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Assistive Technology (A.T.)

 

What is AT | Low-Tech AT

High-Tech AT | How to get AT

The Future of AT

Personal Introduction:

My name is Rita Roberson and I have a BA in Therapeutic Recreation and a Rehabilitation Technology Certificate from San Diego State University. I also have Spastic Athetoid Cerebral Palsy and have been using and even creating Assistive Technology (A.T.) since I was a small child.

If there is something you are interested in seeing on this page or a question about Assistive Technology this page does not adequately address for you, please e-mail me at ritastech@att.net.

Look for the items you request in the “You Asked For It” section at the bottom of this page.

What is Assistive Technology?

For those who may not have heard the term Assistive Technology, Public Law 100-407 defines Assistive Technology as “any item, piece of equipment or product system whether acquired commercially off the shelf, modified, or customized that is used to increase or improve functional capabilities of individuals with disabilities.” Basically you can give the term Assistive Technology to almost anything that gives people with disabilities the ability to do what they wish to.

Assistive Technology (A.T.) Terminology:

Here are some terms within the A.T. field that you may find useful to understand.

    1. Assistive Technology can range from Low-tech to High-tech.
  • Low technology can be something as simple as using a bamboo stick to turn light switches on or using the rubbery shelf lining material sold in grocery stores under a plate to keep it from sliding. A small piece of this material can be easily carried in a purse to hold a checkbook still while signing a check. Low Technology is also usually mass-produced and commercially available which makes it inexpensive.
  • High Technology is usually: more expensive, more technologically advanced, computer related, used by people with disabilities that are more physically limiting.

2. Universally Designed items are created for use by people with as many different abilities as possible. A couple of examples are:

  • The automatic doors in grocery stores are easy for people who are pushing shopping carts as well as people using mobility aids.
  • Computers that come with built-in accessibility features for people with various types of disabilities. (It is much more cost effective to build accessibility into everything than to add it later.)

3. Special-purpose Technology is something that is designed to meet the needs of people with disabilities but is commercially available.

4. Durable Medical Equipment (DME) is defined by Medicare as equipment that:

  • Can withstand repeated use,
  • Is primarily and customarily used to serve a medical purpose,
  • Generally is not useful to a person in the absence of illness or injury,
  • And is appropriate for use in the home.

5. Customized Assistive Technology is technology that is commercially available but needs something changed to better meet the needs of one individual.

6. Custom Assistive Technology is an item that is designed to meet the needs of a specific individual.

Customized and Custom Assistive Technology should only be used When There Is No Other Easily Accessed, Mass-produced or Special-purpose Technology available that meets the necessary requirements of your disability for the following reasons.

A Customized/Custom piece of equipment:

  • Has Not been thoroughly tested by numerous people for potential problems;
  • Can be much more expensive to build;
  • Does not come with technical support; maintenance and repairs can be difficult to obtain (especially if the original designer and builder is no longer available) and is hard to replace.

As technology advances, items that start out in the High technology category migrate to the Low technology designation and that is very good for people with disabilities. One example of this is voice recognition software. It first came out as a Special Technology software costing thousands of dollars and NOW is used in everything from cell phones to very inexpensive toys.

Assistive Technology can be listed in many ways. Here is how the ABLEDATA website (http://www.abledata.com/) breaks it down.

  • Aids for Daily Living
  • Blind and Low Vision
  • Communication
  • Computers
  • Controls
  • Deaf And Hard of Hearing
  • Deaf Blind
  • Education
  • Environmental Adaptations
  • Housekeeping
  • Orthotics
  • Prosthetics
  • Recreation
  • Safety and Security
  • Seating
  • Therapeutic Aids
  • Transportation
  • Walking
  • Wheeled Mobility
  • Workplace

Examples of Low-tech Assistive Technology:

Here are a few websites that have a lot of Low-tech gadgets to make life easier such as reachers, eating utensils, dressing aids, toilet and bathing aids and cooking aids to name a few.
http://www.wrightstuff.biz/
http://www.disabledhands.com/kitchen/index.html
http://www.lifesolutionsplus.com/
http://www.enablemart.com/

It is hard to know what, out of the thousands of items in the categories listed above, to mention here. There are also magnifying glasses, talking medicine bottles, and portable (fit in a purse) scanners that read what is being scanned for people with visual impairments.

