rehabilitation

Transcription

rehabilitation

THE PROVISION OF ASSISTIVE AIDS
– part of a larger system
Information about the provision of assistive aids
The National Insurance Administration
Assistive Technology Division
Sannergt. 2
0426 Oslo
Telephone: 22 92 70 00
Fax: 22 92 72 75
E-mail: [email protected]
Published by the National Insurance Administration 2003
Previously published in 1997, 1998 and 2001
English version 2003
ISDN 82-551-0851-3
Layout: Pippip Design/Aase Bie
Illustrations: Trude Tjensvold
THE PROVISION OF ASSISTIVE TECHNOLOGY
– part of a larger system
Everyone who works with the provision of assistive aids has
discovered that this is a complex field and that teamwork
between the user and helpers across sectors and levels is essential. It is therefore important that we are familiar with the
framework within which we work.
This publication presents the provision of assistive aids as part
of a larger system. It explains and defines the most important
concepts and the conditions under which assistive aidsare
provided. It gives a definition of the tasks of the Assistive
Technology Centres as a county-level service and it describes
the other parties involved.
We hope that this brochure can serve as an introduction to
assistive aids and their importance in the larger system. It is
meant for everyone who works with people with disabilities.
The target group for this brochure is therefore a large one:
professionals at all levels, user organisations and educational
institutions and, of course, the National Insurance Service’s
own employees.
Assistive Technology Division
September 2003
side 3
CONTENTS
Disability .................................................................................. 5
Help for people with disabilities ............................................ 7
Assistive Technology – one of several solutions...................11
Assistive Technology ..............................................................12
Providing Assistive Technology .............................................14
Roles and responsibility ........................................................ 21
The place of assistive aids in the organisation
of the National Insurance Service ........................................ 22
References ..............................................................................26
Literature and video films .................................................... 27
Addresses ............................................................................... 28
side 4
DISABILITY
The Government's Action Plan for Persons with Disabilities defines disability as follows: “A disability is a disparity between the capabilities of
the individual and the functional demands of his/her environment in
areas which are significant for the establishment of independence and
a social life.” (1)
Practical problems
Exclusion
A person with a disability:
• encounters practical problems because he/she is unable to cope with
the demands made by his/her surroundings
• is excluded from important facets of social life.
Professor Ivar Lie puts it this way: “Any restriction in desired self-expression can in principle be perceived as a functional disability. But in terms
of social security legislation, only persons who are seriously restricted in
their ability to live independently and in the context of school and work
can be characterised as disabled.” (2)
Definition of disability
Disability can be described as a ‘gap’ between the individual’s capabili-
Function
ties and the environment’s demands regarding functions.
Solution ▼
Situational
Disability
practical problems
▼
The capabilities
of the individual
Demands of
▼ the environment
By impaired functional capacity we mean loss of or damage to a body
part or body function. This may mean, for example, impaired mobility,
sight or hearing, impaired cognitive function, or other functional impairments due to allergy or cardiovascular disease.
People with impaired functional capacity will not necessarily be disabled.
A functional impairment need not restrict a person’s social participation.
Disability arises when there is a gap between an individual’s capabilities
and the way his/her surroundings are designed or the functions they
require.
Capabilities
A large proportion of the Norwegian population suffers from impaired
functional capacity. The risk of impaired functional capacity increases
side 5
with age. We meet these challenges in a variety of ways. See Report No.
40 (2002-2003) to the Storting (3).
A disability can be reduced by improving the person's capabilities and by
doing something about the demands of the surroundings. The person's
Training, tuition,
care and support
capabilities can be improved with the help of training, tuition, care and
Adaptation and alteration
of the environment
The demands of the surroundings can be changed by adapting and alter-
Assistive aids
Assistive aids or personal assistance can be provided in order to narrow
support.
ing the environment.
the gap between demands and capabilities.
Personal assistance
The person must also be able to carry out and have access to the activity.
Physical, social and psychological factors all affect accessibility and thus
the demands made by the surroundings. It is essential that the person
concerned is interested in carrying out the activity.
side 6
HELP FOR PEOPLE WITH DISABILITIES
When an injury or illness can have or has consequences, a variety of
processes are possible:
• treatment
• tuition/training
• rehabilitation
• vocational rehabilitation
• nursing
One and the same user will often have more than one requirement. The provision of assistive aids may be necessary in all of these processes. They may
also be relevant to prevent undesirable consequences of injuries or illness
(secondary prevention). Plans should be drawn up showing the course each
of the processes is to follow (treatment plan, nursing plan, tuition plan, rehabilitation plan or action plan for vocational rehabilitation).
Treatment
When an injury or illness occurs, the first step to take is usually treatment.
The aim of treatment is to restore the best possible function. This may be
a lifelong process. Assistive aids may be a necessary part of the treatment
process (for example a toilet elevator and crutches after a hip operation).
Tuition
Pupils or students with special requirements are entitled to individually
Hand in hand –
providing assistive aids
and tuition
adapted tuition (Education Act, Chap. 5, Section 5-1). Assistive aids (such
as a computer) may be a necessary part of the tuition process. When
tuition depends on assistive aids, teamwork will be required between the
educational institution and the Assistive Technology Centre.
At the same time, the provision of assistive aids can trigger off the need
for follow-up. A user who needs a computer to make his/her work situation easier will usually also need tuition in the use of the computer.
Vocational rehabilitation
The aim of vocational rehabilitation is to help the user to obtain or to keep
suitable employment. Suitable employment is understood to be employment
that is commensurate with the user’s physical and mental capabilities.
The employer is responsible for in-house rehabilitation. It may be necessary to adapt existing equipment and tools at the workplace. Under the
provisions of the Work Environment Act, it is the responsibility of the
side 7
employer to adapt the workplace for occupationally handicapped
employees. However, financial support is available under the national
insurance scheme provided that the expense incurred by the employer
for assistive aids and adaptation of the workplace exceeds half of the
basic amount under the National Insurance Scheme.
