Example AT Assessments & Outcomes
Sydney has been working to overcome challenges in daily activities since she was 3 years old due to left side functional limitations as a result of a stroke. In addition, Sydney has Cerebral Palsy and Epilepsy. Over the years, through therapy, family support and sheer determination Sydney had successfully implemented strategies and adapted her activities to independently and successfully participate in most areas of daily living.
Sydney had a goal of living independently in community based housing. However, with limited left hand function Sydney continued to struggle with tasks related to kitchen activities. Independently preparing and consuming food were the remaining major barriers for Sydney to achieve this goal.
Through collaboration Assistology, Sydney and her family identified the types of foods Sydney prefers to cook, the tasks she finds most challenging and identified the appropriate assistive technologies.
Sydney was recommended a rocker knife, adapted cutting board, pot handle stabilizer, one handed jar opener, one handed can opener and other assistive technologies for the kitchen.
With the implementation of approximately $300 of adapted kitchen equipment Sydney has enjoyed making chili on a cold Winter day, making herself a taco salad masterpiece, making her mom biscuits and gravy, cutting her own food and opening containers by herself for the first time.
When asked about her new found independence, Sydney said, “Working with Assistology has opened my eyes to having freedom in the kitchen. I’m now cooking and opening cans and bottles and cutting my own food for the FIRST time in my life.”
Sarah has a primary diagnosis of Cerebral Palsy, which affects her left side more than her right side. However, she has a high level of spasticity in both upper extremities. She has extremely limited fine motor dexterity with her right hand and virtually no fine or gross motor skills with her left hand. She is dependent on her power wheelchair for all mobility. She is interested in gaining access to a computer to increase her exposure to current events, allow increased communication with friends and family, as well as further developing her art skills using a computer.
As a result of her disability, she has limited use of her left extremities and relies on her right side to complete tasks. She is able to hold a pen to write (print) when necessary, but reports that it is a difficult task for extended periods of time. Her writing is not legible, but she is very proud of the tasks of daily living she is able to complete. She is able to complete some tasks of daily living. Her cognitive abilities, vision and speech are affected by her disability.
Sarah relies on a power wheelchair with a lap tray. She does not have a computer, and reports that she has limited experience using computers. She has, however, used a desktop computer with standard mouse and keyboard when at the library.
Assessment and trial of a variety of keyboard, mouse and other input options resulted in an accessible system that allows for desktop computer system access with minimal amount of fine motor dexterity.
Her best access method was using a Penny and Giles Joystick with the T-bar controller. When typing, Sarah’s biggest concern is how slow and physically tiring typing is. As a perfect candidate for a rate enhancement program, WordQ proved to be an immediate asset to the system and it increased her typing speed immensely. WordQ allowed Sarah to focus less on spelling, as well as reducing the physical demand on typing.
Since obtaining an accessible computer system Sarah has become active on social media and built a network of friends. She has also continued to explore art through various computer based medium, worked on her writing skills and maintained better contact with her out-of-state family.
TOM, A COLLEGE STUDENT
Tom is a 20-year-old University student n pursuit of a liberal arts degree. He has Moebius Syndrome and experiencing a difficult time completing his coursework in a timely fashion due to limitations due to his impairments. The most challenging components of coursework are the amount of typing and reading required with his assignments.
His disability results in limited mobility, physical deformities, and difficulty with verbal expression due to a lack of facial muscle function. His cognitive abilities are unaffected by his disability and he has a clear grasp of the challenges he faces. He experiences difficulty with visual tracking which makes it challenging to keep up with course reading requirements. Tom also has physical deformity on both is left and right hands which greatly reduces his manual dexterity. As a result, Tom is a two-finger typist, which is a very inefficient method for completing college level coursework.
Results For Computer and Academic Access:
Tom has moderate experience with Assistive Technology, and currently has a sufficient laptop computer. Although several options were considered, Tom ultimately decided that he preferred to continue using his current mouse access methods (trackpad and small wireless mouse). It was determined that Tom would benefit from the study tools in Kurzweil for research and to help organize his thoughts for paper writing. Kurzweil’s screen reading capabilities provide the ability to scan and read aloud handouts, articles, textbooks, research off the Internet, and other course materials. Tom expressed the desire for an alternate means of typing to increase his typing rate. It was determined that the REACH onscreen programmable keyboard would be the best option to allow for word prediction and customized layout design.
With the implementation of a minimally invasive Assistive Technology system Tom was able to successfully restart his college courses and continue to work toward his college degree.
GREG, A GRADUATING HIGH SCHOOL STUDENT
Greg is a 19-year old graduating from High School, intending to attend college to study business. When he was 15 years old he suffered a C1-2 Spinal Cord Injury from multiple gunshot wounds. There was no traumatic brain injury (TBI) and Greg presents a very intelligent persona. He has a history of high academic achievement. As a result of the SCI, Greg has no functional use of his extremities, minimal functional movement of his head, and is able to carry on conversation without difficulty. However, his speech pattern is in sync with the ventilator cycles. He independently drives his powered wheelchair (for mobility) with a sip-and-puff controller. Whether in bed or in his wheelchair, Greg needs to maintain a reclined or tilted position due to muscle spasms.
