The Limitless Future of Assistive Technology in Society

“Know from whence you came. If you know whence you came, there are absolutely no limitations to where you can go.”

~ James Baldwin

I know, I know.  Maybe an overused inspirational quote, but it’s SO GOOD! I love it for a lot of reasons.

With regard to the world of assistive technology (AT) and accessibility, in order to have a vision of what is possible, we have to understand where the industry and the people affected have been.  And once we are aware of this, as a society we can build on the endless possibilities to help create a society that works for people of all ages and all abilities.

Even if history or government were not your favorite subjects in school, there are interesting things to learn from the history of assistive technology with regard to innovation and legislature.  

• Low-tech assistive technology, such as the walking cane, has existed since approximately sometime in the 17th century.
• Higher technology innovation in assistive technology really made its mainstream debut in the late 1800’s. – 1892 with the first Braille typewriter and 1898 with the first electric hearing aid.  
• The initial catalyst for the development of more advanced assistive technology and legislature to regulate access to assistive technology started following WWI when veterans returned from war with injuries, desired to go back to work, but required adaptations or AT to enable them to return to the work force.
• 1918 The Vocational Rehabilitation Act provided funding for state-administered vocational rehabilitation programs.
• 1965 Medicaid (title XIX) and Medicare (title XVIII) allocated funding for services to people with permanent disabilities and guided access to medically necessary assistive technology.  
• 1973 The Rehabilitation Act expanded services to include individuals with mental and emotional disabilities, and expanded services beyond employment into medical and living concerns of persons with disabilities. Its mandates called for increased services and training in community, school and vocational service areas.
• 1975 The Education of the Handicapped Act established the obligation of each public education system to provide a free and appropriate education to all children, 5 years and above.
• 1988 The Technology Related Assistance for Individuals with Disabilities Act (Tech Act) specifically addressed the AT needs of people with disabilities with an increase in funding to states to provide technology, resources and advocacy. It was felt that both high and low technology and adaptations would substantially benefit the nation by reducing dependency costs at work and home. 
• 1990 The Individuals with Disabilities Education Act (IDEA) set expectations and obligations for the access to AT for students in the public school system, ensuring that students are provided access to a quality education in the least restrictive environment AND that they are provided with any AT required to make their academic pursuits successful.
• 1990 The Americans with Disabilities Act (ADA) is legislation that guides access for people with disabilities to community and public spaces, including guidelines for architectural features for renovations and new construction.  This legislation had a primary goal of unrestricted physical access to public environments – ramps, doors, stairs, curb cutouts, signage, with policies and practices incorporated as well.  

Along the way innovators started getting creative and looking at ways to develop assistive technology that matched the needs of individuals in school and work environments.

We know that high tech AT innovation started back in the late 1800s.  But what about over the last 40 years?

• Oct 21, 1976 – Invention of first Kurzweil Reading Machine
• Sep 21, 1981 – First computers used to aid in learning
• Feb 6, 1982 – Dragon Systems (voice recognition) founded
• Jan 26, 1983 – Dynavox founded (AAC systems)
• Sep 6, 1984 – Universal Design for Learning – – Center for Applied Special Technology
• Jul 7, 1991 – First SmartBoard
• Apr 11, 1996 – Kurzweil Founded (Software to support Learning Disabilities)
• Jun 15, 1996 – FM amplification for students with hearing loss
• Few major developments between 1996 and 2008
• Feb 5, 2008 – Next Generation Perkins Brailler released (first modification in 57 years!)
• Apr 20, 2009 – Smart Table
• Apr 6, 2010 – Apple Products: iPad, iPod, iPhone (forever changing AT options for schools and people with visual impairments)
• 2013 – GoBabgyGo starts adapting electric ride on cars for children with mobility impairments to provide independent mobility
• In recent years there have also been significant developments of robots, apps and augmented reality systems to support people with a range of disabilities and help them navigate the daily activities in their life.

(information credit: https://www.timetoast.com/timelines/history-of-assistive-technology?print=1)

Okay, so I promise the history lesson is over.  

Where can we still go?  Where do we still NEED to go?

I think two of the biggest areas where society and the community overall are lacking are:

1) a consistent understanding of universal design concepts and the benefits they offer within society

and

2) effective inter-agency collaboration that ensures a continuity of services resulting in the greatest level of independence and ability for persons with disabilities to more easily contribute to society.

I want to offer a discussion on a few areas I believe there are the greatest opportunities for improvement. Making changes in these areas has the potential of making a difference in the overall quality of experiences for persons with disabilities in the community. And, as I have mentioned before – see Assistology’s blog Universal Access and Design – adjustments we make as a society toward higher levels of inclusivity and accessibility benefit all members of a community, not just those with a disability.

1. If builders, architects and Universal Design experts were to collaborate and develop a certification for accessibility, similar to a GREEN or LEED certifications that buildings can currently obtain, many possibilities exist.

