THE HUMAN COMPONENT

To knowledgeably apply engineering principles and fabricate devices that will help persons
with disabling conditions, it is necessary to have a perspective on the human component and
the consequence of various impairments.
 One way to view a human being is as a receptor, processor, and responder of information.
 The human user of assistive technology perceives the environment via senses and
responds or manipulates the environment via effectors.
 Interposed between the sensors and effectors are central processing functions that include
perception, cognition, and movement control.
 Perception is the way in which the human being interprets the incoming sensory data. The
mechanism of perception relies on the neural circuitry found in the peripheral nervous
system and central psychological factors such as memory of previous sensory experiences
. Cognition refers to activities that underlie problem solving, decision making, and
language formation.
 Movement control utilizes the outcome of the processing functions described previously
to form a motor pattern that is executed by the effectors (nerves, muscles, and joints).
The impact of the effectors on the environment is then detected by the sensors, thereby
providing feedback between the human and the environment. When something goes wrong
in the information processing chain, disabilities often result.
• Augmentative communication classification system (from Church and Glennen, 1992).
 THE HUMAN COMPONENT

• Add-on wheelchair system (from Church and Glennen, 1992).

• Environmental control unit using radio frequency (RF) control (from Church and
Glennen, 1992).
 THE HUMAN COMPONENT

• Alternative keyboards can replace or operate in addition to the standard keyboard.

• (a) Expanded keyboards have a matrix of touch-sensitive squares that can be grouped together to
form larger squares.
• (b) Mini keyboards are small keyboards with a matrix of closely spaced touch-sensitive squares.
• (c) The small size of a minikeyboard ensures that a small range of movement can reach the entire
keyboard.
• (d) Expanded and minikeyboards use standard or customized keyboard overlays.
• (e) Some alternative keyboards plug directly into the keyboard jack of the computer, needing no
special interface or software (from Church and Glennen, 1992
 THE HUMAN COMPONENT

An information processing model of the human operator of assistive

technologies. Each block represents a group of functions related to the use of
technology
 Prevalence of Disabling Conditions in the
United States
• 45–50 million persons have disabilities that slightly limit their activities
• 32% hearing
• 21% sight
• 18% back or spine
• 16% leg and
• hip 5% arm and shoulder
• 4% speech
• 3% paralysis
• 1% limb amputation
7–11 million persons have disabilities that significantly limit their activities
30% back or spine
26% leg and hip
13% paralysis
9% hearing
8% sight
7% arm and shoulder
4% limb amputation
3% speech
 THE HUMAN COMPONENT

