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NeuroRehabilitation 37 (2015) 315–319
DOI:10.3233/NRE-151264
IOS Press
315
Guest Editorial
Why people use and don’t use technologies:
Introduction to the special issue on assistive
technologies for cognition/cognitive support
technologies
Marcia J. Scherera,∗and Stefano Federicib
aInstitute for Matching Person & Technology, Webster, NY, USA
bUniversity of Perugia, Perugia, Italy
Abstract. This special issue focuses on assistive technologies for cognition/cognitive support technologies as well as the ways
in which individuals are assessed and trained in their use. We provide eleven diverse articles that give information on products,
why they are used and not used, and best professional practices in service provision. Our goal is to highlight a broad topic that
has received limited research investigation and offer an insight into how different countries and programs are promoting access
to and use of assistive technologies for cognition/cognitive support technologies
Keywords: Assistive technology devices, assistive technology services, cognitive support technologies, nonuse, abandonment,
Matching Person and Technology Model, brain injury
1. Introduction
Many neurorehabilitation professionals work with
individuals with a combination of cognitive, physical,
sensory or other disabilities and chronic health con-
ditions and at various stages along the rehabilitation
continuum. This special issue discusses the potential of
a variety of devices for individuals ranging from those
in a minimally and supports conscious state to those par-
ticipating in education and the workplace. To illustrate
this wide range of topics, we begin with a review arti-
cle by Federici, Meloni, Bracalenti and De Filippis that
examines the utility of current active, powered, wear-
able lower limb exoskeletons and their load on working
memory and cognition for paraplegic patients with
∗Address for correspondence: Marcia J. Scherer, Institute for
Matching Person & Technology, 486 Lake Road, Webster, NY 14580,
USA. Tel./Fax: +1 585 671 3461; E-mail: IMPT97@aol.com.
gait disorders resulting from central nervous system
lesions. The article by Lancioni, Singh, O’Reilly et al.
presents the positive effects found in the use of a
technology-aided approach to foster responding and
stimulation control in individuals in a post-coma min-
imally conscious state. The contribution by Bilancia,
Marazz and Filippi discusses a treatment method for an
individual with a Specific Learning Disorder involving
reading and writing difficulties through an interven-
tion based on the integration of a sublexical method
and a neuropsychological approach along with assistive
technologies. Leslie, Kinyanjui, Bishop, et al. con-
ducted a large-scale analysis of workers in the USA
with multiple sclerosis and cognitive and functional
limitations. They addressed who utilizes workplace
accommodations, the types of accommodations most
frequently required, and differences in disease vari-
ables, job-related factors, and quality of life between
workers using and not using work accommodations.
1053-8135/15/$35.00 © 2015 – IOS Press and the authors. All rights reserved
316 M.J. Scherer and S. Federici / Guest Editorial
Support from technology can come from various
mainstream or everyday technologies such as comput-
ers and smartphones, as well as specialized products
that become an integral part of that person’s func-
tioning, persona and self-image such as exoskeletons,
wearable cuing devices, and wearable cameras.
Assistive technology devices (ATDs) have a U.S. fed-
eral definition and are mandated to be considered in
several laws such as the Individuals with Disabilities
Education Act (IDEA). Specialized products or ATDs
include wheelchairs, walkers, communication devices,
products to augment hearing and vision and many more.
Individuals with cognitive disabilities may use any
of these as well as specialized software and apps for
memory, executive functioning, and so on in combina-
tion with personal assistance and cognitive/behavioral
strategies.
An ATD is what the person uses. How they obtain
and maintain it and master its use falls under the
purview of assistive technology services. Professionals
increasingly are better able to respond to consumers’
different needs and preferences because the variety of
technology options continues to expand. However, as
noted in the review article by Leopold, the increased
availability of technology options has made the process
of matching a person with the most appropriate device
more complex because people’s predisposition to,
expectations for, and reactions to and benefit from tech-
nologies and their features are highly individualized
and personal.
In addition to the needs and preferences of the user, a
good match of person and technology requires attention
to aspects of the environments in which the technology
will be used and the various functions and features of
the technology. If the match is not a quality one from
the standpoint of the consumer, the technology may
not be used, or will not be used optimally. Such varied
outcomes are (Scherer, 2005a):
1. optimal use under all recommended conditions
and situations,
2. partial use, where it is used in some situations but
not others or part of the time,
3. non-use, where the technology was once used but
is set aside perhaps because it is no longer needed,
4. avoidance of use, where use is not even consid-
ered,
5. reluctant use, where the individual uses it but does
so with displeasure,
6. abandonment, or permanently giving up use usu-
ally out of frustration or annoyance.
Categories 1–3 can be considered a successful out-
come of the process if the individual reports realization
of benefit from using or having used the technology.
Categories 4–6, however, indicate a failure of the pro-
cess to serve that individual well. Indeed, the overall
non-use or abandonment rate has been approximately
30% for the past thirty years (Scherer, 2014).
