The Promise of
Assistive Technology to
Enhance Activity and
Work Participation
Committee on the Use of Selected Assistive Products and Technologies in
Eliminating or Reducing the Effects of Impairments
Alan M. Jette, Carol Mason Spicer, Jennifer Lalitha Flaubert, Editors
Board on Health Care Services
Health and Medicine Division
A Consensus Study Report of
THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu
THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001
This activity was supported by Contract/Task Order No. SS00-13-60048/0007 with the U.S. Social Security Administration. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-45784-2
International Standard Book Number-10: 0-309-45784-X
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2017. The Promise of Assistive Technology to Enhance Activity and Work Participation. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/24740.
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COMMITTEE ON THE USE OF SELECTED ASSISTIVE PRODUCTS AND TECHNOLOGIES IN ELIMINATING OR REDUCING THE EFFECTS OF IMPAIRMENTS
ALAN M. JETTE (Chair), Professor, Health Law, Policy and Management, Boston University School of Public Health
FABRICIO E. BALCAZAR, Professor, Disability and Human Development, University of Illinois at Chicago
LAURA J. BALL, Speech-Language Pathologist and Director, Hearing and Speech Research, Center for Translational Research, Children’s National Health System, and Professor, Pediatrics, School of Medicine and Health Sciences, The George Washington University
RORY A. COOPER, Distinguished Professor and FISA Foundation and Paralyzed Veterans of America Chair, School of Health and Rehabilitation Sciences, University of Pittsburgh, and Senior Career Scientist, VA Pittsburgh Healthcare System
JANNA L. FRIEDLY, Associate Professor, Physical Medicine and Rehabilitation, University of Washington, and Medical Director, Limb Preservation and Amputation Services, Harborview Medical Center
WALTER R. FRONTERA, Professor, Physical Medicine, Rehabilitation, and Sports Medicine and Physiology, University of Puerto Rico School of Medicine
KATYA HILL, Associate Professor, Communication Science and Disorders, University of Pittsburgh
BARBARA L. KORNBLAU, Executive Director, Coalition for Disability Health Equity, and Adjunct Professor, Florida A&M University
FRANK R. LIN, Associate Professor, Otolaryngology-Head and Neck Surgery and Geriatric Medicine, Johns Hopkins University School of Medicine
LAURA A. MILLER, Research Scientist/Prosthetist, Center for Bionic Medicine, Shirley Ryan AbilityLab, and Clinical Associate Professor, Physical Medicine and Rehabilitation, Northwestern University
KENNETH J. OTTENBACHER, Russell Shearn Moody Distinguished Chair in Neurological Rehabilitation and Director, Division of Rehabilitation Sciences, University of Texas Medical Branch at Galveston
LINDA J. RESNIK, Research Career Scientist, Providence VA Medical Center, and Professor, Health Services, Policy and Practice, Brown University
JON A. SANFORD, Director, Center for Assistive Technology and Environmental Access, and Professor of Industrial Design, Georgia Institute of Technology
STEPHANIE J. SJOBLAD, Clinical Coordinator and Professor, Hearing and Communication Center, Division of Speech and Hearing Sciences, University of North Carolina at Chapel Hill
LAWRENCE C. VOGEL, Chief of Pediatrics, Assistant Chief of Staff, Medical Director, Spinal Cord Injury Program, Chicago Shriners Hospitals for Children, and Professor of Pediatrics, Rush Medical College
Consultants
PATRICIA M. OWENS, Consultant, Health and Disability Policy and Programs
AMOL KARMARKAR, Assistant Professor, Division of Rehabilitation Sciences, University of Texas Medical Branch
MAUREEN O’CONNELL, Attorney at Law, Southern Disability Law Center
JAMES R. SHELDON, JR., Supervising Attorney, National Assistive Technology Advocacy Project, Neighborhood Legal Services, Inc.
Study Staff
CAROL MASON SPICER, Study Director
JENNIFER LALITHA FLAUBERT, Associate Program Officer
FRANK R. VALLIERE, Associate Program Officer (until July 2016)
LAURA VERCAMMEN, Research Associate (October 2016-December 2016)
NICOLE GORMLEY, Senior Program Assistant
PAMELA RAMEY-McCRAY, Administrative Assistant
DAVID A. BUTLER, Acting Director, Board on the Health of Select Populations (July 2016-December 2016)
FREDRICK ERDTMANN, Director, Board on the Health of Select Populations (until July 2016)
SHARYL J. NASS, Director, Board on Health Care Services
Reviewers
This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.
