End Of Chapter Questions Flashcards
Identify the elements of formal definitions of AT.
a) Two formal definitions of AT, which are commonly used, come from the United States legislation The Assistive Technology Act of 1998, as amended (2004) and from the WHO International Classification of Functioning, Disability and Health (2001). The US legislation defines an AT device as: “Any item, piece of equipment or product system whether acquired commercially off the shelf, modified, or customized that is used to increase, maintain or improve functional capabilities of individuals with disabilities” (AT Act of 1998, as amended 2004).
b) The WHO defines assistive products and technology as “any product, instrument, equipment, or technology adapted or specially designed for improving the functioning of a disabled person.”
Identify and describe the key components of the ICF, CMOP-E, and PEOP.
a) The WHO’s ICF is a well-recognized and frequently applied model that classifies components of body structures and functions, activities and participation, and the environment in terms of their influence on health. Four aims are stated for the ICF, two of which have relevance to our discussion: to provide a basis for research on health and its determinants and to establish a common language that will foster effective communication across different users.
b) Similar to the HAAT model, the CMOP-E and PEOP are ecological models; specifically, they consider the influence of the interaction of a number of elements on occupational performance, participation, health, quality of life, and well-being.
1. The CMOP-E articulates different roles the clinician plays in the client–therapist relationship. The PEOP articulates a top-down approach that guides the intervention process of enabling occupational performance and participation. Although both are linked to the ICF, the link is stronger for the PEOP.
Describe each of the four principles that guide AT service delivery. Give an example of each.
Person centered: The provision and development of AT are not about fitting the person to the technology but fitting the technology to the user.
b) Focus is on the functional outcome and participation.
c) Evidence-informed process: Use of an evidence-informed process benefits the user of AT through ensuring that elements of AT service comprehensively include steps to identify technology that is most appropriate for the user; to provide necessary training and support for initial and ongoing use of the technology; and to evaluate adequately the outcome of the technology, not only for the individual user but for aggregate groups as well.
d) Ethical process: An ethical process includes multiple perspectives: professional or clinical code of ethics along with embodying constructs of beneficence, nonmaleficence, and autonomy and broader philosophical and ethical worldviews that speak to means of creating an inclusive society that enables meaningful engagement in community participation for all.
e) AT services are provided in a sustainable manner: In the context of AT service delivery, sustainability means providing AT products and services in a manner that ensures that people who need them have access in a timely and continuing manner.
Describe each component of the HAAT model and give an example of each. Describe each of the four contextual components. Give an example of each.
The activity component of the HAAT model assists the understanding of the tasks in which the user of AT participates. It guides product research and development, selection of AT, identification of functional out- comes to evaluate AT use, and definition of the research question. It helps us think about what the user does with the AT, bearing in mind that sometimes the doing is not observable.
2. The human component includes the user’s abilities in motor, sensory, cognitive, and affective areas. Analysis of performance in motor, sensory, cognitive, and affective areas is part of initial and ongoing assessment, and outcome evaluation.
3. Four contextual components are included: (1) physical context, including natural and built surroundings and physical parameters; (2) social context (e.g., with peers, with strangers); (3) cultural context; and (4) the institutional context, including formal legal, legislative acts, and regulations; policies, practice, and procedures at other institutional levels, such as educational, work, organizational, and community settings; and sociocultural institutions, such as religious institutions.
4. Assistive technology in the HAAT model is viewed as an enabler for a human doing an activity in context. This component has four aspects: the human/technology interface (HTI), the processor, the environmental sensor, and the activity output. Interaction with the human is by the HTI, which forms the boundary between the human and the AT. A two-way interaction occurs at this boundary (i.e., information and forces are directed from the human to the technology and vice versa).
Identify and describe each of the four applications of the HAAT model.
a) Product research and development: Products that are developed without consideration of the activity, human, or contextual needs and influences are less likely to meet the needs of the user. For this reason, we advocate conducting preparatory studies that investigate these needs before a product is designed.
b) Usability: Six key aspects – learnability, efficiency, memorability, errors, satisfaction, and ease of use
c) Clinical assessment: The basic process involves identification of the need to be addressed by AT use, assessment of key aspects, synthesis of the assessment results, and device recommendation.
d) Outcome evaluation: Outcome evaluation involves two aspects, evaluation of the outcome of device use by an individual client and outcome of device use for a group of individuals.
What is meant by the term function allocation, and how is it applied to AT systems?
a) In any human/device system, we can allocate some functions to the human, some to the device, and some to a personal assistant. Bailey defines several approaches to function allocation that are used in general human factors design.
Distinguish between hard and soft technologies.
a) Hard technologies are readily available components that can be purchased and assembled into AT systems. This includes everything from simple mouth sticks to computers and software
b) Soft technologies are the human areas of decision-making, strategies, training, concept formation, and service delivery
What are the major approaches to function allocation? What are the strengths and weaknesses of each approach when used in AT system design?
