Abstract

Implementation of Universal Design (UD) and availability of Orphan Technology (OT) have been recognized as challenges to governments and the marketplace, but indispensable to the realization of full citizenship for people with disabilities. The social dimensions of UD and OT have rarely been explored. This article selectively borrows from a transformational theory of technology (Feenberg, 2002) to explore technology transformation by assistive technology change agents. Change agents may harness the transformation potential of technology by involvement with factors internal to technology development such as design, technical codes and standards in order to realize the implementation of UD and availability of OT. They may also harness technology's potential by involvement in factors external to technology development such as attitudes, education, markets, and government incentives and mandates.

Keywords: assistive technology, universal design, orphan technology, Disability Studies, science, technology and society studies

Background

Definitions of Assistive Technology (AT), Universal Design (UD) and Orphan Technology (OT)

The terms assistive technology, universal design, and orphan technology invite analysis from the perspective of Disability Studies in order to identify assumptions and to determine how these categories have been framed. For example, while a chair is regarded as a piece of furniture, a wheelchair is regarded as an assistive device. The notion of universal design seems to have evolved from a group that has challenged the larger community of designers who may perceive themselves as serving a universal population rather than some subset of that population, e.g., people without disabilities. There is no internationally accepted standard definition or term for AT. An international standard, ISO 9999, defines a technical aid (for disabled persons) as "any product, instrument, equipment or technical system used by a disabled person, especially produced or generally available, preventing, compensating, monitoring, relieving or neutralizing the impairment, disability or handicap" (International Standardization Organization, 2002; also see International Standardization Organization, 2005 for proposed changes in classification and terminology). In the U.S. assistive products are frequently referred to as AT or assistive devices. TELEMATE, a European-wide framework for training and education in AT, uses definitions that reflect an emphasis on ergonomics as follows: "Any device, system and ergonomic measure that can reduce the disability gap" or "Any device, system and ergonomic measure that can empower participation of individual users" (TELEMATE). Studies of AT by the U.S. Department of Commerce (2003) and the European Commission (EC) (2003) define assistive technology with more of a focus on function. The EC defines AT as follows: "AT refers to products, devices, or equipment that are used to maintain, increase or improve the functional capabilities of people with disabilities" (p. ii). These definitions pertain to technology mainly intended for use by the individual rather than, for example, to information, transportation systems, and the built environment.

With its "common-use products" Japan may have introduced a bridge between AT and UD or perhaps simply shifted the emphasis in the technology process from UD at the design stage to UD at the supply, distribution and sales stage. (Kyoyo-Hin, 2001; Health Care Market in Japan, 2000). Common-use products are used by a broad range of users and thus create a larger market than AT. Even more so than Europe and the U.S., Japan's market strategies seem to be influenced by the sharp growth in its aging population. Kyoyo-Hin does not appear to address low-use AT or OT.

The definitions and context of UD and OT reflect some of the challenges to their acceptance. In the 1980s U.S. architect Ron Mace defined universal design as "an approach to design that incorporates products as well as building features which, to the greatest extent possible, can be used by everyone" (Iwarsson and Stahl, 2003, p. 61; Adaptive Environments; Center for Universal Design). Mace, himself, recognized that the term universal was not ideal and might be interpreted to promise an impossible standard (Adaptive Environments).

The definition and history of the term Orphan Technology is more difficult to capture, although reference to OT has been made in various publications (Seelman, 1997, 2000; Brandt, 2003). Apparently, the notion of OT was borrowed from the U.S. Orphan Drug Act of 1983 (P.L. 97-414). To qualify for orphan drug status, a rare disease or condition was defined as affecting less than 200,000 persons in the United States or affecting more than 200,000 persons in the U.S., if costs could not be recovered (U.S. Library of Congress, 2001, p. 2). Albeit controversial, the U.S. government provides incentives to manufacturers for development of orphan drugs. The U.S. government does not provide incentives to manufacture AT, perhaps reflecting the difference in political power of the two industries. In this article, market size is used as a key indicator to distinguish an orphan AT product such as telebraille for people who are deaf-blind and who number about 45,000-50,000 in the U.S. (Gallaudet, 2004) from a non-orphan AT product such as wheelchairs which apparently have robust markets in Europe, Japan and the United States. However, the literature suggests that AT and OT companies share many characteristics such as insufficient capital to invest in research and development.

