Assistive technology

Main article: Mobility aid

Main article: Wheelchair

Main article: Patient lift

Main article: Walker

Main article: .

Prostheses are specifically not

orthoses

, although given certain circumstances a prosthesis might end up performing some or all of the same functionary benefits as an orthosis. Prostheses are technically the complete finished item. For instance, a C-Leg knee alone is not a prosthesis, but only a prosthetic component. The complete prosthesis would consist of the attachment system  to the residual limb – usually a "socket", and all the attachment hardware components all the way down to and including the terminal device. Despite the technical difference, the terms are often used interchangeably.

The terms "prosthetic" and "orthotic" are adjectives used to describe devices such as a prosthetic knee. The terms "prosthetics" and "orthotics" are used to describe the respective allied health fields.

An Occupational Therapist's role in prosthetics include therapy, training and evaluations.[20] Prosthetic training includes orientation to prosthetics components and terminology, donning and doffing, wearing schedule, and how to care for residual limb and the prosthesis.^[20]

A powered exoskeleton is a wearable mobile machine that is powered by a system of electric motors, pneumatics, levers, hydraulics, or a combination of technologies that allow for limb movement with increased strength and endurance. Its design aims to provide back support, sense the user's motion, and send a signal to motors which manage the gears. The exoskeleton supports the shoulder, waist and thigh, and assists movement for lifting and holding heavy items, while lowering back stress.

People with balance and motor function challenges often need specialized equipment to sit or stand safely and securely.^[21] This equipment is frequently specialized for specific settings such as in a classroom or nursing home.^[22][23]  Positioning is often important in seating arrangements to ensure that user's body pressure is distributed equally without inhibiting movement in a desired way.^[24]

Positioning devices have been developed to aid in allowing people to stand and bear weight on their legs without risk of a fall.  These standers are generally grouped into two categories based on the position of the occupant.^[25]  Prone standers distribute the body weight to the front of the individual and usually have a tray in front of them.  This makes them good for users who are actively trying to carry out some task.  Supine standers distribute the body weight to the back and are good for cases where the user has more limited mobility or is recovering from injury.

Children with severe disabilities can develop learned helplessness, which makes them lose interest in their environment. Robotic arms are used to provide an alternative method to engage in joint play activities.^[26] These robotic arms allow children to manipulate real objects in the context of play activities.

Children with disabilities have challenges in accessing play and social interactions.^[27] Play is essential for the physical, emotional, and social well-being of all children.^[28] The use of assistive technology has been recommended to facilitate the communication, mobility, and independence of children with disabilities.^[29] Augmentative Alternative Communication (AAC) devices have been shown to facilitate the growth and development of language as well as increase rates of symbolic play in children with cognitive disabilities.^[30][31] AAC devices can be no-tech (sign language and body language), low-tech (picture boards, paper and pencils), or high-tech (tablets and speech generating devices).^[29] The choice of AAC device is very important and should be determined on a case-by-case basis by speech therapists and assistive technology professionals. The early introduction of powered mobility has been shown to positively impact the play and psychosocial skills of children who are unable to move independently.^[32] Powered cars, such as the Go Baby Go program, have emerged as a cost-effective means of facilitating the inclusion of children with mobility impairments in school.^[33]

Many people with serious visual impairments live independently, using a wide range of tools and techniques. Examples of assistive technology for visually impairment include screen readers, screen magnifiers, Braille embossers, desktop video magnifiers, and voice recorders.

Screen readers are used to help the visually impaired to easily access electronic information. These software programs run on a computer to convey the displayed information through voice (

) in combination with magnification for low vision users in some cases. There are a variety of platforms and applications available for a variety of costs with differing feature sets.

Some example of screen readers are Apple

Microsoft Narrator

.

Screen readers may rely on the assistance of text-to-speech tools. To use the text-to-speech tools, the documents must be in an electronic form, which is uploaded as the digital format. However, people usually will use the hard copy documents scanned into the computer, which cannot be recognized by the text-to-speech software. To solve this issue, people often use Optical Character Recognition technology accompanied with text-to-speech software.

