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Fostering Independence, Participation, and Healthy Aging Through Technology: Workshop Summary (2013)

Chapter: 4 Technologies to Promote Community Integration and Participation Through Community Design

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Suggested Citation:"4 Technologies to Promote Community Integration and Participation Through Community Design." Institute of Medicine and National Research Council. 2013. Fostering Independence, Participation, and Healthy Aging Through Technology: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18332.
×

4

Technologies to Promote Community Integration and Participation Through Community Design

The design of communities can promote the integration and participation of all family members, including those with disabilities. In the second panel of the workshop, a pair of speakers discussed two prominent features of community design. Mohammed Yousuf, research engineer at the U.S. Department of Transportation, described several radically new approaches to transportation technologies that could meet the mobility needs of people with disabilities. Jon Sanford, associate professor in the College of Architecture and director of the Center for Assistive Technology and Environmental Access at Georgia Tech, described workplace accommodations that can foster not just participation but inclusion. In both cases, these changes could have benefits for everyone, not just people with disabilities.

NEW TECHNOLOGIES FOR ACCESSIBLE TRANSPORTATION

Mohammed Yousuf, M.S.

U.S. Department of Transportation

More than three-quarters of people with disabilities say that adequate transportation is important to their daily living needs, and more than a quarter consider it a significant problem in accessing jobs. Transportation is also critical in health care, recreation, and aging in place for people with disabilities.

Suggested Citation:"4 Technologies to Promote Community Integration and Participation Through Community Design." Institute of Medicine and National Research Council. 2013. Fostering Independence, Participation, and Healthy Aging Through Technology: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18332.
×

New Paradigm

Yousuf covered three “new paradigms” in transportation that address these needs. The first involves intelligent transportation systems, which include connected vehicle research and automated vehicle research. Connected vehicle research seeks to develop vehicles that communicate with each other and with the traffic infrastructure, such as traffic lights. Pedestrians also can be brought into the mix using wireless technologies. Automated vehicle research, which seeks to create vehicles that can drive on their own, could be an even greater boon to travelers with disabilities.

The second paradigm involves advanced research in such areas as artificial intelligence, computer machine learning, and brain-reinforced learning. Some of this research is being carried out through the SBIR program at the Federal Highway Administration and through the Intelligent Transportation Systems Joint Program Office. These programs are focused largely on mobility in general, but they also have applications for travelers with disabilities.

Finally, Yousuf mentioned synergistic approaches that combine wireless technologies, sensors, robotics, and artificial intelligence. For example, he described a system in which a pedestrian with a smartphone could communicate with the traffic signal to request more time to cross an intersection.1 Such a system could accommodate mobility-impaired, vision-impaired, or hearing-impaired pedestrians in ways suited to each group.

Cost Benefit

New technology solutions could result in big savings, Yousuf said. As an example, he mentioned the idea of converting some paratransit trips to fixed-route trips. If a quarter of the paratransit trips in 2010 were converted, the savings could be $1.5 billion per year. In addition, service could be better, compared with the fragmented and sometimes delayed service that exists today. Building users’ needs into the transportation system at the beginning is generally less costly than retrofitting existing systems.

Understanding Users’ Needs

Yousuf described four major categories of disabilities—mobility, hearing, vision, and intellectual—and focused specifically on the last category as an example. If a parent asks the question, “Did my son get on the bus?,”

____________

1In his presentation earlier in the workshop, Rory Cooper noted that a wheelchair travels at a typical speed of about 0.8 meters per second, which means that the average wheelchair user cannot get across the street before a streetlight changes, because streetlights are set for speeds of about 1 meter per second.

