Annals of Long Term Care

**sub**Assistive Technologies to Improve Function**endsub**
Helen Hoenig, MD, Assistant Professor, Division of Geriatrics, Department of Medicine, Duke University, and the Center on Aging and Human Development, Duke University Medical Center, Durham, NC, began by discussing several categories of assistive devices. These mechanisms include mobility aids, walkers, and canes; bathroom equipment, such as raised toilet seats, bathtub benches, and hand-held showers; self-care devices, including reachers, long-handled sock aids and button aids; and augmentative devices, such as hearing aids and eyeglasses.

Assistive technology is used commonly. A survey of community-dwelling older people in Great Britain (Edwards NI, Jones DA; Age Ageing, 1998) found that, exclusive of eyeglasses and hearing aids, 74% of the participants reported using some type of assistive device, with the most common being nonslip bathmats (55%), canes (30%), and bars in the bathroom (24%). In 1996, reimbursement for over $6 billion worth of equipment was requested from Medicare, an increase of 26% over billing in 1995. There are several reasons why the use of assistive technology is increasing at such as rapid pace, according to Dr. Hoenig. First, and perhaps foremost, there has been an explosion in design options over the last two decades. Second, and in some ways related to enhanced design and options, assistive technology may improve activities of daily living (ADLs), and thus, reduce the use of personal assistance.

Dr. Hoenig reviewed the different types of walkers that are currently available. A walker with four wheels, sometimes called the “rollator,” has brakes on the handles that provide more safety than pushing a pedal to brake, which in some instances would cause the walker to tip over. This type of walker can be particularly helpful for people with cardiopulmonary disorders, as they often have good grasping ability and coordination to manipulate the hand brakes. However, the four-wheel walker is a bit more unstable than a two-wheel walker or a standard frame walker, and thus, may not be suitable for those with particular weaknesses or coordination problems. The advantage of the three-wheel walker is its high maneuverability and somewhat narrower width. This walker is useful for those who must ambulate in a home setting, and for those with fairly good balance and hand coordination. However, it is not optimal for community mobility because it does not have a seat, nor is it useful for someone who lacks the coordination needed to manipulate it. Another variation on the four-wheel walker involves bars all the way around the aid. This type of walker is useful for those who have problems balancing and walking, but who are cognitively intact. Devices that are in development include a walker with a “seeing eye” on its front, which would obviously be helpful for those who are visually impaired; a wheelchair that manually converts from a seated to a standing position; and another chair that changes position through a motorized variant.

Other wheelchair devices are also undergoing changes. A new design option includes a chair with cantilevered wheels that provide a particularly small turning radius. This wheelchair is useful for people who participate in sports such as tennis or basketball. The potential for aerodynamic wheelchairs made out of lightweight materials could enable even those who are paralyzed to waterski. “These design options enhance the utility for specific circumstances and the diversity of circumstances that people are able to access,” stated Dr. Hoenig.

The speaker then focused on the data pertaining to the potential of these devices to improve ADL function. One randomized trial (Mann WC, Ottenbacher KJ, Fraas L, et al; Arch Fam Med, 1999) studied a group of homebound elders and provided them with home visits and access to diverse kinds of equipment.