Assessment Tools for Your AT Toolbox

Presented by the OT PSG at RESNA 2013

You say Evaluation, I say Assessment Who’s right?

It depends!

What do you say?

According to http://www.thefreedictionary.com

/ e•val•u•a•tion ( ɪˌ væl yu ˈ e ɪ ʃə n) n.1. an act or instance of evaluating or appraising.

2. a diagnosis or diagnostic study of a physical or mental condition.

the making of a judgment about the amount, number, or value of something

According to http://www.thefreedictionary.com

/

as · sess ·

ment (-ssmnt)n.1. The act of assessing; appraisal.

2. An amount assessed, as for taxation.

the evaluation or estimation of the nature, quality, or ability of someone or something:

Toe-may-toe or Toe-mah-toe

Functionally, assessment is the measurement of what is there.

Evaluation includes making judgments about what is there, and what is needed

Assessment ?

Let’s call these the tools we put in our toolbox – assessment tools and evaluation the determination of which AT best meets the needs of this particular client

According to the

Technology Act of 2004, P.L. 108 364 Assistive

Evaluation is part of AT service “the evaluation of the assistive technology needs of an individual with a disability, including a functional evaluation of the impact of the provision of appropriate assistive technology and appropriate services to the individual in the customary environment of the individual.”

RESNA Fundamentals Course states Assistive Technology Provision: Assessment – Develop an understanding of the general assessment process and principles.

Regardless of what we call it, using a systematic approach is critical Why?

The story of Lenny

Using a conceptual practice model to guide your evaluation Back to definitions How do we define AT ASSISTIVE TECHNOLOGY DEVICE.—The term ‘assistive technology device’ means any item, piece of equipment, or product system, whether acquired commercially, modified, or customized, that is used to

increase, maintain, or improve functional capabilities of individuals with disabilities.

Enabling a person with a disability to do something, somewhere Specifically, the person is able to do things with the technology that able-bodied people can do without it Conceptual models help us to operationalize these elements of the definition.

Conceptual Practice Models

International Classification of Function (ICF) – World Health Organization Matching Persons with Technology (MPT) – Dr. Marcia Scherer Student Environment Tasks and Tools (SETT)– Dr Joy Zabala Human Activity Assistive Technology (HAAT)– Cook & Hussey Human Interface Assessment (HIA)– Anson

International Classification of Function (ICF)

Matching Persons with Technology (MPT) The characteristics, needs and preferences of each individual user The characteristics of the milieu, i.e. the physical and attitudinal environment in which the AT device will be used The characteristics of the AT devices

The SETT Framework

Environment Task Tools Student

www.JoyZabala.com

The HAAT Model

Evaluation includes: The Human The Activity The Assistive Technology being considered These are all embedded in the environment where the activity is performed

Human Interface Assessment

Human Interface Assessment

The activity and environment make demands on the individual The individual brings a level of skills and abilities to the task

Human Interface Assessment

Human Interface Assessment

When the demands of the task are less than the intrinsic skills and abilities of the individual, no assistive technology is required This does not mean that the individual does not have functional limitations, only that, for this task, in this environment, no restrictions exist In another environment, or another task in this environment, AT might be required

Human Interface Assessment

Human Interface Assessment

When there is an imbalance between the skills and abilities of the human and the demands of the environment, AT can be used to bridge the gap, enabling function

Human Interface Assessment

These conceptual models tell us what to consider Environment Task Tools Person

The Assessment Tools in our Toolbox What to include is the question How do you do it?

A Parable of Tools

A Parable of Tools

There are a wide range of wrench manufacturers, of a wide range of prices Craftsman (Sears) S&K KD Tools Kobalt Most include life-time warrantees, and easy replacement

A Parable of Tools

Drive by almost any mechanics shop, though, and one image is seen:

A Parable of Tools

Why is this one brand so common?

Snap-on wenches are a bit thinner than other brands, while as strong They will reach into tight spaces just a bit better Because the tools fit the usage better, they make the job of the mechanic just a bit easier

A Parable of Tools

For our AT Toolbox, we want assessment tools that most closely meet the needs of the assessor, that reach into tighter spaces, and give us more complete information

What To Assess and How:

Best Practice Guidelines

Quality Indicators for Assessment of Assistive Technology Needs

Assistive technology devices and services are considered for all students with disabilities regardless of type or severity of disability. During the development of an individualized educational program, every IEP team consistently uses a collaborative decision-making process that supports systematic consideration of each student’s possible need for assistive technology devices and services. IEP team members have the collective knowledge and skills needed to make informed assistive technology decisions and seek assistance when needed.

