Ebook Assistive technology assessment handbook (2/E): Part 1

Assistive Technology
Assessment Handbook
Second Edition


REHABILITATION SCIENCE IN PRACTICE SERIES
Series Editors
Marcia J. Scherer PhD
President
Institute for Matching Person and Technology
Professor
Physical Medicine and Rehabilitation
University of Rochester Medical Center

Dave Muller PhD
Visiting Professor
University of Suffolk
Past and Founding Chair of Chamber of
Commerce
Editor-in-Chief
Disability and Rehabilitation
Director
Ipswich Central Ltd.

Published Titles
Ambient Assisted Living, Nuno M. Garcia and Joel J.P.C. Rodrigues
Assistive Technology Assessment Handbook, Second Edition, edited by Stefano Federici and
Marcia Scherer
Assistive Technology for Blindness and Low Vision, Roberto Manduchi and Sri Kurniawan
Computer Access for People with Disabilities: A Human Factors Approach, Richard C.

Simpson
Computer Systems Experiences of Users with and Without Disabilities: An Evaluation
Guide for Professionals, Simone Borsci, Maria Laura Mele, Masaaki Kurosu, and Stefano
Federici
Devices for Mobility and Manipulation for People with Reduced Abilities, Teodiano BastosFilho, Dinesh Kumar, and Sridhar Poosapadi Arjunan
Devices for Mobility and Manipulation for People with Reduced Abilities, Teodiano BastosFilho, Dinesh Kumar, and Sridhar Poosapadi Arjunan
Geriatric Rehabilitation: From Bedside to Curbside, edited by K. Rao Poduri, MD, FAAPMR
Human-Computer Interface Technologies for the Motor Impaired, edited by Dinesh K.
Kumar and Sridhar Poosapadi Arjunan
Multiple Sclerosis Rehabilitation: From Impairment to Participation, edited by Marcia
Finlayson
Neuroprosthetics: Principles and Applications, edited by Justin Sanchez
Paediatric Rehabilitation Engineering: From Disability to Possibility, edited by Tom Chau
and Jillian Fairley
Quality of Life Technology Handbook, Richard Schultz
Rehabilitation: A Post-critical Approach, Barbara E. Gibson
Rehabilitation Goal Setting: Theory, Practice and Evidence, edited by Richard J. Siegert and
William M. M. Levack
Rethinking Rehabilitation: Theory and Practice, edited by Kathryn McPherson, Barbara E.
Gibson, and Alain Leplège
Robotic Assistive Technologies: Principles and Practice, edited by Pedro Encarnção and Albert
M. Cook
Wheelchair Skills Assessment and Training, R. Lee Kirby


Assistive Technology
Assessment Handbook
Second Edition

Edited by

Stefano Federici and Marcia J. Scherer


CRC Press
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Library of Congress Cataloging-in-Publication Data

Names: Federici, Stefano, editor. | Scherer, Marcia J. (Marcia Joslyn), 1948- editor.
Title: Assistive technology assessment handbook / [edited by] Stefano Federici and Marcia Scherer.
Other titles: Rehabilitation science in practice series. 2469-5513
Description: Second edition. | Boca Raton : Taylor & Francis, 2017. | Series:
Rehabilitation science in practice series | Includes bibliographical references and index.
Identifiers: LCCN 2017028616| ISBN 9781498774116 (hardback : alk. paper) |
ISBN 9781498774123 (ebook)
Subjects: | MESH: Self-Help Devices | Technology Assessment, Biomedical |
Disabled Persons--rehabilitation | Disability Evaluation
Classification: LCC RM950 | NLM WB 320 | DDC 617/.033--dc23
LC record available at />Visit the Taylor & Francis Web site at

and the CRC Press Web site at



Contents
Foreword........................................................................................................................................ vii
Preface to First Edition...................................................................................................................ix
Preface to Second Edition........................................................................................................... xiii
Acknowledgments.........................................................................................................................xv
Editors........................................................................................................................................... xvii
Contributors.................................................................................................................................. xix

Section I The Assistive Technology Assessment
Process Model and Basic Definitions
Stefano Federici and Marcia J. Scherer

1. Assessing Individual Functioning and Disability......................................................... 13
Stefano Federici, Marcia J. Scherer, Fabio Meloni, Fabrizio Corradi, Meera Adya,

Deepti Samant, Michael Morris, and Aldo Stella
2. Measuring Individual Functioning................................................................................... 27
Stefano Federici, Fabio Meloni, and Fabrizio Corradi
3. Measuring the Assistive Technology MATCH............................................................... 53
Fabrizio Corradi, Marcia J. Scherer, and Alessandra Lo Presti
4. Assessment of the Environments of AT Use: Accessibility, Universal Design,
and Sustainability................................................................................................................. 71
Mansha Mirza, Andrea Gossett Zakrajsek, and Apeksha R. Gohil
5. Measuring the Impact of Assistive Technology on Family Caregivers..................... 89
Louise Demers and William Ben Mortenson