The employment services are responsible for vocational rehabilitation.
The national insurance scheme covers the cost of assistive aids that are
required in connection with vocational rehabilitation. (4)
The user is the most important person
Problem:
Function
Activity
Participation
Evaluation:
Have the goals
been achieved?
Is other action
necessary?
Follow-up:
Information
Tuition
Different
processes:
Treatment
Tuition
Rehabilitation
Vocational rehabilitation
Nursing/care
Survey:
Function
Activity
Participation
Surroundings
Goals:
Function
Activity
Participation
Solution:
Medication
Surgery
Guidance/training/therapy
Compensatory measures
-assistive aids
The provision
process
Same procedure for
every process:
· treatment
· instruction
· rehabilitation
· vocational
rehabilitation
· nursing
Trying to find the right solution will always be a process. The user is the
most important person in the different processes. The user outlines
his/her problems and requirements and the professional helper provides
information about the available options. The user and the helper decide
which goal(s) they want to attain together and choose between various
ways of attaining this goal. Follow-up and evaluation are a natural part
of the process. It will often be a case of moving back and forward within
the process or of repeating the process if the goal is not attained first
time round.
Providing assistive aids is one possible compensatory solution. This means
moving on into a new process – the provision process (see page 15). This
will be an integrated part of the overall process, often running parallel
with other solutions and processes.
Help can be enlisted from the local authorities, the national insurance
office, the employment office, the employer, the Assistive Technology
Centre and resource centres at county and national level.
side 8
Rehabilitation
Rehabilitation is a process which aims at enabling persons with disabilities to reach and maintain their optimal physical, sensory, intellectual,
Rehabilitation is a process
in which the user's own
goals, motivation and efforts
play a central role.
mental and social functional levels.
Rehabilitation means regaining dignity. The goal is to achieve the best
possible quality of life, coping and participation. The rehabilitation
process is started when it becomes clear that the injury or illness is going
to have long-term consequences. The process is time-limited and can
include solutions which give or restore functions, or compensate for a
lost or defect function or reduced functional capacity. Rehabilitation is
very different from ordinary nursing and care in that it has different
goals and ways of achieving these goals and it focuses on the user's control and personal effort. Rehabilitation is always a cross-disciplinary
process in which a number of players collaborate.
White Paper on Welfare
In the White Paper on Welfare (Report No. 35 to the Storting,
1994–1995), rehabilitation is defined as: The work of assisting persons
whose functions are temporarily or permanently impaired due to illness,
injury or congenital defect to regain, maintain or develop the ability to
function/cope and/or of adapting conditions in the environment around
the person, with a view to the greatest possible degree of independence
and quality of life on the person's own terms. (5)
White Paper on Rehabilitation
In the White Paper on Rehabilitation (Report No. 21 to the Storting,
1998–1999) we find this definition: Time-limited, planned processes with
well-defined goals and means, in which several players work together to
give the necessary assistance to the user's own efforts to achieve the best
possible ability to function and cope, independence and participation
socially and in society. (6)
United Nations Standard Rules
In the United Nations standard rules for the disabled (rule 23), the term
rehabilitation refers to a “process aimed at enabling persons with disabilities to reach and maintain their optimal physical, sensory, intellectual,
psychiatric and/or social functional levels thus providing them with the
tools to change their lives towards a higher level of independence”. (7)
Neither the Storting nor specialists in Norway agree on which definition
is the most apt.
A variety of aids may be relevant in a rehabilitation process, such as
wheelchairs, devices to facilitate dressing and household aids. Treatment,
tuition or vocational rehabilitation is often part of the process.
Habilitation and rehabilitation
It is customary to distinguish between habilitation and rehabilitation.
Habilitation is linked with congenital and rehabilitation with acquired
functional disabilities. Here, we will use 'rehabilitation' as a collective
term.
side 9
Individual rehabilitation plans
The work of rehabilitation must start with an individual, goal-specific
rehabilitation plan for the person concerned. A rehabilitation plan can be
illustrated in the following way:
Goal analysis
➞
Identification of problems
➞
Problem-solving
➞
Evaluation
➞
Follow-up
The first step in any rehabilitation process is a thorough goal analysis
based on the user's own requirements and wishes. The work can then be
initiated by determining which problems have to be solved and how they
are to be solved. The solutions must be evaluated and if necessary followed up with new solutions or adjustments in the goals.
The purpose of assistive aids is to solve the user's practical problems and
they should be part of a plan – a treatment plan, a nursing plan, an education/tuition plan, a rehabilitation plan or an action plan for vocational
rehabilitation.
Individual rehabilitation plans make for a more effective provision of
assistive aids. This type of plan shows what the various services and
professional groups have to do to achieve the goals. It is not a detailed
treatment plan.
side 10
ASSISTIVE TECHNOLOGY
– ONE OF SEVERAL SOLUTIONS
An assistive aid is not a goal in itself and it is not the only means of
solving practical problems. The best solution is often a combination of
several measures. Simple alterations to surroundings or reorganisation
of work methods are often better than large assistive aids.
The purpose of assistive aids is to help to solve practical problems and
compensate for loss of function, and they must be seen in conjunction
with other forms of help to the user. The user must be motivated for the
assistive aid to function satisfactorily. Assistive aids have a function insofar as they solve problems that the user needs to have solved.
Personal Rehabilitation
assistance
training
Assistive aids
Personal contact
Respite
Transportation
Alteration of
surroundings
Alteration
of work
The problem has not been solved until the user is satisfied with the
assistive aid.
side 11
ASSISTIVE TECHNOLOGY
An assistive aid is a device or solution that helps to reduce the practical
problems faced by a disabled person.
