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Rapid Review of Assistive Technologies for Persons with Disability in India

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2020

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D i s c l a i m e r : ThisreporthasbeencommissionedbytheSouthAsiaResearchHub,DepartmentforInternationalDevelopment,GovernmentofUK.TheviewsexpresseddonotnecessarilyreflecttheUKGovernment’sofficialpolicies.

ThisreporthasbeenpreparedbyAmaltasConsultingPrivateLimited,India.Amaltas(www.amaltas.asia)isaDelhi basedorganizationwith themission toworkwithin thebroad scopeof development toprovidehigh quality research and consulting services in support of accelerating improvements in the lives ofpeople.ThereporthasbeenwrittenbyDr.SuneetaSingh,Ms.ManikaTomarandMs.VaishaliSMahendra.ResearchassistancewasprovidedbyAyushiJain,RiyaBansalandShrutiPunn.

Wewould like to thank theexpertswhogavegenerouslyof their insights.These include (inalphabeticalorder): Akila Surendran, Albina Shankar, Anil Joshi, Anil Prabhakar, DR Sarin, George Abraham, KGSatheesh,MBalakrishnan,MukeshDoshi,Nikunja Kishore Sundaray, PrateekMadhav,Maj. RamKumar,Shankar Subbiah, SK Tripathi and Sujatha Srinivasan. Their inputs were invaluable to the study. TheiraffiliationsareprovidedinAnnexureI.

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TABLE O F CONTENTS

ACRONYMS................................................................................................................................6

EXECUTIVESUMMARY.................................................................................................................7

ChapterI-BACKGROUND..........................................................................................................10InternationalClassificationofFunctioning,DisabilityandHealth..................................................10

AssistiveTechnology.......................................................................................................................11

NeedforAssistiveTechnology.....................................................................................................11

HowMuchisRequired.................................................................................................................12

TheStudy........................................................................................................................................12

ApproachandMethodology........................................................................................................12

Limitations..................................................................................................................................13

ChapterII-EVIDENCEBASEONASSISTIVETECHNOLOGY.............................................................15HAATFramework............................................................................................................................15

Context...............................................................................................................................16CulturalContext...........................................................................................................................17

SocialContext..............................................................................................................................17

PhysicalContext..........................................................................................................................18

InstitutionalContext....................................................................................................................18Activities..............................................................................................................................19AssistiveTechnologyinEducation...............................................................................................19

AgingandAssistiveTechnology.....................................................................................................19

AssistiveTechnologyforSports.....................................................................................................20HumanFactors.....................................................................................................................21AssistiveTechnologyforDevelopmentalandLearningDisability...............................................21

AssistiveTechnologyandPhysicalDisability...............................................................................22

AdoptionofAssistiveTechnology................................................................................................22

EngineeringConsiderations...................................................................................................24TypesofAssistiveTechnology.....................................................................................................24

AlternativeandAugmentativeCommunicationDevices.............................................................24

InformationCommunicationDevices.........................................................................................24

Human-ComputerInterfaceDevices...........................................................................................25

CHAPTERIII-THEECOSYSTEMOFASSISTIVETECHNOLOGY..........................................................31SizeoftheProblem..............................................................................................................31UncertaintiesinPrevalenceData................................................................................................31

DisabilityisRising........................................................................................................................32

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DataonRequirementforAssistiveDevices.................................................................................33

PolicyFramework.................................................................................................................33InternationalCommitment..........................................................................................................33

DomesticCommitment......................................................................................................34GovernmentInstitutions.......................................................................................................35Punarbhava,SwavlambanandAccessibleIndiaCampaign.........................................................35

CentreforAssistiveTechnologyandInnovation..........................................................................36

TheNationalTrust.......................................................................................................................36

NationalInnovationFoundation-India........................................................................................36

NationalCouncilofEducationalResearchandTraining..............................................................36

StateInititatives...........................................................................................................................36

Non-GovernmentInstitutions................................................................................................37TheAssociationofPeoplewithDisabilities..................................................................................37

MobilityIndia...............................................................................................................................37

TheNationalCentreforPromotionofEmploymentforDisabledPeople....................................37

DevelopmentandMarketingofAssistiveTechnology..............................................................38KeyAcademicPlayers..................................................................................................................38

AccountingforContext................................................................................................................39

InnovatorsinIndia.......................................................................................................................40

GRIDModelforTechnologyDevelopment.............................................................................41FinancingAssistiveTechnologyStart-Ups...................................................................................42

GapsthatRemain...........................................................................................................................42

ReasonsforConcern....................................................................................................................42

Insufficiency,AccountabilityandReach......................................................................................43

GreaterAwarenessisNeeded......................................................................................................44

DebatesandDiscussions..............................................................................................................45

CauseforOptimism.....................................................................................................................45

ChapterIV-CONCLUSION&RECOMMENDATIONS......................................................................50ResearchGaps.....................................................................................................................50NeedforAssistiveTechnology............................................................................................50AvailabilityofResearchStudies..........................................................................................50TheHAATFramework........................................................................................................51ContextinDisability...........................................................................................................51ActivityasacomponentoftheHAATframework.................................................................51HumanFactors..................................................................................................................51EngineeringSolutions........................................................................................................52

AnEcosystemOutline...........................................................................................................52TheRoleofGovernment.....................................................................................................52

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PrivateSectorResponse.....................................................................................................53ChallengestoAccessibilityandLastMileReach...................................................................53KeyDebatesandDiscussions..............................................................................................53

ImplicationsforaCentreofExcellence...................................................................................54InConclusion.......................................................................................................................55

AnnexureI................................................................................................................................56AnnexureII...............................................................................................................................57

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ACRONYMS

DFID DepartmentforInternationalDevelopmentAAC AugmentativeandAlternativeCommunicationAADI ActionforAbilityDevelopmentandInclusionADIP AssistancetoDisabledPersonsforPurchase/FittingofAidsandAppliancesALIMCO ArtificialLimbsManufacturingCorporationofIndiaBIRAC BiotechnologyIndustryResearchAssistanceCouncilCATI TheCentreforAssistiveTechnologyandInnovationDEPwD DepartmentofEmpowermentofPersonswithDisabilitiesEOG ElectrooculographyGRID Grants-Research-Industry-DisseminationHAAT Human-ActivityAssistiveTechnologyHCI HumanComputerInterfaceIIT IndianInstituteofTechnologyISO InternationalOrganizationforStandardizationNCPEDP NationalCentreforPromotionofEmploymentforDisabledPeopleNISH NationalInstituteofSpeechandHearingR2D2 TheRehabilitationResearchandDeviceDevelopmentUNCRPD UnitedNationsConventionontheRightsofPersonswithDisabilitiesWHO WorldHealthOrganisation

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EXECUT IVE SUMMARY

1. Disability is aprecipitously evolvingpublichealthproblem. It is estimated to affectover abillionpersons intheworldtoday,withextrapolationssuggestingadoublingoverthenext10 years. Its major causes include congenital causes, injury due to conflict or accident,ageing and chronic non communicable diseases among others. The last three causes aregrowingrapidly,thusmakingtheresponsetodisabilityanimmediateconcern.Over80%ofthose with disability live in the developing world. Between 10 - 20% of persons with adisabilityfaceconsiderabledifficultiesincarryingoutactivitiesintheirdailylife.

2. Assistivetechnologyreferstoanydevicestomaintainorimproveanindividual’sfunctioningand independence to facilitate participation and to enhance overall wellbeing. Access toassistive technology serves as the gateway to access to education, employment, socialinclusion and other opportunities to participate in civic life. Assistive technology devicesrangefromsimpleasinawalkingstick,tocomplexasinspeechaids.Ofthemanysolutionsthatareavailableintheworld,severalareavailableinIndia,butfewofhighqualityoreasilyaffordablebythemasses.

3. Research on assistive technology in India is remarkably inadequate, albeit not entirelyabsent.TolocatesufficientresearchforthisrapidreviewonassistivetechnologyinIndia,itwasnecessary to reachout as far back as 1987. In all, 115 studieswere reviewedand15expertsinterviewedfortheirinsightstothesectorandsuggestionsforgreyliterature.Muchoftheresearch issmall inscalereferringtostudieswithasmallnumberofparticipantsordescriptions of the development process of a certain technology.Many studies are ‘non-originating’researchhavingbeencarriedoutbyresearchersincountriesotherthanIndia,orascollaborationsbetweenforeignandIndianresearchers.

4. TheHumanActivityAssistiveTechnologyorHAAT frameworkwas found tobeuseful as away to classify studies for the review, providing insights into the extent and nature ofevidencebaseneededtodevelopassistivetechnologies.

5. Thecontext inwhichpersonswithdisability liveandoperatewas rarely researched for itsownsake.Typically,studiesthatdiscussthecontextinwhichpeoplelivehavebeencarriedout as an adjunct study to the development of a particular aid or device rather than todevelop itsownunderstanding. Studiesalsodonotdiscussengineeringconsiderationsfordesignofassistivetechnologydevicesotherthanasadescriptionlinkedtothepresentationof a particular device. As a result, a holistic picture of the field is not available and fewgeneralisations or signposts are available to the researcher or manufacturer seeking toidentifyareasinwhichmoreworkisrequired.

6. Most of the studies accessed related to work done in the space of mobility and visualimpairment, many relating to modification of mobility devices for the elderly. Researchattentionwas largely on assistive devices that aid in education or employmentwith littleattentiontootheraspectsofaperson’s lifesuchaseverydayliving, leisureandrecreation,

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participationinsociallife,etc.Presentdaydropoutratesfromassistivetechnologythathasbeenadopted,isreportedlyashighas80%–studiesarerequiredtounderstandwhythisissoandwhat canbedone to correct the situation.Thereare several aspectswhichmakeastructuredresponsetodisabilityinIndiadifficult.Tobeginwith,theextentandcontoursofthe problem have not been fully understood. Studies that capture the prevalence ofdisability,whilebeingveryextensive,haveyieldednumbersthatmanycontest.Further,thetwolargestdatasetsdescribingdisabilityinthecountryarenotconsonantandhencerobustcomparisonscannotbedrawnorlessonstakenaway.Extrapolationsastothelikelysizeoftheproblemintheforeseeablefuturehavenotbeencarriedout.Allofthismeansthatanappropriate responsecannotbemounted. Addto this theunderlyingcontextof India–acountry with low per capita income and where demand for health services outstrips itsdelivery.Itisclearthatbetterinformationisrequiredandpoliciesputinplacethatstronglyencouragemarketplayerstoparticipateinthissector.

7. Indiahasbeenanearly signatoryof theUNCRPD. It hashada law relating todisability inplace since 1995whichwas recently revised and replaced in 2016. Several other Acts ofParliament also have helped to develop systems to respond to the needs of those withdisability.Thereisanetworkofnationalinstitutes,digitizationofdisabilitycertificationhastaken place, the National Innovation Fund has recognised and awarded innovators in thespaceetc.Manyschemesareavailabletothosewithdisability–severalareofmanyyears’standingandargumentmaybemadeaboutwhetherornotthesupportthattheyprovideissufficientorneedstobeupdated.

8. Robust researchon thedemand for rehabilitativeandpalliativeservices involvingassistivetechnology has not been undertaken. Global generalisations indicate that over 90% ofdemand may remain unmet – with the expected increase in numbers due to increasinglongevityandnoncommunicablediseases,thismayexpandfurther.

9. ALIMCO is a government sector entity that is easily the largest producer of assistivetechnologysolutionsinIndia,producingover350differentkindsofaidsandappliances.Butquestionsareraisedaboutthesuitabilityandsturdinessofitsaidsandappliances.Therearefewdevelopersorproducersintheprivatesectorexceptinnicheareassuchasspectacles,wheelchairs,walkingcanesetc.

10. Severalchallengesremaintobeaddressed.Inordertomakeassistivetechnologyaccessible,there needs to be greater awareness among persons with disability and their caregivers.Information regarding aids and their utility, source of availability, cost, operating cost,supportservicesetc.mustbepushed.Forthis,abetterunderstandingmustbedevelopedregardingthesizeandnatureoftheproblem.

11. Inordertohelpresearchersandmanufacturersbetterrespondtotheneed,thecontext inwhichtheassistivetechnologymustoperate, theactivities forwhich it is requiredandtheskills and abilities of its users should be the subject of studies, along with studies onaccessibility, affordability and inclusivity of devices. With the context in India being asdiverseasitis,thisisnomeantask–devicesareneededforboththe‘newIndia’aswellastheold, ifmarketpenetrationisadesirablegoal. Theroleofgovernmentasanenablerofsolutions rather than purveyor must be fully explored. A key debate that has important

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implications in the Indiacontext is theappliancevs tooldebategiven itspresent situationand expected rapidly increasing need. Does India need tools that are built-from-scratch,custom-designedandrequiresignificanttrainingfortheusertobeabletouseiteffectively?Or should the focus be on producing appliances that are built on existing technologicalplatforms,easytoadoptandrequireminimalornotrainingforuse?ShouldIndiaadoptaneither-orpolicyorassignsomeexpectationofdistributionofresearchanddevelopmentoneithersideofthisdebate?

12. Disjunctures such as the fact that assistive technology falls within the purview of theDepartment for Empowerment of Persons with Disabilities, Ministry of Social Justice andEmpowerment rather thanMinistry ofHealth and FamilyWelfaremust find resolution. Inorderfortheassistivetechnologymarkettofunction,andfunctionefficiently,allpartsofit–basic and applied research, knowledge translation,manufacturing andmarketingmust bewellconnectedthroughacommonplatform.Thepresentlackoflinkagebetweenkeyactorsinthespacehastobeaddressedsothatefficienciescanbeachieved.

13. Severalrecommendationscanbedrawnfromthestudy:

1. More and better data is required on disability prevalence and unmet need forassistivetechnology.Thedistributionofneedisofparticularimportance,requiringdataontype,geographicalandincomedistribution.2. Data is also required to develop the aids and appliances required for populationsaffectedbydisability.TheHAATframeworkprovidesausefulwayinwhichtoapproachtheproblem;themosturgentdataneedsmayneedtobeprioritised.3. WhileIndianlawdoescoverdisability,policyrequiresfurtherexpansioninordertomorecomprehensivelyaddressmoderndayassistivetechnologydevicesthatneedtobeputin place. In particular, experts point to the absence of an assistive technology Act andstandardsforassistivetechnology.4. Laboratory to market connections remain weak, despite the emergence of greenshootswithrespecttoassistivetechnologyinIndia.Platformsfordiscussionandnetworkingaresorelyneeded,vexedlegalissueswithrespecttosoftwareuseneedtobeexplored,andfinancialsolutionstosupporttheindustrymustbeconsidered.5. There isneed formanymorestudies tosupportastrongandconsidereddisabilityresponse,both todevelopandmanufactureassistive technologydevices aswell as toputsuitablepoliciesinplace.

14. Insum,itmaybesaidthatastrongpushtodevelopIndia’sworkonassistivetechnologyisurgently required to ensure that the needs of a growing complement of persons withdisabilityaremetandproductivityofIndia’sworkforceiscontinued.Withalargenumberof engineering institutions, a vibrant research community, innovative manufacturingcapabilities and a government committed to improvements, India has thewherewithal tomakethishappen.

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Chap t e r I BACKGROUND

Disability has become part of the mainstream. Once perceived as an object of pity, those withdisabilityhavefoughtapitchedbattletosecuretheirdignity.Theyhavedemandeddevicesthatcanhelpthemdowhatotherpeoplecando,beitindailyliving,education,employment,artsorsports.Today,mechanismssuchastheUnitedNationsConventionontheRightsofPersonswithDisabilities(UNCRPD) entitle persons with disability as amatter of right, to assistive technology that ensuretheirfullandequalenjoymentofallhumanrightsandfundamentalfreedoms.1

Severalinitiativeshavebeentakenupinsupportofdisabilityandinclusionataninternationallevel.InJuly2014,WHOestablishedaglobalinitiative,theGlobalCooperationonAssistiveTechnologyor

GATE,toimproveaccesstohigh-qualityaffordableassistiveproducts.More recently, the Global Disability Summit held in London in July2018undertheleadershipoftheGovernmentoftheUK,sawseveralinternational commitments being made to disability.2 In 2011, theWorldReportonDisabilitynotedthatdisabilityprevalenceishighandgrowing.Ofthe1billionpersonsestimatedtobelivingwithdisabilityin the world, about 110 - 190 million face significant difficulties infunctioning. Apart from congenital causes, a growing number of

personsareexperiencingdisabilityasaresultofoldage,chronichealthconditions,conflictaswellasinjury, diet and substance abuse. Disability is also known to bemore prevalent among themostvulnerable–women,olderpeopleandthepoor.About80%ofalldisabilityisestimatedtooccurindevelopingcountries.3

Thetermdisabilityisnotobjectivelydefined.Differentscholarsandorganizationsdefinedisabilityindifferentways.4TheEconomicandSocialCommissionforAsiaandthePacificnotesthat,“disabilityprevalence in the Asia-Pacific region varies dramatically. These figures are heavily shaped by thecontrastingwaysthatgovernmentsdefinedisabilityandcollectdata.…”.5

Internat ional C lass i f icat ionof Funct ioning, Disabi l i ty andHealth

The WHO’s International Classification of Functioning, Disability and Health defines disability interms of challenges that a person faces as a result of the interaction between the state of theirbodily functions and structures, activities and participation in society, and their personal andexternal environment.6 It describes functioning as the (positive) interaction between a person’sabilities and the environmental context, while viewing disability as the (negative) interactionbetween a person’s impairments, activity limitations and participation restrictions and theenvironmental context. Thus, the International Classification of Functioning, Disability and Healthunderscores that assistive technologymust take into account, not only a person’s impairment of

Disabilityisnotobjectivelydefined.Differentscholarsandorganizationsdefinedisabilityindifferentways.Similarly,thedefinitionofassistivetechnologyisverybroadcoveringselection,acquisitionanduseofadeviceandservice.

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functionsandstructuresofbody,butalsotheactivitiesthatthepersonwouldliketocarryoutandthenatureofher/hispreferredmodesofparticipationinsocietyatlarge.7

Figure1:InteractionbetweentheComponentsofICF

Source:WorldHealthOrganisation.(2001).

