Vol. 1 
Issue 2 
Community 
Living Briefs 
A publication of the 
Community Living 
Technical Assistance 
Exchange at ILRU 
“Community Living 
Briefs” is a resource for 
Systems Change grantees 
and their stakeholders, 
which provides practical 
tools and strategies to 
facilitate the full 
integration of people 
with disabilities into the 
mainstream community. 
Achieving Independence and 
Interdependence Through 
Assistive Technology 
Applications 
by Therese Willkomm, Ph.D. 
Assistive technology often makes a critical difference 
in the lives of individuals with disabilities 
and chronic illnesses, yet it remains underutilized 
and poorly understood. This paper discusses 
the concept of assistive technology and 
offers suggestions for finding resources to assist 
individuals to make better use of assistive technology 
to achieve independence. 
Introduction 
One critical element of successful community 
living for many individuals with disabilities and 
chronic illnesses is 
assistive technology. 
Yet the application of 
assistive technology 
to promote independence 
and interdependence 
continues 
to be largely unrealized. This paper provides a 
broad overview of assistive technology, 
describes challenging issues that require further 
attention and suggests resources for finding 
good assistive technology solutions. 
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.1 Assistive technology can be 
low-tech or high-tech and, in a real sense, 
simply means the use of any item to meet the 
needs of individuals. Assistive technology is 
often confused with durable medical equipment. 
Durable medical equipment includes such items 
as prosthetics, orthotics, wheelchairs, communication 
devices and other devices that are deemed 
medically necessary. While assistive technology 
includes durable medical equipment it covers a 
far broader array of devices and equipment. The 
distinction between durable medical equipment 
and assistive technology devices is important 
because insurance carriers, including Medicare 
and Medicaid, typically cover only medically 
necessary services. The majority of assistive 
technology solutions needed by individuals to 
achieve their greatest level of independence at 
home, school, work, and play are not considered 
medically necessary. This means that 
alternative funding strategies often come into 
play. Individuals, families, communities and 
policy makers continue to be innovative in 
developing alternative funding sources for 
assistive technology that is not covered by 
health related insurances. 
Overview of Assistive 
Technology Solutions 
Promoting Independence 
Assistive technology solutions can benefit 
individuals with physical, sensory, or cognitive 
impairments. These solutions include mobility 
aids, grasping aids, back saving solutions, 
devices for blindness and low vision, assistive 
listening devices, electronic aids for daily living, 
alternative and augmentative 
communication 
devices, and memory 
and/or organizational aids. 
In addition to devices, modifications 
to transportation 
equipment, telecommunication equipment, computers 
and home, work, school, and community
1
environments also fall into the purview of assistive technolo- persons who are at risk of acquiring secondary injuries, illgy. 
While the majority of assistive technology solutions are nesses and other conditions. Many of these injuries are precommercially 
available, individuals with a disability frequent- ventable and assistive technology can play an important role 
ly require custom modifications of the design and fabrication in that prevention. Slips and falls are the most common events 
of a new solution to meet individual needs. We might design a that result in these secondary injuries. In addition, slips and custom wheelchair seating system to prevent a pressure ulcer 
falls are the number one cause of emergency room visits for or create a device to make fence repairs for someone with an 
arm amputation. Other examples of how assistive technology individuals with disabilities, mostly elder persons. The applisolutions 
can have a positive impact on everyday life include: cation of assistive technology in injury prevention continues to 
Wheelchair Seating and Mobility: Approximately 6.8 million 
individuals who live in the community in the United 
States use some form of a mobility aid including manual 
wheelchairs, power wheelchairs, power scooters, walkers or 
canes.2 Funding for these aids typically comes from health 
insurance; however, President Bush recently 
assigned a task force to explore funding for 
mobility aids needed to pursue education and 
employment. Such aids, once in the hands of 
an individual, will also provide supports for 
other activities in the community. If a wheelchair 
is needed, then an assortment of other 
assistive technology solutions may be necessary 
to accommodate the full range of the needs of the wheelchair 
user. A proper seating system is often required to prevent 
a potential pressure ulcer. Transporting the wheelchair may 
require the use of a van with a wheelchair lift, tie-down system, 
and other modifications that will enable an individual to 
operate the van independently. If an individual is using a manual 
wheelchair she may need to replace her current automobile 
to allow for easier transport of the wheelchair. 
