When I started working in the field of assistive technology in 1991, “hardware” meant hammer and nails, there was no Internet, and cell phones were usually the size of a brick and tethered to the car. Today, we take for granted that we can speak instantly to anyone, anywhere on the planet. Voice commands and eye-gaze systems that were once the stuff of science fiction are now used routinely and we are now working on a system of “thought transference” where one day computers will be controlled by thinking.
Changes in computers, nanotechnology and biotech are all accelerating at a tremendous rate. As technology advances, the tools available to assist health professionals and the “differently-abled” become more powerful and complex. Assistive technology encompasses many things and is a wide-ranging field, but this article will address the tools used most often in our clinic, including power wheelchairs, augmentative communication devices, environmental aids for daily living, and wearable robotics.
Some of the most notable advancements in the last decade are with power wheelchairs, particularly dynamic position changes incorporated into the electronic mobility devices. These include systems that allow the user to stand up, tilt and recline, and change position in space. Additionally, some wheelchairs are able to elevate, climb stairs and go in all directions, including sideways. Advancements like these impact people’s quality of life and allow them to reliably use these devices all day long. However, although many technical advancements have been invented, the devices that are most likely to be actualized and commercialized are the ones that fit the criteria for government funding.
In the area of augmentative and alternative communication, advancements in technology have been extensive. For those who cannot speak or who cannot write, using a computer with voice-output software capabilities or alternative-access methods can open up a whole new world. Alternative methods of access to computers and speech-generating devices such as touch pads, wireless switches, voice recognition and eye-gaze systems are routinely provided to our most compromised clients, who suffer from rapidly degenerative diseases of the central nervous system. As the devices become lighter and smaller, mounting them on wheelchairs or walkers has become easier and quicker.
The invention of the iPod and the iPad has made a big impact in the area of communication technology and has changed the way we listen to music, watch videos, take photographs and read books. Integrating these devices with some of the speech-generating software for those who cannot speak or voice recognition software for those who cannot use their limbs has revolutionized the way we use technology for disabled individuals.
Environmental aids for daily living (EADLs) are devices that allow people to operate their entire environment with a call from a smart phone, touch of a switch or blink of an eye. The principal innovation in this field over the last decade is the advent of wireless nanotechnologies. Today remote-control devices can be purchased from local retail stores to control lights, TV, DVD and any utility or appliance in the home or work environment. Additionally, much like the scanning of universal product codes in the supermarket, micro wireless tags can be read via scanning technology that allows electronic devices (such as refrigerators, stoves, microwaves and home security systems) to pass messages and signals among themselves and virtually talk to each other. These devices are all available in the public domain and in mass production, which has driven the cost down significantly and made these devices affordable.
In the field of assistive technology, the advent of wireless devices and their ease of use allows EADLs to be seamlessly integrated into clients’ wheelchairs or augmentative communication devices, and enables people to control their environment from anywhere in their home or while they are on the move.
Wearable robotics and computers have recently been incorporated into our clinic’s service delivery model. Functional electrical stimulation has been around for decades, but until very recently the machines were tethered to wires and cables. Today we can use portable electrodes wirelessly to stimulate deep and superficial motor nerves to allow people who have suffered central nervous system ablation (from stroke, multiple sclerosis, spinal injury or traumatic brain injury) to use their limbs once again. The beauty of these wireless devices is that they are not limited to the clinic, but the clients can walk out using them in their day-to-day activities. In the field of assistive technology, the possibilities for robotics, wearable or otherwise, are endless and might be the area of most promise in the next decade for disabled users.
Matching the Technology with the Pathology
With so many advancements and powerful innovations, it is easy to become intoxicated by technology and seduced by its power. However, technology breaks, it changes, and it does not take the place of human contact. Specialized teams of professionals providing interprofessional care are needed to ensure that the technology prescribed matches the pathology that each client is facing. Particular care must be taken in prescribing these very expensive devices to ensure they will meet the client’s needs and remain usable for a reasonable period of time.
Funding for assistive devices varies from province to province. In Ontario, most of the devices that come to market and are successful are those that get accredited and approved by the Ministry of Health’s Assistive Devices Program. Once approved, the technologies are administered by centralized equipment pools that recycle devices and improve access. But funding for the technology is not the only difficulty confronted. The biggest challenge in the future will not be the innovations but how to best deliver these innovations to the users who need them, how to modify them to their needs, and how to provide access to these devices and services and make them affordable.
Technology and the Health Care System
People with chronic and complex neurological conditions need an organized, flexible system of care to provide access to highly specialized technology. Also needed are teams of health professionals who can monitor the conditions effectively, provide a network of care, and keep people out of hospital, living at home and enjoying quality of life.
Geography can be a stumbling block, but the advent of telehealth and video technology provides more virtual ways of interacting with clients and health teams in rural and isolated regions of the province. Cost and quality of specialized services are also a challenge, but if we educate our medical and allied health professionals in this area, quality and access will improve and costs will drop. In the past twenty years, our clinic has grown exponentially, so the cost of running the program has gone up. But the costs per unit of technology and per client have gone down and these productivity gains have been re-invested in the clinical programs.
Considering the amazing advancements made over the last twenty years, we can only imagine what the next twenty years will bring. No doubt significant improvement and changes in technology will continue, but for our patients to benefit, the traditional models of practice must also change and grow. In order to create a fiscally sustainable system, rather than providing new revenues governments need to redirect existing revenues and invest in new models of practice and clinics that can meet the needs of those with chronic neurological and complex diseases. Only then will we be able to keep up with the technology and achieve a truly transformative health care agenda.