Role of Occupational Therapy Practitioners in Mass Market Technology Research and Development.

Performance of many activities of daily living and instrumental activities of daily living involve technology, such as an electric toothbrush or a self-checkout register at the grocery store. Unfortunately, more than 60 million people with disabilities in the United States struggle to use these technologies because of inaccessible designs. Occupational therapy practitioners have a unique expertise in the design of accessible equipment. Practitioners have been involved in the design of adaptive and assistive equipment targeting use by people with disabilities since occupational therapy's beginnings. However, few occupational therapy professionals currently work in the research and development of everyday technologies. This article explores the role of the occupational therapy practitioner on the technology design team, discusses barriers to current practice, and makes recommendations to the profession.

Technology and Occupation: Past, Present, and the Next 100 Years of Theory and Practice.

During the first 100 years of occupational therapy, the profession developed a remarkable practice and theory base. All along, technology was an active and core component of practice, but often technology was mentioned only as an adjunct component of therapy and as if it was a specialty. This lecture proposes a new foundational theory that places technology at the heart of occupational therapy as a fundamental part of human occupation and the human experience. Moreover, this new Metaphysical Physical-Emotive Theory of Occupation pushes the occupational therapy profession and the occupational science discipline to overtly consider occupation on the level of a metaphysical-level reality. The presentation of this theory at the Centennial of the profession charges the field to test and further define the theory over the next 100 years and to leverage technology and its role in optimizing occupational performance into the future.

Integration of Medication Management Into Occupational Therapy Practice.

Occupational therapy practitioners enable clients to improve performance in everyday occupations. As health care reform precipitates changes across health care service organizations, occupational therapy professionals must seize the opportunity to apply their unique skills and perspective to meet the changing needs of clients and other stakeholders. In this article, we explore the role and distinct value of occupational therapy practitioners in one area of changing need: medication management. We find that occupational therapy practitioners have unique skills that complement the factors affecting medication nonadherence and evidence-based interventions. With reforms to research, teaching, and practice, occupational therapy practitioners can better integrate medication management into regular evaluation and treatment, thereby contributing to broader patient outcomes defined by the Affordable Care Act.

Intervention to Improve Medication Management: Qualitative Outcomes From a Phase I Randomized Controlled Trial.

OBJECTIVES: We sought to define an occupational therapy intervention to promote medication management and to evaluate the acceptability and effectiveness of the intervention. METHOD: Nineteen adults with chronic health conditions and poor medication adherence participated in a two-group, blinded, randomized study. They received either an occupational therapy or a standard care intervention. We used a qualitative method to measure participants' changes in medication management through an interview regarding participants' perceptions and behaviors. RESULTS: The occupational therapy intervention group reported greater improvements in medication management and implemented twice as many new adaptive strategies as the standard care group. Participants indicated that interventions related to advocacy, education, assistive technology, environmental modifications, self-monitoring, and good rapport were the active ingredients of the intervention. CONCLUSIONS: Occupational therapy is an acceptable intervention for medication management, and it can lead to self-perceived improvements and the adoption of new medication management behaviors. Further research is warranted.

Intervention Promoting Medication Adherence: A Randomized, Phase I, Small-N Study.

OBJECTIVE: Many people with chronic health conditions fail to take their medications as prescribed, resulting in declines in health and function. The purpose of this study was to perform a Phase I feasibility study to understand whether an integrated occupational therapy intervention could help people with chronic health conditions improve their adherence to medications. METHOD: Using a small-N design, we report single-subject analyses of the medication adherence of 11 participants before and after either an occupational therapy intervention or a standard care intervention. We used a multiple baseline approach with intersubject replication and blinding. RESULTS: The occupational therapy intervention was found to decrease performance variability and to increase medication adherence rates in some people with chronic conditions. CONCLUSION: These findings suggest that an occupational therapy intervention can improve medication adherence in people with chronic health conditions. The intervention tested in this study is feasible and would benefit from further research.

