Making Better Decisions [Modeling the Assistive Technology Assessment

Access to Justice: An SLP’s Guide to Helping Persons with Complex Communication Needs Voice Their Case

The purpose of this study was to 1) identify and describe the population seeking alternative and augmentative communication (AAC) evaluations at an assistive technology (AT) center in the Midwestern United States and 2) describe the AAC device features or services participants identify as most important at their initial AAC evaluations. Charts of 53 participants seeking AAC interventions at an AT center in the Midwestern United States were retrospectively reviewed. Information from the QUEST 2.0 was used to determine what AT features were identified as most important. The majority of participants seen at the AT center had progressive diseases. Across all of the participants, ease of use and effectiveness were identified as the “most important” aspects of an AAC device satisfaction. These findings highlight the importance of determining who is accessing AAC services across AT centers to determine whether barriers to AAC services exist. Moreover, patients report regarding what variables they deem as most important reflect the fact that excellent service-delivery may not overcome the importance of other variables, such as ease of use that impact AAC use.

Supporting Families of Children Who Use AAC

We investigated whether patient adherence to positive airway pressure (PAP) therapy was significantly different between groups whose PAP machines were dispensed by a traditional durable medical equipment (DME) supplier (DME group) versus those provided directly by an integrated sleep practice (ISP group). This was a retrospective cohort study that analyzed 3884 patients (ages 18-64) who were set up with a new PAP machine for sleep-disordered breathing. The channel through which PAP therapy was dispensed (DME vs ISP) was chosen as part of the natural course of treatment, making patient choice and third-party payor likely important selection factors. We analyzed whether the groups had significant differences in adherence rates and nightly usage duration after 30 days, 90 days, and 1 year of therapy. The ISP group had a significantly higher rate of PAP adherence at 30 days (71% vs 66%; P = .004), 90 days (66% vs 56%; P < .00001), and 1 year (52% vs 33%; P < .00001) following initiation of PAP therapy, relative to the DME group. There was a significantly higher duration of PAP use among the ISP group at 30 days (357 vs 345 minutes; P = .002), 90 days (348 vs 319 minutes; P < .00001), and 1 year (312 vs 164 minutes; P < .00001). This study suggests improved short- and long-term PAP adherence rates among patients who received PAP therapy through an ISP. As current health care trends drive sleep medicine practices to adopt chronic care management models, further studies are needed to better understand the tradeoffs of receiving PAP through traditional DME providers.

Assistive technology (AT) assessments involve a dynamic process among the evaluator, the AT user, and the AT device. When accomplished correctly, these assessments are person-centered and ecological, that is, they actively involve the individual being evaluated and incorporate the collection of data from numerous environments in which the person works, learns, and plays. This chapter provides information about how such an AT assessment can be conducted using the Functional Evaluation for Assistive Technology (FEAT; Raskind &amp; Bryant, 2002). Readers are provided with an overview of the importance of person-centered assessments, and then are given a description of each of the FEAT components. A case study is also provided, wherein the process of an effective and efficient AT assessment is described.

Assistive technology has aided children with multiple disabilities to improve access and participation in their school and home environments. Effective educational outcomes from assistive technology use are dependent upon a coordinated assessment and implementation process. The literature on assistive technology with children was reviewed in order to identify current barriers to its effective integration within schools. These barriers were found to include lack of appropriate staff training and support, negative staff attitudes, inadequate assessment and planning processes, insufficient funding, difficulties procuring and managing equipment, and time constraints. A team model for assistive technology assessment and planning is proposed to optimize the educational goal achievement of children with multiple disabilities. Such a model can help target the allocation of occupational therapy resources in schools to best promote educational and broader functional outcomes from assistive technology use.

