Occupational Therapy News OTNews March 2020 | Page 29

TECHNOLOGY FEATURE
ECS provide simple alternative access to everyday
occupations, permitting total independence in a wide variety
of activities. This includes, but is not limited to, telephone
management, control over changing radio and TV channels, and
custom modifications that include door lock release and powered
drapery (for closing curtains and blinds).
Promoting independence
Occupational therapists within the trust recently worked with one
man with a diagnosed learning disability and cerebral palsy, who
is reliant on his self-powered wheelchair, but can perform sit to
stand transfers with support.
Over the last year Daniel’s physical health has deteriorated,
resulting in several hospital admissions. Although fiercely
independent, his deterioration has led to reduced independence
in carrying out routine household activities of daily living, and more
dependence on his 24-hour, one-to-one care team to perform
home occupations.
He was referred to occupational therapy for consideration
of a home automation system. This refers to the mainstream
integration of the electrical components of a person’s house,
which provides a central control to enhance comfort.
This field of ECS can include control of lighting and home
entertainment systems, (Lange and Smith 2002).
Evaluating the environment and daily routine to
identify goals
Daniel lives in a ground floor flat, made accessible, with a lowered
sink and counter tops for example, for him to perform occupations
from his wheelchair. He would regularly prepare his own
workspaces – open and close cupboards, draws and the fridge
for example – with equipment needed to achieve occupations,
and took comfort in being in control of what he wanted to watch
on TV or listen to on the radio.
Daniel was particularly interested in opportunities that would
continue supporting him to achieve household occupations
independently.
It was felt that motorised blinds, curtains, door openers
and switches to control the TV and radio would support him in
achieving his identified goals.
After Daniel identified what he wanted to achieve from
the intervention, the occupational therapist approached the
appropriate services to arrange further ECS assessments.
The occupational therapist collaborated with a consulting team
to assess his capability for learning new tasks and determining
the most complementary method of integrating new skills with old
occupations.
Daniel was able to demonstrate the cognitive ability to perform
the steps involved in operating an ECS and was considered a
viable candidate.
Determining the control
The final step was to determine the style of control switch that would
best suit Daniel’s capabilities to successfully operate the system.
This was completed by assessing muscle strength and range of
motion, visual/aural/perceptual status, and gross and fine motor
co-ordination.
Control was achieved using a centralised control point, which
will be computer based with a user interface involving a large touch
screen consoles connected to his iPad.
To gain an overview of Daniel’s function, the occupational
therapist completed the Model of Human Occupation Screening
Tool at the beginning and end of the intervention.
A six-week follow up after the ECS had been installed identified
that Daniel was participating in more household tasks and
executing choice in performing these tasks independent of his care
team.
Daniel also had an increased confidence in his skill level and
reported feeling greater mentally due to regaining choice and
independence.
To conclude, through technology, people with complex physical
impairments can enjoy a higher level of participation in life’s many
activities.
ECS can make significant contributions to increasing the
functional independence of people with physical impairments and
should be considered by occupational therapists as part of their
essential toolkit when assessing and providing recommendations
for facilitating functional independence interventions.
References
AOTA (2010) Specialised knowledge and skills in technology and
environmental interventions for occupational therapy practice.
American Journal of Occupational Therapy, 64 (Supplement)
Claire M and Verdonck M (2012) The meaning of environmental control
systems (ECS) for people with spinal cord injury: an occupational
therapist explores an intervention. Available online at: https://bit.
ly/2vbrOLC [accessed 2 March 2020]
Dickey R and Shealey SH (1987) Using technology to control the
environment. The American Journal of Occupational Therapy, 41,
717-721
Emiliani PL, Stephanidis C and Vanderheiden G (2011) Technology and
inclusion – Past, present and foreseeable future. Technology and
Disability, 23: 101-114
Lange ML and Smith R (2002) The future of electronic aids to daily living.
The American Journal of Occupational Therapy, 56: 107-109
Polgar JM (2006). Assistive technology as an enabler to occupation:
What’s old is new again. Canadian Journal of Occupational Therapy,
73: 199-205
Weber Dow P and Pearson Rees N.(2002) High-technology adaptations
to overcome disability. In CA Trombly and MV Radomski (eds),
Occupational therapy for physical dysfunction (5th ed.). Philadelphia:
Lippincott Williams and Wilkins
Rebecca Haythorne, occupational therapist and clinical academic
research fellow, Leeds and York Partnership NHS Foundation Trust,
email: [e-mail] or Twitter: @ot_researcher
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