Assistive Technology Assessment Handbook

Book · January 2012with 2,167 Reads
DOI: 10.1201/b11821
Publisher: 978-1-4398-3865-5
Publisher: CRC Press
Abstract
The process of matching a person who has a disability with the most appropriate assistive technology requires a series of assessments, typically administered by multidisciplinary teams at specialized centers for technical aid. Assistive Technology Assessment Handbook fills the need for a reference that helps assistive technology experts perform assessments that more effectively connect the person and the technology. Emphasizing the well-being of the individual with a disability, the book proposes an ideal model of the assistive technology assessment process and outlines how this model can be applied in practice internationally. Organized into three parts, the handbook: Gives readers a toolkit for performing assessments Describes the roles of the assessment team members, among them the new profession of the psychotechnologist, who is skilled in understanding individuals and their psychosocial and technological needs and preferences Reviews cutting-edge technologies for rehabilitation and independent living, including brain–computer interfaces and microswitches The book synthesizes information scattered throughout the international literature, focusing on aspects that are particularly representative or innovative. It also addresses the challenges posed by the variety of health and social care systems and the different ways that individuals who need aid are defined—are they users, patients, clients, or consumers, and how does that affect the assessment?
Assistive Technology
Assessment
Handbook
© 2012 by Taylor & Francis Group, LLC
Rehabilitation Science in Practice Series
Series Edito
Published Titles
Assistive Technology Assessment Handbook,
edited by Stefano Federici and Marcia J. Scherer
Paediatric Rehabilitation Engineering: From Disability to Possibility,
edited by Tom Chau and Jillian Fairley
Forthcoming Titles
Ambient Assisted Living, edited by Nuno M. Garcia, Joel Jose P. C. Rodrigues,
Dirk Christian Elias, Miguel Sales Dias
Assistive Technology for the Visually Impaired/Blind,
Roberto Manduchi and Sri Kurniawan
Computer Systems Experiences of Users with and without Disabilities:
An Evaluation Guide for Professionals,
Simone Borsci, Masaaki Kurosu, Stefano Federici, Maria Laura Mele
Multiple Sclerosis Rehabilitation: From Impairment to Participation,
edited by Marcia Finlayson
Neuroprosthetics: Principles and Applications, Justin C. Sanchez
Rehabilitation Goal Setting: Theory, Practice and Evidence,
edited by Richard Siegert and William Levack
Quality of Life Technology, Richard Schultz
Marcia J. Scherer, Ph.D.
President
Institute for Matching Person and Technology
Professor
Orthopaedics and Rehabilitation
University of Rochester Medical Center
Dave Muller, Ph.D.
Executive
Suffolk New College
Editor-in-Chief
Disability and Rehabilitation
Founding Editor
Aphasiology
rs
© 2012 by Taylor & Francis Group, LLC
CRC Press is an imprint of the
Taylor & Francis Group, an informa business
Boca Raton London New York
Editedby
StefanoFedericiandMarciaJ.Scherer
Assistive Technology
Assessment
Handbook
© 2012 by Taylor & Francis Group, LLC
CRC Press
Taylor & Francis Group
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Boca Raton, FL 33487-2742
© 2012 by Taylor & Francis Group, LLC
CRC Press is an imprint of Taylor & Francis Group, an Informa business
No claim to original U.S. Government works
Version Date: 20120227
International Standard Book Number-13: 978-1-4398-3866-2 (eBook - PDF)
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© 2012 by Taylor & Francis Group, LLC
CRC Press
Taylor & Francis Group
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742
© 2012 by Taylor & Francis Group, LLC
CRC Press is an imprint of Taylor & Francis Group, an Informa business
No claim to original U.S. Government works
Printed in the United States of America on acid-free paper
Version Date: 20120227
International Standard Book Number: 978-1-4398-3865-5 (Hardback)
This book contains information obtained from authentic and highly regarded sources. Reasonable efforts have been made to
publish reliable data and information, but the author and publisher cannot assume responsibility for the validity of all materials
or the consequences of their use. The authors and publishers have attempted to trace the copyright holders of all material repro-
duced in this publication and apologize to copyright holders if permission to publish in this form has not been obtained. If any
copyright material has not been acknowledged please write and let us know so we may rectify in any future reprint.
Except as permitted under U.S. Copyright Law, no part of this book may be reprinted, reproduced, transmitted, or utilized in any
form by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying, microfilming,
and recording, or in any information storage or retrieval system, without written permission from the publishers.
For permission to photocopy or use material electronically from this work, please access www.copyright.com (http://www.copy-
right.com/) or contact the Copyright Clearance Center, Inc. (CCC), 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400.
CCC is a not-for-profit organization that provides licenses and registration for a variety of users. For organizations that have been
granted a photocopy license by the CCC, a separate system of payment has been arranged.
Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identifica-
tion and explanation without intent to infringe.
Library of Congress Cataloging‑in‑Publication Data
Assistive technology assessment handbook / editor[s], Stefano Federici, Marcia J. Scherer.
p. ; cm. -- (Rehabilitation science in practice series)
Includes bibliographical references and index.
ISBN 978-1-4398-3865-5 (hardback : alk. paper)
I. Federici, Stefano. II. Scherer, Marcia J. (Marcia Joslyn), 1948- III. Series: Rehabilitation science in
practice series.
[DNLM: 1. Self-Help Devices. 2. Technology Assessment, Biomedical. 3. Disabled
Persons--rehabilitation. WB 320]
617’.033--dc23 2012000644
Visit the Taylor & Francis Web site at
http://www.taylorandfrancis.com
and the CRC Press Web site at
http://www.crcpress.com
© 2012 by Taylor & Francis Group, LLC
This book is dedicated to the psychotechnologists of today and the
future, regardless of the country in which they work.
© 2012 by Taylor & Francis Group, LLC
vii
Contents
Foreword .........................................................................................................................................ix
Preface .............................................................................................................................................xv
Contributors ................................................................................................................................. xix
Section I The Assistive Technology Assessment Model and
Basic Definitions
S. Federici and M. J. Scherer
1. Assessing Individual Functioning and Disability ........................................................ 11
S. Federici, M. J. Scherer, F. Meloni, F. Corradi,
M.Adya,D. Samant,
M.Morris,and A. Stella
2. Measuring Individual Functioning .................................................................................. 25
S. Federici, F. Meloni, and F. Corradi
3. Measuring the Assistive Technology Match...................................................................49
F. Corradi, M. J. Scherer, and A. Lo Presti
4. The Assessment of the Environments of AT Use: Accessibility,
Sustainability, and Universal Design ..............................................................................67
M. Mirza, A. Gossett Zakrajsek, and S. Borsci
5. Measuring the Impact of AT on Family Caregivers ....................................................... 83
L. Demers and B.W. Mortenson
Section II Assessment Professionals: Working on the
Multidisciplinary Team
M. J. Scherer and S. Federici
6. The Cognitive Therapist ................................................................................................... 107
M. Olivetti Belardinelli, B. Turella, and M. J. Scherer
7. The Special Educator ......................................................................................................... 131
S. Zapf and G. Craddock
8. The Psychologist ................................................................................................................. 149
F. Meloni, S. Federici, A. Stella, C. Mazzeschi, B. Cordella, F. Greco, and M. Grasso
9. The Psychotechnologist: A New Profession in the Assistive Technology
Assessment ........................................................................................................................... 179
K. Miesenberger, F. Corradi, and M. L. Mele
© 2012 by Taylor & Francis Group, LLC
viii Contents
10. The Optometrist ..................................................................................................................201
M. Orlandi and R. Amantis
11. The Occupational Therapist: Enabling Activities and Participation Using
Assistive Technology .........................................................................................................229
D. de Jonge, P. M. Wielandt, S. Zapf, and A. Eldridge
12. Pediatric Specialists in Assistive Solutions ..................................................................245
L. W. Braga, I. L. de Camillis Gil, K. S. Pinto, and P. S. Siebra Beraldo
13. The Geriatrician ..................................................................................................................269
M. Pigliautile, L. Tiberio, P. Mecocci, and S. Federici
14. Role of Speech–Language Pathologists in Assitive Technology Assessments......301
K. Hill and V. Corsi
Section III Assistive Technology Devices and Services
S. Federici and M. J. Scherer
15. Systemic User Experience .................................................................................................337
S. Borsci, M. Kurosu, M. L. Mele, and S. Federici
16. Web Solutions for Rehabilitation and Daily Life ........................................................ 361
G. Liotta, E. Di Giacomo, R. Magni, and F. Corradi
17. BrainComputer Interfaces: The New Landscape in Assistive Technology .......... 379
E. Pasqualotto, S. Federici, M. Olivetti Belardinelli, and N. Birbaumer
18. New Rehabilitation Opportunities forPersonswith Multiple Disabilities
Through the Use of Microswitch Technology ..............................................................399
G. E. Lancioni, N. N. Singh, M. F. OReilly, J. Sigafoos, D. Oliva, and G. Basili
19. Methods and Technologies for Leisure, Recreation, and an Accessible Sport ......421
C. M. Capio, G. Mascolo, and C. H. P. Sit
Index ............................................................................................................................................. 439
© 2012 by Taylor & Francis Group, LLC
ix
Foreword
Global Perspectives and Emerging Themes in
Assistive Technology Assessment
I am delighted and privileged to be asked by the eminent editors of this text, Stefano
Federici and Marcia J. Scherer, to write a foreword. These colleagues are at the forefront
of work within the eld of assistive technology and have pioneered much of the current
thinking resulting in both the delivery of services to individuals and transformational
research. The emergence and importance of this eld can be demonstrated through the
emergence of Disability and Rehabilitation: Assistive Technology as a standalone journal
afliated with Disability and Rehabilitation. This journal, which embraces the broad eld of
assistive technology, is edited by Marcia J. Scherer, ably assisted by Stefano Federici as an
editorial board member.
