Definition of Terms

 

I  Assistive technology [no entry in Oxford English Dictionary]

United Kingdom definitions

Assistive Technology (AT) is any product or service designed to enable independence for disabled and older people.  This definition is from the website of the Foundation for Assistive Technology (FAST) which was established with public funding as a charity in 1998 ... to build an independent partnership between service providers, users, the research community and manufacturers (see http://www.fastuk.org/home.php).

The background is that in March 2001, a King's Fund consultation meeting agreed the definition for 'Assistive Technology' (AT) to replace the term disability equipment in the UK.  This definition is increasingly used because it more accurately reflects the wide range of equipment and services that assists older and disabled people to maximise their independence.  It also acknowledges the crossover between inclusively designed, mainstream products and the technology specifically to assist disabled and older people.

Many people also refer to an alternative definition, which states Assistive Technology is ‘an umbrella term for any device or system that allows an individual to perform a task they would otherwise be unable to do or increases the ease and safety with which the task can be performed' (Royal Commission on Long-Term Care. With Respect to Old Age: Long Term Care - Rights and Responsibilities. London: HMSO, 1999.)

Assistive Technology (AT) is still used to denote a particular range of equipment by different sectors, for example, people working in Education tend to define AT as products and services which assist learning; computers, communication aids and digital learning aids.  Additionally, there has been mention of 'Assistive Technology' within recent government policy denoting telecare and telemedicine applications.  As integration across services to disabled and older people increasingly takes place between health, social care, education, housing and employment services such variation in the use of the term will resolve itself.

United States definitions

A formal, legal definition of assistive technology was first published in the United States Technology-Related Assistance for Individuals with Disabilities Act 1988 (The Tech Act). This act was amended in 1994; in 1998, it was repealed and replaced with the Assistive Technology Act 1998 ("AT Act").  Throughout this history, the original definition of assistive technology remained consistent. This same definition was used in the Access Board's Electronic and Information Technology Accessibility Standards, developed as required by 1998 amendments to Section 508 of the Rehabilitation Act.

The following definitions are from rehabtool.com, an information technology company in Houston, Texas that develops and markets innovative hardware and software integrated into solutions to assist individuals with disabilities and special needs.

Assistive or Adaptive Technology commonly refers to "products, devices or equipment, whether acquired commercially, modified or customized, that are used to maintain, increase or improve the functional capabilities of individuals with disabilities", according to the definition proposed in the United States Assistive Technology Act 1998.

Assistive Technology products can enable people with disabilities to accomplish daily living tasks, assist them in communication, education, work or recreation activities, in essence, help them achieve greater independence and enhance their quality of life. Assistive Technology devices can help improve physical or mental functioning, overcome a disorder or impairment, help prevent the worsening of a condition, strengthen a physical or mental weakness, help improve a person's capacity to learn, or even replace a missing limb.

Assistive Technology Services support people with disabilities or their caregivers to help them select, acquire, or use adaptive devices. Such services include functional evaluations, training on devices, product demonstration, and equipment purchasing or leasing.

Assistive Technology is best understood when divided into categories or product families. To view a comprehensive classification of AT products by disability type, go to www.rehabtool.com/at.html

II   Telecare [no entry in OED]

The terms Telecare and Assistive Technology are often used interchangeably, leading to confusion. Many people regard Telecare as a subset of Assistive Technology.

Telecare has been defined as ‘the remote or enhanced delivery of health and social care services to people in their own home by means of telecommunications and computer-based systems' (Brownsell S, Bradley D. Assistive Technology andTelecare - Forging Solutions for IndependentLiving. Bristol: Policy Press, 2003).

Alternatively, Telecare is the continuous, automatic and remote monitoring of real time emergencies and lifestyle changes over time in order to manage the risks associated with independent living.' (From http://telecareaware.com/what-is-telecare/).

This definition has appeared in a number of publications, but its original source is unclear. To elaborate, telecare devices range from those where the user presses a button that raises an alert at a control centre, to systems that monitor the person's well-being and/or environment and which trigger (without, if necessary, conscious involvement) a warning that the person's well-being has deteriorated, or that an untoward event has occurred.

Some systems give the person immediate feedback so that memory problems in particular can be accommodated and the person's dignity and independence maintained.  In all cases except the latter, procedures for delivering an appropriate response from an external person (carer, neighbour or statutory service, etc.) are vital to the whole system.

