Self Care Assistive Technology

Original Editor -Ewa Jaraczewska based on the course by Ana Gugrenidze

Top Contributors - Ewa Jaraczewska, Jess Bell and Kim Jackson  

Introduction

Timely access to assistive technology (AT) for individuals with disabilities, older individuals or persons with health conditions allows them to maintain and improve their function, health, and well-being. It facilitates active participation in school, work, and social activities. To reduce barriers to accessing assistive technology, healthcare providers should have knowledge of the types of products and devices available and their safe and effective use in daily life. This article explores the impact of assistive technology on functional independence and looks at types of assistive technology commonly used for self-care.

Self Care

Self-care is "the ability of individuals, families and communities to promote, maintain health, prevent disease and to cope with illness." -- World Health Organization (WHO)

In occupational therapy, self-care traditionally refers to an individual's:

• ability to complete activities of daily living (ADL) or personal activities such as eating, grooming, and bathing
• functional mobility, including moving safely in various environments
• community management, which includes grocery shopping, driving, taking public transportation, and managing finances.

Self-Care Activities in the ICF

The International Classification of Functioning, Disability and Health (ICF) provides a standard language to define and measure self-care activities. Terms include washing oneself, caring for body parts, toileting, dressing, eating, drinking and looking after one's health.

ICF clinical practice tools can be used to help identify difficulties with self-care and can provide the basis for planning an intervention. The Rehabilitation Problem-Solving Form (RPS-Form) is an example of one of these tools. It facilitates the assessment of a patient by various health professionals and allows them to address all components of self-care activities, including environmental and personal factors. The RPS-Form enhances a patient's participation in the decision-making process of rehabilitation.

If you would like to learn more about the application of the ICF in clinical practice, please see here.

Assistive Technology (AT)

"Assistive technology is an umbrella term for assistive products and their related systems and services." -- WHO

"Assistive technology is any item, piece of equipment, or product system that is used to increase, maintain, or improve functional capability in performing everyday tasks and activities." -- Ana Gugrenidze

Self-care assistive technologies include:

• bathing, grooming and toileting aids
• dressing aids
• meal preparation and feeding aids

Assistive Technology and Functional Independence

Assistive technology can improve the daily functioning of an individual. However, research shows high rates of non-use of assistive products. This may be because many assistive technology products are generic and are not sufficiently adapted to meet a patient's specific requirements and changing needs.

The following factors can influence the "rates of use" of prescribed assistive technologies:

• equipment suitability (good fit)
• adequate training
• pre-prescription home visits
• personal factors such as age, biological sex and various health conditions
• personal resources

Barriers to access to assistive technology include:

• lack of awareness that a specific technology exists: access to information operates on a top-down model, starting with the Government ministry level, service providers and service users, with a lack of awareness among assistive technology service users
• lack of governance, including legislation, policies, and national programmes
• limited and distant services
• limited quantity, quality, and affordability of assistive technology products available in most countries
• expensive, inconsistent, or unavailable trained personnel to assess, prescribe, and provide rehabilitation services, equipment maintenance, repairs, and local adaptations or manufacturing of the technology
• the presence of physical, cultural or technological barriers

To help promote the use of assistive technology, healthcare professionals should:

• complete a systematic assessment of technology needs
• offer individualised advice about provision services for assistive products
• receive training on the appropriate use of the devices
• be aware of grants and leasing systems to facilitate access to assistive products
• perform periodic assessments of the assistive product needs indicated by changes in the person's functional abilities

Assistive Technology Assessment Tools

The World Health Organization (WHO) has described four steps that are necessary when providing assistive technology. Proceeding through each step allows the user to gain the most benefit from the product and ensure safety. The four steps to assistive technology provision in this model are: select, fit, use and follow-up. If you would like to learn more about these four steps, please see here.

Heerkens et al. also formulated guidelines for the provision of assistive technology, which incorporates the ICF. It has seven steps:

1. Identifying a problem
   • an individual realises that there is a problem and identifies it
   • clarifies the problem with healthcare professional(s)
2. Formulating health care needs
   • functional and medical diagnosis and prognosis are established
   • using the ICF to establish functional deficits helps to address environmental and personal factors influencing the functioning
3. Deciding on a plan of care
   • formulating treatment goals with the patient/client
   • important step: "describing the demands according to the client and the care professional for the assistive product(s) to become (part of) the solution."
4. Selecting, trying out and deciding on a product
   • selecting, ordering, adapting, adjusting, or producing assistive technology product
5. Delivering the assistive product
   • delivering and providing education about the use and maintenance of the assistive product
6. Using the assistive product
   • patient / client uses the assistive technology in daily activities
7. Assessing the outcome
   • evaluating the outcome, the results and the process of care, including client satisfaction with the assistive product