Background Assistive Technology (AT) helps individuals with multiple sclerosis (MS) to overcome limitations and enhance their social engagement by providing support in areas that would otherwise be difficult or unachievable. Objective The aim of this study is to determine the level of AT usage among individuals with MS and to address various questions related to the sociological implications of (non)use of AT devices, (un)awareness, and logistical barriers that prevent the full utilization of AT devices in the daily activities. Method 121 participants with previously diagnosed MS (26 AT users, 95 non-users), aged 18–65, were surveyed using a modified The Rapid Assistive Technology Assessment tool (rATA) covering: demographics, needs, supply, financing, satisfaction, and recommendations. Results Totally 21.5% of MS individuals used AT, dominantly mobility devices. Insecurity prevents desirable usage of AT devices. Affordability is a factor relevant for the device ownership. Both MS individuals and society lacked sufficient AT informedness. Conclusion Based on the results and current guidelines, it’s essential to improve policies, supplying, AT device enhancements, and education to fully utilize AT’s potential in people with MS.

Introduction: Leprosy is of significant public health concern as it is an infectious and chronic disease with the potential to cause physical disabilities. Aim: To identify health technologies in scientific literature for preventing physical disabilities caused by leprosy. Outlining: This is an integrative literature review, based on the research question: "What health technologies are applied to prevent physical disabilities caused by leprosy?" formulated using the PICo strategy, where "P" stands for Population (leprosy), "I" for phenomenon of Interest (technologies), and "Co" for Context of the study (prevention of physical disabilities). Results: Eleven articles published between 2001 and 2020 in Brazil were included. More than seventy technologies were identified for use in disability prevention. The primary types of health technologies for preventing physical disabilities include strategies and materials such as lectures, home visits, and establishing a strong relationship between healthcare professionals and patients. Implications: It was identified that in the context of preventing physical disabilities caused by leprosy, assistive technology (assessment of physical disabilities, wound care, and immobilization, among others); educational technology (such as guidance on hygiene and proper medication use); and managerial technology (clinical meetings, for example) play crucial roles.

Introduction We aimed to test the feasibility and acceptability of SleepWell24, a multicomponent, smartphone-delivered intervention to increase positive airway pressure (PAP) adherence among newly diagnosed OSA patients. Methods SleepWell24 targets PAP adherence along with other health behaviors through education, trouble-shooting, goal-setting, and near real-time biofeedback of PAP machine use, and sleep and physical activity levels (via Fitbit integration), and other chronic disease self-management components. Patients with a first-time diagnosis of OSA (AHI≥5) and prescribed PAP therapy were enrolled from the Centers for Sleep Medicine at Mayo Clinic in Rochester, MN and Phoenix, AZ. Patients were randomized to SleepWell24 or usual care (UC) and assessed for PAP use over 60 consecutive nights. UC patients received a Fitbit monitor to control for non-specific intervention effects related to the introduction of a new personal technology. Feasibility was assessed with recruitment and retention rates and acceptability was assessed post-intervention with the validated, 8-item Treatment Evaluation Questionnaire (TEQ; range:0-4). ANCOVA models, adjusting for age, sex, and AHI severity, compared intervention arms on acceptability ratings. Results OSA patients were consented and randomized (N=111). Before the intervention began 4 participants withdrew, 12 were lost to follow-up, and 5 could not start the trial due to durable medical equipment (DME) vendor barriers. Ninety OSA patients (n=41 SleepWell24, n=49 UC; age M±SD=57.2±12.2; 44.4% female, 61.1% AHI≥15) started the intervention, with 2 participants withdrawing, 1 becoming deceased (unrelated to treatment) and 7 with missing PAP data due to DME vendor barriers. There was no significant between-groups differences on post-treatment acceptability (SleepWell24 M±SD=2.7±1.1 vs. UC M±SD=3.1±0.9, F[1,73]=2.3, p=0.11), and 77% of SleepWell24 participants found the app to be moderately to totally acceptable. Conclusion Overall, SleepWell24 was found to be feasible for delivery in two large clinical sleep medicine centers, and patients found the app to be acceptable. A number of challenges in trial delivery were encountered that have implications for scaled-up efficacy testing: (a) partnerships with DME vendors for near real-time PAP data integration; (b) alignment with clinical practice (i.e., referral, medical record integration); and (c) patient engagement. Support National Institute of Nursing Research / National Institutes of Health: R21NR016046

Assistive technology usage, unmet needs and barriers to access: a sub-population-based study in India.

