Reducing Assistive Device Abandonment by Improving Design through Consilience and Technical, Social, and Medical Education

Antonio R. Rincon, MS, MBA


Many disabled individuals for daily function require the assistance of complex and expensive devices whose advancements in technology are lacking. Abandonment by the disabled community of these devices is a direct result of complex technology not meeting their needs. The lack of advancements in technology for the disabled is due to the improper medical and social education of the designers of these devices in regard to understanding the disabilities of their end users. Another reason is the lack of computer education and experience of the practitioners for the disabled who could provide a means to troubleshoot and improve the devices. The development of these two specialists in the advancement of devices for the disabled will be discussed. Also, their roles in the design process of these devices and their affect on decreasing the abandonment of AT products by disabled individuals is presented.

Key Words:

Abandonment, Designer, Practitioner, Consilience, Technical education.


Potential AT users face a strenuous process of matching their needs with the functions capable on an AT device. This process of adoption is imperfect and too often leads to an AT device being “viewed as ineffective and then becomes abandoned” by the user [(1)]. Research has shown that more than 35% of all AT devices have been unused or abandoned most within the first three months of use and sadly most used devices are repurposed for a specific disability [(2), (3), (4)]. Eliminating the abandonment of AT devices is a step towards a more accommodating and inclusive society. While improving the adoption process will potentially decrease cases of abandonment, only by improving the method of design of AT devices for better usability and effectiveness will cases of abandonment decrease dramatically. This research proposes method improvements in the design of AT devices by implementing the combination of several solutions which reduces the cases of abandonment.


AT design is affected by several contributors whose knowledge and capabilities drive new technology in the field. The recognized contributors discussed are AT designers and practitioners. These individuals directly affect the technology to improve the quality of life (QOL) of disabled individuals. The technology of AT products changes rapidly and current technology reviewed within the last few years reflects this change. Unfortunately, each contributor independently hinders the design process and the result is usually a poorly designed and expensive piece of AT equipment [(5)]. Although specific technologies and protocols implemented within AT products are important, the literature reviewed speaks directly to how each individual contributor affects the design of AT products and supports the solutions offered in the rationale for the study.

It is well known that AT designing is an engineering challenge, but research has shown that inclusive design can reduce challenges while keeping development time down and cost low. Inclusive design allows accessibility functions to be incorporated into current technology during the initial design process rather than creating specific AT devices which will “create families of solutions for a large group of people with disabilities” [(6)]. Research has shown that inclusive design can advance technology as seen by the Tim Language (TL) and Voice XML which are imbedded in languages, protocols, or applications and able to assist the disabled and non-disabled [(7)]. One advantage to inclusive design is the reduction of expensive AT products and their tax burden on society. As the functions of AT products are entwined with common technology products, the numbers of specialized AT products are reduced while the additional cost of the inclusive product will be passed on to a larger consumer base. Another advantage to inclusive design is the possible elimination of negative perceptions by designers. Unfortunately, universal design is disregarded by small companies who have a niche technology market while many other products simply cannot be made accessible to the disabled [(8)].

While the debate on inclusive design continues, recent developments by AT designers include AT software using advanced mathematical models to predict human performance while still providing an interactive and competent product [(9), (10)]. The design complexity of most current AT products results in slow communication rates, timing problems, and poor comprehension rates by consumers. Poor AT product design by engineers can be attributed to a few contrasting reasons. One reason falls in the lack of understanding within the AT engineering field of the several characteristics that each AT product must adhere to. AT products must be compatible to the consumer’s needs and simple to use and small in size so as not to embarrass the consumer with its use. An AT product must be able to be easily modified as the consumers needs or physical condition changes [(9), (11)].

The second AT product design contributor is the AT practitioner whose main responsibilities are to match AT devices to the disabled person they care for and educate them on its features. As with the AT designers, there is a need to educate practitioners on inclusion which is the best way to address negative perceptions of the disabled. AT practitioners must be educated in the disabled culture to truly understand their needs and desires to separate themselves from common stereotypes of the disabled. AT practitioners also lack significant computer skills and as a result, do not properly handle AT issues such as proper knowledge transfer. The complexity of AT products and the poor education in the computer discipline results in the frequent poor matching of devices to persons with disabilities [(12), (13)]. In general, most AT practitioners conduct a trail and error process to evaluate potential of AT products matching the needs of their disabled consumers which hampers the research progress [(7), (11)]. While computer and technology education is a solution to improve the potential contribution of AT practitioners, the literature states that there is an insufficient supply of practitioners. The ever constant shortage of AT practitioners occurs yearly, so is the demand of additional computer and technology education going to drastically decrease their numbers? It is important to understand improving the computer education of AT practitioners without adding to their reduction [(14)].

