Rehabilitative and assistive technologies are tools, equipment, or products that can help people with disabilities function successfully at school, home, work, and in the community.

Assistive technology can be as simple as a magnifying glass or as complex as a digital communication system. An assistive device can be as large as a power wheelchair lift for a van or as small as a handheld hook that assists with buttoning a shirt.

Tools to help people recover or improve their functioning after injury or illness are sometimes called “rehabilitative technology.” But the term is often used interchangeably with the term “assistive technology.”

NICHD supports research on developing and evaluating technologies, devices, instruments, and other aids to help people with disabilities achieve their full potential.

Rehabilitative engineers use scientific principles to study how people with disabilities function in society. They study barriers to optimal function and design solutions so that people with disabilities can interact successfully in their environments.

If you have a disability or injury, you may use a number of assistive devices. These are tools, products or types of equipment that help you perform tasks and activities. They may help you move around, see, communicate, eat, or get dressed. Some are high-tech tools, such as computers. Others are much simpler, like a "reacher" - a tool that helps you grab an object you can't reach.

Some examples of assistive technologies are:

• Mobility aids, such as wheelchairs, scooters, walkers, canes, crutches, prosthetic devices, and orthotic devices.
• Hearing aids to help people hear or hear more clearly.
• Cognitive aids, including computer or electrical assistive devices, to help people with memory, attention, or other challenges in their thinking skills.
• Computer software and hardware, such as voice recognition programs, screen readers, and screen enlargement applications, to help people with mobility and sensory impairments use computers and mobile devices.
• Tools such as automatic page turners, book holders, and adapted pencil grips to help learners with disabilities participate in educational activities
• Closed captioning to allow people with hearing problems to watch movies, television programs, and other digital media.
• Physical modifications in the built environment, including ramps, grab bars, and wider doorways to enable access to buildings, businesses, and workplaces.
• Lightweight, high-performance mobility devices that enable persons with disabilities to play sports and be physically active.
• Adaptive switches and utensils to allow those with limited motor skills to eat, play games, and accomplish other activities.
• Devices and features of devices to help perform tasks such as cooking, dressing, and grooming; specialized handles and grips, devices that extend reach, and lights on telephones and doorbells are a few examples.

Rehabilitative technologies and techniques help people recover or improve function after injury or illness. Examples include the following:

• Robotics. Specialized robots help people regain and improve function in arms or legs after a stroke.
• Virtual reality. People who are recovering from injury can retrain themselves to perform motions within a virtual environment.
• Musculoskeletal modeling and simulations. These computer simulations of the human body can pinpoint underlying mechanical problems in a person with a movement-related disability. This technique can help improve assistive aids or physical therapies.
• Transcranial magnetic stimulation (TMS). TMS sends magnetic impulses through the skull to stimulate the brain. This system can help people who have had a stroke recover movement and brain function.
• Transcranial direct current stimulation (tDCS). In tDCS, a mild electrical current travels through the skull and stimulates the brain. This can help recover movement in patients recovering from stroke or other conditions.
• Motion analysis. Motion analysis captures video of human motion with specialized computer software that analyzes the motion in detail. The technique gives health care providers a detailed picture of a person’s specific movement challenges to guide proper therapy.

Some devices incorporate multiple types of technologies and techniques to help users regain or improve function.

Rehabilitative technology can help restore or improve function in people who have developed a disability due to disease, injury, or aging. Appropriate assistive technology often helps people with disabilities compensate, at least in part, for a limitation.

For example, assistive technology enables students with disabilities to compensate for certain impairments. This specialized technology promotes independence and decreases the need for other support.

Rehabilitative and assistive technology can enable individuals to:

• Care for themselves and their families
• Work
• Learn in typical school environments and other educational institutions
• Access information through computers and reading
• Enjoy music, sports, travel, and the arts
• Participate fully in community life

Assistive technology also benefits employers, teachers, family members, and everyone who interacts with people who use the technology.

As assistive technologies become more commonplace, people without disabilities are benefiting from them. For example, people for whom English is a second language are taking advantage of screen readers. Older individuals are using screen enlargers and magnifiers.

The person with a disability, along with his or her caregivers and a team of professionals and consultants, usually decide which type of rehabilitative or assistive technology would be most helpful. The team is trained to match particular technologies to specific needs to help the person function better or more independently. The team may include family doctors, regular and special education teachers, speech-language pathologists, rehabilitation engineers, occupational therapists, and other specialists, including representatives from companies that manufacture assistive technology.

Some disabilities are quite visible, while others are “hidden.” Most disabilities can be grouped into the following categories:

• Cognitive disability: intellectual and learning disabilities/disorders, distractibility, reading disorders, inability to remember or focus on large amounts of information
• Hearing disability: hearing loss or impaired hearing
• Physical disability: paralysis, difficulties with walking or other movement, inability to use a computer mouse, slow response time, difficulty controlling movement
• Visual disability: blindness, low vision, color blindness
• Mental conditions: post-traumatic stress disorder, anxiety disorders, mood disorders, eating disorders, psychosis

Hidden disabilities are those that might not be immediately apparent when you look at someone. They can include visual impairments, movement problems, hearing impairments, and mental health conditions.

