Approaches to Robust Integration of Assistive Technology Co…

2024 Feb/March Closing The Gap Resource Directory Solutions - Approaches to Robust Integration of Assistive Technology Content into Professional Occupational Therapy Programs By Annabeth Knight

leadership, policy, and implementation

Approaches to Robust Integration of Assistive Technology Content into Professional Occupational Therapy Programs

Summary: Though instruction on assistive technology (AT) has been required in professional occupational therapy education pro- grams for decades, overwhelmingly practitioners report feeling underprepared for service provision in this area. This article explores benefits and challenges of various approaches to curriculum design to support practitioner success. It highlights the hybrid approach of the Entry-Level OTD Program at Methodist University that incorporates AT learning activities through- out a variety of courses, in addition to a stand-alone course in AT.

edge and skills is through intentional curriculum design at the professional program level to help prepare new graduates for the clinical service provision of this portion of the occupational therapy scope of practice. Occupational therapy (OT) is one of many professions which addresses assistive technology within its scope of practice. OTPs work to enable participation of individuals or populations through the therapeutic use of everyday occupations, (AOTA, 2010; AOTA, 2015). Intervention approaches intentional modifi- cation and/or adaptation of activities to enhance participation, frequently through the use of assistive technology, (Cook, Pol- gar, & Encarnação, 2020; WFOT, 2019). The Occupational Ther- apy Practice Framework-4 provides guidance about the scope and execution of occupational therapy, (AOTA, 2020). This framework encourages practitioners to both consider AT as part of the client’s environmental context, and to use assistive technology as an intervention, (AOTA, 2020). The profession’s unique contribution to assistive technology service provision

The provision of assistive technology (AT) services is a vital component of everyday practice for the occupational therapy practitioner (OTP) across practice settings. However, research over the past few decades has indicated that overwhelmingly, OTPs feel they are underprepared to provide services in this specialized area of evaluation and intervention, (Gitlow & San- ford, 2003; Kanny & Anson, 1998; Long & Wolverton, 2007; Mc- Daniel & Gitlow, 2021). This is a growing, but not newly emerg- ing challenge. Since the late 1900s, research has indicated that this knowledge and skills gap exists for OTPs providing AT ser- vices in all areas of practice, (Kanny & Anson, 1998). Barriers to competency and confidence in the area of AT service provision includes the rapid growth of technology, few content experts and specialists in the field, and the perception of a lack of clini- cian education required for practice in this area, (Gitlow & San- ford, 2003; McDaniel & Gitlow, 2021; Sarsak et al., 2023). Though continuing education content is available for OTPs in this area of practice, one approach to addressing these gaps in knowl-

ANNABETH KNIGHT OTD, OTR/L, ATP, is an occupational therapist, assistive technology professional, and assistant professor at Methodist University in Fayetteville, North Carolina. She has over 12 years of clinical experience in pediatric occupational therapy across a variety of settings, working primarily with medically complex children who benefit highly from assistive technology service provision. Annabeth earned her post-professional doctorate in Occupational Therapy from Mount Mary University, and her master’s degree in Occupational Therapy from the University of Scranton. In her current role, Annabeth teaches assistive technology coursework in the Methodist University OTD Program. She also mentors student research in the area of assistive technology, and serves as the Doctoral Capstone Coordinator. Since 2014, Annabeth has presented at national and international conferences on various topics in assistive technology service provision.

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involves the integration of a spectrum of assistive technologies into occupation-based evaluation and intervention to meet client-driven functional goals, (AOTA, 2025; WFOT, 2019). In the professional education of OTPs, the American Certification of Occupational Therapy Education (ACOTE) provides AT service provision standards, that offer specific guidelines for the scope of the content that must be covered in OT curriculum at the associates, bachelors, masters, and doctoral level. The standard regarding assistive technologies requires inclusion of learning activities designed to establish knowledge and skills about AT “used to enhance occupational performance and foster partici- pation and well-being”, (ACOTE, 2018, pp. 37; 60). ACOTE does not, however, provide specific guidance on how to integrate this content knowledge into broad program curriculum. Programs are left to determine this on their own; choosing either to integrate AT concepts throughout a variety of courses, to develop a stand-alone course in AT, or a hybrid of the two. Since the practitioner knowledge gap is still pres- ent despite these standards in curriculum in the United States, there is a need to investigate the details of curriculum design when determining how to bridge the gap between the class- room and clinical practice. Additionally, at this time, there has not been a comparative analysis conducted to investigate any difference in outcomes between programs that have a stand- alone AT course, and those that choose to integrate AT con- cepts across multiple courses and education opportunities. Though there is intentionality and potential benefit to either approach to curriculum design, inclusion of a stand-alone course provides the opportunity to address several of the barri- ers to achieving practitioner competency in AT, while also con- sistently tracking student learning outcomes within this area of knowledge and clinical skills. The Doctor of Occupational Therapy Program at Methodist University in Fayetteville, North Carolina is an entry-level pro- gram, which has designed its curriculum to address AT-related education standards through a combination of a stand-along course in AT, and integration of supplemental AT concepts throughout the program curriculum. This hybrid approach empowers students with the underlying theory informing AT service provision by OTPs across their foundational and clini- cal coursework, and introduces concepts and technologies relevant to particular practice areas and client populations as they progress through the didactic curriculum. Additionally, the stand-alone AT course provides a number of benefits to en- hancing learning through targeted instruction by a variety of content-expert instructors, hands-on learning opportunities, on-campus and community collaboration, and opportunities to contribute to research and capstone projects in the area of AT. The stand-alone course, Supporting Occupational Perfor- mance with Technology and Environments , in Methodist Uni-

