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The Psychologist

  • University of Perugia. Italy
  • Università degli Studi di Perugia e Università per Stranieri di Perugia

Abstract and Figures

8.1 The Languishing Psychologist's Role inAssistive Technology Assessment Psychology itself is dead. Or, to put it another way, psychology is in a funny situation. My college, Dartmouth, is constructing a magnificent new building for psychology. Yet its four stories go like this: The basement is all neuroscience. The first floor is devoted to classrooms and administration. The second floor houses social psychology, the third floor, cognitive science, and the fourth, cognitive neuroscience. Why is it called the psy-chology building? (Gazzaniga 1998, pp. xi–xii)
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The Psychologist
F. Meloni, S. Federici, A. Stella, C. Mazzeschi, B. Cordella, F. Greco, and M. Grasso
8.1 The Languishing Psychologists Role
inAssistive Technology Assessment
Psychology itself is dead. Or, to put it another way, psychology is in a funny situation.
My college, Dartmouth, is constructing a magnicent new building for psychology. Yet
its four stories go like this: The basement is all neuroscience. The rst oor is devoted
to classrooms and administration. The second oor houses social psychology, the third
oor, cognitive science, and the fourth, cognitive neuroscience. Why is it called the psy-
chology building? (Gazzaniga 1998, pp. xi–xii)
8.1 The Languishing Psychologist’s Role inAssistive Technology Assessment ............ 149
8.2 Nothing about “Psycho” without Psychologists: The ICF and the Need for Its
Revision ............................................................................................................................... 151
8.3 The Personal Factors of Functioning and Disability .................................................... 153
8.4 Personal Factors and Assistive Solutions .......................................................................154
8.5 The Psychologist in a Center for Technical Aid: The Specialist in Personal Factors ...155
8.6 Outlining the Psychologists Role in the ATA Process ................................................. 157
8.6.1 When the Psychologist Role in the ATA Process Is Required .........................158
8.6.2 How a Psychologist Facilitates the Awareness of the User/Client’s
Context and Multidisciplinary Team Perspectives ........................................... 160 Methodology ............................................................................................ 160 Goals .........................................................................................................163 What a Psychologist Should Do in Promoting a User/Client
Request ..................................................................................................... 164
8.7 Psychologist “Know Thyself: Psychologist and Professional’s Representations
of the Disabled Users/Clients and Assistive Technologies .........................................164
8.7.1 Professionals’ Representation of Disability ....................................................... 165
8.7.2 New Approach in Psychological Practice ........................................................... 168
8.7.3 Psychological Professional Practice Guidelines in the ATA Process.............. 168 The User.................................................................................................... 169 The Family ............................................................................................... 169 The Professionals’ Multidisciplinary Team ........................................ 170
8.8 Conclusions ......................................................................................................................... 170
Summary of the Chapter ............................................................................................................172
Acknowledgments ...................................................................................................................... 172
References .....................................................................................................................................172
© 2012 by Taylor & Francis Group, LLC
150 Assistive Technology Assessment Handbook
Together with the neuroscientist Gazzaniga, we ask why is the model called the bio-psycho-
social model, one of the classications of the International Classication of Functioning,
Disability, and Health (ICF; WHO 2001), when it contains nothing psychological? We do not
believe that psychology has ended, but surely (clinical) psychologists risk not nding its loca-
tion if the World Health Organizations disability model does not build a “oor” for psychology.
Maybe it would not be so bad if the problem were just circumscribed to the (clinical) psycholo-
gists’ occupation in the world. It is very bad if psychology perhaps has the tools to prevent
the abandonment of assistive technology (AT) (Philips and Zhao 1993; Zimmer and Chappell
1999; Riemer-Reiss and Wacker 2000; Lenker and Paquet 2004; Scherer et al. 2005; Verza et al.
2006; Waldron and Layton 2008; Söderström and Ytterhus 2010), to guarantee an AT assessment
(ATA) “user-driven process through which the selection of one or more technological aids for an
assistive solution is facilitated by the comprehensive utilization of clinical measures, functional
analysis, and psycho-socio-environmental evaluations that address, in a specic context of use,
the personal well-being of the user through the best matching of user/client and assistive solu-
tion.” (see Conclusions, Section I this volume.)
Searching “psychologist role” and “disab*” or “rehabil*” in the “abstract” eld of the
main databases of the scientic indexes, such as Cambridge Scientic Abstracts (CSA),
PubMed, Medline, PsyArticle, PsyInfo, Eric, and Ebsco, from 1900 to date, the ndings
are astonishing: 56 products between 1973 and 2010. By eliminating studies referring to
school psychologists or related only marginally to the (clinical) psychologist’s role in reha-
bilitation and AT assignation, the number of products is reduced to 36, comprising eight
chapters in books and monographs and 28 journal articles. Twenty-three of them were
published in the 26 years between 1973 and 1999, and the remaining 13 were published in
the last 11 years. We found just two conference papers (Mitani et al. 2007; Nihei et al. 2007)
in the Association for the Advancement of Assistive Technology in Europe (AAATE) con-
ference proceedings by searching “psycholog*” in the title or in the abstract.
The international scientic literature has never given a clear denition of the role and
competencies of the psychologist in the rehabilitation eld. In the ATA process, the psy-
chologists role is given but it usually seems to be narrowed down to the testing and diag-
nostic phases.
The professional skills of psychologists and their usefulness in the following are
all issues of minor relevance in the AT scientic literature (Barry and O’Leary 1989;
Scherer 2000):
• Advocating the user’s request in the user-driven process through which the selec-
tion of one or more technological aids for an assistive solution is reached;
• Acting as mediator between users seeking solutions and the multidisciplinary
team of a center for technical aid;
• Team facilitating among members of the multidisciplinary team; and
• Reframing the relationship between the client and his or her family within the
framework of the new challenges and limitations and restrictions they face.
Nevertheless, the recent advance of the bio-psycho-social model in the social and scien-
tic communities (Plante 2005); the integration of objective and subjective measures in the
diagnostic process (Ueda and Okawa 2003; Uppal 2006; Federici and Meloni 2010; Kayes
and McPherson 2010); the recognized relevance of contextual factors and, particularly, the
personal ones affecting the long-term success of AT matching (Nair 2003); and the increas-
ing attention to the “imbalance of power” (Brown and Gordon 2004) in the relationship
© 2012 by Taylor & Francis Group, LLC
151The Psychologist
between professionals and users all require a change of attitudes and practices concerning
the role of the psychologist in the whole ATA process.
It is reasonable to assume that the deafening silence on the psychologists role in the ATA
process is largely due to the absence of personal factor codes in the ICF.
8.2 Nothing about “Psycho” without Psychologists:
The ICF and the Need for Its Revision
The second part of the ICF covers “contextual factors” and is divided into two components:
environmental factors and personal factors. The latter are not actually coded in the ICF
framework but are involved in the process of functioning and disability and are comprised
in the conceptual background of the classication (Geyh et al. 2011). Personal factors are
dened in the ICF as “the particular background of an individuals life and living and
comprise features of the individual that are no part of a health condition or health states”
(WHO 2001, p. 23). They include
gender, race, age, other health conditions, tness, lifestyle, habits, upbringing, coping
styles, social background, education, profession, past and current experience, overall
behaviour pattern and character style, individual psychological assets and other char-
acteristics, all or any of which may play a role in disability at any level. (WHO 2001,
They encompass one domain (internal inuences on functioning and disability) and one
construct (impact of the attributes of the person) (Table 8.1). The domain is “what” the
ICF classies in each of its components at the highest semantic level (e.g., mental func-
tions, structures of the nervous system, learning and applying knowledge, etc.). The con-
struct refers to “how” each category is weighed in an operational way by means of specic
qualiers. For example (WHO 2001, p. 217 Annex 2), the performance of a person (positive
aspect: functioning qualier to weigh) who lost his leg [body structure domain (cod. s750);
negative aspect: impairment qualier (cod. s750.4)] in a work-related accident and since
then has used a cane [environmental factor construct (cod. e1201); positive aspect: facilita-
tor qualier (1201. + 3)] but faces moderate difculties in walking around [activity and
participation construct; negative aspect: activity limitation qualier (cod. d4500.2)] because
the pavements in the neighborhood are very steep and have a very slippery surface [envi-
ronmental factors construct; negative aspect: barriers qualier (cod. e2100.-3)] is classied
as “moderate restriction in performance of walking short distances: cod. d4500.2.
According to a previous vignette, the use of the aid, the cane, reduces the impact of
the physical impairment and the environmental barriers on the individual’s performance,
although the individual’s capacity without assistance and/or in a standardized environ-
ment might be considered more limited (e.g., cod. d4500.2 3). This entire assessment pro-
cess may be carried out by a multidisciplinary team, in which a (clinical) psychologist
professional might not be necessary because competence in human cognition, emotion,
behavior, and social relations systems are not essential for classifying the person in the
example or for assigning him the aid (the cane). According to such biosocial perspectives
on functioning and disability classication, “psycho” remains just a prex to a word to
say that the internal inuences and the impact of attributes of the person on functioning
© 2012 by Taylor & Francis Group, LLC
152 Assistive Technology Assessment Handbook
and disability are not considered, so preventing the cultural and professional develop-
ment of(clinical) psychologist gures even in the eld of the ATA process. Universally,
in a center for technical aid the clinical psychologist does not belong to the center’s mul-
tidisciplinary team of professionals, often being present just as an external consultant.
Engineers, physiotherapists, and specialists in rehabilitation (e.g., speech language pathol-
ogists, audiologists, optometrists, special educators, and occupational therapists) usually
make up the internal team of a center for technical aid and outline the current biosocial
outlook on disability.
