Assistive tech for arms: perspectives & propositions by Yara Peterko

Literature suggests that mobility devices include both lower limb as well as the upper limb mobility (Cowan et al 2012: Zallio & Ohashi 2022), this makes it harder to distinguish statistics in the development of both areas. While assistive devices for lower limb mobility are well known and established, the same can not be said for upper limb technologies. This is also evident in the Global indicators of assistive technology use amongst occupational therapists – report of WFOT (2019), where assistive devices for upper limbs are notably absent from the categories of described products within the past 12 months. This gap raises the question: why is there a disparity, and what can be done to change this?

Given the broad nature of the field, I will focus on orthotic devices in combination with electronic components and adaptive equipment. There are several factors making assistive devices for the upper limb especially difficult to customise to the individual’s needs. Components that mainly influence the use of devices are the size, the weight, the accessibility and also their ability to be used independently by the client (Hays et al 20230, Kabir et al 2023).

This insight was reinforced during my Master’s Degree in Health Assisting Engineering at FH Campus Wien, where interdisciplinary teams assessed multiple assistive devices and direct client interactions. The main objective of the program was that therapists and other medical personnel would understand the thought processes and abilities of the technicians better and that technicians would learn more about clients’ needs and different disabilities and challenges.

One key finding was that the weight of many devices, primarily due to the battery, was too high for users to benefit from them. For example, we assessed gloves designed to support grip strength but could not recommend them because their weight might have caused pain in other parts of the arm. Another issue was that intended users often could not operate the devices independently due to small buttons, strong Velcro without gripping points, or push buttons that were too difficult to press.

Collaboration between therapists and technicians was crucial in identifying these areas for improvement. Technicians were often unaware of the issues, while therapists lacked the technical knowledge to implement necessary changes. Therapists were more advanced in client interviews and engagement than the technicians and also had a better understanding of the technical aspects of the products than the clients themselves. Therefore, having therapists as the link between clients and technicians was essential.

And this is where one of the keys lies for future developments in the field. There needs to be interprofessional collaboration to make sure that the devices actually benefit the target population (Hays et al 2023: Wei Qi Koh et al 2024).

The World Health Organization (WHO) has recently highlighted the importance of developing more inclusive and effective assistive technologies. Their guidelines recommend increased research and evidence-based practices (EBP) to guide developers and therapists. Emphasising on how user-centred design and iterative testing with real users can significantly enhance the efficacy and adoption of upper limb assistive devices (WHO, 2022). Therapists need to be involved in the development process to serve as the crucial link between the client or end-user and the technicians, ensuring that the needs of the users are adequately addressed.

Not only developers and professionals, but also professional associations and policymakers are called upon to contribute to the ten recommendations for the successful integration of assistive devices, as outlined by WHO (2022). They are challenged to invest in evidence-based policies, raise public awareness, and support professionals through continuous professional development (CPD) opportunities.

These CPD opportunities could include access to online courses such as the WHO Training on Assistive Products (TAP) or the Assistive Technologies Programme developed by ReLAB HS and Physiopedia. Additionally, in-person training and company demonstrations are valuable, often offered in combination with congresses and exhibitions, providing insights into the available possibilities. Many companies support their product development through research, making it worthwhile to actively utilise databases for searching related journal publications in the field. Providing these opportunities for healthcare professionals and supporting them with platforms for exchange can actively contribute to Recommendation 3: “Enlarge, diversify, and improve workforce capacity” which states that the knowledge, skills, motivation, attitudes, and deployment of personnel working in the assistive technology sector are keys to success (WHO,2022).

To further progress, it is essential to integrate these WHO suggestions into practical applications. This involves fostering collaborations between researchers, developers, and therapists to ensure that new technologies are not only innovative but also practical and accessible for end-users. Developers should prioritise the unique challenges faced by upper limb device users, incorporating feedback and data from diverse populations to create adaptable and user-friendly solutions.
By embracing a multidisciplinary approach and adhering to WHO guidelines, coupled with active participation in professional associations and continuous learning, we can develop assistive devices that truly meet the needs of those who rely on them. This will significantly enhance their quality of life and independence.