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Steps to Assistive Technology Provision

Original Editor - Robin Tacchetti Top Contributors - Robin Tacchetti, Wanda van Niekerk, Jess Bell, Stacy Schiurring and Rishika Babburu

Introduction

Assistive technology (AT) is a broad term used to describe products whose primary aim is to improve or maintain an individual's independence and function.[1] [2][3] AT can support persons in all aspects of their lives - education, work, health, physical activity, recreation, mental health, leisure, sport, and activities of daily living.[4][5] AT can be used for many types of impairments (e.g. vision, hearing, mobility, self-care) and by people of all ages. AT includes physical devices and digital software,[6] with AT solutions ranging from simple, low-tech devices to highly complex, expensive products.

AT provision is a complex process. It depends on effective multidisciplinary collaboration between users and healthcare professionals.[7] It is not a one-size-fits-all process; each AT device must be tailored to the individual.[2]

Provision

Assistive technology provision is a process aimed at ensuring that each user obtains the most appropriate and beneficial AT solution for their impairment. The fundamental elements of AT provision are listed below:[2]

  • users need to know that AT solutions exist
  • quality products must be available and affordable
  • professionals are required to provide the following services:
    • assessment
    • training
    • follow-up[2]

There are different people involved in AT provision, including[8]:

  • the person needing the AT product
  • the family of the person needing the AT product
  • the people trained to provide the appropriate AT products
  • the people who can identify a person who may benefit from AT and refer them to the appropriate service
  • leaders and policymakers who can help with the availability of AT and ensure accessibility for persons who use AT

Issues with Assistive Technology Provision

There are issues with AT provision in all settings. In high-income countries, the costs of AT may not be fully covered[9] or services may not be integrated, which can have significant cost implications for users. National AT services in middle- and low-income countries might be limited or non-existent, restricting AT access to those who can afford to buy their own products. As a result, people in middle- and low-income countries often depend on donations of AT products from non-profit organisations or charity services. However, these products may not be suitable for the person or their context and there may be no avenues for follow-up or repairs.[10]

Four Steps To Provision

The World Health Organization (WHO) has described four steps that are necessary when providing assistive technology.[8] Proceeding through each step allows the user to gain the most benefit from the product and ensure safety. The four steps to AT provision are: select, fit, use and follow-up.[8]

This video by the WHO summarises the four steps to assistive technology provision:

Select

The select phase of service provision is essentially the assessment. During the assessment, it is important to involve the user and their family or caregivers. This will ensure that the choice of AT is appropriate and tailored directly to the individual and their requirements.[11] The WHO has a range of assessment forms for various assistive products that help determine the best device for the individual.[11] Information that can be gathered during the select phase includes the user's:

  • health
  • ability
  • activity level
  • where they will use the device
  • support services nearby
  • their knowledge of/experience with the device


Having a wide variety of assistive products will make it easier to match a device to the individual's specific needs.[8]

"Critically important is to involve the person and their caregivers to make sure that they understand what they're going to be using and what their needs are."[12]

Fit

After the assistive product has been selected, the next stage in the provision sequence is to ensure a proper fit. This is a crucial step as the device needs to fit well in order to be safe and not cause harm. Additionally, if the fit is not adequate, the user will not gain the intended benefit. The WHO recommends checking the following when fitting an AT device for a user:[8]

  1. Is it properly assembled?
  2. Is it adjusted to the right size?
  3. It is comfortable and safe for the person to use?[8]

When fitting individuals with a selected assisted device, always ask for feedback from the user. The device may need to be modified or adjusted at this time.[8]

Use

The use stage can also be referred to as the teaching stage. It is when the user and/or their caregiver learn how to use the assistive device and how to look after it. The WHO recommends that the following steps are included in this stage:

  1. Explain
  2. Demonstrate
  3. Practise[8]

Follow-Up

The follow-up step is crucial to ensuring that an AT product is still meeting the user's needs. If it is not meeting their needs, a reassessment or an outside referral may be warranted. Coming up with a solution with the user is the best course of action in this scenario.[8]

Follow-up is also a time to check that the product is in good condition and does not require any repairs.[8] Many times this step is left out and users will not have access to repair services, especially in low-income settings.[11]

The WHO recommends checking for the following:

  • Has the individual grown? Does the product no longer work for them because of this?
  • Has the individual's posture changed? Does the product no longer work for them because of this?
  • Are there any screws or bolts that are loose?
  • Is there any rust or are there broken pieces?[8]