Benefits of Student Engagement in Intervention Research.

OBJECTIVE: Accreditation standards require entry-level occupational therapy students to understand, critique, and design research. However, the extent to which students should be embedded in research projects is unclear. The purpose of this study was to understand the benefits of student immersion in research for student learning and research quality. METHOD: Using a multiple case study design, the principal investigator trained six occupational therapy students to implement a manualized intervention with research participants. Learning quizzes, video analysis of research activities, a practical exam, student documentation, an exit interview, and an exit survey identified student learning and research outcomes. RESULTS: Students successfully implemented the study protocols with good reliability (intraclass correlation coefficient = .89) and fidelity (99%). Students also reported improvements in comfort with client interactions, confidence in practice skills, self-efficacy in research, and clinical reasoning. CONCLUSION: Student participation in hands-on research supports researchers in attaining their research goals and provides students with valuable learning experiences.

Criterion and construct validity of prosthesis-integrated measurement of joint moment data in persons with transtibial amputation.

Prosthesis-integrated sensors are appealing for use in clinical settings where gait analysis equipment is unavailable, but accurate knowledge of patients' performance is desired. Data obtained from load cells (inferring joint moments) may aid clinicians in the prescription, alignment, and gait rehabilitation of persons with limb loss. The purpose of this study was to assess the accuracy of prosthesis-integrated load cells for routine use in clinical practice. Level ground walking of persons with transtibial amputation was concurrently measured with a commercially available prosthesis-integrated load cell, a 10-camera motion analysis system, and piezoelectric force plates. Ankle and knee flexion/extension moments were derived and measurement methods were compared via correlation analysis. Pearson correlation coefficients ranged from 0.661 for ankle pronation/supination moments to 0.915 for ankle flexion/extension moments (P < .001). Root mean squared errors between measurement methods were in the magnitude of 10% of the measured range and were explainable. Differences in results depicted differences between systems in definition and computation of measurement variables. They may not limit clinical use of the load cell, but should be considered when data are compared directly to conventional gait analysis data. Construct validity of the load cell (ie, ability to measure joint moments in-situ) is supported by the study results.

Home safety evaluation - getting it right.

PURPOSE: Comprehensive and efficient home safety assessments are needed to provide quality interventions for community living. This study explores early career and experienced home evaluator perspectives on content and usability of HESTIA, a home safety assessment app. METHOD: Four early career and five experienced practitioners rated the HESTIA app using the uMARS usability evaluation and then participated in focus groups. Data were analysed using a key concept analytic approach. RESULTS: Results include "how to do" home safety evaluations and how prompts and training help practitioners "get it right." Early practitioner participants viewed the step-wise processes of the app as necessary whereas the experienced evaluators relied on own knowledge and experiences. CONCLUSIONS: Gobet and Chassy's TempT theory provides insight into the development of expertise in practice for rehabilitation professionals. The procedural complexities of assessment and ethical responsibility to provide competent, quality service to clients with disabilities are integrated into discussion of the development of professional intuition and ethical practice as guided by HESTIA.IMPLICATIONS FOR REHABILITATIONHome safety evaluations and home modifications are essential in helping persons with disabilities to live at home.Mobile applications such as HESTIA can serve as beneficial supports in facilitating effective decision making processes for rehabilitation practitioners conducting home safety evaluations.Technology driven assessments through mobile applications (apps) can help improve proper decision making and client outcomes, as well as aid in the development of intuition in students and early-career practitioners.Decision making support systems can help practitioners uphold their ethical responsibility to provide competent and quality rehabilitative services.

America's housing affordability crisis: Perpetuating disparities among people with disability.

