Need For Assistive Technology Research Articles

Use of Assistive Technology for Persons with Psychosocial Disability: Systematic Review.

Assistive technology (AT) refers to assistive products (AP) and associated systems and services that are relevant for function, independence, well-being, and quality of life for individuals with disabilities. There is a high unmet need for AT for persons with disabilities and this is worse for persons with cognitive and mental or psychosocial disabilities (PDs). Further, information and knowledge on AT for PDs is limited. The aim of this review was to explore the pattern of AT use among persons with PDs and its associated socioeconomic and health benefits. The review was reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), and we conducted systematic searches in the 4 databases: PubMed, Embase.com, APA PsycInfo (Ebsco), and Web of Science (Core Collection) with the following index terms: "Assistive Technology," "Self-Help Devices," "Quality of Life," "Activities of Daily Living," "Mental Disorders." We included only AT individuals with PDs can independently use without reliance on a provider. Identified papers were exported to EndNote (Clarivate) and we undertook a narrative synthesis of the included studies. In total, 5 studies were included in the review which reported use of different AT for schizophrenia, bipolar disorder, depression and anxiety disorders. The APs described in the included studies are Palm tungsten T3 handheld computer, MOBUS, personal digital assistant, automated pill cap, weighted chain blankets, and smartphone function. All the AT products identified in the studies were found to be easily usable by individuals with PDs. The APs reported in the included studies have broad impact and influence on social function, productivity, and treatment or management. The studies were heterogeneous and were all conducted in high-income countries. Our study contributes to and strengthens existing evidence on the relevance of AT for PDs and its potential to support socioeconomic participation and health. Although AT has the potential to improve function and participation for individuals with PDs; this review highlights that research on the subject is limited. Further research and health policy changes are needed to improve research and AT service provision for individuals with PDs especially in low-income settings. PROSPERO CRD42022343735; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=343735.

Assistive technology usage, unmet needs and barriers to access: a sub-population-based study in India.

Assistive technology (AT) is essential to minimize functional limitations. The current study aimed to estimate the prevalence of needs, met and unmet needs for AT, and barriers to accessing AT among a subnational population in India. This cross-sectional study was conducted in eight districts, representing four zones of India, using the WHO Rapid Assistive Technology Assessment (rATA) tool. The tool was administered by trained staff using read aloud technique. Multi-stage cluster random sampling was used, as well as the probability proportional to size, to select smaller administrative units from the larger ones. In total, 8486 participants were surveyed out of 8964 individuals enumerated with a response rate of 94.6%. The sample prevalence of at least one difficulty was 31.8% (2700), with 6.3% (532) having severe or total difficulties. The sample prevalence for AT need was 27.8% (2357) with an estimated population prevalence of 24.5% (95% CI: 23.5-25.4). Similarly, the sample prevalence of unmet needs was 9.7% (823) with an estimated population unmet needs of 8.0% (95% CI: 7.43-8.60). The unmet needs among persons with severe or total difficulties was 52.3% (278/532), and was higher among females, rural residents, and older persons. Spectacles were the most used products, followed by canes/sticks, tripods, and quadripods. Nearly two-thirds of AT users purchased assistive products at their own expense, particularly from the private sector. The inability to afford AT (36.9%) was the most common barrier. The results show that the need for AT was substantial in the study population, the highest being for seeing difficulties. The unmet needs are higher in females, older population, rural residents, and persons having serious difficulties. While the majority of users have to make out-of-pocket payments to obtain AT, inability to afford and limited availability were the common barriers among those with unmet needs. This research is non-commercial, and was conducted in the interest of public health. The authors have not declared any specific grant for this research.

