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ABLE: the future of mechanical aids.

ABLE: THE FUTURE OF MECHANICAL AIDS

It is now time that parents and professionals focus our energy and concern on the coming revolution in rehabilitation technology, a revolution that holds great promise. There has been a steady stream of improvements in the equipment available to people with disabilities. It is now possible to obtain much more effective power mobility systems; there are many more communications technologies; there are a number of systems to help people control their own environment. Taken by themselves, these innovations do not constitute revolutionary, dramatic change of the kind needed to mandate rapid acceptance. As a whole, however, the direction of new developments in rehabilitation clearly changes the very nature of the relationship between people and the mechanical devices that serve them, and this new direction has the potential to be truly revolutionary.

A RADICAL LEAP FORWARD

The evidence is clear that ABLE--Advanced Bio-Mechanical Linkage Enablement Technologies--will constitute a radical leap forward in physical aids to people with disabilities. Just as the CAT scan integrated x-ray and computer imaging technology to create a new diagnostic system, integrating emerging high technologies in rehabilitation will create individualized self-contained care systems that are geometrically greater than the sum of their parts.

THE PERSON/SYSTEM LINKAGE

When Luke Skywalker lost a hand in The Empire Strikes Back, it was replaced by a bionic hand completely indistinguishable from his own. In today's world, this sort of perfect human/machine interface, where the boundary between body and technology becomes blurred, is not yet possible. Short of bionics, the objective of all ABLE Technology is to restore and enhance human functioning through mechanical means, in as normal and as unobtrusive a way as possible.

The intimate linkage between a person and a unified system made up of electronic and mechanical components is the key to ABLE Technology. Remarkable strides have been made, for example, in the variety and technical sophistication of controls that can alternately operate mobility, communication or environmental control systems. Controls that track eye movements, or respond to sound, or require only the smallest head movement are now available on a limited basis.

In an ABLE system, the sophistication in control mechanisms makes possible a range of mobility and communication technologies that are orders of magnitude ahead of what is now available. One system currently under development allows people who are physically and visually impaired to direct their wheelchair to any location in their house by means of a voice command. The voice control system is integrated with a wheelchair equipped with a light reader much like that used in supermarket checkout counters. The wheelchair reads a set of light bands and travels along a course of light sensitive tape applied in a person's home and coded to her individual needs.

Other systems include eye movement controls similar to those now in use in advanced fighter aircraft, which will enable users to perform a wide array of functions merely by looking at designated images on a screen, and speech synthesizers, which transform printed words or symbols on a computer screen into an audible voice.

Just as we seek to design individual education plans to meet the educational needs of our children, ABLE systems seek to create integrated technological systems to meet their medical/social needs.

CURRENT INTEGRATED SYSTEMS

We now have the technical ability to create these systems. This is the first critical element in creating ABLE systems that are accepted and available to those who need them. We are still working on the means to actually integrate the different systems. As these linkages continue to be developed, our ability to help people achieve greater functioning will make a quantum leap forward. Let's look at what exists now.

Recent developments in seating and mobility have included a wide variety of optional or add-on adjustments, from variable tilt and seat and leg recliners, to seat elevators and standers. Yet very few of these are available as part of an integrated system that can be controlled by a single wheelchair switch.

Standing, for example, has both medical and social benefits. For many people with disabilities being able to stand at will can enhance renal function, help prevent muscle atrophy, promote skin integrity and reduce bone deformities. Socially, it can enable some people to stand in performing their jobs, going to the ballgame and speaking with their friends face to face. But most standers are not part of wheelchair or communications systems and still require someone to help the user transfer from one use to another. Even environmental controls are often not integrated with communications systems.

SYNERGISTIC SYSTEM

Many potentially useful systems are on the market now, but their utility is limited by virtue of the fact that the linkage between the user and the technology is so deeply flawed.

When a child is called on to make a speech in class, the classic approach is for her to write a speech, stand at a podium and speak to her peers and instructor. Children with disabilities may not be able to write, or to walk to the front of the room, or to stand at the podium or to speak. Indeed, some children are unable to do any of these things unaided. The systems we currently use to aid them are usually limited to one function each. In order for a child to give this speech, she would need assistance switching from her wheelchair to a stander, more help positioning her communication equipment and so forth.

An effective ABLE Technology system would integrate writing, mobility, standing and speech synthesis functions into one unit that our student could operate by herself. She would use her single control to write the speech and store it in memory; drive her wheelchair to the front of the room; switch to a standing mode; use her built-in stander to face the class; deliver her speech using an integrated speech synthesizer; and answer questions afterward using her communication/writing system, which was integrated with a speech generation unit.

This type of ABLE Technology system is very close at hand. In such a system, our child can use the same control that operates the chair to control the stander and to operate the communications system and the environmental control unit. By virtually eliminating the need for assistance, an integrated system operated by one control mechanism--whether a joystick or an optical scanner--can enable the most seriously involved person to recover many independent abilities.