"Assistive technology services have a great focus on assessment and prescription, without a robust system for evaluating the follow-up process, which is very critical."[12]

This video by the World Health Organization demonstrates how to look for broken components in an assistive device:

After this visit is completed, make an appointment for the next follow-up visit.[8]

The Time Needed to Prescribe Assistive Technology

It is also important to consider the time needed to provide assistive products. Some products can be provided quickly while others will take a long time. The level of support and time required depends on a range of factors, including[8]:

  • the complexity of the specific assistive product
  • a person's health condition and needs
  • the environment where the product will be used
  • the user's experience with the product

Barriers for People with Assistive Products

People may still be confronted with certain barriers, even though they have the appropriate assistive product. Some barriers that are present include[8]:

  • inaccessible environment
  • stigma
  • discrimination
  • lack of accessible information
  • lack of supportive services
  • lack of supportive policies

"Everybody has a role to play to ensure people who use assistive products are included, and can do the things they want to do on an equal basis as others."[8]

Putting it all Together

The video below by Momentum Wheels for Humanity demonstrates the WHO 8 steps to wheelchair provision.

The steps are:

  1. Referral and Appointment
  2. Assessment
  3. Prescription
  4. Funding and Ordering
  5. Product Preparation
  6. Fitting
  7. User Training
  8. Maintenance, Repairs and Follow-Up

If you'd like to read more about each step in detail you can have a look at Eight Steps to Appropriate Wheelchair Provision.

Resources


References

  1. ↑ MacLachlan M, Scherer MJ. Systems thinking for assistive technology: a commentary on the GREAT summit. Disability and Rehabilitation: Assistive Technology. 2018 Jul 4;13(5):492-6.
  2. ↑ 2.0 2.1 2.2 2.3 de Witte, L., Steel, E., Gupta, S., Ramos, V.D. and Roentgen, U., 2018. Assistive technology provision: towards an international framework for assuring availability and accessibility of affordable high-quality assistive technology. Disability and Rehabilitation: Assistive Technology, 13(5), pp.467-472.
  3. ↑ Karki J, Rushton S, Bhattarai S, De Witte L. Access to assistive technology for persons with disabilities: a critical review from Nepal, India and Bangladesh. Disabil Rehabil Assist Technol. 2023 Jan;18(1):8-16.
  4. ↑ World Health Organization. Global report on assistive technology. 2022.
  5. ↑ Smith EM, Huff S, Wescott H, Daniel R, Ebuenyi ID, et al. Assistive technologies are central to the realization of the Convention on the Rights of Persons with Disabilities. Disabil Rehabil Assist Technol. 2024 Feb;19(2):486-491.
  6. ↑ Mishra S, Laplante-Lévesque A, Barbareschi G, Witte L, Abdi S, Spann A, Khasnabis C, Allen M. Assistive technology needs, access and coverage, and related barriers and facilitators in the WHO European region: a scoping review. Disabil Rehabil Assist Technol. 2024 Feb;19(2):474-485.
  7. ↑ Alqahtani S, Cooper R, Cooper RA. Current state and conceptual framework of assistive technology provision in Saudi Arabia. Disabil Rehabil Assist Technol. 2023 Nov;18(8):1357-1363.
  8. ↑ 8.00 8.01 8.02 8.03 8.04 8.05 8.06 8.07 8.08 8.09 8.10 8.11 8.12 8.13 8.14 World Health Organization. Training in Assistive Products Module. 2020. Available from: https://www.gate-tap.org/all-modules/
  9. ↑ Danemayer J, Holloway C, Cho Y, Berthouze N, Singh A, Bhot W, et al. Seeking information about assistive technology: Exploring current practices, challenges, and the need for smarter systems. International Journal of Human-Computer Studies. 2023;177:103078.
  10. ↑ World Health Organisation. Assistive Technology. May 2023
  11. ↑ 11.0 11.1 11.2 Oldfrey, B., Barbareschi, G., Morjaria, P., Giltsoff, T., Massie, J., Miodownik, M. and Holloway, C., 2021. Could assistive technology provision models help pave the way for more environmentally sustainable models of product design, manufacture and service in a post-covid world?. Sustainability, 13(19), p.10867. 
  12. ↑ 12.0 12.1 Tachetti, R. Steps to Assistive Technology Provision Course. Plus. 2022.
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