Assistive Technology

Assistive technology was first termed in 1988 (Mendelsohn & Fox, 2002), but various forms of assistive technologies have have existed long before this date. The computer revolution has speed up this field greatly in the past decade, especially in the field of rehabilitation. Assistive technology can be defined as "the applications of science, engineering, and other disciplines that result in processes, methods, or inventions that support people with disabilities" (Bryant & Bryant, 2003, p.2). Commonly this technology is further categorised into high and low technology devices, for example a modified eating utensil may be considered low tech whereas a speech generating device may be considered high tech.
Since the 1980's there has been a proliferation in the types of medical, assistive and learning technologies developed to help people with cognitive and physical limitations related to disability and illness. Accompanying the availability of these technologies has been a growing concern about their appropriate use by consumers (Tate et.al, 2002). As an Occupational Therapist one of the goals of intervention when working with clients who require an AT device is to ensure that the we are enhancing the independent functioning of that person. An AT device, as defined by the Technology-Related Assistance for Individuals With Disabilities Act of 1988 (P.L. 100-497), refers to any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customised, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities.

For the remainder of this blog I want to look at one of these AT devices in action, in particular Wii-Fit and its use in TBI rehabilitation. Wii Fit Plus has been out for a couple of years now and requires a console and balance board to participate in. Googling Wii Fit and TBI rehabilitation brings up many stories about current successes with this tool in intervention. Here is one I found.

Wii Fi Plus Bundle can currently be purchased for around $128, this includes the software required and the balance board shown on the above video. A Wii consule is required to operate the software and the cheapest option I found for this included Wii sports for $278. To make the experience beneficial the TV display has to be considered, a screen of around 40 inches would be ideal and plasma televisions of this size currently retail for around $650. The following video highlights some of the 15 training games available on Wii Fit.

For those people who have experienced a TBI, occupational transition can mean the transition from one occupational form to the realising of another, as disability or impairment prevents previous occupations from occurring. The presence or absence of an engaging occupation is considered a key determinant for experiencing satisfying occupational patterns in daily life (Christiansen & Townsend, 2010). So while the Wii Fit may have many cognitive and physical benefits for its users, there may be underlying psychological benefits as well. Occupational justice ensures that all members of society have a right to equally participate in their occupations, so that clients have a right to chose whether they participate in this form of rehabilitation.

References:

Bryant, D.P., & Bryant, B.R. (2003). Assistive technology for people with disabilities. Boston MA: Pearson.

Christiansen, C.H., & Townsend, E.A. (2010). Introduction to occupation: the art and science of living. London: Pearson Education Ltd.

Tate, D. G., Riley, B., & Forchheimer, M. (2002). Enhancing the appropriate use of assistive technology among consumers and caretakers. In M. J. Scherer (Ed.), Assistive technology: matching device and consumer for successful rehabilitation. Washington: American Psychological Association.

Blogs of Interest

For this tutorial we were required to source 5 blogs that related to OT practice in a chosen field. I decided to carry on with my TBI theme and used Google reader and Blogger.com to locate the blogs that are posted to the right of my main postings.
I chose the technology blog because I feel that it is important for OT's in any field to keep up to date with what is available on the market to help in the intervention or rehabilitation process. The rehabilitation and physical therapy news runs along the same lines, with up to date information on what is developing in these fields. I included two blogs from people who are sharing their stories about life with a TBI, I feel as an OT it will be important to try and understand as much as is possible what it is like for our clients and this is one way that we can gain insight into that experience. And finally there is a link to a fellow students blog, in case you waned  to gain another perspective or view from an OT student. An example of comments exchanged between myself and fellow bloggers is as follows:

1. 
   Hannah S17 May 2012 20:17

   Hi Amanda,
   This is a really intriguing concept! Are there anymore Hippotherapy centers in New Zealand? If there are not, do you think that this is a valuable form of therapy that should be extended on in NZ?
   