Additional transfer aids or lifting devices such as a transfer 
board, a transfer bench, a shower chair, or an overhead lift will 
assist with transferring the wheelchair into the car, a bed, or 
bathtub. Home modifications, in addition to the assistive technology 
adaptations, are often required to accommodate a 
wheelchair in the home. These may include ramps, wider 
doors, wider turning areas, handrails, stair-lifts, porch-lifts, 
and roll-in showers. Funding for home modifications can 
include assistance through independent living centers, reverse 
mortgages for elderly persons, Medicaid home and community-
based waivers that include funding for home modifications, 
some catastrophic injury insurance policies that cover home 
modifications, and community fund-raising events. Families 
can also choose to fund home modifications themselves. 
Prevention or Reduction of Secondary Injuries: One 
important reason to employ assistive technology solutions is 
the prevention of injury. This is particularly true among elder 
2 
be problematic from an insurance perspective since an individual 
must convince an insurance company that an injury is 
imminent unless recommended assistive technology solutions 
are put into place. Insurers deny coverage on the grounds that 
such interventions are not medically necessary. 
The aging process has an impact on slips and falls. While we 
all may slip on the ice or loose surfaces, our ability to recover 
from a slip diminishes as we age. As a result, falls are more 
likely and recovery is slower. Assistive technology solutions to 
reduce these types of slips include the use of traction tape on 
steps, ramps, and porches; ice grippers that can easily slide 
over one’s shoes; ice gripper cane tips; broad based tips; 
indoor and outdoor rug-gripper tapes to prevent rugs or mats 
from slipping; and footwear that promotes anti-slippage. Since 
slips will occur, railings can be used to help prevent a fall. 
Walkers and broad based canes with different shaped handles 
can improve stability. These preventative measures are well 
established and provide relatively low-tech solutions to the 
prevention of injuries that may be debilitating to the individual 
and very costly to treat. 
Slips and falls for users of wheelchairs often occur during 
transfers. To reduce transfer injuries when moving to or from 
a wheelchair several strategies are useful including reducing 
transfer distances, making level transfers, and using transfer 
aids. Individuals that are providing personal assistance can be 
at risk of back injuries when assisting during transfers. In 
addition to good training there are devices that can facilitate 
the transfer and prevent injury as well; portable transfer lifts, 
overhead lifts, transfer boards, and proper transfer techniques 
are useful in this regard. 
Some non-ambulatory individuals require transfers and repositioning 
to prevent pressure ulcers. Pressure ulcers can be life 
threatening and can cost thousands of dollars to treat. These 
injuries can be prevented by using appropriate assistive 
technology solutions such as appropriate wheelchair cushions, 
customized wheelchair positioning solutions, specialized 
mattresses, and prompting devices to remind individuals and 
personal assistants of the need for repositioning to relieve localized pressure. Cuts, scrapes and burns can be reduced 
with the use of padding, shielding, guards, warning 
detectors, temperature sensors and controls, and appliances 
with automatic shut-offs. Most of these solutions involve 
low-tech, low-cost interventions. 
Assistive Technology and Memory: The ability to remember 
important events, tasks to be completed, and medications to 
take can be difficult for all individuals but particularly for 
those who have memory impairment. There are hundreds of 
electronic memory and prompting aids that are quite effective 
in compensating for memory loss. An electronic pill dispenser, 
voice organizer, alarm, and personal digital assistant are just a 
few of the devices available. The Brain Injury Association 
website at http://www.biausa.org lists assistive technologies 
that can benefit individuals with 
memory impairments. These devices 
are also quite useful for personal 
assistants and family members in 
prompting when to take medications 
and perform other tasks. The assistive 
technologies that the Brain Injury 
Association has espoused work 
equally well for individuals with similar functional impairments 
not attributable to a brain injury. 
Assistive Technology and Mental Illness: Thousands of 
assistive technology solutions exist for individuals with physical, 
sensory, cognitive, or communication impairments. In 
many cases these solutions are useful to individuals with mental 
illness as well. Other approaches may also prove useful. 
