Karel Van Isacker, European Platform for Rehabilitation (EPR)

1. Status AT ICT Usage In Europe

2. Starting point
• Need for consolidated figures on the (non-)usage of AT by people
with disabilities, while also understanding their satisfaction
• Can have impact on policy making
• Can provide guidance for AT sector.
Impact ÆGIS research
• State of the Art analysis
• Broad European in-depth surveys in Belgium, Spain, Sweden, and
The United Kingdom in 2009 (approx. 200 individuals with various
disabilities)
• Feedback received from ACCESSIBLE project survey

3. Some facts
• A total EU population of 501 million*
• An estimated 45 million people in the EU have a long-standing
health problem or disability (LSHPD)**
• IMPORTANT: Different definitions of “disability” (6- 30%
between the Member States)
* http://epp.eurostat.ec.europa.eu, 1 July 2010
** Data extracted from the 2002 EU Labour Force Survey (LFS)
and the 2004 EU Statistics on Incomes and Living Conditions

4. Some facts

5. Overview presented topics
• Fragmented AT market with a complex buying process
• Supportive legislation
• Purchase of AT by end-users
• AT usage and satisfaction: identified barriers for the AT industry
and its end-users

6. Fragmented AT market with a
complex buying process
• EU AT industry is complex and characterised by:
• a large number of products,
• a large number of SMEs,
• different service provider systems (public health systems, public social
systems, private organisations and associations dedicated to the AT sector)
that are used to get AT ICT products to the end-users with disabilities,
• and different reimbursement schemes by national and local authorities.
• Cause:
• Local legislation necessitates a customised approach (e.g. many different
national and local reimbursement schemes) ;
• AT ICT often developed in a local language, thus creating an important
barrier between the different country markets of the EU
• AT software products providers often very small, and have both a limited
product offering and geographical scope

7. Fragmented AT market with a
complex buying process
• 2009 European AT ICT industry survey pinpointed AT actors:
• Information service and training organisations and providers:
• Support informed decision making (what AT is most suitable for what specific disability).
• Not always well organised, focus on few disabilities, often lack well trained personnel.
• Financing organisations:
• Finance AT products and related services on national, regional and local government levels.
• Very heterogeneous and is visible in the heterogeneous reimbursement schemes across EU.
• Technology oriented organisations:
• AT research is largely dependent on the fundamental R&D from other technology sectors.
• But should be led by the specific needs of the disabled and elderly populations.
• Professional and end-user organisations:
• Represent and are advocates for their end-user members.
• Act as lobbyists, equally involved in the policy making process.
• AT ICT industry organisations:
• Mostly composed of SMEs.
• European umbrella organisation missing .

8. Fragmented AT market with a
complex buying process
• Overview of created AT solutions in EU:
• Good reference point is the EASTIN database (http://www.eastin.info)
• Almost 40.000 assistive products listed, using also ISO coding in some cases (e.g.
input from KOC/VAPH)
Country (* participates to EASTIN) National databases
Denmark* Hjælpemiddelinstituttet http://hmi.dk/
Germany* Rehadat http://www.rehadat.de
Italy* Siva - Servizio Informazione e http://www.portale.siva.it
Valutazione Ausili
Netherlands* HANDY-WIJZER http://www.handy-wijzer.nl
Spain* CEAPAT - Centro Estatal de http://ceapat.org
Autonomía Personal y Ayudas
Técnicas
UK* DLF – Disabled Living Foundation http://www.dlf.org.uk
Belgium* Kenniscentrum Hulpmiddelen http://www.koc.be
Austria HANDYNET http://handynet-oesterreich.bmask.gv.at
France Handicat – Handicaps et aides http://handicat.com
techniques
Ireland Assist Ireland http://www.assistireland.ie
Portugal Catálogo Nacional de Ajudas Técnicas http://www.ajudastecnicas.gov.pt
Sweden Sök i Webb-HIDA http://80.80.24.87/

9. Supportive legislation
• Legislation has been put in place, supporting the uptake of AT
by a large number of public service providers.
• Main EU legislations affecting AT and accessibility:
• Legislation to directly subsidise or otherwise support the purchases of
assistive technology for disabled end-users (resulting however in
heterogeneous national and local reimbursements schemes).
• EU legislation ensuring that all public procurement purchases of goods and
services must be accessible (EC Public Procurement Directive 2004 / 18 /
EC).
• Anti-discrimination laws that protect the rights of people with disabilities,
especially in terms of their access to goods and services (Treaty of
Amsterdam introduced new anti discrimination provision in Article 13 in the
EC Treaty).

10. Purchase of AT by end-users
• The medical oriented model:
• Starting point is the handicap where the physician initiates necessary
procedures and must approve the need for listed and reimbursed AT based
on medical arguments.
• The social oriented model
• Based upon national legislation and local and decentralised execution, and
involves national/local agencies that coordinate the provision and funding of
AT, often also after the person with disability is evaluated by a panel of
medical experts (like in the medical oriented model) to define the degree of
disability, and the access to subsidies.
• The consumer oriented model:
• The end-user has direct contact with a retailer in order to get his/her AT
product (e.g. personal budget).