Assistive Device With Conventional, Alternative, and Brain-Computer Interface Inputs to Enhance Interaction With the Environment for People With Amyotrophic Lateral Sclerosis: A Feasibility and Usability Study

Health technology assessment (HTA) can be used both to promote access to safe, efficacious, and cost-effective technologies, and to discourage access to undesirable ones. Yet HTA has had less success than might be hoped in pursuing the latter goal. This paper examines the scope of HTA as currently practiced to contribute to regulation of access to undesirable technologies. The study design is a critical analysis of HTA's methods, based on an exposition of the normative issues involved in restriction of access to health technologies. The paper classifies technologies that might figure as potential candidates for exclusion into five categories and underscores the key social and ethical dilemmas associated with limiting their use. For four of the five categories of technology outlined, limitation of access necessarily involves denial of benefit. Limitation of access thus inevitably raises difficult normative issues. We show that these are ill-addressed by the range of "evidence" typically considered in technology assessments, which centers predominantly on clinical and technical features such as efficacy, safety, and costs. If HTA is to enhance our ability to make reasonable decisions concerning the use and diffusion of health technologies, it must better integrate consideration of the social, political, and ethical dimensions of health technologies into the process of technology assessment. We suggest a framework within which to approach this goal.

For many individuals who experience short- or long-term disability access to assistive products (APs) (e.g., glasses, communication aids, walking sticks) can improve quality of life by minimising or removing functional limitations and barriers to participation in society. However there is an estimated 1 billion people in need of APs globally and with aging populations this demand will continue to increase over time. Assistive technology (AT), which includes different types of APs and may incorporate various aspects of assistive technology systems (ATS), is delivered in diverse contexts, with differing resources, needs and capacity. This chapter will outline how use of a systems thinking approach for AT can address the complexity of how APs are perceived, designed, produced, manufactured, distributed, serviced, and financed, and may help in achieving greater access to APs for those who need them.

The present study sought to update and validate the replacement schedules of various durable medical equipment (DME) and assistive technology (AT) commonly cited in life care plans. For life care plans used in litigation, the 1993 Daubert decision, which placed more onus on testifying experts to rely upon empirically-supported and generallyaccepted literature in their field, increased the need for evidence-based research. In this study, 127 sales representatives and equipment repairers across the United States were contacted to participate in a survey to explore whether replacement values found in similar research conducted in 2005, had significantly changed. Frequency data were analyzed in terms of ranges, median life expectancy of equipment, replacement parts needed for equipment, and current price ranges for equipment, repairs and maintenance. Implications for life care planners are discussed.

The study reported in this paper developed criteria and guidelines for writing up a good-quality AT Assessment Report - a document which is often required to activate an assistive technology intervention for an individual client. The Report should provide precise recommendations about the assistive solutions that best meet the client's needs, explain the underlying reasoning, provide evidence of appropriateness for the funding agency and set the baseline for later measurement of the outcomes of the intervention. Within this study, forty-eight clients with severe disability conditions were recruited in nine rehabilitation Centers in various regions of Italy. They were assessed for assistive solutions by their rehabilitation teams according to a common protocol; assessment Reports were produced for each client according to the same template, and individual AT interventions were activated following the recommendations. Then the Reports underwent a blind peer-review exercise involving over fifty professionals, who evaluated their quality against ten criteria; based on the findings, the template of the AT Assessment Report was revised and good-practice guidelines were inferred for the contents of each field. Now the final version is freely downloadable and is being used routinely in the Centers that participated in the study.