These two journals, like this book, are characterized by their international coverage,
multiprofessional publications, and interprofessional research of the highest quality.
This edited volume includes contributions from ve continents and reinforces the global
approach to responding to the needs of individuals and in some cases communities
requiring support and intervention.
This is no easy challenge, and the need remains to recognize both the integrity of those
contributing disciplines and individuals along with the emerging integrative approach to
rehabilitation.
What this text does is set a framework for future practice and research within the eld
of assistive technology assessment. It is clearly structured into three sections, the rst of
which sets the context, the second brings together perspectives from those professions
working in the eld, and the third focuses on assistive technology devices themselves
and the positive outcomes that can emerge. Each section of this book has a separate
introduction, and these contributions themselves are not only informative but reect the
vision of the editors for this eld of work.
Having been asked to write this introduction, it was with pleasure that I was able to read
the chapters prior to their publication, and rather than repeating or simply reiterating what
can readily be assimilated, I found myself reecting on some of the emerging cross-cutting
themes. Although not comprehensive, the four themes that stood out for me characterize
the need to develop innovative approaches within this eld while recognizing the
individuality of both the user and those professionals engaged.
In many ways the topic all of the authors are addressing and the eld of enquiry is
relatively straightforward. The advances in technology and the potential benets that can
accrue highlight the need to undertake purposeful and sophisticated forms of assessment
of individuals to understand their need and how they can benet from the wide range of
available devices. These individuals themselves in different ways are looking for better
outcomes in response to their disabilities and broadly through the rehabilitative process to
improve in some way or other their quality of life. Therefore, assessment is the rst stage of
© 2012 by Taylor & Francis Group, LLC
x Foreword
this process and facilitates an evaluation of the effectiveness of the intervention that must
be undertaken on a regular basis. What then emerges from my initial reading of these
outstanding chapters from individuals working in this eld?
Assistive Technology Is Increasingly Complex and Sophisticated,
Which Needs to Be Reflected in the Assessment Process
Although this actually states the obvious, it still provides one of the greatest challenges in
undertaking the assessment of individuals to determine how best to deploy technology.
Chapters 16, 17, and 18 highlight the sophistication emerging within the elds of technology
and the potential benets to individuals.
Nevertheless, the more complex both the assessment process and the technological aids
themselves become, there is a danger that they become less accessible, and a number of
authors throughout this text remind us through their work of “abandonment,” with one of
the greatest problems being that individuals stop using the devices. Furthermore, the more
complex the assessment process, the less motivated individuals can become given their
need and their understandable desire to have access to available facilities and support.
And not only is the complexity difcult for the user and those professionals undertaking
the assessments, but there remains the danger that they become more costly and hence
have lower impact.
Indeed, the process of assessment itself is costly given the number of professionals who
potentially need to be engaged, and there is an “opportunity cost” issue here in terms
of direct therapeutic intervention as compared with careful assessment and planning.
Therefore, one of our conundrums is that the more complex and greater technological
advances we make, there remains a potential threat of the extent to which these can be
applied in practice, which in turn affects the vulnerability of those with disabilities.
The Need for Inter- and Multidisciplinary Approaches to Assessment
For me, this is then the second major issue. It is clear from this text that the assessment
process is critical to future success, but that it involves a wide range of disciplines and in
some cases the emergence of new interdisciplinary approaches. For example, Chapter 9
introduces for the rst time to myself the role of the “psychotechnologist.” I am sure there are
other integrated professional approaches yet to be brought together. As knowledge within
the professional elds involved with assistive technology becomes more sophisticated and
our knowledge simply grows exponentially, the capacity to introduce shared professional
education and training becomes increasingly difcult.
Furthermore, we do need to recognize and indeed value the different perspectives
offered by the vast range of individuals working within this eld through their initial
education, training, and postgraduate study. There are different paradigms ranging
from those working primarily in the eld from a medical perspective, through to those
in focused but relatively multidisciplinary professions, and on to those making such
enormous contributions through their technological rather than social skills.
© 2012 by Taylor & Francis Group, LLC
xiForeword
No one person or profession can any longer cover this breadth, and we therefore need to
nd new ways of working together.
Fortunately, it is not the case that people cannot do this, but it is a time-consuming,
resource-intensive process, and the outputs as prioritized and measured need to
demonstrate the effectiveness of such an approach.
I know that myself and Marcia J. Scherer are proud to be editing journals that encourage
multidisciplinary approaches and perspectives on different aspects of rehabilitation and
work hard to include contributions from diverse cultures and backgrounds. In reecting
upon these issues, we should not forget the range of professionals not included in this text,
particularly those working in the eld of employment, advocacy, insurance, and related
business professions. There is nothing negative about recognizing the changing roles of
professionals, but the challenge remains to help all of us take different perspectives and to
give away some aspects of our own understanding to work better with others.
The Impact of the Environment and the Context
Individuals and indeed communities both embrace and are constrained by the context in
which they live. The assessment of an individual has to take this into account, and both
place and context are integral to this process. In relatively structured rehabilitation, there
are well-worked processes and procedures within which to undertake assessment and to
draw upon the services and opportunities presented by the environment within which
this is done. However, there are circumstances in which the assessment process is either
limited through the resources that are available or by the requirement to respond at a
pragmatic level. Community-based programs are often limited by personnel and resources
and rely much more upon those living and working within that particular environment.
Disasters such as those recently affecting Japan and Haiti require swift and emergency
response mechanisms in which the assessment process might be less important when
looking to provide assistive technologies to help support the vast numbers of individuals
clearly in need. These issues are not conned to the environment or the context but to the
interpersonal connections of the individual being assessed.
Chapter 5 highlights the impact on caregivers and the family, but we should add to this
the wide range of individual contacts, including friends, peers, and those in the workplace.
This also affects the social context and inuences those outputs by which the effectiveness
of any intervention is judged, including economic well-being. Underpinning this in many
cases is a commitment to enhance the quality of life, often through participation in the
world of others with the view to retaining and playing a respected role within wider
society.
What the User Wants and How Can It Be Measured?
The importance of participation and enhancing the quality of life as much as alleviating
some aspects of disability was referred to in the previous section. In many cases these
measures are more important to the individual and more greatly affect the way in which
© 2012 by Taylor & Francis Group, LLC
xii Foreword
the success of having access to assistive technology is measured. Chapter 15 is an excellent
overview of the “user experience framework.” Any perceived improvement through the
use of assistive technology must be recognized and valued by the individual himself or
herself for the impact to be measured effectively.
Many studies are published that do show improvement on a range of variables, and
although these are important in demonstrating the efcacy of particular techniques
without recourse to simply measuring the impact on the individual from his or her
perspective, they do lack an element of validity.
