THE ROLE OF DEVICE LOAN IN PROCUREMENT OF APPROPRIATE ASSISTIVE TECHNOLOGY FOR VOCATIONAL REHABILITATION

Leah M. Ross, M.Ed. Device Lending Library Cerebral Palsy Research Foundation of Kansas, Inc.

Abstract: A rehabilitation agency with an emphasis on employment for persons with disabilities has been offering device loan opportunity for five years. Ten percent of the individuals borrowing equipment have voca- tionally related needs. The effect of borrowing and using equipment prior to the commit ment of funds is investigated. General data and case studies are presented. This model is extremely beneficial for Reha bilitation Services who, in an environment of reduced funding, must consider the utilization of assistive technology for their clients.

BACKGROUND

Device Loan Resource

The device loan resource, which is operated by a rehabil itation engineering center, is supported by state funds. Over 700 items are available to be borrowed by persons with dis abilities. The eligibility requirement is to be a resident of the state. The standard loan period is one month; this can be extended by agreement. Criteria for extension are the duration of a temporary need or a training program. As seen in Table 1, during the three-year period, one tenth of the loan incidents related to vocational needs of the borrower. Of these instances, over half (23 of 43) were referred by a counselor of Rehabilitation Services. Items loaned were devices to enable performance of activities of daily living as well as occupa- tional tasks.

Service                                 Total Number Vocational                   Number of

With Year                                           Need                                   Borrowers

1993                                                      131                                          11

1994                                                      127                                          13

1995                                                      172                                          19

Total                                                      430                                          43

Table 1. Borrowers with Vocational Needs

Of those who borrowed devices, 20 of the 43 instances were for an individual who was employed. An employee may ac- quire a limitation in a voca- tionally required function, from trauma or damage by repet itive motion, or a new task may be added to the occupational requirements. The referral may originate from the employer or employee. When significant limitation exists, the employee may be referred to Rehabilita tion Services. In the latter case, the counselor is the party to make the referral. Of the 43 cases cited, 36 (83.7%) had a limitation of hand function. Twenty-five of these persons were limited in their ability to perform com puter keyboard input required in their job. Seven individu als required adapted access to doors in the workplace. This was typically solved by using a simple add-on lever of rubber or metal. The cost of such an adaptation is less than $10. Thirteen required assistive devices to perform activities of daily living in their homes to get ready for work.

VOCATIONAL ASSISTIVE TECHNOLOGY CASE STUDIES

Individual With Hand Injury

A high school teacher was referred for consultation by his vice principal. This individual had been injured in an industrial accident. A major portion of each hand had been severed in a metal shear. Both thumbs were intact, only a small portion of the fingers of the left hand and a part of the index finger on the right, dominant, hand remained. It was impossible for the individual to use a standard computer keyboard. His writing was laborious. The job-related task that required assistance was keyboard input on a com- puter. This would enable him to prepare handouts, exercises and tests for his classes. The Intellitools membrane keyboard was recommended and loaned. This device is trans parent to computer software and is easily installed for use. These characteristics were desirable since the teacher would need to use computers in different locations in the school. After the initial loan period, the user said that the device was very useful. A meeting was arranged with the vice principal, the teacher, and the device librarian. The teacher described his experi ence using the keyboard. The device librarian presented product information, including cost and source of the device. During the meeting, the vice principal said she would autho rize purchase of the device from a fund set aside for ADA compliance. The cost was just over $400. The loan period was extended to allow continued use of the keyboard until the authorized device was received. The outcome of the loan opportunity was that the em- ployer was assisted to purchase an assistive device with the confidence that it would enable the employee to perform a required job task.

Individual With Carpal Tunnel Syndrome

An individual with an office job who had two surger ies for carpal tunnel syndrome reported pain when performing computer keyboard input. A pair of floating forearm sup ports, Ergo Rests, was loaned. This product, manufactured in Finland, was procured from the Adaptive Division of Willow Pond Tools. The user said that these devices were effective in allowing her to perform com puter input without pain. The individual subse- quently obtained employment with a different company. At her request, the device librar ian sent a letter to the new employer describing the forearm rests. The brand name, source, and cost were reported as well as the user's experience with the devices. The new employer elected to purchase the devices at a cost of approximately $350.

Individual With Fibromyalgia

A client of Rehabilitation Services was referred to the device loan resource to iden- tify assistive equipment which could alleviate the various symptoms of fibromyalgia. The client's plan included further university study to allow her to function as a supervising nurse and devices to make homemaking tasks easier. The initial contact was made a month before the semester ended. The immediate concern was to produce handwritten and computer reports. The client said that she could neither type nor write more than one-half page at a time without severe pain in the wrists, elbows, and shoulders. The client chose to borrow a pair of forearm rests to be used with her computer and several items to make it easier for her to perform activities of daily living. The items were returned at the close of the semester. The client reported that she had produced 100 pages of computer-generated material in the final week of the semester without experiencing pain. She also reported that she had been free of chronic headache during that time. Her opinion was that relieving stress on her hands, arms and shoulders had made her more relaxed, thus eliminating the cause of the headaches. The client was extremely pleased. In six subsequent visits to the device library, she bor- rowed 40 devices. Of the 40 devices, 25 related to activi ties of daily living and 15 related to specific vocational or training needs. The client submitted a prioritized list of items to her counselor. Her first choice was the forearm rests, which expended over half of the $600 which had been autho- rized. Fifteen additional items were purchased of which 10 related to vocational needs. The client continues to borrow items from the device library. She has purchased three additional items herself. She has developed a list of items to purchase as personal funds are available.

CONCLUSION

The utility of experimen tal use of adaptive equipment appears to have been demon- strated in the cases presented. The effectiveness of device loan in vocational as well as other areas will continue to be documented by the device loan center.

RECOMMENDATION

The agency sponsoring the device loan resource is an integral part of the "Tech Act" endeavor in its state. Tech act sites are likely facilities for device loan banks. Another mode enabling persons to exper iment with the use of specific assistive equipment would be augmented opportunities for rental or return of purchased equipment from suppliers of durable medical equipment. A statewide database of equipment that is available for purchase, rental, or loan would be use ful.

Sources of Cited Devices

Intellitools, Inc. 55 Leveroni Court, Suite 9 Novato, CA 94949 (415) 82-5959

Willow Pond ,Tools Adaptive Division, P. O. Box 544 435 Deerpath Lane Pembroke, NH 03275 (603) 485-2321

The author wishes to acknowledge the support of the Cerebral Palsy Research Foundation for the Device Lending Library. Leah M. Ross, Director Device Lending Library Specialized Services Division Cerebral Palsy Research Fndn. P. O. Box 8217 Wichita, KS 67208 (316)688-1888