Web Posted on: February 17, 1998
DILEMMAS OF TECHNOLOGIES IN CONTEMPORARY REHABILITATION
Krystyna Bleszynska
School of Education Warsaw University
Seven hundred years ago there lived in France Pierre Abelard. Today we remember mostly his relationship with the beautiful Heloize so tragically terminated. However in the XII century Abelard was considered to be one of the greatest philosophers and teachers of his time. His "Sic and Non" teaching method was famous in the contemporary world.
The essence of Abelard's method is stimulating students by way of putting forward contradictory assumptions and viewpoints related to a chosen branch of thought. And although Abelard used this method in relation to dialectics so popular throughout the Middleages, it seems that today we may also consider it's usefulness in view of the requirements of contemporary concepts concerning employing technologies for disabled people.
1. Assistive Technology devices are formed influenced by assumptions of the contemporary rehabilitation paradigm.
A. Sic.
Normalization is the fundamental rehabilitation paradigm of today. This means in accordance with Wolfenberger's concept (1980) making use of standard and highly evaluated means aimed at enabling the disabled person to secure the appearance, life style and level of functioning only infinitesimally differing from the appearance, life style and level of functioning accepted as normal by the surrounding community. A considerable part of means of assistive technology, particularly the computer network, meet the requirements of the above mentioned assumptions. We have here as well appliances of standard character (computers or optical and electroacustical appliances) which may be used as well by persons without disabilities as means generally considered as attractive and valuable. These very means may enable disabled people to live and function in accordance with the idea of a normal and dignified existence accepted in contemporary societies.
B. Non.
On the other hand some ways of making use of modern technologies to cope with disability (particularly these which abuse the above mentioned means) may in effect bring about a kind of social perception of the disabled individual as different, not selfdependent and unable to lead a normal life outside the technological cocoon. This certainly will take place mostly in cases of making use of the technical means in form and degree surpassing considerably the common standards. Fearsome and biased attitudes towards contemporary medical technologies most common in numerous societies may also have an impact as far as forming of attitudes towards the whole group of disabled people is concerned. Analyzes of public opinion as well as of numerous discussions in the media confirm many misgivings concerning the interference of technique into human life (Man kills himself 1983). Thus we must take into account a process of intensification of the above mentioned mistrust, emotional stresses and feelings of physical and functional differences so common in contacts of nonprofessionals with persons with visible disfunctions, deformations and development disorders. All this may in effect only increase biased attitudes and mental barriers in contacts of persons without disabilities with disabled persons.
2. Development of assistive technology encourages social integration of persons with disabilities.
A. Sic.
One of the conditions of fill normalization of the disabled person's life and social situation is his/her most extensive integration in the life of a larger community. There are numerous rehabilitation programs aimed at compensating chances, creating friendly environment and organizing social services undertaking proper activities as well with disabled people as with people without disabilities functioning in the same community. These activities include in accordance with Landecker's concept normative integration (problems of creating and conveying rules determining interhuman relations), cultural integration (aimed at unification of life styles), functional integration (creating relations and interdependencies among the participants of various kinds of collective life) and communication integration (unifying of communication systems and codes and facilitating mutual understanding). The accomplishment of the above mentioned canon of integration in case of people with disabilities requires, among others, undertaking activities encouraging their ability of perception, making use of information, learning, moving about in space, manipulation and communication. Contemporary technical means may be here effectively helpful, as at present they enable even persons with severe disabilities to lead an active and interesting life.
B. Non.
When going to stress the role of contemporary technology in forming advantageous conditions for integration of the disabled persons with their social environment , we have however to have in mind that, as we use to say in Poland, "every medal has got two sides". On one side called "assistive technology" we have activities aimed at increasing the selfdependence and independence of functioning of an individual with health and efficiency disturbances. Now, what picture present the other side? Some of the above mentioned technologies, particularly these referring to the possibility of computer network, become a kind of intermediary between the disabled person and institutions and people forming his/her so called social environment. These very technologies make it possible to satisfy numerous needs, among others the need to keep contact with other people without obligatory relationship of the "face to face" kind.
Many people make use of the example of the "Internet dog" ("when you sit before your computer and work in Internet nobody guesses that you are a dog") considering the fact of the partner's invisibility as a great advantage. They point out, that this way there are no psychological inhibitions on both sides of the communication. They also take into account the importance of virtual reality which with it's network games, chat sessions and discussions list is capable to provide for their needs of social contact.
