Posted by ABLE Tech on January 15, 2002 at 20:35:13:
In Reply to: How to decide what technology is right for you? posted by Elizabeth on December 29, 2001 at 00:10:30:
Source: ABLE Tech
Taking the Mystery Out of Assistive Technology
Assistive technology is a growing and complex field. New developments happen daily. Assistive technology provides the tools that enable many people with disabilities:
Assistive Technology Device is any item, piece of equipment, or product that is used to increase, maintain, or improve the abilities of people with disabilities. Assistive Technology Service is any service that directly assists a person with a disability in selecting, getting, or using an assistive technology device. A growing number of technology-related options are now available. Unfortunately, ongoing misunderstandings (myths) about assistive technology services and devices cause technology solutions to be overlooked or avoided in meeting the needs of people with disabilities.
Using "Experts" to Justify an Assistive Technology Need
Frequently, assistive technology (AT) disagreements boil down to differing opinions; one side believes device A will best meet a person’s need, the other side says device B or C or even D will work. Typically one option is far more costly than the other. What are the parties to do? How do the parties actually determine what will work for a potential AT user? In cases like this, the opinions of "experts" usually decide. Obviously, it helps tremendously if you use the best expertise available to justify your position. However, how does one determine just who is and is not an "expert." This guide begins by offering some questions that consumers, service providers and funding agents can use to decide if an evaluator can be considered an expert in his or her field.
Who conducts evaluations?
Generally, evaluators (or, people who conduct AT assessments) fall into four categories: Rehabilitation engineers, technologists, vendors, therapists and consultants. People conducting evaluations vary widely in their skill level. Some are licensed, others are not. Rehabilitation engineers/technologists use the principles of engineering design, and application of assistive technology for people with disabilities. Generally they problem solve by using engineering disciplines, mathematics, physical sciences, life sciences and analysis. If you use a rehab engineer, ask about his or her range of training and experience.
A vendor sells equipment for a company or companies. Unless you ask about credentials, you will not know. If a vendor conducting an evaluation represents only one company, it is in their interest to sell their particular product. It is better to use vendors that represent a range of products.
Therapists are professionally trained in a specific medical discipline. Those disciplines may include, speech, physical, or occupational therapy and rehabilitation counseling to name a few. Therapists in Oklahoma must pass a test to receive their license to practice.
A consultant can be a licensed therapist, a rehab engineer, a really creative person or just about anyone. There are no licensure or educational requirements to hang out a shingle and declare yourself a consultant. Most consultants have a background in disability or health services. It is up to the person purchasing services to decide if the consultant is qualified to conduct an evaluation.
Just having a license or degree does not guarantee that a person is an assistive technology expert. Nor does the fact someone is a vendor or consultant preclude them from being an assistive technology expert. It is important to ask about a person’s credentials before an assessment. Nevertheless, do not stop there. Beyond those traditional questions, consider asking the following more specific questions. We designed these questions to help you decide if the evaluator is likely to project the credibility needed to get the nod to purchase a device.
How long has the evaluator been recommending this type of AT?
How many devices of this type has the evaluator recommended? Evaluators have more credibility when they have been in the field a few years and have recommended many devices within a general AT area. Beware of individuals who have recommended assistive technology for limited numbers of individuals in the last year. Remember that for many providers, like physical therapists, occupational therapists, speech/language pathologists and rehabilitation counselors, AT is a very small part of their overall position or practice. Many of these providers have limited experience with AT and have only a handful of cases where they actually recommend devices. It pays to ask for references from evaluators whether they appear to have a lot of experience or not.
What age range and/or disability type does the person primarily assess?
Some evaluators specialize within a specific age range or disability type. Such focused expertise can help your case if the consumer falls within those limiting characteristics. However, if you are an adult and the person conducting the assessment has only seen children up to this point, someone could seriously question their opinion. Likewise, if you have a cognitive disability and the evaluator
primarily sees people with physical disabilities, someone could call into question his/her opinion.
What is the evaluator’s track record?
Do the recommendations represent a variety of manufacturers and devices? It is beneficial for any expert to have a proven track record of recommending devices that were actually procured and successfully used over time. If an evaluator has cases where they recommended devices that were not used successfully, you should anticipate that those cases will call into question his/her credibility.
