Europe: Inclusion with the help of assistive devices

The supply of auxiliary means differs from country to country – within Europe and worldwide. This can lead to problems for the individuals who live with a disability and depend on their assistive aids in order to be mobile and participate in professional and social life. So what exactly is the situation like and what needs to be improved? REHACARE.com investigated.

Wheelchairs, Braille readers or communication aids – the range of auxiliary means for people with disabilities is as diverse as their individual needs are. That is why it is so important to provide a good choice of assistive aids to enable them to live a self-determined life. But not all kinds of disabilities are well met by the market of auxiliary means. People with learning difficulties (so called intellectual disabilities) for example. "The industry has paid scant attention to them," says Maureen Piggot who is a Member of the Executive Board of the organization Inclusion Europe. "Assistive devices are not yet playing a big part in the lives of most people with intellectual disabilities except those, who like others with mobility or sensory impairments, use wheelchairs, hearing aids, or alternative and augmentative communication devices." But she also sees the potential for developing applications and devices for communication support, smart home technology, navigation, personalized learning, decision support and personal assistant functions.

"'Computing' technology could be to people with intellectual disability what the wheelchair is to people with impaired mobility," Piggot says. Computers in all their forms calculate, manage and provide information, keep track of time, simplify operations, organize us and our life, communicate, educate and entertain – "all useful functions if the barrier to your success in everyday tasks is managing complexity and abstract concepts". But Piggot is concerned about the accessibility and usability of consumer devices like smart phones and tablets, and also microwaves, heating controls and other common appliances. All those have usually not been developed with the awareness of what people with learning disabilities need.

Nevertheless, Piggot is convinced that advances in technology, including voice recognition, artificial intelligence, machine learning and natural gesture interfaces hold real promise. "The challenge is to put the complexity inside the machine so that it is personalized to the user who can then operate it with ease and succeed at the task in hand," she explains. But she also warns to take care with this enthusiasm for technology – as remote monitoring and smart house technologies can also lead to new forms of institutional control or even reduce personal contact and increase isolation and loneliness. But nevertheless, there are a lot of chances technology can offer for people with disabilities.

This is something also Alejandro Moledo agrees with. He is Policy Coordinator at European Disability Forum (EDF) and partially sighted himself. In the past he needed a special software to magnify the screen of his computer. Now this magnifying option comes already by default in the operating system of any computer that you buy. And instead of having a telescope in his pocket, he can now use the camera of his smartphone when he wants to see something which is far away. "We see this trend in mainstream technology being more accessible and therefor substituting some sort of assistive technology," Moledo says. "But having said that it's also true that specific assistive devices will keep on playing a crucial role for the independent living of people with disabilities."

For participation in different aspects of social life it is important to ensure accessibility, and to ensure that people with disabilities have access to the most suitable piece of assistive technology that they need. And this is the point where Moledo sees a problem in Europe because there are different delivery models of assistive technologies: "We don't have a real market of assistive technologies in Europe. Because the delivery system may tell you 'Ok, we can only fund or support you buying this specific list of assistive technologies, but not the other ones.' So people cannot say that they have seen a wheelchair from a provider in Sweden for example and think that this wheelchair is the one that meets their needs. Because if the national delivery model for assistive technologies does not allow them to buy this wheelchair. They lack of choice options. And this is really against the value of the EU of having a common internal market." Moledo and the other members of EDF think that this is something the EU could and should be working on in the near future.

As assistive technologies play a fundamental role, they need to be of good quality, and have affordable prices for the users. The support that will be needed for the users needs to be person-centered. Moledo wants the responsibles to assess the context in which the person lives, what the person expects and what the person wants to achieve.

"The industry needs to further evolve. I know the assistive technologies market in Europe is very much dominated by smaller and medium enterprises. But when it comes to hearing aids or cochlear implants for example, it's basically three or four companies on the market," say Modelo. "And obviously lack of choice of providers increases the prices for consumers. So, this is something that the industry could be looking at, but I also think that they are from the public sector, so policy makers should also look at this market as well and try to improve it."

Also Maureen Piggot thinks that a number of things need to happen to improve access to assistive devices: "Families and people with intellectual disabilities should have more exposure to information and examples of what is available and how to obtain it. Also professionals involved in the supply should be encouraged to think how a greater range of available devices could be used by people with intellectual disabilities. For example, talking watches or scales used by people with visual impairment also work for some people who cannot read for other reasons. Importantly, they should also feedback to manufacturers about the inaccessibility of potentially useful devices and applications."

Research and development funding should stimulate more work in the area of supporting cognitive and intellectual functions. National and international conferences, exhibitions and journals should have explicit emphasis on these topics. Facilitating legislation also has an important role to play. "The Tech Act and Rehab Act in the USA are good examples of how infrastructure can be created to drive the right devices to the people and places where they are needed," Piggot says. "As in other sectors where change is needed people with intellectual disability and their families should be enabled to take part in the discussion. The self advocacy movement has demonstrated what a difference it makes when people speak up for themselves."