Adaptive Equipment Basics: Determining the Right Device for Your Patient’s Functional Needs
Adaptive Equipment vs. Assistive Technology
Adaptive equipment includes any tool or device used to assist someone with performing daily living activity on a more independent level. This includes any category in activities of daily living (ADLs) and instrumental activities of daily living (IADLs) as defined by the OT practice framework. Additional tasks may include any hobbies or interests that the patient wishes to actively participate in. Occupational therapists frequently provide adaptive equipment and relevant education for patients when they see a need via the initial evaluation or upon discharge.
Typically, depending on the source you refer to, some equipment providers view adaptive equipment as a subcategory of assistive technology. While assistive technology is any unique device created to meet the needs of a person with disabilities, an adaptive tool is a modification made to an already existing tool. For example, a standard powered wheelchair may be viewed as a form of assistive technology but the ergonomic, custom-made hand control may be considered adaptive technology. Each device is developed for the sake of meeting the unique needs of each patient.
Why would a patient need adaptive equipment?
Adaptive equipment usually comes into play when a patient or client is maxing out on restorative efforts and may need modifications instead to experience success. For example, a patient with Parkinson’s disease may have improved their mobility and dressing tasks after multiple therapy sessions. However, the resting tremor in their hand is a signature symptom of the disease and may not improve any time soon. If that’s the case, maybe weighted utensils could help them improve their fine motor coordination for dressing, hygiene, and self-feeding tasks.
Here are a few other medical-related conditions (not all-inclusive) that impede function and may merit the use of adaptive equipment:
- Post-operative joints (i.e., hip, shoulder, knee)
- Generalized weakness affecting someone’s ability to stand from a seated position
- Visual deficits impeding someone’s ability to read prescription medications, instructions, recipes, etc.
- Paralysis limiting functional reach, fine motor coordination, and postural stability.
- Cognitive issues affecting someone’s ability to complete a functional task in the correct order or in a safe manner
What is the difference between adaptive equipment and durable medical equipment (DME)?
Durable medical equipment (DME) includes any medical-grade device that’s prescribed by a healthcare provider for extended, regular use. Many DMEs are incorrectly labeled as “assistive devices” (according to Medicare), which may get confused with OTs definitions for assistive technology or adaptive equipment. In other words, the DME is coined and defined as “medically necessary” for the individual to function per Medicare guidelines. Common pieces of DME include walkers, wheelchairs, crutches, and respiratory equipment.
Does insurance cover adaptive equipment?
In most cases, Medicare, Medicaid, and private insurances will NOT cover or partially cover the cost of adaptive equipment since these devices don’t meet the eligible criteria to be considered “medically necessary”. Medicare B plans are designed to cover devices that fall under the DME definition. In rare cases, a primary physician or other prescribing doctor may justify coverage if someone needs adaptive equipment for medical purposes and for a lengthy period of time. If an OT can’t obtain a written order from a primary physician, they may appeal to the insurance company to see if they can justify coverage or partial coverage for adaptive equipment.
When insurance coverage is not a possibility, occupational therapists can assist low-income patients and their caregivers by providing them with numerous resources for adaptive equipment. Many assistive devices can be located online, in department stores, or even fabricated by an OT or an equipment specialist. Some equipment provider companies may be available locally to provide demos, rentals, and discounted products.
What are common types of adaptive equipment?
In the world of occupational therapy, there are hundreds of adaptive equipment options available for the geriatric population. Fresh out of school, most OTs know basic equipment including hip kit supplies, shower chairs, and so forth. So, let’s start with some more innovative devices that new OT graduates can add to their bag of tricks:
- Bath benches (back or no back support)
- Suction or installed wall soap dispensers
- Removable shower head
- Suction-cup grab bars (bariatric, standard)
- Bathtub grab rail
- Raised toilet seats
- Toilet aide
- 3-in-1 commode
- Bedside commode
- Button hook
- Zipper aid
- Bra AngelⓇ dressing aid
- Faucet extender
- Wide-handled razors, toothbrushes
- Extended handle for hair brushes
- Extended nail clippers
- Alternate or hands-free toothpaste dispensers
- Adjustable cosmetic mirrors
- Weighted utensils
- Angled utensils
- Plate guards
- NoseyⓇ cups
- Rocker knife
- Suction cup cutlery
- Fall alarms (pull strings, padded sensors, etc.)
- Leg lifters
- Elevated pads or cushions
- Stand-assist rail
- Bed ladder assist
- Slip-free stair strips
- Pill dispensers (automated or manual)
- GPS trackers (community safety)
- Alarm and reminder systems (manual, automated, or digital)
- Screen magnifiers and reading aids
- Speech-generated or augmented communication devices
- Hearing amplifiers
- Wide-handled writing utensils
- Sip and Puff (SNP)Ⓡ technology assist device, eye-gaze, and head-operated trackers
- Mounting systems for screens and other digital devices
In areas such as functional mobility and communication, OTs can expect to consult with fellow disciplines including physical therapy and speech-language pathology. Consultation may confirm the use of certain devices or be a way to check if devices are being assigned by fellow disciplines already.
Tips for measuring a patient for adaptive equipment
Like a new pair of jeans, adaptive equipment is not a “one size fits all” scenario. Each patient should be fitted accordingly to optimize the device and their overall ability to function. For example, a shower chair needs to be adjusted according to all the following:
- Height- obtained through a standard measuring tape
- Weight capacity- obtained through a body weight scale, either through standing or by wheelchair minus the weight of the chair
- Postural stability- static and dynamic sitting and/or standing balance
- Width, length and depth of the pelvis in sitting- through standing measuring tape
- Cognitive capacity- MoCA, SLUMS, or Short-Blessed assessments
- Grip strength: obtained by goniometer measurements
- Joint range: dynamometer measurements
Are there situations where adaptive equipment would not be appropriate?
In cases where the patient’s cognitive or safety awareness comes into question, the occupational therapist may need to think twice about assigning a new device for daily use. For example, providing a person with a rocker knife or other sharp object who has late-stage Alzheimer’s disease may cause more harm than help. There are also instances in which a patient may not have the physical strength, range, or endurance to use the device effectively. So, an alternative device or additional restorative therapy may be a better path.
OTs should consider potential ethical issues surrounding adaptive equipment assignment. Does the patient want the device? Will the device make the task easier or over-complicate it? It’s the OTs responsibility to educate the patient as efficiently as possible about adaptive equipment use; however, OTs can’t force or coerce patients into using newly introduced devices.
Adaptive equipment, when assigned appropriately, can do wonders for an elderly adult’s daily routine. As a new OT practitioner, you can expand your knowledge of adaptive equipment by seeking relevant continuing education or mentorship for your specific setting. Familiarize yourself with current equipment providers and financial resources so that your patients can immediately access affordable adaptive equipment.
Cornerstone Rehab treats older adults in skilled nursing facilities in Kentucky, Florida, Ohio and Pennsylvania. Join our skilled team of occupational therapists and learn about our rewarding careers.