輔具與生活參與——學習輔具申請配置之問題與現況調查

Assistive Devices in Special Education: Current Application Process and Problems

背景：學習輔具的選取需透過輔具專業人員依個案功能及需求評估給定，然除特殊教育學校外，一般學校並無具備輔具評估人員資格之專任治療師的配置，因此身心障礙學生並非都能即時獲得專業的協助。國際健康功能與身心障礙分類系統及台灣的身權法皆強調提升身心障礙者獨立生活及社會參與，而輔具的正確使用對需求者而言正是落實獨立生活與參與的重要一環。身心障礙學生功能的失衡可透過適當的輔具使用及環境的配合來誘發或改善，進而提升學習效益。但輔具選擇是專業性程序，如何評估、選擇並正確使用將影響輔具功效。目的：(1)綜合整理目前學習輔具申請配置面臨的問題及現況，針對其影響進行探討分析；(2)實地訪查十位輔具專業團隊中之治療師相關輔具申請配置問題。方法：(1)本研究回顧學習輔具申請、評估、使用及配置等相關之書籍、調查和文獻，資料收集來源包含如衛福部輔具資源入口網／各中央縣市輔具中心網站／特教資源網／輔具產品公司等國內外輔具資源網站，以及Pubmed/ medline/ ERIC 等文獻資料庫，以「輔具」、「科技輔具」、「身心障礙」、「功能需求」、「ICF」等關鍵字查詢相關資料；調查並統整台灣北區七個縣市（台北市、新北市、基隆市、宜蘭縣、桃園市、新竹縣市、苗栗縣）的特殊教育輔具申請的流程與相關規定。(2)治療師實地訪查內容包含：責任區之服務模式，責任區之服務頻率、責任區之團隊配合現況、及輔具提供的效率、及學校配合度等進行方式。結果與討論：雖然台灣各縣市政府都依據中央制定的特殊教育法，設立專業團隊，並提供相關的輔具申請與補助支援服務，但現今學校系統在輔具服務上面臨層層問題，包含專業評估適配人力的調度、服務時間的立即性、介入方式的有效性，以及輔具選擇的合適度等。以上任一環節出現問題都可能導致輔具失用，資源浪費，甚至使用者的傷害等問題。結論：輔具選擇和配置是一項具有專業性的程序。為使有輔具需求的學生可以正確且有效率的取得服務，本回顧建議可以參照目前輔具申請評估作業較為完善的實務執行方式，再依各縣市區域的生態進行微調。此外，專業評估適配人力的訓練及調度可以由法規面及實務面進行處理，以及學校系統輔具資源中心的業務盤點及統整。以上提出的改善模式期能提供輔具申請及配置實務運作的參考，並期能提供相關政策發展規劃之應用依據，提升身心障礙學童輔具相關服務的品質和有效性。

Assistive technology (AT) devices should be prescribed by the professionals based onthe functional needs of students with disabilities. However, regular schools do not havetherapists specialized in AT employed, except special schools. Therefore theprofessional interventions are not always available on demand. Based on the concept ofInternational Classification of Function (ICF), which emphasizing in individualfunctioning, proper usage of assistive devices can facilitate independence andparticipation in students with disabilities. The prescription of assistive devices must beimplemented by AT professionals, and improper evaluation and utilization lead to harmand ineffectiveness. The purpose of this research was to review the application,evaluation, and prescription of assistive devices to students with special needs throughgovernment websites, domestic and international assistive technology related resources,and Pubmed/ medline/ ERIC database via keywords search: “assistive device”,“assistive technology”, “disabled”, “function” and “ICF”, etc.. In addition, investigatethe current assistive device application process for students with disabilities in school system, via references from official websites, rules and regulations, and therapistinterventions. The results indicated that although most governments of counties andcities establish professional teams for special education based on Special Education Law,problems exist in the current assistive technology services among school system,including the availability of the AT professionals, the promptness of the AT services, theeffectiveness of intervention, and the appropriateness of prescription, etc.. Based on acomprehensive literature review and field intervention, the findings of this studyaddressed the critical concepts to understanding the effectiveness of AT and optimizingits usage for related professionals. The current situations and statistics could also serveas references for further AT application process refinements and policy modifications.