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Assistive technology can benefit clients
Consider it for clients with mobility, cognitive, vision deficits
Assistive technology can make life better for everyone and help people live independently in a safe environment, whether they have a catastrophic illness or injury or are elderly with cognitive and/or vision issues, says Hunter Ramseur, MEd, LPC, CDMS, ATP, principal of Atlanta-based Assistive Technology Consulting LLC.
As an assistive technology consultant, Ramseur gets referrals from the Veterans Affairs hospitals, insurance companies, workers' compensation, life care planners, and others to help choose assistive technology that can help clients live safely at home.
"Assistive technology really plays a role in offering individuals maximal quality of life. It helps keep them safe and gives them a great opportunity to be self-directed in their own care," adds LuRae Ahrendt, RN, CRRN, CCM, nurse consultant, Ahrendt Rehabilitation in Norcross, GA.
Ahrendt and Ramseur suggest that case managers consider assistive technology when they develop a plan of care for patients who may need help with mobility deficits, cognitive issues, or poor eyesight.
"Technology today has so many applications that allow people to be independent. As a case manager, when I evaluate clients for the first time or re-evaluate them for changes in their physical, cognitive, and behavioral status, I look for ways that assistive technology can meet their needs for safety, independence, maximal community integration, and for them to achieve optimal self-direction," Ahrendt says.
The benefits of assistive technology often far outweigh the costs, Ramseur says.
"Technology can save money down the road. If you can get somebody to be more active, they'll be healthier and happier, and less likely to utilize the health care system," he says.
The addition of assistive technology can help people stay independent in their own homes and reduce the cost of care, Ramseur adds.
For instance, the installation of a lift system can help keep a patient with limited mobility out of a nursing home or assisted living center, because it helps caregivers with transfers from the bed to the wheelchair or the wheelchair to the toilet.
With a lift system, the patient has more control in getting in and out of bed alone, and the caregiver, who isn't strong enough to lift the patient, can assist with the transfers safely, he adds.
"Just the slightest amount of empowerment can make a huge difference, even if it doesn't seem significant at first. It builds on itself," he says.
For instance, many of his clients, who are veterans with combat injuries, also struggle with emotional factors and have lost the drive to do anything.
"Some of these clients are in pain and do nothing but sit around and watch television, because it's too painful to do otherwise. A lift chair is a pretty simple way to get them up and going," he says.
If technology is appropriate and safe, it often saves money in the long run, Ahrendt says.
People who have assistive technology in their home environment may not need round-the-clock care, but may be able to stay alone a few hours a day and be safe, Ahrendt points out.
For instance, a spinal cord injury patient who can operate a wheelchair and has enough speech for voice-recognition technology can work on a computer, make telephone calls, and open doors using assistive technology for part of the day instead of having an aide 24 hours a day, she adds.
"Assistive technology is no longer the domain of the most catastrophically impaired individuals. People with chronic conditions, physical problems, cognitive and behavioral impairments that result from a wide range of disorders can also benefit from today's technology," Ahrendt adds.
For instance, personal digital assistants (PDAs) can be programmed to remind disease management clients to take their medication or weight themselves, saving telephone calls and home health visits.
Or, a desktop computer's calendar program can be used to set up a similar reminder system.
Voice-activated cell phones allow people with fine motor issues or those who are losing their eyesight to have a safer environment, Ramseur says.
When developing a plan of care, case managers should think outside the box as to what part assistive technology could play in improving clients' quality of life, and they should bring in technical assistance to help them decide on the right technology, Ahrendt says.
"Finding someone who understands the value of technology and its specific implementation for a specific client and family is a very important piece. No case manager should ever assume they have all the knowledge necessary to choose the right technology," she says.
Identify activities that are critical to what your client wants to do, and look at how the activities can be accomplished with the help of technology, Ramseur suggests.
When he evaluates someone for assistive technology, Ramseur starts by looking at the activities that need to be accomplished, then looking at what the client can or cannot do.
