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Physical disability and technology needs: a preliminary study in response to federal mandate.

Physical Disability and Technology Needs

a preliminary study in response to federal mandate

In order to investigate the technology needs of people with physical disabilities in the State of Arkansas, data obtained from a sub-sample of 981 respondents from a larger study was selected and examined. Unmet needs were identified in all areas of life functioning, with particular emphasis being placed on inaccessibility of transportation, lack of credit options for purchasing needed technology and inability to try out technology before purchasing it. The funding mechanism most often used for technology was Medicare and Medicaid, while the least often employed was the public school systems. Even in light of the limitations of the study in terms of generalization of findings, it represents one of the first attempts to systematically investigate the technology needs of people with physical disabilities.

As readers of American Rehabilitation are aware, people with physical disabilities are an extremely heterogeneous population, exhibiting a diverse range of needs to be met in order for them to become more fully functioning and contributing members of society.[1,2] These needs have presented tremendous challenges to those involved in service delivery to people with disabilities, and have resulted in greater attention being focused on technology and its applications to this population. In recent years, the word has spread that all people, particularly those with physical disabilities, can benefit from technology.[3] Not only does technology provide important tools that facilitate the performance of tasks, but it is often a necessity that promotes necessary interactions within the mainstream of everyday life.[4,5]

It is indisputable that with the increased independence evolving from the utilization of available technology among people with physical disabilities, benefits via reduced costs to society, to people with disabilities and to the families necessarily ensue.[3,6] Such benefits include a reduction in the expenditures associated with early intervention, education, rehabilitation, health care, transportation, telecommunication, and other services needed by people with physical disabilities.

Federal Technology Legislation

With the passage of Public Law 100-407, The Technology-Related Assistance for Individuals with Disabilities Act of 1988, the federal government echoed its recognition that all people with disabilities can benefit from technology. Prior to the enactment of this monumental legislation, there seemed to be a consensus across the country that people with disabilities did not have access to information regarding potentially useful technology, advice on the appropriate selection of assistive devices, or training in the use of assistive devices once they were obtained.[7] A related problem was that existing service delivery systems which were designed to assist people with disabilities to identify, acquire and use assistive technology were incomplete and fragmented in design. Hence, this suggested that the provision of better access to technology is contingent upon an enhanced capacity to provide services designed to support people with disabilities in the use of their technology.

The recent technology legislation is especially important since it reflects a major advancement in the development of necessary support services for people with disabilities. In a general sense, the federal government has authorized grants to states to develop comprehensive statewide service delivery programs for assistive technology. During the first funding cycle in fiscal year 1989, the Office of Special Education and Rehabilitative Services funded 9 initial grants, with an additional 13 grants being funded in April 1990. The specific purposes of the state grants program as delineated under section 345.2 of the regulations are "to create and support comprehensive, consumer-responsive, statewide programs of technology-related assistance designed to increase --

(a) Awareness of the needs of individuals with disabilities for assistive technology devices and assistive technology services;

(b) Awareness of policies, practices, and procedures that facilitate or impede the availability or provision of assistive technology devices and assistive technology services;

(c) The availability of and funding for the provision of assistive technology devices and assistive technology services for individuals with disabilities;

(d) Awareness and knowledge of the efficacy of assistive technology devices and assistive technology services among individuals with disabilities, their families or representatives, individuals who work for public agencies, and private entities that have contact with individuals with disabilities (including insurers, employers, and other appropriate individuals);

(e) The capacity of public and private entities to provide technology-related assistance, particularly assistive technology devices and assistive technology services, and to pay for the provision of assistive technology devices and assistive technology services;

(f) Coordination among State agencies and public and private entities that provide technology-related assistance, particularly assistive technology devices and assistive technology services; and

(g) The probability that individuals of all ages with disabilities will, to the extent appropriate, be able to secure and maintain possession of assistive technology devices as they make the transition between services offered by human service agencies or between settings of daily living."[8]

To address the aforementioned parameters of the legislation, states applying for grants under the legislation must conduct a preliminary assessment of the needs of people with disabilities across all groups -- including the underserved -- the geographic regions of the state for assistive technology services, devices and support. Similarly, a description of the nature of both state and private sector involvement in the provision of technology and related services as well as the continuing role in the provision of such services is required in the grant application.

