Assistive Technology and Mobility Aids for the Older Patient with Disability

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Author(s): 

Helen Hoenig, MD, MPH

Conceptually, assistive technology needs to be thought of simultaneously with adaptive techniques and environmental modifications, as they are typically used in conjunction with one another. Assistive technology refers specifically to devices used to compensate for physical limitations. The term assistive technology may be used narrowly to refer to special tools used to accomplish an activity (eg, a walker), or it may include orthotics (eg, braces, splints) and prosthetics (eg, artificial limbs) as well. Adaptive techniques refer to modifications in the way an activity is carried out. For example, someone with limited shoulder range of motion might place the arms in the sleeves of a t-shirt, then put it over the head rather than the reverse; or a woman might fasten her brassiere in the front, then turn it around rather than trying to reach behind to close the brassiere. Use of almost any assistive device will require some modification in the way the activities performed with the device are carried out. Environmental modifications are changes in the physical surroundings, such as enlargement of a doorway to allow for a wheelchair. The Americans with Disabilities Act (ADA) of 1990 focused on environmental modifications to enhance access to the workplace, public buildings, and transportation (see www.adata.org for further information). Universal design is a term occasionally used in the context of environmental modifications that refer to architectural design to enable access for the widest possible breadth of physical abilities. Thus, generally speaking, assistive technologies and adaptive strategies compensate for extant disability by increasing an individual’s functional abilities, environmental modifications act to reduce the environmental demands on the individual, and all three together help enable people with physical limitations continue to accomplish important activities.

Usage of assistive technology is increasingly common, with growth far exceeding demographic changes in the U.S. population.1 From 1980-1994, the U.S. population increased by 19.1%; however, the age-adjusted use of leg braces increased by 52.1%, walkers by 70.1%, and wheelchairs by 82.6%.2 Approximately one in four older adults use an assistive device, and one-third of those use more than one such device. Assistive technology has improved considerably in functionality, appearance, and diversity over recent years.3,4 While outcomes research on assistive technology is limited,5 existing data show that it may reduce task difficulty and reduce the need for help from another person.6-9

However, many disabled people report that they lack potentially helpful devices, and problems with devices are common.10-14 The very process by which assistive devices are acquired by older adults is part of the problem. Difficulties besetting elderly persons trying to obtain assistive technology include difficulty obtaining information on potentially useful equipment, high cost and limited funding for assistive technology, and fraud and abuse by providers.15 To foster technology-related assistance for consumers, the “Tech Act” was enacted in 1988.16 This legislation spawned availability of information on the Internet and centers in each state to provide assistance with technology to disabled persons. (see www.resna.org/taproject/index.html/at/statecontacts.html for a state-by-state list). Useful websites include http://www.abledata.com (a listing of over 17,000 different assistive devices), http://www.wheelchairnet.org/ (a website specifically focused on wheelchairs), and http://www.resna.org/ (the website for the Rehabilitation Engineering and Assistive Technology Society of North America).

References: 

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