2004 Conference Proceedings

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Melea Balwan
Annalyn Caytap
Molly Doyle
CART- Rancho Los Amigos National Rehabilitation Center
7601 E. Imperial Hwy
Downey, CA 90242
Phone: 562-401-6800
Fax: 562-803-8892
Email: mbalwan@dhs.co.la.ca.us 
Email: acaytap@dhs.co.la.ca.us 
Email: mdoyle@dhs.co.la.ca.us 

The Center for Applied Rehabilitation Technology (CART) at Rancho Los Amigos National Rehabilitation Center provides assistive technology (AT) services to children and adults with severe physical disabilities. CART provides evaluation and therapy services in the areas of seating and mobility, augmentative communication, computer access and electronic aids to daily living. Individuals with disabilities often depend on assistive technology (AT) to perform everyday activities, such as walking, talking, and turning on the television. Examples of assistive technology devices include powered wheelchairs, electronic communication devices, and electronic aids for daily living (e.g. touch lamps, emergency-signaling devices). Many individuals lack the resources to obtain the equipment they need in a timely manner and often have to wait several months while alternative funding sources are explored. Nearly 85% of Rancho patients are either indigent or receive MediCal. These individuals also represent a culturally diverse group. Approximately 30% speak Spanish as their primary language and 10% speak languages other than English or Spanish (e.g. Cantonese, Korean). The socioeconomic, language and cultural issues pose additional barriers to clients obtaining the assistive devices they need.

Description of Equipment Loan Program
To help minimize the delays in acquiring AT devices, CART set up an Equipment Loan Program in 1992, with equipment obtained from donations. The equipment included primarily "low technology" items, such as hand-held typing sticks and call bells. Over the years the Equipment Loan Program has grown to include a range of devices for individuals with different types of disabilities (e.g. spinal cord injury, cerebral palsy).

The benefits of equipment loan have been well-documented (Blackstone, 1990; Beukelman and Mirenda, 1992; Church and Glennen, 1992; Cottier 1993, Doyle, 1998; others). Typically equipment is loaned for trial use prior to purchase or for temporary use while equipment is being repaired. The trial helps clients see the benefits of using the equipment on a daily basis and to appreciate what is involved in maintaining the equipment. Trial periods have resulted in increased satisfaction and subsequent increases in long-term use of the recommended equipment. In our experience, trials with a specific device have helped secure funding for permanent equipment from insurance companies.

In 2002 CART received funding to expand their Loan Program. Funds were allocated for equipment and personnel. The majority of equipment purchased included augmentative communication devices and computer access technology. The program loans equipment for 4 primary purposes: for temporary use by inpatients to participate in rehabilitation and facilitate recovery; for short-term use until permanent equipment is funded; for temporary use while equipment is being repaired; and for trial use in order to determine the most appropriate device. When equipment was not out on loan it was available for client evaluations.

Clients Served and Outcomes
Over a 2 year period approximately 250 AT items were loaned to 175 individuals. Only individuals evaluated by CART were eligible to participate. This allowed the CART team to loan equipment that appropriately matched the client's needs and abilities. This also allowed the team to track use and outcome data. Approximately 38% of individuals who participated in the program were Rancho inpatients, whereas the remaining were outpatients, referred by Rancho or a community agency. The majority of clients 92% were adults ages 22 years and older and presented with a range of physical disabilities (e.g. spinal cord injury, cerebral palsy, stroke).

In terms of type of AT loaned, 22% were augmentative and alternative communication (AAC) devices, 43% were AAC accessories (e.g. mounts), 18% were electronic aids to daily living and 17% were computer access technologies. The majority of individuals borrowed equipment for less than 3 months. On average computer access technology was loaned for the shortest time period whereas augmentative communication devices were loaned for longest time periods (3-6 months in some cases). As would be expected, inpatients borrowed equipment for shorter time periods compared outpatients. Generally inpatients who are recently injured use AT on a temporary basis while they are recovering.

Approximately 58 individuals borrowed AAC devices. Of those who were outpatients, approximately 60% borrowed devices for trial (after an assessment had been conducted and determined a trial was indicated before purchase), 20% borrowed a device while waiting for their own device to be repaired and the remaining 20% borrowed a system while waiting for permanent funding. Preliminary analysis indicates the majority of individuals who trialed devices were recommended that same system be purchased whereas only a small percentage opted for an alternative system that was simpler and was determined to be more appropriate for daily communication needs. All individuals who were recommended a permanent device received funding for the device through insurance. As reported above the largest category of AT provided on loan was AAC accessories, which includes mounting components and switches. These items are loaned to individuals who already have an AAC device however need replacement components because switches break or they receive a new wheelchair that requires a different mounting bracket. For programs similar to CART who serve a significant number of individuals who need AAC this component of the program has been critical.

Client Satisfaction
Clients who participate in the loan program complete a survey rating aspects of the program using a 5 point scale (1= not at all and 5= very). Approximately 85% reported the trial was effective in helping determine their permanent equipment needs. The majority (82%) felt the trial was effective (i.e. score of 4 or above) in increasing their awareness of what is possible through AT. Ninety-two percent of the patients rated their change in quality of life to be 4 or above.

Case Studies
Two to three brief case studies will be presented that describe assessment results, type and purpose of trial, intervention and outcomes.

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