versity’s OTD Program curriculum utilizes a variety of unique strategies to optimize learning outcomes in the area of AT knowledge and service provision. This begins with focus on mapping broad OT theoretical models onto those that are AT specific, providing students with a foundational understanding of how to apply OT specific concepts and interventions to AT models of practice such at the Human Activity Assistive Tech- nology (HAAT) Model, (Cook, Polgar, & Encarnação, 2020). The dissemination of the course material to students calls on the expertise of multiple parties. The primary course instructor is a licensed OTP, as well as a certified Assistive Technology Pro- fessional (ATP). This resume provides a unique knowledge and clinical skillset that other OT instructors who cover AT topics in their coursework may not have. The course is also supported by a lab assistant; an OTP and adjunct instructor whose primary clinical role involves high levels of specialized AT service pro- vision. In addition to having experienced clinicians teach this course, there is intentional use of guest lecturers throughout this course to provide students with the expertise of additional stakeholders in the AT field. As user experience is such an in- strumental component of on engagement in and reflection on outcomes of AT service provision, students learn directly from disabled AT users as they serve as guest lecturers across the course. Students not only gain knowledge about the ex- periences these individuals have with using AT, but also about systematic barriers they may have faced as a disabled AT user. Additionally, students begin reflection about general user ex- perience (UX) design, which is an emerging, non-traditional area of practice for OTPs. Finally, local AT equipment vendors are utilized as guest lectures to offer their expertise on a par- ticular group of technology such as wheelchairs and mobility aids, augmentative and alternative communication systems, and 3D printers. From these lab experiences, students not only gain exposure to a variety of AT, but also learn the importance The entry-level Doctor of Occupational Therapy Program at Methodist University aims to deliver the most contemporary, high- quality educational experience to train future practitioners that are compassionate and ethical leaders who will engage, enrich, and empower the lives and communities they serve.

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continuing education, and referral for AT services for their fu- ture clients. Students learn about complex manual and power mobility equipment and durable medical equipment (DME) through collaborative lecture and lab activities led by their instructor and a local vendor. This seating specialist also pro- vides pressure mapping equipment for students to trial as they learn about approaches to client positioning and conducting mechanical assessment tool (MAT) evaluations. Vendors of augmentative alternative communication (AAC) products also provide hands-on lab experiences for the students, bringing a variety of high-tech AAC systems on campus for students to tri- al while discussing the feature matching process, and the role of the OT on the AAC team. Finally, inclusion of a stand-alone AT course in this program allows for the design and implementation of assignments and learning activities that provide students with opportunities to gain hands-on experience with AT, interact with interprofes- sional team members off campus, and positively impact the community. Throughout the semester, students engage in a switch adaptation lab, an adapted toy project, and a low-tech AT design competition that brings AT application to life in the classroom. Each of these projects have evolved over the past several years to involve more direct application of AT concepts

of collaboration with area vendors to best serve their future clients. The emphasis here is not on having robust knowledge about particular AT vendors and/or equipment companies, but instead on gaining an understanding that as OTPs they do not have to be an expert on all equipment and can rely on the ex- pertise afforded by local vendors as part of the interdisciplinary team. AT service provision is a complex process that begins with understanding of the feature matching process, as well as ex- posure to and hands on experience interfacing with the AT equipment itself, (AOTA, 2015; Cook, Polgar, & Encarnação, 2020; WFOT, 2019). Budgeting to have a robust library of AT equipment can be a barrier for many OT education programs. Though the program at Methodist University has a variety of AT equipment in-house, hands-on experience is supplemented through a variety of channels. Partnerships with local organiza- tions and vendors are utilized to provide access to AT equip- ment in the classroom, and students learn the importance of collaboration with these players as OTPs along the way. Stu- dents in this program begin the semester with a lab experience led by an AT provider from one of the state’s Assistive Technol- ogy Act Program (ATAP) locations. Here, they not only have the opportunity to explore a variety of AT equipment in person, but also learn about the legislation which supports funding of state ATAPs, and the utility of the program for equipment loans, Second-year Doctor of Occupational Therapy students engage in hands-on learning in their assistive technology course through exposure to specialized communication and alternative access technologies.