This is not to say that publications of this kind should not be published; it just further
reinforces the complexity of working in the eld of rehabilitation. The more recent
emphasis on goal-setting both jointly with professionals and individually is a positive
way forward in terms of measuring impact. There is both a realism to goal-setting and the
opportunity to be aspirational and to go beyond that which perhaps others think possible.
The goal of employment is not unlikely to remain critical to many for reintegration into
the life experienced prior to the disability. This might not always be possible, but without
understanding the perspective of the user, the success or otherwise of intervention cannot
fully be understood.
At the heart of undertaking an assessment of an individual for the use of assisted
technology is where this person is starting from, where they want to go or believe they
can get, aspirational thinking to take them further, and the journey itself. I judge that this
book in the way it has brought together such a wide range of committed individuals has
as its underpinning philosophy a commitment to listening to and responding positively
to the voice of the individual participant. Resources are still given to rather than owned
by those requiring them, and as in other changing areas such as education and social care
there may yet be a further strengthening of the role of the user by providing resources
from which they can choose or even purchase.
I found this book stimulating, and I am proud to have had an opportunity to contribute
a few thoughts. Thank you to Marcia and Stefano for this opportunity to join you in
contributing to this debate.
Dave J. Muller
Editor-in-Chief, Disability and Rehabilitation
Suffolk New College, United Kingdom
The collaboration between Marcia J. Scherer and the Centre for Technological Aid and
Research Ausilioteca of the Leonarda Vaccari Institute in Rome was born when Marcia,
accompanied with Stefano Federici, visited our institute. On that day, a warm empathy
between me and Marcia was born. An interesting brainstorm about the various activities
took off: activities that we could carry out together because we realized that we share the
same visions. The activities of the Leonarda Vaccari Institute—with its multidisciplinary
team—reected the working methods for the Matching Person and Technology model
carried out by Professor Scherer.
Almost a year later, I went to Rochester University to see Marcia again, and it was there
that we managed to bring the drafting of the handbook to reality. The Ausilioteca di Roma
(Centre for Technological Aid of Rome) put itself at the authors’ disposal to verify the
© 2012 by Taylor & Francis Group, LLC
xiiiForeword
assistive technology assessment process model and the new competencies that had to be
given to the new specic gure of the psycotechnologist.
The following are just a few words to understand what the Leonarda Vaccari Institute
does and, in particular, what the Ausilioteca di Roma stands for. The Leonarda Vaccari
Institute, the oldest nonprot educational institution in Italy, addresses the special needs of
children, adolescents, and adults with disabilities. Founded in 1936 by Professor Marchesa
Leonarda Vaccari to help children affected with polio, today the institute provides
comprehensive service to hundreds of individuals each year. The Leonarda Vaccari
Institute is acknowledged as the Moral Entity with Royal Charter No. 2032 and public
noncommercial initiative certied by the Region of Lazio; the institute functions under
the National Health Service. Established 75 years ago, today the institution is one of the
most experienced centers for the rehabilitation of people affected by severe mental and/
or physical disabilities between the developmental stages of childhood and adulthood.
On December 8, 2007, the President of Italy, Giorgio Napolitano, awarded the Leonarda
Vaccari Institute with the Gold Medal of Merit for Public Health Service. In the same
year, the center was included in the 2° “Eurispes survey” among the 100 Italian Centres
of Excellence. The Vaccari Institute is certied with the ISO 9001-200 IMQ/CSQ 9211.LVA
quality.
The intent to provide a comprehensive diagnosis and to help people with disabilities
with their special needs have been one of the initiative’s main concerns since its founda-
tion. In accordance with the institute’s 1936 Constitution, treatment extending to the vari-
ous aspects of disability can be synthesised in three procedures: medical care, education,
and integration into the labor market. Since then, the Leonarda Vaccari Institute has been
expanding its activities throughout comprehensive and individualized interventions,
bringing a multidisciplinary analysis to every single case. Each day, the Vaccari Institute
provides support to more than 300 people who require re-education and rehabilitation
care within the framework of full-time hospital care, day care, or outpatient services. The
institute provides a large number of therapies such as kinesitherapy and logotherapy,
alternative communication, psychosensory stimulation, respiratory exercises, drama, etc.,
all charged to the National Health Service. The diagnostic team is composed of experi-
enced clinical and school psychologists, psychotechnologists, psychiatrists, neuropsychia-
trists, neuropsychologists, pediatricians, orthopedists, rehabilitation therapists, and other
professionals working in specic relative elds.
In 1996, the Vaccari Institute founded the Ausilioteca di Roma, a center for
technological aid and research. The sector of technological devices is characterized by a
fast evolution, by the complexities of solutions that need to be found, and by the necessity
to personalize these solutions. This innovative vision leads to different procedures for
the various rehabilitation, welfare, and educational processes. To nd an international
model of assistive technology assessment, the institute has therefore initiated a fruitful
collaboration with Stefano Federici of the University of Perugia, Olivetti Belardinelli
of the Sapienza University of Rome, and Marcia J. Scherer of the Institute for Matching
Person and Technology of Webster, NY. The success of this assistive technology
assessment process lies primarily in the selection and implementation of technical aids
determined by
• The quality of the assignment’s processes,
• The quality of assistive proposals, and
• The taking into account of the specic context of use.
© 2012 by Taylor & Francis Group, LLC
xiv Foreword
The development of this sector nds its cultural motivations and improvement in the
recent declaration of intents issued at the European level (e.g., Madrid 2002; European Year
for People with Disabilities 2003), at the national level (e.g., Guidelines for the Rehabilitation
released by the Ministry of Health in 1998), and at the international level [e.g., the
International Classication of Functioning, Disability, and Health (ICF), promoted by the
World Health Organization].
Digital devices are instruments of an extraordinary importance apt to satisfy the
needs of autonomy and quality of life of people with disabilities and their families. They
also guarantee a suitable proposal by adding value to the right solutions and giving a
permanent help to health service professionals and users. Moreover, a good assistive
technology match can also guarantee the efciency of the public expenses in this sector.
The Ausilioteca is a highly specialized service center that operates together with the
National Health Service, various public entities, and schools, sustaining different projects
and the use of advanced technologies aimed to the best inclusion of people with disabilities
in schools and other life environments.
The handbook, realized in collaboration with academic professionals from different
countries (United States, Europe, Australia, Brazil, and Japan), contains a scientic pattern
for the assignment of assistive technologies to people with disabilities founded under the
ICF model. The fulllment and achievement of the model described in the handbook
together with the highlighted procedures—are one of the best practices carried out by the
highly specialized personnel of the Leonarda Vaccari Institute.
It is with satisfaction and gratitude that I thank the authors of the handbook and in
particular the editors, Marcia J. Scherer of the Institute for Matching Person and Technology
and Stefano Federici of the University of Perugia, for their useful and splendid work.
Saveria Dandini De Sylva
Executive President
Istituto Leonarda Vaccari
© 2012 by Taylor & Francis Group, LLC
xv
Preface
This book is the result of scientic collaboration and sincere friendship that was born in
2001 and has gradually strengthened over time.
The collaboration begins with the creation, at the Faculty of Psychology, Sapienza
University of Rome, of the rst course in psychotechnology that was held in Italy. This
course aimed to combine multiple topics, bringing together technological and ergonomic
arguments and issues concerning the psychology of rehabilitation to train competent
psychologists within assistive technology provision.
The course was designed by Stefano Federici and held at the Sapienza University
of Rome from 2001 to 2008. The term “psychotechnology,” with the meaning adopted
and introduced in the psychology of rehabilitation by Federici, initially sounded like a
neologism. In fact, the objective of the course was to integrate technology and ergonomic
aspects with those more specic of cognitive ergonomics, reread under the lens of the
biopsychosocial model of disability, to train psychologists with both psychological and
technological expertise and who were able to lead a user to meet their needs. Only in this
way would it have been possible for the user to search and nd a technological product
that not only was satisfactory to his or her own person, but was also able to support
him or her in the integration process within its milieu, by preventing, compensating,
monitoring, relieving, or neutralizing disability and social barriers. Therefore, the
psychotechnologist should possess those skills to be spent in centers for technical aid
that, at the end of the last millennium, have begun to be characterized as autonomous
centers of technology device assessment and assignment for an individual’s disability
and independent living.
The main theoretical difculty in designing the psychotechnology course was to
integrate technological-engineering models—not dissimilar in some way by certain
models of cognitive functioning that tend to generalize and idealize the individual—
with the biopsychosocial model of disability. The ergonomic approach to technology,
both of cognitive and engineering types, indeed often tends to neglect the emotional,
motivational, and social user experience so that it does not take into account those
factors that very often affect it with a higher rate of incidence in the successful outcome
in device use.
