When we think about Persons with Disabilities (PWDs), we tend to think of them not just as they are, but with the tools and aids that allow them to interact with society. We think of paraplegics with their wheelchairs, amputees with their prosthetic arms and legs, the blind with their white canes and braille signages, or the deaf with their hearing aids. These familiar devices are part of a broader category of assistive technology (AT), and though it is easy to dismiss AT as being another part of a PWDs’ life, the use and state of AT in the country goes much deeper than that.

Defined by the World Health Organization as a subset of health technology used to improve the lives and functions of PWDs through specialized products, systems, and services (Global report on assistive technology, 2022, p. 5), AT has the potential to revolutionize mobility, communication, and cognitive abilities. Today, AT can even be seamlessly integrated into everyday technology, like smartphones with text-to-speech options. However, despite this, the question remains: do we see these advancements reflected in the Philippines? Is AT accessible for the Filipino PWDs who need them most?

A Specialist's Perspective


John James Jovellano, a licensed occupational therapist (OT)[JJ1] at Quezon City Center for Children with Disabilities and former faculty member of the University of the Philippines-Manila weighed in on the topic of AT in an interview with Ateneo SPEED. As an OT, he prescribes both assistive devices and task modifications for PWDs to use in their day-to-day lives. According to him, “...assistive technology, in one way or another, can help bridge the gap between [PWD’s] impairments, and how they can participate in the occupations that they want to do.”

AT can be broadly categorized into four main types according to the accessibility need it aims to fulfill: visual, auditory, motor, or cognitive. Additionally, AT that are tailored specifically for disabled people to assist them in their daily lives (Jensen, 2023). While wheelchairs, crutches, canes, and hearing aids are familiar examples of the simpler motor and sensory aids, specialized adaptive technology are more technologically advanced and less commonly seen. These marvels of engineering include robotic exoskeletons that allow paraplegics to stand and walk again for short periods of time (Blain, 2019) and hydraulic arms that empower individuals with cerebral palsy or with upper-body mobility impairments to feed themselves independently or move items around without need for assistance.

Even prosthetics are undergoing technological advancements. In the Philippines, national government units[JJ2] offer financial assistance for simple prosthetics through the PhilHealth’s Expanded Z MORPH program. A new type of prosthesis called myoelectric prostheses improve user comfort with the addition of electrodes and battery powered-movement, allowing the brain to control the prosthetic devices in more complex actions (Henson, 2021). Though not yet covered by the Expanded Z MORPH program, it is starting to become more common to see them in amputees and paraplegics worldwide.

Some specialized devices may even be simpler than one may think. Universal cuffs, for instance, are an open wrist orthosis or brace that one can attach tools to in order to make work movement easier. Anyone can attach utensils to it to allow for easier eating for those with limited wrist mobility or chronic wrist pain. They can even be made by local tailors, using inexpensive fabric to provide additional wrist support.

Mr. Jovellano also mentioned the automatic pill dispensers, which help to remind PWDs of when to take their medicines and whose prices range. A more technologically-advanced version of the standard pill box, these dispensers are becoming more and more common for use globally, especially for elderly patients or those with memory problems.

Challenges and Opportunities


However, despite the advances in AT globally, the market for assistive devices remains niche. Though there is a high demand for both mobility aids and advanced assistive devices, supply in the Philippines has yet to catch up with the demand. Mr. Jovellano cited three reasons as to why assistive technologies have yet to find its footing as a market in the country:

Firstly, there seems to be a lack of AT specialists in the country. With there only being approximately one occupational therapist for every 30,000 possible patients (Delos Reyes, 2018), there are few who are capable of, or are even willing to research assistive devices, much less prescribe them. As a result, PWDs are not usually given the option of looking into AT[JJ3] s, or are not prescribed appropriate ATs to further enhance their capabilities. For many PWDs, the only option they may be presented with is hiring a full-time caretaker to assist them in day-to-day living, reducing their agency.