Students gain practical skills switch-adapting electronic toys to provide alternative access to play.

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to real cases, increased collaboration with professional experts to provide students with feedback, and intentional design to impact the community. The switch-adaptation lab provides students with an opportunity to learn and apply engineering principles while building a basic switch and battery interrupter. Students then use their equipment to switch-adapt toys and electronics, while discussing relevant case study applications. The adapted toy project challenges students to adapt an exist- ing toy or game to meet the needs of a disabled child in the community. Students collaborate with area OTPs to discuss real clients on their caseload who could benefit from an adapted toy, and design their adaptations based on the unique needs of that child. This activity allows students to not only implement components of the AT evaluation, development, and interven- tion process, but also provides them with the opportunity to engage in professional communication and collaboration with therapists in the field. The low-tech AT design project in this course has evolved significantly over time to expand its real- life application and impact on the community. Once an in-class project involving a quick presentation of design ideas to peers, the project now involves development of a prototype and pre- sentation to a panel of experts for contest judging. The expert panel includes therapists, community members, students, and professors from related departments such as engineering and kinesiology to provide design and usability feedback from their unique perspectives. This project is designed to mirror a student design competition held annually at the state’s oc- cupational therapy association conference. Students are able to submit their work to this competition at the end of the se- mester, providing them additional opportunity for professional presentation, resume building, and AT community impact. As OT education programs at any level engage in continu- ous quality improvement of their curriculum design, it is im- portant for them to consider the feedback of clinicians about their perceived level of preparedness for AT service provision as new graduates. Future directions at Methodist University include continued expansion of community partnerships that promote opportunities for students to gain more hands-on ex- perience with AT users across the lifespan, and to bring growth to community impact of the program through service learn- ing, collaborative research, and capstone projects. Though we know there are benefits of any effort to enhance to AT content in OT curriculum, it has not yet been determined whether one specific approach of integrating more robust AT-content into programs yields the most optimal academic and clinical out- comes. Further outcomes-driven research is indicated in this area to expand our understanding of the dynamic causes of gaps in AT knowledge amongst OTPs, therefore improving the preparedness of our graduates and the overall quality of AT ser- vice provision.

REFERENCES American Council on Occupational Therapy Education. (2018). 2018 Accreditation Council for Occupational Therapy Educa- tion (ACOTE) standards an interpretive guide . https://acoteo- nline.org/accreditation-explained/standards/ American Occupational Therapy Association. (2020). Oc- cupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Ther- apy, 74(Suppl. 2), 7412410010. https://doi.Org/10.5014/ ajot.2020.74S2001 American Occupational Therapy Association. (2015). The role of occupational therapy in providing assistive technology de- vices and services . https://www.aota.org/about-occupation- al-therapy/professionals/RDP/assistive-technology.aspx AT content experts provide resources to students in addition to hands-on lab experiences, empowering them with community connections to utilize during fieldwork experiences and as future clinicians.

Cook, A., Polgar, J., & Encarnação, P. (2020). Assistive technolo-

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gies: Practice & principles. Elsevier.

Gitlow, L. & Sanford, T. (2003). Assistive technology education needs of allied health professionals in a rural state. Journal of Allied Heath , 32, 46-51. Kanny, E. & Anson, D. (1998). Current trends in assistive technology education in entry-level occupational therapy curricula. American Journal of Occupational Therapy , 52 (7), 586-591. Long, L. & Woolverton, M. (2007). Training needs of pediatric occupational therapists in assistive technology. American Journal of Occupational Therapy , 61 (3), 345-353. McDaniel, K. & Gitlow, A. (2021). Perceptions of assistive tech- nology education from occupational therapists certified as assistive technology professionals. American Journal of Occupational Therapy, 75 (2), 7502205110. Sarsak, H., Kamadu, A., Pearlman, J., Goldberg, M., Kandavel, K., & Augustine, N. (2023). A perspective on occupational therapy and assistive technology: Research, contributions, challenges and global initiatives in the World Federation of Occupational Therapists Bulletin. World Federation of Oc- cupational Therapists Bulletin, 79 (2), 118-126. World Federation of Occupational Therapists. (2019). Occupa- tional therapy and assistive technology: A position paper of the World Federation of Occupational Therapists. World Federation of Occupational Therapists Bulletin, 76 (4), 10-13.

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