assistive technology

assistive technology, any device that is used to support the health and activity of a disabled person. The U.S. Assistive Technology Act of 2004 defined assistive technology device as:

any item, piece of equipment, or product system, whether acquired commercially, modified, or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities.

Assistive technologies enhance the ability of a disabled person to participate in major life activities and to perform tasks that would be otherwise difficult or impossible for the individual to carry out. The principle of enhanced ability includes an increased level of independent action, a reduction of time spent in activities of daily living, more choices of activities, and greater satisfaction in participating in activities.

According to the International Classification of Functioning, Disability, and Health (ICF), which uses disability as a term that covers activity limitations, impairments, and restriction in participation, assistive technology is aimed at reducing limitations and impairments and at promoting full participation in major life activities. In this context, assistive-technology devices include those that improve structure and function (e.g., prosthetic legs, cochlear implants, and electronic implants for bladder control) and those that improve activity performance (e.g., voice entry systems, stair-climbing wheelchairs, and communication boards); environmental modifications (e.g., automatic door openers, level entrances, and accessible bathrooms) that reduce or eliminate restriction to participation are also considered types of assistive technology.

The expression of disability changes with the nature of the affected individual’s environment, and, thus, assistive-technology devices are considered to be a part of the environment that can reduce the expression of disability. For example, they can be used to improve building accessibility, to augment communication, to afford computer access, to allow environmental control over electronic devices, to modify homes for access, to assist with personal care activities and family activities, to enhance mobility, to stabilize seating, and to modify workplaces and schools.

Assistive-technology services

For simple, relatively inexpensive assistive technology, such as an electric toothbrush or a touch lamp, consumers require little if any help in acquiring devices. However, when the assistive-technology device is complex, costly, or paid for by a third party (e.g., insurance), the process of obtaining the device can require the help of individuals trained in providing assistive-technology services. The services required may include evaluations for the types of assistive technology that are needed to enhance physical, sensory, and cognitive functions; to improve performance in activities; and to increase participation in major life activities. The evaluation may involve an interdisciplinary team of people who have training in engineering, therapy, medicine, and device use.

The introduction of assistive technology into the life of a person with a disability requires an analysis of the existing capacities of the individual, the settings where the technology will be used, the features included in the device, and the goals of the consumer and his or her family, employer, and educator. Health insurance may also influence which devices patients may purchase at reduced or no cost. In most cases, in order for assistive technology to be deemed medically necessary, a physician must sign and send to the entity that will pay for the device a letter that describes the individual’s diagnosis and prognosis and the functions that will be improved or maintained by the requested device.

Once a device is acquired, services may be needed to fit, customize, maintain, or repair it. These services are provided by medical equipment companies, rehabilitation facilities, or volunteer organizations. An additional important but often neglected service is the training or technical assistance provided to the consumer and his or her family in the use of the assistive technology. For example, individuals must learn how to use communication boards that allow persons with no or poorly understood speech to make their needs and views known.

Assistive-technology classification and characterization

Thousands of assistive-technology devices have been developed, and multiple classification systems have been created in an attempt to organize them for professionals and patients. Assistive-technology classification systems include the National Classification System for Assistive Technology Devices and Services, the International Organization for Standardization’s classification of assistive products for persons with disability (ISO 9999), and an ICF-based classification (ICF/AT2007). The classifications employ various structures for organizing assistive technology. For example, the National Classification System for Assistive Technology Devices and Services, which is used in the United States, divides assistive technology into the following classes: architectural elements, sensory elements, computers, controls, independent living, mobility, orthotics/prosthetics, recreation/leisure/sports, and modified furniture/furnishings. Each general category has a numeric code, as do the subdivisions of the categories. In Europe, assistive-technology devices used by individuals with disabilities are classified by ISO 9999. The classification uses a three-tiered hierarchical organization, with the highest level (class) describing a broad set of functions such as devices for housekeeping. The second level (subclass) includes a great degree of specificity in the use of the device (e.g., assistive technology for meal preparation). The specific devices are classified at the third level (division), which could include devices such as special knives and cutting boards. These classifications allow for rapid information retrieval, tracking product inventories, and matching devices to impairment, activities, and participation.

