Raji Rajendran: ASSISTIVE TECHNOLOGY

INTRODUCTION

Two formal definitions of Assistive Technology, which are commonly used, come from the United States legislation. The Assistive Technology Act of 1998, as amended (2004) and from the WHO. The US legislation defines AT as: “Any item, piece of equipment or product system whether acquired commercially off the shelf, modified, or customized that is used to increase, maintain or improve functional capabilities of individuals with disabilities.”

Similarly, the WHO (2001) defines AT as “any product, instrument, equipment, or technology adapted or specially designed for improving functioning of a disabled person.”

Assistive technology is an umbrella term that includes assistive, adaptive, and rehabilitative devices for people with disabilities and also includes the process used in selecting, locating, and using them. Assistive technology promotes greater independence by enabling people to perform tasks that they were formerly unable to accomplish, or had great difficulty accomplishing, by providing enhancements to, or changing methods of interacting with, the technology needed to accomplish such tasks.

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.

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.

WHAT IS ASSISTIVE TECHNOLOGY?

Assistive technology (AT) is any item, piece of equipment, software program, or product system that is used to increase, maintain, or improve the functional capabilities of persons with disabilities.

· AT can be low-tech: communication boards made of cardboard or fuzzy felt.

· AT can be high-tech: special-purpose computers.

· AT can be hardware: prosthetics, mounting systems, and positioning devices.

· AT can be computer hardware: special switches, keyboards, and pointing devices.

· AT can be computer software: screen readers and communication programs.

· AT can be inclusive or specialized learning materials and curriculum aids.

· AT can be specialized curricular software.

· AT can be much more—electronic devices, wheelchairs, walkers, braces, educational software, power lifts, pencil holders, eye-gaze and head trackers, and much more.

Assistive technology helps people who have difficulty speaking, typing, writing, remembering, pointing, seeing, hearing, learning, walking, and many other things. Different disabilities require different assistive technologies.

HOW DO YOU CHOOSE THE RIGHT ASSISTIVE TECHNOLOGY?

Most often, the choice is a decision you make with a team of professionals and consultants trained to match particular assistive technologies to specific needs. An AT team may include family doctors, regular and special education teachers, speech-language pathologists, rehabilitation engineers, occupational therapists, and other specialists including consulting representatives from companies that manufacture assistive technology.

WHO PAYS FOR ASSISTIVE TECHNOLOGY?

The answer depends on the technology, the use, and the user. Many kinds of AT may cost you little or nothing, even for some very expensive items. Some examples:

· School systems pay for general special education learning materials as well as technology specified in an IEP.

· Government programs (Social Security, veteran’s benefits, or state Medicaid agencies) pay for certain assistive technology if a doctor prescribes it as a necessary medical device.

· Private health insurance pays for certain assistive technology if a doctor prescribes it as a necessary medical or rehabilitative device.

· Rehabilitation and job training programs, whether funded by government or private agencies, may pay for assistive technology and training to help people get jobs.

· Employers may pay for assistive technology that is a reasonable accommodation to enable an employee to perform essential job tasks.

· Other sources of funds in states or communities include private foundations, charities, and civic organizations.

ASSISTIVE TECHNOLOGY - HISTORICAL OVERVIEW

According to Bryant and Bryant (as cited in Saladin, 2004) the history of AT may be divided into three distinct chronological sections:

a) Foundation period (dating prior to the 20th century)

b) Establishment period (from about 1900 into the early 1970‟s), and

c) Empowerment period (from 1973 to present).

Foundation Period

Early AT of the Stone Age may have been sticks and other natural items used to assist people with continuing their daily activities after experiencing acute injuries or long-term physical disabilities, thus beginning the Foundation Period of Assistive Technology. Documentation of post surgical AT for maintaining daily life activities has been dated as early as 600 CE (Common Era).

