work in the field of FES that has occurred over the last half century has realized meaningful clinical applications to ameliorate functional deficiencies of
Laborie
Figure 9.6. Physiology of micturition produced by the Vocare®sacral nerve stimulator as identified by
cystometrogram recording. X-axis represents time in minutes and seconds with the total tracing lasting approximately 3 min. (a)
Intravesicular pressure in mm water from 0 to 150. (b) Urine flow rate in ml/s with the scale from 0 to 40 ml/s.
(c) Cumulated volume of urine voided in ml with the scale from 0 to 600 ml. (d) Approximate timing of the sacral nerve stimulation used to produce this intermittent voiding pattern.
serious neurological injuries. Several neuropros-thetic devices have gone through regulatory review and have reached the clinical world. Further devel-opment and refinement of this technology will likely enhance the lives of a greater number of patients with disability.
Technological advancements that are currently ongoing relate to the interface to nerve structures and implant stimulator design. The nerve interface is key to the stimulation or inhibition process.
Considerable progress has been made in the design of nerve-based electrodes that provide close contact to the nerve. Advanced stimulator designs are now also being realized. A newly emerging technology, called the BION®, now entering clinical trials in some applications, allows a small single-channel device to be implanted through a cannula into the desired location for activation of the nerve. Multiple units can be controlled through a single encompass-ing external transmittencompass-ing coil powered by an external processor, thus enabling some clinical applications to be realized without surgery. The advances in these technologies and the physiological interven-tions that they enable will make it possible to realize even greater impact in the lives and function of peo-ple with neurological disability.
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Following a stroke or traumatic brain injury (TBI), a person may have residual deficits even after complet-ing a therapeutic program designed to regain func-tion. The deficits may be physical, cognitive, and/or psychosocial. To overcome these deficits, people frequently use assistive technology (AT). The terms assistive technology, assistive device, and assistive technology device are used synonymously. AT device refers to “any item, piece of equipment, or product system, whether acquired commercially, modified, or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities” (Assistive Technology Act, 2004). Assistive devices include both low-technology items such as a long-handled shoehorn, and higher-technology devices such as computers with special interfaces.
Assistive devices range from basic consumer prod-ucts like a television remote, cordless phone, and microwave oven to more specialized devices such as walkers, assistive listening devices, or dressing sticks.
Environmental control devices provide another example of assistive devices. Environmental control devices can be set up to remotely operate electronic devices in the home (Mann, 1998), including lights, television, radio, phone, furnace, or air conditioner.
Light timers, for example, are simple environmental control devices that turn lights on and off at pre-set times of day.
The AT increases a person’s level of independence in performing tasks, and it may also have a positive impact on self-esteem. For example, after having a stroke, a woman experiences hemiplegia and becomes dependent on her husband for cutting food. This
dependency may make her feel more like a child than a wife. To overcome the dependency, the woman works with an occupational therapist, who shows her how to use a rocker knife. This is an adaptive utensil that allows people to cut food with one hand.
With the rocker knife, she no longer needs to rely on her husband. Her newly acquired independence makes her feel more self-reliant.
This chapter focuses on use of AT to address resid-ual deficits resultant from a brain injury. While we recognize psychosocial issues may have an impact on the person’s life and their response to AT, use of AT for physical and cognitive deficits is emphasized. Firstly, the chapter will outline considerations for interven-ing with AT followinterven-ing a neurologic condition resul-tant from injury or disease. Secondly, we will discuss AT for neuromotor impairments. Thirdly, we will present AT for cognitive impairments. Fourthly, we will address AT for sensory-perceptual impairments.
Then, we will cover AT by categories of activities of daily living (ADL) including: bathing, dressing, grooming, toileting, eating/drinking, walking/mobil-ity, telephone use, medication management, food preparation, shopping, and leisure. Finally, the chap-ter will end with a discussion about future AT.
10.1 AT intervention
Prior to recommending assistive devices, a thorough assessment of the individual should be performed.
The assessment must consider the individual’s phys-ical deficits and strengths, cognitive status, sensory