Section II Assessment Professionals: Working
on the Multidisciplinary Team
Marcia J. Scherer and Stefano Federici

6. Assessment of Assistive Technology for Individuals with Cognitive
Impairments......................................................................................................................... 115
Christopher Stavisky, Jaime Rosa Campeau, Simon Carson, Nancy Dukelow, Sheryl
Maier, Amy Pacos Martinez, and Sarah Kysor
7. The Special Educator.......................................................................................................... 135
Susan Zapf, Trish MacKeogh, and Gerald Craddock

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Contents

8. The Psychologist.................................................................................................................. 157

Fabio Meloni, Stefano Federici, Aldo Stella, Claudia Mazzeschi, Barbara Cordella,
Francesca Greco, and Massimo Grasso
9. The Psychotechnologist: A New Profession in the Assistive Technology
Assessment............................................................................................................................ 189
Klaus Miesenberger, Fabrizio Corradi, and Maria Laura Mele
10. The Occupational Therapist: Enabling Activities and Participation Using
Assistive Technology.......................................................................................................... 211
Desleigh de Jonge, Melanie Hoyle, Natasha Layton, and Michele Verdonck
11. Pediatric Specialists in Assistive Solutions................................................................... 235
Lucia W. Braga, Ingrid Lapa de Camillis Gil, Katia Soares Pinto, and Paulo Sérgio
Siebra Beraldo
12. The Geriatrician................................................................................................................... 265
Martina Pigliautile, Lorenza Tiberio, Patrizia Mecocci, and Stefano Federici
13. Role of Speech–Language Pathologists in Assistive Technology Assessments..... 301
Katya Hill

Section III  Assistive Technology Devices
Stefano Federici and Marcia J. Scherer

14. The Systemic User Experience Assessment................................................................... 329
Simone Borsci, Masaaki Kurosu, Maria Laura Mele, and Stefano Federici
15. Gesture, Signing, and Tracking....................................................................................... 355
Michael P. Craven
16. Using Brain–Computer Interfaces for Motor Rehabilitation..................................... 373
Giulia Liberati, Stefano Federici, and Emanuele Pasqualotto
17. Graphic User Interfaces for Communication................................................................. 403
Maria Laura Mele, Damon Millar, and Christiaan Erik Rijnders
18. Exoskeleton: The New Horizon of Robotic Assistance for Human Gait................. 421
Marco Bracalenti, Fabio Meloni, and Stefano Federici
19. Assistive Technologies for Children with Autism Spectrum Disorder................... 435

Chiara Pazzagli, Giovanni Fatuzzo, Simone Donnari, Valentina Canonico,
Giulia Balboni, and Claudia Mazzeschi
20. Technology Developments in Music Therapy............................................................... 457
Wendy L. Magee and Thomas Wosch
Index.............................................................................................................................................. 471


Foreword
At its most general, the challenge of assistive technology (AT) assessment is to balance
the technological–engineering conception of the user–AT interface with the modern
biopsychosocial understanding of functioning and disability, in order to account for
the user experience, without neglecting the ergonomic features of the AT. The Assistive
Technology Assessment Handbook elegantly achieves this balance through the integration of
the Matching Person & Technology model developed by Marcia Scherer and the theoretical insights and practical applications of the “psychotechnology” of Stefano Federici. This
much-expanded second edition is therefore highly welcome.
The Handbook has tracked the salient developments in disability conceptualization, measurement, and policy development at the World Health Organization (WHO), beginning
in 2001 with the endorsement of the International Classification of Functioning Disability and
Health (ICF). The ICF provided both the impetus and the theoretical and technical foundations for the WHO’s World Report on Disability in 2011, the Disability Action Plan, 2014–2020
(in which access to high-quality AT is a major action objective), the launch of the Global
Cooperation on Assistive Technology (GATE) initiative and the release of the World Report on
Ageing and Health in 2016, and, most recently, the WHO’s Rehabilitation Call for Action 2030.
Not only does the crucial importance of affordable, available, appropriate, and accessibility AT figure prominently in all of these WHO documents, but also the key components of the The Assistive Technology Assessment Model developed in the Handbook are
also the building blocks of the WHO programmatic approach. These are, namely, the ICF
foundations, the Person-Environment Matching model, the need for multidisciplinary
assessment, the key role of rehabilitation, the user-driven approach (with its full-bodied
acknowledgment of the emotional, psychological, and social dimensions of the user), and
the lifespan perspective.
The recent initiatives at the WHO have led to a more coherent and theoretically sound
approach to thinking about disability, rehabilitation, and AT that directly impacts how we
understand AT, its place within rehabilitation services, and the assessment process. Three

