senate, Special Committee on Aging. Developments in Aging: 1987, Volume 3. U.S. Government Printing Office, Washington, DC, February 1988.

Ward, C. "Subsidy Programs for Assistive Devices." Electronic Industries Foundation Rehabilitation Engineering Center, Washington, DC, September 1989.

NOTE

Robert Elliott is an undergraduate student at the University of Pennsylvania. He prepared this paper as part of a summer internship in the Division of Long-Term Care and Aging Policy, Office of Family, Community, and Long-Term Care Policy, Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services.

For further information, contact: Robert F. Clark, D.P.A., DHHS.OS/ASPE/FCLCP, Room 424E, H.H. Humphrey Building, 200 Independence Avenue, S.W., Washington, D.C. 20201, Phone (202)245-6443

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Assistive Technology for the Frail Elderly: An Introduction and Overview

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PDF Version (19 PDF pages) This report was prepared under contract between HHS's Office of Family, Community and Long-Term Care Policy (now DALTCP) and the University of Pennsylvania. For additional information about this subject, you can visit the DALTCP home page at http://aspe.hhs.gov/_/office_specific/daltcp.cfm or contact the office at HHS/ASPE/DALTCP, Room 424E, H.H.

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OTs role within advocacy and research is to advocate and promote occupational therapy and client-centered care for individuals, communities, and legislative policies (AOTA, 2022). Research is imperative for both the advocacy of the occupational therapy profession and support for evidence-based practices by occupational therapy clinicians.

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1. Stair lift (Acorn)
2. Motorized wheelchair
3. Brailler
4. Cochlear Implant
5. Electrically powered/Myo-electric prosthesis

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Beyond bionics: how the future of prosthetics is redefining humanity

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https://lucymarmitchell.medium.com/health-tech-an-occupational-therapists-perspective-56195fd19ba0

https://www.nhs.uk/better-health/

American Occupational Therapy Association. (2015). Fact sheet: Occupational Therapy’s Role with Health Promotion. https://www.aota.org/~/media/corporate/files/aboutot/professionals/whatisot/hw/facts/ factsheet_healthpromotion.pdf

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I'm fascinated by the intersection of health and technology. We only get one shot at this rollercoaster ride of life and one body, so the concept of digitally managing healthcare, or automating portions of it, really excites me if it means improving management of and access to records, patients having increased autonomy in their own care, and clinicians being freed from administrative tasks which take up a disproportionate amount of time. In short, to me health technology represents the opportunity to improve quality of life.
What is digital health?
It's a massive field incorporating lots of different aspects and approaches.
Digital health Generally, digital health is concerned about the development of interconnected health systems to improve the use of computational technologies, smart devices What is occupational therapy? Why is this relevant? , computational analysis techniques and communication media to aid healthcare professionals and patients manage illnesses and health risks, as well as promote health and wellbeing. OTs promote and help people work towards achieving independence. is the convergence of digital technologies with They look at activities you find difficult and see if there's another way you can do it. , healthcare, living, and society to enhance the efficiency of What is the point of this article? healthcare delivery and make medicines more personalised and precise. The discipline involves the use of information and communication technologies to help address the health problems and challenges faced by patients. These technologies include both hardware and software solutions and services, including telemedicine, web-based analysis, email, mobile phones

unifying the different IT systems/structural framework of the current NHS

embracing new technologies which would revolutionise current practice

and applications, Apps text messages, wearable devices, and clinic or remote monitoring sensors. Preventative medicine and digital self-monitoring:
Digital health is a multi-disciplinary domain and a booming industry sector, and has more stakeholders than just patients. On a core level it brings together these patients (as service users) with clinicians, researchers and scientists across public health, engineering, social science, economics and development.

Ah, how my heart rejoices when I don't have to explain what occupational therapy is to someone. Why is it difficult? Because it's nebulous. You can be an OT in a hospital, in the community, for children, for the elderly, for war vets, for people with serious mental health conditions - and every single job description would be very different. The unifying thread would be:

or, as the NHS puts it:
Dementia:
Let's get this out of the way now. "Occupation" in this context is nothing to do with an employer. It refers to any human occupation or 'activity'. Broadly, OT rubric tends to classify all human activities into categories of leisure, self care, or productivity (though there are other approaches).

