Assistive Technology in Daily Life: Support That Makes Equipment Used

Each OT is familiar with the archaeology of a home visit, the shower chair that hasn't been moved from its spot beside the shower, the four-wheel walker still in the garage behind the mower, the communication device still in its package, and the kitchen aids still in their box on top of the fridge.

They were evaluated, explained, funded and prescribed appropriately, and now they are furniture. When assistive technology devices are abandoned, it is typically treated as a prescription issue, an inappropriate device, a poor fit, sometimes just bad luck. But take a stroll through the same homes and another story becomes apparent: the items that remain are the ones someone actively helped that person use in the early days, when they were used differently and slower than they used to be. Abandonment is most often a support design failure in disguise as an equipment one.

With that reframing, support workers are at the core of the AT outcomes, as the awkward first few weeks take place on their shifts.

Why good equipment gets abandoned

The mechanics are predictable. New AT front-loads costs, back-loads benefits: the walker is slower than furniture surfing; the energy-saving methods seem like giving up; the changed cutlery makes them stand out at their own table. The person will make whatever locally rational choice it is that day, the way it was before, the old way, and after 30 todays it will be furniture. Include the secondary forces, a family member who can help more quickly than the equipment, embarrassment, a setup that wasn't quite adjusted after delivery, and the abandonment rate will no longer be mysterious. None of these forces are clinical. They are all accessible to the one present at the time of use.

Designing the support around the equipment

Make AT adoption a part of the support arrangement, clearly stating that the intervention is part of a job. The support brief, in the shift-language discussed in the previous part of this series, is a list of equipment, moments, and the worker's role during each of them: set it up before the moment comes, so that using it is the path of least resistance; prompt and encourage through the slow weeks, with the specific framing that works with this person; do not do the task for her in the name of speed; and report the friction honestly, because "she avoids the rail on the left side" (three weeks early) is an adjustment, while "she avoids the rail on the left side" (three months late) is a garage. When there is a setup or adjustment dimension, the joint session gets one more shot at success: one demonstration, correct height, placement and technique, with a regular worker present, will stop a season of subtle misuse.

The worker as your early warning system

The feedback channel is important to AT, since there's no sound of abandonment. No one calls the OT when the walker goes to the garage, and it comes up at review, after the funding year has passed and the risk of falls has returned. If the worker has been briefed on the early warning signs, the workarounds, the item moving away from where it belongs, or the "we didn't bother with it today" attitude becoming a habit, abandonment becomes a mid-course correction instead of a review discovery. The reporting list on the bottom of the AT brief, then, is no place for administrative decoration. It is the difference between adjusting a prescription and having to re-justify one.

How this plays out in practice

Imagine a man in his 70's who receives a walker and bathroom rails after a fall and receives support every day while living alone. The unsupported edition is the traditional one: the walker embarrasses him, the rails are on the other side of habit, by review both are furniture, and the falls conversation begins de novo at a lower level. The designed version involves the worker placing the walker at the bedroom door in the morning and walking with him for the first two weeks, reporting in the third week that he avoids the left rail, it was two centimetres too low, and the support is adjusted that week. At review the equipment is an integral part of his day, the whole clinical outcome, and it was carried on his shifts.

Next steps

Include the adoption paragraph in the support brief for your next AT prescription to a supported participant: the moments, the role of the worker, the never-do, and the three early warning signs to report. It's five sentences, and it's the five that determine the rest.