Assistive Technology Devices (ATD): Applications and Types


Any discussion regarding the development of assistive technology devices (ATD), such as implantable neural prosthetics, would be incomplete without addressing the importance of understanding specific and environmental factors that effect ATD use, and exactly how these factors interact with the societal and ethnical landscape in which they operate. The next section provides a succinct overview of the context where most ATDs are being used and by whom; the role and purpose of the unit in the lives of individuals with disabilities, and the value of integrating direct reviews from potential device users during the development levels. A proposed mechanism for integrating consumer responses into the device development process and lastly a historical example of divergent reactions within specific impairment populations to the release of implantable prosthetics will then be examined.

Assistive Technology in the Framework of Disability

An essential part of the process of developing ATDs, including implantable neuroprosthetics, should be to establish a knowledge of the framework in which the device will be utilized, and who it will be used by. Because the most important consumers of ATDs are individuals with disabilities, considering these factors within the disability context is very important. Divergent beliefs regarding how impairment should be conceptualized have given climb to lots of classification systems influenced by medical, sociable, and practical perspectives. However, the global presence and integrative characteristics of the International Classification of Functioning, Disability and Health (ICF) from the entire world Health Corporation, establishes the ICF as a solid applicant model for conceptualizing impairment (WHO, 2013). The ICF offers a general nomenclature and conceptual basis for the dimension of impairment, and stresses the integration of biological, psychological and social factors in understanding the starting point and succeeding impact of impairment, and exactly how these factors interact to restrict participation in activities (WHO 2013).

International Classification of Working, Disability and Health

The ICF is structured into two main divisions, including: (1) "Functioning and Disability", and (2) "Contextual Factors". Each one of these domains consists of two additional divisions. "Functioning and Disability" is further split into (a) "Body Functions and Body Structures" that are understood as the physiological functions and buildings of your body, and (b) "Activities and Participation" which signify the execution of a task by a person, and involvement in life activities, respectively. According to the ICF, the word "impairment" refers to "problems in body functions and buildings such as significant deviation or loss", whereas "activity restrictions" are present when an individual experiences complications in performing specific activities. Finally, "Participation Constraints" describe problems or problems an individual might experience in engagement in life circumstances (WHO, 2001). Notably, a person's overall level of functioning in differing areas is considered to result from connections between that each, their unique health condition, and extra extraneous contextual factors. These connections are dynamic, unpredictable, and bidirectional. That is an individual's personal factors can affect their choice of environment equally easily as the environment can impact personal factors, while both simultaneous impact their experiences of your health (WHO, 2013). By considering these domains, technology developers can take steps to guarantee the utility of ATDs, while responding to concerns and potential device shortcomings before a finish product is delivered to the consumer.

The ICF explains "Functioning" and "Disability" as dimensional constructs that signify an individual's discussion with their environment, alternatively than endogenous characteristics of that individual (WHO, 2001). This conceptualization is a dramatic divergence from early on medical models, which express disability within the average person anticipated to diagnosed impairments related to injury, disease, or developmental processes (White, Simpson, Gonda, Ravesloot, & Coble, 2010). As identified in the ICF, "Functioning" refers to strengths of the connection between a person and various the different parts of that individual's context. Conversely, "Disability" encompasses the "Impairments", "Activity Limitations", "Participation Restrictions", and other negative areas of the discussion between an individual and that individual's "Contextual Factors" (WHO, 2001). These "Contextual Factors" are grouped as (a) "Environmental Factors", which will make up the physical, sociable, and attitudinal environments where people live and carry out their lives, and (b) "Personal Factors", that have not yet been layed out in the ICF [1, p. 171]. The ICF considers assistive technology and assistive technology devices to be an integral component of the "Environmental Factors" domain.

Considerable conceptual overlap prevails between your ICF's "Products and Technology" classification, and the definitions of assistive technology recently help with by documents such as the Technology-Related Assistance of people with Disability Work of 1988 and the International Business for Standardization (ISO 9999). This convergence implies a consensus of what constitutes ATDs, and who the principal consumers of the technologies are. Within the ICF, "Products and Technology" refers to "any product, device, equipment or technology modified or specially made for improving the functioning of a impaired person, which may lead to increased involvement in activities". This description allows for broad interpretation of what is considered an ATD, which range from "low-tech" devices to "high-tech" devices such as neural prosthetic implants. However, the defining attribute of this classification is the concentration positioned on the efficient improvement and increased opportunity for regular involvement in desired activities and societal integration. It really is this perspective, that individuals coping with disabilities must have equal chance to take part in activities commonly accessible to individuals without disability, which gave go up to the Independent Living model.

