1 Lecture 8 AT systems 2 ‘Environmental factors make up the physical, social and attitudinal environment in which people live and conduct their lives’

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Lecture 8

AT systems

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‘Environmental factors make up the physical, social and attitudinal environment in which people live and conduct their lives’ Health. P.171 ICF. Geneva: World Health Organization; 2001.

Included in environmental factors is Products and Technology, closely aligned to the International Standards

Organizations classification of ‘Technical Aids for Disabled Persons’ or ISO 9999 which is focused

on ATDs [ibid p173] and is called ‘‘Assistive Products for Persons with Disability’’ in ISO 9999:2007

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Personal Factors

Although not classified in the ICF, personal factors have been broadly described as follows:“Personal factors are the particular background of an individual’s life and living, and comprise features of the individual that are not part of a health condition or health states.”

p.17 World Health Organization. International classification of functioning, disability and health (ICF). Geneva: WHO 2001

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These factors may include gender, race, age, other health

conditions, fitness, lifestyle, habits, upbringing,

coping styles, social background, education, profession, past and current

experiences, overall behaviour pattern and character style,

individual psychological assets and other characteristics, all or any of which may play a role in disability at any level

World Health Organization. International classification of functioning, disability and health (ICF). Geneva: World Health Organization; 2001.

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Negative impact: Barriers

The terms barriers/hindrances apply to factors that have a negative impact. For example, barriers within the social environment exist when trained personnel to assist in selecting and obtaining AT devices are not available.

Another barrier can be the failure to conduct a comprehensive assessment of an individual’s needs, priorities and AT preferences at the beginning of the AT and support-selection process.

Barriers also occur when some professionals do not acknowledge that a person with a disability develops and changes perspectives over time.

Additional examples of environmental barriers to ATD use include the lack of funds to purchase an ATD and non-supportive attitudes of family members, teachers or employers toward ATD use.

Scherer M, Jutai J, Fuhrer M, Demers L, DeRuyter F. A framework for modelling the selection of assistive technology devices (ATDs). Disabil Rehabil: Assist Technol 2007;2:1–8.

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Predispositions People’s predispositions to, expectations

for, and reactions to assistive technology use are highly individualised and personal.

These predispositions, expectations and reactions emerge from such influences as varying needs, abilities, preferences and past experiences with and exposures to technologies

Scherer, M, Craddock G & Tmackeogh (2011)The relationship of personal factors and subjective well-being to the use of assistive technology devices Disability and Rehabilitation, 2011; 33(10): 811–817

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IMPT

The following seven factors were found to impact on the QOL of the students

The Benefits of the Statement of Need and a collaborative approach

What type of technology was utilised whether high or low technology or a combination of both

What strategies or supports were used to access the curriculum, note taking or personal assistant, copies of notes

Whether the students received all or any of their technology

Work ethic of the student Length of study Availability of Transport to college Craddock G. The AT continuum in education: novice to power user. Disabil Rehabil:

Assist Technol 2006;1:17–27.

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AT & students with disabilities

The research clearly showed that a collaborative/partnership approach between service provider and the student with a disability was a key factor in the successful selection, acquisition and long-term use of the specific AT.

The students’ quality of life was improved by reducing the length of time they had to spend studying.

The technology made life easier by allowing them to concentrate on learning rather than struggling to read, write and understand what was said or written.

This also provided time to do other things outside of education that had not been possible before.

Both formal (Disability Liaison Officers, technology support) and informal (parents, friends) support networks were also critical to the successful and continued use of the AT

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AT & students with disabilities

The strategies learned and used by the students in accessing the curriculum were further factors

however a critical element to emerge in the change process was the importance of both time and timing,

particularly in respect of the timing of the intervention in relation to the person’s life development, timing of receipt of AT within the educational continuum and the length of time that the students were using the technology and the duration of the evaluation process

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AT & students with disabilities

Two discernable groups of students emerged from the study distinguishable by the type of technology they used, how successful they were using the technology and its impact on their quality of life, how they used it, and how satisfied and comfortable they were with the technology.

The novice and power users with students progressing between the two stages characterized as transition users.

