Summary Technologies That Aid Manipulation and Control of Environment

Elders can live more independently and safely in their homes with technologies that provide personal mobility and manipulation capabilities. Technology can enhance the quality of life for older people, enable them to live safely in their homes, and enable them to participate in their communities as they age. Technology affects people with different levels of functioning in a variety of settings. In the home, technology may provide personal support and help for daily living. In a neighborhood, technological systems can enable a person to engage in community activities. In the larger community, technology may make it easier for an older person to commute to work and contribute to society through employment.

In each of these settings, technology may improve a person’s functionality by enhancing dexterity and mobility, helping with some home chores, reinforcing some kinds of memory, coaching for particular functions, either by providing information or by monitoring and intervening when necessary, and making it easier and safer for older people to drive. In other words, assistive technology may affect almost any aspect of daily life.

Although the United States is in many ways an example for other countries in the world to follow, in the areas of assisting people with disabilities, rehabilitating people, and integrating older adults into our communities and culture we are losing ground. Ensuring the availability of assistive technology and accessible environments, providing sufficient support for research and development and adequate health care, and reaching consensus on a definition of disability are all issues we must address. If, as has been said, older people are the “canaries in the coal mine” of American society, the critical precursors of impending disaster, we must find a way to increase support for research, development, and education to create a basis for good decision making, invigorate translational science and engineering capacity for new technologies and services, improve our surveillance to get a better understanding of the problems facing older adults, and reform regulatory policy and legislation to meet their needs.

One problem facing every society, whether wealthy or poor, is integrating people with impairments and disabilities into the mainstream of life. The concept of “disability,” the interaction between a person’s impairment and attitudinal and environmental barriers that keep that person from full and effective participation in society, continues to evolve. Bringing the issues of disability, including the impairments of aging, into mainstream discussions is integral to the development of strategies for sustainable development and civil society. Older adults deserve to maintain their autonomy and independence, including the freedom to make their own choices, and they should have an opportunity to participate in decision making, especially when those decisions directly affect them.

Barriers to the Development and Use of Assistive Technologies
Although a plethora of assistive devices is available in the marketplace and a small research pipeline continues to make progress on assistive technologies, there are also notable individual, technical, policy, and societal challenges to be overcome.

• Individual and Technical Barriers
  The challenges faced by the individual cut across all other domains. These challenges include, but are not limited to, financial limitations, intellectual capacity, physical ability, sensory impairment, home environment, and the attitude toward technology.
• Technical barriers are largely defined by the complexity and intimacy of interactions between assistive technologies and older adults. Human beings are extremely complex. Despite centuries of study, our depth of understanding about older people is still rudimentary. Assistive technology must be used by people with physical, sensory, or cognitive impairment, often a combination of all three. In addition, these technologies must function reliably day in and day out for months, if not years, with little maintenance, often in contact with or in close proximity to the person. An assistive device must function predictably and reliably, do no harm, and degrade or fail gracefully. The more one considers the environment and inter-actions between a device and its operating environment, the more complicated the design of the device becomes.
• Policy Barriers
  A few simple examples can illustrate the tremendous impact of public policy, such as Medicare policy, on the development, deployment, and use of assistive technologies by older adults. Most older people rely almost exclusively on Medicare for their primary health insurance.

• Cultural and Social Barriers
  In the simplest case, many cultures place a high value on the ability to walk. This may be entirely natural and intuitive, but it may have the inadvertent and possibly unintended consequence of devaluing people who use wheelchairs. It may also affect the allocation of resources to create an environment that is wheelchair accessible. One need only think of the difficulties and resentment aroused by the passage of the Americans with Disabilities Act (ADA), civil-rights legislation enforced by the U.S. Department of Justice.

 Devices that Enhance Mobility and Manipulation

Mobility and manipulation are critical to living independently and are often strongly associated with the ability to continue to live safely in one’s home. Simple devices such as crutches, canes, walkers, and rollators (rolling walkers) can assist a person who has the endurance and strength to walk distances, but these devices must also provide some support or feedback to keep the person from losing their balance or enable the person to rest, when necessary. One of the challenges for engineers is matching an individual with the appropriate technology.

Transition to a wheelchair can be a significant personal hurdle for many people, although once the transition is made, it can be a liberating experience. A common experience of older adults is the gradual contraction of their sphere of mobility; over time, they leave home less and less often. When the appropriate mobility technology, such as a wheelchair, is introduced, their sphere of mobility can once again expand. Knowing when to introduce a new device requires assessing a person’s capabilities, home environment, and transportation.

Advances in Wheelchair Technology

Critical advances in wheelchairs have been made in the past decade. Manual wheelchairs now make more extensive use of titanium, carbon fiber, and medical-grade viscous fluids, which have resulted in chairs with a mass of less than 9 kilograms. Several studies have shown that reducing the mass of the wheelchair and user system reduces the strain on the arms and increases activity.