For those of us who need help reaching light switches and lamp controls there are environmental control assistive devices that are low cost. Extension cords with switches at one end and timers help turn lights, TVs and other small appliances on and off. Here are a couple of examples:

Woods®
15′ 16/2 Household Extension Cord with On/Off Switch

http://www.lowes.com/productId=18569-25651-88359

“EasySwitch household extension cord Provides the convenience of an on/off switch that can be placed for easy access.” I use one like this to turn my swag lamp that is hanging over my desk on and off. We dealt with the extra length of cord (left over because the lamp is over my desk so the cord only needed to go, at the most, five feet for it to be within my reach) by folding it together and puting a zip tie around it.

Zip ties are marvelous Assistive technology aids and come in different colors, lengths and sizes.

This X10 Wireless Remote Control System is a slightly higher tech version of another relatively inexpensive environmental control unit that comes with a remote control. http://www.x10.com/automation/x10_rc5000.htm

The next items are for women or mothers so I thought they belonged on this page. The first item I have not tried but it looked useful.

BraAngel

The Bra-Angel helps single-handed women hook their bras without a hassle.
http://www.dynamic-living.com/bra-angel.htm

The picture is a white bust of a woman on a royal blue background. There is an oval shaped white plastic tube approximately an eighth of an inch thick hanging around its neck. A flat pink heart shape that is also an eighth of an inch thick with a white boarder is incorporated into the design and is lying in the middle of the bust’s chest. There is a straight, hollow white tube attached to the bottom of the heart reaching down to the level of the beginning of the rise of the breasts. A second straight piece extends another inch from the tube (this makes its length adjustable) with a piece of tube smaller in diameter and shaped like a paper clip threaded horizontally through it. A straight, flat piece of plastic with a small round ball at the top goes approximately three quarters of the way up the middle of the paper clip shape. This last piece is what you hook one end of the bra on to hold it while you maneuver the other end around your body.

One of the comments posted about this product was that a clothespin could do the same thing clipped on to pants or panties. That person stated that wooden clothespins are more durable when used for this task.

The
 “STADIUM GAL” Is an external female catheter that actually works for me. Over the past twenty or more years I have tried every external Female catheter that I could find and none ever worked until this one. While the “Stadium Gal” isn’t easy enough to put on to solve the daily problem, it is useful for those all day events when my PCA can’t join me; it is much easier to ask someone to empty a leg bag then it is to find someone capable of transferring me. It is also very comfortable and I can almost forget I have it on. If You use it, you have to be able to stop the flow of urine before it fills the little bag that attaches to the leg bag. When I giggle I lose bladder control and that forces it to come lose; But it works when I do not giggle. http://www.biorelief.com/stadium-gal.html

Female SPIL-PRUF® Urinal

This is comfortable but tends to leak when the female attachment disconnects in the process of being pulled away from my body. http://www.lifesolutionsplus.com/spilpruf-urinals-p-156.html

Plastic Urinal CEXP706OO

This one has the same shape and will not come apart but doesn’t have the spill prevention feature.

http://www.bdnmedicalsupply.com/

Water Power Tub Lift

As I mentioned before, I have cerebral palsy and like a lot of women, I Love to take hot baths. I use this bathtub lift

This Picture is of the bath lift. It is a beige one-piece plastic back rest and seat with rounded metal armrests where a lever is mounted that controls the water running in and out of the cylinder on the back of the seat. The cylinder allows the seat to swivel making it easier to move legs in and out of the tub and the water pressure in it raises and lowers the seat.
http://www.sunrisemedical.com/prd_id=845524441858713

instead of a shower bench because I have found that my spasticity makes using a shower bench hard and dangerous. I tend to get cold after the water is turned off and as my body stiffens from being cold it becomes harder for my PCA to help me. That is why Medicaid pays for this instead of a shower bench (which they prefer). I explained it to my doctor and he wrote the prescription. It is much better for me than a shower bench but I am not able to get even my legs submerged completely. If you have a similar situation and a doctor who listens to you then it is definitely worth trying to get one. There are other brands of bath lifts that may meet your needs better http://www.usmedicalsupplies.com/Bath-Lifts.htm but this is the one I have experience with.

