User's responses to assistive devices for physical disability

Sot. Sci. Med. Vol. 32, No. 12. pp. 1417-1424. 1991 Printed in Great Britain. All rights reserved

0277-9536/91 S3.00 + 0.00 Copyright Q 1991 Pergamon Press plc

USERS’ RESPONSES TO ASSISTIVE DEVICES FOR PHYSICAL DISABILITY

NANCY A. BROOKS

Department of Sociology, Wichita State University, Wichita, KS 67208, U.S.A.

Abstract-A mailed survey of scientists and engineers with disabilities was conducted to investigate how assistive devices for disability utilized in various social settings were perceived by persons with disabilities who also maintained valuable occupational positions. The respondents (N = 595) reported assistive-device utilization in social settings and user attitudes toward using assistive mechanical aids. The minority-group conceptual framework guided analysis of assistive technology as a symbol of disability. Variations in device use within public and private settings and differences in attitudes according to demographic and disability characteristics also are described.

Findings show general user satisfaction with devices. Utilization varies among social settings and also varies by disability type, especially between persons with sensory impairment and those with nonsensory impairment. public responses were not perceived to be problematic, although users do indicate that the actual application of devices may be unsatisfactory. Users’ suggestions for further research chiefly propose examination of the systems that develop and distribute assistive devices. Results encourage examination of socioeconomic arrangements that reinforce the minority position of people with disabilities by restricting access to aids perceived as beneficial to social roles.

INTRODUCTION

Although there has been much study of the environments encountered by people with physical disabilities, the most immediate environmental element of disability, the mechanical implement that aids the person’s functions, has not been fully examined. Assistive devices such as crutches, hearing aids, and wheelchairs underscore the existence of impairment and clearly identify assistive-device users as subjects for the social evaluations that are applied to disability, but the social-psychological consequences of using assistive devices have been largely overlooked. Previously, engineering or therapeutic viewpoints have chiefly been utilized to measure device functioning capabilities. In contrast, the purpose of this study is to explore social-psychological outcomes of disability technology.

PURPOSE

This paper reports the user’s view of assistive devices rather than the observer’s, and thereby adds an important perspective to studies of the disability experience. Specifically, this research asks: (1) how adults with disabilities view their assistive devices, (2) how users’ attitudes toward their devices vary by social setting and user’s disability type, and (3) what issues about assistive devices concern users. The present inquiry extends the study of disability symbols by describing responses of assistive-device users to their assistive devices as those devices are applied in various social settings. A serious weakness in disability technology research-the lack of users’ perspectives-is addressed here from the social- psychological standpoint.

American scientists and engineers who have disabilities comprise the research sample. Scientists and engineers are an excellent group for study here because they hold the kinds of social positions

becoming increasingly available to people with disabilities, and so they represent more contemporary rather than traditional and socially restricted expectations for people with disability. Having such an educated and socially active research population also allows the project to describe how devices are perceived by users as cues to the disability role when device users hold valuable occupational positions rather than positions of dependency and low social status.

For the purposes of this paper, assistive devices are defined as mechanical implements specifically designed to aid people with disabilities to accomplish what they need and want to do. The paper will also use the phrase ‘people with disabilities’ rather than ‘disabled people’ to reduce the semantic connotation that the entire person is disfunctional.

Assistive Devices and the Disability Social Role

Technology is a good mirror for society’s expectations because it provides tangible objects that sig nify social complexities such as shared values and social change [l]. Yet, especially in this highly technological time, it is advisable to remember that technology alone does not determine the outcome of human efforts and arrangements, because whichever technology is accepted and employed demonstrates group values and choices [2]. Many of the economic and ethical questions currently attached to technology, perhaps especially medical technology, have arisen more from social than technical concerns. Studying the social context of assistive devices for people with disabilities aids comprehension of the relationship between technology and social roles generally.

Assistive devices have particular effects as cues to social roles because they are intimate to the user’s body and are often essential to personal functions such as mobility, eating, or communicating. While they are performing these personal functions,

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assistive devices are generally observable to others, which in turn influences the device user’s self-perceptions. To the observer, assistive devices often appear inseparable from the user; users must accommodate somehow to that perception. Devices persistently remind participants in social interaction that an unusual feature (disability) is present that requires behaviors for which observers may be unprepared.