Assist ive Technology

The WHO refers to assistive technology as “Assistive devices and technologies are those whoseprimarypurposeistomaintainorimproveanindividual’sfunctioningandindependencetofacilitateparticipation and to enhance overall wellbeing. They can also help prevent impairments andsecondary health conditions.”8 Another useful way to think about assistive technology is that itrefers to items, a piece of equipment, or a product system, whether acquired commercially,modified, or customized to use for increase, maintain, or improve functional capabilities ofindividualswithdisabilities.Itcanalsodenoteaservicethatdirectlyassistssuchanindividualintheselection, acquisition, or use of an assistive technology device.9 Such assistance enables personswith disability to independently function and participate in everyday life, and enjoy inclusion andintegrationintomainstreamsociety.10

Need for Assistive Technology There is a striking lack of data in India on the unmet need forassistive technology. Access to assistive technology in individual countries can be difficult toestimate, and the Convention of Rights of Personswith Disability reports on assistive technologyprovideonlythenumberofpersonswithdisabilitywhohaveaccesstothetechnologybutnotthetotalnumberofpersonswithdisabilitywhoneedthem.11Furthermore,althoughitisacknowledgedthat there is a large and growing need for assistive technology within low and middle-incomecountries,thereisalackofresearchinthesesettings,whichhindersthedevelopmentofevidence-informedpolicyandpractice.12

A2016 reportof theGovernmentof India’sMinistryof StatisticsandProgramme Implementationnotesthatitisessentialtodeterminetheneedsofpersonslivingwithdisability,includingtheroleofassistive technology for inclusivedevelopment.13Anunderstandingofassistive technology in Indiabegsanintersectionalandcontextualapproach.Identitiessuchasgender,age,location,class,casteandethnicityinteractwithsocio-culturalnormslikepatriarchyshapethelifechancesofpersonswithdisability.Thedisabledareamongthemostdisenfranchisedeconomically,educationallyandhealth-wise, as well as face significant discrimination. Subalterns such as women, Dalits and poor thusbecomedoublydisadvantagedinthisregard.14

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HowMuch isRequired Howmanypeople requireassistivedevices? For India, this isanestimatethat is difficult to find. It is clear that the overall need is great. The Global Disability Summitacknowledgedthatthereisnotenoughrobustestimationoftheneedsofpersonswithdisability.TheUNCRPDhighlightstheintersectionalityof ageinganddisability.15 It noted that therearemore than1billionpeoplepresentlyinneedofoneormoreassistiveproducts.1617Ageingis intricatelyconnectedtodisabilityasmore than46%ofolderpersons - thoseaged60yearsandolder-havesomesortofdisability.Infact,morethan250millionolderpeopleexperiencemoderatetoseveredisability.18WHOnotesthatonly5-15%ofthepeoplerequiringassistivetechnologyhaveaccess to it in low and middle-income countries.19 Overall, only 3% of the hearing aids that areneeded are available.20 It is estimated that only 1 in 10 people in need overall, have access toassistiveproducts.Currentextrapolationssuggestthatmorethan2billionpeoplewillneedatleastoneassistiveproductby2030,withmanyolderpeopleneeding2ormore.21

In India,theprevalencefiguresmostcommonlyquoteddrawuponthe2011Census.Thissuggeststhat 2.21% of India’s population or 26.8million have some form of disability. However, expertspoint out that these figures are too low and the realistic expectations are closer to 50million.22There are practically no estimates for unmet need for assistive technology in India; from nearbyBangladesh,astudysuggeststhatunmetneedmaybeashighas80–90%.23

TheStudy

InorderthatIndiacanaddressitsrequirementsforassistivetechnologies,abetterunderstandingoftheavailableinformationandguidanceisneeded.ThepurposeofthepresentstudyistocarryoutarapidreviewinsupportofabetterunderstandingoftheexistingevidenceonassistivetechnologyinIndiaandtherebysupportasuitableandeffectiveresponse.

Threespecificresearchquestionswereidentifiedinthetermsofreference:

1. Broadly speaking, what is the ecosystem of Assistive Technologies in India?Who are themainplayersandwhatkindsofneedsdotheyaddress?

2. WhataretheclearresearchgapsindatainthecontextofAssistiveTechnologiesinIndia?3. HowcouldapotentialCentre for Excellence support aneffective response to thegrowing

needofAssistiveTechnologiesinIndia?

ApproachandMethodology Two approacheswere adopted for the study: the first involved arapid review of the published literature available on assistive technology in India; and thesecond drew upon local expert knowledge to gather further information, both published andotherwise. The report is a collation of both published and grey literature to develop a rapidreviewofthematerialonthesubject.

Google Scholar was searched to find relevant materials. While the most recent literature wassought, in fact, literature going back to 1987was accessed, as therewas a general paucity ofpublished materials pertaining to the Indian situation. Over 110 reports, and relevant policieswere accessed through official websites of the country’s government. In all, 15 experts wereinterviewedinordertocapturetheirexperientialinsightsandcollectgreyliterature.Keywordsusedto interrogate the database were along the following themes: disability; assistive technology;

Itisestimatedthatonly1in10peoplewhoneedassistivedevices

haveaccesstothem.

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frameworks for assistive technology analysis; availability of assistive technology; demand forassistive technology; human factors and aging; spectrum disorders and culture; stigma; socialinteractions; disability and its context; disability for activities of daily life; informationcommunication technologies and development; product design; user-centred designs; technologyforlearningdisability;inclusivegrowth;economicintegration;policyinterventions;marketplayersinassistivetechnology;upandcomingincubators;keyinitiativesindisability;andleadingorganisationsindisability.

LimitationsLimitationsmustbementionedattheoutset.One,duetotheshorttimeframeinwhichthe study was to be carried out, this is a rapid review rather than a comprehensive one. Two,availabledataandreports/papershaveanemphasisonmotorandvisualassistivetechnologies,andon education and employment for the most part. Third, the preponderance of information isavailablefromsmallstudiesonaparticulartypeofassistivetechnologyratherthosetakingawiderapproach.

Inthechaptersthat follow,wediscusstheecosystemforassistivetechnology in Indiaandthekeyevidenceavailabletoguidepresent-daypolicyandimplementation.

K E Y T A K E AW A Y S

§ International conventions entitle personswith disability to assistive technology that ensuretheirfullandequalenjoymentofallhumanrightsandfundamentalfreedoms.

§ TheInternationalClassificationofFunctioning,DisabilityandHealthdefinesdisabilityintermsofthechallengesthats/hefacesasaresultoftheinteractionbetweentheirbodilyfunctionsand structures, activities and participation in society, and their personal and externalenvironment.

§ AssistivetechnologyisdefinedbyWHOasassistivedevicesandtechnologieswhoseprimarypurpose is to main or improve an individual’s functioning and independence to facilitateparticipationandenhanceoverallwellbeing.

§ Disabilityprevalence ishighandgrowing.Howeverthere isastriking lackofdataonunmetneedforassistivetechnology.

§ The study had three objectives in relation to India: (i) briefly describing the ecosystem ofassistive technology; (ii) identifying clear research gaps on the subject; and (iii) uncoveringhow a potential Centre for Excellencemight support an effective response to the growingneedforassistivetechnology.

§ BetweenOctober2019andFebruary2020, thisstudyundertooka rapidreviewofavailableliterature on assistive technology in India and interviews with key experts. In all, 115documentsfrom1978–2019wereaccessedandinterviewsheldwith15experts.

§ Thisrapidreviewfocusesontheecosystemofassistivetechnology in India, identificationofresearch gaps, and how a potential Centre for Excellence could support Indian efforts toprovideaneffectiveresponsetotheneedforassistivetechnology.

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E n d N o t e s 1UN.(2017).ConventionontheRightsofPersonswithDisabilities.Resolution61/106.NewYork:UnitedNations.2GlobalDisabilitySummit.(2018):OfficialReadoutAccessedat

https://drive.google.com/file/d/15PZ3CJf841KxpaTLvp3ARE_hilACPro6/view.3WHOandTheWorldBank.(2011)WorldReportonDisability.Factsheet.Accessedat

https://www.who.int/disabilities/world_report/2011/factsheet.pdf?ua=14Jeffery,R.&Singal,N.(2008).MeasuringDisabilityinIndia.EconomicandPoliticalWeekly,43(12/13),22-24.5ESCAP.(2015).DisabilityataGlance:StrengtheningemploymentprospectsforpersonswithdisabilityinAsiaandthe

Pacific.6WHO.(2001).InternationalClassificationofFunctioning,DisabilityandHealth:ICF.Geneva,WHORetrieved,10March

2019,fromhttps://apps.who.int/iris/bitstream/handle/10665/42407/9241545429.pdf;jsessionid=04A11665500DC9A983E067BE746143A0?sequence=1

7TheICF:AnOverview.(n.d.).https://www.cdc.gov/nchs/data/icd/icfoverview_finalforwho10sept.pdfRetrieved,10March2019,fromhttps://www.cdc.gov/nchs/data/icd/icfoverview_finalforwho10sept.pdf

8WHO.(2020).Accessedathttps://www.who.int/disabilities/technology/en/9Alper,S.&Raharinirina,S.(2006)AssistiveTechnologyforIndividualswithDisabilities:AReviewandSynthesisofthe

Literature.JournalofSpecialEducationTechnology.10WHOandTheWorldBank.(2011)WorldReportonDisability.Factsheet.Accessedat

https://www.who.int/disabilities/world_report/2011/factsheet.pdf?ua=111SrisuppaphonD.,SriboonrojA.,RiewpaiboonW.&TangcharoensathienV.(2017).Effectiveimplementationofthe

UNCRPDbyThailandStateParty:challengesandpotentialremedies.BMCInternationalHealthHumRights.12TangcharoensathienV.,WitthayapipopsakulW.,ViriyathornS.&PatcharanarumolW.(2018).Improvingaccessto

assistivetechnologies:challengesandsolutionsinlow-andmiddle-incomecountries.WHOSouth-EastAsiaJPublicHealth[serialonline].

13Verma,D.,Dash,P.,Bhaskar,S.,Pal,R.P.,Jain,K.&Srivastava,R.P.(2016).DisabledPersonsinIndia:AStatisticalProfile.MinistryofStatisticsandProgrammeImplementation,GovernmentofIndia.

14Janardhana,N.,Muralidhar,D.,Naidu,D.&Raghevendra,G.(2015).DiscriminationagainstdifferentlyabledchildrenamongruralcommunitiesinIndia:Needforaction.JournalofNaturalScience,BiologyandMedicine,6(1),7.

15UN.(2007).ConventiononRightsofPersonswithDisabilities.DepartmentofEconomicandSocialAffairs.Accessedathttps://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities.html

16WHO.(2011).SummarytheWorldDisabilityReport.WHOandTheWorldBank.17.GlobalDisabilitySummit.(2018).OfficialReadoutAccessedat

https://drive.google.com/file/d/15PZ3CJf841KxpaTLvp3ARE_hilACPro6/view18UN.(2015).AgeingandDisability.DepartmentofEconomicandSocialAffairs.Accessedat

https://www.un.org/development/desa/disabilities/disability-and-ageing.html19WHO.(2010).Assistivedevices/technologies.Geneva:WorldHealthOrganization.20WHO.(2004).Guidelinesforhearingaidsandservicesfordevelopingcountries.Geneva:WorldHealthOrganization.21WHO.(2018).Factsheetsdetailsonassistivetechnology.(2018).Accessedathttps://www.who.int/en/news-room/fact-

sheets/detail/assistive-technology22TheWorldBank.(2007).PeoplewithdisabilitiesinIndia:FromCommitmentstoOutcomes.HumanDevelopmentUnit,

SouthAsiaRegion.Accessedathttp://documents.worldbank.org/curated/en/358151468268839622/pdf/415850IN0Disab1ort0NOV200701PUBLIC1.pdf

23Pryor,W.,Nguyen,L.,Islam,Q.N.,Jalal,F.A.&Marella,M.(2018).UnmetNeedsandUseofAssistiveProductsinTwoDistrictsofBangladesh:FindingsfromaHouseholdSurvey.InternationalJournalofEnvironmentalReseachandPublicHealth.Accessedathttps://www.google.com/search?q=unmet+need+for+assistive+devices+india&oq=unmet+need+for+assistive+devices+india&aqs=chrome..69i57.208403j0j7&sourceid=chrome&ie=UTF-8

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Chap t e r I I E V IDENCE BASE ON A S S I S T I V E T ECHNOLOGY

InChapter2,wediscusstheevidenceavailabletosupportthedevelopmentofassistivetechnologysuited to the Indiansituation. Inorder to identify thebestpossibleway inwhichevidencecanbediscussed, various models and frameworks that are used in the assistive technology space werereviewed.Whatwewere looking forwasa framework thatwouldsupportdevelopmentofamapthatcouldidentifyevidenceavailabilityandinformfuturedataneeds.

HAATFramework

Cook and Hussey’s Human Activity Assistive Technology (HAAT)model first mooted in 1995, is awidely recognized framework for assistive technology provision. (See Figure 2). The functionaloutcomeofanassistivetechnologysystemisdefinedas,“someone(personwithadisability)doingsomething(anactivity)somewhere(withinacontext)”.24TheHAATframeworkdescribestheprocessby which assistive technologies that are the most optimal for a person with disability can beselected.25TheHAATframeworkthushighlightstheperformanceoftheentiresystemwithinwhichassistive technology is located rather than the isolated evaluation of the human performance. Indoing so, the HAAT framework provides the basis of discussion of evidence availability moregenerally.

TheHAATmodel isoneof theearliestmodelsofAssistiveTechnology in the fieldof rehabilitationengineering. It isbuiltonBailey’sHumanPerformanceModelusedinhumanfactorengineering,incorporatingtwosubstantialchanges.First,assistivetechnologyissetasseparateandimportantelementhavingadirectandinterdependentrelationshipwiththeotherthreeelements i.e. human element, activity element and the contextelement.26Second,thecontextoccupiesamoreprominentpositionas does its association with the other elements. Context is notdescribedsimplyasthelocationandphysicalenvironmentinwhichan activity occurs. There is an embedded impact of social, culturaland institutional factors as well. There is a “dynamic interactionbetween initial three factors and the pervasive influence of the

contextonthem,bothindividuallyandcollectively,withhumansidentifiedasacentralfocus”.27

TheHAATframeworkconsidersthefollowingindiscussingassistivetechnology:(i)contextinwhichuseistotakeplace;(ii)activitiesforwhichtheassistivetechnologyistobeused;(iii)humanfactorsthatdetermine readiness toutilizeassistive technology;and (iv)engineeringconsiderationsof theassistive technology. Context comprises the social and cultural context as well as institutionalcontext(e.g., infrastructureandlegislation);andphysicalvariables.Activitiesaredividedintothree

CookandHussey’sHAATframeworkfirstmootedin1995highlightstheperformanceoftheentiresystemwithinwhichassistivetechnologyislocatedratherthantheisolatedevaluationofhumanperformance.Itconsidersthefollowingaspects:context;activities;humanfactors;andengineeringfactors.

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broadcategoriesofself-care,productivity,and leisurecomprisingofcommunicationandaccesstoinformation,mobility,cognitiveactivities,daily living,educationandemployment,andrecreationalactivities.Thehumanfactorcapturesthedistinctionbetweenaperson’sabilities,fromher/hisskillsinusingassistivetechnology,tomotivationthatthepersonwouldrequiretousethetechnology.

Engineering considerations comprise the following components: activity specification (taskspecification and user requirement), design issues (design approach and technology selection),systemtechnology issues (systeminterfacesandtechnicalperformance)andenduser issues (easeand attractiveness of use, cost of the device, mode of use, training requirements anddocumentation).

Inthesectionsthatfollow,wediscusstheevidenceavailableforeachoftheseaspectsthatmustgointothedevelopmentofassistivetechnologies.Context

Thedesignandsubsequentsuccessofassistivetechnology interventions isappreciablyaffectedbythebackgroundinwhichitisdeployed.Contextcomprisesofthesocialandculturalcontext–bothsociety-wideaswellastheuser’sindividualsocialandculturalcontext;infrastructure,legislativeand

Source:McDonnel,K.(2018).

Figure2:TheHAATFramework

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assistive technology context; and the local setting namely, location, environment and physicalvariables.

CulturalContextAperson’snativeculture,language,beliefs,institutionalrestraints,customsmustbetakenintoaccountastheyrelatedirectlytotheperson,andtothelargercommunity.Researchon assistive technology generally focuses upon functionality and usability of the devices, yettechnology use does not happen in a social vacuum.28 Personal preferences in the social contexttendtodictatehowandwhetheradevice isused.Definingaculture iscomplicatedbutRipatandWoodgate (2011) define culture in the perspective of disability and assistive technology as,“…culturerefers tothebeliefs,values,meaningsandactionsthatshapethe livesofacollectiveofpeople, influencing the ways people think, live and act. These beliefs, values and ways ofunderstandingaresociallyconstructedandspecifictothecultureinwhichtheyarefound”.29

Krishnan,Venugopalanandothers(2009)undertookastudythatdescribedhowtheculturalpracticeofremovingfootwearcreatesachallengeforthevisuallyimpairedpeopleasfindingtheirfootwear

wouldrequiretouchingalotofshoes,sometimesperformedonhandsand knees.30 The project aimed to design a prototypical device thatcould assist visually impaired individuals to locate their footwearthrough electronic means. Selection criteria for the technologycomprised four important factors:maximumdetection distance; lowmaintenance and cost requirement; low power consumption andminimumsizeandweightofthedevice.McPherson(2014)talksaboutthe challenges to access hearing assistive technology devices indevelopingcountries.Suchchangecanonlybeachievedovertimeandwith sustained inputat thesocietaland individual level.He refers totraining programs and curriculum for hearing health workers to

change the attitude of the individuals towards disability.31 Popularization of online learning alongwithincreasingpenetrationoftelecommunicationsinlowandmiddle-incomecountrieshavepavedawayforinternetbasedhearinghealthmodules.Thisisexpectedtobreakthecurrenttendencyofdichotomizing hearing devices fitting programs as either ‘audiologist test’ or ‘community-based’.Modulesincludematerialthatextendsusualaudiologicalscopeofpractice–althoughthishassocial,culturalandethicalimplicationsthatrequireconsideration.32

SocialContext Similarly,autismisaconditionthathasimpactedlivesofmanyfamiliesaroundtheworldandisprevalentincultures,racesandsocialclassesinmorethan80countries.33Asubstantialdiscussion on autism across cultures is presented by Grinker’s (2007) ‘Unstrange Mind’ whichfocusesonhisexperienceasafatherraisingagirlwithautism,whilediscussingtheexperiencesoffamilies living with autism in South Korea, South Africa and India.34 Grinkler asks the reader tounderstandAutism as shaped by culture and historical framework. Bourjarwah and others (2011)discuss how theunderstandingof peoplewith autism candiffer considerably across societies andimpacthowtheyareintegratedintoacommunity.35Thisisinlinewithresearchthathasshownthatdifferencesinpracticesandvaluesinsocieties,culturesandsocio-economicstanding,whichleadstosignificant variation in the experience of autism.36 The study concluded that family structure,linguistic environment and religion are the most prominent cultural factors in developing SouthAsiancountriesinshapingtheperceptionsandexpectationsofindividualswithautism.

Aperson’snativeculture,beliefs,institutionalrestraints,customsmustbetakenintoaccountastheyrelatedirectlytothepersonandtothelargecommunity.Researchonassistivetechnologyusuallyfocusesonfunctionalityandusabilityofthedevices,yetthetechnologydoesnothappeninasocialvacuum.

