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The automated wheelchair prototype for tiny tots, pictured below, was my favorite AT/AE presented at the 2019 Boston Abilities Expo.  The chair featured bright, fun, colors, an adjustable seat for moving the child closer to or further away from the lap tray, a fun underwater scene on the lap tray, a simple joystick-like controller, as well as an elevation feature to help the child be involved in activities occurring at various heights.

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The example pictured in the two images below is of a specially-designed chair which fits into a track, enabling an individual to remain in the same chair, with only the lower part of the chair changing. For example, when transferring from a wheelchair to a shower chair, the seat moves from the wheelchair base to the shower chair base. This simplifies chair-to-chair transfers for individuals who are dependent in mobility and eliminates the use of a mechanical lift for such transfers, which can be traumatic for some individuals.

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The low tech transfer device pictured below was presented at the 2019 Boston Abilities Expo.  It is a multi-handled transfer seat cover that folds into a shoulder bag, for easy portability.  It is a strong, but easily cleanable, fabric.  It features storage pockets for the individual using the device  and it has several handles to secure the fabric over whatever chair it is in as well as to enable multiple hand to assist in a chair-to-bed, bed-to-bed, or chair-to-chair transfer, if necessary.

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The device pictured below is a tool known as an augmentative and alternative communication device. This one, in particular, was designed for children who are speech impaired.  It was presented at the 2019 Boston Abilities Expo, by Easter Seals.  It is a software program for tablet computers that uses images to help children communicate without speech. They simply select the item which they are communicating about and the device uses predictive text to assist the child in forming a complete sentence, which the device reads aloud for the child, to express themselves verbally without the child needing to be verbal themselves.

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Low tech devices to assist the hearing impaired can range from use of a pen and paper for non-verbal communication, to a magnetic letter board with large letters for individuals with fine motor challenges, to a service animal hearing dog.

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High tech AT devices and equipment are complex.  They
have electronic or digital components, usually require training, and tend to be the most expensive.
Pictured below is an example of high tech AT. It is a TENS (trancutaneous electrical nerve stimulation) massage sandal, which uses electrical impulses to trigger gentle muscular contractions to increase circulation to the foot and relax the muscle to decrease pain. This item was presented at the 2019 Boston Abilities Expo.

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Low tech AT is much less complex.  It doesn't usually require much, if any, training or have mechanical features, and it is usually less expensive.
The following picture is of a low tech device, which was presented at the 2019 Boston Abilities Expo.  It is a multi-handled transfer seat cover that folds into a shoulder bag, for easy portability. It is a strong, but easily cleanable, fabric. It features storage pockets for the individual using the device and it has several handles to secure the fabric over whatever chair it is in as well as to enable multiple hand to assist in a chair-to-bed, bed-to-bed, or chair-to-chair transfer, if necessary.

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Broadly, assistive technology is any product or piece of equipment which assists the functioning of individuals (Goodrich, & Garza, 2015).

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Understanding Assistive Technology: Simply Said

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Understanding Assistive Technology: Simply Said

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(Paracenter, 2010)

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Understanding Assistive Technology: Simply Said

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AE is nearly synonymous with AT.  All AE is AT, but not all AT is AE.  All AE is AT because AT includes all devices, both high and low tech, which can modify the person, activity, or environment to increase occupational performance.  In a nutshell, that defines what AE is.  AT, however, also includes services, such as AT use training, which does not fall under the AE umbrella.

For more information, use the following link to read about the Federal definition of AT: https://ectacenter.org/topics/atech/definitions.asp

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Easter Seals presented the device in the two images below at the 2019 Boston Abilities Expo.  It is a battery intercept, which utilizes a large push button to activate whatever the battery is powering.  In the examples below, a child lacking the muscle strength, coordination, or power or fine motor ability to operate the dinosaur or penguin slide toy need only utilize the gross motor capacity to push the large red button to activate the toys for play participation.

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Examples of low tech for the pediatric population may include small, stackable, cubes for learning in-hand manipulation, visual schedules which provide children who have difficulty with transitions to anticipate activity changes, pencil grips can assist children with immature grasp patterns to write, highlighters can assist children with visual tracking when they read, slant boards assists children in putting their fingers into a flexed position while they write, and adapted paper can help children with visual deficits learn to write by making the borders for letter writing clearer.

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Cook, A., & Hussey, S. (2015).  Assistive technologies: principles and practice. St. Louis, Mosby-Elsevier.

Goodrich, B. & Garza, E. (2015). Assistive technology defined. Retrieved from https://www.aota.org/About-Occupational-Therapy/Professionals/RDP/assistive-technology.aspx

Goodrich, B. & Garza, E. (2015). AOTA fact sheet: The role of occupational therapy in providing assistive technology devices and services [PDF Document]. Retrieved from https://www.aota.org/~/media/Corporate/Files/AboutOT/Professionals/WhatIsOT/RDP/Facts/AT-fact-sheet.pdf

Massachusetts Department of Elementary and Secondary Education. (2012, November). Access to learning: Assistive technology and accessible instructional materials [PDF Document]. Retrieved from http://www.doe.mass.edu/sped/assistive/AccessToLearning.pdf

Ohio State Wexner Medical Center. (2018, June 6).