   Thanks Hannah

   ReplyDelete
2. 
   Hannah S17 May 2012 20:17

   I mean expanded on :)

   ReplyDelete
3. 
   Snicklefritz Farquhars17 May 2012 20:48

   Hi Hannah, I know there are quite a few Riding for the Disabled Centres around NZ but hippotherapy requires specialised therapists so am not sure as to any others apart from Auckland. Definately something that could work well in other parts of NZ though.

   ReplyDelete

Internet and On-line Communities

For this blog I will be posting about three different online communities that offer support and networking for people with Traumatic Brain Injuries. I chose this topic in particular as it was the setting for my first placement and so holds particular meaning for me. The availability of online healthcare information and support has seen many individuals and healthcare providers start communities where individuals can go to learn more about their impairments and connect with others whom share their disabilities. Social isolation is often a common side effect of TBI and can lead to depression and other negative side effects. These internet applications can be useful for occupational therapists during therapy sessions, or as a means for furthering functional independence (Griffiths et. al, 2003).
The first online community is a Brain injury support group: http://www.dailystrength.org/c/Brain-Injury/support-group. On this site people can chose to post anonymously on issues they may be having relating to TBI, and receive feedback or support from other posters. This site allows members to make contact over great distances, as it is a worldwide posting and can generate understanding and unity between its posters. It gives observers the opportunity to participate or not as they chose and does not require money to join. There does not appear to be any professional advisor's however, in the way of health professionals and I was unable to detect any moderators for the site. This means that the posts are open to abuse, which could be detrimental to its users.
The Second online community is the Brain Song Community:http://brainsong.site-ym.com/ , which is an online community for female survivors of TBI. This is a non-profit organisation, with a board of directors complete with a mission statement. It offers resources and information for members, and requires its posters to sign up with a username and password. Again this site is a worldwide posting, but I imagine many of its members are from the USA as it has its origin there. As this site has built in security features you are unable to browse through postings without first joining the community. This has advantages in that you know the site is being moderated and is unlikely to be abused.
The third online community is the TBI survivors worldwide community: http://tbisurvivors.net/. This site has information on the causes of TBI and a Facebook link where they promote brrain injury survivor advocacy, information, networking, peer support and resource exchange. Although they are not specifically an online community themselves they do give guidelines for rating other brain injury websites and online social communities. This includes criteria on who operates the site, your privacy, information accessibility, activities of the site you should be told about up front and honesty and candor. These are all relevant and important things that one should consider when posting personal information onto a worldwide site and I think that this site is important for people to read and understand before doing so, which is why I have included it on my list.
The anonymity that these sites provide allow posters to contribute and ask questions online that they may be reluctant to do face to face with a health provider or family member. Knowing that there are other people out there sharing similar experiences can give a great sense of relief to some, and the advice and comments shared can break down the isolation barriers that can lead to secondary illnesses such as depression.
Information on these sites is shared usually via two ways. The first is one-way information where information is presented in a way where it can not be commented on or interacted with, this is usually based on medical information where there is no expected reciprocation. The second way information is shared is via discussion and chat rooms, where information is reciprocal and the poster can share their thoughts, feelings, opinions and experiences on a topic and expect feedback from moderators and other posters.


References:
Griffiths, M., Davies, M.N.O., & Chappekk, D. (2003). Breaking the stereotype: the case of online gaming. Cyber Pschyology and Behaviour, 6(1), 81-91.

(1992) KWN "TAILS OF LOVE - The Pet Therapy Program".mp4

Get the tissues ready for this one. Although made a few years ago by a group of young New York primary school kids I like how they have approached this topic. While on placement I got to visit a couple of nursing homes with a therapy dog and got to see first hand the joy he brought them for that 10-15 minutes he spent in their company. Most had had dogs in their lives at some stage and were eager to share stories about that pet, and it opened up conversation for many other topics. I know that other animals are used on visits, the nursing home had two resident cats and a rabbit that visited regularly. We have to remember that not everyone is a dog person!

Hippotherapy

Finally a something a little different from the animal world. Hippotherapy is a form of occupational, physical and speech therapy that utilizes the characteristic movements of a horse to provide carefully graded motor and sensory input. Apparently a horses pelvis has a similar 3-dimensional movement to the humans pelvis at a walk. As explained in this video, it is this movement which is tailored to each clients individual needs to set a course of treatment designed around what sensory or motor deficits are requiring work. Pretty cool huh! New Zealand has its own hippotherapy centre in Auckland  http://www.totaraparkrda.org.nz/who_can_benefit.htm, hopefully I will get a placement with them!