Electronic memory/prompting aids are helpful for some individuals 
by improving the ability to stay on task. Changes in 
light, color, and sound in the individual’s environment often 
prove helpful in furthering recovery for a person who experiences 
a mental illness. Other effective strategies include 
removing clutter, utilizing organizational aids and repositioning 
objects in the environment. 
Electronic Aids for Daily Living: Increasing independence 
at home requires the ability to operate a variety of electronic 
appliances. These appliances include radios, television sets, 
thermostats, fans, washers, dryers, air conditioners, lights, 
security systems/door buzzers, automatic door openers, CD 
players, VCRs, dishwashers, garbage disposals, food processors, 
microwave ovens, DVD players and computers. Many of 
these items have remote control units that come with the 
appliance. In addition, several appliances have a series of 
buttons that need to be pushed. Existing controls can be 
difficult to operate due to physical or cognitive limitations. 
Electronic aids for daily living can be obtained to compensate 
for these limitations. Personal digital assistants are now 
available to replace several controls. However the cognitive 
demands of existing personal digital assistants is a barrier to 
their use for some individuals. 
In many respects this is not a disability issue at all but 
rather a fact of life for everyone in the current age of proliferating 
devices. The long-term goal of providing real time access to 
services and supports is likely to require that we train everyone 
in our society to be literate with digital devices and computers 
so each individual can access information on the interactive 
websites being developed in each of the states and territories. 
Assistive Technology and Communication: The ability to 
call for help, ask for something, or tell the doctor where it 
hurts can be made simpler by using assistive technology interventions. 
Augmentative and alternative communication technologies 
can be used to communicate a single message or an 
infinite number of messages. Telecommunication is critical for 
individuals with disabilities. TTYs, TDDs, relay services, and 
emergency call systems have been in 
use for years. The use of video phones, 
and Internet computer-based systems for 
individuals with disabilities is less widespread 
because the technology is newer 
and still being perfected. Limited bandwidth 
that impacts the speed of transmission of communications 
is a barrier; new high speed and affordable transmission 
lines are eliminating this barrier to full and timely access. 
Assistive Technology At Home, School, Work, and Play: 
Assistive technology can help individuals to perform essential 
tasks of daily life and all life functions. Thousands of solutions 
exist that are being marketed as assistive technology as 
well as labor saving devices. Tech Connections 
http://www.techconnections.org, Job Accommodation 
Network http://janweb.icdi.wvu.edu, and AgrAbility 
http://www.agrabilityproject.org are just a few organizations 
that track this equipment. Equipment can also be searched 
over the Internet using functional limitation keyword searches 
and activity searches. Databases and search engines can be 
used to locate commercially available products and new strategies 
of adaptations to the environment. 
Selecting the best assistive technology solution to meet a 
particular need involves a decision making tree. First, can the 
task be performed safely and effectively without the purchase
3
of a commercially available device? Often individuals have 
resources and equipment in their homes, attics, and garages 
that can be used to overcome a particular challenge. Perhaps 
a task can be eliminated all together or maybe it’s more cost 
effective and time-efficient to have someone else 
perform it. 
Frequently commercially available solutions need further 
modifications to work for an individual’s specific needs. The 
person, family member, or professional who specializes in 
design and fabrication of assistive technology solutions can 
often make needed modifications. Individuals with disabilities 
frequently require one-of-a-kind solutions to perform a 
specific task. Since these solutions are not commercially 
available, a solution must be designed and fabricated from 
scratch. Due to the unique characteristics of a particular 
solution, the chance of the solution failing can be high but 
once a workable solution is found the reward to the individual 
is higher still. 
Assistive Technology and Community Participation: The 
application of assistive technology must go beyond the need 
to be productive at home or in a workplace. Assistive technology 
should support individuals to participate fully as 
members of their communities. Communities, for their part, 
must make places and activities fully accessible. While communities 
support this concept, lack of economic resources is 
frequently cited as the primary reason why this has not yet 
been accomplished. In reality, the primary barriers are lack 
of knowledge, lack of awareness, and failure to plan. Model 
communities are attacking and removing these barriers with 
great success. They recognize that disability is a natural life 
experience that everyone will someday experience and they 
consciously strive for the inclusion of all their citizens. 