Development and functional validation of tarsometatarsal prosthesis

Assistive Technology (AT) plays a crucial role in providing aid products, including prostheses to persons with disabilities. Tarsometatarsal (TMT) disarticulation, a type of partial foot amputation, is associated with complex gait disorders. However, there is limited research on the functional impact of TMT prostheses on gait. This study aims to develop and functionally validate a 3D-printed TMT prosthesis using finite element analysis and human motion laboratory studies. A 65-year-old patient with TMT amputation participated. Digital models of the amputated and healthy feet were obtained through 3D scanning. The prosthesis design was created using Fusion 360 software. Finite element analysis validated the prosthesis design. The prosthesis was manufactured using thermofusion printing with a biocompatible thermoplastic elastomer material. Functional validation included walking, running, and the Timed Up and Go test using motion analysis technologies. Finite element analysis demonstrated the structural integrity and safety of the TMT prosthesis during propulsion. The manufacturing process resulted in an adjustable and cost-effective prosthesis. Functional validation revealed improvements in gait quality, symmetry, and spatiotemporal parameters with the prosthesis. Vertical ground reaction forces during walking resembled the normal range, and running performance showed increased symmetry and propulsion velocity. The Timed Up and Go test showed that prostheses reduce time and improve efficiency. The development and functional validation of the 3D-printed TMT prosthesis offer a promising solution for individuals with TMT disarticulation. This approach addresses the need for assistive technologies in low-income countries with limited access to prostheses. Advanced technologies and a patient-centred approach contribute to improving mobility, gait patterns, and overall quality of life for individuals with partial foot amputations. Future research will focus on exploring additional parameters and developing new prostheses to further enhance gait improvements.

Development of BrailleBunny: a device to enhance braille learning

Purpose Braille use has been linked to higher rates of employment, education, financial self-sufficiency, and self-esteem. One area of the world particularly impacted by braille illiteracy is the Philippines. In 2016, Digital Learning for Development and All Children Reading released a “Grand Challenge for Development” that challenged researchers to address the need for assistive technologies to help children with sensory disabilities learn to read in the Philippines. The purpose of this research was to identify technical specifications, and then co-design and test a device that could be used both in developed and developing countries, specifically Canada and the Philippines. Methods An iterative, co-design process was undertaken to develop a prototypical device, BrailleBunny. The extent to which the device fulfilled the design criteria and directions for future development were determined through a series of case studies with 25 end-users. Results The prototypical device requires improvement in financial accessibility, durability and reliability. All other criteria were met. Conclusions Despite identified areas for improvement, the user feedback was positive, with the majority of users identifying that this device could provide transferrable learning to standard-size braille. With improvements, BrailleBunny, could be a valuable tool to increase the uptake of learning braille in the Philippines.

An IoT-Based Multimodal Real-Time Home Control System for the Physically Challenged: Design and Implementation

Physical impairments affect a significant proportion of the global populace, emphasizing the need for assistive technologies to increase the ability of these individuals to perform daily activities autonomously. This study discusses the development and implementation of a multimodal home control system, designed to afford physically challenged individuals greater control over their home environments. This system utilizes the Internet of Things (IoT) for its functionality. The system is primarily based on the utilization of the Amazon Alexa Echo Dot, which facilitates speech-based control, and a sequential clap recognition system, both made possible through an internet connection. These methods are further supplemented by an additional manual switching option, thereby ensuring a diverse range of control methods. The processing core of this system consists of an Arduino Uno and an ESP32 Devkit module. In conjunction with these, a sound detector is employed to discern and process a variety of clap patterns, which is set to function at a predefined threshold. The Amazon Alexa Echo Dot serves as the primary interface for voice commands and real-time information retrieval. Furthermore, an Android smartphone, equipped with the Alexa application, provides alternate interfaces for appliance control, through both soft buttons and voice commands. Based on an analysis of this system, it is suggested that it is not only viable but also effective. Key attributes of the system include rapid response times, aesthetic appeal, secure operation, low energy consumption, and most importantly, increased accessibility for physically disabled individuals.

Testing for acceptance of an assistive social robot for dementia and caregiving

AbstractBackgroundApproximately 5.8 million older adults in the U.S. are living with AD and it is estimated that by 2060, this number is projected to triple. People with AD often require high levels of care and assistance to maintain daily activities. The majority of care provided to a person living with AD or other forms of dementia is from a family caregiver, representing 18.6 billion hours of unpaid care valued at $244 billion. The long duration, time‐intensive nature of caregiving imposes high burdens on caregivers. There is a great need for assistive technologies and innovative solutions for the future of dementia care because of the increasing rise in adults with dementia.MethodA multidisciplinary team of faculty and undergraduate and graduate students was created to design a low‐cost social robot to serve as assistive companions for people with AD. Focus group meetings with caregivers and those with beginning stages of dementia were held, where the team worked in identifying the audience’s needs and robot’s responsibilities. Initial sketches were formulated before being brought to life in Fusion 360 as 3D CAD objects and printed using a 3D printer. Several rounds of iterations of the social robot’s body and user interfaces were created and two final robot designs were tested with undergraduate students (N = 15) for general attitudes of acceptance and feelings of overall experience.ResultResults from our user testing showed that users preferred one design more than another. Users wanted options in their interactions – having the ability to have speech conversation and touch‐screen abilities. Overall, the results from the user testing were positive, and the team is currently working on a final robot design before testing at nursing homes and assisted living facilities.ConclusionEstimated to be less than $300, our socially assistive robot holds promise to help address the disparity issues in the underserved.