America's housing affordability crisis has had various indirect costs on health and safety among people living with disability. The skyrocketing housing prices have exponentially increased with the onset of the COVID-19 pandemic leaving many people at risk for eviction after federal and local moratoriums providing protection during the pandemic expire. Americans with disabilities have been particularly affected by the affordability crisis and it is expected that this major public health problem will only grow as government-provided protections and supports wane. It is critical that both government and various housing organizations consider ways to support affordability, quality, and accessibility in this particularly hard-hit population.

Toward a national system of assistive technology outcomes measurement.

For more than two decades the assistive technology outcomes literature has featured repeated calls for clinical research to demonstrate the impact of device recommendations, as well as substantial discussion of tools for measuring AT outcomes. Unfortunately, data are still not routinely collected in most AT service delivery settings, which undermines the field. This paper describes a framework for developing a national cloud-based system of AT outcomes measurement that emerged from structured discussions with clinicians, researchers, and manufacturers. Such a system would: (a) allow collection and upload of outcomes data by geographically dispersed researchers, practitioners, and consumers; and (b) enable policymakers, third-party funders, consumers, practitioners, and researchers to retrieve outcomes data for specific disability and/or device groups.

The development of an iPad application for the pain assessment of individuals with developmental disabilities and complex communication needs.

Aims: Develop a new pain assessment for youth with communication challenges. The Guard-Putzer Pain Assessment Domains (gPAD) mobile application (app) was designed and tested as a universally accessible way for youth, ages 7-12 years, with a developmental disability (DD) to express their pain experiences through self-report. Methods: A two-phase process developed the design for an app, created an interactive prototype, and tested its face validity and user interface. This work included a comprehensive scoping review of current assessments and pain apps as well as a survey to obtain descriptive data on the clinical practicality of the gPAD to guide the app design. Additionally, 15 therapists reviewed the gPAD assessment. Results: Thirteen respondents (87%) agreed to the statement that they would use the gPAD for this population. School-based practitioners seemed to highlight the most significant needs for the app. Conclusions: Advancement of this app could mainstream the assessment of pain in youth with DD, and other potential populations.

Effect of assistive technology in a public school setting.

The Individuals With Disabilities Education Improvement Act of 2004 (IDEA) requires assistive technology (AT) be considered at the yearly individualized education program (IEP) meeting of every student in special education. IDEA also directs that AT be implemented on the basis of peer-reviewed literature despite a paucity of research on AT's effectiveness in the public schools. This repeated-measures quasi-experimental study explored AT's effect in a public school special education setting. Participants (N=13) were a heterogeneous group of students in 1 school system who had newly provided AT to address academic and communication goals in one school year. Results suggest that relative to other interventions, AT provided by a multidisciplinary team may have a significant effect on IEP goal improvement (t[12] = 5.54, p= .00) for students in special education (F[2] = 9.35, p= .00), which may support AT's use in special education by occupational therapists as directed by IDEA.

Opening the GATE: systems thinking from the global assistive technology alliance.

Purpose: This paper describes international actions to collaborate in the assistive technology (AT) arena and provides an update of programmes supporting AT globally. Methods: The World Health Organisation (WHO) identifies the severe global uneven distribution of resources, expertise and extensive unmet need for AT, as well the optimistic substantial capability for innovations and developments in appropriate and sustainable AT design, development and delivery. Systems thinking and market shaping are identified as means to address these challenges and leverage the ingenuity and expertise of AT stakeholders. Results: This paper is a 'call to action', showcasing emerging AT networks as exemplars of a distributed, but integrated mechanism for addressing AT needs globally, and describing the Global Alliance of Assistive Technology Organisations (GAATO) as a vehicle to facilitate this global networking. Conclusion: Partners in this Global Alliance aim to advance the field of assistive technology by promoting shared research, policy advocacy, educating people and organisations within and outside the field, teaching, training and knowledge transfer by pulling together broad-based membership organisations.Implications for RehabilitationCollegial, cross discipline and multi-stakeholder collaborations support assistive technology research and practice.Knowledge exchange within and across countries and regions is mutually beneficial.Self-organising assistive technology communities are emerging and supported by global movements such as WHO GATE and GAATO.

