Assistive Technologies in the Context of Work

Bidding Process

Essential Functions

Individual Plan for Employment

Qualified Individual With a Disability

Reasonable Accommodation

Undue Hardship

Vocational Rehabilitation Agencies

Vocational Rehabilitation Counselor

Communication

Communication includes all the various information-handling activities in the workplace. Activities in this category include writing (pen/pencil or typing), reading, interacting with others in person, using a computer and keyboard, and using the telephone.

Interacting with others involves numerous skills, including oral motor skills required for speech; auditory function; cognitive skills, including receptive and expressive language; and social skills. Many of these skills are described in Chapter 3, and Chapter 11 describes the skills specifically needed to carry on a conversation. In some cases, individuals lacking these communication skills can use alternative modes of communication and an augmentative communication device. These devices are discussed in detail in Chapter 11.

A person with a disability may have trouble using the telephone to communicate as a result of deficits in communication, sensory, or motor skills. All aspects of telephone use may be problematic including difficulty with (1) dialing a number because of visual, cognitive, or motor impairments, (2) lifting and holding the receiver, and (3) speaking to and hearing the communication partner. A range of low- and high-tech options is available to assist with these activities. Reading requires motor, sensory, and cognitive skills. Many of the skills described in Chapter 15 for educational application apply in the workplace as well. The motor skills associated with positioning the reading material, turning pages, and handling materials (e.g., picking up a book, opening it, using an index, thumbing through pages) are necessary for use of print media. Chapter 7 discusses devices to aid in the motor tasks involved with reading printed materials. The motor tasks to operate a mouse and keyboard are important for electronic media (see Chapter 7).

Reading also requires sensory abilities such as visual field, visual acuity, and oculomotor function to scan text and recognize letters and words. If the individual lacks these capabilities because of a visual impairment, an alternative format in either tactile (braille) or auditory (speech) form can be used (see Chapters 8). Individuals who have hearing loss (including deafness) can make use of adaptations such as those discussed in Chapter 9. Basic literacy skills are also required for reading. The level is determined by the specific job requirements. For example, a job as a stock clerk may only require the reading of simple labels, whereas a job as a paralegal or an attorney requires a higher level of skill for the reading of complex legal documents. Assistive technology applications to aid individuals who have cognitive disabilities are discussed in Chapter 10.

Whether writing is accomplished by handwriting or typing, it requires motor, sensory, and cognitive skills. The use of pencil or pen and paper requires fine motor control to hold the pen or pencil and to produce letters. Chapter 15 describes the use of different types of writing (note taking, messaging, and formal writing) as they apply to educational settings. Many of the considerations in the workplace are the same. There are also many alternatives to handwriting for successful completion of writing tasks (see Chapters 7, 10, 11, and 15). These include assistance provided by a personal assistant, computer-aided writing using word processing, personal digital assistants that recognize handwriting on a screen and store it as text for editing, modified pens and pencils (e.g., enlarged grip or holder), and systems that recognize speech and translate it directly into text (automatic speech recognition).

Keyboard or mouse use is required for all data entry tasks, including writing. There are many alternatives to keyboard/mouse entry, including automatic speech recognition (see Chapter 7). Sensory skills for monitoring what is being written include visual, auditory, and tactile approaches, some using various types of assistive technologies. Cognitive and language skills for writing are described in Chapters 10 and 15.

Manipulation

The activity output of manipulation also includes a number of different tasks. In general, manipulative activities in the workplace are those that have anything to do with handling of material, which includes filing, sorting, assembling, lifting and moving objects such as books, documents, and equipment and using office machines such as copiers, adding machines, or fax machines. Besides requiring fine motor skills, these activities require sensory and cognitive skills. The ATP needs to follow the process identified in Chapter 2 and to analyze the activities required in an employment setting and describe these in terms of their motor, sensory, cognitive, and affective demands.