Assistive technology: The current perspective in India.

The world, today, recognizes the increasing importance of assistive technology (AT) that can reduce the functional limitations of persons with disabilities, individuals with chronic debilitating diseases, and elders. This indicates that at some point, everyone, either temporary or permanent, will require AT to improve their physical and functional abilities, thus contributing to independent living, social inclusion, and education. Besides this, the need for AT will be growing with a majority from low-middle-income countries. The same is true for India though we are not sure how many people have met a need, and unmet need for AT to date, but the requirement will continue to increase. There is a significant gap between needs and access to AT. Recently, the WHO has led many initiatives related to AT services after the 71st World Health Assembly's resolution in 2018, to improve access to AT for its member states. The UN Sustainable Development Goals (SDGs) have pledged that no one should be left behind irrespective of personal characteristics. India, a ratified member state, needs to align with various initiatives undertaken by the WHO and the UN. Despite many challenges, India needs to formulate evidence-based AT policy, planning within the purview of the healthcare delivery system in collaboration with various government and nongovernment sectors, including industries. This article explores the need, access, and potential challenges associated with AT services in India. Finally, we discussed various initiatives on AT in the country and possible recommendations to improve AT services across.

Healthcare professionals’ perspectives on development of assistive technology using the comprehensive assistive technology model

ABSTRACT The implementation of technology in healthcare shows promising results and provides new opportunities in rehabilitation. However, the adoption of technology into daily care is largely dependent on the acceptance rate of end-users. This study aims to gather information from healthcare professionals on the development of new assistive technology that match users’ needs using the Comprehensive Assistive Technology model. In total 27 healthcare professionals (12 occupational therapists, 8 physiotherapists, 3 nurses, 2 allied health directors, a physician and a speech therapist) attended one of four online focus group discussions. These focus group discussions were structured using a question guide based on three predefined scenarios. Recordings were transcribed and data was analyzed using a thematic analysis (NVivo). Major themes identified in this study were safety, price and usability. Healthcare professionals focused on both functional capabilities of the user, as well as behavioral aspects of usability and attitude toward technology. Furthermore, the need for assistive technology that were catered toward the limitations in activity and user experience, was highlighted extensively. Based on information gathered from healthcare professionals a user-centered approach in development of safe, low-cost devices that maximize both functional outcomes and user acceptance, could potentially increase the adoption of new technology in rehabilitation.

Comprehensive Senior Technology Acceptance Model of Daily Living Assistive Technology for Older Adults With Frailty: Cross-sectional Study.

There are considerable gaps between the need for assistive technologies and the actual adoption of these technologies among older adults, although older adults are among the groups that most need assistive technologies. Consequently, research is needed in this area because older adults' technology acceptance and influencing factors may differ depending on their level of frailty. The objective of this study was to compare frail, prefrail, and robust groups of South Korean adults regarding their behavioral intention to use daily living assistive technologies and the affecting factors-namely, technological context factors, health contexts and abilities, and attitudinal factors-based on a comprehensive senior technology acceptance model. A nationwide sample of 500 older South Korean adults (aged 55-92 years) was analyzed, and multivariate linear regression analyses of the robust, prefrail, and frail groups were performed. The independent and dependent variables consisted of 3 factors based on previous studies. First, technological context factors consisted of gerontechnology self-efficacy, gerontechnology anxiety, and facilitating conditions. Second, health contexts and abilities consisted of self-reported health conditions, cognitive ability, social relationships, psychological function, and physical function. Third and last, attitudinal factors consisted of behavioral intention to use assistive technologies, attitude toward use, perceived usefulness (PU), and perceived ease of use (PEOU). The results of the analyses showed that technological context factors such as gerontechnology self-efficacy, health contexts and abilities such as self-reported health conditions and psychological function, and attitudinal factors such as attitude toward use, PU, and PEOU had significant effects on behavioral intention to use daily living assistive technologies. In particular, gerontechnology self-efficacy had a significant relationship with behavioral intention to use these technologies in the robust (r=0.120; P=.03) and prefrail (r=0.331; P<.001) groups. Psychological function (life satisfaction) had a significant relationship with behavioral intention to use these technologies in the robust group (r=-0.040; P=.02). Self-reported health conditions had a significant relationship with behavioral intention to use these technologies in the prefrail group (r=-0.169; P=.01). Although each group had a different significant relationship with the variables, attitudinal factors such as attitude toward use affected all groups (robust group: r=0.190; P=.03; prefrail group: r=0.235; P=.006; and frail group: r=0.526; P=.002). In addition, PU and PEOU in the attitudinal factors had a significant relationship with behavioral intention to use assistive technologies in the robust (PU: r=0.160; P=.01; and PEOU: r=0.350; P<.001) and prefrail (PU: r=0.265; P<.001; and PEOU: r=0.120; P=.04) groups. This study found that the comprehensive senior technology acceptance model of daily living assistive technologies had different associations according to the frailty group. These findings provided insights into the consideration of interventions with daily living assistive technologies for older adults with varying levels of frailty.

