1. Assistive Technologies and Rehabilitation- Challenges and Solutions -Jan Alberssenior consultant EPRAEGIS conference 30 November 2011 / Brussels 1

2. Structure Background Major developments and challenges Possible approaches and solutionsAEGIS Brussels, 30 November 20112 3. Background Dutch Study University Heidelberg Director Communication SRH Director VT Centre Hoensbroek CEO Hoensbroek (SRL / now Adelante) Co-founder EPR International activities (EU / RI a.o.)AEGIS Brussels, 30 November 20113 4. AT and Rehabilitation Long common history Focus on individual AEGIS Brussels, 30 November 2011 4 5. AT not new but new is . Speed of technological developments and theirpossible applications Context of disability world / rehabilitationKey: changeAEGIS Brussels, 30 November 20115 6. The message DC + DC DOAEGIS Brussels, 30 November 20116 7. Environment/contextSocial economic AdaptChallengesto changing needs FinancesModernisation Globalisation Understand needs Labour market flexibility Flexible responses Individualisation New target groups New services Ageing New ways service provision InclusionSophisticated and complexIncreasing and diversifyingservices demand 7 8. ContextParadigm shift in health and social services From public programming to more market-based regulationPositive & proactiveHigh level expertise approachModernisation / Change Mainstreaming/partnership Demonstrate added value Inclusion / maximise potential Quality assurance Empowerment Competition: tendering Decentralization Market analysis and orientation Paradigm shift in disability field 8 From medical model to social / consumer model 9. AT - not a normal product An assistive product A need unexpected and not createdAEGIS Brussels, 30 November 2011 9 10. AT - not a normal product An assistive product A product that nobody wantsAEGIS Brussels, 30 November 2011 10 11. AT - from individual to environment Independent living AT not uncontroversial Critics about technology driven nature Stigmatizing character No replacement of communication11AEGIS Brussels, 30 November 2011 12. AT - Definition Any item, piece of equipment or product system,whether acquired commercially, modified orcustomized, that is used to increase, maintain orimprove functional capabilities of individuals withdisabilities.(The US Assistive Technology Act of 1998, Section 3) AT has the potential to help people with disabilities tolive in the least restrictive environments and attain theirpersonal and vocational aspirations.(Peterson DB, Murray GC. Ethics and assistive technology service provision. Disability and Rehabilitation:Assistive Technology 2006;1:5967)AEGIS Brussels, 30 November 201112 13. AT and Telecare AT&T = the delivery of health and social care toindividuals within the home or wider community outsideformal institutional settings, with the support of devicesenabled by information and communicationtechnologies(Tang P, Curry R, Gann D. Telecare: new ideas for care and support @ home. Bristol: The Policy Press, 2000.)AEGIS Brussels, 30 November 201113 14. AT and AAL (housing / environment) (Semi)independent living elderly and pwd Security Communication Comfort / convenience Support Avoid institutionalizingAEGIS Brussels, 30 November 201114 15. AT universal design Universal design strives to be a broad-spectrumsolution that helps everyone, not just people withdisabilities and it recognises the importance of howthings look.Assistive technology which is not guided by theuniversal design concept may benefit people withdisabilities but result in separate and stigmatisingsolutions, for example, a ramp that leads to a separateentry to a building from the main stairway..(Perry J, Beyer S, Holm S. Assistive technology, telecare and people with intellectial disabilities: ethicalconsiderations. J Med Ethics 2009;35:81-86.)AEGIS Brussels, 30 November 2011 15 16. Experience of rehabilitationprofessionals 75% of AT professionals believe thatpersons with disability do not receive theAT that they needAssistive product as a successful solution isvery knowledge demanding and needsprofessional expertise of various domainsAEGIS Brussels, 30 November 201116 17. Critical Success Factors (CSF) Knowledge Assessment Expectations / stigma / acceptance Ongoing process Sustainability / durability17AEGIS Brussels, 30 November 2011 18. Different skills needed (not only technical) Profound knowledge of market (many and complex products) National and international networking Involvementand training of clientsNOTE: lack of sufficient evidence based practiceAEGIS Brussels, 30 November 2011 18 19. Multidisciplinaryteam - flexible and continuous Person-centeredapproach Taskanalysis (real-life scenarios) and site trials documentationthe assessment Education/ training of the team, including theclient Wide scope of knowledge is required to service delivery of ATAEGIS Brussels, 30 November 201119 20. High or low expectations Trial and error process AThe / she has a disability Involvement of users from the very beginning Creating informed choices Involvement of environment / familyAEGIS Brussels, 30 November 201120 21. AT is more than a product after sale is crucial Time lapse between need and provision (re)assessment as continuous process AT service includes training and ongoing trainingAEGIS Brussels, 30 November 201121 22. 75% of AT devices abandoned within 3 yearsReasons: too complex no acceptance by users no acceptance by environment not enough training provided bad qualityTo do: better follow-up awareness raising and information (re)assessment as ongoing processAEGIS Brussels, 30 November 2011 22 23. is like a positive catalyst - it participates in the chemical reaction,speeds it up, but is not consumed by the reaction itself it must bethere but forgotten!Client skill and competency developmentMaximum independenceFull participation in society / InclusionAEGIS Brussels, 30 November 201123 24. Ethical Issues Universal application / access for all Privacy Data protection Delegation of responsibility to machines personal care vs. technology Relation provider / user 24AEGIS Brussels, 30 November 2011 25. Ethical guideliness Privacy: access / protection Autonomy: decision about use of AT Integrity and dignity: respecting individuals as human beings Reliability: reliable AT solutions . No threat physical / mentalhealth E-inclusion: accessible for all user groups Benefit for society: use of AT increase quality of life25AEGIS Brussels, 30 November 2011 26. Core drivers AT / ICT developmentKnowledge disabled end-userKnowledge diagnostician, (para)medical/technical professionals (eastin)Knowledge rules and procedures of service provider systems and reimbursement schemes in EuropeFlexibility in product design (different geographical markets)AEGIS Brussels, 30 November 2011 26 27. Barriers AT / ICT developmentLack of knowledge marketDifferent interpretations national/regional levelsLack of coordination involved stakeholders Different national SP systemsHigh prices AT / ICT devicesAEGIS - Brussels, 30 November 201127 28. Industry key player AT / ICT Fragmented interest Mainly restricted to specialised niches Not recognizing market potential Major international industries developed only for US market European signal (Inclusion driven calls within FP6 and FP7-first step) Appropriate EC legislative frameworkAEGIS Brussels, 30 November 201128 29. Purchase of AT / ICT by end userMedical model Disability / physicianSocial model National legislation / systems / agencies / fundingConsumer model Direct contact user - supplierAEGIS Brussels, 30 November 201129 30. Future role of Rehab SP in AT/ICT (1) Participation in R&D Alliances with universities, research centers Cooperation with industry Involvement of own professionals in ATdevelopmentAEGIS Brussels, 30 November 201130 31. Future role of Rehab SP in AT/ICT (2)Cooperation with mainstream organizationsEmpowerment of service usersTraining of service usersAT is a challenge but even more an opportunityAEGIS Brussels, 30 November 2011 31 32. The message DC + DCDO AEGIS Brussels, 30 November 2011 32