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PhysicalContextAfunctionalperspectiveonthemobilityneedsofwomeninIndiaidentifieshowanindividual with decreased and inefficient mobility is faced with many environmental andsocioculturalbarriersimpactingherorhisabilitytoparticipatefullyinlife.37Determiningfunctionalmobilityrequiresaskingwhen,where,howandforwhatpurposeindividualmustmovetoperformtheactivitiesofdaily living successfully.Halender (1993) identifies thenecessityofaddressing theneedsof thepersonswithdisabilitiesnestledwithin the context fromwhich theyoperate,beforedesigning any new rehabilitation intervention or technology.38 A comprehensive approach thataddresses the functional status, social and cultural considerations, physical environment, personalphysicaldimensionsand institutional constraints isexpected tomaximize thematchbetween rideand thewheelchair.39 The purpose of the studywas to present formal research aboutwomen indisabilitieswhichwasdescriptiveinnatureandsensitivetothelocalcultures.Thedataprovidedthepreliminaryfindingthatthefunctionalityandqualityoflifeasdeterminedinasocietyforwomenishighlyrelevanttothemobilityneedsofthesewomen.40

Pal et al. (2017) discuss the physical environment in reference to fit and usability of assistivetechnology.41Themixedmethodfieldstudyofsmartphoneadoptionby81visuallyimpairedpeoplein Bangalore, India proposes a nuanced understanding of usefulness and usage based on needrelated social and economic functions. They move away from the reductionist technologyacceptancemodelwhichonlydiscusseswhetheratechnologyisadoptedorabandoned.Insteadhearguesthatthereisagreaterneedtofocusonthehumanagencywithinthenecessityofadoptingcertain mainstream devices, for instance the smartphones. They conclude that there is growingirrelevance of frameworks that fail to account for history of use or the user’s trajectory throughvarious technology and writes, “Broadening adoption investigations to include functions ofusefulnesscanhelpinunderstandingexactlywheretechnologyisworkingandwhereweneedmoreeffort.Whatmattersintechnologyadoptionthenisnotwhetheratechnologyisadopted,butratherhowitis—andwhatthatcantelldesignersandpractitionersabouttheneedsofusers”.42

InstitutionalContextMohammedandJamil(2015)speakaboutchangesrequiredintheinstitutionalframework of the country to create an economic inclusion for all sections of the society.43 Theybelieve that promoting entrepreneurship among the disabledpopulation is away to achieve this.Kitching(2014)alsohighlightsthe importanceofentrepreneurshipamongpersonswithdisabilitiesand discusses how this can be achieved through the support of the government.44 Governmentsupport can create favourable conditions and environment for persons with disabilities. Kitchingassociatesfavourableenvironmenttopoliciesrelatedtolegislation,infrastructure,legalframework,taxation,regulations,financingetc.

The available evidence on context highlights the importance that social, cultural, physical orinstitutionalcontextplayindesignandadoptionofassistivetechnology.Contextnotonlyshowhowcoming in of assistive technology is perceived and accepted in a society but the socioculturalstandingassociatedwithassistivetechnologymaymeanthatitmaynotbemadeaccessibleonceithas been made available. Experts interviewed highlight the importance of looking at assistivetechnology from a broader perspective, creating an end-to-end ecosystem in India with thegovernmentfocusingontheholisticdevelopmentofassistivetechnologyTheypointtotheneedtoprovidetrainingthatacquaintsresearcherswithexistingandnewtechnology,remarking,“whilethelocal socio-cultural context is an important factor to consider, the use of technology can bedisruptiveforsomeonewhoisusedtotraditionalmethods.”45

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Activ it ies

An essential feature of the HAAT framework is the recognition that assistive technology mustsupportactivitiesthatpersonsengageinaspartoftheirdailylife.Thisvariesacrossagegroups(e.g.,child,youngadult,olderperson);bygeographicallocation(e.g.,rural,urban);ormaybeexceptional,asinthecaseofextreme/competitivesports.Assistivetechnologyhasaroleinhelpingpersonstocarryouttheiractivitieswhentheyfacedifficulties.Literatureonassistivetechnologyasitrelatestoactivitiesthatpersonswithdisabilitymightneed,isdifficulttocomeby.Thediscussionondisabilityinreferencetovariousactivitiesdoesexistamongcertainorganizations,e.g.theIndianInstitutesofTechnology (IITs), Torchit, Saksham Yuva, the Department of Employment in Haryana and theParalympicCommitteeofIndia.Howeverthisbynomeansaddsuptoampleliteratureinthearea.Experts interviewedattest to the lackof researchersworkingonactivitybasedneeds forassistivetechnology.46

AssistiveTechnology inEducation AsystematicreviewbyPalandLakshmanan(2012)ofevidenceon accessibility of education in India suggests a positive correlation between the use of assistivetechnologyandbetteroccupationaland financialoutcomes.47 Vashisthaetal (2014)while talkingabouttheaccesstoeducationamonglow-income,visuallyimpairedpeoplerevealsthelimitationsofbraille books and audio recording in India and the disparity in the demand and supply of custommadeassistivetechnologydevicesthatleadpeopletocreatetheirownaudiorecordingsforcontentcreation.48Theavailabilityofbraillebooks,audio recordings forprovidingpersonswithdisabilitieswitheducationalcontentinIndiahasfacedphysicalandfinancialconstraints.49Anotherproblemisof the unavailability of assistive technology devices like screen readers, audio recording etc. inregionallanguages.HurstandTobi(2011)arguethatthehighcostofthedevicesresultsindisabledstakeholders using general-purposedevices. The choice touse commodity cell phones for visuallyimpairedpersons rather thancustommadecellphones isoneexampleofan inexpensivesolutionwithbetteradoptionratesforthetechnology.50

Ahmad(2015)inhislandmarkstudytalksaboutthegapininclusiveeducationbetweendevelopedand developing countries that is created by the (non)availability of good quality customisableassistivetechnology.51Hereferstotheskewedresearchonsuccessstoriesofinclusiveeducationinthe developed world, while countries in Asia, Europe and Africa deal with difficulties in theimplementation of inclusive education. The most common difficulties are limited governmentalsupport, ineffective policies and legislation, inadequate funding, insufficient trained teachers andsupportstaff,politicalinstability,andeconomiccrisis;theineffectiveandinefficientuseofassistivetechnologyisseentobeamajorobstaclehinderinginclusion.52535455

AgingandAssistiveDevicesThegrowingaverageageofIndiaisamedicalsuccessstorybutcomeswithitsownchallenges.ItdemandsthatIndiansocietyadaptintheareasofpublichealthpolicytomaximize the functional capacityofolderpeopleand increase their socialparticipation.56 In India,assistive technology is accompanied by a negative connotation which hinders its use among theolderpopulation.Goyal andDixit (2008) feel that this couldbe remediedby categorizing assistivetechnology devices differently (as wellness or enabling devices).57 The approach to assistivetechnologybecomes verydifferentwhen it dealswith recreational activities especially among theolderpopulationof thecountry. Itcanhelp thepersonswithdisabilities tocommunicatewellandparticipate in the socialenvironment.However, thismaynotbe thecaseamongagingpopulation

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due to reasons ranging from hesitation to use devices that are labelled as ‘aids for personswithdisabilities’ or theunwillingness touseassistiveaids/appliancesatthisstage in life. Studies exploring theintention of elderly population touse devices to maintain theirindependence discuss the socio-cultural factors, the financialconsiderations, considerations ofgender in terms of accessibility toassistive technology.58 Goyal andDixit (2008) listout the technologyinterventions in the fieldofelderlycare for the end users keeping inline with the deliberation andconsultations on home design,networking avenues, recreationand health among others (SeeFigure3).59

Having the right assistivetechnologydevicemaytranslatetoa life with the opportunity to beemployed and earn a living. Theresearchondisabilityandaccesstojobs has mostly been restricted tothe developed world. In the pastdecade has there been aconsiderable focus on economiceffects of disability on labourmarkets, the relationship betweendisability and poverty.60 61 62 Therehave been some ethnographicstudies that have highlighteddisability in the context of

development. Pal and Lakshmanan’s (2012) study was based on open-ended interviewsincorporating survey informationondemography,numberof yearsusing screen readers, conformlevel, access to technology information, workspace experience etc. to 37 visually impairedrespondents. It has contributed to theon-going conversationon thepositive correlationbetweenaccesstoemploymentandassistivetechnology.63

Assistive Devices for Sports Wheelchairs are generally accessible in high and middle-incomecountries.However, access tomobilitydevices for sports activities is difficult even inhigh-incomecountries suchas theUSAdueof lackof funding.Appropriatewheelchairs forbasicmobilityhavebecomeavailableinIndiaonlyintherecentyears.Thesituationisworseforlow-incomecountries.Ithas been estimated that between 20 - 130 million require access to wheelchairs in developing

Source:Goyal,V.C.&Dixit,U.(2008).

Figure3:EnablingandWellnessAssistiveTechnologyfortheElderly

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countries.64The‘Paralympian’presentsrecenteventsinthefieldofsports,highlightingsportsinthepresenceofdisabilityinthedevelopingcountries.Aurthieretal.(2007)highlightintheirpaper,theprocess of developing an affordable wheelchair for low income countries. He designed a sportswheelchairforlow-incomecountriesusingmaterialandcomponentsthatwouldbeeasilyavailableinthesecountries.65Thefabricationprocessintheconstructionwassimpleenoughtobeadoptedbystudentswithnoexperienceandvirtuallyzerosupervision.66Thisshowshowtheconsiderationforassistive technology for sports as an activity among persons with disability has been gainingmomentuminlowtomiddleincomecountries.

Not only in physical disability, there is also evidence of speech modification through the use ofassistive technologydevices can aid childrenwithdyslexia.67 There is evidence thatAugmentativeand Alternative Communication (AAC) devices have been very helpful in catering to thecommunicationneedsofchildrenwithdevelopmentalconditions likeAutism.68Experts in the fieldnotedthattheawarenessofdifferentassistivetechnologyfordifferentactivitiesisrisingandnewerproducts demonstrate an awareness of user requirements. The overall ecosystem of assistivetechnology seems tobeexpandingas thediscourseondisability in relation to variousactivities isswelling.69

HumanFactors

Assistivetechnologyenablesapersontocarryoutactivitiesofdaily livingandsupports learningtoacquire various skills. The human component of the model encompasses ability as well as skillsacquired; some add the notion of motivation to human factors.70 This section summarizes theevidenceavailableonhumanfactorsastheyrelatetoassistivetechnologyinIndia.

AssistiveDevicesforDevelopmentalandLearningDisabilityAparadigmshifttowardsuniversalandinclusivedesignismakingtechnologywithenablingfeaturesavailableinmarkets.Forexample,twosystems have been developed at International Institute of Information Technology, Hyderabad incollaboration with teachers and parents of children with autism –AutVisCommasacommunicationsystemdevelopedontablets,andAutinect as a set of activities developed to teach children withAutismsocialskills.Thetwoapplicationshavebeendesignedtoactas early intervention tohelp childrenwith autismgain social skills.Sampath et al (2013) talk about the increasing influenceof technology to complement traditionaltherapy.71 Thismaybeevenmoreeffective in autismbecauseof the affinity that individualswithautismhavefortechnology.

Nagavalli and Juliet (2016) address their research to dyscalculic children with a range of mathlearningdisabilities(verbal,operational,lexical,ideognostic,practognostic).Theypointoutthatthetreatment of dyscalculia should address all the areas of the disorder with a central focus oneducational intervention to improve study skills.72 Nagavalli and Juliet are of the opinion thatassistivetechnologycouldhelpchildrenwithdisabilitiestolearnindependentlyandperformbetterin the class. Computed Assisted Instructions are known tomotivate students with dyscalculia byproviding individual instructions, carrying out precisemonitoring for teachers alongwith drill andpractice type activities inmaths. They have in their paper, provided an extensive list of assistivedevices for dyscalculia divided into broad categories ofmultimedia andmultisensory resources. A

Aparadigmshifttowardsuniversalandinclusivedesign

ismakingtechnologywithenablingfeaturesavailablein

markets.

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numberofresearchersalsoproposetheuseofcomputertechnologyandotherformsofinformationtechnologyto‘enhanceandequalizetheabilityofindividualswithdisabilities’toaccesseducation.73

Assistive Devices and Physical Disability Technology opens opportunities that were closed tochildrenwithdisabilityinwhichtouchtechnologywitheducationalapplicationshavesimplifiedthedevelopmentofskillsandeducation.SinghandKaur(2015)discusstheuseoftouchtechnologytoeducate studentswith physical disability. They note that the ‘app’ phenomenon is very helpful inincreasingparticipation,and the levelof interaction in the livesof thepersonswithdisability.Thestudyshowcasesthedevelopmentofskillsandmotivationalincentivesthroughtheuseofe-learningtoolsembeddedinandroidapplications.74

The availability of evidence on safety and efficacy of the Wheelchair Skills Program in CanadamotivatedCooperandKirby (2007)toexplore itsapplicability in India.75 AlthoughtherearemanyusersofthewheeledmobilitydevicesinIndia,alargeproportionofthemwhorequiresuchdevicesdonothaveaccesstothem–oneestimateputstheglobalnumberashighas~95%oftheestimated10million excludingolder populations.76 Cooper andKirbyhighlight theproblemsassociatedwiththelimitedreachofWheelchairSkillsProgramsinIndialikeunavailabilityoftheprograminregionallanguages, lack of wireless connectivity, impassable sidewalks. These reasons demotivate themajorityofthepopulationinneedofWheelchairSkillsProgramtoavailthem.Simmonsetal.(1995)acknowledge the importance of Wheelchair Skills Programs as well and conclude their study‘Wheelchairsasmobilityrestraints…’withthestatement,“Improvingwheelchairskillswithtargetedintervention programs, along with making wheelchairs more ‘user friendly’ could result in morewheelchair propulsion with resultant improvements in the resident’s independence, motivation,freedomofmovementandqualityoflife”.77

AdoptionofAssistiveDevicesCriticalanalysisofthenatureofevidencecreatesaspaceforperson-centred methodologies dealing with people, environment and technology against individualizedoutcome. Pal and Lakshmanan (2012) elaborately discuss the testimonials of the people whereintheymake a direct correlation between themotivation of a person to avail assistive devices andher/his access to assistive technology. Besides people in direct contact, therewas an aspirational

effectbetweenuseofassistivetechnologydevicesbynon-connectedpeers forpersonswithdisability tostartadoptingandusingassistivetechnologydevices.78Theyalso talkabout theavailabilityofassistivetechnology and the skills acquired by its use, andmake a direct linkfrom skill to increase in status and prestige especially in the Indian

context.Theysay,“theinabilitytostudythesciencesputsapsychologicalburdenontheindividual.The access to assistive technology plays an unusual role in this case – since learning to use acomputer is often seen in the same terms as learning engineering. Thus, even if the individual isdissuadedfromstudyingatechnicalsubjectatanearlystageinlife,thelateraccesstotechnologyisoftenseenastransformative”.79

RogersandFisk (1991)makeanexpansive tourontechnologyusability,adoptionanddesign fromtheperspectiveofthedisciplineofhumanfactors.80Theresearchapplieshumanfactorprinciplesfortraininganddesigntoreducethedifficultyexperiencedwithtechnologyarisingfromnormativeagedifferenceintheabilitiesofpeople.Drawingonthesurveydataamongthegeneralpopulation,theypoint out that the everyday consumer products pose a greater difficulty for the older than the

Thereisadirectcorrelationbetweentheuseofassistivetechnologybytheirpeersandthemotivationtoavailitandcontinueusingit.

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younger population. Even though these differences are not consistent, complaints on the designflawsamongtheolderpopulationwerehigherthantheyoungerpopulation.Thiscouldbeapossibleoutcome either cohort effect (stiff upper lip) ormay have represented survival of the fittest. Fortraining, theyprovideexamples toreiteratehowbest toemploydesigntraining interventionsthatwork. Willis and Schaie (2003) show the narrow transfer of technology and elaborate on howtraining interventions such as those suggested by Roger and Fisk are viable to improve theperformanceoftheolderpopulationoncomplexproblem-solvingtasks.81Anexpertnotes,“Abilitiesenhancedduetoassistivetechnologyimplementationhaveallowedgreateraccesstopersonswithadisability to everyday activities of daily life, education, employment, leisure and recreation. Forexample,simpleassistivetechnologytoidentifyabrushwithvisualcuesliketactilestripsordifferentcolour,supportchildrenwithvisualorcognitiveimpairmentstochoosetheirownbrushtobeginamorning.Andskillsontheotherhand,cangetenhancedwiththeuseofassistivetechnologyrightfromlifeskillsbyaccessibleinstructions,contentdeliveryandaccess.Ithasimprovedmobilitywithaids like smart cane and its variants among persons with visual impairments detecting obstaclesthoughour trafficandmovingpopulationonroadsandpavementuseculturehas tobecorrectedrightfromchildhood.”82

Needsofthepeopleareoftencomplex.Assistivetechnologyisaninterfacebetweenthepersonandtheseriestaskthattheywouldliketocomplete.Thisemphasisestheneedofamodelthatisperson-centric and supports the relevanceof theHAAT framework to gather theevidenceon thehumanfactors.McCarthy,Pal andCutrell (2013) showcase theadoptionand the continueduseof screenreadersamongvisually impairedpeople in India.Theydiscussthefactorsthatdriveearlyadoptionsome of which are text to speech voice quality, low prices of market dominated softwareapplications,availabilityofregionallanguages,existenceoftechnicalsupport,voicequalityandtheexistenceofacommunityofusers.83Thestudydiscussestwotheoreticalperspectives–firstthroughtheapplicationsoftheeconomicsofswitchingbehaviour,andthesecond,aboutnoviceandexpertapproaches toward new product adoption.84 Themotivation towards the adoption of technologydiffersforthenoviceandtheexpert.Thenoviceusersofscreenreadersoptforthesalientfeaturesoftheproductsavailable,forinstanceText-to-Speech(TTS)voiceandJobAccesswithSpeechwithaText-to-Speech) JAWS TTS output. Text-to-Speech is a primary output for people with visualimpairment andhence its voice quality is sure to act as amotivation for technology adoption fornovice.Theexpertscreenreaderplacesvery littleemphasison thevoicequalityandmoreonthefundamental performance factors, for instance application support above all else. Ksethri (2004)discussesthecostsassociatedwithlearninganewprogramorthesunkcostsassociatedwithceasingtouseanalreadylearnedprogram,whichplaysarelevantroleinsoftwareswitches.85

Innovations in household devices and the average increase in the age of the population in Indiameansthatpeoplearebecomingfamiliarwiththeuseoftechnologyintheperformanceofactivitiesof daily living.86 The majority of the older population lack access to information and computertechnology,thereishopethataccessibilitywillbecomelessofabarrierinthetimestocome.Whereaccessibilityisthestartingpoint,motivationisacriticalpieceofpuzzle,particularlywhenitcomestoadoptionanduseoftechnology.Everydaytechnologymayhelpolderpeopleto live independentlyby supporting the basic activities of daily life. Ability (e.g. spatial ability) has shown to be animportant mediator of success in using technology. Specific abilities may be more proximaldeterminants of successful technology use.87 Themore important thing would be to have betterdesignandtrainingprinciplestofurthertheeffortoftechnologyadoptionasthepopulationages.A

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newwayforwardisbycreatinganewpoolofassistivetechnologyprofessionalsviz.,thosethataretech-savvyaswellasacademiciansoperatinginthefieldofdisability.88

EngineeringConsiderat ions

Assistive technologies, also known as extrinsic enablers, provide abasis of improvement of human performance in the presence ofdisability. This section covers the evidence on development ofengineeringconsiderationsinassistivetechnologyinIndia.

