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Andrich R.,Polo Tecnologico Fondazione Don Carlo Gnocchi Onlus
Assistive Technology Research Series | Year: 2011

Objectives. Within the overall individual rehabilitation plan, selection and fitting of assistive technology equipment (AT) is often carried out within occupational therapy (OT) programs. An analysis of working practices revealed that most OT programs focus on the recovery of the person's " intrinsic" abilities, while the assessment for technological enablers (AT devices, environmental adaptations etc.) tends to take place towards the very end of the treatment. This yields three drawbacks: 1) the user is discharged from the treatment cycle without being familiar enough with the AT he or she will need in the daily life context; 2) the AT choice may be driven only by professionals without informed and responsible user's participation and 3) the devices risk to be delivered to the user long after the treatment has finished, with little or no control by the rehab team on possible technical malfunctions. In this paper, a revised protocol for OT programs is proposed that embodies early assessment for AT. Method. An analysis of current practices in occupational therapy was carried out in the OT Department of the "S.Maria Nascente" Rehab Hospital of the Don Gnocchi Foundation in Milano. Staff members were interviewed and asked to report anecdotally the work done with "typical" patients. A critical analysis followed, based on literature findings, that showed strengths and weaknesses in relation to the AT issue. Focus groups were carried out to find out how such weaknesses could be overcome; an upgraded OT protocol was eventually defined that takes into account the candidate AT equipment at earlier stages, and empowers the user to make informed and responsible choices before the end of the treatment. Results. The upgraded protocol is composed of 15 conceptual steps serving as a guide to the therapist for planning the individual treatment. AT assessment takes place at step 5 (initial), 7 (intermediate) and 12 (final). A purposely developed checklist (DAT-OT-OBJ) helps to carry out this steps. A case history of a client who went through the new protocol ("Alberto") is presented. Conclusion. Recent advancement in AT has opened unprecedented opportunities for people with disabilities; within OT programs, it calls for an empowerment approach leading the client to become informed and responsible user of AT. The upgraded protocol showed effective for this goal; however it may require re-training and some cultural paradigm shift in the involved professionals. © 2011 The authors and IOS Press. All rights reserved.


Andrich R.,Polo Tecnologico Fondazione Don Carlo Gnocchi Onlus | Gower V.,Polo Tecnologico Fondazione Don Carlo Gnocchi Onlus | Pigini L.,Polo Tecnologico Fondazione Don Carlo Gnocchi Onlus | Caracciolo A.,Polo Tecnologico Fondazione Don Carlo Gnocchi Onlus | Agnoletto A.,Polo Tecnologico Fondazione Don Carlo Gnocchi Onlus
Assistive Technology Research Series | Year: 2011

Context. In Italy the categories of assistive devices eligible for provision through the National Health Service (NHS) are established by the Ministry of Health. A medical prescription is needed for these products. Users who need assistive equipment currently falling outside the NHS schemes (e.g. ICT equipment) have to buy them out of their pocket; however schemes exist at national, regional or local level to get financial contribution, as well as fiscal benefits. Individual assessment for the choice of the appropriate assistive solution is mainly a responsibility of the Local Health authority. The competences needed for effective assessment are unevenly distributed throughout the Country. A network of Assistive Technology Centres (public or private) exists where people can apply for professional support. Overall, the Assistive Technology market is partially intermediated by professionals of the NHS or other Agencies, while partially is directly driven by the end-users. The Information system. The SIVA Portal has been designed having in mind five main targets: 1) end-users of AT 2) care professionals 3) industrialists 4) policy-makers and 5) researchers / developers. The Portal is bilingual (Italian/English) and includes six main databases 1) products 2) companies 3) centres 4) ideas 5) experiences 6) library, and a set of interactive services. An advanced search engine guides the user in retrieving information on AT in the different databases. The data are updated mainly by the manufacturers and then validated by the Portal Editorial Team on the basis of a ISO-9000 certified procedure. Impact. The Portal databases currently include some 8500 products, 1400 companies, 250 assessment and research centres, 650 hints for daily living and 300 library documents; it is considered the "golden standard" of AT information in Italy for end users, health care professionals, industrialists, policy makers and researchers; it is the key instrument for the activity of the assistive technology centres. Further developments. The ongoing developments include 1) the extension of the Portal to manage the national Register of AT products eligible for NHS provision 2) additional tools for supporting rehabilitation professionals 3) an overall re-engineering with state-of-the-art technology and 4) the upgrade of the automatic translation system. © 2011 The authors and IOS Press. All rights reserved.


