LITERATURE REVIEW – Dissertation – Occupational therapy Research question (AIM): To explore how the use of assistive technology impacts occupational performance (this could either be self-care or...

OCCUPATIONAL THERAPY 1
OCCUPATIONAL THERAPY 34
LITERATURE REVIEW
HOW THE USE OF ASSISTIVE TECHNOLOGY IMPACTS OCCUPATIONAL PERFORMANCE OF OLDER PEOPLE
Submitted by:…………..
Submitted to:……………….
University:…………………….
ABSTRACT
The study aims to analyze the role of Assistive Technology and devices in improving the health condition of old age people. The study involves a systematic reflection of various studies conducted in this regard about the hand movement, complete body movement, and capacity of performing daily activities independently. The methods used in most of the studies are set of Randomized Controlled Trials and the Questionnaire to collect the data from recipients, the occupational therapists and caregivers. The key findings reveal that with the advancement in technology, better-automated devices are being made available for the old age people. However, the old age people are not tech friendly to use these devices on their own effectively. They need assistance in operating them. Further research and effective implementation of policy is recommended to increase the training and participation of these elderly people in technical activities.
    Keywords: Occupational Therapy; Automated; Assistive Technology.
ACKNOWLEDGEMENT
I thank my Professor……………….. who offered the expertise and insight that helped the research enormously. The research was also supported by …………………………which greatly improved the methodology and the whole manuscript. I would also like to show my gratitude to…………………and the reviewers for providing me their guidance during the course work. Their valuable interpretations made my work consistently flawless and granted me an opportunity to review all the parts of the work.
TABLE OF CONTENTS
1. Introduction………………………………3
2. Process & Method………………………..4
3. Background………………………………4
4. Literature Review………………………….4
5. Discussion……………………………….5
6. Conclusion………………………………...6
7. Reflection………………………………..7
8. Recommendations………………………..8
9. Limitations……………………………….9
10. References…………………………………10
11. Appendices……………………………….11
INTRODUCTION
The study aims to analyze the use of Assistive Technology in improving the outcomes of Occupational Therapy mainly for the old aged people.
Assistive Technology uses assistive devices like mobility aids (wheelchair, walkers, crutches, hearing aids and many other orthotic and prosthetic devices), hearing aid, speech aid, vision, communication, and reading aid to improve the functional capabilities of the body. It uses interventions and assessments to help the people with sensory, physical or cognitive impairments to make them independent in performing their daily life activities or occupations.
Assisted Technology may involve all the solutions and the devices which assist in overcoming the restricted functionality at old age. The old age people prefer to live at their homes at old age however there are certain environmental ba
iers which threaten their capacity to age in place. A study by Wielandt et al finds that the occupational therapists must ensure that the home modifications and occupational technology imparted by them is Person Centered. Right interventions must be offered at right time considering their activity, demand and nature of immobility. The occupational therapy along with assisted technology with home modifications may offer immediate relaxation to the patient and may also minimize the care costs for elderly people.
PROCESS & METHOD
In a survey conducted by Ocepek, J. et al (2012) in Slovenia, the sample population of old age people was selected from a wide age range of greater than 64 years. A total of 50 participants were selected and each one was given a questionnaire about the role of assisted technology in improving their quality of life, was sent through mail. Similarly a number of researches have been conducted in the past and consistently being ca
ied out to develop better devices and technology for the welfare of old age people. A survey conducted by Hoffmann & McKenna (2004), examined the use of Assistive Technology by the old age people after their discharge from the hospital settings. The study included 127 clients with mean age of 78.7 years. These patients were given few assistive devices. After using these devices for 10 weeks, these people were sent a postal questionnaire to complete. It was found that the participants who used to live alone mostly used shower chairs and toilet equipments while the patients who were living with the families used them rarely (p<0.05). The equipments having long handles were least used. 16.5% of the devices were not used at all as the people felt no need to use them.
The research of McDonald et al (2016) aimed to assess the effectiveness of adaptive silverware on hand motions involved hand measurements of various joints of hand bones like Metacarpophalangeal joint, proximal interphalangeal joint and distal interphalangeal joint for finger and thumb. The participants included 34 females with a mean age of 20 years without any earlier history of hand abnormalities. The participants caught their spoons with handles. A range of motion was measured using electrogoniometer to predict the angle of each joint during the movement of hand.
Source: McDonald et al, 2016)
Figure above shows adaptive utensils with modified handles. “A” spoon is a standard spoon. “B” spoon has diameter of 3.18 cm. “C” spoon has 4.45 cm diameter.
A number of mix methods are used to conduct randomized control trials to investigate whether prolonged use of Assistive Technology improves the functional independence of the old age people and reduce the burden on the care providers.
