For Americans without disabilities, technology makes things easier. For Americans with disabilities, technology makes things possible.
Mary Pat Radabaugh
Study on the Financing
of Assistive Technology
Devices of Services for
Individuals with Disabilities
Technology has been defined as the system by which a society provides its members with developments from science that have practical use in everyday life. Today, technology plays a vital role in the lives of millions of disabled and older Americans. Each day, people with significant disabilities use the products of two generations of research in rehabilitation and biomedical engineering to achieve and maintain maximum physical function, to live in their own homes, to study and learn, to attain gainful employment, and to participate in and contribute to society in meaningful and resourceful ways. It is more than a coincidence that these remarkable advances have occurred during the period in which federal funds have supported research, development, and training in rehabilitation engineering.
In planning the future of rehabilitation engineering research, NIDRR and its constituents in the consumer, service, research, and business communities will continue to identify flexible strategies to address emerging issues and technologies, to promote widespread use of research findings, and to maximize the impact of NIDRR programs on the lives of people with disabilities. NIDRR is particularly well-positioned to continue its leadership in rehabilitation engineering research, since NIDRR locates rehabilitation engineering research on a continuum that includes related medical, clinical, and public policy research; vocational rehabilitation and independent living research; research training programs; service delivery infrastructure projects; and extensive consumer participation.
The institute supports engineering research on technology for individuals and on systems technology. For example, NIDRR has supported hearing aid and wheelchair research on the individual level, and telecommunications, transportation, and built environment research at the systems or public technology level. NIDRR also supports research on ergonomics and interface problems related to the compatibility of various technologies, such as hearing aids and cellular telephones.
Technological innovations benefit disabled people at the individual level and at the systems level. At the individual level, assistive technology enhances function; at the systems (or public technology) level, technology provides access that enhances community integration and equal opportunity. Most assistive technology for disabled individuals falls into the category of orphan technology because of limited markets; frequently this technology is developed, produced, and distributed by small businesses. Often, technology on the systems level involves large markets and large businesses. Access to technology can be increased by incorporating principles of universal design into the built environment, information technology and telecommunications, consumer products, and transportation.
Assistive Technology For Individuals
In 1990, more than 13.1 million Americans, about 5 percent of the population, were using assistive technology devices to accommodate physical impairments, and 7.1 million people, nearly 3 percent of the population, were living in homes specially adapted to accommodate impairments. While the majority of people who use assistive technology are elderly, children and young adults use a significant proportion of the devices, such as foot braces, artificial arms or hands, adapted typewriters or computers, and leg braces (LaPlante, Hendershot, & Moss 1992).
Assistive technology includes devices that are technologically complex, involving sophisticated materials and requiring precise operationsoften referred to as high-techand those that are simple, inexpensive, and made from easily available materialscommonly referred to as low-tech. Scientific research in both high-tech and low-tech areas will serve the consumer need for practical items that are readily available and easily used. Low-tech devices, for example, are widely used by older people with disabilities to compensate for age-related functional losses. The importance of creating both types of assistive technologies is found in the words of one engineer, who stated, It is not high-tech or low-tech that is the issue; it is the right tech. NIDRR research must be able to identify the most appropriate technological approach for a given application, and continue to develop low-tech as well as high-tech solutions.
Given the current trend toward more restrictive utilization of health care funds in both public and private sectors, rehabilitation engineering research must justify consumer or third-party costs in relation to the benefits generated for consumers. These benefits may be in the form of long-term cost savings and consumer satisfaction. Equally important, rehabilitation engineers must develop products that are, in addition to being safe and durable, marketable and affordable. End-product affordability is important, not only in meeting consumer needs, but also in creating the market demand that will encourage manufacturers to enter production.
Systems Technology: Universal Design and Accessibility
As disabled people enter the mainstream of society, the range of engineering research has broadened to encompass medical technology, technology for increased function, technology that interfaces between the individual and mainstream technology, and finally, public and systems technology. Key concepts of universal design are: inter-changeability, compatibility of components, modularity, simplification, and accommodation of a broad range of human performance capabilities.