Andrich R.,Polo Tecnologico Fondazione Don Carlo Gnocchi Onlus
Assistive Technology Research Series | Year: 2011

Objective. Individual assessment for assistive technology solutions (AT) is often part of the rehabilitation program; however, it may also be carried out as a specialist consultation in Assistive Technology Centres (ATCs), especially when inter-disciplinary competence and trial equipment are required. Currently, this specialist consultation is not officially recognized by the Italian National Health Service (NHS): thus it is not eligible for reimbursement. For custom-made equipment, this is not a big problem (as the cost of the professional work is embedded in the cost of the device). Conversely, it is critical for the sustainability of Institutions operating ATCs. In view of prospective accreditation and reimbursement, protocols for these consultations have been defined in order to make sure that the same type of consultation, provided by different ATCs, has a similar output at a comparable quality level. Based on economic analyses, tariffs have also been established for negotiation with Regional Authorities. Method. First, the methods used by several ATCs have been analysed; similarities and differences encountered have been extensively discussed until achieving a consensus on a taxonomy of AT Consultations in terms of topics dealt with (mobility, communication etc.) and generated output (recommendation for prescription; assistance during provision; etc.). Armed with these findings, a further analysis was carried out within a subset of ATCs until agreeing a proposal ready for submission to regional authorities as a basis for tariffs negotiation. An economical model was purposely developed to support such tariffs with evidence. Results. Eleven Consultations have been identified: 1) On-Centre Assessment of general AT needs; 2) On-Centre Assessment for mobility/seating; 3) On-Centre Assessment for ADL equipment; 4) On-Centre Assessment for home adaptation; 5) On-Centre Assessment for environmental control; 6) On-Centre Assessment for computer access; 7) On-Centre Assessment for augmentative communication; 8) On-Centre Assessment for educational technologies; 9) Home Assessment for general AT needs; 10) Home verification of the equipment provided and 11) Technical Check-up of the equipment provided. For each Consultation, a protocol has been established, as well as a tariff covering the related costs. Conclusions. The work has led to the first widely-agreed proposal for an Italian quality standard on AT assessment. Currently, the proposal has been submitted to the largest Italian Region (Lombardy) and is waiting for feedback. © 2011 The authors and IOS Press. All rights reserved.


Pigini L.,Polo Tecnologico Fondazione Don Carlo Gnocchi Onlus | Andrich R.,Polo Tecnologico Fondazione Don Carlo Gnocchi Onlus | Liverani G.,Polo Tecnologico Fondazione Don Carlo Gnocchi Onlus | Bucciarelli P.,Polo Tecnologico Fondazione Don Carlo Gnocchi Onlus | Occhipinti E.,Polo Tecnologico Fondazione Don Carlo Gnocchi Onlus
Disability and Rehabilitation: Assistive Technology | Year: 2010

If working tasks are carried out in inadequate conditions, workers with functional limitations may, over time, risk developing further disabilities. While several validated risk assessment methods exist for able-bodied workers, few studies have been carried out for workers with disabilities. This article, which reports the findings of a Study funded by the Italian Ministry of Labour, proposes a general methodology for the technical and organisational re-design of a worksite, based on risk assessment and irrespective of any worker disability. To this end, a sample of 16 disabled workers, composed of people with either mild or severe motor disabilities, was recruited. Their jobs include business administration (5), computer programmer (1), housewife (1), mechanical worker (2), textile worker (1), bus driver (1), nurse (2), electrical worker (1), teacher (1), warehouseman (1). By using a mix of risk assessment methods and the International Classification of Functioning (ICF) taxonomy, their worksites were re-designed in view of a reasonable accommodation, and prospective evaluation was carried out to check whether the new design would eliminate the risks. In one case a man with congenital malformations who works as a help-desk operator for technical assistance in the Information and Communication Technology (ICT) department of a big organisation the accommodation was actually carried out within the time span of the study, thus making it possible to confirm the hypotheses raised in the prospective assessment. © 2010 Informa UK Ltd.


PubMed | Polo Tecnologico Fondazione Don Carlo Gnocchi Onlus
Type: Case Reports | Journal: Disability and rehabilitation. Assistive technology | Year: 2010

If working tasks are carried out in inadequate conditions, workers with functional limitations may, over time, risk developing further disabilities. While several validated risk assessment methods exist for able-bodied workers, few studies have been carried out for workers with disabilities. This article, which reports the findings of a Study funded by the Italian Ministry of Labour, proposes a general methodology for the technical and organisational re-design of a worksite, based on risk assessment and irrespective of any worker disability. To this end, a sample of 16 disabled workers, composed of people with either mild or severe motor disabilities, was recruited. Their jobs include business administration (5), computer programmer (1), housewife (1), mechanical worker (2), textile worker (1), bus driver (1), nurse (2), electrical worker (1), teacher (1), warehouseman (1). By using a mix of risk assessment methods and the International Classification of Functioning (ICF) taxonomy, their worksites were re-designed in view of a reasonable accommodation, and prospective evaluation was carried out to check whether the new design would eliminate the risks. In one case - a man with congenital malformations who works as a help-desk operator for technical assistance in the Information and Communication Technology (ICT) department of a big organisation - the accommodation was actually carried out within the time span of the study, thus making it possible to confirm the hypotheses raised in the prospective assessment.

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