By Andria Segedy
The ABCs of AT How to choose the best educational options in the field of assistive technology. A clinician in a continuing education course on wheeled mobility was surprised to learn that a wheel could be removed from a wheelchair. During a course on wheelchair seating, a clinician could not identify a lateral trunk support and did not know the meaning of seat depth. These are real examples of the limited knowledge of some clinicians responsible for assessing client mobility and seating needs, according to Jean Minkel, MA, PT, who has an independent consulting firm in New Windsor, NY, specializing in assistive technology, and Kelly Waugh, MA, PT, a seating specialist for Children’s Specialized Hospital, Mountainside, NJ. According to Joy Hammel, PhD, OTR/L, assistant professor, Occupational Therapy and Disability Studies, University of Illinois at Chicago similar examples can be found with clinicians working in computer access, augmentative and alternative communication, universal design, and other assistive technology (AT) fields. “The level of expertise and knowledge really varies,” Waugh explains of clinicians who enroll in her courses, “but as a general rule, it is pretty poor. “It’s not the clinicians’ fault. There is an expectation in the system that therapists know seating evaluation,” she says, “yet they don’t study it in school. We say the evaluation process should involve a clinician, but there is no formal system for giving them that knowledge.” Why AT Education “When I started 18 years ago,” Minkel says, “I had 21 children on my caseload and one ambulated. I had one catalog, and if you knew that book, you knew all the technology that was available then. For a new graduate, there are five football fields of equipment to choose from. It is absolutely overwhelming. It’s up to clinicians to sort through it.” Consumer need has created this expanding market, and the Internet has broadened both clinicians’ and clients’ ability to access a wide variety of information. In addition, work-site opportunities are changing. During the past 5 years, traditional rehabilitation facilities have closed clinics that specialize in AT, such as in seating or computer access, because of financial reasons, according to Minkel. But the need for that technology continues to thrive and consumers are finding it at alternative sites. For patient assessment, clinicians need to know the basics, including: the categories of AT; how to assess from a functional standpoint; service delivery specialists and the process of delivery; and payors and what they will fund. “Don’t assume a person in a wheelchair only needs seating,” she stresses. “It is better to take a course that covers several areas of technology.” Finding the Courses There are at least 20 structured graduate programs or certificate opportunities within graduate programs that focus on AT or some specialization, such as wheeled mobility or computer access.1 Jim Lenker, MS, OTR/L, ATP, clinical assistant professor, Department of Occupational Therapy, State University of New York at Buffalo, comments, “The university-based degree programs offer a chance for people to do mentored or guided exploration of new content and to go through a growth period over time. They also provide the chance to systematically study an issue and form opinions on issues. Not that you can’t do that with weekend courses, but that is not really their objective. The primary objective of short courses is to convey information on a relevant topic. At a university, you help people conduct research projects that arrive at systematic answers to relevant clinical questions.” Word of mouth is the best mode of finding the good courses. “Talk to others who have gone through the same program,” Lenker advises. “Be sure to compare their goals with yours. Others may like or dislike a program because their needs or expectations are different from yours.” Hammel suggests looking for names in the field and asking colleagues. “Join the American Occupational Therapy Association (AOTA) and the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) list serves, and ask who gives good lectures. The quality can vary radically,” she says. Check for local opportunities. For example, Ohio’s Assistive Technology Distance Learning Project is targeted to clinicians and other professionals working in the schools, according to Mary Binion, MA, executive director of Columbus-based Ohio Resource Center for Low Incidence and Severely Handicapped (ORCLISH). The Distance Learning Project is cosponsored by ORCLISH, a statewide, federally funded project under the direction of the Ohio Department of Education, Division of Special Education. About 20 courses are offered each year. Content varies from technology solutions to how to fund them. More than 250 professionals in education have enrolled since it debuted during the 1997-1998 school year. Graduate credit hours are available through Bowling Green State University, Ohio. Making the Right Choice Because AT broadly covers so many technologies and solutions, clinicians who teach in these areas stress the value of a general course that provides an overview of all these opportunities. These lecturers agree that solutions to one challenge typically affect the end result of another challenge and its solution. “I don’t send people to conferences if it is their first shot at technology because I think it is overwhelming,” Hammel says. “You are more likely to get a good course that provides the basics either from a university or from the RESNA introductory course. They are not trying to sell products.” Courses sponsored by manufacturers are typically hawking their specific products. “A clinician needs to know how to analyze features of products from various manufacturers to be sure the right solution is found,” Hammel explains. Courses should disclose the affiliations of all speakers so attendees know if a presenter works for a manufacturer. Hammel advises clinicians to get the details of the course by asking for a copy of the syllabus and find out how much of the course is hands-on. She notes, “If you don’t get to touch anything, you won’t learn it.” Hammel also stresses the value of taking courses that offer graduate credit or at least continuing education credits (CEUs). Many facilities give raises to clinicians on the basis of graduate credits earned. “Credits look better than CEUs,” she says. “If [clinicians] want the information to expand their skills for clinical practice, then quality continuing education is fine. If they want to add to a degree, then they need to think of a total program of credits. And there is little to regulate the quality of either. So, just because a course is for graduate credit does not mean it’s good. Once again, they need to look at the content and the presenters and know what they want to get out of the course,” says Elaine Trefler, MEd, OTR, FAOTA, ATP, University of Pittsburgh. She developed content for the university’s AT home study and workshop courses and is one of the founding course developers of the International Seating Symposium, which began almost 20 years ago. The AT Training Program is a home study course developed by the University of Pittsburgh. The next step is to turn the home study program into a course that can be taken over the Internet later this year, she adds. “There is a huge demand for online courses,” says Lenker. “People who get involved in AT are a few years into their career, they are in a geographical area they like, they have family commitments, and they don’t want to move anymore.” Editor’s Note: For resource information, see the Web version of this story at www.rehabpub.com. Andria Segedy is a contributing writer for Rehab Management. Reference 1. Lenker JA. Professional education programs in rehabilitation engineering and assistive technology. Technology and Disability. 1998;9:37-48. Resources Ohio Resource Center for Low Incidence and Severely Handicapped Contact: Kim Finnerty 470 Glenmont Ave Columbus, OH 43214-3292 (614) 262-6131 (800) ORCLISH (614) 262-1070 fax (614) 262-5989 TTY kim_finnerty@coserrc.esu.k12.oh.us www.orclish.org Rehabilitation Engineering and Assistive Technology Society of North America 1700 N Moore St, Suite 1540 Arlington, VA 22209-1903 (703) 524-6686 (703) 524-6630 fax (703) 524-6639 TTY info@resna.org www.resna.org University of Pittsburgh School of Health and Rehabilitation Sciences Contact: Linda Szczepanski 4020 Forbes Tower Pittsburgh, PA 15260 (412) 647-4222 (412) 383-6535 fax (412) 383--6529 TDD szczepan+@pitt.edu www.shrs.pitt.edu