The discovery by Federici of the Matching Person and Technology model by MarciaJ.
Scherer was like the key to squaring the circle. It is a model that has combined people
with disabilities’ needs with assistive technologies in a user-centered context, without
neglecting the functional and ergonomic features of the device. The answer to that fateful
question was found, namely, that the psychotechnologist usually turned to him- or herself
to nd an effective integration of knowledge. As Federici was used to repeating in the
psychotechnology course at the Sapienza University of Rome: “This course could also be
called ‘Matching Person and Technology from the psychologist’s standpoint.
The collaboration between the Sapienza University of Rome and the Institute for Matching
Person and Technology has produced dozens of theses and several doctoral dissertations
concerning the adaptation and validation of the Matching Person and Technology model
and tools or related to the professional prole and role of the psychologist in the assistive
technology assessment and assignment processes. Some of those researchers and students
are now successful professionals in psychotechnology. Furthermore, many authors who
© 2012 by Taylor & Francis Group, LLC
xvi Preface
took part in writing of the chapters of this book come from that experience of study and
research.
However, the collaboration and friendship between Marcia and Stefano has not only
led to the sharing of ideas and research projects, but they have also created a scientic
network among Italian, American, and other nations’ scholars who have formed the
scientic community that has allowed such a large participation of authors in the writing
of this work.
As the editors, let us now respond to the reasons for this book, which certainly was
not intended to be a history of this social network or a biography of its editors. This
book is a challenge for us: to develop an international ideal model of the assistive
technology assessment process that gathers the most recent scientic developments in
the assessment and provision of technical aids for an outcome that, if reached, would be
a real success—the well-being of the disabled person. Therefore, this model intends to
express in an idealized and essential form an assessment process performed in a center
for technical aid because it provides such tools for the assessment and the professional
proles that we might also dene as “psychotechnological.
Of course, just because we speak of “challenge,” we reveal our awareness about the
problems and limitations of an “international” ideal model. For example, one of the
unsolved problems is the difculty, already met several times, in dening the features
of a center for technical aid. The modeling process of a center for technical aid is difcult
if one takes into account the extraordinary variety of systems of regional and national
health and social care, both public and private. This variety inuences in different ways
the specic characteristics that are required at a center. Furthermore, the different nature
of the center for technical aid makes problematic the denition itself of the individual
who addresses to it: user, patient, client, or consumer? The user (for convenience we use
this denition, a little more generic than the others) of a center for technical aid could
be a patient of a physician (physiatrist) who operates in a national system of health care
and sends him or her to a specialized facility, the center for technical aid indeed, for a
more thorough assessment of a particular device. This assessment can be provided free of
charge if the center is part of a national health system or by paying out money if the center
is part of a private health system. Furthermore, the product chosen by the user could
be sold or assigned directly from the center for technical aid or, alternatively, the device
provision may be made later by other providers, external and independent from the center
for technical aid.
These are just some of the issues to be discussed by the authors of this book. In fact,
other issues will be also addressed that are even more problematic from a scientic
viewpoint. We refer to those that are intrinsically linked to the design of an international
model. Because of the difculty in nding an adequate and effective synthesis of the
various models proposed by specic national systems of public health and welfare, the
scientic community faces a modeling of assistive technology system delivery that will
be increasingly individualized with respect to either the social and cultural diversity
of users or to the necessary adjustment of the center for technical aids functioning to
the local health system. However, it should be noted that this particularization of the
models clashes with some trends that are aimed at instead promoting their globalization
(for example, this occurs both in social and health policies of the European Community
and in those of the World Health Organization). The internationalization of a model is
indeed advantageous because it often emerges as a synthesis of experiences and know-
hows of regional models. Moreover, it offers the opportunity, by sharing the theoretical
© 2012 by Taylor & Francis Group, LLC
xviiPreface
model and evaluation criteria, to share data essential to scientic research, planning,
and evaluation of national and international policies and verify the quality of public
services.
A goal that we set in the writing of this project was to narrow the topics, trying to
legitimate the choice made. In fact, our intention was not only to provide a theoretical
text that aims to develop an ideal model of assistive technology assessment processes,
but also to provide an operational tool that is able to outline both the specic space of
applicability of the model itself and the main characteristics of a center for technical
aids functioning, a tool-kit for a proper assessment, and proles of professionals acting
within the center. Moreover, it even seemed essential for us to compare our model with
some of the most advanced researches in technologies for rehabilitation and supports
for independent living. However, we were well aware that a detailed description of all
matters regarding the functioning of a center for technical aid (i.e. assessment tools,
professional proles, the latest technology devices for rehabilitation and independent
living) would have required an encyclopedia and not a manual such as this book.
Therefore, and this could be read both as a limit and as well an advantage of this book,
we have chosen, for each of the three areas mentioned—the tools of evaluation, the
experts of the evaluation in a center for technical aid and new technologies—the aspects
of the current state of the art that we judged as the most representative or innovative.
So, we not only identied for each topic the leading experts and invited them to write
about their topic, but also, where possible, we tried to ensure that each chapter was
written by more hands, concerted and promoting cross-cultural viewpoints. For this
reason, the reader should certainly not be surprised if he or she will not nd mention
some professions among those that could be treated in such a manual. We tried to
give more prominence to the denition, training, and professional role of the new
profession of psychotechnologist, as well as to highlighting the professional prole of
the speech language pathologist because of the relevance of dysfunctions in language
in today’s international health and social policies.
Finally, we would like to stress that this book does not intend to model the assistive
technology assessment process as a result of a mere academic mental exercise, but it
has even faced an applied research of the model. This is for two main reasons: The
theoretical view of the authors’ chapters and editors emerge from experimental research
applied to rehabilitation and assistive technologies. In addition, the international ideal
model of the assistive technology assessment process is already applied in centers for
technical aid. Thanks to scientic and clinical collaboration, economic and operational
support of the Centre for Technical Aid of Rome, Leonarda Vaccari Institute—which, in
turn, is part of the Italian Network of Centres Advice on Computer and Electronic Aids
and cooperates with the Institute for Matching Person and Technology and Columbia
University, with whom it shares the principles that underlie the assistive technology
assessment process—it was possible to dene the assessment model proposed in this
book because the model is already operative in the Centre for Technical Aid of Rome.
This center offers a noncommercial advisory and support on assistive technology and
computers for communication, learning, and autonomy. The service is free of charge for
users who access it through the Italian National Health Service. Several scientic projects
granted by the institute are in progress at the center to verify not only the advantages of
a systematic application of the Matching Person and Technology tools in the assessment
process, but also the application of the assistive technology assessment process model.
Some results will be presented and discussed in the chapters of this book.
© 2012 by Taylor & Francis Group, LLC
xviii Preface
Sincere thanks go to the authors of the chapters who have welcomed with enthusiasm our
model, enriching in many parts the initial draft of this work and giving it a wide-ranging
speech that is updated and credible. Special thanks also go to the publisher, Taylor &
Francis, who accepted the project with competence, supporting the long process of drafting
and revising the work. Again, special thanks go to many peer-reviewers of the chapters,
who have played a generous and valuable role, such as guarantors for the scientic nature
and validity of each contribution as well as representatives of the international scientic
community in this area.