(a) This system generates temporal signatures from one set of myoelectric
electrodes to control multiple actuators.
(b) Electrical stimulaton of the forearm to provide force feedback may be
carried out using a system like this one (from Webster et al., 1985).
 PRINCIPLES OF ASSISTIVE TECHNOLOGY
ASSESSMENT
• Rehabilitation engineers not only need to know the physical principles that govern their
designs, but they also must adhere to some key principles that govern the applications of
technology for people with disabilities. To be successful, the needs, preferences, abilities,
limitations, and even environment of the individual seeking the assistive technology must be
carefully considered. There are at least five major misconceptions that exist in the field of
assistive technolog.
• Misconception #1. Assistive technology can solve all the problems. Although assistive devices
can making accomplishing tasks easier, technology alone cannot mitigate all the difficulties
that accompany a disability.
• Misconception #2. Persons with the same disability need the same assistive devices. Assistive
technology must be individualized because similarly disabled persons can have very different
needs, wants, and preferences (Wessels et al., 2003).
• Misconception #3. Assistive technology is necessarily complicated and expensive. Sometimes
low-technology devices are the most appropriate and even preferred for their simplicity, ease
of use and maintenance, and low cost.
 Contd
• Misconception #4. Assistive technology prescriptions are always accurate
and optimal. Experiences clearly demonstrate that the application of
technology for persons with disabilities is inexact and will change with
time. Changes in the assistive technology user’s health, living
environment, preferences, and circumstances will require periodic
reassessment by the user and those rehabilitation professionals who are
giving assistance (Philips and Zhao, 1993).
• Misconception #5. Assistive technology will always be used. According to
data from the 1990 U.S. Census Bureau’s National Health Interview
Survey, about onethird of the assistive devices not needed for survival are
unused or abandoned just 3 months after they were initially acquired.
 Contd
• In addition to avoiding common misconceptions, a rehabilitation engineer and
technologist should follow several principles that have proven to be helpful in
matching appropriate assistive technology to the person or consumer. Adherence to
these principles will increase the likelihood that the resultant assistive technology
will be welcomed and fully utilized.
Principle #1. The user’s goals, needs, and tasks must be clearly defined, listed, and
incorporated as early as possible in the intervention process. To avoid overlooking
needs and goals, checklists and premade forms should be used. A number of helpful
assessment forms can be found in the references given in the suggested reading list
at the end of this chapter.
Principle #2. Involvement of rehabilitation professionals with differing skills and
know-how will maximize the probability for a successful outcome. Depending on
the purpose and environment in which the assistive technology device will be used,
a number of professionals should participate in the process of matching technology
to a person’s needs. Table 5.4 lists various technology areas and the responsible
professionals.
 Contd
• Principle #3. The user’s preferences, cognitive and physical abilities and
limitations, living situation, tolerance for technology, and probable changes
in the future must be thoroughly assessed, analyzed, and quantified.
Rehabilitation engineers will find that the highly descriptive vocabulary
and qualitative language used by nontechnical professionals needs to be
translated into attributes that can be measured and quantified. For example,
whether a disabled person can use one or more upper limbs should be
quantified in terms of each limb’s ability to reach, lift, and grasp.
• Principle #4. Careful and thorough consideration of available technology
for meeting the user’s needs must be carried out to avoid overlooking
potentially useful solutions. Electronic databases (e.g., assistive technology
websites and websites of major technology vendors) can often provide the
rehabilitation engineer or assistive technologist with an initial overview of
potentially useful devices to prescribe, modify, and deliver to the consumer.
 Contd
• Principle #5. The user’s preferences and choice must be considered in the selection of
the assistive technology device. Surveys indicate that the main reason assistive
technology is rejected or poorly utilized is inadequate consideration of the user’s needs
and preferences. Throughout the process of searching for appropriate technology, the
ultimate consumer of that technology should be viewed as a partner and stakeholder
rather than as a passive, disinterested recipient of services.
• Principle #6. The assistive technology device must be customized and installed in the
location and setting where it primarily will be used. Often seemingly minor or innocuous
situations at the usage site can spell success or failure in the application of assistive
technology.
• Principle #7. Not only must the user be trained to use the assistive device, but also the
attendants or family members must be made aware of the device’s intended purpose,
benefits, and limitations. For example, an augmentative communication device usually
will require that the communication partners adopt a different mode of communication
and modify their behavior so that the user of this device can communicate a wider array
of thoughts and even assume a more active role in the communication paradigm, such as
initiating a conversation or changing the conversational topic.
 PRINCIPLES OF REHABILITATION
ENGINEERING
• Knowledge and techniques from different disciplines must be utilized to design
technological solutions that can alleviate problems caused by various disabling
conditions. Since rehabilitation engineering is intrinsically multidisciplinary, identifying
universally applicable principles for this emerging field is difficult. Often the most
relevant principles depend on the particular problem being examined. For example,
principles from the fields of electronic and communication engineering are paramount
when designing an environmental control system that is to be integrated with the user’s
battery-powered wheelchair. However, when the goal is to develop an implanted
functional electrical stimulation orthosis for an upper limb impaired by spinal cord
injury, principles from neuromuscular physiology, biomechanics, biomaterials, and
control systems would be the most applicable.
• Whatever the disability to be overcome, however, rehabilitation engineering is
inherently design oriented. Rehabilitation engineering design is the creative process of
identifying needs and then devising an assistive device to fill those needs. A systematic
approach is essential to successfully complete a rehabilitation project. Key elements of
the design process involve the following sequential steps: analysis, synthesis, evaluation,
decision, and implementation.
 Analysis
• Inexperienced but enthusiastic rehabilitation engineering students often respond to a
plea for help from someone with a disability by immediately thinking about possible
solutions. They overlook the important first step of doing a careful analysis of the
problem or need. What they discover after much ineffectual effort is that a thorough
investigation of the problem is necessary before any meaningful solution can be
found. Rehabilitation engineers first must ascertain where, when, and how often the
problem arises. What is the environment or the task situation? How have others
performed the task? What are the environmental constraints (size, speed, weight,
location, physical interface, etc.)? What are the psychosocial constraints (user
preferences, support of others, gadget tolerance, cognitive abilities, and limitations)?
What are the financial considerations (purchase price, rental fees, trial periods,
maintenance and repair arrangements)? Answers to these questions will require
diligent investigation and quantitative data such as the weight and size to be lifted,
the shape and texture of the object to be manipulated, and the operational features of
the desired device. An excellent endpoint of problem analysis would be a list of
operational features or performance specifications that the ‘‘ideal’’ solution should
possess.
 Develop a set of performance specifications for an
electromechanical device to raise and lower the lower leg of a
wheelchair user (to prevent edema).

