Cook and hussey's assistive technologies pdf

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Albert M. Cook, PhD, PE Professor and Dean Faculty of Rehabilitation Medicine University of Alberta Edmonton, Alberta

Jan Miller Polgar, PhD, OT Reg. (Ont.) FCAOT Associate Professor, School of

Occupational Therapy Chair, Graduate Program in Health

and Rehabilitation Sciences Faculty of Health Sciences The University of Western Ontario London, Ontario

Author Emerita Susan M. Hussey, MS, OTR/L Professor and Coordinator Science and Allied Health Division Sacramento City College Sacramento, California

11830 Westline Industrial Drive St. Louis, Missouri 63146

COOK & HUSSEY’S ASSISTIVE TECHNOLOGIES: PRINCIPLES ISBN: 978-0-323-03907-9 AND PRACTICE, THIRD EDITION Copyright © 2008, 2002, 1995 by Mosby, Inc., an affiliate of Elsevier Inc.

All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Permissions may be sought directly from Elsevier’s Health Sciences Rights Department in Philadelphia, PA, USA: phone: (+1) 215 239 3804, fax: (+1) 215 239 3805, e-mail: healthpermissions@elsevier.com. You may also complete your request on-line via the Elsevier homepage (http://www.elsevier.com), by selecting ‘Customer Support’ and then ‘Obtaining Permissions’.

Library of Congress Control Number: 2007928477

Publishing Director: Linda Duncan Senior Editor: Kathy Falk Senior Developmental Editor: Melissa Kuster Deutsch Publishing Services Manager: Patricia Tannian Project Manager: Claire Kramer Designer: Andrea Lutes

Printed in China

Last digit is the print number: 9 8 7 6 5 4 3 2 1

Notice

Neither the Publisher nor the Authors assume any responsibility for any loss or injury and/or damage to persons or property arising out of or related to any use of the material contained in this book. It is the responsibility of the treating practitioner, relying on independent expertise and knowledge of the patient, to determine the best treatment and method of application for the patient.

The Publisher

For giving us the reason and the direction for this work,

we dedicate this book to all our students

and to consumers of assistive technologies, especially

Elizabeth Cook, Brian Cook, Beatrice Miller, and Geraldine Kraft

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Kim Adams, MSc in EE, PEng ATP Assistant Professor Faculty of Rehabilitation Medicine University of Alberta Edmonton, Alberta Research Affiliate Glenrose Rehabilitation Hospital Edmonton, Alberta

Roger Calixto, Eng MSc Graduate student Biomedical Engineering Department University of Alberta Edmonton, Alberta

Lui Shi Gan, BSc Master’s candidate Department of Biomedical Engineering University of Alberta Edmonton, Alberta

Andrew Ganton, BSc(Eng) Research Associate Department of Biomedical Engineering and Centre

for Neuroscience University of Alberta Edmonton, Alberta

J. Andrew Rees, BSc (Mech. Eng) Edmonton, Alberta

Tyler Simpson, BEng Graduate student Biomedical Engineering Department University of Alberta Edmonton, Alberta

Rebecca Watchorn Graduate student Psychology Department University of Alberta Edmonton, Alberta

C O N T R I B U T O R S

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Sarah Blackstone, PhD President Augmentative Communication Inc Partner/Project Director Rehabilitation Engineering Research

Center on Communication Enhancement Monterey, California

Deb Finn Assistive Devices Industry Office Industry Canada Ottowa, Ontario

Lewis Golinker, Esq. Director Assistive Technology Law Center Ithaca, New York

William Hodgetts, BA (Hons), MSc (Audiology), PhD Candidate

Assistant Professor Department of Speech Pathology

and Audiology University of Alberta Edmonton, Alberta

Trevor Jones, B. Appl. Sc, Grad Dip (applied physics)

Principal Bioengineer Royal Perth Hospital Department of Medical Engineering

and Physics Bioengineering Division Perth, Western Australia

Gary Moulton Accessibility Technology Group Microsoft Corporation Redmond, Washington

Annuska Zolyomi Perkins, BS Industrial Engineering

Product Planner Accessibility Technology Group Microsoft Corporation Redmond, Washington

E D I T O R I A L R E V I E W B O A R D

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The use of assistive technologies by persons with disabil- ities to pursue self-care, educational, vocational, and recre- ational activities continues to increase in both quantity and quality. The number of academic programs, clinical centers, schools, and hospitals applying these assistive technologies has increased dramatically.