The ICF imputes the lack of codes for the personal factors to “the large social and cul-
tural variance associated with them” (WHO 2001, p. 9). However, the real novelty of the
bio-psycho-social model compared with the previous medical and social ones is precisely
the presence of the “psycho” prex between “bio” and “social.” The failure in coding such
an important component of the contextual factors 10 years after the ICF edition, given also
the distinctive value for the whole classication, creates a disturbing parallel between the
International Classication of Impairments, Disabilities, and Handicaps (ICIDH) of 1980
(WHO 1980) and the ICF because ICIDH aimed to describe and represent disability in
terms of the social model but ended up revealing a substantial consistency with the medi-
cal model: So the ICF seems to ignore the call to complexity, implied in the bio-psycho-
social model, to be only, literally, an integration between the medical and social models
An Overview of ICF
Part 1: Functioning and Disability Part 2: Contextual Factors
Components Body functions
and structure
Activities and
Personal factors
Domains Body functions
Body structures
Life areas
(tasks, actions)
inuences on
and disability
inuences on
functioning and
Constructs Change in body
Change in body
tasks in a
tasks in the
Facilitation of
impact of
features of the
social and
Impact of
attributes of the
Functional and
Activities and
Facilitators Not applicable
Impairment Activity
Not applicable
Source: World Health Organization (WHO). ICF: International Classication of Functioning,
Disability, and Health, Geneva, Switzerland: WHO, 2001.
© 2012 by Taylor & Francis Group, LLC
153The Psychologist
without a comparatively real qualitative leap. The psychological variables included in the
ICF personal factors can make substantial differences to the rehabilitation process and,
particularly, they play a central role during the ATA process. The lifestyle, the coping style,
the social and cultural background, or the character style really determines the success of
matching the person with technology. An appropriate psychological evaluation or a pre-
cise clinical intervention with the user/client and/or their signicant human context over
the course of the whole AT assignment process may prevent, for example, the abandon-
ment or the discard of the assistive solution provided and is a big problem in the matching
outcome. It is reasonable to assume that the lack of importance given to the “systemic”
skills of the psychologist in the process of matching the person with technology is largely
due to the noncoding of personal factors in the ICF.
The ICIDH needed to be revised because it needed to include environmental factors into
the coding scheme (Pfeiffer 1998); today we claim that the ICF needs to be revised because
there is an urgent need to develop personal factors (see also Steiner et al. 2002). Moreover,
as Geyh and colleagues remark, concluding a recent literature review on the conceptual-
ization of the personal factors component of ICF, personal factors “have not been studied
extensively or are undervalued (Lehman 2003; Threats 2007; Cruice 2008; Weigl et al. 2008)
[]. It is suggested that one aim of further research should be the development of PF cat-
egories within the ICF (Khan and Pallant 2007)” (2011, p. 1097).
8.3 The Personal Factors of Functioning and Disability
The recent literature review, already cited in the previous paragraph—carried out by
Geyh along with other eminent scholars of the ICF Research Branch and Classications,
Terminology, and Standards Team of the WHO (Geyh et al. 2011) on the conceptualiza-
tion of the personal factors component of the ICF—yielded 353 citations in 79 papers. Five
hundred and thirty-eight statements about personal factors were classied. In addition
to conceptual statements, authors have identied personal factors (Verbrugge and Jette
1994; Fougeyrollas et al. 1999; Ueda and Okawa 2003; Badley 2006; Viol et al. 2006). Authors
maintain that there is a need for standardization, pointing to “the potential of PF [per-
sonal factors] in enhancing the understanding of functioning, disability and health, in
facilitating interventions and services for people with disabilities, and strengthening the
perspective of individuals in the ICF” (Geyh et al. 2011, p. 1089). An outline list of personal
factors is already provided by the ICF and the ICF-CY: “gender, race, age, other health con-
ditions, tness, lifestyle, habits, upbringing, coping styles, social background, education,
profession, past and current experiences, overall behavioural pattern and character style,
individual psychological assets” (WHO 2001, pp. 23–24; 2007, pp. 15–16). A more compre-
hensive list of 238 examples of personal factors not named in the ICF denition is cre-
ated by Geyh and colleagues (2011) by collecting all of those named in 23 papers of the 79
reviewed. 199 factors out of 238 are found only one time and each one just in a single paper.
Of the 39 remaining concepts, the consensus of more than ve papers converges on only
three concepts: self-efcacy (13), motivation (7), and personality (7). These ndings push
authors to claim “a need for further standardisation in relation to personal factors as part
of the ICF” (Geyh et al. 2011, p. 1099).
The contexts in which personal factors are most frequently mentioned are the rehabili-
tation of communication disorders and musculoskeletal conditions. In any event, there
© 2012 by Taylor & Francis Group, LLC
154 Assistive Technology Assessment Handbook
is universal agreement on the role of personal factors in all stages of the rehabilitation
process (Geyh et al. 2011; Gutenbrunner et al. 2007; Steiner et al. 2002) especially “when
the ICF was introduced as a framework for comprehensive, holistic and multidisciplinary
assessment in a clinical context” (Geyh et al. 2011, p. 1097). But what about personal factors
and assistive devices?
8.4 Personal Factors and Assistive Solutions
According to the authors of the above-mentioned reviewed literature (Geyh et al. 2011),
personal factors are prevalently mentioned in papers related to occupational and voca-
tional rehabilitation, psychiatric rehabilitation, rehabilitation counselling, and psychoso-
cial care intervention, and in just four papers related to assistive devices (Barker et al. 2006;
Cruice 2008; Henderson et al. 2008; Howe 2008). In addition to these four papers, Stephen
and Kerr (2000), Pape et al. (2002), Scherer and colleagues (Scherer et al. 2004; Scherer 2005,
2011; Scherer and Dicowden 2008, 2005), and Jahiel and Scherer (2010) pointed out that rel-
evant personal factors affect the use and abandonment of assistive devices, consistent with
Philips and Zhao’s ndings in 1993 in their famous research to determine how technology
users decide to accept or reject assistive devices: Three of four factors signicantly related
to abandonment—lack of consideration of user opinion in selection, easy device procure-
ment, and change in user needs or priorities—were related to personal factors (Philips and
Zhao 1993).
Notwithstanding the scarcity in the attention given in international scientic litera-
ture to the role and competencies of the psychologist in the ATA process, it is universally
ascertained that personal factors are an essential and unavoidable dimension for the best
matching of user/client and device. This outlook has pushed scholars in the AT eld to
reword AT as assistive solution to stress that it is more than a technological device for a
technical x or to overcome a disablement (Roulstone 1998); it involves “something more
than just a device, it often requires a mix of mainstream and assistive technologies whose
assembly is different from one individual and another, and from one context to another”
(AAATE 2003).
A useful tool for identifying personal factors that might play a decisive role in success-
fully matching user/client and AT is provided by the paper of Pape and colleagues (2002).
In this review article, 81 publications are considered to individualize meanings assigned to
AT and how these personal meanings inuence the integration of AT into daily activities
(p. 5). In addition to each personal factor code retrieved from the literature reviewed, the
paper offers a novel tool for seeking which meanings are ascribed to AT by individuals. A
topic guide implemented by questioning routes makes up a worksheet for exploration of
personal factors. The questions are classied under two main criteria: disability types and
variation factors. The rst relates to four disability types: disability due to aging, acquired
disability, congenital disability, and disability due to progressive disorder. The variation
factors relate to the type and morbidity of impairment, namely the peculiarities referable
to the body factors: impairment type and degree, illness type and severity, origin and
diagnosis of disability, and functional improvements. The authors then transformed the
personal factor concepts emerging from the 81 papers reviewed using operationally proba-
tive questions. These probative questions involve psychological, cultural, and adaptation
issues (Pape et al. 2002, p. 12).
© 2012 by Taylor & Francis Group, LLC
155The Psychologist
Despite the scarcity of scientic works focusing on the relations between personal fac-
tors and the assignment of suitable AT according to a bio-psycho-social perspective, the
personal factors emerge as central to successful matching. Therefore, the most skilled pro-
fessional prole in the knowledge of individual features and behavior is denitely that of
the psychologist.
8.5 The Psychologist in a Center for Technical Aid:
The Specialist in Personal Factors
As stated by Scherer, Craddock, and MacKeogh,
People’s predispositions to, expectations for, and reactions to ATD [assistive technology
device] use are highly individualised and personal. These predispositions, expectations
and reactions emerge from such inuences as varying needs, abilities, preferences and
past experiences with and exposures to technologies. Importantly, predispositions to
use support (as well as realised benets from use) also depend on one’s sense of well-
being and satisfaction with current performance of activities and participation in daily
life events (2011, p. 812).
Of all of the professionals making up the multidisciplinary team, the psychologist is the
one who, in terms of curriculum and training, is the greatest expert in personal factors as
they are conceptualized by ICF, expertise that he or she only partly shares with the psy-
chotechnologist (see Chapter 9). The psychotechnologist’s skills are more focused on the
technological side of matching the person with technology and are less oriented to clinical
and psychological dimensions of human-technology interaction:
The psychotechnologist is an expert of Information and Communication Technologies
(ICT), in particular in Human-Computer Interaction (HCI) and human factors and he or
she analyses the relations emerging from the person-technology interaction by taking
into account: a) all the psychological and cognitive components []; b) the possibilities
of adapting and designing eSystems and eServices in an adaptable and accessible man-
ner (eAccessibility) (Chapter 9 of this text, p. xxx).
