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Investigating the psychology of assistive device use in ALS: Suggestions for improving adherence and engagement 

Investigating the psychology of assistive device use in ALS: Suggestions for improving adherence and engagement
Chapter:
Investigating the psychology of assistive device use in ALS: Suggestions for improving adherence and engagement
Author(s):

Christopher D. Graham

DOI:
10.1093/med/9780198757726.003.0012
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date: 24 February 2020

In ALS, assistive devices—such as wheelchairs, augmentative, and alternative communication devices (AAC) and environmental controls—are often used to compensate for the functional impairments caused by the condition. These devices may help maintain meaningful functioning and help preserve quality of life. Yet adherence to and uptake of such devices is sub-optimal. Drawing on the literature from ALS and other diseases, this chapters explores the psychosocial challenges of assistive device use, and factors that might affect usage—cognitive impairment and mood, threats to identity, social context, illness adjustment/acceptance, and the desire to maintain control over one’s health care. Methods that clinicians can use to intervene to improve non-adherence are then suggested—bio-psychosocial assessment (formulation) informed by cognitive and mood screens, voice-banking for appropriate accents in AAC devices, increasing illness acceptance via counselling, or acceptance and commitment therapy, and empathetic clinician-facilitated discussions with patient-significant other dyads and families.

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