Related Concepts

A number of related AT concepts have emerged, especially in Europe, Japan and the Commonwealth Countries including Australia. The Japanese concept of Kyoyo-Hin services is similar to UD but emphasizes distribution and sales to break down barriers in the community. The European concept Design for All (DFA), (European Commission, 2003, p. 161) is closely associated with universal design. Both DFA and UD are holistic approaches that enlist ergonomics to create goods, processes, and environments accessible to all. Sidewalk ramps in the built environment and television closed captions in the information environment are familiar examples of applications of the UD/DFA approach. User-centered design is a concept that identifies the user's needs as one of the key elements of design. Finland, for example, has incorporated user-centered design into higher education so as to have a technical workforce that can comply with the International Standard Organization's standard on Human-centered Design (Hautenen et al, 2003). Finland is one of many countries to have recognized the social significance of technical standards.

Family of AT Solutions

Harry Knops, president of the Association for the Advancement of Assistive Technology in Europe, recently highlighted design for diversity as an objective in shaping future assistive technology solutions (Knops, 2003). He identified the following as a family of assistive technology solutions: a) Mainstream consumer goods; b) Design for all; c) Development of optimal accessibility features; d) Plug-in accessibility systems; e) Stand alone AT. While Knops did not rank these solutions, the stand-alone AT solution might well be the least desirable solution and a target for absorption by the other solutions. An Australian study of accessible text telephones for people who are deaf-blind stated that text telephone components should be as mainstream as possible (Noonan, 1997, p. 22). This case suggests that reducing the stand-alone characteristics of telebraille would increase eventual availability.

In this article, DFA is associated with UD; stand-alone AT is associated with Orphan Technology. While optimal accessibility features, plug-in accessibility systems, and mainstream consumer goods are not the focus of this article, mainstream public technology is a concept worthy of some attention. Public technology systems, such as transportation and communication, are government mandated. Technology systems financed by and designated for public use have considerable transformational potential and are a useful complement to UD and AT (Feenberg, 2002, p. 128). Public technology provides a democratic ideological justification for UD/DFA and for use by a universal public. The transformational power of public technology is clearly linked to society's commitment to Welfare State values of collective responsibility, and related policy and revenue streams. Orphan technology – and perhaps a significant portion of AT – associated with small, unprofitable markets, may also be dependent on favorable public policies. OT markets, in contrast to UD markets, do not have the same degree of relative advantage – applying criteria of economic profitability and social prestige (Rogers, 1995, pp. 212-223).

Significance of Transformational Theory for AT, UD and OT

Transformational theory has the potential to identify common ground between critical theory, which is often used by thinkers within Disability Studies, and the scientific method used by the science and technology professions. During a period of decline of the welfare state and collectivist values and ascendance of market values such as efficiency, the viability of UD and OT may be more dependent on increased collaboration among consumers, professionals, and suppliers. Technical people and consumers around the world have advocated for the availability of AT and the adoption of the UD approach, where practical. AT guidelines have been embedded in a wide range of documents including United Nations rules, international and national technical standards, governmental laws, regulations, and technical codes.

The diffusion and acceptance of UD and OT also have implications for meeting the demands of disability and aging populations to maintain their independence in society. A new integrative model of disability is emerging which has its clearest representation in the International Classification of Functioning, Disability and Health (ICF) (WHO, 2001; Seelman, 2003a & 2003b). The World Health Organization (WHO) ICF classification gives assistive technology a major role in realizing societal participation and accessible and usable environments while incorporating relevant aspects of the function and structure of the human body. Advancement of technology is one of the factors that change agents have used to challenge older WHO models, most especially the medical model (Andrich, 2003, p. 6). The usefulness of the ISO 9999 AT classification is being explored by the WHO Collaborating Centers for the Family of International Classifications (World Health Organization, 2003; ISO, 2005). Transformation from medical and social models of disability to an integrative model of disability is linked to the availability of technology that has characteristics of universal design and AT/OT.