Suggested Citation:"4 Technologies to Promote Community Integration and Participation Through Community Design." Institute of Medicine and National Research Council. 2013. Fostering Independence, Participation, and Healthy Aging Through Technology: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18332.
×

wireless technologies could provide an answer quickly and inexpensively. Furthermore, technologies developed to overcome one type of disability can help overcome others and benefit travelers without disabilities as well. Technologies can apply to many travel modalities, including sidewalks, automobiles, buses, trains, and planes, as well as many reasons for traveling, including work, school, errands, and leisure. And technologies can be particularly powerful if they are inclusive and universal so that the same technology works in Chicago or San Diego.

Data standards are a big piece of the puzzle, said Yousuf. Is an elevator working? Is a bus wheelchair accessible? Answering such questions requires data capture and management from vehicles, cell phones, and other devices. Smartphones, cloud computing, and analysis of “big data” all could be harnessed to meet these needs if standards for data and metadata are in place.

The proper use of technology can support all aspects of travel, from the initial planning to the end of a trip. User needs can be integrated so that if someone is traveling to Chicago, for example, he or she will know if a hotel is accessible and has the kind of bathroom that is needed. Travelers will be able to get to their destinations safely, reliably, and on time.

Yousuf, who has a physical disability himself, closed with a vision of a transportation system in which he could take a Segway-type device to a bus stop, leave the device there, and then pick up a similar device when he gets off the bus, just as bike-sharing systems allow people to acquire bikes when and where they need them. People with disabilities should not have to worry about how to get from point A to point B, he said.

WORKPLACE ACCOMMODATIONS

Jon Sanford, M.Arch.

Georgia Tech

Workplace accommodations support the execution of work-related tasks, coordination of group and collaborative activities, transmission of office culture, and team building. They enhance work outcomes through higher individual and firm productivity, increased satisfaction with colleagues and their work, and lower levels of intention to leave their jobs. Thus, workforce accommodations have positive benefits for individuals who work and for the firms in which they work.

These accommodations are mandated by the Americans with Disabilities Act.2 Title III of that act mandates particular technical requirements for public facilities. For the workplace, Title I of the act mandates “reasonable

____________

2Americans with Disabilities Act of 1990, Public Law 336, 101st Congress, 2nd sess. (July 26, 1990).

Suggested Citation:"4 Technologies to Promote Community Integration and Participation Through Community Design." Institute of Medicine and National Research Council. 2013. Fostering Independence, Participation, and Healthy Aging Through Technology: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18332.
×

accommodations,” which is defined as “any change in the work environment or in the way things are customarily done that enables an individual with a disability to enjoy equal employment opportunities.” For example, accommodations could include changes to a job application process that enable a qualified applicant with a disability to be considered for the position, changes that enable an employee with a disability to enjoy equal benefits and privileges of employment as others, or changes to the work environment or way in which work is customarily performed that enable a qualified individual with a disability to perform the essential functions of that position. Workplace accommodations are contextual, Sanford emphasized. They encompass whatever needs to be done—within reason—with the determination of what is reasonable often a matter of cost.

Survey of Workplace Accommodations

A recent survey of 394 currently employed individuals with at least one functional limitation sheds light on the kinds of accommodations that are deemed reasonable (Williams et al., 2006). In all these cases, the satisfaction of employees with these accommodations was rated slightly or moderately lower than their importance. With the exception of hearing aids, older adults are less likely to get big-ticket items, such as modified workstations and accessible transportation. Except for hearing loss, receiving no accommodations consistently increases with age.

Vision Limitations

Employees with vision limitations reported receiving such accommodations as reading aids, electronic media scanners, magnifiers, enlarged print, Braille documents, antiglare devices, new displays, assistants, and redesigned jobs. Nonetheless, 12 percent of 18- to 54-year-olds, 17 percent of 55- to 64-year-olds, and 50 percent of employees older than 64 reported receiving no accommodations at all (see Table 4-1).

TABLE 4-1 Percentage of Adults Reporting Accommodations for Vision Limitations

Group Electronic-Formatted Materials (OCR) Screen Reading Software Braille-Formatted Materials None Provided
18-54 10% 14% 7% 12%
55-64 7% 7% 4% 17%
65+ 0% 0% 0% 50%

NOTE: OCR = optical character recognition.

