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We are all familiar with the stories of the amazing things that assistive technology (AT) enables people with disabilities to do. What is usually not discussed is that AT usage in the real world, particularly in LMICs, spans a continuum from appropriate to highly inappropriate for the person and their environment.
It is nice to imagine that when a person with a disability is provided with an assistive mobility device such as a wheelchair or prosthesis, there are only benefits. But the fact is that these devices are not created equal. Some of them are so inappropriate for the person that they lead to diminishment of their natural development and residual abilities. In other words, the use of inappropriate assistive technology causes bodily disfunction just like a disease.
When it comes to wheelchairs, it is commonly said “Isn’t any wheelchair better than no wheelchair at all?” Here is another way to look at it. Is bad healthcare better than very bad healthcare? Not having a wheelchair when you need one for mobility is an extreme form of inappropriate assistive technology. Providing someone a wheelchair which causes bodily disfunction is also a form of inappropriate assistive technology. Both are undesirable situations. But in the former situation, the problem is obvious to all (no wheelchair), in the latter situation, the problem is less visible. It may take time to develop (just like a slow moving disease). The problem might not be recognized until the disease has progressed beyond hope of a reversal (if it is recognized at all).
For example, if you put a child or teenager in an oversized hospital wheelchair which they can barely self-propel, the physiological function of their nondisabled body systems will not develop properly and will likely diminish over time. Whereas, as if they were able to use an appropriate wheelchair, the nondisabled parts of their body would develop properly. The cause of their lack of development (disease) is the long term use of the inappropriate wheelchair.
As analogy, what happens when a healthy baby is left in an unstimulating environment for too long? It is well established that their development is hindered. Their body doesn’t function as it should. In this case, the disease is caused by neglect. When someone with a disability is forced to use inappropriate AT, such as hospital style wheelchair long term, they typically don’t become stronger, they become weaker. Just like the neglected baby, they are unable to participate in activities and be as mobile as they could be. Many of their bodily functions decline due to lack of engagement in heathy mental and physical activities.
Society generally thinks this decline and low function is an inherent aspect of having a disability, when in many cases, the decline is a direct result of IATD. The lack of recognition of IATD results in no effort to stop the disease from progressing. You can’t cure a disease that you don’t know is happening. Society, particularly those in LMICs, has deemed the hospital style wheelchair to be an acceptable wheelchair for many people with permanent mobility disabilities like spinal cord injuries. The poor functionality of this wheelchair is rarely questioned.
There is no great conspiracy to keep people with disabilities in hospital style wheelchairs. It comes down to simple economics. The hospital style wheelchair has been designed to be manufactured as cheap as possible. Hence, it is available worldwide. While its relative price may be expensive in low resource countries, it is the cheapest wheelchair known to mankind. Since the general expectation is that the person with a disability will not be a productive member of society anyway, what difference does a wheelchair make? Why not spend as little on the wheelchair as possible? This mentality of low expectations is also common in high income countries. It explains why the most popular wheelchair sold on Amazon.com (selling thousands per month) is also the cheapest one that they sell.
Reversing IATD begins with developing awareness of the existence of the problem. Next, individual AT users need to be assessed to determine the appropriateness of the AT they are currently using. If the AT is found to be inappropriate, steps need to be taken to replace or modify it whenever possible. Finally, physical/movement therapy and training will likely be required to mitigate or reverse the deterioration.
On a societal level, it is far easier and cheaper to develop and provide appropriate AT at the outset than to deal with systemic IATD.
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