We thank the following individuals for their review of this report:
Kendra Betz, VA National Center for Patient Safety
William R. Botten, U.S. Access Board
George Demiris, University of Washington
William A. Erickson, Cornell University
Alberto Esquenazi, MossRehab
Howard H. Goldman, University of Maryland at Baltimore
Helen Marie Hoenig, Durham VA Medical Center
Lisa I. Iezzoni, Harvard Medical School and Massachusetts General Hospital
Andrew J. Imparato, Association of University Centers on Disabilities
Susan Kapp, University of Washington
Todd Kuiken, Rehabilitation Institute of Chicago
Cathy L. Lazarus, Mount Sinai Beth Israel
Rachel McArdle, U.S. Department of Veterans Affairs
Ryan McCreery, Boys Town National Research Hospital
David McNaughton, Pennsylvania State University
Joseph J. Montano, Weil Cornell Medicine
Edward L. Myers III, Attorney at Law (Retired)
Frank A. Sloan, Duke University
Kathryn M. Yorkston, University of Washington
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report nor did they see the final draft before its release. The review of this report was overseen by Robert S. Lawrence, Johns Hopkins University, and Bradford H. Gray, Urban Institute. They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies.
Acknowledgments
The study committee and the National Academies of Sciences, Engineering, and Medicine’s Health and Medicine Division project staff take this opportunity to recognize and thank the many individuals who shared their time and expertise to support the committee’s work and inform its deliberations.
This study was sponsored by the U.S. Social Security Administration (SSA). We thank McArthur Allen, Gina Clemons, Joanna Firmin, Scott Marko, Nancy Miller, and Mary Beth Rochowiak for their guidance and support, as well as Megan Butson and Thomas Mulherin for their assistance. The committee also acknowledges SSA for verifying relevant technical content for accuracy. The committee benefited greatly from discussions with the individuals who presented at and attended the committee’s open sessions: Laura J. Ball, Susanne M. Bruyère, Megan Conway, Justin Creamer, Melissa Day, William A. Erickson, Bradley Flohr, Amy S. Goldman, Michelle C. Jackson, Michael Kidd, John Kramschuster, Daniel E. Kubrin, Jo Anne Materkowski, Ryan McCreery, Susan M. Miller, Penny L. Nechanicky, Patricia M. Owens, Mark Schmeler, Gerald Stark, Colleen Thoma, and Kristin Tugman. The committee is grateful to these presenters for volunteering to share their expertise, knowledge, data, and opinions not only with the committee but also with the members of the public who participated in the committee’s open sessions. The committee also appreciates the efforts of numerous individuals who assisted project staff in identifying the presenters. Particular thanks go to Winthrop Cashdollar for his introductions to representatives from the private disability insurance industry.
The committee acknowledges the many staff within the Health and Medicine Division who provided support in various ways to this project, including Carol Mason Spicer (study director), Jennifer Flaubert (associate program officer), Nicole Gormley (senior program assistant), Karen Helsing (senior program officer), Frank Valliere (program officer), Laura Vercammen (research associate), and Julie Wiltshire (financial associate). The committee extends great thanks and appreciation to the Health and Medicine Division board directors who oversaw the project: Rick Erdtmann, David Butler, and Sharyl Nass. Research assistance was provided by Rebecca Morgan (senior research librarian, National Academies). Finally, Rona Brière and Alisa Decatur are to be credited for the superb editorial assistance they provided in preparing the final report.
Contents
SSA’s Consideration of Selected Assistive Products and Technologies
2 ENVIRONMENTAL FACILITATORS FRAMEWORK
The International Classification of Functioning, Disability and Health and Related Models
Environmental Facilitators Framework
3 WHEELED AND SEATED MOBILITY DEVICES
The Use of Wheeled and Seated Mobility Devices
Overview of Conditions Benefiting from Upper-Extremity Prostheses
5 SELECTED HEARING TECHNOLOGIES
Overview of Prevalence and Severity of Hearing Loss and Use of Hearing Aids
6 AUGMENTATIVE AND ALTERNATIVE COMMUNICATION AND VOICE PRODUCTS AND TECHNOLOGIES
7 COVERAGE FOR RELEVANT PRODUCTS AND TECHNOLOGIES
Workplace Reasonable Accommodations
Health Literacy, Education, and Knowledge of Assistive Products and Technologies
8 REVIEW OF SOCIAL SECURITY AND OTHER SELECTED DISABILITY COMPENSATION PROGRAMS