BACKGROUND

When we wrote the first edition nearly 15 years ago, there was a lack of carefully articulated principles and practices in the emerging assistive technology field, despite the growth in interest, application, and training. The common approach had been to focus on available devices with little synthesis of principles and practices. Some books focused on specialized areas (e.g., augmentative communication devices or seating systems), whereas others covered a broader range of devices. The first edition of this text was written to provide a frame- work for assistive technology application that was both broad in scope and specific in content. This approach was con- tinued in the second edition with the addition of chapters describing the role of assistive technologies meeting educa- tional and vocational needs of persons with disabilities. We are grateful for the extremely positive response to the first two editions from an international audience of professionals, educators, and students. In this third edition, Jan Polgar has taken over for Sue Hussey.

ORGANIZATION

Given the passage of time since the first edition and the rapid pace of technological change, it is not surprising that this edition has been significantly revised and expanded. The book is organized into five main parts. Part One pres- ents information on the assistive technology industry, including a historical perspective, relevant legislation, and

issues of professional practices (Chapter 1). In Chapter 2, the fundamental framework for the text, the Human Activity Assistive Technology (HAAT) model description, is developed. We have revised the HAAT model into a three-dimensional format and more closely related it to practice in rehabilitation, particularly occupational therapy. The HAAT model, the fundamental unifying concept in the text, is a framework that describes the consumer participat- ing in activities together with the assistive technologies and their contexts of use. This model embodies the most funda- mental of the concepts in the text (i.e., that assistive technolo- gies represent someone [consumer with a disability] doing something [e.g., communicating, moving, manipulating] somewhere with someone [e.g., at home, at work, with peers, with strangers] through the use of assistive technologies). We use this model to develop principles for assistive technology application, which address everything from needs identifica- tion through system implementation to measurement of out- comes. The book also provides the basis for discussion of current practices in this field and of the major technologies now in use across a wide range of specific application areas. Chapter 3 discusses the human operator in terms of the skills and abilities that are brought to assistive technology use.

Part Two focuses on service delivery in assistive technolo- gies. In Chapter 4 we focus on the service delivery system through which the consumer obtains assistive technologies. This chapter also includes a discussion of outcome measure- ment for assistive technologies. In Chapter 5, in which assis- tive technology funding is described, U.S. funding has been completely revised, and we have expanded the chapter to included Australian and Canadian funding programs. In making these revisions we received major assistance from Lew Golinker (United States), Trevor Jones (Australia), and Deb Finn (Canada).

Part Three is devoted to general purpose assistive tech- nologies, which apply across a wide range of areas. In Chapter 6 we develop basic concepts underlying seating and positioning. The goals of seating and positioning include

P R E FA C E

“Writing is no trouble: you just jot down ideas as they occur to you. The jotting is simplicity itself—it is the occurring which is difficult.”

—Stephen Leacock

tissue integrity, positioning for postural control, and the achievement of comfort through proper positioning. The chapter is reorganized to identify principles of seating tech- nologies that apply to each of these goals. The actual tech- nologies are presented to highlight the applications to each of these areas, demonstrating the potential of each to meet one or more of the major goals of seating and positioning.