We know that there are highly individualized rea-
sons for AT non-use and abandonment. In addition
to the nature of the functional need for the AT and
related functional capabilities/limitations of the per-
son, these reasons arise from consumer (1) personal
factors, including preferences and expectations, and
(2) judgments of the subjective useworthiness of the
device and doworthiness of the task that directly impact
device use and non-use. Research conducted by the
authors has revealed factors common to people who
later stopped using and abandoned their device (see the
recent study on assistive technology abandonment by
Federici, Meloni, and Borsci (in press)). These factors
are summarized in Table 1 according to three primary
influences: of the characteristics of the environment,
person, and technology (Scherer, 2005a).
Persons with disabilities differ as much personally
as they do functionally. They bring expectationsto the
support selection process that are internal and external.
Table 1
Factors associated with device non-use according to characteristics of the characteristics of the environment, person, and technology
Environment Person Technology
Non use •Lack of a user-centered process •Unrealistic expectations of benefit •Discomfort/strain in use
for technology selection •Embarrassed or self-conscious •Obtrusive and intrusive to use
•Little or no support for use from about using device •Is incompatible with the use of
family/peers/employer •Resistant to help from technology other devices
•Setting/environment discourages use or •Doesn’t like a device’s discipline •Is too unwieldly, heavy
makes use difficult or uncomfortable •Many changes in lifestyle with •Is complex and difficult to use
•Requires support that is not available device use •Device is inefficient
•Device choice made by someone else •Lacks skills to use device and •Repairs/service not timely or affordable
training not available •Other and preferred options are available
•Doesn’t trust technology
Source: Institute for Matching Person & Technology as adapted from Scherer (2005a).
M.J. Scherer and S. Federici / Guest Editorial 317
Table 2
Condensed options consumers can choose to indicate why they stopped using an assistive technology device
Assistive Technology Device Predisposition Assessment Follow-up Consumer Form: Reasons for Not Using One or More Devices
a. *It broke and I can’t use it1g. *#I felt self-conscious using it3
b. *#%&It was too inconvenient to use1h. *I didn’t get the training I needed to use it well2
c. *#It wasn’t the right device for me1i. #&It didn’t fit with my needs/preferences/lifestyle3
d. *#%It didn’t help as much as I hoped3j. *#I replaced it with a different device or support. 1What?
e. *#&It was too complicated to use1k. I no longer need to use it because:4
f. *#&It costs too much money to use1l. Other:
g. #&The purpose for using the device isn‘t important to me
1characteristics of the device and its selection for the person. That is, it was a poor selection and decision-making process. 2training for use.
3characteristics and preferences of the person. 4could be due to the person getting better but regardless, it is a body functions and structures item.
*usability; # useworthiness; % doability; & doworthiness.
They carry the expectations of parents, teachers,
employers, peers, and society in general that reflect
varying values and cultural priorities. Individuals also
place expectations on themselves that have evolved
from their prior history with support use, the edu-
cational system and so on. Their particular level of
motivation, judgment, and outlook, and many other fac-
tors serve to combine in a way that defines each as a
unique individual. It is important to note that these influ-
ences interact and affect one another, and can change
with the passage of time and accumulation of experi-
ence. Thus, at a given point in time, each person has a
predisposition to view technology use as being favor-
able or not for certain purposes and in particular settings
or environments. This is well exemplified in the con-
tribution by Adolfsson, Lindstedt and Janesl¨
att who
conducted a qualitative examination of the experiences
of twelve individuals who used electronic planning
devices.
The attitudes of providers and their expectations of
the individual can have a profound influence on persons
with disabilities and their expectations of themselves.
What may seem to be a vital task to the individual
may be given little attention by the provider, and vice
versa. Thus, to achieve a good match of person and
technology, it is important that the potential tech-
nology user be paired with a well-informed and
person-centered provider and that the degree to which
consumer and provider perspectives are shared is
addressed.
The most important influence on an individual’s use
of the selected support is how well it actually serves
that person. That is, how much it helps the individual
accomplish desired goals and activities, fits with his
or her lifestyle, routines, and preferences and does not
result in stress and frustration, and enhances well-being.
Therefore, also considering individual’s affective and
emotional states can improve the process of matching
person and technology. To this end, Liberati, Fed-
erici and Pasqualotto performed a systematic review of
studies investigating the recognition of emotions from
neurophysiological signals, in order to improve the use
of brain-computer interfaces (BCIs), by adapting them
to the user’s needs.
When the goal involves support from technologies,
key factors for consideration are motor skills, moti-
vation and psychological readiness for use. For many
users of assistive technologies, their devices become
an extension of the self, not just to themselves but
also to other persons. The device, then, is incorporated
into the individual’s identity. But this process can be
difficult for some, thus leading to underutilization
or nonuse.
