1998 Conference Proceedings

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Bruce Fleming, B.S.M.E.
Rehabilitation Engineer
voice: (650) 497-8199
email: re.btf@lpch.stanford.edu

Judy Henderson, M.A., C.C.C.
Speech Language Pathologist
voice: (650) 497-8170
email: re.jzh@lpch.stanford.edu

Christine Wright, M.P.A., O.T.R.
Occupational Therapist
voice: (650) 497-7877
email: re.czw@lpch.stanford.edu

Rehabilitation Engineering Center
Lucile Packard Children’s Health Services at Stanford
725 Welch Road
Palo Alto, CA 94304
voice: (650) 497-8199
fax: (650) 497-8153
Internet: http://www.med.stanford.edu/lpch/rec


The growing variety of Assistive Technology (AT) products challenges the AT provider to keep on top of the myriad details related to integrating components into a system to provide functional independence to a user.

Our presentation addresses the interrelated details of integrating Mobility, Augmentative/Alternative Communication (AAC) and Environmental Control Unit (ECU) systems, and discusses a checklist to aid the AT ntifying these details when recommending AT products. The authors offer this checklist as a “work in progress" and welcome suggestions for additions to enhance its usefulness.


Service delivery at the Rehabilitation Engineering Center (REC), a department of the newly merged UCSF Stanford Healthcare, includes team-based evaluation, specification, and delivery of AT services and equipment to people of all ages and a variety of disabilities. Members of the REC staff include occupational and physical therapists, orthotists and prosthetists, speech language pathologists, medical physicians, and mechanical and electrical technicians and engineers. They assemble to address each particular client's needs through an assessment process that strives to identify their current and future capabilities and needs, and match them with specific features of specific technologies and products. Each team member contributes expertise in specific area, and ensures that the group considers all the crucial details of the often sophisticated products under consideration.

Through our work, we see the effects of successful integration of systems for our clients and others, and the failures grown out of technology provision without consideration of how it fit into the user’s system of components. Since few AT providers (and their clients) have the benefit of regularly working as part of a team of specialists, we began to compile the A.T. Integration Checklist as a tool for AT providers. It should serve as a guide to highlight the major details to consider when addressing the needs of a specific user with technology systems.


The technology areas covered by this checklist form a trio of systems that often influence each other. For example, a person who requires an electronic AAC device for communicating, an ECU to operate household items, and a power wheelchair for mobility, requires some form of integration of the three kinds of components in their AT system to be functional and independent thro of the device, and the user's access method become a foundation of requirements for assembling the components of the integration trio.

In this discussion, the Mobility devices category includes manual and power wheelchairs, and walkers. The AAC category includes manual and automated systems for written and auditory communication. The ECU category refers to any device or system of devices that give the user control over their surroundings. Note that each category covers single devices as well as systems of components; for example, a user's AAC (written and auditory communication) technology can be a dynamic-display communication device, head-controlled mouse emulator, printer, and a cable or infrared connection to a desktop computer for computer access and backup of communication files.


The check list covers each group of the trio by providing lists of components to consider during the assessment process. Most items have a short explanation of their importance or impact on the process stated on an adjoining page. For example, the section on headrests for seating and positioning systems discusses how a particularly shaped headrest can enhance or inhibit functional head control for driving a power wheelchair with the head or using a head- controlled mouse emulator for computer access. The section on mounting devices to wheelchairs and walkers provides line items to address types of mounts, mounting locations, and discusses features of mobility devices (such as tilt or recline seat frames)that impact the design of a mount. The two-part layout allows the AT provider to quickly peruse the topic areas to find items that apply to a particular system, and consult the explanations to reduce confusion.


While providing appropriate and successful AT for a specific user requires matching device features to the person's needs, functional integration involves matching the functional requirements of one device or system to the resources of another. The proce eds, but it's focused on assembling a system of parts that work together.

The three kinds of AT systems integrate via two distinct modes:

An example of using both modes of integration is a mechanical mount to hold an AAC device on a power wheelchair, and an electrical interface cable and wheelchair controller programmed to give the user control of the device via their wheelchair joystick. Underlying this successful integration is a functional seated position for the user, a location for the AAC device that allows the user to see the display, and a reliable means of access. Our presentation will include real-world examples of successfully integrated systems, and examples of less optimal systems.


The AT Integration Checklist covers the trio of AT, including AAC, ECU and Mobility. Successful integration of AT systems requires extensive knowledge of the features, requirements, and constraints of many products, and a foundation of knowledge about the user’s functional position, the equipment's location, and the user’s access methods. The checklist was developed to help AT providers with the task of addressing the major issues involved in the integration process. Where complete solutions to AT integration do not exist, the AT provider and the client or user must determine a balance of needs and compensation strategies that provides them with the greatest amount of functional independence.

We hope the AT Integration Checklist becomes a useful tool for AT providers, and we look forward to the adding more content to it, based on the suggestions and contributions of peers in the field who put it to use in their work.

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