SOURCE: Williams et al., 2006.

Suggested Citation:"4 Technologies to Promote Community Integration and Participation Through Community Design." Institute of Medicine and National Research Council. 2013. Fostering Independence, Participation, and Healthy Aging Through Technology: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18332.
×

TABLE 4-2 Percentage of Adults Reporting Accommodations for Hearing Limitations

Group Hearing Aids Written Communication Sign Language None Provided
18-54 29% 17% 12% 21%
55-64 39% 19% 6% 12%
65+ 39% 14% 3% 17%

SOURCE: Williams et al., 2006.

Hearing Limitations

For people with hearing limitations, typical accommodations included hearing aids, written communication, communication devices, sign language, ear protection, redesigned jobs, and assistants. In this case, 21 percent of 18- to 54-year-old employees, 12 percent of 55- to 64-year-old employees, and 17 percent of employees older than 64 reported receiving no accommodations, suggesting that older people with hearing limitations are more likely to receive accommodations than older people with other kinds of limitations (see Table 4-2).

Cognitive Limitations

For people with cognitive limitations, accommodations to help them attend to their tasks included checklists, reminder devices, timers, job coaches, assistants, and redesigned jobs, but 32 percent of 18- to 54-year-old employees, 42 percent of 55- to 64-year-old employees, and 50 percent of employees older than 64 reported receiving no accommodations (see Table 4-3). Some cognitive limitations are hard to prove, Sanford said, and sometimes people do not want to ask for an accommodation or do not want others to know that they need an accommodation.

TABLE 4-3 Percentage of Adults Reporting Accommodations for Cognitive Limitations

Group Checklists Reminder Devices None Provided
18-54 25% 22% 32%
55-64 26% 11% 42%
65+ 25% 13% 50%

SOURCE: Williams et al., 2006.

Suggested Citation:"4 Technologies to Promote Community Integration and Participation Through Community Design." Institute of Medicine and National Research Council. 2013. Fostering Independence, Participation, and Healthy Aging Through Technology: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18332.
×

TABLE 4-4 Percentage of Adults with Mobility Limitations Reporting Accommodations to Maintain Body Position

Group Modified Workstation Ergonomic Chairs Steps or Lifts None Provided
18-54 24% 20% 13% 43%
55-64 25% 25% 5% 45%
65+ 14% 29% 21% 36%

SOURCE: Williams et al., 2006.

Mobility Limitations

For people with mobility limitations, accommodations to maintain body position include modified workstations, ergonomic chairs, and steps and lifts. For these limitations, 43 percent of 18- to 54-year-old employees, 45 percent of 55- to 64-year-old employees, and 36 percent of employees older than 64 reported receiving no accommodations (see Table 4-4).

Dexterity Limitations

Finally, with dexterity limitations, accommodations include equipment modifications, gripping aids, carts, custom devices, clamping devices, leverage aids, lifts, hoists, measuring tools, assistants, and redesigned jobs. In this case, 15 percent of 18- to 54-year-old employees, 21 percent of 55- to 64-year-old employees, and 21 percent of employees older than 64 reported receiving no accommodations (see Table 4-5).

Barriers to Workplace Participation

Accommodations tend to be abandoned over time, Sanford reported. Sanford described data collected in an unpublished study by the Rehabilitation Engineering Research Center on Workplace Accommodations at the Center for Assistive Technology and Environmental Access at Georgia Tech. This telephone survey of 54 vocational rehabilitation clients found

TABLE 4-5 Accommodations for Dexterity Limitations

Group Buddy System Assistant Equipment Modifications Gripping Aids None Provided
18-54 14% 12% 11% 11% 15%
55-64 21% 11% 5% 5% 21%
65+ 7% 14% 7% 7% 21%

SOURCE: Williams et al., 2006.