In general, public health campaigns and increasing concern for the education for people with disabilities became an impetus for the development of AT. This was a time when people began to be concerned that people with disabilities were able to survive injuries, carry out activities of their daily life, and become educated. Around 1834, Louis Braille presented a method of reading for people who are blind which had been originally designed so French soldiers could read at night. In addition to changes in public opinion and broader technological innovations, soldiers returning from the American Civil War sparked keen interest in the development of wheelchairs and prosthetic devices. The Foundation Period can be summarized by noting that from early prehistoric documentation until the close of the nineteenth century, important steps were taken to lay the groundwork for more modern developments in AT.

Assistive Technology Classiﬁcations as deﬁned for reporting under the AT Act

Classiﬁcation of Devices

There are l0 categories for classifying devices.

1. Vision

2. Hearing

3. Speech communication

4. Learning, cognition, and developmental

5. Mobility, seating, and positioning

6. Daily living

7. Environmental adaptations

8. Vehicle modiﬁcation and transportation

9. Computers and related

10. Recreation, sports, and leisure

1. Vision

Deﬁnition: Products designed to assist with vision

Decision rules: Products intended to facilitate access and participation for people who are blind or visually impaired are classiﬁed in this category, even if they are used for activities of daily living, computer access, reading/learning, recreation, etc.

Products in this category characteristically provide output of information through large print/display, synthetic speech or Braille/tactile. If the adaptation is for an individual who is both visually impaired and hearing impaired, categorize according to the primary functionality of the device. Reading systems to accommodate vision are classiﬁed here while similar systems to accommodate learning are classiﬁed accordingly.

Examples:

· Magniﬁers including CCTV systems;

· talking scales, blood pressure gauge, glucometer etc.;

· screen readers, screen magniﬁers and Braille displays;

· Daisy or Victor Readers;

· PDA’s with large print, speech or Braille output;

· talking or Braille GPS, white canes, talking or tactile compass, etc.;

· OCR reading systems; talking thermostats, household appliances etc.

2. Hearing

Deﬁnition: Products designed to assist with hearing

Decision rules: Products intended to facilitate access and participation for people who are deaf or hard of hearing are classiﬁed in this category, even if they are used for activities of daily living or could have another application for people with other disabilities or for other functions. Products intended to facilitate telephone usage for individuals with hearing disabilities are categorized here, rather than as aids to daily living. If the telephone adaptation is for an individual who is both visually impaired and hearing impaired, categorize under EITHER vision or hearing. Products that amplify voice are classiﬁed here if the purpose is to enhance the volume of speech produced by an individual without a disability, in order for his/her speech to be heard by persons who are deaf or hard of hearing. This category also includes systems that provide for text communication, both via telecommtmication (text messaging; TTY) and face to face (Interpretype). Peripherals designed to facilitate access or otherwise support the use of a device for hearing (e.g. neck loop induction coils; TeleLink phone couplers; conference microphone; telephone signalers) are counted in this category.

Examples:

· telephones and Signalling devices (visual and/or tactile alerting to incoming phone calls)

· Classroom Captioning System

· I Communicator (Voice to text system)

· Audio See (enhanced view of speaker for speech reading, in addition to FM capabilities)

3. Speech Communication

Deﬁnition: Products designed to assist with speaking and face-to-face communication for individuals with speech disabilities.

Decision rules: Products intended to facilitate computer access and usage for written communications are classiﬁed under Computers. Products intended to facilitate telephone usage for individuals with speech disabilities will be classiﬁed under activities of daily living, EXCEPT when the adaptation is for an individual who is deaf or hard of hearing in which ease it is classiﬁed under hearing. Products that amplify voice are classiﬁed here if the purpose is to enhance the volume of speech produced by an individual with a disability, in order for his/her speech to be audible by persons without disabilities. The purpose of the ampliﬁer is to enhance the volume of speech produced by an individual without a disability, in order for his/her speech to be heard by persons who are deaf or hard of hearing, the device is classiﬁed under hearing. Peripherals designed to facilitate access or otherwise support the use of a device for speech communication (e.g. mounting systems; carrying cases, switch or mouth stick used for access) are counted in this category.

