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Fundamentals of Robotic Assistive Technologies

Pedro Encarnagao


Assistive Technology 1

Robots 8

Safety of Service Robots 11

Technology Readiness Scale 14

Summary 20

References 21

Learning Objectives

After completing this chapter, readers will be able to

  • 1. Describe the different conceptualizations of disability.
  • 2. Define assistive technology.
  • 3. Describe the Human Activity Assistive Technology (HAAT) model.
  • 4. Define and classify a robot.
  • 5. Justify the use of robots in rehabilitation.
  • 6. Discuss the current international safety standards for robotic assistive technologies.
  • 7. List some of the challenges of the rehabilitation robotics market.
  • 8. Explain the goal of a Technology Readiness Levels scale.

Assistive Technology

The term rehabilitation in this book refers to the entire process aimed at enabling people with disabilities “to reach and maintain their optimal physical, sensory, intellectual, psychological and social functional levels” (World Health Organization [WHO] 2016a). The concept of disability has evolved through the years. It was first seen as a purely medical problem: a disease led to an impairment (abnormality of a body structure or appearance or malfunction of an organ or system), which led to a disability (limitation to functional performance and activity of the individual), which in turn led to a handicap (disadvantage experienced by the individual as a result of the individual’s disability and impairments) (WHO 1980). Focus was on the impairment that prevented an individual from performing. The social model by Oliver (1990) completely changed the perspective focusing on the barriers erected by society that hinder full participation of people with disabilities. Under this model, it is the society that disables people; disability is not something intrinsic to the individual.

In 2001, WHO adopted the International Classification of Functioning, Disability, and Health (ICF) that integrates the medical and the social models of disability into a biopsychosocial model (WHO 2001). In the ICF, disability covers impairments, activity limitations, and participation restrictions. Impairments are related to problems in the individual’s body function or structure; activity limitations refer to the difficulties encountered by an individual in executing a task or action; and participation restrictions encompass problems experienced by an individual in involvement in life situations (WHO 2001). Disability reflects the negative aspects of the interaction between the individual’s health condition and contextual (environmental and personal) factors. Equally relevant in ICF is the concept of functionality covering body functions, body structures, activities, and participation and denoting the positive or neutral aspects of the interaction between the individual’s health condition and that individual’s contextual factors (WHO 2001). Figure 1.1 illustrates

Interactions between the components of ICF. (From World Health Organization. International Classification of Functioning, Disability and Health (ICF). Geneva

Figure 1.1 Interactions between the components of ICF. (From World Health Organization. International Classification of Functioning, Disability and Health (ICF). Geneva: WHO, 2001.) the ICF conceptualization of disability as multidimensional and interactive, resulting from the dynamic interaction between body functions and structures, activities, and participation, influenced by the individual’s health condition and environmental and personal factors. Despite this paradigm shift, the medical perspective is still omnipresent in statements like “he can’t read the newspaper because he’s blind.”

A major goal in rehabilitation is allowing independence and selfdetermination for people with disabilities. To bridge the gap between the capabilities of an individual with disabilities and the requirements of an activity the person wants to perform, one or a combination of the following four strategies can be used (EUSTAT 1999): (1) receive training to improve the individual’s capabilities; (2) change the environment to reduce the requirements of the activity; (3) use adequate assistive technology to perform the activity; or (4) have a personal helper do or help with the activity.

Assistive Technology means technology designed to be utilized in an assistive technology device or assistive technology service. Note that the term technology is used here as “the practical application of knowledge especially in a particular area” (“technology,” Merriam-Webster OnLine) and not as a machine or piece of equipment that is created by technology. The latter is designated here by the term technology device. According to the U.S. Assistive Technology Act of 2004, as amended (Public Law 108364 2004, 118 STAT. 1709-1710):

The term “assistive technology device” means 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.

The term “assistive technology service” means any service that directly assists an individual with a disability in the selection, acquisition, or use of an assistive technology device. Such term includes

  • (A) The evaluation of the assistive technology needs of an individual with a disability, including a functional evaluation of the impact of the provision of appropriate assistive technology and appropriate services to the individual in the customary environment of the individual;
  • (B) Services consisting of purchasing, leasing, or otherwise providing for the acquisition of assistive technology devices by individuals with disabilities;
  • (C) Services consisting of selecting, designing, fitting, customizing, adapting, applying, maintaining, repairing, or replacing assistive technology devices;
  • (D) Coordination and use of necessary therapies, interventions, or services with assistive technology devices, such as therapies, interventions, or services associated with education and rehabilitation plans and programs;
  • (E) Training or technical assistance for an individual with disabilities, or, where appropriate, the family members, guardians, advocates, or authorized representatives of such an individual; and
  • (F) Training or technical assistance for professionals (including individuals providing education and rehabilitation services), employers, or other individuals who provide services to, employ, or are otherwise substantially involved in the major life functions of individuals with disabilities.

In other words, assistive technology refers to technology that helps an individual carry out a functional activity, taking part in the person’s daily life. Technology used in rehabilitative or educational processes, respectively termed rehabilitative or educational technology, is outside the scope of this book.