The most significant changes have occurred in those areas involving assistive technology in computer applications. In earlier editions, we separated computer use into a sepa- rate chapter. As time has passed, computer use has become much more common, and much of the information in pre- vious editions regarding general computer use was no longer relevant. Our approach has been to treat the motor and sen- sory disabilities in separate chapters. In Chapter 7 we have combined computer access for individuals with motor dis- abilities with our discussion of control interfaces for all applications. Chapter 7 also discusses the development of principles of selection and effective application for control interfaces. Material related to input acceleration (e.g., pre- diction, abbreviations) has also been moved to this chapter. In Chapter 8 and Chapter 9, we have combined information regarding computer access for individuals with visual and auditory disabilities, respectively, with other assistive tech- nologies that meet the needs of these populations. Chapter 8 also includes a discussion of World Wide Web access for persons with disabilities. In revising these chapters we received help from Gary Moulton and Annuska Perkins from the Accessibility Technology Group at Microsoft.

In Part Four our emphasis shifts to a discussion of specific areas of application for assistive technologies. Chapter 10 is completely new for this edition and addresses the emerging area of assistive technology applications for individuals who have cognitive disabilities. The augmentative communication chapter is now Chapter 11 and has been significantly revised with major assistance from Sarah Blackstone. The former chapter on mobility has been divided into two chapters to describe personal mobility (i.e., manual and electrically pow- ered wheelchairs) and transportation. Chapter 12 describes structure and controls of manual and electrically powered wheelchairs. It identifies principles to guide recommendation of these technologies and introduces new advances in these areas. Chapter 13 has two main components: (1) technology for safe transportation when traveling in a vehicle, while seated either in the vehicle seat or in a wheelchair, and (2) technology for driving. A section that describes proper selection of a child restraint system and systems specific to children with physical disabilities is added in this edition.

In Chapter 14 we discuss the use of assistive technologies to replace or augment manipulative ability. Also included are a wide variety of technologies, which range from simple, low- technology aids (e.g., enlarged forks) to specialized electro- mechanical devices (e.g., feeders, electronic aids to daily living, robots).

In Part Five we consider two particularly significant contexts for assistive technology application. In Chapter 15 we describe educational applications and in Chapter 16, vocational applications. These two chapters bring together concepts, technologies, and strategies from the previous 14 chapters and show how they are interrelated in these major areas of application.

NEW TO THIS EDITION

Case examples and illustrations of devices in use foster the understanding of how assistive technologies are used and how they function. For this third edition, these have been expanded. The glossary of terms has also been expanded and incorporates a list of resources that includes major conferences, professional associations, and manufacturers’ associations with Internet sites.

Many assistive technologies, especially those that are elec- tronically based, have features that are best understood by see- ing or experiencing them, in addition to reading about them. A major addition to this edition of the text is a CD with demonstrations of assistive technologies, interactive exercises with assistive technology characteristics, video case studies, and demonstrations of devices in use and Web links for obtaining more information. There is also an Evolve Web site for the text (http://evolve.elsevier.com/Cook/assistive/) that contains additional links and resources. Resources for instruc- tors include a test bank and instructor’s manual.

WHO WILL BENEFIT FROM THIS BOOK?

The primary audience for this book remains undergraduate and graduate university students.The first and second editions, however, also proved useful to assistive technology practition- ers and assistive technology suppliers, many of whom used this text for RESNA (Rehabilitation Engineering & Assistive Technology Society of North America) certification examina- tion review. These individuals represent a secondary audience: professionals who are practicing in this area even though they have had no formal training in this field while in school. Our intended audience is a transdisciplinary professional popula- tion including occupational therapists, speech-language pathologists, physical therapists, special educators, rehabilita- tion engineers, and vocational rehabilitation counselors.

CONCEPTUAL APPROACH

The strength of our approach is that concepts are unified through the use of the HAAT model and reinforced as each specific application is presented. For each specific

xii Preface

technology application, we discuss assessment and training of the consumer, devices that are available, strategies for their use, and evaluation of outcomes. Learning objectives, key terms, study questions, and references are included for each chapter. Case studies have been added throughout the text. It is assumed that the reader will have a general understanding of normal human anatomy and physiology and disabilities.