Outcome measures for assistive technology have not been well established, but the literature suggests considering the following domains:

• device usage
• device effectiveness
• device efficiency
• user satisfaction
• quality of life impact
• social role performance impact

The following assessment tools can be useful in measuring the above outcomes:

• Canadian Occupational Performance Measure
• The Individually Prioritised Problem Assessment (IPPA)
• The Matching Person Technology (MPT)
• Quebec User Evaluation of Satisfaction with Assistive Technology
• Psychosocial Impact of Assistive Technology Scale

Dressing and Assistive Technology

There are a number of assistive technology devices that can help people dress and undress, including tools that can help with fasteners, buttons and zips:

• dressing stick: reduces the need for excessive stretching or bending, promotes comfort, minimises strain, and assists with dressing, particularly when shoulder mobility is limited
• sock aid: assists when mobility or flexibility is impaired, including for individuals with back pain or those recovering from hip or knee surgeries
• button hook: useful for individuals with conditions that affect fine motor dexterity and for people who have difficulty handling small items between their fingertips
• zipper pull: recommended for people with decreased fine motor strength and sensation in their hands
• shoehorn: helps individuals with reduced mobility / flexibility slip on their shoes without strain
• shoe fastener: elastic shoelaces eliminate the need for intricate knots

Please read this Physiopedia article if you would like to learn more about dressing aids.

Feeding and Assistive Technology

Assistive technology devices for feeding include specialised cups, bowls, plates, and various utensils to facilitate independent eating:

• scooper plate and bowl: assist people with limited muscle control and help individuals who can only use one hand
• flexi cup (nosey cup): designed for individuals who have difficulty tilting their head back or limited neck movement
• recessed lid cup: assists individuals with limited hand movement or who have problems controlling liquid flow - these cups improve lip closure and tongue retraction and enable individuals to mimic drinking from an open cup, but without spillage
• shallow spoon (maroon spoon): assists individuals with poor lip closure, oral hypersensitivity, or tongue thrust
• offset spoon: designed for easier self-feeding for individuals with limited wrist and hand mobility
• rocker knife: beneficial for individuals experiencing challenges with traditional knives due to weakness or poor hand control
• large handles: helps individuals with limited grip strength
• universal cuff: helps individuals with limited or absent finger flexion to hold a spoon or a fork; these cuffs can also be used to hold a pencil or a hairbrush
• weighted utensils: assist individuals with reduced coordination or unsteadiness in their arm; they enhance proprioceptive input, reduce tremors, and bolster control during mealtimes

If you would like to learn more about assistive products for eating and drinking, please see Eating and Drinking Assistive Products.

Personal Hygiene and Assistive Technology

Bathing

The primary consideration for bathing should be ensuring safe positioning in the bathtub or shower. Other considerations depend on an individual's diagnosis and functional status, including their range of motion, strength, motor skills, and balance:

• non-slip mats: prevent slipping
• grip rails: provide support and stability, help individuals navigate the bathroom, and assist with transitional movements, including getting up, sitting and transferring
• bath seat, transfer bath bench, shower chair and bath board: designed to help individuals transfer in and out of the bathtub or shower, allowing for safe bathing when an individual has decreased balance or lower body weakness
• paediatric shower chair: offers stability, reduces slips and falls during bath time, and reduces physical strain on a caregiver's back and arms

If you want to read more about different types of shower chairs, please see Shower and Toilet Chairs.

Toileting

Many individuals, from children to adults, may benefit from toileting devices to gain independence with toileting. Devices include toilet frames, toilet surrounds, toilet seat raisers, and static commodes, which help people get up, stand, and squat. They also help reduce the risk of falls:

• toilet frame: helps a person safely and comfortably transition on and off the toilet
• toilet surround: helps individuals rise from and lower themselves to the toilet; they are helpful for people who need their upper body to provide stability
• toilet seat raiser: provides additional seat height when hip flexion is limited or protected
• static commode: provides comfort and safety for overnight use and facilitates continence

Grooming

The following assistive technology grooming devices can be useful:

• long-handled brushes and combs: beneficial for people with reduced range of motion or painful upper limb joints, especially during overhead movements
• long-handled sponge: reduces the need for users to bend at the hips, knees, or upper limbs during bathing
• electric razor or shaver: helps individuals with limited hand control or mobility
• nail care device: assists a person with hand weakness and impaired dexterity
• grooming aids for oral care: beneficial for individuals with hand and wrist weakness

Resources

• The OT Toolbox: Adaptive Equipment for Eating
• Technological Aids for Self-Care and Environmental Adaptations
•  Global report on assistive technology