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By Marcia Scherer Ph.D., MDH,
Institute for Matching Person and Technology
A great many persons with disabilities can now lead more independent lives in their communities, attend regular schools, and seek professional careers than ever before in our history.
As assistive technology providers, we have changed our focus from people with disabilities as requiring treatment and intervention, to the person with a disability and the minimization of obstacles to living in the community and participating in the workforce. Assistive technologies have been one key to successful community participation.
However, in spite of the assistance and promise of independence offered by many devices and the growth in assistive technology options, the rate of assistive technology non-use, abandonment and discontinuance remains high - on average, about 1/3 of all devices provided to consumers. To understand and ultimately reduce the non-use and discontinuance of assistive technology and increase its optimal use, we need to measure the outcomes of the assistive technology devices and services we provide.
We know already that the single most important reason devices are not used by consumers is lack of consumer involvement in selection. People select their assistive technologies based, first, on how well they satisfy goals, needs and preferences, then according to their attractiveness and appeal. If the device meets the person's performance expectations and is easy and comfortable to use, then a good match of person and technology has been achieved. The perspective of the user will increasingly be the driving force in device selection, not which technology is most affordable or quickest to obtain.
In December 2001, ABLEDATA (http://www.abledata.com), the assistive technology product database sponsored by the Institute on Disability and Rehabilitation Research, U.S. Department of Education, contains approximately 19,000 currently available products from over 2,000 different companies. This large number means we can, with enough diligence, find assistive technology products that conform to varied preferences and needs of individuals. To reduce device discontinuance, non-use and abandonment, increasing attention needs to be paid to the person with a disability as a unique user of a particular device.
Users of assistive technology differ as much personally as they do functionally. Each potential user brings to the assistive technology evaluation and selection process a unique set of needs and expectations as well as attraction to assistive technology use and readiness for use. To achieve better assistive technology outcomes, these factors are ideally assessed so that assistive technologies can be customized to the user, training and trial use of devices are arranged, and additional supports identified.
Psychological readiness for technology use, or lack of readiness, is a strong determinant of use, non-use or less than optimal use. For many users of assistive technologies, their devices become an extension of the self, not just to themselves but also to other persons. The device, then, is incorporated into the individual's identity. But this process can be difficult for some, thus leading to underutilization or non use of assistive technologies. It is also the case that if a person does not see how an assistive technology will help them achieve desired goals and dreams, assistive technology use has less appeal.
Rehabilitation professionals are concerned about the quality of life of individuals with disabilities and how assistive technologies can positively affect an individual's quality of life. Quality of life has been described as life satisfaction, subjective well-being and a positive general affect. In addition to these global constructs, it is associated with satisfaction in specific areas of life such as work, social relationships, and being able to go where one wishes beyond the mere physical capability to do so. For an assistive technology to enhance a user's quality of life, it should be able to be incorporated into the individual's accustomed routines and lifestyle and not introduce new, time-consuming, and disruptive elements which are viewed as interfering with one's customary and/or desired activities.
A key influence on decisions to use or not use an assistive technology has to do with pain as it is subjectively experienced. Pain must be assessed and addressed. Pain may also be an outcome of assistive technology use. Once an assistive technology is obtained and used, the matching process cannot be said to be over. It is important to assess the users' physical and psychological comfort with a device and their level of satisfaction with use in various environments.
The successful integration of an assistive technology into a user's lifestyle ideally results in a higher quality of life for that person. The psychosocial aspects of achieving this through assistive technology use require further exploration. Successful integration of assistive technology use into a person's lifestyle also depends heavily upon the acceptance of assistive technology by family members and the willingness to adjust customary routines to accommodate use. Ways rehabilitation professionals can help persons with disabilities and their families and caregivers examine the benefits of technology (even in a challenging arena of shorter lengths of inpatient stays and restrictive healthcare financing) also need further attention.
We are hearing the plea around the world to move away from the medical model of rehabilitation, which focused on the disability and the limitation of its effects, to a social model, which emphasizes the person and his or her participation in society at large. This has resulted in an evolution from a philosophy of normalization (persons with disabilities should strive to be like non-disabled persons) to empowerment (persons with disabilities have the right to be self-determining and to make their own choices about their lives and to achieve the quality of life each believes is personally best). As much - or more - emphasis is to be placed on community (re)integration as on physical rehabilitation and functional capabilities.
One example of this change is the newly revised International Classification of Functioning, Disability and Health or ICF (World Health Organization, 2001) where a disability is seen as the consequence of efforts to interact and participate within a variety of environments. Thus, rehabilitation attention is now to be focused on the built and attitudinal features of environments that impede a person's participation. This has tremendous implications for all rehabilitation professionals and the services they provide. A key service that will be given increased attention as a result is assistive technology.
No longer is a disability considered to be merely a reflection or result of an individual's developmental or medical condition, but a situation that arises from a societal perspective of what it means to have a limitation in one or more aspects of expected functioning. Therefore, rehabilitation now must address societal (or social) and cultural views of disability as well as the personal meaning (or construction) of disability.
The physical/architectural, legislative/political and attitudinal/cultural environments in which assistive technology services are provided and in which consumers will live and work will be affected by legislation and changes in healthcare policies. Accessible transportation will need to be provided throughout an entire community (central city and suburbs). Assistive technology use in school, the home, workplace and community will all receive increasing attention.
Rehabilitation professionals can expect to see changes in how they work with consumers and deliver assistive technology services, as society increasingly moves from a medical to a social model of rehabilitation. More often, consumers will "partner" with providers in product evaluation and selection as professionals strive to individualize services, help people achieve their self-determined goals and be included in all aspects of community life. To achieve a good match of person and technology, to achieve improved rates of optimal assistive technology use, it is important that the potential technology user be paired with a well-informed provider.
Scherer, M.J. (Ed.). (2002). Assistive Technology: Matching Device and Consumer for Successful Rehabilitation. Washington, DC: APA Books.
Scherer, M. J. (2000). Living in the State of Stuck: How Technology Impacts the Lives of People with Disabilities, Third Edition. Cambridge, MA: Brookline Books.
[Also available from the U.S. Library of Congress in recorded format and Grade 2 Braille.]
Scherer, M.J. (1998). Matching Person & Technology Model and Accompanying Assessment Instruments. Webster, NY: Institute for Matching Person & Technology.
Special Issue on Assistive Technology. (2002). Disability & Rehabilitation: Taylor and Francis Group UK
World Health Organization. (2001). International Classification of Functioning,
Disability and Health. Geneva, Switzerland: Author.
Dr. Scherer is Director, Institute for Matching Person & Technology. She is also Senior Research Associate, International Center for Hearing and Speech Research (a joint program of the University of Rochester and National Technical Institute for the Deaf/Rochester Institute of Technology) and is Associate Professor of Physical Medicine and Rehabilitation, University of Rochester Medical Center.
Dr. Scherer has authored and edited several books and many research papers on assistive technology. She is a Fellow of the American Psychological Association in Rehabilitation Psychology as well as in Applied Experimental and Engineering Psychology.
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