Low-tech Items for Moms:

BottleTenders™ Baby Bottle Holder
http://www.bottletenders.com/
Description: a photo of four babies seated in Baby Carriers that are lined up vertically across a room with white walls, chair rail, wide molding and horizontal blinds on the window in the far wall. The babies are drinking from bottles held in the correct position with a stuffed animal lying on each of their laps. All four babies have a different kind of animal and the ring around the bottle is detachable and made from the same material as the stuffed animal.

Description: a baby seated in a Baby carrier, facing the Camera with a beige and white stuffed teddy bear lying across the lap and showing a better angle of the ring holding the bottle while attached to the teddy bear.

 

Wheelchair Accessible Changing Table

from the Fine Round Cribs Company
http://www.fineroundcribs.com/wheelchair.htm

This is a picture of a woman sitting in a lightweight wheelchair (without armrests) with her legs all of the way under the Changing Table. She is holding the skirt of a baby girl’s lavender dress up with both hands. The baby is lying on a thick pad covered in white material with her feet closest to the woman. The sides of the pad are slightly raised to protect the baby’s arms from hitting the wooden rail that surrounds the baby on three sides. The table and protective railing are a dark brown and there is extra table space outside the rail where a clean disposable diaper is lying. A white soiled diaper container is sitting next to the table where the woman can reach it.

This company also sells round cribs that can be rolled under and reach 80% of the crib. It is strong enough for a grown-up to curl up with the baby to comfort it.

Clothing:

Because most women are interested in clothes and many of us face challenging clothing issues I have included a web site that sells clothes that are designed to be easy to get in and out of. Many of the stores I have looked at that sell this type of clothing Target the elderly, but I found this one website that sells wraparound skirts and pants that can be put on while seated so I thought I would include it. I find wraparound skirts very useful and I would like to hear your opinion on the clothes on this and other clothes resources. http://www.silverts.com=womenshop

Examples of High-tech Assistive Technology:

Most Augmentative Alternative Communication devices are under this category as you may have guessed and because this web site is dedicated to women with speech disabilities I will cover this more in depth. But this is also where computer access devices and software, power wheelchairs, self-feeding devices, ceiling lifts, wheelchair equipped vehicles and other exciting items are found.

Augmentative, Alternative Communication (AAC):

Augmentative, Alternative Communication (AAC) devices are used by individuals who cannot speak clearly enough to be understood by everyone. They are designed for individuals who can read and spell and for those who are unable to read. People who are speed typists to people who can only blink or move one part of their body can use an AAC Device. Many of these devices use Decktalk, which is considered by most to be the most understandable voice synthesizer available today. Decktalk also offers different voices for women, men and children. Some AAC Devices are loud enough to be heard in a noisy, crowded room. They come in different sizes from PalmPilot to an average computer screen size and some companies now offer a small selection of colors to choose from.

Some options people can use to access AAC Devices include touch screen, mouse, joystick, Morse code, visual and auditory scanning, SCATIR Switch, headmouse and head tracker, along with a broad selection of on-screen keyboards. The more computerized AAC Devices have the storage capacity to store many day-to-day conversation words and phrases as well as whole speeches. One speed enhancement feature that many of these devices utilize is the ability to store daily conversation sentences on buttons. The buttons are grouped on pages by subjects such as: personal information, likes and dislikes, daily activities, favorites, etc., and it is easy to navigate between pages. Programming the buttons is easy and can even be done by a person who uses scanning as their method of input. For people who cannot read pictures are inserted on the button to depict what the button will say. With built in Bluetooth, Wifi and Infrared capabilities, some AAC Devices can be used to make phone calls and access environmental controls. The more advanced devices are built on the latest PC computer and (if purchased through private insurance or other funding source) can be used as a computer to create Word documents, surf the Internet, send and receive e-mail and text messages, etc., however

Medicaid and Medicare will not purchase a device that serves as anything but a communication device. The companies who sell these devices have created a separate product with the access to the regular computer programs disabled for Medicaid and Medicare to purchase.  *I recently found that, after the dedicated device has been delivered, there is a CD you may purchase from at least one of these companies for $45 that will unlock the computer function part, allowing regular computer use. 