Universal design principles can be applied to the built environment, information technology, and telecommunications, transportation, and consumer products. These technological systems are basic to community integration, education, employment, health, and economic development. The application of universal design principles during the research and development stage would incorporate the widest range of human performance into technological systems. Universal design applications may result in the avoidance of costly retrofitting of systems in use and the possible reduction in the need to develop orphan products.
The institutes emphasis on applied research challenges NIDRR and its researchers to find effective ways of ensuring technology transfertransfer of ideas, designs, prototypes, or productsfrom the basic to the applied research environment, to the market, and to other research endeavors. Market size, the potential for manufacturability, intellectual property rights, patents, and regulatory approval are considerations in the conceptualization and design phase of research efforts. NIDRR-funded Rehabilitation Engineering Research Centers (RERCs) consider potential industry partners in selecting research projects that will result in marketable products.
Issues of orphan technology are key to the process of technology transfer, with small markets that have limited capital occasioning the need for subsidies, guaranteed financing for purchases, or other incentives for producers. Future technology transfer efforts at NIDRR will explore better linkages to the Small Business Innovative Research (SBIR) program, a government-wide program intended to support small business innovative research that results in commercial products or services that benefit the public. Innovativeness and probability of commercial success are both important factors in SBIR funding decisions.
Building a Research Agenda
Future rehabilitation engineering research agendas must incorporate several crosscutting issues, including the problem of small markets and the need for reliable outcomes measures. In addition, research must continue to lead to improvements in the functional capacities of individuals with sensory, mobility, manipulation, and cognitive impairments. Telecommunications and computer access offer significant potential to improve participation of people with disabilities in all facets of life. Continuous innovations in these areas require that the needs of people with various disabilities be recognized and accommodated. Finally, access to the built-environment remains a critical need for people with disabilities, and thus requires ongoing research.
The purposes of NIDRRs research in the area of technology are to:
- develop assistive technology that supports people with disabilities to function and live independ-ently and obtain better employment outcomes;
- develop biomedical engineering innovations to improve function for people with disabilities;
- promote the concept and application of universal design;
- remove barriers and improve access in the built environment;
- ensure access of disabled people to telecommunications and information technology, including through the application of universal design principles;
- ensure the transfer of technological developments to other research sectors, to production, and to the marketplace;
- identify business incentives for manufacturers and distributors;
- identify the best methods of making technology available to people with disabilities;
- ensure that research and development at both the personal and systems levels take into account cultural relevance for diverse ethnic and geographic populations;
- develop rehabilitation engineering science, including a theoretical framework to advance empirical research; and
- raise the visibility of engineering and technological research for people with disabilities as a means of increasing attention to these research areas in national science and technology policy.
Future Research Priorities for Technology
NIDRRs research priorities in engineering and technology will help improve functional outcomes and access to systems technology in sensory function, mobility, manipulation, cognitive function, information communication, and the built environment. The priorities also will promote business involvement and collaboration.
Research to Improve or Substitute for Sensory Functioning. Sensory research is directed toward the problems faced by individuals who have significant visual, hearing, or communication impairments. These major conditions have been the focus of a long tradition of engineering research emphasizing both expressive communication and the receipt of information. Research priorities in the area of sensory functioning will focus on enhancing hearing, addressing visual impairments, and accommodating communication disorders.
In the area of hearing impairments, specific research priorities include:
- development and evaluation of hearing aids that exploit the potential of digital technology and use advanced signal processing techniques to enhance speech intelligibility, attain a better fit, and ensure com-patibility with telecom-munications systems and information technology;
- evaluation of the application of digital processing techniques to assistive listening systems;
- evaluation of modern methods of sound recognition in alerting devices; and
- development of interfaces for assessment of automatic speech recognition systems.