Mobility

The activity output of mobility is characterized by activities that involve personal movement to and from the work site and within the workplace. In considering these activities it is important to determine what movements are required of the individual to complete the job and, when the individual lacks these movements, what alternative methods are available.

Getting to work is a significant barrier for many individuals (Gillen, 2000; Rumrill, Schuyler and Longden, 1997; Zwerling et al, 2003). Arranging wheelchair-accessible public transportation often means booking pickup times with a range of an hour or more, booking far in advance, and paying additional fees for the accessible service. If private transportation is used, the cost of a modified vehicle (see Chapter 13) is much higher than that of a standard vehicle. Furthermore, finding a parking space at work that is accessible and close to the work site may also be a problem. Thus the options for transportation are significantly more challenging than for nondisabled workers.

Once at work, mobility and access in and around the work environment can be a challenge for some people with disabilities. Activities to consider are whether the person can enter and exit the building safely and in an emergency, open and close doors, and climb stairs. Sitting and standing requirements of the job also need to be considered. Sitting applies to the employee who requires seating technologies for postural control, tissue integrity, or comfort to be an effective employee (see Chapter 6). It is important that the employee has good postural alignment and postural support as needed to maximize function in the work environment, including the manipulation of objects and operation of assistive devices.

In addition to postural alignment and proper positioning, the employee needs to be free from pain while sitting and be able to perform pressure-relief activities if needed. Persons who have had a back injury may have difficulty maintaining a static position in either sitting or standing for any length of time because of pain or fatigue. They may require modifications to the work area that enable them to alternate between the two positions. Other individuals may have difficulty in coming to a standing position from sitting.

McNeal, Somerville, and Wilson (1999) conducted a study in which one of the purposes was to document the types of problems experienced by workers with spinal cord injury and workers with postpolio syndrome. The group of individuals with spinal cord injury reportedly had the greatest number of problems (39.8%) in the category of “using equipment/tools/furniture.” More than one third of these problems had to do with desks, including an inability to get up to the desk because of the wheelchair, inability to access items on the desk, or a workspace that was too limited.

Activities of Daily Living in the Context of Work

While an employee is at work, there are also a number of activities of daily living (ADLs) he or she may need to carry out. These activities may have unique requirements because they are being performed in the work setting. These activities include going to the bathroom, taking medications, and eating lunch or other meals. Accommodations for these activities can have as much of an influence as an accessible desk or workbench. If the workplace does not have accessible restrooms, then the worker who has a disability is at a significant disadvantage compared with fellow workers. If assistance for taking medications is not available, the worker may not be able to perform the tasks of the job.

Besides the requirements related to physical accessibility for completing these ADLs, time factors are also an issue. Some individuals may require additional time for toileting or eating. A flexible schedule with time off during the workday is needed. Issues of privacy and whether to ask coworkers for assistance also come into play. A final consideration relates to the level of fatigue a worker with a disability may experience. Some individuals may require a rest break during the day or a shortened work day to accommodate fatigue (Garcia, Laroche, and Barrette, 2002).

Physical Context

The HAAT model identifies the natural versus built environments and the physical parameters of noise, temperature, and light as elements of the physical context. These elements will now be considered in the vocational context.

Often discussions of assistive technologies in the vocational setting focus primarily on work that occurs in an office environment. Although the office is certainly a main setting for the application of assistive technology, considerations for designing the assistive technology system must also include its use outside of an office (e.g., travel to a client’s site or assistive technology use in an industrial or commercial setting). Office applications might indicate a system setup that is used predominantly in one place; applications outside the office need to be transferable across environments and may be influenced to a greater degree by the physical parameters named above.

Communication partners include coworkers, supervisors and supervisees, and clients or customers. Communication involves both giving and receiving information (Garcia et al, 2002; McNaughton, Light, and Groszyk, 2001). The communication may be written or oral and could be something that is prepared such as a presentation or spontaneous such as interacting with a client or in a meeting. Written communication technologies are likely to be used at a single workstation that specifically accommodates for the user’s abilities, although some components (e.g., a laptop computer) may travel with the user between work site and home or between client locations. Oral communication aids will move with the client so need to work across different environments. Chapter 11 discusses oral AAC applications across environments and Chapters 10 and 15 consider written communication in more depth.

