Assistive Technology

Agreeing on universal definitions for terms such as disability, assistive technology device or service, activity limitations and participation restrictions was the first step towards writing legislation that would further inclusion and full participation for individuals with a disability. Creating affordable access to, and training on, technology came next.

A national perspective

Assistive technology, today, is an umbrella term commonly used to cover a wide assortment of devices and services that improve and enable the lives of individuals with disability and impairment.

Individuals with impairment encounter environmental challenges during daily living which, in turn, create barriers to opportunities afforded to individuals without impairment. It is a national, as well as international, priority to create barrier-free societies. These barriers include:

• Activity limitations – a difficulty encountered by an individual in executing a task or action
• Participation restrictions – a problem experienced by an individual’s involvement in a life situation

Activity limitations and participation restrictions occur when an individual with impairment encounters a cultural, physical, or social barrier that prevents him or her from participating on an equal opportunity basis in situations readily available to the masses. These limitations and restrictions then become barriers.

Affordable and accessible assistive technology can greatly minimize, or eliminate, such barriers providing those with impairment with better quality of life and the ability to contribute on an equal basis. Assistive technology plays a very important role in the lives of those with Cerebral Palsy.

Assistive technology incorporates a broad range of supportive devices, from adaptive equipment to mobility aids to communication technology. Technology provides functionality and accessibility in a myriad of ways, dependent upon a person’s abilities, needs and required tasks. Technology can help an individual communicate, learn, move, function and perform tasks that others without impairment accomplish quite easily.

Technology can be used to provide accessibility through modifications to home, auto, or building design. It also allows access to public spaces, housing opportunities, education, entertainment venues, transportation and work. Often, technology opens the world to those with disability.

Assistive technology as defined in American history

According to the Assistive Technology Act of 2004, or ATA, over 54 million individuals in the United States have disabilities, mostly severe, affecting ability to see, hear, communicate, reason, walk, and perform basic life functions.

To the individual, assistive technology allows a person to minimize deterioration, maintain functioning, or achieve a higher level of independence in task and within society. By breaking down barriers to opportunity for those with disability, assistive technology also plays an increasingly major role in the strength and vibrance of the nation’s economy.

The ATA strives to make assistive technology accessible and affordable so individuals can:

• Live independently
• Enjoy self-determination and make choices
• Benefit from an education
• Pursue meaningful careers
• Enjoy full inclusion and integration in the economic, political, social, cultural, and educational mainstream

The U.S. definition of assistive technology was first described in American legislation in the following acts:

• Technology-Related Assistance for Individuals with Disabilities Act of 1988, also known as the “Tech Act”
• Access Boards Electronic and Information Technology Accessibility Standards – stated in the 1998 amendments to Section 508 of the Rehabilitation Act of 1973
• The Assistive Technology Act, also known as the “AT Act” – replaced the Tech Act

The commonly held definition is:

Assistive technology – “any item, piece of equipment, or system, whether acquired commercially, modified, or customized, that is commonly used to increase, maintain, or improve functional capabilities of individuals with disabilities.”

The definition of assistive technology was further divided into two useful sub-categories – devices and services – in legislation.

• The Americans with Disabilities Act of 1990, or ADA
• The Individuals with Disability Education Act of 2004, or IDEA – replaced the Education for All Handicapped Children Act of 1975, or EAHCA, which was renamed as the Individuals with Disabilities Education Act in 1990, or IDEA, which was amended in 1997 and 2004.
• The ADA Amendment Act of 2008, or ADAAA

The definitions are:

• Assistive technology device – “any item, piece of equipment or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities.”
• Assistive technology service – “any service that directly assists an individual with a disability in the selection, acquisition, or use of an assistive technology device.”

Assistive technology services include:

• Evaluation and qualification – evaluation of technology needs, including functional evaluation of the individual’s customary environment.
• Availability, affordability, and procurement – purchasing, leasing or otherwise providing for assistive technology device acquisition.
• Designing and fitting – selecting, designing, fitting, customizing, adapting, applying, maintaining, repairing or replacing assistive devices.
• Training – coordinating and using therapies, interventions, or services with assistive technology devices, including education, training, rehabilitation, therapy, activities of daily living, and recreation.
• Support – training or technical assistance for professionals, employers, educational leaders, family members, guardians, advocates, or other authorized care providers.

Who qualifies for assistive technology in the United States?

Each program or service has its own qualifiers for disability and its own guidelines for obtaining program benefits. In general, the Civil Rights Act of 1964 prohibits discrimination, while the Americans with Disability Act of 1990 as amended in 2008, or ADAAA, prohibits discrimination based on disability. The ADAAA clarifies the following terminology:

• Disability – “a physical or mental impairment that substantially limits one or more major life activities of such individual; a record of such an impairment; or being regarded as having such an impairment.”
• Major life activities – “include, but are not limited to, caring for oneself, performing manual tasks, seeing, hearing, eating, sleeping, walking, standing, lifting, bending, speaking, breathing, learning, reading, concentrating, thinking, communicating, and working.”
• Major bodily functions – “includes the operation of a major bodily function including, but not limited to, functions of the immune system, normal cell growth, digestive, bowel, bladder, neurological, brain, respiratory, circulatory, endocrine, and reproductive functions.”
• Being regarded as having such an impairment – if the individual establishes that he or she has been subjected to a prohibited action “because of an actual or perceived physical or mental impairment whether or not the impairment limits or is perceived to limit a major life activity.” However, it “shall not apply to impairments that are transitory and minor. A transitory impairment is an impairment with an actual or expected duration of 6 months or less.”

