Chapter 17: Assistive Technology in Intervention: Focus on Wheelchairs, Assistive Devices, and Orthoses

Chapter Objectives

Upon completion of this chapter, the learner will be able to:

1. Define “assistive device” in conceptual terms.

2. Describe federal legislation that supports access to assistive technology for individuals with disabilities.

3. Identify factors that would affect a decision about the acquisition of assistive technology in a given case scenario.

4. Provide a rationale for incorporating supported standing in the intervention plan for nonambulatory individuals.

5. Determine wheelchair (or other seating) specifications for a given case scenario.

6. Justify use of various types of assistive gait devices for particular conditions based on evidence.

7. Provide a rationale for the use of various common orthotic devices in patients of all ages with neuromuscular conditions.

8. Outline the essential components of a letter of medical necessity for assistive technology.

Introduction

Assistive technology devices, carefully selected and used, can dramatically improve the functional status of individuals with disabilities. The Americans with Disabilities Act (ADA), Public Law (PL) 110-325, describes an individual with a disability as someone whose “important life activities are restricted as to the conditions, manner, or duration under which they can be performed in comparison to most people” (U.S. Department of Justice, 2008, Section 12102). Consistent with the broad ADA definition, the overall purpose of assistive devices is more than just enhancing physical capability. “Assistive technology should help people achieve selfdetermined goals and be included in all aspects of community life” (Scherer, 2002, p. 11). Assistive technology bridges the gap between impairments of body structure and function and environmental factors to allow participation in all areas of life consistent within the International Classification of Functioning, Disability, and Health (ICF) framework (World Health Organization, 2001).

The ADA was enacted in 1990 and had broad implications. However, relatively few data were available about the population of individuals with disabilities. In a major interagency initiative, the federal government conducted a two-phase data collection plan with a series of questionnaires in 1994 and 1995. The purpose of the National Health Interview Survey on Disability (NHIS-D) was “to understand disability, to develop public health policy, to produce simple prevalence estimates of selected health conditions, and to provide descriptive baseline statistics on the effects of disabilities” (Russell, 1994). The NHIS-D has not been repeated in its entirety, although a number of survey questions have been incorporated into the annual NHIS conducted by the National Center for Health Statistics (NCHS), which is part of the Centers for Disease Control and Prevention (CDC) (Ward, 2016). Specific information on the use of assistive technology has not been included.

NHIS-D results revealed that 15% of adults had great difficulty with at least one of nine functional physical activities performed without help and without use of special equipment. The functional activities included walking a quarter of a mile; climbing 10 steps without resting; standing for 2 hours; sitting for 2 hours; stooping, bending, or kneeling; reaching over the head; using the fingers ...