Noise and light are the primary physical parameters that will affect the use of communication aids in the vocational context. Frequent mention has been made of the influence of ambient noise on the use of voice recognition technologies. Noise is also a consideration for the communication partner’s ability to understand the synthesized or digitized speech output of a speech-generating device voice or the speech of an individual with a voice impairment (Garcia et al, 2002). Noise will be an important consideration for an individual working in an open concept office, industrial, or commercial environment. Noise can be a significant factor for individuals who have hearing loss (see Chapter 9) and for workers who have attention disorder–like disabilities (see Chapter 10). Light is important when the worker uses a device in different environments and needs to read information from a screen. Intensity and color of ambient light can also have a major impact on workers who have visual impairments (see Chapter 8).

Mobility refers to travel to and from the work site and within the worksite. Safe and reliable access in, out, and within the worksite are key. Consideration should be given to the different areas within the work site that the worker needs to access, including the primary workstation (or office), washroom, and lunch area. A path of travel should be identified between different locations within the work site. Box 16-2 lists a number of questions that should be considered when evaluating mobility among key areas in the work environment.

Consideration of the natural and built environments needs to be made if the individual is traveling between different work sites, either moving from one building to another by using a personal mobility device or some form of vehicle. Climate considerations influence assistive technology system design when the user is traveling outside between home and work or work settings. For example, consideration should be given to the battery life of an electrically powered wheelchair. These were discussed in Chapter 12.

As identified earlier, manipulation demands include those involved with completion of work tasks and with ADLs that are completed at the work site. Once again, the ATP must identify the elements of the physical environment that facilitate these manipulation demands, such as lever-style faucet or door handles, and those that present barriers to use, such as heavy entrance doors. Technology exists to reduce the influence of most of these physical barriers and has been identified in an earlier chapter on manipulation (Chapter 14). It is frequently the social, cultural, and institutional contexts that limit the ability to improve the accessibility of the vocational environment.

Institutional Context

The institutional context is an important consideration for the provision of assistive technology in the workplace. Many jurisdictions have some form of legislation that prevents discrimination of persons with disabilities in the work setting and requires different degrees of accommodation. Some examples of legislation include (1) the Rehabilitation Act and the Americans with Disabilities Act (ADA) (United States), (2) Disability Discrimination Act of 1995 and 2005 (United Kingdom), (3), Disability Discrimination Act, 1992, and Amendment, 2002 (Australia), (4) Ontarians with Disabilities Act 2005 (Ontario, Canada), and (5) Disability Act 2005 (Ireland).

The ATP needs to be familiar with the legislation in his or her jurisdiction that regulates accommodation for persons with disabilities in the workplace. The following are some of the aspects of the legislation that are important to know. First, what is the definition of disability? Is the definition restrictive or inclusive? Inclusive definitions include physical, mental health, sensory, cognitive/intellectual, neurological, and behavioral diagnoses as well as chronic illnesses such as HIV/AIDS. An inclusive definition of disability also requires accommodations to be put in place from the time a progressive condition affects function.

The requirements for accommodation are an obvious part of the ATP’s knowledge acquisition. Most pieces of legislation identify modification of the job or the environment and the purchase and use of equipment or technology as reasonable accommodations. Further, the legislation often includes some statement about the degree of accommodation. For example, the ADA uses the language of a reasonable accommodation and least restrictive environment. This language suggests that the accommodations that are made in the workplace do not need to be the best or most appropriate fit for the employee. Rather, they are what it is reasonable to expect of the employer given the context. Obviously, this type of language can be broadly interpreted and can result in accommodations that do not fully support the employee’s needs in the workplace. Legislation also explicitly states that accommodations must be made when advertising a position, during the hiring process, and return to work situations, as well as the obvious accommodations required during the tenure of a person’s employment.