Secondly, even if PWDs were to be prescribed AT by a professional, they would not have easy access to it. According to Mr. Jovellano, most of the suppliers for mobility and sensory aids are stationed in China and Japan, while suppliers for more specialized devices such as hydraulic arms and exoskeletons are limited to Europe and America. Though some devices, such as the universal cuff, may be made for cheap in the Philippines, the primary mobility aid manufactured here are manual wheelchairs, with technological advancements such as the Oticon Real only having recently entered the market (Manila Hearing Aid, 2023). As there are few specialists with an interest in AT, those who do prescribe them to patients must recommend imported devices from abroad.

Thirdly, AT remains to be an expense that not many PWDs, who face a higher likelihood of unemployment and poverty (Soto, 2021), are unable to afford. Due to the first two reasons, AT remains a financially inaccessible option for most PWDs. Exoskeletons can cost as much as US$ 70,000 for an initial payment, and maintenance may cost up to US$ 8,500 per year (Pinto et al., 2021), which for the average Filipino would be too expensive to even think of having, much less maintaining. In many ways, then, though having full-time caretakers limits one’s autonomy and capacity to participate in the work that they want to perform, it would seem to be more feasible and preferable than having to pay hundreds of thousands of pesos for AT.

Solutions: Bridging the Gap Beyond Technology


When asked how to resolve these problems, Mr. Jovellano mentions two solutions: improving access to AT, and changing the attitudes of Filipinos towards PWDs and AT.

For him, as much as local supply of assistive devices is important, it is especially crucial that society empowers those with disabilities to feel more comfortable using assistive devices in the first place. Currently, the stigma regarding the use of simple assistive devices makes the option less appealing to PWDs, leading to less usage despite the help it could give. Many perceive PWDs as weak individuals already, and for the less aware, assistive technologies can only build up that image. As Mr. Jovellano put it when talking about PWDs’ hesitance to use assistive devices, “Kahit anong push ‘yan, kung hindi siya comfortable using it, hindi niya gagamitin ‘yan.” (“No matter what ‘push’ you give, if they are not comfortable using it, they won’t use it.”).

The community is just as important as a stakeholder in the discussion regarding AT. Effective and consistent use of AT can only happen in a community where PWD’s capacities are accepted, and the use of AT to provide recognition of a PWD’s capabilities is encouraged. PWDs need to be seen as people who are just as capable as persons without disabilities, who only need the help of AT to ‘bridge the gap’.

Thus, for Mr. Jovellano, education on the part of both the user and the therapist on the benefits of AT are necessary. For the door to AT options to be open to PWDs in the country, more healthcare professionals would need to be made aware of how AT works, how they can be executed, and how it can help people with certain disabilities. If educated early, Mr. Jovellano says, therapists would be more willing to prescribe AT to those who need them, and would be more capable of assessing the lifestyle modifications necessary to provide more comfort and empower their patients. Education then, it would seem, is the key to ensuring that there is enough demand and supply of AT to encourage advancements in the local market.

To a Wider Reach: Other Examples of Assistive Technologies


The World Health Organization has plenty of resources on assistive technology, among them the Global Report on Assistive Technology (2022) detailing the state of AT globally, connecting access to AT with its Sustainable Development Goals (SDGs). They also produced its Priority Assistive Products List (2016), which is meant to serve as a guide for national governments to the various assistive devices they need to make more available for their citizens. Though meant for a global audience, the resources have a comprehensive and easily digestible list for anyone interested in becoming more aware of the types of AT currently available on the market.

More digestible information about assistive devices can be found on America-based social media page TechOWL - Technology for Our Whole Lives. Showcasing different types of AT for PWDs of all ages through short videos, they also pioneer the concept of AT lending libraries which may be of interest for physical and occupational therapists in the country, as well as a source of inspiration for local lawmakers and technological innovators.

For more local options, there are also local manufacturers of mobility and sensory aids in the country. The Philippine School of Prosthetics and Orthotics (PSPO) of UERM-MCI are one of the leading providers of prosthetic limbs under the Z MORPH program, and are pioneers of many of the local innovations made for local prosthetics in the past ten years (Uy, 2021). Mobility Supplies is a Philippine-based wheelchair retailer specializing in remote-controlled and active sports use wheelchairs.