Technology Access for Arkansans

In the Spring of 1988, prior to the passage of Public Law 100-407, a cooperative effort to find solutions to problems that Arkansans with developmental disabilities experience was initiated. The resulting project, the Technology Access for Arkansans (TAARK) project was planned by seven public, private and consumer agencies to:

* Identify the need and quality of technology provisions in Arkansas;

* Disseminate information about the appropriate technology and funding;

* Educate Arkansans about technology and funding;

* Educate Arkansans about technology and advocacy;

* Develop a coordinated state plan; and

* Provide technical assistance to the Governor's Developmental Disabilities Planning Council (DDPC).

The project was funded in part through the DDPC and in part through the University of Arkansas-University Affiliated Program. However, soon after this project was funded at the state level, the federal technology legislation was enacted providing the impetus for bi-level planning activity to develop: (a) a broad state plan addressing the technology needs of people with disabilities; and (b) a response to the opportunity for federal assistance in developing a model plan for technology provision to people with disabilities via grant application processes.

This study reports on a subcomponent of a study used for state planning efforts evolving from the TAARK project wherein the grant application processes of Public Law 100-407 were addressed. The report focuses specifically on the assessment of needs of people with physical disabilities who are potential consumers of technology, with implications of the findings presented for future planners of technology service delivery systems.


In January 1989, a Coordinated Planning Committee of 17 people representing a cadre of state, private and consumer organizations in Arkansas met and discussed components of Public Law 100-407. Given that little information appeared to exist relating to the technology needs of people with disabilities, a decision was made to conduct a statewide survey of consumers with disabilities to gain information for planning efforts. A Consumer Needs Study Group was organized to draft a document designed to assess the technology-related needs of people with disabilities. The resulting instrument was subjected to a series of reviews and modifications by the entire Coordinated Planning Committee which, by May of 1989, had grown to a constituency of 48 people, including people with disabilities, family members, vendors of technology, and representatives of 25 different public and private organizations.

Consumer Survey

Each participating member of the Central Planning Committee was requested to provide a mailing list of people with disabilities and/or consumers. Groups providing mailing lists included Advocacy Services, Arkansas Association for the Hearing Impaired, Arkansas Easter Seal Society, Central Arkansas Area Agency on Aging, Coalition for the Handicapped, Department of Human Services (DHS), Developmental Disabilities Services, DHS Division of Rehabilitation Services, DHS Division of Services for the Blind, and Mainstream Living Center, which is an independent living center funded through Title VII Part B. Some 10,000 mailing labels were submitted for use in the consumer survey, constituting a sample of a wide range of consumers, including people with mental retardation, hearing impairments and multihandicaps. To address the elderly population of the state -- a significant component of the Arkansas population base[9] -- contact was made with publication headquarters for Arkansas Aging, a periodical of the DHS Division of Aging and Adult Services and the Arkansas Association of Area Agencies on Aging, and consent was obtained to reproduce the Consumer Survey instrument in its newspaper. This publication has a circulation of approximately 35,000 in Arkansas. Consent was also obtained to reproduce the Consumer Survey in ARC News, a monthly newsletter disseminated by the Association for Retarded Citizens/Arkansas with a circulation of around 4,000. These three sources resulted in the potential to reach some 49,000 Arkansans.