Braille is a system of raised dots formed into units called braille cells. A full braille cell is made up of six dots, with two parallel rows of three dots, but other combinations and quantities of dots represent other letters, numbers, punctuation marks, or words. People can then use their fingers to read the code of raised dots. Assistive technology using braille is called braille technology.

A braille translator is a computer program that can translate

into braille or braille into inkprint. A braille translator can be an app on a computer or be built into a website, a smartphone, or a braille device.

A braille embosser is, simply put, a printer for braille. Instead of a standard printer adding ink onto a page, the braille embosser imprints the raised dots of braille onto a page. Some braille embossers combine both braille and ink so the documents can be read with either sight or touch.

A refreshable braille display or braille terminal is an electro-mechanical device for displaying braille characters, usually by means of round-tipped pins raised through holes in a flat surface. Computer users who cannot use a computer monitor use it to read a braille output version of the displayed text.

Desktop video magnifiers are electronic devices that use a camera and a display screen to perform digital magnification of printed materials. They enlarge printed pages for those with low vision. A camera connects to a monitor that displays real-time images, and the user can control settings such as magnification, focus, contrast, underlining, highlighting, and other screen preferences. They come in a variety of sizes and styles; some are small and portable with handheld cameras, while others are much larger and mounted on a fixed stand.

A screen magnifier is software that interfaces with a computer's graphical output to present enlarged screen content. It allows users to enlarge the texts and graphics on their computer screens for easier viewing. Similar to desktop video magnifiers, this technology assists people with low vision. After the user loads the software into their computer's memory, it serves as a kind of "computer magnifying glass". Wherever the computer cursor moves, it enlarges the area around it. This allows greater computer accessibility for a wide range of visual abilities.

A large-print keyboard has large letters printed on the keys. On the keyboard shown, the round buttons at the top control software which can magnify the screen (zoom in), change the background color of the screen, or make the mouse cursor on the screen larger. The "bump dots" on the keys, installed in this case by the organization using the keyboards, help the user find the right keys in a tactile way.

Assistive technology for navigation has expanded on the IEEE Xplore database since 2000, with over 7,500 engineering articles written on assistive technologies and visual impairment in the past 25 years, and over 1,300 articles on solving the problem of navigation for people who are blind or visually impaired. As well, over 600 articles on augmented reality and visual impairment have appeared in the engineering literature since 2000. Most of these articles were published within the past five years^[when?], and the number of articles in this area is increasing every year. GPS, accelerometers, gyroscopes, and cameras can pinpoint the exact location of the user and provide information on what is in the immediate vicinity, and assistance in getting to a destination.

Wearable technology are smart electronic devices that can be worn on the body as an implant or an accessory. New technologies are exploring how the visually impaired can receive visual information through wearable devices.^[34]

Some wearable devices for visual impairment include: OrCam device, eSight and Brainport.

manual dexterity disability is making choices on a touchscreen

with a head dauber.

Personal emergency response systems (PERS), or Telecare (UK term), are a particular sort of assistive technology that use electronic sensors connected to an alarm system to help caregivers manage risk and help vulnerable people stay independent at home longer. An example would be the systems being put in place for senior people such as fall detectors, thermometers (for hypothermia risk), flooding and unlit gas sensors (for people with mild dementia). Notably, these alerts can be customized to the particular person's risks. When the alert is triggered, a message is sent to a caregiver or contact center who can respond appropriately.

In human–computer interaction, computer accessibility (also known as accessible computing) refers to the accessibility of a computer system to all people, regardless of disability or severity of impairment, examples include web accessibility guidelines.^[35] Another approach is for the user to present a token to the computer terminal, such as a smart card, that has configuration information to adjust the computer speed, text size, etc. to their particular needs. This is useful where users want to access public computer based terminals in Libraries, ATM, Information kiosks etc. The concept is encompassed by the CEN EN 1332-4 Identification Card Systems – Man-Machine Interface.^[36] This development of this standard has been supported in Europe by SNAPI and has been successfully incorporated into the Lasseo specifications, but with limited success due to the lack of interest from public computer terminal suppliers.

