The high cost of assistive technology



Introduction Advancement in access technology for people with visual impairments is the largest single contributor to the re-shaping of the psychosocial experiences of children and adults with visual impairments here in the United States. The World Wide Web is about twenty-five years old and since its inception the way people communicate around the world has changed completely.

We tend to think of access technology contributing the most to internet access through the invention of screen reading software, Braille keyboards, low vision software, and other types of handheld and desktop tools. Technology, however, provides other forms of access and assistance for people with visual impairments as well.

These days we tend to consider only the high-tech tools as being the ones which change the public presence of blind people in society, but it is also important to remember the low-tech technology as well. The original slate and stylus (I have a stylus which looks like a pen), the folding cane, and talking alarm clocks were some of the earliest forms of technology developed to expand the productivity and independence of people with visual impairments.

The first electronic print text reader (which is no longer made was called the Optocon). I remember it coming on the market when I was nineteen. You held a small device which had a camera in it and ran it over lines of printed text. You put another finger on a little pad and the letters were raised up using tiny pins so you could read the print. This was ground-breaking technology and what was available before the invention of screen reader software.

The first screen reader technology

The first screen reader adaptation was known as the Dek Talk. I was fortunate enough to meet the inventor of the Dek Talk a few years ago. I had a flash of geekie glow when I met him. For me, meeting him was like talking to a rock star. He gave me the prototype of the Dek Talk which still works and is one of my most prized possessions since it is part of the blind populationís history.

The Dek Talk is an external box which attaches to a hard drive and provides the operating system for the speech software. It was needed before sound cards were common in computers. They are not used much anymore, but I still use mine. I use it because it allows the computer to run faster since the software doesnít have to tie up memory in order to operate.

Today we have other forms of technology to assist us in the wider community. We already spoke about the talking ATM machines in some of the banks. Elevators which have Braille markers on them along with a ringing bell or voice announcement to indicate which floor we are on are all over the place, audible signals at crosswalks, and fully accessible cell phones (I donít have one of these yet, but I really want one) are easily available now.

One off-beat aspect of the way technology shapes the internal psychosocial relationship of a blind person is that many things speak electronically and you can have a community of voices in your home. I used to think this was odd when I was younger, but I am used to it now. The one piece of talking equipment I have that really startles people is my talking bathroom scale. It is the one thing that seems to disturb by guests. I donít know why that is.

The high cost of assistive technology

As I am sure you know the adaptive equipment used by people with visual impairments is very expensive. It can be difficult to purchase the things we really need. Often equipment needed for school or work will be given to a blind client by his or her local Commission for the Blind. Smaller pieces of adaptive technology can be purchased from places like Independent Living Aides as well.

One thing that a lot of people with visual impairments do (including me) is surf through stores like the Sharper Image and Brookstone for items that are not sold as adaptive aides, but can be used to assist our lives. This is one of the more creative ways people who are blind will provide for themselves.

A lot of the time the items are less expensive and are more durable. I have the most success with the Hamaker Schlemmer catalogue. It offers a lot of high-tech toys which are fun and very useful. People will also buy things like the little stars teachers put on childrenís homework and use them as marker dots. They are much cheaper than the Loc-Dots sold for the same purpose.

It is understandable that people with low incomes would be concerned with the high prices of the adaptive technology developed for blind peopleís use, but the balance of this concern is the creativity birthed from it. I enjoy finding interesting ways to provide myself with support. Being able to attract items which support my life gives me the feeling of being unlimited. You can assist those you will be working with the same way.

The development of adaptive computer technology has also contributed to the employment of many people with low vision or who are blind. I certainly couldnít do my job well without it. A side effect of the technology developing the way it did is that a significant number of people who are visually impaired went into technology careers. I never intended to be doing the kind of work I do now, but I got into it because I am a high-end computer user. I didnít even own a computer until I was thirty and for the first month I had it I thought it was going to blow up every time I turned it on.

Technology as a career for blind people

Unfortunately not all blind people are suited to work with technology. There is an assumption that we are all good at technology (a radical misconception) and that we all like using it. I respect my equipment and I am grateful that I have it, but there are times when I wish I didnít have to listen to a mechanical voice all day. It can give me a tremendous headache. Technology has also broken down a great deal of the isolation blind children and adults feel. Some people believe (even though there is no research on it) that access technology has created the first true community of blind people.

There is a lot of controversy over whether or not there is such a thing as blind culture and if there is a real community of people with vision loss in the country. There are those who contend there is an element of community generated by the internet and the ways blind people interact via their computers. There is also the same argument which says that blind people are able to communicate in a non-disabled way through the use of computers (remember my comment about telling you all that I donít see).