Think about it this way: if you get sick (short term or 'acute') or you're affected by illness for a long time/a lifetime (a chronic condition), it will have significant impacts on your ability to function. Broken arm? Tying your hair up = difficult. Broken ankle? Driving your car suddenly not possible. Moderate to severe anxiety? Potentially no more going to the supermarket for you. Elderly and frail? High likelihood of spilling boiling water on yourself when lifting up kettle to make tea, or slipping when climbing out of the bath. Arthritis? Even doing up the buttons on your shirt, or dialling a phone number can be a trial. An OT can help with ANY AND ALL of these things. They are the NHS's secret weapon and benefit patients' lives hugely.
Gamifiying physical rehab:
If I could find ways to help patients help themselves where it was appropriate to do so (be their own OTs, to a degree), I would really feel like I had achieved something. Teach a man to fish, and you feed him for the days he wants to eat fish. Teach someone to manage their own health, and you have helped them improve their quality of life for as long as they live.
Reduced vision:
An article covering all the different ways in which technology currently contributes to healthcare would end up gargantuan and unwieldy. Many articles already exist citing that month's most exciting fitness or calorie tracker app. As an occupational therapist, I am a professional uniquely concerned with individual engagement in meaningful activities, and how I can help people overcome barriers. As a developer, it really excites me to see how people are coming up with interesting and innovative apps to further encourage this engagement. Business and profit aside, a lot of the time, it just warms my heart to see how tech can contribute to improving quality of life. Writing this article could help me find ways in which I can contribute, too.
Primary Care:
When I lived in South London, I would ride past a building now requisitioned as a sexual health clinic. Every day, I would see this wonderful plaque:

It made a huge impact on me, and has stayed with me ever since, as it put into words how I feel about healthcare. If you have ever been seriously unwell or known someone who has been, you know how much other aspects in your life suddenly play second fiddle to your health. There truly is nothing more important than your mental and physical health in this life. Improving global healthcare (both access to, and delivery of) is of paramount importance.
What else is there to consider, though?
Having worked in the National Health Service, I can immediately see the benefit of improved technology for clinicians alone. I could write a gobsmackingly long article on the inadequacies of the current IT system; how utterly unusable and contrary to efficient clinical service provision it is, but also how it renders the system virtually inaccessible to patients/service users. Imagine trying to provide care for patients when the information is spread out over at least 6 databases, none of which talk to each other. I am heartened by the fact that the work undertaken in the past by the heroic and trailblazing Human Genome Project, which took 13 years and over £2 billion to complete, can now be accomplished in under 24 hours for not much more than a thousand pounds. I live in hope for public healthcare in the UK.

Still - this highlights something interesting about contemporary conversations surrounding health tech. There are actually two issues here:

Both of them involve incorporating a pro-tech outlook on health and a total paradigm shift in how we look at healthcare; a focus on prevention rather than cure, of self-management and patient autonomy rather than clinician power, gatekeeping access to services. If service users are more engaged with monitoring their own health and acting early to prevent deterioration, access to treatment would end up not being so heavily oversubscribed. I will be focussing more on the second point, and hopefully able to write more clearly on the first following further research.

The NHS currently has a beta list of apps which it endorses and which promote a healthy lifestyle.

There are also lots of private companies doing the same. Some, like Strava, Sleepcycle, and Headspace (for cycling, sleep cycle monitoring, and meditation respectively) have been around for some time with a high take-up rate from the public. Though I haven't been able to find a more up to date statistic, Business Insider reported in 2014 that

approximately 85% of health apps in the market [...] are for wellness, designed to be used primarily by the consumer, and the remaining 15% are medical, designed to be used by physicians.

There are amazing technologies being designed and trialled now, and many ventures being supported by things like the Digital Health London Accelerator Scheme. I wanted to get a better overview of what's happening and available on the market (or just about to be) so I picked a few for the following themed list; in no way exhaustive or in any order, we have:

One of the most fundamental aspects of the exciting new world of digital health is, to me, the possibility that patients can have more control through a preventative approach to healthcare. In short, this is the embodiment of the phrase "prevention is better than cure". It's better for your health to try and lead a healthy and balanced life, and keep an eye on things as you go, rather than live obliviously then end up seriously unwell and getting emergency treatment.