Division 22 of the American Psychological Association, by reporting Scherer and col-
leagues’ entire entry of The Corsini Encyclopedia of Psychology and Behavioral Science (2004),
remarks that the “rehabilitation psychologist works with the individual with a disability
to address personal factors impacting on the ICF domains of activities and participation”
(2004, p. 802). Moreover, it illustrates most of the issues that should be investigated by a
psychologist in a center for technical aid:
Neurocognitive status, mood and emotions, desired level of independence and interde-
pendence, mobility and freedom of movement, self-esteem and self-determination, and
subjective view of capabilities and quality of life as well as satisfaction with achieve-
ments in specic areas such as work, social relationships, and being able to go where
one wishes beyond the mere physical capability to do so. (Scherer et al. 2004, p. 802)
Because the psychologist works on the adaptive changes on the human side of the person-
environment polarity, he or she should take care to know the features and properties of
the personal factors. One of the most relevant categorizations focuses on which personal
© 2012 by Taylor & Francis Group, LLC
156 Assistive Technology Assessment Handbook
factors are changeable and which are not (Threats 2003, 2007; Howe 2008; Geyh et al. 2011).
Ethnicity, language, cultural background, gender, age, developmental level, sexual orienta-
tion, and sexual identity are all unchangeable personal factors that highly affect, in a given
context, the relation of the user/client with technology (Threats 2003, 2007; Howe 2008;
Geyh et al. 2011). This distinction plays a central role because the psychologist, according to
the humanistic and cross-cultural psychology principles (Olkin 1999), promotes the user/
clients awareness of the individual resources on which he or she can operate to obtain the
best person-technology matching and empowers user/client well-being. In other words,
the team of the center for technical aid operates not only to turn environmental barriers
into facilitators but also to motivate the user/client to do the same on his or her adjustable
individual resources. The psychologist encourages the user/client to explore his or her
individual features and to leverage on all of his or her personal factors that can disclose an
adaptive potential in a given context.
Another main distinction within personal factors concerns the difference between objec-
tive and subjective factors. As reported by Wade, “the focus of rehabilitation is the patient’s
activities, their behavior” (2000, p. 115), but “the nature of a patients beliefs and expecta-
tions can inuence the extent and nature of disability, and indeed may on occasion be the
primary cause” (p. 117). The subjective dimension of functioning has been described by
Ueda and Okawa (2003) as a combination of negative and positive subjective experiences
situated at a “psychological–existential level” (Ueda and Okawa 2003, p. 599). The subjec-
tive dimension is strictly linked with the objective one, interrelated and interacting but also
strongly independent of each other. Ueda and Okawa (2003) make a distinction between
personal factors and the subjective dimension because they put almost all of the traits pro-
posed in literature as belonging to personal factors within the objective level. Aside from
whether or not any consideration of the subjective dimension of functioning is gathered by
the personal factors of the ICF and the extent to which they overlap, there is no doubt that
the “psychological-existential level” should be held in high consideration by the psycholo-
gist. In other words, objective and subjective dimensions are concerned with the different
point of view of individual functioning: On the side of the professional, most of the ICF’s
dimensions can be viewed as objective dimensions, for a codiable and measurable indi-
vidual functioning; on the side of the user/client, most of the ICF codes are relevant insofar
as these are elements of subjective individual functioning or disability experience. Because
the goal of the ATA process is user/client well-being, by providing the best match of user/
client and assistive solution, with human well-being as an outcome of a subtle equilibrium
between the subjective and objective dimension of health (Sen 2002; Federici and Olivetti
Belardinelli 2006; Chapter 2 of this text), the psychologist then should pay signicant atten-
tion to balancing the subjective and objective factors by mediating between the user/
clients request and the multidisciplinary teams assistive solution provision.
The psychologist should give special attention to the difference between body functions
and personal factors. As reported by Threats (2007), there has been some confusion in the
literature between those two components and it is really important to make the right attri-
bution, especially during the assessment stage. In a center for technical aid this distinction
may become particularly relevant when the professional measures the predisposition of
the user/client to the use of technology. Technology use was found to be inuenced not
only by factors associated with the user’s environment and technology characteristics, but
also by nature, characteristics of the purpose of use, and by personal characteristics of the
user (Scherer 1998, 2002). Properly encoding the predisposition to the use of the technol-
ogy allows for the identication of the best-matching solution. For example, if a client with
palsy due to a car accident indicates that he was not condent with technology prior to the
© 2012 by Taylor & Francis Group, LLC
157The Psychologist
incident and that he continues to lack condence, this trait may be considered a personal
factor. However, if he reports that his condence reduced coinciding with the onset of his
palsy, this factor may be categorized within the body function component (Howe 2008).
From this point of view, the Matching Person and Technology (MPT) series of assessments
(Scherer 1998) is a useful measure to make the right attribution concerning the technology
predisposition of the user/client:
The MPT model and accompanying assessment instruments address three primary
areas to assess as follows: (a) determination of the milieu/environment factors inuenc-
ing use; (b) identication of the consumers needs and preferences; and (c) description
of the functions and features of the most desirable and appropriate technology (Scherer
and Cushman 2001, p. 127).
Two instruments within the MPT tool kit are particularly suitable for the psychologist’s
use: the Assistive Technology Device Predisposition Assessment (ATD PA) and the Survey
of Technology Use (SOTU). The ATD PA is a self-report questionnaire with items on a
ve-point scale and yes/no questions that measure an individual’s predisposition to and
readiness for AT device (ATD) use. The follow-up version assesses the realization of benet
from the selected ATD and reasons for situations of nonuse. The ATD PA was developed to
help reduce inappropriate ATD recommendations and the frustration that often accompa-
nies a poor match of person and device (Scherer et al. 2011). In addition, some of the areas
investigated by ATD PA (section B: Well-Being, QOL, and section C: Psychosocial factors)
offer insights for further investigations of the personal traits of the user/client (Scherer
2005). The SOTU is another MPT instrument designed for professionals considering pro-
viding an individual with any kind of technology but who suspect that the individual
may be reluctant to use it. The purpose of the psychologist in administering SOTU is both
to detect if the user/client feels that the use of technology threatens his/her well-being or
self-esteem and to help him/her to discover the positive aspects (Scherer 1998).
Concluding this section, we hold that the psychologists prole in a center for techni-
cal aid is that of the specialist in personal factors, who, more than a rehabilitator, is an
enhancer and an “empowerer” of personal awareness and a mediator and defending
counsel of personal and subjective factors in the multidisciplinary team of professionals.
8.6 Outlining the Psychologists Role in the ATA Process
Although we do not believe that psychology has ended, as we held above in contradic-
tion to Gazzanigas statement, modern psychology has assumed a paradoxical attitude
toward disability not facilitating the formation of a clear role for the psychologist in the
eld of disability. On the one hand, Finkelstein’s autobiography assertion about the risk of
psychology imprisoning disabled people in their bodies “as being not-able” when he was
introduced to the concept of mental decits in brain functioning” (1998, p. 31) is certainly
true if that little mention of disability is raised only during the study of neurophysiology.
What is proved otherwise is that a defense of a discipline as “abnormal psychology” does
not resolve Finkelstein’s assertion when it is claimed that
the distinctions of normal and abnormal are not synonymous with good or bad.
Consider a characteristic such as intelligence. A person who falls at the very upper
© 2012 by Taylor & Francis Group, LLC
158 Assistive Technology Assessment Handbook
end of the curve would t under our denition of abnormal; this person would also be
considered a genius. Obviously, this is an instance where falling outside of the norms is
actually a good thing. (Cherry 2010)
It does not sound very convincing, but it almost says excusatio non petita, accusatio mani-
festa.* On the other hand, modern psychology has grounded its theory in the “school of
suspicion” (Ricœur 1976) of Freud. Abnormality reveals the structures and dynamics of
human behavior. As an anachronistic anticipation, clinical and developmental psychol-
ogy is founded on the basis of a universal model of abnormality. The cases of hysteria and
neurosis gave Freud not only an insight for developing a new therapeutic methodology
but, much more, for creating an ontogenetic human theory. Whereas cognitive neurosci-
ences observe the abnormal behavior of people with brain injury to understand the normal
nervous representation of mental processes, so that abnormality remains an exception in
the human normal functioning (see the section Cognitive Neural Science Integrates Five Major
Approaches to the Study of Cognitive Function in Kandel 2000, p. 384), clinical and dynamic
psychology conversely generalize the abnormal behavior because the mechanisms below,
highlighted by mental illness, are shared by the whole human race. What Zola did in the
1990s, by promoting a demystication of the “specialness” of disability (1989) and assum-
ing a conception of disability that is uid and contextual, modern clinical psychology had
done 100 years before. As a contemporary master of suspicion, Zola indeed reafrmed what
was an acquired theory of clinical psychology—that the dichotomy between normal and
abnormal “is not a human attribute that demarks one portion of humanity from another
[]; it is an innitely various but universal feature of the human condition” (Bickenbach et
al. 1999, p. 1182; see also Zola 1989; WHO and World Bank 2011). The issue of disability for
individuals “is not whether but when, not so much which one, but how many and in what com-
bination” (Zola 1993, p. 18, italics in the original). The clinician psychologists well know that
it is not the basal mechanisms (i.e., body structures and functions) that make the difference
among individuals, but the degrees and combinations of individual functioning.
So, in outlining the psychologists role in the ATA process, we do not want to pour “new
wine into old wineskins,” namely, to create a new psychologists prole from a psychology
that is past. We would recover that which is owned by modern psychology: a hermeneutic
suspicion toward all assessment processes that transform users/clients “as objects to code
rather than human beings to support” (Duchan 2004, p. 65). We would like to outline a
psychologists role that is grounded in the psychologys assumption that the goal of any
psychological support is not the technical x of an abnormal functioning individual, but
personal well-being. In plain words, the psychologist in the ATA process will answer for
a person-centered evaluation through which the selection of one or more technological
aids is facilitated by the (self) awareness of the user/client and his/her milieu in which the
assistive solution provided is only for the personal well-being of the user.
