Assistive Technology Services

Woodrow Wilson Rehabilitation Center offers state-of-the-art evaluation, consultation, and treatment programs for individuals who require assistive technology to live, work and go to school as independently as possible. The Assistive Technology Services program at WWRC is part of the statewide DRS Assistive Technology plan, and as such, provides services to individuals with disabilities across the Commonwealth of Virginia. Services are available to adolescents and adults, with an emphasis on work and independent living. Services are provided by interdisciplinary Assistive Technology Teams whose objectives include integrating all technologies into a person's lifestyle and personal goals.

Mission Statement

In partnership with persons with disabilities and rehabilitation professionals, the Assistive Technology Services program provides comprehensive interdisciplinary technology assessments and customized technology services, which may include special and individualized computer technology, customized rehabilitation engineering and fabrication, augmentative alternative communication, mobility enhancement, and adaptive devices for daily living and recreation, in order to improve employment potential, foster independence, and promote full inclusion in society through the use of assistive technology.

The Assistive Listening and Alerting Devices Center is coordinated through the Audiology and Deaf Services programs at WWRC. In this program, audiologists provide evaluation, consultation, and training for individuals who are deaf or hard of hearing in the selection and use of a variety of assistive devices to help them operate independently in their communities. Consultation is also available to case managers, employers, and other interested individuals regarding the selection and use of assistive listening devices.

Purpose

The purpose of the Assistive Computer Technology Program is to help people with disabilities access computers for educational and vocational goals, and to enhance their overall quality of life. The ACT Lab at WWRC is designed and staffed to provide interdisciplinary team evaluations of clients’ abilities in order to identify safe and effective adaptive technologies. These technologies may include hardware and software for full computer accessibility. The WWRC lab is able to provide services for consumers with the most severe disabilities, and who require a full interdisciplinary team, including Occupational Therapists, Computer Systems Engineers, Speech-Language Pathologists, Physical Therapists, Rehabilitation Engineers, and / or Education Specialists.

Services in Order of Priority

In order to provide efficient and timely services, and utilize professional staff most effectively, the following priorities have been established for ACT service provision

1. Computer accommodation evaluations
    
2. Consultations regarding accommodation, computer specifications, etc.
    
3. Set-up of computers with adaptive technologies and software for DRS Consumers
    
4. Troubleshooting of computers with assistive and adaptive technology
    
5. Training in use of adaptive technologies and software may be possible

In all of these services, top priority will be given to consumers for whom computer services are urgently needed in order for the client obtain or keep a job.

On-Site Services

Under certain circumstances, on-site services can be provided in a consumer’s workplace, workshop, home, or residential facility. These are considered to be exceptions to the usual policy of providing services in the ACT Lab or during mobile clinics. The criteria for determining if an evaluation or other service should be completed on site are

• A specific situation is identified which must be evaluated in the client's home, work, or school environment to determine appropriate recommendations.
   
• Home-bound clients who absolutely cannot access transportation to WWRC or mobile clinics, and for whom home health or other community-based services are not able to meet the identified service need.
   
• Medical attention required (e.g., suctioning, ventilator, tube feedings, IV's) exceeds that which could be safely and effectively provided in the ACT Lab. In other words, the consumer would be at risk of medical complication outside of their home environment.

Mobile Clinics

• Abingdon / Wytheville - 2nd Thursday, monthly
• Northern Virginia, Alexandria Office - 4th Thursday, monthly
• Roanoke - 2nd Wednesday, monthly

Who typically needs the service?