Who is required to make workplace accommodations is a third consideration. Often employers who employ a small number of employees (e.g., fewer than 15-20) are exempt from the legislation. Further, exceptions may be made if the necessary accommodations create an undue hardship (usually financial) for the employer. Accommodations are not universally made for every job. There is frequently a clause in legislation that states that the applicant or employee must be able to do the essential activities of a job. For example, marketing jobs require an employee to give oral presentations to clients. An employer can deny employment to an applicant who cannot communicate orally. However, the notion of an essential activity does not define how that activity is accomplished. So an applicant who uses a voice-output communication aid can give an oral presentation and is therefore able to complete an essential activity of the job.

Finally, the ATP should identify whether there is a legislated process for identifying, implementing, and funding workplace accommodations and an appeals process if either party is dissatisfied with recommended or implemented accommodations. The Rehabilitation Act and the ADA are key pieces of legislation in this area so will be considered in more detail here.

The Rehabilitation Act establishes several important principles. One of the most important of these is the concept of reasonable accommodation in employment (see Chapter 1). The act mandates that employers receiving federal funds accommodate the needs of employees who have disabilities. It specifically prohibits discrimination in employment solely on the basis of a disability. This law originally described both reasonable accommodation and least restrictive environment (LRE), a term relating to the degree of modification that is acceptable in a job.

As a result of the Rehabilitation Act of 1973, many employers made architectural changes to reduce barriers. These included installing elevators, placing ramps and curb cuts to accommodate wheelchair users, and adding voice and braille labels to signs (including elevators) to accommodate persons with visual impairment. Many of these efforts to achieve accommodation involved the use of assistive technologies.

The Rehabilitation Act Amendments of 1998, which are contained in the Workforce Investment Act of 1998 (Public Law [PL] 105-220), are the most recent amendments to the Rehabilitation Act. These amendments include several provisions involving assistive technologies. First the amendments require that each state include within its vocational rehabilitation plan a provision for assistive technology (referred to in PL 99-506 as rehabilitation engineering or technology and in PL 105-220 as rehabilitation technology).

This plan is the basis by which states receive federal funding for vocational rehabilitation, and there is a strong incentive to provide these technology-related services to ensure continuation of the transfer of federal funds for rehabilitation programs. The Rehabilitation Act also requires that provision for acquiring appropriate and necessary assistive technology devices and services be included in an Individual Written Rehabilitation Plan developed for the individual. For individuals who are eligible for services through state vocational rehabilitation programs, the Rehabilitation Act has excellent provisions for the inclusion of assistive technology in all phases of the rehabilitation process, from evaluation through placement in employment. In its analysis of assistive technology policy in employment, the National Council on Disability (NCOD, 2000) identified the following limitations in these provisions: (1) limits of funding for vocational rehabilitation and (2) implementation difficulties such as insufficient staff expertise with assistive technology and lack of service providers with this expertise.

Section 508 of the Rehabilitation Act is an important provision because it ensures access to “electronic office equipment” by persons with disabilities who work for the federal government. Because the federal government is such a large purchaser of computers and other office technology, any purchasing specifications it makes take on the role of informal standards affecting all manufacturers of equipment and therefore all employers who purchase that equipment. Persons who are blind or have low vision and those with difficulty in accessing the keyboard have benefited from standards derived as a result of Section 508, and several manufacturers have included features in the basic designs of their computer systems technology that increase access (see Chapter 7). The provisions cover access to electronic office equipment and electronic information services provided to the public by the federal government, which includes ensuring that end users with disabilities (1) have access to the same databases and application programs as other end users, (2) are supported in manipulating data and related information resources to attain equivalent results as other end users, and (3) can transmit and receive messages using the same telecommunication systems as other end users. As described in Chapter 1, the ADA is a federal civil rights law that is designed to prevent discrimination and enable individuals with disabilities to participate fully in all aspects of society. One fundamental principle of the ADA is that individuals with disabilities who want to work and are qualified to work must have an equal opportunity to work.