A speech-language therapist can help you pick the correct device for your needs and if there is an Assistive Technology Center near you, they may have the different devices to try and maybe borrow. The large companies like Dynavox have representatives that come to you and rental opportunities. Medicaid and Medicare have a mandatory rental period before they will purchase it because they do not want to purchase something that you find you can’t use when you get it.

 

Here are the web site addresses for the better-known companies that sell Augmentative, Alternative Communication devices:

There is one other thing that you should know about using High-tech AAC Devices. Always have a Low-tech device such as a pen and paper, picture book, letter board or eye gaze chart as a backup because as much as we love our High-tech gadgets, we also know that when they decide to break down or just have a computer glitch (which they’ve been known to do at the least convenient time) they can cause us to have a very frustrating time if we don’t have a backup plan.

Computer Access Assistive Technology

If you have trouble manipulating a standard computer mouse and/or keyboard, there are many alternative ways to access a computer. First I will cover Speech Recognition software. If you have a speech disability the experiences I am going to share, may help you. My cerebral palsy gives me a “C.P. Accent” that most people can understand if they speak American English well, do not have a significant hearing loss and take the time to listen to what I am saying. So, when I tried using Dragon Dictate and Dragon Naturally Speaking three or four years ago, I was surprised to find it unable to learn my speech. Then the teacher of a class about Speech Recognition software at my first Assistive Technology conference explained why the program had trouble learning to “understand” my speech. At that time the computer recognized speech by saving sound bytes and going back to retrieve the ones that match so it worked for anyone who consistently said words the same way every time. After many hours of training it, people who had very hard to understand speech could use this software and it sometimes understood them better than someone who frequently interacted with them. But for people like me, who don’t say words exactly the same consistently (for me, this is caused by my lack of breath control) it does not work. Speech recognition software is getting better and I am anxious to try it out on my new cell phone but from what I understand, I do not expect it to work very well for me yet. I will update this with my results.

However, there are many other hardware and software alternatives that may increase computer access, speed and/or accuracy for you.

Hardware:

There are numerous different types of mouse alternatives and the Trackball and Joystick mouse are two of the most popular choices. This website has a broad selection of Alternative Pointing devices http://www.infogrip.com/

There are also numerous keyboard designs and configurations. If you type with one hand and have good fine motor control in your hand, there are one-handed keyboards that require depressing two keys at the same time to get a letter (is called Cording). There are also large keyboards for people who have limited eye-hand coordination.

I use the Roller II Joystick with the EZ-Reach keyboard.

Picture of three Roller two joystick pointing devices with different types of grips on the stick: A flat, round knob; a t-bar and a soft, round foam rubber approximately the size of a tennis ball. EZ-Reach keyboard description follows in HTML

I type with my right hand and have poor range of motion so a small keyboard makes it much easier to reach the keys. I really like the extra Backspace and Enter keys that are placed down the middle of the keyboard and the extra Ctrl, Alt and Shift keys down the right side. I miss them when I have to use a regular keyboard! Both of these products are sold by Infogrip.

Software:

For those of you who may not be familiar with the Accessibility software that is included on all computers, here is a list of access features included in Windows XP software and a short description. They are bundled together and located in the Control Panels; look for the wheelchair icon.

Display and Readability:

These features are designed to increase the visibility of items on the screen.

  • Font style, color, and size of items on the desktop—using the Display options, choose font color, size and style combinations.
  • Icon size—make icons larger for visibility, or smaller for increased screen space.
  • Screen resolution—change pixel count to enlarge objects on screen.
  • High contrast schemes—select color combinations that are easier to see.
  • Cursor width and blink rate—make the cursor easier to locate, or eliminate the distraction of its blinking.
  • Microsoft Magnifier—enlarge portion of screen for better visibility.

Sounds and Speech:

These features are designed to make computer sounds easier to hear or distinguish - or, visual alternatives to sound. Speech-to-text options are also available.

  • Sound Volume—turn computer sound up or down.
  • Sound Schemes—associate computer sounds with particular system events.
  • ShowSounds—display captions for speech and sounds.
  • SoundSentry—display visual warnings for system sounds.
  • Notification—Get sound or visual cues when accessibility features are turned on or off.
  • Text-to-Speech—Hear window command options and text read aloud.

Keyboard and Mouse:

These features are designed to make the keyboard and mouse faster and easier to use.