Overview of Social Security Administration and Other Selected Programs
Disability Determination (Adjudication) Processes and Evidence Considered
Consideration of Selected Assistive Products and Technologies
Summary of Points of Comparison Among Different Programs
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Boxes, Figures, and Tables
BOXES
3-1 Summary of Wheeled and Seated Mobility Devices
4-1 Upper-Extremity Prostheses
6-1 Augmentative and Alternative Communication (AAC) Systems
9-1 Overall Conclusions and Supporting Evidence
FIGURES
2-1 Organization of the International Classification of Functioning, Disability and Health
2-3 Environmental facilitators framework
3-1 Projected number of wheelchair users (linear and polynomial model)
3-3 Example of a standard manual wheelchair
3-4 Example of a standard hemi-wheelchair
3-5 Examples of high-strength lightweight model wheelchairs
3-6 Examples of ultra-lightweight wheelchairs
3-7 Segway modified to serve as a wheelchair
3-8 Action Trackchair for outdoor use
3-9 Examples of three- and four-wheel power operated vehicles
3-10 Example of a powered wheelchair in Medicare Group 1
3-11 Example of a powered wheelchair in Medicare Group 2
3-12 Example of a powered wheelchair in Medicare Group 3
3-13 Examples of powered wheelchairs in Medicare Group 4
3-14 Example of a power assist wheelchair
3-15 Distribution of ATP and SMS certified professionals
4-1 Levels of upper-limb amputation
4-2 Body-powered prosthesis on a person with a transradial amputation
4-3 Myoelectric prosthesis on a person with a transradial amputation
4-4 Transhumeral configuration of a DEKA arm
4-5 Example of a hybrid prosthesis
4-6 Examples of body-powered hooks
4-7 Examples of two powered hooks
4-9 Examples of three multiarticular hands, all shown without a glove
5-1 Prevalence of hearing loss in the United States by age, 2001-2008
6-1 Illustration of esophageal speech
6-2 Tracheoesophageal puncture with prosthesis
TABLES
3-1 Characteristics of the SIPP, NHIS/NHIS-D, and CMS DME Data Sources
3-2 Demographic Characteristics of Users of Wheeled and Seated Mobility Devices by Gender
3-4 Use of Manual Versus Powered Wheelchairs by Age and Race/Ethnicity
3-5 Estimated Number of Wheeled and Seated Mobility Devices by CMS Diagnostic Categories
Annex Table 3-1 Taxonomy of Wheeled and Seated Mobility Devices
Annex Table 3-2 Functionality of Wheeled and Seated Mobility Devices
4-1 Upper-Limb Prostheses Provided to Beneficiaries by Type
4-2 Demographic Characteristics of Recipients of Upper-Limb Prostheses
4-3 Estimated Percentage of Upper-Limb Prosthetic Devices by Amputation Category
Annex Table 4-1 Upper-Limb Prosthetic Device Taxonomy
Annex Table 4-2 Ability of Upper-Limb Prosthetic Devices to Mitigate the Effects of Impairment
5-2 Prevalence of Hearing Aid Use Among Adults with Hearing Loss >25 dB (95% CI)
Annex Table 5-1 Selected Hearing Technologies Taxonomy
Annex Table 5-2 Selected Hearing Technologies Function
6-1 Communication-Related Features of Aided AAC Systems
6-2 Components of AAC Technology
6-3 Personnel Involved in AAC Assessment and Treatment,
Annex Table 6-2 Augmentative and Alternative Communication Software and Hardware
Annex Table 6-3 Augmentative and Alternative Communication Technology Function
Annex Table 7-1 Summary of Payer or Coverage Options for Assistive Devices
Annex Table 8-1 Comparison of Social Security Administration and Similar Programs
C-2 Berenson-Eggers Type of Service Codes: Durable Medical Equipment
C-4 Healthcare Common Procedure Coding System (HCPCS) Codes for Upper-Extremity Prostheses
C-5 Healthcare Common Procedure Coding System (HCPCS) Codes for Speech-Generating Devices
C-6 International Classification of Diseases, Ninth Revision (ICD-9) Codes and Diagnostic Categories
Acronyms and Abbreviations
AAC |
augmentative and alternative communication |
ABC |
American Board for Certification in Orthotics, Prosthetics and Pedorthics |
ABLE |
Achieving a Better Life Experience |
ABN |
advanced beneficiary notice |
ACA |
Patient Protection and Affordable Care Act |
ACTA |
Air Carrier Transportation Act |
ADA |
Americans with Disabilities Act |
ADL |
activity of daily living |
ADMC |
Advance Determination of Medical Coverage |
AFP |
Alternative Financing Program |
AL/EL |
artificial/electrolarynx |
ALS |
amyotrophic lateral sclerosis |
APRN |
advanced practice registered nurse |
ASHA |
American Speech-Language-Hearing Association |
ASoC |
Amputation System of Care |
AT |
assistive technology |
ATP |
