Assistive technologies are central to the realization of the Convention on the Rights of Persons with Disabilities

Abstract

Assistive technologies (ATs) promote participation and inclusion in society, and support access to health, social services, education, work and other important life experiences for persons with disabilities, older people and those with chronic conditions. The Global Report on Assistive Technology, launched in May 2022 by WHO and UNICEF, calls for concrete actions to improve access to AT globally, and recognizes AT as both a means to, and an end itself, in the achievement of rights of persons with disabilities. The UN Convention on the Rights of Persons with Disabilities (CRPD, 2006) is the most widely ratified human rights convention, affirming the right to participation in society on an equal basis with others.

Purpose

In this paper, we highlight examples of how AT may play a role in realizing each of the fundamental rights affirmed in the UNCRPD.

Materials and methods

We conducted an indicative literature search for relevant literature to each of the substantive articles of the CRPD.

Results

Assistive technology plays a critical role in achieving the rights affirmed by the Convention on the Rights of Persons with Disabilities.

Conclusions

Ensuring adequate provision of AT by states parties is critical to the progressive realization of the rights of persons with disabilities and to fulfilling commitments made by states parties upon ratification of the CRPD.

Implications for rehabilitation

• Assistive technology (AT) is critical to enable full participation of persons with disability in society and the achievement of rights affirmed by the Convention on the Rights of Persons with Disabilities.

• Governments and other key stakeholders should endeavour to improve access to AT through inclusive, evidence-informed programs and services.

• Advocacy is required to improve access to AT through universal health coverage.

Keywords:

• Assistive technology
• human rights
• disability
• CRPD

Background

The Universal Declaration of Human Rights recognizes the fundamental rights and freedoms afforded to all people, regardless of race, sexual orientation, gender, origin or other status, including disability [1]. For persons with disabilities, these rights are further described and protected through the United Nations Convention on the Rights of Persons with Disabilities (CRPD) [2]. The CRPD was developed in recognition that persons with disabilities experience circumstances which are inequitable and different to people without disabilities, and that it was necessary to have the specific rights of persons with disability defined and enshrined in international law. Persons with disabilities have the same rights as anyone else in society, and these rights require additional protections due to discrimination, to enable full participation in society [2]. The CRPD promotes a human rights model of disability, incorporating the social model of disability [3], and recognizing that individuals who live with physical, mental, intellectual, cognitive or sensory difficulties experience disability in “interaction with various barriers [which] may hinder their full and effective participation in society on an equal basis with others” [2].

The CRPD defines 50 articles, of which the first five comprise the purpose, definitions, general principles and obligations of states parties, and affirm the principles of non-discrimination [2]. Articles 31 through 50 are primarily administrative, and relate to data collection, reporting requirements, international cooperation, committee structures, signatures and consents; however, Article 32 (International Cooperation) specifically asks for international cooperation among Member States to provide technical and economic assistance, including by facilitating access to, and sharing of, accessible and assistive technology (AT), and through the transfer of technologies [2]. The remaining 25 articles (six through 30) relate to the specific rights of individuals [2]. These rights are broad ranging, and address many aspects of daily life which are critical to promoting participation, well-being, and the inherent dignity of persons [2]. However, it is left to states parties to determine how to ensure these rights are realized within their local context, and to enact the policies and programs required to achieve full and equal participation of all.

The provision of AT as a pillar of universal health coverage supports the participation of persons with disabilities in society [4]. Assistive technology is an umbrella term, referring to the systems and services related to the delivery of assistive products. Assistive products are digital or physical technology which maintain or improve an individual’s functioning and independence [5]. AT is central to promoting participation in society for persons with disabilities, or chronic illness and for people as they age [6,7], and it has thus been a key focus for the World Health Organization through the Global Cooperation on Assistive Technology initiative, and other key international organizations. The Global Report on Assistive Technology acknowledges the role of AT as both a means to, and an end itself, in the realization of rights of persons with disabilities. AT has also been demonstrated to be critical to achieving each of the sustainable development goals [8].