Mouse Options:

  • Double-Click Speed—choose how fast to click the mouse button to make a selection.
  • ClickLock—highlight or drag without holding down the mouse button.
  • Pointer Speed—set how fast the mouse pointer moves on screen.
  • SnapTo—move the pointer to the default button in a dialog box.
  • Cursor Blink Rate—choose how fast the cursor blinks—or, if it blinks at all.
  • Pointer Trails—follow the pointer motion on screen.
  • Hide Pointer While Typing—keep pointer from hiding text while typing.
  • Show Location of Pointer—quickly reveal the pointer on screen.
  • Reverse the function of the right and left mouse buttons—reverse actions controlled by the right and left mouse buttons.
  • Pointer schemes—choose size and color options for better visibility.

Keyboard Options:

  • Character Repeat Rate—set how quickly a character repeats when a key is struck.
  • Dvorak Keyboard Layout—choose alternative keyboard layouts for people who type with one hand or finger. [This arrangement of the keyboard was designed for efficiency, unlike the standard Qwerty keyboard that was arranged to prevent typewriter keys from jamming when pressed simultaneously.]
  • StickyKeys—allow pressing one key at a time (rather than simultaneously) for key combinations.
  • FilterKeys—ignore brief or repeated keystrokes and slow down the repeat rate.
  • ToggleKeys—hear tones when pressing certain keys.
  • MouseKeys—move the mouse pointer using the numerical keypad. http://www.washington.edu/accessit/articles?1012

In Mac OS X these features are available but some are not located in the accessibility icon which is called Universal Access and has an icon that is a blue circle with a white boarder and person standing with feet spread and arms straight out horizontally. The Mac version of a screen reader, VoiceOver, does not work with Microsoft products because Microsoft has not changed to using the code that VoiceOver can read. However, there is a text reader located in the Speech icon of System Preferences and it will read anything that is highlighted in any software program. This program offers several different voices, speed control and choice of keys that turn it on and off. The one option that it does not offer is the ability to stop the reading and start up where it stopped. If what was being read is still highlighted it will start at the beginning unless you manually highlight from where it stopped reading before you start it up again. I use it to speed up my reading time.

System Preferences is the equivalent of Control Panels and is where Universal Access and the other access features are located.

Word prediction software is another speed enhancing program that I find very useful. Here is how it works. When the first letter is typed it gives several choices of word all starting with that letter. To choose the word you want to use just type the number next to that word (instead of the rest of the letters) or the next letter for more words. It can automatically space, guess what the next word might be based on grammar and learn your writing style for more accurate guesses.

I use CoWriter sold by Don Johnston Inc. http://www.donjohnston.com/products/cowriter/product_tour.html
It is one of the best Word Prediction Programs but there are less expensive programs especially for Windows based computers.

Computer information:

Here are some things about computers you may not know.
For instance, you might be interested to know the reason why I have stuck with the Apple Mac since I bought my first computer. Does this sound like anything you have experienced while using a computer?

I will be typing along on a Windows Based Operating System and suddenly it either freezes, gives a warning that no one has ever seen before or gets into a command activated Function that the trouble shooters don’t recognize and do not know how to get out of.

If this is happening to you, I bet you figured out the cause of this frustrating phenomenon. This is what is happening. Two keys (one of which you may or may not have wanted) are being pushed simultaneously. (Yes, I do know that custom keyguards are available that are supposed to prevent this type of mistake but I have never been able to get comfortable using one of them.)

However, working on a Mac has been my solution to this situation because it very rarely (if ever) happens on a Mac? This is why. The Mac was created for mouse-driven cursor navigation so it does not have the copious amount of built-in key commands that can be used to navigate with the keyboard. Those Windows based operating system commands are very necessary for people who are visually impaired but they are a very big frustration point for me and that is why I continue to use a Mac.

It is true that there are some other frustrations to live with when using a Mac. They are:

  • Assistive Technology hardware and software is sometimes not compatible with a Mac.
  • The compatible software is usually more expensive and may work better on a Windows based operating system.
  • Accessibility software is not always, but should be the same across all types of computers for easier use by people who need or want to switch from one operating system to another.
  • Developers do not update their software fast enough to keep up with the changes that are being made by Apple to the operating system and the older software will not work on new and sometimes updated Macs.
  • Unfortunately it is sometimes difficult to find people outside of authorized Apple repair places who can troubleshoot for Macs. (My friends have been trying to get me to switch for years because they all know Windows based computers and they want to help me when I have problems, however, they envy me when their computers die and my Mac is still running fine.)

