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The term “assistive devices, technologies and related services” encompasses an expansive range of items and related services that assist people with disabilities and chronic conditions of all ages in virtually all aspects of their lives. These devices range from low technology aids such as handheld magnifiers and Velcro to high technology speech synthesizers and hearing aids. Assistive technology includes mobility devices, augmentative communication devices, certain computer
applications, and thousands of other items. Assistive devices can be medical in nature, e.g., a prosthetic limb, or completely non-medical but important to the individual’s functionality, e.g., a modified work station.
The following examples illustrate the importance of assistive devices,
technologies and related services to the millions of Americans of all ages
with disabilities and chronic conditions.
Assisting People with Mobility Impairments
Individuals with mobility impairments rely on a wide range of assistive
devices to be as healthy, independent and functional as possible. While
canes, walkers, crutches, and manual wheelchairs are appropriate for many
individuals, higher technology devices such as power wheelchairs and power
operated vehicles (“POVs” or “scooters”) are needed by some to be fully
functional. Many wheelchair users require special seating systems or other
accessories such as tilt and recline capability. Each of these devices
offers their user the ability to maximize freedom and independence. For
instance, ultralight weight manual wheelchairs, which are designed to permit
the user to propel herself over a period of years while reducing the likelihood
of developing injuries due to prolonged manual wheelchair use, enable users
to participate more fully in community activities, including employment
and education.
Example:
- Power wheelchairs. Power wheelchairs utilize a battery to propel the user and are operated through a joystick device or some other mechanism. They can prevent pain and injury in the upper limbs caused by long term manual wheelchair use and can be extremely liberating for people with severe mobility limitations. Advances in wheelchair design include power-assisted manual wheelchairs, specialty wheelchairs for specific activities, and even power mobility devices that climb curbs and stairs.
Assisting People with Hearing Impairments
Without assistive technology, millions of people with hearing loss would be unable to discern speech and environmental sounds, or to converse by telephone. Appropriately fitted hearing aids, which tailor amplification to the needs of the individual, are the first key step to improved hearing. Assistive listening devices extend the capabilities of hearing aids in background noise, poor acoustical environments and where speech is weakened by distance. Visual, tactile, and adjustable audible devices alert individuals to everyday sounds and emergencies such as smoke alarms, phone rings, babies’ cries, and doorbells. Captioning and CART (Computer Assisted Realtime Transcription) provide visual representation of spoken words and sounds. Deaf-blind individuals may require equipment with refreshable Braille displays for telephone communication, computer use, and communication access at meetings. When hearing aids are no longer effective, cochlear implants are another option for children and adults.
Example:
- Hearing Aids. Hearing aids, essential for millions of people of all ages
to participate fully in mainstream society, differ in design, type of circuitry,
size, and amount of amplification. However, all have the same basic components:
a microphone, amplifier circuitry, a speaker, a specially fitted ear mold,
and batteries for power. Hearing aids are customized for the person’s hearing
loss, and many programmable hearing aids provide multiple programs that
allow the user to attain optimal functioning in different situations. In
addition, many but not all hearing aids are designed to be compatible with
assistive listening devices to facilitate maximum speech discrimination
in a variety of situations.
Assisting People with Visual Impairments
People who are blind or who have significant vision impairment benefit
from technologies designed to assist them in accessing print or visually
displayed information. Access to this kind of information can be provided
by a wide range of devices, from screen readers which can convert information
on a computer screen to speech, to video magnifiers (commonly called closed
circuit televisions or “CCTV”) used to magnify print pages. Other devices
include portable handheld magnifiers and white canes which are used to
travel independently and safely. Also, access to information from at-home
medical tests or prescription medication labels is crucial for actively
controlling health. For instance, voice-output blood glucose meters allows
people with diabetes, a condition which can lead to severe vision loss,
to perform the functions necessary to conduct the test, read the results
and treat themselves.
