Ethical issues in assistive technology

Outline Introduction and definitions Any conflicts between goals of therapists and engineers? Advantages and disadvantages of AT Some examples Use and abandonment of assistive technology Conclusions

Definitions Occupational therapy: helps people regain, develop, and build skills that are essential for independent functioning, health, and well-being. Rehabilitation engineering the application of science and technology to improving the quality of life of a persons with disabilities.

More definitions Assistive technology: products, devices or equipment … that are used to maintain, increase or improve the functional capabilities of individuals with disabilities (1998 Tech Act)

Any conflicts? OTs, (and PTs, SLPs, etc.) and Rehab Engineers have similar goals Each uses different techniques to achieve those goals Therapists work directly with clients to help them develop skills needed for independent living Engineers work with clients, too, but they design and build things to help the client

The potential conflict Engineers (and others) can get carried away with what we can accomplish with technology Sometimes, technology isnt the most appropriate solution

Advantages and disadvantages of an AT device Advantages It can always be there It can be powerful Disadvantages It may not always work as intended in every possible situation It doesnt grow with the client It may break It may encourage the consumer to rely on (imperfect) technology instead of developing their own skills

Some examples follow To build or not to build… Are there alternatives to AT When are the alternatives appropriate? When is the AT appropriate?

Prosthetics Prosthetics can provide functionality for a lost limb However, it is imperfect technology Are there alternatives? Yes, children, in particular, can learn to compensate for a lost limb They may not realize they are missing anything When are the alternatives appropriate? When is a prosthetic device appropriate?

Cochlear implants The cochlear implant technology is still relatively new The cochlea (inner ear) is very complex Cochlear implants do not nearly match the performance of the human cochlea Are there alternatives? Yes, children and adults can learn to communicate using sign language When are the alternatives appropriate? When is a cochlear implant appropriate?

Climbing Wheelchair Wheelchairs have been developed that can climb stairs With this wheelchair, people with disabilities can access more places But – will this work on any type of stairs? And what if it malfunctions? Are there alternatives? modify the environment instead When are the alternatives appropriate? When is a climbing wheelchair appropriate?

Case study: laptop computer Jim has cerebral palsy with poor motor control A laptop computer was given to him in kindergarten because he had difficulty with handwriting His teachers and therapists assumed that he would eventually rely on a laptop for all his writing But, Jim wanted to be like everyone else and was motivated to write like everyone else His therapist worked with him on handwriting skills for the next four years By fourth grade, his handwriting was adequate for his age level

Laptop computer, continued An individual who has poor motor control can use a laptop for writing Are there alternatives? Yes, work with an OT and PT on handwriting When are the alternatives adequate? When is it appropriate to use a laptop for writing?

Use and abandonment of AT Studies show that up to 75% of AT devices are abandoned within 3 years This may be a positive thing Consumer no longer needs AT Consumer needs a more complex device However, it is often a negative thing

Why abandon AT? Not well matched to individual Little or no training provided Families not accepting of technology Family members from varying cultures may have different perceptions of the need for technology Consumer or their family doesnt want to stand out by using the technology School or workplace not accepting of technology

To be successful… Insure that your device will help the client and their family achieve their goals Work as a team with client, family, therapists, teachers, supervisors, etc. Communication is crucial

What does this mean? Should engineers continue research on cochlear implants, etc? What is the role of the engineer and the clinician in discussions of new technologies for clinical use? Be careful – many clinicians are fascinated by technology, just like engineers

References [1] Assistive Technology Training Online Project (ATTO). [2] Michigans assistive technology resource. [3] Family-Centered Decision Making in Assistive Technology

The end The benefits of technology are as extensive as the abilities and goals of the students using them. However, professionals and parents should exercise certain cautions. Technology must not been seen as a panacea. [1]