"Nothing About Us, Without Us"

The progression towards unbiased living was created from the disability rights movement in the United States throughout the 1950's and 60's, which was propelled by the creation of membership organizations like the Country wide Federation for the Blind, National Alliance on Mental Condition, and Americans Impaired for Accessible Travel (Meyer, Peck, & Brown, 1991; Pelka, 1997). These organizations catered to the specific needs and priorities of its regular membership, and provided a unified tone to advocate on the behalf of specific disability populations. Ahead of this time disability was thought of as awful hardship that simply would have to be endured (Barnes & Mercer, 2005). Impairment activism spearheaded by individuals with disabilities and impairment groups acted as a catalyst for the move from the dependence seen in antiquated medical models towards independence, autonomy and consumer-centered service provision.

Perhaps one of the very most widely cited types of people with disabilities advocating for communal justice and civil protection under the law is Ed Roberts (White, Simpson, Gonda, Ravesloot, & Coble, 2010). Roberts, who possessed developed polio in the 1950's, wished to enhance his education at the School of California, Berkeley, but was rejected admittance scheduled to his physical impairment. However, Roberts made arrangements for personal aides to aid him in preparing for classes and took up home in the college or university hospital. By using other students who wanted to secure civil protection under the law and entrance to the school, Roberts was able to get started on a disability rights advocacy group known as the "Rolling Quads" (Oxford & McDonald, 1999). The Rolling Quads primary goal was to advocate on the behalf of students with disabilities to eliminate obstacles that precluded their participation and access to the resources provided by the school. Roberts continued to obtain national money from the Treatment Administrations, which he used to establish the inaugural Middle for Individual Living (CIL) nationwide (Shapiro, 1994). The Oakland CIL pressured the value of personal independence, consumer choice, and autonomy; and its success dished up as the catalyst for the establishment of CILs over the USA (Willig-Levy, 1988). Personal choice and consumer empowerment continue to be the essential tenants of CIL service delivery. However, the independent living model is more than a grassroots communal justice movement; it also symbolizes a philosophy produced by people who have disabilities that places the target of rehabilitative services on the average person, making it's a consumer-centered practice (Deegan, 1992).

Within medical models of disability, clinicians are considered experts who normally have unilateral decision-making power regarding treatment planning and rehabilitative intervention. This process precludes individuals with disabilities from being dynamic individuals in their own health care, and establishes an power role for the clinician (White, Simpson, Gonda, Ravesloot, & Coble, 2010). Conversely, conceptualizations of disability based on the 3rd party living platform view impairment as resultant from problems endogenous to the environment, and assert that lots of of the problems facing individuals with disabilities stem from reliance on specialists and family when making decisions (DeJong, 1979). However, given the frequent long-term nature of disability, individuals become experts on their own body, facilitating chance of direct involvement in making informed health-care options. This gained know-how allows people with disabilities to advocate on their own behalf and offer vital information to ATD builders based on information generally unavailable to individuals that do not promote similar disability activities.

The IL model gets rid of people with disabilities from the role of passive receiver, and establishes them as effective, proficient, and empowered consumers who are completely engaged in handling their own lives. Concerning prospective consumers of ATDs in the development process is consistent with the IL method of disability through creating opportunities for immediate engagement in meaningful decision making. Because individuals with disabilities are experts independently lives, they are simply uniquely trained to provide information and advice throughout the development process of ATDs. By including this responses, technology designers can ensure that the most germane concerns and personal preferences expressed by possible end-users are believed before the completion of a final product. Moreover, this process also defends against erroneous or inaccurate assumptions created by technology developers regarding the desired functioning of the device, the amount of risk possible users would be prepared to accept with all the device, and what characteristics are likely to bring about device abandonment or poor consumer satisfaction. The Matching Person and Technology (MPT) model, may serve as a theoretical starting point for ways to consider and integrate vital consumer source during device development.