Also, the price of a low end Mac has also gotten more comparable to a Windows based computer and that will make it easier to get one funded.

I hope this information helps you make a more informed decision with your next computer purchase.

The good news is, if there is a part of your body you can control including eyes and tongue, you can use a computer.

How to Get Customized or Custom Assistive Technology:

These are resources that have either worked for me or I have heard of from other people.

The Tetra Society of North America http://www.tetrasociety.org/. This is what their web site says, “The purpose of Tetra is to recruit skilled volunteer engineers and technicians to create assistive devices for people with disabilities. This unique program was developed in response to difficulties that people with disabilities experience in their search for greater independence and integration within their communities. The solutions are often simple but can change someone’s life. Tetra recognizes that people are not handicapped by their disabilities but by obstacles or barriers in their living environment. Volunteer engineers, design technicians, and health professionals work one to one with their clients to make assistive aids or modifications to their environment so that greater independence can be achieved. Tetra’s services are offered at no charge. Clients pay only for materials and the volunteer’s expenses. The Tetra Society operates on a charitable, non-profit basis with no core fundraising, relying instead on charitable contributions from a variety of sources.” Tetra Chapters in the U.S. are located in these cities:

Los Angeles, California;
San Diego, California;
Miami, Florida;
Cincinnati, Ohio;
Columbus, Ohio;
Salt Lake City, Utah.

Hopefully new chapters will be forming in many more locations soon. Please see their web site for chapters in Canada.

However, if Tetra doesn’t work for you, try contacting the Independent Living Center for your area to ask them for suggestions.

Mechanical or Electrical Engineering Students:

If there is a college or university near you, find out if they have a Mechanical or Electrical Engineering department because students always need projects for those types of classes.

Firefighters:

Sometimes firefighters are looking for projects to do in their spare time (I have had them build a special art cabinet for a non-profit organization that I worked with but you can probably find people with different skills through them as well).

My last suggestion is Public Service groups like the Elks, Kiwanis or Lions clubs.

Free Assistive Technology Resources:

Most of the opportunities for free equipment are Loan Libraries and that is a good way to try something to see if it works for you before going to the effort of getting the item funded.

Every State and territory in the United States has an Assistive Technology loan program and this web site provides contact information for all of them: http://www.resna.org/taproject/at/statecontacts.htm.

United Spinal Association (U.S.A.) Tech Guide is another web site list of organizations that loan equipment: http://www.usatechguide.org/links.php?catid=91

but you may have to do a little more searching with it because it doesn’t always include the physical location and not all of the links work. However, I was able to find the web sites for the links that didn’t work by Googling the name of the link.

California Telephone Access Program (CTAP)

If you live in California And meet the certification requirements for utilizing this service, this is a great resource to use! (For those who are not in California, this web page tells which States have this type of program http://www.tedpa.org/tedpainfo/stateprograms.htm)

“The California Telephone Access Program (CTAP) distributes telecommunications equipment and services to individuals certified as having difficulty using the telephone. CTAP is a California State mandated program, under governance of the California Public Utilities Commission (CPUC). Equipment and some network services are available at no charge to eligible consumers.

Californians who are deaf, hard of hearing, speech disabled, blind, or who have low vision, cognitive impairments, or restricted mobility, are eligible to receive equipment with certification by a medical doctor, a licensed audiologist, a qualified state agency, or a hearing aid dispenser.

CTAP is funded by a small surcharge that appears on all telephone bills in California. The money collected from this surcharge pays for both the California Telephone Access Program (CTAP) and the California Relay Service (CRS). This surcharge appears on your phone bill as “CA Relay Service and Communications Devices Fund.” http://www.ddtp.org/CTAP/

Here is a Web site that lists FREE Assistive Technology Software “One Stop for Free Assistive Technology.” http://www.onlineconferencingsystems.com/at.HTM

Funding For Assistive Technology:

As you probably know, getting A.T. funded can be very frustrating so I hope this information will help minimize the potential exasperation of acquiring your next piece of Assistive Technology.

