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Living in the state of stuck

How assistive technology impacts the lives of people with disabilities

Book cover with person in a canoe, having transfered from their wheelchair

Marcia J Scherer (2000), (3rd ed), xvii, 217 pages.
Brookline Books: Cambridge, MA

Update: 4th edition now out!

Over the years advancements in technology have produced many solutions that enable persons with disabilities to independently undertake a variety of personally relevant activities of daily living. Whilst the use of assistive technology (AT) has been helpful for some persons, the consistent reporting of AT abandonment or discontinuance (over a 40 year period in the rehabilitation literature) has been of concern to health practitioners. Scherer advises "the physical freedom offered by many technical advances has not resulted in the improved quality of life that many envisioned". Recommendation of AT solely on the basis of the person's diagnosis is now known to have contributed to AT abandonment or discontinuance, as no consideration was given to the persons' unique needs. Currently practitioners are encouraged to use a client-centred approach when recommending AT as it is collaborative in nature and acknowledges the clients' opinions, values and beliefs.

This book is a valuable resource for any health practitioner or health science student. As a university lecturer in occupational therapy I have used this book with students to facilitate their understanding about the human perspectives of AT use. Scherer advises that the purpose of the book is "to give voices to the users of this technology, and thereby to educate their friends, their families and the professional who work with them". Students report this book helps them to understand that there are broader client-centred issues to be considered to ensure that there is an accurate match between client and technology, rather than just recommending AT to improve functional abilities. Additionally, after reading this book students appear to have a better grasp surrounding the pragmatic and emotional adaptations which persons experience when coming to terms with an illness or disability.

The author uses case studies throughout this book to provide examples of the impact of AT for persons with congenital (cerebral palsy) and acquired physical disabilities (spinal cord injuries). In the first two chapters the author presents the physiological, psychological and psychosocial characteristics for the two groups as well as providing the reader with an informative comparison. The biographies of the people whose stories are used in this book are also included.

Chapter Three provides a definition of AT, discusses the differences between low-tech, medium-tech and high-tech items and describes the various types (mobility, seating, low tech aids to daily living, transport, communication etc) that are available.

The history of rehabilitation up to 2000, for those persons with disabilities in the United States, is provided in Chapter Four and is particularly interesting as it describes the legislative background to many changes that have occurred within society regarding the visibility of persons with disabilities. The author quite rightly asserts that this does not equate to assimilation.

The concept of rehabilitation success is explored in Chapter Five and highlights the divergent views of persons with disabilities and the rehabilitation providers. This chapter is particularly useful in demonstrating that each person will have their own expectations of the rehabilitation process.

Chapter Six entitled " Struggles and Strivings" identifies quality of life issues commonly experienced by those persons with disabilities. The stand out message is that being able to independently complete daily tasks is not enough, persons with disabilities want AT that address their psychosocial needs as well. This will go towards ensuring that they experience a better quality of life.

The issue of adjustment to disability is covered in Chapter Seven. The use of Maslow's Motivational Needs Hierarchy is very skilfully used to illustrate this important process which is highly individualised.

In Chapter Eight the author outlines the reasons for AT abandonment or discontinuance. She uses her expert knowledge from years of work in the area to highlight the various factors which can influence people's use of their AT. She then goes on to provide guidelines which will facilitate an accurate match between the person, the AT features and the context in which the AT is to be used.

Chapter Nine provides the reader with an update (to 2000) for each of the people who have told their story in this book about experiencing life with AT.

The final chapter suggests the need for the involvement of AT users in the development and refinement of AT, discusses funding issues and the problems for persons with disabilities associated with them obtaining quality personal assistance. There is also comprehensive appendices which provide various checklists for AT evaluation and selection.

This book is a great resource. It is easy to read and most insightful. The use of case studies provides the reader with useful examples of the unique requirements of each of the persons who have related their story about how AT has impacted their life.

Whilst this book is highly recommended reading for health professionals I also believe it would be useful for the anyone with an illness, (their significant others included), to assist them through the adjustment process to experiencing life with AT.

For more information or to purchase a copy of Living in the state of stuck 3rd Edition visit Amazon.com

Reviewed by:

Dr Trish Wielandt
Senior Lecturer, Occupational Therapy Unit
School of Public Health & Tropical Medicine
James Cook University
Townsville, Queensland
Email: Trish.Wielandt@jcu.edu.au

July 2004

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