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ASSISTIVE TECHNOLOGY

ASSISTIVE TECHNOLOGY

This study focuses on assistive technologies (AT) for two specific conditions of disability: 1) blindness and visual impairment; 2) deafness and auditory impairment. These two conditions share a potential invisibility, say, they can be difficult for others to recognise or acknowledge. People affected by hidden (or non-immediately apparent) disabilities run the “risk” to be misjudged or neglected. They could be even accused of faking or imagining their disability.

Definitions

Blindness is a loss of useful sight (say, it is not necessary a 100%loss of sight to speak of blindness), in more rigorous terms it is condition in which 1) there is no perception of light, or 2) there is a light perception of less than 3/60 or a visual field of less than 10 degrees in the better eye with best correction. Seeing is likely to be the most important sense for humans. It is estimated that 50 per cent of the cerebral cortex is involved in visual functions, and visual dominance is a universal characteristic of human cultures.

Deafness is a condition in which an individual has very little or no hearing. Hearing impairment is the inability to hear as well as someone with normal hearing. The hearing threshold is the sound level below which a person‘s ear is unable to detect any sound. Thresholds between -10 and +20 decibels hearing level (dB HL) are considered in the normal range. Thresholds greater than 25 dB in both ears are defined as hearing impairment. Acoustic experience plays a key role in all human cultures; moreover, acoustic experience is connected to verbal language and to social interaction and communication. “Deaf Culture” is a concept that has been developing since the early 1970s. Members of the Deaf community represent themselves as an ethnic minority, using their own language and possessing their own cultural tradition and heritage. Accordingly, deaf people who identify themselves into the Deaf community reject any account of deafness and hearing loss in terms of disability or disease.

  1. ATs for blindness and visual impairment

Current ATs for blindness and visual impairment include, 1) haptic aids, 2) travelling aids, 3) AT for accessible information and communication, 4) AT for daily living, 5) phone and tablet applications for blind and visually impaired people. Haptic aids are low-tech (e.g., white cane, traditional Braille system, embossed pictures, including tactile maps etc.) and high-tech, which includes 1) advanced Braille applications, 2) advanced canes, 3) haptic aids for computer usage and 4) matrices of point stimuli. Travelling Aids can be classified into 1) primary aids, which provide sufficient information for the blind or visually impaired traveller to move around independently; they can safely be used alone; 2) secondary aids, which do not provide by themselves sufficient information for a blind or visually impaired person to safely and independently get around; they must be used in conjunction with a 8 primary aid; 3) embedded technologies, which make the environment easier to cross and navigate; and 4) mixed systems. Technology for accessible information and communication includes technologies for specific purposes, such as education, working and employment, leisure and recreation. They comprise accessibility tools for television, computer, Internet navigation and mobile phone communication. Low vision aids aim at maximizing the remaining sight. Systems tailored to the needs of blind people turn visual information into other sensory modalities. ATs for daily living include devices for 1) personal care, 2) time keeping, alarms, alerting, 3) food preparation and consumption, 4) environmental control and household appliances, 5) money, finance and shopping.

Emerging ATs include 1) devices that can interface with neurons in the retina or in the optic nerve (“bionic eyes”), artificial silicon retina (ASR), retinal prostheses; 2) Augmented reality (AR) spectacles; 3) Implantable miniature telescopes; 4) Telescopic contact lenses.

AT for blind and visual impaired people is driven by: 1) increasing wear ability and portability (driven by miniaturization, reductions in power needs and availability of new, more affordable and smaller power sources); 2) innovations in display technologies and new flexible user interfaces and input options (e.g. touch screens, gesture recognition, brain interfaces, haptic feedback); 3) consumer-level access to tools of development and creation (e.g. 3D printers, app development tools for blind people).The main challenges concern accessibility and economic affordability.

  1. ATs for deaf and hearing impairment

ATs for deaf and hearing impaired people include three broad classes of devices: 1) hearing technology, 2) alerting devices and 3) communication technology. Hearing technology includes devices used to improve the level of sound available to a listener and is, therefore, not made for deaf people with a complete loss of their hearing ability. This technology includes devices for hearing aids, assistive listening devices, personal sound amplification products (PSAPs) and cochlear implants. Personal sound amplification products (PSAPs) are devices that increase sound levels and reduce background noise. The cochlear implant (CI) is a surgically-implanted sensor that converts sound inputs into electrical outputs that can be transmitted through the auditory nerve. Cochlear implants are recommended for deaf children with the immediate goal to allow them to acquire basic speaking and listening skills, being the wider objective to improve their social interactions, their school performance and, finally, their quality of life. The Deaf community has, however, raised the basic objection that cochlear implants are more for making life easier to “oral culture” people than for improving deaf people’s life. Alerting systems are devices that are suited also for deaf people, because they do not usually require any residual hearing capacity. They use light or vibrations or a combination of them to alert users that a particular event is occurring. Communication support technology, also known as augmentative and alternative communication (AAC), includes various tools that overall aim at improving communication skills of the disabled person. They are usually classified under two main headings: 1) telecommunication services and 2) person-to-person interactions. Telecommunication services include mainly standard technologies, such as physical and virtual keyboards, touch screens, video calling, captioning for phone calls, text messaging and other social media and text-based technology (e.g. WhatsApp, FB Messenger, Snapchat etc.). There are also systems that use voice recognition software and are able to translate spoken words into sign language or text.