Technology Transformation Theory and AT

In his book, Transforming technology, Feenberg (2002) posits a theory that finds common ground between critical theory and the scientific and technical professions. Like many thinkers in the field of science, technology and society (STS) (Jasanoff et al., 1995; Seelman, 2001), Feenberg argues that technology involves two kinds of knowledge. Technology involves scientific knowledge such as general relativity theory in physics, which is objective knowledge and also social knowledge about human relationships and culture, which is open to interpretation. STS literature provides many accounts of unanticipated effects of technology such as the events at Three Mile Island and Chernobyl (Pool, 1997, p. 15). These events point to the need for reorientation of perspectives about technology because society can no longer afford to think of technology exclusively in engineering terms but must take into account non-engineering factors. The design of products, processes, systems and environments to exclude people with disabilities may be another unanticipated outcome of technology. For example, an electrical code may exclude people who are deaf by not providing sufficient amperage to accommodate the alerting devices needed to function safely and efficiently at home. Code development most likely did not involve the interests and participation of people who are deaf.

Instrumentalism and determinism vs. transformational potential and change agents

Feenberg moves beyond traditional and popular assumptions about technology such as instrumentalism, which assumes that tools are neutral and determinism which assumes that technological transformations cannot be mediated. He turns to the technical sphere itself as having potential for change and focuses on two areas, design and technical codes. Feenberg's concept of technical code refers to an ideal type of an implicit or explicit criterion that selects between alternative possible technical designs in terms of a social goal. Possible means technically workable. The sidewalk ramp is an example. Feenberg's focus on codes may also reflect his ideological position on a more regulatory role for government in product development. This article focuses more on the considerable effort to transform technology through voluntary standards. While voluntary standards, recommended practices, and guidelines are not written in mandatory language, codes are systematically arranged laws and regulations. Feenberg argues that human change agents involved in techno-social networks (Rose, 1999, p. 17), especially those on the margin of these networks, see the unfulfilled potential of technology and attempt to realize that potential (Feenberg, 2002, p. 34). Like many of those involved in AT, he recognizes that this potential can be realized by transforming product design and technical codes. According to Feenberg, technical codes define rules that permit or forbid behaviors (Feenberg, 2002, pp. 76-77), as, for example, a recent spate of guidelines in the U.S. for using powered wheelchairs and scooters in communities and the technical codes that provide meaning to the guidelines by stating what is safe or unsafe in the use of powered mobility (personal communication with Mark Schmeler, Center for Assistive Technology, University of Pittsburgh, September 2004). For electrical codes, rules limit amperage according to measures related to supply and demand and safety.

Assistive technology change agents

Clearly, no leap of imagination is necessary to apply transformational theory to AT. AT change agents exert their influence within networks that can tap the potentiality of design, codes and standards to transform technology so that it is usable by people with disabilities. The social goal of facilitating participation by people with disabilities selects between alternative designs. The Tokushima Agreement of 2000 signed by the rehabilitation engineering associations of Australia, Europe, Japan, and the United States attest to the ongoing activities of those with technical credentials in worldwide networks related to standards development, research collaboration, information exchange and advocacy (RESNA 2002). The efforts of the Daisy Coalition and the World Blind Union to have consumer's interests incorporated into the work of the World Summit on the Information Society attests to their ongoing activities within the technical and social spheres (World Summit on the Information Society). However, a recently released International Organization for Standardization's (ISO) new work item on the development of guidance on a standard for social responsibility attests to the barriers these change agents face (International Organization for Standardization, 2004). The ISO document, which cites useful technical documents, international bodies, and liaison organizations in its annexes, does not include a disability reference, not even Rule 5 of the United Nations Standard Rules on the Equalization of Opportunities adopted by the UN General Assembly in 1993 that identifies accessibility in the built environment and access to information and communication as crucial to equal opportunity (United Nations, 1993).

