Current and Future Assistive Technology

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Current and Future Assistive Technology

• Linking Independent Living to Technology
• Patty McDonald
• Aging and Disability Services Administration
• Email mcdonpm_at_dshs.wa.gov
• 360-725-2559

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Objective of todays workshop

• Promoting the concepts of independent living
  philosophy and universal design and the need for
  adequate funding aid people with disabilities
  achieve success and live with dignity in their
  own homes and community.

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StatisticsA Minority that includes all People

• There are an estimated 54 million people with
  disabilities living in the United States. (U.S.
  Census Bureau)
• There are nearly 7 million school-aged children
  with disabilities in the U.S. (Congressional
  Research Service)
• Nearly 70 percent of working-age adults with
  disabilities are unemployed. (U.S. Census Bureau,
  Population Division and Housing and Household
  Economic Statistics Division)
• Almost 40 percent of working-age Americans with
  disabilities live in poverty. (World Institute on
  Disability)
• Fewer than 25 percent of people with disabilities
  who could be helped by assistive technology are
  using it. (Alliance for Technology Access)

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Meaning of Disability and the Influence of
Independent Living Philosophy

• General definition - lack of adequate power,
  strength, or physical or mental ability
  incapacity.
• The Independent Living Philosophy asserts that
  people with disabilities are the best experts on
  their needs, and therefore they must take the
  initiative, individually and collectively, in
  designing and promoting better solutions and must
  organize themselves for political power.
  Wikipedia

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Independent PhilosophyBased on Civil Rights

• Persons with disabilities have the same right to
  participation, to the same range of options,
  degree of freedom, control and self-determination
  in every day life and life projects that other
  citizens take for granted.
• The disability rights movement aims to improve
  the quality of life of people with disabilities
  and started in the 1970s.
• In most countries, proponents of the disability
  rights movement argue preconceived notions and a
  predominantly medical view of disability
  contribute to negative attitudes towards people
  with disabilities, portraying them as sick,
  defective and deviant persons, as objects of
  professional intervention, as a burden for
  themselves and their families, dependent on other
  peoples charity.
• People with disabilities are primarily seen as
  citizens and only secondarily as consumers of
  healthcare, rehabilitation or social services.
  People first.

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The ADA

• 1990's landmark Americans with Disabilities Act,
  mandated equal access to education, employment,
  and other essential activities and services for
  the country's largest minority group. The
  benefits of new technology, new laws, and new
  design concepts do not have adequate funding due
  to the lack of information, and political will.
  As a result, society as a whole misses the chance
  to maximize human potential and productivity.

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Four key needs

• Accessible housing
• Accessible transportation
• Access to assistive technology devices and
  services
• Access to personal assistance services
• Without these being available, can lead to
  unneeded institutionalization and dependence.

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Stephen Hawking

• For a time, the only way I could communicate was
  to spell out words letter by letter, by raising
  my eyebrows when someone pointed to the right
  letter on a spelling card. It is pretty difficult
  to carry on a conversation like that, let alone
  write a scientific paper. However, a computer
  expert in California, called Walt Woltosz, heard
  of my plight. He sent me a computer program he
  had written, called Equalizer. This allowed me to
  select words from a series of menus on the
  screen, by pressing a switch in my hand. The
  program could also be controlled by a switch,
  operated by head or eye movement.
• David Mason, of Cambridge Adaptive Communication,
  fitted a small portable computer and a speech
  synthesizer to my wheel chair. This system
  allowed me to communicate much better than I
  could before. I can manage up to 15 words a
  minute. I can either speak what I have written,
  or save it to disk. I can then print it out, or
  call it back and speak it sentence by sentence.
  Using this system, I have written a book, and
  dozens of scientific papers. I have also given
  many scientific and popular talks. They have all
  been well received. I think that is in a large
  part due to the quality of the speech
  synthesizer, which is made by Speech Plus. One's
  voice is very important. If you have a slurred
  voice, people are likely to treat you as mentally
  deficient Does he take sugar? This synthesizer
  is by far the best I have heard, because it
  varies the intonation, and doesn't speak like a
  Dalek. The only trouble is that it gives me an
  American accent.

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Independent Living Philosophy Supports

• The removal of infrastructural, institutional and
  attitudinal barriers and the adoption of the
  Universal Design principle is critical for people
  with disabilities to achieve success and live
  with dignity in the community.
• Depending on the individuals disability, support
  services such as assistive technology, income
  supplements or personal assistance are seen as
  necessary to achieve equal opportunities.