People in the deaf and hard of hearing community have a more difficult time receiving auditory information as compared to hearing individuals. These individuals often rely on visual and tactile mediums for receiving and communicating information. The use of assistive technology and devices provides this community with various solutions to auditory communication needs by providing higher sound (for those who are hard of hearing), tactile feedback, visual cues and improved technology access. Individuals who are deaf or hard of hearing use a variety of assistive technologies that provide them with different access to information in numerous environments.^[37] Most devices either provide amplified sound or alternate ways to access information through vision and/or vibration. These technologies can be grouped into three general categories: Hearing Technology, alerting devices, and communication support.

A hearing aid or deaf aid is an electro-acoustic device which is designed to amplify sound for the wearer, usually with the aim of making speech more intelligible, and to correct impaired hearing as measured by audiometry. This type of assistive technology helps people with hearing loss participate more fully in their hearing communities by allowing them to hear more clearly. They amplify any and all sound waves through use of a microphone, amplifier, and speaker. There is a wide variety of hearing aids available, including digital, in-the-ear, in-the-canal, behind-the-ear, and on-the-body aids.

Assistive listening devices include FM, infrared, and loop assistive listening devices. This type of technology allows people with hearing difficulties to focus on a speaker or subject by getting rid of extra background noises and distractions, making places like auditoriums, classrooms, and meetings much easier to participate in. The assistive listening device usually uses a microphone to capture an audio source near to its origin and broadcast it wirelessly over an FM (Frequency Modulation) transmission, IR (Infra Red) transmission, IL (Induction Loop) transmission, or other transmission methods. The person who is listening may use an FM/IR/IL Receiver to tune into the signal and listen at his/her preferred volume.

This type of assistive technology allows users to amplify the volume and clarity of their phone calls so that they can easily partake in this medium of communication. There are also options to adjust the frequency and tone of a call to suit their individual hearing needs. Additionally, there is a wide variety of amplified telephones to choose from, with different degrees of amplification. For example, a phone with 26 to 40 decibel is generally sufficient for mild hearing loss, while a phone with 71 to 90 decibel is better for more severe hearing loss.^[38]

Augmentative and alternative communication (AAC) is an umbrella term that encompasses methods of communication for those with impairments or restrictions on the production or comprehension of spoken or written language.

Cognitive impairments

Assistive Technology for Cognition (ATC)^[41] is the use of technology (usually high tech) to augment and assist cognitive processes such as attention, memory, self-regulation, navigation, emotion recognition and management, planning, and sequencing activity. Systematic reviews of the field have found that the number of ATC are growing rapidly, but have focused on memory and planning, that there is emerging evidence for efficacy, that a lot of scope exists to develop new ATC.^[42] Examples of ATC include: NeuroPage which prompts users about meetings,^[43] Wakamaru, which provides companionship and reminds users to take medicine and calls for help if something is wrong, and telephone Reassurance systems.^[44]

Memory aids are any type of assistive technology that helps a user learn and remember certain information. Many memory aids are used for cognitive impairments such as reading, writing, or organizational difficulties. For example, a Smartpen records handwritten notes by creating both a digital copy and an audio recording of the text. Users simply tap certain parts of their notes, the pen saves it, and reads it back to them. From there, the user can also download their notes onto a computer for increased accessibility. Digital voice recorders are also used to record "in the moment" information for fast and easy recall at a later time.^[45]

A 2017 Cochrane Review highlighted the current lack of high-quality evidence to determine whether assistive technology effectively supports people with dementia to manage memory issues.^[46] Thus, it is not presently sure whether or not assistive technology is beneficial for memory problems.

Educational software is software that assists people with reading, learning, comprehension, and organizational difficulties. Any accommodation software such as text readers, notetakers, text enlargers, organization tools,

, and talking word processors falls under the category of educational software.

Adaptive eating devices include items commonly used by the general population like spoons and forks and plates. However they become assistive technology when they are modified to accommodate the needs of people who have difficulty using standard cutlery due to a disabling condition. Common modifications include increasing the size of the utensil handle to make it easier to grasp. Plates and bowls may have a guard on the edge that stops food being pushed off of the dish when it is being scooped. More sophisticated equipment for eating includes manual and powered feeding devices. These devices support those who have little or no hand and arm function and enable them to eat independently.