8.6.1 When the Psychologist Role in the ATA Process Is Required
According to the ideal model of an ATA process in a center for technical aid proposed by
Federici and Scherer, the phases in which the clinical psychologist’s competencies are spe-
cically used may be divided into six steps (follow in Figure 8.1 the three blue hexagons
with “ψ”):
An excuse that has not been sought [is] an obvious accusation.
© 2012 by Taylor & Francis Group, LLC
159The Psychologist
1. Acceptance and evaluation of the users request (ψ hexagon 1)
a. User data collecting: When the user provides data to the center for technical aid,
data are collected; then, the case is opened and transmitted to the multidisci-
plinary team. All of the clinical measures, functional analyses, and psycho-
socio-environmental evaluations provided by the user/client are analyzed by
the clinical psychologist to: (i) prole, within the limits of the data collected,
the user/client according to a bio-psycho-social and holistic perspective; and
(ii) draw up a psychological report for the following multidisciplinary team
b. Meeting with the multidisciplinary team: The multidisciplinary team evaluates
the user’s request and data. The clinical psychologists tasks at this stage are
(i)to emphasize the unique and peculiar aspects of the case represented by
the user/client in terms of personal factors and of his or her human and rela-
tional context of life; (ii) to advocate the user/client’s request in the multi-
disciplinary team; and (iii) to facilitate team members’ communications and
solution-seeking in the interest of the user/client.
User’s actions
User/client REQUEST
Request to
solve activity
Request to solve
Providing history
(medical, rehabilitation,
support use) and
environmental data
AT Assessment components
Center for technical aid
User subjective
evaluation of
technological aids
evaluation of
Assistive solution obtained:
public health system or
public/private insurance
Short/long-term use
-Personal, emotional,
social, comfort with use
-Subjective well-being
User living solution
User checking solution
User seeking solution
Personal well-being, user
satisfaction, and benefit
from use
Assistive solution provision
User support
Follow up
process (see
the Usability
Matching process:
Assistive solution
- assistive solution proposal
- assistive solution user-trial
- assistive solution outcome
team evaluation
- user data valuation
and - setting design
User data collection
Setting set-up
team meeting for:
Data elaboration
ICF factors
(user request)
Clinical measures, functional
analysis, and psycho-socio-
environmental evaluations
Assistive solution
aid selection
Flow chart of the ATA process in a center for technical aid: the ATA process can be read both from the perspec-
tive of the user/client or from the perspective of the centre for technical aid. The central column indicates the
ATA components. The three blue hexagons with a “ψ” point out where the clinical psychologist’s competencies
are specically requested.
© 2012 by Taylor & Francis Group, LLC
160 Assistive Technology Assessment Handbook
2. Promoting the assistive solution (ψ hexagon 2)
a. Assistive solution multidisciplinary team evaluation: The multidisciplinary team
arranges a suitable setting for the matching assessment and, along with the
user/client, assesses the assistive solution proposed, tries the solution, and
gathers outcome data. After the matching process the multidisciplinary team
evaluates the outcome. If successful, the team proposes an assistive solution
to the user/client and schedules a new appointment. If not successful, the
process restarts. In this step the clinical psychologist advocates the user/cli-
ent’s request guaranteeing a user-driven assignation process through which
by selecting one or more technological aids an assistive solution is reached.
Active listening, empathy, and ability to reformulate in a shared language the
user/client requirements are the main instruments used by the clinical psy-
chologist in this step. Furthermore, the psychologist might offer the opportu-
nity to reframe the relationship between the user/client and his or her family
within the framework of the new challenges, limitations, and restrictions they
face with the introduction of a new AT.
b. User/client agreement: The multidisciplinary team proposes the assistive solu-
tion to the user/client, who evaluates whether or not the technological aid
proposed by the professionals is a suitable solution. If yes, the user/client then
goes ahead with the process; if no, the user/client exits the process without a
solution for their request or waits for new technological products or profes-
sionals’ solutions. The clinical psychologist may play a central role in this
step (e.g., by requesting that the user/client explores the reasons for rejection,
especially if they are related to personal factors or factors depending on the
context of human relationships). Although the main objective of the ATA pro-
cess is the best assistive solution for the user/client, it is equally true that often
a sufciently good solution is better than no solution.
3. User support and follow-up (ψ hexagon 3)
When the technological aid is delivered to the user/client, a follow-up and ongo-
ing user support are activated. The clinical psychologist works to promote the
well-being of the user/client by regularly monitoring the good quality of matching
achieved in terms of impact on his or her personal empowerment.
8.6.2 How a Psychologist Facilitates the Awareness of the User/
Client’s Context and Multidisciplinary Team Perspectives Methodology
In the model we propose here, we suggest that the person with disability should be the
focus of intervention, being the real “protagonist” of the overall process. Some specica-
tions are otherwise requested, depending on the specic features of the subject, by which
we mean macrofeatures that can be used as guidelines to orient the methodology of working
with” the subject. These features are the age of the disabled subject and the type of disabil-
ity. These variables overlap with other variables connected with the “time” and thus with
when the clinical psychologist operates, whether during the assessment phase, the evalu-
ation of the user’s request, the phase of promotion of the assistive solution, or, in the third
moment, the phase of support and follow-up (see Section 8.6.1). From the methodological
point of view, the clinical psychologist has tools specic to his or her profession: the clinical
interview and psychological tests (personality tests, performance-based personality tests,
© 2012 by Taylor & Francis Group, LLC
161The Psychologist
questionnaires, rating scales, etc.), tools that belong to the realm of psychological assess-
ment for evaluating personality function in the case of disability.
The psychological assessment, having the specic aim to investigate and know the per-
sonal factors (psychological ones) that can mediate the choice and, then, the efcacy of
the use of the AT chosen, will be conducted in a multimethod way (e.g., Hunsley and
Meyer2003), thus by using a multimethod assessment battery, to maximize the validity of
individualized assessments (Meyer et al. 2001).
Moreover, in the area of psychological assessment, a relatively new way of conduct-
ing evaluation has recently emerged that has also been applied in different elds (e.g.,
McInerney and Walker 2002; Tharinger et al. 2009). It is called collaborative assessment and
is mainly based on collaboration between the subject(s) and the psychologist. According
to Finn and Fischer (1997; see also Finn 2003), in the collaborative approach to the assess-
ment the psychologist and the client work together to develop productive understanding,
ensuring that patients will get the most out of their assessment. In the last few years in
the eld of therapeutic research a new paradigm called collaborative assessment has been
devised. This approach, rst devised in 1982 by Fischer in the United States, is based on
the assumptions of collaboration between the psychologist and the client starting from
the testing session. Its major features are collaboration, individualization of the assess-
ment procedure (in the choice of assessment tools), and exibility (different pathways for
different clients). In the assessment conducted with a collaborative approach, the client is
directly engaged: The psychologist asks for client feedback on the assessor’s integrated
impressions. The ndings are thereby tailored to the client’s words (APA 2010). A recent
meta-analysis shows that psychological assessment procedures—when combined with
personalized, collaborative, and substantial test feedback—have positive, clinically mean-
ingful effects on treatment, especially regarding treatment processes, and improve the
impact (Poston and Hanson 2010).
We believe that this method of conducting assessment could guide the work of the clini-
cal psychologist in the ATA center with different clients.
• Phase 1. Acceptance and evaluation of the user’s request (see Figure 8.1, ψ hexagon 1):
• Children: Children with disabilities do not arrive at the ATA center alone but
with their parents or caregivers. For this simple but important reason, it will be
necessary to involve the parents (caregivers) in the evaluation process because
they mediate the information with the child and because they will be respon-
sible for guaranteeing the sustainability and the use of the chosen assistive
solution. For this reason we think that, with children, the search for a suitable
assistive solution is a task that should involve the entire family (see Chapters
5 and 13 of this text). The clinical psychologist will meet the parents together
in a clinical interview, separately from the child, to give them the necessary
time and space for freedom of expression without reciprocal inuence. After
the clinical interview and on the basis of what arises at that stage, tests will be
used for better understanding and objectively acknowledging aspects of the
parenting function that can support, or hinder, the ambition of the ATA center
for the child with a disability. In general, the use of psychological tests in this
phase will concern both parents and the child. This psychological assessment
phase, conducted with the use of a few tests and thus constituting a multi-
method approach (e.g., Hunsley and Meyer 2003), has the specic aim of inves-
tigating and ascertaining the personal factors (psychological ones) that can
mediate the choice and consequently the efcacy of the technical aid.
© 2012 by Taylor & Francis Group, LLC
162 Assistive Technology Assessment Handbook
• Preadolescents and adolescents: What is stressed for childrens and parents’ (or
caregivers’) involvement in the assessment phase is also true for this age
group, but, because the main goal of this age is the construction of self-identity
in terms of self-autonomy, the involvement of the subject in the assessment
phase is particularly important and delicate. Because self-efcacy is central to
the adolescents psyche, the clinical psychologist will evaluate through the use
of the clinical interview and psychological tests—administered in a collabora-
tive way—the active participation of the subject to ensure that the adolescent
is engaged in the process of evaluation of the technical aid, also considering
the impact it could have, especially as it regards his or her self-esteem and self-
image. Parents will also be involved and evaluate if and how their functioning
facilitates or hinders the development of the adolescent in the presence of the
technical aid.
• Adults: The adult subject with a disability has to be treated as a person.