Assistive aids must be part of a comprehensive plan and they must help to:
• improve functional capacity
• increase self-sufficiency
• facilitate the care of the disabled person
Who is entitled to assistive technology?
Persons whose functional capacity is permanently (more than two years)
and significantly impaired due to illness, injury or bodily defect are entitled
to receive financial support for assistive aids under the National Insurance
Scheme. Persons who have a temporary need for assistive aids must apply
for financial support elsewhere, usually through the local authorities.
Assistive technology for day-to-day needs
The assistive aids must be necessary and suitable with regard to improving the
person’s ability to solve day-to-day practical problems or to be nursed at home.
Under the National Insurance Scheme financial support is usually granted for
the most reasonably priced types of assistive aids that meet the user's needs.
Assistive aids
+ framework agreement
= national assortment
In the case of major categories of assistive aids, such as manual and electric wheelchairs, the National Insurance Administration enters into framework agreements with individual suppliers. Assistive aids covered by
framework agreements constitute the national assortment. The purpose
of framework agreements is to ensure a national assortment of good
quality at an acceptable price.
The Assistive Technology Centres choose their local assortment from the
national assortment. The National Insurance Administration does not
enter into framework agreements for smaller categories of assistive aids,
such as ADL aids. The Assistive Technology Centres make their own
agreements for these aids direct with the suppliers.
If an Assistive Technology Centre does not have the assistive aid applied for, it
can either obtain an equivalent aid that suits the purpose from another Centre
or purchase it. If the national assortment does not include any assistive aids
that meet the user's needs, an application can be made for dispensation to purchase other aids. There must be very good reasons for making this application.
Financial support is not given for assistive aids in the home which are usually
also used by non-disabled persons. This rule refers to household appliances
such as washing machines, television sets and ordinary kitchen equipment.
However, grants are available for extra equipment to adapt these appliances.
side 12
Assistive Technology at the workplace
Financial support is available under the National Insurance Scheme for
assistive aids, conversion of machinery and adaptation of physical surroundings at the workplace when appropriate and necessary for the purpose of enabling the disabled person to obtain or keep suitable work.
Suitable work is understood to be work the user can cope with based on
his/her physical and mental capabilities.
Under Section 13 of the Work Environment Act it is the responsibility of the
employer to adapt the workplace for occupationally disabled employees.
However, grants are available under the National Insurance Scheme to ensure
that occupationally disabled employees are able to keep suitable work. As a
general rule, grants are available if the expense incurred by the employer for
assistive aids and adaptation exceeds half of the National Insurance Scheme's
basic amount, see Section 10-15 of the National Insurance Act.
In cases where grants are given to ensure that the disabled person is able
to obtain suitable work, this will often be part of vocational rehabilitation. If so, an action plan for vocational rehabilitation must exist, drawn
up by the applicant for rehabilitation and the Employment Services.
Grants are available for assistive aids which a disabled person needs during education, even if the education is not part of vocational rehabilitation. Grants are available to self-employed persons when required to
enable them to continue their business. (4)
Assistive Technology for training, stimulation and activation
Under the National Insurance Scheme, assistive aids are available for training, stimulation and activation of children and young people under the age
of 26. Special or extra equipment is also available for games and sports, but
these must be designed especially for the disabled or be necessary for
him/her to carry out the activities. Examples of these are a switch to use a
toy, assistive ski equipment, etc. Assistive aids for use in competitive sports or
ordinary toys or sports equipment are not available under the scheme.
Assistance in other areas
The National Insurance Scheme provides assistive aids and grants for other
solutions in a number of areas. However, certain conditions are attached to
some of these areas, such as limits for grants and number of times a year:
Interpreters
Guide dogs
• Hearing aids and interpreter assistance for the hard of hearing
• Interpreter and escort assistance for deaf-blind people
• Guide dogs and reading and secretarial assistance for people with
impaired vision
• Basic sewing patterns for making clothes
• Computer equipment as a means of communication
• Computer equipment for the training, stimulation and activation of
children and young people
• Educational aids
• Motorised vehicles and other means of transport
side 13
PROVIDING ASSISTIVE TECHNOLOGY
Teamwork
Different services and sectors have to work together to achieve a holistic
assistive aids solution. The user has to relate to very many different people.
Good solutions depend on teamwork between these parties and the user
and between the different parties themselves towards a common goal.
Education
sector
Employment
services
National
Insurance
Service
Social
welfare
service
The user
Next of kin
Health
service
Employer
Transport
and communications
sector
Suppliers
Technical
services
Cultural
sector
The user's public network
Together these parties make up a public 'network' with the user in the
centre.*
Rare
Complicated
Specialists
County level
Frequent
Simple
Education
Municipal level
Employment
Health
Nat.
Insurance
Generalists
Social Welfare
sectors
Sectors
THE USER
Providing assistive aids requires expertise from different sectors and different levels. It is important to involve all the relevant sectors. Both simple and more complicated problems can be solved at municipal level if
the local authorities have had experience of similar problems. Rare and
complicated problems often require specialist knowledge at a higher
level. It is important to ask for advice and guidance from a higher level
if one's own expertise is insufficient.
* The user's public network: Marianne Rand-Hendriksen
side 14
THE USER
National
level
Responsibility
Municipal
The local authorities are responsible for the health and rehabilitation of
their inhabitants. Providing assistive aids is part of this responsibility.
When the local authorities do not have sufficient expertise, they have to
enlist the help of specialist services at higher levels.
Regional
The Assistive Technology Centres are resource centres serving the whole
county in the field of assistive aids. They know how assistive aids, sign language interpreters and ergonomic assistance can compensate for or alleviate loss of functions. The Assistive Technology Centres give advice and
guidance to the local authorities and to other partners in the county.
National
There are three resource centres at national level within the National
Insurance Service: a nation-wide vehicle centre and the Centre for
Assistive Information Technology in Oslo and in Bodø. These centres specialise in certain fields of assistive aids provision and they serve users and
the municipal and regional services throughout the country. Outside the
National Insurance Service, there are a number of national and regional
resource centres, such as the centres for rare disorders at Berg Gård and
Frambu.