The examples provided give just a snapshot of how assistive 
There are a variety of consultants who are also available to technology can promote independence. The actual assistive 
help individuals and providers select the most appropriate technology product, device or modification is only one part 
solution when a commercial option is desired. Technology of a good assistive technology solution. Other factors impact 
loan centers enable consumers to try out devices before they whether a successful outcome occurs. 
are purchased. These trial 
centers help to reduce tech- Awareness and Knowledge: Our attitudes and perceptions 
nology abandonment. In are based upon our prior experiences and knowledge. When 
approximately one-third of our knowledge and awareness are restricted, they can serve 
purchased assistive technol- as a barrier to seeing new possibilities. We overcome these 
ogy solutions the individual attitudinal barriers with new learning. Our awareness and 
does not like the device and does not use it. Unless the knowledge about assistive technology can be broadened 
individual donates this abandoned equipment so that some- through training and awareness events, assistive technology 
one else can use it, the expenditure is a total waste of dollars. expos, assistive technology exploration centers, and what we 
Challenges to Assistive 
Technology Access 
see in the media. 
Fear of Complexity: To many, the word “technology” 
equates to the use of a computer or something that is electronic. 
High-tech devices may intimidate individuals who 
have not had experience with them. Yet most assistive technology 
is very low-tech and costs less than $100. To the 
average person much of assistive technology would be better 
described as “gadgets that are useful.” Choice of words when 
discussing assistive technology with the general public can 
make a large difference in understanding and acceptance. 
Frequently the solutions involve looking creatively at existing 
tools and equipment found in our everyday environment 
and exploring how these resources can be used for an assistive 
technology solution. Local hardware stores have hundreds 
of assistive technology solutions just waiting for creative 
people to identify them. 
Funding Limitations: Funding mechanisms for assistive 
technology often pose issues for individuals. Where a 
payer exists for these devices and 
adaptations, each has its 
own limitations on what type of 
disability or functional limitation, age, 
type of technology and funding cap will be employed. 
Even when funding is available there is frequently a significant 
delay before the individual actually acquires the 
assistive device. 
Timeliness of Assistive Technology Solutions: The reality is 
that both assistive technology solutions and durable medical 
Interested communities can contact Independent Living 
Centers and their governor’s office on disabilities for 
4 
information on community accessibility; these resources 
frequently make accessibility audits available to communities.
equipment can take a long time to acquire. All too often the 
process is one of “hurry up and wait.” While thousands of 
assistive technology solutions are available, there is often 
extensive time involved in identifying the best solution, 
securing funding, ordering an item, delivering the item, and 
correcting the fit of the selected assistive technology solution. 
It is not uncommon for this process to take six months 
to a year because of the steps needed to complete the 
acquisition process. 
Training: Training in how to effectively use a device is critical. 
Thousands of dollars are spent on assistive technology 
that is not used due to insufficient training. We think nothing 
of extending a typing course over a whole semester yet we 
often give complex devices to 
individuals and expect them to 
master them instantly. Learning 
how to use assistive technology or 
computer software takes an investment 
of time in learning as well as time in teaching. Without 
this investment an assistive technology solution fails to 
achieve its potential and may actually be abandoned. 
Serviceability and Equipment Maintenance: Assistive 
technology devices do break and it is not a question of if, but 
rather a question of when. Frequently assistive technology 
devices do not come with extended warranties or maintenance 
agreements. Products that do have maintenance agreements 
or dealerships available require the individual user to 
travel, often-great distances, to get a product repaired. 
Technology Abandonment: Many assistive technology 
devices end up abandoned to the clutter in the closet. Factors 
affecting whether or not assistive technology is abandoned 
include product serviceability, learnability, reparability, reliability, 
usability, aesthetics, and cost. Assistive technology can 
also be abandoned if the person’s condition improves or 
worsens such that the device is no longer appropriate. 
Changes in the overall home or work environment or 
changes in personal assistants will also affect technology 
abandonment. If assistive technology takes too much time, or 
is too physically or cognitively demanding, the individual 
may find it easier to have an assistant perform the task then 
to do it himself. Selecting the most appropriate assistive 
technology solution often involves trade-offs or sacrifices. 
Frequently the solution may not be all that the consumer 
hoped. It is worthwhile to assess the factors that impact 
abandonment before selecting the most appropriate solution. 