During his last year of high school Greg was provided with some Assistive Technology (AT) to assist him in his academic goals. The transition from living at home and going to high school, to living in an apartment/dorm and taking college courses is going to be a difficult transition. Although he has some assistive technology for computer use and to assist in daily living tasks, he requires some additional technology to ease his transition to college. He will need to be able to use the equipment both in home and academic environments. He reported experiencing neck and mouth fatigue (in the past) when using the Quad-Joy at school for mouse control and typing on the computer with an on-screen keyboard.
Results for Advancing Academic Access:
Greg was provided a new laptop that could be accessed from bed, his wheelchair and transported for use in classes. He benefited from an updated version of Dragon Naturally Speaking (DNS) and a high quality array microphone for improved accuracy. The QuadJoy gives Greg the freedom of mouse control without voice activation. This gives him better control over his computer. He also uses the onscreen keyboard as a way to type small amounts of text or spell out words that DNS does not recognize. Greg benefited from having a digital voice recording system to obtain audio of the lectures to enable him to listen again in his own time.
With an updated system and several hours of additional training Greg was able to master the new system and head off to college with the tools he needed to succeed with college courses.
Carrie is living with a medical diagnosis of Amyotrophic lateral sclerosis (ALS), and by nature of this condition, her symptoms are progressive and her level of functioning in daily activities is affected accordingly. She lives with her husband in their single family home, which has been modified previously to allow for wheelchair access on the main level of the split level home. At the time of service, Carrie’s most reliable mode of access for technology was voice control.
As she and her husband plan for the progression of her disease, they desire the home to be equipped with smart technology to offer Sarah as much independence, safety and autonomy as possible.
During the initial in-home visit the primary areas of concern to be addressed through voice controlled home automation are:
- Front door security
- Thermostat control
- Wifi enabled Interior security cameras
The recommended and implemented equipment were:
- Amazon Echo Dot devices throughout the house allowing Carrie the ability to community with individuals throughout the home as well as control smart devices throughout the home.
- Amazon Echo Show in Carrie’s bedroom allowing her control of devices, visibility of the front door, access to security camera feeds and video communications with individuals.
- The Alexa compatible Kwikset Smart Lock with Hub allows for control via voice, use of an app of with digital eKeys. This allows Sarah to provide individuals, specifically caregivers and medical personnel with access codes that can be deactivated as needed, as well as have a record of home access.
- Integration of existing Ring video doorbell. This allows Carrie visibility of visitors at the door.
Interior Security Cameras
- As the number of caregivers coming and going was expected to increase as Carrie’s disease progressed, they desired better visibility of the house for Sarah’s safety and security of the home. The Wyze Camera is Alexa compatible, has 2-way audio and automatically records when it senses motion.
- The Ecobee 3 Smart Thermostat with sensors was recommended based on ease of installation with their HVAC model, its Alexa compatibility and overall ease of use. Alexa compatibility allows Carrie to control the temperature of any environment using her voice. The Ecobee3 works with room sensors to help the system adjust based on different room temperatures.
Blake obtained a level C1-C4 spinal cord injury. He currently lives in an apartment with his family and receives PCA during the day, and his family takes care of him during the evening and night. His injury has affected many areas of his daily living, including his mobility and fine motor dexterity.
At the time of the accident he was taking college classes in the business program and is interested in resuming college courses. Additionally, he is interested gaining increased control of his environment. He spends his time either in his wheelchair or in bed relaxing.
He has maintained feeling from his upper chest and above, has good head control, and is able to shrug his shoulders. He is also able to slightly move his right hand (enough to activate a switch), however he does not have fine motor dexterity in his hands. He primarily uses sip-and-puff switches to control his wheelchair, phone, and alarm switch. His speech, vision, hearing and cognition appear to be unaffected by his disability, and within normal limits. He has a good handle on scanning, and presents the ability to learn new information.
Blake expressed a desire to have better control over his environment including his tv, cable box, DVD player, bed and lamp. In order to increase his independence around the home, an environmental control system is desired, and recommended. Blake uses a powered wheelchair and Dialogue RC phone (which he accesses with a sip-and-puff switch).
His preference is to control all movements of his bed (head, feet and bed up/down).
Blake was introduced to the different EADL options to be considered. Collectively, we agreed that the PROG system is the best option based on its portability, versatility, reliability, ease of maintenance and switch activation. Additionally, he is familiar with the scanning process, and using switch access to make selections.
Blake will need to be able to use the PROG both in his chair and when in bed. The desire is for him to have a simple switch that will be able to be easily transported between his bed and chair. He has sip-and-puff switches for his emergency call system and phone that he received from the rehab facility. The goal with this type of switch is to take up as little space as possible, and provide him with a reliable access method. The Quartet sip-and-puff switch is recommended for use in bed. It is known to work well with the PROG, and it will easily attach to the rails of his bed. However, it takes up more space than desired in this situation. A similar switch as with his phone system would be small, simple to transport and can be attached to a number of surfaces.
Results for Advancing Independent Environmental Control:
To appropriately set up the PROG system for Blake uses (1) the PROG remote, (2) a Jantek X-10 bed control, (3) an X-10 lamp module, (4) an IR commander, (5) one TASH mounting arm, (6) one TASH Plate Connection, (7) one TASH Mounting Clamp, (8) portable sip-and-puff switch.
As a result of the new system Blake has the ability and freedom to control aspects of his environment he previously depended on a PCA for. He is not only able to reduce his dependence on scheduled staff, but increase his quality of life through independent choice. He has increased safety in being able to adjust his environment as needed, and gained the ability to have more privacy in his day.