Helping people to help themselves

Assistive technology has a key role to play in the rehabilitation of victims, says Paul Doyle, but such solutions need to be more than an afterthought in personal injury claims

The inclusion of an effective assistive technology provision is an important factor to consider when pursuing a personal injury or medical negligence claim.

However, there are a number of issues that need to be considered in a timely manner in order to ensure that any assistive technology recommendations made during the process are able to fully maximise a client’s capacity to live as independently as they want.

Wide spectrum

Assistive technology (AT) is any product or service designed to enable independence for disabled and older people. It incorporates a wide spectrum of products and/or services that have applications across a broad range of needs in a disabled person’s life, from alternative and augmentative communication (AAC) devices to wheelchairs.

For many professionals, AT tends to be associated with the technologies they encounter when engaged in their professional roles. For example, to a carer delivering personal care to an individual with a spinal cord injury, it could be a wheelchair, hoist, or postural management equipment. Similarly, to a teaching professional, AT might be considered as something that enables a child with cerebral palsy to access the computer in a classroom setting or that enables them to communicate effectively with their teachers and fellow students.

In general, the provision of AT tends to be the responsibility of professionals employed in the health, social care, and educational sectors.

Underpinning all of these is a group of professionals who are experts in the field of AT; they have grounding in and an understanding of the technical aspects of the devices, hardware, and software that are used in concert with practical support as part of a multidisciplinary response, and their mission is to maximise a person’s capacity to live as independent a life as possible.

As AT is often considered to be part of a clinician’s, teaching professional’s, and therapist’s ‘toolkit’, it is therefore incumbent on the AT expert to understand fully the interventions, their reasons for being implemented, and how any recommendations made by the AT expert may impact on those made by other members of the multidisciplinary team supporting the client.

The AT expert witness is therefore charged with taking into consideration the needs and aspirations of the client and their loved ones, and the recommendations of other experts, and writing a report that sets out their recommendations while integrating them into a realistic context, usually within the client’s residential setting.

As AT has such an extensive footprint and crosses so many disciplines, the AT expert witness is often asked to attempt to ‘glue together’ seemingly disparate and unconnected technologies into one convenient and effective integrated solution.

Indeed, it is not unusual, for example, for a client’s powered wheelchair to have the capacity to provide the user with a control mechanism that enables them to access their home computer, or to control their home environment, including doors, lighting, curtains, and home entertainment equipment.

Similarly, many communication aids are built on computer-based platforms with additional functionalities that enable a user to control access to the internet and make telephone calls using the same device.

In their report, the AT expert witness needs to carefully consider how such technologies may be integrated in order to create bespoke solutions that enhance a person’s independence while remaining as reliable and safe as possible.

Unfortunately, it is often the case that this aspect of a client’s provision tends to be considered after other experts have been instructed, have carried out their assessments, and have written their reports. This sometimes results in AT assessments of need and the provision of reports taking place when a client’s property has already undergone the adaptation process and been designed, or even completed.

This has sometimes led to the need to retrofit AT, with all of the attendant disruption and compromise in functionality and aesthetics that such an outcome engenders.

A practical example of how to counter this would be to instruct an AT expert at the beginning of the process in order that they can work with accommodation experts and other professionals to ensure they include the provision of AT in the design stage of any property adaptation or build.

Integral role

Another issue faced by the AT expert is one that arises when recommending an AT-based solution. It can sometimes be considered in a legal context that there exists an ‘either/or’ approach to AT provision or human support, in that AT is sometimes perceived as a direct replacement for care and thus may inevitably impact on a final financial settlement.

However, it is not as simple as that. It is not unusual for a person who is in the early stages of their rehabilitation post injury (or, in the case of an individual with a disability from birth, as they mature) that most of the individual’s support is provided via carers in the form of practical support and, as a result, the role of AT initially takes a secondary position.

As the individual undergoes rehabilitation or participates in their education, AT often plays an integral role in maximising their potential for independence. The capacity to alter or reduce the amount of human support as a person’s skills and confidence in using an AT-based solution increases is essential in supporting the client. Therefore, when undergoing such processes, both types of support need to be in place concurrently.

Even when the client is a mature individual, no longer obliged or indeed wanting to be involved in education, the setting of pragmatic and achievable goals related to the implementation and use of AT is crucial. By doing so, the client is able to build on success and is therefore more likely to successfully adopt and continue with their use of AT.

In some instances, such goals may appear minimal, or indeed (from an external perspective) redundant (if one has carers in place). But it is very much the case that if a person is able to do something for themselves independently, no matter how apparently insignificant that action may appear, this is widely accepted as having a substantial and positive impact on their psychosocial wellbeing and also on the wellbeing of their loved ones.

An effective transition to independence is therefore best facilitated by the multidisciplinary team supporting the client and underpinned by the setting of personalised goals based on an individual’s current and future aspirations and capabilities, and should be considered an important aspect of an AT intervention.

Bespoke programme

To that end, a mechanism that might be employed to support a young person’s transition to independence is the recently introduced education health and care plan (EHCP).

EHCPs are intended to replace statements of special educational need. They identify educational, health, and social needs and set out the support required to meet those needs.

An aspect of EHCP provision intended to address the specialist educational needs of disabled young people originates from the Special Educational Needs and Disability Regulations 2014. In the accompanying code of practice it states: ‘High-quality teaching that is differentiated and personalised will meet the individual needs of the majority of children and young people. Some children and young people need educational provision that is additional to or different from this.’

Taking the notion into consideration that additional or different educational provision is something that may be included in a young person’s provision, I have latterly suggested in my reports that it is good person-centred practice to include a client’s AT provision among the teaching and learning resources available to them, including the AT they have at home.

If a client has an aspiration to live independently then it makes sense to identify the effective use of home-based AT as part of their goal setting within a bespoke academic programme.

EHCPs are an ideal vehicle to support this method of working collaboratively and to help facilitate relationships between home and school/college.

However, it is essential that someone is in a position to ensure such an approach is followed through and, with the current economic climate putting increasing pressure on statutory services’ resources, it would be further good practice to recommend in an AT report that a case manager or a similar professional be provided with the appropriate authority and financial resources to coordinate and monitor such an approach.

That said, it is important to recognise the
value of including and setting pragmatic goals
for AT adoption and use, regardless of an individual’s age. SJ

Paul Doyle is head of access, research, and development at Hereward College