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AT & students with disabilities

The study clearly demonstrated that many students became ‘power users’ of AT. For these students’, the factors relating to the three domains are coalesced providing the necessary support and space for the assimilation of AT resulting in the changes within their self-esteem.

It was found that positive changes occurred within family relationships and the students’ ‘connective’ social relations.

The students had a positive perception of themselves as equal participants within their relationships and society and found they excelled with this added support.

AT became a positive factor in their lives; they were both confident in the assimilation of AT

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ATD PA

The Assistive Technology Device Predisposition Assessment (ATD PA) is a measure of an individual’s predisposition to and readiness for ATD use.

The follow-up version assesses realisation of benefit from the selected ATD and reasons for situations of nonuse.

The ATD PA was developed to help reduce inappropriate ATD recommendations and the frustration that often accompanies a poor match of person and device.

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MPT

Section A (9 items): consumer ratings of functional capabilities (5-point Likert scale), .

Section B (12 items): quality of life/ SWB in the context of the ICF, Disability and Health (ICF)28 domains of activity and participation (5-point Likert scale),

Section C (33 items): consumer personal and psychosocial characteristics (yes/no) . This section is comprised of eight subscales as follows: Mood, temperament, self-esteem, self-determination and autonomy, family support, friend support and readiness and motivation to use support.

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Assistive Technology Device Predisposition Assessment Name Date of Birth

Primary Goals (6 months): Today’s Date

Primary Goals (1 year+): Form completed by A. How are your capabilities today in the following areas with AT (or other support)? Circle the best response for each and write in

the name of the primary device or support you use where relevant. Then, put a plus [+] for any device or support needs that you believe will increase over the next 12 months. Put a minus [-] for any that you believe will decrease over the next 12 months.

Name of Need increase [+]

Poor Average Excellent Support or decrease [-] 1. Eyesight 1 2 3 4 5 __________________________ _____

2. Hearing 1 2 3 4 5 __________________________ _____

3. Speech 1 2 3 4 5 __________________________ _____ 4. Understanding, remembering 1 2 3 4 5 __________________________ _____

5. Physical strength/stamina 1 2 3 4 5 __________________________ _____ 6. Lower extremity control 1 2 3 4 5 __________________________ _____

7. Grasping and use of fingers 1 2 3 4 5 __________________________ _____

8. Upper extremity control 1 2 3 4 5 __________________________ _____

9. Mobility 1 2 3 4 5 __________________________ _____ B. How satisfied are you currently in the following areas? Circle your response to each. Then, circle the number of the item(s) you

most want to see improve over time. If more than one is circled, indicate under the column labeled Importance, the item that is #1 in importance, #2, etc. For circled items, indicate if the primary obstacle you face is due to environmental barriers [E] or to your disability [D].

Not Very Primary Satisfied Satisfied Satisfied Importance Obstacle [E], [D] 10. Personal care and household activities 1 2 3 4 5 _____ _____

11. Physical comfort & well-being 1 2 3 4 5 _____ _____ 12. Overall health 1 2 3 4 5 _____ _____

13. Freedom to go wherever desired 1 2 3 4 5 _____ _____ 14. Participation in desired activities 1 2 3 4 5 _____ _____

15. Educational attainment 1 2 3 4 5 _____ _____

16. Employment status/potential 1 2 3 4 5 _____ _____

17. Family relationships 1 2 3 4 5 _____ _____ 18. Close, intimate relationships 1 2 3 4 5 _____ _____

19. Autonomy and self-determination 1 2 3 4 5 _____ _____ 20. Fitting in, belonging, feeling connected 1 2 3 4 5 _____ _____