developments can be highlighted in this context.
First, after decades of silence, the WHO has now brought rehabilitation to the forefront.
Demographic aging and the rapidly increasing prevalence of chronic noncommunicable
diseases means that people are living longer but with more disability. The overall objective of rehabilitation as a health strategy is to optimize a person’s intrinsic health capacity
and to enhance the person’s facilitating environment by the provision of AT so that the
interaction results in optimal health and well-being, manifested by participation in all
domains of life. Owing to this objective, the WHO argues, rehabilitation will become the
prominent health strategy of the twenty-first century. The Handbook reflects this new role
for rehabilitation.
Second, as the GATE initiative emphasizes, traditional service delivery models are
responsible for the fact only 1 out of 10 individuals who could profit from an assistive
devices has access to one. These models are notable for financing and procurement mechanisms and restrictive regulatory that serve primarily to limit access to AT. Viewing AT as
“special equipment” is a barrier to access when it sends the message that these products
require high levels of regulatory scrutiny. One of the many strengths of this Handbook is
that it not only recognizes this issue—and the role it plays in adverse phenomena such
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Foreword

as abandonment—but also offers thoughtful discussions about how to overcome these
socially created obstacles.
Finally, the WHO has, at least since the development of the ICF in the late 1990s, been
skeptical of the view that “disability” is a particular social marker of a minority of individuals, the so-called “people with disabilities.” Inherent in the ICF model of functioning
and disability, and the Handbook as well, is the proposition that both health determinants—the impairments associated with health conditions such as diseases, injuries, and
aging—and environmental determinants—including AT—create the experience of disability. Since functioning in a domain is assessed on a continuum, problems in functioning—certainly when viewed across the life span—are an absolutely universal human
phenomenon. Everyone has, or will have, some degree of limitation in functioning—some
degree of disability—in one or more domains. Disability is not a matter of “yes or no” but

“more or less.”
Consequently, as the authors in this Handbook are fully aware, AT is not some special
product or technology designed and provided to a designated minority of people called
“disabled”—it is an environmental facilitator that can compensate, relieve, modify, moderate, neutralize, prevent, or merely monitor some limitation in participation in domains the
individual views as important that has resulted either from an environmental restriction
on performance or a health limitation on capacity.
In this second edition of the Assistive Technology Assessment Handbook, the same robust
theoretical foundations from the first edition are supplemented with high-quality chapters setting out the Assistive Technology Assessment Model and related tools for assessment within centers for AT evaluation and provision. The Handbook’s chapters explain the
competencies of the diverse assessment professionals who comprise the multidisciplinary
assessment team. Finally, other chapters explain the role of user experience evaluation in
AT assessment and introduce the reader to cutting-edge technological advances to address
diverse needs in all facets of people’s lives. In this last section, recognizing the impossibility of keeping abreast with technological developments, the editors wisely choose to
focus on “new landscapes” in AT development—technology that tracks bodily gestures,
brain–computer interfaces, graphic-user interfaces, and robotic exoskeleton assistance for
mobility.
Reading through this third section, with all of its wonders of innovation, one might
do well to focus on another balance, one as challenging as that which the editors have
already achieved between the user–experience and technological–ergonomic realities:
Exciting new technological developments that enhance participation and well-being are
of little social importance if their availability is limited to a small group of people who
can afford them. Breaking through the limits of our technological boundaries is challenging and exciting, but equally important is finding the social mechanisms of distribution
that ensure that as many of those who could profit from a technological marvel have
access to it.
Jerome Bickenbach
Swiss Paraplegic Research, Nottwil, Switzerland
and
Department of Health Sciences and Health Policy
University of Lucerne