Under Title I of the ADA the employer is required to provide reasonable accommodation to qualified individuals with disabilities who are employees or applicants for employment unless to do so would cause undue hardship. A qualified individual with a disability has the skills, education, experience, or other requirements needed for the job and can perform the essential functions of the position with or without reasonable accommodation (Equal Employment Opportunity Commission [EEOC], 1996). The essential functions of a job are those job duties that are so fundamental to the position the individual holds or desires that he or she cannot do the job without performing them. An essential function of a nurse in a hospital would be to respond to a patient’s call for assistance. An essential function for a painter might be to lift a 5-gallon bucket of paint weighing 42 pounds. An essential function for a clerical worker might be to type 75 words per minute. It is the employer who determines the essential job functions.

There are many individuals with disabilities who can apply for and perform job duties without any reasonable accommodations. However, there are barriers in the workplace that prevent other individuals with disabilities from doing the same thing unless they are provided with some form of accommodation. These barriers may be physical in nature (such as facilities or equipment that are inaccessible), or they may be procedures or rules (such as rules regarding when work is performed, when breaks are taken, or how essential or marginal functions are achieved). Reasonable accommodation can remove these barriers. Reasonable accommodation is “making existing facilities used by employees readily accessible to and usable by individuals with disabilities” (ADA, 1990, Section [9] [A]). Reasonable accommodation is available to qualified applicants and employees with disabilities and must be provided regardless of whether the employee works part time or full time or is considered probationary. It is the responsibility of the individual with a disability to inform the employer that an accommodation is needed. The general types of reasonable accommodations that an employer may have to provide are illustrated in Box 16-3, along with examples of each type.

An accommodation is not required if the employer finds it would impose undue hardship on the operation of the employer’s business. Undue hardship is defined as an “action requiring significant difficulty or expense” (ADA, 1990, Section [10] [A]) when considered on a case-by-case basis. In determining whether an accommodation would impose an undue hardship, the nature and cost of the accommodation in relation to the size, resources, nature, and structure of the employer’s operation is considered. If the facility making the accommodation is part of a larger entity, the structure and overall resources of the larger organization are considered, as well as the financial and administrative relationship of the facility to the larger organization. Generally a larger employer with greater resources is expected to make accommodations requiring greater effort or expense than that required of a smaller employer with fewer resources. In situations where an accommodation would impose an undue hardship, the employer must try to identify an alternative accommodation that meets the employee’s need and does not impose a hardship. The individual with a disability should also be given the option of paying for the cost (or a portion thereof) of an accommodation that would create an undue hardship.

There are a number of modifications or adjustments that are not considered forms of reasonable accommodation. For example, the individual must be qualified for the position sought; there is no obligation to find a position for an applicant who is not qualified. An employer is not required to eliminate an essential function (i.e., a fundamental duty of the position). Although employers may have to provide reasonable accommodations to enable an employee with a disability to meet quality or quantity production standards, they are not required to lower standards that are applied uniformly to employees with and without disabilities. Glasses and hearing aids may be considered personal effects and are not included as reasonable accommodations, although there are exceptions and the ATP needs to explore whether these are covered.

There is a perception among employers that job accommodation is a complex and costly process (Driscoll, Rodger, and de Jonge, 2001; Langton and Ramseur, 2001; Peck and Kirkbride, 2001). To the contrary, most accommodations are simple, inexpensive, and can reduce Workers’ Compensation and other insurance costs (Job Accommodation Network [JAN], 2000). In addition, for qualifying small businesses, tax incentives are available to help cover the cost of providing accommodation. The JAN Web site provides information on the costs of different accommodations (http://www.jan.wvu.edu/).