However virtual reality is not the real world. And rehabilitation activities are aimed at creating proper conditions for the disabled person in the real world surrounding him/her. Such a presence requires not only an effective concealment of the fact of disability from the partner in the interaction actually taking place and learning to coexist and mutual acceptance of disabled people and people without disabilities. As pointed out by Philip Zimbardo from Stanford University, in case of shy persons, persons afraid of direct contacts with other people, Internet may become a safe refuge, a route of escape, a shelter for hiding from real as well as imagined problems of interhuman relations. As far as this very kind of individuals is concerned the feeling of security and comfort they find in virtual reality may easily prevail the need of participation in the real world. In effect Internet considered as a route of escape from the potentially dangerous contact with other people may become instead of a useful tool of integrating the social system one more barrier hindering such integration.
3. Assistive technology device is defined as "any item, piece of equipment or product system acquired commercially off the shelf, modified or customized, that is used to increase, maintain or improve functional capabilities of people with disabilities" (Murphy 1991, XIII). Increasing this capabilities is most helpful as far as the extension of the disabled person's personal selfedependence and independence are concerned. And this aim is as we know one of the fundamental determinants of the contemporary rehabilitation paradigm. Thus the regularly progressing technical development is followed by various more and more perfect devices decreasing deficiencies and facilitating the functioning of disabled persons. So this is a way to increase the social and functional independence of people with various kinds of disfunctions, deformations, health problems and development disorders.
B. Non.
These devices which truly increase the disabled person's activity opportunities and his/her independence as far as constant other people's help is concerned, may nontheless create a different kind of independence of complex psychofunctional character. The substance of this very dependence is the preference for employing technology devices in circumstances in which it is entirely possible to make use of other devices, among them an increased personal effort. In everyday life we quite often come across this kind of dependence. Examples of such attitudes present dependencies on the car, telephone, computer or television which hinder the need of contact with other people, the wish, to increase one's knowledge of the world and of rest. Satisfaction to be felt because of comfort created by these means usually makes us to forget the negative effects which will certainly follow. However let's try to imagine a school program without the learning of addition, subtraction, multiplication and division (which indeed is done a lot more quickly and faultless by computers). Also the arduous learning of handwriting is much more troublesome than simply employing computer text editors. But we may easily foresee that such developments will cause a limitation of intellectual and manual efficiency of the new generations and will make them dependent of the efficient functioning of feeders, which in effect instead of serving us will determine the way of our functioning.
These considerations are also relevant as far as assistive technology is concerned. It's true that very often assistive technology creates a chance of a relatively normal life for people with severe disabilities, without it's help would not be able to provide for their basic needs. However we have to take into account the different possible results of adapting the keyboard in accordance with the individual needs of the disabled person. This may help to develop the disabled person's literary talent, but may also limit exercises aimed at increasing efficiency of the hand or create health problems concerning eyesight and the spine. The development of electronics system, of employing the household appliances may increase the individual's capability to supervise the household, but may at the same time have a negative impact on arduous and time consuming physical exercises. The point is these exercises are often absolutely necessary to enable the disabled person to function outside his/her home. It would like to use this opportunity to inform you, that in the Polish rehabilitation system the development of the disabled person's selfdependence in everyday life place a particularly important role, as we are still unable to provide the disabled members of our society indiscriminately with modern devices of assistive technology. And it is because of this strategy our disabled sportsmen are in the forefront of the world's disabled champions and moreover are considered to be particularly physically efficient and selfdependent.
Polish observations of applying speech synthetizers provide also an interesting contribution to consideration presented in this paper. They suggest that above mentioned appliances while being helpful for people with a considerably limited capability of verbal communication, may at the same time discourage the disabled person to continue logopedic exercises as less effective and more tiresome. Disabled people object very often to encouraging them to make use of alternative forms of communication and technologist enabling employing standard forms of communication. Quite often disabled people feel that suggesting them to use the above mentioned technologies is a kind of repression rejecting their own means of communication and an attempt to impose them the language of the dominating groups. (Lane 1992). This way of interpretation is of course not helpful as far as the aspiration to increase the feeling of subjectivity and independence of the individuals in question is concerned.
