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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. The Promise of Assistive Technology to Enhance Activity and Work Participation. Washington, DC: The National Academies Press. doi: 10.17226/24740.
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The Promise of
Assistive Technology to
Enhance Activity and
Work Participation

Committee on the Use of Selected Assistive Products and Technologies in
Eliminating or Reducing the Effects of Impairments

Alan M. Jette, Carol Mason Spicer, Jennifer Lalitha Flaubert, Editors

Board on Health Care Services

Health and Medicine Division

A Consensus Study Report of

images

THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. The Promise of Assistive Technology to Enhance Activity and Work Participation. Washington, DC: The National Academies Press. doi: 10.17226/24740.
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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001

This activity was supported by Contract/Task Order No. SS00-13-60048/0007 with the U.S. Social Security Administration. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-45784-2
International Standard Book Number-10: 0-309-45784-X
Digital Object Identifier: https://doi.org/10.17226/24740
Library of Congress Control Number: 2017944212

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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2017. The Promise of Assistive Technology to Enhance Activity and Work Participation. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/24740.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. The Promise of Assistive Technology to Enhance Activity and Work Participation. Washington, DC: The National Academies Press. doi: 10.17226/24740.
×

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The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president.

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The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president.

The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine.

Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. The Promise of Assistive Technology to Enhance Activity and Work Participation. Washington, DC: The National Academies Press. doi: 10.17226/24740.
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Image

Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task.

Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies.

For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. The Promise of Assistive Technology to Enhance Activity and Work Participation. Washington, DC: The National Academies Press. doi: 10.17226/24740.
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COMMITTEE ON THE USE OF SELECTED ASSISTIVE PRODUCTS AND TECHNOLOGIES IN ELIMINATING OR REDUCING THE EFFECTS OF IMPAIRMENTS

ALAN M. JETTE (Chair), Professor, Health Law, Policy and Management, Boston University School of Public Health

FABRICIO E. BALCAZAR, Professor, Disability and Human Development, University of Illinois at Chicago

LAURA J. BALL, Speech-Language Pathologist and Director, Hearing and Speech Research, Center for Translational Research, Children’s National Health System, and Professor, Pediatrics, School of Medicine and Health Sciences, The George Washington University

RORY A. COOPER, Distinguished Professor and FISA Foundation and Paralyzed Veterans of America Chair, School of Health and Rehabilitation Sciences, University of Pittsburgh, and Senior Career Scientist, VA Pittsburgh Healthcare System

JANNA L. FRIEDLY, Associate Professor, Physical Medicine and Rehabilitation, University of Washington, and Medical Director, Limb Preservation and Amputation Services, Harborview Medical Center

WALTER R. FRONTERA, Professor, Physical Medicine, Rehabilitation, and Sports Medicine and Physiology, University of Puerto Rico School of Medicine

KATYA HILL, Associate Professor, Communication Science and Disorders, University of Pittsburgh

BARBARA L. KORNBLAU, Executive Director, Coalition for Disability Health Equity, and Adjunct Professor, Florida A&M University

FRANK R. LIN, Associate Professor, Otolaryngology-Head and Neck Surgery and Geriatric Medicine, Johns Hopkins University School of Medicine

LAURA A. MILLER, Research Scientist/Prosthetist, Center for Bionic Medicine, Shirley Ryan AbilityLab, and Clinical Associate Professor, Physical Medicine and Rehabilitation, Northwestern University

KENNETH J. OTTENBACHER, Russell Shearn Moody Distinguished Chair in Neurological Rehabilitation and Director, Division of Rehabilitation Sciences, University of Texas Medical Branch at Galveston

LINDA J. RESNIK, Research Career Scientist, Providence VA Medical Center, and Professor, Health Services, Policy and Practice, Brown University

JON A. SANFORD, Director, Center for Assistive Technology and Environmental Access, and Professor of Industrial Design, Georgia Institute of Technology

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. The Promise of Assistive Technology to Enhance Activity and Work Participation. Washington, DC: The National Academies Press. doi: 10.17226/24740.
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STEPHANIE J. SJOBLAD, Clinical Coordinator and Professor, Hearing and Communication Center, Division of Speech and Hearing Sciences, University of North Carolina at Chapel Hill

