November 11, 2020

Rehabilitative and Assistive Technology in Medical Care

Rehabilitative and assistive technology help people with disabilities to function more easily in their everyday lives and also for caregivers to care more easily for a disabled person. “Rehabilitative technology” sometimes refer to aids used to help people recover their functioning after injury or illness. “Assistive technology” may be as simple as a magnifying glass to improve vision or as complex as a digital communication system to improve communication ability.

Synonyms: Accessible technology, Adaptive devices or equipment, Assistive devices and technology, Communication aids, Independent living aids, Mobility aids, Prosthetics, Rehabilitation robotics, Wheelchairs, Medical rehabilitative aids and devices, and Rehabilitative engineering.

In this article:
What is rehabilitative and assistive technology?
What are some types of assistive devices and how are they used?
What are some types of rehabilitative technologies?
Who can benefit from assistive technology?
What are the impacts of assistive technology?
What challenges does rehabilitative and assistive technology have?

What is rehabilitative and assistive technology?

Rehabilitative and assistive technology, or simply assistive technology, is an umbrella term covering the systems and services related to the delivery of assistive products and services. It refers to tools, equipment, or products that can help a person with a disability to function successfully at school, home, work, and in the community. Disabilities are disorders, diseases, health conditions, or injuries that affect an individual’s physical, intellectual, or mental well-being.

Assistive products and technologies maintain or improve an individual’s functioning and independence, thereby promoting their well-being. Hearing aids, wheelchairs, communication aids, spectacles, prostheses, pill organizers (also called pill container, dosette box, pillcase or pillbox) and memory aids (or memory reminders) are a few examples of assistive products.

Assistive technology enables people to live healthy, productive, independent, and dignified lives, and to participate in education, the labour market and civic life. Assistive technology reduces the need for formal health and support services, long-term care and the work of caregivers. Without assistive technology, people are often excluded, isolated, and locked into poverty, thereby increasing the impact of disease and disability on a person, their family, and society.

For example, memory aids are placed in a prominent area and set to sound an alarm or recorded message designed to prevent someone forgetting an important task, such as taking their medication. Memory reminders are particularly useful for those suffering from Alzheimer's disease or dementia.

According to World Health Organization (WHO) statistic, only 1 in 10 people in need today have access to assistive technology due to high costs and a lack of awareness, availability, trained personnel, policy, and financing.

What are some types of assistive devices and how are they used?

Some examples of assistive technologies are:
  • Mobility aids, such as wheelchairs, scooters, walkers, canes, crutches, prosthetic devices, and orthotic devices.
  • Hearing aids to help people hear or hear more clearly.
  • Cognitive aids, including computer or electrical assistive devices, to help people with memory, attention, or other challenges in their thinking skills. An example is the memory aid described above.
  • Computer software and hardware, such as voice recognition programs, screen readers, and screen enlargement applications, to help people with mobility and sensory impairments use computers and mobile devices.
  • Tools such as automatic page turners, book holders, and adapted pencil grips to help learners with disabilities participate in educational activities.
  • Closed captioning to allow people with hearing problems to watch movies, television programs, and other digital media.
  • Physical modifications in the built environment, including ramps, grab bars, and wider doorways to enable access to buildings, businesses, and workplaces.
  • Lightweight, high-performance mobility devices that enable persons with disabilities to play sports and be physically active. An example is seen in the image below.
  • Adaptive switches and utensils to allow those with limited motor skills to eat, play games, and accomplish other activities.
  • Devices and features of devices to help perform tasks such as cooking, dressing, and grooming; specialized handles and grips, devices that extend reach, and lights on telephones and doorbells are a few examples.
A New York City Marathon competitor uses a racing wheelchair. Credit: Howard N2GOT, CC BY 2.0, via Wikimedia Commons

What are some types of rehabilitative technologies?

Rehabilitative technologies and techniques help people recover or improve function after injury or illness. Examples include the following:
  • Robotics. Specialized robots help people regain and improve function in arms or legs after a stroke.
  • Virtual reality. People who are recovering from injury can retrain themselves to perform motions within a virtual environment.
  • Musculoskeletal modeling and simulations. These computer simulations of the human body can pinpoint underlying mechanical problems in a person with a movement-related disability. This technique can help improve assistive aids or physical therapies.
  • Transcranial magnetic stimulation (TMS). TMS sends magnetic impulses through the skull to stimulate the brain. This system can help people who have had a stroke recover movement and brain function.
  • Transcranial direct current stimulation (tDCS). In tDCS, a mild electrical current travels through the skull and stimulates the brain. This can help recover movement in patients recovering from stroke or other conditions.
  • Motion analysis. Motion analysis captures video of human motion with specialized computer software that analyzes the motion in detail. The technique gives health care providers a detailed picture of a person’s specific movement challenges to guide proper therapy.