Assistive devices also have great potential to elicit associations with formal social systems such as medicine or social-welfare organizations; they often are subjects of medical prescriptions or social-welfare intervention. This means of obtaining personal goods is relatively unusual for the general population and imposes a public dimension upon the user’s choice of such a personal belonging as an assistive device. Since assistive devices have the potential to introduce social strain into interactions which might otherwise dem- onstrate the current integration of the disabled population, they deserve study beyond their overt function into their contributions to the social environment around disability.

There are several ways in which an assistive device is related to disability as a social role. First, an assistive device triggers shared understandings for body movements, appearance, and use of space. How the body appears has great social significance, and an assistive device makes substantial additions to that appearance. Organized attempts to simulate disability, such as for educational purposes, often use assistive devices as markers of the actor’s assumed disability [3,4]. Even the international symbol of disability is an assistive device-a stylized wheelchair. Kriegel articulates the issue from his experience:

My crutches are as visible as a black man’s skin and they form a significant element. . in the way I measure myself against the world [5].

Second, devices clarify the disability designation. People who use assistive devices can generally be assumed to have authentic disabling conditions. An assistive device may also indicate the severity and relative permanence of the impairment (e.g. a cast for a broken leg). By making private conditions public, devices open the door for social acknowledgement of a disability. A device announces the physical difference, facilitating social-psychological interpretations of that difference.

Third, assistive devices are neither conventional nor desirable. Their unfamiliarity may strain social interactions. Because devices are employed as re- placements for more typical and desirable physiologi- cal functions, assistive devices are not symbols of valued social status. Instead, assistive devices are understood to be substitutes for routine bodily ac- complishment and additionally may serve unwanted medical purposes (e.g. a respirator). Very rarely will an assistive device be an accessory that demonstrates personal choice, taste, or social fashion.

People with Disabilities as a Minority Group

People who have disabilities by definition present unusual characteristics and functioning capacities, leading to activities and appearances which do not conform to social expectations. This project applies the minority-group conceptual framework to describe

a collective social experience of people who have disabling conditions [6].

People with disabilities can be considered a minority group since, according to the definition by Wirth, a minority group is any group of people who

because of their physical or cultural characteristics are singled out from others in the society in which they live for differential treatment and unequal collective discrimination (71.

The minority-group model emphasizes the influence of environmental above biological or psychological forces for shaping major life experiences of people with disabilities. Hahn is one observer who argues that having to live within the shared con- straints of inaccessible physical, social, and commu- nicative environments and being denied equal access to education, employment, transportation, and hous- ing while contending with negative stereotypes and minimal political power has constructed a distinct minority-group experience which includes the segre- gation, discrimination, and exploitation of people with disabilities [8].

Others have also seen usefulness in the minority- group concept regarding disability. Safilios-Roth- schild observes that people with disabilities have been collectively stereotyped with numerous negative characteristics, including the frequent assumption that a disabled body is associated with lower intelli- gence and poor judgment [9]. Socioeconomic disad- vantages have been documented as have the incidence of strained social interaction and negative attitudes expressed by others [3, 10, 111. The minority-group concept has also been usefully employed to analyze the combined effects of disability and other minority statuses [ 121.

However, there is some question about applying the minority-group model to the disabled population. Some observers note that the concept is weak, especially as applied to disability [13, 141. Several matters are problematic. First, anyone may acquire a disabling condition or be so labeled at any time; life events, rather than ethnic, racial, or religious descent, produce the disability status for anyone. Second, there is inconsistent group definition and self-identification among the disabled population. Last, people may completely escape the disability label through cure or rehabilitation, and they may carry little or no stigma with them as their lives are ‘normalized’.

Other conceptual models are available to guide understanding of disability’s place in society. First, a prevailing framework that guides many traditional orientations toward disability is the medical model. Since the medical model focuses upon abnormality, disabling conditions would come to be categorized as “something wrong that should be fixed” [IS]. This orientation underlies a great many social expectations about people with disability and justifies to the public a passive role for people with disability as recipients of socially legitimate aid that will be generated and controlled by others.

Second, a social-psychological model frequently used for research emphasizes the personal problems and differences assumed to be inevitable with disability, e.g. feelings of loss, the struggle to cope, adjustment, and the change in identity [3]. The

Users’ responses to assistive devices for physical disability 1419

social-psychological view acknowledges the strain of managing tense social interactions while experiencing personal uncertainties about the disability. Like the medical model, the social-psychological approach tends to study individual experience rather than external systems.

