SPINAL CORD INJURY TREATMENT: ASSISTIVE DEVICES TECHNOLOGY
The term “assistive devices technology” refers to the range of tools used by disabled people to interact more effectively with the environment. In the broadest sense, assistive devices include braces, splints, canes, crutches, walkers, wheelchairs, reachers, grab bars, powered hospital beds, communication systems, and even personal computers. Advances in assistive devices technology have a huge impact on the lives of individuals with spinal cord injuries.
One critical area is wheelchair design. For an individual who spends much of the day in a wheelchair, the characteristics of that chair are critically important. The chair must be comfortable, lightweight, sturdy, and maneuverable. For individuals with quadriplegia, a power wheelchair is often necessary. Sophisticated control devices have been developed for individuals with injuries of the upper cervical spinal cord, who may have difficulty controlling a power wheelchair. These devices include modified joystick controls, “sip and puff” controls, tongue switches, head controls, and chin controls.
A particular problem for people with quadriplegia is performing the pressure releases necessary to prevent decubitus ulcers – many find these difficult or even impossible to perform independently. Sophisticated power wheelchairs often can perform automated pressure releases. The entire positioning system of the chair can tilt backward, under the control of a small accessible switch: the seat, backrest, headrest, and leg-rests all tip backward, taking the weight of the body off the sitting surface. This restores blood flow to the skin under the buttocks and prevents skin breakdown.
Another important area of assistive devices technology is the environmental control unit. This device enables a severely physically disabled individual to control electronic devices in the environment, such as lighting, telephones, radios, televisions, air conditioners, and computers. A key element of an environmental control unit is the interface with the user, which may be a simple on/off switch or a complex, sophisticated, personal computer with specialized software. The environmental control unit interfaces with the appliances or devices in the environment by direct wiring or by remote control using radio waves or infrared light.
After some research, Bella, who has incomplete C4 quadriplegia, has acquired a variety of technological innovations that let her manage her life more independently. In her bedroom she has a portable heater with a timer that turns the heat on and off during the night, and a fan with the same features. Her speakerphone picks up automatically on the third ring and hangs up automatically when the other person hangs up. An X-10 internal board on her computer links to addressable electrical boxes that control lights, stereo, TV, VCR, electrical doors, bells and buzzers, and appliances throughout the house.
A final important area of assistive devices technology is augmentative communications, electronic and mechanical devices that enable individuals with speech and language impairments to have spoken or written communication. Augmentative communication has limited applicability for spinal cord injury, because most individuals with paraplegia or quadriplegia have no difficulty speaking and understanding speech. However, some individuals who require long-term use of a mechanical ventilator are unable to speak independently and can benefit from augmentative communications systems.
A related communication technology is the voice-activated computer, which can be useful for people with limited hand function.
Pauline, whose job involves writing long reports, used to rely on hired stenographers to transcribe her dictations after her C4-5 injury. She now uses a voice-activated computer. This evolving technology is becoming less costly and more effective. Pauline also uses a voice-activated switch for the call-light in her nursing-home room. This allows her to communicate easily with nursing staff when she needs assistance. Previously, she had to shout down the hall because she couldn’t turn on the light switch. This has changed everything from her sleeping habits to her personality says Pauline.
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