Depending on the specicity of his or her disability, the assessment of his or
her personal factors (psychological assessment) will be done with the use of
the clinical interview and of psychological tests (in a multimethod approach),
also using in this case a collaborative approach, which enhances his or her
active engagement and participation in the process to choose the best techni-
cal aid. Through the clinical interview(s), the psychologist will be allowed to
observe the personal and interior experience of the subject with respect to the
disability and to investigate his or her representations of self with respect to
the disability, his or her expectations of the technical aid, his or her availability
regarding the use of the aid, the best choice of aid, his or her wish for auton-
omy, and his or her self-efcacy. The use of psychological tests—proposed in
a collaborative way and according to a multimethod approach—will allow the
psychological assessment to focus better on aspects of his or her psychological
functioning (personal and relational) that can hinder or support the use of the
shared choice of the technical aid.
• Elderly people: Assessment of personal factors depends on his or her level of cog-
nitive and affective autonomy. If the subject is autonomous and self-sufcient,
he or she will be regarded as if they were an adult. With regards to the older
person, we must consider his or her life perspective and the impact of the tech-
nical aid on this in terms of improving his or her quality of life. If the subject is
not autonomous or self-sufcient, the psychologist will consider and carefully
evaluate the subject’s context (caregivers). In this sense personal factors will not
be separate from the contextual ones.
• Phase 2. Promoting the assistive solution (see Figure 8.1, ψ hexagon 2): In this phase, the
clinical psychologist, by the use of the clinical interview and, if needed, tests, will
observe the suitability of the choice in light of what happened in phase 1. Working
with the subject with the disability (and with the family in the cases described
above), the clinical psychologist gives psychological support to the subject and, as
in an assessment phase, detects the presence of obstacles to the use of the chosen
technical aid, difculties in its acceptance by the subject (or by his or her context),
and aspects of his or her functioning that could interfere with the use of the aid.
The clinical psychologist observes, from the point of view of the subject with dis-
ability (e.g., efcacy, autonomy, mood, self-esteem, and satisfaction), the impact the
aid has on his or her life (and life context) in a positive sense (increment) and in a
© 2012 by Taylor & Francis Group, LLC
163The Psychologist
negative sense (e.g., depressive mood, isolation, withdrawal, etc.). Active listening,
empathy, and the ability to reformulate in a shared language user/client require-
ments are the main instruments used by the clinical psychologist in this stage
within the interview. Furthermore, the psychologist might offer the opportunity
to reframe the relationship between the user/client and his or her family within
the framework of the new challenges, limitations, and restrictions they face with
the introduction of a new AT.
• Phase 3. User support and follow-up (see Figure 8.1, ψ hexagon 3): In this phase the
clinical psychologist assesses the match between the subject and the aid together
with the client. If phase 1 has been conducted rigorously with the psychologist
listening carefully to the subject, it is probable that this third phase will be a good
outcome to the process. It is also possible that in this phase events (external or
internal) in the life of the subject may occur that require a “revision—a new
assessment phase—to reframe the rst choice of aid. Factors of change can also
result from developmental facts (e.g., children with technical aids for learning dis-
abilities). Through the use of the clinical interview and tests, the psychologist will
conduct this phase as a follow-up step in the process. We expect that particular
attention will be paid to the satisfaction of the subject as a measure of the efcacy
of the matching intervention that the psychologist and the client have conducted
together. Quality of life will also be a measure to be taken into account. Goals
The role of the clinical psychologist within the ATA center is mainly linked to his or her
diagnostic competencies and skills and the planning of the intervention. These are clini-
cal competencies: assess to know (in our model, assessing and knowing together) and to
intervene if convenient, useful, and necessary.
The rst goal then is the identication of those aspects of psychological functioning
(personal factors) that promote and sustain the awareness of the subject with a disability
and that are supposed to mediate (1) the choice of a certain technical aid, (2) the acceptance
of the aid, (3) its use, (4) its use over time, and (5) the possibility to change it (for another or
none) if personality changes occur in the person and in case the that the aid is no longer
useful or suitable. In this context, another aspect on which the clinical psychologist will
work—compatibly with the cognitive psychological functioning of the subject with dis-
ability—is the possibility to improve the reective functioning of the subject with the aim
of identifying aspects of the self (of the present and of the future) that mediate the use and
acceptance of the technical aid. The clinical psychologist will also detect and assess clini-
cal conditions signicantly connected to the decit that could hinder the intentional use
of the aid (e.g., depression in a boy affected by injury to the legs after a traumatic accident.
The boy does not accept the wheelchair that could help him to improve his autonomy
because he does not accept the limitation and he is ashamed and feels different from his
friends. He withdraws, does not go outside of his home and does not accept the aid wheel-
chair because it makes him feel different from others).
Tools used in the assessment phase can be used again in the follow-up phase as mea-
sures of the efcacy of the intervention. Other specic measures, such as the perceived
quality of life, will be used to verify the efcacy of the intervention, including measures
directly taken by the subject with disability (and/or by the caregivers) and measures taken
by the psychologist him/herself (or by an external member of the team). Other measures
© 2012 by Taylor & Francis Group, LLC
164 Assistive Technology Assessment Handbook
concern the global evaluation of the subjects autonomy and more specic measures assess
the change of the psychic function with respect to the technical aid used. What a Psychologist Should Do in Promoting a User/Client Request
To conclude this section on the psychologist’s role in the ATA process, we remark, in a
guidelines style, what a clinical psychologist should do in promoting a user/client request.
• Be an expert in the relational eld that is able to listen, receive, and understand
• Be aware of the idiographic approach and sensitive to individual differences in
psychological functioning.
• Have expertise and dynamic comprehension of the bio-psycho-social variables of
functioning, so that the hyphen between “bio-,” “psycho-,” and “social” will not be
a separator but a connector. The perspective is that of interaction, something less
valued by the ICF model.
• Have a developmental perspective, not only when working with children but also
with adults and elderly people. This allows him/her to appreciate the change
always present in life (decremental or incremental; continuous or discontinuous).
• Be able to actively involve the subject in the psychological assessment process with
the aim of improving his or her awareness of the personal factors that mediate the
choice and use of the technical aid.
• Be able to work with, depending on the subject, the different people that belong to
his or her life, respecting their roles and competencies.
• Have clinical competencies: evaluation and planning of the intervention. He or
she should be able to conduct an early assessment but also be able to evaluate the
course of the process and to test its efcacy. We consider as intervention the process
of the choice of a specic aid, done together with and for a specic person with a
disability, which has the specic features of psychological-personal –functioning.
• Be able to use psychological tests and conduct a psychological assessment through
the use of tests in a multimethod way (using not just one instrument but several to
ensure the incremental validity of the evaluation to appreciate the psychological
functioning of the subject). Working in a team that includes the neuropsycholo-
gist, clinical psychologists with such competencies will orient their evaluation to
the axis of psychological functioning with regard to relational functioning and
emotional-affective functioning, being aware of their strong connection.
8.7 Psychologist “Know Thyself: Psychologist and
Professional’s Representations of the Disabled
Users/Clients and Assistive Technologies
The perspective that takes into account human complexity and its mutability better than
others is the biopsychosocial one. The possibility of carrying out this perspective, usefully
combining the contribution of professionals working in the team, needs to acknowledge
© 2012 by Taylor & Francis Group, LLC
165The Psychologist
the specicity and the asset value of interdisciplinary work (Telfener 2011) despite litera-
ture showing how the physicians’ and social workers’ identities are better dened than the
psychologists. In fact, the psychologist’s professional identity tends to follow the physician
or social worker’s model depending on the context (Grasso 2001), as has been highlighted
in a recent study (Cordella et al. 2011) carried out by the Dynamic and Clinical Psychology
Department of the Medicine and Psychology Faculty at Sapienza University in Rome.
8.7.1 Professionals’ Representation of Disability
Research has been performed in an Italian vision rehabilitation center that serves the cen-
tral and southern areas of the country and has worked in the eld for almost one and a
half centuries. It provides many services, including rehabilitation for blind and visually
impaired people of all ages, with a multidisciplinary approach carried out by a variety of
professional gures making up the team. The aim of the study was to explore profession-
als’ identity by using their narrations (Freda 2009) of their professional experiences in the
rehabilitation of people with visual disability.
Interviews were integrally audiotaped, transcribed, and underwent a text analysis per-
formed with a computer software package, T-Lab (Lancia 2004). T-lab performed a cor-
respondence analysis and a cluster analysis to identify groups of lemmas having high
variances within and between clusters. This analysis allows for the identication of reveal-
ing words that characterize the way professionals represent their professional function,
their impaired patients, and the rehabilitation process.
The results show four different clusters characterizing professionals’ accounts that reect
the richness of professionals’ skills and experiences. They highlight the professionals’ abil-
ity to deal with a large variety of problems connected with disability. Management, pre-
vention, training, and advocacy seem to be the goals of the rehabilitation process carried
out by the interaction of the multidisciplinary team. Moreover, professionals working at
the vision rehabilitation center represented four groups: physicians, paramedics, psycho-
social workers, and vision rehabilitation professionals (Table 8.2), and the cluster distribu-
tion in each group was ascertained to explore how it characterizes each group (Figure 8.2).
Profession Groups
A: PHYSICIANS 6 Neuropsychiatrist 4
Ophthalmologist 1
Psychiatrist 1
B: PARAMEDICS 12 Logotherapists 2
Music therapist 1
Nurses 2
Occupational therapist 1
Optometrists 2
Physiotherapist 1
Psychomotricity therapists 3
Social worker 1
13 Typhlo-therapists 13
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166 Assistive Technology Assessment Handbook
The management cluster mostly characterizes physicians and refers to the need to man-
age the working team. Their accounts seem to have contributed particularly to this cluster
construction. Working in a multidisciplinary team determines the necessity to consider
different needs and points of view for these professionals. A comprehensive vision reha-
bilitation service seems to imply the necessity to work on professionals’ interactions.