The provision process
Assistive aids are provided to help solve the user's practical problems and
they are part of a comprehensive rehabilitation plan, tuition plan or
action plan for vocational rehabilitation. Assistive aids can also help to
prevent loss of function, to maintain and retain functions and to facilitate the nursing situation. During the provision process the user and the
specialists work together to arrive at the right solution.
Practical problem
Evaluation of
overall situation
Evaluation
Feedback
Repair
Technical service
Goal-setting
The user
Testing
Assessment
Choice
Follow-up
Guidance
Training/practice
Tuition
Adaptation
Special adaptation
Application
Decision
Purchase
side 15
The starting point for the provision process is a practical problem resulting from impaired functional capacity, either physical or mental. This
requires an evaluation of the user's overall situation and a goal for the provision process. This should be incorporated in plans for treatment, nursing,
tuition, rehabilitation or vocational rehabilitation.
After testing and assessing the various options, one or more assistive aids
are selected. Professional helpers can contact the Assistive Technology
Centre if they wish to borrow assistive aids for a trial period.
The next step is to formulate an application (claims form) and send it to
the Assistive Technology Centre for its assessment and decision. It is
important to provide adequate and good reasons backed up by relevant
information. This helps to speed up the process. The comments to the
National Insurance Act list thirteen items that can be of significance in
assessing the application. See page 18.
If the Assistive Technology Centre approves the application, the applicant
will be issued with the assistive aid.
Assistive aids often have to be adjusted and adapted. Sometimes major
adjustments are required.
Adequate guidance, instruction and practice in using the assistive aid are
just as important as the assistive aid itself. The helper who has
recommended the assistive aid is responsible for the follow-up and for
the evaluation along with the user to ascertain whether it actually solves
the user's problems and whether further instruction or adjustment is
required.
The user must be given both verbal and written information about
whom to contact, and how to contact them, if service or repairs are
required. See form on page 19.
The process must be evaluated to make sure that the user has received
adequate help, i.e. the correct assistive aid within the anticipated time
frame.
side 16
Agreements and documentation
Cooperation between the user and professional helpers often results in
plans, applications and agreements. These must be made in writing and
be available to the user. Examples of such documents are:
• Rehabilitation plan with problems and goals
• Action plan for vocational rehabilitation with solutions and goals
• The National Insurance Administration's check-list (see page 18) which
should be included in the plan.
• Copy of the application for assistive aid(s)
• List or form showing who is responsible for what (see page 19)
• Information regarding delivery time, collection and assembly
• Instructions for use
• Tuition programme and tuition agreements
• Service agreement
The figure below shows the documentation and agreements in relation
to the different stages in the provision process.The different parties have
different tasks in the process. This must be documented in the list of who
does what.
Report from
whom to whom?
Criteria for success
Joint
problem definition
Joint
rehabilitation
goals/plan
Who takes the job when?
Service agreement
Who follows up what,
when and how often?
The user
Tuition goal
Who?
Tuition programme
Goal for
assistive aid's function
Application
Who does what?
Delivery time
Collection
Assembly
Instructions for use
side 17
Check-list for required information when a claim is made for assistive aids
From the National Insurance Act
It is stipulated in Section 11 of the Public Administration Act, cf. Section
21-1 of the National Insurance Act, that national insurance bodies have a
duty to advise members of the National Insurance Scheme about their
rights and obligations under the law and a duty to obtain the information that is needed to deal with claims for benefits.
In order to ensure that the user is given adequate help, the National
Insurance Service must have sufficient information to enable it to carry
out an overall assessment of the need for an assistive aid.
Answers to the following questions should help to decide whether an
assistive aid is necessary and appropriate for the user and whether the
assistive aid chosen is included as part of a plan:
1. What role does the use of the assistive aid applied for play in a treatment plan, nursing plan, rehabilitation plan, vocational rehabilitation
plan or tuition plan?
2. What medical information/diagnosis/cause/previous history/prognosis
is of significance for the utilisation of the assistive aid?
3. What factors in the user's life situation as regards housing, employment, school and family relations can have significance for the use of
the assistive aid?
4. Describe the type and scope of the practical problems that the assistive aid is intended to solve.
5. What other means have been used to solve the user's practical problems at home, school, work or in the nursing situation?
6. Describe why any earlier solutions were not satisfactory with regard
to the problems that are to be solved by the assistive aid applied for.
7. How does the applicant master the use of the assistive aid and what
consequences does the assistive aid have for his/her participation in
work, education and daily life?
8. What improvement in level of function/nursing situation is expected
to be achieved by purchasing the assistive aid?
9. Have other more reasonably priced alternative assistive aids been
tried?
10. What help does the assistive aid give that other assistive aids cannot
give?
11. What tuition/practice is required before the applicant can start using
the assistive aid?
12. Who is to be responsible for the tuition?
13. What plans exist for local follow-up of the use of the assistive aid as
far as the user is concerned?
side 18
Example of a form containing information about the responsibility for providing and following up assistive aids.
To be filled in by a municipal helper in cooperation with the user.
One copy of the form will be given to the user.
Name of user
Date of birth
Address
Telephone
Name, position and telephone number of the municipal helper
A medical rehabilitation plan/nursing plan/vocational rehabilitation plan has been drawn up in collaboration with the following bodies and persons. State telephone numbers.
An agreement has been made to evaluate the need for the assistive aid
State time, place and which persons are to take place in the analysis. State telephone numbers.
An agreement has been made to try out the assistive aid
State time, place and which persons are to take part in the test. State telephone numbers.
An application for the assistive aid has been completed and sent
State date and who has given reasons for the application.
An agreement has been made to follow up the application
State date and who is responsible.
