Assistive Technology Assessment – Skills evaluation

Assistive Technology Assessment – Skills evaluation Lecture 9

Cognitive assessment • Sensory assessment • Motor assessment • Environmental assessment

Resna definitions re professionals involved in the field of AT Rehab Science, for the purposes of the program, is defined as one of the following: medicine, nursing, low vision rehabilitation, occupational therapy, physical therapy, speech-language pathology, audiology, special education, vocational rehabilitation, engineering (biomedical, clinical, or rehabilitation), prosthetics & orthotics, recreation therapy, and rehabilitation technology (rehabilitation technology defined as an Associate degree curriculum for technicians focusing upon application of technologies to the needs of people with disabilities).

Multidisciplinary contributions can be interpreted as the bringing together of disciplines which retain their own concepts and methods that are applied to a mutually agreed subject. Interdisciplinarity can be considered as the mixing together of disciplines, whereas transdisciplinarity implies a fusion of disciplinary knowledge with the know-how of lay-people that creates a new hybrid which is different from any specific constituent part.

“Interdisciplinarity differs from multidisciplinarity in that it constructs a common model for the disciplines involved, based on a process of dialogue between disciplines” (Ramadier 2004). In other words an inter-discipline is often a discipline of its own. Examples of this synthesis of disciplines are numerous and include such fields as biochemistry, social psychology, and biological anthropology.

Trans-disciplinary teams requires that traditional boundaries and responsibilities be set aside so that team members can fully embrace new skills and knowledge. It requires that team members be willing to step away from the prejudices of their individual disciplines and open themselves up to the perspectives of others, including laypeople, and embrace the learning that takes place when distinct ideas are threaded together.

AT direct consumer-related services, Resna Definition • . Services may include but are not limited to: • Assessment & evaluation services • (needs assessments, physical/functional/sensory assessments, site assessments, simulations, and product trials) • Fitting, adjustment, and readjustment services • (fine tuning of equipment to meet consumer needs and reflect changes in consumer status) • Implementation and training services • (training in use of AT or strategy to maximize function and interface with the environment of use, instruction in use, and maintenance)

Skills Evaluation - Sensory • Needs identification process • Individual needs & goals – identifying needs is the most critical component of the service delivery process • Cornerstone for measuring the effectiveness of the final outcome • Essential to meet consensus on the nature and scope of problem

Potential Barriers • Identify potential barriers • Policy barriers, regulations, legislation or agency policies eg school policy on technology in school and home, work situation etc • Practice barriers, routine activities eg school or work situation • Attitudinal barriers • Knowledge or skill barriers

Skills Evaluation: Sensory • Consumers’ sensory abilities and limitations -Auditory – audiologist -Tactile – physical/occupational -Visual- optomologist • Details of previous evaluations by specialist is essential

Functional Vision • Identifying any visual field deficits is important • Assessment of visual skills needed for AT use are sufficient to see the symbols or identify small items in the environment • Visual tracking ability • Reading ability

Visual Difficulties • Clients may be perceived as having cognitive difficulties if making mistakes whereas they may have a visual field deficit • Visual field commonly assessed by having the consumer look straight ahead and indicate when a moving object comes into their left or right peripheral view

Visual Tracking • Limitations in visual tracking - ability to follow a moving object • Visual tracking deficits can reduce AT options • Tested by having a consumer follow a moving object with the eyes • Note • whether the two eyes track together • whether there is a delay in tracking • Or whether the eyes can track without head movement

Visual Scanning • Ability to move eyes to view space around • Individual’s ability to see or distinguish - • The size of an object • The contrast between the object and the background • Spacing between the object and background

Visual Tracking & Scanning • Information important for the type and size of symbols • Goal is to find the smallest size of symbol that can be seen well by the consumer • Trials of size should be repeated 3 times to identify successful use • If the client can read but has difficulty seeing words, different backgrounds etc should be used • Test contrasts, letter spacing, colours of background and letters