Return envelopes were included in the mailing of 10,000 survey instruments, though no return envelopes were included in the published versions of the survey in the aforementioned newsletters. It was recognized from the outset that this strategy would significantly affect return rates from the readership of these newsletters, yet project budgetary constraints prohibited the use of return envelopes with such a volume of mailouts. Surveys were mailed during the first week of April 1989. To insure that the elderly sector of the state was adequately represented in the survey, a second mailing, using return envelopes, to six Area Agencies on Aging was conducted in June of the same year. This procedure was warranted, given the poor response rate which often is associated with survey procedures wherein return envelopes are not provided.

Inter-Data Entry Reliability

Data from returns were entered on computer by two project staff personnel and two work study employees who assisted in the data entry phase of the project. All records were entered on a PANORAMA[10] database in which a formatted screen for each section of each survey instrument was visible to data entry personnel. All data were combined into a single data base. Data entry reliability was determined by examining a random sample of 10 percent of the returned consumer and professional survey forms and comparing actual data entered to that exhibited on the survey forms. Since data were entered in a visible screen section, or window, relating to the actual survey instrument, an error rate ranging from 0 to 5 percent for various sections, or windows, was demonstrated and was deemed to be acceptable for analysis purposes.

Consumer Survey Results

A total of 2,201 consumer survey forms were received by August 10, 1989. This reflects a return rate of around 20 percent of the survey forms mailed with return envelopes. Of this group, 981 surveys, or 46 percent of the total respondent class, were completed by people with physical disabilities. Surveys which were disseminated via the mechanism of Aging Arkansas and ARC News were not included in data analysis due to the poor response rate that resulted because return envelopes were not provided.

The results of the survey of people with physical disabilities are reported in Tables 1 and 2. Examination of the survey responses shows that all counties in the state were represented and that the return rates from these counties typically mirrored population densities of these counties. Also, all age groups were represented among the survey respondents (range = 0-99 years; mean = 37 years). Self-reports of concomitant disability category by participants with physical disabilities in the survey included the following: visual problems, 37 percent; learning problems, 38 percent; speech problems, 35 percent; mental retardation, 31 percent; hearing problems, 21 percent; heart problems, 16 percent; breathing problems, 15 percent; emotional problems, 13 percent; head injury, 8 percent; and other, 21 percent.

Table 1 reports levels of satisfaction experienced by consumer survey respondents with physical disabilities. A majority of respondents (71 percent) reported that they participated in an assessment or evaluation prior to obtaining their assistive devices/services. Similarly, a large number of respondents (68 percent) also reported that they were satisfied with the services they received for their assistive devices. However, 58 percent reported that they needed more information regarding assistive devices/services. This need for information was supported by the high number of unmet needs reported in all categories of assistive devices/services (see Table 2).

In the area of equipment purchasing practices, it is noted in Table 1 that only 20 percent of the respondents expressed having had the opportunity to purchase assistive devices on a "buy-on-time," or credit plan, and 58 percent reported that such a plan would be helpful in purchasing needed devices. A considerable number of respondents (18 percent) reported that they did not receive adequate training in the use of their devices, while 31 percent reported that they did not have an opportunity to try these devices before being required to pay for them. A moderate number of respondents (19 percent) expressed dissatisfaction with the length of time required for servicing when their devices were in need of repair. Interestingly, of the 418 respondents who appeared to be employed, a substantial number (34 percent) indicated that no attempt was made by their employers to adapt the environment to make the workplace more accessible.

Areas of Technology Usage and Unmet Needs

Technology usage was reported in all areas of life functioning by the consumer respondents with physical disabilities. As noted in Table 2, the areas in which technology was most often used as reported by the respondents was getting around, 57 percent; self-help, 37 percent; building accessibility, 25 percent; taking care of the home, 24 percent; and artificial limbs, braces and prostheses, 23 percent. Unmet needs were also reported in all areas of life functioning. In some of these unmet needs categories -- work and work training, school training, using a telephone, talking with others, reading, writing and typing, recreation, hearing aids and other devices, using a computer, building accessibility, and specialized cars, vans, and buses -- consumers reported unmet needs more often than usage. In the area of building accessibility, equivalent levels of use and unmet needs were reported by the respondents.