Where the use of computers and access to the Internet has opened community the most is for blind children living in rural areas. In less well populated parts of the country public services are not as available and there is often no opportunity for social interaction for children unless their parents drive them to social outings. Children with visual impairments frequently have difficulty socializing with others their age and not being able to travel interferes significantly.

Getting into a chat room or on a list server opens up a lot of chances to talk and make friends on-line. Since Internet communication is popular with sighted children as well, the blind children can participate in at least one social event with their peers. The flip side of this is that there is some growing concern that the children are becoming more isolated than they need to be and their face to face social skills are diminishing. I agree with this assessment.

There is also some concern that children are not learning Braille as effectively because they use screen reader software so much. We will talk more about this in the section on Braille. Another interesting feature of the use of technology for supporting people with visual impairments is that their counselors have to learn about the technology and stay on top of it so they can teach it to their clients. This is more of an issue with TVIs than O/M counselors.

There is a great deal of emerging technology and keeping up with it can be a challenge for some. The TVIs often have a hard time staying current with the new stuff as well as making sure their clients have the right equipment at the right time. TVIs also have to be the champions of technology at times as well. School systems may have to buy adaptive equipment for a child in its program.

Frequently the school will not allow the equipment to be taken home by the child. If the parents of the child cannot afford to purchase the equipment not having access to the adaptive equipment affects how well the child can perform academically. This can be a big issue in the schools and the TVI may have to be an advocate for resolving this issue. Another issue which comes up is when a child needs brailed materials and the TVI either doesn't have the time or the training to operate a Braille printer. Producing Braille on a Braille printer takes time and there is some talk about who should be providing this service, the TVI, a Para-professional, or a paid technical professional who understands the technology and can use it well.

A different aspect of the social climate in service provision is that the parents of children with visual impairments have become more vocal in requesting materials and services for their children. TVIs rehab. Counselors and O/M counselors (to a lesser extent) feel caught between the parent's demands and what the vision rehabilitation system can provide. This issue comes up when children started spending time together and seeing what types of adaptive equipment they each have. Being kids they want what their peers have and decisions about what kinds of technology each child receives is based on a needs assessment.

Since the local commissions for the blind usually have their own staff making the determinations on what equipment will be provided this can leave the TVI in an awkward position. A solution to this is to be clear with the family on how the commissions make their decisions and send them directly to the technology specialist at the institutions.

The last psychosocial aspect involving technology we will discuss today is that there is a general view among vision service providers that people with visual impairments have a sense of entitlement and expect that everything they need or want will be provided for them. The view also says that blind people are not motivated to go forward in taking personal responsibility for their lives and think that their service providers should find them jobs, get them into schools, and give them every piece of adaptive technology they want. Right now we are speaking about adults more than children.

Obviously this is a gross exaggeration, but there is some truth in it. The view that blind people feel entitled grew up out of the rapid development of services which out strip most of the services provided for other groups of people with disabilities. Remember I said in an earlier lecture that services and benefits for blind people are determined differently from all other disabilities.

This also comes from the concern that blind people cannot become independent without a lot of intervention. I think this developed more from the fears blindness brings up for people as a metaphor rather than direct experience. The upshot of this, however, is that many blind people participate in the view of not being able to go forward because they donít have either role models or the impotence to create their lives the way they want. I also think that blind people are judged by an external definition of independence and what happens is that the rehab. System tries to provide a lot of support for blind people becoming employed, but only provides the support within the context of what the system thinks are appropriate employment roles for blind people.

Unemployment is still at 70%. It may be true that many blind people don't want to work, but before we can conclude that we have to look at the big picture at how the rehab. System along with the larger society gives messages about our capacity to work and how possible it is for us to survive on public welfare and other charitable systems. All these kinds of psychosocial issues break down into the discussion on technology because technology is regarded to be the big leveler in opening up accessibility. It is a wonderful thing, but seeing it only as a leveler has the potential of creating another vehicle for dependence.

Depending on technology to open doors is like depending on electricity. We never think about how much we all depend on electricity until we have a power outage. It's always there and we grow used to having it available. The moment it isn't there we suddenly realize how much we need it and it throws us into feelings of helplessness. It is important to think of technology only as a tool and to work with your clients in developing their technical skills as part of their choice to be the people they want to be. It is not meant to replace human interaction or relationships. Unfortunately that is what happens a lot of the time.