In the United States and other countries, Social Security benefits provided to people with disabilities can act as a disincentive for people to work (Frieden, 1997). Often the income from jobs is only slightly more or the same as the benefits they receive. The loss of health care benefits is also a concern for individuals with disabilities once they become employed. People with disabilities want to work but frequently have difficulty trying to obtain health insurance when they leave the public health care system and enter the work force (NCOD, 2000). Because health care, including assistive technologies, is often a critically needed service, choosing between employment and health care does not take much in the way of deliberation. This issue is a significant barrier to participation in the work force by people with disabilities, and the ADA does not address it. The Work Incentives Improvement Act has the potential to provide better health care options for persons with disabilities wishing to work. This legislation gives states the option of allowing working-age adults with disabilities to “buy in to” Medicaid coverage if they leave the Supplemental Security Income program to work. However, depending on the state in which one lives and the assistive technology needs of the individual, the measures may be limited in improving access to assistive technology (NCOD, 2000). Because Medicaid coverage of assistive technology varies from state to state (see Chapter 5), a state’s decision to allow Medicaid buy-in may not result in improved access to assistive technology needed by individuals who wish to enter the work force (NCOD, 2000).

Social and Cultural Contexts

In the context portion of the HAAT model, we use social and cultural contexts to describe important aspects of both interaction and acceptance of assistive technologies. Social and cultural factors also include policies and attitudes toward technology and toward disability by employers and fellow employees. The social and cultural aspects of the context can be the most important for assistive technology use in a vocational setting (de Jonge, Scherer, and Rodger, 2007; Driscoll et al, 2001; Garcia et al, 2002; McNaughton et al, 2001; Peck and Kirkbride, 2001; Strobel et al, 2006). We need to examine the policies and attitudes of employers and employees, the types of relationships the person has with people at work, and how they affect interactions and use of assistive technology when considering the social and cultural contexts at work. These factors can impose barriers to successful assistive technology application.

The social context of the workplace includes the other people in the environment. These people include the employer or supervisor, employees, coworkers (both those who work closely with the individual and those with less frequent involvement), other workers at the job site, and clients or consumers. Their knowledge of disabilities and attitudes toward individuals with disabilities are a significant determinant of whether the person with a disability will be successful in the work setting. Knowledge of and willingness to provide workplace accommodations are further determinants of success in the workplace (Driscoll, Rodger, and de Jonge, 2001; Gamble, Dowler, and Orslene, 2006; Garcia et al, 2002; McNaughton et al, 2001; Strobel et al, 2006). Legislation that requires accommodations for persons with disabilities exists widely, but the support of others in the environment, particularly an employer or supervisor, is critical for these accommodations to enable the individual to complete job tasks.

As indicated in the introduction to this chapter, people with disabilities have a significantly higher rate of unemployment or underemployment than the general population. Some persons with disabilities report a lack of value of their capacity to contribute in a work setting. Frequently, this lack is seen when individuals with disabilities are asked to volunteer in a setting rather than being paid for their involvement. The perception of the person with a disability is that the employer or the representatives of an organization feel they are doing the individual a favor by providing the volunteer opportunity (King, Brown, and Smith, 2003). Individuals who are employed report prejudice and social barriers in the workplace (Chan et al, 2005).

Community participation by persons with disabilities has increased over the past decade. However, it is still typical for an employer to have little knowledge of the capacity of an individual with a disability and the role that technology and environmental modifications can play in enabling her contribution in the workplace. This lack of knowledge may result in the employer’s perception that the person with a disability is incapable of completing work tasks (Peck and Kirkbride, 2001). Consequently, he or she may be denied certain employment, given a job that does not use his or her abilities, or denied access to technology and modifications that would fully enable him or her in the workplace. A later section of this chapter will discuss introduction of technology into the workplace and we will discuss strategies for educating employers and advocating for appropriate modifications in the workplace.

