Sharing 40 years of experience and some thoughts on where the AT sector is going
The pace of change has increased incredibly in the assistive technology sector, just as in all other parts of our society. In these rapidly moving times, experience is a foundation and provides valuable background. It was therefore our particular pleasure to win Björk Pálsdóttir for an interview. Björk has started out as occupational therapist in 1980 in Denmark, before moving on to Iceland, where she first worked as occupational therapist and consulted in ergonomics. She was director of the AT Center Icelandic Health Insurance and senior project manager before retiring in 2021, and of course long-standing member of AAATE. Who better to ask for some insights into the AT sector, how it has developed and where it is going?
Q: Can you give us a quick overview of your work and career in the assistive technology field?
Björk: I was asked to build up an AT-Center in Iceland back in 1986, based on similar centers in the other Nordic countries. To make the story short, it all worked out and I retired on June 1st after a very rewarding and memorable career. A lot of challenges, great development work and very good co-operation with colleagues, Nordic co-operation and many other parties, such as users, government and Nordic colleagues. I was the director of the Assistive Technology Center until June 2020 when I applied for a part-time job for a year before retiring.
Q: What were for you the most striking developments over the past decades? (internationally and in Iceland)
Björk: It can be divided into five steps:
The first step was the development of the AT Center in Iceland, ensuring good service, delivery of aids, repair services and a consensus on the reuse of aids. Nordic role models, consultation and excellent co-operation were the key to our good work. Various co-operation projects with Nordic grants enabled us to obtain knowledge of assistive technology rapidly. The AT Center has been in constant development and is changing in line with the increase in the number of users as well as the development in services and technology. The number of employees grew in line with the operations, including occupational therapists, physiotherapists, health engineers, health biologists, business professionals, office workers and technicians. The AT-Center is a unit within the Icelandic Health Insurance (Sjúkratryggingar Íslands) and there is a collaboration with other departments on various issues.
The second step was characterized by the development of procurement of aids, tenders and contracts with suppliers. Tenders for devices and subsequent contracts, in collaboration with the State Procurement Agency and the National Hospital (Landspítalinn), enabled suppliers to establish new companies with assistive devices and ensure an operational basis for them. In the first years, there was really only one supplier for technical aids and then a few companies that did not have aids on display but were agents for foreign manufacturers. This quickly changed with the contracts and therefore the availability of aids for inspection and testing by users became common.
The third step was the digitization of the entire system, the application process, procurement, delivery, reuse, history of the devices, stock of reusable aids and electronic communication system with users, suppliers and healthcare professionals. These components are all digitized, which increases efficiency and transparency. It is worth mentioning that during COVID-19, when most people were working from home, all services ran as usual.
The fourth step is increased collaboration with health professionals. In recent years, we have been increasing the involvement of healthcare professionals in the local community to give them more responsibility regarding aids and delivery. Occupational therapists, physiotherapists and other professionals working with users of assistive devices are given an increased mandate to order assistive devices and have access to the AT Center’s digital storage system to obtain their own inventory for delivery of devices quickly and efficiently. This is primarily done to meet the growing number of applicants due to the growing number of senior citizens.
A few years ago, the AT Center also established a team of expert consultants for applications for specialized communication aids. The team consists of occupational therapists, speech therapists and a health engineer. This group has received training and skills in specialized communication solutions and provides independent and impartial advice. Specialized communication aids include more complex devices for easy communication such as computer equipment (including special software) with special controls such as specially equipped switches or eye controls. This is based on experience from Finland and collaboration with the Tikoteekki Center in Finland.
The fifth step and the last thing I want to mention is collaboration on research work in university student projects. Increasingly master projects in the health professions is about assistive technology and we are very happy with that. These projects can be very useful for further development of the business. Our IT systems have various information on the allocation of assistive technology as well as user information. We use ICD and ICF classification on diseases and skills of applicants, and ISO9999:2016 on classification of assistive products. As example of projects at the University of Iceland for the degree of Master of Science in Physical Therapy are: Mobility aids for stroke survivors in Iceland – Satisfaction, participation and cost and Mobility aids for children with mobility disabilities – Use, pleasure and effect. In both studies the Quest assessment tool was used (Quebec User Evaluation and Satisfaction with assistive Technology).
Q: What current developments do you find promising, what worries you?
Björk: I find it promising that the current Minister of Health appointed a working group in 2019 to examine arrangements for assistive devices in Iceland with regard to the United Nations Convention on the Rights of Persons with Disabilities, opportunities for independent living, social and economic participation and division of tasks between the state and municipalities. Some good changes have been made to the regulation on assistive devices, but I am worried that changes that would be for the better will not be seen in the near future. There were parliamentary elections this autumn, so now we just have to wait and hope that this work will continue. One of the things that can be improved is that that the responsibility for assistive technology will be with the same government and fewer institutions.
Q: How can an organisation like AAATE best support professionals in the AT sector like yourself?
Björk: The best way is to have international conferences / seminars / discussions that cover the latest and experiences in the field of assistive technology as AAATE does, covering development, research, measuring instruments, policies, services, cross-border comparisons and best practices.
Q: If you were a policy maker on European/national level, what would be your vision?
Björk: The same access to assistive devices for everyone regardless of residence.
Q: Do you have any recommendations for young professionals just starting out in AT?
To enjoy technology and work with people, identify themselves with the situation of those who need help, listen and be open-minded for solutions.
Many thanks, Björk!