It is our hope that those individuals familiar with assistive technologies will find something new in this text and that those readers who are new to this subject will develop familiarity with assistive technologies and appreciate their potential.

Albert M. Cook Janice M. Polgar

Preface xiii

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A C K N O W L E D G M E N T S

I am indebted to Sue Hussey for her work on the first and second editions of this book. She and I worked well together and found many ways to support, as well as challenge, each other to have the best result that we could. We are grateful for the strong support that those two editions generated. When Sue decided that she could not continue with the third edition, I immediately contacted my friend and colleague, Jan Polgar. I had known Jan through other projects and knew that she was thoughtful, critical, and highly productive—all qualities I wanted in a co-author. I also knew that she was fun and had a great attitude. While Jan may have questioned the wisdom of her decision to join me in developing this third edition, I have had no regrets. Working with Jan has been a delight from start to finish. Always thoughtful, always critical, and most important, always kind, she has made many major improvements in the text. Thank you, Jan, for all of the effort and for the quality product that resulted.

Book writing is a solitary pursuit, and I am indebted to a number of friends who have supported me over the course of this revision. Cheryl Kolbuc, Jeff Kolbuc, Linda Lawrence, and Ron Hazelaar have been remarkably supportive of me and my work. My friend Claire Redpath has helped me to understand much about myself and to place my work in perspective. Norma and Cheryl Harbottle and Dave Polvere provided technical support for this edition.

A book of this type, focusing on technology, requires a great deal of time for revision. This time is often stolen from family. I cannot express the gratitude I have for the contin- uing support, love, and understanding of my wife, Nancy, and the support of my daughters, Barbara and Jennifer. Finally, my son, Brian, continues to inspire me to understand the ways in which technology can ameliorate the problems faced by individuals who have disabilities.

Al Cook

When Al Cook asked me whether I would be interested in becoming his co-author for the third edition of this book, I thought it would be fun and exciting. And now, 2 years later, it is still mostly fun and exciting. I could not have asked for a better co-author than Al, who has been encouraging and supportive and who has been a wonderful teacher throughout.

During those times when this occupation became over- whelming, Al would offer wise advice or take more of this work into his busy schedule. Al, I value your friendship.

Many other people have supported me through this process. My colleagues in the School of Occupational Therapy at The University of Western Ontario maintained interest in the project and helped me to strategize approaches to different topics. I am grateful for my many friends in the seating and mobility field who shared their resources and expertise. My running and triathlon training partners, particularly the KIN boys, tolerated my tales of early morning writing sessions and the never-ending details of the process. In particular, I thank Jill Jacobson, my research associate, who helped with many elements of the preparation of this book and kept me organized. My parents, Charles and Evelyn Miller, gave me the confi- dence and perseverance to undertake a task of this size. Most important, I want to thank my family: my husband, Roger; my daughter, Andrea; and my son, Alex, for giving me the time to work on this book. I can’t do what I do without you.

Jan Miller Polgar

There are many individuals who helped us with the prepa- ration of this edition of our textbook, and we would like to acknowledge their valuable contributions. Chris Beliveau of the Glenrose Rehabilitation Hospital I CAN Centre in Edmonton provided pictures of devices in use, whereas Kathy Howrey provided much of the framework for Chapter 15. Rob Hussey provided some of the original artwork used in all three editions, and Gaëtan LaBelle provided the original artwork portraying the HAAT model in Chapter 2 of this edition. We are grateful for their creativity. Kathy Falk, senior editor; Melissa Kuster, senior developmental editor; Claire Kramer, project manager; and the editorial assistants at Elsevier provided highly professional support and assistance in the production of this text. A new feature of this edition is the accompanying CD. Melissa and Satyen Vora, producer, developed this CD from our content. Thanks to all of the Elsevier staff for making this project successful.