Assistive technology in sports is an area of technology design that is growing. Assistive technology is the array of new devices created to enable sports enthusiasts who have disabilities to play. Assistive technology may be used in

, where an existing sport is modified to enable players with a disability to participate; or, assistive technology may be used to invent completely new sports with athletes with disabilities exclusively in mind.

An increasing number of people with disabilities are participating in sports, leading to the development of new assistive technology.^[47] Assistive technology devices can be simple, or "low-technology", or they may use highly advanced technology. "Low-tech" devices can include velcro gloves and adaptive bands and tubes. "High-tech" devices can include all-terrain wheelchairs and adaptive bicycles.^[48] Accordingly, assistive technology can be found in sports ranging from local community recreation to the elite Paralympic Games. More complex assistive technology devices have been developed over time, and as a result, sports for people with disabilities "have changed from being a clinical therapeutic tool to an increasingly competition-oriented activity".^[49]

In the United States there are two major pieces of legislation that govern the use of assistive technology within the school system. The first is Section 504 of the Rehabilitation Act of 1973 and the second being the Individuals with Disabilities Education Act (IDEA) which was first enacted in 1975 under the name The Education for All Handicapped Children Act. In 2004, during the reauthorization period for IDEA, the National Instructional Material Access Center (NIMAC) was created which provided a repository of accessible text including publisher's textbooks to students with a qualifying disability. Files provided are in XML format and used as a starting platform for braille readers, screen readers, and other digital text software.^[50] IDEA defines assistive technology as follows: "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 a child with a disability. (B) Exception.--The term does not include a medical device that is surgically implanted, or the replacement of such device."^[51]

Assistive technology listed is a student's IEP is not only recommended, it is required (Koch, 2017).^[52] These devices help students both with and without disabilities access the curriculum in a way they were previously unable to (Koch, 2017).^[52] Occupational therapists play an important role in educating students, parents and teachers about the assistive technology they may interact with.^[52]

Assistive technology in this area is broken down into low, mid, and high tech categories. Low tech encompasses equipment that is often low cost and does not include batteries or requires charging. Examples include adapted paper and pencil grips for writing or masks and color overlays for reading. Mid tech supports used in the school setting include the use of handheld spelling dictionaries and portable word processors used to keyboard writing. High tech supports involve the use of tablet devices and computers with accompanying software. Software supports for writing include the use of auditory feedback while keyboarding, word prediction for spelling, and

. Supports for reading include the use of text to speech (TTS) software and font modification via access to digital text. Limited supports are available for math instruction and mostly consist of grid based software to allow younger students to keyboard equations and auditory feedback of more complex equations using MathML and Daisy.

One of the largest problems that affect disabled people is discomfort with prostheses.^[53] An experiment performed in Massachusetts used 20 people with various sensors attached to their arms.^[53] The subjects tried different arm exercises, and the sensors recorded their movements. All of the data helped engineers develop new engineering concepts for prosthetics.^[53]

Assistive technology may attempt to improve the ergonomics of the devices themselves such as

Assistive technology devices have been created to enable disabled people to use modern touch screen mobile computers such as the

Apple VoiceOver

feature in combination with a basic switch. This brings touch screen technology to those who were previously unable to use it. Apple, with the release of iOS 7 had introduced the ability to navigate apps using switch control. Switch access could be activated either through an external bluetooth connected switch, single touch of the screen, or use of right and left head turns using the device's camera. Additional accessibility features include the use of Assistive Touch which allows a user to access multi-touch gestures through pre-programmed onscreen buttons.

For users with physical disabilities a large variety of switches are available and customizable to the user's needs varying in size, shape, or amount of pressure required for activation. Switch access may be placed near any area of the body which has consistent and reliable mobility and less subject to fatigue. Common sites include the hands, head, and feet. Eye gaze and head mouse systems can also be used as an alternative mouse navigation. A user may use single or multiple switch sites and the process often involves a scanning through items on a screen and activating the switch once the desired object is highlighted.

The form of

Assistive technology and innovation

Innovation is happening in assistive technology either through improvements to existing devices or the creation of new products.

In the

reality) or by the inclusion of implantable products/components. Such emerging assistive products are either more sophisticated or more functional versions of conventional assistive products, or completely novel assistive devices.