LAWRENCE C. VOGEL, Chief of Pediatrics, Assistant Chief of Staff, Medical Director, Spinal Cord Injury Program, Chicago Shriners Hospitals for Children, and Professor of Pediatrics, Rush Medical College

Consultants

PATRICIA M. OWENS, Consultant, Health and Disability Policy and Programs

AMOL KARMARKAR, Assistant Professor, Division of Rehabilitation Sciences, University of Texas Medical Branch

MAUREEN O’CONNELL, Attorney at Law, Southern Disability Law Center

JAMES R. SHELDON, JR., Supervising Attorney, National Assistive Technology Advocacy Project, Neighborhood Legal Services, Inc.

Study Staff

CAROL MASON SPICER, Study Director

JENNIFER LALITHA FLAUBERT, Associate Program Officer

FRANK R. VALLIERE, Associate Program Officer (until July 2016)

LAURA VERCAMMEN, Research Associate (October 2016-December 2016)

NICOLE GORMLEY, Senior Program Assistant

PAMELA RAMEY-McCRAY, Administrative Assistant

DAVID A. BUTLER, Acting Director, Board on the Health of Select Populations (July 2016-December 2016)

FREDRICK ERDTMANN, Director, Board on the Health of Select Populations (until July 2016)

SHARYL J. NASS, Director, Board on Health Care Services

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. The Promise of Assistive Technology to Enhance Activity and Work Participation. Washington, DC: The National Academies Press. doi: 10.17226/24740.
×

Reviewers

This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.

We thank the following individuals for their review of this report:

Kendra Betz, VA National Center for Patient Safety

William R. Botten, U.S. Access Board

George Demiris, University of Washington

William A. Erickson, Cornell University

Alberto Esquenazi, MossRehab

Howard H. Goldman, University of Maryland at Baltimore

Helen Marie Hoenig, Durham VA Medical Center

Lisa I. Iezzoni, Harvard Medical School and Massachusetts General Hospital

Andrew J. Imparato, Association of University Centers on Disabilities

Susan Kapp, University of Washington

Todd Kuiken, Rehabilitation Institute of Chicago

Cathy L. Lazarus, Mount Sinai Beth Israel

Rachel McArdle, U.S. Department of Veterans Affairs

Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. The Promise of Assistive Technology to Enhance Activity and Work Participation. Washington, DC: The National Academies Press. doi: 10.17226/24740.
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Ryan McCreery, Boys Town National Research Hospital

David McNaughton, Pennsylvania State University

Joseph J. Montano, Weil Cornell Medicine

Edward L. Myers III, Attorney at Law (Retired)

Frank A. Sloan, Duke University

Kathryn M. Yorkston, University of Washington

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report nor did they see the final draft before its release. The review of this report was overseen by Robert S. Lawrence, Johns Hopkins University, and Bradford H. Gray, Urban Institute. They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. The Promise of Assistive Technology to Enhance Activity and Work Participation. Washington, DC: The National Academies Press. doi: 10.17226/24740.
×

Acknowledgments

The study committee and the National Academies of Sciences, Engineering, and Medicine’s Health and Medicine Division project staff take this opportunity to recognize and thank the many individuals who shared their time and expertise to support the committee’s work and inform its deliberations.