Assistive technology access in longitudinal datasets: a global review.

Functional limitations become more prevalent as populations age, emphasising an increasingly urgent need for assistive technology (AT). Critical to meeting this need trajectory is understanding AT access in older ages. Yet few publications examine this from a longitudinal perspective. This review aims to identify and collate what data exist globally, seeking all population-based cohorts and repeated cross-sectional surveys through the Maelstrom Research Catalogue (searched May 10, 2022) and the Disability Data Report (published 2022), respectively. Datasets incorporating functional limitations modules and question(s) dedicated to AT, with a wave of data collection since 2009, were included. Of 81 cohorts and 202 surveys identified, 47 and 62 meet inclusion criteria, respectively. Over 40% of cohorts were drawn from high-income countries which have already experienced significant population ageing. Cohorts often exclude participants based on pre-existing support needs. For surveys, Africa is the most represented region (40%). Globally, 73% of waves were conducted since 2016. 'Use' is the most collected AT access indicator (69% of cohorts and 85% of surveys). Glasses (78%) and hearing aids (77%) are the most represented AT. While gaps in data coverage and representation are significant, collating existing datasets highlights current opportunities for analyses and methods for improving data collection across the sector.

A computer interface controlled by upper limb muscles: effects of a two weeks training on younger and older adults.

As the population worldwide ages, there is a growing need for assistive technology and effective human-machine interfaces to address the wider range of motor disabilities that older adults may experience. Motor disabilities can make it difficult for individuals to perform basic daily tasks, such as getting dressed, preparing meals, or using a computer. The goal of this study was to investigate the effect of two weeks of training with a myoelectric computer interface (MCI) on motor functions in younger and older subjects. Twenty people were recruited in the study: thirteen younger (range: 22-35 years old) and seven older (range: 61-78 years old) subjects. Participants completed six training sessions of about 2 hours each, during which the activity of right and left biceps and trapezius were mapped into a control signal for the cursor of a computer. Results highlighted significant improvements in cursor control, and therefore in muscle coordination, in both groups. All participants with training became faster and more accurate, although people in different age range learned with a different dynamic. Results of the questionnaire on system usability and quality highlighted a general consensus about easiness of use and intuitiveness. These findings suggest that the proposed MCI training can be a powerful tool in the framework of assistive technologies for both younger and older subjects groups. Further research is needed to determine the optimal duration and intensity of MCI training for different age groups and to investigate long-term effects of training on physical and cognitive function.

Listening to the Voice of People with Vision Impairment

Extensive research developed assistive technologies (ATs) to improve mobility for people with vision impairment (PVI). However, a limited number of PVI rely on ATs for mobility. One of the factors contributing to the limited reliability and low acceptance of ATs is the developers’ failure to consider PVI mobility traits from the target group’s perspective. Many developers and researchers proposed solutions based on their knowledge and experiences, where PVI have been excluded from several studies except for limited involvement in testing phases. Accordingly, this study aims to bridge this gap by providing comprehensive information on PVIs’ behaviors, challenges, and requirements for safe and independent outdoor mobility. Therefore, a total of 15 participants with vision impairment were involved in semi-structured interviews and two observation sessions. One key finding highlights the need for AT that complements the conventional cane and overcomes its limitations, not substituting the cane. Moreover, the proposed AT should address instant mobility and future needs simultaneously. Overall, the study contributes to providing comprehensive knowledge on PVI safe and independent mobility traits, which assist AT developers to explore the potential barriers and facilitators of the adoption of ATs among PVIs and leads to develop effective and reliable ATs that meet their needs. For future work, the researchers will develop an AT that complements the conventional cane, supports instant mobility, and enhances cognitive map formation.