An agreement has been made to deliver the assistive aid. State date.
An agreement has been made to adapt/give tuition in the use of the assistive aid.
State time, place and which persons are to take part in the adaptation/tuition. State telephone numbers.
An agreement has been made to follow up the assistive aid.
State time, place and which persons are to take part in the follow-up. State telephone numbers.
The user should report his/her experience with the assistive aid to the following body and person. State telephone number.
Simple repairs are carried out by the following enterprise and person. State telephone number.
Complicated repairs are carried out by the following enterprise and person. State telephone number.
Outside normal working hours, repairs are carried out by the following enterprise and person. State telephone number.
side 19
Knowledge and information
Both the users of assistive aids and the persons who help to provide them
need knowledge and information in many fields. Some of this information is expertise that the helpers will have acquired through studies and
experience, for example knowledge about systems, legislation,
methods, solutions and products. However, they also need to study and
collect knowledge about the user’s surroundings and the demands they
make. Other knowledge, for example about the user's state of health
and prognosis, problems and needs, wishes and options, is obtained and
developed in the course of the process, during the interaction between
the user and the helpers.
side 20
ROLES AND RESPONSIBILITY
The user
Assistive aids must be provided on the user's terms. It is the user who will
benefit from the assistive aid. It is therefore the user him/herself who has
to apply for the assistive aid. In most cases, however, this is done in consultation with the helpers. It is also the user's responsibility to handle the
assistive aid correctly and to notify the social services if it is no longer
being used. The user is entitled to professional help at all stages of the
process.
The local authorities
The Health Services Act gives the local authorities a fundamental responsibility for habilitation and rehabilitation. The local authorities thus have
a general duty to solve the disabled person's problems. This responsibility
also includes the provision of assistive aids and ergonomic measures.
It is the responsibility of the local authorities to ensure that all stages in the
provision process can be carried out in an acceptable manner. This means
that the local authorities are responsible for discovering and analysing local
requirements and for giving tuition in the use of the assistive aid. It is also
the responsibility of the local authorities to follow up the users over time,
adjust the assistive aid if necessary and report it if assistive aids no longer
meet the requirements. This also applies to educational aids.
The local authorities must enlist the help of the Assistive Technology Centre
or other resource centres if the local network does not have sufficient
expertise. Local authorities have agreements to collaborate with the Assistive
Technology Centre in their county. It is a prerequisite that the local authorities
themselves are always involved in the provision of assistive aids.
Assistive Technology Centres at county level
The Assistive Technology Centres have an overarching, coordinating
responsibility for assistive aids in their county. They must contribute to
equal and comprehensive solutions for people with disabilities – at home,
at school, at work and in their leisure time – by providing assistive aids,
ergonomic measures and an interpreting service. The Assistive
Technology Centres are county-level resource centres for public bodies
and people who are responsible for solving disabled persons’ problems.
In addition to helping, for example, local authorities to provide assistive
aids, the Assistive Technology Centres have an administrative responsibility. This entails ensuring that the assistive aids are distributed in accordance with the National Insurance Service's rules and managing the
financial side of assistive aid provision. Here the watchwords are effective
purchases, satisfactory product flow and reuse of assistive aids. (8)
side 21
ASSISTIVE AIDS IN THE ORGANISATION
OF THE NATIONAL INSURANCE SERVICE
There is a Assistive Technology Centre in every county. The Assistive
Technology Centre is organised as a separate department of the County Office
National responsibility
of the National Insurance Service. The National Insurance Administration has the
overall professional, financial and administrative responsibility for assistive aids.
The National Insurance Administration manages one of the cornerstones of
the Norwegian welfare society: the National Insurance Scheme and other
social security schemes. The intention of the National Insurance Scheme is to
secure income for individuals, compensate for expenses and help people to
help themselves, so that they can manage on their own in personal and workrelated situations. As the Central administration of the National Insurance
Service, the National Insurance Administration has the overall responsibility
for the administration, initiation, follow-up and development of the National
Insurance Scheme, contributive support schemes and assistive aids.
As leader of the National Insurance Service it is the duty of the National
Insurance Administration:
• to ensure that the National Insurance Service fulfils the intentions of the law
• to guarantee the population legal protection, so that they are treated
equally no matter where they live in Norway
• to be a national 'motor' in developing services, and ensure that they are
always adapted to the needs of the users, and to consider comprehensive
solutions for the users in cases where other welfare schemes are involved.
• to cooperate with and establish relations with other relevat parties in society.
The National Insurance Administration has the overall responsibility for
ensuring that the Assistive Technology Centres all have the same goals and
priorities – as part of the work of developing a uniform, national system
Development of human
resources
Information
for the provision of assistive aids. This will ensure that the users are given
the same help and are met by professionals with the same expertise regardless of where they live. The development of human resources is therefore a
key area and an essential tool in achieving this goal. The introduction of
national standards for some of the Assistive Technology Centres' spheres of
work from the year 2000 is another step towards achieving this goal.
It is the responsibility of the National Insurance Administration to follow
up and coordinate input from the Centres regarding the need for development measures and to initiate pilot projects. It is also the responsibility of
the National Insurance Administration to coordinate and facilitate teamwork between the Assistive Technology Centres and the relevant specialists
and researchers – and to enter into agreements with them.
The National Insurance Administration shall also:
• implement measures in connection with the preparation of framework
agreements for assistive aids, testing and assortment evaluations.
side 22
• evaluate the provision of assistive aids and cost trends at national level.
• coordinate the Assistive Technology Centre system by, among other
things, making use of the possibilities that lie in purchasing and reuse
across county borders, joint IT systems, specialist networks, etc.
In 2002, assistive aids, parts, accessories and services in this field were purchased for a total of NOK 2.7 billion. The National Insurance Service owns the
assistive aids which are lent to the users.