Preface to First Edition
This book is the result of scientific collaboration and sincere friendship that was initiated in 2001 and has gradually strengthened over time. The collaboration begins with
the creation, at the Faculty of Psychology, University “La Sapienza” of Rome, of the first
course of psychotechnology that was held in Italy. This course aimed to combine multiple
topics, bringing together on the one hand, technological and ergonomic arguments and
issues concerning the psychology of rehabilitation in order to train competent psychologists within assistive technology provision.
The course, designed by Stefano Federici, addressed hundreds of Italian students who
have enrolled for eight years at the University of Rome. The term “psychotechnology,”
with the meaning adopted and introduced in the psychology of rehabilitation by Federici,
initially sounded like a neologism. In fact, the objective of the course was to integrate
technology and ergonomic aspects with those more specific to cognitive ergonomics, read
under the lens of the biopsychosocial model of disability, in order to train psychologists
with both psychological and technological expertise and who were able to lead a user to
meet their needs. Only in this way would it have been possible for the user to search and
find a technological product that not only was satisfactory to his or her own person, but
was also able to support him or her in the integration process within the relevant milieu,
by preventing, compensating, monitoring, relieving, or neutralizing disability and social
barriers. The psychotechnologist, therefore, should possess those skills useful in centers
for technical aid which, at the end of the last millennium, have begun to be characterized
as autonomous centers of technology device assessment and assignment for an individual’s disability and independent living.
The main theoretical difficulty in designing the psychotechnologies course was to integrate technological-engineering models—not dissimilar in some ways to certain models
of cognitive functioning that tend to generalize and idealize the individual—with the biopsychosocial model of disability. The ergonomic approach to technology, both of cognitive
and engineering types, indeed, often tends to neglect the emotional, motivational, and
social user experience, so that it does not take into account those factors which very often
are affecting it with a higher rate of incidence in the successful outcome in device use.
The discovery, by Federici, of the Matching Person and Technology model by Marcia Scherer
was like the key to closing the circle. It is a model that has combined people with disabilities’ needs with assistive technologies in a user-centered context, without neglecting the
functional and ergonomic features of the device. It was found to be the answer to that fateful question that the psychotechnologist usually turned to him- or herself, “What is the
most effective integration of what I know about this unique person?” As Federici was used
to repeating in the Psychotechnology course at the University of Rome: “this course could

also be called Matching Person and Technology from the psychologist’s standpoint.” The collaboration between the University “La Sapienza” of Rome and the Institute for Matching Person
and Technology has produced dozens of theses and several doctoral dissertations concerning the adaptation and validation of the Matching Person and Technology model and tools
related to the professional profile and role of the psychologist in the assistive technology
assessment and assignment processes. Some of those researchers and students are now
successful professionals in psychotechnology. Furthermore, many authors who took part
in writing chapters of the current book come from that experience of study and research.
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Preface to First Edition

However, the collaboration and friendship between Marcia and Stefano has not only led
to the sharing of ideas and research projects, but has created a scientific network among
Italian, American, and scholars from other nations who have formed the scientific community that has allowed such a large participation of authors in writing this work.
As editors of this handbook, let us now provide the reasons for this book, which organizes a key challenge for us: to develop an international ideal model of an assistive technology assessment process that gathers the most recent scientific developments in assessing
and providing technical aids for an outcome that, if reached, would be a real success: the
well-being of the person with a disability. This model, therefore, intends to express in an
idealized and essential form, an assessment process carried out in a center for technical
aid, since it provides such tools for assessment and the professional skill set that we define
“psychotechnological.”
Of course, just for the fact that we speak of “challenge,” we reveal our awareness about the
problems and limitations of an “international” ideal model. One of the unsolved problems,
for example, is the difficulty, already met several times, to define the features of a center for
technical aid. The modeling process of a center for technical aid is difficult if one takes into
account the extraordinary variety of systems of regional and national health and social care,
both public and private. This variety affects in different ways the specific characteristics that
are found at any particular center. Furthermore, the different nature of the center for technical aid makes problematic the definition itself of the individual who is served by it: user,
patient, client, or consumer? The user (for convenience we use this definition, a little more

generic than the others) of a center for technical aid could be a patient of a physician (physiatrist) who operates in a national system of health care and sends him or her to a specialized
facility, the center for technical aid indeed, for a more thorough assessment for obtaining a
particular device. This assessment can be provided free of charge, if the center is part of a
national health system, or paid for by a private health system or even out of the individual’s
own funds [?]. Furthermore, the product chosen by the user could be sold by or procured
directly from the center for technical aid or, alternatively, the device provision may be made
later by other providers, external and independent from the center for technical aid.
These are just some of the issues discussed by the authors of this handbook. Other issues,
in fact, are also addressed that are even more problematic from a scientific viewpoint. We
refer to those that are intrinsically linked to the design of an international model. Because
of the difficulty of finding an adequate and effective synthesis of the various models proposed by specific national systems of public health and welfare, the scientific community is
facing an assistive technology delivery system, which will be increasingly individualized,
due to the social and cultural diversity of users and the necessary adjustment of the center
for technical aid’s functioning to the local health system. However, it should be noted that
this particularization of the model is to clash with some trends that are aimed at promoting,
instead, globalization (e.g., this occurs both in social and health policies of the European
Community and in those of the World Health Organization). The internationalization of
a model, indeed, is advantageous since it often emerges as a synthesis of experiences of
regional models. Moreover, it offers the opportunity, by sharing a theoretical model and
evaluation criteria, to share data essential to scientific research, planning, and evaluation
of national and international policies and the verification of the quality of public services.
A goal that we set in writing the present project was to narrow the topics, trying to
legitimate the choice made. In fact, our intention was not only to provide a theoretical
text, which aims to develop an ideal model of assistive technology assessment processes, but
to provide an operational tool able to outline both the applicability of the model itself as
well as the main characteristics of a center for technical aid’s functioning, endeavoring to


