"Powered mobility liberated me..."
References: (2002). Letters to the Editor: Lee Kirby, R. Where does AT fit in ICIDH-2; Stineman, M. AT outcomes: commodity or therapy?American Journal of Physical Medicine and Rehabilitation, 81 (8), 636-637.
This exchange between two medical practitioners, one with a disability, occurs in the reputable American Journal of Physical Medicine and Rehabilitiation. It demonstrates the significance of equipment (assistive technology) as a means of improving people's lives, and captures two standpoints, namely that of the treating physician and the AT user.
Dr Lee Kirby states,
'There are limits on the extent to which we in the rehabilitation professions can help to improve on someone's impairments (e.g., strength, range of motion, pain) and the broader environment in which they live (at least in the short run). However, what a person with activity and participation limitations can instantaneously do when provided with the appropriate technology is far less constrained - witness the impact of a powered wheelchair or an interface that allows access to the Internet.... Failure to acknowledge in our outcome measures and conceptual frameworks the extent of the freedom that good AT provides can lead to a significant underestimation of what rehabilitation can do' (p 636).
Dr Steinemann replies,
'I agree wholeheartedly with Dr. Kirby's assertion that assistive technology (AT) can empower people with disabilities in ways that go far beyond medicine and surgery. Witness my own life! Powered mobility liberated me to achieve my dreams to complete internship, become a doctor, and practice medicine. A compressed speech machine provided me the means to listen to medical texts at a speed close to the reading speed of those with normal vision. Computerisation helped counteract trouble using my arms. My stories, as a practicing physician, are no more compelling than those of my patients. Yet, ongoing discoveries of new AT solutions to my lifelong challenges suggest that the power of AT is under-recognised (even by physicians with disabilities) and that the potential of AT as an aid to patients is not fully tapped...'(p 636)
Where does AT fit in ICIDH-2: R. Lee Kirby, MD
'to my mind, AT is one of the most important of our rehabilitation therapeutics, perhaps even the most important (if we remove our anti-business biases and look at the amount of good that is done). There are limits on the extent to which we in the rehabilitation professions can help to improve on someone's impairments (e.g., strength, range of motion, pain) and the broader environment in which they live (at least in the short run). However, what a person with activity and participation limitations can instantaneously do when provided with the appropriate technology is far less constrained - witness the impact of a powered wheelchair or an interface that allows access to the Internet.... Failure to acknowledge in our outcome measures and conceptual frameworks the extent of the freedom that good AT provides can lead to a significant underestimation of what rehabilitation can do' (p 636).
AT outcomes: commodity or therapy? M Stineman, MD
(uses concept of 'health environmental integration')
I agree wholeheartedly with Dr. Kirby's assertion that assistive technology (AT) can empower people with disabilities in ways that go far beyond medicine and surgery. Witness my own life! Powered mobility liberated me to achieve my dreams to complete internship, become a doctor, and practice medicine. A compressed speech machine provided me the means to listen to medical texts at a speed close to the reading speed of those with normal vision. Computerisation helped counteract trouble using my arms. My stories, as a practicing physician, are no more compelling than those of my patients. Yet, ongoing discoveries of new AT solutions to my lifelong challenges suggest that the power of AT is under-recognised (even by physicians with disabilities) and that the potential of AT as an aid to patients is not fully tapped......
Some people with disabilities argue that AT is no more a therapeutic than an automobile, a computer, or a bicycle!. The prescription of AT without knowing what life with disabilities means is as ludicrous as having a stranger (rather than yourself) select the options on the car you just purchased. Yet, the wrong wheelchair or environmental interface can have consequences as devastating as the wrong antibiotic. In these contexts, AT might be viewed as both a commodity and a therapy! Although the clinician needs a special knowledge base to prescribe and attend to those details with health implications (appropriate seating, optimal biomechanics etc) the patient (or consumer) must be involved in all aspects of AT selection. An AT aid can be as intimate and omnipresent as clothing....