The following paper was produced by the Misourri Assistive Technology
Project, a entity funded by the federal government through the
Individuals with disabilities Technology Assistance Act.  This
organization and the Illinois Assistive Technology Project, which helped
secure the document in accessable format, are federally funded.

I am writing a different version of this for an upcomming newsletter that
is broader in scope and less academic in tone.

kelly





ISSUES IN ASSISTIVE TECHNOLOGY
Use of "Experts"

Frequently assistive technology (AT) disagreements boil down to a battle of
opinions; one side says device A is needed, the other side says device B or
another alternative will meet the individuals' needs.  Typically one option is
far more costly than the other; and the question remains, what is actually
required?

The opinions of "experts" are usually significant in making a final
determination.  With no assistive technology credential to assure competence, it
is critical to carefully select an individual with the right expertise to
justify your position.  In addition to traditional questions regarding
education and training, the following are more specific questions designed to
help determine if an expert is likely to project credibility when providing
opinions on assistive technology issues.

How long has the expert been recommending this type of AT and how many devices
of this type has the expert recommended in the last year?

        Experts have more credibility when they have been in the field a few
years and have recommended a number of devices within a general AT area.  Beware
of individuals who have recommended assistive technology for limited numbers of
individuals in the last year.  Remember that for many providers, such as
physical therapists, occupational therapists, speech/language pathologists,
special education teachers, and rehabilitation counselors,  AT may be a very
small part of their overall position or practice.  In fact, their existing
credential does not necessarily mean they have any experience with AT.  The
experience  of some of these providers will also be limited to individuals
within a specific age range or disability type.  Such focused expertise can help
your case if the individual falls within those limiting characteristics.
However, if your case is the only adult the expert has ever evaluated, or the
first person with cognitive disabilities for whom they have recommended a
device, their opinion may be seriously questioned.

What is the expert's track record in device recommendations?  Do the
recommendations represent a variety of manufacturers and devices?

        It is most advantageous for an expert to have a proven track record of
recommending devices that were actually procured and used successfully over
time. If the expert has cases in which they recommended devices that were not
used successfully, you should anticipate those cases being used to question
their credibility.  Beware of experts who recommend the same device for many or
most individuals.  How can the expert address individual differences if he/she
is recommending the same device for everyone?  Were all of the individuals
really that much alike?  Recommending the same device over and over again will
likely be used to imply a disregard for individual differences. It could also be
argued that recommendation of the same device reflects limited knowledge of the
full range of devices available.  Look for experts who have current knowledge of
the myriad of device options available, who have access to a variety of devices
to use during their assessment process, and have a track record of recommending
a variety of devices.

What assessment procedures did the expert use to arrive at the recommendation?

        Beware of experts who use volumes of standardized testing data in areas
such as cognition, visual acuity, auditory acuity, range of motion, fine and
gross motor, receptive and expressive language, etc. as the basis for their
device recommendation.   While standardized testing in traditional areas may be
helpful in AT assessments, it should not form the sole basis for a device
recommendation.  Best practice would include consideration of many other factors
in the development of a device recommendation.  These would include the
environments in which the device is to be used, the expectations for the
individual in those environments, the supports needed for device use, and
individual preference in device use.  The features of a variety of devices
should be compared to these factors to ascertain which device(s) might meet the
individuals needs.

Did the person actually try the device recommended?  For how long?  What
outcomes or behaviors were observed during the device usage?

        By far the best procedure for determining if a device will work for an
individual is actual use of the device, in a natural environment, to perform the
activities desired.  Careful documentation of the degree to which the device
provides the desired outcomes provides almost irrefutable justification for the
device recommendation.  While some trial device usage data can be collected in a
structured evaluation setting, typically the limited device usage time and the
unnatural environment of a structured evaluation makes such trial data less than
optimal.  Trial usage of a loaned or rented device over a longer time period,
such as a few weeks, in the environments of actual use, provides powerful data
to support a device recommendation.  An expert who is able to present
"real-life" observations of the individual using the recommended device is far
more persuasive than one who presents only a theoretical rationale for their
recommendation.

What standard is the expert using for their recommendation?  Is it consistent
with the legal standard in question?

        Experts sometimes are not aware of the difference between their
professional opinion as a medical, rehabilitation, or education provider and the
legal standard in question.  Many providers will recommend devices designed to
maximize an individual's function which is appropriate based on the professional
standard of "best"  client services.  However, such a recommendation may not be
consistent with the legal standard applicable to the case.  For example, a
device that maximizes client function may not be consistent with the
"appropriate" standard of IDEA, the "effective communication" standard of ADA,
the "necessary for employment" standard of VR, the "medically necessary"
standard of Medicaid, and so on.  Make sure that your expert understands the
legal standard upon which their device recommendation must be based.

For more information contact:           Missouri Assistive Technology Project
                                        4731 South Cochise, Suite 114
                                        Independence, Missouri 64055-6975
                                        800/647-8557 (V)   800/647-8558 (TTY)