Beware of evaluators who recommend the same device for many or most individuals. How can the evaluator address individual differences if he/she recommends the same device for everyone? Were all of the individuals really that much alike? Recommending the same device repeatedly again implies a disregard for individual differences. One could also argue that recommending the same device reflects limited knowledge of the full range of devices available. Look for evaluators who have current knowledge of the myriad of device options available. Also look for those who have access to a variety of devices to use during their assessment process, and have a track record of recommending a variety of devices. You can also checkout the range of devices on your own, prior to an evaluation, to have firsthand knowledge of what is available.
What assessment procedures does the evaluator use to arrive at a recommendation?
Beware of evaluators who use volumes of standardized testing data in areas such as cognition, visual acuity, auditory acuity, range of motion, fine and gross motor, receptive and expressive language, etc. as the basis for their device recommendation. There is no denying that standardized testing in traditional areas are helpful. However, in AT assessments, it should not form the sole basis for a recommendation. Best practice would include consideration of many other factors. These would include assessing the environments where the person will use the device, the user’s expectations in those environments, the necessary supports for device use, and individual preference in device use. The evaluator should also compare the unique features of a variety of devices to decide which device(s) might meet the individual’s needs.
Will the user actually try the device? For how long?
What outcomes or behaviors were observed during the device usage? The best procedure any evaluator can use to find out if a device will work is to actually have the user perform the desired activity using the device in their natural environment. The evaluator should carefully document the degree to which the device provides the desired outcomes. It makes for an almost irrefutable justification for the device recommendation. While evaluators can yield some information from a structured evaluation setting, typically the fact that the user has so little time with a device, and in an unnatural environment, makes the data less than optimal.
Using a loaned or rented device over a longer time, like a few weeks, in a natural environment, provides powerful data to support a particular device. An evaluator who presents "real-life" observations in a recommendation is far more persuasive than one who presents only a theoretical rationale.
What standard does the evaluator use for his/her recommendation?
Is it consistent with the legal standard in question? Evaluators need to be aware of the difference between their professional opinion as a medical, rehabilitation, or education provider and the legal standard in question. Many providers will recommend devices designed to maximize an individual’s function, which is appropriate based on the professional standard of "best" client services. However, such a recommendation may not be consistent with the legal standard applicable to the case. This is not as complicated as it sounds.
For example, say an evaluator recommends a particular communication device for an individual. He/she may do so because in his/her opinion it represents the "best" standard of client service. However, if a school district is going to pay for a device, "best" is not the standard by which they measure. IDEA, the federal law that governs special education, only requires schools to provide what is "appropriate." Likewise, in an ADA case, the legal standard is to achieve "effective communication." In vocational rehabilitation the legal standard is "necessary for employment." For Medicaid to cover the device it must be "medically necessary." Make sure that your evaluator understands the legal standard upon which his/her device recommendation must be based.
Summary… Finding a person to conduct an assistive technology evaluation is often a difficult task. Ensuring that the person conducting the evaluation is an assistive technology "expert" is even more difficult. We hope this information gives you new questions you can ask evaluators. Our hope is that with this new knowledge you will be better able to pick the professionals whose job it is to make your life better.
The Right Stuff... How to Choose Appropriate Assistive Technology
People with disabilities can use assistive technology (AT) to gain new skills, keep old ones and live more independently. However, choosing the right technology is often a difficult task. Being informed about purchases is important in the ‘90’s. Funding sources want to make sure any device they purchase with dwindling resources is fully utilized. So, whether you are using your own precious resources, or third-party payer funds, you need to spend the money wisely.
Basic Principles
The principles below are universal. No matter what the AT, where it is used or the age of the user... applying these principles will ensure that the device helps you do the job.
A Team Approach is Always Best Even when you are choosing a very simple, low-tech piece of equipment, talking it over with another user, or a person who knows you well, will offer another perspective. He/she may also see some pitfalls that weren’t obvious to you.
Assistive technology assessment teams usually come from different disciplines and can vary from team to team depending on the user’s abilities and needs. Traditionally, the user, a family member or significant other, medical personnel, rehabilitation specialists and occupational, physical and/or speech therapists are members of the team.
Try adding nontraditional team members if you think it will improve the group’s problem solving skills. A custodian, shop teacher, local handy-person or someone good at crafts will look at the issues differently and often have valuable insights. Don’t be afraid to be a courageous problem solver. It will make for a much more elegant solution.
The User is the Most Crucial Team Member Think about your closets for a few minutes. Is there something there that you do not use? Why aren’t you using it? The wrong size? Not your style? Uncomfortable to use? Ugly? It’s too fancy and you’re a jeans and sweatshirt kind of person? Spend a few minutes trying to decide all the reasons this perfectly good item doesn’t work for you. More than likely your reasons will be in the category of "It’s just not who I am!" Like most things we use, assistive technology must ‘fit’ who we are... physically, emotionally, culturally and personally. When the user is central to making the decision, the more likely assistive technology will effectively promote independence.