Despite a general consensus on the importance of AT by global organizations and experts in the field, estimates suggest only one in 10 has access to the assistive products they need, with an estimated 1 billion people now requiring AT [9] and this number is expected to increase to 2 billion by 2050 due to an increase in survivability of previously fatal conditions in childhood, to greater longevity with non-communicable diseases, and general demographic trends towards an ageing population [9]. This emphasizes that AT also cuts across conventional siloes in health and social services. Given the importance of AT, it is both surprising and concerning that an analysis of States Parties reports on implementation of the CRPD found little to no mention of AT within them [10].

While there is a general understanding among AT users, practitioners and researchers of the critical nature of AT in achieving and realizing rights identified in the CRPD, there is minimal research to demonstrate this link, nor the contributing factors which support or impede AT use and its subsequent potential for promoting rights realization. In this commentary, we argue that AT is central to the realization of the CRPD as a whole, and more specifically, to each of the rights outlined in the Convention. Through an indicative review of the AT literature, we aim to demonstrate how AT can be used to realize each of the substantive articles of the CRPD, bearing in mind the intersecting nature of the AT user and the diverse contexts in which AT is used. We therefore hope this commentary will serve two purposes: (1) to demonstrate the applicability of AT to all of the articles of the CRPD (not only those commonly cited or named in relation to AT) and (2) to catalyse dialogue, future research and policy related to AT as essential to human rights, ultimately improving the overall quality of research highlighting the relationship between AT and the realization of rights.

Approach

We used a collaborative approach between members of our research team to identify relevant literature for each of the 25 substantive articles of the UNCRPD which outline the specific rights of individuals (Articles 6–30). This approach mirrors the approach taken by Tebbutt et al. in demonstrating the role of AT in achieving the Sustainable Development Goals [8]. Literature was identified based on the collective expertise and knowledge of the field of our team members, and through literature search using Google Scholar or Pubmed to identify key papers, prioritizing systematic or other reviews of the literature wherever possible. The team has particular expertise in this area, and is comprised of researchers, practitioners, civil society representatives and persons with disability who work primarily in the area of AT, and represents several global regions. The intention of the search was to identity indicative and compelling examples from existing research of how AT is contributing to achieving each of the CRPD articles, and not to complete a comprehensive systematic review or theoretical analysis of the literature. A single example from the literature was selected for each of the CRPD articles to provide a clear and concrete example of the relationship between the AT indicated, and the rights realized. We consciously selected research representing a range of assistive products, and a breadth of geographic regions, across the CRPD articles to indicatively showcase diverse examples of how AT not only links to the CRPD articles, but also how AT demonstrates potential to support their achievement.

Findings and discussion

There is evidence for the relevance of AT to achieving each of the 25 specific rights-based articles of the UNCRPD. Table 1 lists each of the 25 articles and provides a conceptualization of how AT contributes to their realization, with indicative examples supported by the literature.

Table 1. The contribution of AT to the realization of rights outlined in the CRPD.