Types of Assistive Technology Experts stressed that assistivetechnology does not require esoteric, complicated engineering,ratheritisamind-setthatlooksforsolutionstoeverydaydifficultiesencounteredbythosewithchallenges.Inthisvein,oneclassificationdescribes assistive technology as having three levels: (i) Low-tech:optionsareeasy touse, areof lowcost and typicallydonotuseapower source; (ii) Med-tech: easy to operate but usually use apowersource;and(iii)High-tech:usuallycomplexandprogrammable,andincludeitemsthatrequirecomputers and/or electronics, to perform a function.89 Others introduce another level - No-tech:which is the adaptation of behaviour or method to communicate e.g., using gestures instead ofspeaking.90

Alternative and Augmentative Communication Devices To aid individuals with communicationsdifficulties, Alternative and Augmentative Communication Devices (AAC) systems are developed.Sampath,AgarwalandIndurkhya(2013)describetheirexperiencesofdevelopingtoolsforchildrenwith autism. Two systems were developed one of which is AutVisComm - an assistivecommunicationdevicedevelopedontabletswhiletheotherisAutinect-asetofactivitiestoteachsocialskillswiththeuseofMicrosoftKinectasacontroller.91Thestudystartsoutbyconductingasurvey to determine the preferences of these platforms of Indian parents. Over 70% of the 20parentssurveyedindicatedapreferencefordevicesthatareportable,sociallyacceptable,havehighutility purpose and low cost. The involvement of the teachers, parents and children from theinception stage is considered to be crucial for effective interface design. This observation hasrelevance in the Indian context inwhich specialised supportmaynotbeavailableoften. Sampathandothers (2013)showthroughthedevelopmentof twoapplications thatcognitiveprofileof thechildrenwithautismoughttobeamajorconsiderationforinterfaceandinteractiondesign.92

Madhuri and others (2013) from the Department of Biomedical Engineering at Sri RamaswamyMemorialinstituteofScienceandTechnologypresentamobilevision-basedsignlanguagedeviceforautomatic translation of Indian sign language into English speech to assist the speech impairedpeople to communicate. They used a real-time vision-based system to recognise finger spellingcontinuousSignLanguageusingasinglecameratotracktheusersunadornedhands.93ThesystemisaninteractiveapplicationprogramusingLABVIEWsoftwareincorporatedintoamobilephone.Thelimitationoftheapplicationliesinthemisinterpretationofasignthatwassimilartoanothersigningestureorpostureresultingdecreasedaccuracyofthesystem.

Information Communication Technology Older people are known to bemore prone to illnesses,although the advances in technology, health andmedicinehave increased the average ageof the

Assistivetechnologycanbe(i)No-Tech:adaptationofbehaviourormethodto

communicate(ii)Low-Tech:easytouse,low

cost,donotuseapowersource

(iii)Med-Tech:easytooperate,butuseapower

source(iv)High-Tech:complexand

programmable,usecomputersand/orelectronics

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person.Thereisagrowingneedforinformationcommunicationtechnologybasedapplicationsthatsupport independent living as the aging population of the country grows. There are enablingtechnologythatcanbeusedinawaythatcomplementsandextendstheexistingservicedelivery.94

Basu et al. (2008) at the Department of Computer Science and Engineering, IIT Kharagpur havedeveloped a multilingual education and communication tool for children with cerebral palsy andspeechimpairmenttocatertoIndianpopulationsthatcannoteitheraffordtheexpensiveAACtoolsorthetoolsthatdonotcatertotheirregionallanguages.95Thecommunication/educationtoolwasdesignedusingJavaprogramminglanguage.IconswerestoredinadatabasestructureimplementedusingJavaprogramming.TheiconbasedgallerywasfoundtobeeffectiveforAACusersfromsimpleconceptslike‘apples’toarelativelycomplexconceptof‘abusystreet’.Theiconlanguageneedstobe supported by intelligent processing that can translate icons to words and phrases that caneventuallybeusedingeneratingcoherentandmeaningfulsentences.9697

Although text readers are now available in Indian markets, diagrams that form part of theexplanationofconceptsarenottranslatabletovoicedescription.Thislimitsthechoicethatpersonswithvisualimpairmentcantakeup.98Lipikaandothers(2017)attheCentreofExcellenceatTactileGraphicsatIITDelhidevelopedend-to-end,costeffectivetechniquesformakingtactilegraphicsthatareaffordableandcanbemassproduced.993-Dprintingtechnologywasusedformouldmaking.Keydesignconsiderationsthatwereappliedwere:simplificationofthedesign;resizingofthediagramstoensurethattheyaredistinguishablebytouch;decompositionofthediagramsintotwopartsetc.TheCentreconductedtestingsessions in threeblindschoolsandfive inclusiveschools toevaluatethe effectiveness and usability of the diagrams. Feedback was collected using a questionnaire tounderstandthebottlenecksandtherequirementsoftheusergroup.Becausestudentshadlimitedexposure to tactile diagrams, it was initially difficult for them to understand the diagrams. Thisimprovedasexposurewaslengthened.

Human-Computer InterfaceDevices Human-computer interface (HCI) acts as a good facilitator inthe development of assistive technology. Recent research has shown development of assistivetechnologythatincorporatesHCIintohumanphysiology.TheprimaryfunctionofHCIistogeneratecontrol signals for external devices based on real-time scrutiny of measured biological signals.100While some persons with disability may have very low or no voluntary muscle movement, theircognitive functions are intact. The purpose of HCI in these cases is to amplify signals fromweakfunctionalmusclemovementtocarryouttaskshithertoimpossible.Forexample,atooldevelopedbySwamiandothers(2012)useselectro-oculogram(EOG)signalsforinteractiveinnovationfortherehabilitation of personswith severe disability, especially neural disability.101 The EOG provides anon-invasivemethodforrecordingthefullrangeofeyemovements.BesidestheclinicaluseoftheEOG, ithas inspiredfurtherdevelopmentsofpracticaldevices.However,mostofthedeviceshaveslowprocessingandcomplexdesignwhichmakes theuseof suchdevicesunsuitable in real-time.Thewireless transmission toolmakes it robust for real-time implementation fordiagnostics. Sincethemajorityofthedisabledpopulationretaintheircontroloverocularmotorsystems,thesesignalsarethemostlikelycandidatesforHCI.

Slowik et al. (2009) from University of Detroit Mercy designed assistive technology to cater tovisually impaired persons on problems that arise out of cultural practices prevalent in India.102People in India remove their footwear when entering temples, houses because of prevalence of

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sittingonthefloortoeatorpraywhichbecomesproblematicforpeoplewithvisualimpairment.Itinvolved finding his or her pair of footwear by touching each individual pair which is not onlyunhygienic but is also not deemed desirable. The device incorporates a normal cane and acomplementarydevicelocationonthefootwear.TheselectioncriteriatobeusedfordesigningtheprototypeofthecanewithRFIDsystemfocusareaswere:(i)maximumdetectiondistance;(ii) lowmaintenance; (iii) low power consumption and (iv) minimum weight the device to make thetechnology design accessible to end-users. A Radio Frequency Identification Systemwas designedthatusedtwosources:(i)anactivetagthatrequiresapowersource,and(ii)apassivetagthatre-radiates the signalpower receivedby the interrogator.TheRadioFrequency IdentificationSystemtagsaredurableandlowcostwhichcanbetapedeasilyontothefootwearorinsertedinsidethesoleofthesandals/shoesbyavisually impairedperson.Fittingmultiplepairsoffootwearwiththetagsand linking themwith the same interrogator provides the ability to choose footwear in real-timeaccordingtotheirneeds.

Figure4:Maximisingdetectiondistancethroughantennadesign

Source:Slowik,R.,Krishnan,M.,Venugopal,P.,Yost,S.A.&Das,S.(2009).

Mulhollandandothers (2000)have tried to address theneedsofwomenwithdisabilities in Indiathrough the development of appropriate technology. Appropriate technology, according to them,mustaddressalldesignparameterskeepinginmindtheIndiancontext,forinstancewheelchairsto

cope with rough terrain, wheelchair and tricycleposition the rider at table height which means thatdismounting would be necessary to perform groundheightactivities,theabilityofthedevicetocover longdistances.103Thereisaneedtofindanoptimalbalancebetween individual’s needs, therapeutic or medicalconcerns, technical and engineering constraints. Thetechnology group of International Centre for theAdvancement of Community Based Rehabilitationbased inQueen’sUniversity,CanadacollaboratedwiththeNationalinstituteofDesign,Ahmedabadtodevelopa wheeled ground mobility device for women with

lowerextremitydisabilities inIndia.Thestudyusedthefirstfullscaleworkingmodelofthedevicecalled GADI2 to gain feedback from women to determine the functional mobility needs of thewomen. Function and quality of life were the prominent areas of improvement.Mulholland and

Source:S.JMulhollandet.al.(2000).

Figure5:PictureoftheGAD12

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teambelievedthatfeedbackandrecommendationfrompotentialusersisanimportantpartofthedesignprocess.104

Based on the discussion above, it is clear that while patchy information exists, there remainsignificantareasofgapinconstructingasuitableassistivetechnologyresponsetotheneedsofanyonepopulationgroup.Thelackofpublicationsinthefieldisseenasamajorbarrier.105Eachsolutionthatissoughttobecreatedhastobebackedbyfreshbackgroundresearch.Littleresearchhasbeenconducted on emerging needs, even less so on solutions thatwill be required on amass level asageingandnoncommunicablediseasesbegintomakedisabilitymorecommonplace.

K E Y T A K E AW A Y S

§ TheHAATframeworkprovidesausefultooltodiscussthewholesystemthatmustbetakenintoaccountwhenresearchinganddevelopingassistivetechnology.

§ The four components of the HAAT framework relate to the context in which the use ofassistivetechnologyistotakeplace;activitiesforwhichtheassistivetechnologyistobeused;humanfactorswhichdeterminereadinesstoutilisetheassistivetechnology;andengineeringconsiderations of the assistive technology. Many of the studies relate to activities ofeducation and employment. Less focus is available on leisure and recreational activities oreven,activitiesofdailylife.

§ The ability and interest in adopting assistive technology is an important prerequisite to itsultimateuse.Universalandinclusivedesignhasmuchtodowithdevelopingtheskillstouseassistivetechnology.

§ Technologymust be of use in away that is at easewith the person’s environment – bothphysicalandsocio-cultural.Theinstitutionalenvironmentwithinwhichitisdeliveredisakeytoeffectivedistributionandutilisation.

§ Engineering considerations are paramount to the effectiveness of the assistive technology;howevertheywererarelydiscussedexceptasdescriptionsinthestudiesaccessed.

§ Assistive technology can be No-Tech, Low-Tech, Med-Tech or High-Tech ranging fromtechnology that does not require a device all the way to those that require computingdevices.

§ Engineering solutions that have been developed in India use a range of engineeringapproachesincludingAAC,ICTandHCI.

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Chap t e r I I I THE E COSYSTEM OF A S S I S T I V E T ECHNOLOGY

Anysolution,ifitistoreachmarket,mustbedevelopedwithinasupportiveecosystem.First,theremustberecognitionoftheproblemandestimationofitssize.Second,assumingthefirstisinplace,policyenablersmusthaveanintentiontoaddressit.Thirdly,thereneedstobedemandfromthosewhorequiretheassistivedevices.Andfinally,thereneedtobepeoplewillingtoinvesttimeandeffortondevelopingandmarketingthesolutions.InChapter3,weexaminetheecosystemofassistivetechnologyinIndia.

Size of theProblem

AfundamentaldifficultytodevelopingarobustresponseonassistivetechnologyinIndialieswithanincompleteinformationbasetoworkfrom.ThereislimiteddataondisabilityinIndia.

Uncertainties in Prevalence Data To make matters more obscure, data from the two availablesources - theCensusof Indiaand theNationalSampleSurvey -arenotcomparable toeachotherbecauseof differences in thedefinition adopted anddata collection techniquesused. TheCensusand National Sample Survey definitions of four out of five major impairments are radicallydifferent.106Thefigurethat ismostcommonlyusedinIndia isthatfromthe2011nationalCensus,which indicates thatpersonswithdisabilityconstitute2.21%of the Indianpopulation. Incontrast,WHO estimates that today, about 15% of persons worldwide are living with disability of somedegree.107

Further,someexpertschallengetheCensusestimatesof2011,andsaythatthenumbershouldhavebeencloserto40millionin2011andcouldriseto60millionin2021,anestimated50%increase.108Theyalsopointtotheissueoftemporarydisabilitywhichcouldaffectanywherebetween400,000–500,000peopleperyear.109Morepersistentinquiryatthevillagelevelisexpected to provide a better mapping of those with disability. Forexample,whenidentifyingbeneficiariesaftertheOdishasupercyclone,thenumbers identifiedwithdisabilitywere20timeshigherthanthoseregisteredatthedistrictlevel.110

Little credible information exists apart from the prevalence data ondisability,andeventhatiscommonlyacceptedtobeunreliable.InIndia,CensusandNationalSampleSurveydatathatisavailableindicatesthatdisability is more common in rural areas (2.24%) than urban areas(2.17%); and that disability ismore common amongmen (2.4%) than

18.8

18.9

7.520.3

2.77.6

7.9

18.4

Seeing HearingSpeaking MovementMentalillness Mentalretarda?onMul?pledisabili?es Other

Figure6:NatureofDisabilityinIndia,CensusofIndia2011

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women(2.0%).Amongthosewithdisability,thetypesofdisabilityarereportedintheseproportions:(i) seeing18.8%, (ii)hearing18.9% (iii) speaking7.5% (iv)movement20.3% (v)mental retardation7.6%(vi)mentalillness2.7%,(vii)multipledisabilities7.9%(viii)other18.4%.(SeeFigure6).

Disability isRising It isexpected in Indiaas inotherdevelopingcountries, that theprevalenceofdisabilitywillcontinuetoincreasedueanageingpopulation,increaseinchronichealthconditionssuchasdiabetes,cardiovasculardisease,cancer and mental health disorders as well as injuries andviolence.111DatafromtheInstituteofHealthMetricsandEvaluation’sGlobal Burden of Disease study shows that the causes of disabilityhavechangeddramaticallybetween2007and2017.112(SeeFigure7).Itisclearthatthereisagrowingshareofnon-communicablediseaseslinked to death and disability, partly owing to their increasing

incidence,aswellastotheoverallincreaseinlongevityofbothmenandwomeninIndia.(SeeFigure8).

Figure7:Whatcausesthemostdeathanddisabilitycombined?

Source:InstituteforMetricsandEvaluation.(2019).

Figure8:IncreasingaverageyearsoflifeinIndia

Source:InstituteforMetricsandEvaluation.(2019).

Accordingtothe2011Census,whichcollatesinformationoneighttypesofdisability,India’sdifferently-abledpopulationstandsat2.68crore.TheWorldBank'sestimatespegthisnumberatamuchhigherfigure.

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Dataofthiskindhas implicationsforanyeffortstodevelopandmakeassistivetechnologydevicesfor persons with disability available and accessible. The differential in estimates of disabilityprevalencebyIndiaandWHOindicatetheneedtodevelopmorerobustestimatesforthecountry.113114Thenatureofthedistributionacrossvarious‘types’ofdisabilityprovidecluesastothekindsofneedsthatIndiansocietyhas,butthesemustbefurtherrefinediftheyaretobeuseful.Finally,thegreater prevalence of non-communicable diseases and increasing longevity spell trouble for theIndian public health system; both translate to a higher requirement for assistive technologysolutions.

DataonRequirementforAssistiveDevicesExpertsattesttothelackofdataonassistivetechnologyinIndia.“Thenumberswehavewouldsuggestthat6%ofourpopulationrequireassistivedevices.But we haven’t been able to narrow that down - what type of assistive device, what age group,etc.”115Personswithdisabilityarenothomogenous,theyhavedifferentwantsandneeds”.116Dataisalso required on the present state of play on aids and appliances being used by persons withdisability.Suchdataispresentlylacking.Muchofthedatainthisspaceisrelatedtoinputtypedataandthereisnoconsolidationofeveninputdataacrossorganisationswhoaredistributingassistivetechnologydevicesandindividualswhoreceivethemorbuytheirowndevices.Thismeansthatanyestimationofneedisappreciablyflawed.117

Pol icy Framework

TheGovernmentof Indiahas several lawsandpolicies inplace to guide theprovisionof assistivetechnology.Neverthelessgapsremain,asthissectionoutlines.

International Commitment The international framework describing the role that governmentsmight play to support integration, and assist the ease of living of persons with disability, is the

UNCRPD.118 India became a signatory to the UNCRPD in2007andratifieditinthesameyear.119Articles4,20and26of theUNCRPDaskStates topromote theavailabilityof appropriate devices and mobility aids and provideaccessible information about them. The Standard Ruleson the Equalization of Opportunities for Persons withDisabilities also call upon States to support thedevelopment, production, distribution and servicing ofassistivedevicesandequipmentandthedisseminationofknowledge about them. To achieve access to these,governments and other signatories need to carry outmeasures related to policy, legislation, research,development, production, training, information, use andcooperation.120 In 2016, India passed the Rights ofPersonswithDisabilitiesAct. This Act,while speaking totherightsofpersonswithdisability,recognisesthatsuch

personsmusthaveaccess toassistive technologydevices.Nevertheless, thepassageof theActaswellasitspriorratificationoftheUNCRPDsignalsIndia’sresolvetoaddresstheneedsofthosewithdisability.

EightGuidingPrinciplesoftheUNCRPD

1. Respectforinherentdignity,individualautonomyincludingthefreedomtomakeone’sownchoices,andindependenceofpersons.

2. Nondiscrimination3. Fullandeffectiveparticipationand

inclusioninsociety4. Respectfordifferenceandacceptanceof

personswithdisabilityaspartofhumandiversityandhumanity

5. Equalityofopportunity6. Accessibility7. Equalitybetweenmenandwomen8. Respectfortheevolvingcapacitiesof

childrenwithdisabilityandrespectfortherightofchildrentopreservetheiridentities

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Compliancewith theUNCRPD requires that assistive technology be equitably available, accessibleand affordable irrespective of gender, age or impairment. However, according to manyrehabilitation specialists in lower-income countries, the need for assistive technology outweighsavailability.121 Estimates of availability are as low as 5 - 15% of requirement in low- andmiddle-incomecountries.122The2011WorldReportonDisabilityreportsthattheaccessibilitychallengesarereinforcedinlow-andmiddle-incomecountriesbecauseofinadequatepoliciesandlackofprovisionof medical rehabilitation, welfare services, negative societal attitudes towards persons withdisabilityandvocationaltraining.123

Domestic Commitment The rights of personswith disability are enshrined in the Constitution ofIndia. Articles of the Constitution that guarantee life, liberty, right to equality and freedom fromdiscriminationonanycount,applyequallytothosewithdisabilityasthosewithout.Indiahashadalawaddressingtherightsofpersonswithdisabilitysince1995.