Therefore, working together is not just a resource because it produces an additional job
that overcomes problems caused by multidisciplinarity. In addition, in this cluster the tar-
get is the team itself and the professional function is focused on management and coor-
dination. Moreover, this representation of the rehabilitation process is not vision-specic.
This representation of the professional function focuses on problematic situations and
puts aside the visual center specicity. Therefore, it targets the team of professionals work-
ing on interventions’ denition rather than the person with disability needs.
Accounts of paramedics and physicians have particularly contributed to the construc-
tion of cluster 3 (prevention). In fact, cluster distribution in the paramedics’ group is
similar to that of the physicians, although it does not overlap with it. In fact, cluster 3 char-
acterizes both of these groups, but for paraprofessionals it seems to be the most important
one. These professionals seem to focus on disabilities associated with visual disability,
giving particular attention to multihandicapped children who need a multidisciplinary
approach. Therefore, professional function is focused on a particular aspect of disability,
especially intellectual, losing visual specicity. The patient is represented as multihandi-
capped and the professional function does not deal directly with visual disability.
It was interesting to note that psychologists have an almost equal distribution in all clus-
ters not being particularly characterized by any of them, suggesting that these profession-
als do not have professional function specicity. Nevertheless, clusters 1 and 3 are slightly
more represented. Hence, probably like physicians and paramedics, these professionals
Cluster 1Cluster 2Cluster 3
Cluster 4
Clusters distribution in four groups of professionals.
© 2012 by Taylor & Francis Group, LLC
16 7The Psychologist
focus their attention on the plurality of disability affecting the young person that neces-
sarily needs a multidisciplinary approach.
Accounts of vision rehabilitation professionals contribute mostly to clusters 2 (training)
and 4 (advocacy), which characterize this group. They represent their professional func-
tion more like training (cluster 2). The process is focused on the professional intervention
of teaching specic solutions through professional training and experience. The process is
considered morally right and attention is not directed to the relationship with someone but
on the professionals’ performances. Although this representation refers to specic tools,
no attention is given to the employment of tools. Therefore, it suggests that rehabilitation
is focused on professional performance rather than on the person with disability needs.
These professionals are also characterized by advocacy (cluster 4), aiming to support
people in the development of knowledge. Visual disability implies behavioral limits that
could hinder the learning process. Therefore, the intervention is directed to young stu-
dents and aims to support their learning as a way to emancipate them from disability. It
is for this reason that the professional’s function is to replace their patient’s decient one.
Whereas the rehabilitation process seems to be focused on a particular moment in life, this
cluster does not take into account the possibility of building new abilities. Substitution
seems to be the only possibility to help the disabled person, but it implies a high personal
involvement for these professionals.
Therefore it is interesting to observe the following:
• Disabled people’s representations focus on their deciencies rather than on the
resources enhancing them. They are not represented as independent, produc-
tive, self-effective, or able to solve problems. This representation does not help
professionals to motivate their patients or help them to assume an active role. A
few recent studies suggest that taking responsibility for managing their own con-
ditions with support and advice from health-care professionals is an important
factor in the rehabilitation process for patients with chronic conditions (Holman
and Lorig 2000; Bodenheimer et al. 2002; Girdler et al. 2010). This is different from
the professional teaching particular solutions or making changes to the patients
home environment. Hence, to assume an active role in the process, people with
disability need to be motivated. This new paradigm in health care aims to pro-
vide the patients with skills and resources to manage the practical, social, and
emotional consequences of their disabilities and to seek specialist support when
• Professionals often address children and young people, whereas the ability to deal
with disabled adults of working age seems to be unexplored. In fact, restrictions
related to disability often result in loss of independence, which is often associated
with a loss of social and economic status, which also implies a cost to society.
• Those who train in the use of ATs do not wonder what these aids represent for the
disabled person and how they will be used.
• Finally, psychosocial workers seem to have less professional function specicity.
In fact, the psychological professional’s function seems to nd its specicity par-
ticularly when it overlaps with psychotherapeutic specicity (Carli 1993; Cordella
et al. 2001). Nowadays, in the disability area, psychological function aims to sup-
port disabled people to face the emotional difculties that arise from the loss of
an ability. Nevertheless, this is not the only function psychologists can carry out,
although it remains useful in the rehabilitation context.
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168 Assistive Technology Assessment Handbook
Considering psychological professional expertise as the ability to seize, interpret, and
make more functional the representations that mediate the relationship between individu-
als and their contexts would allow the widening of the psychologists’ area of intervention.
In this approach, psychologists could facilitate the work of professionals and the multidis-
ciplinary team, making the rehabilitation process of the disabled person more effective.
8.7.2 New Approach in Psychological Practice
To understand how psychological practice could be useful in the ATA process in a center
for technical aid, it is important to introduce the concept of representation. According
to cognitivism, individuals categorize reality not only on the basis of their perceptions,
but also on beliefs related to the perceived object, which makes some similarities more
important than others (Neisser 1989). Therefore, there is a connection between culture and
human cognition, in which the context inuences the individuals’ perception, attitudes,
and behaviors (Ugazio 1989).
According to Moscovici (Moscovici 1961; Farr and Moscovici 1984), representation is
a system of ideas, values, and practices that provides individuals with a code for social
exchange and for categorizing and naming various aspects of their world. Therefore, it
facilitates communication and orientates individuals in their social world, allowing them
to master it. Representations are an approach to the interpretation and social sharing of
knowledge. They are learned from the social context and, at the same time, are discursively
constructed by individuals belonging to the context itself. Therefore, representations are
the process and the result of social construction, constantly converted into a social reality
while continuously being reinterpreted, rethought, and re-presented.
Finally, Matte Blanco (1975) suggests that individuals categorize reality not only by
means of a cognitive process but also through an emotional one. Individuals facing real-
ity categorize it emotionally and cognitively, which allows them to perceive the context as
intentioned. For example, the child that bumps against the corner of a table and strikes it
back attributes a negative intention to the table. Therefore the child recognizes the object
(table) because of his or her ability to categorize it cognitively and, at the same time, he or
she sets his or her behavior (striking the table back) through his or her ability to categorize
it emotionally, representing it. Hence, each time individuals relate with an object (person,
thing, service, technical aid, etc.) they categorize it cognitively and represent it emotionally
depending on their own culture. Therefore, representations determine behaviors that can
be more or less effective in achieving goals.
According to this perspective, psychological expertise is the ability to identify individuals’
emotional representations, helping them to eventually understand how they can hinder
goal achievement (Carli 1993; Grasso et al. 2003; Grasso and Salvatore 1997; Grasso 2010).
For example, a child’s ability to avoid the table’s impact is granted by his or her ability to
pay attention to barriers surrounding him rather than striking back the table. Therefore,
working on individuals’ representations allows for intervention in the problem (avoid
bumping against the table) rather than on the behavior (striking back the evil table) or
directly on the object perceived by the individual as responsible for the problem (the evil
table). Moreover, it helps individuals to relate effectively with their context adapting to it.
8.7.3 Psychological Professional Practice Guidelines in the ATA Process
As claimed previously, psychologists have the skill to work on representations by making
them more functional. Therefore, some guidelines about the psychological approach in the
© 2012 by Taylor & Francis Group, LLC
169The Psychologist
ATA process is drafted here to better understand how to set the practice according to the
target. In fact, psychologists can usefully contribute to the professional team during the
six steps of the ATA process, working on representations and thereby improving service
effectiveness. The User
The user who comes to a center for technical aid has his or her own representation of the
center and of the service provided, which sets his or her requests, behavior, attitudes, and
expectations. This representation will inuence his or her relationship with the profession-
als of the center, hindering or facilitating their work. Hence, the psychologist could start
his or her work from the incoming user request for technical aids. He or she should explore
which needs pushed the disabled user to ask for technical aid at that particular moment
of his or her life. If the professionals take for granted the answer to the user’s request, the
intervention will be focused on the user’s disability rather than on the representation he
or she has of his or her problem. Accordingly, only the “bio” and “social” dimensions of
disability are focused on, omitting the “psycho” dimension, which inuences the way that
the user builds his or her own relationships.
The user’s representation of the service provided by the center determines his or her
request. In fact, two users with the same disability can differently represent their prob-
lems and expect a different reaction (service) from the center. Therefore, one of them could
focus on the right he or she has to obtain the technical aid because of his or her disability,
setting his or her request as a claim for damages and pretending reparation from the pro-
fessionals. The other could focus on his or her passive and dependent role because of his
or her inability, limiting extremely his or her participation and complaining and distrust-
ing professionals. Both of these users would not benet entirely from the service and the
professionals would probably face difculties in working with them, being limited in their
effectiveness by the users’ representations.
Integrating the ATA process with psychologists that are trained to seize, interpret, and
make representations more functional could facilitate the professionals’ work and make it
more effective. In fact, psychologists can work on users’ representations of the center for
technical aid and of the disability, promoting a functional development of their represen-
tations so as to facilitate their active participation in the process. The Family
Families also have their representations of the center and of the disability, which can hin-
der or facilitate the disabled user and increase or decrease center effectiveness and the
professionals’ work. Some families are overprotective whereas others are less protective.
They might have expectations overestimating or underestimating the outcomes, which
will condition their relationship with the disabled user and the professionals.