User participation
A national committee has been set up to ensure user participation in the
assistive aids area. This committee is a meeting place for the Norwegian
Federation of Organisations of Disabled People (FFO), the Forum for
Cooperation between Organisations of Disabled People (SAFO), and the
Assistive Technology Division and the Division for Assistive Technology
Procurement Contracts in the National Insurance Administration. It is the
aim of this committee – through frequent contact, exchange of information and discussions of important issues in the field of assistive aids – to
assure the quality of and develop the aids that are available to the users.
The committee is also a meeting place for feedback and input from the
user organisations and their members to the National Insurance Service
and from the National Insurance Service and its employees to the user
organisations and the users. Meetings are held once every quarter.
In the counties
Area committees for assistive aids have also been established in each county.
Assistive Technology Centres
The vision of the Assistive Technology Centres is to give everyone the
possibility of coping and participating and this is the guiding principle for
their activities and plans. The goal is to develop equal and uniform provision of assistive aids throughout the country. The Assistive Technology
Centres are resource centres at county level.
The Assistive Technology Centres have expert knowledge about how
assistive aids, interpreter services and ergonomic measures can compensate for or alleviate loss of function. This means:
• knowledge about functional disabilities and their consequences
• knowledge about possible solutions.
The Assistive Technology Centres have the expert knowledge needed to
find solutions for an overall situation including home, school, work and
leisure time. This means:
• being fully informed about the products that are available on the market
• having expert knowledge about the products' area of application,
adaptability and possibility of repair, maintenance and re-use
• having expert knowledge about adapting the physical environment
• having expert knowledge about the provision process
side 23
The Assistive Technology Centres have expert knowledge about how the
system works. This means:
• knowledge about the conditions for and rights to assistive aids, interpreter services and ergonomic measures pursuant to the National
Insurance Act
• knowledge about the division of responsibility and interaction
between and across levels and services in local, regional and central
administration (such as the municipal, county and national services,
educational authorities, Employment Services, resource centres,
rehabilitation and habilitation facilities).
• being fully informed about the expertise and responsibilities of other
people in the assistive aids area and associated areas.
• knowledge about the user organisations and the way they are organised.
In practice the Assistive Technology Centres
• give advice and guidance to the local authorities and other partners in
their own counties
• organise and carry out courses for the municipal service and other
partners
• distribute information about the Centres' activities and area of work
• provide information about national and local assortments of assistive
aids
• collect, systemise and document experience and develop methodology
• take a proactive approach to development work.
Nation-wide expertise
There are three nation-wide resource centres under the National
Insurance Service: a vehicle centre and the Centre for Assistive
Information Technology in Oslo and Bodø.
LBS
The National Car Adaptation Centre for Disabled Drivers (LBS) is a nationwide resource centre which provides vehicles for the disabled. The object
of this centre is to assist persons suffering from loss of function to choose
a suitable vehicle and assistive devices for the vehicle. The centre gives
advice and guidance to the Assistive Technology Centres and contributes
to the development of human resources. The centre also helps the
National Insurance Administration and the county offices of the National
Insurance Service to assess cases or problems relating to vehicles and disabled drivers. The Centre is located in Oslo.
side 24
Centre for Assistive Information Technology
Oslo
The National Insurance Service has established an administrative unit called
the Centre for Assistive Information Technology, which develops human
resources and spreads information about IT aids. This unit has two target
groups and two teams have been set to take responsibility for these groups.
Cross-team resources are used to deal with joint professional problems,
human resources development and dissemination of knowledge.
One team deals with complex mobility problems and helps people with a
physical handicap and/or brain damage, who may need information technology aids in the field of mobility, devices to control the environment, and
communication aids.
This team’s expertise covers the following fields:
• physical, cognitive and language function problems
• assessment of needs
• IT aids and their possibilities
• individual modifications
• how computer technology, software and other aids can function together
• ergonomic, pedagogical and therapeutic factors in the compensation
process
• alternatives to information technology
The other team helps people with combined loss of senses and focuses on
users who need computer-based aids to communicate, read and write, and
mobility aids to orient themselves and get about on their own.
The intention is to provide the same service regardless of place of residence. Priority is given to newly registered deaf-blind patients and children
and young people with Usher’s syndrome.
The Centre takes an active part in providing assistive aids for the deafblind
where other partners do not have sufficient expertise.
Its area of expertise is information technology aids for persons with serious
mobility problems and brain damage and combined loss of senses.
Its sphere of activity includes giving assistance to the ordinary support personnel in the provision of assistive aids either over the telephone (regular
and video telephone) or by personal visits to any part of the country,
human resources development through different projects and dissemination of knowledge through courses, talks, literature and other informational activity.
Bodø
This unit consists of a multidisciplinary team, located in the Assistive
Technology Centre in Nordland in the north of Norway.
It specialises in IT aids for “everyone with a disability”, whatever their age,
but gives priority to Norway’s four northernmost counties: Nord-Trøndelag,
Nordland, Troms and Finnmark.
The Centre’s tasks are to give guidance to support personnel on the provision of ICT aids, human resources development through different projects
and dissemination of knowledge through courses, talks and other informational activity.
side 25
REFERENCES
1 Regjeringens handlingsplan for funksjonshemmede (The Government’s
Action Plan for Persons with Disabilities), 1994–1997. Ministry of
Health and Social Affairs. Norwegian only.
Report No. 8 (1998–99) to the Storting: Om handlingsplan for
funksjonshemma 1998–2001 (About the Action Plan for People with
Disabilities 1998–2001). Ministry of Health and Social Affairs.
Norwegian only.
2. Rehabilitering og habilitering (Rehabilitation and habilitation). Ivar
Lie, Ad Notam, Gyldendal, 1996. Norwegian only.
3. Report No. 40 (2002-2003) to the Storting Nedbygging av funksjonshemmende barrierer (Dismantling disabling barriers). Norwegian only.