If more interested in active volunteer work, Be My Eyes is an assistive digital app available on all devices. Serving multiple countries including the Philippines, Be My Eyes connects blind and visually-impaired clients with ‘sighted volunteers’ who can assist them in daily activities such as picking out groceries or distinguishing between clothes to wear. Their new AI photo-recognition service also allows their users to take pictures of items to be converted into verbal descriptions (Be My Eyes, n.d.).

So, are assistive devices helpful for Filipino PWDs?


They definitely can be. For there to be advancements though, there must also be a general awareness of these devices for there to be a local supply that can meet with the demand. Everyone involved in the process, from the therapists to the PWDs, to the guardians and even the general public, need to be given the chance to know about the wonders of AT. For the everyday individual, whether disabled, a caretaker, or not, there are plenty of avenues online to gain awareness and spread the word about the wonders of AT, and the crucial role they play in bridging the gap between PWDs and a society that should welcome them with open arms.

Ateneo SPEED would like to thank Mr. John James Jovellano for his time and insights lent to this article.

The views and opinions of the writers and editors do not necessarily reflect or state those of the publication’s nor the organization’s.

References:

Assistive product list. (2016). https://www.who.int/teams/health-product-policy-and-standards/assistive-and-medical-technology/assistive-technology/promoting-access

Assistive technology. (2024, January 2). https://www.who.int/news-room/fact-sheets/detail/assistive-technology

Be My Eyes - See the world together. (n.d.). https://www.bemyeyes.com/

Blain, L. (2019, October 4). Brain-controlled exoskeleton allows quadriplegic man to walk and manipulate items. New Atlas. https://newatlas.com/medical/brain-controlled-exoskeleton-quadriplegic-walking/

Disability Spares No One: A New Perspective. (2019, May 3).

Global report on assistive technology. (2022, May 15). https://www.who.int/publications/i/item/9789240049451

Henson, A. (2021, January 18). Introduction to Myoelectric Prostheses. Arm Dynamics. https://www.armdynamics.com/upper-limb-library/introduction-to-myoelectric-prostheses

Jensen, M. (2023, March 2). Types of assistive technology tools. AudioEye. https://www.audioeye.com/post/types-of-assistive-technologies/#what-is-assistive-technology

Manila Hearing Aid brings the new Oticon RealTM hearing aids to PH. (n.d.). Philstar Life. https://philstarlife.com/self/171254-manila-hearing-aid-brings-oticon-real-ph

Pinto, D., Garnier, M., Barbas, J., Chang, S. H., Charlifue, S., Field-Fote, E., Furbish, C., Tefertiller, C., Mummidisetty, C. K., Taylor, H., Jayaraman, A., & Heinemann, A. W. (2020). Budget impact analysis of robotic exoskeleton use for locomotor training following spinal cord injury in four SCI Model Systems. Journal of Neuroengineering and Rehabilitation, 17(1). https://doi.org/10.1186/s12984-019-0639-0

Reyes, R. C. D. (2018). Burnout among Filipino occupational therapists: A Mixed methods analysis. The Open Journal of Occupational Therapy, 6(4). https://doi.org/10.15453/2168-6408.1469

Soto, S. (2021, July 23). DISABILITY AND POVERTY IN THE PHILIPPINES. The Borgen Project. https://borgenproject.org/disability-and-poverty-in-the-philippines/

Uy, D. N. (2021, August 11). Philippine School of Prosthetics and Orthotics: A trailblazer in Philippine healthcare education. Philstar.com. https://www.philstar.com/other-sections/supplements/2021/08/11/2118225/philippine-school-prosthetics-and-orthotics-trailblazer-philippine-healthcare-education

[JJ1]At Quezon City Center for Children with Disabilities

[JJ2]National government project si Z MORPH, not local.

[JJ3]Or not prescribed appropriate ATs