In the area of visual impairments, specific research priorities include:
- identification and evaluation of methods to enhance accessibility of visual displays;
- development and evaluation of graphical user interface technologies for various document and graphic processing systems; and
- improvement of signage in public facilities.
In the area of communication impairments, specific research priorities include:
- identification and evaluation of technologies to enhance the communication abilities of people who are deaf-blind; and
- assessment of the capacity of research in cognitive science, artificial intelligence, biomechanics, and human and computer interaction to improve the rate, fluency, and use of communication aids.
Research to Enhance Mobility. Mobility research is directed toward the problems associated with moving from place to place. Mobility can be enhanced by accessible public transportation, modified privately owned vehicles, wheeled mobility devices such as wheelchairs, orthoses and prostheses, and barrier removal.
In the area of enhancing mobility, specific research priorities include:
- development, evaluation, and commercialization of wheelchair designs that reduce user stress, repetitive motion injury, and other secondary disabilities, while improving safety, ease of maintenance, and affordability;
- revision and dissemination of wheelchair standards;
- development and evaluation of techniques to assist consumers and providers in selecting and fitting wheelchairs and wheelchair seating systems;
- identification of a theoretical framework of gait and other aspects of ambulation;
- development and evaluation of advanced prosthetic and orthotic devices, as well as footwear and other ambulation devices;
- development and evaluation of methods to improve person-device interfaces, post-surgical management and fitting, and materials used in bio-engineering applications; and
- development of devices to assist with ADLs for people with disabilities and their caregivers.
Research to Improve Manipulation Ability. The manipulation area includes research directed toward restoring functional independence for people with limited or no use of their hands. This encompasses upper extremity prosthetic and orthotic devices and novel methods of upper extremity rehabilitation. Issues of weight, durability, and reliability remain challenges in this field.
Repetitive motion injury is emerging as one of the most serious problems among workers. Although there have been a number of ergonomic devices introduced to address this problem, the incidence of this condition continues to increase.
In the area of improvement of manipulation, specific research priorities include:
- identification of methods to improve the design of, and achieve multifunctional control for, hand and arm prosthetic technology;
- development and evaluation of surgical approaches that increase functionality;
- development of assistive devices to address manipulation issues for individuals who experience serious weakness, fatigue, or pain, including that attributable to progressive deterioration of function; and
- development and evaluation of devices and techniques to help prevent repetitive motion injuries and to rehabilitate those with the condition.
Research on Technology to Enhance Cognitive Function. Limitations in perception, processing information, organizing thoughts, concentration, memory, and decision-making may result from a range of etiologiesincluding mental retardation, traumatic brain injury, stroke, mental illness, dementia, and othersand may constitute substantial barriers to function and social integration. These barriers can be exacerbated by sophisticated technology interfaces that require memorizing sequences, reading or interpreting information, or responding to complex auditory or visual cues. Conversely, technology has the theoretical potential to simplify many daily activities and contribute to self-management and independence.
There are three objectives in developing technology to meet the needs of people with limitations in cognitive functioning. The first objective is to assure that new technologies for communication, environmental control, and health maintenance, for example, are accessible to those with cognitive limitations and do not exacerbate their exclusion from mainstream activities.
The second objective is to develop technologies that will assist people with cognitive limitations in the performance of daily activities. Reminders and cueing devices, trackers and wandering devices, and portable instructional technologies are some of the approaches that enable people with cognitive limitations to remember appointments and medications, locate themselves positionally, follow common instructions, and obtain assistance.
The third objective is to develop technologies that can enhance or restore some cognitive functions. Automated systems to improve memory have been developed and tested, for example. As the fields of cognitive science and neuroscience create a better understanding of the biology of cognitive functioning, and as there are concomitant advances in artificial intelligence and expert systems and in the flexibility of microprocessors, a new research frontier may emerge.