For instance, in conventional self-care assistive technology, technologies involved typically include adaptive clothing, adaptive eating devices, incontinence products, assistive products for manicure, pedicure, hair and facial care, dental care, or assistive products for sexual activities. In comparison, emerging self-care assistive technologies include health and emotion monitoring, smart diapers, smart medication dispensing and management or feeding assistant robot. Although the distinction between conventional and emerging technologies is not always clear-cut, emerging assistive technology tends to be "smarter", using AI and being more connected and interactive, and including body-integrated solutions or components.

To a great extent this « conventional » versus « emerging » classification is based on the WHO's Priority Assistive Products List^[58] and the ISO 9999^[59] standard for assistive products for persons with disabilities, the APL delineating the absolute minimum that countries should be offering to their citizens and ISO 9999 defining those products which are already well established in the market.

This "well-established status" is reflected in the patent filings between 2013 and 2017.

.

In the past, the top patent offices for filing, and therefore perceived target markets, in assistive technology have been the

. This pattern is observed for both conventional and emerging assistive technology, with China's annual filings surpassing those of the U.S. in 2008 for conventional and 2014 for emerging assistive technology. Patent filings related to conventional assistive technology have also declined in Europe, especially in Germany, France, the Netherlands and Norway.

Patenting activity indicates the amount of interest and the investment made in respect to an invention's applicability and its commercialization potential. There is typically a lag between filing a patent application and commercialization, with a product being classified in various stages of readiness levels, research concept, proof of concept, minimum viable product and finally commercial product. According to the 2021 WIPO report,^[57] the emerging technologies closest to a fully commercial product were for example:

• myoelectric control of advanced prosthetics and wheelchair control (mobility),
• environment-controlling hearing aids (hearing),
• multifocal intraocular lenses and artificial retina, along with Virtual and Augmented Reality wearables (vision);
• smart assistants and navigation aids (communication);
• smart home appliances (environment);
• medication management
  and smart diapers (self-care).

The technology readiness level and the related patenting activity can also be explained through the following factors which contribute to a product's entry to market, such as the expected impact on a person's participation in different aspects of life, the ease of adoption (need for training, fitting, additional equipment for interoperability, and so on), the societal acceptance and potential ethical concerns, and the need for regulatory approval. This is mainly the case for assistive technology that qualifies as medical technology.

Among these aspects, acceptability and ethical considerations are particularly relevant to those technologies that are extremely invasive (such as cortical or auditory brainstem implants), or replace the human caregiver and human interaction, or collect and use data on cloud-based services or interconnected devices (e.g., companion robots, smart nursing and health-monitoring technologies), raising privacy issues and requiring connectivity, or raise safety concerns, such as autonomous wheelchairs.

Beyond the patent landscape,

). Design often plays a role after the patenting activity, as a product needs to be re-designed for mass production.

Overall, assistive technology aims to allow disabled people to "participate more fully in all aspects of life (home, school, and community)" and increases their opportunities for "education, social interactions, and potential for meaningful employment".^[61] It creates greater independence and control for disabled individuals. For example, in one study of 1,342 infants, toddlers and preschoolers, all with some kind of developmental, physical, sensory, or cognitive disability, the use of assistive technology created improvements in child development.^[62] These included improvements in "cognitive, social, communication, literacy, motor, adaptive, and increases in engagement in learning activities".^[63] Additionally, it has been found to lighten caregiver load.^[64] Both family and professional caregivers benefit from assistive technology. Through its use, the time that a family member or friend would need to care for a patient significantly decreases. However, studies show that care time for a professional caregiver increases when assistive technology is used. Nonetheless, their work load is significantly easier as the assistive technology frees them of having to perform certain tasks.^[65] There are several platforms that use machine learning to identify the appropriate assistive device to suggest to patients, making assistive devices more accessible.^[66]

In 1988 the

Since this grant, many others have been written.

Shortage of both paid personal assistants and available family members makes artificial assistance a necessity.

rATA Tool by World Health Organization

The rapid assistive technology assessment (rATA) is a tool developed by World Health Organization in order to undertake household surveys which can measure various parameters needed to access assistive technology and to make informed policies for governments around the world.^[69][70]

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External links

• WHO fact sheet on assistive technology