Examples:

· Speech generating devices such as BIGMack; DV4; ChatPC; Dynawrite; Pathﬁnder; talking photo albun

· Communication boards/books

· Devices that produce text but not voice output for face-to-face communication (e.g. Crespeaker)

· Voice clariﬁers (e.g. Speech Enhancer)

· Voice ampliﬁers (e.g. Falck ampliﬁer)

4. Leaming, Cognition, and Developmental

Deﬁnition: Products to provide people with disabilities with access to educational materials and instruction in school or other environments; products that assist with learning, and cognition.

Common subcategories:

· Cognitive aids

· Early intervention aids

· Instructional materials

· Memory Aids

· General Personal Organization Tools

· Sensory/Developmental Stimulation Products

Decision rules: Products intended to mitigate, compensate, or address learning or cognitive limitations should be classiﬁed here along with products used to facilitate computer access for individuals with learning/cognitive limitations. Products designed to assist people who are blind or visually impaired with reading, organization, learning, computer access, etc. are classiﬁed under vision.

Examples:

· Calculators and measurement tools

· Clocks/Timers/Wake-up Systems

· Electronic Reference Tools and Money Management Tools

· Memory Aids

· Electronic Notakers, Portable Word Processers, and Recording Devices

· Electronic Organizers/Personal Digital Assistants

· Scientiﬁc Equipment

· Educational/Instructional Software (cause and effect, reading, language, spelling, math,writing, science, history, etc)

· Cognitive/Perceptual Training Software

· Tape or other audio players (except as related to vision)

· Text-to-speech systems (WYNN, Read and Write Gold, etc. — not related to vision)

· FM systems (to support auditory processing - not related to hearing loss)

5. Mobility, Seating, and Positioning

Deﬁnition: Products whose main focus is on augmenting or replacing the functional limitations of an individual’s mobility

Decision rules: Wheelchair restraints associated with seating & positioning (shoulder or safety belts) are classiﬁed in this category. Wheelchair restraints associated van locks which allow a power chair user to drive and/or be transported safely is classiﬁed under “Vehicle Modiﬁcation and Transportation.”

Examples:

· Ambulatory aids: low tech aids such as canes, walkers or crutches; also includes orthotics & prosthetics

· Wheelchairs: dependent (such as strollers & transport chairs) & independent manual mobility (4-wheels propelled independently)

· Scooters and power chairs: Functionally matched motorized independent power mobility bases

· Seating and positioning — considerations based on postural control & deformity management, pressure & postural management, and/or comfort & postural accommodation.

6. Daily Living

Deﬁnition: Devices that enhance the capacity of people with disabilities to live independently, especially AT that assists with Instrumental and other Activities of Daily Living, (ADLs, IADLs) such as dressing, personal hygiene, bathing, home maintenance, cooking, eating, shopping and managing money.

Common Subcategories:

· Personal hygiene, care and toileting

· Dressing and apparel, and aids to dressing

· Housekeeping, cleaning, maintenance

· Cooking and eating

· Handling, reaching, manipulating

· Alerting and signalling

· Household management, bill paying (not cognitive, vision, or hearing AT)

· Telephony equipment

Decision rules: Architectural/home adaptations or modiﬁcations are classiﬁed underEnvironmental adaptations. Life safety devices and systems that do not involve home modiﬁcations are categorized here. Devices intended to accommodate speciﬁc disabilities, such as hearing or vision, are assigned to those categories. Devices that assist with personal organization are classiﬁed as Learning, Cognition and Developmental AT. Devices used to accommodate multiple disabilities are categorized here. Devices that assist persons with motor impairments not categorized elsewhere are included here. EADLs that also function as environmental controls are classiﬁed according to their primary use. Telephony equipment not intended to accommodate other categories of disabilities is listed here.

Examples:

· Writing guides, adapted writing implements

· modiﬁed or large-handled tools and utensils

· eating/feeding equipment, spiked cutting board, jar opener

· zipper pulls, button hooks, needle threader

· personal pager, multi-sensing/multi-sensory alerting devices

· wheelchair desks/trays

· wheelchair/walker bag

· switch-adapted food processor or other appliance

· Large-button telephone (not for vision or cognitive accommodation.