Best Practice Guidelines

Decisions regarding the need for assistive technology devices and services are based on the student’s IEP goals and objectives, access to curricular and extracurricular activities, and progress in the general education curriculum. The IEP team gathers and analyzes data about the student, customary environments, educational goals, and tasks when considering a student’s need for assistive technology devices and services. When assistive technology is needed, the IEP team explores a range of assistive technology devices, services, and other supports that address identified needs. The assistive technology consideration process and results are documented in the IEP and include a rationale for the decision and supporting evidence.

Assessment Tools

There are

NO

valid!

assessment tools that are reliable and There are tools that are reliable and valid for specific applications. It is important that tools be used as they are designed to be.

It is important that tools be used where they are designed to be.

Client Centered

Critical to include the client/consumer in the decision making process.

Every Client is unique Decreases abandonment

What to Assess

Virtually all of the models agree that the assessment must include: The task The person The environment The AT being recommended

The Task

This is nothing more than an activity analysis, which OTs have been doing since the birth of our profession What physical skills are required for the task?

Strength, ROM, dexterity, postures, endurance What sensory skills are required for the task?

Sight, sound, touch, smell, taste, temperature What cognitive skills are required for the task?

Concentration, vigilance, reaction time, sensory integration

The Person

Most of the information required is included in a traditional evaluation Strength, ROM, endurance, bilateral tasks, etc.

Vision, sound, proprioception, kinesthesia, touch are standard Smell, taste, color spectrum might require specialized testing Cognition, executive function, memory, computation, etc.

The Environment

On a basic level, is the environment ADA compliant?

Keep in mind that this is minimal accessibility, and can be used to identify environmental barriers, but is not enough for school or work access Environmental conditions include: Lighting levels and colors Sound levels of important and background sounds Frequencies of sounds that are important to the job Temperature and temperature range Humidity Smells and chemical exposures

The Assistive Technology

First, compare the skills and abilities of the individual with the demands of the task and restrictions of the environment Does the AT operate within the constraints of the environment?

Does the AT amplify or support the functions needed for the task?

Can the AT be perceived and controlled by the individual?

Is the AT acceptable to the individual?

Infusing Conceptual Models into Practice Same tools New Look Exploring Roles Maximizing goals

Rehabilitative and Educational Technologies “Depending on the client’s contexts, rehabilitation and educational technologies have the role of remediation, restoration, or acquisition of foundational skills.” - Cook & Polgar, 2008

Occupational Technology

“Studying the development and maintenance of wellness and social health in persons with disabilities in a technologically changing society” - Breines & Pellerito, 2003

Emergent motivation

“experience a new or previously unengaging activity as intrinsically motivating if we once find flow in it. The motivation to persist in or return to the activity arises out of the experience itself. The flow experience is thus a force for expansion in relation to the individual’s goal and interest structure, as well as for growth of skills in relation to an existing interest” - Nakamura & Csikszentmihaly, 2002

The virtual context allows clients to discover alternate ways of achieving goals.

EXPLORING ROLES / MAXIMIZING GOALS P R E P A R A T I O N Patient interests/Roles/Meaningful Activity Exploring Software/Apps for desired Virtual Context (Task Anaylsis) Isolating Software/Apps that contain features/settings to facilitate client goals (Task Anaylsis) Occupational Goal Performance demands of occupation (Task Anaylsis) Isolation of desired Movement/Vision Process/Cognitive Strategy

F A I C L T I A T O N EXPLORING ROLES / MAXIMIZING GOALS Positioning of client to facilitate motor/vision/cognitive strategies Monitor client participation for maximal engagement Selection and positioning of equipment to isolate motor movement or facilitate participation in vision/cognitive activity Monitor client participation for desired motor/vision/cognitive strategies Introduction of software to enhance client participation

Flemings Tracks of Clinical Thinking The

procedural reasoning

strategy was used when the therapist thought about the person's physical ailments and what procedures were appropriate to alleviate them.

Interactive reasoning

was used to help the therapist interact with and understand the person better.

Conditional reasoning

, a complex form of social reasoning, was used to help the patient in the difficult process of reconstructing a life now permanently changed by injury or disease.

Questions to ask

Standardized vs. Non standardized tools How can we assess the impact of the provision of appropriate assistive technology ?

Formal vs. Informal procedures

How do you do it?

Group discussion

Resources for assessment tools

ID-AT-Assessments (Informational Database of Assistive Technology Assessments) AbleData.com

WHODAS 2.0

Rehabilitation Measures Database The Boston Rehabilitation Outcomes Center ADA CAT

Resources for assessment tools

Frameworks, models and taxonomies http://www.r2d2.uwm.edu/atoms/archive/technicalrep orts/fieldscans/fs7/tr-fs-taxonomiesmodels resource.html

AT Assessments http://www.r2d2.uwm.edu/atoms/idata/