Physicians and Assistive Technology: A Practical Spectrum from "Low Tech" to "High Tech"
Richard S. Kaplan, MD
Guest Editor: "The role of physicians in the selection and use of
assistive technology, despite all the new players in the field, is
still vitally important. This issue of Tapping Technology provides
some valuable insight into both aiding physicians in their role with
Lisa Reeves article on "Guidelines for the Use of Assistive
Technology" on page 6 as well as exploring new paradigms with Steve
Mendelsohn's lead article on "New Approaches to Physician Involvement
in Assistive Technology.'' Enjoy these articles, and a wealth of other
good information, including my article which follows.
The practice of physical medicine and rehabilitation is, by its very
nature, closely intertwined with the development and application of
assistive technology. One of a physiatrist's roles related to the
provision of assistive technology services is to be aware of a
spectrum of available devices and community resources in order to
refer a given patient to the most appropriate facility or health
professional for a given clinical situation.
Although assistive technology most commonly is discussed in the
context of relatively sophisticated engineering solutions for
moderately or severely physically disabled individuals, in practice
assistive technology represents a spectrum of devices and techniques
applicable to a large number of individuals. It would be my hope that
this article will serve to open community discussion regarding very
real needs within the community for inexpensive, practical technology
which could greatly improve the quality of life for disabled
individuals, particularly in relatively medically underserved
regions.
Tapping Technology
Low-Tech Gait Aids and Accessible Architecture Some of the most basic
assistive technology devices have been around for quite some time:
gait aids and accessible architectural design. Some commonly known
examples include the following:
- Walkers (with options including wheels, brakes, platform grip,
adjustable height, and collapsibility)
- Hemi-walkers
- Canes (single point, narrow quad, wide quad)
- Lower extremity orthotics, including ankle-foot orthoses ("short
leg braces") and knee-ankle-foot orthoses ("long leg braces" )
- Ramps (typically l" rise for each horizontal foot)
- Curb cuts
This list represents but a few of many common, "low technology" items
which can have a profound effect on improving the lives of disabled
individuals. Despite their apparent simplicity, significant academic
research exists regarding the engineering aspects of these
devices. Moreover, there appears to be a trend in our communities and
our media to publicize and encourage development of sophisticated
interventions and devices, where more traditional technology might be
not only less expensive but also more reliable.
Particularly in rural regions of the country (including Maryland),
many patients do not have the modest means required to obtain
assistive technology of this nature.
Many patients in rural Maryland and elsewhere in the country cannot
leave their homes simply for lack of an appropriate wheelchair ramp or
other assistive device. Certainly a small investment by a community
could reap significant future rewards in terms of both improving
quality of life and minimizing eventual long-term care costs. Working
toward universal access to these devices would perhaps be an excellent
project for community service organizations and local political
leaders.
High-Tech: The InterNet and World Wide Web Among the more practical,
relatively affordable "high tech" roles of assistive technology is the
dissemination of information to individual patient homes as well as to
physician offices in towns which are distant from a medical
library. Many concepts are currently under commercial development,
including sophisticated remote consultation systems and remote
radiology / pathology interpretation sites. On a somewhat more
practical and widely affordable level are various medical applications
of the InterNet, the expanding international "information
superhighway."
The InterNet provides a number of vehicles for physicians and/or
patients to expand knowledge of assistive technology:
E-mail
InterNet electronic mail allows for one on one discussion and
consultation with assistive technology professionals by physicians or
patients located in distant, rural locations. E-mail addresses for the
Maryland Technology Assistance Project staff, for example, have
previously been published in this newsletter.
USENET Newsgroups
USENET Newsgroups are public forums for discussion and information
sharing on thousands of academic, recreational, or scientific
topics. They are particularly useful for persons with esoteric
interests or with rare disabilities, as they provide a forum for
discussion with others around the world. A number of Newsgroups are
particularly pertinent for those with an interest in disabilities or
assistive technology, including the following:
- misc.handicap
- Disability-related discussion group
- sci.med
- General discussion group regarding medical issues
- sci.med.vision
- Discussion of vision-related issues, including vision-related disabilities
- alt.support.arthritis
- Arthritis support group
- alt.support.cerebral-palsy
- Cerebral palsy support group
- alt.support.dev-delays
- Developmental delays support group
- alt.support.dwarfism
- Dwarfism support group
- alt.support.mult-sclerosis
- Multiple sclerosis support group
- alt.support.musc-dystrophy
- Muscular dystrophy support group
- alt.support.spina-bifida
- Spina bifida support group
- alt.support.post-polio
- Post-Polio support group
World Wide Web
The World Wide Web is a means of publishing information graphically
and instantaneously via computer. The Web could be thought of as
analogous to interactive television with a nearly infinite number of
channels and a relatively low cost to become an information
provider. The Web includes sites on an extremely broad range of
topics, many of interest to those seeking medically related or
assistive technology related information. The following is a partial
list of addresses for a few of the many medically / technologically
related Web Sites. A picture is certainly worth a thousand words, so
please access the Web yourself for a demonstration, as you certainly
will not be disappointed.
Web Sites:
- http://www.missouri.edu/~ccact/
- University of Missouri-Columbia Adaptive Computing Technology
Center Excellent collection of adaptive computing resources on the net
- http://137.108.67.9/dis/disability.html/
- Multimedia Enabling Technologies Group, U.K. (from Britain) The
best comprehensive guide to disabilities-related materials on the
InterNet
- http://cosmos.ot.buffalo.edu/aztech.html
- Ztech Inc. Assistive Technology home page
- http://www.webable.com/csun.html
- CSUN Center on Disabilities ~~ Referral page to the California
State University Center on Disabilities
- http://www.icdi.wvu.edu/RIS/Keywords.html
- West Virginia University Rehabilitation Information System
Outstanding collection of pointers to extensive rehabilitation and
rehabilitation technology related information on the InterNet
- http://branch.com:1080/adaptek/adaptek.html
- Kurzweil/VOILA Technology, Inc. Information on commercially
available Kurzweil VOICE system for Windows
- http://hospital.net/
- Hospital Net -- A resource for doctors, patients, and medical
students providing a broad set of resources on medicine and medical
education
Dr. Kaplan is a physiatrist a (a physician specializing in a physical
medicine rehabilitation) formerly practicing in Salisbury, Maryland
and currently Medical Director of the Department of Physical Medicine
at Uniontown Hospital, Uniontown, Pennsylvania. Prior to studying
medicine, Dr. Kaplan was employed as a biomedical engineer designing
medical instrumentation. He is also an active private pilot and FAA
aviation medical examiner as well as an aspiring flight instructor
with an interest in wheelchair aviation. He may be reached on the
InterNet as rkaplan@netcom.com.
