Posted by Chris on February 01, 2003 at 17:22:51:
In Reply to: What categories of Assistive Technology can be found? posted by Chris on December 17, 2001 at 22:48:13:
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Clinical Application of Assistive Technology
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By RESNA, 1998 (Excerpt only - For complete article, visit http://www.resna.org)
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Learning Objectives
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- Recognize the major disabilities that use Assistive Technology (AT)
- Describe how particular features of technology can help certain impairments
- Use appropriate clinical terminology
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Spinal Cord Injury
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- Partial or complete severing of spinal cord
- Usually due to trauma (mva, gun shot, fall)
- Young men, risk takers
- Most can be fully independent; someone with high level quadriplegia may require assistance
- Congenital Spina Bifida, born with developmental defect in spine and cord
- Non-progressive
- Paraplegia or Quadriplegia; Function depends on level of lesion
- Partial vs. complete
- Flaccid paralysis or spasticity
- Sensation Impaired
- Cognition intact
- Heterotopic ossification, osteoporosis
- Autonomic dysfunction
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Spinal Cord Injury AT Use
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- ADL devices to replace/enhance had grip & reach
- Electronic Aids to Daily Living (EADL)
- Wheelchair & vehicle mobility
- Special seating to support alignment and relieve pressure
- Computer with enhances access/switches
- Architectural modifications
- Recreational technology
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Stroke
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- Cerebral Vascular Accident (CVA)
- Blood supply interrupted in specific area of the brain (clot, bleed, blockage)
- Extent of damage determines impairment; Functional Independence varies
- Recovery most significant in first 6 months
- Geriatric population may have complications from other diagnoses.
- Non-progressive
- Hemiplegia
- Abnormal tone, spastic or flaccid
- Contractures, shoulder subluxation
- Poor motor control, synergy patterns associated reactions
- Decreased balance, coordination
- May affect sensation, cognition, perception, vision, speech, swallow, bowel and bladder.
Left Stroke
- Right hemiplegia
- Aphasia
- Poor motor planning
- Poor math
- Slow at tasks
Right Stroke
- Left hemiplegia
- Visual field cuts
- Perceptual problems
- Left neglect, denial
- Impulsivity
- Emotional liability
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Stroke AT Use
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- ADL tools, reacher, shower chair, raised toilet seat
- EADLs
- Quad cane, manual wheelchair with one hand and one foot propulsion
- Seating with postural support to reduce lean, support arm
- Cognitive aids, reminders, alerts
- Augmentative Communication Systems
- Computer with one hand access, small keyboard
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Brain Injury
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- Damage to brain due to sudden injury
- Primary insult is concussion, coma, fracture, contra-coup injury
- Secondary insult is swelling, hematoma, hypoxia, ischemia, infection
- 15-25 year olds, males>females
- Recovery varies, unpredictable
- Usually plateau after about 12 months
- Abnormal muscle tone, rigidity, spasticity, paralysis, high risk for contractures
- Poor motor control, motor planning (apraxia), coordination (ataxia), balance
- Vision, hearing, speech problems, aphasia, language problems
- Emotional & behavioral problems, poor attention, frustrate easily, lack motivation, lack social inhibition
- Cognitive, memory, attention, and perceptual problems
- Seizures possible
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Brain Injury AT Use
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- ADL tools
- EADLs
- Sensory and vision aids
- Seating to reduce tone, prevent deformity, tilt or recline
- Mobility Aids
- Augmentative Communication Aids
- Cognitive aids, reminders, alerts
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Cerebral Palsy
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- Can be a catch-all term
- Often an anoxic injury
- Brain damaged before, during, or soon after birth
- Interferes with normal development of brain
- Non progressive, non-hereditary
- Severity varies
- Impaired gross and fine motor skills
- Primitive reflexes may dominate
- Abnormal muscle tone - Spastic, Hypotonic, Athetoid
- Orthopedic deformities
- Range of motion limitations
- Impaired oral motor, poor swallow & speech
- With or without cognitive deficits
- Visual, oculomotor, & sensory impairments
- Bowel and bladder impairments
- Seizures
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Cerebral Palsy AT Use
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- Toys, developmental aids
- ADL tools & EADLs
- Sensory and vision aids
- Seating to reduce tone, prevent deformity
- Mobility devices
- Communication aids
- Alternative computer access aids
- Work-site and architectural modifications
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Muscular Dystrophy