The following web sites provide links to web page that give well developed, step by step instructions on how to approach the different funding sources. However, I will share some information I have gleaned in the last few years before providing the web site addresses.

The various funding sources can be categorized as three general types:

  • public,
  • private,
  • and other.

Public funding sources include:

  • federal,
  • state,
  • and local government agencies;

There are more than 30 programs established by the United States Congress that affect U.S. residents with disabilities and more than 12 agencies on the federal level that oversee these programs.

Medicare:

It covers individuals age 65 and older and those adults under age 65 who are blind, are totally and permanently disabled, and have received Social Security Disability Insurance (SSDI) benefits or Adult Disabled Child benefits for at least 24 months. Medicare has two types of coverage. Part B is [the] supplemental policy in which the individual pays a small premium to cover services such as outpatient therapies and durable medical equipment.

Durable medical equipment is defined by Medicare as:

  • equipment that is primarily and customarily used to serve a medical need,
  • can withstand repeated use,
  • and is generally not useful to a person in the absence of an injury and illness.
  • Equipment purchased or rented under Part B:
  • must be used in the patient’s home
  • and deemed “necessary and reasonable” for the treatment of the injury or illness or for improving the function of an impaired body part.

A physician’s prescription is necessary to substantiate medical necessity for the device. This prescription indicates the:

  • individual’s diagnosis and prognosis,
    the reason for the device,
  • and the length of time the device will be needed.

The provider must also substantiate the reasonableness of the device by:

  • Indicating other alternatives that were considered
    and demonstrating that the one recommended is the least costly in terms of its expected therapeutic benefits.
  • Reimbursement for the equipment is denied if the provider fails to prove reasonableness.

MEDICAID (California Medi-Cal)

The scope of services provided by Medicaid varies widely from state to state. Assistive technology is not specified as one of the services mandated by the federal government, nor is it found on the list of optional Medicaid services. However, assistive technology services and devices are within the scope of each state’s Medicaid program.
The federal definitions of the intent and scope of mandated and optional services should be used as a starting point to determine the basis of Medicaid funding for assistive technology. In order to receive federal funding for Medicaid, all states must comply with these definitions of services. [There are] eight services among the list of mandatory and optional Medicaid services under which funding for assistive technology and services may qualify. These services are:

  • Early and periodic screening,
  • Diagnostic treatment services,
  • Home health care services,
  • Prosthetic devices,
  • Occupational therapy,
  • Physical therapy,
    Rehabilitative services,
  • Skilled nursing facility, and services and intermediate care facility services for persons with mental retardation, developmental disabilities, and related conditions (icf/mr-dd).

Because assistive technology devices and services are not listed as such in the Medicaid vocabulary, it is recommended that use of these terms be avoided when applying for funding under Medicaid.

Instead, the device being requested should be identified by its specific name in all documentation and any descriptive terms used should match those in the definition of one of the Medicaid services listed above.

One of the general criteria for funding of all Medicaid services is that the requested equipment or service be considered a medical necessity. Another general criterion for funding of Medicaid services is that prior approval or prior authorization is required for nearly all services and equipment.

Programs for the Developmentally Disabled (Regional Center?)

Within each state, programs for the developmentally disabled provide a range of services, including case management, advocacy, community living, and purchase of other services. Assistive technology services and equipment may be funded from these programs.

CHAMPUS

The Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) is a federally funded program that provides medical benefits to dependents of active duty members of the armed forces and to retired members. CHAMPUS contracts with various health insurance companies to administer this program, which provides medically necessary equipment and assistive technology services.

Private Sources of Funding:

Sources under this heading include Grants and loan sources through organizations like Easter Seals, the United Cerebral palsy Association (UCP), Muscular dystrophy Association, Multiple sclerosis Society, A.L.S. Association, etc., Service Clubs, Religious establishments and private fund raising (such as bake sales and garage sales).

The following web pages give detailed instructions on accessing all types of funding sources. This web site, the Disability Resources Monthly (DRM) Web Watchers Home page http://www.disabilityresources.org/ , is full of links of interest to people with disabilities including an Assistive Technology link where I found this Assistive Technology-Funding link. That is where I found this funding link with the following description:

“Financing Assistive Technology: Handbook for Funding

A very comprehensive handbook. Some information is dated, but the principles still apply.”

