Assistive Technologies – Improving the Quality of Life for Millions. But, Challenges Remain.

“My advice to other disabled people would be, concentrate on things your disability doesn’t prevent you from doing well and don’t regret the things it interferes with. Don’t be disabled in spirit as well as physically.“

Steven Hawking. Theoretical physicist, cosmologist, and author.
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Assistive technology (AT) is any item, piece of equipment, software program, or product system used to increase, maintain, or improve the functional capabilities of persons with disabilities. Assistive technology helps people who have difficulty speaking, typing, writing, remembering, pointing, seeing, hearing, learning, walking, and many other things.

Assistive technology can also help those with disabilities to lead a more connected life. Globally, over 1 billion users currently need assistive technology. This figure will reach 2 billion by 2050 as the population ages, and consumer electronics and assistive products converge.

More than 40 million people in the United States have a disability, according to the U.S. Census Bureau. But even as majorities of these Americans report having certain technologies, the digital divide between those who have a disability and those who do not remain for some devices.

Image Credit: Pew Research Center Survey, 2021

Organizations like Cyber-Seniors train young people to be technology tutors for older adults. National efforts (like the OATS-AARP collaboration) will further attempt to make tech training available for older adults new to technology in 2022, hopefully reducing the digital divide further.

In the emerging assistive technology space, the most active domain is hearing, followed by mobility, vision, and communication. Assistive technology has traditionally been considered external to the human body and non-invasive. The field is now converging with medical technologies. Several emerging assistive products include implants and other products that would qualify as medical devices, with many of those moving beyond assistance towards augmentation or recovery of missing human functions.

The primary crossover disciplines in emerging assistive technologies are information technology, data science, materials science, and neuroscience. The overlaps with the consumer electronic goods market are mainly in communication, navigation, and gaming. The convergence between disciplines, domains, and markets increases the breadth of functionality of products for different user-profiles and boosts the pace of innovation in emerging assistive technology.

Segmenting the assistive technology market is a complex exercise that depends on how broadly one defines the space. I’ve found that this six-part segmentation model developed by Assistive Technology U.S. helps me frame conversations with startups looking to enter the market.

Image Credit: Assistive Technology U.S.

Using this framework, here are some of the key emerging development trends in each segment as identified by the World Intellectual Property Organization:

Mobility segment trends – Emerging products and devices introduce advanced versions of conventional assistive products, namely advanced walking aids (balancing aids and smart canes), advanced prosthetics (neuroprosthetics, smart and 3D printed prosthetics), advanced wheelchairs (including self-driving wheelchairs and wheelchair control) and exoskeletons (full-body exosuits, lower and upper body exoskeletons and control thereof).

Video Credit: Abby Marsh YouTube channel

Cognition segment trends – This is the largest area of growth within the conventional technology dataset, reflecting the recent recognition of the importance of assistive technology to support cognitive decline. This field includes memory support and medication dispensing devices, as well as timers. Researchers at Oslo Metropolitan University in Norway recently reviewed the scientific literature. They found that some standard technologies can support time orientation, memory, and safety in people with mild cognitive impairment/dementia. Technology can also help relieve a bit of the burden on caregivers. And AARP has compiled a list of promising technologies for families to consider.

Video Credit: iN2L YouTube channel

Communication segment trends – Technology companies are driving developments in software-based assistive technology in communication. Two-thirds of emerging communication patent filings relate to intelligent assistants. The 2022 versions of voice-first interfaces (like Amazon Alexa, Google Home, or Apple’s Siri) raise the bar on in-home tech experiences for the growing numbers of owners, now 48% of all households with Internet access. Areas of recent development with great potential are brain-computer interface-based control of devices and sensory substitution technology.

