Consumers Perspectives on Assistive Technology: Simplicity, Function, Appearance and Cost

Diane M. Collins, PhD1,2 ; Marcia Scherer, PhD3 ; Desleigh de Jonge BOccThy, MPhil (OT)4 , Amol Karmarkar, MS1,2 , Fran Harris, PhD5 ; and Rory A. Cooper, PhD1,2

1 University of Pittsburgh, Rehabilitation Science and Technology Department, Pittsburgh, PA
2 Human Engineering Research Laboratories – VA Pittsburgh Healthcare System, Pittsburgh, PA
3 Institute for Matching Person and Technology, Webster, NY
4 President, ARATA; The University of Queensland, Brisbane, Queensland Australia
5 Center of Assistive Technology & Environmental Access, Georgia Institute of Technology, Atlanta, GA


Providing a good fit between the needs and desires of consumers and AT devices or systems is the ultimate goal of the assistive technology field. To share consumer perspectives on their AT devices with rehabilitation engineers, manufacturers, and clinicians, a consumer panel discussion was held in 2007. Consumers reported they desired simple, user-friendly devices that are attractive and make it easier to engage in life’s activities. More robust AT devices, such as electronics thatwithstand hot and humid environments as well as in-home, controlled environments were also sought. Unmet needs included devices that assistedconsumers to manipulate and carry different items on their mobility devices and engage in a broad range of activities including recreation. Consumers highlighted the need to be included in the evaluation process to reduce the need for customizations after purchase. Insurance policy was identified as being inadequate in providing coverage for repairs or maintenance of currently owned AT. Furthermore, insurance policies that limit choices of AT devices and timely replacement should be examined. Consumers also highlighted the importance of considering the full range of activities and settings for device use.


Assistive Technology; Consumers; Satisfaction; Service Delivery;


Consumers drive the assistive technology (AT) process from assessment and prescription to final use, or non-use, of the device or system.(1) Providing a good match or fit between the needs and desires of the consumer and the AT should be the ultimate goal of all assistive technology practitioners.(1) By investigating which product characteristics, features, and functions are desired by consumers, AT practitioners will make better clinical decisions in the complex process of evaluating which AT devices or systems best fit consumer needs and desires.(2-4)

Without the valuable and knowledgeable input of consumers, costly AT may not meet the needs of the consumer, and thus result in non-use or premature abandonment of the AT.(2,5) AT non-use has been identified as an extensive and costly problem for AT practitioners.(2,5) In a 1993 study of 273 consumers, 29% of AT devices were completely abandoned, with mobility aids being the most frequently rejected.(6) Lack of consideration of consumer opinion, ease of device procurement, poor device performance, and changes in users’ needs were the four main reasons for these findings. In a 1996 study, Cushman and Scherer reported two reasons for AT device abandonment: functional improvement, which accounted for approximately 50% of non-use of 86 devices, and discrepancies in perceptions about utility and aesthetic characteristics of devices between clinicians and consumers, which accounted for the remaining non-use of devices.(7)


Consumer input is too often ignored during the AT assessment and selection process and results in a mismatch between the consumer and the AT device prescribed and possibly results in costly, premature abandonment of the AT device.


The Consumer Perspectives on Assistive Technology, Special Interest Group 22 (SIG 22) of the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) was created to emphasize the inclusion of consumer preferences and the human aspects of technological design into the AT process. Consumer perspectives, when considered, can result in a better match between the consumer and the most appropriate and desired AT devices and systems with the greatest likelihood of success, use, and consumer satisfaction. An initial step of SIG 22 to achieve this mission was to collect qualitative information on consumer perspectives of AT use by holding a consumer panel discussion at the 2007 RESNA conference in Phoenix, AZ, to encourage sharing of information, thoughts and perspectives among consumers, clinicians and engineers.

Several disability organizations local to Phoenix, AZ, were contacted to assist in recruiting local consumers for the panel discussion, including the Arizona Bridge to Independent Living Center (ABIL), the Arizona Paralyzed Veterans of America (AZPVA), as well as others contacted by ABIL and AZPVA. Our intent was to invite consumers with a range of disabilities who would typically use AT devices along a continuum of AT complexity.

After introducing the panel members and SIG 22 presentation coordinators, a short presentation on the history and goals of SIG 22 was provided. The panel members were then asked to give their opinions of the AT devices they currently use and, if they were to change their devices in any way to improve their fit, design, or performance, what would they do? The consumers directed the discussion and the audience was asked to participate with questions and comments.


Seven local consumers who were not members of RESNA participated on the panel, including five men and two women, of whom two are U.S. veterans, three use power wheelchairs, three use manual wheelchairs, and one person uses a scooter. Four themes emerged from the consumer panel members’ presentations, and are presented below from the most general themes to device-specific recommendations. These themes were: 1) Desired AT Devices Characteristics; 2) Unmet AT Needs; 3) AT Service Delivery; and 4) AT cost and insurance coverage.

Desired AT Device Characteristics:

Consumers identified a number of characteristics they considered important in their choice of AT devices including:

Less is More:

Several consumers said that when it came to AT devices, less is more. Simple, user-friendly devices were preferred over the more complex devices that may not be as reliable as the most simple, robust devices with fewer parts and switches.

Make Life Easier:

The consumers felt that the goal of AT tools and devices should be to make their lives easier or contribute to the comfort of everyday living. For example, AT devices should be able to be used in all environments the consumer readily encounters without falling apart or breaking down.

