The Future of Disability in America (2007) / Chapter Skim
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7 Assistive and Mainstream Technologies for People with Disabilities
7 Assistive and Mainstream Technologies for People with Disabilities
Pages 183-221
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From page 183... ...
These helpful technologies may work by augmenting individual abilities (e.g., with glasses or hearing aids) , by changing the general environment (e.g., with lever door handles or "talking" elevators)
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From page 184... ...
report Disability in America, the world of assistive technologies has changed significantly in a number of areas. Perhaps the most dramatic advances involve the expanded communication options that have accompanied the improvement and widespread adoption of personal computers for use in homes, schools, and workplaces.
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From page 185... ...
. Findings such as those just cited suggest that the greater availability and use of assistive technologies could help the nation prepare for a future characterized by a growing older population and a shrinking proportion of younger people available to provide personal care.
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From page 186... ...
For example, certain assistive technologies, such as prostheses, require a physician's prescription and expert training in safe and effective use. The distinction may also affect what health plans pay for, as discussed in Chapter 9.
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From page 187... ...
. Assistive technologies can be subdivided to distinguish many kinds of products.
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From page 188... ...
In general, insurance plans do not cover assistive technologies, as broadly defined by the Assistive Technology Act. (See Chapter 9 for a discussion of financing for assistive technologies under Medicare, Medicaid, private health plans, and other programs.)
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From page 189... ...
would be mainstream device, whereas a handrail installed along the hallway in the home of someone with mobility limitations would be an assistive device and an environmental modification. Mainstream technologies include such disparate items as pens and pencils, personal computers, kitchen gadgets and appliances, cash machines, automobiles, cell phones, alarm clocks, trains, microwave ovens, and elevators.
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From page 190... ...
Human factors engineering often does not consider the capacities of people with visual, hearing, mobility, or other impairments. Nonetheless, its principles and methods can be applied to the design of mainstream and assistive technologies to take into account how people with different kinds of impairments interact with such technologies.
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From page 191... ...
11 ASSISTIVE AND MAINSTREAM TECHNOLOGIES technologies much simpler and less obtrusive. A web page designed so that it can easily be used with computer screen readers is an example.
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Some policies -- notably, the Assistive Technology Act -- aim to make different kinds of technologies more available, more useful, and more affordable. Other policies, such as coverage provisions of health insurance programs such as Medicare and Medicaid, do not focus on assistive technology as such but significantly affect access to it (see Chapter 9)
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From page 193... ...
It authorizes federal support to states to promote access to assistive technology for individuals with disabilities. For fiscal year (FY)
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.8 EXTENT OF ASSISTIVE TECHNOLOGY USE Assistive technologies have been developed to meet a wide range of needs. A database (ABLEDATA)
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The majority of respondents reported that they had received little or no information about assistive technologies or of listed items that are intended primarily for use by people with specific impairments include a vegetable peeler with a clamp that allows use with only one hand and a carbon monoxide detector for use by people with hearing limitations.
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From page 196... ...
The great majority (approximately 90 percent) agreed that changes in laws or program policies in the previous decade had helped people with disabilities get access to assistive technologies.
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From page 197... ...
Despite the increasing use of assistive technologies and the creation of a number of federal programs to promote the development and availability of these technologies, the amount of information on the effectiveness of these technologies in improving function and, in particular, increasing independence and community participation appears to be relatively sparse across the range of available technologies and users (AAPM&R/The Foundation for PM&R, 2003; Carlson and Ehrlich, 2005) .11 As discussed in Chapter 10, government funding for disability-related research is, in general, very small in relation to the personal and societal impact of disability.
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From page 198... ...
The committee identified a few controlled studies that compared assistive technologies or that compared the use of an assistive technology with no use. For example, several studies have compared hearing aids and other devices used to enhance hearing (see, e.g., Cohen et al.
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From page 199... ...
. Several population-based studies suggest that assistive technologies may substitute for or supplement personal care (Manton et al., 1993; Agree, 1999; Agree and Freedman, 2000; Allen, 2001; Hoenig et al., 2003; Agree et al., 2005)
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From page 200... ...
At least one controlled trial (Mann et al., 1999) found cost savings with the substitution of assistive technology for some personal care.15 Using a variety of outcome measurement tools, the investigators also found that the group that used the technology experienced slower rates of functional decline and less pain than the control group.16 As is evident from this discussion, the availability of assistive and accessible mainstream technologies may have consequences that reach beyond individual users to affect formal and informal caregivers, including family members.
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From page 201... ...
With electronic technology being integrated into products and services in education, employment, health care, and many other aspects of daily life, the inability to use these electronic features can itself be disabling. For example, a person with vision loss who could work a traditional stove TABLE 7-1 Examples of Barriers Created by Mainstream Technologies Mainstream Use Example of Barrier Medical diagnosis Magnetic resonance imaging devices that do not allow use by people with spinal deformities or morbid obesity Mammography machines do not accommodate women in wheelchairs or scooters Medical therapy Home blood pressure monitoring devices that are difficult for people or monitoring with low vision to read Alarm systems on glucose monitoring devices that have no visual indicator for people with hearing loss General built Buildings with doors, hallways, seating areas, and other features that environment are awkward or impossible for people with mobility limitations to use Activities of daily Ovens, washing machines, and other appliances in rental apartments living that have touch screens or other features that limit their use by people with vision or other impairments New products that require complex sequences of commands that exceed the capacities of people with cognitive impairments or that require intensive training Information Displays on fax and other machines that are positioned so that they are technology not visible to people in wheelchairs Commercial firms that operate only through the Internet and that have websites that are not compatible with computer screen readers used by people with vision impairments Transportation Buses that have access features that are not functioning because of a lack of timely maintenance and repair Fare machines that are difficult to use by people with cognitive limitations or that assume a person's familiarity with operating procedures
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From page 202... ...