Preface to First Edition

xi

provide a tool-kit for a “proper assessment,” and profiles of professionals acting within the
center. Moreover, it even seemed essential to us comparing our model with some of the
most advanced researches in technologies for rehabilitation and supports for independent
living. However, we were well aware that a detailed description of all assessment tools useful in a center for technical aid, a presentation of all possible professional profiles working
within and in collaboration with a center for technical aid as well as an overview of the latest technology devices for rehabilitation and independent living would have required an
encyclopedia and not a handbook, much more operational, as is the current text. Therefore,
and this could be read both as a limit and as well an advantage of this book, we have chosen, for each of the three areas mentioned—the tools of evaluation, evaluation experts in
a center for technical aid and new technologies—the aspects of the current state of the art
we judged to be the most representative or innovative. So, we not only identified for each
topic the leading experts and invited them to contribute, but also, where possible, for each
lead author to collaborate with coauthors to achieve a comprehensive, cross-cultural chapter. For this reason, the reader should not be surprised if he or she will not find mention
of some professions among those that could be treated in such a handbook. We tried to
give more prominence to the definition, training, and professional role of the new profession of psychotechnologist, as well as to highlight the professional profile of key allied
health professions. Finally, we would like to stress that this handbook does not intend to
model the assistive technology assessment process as a result of a mere academic mental exercise, but to provide examples of applications of it. This is emphasized for two main reasons: the theoretical view of the authors’ chapters and editors emerge from experimental
research applied to rehabilitation and assistive technologies; the international ideal model
of assistive technology assessment process has already been applied in centers for technical
aid. Thanks to scientific and clinical collaboration, economic and operational support of
the Centre for Technical Aid of Rome, Leonarda Vaccari Institute—which, in turn, is part
of the Italian Network of Centres Advice on Computer and Electronic Aids and cooperates with the Institute for Matching Person and Technology and the Columbia University, with
whom it shares the principles that underlie the assistive technology assessment process—it
was possible to define the assessment model proposed in this handbook since the model
is already operative in the Centre of Rome. This Centre offers a non-commercial advisory
service and support on assistive technologies and computers for communication, learning, and autonomy. The service is free of charge for users who access it through the Italian
National Health Service. Several scientific projects granted by the Institute are in progress
at the Centre to verify not only the advantages of a systematic application of the Matching
Person and Technology tools in the assessment process, but also the application of the assistive technology assessment process model. Some results will be presented and discussed in
the chapters of this book.

Sincere thanks go to the authors of the chapters who have welcomed with enthusiasm
our model, enriching in many parts the initial draft of this work and giving the work as a
whole a widely applicable, current and credible content. Special thanks also go to the publisher, CRC Press, Taylor & Francis Group, who eagerly accepted the project and supported
the long process of drafting and revising sections of the handbook. Again, special thanks
is extended to the many peer-reviewers of the chapters, who played a generous and valuable role, both in the validation of scientific nature and quality of each contribution as well
as representing the international scientific community in this area.
Marcia and Stefano



Preface to Second Edition
The first edition of the Assistive Technology Assessment Handbook (2012) was shaped by the publication of the first World Report on Disability in 2011, which provided the context for our chosen path to read the assistive technology assessment process in light of the biopsychosocial
model of individual functioning, as proposed by the International Classification of Functioning,
Disability and Health. When person and environment, individual functioning and context are
integrated in the framework of an assistive technology assessment process, then the selection of the technology becomes more appropriate to the user and the user’s environment.
This reduces the mismatch between the person’s needs and the demands of the environment. Consequently, these are powerful tools to increase independence and wellbeing.
The ideal model of the assistive technology assessment process was proposed in the first
edition, based on Marcia J. Scherer’s Matching Person and Technology (MPT) model. Since
the 1980s, Scherer has realized the importance of including personal factors in the selection process for an assistive technology. This rehabilitation approach was given a favorable
reception by the scientific community and professionals. For this reason, we were happy
to welcome the invitation of Michael Slaughter, executive editor of CRC Press, Taylor &
Francis, to edit a second edition.
As in the first edition, this second edition was inspired by the initiative conducted by
the World Health Organization and promoted by the General Assembly of the United
Nations since September 2013. The United Nation’s requests were focused on the development of a global initiative to realize the obligations of the Convention on the Rights of
Persons with Disabilities toward increasing access to assistive technology. In July 2014, the
World Health Organization responded to that request by establishing a global initiative:
the Global Cooperation on Assistive Technology (GATE).
Along with all of the authors of our chapters, we are very proud to have made a contribution to GATE’s activities, one of which is strongly focused on the assistive products service
delivery model. Our ideal model of assistive technology evaluation and provision can be

