Gaps as wide as the Grand Canyon
The technological evolution in assistive technology (AT) over the past 20 years has been as stunning as the evolution in consumer electronics. However, the availability and provision of these technologies lags behind and while in some countries AT is increasingly high-tech, people in other countries do not have access to the even most basic tools. Several speakers at the AAATE 2018 workshop outlined the issue with concrete examples and some suggestions for remedies.
Europe can currently be considered among the leading world regions in terms of assistive technology provision – both in the quality of products and services as well as in delivery and funding systems. It is further privileged to be looking into social robots, IoT applications and top tech to support the elderly and people with disabilities.
However, even in Europe and other developed countries, these highly innovative tech solutions are often miles away from the lives of the people they intend to serve. The gap between what “real people” would need to support them and the availability of affordable AT solutions is as immense as the Grand Canyon – in the words of Luc de Witte, president of AAATE and professor at the Centre for Assistive Technology & Connected Healthcare, The University of Sheffield, UK.
Even across European countries, assistive technology delivery systems differ significantly. There are differences in who is eligible and for what. Different terms are used in different contexts. But AT can only make sense if contextual factors are taken into account, as pointed out by Renzo Andrich, president of EASTIN and researcher at the IRCCS Fondazione Don Carlo Gnocchi, Italy.
Overall it is estimated that only 10% of needs of people with disabilities, chronic disease and functional limitations are met by AT. And in funding, it is easier today to get 200,000€ for robotics or research in artificial intelligence (AI) then 20,000€ for improving ‘simple’ AT solutions. Furthermore, funding schemes are usually limited to an exhaustive list of tools they provide funding for. These lists do not include mainstream products such as laptops but which, with their in-built accessibility function, might provide everything the person needs for the intended use (studying, working…).
A gap as big as the Grand Canyon does not only exist between what leading edge AT research is looking into and what people on the ground would actually benefit most from. It also exists between what is available in developed countries and the lack of the most basic in developing countries.
2 models for improving AT delivery in developing countries
We can only develop good delivery systems for assistive technology that are based on models suitable in the local context of low resource settings when working with regional AT centres and training non-professionals in the community so that they can actively reach out to the people who need support. These non-professionals can themselves be supported by smart technology, such as decision support apps, remote advice, etc. It also means that we need to think about how to educate big corporations like Apple, Google & Co to deploy functions like artificial intelligence in low-end, low-tech products and services. To underline these points, Luc de Witte shared the experiences of people with severe disabilities in rural India – people who currently need to survive without any medical help or assistive technology support.
All of the above does not mean that we should abandon research and innovation into high tech solutions. Rather we need to opt for a two-track innovation strategy, which on the one hand pushes the development of new solutions, while at the same time also invests in the delivery of affordable solutions based on proven technologies. “What if it would be compulsory for every company or funding body in this field to spend at least the same amount on ‘low end’ solutions?” Some resources must also go into studying how our wonderful AT solutions can best be put into the hands of those people whose lives can be transformed by them.
A second approach for effectively providing AT in low-income countries could be the Sustainable Community of Practice (SCOP) Model. Again, stakeholder and user engagement are key factors for success. Rosemary J. Gowran, professor at the University of Limerick, Ireland, explained the SCOP Model with the example of a wheelchair provision strategy for Romania and the Philippines. In collaboration with international and in-country organizations of persons with disabilities, the pilot sites were supported by a wheelchair sector consultant, to establish their country specific narratives, conducting organisational ethnographic studies (review of the literature and legislation, questionnaires, interviews and stakeholder-centred (wheelchair users, providers, policy makers), workshops). Results show the distinct nature of country specific contexts and an overall picture of the historical development of wheelchair provision in Romania and the Philippines drawing out the social, economic, environment and political pillars that impact on country specific provision systems.
Innovative solutions on local level
Another interesting example for India was presented by Peter Cudd, professor at the Centre for Assistive Technology & Connected Healthcare, The University of Sheffield, UK. A van equipped with medical and telemedicine facilities drives to rural areas where the team screens patients connecting via VSAT technology to the medical centre in Sankara Nethralaya. A diagnosis is made and if required spectacles are dispensed from the van. This example shows, that if the AT comes in a networked or connected form, remote support might be faster, cheaper and maybe even more efficient than our traditional delivery systems. However, who would check if the remote AT assistance is done well? There is little published information on good practice in remote AT services, and experiences so far are often limited to specific AT solutions.
Another, very bottom-up development is do-it-yourself (DIY) assistive technology. As we have seen in other areas, general technological developments do not leave the assistive technology field untouched. Do-it-yourself (DIY) design and prototyping with the help of cloud based 3D design software and 3D laser printing has democratized design and fabrication to the point where we see a growing AT makers movement and an upwards trend in sharing AT designs online.
Aejaz Zahid also from the Centre for Assistive Technology & Connected Healthcare, The University of Sheffield, UK, shared the example of the open prosthetics community e-Nable, which now boasts thousands of children successfully using adaptable prostheses designed uniquely for each individual’s needs.
The above examples show that the deployment of technology in different cultural contexts is not an automatic process and will require a bottom-up approach as well as bringing the technology to where it is needed rather than bringing the person to the technology.
All these examples and more were discussed at AAATE’s 2018 workshop on “Excellence in the Process of AT Provision”, held on 10 July 2018 in Linz, Austria. A detailed workshop report has been published and can be accessed here.