As defined by Public Law 100-407
Assistive technology means 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 the functional capabilities of children with disabilities. (Federal Register, August 19, 1991, p. 41272)
History and legislation
Technology-related assistance for individuals with Disabilities Act (the Tech Act)
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Signed into law in 1988 and amended in 1994
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All states have to develop systems for providing a variety of technology assistance to children and adults with disabilities and their parents and guardians.
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The purpose of PL 100-407 is to provide financial assistance to the states to enable them to conduct needs assessments, identify technology resources, provide assistive technology (AT) services, and conduct public awareness programs, among others.
The federal regulations go on to state that an array of services is included when considering applications for AT. Such services include activities such as evaluation of a person’s needs for AT devices, purchasing or leasing AT devices for people, designing and fabricating devices, coordinating services offered by those who provide AT services, providing training or technical assistance to a person who uses AT, and training and technical assistance to those who work with people who use AT devices, such as teachers or employers.
Individuals with Disabilities Education Act, public law 105-17
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Guarantees the right of all children with disabilities to a free and appropriate public education in the least restrictive environment passed in 1997
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Most important is the development of an Individualized Education Program (IEP) for every student who is enrolled in special education, which are now extended to preschool programs for students who are entitled to an Individualized Family Services Plan (IFSP) and to those who are eligible for rehabilitation services through the development of an Individualized Written Rehabilitation Plan (IWRP)
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Requires the development of an Individualized Transition Plan (ITP) for all special education students of 14 years of age or older to prepare the student for postschool environments
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As part of the IEP planning process, IDEA mandates that the AT needs of all students be considered [P.L. 105-17, Section 1414 (d)(3)(B)(v)]. This provision applies equally to students with learning disabilities who may require the use of a device, such as a spelling checker, to assist them with written communication.
Reauthorization of the Rehabilitation Act (2003)
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Recognized role of employment in enabling individuals with disabilities to become economically self-sufficient and integrated into communities
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Mandates that AT devices and services are considered and provided as a means to acquire vocational training and to enter into and maintain employment
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Vocational rehabilitation (VR) has become an important source of funding for AT devices.
Augmentative and alternative communication
Definition
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Tools, systems, and strategies that are used specifically to assist or support communication
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Multimodal
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Supplement deficient oral communication or limited oral communication skills
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Low-technology (do not use electronics) or high-technology (use electronics) devices
Information and communication technologies
Definition
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Any device or application used for communication
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Includes technology such as email, internet, and mobile phones that enable users to access, store, transmit, and manipulate information
Switches
Switches are devices that can be connected to other devices to control them.
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Can be simple or more complex and can be activated in different ways (pushing, pulling, sipping and puffing, pressing, blinking)
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Can be generic, able to connect to various devices with adapter cords, or designed with a specific functionality for a specific device
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Single switches are less physically demanding but are slower when there are more options to scan.
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Multiswitch scanning is more cognitively and physically complicated but allows the options to be organized in such ways that choices can be made faster.
Choosing the most appropriate switch depends on multiple variables:
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Consideration must be made to the patient’s cognitive and physical abilities
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Complexity of what is being controlled
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Cost
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Mounting options
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Necessary to try multiple switches before settling on the best option
Environmental control
Environmental control (EC) devices allow a person to interact with their environment and assist in maintaining independence with daily living.
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Control home devices: lights, locks, security system, television, music players, robotic vacuums
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Vehicle controls: remote start, doors, ramps
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Communication: telephone, video phone, computers
Electronic devices are now sold as smart devices and can be remotely controlled by a single device. Apps have been developed that allow users to use their smartphones, electronic tablets, and computers to remotely control devices throughout their homes, including lights, alarm systems, thermostats, televisions, etc. Devices that are not designed to be remotely controlled can be plugged into electronic switches that can be controlled remotely, essentially making them into smart devices.
Voice-activated devices are becoming more available commercially. Multiple products that can connect to multiple smart devices throughout a home environment allow people to speak commands to activate them. This gives patients with significant physical impairments the ability to manage their environment around them without the assistance of others.
Considerations for environmental controls
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Physical impairments
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Cognitive deficits
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Verbal communication impairments
Electronic memory AIDS
Cognitive deficits after traumatic brain injury (TBI) are quite common. Problems with memory, attention, and executive function are common and can significantly limit an individual’s independence. More and more, technology is being used to compensate. Some devices have been adapted to help, whereas others have been designed to fill a specific need. These devices come in various styles (see Table 44.1 and 44.2 ). Some have a single purpose and others, such as smartphones, are more complex and have multiple functions.
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