Using assistive technology outcomes research to inform policy related to the employment of individuals with disabilities.

We know that work is recognized as a central component of life for individuals with and without disabilities. It yields many physical and psychological benefits to the individual while simultaneously contributing numerous benefits to society. Lawmakers have enacted a plethora of laws designed to prevent discrimination, provide incentives for employers to hire individuals with disabilities, and facilitate job training/career preparation. Assistive technology figures prominently in disability employment law as a critical strategy for gaining access and supporting employment and upward mobility in the workplace. However, little systematic effort has been devoted to examining assistive technology use and outcomes as they relate to the employment of individuals with disabilities. The purpose of this article is to articulate a series of issues that permeate assistive technology outcome measurement in employment settings and subsequently affect the use of research knowledge for federal and state policy makers. For each issue, the authors pose three questions for critical analysis: Does the law compel the provision of assistive technology? Does outcome data play any part in the operation of the law? When it does, what kind of data would be useful to collect and where could it be found? Finally, the authors provide a brief glimpse of the current and future research efforts concerning the RSA-911 database. The recent database summaries exemplify the importance of such a national data collection system for informing federal policy, particularly concerning the contributions of assistive technology device use and services on improving the employment of individuals with disabilities.

Assistive technology products: a position paper from the first global research, innovation, and education on assistive technology (GREAT) summit.

This paper is based on work from the Global Research, Innovation, and Education on Assistive Technology (GREAT) Summit that was coordinated by WHO's Global Cooperation on Assistive Technology (GATE). The purpose of this paper is to describe the needs and opportunities embedded in the assistive product lifecycle as well as issues relating to the various stages of assistive product mobilization worldwide. The paper discusses assistive technology product terminology and the dangers of focusing on products outside the context and rolling out products without a plan. Additionally, the paper reviews concepts and issues around technology transfer, particularly in relation to meeting global needs and among countries with limited resources. Several opportunities are highlighted including technology advancement and the world nearing a state of readiness through a developing capacity of nations across the world to successfully adopt and support the assistive technology products and applications. The paper is optimistic about the future of assistive technology products reaching the people that can use it the most and the excitement across large and small nations in increasing their own capacities for implementing assistive technology. This is expressed as hope in future students as they innovate and in modern engineering that will enable assistive technology to pervade all corners of current and potential marketplaces. Importantly, the paper poses numerous topics where discussions are just superficially opened. The hope is that a set of sequels will follow to continue this critical dialog. Implications for Rehabilitation Successful assistive technology product interventions are complex and include much more than the simple selection of the right product. Assistive technology product use is highly context sensitive in terms of an individual user's environment. The development of assistive technology products is tricky as it must be contextually sensitive to the development environment and market as well. As a field we have much to study and develop around assistive technology product interventions from a global perspective.

Consequential validity of an assistive technology supplement for the School Function Assessment.

Educators and therapists implement assistive technology to maximize educational outcomes of students with disabilities. However, few measure the outcomes of interventions because of a lack of valid measurement tools. This study investigated whether an assistive technology supplement for the School Function Assessment demonstrates an important aspect of construct validity. Specifically, the study examined a type of consequential validity. Twenty-eight school-based therapists participated in the study. Two t tests compared a group using the School Function Assessment (n = 13) to a group using the assistive technology supplement to the School Function Assessment (n = 15). The first t test examined the difference in confidence therapists perceived in their ability to develop assistive technology interpretations. The second t test compared the number of assistive technology interpretations matching those of an expert panel. The first t test did not achieve significance (p = .998). The second t test achieved significance (p = .001). These results suggest, with certain limitations, that the assistive technology supplement for the School Function Assessment exhibits this important aspect of construct validity.

Survey of state vocational rehabilitation counselor roles and competencies in assistive technology.

