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Gregg Vanderheiden on Assistive technology (AT) Abandonment

I was recently asked for my view on AT Abandonment.   Here was my reply, shared here for general information and to get feedback.  Feel free to use the feature at the bottom of the page to send thoughts,  or contact me directly at  GreggVan-at-umd.edu

 

My thoughts about AT abandonment are 

  1. Abandonment is overemphasized for AT
     
  2. The primary reason that AT Abandonment is often raised is that there are ‘dead bodies’ that people don’t want to discard.
     
  3. The problem with raising the AT abandonment issue is not when it is raised to  look at ways to reduce it  (which is a very good idea)  — it is when it is raised to  try to reduce the provision of AT in general or for an individual (i.e. AT abandonment is evidence that AT is being over-prescribed rather than AT abandonment is evidence we should be spending more on selecting it.)
     
  4. We should be talking about PREMATURE AT abandonment only.      ALL AT SHOULD BE ABANDONED.   Like clothes, drugs, cars, and everything else in life,  AT has a lifetime.  After that it should be replaced.    Sometimes it loses its effectiveness  

Taking each one in turn

1) Abandonment is overemphasized for AT

I don’t think AT is not abandoned prematurely  nearly as much as drugs or therapies.     People pay for drugs all the time that they do not take.  And pay for PT all the time when they don’t do their therapy between and then abandon it before done. 

Or think of clothes.   All these people abandoning clothes that they bought.   Must be bad purchase of clothes — or else clothes are not worth it. 
Ditto for computers  — and phones.  People are abandoning them all the time. 
or Glasses 

There is no problem with AT abandonment — that is what SHOULD happen.  AT should be abandoned when the person outgrows them or if the AT becomes obsolete --- just like clothes --- just like glasses --- just like computers. 

The problem isnt abandonment -- it is pre-mature abandonment 

  • But you must ask why it was abandoned...  
    • bad recommendation?
    • people wanting user to use something they don’t want?  

We should also ask how big the premature abandonment problem is for AT.

  • Is premature abandonment any worse than for Drug prescriptions?   or Therapy?      
  • Both seem to be abandoned by many before they are done.  And many cost as much or more than AT.

 

2) The primary reason that AT Abandonment is often raised is that there are ‘dead bodies’ that people don’t want to discard.

  • When clothes are abandoned they are thrown away (or given away)

  • When computers are abandoned they are given away or thrown away

  • When drugs are abandoned they are thrown away or fit in the back of some drawer

But when AT are abandoned — they are put into a closet - where they take up room  -  and where they haunt the program - and people talk about AT abandonment. 
If computers were all kept in closets instead of being disposed of there would be piles of them too. 

3) The problem with raising the AT abandonment issue is not when it is raised to look at ways to reduce it (which is a very good idea) — it is when it is raised to try to reduce the provision of AT in general or for an individual  

The problem isn't with abandonment per se.   AT abandonment ie either natural and not a problem,  or because of bad prescription in which case more attention and funding for selection should be the concern.

The problem is when abandonment is used to say that AT should not have been purchased.

I suggest that

  • if you have PREMATURE ABANDONEMENT -
    • you should invest MORE in the prescription/selection/trial of the AT so that it is correct, useful and wanted.   Selection is where the problem lies.
      ​
  • And if the ABANDONMENT IS NOT PREMATURE -
    • then we should ensure that  the ‘dead bodies’ are properly disposed of right away so they do not lay around and clog up the works and closets.       
    • Put them into a lending bank IF (AND ONLY IF) they are still in good shape and not obsolete
    • If not in good shape and still useful - dispose of them like any other computing device if it is old and no longer appropriate

4) We should be talking about "PREMATURE" AT abandonment only.       ALL AT SHOULD BE ABANDONED sometime.   

We should be shifting the conversation to PREMATURE AT abandonment.  

We should emphasize that ALL ASSISTIVE TECHNOLOGIES SHOULD BE ABANDONED at some point. 

And we should shift the conversation from "AT that is abandoned is bad" —   or   "AT is bad because it is abandoned".   to  "AT that is prematurely abandoned  was AT that was inappropriately prescribed./selected"   and more focus and money should be tuned to that. 

(Note:  if circumstances change shortly after prescription/selection - then the AT may not longer be appropriate shortly after prescription/selection.  In that case the abandonment is not premature - it is just appropriate but very quick.     Expected changes in circumstance should be taken into account in prescription/selection.

 

Comments welcome.