Occupational Deprivation

Occupational Deprivation through environmental inequality

There are many factors that can produce occupational deprivation, including social, economic, environmental, geographic, historic, cultural and political (Christiansen & Townsend, 2010). The challenge for our group was to produce a short (1 minute) video film highlighting the issues of occupational deprivation. We chose to focus on environmental aspects, and put one of our actors in a wheelchair to show the challenges faced when accessing everyday utilities. Whiteford (2000) describes occupational deprivation as a "state in which a person or group of people are unable to do what is necessary and meaningful in their lives due to external restrictions" p.200. 

As a team we planned and organised a rough storyboard before filming. We had an idea of what and where we wanted to shoot, and had decided that it would be black and white beforehand. We were fortunate to have an experienced photographer and editor in our group which made these processes much easier. The film was to highlight difficulties wheelchair users face in everyday tasks and some not so everyday (emergency situations). Most challenges were environmentally based, such as the dimensions of the toilet doors and the reachable heights of the book shelves. Fire escape procedures I would assume would come under political.

References:

Christiansen, C.H. & Townsend, E.A. (2010). Introduction to occupation: the art and science of living (2 ed.). London: Pearson Education Ltd.

Whiteford, G. (2000, May). Occupational deprivation: global challenge in the new millennium. British Journal of Occupational Therapy, 63(5),  200-204.

Amy and Bonnie

Amy and Bonnie are New Zealand based. Amy has cerebral palsy, and having Bonnie means she is able to maintain her independence and grow in confidence. Mobility and assistance dogs have the same rights as guide dogs in New Zealand, meaning they are able to use public transport and access supermarkets, restaurants and cafes etc. Her family and friends have a greater sense of confidence for Amy's safety now that she has Bonnie, knowing that she is trained to help Amy should she get into difficulty. Bonnie is also trained for unusual tasks like helping Amy transfer from her wheelchair to bed, by stiffening her back Bonnie is able to take Amy's full body weight!

Seizure Alert Dogs - Canine Partners For Life - Comcast OnDemand 4/2009

I chose this video because it shows the many facets of animal assistance for people who have impairments. My supervisor on my first placement had a trained seizure alert dog, so this is something that is of great interest to me. Not every dog is suitable for this role, they need to be finely tuned to their handlers physical state. I personally find it fascinating that a dog can sense a seizure coming on, obviously there are physical changes going on for the owner up to an hour before the seizure that the dog can detect.... are they electrical, chemical, what is it that the dog is picking up on? And then they are also trained to support the person while they are going through the seizure as well, staying close by and often bringing a phone or medication if required. Amazing.

Effects of Animal Assisted Therapy on Autism (Video 3 of 5)

This is a series of videos which shows an Occupational Therapist working with a young man (Zachary) who has autism. I chose it because it shows the progress they make using animal assisted therapy. The connection Zachary has with Henry the dog is plain to see, and having a meaningful occupation (cutting up treats for Henry) enables Zachary to accomplish hand motor skills (using kindergarten scissors).

Doing, being, becoming and belonging….the multi-dimensions of owning Fido.

I never knew that Fido was actually the name of Abraham Lincoln’s dog; apparently he died not long after Lincoln was assassinated. I have always been fortunate to have animals in my life (images 1-6), so I was ecstatic to gain my first placement in an area where dogs were involved. My supervisor had a trained therapy dog who not only visited rest homes in the area (image 19) with clients but was also a seizure alert dog (image 17), who could give her up to 30 minutes warning of an impending epileptic attack. We also had a community client who was in the process of training his pet dog towards mobility assistance certification (images 12-14). I couldn’t have asked for a better first placement really.