Expenditures for Assistive Technology

Consumers were asked to report their expenditures for devices, services and/or maintenance. A majority of respondents (29 percent) reported expending less than $100 for technology devices and services in 1988. Expenditures of between $100 and $500 were reported by 14 percent of the respondents. Larger expenditures for technology were reported less frequently, with 8 percent indicating personal costs of $501 to $1,000, 9 percent noting costs of $1001 to $5,000, and only 3 percent reporting expenditures greater than $5,000. Almost one-fourth of the participants (23 percent) in the survey reported lack of knowledge of the cost of their assistive technology in 1988.

Funding Sources

Funding sources for assistive devices/services which were reported for those respondents with physical disabilities in the survey included a wide range of mechanisms, though several funding sources appeared to be used more often. The largest funding sources for assistive devices/services reported were Medicare/Medicaid, 50 percent; the consumer and/or their family, 35 percent; DHS Division of Rehabilitation Services, 21 percent; DHS Division of Services for the Blind, 17 percent; and Area Agency on Aging, 13 percent. Interestingly, only 3 percent of the respondents reported having their assistive technology funded through the public school systems.

Travel Practices

In the area of travel practices demonstrated by consumers, 24 percent of the 899 people with physical disabilities who responded to this survey item reported that no travel was involved in receiving assistive devices/services. Another group of respondents (29 percent) indicated traveling only 1 to 20 miles to receive their assistive devices/services. Another 13 percent reported they had to travel 21 to 50 miles to receive such services. A large number of respondents (35 percent) reported having to travel over 50 miles to receive assistive devices/services.


In examining the reports of satisfaction with technology services provided to consumers, several interesting trends appear to emerge (see Table 1). First, there are levels of dissatisfaction in all surveyed categories of life functioning reported by consumers. The area in which services appeared to be the most deficient was that of transportation, as 60 percent of the consumer respondents with physical disabilities reported not having such services provided to them. It is a recognized fact that transportation services available to people with disabilities are, for the most part, inadequate.[1,11] To receive appropriate education, medical care, vocational training, employment, and other types of services, people with disabilities must leave their residences and travel to other facilities. Characteristically, mass transportation systems have yet to incorporate modern technologies into the design of these systems to assure total access to people with disabilities, due in part to attitudes toward people with disabilities as well as lack of awareness of technology or cost factors involved in modifying transportation systems. Given that 71 percent of the respondents indicated having an evaluation prior to receipt of their assistive technology, it must be speculated that either transportation is being provided by family members to the sites where evaluations are conducted or the evaluations are conducted in the homes by service providers via such modes as outreach teams. Conversely, many consumers may be using public transportation such as that provided through P.L. 88-365, the Urban Mass Transportation Act of 1964,[12] and not perceive this transportation modality as a service. Transportation, admittedly, is a crucial service for people with physical disabilities, particularly in states that have a rural nature, such as Arkansas, where there is a tendency to centralize resources in the larger metropolitan areas. Without transportation to services which are geographically centralized, consumers may be systematically denied necessary technology and related services that can enhance the quality of their lives.[4]

This lack of transportation services reported by a majority of disabled respondents is interesting in light of responses pertaining to satisfaction with technologies received. A majority (68 percent) voiced satisfaction with their technology and related services, and yet 58 percent of the total respondent group wanted more information about technology which could help them. At the very least, this is suggestive that concerns are present regarding existing technologies used by respondents. Consumers are either more unsatisfied than they have reported or they feel that there may be something better available. In any event, a real need exists for greater dissemination of information within the system and for an enhanced transportation component to provide services to people with physical disabilities.