Evaluation and intention to use the interactive robotic kitchen system AuRorA in older adults.

BackgroundThe number of older adults in need of care and living at home is increasing in Europe. At the same time, the number of professional caregivers is decreasing. This development reinforces the need for assistive technology to support care recipients in their own homes and promote their independence. One of the main challenges of independent living is the preparation of food. Interactive robots could assist older adults with difficulties performing physically demanding tasks. Within the project AuRorA (full German project title: Wiederverwendbare, interaktive Verhalten für proaktive Roboter im Smart Home), an interactive voice-controlled robot arm was developed as an assistance system in the kitchen.ObjectiveThe aim of the study was to assess how older adults evaluate the AuRorA system and to collect data on actual willingness to use the technology. Older adults were asked to evaluate the system in terms of usefulness, usability, accessibility and intention to use.Material and methodsDue to the ongoing coronavirus disease 2019 (COVID-19) pandemic, the older adults evaluated the system via an online survey. The validated questionnaire Technology Usage Inventory (short: TUI) was used in conjunction with self-developed questionnaires to collect data on study population characteristics.ResultsA total of 106 participants were included in the analysis. The acceptance, usability and usefulness of the system were rated as medium, while the intention to use was rated as low. A significant strong correlation was found between the TUI subscales intention to use and usefulness.ConclusionIt can be assumed that the actual need of the individual participant for such a robotic assistive system had an influence on the evaluation of the system. The perceived usefulness may have been a crucial influence on the intention to use and the overall assessment of the system.Supplementary InformationThe online version of this article (10.1007/s00391-022-02105-8) contains supplementary material, which is available to authorized users.

How digital fabrication technologies within digitalized innovation environments lead to participative aid development

PurposeFacilities such as FabLabs and Makerspaces are characterized by the facilities' wide range of digital fabrication technologies as well as facilities' interdisciplinary user base and collaborative problem solving and product development. These possibilities can also hold great potential for people with disabilities who have a specific need for assistive technology. Since there are no established models of such participatory development processes (PDP) within digitalized innovation environments (DIE), this study intends to provide a comprehensive understanding of these processes along with the influencing factors.Design/methodology/approachThrough a cooperation with a Thalidomide Association, various PDPs were accompanied within a DIE and interviews were conducted with 16 stakeholders involved. Hereby, the perspective of thalidomide-affected people (5) as well as the supporting makers (6) and experts (5) were taken into account. Through a subsequent structured analysis, various dimensions as well as relevant influencing factors could be identified.FindingsIn total, 33 paraphrases could be formed in 8 categories and four dimensions concerning the PDPs investigated. In addition, 17 paraphrases on potentials and challenges could be extracted through generalization.Originality/valueDue to findings' holistic approach, the findings form an empirical basis for further research into this still very young research topic and represent a first step toward theory building. By the applicability of the identified influencing factors an important contribution can be made to the supply of aids and the inclusion of people with disabilities.Peer reviewThe peer review history for this article is available at: https://publons.com/publon 10.1108/JET-01-2022-0013

Restorative rehabilitation robotics to promote function, independence and dignity: users’ perspectives on clinical applications