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- Many Forms: Most common is Duchenne MD, Spinal Muscular Atrophy (SMA), Congenital Myopathy
- (Duchenne MD) Hereditary, usually boys, age 3-7
- (Duchenne MD) Muscle fibers destroyed and replaced by fat
- (Duchenne MD) Progressive, usually die by age 30
- (Duchenne MD) Non-ambulatory by about age 12
- (Duchenne MD) Symmetrical & progressive muscle weakness; proximal before distal
- (Duchenne MD) Weak hips & trunk + poor sitting posture contractures
- Lumbar hyper-lordosis; eventually scoliosis
- Risk for pressure ulcers
- Somatosensory usually intact, discomfort
- Cognition is lower in about 50%
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Muscular Dystrophy AT Use
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- ADL adaptive devices & EADLs
- Seating support with pressure relief cushion
- Mobility devices
- Independent method of pressure relief
- Computer access aids
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Multiple Sclerosis
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- Onset 20-40 years old, female>males
- Nerves damaged by unknown inflammatory process, probably autoimmune
- Myelin sheath destroyed; prevents nerve fiber from transmitting signal; get sclerotic patches of nerve loss anywhere in CNS
- Symptoms vary depending on which nerves are attacked
- Exacerbation and Remission
- Usually progressive weakness, fatigue, ataxia
- May have spasticity, pain, paralysis, contractures
- May have breathing, speech, swallow, bowel & bladder problems
- May affect motor, vision, sensation
- May include dementia, euphoria, liability
- May deny progression, difficulty planning for future
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Multiple Sclerosis AT Use
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- Acceptance of AT may be an issue.
- AT needs vary, Unstable, Unpredictable. Use versatile and adaptable equipment.
- ADL devices & EADLs
- Sensory & Vision adaptations
- Mobility - orthotics, cane, manual, power, switches, add-on respiratory equip.
- Seating for support
- Adaptive vehicle
- Computer access aids
- Augmentative Communication aids
- Work-site and architectural modifications
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Amyotrophic Lateral Sclerosis (ALS)
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- Motor nerves of Corticospinal system deteriorate from unknown cause, from cortex to periphery
- Rapid progression of muscle weakness and atrophy
- Usually fatal within 6 years
- Onset usually after age 40
- Males>females
- Starts in hands; progresses through body
- Swallow, breathing, speech muscles are eventually lost; use respirator and g-tube
- Sensory and cognition stay intact
- Increased spasticity
- ALS Variants
* Progressive Spinal Muscular Atrophy
- Anterior horn cell involvement > corticospinal involvement
- General muscle weakness and atrophy
- 20-25 yr. Prognosis possible
* Progressive Bulbar Palsy
- Cranial nerve & corticobulbar track involvement
- Initially affects swallowing, speech
- 1-3 yr prognosis
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ALS AT Use
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- Allow for rapid progression, changing needs
- ADL tools first for grip, then reachers, etc
- EADLs
- Mobility (Interfacing)
- Seating for support
- Computer access aids
- Communication aids very important since cognition stays intact
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Post-Polio Syndrome
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- Onset is decades later, after stable life
- Gradual deterioration in motor ability
- Easily fatigue, muscle & joint pain
- Self-determined, very independent
- May deny deterioration, resist additional technology
- May also have geriatric issues
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Post-Polio Syndrome AT Use
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- More ADL devices, Computer access
- EADLs
- Mobility - may go straight to power due to poor endurance, switches, add-on respiratory equipment
- Seating for support
- Adapted vehicle
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Arthritis
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- Rheumatoid Arthritis due to chemical imbalance
- Possibly auto immune
- Osteo-arthritis due to degeneration
- Inflammation of the joints
- Exacerbation and remission
- Joint pain, contractures, deformities
- Weakness due to disuse
- Self determined personality; may have established routines
- May resist increasing need for technology
- Avoid stress on joints and fatigue
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Arthritis AT Use
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- Devices to reduce stress on the joints
- ADL devices
- EADLs
- Computer access aids
- Mobility aids
- Seating- normalize alignment within the limits of pain, accommodate deformities
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Amputations
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- Upper or lower extremities
- Hemipelvectomy
- Congenital or acquired
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Amputations AT Use
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- Wheelchair amputee axle bracket
- Upper & lower extremity prosthetics
- EADLs
- Computer access aids