assistive technology professional |
C&P |
compensation and pension |
CAP |
Computer/Electronic Accommodations Program |
CARF |
Commission on Accreditation of Rehabilitation Facilities |
CDC |
U.S. Centers for Disease Control and Prevention |
CHIP |
Children’s Health Insurance Program |
CMS |
Centers for Medicare & Medicaid Services |
CPP |
Canada Pension Plan |
CPT |
Current Procedural Terminology |
CR |
cost reimbursement |
DASH |
Disabilities of the Arm, Shoulder, and Hand (questionnaire) |
dB |
decibels |
DBS |
disability benefits specialist |
DDS |
Disability Determination Services |
DE |
disability examiner |
DM |
digital modulation |
DME |
durable medical equipment |
DME-MAC |
Durable Medical Equipment-Medicare Administrative Contractor |
EHLR |
Education for the Handicapped Law Report |
EMG |
electromyographic |
EN |
employment network |
ENT |
ear, nose, and throat |
EPSDT |
Early and Periodic Screening, Diagnostic, and Treatment |
ESS |
esophageal speech |
FBR |
federal benefit rate |
FDA |
U.S. Food and Drug Administration |
FFP |
federal financial participation |
FM |
frequency modulated |
FODAC |
Friends of Disabled Adults and Children |
FY |
fiscal year |
GAO |
U.S. Government Accountability Office |
HCBS |
home- and community-based services |
HCPCS |
Healthcare Common Procedure Coding System |
HMO |
health maintenance organization |
IADL |
instrumental activity of daily living |
ICD-9 |
International Classification of Diseases, Ninth Revision |
ICF |
International Classification of Functioning, Disability and Health |
ICIDH |
International Classification of Impairments, Disabilities, and Handicaps |
IDEA |
Individuals with Disabilities Education Act |
IDELR |
Individuals with Disabilities Education Law Report |
IEP |
individualized education plan |
IMU |
inertial measurement unit |
IRS |
Internal Revenue Service |
ISO |
International Organization for Standardization |
JAN |
Job Accommodation Network |
LCD |
Local Coverage Determination |
MAE |
mobility assistive equipment |
MRADL |
mobility-related activity of daily living |
MSP |
Medicare Savings Program |
NAAL |
National Assessment of Adult Literacy |
NCART |
National Coalition for Assistive and Rehab Technology |
NCD |
National Coverage Determination |
NHANES |
National Health and Nutrition Examination Survey |
NHIS |
National Health Interview Survey |
NHIS-D |
National Health Interview Survey-Disability |
NIDILRR |
National Institute on Disability, Independent Living, and Rehabilitation Research |
OSEP |
Office for Special Education Programs |
P&A |
protection and advocacy |
PA |
physician assistant |
PAAT |
Protection and Advocacy for Assistive Technology |
PANS |
Polytrauma/Amputation Network Sites |
PASS |
Plan to Achieve Self-Support |
PC |
psychological consultant |
PDA |
personal digital assistant |
PIDA |
Power Mobility Indoor Driving Assessment |
PM&R |
physical medicine and rehabilitation |
POMS |
Program Operations Manual System |
POV |
power operated vehicle |
PRAT |
Polytrauma Rehabilitation Assistive Technology Lab |
PSAP |
personal sound amplification product |
PTSD |
posttraumatic stress disorder |
QDE |
qualified disability expense |
RAC |
Regional Amputation Care Center |
RERC |
Rehabilitation Engineering Research Center |
RESNA |
Rehabilitation Engineering and Assistive Technology Society of North America |
RFC |
residual functional capacity |
RSA |
Rehabilitation Services Administration |
RVSR |
rating veterans service representative |
SGA |
substantial gainful activity |
SGD |
speech-generating device |
SHAP |
Southampton Hand Assessment Procedure |
SIPP |
Survey of Income and Program Participation |
SLP |
speech-language pathologist |
SMS |
seating and mobility specialist |
SSA |
U.S. Social Security Administration |
SSDI |
Social Security Disability Insurance |
SSI |
Supplemental Security Income |
TAI |
Transfer Assessment Instrument |
TEP |
tracheoesophageal voice prosthesis |
TRS |
telecommunications relay service |
TSV |
tracheostomy speaking valve |
UCP |
United Cerebral Palsy |
UEP |
upper-extremity prosthesis |
VA |
U.S. Department of Veterans Affairs |
VASRD |
VA Schedule for Rating Disabilities |
VBA |
Veterans Benefits Administration |
VC |
voluntary closing |
VHA |
Veterans Health Administration |
VO |
voluntary opening |
VR |
vocational rehabilitation |
VR&E |
Vocational Rehabilitation and Employment |
VSC |
Veterans Service Center |
WHO |
World Health Organization |
WIOA |
Workforce Innovation and Opportunity Act |
wpm |
words per minute |
WSMD |
wheeled and seated mobility device |