Article	Conceptualization	Indicative example (study type, type of AT, context)
Article 6: Women with disabilities	Access to AT reduces vulnerability to sexual and gender-based violence, which impact women and girls with disability at a much higher rate than men with disabilities, or the general population.	AT for communication disability, such as hearing or speech-impairments, provided a means to report abuse and receive support services, and to engage in sexual health education and advocacy. [11] (Interviews and Focus Groups, Communication AT, Rwanda)
Article 7: Children with disabilities	AT is critical to supporting the social inclusion, education, and acquisition of developmental milestones in children with disabilities.	AT facilitates social interaction between children with severe disabilities and their peers, enhancing play and social inclusion. There are links between the use of AT and improved activities of daily life outside the classroom, including bathing and feeding. [12] (Literature Review, range of AT, Global)
Article 8: Awareness raising	AT is used by persons with disabilities for self-advocacy, providing opportunities of increased awareness of the experiences and rights of persons with disabilities.	A study of adolescent AT users using cameras with necessary AT to allow them to document daily experiences through a photovoice approach identified a key theme of “photos as a means of consciousness-raising.” [13] (Photovoice, range of AT and adapted cameras, Canada)
Article 9: Accessibility	AT promotes access to the built environment, transportation, and information and communication on an equal basis with others.	Access to adequate ramps and accessible washrooms fosters equitable access to public and private buildings for users of wheelchairs and ambulation aids. [14] (Systematic Review, accessibility technology, Global)
Article 10: Right to life	AT supports individuals in living an enjoyable life on an equal basis with others.	Mobile health apps can help to reduce depression, psychological distress and self-harm, commonly experienced by persons with disability. [15] (Systematic Review, mobile health technology, Global)
Article 11: Situations of risk and humanitarian emergencies	AT service provision which is integrated within emergency response mechanisms helps to ensure the protection and safety of persons with disabilities in situations of humanitarian risk and promotes best outcomes for person who acquire a disability during a humanitarian emergency.	A recent review identifies critical recommendations for increasing access to AT in humanitarian emergencies including the deployment of rehabilitation professionals alongside emergency response teams, and the development of an “AT Provision and Coordination Framework” for humanitarian settings. [16] (Thematic Review, range of AT, humanitarian emergencies)
Article 12: Equal recognition before the law	AT promotes independent management of financial and legal affairs by persons with disabilities.	AT, including the use of voice recognition, screen readers or other communication technologies support exercising legal capacity by persons with disabilities with respect to healthcare and financial decision-making. [17] (Literature review, communication technology, global)
Article 13: Access to justice	AT supports persons with disabilities to participate in justice processes as jurors, witnesses, accused persons, or victims in legal processes.	The International Principles and Guidelines on Access to Justice for persons with Disabilities calls for access to legal advice for persons with disabilities using AT where necessary, and for States to ensure procedural accommodations including AT are available for legal practitioners to communicate with witnesses and clients with disabilities. [18,19] (Guidelines, communication technology, global)
Article 14: Liberty and security of the person	AT provides support for community living and the de-institutionalization of persons with disabilities.	AT is used to support independent choice for people with intellectual disability, increasing options for community living and the de-institutionalization of disabled people. [20] (Commentary, range of AT, global)
Article 15: Freedom from torture, or cruel, inhuman, or degrading treatment or punishment	AT increases freedom of persons with disabilities and reduces the use of harmful or degrading treatments or punishments.	The use of assistive technologies by people with dementia reduced the number of falls, while simultaneously reducing the number of physical restraints used on patients. [21] (Pilot RCT, home independence AT, Netherlands)
Article 16: Freedom from exploitation, violence, and abuse	AT can empower persons with disabilities to report abusive, violence, or exploitative practices.	A mobile computing-based reporting system demonstrates promise for empowering people with intellectual and developmental disabilities to report abuse. [22] (Focus groups, mobile computing, USA)
Article 17: Protecting the integrity of the person	AT provides the tools for meaningful and informed consent for medical procedures and/or research.	Digital technologies may be a more accessible option to support sharing of information and understanding of ideas for children and youth with disabilities in decision making and consent procedures. [23] (Commentary, Digital technology, N/A)