Suggested Citation:"4 Technologies to Promote Community Integration and Participation Through Community Design." Institute of Medicine and National Research Council. 2013. Fostering Independence, Participation, and Healthy Aging Through Technology: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18332.
×
images

FIGURE 4-1 Abandonment of workplace accommodations over time.
SOURCE: Reprinted with permission from Jon Sanford, Georgia Tech.

that 38 percent never used their accommodations or discontinued use within 1 year, and two-thirds discontinued use within 5 years (see Figure 4-1). Among those who abandoned an accommodation, one-third left their accommodations behind when they left a job and could not take the accommodation with them. Another third abandoned a technology when it became outdated.

Abandonment of a technology is just one of several barriers to participation that Sanford cited. Others include negative attitudes on the parts of employers and coworkers, lack of awareness about available accommodations, the inaccessibility of technologies, the lack of acceptance of accommodations, and the technologies’ expense. Sanford also cited three less obvious barriers to obtaining the right technology. A technology may produce workplace activity but not workplace participation if an employee is not able to engage in a shared experience that creates a sense of belonging. Similarly, accessibility implies access not only to spaces but to conversations, meetings, social events, and the other aspects of the workplace. An employee may not be able to get to the cafeteria, participate in a training session, or even go to an office party if it is in an inaccessible place. Awareness and understanding of how to keep people engaged in the workplace, and not just in work, is the issue. True participation implies a sense of belonging, inclusion, and recognition that a person’s work is adding value to a workplace.

Suggested Citation:"4 Technologies to Promote Community Integration and Participation Through Community Design." Institute of Medicine and National Research Council. 2013. Fostering Independence, Participation, and Healthy Aging Through Technology: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18332.
×

Part of the problem is that workplace participation still draws on a paradigm based on the Americans with Disabilities Act, which is focused on the performance of activities as a measure of participation. But a better paradigm for the 21st century is the framework of the International Classification of Functioning, Disability, and Health (ICF), in which accommodations for both work tasks and inclusive interactions lead to participation. Activity and participation are linked, but they are independent and equally important outcomes. For example, Sanford and his colleagues found that employed individuals with disabilities have unmet needs in shared workspaces more frequently than in their individual workspaces. And those with unmet needs have a much higher level of dissatisfaction with activity and participation outcomes than people without disabilities who do not have unmet needs.

The policy implication Sanford drew is that the assumptions within the Americans with Disabilities Act about activity leading to participation are not supported. In the ICF, activity and participation are independent constructs, and they require different types of technologies to facilitate both activity and participation.

Emerging Technologies and Approaches

Sanford pointed to several examples of emerging technologies that can increase the participation of employees with disabilities in the workplace. Telepresence robots, devices that allow for mobile videoconferencing, can bring people in remote locations together to collaborate or provide remote job coaching and training. Collaborative software and applications of social media can coordinate distributed teams and enhance social inclusion and networking, especially for teleworkers. Gaming platforms or virtual reality can be used for training, collaboration, and social interactions. Augmented reality, which involves superimposing content onto a scene that is either in physical space or a computer-generated image, can be used as a navigation tool, provide coaching for specific tasks, or offer job training. Finally, universal design can incorporate accessibility technologies into the everyday design of product and spaces to support both activity and participation. Universal design in the workplace can benefit workers both with and without disabilities across an employee’s work life. Universal design features save time, money, and effort. And workers no longer have to leave accommodations behind because they already exist in the workplace.