When the second edition was being developed, the editors obtained a series of pictures from an on-line source. Sue and I quickly agreed that the picture of a man in a wheelchair,

obviously enjoying life to the fullest with the use of assistive technology, was our choice. We didn’t know who the man was until we received an e-mail during the preparation of this third edition. His OT, Teresa Valois, identified Gary Miller as our “cover man.” Teresa also informed us that Gary had passed away. We want to acknowledge the contribution Gary made to the second edition by bringing his sense of joy to our cover.

As Teresa noted, “It is sad to have Gary no longer coming into our Assistive Technology lab and clinic, but to know him was special and he was truly a great user of AT.”

Jan Miller Polgar Al Cook

xvi Acknowledgments

PART 1 Introduction and Framework, 1

1 Introduction and Overview, 3

2 Framework for Assistive Technologies, 34

3 Disabled Human User of Assistive Technologies, 54

PART 2 Service Delivery in Assistive Technologies, 89

4 Delivering Assistive Technology Services to the Consumer, 91

5 Funding Assistive Technology Services and Systems, 143

PART 3 The Activities: General Purpose Assistive Technologies, 177

6 Seating Systems as Extrinsic Enablers for Assistive Technologies, 179

7 Human/Assistive Technology Interface, 213

8 Sensory Aids for Persons With Visual Impairments, 274

9 Sensory Aids for Persons With Auditory Impairments, 310

PART 4 The Activities: Performance Areas, 335

10 Assistive Technologies for Cognitive Augmentation, 337

11 Augmentative and Alternative Communication Systems, 370

12 Technologies That Enable Mobility, 408

13 Technologies That Aid Transportation, 443

14 Technologies That Aid Manipulation and Control of the Environment, 460

PART 5 Contexts for Assistive Technology Applications, 497

15 Assistive Technologies in the Context of the Classroom, 499

16 Assistive Technologies in the Context of Work, 525

Glossary, 545 Resources, 556 Index, 559

C O N T E N T S

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PA R T 1

Introduction and Framework

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Introduction and Overview

Chapter Out l ine

ASSISTIVE TECHNOLOGIES: A WORKING DEFINITION Definition of Assistive Technology Devices and Services Characterization of Assistive Technologies Assistive Versus Rehabilitative or Educational Technologies Low to High Technology Hard and Soft Technologies Appliances Versus Tools Minimal to Maximal Technology General Versus Specific Technologies Commercial to Custom Technology Summary

HISTORICAL PERSPECTIVE ON ASSISTIVE TECHNOLOGY DEVICES AND SERVICES

(Very) Early Developments in Assistive Technologies Evolution of State-of-the-Art Assistive Technology U.S. Federal Legislation Affecting the Application

of Assistive Technologies Rehabilitation Act of 1973 (Amended) Americans With Disabilities Act (ADA) of 1990 Individuals With Disabilities Education Act Amendments of 1997 and 2004

Elementary and Secondary Education Act (2001 Reauthorization) Assistive Technology Act of 1998, as Amended (2004) Developmental Disabilities Assistance and Bill of Rights Act Medicaid Medicare

ASSISTIVE TECHNOLOGY INDUSTRY TODAY Consumer and Direct Consumer Services The Consumer Characteristics of Direct Consumer Service Programs Basic Research Applied Research Product Development Manufacturing Distribution of Hard Technologies Information and Referral Education

PROFESSIONAL PRACTICE IN ASSISTIVE TECHNOLOGY Providers of Assistive Technology Services Ethics and Standards of Practice Code of Ethics for Assistive Technologies: The RESNA Code of Ethics

Standards of Practice Quality Assurance Overview Standards for Service Providers Standards for Devices Outcomes of Assistive Technology Delivery

SUMMARY

Learning Objectives

On completing this chapter, you will be able to do the following:

1. Define assistive technology 2. Delineate the characteristics of assistive technologies 3. Describe the history of assistive technology practice 4. List the major legislative initiatives that have affected the application of assistive technologies 5. Describe the components of the assistive technology industry 6. Explain the roles of the consumer 7. Identify several distinguishing features of service delivery programs

3

C H A P T E R 1

In the last 25 to 30 years there has been major growth in theapplication of technology in ameliorating the problems ofpersons with disabilities. Until the publication of the first edition of this book in 1994, there was no unified set of prin- ciples for this application of technology. This chapter begins by providing an overview of assistive technologies and the industry that supports their development and distribution. A brief historical perspective and a summary of the major United States federal legislation that provides the mandate for assistive technologies are also presented.