This study was sponsored by the U.S. Social Security Administration (SSA). We thank McArthur Allen, Gina Clemons, Joanna Firmin, Scott Marko, Nancy Miller, and Mary Beth Rochowiak for their guidance and support, as well as Megan Butson and Thomas Mulherin for their assistance. The committee also acknowledges SSA for verifying relevant technical content for accuracy. The committee benefited greatly from discussions with the individuals who presented at and attended the committee’s open sessions: Laura J. Ball, Susanne M. Bruyère, Megan Conway, Justin Creamer, Melissa Day, William A. Erickson, Bradley Flohr, Amy S. Goldman, Michelle C. Jackson, Michael Kidd, John Kramschuster, Daniel E. Kubrin, Jo Anne Materkowski, Ryan McCreery, Susan M. Miller, Penny L. Nechanicky, Patricia M. Owens, Mark Schmeler, Gerald Stark, Colleen Thoma, and Kristin Tugman. The committee is grateful to these presenters for volunteering to share their expertise, knowledge, data, and opinions not only with the committee but also with the members of the public who participated in the committee’s open sessions. The committee also appreciates the efforts of numerous individuals who assisted project staff in identifying the presenters. Particular thanks go to Winthrop Cashdollar for his introductions to representatives from the private disability insurance industry.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. The Promise of Assistive Technology to Enhance Activity and Work Participation. Washington, DC: The National Academies Press. doi: 10.17226/24740.
×

The committee acknowledges the many staff within the Health and Medicine Division who provided support in various ways to this project, including Carol Mason Spicer (study director), Jennifer Flaubert (associate program officer), Nicole Gormley (senior program assistant), Karen Helsing (senior program officer), Frank Valliere (program officer), Laura Vercammen (research associate), and Julie Wiltshire (financial associate). The committee extends great thanks and appreciation to the Health and Medicine Division board directors who oversaw the project: Rick Erdtmann, David Butler, and Sharyl Nass. Research assistance was provided by Rebecca Morgan (senior research librarian, National Academies). Finally, Rona Brière and Alisa Decatur are to be credited for the superb editorial assistance they provided in preparing the final report.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. The Promise of Assistive Technology to Enhance Activity and Work Participation. Washington, DC: The National Academies Press. doi: 10.17226/24740.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. The Promise of Assistive Technology to Enhance Activity and Work Participation. Washington, DC: The National Academies Press. doi: 10.17226/24740.
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2-3 Environmental facilitators framework

3-1 Projected number of wheelchair users (linear and polynomial model)

3-2 Rollator example

3-3 Example of a standard manual wheelchair

3-4 Example of a standard hemi-wheelchair

3-5 Examples of high-strength lightweight model wheelchairs

3-6 Examples of ultra-lightweight wheelchairs

3-7 Segway modified to serve as a wheelchair

3-8 Action Trackchair for outdoor use

3-9 Examples of three- and four-wheel power operated vehicles

3-10 Example of a powered wheelchair in Medicare Group 1

3-11 Example of a powered wheelchair in Medicare Group 2

3-12 Example of a powered wheelchair in Medicare Group 3

3-13 Examples of powered wheelchairs in Medicare Group 4

3-14 Example of a power assist wheelchair

3-15 Distribution of ATP and SMS certified professionals

4-1 Levels of upper-limb amputation

4-2 Body-powered prosthesis on a person with a transradial amputation

4-3 Myoelectric prosthesis on a person with a transradial amputation

4-4 Transhumeral configuration of a DEKA arm

4-5 Example of a hybrid prosthesis

4-6 Examples of body-powered hooks

4-7 Examples of two powered hooks

4-8 Single-degree-of-freedom hand showing cutout of glove and hand shell to display internal mechanism

4-9 Examples of three multiarticular hands, all shown without a glove

5-1 Prevalence of hearing loss in the United States by age, 2001-2008

6-1 Illustration of esophageal speech

6-2 Tracheoesophageal puncture with prosthesis

6-3 Chin placement of artificial/electrolarynx

6-4 Tracheostomy speaking valve

Page xvii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. The Promise of Assistive Technology to Enhance Activity and Work Participation. Washington, DC: The National Academies Press. doi: 10.17226/24740.
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TABLES

3-1 Characteristics of the SIPP, NHIS/NHIS-D, and CMS DME Data Sources

3-2 Demographic Characteristics of Users of Wheeled and Seated Mobility Devices by Gender

3-3 Estimated Number of Wheeled and Seated Mobility Devices by Healthcare Common Procedure Coding System (HCPCS) Codes

3-4 Use of Manual Versus Powered Wheelchairs by Age and Race/Ethnicity

3-5 Estimated Number of Wheeled and Seated Mobility Devices by CMS Diagnostic Categories