Also, there appears to be a real need to develop more creative alternatives for purchasing technology by the consumers in this study. More than one-half (58 percent) of the total respondents reported not having had the opportunity to buy their technology on some type of credit or time payment program. Of those who reported not having had such an opportunity, 37 percent expressed that time payment plans would have been helpful. Credit-based funding systems have been acknowledged as being important components of any technology service delivery system.[3,13] Subsequent to the recommendation made by the Office of Technology Assessment,[3] numerous strategies at varying levels have been demonstrated to address the needs of disabled people for credit-based funding systems. Examples at the state level include the direct loan model established under the New York State Equipment Loan Fund for the Disabled and California's Handicapped Transportation and Supported Employment Loan Guarantee Programs.[13] At the private sector and nonprofit agency level, alternatives are being developed across the country, each with the conceptual underpinning that with adequate planning, people with disabilities are good risks for loans and credit purchases.

Coinciding with the aforementioned finding was the report that 38 percent of the total consumer respondents were unable to try out their technology before paying for it. It is an axiom among non-disabled consumers that, prior to purchase of technology in our society, vendors allow the consumer access to the technology to inspect it and to ascertain whether the technology meets the consumer's needs. Unfortunately, people with physical disabilities are more often than not denied such access and must rely on the judgments of the professionals involved in selecting the technologies for them. In view of the current practice of requiring full payment before an assistive device is ordered, it is important that consumers are able to try out a particular technology before they or funding agencies make a financial investment in it.[14] Many times, technologies are selected primarily because they are families to the professional, or because a conflict of interests exists (e.g., the professional is a consultant for a company/vendor of the technology). In other instances, technologies may be selected solely due to fiscal considerations. In either case, inappropriate technologies may be acquired for the person with a disability.[3,14,15]

Given the significant role which public schools have in the lives of children with disabilities, it would be expected that many technologies would be funded through the mechanisms of P.L. 94-142 or its sister legislation, P.L. 99-457. Both laws contain language which implicates the provision of assistive technology in the design of educational plans for children whose needs warrant such technology. However, for this sample of people with physical disabilities, only 3 percent reported that their technologies were funded through the public schools. In view of the tremendous problems currently faced by the entire system created under these laws, and in light of looming threats to the integrity of these programs,[13] it is difficult to assume that assistive technology will demand a great deal of attention from administrators and most practitioners for some years to come. Regardless of this somewhat bleak observation, progress is being made across the country on the utilization of technology in planning processes and direct service provision to students with disabilities. Computerized Individualized Education Plan programs are now available and are being subsidized with state appropriations. Similarly, school systems are attempting to incorporate assistive technology into initial procurements early on in the educational careers of students to minimize add-on costs. Finally, school systems are beginning to explore the possibilities of multi-student use of technology, thereby lowering their costs.

It is also interesting to note that the percentage of people with physical disabilities reporting unmet needs in the area of computer usage (25 percent) was almost three times that of reported usage (9 percent) by those responding to this item (see Table 2). Given the impetus toward use of computers in educational and rehabilitation environments nationwide, it appears that utilization of this technology remains far from adequate to meet the needs of this particular sample of people with physical disabilities. The technology exists which can enable even those with the most serious physical disabilities to manipulate computer keyboards in ways that they would not normally be able to.[16,17]

Before inferences can be made regarding this data, the limitations of this preliminary investigation of the technology needs of people with physical disabilities and the professionals who serve them must be considered. Even though a reasonable response rate was obtained from consumers, only a small sample of the total population of people with disabilities was surveyed from across the state. A recent study has reported that more than 300,000 people with disabilities may exist in Arkansas. The consumers surveyed represent the clientele of a limited cross section of agencies known to be involved in service provision to people with disabilities. Even though the data suggest that many types of disability categories were reflected in the survey, comparable representation across disability categories was not demonstrated. For example, a large percentage of the consumer respondents (46 percent) reported having a physical handicap while people with head injuries, breathing problems, emotional problems, and heart problems constituted a much smaller proportion of the total respondent class. Similarly, equal representation across agencies which are involved in technology service provision was not reflected by the professional survey respondents.