"For instance, the activity that needs to be accomplished may be to access the bathroom safely. Then I assess the person's function loss and put the two together to decide what is needed to accommodate the activity," he says.
Don't just hook people up with technology. Make sure they know how to use it, Ramseur suggests.
"In almost every case, clients have a significant need for training, and it needs to happen in the home whenever possible. A lot of times, people are given equipment in the hospital and trained on how to use it, but they forget how when they get home. It's more effective to get them comfortable using assistive technology in their home environment," he says.
For instance, voice-recognition software for computers and cell phones is fairly straightforward when people are taught how to use it, but that process usually involves several orientation sessions to make sure the technology is being used correctly, Ramseur says.
PDAs are standard issue for patients with traumatic brain injury being discharged from a Veteran's Affairs hospital, Ramseur says. However, when he goes to the veteran's home for a consultation on other technology, he often finds that the PDA has been abandoned, because the client didn't understand how to use it.
Consider an ergonomic evaluation for your clients who spend a lot of time at the computer, Ramseur suggests.
"People who spend hours on the computer often have back and neck pain and repetitive stress issues in the upper extremities. If they have good ergonomics, it adds efficiency and comfort," he says.
Good ergonomics starts with a good adjustable chair with back support that fits the user's body dimensions. Other options include one-hand keyboards, ergonomic keyboards, and mouse variations, he says.
"There is so much technology out there that is becoming more universally available," Ramseur says.
Computers have opened up the world for people who have almost no function, Ramseur says.
Voice-recognition software for computers, which has been available for many years, is now in its 10th version and is 90% to 95% accurate, Ramseur says.
"This opens up a new world for someone like a quadriplegic who has limited use of his hands but his voice is still strong," he says.
There is even a product that combines hardware and software to allow someone to look at a computer screen and activate what he or she sees using a sophisticated camera calibrated to his or her eye, Ramseur says.
For instance, the screen can be set up with a virtual keyboard and when the user looks at a key, it interfaces with a laptop or desktop computer and activates a key on the computer.
"They can create e-mail documents or go to an environmental control screen and turn on the lights by looking at a certain module," he says.
One scientist who has worked on developing the product can type 30 words a minute using her eyes, he says.
"Patients who have no function at all, such as high-level quadriplegics on ventilators or people with ALS or multiple sclerosis who are losing their speech, can communicate by using this type of program," he says.
Software programs developed for people with learning disabilities also can be helpful for people with traumatic brain injury or other cognitive defects who need help with concentration and memory, Ramseur says.
Some of the software has voice output that will speak what is on the screen and highlight the words as they are spoken.
Home automation technology offers safety and security to clients, Ramseur points out.
For instance, someone who is bedridden can use a computer to check to see who is at the door, then push a button that automatically lets the visitor in.
There are low-tech options available, Ahrendt points out.
For instance, retail stores sell monitoring systems that use live-view web cams that people can use to check on their loved ones or the person caring for them while they are at work.
In addition to grab bars and zero-step showers, devices such as bath lifts can help disabled people bathe in safety and comfort, Ramseur says.
"Getting out of bed or transferring in and out of a wheelchair or bathing chair is a struggle for a lot of people. An overhead lift system can give them independence. If they have some upper-body function, they can activate it themselves," he says.
One of Ramseur's clients was a veteran with a combat-related injury that left him a quadriplegic with head injuries. His mother and younger brother were struggling to take care of him but had trouble helping him transfer from the bed to a wheelchair and to the bathroom.
"The overhead lift system allowed him to get himself out of bed and into the rolling shower chair or wheelchair. It gave him a measure of independence and gave his caregivers some relief," he says.
Ramseur recommends a global positioning system (GPS) for some brain injury patients and veterans who have issues with anxiety concentration difficulties.
"Sometimes people get distracted and forget how to get home. This is an example of how a simple thing can make a difference," he says.
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