Annex Table 3-1 Taxonomy of Wheeled and Seated Mobility Devices

Annex Table 3-2 Functionality of Wheeled and Seated Mobility Devices

4-1 Upper-Limb Prostheses Provided to Beneficiaries by Type

4-2 Demographic Characteristics of Recipients of Upper-Limb Prostheses

4-3 Estimated Percentage of Upper-Limb Prosthetic Devices by Amputation Category

Annex Table 4-1 Upper-Limb Prosthetic Device Taxonomy

Annex Table 4-2 Ability of Upper-Limb Prosthetic Devices to Mitigate the Effects of Impairment

5-1 Prevalence of and Numbers of Individuals with Hearing Loss, by Age and Severity: National Health and Nutrition Examination Survey, United States, 2001-2010

5-2 Prevalence of Hearing Aid Use Among Adults with Hearing Loss >25 dB (95% CI)

Annex Table 5-1 Selected Hearing Technologies Taxonomy

Annex Table 5-2 Selected Hearing Technologies Function

6-1 Communication-Related Features of Aided AAC Systems

6-2 Components of AAC Technology

6-3 Personnel Involved in AAC Assessment and Treatment,

6-4 Voice and Speech Restoration and Amplification Taxonomy

Annex Table 6-1 Summary of Aided Augmentative and Alternative Communication (AAC) Products and Technologies

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. The Promise of Assistive Technology to Enhance Activity and Work Participation. Washington, DC: The National Academies Press. doi: 10.17226/24740.
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Acronyms and Abbreviations

AAC

augmentative and alternative communication

ABC

American Board for Certification in Orthotics, Prosthetics and Pedorthics

ABLE

Achieving a Better Life Experience

ABN

advanced beneficiary notice

ACA

Patient Protection and Affordable Care Act

ACTA

Air Carrier Transportation Act

ADA

Americans with Disabilities Act

ADL

activity of daily living

ADMC

Advance Determination of Medical Coverage

AFP

Alternative Financing Program

AL/EL

artificial/electrolarynx

ALS

amyotrophic lateral sclerosis

APRN

advanced practice registered nurse

ASHA

American Speech-Language-Hearing Association

ASoC

Amputation System of Care

AT

assistive technology

ATP

assistive technology professional

C&P

compensation and pension

CAP

Computer/Electronic Accommodations Program

CARF

Commission on Accreditation of Rehabilitation Facilities

CDC

U.S. Centers for Disease Control and Prevention

CHIP

Children’s Health Insurance Program

CMS

Centers for Medicare & Medicaid Services

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. The Promise of Assistive Technology to Enhance Activity and Work Participation. Washington, DC: The National Academies Press. doi: 10.17226/24740.
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CPP

Canada Pension Plan

CPT

Current Procedural Terminology

CR

cost reimbursement

DASH

Disabilities of the Arm, Shoulder, and Hand (questionnaire)

dB

decibels

DBS

disability benefits specialist

DDS

Disability Determination Services

DE

disability examiner

DM

digital modulation

DME

durable medical equipment

DME-MAC

Durable Medical Equipment-Medicare Administrative Contractor

EHLR

Education for the Handicapped Law Report

EMG

electromyographic

EN

employment network

ENT

ear, nose, and throat

EPSDT

Early and Periodic Screening, Diagnostic, and Treatment

ESS

esophageal speech

FBR

federal benefit rate

FDA

U.S. Food and Drug Administration

FFP

federal financial participation

FM

frequency modulated

FODAC

Friends of Disabled Adults and Children

FY

fiscal year

GAO

U.S. Government Accountability Office

HCBS

home- and community-based services

HCPCS

Healthcare Common Procedure Coding System

HMO

health maintenance organization

IADL

instrumental activity of daily living

ICD-9

International Classification of Diseases, Ninth Revision

ICF

International Classification of Functioning, Disability and Health

ICIDH

International Classification of Impairments, Disabilities, and Handicaps

IDEA

Individuals with Disabilities Education Act

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. The Promise of Assistive Technology to Enhance Activity and Work Participation. Washington, DC: The National Academies Press. doi: 10.17226/24740.
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IDELR

