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  • studying if there are long-term savings and costs related to paying for customized technology;

  • exploring whether strategies for the prevention of secondary conditions should accompany the delivery of various types of DME (e.g., whether, when wheeled mobility is prescribed, overweight and obesity prevention services and guidance on how to protect overused muscles and joints should be part of the service package);

  • determining if coverage for repairs to a device, as well for training regarding the use and maintenance of a device, extends the life of the device and reduces its replacement cost;

  • reducing the weight, size, and costs of devices and improving their ease of operation;

  • documenting whether there are any differences between the use of customized assistive technology and noncustomized assistive technology in long-term physical and financial costs; and

  • documenting or disproving the existence and scope of the “woodwork effect.”

Resistance to modernizing policies is often based on fear of the so-called woodwork effect. That is, if more generous benefits are available, unimaginable numbers of beneficiaries will emerge “from the woodwork” to seek the service. Is there any validity to the use of the woodwork effect by policy makers and insurance carriers as an excuse not to improve policy? Is this an excuse that actually costs more in the long run?


For me and my peers, this updating of Disability in America by IOM is serious business. It is about “getting it right” in areas that are essential to our health and independence. It is about giving many of us the tools and services that we need to keep going, to be productive, and to prevent the world from unnecessarily closing in on us and becoming confining. It is about translating the words and the mantras like “quality living in the community” into reality. Life is short, so be productive and focus on converting the words to reality so that they do not remain empty promises.


Brandt EN Jr., Pope AM, eds. 1997. Enabling America: Assessing theRole of Rehabilitation Science and Engineering. Washington, DC: National Academy Press.

Pope AM, Tarlov AR, eds. 1991. Disability in America: Toward a National Agenda for Prevention. Washington, DC: National Academy Press.

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