Article 18: Liberty of movement and nationality	AT supports safe migration of persons with disabilities within and across national borders.	Accessible transportation is critical to the safe evacuation of people with mobility disability from conflict situations. [24] (Review, accessible transportation, global)
Article 19: Living independently and being included in the community	AT promotes an equal and effective enjoyment of the right to live independently and participate actively in the community by promoting inclusion and reducing isolation.	AT for independent living includes products which, among others, assist in daily living, communication, computer access, and environmental control systems. [25] (Policy analysis, independent living technology, global)
Article 20: Personal mobility	AT for mobility promotes access to home and community for people with mobility disabilities.	Powered wheelchairs increase life-space mobility for adults and older adults with mobility disabilities. [26] (Cohort study, mobility technology, Canada)
Article 21: Freedom of expression and opinion, and access to information	AT increases access to information for people who require accessible forms of communication and information sharing.	Digital AT, including telecommunication technologies, including captioning apps, have accessible communication for people who are D/deaf and hard of hearing during the COVID pandemic. [27] (Viewpoint, communication technology, N/A)
Article 22: Respect for privacy	Persons with disabilities can exercise individual choices using AT and computing devices, without relying on others, and thereby maintaining their privacy.	Non-invasive brain control interfaces can provide persons with disabilities increased control over mobility or other assistive technologies while maintaining their privacy. [28] (Pilot study, brain control interfaces, Italy)
Article 23: Respect for the home and the family	AT promotes freedom of choice in marriage and fertility decisions.	Access to accessible transportation and health care facilities reduces barriers to reproductive health services for persons with disabilities in low and middle income contexts. [29] (Review, accessible transportation and facilities, low- and middle-income countries)
Article 24: Education	AT supports participation and achievement in education for persons with disabilities.	A systematic review demonstrated that AT can be an “enabler of academic engagement,” and that barriers to AT use “can hinder academic engagement” in higher education settings. [30] (Review, educational technology, global)
Article 25: Health	AT supports access to health services in the community for preventative and ongoing health maintenance.	AT can enable people with disabilities to circumscribe structural barriers to accessing health care, including access to health facilities, washrooms, examination tables, and beds. [31] (Review, accessibility technology, South Asia)
Article 26: Habilitation and rehabilitation	AT is a critical component of habilitation and rehabilitation experiences for persons with disabilities, promoting independence and participation in the community.	AT for cognition increases the efficacy of traditional rehabilitation activities by increasing independent engagement and contextual environments where tasks can be completed. [32] (Narrative review, cognitive supports, global)
Article 27: Work and employment	AT enhances the potential to work and earn a living, and to create inclusive work practices and accessible environments that allow equal participation and retention of workers with disabilities.	AT has been found to reduce the systemic exclusion of blind people from work through enhancing self-reliance, resulting in broadening managerial perspectives about additional jobs that that blind staff could perform. [33] (Case study, mobile technology, USA)
Article 28: Adequate standard of living and social protection	Access to AT is associated with reduction of poverty for persons with disabilities, thereby improving standard of living.	Access to AT in Bangladesh was associated with reductions in capability poverty, an important factor in reducing income poverty and increasing standard of living. [34] (Cross-sectional study, range of AT, Bangladesh)
Article 29: Participation in political and public life	AT promotes access to formal and informal citizenship, including participation in elections.	Assistive technologies allow persons with disabilities access to participate in elections, and those who are blind or have visual impairments to vote privately and independently in general elections [35,36] (Interviews and focus groups, range of AT, Sierra Leone and Zimbabwe)
Article 30: Participation in cultural life, recreation, leisure, and sport	AT allows persons with disabilities to access cultural, recreation, leisure and sport facilities, and to participate in activities in similar ways to their non-disabled peers.	Basic AT promotes sport participation across a range of types of sport and levels of participation. [37] (Survey, range of AT, global)