A combination of qualitative and quantitative analysis was done to analyze different perspectives on the outcomes of the interventions. During the execution of intervention the therapists would experimentally record the successful and unsuccessful outcomes of the experiment over the sample. Assessment of eligibility is identified, and using randomization process, the sample population would be divided into two parts namely experimental and control groups. Each group had nearly equal number of participants. Base line data was collected during the first week of the intervention. The experimental group was subjected to ATPUT intervention and the control group was provided Customary care. Recu
ent data was collected for consecutive weeks for the duration of 58 weeks approx.
Source: (Demers et al, 2016)
The figure above shows Quantitative Study Design during the study performed by Demers et al (2016). The study collected the participants from three distinct places in Canada namely Vancouver, Ottawa and Montreal. The eligibility criteria for the population was age> 55 years, residing at home, must have problems with mobility, and must be requiring assistance in doing daily routine activities. The participants were recruited through respective healthcare service centers in three respective cities in Canada. Site coordinators were deployed to assist the participants to confirm their eligibility, reply to the queries, elaborate the project to the participants, and get informed consent from the participants and their family members. Due to ethical constraints, the coordinators could not insist or force any participant to keep enrolled in the project if he intends to withdraw. The experimental group was given ATPUT (At Provision, Updating and Tune Up) intervention while the control group was provided with customary care which was not standard care. In customary care, the participants were not allowed to include their personal caregivers. The equipments provided were just based on local funding policies. The experimental Intervention involved in depth assessment of home environment of the old age adults,. It was aimed to encourage shared decision making by the users of AT devices and the care providers. The intervention was being done under the supervision of clinicians, care providers and the AT recipients. The trial was safe, relevant for the participants and feasible. It included 5 main steps (Demers et al, 2016):
1. Assess and identify the risky daily activities and assess the difficulties involved faced by the old age people cu
ently to determine the extent of assistance.
2. Discuss potential Assistive Technology required, its advantages and disadvantages. Get consent from the family members regarding agreement about use of At devices to support the functionality.
3. Choose the most appropriate AT strategy and inform all the family members and the recipient of the strategy.
4. Demonstrate the use of AT device and strategy, and promote the practice of use.
5. Analyze the effectiveness of AT strategy and recommend the solutions for the problems if any faced while using the device.
The Quantitative assessments and measures were recorded four times: During baseline, After 6 Week, 22 week and 58 week, using different tools as shown below:
Source: Demers et al (2016).
After the evaluation, data was entered through raters into SPSS statistic data editors. The scores like CATOM and SMAF were compared between the two groups. The sensitivity analysis was also done to find out the impact of such interventions on the spouse and children of the recipient.
The data could be affected by various factors like socio demographic and clinical characteristics of the older adults, issues pertaining within the house, the environment of house, the kind of AT devices available and being offered, The qualitative and quantitative data collected in the research would be greatly helpful to proceed with advance studies in future. It may act as a way to improve the education and awareness about AT Devices.
BACKGROUND
It is observed that the old age people are in greater need of assisted technology. The technology has undoubtedly improved the quality of life of many elderly people. A survey performed by Ocepek J et al (2012) in Slovenia found that the occupational therapists can recommend better interventions to these people to assist them to maintain independence at home. As the Institute of Public Health Slovenia ascertains the old age people generally get affected by the chronic diseases like BP, cholesterol, spinal cord issues and heart problems. They easily get fractures which impair their mobility, independence and quality of life. Therefore they frequently require assisted therapy.
With evolutions in technology, new and better innovations in assisted technology have largely increased their focus on client centered care. According to the postulates of Goodwill et al (2016), it is necessary to consider all the aspects like the environment, the client, his occupation and the context when developing the interventions for the clients. The Therapists are experts in assessing the needs of client, demand of occupations, the tasks and the concerned environment however they may collaborate with multidisciplinary teams to develop more personalized approach in decision making. Assisted Technology may be used to achieve specific results out of occupational therapy.
The therapists use analysis of the activities in the process of occupational therapy to achieve the demands of client’s occupation. They use a variety of tools to achieve the demands of client’s activity and explore the match between the skills of the client and the application of tools. When the client achieves improvements in functional capabilities, the applied tools are said to be assistive. If the tools do not meet the specified requirements of the client, the therapists try to modify them to achieve the occupational functionality. Therefore, the Assistive technology services support the people to reduce the ba
iers to live normal life.
Dementia is an impaired cognitive condition in old age people which results from slow degradation of
ain cells. Most of the cases of dementia (60-80%) are reported to have Alzheimer (Alzheimer’s Association, n.d.). The person feels short term loss of memory, reduced problem solving capabilities, decreased perceptual skills, and communication related issues. The occupational therapists through activity analysis take dementia as a problem that lowers the activity level of the patient. In coordination with the family members, the therapists evaluate the patient to determine the impairment level and the areas which require assisted technology (Schaber & Lieberman, 2010). The occupational Therapy for the old age Dementia patients involves Health promotion, Remediation, Maintenance and Modifications.