© 2012 by Taylor & Francis Group, LLC
xix
Contributors
M. Adya
Burton Blatt Institute
Syracuse University
Syracuse, New York
R. Amantis
Leonarda Vaccari Institute for
Rehabilitation
Integration, and Inclusion of Persons with
Disabilities
Rome, Italy
G. Basili
Department of Pediatrics
Senigallia General Hospital
Senigallia, Italy
N. Birbaumer
Institute of Medical Psychology and
Behavioral Neurobiology
Eberhard-Karls University
Tübingen, Germany
and
IRCCS, San Camillo Scientic Hospital
Institute
Venezia Lido, Italy
S. Borsci
Department of Human Science and
Education
University of Perugia
Perugia, Italy
and
School of Information Systems, Computing
and Mathematics
Brunel University
Uxbridge, United Kingdom
and
Mathematics for Match Plus Project Brunel
University Uxbridge,
United Kingdom
L. W. Braga
Director, Neurosciences and
Neurorehabili tation Division
SARAH Network of Neurorehabilitation
Hospitals
Brasilia, Brazil
C. M. Capio
Institute of Human Performance
University of Hong Kong
Hong Kong, China
B. Cordella
Department of Dynamic and Clinical
Psychology
Sapienza University of Rome
Rome, Italy
F. Corradi
Leonarda Vaccari Institute for
Rehabilitation Integration,
and Inclusion of Persons
with Disabilities
Rome, Italy
V. Cor si
F.A.R.E—Specialist Centre for Dyslexia
and Learning Difculties
Perugia, Italy
G. Craddock
Centre for Excellence in Universal Design
Dublin, Ireland
I. L. de Camillis Gil
Neurological Rehabilitation Division
SARAH Network of Neurorehabilitation
Hospitals
Brasilia, Brazil
© 2012 by Taylor & Francis Group, LLC
xx Contributors
D. de Jonge
Division of Occupational Therapy
School of Health and Rehabilitation
Sciences
University of Queensland
Brisbane St. Lucia, Queensland, Australia
L. Demers
School of Rehabilitation
Université de Montréal
Montréal, Quebec, Canada
E. Di Giacomo
Department of Computer Engineering
University of Perugia
Perugia, Italy
A. Eldridge
Division of Occupational Therapy
School of Health and Rehabilitation
Sciences
University of Queensland
Brisbane St. Lucia, Queensland, Australia
S. Federici
Department of Human Science and
Education
University of Perugia
Perugia, Italy
and
CIRID - Interdisciplinary Centre for
Integrated
Research on Disability
Sapienza University of Rome
Rome, Italy
A. Gossett Zakrajsek
Occupational Therapy Program
School of Health Sciences
Eastern Michigan University
Ypsilanti, Michigan
M. Grasso
Department of Dynamic and Clinical
Psychology
Sapienza University of Rome
Rome, Italy
F. Greco
Department of Dynamic and Clinical
Psychology
Sapienza University of Rome
Rome, Italy
K. Hill
Performance and Testing Teaching
Laboratory
School of Health and Rehabilitation
Sciences
University of Pittsburgh
Pittsburgh, Pennsylvania
M. Kurosu
Center of ICT and Distance Education
Open University of Japan
Chiba City, Japan
G. E. Lancioni
Department of Psychology
University of Bari
Bari, Italy
G. Liotta
Department of Computer Engineering
University of Perugia
Perugia, Italy
A. Lo Presti
CIRID
Interdisciplinary Centre for Integrated
Research on Disability
Sapienza University of Rome
Rome, Italy
R. Magni
Pragma Engineering Sr1
Perugia, Italy
G. Mascolo
External collaborator at the Department of
Dynamic and Clinical Psychology
Sapienza University of Rome
Rome, Italy
© 2012 by Taylor & Francis Group, LLC
xxiContributors
C. Mazzeschi
Department of Human Science and
Education
University of Perugia
Perugia, Italy
P. Mecocci
Institute of Gerontology and Geriatrics
University of Perugia
Perugia, Italy
M. L. Mele
ECoNA—Interuniversity Centre for
Research on Cognitive Processing in
Natural and Articial Systems
Sapienza University of Rome
Rome, Italy
F. Meloni
CIRID
Interdisciplinary Centre for Integrated
Research on Disability, and Department
of Psychology
Sapienza University of Rome
Rome, Italy
K. Miesenberger
Institute Integriert Studieren
University of Linz
Linz, Austria
M. Mirza
Institute for Healthcare Studies
Northwestern University
Chicago, Illinois
M. Morris
Burton Blatt Institute
Syracuse University
Syracuse, New York
B. W. Mortenson
School of Rehabilitation
Université de Montréal
Montréal, Quebec, Canada
M. Olivetti Belardinelli
Department of Psychology and CIRID
Interdisciplinary Centre for Integrated
Research on Disability
Sapienza University of Rome
Rome, Italy
and
ECoNA Interuniversity Center for
Research in Cognitive Processing in
Natural and Articial Systems, and
Department of Psychology
Sapienza University of Rome
Rome, Italy
D. Oliva
Lega F. D’Oro Research Center
Osimo, Italy
M. F. O’Reilly
Meadows Center for Preventing
Educational Risk
University of Texas at Austin
Austin, Texas
M. Orlandi
Vision Research Center of Rome
Rome, Italy
E. Pasqualotto
Institute of Medical Psychology and
Behavioral Neurobiology
Eberhard-Karls University
Tübingen, Germany
M. Pigliautile
Institute of Gerontology and Geriatrics
University of Perugia
Perugia, Italy
and
Department of Psychology
Sapienza University of Rome
Rome, Italy
© 2012 by Taylor & Francis Group, LLC
xxii Contributors
K. S. Pinto
Pediatric Rehabilitation Divisison
SARAH Network of Neurorehabilitation
Hospitals
Brasilia, Brazil
D. Samant
Burton Blatt Institute
Syracuse University
Syracuse, New York
M. J. Scherer
Institute for Matching Person &
Technology, Inc.
Webster, New York
and
Burton Blatt Institute
Syracuse University
Syracuse, New York
P. S. Siebra Beraldo
Clinical Research Division
SARAH Network of Neurorehabilitation
Hospitals
Brasilia, Brazil
J. Sigafoos
School of Psychology and Pedagogy
Victoria University of Wellington
Wellington, New Zealand
N. N. Singh
American Health and Wellness Institute
Verona, Virginia
C. H. P. Sit
Institute of Human Performance
University of Hong Kong
Hong Kong, China
and
Department of Sports Science and Physical
Education
Chinese University of Hong Kong, China
A. Stella
Department of Comparative Cultures
University for Foreigners
Perugia, Italy
L. Tiberio
Institute for Cognitive Science and
Technologies
National Research Council of Italy
Rome, Italy
B. Turella
Department of Psychology
Sapienza University of Rome
Rome, Italy
P. M. Wielandt
Department of Occupational Therapy
School of Health & Human Services
Central Queensland University
Rockhampton, Australia
S. Zapf
Children’s Journey to Shine, Inc.
Houston, Texas
© 2012 by Taylor & Francis Group, LLC
Section I
The Assistive Technology
Assessment Model and
Basic Denitions
S. Federici and M. J. Scherer
Introduction
As a part of the human condition, “Disability is complex, dynamic, multidimensional, and
contested(WHO and World Bank 2011, p. 3). The concept of disability conveys a very wide
set of different and correlated issues: from disability models to individual functioning
and its measurement, from social barriers to the digital divide, from the objective quality
of life to subjective experience, to concepts of functioning, activity and participation,
human rights and poverty, health and well-being, morbidity, and quality of life (WHO
and World Bank 2011). Because of the multidimensionality of disability, the International
Classication of Functioning, Disability, and Health (ICF) would like to make clear that
disability (and its correlated term “functioning”) must be understood as an umbrella term,
encompassing all body functions, activities and participation” (WHO 2001, p. 3).
Disabilitys multidimensionality and complexity entails a kind of “denitional paradox”
(Madans and Altman 2006): On the one hand, any theoretical denition of disability
implies aporia, and on the other hand, operational meaning is determined by the purpose
of research. In fact, Mont explains:
[If] each domain represents a different area of measurement and each category or ele-
ment of classication within each domain represents a different area of operationaliza-
tion of the broader domain concept, [then] to generate a meaningful general prevalence
measure one must determine which component best reects the information needed to
address the purpose of the data collection. (2007, p. 4)
1
© 2012 by Taylor & Francis Group, LLC
9Section I: The Assistive Technology Assessment Model and Basic Definitions
user/client and assistive solution. Because the assistive solution represents the outcome of
a user-driven process aimed toward the improvement of individual functioning, it can be
considered as a mediator of quality of life and well-being in a specic context of use. For
these reasons, it is important to underscore that the assistive solution does not coincide
with AT because the rst one is a complex system in which psycho-socio-environmental
factors and AT interact in a nonlinear way by reducing activity limitations and participation
restrictions by means of one or more technologies.
The denition of ATA represents the core denition of this handbook, summarizing the
properties of the ATA process. All of the chapters in the section rst refer to this denition
and follow a guiding reference model (see Figure I.1).