Now, the Internet is becoming the primary or least expensive place to obtain certain types of goods, particularly specialty items that may not be available in many smaller communities. If computer technologies in general and websites in particular are not accessible, people with disabilities may face serious limits in their ability to find and purchase these less common products, including certain assistive technologies.
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From page 203... ...
. CHALLENGES TO DEVELOPMENT AND EFFECTIVE PROVISION AND USE OF ASSISTIVE TECHNOLOGIES As illustrated in the discussion to this point, assistive technologies constitute a quite broad and varied array of products that are directed toward a very diverse population of device users.
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, and health plan coverage of assistive technologies that is more restrictive than coverage of medical and surgical services (see Chapter 9)
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. The following discussion first examines the stages of research, development, and commercial application for assistive technologies.
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From page 206... ...
Even when the number of children with a condition is sizeable, children's growth and development mean that many different sizes of a product may be required. Unlike a medication, which often can be provided in different doses to people of different ages, many medical devices and assistive technologies cannot be manufactured in one form and then easily "sized" at the time of delivery or use (IOM, 2005b)
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From page 207... ...
The 1997 IOM report Enabling America suggested that the situation for assistive technologies is similar to that for so-called orphan drugs for people with rare medical conditions.18 Unfortunately, it has proved difficult for the U.S. Congress to identify incentives for the development of medical equipment for small user populations similar to those identified for the development of orphan drugs (IOM, 2005b)
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as well as assistive technologies. Some centers focus on conditions (e.g., spinal cord injuries)
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20 ASSISTIVE AND MAINSTREAM TECHNOLOGIES BOX 7-2 Focus of NIDRR-Supported Rehabilitation Engineering Research Centers Condition, impairment, or group characteristic Spinal cord injuries Low vision, blindness, and multisensory loss Children with orthopedic disabilities Technology access for land mine survivors Technology for successful aging Technology Accessible medical instrumentation Wheeled mobility Prosthetics and orthotics Communication enhancement Telecommunications access Wireless technologies Universal interface and information technology access Universal design and the built environment Telerehabilitation Robotics and telemanipulation (machines that assist with recovery from stroke) Recreational technologies and exercise physiology Other Workplace accommodations Accessible public transportation Wheelchair transportation safety Technology transfer SOURCE: NARIC (2006b)
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From page 210... ...
. If the average user of, for example, home medical equipment is an older woman with mobility or sensory limitations, or both, then the development of equipment using standards derived from data based on a population that is quite different is not appropriate.
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From page 211... ...
have observed, "[p] eople want to believe they are competent and capable and they are happy to ignore the safety risks associated with not using assistive technology, for the sake of appearing competent." The University of Michigan survey of people with disabilities discussed earlier in this chapter reported that roughly half of the respondents reported that they had received little or no information about assistive technologies.
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From page 212... ...
, and other information resources developed by governmental agencies, nonprofit organizations, and manufacturers. Although NIDRR, which administers the Assistive Technology Act of 1998, supports activities to help increase consumer awareness of useful technologies, the agency's website is (in the committee's view)
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From page 213... ...
Physicians who specialize in care for people with particular disabilities may be aware of products that require medical assessment and prescription, but they may not always be well informed about household and other products that could benefit their patients. For both simpler and more complex technologies, physicians and other health care professionals should be alert to their patients' ability to benefit from assistive technologies and be prepared to provide guidance and information or to refer them as appropriate to other information sources.
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This again suggests the need for a more intensive public awareness effort. As discussed further in Chapter 9, Medicare and private insurance coverage of assistive technologies is limited and often complex.
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From page 215... ...
In addition, when an effective product is prescribed and is then used and wears out, people often find that their insurance does not provide for replacement or does not provide for replacement frequently enough. Chapter 9 recommends revisions in health plan policies to increase access to assistive technologies and support their maintenance, replacement, and repair.
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From page 216... ...
. Abandonment or nonuse of a technology, particularly an expensive one, is a costly and wasteful outcome that contributes to policy maker and insurer concerns about the provision of coverage for assistive technologies and to the adoption of restrictive coverage policies and practices.
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From page 217... ...
Recommendation 7.1: Federal agencies that support research on assis tive technologies should collaborate on a program of research to im prove strategies to identify, develop, and bring to market new or better assistive technologies for people with disabilities. Such research should involve consumers, manufacturers, medical and technical experts, and other relevant agencies and stakeholders.
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From page 218... ...
One study that examined patent applications in an attempt to assess the impact of the ADA on assistive technology development found that although references to civil rights laws were not typical in patent records, applications mentioning the ADA increased after passage of the act (Berven and Blanck, 1999)
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The objectives would be to assist the people with disabilities, family members and friends, and health professionals in learning about (1) the existence and range of potentially beneficial mainstream and assistive technologies and (2)
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From page 220... ...
In some cases, people are aware of products but consider them unattractive or stigmatizing, which can be a major barrier to their use. A large-scale, long-term, repetitive public media campaign to increase the acceptance of assistive technologies can highlight what products are available to "make life easier" and convey that it is normal to use smart technologies.
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From page 221... ...
Nonetheless, in the committee's experience, the lack of awareness by health care professionals (especially those who are not rehabilitation specialists) of the range of assistive technologies and their potential uses is a significant barrier to the wider and more effective use of these technologies.
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