Page 102 - Handbook of Electronic Assistive Technology

Chapter 4 • Assessment and Outcomes 89

Discussion with other services will be required to ensure that the technology you
are prescribing does not adversely impact on any other pieces of technology or recom-
mendations for equipment elsewhere. This is particularly the case in countries where
equipment services are fragmented, e.g., where a wheelchair service is separate from
a communication aid service. These services might also be provided through different
agencies (i.e., health vs. social care), which can sometimes introduce a gap in processes
and prevent close working. Fragmentation can introduce inefficiencies, particularly for
clients with multiple disabilities. Clients will need to go to one service for a powered
wheelchair, another for their communication aid and another for their home automa-
tion equipment, etc. In some instances, they may also be restricted as to where the
equipment might then be used or how it might be used (e.g., a tablet computer only
being available to a child in school and not at home). It also makes the process more
burdensome from the client’s viewpoint as they need to go to and fro between service
when attempting to resolve issues.
This fragmented model gives rise to multiple assessments for those with complex or
multiple disabilities. It also increases the risk of gaps occurring if each service view itself
in isolation. An example of this might be where an integrated access method is going to
be the optimum solution for a client who uses a powered wheelchair, communication aid
and environmental control. However, where the funding and maintenance of that inte-
grated system comes from is not clear and so the client might instead be provided with
three separate access methods and so will require assistance to change from the use of one
device to another. This outcome might be ideal if that is what the client chooses but not if
they wish to be as independent as possible in the use of their equipment.
To give the reader an idea of the extent of the issue, Table 4-1 indicates the range
of equipment an individual with quadriplegic cerebral palsy (Gross Motor Function

Table 4-1 Range of Equipment and Services that a Person with Severe Disabilities
May Require Access to

Range of Equipment Required Range of Services Which Provide Equipment
• Splints (ankle foot orthosis) • Physiotherapy
• Hand splints • Occupational therapy
• Wheelchair and seating • Wheelchair service
• Standing support • Charity
• Lying support • Community equipment provider
• Static seating system • Wheelchair service
• Powered wheelchair • Environmental control service
• Shower chair/toilet seat • Communication aid service
• Computer access • Social services
• Communication aid • Local Education Authority
• Environmental control
• Hoisting
• Profiling bed