Assistive Technologies for Physical and Cognitive Disabilities

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A variety of federal and state laws have been adopted to ensure that individuals with disabilities have increased access to technology supports. The ADA is designed to protect individuals from employment discrimination based on a disability when the individual can perform the essential functions of the job with or without reasonable accommodation. A reasonable accommodation can include AT or other technology access.

The ATA is designed to provide funding for states to ensure an increase in the availability of AT to improve their quality of life, work, and education. The Rehab Act helps people acquire AT to meet their employment goals and requires that all federal agencies make their electronic and information technology accessible. Under IDEA, AT must be considered for every student with disabilities in assessing what technology might be needed to help the child receive a free, appropriate, public education. New Hampshire state law addressing services for the developmentally disabled requires all individuals with developmental disabilities accessing services be comprehensively assessed for assistive technology needs.

State education regulations require that children be assessed for and provided with technology necessary to ensure they receive a free, appropriate, public education as required by the IDEA. The provision in state law for persons seeking an assessment and provision of assistive technology under the developmentally disabled laws is in N. RSA A More information about services for individuals with developmental disabilities also can be found on the N. Issue 1 Issue 2. Issue 1 Issue 2 Issue 3 Issue 4.

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Issue Issue Issue 3 Issue 4. Issue 1 Issue Issue Issue Issue 1 Issue 2 Issue Issue 1 Issue Issue 4. Given the different understandings surrounding the concept of autonomy, it will be useful to start with a working definition. We can then say that at minimum, autonomy consists of self-rule, of deciding for oneself what one would like to be able to do. As such three components stand out: 1 knowledge, 2 , authenticity, and 3 liberty. Knowledge will be required in order for a person to make decisions about what he or she values, as well as being essential if one is to determine what one wants to do in pursuit of their values.

Authenticity is then required if the person is to be the initiator of his or her own actions—if a person is merely following someone else's plan or is brainwashed, then he or she is not fully autonomous. Here, liberty means political autonomy or having rights over themselves. In relation to ATs, Leslie Francis notes that people with physical disabilities use assistive devices, but his or her actions involving these devices are still considered to be his or her own; she also correctly notes that people without intellectual disabilities also use assistive devices.

ASSISTIVE TECHNOLOGY WITH COGNITIVE DISABILITIES EMPHASISPage of NeuraLinksPlus by Prof. Mark Dubin

So, the fact that someone might use an assistive device does not necessarily mean that they have diminished autonomy. Francis contends that. Clearly, using assistive technologies does not mean that a value, choice, or a plan is insufficiently a matter of a person's individual psychological processing to be regarded as theirs. Francis is arguing against a perception that PIDD lack autonomy and is pointing out that a person's use of ATs should not be held against him or her. Nonetheless questions over whether someone's values, choices, or plans of action are a matter of their individual psychological processing is of great ethical importance including in terms of assistive technologies, and including more specifically assistive technologies for PIDD.

Let us first examine the many ways in which ATs could promote autonomy. Technological aids could help PIDD overcome or manage a number of these deficits, thus promoting autonomy. In what follows, the ways in which ATs may be able to promote three subsets of autonomy—knowledge, authenticity, and liberty—are outlined. A number of PIDD have difficulty retaining information, so technological aids that supply knowledge in an easily digestible form will be of immense use.

Maps and guides are obvious examples, but technology that informs PIDD of what various signs and signals do will also be important, e. ATs might be used to provide reminders of what their long-term goals are, thus nudging them to align their current desires with previous plans or preferences possibly made in conjunction with family members or carers. As such, ATs could help with impulse control. As such, it is extremely difficult to determine what, if any, their preferences are. In some cases, it will be difficult to determine the authentic desires of people with severe cognitive impairments.

For example, a person with severe apraxia might struggle to communicate a sentence, perhaps taking an hour to complete the sentence. While ATs could help, they could also easily distort what the person is likely to say. ATs that aid their communication or that are able to interpret their preferences e. If they are able to communicate, then the goals they are given or that they choose are likely to reflect their interests and preferences.

This presupposes that they can be said to have preferences from which interests can be generated. ATs might also be useful in helping PIDD particularly those with moderate or mild impairments determine their preferences and order their lives. Assistive devices can be used to make up for deficits in planning ahead and pursuing goals. Some PIDD have poor impulse control—ATs may be able to promote being one's own person by helping people choose courses of action that should help them achieve their goals in life rather than being led by their intuitive and emotional responses to things.

ATs could be used to nudge PIDD toward certain goals ideally worked out in conjunction with the user. Nudging works by appealing to people's automatic affective systems i. This is relatively easy to illustrate—suppose a person's long-term goal is to eat more healthily in order to live longer, but his or her affective self responds to a cake at the counter by buying the cake.

