Assistive device is also known as assistive technology device to help rehabilitation, so it is also referred to as rehabilitative and assistive technology. An assistive device is defined as any product, instrument, device or technical system that helps prevent, compensate for, mitigate or replace the loss or absence of a physical function or a functional limitation caused by a disability. The primary purpose of assistive products is to maintain or improve an individual’s functioning and independence, thereby promoting their well-being.

 

The origination and development of assistive devices are closely related to the needs of persons with disabilities. After World War II, there was a dramatic increase in the number of people with disabilities. In order to protect their rights and interests, the United States Department of Veterans Affairs (VA) took the lead in establishing the Office of Rehabilitation Research and Development (RR&D), specializing in the research and development of rehabilitation technology for the disabled.

 

Assistive devices were initially aimed at people with disabilities, especially those with physical disabilities, and then the extended groups of users including aging seniors, patients with injuries or illnesses, pregnant women and even people with sub-health conditions. Wheelchairs, crutches, canes, glasses and cochlear implants are all assistive devices. In recent years, with the acceleration of world population ageing and people’s pursuit of convenience, the demand for assistive devices has been growing rapidly, facilitating rapid development of the assistive device industry at a global scale.

 

The assistive device sector had a relatively later start in developing countries and people with disabilities cannot easily access assistive devices to realize their due rights. People with disabilities often encounter these problems in daily life: unable to afford an assistive device because it is too expensive; hard to find a suitable assistive device because there are limited options; suffering secondary health complications due to poor quality assistive devices, etc. According to the World Report on Disability by World Health Organization (WHO), around 15% of the world’s population live with a disability, in need of assistive technologies; and more than 2 billion people around the world are expected to need at least one assistive device by 2030.

 

WHO’s community-based rehabilitation (CBR) guidelines stated: “Access to assistive devices is essential for many people with disabilities and is an important part of any development strategy. Without assistive devices, people with disabilities may never be educated or able to work, so the cycle of poverty continues.” This thus underlines the necessity of assistive devices for people with disabilities to develop their potential, compensate for or replace the lost capabilities, and overcome their physical or functional impairments.

 

Individuals with disabilities have their unique conditions, and there are many types of assistive devices with different functions. So these individuals need suitable assistive devices with the right functions for them. Generally, assistive devices have three main types of functions: compensating for a functional limitation, replace a lost function, and creating barrier-free environments. Moreover, in terms of the lost capabilities of disabled individual and the functional strength of assistive devices, these assistive devices can be classified into three types: strengthening, substitutive, and adaptive devices.

 

(1) Compensate for a functional limitation. People with disabilities that experience difficulties in mobility and social participation due to a limited function, may still have potential to use the remaining part of that function. In this case, they can supplement or compensate for the lost part with the strengthening assistive devices to overcome the limitations and restart their social participation. For example, wearing hearing aids enables the deaf that have remaining “residual” hearing to hear the world again.

 

(2) Replace a lost or absent function. In the event of the complete loss or absence of a function, individuals with disabilities will not be able to participate in society through compensation because there is no remaining part left, and they need to replace the lost function by using substitutive assistive devices, so as to resume mobility and social participation. For example, the blind replace their lost visual function with assistive devices like tactile and auditory aids, such as canes and braille; people with limb amputation can still walk, ride bicycles and work with heavy loads by fitting prosthetic limbs.

 

(3) Create barrier-free environments. When the above two types of assistive devices fail to address the social participation limitations for persons with disabilities, the adaptive devices should be used to create barrier-free environments for their social engagement and participation. For example, for a blind person to cross the road, there is no guide device for the blind available on the market that recognizes the traffic light, so a buzzer is required to indicate the traffic light with different sounds. This is an application scenario for adaptive assistive devices.

 

Different types of assistive devices have different functions, and they can effectively compensate for the impaired (lost) capabilities for people with disabilities, mitigate the effect accompanied with the weakening of a body function, help reduce their demand for care givers, and prevent primary and secondary health problems, and lower the states’ costs on health and welfare.

 

 

Access to assistive devices is gaining more and more significance because assistive devices play an important role in enhancing physical functions of persons with disabilities, and ensuring that they can maintain their independence and dignity for social participation. At the 10th World Congress of the International Society for Prosthetics and Orthotics (ISPO) in 2001, Dr. Enrico Pupulin presented the Knud Jansen Lecture and proposed the 3A standards for assistive devices, which are: appropriate technology, appropriate thinking, and appropriate quality. By these standards, expensive prices do not always mean better assistive devices. The best way to maximize the functions of assistive devices is to keep the disabled well informed of these devices and enable them to choose the most suitable one(s), which is the only effective way to actually secure the rights and interests of people with disabilities.