• Persons with physical, sensory, and/ or cognitive impairments that may affect their ability to utilize a computer within and across specific environments.
• Persons with physical/cognitive deficits that may include
• Cerebral Palsy
• Spina Bifida
• Spinal Cord Injury
• Traumatic Brain Injury
• Cerebro Vascular Accident
• Multiple Sclerosis
• Muscular Dystrophy
• Amyotrophic Lateral Sclerosis (ALS)
• Parkinson’s Syndrome
• amputations
• arthritis
• orthopedic and mobility limitations
• chronic pain
• visual deficits
• learning disabilities
• Attention Deficit Disorder (ADD, ADHD)
• other disabilities not specified

The Adaptive Driving Program is coordinated by occupational therapists with specialized training in adapted driving. The program provides evaluation of driving potential, devices required for safe and effective vehicle control by the individual, and on the road training in use of the devices. Recommendations are also provided for van and car modifications for wheelchair access and tie-downs.

Many times after an injury or illness, it may be necessary to relearn and adapt to driving (possibly using adaptations to your vehicle) before getting back out on the road again. WWRC’s Occupational Therapy (OT) department offers a state-certified driving program with nationally certified Driving Rehabilitation Specialists.

One of these Driving Rehabilitation Specialists will evaluate your ability and potential to drive. The first part of the evaluation is done in the OT department and includes

• Visual, perceptual and cognitive screening
• Physical skills evaluation
• Reaction time testing in an electronic car simulator (see photo below)

Next you will be introduced to driving on the quiet roads around our campus facility using whatever adaptive devices are needed (for example, hand controls for gas and brake). As your instructor feels confident in your abilities, your instructor will begin to introduce you to real-life driving situations around town and then onto the highway.

Specialized Driving Program offerings provided by the Driving Rehabilitation Specialists include

• Van/Driver's Evaluation: if you would need to drive a van because you are unable to transfer from the wheelchair to a vehicle seat and load the chair.
• Adaptive Driver Controls Evaluation and Training: a wide variety of adaptive controls are available when you can no longer drive with standard gas and brake pedals. These range from hand controls or left-foot accelerators to highly sensitized low-effort steering and electronic gas and brake hand controls (see photo below).
• Dependent Van Evaluation: an evaluation to identify the type of van and modifications that would be needed for individuals with disabilities who will be riding as a passenger in a van.
• Van Education: for individuals who are considering purchasing a van, but need clarification on type of van to buy (usually precedes prescribing van modifications); contact information for driving equipment manufacturers and adapted driving vendors.
• Van Modification Evaluation: for individuals who own a van but need recommendations regarding appropriate modifications for safe driving; provides detailed driving equipment prescriptions.
• Bioptics Evaluation and Training: driving services for individuals using bioptic telescopic lenses for vision.
• For those who may not require special driving controls, but need some additional supports and on-the-road practice before obtaining their drivers license, WWRC offers state-certified driving instructors who provide
  • Driver's Education: class work to prepare for the written driving test required for licensure.
  • Driver's Training: on-the-road training to gain skills required for safe driving.

Resources

• How might a disability affect someone’s driving abilities? The Association for Driver Rehabilitation Specialists (ADED) has a web site with a “Fact Sheets” page that provides some information related to this question. www.driver-ed.org.
• Vehicle Modifications: The WWRC Driving Program can provide you with recommendations for special vehicle needs including information on the types of vehicles that will best match your special driving needs and the rest of your mobility equipment (for example, if you use a wheelchair or scooter). The National Medical Equipment Dealers Association is the professional organization that sets standards for vendors who perform vehicle modifications. You may visit their web site to find a qualified vendor near you or to search through their publications related to driving with a disability. www.nmeda.org.
• “Disabled Does Not Mean Immobile” by Becky Plank is a good book written for the person who may have questions about what type of adaptive equipment they might need to drive after a disability. www.nmeda.org/DDMIBook.htm.
• Bioptic Driving: This website is maintained by a national non-profit organization whose mission is to promote information and research relevant to persons with low vision who desire to drive. www.biopticdriving.org.

Forms

Customer Medical Form: When you call to schedule a driving evaluation at WWRC, you will be sent a packet of information that will include a copy of the DMV's Customer Medical Form. Please have this form completed by your physician and return the form as directed in the Admissions packet (form must be received for scheduling to occur).