Pleasing Appearance:

Another important characteristic of the AT device is to look good and not as though it just came out of a nursing home. The consumers said, “We want to be chic,” and “We want our devices to be attractive.” The look of the devices used daily influences the self-esteem and image of the consumer, something developers and manufacturers need to consider in product development.

More Robust Devices:

One consumer said that AT devices should be more robust, such as joysticks that malfunction when in hot environments

More Choices:

One consumer said that different lifestyles, interests, and needs, such as fatigue issues for some, result in the need for more choices to be available then are currently available in AT devices. Likewise, the consumer explained that individuals with more than one disability had varying needs that required more complex AT solutions. However, the consumer recognized that additional and more complex choices present challenges for engineers and vendors.

Unmet AT Needs:

Unmet needs included devices that assistedconsumers to manipulate and carry different items on their mobility devices and engage in a broad range of activities, including recreation. One consumer, for example, suggested that a way should be devised to assist a wheelchair user in carrying a lot of items such as luggage on a wheelchair. Another consumer suggested that a need existed for the development of a device she referred to as a “gotta get a grip” handle to use for improving grasp with sports equipment such as when handling kayaks and ski poles. Other panel members agreed that a device to help individuals with weak handgrip to be able to manage large objects would be useful. A last consumer suggested that a “bat holder” be developed for use during wheelchair softball.

AT Service Delivery

The importance of including the perspective of the consumer during the assessment/evaluation process and when acquiring the AT device was a recurring theme throughout the discussion. Consumers cited that failing to elicit their perspectives was compounded by miscommunication or non-communication among consumers and others on the AT team. As a result, individual consumers often had to create their own device customizations to improve fit and device performance. One consumer felt that these communication problems occurred due to the emphasis placed on “making the sale” rather than serving the consumer. Consumers felt the need for extended equipment trials were necessary to identify which devices were most appropriate in varying environments. A final item that was discussed was that consumers felt that 90-Day warranties were too short and should be extended.

AT Cost and Insurance Coverage:

The expense of AT devices can be prohibitive and keep consumers from obtaining needed AT. All panel members felt insurance policy limits prevented them from obtaining appropriate AT to meet just their basic needs. One example provided by a consumer was his difficulty in trying to get more than one wheelchair for use in different environments, such as a chair that could travel through snow or over rough terrain versus for use in the home, or covering the costs of different wheelchair cushions for varying activities. One consumer felt that a hierarchy of disability and equipment existed (i.e., wheelchairs are viewed as being more essential than communication devices). Also, perceptions of need of the insurer or healthcare provider did not match that of the consumer. Consumers also commented on repair and replacement, and suggested that these costs should be anticipated in the initial payment for the wheelchair. At this point, an audience member quickly informed the room that repairs of AT devices are not covered by insurance and often is completed as a “good-will” gesture of the service provider, who pays for any out-of-pocket expenses incurred.


The panel discussion was highly attended (it was, in fact, “standing room only”). Also, much positive feedback was received by the coordinators, thus highlighting the desirability of establishing future SIG 22 and RESNA venues of communication among consumers and all members of the AT team.

Many of the issues highlighted by the consumers in this session reflect the issues raised by consumers in the literature (8,9) and which are reported in other studies (7,10). Consumers emphasized the need and desire for attractive devices that are simple to use and address their preferences in a variety of activities, settings and conditions.Why do these themes continue to emerge? Are the perspectives of consumers and end-users being heard, or are the preferences of others (i.e., insurers, manufacturers or clinicians) taking precedence? Why have we been unable to meet these needs? Could participatory action research and development designs assist in understanding and addressing the needs of the AT user?

Consumer-centered practice means more than providing consumers with a choice between devices. It requires that consumers are included in all aspects and levels of the AT field (11). In order to be considered truly consumer-centered, the AT field needs to ensure that consumers are involved in product design and development, service delivery and policy development as well as research. Applied research should not only develop products based on “clinical need” and test assistive devices for technical performance, but should also research the “real needs” as experienced by the consumers and systematically investigate the application of AT in the real world. Consumer input can no longer be confined to testing prototypes or commenting on new developments. It is clear that consumers have much to offer in terms of understanding the aesthetics, performance, usability, versatility, durability and portability of devices that is not actively being captured. Despite the rhetoric of consumer-centered practice, they continue to feel uninvolved in the process where their needs are frequently compromised by service and funding policies and unheard by an industry that professes to be interested in the assistive technology needs of people with disabilities.

This panel has highlighted the value of understanding the perspective of consumers in developing policies for the further development of AT products and services. Future panels would benefit from including representative from the insurance industry, especially the Centers for Medicaid/Medicare as they set the standard for other agencies to follow. Also, consumers of other types of AT devices, rather than just mobility devices, should also be included in these panel discussions.

Study Limitations: Individuals who used alternative communication devices or telecommunication devices for the deaf were invited to participate but were not able to attend the panel discussion. Thus, consumer input is not representative of the wide audience of individuals who use a variety of AT devices and systems. Further, those consumers who did participate were not randomly selected and represent a convenience sample.


This study was supported by the RESNA Central Office, the VA Center of Excellence for Wheelchairs and Associated Rehabilitation Engineering (WARE), and the Institute for Matching Person and Technology. The authors would also like to acknowledge two RESNA members for their assistance with this paper: Alan Cantor, PhD and Caren Sax, EdD.


Diane Collins, PhD, VAPHS – Human Engineering Laboratories, 7180 Highland Dr., 151R1-HD, Pittsburgh, PA 15206; 412-365-4850;


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