Disability- Affirmative Therapy by Rhoda Olkin

Author:Rhoda Olkin
Language: eng
Format: epub
Publisher: Oxford University Press
Published: 2017-11-15T00:00:00+00:00

Assistive Technology

Assistive technology (AT) (discussed in Chapter 4) can be simple (a modified fork), unobtrusive (a plastic ankle or foot orthotic), or readily apparent (a wheelchair) and costly (a van with wheelchair lift). Prices vary tremendously, but as soon as an item is labeled as a medical device its costs are considerably higher. An example is the small, 1 by 2 inch piece of foam used as a filter on CPAP machines for treatment of sleep apnea, which costs $25 from a medical supplier; buying foam at a hardware store and cutting it to size costs about $3.

Some AT is classified by insurance companies as durable medical equipment and subject to higher copays or exclusion. For example, it is common for insurance to cover a wheelchair but not ramps or lifts or an attached holder for crutches. Furthermore, insurance usually limits the vendors to be used, which in turn limits the options of brands and types of AT. The process of getting AT takes much of the choice away from the consumer, and studies show that this tends to disempower the consumer and make it more likely that the AT will go unused (Philips & Zhao, 1993; Riemer-Reiss & Wacker, 2000; Wessels, Dijcks, Soede, Gelderblom, & De Witte, 2003).

Using AT affects the user’s body image. For someone whose onset of disability was in childhood, AT can bring back unpleasant, even traumatic memories. An orthotic might remind the person of a heavy metal full-leg brace; buying shoes might remind the person of ugly corrective shoes; using crutches or a cane can be a reminder of previous surgery. So adopting the use of AT may have many layers of meaning to the person and is rarely a simple transition. Additionally, the use of AT visible to others will immediately change most social interactions in ways both subtle and overt. Different AT has different social connotations and evokes different interpersonal reactions (e.g., a white cane versus a service dog), and these may need to be parsed in therapy before a person can experiment with AT.

Interestingly, those with earlier-onset disabilities are more likely to adopt AT than those with later-onset disabilities (Kaye, Yeager, Reed, 2008; Olkin et al., 2006). This makes sense, in that the person with early-onset disability has to make only one transition in body image (body with disability → body with disability + AT), whereas the person with later-onset disability has to make two transitions (able-bodied → body with disability → body with disability + AT).

Once AT has been selected, actual usage requires not just physical but emotional components (Bates, Spencer, Young, & Rintala, 1993). Once adopted, the AT often becomes integrated into the person’s body image and boundaries (Lund & Nygård, 2003). These boundaries must be carefully preserved—the assistive devices become a part of the personal space. Just as you wouldn’t go up to someone and start feeling their glasses, scooters, crutches, canes, wheelchairs, and communication devices are defined as parts of the body. The AT functions as an extension of the self, performing tasks with the person.

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