References
Dijcks, B. P. J., De Witte, L. P., Gelderblom, G. J., Wessels, R. D., and Soede, M. (2006). Non-Use of
Assistive Technology in the Netherlands: A Non-Issue? Disability and Rehabilitation: Assistive
Technology, 1(1–2), 97–102. doi:10.1080/09638280500167548
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Wheelchairs for Three Individuals with a Spinal Cord Injury. Disability and Rehabilitation, 24(1–
3), 106–114. doi:10.1080/0963828011006678 5
Madans, J. H., and Altman, B. M. (2006). Purposes of Disability Statistics. Paper presented at the
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Madans, J. H., Altman, B. M., Rasch, E. K., Synneborn, M., Banda, J., Mbogoni, M., et al. (2002).
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Madans_Altman.ppt
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© 2012 by Taylor & Francis Group, LLC
10 Assistive Technology Assessment Handbook
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Conference on the International Classication of Functioning, Disability and Health (ICF),
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© 2012 by Taylor & Francis Group, LLC
11
1
Assessing Individual Functioning and Disability
S. Federici, M. J. Scherer, F. Meloni, F. Corradi,
M.Adya,D. Samant, M. Morris, and A. Stella
1.1 The Universal Model of Disability
The origins of the biopsychosocial model date back to the proposal put forward by psy-
chiatrist George Engel in 1977 to integrate within the medical model the dominant social
and psychological variables:
The dominant model of disease today is biomedical, and it leaves no room within its
framework for the social, psychological, and behavioural dimensions of illness. A bio-
psychosocial model is proposed that provides a blueprint for research, a framework for
teaching, and a design for action in the real world of health care. (1977, p. 130)
Engel made the leading theoretical contribution to building the biopsychosocial model,
identied in von Bertalanffys general systems theory (von Bertalanffy 1950). According
to this approach, the unifying principles in the scientic context are not a reduction of
but the organization that explains a scientic phenomenon. It is not sufcient to divide a
scientic phenomenon into a simpler unit of analysis and study such units one by one, but
it is necessary to study the interrelations among these units. We contrast the old scientic
method, which refuses all forms of teleology and is based on linear causality and relations
CONTENTS
1.1 The Universal Model of Disability .................................................................................... 11
1.2 Classication, Declaration, and International Denitions of Functioning and
Disability ...............................................................................................................................13
1.3 Where Individual Functioning and Disability Are Assessed:Assistiveand
Rehabilitation Technology Service Delivery Models ..................................................... 16
1.3.1 Charity-Based Models ............................................................................................. 17
1.3.2 Community-Based Rehabilitation Models ...........................................................17
1.3.3 Individual Empowerment Models ........................................................................ 17
1.3.4 Entrepreneurial Models .......................................................................................... 17
1.3.5 Globalization Model ................................................................................................ 18
1.3.6 Universal Design Models........................................................................................18
1.4 Assessing Individual Functioning Within a Rehabilitation Process ...........................18
1.5 Assessing Individual Functioning and Disability in the ATA Process ....................... 20
1.6 Conclusions ...........................................................................................................................23
Summary of the Chapter ..............................................................................................................23
References .......................................................................................................................................23
© 2012 by Taylor & Francis Group, LLC
23Assessing Individual Functioning and Disability
technical aid column, Figure 1.2) and subjective (the user’s actions column, Figure1.2),
or rather between the objective and subjective functioning measurements. The features
of this dynamic, within the assessment process, tie professionals of rehabilitation to
nding solutions that take into consideration the social and cultural context of an
individual.
1.6 Conclusions
An ATA model is needed and proposed in this chapter that is consistent with the ICF in that
it emphasizes the individual’s well-being and the best match between the user/client and
the assistive solution. This requires a user-driven process through which the selection of
one or more technological aids for an assistive solution is facilitated by the comprehensive
use of clinical measures, functional analysis, and psycho-socio-environmental evaluations.
Summary of the Chapter
This chapter discusses the biopsychosocial model as operationalized by the WHOs
International Classication of Functioning, Disability, and Health, the Convention on the
Rights of Persons with Disabilities, the 2002 AAMR Denition, Classication, and System
of Supports, and most recently the World Report on Disability. A move from the medical to
social view of disability requires that assistive technology professionals view disability as
existing within a cultural, political, and economic milieu. International models of assistive
technology service delivery are reviewed and the need for enhanced assessment of the
person with a disability’s functioning is highlighted in order to achieve a good match of
person and technology.
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© 2012 by Taylor & Francis Group, LLC
24 Assistive Technology Assessment Handbook
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© 2012 by Taylor & Francis Group, LLC
25
2
Measuring Individual Functioning
S. Federici, F. Meloni, and F. Corradi
2.1 What Individual Functioning Measures
2.1.1 The Best Measure: Is There an Elixir of Measurements
for Turning an Assessment into Gold?
In June 2001, the U.N. International Seminar on the Measurement of Disability brought
together a large number of experts in disability measurement from developed and devel-
oping countries to review the current status of methods used in population-based data
collection activities to measure disability in national statistical systems (UN 2001). The
seminar developed recommendations and priorities to advance work on the measurement
of disability. In particular, the seminar improved principles and standard forms for global
indicators of disability for use in censuses and helped to build a network of institutions
and experts given the broad consensus on the need for population-based measures of
disability for countrywide use and international comparisons. The U.N. international
seminar experts selected the International Classication of Functioning, Disability, and
CONTENTS
2.1 What Individual Functioning Measures .......................................................................... 25
2.1.1 The Best Measure: Is There an Elixir of Measurements for Turning an
Assessment into Gold? ............................................................................................ 25
2.1.1.1 Fitting Measure for the Purpose of the Assistive Technology
Assessment .................................................................................................28
2.1.1.2 From the Measures to the Purposes (Well-Being), from the
Purposes to the Measurers (Multidisciplinary Team) .........................29
2.1.1.3 What Is Measured Versus Who Measures: Balancing the Power
of the Assessment .....................................................................................30
2.2 How to Measure Individual Functioning ........................................................................31
2.2.1 Guidelines for Measurement and Assessment ....................................................31
2.2.2 Measurement and Assessment in the ATA Process ...........................................32
2.2.3 Monitoring Individual Functioning in the Context of an AT Use: The
Outcome of the ATA Process..................................................................................34
2.3 Suggested Measurement Tools for an ATA Process .......................................................35
2.3.1 Outcome Analysis Tools .........................................................................................39
2.4 Conclusions ...........................................................................................................................42
Summary of the Chapter ..............................................................................................................43
References .......................................................................................................................................44
© 2012 by Taylor & Francis Group, LLC
44 Assistive Technology Assessment Handbook
valid for every assessment. Additionally, the only guiding principle for a proper mea-
surement is the clarity of the purpose of the measurement. The second section focuses
on how to measure individual functioning by both pointing out some guiding principles
for choosing and applying a set of measures and by suggesting some tools that t these
principles. The third section suggests some measurement tools for an ATA process used in
a center for technical aid.
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© 2012 by Taylor & Francis Group, LLC
49
3
Measuring the Assistive Technology Match
F. Corradi, M. J. Scherer, and A. Lo Presti
3.1 Introduction
The World Health Organization (WHO) Disability and Rehabilitation Action Plan 2006
2011 (2006) reports that approximately 10% of the worlds population experiences some
form of temporary or permanent disability. This document highlights that assistive tech-
nology (AT) may be a helpful aid for people with disabilities “to increase their level of inde-
pendence in their daily living and to exercise their rights” (WHO 2006, p. 5). To achieve
this goal, it is necessary to further the development, production, distribution, and support
to use AT. In particular, the aims of the WHO are to
• Support member states to develop national policies on AT;
• Support member states to train personnel at various levels in the eld of AT,
especially in prosthetics and orthotics; and
• Promote research on assistive technology and facilitate transfer of technology.
WHO’s World Report on Disability (2011) afrms this commitment.
Different studies show an average rate of approximately 30% of abandonment of AT
within the rst year of use, realizing that rates vary depending on the type of AT (Philips
and Zhao 1993; Scherer 1998; Kittel et al. 2002; Scherer et al. 2004, 2005; Dijcks et al. 2006).