People with mobility impairments have reported that improving their walking is one of the most important goals of their rehabilitation. Novel robotic technologies using powered exoskeletons for the lower limb could potentially offer efficient and less labour-intensive approaches to rehabilitation with shorter recovery times. To gather users’ and carers’ perspectives of assistive device use to provide information to design personalised and safe mobility rehabilitation technology. Semi-structured interviews were carried out with people with experience of mobility impairments. Iterative data collection was used to gather information about the social phenomena surrounding patient interaction and requirements for assistive devices for mobility impairments. Cycles of continuous data collection and thematic analysis using a theoretical, semantic approach was used to develop key themes within the data. We interviewed eight people: six people with mobility impairments and two carers. We identified five main themes: relationship with assistive technology, requirements for assistive technology, function and goal setting, personal factors to assistive device use and psychosocial factors to assistive device use. There was variability in the importance placed on each theme, particularly in the trade-off between the function and comfort of assistive technology. Patients emphasised the need for assistive technology to be personalised; they reported the ability to stand, control spasticity and involvement in community roles as key goals of their rehabilitation. These results highlight the variation in requirements for assistive technology between people with different mobility impairments; individuals’ experiences are unique and future prototypes need to account for different levels of impairments and personal goals. These findings will also inform the user evaluation stage of assistive device testing. The acceptability of assistive devices is dependent upon a number of factors, including personalisation, comfort and function. Future pilot studies should gather qualitative data to determine the acceptability of actual device use.

Age related increase in impairment across the life course: the use of Zomba curves to estimate assistive technology needs in Malawi

Purpose Global population growth and increasing longevity means that the need for Assistive Technology (AT) will continue to increase. The level of unmet need for AT is greatest in low-income settings. The aim of this study is to identify age-related increase in impairment and to estimate the AT needs. Materials and Methods We analysed secondary data from the 2018 Malawi Population and Housing Census (MPHC) based on the Washington Group on Disability Statistics (WG) short-set of questions. Results Out of the 1,556,670 persons with one or more functional limitations or disabilities identified in the census, self-reported difficulties in all domains were markedly higher from age 40 and above. The proportion reporting one functional limitation is higher compared to two or more limitations, but at age 78–80 the proportion reporting two or more functional limitations increased above those reporting one functional limitation. Although 60.9% (60.7–61.0) and 63.5% (63.3–63.6) of those who reported difficulty in seeing and hearing were using glasses and hearing aids respectively, the estimated total need for glasses and hearing aids in this group was 98.9% (98.0–99.0) and 98.4% (98.3–98.5) respectively. The unmet need for glasses and hearing aids were therefore 38.1% and 34.9% respectively. Conclusion The differential slope of impairment curves against age is a guide to the increasing demand for AT across the life course and across different domains of functioning. Country specific analysis of impairment across age and domains is essential to understand and plan for the growing need for AT globally. IMPLICATIONS FOR REHABILITATION It is important to estimate and plan for impairment across life course to address the age-related increase in impairment and the increasing need for AT with age. The Zomba curves show the cumulative nature of impairment with age and the need for age and need specific provision of AT across the life course through proactive policy level actions. The significant high unmet need for glasses and hearing aids attests to similar need for other assistive products and the need for setting specific interventions to address needs of affected persons. The differential slope of impairment curves against age is a guide to the differing and increasing demand for assistive technology across the life course and across different domains of functioning

The informal economy as a provider of assistive technology: lessons from Indonesia and Sierra Leone.

Promoting the use of assistive technology (AT) is crucial for the health and well-being of users, but there is a huge global problem of unmet need for AT. In this context informal (unregulated) providers of AT play a significant role of meeting AT user need, particularly in less-resourced settings. This study draws on research into formal and informal AT provision in low-income urban communities in Indonesia and Sierra Leone to explore the potential of informal providers in addressing unmet need. Specifically, it looks at the different performance of formal and informal providers regarding the availability and the adequacy of AT that they provide. The study concludes by proposing further research into the scope for coproduction of AT between formal and informal providers.