TheRightsofPersonswithDisabilitiesActwassigned in2016after revisions to thePersonswithDisabilitiesActof1995afteragreatdealofdebateanddelay. The2016Acttalksabouttherightsand empowerment of personswith disability through inherent dignity, individual autonomy, non-discrimination, participation and inclusion in the society, equality of opportunity, accessibility andthe rights of childrenwith disability to preserve their identity. The principles in the Act reflect aparadigmshift in thinkingaboutdisability as a socialwelfare concern toahuman rights issue. Inaddition,otherlawsareinplacetoassistpersonswithdisability,namelytheNationalTrustfortheWelfare of Personswith Autism, Cerebral Palsy,Mental Retardation andMultiple Disabilities Act,1999;andtheRehabilitationCouncilActof1992.Theprovisionofsocialsecurity,equalparticipationinthesociety, living independentlyandaccessibilityarethecentralprinciplespresentacrosstheseacts.GovernmentofIndiawillalsoassistpersonswithdisabilityinsecuringdurableandmodernaidsandappliancesguidedbyISOstandardstoensuretheirindependenceinvariousactivitiesleadingtophysicalpsychologicaldevelopmentandsocialinclusion.124

The Assistance to Disabled persons for Purchase/Fitting of Aids and Appliances (ADIP) Scheme,2011reflectsthegovernment’scommitmenttopersonswithdisability.TheMinistryofSocialJusticeand Empowerment implements the ADIP scheme by providing grants to agencies of the central/state government and non government organisations. The scheme aims to reduce the impactcreated by disability in an individual’s life by enhancing the economic potential of people withdisabilitybymakingdurable,modern,scientificandsuitableaidsandappliancesaccessible.125Asperthe scheme assistive devices are available to persons with disability in families with earningsspecified to be below INR 15,000 per month. Any person with disability is entitled to aids andappliances under the ADIP scheme. Under the scheme, both small and mega camps are held atvarious locations across the country by government and non-government organization throughwhichpersonswithdisabilityarecontactedanddistributioneffected.Schemescover schoolgoingchildren, the elderly and other personswith disability. Distribution figures run into the lakhs peryear.126

However, a 2013 study by the (then) Planning Commission found a number of constraints thathinder the effective implementation of the ADIP scheme. Among them are weak institutionalcoordination, low utilization of the funds, unavailability of good quality aids and appliancesaccordingtotheinternationalstandards, lackofpoorandupdateddataonthenumberofpersons

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withdisability, lackofmaintenanceoftheassistivedevicesastheybecomenonfunctionalwithnoprospectofservicingetc.127Expertsinterviewedremarkedthatduetothenatureofthedistributionevents,notenougheffortismadetoeducatepersonsonthecorrectuseandmaintenanceoftheirassistivetechnologydevice.128TheynotedthatwhiletheADIPschemehelpsorganisationstoscaleupproductionofassistivetechnologydevicesbecausedistributiontakesplacethroughgovernmentinstitutions for personswith disability; the scheme has somany constraints thatmake it close toimpossiblefororganisationtobeempanelled.129Whileacknowledgingthatassistivetechnologyisadynamicspacewhichisevolving,itwasstressedthatinitiativesshouldcovertheentirepopulationofpersonswithdisabilityratherthanhavepocketsofexcellencetowhichpeoplewouldhavetotraveltoreceiveservices.130

Government Inst itut ions

The Government is a key player and has invested in research, design and supply of assistivetechnologydevices,developingpoliciesandschemestoenabletheiraccessibilityandavailabilitytopeoplewhoneedthem.Itisclearthatassistivetechnologyisnowatthefrontofthegovernment’svision with the NITI Aayog organizing discussions on the subject.131 132 The Department ofEmpowerment for Persons with Disabilities (DEPwD) under the Ministry of Social Justice andEmpowerment is the nodal department responsible for new policies and schemes in the area ofdisability.TherearesevenNationalInstitutesundertheDEPwDofwhichthreeoperateinthespaceof locomotor disability, one on intellectual disability, one specialising in speech and hearingimpairment, one working in the visual impairment space and one onmultiple disabilities.133 It isexpected that a National Institute for Assistive Technology and support centre for persons withdisabilitywillbesetupatRaipur,Chhattisgarh.134Theincreasingparticipationofthegovernmenthasbeenacknowledgedby theexperts interviewed,withonenoting that, “Disabilityhas comecentrestage because of the present government - the PrimeMinister has been actively involved in thisregard. A greater number of appliances are available for the visually and hearing impaired, forexample, the introductionofcochlear implants forchildren fromthetimeofbirth till theageof5years.Thepolicyframeworktoohasbecomemuchmorerobust:fundinghasincreasedfourtofivetimes; government reservations for the disabled has increased from 3% to 4%; the number ofschemesforthedisabledhaveincreased”.135

Punarbhava, Swavlamban and Accessible India Campaign A national interactive web portal ondisability, Punarbhava provides a gateway to information for persons with disability and allconcernedwiththesector.Thisportalhascreatedadistinctnicheincyberspacetofindinformation,discussissues,network,findemployment,lookforappliancesandassistivedevices,seekredressalofgrievances,undergotraining,researchandstudy,andsomuchmore.SwavlambanisadirectoryofAids and Assistive Devicesmaintained by the DEPwD. The Accessible India Campaign launched in2015 under theDEPwD aims to achieve universal accessibility for personswith disabilities and tocreate an enabling andbarrier-free environment for thembymakingpublic utilities andbuildingsaccessibletopersonswithdisabilities. 136Accessibilityof infrastructurethroughthecampaign isanimportant(prior)steptomakeassistivetechnologydevicesforlocomotordisabilitysuccessful.137138Access to information is key to inclusion of persons with disability. Respondents were veryappreciativeofthosewebsiteswhichhavebecomeaccessible.However,therehavebeensignificantgaps in following up on the targets of the campaign.139 140 The slow response from stategovernments tomakegovernmentwebsitesaccessibleprompted theDEPwD to initiateEducation

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andResearchNetworkorERNET.EducationandResearchNetworkhasidentified917websitestobemadeaccessible,ofwhich104werelivein2018.141

CentreforAssistiveTechnologyandInnovationTheCentreforAssistiveTechnologyandInnovation(CATI)wasestablishedin2015attheNationalInstituteofSpeechandHearingorNISH,Kerala,India.ThiswasthefirstAssistiveTechnologyCentreinthecountry.Itoperatesaprogrammethatcaterstothe accessibility and accommodation needs of students and clients of the National Institute ofSpeech and Hearing (NISH). The programme is directed to support independent living needs ofpersonswithdisability,includingneedsassessment,devicedemonstrations,training,customisation,loans and financing of products, and service/maintenance of assistive technology solutions tofacilitate . The Centre also serves as a resource centre for assistive technology solutions wheretechnologydeveloperscancollaboratetoencourageproductdevelopment.TheCentreforAssistiveTechnologyandInnovationatNISHoperatestomeettheassistivetechnologyneedsofpersonswithdisability,especiallyaccessibilityandaccommodationneedsofthestudentsandclientsofNISH.142

The National Trust The National Trust is a statutory body of theMinistry of Social Justice andEmpowerment,Governmentof India, set upunder the ‘National Trust for theWelfareof PersonswithAutism,CerebralPalsy,MentalRetardationandMultipleDisabilities’Act(Act44of1999).TheNational Trust’smission is to create an enabling environment for personswith disability throughcomprehensivesupportsystemswhichcanalsobedonebycollaboratingwithotherMinistries,etc.,whichwillleadtowardsthedevelopmentofaninclusivesociety.TheNationalTrusthasestablisheda National Resource Centre - Sambhav - at Action for Ability Development and Inclusion for thedisplayofavailableassistivedevicesinNewDelhitodemonstratethepossibilityofindependentorassisted living for persons with developmental disabilities through the use of aids and assistivedevicesandtechnology.143Thesecentresshowcaseasamplebedroom,kitchen,bathroom,toiletetc.which are disabled friendly and accessible to persons with disabilities. Various assistive devices,includinglearningkits,aidsrelatedtomobilityandcommunicationaredisplayed,whichareusefultoimprove the quality of life of persons with disability. Sambhav Centres are proposed to beestablished in other cities of the country having population more than 5 million. The NiramayaSchemeof theNational Trust provides insurance cover to personswith the four index conditions(Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities) covered by the Trust.Unfortunately,thecoverofthehealthinsuranceprovidedforassistivetechnologyundertheschemeissmall-thebeneficiaryisentitledtoamaximumofRs.100,000forassistancewhichvariesbasedon the nature of assistance requested: hospitalization/surgery, non hospital medical treatment,transportationcostsoradditionalmedicaltreatment.Thisneedstobeenhancedsignificantlytobeofusetobeneficiaries.144

National Innovation Foundation-India The Foundation has recognised ideas/ innovations aboutassistivetechnologybygrassrootsinnovatorsandstudentswhichcouldprovetobeagamechangerfor the elderly, especially thosewith disability. The country’s First Assistive Technology Conclave,2019focusedonTechStart-upsforDisabilitywhichbroughtthebestassistivetechnologystart-ups,visionaries and thought leaders together and to discuss topics that will help shape the future ofassistivetechnologyecosystem,anditsimpactontheworld.

National Council of Educational Research and Training This educational body has tried to useassistive technology in the spaceofeducation.Management institutes suchas Indian Institutesof

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Management at Bangalore and Ahmedabad are using assistive technology to make their spacesmore inclusive. In Delhi University, Miranda House College has used technology to make theircampusaccessible.Theyhaveuseddigital technology tohelpvisually impairedpeople tonavigatethecampus.Disabilityorganisationsarereportedlyworkingonanationaldatabaseofpersonswithdisabilitysothattheycanbereachedwithactualsolutions.Forthispurpose,disabilityorganisationsareworkingwiththegovernmenttocreatesuchadatabasethroughupcomingCensus2021.145

State initiatives Disability is on the concurrent list of the Constitution, making it not only theresponsibilityof theUniongovernment,butalsotheStategovernment.146For instance, theKeralaSocialSecurityMissionhasbeenproactivelyengagedinprevention,education,employabilityofthedisabled throughan initiativecalledSnehasanthwanamwhereinmonthlyassistanceofRs.700/- isprovidedtocaregiversofEndosulfanvictimsunderaspecialAswasakiranamScheme.147TamilNaduhas five schemes in place pertaining to disability in leprosy cured, hearing impairment, blindness,intellectualdisabilityandmusculardystrophywhiletheKeralastateinitiativedealswithintellectualdisability. State government schemes that deal with populations with disability are few. Themajorityofschemesthatfallunderthestategovernmentpurviewareanextensionoftheschemesbythecentralgovernment.148

NonGovernment Inst itut ions

SeveralNGOswork in the field of disability; some are peer based organisations, seeking tomakethingsbetterfortheirmembershipofpersonswithdisability;othersaredevotedtoaddressingoneoranotherdisabilitytype.DescribedbelowareexamplesofthreeNGOsworkinginthespace.

The Association of Peoplewith Disabilities (APD India) APD India is an NGO has beenworking totransformlivesofunderprivilegedpeoplewithdisabilitysince1959.BasedinBengaluru,Karnataka,the organisation runs extensive programs in rural and urban Karnataka to enable, equip andempower children and adults with a range of disabilities including locomotor, spinal cord injury,speechandhearing, cerebral palsy, and to someextent,mental health issues. Todate, theyhaveimpactedover50,000livesofpersonswithdisability.

Mobility India This NGO is committed to improving the lives of persons with disabilities throughrelevant and comprehensive community programs and facilitating access to services related torehabilitation and assistive devices. Its programmes include research and development ofappropriate assistive technology and improving its access at an affordable cost, developingappropriate human resources in the field of disability, rehabilitation and assistive technology atnational and international level and capacity building of grassroots organizations in the field ofdisability. TheNational Conference on Assistive Technology for All 2030 held in August 2019washostedbyMobility India. TheConference focusedon the theme: ‘Improvingaccess toqualityandaffordableassistive technology foreveryone,everywhere.’ The themeemerges fromtheUN2030agendaforsustainabledevelopment,whichplaces“goodhealthandwell-beingforallatallagesasthecentreofanewdevelopmentvision.”149

TheNationalCentreforPromotionofEmploymentforDisabledPeople(NCPEDP)Thisisanon-profit,voluntary organisation, working as an interface between the government, industry, internationalagenciesandthevoluntarysector,towardsempowermentofpersonswithdisability.NCPEDPworkson five core principles, also called the five pillars of the organization, namely: (i) education; (ii)

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employment; (iii) accessibility; (iv) legislation/policy; and (v) awareness/ communication.NCPEDPstresses the need tomove away from traditionally held views of charity andwelfare to those ofproductivity and empowerment of persons with disability. Despite the presence of various otherstakeholders in India (NGOs,disabilityassociations,disabilityexperts)applytraditionalmethodstohelp persons with disabilities.150 NCPEDP is working with its partners to create and implement astrategytogettheGovernmentofIndiatoadoptaprocurementpolicythatspecificallyrequiresthepurchaseofaccessiblegoodsandservices.Ithas inthepast,engagedwiththeMinistryofFinanceon issuesof concession/exemptionof excisedutyonassistive technologyanddevices forpersonswithdisabilitiesandontheneedofallocatingagreaterproportionoftheUnionandStateBudgetsoninitiativesandprogrammesfortheempowermentofpersonswithdisabilities.

DevelopingandMarketingAssistiveTechnology

Multiple actors are involved in designing, developing,manufacturing and provisioning of assistivetechnology in India. Currently the assistive technology industry is specialized, producing productsthat mainly serve high-income markets. The Artificial LimbsManufacturing Corporation of India (ALIMCO), established by theGovernment’sMinistry of Social Justice and Empowerment, providesassistiveaidstothosewithdisabilityandtheelderly in India.ALIMCOproduces 355 different kinds of assistive aids for orthopedically,visually, and hearing impaired people and partners in variousgovernment schemes. One such is the Rashtriya Vayoshri Yojana which supports aids to elderlybeneficiaries,generallypoorpeople.151

However, many report that the devices ALIMCO makes figure on the lower end of the assistivetechnology spectrumand suggest that theyaremore concernedaboutdistributing largenumbersratherthanensuringthatthesedevicesmeettheneedsofthepeople.152153Someseethefocusonlow-tech devices as legitimate, maintaining that the present challenge is to ensure that there isgreatercoverageofthecountrythanafocusonhigherendtechnologydevices.154Nevertheless,thevolumesofwheelchairsneeded in Indiahasprompted thegovernment to seek collaborationwiththeNationalInstituteonDisabilityandRehabilitationResearchandwheelchairsdesignersintheUSto improve the quality ofwheelchairsmanufactured and distributed in India. A collaboration hasbeenundertaken toproducequalitywheelchairsoveraperiodof fouryears.155Anexample is thestandingwheelchairthatwillbedevelopedinpartnershipwithacompanyinChennaiwhichwouldmanufactureandmarkettheproduct.156

KeyAcademicPlayersKeyplayersinresearchanddevelopmentofassistivetechnologyaresomeofthepremiumacademicinstitutesinthecountry.AtleastfouroftheIndianInstitutesofTechnology(IIT) in Delhi, Chennai, Kharagpur and Mumbai; National Institute of Technology Durgapur haveplayedakeyroleonthedesignanddevelopmentsideofassistivetechnology.157158Despitethekeyrolethat theacademic institutionshaveplayed indevelopingassistiveaidsanddevices, theyhavenot been successful in taking it to scale and to market due to large disconnect between theinnovatorsandthemarket.159

IITMadras’sRehabilitationResearchandDeviceDevelopment(R2D2)laboratoryhasbeeninvolvedinresearchrelatedtohumanmovement,theinfluenceoforthoticandprostheticdevicesonhumanmovement, and the design and development of mechanisms, products and assistive devices for

ALIMCO, a public sector entity,

is India’s largest manufacturer

and distributor of assistive

technology devices.

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people with impairments. AssisTech at IIT Delhi is an inter-disciplinary group of faculty, researchstaffand students that isengaged inusingmodern technology for findingaffordable solutions forthevisuallyimpaired.Thefocusisonmobilityandeducationwhicharefundamentaltoenableanypersontoliveindependentlywithdignity.Apartfromworkingonspecificsolutionsbasedonneedsidentifiedby theusers themselves, theyhope to createaneco-system thathelps to sensitizeandigniteyoungmindstowardsrealday-to-daychallengesofthedifferentlyabled.

Asanotherexample,braillebooks in Indiaareavailable for visually impaired studentsonly in textanddonothavediagramstoillustratetheconcepts.Anexpertnoteshowthislimitstheavenuesforastudentwhostaysunacquaintedwithsubjectsthatrelyheavilyonexplanationsthroughdiagrams.AssisTechatIITDelhihassetupasolutionfordevelopingtactilediagramsthatthevisuallyimpairedcouldunderstand.AssisTechhasalsodevelopeda‘SmartCane’toaidmobilityforvisuallyimpaired.Infact,respondentsremarkedthatacademicinstitutionslikeIITMadrasarecentraltoinnovationinassistivetechnologybuttheyfailtomakeitintoasuccessfulbusinessventure.160Thisresultsinpooravailabilityandaccessibilityasthereisnowayforthepopulationthatneedstheaidstoavailitfromaphysicalmarketplace.”161

R2D2andAssisTechhavebeenmakingsignificantinroadsintermsofassistivedevicesdevelopmentinordertomakeaffordabletechnologyavailable.“Alikelyareaintowhichassistivetechnologymustexpandisartificial intelligence.Premierengineeringinstitutionsliketheonesmentionedaboveareexpected tomake someprogress in the area. Artificial intelligencehas the benefit that it doesn’ttire,makingittheidealsolutionof24by7careforpersonswithsignificantdisability”.162

Accounting forContext For ground level implementation, theecosystem for assistive technologymust support assessment, selection, product procurement policies, training, maintenance andsupport. ADIP and other state-owned schemes must be constantly updated in this regard, andfacilitate start-ups to evaluate their products, enhance distribution and support networks forsustainability.Thiswillfosterresearchinthespaceofassistivetechnologyanddevelopmentinthecountry.163

Cultural practices of persons needing assistive technology devices need to be factored in whiledesigninganddevelopingassistivetechnology.ArecentpilotstudybyIITMadrasdiscussedissuesinassistive technology that users faced with the lower limb (knee-ankle-foot) orthosis in South Indian states of Tamil Nadu andKarnataka.Mostoftheusersreportedpain-relatedissuesassociatedwiththebracealongwithpainwhileperformingthebasicactivitiesof daily life in India such as squatting, kneeling, riding a bicycle,walkingonsand,walkingonmudandcross-leggedsittingwerethetopsix.”164InastudytoprovideassistiveinternationalsoftwaretoIndiathatmakescomputerusagepossible for the population with disabilities, Jhangiani (2006) stated that “during localization ofsoftware it is important to understand the needs and requirements and target the culture ofusers.”165

Designingfordiverseusersfromdifferentculturesposesachallenge.Inordertobuildsystemsthatareusableuniversally,designersmustaccountfordifferenttypesoftechnology,userdiversityandgapsinuserknowledge.166Researchhasfailedtoaddressabroadrangeoftechnologytypesuchassensoryandcognitiveaids.167Sharmaetal.(2014)showedthelackofassistivetechnologyfacilities

TheresponsetodisabilitymustbecontextualisedtoIndiaifitistobeuseful.Simplyimporting

technologymaynotprovidethesolutionsneededforthe

population.