4. Tilrettelegging av arbeidsplassen – et samarbeid mellom mange parter
(Adaptation of the workplace – teamwork involving many parties),
National Insurance Administration, 1999. Norwegian only.
5. Report No. 35 (1994–95) to the Storting: Velferdsmeldingen (White
Paper on Welfare), Ministry of Health and Social Affairs. Norwegian
only.
6. Report No. 21 ( 1998–1999) to the Storting: Ansvar og meistring.
Mot en heilskapleg rehabiliteringspolitikk (Responsibility and coping.
Towards a comprehensive rehabilitation policy).
White Paper on Rehabilitation, Ministry of Health and Social Affairs. .
Norwegian only.
7. United Nations Standard Rules on the Equalization of Opportunities
for Persons with Disabilities. Norwegian translation by the Norwegian
State Council on Disability, Oslo, 1995.
8. Forskrift om hjelpemiddelsentralens virksomhet og ansvar (Regulations
governing the Activities and Responsibilities of the Assistive
Technology Centres), Ministry of Health and Social Affairs, 1997.
Norwegian only.
side 26
LITERATURE AND VIDEO FILMS
• Bruk av skjønn i bilsaker, 2003 (Vehicles for the disabled - assessing
needs). Norwegian only.
• Tekniske hjelpemidler for funksjonshemmede. En brukerveiledning.
(Assistive aids for the disabled. A guide for users.)
Norwegian Association of the Disabled, 1999. Norwegian only.
• Ny lov om folketrygd (New National Insurance Act), National Insurance
Administration, Cappelen Akademisk Forlag, 1997. Norwegian only.
• Problemer med hørselen? (Hard of hearing?), 5 booklets, National
Insurance Administration, 1997. Norwegian only.
• Elektriske rullestoler i trafikken (Electric wheelchairs on the road),
National Insurance Administration, 1999. Norwegian only.
• Barnehjelpemidler (Assistive aids for children), National Insurance
Administration, 1999. Norwegian only.
• Rehabilitering. Et liv i verdighet. (Rehabilitation. Living life with dignity)
Ministry of Health and Social Affairs, 1996. Norwegian only.
• Report No. 39 (1991–92) to the Storting. Attføring og arbeid for
yrkeshemmede (Rehabilitation and work for persons who are occupationally handicapped). Ministry of Labour and Government Administration.
Norwegian only.
• Formidling og forvaltning av tekniske hjelpemidler (Provision and administration of assistive aids). An evaluation of the activities of the Assistive
Technology Centres. Norwegian Directorate of Public Management.
Report 1997 I:5. Norwegian only.
• Medisinsk rehabilitering – planlegging og organisering (Medical rehabilitation – planning and organisation). One of a series of guides published
by the Norwegian Board of Health (3-91). Norwegian only.
• Rehabilitering av slagrammede (Rehabilitation of stroke patients). One of
a series of guides published by the Norwegian Board of Health (4-96).
Norwegian only.
• Habilitering av barn og unge (Habilitation of children and adolescents).
One of a series of guides published by the Norwegian Board of Health
(1-98). Norwegian only.
• Lekeplassen for alle! (Playground for everyone!) DELTA Centre, 1999.
Norwegian only.
• Universitetet For Alle (University for everyone). DELTA Centre, 1999.
Norwegian only.
• Troll i ord (Don’t say that; it might come true). Norwegian State Council
on Disability, 1996. Norwegian only.
• Rehabiliteringsmagasinet BRIS (Magazine for rehabilitation personnel),
National Insurance Administration. Two issues per year since 1998.
Norwegian only.
side 27
• Video: Hjelpemiddelformidling. Hjelpemiddelsentralen som ledd i et
helhetlig tilbud (Assistive aids services. The Assistive Technology
Centre as part of a comprehensive service). The National Insurance
Administration, 1999. Norwegian only.
• Video: Tilrettelegging av arbeidsplasser – et samarbeid mellom mange
parter. (Adapting workplaces – a joint effort between many parties).
The National Insurance Administration, 1999. Norwegian only.
• Video: Universitet for alle. Om tilrettelegging etter prinsippene om
universell utforming (University for everyone. About adapting on the
principles of universal design). DELTA Centre, 1999. Norwegian only.
• Video: Demonstrasjon av hjelpemidler i bil (Demonstration of
assistive aids in a vehicle), LBS, 1997. Norwegian only.
• Video: Synlig berørt (Visibly affected), Vest-Agder Assistive
Technology Centre, 1996. Norwegian only.
• Video: En av oss, eller? (One of us, or?), Vest-Agder Assistive
Technology Centre, 1996. Norwegian only.
• Video: Når syn og hørsel svikter (When eyesight and hearing fail).
Central Unit for the Deaf-Blind, 1999. Norwegian only.
• Video: Reisen tilbake fra Koma (Returning from Coma), KreSS
(Sunnaas cognitive rehabilitation centre) 1999. Norwegian only.
• Video: Rehabilitering av barn og ungdom (Rehabilation of children
and adolescents), Norwegian Board of Health, 1999. Norwegian only.
See also references, page 26.
side 28
ADDRESSES
Assistive Technology Centre
for Akershus
Stasjonsveien 1
POBox 34, 2011 Strømmen
Telephone: +47 64 84 11 00
Fax: +47 64 84 11 01
E-mail: hjelpemiddelsentralen.
[email protected]
for Aust-Agder
POBox 1853 Stoa, 4858 Arendal
Telephone: +47 37 00 43 00
Fax: +47 37 00 43 01
E-mail: fylkestrygdekontoret.
