Biomedical Engineering Reference
In-Depth Information
Two uncontrolled intervention studies have suggested that AT interventions can be
beneficial to caregivers. Using a single subject research design, Rigby et al. (2001) found
that provision of a rigid pelvic stabilizing bar for children with cerebral palsy reduced
caregiver assistance with some bimanual and reaching tasks and reduced their need to
perform repositioning during the day. Ryan and colleagues (2009) found that provision
of two special-purpose seating devices was associated with a significant improvement in
Family Impact of Assistive Technology Scale scores for children and their parents, whereas
removal of the devices was associated with a return to baseline scores.
Generally, there are three main limitations with research in this area. First, cross-
sectional research designs do not enable causation to be established. Second, the impact of
AT is often measured in terms of hours of care, which is a very crude metric. For example,
if a caregiver reallocates time saved through the use of AT to other, perhaps more enjoyable
caregiving tasks, this change would go unmeasured. Third, outcomes reported in the cur-
rent literature often provide insufficient detail to capture all of the benefits of providing
AT interventions. More studies like those by Ryan et al. (2009) are required to develop a
complete understanding of the impact of AT interventions on informal caregivers.
5.3 Conceptual Frameworks on the Impact of AT on Caregivers and Users
In this section, we introduce three conceptual models to help understand the relationship
between AT interventions and outcomes for informal caregivers. In the first model, we
describe how an assistance user's personal assistance strategy, which frequently includes
the use of AT, affects themselves and their informal caregivers. In the second model, we
demonstrate how AT can alter caregivers' stressors so that their participation, health, and
quality of life can be facilitated. In the third model, we describe an informal caregiver
inclusive AT intervention process.
5.3.1 Conceptual Framework 1
On the basis of research and clinical work in this area, we developed conceptual frame-
work 1 to examine the impact of an AT intervention on the assistance user/caregiver
dyad (Demers et al. 2007) (see Figure 5.1). The framework starts with a mobility-related
AT intervention, which alters the personal adaptive strategy (assistance solution in the
Matching Person to Technology model). An assistance user's adaptive strategy consists
of two possible components: (1) AT, which includes assistive devices, special equipment,
and the services rendered to provide them, and/or (2) the assistance of others, composed
of informal support from caregivers and/or formal support. This framework parallels the
Matching Person to Technology model in that it acknowledges that selection of assistive
devices is facilitated by use of context-specific clinical measures, functional analysis, and
psycho-socio-environmental evaluations. This framework extends the Matching Person to
Technology model by indicating how the presence of a caregiver creates the potential for
a variety of assistive strategies to reduce activity limitations and participation restrictions,
which may include caregiver assistance, use of assistive devices, or a combination of the
two. The conceptual framework highlights the concomitant effects of an AT intervention
on the person with a disability and on his or her caregiver. Caregivers like Jean, Susan,
and Harold may have few, if any, opportunities to modify their role unless a new AT or a