Several models have been proposed conceptualizing assistive technology. Examples include the HEART (Horizontal European Activities in Rehabilitation Technology) model (Azevedo et al. 1994); the HAAT model (Cook and Polgar 2015); the Enders (1999) model; and the dynamic circles of human activities model by Azevedo (2006). Common to all models is the focus on the activity that the individual with disabilities wants to perform, including the assistive technology necessary to perform the activity and the context in which the activity takes place.

For a comprehensive discussion of the HAAT model, please refer to the work of Cook and Polgar (2015). A short description is provided here. The HAAT model has four components: the human, the activity, the assistive technology, and the context that frames the first three factors. It models an assistive technology system representing a person with a disability doing an activity using an assistive technology within a context.

The activity defines the overall goal of the assistive technology system. Activities can be categorized into activities of daily living (e.g., dressing, hygiene, eating, communication); work and productive activities (including home management, educational, vocational, and care-of-others activities); and leisure activities (Canadian Association of Occupational Therapists 2002). The same activity for different persons or in different contexts can be placed in a different category. For example, one person may cook for work while another cooks to relax. Or, the same person may drive a car differently in the role of a professional driver compared to when travelling with the family. The selection of an assistive technology depends on a deep understanding of the activity. Important questions to be addressed include the following: Which skills and abilities does it require from the person? What is the meaning of the activity to the person? In which contexts is the activity performed?

The human component of the HAAT model refers to the person with disabilities with his or her physical and cognitive abilities and emotional states. The human should be the central component in the assistive technology system. It is the person with disabilities who selects the activities he or she would like to perform and within which contexts. It is the gap between the capabilities of the person with disabilities and the requirements of the activity, along with the preferences of the person, that dictates the choice of an assistive technology. The subjective assessment of the person with disabilities plays a leading role when evaluating the effectiveness of an assistive technology system. Even more, persons with disabilities should be involved in the research and development of assistive technologies and not viewed solely as the recipients of the technologies.

The context in which activities are performed includes physical, social, cultural, and institutional facets. Contexts may enable or hinder the use of assistive technology. The physical characteristics of the natural or built environment in which a given activity will be performed have a direct influence on the assistive technology that can be used. For example, they determine the maximum width that a wheelchair can have to be able to cross doorways, or they determine the reflective properties of a display that is supposed to be used under natural light. But, social (referring to those persons who interact with the assistive technology user), cultural, and institutional environments are also of paramount importance when considering assistive technology. Persons with disabilities often report that attitudes of others are frequently more disabling than physical barriers. The use of assistive technology can accentuate disability and contribute to stigmatization (see Chapter 10). Success of assistive technology use depends also on how knowledgeable of assistive technology the persons interacting with the individuals with disabilities are. Examples of cultural factors that affect assistive technology delivery are the degree of importance attributed to physical appearance and to independence, typical coping strategies, and typical roles of a person in society. Finally, funding policies and regulations, accessibility legislation, and standards for product design are examples of factors in the institutional context that affect assistive technology.

The assistive technology component in the HAAT model is what enables the human to perform the activity within a given context. Assistive technology devices can be conceptually divided into functional blocks that represent the information flow and the interaction between the device and the other components of the model (Figure 1.2).

Block diagram of an assistive technology device. (Adapted from Cook, A M, and J M Polgar. Assistive Technologies

Figure 1.2 Block diagram of an assistive technology device. (Adapted from Cook, A M, and J M Polgar. Assistive Technologies: Principles and Practice. 4th ed. St. Louis, MO: Elsevier, 2015.)

The human-technology interface encompasses the interactions from the human to the technology and from the technology to the human. It thus includes positioning devices that enable a person to maintain a functional position to interact with the technology; control interfaces that allow a person to control the technology (e.g., joysticks, keyboards, switches); and displays (visual, auditory, or tactile) that relay information to the user. Chapter 2 discusses the human-technology interface in robotic assistive technologies. The environmental interface is responsible for gathering environmental information necessary for the functioning of the technology. For example, cameras can be used for a socially assistive robot (SAR) to perceive the user affect (cf. Chapter 8). The processor block receives and processes the user commands and the environmental inputs, generating the output for the activity and feedback to the user. Activity outputs depend naturally on the activity. They can be synthesized speech for a communication activity, a manipulator movement for a manipulation activity, or suggestions of words when writing with the assistance of a word predictor.

All components of the HAAT model need to be considered in assistive technology assessment and intervention. A collaboration should be established between different professionals (e.g., physical and occupational therapists, speech and language pathologists, assistive technology practitioners) and all of those who are involved with the user (e.g., family members, teachers/employers, representatives from the funding source). The role of the different professionals should be advisory to the user, such that he or she can make an informed decision regarding what assistive technology to acquire. In the end, the user choices and preferences should be followed as closely as possible. Failure to meet those preferences will likely result in technology abandonment.

The ICF and HAAT models are closely related. Body functions and structures and the person’s health condition in the ICF model are included in the human component of the HAAT model; ICF’s activities and participation correspond to the HAAT activity component; and the environmental and personal factors in the ICF model are captured in the context component of the HAAT model. The assistive technology is a separate component in the HAAT model, while in the ICF model the assistive technology is included in the environmental factors. This reflects the fact that the HAAT model is a conceptualization “of the place of assistive technology in the lives of persons with disabilities, guiding both clinical applications and research investigations” (Cook and Polgar 2015, 36), while the ICF is a general classification of health and health- related domains (WHO 2001).

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