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Definitions

• Assistive Technology - maximizes functional
  opportunities for individuals with disabilities
  in all environments through devices,
  modifications and services.
• Durable Medical Equipment (DME) - equipment which
  can withstand repeated use and which is used to
  serve a medical purpose when supplied to
  individuals with an illness, injury or
  disability. DME includes, but is not limited to
  wheelchairs, walkers, specialty beds, and
  mattresses.

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Universal Design (UD)

• Universal design is a relatively new paradigm
  that emerged from "barrier-free" or "accessible
  design" and "assistive technology.
• " Barrier free design and assistive technology
  provide a level of accessibility for people with
  disabilities but they also often result in
  separate and stigmatizing solutions, for example,
  a ramp that leads to a different entry to a
  building than a main stairway.
• Universal design strives to be a broad-spectrum
  solution that helps everyone, not just people
  with disabilities. Moreover, it recognizes the
  importance of how things look. For example, while
  built up handles are a way to make utensils more
  usable for people with gripping limitations, some
  companies introduced larger, easy to grip and
  attractive handles as feature of mass produced
  utensils. They appeal to a wide range of
  consumers.

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Principles of Universal Design

• Equitable use
• Flexibility in use
• Simple and intuitive
• Perceptible information
• Tolerance for error
• Low physical effort
• Size and space for approach and use
• From the Center for Universal Design NC State
  University

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Universal Design ConceptAesthetically Beautiful
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UD Design in Environmental Design
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Applying UD to Old Technology
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Smart HomesHome automation improves life

• Security while you are there or remotely using
  your phone
• Control lighting and audio with touch panels
• Lights dim, the shades close, the plasma TV turns
  on and your favorite movie begins
• Window treatments are programmed to adjust at
  pre-set times to reduce glare and protect from
  harmful direct sunlight
• At night the hallway lights automatically
  illuminate as you walk by
• Monitor indoor and outdoor temperature for
  comfort and energy savings
• Vehicle detection outside home

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Should we be afraid of new technology?

• New technology can reduce jobs or supplement
  workforce shortages?
• Create the illusion that physical access is no
  longer needed or enhance universal design
  concept?
• What will information from smart homes be used
  for?
• Create moral and legal dilemmas or solve them?

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• Technology created for questionable purposes.
• This fully-motorized wheelchairbuilt from an
  electric golf cart and a Marine rescue helicopter
  seatis equipped with a flamethrower capable of
  firing 15-foot flames.
• Capable of hitting 20 miles per hour and a
  perfect opportunity for disabled people of the
  world to get even-Steven with all those punks who
  always park in the wrong spots.
• http//gizmodo.com/393927/flamethrowing-wheelchai
  r-makes-me-want-to-break-a-leg

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After all hundreds of years ago, people thought
books were new technology. Joelle Brouner
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Progression of technology

• Technology started to make care easier for
  providing the care
• Then it progressed to allow the person with the
  disability to be more independent
• And is now progressing to allow anyone with or
  without a disability to use it and to benefit
  from it, which allows for more affordability

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Example Wheelchairs

• One of the first wheelchairs was invented by King
  Phillip II of Spain. The drawing below shows the
  King dated 1595 in a chair with wheels, armrests
  and footrests.
• Not usable independently.
• High costs

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In the last two decades progress has accelerated
for modern wheelchairs

• They are lighter and perform better than ever
  before. There are now many possibilities
  available to improve the ride, from suspension
  systems which help to remove vibrations and
  jolts, to ultra-light weight frames which enable
  better performance, to special designs for every
  individualized need and taste.
• Much easier for individuals to use
• Still high costs

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Recent progress
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Segway

• For commuting and recreation
• More individuals are able to use it
• But not all can use it

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• Transformable Wheelchair Concept by Caspar
  Schmitz
• This wheelchair is made of an elastic as well as
  strong plastic, for example Polyurethane. The
  vehicle becomes adapted to contact face and the
  center of gravity to the situation. Through
  vertical pressure on the handle bar the round
  wheel converts to ellipsoid. As a result of which
  steps and barriers can be taken care of easily.
  This transformable wheel will surely abolish lots
  of barriers and assist people with disabilities
  to carry on their life easily.
• http//www.tuvie.com/transformable-wheelchair-conc
  ept-by-caspar-schmitz

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Robotics vacuum cleaner riding vacuum
cleaner
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Care-O-Bot Can Take Good Care of YouWith rising
spending power and better lifestyle, the need for
providing care services is on the rise. To cater
to these care needs Fraunhofer IPA has developed
the mobile robot assistant to take care of
humans. It is designed to take care of day to day
needs for everyone. The first Care-o-bot was
developed in 1998 with its ability to move around
safely in the human environment. The subsequent
developments have given it the ability to
manipulate regular household tasks.
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Future use for wheelchair users?
http//www.bostondynamics.com/content/sec.php?sect
ionBigDog
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Current lift systems
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Future systems
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Say the word "exoskeleton" and most people think
of actress Sigourney Weaver in the movie Alien.
http//www.israel21c.org/link.jsp?enDispWhoArtic
lesl2202enZoneHealth

• ReWalk is an Israeli-developed quasi-robotic
  ambulation system developed by ARGO Medical
  Technologies that provides a viable, upright
  day-to-day alternative to wheelchair users.