Third, a long-standing sociological model inter- prets disability as social deviance, a disturbance of the norms that calls for and receives distinct social controls [16]. Although there are several variations of the deviance interpretation for disability (see Ref. [ 171 for a review), the model also tends to focus upon the disabling condition rather than social processes. AC- cording to the deviance model, society makes an imputation that the occurrence of disability produces an unusual and generally objectionable circumstance that requires some form of social control or at least categorical social identification [ 181. The deviance model thus studies the development and consequences of disability’s social assignment.

Many people with disabilities now challenge the traditional models summarized above. Harris found 45% of a national sample of people with disabilities agreeing that disability is a minority status [19]. In several societies, organizations of people with disabilities have confronted institutionalized discrimination through advocating political pressure for legal and environmental reforms [20]. The Independent Living movement, for example, is not only an active force in constructing those institutional changes, it has also formulated and distributes an ideology that presents people with disabilities as choice-making consumers of goods and services rather than as passive recipients of social evaluation and action [21,22]. Conceptually, the effect of these changes has been to encourage greater research emphasis upon social systems and processes than upon the person’s accommodation to impairment.

Each conceptual model briefly summarized above serves different purposes. For this study, the minority-group model guides inquiry into the relationship of an environmental feature (assistive devices) and disability as it is experienced by users in various social settings. Thus, the project extends investi- gations into external rather than personal aspects of disability. The minority-group model is also appropriate here because it guides inquiry into user comfort with an environmental element that is a cue for social difference. The very lack of study about users’ responses to disability technology demonstrates the disadvantaged position of the disabled population.

LITERATURE REVIEW

There has been little systematic investigation into the relationship between assistive devices and disability as a social condition. As yet, research about the user’s perspective on assistive devices is limited and scattered through many resource categories, but what is available does show that users and observers give diverse interpretations of the device-use experience. Research efforts in this area are primarily descriptive and exploratory, although they have moved beyond functional device assessment into more complex psychological and social questions. Four themes

emerge from this literature: (1) how adjustment to disability interacts with devices, (2) user acceptance of devices, (3) the place of devices in the rehabilitation system, and (4) the influence of social environments upon devices.

Adjustment to Disability

Disability researcher Beatrice Wright observes that assistive aids are disability symbols and as such are linked to the adjustment process [3, p. 2081. Other researchers have found that users’ accommodation to disability is related to more flexible use of devices [23].

Acceptance of Devices

Observers have found that users perceive devices as extensions of the body and that device acceptance is related to patient vs therapist roles; rehabilitation patients have been found more accepting than thera- pists [24]. User acceptance also varies from strong positive evaluations and high utilization [25] to rejection [26]. Suffering the ‘technological indignities’ of managing wires and gadgets hooked to themselves may lead users to device rejection [27]. At the most subjective level, users may reject devices because implements lack the capacity for meaningful personal touch and communication [28].

Place in the Rehabilitation System

Technology use occurs within a social context; so the informed, positive attitudes of rehabilitation professionals, educators, family, and employers are as relevant to device application as is user acceptance [29]. However, some observers note that devices are not well integrated into the rehabilitation system. Too often, professionals see devices as cures rather than as components of the total rehabilitation process [30] or have exaggerated expectations for devices. It may be more useful to question the suitability of aids prescription and their related distribution systems than to press solely for user adoption in all circumstances [3 11.

Social Influences upon Devices

Each culture and historical period assigns its own meanings to devices, and those meanings will affect social interaction. For example, European wheelchairs were once produced only in black because disability was believed to be sinful [32]. Western interpretations of assistive devices have since changed, at least somewhat, but aids often still carry the tension of unfamiliarity [33]. Disruption of social norms may follow [4]. Safilios-Rothschild proposes that the social environment surrounding assistive devices may become more congenial as more non- disabled people begin using personal technology in routine ways for their own needs 1341. As yet research about the users’ perspective on assistive devices is limited and scattered through many resource categories, but what is available does show that users and observers give diverse interpretations of the device-use experience. Research efforts in this area are primarily descriptive and exploratory, although they have moved beyond functional device assessment of the implement to more complex psychological and sociological questions.