Assistive Technology involves a
oad range of technologies and specialized areas such as Seating and positioning, Physical Therapy, Speech Language pathology, audiology, engineering, psychology, ergonomics, Computer Technology or Telecommunication. It involves the use of many advanced devices which are easy to wear for the people and make a great difference in their life.
The old age people also get reduced hand and body movements. Hence adaptive utensils having handles with greater diameter are used to help them better manage their hand movements. There is very less research conducted till now to analyze biomechanical role of feeding spoon handles and their improved version. McDonalds et al (2016) demonstrated that adapted spoons can offer additional advantage to the old age people in feeding on their own rather than normal spoons.
LITERATURE REVIEW
Literature
According to American Occupation Therapy Association (2018), the Assisted Technology uses many devices for helping the people improve their life activities. The figure below lists few such Assistive Technology devices.
Source: American Occupational Therapy Association (2018)
Most of the people feel that the low technical devices are low cost, and more effective. The Assistive Technology Devices like Countdown timers, iPod touches and handheld computers, cueing systems and the pen paper calendars can be effectively utilized to help the old age people in their daily routine (Gentry et al, 2015).
The technology which is easy to use and a good fit for the people effectively
ing improvement in the outcomes, by helping the people develop greater independence, enhanced self-management and better quality of life (Fairman et al, 2016). Various projects like CPID aim to assess the requirements of the people, issuing them right AT devices, and making them trained to use them. In Virginia, every state has AT projects working under the um
ella of Virginia Assistive Technology System (VATS) which help the people to get affordable and appropriate Assistive Technology devices. The VATS services are legal under the AT Act 2004, and provide loans for buying equipment, technical assistance for reuse and increase awareness about AT services. The AT professionals help the people to try the devices before buying them.
Numerous Sensory Adaptations, chair to provide kinesthetic input, and a Fitbit to give reminders about the main activities to be performed, help the old age people in maintain alertness and staying focused (American Occupational Therapy Association, 2018, p.13)
As Pe
(2002) postulates in his research, the use of Computer-based Interventions can also be an innovative step. Computer based therapy is used I form of treatment modality in psychotherapy and vocational training. Specialized software are used to deliver client centered interventions to improve the memory, focus and attention in old age people. They may use internet services like dashboards, blogs and forums to discus important topics with many other people like them. This way they may increase their information sharing and social group interactions.
During a program aimed to identify the experience of old age people in using computer system, conducted by Pe
& Burwell (2008), many participants accepted that they have problems in vision and hand tremors when they use Computer-based gadgets and the widows based interface. They liked the use of the computer and regarded as a motivating experience. The use of computer activities improved their attention and focus. However, the patients also reported having issues like blu
ed vision, tremors, hand and arms stiffness, and lack of coordination in body parts. Impaired tactile sensation was also reported by few of them as a main cause of difficulties in using keyboard. Some participants had functional limitations and typing issues. Many participants also had issues in opening a package of CD. The information was also discussed with occupational Therapists about how they are working to improve the life of these old age people. They suggested that some of the patients are not comfortable to use the computer system due to psychiatric problems. Hence, they are less likely to use computer system.
The Assistive Technology services may consult with such clients to offer courses to these vocational therapists about adjustments in mainstream technology and the use of alternative devices. Majority of the issues of old age people can be co
ected by the smart use of Assistive technology devices and they can be imbibed into regular computer based learning.
A study performed by Hamm et al (2017), analyzed the fitment of AT devices at home to check to reduce the fall risk factors in old age patients. The clinicians assess and measure the dimensions of furniture at home and other factors related to the body. These recorded measurements are used to fit the appropriate Assistive Engineering devices within the environment of home. The equipments are fit considering the co
ect locations of the furniture, and patient. The devices may involve chair raisers, bath boards, bathroom grab rails, stairs grab rails and toilet raisers. The accurate measurement is necessary to identify whether the height of the furniture supports or hinders the mobility of the person.
The devices like 3D MAP can be deployed easily on any android applications like tablets and mobiles and helps to assess the measurements of the furniture. It shows most commonly used 5 areas like toilet, bed, bath, stair and chair, which are considered as most general areas of fall at home environment. Such devices give audio assistance to the old age people about which places are there in the way of their walk and they can prevent the risk of fall.
In his study,  Ocepek J et al, defines the assistive technology as a product modified or customized which is used to improve or increase the functional capability of aged individuals with disabilities. In other words the assistive technology includes the devices and solution to overcome the functional limitations and independent living of aged individual. The aim of this study was to inform the members of pensioner association of Slovenia about the assistive technology and its usefulness.
According to the study conducted by Mc Donald et al (2016) on ‘effectiveness of adaptive silverware on range of motion of the hand’ to examine the biomechanical handles to help the individuals suffering with arthritis or hand functioning disabilities to perform the daily living activities. The aim of this study was to measure...