In 2004, the Assistive Technology Act of 2004, or ATA reaffirmed that the comprehensive statewide programs of assistive technology are centered in being “consumer-responsive.” This means being equally responsive to all individuals with disability “regardless of their type of disability, age, income level, or location of residence in the State, or the type of assistive technology device or assistive technology service required.”

According to ATA, assistive technology should be based on the following principles:

• Respect for individual dignity, personal responsibility, self-determination, and pursuit of meaningful careers, based on informed choice of individuals with disabilities
• Respect for the privacy, rights, and equal access (including the use of accessible formats) of such individuals
• Inclusion, integration, and full participation of such individuals in society
• Support for the involvement in decisions of a family member, a guardian, an advocate, or an authorized representative, if an individual with a disability requests, desires, or needs such involvement
• Support for individual and systems advocacy and community involvement

The entity, program, or activity providing the assistive technology must make assistive technology devices accessible in a timely and appropriate manner, and must ensure the equipment is useable by the individuals with disability or by the responsible family member, guardian, advocate or authorized representative.

Inclusion and accessibility to assistive technology from all levels of government

Access to assistive technology greatly enhances quality of life for those with impairments. Many life-altering benefits of assistive technology are available to those with Cerebral Palsy, such as:

• Reducing or eliminating activity limitations
• Reducing or eliminating participation restrictions
• Facilitating inclusion
• Providing equal access opportunity to those with impairment
• Lending qualify-of-life
• Increasing independence and self-care
• Providing barrier-free environments at home, school, in the public domain, and in the workplace
• Building self-worth, self-confidence, and self-esteem

The U.S. government, on all levels, strives to provide inclusion and accessibility to individuals in need, including:

• International collaboration – As a member state to the United Nations, or UN, the United States is a contributing member to policy and procedures being developed under the UN’s World Health Organization’s, or WHO, guidelines to further the human rights of those with disability and impairment. WHO strives for worldwide initiatives to prevent disabilities and reduce (or eliminate) activity limitations and participation restrictions.
• National commitment – The U.S. government develops and implements strategies to encourage barrier-free environments and equal-access opportunities for those with impairment. Their programs provide access to, and affordability of, technology and services to enrich the lives (and rights) of individuals with disability. Programs include social welfare, health care, special needs educational opportunities, barrier-free environments, and access to assistive technology devices and service. The national initiatives provide the framework, guidance, funding, and research required for the programs to run efficiently. Within the national government there are many departments that are involved in opportunities for those with disability. Two departments in particular are very beneficial to those with disability:
  • The Department of Health and Human Services (DHH) protects health and provides essential human services. The DHH, which has 11 operating divisions, includes the Centers for Medicare and Medicaid, Centers for Disease Control and Prevention, the Administration for Children and Families, and the National Institute of Health.
  • The Office of Special Education and Rehabilitation Services (OSERS) plays a key role in helping to identify disabilities and qualifies students for early intervention. School administration, parents, health professionals, community specialists, and technology experts implement educational plans, which may include therapies, treatments, and assistive technology and services. Vocational opportunities are also offered to transition individuals with disabilities from school into society.
• State-wide program administration – States within the U.S. implement the national initiatives. They follow the policies and programs that are developed and funded nationally by administrating and overseeing implementation. Program monitoring and reporting are also undertaken at this level.
• Local distribution – At the local level, government agencies, the public education system, organizations, and suppliers collaborate to identify and accommodate those with disabilities. They identify those who fit the definition of disability, educate those individuals about the services available and connect them with funding sources, vendors and training. The public school system, through the IDEA policies, encourages early intervention and participation with the special needs programs. Children are evaluated through a process called the Independent Education Program (IEP) for services and assistive technology. The IDEA also transitions those with special needs from the school setting into vocational and workforce training to foster independence, self-care, and optimally function within their capabilities in society.

How to obtain assistive technology

Assistive technology is any item that allows an individual, with or without disabilities, to perform in some way they would not have otherwise been able to perform.

The public school system is usually a family’s first line of defense when obtaining assistive technology. In the United States, every child has a right to a free and appropriate public education, or FAPE, in the least restrictive environment, or LRE. Whether a child is mainstreamed, included in special education classes, or provided school assistance outside the school, they are to be afforded the opportunity for special education services evaluation. The Individuals with Disabilities Act and the No Child Left Behind provisions optimize the child’s ability to learn. Under this process a child is evaluated on a case-by-case basis to assess the child’s needs in five developmental areas:

• Adaptive development (self-care skills)
• Cognitive development (intellectual ability)
• Communication development (speech and language)
• Physical development (mobility, fine motor skills, and gross motor skills)
• Social and emotional development (social Skills and emotional control)

To qualify for special education services, the student must demonstrate disability in one of 13 specific categories:

• Autism
• Developmental disability
• Specific learning disability
• Intellectual impairment
• Emotional and/or behavioral disability
• Speech and language disability
• Deaf-blind
• Visual impairment
• Hearing impairment
• Orthopedic or physical impairment
• Other health impaired
• Multiple disabilities
• Traumatic brain injury

The evaluation will identify areas for assistance, which may include:

• Assistive technology
• Audiology or hearing services
• Counseling and family training
• Medical services
• Nursing services
• Nutrition services
• Occupational therapy
• Physical therapy
• Psychological services
• Speech and language services
• Vocational therapy

The yearly evaluation is known as an Individual Education Plan, or IEP. When the child turns 16, the process begins to concentrate on transitioning the child from school into adult life with occupational training in self-care, independence, post-secondary education, and workforce development skills.

In adulthood, programs and services are available through government agencies, organizations, and product vendors. By far, the greatest challenge is identifying what services are available, where to find them, and how they may become more affordable.