1420 NANCY A. BROOKS

STUDY POPULATION AND METHODS

A national mailed survey was conducted using the Resource Group of disabled scientists and engineers which has been identified by the American Associ- ation for the Advancement of Science. Although this population is a very specialized segment of the population with disabilities, it was chosen for study because the members would be particularly likely to utilize assistive devices and to use them in a variety of social settings. The total number of questionnaires mailed was 1254, of which 595 (47.4%) were returned for analysis. Information on nonrespondents was not gathered.

It is assumed that choosing to utilize an assistive device in the presence of others indicates that the user has at least minimal comfort with the social response to assistive devices, making device utilization in social settings a directly observable indicator of device acceptance by the user.

The research sample is 78% male, highly educated (38% with a graduate degree), and likely to be employed (81%). A high 66% of the population is employed full-time. Eight percent who are employed work part-time, 4% are self-employed, and 6% are retired. The mean age is 47.2 years, with a range from 19 to 88. Respondents’ disability types are distributed as follows: vision impairment (13%), hearing impairment (17%), speech impairment (l%), limb loss (27%), neuromuscular impairment (35%), and multiple or other disabilities (4%).

The respondents reported that they are most likely to use assistive devices for mobility, transportation, and employment, while they are least likely to use devices which assist housekeeping and child care.

Since the study used a population survey rather than probability sampling to derive the subjects to whom the questionnaire was sent, the appropriate statistical methods of analysis are descriptive measures. Findings that are observed at the moderate level of statistical association or above are reported here. Statistical measures of association are employed in accordance with the level of measurement for each variable under study. It is important to note that despite the large size of the population (N = 595), the respondents are very homogeneous in occupation, education, gender, and work involvement. This homogeneity is reflected in the lack of strong variations shown in many of the findings given below.

Demographic Characteristics and Device Utilization

Age In general, age shows very little association with

disability type, device use, or the social context of devices used. The only notable finding shows that there is a weak tendency for older respondents to report using devices in employment more than younger persons do.

Gender

Of the 595 scientists and engineers responding to the survey, 120 were female. This demographic characteristic showed no notable associations with responses to assistive devices, disability type, or social setting variations where devices might be used.

Educational level

Education attained shows no association with device use or the social environment of device utilization. The lack of relationship is most likely linked to the minimal educational variation of the population. The population distribution is highly clustered in the top few years of educational attainment.

Work

The majority of the population is employed outside the home full-time (66.1%), but only one disability shows an association with employment. Speech limi- tation has a weak association with employment, meaning that full-time employment is likely to be reported by respondents with speech impairment.

The actual use of devices does produce clearer associations with work. Work arrangement is associated with use of Employment Device (Cramer’s V = 1.261, N = 580) [34]. Here the respondents who work full- or part-time are more likely to use employment devices than are persons who are self-employed, retired, homemakers, or ‘other’. Use of Housekeep- ing Device has a small but interesting association with work arrangement (Cramer’s l’ = 0.207, N = 571) [35], as full-time and ‘other’ workers are more likely to use housekeeping devices than are part-time or retired workers.

Disability Type, Social Setting and Device Utilization

Disability type

The type of disability variable is divided into seven categories: vision, hearing, speech, limb loss, neuromuscular impairment, and other. When this variable is applied to utilization of specific device types, the findings show noteworthy associations as summarized in Table 1.

Type of device

The kinds of devices used by subjects do vary with disability type. Personal care/hygiene devices (such as eating, grooming, toileting aids) are more utilized by people with neuromuscular impairment and those with limb loss. Employment devices, such as tactile measuring devices and optical scanners, are used most by people with visual impairment and least by those with speech impairment. Housekeeping and child-care devices such as baby monitors and child lifts show no associations with disability type. Transportation devices (car hand-controls, vehicle wheelchair-lifts, and electric carts) are used most by people with neuromuscular impairment and least by hearing-impaired persons. People with hearing and visual impairment use communication devices more than other disability types do. Educational devices such as talking calculators and print-enlargers are utilized most by people with visual impairment, while people with neurological impairment use them least. Mobility devices show the greatest use in the neuromuscular category. These devices include wheelchairs, crutches, and canes.

