Living in the State of Stuck: How Assistive Technology Impacts the Lives of People With Disabilities,   ISBN:9781571290984

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I use this text for an occupational therapy course that I teach about assistive technology. Students enjoy reading the book and say it gives them a better understanding of the human perspectives of assistive technology use. This is what one student said recently.

The first time I head of this book is in a workshop of Assistive Technology. It interested me by the case stories shared by other participants. But I just thought that would be a dry textbook with some interesting case stories. When I actually picked up this book, I did not expect that I could not put it down. Although this book is talking about people with disability and assistive technology, its meaning does not limit to "cold, hard" assistive technology. It is good for all rehabilitation professionals to gain an insight of the life change and its meaning to their clients.

Being an OT student, I have been educated to focus on functioning, which I am very proud of as I think that distinguish us from other professions. In practice, when we assess/treat clients, we sometimes tend to look at client's impairments and provide intervention accordingly, but overlook what is the client's priority. Does the improvement in client's functioning really promote client's quality of life? This question was often skipped from our mind. The point made by Dr. Scherer prompted me to think the difference between functioning and quality of life. Dr. Scherer claimed that improving functioning ability does not necessary lead to the improvement of quality of life, which was illustrated by the case story in this book. It inspired me to rethink the ultimate goal of the rehabilitation and what the client-centered practice really mean.

It is not uncommon to prescribe assistive device to compensate client's functioning impairments. But the case presented by Dr. Scherer raised a question: is the client really satisfied with the compensation? In western culture and society, we emphasize the independence. But as the population of North American diverse, the original culture of some clients may emphasize more on interdependence. Therefore, the provision of assistive technology may improve the independence of client but jeopardize the value of interdependence. For example, some simple device would enable a client to dress him/herself, but in some culture, helping the seniors dressing is a responsibility of young generation. They deem it as a good opportunity for young generation to learn how to honor the elderly and it helps to pass this tradition down to young generation. In this sense, as a professional, we should be sensitive to client's different culture background and their values. This is applicable to not only people with different culture but also within the same culture.

In addition, Dr. Scherer also pointed out the importance of the psychosocial impact to client's life posed by using assistive technology as it will improve client's sense of control and self-esteem, etc. However, like every coin has two sides, this is not always the case. The book presented a story in which the client was prescribed an adaptive device for self-feeding. The prescription was not appreciated by the client because having someone to feed him is his only opportunity to socialize with the care giver, which in turn decrease his feeling of isolation. Through this example, Dr. Scherer reminded us to ponder over the issue: what is the goal of providing assistive device? Is the provision match the client's needs and their environment/situation? According to Dr. Scherer's research, the abandonment of AT are usually caused by the failure of considering user's opinion and preference. The individualization of AT is critical as AT has different meaning for different person.
I use this book in an occupational therapy course that I teach about assistive technology. Students enjoy using the text and find that it helps them to have a better understanding of the human perspectives of assistive technology use. This is what one of them said recently.

As a rehab student who originated from a developing culture, I am also interested in the introduction of a brief historical review of rehabilitation practice. I was wondering if the progress of rehabilitation in developing countries would follow the same stpes in North American. This might be an interesting research area, and would promote the development of rehabilitation in these developing countries. Lei Zhou

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This is a book about people with disabilities and access technology. It's the first book I've seen on the subject of how disabled people relate to access technology. This author has done most of her work with spinal cord injuries, so in that sense it isn't about people with vision problems; but I was absolutely struck by how many parallels there are between issues faced by the blind, and the issues faced by those with severe spinal cord injuries or cerebral palsy. I was very gratified to see that we aren't the only population for whom technology is really a mixed bag. As with us, the technology they use can in some way define the way they interact with the general public so it affects the way they feel about themselves. (For example, I will not use speech products unless I am with family or by myself.) Just as in the general public, they have their technophiles and their technophobes.
As it is for us, their biggest problems are psychological and sociological, not their actual disability. I was struck by how similar their population is relative to people born with disability versus those who become disabled later in life and how that effects their response to technology. Having used a slate and stylus all through college, I will never forget how thrilled I was the first time I saw refreshable Braille! I knew immediately that it would revolutionize my life, and it did! During my former lives in high technology for blind folks, I was always dumbfounded when other blind people didn't have the same response to refreshable Braille that I had. Dr. Scherer's book talks about how people who were born with a physical disability relate so much differently to a motorized wheelchair and other technologies than those who become disabled because of an accident or disease. Well, that really describes my experience relative to refreshable Braille. Naturally, the people who didn't get as excited about it as I got were usually those who had been blinded at some point in life. To me, the ability to insert and delete text, to erase and write over something without making an unreadable mess, and the ability to locate something by Brailing in a search string was enchanting and magical. I suppose to someone who had used print, these features weren't anything new so they didn't have the same level of wow that I did. I do remember that other congenitally blind folks reacted to the technology much as I had, with awe and passion. I always thought this was really a function of Braille mastery, but now, after reading Dr. Scherer's book, I believe it's partly a matter of how someone who becomes disabled feels about the compensating technologies.

The quadriplegics in Dr. Scherer's book have similar coping issues and they have some of the same kind of employment history and problems that we blind folks have. Naturally, they have some of the same challenges with government benefits; and they have some of the same problems trying to fund the technology they need. They have similar issues with service animals. It seemed like they have some of the same challenges relative to human help versus technology. As with us, their "quality of life" is often a function of the quality of help they get from family, volunteers, and paid help and they don't want to completely replace human assistance with technology. They have very similar issues with privacy, dignity, self-sufficiency, and learned helplessness.

Dr. Scherer reports that one third of all access technology is abandoned. She discusses reasons for this and talks a good deal about how to remedy the problem by making sure the proper product is recommended and purchased. It is a crime to spend so much money on technology that isn't utilized! One of the saddest thing I know of is when someone goes through fire to get a piece of technology and then is so frustrated by it that they end up not using it. Dr. Scherer's theories on why this happens and what should be done about it are interesting indeed.