Chapter 3: How Can I Decide?

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• Steps Involved
• Defining Needs
• Defining Goals
• Marion's Analysis of Activities of Daily Living
• Reviewing the Options
• Personal Assistants
• Terms of Sale, Written Guarantees
• Selecting the Right Solutions
• Easy as Pie?

This chapter provides you with a step-bystep process for clarifying your needs and setting your goals for assistive technology. In addition, it offers advice that will help you gain a greater sense of control in obtaining assistive devices.

Steps Involved

There are four general steps involved in determining what assistive technology you will need:

1. Defining your needs: what is necessary/important for you in order to do what you want?
2. Defining your goals: how do you want your solutions to work?
3. Reviewing options and solutions.
4. Selecting the right solutions: testing out and making decisions among possible alternatives.

Defining Needs

To reach an eventual decision, it's important to prepare a detailed description of your daily activities from all points of view. This allows you to find out which activities give you trouble (your needs) and examine the best ways to find solutions (your goals).

The following pages provide the forms used by Marion to describe and analyze her daily activities. For your convenience, a blank version of the forms (and instructions to fill them out) are provided in Appendix 2 . You can use Marion's list as a guide, but make sure you adapt the form to your own life and activities. Once you've completed the analysis of your own situation, you'll be ready to go on to the next step.

Defining Goals

Once Marion had defined her needs using the form, she was able to identify important factors:

• Pain and lack of balance are her most common problems.
• She wishes to get around safely.
• She wants to do personal activities like washing, going to the toilet, dressing, eating, etc., by herself.
• There are some areas where she would not mind getting help or hiring someone else to complete the tasks.
• She wouldn't mind using some assistive devices if they are functional and non-intrusive.
• It's important for her to continue doing her volunteer activities.
• She wants to be able to maintain her several leisure activities.

In the end, solutions must allow Marion to do the activities she finds most important, and they must allow her to keep her dignity and maintain her volunteer and leisure  activities.

Marion's Story

Marion slipped on the ice last winter and broke her right hip. She's had surgery and now her hip no longer has the range of motion it used to. The doctors have done their best but Marion's hip will never be quite the same again. Marion walks insecurely and she can't sit in an ordinary chair or drive her car. She suffers psychologically as well and is afraid of falling and going outside.

What's more, her knees have begun to ache when she walks and her right leg no longer functions as it did before her fall. As she suspects the situation will not improve, she will need assistive technology to live an independent life.

Marion wants to be sure to get the right solutions and begins the process of obtaining personal assistive technology.

*Importance rating:

1 = You don't care whether you can do it yourself or at all.
2 = You're willing to accept help.
3 = It's very important for you to do this yourself.

*Importance rating:

1 = You don't care whether you can do it yourself or at all.
2 = You're willing to accept help.
3 = It's very important for you to do this yourself.

Reviewing the Options

Marion is the expert on her own activities and what she wants today and in the future. While she had some idea of the various assistive devices available, she had limited knowledge  about:

• the breadth of possibilities
• the latest models
• ways of changing routines
• methods of performance
• availability
• benefits

Her next step was to contact people who know more about assistive devices and accessibility and who could help her make informed decisions on the best options and solutions. For each activity, she needed to consider if her goals could be reached through therapy/rehabilitation, changing the surroundings, having assistive devices or using a personal assistant.

But before she contacted an expert, she did some investigation on her own. She talked to a friend who works as a nurse. Afterwards, she visited the library to search information on assessments and overviews of assistive devices.

The material was limited, but she discovered the addresses of local organizations for seniors and persons with a disability. Through contacting them, she learned more about the process of getting assistive devices. She learned about exhibits where products are shown. Through a municipal organization, she linked with a woman with similar problems who advised her from personal experience. She searched the Internet and found vendors and other information on assistive devices.

Well informed, she visited the local health care centre, bringing her personal list of activities and goals. There, she met an occupational therapist called Karen, who is an advisor on assessment and therapy/rehabilitation. Karen knows what assistive technology is available and if necessary, works with other specialists such as physiotherapists, psychologists, speech therapists and social workers.

