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Technology has impacted the field of health care in numerous ways. Health care practitioners who practised a century ago would be amazed by the capabilities of technology in mainstream medicine and specifically in the field of rehabilitation. This article explains the various types of technology occupational therapists (OTs) can utilize in their practice; it describes the context in which it is used and provides an overview to occupational therapy students on the impact technology can have on the functionality of their clients.
The term 'rehabilitative technology' is an overarching term, that encompasses both adaptive and assistive technology. As per the Occupational Therapy Practice Framework: Domain and Process (4th ed; AOTA, 2020), occupational therapists are responsible for the selection, positioning and use of devices, to enhance a client’s function in everyday occupations.
Assistive Technology versus Adaptive Equipment
The terms adaptive and assistive technologies should not be used interchangeably, although both enable a person to complete their daily occupations. Assistive technology is a broad term that includes adaptive equipment and more. It is a whole range of systems that can be hardware, software, or any tool that assists people with disabilities (AOTA, 2020b). All adaptive technology is assistive technology, but not all assistive technology is adaptive.
The purpose of adaptive equipment is to enhance independence and efficiency with daily activities, which involves making a change to an existing piece of technology, hence the use of the word adaptive (Salvador et al, 2016). Adaptive equipment helps people experiencing injury or illness to complete ADLs such as bathing, dressing, feeding, back-scrubbing and shoe tying. The table below provides examples of each.
Technology Classification Table - Examples
Types of Technology | Image | Classification | Reason |
|---|---|---|---|
Adaptive Car Equipment |   | Adaptive | Equipment such as hand controls, levers and buttons, pedal extensions and left foot gas pedals are integrated to the vehicle, to enable easy operation. Makes occupations for the client easier. |
Walker |  | Assistive | Coined as assistive, as they improve stability in those with lower extremity weakness or poor balance and facilitate improved mobility, by increasing the patient's base of support. |
Screen Readers |  | Assistive | An assistive technology, primarily used by people with vision impairments. It converts text, buttons, images and other screen elements into speech or braille. |
On-Screen Keyboard |  | Adaptive | An accessibility utility that displays a virtual keyboard on the computer screen, that allows people with physical impairments to type data by using a pointing device or joystick. On-Screen Keyboard can also be used as a typing tutor, hence can be adapted to a variety of requirements. |
Alerting Devices with Visual Indicators |  | Adaptive | These connect to a doorbell, telephone, or alarm that emits a loud sound or blinking light, to notify the person with disability. Hence it can be adapted to enhance a person’s function in various ways. |
Technology in Context
Occupational therapists use activity analysis as part of the occupational therapy process, to analyze the strengths and needs of each client in their desired occupations, environments, and contexts. This analysis includes the client’s use of assistive technology. In this case, OTs proceed through the typical steps with clients including referral, needs analysis, recommendations, implementation and follow-up, as it relates to the technology being used (Christiansen et al., 2001).
Case Study: School setting
Consider an occupational therapy fieldwork (FW) student [UK: placement], completing a rotation in an elementary school with a student with cerebral palsy, under the supervision of an OTR/L. Usually a FW is around twelve weeks and, by week nine, the student OT would require less direct supervision and will be able to complete at least half of the caseload. The following example would be for someone who has demonstrated competency in handling treatment planning and implementation, based on existing individual education plans (IEPs) and development of treatment materials to be used in treatment sessions...
After receiving a referral from the teacher and completing a screening process in the classroom, to determine whether occupational therapy is warranted, the FW student starts to make recommendations based on the student’s strengths and needs. Upon observation, the fieldwork student observes the child struggling to keep up with the teacher's spoken instruction. During the fieldwork process of learning, usually students will be expected to run their findings by their supervisor at every step of the process, as per the policies of the facility. In this case, every finding has to be signed off by the supervisor. The student will make suggestions to the teacher, as well as to the interdisciplinary team during the IEP meetings, with approval from the supervisor OTR.
The goal is always to devise interventions that provide the ‘just-right challenge’ for the student.
The FW student at this point considers the use of a portable word processor, that can be used in order to assist with note-taking skills. If the word processor is approved, the student OT will utilize pre-made labels and tablet computers with text-to-use features (adaptive technology) with the child during group tasks, so that the child does not have to write continuously and become fatigued and frustrated. Since school-based practice is mostly multidisciplinary (every profession has an input), other professions - such as the social worker, general ed teacher and others involved with the student - will likely contribute to the implementation of the assistive technology.
After the technological plans are implemented, the teacher will use the device in the classroom with the student. They will provide feedback to the OT in charge on a regular basis, on how well the child is able to use the technology and whether it is helping to achieve the goals in the IEP. The student OT will use activity analysis, as employed in the occupational therapy process, in order to meet the demands of the student’s desired occupation in context - in this case, to be able to write continuously without being fatigued. During the screening and evaluation process, the student OT must consider the match between the skills and abilities of the student with the use of the word processor. This technology has to either increase, maintain or improve the client’s functional capabilities, in order for it to qualify. At all times during FW, the student OT has the ethical and professional obligation to run these recommendations by the concerned supervisor and eventually be signed off by the IEP team.
Future Implications for Occupational Therapy
The demand for rehabilitative services is on the rise, indicating an ongoing need for more advanced technologies across the entire continuum of care (Salvador and Goodrich, 2016)
Providing services to clients using assistive and adaptive technology is a collaborative and multidisciplinary process, that may include consultation with other health care professionals, such as educators, assistive technology device vendors and manufacturers. At all given stages of the assistive technology process - from selecting technology to implementing it into daily routines - OT practitioners and students must advocate for clients and remain vigilant in their continued education, to ensure the best outcomes.
Ultimately, the most important thing an OT can do to effectively use technology in practice is to understand the client’s occupational needs, context and current performance, before implementing any interventions. In doing so, practitioners not only adhere to the state licensure laws and professional ethics, but also demonstrate a commitment to contextualized, culturally-relevant and person-centered OT service, even in this ever-evolving, technological time.
References
American Occupational Therapy Association (2020a) AOTA 2020 occupational therapy code of ethics. American Journal of Occupational Therapy. 74 (Suppl. 3), 7413410005. https://doi.org/10.5014/ajot.2020.74S3006
American Occupational Therapy Association (2020b) Occupational therapy practice framework: Domain & process (4th ed). American Journal of Occupational Therapy. 74, 7412410010. https://doi.org/10.5014/ajot.2020.74S2001
Christiansen, C. and Lou, J. (2001) Ethical considerations related to evidence-based practice. American Journal of Occupational Therapy. 55, 345–349. https://doi.org/10.5014/ajot.55.3.345
Dishman, K.M. and Duckart, J. (2021) Perceptions of assistive technology education from occupational therapists certified as assistive technology professionals. American Journal of Occupational Therapy. https://doi.org/10.5014/ajot.2021.041541
Salvador, B. and Goodrich, B. (2016) Assistive Technology and Occupational Performance. American Journal of Occupational Therapy. 70 (Supplement 2). https://doi.org/10.5014/ajot.2016.706s02