Example:
- Video Magnifiers/CCTV. Video magnifiers, also know as “CCTV,” magnify print
pages and can be used in the home, school, work, and the community where
access to printed or visually displayed information is critical to independent
functioning. For instance, utilizing CCTV, individuals with vision impairments
are able to self-monitor their chronic conditions, read their prescriptions,
pay their bills, and perform other fundamental tasks of independent living.
The most popular version of CCTV is a desktop system with a movable table
for reading and either a video monitor or a television screen. These devices
are particularly useful for older individuals because they generally feature
simple controls.
Assisting People with Cognitive and Neurological Impairments
Assistive technologies can promote greater independence and function for
individuals with a variety of cognitive and neurological impairments, including
people with brain injury, learning disabilities, speech and language impairments,
mental retardation, chronic conditions such as Alzheimer’s, and stroke
survivors. “Low-tech” devices such as highlighters, templates for writing
checks, talking clocks, and tape recorders can dramatically help a person
with a cognitive disability process and remember information. Personal
digital assistants (PDAs), reading comprehension programs, smart phones,
speech synthesizers (often referred to as text-to-speech (TTS) systems),
and speech recognition systems are among the higher technology devices
that can assist individuals with cognitive and neurological disabilities
in their community, educational and work opportunities and interactions.
These devices are also often essential for individuals with cognitive disabilities
to live independently, by helping them to remember such information as
when to take medications or attend doctor appointments.
Example:
- Smart Phones. Smart phones are computerized phones that enable individuals
with cognitive and neurological impairments to interact with, monitor,
and control their surroundings and other remote resources and services.
Some examples of smart phone applications include: a location tracker,
a security or emergency alert, the ability to lock or unlock doors, medication
reminders and bookkeeper of health measurements, a mapmaker and direction
finder, a switch function (lights, stereo, etc.), mail notification, grocery
assistant, and dictation for the individual. Smart phone technology has
endless possible applications, including interface and coordination with
environmental control units (ECUs), which are often stationary in the home
or work environment.
Assisting People with Limb Loss
Many Americans with limb loss due to illness, injury, or congenital condition
utilize prosthetic limbs to be functional and independent, either with
or without canes, crutches, or wheelchairs to assist in mobility. Prosthetic
limbs are custom made and fit to the unique needs of the user. There is
a wide range of technological innovation in prosthetics, with some of the
more advanced prostheses using lightweight but strong materials, and components
that replicate natural human movement. Prosthetic technologies enable people
with artificial limbs to be highly active and perform a variety of fitness
activities such as running and swimming.
Example:
- Microprocessor controlled prosthetic knee. These new computer-assisted “smart” knee joints “learn” from a person’s movements to assist in reducing falls and improving one’s gait. They have been shown to benefit users by reducing energy expenditure, increasing stability, increasing the ability to walk on uneven terrain, slopes and stairs, and reducing trauma to sound limbs (for unilateral amputees), hips, and the spine.
Assisting People with Communication Impairments
For people with cognitive, learning, speech, and other impairments, the use of augmentative and alternative communication devices (“AAC”) is an important means of augmenting the ability to communicate in a variety of contexts. AAC is a broad term for a variety of devices that enable the user to effectively communicate, aid in the expression of needs and wants, and transfer information. Useful devices range from low technology typewriters and special boards with pictures or words where a person can point to convey his or her meaning, to sophisticated speech computers with touch screens and a speech synthesizer (text-to-speech (TTS)) system that produces sounds imitating the human voice.
Example:
- Speech synthesizer. A speech synthesizer translates written text into verbal
words so that individuals may communicate verbally by typing messages,
which are read aloud by the speech synthesizer. Pre-programmed instant
phrases are recorded into the device, and can be played back by hitting
the designated button. Speech synthesizers also allow individuals with
vision impairments to read written documents by listening to them. Most
synthesizers have several voices to choose from, including male, female,
and child voices, and also allow the adjustment of pitch and rate of speech.