Internal and external factors important to UD and OT

Internal and external factors important to the acceptance and deterrence of UD and OT are explored in this section. Particular attention is directed to the role of change agents as they seek technology transformation through involvement with internal factors in technology development such as design, codes and standards. External factors such as attitudes, education, service delivery, markets and government policies are explored in terms of their potential for transformation when coupled with internal factors and as stand alone factors.

Universal design

Early history, change agents and their education and disability experience

The early history of UD involved changes agents, some of whom were both technically trained and had a disabled user's experience with products and environments. These change agents set out to transform design, codes and standards. Ron Mace, who was instrumental in introducing UD in the U.S., was both technically educated and knowledgeable about the experience of disability. When Mace founded Barrier Free Environments, Inc. in 1974, he and his colleagues focused their initial work in writing and illustrating access codes in the state of North Carolina (Center for Universal Design). In 1974-79 his colleague, Edward Steinfeld, also an architect, led research for the revised American National Standards Institute (ANSI) A. 117 Standard, which involved building code accessibility for people with disabilities. (E. Ostroff, personal communication, January 2004). Mace led a group of designers and advocates in the mid-1990s in the creation of a set of seven principles of universal design that address both equity, which has a social knowledge base akin to a Disability Studies orientation, and usage, which has a technical knowledge base conforming more to the scientific method (Iwarsson and Stahl, 2003, p. 61). As indicated earlier, Mace recognized the term universal was not ideal because it could be interpreted to promise an impossible standard. He understood that there would always be a small group of people for whom an individual design could not work.

Markets

Studies of the U.S. AT industry, AT in Europe and Japan emphasize the need for more robust markets (U.S. Department of Commerce, 2003; European Commission, 2003; Kyoyo-Hin, 2000). In these reports the UD approach is associated with stronger markets and AT seems to be associated fragmented and small markets. The U.S. report argues that the challenge before many U.S. companies is to design products, where practical, that are needed by people with disabilities and by the larger general population (U.S. Department of Commerce, p. 34). The EC study indicated that UD (DFA) is promoted for two main purposes: "on the one hand to meet the needs of consumers who have often experienced difficulty in using products, and on the other hand to meet the needs of companies who want to expand their potential market" (p. 160). These reports emphasize the worldwide increases in the number of older people will generate demand for the application of UD to products (United Nations Department of Economic and Social Affairs Population Division, 2002).

Stigma and other deterrents to acceptance

Aesthetics may also be a factor in expanded applications of UD. Present and future UD markets may be stimulated as a reaction to the stigma attached to disability or the medical appearance of some AT products. Some products have crossed over from OT and/or AT to UD after starting as AT devices. In 1990, Oxo International introduced its Good Grips kitchen utensils for people who were limited by arthritis (Center for Universal Design). These upscale products immediately found an enthusiastic audience even though their advantages over utensils with oversized handles sold through assistive technology suppliers were primarily aesthetic. Oxo International grew at a 40% to 50% annual rate from 1990 to 1995.

The diffusion and acceptance of closed captioning television programs in the United States provides another example of crossover from AT to UD and the possible stigma associated with AT (About health and fitness; National Captioning Institute; Garry Robson). Initially captioning was open captioning but it was unfavorably reviewed by the general public so it became closed captioning. Users had to purchase a television and a separate black box called a decoder to view the few programs that were captioned. Cost and benefits, such as limited availability of programs and cost and complexity of the decoder, may have contributed to the small market for decoders. Change agents, especially in the public broadcasting sector and consumers, eventually succeeded in having legislation passed such as the Decoder Circuitry Act and the Telecommunications Act, described below, that mandated that all televisions manufactured and sold in the U.S. would include captioning technology and that programs would be captioned–with some loopholes. Costs and benefit ratios were re-aligned when the cost was shifted to the larger market and television programs became more available. As in the case of sidewalk ramps, the mainstream public found captions useful as for example, when watching television in noisy environments.

