Focus: Assistive technology for children
By Johan Borg
Department of Health Sciences, Lund University, Sweden
‘Assistive technology’ consists of products and services adapted or specially designed to improve the functioning of people with disabilities. For many children, it represents the difference between exclusion and inclusion – between deprivation and the equitable enjoyment of rights.
Assistive technology products range from simple (a walking stick to aid mobility) to complex (a GPS navigation device for the vision-impaired). Assistive technology services include assessment of the child, selection, adaptation, modification and fitting of the product to the child, training of the child and family members, follow-up, maintenance and repair. These services can have a substantial effect on the outcomes of using a product. For example, incorrectly prescribed spectacles could result in headaches that might hamper learning. Therefore, service personnel must have the skills to correctly assess or fit the product.
Assistive technology can be instrumental for children’s development, health and participation in communication, mobility, self-care, household tasks, family relationships, education, recreation and leisure. Assistive technology can enhance the quality of life of children and their families. If a girl cannot walk she might be confined to life indoors with no chance to attend school or accompany her family outside their home. When she gets a wheelchair, she is able to move around by herself, participate in activities and interact with others. As a result, her physical health, social interactions and self-esteem improve. Family members no longer have to carry her as much as before – a task that becomes heavier, literally, as she grows. This reduces their stress and worries related to her current and future situation and frees up time for them to work, rest and otherwise improve the family’s quality of life.
For many children, assistive technology constitutes a necessary precondition for them to enjoy and practise their rights. Children’s use of assistive technology can also contribute to preventing future poverty by enabling them to participate in education, a gateway to better income opportunities.
A right to assistive technology
Articles 4, 9, 20, 21, 24, 26, 29 and 32 of the Convention on the Rights of Persons with Disabilities (CRPD) make explicit mention of specific aspects of assistive technology. General obligations, such as taking “all necessary measures” or “appropriate measures,” which may include assistive technology implicitly, are found in an additional 17 articles.
Implementing the assistive technology-related measures of the CRPD among children entails ensuring that products and services are available, affordable and well suited to all who need them.
In the first instance, assistive technology services and products should be adapted and modified so they are appropriate to the needs and requirements of individual children. They need to accommodate conditions unique to each child (for example, health status, body structure, capacity, gender, age and preferences) as well as such environmental factors as terrain, climate and culture. Effective products and services are those that can be adapted to keep up with children as they grow and their abilities change. They are also made to prevent new and secondary health problems such as pressure sores, pain and deformities due to flaws in design or adaptation.
Assistive technology services and products are most likely to be acceptable when the children and families who will use them are involved in the provision process and if their needs, preferences and expectations are taken into consideration. Efficiency, reliability, simplicity, safety, comfort and aesthetics all matter.
Product quality is equally important and can be measured in terms of strength, durability, capacity, safety and comfort. If national standards have not been adopted, products should comply with relevant International Organization for Standardization benchmarks. User satisfaction and quality of life should be considered paramount.
Providing assistive technology to children as early as possible facilitates their development and prevents secondary conditions such as deformities. For example, correction of a club foot by the means of a simple, inexpensive foot orthosis (sometimes made from a shampoo bottle) at an early age may reduce the need for surgery when the child is older.
Ensuring that assistive technology is available and accessible also requires supporting infrastructure and human resources to deliver products and services to all who need them. Provision should eliminate inequities based on gender, type of impairment, socio-economic status and geographic location. In many cases, ensuring that these products and services are affordable to the family or caregiver of every child who needs them entails a partial or total financial subsidy.
Making assistive technology of an appropriate quality available, accessible, affordable, adaptable and acceptable to children and their families is easier when governments and other providers:
- Estimate children’s needs for various assistive technologies as a prerequisite for planning equitable services. It is important that the needs of children with all types of disabilities are considered, including those with physical, cognitive and sensory disabilities.
- Incorporate the provision of assistive technology to children into legislation, strategies and policies. The goal of these efforts is to enable children to obtain and use assistive technology at home, school or play.
- Draw up budgets and raise funds effectively. This can involve government or donor funding, national or private insurance schemes, public or private assistive technology funds, user contributions, tax reduction, duty exemption on imported materials and products, and corporate social responsibility schemes.
- Provide appropriate training for decision-makers and personnel at all levels. The World Health Organization, academic institutions and other organizations offer guidelines, training materials and courses on the provision of various types of assistive technology.
It may be cost-efficient to utilize already existing systems and infrastructure for health care, community-based rehabilitation, education and other necessities. Determining needs and access to assistive technology, as well as ensuring maintenance, repair and replacement, are important aspects of community-based rehabilitation. In Thailand, for example, the school system is used to ensure that students with disabilities get necessary assistive technology.
A broad range of stakeholders need to be involved in the above actions. They include government ministries and departments, international partners, non-governmental organizations, the private sector, professional organizations, disabled people’s organizations, and children with disabilities and their families. The development of partnerships among these domestic and international stakeholders can support national efforts, coordination and collaboration, and help prevent duplication.