Promoting Independence and FUNction with ADL and Communication Equipment A Philosophy and Practical...
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Transcript of Promoting Independence and FUNction with ADL and Communication Equipment A Philosophy and Practical...
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Promoting Independence and FUNction with ADL and
Communication Equipment
A Philosophy and Practical Applications Presentation
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Objectives By being familiar with what is available And putting up with a mess of philosophical and
historical material from Dr. Stefans, AGAIN… You will become able to set expectations, select
and encourage use of effective technologies for specific situations and disabling conditions
Overcoming all barriers with persuasive examples and justifications “Narrative Research“ http://www.med.umich.edu/pmr/nrdr/index.htm
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As a physiatrist you can increase the quality of life for people with physical disabilities by helping them reach goals which they desire and are achievable. To do all of this, you must be able to establish rapport so that you can identify and prioritize goals. Then you teach the patient and the family to acquire the knowledge and skills which will promote achievement of goals and adaptation to disability.
As a physiatrist be sensitive, askable, flexible, negotiable, creative, enthusiastic, and sincere. Understand your own values, attitudes, limits, and strengths in order to help others without imposing upon them. Place a high value on humanness. Acknowledge discomfort and pain including your own. Carry a low burden of guilt or envy for the circumstances of other people. Lastly, trust people to accept responsibility for themselves.
- Theodore M. Cole M.D., as Chairman, PM&R Department, University of Michigan, Ann Arbor
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What is Adaptive Technology?
Assistive technology (AT) is any kind of device or tool that helps people learn,
work, communicate and live more independently.
AT can be very simple and inexpensive, like a modified knife and fork, or it can be very
sophisticated and costly, like a computerized speech device.
- Arkansas ICAN website
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What is “appropriate technology?”
From Disabled Village Children, Hesperian Foundation Publications
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Appropriate Technology Jaipur leg
Rubber, wood, aluminum Estimated $28.00-$40.00 cost
Hotchkiss wheelchair http://maic.jmu.edu/Journal/12.2/
notes/prvulov/prvulov.htm bike parts
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It’s All About Participation
Unique to individual Needs, Wants, and Circumstances
“Functional and Fun”
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Standing wheelchairs
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Cultural relevance
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Going potty Not necessary to wait
for walking and talking Support feet, trunk if
needed, reduce size of hole to reduce fear of falling in
How important is it to be out of diapers? – Cindy’s story
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"She can't/We didn't because..."
Bad models of disability Perpetual infant/Little Innocent Angel Sick role/invalid "Medical Necessity" Geriatric/Terminal
Low expectations Dependency, limited or no autonomy Top (or only) priorities become safety,
protection, ease and convenience for caregiver
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ADLs - Eating Ataxia – bigger, heavier utensils Reduced dexterity – swivel and/or bent spoon
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Winsford feeders Cheek switch to
scoop and present food
Need some head control
Hands-free
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Food preparation
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So, who dresses you? 46 year old with C6 quadriplegia does not want
to stay at world famous rehab center longer to learn dressing skills
12 year old girl starting to have conflict with mom over clothing choices
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It’s OK to get your adaptive technology at Wal-Mart when… Regular car seat OK for moderate limitations in
trunk control, check weight/height limits They start selling I-Pads and you can afford one It’s just what you need and costs a lot less
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Gadget Tolerance = Independence
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I want to get my son a voice activated computer to use at school!
Simple handwriting replacement – consider portable keyboard instead (AlphaSmart/QuickPad)
Voice recognition continues to improve Still slower Hands free use possible Different style of proofreading – spellcheck won’t work
Adaptive keyboards, alternative mouse access Small for weaker or lower arm mobility Larger for less accurate hand use Trackball, HeadMouse, MouseKeys aboutonehandtyping.com
Or…
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Writing and typing Writing bird, typing stick (or use pencil, eraser
end down in cuff) Don’t underestimate two or even single finger
typing
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Motor, sensory, or cognitive issues Tactile mouse for blind person experimental
Need keystroke navigation
Screen reader = text to speech KE:NX – reads what you have written Magnification software, large monitors Scanning access – severe motor issues
Low efficiency Compensate with word prediction
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Web Accessibility PDF is no longer “Pain, Despair and Frustration” Flash is the new PDF Section 508
Alt text Captions and transcripts Think about screenreaders EASI at RIT
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AAC - PM&R/Physician Roles Identify potential Document medical necessity Write Rx, make referrals Guide selection – PECS vs Liberator Reassure and educate re process and outcomes
Appropriate expectations of appropriate technology
Let kids tell bad jokes in clinic Learning cause and effect
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Alternative – Augmentative Prerequisites vs Participation Interdisciplinary evaluation mandatory
Rx “therapy units as needed” Stress medical, not peer communication Different choices for ambulatory vs w/c with tray user
Verbal communication may increase Signing increases Language Communicate more than basic needs or yes/no to
familiar caregivers May interface with computer (or be a computer) Training and programming issues
Literate English vs special language vs pictures Need for support, upgrades (college level)
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The McDonald’s Shake Story
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The Strawberry Shake Story
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Resources Arkansas Easter Seals Society
http://ar.easterseals.com/site/PageServer?pagename=ARDR_tcc
ICAN Increasing Capabilities Access Network http://www.ar-ican.org/
International Society for Augmentative and Alternative Communication http://www.isaac-online.org/en/home.shtml
RESNA http://resna.org/ Prentke-Romich and other AAC companies
http://www.prentrom.com/ John Halloran
http://www.pedspmandr.net