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4.0 Assistive Technology - Definitions and roles

Øivind Lorentsen, Rehab-Nor, Norway

Introduction

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As you can see from earlier lectures, Assistive Technology (AT) has large empowerment potentials for disabled and older persons. Referring to Fig 10 of section 3.1, you will see that AT may have impacts on all three major components of intervention, but in particular on the environment component (contextual), - in the meeting place between the user on the one side, and the physical, psychological and social environment on the other.

Referring to the gap theory (section 2.0), one definition of assistive technology can be:

Any device, system and ergonomic measure that can reduce the disability gap.

Another definition can be:

Any device, system and ergonomic measure that can empower participation of individual users.

The two definitions are aiming at the same targets, but just having different ways of phrasing it.

Here is an official definition given by ISO (see below). This is included even though it is based upon the first version of ICIDH: "Any product, instrument, equipment or technical system used by a disabled person, especially produced or generally available, preventing, compensating, relieving or neutralizing the impairment, disability or handicap". This definition needs revision in light of new developments of the conceptual thinking of disability and rehabilitation, referring to ICHDH-2 and the basics described in earlier lectures.

There are also several other definitions around, however, we will stick to the two first simple versions given in bold above. The definition favoured by TELEMATE is that which refers to the disability gap, to link to the gap theory. - The gap denoting the consequences of disability on the individual level.

As you see, the definitions given in bold above are quite wide in their scope. Assistive technology is not only referring to devices and systems, but also to ergonomic measures. Such ergonomic measures are referring to special adaptations of physical environment, of public transportation and communication at large, and a serious of other issues. However, the concepts of universal design, and design for all are not covered by the definition of assistive technology.

When advising measures to ensure participation of all citizens in our society, we distinguish between four levels of approach:

Public and societal attitudes. Cultural related issues.
Physical environment for all, universal design, and design for all.
Special adaptations of regular consumer products and services for individuals with special needs.
Special systems and devices.

Cultural issues reflect attitudes and behaviour of the society in general towards disabled and older persons. It also reflects the willingness of the society, individual citizens as well as public and private sectors, to take on board responsibilities to respond to the situation of their fellow citizens, disabled and older persons, in practice.

Universal design reflects the responsibilities of all sectors, public and private to ensure that physical environments, products, systems and services are designed in a manner to meet functions of all citizens as far as possible. This includes public and private buildings, transport systems, telematics services, regular consumer goods and services, banking and post services, mass media, cultural oriented products and events, work premises and a long range of other products, systems and services.

Fig. 24 indicates an older person feeling out of reach of a telematic product due to hearing problems. Such products may also be made accessible to this person if properly designed. Or, this product may be modified to accommodate the functional needs of this person, indicated by level 3 above. Such a modification can be accomplished by the integrating of a sound amplifying function.

Another example of special adaptations to meet individual needs is special adaptations of cars, which may facilitate driving of disabled users.

In the USA, Acts have been introduced reinforcing the responsibilities of the society (private and public) to ensure the accessibility to contextual matters. Two examples of such Acts are Technology-Related Assistance for Individuals with Disabilities Act of 1988, and the Americans with Disabilities Act of 1990.

Fig. 25 indicates the same old person who not longer can manage stairs. One solution may be to accommodate his home on one level. If this is not possible we may have to introduce a special assistive device, in this case a stair lift, as seen in Fig. 26.

The strategy of approach should have the order as given by the numbers of the four strategies above.

The societies of today are starting to become aware of the potentials of universal design. Several educational institutions and other organisations are starting up activities in this direction. We recommend that you look more into this area, and you are referred to the NC State School of Design. Click on Center for universal design, and you can find more out about the universal design, definitions, principles and guidelines, programmes, and others. You will also find links to other centres such as Trace Research and Development Centre, a well-known institution in this area.

Probably, you also have institutions in your own country working on universal design. Maybe you want to find out?

The definition of assistive technology includes the items 3 and 4 of the four levels of approach to support participation for all.