Karen began by assessing Marion's mobility: how strong she is, how well her joints bend, how safe and stable her movements are. Then, using the analysis of activities forms Marion had brought with her, they reviewed her activities, her future situation and the accessibility of her surroundings; they discussed the possibility of rehabilitation solutions and explored ways of changing her routine in order to avoid pain and fatigue; they even talked about the possibility of a personal assistant. Together, they reached agreement on Marion's personal goals and began to look for relevant assistive devices. They selected a number of them to try and looked over the vendor catalogues on hand in the health centre.

The centre also had a number of products available that could be borrowed to test at home. This is especially important in the case of wheeled walkers or wheelchairs.

Karen visited Marion's home to see her actual surroundings and the way she manages her different activities. Although Marion had been thorough in her activity analysis, as a professional, Karen found a few additional problem areas.

After this meeting, the selected assistive devices were brought to her home and installed, and Marion was trained in their use until she felt secure.

Within a month Marion realized a couple of the assistive devices did not suit her needs and she contacted Karen to discuss these problems and find better solutions.

After two months, Marion came to the conclusion that she did require a wheelchair for her outings and with the help of Karen, began the assessment process to obtain the right wheelchair.

A follow-up appointment was scheduled three months later to check that everything was functioning, to assess the solutions put in place, and to discuss any new problems.

The quality of Marion's daily life is much improved!

Personal Assistants

In some situations, it might be more beneficial for you to have a personal assistant than to use assistive devices. This applies in situations where so much of your own energy is used on one activity that you have no strength left for other activities, or in situations where no assistive device can help manage what you need done.

Assistants can be your family, friends or colleagues (informal helpers). You can also use job-contract assistants who are paid by you or by government or insurance. This varies from province to province.

Regardless of whether they're paid or family personal assistants, it's important to give them honest information and training in the best way to assist you.

Terms of Sale, Written Guarantees

When you buy an assistive device, be sure to get a guide or handbook for its use, cleaning and maintenance, and ask about the process of getting proper training in its use. These issues, as well as conditions of sale and warranty, are especially important when getting a complicated or expensive assistive device like a wheelchair, car adaptation or communication aid. Get a written sales agreement, with:

• specific description of the assistive device
• description of special adaptations
• description of special equipment and accessories
• precise time of delivery
• notes about free repairs during the warranty period, including duration for these repairs, substitution of the assistive device during the time of repair, and paying of transport during the time of repair
• warranty period, exclusions if modified, and the availability of spare parts after delivery
• maintenance and service agreements
• sales price with clear definition of what it covers (special adaptations, accessories, repairs in the warranty period)
• how the payment is executed
• other issues relevant for you

Selecting the Right Solutions

When testing devices, it's important to be thorough and consider the following questions:

• Does it solve your problem?
• Does it fulfil your needs?
• If not, can you exchange it?
• Is it well designed and easy to use?
• Do you like it?
• Is it easy for your personal assistant to use?
• Can you manage to clean it yourself? If not, who can?
• Can you manage the maintenance yourself? If not, who can?
• Can you handle repairing it yourself? If not, who can?
• Do you have the instructions?
• Can you be trained on its use?
• Can you easily get help and advice if you have problems with the assistive technology?
• If the assistive device breaks, can you get a substitute quickly?
• Can you afford it?
• Do you have room to store it when not in use?
• Will it fit? (e.g. through the door, in your car)

If the answers to some of these questions are "no," it's important to discuss the problems with your advisor to find a better solution or change the conditions.

Easy as Pie?

The process of getting assistive devices in "real life" is not always easy. You may find it difficult to collaborate with your advisor, impossible to find the right solution for your problems, or challenging to get the funding you need for the device you want.

What's more, having the right device and using it for a while is not always a story of success. Testing different devices and adaptations is often necessary before you find the best solution for you. Even then, sometimes only parts of your goals may be met.

Assistive technology offers you new possibilities, but at the same time it might give you constraints (e.g. if your computer for communication breaks down, you will be unable to communicate for a period of time).

The process of getting advanced and complicated assistive devices like electric wheelchairs or computerized communication aids can be a long journey for both the user and the advisor. And then, starting your new life with an assistive device might still cause problems, which you will have to manage and solve.

Persevere. You deserve it!

 

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