Several studies contradict the main idea of multidisciplinary contributors and better consilience through the concept of virtual reality. Virtual reality creates an artificial environment where the consumer is provided a wider range of responses. As an AT technology, virtual reality can lessen the burden of training for the AT practitioner, provide built-in training for the consumer, and reduce the demands on AT designers [(15), (16)]. While virtual reality is in its infancy within the AT discipline and its difficulty to implement well known, its limited usage is positive and well received by the consumers. One device called the smart wheelchair component system (SWCS) uses sensors and obstacle-avoidance technologies on wheelchairs for those individuals whose mobility is severally limited [(16)].

A minor contributor to the process of AT design complexity and abandonment is cost and product price. As a result of the major contributors each of whom introduces limitations to the design process, the final AT product is priced expensively. The limited market of buyers of AT products which is only 13% of the disabled population also contributes to the high price of devices [(17), (18)]. The average disabled person depends on an incredible amount of financial support but there are very few funding sources in existence for AT especially for minority populations [(19), (20)]. Consumers will usually not utilize a product with a high price and adopt a product that does not satisfy their needs which usually results in product abandonment. It is important to keep in mind when researching the factors of complexity of AT product design that cost factors into the product’s acquisition and usage as well.


The qualitative method suggested for the proposed research is a case study. AT products are all too commonly discarded by end users due to their complexity and poor usability. Little is known on how the usability of AT products is influenced by the several factors previously discussed involving the main contributors to AT design. The research will be accomplished through the analysis of AT products and what will improve their designs while at the same time maintaining their price or possibly lower it. A clear understanding of how the major contributors to AT affect the end-user is essential. First information will be gathered on the AT education and training that the medical practitioners receive to determine what deficiencies there are in the field. Second, information will be gathered on the AT computer science curricula to evaluate the reasons for the lack of interest in this technology.

The information will be gathered through a sampling method consisting of a combination of site selection and sampling by case type. The combination of these purposeful sampling strategies will provide significant information in the particular case studied without the need to generalize on all cases relating to AT. The researcher intends to sample individuals and sites to explore concepts within the theory of AT device complexity. One group consists of the top ten universities in the US focusing on special education whose teaching curriculum data will provide information on the level of student education in the areas of computer basics and human-computer interaction (HCI). Another group consists of the top ten universities focusing on computer engineering programs in the US. Between five and twenty-five individuals with high grade point averages from each of these groups will be interviewed to further understand their knowledge of AT products and the needs of the disabled. Other sites will include several facilities that support the disabled community whose practitioners will be interviewed to collect data on their experiences with AT devices, their usability, and reasons for abandonment by their disabled community.


While no formal interviews or information was gathered as described in the approach considered section, the current technology and methods reviewed did achieve a preliminary understanding of the factors that affect the abandonment of AT devices. The literature clearly supports the notion that the main contributors affect the design of AT products and their abandonment by the end users. Multidisciplinary education, consilience between designer and practitioner, AT device training, and understanding the disabled are the factors that could possibly improve AT product acceptance in the disabled community while potentially reducing their cost [(3), (13), (18), (21)]. These methods of improving AT devices continue to result in the discontinuation of their usage by the end user. Between the years of 1993 and 2003, approximately 1,000 AT products were submitted for licensing and sale but only 40 of them were commercialized for usage by the disabled population [(22)]. The literature clearly supports the notion that the main contributors affect the usability and effectiveness of AT products but abandonment by the end user is still a major concern.


The research proposed makes a significant contribution to the field by recommending a more diverse and interdisciplinary solution to the problems of usability and effectiveness of AT devices. There is a need in the field to “generate new conceptual frameworks for how to advance assistive technology research” [(23)]. Past contributions focus on improving the involvement of the individual contributors to AT design methods separately. The research proposed provides a new cohesive framework involving the major contributors to AT design rather than only focusing on improving each one individually. Morris states that only through advancement of technology and better consilience will the disabled be protected and supported and not through the laws of government [(7)].


Further research is needed to understand what education and amount will affect the complexity of AT design by each contributor. For the AT designer, there are conflicting opinions that education in HCI is the most important while others state that understanding disabilities and their stages is the most important [(12)]. For the AT practitioner, several opinions state that more computer education is necessary while others believe better AT product-to-consumer matching education is necessary [(4)]. Once again, it is not clear what type of computer education or matching education provides an improvement in the design of AT products. It is unclear what education or methods will reduce the misunderstandings about the disabled which affect AT design. Research clearly shows that AT knowledge and skill can be provided in two ways. First, it can be infused into currently existing courses which is simpler to implement. Second, it can be provided by a dedicated technology course or program that contains courses for inclusive design, disability education and user assessment methods [(14)]. It is unclear though which of these two methods of education provide the most AT knowledge and skill while keeping costs low to universities and specialization schools. Not specifically discussed in this study, AT consumer opinion is important, but its relevance within the stages of the design process is unclear. There is a need to understand what methods to obtain valuable information from consumers who lack communication skills to begin with are the most beneficial. Finally, further research is necessary to understand how a small target market and high cost affects the design process. One idea not made clear within the literature is how the cost of researching, producing, and training an AT product is incorporated in the price. A product with an extremely high price will usually not be utilized by a consumer no matter its benefits. For these reasons stated above, further research is necessary.


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