THE NEED FOR UNIVERSAL STANDARDS

More and more, universal standards that will break down the barries that exist between manufacturers and technologies are being developed. Universal standards will provide interchangable technology through a system of mutual parts and components. There is currently a movement toward an international standard for infrared environmental control units, and virtually all seating systems can be fitted to any mobility system.

But key links in the ABLE chain have yet to be forged. Most notable of these are the links among the control systems for communications, mobility and environmental units. Interfaces have been created between some communications and wheelchair producers that will soon allow communications controls to operate wheelchair systems. As this kind of sharing becomes more commonplace among producers, individualization will become routine--almost standard--for users. And it is only with a high degree of individualization that we can hope for a human/machine interface that helps us approximate "normal" functioning.

BARRIERS TO ACCEPTANCE

In order to best understand how the pace of change can be affected, we might look at projected obstacles in the way of developing ABLE technologies.

There is bound to be a "cultural lag" in acceptance of new technologies. The delay can be caused by the lack of information about new products and technologies, the natural reluctance of practitioners to change "proven," or at least familiar, techniques, and the need of manufacturers, practitioners and regulators to maintain a status quo in their own fields.

In many places, it is extremely difficult to obtain insurance approvals for equipment that has medical benefits but is seen as 'merely' improving the quality of life. In part, the relatively slow pace of innovation in rehabilitation in the United States has been determined by what insurance companies will purchase.

Even if the technological capability exists for persons with disabilities to accomplish many things they never dreamed of before, there will still be barriers that prospective users will have to cross. The current constellation of organizations (caregivers, product manufacturers, charities and insurance companies) that service the disability community have become accustomed to doing things in particular ways. Some of these organizations would have to radically change their activities, staffing and sources of financial support, if they were to accommodate the full potential of the coming ABLE Technology.

Much of the support offered to people with disabilities has historically depended on personnel intensive rather than capital intensive approaches. If ABLE Technology advances to the point where this balance must change, these organizations would likely be slow to change, taking things in small steps. There may well not be a conscious effort to slow the progress, but rather a knee jerk response by organizations whose interest is to maintain the system as they know it.

For example, one characteristic of ABLE Technology would be a system whose component parts need replacement at different times, rather than all at the same time. In systems that do much more, anc can last longer, it is likely that modification of only one sub-system at a time would be necessary. Currently, funding sources commonly approve a basic power wheelchair with a low unit cost. They expect to replace the whole unit every three years. In an ABLE system, they might be faced with a much higher initial cost, but lower costs over the lifetime of the person using it. Even if the case for lower average costs is compelling, entrenched bureaucratic practices can still slow the pace of acceptance.

MAKING IT HAPPEN NOW

It is up to all of us to support ABLE advances and inoovations if we wish to see our children function at a higher level and act more independently. Here are a few things we can do now to speed the process along. . Work with Your Professional Care Team

Just as it is important for your child's support system to be integrated, it is equally important that your professional care team work jointly to come up with a prescription for a system that will be technically correct and useful and will be reimbursed by your insurance carrier.

Many physicians, physical, occupational and speech therapists are aware of the benefits of ABLE systems. They will explore all possibilities to ensure that an integrated system will be designed for your child. . Look for Integrated System

Sometimes health professionals are not aware of all the possibilities that might exist to create the best interface between your child and his or her physical support system. It is important to keep up with new developments and to ask your team to help you with these efforts. . Pursue Payers

If an ABLE system has been prescribed for your child, don't take no for an answer if your insurance company maintains that other systems can do it cheaper. Chances are that other systems might do something cheaper, but not nearly as well. If a system has been endorsed by your team of professionals, you should exhaust all avenues of appeal in seeking to obtain it. . Make the Most of Legislation

Now that Sen. John Kerry's (D-Mass.) bill to create technology centers for children with disabilities has been passed, push for implementation and funding. These centers will provide information about ABLE technologies and will also help consumers provide the impetus to create more and more ABLE systems. . Advocate for ABLE Technology Systems

Discuss these issues at your parent support group, or through the forum that EXCEPTIONAL PARENT and other publications provide. It is virtually certain that widespread acceptance of these new technologies by the professional, medical and insurance communities will require grass roots supports, much like the movement for individualized educational planning did a decade ago.

We cannot relax until the use of all available advanced technologies, in its best, most individualized and most ABLE applications, becomes routine practice.

For more information about ABLE Technology, contact these organizations: .RESNA (formerly the Association for the Advancement of Rehabilitation Technology), 1101 Connecticut Ave., N.W., Suite 700, Washington, D.C. 20036, (202)857-1199. .American Academy for Cerebral Palsy & Developmental Medicine, 1910 Byrd Ave., P.O. Box 11086, Richmond, Va. 23230-1086, (804)355-0147. .National Institute on Disability & Rehabilitation Research (NIDRR), U.S. Department of Education, 400 Maryland Ave., S.W., Switzer Bldg., Room 3070, Washington, D.C. 20202, (202)732-1207.
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Title Annotation:Advanced Bio-Mechanical Linkage Enablement Technologies
Author:Lowell, Harvey; Finkelstein, Stan
Publication:The Exceptional Parent
Date:May 1, 1989
Words:2109
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