These patterns suggest that persons with sensory disabilities tend to apply devices for specific social tasks, while people with nonsensory disabilities are more likely to utilize devices for general living.


Table 1. Frequency of device types used, by disability type

Utilization of devices Most freauent users Least frequent users Device tvoes Measure

Personal care hygiene

Employment

Transportation

Communication

Education

Mobility

Nemo-muscular and limb loss

Visually impaired

Neuro-muscular

Hearing and vision impaired

Hearing and vision impaired

Ncuro-muscular

Hearing impaired

Speech impaired

Hearing impaired

Nemo-muscular

Neuro-muscular

Hearing impaired

Cramer’s V = 0.399 N = 588 Cramer’s V = 0.244 N = 588 Cramer’s V = 0.427 N = 587 Cramer’s V = 0.588 N = 588 Cramer’s V = 0.391 N = 586 Cramer’s V = 0.598 N = 587

Examples of device types: Personal care/hygiene: Grooming, eating, dressing, toileting devices. Employment: Computers, telephone systems, stand aids. Transportation: Vehicle lifts, transfer boards, hand controls. Homemaking: Cooking, sewing, cleaning, organidng devices. Childcare: Bathing, changing, monitoring devices. Communication: Hearing aids, electronic larynxes, communication boards. Education: Page turners, print enlargers, talking calculators. Mobility: Wheelchairs, electric carts, canes.

Social settings and device use This set of findings reports device utilization in a

variety of social settings from the .public to the private. Readers are reminded that attention here is on the type of social setting, not on the device type. (See Table 2 for summary.) This section examines variations in device use by social environment.

Public settings show a moderate association with disability type. All but two disability groups show respondents being more likely to use their devices Often or Always in public. The two disability types more likely to report that they Never use devices in public are those with vision impairment and hearing impairment. Whether this tendency reflects social difficulties with devices, or the lack of need for devices in public, or different definition for what constitutes an assistive device is not demonstrated.

Employment settings show a moderate association with disability type. Hearing impairment is most often associated with the Never response, vision impairment with Often, and neuromuscular impairment with Always. This pattern may indicate either the nature of the jobs the respondents hold (requiring devices or not), or the responses could indicate that there is variable employer acceptance of employment devices for certain disabilities. The finding that hearing-impaired persons frequently use communication devices but are unlikely to use devices in employment settings raises questions about the nature of those settings.

Education settings. Educational environments have a moderate association with device utilization. For the Never response, three disability categories shared equally in the tendency to respond Never: vision, hearing, and multiple impairment. Of those Often utilizing devices in educational settings, the visually impaired were most frequently observed. The group most likely to report Always was the neuromuscular category.

Frienakhip settings. Device utilization among friends has a strong moderate association with disability type. Here the visually impaired are most likely to respond Never, while the neuromuscular impaired were the group responding most frequently to Often and Always. The vision category deserves further discussion, since another view of the data shows that 32.6% of the visually impaired respond that they Never use devices with friends, 55.8% respond Often, and 11.6% respond Always. This intriguing pattern indicates that devices utilized by people with visual impairment are not strongly linked to friendship occasions. Perhaps vision devices are more cumbersome or inappropriate to friendship social settings. No other disability category displays a similar pattern.

Family settings show a moderate association with disability type. Again, respondents with vision impairment are most likely to respond Never use devices, and those with neuromuscular impairment dominate the Often and Always responses. In family

Table 2. Freauent users of devices. bv social settina

Social setting

Public

Employment

Education

Friendshtp

Family

Alone

Users of devices Most frequent

Neuro-muscular limb loss, speech

Nemo-muscular

Neuro-muscular

Neuro-muscular

Neuro-muscular

Limb loss

Infrequent

Vision and hearing impaitment

Hearing impaired

Vision, hearing, multiple impairment

Vision impairment

Vision impairmenl

Neuro-muscular

Measures

n = 0.326 N = 458 I/ = 0.286 N =475 rj = 0.326 N =434 n = 452 N=464 q = 0.374 N = 457 a = 0.223 N = 457

1422 NANCY A. B~ooxs

settings, the pattern for people with visual impairment is: Never, 32.6%; Often, 51.2%; and Always, 16.3%. Devices for visual impairment thus are more often utilized in family than friendship settings as discussed above, but still in a reverse pattern than nonsensory-disability groups report; the other disability groups are more likely to report that they do use devices in intimate settings than not. Further research is needed to determine whether people with visual impairment may choose to use devices less often in intimate settings due to social pressures, greater familiarity with intimate settings, or because of lack of device usefulness in intimate environments.