Suggested Citation:"4 Technologies to Promote Community Integration and Participation Through Community Design." Institute of Medicine and National Research Council. 2013. Fostering Independence, Participation, and Healthy Aging Through Technology: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18332.
×
Page 27
Suggested Citation:"4 Technologies to Promote Community Integration and Participation Through Community Design." Institute of Medicine and National Research Council. 2013. Fostering Independence, Participation, and Healthy Aging Through Technology: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18332.
×
Page 28
Suggested Citation:"4 Technologies to Promote Community Integration and Participation Through Community Design." Institute of Medicine and National Research Council. 2013. Fostering Independence, Participation, and Healthy Aging Through Technology: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18332.
×
Page 29
Suggested Citation:"4 Technologies to Promote Community Integration and Participation Through Community Design." Institute of Medicine and National Research Council. 2013. Fostering Independence, Participation, and Healthy Aging Through Technology: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18332.
×
Page 30
Suggested Citation:"4 Technologies to Promote Community Integration and Participation Through Community Design." Institute of Medicine and National Research Council. 2013. Fostering Independence, Participation, and Healthy Aging Through Technology: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18332.
×
Page 31
Suggested Citation:"4 Technologies to Promote Community Integration and Participation Through Community Design." Institute of Medicine and National Research Council. 2013. Fostering Independence, Participation, and Healthy Aging Through Technology: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18332.
×
Page 32
Suggested Citation:"4 Technologies to Promote Community Integration and Participation Through Community Design." Institute of Medicine and National Research Council. 2013. Fostering Independence, Participation, and Healthy Aging Through Technology: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18332.
×
Page 33
Suggested Citation:"4 Technologies to Promote Community Integration and Participation Through Community Design." Institute of Medicine and National Research Council. 2013. Fostering Independence, Participation, and Healthy Aging Through Technology: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18332.
×
Page 34
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The Institute of Medicine (IOM) and the National Research Council (NRC) have had prominent roles in discussions of aging, disability, and technology for decades. In 1978, Aging and Medical Education (IOM, 1978) raised national awareness of the challenges to physicians posed by the aging of the U.S. population. Thirty years later, Retooling for an Aging America highlighted concerns for the entire health care workforce in view of the aging of the population, including the role of technology in caring for older populations. The 1988 report The Aging Population in the 21st Century examined social, economic, and demographic changes among older adults, as well as many health-related topics: health promotion and disease prevention; quality of life; health care system financing and use; and the quality of care— especially long-term care. In 1991, the landmark report Disability in America laid out a national agenda to prevent disability and improve the lives of people with disabling conditions. The 1997 report Enabling America: Assessing the Role of Rehabilitation Science and Engineering examined the knowledge base of rehabilitation science and engineering and proposed ways to translate scientific findings into interventions that produce better health. And the 2007 report The Future of Disability in America examined progress made since the earlier reports and looked at continuing barriers that limit the independence, productivity, and participation in community life of people with disabilities.

All these reports were produced by committees appointed in accordance with guidelines of the National Academies and met multiples times to compile and review evidence, reach consensus on conclusions and recommendations, draft a report of the committee, and then modify that draft report in response to comments from outside reviewers. The IOM and NRC have also held several workshops related to aging, disability, and technology and published summary reports, such as Technology for Adaptive Aging and Grand Challenges of Our Aging Society. The IOM and NRC also convene groups that take a different approach to issues of pressing national and international importance. Often known as forums or roundtables, these groups meet regularly to foster dialogue and confront issues of mutual interest and concern among a broad range of stakeholders. They can convene workshops, initiate cooperative projects among members, commission independently authored articles, and generate ideas for independent consensus studies.

In 2012 the IOM and NRC joined together to establish the Forum on Aging, Disability, and Independence to provide a neutral venue for broad-ranging discussions among the many stakeholders involved with aging and disability. The goals of the forum are to highlight areas in which the coordination of the aging and disability networks is strong, examine the challenges involved in aligning the aging and disability networks, explore new approaches for resolving problem areas, elevate the visibility and broaden the perspectives of stakeholders, and set the stage for future policy actions. Forum sponsors and members include federal agencies, health professional associations, private sector businesses, academics, and consumers. Fostering Independence, Participation, and Healthy Aging Through Technology summarizes this workshop.

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