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forhearingimpairedusersintheinstitutions/libraries.168Notmuchisdocumentedaboutavailabilityand accessibility of assistive aids for children with developmental disorders such as autism anddyslexia169,andforlearningdisabilitieslikedyscalculia.170Inaddition,itisalsonecessarytotakeintoaccountthesupportiveservicesthatmayornotbeavailable.Forinstance,thesuccessofpoweredtechnology depends heavily on the ability of the country to provide charging outlets and theorientationofthepeopleforreadyacceptability.171

Notonlydoesassistivetechnologyhavetobe ‘fit-to-purpose’ foreachuser,theusermustreceiveappropriate and adequate training that permits her/ him tomakeuse of the device. Respondents attest to the need of training forassistivedevicespostsales.172173Infact,dropoutfromusemaybeashighas80-85%dueto inadequateeducationtousethedeviceand insufficient attention to its customization to the physical andculturalcontext.174Toprovideassistivetechnologydevicesatscale,

costsare incurredto identifyusers,markettothemaswellastobuildcapabilitiesof theproviderorganisation.Further,costisalsoincurredonprovidingthedevicesincemany,ifnotmost,usersarenotabletoaffordassistivetechnology;andfinally,costsarealsoimplicatedinthetrainingrequiredtoseethattheuserisabletousethedeviceeffectively.175

Thechallengeofadapting imported technology to the localconditionsof thecountryandsettingswasreiteratedbyexperts.Theyfeltthatmostofthehigh-end,importeddevicesmaynotbeusablein Indian settings as they were “not suitable for our terrain, our climatic conditions etc.”176Therefore,while focusingonmakingassistive technologyavailable, it is important thatusability isnotoverlooked.Somerehabilitationspecialistsmaintainthatusabilityandaccessibilityaretwosidesof the same coin. A study on applicability of the wheelchair skills program in the Indian contexthighlighted theneed toaddress the communitybasedobstaclesobservedby the researchers. Forexample,thecurbsdidnotprovideasurfaceforwheeledlocomotionandsidewalks,wherepresent,were often impassable.Moreover,most of thewheelchair users did not use lightweightmodularwheelchairs, or electrically poweredmobility aids. Thus, training tips needed to be redesigned toaddress the context specific issues to make the program relevant and useful for the Indianwheelchairusers.177InnovatorsinIndiaInitiativeshavealsobeentakenbysometodevelopassistiveaids suitable for the Indian elderly. Manufacturers like Dhingra Surgicals, Navchetan OrthopedicAppliances,Surgicalelectronics,NarwalOrthopedicandRehabilitationAids,Surgico-Furn(India)Ltd.,SAGE (Everest Engineers) and organisations like Bhagwan Mahaveer Viklang Sahayata Samiti areworking consistently on developingmobility aids, prosthesis, tricycles,wheelchairs, commodepotchairs,cervicalaids,abdominalsupports,varioushandandlegsupports,orthopedicshoes,calipers,etc.tohelptheelderlyparticipateactivelyinsociallife.Somesuchideas/innovationsincludeachairwithshowersystemforelderlytotakebathindependently,awalkerwithheightadjustablefrontlegto climb stairs, a walking stick with features like counting of steps, medicine reminder, locator,emergencyalarm, fall detector, andautomatic torch, shoeswithanegativeheel toalleviate kneepain among elderly, and modified wheelchair that can be converted into crutches by variousinnovatorsoperatingtomake livesbetter forpersonswithdisabilities.178Megalingametal. (2012)haveproposeda systemHOPEwith sensors tomonitorheart rate,body temperature, tilt and fallandsendthedatatocaregiverincaseofemergency.179MohanKumaretal.(2012)havedevelopedmultipurposewheelchair,whichalsoassistsindefecation,cleaning,andchangingofclothes.Inthe

Assistivedevicesneedtobe‘fit-to-purpose’andtheirusebesupportedbyausereducationprogramme.

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wheelchairs,aprovisionofadjustablearmrest,backrest,andlegresthasalsobeenmadetoprovidecomfort to users while resting.180 An ergonomic wheelchair with features like back recliner andstandingmechanismhasalsobeendesignedbyOram.AdeviceformanagingurinaryincontinenceinoldagehasbeendevelopedbyRameshetal.Abedrail toassisttheelderlyforgetting inandoutfrombedhasbeendevelopedatIITMumbai.Atablet-basedsystemtocheckthewell-beingoftheelderly has been designed and assessed by Ray et al.181 Sarkar and Das (2017) conceptualizedmodularityinpoweredwheelchairforelderlywithmobilityimpairment.182

GRIDModelforTechnologyDevelopment

Traditionalmodelsofresearchanddevelopmentmaynotworkeffectivelyincost-sensitivemarkets.TheGRIDmodel is basedon the four pillars ofGrants-Research-Industry-Dissemination to involveacademia,fundingagencies,industrypartnersanduserstodeveloptheappropriateassistivedevice.Thenetworkofgovernmentandnon-governmentandprivateorganizationsundertheGRIDmodelprovide effective solutions to develop quality assistive technology solutions to persons withdisabilityindevelopingcountries.ThestandingwheelchairdevelopedaspartofagraduatestudentprojectatIndianInstituteofTechnology,Madrasisaclearexample.183TheGRIDmodelwasappliedto successfully translate the concept into themarket. The involvement of important stakeholdersfromtheearlystageofmodelbuildingensuresallviewpointshavebeentakenintoconsiderationforproper dissemination among end-users, user groups, rehabilitation centres, therapists fitting andtrainingpersonnel.

Development, advancement and adaptation of various assistive technology keeping in mind theIndian context ensuring its affordability is crucial.184 Creatingawarenessamongstakeholders-designers,architects,technologistsand other specialists, industry and service providers, etc. for theneeds and constraints of the user is also required. Yet severalexpertspointedout that themarket is highly fragmented. There isno pooling of demand as persons with disability are economicallyweakanddonothavemuchpurchasingpower.Thesupplychain islikewise weak and the industry struggles with the issues detailedabove. Finally, even when there is development of a solution itcannotbeproductizedbecauseofthesmallmarketsizeandlackofrehabilitativeprogrammes.185186Eventhoughthereisimportofnewtechnologytothecountry,thegovernmentisnotveryawareontheprocurementstrategiesfordistribution.187

Thecontrolof intellectualproperty rights isamajorbarrier toacountrystruggling toestablish itsown assistive technology programme. Issues such as ‘Freedom-to-Operate’ and ‘Infringement ofIntellectualPropertyRights’arenotwellunderstoodbytheinnovatorsinIndia.188Manyinnovationsarebuilttooperateonexistingsoftwareplatforms.Technologyaccessibilityisusuallyconstrainedbyintellectualpropertyrights.Evenifhardwareweretobeproducedincountryat lowcost, itwouldrequire the platform in order to be functional, thus driving up its cost. This makes even locallyproduced solutions often too expensive to reach the masses.189 Many of the organizationsdevelopingtechnologysolutionsareeithersponsoredorself-funded.However,innovatorsmaynotbebestplacedtotaketheirinnovativesolutionstomarket.190Severalstart-upsareenthusiasticallyconvertinggoodintentionsandtechnologicalcompetenceintosectorspecificassistivedevices.The

Traditionalmodelsofresearchanddevelopmentmaynot

workeffectivelyincost-sensitivemarkets.TheGrants-

Research-Industry-DisseminationorGRIDmodel

couldbeusedtodevelopappropriateassistivetechnologydevices.

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estimatedcostofdevelopmentoftechnologyintheprivatesectorisoftenexpensive.Theproblemwithinnovationbyacademiaisthattheyarenotwillingtoconsidertheneedsofthepeople.Theysell their innovations to private entities which hike up the cost. Government providers such asALIMCOthenhavetopurchasesuchassistivetechnologyatquiteahighprice.191

FinancingAssistiveTechnologyStart-Ups In recentyears, innovatorsandventurecapitalistshaveventured into the assistive technology space alongside the government. Social Alpha is a venturecapitalist by Tata Sons and is focussed on enabling meaningful impact through science andtechnology for persons with disability. As venture capitalists and incubators, organizations arealwayskeepinganeyeout forupandcoming innovations inthespaceofassistivetechnologyandhelp them by providing resources and a platform. The Assistive Technology Accelerator is anincubator supporting three start-ups that have been very successful in the recent times- Eye-D,Innovision and Inclov. The BIRAC-Social Alpha Quest for Assistive Technologies, supported byMphasis is a search for the top10 innovativeandentrepreneurial teams in thecountry thathavedeveloped market-ready assistive technology and inclusive solutions. Barrier Break (DigitalAccessibility Consulting) was founded on three basic principles – technology, hiring people withdisabilitiesandafor-profitmodel.

Experts note that, “There is an influx of social entrepreneurs in the market place operating inassistive technology in India.”192 The entry of innovators and social entrepreneurs will help bringfundingforresearchanddevelopmentofnewaffordabletechnologyfortheIndianpopulation.Thismayhelpmakeassistivetechnologymoreeasilyavailableandaccessibletopersonswithdisability.Buttheimportanceofgovernmentfinancingintheearlydaysoftheindustrycannotbegainsaidas,“a for-profit assistive tech business model needs encouragement for product innovation andinventionwiththeinfluxoffundsandalackofthatinIndiakeepstheindustrywhereitis.”193

An expert stressed the need for start up funding support, citing the Kerala StartUpMission as agood example of a government agency supporting entrepreneurship and incubation in thecountry.194Oneout-of-the-boxincentiveforstartupcentreswasproposedbyoneexpertwhosaid,“ .. the government now pushing for Institutes of Eminence to be set up.My proposal is that itshould be made mandatory for institutes that want such a tag have centres for inclusiveeducation.”195Anotherperspectiveonsimilarlinesnotesthatifgovernmentwouldlikethefuturetobe inclusive in the truesenseof theword, it shouldmandate thatallprocurementcarry technicalspecificationsthatmaketheserviceinclusiveforpersonswithdisability.196

GapsthatRemain

Despite the increased role and awareness about disability and the need of assistive technology,certain anomalies remain. India does not have an assistivetechnologyact forpersonswithdisabilityasofnow,unlike theUS,where such an act had preceded the disability act. This acted as aspur tomanufacturingofassistive technologydevicesasassistancebecameavailabletopersonswithdisabilityfortheexclusivepurposeof providing such devices.197 This is linked to the call to establishstandards in the field of assistive technology devices,whichwould

Anumberofweaknessesafflictthesystem:reach,accessibility,affordability,customisationtoneed,customisationtoIndian

conditions,trainingforuseandpostsalesservicing.

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help the start ups orient themselves tomeet the basicminimum requirement for a good qualityassistivedevice.198

Reasons for Concern The growing focus on easy accessibility to assistive technology to thoserequiringthemmakesacriticalreviewoftheevidence,centraltodriving improvementandrobustpolicydecisionsinthisregard.Assessmentofexistingpoliciesandprogrammesarecrucialtoensurethateffectiveservicesare inplaceforpersonswithdisability.A2016reportoftheGovernmentofIndia’s Ministry of Statistics and Programme Implementation identified that it is essential todeterminethesocialneedsofpersonslivingwithdisability,suchastheroleofassistivetechnologyforinclusivedevelopment.199Yetothersargue,“Governmentfundinghasincreasedforresearchanddevelopment in this space.” The government has invested in good high-speed braille presses andeverystatehasoneormaybeevenmorethanonebusiness.200Nonetheless,itisgenerallyacceptedthatthetoolsofpolicysuchasinformationdissemination,availabilityofgoodsandservices,pricingofgoodsandservices,andregulationhavenotbeenfullyleveragedtocreatethepolicyenvironmentinwhichassistivetechnologyisnurturedandthoseinneedofit,areenabledtoaccessit.201202203

Concern was also expressed with respect to naive adoption of policies of theWest to India. Anexamplewasprovidedofthecreationofresidential‘blindschools’inIndiawhichhavebeenunableto cater formuch of the blind population of the country due to various reasons (lack of trainingamong the teachers todealwith theblind students, lackof studymaterialetc.),while imposingahighcosttotheexchequer.204Otherareasthatfoundmentionfromexpertsinterviewedinclude:theneedtobringtheMinistryofSocialJusticeandEmpowermentclosertotheMinistryofHealthandFamilyWelfaretoaccountfortheaccessibilityandavailabilityforassistivedevicesasapublichealthmatterasagreaternumberofpersonswithchronichealthissuesfacedisabilityintheirlateryears.205206AconcernamongprovidersisthevariableGoods&ServiceTaxleviedbythegovernment;thisvaries from 0 – 18% depending on the nature of the support provided, making the tax returnsprocesscumbersome.Thisissuretocreateanimpactonthepricingofassistivetechnologiesaswellasthereluctanceofthesellertoservicethesectorbecauseofthemultifactorialnatureofthepricingprocess.207

Insufficiency, Affordability and Reach Commonly available assistive technology are spectacles,hearing aids,walking canes,wheelchairs and canes for the visually impaired.208 Callipers for polioaffectedpersons;prostheticsandartificial limbsarealsoavailable,butmostly for the lower limbs.Options for the upper limbs were limited. Experts noted that there is a growing need ofcustomisabledevicesasthewidespectrumofdevicesavailableinIndia,theoptionsarelimitedonside of the spectrum due to rudimentary design with obsolete technology provided at low cost.Thesedevicesdonotmeettheneedsofthepeople.Attheotherend,areimportedandexpensivedevicesthatarenotaccessibletomostpersonswithdisabilityowingtotheirhighcost.”209

Fromauserperspective,thefollowingwerecitedastheroleofgovernmenttoensureavailability:(i)to encourage development of assistive technology; (ii) provide subsidies especially given thatpersonswith disability tend to be economicallyweaker; (iii) ensure affordability and geographicalavailability; and finally (iv) consideration of Indian context and disability type in the process oftechnologydevelopment(v)tomakesurethatthegovernmentspaceisdigitizedandaccessible.210

Toenableavailabilityandaccessibilitytoassistivetechnology,itisimportanttocreatesuchproductsandservices thatareequallyaccessible to thepersons inneed for them. However,availabilityof

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high-qualityandaffordableassistiveproducts isaseriousproblemformanyespecially inamiddleincomecountrylikeIndia.211Thepointisnotjusttodistributestateofartequipmenttopeoplewhoneed thembut to look at the utility of those devices in certain socio-economic and environmentfactors.

The insufficiency of assistive technology in India is reiterated by otherswho call attention to thefragmentedassistivetechnologymarketwhereinthe interventions forcertaindisabilitiesaremoreprevalentthanothers.212Another intervieweementionedthat ifassistivetechnologyistoprovetobe of help, all three need to work together – developers, aggregators and grassrootsorganisations.213 Affordability was identified by many specialists as a key component of makingassistive technology available and accessible to the end users in India. To add to the availabilitydebate,expertsnoted that, “whilea lotof technologywasavailable fromoverseas, it tends tobefrightfullyexpensive.Therefore,manypeopleinIndiafinditdifficulttoacquireit.”214Ruralareasandcertaingeographiessuchastribalbelts,isolatedregionsofthecountryseemtobelessservicedthanothers,raisingconcernsaboutequityissues.215

Greater Awareness is Needed Little information is available regarding the demand for assistivetechnologies.Manypersonswithdisabilitydependonassistivedevicestoenablethemtocarryoutdailyactivitiesandparticipateactivelyandproductively incommunity life.Trainingonhowtouseassistive technology was also linked with accessibility to populations who need the devices. In avisualrehabilitationclinicinNewDelhi,themajorityoftheresearchparticipantswereawareofonly2-3devicesofthe42assistivetechnologydevicesavailablefortheiruse.Also,onlythreedeviceswerereportedashavingmoderateutilization.Theresearchersconcludedthattoenablemaximumuseofresidualvisionwiththehelpofvisualbaseddevices,itwasimportanttonotonlyensuretheiravailability but, also training them in theuseof these assistive devices.216 These sentimentswereechoed:“Thewhitecaneforvisually impairedwasavailabletoa largenumberofpeopleas itwasnotveryexpensivebutthelackoftrainingonhowtouseitlimiteditsaccessibility.”217

Similarly, in a review of assistive technology for the elderly in India, Kumar and others (2009)concluded that the elderly were ignorant about the availability of majority of the aids with theexceptionofcertainhearingaids.Thoughsomeinnovativeaidshadbeendevelopedinrecentyearslike walker for climbing stairs, multipurpose wheelchair, wheelchair that can be converted intocrutches,bedrail,etc.,theyhavenotbeenavailedbytheelderly.Otherthanthelackofawarenessabout the aids, the elderlywerenot very informedonhow to procure thesedevices.218 Likewise,screenreaderssuchasNonVisualDesktopAccesswerefreelyavailableonline,buttheirawarenessanduseamongtheelderlywerepoor.Theotherreasonforlimiteduseofscreenreaderscouldbethenon-availabilityof the readers in thedifferent regional languages.Anotheraid for thevisuallyimpaired i.e. braille is available in major Indian languages however the screen readers are onlyavailable in three or so major languages. The lack of such nuanced features that make it moreacceptableamongtheIndianpopulationisachallengethatneedstobeaddressed.219

It is also important to address demand side barriers to improve the gaps in access to and use ofassistivetechnology.220Otherimportantbarriersarelackoffundingforaidsanddevices;highcostofdevices; and lack of distribution networks that makes it difficult to access assistive technologydevices. Since assistive technology falls between the purview of both - state and centre, thiscomplicates the scalingupof industriesoperating in theassistive technology space.221Thisaffects

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the pricing of the devices which eventually affects the accessibility. As a result, persons withdisabilityhavetofallbackoninefficienttechnologyprovidedthroughtheADIPschemeduetohighcosts of devices that are available in the privatemarket.222Other problems relate to financing ofsustainableservicessuchastransportation,accessiblearchitecture,communication,developmentofstandardsforgoodsandservices,etc.223

DebatesandDiscussionsAssistivetechnologyisamuch-neglectedareaandhassparkeddebatesonwhetherIndianeedstodevelop‘appliance’or‘tools’.Theappliancevstooldebaterefertotheneedto use common-use devices (appliances) as themeans to achieve the purpose rather than highlycustomised devices (tools) which require a great deal of learning on the part of the personwithdisabilityinordertoreapbenefits.224Asolutiontothismaybeprovidedbydesigningthreekindsofassistivetechnologydevices.“Firstly,productswhichareexclusivelydesignedfortheblind;secondareproductsandappliancesthatcanbeputtoalternativeuseinordertofacilitatevisuallyimpairedpeople;andthethirdisthetypeofproductswillcanbeusedbyeverybody,suchassmartphones.”Thisreferstotheuniversaldesignprincipleinwhichaproductorserviceisdesignedinsuchawaythatitisequallyusablebypersonswithdisabilitiesaswellaspersonswithoutdisabilities.225Thiswillhelpeliminatetheneedtocreatemultipleproductsorservicestocatertothesamerequirementofpeoplebelongingtodifferentcategories.Thisishighlyusefulinnotonlycreatingaccessiblesystems,butalsocurtailingexpensesandreducingredundantefforts.Respondentsmentionedtheneedforcustomizabledesignsthatcanbemassproduced.