Augmentative and alternative communication (AAC) program at Ohio State

[Video file]. Retrieved from
https://www.youtube.com/watch?v=uMDSeh482AM

Pacercenter. (2010, November 12). Understanding assistive technology: Simply said [Video file]. Retrieved from https://www.youtube.com/watch?v=DB9pKkZoJDc

Regier, A. D., Berryman, A., Hays, K., Smith, C., Staniszewski, K., & Gerber, D. (2014). Two approaches to manual wheelchair configuration and effects on function for individuals with acquired brain injury. NeuroRehabilitation, 35(3), 467–473. Doi:10.3233/NRE-141138

Sparacio, J., Chovan, C., Petito, C., Hall, J.A., Pedersen, J.P., Jackson, L.A., & Gregorio-Torres, T.L. (2017). AOTA fact sheet: The role of Occupational Therapy in providing seating and wheeled mobility services [PDF Document]. Retrieved from https://www.aota.org/~/media/Corporate/Files/AboutOT/Professionals/WhatIsOT/RDP/Facts/Wheeled-Mobility-fact-sheet.pdf

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AT services fall well within the scope of practice of Occupational Therapy (OT) as the professional focus of OT is in developing, maintaining, and restoring occupational functional performance in clients (Goodrich, B. & Garza, 2015). AT can augment OT services in meeting this primary objective. (Goodrich, B. & Garza, 2015)

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Selection considerations should begin with low tech first, as low tech may be less expensive and easier to learn how to use as well as to operate and maintain (Massachusetts Department of Elementary and Secondary Education, 2012).  Individuals should try out the device in the presence of a trained professional, in order to assist in determining if the device is appropriate for the individual’s cognitive and physical status as well as the time and resources needed for the individual to learn to use the device (Massachusetts Department of Elementary and Secondary Education, 2012).  It is also important, however, for the client to engage in the trial in as natural a setting, or settings, as possible so that the experience is as authentic as possible to what the client will experience when they are actually using the device in their day to day life (Massachusetts Department of Elementary and Secondary Education, 2012).

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The HAAT, or human activity assistive technology, OT model of practice focuses on an individual performing an activity in context and uses AT to facilitate participation and maximize performance in the activity (Cook & Hussey, 2015).

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What AT selection should come down to is a holistic combination of which device will best develop, maintain, or improve function (depending on specific client factors and goals) and what the client prefers.  Other factors may also dictate selection, such as affordability, client factors and cognition, product availability, and practicality.

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OTs role in                    Seating & Positioning 

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OTs role in                    Seating & Positioning 

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The role of OT in seating and positioning is in holistically assessing clients and recommending durable medical equipment (DME), mobility systems, and cognitive rehabilitation therapy (CRT) for clients in order to improve their quality of life by improving their environmental access and safety of their daily occupations (Sparacio et al., 2017).  Occupational Therapists are uniquely qualified to do this because of the professional perspective that considers the client in context with their environment and with appreciation of their valued occupations (Sparacio et al., 2017).  Occupational Therapists are responsible for a significant number of the letters of medical necessity (LMN) which are written up with for DME and CRT equipment due to the fact that the AE is deeply enmeshed in client function.  The OT role in seating mobility doesn’t end with the LMN.  Occupational Therapists also: customize equipment; aid and educate clients, caregivers, and family in using and adapting to the new device(s); keep up with technological advances to benefit clients as well as on policy and documentation changes; and measure client outcomes (Sparacio et al., 2017).

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In the article entitled, “Two approaches to manual wheelchair configuration and effects on function for individuals with acquired brain injury” (Regier et al., 2014), clients with hemiparesis resulting from stroke are discussed.  These clients can navigate their environments by self-propelling in a wheelchair and the specific seat to back angle, cushion firmness, and cushion angle can have a significant effect on the client’s functional mobility without compromising comfort or position (Regier et al., 2014).  It is clear that use of evidence-based practice combined with the client-centered, holistic, nature of Occupational Therapy in assessing, recommending, and customizing DME can have a dramatic impact on client well-being and quality of life.  Addressing this type of functional deficit is central to the scope of OT practice, which is concentrated on issues with function, as clients who have survived acquired brain injuries from stroke and endure residual hemiparesis rely on mobility AT for many activities of daily living, such as dressing, toileting, grooming, and more.

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Augmentative and Alternative Communication (AAC)

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Augmentative and Alternative Communication (AAC)

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What is AAC?
(Ohio State Wexner Medical Center, 2018)

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Augmentative and Alternative Communication (AAC) program at Ohio State

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It is within the OT scope of practice to make specific recommendations with regards to AT which can optimize functional abilities in our clients (Goodrich & Garza, 2015).  Since communication is an integral part of instrumental activities of daily living, such social participation, recommendations about AAC for effective communication is relevant to the OT scope of practice.  It is also within the OT scope of practice to train clients in the use of such devices as well as to advocate for physician’s orders and payments to cover the costs of the devices (Goodrich & Garza, 2015).

Occupational Therapists often fit clients with appropriate AT as a part of a multidisciplinary team (Goodrich & Garza, 2015).  In cases of cognitive deficit, it is important for care providers to participate in the process, to help get a broader picture of the client’s abilities and limitations, as well as to train the care provider to help the client with the device as needed.