used by professionals to check the functioning and to (re-)conceptualize the phases of an
assistive technology delivery system according to the biopsychosocial model of disability.
The assistive technology assessment process model can be a useful driver for arranging
the relationships among professionals and end-users, and for determining when a multiperspective assessment of the match between the user and the technology product and
assistive solution would be beneficial in the delivery process. It has been thought that this
is a useful process of assistive technology assessment and delivery process for any kind of
technology. The model outlines an ideal process which provides reference guidelines for
evidence-based practice, steering both public and private centers who wish to compare,
evaluate, and improve their own matching person and technology model.
It is imperative today that the field and profession of assistive technology avail of and
encourage technological, medical, and cultural advances throughout the world. Organizing
the myriad needs as well as opportunities in ways that maximize the well-being and life
quality of the unique person with a disability requires a strong foundation from which to
work and a framework to guide the process of providing assistive support. Our goal is to
provide just one such framework for our colleagues to use, expand, and improve.
Marcia and Stefano
xiii



Acknowledgments
Permission to reproduce extracts from British Standards is granted by BSI Standards
Limited (BSI). No other use of this material is permitted. British Standards can be obtained
in PDF or hard copy formats from the BSI online shop: www.bsigroup.com/Shop.
Professor Penny Standen and Dr. Peter Collins at the University of Nottingham kindly
read the manuscript draft and provided Dr. Michael P. Craven valuable feedback.

xv

Editors
Stefano Federici is a professor in general psychology and psychology of disability at the
University of Perugia, Italy. He has been a very active researcher in assistive technology for
the disabled over the past 15 years and has published extensively in this area. In addition
to the first edition, he has also published several additional reference works in the field.
Marcia J. Scherer is a chaired and tenured professor at the University of Rochester and is
a world class researcher in the field. She has published over 200 refereed papers in rehabilitation studies.

xvii



Contributors

Meera Adya
Burton Blatt Institute
Syracuse University
Syracuse, New York
and Washington, DC
Giulia Balboni
Department of Philosophy, Social and
Human Sciences and Education
University of Perugia
Perugia, Italy
Paulo Sérgio Siebra Beraldo
Clinical Research Division
SARAH Network of Neurorehabilitation
Hospitals
Brasilia, Brazil

Simone Borsci
Diagnostic Evidence Co-operative
Division of Surgery
Imperial College of London
London, United Kingdom
Marco Bracalenti
Department of Philosophy, Social and
Human Sciences and Education
University of Perugia
Perugia, Italy

Valentina Canonico
Atlas Centre–Associazione Sementera
ONLUS
Perugia, Italy
Simon Carson
Department of Physical Medicine and
Rehabilitation
University of Rochester Medical Center
Rochester, New York
Barbara Cordella
Department of Dynamic and Clinical
Psychology
Sapienza University of Rome
Rome, Italy
Fabrizio Corradi
Center for Technical Aid
Vaccari Institute for Disabled People
Rome, Italy
Gerald Craddock

Centre for Excellence in Universal Design
National Disability Authority
Dublin, Ireland

Lucia W. Braga
Neurosciences and Neurorehabilitation
Division
SARAH Network of Neurorehabilitation
Hospitals
Brasilia, Brazil

Michael P. Craven
Bioengineering Research Group
Faculty of Engineering
University of Nottingham
and
NIHR MindTech Healthcare Technology
Co-operative
Institute of Mental Health
University of Nottingham Innovation Park
Nottingham, United Kingdom

Jaime Rosa Campeau
Department of Otolaryngology
University of Rochester Medical Center
Rochester, New York

Desleigh de Jonge
LifeTec Australia
The University of Queensland

Brisbane, Queensland, Australia
xix


xx

Louise Demers
Université de Montréal
and
Centre de recherche de l’Institut
universitaire de gériatrie de Montréal
Montreal, Quebec, Canada
Simone Donnari
Atlas Centre–Associazione Sementera
ONLUS
Perugia, Italy
Nancy Dukelow
Department of Physical Medicine and
Rehabilitation
University of Rochester Medical Center
Rochester, New York
Giovanni Fatuzzo
Atlas Centre–Associazione Sementera
ONLUS
Perugia, Italy
Stefano Federici
Department of Philosophy, Social and
Human Sciences and Education
University of Perugia
Perugia, Italy