Standards

As indicated by Steinfeld's involvement in research on national building code standards, change agents have recognized the transformational potential of standards to implement the UD approach in the built environment at least as early as the 1970s in the U.S. Over time, international and national standards associations such as ISO and ANSI have issued standards for the built environment, many of which have been referred to in codes that have enforcement power.

There are many ways of developing codes and standards. More recently, applications of UD for information technology have been adopted in the U.S., Europe and Japan. The World Wide Web Consortium (W3C) develops and maintains the protocols used on the Web to insure interoperability to promote universal access. W3C has a patents and standards group. The W3C's Web Accessibility Initiative (WAI) has developed guidelines for Web authors. Studies of Web sites have shown considerable variability in accessibility (Jackson-Sanborn & Odess-Harnish, 2002; McMullen, 2002; Sullivan & Matson, et al, 2000; Zeng & Parmanto, 2004). Studies show that U.S. Government Web sites are more accessible than their corporate and association equivalents, perhaps reflecting the impact of legislation on government behavior. UD has enjoyed considerable government support in the United States through legislation and the related development of standards and guidelines, perhaps especially the electronic and information technology standards in Section 508 of the Rehabilitation Act of 1973 as amended in 1998 (U.S. Department of Justice).

The latest trend in ISO standards for products for seniors and elders seems to reflect a Kyoyo-Hin approach. For example, ISO/TEC Guide 71:2001 provides guidelines for standard developers to address the needs of these two groups (International Standardization Organization, 2001).

Incentives and mandates

In the U.S., change agents have transformed technology by harnessing the power of government incentives and mandates to stimulate and grow UD markets. Government incentives and mandates have taken a number of different forms. Government procurement was linked to UD through Section 508 of the Rehabilitation Act of 1973 as amended in 1998. Section 508 requires electronic accessibility in the government work environment. UD was also linked to the U.S. government's regulatory power over public communications such as telephones and television. The Hearing Aid Compatibility Act of 1988 mandated universal design applications for hearing aid compatible hard-wired telephones. The Decoder Circuitry Act of 1990 mandated universal design applications for televisions by incorporating captioning technology in all televisions manufactured and sold in the U.S. The Telecommunications Act of 1996 Section 255 mandated that if readily achievable, telecommunication services and equipment be accessible and useable to people with disabilities. According to the U.S. Department of Commerce (p.35), these laws have driven manufacturers and designers of commercial products, media, housing, and buildings to give much greater consideration to the needs of persons with disabilities as well as to the requirements of the general public.

The application of the Americans with Disabilities Act's Title III, which pertains to public accommodations and commercial facilities, to the Internet is unclear. Peter Blanck, who is a U.S. lawyer, scholar and advocate, observed recently that: "the courts are split" (Blanck, 2004; ADA's Title III).

Orphan technology

According to Dan Brandt, former Chair of the U.S. Federal Laboratory Consortium, "the development of AT has historically been a unique proposition involving customized solutions " (Brandt, 2003, p. 201). AT markets are "niche" markets, not robust mass markets. He notes that many AT devices must be produced in small quantities and do not achieve economies of scale. According to Brandt, "markets for specialized needs are smaller and returns are lower so that there are fewer perceived financial gains." These characteristics limit industry's ability to drive industry and limits interest in product development. Many companies working in this area are small firms, so there is no solid industry base and limited capital to invest in research. Brandt argues that most assistive devices would qualify as orphan technology, which he defines as a market of 300,000 users (Brandt, 2003, p. 201).

In contrast to Brandt's rather bleak description of AT and OT, the U.S. Department of Commerce describes the AT industry as a multibillion dollar world market in which U.S. companies can claim the largest sales revenues (U.S. Dept of Commerce, 2003, p.4). The AT market may be dominated by a few large product areas such as mobility aids, orthotics and prosthetics or communications and sensory aids. However, their country-based sales may be linked to reimbursement practices. Europe's health and social systems may reimburse for hearing aids for adults but U.S. Medicare, the public insurance program for people who are elderly and some people who are disabled, does not. Japan's Long-term Care insurance law implemented in 2000 provides Japan's seniors with AT purchasing power. In Japan purchasing AT may be as easy as going to the local department store or specialty store (Kyoyo-Hin Foundation, 2001). As noted earlier, AT that has appeal to larger markets may crossover to the mainstream and away from specialized assistive technology that may be associated with stigma and other rejection factors (Technology and Disability, 2002).