7. Environmental Adaptations

Deﬁnition: Environmental and structural adaptations to the built environment that remove or reduce barriers and promote access to and within the built home, employment and community facilities for individuals with disabilities. Environmental adaptations usually involve building construction, engineering, and architecture, but also include environmental controls and switches that can control a large portion of or an entire living environment. Environmental adaptations are typically permanent or semi-permanent structures, modiﬁcations or additions

Decision rules: Adaptations or modiﬁcations to vehicles are classiﬁed under Vehicle modiﬁcations. Adaptations to furniture such as chairs, couches, beds, etc., would be generally be classiﬁed under Mobility, Seating, and Positioning. For example, shower chairs, commodes, raised toilet seats and similar portable items should be classiﬁed in the daily living category where as a roll in shower, wall or ﬂoor mounted grab bars, installed ramps, etc would be classiﬁed here because they become part of the building structure.

Examples:

· Accessible HVAC controls, accessible plumbing ﬁxtures and controls

· Adapted playground equipment and structures

· Alarm and Security Systems

· Cabinetry and Storage equipment

· Door/Gate Openers

· Environmental controls and switches (i.e., electronic systems that enable people

· To control various appliances, lights, telephones, security systems etc.)

· Flooring and Surface materials/Detectable warning surfaces

· General Environmental Access Products

· Lifts

· Lighting/lighting controls

· Ramps

· Signage/signalling products

· Workstations/Desks/Tables, Home-workplace adaptations

8. Vehicle Modiﬁcation and Transportation

Deﬁnition: Products that give people with disabilities independence and enhance safety in transportation through adaptation of vehicles.

Decision rules: Vehicle ramps are classiﬁed in this category. Versatile/portable ramps (temporary adaptation) and wheelchair lifts (permanently installed in buildings) are classiﬁed under Environmental adaptations.

Examples:

· Adaptive shoulder and seat safety belts

· Tie downs and lock downs that secure the wheelchair to the vehicle ﬂoor

· Hand controls

· Extended directional mirrors.

· Vehicles and vans modiﬁed with lifts, ramps, raised roofs, etc.

9. Computers and Related

Deﬁnition: Hardware and software products that enable people with disabilities to access, interact with, and use computers at home, work, or school. Includes modiﬁed or alternate Keyboards, switches activated by pressure, touch screens, special software, voice to text software.

Decision rules: Classify standard computers and computer-related devices (those that will be used without any adaptations) in this category, along with input adaptations used to mitigate, compensate or address motor limitations. Do not include computer adaptations used to address vision or learning, cognitive or developmental limitations.

Examples:

· Standard software

· Standard hardware

· Computer accessories

· Alternative keyboards and pointing devices

· Switches and scanning software used for computer access

· Touchscreens

· Voice recognition systems

10. Recreation, Sports, and Leisure Equipment

Deﬁnition: Products not already classiﬁed in other categories that help persons with disabilities to participate in sport, health, physical education, recreation, leisure, and dance events.

Common subcategories:

· Toys and games

· Sports equipment

· Fitness equipment

· Specialized wheelchairs and recreational mobility equipment

· Musical instruments and related devices

· Arts, crafts and photography equipment

· Gardening and horticultural equipment

· Hunting, ﬁshing, shooting equipment

· Camping, hiking and other outdoor recreational equipment

· Audio and video entertainment equipment

Decision rules: Devices intended to accommodate speciﬁc disabilities, such as hearing or vision, are assigned to those categories. Specialized products designed speciﬁcally for recreational, leisure or athletic pursuits are categorized here. Devices that may have other uses, but are selected as AT for a recreational setting, should be categorized here. Devices for environmental control that also serve as entertainment system controls (e. g. television remote) are classiﬁed according to their primary use.

Examples:

· Switch-adapted toys and games;

· Tennis wheelchairs; beach wheelchairs

· Skiing equipment; sled/sledge hockey equipment

· Gardening tools and equipment;

· Playing card shufﬂer;

· Adapted camera and other photography equipment;

· Adaptive exercise equipment (not used in a rehabilitation setting);

· Adaptive equipment for ﬁshing, hunting, and camping;

· Adaptive musical instruments and accessories (not used in a school setting)

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.