Visual Perception • Process of giving meaning to visual information • Depth perception, spatial relationships, form recognition or constancy and figure-ground discrimination • Important to observe the client during functional tasks for any apparent perceptual problems http://www.visionandlearning.org/visualintegration08.html

Visual Perception • Visual Form Recognition/Discrimination & Constancy: The ability to discriminate differences in forms. This includes differences of size, shape, color and orientation. Recognition that visual information in a form is consistent in spite of the object, size in the back of the eye, or location. e.g. DOG = dog = Dog, or that a cup of water is a cup of water whether in a tall glass or shallow bowl.

visual discrimination • Used to identify, sort, organize, store and recall visually presented information. It is the ability to take in visual information remember it and apply it later. • Children with poor visual analysis skills often have trouble learning the A, B, C's and recognizing words or simple forms even when presented repeatedly; for example, they may correctly read the word "house" in one sentence and incorrectly read "horse" two lines later. These kids tend to mistake words with similar endings or beginnings, generalise when grouping objects. • They also have a hard time understanding size and magnitude, (a cup of water in a tall glass and a cup of water in a shallow bowl are not seen as equal amounts).

Symptoms of Visual-Discrimination Difficulties • Trouble learning the alphabet • Trouble recognizing words • Mistakes words with similar beginnings • Overgeneralises - confuses minor likenesses and differences • Does not recognize the same word if repeated again on a page • Trouble with remembering and writing letters and numbers • Distractible • Short attention span • Problems concentrating • Difficulty with understanding instructions • Hyper or hypo active

Visual Spatial Skills • These are the skills we use to understand directional concepts to organize our visual space. This is how we visually project our body coordinates out into the world. • For example: When you say, "It is over to the left," the "to the left" has no meaning unless it has a point of reference. So actually, you are really saying to the left of where YOU are. If you don't know where your body is, it is hard to know where things are in relation to you. • Visual spatial skills require observing an object, then accurately reporting its relationship in space relative to your own self.

Symptoms of Visual-Spatial Difficulties • Lack of coordination and balance (clumsy) • Difficulty learning left and right • Reverses letters or numbers when writing or copying • Difficulty with activities involving rhythm • Not good at sports • Does not cross the midline when doing tasks (switches objects from hand to hand) • Does not use nondominant hand for support when writing or copying • Rotates body when writing or copying (again to not cross the midline)

Visual-Motor Integration (VMI) • Visual motor integration (VMI) consists of coordinating visual perceptual skills together with gross-motor movement and fine-motor movement. It is the ability to integrate visual input with motor output. This is how individuals plan, execute and monitor motor tasks, such as threading a needle, tying shoe laces, catching or hitting a ball. It is also essential in academic performance. • This is commonly referred to as Eye-Hand Coordination.

Symptoms of Visual-Motor Integration difficulties • Sloppy writing or drawing skills • Can't stay on or in the lines • Erases excessively • Poor organization • Does not recognize mistakes • Close working distance • Poor posture when writing • Excessive or inadequate pencil grip • Trouble aligning numbers in columns for math problems • Can't get answers on paper • Tests poorly even if they know the subject • VMI problems can be called developmental apraxia,

Visual-Auditory Integration • Visual-auditory integration require linking together visual information with information heard. Abilities such as seeing a word and saying it aloud, or hearing a word and writing it down, are examples of visual-auditory integration.

Symptoms of Auditory-Visual Integration Difficulties • Needs to have directions repeated all the time • Poor spelling ability • Trouble learning to read phonetically • Difficulty relating symbols to their relevant sounds (Example: The "ah" sound is not recognized as relating to the letter "a")

Tactile Function • Seating & positioning assessments • individuals who lack sensation may sit for long periods which could result in skin breakdown observation and monitoring of the skin surface is important • Evaluating tactile input for the use of control interfaces • Tactile alternatives to vision or hearing

Auditory Function • In cases of suspected hearing loss a formal evaluation by an audiologist is essential • Information should be include - whether the individual responds - distracted by sounds – beeping sounds - recognises auditory stimuli

Physical Function • Overall goal of the physical skills evaluation is to determine the most functional position for the individual and evaluate his or her ability to access a device physically • Physical skills include – motion, strength, muscle tone, type movement

Muscle Strength • Muscle strength graded from unable to move independently, to move independently with support e.g type of wheelchair, walker, crutch, PA etc • Position of person is important when accessing strength

Muscle Tone Physical disorders can result in abnormally low hypotonia or high hypertonia muscle tone.