In fact, relatives’ representations of disability can help or limit the disabled person’s
independence, inuencing their expectations of his or her abilities. In some rehabilitation
centers performing ATA, a day’s role play session has been set up to put relatives in the
same condition as the person with the disability, helping them to face the same challenges
(Greco in press). At the end of the day, participants have an interview with a psycholo-
gist aiming to reorganize their representations of disability. This process helps relatives
to develop a more functional representation, overcoming their fears about disability.
© 2012 by Taylor & Francis Group, LLC
170 Assistive Technology Assessment Handbook
Furthermore, it helps them to cooperate with the disabled user and with the professionals
to solve problems related to disability. The Professionals’ Multidisciplinary Team
Psychologists can also work on professionals’ representations of the center and of the dis-
abled users because they can hinder or facilitate the process and the achievement of goals.
In fact, as has been highlighted in the previously presented study, if the representation
of the user is passive, user abilities are not taken into account, hindering the user’s active
participation in the process. This representation does not help professionals to motivate
their users in assuming an active role. To be effective, the process needs the users’ collabo-
ration; they should take responsibility for managing their own conditions and use support
and advice provided by professionals to become independent. For instance, assigning a
long cane to a disabled user and teaching him to walk with it does not imply that once the
process is over, the disabled person will use the cane to get out of his or her home. There
is a difference between obtaining or being trained in the use of a technical aid and using
it in everyday life.
Because of the psychological difculties people face in adapting to disability, it is up
to the professionals to promote a change in the users’ attitudes (Hayeems et al. 2005;
Godshalk et al. 2008). To achieve this goal, it is important for professionals to perceive the
user as able to state his or her needs and solve his or her problems, representing him as
independent, productive, and self-effective. This is why passive user representation does
not help professionals in being effective. Moreover, the incoming user may not have an
active representation of himself or herself.
Users’ passivity is not negative in all cases. Sometimes it is important for a person to
rely upon the professionals’ ability to take care of them (e.g., when it is not possible to act
directly in relation to the problem, as when it is necessary to undergo surgery). In fact,
passivity can solicit professionals’ care, and it is useful because intervention relies upon
their performance. Nevertheless, in the ATA process, users have to rely upon profession-
als’ performance, but participate actively, because it helps them to collaborate effectively
with professionals.
Moreover, a team of professionals implies different representations that have to be com-
bined. As shown in cluster 1 (management) of the research, this does not facilitate the work
and needs extra effort to manage it. The difculty faced in combining types of professional
expertise can lie within the professionals’ different representations of the process and of
the user.
Finally, the possibility to understand and reorganize the representations of all of the
participants in the ATA process (users, professionals, relatives) would allow for the
improvement of the service provided by professionals, thus making it more effective for
the disabled user in the short and long term. Furthermore, the center could become a real
reference for the disabled user if further problems should occur.
8.8 Conclusions
This chapter deals with the professional skills of the psychologist and the way in which
they are applied in a center for technical aid. This chapter also provides an original
© 2012 by Taylor & Francis Group, LLC
171The Psychologist
contribution to the study of the representations that psychologists and other professionals
endorse of disabled people and AT.
As Meloni, Federici, and Stella demonstrated in a recent study (2011), and as is reported
and discussed in Sections 8.1–8.3, the international scientic literature pays very little
attention to the role and skills of the psychologist in the eld of rehabilitation and, in par-
ticular, in the process of matching people with AT. One of the likely causes of this neglect
could be that the real novelty of the biopsychosocial model, constituted by the presence of
the prex “psycho” between “bio” and “social,” has been largely disregarded through the
noncoding of personal factors in the ICF. The psychologist in a center for technical aid is,
rst and foremost, an expert on personal factors because the predispositions and reactions
of people to using AT are highly personal and individual. Only the psychologist has the
appropriate curriculum and expertise to investigate personal factors, to identify which
ones are critical in allowing or hindering the matching of person and technology, and to
promote adaptive changes on the human side of the person-environment polarity. More
specically, the competencies of the psychologist are involved in some crucial phases of
the ideal model of the ATA process: (1) accepting and evaluating the user’s request, (2) pro-
moting the assistive solution, and (3) providing support and follow-up.
In Section 8.6, Mazzeschi highlighted the psychologist’s main professional goals in a
center for technical aid, which we can summarize as follows: (1) to advocate the user’s
request in the user-driven process, through which the selection of one or more technologi-
cal aids for an assistive solution is made; (2) to act as a mediator between users seeking
solutions and the multidisciplinary team of a center for technical aid; (3) to facilitate team-
building among the members of the multidisciplinary team; and nally (4) to reframe the
relationship between the client and his or her family or caregivers within the framework
of the new challenges, limitations, and restrictions that they are faced with. To achieve
these goals, the psychologist should be an expert in handling the main diagnostic and
assessment tools and in using his or her relationship with the user/client to promote
personal awareness, growth, and the development of human potential and to maximize
In the last section, Cordella, Greco, and Grasso developed another important point in
outlining the psychologists role in a center for technical aid that concerns the represen-
tations that the psychologist and other multidisciplinary team members endorse of dis-
ability and the functions of AT. The quality of life and well-being of a disabled person
depend largely on the ability of professionals, relatives, and caregivers to imagine a range
of existential alternatives and not to nail the prevailing social stereotypes and cultural
prejudices onto the disabled person. For this reason, the psychologist should be engaged
in promoting (both in the multidisciplinary team and in the broader sociocultural context)
the diffusion of a complex, multidimensional, universal, and holistic approach to disabled
people that is rmly founded on the biopsychosocial model of disability.
In conclusion, we have noted the need for a change in attitude and practice in relation to
the role of the clinical psychologist in the ATA process, spurred on by the recent advance
of the biopsychosocial model in the social and scientic communities, the integration of
objective and subjective measures into the diagnostic process, the recognized relevance
ofcontextual factors and, in particular, the personal factors affecting the long-term success
of AT matching, and the increasing interest in the “imbalance of power” in the relationship
between professionals and users. We are convinced that a revision of the ICF is urgently
needed to develop those personal factors that can make a substantial difference during the
rehabilitation process and, in particular, during the ATA process.
© 2012 by Taylor & Francis Group, LLC
172 Assistive Technology Assessment Handbook
Summary of the Chapter
This chapter deals with the role and the competencies of the psychologist in a center for
technical aid. The lapse of the psychologists role in ATA is probably due to the noncoding
of personal factors in the ICF. In viewing the psychologist as the “specialist” on personal
factors, the authors call for a revision of the ICF so that in the biopsychosocial model, the
psycho” does not remain as just a prex. The psychologist in the center has the goals
to support the user’s request in the user-driven process as well as to act as a mediator
between users seeking solutions and the multidisciplinary team. He or she also acts to
build a team spirit and enhance the relationship between the client and his or her home
environment. Finally, an original study closes the chapter, focusing on psychologists and
professionals’ representations of disabled users/clients and ATs.
Fabio Meloni, Stefano Federici, and Aldo Stella contributed equally to this study, except for
Section 8.6, which was edited by Claudia Mazzeschi, and Section 8.7, which was edited by
Barbara Cordella, Francesca Greco, and Massimo Grasso.
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... A basic understanding of human behavior is considered sufficient by many in the AT field to assess the personal factors of a potential AT user. Implicitly or explicitly, this seems to be the attitude of several AT service delivery models (Meloni, Federici, & Stella, 2011;Meloni, Federici, Stella, Mazzeschi, Cordella, Greco et al., 2012). However, this behavior carries the risk of under-evaluating the effect of personal factors on effective AT selection, use, and realization of benefit from use because knowledge of personal factors is not equivalent to knowledge of subjective dimensions and individual functioning. ...
... The psychologist in an AT service delivery process provides an appropriate psychological evaluation or a precise clinical intervention with the users and/or their significant human context over the course of the whole AT assignment process. Assigning greater importance to personal factors would help dramatically reduce the abandonment rate of technologies by users (Phillips & Zhao, 1993;Riemer-Reiss & Wacker, 1999;Riemer-Reiss & Wacker, 2000;Scherer & Craddock, 2002;Scherer, 2005;Scherer et al., 2005;Verza et al., 2006;Söderström & Ytterhus, 2010;Meloni et al., 2011;Meloni et al., 2012). Meloni and colleagues (2012) have defined five points in the psychologist's role and the professional skills of psychologists in the ATA process: ...
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Background. The introduction of assistive technology (AT) into people’s lives is a deliberative and long-term process, which presupposes teamwork as much as professionalism, time, and experience. The aim of the assistive technology assessment (ATA) process is to suggest guidelines to follow in order to reach valid results during the AT selection and assignment process. Purpose. Critically discuss the application of the model of the ATA process developed by Federici and Scherer in the 2012. Method. Cross-cultural comparison of AT service delivery systems and discussion of the ATA process model adopted by Leonarda Vaccari Institute of Rome. Conclusion. Nowadays, the wide variety of AT devices on the market opens new frontiers to the individual’s enhanced functioning, inclusion, and participation. Since the choice of the most appropriate match is often a complex process, a systematic selection process such as the ATA process described in this article can help practitioners to efficiently achieve successful outcomes.