The occupation of dog ownership encompasses more than the act of just owning a dog, it can be expressed through other things such as a reason to keep busy, having something to wake up for, exploring new activities and contributing to others (Hammell, 2004). Looking at the images we can see people engaging in activities such as dog agility (slide 7), dog sled racing (slide 8), canine freestyle dancing (slide 9) and the search and rescue team from the Christchurch earthquake (slide 10). All these activities provide the owners with a sense of enjoyment, purpose and fulfilment. This leads to an increased sense of self-worth, capability and respectability.

Being is harder to define as it has a more philosophical flavour, it is simply experiencing life and the environment around us. In my experience no other animal knows the joy of just being than a dog, unlike humans. This is Joshua Bell, one of the world’s greatest violin players…how many people do you think stopped to listen to him play at a busy Metro stop? (http://www.youtube.com/watch?v=hnOPu0_YWhw).The joy of dogs however is that they are able to share their ‘being’ (slide 11,12 & 13), its scientifically proven that for most people petting an animal reduces blood pressure and can alleviate depression.

Becoming explores the idea of how people envisage themselves in the future, what possible lives they may have and how their lives might be experienced as worthwhile (Hammell, 2003). For people with impairments owning a dog who can assist them with activities in daily living, becoming involves a sense of independence that they would not have without their canine companion (14,15,16& 17).

As humans perhaps the most important term as social beings is belonging. Rebeiro et al. (2001) describes this as the necessary contribution of social interaction, mutual support and friendship, the desire to be included. For children with autism, some respond first verbally to animals before humans (image 18). In some schools programs have been developed where children struggling to read are encouraged to read to therapy dogs, a fun, comforting and non-judgmental way to enhance learning (image 19). And finally the local dog park provides just as much social opportunity for the dogs as it does for their owners (image 20).


When posting photos on-line there are a few ethical considerations. I was aware that posting my own personal photos would mean they would be accessible to anyone who used the internet worldwide, so I made sure that I was happy with this personally. My other photos came from sites such as www.flickr.com and newspaper articles where I knew that consent would have been made prior to images being posted. I made sure to reference each photo to ensure authenticity and did not include any photos that may be offensive to people. 

As Occupational Therapists I don’t think we have even begun to touch the surface of what the animal world can do for humans, both through biomimicry and therapeutic applications. I will leave you with what I hope to achieve in New Zealand when I graduate (http://www.abc.net.au/local/videos/2011/10/11/3336788.htm)

Slideshare presentation

View more PowerPoint from Kiwi1974
References for photos:
First photos 1-6 are own personal photos.
Photo 7: Retrieved from http://www.stuff.co.nz/dominion-post/news/5962425/Corgis-compete-to-be-top-dog
Photo 8 : Retrieved fromhttp://www.odt.co.nz/your-town/wanaka/20819/no-time-paws-dogged-effort-needed
Photo 9: Retrieved from http://julieannamos.hubpages.com/hub/Doggy-Dancing-Canine-Freestyle
Photo 10: Retrieved from http://www.stuff.co.nz/national/christchurch-earthquake/4925431/Canine-heroes-to-be-recognised
Photo 11: http://www.flickr.com/photos/childrensla/5039177921/
Photo 12: http://4petsonline.com/pet-therapy/
Photo 13: http://www.healthyfellow.com/289/animal-assisted-therapy/
Photo 14: http://servicedogssite.com/?attachment_id=81
Photo 15 and 16: http://www.spinal-injury.net/assistance-dog-
tasks.htm
Photo 17: http://www.heraldsun.com.au/news/round-the-clock-help-a-bark-away/story-e6frf7jo-1225711570470
Photo 18: http://www.nypost.com/p/entertainment/good_dogs_PEwwznLJygkcHNBTDdu0OK
Photo 19: http://blog.oregonlive.com/washingtoncounty/2008/02/boydog.JPG
Photo 20: http://www.auntkitpetnanny.com/2011/04/el-paso-county-dog-park-etiquette/

Are you there TechnoGod? Its me Snickelfritz……

If you are reading this, welcome, my first attempt at writing a blog. As an Occupational Therapy student we are often asked to try new experiences, so this will be yet another notch on the proverbial therapeutic belt. I should briefly explain my blog name, its no secret…. the age old “what’s your porn star name?” Substitute your first pet's name with the name of the street you grew up with and there you have it! (Should you wish to see a photo of said Snicklefritz please view profile pic).