I believe it does give you good information on the process even though the specifics for the various agencies are old so I am including this link with the above disclaimer.

Financing Assistive Technology: Handbook for Funding http://trace.wisc.edu/archive/fintech/fintech.html

The Abledata web site is another very good resource for information regarding disability related issues, including Funding.

ABLEDATA.COM Funding Resource Center

http://www.abledata.com/abledata.cfm?pageid=113573&top=16040&ksectionid=19326

Tips to Consider When You Are Replacing Assistive Technology:

First, having experience as both a recipient of Assistive Technology and being a certified Assistive Technology Practitioner (A.T.P.), I assure you that most ATPs really will want to work with you to get what is best for you. However, I am writing this for those times when no one seems to be listening and/or working with you.

Replacing old, worn-out equipment is usually at the best not easy to deal with, and can be, very traumatic. I hope these tips will take some of the trauma out of it.

On computers: I learned that there are CD/DVD drives that will burn rewriteable disks and ones that won’t; And not all Mac Minis come with the one that does, After I bought the computer.

Tip: research, research, research! Ask, “Why didn’t the rewriteable disks work as rewriteable in my old computer?”

Tip: make a list of things you use your computer for.

  • Find out what hardware and software is required for what is on your list.
  • Ask two or more sources the same questions about the technology you wish to acquire. If the answer is not the same, do more digging.

Wheelchairs:
If the wheelchair you are using works well for you but needs to be replaced:

Make a list of:

  • The features Existing that work for you,
  • Features you need that the old one didn’t have,
  • And the features you did not like about it.

Remember that doctors, therapists and Assistive Technology Practitioners do not live in your body: you do. If something really doesn’t sound like it will work for you, don’t be afraid to question it.

However, be open to trying something suggested to you (especially if you can try it before it is purchased for you).

If you live alone and you try to transfer into a wheelchair they think will work for you and you can’t do it in the store, do not let them tell you that you will be able to do it with the one they order to fit you. You may be able to, but ask what they will do if it doesn’t work for you and you are alone without a wheelchair?

Also, make sure they know how you do it with your old equipment and (unless it is necessary to drastically change it for health reasons) if a drastically different way of doing it is suggested to you make them prove that you will be able to do it before you let them purchase it for you.

Take your own measurements (or ask someone you trust to do it) And ALWAYS Double-check the measurements before you start the process with the provider. This is especially necessary if you transfer independently, but it is also necessary if you do a standing transfer with assistance! If the seat is too high you may not be able to get into it independently and it may be difficult to transfer out of if it is too low. For me, sometimes as little as an eighth of an inch difference can turn an easy activity into a very difficult one.

When you have a mount for a lap tray or other piece of equipment attached to the wheelchair that is being replaced, Remember to remove it before the old wheelchair is taken away, especially if that piece of equipment is no longer being sold!

When you receive the new equipment, if possible keep the old one as a last resort option. It may be necessary to use it to help modify the new one. I must reiterate that it is very, very important that you use your new equipment as much as possible for as long as you can so that you can honestly tell your equipment provider exactly why it doesn’t work for you. However, do not use it long if it is causing a health problem. My posture deteriorated while I tried for two years to adjust to a firm back rest the physical therapist ordered for my new power wheelchair (I have been using sling backs for over thirty years and later I heard of others who had similar problems with this). All I had to do then was explain what was happening to my equipment provider and ask them to replace the back rest with a sling back. If you are forced to do something like this, ask them to note it in your records or they will work off the original order when they order replacement parts.

If a replacement item (with what you see as the most important feature(s) of that item) is not available, your equipment provider may not be able to legally recreate it for you for one or more of these reasons:

  • Your insurance will not cover custom equipment,
  • It is impossible to exactly recreate it using the same materials and using the available material to make it would be dangerous for you in certain circumstances. That would make them legally liable.

In case that happens you will have to use an alternate resource to customize it for you and try to make it as safe as possible and use it responsibly.

 

You Asked for It:

I believe one of our members asked about wheelchair Soccer so here are a couple of Web Sites I found for that:

http://www.adaptedsports.org/leagues/soccer/index.html

http://www.powersoccershop.com/index.asp?gclid=CP2Jm_LR-ZACFRrHIgodcWHaxw

 

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