Meeting AT needs in humanitarian crises: The current state of provision

ABSTRACT Humanitarian coordination systems increasingly recognize and aim to respond to the needs of people with disabilities within populations affected by crises, spurred on by the UN Convention on the Rights of Persons with Disabilities (CRPD) which was adopted in 2006. Many agencies state their aim to meet the requirements of the CRPD using a “twin track” approach: ensuring the inclusion of people with disabilities in mainstream provision, alongside targeted support for their needs, which may include the need for Assistive Technology (AT). However, there is very little evidence of AT provision in humanitarian settings, which is a specific and urgent need for many people including the elderly and people with disabilities, and an implicit requirement of Article 11 of the CRPD and World Health Assembly resolution on improving access to assistive technology. There is also little evidence of effective mechanisms for AT provision in humanitarian settings. This is despite high and growing levels of unmet AT need in crises, and despite the legally binding requirement in the CRPD to provide AT for those who need it. AT provision faces unique challenges in humanitarian settings. This paper discusses the evidence available in the literature for the scale and quality of AT provision interventions in crises, and what is known about the challenges and facilitators of provision. We conducted a search of the academic literature and retained literature that reported on any form of AT provision following crisis, where international humanitarian response was in place, published in English between January 2010 and June 2020. We found very few examples in that academic literature of systematic and coordinated AT provision at the acute stage of crisis, and even less in the preparedness and post-acute stages. However, it is difficult to assess whether this is the result of insufficient academic attention or reflects a lack of provision. The small body of academic literature that describes AT provision in humanitarian settings paints a picture of small-scale provision, specialized to single types of impairments, and delivered by predominantly by NGOs. We also conducted a search of the gray literature, using the same inclusion criteria, in two countries: Afghanistan and South Sudan (case studies forthcoming). This gray literature provided supplementary evidence of the types of AT providers and AT provision available in those protracted crises. There are very few examples of how AT services can be scaled up (from a very low baseline) and maintained sustainably within a strengthened health system. The literature also describes more examples of provision of assistive products for mobility over assistive products for other impairments. If the paucity of literature on AT provision in humanitarian settings is a reflection of the scale of provision, this implies a deficiency in humanitarian response when it comes to providing people with AT needs with the essential products and services to which they have a right, and which will enable their access to basic, life-saving assistance. We conclude by providing recommendations for urgent actions that the AT and humanitarian community must take to fill this critical gap in the provision of essential products and services for a potentially marginalized and excluded group.

Inclusive education: The case for early identification and early intervention in assistive technology

ABSTRACT This paper starts by presenting the argument that inclusive education for learners with disabilities is often not possible without their access to fit-for-purpose assistive technology (AT), as the barriers to their education are often environmental. The paper will argue that, if assistive technology is an enabler for learning, then the processes by which children with disabilities are identified as users of assistive technology must take place as early as possible in the lifecycle. Mechanisms associated with Early Identification and Early Intervention (EI/EI) must be outfitted with all necessary resources for identifying and addressing the unique assistive technology needs of each individual child, but also have a prospective view of the use of the assistive technology in order to ensure school-age children start benefiting from assistive technology as early as possible. A further argument will be made that, when adequate identification of the need for assistive technology has not taken place early, education systems must be prepared to – in collaboration with other ministries or departments – identify, assess and provide the necessary assistive technology not only as it relates to education use, but to all-inclusive and holistic use. The argument will be made for adequately resourcing “support services for inclusion” and creating transdisciplinary teams of professionals that can effectively ensure equitable access and participation of all children with disabilities in inclusive education. Throughout, some examples of good practices will support the narrative, and the paper will close with recommendations for stakeholders involved in developing policies and practices for inclusive education.

The relationship between unmet need for home and community-based services and health and community living outcomes

BackgroundFew studies have examined user-reported perspectives about the quality and sufficiency of home and community-based services (HCBS) and their relationship to key health and community living outcomes. ObjectiveTo examine the association between unmet need for HCBS and health and community living outcomes in a multi-state, multi-program sample of Medicaid HCBS users. MethodsWe used data from the 2017–2018 National Core Indicators-Aging and Disability (NCI-AD) survey, collected among older adults and adults with physical disabilities who were receiving Medicaid HCBS across 13 states (N = 10,263). We conducted descriptive analysis on the demographic, functional, and health characteristics of the sample, and examined the prevalence of unmet need for HCBS across five domains: 1) assistance with daily activities, 2) assistive technology, 3) home modifications, 4) transportation, and 5) sufficiency of services for meeting user needs and goals. We used logistic regressions to estimate adjusted odds ratios for the association between unmet need for HCBS and health care utilization (ED visits, hospital/rehab stays, preventative care) and community living outcomes (active in the community, interacting with family/friends, satisfaction, control). ResultsAcross the five domains, prevalence of unmet need ranged from 21% (unmet need for assistance with self-care or other daily activities) to 54% (unmet need for assistive technology). Individuals who experienced unmet need had consistently worse health and community living outcomes than those who reported no unmet need, after adjusting for key user demographic, functional, and social characteristics (p < 0.05). ConclusionsUnmet need for HCBS is consistently and significantly associated with poor health and community living outcomes among Medicaid users.