The Department of Motor Vehicles (DMV) requires that your physician or eye doctor complete this Medical Statement form in the following situations

• Following any illness or injury that might have affected your driving abilities
• Spinal cord injury or any other complete or partial paralysis of one or more limbs
• Cerebral palsy
• High blood pressure
• Stroke or cerebral vascular accident (CVA)
• Heart disease
• Brain injury or other conditions affecting memory, judgment, decision-making or reaction times
• Amputation of either arm/s or leg/s
• Visual problems
• Orthopedic injuries or problems like arthritis that limits movements
• Seizures, epilepsy, blackouts, dizzy spells
• Progressive neurological disorders like muscular dystrophy or multiple sclerosis
• If you may need adaptive equipment to drive (for example, hand controls),
• If there is any question of driving abilities due to emotional, behavioral or cognitive problems including psychiatric impairments or alcohol/drug abuse

Disabled Parking: Information about getting temporary or permanent disabled parking permits.

Minimum Vision Requirements for Driving: The DMV has established requirements for vision as part of the licensure process. Vision testing allows you to wear your corrective lens (glasses or contacts).

Bioptic Lens Users: For persons using these special lenses for driving, the DMV requires that this form to be completed by your eye doctor.

Deaf or Hard of Hearing: Special decals are available from the DMV for persons driving who have hearing impairments.

Augmentative and Alternative Communication is a specialty area of clinical practice in speech language pathology that assists individuals with severe expressive communication disorders of communication (ASHA). In the Augmentative and Alternative Communication Program, a unique team works together to assess the communication needs of individuals with severe speech impairments or who have no functional speech. Both low and high technology solutions are applied to provide the individual with the most appropriate communication system to meet daily communication needs. Specialized training in using the systems in daily functional settings is incorporated into all client programs. This team is headed by a speech-language pathologist and may include an occupational therapist, physical therapist, rehabilitation engineer, vocational evaluator, or computer systems engineer.

Additional components of the Augmentative and Alternative Communication assessment may include

• Speech-Language Assessment
   
• Cognitive and Behavioral Assessments
   
• Vision / Visual Perception Assessments
   
• Motor Control Assessments
   
• Seating and Positioning Assessments
   
• Access Assessments

Together these areas assist with determining which device which would best suit the individual’s communication needs.

Who typically needs the service?

• People with speech impairments that alter the effectiveness of their communication.
   
• People who are not able to communicate all functional needs (such as presence of pain, desire for food, or need to use the bathroom) by their present communication modes.

 

• People with communication deficits that may include the following diagnoses:
   
  • Congenital: examples include Cerebral Palsy, Autism, or genetic syndromes
     
  • Acquired: examples include traumatic brain injury, cerebrovascular accident, or ventilator dependent diagnoses
     
  • Progressive: examples include Multiple Sclerosis, Muscular Dystrophy, Amyotrophic Lateral Sclerosis, and Parkinson’s syndrome

Empowerment Through Communication (ETC) Program

The Woodrow Wilson Rehabilitation Center Augmentative and Alternative Communication (AAC) team offers the Empowerment Through Communication (ETC) Program twice yearly. It is offered to participants who already own their communication devices and desire to become more proficient with utilizing them to meet daily communication needs. The purpose of this 2 week intensive program is to facilitate communicative competence through intensive group communication activities and to provide empowerment training to broaden their horizons as well as encourage their consideration of vocational and independent living goals.

Many of us take for granted being able to turn on a light or to change the channel on the television. People with disabilities may often have difficulty with many activities of daily living (ADL). Occupational Therapists (OT) evaluate a client’s motor function, cognitive function, and psychological function to determine the need for treatment, adaptive techniques, and/or adaptive equipment. Adaptive devices enable people with disabilities to independently carry out a variety of tasks (such as adaptive sock-aid to put their socks on). Occupational Therapy offers evaluation and training in the use of Electronic Aids to Daily Living (EADL). EADL’s range from simple to complex adaptations that provide a means of alternative access to turn on lights, appliances, and small electronic devices. Access can be direct with a remote control or alternative such as by a switch, voice, or serial input. EADL’s allow a person with a disability to independently control various items in their home environment.