Examples of telecare devices are:

Movement/non-movement sensors                     Falls sensors

Fire/smoke alarms                                            Automatic lighting sensors

Food/water alarms                                            Fridge activity sensors

Window/door sensors                                        Carbon monoxide sensors

Bed/chair occupancy sensors                             Temperature range sensors

Gas shut off devices                                          Medication reminder systems

Wrist-worn wellbeing monitors


III  Telehealth

Often regarded as a form of Telecare, Telehealth is a form of technology which enables monitoring of people's health in their own home.

From http://telecareaware.com/what-is-telecare/

Here is the best definition of home-based telehealth monitoring to date.  It is from Telecare: Using Information and Communication Technology to Support Independent Living by Older, Disabled and Vulnerable People July 2003 Curry RG, Trejo Tinoco M, Wardle D.

‘Telehealth monitoring is the remote exchange of physiological data between a patient at home and medical staff at hospital to assist in diagnosis and monitoring (this could include support for people with lung function problems, diabetes etc).  It includes (amongst other things) a home unit to measure and monitor temperature, blood pressure and other vital signs for clinical review at a remote location (for example, a hospital site) using phone lines or wireless technology.'

Examples of telehealth devices are:

Although it is easy to predict that telecare and telehealth technologies will merge, and although the clients and patients they benefit are often one and the same individuals, it is still useful - that is, less confusing in this stage of technological and linguistic evolution - to maintain a difference in the terms.

However, just as people want entertainment, not necessarily a TV, some people also need a service that helps them to stay independent, with dignity.  The technology should only be one means to that end.

From the Telecare and Telehealth Special Interest Group of the British Geriatrics Society:

(see http://www.bgs.org.uk/Special%20Interest/new_technology.htm)

Telecare is derived from: tele for distance and care, so it translates to ‘care at a distance'.  A formal definition is ‘the delivery of health and social care to individuals within the home or wider community, with the support of devices enabled by information and communication technologies'.  Examples include:

1.  Safety at home, e.g. fire, flood, smoke etc alarms
2.  Lifestyle monitoring, e.g. fall alarms, bed/chair monitors, wandering detection etc.

Telehealth enables remote interaction between clinicians and patients, through the use of information and communication technologies such as interactive video, digital imaging and electronic data transmission. This includes telemedicine application for diseases such as CHF, COPD, Diabetes and IHD. 

IV  Telemedicine

From http://telecareaware.com/what-is-telecare/

Telemedicine as a term has been in use for some time and is therefore better defined.  The following, by the World Health Organisation, is simple and clear.

Telemedicine is the practice of medical care using interactive audio visual and data communications. This includes the delivery of medical care, diagnosis, consultation and treatment, as well as health education and the transfer of medical data.'

Telemedicine is therefore essentially doctor-to-doctor, with the patient somewhere in the system, and typically involves consultations with specialists at a distance. There are also other branches of medical ‘tele-s' such as teleradiology and telepathology.

V   Prosthesis & Othortics

Prosthesis:

From Oxford English Dictionary, with in brackets dates of first recorded use.

(a) [1706] that part of surgery which consists in supplying deficiencies, as by artificial limbs or teeth, or by other means.

(b) [1900] an artificial replacement for a part of the body.

Prosthetics (as a plural noun): [1896] The branch of surgery concerned with the replacement of defective or absent parts of the body by artificial substitutes.

Orthosis:

An orthopaedic appliance or apparatus used to support, align, prevent or correct deformities or to improve the function of movable parts of the body.

Examples include:

USEFUL READING

Department of Health 2005.  Building Telecare in England.  Department of Health, London.  [Available online at http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/ PublicationsPolicyAndGuidance/Browsable/DH_4122310]

University of Washington and AccessIT (no date).  What is Accessible Electronic and Information Technology?  Factsheet 110 (sic), Accessible Information Technology Series, National Center on Accessible Information Technology in Education, University of Washington, Seattle.  [Available online at http://www.washington.edu/accessit/articles?109]

Steve Hards, Briefing Paper: What is Telecare?  Telecare Aware, May 2006.  [Available online at http://telecareaware.com/otherpages/what_is_telecare_briefing_may06.pdf]