 

Since the 1980s, many international documents have included provisions on “access to assistive devices”. In 1982, the UN General Assembly adopted the World Programme of Action Concerning Disabled Persons. The Programme stresses that societal barriers impede the full participation by persons with disabilities in society, and securing access to assistive devices is a key measure to compensate for their lost capabilities and remove such barriers so that persons with disabilities will readapt to social life. According to the Standard Rules on the Equalization of Opportunities for Persons with Disabilities adopted in 1993, States should ensure sufficient provision of assistive devices, and provide such devices and equipment free of charge or at such a low price that persons with disabilities or their families can afford to buy them, and ensure that all persons with disabilities who need assistive devices should have access to them in order to truly achieve the equalization of opportunities. In 2006, the Convention on the Rights of Persons with Disabilities (CRPD) made “access to assistive devices” an important right in the international human rights law. As stipulated in Article 4 - General obligations of the Convention, States Parties are obliged to undertake or promote research and development of, and to promote the availability and use of new technologies, including mobility aids, devices and assistive technologies, suitable for persons with disabilities, giving priority to technologies at an affordable cost; and provide accessible information to persons with disabilities about such devices or new technologies. Further, there are also provisions regarding the access to assistive devices in the specific articles about the rights of persons with disabilities. For example, Article 20 of the Convention stipulates that States Parties should facilitate access by persons with disabilities to quality mobility aids, devices ad assistive technologies at affordable cost. In the Law of the People’s Republic of China on Protection of Disabled Persons, Article 17 stipulates: “The government departments concerned shall organize and support the research, manufacture, supply and maintenance of rehabilitation instruments, appliances for self-service, special supplies and other assistive devices for the disabled persons.” States should actively provide assistive devices to people with disabilities, which is an important measure to ensure the realization of their right to rehabilitation.

 

In short, access to assistive devices means that people with disabilities can access high quality, sufficient supply, and affordable assistive devices to meet their needs and environmental conditions.

 

Access to assistive devices has its conditions. The provision of a single piece of assistive equipment for individuals with disabilities does not constitute access to assistive devices; instead there are requirements to be met: First, assistive devices must be accessible within the affordability of the people with disabilities; second, assistive devices must be suitable for people with disabilities to meet the needs and compensate for their lost capabilities; third, assistive devices must be appropriate to the environment of the disabled; fourth, persons with disabilities must be provided with sufficient supply of assistive devices of appropriate quality. Access to assistive devices for the general population in developing countries is not optimistic. There are several common issues, such as the expensive prices, small variety, low technology, and poor quality.

 

 

In 2000, the Committee on Economic, Social and Cultural Rights (CESCR) adopted Substantive Issues Arising in the Implementation of the International Covenant on Economic, Social and Cultural Rights (General Comment No. 14): The Right to the Highest Attainable Standard of Health (Article 12), which defines States parties’ obligations, both domestic and international, with respect to the protection of the right to health. International obligations include providing necessary assistance and avoiding agreements that affect the protection of the right to health. The former means that States parties and other actors in a position to assist, to provide “international assistance and cooperation, especially economic and technical”; the later means that the failure of the State to take into account its legal obligations regarding the right to health when entering into bilateral or multilateral agreements with other States will be regarded as a violation of the obligation to protect the right to health. Domestic obligations require States parties to ensure that legal and other regimes in place to protect the moral and material benefits arising from authors’ scientific, literary and artistic works do not affect compliance with States parties’ core obligations of the right to health. China has included the provision on assistive devices in the Law on Protection of Disabled Persons as a form of rehabilitation services.

 

In recent years, China has moved forward fast with its agenda on the protection of people with disabilities, for example, the inclusion of assistive devices in the catalog of national basic public services, the expanding variety of assistive products, and the continually improved quality of services, which has brought great convenience for the disabled individuals in terms of daily life, learning and work. In October 2021, Care & Rehabilitation Expo China was held at China National Convention Center in Beijing. The host set up exhibition areas for a range of exhibits including assistive technology results for the disabled, walking and mobility aids, prostheses and orthoses, barrier-free facilities, rehabilitation equipment and therapy, and communication and information aids. The expo presented a comprehensive demonstration of the development achievements of assistive devices for the disabled in China during the “13th Five-Year Plan” period, focusing on the cutting-edge technologies, products and solutions in the field of assistive devices in the country, reflecting the remarkable achievements of the Chinese assistive device industry.

 

However, in general, the development of assistive devices and public services for the disabled in China is still at a low level, which is far from meeting the growing needs of disabled people in terms of living, rehabilitation, education, and employment. On the one hand, there is a huge demand for assistive devices for the disabled in China. According to the data from the Second China National Sample Survey on Disability, China has about 83 million people with disabilities, among whom 38.56% are in need of assistive devices. However, only 7.31% of these disabled people have access to assistive devices and services. In particular, due to the rapidly growing population ageing and the epidemic prevention and control measures, more and more disabled people are in need of assistive devices. On the other hand, people with disabilities have increased their requirements for access to assistive devices. With the social development and the improvement of people’s living standards, most disabled people have gradually shifted their requirements for assistive devices, from the basic devices in the past to more personalized adaptive assistive devices. They have begun to lost interest in some general-purpose assistive devices that lack technological content, such as ordinary crutches and wheelchairs. Therefore, China still needs to take active measures to improve the adaptation rate of assistive devices in the country, so that more disabled people can access assistive devices suitable for them.