Who can benefit from assistive technology?

Rehabilitative technology can help restore or improve function in people who have developed a disability due to disease, injury, or aging. Appropriate assistive technology often helps people with disabilities compensate, at least in part, for a limitation.

Some disabilities are quite visible, while others are “hidden.” Hidden disabilities are those that might not be immediately apparent when you look at someone. They can include visual impairments, movement problems, hearing impairments, and mental health conditions.

People who most need assistive technology include:

What are the impacts of assistive technology?

Health, well-being and socioeconomic benefits

Assistive technology can have a positive impact on the health and well-being of a person and their family, as well as broader socioeconomic benefits. For example:
  • Proper use of hearing aids by young children leads to improved language skills, without which a person with hearing loss has severely limited opportunities for education and employment.
  • Manual wheelchairs increase access to education and employment while reducing healthcare costs due to a reduction in the risk of pressure sores and contractures.
  • Assistive technology can enable older people to continue to live at home and delay or prevent the need for long-term care.
  • Therapeutic footwear for diabetes reduces the incidence of foot ulcers, preventing lower limb amputations and the associated burden on health systems.
More simply put, rehabilitative and assistive technology can enable individuals to:
  • Care for themselves and their families
  • Work
  • Learn in typical school environments and other educational institutions
  • Access information through computers and reading
  • Enjoy music, sports, travel, and the arts
  • Participate fully in community life
Assistive technology also benefits employers, teachers, family members, and everyone who interacts with people who use the technology.

What challenges does rehabilitative and assistive technology have?

Unmet global need for assistive technology

Across the globe, many people who need assistive technology do not have access to it. Examples of the unmet global need for assistive technology, according to WHO statistics, include:
  • 200 million people with low vision who do not have access to glasses or other low-vision devices.
  • 70 million people who need a wheelchair and only 5% to 15% of those in need who have access to one.
  • 360 million people globally have moderate to profound hearing loss. Hearing aid production currently meets less than 10% of the global need.
  • Huge workforce shortages in assistive technology: over 75% of low-income countries have no prosthetic and orthotics training programmes. Countries with the highest prevalence of disability-related health conditions tend to be those with the lowest supply of health workers skilled in provision of assistive technology (as low as 2 professionals per 10 000 population).
Lack of affordability in low-income countries is a major reason people in need do not possess assistive products.

Other serious challenges

1). Policy: Very few countries have a national assistive technology policy or programme.

In many countries, access to assistive technology in the public sector is poor or non-existent. Even in high-income countries, assistive products are often rationed or not included within health and welfare schemes, leading to high out-of-pocket payments by users and their families.

For example, it is common policy in a number of European countries for the state to provide older people with only 1 hearing aid, despite the fact that most people with age related hearing loss require 2 hearing aids to function.

2). Products: The assistive products industry is currently limited and specialized, primarily serving high-income markets. There is a lack of state funding, nationwide service delivery systems, user-centred research and development, procurement systems, quality and safety standards, and context-appropriate product design.

3). Provision: In high-income countries services are often stand-alone and not integrated. People are forced to attend multiple appointments at different locations, which are costly and add to the burden on users as well as caregivers, and on health and welfare budgets.

In many low- and middle-income countries, national service delivery for assistive products does not exist. Those who can afford them buy assistive products direct from a pharmacy, private clinic, or workshop.

People from the poorer sectors of society must rely on erratic donations or charity services, which often focus on delivering large quantities of low-quality or used products. These are often not appropriate for the user or the context, and lack mechanisms for repair and follow up. A similar scenario is also common in emergency response programmes.

4). Personnel: Trained health personnel are essential for the proper prescription, fitting, user training, and follow-up of assistive products. Without these key steps, assistive products are often of no benefit or abandoned, and they may even cause physical harm (as is the case of providing wheelchairs without pressure relief cushions for people with spinal injury).

Reference(s)
1). World Health Organization (May 2018). Assistive technology. Available Online.
2). US Department of Health and Human Services / National Institutes of Health (October 2018). Rehabilitative and Assistive Technology. Available Online.
3). Medline Plus / National Institutes of Health (September 2016). Mobility aids. Available Online.
4). Centers for Disease Control (September 2020). Disability and Health Promotion. Available Online.

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