A comparison of assistive technologies in the EU: "Technology solutions must keep social context in mind"

Digitization continues to advance – whether we are able to keep up is presently up to politicians. For people with disabilities, assistive technologies can be useful helpers that make everyday life, work and education easier. Meanwhile, accessibility also plays a major role. People are still excluded from using the internet to the full extent or benefiting from digital tools because their needs were not considered during the development stage. For one year, a study by the Institute for Technology Assessment and Systems Analysis (ITAS) at the Karlsruhe Institute of Technology (KIT) focused on assistive technologies and their benefits in four different European countries, and was able to identify fundamental differences in the general approach to people with disabilities.

In this REHACARE.com interview, project manager Linda Nierling and her colleague Maria Maia detailed these for us, described where Germany has some catching up to do and illustrated the opportunities, as well as the problems assistive technologies have to offer.

Ms. Nierling, as part of your study titled "Assistive technologies for the inclusion of people with disabilities in society, education and jobs", you compared EU countries that have ratified the UN Convention on the Rights of Persons with Disabilities. Why did you explicitly examine Hungary, Portugal, Sweden, and Germany and their particular differences in their approach to people with disabilities?

Linda Nierling: Our project was commissioned by the European Parliament. A key objective of selecting the countries was to get a comprehensive assessment of the situation of people with disabilities in Europe, which is individually reflected in different cultural, political, and economic contexts. We chose Sweden as representative of the Northern European countries due to its long tradition of government policies and services combined with a strong openness to digital solutions, specifically as it pertains to the inclusion of people with disabilities. By contrast, Hungary exemplifies Eastern Europe with a socialist past, where the responsibility for the integration of people with disabilities is far less supported by the government. As is the case with Portugal, which represents Southern Europe, and where responsibilities for people with disabilities are still strongly rooted in family caregiving. In turn, Germany epitomizes a Central European country with an impressive economic performance and a comprehensive social security system. Our goal was to uncover and to study this diversity.

In which areas could Germany take a cue from Portugal, Hungary or Sweden in terms of its approach to people with disabilities?

Nierling: When it comes to education, Germany could learn from Portugal. Portugal closed all special needs school, for example, and requires all students with disabilities to be mainstreamed and integrated in regular schools. In terms of legal and political rights, Sweden might be a helpful model. Not only does it grant people with disabilities equal legal capacity, it also endows the right to vote, which it established for all people. Unlike Germany, Hungary, Portugal, and Sweden have legally mandated the accessibility of public buildings, regardless of whether they are privately or publically owned and run. Germany only takes publicly run buildings into consideration. Another great example comes from Hungary, which developed a national autism spectrum disorder strategy aimed at improving the inclusion of people with autism in key areas like education and employment.

In addition to the above-mentioned countries, Ireland is likewise a very interesting case. It features the "assistive technology professional" certification, an additional qualification for different health professions which allows, as an expert in technical support, to also prescribe assistive technologies.

Having said that, unlike the other three surveyed countries, Germany has already signed the Marrakesh Treaty, which aims to facilitate access to published works for persons who are blind and visually impaired.

Many stakeholders don’t consider Germany a leader when it comes to inclusion. What is your assessment from a scientific perspective?

Nierling: We established that government aid is fundamental to the quality and difficulty in accessing assistive technology. While government funding plays an important role both in Germany and Sweden, Hungary and Portugal offer less support – partly due to fewer available economic resources, but also because of different organizational embedding of assistive technologies (AT). While NGOs provide the lion’s share of ATs in Hungary, Portugal still continues to rely on family support to cover most aspects. In comparison, Germany’s situation is quite good, though it takes a backseat to Sweden in this setting. However, in addition to national differences, it should be emphasized that regulation at the regional or local level also plays an important role in Germany. On the one hand, this heterogeneity enables personalized and flexible approaches, but this can also result in variances in access to and the quality of AT services ("postcode lottery").

You just mentioned assistive technologies. What are the barriers to accessibility when it comes to the latest technical innovations?

Nierling: Unfortunately, none of the four countries in the survey are great examples when it comes to digital accessibility. Despite various political efforts on the part of the European Commission, the implementation is still very limited and primarily applies to web accessibility pertaining to the public sector. The absence of transition periods or the lack of sanctions for omitted implementation seem to be crucial factors in this setting. It is expected that many of today’s barriers can be overcome in the future as a result of the European Accessibility Act (EAA).

Our findings also indicated that technology solutions often don’t meet the needs of people with disabilities in other areas. An increased focus on the technological development process seems to be crucial in this setting. As has been laid out in several other studies, a collaborative creative process between technology developers and potential users (people with disabilities) early on in the product development process is very expedient to ensure that next generation technologies correctly meet the needs and expectations of end users and are subsequently well received.

Our study revealed that people with disabilities, on the whole, are very open towards technology. However, it is key that these technology solutions must always keep the social context in mind in which people with disabilities use these technologies. For example, despite the fact that there are many high-quality technologies that enable people with disabilities to integrate into the workplace and labor market – including virtual reality tools for people on the autism spectrum –, access to the labor market still depends less on the availability or implementation of these technologies and is more influenced by social barriers that already exist in the job application process and have an exclusion effect.

What impact do the surveyed countries have on the development and access to these resources?

Linda Nierling: Undoubtedly, digitization also has a pivotal impact as it pertains to assistive technologies. That’s why there is a trend in assistive technologies to understand these technologies less as medical devices and more as "conventional" technologies, especially within the realm of digitization, i.e., as integrated features of the smartphone, open-source software etc. Needless to say, this poses major challenges for laws and regulations pertaining to assistive technology as medical devices as the must strike a balance between access, innovation potential, security, and privacy aspects.

Having said that, our findings indicate that it is often not about "the perfect" high-tech solution like brain-computer interfaces or a bionic eye, but rather about developing AT options in the midrange – so-called "mid-tech" solutions – that focus on social inclusion in the respective context.

The European comparison, in particular, indicates that the practice of national anti-discrimination policies is also a determining factor in technology use. It is essential to cultivate a long-term perspective and development to ensure accessibility, whether it is of a physical (buildings, mobility) or virtual (Internet) nature. And while countries like Sweden have already fostered this for the past 35 years, Portugal is still only in the early stages of this process. An exchange of "best practices" across European national borders, as well as a thorough inventory, can make a major contribution to the use and provision of assistive technologies.