Matching Person and Technology: Applications to Neuroprosthetic Device Development

The Matching Person and Technology model proposes a comprehensive analysis of the contextual, social, technical, and personal factors that impact the recognized success, useful gain, and in the end the use of many technologies made to assist people with disabilities. This model has close conceptual ties to the ICF, and addresses the many facets determined as probably influential on the use of ATDs. While this model has historically been used to complement individual consumers to presently available technology modalities, a report implementing the principle tenants of the MPT model suggest that it may have potential request during the development process of new neuroprosthetic devices as well (Kilgore, Scherer, Bobblitt, Dettloff, Dombrowski, Godbold, Jatich, Morris, Penko, Schremp, & Cash, 2001).

The MPT model posits that consumers of assistive solutions have highly diverse and unique prospects which are molded by specific needs, abilities, limitations, preferences, and earlier encounters with technology (Scherer and Cushman, 2001). The MPT model aims to judge and take into account these idiosyncrasies in technology use through the execution of a thorough and collaborative assessment process that allows the consumer to provide direct reviews and information regarding their specific needs and desires (Scherer & Cushman, 2001). This device for adding consumer input in to the ATD selection process allows specific technological needs and choices to be dealt with, maximizing the power and success of the ATD in daily use.

The MPT model emphasizes evaluation of three different but interrelated components which were found to influence the utilization of ATDs. These components include (1) the characteristics of the individual who will be using the technology; (2) the technology itself; and (3) the environment where the consumer will be using the technology. Each one of these domains independently and in blend, contributes negative or positive affects on the consumer's satisfaction with the technology in use. For optimal usage and satisfaction with a specific technology, each domain name should be evaluated to ensure that the technology is efficiently fulfilling the precise needs and wants of the buyer. While creating advanced implantable neuroprosthetics on a person basis may represent a daunting and potentially unrealistic organization, the main tenant of integrating the opinions of potential device consumers remains vital. Doing so through the development process provides a means for dealing with concerns and advice which might be prevalent within the specific disability population the device is intended for.

The development of neuroprosthetic devices that comes after a "one size meets all" mentality, without including tips and concerns from stakeholders and individual users may become more likely to be abandoned or bring about decreased consumer satisfaction. When a technology will not fulfill the need of the consumer, or will so at the price tag on the areas of functioning, the device is often abandoned and goes unused. Actually, around one-third or all assistive technologies are abandoned by their users (CITE 13). Perhaps more than any other form of ATD, the introduction of implantable prosthetic devices, which can be intended to become at least semi-permanent accessories in the body, should be informed by the tips of the to-be implanted stakeholders. Unlike a long-cane or wheelchair, which may be more readily substituted or adapted to fit the needs of an individual, the inherent dynamics of implantable prosthetics often precludes easy update or removal. Furthermore, regarding people who have disabilities in the development process will serve as a mechanism for understanding how individuals that the device is being created for are likely to react to and adopt the device into daily use. Historically, ATDs designed to restore performing in individuals with disabilities have never been unanimously welcomed.

Disability Culture: The Cochlear Implant

While it might be assumed that ATD coders are inherently well intentioned when producing technology designed to bring back or supplement performing in people with disabilities, history has proven that ATDs have never been universally accepted and implemented into disability culture. In fact, the cochlear implant, which is a "high-tech" ATD, confronted considerable amount of resistance from the Deaf culture when first introduced, and is still a topic of debate and contention among many individuals who considered themselves part of the Deaf community. According to the United Nations Conventions on the Privileges of Persons with Disabilities, those who consider themselves people of Deaf culture "will be entitled, on identical basis with others, to popularity and support of these specific cultural and linguistic identity, including sign languages and deaf culture". Instead of browsing deafness as a disability, constituents of Deaf culture assert that being deaf is a variant in human being experience, and any technology that designed to "cure" deafness shows that deaf experience is inferior compared to the experience of reading individuals (Nunes, 2001).

While the proposed protocol of including possible end users in the debate of device development may not have completely mitigated the reaction seen with the launch of the cochlear implant, it may have provided coders with a much better knowledge of what resistance they could face and the way to work towards alternatives that addresses the concerns expressed.


Suggested citation

World Health Firm. How to use the ICF: A practical manual for using the International

Classification of Working, Impairment and Health (ICF). Visibility draft for comment. October

2013. Geneva: WHO

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