Assistive-technology devices that help people perform activities can be characterized in many ways. Some devices are technologically complex, involving sophisticated materials and requiring precise operations, and thus are referred to as “high-tech.” Examples include prosthetic limbs that have joints that can move in several planes, powered mobility devices that balance on two wheels, communication devices that are programmed to output speech, and computer screen readers for graphic displays. Simple, inexpensive, and easy-to-obtain devices are commonly referred to as “low-tech.” Finger extenders, large-handled eating utensils, canes, and large-print reading materials are examples of low-tech devices.

Other terms used to distinguish different aspects of assistive technology are hard technologies and soft technologies. Hard technologies are tangible components that can be purchased and assembled into assistive-technology systems. They include everything from simple mouth sticks to computers and software. Soft technologies include the human areas of decision making, strategy development, training, and concept formation. They may be available in one of three forms: people (e.g., a teacher or therapist), written words (e.g., an instruction manual), or computers (e.g., help screens). Hard technologies cannot be successful without the corresponding soft technologies; however, the latter are difficult to acquire because they depend on human knowledge that is obtained through formal training, experience, and textbooks.

Another distinction is between devices that are mass-produced for the general population or for individuals with disabilities and those that are custom-made for an individual. Mass-produced devices often are developed according to the principles of universal design, which allows them to be usable by all people without the need for adaptation or specialized design.

Certain assistive-technology devices are used in many different ways across a wide range of applications (general purpose), whereas others are intended for a specific application (special purpose). Examples of the first type include positioning systems for body support, control interfaces (e.g., keyboards, switches, and joysticks), and computers. Examples of specific applications include devices for communication, manual and powered wheelchairs, feeding devices, hearing aids, and mobility aids for persons with visual impairments. Because of the unique needs of people with disabilities in each of these areas, the assistive devices must be specially designed to be effective.

An assistive device may function as an appliance or a tool. The distinction is based on whether skill is required to operate the device. If skill is required, the device is referred to as a tool, and soft technologies become important. If no skill is required, then the device functions as an appliance. Examples of appliances are eyeglasses, splints, a wheelchair seating system designed for support, and a keyguard for a computer keyboard. Since a powered wheelchair requires skill to maneuver and success depends on the skill of the user, the powered wheelchair is classified as a tool. Other examples are augmentative communication devices, electronic aids to daily living (EADLs), and reading devices for individuals who are blind.

Assistive-technology users and payment

The majority of persons who use assistive technology are elderly. Elderly persons primarily use low-tech devices for maintaining their capacity for personal care (e.g., grab bars in the bathroom, special kitchen utensils, brighter lighting, canes, and walkers). Children and young adults use a significant proportion of devices such as foot braces, artificial arms or hands, adapted typewriters or computers, and leg braces. Several studies have reported that the most frequently used forms of assistive technology across all age groups are mobility devices. Hearing, anatomical, and vision devices are also widely used.

The sources of payment for assistive-technology devices vary. Devices may be paid for in full or in part by individuals, health insurance, vocational rehabilitation, employers, veteran support organizations, or charitable organizations. Consumers often pay for mobility devices (canes, crutches, walkers, specialized recreational wheelchairs), hearing devices, and home modifications. However, costs may be offset through deductions from earned income. In the United States, small businesses that make their buildings accessible may be eligible for tax deductions. Many charitable organizations raise funds that are used to provide assistive technology for children whose families cannot afford to pay for the devices.

High-tech devices for mobility (e.g., electric-powered wheelchairs), vehicle modification, voice-recognition systems, and prosthetic limbs often are too expensive for individuals or families to purchase on their own. In many cases, those devices can be paid for by a third party, such as private insurance, schools, or funds for special education. In some cases, high-tech devices may be donated or loaned to users.