My first entry is focused on Information Technology (IT)/Information Communications Technology (ICT). Yadav (2006) defines IT as a generic name for the following functions; information/data representation, storage, retrieval and processing, and communication. The computer is the tool we use today to carry out these tasks as effectively and efficiently as possible and with increasing speed as technology advances. ICT is similar to IT but includes telecommunications (telephone lines and wireless signals) such as computers, broadcast media and video and audio processing. So that is any product that will store, retrieve, manipulate, transmit or receive information electronically in a digital form.

To say that technology is not prevalent in modern industrialised society would be insanity; it is everywhere you look even if on occasion it is invisible to the naked eye. The rapid expansion over the last 20 years of communication and personal digital assistant (PDA’s) devices is phenomenal, and the market competition is incredibly fierce. Watch Steve Job’s talk about the development of Apple’s post personal computers products here; (http://www.youtube.com/watch?v=H3QBw0QMzWU&feature=related); a genius in his own right and a truly inspirational speaker on entrepreneurship should you ever come across a video. In the first 9 months of Apple’s iPad release in 2010 over 15 million units were sold, that’s $9.5 billion in revenue! It often reminds me of the arms race you find in nature, the prey (technology) is constantly trying to evolve greater strategies to stay ahead of the predator (human race). But I guess it’s more of a supply/demand scenario. The following video is a clever account of the evolution of technology, although it is 4 years out of date; http://www.youtube.com/watch?v=JcSzqm5Whwc&feature=related.

I personally do not own any fancy gadgets, its not that I don’t want too it’s more of a financial restriction for now. I will admit to being a bit of a feature and design snob, its got to look sexy first and foremost and then be user friendly before I would consider purchasing it. I would buy an Apple iPhone 4s in a heartbeat if I won Lotto. My laptop is an old Dell inherited from my father’s workplace, it is sworn at daily for its slow processing capabilities and one day I will put a sledge hammer through its screen. But for now it serves its purpose and I don’t want to upset the technology karma gremlins.

Technology is becoming such an important part of everyday life that as of 2011, Occupational Therapists have a new assessment available to them in order to gauge the ability of some clients to manage the use of everyday technologies (Malinowsky, Nygard & Kottorp, 2011). But while for some technology may be a hindrance or safety issue for others it is a way to reconnect with family and society. I was fortunate enough to work with a supervisor on my first placement who was technologically savvy. One client in particular while I was there received his new iPad, which once attached to his wheelchair enabled him through a touchscreen and the use of interactive Prologuo2Go app to communicate effectively for the first time since his stroke. The following blog gives one woman’s account with her experience with this device and application, and how it helped her cope with cerebral palsy; http://www.doitmyselfblog.com/2010/the-ipad-as-an-affordable-communicator-initial-review/. I personally think as OT’s we cannot ignore the technology that could be yet another effective tool or enabling agent in the problem solving process. At the same time we must be mindful that not everyone is technologically aware or comfortable enough to use this equipment in which case education or alternative methods may be more suitable.

The final consideration for this blog and IT will be the ethical implications that arise from the capturing, sharing and transferring of information via PDA’s. Illegal downloading is recently been heavily targeted both in the media and in the courts, but copyright and intellectual property is something that should be respected when accessing information via the internet. The problem arises however when information starts crossing international borders and therefore differing regulations. This is clearly obvious when we look at the current Kim Dotcom saga. As OT students any photos taken while placement required informed consent from not only the organisation we are working for but if they include clients, then the clients as well. Quite often there will be strict guidelines to when and where they can be used and they certainly wouldn’t be put on the internet where anyone could copy and share it.

References:

Malinowsky, C., Nygard, L., & Kottorp, A. (2011). Psychometric evaluation of a new assessment of the ability to manage technology in everyday life. Scandinavian Journal of Occupational Therapy, 18, 26-35.

Yadav, D.S. (2006). Foundations of Information Technology. 3rd Edition. New Age International (P) Ltd, New Delhi.