Some medical conditions may also contribute to disabilities or may be categorized as hidden disabilities under the Americans with Disabilities Act (ADA). For example, epilepsy; diabetes; sickle cell conditions; HIV/AIDS; cystic fibrosis; cancer; and heart, liver, or kidney problems may lead to problems with mobility or daily function, and may be viewed as disabilities under the law. The conditions may be short term or long term; stable or progressive; constant or unpredictable; and changing, treatable, or untreatable. Many people with hidden disabilities can benefit from assistive technologies for certain activities or during certain stages of their diseases or conditions. Visit https://www.ada.gov/ada_intro.htm for more information about the ADA.

People who have spinal cord injuries, traumatic brain injury, cerebral palsy, muscular dystrophy, spina bifida, osteogenesis imperfecta, multiple sclerosis, demyelinating diseases, myelopathy, progressive muscular atrophy, amputations, or paralysis often benefit from complex rehabilitative technology. The assistive devices are individually configured to help each person with his or her own unique disability.

Assistive technology (AT) is any service or tool that helps older adults or persons with disabilities perform activities that might otherwise be difficult or impossible.

For older adults, such technology may be a walker to improve mobility or an amplification device to make sounds easier to hear. It could also include a magnifying glass for someone who has poor vision or a scooter that makes it possible for someone to travel over distances that are too far to walk. In short, AT is anything that aids continued participation in daily activities.

AT allows many people to live independently without long-term nursing or home health care. For some, it is critical to the ability to perform simple activities of daily living, such as bathing.

Choosing AT

Older adults should carefully evaluate their needs before purchasing AT. Using AT may change the mix of services that they require or affect the way that those services are provided. Needs assessment and planning are very important.

Usually, a needs assessment is most effective when done by a team working with the older adult in a place where the AT will be used. For example, someone who has trouble communicating or hearing might consult his or her doctor, an audiology specialist, a speech-language therapist, and family and friends. Together, they can identify precise challenges and help select the most effective devices available at the lowest cost. A professional member of the team, such as the audiology specialist, can also arrange for any training needed to use the equipment.

When considering AT, it is useful to consider high-tech and low-tech solutions. Older adults should also think about how their needs might change over time. High-tech devices tend to be more expensive but may address many different needs. Low-tech equipment is usually less expensive but also less adaptable.

Rehabilitation engineering is the use of engineering principles to 1) develop technological solutions and devices to assist individuals with disabilities and 2) aid the recovery of physical and cognitive functions lost because of disease or injury.

Powered prosthetic leg. Source : M. Goldfarb, Vanderbilt U.

Rehabilitation engineers design and build devices and systems to meet a wide range of needs that can assist individuals with mobility, communication, hearing, vision and cognition. These tools help people with day-to-day activities related to employment, independent living and education.

Rehabilitation engineering may involve relatively simple observations of how individuals perform tasks, and making accommodations to eliminate further injuries and discomfort. On the other end of the spectrum, rehabilitation engineering includes sophisticated brain computer interfaces that allow a severely disabled individual to operate computers and other devices simply by thinking about the task they want to perform.

Rehabilitation engineers also improve upon standard rehabilitation methods to regain functions lost due to congenital disorders, disease (such as stroke or joint replacement) or injury (such as limb loss) to restore mobility.

For more information on rehabilitation engineering at NIH, see https://www.nichd.nih.gov/publications/pubs/Documents/NIH_ResearchPlan_Rehabilitation.pdf

Ongoing research in rehabilitation engineering involves the design and development of innovative technologies and techniques that can help people regain physical or cognitive functions. For example:

• Rehabilitation robotics, to use robots as therapy aids instead of solely as assistive devices. Smart rehabilitation robotics aid mobility training in individuals suffering from impaired movement, such as following a stroke.
• Virtual rehabilitation, which uses virtual reality simulation exercises for physical and cognitive rehabilitation. These tools are entertaining, motivate patients to exercise, and provide objective measures such as range of motion. The exercises can be performed at home by a patient and monitored by a therapist over the Internet (known as tele-rehabilitation), which offers convenience as well as reduced costs.
• Physical prosthetics, such as smarter artificial legs with powered ankles, exoskeletons, dextrous upper limbs and hands. This is an area where researchers continue to make advances in design and function to better mimic natural limb movement and user intent.
• Advanced kinematics, to analyze human motion, muscle electrophysiology and brain activity to more accurately monitor human functions and prevent secondary injuries.
• Sensory prosthetics, such as retinal and cochlear implants to restore some lost function to provide navigation and communication, increasing independence and integration into the community.
• Brain computer interfaces, to enable severely impaired individuals to communicate and access information. These technologies use the brain’s electrical impulses to allow individuals to move a computer cursor or a robotic arm that can reach and grab items, or send text messages.
• Modulation of organ function, as interventions for urinary and fecal incontinence and sexual disorders. Recent developments in neuromodulation of the peripheral nervous system offer the promise to treat organ function in the case of a spinal cord injury.
• Secondary disorder treatment, such as pain management.