Even though 21 different agencies and groups were included in the survey, other groups which are involved in technology service provision to people with disabilities were not included. For example, the Veterans Administration, which is a primary service mechanism for veterans with disabilities, was not included. Similarly, only a small number of nurses and physicians were included in the survey, limiting the input from the medical community.

However, despite these limitations, it is recognized that this is the first attempt demonstrated in the State of Arkansas to comprehensively identify the technology needs of people having disabilities; and it is also the only report known in the professional literature to date which addresses the issues herein discussed. These considerations alone suggest the importance of the findings for those involved in planning for the technology needs of people with disabilities, particularly for those who are planning to respond to P.L. 100-407. [Tabular Data 1 and 2 Omitted]

PHOTO : Burton Pusch uses lighting systems that incorporate touch sensitive switches.

PHOTO : Burton Pusch uses simple technologies for daily living activities. Here, a hand held

PHOTO : vacuum cleaner has been modified with an extension handle.


[1]DeLoach, C., and Greer, B. G. Adjustments to severe physical disability. New York: McGraw-Hill, 1981. [2]Bleck, E. E., and Nagel, D. A. Physically handicapped children. A medical atlas for children. (2nd ed.). New York: Grune & Stratton, 1982. [3]Office of Technology Assessment. Technology and handicapped people. Washington, DC: U.S. Government Printing Office, 1982. [4]Governor's Task Force on Technology and Disabilities. A final report of the task force on technology and disabilities. Albany: State of New York, 1987. [5]Issue Team on Technology for People with Disabilities. Governor's report on technology for people with disabilities. Abilities and technology. St. Paul, MN: Developmental Disabilities Program, Minnesota State Planning Agency, 1985. [6]Center for Special Education Technology. Special Edition: P.L. 100-407. The Marketplace. 1989. Spring: 1-4. [7]Office of Special Education and Rehabilitative Services. Access to technology. OSERS News in Print. 1989. 2: 2. [8]Public Law 100-407, The Technology Related Assistance for Persons With Disabilities Act of 1988, 29 U.S.C. 2201(b)(1). [9]Demographic Research, Center for Information Services. Provisional projections of the population of the State of Arkansas, by county, 1980-2000. Demographic Bulletin No. 2, Little Rock, AR., 1986. [10]ProVUE Development Corporation (1988). PANORAMA. Huntington Beach, CA: Author. [11]Dunham, J. R. Transportation. In: R. M. Goldenson, J. R. Dunham and C. S. Dunham (eds.). Disability and Rehabilitation Handbook. New York: McGraw-Hill, 1978. [12]Public Law 88-365, The Urban Mass Transportation Act of 1964, Section 16, as amended by Public Law 100-117, 49 U.S.C. 1601. [13]Mendelsohn, S. Payment issues and options in the utilization of assistive technology. Paper presented to the National Workshop on Implementing Technology Utilization, Washington, D.C., 1989. [14]Pfrommer, M.C. Utilization of technology: Consumer perspective. In: Discovery '84: Technology for disabled persons. Conference papers. Menomonie, WI: Stout Vocational Rehabilitation Center, 1984. [15]Cavalier, A. Ethical Issues Related to technology. Paper presented to the Pre-conference for the Association for Retarded Citizens/ARK 1989 Annual Conference, Little Rock, AR., 1989. [16]Gaylord-Ross, R. J., and Holvoet, J. F. Strategies for educating students with severe handicaps. Boston: Little, Brown, and Co., 1984. [17]Office of Technology Assessment. Power on. New Tools for teaching and Learning. Washington, DC: U.S. Government Printing Office, 1988.

Dr. Parette is Director, Technology Access for Arkansans, and Dr. VanBiervliet is Associate Professor, Center for Research on Teaching and Learning, University of Arkansas at Little Rock.
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Author:VanBiervliet, Alan
Publication:American Rehabilitation
Date:Mar 22, 1990
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