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AT Final > Introduction/Seating/Funding > Flashcards

Introduction/Seating/Funding Flashcards

1
Q

Assistive Technology Definition

A

“ any item, piece of equipment, or product systems, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities”

  • IDEA defines as a device and a service
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2
Q

HAAT Model

A
  • Human
  • Activity
  • Assistive Technology
  • Context is at the bottom, Human mostly and activity a little interacts
  • Assistive Tech is on top of human, intersecting with activity
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3
Q

HAAT: Human Factors

A
  • physical
  • cognitive
  • emotional/ psychosocial
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4
Q

HAAT: Activity Factors

A
  • self-care
  • productivity (education, vocation)
  • leisure
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5
Q

HAAT: Assistive Technology Factors

A
  • Human-technology interface: how does the person interact with tech
  • processor
  • environmental interface
  • activity output
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6
Q

HAAT: Contextual Factors

A
  • physical context
  • institutional
  • cultural
  • – ethnicity
  • – environmental culture
  • social concerns
  • support: setup and maintenance
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7
Q

Low Tech

A
  • easy to use
  • minimal learning time
  • no electrical power
  • little to no training
  • Ex: planner, reacher
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8
Q

Elementary Tech

A
  • battery operated devices
  • easy to use
  • minimal amount of learning time
  • Ex: remote, old cell phone
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9
Q

High Tech

A
  • complex and programmable
  • requires training
  • may be costly
  • Ex: dragon, that pen for notetaking
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10
Q

Universal Design

A

“environments and products, to the greatest extent possible, should be usable by everyone regardless of their age, ability, or circumstance”

  • Build in accessibility in computer programs
  • Door levers instead of knobs
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11
Q

Hierarchy of AT

A
  1. Adapt activity or task
  2. Commercially available mainstream tech
  3. Combine/modify commercially available products in an innovative way
  4. Design/fabricate custom equipment
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12
Q

Proper Seating to Maximize Function

A
  • Comfort and Safety
  • Increase sitting tolerance
  • Prevent sliding, falling, tipping
  • Balance
  • Compensate for impaired trunk control
  • Proximal stability enhances distal mobility
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13
Q

Seating Assessment: What should be considered

A
  • contexts for use
  • what worked/didn’t work in the past
  • client goals
  • medical history
  • client factors and body structure
  • cognition and behavior
  • safety awareness
  • personal preferences
  • functional skills
  • other equipment used
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14
Q

Mat Level Assessment

A
  • ROM - can client tolerate sitting with pelvic flex 90 degrees
  • external supports needed for sitting/maintaining posture
  • weight shifting for pressure relief, transfers?
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15
Q

Fixed Deformities

A
  • Postural issue cannot be easily moved

- Accommodate to prevent worsening or injury

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16
Q

Flexible Deformities

A
  • Postural issue can be easily moved back to appropriate alignment
  • Correct the deformity
  • Provide necessary supports to bring body into proper alignment
  • Prevent permanent deformity
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17
Q

Decubiti

A
  • ulcer wound caused by rubbing or remaining in one spot
  • shear and friction
  • pressure
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18
Q

Potential risks of wounds

A
  • pain
  • hospitalization
  • limits on activity level
  • medical treatment, surgery
  • interruption of lifestyle
  • infection
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19
Q

Preventing Pressure Ulcers

A
  • Optimize/ Minimize Forces
  • Optimal Environment
  • Tools
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20
Q

Optimize/Minimize Forces to Prevent Ulcers

A
  • distribute load

- reduce shear/friction

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21
Q

Optimal Environment to Prevent Pressure Ulcers

A
  • Moisture control
  • Heat/air flow
  • chronic issues
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22
Q

Tools for Preventing Pressure Ulcers

A
  • medical history
  • pressure mapping
  • regular skin inspection
  • routine pressure relief
23
Q

Shifting Weight to Prevent Pressure Ulcers

A
  • shift for 15 sec every 15 min
  • shift for 30 sec every 30 min
  • bed repositioning schedule
  • wheel-chair pushups, lateral/forward leaning
  • power tilt, power recline
24
Q

Ideal Seated Posture

A
  • 90 degrees at hip
  • 90 degrees at knee
  • 90 degrees at ankle
  • head in midline all planes
  • trunk in midline all planes
  • arms resting and supported in neutral
25
Q

Cushions

  1. Foam
  2. Flotation
  3. Gel
A
  1. greatest support, low maintenance
  2. greatest pressure relief, must maintain
  3. heavy, retains heat, not used anymore
26
Q

Cushions

  1. Hybrid
  2. Custom Molded
A
  1. combo of flotation and foam (support for legs, pressure relief for butt)
  2. can off-weight an existing pressure ulcer
27
Q

Trunk Supports

A
  • curved backrests
  • lateral supports
  • different heights/dimensions
28
Q

Custom Molded Supports

A
  • molded during seating appointment

- for when conventional laterals and contoured backs do not support the individuals needs

29
Q

Manual Wheelchair: Folding

A
  • most common
  • some propulsion efficient lost in frame wiggle
  • folds thinner
  • a bit heavy (>30 lbs)
  • lower cost
30
Q

Manual Wheelchair: Rigid

A
  • improved durability
  • improved maneuverability
  • lighter for propulsion/transport
  • more efficient to propel
  • can be ultra-lightweight (<16 lbs)
31
Q