This preventive approach conserves scarce resources while 
maximizing the likelihood that the individual gets a product 
that will actually serve to improve her quality of life.3 
Innovative Approaches to 
Overcoming Challenges 
Many of the challenges in the assistive technology marketplace 
are met successfully through innovation and the 
adoption of new approaches. Some of these solutions are 
described below. 
No Cost/Low Cost Assistive Technology Solutions: When 
funding is tight, we must be creative in using existing 
resources in new ways. Our homes and communities are a 
gold mine for such solutions. Plastics, foams, adhesives, foils, 
fasteners, tapes, magnets, art supplies, and a variety of “dumpster 
digs” are just a few of the treasures that can be used to 
create solutions. Throw-away packaging such as AOL® boxes, 
Snapple® lids, and plastics can be used as switch effectors 
because of the spring load nature of these materials. A switch 
can be used to operate a call system, turn on a fan, call 911, or 
communicate a message to someone. Plastic trash bags can be 
used as a back saving solution when transferring someone in 
and out of bed. Big wheels and small wheels found at the local 
dump can be used for moving heavy objects. Assistive 
Technology Refurbishing Centers can be a great source for 
low cost or no cost assistive technology products such as 
wheelchairs, mobile carts, ramps, bathroom equipment, and 
grab bars. Duct tape and bailing wire are quick fasteners for 
almost anything that needs to be quickly attached or adapted. 
Local Businesses as Suppliers of Assistive Technology 
Solutions: As assistive technology becomes more mainstreamed, 
access to such solutions that otherwise would take 
months to obtain, can be purchased immediately at local 
businesses. Wal-Mart, K-Mart, Target, Home Depot, Ace 
Hardware, True Value Hardware, and Lowe’s Home 
Improvement are just a few of the many retail businesses that 
are now carrying an assortment of assistive technology products 
for their customers. Local bicycle shops can become 
places for maintenance and repair of manual wheelchairs. 
When local businesses carry specific products or provide 
needed assistive technology solutions, wait time and distances 
that individuals must travel are reduced. And the ability to 
contribute to the local economy fosters further community 
inclusion for individuals. 
Decreasing Wait Time: Service providers need to become 
more efficient in assistive technology service delivery. This is 
especially true for providers in rural areas. The traditional 
5
assistive technology service delivery model involves someone 
doing intake or assistive technology screening, a site visit to 
perform an assistive technology evaluation, researching the 
most appropriate solutions, securing funding for the solution, 
ordering the solution, and fitting the solution to the individual 
once the item is obtained. This process can be very time 
consuming and paper intensive. Extensive paperwork and 
reports are developed and submitted to family members, 
service providers, and funding sources, yet the customer 
needs solutions and outcomes immediately. Individuals are 
unable to wait. Innovative solutions shave off months, 
weeks, days, and hours from the traditional process. It is possible 
in one home visit to conduct a quick mismatch analysis 
related to assessment. This analysis can lead to immediate 
assistive technology solution research via 
computerized/Internet databases that can be searched at the 
individual’s home. Service providers can carry an assortment 
of the most frequently requested assistive technology items 
associated with specific functional limitations. Solution kits 
related to one-handed use, arthritis, back saving solutions, 
solutions for preventing slips and falls, electronic memory 
aids, electronic aids for daily living, are just a few of the kits 
that can be transported in the car. These solutions can be 
tried at the individual’s home or place of business. An assortment 
of fabrication tools and materials can be transported in 
modular break down units that fit in the car’s trunk. This 
enables quick and easy repairs, rapid prototyping, and fabrication 
of solutions. Preliminary screenings over the phone 
will help service providers in packing what will be the most 
useful resources to take with them on the road. Service 
providers can also use an assortment of time saving solutions 
to reduce paperwork. 
Assistive Technology Transition Needs: When an individual 
leaves a hospital or nursing facility to return home or 
when she is at home and a critical 
piece of equipment requires repair, 
an immediate solution is needed. 
Loan pools of equipment must be 
available while the consumer’s 
equipment is on order or equipment 
needs are still being evaluated. 
These loan programs must have the flexibility to be long 
term if needed. Assistive technology device trials may take 
longer than a standard 30-day loan. 
