Steps to Assistive Technology Provision

Original Editor - Robin Tacchetti Top Contributors - Robin Tacchetti, Wanda van Niekerk, Jess Bell and Rishika Babburu

Introduction

Assistive technology (AT) is a broad term used to describe products whose primary aim is to improve or maintain an individual's independence and function. Assistive technology can support persons in all aspects of their lives - education, work, health, physical activity, recreation, mental health leisure and sport, activities of daily living. AT can be used for many types of impairments (e.g. vision, hearing, mobility, self-care) and by people of all ages. AT solutions can range from very simple, low-tech devices to highly complex, expensive products. The range of products makes AT provision a complex process. This process is further complicated by the fact that AT provision is not a one-size fits all; it must be tailored to the individual.

Provision

Assistive technology provision is a process aimed at ensuring that each user obtains the most appropriate and beneficial AT solution for their impairment. The fundamental elements of AT provision are listed below:

• Users need to know that AT solutions exist
• Quality products must be available and affordable
• Professionals are required to provide the following services:
  • Assessment
  • Training
  • Follow-up

There are different role players involved in assistive technology provision and these can include:

• the person needing an assistive technology product
• the family of the person needing and assistive technology product
• persons trained to provide the appropriate assistive technology products
• persons who can identify a person that may benefit from assistive technology and refers them to the appropriate service
• leaders and policy makers who can help with the availability of assistive technology and allow for accessibility for persons who use assistive technology

There are issues with the provision of assistive technology in high-, middle- and low income countries. In high-income countries the assistive technology services are often not integrated which leads to persons having to attend multiple appointments at different locations. There are cost implications to this for users. In middle- and low-income countries national services for assistive products may be non-existing. Only those who can afford to will buy the products they need directly from a pharmacy or private clinic. Often times people are dependent on donations of assistive technology products from non-profit organisations or charity services. The issue with this is that often the product is not suitable or appropriate for a specific person or their specific context. There are also no ways to ensure follow-up and repairs if necessary.

Four Steps To Provision

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 AT provision are: select, fit, use and follow-up.

This video by the WHO summarises the four steps to assistive technology provision:

Select

The select phase of service provision is essentially the assessment. During the assessment, it is important to involve the user and their family or caregivers. This will ensure that the choice of AT is appropriate and tailored directly to the individual and their requirements. The WHO has a range of assessment forms for various assistive products that help determine the best device for the individual. Information that can be gathered during the select phase includes the user's:

• Health
• Ability
• Activity level
• Where they will use the device
• Support services nearby
• Their knowledge of/experience with the device

Having a wide variety of assistive products will make it easier to match a device to the individual's specific needs.

"Critically important is to involve the person and their caregivers to make sure that they understand what they're going to be using and what their needs are."

Fit

After the assistive product has been selected, the next stage in the provision sequence is to ensure a proper fit. This is a crucial step as the device needs to fit well in order to be safe and not cause harm. Additionally, if the fit is not adequate, the user will not gain the intended benefit. The WHO recommends checking the following when fitting an AT device for a user:

1. Is it properly assembled?
2. Is it adjusted to the right size?
3. It is comfortable and safe for the person to use?

When fitting individuals with a selected assisted device, always ask for feedback from the user. The device may need to be modified or adjusted at this time.

Use

The use stage can also be referred to as the teaching stage. It is when the user and/or their caregiver learns how to use the assistive device and how to look after it. The WHO recommends that the following steps are included in this stage:

1. Explain
2. Demonstrate
3. Practise

Follow-Up

The follow-up step is crucial to ensuring that an AT product is still meeting the user's needs. If it is not meeting their needs, a reassessment or an outside referral may be warranted. Coming up with a solution with the user is the best course of action in this scenario.

Follow-up is also a time to check that the product is in good condition and does not require any repairs. Many times this step is left out and users will not have access to repair services, especially in low-income settings.

The WHO recommends checking for the following:

• Has the individual grown? Does the product no longer work for them because of this?
• Has the individual's posture changed? Does the product no longer work for them because of this?
• Are their any screws or bolts that are loose?
• Is their any rust or are there broken pieces?

"Assistive technology services have a great focus on assessment and prescription, without a robust system for evaluating the follow-up process, which is very critical."

This video by the World Health Organization demonstrates how to look for broken components in an assistive device:

After this visit is completed, make an appointment for the next follow-up visit.

Considerations in Assistive Technology Provision

Time needed to provide assistive products - some products can be provided quickly while others will take a long time. Factors that influence this are:

• the complexity of the specific assistive product
• a person's health condition and needs
• the environment where the product will be used in
• experience of the person using the product

Barriers for People with Assistive Products

People may still be confronted with certain barriers, even though they have the appropriate assistive product. Some barriers that are present include:

• inaccessible environment
• stigma
• discrimination
• lack of accessible information
• lack of supportive services
• lack of supportive policies

"Everybody has a role to play to ensure people who use assistive products are included, and can do the things they want to do on an equal basis as others."

Putting it all Together

The video below by Momentum Wheels for Humanity demonstrates the WHO 8 steps to wheelchair provision.

The steps are:

1. Referral and Appointment
2. Assessment
3. Prescription
4. Funding and Ordering
5. Product Preparation
6. Fitting
7. User Training
8. Maintenance, Repairs and Follow-Up

If you'd like to read more about each step in detail you can have a look at Eight Steps to Appropriate Wheelchair Provision.

Resources

• World Health Organization Assistive Technology - Training in Assistive Products (TAP) Modules
• CLASP: Service Provision
• Access to Assistive Technology
• What is Assistive Technology