Tilt in Space

A
  • seat back angle remains fixed
  • frame tilts to redistribute weight from hips to back
  • no shear forces
  • excellent durability
  • heavier: 40 - 60 lbs
  • hard to disassemble for trunk
  • more positioning options, better with tone issues
32
Q

Factors that contribute to the development of pressure ulcers

A
  • poor nutrition
  • decreased mobility
  • moisture
  • activity
  • friction and shear
  • heat
  • presence of toxins (urine?)
  • sensory perception
  • circulatory issues
33
Q

Common Areas for Pressure Ulcers

A
  • sacrum/coccyx
  • ischia tuberosities (part of hip you sit on)
  • trochanters (top of femur)
  • malleoli (ankle bones)
  • heels
34
Q

Ideal Positioning

A
  • hips all the way back in seat
  • pelvis in slight anterior tilt
  • – supporting the trunk will support breathing
  • elbows can rest on armrests
  • neutral hip rotation
  • legrests adjusted to support femur
  • cushion length is good
35
Q

Considerations for a manual vs power wheelchair

A
  • self-propel in home/community
  • safely operate a power wheelchair
  • insurance
  • progressive disorder
  • transport chair, in/out of house
  • risk of secondary injury (shoulder, hands)
36
Q

Types/Features of Power Wheelchairs

A
  • Rear wheel: can navigate terrains better, faster outsides, can’t make tight turns
  • Middle wheel: can navigate terrains, can make tight turns
  • Front wheel: can’t make tight turns
  • Conventional vs rehab seating
  • Power positioning: tilt, recline, seat elevation, legrest elevation, lateral tilt, sit-to-stand, power seat-to-floor
37
Q

Power Wheelchair Alternative Drive Controls

A
  • head array
  • sip and puff
  • chin operated joystick
  • switch controlled drive
38
Q

Public Funding for AT

A
  • Congress passes a law –> federal agency identifies criteria and scope
  • Federal funds and criteria distributed to states
  • Rehab Act of 1973
  • Assistive Tech Act of 2004
39
Q

Rehab Act of 1973

A
  • mandated reasonable accommodations for all federally funded programs
  • requires AT and services included in voc rehab service plans
  • section 508: equal access to electronic office equipment for all federal employees
  • Defines rehab tech as AT devices and services
40
Q

Assistive Tech Act of 2004

A
  • Replaced tech related assistance for Individuals with Disabilities Act of 1988/98
  • Improved funding for AT services, including alternative financing
  • improved coordination of state services
  • – device loan programs, device reutilization programs, device demonstration programs, state financing activities
  • Projects: trialing AT before you buy
41
Q

AT Funding by Private Health Insurance

A
  • varies by provider, plan, employer
  • may dictate which provider/supplier
  • May cover features that medicaid/medicare do not
42
Q

AT Funding Through Worker’s Compensation

A
  • work-related injuries

- funding is employer and state

43
Q

AT Funding from Dept of Veteran’s Affairs

A
  • must have service related disability

- will fun AT, esp to promote independence

44
Q

DME

A
  • withstand repeated use
  • serves a medical purpose
  • not useful if person wasn’t ill
  • for use in the home
45
Q

IDEA Funding and AT

A
  • AT services provided from age 3-21
  • IEP to consider AT
  • increased emphasis on education related AT –> must address educational goals
  • no federal oversight, variations by district
  • sometimes advocacy and litigation are needed
46
Q

Medicaid Funding and AT

A
  • joint federal and state program
  • income dependent
  • AT must be a medical necessity
  • emphasis on dme and prosthetics
  • prior approval/authorization necessary
  • coverage disputes: vague criteria, state variations
47
Q

Vocational Rehab Funding and AT

A
  • federally funded, distributed by state
  • IPE: individual plan for employment
  • supports differ by state
  • must address vocational goal
  • Goal: individual earns income –> contributes to economy –> reduces enrollment in social programs
48
Q

To pay for initial evaluation

A
  • informal write up
  • this may be all that is needed for simple equipment requests
  • common
  • part of medical record
49
Q

To pay for implimentaion of evaluation recommendation

A
  • letter of justification
  • dates of eval
  • diagnosis, medical history, activity level
  • recent changes in status
  • age of existing AT
  • home accessibility
  • level of caregiver support
  • problems with existing equipment
  • how long equipment will be needed for
  • medical risks
  • why chosen AT is the most cost-efficient/best choice
50
Q
  1. Pay for device, setup, training

2. Pay for follow-up and follow-along

A
    • repairs

- training new caregivers, teachers, employees, etc

51
Q

Barriers to Funding

A
  • Lack of consistency across agencies
  • No centralized system or coordination amongst agencies
  • Different needs for AT (educational, vocational, medical)
  • Use of approved DME providers limits choices
  • Regulations open to interpretation
52
Q

Justification for Funding

A
  • Identification of functional limitation
  • Detailed description of device(s)
  • How device will help fx’l limitation
  • Evaluation process
  • Why device best one
  • Why least costly
  • Your relationship/credentials
  • Medical/Educational/Vocational Necessity based on payer
53
Q

If funding is denied, appeals…

A
  • Determine procedure and timeline from funding source
  • Determine why request was denied
  • Develop appeal plan
  • Submit appeal with new information that specifically addresses denial
  • Your documentation may end up in court!

AT Final (4 decks)

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