Utilization of Electronic Aids for Daily Living (formerly called Environmental Control Units - ECUs) is assessed by our occupational therapists, often in collaboration with a physical therapist, speech-language pathologist, or rehabilitation engineer. These devices allow an individual to control lights, television, telephone, room temperature, or other devices in their environment by accessing a switch. Consultation with other team members ensures appropriate system integration with computer, communication, and power wheelchair technology.

  

Often after an injury or illness an individual will need temporary or permanent modifications to their home, school or work place so that they can be more independent. Some individuals may have simple needs such as rearranging furniture and removing throw rugs. More complex needs may be identified such as building a ramp, widening doorways or replacing a tub with a roll-in shower. A visit to a person's home is frequently completed during an individual's treatment program, if this need is determined. Referrals can also be made for this service alone.

There are some circumstances when an OT completes a home visit and consults primarily with the client and family. There are other situations when additional team members are called upon such as a Rehabilitation Engineer, Physical Therapist and case manager depending on the client's needs and their environment.

Seating and Mobility Technology includes wheeled mobility, seating and positioning, and personal transportation.

For Seating and Wheeled Mobility, the Physical Therapy Department offers specialized services and clinics for assessment and treatment of individuals with physical disabilities who use wheelchairs, scooters, or walkers for mobility. WWRC maintains a fleet of state-of-the-art wheelchairs which are used to ensure prescriptions with the most appropriate and current system available. Through consultation with physicians, rehabilitation engineers, occupational therapists, and vendors, adapted seating systems are also developed which maximize the individual’s abilities and help in prevention of orthopedic deficits by providing optimal postural support in the wheelchair.

Rehabilitation Engineering is a long-standing program at WWRC. A full-time Rehabilitation Engineer and Rehabilitation Engineering Technician, or Fabricator are available for making modifications to existing systems or fabricating and customizing systems to enable individuals with physical disabilities to live more independently. An extensive fabrication shop is available at WWRC, and a full fabrication facility is also available within the Mobile Rehabilitation Engineering Van, enabling the team to travel to consumer work and home sites to provide services.

Persons Served

Any person with a disability who may benefit from individualized engineering technology.

Program Goal

To assist the consumer with recommendations, guidance , and customization of assistive devices and products. The scope of these services are diverse, and could include a completely restructured jobsite, customizing a traditional powered wheelchair, inventing an entirely new product, or identifying a strategy that could eliminate the need for assistive devices.

Program Features and Specialties

• Outpatient / Inpatient Clinics and Services
• Wheelchair or mobility device seating and positioning, driving accommodations, job related difficulties, and independent living solutions
• In house research and development, as well as staff design and manufacturing, of complex assistive technology that is non-existent commercially
• Mobile assessment and fabrication services through the use of a Mobile Rehab Engineering Shop allows staff to access fabrication tools and materials during off site consultations and services
• Job Accommodation Assistance provided to counselors and employers, to ensure an optimal match of Human/Machine interface
• Tool redesign leading to reductions in repetitive motion injuries, maximized productivity of the consumer, and enhanced safety on the job site

Contract services may be negotiated with organizations, facilities, or companies to provide Rehabilitation Engineering services for consumers, which may include modification of specific worksites in order to accommodate the needs of persons with disabilities. A full fabrication facility at WWRC supports the Mobile Rehabilitation Engineering Shop, which enables the program to travel to businesses and consumers to provide services, regardless of the complexity.

A client's team is based on that individuals specific needs and abilities and may include any or all of the following

• Computer Systems Engineer
• Occupational Therapist
• Physical Therapist
• Rehabilitation Engineer
• Social Worker
• Speech-Language Pathologist

Dr. Linda Meyer
Medical AT Coordinator
(800) 345-WWRC (ext. 7086)