De Jonge, Scherer, and Rodger (2007) describe a dilemma faced by employees with disabilities and their employers. Employers reported little knowledge about assistive technology that would be useful in the workplace and even less knowledge of the process involved in securing technology for the workplace. They made an assumption that the employee would have this knowledge. Although employees who had used assistive technology for a long time did have some of this information, it might not be specific to the work setting. Further, those employees with no assistive technology experience were often in the same position as their employers with respect to knowing how to access assistive technologies. Employees with disabilities reported feeling hesitant to ask for technology that would enable them to complete their job, mainly because of their concern that such requests would focus attention on their disabilities (de Jonge, Scherer, and Rodger, 2007). This dilemma led to a communication problem that prevented satisfactory assistive technology solutions for the workplace.

The workplace culture will influence the participation of an individual with a disability. A work setting that fosters collaboration and communication and accepts different ways of doing tasks will likely support the needs of an individual with a disability. Generally, employers have recognized the range of needs of their employees, such as the need for child day care, flexible work hours, and creative accommodations such as job sharing. Companies or organizations that recognize the needs of their employees are more likely to support the accommodations required of an individual with a disability. Employment situations that place a high value on productivity over other workplace behaviors or outcomes may be an integration challenge.

As described in Chapter 2, social influence on individuals is related to what is considered normal or expected, and individuals who have disabilities may be stigmatized because of their disability (Fougeyrollas, 1997). Unfortunately, the use of assistive technologies in the workplace can contribute to this labeling and lead to further isolation. In one study, some of the individuals surveyed reported that they deliberately tried to hide from their employer the fact that they were disabled or were having problems (McNeal, Somerville, and Wilson, 1999). Some were fearful that their employers would fire them if they learned about the problems related to the disability. This fear may prevent some individuals from requesting needed accommodations. The degree to which assistive technologies contribute to stigmatization differs (e.g., the stigma of a hearing aid as opposed to eyeglasses). Because the social context plays such a major role in assistive technology use in the workplace, it is important to consider the stigmatizing effect of any proposed workplace assistive technologies and to provide assistance to the worker in overcoming them, which may include awareness training for coworkers and strategies for assistive technology use by the worker.

As discussed earlier, most legislation related to discrimination of individuals with disabilities contains some language that provides employers with a way to avoid making workplace modifications (Peck and Kirkbride, 2001). Typically, the influence on the company’s bottom line is used as an excuse to avoid these modifications. If accommodations are considered to create financial hardship for the employer, they do not need to be made. This type of language recognizes only one side of the financial equation: the money initially spent to purchase technology or modify an environment. It does not recognize the contribution that the employee will make to the company, nor does it amortize the initial equipment expense over the length of time the technology may be used (often years). This corporate attitude is a significant barrier to full access to employment of individuals with disabilities, one that will require more than legislation to eliminate.

Marcia Scherer developed a series of assessments to help determine an appropriate fit between the individual, the environment, and technology. The Workplace Technology Device Predisposition Assessment (Scherer, 2005) is a short questionnaire completed by the employer and the employee. It assesses aspects of the technology and the employee’s and employer’s perspectives on training available to learn use of the technology, support for use of the technology, and perception of the person with a disability as a respected employee (Scherer, 2005). This assessment is a useful tool to help identify whether technology will be supported in the environment and as a way to bring the employee and employer together to discuss introduction and use of technology in the specific work environment.

In summary, the social context of the workplace includes many different people, with whom an employee interacts in different ways and frequencies. Advances in technology, both mainstream and for individuals with disabilities, can accommodate many workplace activities and minimize physical barriers in the environment. However, the knowledge and attitudes of others in the workplace, particularly those who make decisions about hiring and workload, have a greater influence on the ability of an individual with a disability to fully participate in employment. These two determinants need to be addressed when introducing technology into the work site.

Accommodating an Employee With a Visual Impairment

An individual with a visual impairment will require modifications that support the activities of way finding in the environment, location, and manipulation of objects and materials and perception of any information that is presented visually. Chapter 8 discussed assistive technology for use by individuals with a visual impairment. Table 16-1 lists a number of sample modifications for persons with visual impairment. Read the following case study and use the information found in this table and in Box 16-1 to develop a plan for the assessment process and make recommendations for accommodations.

