1. Assistive Technologies and Rehabilitation
- Challenges and Solutions -
Jan Albers
senior consultant EPR
AEGIS conference 30 November 2011 / Brussels
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2. Structure
 Background
 Major developments and challenges
 Possible approaches and solutions
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3. Background
 Dutch
 Study University Heidelberg
 Director Communication SRH
 Director VT Centre Hoensbroek
 CEO Hoensbroek (SRL / now Adelante)
 Co-founder EPR
 International activities (EU / RI a.o.)
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4. AT and Rehabilitation
 Long common history
 Focus on individual
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5. AT not new … but new is ….
• Speed of technological developments and their
possible applications
• Context of disability world / rehabilitation
Key: change
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6. The message
DC + DC DO
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7. Environment/context
Social economic Adapt
Challenges to changing needs
• Finances
Modernisation
• Globalisation • Understand needs
• Labour market flexibility • Flexible responses
• Individualisation • New target groups
• New services
• Ageing
• New ways service provision
• Inclusion
Sophisticated and complex
Increasing and diversifying services
demand 7

8. Context
Paradigm shift in health and social services
From public programming to more market-based regulation
Positive & proactive
High level expertise
approach
Modernisation / Change
• Mainstreaming/partnership • Demonstrate added value
• Inclusion / maximise potential • Quality assurance
• Empowerment • Competition: tendering
• Decentralization • Market analysis and orientation
Paradigm shift in disability field
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From medical model to social / consumer model

9. AT - not a ‘normal’ product
 An assistive product
A need unexpected and not
created
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10. AT - not a ‘normal’ product
 An assistive product
A product that nobody wants
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11. AT - from individual to environment
 Independent living
 AT not uncontroversial
 Critics about technology driven nature
 Stigmatizing character
 No replacement of communication 11
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12. AT - Definition
 Any item, piece of equipment or product system,
whether acquired commercially, modified or
customized, that is used to increase, maintain or
improve functional capabilities of individuals with
disabilities.
(The US Assistive Technology Act of 1998, Section 3)
 AT has the potential to help people with disabilities to
live in the least restrictive environments and attain their
personal and vocational aspirations.
(Peterson DB, Murray GC. Ethics and assistive technology service provision. Disability and Rehabilitation:
Assistive Technology 2006;1:59–67)
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13. AT and Telecare
 AT&T = the delivery of health and social care to
individuals within the home or wider community outside
formal institutional settings, with the support of devices
enabled by information and communication
technologies
(Tang P, Curry R, Gann D. Telecare: new ideas for care and support @ home. Bristol: The Policy Press, 2000.)
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14. AT and AAL (housing / environment)
• (Semi)independent living elderly and pwd
• Security
• Communication
• Comfort / convenience
• Support
Avoid institutionalizing
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15. AT – universal design
 Universal design strives to be a broad-spectrum
solution that helps everyone, not just people with
disabilities and it recognises the importance of how
things look.
Assistive technology which is not guided by the
universal design concept may benefit people with
disabilities but result in separate and stigmatising
solutions, for example, a ramp that leads to a separate
entry to a building from the main stairway..
(Perry J, Beyer S, Holm S. Assistive technology, telecare and people with intellectial disabilities: ethical
considerations. J Med Ethics 2009;35:81-86.)
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16. Experience of rehabilitation
professionals
 75% of AT professionals believe that
persons with disability do not receive the
AT that they need
Assistive product as a successful solution is
very knowledge demanding and needs
professional expertise of various domains
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17. Critical Success Factors (CSF)
 Knowledge
 Assessment
 Expectations / stigma / acceptance
 Ongoing process
 Sustainability / durability 17
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18.  Different skills needed (not only technical)
 Profound knowledge of market (many and complex
products)
 National and international networking
 Involvement and training of clients
NOTE: lack of sufficient evidence based practice
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19.  Multidisciplinary team - flexible and continuous
 Person-centered approach
 Task analysis (real-life scenarios) and site trials
 documentation the assessment
 Education/ training of the team, including the
client
 Wide scope of knowledge is required to service delivery of AT
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20.  High or low expectations
 Trial and error process
 AT he / she has a disability
 Involvement of users from the very beginning
 Creating informed choices
 Involvement of environment / family
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21.  AT is more than a product
 “after sale’ is crucial
 Time lapse between need and provision
 (re)assessment as continuous process
 AT service includes training and ongoing training
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22. 75% of AT devices abandoned within 3 years
Reasons:
 too complex
 no acceptance by users
 no acceptance by environment
 not enough training provided
 bad quality
To do:
 better follow-up
 awareness raising and information
 (re)assessment as ongoing process
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23.  is like a positive catalyst - it participates in the chemical reaction,
speeds it up, but is not consumed by the reaction itself – it must be
there but forgotten!
 Client skill and competency development
 Maximum independence
 Full participation in society / Inclusion
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24. Ethical Issues
 Universal application / access for all
 Privacy
 Data protection
 Delegation of responsibility to machines
 ‘personal’ care vs. technology
 Relation provider / user
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25. Ethical guideliness
 Privacy: access / protection
 Autonomy: decision about use of AT
 Integrity and dignity: respecting individuals as human beings
 Reliability: reliable AT solutions . No threat physical / mental
health
 E-inclusion: accessible for all user groups
 Benefit for society: use of AT increase quality of life
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26. Core drivers AT / ICT development
Knowledge disabled end-user
Knowledge diagnostician, (para)medical/technical
professionals (eastin)
Knowledge rules and procedures of service provider
systems and reimbursement schemes in Europe
Flexibility in product design (different geographical
markets)
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27. Barriers AT / ICT development
Lack of knowledge market
Different interpretations national/regional levels
Lack of coordination involved stakeholders
 Different national SP systems
High prices AT / ICT devices
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28. Industry key player AT / ICT
 Fragmented interest
 Mainly restricted to specialised niches
 Not recognizing market potential
 Major international industries developed only for US market
 European signal (Inclusion driven calls within FP6 and FP7-first step)
 Appropriate EC legislative framework
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29. Purchase of AT / ICT by end user
Medical model
 Disability / physician
Social model
 National legislation / systems / agencies / funding
Consumer model
 Direct contact user - supplier
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30. Future role of Rehab SP in AT/ICT (1)
 Participation in R&D
 Alliances with universities, research centers
 Cooperation with industry
 Involvement of own professionals in AT
development
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31. Future role of Rehab SP in AT/ICT (2)
 Cooperation with mainstream organizations
 Empowerment of service users
 Training of service users
AT is a challenge but even more an opportunity
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32. The message
DC + DC DO
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