Ingrid Lapa de Camillis Gil
Neurological Rehabilitation Division
SARAH Network of Neurorehabilitation
Hospitals
Brasilia, Brazil
Apeksha R. Gohil
Department of Occupational Therapy
School of Primary and Allied Health Care
Monash University
Melbourne, Victoria, Australia
Massimo Grasso
Department of Dynamic and Clinical
Psychology
Sapienza University of Rome
Rome, Italy
Francesca Greco
Department of Dynamic and Clinical
Psychology
Sapienza University of Rome
Rome, Italy

Contributors

Katya Hill
School of Health and Rehabilitation
Sciences
AAC Performance and Testing
Teaching Lab
University of Pittsburgh
Pittsburgh, Pennsylvania

and
ICAN™ Talk Clinic of the AAC Institute
Carnegie, Pennsylvania
Melanie Hoyle
The University of Queensland
Brisbane, Queensland, Australia
Masaaki Kurosu
The Open University of Japan
Chiba-shi, Chiba, Japan
Sarah Kysor
Department of Physical Medicine and
Rehabilitation
University of Rochester Medical Center
Rochester, New York
Natasha Layton
La Trobe University
Summer Foundation
Bundoora, Victoria, Australia
Giulia Liberati
Institute of Neuroscience
Université Catholique de Louvain
Louvain, Belgium
Alessandra Lo Presti
Graduated in Psychology and Disability
Study
Rome, Italy
Trish MacKeogh
Central Remedial Clinic
Dublin, Ireland
Wendy L. Magee

Music Therapy Program
Boyer College of Music and Dance
Temple University
Philadelphia, Pennsylvania


xxi

Contributors

Sheryl Maier
Department of Otolaryngology
University of Rochester Medical Center
Rochester, New York

Mansha Mirza
Department of Occupational Therapy
University of Illinois at Chicago
Chicago, Illinois

Amy Pacos Martinez
Department of Physical Medicine and
Rehabilitation
University of Rochester Medical Center
Rochester, New York

Michael Morris
Burton Blatt Institute
Syracuse University
Syracuse, New York

and Washington, DC

Claudia Mazzeschi
Department of Philosophy, Social and
Human Sciences and Education
University of Perugia
Perugia, Italy

William Ben Mortenson
Department of Occupational Science and
Occupational Therapy
University of British Columbia
and
International Collaboration on Repair
Discoveries
Vancouver Coastal Health Research
Institute (VCHRI)
and
GF Strong Rehabilitation Research
Program, VCHRI
Vancouver, British Columbia, Canada

Patrizia Mecocci
Institute of Gerontology and Geriatrics
Department of Medicine
University of Perugia
Perugia, Italy
Maria Laura Mele
Department of Philosophy, Social and
Human Sciences and Education

University of Perugia
Perugia, Italy
and
COGISEN
Engineering Company
Rome, Italy
Fabio Meloni
Department of Philosophy, Social and
Human Sciences and Education
University of Perugia
Perugia, Italy

Emanuele Pasqualotto
Institute of Neuroscience
Université Catholique de Louvain
Louvain, Belgium
Chiara Pazzagli
Department of Philosophy, Social and
Human Sciences and Education
University of Perugia
Perugia, Italy
Martina Pigliautile
Psychologist
Perugia, Italy

Klaus Miesenberger
Institute Integriert Studieren
Johannes Kepler University Linz
Linz, Austria

Katia Soares Pinto
Pediatric Rehabilitation Division
SARAH Network of Neurorehabilitation
Hospitals
Brasilia, Brazil

Damon Millar
COGISEN
Engineering Company
Rome, Italy

Christiaan Erik Rijnders
COGISEN
Engineering Company
Rome, Italy


xxii

Deepti Samant
Burton Blatt Institute
Syracuse University
Syracuse, New York and Washington, DC
Marcia J. Scherer
Institute for Matching Person and
Technology
Webster, New York
Christopher Stavisky
Department of Physical Medicine and
Rehabilitation

University of Rochester Medical Center
Rochester, New York
Aldo Stella
Department of Philosophy, Social and
Human Sciences and Education
University of Perugia
Perugia, Italy