Individuals with Disabilities Education Law Report

IEP

individualized education plan

IMU

inertial measurement unit

IRS

Internal Revenue Service

ISO

International Organization for Standardization

JAN

Job Accommodation Network

LCD

Local Coverage Determination

MAE

mobility assistive equipment

MRADL

mobility-related activity of daily living

MSP

Medicare Savings Program

NAAL

National Assessment of Adult Literacy

NCART

National Coalition for Assistive and Rehab Technology

NCD

National Coverage Determination

NHANES

National Health and Nutrition Examination Survey

NHIS

National Health Interview Survey

NHIS-D

National Health Interview Survey-Disability

NIDILRR

National Institute on Disability, Independent Living, and Rehabilitation Research

OSEP

Office for Special Education Programs

P&A

protection and advocacy

PA

physician assistant

PAAT

Protection and Advocacy for Assistive Technology

PANS

Polytrauma/Amputation Network Sites

PASS

Plan to Achieve Self-Support

PC

psychological consultant

PDA

personal digital assistant

PIDA

Power Mobility Indoor Driving Assessment

PM&R

physical medicine and rehabilitation

POMS

Program Operations Manual System

POV

power operated vehicle

PRAT

Polytrauma Rehabilitation Assistive Technology Lab

PSAP

personal sound amplification product

PTSD

posttraumatic stress disorder

QDE

qualified disability expense

RAC

Regional Amputation Care Center

Page xxii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. The Promise of Assistive Technology to Enhance Activity and Work Participation. Washington, DC: The National Academies Press. doi: 10.17226/24740.
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RERC

Rehabilitation Engineering Research Center

RESNA

Rehabilitation Engineering and Assistive Technology Society of North America

RFC

residual functional capacity

RSA

Rehabilitation Services Administration

RVSR

rating veterans service representative

SGA

substantial gainful activity

SGD

speech-generating device

SHAP

Southampton Hand Assessment Procedure

SIPP

Survey of Income and Program Participation

SLP

speech-language pathologist

SMS

seating and mobility specialist

SSA

U.S. Social Security Administration

SSDI

Social Security Disability Insurance

SSI

Supplemental Security Income

TAI

Transfer Assessment Instrument

TEP

tracheoesophageal voice prosthesis

TRS

telecommunications relay service

TSV

tracheostomy speaking valve

UCP

United Cerebral Palsy

UEP

upper-extremity prosthesis

VA

U.S. Department of Veterans Affairs

VASRD

VA Schedule for Rating Disabilities

VBA

Veterans Benefits Administration

VC

voluntary closing

VHA

Veterans Health Administration

VO

voluntary opening

VR

vocational rehabilitation

VR&E

Vocational Rehabilitation and Employment

VSC

Veterans Service Center

WHO

World Health Organization

WIOA

Workforce Innovation and Opportunity Act

wpm

words per minute

WSMD

wheeled and seated mobility device

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. The Promise of Assistive Technology to Enhance Activity and Work Participation. Washington, DC: The National Academies Press. doi: 10.17226/24740.
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The U.S. Census Bureau has reported that 56.7 million Americans had some type of disability in 2010, which represents 18.7 percent of the civilian noninstitutionalized population included in the 2010 Survey of Income and Program Participation. The U.S. Social Security Administration (SSA) provides disability benefits through the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. As of December 2015, approximately 11 million individuals were SSDI beneficiaries, and about 8 million were SSI beneficiaries.

SSA currently considers assistive devices in the nonmedical and medical areas of its program guidelines. During determinations of substantial gainful activity and income eligibility for SSI benefits, the reasonable cost of items, devices, or services applicants need to enable them to work with their impairment is subtracted from eligible earnings, even if those items or services are used for activities of daily living in addition to work. In addition, SSA considers assistive devices in its medical disability determination process and assessment of work capacity.

The Promise of Assistive Technology to Enhance Activity and Work Participation provides an analysis of selected assistive products and technologies, including wheeled and seated mobility devices, upper-extremity prostheses, and products and technologies selected by the committee that pertain to hearing and to communication and speech in adults.

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