Utilization when alone has a weak association with disability type. The Never response was chosen by only 20 of the 457 persons responding to the question. The neuromuscular category dominates this response, having 9 of the 20 who reported Never using devices when alone. Devices which assist mobility are used when the person is alone to a greater extent than those which assist communication, although it would be useful to discover other uses of communication devices-safety, for example.

To summarize, the social setting in which subjects report use of their assistive devices is associated with disability type. The neuromuscular impaired are the disability type most likely to use their devices in the following social settings: public, employment, education, friendship, and family. In contrast, subjects with sensory (vision and hearing) impairments are less likely to use assistive devices in those settings.

The section above has presented what may appear to be findings contradictory to those of the section reporting on disability type and device use. The findings on social setting and device use, for example, show vision-impaired persons as unlikely to use devices in education settings; yet the visually impaired group are frequent users of education devices. These findings suggest that users perceive device type and social environment as separate entities. The findings also suggest an association between disability type and device use. Further research is needed to dis- tinguish the nature of the specific assistive devices (in functionality, appearance to others, cost, etc.) and circumstances of the disabling condition.

Attitudes Toward Assistive Devices

Respondents perceive the general public reaction to assistive devices as ‘about average’, with more respondents observing positive rather than negative reactions from the public. A large proportion (66%) do use devices to avoid the sometimes uncomfortable transaction of receiving help from others. Fifty-seven percent say that using devices is always socially acceptable.

When users were asked how they feel about devices, the respondents indicated that they see assistive devices as mostly beneficial, necessary, and sup- portive of ‘normality’. But 32% say devices are often restricting, 32% feel devices are often inconvenient, and only 11% say they are always proud of their devices. (See Table 3.)

Overall, assistive devices are viewed positively by users. Users also tend to see the public responding to devices with acceptance, not rejection.

Table 3. Type of device utilized, by adjustment to disability

Adjustment to disability

More Less

Device type fortunate fortunate Measure

Personal care/hygiene Not using Using y = 0.248

N = 567

Housekeeping Not using Using y = 0.214

N = 567

Transportation Not using Using y = 0.257

N=566

Mobility Not using Using y = 0.222

N=566

Respondents are not unrealistically positive in their personal evaluations of devices. Instead, they report that devices are not generally a source of pride, and devices may be inconvenient or restricting. These more cautious observations balance the general approval which respondents express.

Users’ Attitudes by Social Setting

Findings show that negative attitudes toward devices tend to have associations with the use of devices themselves rather than with social environments surrounding devices. Table 4 lists the number of either positive or negative attitudes about devices observed in this analysis. This is a summary table which shows the total number of moderate associations observed between attitudes and disability type, device type, and demographic characteristics.

Negative attitudes toward devices (such as Incon- venient, Frustrating, Restricting) tend to show associations with measures of respondents’ actual use of devices. Positive attitudes are more likely to have positive statistical associations with the use of devices in social settings. For example, feeling that devices are beneficial has positive association with greater use of devices in public, employment, education, friendship, and family settings, but not when alone.

Table 4. Using assistive devices is - for me (%)

Total

Attitude Always Often Rarely Never NR (%)

Beneficial 57 30 3 0 9 99

Necessary 58 29 4 I 9 101

Key to normality 38 30 10 10 12 100

Source II 18 23 32 16 100

Socially acceptable 35 36 I2 2 I4 99

Just a job I5 20 16 26 22 99

Inconvenient 7 32 39 IO I3 101

Restricting 9 32 35 I2 I2 100

Frustrating 6 32 41 9 I3 101

Table 5. Number of associations observed between attitudes toward

devices and major research dimensions

Associations with major

research variables

Attitudes Disability Device Social

toward devices type Demographics type setting

Positive

Beneficial 2 6

Necessary I 3 6

Source of pride 3 2

Socially acceptable 3

Negative

Inconvenient 5 I

Restricting 2 1 3 I

Frustrating 2 2


Although the experience of using devices may be related to negative attitudes about devices, when mechanical aids are used within social settings, positive attitudes about devices are found. This pattern could arise because the people who actually use devices in social settings have more optimistic attitudes in general, perhaps social use of devices demonstrates how effective devices can be for social roles, or perhaps the people who use devices in social settings have learned skills for more positive experiences both with devices and with social environments.

