Assistive Technology and Occupational Therapy: the perfect marriage?

In 2018 the World Health Assembly adopted an important resolution, urging member states to develop, implement and strengthen policies and programmes to improve access to AT for everyone who might need it  . This resolution was the result of the powerful GATE initiative (Global Cooperation on Assistive Technology), started by the WHO a few years earlier. GATE is a partnership of UN Agencies, international organisations, donor agencies, professional organisations, academia, and organisation of persons with disabilities. The aim of GATE is to ‘open to gate’ to affordable high quality assistive technology for everyone who needs it. 

This is a hugely important aim, because ‘the gate’ to AT is practically closed for most persons who experience functional limitations in their lives. According to the WHO, only about 10% of the people who might benefit from Assistive Technology has access to it. This is a global estimate, based on limited data about the needs for AT, but it is clear that there is huge gap between needs and what is available. And this gap does not only exist in low- and middle-income countries, but also, be it to a lesser extent, in developed and rich countries. 

There are many factors that explain the gap mentioned: lack of awareness, lack of legislation, limited resources, lack of knowledge and expertise, social stigma, taboos, some assistive products not being available in certain countries, and many more. Whatever the reasons are, from a human rights perspective it is unacceptable that such a huge gap exists. It fundamentally limits many people to live independent lives, to participate in their societies, to access education and work, and to have control over their lives. The fundamental right to have access to AT is enshrined in the United Nations Convention on the Rights of Persons with Disabilities (CRPD)  , published already in 2006 and ratified by 182 countries in the world. 

Looking at the current situation of the huge gap between AT needs and access against the principles of the CRPD, it is quite shocking that the situation has not fundamentally improved over the past 14 years. Many countries have made serious efforts to improve their legislative frameworks and to establish AT provision systems, but on the ‘grass root level’ of persons with disabilities trying to live their lives much is still the same. 

A recent PhD thesis of an Indian colleague with the provocative title ‘Invisible lives; tales of people with severe disabilities living in rural India’   clearly demonstrates this. The author describes the huge distance between legislation and policy on the one hand and the everyday reality of persons with disabilities on the other. This is of course only one study, but there are many reports presenting similar findings. 

The WHO is working on the Global Report on Assistive Technology, to be published end of 2021 or early 2022. This report will provide an in-depth description of the status of AT provision across the world. It will collate all the knowledge available about AT needs and the extent in which these needs are met; it will demonstrate the impact AT can have on the lives of people with disabilities; and it will describe pathways to improvement of the situation.  

In bridging the gap between AT needs and access lies an important responsibility and a fantastic opportunity for healthcare professionals. These professionals are the ones that can ‘translate’ needs into possible solutions and make sure that people get what they need. They are also the ones who can be advocates for people who need AT, and the ones who can help empower these people. 

But there is an important problem: there is not one obvious professional group who could call themselves ‘AT professionals’.  In different countries and within countries in different sectors of the AT field, very different professionals play a role. Nurses, physiotherapists, doctors, prothesists, employers of AT companies and occupational therapists can all be involved in different steps of AT provision, from assessment to fitting and evaluation. And in many countries volunteers who work for an NGO play an important role. Most of these professionals or volunteers have no specific training about AT. Some have expert knowledge about specific AT products, but only in a few countries there is something like an accredited AT professional  . 

It is very important that the field of AT provision is further professionalised. It is needed to be able to bridge the gap described. But is also needed because the field of AT is rapidly changing, driven by impressive technological developments. New assistive products have entered the field as realistic solutions, and many more are being developed. Examples are robots and a whole range of digital solutions. 

In March 2021 the World Intellectual Property Organisation (WIPO) will publish a flagship report about developments in the field of AT. This report presents an overwhelming number of advances in seven major emerging technology domains that will likely have an impact on the field of AT. 

In a background study for the WHO Global Report, entitled ‘Emerging Technologies and Their Potential for Assistive Technology’, the authors also try to give an overview of the most important developments, based on an extensive review of the grey literature and an analysis of patents, done together with the WIPO  .  They distinguish seven major emerging technology domains: Artificial Intelligence; human-computer interfaces; sensor technologies; robotics; advances in computing and connectivity; additive manufacturing; and new materials. In combination these fields offer unprecedented new possibilities. 

This is clearly reflected in the large number of patents in these fields: more than 3.7 million in the past 20 years. Only a small percentage (0.3%) of these patents explicitly refer to Assistive Technology in general or Assistive Technology users, but these figures suggest an immense potential to revolutionise the AT field. 

An important finding is that the technologies mentioned reinforce each other; in combination they lead to completely new solutions. An example is again the field of robotics; advancements in Artificial Intelligence and connectivity create the basis for robots to become much ‘smarter’ and more responsive/adaptive. And that means that applications to support people with disabilities in their everyday lives become realistic and possible. Other examples are new human-computer interfaces, eye tracking solutions, navigation systems, etc. 

These rapid developments and their complexity require specialist expertise to match the solutions they create to the needs of individuals. Apart from the need for more professionals, these technological developments call for professionalization of this field.  

Why has this not (yet) happened to the extent needed? 

Occupational Therapists have a great starting position to take a leading role here, because they learn to analyse the interaction between a person with their limitations and possibilities, their ambitions and wishes and the environment in which they need or want to function. That is exactly what is needed to assess the needs for AT and to design solutions for individual users. For the OT profession there is a fantastic opportunity to profile itself as THE Assistive Technology professional. 

Why not create such a specialism within the OT profession? There is a clear worldwide need for this kind of expertise, other professions are not doing it, there is a good starting position, …… so, what is the barrier?