The delivery of assistive technology (AT) within the state and federal vocational rehabilitation systems in the United States has been developing and refining itself over the last twenty years. Many challenges have been confronted in an attempt to use this relatively new service to increase the employment options and success for individuals with disabilities. In this process, the rehabilitation counselor serves as a critical player in the planning and delivery of AT as it articulates with other rehabilitation services. This study investigated counselor views regarding their role and competence in providing AT services and devices to individuals with disabilities throughout the state of Wisconsin. The results of the survey indicated, in general, that counselors find AT to be a cost-effective service that can increase employment related outcomes. As with other service areas, the counselors' role in AT service delivery involves coordinating, purchasing and following up on services. Interestingly, while counselors expressed confidence in performing these overall functions, they reported a lack of confidence in identifying the need for AT services. Without a comfort level to make this determination, benefits from the implementation of AT may be quite limited. Results suggest that intervention is needed to improve counselors' abilities to make decisions regarding AT services.

Effects of physical exertion on trans-tibial prosthesis users' ability to accommodate alignment perturbations.

BACKGROUND: It has long been reported that a range of prosthesis alignments is acceptable in trans-tibial prosthetics. This range was shown to be smaller when walking on uneven surfaces. It has also been argued that findings on gait with prostheses that were obtained under laboratory conditions are limited in their applicability to real-life environments. OBJECTIVES: This study investigated the hypothesis that efforts to compensate for suboptimal alignments by active users of trans-tibial prostheses become less effective when levels of physical exertion increase. STUDY DESIGN: A 2 × 2 repeated-measures analysis of variance was conducted to compare the effects of physical exertion and subtle alignment perturbations on gait with trans-tibial prostheses. METHODS: The gait of eight subjects with trans-tibial amputation was analyzed when walking with two different prosthesis alignments and two different physical exertion levels. The main and interaction effects were statistically evaluated. RESULTS: Bilateral step length symmetry and measures of step variability within the same leg were found to be affected by the intervention. There was no significant effect on index variables that combined kinematic or kinetic measures. CONCLUSION: Findings showed that persons with trans-tibial prostheses responded heterogeneously to the interventions. For most variables, the research hypothesis could not be confirmed. CLINICAL RELEVANCE: Findings support the practice of allotting several sessions to the alignment of trans-tibial prostheses, as users' gait responds differently to perturbations when external factors (e.g. exertion) change. Furthermore, the found inhomogeneity in the population of persons with trans-tibial amputation supports the use of technical gait assessment methods in clinical practice.

Assistive technology outcomes in work settings.

Successfully documenting the outcomes of assistive technology (AT) interventions in the workplace benefits people with disabilities, service providers and agencies. However, no work related system currently exists that comprehensively collects the data needed to analyze such outcomes. Part of the reason for this absence of an outcome system is that, while the concept is simple, the process is complex and depends on the acquisition of data that represent many outcomes related variables. This article describes the exploratory work of the NIDRR (National Institute on Disability and Rehabilitation Research) funded ATOMS Project (Assistive Technology Outcomes Measurement System) and its efforts to identify existing data that might be used as the basis for an outcomes measurement system. Sample records from four assistive technology service programs were acquired and evaluated for the data they housed. This study discovered that AT service programs fail to collect consistent or sufficient data for outcomes analysis. However, discussions with AT programs that provided services to State vocational rehabilitation agencies revealed an interesting potential. Assistive technology service data in combination with data collected by State vocational rehabilitation departments might coalesce the needed data. The Federal Rehabilitation Services Administration (RSA) 911 Report aggregates many variables of outcomes related information including employment status and the success of the vocational rehabilitation investment. This combined database could answer a range of assistive technology outcomes related questions of interest to service providers, people with disabilities, and vocational rehabilitation State agencies. This paper describes the data needed in an outcomes system, reviews the data that appear to be available today related to AT outcomes, and projects how data from two diverse programs might be used together to create a significant outcomes database.