AT change agents, like UD change agents are consumers, professionals, and suppliers. However, in contrast to products that are universally designed and in the mainstream market, AT/OT is routinely manufactured and distributed in segregated markets within a context configured to conform to the requirements of health and social service systems. Consumer and professional roles are more clearly distinguished and rules originate from complex expert agencies. Consumers are clients or patients rather than customers; professionals are experts trained in medicine or rehabilitation and both interact within service delivery systems. Rules may originate from agencies such as the U.S. Centers for Medicare and Medicaid. The culture of these agencies can be steeped in arcane bureaucratic regulations and expert knowledge in medicine and health-related fields. Groups that do not have these credentials are at a considerable disadvantage in advocacy for change in agency practices.

Markets

While the U.S Department of Commerce study indicates that U.S. AT manufacturers must operate more efficiently, the study recommendations do not include incentives for capital-poor small and medium-sized firms to become more competitive. Observations by Stephen Bauer who works in technology transfer in the USA mirror those of Dan Brandt (Brandt, 2003, pp. 289-291). Bauer recognizes the potential of UD, but acknowledges that AT products will always be needed for small, highly diverse disability markets. The purchase price of many AT products is strongly influenced by third party reimbursement rather than by competitive market forces. Bauer notes that in an open competitive market, manufacturers add or refine product features in order to attract customers and increase market share. In a market capped by reimbursement, a manufacturer may have an improved product but not incorporate it unless the third party payer will cover the cost. Bauer also notes that people with disabilities and elders are often under employed, unemployed and/or low income. He delivers the hard message that trade offs must be made between cost, features, and quality. The European Commission, which includes countries with more social support for AT reimbursement report notes:

For assistive devices, in particular those that have to be adapted or be tailor-made, globalization of markets are unlikely. In such situations, it is imperative that the distance between the end-user and the producer be limited (EC, 2003, p. 164).

Dr. S. Yamauchi at the National Rehabilitation Center for Persons with Disabilities in Japan hypothesizes that OT/AT that costs more than 1.5-2 million yen (approximately $14-$19,000 US dollars in March 2005) will not survive in the Japanese market (S. Yamauchi, personal communication, March 2005). The Japanese government will not reimburse for products above that price though he does name exceptional cases such as myoelectric arms.

Standards

Assistive technology change agents throughout the world have targeted standards as having potential to transform technology for people with disabilities. Standards, which are voluntary, reduce uncertainty related to product safety, quality and usage and therefore, can enhance acceptance among adopters and purchasers. In 1983 a first meeting was arranged to set up an international classification system for technical aids (World Health Organization, 2003). In 1992, ISO published ISO 9999:2000 a classification of technical aids for disabled persons which has been revised periodically. The ISO-proposed 2005 revision specifically addresses the relationship between the standard and the WHO Family of International Classifications (ISO 2005, p. 5).

While studies are needed to ascertain which AT products and processes are likely to be standardized, a study on the needs of people who are deaf-blind is instructive. The study indicates that "the problems thus far experienced are centered on lack of international standardization" (Noonan, 1997, p. 17). At the time of the study, there was no common text telephone approach used internationally.

Incentives and mandates

Governments seem to provide Assistive Technology and OT benefits more on the demand side rather than the supply side. Section 508 of the Rehabilitation Government Act is a notable exception insofar as it appears to stimulate supply by mandated procurement of accessible electronic equipment. Also on the supply side, governments provide research and commercialization grants such as those provided across most U.S. government departments. In general, AT is not an integrated part of the U.S. science and technology infrastructure. Science and technology policy may set goals for research and development in areas of defense and energy, but national laboratories, for example, do not have a mission in AT (Seelman, 2001; Brandt, 2003).

