Universal design ensures better quality of life for people with disabilities.

People with conditions such as arthritis may encounter the myriad technologies of modern life in somewhat different ways than people without disabilities. Doorknobs, kitchen tools, or shirt buttons that do not produce a second thought for most people can become obstacles for someone with arthritis. In turn, a lever door handle substituted for a doorknob may be a significant aid to that individual—and also be welcomed by many others, such as parents juggling packages and children. A simple buttonhook device, although not useful to most people, can assist someone who finds it difficult to manipulate buttons. Thus, although certain technologies create obstacles to independence for people with disabilities, other technologies—some of which are designed to accommodate impairments and some of which are designed for general use—provide the means to eliminate or overcome environmental barriers. These helpful technologies may work by augmenting individual abilities (e.g., with glasses or hearing aids), by changing the general environment (e.g., with lever door handles or “talking” elevators), or by some combination of these two types of changes (e.g., with computer screen readers).

Given the projected large increase over the next 30 years in the numbers Americans at the highest risk for disability, as discussed in Chapter 1, designing technologies today for an accessible tomorrow should be a national priority. Otherwise, people who want to minimize the need for personal assistance from family members or others, who want to avoid institutional care, who want or need to work up to and beyond traditional retirement age, or who have talents to volunteer in society will face avoidable barriers that will diminish their independence and role in community life. Accessible technologies are also a matter of equity for people with disabilities, regardless of age. One of the goals of Healthy People 2010 is a reduction in the proportion of people with disabilities who report that they do not have the assistive devices and technologies that they need (DHHS, 2001; see also DHHS [undated]).

Since the publication of the 1991 Institute of Medicine (IOM) report Disability in America, the world of assistive technologies has changed significantly in a number of areas. Perhaps the most dramatic advances involve the expanded communication options that have accompanied the improvement and widespread adoption of personal computers for use in homes, schools, and workplaces. Spurred in part by federal policy incentives and requirements, industry has developed a range of software and hardware options that make it easier for people with vision, hearing, speech, and other impairments to communicate and, more generally, take advantage of electronic and information technologies. In many cases, these options have moved into the realm of general use and availability. For example, people who do not have vision or hearing loss may find technologies like voice recognition software valuable for business or personal applications. Prosthetics technology is another area of remarkable innovation, with research on the neurological control of devices resulting in, for example, prosthetic arms that people can move by thinking about what they want to do (Murugappan, 2006).

Research suggests that assistive technologies are playing important and increasing roles in the lives of people with disabilities (see, e.g., Russell et al. [1997], Carlson and Ehrlich [2005], Spillman and Black [2005a], and Freedman et al. [2006]). For example, using data from the 1980, 1990, and 1994 National Health Interview Surveys, Russell and colleagues (1997) concluded that the rate of use of mobility assistive technology increased between 1980 and 1994 and that the rate of increase was greater than would have been expected on the basis of the growth in the size of the population and changes in the age composition of the population. A more recent analysis by Spillman (2004), which examined data from the National Long-Term Care Survey (for the years 1984for the years 1989for the years 1994, and 1999), found that the steadily increasing use of technology was associated with downward trends in the reported rates of disability among people age 65 and over. Other research, discussed later in this chapter, suggests that assistive technologies may substitute for or supplement personal care. Surveys also report considerable unmet needs for assistive technologies, often related to funding problems (Carlson and Ehrlich, 2005).

Findings such as those just cited suggest that the greater availability and use of assistive technologies could help the nation prepare for a future characterized by a growing older population and a shrinking proportion of younger people available to provide personal care. The increased availability of accessible general use technologies is also important.

Chapter 6 pointed out that people with disabilities encounter technology barriers in many environments, including health care. As surprising as it may seem, individuals with mobility limitations and other impairments may find that examination tables, hospital beds, weight scales, imaging devices, and other mainstream medical products are, to various degrees, inaccessible (see, e.g., Iezzoni and O’Day [2006] and Kailes [2006]). Chapter 6 urged the stronger implementation of federal antidiscrimination policies and the provision of better guidance to health care providers about what is expected of them in providing accessible environments.

Many kinds of technologies, such as medical equipment, voting machines, and buses, cannot be purchased or selected individually by consumers and are, in a certain sense, public goods even when they are privately owned. Their development and accessibility often depend on policies that require or encourage public and private organizations to make environments, services, and products more accessible. Other public policies tackle environmental barriers by encouraging consumer awareness of assistive and accessible products or by helping people purchase or otherwise obtain such products. Yet other policies promote research and development to make all sorts of technologies more usable and accessible to people with different abilities.

This chapter examines the role of assistive and mainstream technologies in increasing independence and extending the participation in society of people with disabilities. It also considers how technologies may act as barriers. Many of the topics discussed are themselves worthy of evaluation in separate reports, so the committee’s review has necessarily been limited in scope and depth. The chapter begins with definitions of assistive technology, mainstream technology, and universal design. It then briefly reviews public policies affecting the availability of assistive and accessible technologies, summarizes information on the use of assistive technologies, discusses obstacles to the development of better products and the effective use of existing products, and highlights how mainstream technologies can limit or promote independence and community participation. The chapter concludes with recommendations.