Significant Others are the Next Most Crucial Members This is especially true for children. Parents will provide the reinforcement, maintenance, training and other aspects of supporting the technology the child will use. If a child needs a computer-based communication device and the only mouse the parents know is the Disney character...the team needs to be aware of that fact and deal with it. If parents are not comfortable with the technology solution, then the child is not likely to see any benefit. For adults, this can also be true, depending on the user’s need for assistance. However, it’s important to remember that just because a person needed assistance in the past, does not necessarily mean that he/she will need it in the future. An appropriate assistive technology solution may dramatically decrease a person’s need for help or eliminate it all together.
IT’S NOT UNTIL YOU TRY A DEVICE IN THE ‘REAL WORLD’ THAT YOU CAN BE SURE IT WILL WORK FOR YOU!
Focus on Function Often disability distracts people. They are unable to see any potential or ability...only the disability. By focusing attention on functional skills, we move away from looking at someone in a clinical way and more toward a functional assessment. A good question to ask when you want to focus on function is, "What does this person want or need to do that he/she currently cannot do?" From there the team can begin to look for ways to alter the environment to enable the person to function more independently.
Strive for Simplicity Techies love wonderfully complicated electronic gizmos with a zillion or more functions. However, assistive technology users only need what will help in accomplishing the task, in the simplest, most efficient way. It’s been said that the best technology solution is a no-technology solution.
For example, a reacher is very simple technology. It allows a person to grab an object they could not otherwise reach. It’s uncomplicated, and not very costly...so a good solution, right? Not necessarily. It may be a better solution to move the out-of-reach items within reach so the user doesn’t need any technology at all.
Keeping solutions simple also reduces maintenance and repair costs. Simple solutions are often easier to use and therefore will be used. Generally they are cheaper solutions, so a funding source (whether it is the user or a third party source) is more likely to fund it.
Generalize About the Use of the Device Where will you use the device? Could it be helpful in other settings? Are there other members of the family who could use the device? By thinking in general terms about the device, you can get more use or increase the effectiveness of the device. Sometimes parents consider purchasing a computer for their child so he/she can do homework. When they consider the purchase, they need to look at the computer needs of the entire family. Could an older sibling use it to write reports? If it came with a modem, can dad or mom fax or E-mail work from home? A computer with a CD ROM drive or modem provides ‘paperless’ access to a wealth of information. Generalizing about the who, when, where, why and how aspects of the product can help the user find a product that meets many, rather than just a specific need. However, remember that if several family members use a device, it will limit access to third party payers.
Considerations for Choosing Assistive Technology
Technology users need to be informed consumers. They need to be smart shoppers, not satisfied with just having someone tell them what they need. They should constantly ask questions about how the technology will work for them. No matter who pays for the device, AT users are obligated to ensure the device is used. To ensure that, they need to make sure it ‘fits’ them.
But, how is that done? By simply asking yourself, the team, other users and the equipment vendors questions and continue to ask them until he/she has a satisfactory answer. Here are some questions a consumer should ask to make sure a device will help him/her accomplish his/her goals.
Personal Considerations
Does it help me do what I want/need to do? If it doesn’t, don’t get it! This may sound like an elementary question, but, many people receive AT and from day one it does not work for them. When this happens, you can be sure the user was not an integral part of the assessment team. More than likely the team told the user what would work for him/her. As a consumer of technology and services, you should never allow that to happen. Speak up for yourself and your needs.
Are there any limitations or risks? Users often see the benefit of AT, but don’t bother looking at the other side...and there is nearly always another side. While the AT may help you do what you want to do...it may also limit other aspects of your life. For example, a user is considering purchasing a standing wheelchair to improve circulation and movement. He/she should also know that standing wheelchairs can weigh up to three times more than a lightweight manual chair. While it may improve movement and circulation, the weight could cause exhaustion. Does that mean a standing wheelchair is not a good product? Not at all, it just means that the user will need to measure the pluses and the minuses. Maybe he/she will want to keep his/her old lightweight chair and use one or the other when it’s appropriate.
Is it comfortable to use? Have you ever worn a shirt a half-size too small? If you have, when it was time to wear it again, you probably thought twice about it. If there was at least one other clean shirt in your closet, the small one would just sit there. The same applies to any AT you use. If it is not comfortable, you will eventually discard it. Better to speak up during the assessment process than wait until it’s over and the device is in the closet...and you are no closer to your goal than you were before the process began.