Issues Identified by Respondents

Open-ended questions elicited respondents’ suggestions for further research. Respondents’ suggestions, paraphrased here and in order of frequency, including proposals to learn more about device cost and effectiveness, to discover how people can learn about and obtain devices, and to investigate how devices are developed and distributed. Less frequent suggestions inquired about the effects of device use upon self- attitudes and the relationship between device use and the ability to maintain social roles.

DJSCUSSION

Basic demographic variables provided very little association with device utilization or attitudes, poss- ibly due to the homogeneity of the study sample. Relationships were found between the variables of device type and disability type; persons with sensory impairments had a greater tendency to utilize devices linked to specific social roles such as employment, whereas nonsensory-impaired respondents were more likely to use devices for personal care and mobility. While sensory impairment permits users to choose when and where to use devices, nonsensory impairments may encourage device use for everyday existence.

Overall, respondents were satisfied with their devices but also reported displeasure about device inconvenience. Although respondents found the public generally accepting of assistive devices, respondents also did not see their devices as a source of pride.

Respondents’ perceptions differed between the actual use of devices and using devices in social settings; users’ attitudes toward devices were more favorable when they considered using devices in social settings than when they reported actual device use. The distinction between sensory and nonsensory impairment reappeared as respondents with sensory impairment reported being less likely to use devices in the intimacy of family and friendship settings than did persons with nonsensory impairment.

The overall user satisfaction with devices suggests possible differences between user and observer attitudes toward devices. Observers may respond primarily to device unconventionality, but users may be attending more to device assistance with physical needs and social roles. When respondents suggested areas for further study, their primary interest was in the pragmatic and economic concern for acquiring assistive devices.

Implications Assistive devices are often necessary for people

with disabilities to exercise either valued or ordinary social roles; yet even the present highly educated, primarily employed research subjects find that the systems which provide assistive devices are neither clear nor readily available to the user. Although these scientists and engineers perceive that many social settings are sufficiently comfortable environments for device utilization and they also observe generally accepting public responses to devices, the subjects report frustration with the means for obtaining assistive devices. The minority-group model assists understanding of this position. When users identified access to assistive devices as their chief concern about devices, they were voicing a minority-group experience of denial to necessary resources. Users report favorable attitudes toward devices and using devices in social settings. But if scientists and engineers report problems with learning about and obtaining assistive devices, other groups are likely to experience even less control over such an essential life feature.

As long as the U.S. system is built around a passive minority placement for assistive-device users, the calls for user initiative in device development and evaiu- ation [36] will be futile. Users might organize to develop, inform about, and promote low-technology and other devices, but distribution problems will persist as long as most assistive devices are distributed through medical systems and financed largely through public reimbursement [37,38,29]. The existing distribution systems exercise strong social control over assistive devices. Making changes to add user involvement will challenge the minority placement and evaluation of people with disabilities.

The findings of this study further suggest application of the minority model by showing a link between assistive-device utilization as a socially overt marker of disability and social-setting variations. Further research is needed to discover how the variations observed here reflect differences in social- setting accommodation to assistive devices and how that accommodation may change over time. Viewing the disabled population from a minority-group perspective will permit future research to consider complex interactive effects upon disability during times when people with disability are working to integrate major social systems.

It will be valuable to consider simultaneously the combined effects of biological, medical, psychological, social, and physical settings in the disability experience. Dynamic research into the complex and interactive features of disability can be conducted as people with disabilities bring changes to the very social and environmental systems that intimately influence their life conditions and social interpretations. The observation of users’ repsonses to their assistive devices is a small move toward that end.

Acknowledgemenrs-Partially supported by joint consul- tantship from the American Association for the Advance- ment of Science with Martha R. Redden. An earlier draft was presented with Redden at the 9th annual conference of RESNA, Minneapolis, Minnesota, 1986. A different treatment of these data appears in John Leslie and Ray Smith, Eds, Rehabilitation Engineering, CRC Press, Boca Raton, FL, 1990.

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User's responses to assistive devices for physical disability