Commentary: Psychological Influences on the Use of Assistive Technology: A Need for Research
Samuel T. Gontkovsky, PsyD; and Rochelle Busby, BS
In its broadest sense, assistive technology (AT) refers to a range of devices, services, strategies, and practices conceived and applied to ameliorate the difficulties confronted by persons with disabilities (Cook & Hussey, 2002). More narrowly, AT may be thought of as equipment utilized for the purpose of increasing the functional capabilities of individuals with disabilities. Such equipment may augment an individual’s abilities, as in the case of a brace used to assist a person with ambulation, or a replace lost capabilities, as in the case of an electric wheelchair to enable mobility. AT may help people with disabilities perform basic activities of daily living, such as eating and grooming, or may allow individuals to successfully integrate back into more complex tasks, such as driving, working, and attending school.
AT is critical for many individuals who have experienced spinal cord injury or disease (SCI/D). Although some persons with SCI/D may recover to a degree that AT is not necessary during or following hospitalization, these cases are few and far between. Following SCI/D, most individuals begin using AT during the process of rehabilitation and continue its use long after discharge and oftentimes throughout the remainder of their lives.
In order for AT to be effective in overcoming the functional limitations of persons with disabilities, the selection of equipment should be done on a case-by-case basis to match not only the specific needs but also the particular capabilities and characteristics of each user. Obvious factors to consider in selecting appropriate AT include the user’s motor capacities, sensory and perceptual skills, and cognitive functioning. Generally, less attention is given to the various psychosocial factors that may influence the use of AT by persons with disabilities. Depoy and Kolodner (1991) discuss the manner in which issues of development, motivation, and personal identity may influence the utilization of AT. In terms of developmental considerations, age may reflect an individual’s familiarity with newer technologies and eagerness to engage in learning to operate AT. Additionally, it also must be considered that the wants and needs of teenagers are likely to differ from those of older adults (see King, 1999).
Motivation involves a multitude of interacting factors, originating from the internal and external environment of the individual, that function to influence behavior. Houston (1985) characterizes motivation as it relates to behavior in terms of initiation, direction, intensity, and persistence. The relationship between motivation and use of AT is a positive one, in that the lack of motivation is a primary reason that AT is not utilized (Scherer & Galvin, 1996). On the other hand, AT can function to increase an individual’s motivation by providing reinforcements that might not otherwise be available without the person’s use of AT, such as social interaction.
Identity revolves around the question of “Who am I?” (Cook & Hussey, 2002). Like motivation, identity is comprised of several interrelated constructs, such as self-concept, self-esteem, locus of control, and personality. The manner in which these factors interact to influence the use of AT by individuals with disabilities is complex. A straightforward example of this interaction might be that of a young, athletic male who sustains a traumatic SCI as a result of a fall while skiing. If, prior to injury, this individual’s view of himself and his perception of how he is viewed by others was that of a strong and independent person and this view remains unchanged post-SCI, he may be less likely to use AT for fear of shattering this withstanding image.Development, motivation, and identity all are related in complex ways to emotional symptomatology. Indeed, it is known that the emotional experiences of children may differ from those of adults (Ammerman, Hersen, & Last, 1999; Van Hasselt & Hersen, 1992). Houston (1985) notes that it is difficult to speak of motivation without invoking the concept of emotion and without accounting for the fact that motivational states regularly lead to emotional changes, and several studies document the relationship between constructs of identity and negative emotional symptomatology among persons with disabilities (Overholser, Schubert, Foliart, & Frost, 1993; Vickery, Gontkovsky, & Caroselli, 2005).It is well known that many individuals experience psychological disturbance following SCI/D. Most often this seems to be in the forms of depression and anxiety (Richards, Kewman, & Pierce, 2000; Moverman, 2003), although varying emotional problems certainly may arise. Presumably, psychological stress could, and likely would, negatively influence use of AT by persons with SCI/D, either in a direct fashion, or as a moderating variable between development, motivation, or identity and the use of AT. Additionally, emotional symptomatology could impact the association between cognition and AT utilization. For example, Scherer (1998) suggests that individuals who are depressed at the time of selecting AT may be incapable of exercising appropriate judgment. As noted previously, AT may also function to alleviate emotional stress by providing reinforcing opportunities, for example, social and recreational events, that may not otherwise be available. Despite these obvious possibilities, sufficient empirical research examining these issues is lacking. Findings of such studies have potentially important implications with respect to both the treatment and outcome of individuals with SCI/D.
This need for research further suggests that funding agencies should consider allocating monies to the systematic examination these issues. As psychologists and social workers are uniquely positioned to investigate the manner in which emotional symptomatology and other psychological factors relate to use of AT by persons with disabilities, it is time for us to step up to the plate.
References
Ammerman, R. T., Hersen, M., & Last, C. G. (Eds.), (1999). Handbook of prescriptive treatments for children and adolescents (2nd ed.). Boston: Allyn and Bacon.
Cook, A. M., & Hussey, S. M. (2002). Assistive technologies: Principles and practice (2nd ed.). St. Louis, MO: Mosby.
Depoy, E., & Kolodner, E. L. (1991). Psychological performance factors. In C. Christiansen & C. Baum (Eds.), Occupational therapy. Thoroughfare, NJ: Slack, Inc., Professional Book Division.
Houston, J. P. (1985). Motivation. New York: Macmillan.
King, T. W. (1999). Assistive technology: Essential human factors. Needham Heights: MA: Allyn and Bacon.
Moverman, R. A. (2003). Psychosocial factors in spinal cord injury. In V. W. Lin (Ed.), Spinal cord medicine: Principles and practice. New York: Demos.
Overholser, J. C., Schubert, D. S. P., Foliart, R., & Frost, F. (1993). Assessment of emotional distress following a spinal cord injury. Rehabilitation Psychology, 38, 187-198.
Richards, J. S., Kewman, D. G., & Pierce, C. A. (2000). Spinal cord injury. In R. G. Frank & T. R. Elliott (Eds.), Handbook of rehabilitation psychology. Washington, DC: American Psychological Association.
Scherer, M. J. (1998). The impact of assistive technology on the lives of people with disabilities. In D. B. Gray, L. A. Quatrano, & M. L. Lieberman (Eds.), Designing and using assistive technology: The human perspective. Baltimore: Paul H. Brooks.
Scherer, M. J., & Galvin, J. C. (1996). An outcomes perspective of quality pathways to the most appropriate technology. In J. C. Galvin & M. J. Scherer (Eds.), Evaluating, selecting and using appropriate assistive technology. Gaithersburg, MD: Aspen.
Van Hasselt, V. B., & Hersen, M. (1992). Handbook of social development: A lifespan perspective. New York: Plenum Press.
Vickery, C. D., Gontkovsky, S. T., & Caroselli, J. S. (2005). Self-concept and quality of life following acquired brain injury: A pilot investigation. Brain Injury, 19, 657-665.
Samuel T. Gontkovsky, PsyD, is an associate professor in the Department of Psychology, Jackson State University, and a scientist at the Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center.
Rochelle Busby, BS, is a doctoral student, in the Department of Psychology, Jackson State University.