Cause forOptimism The growing focus on assistive technology has also led to greater optimismaboutthefutureofdisability. Whiletalkingaboutthechangingecosystem,anexpertremarked“Iwouldn’t have said this 20 years ago. But now I tend to believe that therewould be a daywhenassistivetechnologywouldmakeatotallyblindperson,notfeelthathe'slosthissight,youknow.So,I think that's the potential that assistive technology can provide and that is beginning tohappen …”.226 People with disability have also devised simple to use solutions to their everydayneeds.Forexample,oneladywhoneedstodirecttherickshawinwhichshetravelstohergate,hasfixedadoorbellontothegate. Whenshefeels thatshe isclosetohome,shepressestheremoteuntilwithinthedistance inwhichthedoorbellcanpickupthesignal. Inthisway,shecangettheauto-rickshaw to take her to her doorstep. These are ingenious ways of using technology, notdesignedfortheblind,butblindpeopleareusing.227

Even though assistive technology have created a positive impact on the lives of persons withdisabilities,thelackofaccesstoitnotonlyaffectsthelivesoftheconcernedpersonswithdisability,butalsotheirfamilyandsociety-at-large.Withoutappropriateassistivetechnologyanddevice,thepersons with disability are isolated and segregated from every sphere of life. Furthermore, theyregularly encounter stigma, discrimination and inequalities. Therefore, to enable persons withdisabilitytofulfiltheirpotential inamoreinclusiveandenablingsociety,thefirststepistoensuretheiraccesstoassistivetechnologyanddevicesandallformsofrequiredrehabilitationservices.228Akey factor in the use of assistive technologies is themotivation to use them based on perceivedutilityandneedandtheawarenessonavailability.229

Collaboration between the government and NGOs is essential to reach large numbers. Using thepublichealthsectorasadeliverymechanismhelpsto“ensurelastmilereachbecauseinmanycases,the lackofmarketpenetration is theonly reason that thenumbersofpeoplewhohavenotbeen

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served with these assistive devices is huge.”230 Despite the prospect of using the governmentsystemstodeliversolutions,manyreiteratedthatsystemswouldneedtobeupgraded ifnewandupcoming technologywere tobedistributed topersonswithdisability through thischannel.231Anexample came from IIT Delhi which has developed a Smart Cane. The device is considered verysuccessful,buthasreachedonly70,000ofapotential5millionusersinIndia.232

KEYTAKEAWAYS

§ Datadoesnotprovidethefullpictureofdisabilityinthecountry.Availablefiguresarewidelyacceptedtobeanunderestimateoftheproblemandarechallenged.

§ Dataondistributionofdisabilityacrossgeographiesandincomeislackingasisdataonnatureandextentofdisability.DisabilityinIndiaisexpectedtogrowsharplyduetorisinglongevity,non-communicablediseaseandinjuries.

§ Acommensuraterisingrequirementforassistivetechnologydevicesisexpected.Further,oneexpertnotes the lackof informationon thewantsandneedsof thepersonswithdisability,makingresourceallocationlikelytobedisproportionatetodemand.

§ India’slawandpolicyframeworkisquiterobust,markingthecountry’sdesiretoaddresstheneeds of those with disability. However critical areas remain to be addressed, notably anassistivetechnologyActandstandardsforassistivetechnologydevices.

§ There is a network of government institutions in place. In 2015, the Centre for AssistiveTechnology and Innovation was set up and the Accessible India campaign launched.Government-runALIMCOprovidesthebulkoftheassistivetechnologydevicesinIndia.

§ Severalnongovernmentorganizationsworktogenerateandaggregatedemandforassistivetechnology in India. Nonetheless there needs to be much more attention to creatingwidespreadawarenessofassistivetechnologyanditsbenefitsamongthepopulace.

§ Thereareseveralinitiativesandstart-upsintheassistivetechnologyspace.Butthelaboratorytomarketlinkagesareweakandoftenfailthedeveloper.

§ Someventurecapitalistsarebeginningtoappear intheenvironment–butmoreandbetterstudiescouldhelpdefinethecontoursofthemarket.Severalpolicychangesare likelytoberequiredtomakethemarketattractivetoseriousinvestors.

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125SchemeofAssistancetoDisabledPersonsforPurchase/FittingofAids/Appliances(ADIPSCHEME).MinistryofSocialJusticeandEmpowerment,GovernmentofIndiaaccessedathttp://disabilityaffairs.gov.in/upload/uploadfiles/files/sipda/adiprevised010414.pdf

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142CentreforAssistiveTechnologyandInnovationatNationalInstituteofSpeech&Hearing.http://www.nish.ac.in/cati

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143Swavlamban,DirectoryofAidsandAssistiveDevices,Dept.ofEmpowermentofPersonswithDisabilities,Ministryof

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feedbacksurveyoforthosisusersinIndia.DisabilityandRehabilitation-AssistiveTechnology.165Jhangiani,I.(2006).Usabilityandaccessibilityissuesinthelocalizationofassistivetechnology.Proceedingsofthe8th

InternationalACMSIGACCESSConferenceonComputersandAccessibility-Assets’06,299–300166Jhangiani,I.(2006).Usabilityandaccessibilityissuesinthelocalizationofassistivetechnology.Proceedingsofthe8th

InternationalACMSIGACCESSConferenceonComputersandAccessibility-Assets’06,299–300167Matter,R.,Harniss,M.,Oderud,T.,Borg,J.&Eide,A.H.(2016).Assistivetechnologyinresource-limitedenvironments:

ascopingreview.DisabilityandRehabilitation:AssistiveTechnology,12(2),105–114.168Sharma,G.&Kumar,S.(2014).AssistiveTechnologiesforpeoplewithdisabilitiesinNationalCapitalRegionLibrariesof

India.LibraryPhilosophyandPractice.169Sampath,H.,Sivaswamy,J.&Indurkhya,B.(2010).Assistivesystemsforchildrenwithdyslexiaandautism.ACM

SIGACCESSAccessibilityandComputingNo.96.170Nagavalli,T.&Juliet,P.(2016).TechnologyforDyscalculicChildren.SSCE.Salem.ArtificialLimbsManufacturing

CorporationofIndia(ALIMCO).www.alimco.in171KII_12172KII_09173KII_10174KII_06175KII_01176KII_04177Kirby,R.L.,Kirby,R.L.&Cooper,R.A.(2007).ApplicabilityoftheWheelchairSkillsProgramtotheIndiancontext.

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ElderlyinIndia:AReview.SpringerNatureSingaporePteLtd179Megalingam,R.K.,Unnikrishnan,D.K.M.,Radhakrishnan,V.&JacobD.C.(2012):HOPE:anelectronicgadgetforhome

boundpatientsandelders.In:2012AnnualIEEEIndiaConference(INDICON).180MohanKumarR.,Lohit,H.S.&RanjanMishra,M.(2012).DesignofMultipurposeWheelChairforPhysicallyChallenged

andElderPeople.inSASTECH.2012.Volume11,Issue1.181Maurya,C.M.,Maurya,N.&Das,A.K.(2019).Awareness,AvailabilityandAccessibilityofAssistiveTechnologiesforthe

ElderlyinIndia:AReview.SpringerNatureSingaporePteLtd182Sarkar,S.,&Das,A.K.(2017).Designmodularityintheassistivedevicesforelderlypeople.In:Chakrabarty,A.,

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184Sarkar,R.(2018).SupportingparticipationandinclusionofindividualswithDisabilitiesthroughAssistiveTechnology.

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MinistryofStatisticsandProgramme,GovernmentofIndia.200KII_01201KII_04202KII_02203KII_08204KII_01205KII_07206KII_13207KII_13208KII_04209KII_04210KII_10211KII_04212KII_02213KII_07214KII_01215KII_07216Senjam,S.S.,Foster,S.,Bascaran,C.&Vashist,P.(2019).Awareness,utilizationandbarriersinaccessingassistive

technologyamongyoungpatientsattendingalowvisionrehabilitationclinicofatertiaryeyecarecentreinDelhi.IndianJournalofOpthalmology.

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ElderlyinIndia:AReview.SpringerNatureSingaporePteLtd.219KII_01220Tangcharoensathien,V.et.al.(2018).Improvingaccesstoassistivetechnologies:challengesandsolutionsinlow-and

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Chap t e r I V CONCLUS ION & R ECOMMENDAT IONS

Assistivetechnologyenablespersonstoundertakeactivitiesthattheycouldnototherwisecarryoutto theirownsatisfaction, thus improvingtheir functioningand independence,andenhancingtheiroverall sense of wellbeing. It helps persons with disability to overcome that, which hinders theirfullestenjoymentoflife.Assistivetechnologydevicescanrangefromsimple,asinwalkingcanes,tocomplex, as in speech aids. Access to assistive technology serves as the gateway to education,employment,socialinclusionandotheropportunitiestoparticipateinciviclife.

ThisrapidreviewwasundertakentomeetthreeobjectivesinthecontextofassistivetechnologyinIndia:

1. Understandresearchgaps2. Outlinetheecosystemofassistivetechnology3. DiscusshowaCentreofExcellencecouldsupportaneffectiveresponse

In this chapter, we provide a summarisation of the findings of our review of the literature andmapping of the ecosystem of assistive technology in India. The chapter then discusses theimplications of these findings in the context of setting up of a Centre for Excellence by theGovernmentofIndia.

ResearchGaps

Need for Assistive Technology The prevalence of disability is growing rapidly. Among themajorcausesareinjuryduetoconflictoraccident,ageingandchronicnoncommunicablediseases.Theseare expected to increase exponentially in the years ahead, making a response to disability animmediateconcern.Butrobustsizedataontheneedforassistivetechnologyintheworldislacking.Itisnotknownhowmanypeoplerequireassistivetechnologydevicesworldwide;modestestimatessuggest that in 10 years’ time more than 2 billion persons worldwide will require assistivetechnology.Norisdataavailableonunmetneedfordevices,butthemostcommonunderstandingisthatonly10%haveaccesstothem.

AvailabilityofResearchStudiesResearchonassistivetechnologyinIndiaisinadequate,albeitnotentirely absent. Small scale research is available – most studies are with a small number ofparticipantsordescriptionsofthedevelopmentprocessofacertaintechnology.Manyofthestudiesare carriedoutby researchers in countriesother than India, or as collaborationsbetween foreignand Indian researchers. Robust research on the demand for rehabilitative and palliative servicesinvolving assistive technologyhasnotbeenundertaken. Global generalisations indicate thatover90% of demand may remain unmet – with the expected increase in numbers due to increasinglongevityandnoncommunicablediseasesinIndia,thismayexpandfurther.

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The HAAT Framework The Human Activity Assistive Technology or HAAT framework provides ausefulway toclassify studies for the review. Itsuseallows insights into theextentandnatureofevidence base available on assistive technologies. The HAAT framework pays attention to fouraspectsofassistivetechnology: (i) thephysical,social,culturalandeconomiccontext inwhich it issought to be used (ii) the nature of activities forwhich it is intended to be used; (iii) the humanfactorsthatenableitsuse;andfinally,(iv)theengineeringaspectsoftheassistivetechnology.

ContextinDisabilityLocalculturalpracticesareoftenthekeyindeterminingtherequirementandreadinesstouseassistivetechnology.Thecontextinwhichpersonswithdisabilityliveandoperatehasrarelybeenresearchedwithaperspectivetoassistivetechnology.Typically,studiesthatdiscussthecontextinwhichpeopleliveandwishtouseassistivetechnologyinhavebeencarriedoutasanadjunct study to the development of a particular aid or device rather than to develop its ownunderstanding. Most of the studies that have been accessed, relate to mobility and visualimpairment with several others relating to modification of mobility devices for the elderly. Newdevicesareavailablethatcandistinguishbetweenaselectionoffootwearbytheblind,eliminatingtheneedtotouchthemandtotrainpersonsnewlyfittedwithhearingaids.Otherstudiestakeanethnographicapproachanddiscuss thewidelydifferentexperiencesof familieswith childrenwithautismindifferentpartsofthecountry.Studiessuggestthatthereisneedtoexplorehumanagencyin adoption of mainstream devices such as smartphones to overcome disability. Likewise, afunctionalperspectiveofmobilityneedsofwomenindicatesthatacomprehensiveunderstandingofcontextisrequiredtorespondtotheseneeds.Institutionalresponsesfromgovernmentwouldgoalong way in ensuring that entrepreneurship among those with disability to solve their poverty isurgentlyneeded.

ActivityasaComponentof theHAATFramework Akey featureof theHAATframework is that itshines a spotlight on the activity forwhich a particular assistive technology device is being used.Studies accessed related primarily to assistive technology devices that aid in education oremployment. However, little attention has been paid to other aspects of a person’s life such aseveryday living, leisureandrecreation,participationinsocial life,etc. Educationinparticular isanarea of concentration. Many studies discuss the availability of braille and audio books. Severalobstacles contribute to difficulties in providing assistive technology to students with disability,rangingfromlimitedgovernmentsupporttoinsufficientteachers.Increasinglongevityhasmeantagrowingpopulationofpersonswithdisability.Amajorconcernamongthisgroupistoincrease,orattheveryleast,tomaintainsocialparticipationthroughassistivetechnology.Studieshavehighlightedthe relationship between disability and earning capacity. A study in the context of blindness forexample,discussesthecorrelationbetweenemploymentandassistivetechnology.Wheelchairsareoneofthemosticonicformsofassistivetechnology,buteventhesehavelimiteddistributionamongthose who need them. In the context of sports, these are even more difficult to come by. AACdevices havebeenused in autism to improve communication. Yet, itmust be said that there is arisingawarenessaboutassistivetechnologydevicesamongthepopulationofpotentialusers.

Human Factors The ability and interest of potential users in adopting assistive technology is animportantprerequisitetoitseventualuse.Verylittleisavailableonthehumanfactorswhichmaymodify the use of assistive technology devices, particularly, ability to pick up new skills andmotivationforuse.Universalandinclusivedesignisanattributethatsupportsthedevelopmentofskillseasily. ApproachessuchasComputerAssistedInstructions,Touchtechnologyetc.havebeen

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usedtoaddressphysicalanddevelopmentalchallenges.Oncetakenuphowever,notalltechnologycontinues to be used. One observation from India is that environmental factorsmay reduce theeventual utilization of wheelchairs that have been received by persons with mobility challenges.Somehavepromotedperson-centredmethodologieswhichleverageaspirationto improveuptake.Olderpeoplemayshowgreater reluctanceto tryand lateradoptassistive technology.Butstudieshave shown that those who do adopt them demonstrate improved social participation. Earlyadoptionofscreenreadersforexample,couldbetheresultofseveralfactors.Forolderpopulations,everyday technology such as lifts, staircase climbers etc.may play an important role in adoption.EngineeringSolutionsNotallassistivetechnologyrequiressophisticatedengineering.Ausefulwayto classify assistive technology is as follows: (i) No-Tech: adaptation of behaviour or method tocommunicate; (ii) Low-Tech: easy to use options of low cost, and typically do not use a powersource; (iii) Med-Tech: easy to operate, powered devices; and (iv) High-Tech: complex andprogrammabledevicesthatrequirecomputers/electronictoperformafunction.

The cognitive profile of the user is an important consideration in engineering design. Similarly,expertsoftentakecarefulaccountoftheenvironmentalconditionsthattheengineeringmustsolvefor.Oneexampleisthegroundmobilitysolutionforwomenwithlowerextremitydisability.StudiesdiscussedinthesectionrangefromAutVision;Autinect;automatictranslatordevicesfortheIndiansignlanguage;solutionsfortheelderly;multilingualeducationandcommunicationtools;andsportswheelchairs. Use of technologies such as HCI, EOG and RFID has yielded practical solutions. Onestudy suggests that in cost sensitive markets, the GRIDmodel can support innovation. Examplesinclude the recentlydeveloped standingwheelchair and tactilediagrammingdevicesdeveloped inIndia. Studiesoftenpresentonlyadescription linkedtotheparticulardevice,but fewstudiesareavailable that discuss engineering aspects for their own sake i.e., pros and cons of variousengineeringapproaches.Asaresult,aholisticpictureofthefieldisnotavailableandlittleguidanceisavailabletotheresearcherormanufacturerseekingtoidentifyareasinwhichmoreworkcouldbedone.

AnEcosystemOutline

TheRoleofGovernmentIndiahasbeenanearlysignatoryoftheUNCRPD.Athome,Indiahashadalaw relating to disability in place since 1995, which was recently revised and replaced in 2016.SeveralotherActsofParliamentsuchastheNationalTrustAct, theRehabilitationCouncilof IndiaActetc.havehelpedtodevelopsystemstorespondtotheneedsofthosewithdisability.Aseparatedepartment has been designated under the Ministry of Social Justice and Empowerment – theDepartmentforEmpowermentofpersonswithDisability. TheCentreforAssistiveTechnologyandInnovationhasbeenestablishedin2015attheNationalInstituteforSpeechandHearinginKerala.

There isanetworkofnational institutes,digitizationofdisability certificationhas takenplace, theNational InnovationFundhasrecognisedandawarded innovators inthespaceetc.Manyschemessuch as ADIP are available to those with disability – facilitatory information is available fromPunarbhava,Swavlambanetc.websites thathavebeenput inplace.Several schemesareofmanyyears’standing,andargumentmaybemadeaboutwhetherornotthesupportthattheyprovideissufficientorneedstobeupdated.AnimportantnationalresourcecentreisALIMCO,responsibleforthebulkofproductionanddistributionofassistivetechnologyinIndia,producingover350differentkindsofaidsandappliances.ALIMCO’smottoistostaysimpleanddistributewidely.Butquestions

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areraisedaboutthesuitabilityandsturdinessofitsaidsandappliances.Therearefewdevelopersorproducersintheprivatesectorexceptinnicheareassuchasspectacles,wheelchairs,walkingcanesetc.

IndiadoesnothaveanassistivetechnologyAct,norarestandardsforassistivetechnologydevicesinplace.Withdisabilityexpectedtogrowrapidlyincomingyears,thereisneedtobringtheMinistryofSocialJusticeandEmpowermentclosertotheMinistryofHealthandFamilyWelfare.Itisgenerallyacceptedthatmuchmoreremainstobedonetoensurethatallpolicytoolsarebroughttobearontheissue.

PrivateSectorResponseThereareanumberofnon-governmentorganisationsthatareseekingtoplugthegapsinthegovernmentresponse.Somesupportnetworksofpersonswithvariousformsofdisability;othersseektocreateassistivetechnologydevicesthatcansolvefortheproblemsfacedbypersonswiththesechallenges.Thereareafewfor-profitplayersintheassistivetechnologymarket.Eventhemostsuccessfulpresent-daydevicesdistributedthroughthegovernmenthavehadlimitedmarket penetration. Most agree that the market is fragmented and needs are very diverse. Inaddition, disability often results in lower income. Thus the demand for assistive technology andpurchasingpowerofpersonswithdisabilitydonotsupportafor-profitresponse.

Allagree that stepsmustbe taken for thedevelopment,advancementandadaptationofassistivetechnologykeepinginmindtheneedsoftheIndiancontext,inparticularaffordability.Thereislackofawarenessamongdesigners,architects,technologists,engineers, industry,andserviceprovidersmakingthedevelopmentofnewtechnologyforpersonswithdisabilitysluggish.Thesupplychainisweak and there is a paucity of rehabilitative programmeswhich incorporate assistive technologysolutions. Legal concerns that add to cost and distribution need to become widely known andappreciated.Expertsalsopointtotheneedforthegovernmenttokeeppacewithandprocurenewtechnologyenteringthemarketfordistribution.Afewventurefundshavebeguninvestmentinthisspace-theeffectofthisnewlyavailablecapitalisyettobefelt.