[email protected]
for Buskerud
Buskerudvn. 126
POBox 3513, 3007 Drammen
Telephone: +47 32 21 85 00
Fax: +47 32 21 85 10
[email protected]
for Møre og Romsdal
Åsehaugen 1
POBox 7055 Spjelkavik, 6022 Ålesund
Telephone: +47 70 17 22 00
Fax: +47 70 17 22 01
for Sogn og Fjordane
Steinavegen 12, 6800 Førde
Telephone: +47 57 83 05 00
Fax: +47 57 83 05 01
[email protected]
for Nordland
Haakon VII gt. 98, 8041 Bodø
Telephone: +47 75 50 36 00
Fax: +47 75 50 36 50
[email protected]
for Sør-Trøndelag
Bromstadveien 59
Pb. 2976 Sluppen, 7438 Trondheim
Telephone: +47 73 84 86 00
Fax: +47 73 84 86 01
Text telephone: +47 73 84 86 11
e-mail: hjelpemiddelsentralen.
[email protected]
for Nord-Trøndelag
Kirkegata 2C, 7600 Levanger
Telephone: +47 74 08 38 00
Fax: +47 74 08 38 01
[email protected]
for Finnmark
Peder Sivertsens vei 20, 9700 Lakselv
Telephone: +47 78 46 02 00
Fax: +47 78 46 13 31
[email protected]
for Oppland
Helgerudveien 49, 2816 Gjøvik
Telephone: +47 61 11 40 00
Fax: +47 61 11 40 40
[email protected]
for Hedmark
Kirkevn. 74, 2418 Elverum
Telephone: +47 62 43 56 00
Fax: +47 62 43 56 01
Assistive Technology Centre for Oslo
Peter Møllers vei 15
POBox 324 Alnabru, 0614 Oslo
Telephone: +47 810 20 620
Fax: +47 815 81 670
for Hordaland
Kokstaddalen 35
Pb. 121 Kokstad, 5863 Bergen
Telephone: +47 55 52 67 00
Fax: +47 55 52 67 01
[email protected]
for Rogaland
Svanholmen 7
POBox 260, 4066 Stavanger
Telephone: +47 51 96 55 00
Fax: +47 51 96 55 01
[email protected]
for Telemark
Bedriftsveien 46
POBox 2861 Kjørbekk, 3702 Skien
Telephone: +47 35 91 31 00
Fax: +47 35 91 31 01
[email protected]
for Troms
Stakkevollvn. 49-51, 9293 Tromsø
Telephone: +47 77 66 33 00
Fax: +47 77 66 33 01
[email protected]
for Vest-Agder
Blokkhusgata 4
Servicebox 622, 4606 Kristiansand
Telephone: +47 38 12 18 00
Fax: +47 38 12 18 01
[email protected]
side 29
for Vestfold
Heimdalsvingen 1, 3117 Tønsberg
Telephone: +47 33 30 75 00
Fax: +47 33 30 75 01
[email protected]
for Østfold
Gamle Tindlundsvei 3, Greåker,
POBox 574, 1703 Sarpsborg
Telephone: +47 69 97 10 00
Fax: +47 69 97 10 01
[email protected]
Centre for Assistive Information
Technology
(Senter for IKT-hjelpemidler)
Oslo:
Rikstrygdeverket, Sannergt. 2,
POBox 5200 Nydalen, 0426 Oslo
Telephone: +47 22 92 71 79
Fax: +47 22 92 79 06
Bodø:
Haakon VII gt. 98, 8041 Bodø
Telephone: +47 75 50 36 11
Fax: +47 75 50 36 63
National Vehicle Centre
(Landsdekkende bilsenter)
Rikstrygdeverket, Sannergt. 2,
Telephone: +47 22 92 70 00
Fax: +47 22 92 70 70
Directorate for Health and Social
Affairs: National Resource Centre
for participation by and accessibility
for people with disability
(DELTA-senteret, Sosialog helsedirektoratet)
Universitetsgata 2
POBox 8054 Dep, 0031 Oslo
Telephone: +47 24 16 30 00
Fax: +47 24 16 30 04
National Council on Disability
(Statens råd for funksjonshemmede)
Telephone: +47 24 16 40 49
Fax: +47 24 16 30 04
Norwegian Federation of
Organisations of Disabled People
(Funksjonshemmedes
Felleorganisasjon)
Telephone: +47 22 79 91 00
Fax: +47 22 79 91 98
Norwegian Association
of the Disabled
(Norges handikapforbund)
POBox 9217 Grønland, 0134 Oslo
Telephone: +47 24 10 24 00
Fax: +47 24 10 24 99
Directorate of Labour
(Arbeidsdirektoratet)
Telephone: +47 23 35 24 00
Fax: +47 23 35 27 50
Centre for Vocational Rehabilitation
Senter for yrkesmessig attføring (SYA)
Telephone: +47 22 98 72 30
Fax: +47 22 98 72 31
side 30
Resource Centre for Oral Health in
Rare Medical Conditions
(Tako-senteret)
Det odontologiske fakultet,
Lovisenbergt. 7a, 0456 OSLO
Telephone: +47 22 70 49 49
Fax: +47 22 70 49 48
Centre for Rare Disorders
(Senter for sjeldne sykdommer
og syndromer)
Smågruppesenteret Rikshospitalet,
Pilstredet 32, 0027 Oslo
Telephone: +47 23 07 53 40
Fax: +47 23 07 53 53
Rehabilitation Resource Centre
(Trenings- og rådgivningssenteret)
Sunaas sykehus, 1450 Nesoddtangen
Telephone: +47 66 96 91 91
Fax: +47 66 96 93 31
National Information Centre for
Rare Disorders and Disabilities
(Frambu senter for sjeldne
funksjonshemninger)
Sandbakkveien 18, 1404 Siggerud
Telephone: +47 64 85 60 00
Fax: +47 64 85 60 99
Section for Child Neurology,
Berg Gård
(Rikshospitalets Barnenevrologiske
seksjon, Berg gård)
Bergsalleen 21, 0854 Oslo
Telephone: +47 22 59 33 01
Fax: +47 22 59 33 71

rehabilitation

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