The CRPD outlines general principles to guide the interpretation of subsequent Articles, explicitly stating, “Full and effective participation and inclusion in society” [2]. Further, the Committee to the CRPD issued General Comment no. 7 regarding Articles 4.3 and 33.3 of the CRPD, reinforcing the participatory approach used to draft the Convention by obligating States Parties to follow suit in all decision-making, implementation and monitoring processes [38]. Recognizing the mandate to include persons with disabilities in all decisions affecting them, AT becomes a mechanism to achieve both a participatory process in current inaccessible social environments, as well as drive compliance in each of the Articles by their very use. As such, AT becomes essential to uphold the normative principles underlying each Article of the CRPD.

To achieve this aim, the World Health Assembly’s resolution WHA71.8 calls on states parties to develop and implement contextually relevant AT policies and programmes within universal health and/or social services coverage [39]. Evidence suggests a very high return on investment for the provision of AT, at a rate of return of 9:1 [40]. The return on investment comes in the form of higher rates of education and employment, leading to greater economic participation, and better health and social inclusion, reducing associated healthcare costs and improving quality of life [40]. The Global Report on Assistive Technology provides an overview of the different aspects of an AT system that are required to ensure access to AT for people in need [41].

Empirical evidence on structures, processes and outcomes associated with AT provision is building and summarized in the Global Report on Assistive Technology. While new research is undertaken, it is important to use existing research to advocate for the changes to AT provision that are necessary to the ambitions of the CRPD to be fully recognized. This paper, for the first time, demonstrates how AT can contribute to realizing each of the substantive rights in Articles 5–32 of the CRPD through exemplars from existing AT research. Table 1 therefore provides a valuable resource for those who wish to advocate for greater attention to AT provision in health and social welfare policy. CRPD rights are not stand-alone, but interlocking, and so Table 1 also supports advocacy for AT in other areas related to inclusion, participation, wellbeing and quality of life; such as education, employment, sport, cultural activities and access to justice.

In some cases, AT is specifically mentioned in specific articles of the CRPD (i.e., A. 20: Mobility, A. 32: International Cooperation) and it is therefore easier to make the link between AT and the realization of those rights. However, there are many cases where AT is critical to the realization of a right, but may not be specifically mentioned. For example, AT can improve access to health services (A. 25) in terms of better physical access, better communication between clinicians and services users, and stronger participation in decision making, including assisted decision making. It has been argued that the experience that persons with disabilities have of healthcare constitutes a very good probe for the overall effectiveness of the health system, in terms of accessibility, equity and right to health [42]. In the context of rehabilitation and habilitation (A. 26), the use of AT is important in both helping people regain capabilities that they may have lost (rehabilitation) and in helping people develop new capabilities that allow them to cope more effectively (habilitation). Some ATs can help people in quite different contexts, for instance, robotic technologies developed to assist older people [43], may also have applications for younger people with an intellectual disability [44].

AT provides more opportunity than simply mediation between an individual and an inaccessible physical or social context. Adolescent’s use of camera footage to document and disseminate conditions of daily life (A. 8), or mobile systems for individuals with intellectual disabilities to report abuse (A. 16) show how AT can also assist in challenging the institutional arrangements of social systems that perpetuate systemic inequality. These technologies in turn can support the momentum from disability communities to shift paradigms of disability from a charity, deficit or medical model to a social and rights-based model where individuals have and contribute meaningful roles in society.

As explicated above, it is necessary for states parties to develop and implement contextually relevant AT policies and programmes, as inevitably, the unique interplay of sociopolitical, environmental, economic, cultural and historical factors will shape and contribute the potential of AT to realize rights. Future research which explores the degree to which AT contributes to the realization of each of the rights of the CRPD would guide such policy and programing and provide additional rationale for the provision of AT in universal health care systems in order to promote realization of specific rights. In particular, research which positions AT within context is suggested to examine how existing structural and systemic factors can support AT and the realization of rights, or to identify how they impede AT and human rights in the first place. An intersectional perspective of AT users and the contexts AT is embedded within, is one such example which can illuminate the contributory factors that support or impede the realization of human rights through AT and ultimately the provision of AT in universal health care systems.

Conclusions

The findings of this indicative review suggest the centrality of AT to both achieving the CRPD, and to each of the rights outlined within the convention, ultimately calling for further research and dialogue on the topic to inform equitable policy and programming. Ultimately, enhancing access to AT through universal health and/or social care systems is necessary for states parties to meet their obligations to the UNCRPD and will ensure persons with disabilities, older people and people living with chronic conditions enjoy inclusion and equal participation on the same basis as others.

Disclosure statement

No potential conflict of interest was reported by the author(s).