May I have a trial period to see if it works for me? Let the buyer beware. Don’t get caught in the trap of thinking you have to purchase the device outright before you agree to use it. Ask for a trial period. Most reputable vendors will allow you to rent the device for a month or two and then apply the rental payments toward the purchase. Others have a 30-60 day return policy on the device if it does not work for you. It’s common for users to successfully use a device in an insulated clinical setting (when evaluating or learning about the device) and still be unable to use it in a ‘real world’ setting. A child may be able to use a communication device in formal speech therapy sessions, but be unable to use it to order lunch at McDonald’s. It’s not until you try it in the real world that you can be sure the device will work for you!
Training Considerations
Is it ready to use? Imagine this. A user receives his/her AT at home or office. The box is placed in the center of the room and the delivery person leaves. The user did not ask about set up procedures or support. He/she can’t open the box. Even if the box were open, he/she would not know how to set the device up. By asking this question ahead of time, a user can eliminate these problems once the device arrives.
What skills do I need to learn? Let’s assume a user and his/her team decide a specific computer and software package is just the thing to help a child benefit from his/her educational program. However, he/she has never used a computer alone before. He/she will need many skills before the device really helps. Until that day comes, the team needs to have alternate plans in place. The child needs to become proficient in using the technology. By asking this question, you ask the team to consider technology’s appropriateness and any learning curve the user may need to get comfortable with a device.
How does it work? The device you are trying out may seem simple enough to use, but it may have taken the evaluator three days to program it so that you could use it. Ask about set up, what you will need to know about it, what other functions it has and how can you access those too.
Where do I get training? Will the person who conducts the assessment also provide your training? Do you have a good rapport with him/her? Will the training come from the sales representative? Is there a 24-hour support line available should you need it? How long will that be available to you?
Is training included in the purchase price? Wow, what a shock to learn you’re responsible for training, when you assumed the price included it. Unfortunately, some folks don’t ask ahead of time. Also, decide who needs training. Certainly the user will need it, but what about others? Teachers, family members, roommates, spouses are just a few examples of others who may need to know the device as well, or better than the user.
Access Considerations
Where can I use the AT? Think about what uses you have for a specific device. If you will use it in multiple settings, how well will it travel? Is there room for it there? Is it noisy? Will it disturb others around you? Will it need to be reprogrammed to use it in different settings? Who will do that? Will that limit the use? Is it bulky? A device that works well in a stationary setting, may be just fine, unless you need to lug it to the library twice a week. Imagine all the settings you will be using the device in and consider how portable it needs to be. Can I use it indoors or out? How does moisture affect functioning? Climate changes can affect how a device works. If you will be operating the device at the bus stand and it starts to rain, or you drool, you may need to be concerned about this issue. Ask! What is the battery life? Battery life is a HUGE issue when considering AT.
If you don’t stop to ask this questions PRIOR to the purchase, you may have a non-functioning device when you need it. If the device required recharging after every three hours of use, and you will use it twice that amount of time, obviously you’ll need extra batteries. But if you don’t ask, you won’t know. Batteries eventually wear out. Find out how soon you will need new ones. If powered, can you plug it in, or is there a power source where you want to use it? You can often conserve battery life by "plugging in." So, think about the places you can hook your AT to an electric outlet. For example, consider sitting next to the wall outlet when you take a laptop to class. You will have more battery life for times when no outlet is convenient.
Repair and Maintenance
Is it reliable? The best place to get this information is to ask other users. They have experience with the device, its quirkiness, features and reliability. To find other users, contact a local independent living center, or other disability related social service agency. Ask them to help you find someone who has used the device. Remember that the vendors and manufacturers are there to sell products, not necessarily to be candid about product reliability. What is the life expectancy? Nothing lasts forever and at some point your AT will reach the end of its natural life. Knowing the life expectancy of a device will help you decide if it’s time to repair or replace the device. Funding sources should also be aware that eventually, replacing the device is far more cost effective or efficient than repairing it. What is average use? All technology has a lifespan. Not all devices can be used constantly. Find out what the manufacturer considers an average amount of use for the device. For example, you plan to purchase a device and anticipate using it every 25 seconds. However, average use is once every 10 minutes. The device is going to wear out much quicker than usual. Again, if you don’t ask...you don’t know. ASK!