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Being able to use your body
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Low and high technology for personal public
transportation
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Universal Design Concept for Transport

• There was good news for parents with small
  children and wheelchair users today as Translink
  launched Northern Irelands first fully
  accessible, low floor Goldline coach,  the first
  vehicle of its kind in the UK and Ireland. Fitted
  with an electronic ramp and a wide opening door,
  it is the first of 25 fully accessible double
  deck Goldline coaches ordered by Translink as
  part of the overall 50 million investment in
  buses announced in December 2004.  Three-year-old
  Alex Beggs is pictured with mum Helen. Looking on
  is Deirdre Brady, Chief Executive of NIMBA
  (Northern Ireland Mother Baby Action).

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Barriers

• Adequate funding
• Information what is out there
• Living with dependence on humans and technology
  and no back up plan

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Being Dependent on Technology

• Need for back-up technologically
• Need for human back-up
• Service animals are great back-up
• Use alternatives
• Build an emergency kit
• Create emergency plan

Julie Keefe for The New York TimesMAINTENANCE
Neal family members check the batteries, gauges
and generator of their power supply.
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Using Service Animals Instead of Technology
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• But even animals can benefit from technology

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P.L. 100-407, the Technology Related Assistance
for Individuals with Disabilities Act of 1988
(Tech Act)

• 1. During the past decade there have been major
  advances in technology.
• 2. Technology benefits all individuals.
• 3. For some individuals with disabilities,
  assistive technology is a necessity that enables
  them to engage in or perform many tasks. Tasks
  listed include those at home, school, work, and
  in the community.
• 4. There already exists a substantial number of
  assistive technology devices that could be used
  in early intervention and education,
  rehabilitation and training, employment,
  residential living, independent living,
  recreation, and other aspects of daily living.

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Tech Act

• 5. The use of assistive technology devices and
  services by individuals with disabilities can
  reduce the costs of disabilities.
• 6. Many individuals with disabilities do not have
  access to the assistive technology devices and
  services needed to allow such individuals to
  function in society commensurate with their
  ability.
• 7. There are insufficient incentives for
  commercial pursuit of the application of
  technology devices because of limited markets.
• 8. At the federal level, there is a lack of
  coordination among agencies that provide or pay
  for the provision of assistive technology.

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Funding Sources for AT DME

• Private Insurance
• Medicare
• Medicaid and Waivers
• Medicare/Medicaid dual coverage
• Veterans Administration
• State Vocational Rehabilitation Programs
• Labor Industries
• Out of Pocket
• Charity

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Many of the devices, modifications, services
discussed are not covered under current funding
sources.

• Private Insurance, Medicare and Medicaid cover
  DME that is deemed medically necessary
• Increase in physical independence, being able to
  access your community, education and employment
  may not meet the medical necessity definition.

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Funding of assistive technology must not be
geared toward a medical view of disability

• Independent Living Philosophy - Persons with
  disabilities have the same right to
  participation, to the same range of options,
  degree of freedom, control and self-determination
  in every day life and life projects that other
  citizens take for granted.
• The disability rights movement argue preconceived
  notions and a predominantly medical view of
  disability contribute to negative attitudes
  towards people with disabilities, portraying them
  as sick, defective and deviant persons, as
  objects of professional intervention, as a burden
  for themselves and their families, dependent on
  other peoples charity.
• This view also has a negative effect on adequate
  funding for future assistive technology.

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Ideas for Reform

• Reforming insurance coverage (private
  Medicaid/Medicare
• Providing Services in the Cash and Counseling
  Model
• Legislation that supports universal design in
  products and architecture
• Provide incentives to businesses to create
  technology that doesnt have a wide market
• Others???

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Limited Resources Public Policy

• The access to assistive technologies is properly
  set in the context of civil rights and public
  policy rather than limited to the realm of
  charity or good will. Freedom Machines 2004

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Support Technology

• Patty McDonald
• Aging and Disability Services Administration
• Email mcdonpm_at_dshs.wa.gov
• 360-725-2559