Design and Use of Assistive Technology

What are the fundamental values that should guide the practice of assistive technologists? This essay examines two sources that appear to inform current understandings of the ethics of assistive technology: medical ethics and engineering ethics. From medical ethics comes the notion that assistive technology should aim to restore its users to normal functioning, making them like new. Engineering ethics, on the other hand, recommends enhancing users’ functionality, even if functioning is not achieved in a species typical way. From this engineering perspective, it is permissible and even desirable for assistive technology to make its users function even better than new. Thus enhancing functionality is a central value in assistive technology. Professionals in the field have the ability, and the responsibility as well, to address and counter societal suspicion of artificially enhanced functioning achieved through technology. Consequently, assistive technology professionals should fight against discrimination that excludes people with disabilities, whose functioning depends on prostheses and other products of technology, from the mainstream of social life.

The meaning that assistive technology (AT) holds for the user is a key determinant of whether the device will be used or abandoned. Two concepts, stigma and liminality (existing in a state of transition), are used to frame users’ perceptions of the assistive technology they use, as generated through research projects investigating aspects of assistive technology use. Implications of the meaning of AT to the design and selection process are described. Assistive technology that is seen as a tool, as just another way of achieving a desired activity is much more likely to be assimilated into the user’s daily life. Technology perceived in this manner enables people to share activities with others and augment their personal abilities. Alternately, technology can be seen as a visible sign of disability, reinforcing stigma associated with a disability and the perception of the AT user as existing somewhere between health and illness. Individuals with this view of technology may avoid or resist use of technology, resulting in avoidance of meaningful activities and both social and physical isolation. These findings support the conclusion that technology is not neutral. Inclusion of users in both the design and selection process and understanding the meaning that AT use holds are integral to the development of assistive technology that achieves the desired outcome of enabling participation in daily life.

In this chapter, we discuss assistive technology from the view of the consumer. Consumers of assistive technology follow the social model of disability, that is, persons with disabilities are part of the diversity of life, not necessarily in need of cure or special assistance. Their identity does not revolve around being a patient or client, but focuses on their human desires to work, play, and associate with others. The social model of disability dictates an empowering approach to assistive technology research and development where consumers are given the power to configure and even create technology to suit their own needs and desires. The technology that comes from this approach is called accessible technology, rather than assistive technology, emphasizing its role in making human activities more accessible.

The potential of robots as assistive tools for play activities has been demonstrated through a number of studies. Children with motor impairments can use robots to manipulate objects and engage in play in activities that parallel those of their typically developing peers. This participation creates opportunities to learn cognitive, social, motor, and linguistic skills. By comparing disabled children’s performance with that of typically developing children, robot use can also provide a proxy measure of cognitive abilities.

Unfortunately, device abandonment (by clients or caregivers) is a pervasive problem in the provision of assistive technology. This is not necessarily the result of poor design of the technology, but rather a failure to account for other factors or determinants. This issue can be successfully addressed by employing the human activity assistive technology (HAAT) model when considering potential solutions for clients. The model conceptualizes the consumer, their activities, environment, and assistive technology as an integrated system in which changing one element affects all other elements in the system. The model can be applied in the design, selection, and evaluation of technology for use by an individual, or as a conceptual model for exploring the influence of assistive technology on participation in daily activities. In this chapter, examples and explanations are given for both “successful” and “failed” technologies with specific reference to the HAAT model.

Evaluation in the context of assistive technology can take several forms. Engineers evaluate the devices and technologies they develop. Clinicians perform clinical evaluations to decide which device(s) are most appropriate for their client. Finally, researchers hope to evaluate the long-term outcomes of assistive technology interventions. Evaluating a new assistive technology in the lab can be complicated by small user populations and the lack of universally accepted performance measures. The obstacles to effective clinical evaluations include the wide variety of devices that can meet each client’s needs and the limited time and resources available to clinicians and their clients. Evaluating assistive technology outcomes is a relatively new pursuit, with many open questions.

CanAssist is a university-based program at the University of Victoria that is dedicated to developing and providing services and technologies to those with disabilities. All of CanAssist’s activities are in response to requests from the community. The program has engaged many thousands of students (from a broad range of disciplines), faculty and staff, as well as many hundreds of community volunteers. The CanAssist model extends the traditional mandate of universities, to undertake research and education, by adding a third core pillar of activity – community service. This additional task is highly augmentative in that it creates outstanding new research avenues and provides students with a myriad of extraordinarily challenging and rewarding experiential learning opportunities.

Academic research is an invaluable development engine for creating assistive technology. Commercial enterprises are critical for making academically developed technology available to individuals provided that there are sufficient numbers of people with substantially similar technology needs. Unfortunately, there is little incentive for academic research organizations to optimize user interface, fit, finish, or function attributes associated with the assistive technology that they develop. The rate at which technology is being created that could be used to help people with disabilities is staggering. However, disturbingly little of that technology is being harnessed to provide actual benefit to the disabled community because the adaptation of that technology is viewed as too customized or the market size too small to justify commercialization. In this paper, the authors focus on the use of uniquely created non-profit organizations, such as YokyWorks Foundation, to bridge the gap between academic research and traditional commercial enterprises.

A survey on the ethics of assistive technologies was commissioned to identify debatable issues that could facilitate discussion about assistive technologies in a multidisciplinary setting. The survey was designed by a multidis ciplinary group of researchers in assistive technology prior to the workshop. All workshop participants completed the survey, as well as members of the general public. The results of the survey provided data about which issues were non-controversial, and which issues were far less clear.

Information and communication technologies (ICT) are directly or indirectly a form of assistive technology. Indeed, many forms of new emerging ICT have the potential to provide opportunities for persons with disabilities to obtain inclusion in the mainstream of society to an extent never before accomplished. However, due to the rapid ubiquitous insertion of these technologies into our society and given that most of these technologies are not accessible to persons with disabilities they are forming new barriers rather than opening up new opportunities. New strategies need to be adopted to deal with this trend and, particularly in the relatively near term, it is argued that the most important strategy is the development of enforceable regulations and standards that impact the accessibility of these new emerging technologies.

While the inherently small market for assistive technology (AT) can be a significant hurdle in the development of AT solutions, small markets can also provide opportunities to foster technology innovation under the right circumstances. Focusing on the wheelchair industry, I summarize the numerous obstacles that small companies face in trying to address small AT markets, as well as the range of opportunities available to assist small companies in their efforts to impact the quality of life of those with disabilities. Indeed, small market AT may be a perfect fit for the growing field of “small batch” manufacturing in combination with motivated individuals suddenly empowered by a host of new technologies. I close with a brief discussion of future possibilities for AT in small markets.