Accommodating an Employee With a Motor Impairment

Throughout this chapter the importance of ensuring that the employee’s work site and workstation are fully accessible to the employee has been stressed. Because this area most often relates to individuals with motor impairments, these accommodations are described in this section.

A valuable resource for parameters on building or remodeling a work site to make it accessible is the ADA Accessibility Guidelines as Amended, 1998 (ADAAG). This document, which can be found on the Internet at http://www.access-board.gov/adaag/html/adaag.htm, specifies the technical requirements for accessibility to buildings and facilities by individuals with disabilities under the ADA of 1990. Another useful publication on modifying the workplace is The Workplace Workbook: An Illustrated Guide to Job Accommodations and Assistive Technology (Mueller, 1990). This book contains detailed descriptions with accompanying illustrations related to three workplace topics: the universal workplace; seating, storage, and workstations; and computers, information displays, communication devices, and controls.

There are office products, such as adjustable-height desks, filing systems, and carousels, that are commercially available to meet the accommodation needs of someone with a motor impairment. These modular workstation components can be assembled in configurations to meet a range of work-related needs of office employees with a disability. The modules can be controlled manually, by a motorized switch control, by computer, or by a computer-controlled robotic arm. Components are available that allow the individual to manipulate files, store and retrieve books, refer to reference materials, open mail, staple papers, and answer the telephone.

Accommodations to the workstation and other types of accommodations for persons with mobility impairments are listed in Table 16-2. Read the following case study and use the information found in this table and in Box 16-1 to develop a plan for the assessment process and make recommendations for accommodations.

Study Questions

Berthoud, R. The employment rates of disabled people. Leeds, UK: Department of Work and Pensions, Controller of Her Majesty’s Stationery Office, 2006.

Butterfield, TM, Ramseur, JH. Research and case study findings in the area of workplace accommodations including provisions for assistive technology: a literature review. Technol Disabil. 2004;16:201–210.

Canadian Council on Social Development, Persons with disabilities on the job. Canadian Council on Social Development’s Disability Information Sheet 2002:18. www.ccsd.ca/drip. [Accessed Jan 2007.].

Canadian Council on Social Development, Workers with disabilities and the impact of workplace structures. Canadian Council on Social Development’s Disability Information Sheet 2004:16. www.ccsd.ca/drip. [Accessed Jan 2007.].

Canadian Council on Social Development, Employment of persons with disabilities in Canada. Canadian Council on Social Development’s Disability Information Sheet 2005:18. www.ccsd.ca/drip. [Accessed Jan 2007.].

Chan, F, et al. Drivers of workplace discrimination against people with disabilities: the utility of Attribution Theory. Work. 2005;25:77–88.

Cossette, L. A profile of disability in Canada. Ottawa: Minister of Industry, 2002.

de Jonge, DM, Scherer, MJ, Rodger, SA. Assistive technology in the workplace. St Louis: Mosby Elsevier, 2007.

Demers, L, Weiss-Lambrou, R, Ska, B. The Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST2.0): an overview and recent progress. Technol Disabil. 2002;14:101–105.

Driscoll, MP, Rodger, SA, de Jonge, DM. Factors that prevent or assist the integration of assistive technology into the workplace for people with spinal cord injuries: perspectives of the users and their employers and co-workers. J Voc Rehabil. 2001;16:53–66.

Flynn, CC, Clark, MC. Rehabilitation technology assessment practices in vocational rehabilitation agencies. Assist Technol. 1995;7:111–118.

Fougeyrollas, P. The influence of the social environment on the social participation of people with disabilities. In Christiansen C, Baum C, eds.: Occupational therapy: enabling function and well-being, ed 2, Thorofare, NJ: Slack, 1997.

Fougeyrollas, P, Gray, DB. Classification systems, environmental factors and social change. In: Gray DB, Quatrano LA, Lieberman ML, eds. Designing and using assistive technology: the human perspective. Baltimore: Paul H Brookes; 1998:13–28.

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