Augmentative and alternative communication (AAC) for person to-person interactions includes picture boards, keyboards, touch screens, display panels, speech generating devices and software. Some of these technologies address also born-deaf people and deaf people who run the risk of losing their speaking ability as well as deaf-blind people Emerging ATs include 1) advanced cochlear implants; and 2) auditory brainstem implant (ABI), which is a hearing device that stimulates neurons directly at the human brainstem, bypassing the inner ear and acoustic nerve. This device is designed primarily for children with profound hearing loss at birth who cannot receive – because of various medical reasons – cochlear implants. Other emerging technologies for deaf and hearing impaired people are essentially applications of existing technologies (e.g., Google glasses equipped with sign language interpreters; systems to provide real-time captioning; Assistive technologies for people with disabilities purpose-designed software for laptops and tablets; several smartphone applications to be used as personal hearing technology). The main promise of future AT for deaf and hearing impaired people is likely to be new software for translating sign language into spoken and written languages and vice versa. The main challenge to be met is likely to concern economic costs and affordability of hearing aids.

Analysis

ATs can be either low or high tech. This distinction is based on R&D intensities. Low-tech devices are mostly mechanical and do not necessarily require a power source; they are very easy to operate and usually low cost. High-tech devices always require a power source, are more difficult to program and use and are usually more expensive. In the three disability areas, there is an overall balance between low- and high-tech solutions, very high-tech devices are quite rare, the tendency is to stay somewhere “in between”.

ATs can be also categorised into technologies intended primarily to enhance ability or improve accessibility. This distinction comes from the ergonomics theory. The European Parliament study shows a common trend to privilege “accessibility” over “ability”, which is more evident in the case of AT for blind and visually impaired people.

A further perspective that can be used to analyse ATs is through the two categories augmentation and automation, which come from the theory of manufacturing. Augmentation refers to strategies in which human labour and technology are combined to create effective and efficient outcomes. Automation refers to strategies in which technology takes over human labour and machines substitute humans. European Parliamentary Research Service study shows that the trend is towards automation, which means that current and emerging ATs tend more and more to take over the work of human caregivers.

Finally, ATs can be also categorized according to the two models integration and inclusion, which describe two different mechanisms of social assimilation. Integration means a process of incorporation in which individual diversity is “metabolised” and cancelled. The goal of integration is uniformity. Inclusion means a process in which individual diversity is protected and preserved. The goal of inclusion is parity. In the last decades, most representatives of people with disabilities have advocated an approach to disability based on the notion of “disabled identity”, which means considering disabilities as biological variations not to be treated but to be socially included. This is mirrored by a corresponding trend towards inclusive technology, which emerges from European Parliamentary Research Service study.

Conclusion

  • The traditional dichotomy between low and high tech holds. Yet, it is evident that there is a vast area of medium-tech devices, which tend to differ very little from mainstream technology. This is due to many factors, not least due to an approach that is increasingly based on universal design principles. There are no signs that this trend is going to reverse; on the contrary, it seems destined to enlarge and to involve more and more ATs. In the longer term, one could even imagine that the distinction between non-assistive and assistive technology might fade away
  • People with disabilities suffer from a lack of autonomy. Most ATs aim to restore autonomy of the person with disabilities. This goal can be achieved either by improving the impaired or by modifying the context, or by doing both. Today societal emphasis on autonomy is not totally risk-free. There is the actual risk that autonomy could turn into isolation and social indifference. This risk should be properly addressed.
  • Some emerging technologies can hardly be distinguished from prosthetics. The border between AT and augmentation technology runs the risk of becoming increasingly blurred, posing a myriad of legal, ethical and social issues. It is not by chance that most disabled people’s associations are extremely reluctant to accept “prosthetic AT” and question its legitimacy.
  • The main gap observed in this study concerns the disequilibrium between ATs for blind and visually impaired people, and all other ATs. ATs for blind and visually impaired people outnumber other ATs and cover a much wider set of functions. There are cultural reasons that could explain this gap; a further reason might regard the information revolution, which has till now privileged visual communication. Yet, technology advances are increasingly enriching online communication, which now includes sounds and in the next future will include more and more tactile sensations. In the longer term, maybe other sensory modalities will be conveyed electronically. These trends are likely to affect future ATs.
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