ABSTRACT
Rory Cooper
New Technologies
Rory Cooper
Quality of Life Technology Centre
Codirector
Technology to Promote Quality of Life for People – Does It Need to be Adapted to Local Conditions?
The future of rehabilitation will be dependent strongly on understanding and documenting the confluence of two critical factors represented by the new paradigm of "functionality." That confluence is medical restoration and consumer participation. Historically medicine has "fixed" or intervened on the injury or disease plateau and the consumer simply "carried on." Now, the International Classification of Function (ICF) has elevated the therapy or technology to more strongly match the desired activity and participation of the consumer. No one knows how to quantify or qualify this new level, and so rehabilitation like all medicine is aspiring to harness their science towards this challenge.
Whether we're talking about stroke or spinal cord injury or burn or cognitive impairment, rehabilitation and habilitation need to address this new paradigm. To do so constructively the field needs evidence from scholars, practitioners and consumers. We can work together successfully to meet this challenge. The confluence of these new or realigned partnerships suggest the emergence of a possible new endeavor that we shall refer to as Quality of Life Technology (QoLT).
The concepts of Person and Society (P&S) must permeate all assistive technology research and education efforts as a cross-cutting and integrated activity, (see Figure 1). The assimilation of individual, social, policy, and privacy components of research, development, design, deployment, and education related to people with disabilities and older people is among the more unique features of the domain of assistive technology and rehabilitation engineering. Indeed, the P&S form the foundation for assistive technology innovation. The P&S must create the pressure in the pipeline for the generation of research ideas, serves as a pathway through the research and development phases, and provides the consumer pull for the deployment of products and services.
Knowledge of the P&S must be integrated into engineering teams. Just as QoLT engineering can not be done effectively in isolation from scientists connected with end-users, social scientists investigating new technological directions need to be working effectively with engineers. The goal of QoLT must be to support the concept of self-determination for older adults and people with disabilities. Success in the development of QoLT requires technical competence and imagination, but equally or even more importantly, it depends on a thorough appreciation and understanding of aging, older adults, disabilities, people with disabilities, environment, costs, regulations, policies and other limiting factors. Some otherwise remarkable engineering accomplishments have been dismal failures from lack of awareness and appreciation of limitations posed by these factors. We believe that a unique blend of complementary talent and experience that combines the best in engineering, science and technology with consummate understanding and appreciation of the relevance of social, cultural, behavioral, regulatory, economic and environmental dimensions and considerations is essential to address the burgeoning issues of aging and disability.
Independence, autonomy, and control over the environment are fundamental human motives, see Figure 2. One consequence of disability and aging is that one’s direct control over the environment is eroded, either because of acute medical events or more gradual age-related declines in physical and cognitive functioning. We further recognize that the impact of disabling conditions is shaped by their cause, timing, functional consequences, and social contexts, all of which must be considered in designing and implementing successful technology. Humans have a strong capacity to adapt psychologically to decline in functioning, but at the same time they will embrace technologies that preserve and/or enhance their abilities to maintain control over their environments.
Central to the concept of QoLT is the conduct of research in the ‘natural environment’ of our extended community. This ‘community’ of human and organizational resources must be the ‘laboratory’ for comprehensive study of aging and living with a disability and the issues associated with the development, transfer and utilization of technology. QoLT research, development, education and outreach activities must integrate expertise and experience in the areas of geriatrics, gerontology, engineering, computer science, assistive technology, rehabilitation, behavioral and social sciences, policy study, education, participatory action research and technology transfer. A new ‘paradigm’ must be established to address the physical, functional, social, behavioral, economic, regulatory, policy and, perhaps, even spiritual dimensions of aging and disability.
Acknowledgement: The concepts, presented within this paper, are the result of hours of discussion and correspondence with numerous colleagues at the University of Pittsburgh and Carnegie Mellon University. Most notably, Drs. Takeo Kanade, Clifford E. Brubaker, Howard Wactlar were instrumental in forming the notions put forth.