Government has provided AT incentives and mandates in many areas including technical codes, civil rights and anti discrimination, direct and indirect reimbursements of devices by health and social service systems, tax credits and benefits to individuals with disabilities, parents and businesses that accommodate or employ persons with disabilities. Governments have supported professional and consumer training, information and referral and loans such as in the U.S. Assistive Technology Act of 2004.

Service delivery

The European Commission report (2003) identifies problems with service delivery that have relevance beyond European boarders. The EC recognizes that the complexity of the health care and social systems that organize and regulate the provision of assistive devices ought not to have a negative impact on those in need of AT. Therefore the report recommends a one-stop for people with disabilities (EC, 2003, p. 14). One-stops would make acceptance procedures for assistive devices more transparent and could set standards on quality levels to apply to all European Union member states which would make it possible to have uniform testing procedures (EC, 2003, p. 14). The U.S. AT industry study also identifies many opportunities for federal and state agencies and private insurers to streamline (EC, 2003, pp. 57-58). The report names particular areas that need attention such as AT product regulations, processes and to greater standardization in reimbursement policies in classes of AT products.

Conclusions

There appears to be a salutary trend away from assistive technology and toward products that are universally designed for mainstream markets. While this trend will benefit large populations, such as the elderly, it is important to identify the costs. If there are groups who may lose as a result of this trend, then they should be identified and compensatory action should be taken. The following are concluding observations and recommendations.

1. Disability Studies should more fully utilize concepts from technology studies. Feenberg's concept of a technical code as an ideal type provides possibilities for choices in technical design that would, in turn, facilitate disability-related social goals such as participation. User involvement and lay expertise in the development of codes, regulations and other government and professional activities have transformed technology. Processes, such as AT standards and regulation and reimbursement of AT that involve expert systems often limit the decision makers to those with medical, engineering and other more technical credentials. Studies in Science, Technology and Society literature have shown that lay people have the capacity to be become lay experts and enhance product outcomes (Epstein, 2000). Disability Studies should generate studies of individuals with disabilities functioning as lay experts as well experts who are dually credentialed by disability experience and education. Science, Technology and Society literature includes many examples of participation in complex decision making (Jasanoff et al 1995; Seelman, 2001).

2. Orphan Technology, Assistive Technology and Universal Design should invite further analysis of assumptions embedded in the concepts in terms of the traditional Disability Studies critique of ableism and the medical model and also in terms of culture, race/ethnicity, class and gender. Disability Studies should join with technology studies to analyze these concepts in areas such as research and development, commercialization, marketing, users/consumer studies and professional development. According to the U.S. National Science Foundation (1999) persons with disabilities are underrepresented in science.

3. Future studies should address small AT/OT marginal businesses and the populations who need these products in order to determine the feasibility of standardization and to identify other incentives to enhance their availability. With the growth in the size of the population of elders, products will profile their needs. Are there distinctions between the product needs of the elderly population and the often younger disabled population whose markets may be more fragmented?

4. Using Knops family of solutions, studies might begin to identify products, technology categories, or even disability groups that fit or have the potential to fit in each of his solution categories in order to determine potential underserved populations. Study recommendations would address internal and external factors that could transform the potential of orphan products.

5. Successfully transforming technology is closely related to harnessing government involvement. Orphan technology could benefit from studies of the role of government at every stage of development. These stages include research and development, commercialization, distribution, marketing and sales, and reimbursement. Studies may identify characteristics such as stigma attached to small market devices in particular and generate antidiscrimination recommendations.

6. Ongoing WHO ICF activities hold promise in realizing the new paradigm of disability and the integrative model of disability, especially as the WHO become more involved with the ISO and other non-medical technical organizations.

7. The technology needs of people with disabilities and elders are not well-integrated into mainstream national and international science and technology research and development infrastructures. These infrastructures should be studied with the aim of identifying internal and external factors in which AT change agents might become involved.

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