ASSISTIVE TECHNOLOGIES: A WORKING DEFINITION

The document International Classification of Functioning, Disability, and Health (ICF) describes a system developed by the World Health Organization (WHO) that is designed to describe and classify health and health-related states. These two domains are described by body factors (body structures and functions) and individual and societal elements (activities and participation) (WHO, 2001). It is a revision of the previous classification system, described in the International Classification of Impairments, Disabilities, and Handicaps (ICIDH) (WHO, 1980). Two primary shifts in philosophy discriminate between the ICIDH and the ICF classification systems: the recognition of the importance of the environment as a mediating factor in the performance of daily function and the use of more pos- itive language (i.e., the construct of function replaces that of disability).

Body structures and function refer to the structural and physiological functions of the body. For example, the classi- fication relating to vision lists the anatomical structures of the eye and the sensory and motor and perceptual elements of vision. Activity and participation are considered to be a single classification. There is much debate on whether it is

possible to differentiate between an activity and participation. Something that may be considered participation at one stage in life becomes an activity at a later stage. The ICF defines activities as the “execution of tasks” and participation as “involvement in life situations” (WHO, 2001, p. 10). Examples of the different components of activity and partici- pation include learning and applying knowledge, communica- tion, mobility, self-care, and community, social, and civic life.

The ICF recognizes two contextual factors that modify health and health-related states: environment and personal factors (WHO, 2001). The latter are not classified but merely identified and include age, sex, race, lifestyle habits, and social and cultural backgrounds, among other factors. The inclusion of these factors in the ICF recognizes their ability to influence differentially the outcome of the same impairment in two individuals.

The ICF does classify environmental elements. Assistive technologies are located in this classification, most promi- nently in the products and technology chapter. They are specifically mentioned related to activities of daily living, mobility, communication, religion, and spirituality and in specific contexts such as education, employment and culture, recreation, and sport (WHO, 2001). Many of the remaining environmental chapters have implications to assistive tech- nology, although it is not mentioned explicitly. These chap- ters include access to public and private buildings, the natural and built outdoor environments, people and animals that provide physical and emotional support (personal care attendants and health care professionals are identified here; service animals are not), attitudes of individuals and others and services, systems, and policies, that include legislation (WHO, 2001). Scherer and Glueckauf (2005) reviewed the ICF and discussed the implications to provision of assistive technologies. They concluded that the revised classification system puts the onus on the assistive technology provider to demonstrate positive outcomes for assistive technology recommendations and use.

4 C H A P T E R 1 Introduction and Overview

8. Identify the professionals who may work as assistive technology practitioners 9. Understand the transdisciplinary approach to assistive technology service delivery

10. Discuss the major professional issues in assistive technology practice

Key Terms

Activity Alpha Testing Assistive Technology Assistive Technology Practitioner (ATP) Assistive Technology Service

Assistive Technology Supplier Beta Testing Consumer of Assistive Technologies Device Direct Consumer Services Participation

Prototype Quality Assurance Reasonable Accommodation Telerehabilitation Transdisciplinary Team Approach Universal Design

Definition of Assistive Technology Devices and Services

Dictionaries provide the following definition of technology: (1) the science or study of the practical or industrial arts, (2) applied science, and (3) a method, process, and so forth for handling a specific technical problem (Guralnik, 1979; McKechnie, 1983).

Surprisingly, none of these definitions says anything about a “device”; instead the emphasis is on the application of knowledge. This is an important concept, and the term assistive technology will be used to refer to a broad range of devices, services, strategies, and practices that are conceived and applied to ameliorate the problems faced by individuals who have disabilities.