Unicorn Roots

Access

Assistive Technology (AT) can take many forms: high-tech, low-tech, products, systems, and services. In fact, most people who use ATs regularly use more than one type, which shows just how important integration and integrative services are. More than 2.5 billion people worldwide use AT, and that number is expected to reach 3.5 billion by 2050. However, in many parts of the world, the majority of people who need the independence that AT provides have no access to the technology that could help improve their hearing, vision, mobility, self-care, cognition, communication, and much more. Greater access could help not only AT users; it could improve the well-being and inclusion of communities, enabling greater participation in the political, economic, and social life (World Health Organization, 2024).

Most people will need some form of AT as they age, and the majority of AT users are seniors, disabled people, and those with long-term health conditions. However, AT has the potential to help everyone. Research shows that early access to appropriate AT can support language and communication development, improve access to education and employment, help prevent secondary complications, and support a greater sense of independence and safety. Still, the gaps in access globally are shocking. Nearly 80 million people require a wheelchair, while only up 35% of them have access to one. Around 1.5 billion people are deaf or hard of hearing, but fewer than 10% have access to a hearing aid (World Health Organization, 2024).

It’s easy to assume that these numbers are disproportionate solely because of costs, and funding is certainly a factor. But other barriers play a significant role as well. A general lack of awareness, issues with physical access, limited product range, procurement challenges, workforce issues, and inadequate policy-making are just a few examples. The 2030 Agenda for Sustainable Development emphasizes universal health coverage (UHC) as a path toward universal access to health services, including the rights established by the Convention on the Rights of Persons with Disabilities. In 2022, the WHO and UNICEF Global Report on Assistive Technology provided recommendations for governments and stakeholders to work towards universal AT access for all. Examples of these recommendations include improving AT access across development sectors, involving AT users and their families in development processes, increasing public awareness to combat stigma, investing in data-driven policy, and supporting research and innovation (World Health Organization, 2024).

To better understand what specific ATs are needed for any given group, it’s important to understand how different disabilities affect those living with them. Understanding this can help us understand what types of AT will benefit which individuals. This is where classification and categorization systems are truly valuable.

The International Classification of Functioning, Disability, and Health (ICF) defines disability as encompassing activity limitations, impairments, and restrictions in participation. The purpose of AT is to decrease these limitations while promoting participation in society. As I covered in part 1, AT helps by aiding body structure and function, activity performance, and environmental modifications. Some options require insurance, prescriptions, or detailed documentation, while other options are readily available, such as touch lamps and electric toothbrushes. Some AT options may also require services to help with specialized customization, maintenance, and repair. Because the effects of an individual’s disability can also change with their environment, ideally, AT should be considered part of an adaptable environment rather than a standalone solution (Gray et al., n.d.).

AT classification systems, such as the National Classification System for Assistive Technology Devices and Services used in the US and the International Organization for Standardization (ISO) and ICF-based classifications used internationally, organize AT into classes and subclasses for ease of access. The US system divides AT into classes, including architectural elements, sensory elements, computers, controls, independent living, mobility, orthotics and prosthetics, recreation and leisure, and modified furnishings, each with a unique numeric code. Europe uses a similar ISO-9999 and 3-tiered system. Both systems support efficient information retrieval, inventory management, and appropriate acquisition. These systems also specify hard technologies (tangible devices that can be assembled), soft technologies (human decision-making elements), as well as strategy and training materials. Within these systems, AT that requires specific skill is classified as a tool requiring additional soft technology, while AT that does not require specific skill is classified as an appliance (Gray et al., n.d.).

Unsurprisingly, the majority of AT users are seniors relying on low-tech supportive appliances like walkers, canes, and glasses. Children and young adults more commonly use AT tools such as braces, prosthetics, and adaptive keyboards. However, mobility aids are the most widely used AT category. All of this classification and categorization also helps to determine costs and payment systems. Payment may be made in full or in part by individuals and families, or by insurance, rehabilitation centers, employers, veterans organizations, charities, or other third parties. Some AT can even be donated or loaned. In some US jurisdictions, businesses may be offered tax deductions for making their buildings fully accessible (Gray et al., n.d.).

Two key tools used for measuring AT effectiveness are the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST) and the Psychosocial Impact of Assistive Devices Scale (PIADS) questionnaires. Both of these questionnaires collect data on AT benefits and user satisfaction using criteria such as environment, expectations, perceptions, psychological factors, adaptability, competence, self-esteem, and specific AT characteristics. While some important factors like changes in satisfaction, self-esteem, adaptability, safety, and continued competence haven’t been adequately studied, current evidence shows that AT users have seen significant improvement in their ability to complete ADLs and in their overall quality of life (Gray et al., n.d.).

It’s also easy to see how AT advancement is closely connected to overall technological advancement and the growth of the internet. This relationship has made it easier for disabled people to access AT and paved the way for new innovations. At the same time, the rise in graphics-rich and audio-dependent content has contributed to existing challenges that AT was initially created to help prevent (Gray et al., n.d.).

References

World Health Organization (2024). Assistive Technology. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/assistive-technology

Cook, A.M. (n.d.). Assistive Technology. Britannica. https://www.britannica.com/science/assistive-technology