A recent study (Federici and Borsci 2011) found approximately 25% AT abandonment in a
CONTENTS
3.1 Introduction .......................................................................................................................... 49
3.2 Measuring the Assistive Technology Match ....................................................................51
3.2.1 The ICF and Other Outcome Measures ................................................................ 51
3.2.2 The Matching Person and Technology Model .....................................................52
3.2.3 The MPT Process and Measures ............................................................................55
3.2.4 The MPT Model and the ICF ..................................................................................58
3.2.5 Different Versions of Matching Person and Technology ...................................58
3.3 The Assistive Technology Assessment Process ...............................................................58
3.3.1 The ATA Process in the Center for Technical Aid and in the
Rehabilitation Project ..............................................................................................60
3.4 The MPT and the Assistive Technology Assessment Process ...................................... 61
3.5 Conclusions ...........................................................................................................................62
Summary of the Chapter ..............................................................................................................62
References .......................................................................................................................................63
© 2012 by Taylor & Francis Group, LLC
63Measuring the Assistive Technology Match
and private centers for technical aid provision, allowing them to compare, evaluate, and
improve their own matching model. The actions required by the ATA model to centers for
technical aid can be divided into four fundamental steps: access to the structure and acti-
vation of the process, evaluation and activation of the aid/AT selection, delivery, and fol-
low-up. The ATA is a user-driven process through which the selection of one or more aids/
AT is facilitated by the utilization of comprehensive clinical measures, functional analysis,
and psycho-socio-environmental evaluations that address, in a specic context of use, the
personal well-being of the user through the best matching of user/client and assistive
solution (Scherer et al., Early Online). Because the ATA process and the MPT model and
accompanying measures share a user-driven working methodology and embrace the ICF
biopsychosocial model, they can be integrated within a path aiming for the best combina-
tion of AT to promote user/customer’s personal well-being.
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67
4
The Assessment of the Environments of
AT Use: Accessibility, Sustainability,
and Universal Design
M. Mirza, A. Gossett Zakrajsek, and S. Borsci
4.1 Introduction
The role of the environment in inhibiting or supporting full societal participation of people
with disabilities is increasingly being acknowledged. Theoretical frameworks of disability
such as the social model (Oliver 1990) and the International Classication of Functioning,
Disability, and Health (ICF; WHO 2001) recognize the role of the environment in “produc-
ing” disability, albeit to varying extents. Even the preamble of the United Nations (UN)
Convention on the Rights of Persons with Disabilities afrms that disability results from the
interaction between individuals with impairments and environmental barriers (UN 2006).
Furthermore, research studies have repeatedly underscored the dynamic relationship
between environmental factors and the community participation of people with disabili-
ties (Egilson and Traustadottir 2009; Verdonschot et al. 2009). In addition, there is a robust
body of literature demonstrating that conict between assistive technology (AT) and its
context of use is an important contributor to AT nonuse and abandonment (Philips and
Zhao 1993; Day et al. 2001; Kittel et al. 2002; Scherer 2002; Scherer et al. 2004, 2005; Dijcks
CONTENTS
4.1 Introduction ..........................................................................................................................67
4.2 Accessibility, Sustainability, and Universal Design: An Overview ............................68
4.2.1 What Do We Mean by Accessibility, Sustainability, and
UniversalDesign? ........................................................................................... 68
4.2.2 Interaction between Accessibility, UniversalDesign, and
Sustainability .............................................................................................. 69
4.3 Environment Assessment in the ATA Process Based on the concepts of
Accessibility, Sustainability, and Universal Design ........................................................71
4.4 The Environmental Assessment Process: An Overview ...............................................72
4.4.1 The EA Process: Step-by-Step Decision Making ................................................. 75
4.4.2 Case Evaluation: Considering Accessibility, Universal Design, and
Sustainability Within the EA Process ...................................................................76
4.5 Conclusions ...........................................................................................................................79
Summary of the Chapter ..............................................................................................................79
Acknowledgments ........................................................................................................................80
References ......................................................................................................................................80
© 2012 by Taylor & Francis Group, LLC
80 Assistive Technology Assessment Handbook
achieve the “ideal” design solution which will enhance the match between the AT, the user,
and his/her environment. The second part of this chapter offers a step-by-step decision-
making process to guide the multidisciplinary team to effectively evaluate the environ-
ment as an on-going component of the ATA process. The overall aim of this environmental
assessment process is to help practitioners arrive at an assistive solution that will optimize
user participation and satisfaction in the context of use. The chapter concludes with a case
study exemplifying the environmental assessment process in practice.
Acknowledgments
We acknowledge the role of Ann Kathleen Barnds and Daisy Feidt in developing some of
the key concepts presented in this chapter. We also thank Joy Hammel and Barbara Knecht
for their valuable input and guidance in relation to the UD project that this chapter draws
upon. Finally, special thanks to Hsiang-Yi Tseng for her work during the UD project.
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© 2012 by Taylor & Francis Group, LLC
83
5
Measuring the Impact of AT
on Family Caregivers
L. Demers and B.W. Mortenson
5.1 Introduction
It is generally understood that assistive technology (AT) has the potential to enhance
users’ functioning, and, in the process, allow them to be less dependent on the assistance
of others. However, for the vast preponderance of ATs, this secondary assumption is not
buttressed by systematic evidence (McWilliam et al. 2000; Henderson et al. 2008). To create
an enhanced understanding of the impact of AT on caregivers, we need (1) better empirical
evidence, (2) an improved conceptual understanding of the inter-relationship of outcomes
between assistance users and caregivers, and (3) more developed and rened measure-
ment tools. To address these needs this chapter has the following goals:
• To provide an overview of current literature that explores the impact of AT on
informal caregivers of children and adults,
• To offer theoretical contributions that explicate the relationship between AT inter-
ventions and outcomes for assistance users and their informal caregivers and
CONTENTS
5.1 Introduction .......................................................................................................................... 83
5.2 Overview of Current Literature .........................................................................................84
5.2.1 AT and Human Assistance .....................................................................................84
5.2.2 Caregivers of Assistance Users ..............................................................................85
5.3 Conceptual Frameworks on the Impact of AT on Caregivers and Users ....................87
5.3.1 Conceptual Framework 1 ........................................................................................87
5.3.2 Conceptual Framework 2 ........................................................................................89
5.3.3 Conceptual Framework 3 ........................................................................................90
5.4 Measurement Tools Adressing AT Impacts on Family Caregivers .............................. 91
5.4.1 Caregiver Assistive Technology Outcome Measure ...........................................91
5.4.2 Family Impact of Assistive Technology Scale......................................................92
5.4.3 Examples of Outcome Measurement With Vignettes Based on the
Assistance Users/Caregiver Dyad Assistive Technology Process Model .......93
5.4.3.1 Vignette 1 ....................................................................................................93
5.4.3.2 Vignette 2 .....................................................................................................95
5.5 Future Directions .................................................................................................................97
5.6 Conclusions ...........................................................................................................................97
Summary of the Chapter ..............................................................................................................98
Acknowledgments ........................................................................................................................ 98
References .......................................................................................................................................98
© 2012 by Taylor & Francis Group, LLC
98 Assistive Technology Assessment Handbook
test their psychometric properties. Given the stage of development of research in this area,
mixed methods research studies may provide invaluable data about the impact of AT on
informal caregivers from a variety of perspectives. By developing a thorough understanding
of the impact of AT on assistance users and their informal caregivers, interventions that are
more suitable can be offered and funding that is more appropriate can be sought.
Summary of the Chapter
In this chapter, we have provided an overview of research that has explored the impact of
AT on informal caregivers. We have offered informal caregiver-specic models that help
explicate how AT may impact informal caregivers, and we described two measures that
are intended to capture this effect. We have proposed that the process of AT provision
needs to explicitly acknowledge the role of the informal caregiver. With two vignettes, this
chapter provides examples of how these measures could be used to capture the impact
of AT on informal caregivers. We have provided suggestions for future work in this area.
Acknowledgments
Dr. Demers is supported by the Fonds de la Recherche en Sante du Quebec as a senior
research scholar. Dr. Mortenson is supported via a postdoctoral fellowship for the Canadian
Institutes of Health–Institute of Aging. Funding for the development of the CATOM was
provided by the National Institute on Disability and Rehabilitation Research through the
Consortium on Assistive Technology Outcomes Research (CATOR, http://www.outcomes.
org/). (Grant # H133A060062).
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Section II
Assessment Professionals:
Working on the
Multidisciplinary Team
M. J. Scherer and S. Federici
Introduction
How disability is diagnosed and treated differs according to age at onset and the type
of disability. Developmental disabilities, which occur in infancy and childhood, are
typically diagnosed after behavioral and maturational anomalies are observed and are
then conrmed medically. Acquired disability can occur at any time in the life span and
treatment is often initiated in a hospital emergency room. Disability associated with a
degenerative condition, typically associated with advanced age, is generally managed by
primary care physicians, neurologists, gerontologists, and family members.
