Delivering AT Flashcards
Primary purpose of AT intervention
Enablement
AT Assessment/Intervention should include:
- Collaboration
- Family, spouse, employer input
- Consumer-centered approach
Order of AT Service Delivery
1) Evaluation
2) Needs Identification
3) Recommendations
4) Implemented Action
5) Follow-up
Quantitative Measures
Assign a number to an attribute
Criterion-referenced measurement in AT use
Preferred for measuring performance of AT use because it uses behavioral or functional descriptors to describe ABILITY LEVELS.
Needs Identification Phase of Service Delivery
Most critical component of service delivery process for describing the conditions under which the client wants to use the device.
Visual Acuity
Clarity with which a person can see objects in an environment.
Somatosensory Function
Same as tactile function.
Contextual Factors considered in prescribing AT:
- Physical
- Social
- Cultural
- Institutional
Downsides to using Trial Equipment
- Lack of availability
- Expense of trial equipment inventory/maintenance
- Additional resource to maintain, restock and track the equipment
Crucial indicator of continued use and acceptance of AT device:
Training
Operational Competence
Training the user on how to work the device.
Follow-up Activities:
- Ensuring proper fit and set-up of device immediately following delivery
- Determining the effectiveness of the device, training, and user strategies
- Reevaluating the client at regular intervals following acquisition of the device
Outcome Measures
Effective because they gather data that indicate the effectiveness of the intervention.
Steps of AT Delivery:
1) Referral and intake
2) Initial evaluation
3) Recommendation and report
4) Evidence based research used to determine appropriate AT for specific client needs
5) Identify/obtain funding for AT
6) Ordering and set up
7) Delivery and fitting
8) Follow-up and follow-along
Step ONE of AT Delivery: Referral and Intake
- Client referred by Dr., PT, SLP, educators
- Identified needs and intrinsic/extrinsic factors as criteria for service
- Gather info about person, activity, context (HAAT)
- Determine match betw consumer and assessor (is assessor experienced with AT needs of client?)
- Observe client performing ADL/IADL
Step TWO of AT Delivery: Initial Evaluation
Used to assess AT. May be informal methods. Uses: • Observation • Needs assessment • Skills evaluation: Sensory • Eval of Functional Vision • Eval of Tactile Function • Eval of Auditory Function • Skills Eval: Physical • Skills Eval: Cognitive • Skills Eval: Language
Skills Identification: Visual Skills
Determining visual skills during AT evaluation. Includes:
• Visual Field (central/peripheral deficits)
• Visual Acuity (clear sight)
• Visual Tracking (tracking moving objects)
• Visual Contrast (figure-ground perception)
Skills Identification: Auditory Skills
Audiologist determines client’s functional hearing skills during AT evaluation. Includes:
• Auditory Thresholds
• Frequency
• Amplitude (min. is ability to hear ticking watch in quiet environment 20 feet away)
Skills Identification: Tactile Skills
Determining client’s tactile discrimination skills during AT evaluation. Includes:
• Perception of Touch (feather to deep pressure)
• Temperature Perception
• Pain Perception (sharp vs dull)
• Proprioceptive Input (joint/limb/head position in space)
Skills Identification: Physical Skills
Determining client’s physical abilities during AT evaluation. Includes: • ROM • Muscle strength • Muscle tone • Presence of obligatory movements
Skills Identification: Cognitive Skills
Determining client’s cognition during AT evaluation. Includes:
• Orientation (to self, place, time)
• Attention (attends to stimulus > selective attention/filtering stimuli)
• Memory (working, LT, ST; Encoding (taking in info); Storage; Retrieval; Implicit)
• Executive Functioning (higher level of cog.; judgement, insight, prob solving, planning, organizing, self-monitoring)
Skills Identification: Language Skills
Determining client’s language abilities during AT evaluation. Includes: • Expressive language • Receptive language • Sequencing items • Symbol use • Complex thoughts/Combination of ideas
- NOTE: Augmentative Communication Devices require use of several language skills
Contexts Considered in AT Evaluation
- PHYSICAL (where AT used; physical barriers?)
- SOCIAL (who is in the environment to support use of AT?)
- CULTURAL (Does cultural context expect independence? Will AT be sign of weakness?)
- INSTITUTIONAL (Are limits in instit context preventing use of AT in other contexts?)
• Are there BARRIERS to the use of the AT? (ie: wheelchair accessibility)
Determining Appropriate AT during Evaluation
Include assessment of:
• General device features (look? Color? Capacity size? Speed?)
• Feature matching (to client’s needs)
• Human/Technology Interface (HTI) – Keyboard? Joystick?
• Physical properties (size, weight, sensitivity, light, sound, texture)
Step THREE of AT Delivery: Recommendation and Reporting
- Written report prepared that details assessment and recommendations for AT system
- Summary of client’s skills applicable to AT device; description of generic characteristics to be incorporated into device
- Summary of recommendations for type/qualities of AT best fitting client
- Funding sources reviewing this report determine funding
Implementation of AT Plan
- Ordering and Set-up
- Delivery and Fitting
- TRAINING (@ time of delivery, orients pt to device, safety/care of AT, reassess if needed)
- May be time-based training (amt of time funding source provides for training)
LAST Step of AT Delivery: Follow-Up and Follow-Along
FOLLOW-UP: Measure satisfaction and skills of client. Was device effective? Training sufficient? Strategies developed?
FOLLOW-ALONG: Schedule intermittent check-ups with client to check effectiveness, esp. in school as kids change a lot! Monitor client use of AT; observe changes/limits; implement updates to be more effective.
Autonomy in AT
The right to self-determination and freedom from unnecessary constraints, interference, or loss of privacy. Freedom of ACTION and CHOICE.
Areas where issues of Autonomy arise:
• Intellectual disability
• Cognitive disability (CVA, TBI)
• Aging
Fidelity in AT
Requires faithful, loyal, honest, and trustworthy behavior. Clients expect to be treated with respect, that you are competent, that you adhere to code of ethics, that you follow policies and laws, and that you honor agreements made.
• Most common source of ethical conflict.
Beneficence in AT
Includes all forms of action intended to benefit or promote the good of other persons, helping them to further their interests.
• AT addresses natural deficiencies in what the client needs to be an effective member of her community; beneficence is to ameliorate these needs and provide benefit to those with disabilities.
Nonmaleficence in AT
Principle of not causing harm to others directly or through avoidance of actions that risk harming others. Preventing hazards in AT design. Use of proper training of AT to avoid harm. Avoiding restricting a person’s privacy or liberty (ie: use of restraints).
Justice in AT
Deals with the issue of fairness in individual, interpersonal, organizational, and societal contexts. Includes:
• Distributive Justice (availability of AT to all)
• Capabilities (expanding independence to all)
Distributive Justice
Normative principles designed to guide allocation of benefits and burdens of economic activity. 3 Principles:
1) What is subject to distribution (income, wealth, AT?)
2) What is nature of subjects of distribution (individuals, reference classes ie: persons with disabilities?)
3) What should basis of distribution be (equality?)
**In AT, it is the functional outcome of the distribution that is important.
Ambient Environment
Monitoring and surveillance; computing and communication systems linked through local networks or internet.
(Ambient Intelligence: Embedded computing and communication among devices.)