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Objective: This review examines the utility of current active, powered, wearable lower limb exoskeletons as aids to rehabilitation in paraplegic patients with gait disorders resulting from central nervous system lesions. Methods: The PRISMA guidelines were used to review literature on the use of powered and active lower limb exoskeletons for neurorehabilitative training in paraplegic subjects retrieved in a search of the electronic databases PubMed, EBSCO, Web of Science, Scopus, ProQuest, and Google Scholar. Results: We reviewed 27 studies published between 2001 and 2014, involving a total of 144 participants from the USA, Japan, Germany, Sweden, Israel, Italy, and Spain. Seventy percent of the studies were experimental tests of safety or efficacy and 29% evaluated rehabilitative effectiveness through uncontrolled (22%) or controlled (7%) clinical trials. Conclusions: Exoskeletons provide a safe and practical method of neurorehabilitation which is not physically exhausting and makes minimal demands on working memory. It is easy to learn to use an exoskeleton and they increase mobility, improve functioning and reduce the risk of secondary injury by reinstating a more normal gait pattern. A limitation of the field is the lack of experimental methods for demonstrating the relative effectiveness of the exoskeleton in comparison with other rehabilitative techniques and technologies.
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The aim of the present work is to show a critical review of the international literature on eye-tracking technologies by focusing on those features that characterize them as 'psychotechnologies'. A critical literature review was conducted through the main psychology, engineering, and computer sciences databases by following specific inclusion and exclusion criteria. A total of 46 matches from 1998 to 2010 were selected for content analysis. Results have been divided into four broad thematic areas. We found that, although there is a growing attention to end-users, most of the studies reviewed in this work are far from being considered as adopting holistic human-computer interaction models that include both individual differences and needs of users. User is often considered only as a measurement object of the functioning of the technological system and not as a real alter-ego of the intrasystemic interaction. In order to fully benefit from the communicative functions of gaze, the research on eye-tracking must emphasize user experience. Eye-tracking systems would become an effective assistive technology for integration, adaptation and neutralization of the environmental barrier only when a holistic model can be applied for both design processes and assessment of the functional components of the interaction.
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The Assistive Technology Device Predisposition Assessment (ATD PA)—Person Form is one form in the Matching Person and Technology Assessment Process (1). It has initial/baseline and follow-up versions with 54 items divided into three sections: Section A (9 items) captures consumer subjective ratings of functional capabilities with assistance, Section B (12 items) addresses subjective quality of life with or without assistance in the context of activity and participation (2). Sample items from Section B are: • Freedom to go wherever desired; • Participation in desired activities; • Employment status/potential; • Close, intimate relationships; • Fitting in, belonging, feeling connected; and • Emotional well-being.
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Therapeutic Assessment (TA) with children is a hybrid of psychological assessment and short-term intervention. It uses the ongoing process and results of psychological assessment to enhance parents' understanding of their child and to facilitate change. Clinical reports and single case studies suggest that TA with children is an acceptable and effective brief intervention. However, no aggregate data have been published to support this claim. This pilot study investigated the acceptability and preoutcome-postoutcome of TA with 14 clinically referred children with emotional and behavior problems and their parents. Results indicated high treatment acceptability as well as significantly decreased child symptomatology and enhanced family functioning as reported by children and mothers. In addition, mothers demonstrated a significant increase in positive emotion and a significant decrease in negative emotion pertaining to their children's challenges and future. The findings, although limited due to the design and small sample size, support assertions from published single case studies that TA is possibly an efficacious child and family intervention for children with emotional and behavioral problems and should be studied in a larger, comparison design.
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Recent disability studies and classifications use a simple concept of person-environment interaction. Further advances in theory and praxis may require a more complex understanding of that interaction. To present (1) a framework for person-environment interactions that highlights their diversity and (2) initial steps in applying it to theory and practice. For the person, we focus on the identities that the person may assume over time. For the environment, we focus on the initial state and change in reaction to the person or to the effects of the interaction. We take into account overlaps between the person and the environment. THE FRAMEWORK: The framework includes four components of the person's identity: non-disabled, disabled, identity project and identity imputed by others and four components of the environment: the given, the reactive during interaction, modified after interaction and internalised. We also include interactions of the person in different environments that may influence each other, and, do the same for interactions among key actors. An example is given in detail. The praxis of rehabilitation may be enhanced by taking into account the relations among these subsets of personal identity and environment in programme planning, for instance, in the matching of person and assistive technology or in home support services. The framework may serve to build a theory of person-environment interaction in disability that is compatible with interaction in other forms of difference among individuals. Thus, further social theoretical studies would encompass three distinct theories of impairment disability and person-environment interaction, respectively.
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Technology abandonment may have serious repercussions for individuals with disabilities and for society. The purpose of this study was to determine how technology users decide to accept or reject assistive devices. Two hundred twenty-seven adults with various disabilities responded to a survey on device selection, acquisition, performance, and use. Results showed that 29.3% of all devices were completely abandoned. Mobility aids were more frequently abandoned than other categories of devices, and abandonment rates were highest during the first year and after 5 years of use. Four factors were significantly related to abandonment--lack of consideration of user opinion in selection, easy device procurement, poor device performance, and change in user needs or priorities. These findings suggest that technology-related policies and services need to emphasize consumer involvement and long-term needs of consumers to reduce device abandonment and enhance consumer satisfaction.
This paper begins with four reinterpretations about the prevalence, trends, temporality, and spread of disability. Together they lead to a different view of disability as quite pervasive in terms of sheer numbers, length of disability experience, and domains of life, as well as organ systems affected. The denial of this reality is related to our attempt to make disability "fixed" and "dichotomous," whereas it is better conceived of as "fluid" and "continuous." The costs of maintaining the former position are traced in notions of disability's "real" numbers and measurement, as well as in research, policy, and advocacy arenas. A redirection is suggested in terms of a more multidimensional approach and a purging of the inherent negative elements in current conceptions and measurement of disability.
People who have sustained brain injury are administered standardized neuropsychological tests designed to evaluate brain dysfunction. Phenomenology is a descriptive method that seeks to explicate people's lived experience and hence goes beyond the realm of mere brain function. Our method of neurophenomenological assessment mitigates the dangers of reducing people to brain dysfunction, and facilitates collaborative assessment of people who have brain injury. We offer examples of how clinicians can supplement their understanding of brain‐injured people, and we report concrete suggestions that relate to these clients’ everyday lives.
Past discussions of the International Classification of Functioning, Disability and Health (ICF) have focused minimally, if at all, on quality of life. This paper critically discusses the contribution of the ICF to quality of life concept development, and the impact that the ICF has had thus far on health-related quality of life measurement. “Contribution” focuses on modelling the relationship between disablement and quality of life, evaluating the content of existing instruments, and thinking holistically about the individual. “Impact” relates to the association of quality of life with functioning, pathology and outcomes, the trend towards life compartmentalization, and the disproportionate emphasis on individuals' functioning at the expense of their life context. Examples are drawn from adult acquired conditions (mainly aphasia), and terminology used in the paper reflects a rehabilitation stage of service provision. The World Health Organization's approach to quality of life definition and measurement is also discussed. An operational definition of quality of life for adults with acquired communication and swallowing disorders is presented, alongside an alternative conceptualization of quality of life. This paper ends with recommendations for future research concerning the importance of context, the subjective or personal perspective, and having a goals orientation for life as well as rehabilitation. It is also argued here that the ICF and quality of life are different constructs and that quality of life should be the starting point for understanding the client's perspective of his/her goals and/or his/her disability.
To ascertain whether a physician's positive or negative attitude significantly impacts the quality of life of ophthalmic patients. A standardised, validated, time trade-off, utility instrument was administered to consecutive vitreoretinal patients by interview to assess the quality of life associated with their current ocular health state (baseline scenario). Each was then given a scenario for the exact same health state with the same long-term prognosis in which their doctor emphasised the possible negative consequences (bad-news scenario) and one for the same health state in which their doctor emphasised the positive consequences (good-news scenario). Among the 247 patients enrolled were 140 women (57%) and 107 men (43%) with a mean age of 66 years and a mean educational level of 13.8 years after kindergarten. The mean baseline utility for 247 patients was 0.87 (SD = 0.19; 95% CI 0.84 to 0.89). The mean bad-news scenario utility was 0.80 (SD = 0.22, 95% CI 0.78 to 0.83), a 70% diminution in quality of life compared with the mean baseline utility (p = 0.0009). The mean good-news scenario utility was 0.89 (SD = 0.18, 95% CI 0.86 to 0.91), an insignificant difference compared with the mean baseline utility (p = 0.26). Ocular patients had a considerably poorer quality of life when their physician emphasised the possible negative consequences associated with their eye disease(s), as opposed to a more positive approach. While at times necessary, a negative emphasis approach can theoretically result in a considerable loss of life's value.
The World Health Organization's International Classification of Functioning, Disability and Health (ICF) conceptualizes functioning and disability as a dynamic interaction between a person's health condition and their contextual factors. Contextual factors "represent the complete background of an individual's life and living" and comprise two components: Environmental Factors and Personal Factors. This review aims to: (1) discuss why contextual factors are important for speech-language pathologists to address in their clinical practice, (2) describe how environmental factors are coded in the ICF, (3) identify environmental factors that are relevant for people with communication disorders, and (4) identify personal factors that are relevant for people with communication disorders. Research on environmental factors that can influence the functioning of individuals with various communication disorders is presented, in addition to studies on personal factors that are important for speech-language pathologists to consider. The paper concludes that speech-language pathologists need to address contextual factors routinely, in order to provide a holistic approach to intervention for their clients. Furthermore, although a number of contextual factors that are relevant for people with communication disorders have been reported in the literature, more research is needed in this area.
Issues confronting people with disabilities do not result solely from physical or mental impairment, but from the fit between impairments and practically every feature of the social, economic, physical, and political environment. Changes in housing, transportation, and employment policies would augment the quality of daily living for those with disabilities today and in the future. With the entire population facing chronic illness and activity limitations, a universal approach to disability is virtually required, rather than policies focusing exclusively on a person's special needs. The absence of such a universal perspective will lead to the expansion and perpetuation of the segregated and unequal society visible at present.