Closing the Funding Gap for Assistive Devices
Readers of this publication know well the impact that new technologies can have on people with neurological impairments. A new publication from the National Academies helps make that case even stronger. The Promise of Assistive Technology to Enhance Activity and Work Participation was authored by a team of experts within NAS, NAE, and NAM (formerly IOM). The publication results from a 2012 recommendation from the U.S. Government Accountability Office to the Social Security Administration to “conduct limited and focused studies on the availability and effects of considering more fully assistive devices and workplace accommodations in its disability determinations.” Without these studies, SSA may be missing an opportunity to help people living with impairments return to work and thus save taxpayers years of disability benefit payments. SSA currently encourages people with disability to return to work through its Ticket to Work program. The employment rate among this population is only 34 percent compared to 75 percent among people without a disability.
The study took into account both medical and nonmedical assistive devices and only covered wheeled and seated mobility devices, upper extremity prostheses, and assistive devices for hearing and speech communication. A notable recommendation from the authors is the need to properly fit new technologies to the potential user as well as training and follow-up. Another recommendation addresses reimbursement and current funding shortfalls. Access is “contingent largely on reimbursement policy rather than patient need,” the authors reported.
The report features a useful section on upper extremity prostheses but sadly lacks consideration of lower limb prostheses. The authors noted that according to the SSA, people living with lower limb amputation who are capable of wearing a prosthesis are determined to be “not disabled.” The publication solely focused on technologies for upper limb amputation thus leaving behind those with paralysis. Advanced prosthetic technologies such as myoelectric and EMG sensors were highlighted, along with the transhumeral DEKA arm. Although unable to find any published studies in the U.S., the contributors did note that there are international studies suggesting that the use of upper extremity prosthesis is a “predictor of work participation.”
The publication concludes by evaluating funding sources for technologies mentioned in the study using public and private sources. It includes a table comparing payer and coverage for reviewed technologies.
Despite the shortcomings, this publication is a viable first step of a much needed analysis that highlights the struggles that investigators and entrepreneurs in the neurotech device industry have been facing for years.
Senior Editor and Associate Publisher