The last presented example suggests that sometimes providing disabled people with technology may limit their interest in exercises aimed at improving their physical fitness and their capability to cope selfdependent with life problems. Moreover it may negatively influence their perception of their own subjectivity and responsibility for their own life. We assume thus that basing rehabilitation activities on providing ever more perfect assistive technology devices may cause a rather negative effect as far as changes in the disabled' person's consciousness is concerned. The aim of rehabilitation systems is stimulating the disabled person develop his/her need of activity and subjectivity, enterprise, selfdependence and responsibility for oneself and one's family. This should also encourage systematic effort, a need of success and capability to come to terms with defeat. However excessive dependence of technological devices may in effect make the disabled person feel that the responsibility for their way of functioning and life style rests with experts planning the general use of assistive technology. In consequence there may appear phenomenons of alienation and learned helplessness and passivity.
4. Technical progress increases systematically the disabled' persons' access to assistive technology.
A. Sic.
The general technical progress and the development of knowledge and respect for the disabled persons' rights leads to create more and more perfect assistive technology devices. Thanks to contemporary means individuals who in the past would be obliged to spend their life in custody of special institutions are today able to lead the life, the style of which is accepted as normal. All the above mentioned factors enable also people witch all kinds of slight disabilities to participate actively in social life and be relatively selfdependent as far as providing for their personal needs is concerned.
The changes in attitudes towards disabled people and the growing understanding that disabled people are not only a passive object to be taken care of but as well active consumers, taxpayers and an electorate have also brought about a change of attitude towards assistive technology. Treated for a long time as being of minor importance assistive technology occupies at present one of the most important places in numerous research studies and laboratory programs. And one may add, that these studies and programs get more and more funds from public as well as from private sources. This money is also used to increase the access to already functioning devices.
B. Non.
However in spite of all this work and efforts we are still very far from a state of common happiness. To stay nothing of our end's of century long list of disappointments relating to the realm of technique, we state that inequalities in the disabled people's access to assistive technology intensify at present. The fact is that many among these means employing highly developed technologies require large funds and also some acquaintance with contemporary technique. But as we know from recent studies, presently there takes place a rapid process of economic and technologic stratification of the social communities. It's evidence on a global scale is the intensifying conflict between countries of the rich North and the poor South, on the local scale the unequal access to civilization benefits of people from different social circles. In Poland, which has just undergone the transformation of the political system, there exists a considerable inequality of the life opportunities for inhabitants of cities and people living in the country. In one of the richest countries in the world - in the United States there is the problem of social inequalities concerning ethnic minorities (Wright, Leung 1993). In numerous countries of the world the situation of the individual depends on some extent on his/her sex and age, and in all countries education plays a considerable role as far as the individual's social position is concerned.
The high costs of developed technologies and common inequalities of access to benefits of civilization suggest that high technology products for disabled people may find consumers only in some often quite limited social circles. Also rather doubtful seems making use of them in countries of different cultures where a feeling of solidarity and social bonds is very strongly stressed instead of respect for the individual and individualism so important in our cultural sphere. All this concerns also countries less developed economically and with larger social stratification. In view of all the above mentioned circumstances the trend to put on the market first of all highly technologically developed and thus very expensive devices for people with disabilities may be seen as a form of exposing the existing social inequalities. If at the same time there is no trend to universalize the technology and access to poorer people, assistive technology will become one more from of strengthening the existing social divisions, particularly as far as less educated and poorer disabled people are concerned.
Recapitulation.
Recapitulating one may state that introducing new assistive technology devices certainly creates new chances for disabled people, chances to overcome the hindrances of disability, to better provide for one's needs and leading a more satisfying life. At the same time we can't deny being afraid that if spontaneously introduced these devices may be followed by above mentioned undesirable effects. Particularly dangerous seems to be a tendency to see technology as isolated from the rehabilitation system as a whole. Assistive technology devices cannot be treated as independent means able to solve all problems of disability. The notion of technology has namely to two meanings. The more limited meaning is that of making use of technical means with a certain aim in view. In the broader sense it is the whole sphere and way of employing them in the process of striving at one's aim. The choice of one of these attitudes may influence not only the form and direction of the assistive technology's further development, but also the life of thousands of disabled women and men, adults and children.