1. Assisitive Technologies in rehabilitation services Is the sky really the limit? Prague, 8 September 2011 Jan Spooren, Secretary General EPR

2. The limits and risks of AT Anassistiveproduct A productthat no onewants!

4. Inclusion / maximise potential

5. Empowerment

6. Decentralization

7. Demonstrate added value

8. Quality assurance

9. Competition: tendering

10. Market analysis and orientationParadigm shift in disability field From medical model to social model

11. The limits and risks of AT Anassistiveproduct A neednotcreatedandunexpected

12. Use of ATin rehabilitation – Preliminary remarks Assumption: Disabled and elder people wish to lead independent lives in a familiar environment. AT are not new and their use has never been uncontroversial. Technological advances will considerably expand the areas in which AT are used. Literature is critical of the technology-driven nature of AT development. Care should be taken that AT supports communication.

13. Assistive Technology (AT) – Definition Any item,piece of equipment or product system, whetheracquired commercially, modified or customized,that is used to increase, maintain or improvefunctional 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) 6

14. ATand Telecare AT&T = the delivery ofhealth and social care to individuals within thehome or wider community outside formal institutionalsettings, with the support of devices enabledby information and communication technologies (Tang P, Curry R, Gann D. Telecare: new ideas for care and support @ home.Bristol: The Policy Press, 2000.) 7

15. AT – universal design 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. 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. (Perry J, Beyer S, Holm S. Assistive technology, telecare and people with intellectial disabilities: ethical considerations. J Med Ethics 2009;35:81-86.)

16. 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 technical expertise of various domains Experience of rehabilitation professionals

18. Too many and complex products

19. Different skills needed (communication, mobility, computer access, orientation) and continuous updating

20. “one-size fits all” mentality

21. Not sufficient evidence-based practice

22. Solutions

23. International and national professional network using electronic information resources

24. defining outcomes measure for the AP

25. documenting the AP service – product and service provided

27. high or low expectations

28. the AT says “she/he has a disability”

29. “what is good for him is good for me” mentality

30. AT as decision making is predominantly a trial and error process due to the “lack of a valid predictive model” to direct the selection of devices

31. Solutions

32. empower consumers by providing them with the information they need to make informed choices

33. involve the client in the initial process

35. AT service as a PRODUCT

36. AT service does not finish with the AT product supply

37. time lapse between need and provision

38. Solutions

39. include within the AT service training and on-going training

40. follow-up actions and processes in place

43. Awareness raising and information

44. Follow-up actions and processes in place

46. Client skill and competency development

47. Maximum independence

49. Ethicsconnected to relationships provider vs. user Privacy:personal data protection! (Privacy Laws: personal/medical information of individuals). AT: from non-invasive (without operation/intervention into the body) to invasive (operation: integrated circuits, pumps etc.: invasion in the integrity of human being). Position: provider is in a superior position towards the user (inferior position). Power: provider has power over the user (weakness). Reliability: Providing regular and irregular services/repairs (for software and hardware).

50. Ethical guideliness for the use of AT Privacy: an individual shall be able to control access to his/her personal information and to protect his/her own space. Autonomy: an individual has the right to decide how and to what purposes he/she is using technology. Integrity and dignity: individuals shall be respected and technical solutions shall not violate their dignity as human beings. Reliability: Technical solutions shall be sufficiently reliable for the purposes that they are being used for. Technology shall not threat user's physical or mental health. E-inclusion: Services should be accessible to all user groups despite of their physical or mental deficiencies. Benefit for the society: The society shall make use of the technology so that it increases the quality of life and does not cause harm to anyone.

51. The variety of actors who participate – directly or indirectly – in the AT ICT industry Source: Analysing and federating the European assistive technology ICT industry, Final Report, March 2009

53. Knowledge of the disabled end-user

54. Knowledge of the diagnostician, prescriptor of product solutions

55. Knowledge of the rules and procedures of different national service provider systems in Europe, but also reimbursement schemes

56. Flexibility in product design to be able to serve different geographical markets

57. Barriers

58. The lack of knowledge by the marketplace of the types of solutions available (i.e., not all possible AT ICT solutions are included in national service provider systems).

59. The cost and time needed to navigate the different national service provider systems in Europe in order to ensure compliance

60. The different interpretations of national service provider systems at the regional level (thereby fragmenting a national market into regional markets)

61. The lack of a coherent social policy for subsidising/reimbursing assistive technology products and the lack of coordination between the stakeholders involved.

63. Purchase of AT ICTs by end user The medical oriented model: Starting point is the handicap where the physician initiates necessary procedures and must approve the need for listed and reimbursed AT based on medical arguments. The social oriented model Based upon national legislation and local and decentralised execution, and involves national/local agencies that coordinate the provision and funding of AT, often also after the person with disability is evaluated by a panel of medical experts (like in the medical oriented model) to define the degree of disability, and the access to subsidies. The consumer oriented model: The end-user has direct contact with a retailer in order to get his/her AT product (e.g. personal budget).