Assistive devices cover a large range of devices and systems. In order to ensure a structure of all these devices, and to ensure that the different persons, agencies and countries are able to talk somewhat the same language, an international classification system has been implemented. Most countries have adopted this classification system formally, but may be lagging behind in implementing the system in practice. The classification system is called ISO 9999. ISO is the acronym for International Organization for Standardization. This classification system has three major classes, XXYYZZ. Fig. 27 gives information on the XX classes, which constitute the major classes. You can purchase the ISO 9999 from your national standardisation organisation, and you can find the many classifications available. All together there are many thousands of different assistive devices available on the market that can be classified according to ISO 9999

International Standard ISO 9999

Aids for therapy and training

Orthoses and prostheses

Aids for personal care and protection

Aids for personal mobility

Aids for housekeeping

Furnishings and adaptations to homes and other premises

Aids for handling products and goods

Aids and equipment for environmental improvement, tools and machines

Aids for recreation

Figure 27 ISO 9999

It is not the intention to go through these devices in this unit. If you are interested, you may want to look into some of the databanks running on assistive devices. Your local course organiser can inform you about the availability of such databanks in your country. However, you may also find it interesting to look into AT databanks such as Rehadat (Germany), or Abledata (USA).

In the final part of this section, and in sections 4.1 and 5.0, I am going to focus on characteristics of assistive technology. Where does AT actually fit in, what are the advances and what are the limitations, and what does it take to make AT useful to the individual user.

A user - assistive technology - context - model

Fig. 28 shows you a model of the relations between the user, assistive technology, and context.

Figure 28. Relations between the user, assistive technology, and context.

The user is characterised by body (somatic and psychological), functions and skills, activities (IPA), inner relations (IPR), and outer relations (IOR).

The quality of life of the individual person is influenced by the meeting place between the user characteristics and the context; - physical, , social, cultural, technical, economical, for example. Whenever there is a mismatch, a gap, between the user characteristics and the context (remember the gap theory?), then assistive technology may reduce/accommodate this gap. Or, in other words, assistive technology may empower individual users to reach the individual prioritised qualities of life goals. The solutions that may be necessary are depending upon the specific user characteristics, his/her priorities and values as to life, and the life context. Thus, we have to focus on the individual level, as described several times before in earlier parts of the course.

Assistive technology can play important roles on the body level, on individual functions and skills, on activities, and on inner and outer relations.

We usually distinguish between three major groups of assistive devices:

Body oriented assistive technology.
Assistive technology for training and skill developments.
Problem-solving assistive technology.

Body oriented assistive technology are solutions that are "close" to the body, such as stimulators (FES, pacemakers), hearing aids, oxygen concentrators, ventilators, antidecubitus aids, infusion pumps and others). A large group of body oriented assistive technology is orthoses and prostheses. These solutions are associated mostly to the "body" and the "functions and skills" components of rehabilitation. Body oriented assistive technology may have a fairly high general functional replacement capacity, and may as such also have a value in solving problems in daily life.

Assistive technology for training and skill development support the second component of rehabilitation (functions and skills), in particular. Examples are physical training devices; toys and games for disabled children, - including feedback support; special pedagogic oriented devices and systems, such as special software programmes.

Problem solving assistive technology constitute the large range of solutions focusing on solving daily problems as experienced by the individual user. The vast majority of assistive technology is of this latter kind. Problem solving assistive technology usually has a low functional replacement value, but may be capable of solving problems experienced by the user in daily life.

We distinguish between these three major groups of assistive technology since they are to a large degree handled differently. Medical oriented AT is handled more by medical oriented professions in institutions, while professions related to physical training, special education, and psychology mostly handle the second group The third group, problem solving AT, is handled by a big variety of professions, as close to the user home environment as possible. However, there are many grey-zones between the three groups of AT. In general, it is important to know that no single profession has ownership to a particular AT service delivery, with some exemptions.

In the next section, I will return to characteristics of AT.

Before ending this part of the course, I want to identify a problem of terminology. In the course we talk about problem solving. There is a natural trend of today not to focus on problems, but rather on positive potentials, - on empowerment. We agree with this approach, but still use the term problem solving to be clear in the presentations. You may be aware of this terminology problem, and should be sensitive to it when meeting users and other professionals.

Exercises:
1. Obtain ISO 9999 and go through the different classifications to acquaint yourself with the great variety of AT. Individually
2. Find out if there are any Acts, regulations, and/or guidelines on accessibility in your country. Within your group formulate a list and post it to the bulletin board. Group
3. Familiarise yourself with an AT databank, in your own country, or the two mentioned in this lecture. What are its strengths and weaknesses? Post your opinion to the bulletin board. Individually

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