A nudge in such a scenario would arrange the presentation of food so that the cake is not as tempting; an AT might remind the person of their longer-term goal of not eating the cake, thus helping the person achieve this goal; or might suggest lunches; or might calculate the calories of the items that the person buys. Interesting research has been done, for instance, on the links between harmful use of alcohol and tobacco and the density of outlets supplying such products 17 , In terms of PIDD, this sort of nudging is trickier as in some cases of intellectual disability the capacity to form long-term strategic goals might not exist.

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By helping PIDD communicate, understand information, and deal with new scenarios and new people, the range of choices available in social and political spheres is increased and thus this aspect of his or her autonomy is increased. For those who argue for relational autonomy, having normative authority over one's central values and commitments is seen as being of utmost importance, i. In this case, then, so long as PIDD validated the values being promoted by the ATs, they would be seen as autonomous in the relational sense.

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ATs, by helping PIDD interact with the rest of society more easily, will facilitate their social recognition, and thus promote self-respect and dignity. Let us focus on the ways in which ATs might impact the knowledge, authenticity, and liberty conditions of autonomy. This is not to say that all interference or suggestion undermines autonomy.

Electronic ATs i. Often the information being made available for PIDD will necessarily be simplified so as to make it comprehensible. Depending on the degree of simplification, this could result in misrepresentations of knowledge. The choices made in terms of what information to omit or what to emphasize could be seen as distortion. Designers of ATs will also need to ensure they minimize their own biases.

The addition of a layer of technology to the relationship between PIDD and the world around them might complicate matters as much as simplify them. We mentioned that some apps might help PIDD communicate their inner psychological states to others. There are potential drawbacks to this ostensible benefit—the risk that the user's inner psychological state will be misrepresented.

It may be distorted or manipulated in translation. In cases of people with profound cognitive impairments, it might be extremely difficult to determine if the AT is in error or if their preferences have changed. Secondly, if an app—for instance—offers the user a range of options from which to choose, the choice architecture [c. The degree of nudging, which is unavoidable, risks undermining their autonomy.


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Of course, this is not only the case for PIDD. Companies in possession of huge amounts of data about a person that develops apps for that person will be easily able to provide us with stimulation that we crave, thereby undermining capacities for self-regulation which is said to be finite as well making claims on our attention.

The less attentional resources we are able to muster at any time, the more pliable we become and the more vulnerable we are to manipulation. Novel technologies, by gathering data about us, are better able to determine which nudges and techniques will grab our attention. ATs might be used either to help determine what a PIDD's preference are, or to create those preferences. If some third party creates the preferences, it becomes difficult to claim that the PIDD is autonomous.

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If a PIDD has no or severely reduced personal autonomy in the sense of them initiating their own actions, developing, and following their own plans, or choosing their own values, then they cannot be said to have very much autonomy. As such, there would be severe problems with political autonomy. If they were not authentically choosing how to vote, for instance, but were instead voting according to preferences suggested to them by an AT, or making jury-deliberations, there would be a risk to the legitimacy of those processed.


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If this were to happen it would set back the cause of obtaining equal civil and political rights for PIDD. Less individualistic accounts of autonomy such as relational accounts 23 of autonomy do not necessarily help in this case either. Relational accounts of autonomy focus on recognition of the person's autonomy, and on the importance of a person validating their own values. However, this simply shifts the problem—ATs could nudge the person toward validating the values the AT suggests. The user might be seen not as the origin of these values but as validating them.

If they have been nudged toward validating them, then the problem remains. Our notions of autonomy emphasize the importance of individuals making choices according to their own individual preferences. Indeed, a core tenet of political liberalism is that people should be allowed to pursue their own subjective account of the good. In developing ATs for PIDD, we must be extremely careful to ensure that novel technologies do not in fact create preferences based on the interests of technology designers, engineers, or carers.

As such, they are useful, but they also risk misrepresenting an individual's subjective experiences, or constructing preferences by framing responses to certain things or directing their attention in specific ways that are in fact in the interests of the developer. The issue of ATs undermining the autonomy of PIDD will be most pronounced in cases of profound cognitive impairment, as it is in these cases that it is difficult to determine the preferences of PIDD and their degree of autonomy.

They are likely to facilitate greater independence by serving as memory aids, guides, and planners.

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They will certainly promote autonomy in this sense. They may help people develop and pursue life goals. In terms of people with moderate or severe ID, they can promote autonomy in the sense of providing means to communicate and to control impulses. In all cases there remains a risk that they will also make users biased toward or against particular goals.


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  7. The degree to which nudging undermines autonomy is pressing then. ATs insert an extra-layer into decision making for people with severe ID. While Silvers and Francis have argued that it might be possible to determine someone's subjective good, this relies on others to do so.