Prior to recommending assistive devices, a thorough assessment of the individual should be performed. The assessment must consider the individual's physical deficits and strengths, cognitive status, sensory status, functional status, environment, the tasks the person performs or would like to participate in, care-givers, and others living in the person's environment (Mann, 1998).
Functional status relates to how much assistance an individual requires to complete tasks and activities. Functional status alone is not enough to decide where to intervene with AT. The type of AT to recommend will also depend on what activities the client wishes to accomplish and what device features are important to the client. For some tasks, different devices accomplish the same thing, but each device may offer unique features and a distinctive design.
The assessment must also address the role and needs of informal caregivers. For example, a stroke survivor may be able to put on his pants independently with a dressing stick, but the task could take 40 min and result in fatigue. But if he lives with his wife, who assists as a primary caregiver, her assistance with donning his pants could save him time and energy. In this example, the dressing stick would allow the patient to be independent, but be an inappropriate intervention given his living situation. When AT is prescribed inappropriately, it often ends up unused.
Physical status is also important in prescription of AT. While recognizing deficits, remaining abilities must be considered in recommending AT. Consider a person who is unable to squeeze a fingernail clipper with her left hand to trim the nails on her right hand. With the remaining strength in her left arm, using an adapted nail clipper that can be pressed with a gross motor movement of the left hand, she is able to trim her own nails on her right hand.
Sensory deficits, which are often not obvious, are also important to consider in recommending assistive devices. Intact sensation is important in using many assistive devices safely and effectively. For instance, in using a reacher one must be able to sense how much force is being applied to ensure objects are adequately grasped. A person with decreased sensation may not be able to determine the applied force, and become quickly frustrated in trying to use a reacher to grasp objects.
Cognition is also very important in being able to use assistive devices effectively. If a patient has impaired cognition, he or she may not remember how to use a device, or may forget that they have the device. On the other hand, assistive devices may be used to increase the safety of people with cognitive deficits. Automatic braking systems on wheelchairs lock when an individual moves from sitting to standing without applying the brakes manually, and work well for individuals with both mobility and memory impairment. Wander alerts help caregivers supervise people with impaired cognition by alerting them when the person moves beyond a prescribed environment.
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