Assisting People to Prevent Injuries and Live Safely
Assistive devices play a crucial role in preventing injuries in persons
with disabilities and chronic conditions of all ages. Lack of (or improper)
assistive devices can lead to deterioration in health status, through muscular
weakness, hip fracture, shoulder damage, and increased risk for developing
secondary conditions. A modest investment in safety devices such as grab
bars for the shower and/or bathtub or handrails installed throughout the
home can prevent costly hospitalization due to slips and falls. Grabbers/reachers,
which can lift objects from a distance or manipulate doorknob grips or
levers, allow for safer and more effective extension of the body as well
as easier exiting from a room or building in case of an emergency. High
tech devices include a video security monitor attached to a telephone or
other strategic location. Furthermore, without proper assistive technology,
individuals with disabilities are increasingly unable to visit their primary
health providers which can aggravate existing conditions or cause new injuries.
Example:
- Grab bars and handrails. The installation of grab bars along the interior
walls of a bathtub and shower allow a person susceptible to falls or hip
injuries to continue to use the shower while minimizing the risks of falling
when one’s balance is compromised. Handrails are also simple yet very important
assistive devices in the prevention of injury. Strategically placed handrails
can provide extra support and balance to people with disabilities, and
significantly aid in the prevention of disastrous slips and falls.
Assisting People to Live Independently
Assistive technologies allow people with disabilities and chronic illnesses
to meet everyday needs and stay connected to their communities. Technologies
(both high-tech and low-tech) can often make the difference between remaining
independent and losing independence. For example, certain types of bathroom
equipment, such as a rolling shower chairs, bath seats, or long-handled
brushes, promote independent living for people with significant disabilities
as they manage the most intimate activities of daily living. Other “low-tech”
devices include easy-grip jars for food preparation, clothing with Velcro
closures, baskets on walkers, book holders, and spring scissors. “High-tech”
computer technologies such as environmental control units have the ability
to create “smart homes” for people with disabilities.
Example:
- Environmental Control Units (ECUs). Environmental control units are hardware
or software systems that permit programmed or spontaneous remote control
of electrically operated appliances and devices in a person’s immediate
surroundings. ECUs empower individuals with a range of disabilities by
allowing them to maximize control of their environment. Using ECUs, a person
can independently turn lights on and off, radios, and televisions, answer
or initiate phone calls, adjust climate controls, unlock doors, or control
essentially any other aspect of the environment depending upon the system’s
complexity. These systems can be voice- or switch-activated, or can have
a pneumatic “Sip and Puff” feature. ECUs also serve the important purpose
of allowing the user to summon medical help in an emergency.
The Importance of Training and Related Services
One of the greatest misunderstandings of the entire field of assistive
devices and technologies is that they are merely products, with no training
or servicing necessary to make these devices functional and effective for
the individual user. This could not be farther from the truth. For instance,
an augmentative communication device requires extensive training to fully
utilize its functions and master the ability to speak with the use of a
keypad. Similarly, hearing aids and vision technologies require training
and servicing to ensure they are effective for the user and not rejected
in frustration. New prosthetic limb or orthotic brace users require gait
training by therapists and ongoing clinical services from prosthetists
and orthotists to ensure proper fit and function. Most power wheelchairs
require training by qualified personnel and rapid servicing to prevent
the need for a wheelchair repair from interfering with the daily activities
of the user.
Example:
- Training for Use of Assistive Technologies for Individuals with Visual
Impairments. Individuals who are blind or severely visually impaired require
a functional evaluation of the impact of the appropriate assistive technology.
Such an evaluation can review, for example, the effect of closer working
distances for remaining vision or proper orientation to customary environments
when there is no remaining functional vision. Beyond the functional evaluation,
training services usually include but are not limited to selecting the
proper aid, coordination of necessary therapy, and training and technical
assistance for the individual in the proper use and maintenance of the
device.
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Assisting People with Mobility Impairments
Assisting People with Hearing Impairments
Assisting People with Visual Impairments
Assisting People with Cognitive and Neurological Impairments
Assisting People with Limb Loss
Assisting People with Communication Impairments
Assisting People to Prevent Injuries and Live Safely
Assisting People to Live Independently
The Importance of Training and Related Services
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