• There could be an increase in consistency in the accessibility of building design and higher levels of accommodation available both in structure and interior design concepts;
• Businesses would expand their clientele due to increased accommodations and accessibility;
• Persons with disabilities would gain more independence in more settings, and person’s without disabilities would likely have a more enjoyable experience as well.
• As Stuart Shell points out in the Forte Building Science paper “Why Buildings Designed for Autistic People are Better for Everyone” buildings designed to be accommodating for a disability are better for everyone.

2. I feel strongly that architects and other building science industries need additional education on accessible design – beyond the bare minimum structural requirements that ADA mandates.  When creating a floor plan design, the average architect does not typically consider:

• Drawer & cabinet locations and think about if a person in a wheelchair (or with other mobility impairments) can unload the dishwasher and put dishes or silverware away while in their wheelchair based on their design;
• The positive effects on safety in independent living housing that it offers to have a light go on in the entryway when the front door opens;  
• The locations of light switches with regard to ease of access and safety throughout the rooms.  
• That while the ADA guidelines for clearance (to allow a wheelchair proper space for a standard turning radius) work for someone in a standard, manual wheelchair (that has a small physical footprint), these clearances are inadequate for someone in a large, powered wheelchair that has to maintain a reclined position – significantly increasing the device footprint and thus increasing the necessary clearance for turning.  

Designing a space with these types of considerations in mind are things all people would benefit from – but to my knowledge no one is emphasizing these ideas in the education process.

I have asked architects who on their design team considers accessibility beyond ADA. Their responses have been, “No one.” and, “We probably have a lot to learn in that area.”

If the Universal Design concepts were emphasized as part of the education process in construction education, interior design, architecture, environmental engineering, industrial engineering and other related fields, community spaces could be designed based on  the 7 Principles of Universal Design from the beginning, resulting in a significantly more accessible environment.  But, how can practices change if at the point of education these concepts are omitted?

3. One issue that is eternally frustrating for me, and probably any AT provider, is the silo approach to service delivery due to the funding structure, restriction and limitations for disability services.  I could write a book on what needs to be done on this.  But the main point I want to make is that when we restrict providers to functioning only within their team, in their setting we do a disservice to the individual needing services – the person we are supposed to be helping.   

AT policies that restrict the use of a purchased device to one setting significantly limit the individual’s ability to become proficient (due to lack of practice), as well as inhibit them from having unrestricted access to their preferred activities.  

Funding restrictions that discourage providers from communicating with new care team members through a transition – such as from acute care to home health – results in duplicate work as the new team often has to establish baselines and their own and spend time they could be working with the individual tracking down information the previous team had.  

When funding is SO restricted that providers feel pressure to not spend an extra 5 minutes once their role is “complete” there is a breakdown in the process and the individual suffers as a result.

4.  Architecture and physical building structures are not the only area of community access and supports that needs to get inspired by designing policy for all abilities. Insurance pays for assistive technology and durable medical equipment (i.e. commodes, wheelchairs, hospital beds, communication devices) that they deem medically necessary for a person’s daily function.  However, there is minimal, if any, funding made available to people with disabilities and their families to purchase assistive technology that would aid someone in daily tasks and increase their independence and quality of life.  

Recently, I asked a Nebraska state funding coordinator about funding options for individuals for purchasing items for daily living and independence (like adapted kitchen or eating utensils).  Her actual response to me was that no one funds these types of purchases; that they didn’t need to worry about it because the person would have someone around to do the task for them.  Simply because of “that’s the way we have always done it” attitudes, we are denying individuals the opportunity to expand their skills and level of independence; limiting their opportunities to contribute to society; increasing reliance on state programs; denying them dignity of self-care and ignoring their right to a quality of life.

This is WRONG on so many levels! An approach to services that assumes an individual prefers to have someone perform tasks for them such as brushing their teeth, feeding, taking off their shoes, making their phone calls, turning their book pages and other tasks we take for granted is archaic and uninspired.  It is time to break the chains of current policy and find a better way to do things.

You may be asking, 

“What would the outcomes be if there was more funding geared toward non-medically necessary assistive technology intended for independent living goals?”

In short, this would allow:

1. more elderly to age in place;

2. better support to individuals desiring to seek employment or volunteer and contribute to society;  

3. creation of a community where people of all abilities have more options for residential living;

4. provide added motivation for performing self-care activities – reducing dependence on caregivers;

5. improved social engagement.  

6. All of these things ultimately lead to a final result of having stronger communities.

Remember that quote we reflected on 5 pages ago? Once we understand where we have been, we can envision all the places we can go.

We can do SO much more and SO much better.

Okay, so maybe (especially for #3 and #4) this is a little bit of a call to action.  But the bigger the voice, the more things can change!  For issues that are a result of legislation – talk to your senators, start petitions, start an advocacy group or social media campaign. Find a way to make your voice heard for the greater benefit of society.

All members of society deserve an opportunity to pursue their dreams and goals.