Muscle Tone • Important considerations particularly for individuals with neurological disorders • Muscle tone assessed in various functional positions to determine degree of support needed • Sitting and standing balance should be considered • Sitting balance should be hands free • Reflexes should also be assessed to determine how they effect function

Motor skills Gross & fine motor assessments must include • balance • performing symmetrical and asymmetrical movements of upper and lower extremities, • co-ordinating one side of the body, • lifting and carrying objects • Finger movements • Manipulating objects of different sizes

Anatomical sites for control • Hands and fingers are the preferred control sites because they can give finer adjustment for manipulation tasks • Head and mouth are considered next – mouthsticks, head pointers can be used to control a device • A third option is the foot but there can be difficulties with seeing the screen or the device

Assessing Hand function • Grasp – 7 functional grasp patterns eg cylindrical , tip, hook or snap, palmar, spherical grasp, lateral grasp • Did the client having difficulty picking up or releasing • Was the movement good • Did the client have depth perception problems when reaching

Hand function • If hand use is good, the next step is to determine arm range for an appropriate workspace • Select control interfaces and test the client’s ability to use and understand usage • When considering alternative access eg keyboards with guards, mouthsticks etc each possible method should be tested for the best control and also for the speed of response and accuracy of response

Skills evaluation: cognitive • In AT assessment, clinical observation is the major strategy used to determine a client’s cognitive ability • Previous tests by specialist may be available to assist but largely the AT practitioner will determine the client’s ability through observation at assessment eg by observing a client using switch activated program, the level of the client’s attention ability, response, understanding, motivation and ability to follow directions can all be monitored to determine the client’s cognitive ability • Problem solving can be measured during functional tasks as use of any technology requires a high degree of skill and understanding

Skills evaluation: Language • Evaluation of language skills needed for AT devices focuses on both expressive and receptive abilities • Ability to sequence items, use symbol systems and use codes • Specific areas needed to be evaluated include ability to categorise, sequence, social communicate skills (degree of interaction), receptive language skills (recognition of words or symbols, understanding of simple commands)

The Trusted Assessor UK The term “Trusted Assessor” was originally coined to describe staff, such as assistants or support workers, who had undergone specific training because of their growing importance in providing people with disability equipment, as part of delivering community care services. It was envisaged that their work would be within the realms of ‘straightforward’ and relatively low risk needs, leaving qualified staff to concentrate on people with more complex, higher risk needs www.cot.co.uk/sites/default/files/.../Competence-framework.pdf

Summary • Just as there is no such thing as the average person (Norman, 1993), there is no typical disability. Many disorders are best described as a spectrum with varying degrees to which a person is affected. • There is great variability within each category of disability: cognitive, sensory, and physical.

summary • Cognitive disabilities can affect comprehension, expression, fluency of ideas, memory, reasoning, problem solving, hearing, attention, generalization skills, and motor skills. • Sensory impairments involving vision can involve acuity, depth perception, colour discrimination, peripheral vision, glare sensitivity, orientation and visual attention

Summary • Hearing impairments can affect hearing acuity within a range of pitches and frequencies, sound localization and auditory attention. The speed by which one comprehends what one is seeing or hearing and is able to react is also a factor.

Summary • Physical impairments involve strength, flexibility, gross motor coordination, stamina, fine motor control, reaction time, rate control, speed, multi-limb coordination, and selective attention

Assistive Technology Assessment – Skills evaluation