As Helen Parrot points out, the NHS has long advocated for people (especially those living with chronic conditions) to take more responsibility for monitoring their health, but has consistently failed to provide people with the tools to do so. Wearables like the Fitbit and Apple Watch now enable the lay person to have access to capturing personalised health data like their heart rate, and more. Apple is reportedly working on a new product to monitor blood glucose levels without piercing the skin, for people with diabetes to have more autonomy in their essential daily monitoring - but there are other companies and initiatives working on the same.

Apps in particular, thanks to the ubiquity and accessibility of smartphones, can encourage users to stay more engaged with symptom tracking and management, linking them more with feedback from their idiosyncratic health situation, ranging from diabetes to hypertension, atherosclerosis, and chronic obstructive pulmonary disease(COPD).

We are living in a time both of population growth and of increasing life expectancy; managing multiple comorbidities in an ageing population. Someone in the world develops dementia every three seconds. Dementia detection has historically relied on pen and paper tests administered by GPs, and referral to a memory clinic if memory is affected (which suggests significant disease progression). But progress has been made by AI and big data in the field of dementia detection. This could mean not just earlier detection, but more personalised and effective care to complement the advice on assistive technology and lifestyle for those with dementia (especially Alzheimers), and those who care for them. We can't yet treat dementia fully, but if given earlier warning, perhaps lifestyle changes and treatment could be more easily incorporated. Every little helps.

For older adults who may or may not live with dementia as well as other health conditions, the likelihood of staying well and staying put in your own home dwindles. As an OT, my heart rejoices to see companies like Birdie looking into and promoting ways to keep people in their own homes, and still meet their care needs.

One of my most beloved rotations in OT was hand therapy. Highly specialist, it aims for full return to function for those who have had a hand or wrist injury of any type (as a developer, I've given more than my fair share of advice to devs struggling with carpal tunnel!). It covers the full spectrum, from chronic, early onset and lifelong arthritis - of which there exists multiple types - to avocado hand, severed tendons, knife and gun injuries, amputations, circular saw injuries, and tendonitis. One of the most crucial aspects of my job was to introduce assistive and adaptive tools, and maintain their essential engagement with a personalised rehab program, because they simply will not recover if they don't do the exercises. Physiotherapists have a very similar struggle - and now they are starting to approach it as something to collaborate with patients on as a game, and enjoy it, rather than take the traditional didactic approach. There are also the beginnings of physio apps for people to take more control and logging of their rehab data - I would love for these to become the norm in clinical settings and have patients be able to take their progress home with them.

An inability to visualise the world and your immediate surroundings can drastically curtail involvement. Aira offers a service where people with reduced vision can access the world around them safely and informedly via a pair of smart glasses and phone call connection to an 'agent' who can verbally feed information back to them.

There are many caveats to primary care/GP access. The issue of getting an appointment within the next 3 weeks notwithstanding, if (like me) you are one of the 10,000 people in London who live on a boat and must travel 20+ miles over the course of a year, even getting to the practice itself can be problematic to say the least. All this has been revolutionised by the app GP At Hand. Powered by Babylon Health and partnered with the NHS, the app gives you the option to connect via voice- or phone-call with a GP in minutes, and electronic prescription services sent to your local pharmacy. Digital appointment summaries are available immediately following an appointment and the app links up with your calendar and phonebook if you want, to ensure success is maximised.

Despite the huge failure so far of updating the NHS system and its records, the positive impact of GP At Hand for those who struggle with traditional GP services makes me feel hopeful about the NHS app which is apparently to be publicly released at the end of 2018.

A lot of health technology rests upon the Internet of Medical Things ( IoMT),

the collection of medical devices and applications that connect to healthcare IT systems through online computer networks.