Specific priorities in the area of technology to address cognitive limitations include:
- assessment of state-of-the-art technology and its applications to address cognitive functioning;
- assessment of consumer need and competencies to use various device features;
- development of technologies to improve job skills and to improve employment opportunities;
- development of technologies to maximize independence and the ability to perform ADLs and IADLs; and
- development of strategies to ensure that new technologies for the general population are accessible to people with cognitive limitations.
Research to Improve Accessibility of Telecommunications and Information Technology. Computerized information kiosks, public Web sites, electronic building directories, transportation fare machines, ATMs, and electronic stores are just some current examples of rapidly proliferating systems that face people living in the modern world. To make such computerized information systems usable by people with a range of disabilities, NIDRRs research priorities will include development and evaluation of techniques to assist people with disabilities in successfully accessing these systems.
The trend in the information technology and telecommunications industries is to stay away from standardized operating systems and monolithic applications and move toward net-based systems, applets, and object-oriented structures. This trend has significant implications for accessibility for some people with disabilities. Maintaining access to the Internet and World Wide Web is also a formidable challenge facing individuals with disabilities.
Another concern in telecom-munications is electromagnetic interference from the rapidly proliferating wireless communication systems (e.g., beepers, cellular telephones) and other electronic devices using digital circuitry (e.g., computers, fluorescent light controllers). This interference is complicating the use of assistive listening devices. Moreover, the interference caused by the overuse of spectrum is presenting problems in the use of FM assistive listening systems.
During the past decade, virtual reality techniques, originally developed by the National Aeronautics and Space Administration and the military for simulation activities, have been applied in a number of other fields including architecture and health. Applications can be found in telerobotic systems, sign language recognition devices, intelligent home systems, and aids for people with visual impairments. There has been some beginning research on the use of virtual reality as an evaluation and therapy tool.
Telecommunications also emerges in other important areas of the lives of people with disabilities. In a managed care approach to health care, individuals are discharged from acute rehabilitation hospitals earlier than in the past. Because of the decreased lengths of stay, there is less time for consumers to learn how to manage their conditions. One promising option for ameliorating these effects is telemedicine or telerehabilitation. Telerehabilitation may allow for distance monitoring of chronic conditions and for monitoring consumer compliance and progress.
In the area of improving accessibility to telecommunications and information technology, specific research priorities include:
- development and evaluation of fine motor skill manipulation interfaces, telecommunication interfaces, and analog to digital communication technologies;
- identification of methods to address issues of accessibility through Internet communications;
- development and evaluation of methods for reducing emerging forms of interference that affect hearing aids, telephones, and other communication devices;
- determination of the efficacy of virtual reality techniques in both rehabilitation medicine and in applications that affect the daily lives of people with disabilities; and
- identification of appropriate telecommunications strategies for use in distance follow-up to rehabilitation treatment.
Research to Improve Access to the Built Environment. The built environment includes public and private buildings, tools and objects of daily use, and roads and vehicles, any of which can be accessible or disabling. Architects, industrial designers, planners, builders, and engineers are among the professionals that create this environment.
In the area of access to the built environment, specific research priorities include:
- analysis of human factors;
- development and evaluation of modular design;
- determination of the best methods of disseminating information on universal design;
- development and evaluation of compatible interfaces; and
- development and promulgation of design standards.
Future engineering research also must recognize the changing roles of consumers, whose participation in research is vital, and the role of assistive technology industries, whose technical capabilities and needs for product development and research are changing. Small businesses, the engine of the orphan technology industry, often cannot support the sophisticated research and development efforts necessary to bring quality products to market.
NIDRRs research can identify public policy issues, such as orphan technology and tax credits, to foster small business investment in assistive technology innovation. Similarly, NIDRR research can identify public policy and business issues related to mainstream systems and public technology. NIDRR will maintain a research capacity that provides a continuing stream of new ideas, and evidence to validate those ideas, to stimulate the industry.
Chapter 6: Independent Living and Community Integration