Assistive Technology Loans and Trials: Many states have 
a variety of assistive technology loan programs. Financial 
loans are often available through a revolving loan fund or a 
guaranteed loan fund that have been set up by state Tech Act 
6 
projects http://www.resna.org. In addition to financial loans, 
there are assistive technology loan libraries, loan closets, 
and exploration centers that enable individuals to try out an 
assortment of devices before an item is purchased. Many of 
these programs are funded through local or state resources. 
Refurbishing Centers: Many states have refurbished 
equipment programs in which used assistive technologies are 
donated, refurbished, and redistributed to individuals that are 
unable to afford new equipment. These centers can also use 
this equipment for evaluations and short-term loans. 
Medicaid, Medicare, and private insurance policies and rates 
for durable medical equipment and assistive technology can 
result in restricted access to state of the art equipment or 
back-up equipment. Many individuals’ insurances have a 
$3,500 cap on durable medical equipment or limitations on 
how many mobility aids a person can have. If an individual 
needs both a power wheelchair and a manual wheelchair 
health insurance will only pay for one wheelchair. 
Refurbishing centers can help to supplement this limited 
coverage by making equipment available to individuals at 
significant savings. 
Service, Maintenance, Training, and Support Plans Must 
Be in Place: These plans should involve family members, 
co-workers, personal assistants, other providers, and 
paraprofessionals located at the community 
level. Local resources require 
the skills and knowledge to support 
the assistive technology user. 
Assistive technology training must be 
incorporated into pre-service curricula. 
Community colleges offer an excellent local opportunity to 
provide education and training in assistive technology. 
The Future of Assistive Technology 
and Service Delivery Practices 
According to the World Health Organization,4 the number of 
individuals with disabilities will continue to rise; however, 
the available funding to meet the needs of this rising number 
of individuals will become stagnant. We will need to use 
these scarce resources efficiently to leverage what resources 
we have for the greatest benefit possible. The U.S. 
Department of Agriculture is currently supporting 
tele-rehabilitation for rural areas. As bandwidth and transmission 
speeds increase, service providers will be able to 
conduct assistive technology screenings, consultations, and 
follow-ups on-line. However, one-on-one assistive technology 
evaluations and fittings will continue to be necessary. New
products that are being developed will incorporate 
universal design principals. These products will benefit an 
increasingly aging population as well as individuals with and 
without disabilities. Paraprofessionals and family members 
will substitute for some assistive technology services that were 
previously provided by highly trained professionals like rehabilitation 
engineers, occupational therapists, speech and 
language pathologists, and physical therapists. Innovation 
will continue. 
Summary 
Assistive technology can play a critical role in injury prevention 
and in the creation of environmental adaptations that promote 
full participation of individuals in their communities. 
Since we all want easy and convenient access to tools that 
make everyday living easier, assistive technology works for 
everyone, not just for individuals with disabilities. While there 
are challenges before us to find new innovations and sources 
of funding, assistive technology will continue to be an 
1Public Law 100-407, The Technology-Related Assistance to Individuals with Disabilities Act of 1988. 
2H. Stephen Kaye, Ph.D. et al, "Mobility Device Use in the United States," Disability Statistics Center, Institute for Health and 
Aging, University of California, San Francisco, June 2000. 
3Osobel Ebner, OTR, Michigan's Assistive Technology Resource, "Abandonment of Assistive Technology," Paper presented at the 
1999 CSUN Conference ("…the rate of technology abandonment is as high as 75% to 80%.") 
4Unidentified speaker from WHO, Statement made at the UN Conference on Rehabilitation Engineering, Prague Czech 
Republic, 1991. 
important support for individuals as we find new ways to meet 
individual challenges one solution at a time. 
About the Author 
Dr. Therese Willkomm is Executive Director of ATECH (An 
Alliance for Assistive Technology, Education, and Community 
Health Services) in New Hampshire, an Assistant Professor in 
the Occupational Therapy Department at the University of 
New Hampshire; and Co-Director of the New Hampshire 
Technology Partnership project. She holds a Ph.D. in 
Rehabilitation Technology from the University of Pittsburgh 
and has over 22 years experience in providing and managing 
assistive technology services. Over the past 20 years Dr. 
Willkomm has presented in 32 states and five foreign countries; 
authored 22 publications, and received 18 national 
awards including 4.5 million in competitive grants and foundation 
awards from CDC, NIDRR, USDA, RSA, Kellogg 
Foundation, and the Dole Foundation.
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