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 people with disability, advanced-age individuals, and people with health conditions allows them to maintain and improve function, health, and well-being. It facilitates active participation in school, work, and during social activities.To reduce barriers to accessing assistive technology, healthcare providers should have knowledge of product availability and their safe and effective use in daily life. This article discusses what assistive technology means for functional independence and what type of AT may be beneficial to use in 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." --WHO

Traditional occupational therapy perspectives on self-care include:

• An individual's ability to complete activities of daily living (ADL) or personal activities such as eating, grooming, and bathing.
• Functional mobility includes moving safely in various environments.
• Community management involves grocery shopping, driving, taking public transportation, and managing finances.

Self-Care Activities in the ICF

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

ICF clinical practice tools can help to identify problems from the clinician and patient perspective and provide the basis for planning an intervention. An example of such a tool is The Rehabilitation Problem-Solving Form (RPS-Form). 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 the patient's participation in the decision-making process of rehabilitation.

You can learn more about ICF application in clinical practice from this article.

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

Examples of self-care assistive technologies include the following:

• 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, the literature has found high rates of non-use of assistive products. Up to 82% of prescribed equipment is used by older adults, which decreases over time. Assistive technology products are abandoned or non-used because generic products may not be adaptable to individual needs and fail to meet individuals' changing conditions.

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, 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 AT 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 entirely 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 in the environments.

To help promote the use of this equipment, healthcare professionals should:

• Complete a systematic assessment of technology needs.
• Offer individualised advice about the services of provision of assistive products.
• Train 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 general guidelines for the provision of assistive technology follow 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 ICF to establish functional deficits helps to address environmental and personal factors influencing the functioning
3. Deciding about a plan of care
   • Formulating treatment goals with 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 product, trying out and deciding
   • Selecting, ordering, adapting, adjusting, or producing assistive technology product
5. Delivering the assistive product
   • Delivering and instructing about the use and the 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 and the results and the process of care, including client satisfaction with the assistive product

The outcome measure for assistive technology has not been well established, but the literature suggests 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

The most common assistive technologies that facilitate dressing and undressing, assisting in manipulating clothing and fasteners, include the following: dressing stick, sock aid, button hook, zipper pull, shoehorn, and shoe fasteners:

• Dressing stick: reduces the need for excessive stretching or bending, promotes comfort, minimises strain, and assists with dressing when shoulder mobility is limited.
• Sock aid: assists when mobility or flexibility is impaired. It benefits individuals with back problems or those recovering from hip or knee surgeries.
• Button hook: helps in conditions that affect fine motor dexterity and assists individuals with difficulty handling small items between their fingertips.
• Zipper pull: recommended for people with decreased fine motor strength and sensation in the hands.

Read this Physiopedia article for more information on dressing aids.

Feeding and Assistive Technology

AT for feeding includes specialised cups, bowls, plates, and various utensils to accommodate the need for successful eating:

• Scooper plate and bowl: assist people with limited muscle control and help individuals who can use only one hand.
• Flexi nosey cup: designed for individuals with difficulty tilting their head back or limited neck movement.
• Recessed lid cup: assists individuals with limited hand movement and problems controlling the liquid flow. It improves lip closure and tongue retraction and mimics drinking from an open cup 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 persons 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:assists with holding a spoon or a fork for patients with limited or absence of fingers flexion. It can also help with holding a pencil or a hair brush.
• Weighted utensils: assists with unsteady or uncoordinated arm. They enhance proprioception input, reduce tremors, and bolster control during mealtimes.

Learn more about eating and drinking assistive products from this Physiopedia article.

Personal Hygiene and Assistive Technology

Bathing

The primary consideration for bathing should be safe positioning in the tub or the shower. Other considerations depend on the diagnosis and include range of motion, strength, motor skills, and balance:

• Non-slip mats: prevent slipping
• Grip rails: provide support and stability, help 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 transfer in and out of the bathtub or shower, allowing for safe bathing when poor balance or lower body weakness is present.
• Paediatric shower chair: offers stability, reduces slips and falls during bath time, and reduces physical strain on the caregiver's back and arms.

Read more about different types of shower chairs here.

Toileting

Many individuals, children and adults, may benefit from toileting devices to gain independence with toileting. These devices include a toilet frame, toilet surround, toilet seat raiser, and static commodes, which help with standing, getting up, squatting and fall risk reduction.

• Toilet frame: assists a person safely and comfortably transitioning on and off the toilet.
• Toilet surround: helps lower and raise from the toilet when the upper body needs 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

• Long-handled brushes and combs: beneficial for people with a reduced range of motion or painful upper limb joints, especially with overhead movement.
• Long-handled sponge: reduces the need to bend at the hips, knees, or upper limbs.
• 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
• Assistive Technology: Self Care and Environment Products
•  Global report on assistive technology