ChallengestoAccessibilityandLastMileReachSeveralchallengesremaintobeaddressed.Inordertomakeassistivetechnologyaccessible,thereneedstobegreaterawarenessamongpersonswithdisabilityandtheircaregivers.Informationregardingaidsandtheirutility,sourceofavailability,cost,operating cost, support services etc. must be pushed. For this, a better understandingmust bedeveloped regarding the size and nature of the problem. In order to help researchers andmanufacturers better respond to the need, the context in which the assistive technology mustoperate, theactivities forwhich it is requiredandtheskillsandabilitiesof itsusersshouldbethesubjectof studies, alongwith studiesonaccessibility, affordability and inclusivityofdevices.WiththecontextinIndiabeingasdiverseasitis,thisisnomeantask–devicesareneededforboththe‘newIndia’aswellastheold,ifmarketpenetrationisadesirablegoal.Presentdaydropoutratesfromassistivetechnologythathasbeenadopted,isreportedlyashighas80%–studiesarerequiredtounderstandwhythisissoandwhatcanbedonetocorrectthesituation.

Key Debates and Discussions The role of government as an enabler of solutions rather thanpurveyormustbefullyexplored.AkeydebatethathasimportantimplicationsintheIndiacontextistheappliancevstooldebategivenitspresentsituationandexpectedrapidlyincreasingneed.DoesIndianeedtoolsthatarebuilt-from-scratch,custom-designedandrequiresignificanttrainingfortheusertobeabletouseiteffectively?Orshouldthefocusbeonproducingappliancesthatarebuilt

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onexistingtechnologicalplatforms,easytoadoptandrequireminimalornotrainingforuse?ShouldIndia adopt an either-or policy or assign some expectation of distribution of research anddevelopmentoneithersideofthisdebate?

ImplicationsforaCentreofExcellence

The research gaps and current ecosystem of assistive technology in India that have beensummarised above provide learning for a potential Centre of Excellence. They point clearly torecognitionthatthefieldofassistivetechnologyinIndiahassofarbeenscantilycharted,andmuchremains to be done to develop a considered response. The main implications for a Centre ofExcellencearecapturedbelow:

1. There are several reasons why a structured response to disability in India is difficult toconstruct. Tobeginwith,theextentandcontoursoftheproblemhavenotbeenfullyunderstood.Data on disability in India is both limited and questioned. The two largest datasets describingdisability in the country are not consonant and hence robust comparisons cannot be drawn orlessons takenaway.Further,extrapolationsas to the likely sizeof theproblem in the foreseeablefuture have not been carried out. Finally, data on the nature and extent of disability is lacking.Distributionoftheproblemalsoneedstobebetterunderstood–whatisthenatureofthedisability,inwhichgeographiesandinwhichincomegroups.ACentreofExcellencecouldaddressthesedatagaps.

2. Data is also required to develop the aids and appliances required for the populationsaffected by disability. The HAAT framework provides a useful way in which to approach theproblem.Akeyareaofunderstandingistheactivitiesforwhichthetoolsarerequired.AtthispointinIndia’sresponsetotheproblem,itmaywellbethatacarefulprioritizationisrequiredsothatthemost urgent needs are addressed. Better understanding is also required of the abilities andmotivationofthosewithdisability,bothacrossageandacrosscultures. Moreneedstobeknownabout the context in which the assistive technology is expected to be used – both physical andsociocultural; as well as the institutional context in which it is sought to be delivered. Finally,engineeringconsiderationsneedtobeappliedanddiscussed,bothinthecontextofdevelopmentoftechnology, but also in of themselves; so the science that would be useful in development ofassistivetechnology,needstobebothbasicandapplied.Theseareascould formthebasis for theorganisingthedepartmentsoftheCentreforExcellence.

3. India has a good track recordof puttingdisability-sensitive laws in place and is compliantwithinternationalconventions.ACentreforAssistiveTechnologyandInnovationwasestablishedin2015 inKerala.Manypolicieshave alsobeenput inplace althoughwhether theyhavebeen fullyimplemented could be challenged. Owing to the poor income profile of persons with disability,realisticsubsidiesformodern-dayassistivetechnologydevicesneedtobeputinplace.Inparticular,expertspointtotheabsenceofanassistivetechnologyActandstandardsforassistivetechnology.AlsoofconcernisthelackofformalmechanismsforcoordinationbetweenMinistryofSocialJusticeand Empowerment and the Ministry of Health and Family Welfare, both important in theformulationofappropriatepolicytoolsforassistivetechnology.StudiesthatsupporttheseareasofpolicyconsiderationfortheGovernmentwouldbeanotherareathattheCentreofExcellencecouldaddress.

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4. Laboratorytomarketconnectionsremainweak,despitetheemergenceofgreenshootswithrespecttoassistivetechnologyinIndia.Platformsfordiscussionandnetworkingaresorelyneededso that ideas canbe exchanged andbusiness partnerships canbe fostered. There are vexed legalissues with respect to software use that need to be explored and understood better. Likewise,financialsolutionstosupportaburgeoningmanufacturing industrymustbeconsideredfora fullerresponse to the disability problem in India. Better understanding of geography and incomedistributionwouldalsopermitformulationofpoliciesandoptionsthatsupportaccessibilityandlastmile reach. The Centre of Excellence would be the appropriate institution to carry out studiesrelating to market realities; policy making that supports better laboratory-market linkages andensureswiderandmoreaccessibledistributionofassistivetechnologydevices.

5. It cannotbe stressedenough that India ispresentlyon thecuspofanewepidemiologicalprofileofherpopulation.TheemergenceofnoncommunicablediseaseasamajorfeatureaffectingIndia’s population, the rising graph of injuries related to traffic and other activities, and theincreasing longevity of her people are adding to the expanding requirement for a strong andconsidereddisability response.There isneed formanymorestudies tosupport thisneed,bothtodevelopandmanufactureassistivetechnologydevicesaswellastoputsuitablepoliciesinplace.Keydebatesanddiscussionsneedtobehadsothataclearpathcanbecharted. Akey inputthattheCentreofExcellencecouldprovideistodevelopclearforecastsoftheneedforassistivetechnologyamongvarioussubsectionsofIndia’spopulation.Further,theCentrecouldalsocommissionstudiesthatconsiderthedebatesthatinformthedevelopmentofassistivetechnologydevicesinIndiawithaviewtoadvisinggovernmentontheappropriateapproachatthistime.Thiswouldhelpleadthewaytoindistributingassistivetechnologydeviceseffectively.

InConclusion

AstrongpushtodevelopIndia’sworkonassistivetechnologyisurgentlyrequiredtoensurethattheneedsofagrowingcomplementofpersonswithdisabilityaremetandproductivityofIndia’sworkforceiscontinued.Mostexpertswouldagreethatthenumbersofthosewithdisabilityarelikelytobemuchhigherthanispresentlyknown.Thereisanexpectedrapidincreaseintheconditionsthatresultindisability.AddtothistheunderlyingcontextofIndia–acountrywithlowpercapitaincomeandwhere demand for health services outstrips its delivery. It is clear that better information isrequired and policies put in place that strongly encourage market players to participate in thissector.Inorderfortheassistivetechnologymarkettofunction,andfunctionefficiently,allpartsofit– basic and applied research, knowledge translation, manufacturing andmarketing must be wellconnectedthroughacommonplatform.Thepresentlackoflinkagebetweenkeyactorsinthespacemusttobeaddressedsothatefficienciescanbeachieved.

Withalargenumberofengineeringinstitutions,avibrantresearchcommunity,innovativemanufacturingcapabilitiesandagovernmentcommittedtoimprovements,Indiahasthewherewithaltomakethishappen.

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AnnexureI

# Respondents Organization1 AkilaSurendran CentreforAssistiveTechnology&Innovation,NISH,Trivandrum2 AlbinaShankar MobilityIndia,NewDelhi3 AnilJoshi IBM,Gurugram4 AnilPrabhakar IndianInstituteofTechnology,Chennai5 DRSarin ArtificialLimbsManufacturingCorporationofIndia6 GeorgeAbraham TheScoreFoundation,NewDelhi7 K.G.Satheesh CentreforAssistiveTechnology&Innovation,NISH,Trivandrum8 MBalakrishnan AssisTech,IITDelhi9 MukeshDoshi IndianAssociationofAssistiveTechnologists10 NikunjaK.Sundaray TheNationalTrust11 PrateekMadhav AssistiveTechnologyAccelerator,Bangalore12 RamKumar NationalInstitutefortheEmpowermentofPersonswith

IntellectualDisabilities,Noida13 ShankarSubbiah AgateInfotekPrivateLimited,Chennai14 SKTripathi ArtificialLimbsManufacturingCorporationofIndia15 SujathaSrinivasan RehabilitationResearchandDeviceDevelopmentLab,IITMadras

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AnnexureII

R e l e v a n t P u b l i c a t i o n s

McDonald,R.Thomacos,N.&Inglis,K.(2013).Reviewofcurrentandemergingassistivetechnologiesforthereductionofcareattendanthours:costeffectiveness,decisionmakingtoolsandemergingpractices.MONASHUniversity:Medicine,NursingandHealthSciences&InstituteforSafety,CompensationandRecoveryResearch.

Peterson-Karlan,G.R&Parette,H.P.(2007).Evidence-BasedPracticeandtheConsiderationofAssistiveTechnologyEffectivenessandOutcomes.IllinoisStateUniversity

Smith,R.O. (2016). TheEmergenceandEmergencyofAssistiveTechnologyOutcomesResearchMethodology. Department of Occupational Science& Technology, College of Health Sciences&RehabilitationResearchDesign&DisabilityCentre,UniversityofWisconsin-Milwaukee.

O n l i n e R e s o u r c e s

Devexisamediaplatformfortheglobaldevelopmentcommunity.Itisalsooneofthelargestproviderofrecruitingandbusinessdevelopmentservicesforglobaldevelopment

NewzHookisanaccessiblenewschannelwithafocusondisabilityrelatednews.Thewebsiteisaccessibletovisuallyimpairedscreenreaderuserspromotingsignlanguagenewsfordeaf.

Punarbhavawebsiteisanattempttoprovideconsolidatedinformation,discussissues,network,findemployment,listofavailabeappliancesandtools,seekredressalofgrievances,undergotraining,researchandstudyetc.

I n c u b a t o r s i n A s s i s t i v e T e c h n o l o g y i n I n d i a

ARTILABFoundationisayounganddynamicsocialsectororganisationdedicatedtowardsfosteringaccessibleinnovationinthedisabilitysector.

AssistiveTechnologyAcceleratorisanincubatorcreatedwithavisiontoimprovethelivesofdisabledpeoplebycreatinganecosystemthatcanhelpassistivetechnologystart-upstoscaleupSocialAlphaisanon-profitstart-upincubatorfundedbyTataTrustsofferingafellowshipprogramforaspiringentrepreneursinthedevelopmentsector.

G o v e r n m e n t I n t e r v e n t i o n s

DisabilityRelatedTechnology,ProductsandIssuesbyDepartmentforempowermentofPersonswithDisabilities,MinistryofSocialJusticeandEmpowermentprogrammeisexpectedtocreateholisticdevelopmentoftheindividualsandtheirfamiliesandcreateanenablingenvironmentfortheempowermentofthepersonswithdisabilities.

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SchemeofAssistancetoDisabledPersonsforPurchase/FittingofAidsandAppliances(ADIP)willassisttheneedydisabledpersonsinprocuringdurable,sophisticatedandscientificallymanufactured,modern,standardaidsandappliancestopromotephysical,socialandpsychologicalrehabilitationofpersonswithdisabilitybyreducingtheeffectsthedisabilitiesandatthesametimeenhancetheireconomicpotential.

SchemeofFinancingAssistiveDevicestoEnhancetheEmployabilityorIncreasedOpportunityofSelfEmploymentofPersonswithDisabilitybyNationalHandicappedFinanceandDevelopmentCorporationwillassisttheneedydisabledpersonsinprocuringaidsandappliancesbyprovidingconcessionalloans.

SchemeofSports&GamesfortheDisabledisaCentralSectorSchemebeingintroducedbytheMinistryofYouthAffairs&Sportsin2009-10duringtheXIPlanPeriod.TheobjectiveoftheSchemeisbroad-basingparticipativesportsamongthedisabled.

SchemeforTrans-DisciplinaryResearchforIndia’sDevelopingEconomy(STRIDE)byUniversityGrantsCommission,MinistryofHumanResourceDevelopmentwillstrengthenresearchcultureandinnovationinhighereducationinstitutionsforsociallyrelevant,locallyneed-based,nationallyimportantandgloballysignificantprojects.

Technology Interventions for Disabled and Elderly (TiDE) by Department of Science andTechnology is a programme to promote research and development of Assistive Technology forempowermentofelderlypopulationanddivyangjaninIndia.TIDEProgrammeprovidesGrant-in-Aid support to Knowledge Institutions, recognized R&D Labs and S&T based VoluntaryOrganizations for design and development of Assistive Devices, Processes and Protocols forimprovedAutonomy,QualityofLifeandSocialInclusionoftargetbeneficiaries

K e y I n i t i a t i v e s a n d P r o g r a mm e s i n A s s i s t i v e T e c h n o l o g y

Agate Infotekworks in the space of assistive technology to create accessibility for children andadults with special needs by creating awareness to assistive tools adaptive devices, methods,software,accessibleopportunitiesavailable.

Anushruti Academy for Deaf (AAD) is a social initiative of the Indian Institute of Technology,Roorkee.TheschooldeliversqualityeducationtodifferentlyablechildrenwithspeechandhearingimpairmentsinUttarakhand.

ArtificialLimbsManufacturingCorporationofIndia(ALIMCO)isacentralgovernmentPublicSectorEnterprisewiththeobjectiveofbenefitingpersonswithdisabilitybymanufacturingrehabilitationaidsandbypromoting,encouraginganddevelopingtheavailability,use,supplyanddistributionofartificiallimbsandotherrehabilitationaidstothedisabledpersonsofthecountry.

AssisTechisaninter-disciplinarygroupoffaculty,researchersandstudentsfromIndianInstituteofTechnology,DelhiengagedinusingmoderntechnologyforfindingaffordablesolutionsforpersonswithdisabilityinIndia.

CentreforDisabilitySportswillbesetupatGwalior inMadhyaPradesh.Theproposalregardingsettingupof ithasbeenapprovedby theGovernment.Theobjectiveof theCentre is toensure

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effectiveparticipationofPersonswithDisabilitiesinsportsactivitiesandenablethemtocompeteindifferentsportingeventsatnationalandinternationallevel.

Embright Infotech works to create technology for Autism care and contextual and immersivelearning.

EnableMakeathon(EMx)isaprogrammeforfosteringresearchtoproducthappeninginAssistiveTechnologywithevidencebasedproblemstatementcollected,analysedandproductsdeveloped.EMx works with start-ups and innovators to design, prototype, test the assistive technologyproductandtaketheirproducttothemarket.

Enability Foundation for Rehabilitation is a not for profit company that focuses on deliveringassistive technology solutions catering to the activities of education, communication, mobility,dailyliving,leisureandemploymenttothemarginalizedanddisadvantagedsectionsofsociety.

Human Factors and Sociotechnical Systems Studios (HFSS Studios) at IDC School of Design, IITBombay,aimstoincorporatethehumanasasystemcomponentwithoutmakingitmechanisticinnature.

IndianAssociationofAssistiveTechnologists(IAAT)isanindependent,non-political,not-for-profitmemberassociation of rehabilitation (health) professionals and providers of assistive devicesand/orservicestopeoplewithdisabilitiesandelderlypeopletoliveindependently.

IBM India Research works towards inventing technology that is more human, empathetic andadaptivetoeveryone’sageandability.Theaccessibilitychecklistincludestechniquesandguidancecoveringsoftware,documentationandwebcontent.

MobilityIndia’svisionofanempoweredandinclusivecommunity,pointstoafutureinwhichthere is greater equity and neglected sections specifically people with disabilities, elderlypopulationandotherdisadvantagedgroupsarepartofthedevelopmentprocess.

National Institute for the Empowerment of Persons with Intellectual Disability (NIEPID) is anautonomousbodyunder theadministrative controlofDepartmentof EmpowermentofPersonswith Disabilities. NIEPID is dedicated to provide quality services to persons with intellectualdisability.

NationalInstituteofSpeechandHearing(NISH)isanautonomousorganizationregisteredasa society by the Social Justice Department, Government of Kerala. NISH is a comprehensivemulti-purposeinstitutefocusingontheidentification,intervention,rehabilitationandeducationofindividualswithdisabilities

Score Foundationwas step upwith the objective to change themindset of people towardsblindness and visual impairment. Score foundation aims to provide equal opportunity,contributionandspaceforvisuallyimpaired.

TTK Center for Rehabilitation Research and Device Development (R2D2) group is involved inresearchrelatedtohumanmovement,theinfluenceoforthoticandprostheticdevicesonhumanmovement, and thedesign anddevelopmentofmechanisms, products and assistive devices forpeoplewithimpairments.

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TheCentreforRehabilitationEngineeringandAssistiveTechnology(CREATE)isamultidisciplinarytranslational research and educationalinitiative of IIT Madras. It was conceived as we beganinteractingwithNGOsandinclusiveschools.

The National Trust is a statutory body of the Ministry of Social Justice and Empowerment,Governmentof India, set upunder the “National Trust for theWelfareof PersonswithAutism,CerebralPalsy,MentalRetardationandMultipleDisabilities'Act.

WORTHTrustproducesvariousassistivedevicesessentialfortheeducationofchildrenwithvisualdisabilitiesathighlysubsidizedpricesmaintaininginternationalqualitystandards

L e a d i n g A s s i s t i v e T e c h n o l o g y i n I n d i a

Ariseisamanualwheelchairwithaninbuiltfeaturethatallowstheusertoindependentlyrisetoastandingwheelchair.

Avazisapictureandtextbasedcommunicationappforchildrenandadultswithcommunicationdifficulties

BleeTechInnovationsoffersdesignandtechnologysolutionsforthedeafcommunity.TheBleeTVapp and BleeTV Library showcases variety of information and learning content in Indian SignLanguage

Dubsnuboffersaudiodescriptionservicesinmorethan70languagesthroughanextensivepartnernetworkofaudiodescribers,transcribersandproductionmanagers.

Eye-D is working in the field of visual impairment to provide affordable technological solutionswithassistancefromdifferentgroups.

Innovisionhaslaunchedamulti-languagedigitalbraillecalledBrailleMe,designedforthevisuallyimpairedwithquickaccesstobooks,filesandnotesataffordableprices.

Jellow Communicator is a friendly Augmentative andAlternative Communication (AAC) solutionthatusesiconstoaidcommunicationinpeoplelearningtospeakorwithdifficultywithspeechandlanguage.

SaarthiAssistiveMobilityDevice isdesignedtoworkboth insideandoutsidehelpingpeopewithvisual impairment navigate well. Torchit operating in the space of visual impairments aims toprovideIndianmademobilitydevicestothepeople.

Tactopusisamuti-sensorylearningaidforchildrenofages3+withafocusonchildrenwithvisual,developmentalandlearningdisabilities.

Thinkerbelllabs has come up with the tactile hardwaremodule coupled with soft human voiceguidingstudents.AnnieTM isacompanionappthatenablesastudentto learntoread,writeandtypebrailleontheirown.

ThesevenproductsofvoiceandspeechsystemsdesignedbyVagmionlinetocatertotheneedsofpeoplewithvoice,speechandhearingdeficiencies.