Contributors

Lorenza Tiberio
Psychologist
Rome, Italy
Michele Verdonck
University of the Sunshine Coast
Sippy Downs, Queensland, Australia
Thomas Wosch
University of Applied Sciences
Würzburg-Schweinfurt
Würzburg, Germany
Andrea Gossett Zakrajsek
School of Health Sciences
Ypsilanti, Michigan
Susan Zapf
Children’s Journey to Shine, Inc.
Friendswood, Texas


Section I

The Assistive Technology
Assessment Process Model
and Basic Definitions
Stefano Federici and Marcia J. Scherer
CONTENTS
I.1Introduction.............................................................................................................................1
I.2 The Assistive Technology Assessment Process Ideal Model...........................................3
I.3 AT Abandonment: The Service Delivery System in Different Countries....................... 6
I.4 Presentation of the Chapters of Section I............................................................................7
I.5Conclusion............................................................................................................................... 9
References.......................................................................................................................................... 9

I.1 Introduction
As a part of the human condition, “Disability is complex, dynamic, multidimensional, and
contested” (WHO and World Bank, 2011, p. 3). “Contested” refers to difficulties reaching a
consensus in defining disability. There are multiple models of disability in operations and,
often, in opposition. When talking about disability, there are many surrounding and supporting issues that become relevant such as individual functioning and its measurement,
the existence of social barriers and a digital divide, objective quality of life and subjective
well-being, activity performance and participation, human rights and disparities in wealth
and health, and morbidity and mortality. Given the multidimensionality of disability, the
International Classification of Functioning, Disability, and Health (ICF) aims to make clear
that disability (and its correlated term “functioning”) must be understood as an umbrella
term, “encompassing all body functions, activities and participation” (WHO, 2001, p. 3).


2

The Assistive Technology Assessment Process Model and Basic Definitions

Disability is a multidimensional construct, and its measurement is multidimensional

and cannot be held to a “gold standard” that is valid for all contexts and purposes (see
Chapter 2, “Measuring Individual Functioning”). The only appropriate measure is the one
that best suits the context, purpose, and person to which it is addressed, rather than the
concept of disability in the abstract. Moreover, the variety of measurement tools and the
flexibility to change the measurement procedures, adapting them to different people, contexts, technologies and other supports, and purposes, provide the most reliable scientific
approach and clinical/practical solutions.
A well-known paradox in measuring disability arises from the fact that an individual’s
understanding of their well-being may not accord with the evaluations of medical experts
(Federici, Bracalenti, Meloni, and Luciano, 2017). Sen (2002) has noted the conceptual difference between perception and observation of health. There is often a discrepancy between
an individual’s subjective view of their health, based on personal perceptions, and the
views of doctors or professionals, which are based on objective data (Federici, Meloni, and
Corradi, 2012). Albrecht and Devlieger (1999) state that the “disability paradox” implies
that personal experience with disability is an important aspect of any assessment of disability; hence, assessments of it should combine objective observations with subjective,
self-report data.
Madans and colleagues. (2002) identify, at the aggregate level, three main classes of
reasons for measuring. Here, “providing services” (2002, slide 11)—including the development of programs and policies for service provision and their evaluation—is the first
among the three classes. Particularly, the Assistive Technology Assessment (ATA) process
can be viewed as one aspect of the first-mentioned class.
Assistive Technology (AT) plays a key and fundamental role in facilitating the social
integration and participation of people with physical, sensory, communicative, and cognitive disabilities. We use the term AT, except where otherwise stated, as an umbrella
term (WHO, 2004), with the meaning more commonly attributed to the “Assistive
Technology device” term, as stated by the U.S. Assistive Technology Act (United States
Congress, 2004) and acknowledged by the World Health Organization in the recent
World Report on Disability (WHO and World Bank, 2011), as follows: “Any item, piece of
equipment, or product system, whether acquired commercially, modified, or customized, that is used to increase, maintain, or improve functional capabilities of individuals
with disabilities” (p. 101). This definition stresses that what make a device an assistive
product, namely an AT, is who uses the product, rather than its intrinsic characteristics.
Thus, mainstream/everyday/universal technologies such as smartphones and robots are
considered ATs when they are used for enhancing capabilities and functioning of individuals with disabilities.
Furthermore, the International Standards Organization (ISO) has recently revised the

definition of Assistive products for persons with disability, integrating the first definition
of 1998 (ISO 9999) with the ICF’s concepts:
“any product (including devices, equipment, instruments and software), especially
produced or generally available, used by or for persons with disability for participation, to protect, support, train, measure, or substitute for body functions, structures,
and activiies, or to prevent impairments, activity limitations, or participation restrictions”
(ISO, 2016).

According to the ISO 9999, AT is a mediator, an interface that tends to reduce the mismatch between the person’s needs and the requests of the environment, neutralizing