21. Emotional well-being 1 2 3 4 5 _____ _____

C. Please circle all the statements below that describe you.

22. I have the support I want from family 33. I’m usually calm and patient 44. I find technology interesting 23. I have the support I want from friends 34. My life has purpose, meaning 45. I’m cooperative 24. I feel encouraged by therapists, caregivers 35. I’m self-disciplined 46. I prefer a quiet lifestyle 25. I feel the general public accepts me 36. I’m often angry 47. I often feel isolated & alone 26. I aspire to go to school or work 37. I’m often depressed 48. I accomplish what I set out to do 27. I have many things I want to accomplish 38. I prefer to be left alone 49. I’m not sure who I am now 28. I do what my therapists say without question 39. I’m often discouraged 50. I want more independence 29. I think of my therapist(s) as my friends, too 40. I’m quite resourceful 51. I have a good self image 30. I’m often frustrated or overwhelmed 41. I like having a challenge 52. I often feel insecure 31. I’m curious & excited about new things 42. I’m responsible & reliable 53. I feel as if I have little privacy 32. I’m determined to meet my goals 43. I’m generally satisfied with 54. My therapist(s) know better than I

my life what is best for me COMMENTS:

Copyright 2003 M.J. Scherer

Form 4-1 Person

Initial

Assistive Technology

Device Predisposition

Assessment

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ATD PA Personal Factors mapped on the ICF

ATDPA Section C: Personal Factors Scales ICF Classification: Contextual Factors______________________________________________________________________

Perceived support from family, Support from family (e310, 410), friends Support from friends (e320,420)

Temperament Personal, Temperament & personality (b126)

Mood Emotional functions (b152)

Autonomy and self-determination Making decisions(d177), Higher cognitive functions (b164), Attitudes (e4)

Self-esteem Personal, Emotional functions (b152)

Readiness for technology use Incentive to act (b1301), Forming an opinion

(b1645)

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Activities and Participation

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The guidelines are very specific about the elements that should be included in the AT assessment framework.

The framework represents a bio-psychosocial approach in that it focuses on the learner in terms of his or her history, interests, abilities, learning, attitude and academic and physical skills.

The environment is considered in terms of the physical context at school and home and social factors such as the role and attitudes of peers, teachers and family.

The guidelines also describe the tasks, goals and tools for assessment.

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Students of AT Female, aged 19, with a visual impairment, who wanted to take social studies in her

local Institute of Technology. She has difficulty reading the blackboards and experiences eye fatigue reading books.

She has a laptop and uses Lunar ’95 as well as Telescopic lens. She received the laptop in the middle of her second last year in secondary school.

A separate room to sit the Leaving Certificate, with laptop, large print and extra time, though they forgot english paper!

After the leaving certificate, the school took her laptop back, no system for third-level so she went back to her secondary school and asked could she borrow her laptop, they said “no way”. She since found out that the vice principal was using the laptop.

Had to reapply for the technology again, for third-level use. This took another year, she eventually received another laptop two weeks before her 1st year college exams, and was told to use it by the college. She told them there was no way she could use it, having not had it for over a year, it also had a totally different software package. The exam authorities enlarged the paper for her 1st year exams

She had a very good second year with her laptop until her final exams. In her final exams, the papers were not enlarged. She wrote to the Department of Education and the Minister of Education, but she got no reply. She also wrote to the head of exams and the president of the college, but they did not reply either. She was looking for extra marks for the subjects.

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Students of AT

Student four is Female, aged 20 years, with dyslexia, this is her account taken at the post-leaving certificate stage, two years after the project. She had no access to any assistive technology in school; she used school computers as part of the curriculum

recommended that she needed a high-spec computer with Dragon Naturally Speaking, Quicktionary Pen, Kurzweil 3000 and a Franklin Spellmaster with Thesaurus with copies of lecture notes in digital form, access to photocopying and one-to-one tutoring

The school alerted examiners to issues of readability of the exam scripts. She sat the applied Leaving Certificate and was awarded 93%, the second highest in her year.

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Students of AT

Student three is a male who is twenty-two years of age. He has poor hand and lower limb capabilities which means he has great difficulty writing and walking.

In secondary school he studied English, History, Business Organisation, German and Biology at honours level and Irish and maths at lower level in the leaving certificate. He wanted to get 430 points in the leaving certificate to go onto University.

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Students of AT

The student is male, twenty-one years of age and has a severe disorder of the skin. This results in the constant breakdown of the skin and the dexterity of his hands is poor, making writing difficult if not impossible.

unable to sustain legible writing for long periods. Dragon Dictate Systems products. “the headmaster always kept me informed of

assistive technology demonstrations and assessment schemes” Student

A computer company sponsored him for the Leaving Cert, and provided him with a new laptop computer