ROBINSON CRUSOE[PLOT]

R obinson Crusoe is an Englishman from the town of York in the seventeenth century, the youngest son of a merchant of German origin. Encouraged by his father to study law, Crusoe expresses his wish to go to sea instead. His family is against Crusoe going out to sea, and his father explains that it is better to seek a modest, secure life for oneself. Initially, Robinson is committed to obeying his father, but he eventually succumbs to temptation and embarks on a ship bound for London with a friend. When a storm causes the near deaths of Crusoe and his friend, the friend is dissuaded from sea travel, but Crusoe still goes on to set himself up as merchant on a ship leaving London. This trip is financially successful, and Crusoe plans another, leaving his early profits in the care of a friendly widow. The second voyage does not prove as fortunate: the ship is seized by Moorish pirates, and Crusoe is enslaved to a potentate in the North African town of Sallee. While on a fishing expedition, he and a slave boy break free and sail down the African coast. A kindly Portuguese captain picks them up, buys the slave boy from Crusoe, and takes Crusoe to Brazil. In Brazil, Crusoe establishes himself as a plantation owner and soon becomes successful. Eager for slave labor and its economic advantages, he embarks on a slave-gathering expedition to West Africa but ends up shipwrecked off of the coast of Trinidad.
Crusoe soon learns he is the sole survivor of the expedition and seeks shelter and food for himself. He returns to the wreck’s remains twelve times to salvage guns, powder, food, and other items. Onshore, he finds goats he can graze for meat and builds himself a shelter. He erects a cross that he inscribes with the date of his arrival, September 1, 1659, and makes a notch every day in order never to lose track of time. He also keeps a journal of his household activities, noting his attempts to make candles, his lucky discovery of sprouting grain, and his construction of a cellar, among other events. In June 1660, he falls ill and hallucinates that an angel visits, warning him to repent. Drinking tobacco-steeped rum, Crusoe experiences a religious illumination and realizes that God has delivered him from his earlier sins. After recovering, Crusoe makes a survey of the area and discovers he is on an island. He finds a pleasant valley abounding in grapes, where he builds a shady retreat. Crusoe begins to feel more optimistic about being on the island, describing himself as its “king.” He trains a pet parrot, takes a goat as a pet, and develops skills in basket weaving, bread making, and pottery. He cuts down an enormous cedar tree and builds a huge canoe from its trunk, but he discovers that he cannot move it to the sea. After building a smaller boat, he rows around the island but nearly perishes when swept away by a powerful current. Reaching shore, he hears his parrot calling his name and is thankful for being saved once again. He spends several years in peace.
One day Crusoe is shocked to discover a man’s footprint on the beach. He first assumes the footprint is the devil’s, then decides it must belong to one of the cannibals said to live in the region. Terrified, he arms himself and remains on the lookout for cannibals. He also builds an underground cellar in which to herd his goats at night and devises a way to cook underground. One evening he hears gunshots, and the next day he is able to see a ship wrecked on his coast. It is empty when he arrives on the scene to investigate. Crusoe once again thanks Providence for having been saved. Soon afterward, Crusoe discovers that the shore has been strewn with human carnage, apparently the remains of a cannibal feast. He is alarmed and continues to be vigilant. Later Crusoe catches sight of thirty cannibals heading for shore with their victims. One of the victims is killed. Another one, waiting to be slaughtered, suddenly breaks free and runs toward Crusoe’s dwelling. Crusoe protects him, killing one of the pursuers and injuring the other, whom the victim finally kills. Well-armed, Crusoe defeats most of the cannibals onshore. The victim vows total submission to Crusoe in gratitude for his liberation. Crusoe names him Friday, to commemorate the day on which his life was saved, and takes him as his servant.
Finding Friday cheerful and intelligent, Crusoe teaches him some English words and some elementary Christian concepts. Friday, in turn, explains that the cannibals are divided into distinct nations and that they only eat their enemies. Friday also informs Crusoe that the cannibals saved the men from the shipwreck Crusoe witnessed earlier, and that those men, Spaniards, are living nearby. Friday expresses a longing to return to his people, and Crusoe is upset at the prospect of losing Friday. Crusoe then entertains the idea of making contact with the Spaniards, and Friday admits that he would rather die than lose Crusoe. The two build a boat to visit the cannibals’ land together. Before they have a chance to leave, they are surprised by the arrival of twenty-one cannibals in canoes. The cannibals are holding three victims, one of whom is in European dress. Friday and Crusoe kill most of the cannibals and release the European, a Spaniard. Friday is overjoyed to discover that another of the rescued victims is his father. The four men return to Crusoe’s dwelling for food and rest. Crusoe prepares to welcome them into his community permanently. He sends Friday’s father and the Spaniard out in a canoe to explore the nearby land.
Eight days later, the sight of an approaching English ship alarms Friday. Crusoe is suspicious. Friday and Crusoe watch as eleven men take three captives onshore in a boat. Nine of the men explore the land, leaving two to guard the captives. Friday and Crusoe overpower these men and release the captives, one of whom is the captain of the ship, which has been taken in a mutiny. Shouting to the remaining mutineers from different points, Friday and Crusoe confuse and tire the men by making them run from place to place. Eventually they confront the mutineers, telling them that all may escape with their lives except the ringleader. The men surrender. Crusoe and the captain pretend that the island is an imperial territory and that the governor has spared their lives in order to send them all to England to face justice. Keeping five men as hostages, Crusoe sends the other men out to seize the ship. When the ship is brought in, Crusoe nearly faints.
On December 19, 1686, Crusoe boards the ship to return to England. There, he finds his family is deceased except for two sisters. His widow friend has kept Crusoe’s money safe, and after traveling to Lisbon, Crusoe learns from the Portuguese captain that his plantations in Brazil have been highly profitable. He arranges to sell his Brazilian lands. Wary of sea travel, Crusoe attempts to return to England by land but is threatened by bad weather and wild animals in northern Spain. Finally arriving back in England, Crusoe receives word that the sale of his plantations has been completed and that he has made a considerable fortune. After donating a portion to the widow and his sisters, Crusoe is restless and considers returning to Brazil, but he is dissuaded by the thought that he would have to become Catholic. He marries, and his wife dies. Crusoe finally departs for the East Indies as a trader in 1694. He revisits his island, finding that the Spaniards are governing it well and that it has become a prosperous colony.