• Solution A sample set of performance specifications about

the ideal mechanism might be written as follows: & Be able to
raise or lower leg in 5 s & Independently operable by the
wheelchair occupant & Have an emergency stop switch &
Compatible with existing wheelchair and its leg rests & Quiet
operation & Entire adaptation weighs no more than five
pounds
 Synthesis
• A rehabilitation engineer who is able to describe in writing the
nature of the problem is likely to have some ideas for solving the
problem. Although not strictly sequential, the synthesis of
possible solutions usually follows the analysis of the problem.
The synthesis of possible solutions is a creative activity that is
guided by previously learned engineering principles and
supported by handbooks, design magazines, product catalogs,
and consultation with other professionals. While making and
evaluating the list of possible solutions, a deeper understanding
of the problem usually is reached and other, previously not
apparent, solutions arise. A recommended endpoint for the
synthesis phase of the design process includes sketches and
technical descriptions of each trial solution.
 Evaluation
• Depending on the complexity of the problem and other
constraints such as time and money, the two or three most
promising solutions should undergo further evaluation, possibly
via field trials with mockups, computer simulations, and/or
detailed mechanical drawings. Throughout the evaluation
process, the end user and other stakeholders in the problem and
solution should be consulted. Experimental results from field
trials should be carefully recorded, possibly on videotape, for
later review. One useful method for evaluating promising
solutions is to use a quantitative comparison chart to rate how
well each solution meets or exceeds the performance
specifications and operational characteristics based on the
analysis of the problem.
 Decision
• The choice of the final solution is often made easier when it is
understood that the final solution usually involves a
compromise. After comparing the various promising solutions,
more than one may appear equally satisfactory. At this point,
the final decision may be made based on the preference of the
user or some other intangible factor that is difficult to
anticipate. Sometimes choosing the final solution may involve
consulting with someone else who may have encountered a
similar problem. What is most important, however, is careful
consideration of the user’s preference (principle 5 of assistive
technology).
 Implementation
• To fabricate, fit, and install the final (or best)
solution requires additional project planning
that, depending on the size of the project, may
range from a simple list of tasks to a complex
set of scheduled activities involving many
people with different skills.
Example Problem
• List the major technical design steps needed to build the automatic battery-
powered leg raiser described in Example Problem 5.1.
Solution The following are some of the key design steps:
Mechanical design of the linkages to raise the wheelchair’s leg rests
Static determination of the forces needed to raise the occupant’s leg
Determination of the gear ratios and torque needed from the electric motor
Estimation of the power drain from the wheelchair batteries
Purchase of the electromechanical components & Fabrication of custom parts
and electronic components
Assembly, testing, and possible redesign & Field trials and evaluation of
prototype device