Treating Developmental Disabilities
Developmental disabilities such as Down syndrome or cerebral palsy cannot be “cured.
However, interventions applied as early as possible can make a great deal of difference
in current and future functioning. Orthopedic and neurological impairments can be
surgically corrected or medically managed. Often children with developmental disabilities
undergo many treatments during their initial development with the goal of strengthening
or extending the use of existing capabilities (Scherer 2005). Sensory disabilities can be
greatly helped with advances in technology and the means to communicate can be made
possible through alternative and augmented communication devices.
101
© 2012 by Taylor & Francis Group, LLC
105Section II: Assessment Professionals
The Joint Committee states that
When cognitive, communication, emotional, and psychosocial domains are affected,
the team should include at least a clinical neuropsychologist or rehabilitation psycholo-
gist, and speech–language pathologist. Team membership will vary with the age of the
persons served, the type of impairment, the stage of recovery, and the special training
of team members (2007, p. 4).
Thus, there is considerable consistency in these two views of the rehabilitation team, the
rst from Singapore and the second from the United States.
The nine chapters presented in this section (Table II.1) focus on and describe the role of
many professions in the rehabilitation of persons with disabilities and their match with
appropriate assistive technologies.
Each chapters was written by an international expert in his or her area of specialty. What
unites these authors is not only their commitment to optimal rehabilitation outcomes, but
their perspective of the biopsychosocial approach to the assistive technology evaluation,
selection, and provision.
Conclusion
The best rehabilitation outcomes are achieved when individuals with shared perspectives,
but representing different areas of knowledge and skill, pool their expertise to derive
interventions that meet the personal, psychosocial as well as physical needs and preferences
of the individual with a disability. This teamwork also needs to be brought to bear on
the selection and provision of assistive solutions. Each of the contributors to this section
describes how this can be achieved from the viewpoint of their training and practice.
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TABLE II.1
Chapters of Section II
Chapter Topic
6 The Cognitive Therapist (Olivetti Belardinelli, Turella, and Scherer)
7 The Special Educator (Zapf and Craddock)
8 The Psychologist (Meloni, Federici, Stella, Mazzeschi, Cordella, Greco, and Grasso)
9 The Psychotechnologist (Miesenberger, Corradi, and Mele)
10 The Optometrist (Orlandi and Amantis)
11 The Occupational Therapist (de Jonge, Wielandt, Zapf, and Eldridge)
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© 2012 by Taylor & Francis Group, LLC
106 Assistive Technology Assessment Handbook
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107
6
The Cognitive Therapist
M. Olivetti Belardinelli, B. Turella, and M. J. Scherer
6.1 Cognitive Therapy
The origins of cognitive therapy are generally grounded in behavioral therapies. This is
true when we consider the original modalities of the behavioral therapies. However, in the
frame of the cognitive therapy panorama, we nd that it is important now for therapists to
consider behavior within a psychodynamic frame.
Behavioral therapy started in the 1940s and 1950s using the conditioning techniques
envisaged by Pavlov for human behavior. On this basis, some authors explained human
behavior by means of mediators, dened as intervening variables of a biological basis
or cognitive type able to interact with antecedents through conditioning to particular
consequences. The paradigm of instrumental conditioning afforded the possibility of
modifying human behavior. In the rst years behavioral modications were obtained in
situations in which it was easy to manipulate the environmental variables, or with subjects
characterized with “cognitive simplicity,” such as children, psychotics, and “generically
disabled people.” Afterward, neuroses, emotional problems, and behaviors connected
with anxiety and depression were faced.
The name behavioral therapy was given by Lazarus to contrast it with the contemporary
psychodynamic therapies. Lazarus based his approach on learning experience and
conditioning principles.
CONTENTS
6.1 Cognitive Therapy ............................................................................................................. 107
6.2 The Cognitive Therapist ................................................................................................... 110
6.3 Cognitive Therapy With Individuals Having Cognitive Disability ........................... 114
6.4 Cognitive Rehabilitation ................................................................................................... 115
6.5 Assistive and Cognitive Support Technologies ............................................................. 116
6.6 Case Study .......................................................................................................................... 121
6.6.1 A Real-Life Example of a Vocational Rehabilitation Counselor’s
Solution-Seeking for James, Who Has Early Onset Alzheimer’s Disease .... 121
6.6.2 MPT Survey Results and Assessment Analysis ................................................ 122
6.6.3 Research, Implementation, and Recommendations .........................................123
6.7 Conclusions .........................................................................................................................125
Summary of the Chapter ............................................................................................................125
References .....................................................................................................................................126
© 2012 by Taylor & Francis Group, LLC
126 Assistive Technology Assessment Handbook
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131
7
The Special Educator
S. Zapf and G. Craddock*
7.1 The Role of the Special Educator in Assistive Technology Assessment
The World Health Organization and the United Nations Global Disability report esti-
mates that individuals with disabilities account for 15% of the world population, and
there are approximately 150 million children with disabilities in the world (WHO 2010).
The denition of special education varies worldwide because many countries use a
social classication system similar to the International Classication System addressing
the childs ability to participate across the educational domain, whereas other counties
focus on a medical model for education that is based on specic categories of impair-
ment or disabilities. Assistive technology (AT) has long been recognized as a tool for
enabling independence and access for individuals with disabilities (Bowe 1995; Østensjø
et al. 2005; Watson et al. 2010). Although changes in legislation have provided a positive
shift to include the consideration of AT in the students educational plan/setting, there
still remains a deciency in many developing countries for children with disabilities to
have access to needed AT to assist with meeting their educational plan and participation
in daily activities. The World Health Organization reports that only 5–15% of individuals
with disabilities have access to AT in many developing countries. The United Nations
Standard and World Health Organization Rule 4 (WHO 2010) promotes the training of
personnel at various levels in AT to improve access for technology. The special educator
can play a vital role in providing technology access and implementation of tools to be
used with students in the educational setting.
CONTENTS
7.1 The Role of the Special Educator in Assistive Technology Assessment .................... 131
7.2 Teaching Alternatives Using AT ......................................................................................134
7.3 Outcome Studies of Assistive Technology in the Educational Setting ......................136
7.4 Environmental Factors to Promote AT in the Classroom ............................................ 136
7.5 Going Forward: Universal Design for Learning (UDL) ............................................... 138
7.6 Case Evaluation ..................................................................................................................139
7.6.1 First Case Study: Zoey ..........................................................................................139
7.6.2 Second Case Study: John ...................................................................................... 140
7.7 Conclusions ......................................................................................................................... 145
Summary of the Chapter ............................................................................................................ 146
References ..................................................................................................................................... 146
* The views expressed by Dr. Ger Craddock are his own and are not of his employer, the National Disability
Authority.
© 2012 by Taylor & Francis Group, LLC
146 Assistive Technology Assessment Handbook
can determine use or nonuse of AT. Finally, as technology advances and AT is increasingly
supported within the mainstream market, the authors outline the next stage of technology
provision within the classroom—UDL. Ultimately, providing an educational environment
where classrooms are designed to cater for all types of students regardless of their disability
or special need is optimal. It is imperative for teachers to recognize that all students have
varying ability, and it is a measure of their ability, not disability, that should determine how
their education is supported. The classroom should provide a range of supports for any stu-
dent who may have issues in accessing the curriculum—from reading difculties to writing
to understanding. A special educator should have the knowledge, skills, and competence
backed up with the support of technologies to support all within the education environment.
Summary of the Chapter
This chapter describes the importance of assistive technology in education and the role
of the special educator in the process of integrating assistive technology for students with
disabilities into the educational system. The special educator is a crucial team member,
providing knowledge of the students’ educational capabilities and their daily interaction
in the use of assistive technology. Assistive technology can provide many children and
adolescents with disabilities the tools necessary to be more successful in school, at work,
and at achieving independence in daily living. Unfortunately, many special educators do
not receive training in the application of assistive technology nor do they have adequate
resources to effectively assess, implement, and follow-up on the use of assistive technology
in the classroom. This chapter will identify the special educator’s role in the assessment
and implementation of AT. Recommendations for future training needs for special educa-
tors will also be discussed.
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