11. Purchase of AT by end-users
APPLS FOR VOICE SOFTWARE FOR ENVIRONMENTAL
HEARING AIDS BRAILLE READERS
COMMUNICATION COMMUNICATION CONTROL SYSTEMS
AUSTRIA medical social social social social
BELGIUM medical social social social social
DENMARK social social social social social
FINLAND medical medical medical medical medical
FRANCE medical social consumer social + consumer social + consumer
GERMANY medical social social social social
GREECE medical consumer consumer consumer consumer
HUNGARY medical consumer consumer consumer consumer
IRELAND medical + consumer medical + consumer medical + consumer medical + consumer medical + consumer
ITALY medical medical medical medical social
NETHERLANDS medical social social social social
PORTUGAL medical consumer medical + social social + consumer consumer
SLOVAKIA medical social social social consumer
SLOVENIA medical medical medical social + consumer social + consumer
SPAIN medical * consumer social + consumer social + consumer social
SWEDEN medical medical medical medical medical
UK medical social social consumer social
Source: Analysing and federating the European assistive technology ICT industry, Final Report, March 2009,
Jennifer Stack, Leire Zarate, Carmen Pastor, Niels-Erik Mathiassen, Ricard Barberà, Harry Knops, Hugo
Kornsten

12. AT usage and satisfaction:
identified barriers for the AT
industry and its end-users
• Usage:
• No concrete figures.
• But example (Greece) speaks for itself*:
• Only 4 in 10 PwD aware of AT solutions that meet their accessibility needs in using ICT.
• 11% of non-users of ICT with a disability believe that their disability prohibits them from using
AT.
• 9% indicates that there is no AT adapted to their needs.
• Non-use of ICT attributed to lack of digital skills for 23% of non-users with a disability.
• 45% of all participants with a disability believe that using ICT and AT requires a high level of
digital skills.
• Experts rate usage at less than 50% of PwD EU population overall.
* Source: Disability Now, Nikos Voulgaropoulos, Anna Evangelinou, Eleni Strati

13. AT usage and satisfaction:
identified barriers for the AT
industry and its end-users
• Satisfaction:
• AT industry issues:
• Local language versions of AT software are missing (often English).
• About 80% of the software that is available for AT applications is
available only in English, while a majority is also only available in the
local language of the manufacturer.
• Language differences necessitate a local presence. Often financially
not feasible nor viable for the AT SMEs.
• Compatibility problems arise with AT (voice recognition and screen
reader software) and hardware.
• European research and innovation on Assistive Technology is rather
poor.
• Assistive devices are often purchased through tendering. These
(often hard to obtain) procedures are hard to follow for foreign
producers or distributors who have no local distributor.

14. AT usage and satisfaction:
identified barriers for the AT
industry and its end-users
• Satisfaction:
• Policy issues:
• Incoherent social policy for subsidising/reimbursing
assistive technology products.
• Different interpretations of national service provider
systems at regional level lead to different price-
settings, even within a country.
• Specialised agencies to assist people with disabilities
in making their choice of AT lack in majority of the
EU countries.

15. AT usage and satisfaction:
identified barriers for the AT
industry and its end-users
• Satisfaction:
• End-user issues:
• Awareness
• Devices that are most commonly owned are the cheapest and outdated ones.
• End users in general are not very aware of what AT solutions in the ICT domain are available to
them or exist. People with vision impairments, on the other hand, seem to be very well informed
about available AT.
• Lack of (local and accessible) dedicated training in AT products and their functionalities (e.g. for
technical experts, but also for end- users).
• Training seldom presented in an adequate format or targeted at specific needs that come from
specific impairments.
• Lack of dedicated training in Assistive Technology products and their capabilities functionalities
(e.g. for technical experts, but also for end- users).
• Need to promote e-learning for training purposes (including the development of learning
materials that can be used across borders).
• AT that are the easiest to obtain are also the ones most abandoned.
• Non-use arises less frequently among people who are repeatedly provided with AT products, as
compared to first-time users of AT.

16. AT usage and satisfaction:
identified barriers for the AT
industry and its end-users
• Satisfaction:
• End-user issues:
• Access
• Distribution of AT still mainly goes through the traditional rehabilitation centre channel and
related care sector, as well as specialised AT entities (for example the ONCE Foundation), and
not directly to the end-users.
• Most countries have regulations which ensure that costs of workplace adaptations for PwD can
be partially and sometimes fully financed. Little use is made of this  ignorance of what is
available, and the administrative burden.
• Price
• High purchasing costs for end users.
• Prohibitive prices of specialised equipment for visually impaired people.
• Satisfaction
• Need for customisability or personalisation.
• Preference for simpler interfaces.

17. AT usage and satisfaction:
identified barriers for the AT
industry and its end-users
• Main concern
• Mismatch between end-user needs and offered AT
• End users are not provided with the required AT, resulting in a
high percentage of obtained ATs being discarded within a year
(e.g. up to 30% in the USA , ).
• AT that is being offered does not satisfy the actual needs of the
people with disabilities, hence their refusal to use them.
• Almost half of the end-users experience problems using AT.

18. Conclusion
• Some recurring themes and arguments. Most
important problems with the use of AT are
• the lack of user awareness,
• the difficult access,
• the high purchasing costs,
• the mismatch between end-users needs and the offered
AT.
• “Ignorance is bliss, but an abyss for impaired end-
users”
• Basic functionalities like text messaging, sending emails or
creating documents are frequently used, but end-users still
have to face many barriers when trying to access these
basic functionalities.
• Emphasizes the need for adequate training and instruction
material on how to use AT.