Irish Occupational Therapists' Views of Electronic Assistive Technology
Verdonck, Michele, McCormack, Cathy, Chard, Gill, British Journal of Occupational Therapy
Technological advances in the last decade have shaped the world in which we live. Information and communication technology, including mobile phones, satellite navigation systems and the internet, is an integral part of our daily lives. These developments have led to other innovative applications, such as telehealth, telemedicine, smart housing and home automation (Doughty et al 2007). Innovative applications of these technologies have resulted in greater freedom for people living at home with disabilities, including frail and older people (Curry et al 2002, Hoogerwerf et al 2002, Stead 2002). It follows that these advances in technology are slowly being reflected in occupational therapy literature (Chard 2007, Gentry 2008, Verdonck and Ryan 2008, Bodell et al 2009).
Provision of electronic assistive technology services
The scope of assistive technology is extensive and includes thousands of devices (Scherer 2000). High technology devices can be grouped together as electronic assistive technology (EAT), which is defined as:
... a subset of assistive technology which comprises communication devices, environmental control systems, personal computers and the interface which permit their integration with information technology and with wheelchair control systems (Royal College of Physicians 2000, p3).
In Ireland and in the United Kingdom, there is a two-tier system for the provision of assistive technology (AT). Low technology devices are issued by local community services while EAT is the role of specialists (Stead 2002). In addition, EAT can be funded by a variety of sources, including charities and health, employment and education services, making the delivery of an integrated EAT service very difficult. For example, powered wheelchairs, environmental control systems and augmentative assisted communication are all provided through different sources, thus making an integrated service less likely (Stead 2002). EAT services have been described as inconsistent, fragmented and uncoordinated, and specialist services in particular are difficult to access and not available to everyone (Hoogerwerf et al 2002). Similarly, local professionals in health, education and social care have been described as lacking knowledge of AT (Curry et al 2002, Hoogerwerf et al 2002). Despite this, the implementation and expansion of EAT and AT is supported by government policy and projects across Europe (Curry et al 2002, Roe 2007).
Providers of AT may include occupational therapists, engineers, speech and language therapists and teachers, as well as individuals and families (Curry et al 2002, Cook and Polgar 2008). As Smith (2000) pointed out, AT has had a substantial effect on defining the role of occupational therapy practitioners in the past. With the continuing development and sophistication of EAT, it is likely that the role of occupational therapists and others in the interdisciplinary team in relation to AT will continue to grow (Hawley 2002). Additionally, users of occupational therapy services will require more sophisticated equipment provision if they are to live independent lives in their own homes and on their own terms.
Occupational therapists' knowledge and use of EAT
Occupational therapists are actively involved in the assessment and prescription, as well as the supply and maintenance, of all ATs, ranging from low technology devices, such as raised toilet seats, to high technology devices, such as powered wheelchairs. Daily challenges when dealing with AT include maintaining a client-centred focus, limiting abandonment and keeping up to date with emerging products, while also adhering to funding restrictions and organisational procedures (Galvin and Donnell 2002, Cook and Polgar 2008). Orton (2008) surveyed 36 occupational therapists and found that more general AT training and better information about environmental control systems were needed. …