What is the service record of the manufacturer/vendor? Again, to be a good self advocate, you must check the sales/service record of the manufacturer and vendor of the device. You could find a device that works very well for you, but unfortunately, other users have had nothing but problems with the vendor’s reliability with follow-up and regular maintenance. Unless you ask other people who have worked with them, you don’t know. It is your responsibility as a consumer to compare prices of the same product with different vendors.
Is repair service convenient? Find out where the device will need to go for maintenance and repair. If you need to send it to Outer Mongolia, it’s going to take a long time get there and get back. Perhaps another device can do the same job and repairs will be closer. Also, find out if the vendor has loaner equipment available while your device is in the shop.
What is regular maintenance? You may be able to perform some of the maintenance yourself. Other maintenance may need specialized training. Find out what kind of maintenance your device needs and to prolong the life of the device, follow the directions carefully.
What is the Defective Assistive Device Act? In Oklahoma a new law requires that
manufacturers of assistive devices for person with disabilities provide a one year warranty for their products. Under the law consumers who purchase a defective device can get the item repaired or in some cases replaced.
Financial
Financial issues often scare people away from devices. They think, "I’d love to have that, but gosh...I could never afford it." Don’t get caught in that mind set. Often going through the process of finding out exactly what you need will provide the documentation that a funding source needs to purchase the device for you. You may also find out that other funding sources are more appropriate than the one you originally thought.
What is the total final cost? Some devices come all in one piece, others come with add-ons that will up the cost of the device. Be sure to get the total cost of the item with all the add-ons you need. Are there package deals? Will you need a specifically designed mounting system? Will you need two battery packs instead of one? It’s frustrating to finally get the device and then find out that you need another item to make it work for you. Are there training costs? Is training included in purchase price? If you don’t ask these questions prior to purchase, you may find training costs will make the device unattainable. Purchasing it and being unable to use it because you lack training is a discouraging experience.
Who will fund maintenance and repairs? Imagine how you will feel if your device needs repair, and you find out that you are responsible for the cost of repairs and you didn’t know it. Ask before the purchase if the manufacturer or vendor is familiar with the Defective Assistive Device Act! Are rental/lease plans more cost effective? If you are going to use the device on a short term basis, you may want to consider renting or leasing options. It’s also a good idea to try out the device before you invest much money in it. Most reputable dealers have rental/lease options that either will let you apply the money toward the purchase price, or offer a 30-60 day return policy. You’ll need to ask so you know the specific details of the ‘trial’ period. If you are working with a vendor that does not allow that type of option, look elsewhere. They may not be there after the purchase if they are so uncompromising prior to it. Will I need to change devices or upgrade soon? If you are gaining and/or losing skills because of the type of disability you have, consider how much time you will be using the device. Measure these factors into the equation about whether the device will work...really work...for you.
Will I get a trade-in, upgrade, or allowance? With the rapidly changing world of technology, things you purchase may be obsolete in a year. As long as the device still works for you, that’s fine. However, you need to realize that it will have very little market value if you need another device or decide to upgrade.
Parting Words
Consumers with disabilities need to become advocates for their own needs. Relying on professionals alone to figure out what you need means you will not get the best device for you. You need to use professionals to help figure out the kinds of devices that will help you perform certain tasks; however, you alone will ultimately decide if a device works for you. If you are not comfortable with a device for any reason, speak up! It will be better in the end if you express your opinions prior to the purchase. Complaining to a funding agent that a device doesn’t meet your needs months after the fact, is upsetting and disheartening for the funder and you.
Finally, it’s important to realize that often the best technology solution is a ‘simple-tech’ solution. Consider how environmental adaptations can meet your needs prior to purchasing any device. Environmental changes are long lasting and usually don’t require ongoing repair and maintenance. However, environmental changes aren’t the answer for all the barriers people with disabilities face. After deciding that an environmental change won’t work, AT may be the most practical option...however, always keep in mind that the AT solution should be appropriate for the task and meet your need as well as your own sense of who you are. Good Luck!!
Assistive Technology - What You Need to Know is a publication of the Oklahoma ABLE Tech program. This material may be duplicated in whole or in part, ABLE Tech requests that it be credited appropriately. ABLE Tech is funded by the National Institute on Disability and Rehabilitation Research of the U.S. Department of Education Grant #H224A50007. This publication does not necessarily reflect the position or policy of NIDRR/ED, and no official endorsement of material should be inferred. Oklahoma ABLE Tech, 1514 W. Hall of Fame Dr. Stillwater, OK 74078-2026
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