Adaptive equipment + assistive technology cover the long tail of low- and mid-tech devices that enable activities of daily living (ADL) for patients across the disability spectrum. This chapter walks the ICF framework for matching device-class to patient-need, the standards stack governing wheeled mobility (ISO 7176), seating + positioning (ANSI/RESNA WC-4), and the prescription + reimbursement workflow. The category is broader than people often realise — pencil grips, weighted blankets, sock aids, reachers, sock-and-stocking donners, jar openers, button hooks, and adaptive eating utensils are all assistive-technology devices, even if none of them require a power supply.
The WHO International Classification of Functioning, Disability and Health (ICF) frames the patient's need: body-function impairment (ICF b-codes), activity limitation (d-codes), participation restriction (d-codes), and environmental factors (e-codes including assistive products + technology under e1xx). Matching device-class to ICF qualifier ensures the prescription targets the actual functional gap rather than the diagnostic label alone. The same ICD diagnosis (e.g., spinal cord injury at C6) maps to dramatically different ICF profiles depending on patient adaptation, environment, and participation goals — and consequently to different device prescriptions.
ISO 7176 covers the wheelchair-and-scooter envelope: ISO 7176-19 wheelchair tie-down systems for transport; ISO 7176-7 seating + posture; ISO 7176-8 static + dynamic strength; ISO 7176-21 EMC; ISO 7176-22 set-up procedures; ISO 7176-26 vocabulary. Per-patient prescription follows the seating-and-positioning evaluation (postural alignment, pressure-distribution mapping per Pressure Mapping per RESNA), per-patient transfer envelope, per-environment access envelope.
ANSI/RESNA WC-4 covers the seating-system envelope. Pressure injury prevention follows the National Pressure Injury Advisory Panel (NPIAP) staging + the per-patient Braden Scale (Braden + Bergstrom 1987) + per-patient pressure-mapping data. Custom-moulded vs modular seating depends on per-patient postural complexity. Cushion technology (ROHO air-cell, Jay gel, Stimulite honeycomb, Vicair multi-cell air, foam-laminate) is selected against the per-patient pressure-distribution data.
Augmentative + Alternative Communication (AAC) devices: high-tech speech-generating devices (SGD), low-tech communication boards, eye-gaze access (Tobii Dynavox per ISO 9241-410), switch access (per the per-switch sip-and-puff + head-mounted + pneumatic catalogue). Computer access alternatives: head pointers, eye-gaze, brain-computer interface (BCI) per Chapter 5 §5.4, voice control, switch-scanning. The per-patient evaluation maps cognitive + motor + visual capacity to the per-device access modality.
Per-US Medicare DMEPOS Local Coverage Determination governs reimbursement. Per-EU member state coverage varies; ISO 9999:2022 provides the international classification of assistive products, useful for cross-jurisdiction inventory + reimbursement. The prescription chain runs: licensed clinician evaluation → letter of medical necessity → per-payer prior-authorisation → device delivery + fitting → per-patient training → per-device maintenance + repair envelope across the device service life. Documentation requirements are heavier than people expect; the per-payer denial rate runs 10–30% on first submission, with appeals successful in roughly half of denied cases when the medical-necessity narrative is well-constructed.
ANSI/RESNA technical standards cover wheeled mobility (RESNA WC-1 through WC-26 series), seating, and AT service delivery. The RESNA Assistive Technology Professional (ATP) credential and the Seating + Mobility Specialist (SMS) credential professionalise the prescription workflow. Service-delivery models follow the AT process per ATIA + AAATE + RESNA position papers — device-only delivery without per-patient training has high abandonment rates; integrated delivery with per-patient training + per-environment fit-out + per-device follow-up has retention rates above 85%.