As of January 2018, there were 3.7 million medical devices in use to monitor different parts of the body and inform healthcare decisions. The benefits are huge - objective, precise and potentially remote reporting of individual data. However, the use of tech like fitness or calorie counting apps have also been linked to "eating disorder behaviours", and have the potential to create harm or detract from health. Even "well-intentioned" apps can have unintended consequences and exacerbate unhealthy behaviours to meet the app's goals. Similarly, there are few apps which have been through any scientific rigour or standardised testing prior to being available publicly.

It is prudent not to succumb to what has been termed 'apptimisim' and (as with anything that is a product of the internet, or the Internet of Things) treat it with as much caution as celebration. They're just tools. " You can't blame the hammer for what the carpenter does with it ".

Lastly, though there are innovative things being designed with great potential to do good and improve healthcare, it doesn't necessarily mean the market will support them, or services will take them on. I am excited to see what comes next, and keep thinking of ways I can add value to this global conversation.

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Health Tech: An Occupational Therapist's Perspective

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I'm fascinated by the intersection of health and technology. We only get one shot at this rollercoaster ride of life and one body, so the concept of digitally managing healthcare, or automating portions of it, really excites me if it means improving management of and access to records, patients having increased autonomy in their own care, and clinicians being freed from administrative tasks which take up a disproportionate amount of time.

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1. Sock aide
2. Dressing stick
3. Elastic shoe laces
4. Mobility devices (rolling walker, cane, standard wheelchair, etc.)
5. Universal Cuff

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1. Association memberships (Networking/Research)
2. Podcasts (Microphone, computer/editing technology) (Advocacy)-- Can be low tech if listening to Podcasts (Research)
3. Statistical Technology (Advocacy, Conducting research)
4. Seminars (projector, microphone, etc.) (Advocacy)
5. Website (Advocacy)

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1. Social Media (Networking/Advocacy)
2. E-mail (Advocacy/Networking)
3. Open Access Journals (Google Scholar, Pub med, etc. ) (Research)
4. Zotero (Free citation manager) (Research)
5. Library Resources (Research)

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https://www.nichd.nih.gov/health/topics/rehabtech

https://www.nichd.nih.gov/health/topics/rehabtech/more_information/resources

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Rehabilitative and assistive technology refers to tools, equipment, or products that can help people with disabilities successfully complete activities at school, home, work, and in the community. Disabilities are disorders, diseases, health conditions, or injuries that affect a person's physical, intellectual, or mental well-being and functioning. Rehabilitative and assistive technologies can help people with disabilities function more easily in their everyday lives and can also make it easier for a caregiver to care for a person with disabilities. The term "rehabilitative technology" refers to aids that help people recover their functioning after injury or illness. "Assistive technologies" may be as simple as a magnifying glass to improve vision or as complex as a digital communication system.

Some of these technologies are made possible through rehabilitative engineering research, which applies engineering and scientific principles to study how people with disabilities function in society. It includes studying barriers and designing solutions so that people with disabilities can interact successfully in their environments.

NICHD houses the National Center for Medical Rehabilitation Research (NCMRR), which is charged with advancing scientific knowledge on disabilities and rehabilitation, while also providing vital support and focus for the field of medical rehabilitation to help ensure the health, independence, productivity, and quality of life of all people. Through the NCMRR, NICHD supports the development and testing of rehabilitative and assistive technologies, with a focus on physical rehabilitation.

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Rehabilitative and assistive technology refers to tools, equipment, or products that can help people with disabilities successfully complete activities at school, home, work, and in the community. Disabilities are disorders, diseases, health conditions, or injuries that affect a person's physical, intellectual, or mental well-being and functioning.

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https://www.aota.org/advocacy

https://research.aota.org/ajot

American Occupational Therapy Association. (2022). Advocacy: AOTA is advocating for you. https://www.aota.org/advocacy

Bradenburg, M. (2021). Evidence perks: improving evidence-based practice: why OT professionals are listening to podcasts. https://www.aota.org/publications/ot-practice/ot-practice-issues/2021/evidence-perk-improving-evidence-based-practice

Thackeray, R. & Hunter, M. (2010). Empowering Youth: Use of Technology in Advocacy to Affect Social Change. Journal of Computer-Mediated Communication, 15(4), pp. 575–591. https://doi.org/10.1111/j.1083-6101.2009.01503.x

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Technology Outreach to Reduce Health Disparities and Stigma