The simplest approach is comparison allocation. For example, a telephone is designed with the assumption that the user can hold the phone, press the buttons to dial, hear the other person, and speak into the telephone. These are all functions assigned to the user. However, if the user cannot perform any of these tasks, the AT must provide alternatives. We often use comparison allocation when matching characteristics of technology to a consumer’s skills.
b) A second allocation approach is leftover allocation, in which as many functions as possible are assigned to the human, and the device carries out the remainder. In AT system design, this approach is often followed to give the consumer as much natural control over his activities as possible but to aid when needed.
c) A third approach is economic allocation, in which the basic consideration is whether it is cheaper to select, train, and pay a personal assistant to do the activity or to design an AT system for this purpose.
d) The final approach is flexible allocation. In this approach, the user can vary his degree of participation in the activity based on skills and needs. Whenever possible, we use this approach in AT systems. The capabilities of the human and technology components can change based on the specific activities and tasks to be carried out. Initially, the novice user of a mobile phone may rely on the most basic features, such as dialing a number. As knowledge of the device operation increases, more advanced features, such as contact lists, texting, web browsing, and others, can be used.
Describe the key elements of the human-technology interface for:
Electronic
postural support
Mechanical
List three types of environmental sensors used for different AT applications.
The most common examples in mobile technologies are light sensors (cameras), sound sensors (microphones), motion sensors (accelerometers), and location sensors (GPS receivers).
What are the six ICF body structures and function classifications that are relevant to AT use?
Mental functions
Visual functions
Hearing functions
Tactile functions
Voice functions
Neuromuscular and movement related functions
Muscle functions
Describe the key parameters of the physical context and their relationship to AT
Physical attributes of the environment
Discuss the influence on the culture for the acquisition and use of AT
Shared beliefs, aspirations, time, place, and space are relevant to AT design
List the five types of ethical principles.
Autonomy
Fidelity
Beneficence
Nonmaleficence
Justice
Why do we say that fidelity is perhaps the most common source of ethical conflict?
Issues of conflict of interest can arise that may compromise fidelity.
The concept of fidelity can be applied at several levels in the AT process. Describe how it applies to the clinician, the distributor, and the manufacturer.
An AT manufacturer or distributor has an ethical responsibility to ensure the production of a quality-controlled product and the completion of necessary testing to ensure the product meets required standards.
What do we mean by the statement that “the understanding of beneficence involves finding the balance between risk tolerance and risk aversion?”
The use of monitoring technology can reduce risks for vulnerable populations, particularly those with cognitive disabilities.
What does the principle of nonmaleficence refer to and how does it affect AT practice?
Nonmaleficence refers to the principle of not causing harm to others directly or through avoidance of actions that risk harming others (Kitchner, 2000). This concept is fundamen- tal to clinical practice including that focusing on ATs. Causing harm through ATs is not something that is overtly done. Because technologies can inherently be harmful if improperly applied, AT service delivery requires adher- ence to the principle of nonmaleficence, including adequate education and training in the proper use and maintenance of the technology.
How is stigma related to nonmaleficence?
Stigma is related to a number of social processes, including the separation of people into categories that bear labels that are negative. This identification can lead to stereotypes and discrimination.
List at least three ways that ATs can contribute to stigma.
When the aesthetics of AT devices call attention to the individual’s disability, that can increase the stigma associated with perceived weakness.
Surveillance and monitoring AT may be particularly stigmatizing because the individual may believe that she has been “tagged”.
Individuals in the environment who see or interact with people using AT may accord them less ability than they actually have due to the presence of AT.
List three major benefits and the major ethical concerns associated with surveillance and monitoring applications.
“Tagging”
May be more acceptable while providing the same surveillance as a more conspicuous, specially designed monitoring device.
Accepting the premise that disability is bad.
We state that ATs can both reduce the differences between those with disabilities and increase those differences. Explain how this can happen.
For some the AT is an extension of their own capabilities and is highly valued.
List Nussbaum’s (2006) central human capabilities. How do these apply to the use of ATs?
If one views ATs as enabling and leading to expanded independence, then they in effect may be seen as contributing positively to the capabilities of a person with disabilities.
How does the application of ATs relate to the three types of privacy described by Tavani (2007)?
Accessibility privacy, which is physically being left alone or
being free from intrusion into your physical space
Decisional privacy, which relates to the freedom to make
personal choices and decisions
Informational privacy, which is control over the flow of
personal information, including the transfer and exchange of information.
What role does informed consent play in the ethical practice of AT delivery?
(1) providing details about benefits and risks of proposed intervention; (2) not subjecting the individual to control by others without their explicit consent; and (3) respectful interaction when presenting information, probing for understanding, and attempting to enable autonomous decision making.
What are the major ethical considerations associated with the application of ATs based on the ambient environment?
The pervasive nature of technology, self-determination which is the opportunity to make a choice on how and when daily functions such as taking a shower, bathing, dressing and undressing, using the toilet, and eating are carried out as well as completing activities such as shopping, cleaning, preparing meals, and taking care of financial affairs.
Remmers (2010) stated that the challenge is to balance the potential benefits of ambient environments, AI, and technologies such as robotics with ethical concerns of autonomy and privacy, but the stakes are higher because of the pervasive nature of the technology. What does this mean in terms of ethical principles?
The ethical principles of beneficence, nonmaleficence, and justice need to be applied to considerations of aids to daily living as well as other ATs.
