Monday, March 22, 2010

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.