Video Credit: Blythedale Childrens Hospital YouTube channel

Hearing segment trends – Emerging assistive products include environment-controlling and mind-controlled hearing aids, with cochlear implants accounting for nearly half of the emerging filings. The hearing technology market is being disrupted by Blue-tooth connected hearables. Led by Apple, these dangling devices have legitimized a form factor of a visible device in the ear. The only requirement? A smartphone app for adjustment. 2021 saw more innovation in hearing aids that are higher function, lower cost, or more available through direct-to-consumer channels, self-configurable by the user. Most are still not reimbursed by insurance, and for those with mild-to-moderate hearing loss, hearables will suffice – and potentially attract those who don’t wear any hearing aid because of fear of stigma. With the introduction of Over-the-Counter Hearing aid sales (and recommended guidelines), coupled with the beginnings of insurance reimbursement, those with mild-to-moderate hearing loss are likely to benefit from many of these changes.

Video Credit: Southside Housing and Supportive Services YouTube channel

Self-care segment trends – Conventional assistive products in self-care include adaptive clothing, incontinence products, and adaptive eating devices. These same technologies form the basis for advanced products, such as smart diapers and feeding assistant robots. Wearable and non-wearable health- and emotion-monitoring devices (smart bands, clothing, insoles, smart mirrors, and carpets) account for over half of emerging self-care patent filings, reflecting an overall trend in digital health and wearables. These products support independent living, active aging, and telemedicine or smart nursing. Small and fast-growing areas are smart medication dispensing and management and smart diapers.

Vision segment trends – While most patent filings in conventional vision are related to glasses and tactile devices, such as tactile screens, small portfolios are growing fast, such as screen readers or phones with Braille. In the emerging vision assistive technology space, most filings relate to intraocular lenses (IOL) with several sensors and functionalities, including artificial silicon retina (ASR), smart eyewear, and augmented reality (AR) devices.

Video Credit: KSAT, San Antonio, Texas

Commercialization challenges – In some of the advisory work I do with startups looking to develop products and services for assistive technologies, the most challenging conversations we have usually revolve around the fact that they underestimate the commercialization timeline – often by a lot. Several factors may influence commercialization. Regulation and standards assure quality and safety but can present delays in or obstacles to commercialization, particularly when devices are classified as medical devices. And in my experience, most companies don’t understand the FDA submission process and how long that might take. These factors are particularly challenging for smaller companies and individual inventors, featuring prominently across several assistive technology areas. So a lot of the guidance is connecting them with an ecosystem of developers, academia, investors, and venture capitalists, to help them accelerate the commercialization process.

Another challenge to the widespread commercialization and adoption of assistive technologies is payment (no surprise here). Payment is spotty at best, and for specific technologies, non-existent. As of this writing, the payment landscape can be summarized as follows:

  • School systems pay for general, special education learning materials as well as technology specified in an IEP (Individualized Education Plan).
  • Government programs (Social Security, veteran’s benefits, or state Medicaid agencies) pay for specific assistive technology if a doctor prescribes it as a necessary medical device.
  • Private health insurance pays for specific assistive technology if a doctor prescribes it as a necessary medical or rehabilitative device.
  • Rehabilitation and job training programs, whether funded by government or private agencies, may pay for assistive technology and training to help people get jobs
  • Employers may pay for assistive technology that is a reasonable accommodation to enable an employee to perform essential job tasks.

The Assistive Technology Industry Association’s Funding Resources Guide, while somewhat dated, provides sources and resources to investigate as prospective options.

The future of assistive technologies is undoubtedly one of continued growth, relying on the convergence of multiple exponential technologies like AI, machine learning, affective computing, and brain-computer interfaces. The big challenge will involve Intellectual Property and licensing laws. AI, in particular, solicits debate over patentability requirements and inventorship, and, as other enabling technologies, such as brain-computer interface, develop further, similar or new IP-related questions may emerge. The unprecedented collection and use of data and the related insights it provides are essential to enabling technology. Still, they are not without challenges: data and privacy issues are more accentuated in assistive technology, given the more vulnerable groups involved.

Finally, we must address the issue of accessibility for all. The recognition of access to assistive technology as a human right, contributing to social and economic development objectives for persons with disabilities, should be an impetus for all policymakers in supporting the availability of assistive technology, while market-shaping approaches by different multi-stakeholder initiatives like non-profits and NGOs, and other partnerships could also contribute to increased availability. The demand is there. Now it’s up to us to make this a reality.

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