Benefits of assistive technology

With the introduction of assistive technology, some people with disabilities found that they were able to perform activities without the help of family members or paid assistants. For example, some disabled individuals were able to participate in parenting, improve work productivity, and join in active recreational activities. Others were able to avoid being institutionalized. However, although many people with disabilities report that the use of assistive technology has greatly improved their quality of life, measurement of change in their satisfaction, self-esteem, adaptability, safety, and competence has been little studied. This has prompted the development of several means for objectively evaluating the benefits of assistive technology.

The Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST) collects information about the benefits of assistive technology and attempts to measure individuals’ satisfaction with their devices. QUEST uses different types of variables to measure user satisfaction, including those that take into account the environment, pertinent features of the person’s attitudes, expectations, and perceptions, as well as the characteristics of the assistive technology itself. QUEST allows the user to determine the relative importance of the satisfaction variable. The Psychosocial Impact of Assistive Devices Scale (PIADS) is a questionnaire that provides a measure of user perception and other psychological factors associated with assistive-technology devices. Three components of PIADS are adaptability, competence, and self-esteem. PIADS has been applied to the measurement of outcomes with a variety of assistive-technology devices, from eyeglasses and contact lenses to EADLs. PIADS and QUEST provide reliable measures of the consumer perspective and often are considered in conjunction with assessments of functional status.

Factors affecting the use of assistive technology

Issues of design, consumer preference, cost, and policy can influence the use, disuse, or abandonment of assistive technology. Multiple factors are related to the abandonment of assistive-technology devices, including failure by providers to take consumer opinions into account, lack of easy device procurement, poor device performance, and changes in consumer needs or priorities. An essential component of the assistive-device delivery system is an effective process that ensures that the needs and goals of the individual are accurately identified. Easy device procurement refers to the situation in which a consumer obtains a device from a supplier without an evaluation by a professional provider. This most often occurs with simple devices, such as crutches, canes, or reachers. Poor device performance may be the result of inaccurate or inappropriate expectations on the part of the user, a mismatch between consumer skills and device characteristics, or actual device failure.

Advancement of assistive technology

Advancements in assistive-technology devices have come mostly as a result of advances in technology generally. However, improvements in the services associated with assistive technology and in government policies and programs relevant to assistive technology have also fueled progress in the design and use of devices.

The Internet became increasingly important for disabled individuals as a place where they could purchase devices that were otherwise difficult to find. However, the Internet in general has become increasingly dependent on multimedia involving complex graphics, animation, and audible sources of information, which present a significant challenge in the retrieval of information for the disabled. This is the case especially for those who are blind or deaf. To overcome these issues, policy makers, consumer advocates, and others have been working to develop financial resources for disadvantaged individuals to purchase computers and gain access to the Internet and to encourage Web site developers to build in accessibility features in their mainstream devices.

Other advances in assistive technology are under way for handheld, portable, and satellite-based communication. Control interfaces that directly sense signals from the brain or nerves are being further developed to allow greater control of devices by people with severe physical disabilities. Intelligent interfaces are required to adapt to the needs of persons with disabilities to allow greater participation in work, recreation, and self-care. Devices that can transmit messages from the brain to activate target muscles (e.g., fingers, arms, feet, legs) without having to pass through the spinal cord are moving from basic research laboratories to clinical trials. Similar progress has been made for devices based on direct stimulation of the brain for those with visual and hearing loss. In addition, as materials themselves advance, wheelchairs and other assistive-technology devices are expected to become lighter, stronger, and more durable than existing products.

Others are working to improve service delivery. For example, in some places, individuals can try out different types of assistive technology at community centres, schools, or other locations before committing to the purchase of a device. In the past, the resources to support such trial runs often were lacking. To help avoid device abandonment, researchers and organizations also have increasingly sought consumer input. Studies to assess the effects of assistive-technology interventions on the lives of consumers and tax reforms to reduce the cost of assistive technology represent additional avenues that are considered to be important to the advancement of assistive technology.