2. Personal and technology factors
The individual’s use of an AT will be affected sig-
nificantly by characteristics of the device itself as well
as the priorities and preferences of the person. Accord-
ing to Oskar Krantz (2012), device usability (that is, its
size, weight, durability, etc.) may or may not correlate
with the subjective determination of its “useworthi-
ness.” Krantz illustrates the differences in these terms,
as well as task doability and doworthiness, as follows:
A wheelchair with mechanical properties match-
ing the user (usability) increases the mobility of
the user, allowing for a greater number of activi-
ties (doability). However, the wheelchair has to be
worth using in order to be utilized (useworthiness)
and the activity has to be worth performing in order
to be performed (doworthiness) (p. 193).
Once the device is usable by the person, then the per-
son has to value the task or purpose for which the device
is intended. Thus, useworthiness is related to individual
318 M.J. Scherer and S. Federici / Guest Editorial
values and judgement whereas usability can be more
objectively measured. Useworthiness and usability both
need to be present for a good match of person and
device. AAC devices provide a good example. A per-
son may be able to use one very proficiently. But if the
person prefers to have a caregiver speak for them to
conserve energy then it lacks useworthiness.
In line with Federici and Borsci (2014), dowor-
thiness and useworthiness, as well as usability and
environments of use (Mirza, Gossett Zakrajsek, &
Borsci, 2012), are factors that have to be considered
by providers during the process of technology selec-
tion and delivery. In fact, a strong relationship was
found between the quality of the delivery processes of
providers and the likelihood of technology abandon-
ment. The more the providers applied a user-centered
approach and took into account key personal factors,
the more likely it was that people used the technology
(Federici & Borsci, 2011, 2014).
2.1. Matching Person and Technology (MPT)
model
Table 2 depicts a section of the Assistive Technol-
ogy Device Predisposition Assessment, one form in the
Matching Person and Technology Model and Assess-
ment Process (Scherer, 2005b). The Matching Person
and Technology (MPT) Model has been described in a
trilogy of books (Scherer, 2004, 2005a, 2014) as well
as an edited volume on assistive technology assessment
(Federici & Scherer, 2012) and a journal article (Scherer
& Craddock, 2002).
Fundamentally,theMPTModelhas three crucialareas
of foci that represent the primary biopsychosocial com-
ponents that most influence use of assistive technologies
(see Table 1): (a) The needs, preferences and character-
istics of the unique person (b) the milieu/environment(s)
in which the user will interact with the technology,
and (c) the functions and features of the most desir-
able and appropriate technology. The MPT model
was operationalized by developing an evidence-based,
client-centered assessment for determining the match of
individuals with the most appropriate technologies for
their use. The assessment process consists of a series of
measures that provide a person-centered and individu-
alized approach to matching individuals with the most
appropriate technologies for their use. It has been the
foundation for research by others internationally and
has been translated into multiple languages. Examples
of its use in the USA are provided by the contribu-
tions from researchers associated with Project Career, an
effort to assess and address the needs of adults with trau-
matic brain injuries enrolled in college across multiple
institutions. These articles were written by Hendricks,
Sampson,Rumrillet al. andNardone,Sampson,Stauffer,
et al. An example of its use in acute and outpatient cog-
nitive rehabilitation is provided by Fleeman, Stavisky,
Carson, et al. It has also been found helpful in training
individuals in the use of assistive technologies for cog-
nition/cognitive support technologies (Powell, Glang,
Pinkelman, et al.).
Successfully treating, supporting and empowering
consumers and their families to live with neurological
disability involves more than medical intervention.
As Williams and Edwards (2003) have claimed in
the special issue on Biopsychosocial Approaches in
Neurorehabilitation, much of what happens in neu-
rorehabilitation requires understanding the complex
interaction of biological, psychological and social
influences on affect and behavior. In this special issue,
we intend to provide insights to neurorehabilitation
professionals and experts in how different countries and
programs are promoting access to and use of assistive
technologies for cognition according to a biopsycho-
logical approach. Overcoming a neurological issue
through the use of an assistive technology requires
more than just a device. It requires matching that
device or support to the person’s preferences and char-
acteristics, and to evaluate the interaction of the device
with the family and the environments of everyday
life.
Acknowledgments
The development and validation of the Matching Per-
son and Technology Model and assessments were made
possible by funding from the following sources:
Centers for Disease Control and Prevention, Grant
number DD000219 to the Institute for Matching Person
& Technology, Inc. for the project, Matching Assistive
Technology and CHild (MATCH).
National Institutes of Health, National Institute of
Child Health and Human Development, National Cen-
ter for Medical Rehabilitation Research. Grant number
HD052310 to The Institute for Matching Person &
Technology, Inc. for the project, Improving the Match
of Person and Assistive Cognitive Technology.
National Institutes of Health, National Institute of
Child Health and Human Development, National Cen-
ter for Medical Rehabilitation Research. Grant number
HD38220 to The Institute for Matching Person &
M.J. Scherer and S. Federici / Guest Editorial 319
Technology, Inc. for the project, Improving the Match
of Person and Mobility Technology.
National Science Foundation, Ethics and Values
in Science and Technology and Biotechnology &
Research to Aid the Handicapped. Grant number RII-
8512418 for research project, Improving Technological
Innovations for People with Physical Disabilities.
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