CHARECTARIZATION OF ASSISTIVE TECHNOLOGIES

1. Assistive Versus Rehabilitative Or Educational Technologies:

Technology can serve two major purposes: helping and teaching. Technology that helps an individual to carry out a functional activity is termed assistive technology. Technology can also be used as part of an educational or rehabilitative process. In this case the technology is usually used as one modality in overall education or rehabilitation plan.

2. Low To High Technology

This distinction is imprecise, inexpensive devices that are simple to make and easy to obtain are often described as “low” technology and devices that are expensive, more difficult to make, and harder to obtain as “high” technology. According to this distinction examples of low technology devices are simple pencil and paper communication boards, modified eating utensils, and simple splints. Wheelchairs, electronic communication devices, and computers are high technology devices.

3. Hard And Soft Technologies

4. Appliances Versus Tools

An appliances is a devise that provides benifits to the individual independent of the individual’s skill level. Tool on the other hand, require the development of skill for their use. The determining factor in distinguishing a tool from an appliance is that the quality of the result obtained using a tool depends on the skill of the user.

5. Minimal To Maximal Technology

Assistive technology are specified and designed to meet a continuum of needs. Maximal assistive technologies that replace significant amounts of ability to generate functional outcomes. Minimal technologies generally augment rather than replace function.

6. General Versus Specific Technologies

Assistive technologies are differentiated according to whether they are used in many different applications or whether they are intended for a specific application. General purpose assistive technology includes 1. Seating and positioning system, 2. Control inferences and 3. Computers.

Specific purpose assistive technologies facilitate performance in one unique application area.

7. Commercial To Custom Technology

GUIDING PRINCIPLES FOR ASSISTIVE TECHNOLOGY

1. The primary goal of assistive technology is the enhancement of capabilities and the removal of barriers to performance.

2. Assistive technology can be a barrier.

3. Assistive technology may be applicable to all disability groups and in all phases of education.

4. Assistive technology is related to function, rather than to a specific disability.

5. The least complex intervention needed to remove barriers to performance should be a first consideration.

6. Assessment and intervention form a continuous, dynamic process.

7. Systematic problem analysis and solving are essential.

8. Assistive technology does not eliminate the need for instruction in social and academic skills.

9. A team approach is required.

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.

ASSISTIVE TECHNOLOGY - FACTORS INFLUENCING DEVICE ACCEPTANCE AND USAGE

The AT outcomes from the perspectives of the users with locomotor disability has been found to be influenced by various set of factors. These factors encompass the entire psychosocial experience as perceived by a person with locomotor disability using devices. For the convenience of assessment and interpretation the various factors have been grouped as socio-demographic, condition specific and device specific factors.

Socio-Demographic Factors

The influence of various socio-demographic factors, on the usage of assistive technology. These include age, gender, type of organization, local support, migration towards the facility, social support, working status, educational status, living situation, and socioeconomic status. Research has shown that participation, life satisfaction, and a person‟s subjective experience of contentment with his or life, are affected in people with disabilities.

Condition Specific Factor

The influence of various condition specific factor or relevant clinical factor, as considered in current study, on the usage of assistive technology. The factors included functional status, severity of condition, diagnosis, age of onset, duration of the problem.

Functional independence or functional status itself is regarded as a self-evident goal for AT users and is part of an overall sense of well-being. It is linked to both successful functional outcomes and viewed as a prerequisite to successful participation.

Device Specific Factor

Some of the relevant device related factors as cited in literatures on AT services, user‟s involvement, waiting period, AT training and maintenance, information and instructions, prescription, funding, and AT usage frequency.

REFERENCES

· https://www.britannica.com/topic/assistive-technology#ref1185943

· Albert M. Cook, Janice Miller Polgar, (2008). Cook and Hussey's Assistive Technologies: Principles and Practice (3^rded). Mosby Elsevier:

· http://www.uvm.edu/~cdci/tripscy/localpdf/AT_Guiding_Principles.pdf

· http://shodhganga.inflibnet.ac.in/

Raji Rajendran

Tuesday 7 March 2017

ASSISTIVE TECHNOLOGY

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