From individual innovation to global impact: the Global Cooperation on Assistive Technology (GATE) innovation snapshot as a method for sharing and scaling

Abstract

Assistive technology (AT) is an essential facilitator of independence and participation, both for people living with the effects of disability and/or non-communicable disease, as well as people aging with resultant functional decline. The World Health Organization (WHO) recognizes the substantial gap between the need for and provision of AT and is leading change through the Global Cooperation on Assistive Technology (GATE) initiative. Showcasing innovations gathered from 92 global researchers, innovators, users and educators of AT through the WHO GREAT Summit, this article provides an analysis of ideas and actions on a range of dimensions in order to provide a global overview of AT innovation. The accessible method used to capture and showcase this data is presented and critiqued, concluding that “innovation snapshots” are a rapid and concise strategy to capture and showcase AT innovation and to foster global collaboration.

• Implications for Rehabilitation

• Focal tools such as ePosters with uniform data requirements enable the rapid sharing of information.

• A diversity of innovative practices are occurring globally in the areas of AT Products, Policy, Provision, People and Personnel.

• The method offered for Innovation Snapshots had substantial uptake and is a feasible means to capture data across a range of stakeholders.

• Meeting accessibility criteria is an emerging competency in the AT community.

• Substantial areas of common interest exist across regions and globally in the AT community, demonstrating the effectiveness of information sharing platforms such as GATE and supporting the idea of regional forums and networks.

     

Assistive technology policy: a position paper from the first global research,innovation, and education on assistive technology (GREAT) summit

Abstract

Increased awareness, interest and use of assistive technology (AT) presents substantial opportunities for many citizens to become, or continue being, meaningful participants in society. However, there is a significant shortfall between the need for and provision of AT, and this is patterned by a range of social, demographic and structural factors. To seize the opportunity that assistive technology offers, regional, national and sub-national assistive technology policies are urgently required. This paper was developed for and through discussion at the Global Research, Innovation and Education on Assistive Technology (GREAT) Summit; organized under the auspices of the World Health Organization’s Global Collaboration on Assistive Technology (GATE) program. It outlines some of the key principles that AT polices should address and recognizes that AT policy should be tailored to the realities of the contexts and resources available. AT policy should be developed as a part of the evolution of related policy across a number of different sectors and should have clear and direct links to AT as mediators and moderators for achieving the Sustainable Development Goals. The consultation process, development and implementation of policy should be fully inclusive of AT users, and their representative organizations, be across the lifespan, and imbued with a strong systems-thinking ethos. Six barriers are identified which funnel and diminish access to AT and are addressed systematically within this paper. We illustrate an example of good practice through a case study of AT services in Norway, and we note the challenges experienced in less well-resourced settings. A number of economic factors relating to AT and economic arguments for promoting AT use are also discussed. To address policy-development the importance of active citizenship and advocacy, the need to find mechanisms to scale up good community practices to a higher level, and the importance of political engagement for the policy process, are highlighted. Policy should be evidence-informed and allowed for evidence-making; however, it is important to account for other factors within the given context in order for policy to be practical, authentic and actionable.

• Implications for Rehabilitation

• The development of policy in the area of asssitive technology is important to provide an overarching vision and outline resourcing priorities.

• This paper identifies some of the key themes that should be addressed when developing or revising assistive technology policy.

• Each country should establish a National Assistive Technology policy and develop a theory of change for its implementation.

     

Opening the GATE: systems thinking from the global assistive technology alliance

Abstract

Purpose: This paper describes international actions to collaborate in the assistive technology (AT) arena and provides an update of programmes supporting AT globally.

Methods: The World Health Organisation (WHO) identifies the severe global uneven distribution of resources, expertise and extensive unmet need for AT, as well the optimistic substantial capability for innovations and developments in appropriate and sustainable AT design, development and delivery. Systems thinking and market shaping are identified as means to address these challenges and leverage the ingenuity and expertise of AT stakeholders.

Results: This paper is a ‘call to action’, showcasing emerging AT networks as exemplars of a distributed, but integrated mechanism for addressing AT needs globally, and describing the Global Alliance of Assistive Technology Organisations (GAATO) as a vehicle to facilitate this global networking.

Conclusion: Partners in this Global Alliance aim to advance the field of assistive technology by promoting shared research, policy advocacy, educating people and organisations within and outside the field, teaching, training and knowledge transfer by pulling together broad-based membership organisations.

• Implications for Rehabilitation

• Collegial, cross discipline and multi-stakeholder collaborations support assistive technology research and practice.

• Knowledge exchange within and across countries and regions is mutually beneficial.

• Self-organising assistive technology communities are emerging and supported by global movements such as WHO GATE and GAATO.

     

Assistive technology products: a position paper from the first global research,innovation, and education on assistive technology (GREAT) summit

Abstract

This paper is based on work from the Global Research, Innovation, and Education on Assistive Technology (GREAT) Summit that was coordinated by WHO’s Global Cooperation on Assistive Technology (GATE). The purpose of this paper is to describe the needs and opportunities embedded in the assistive product lifecycle as well as issues relating to the various stages of assistive product mobilization worldwide.

The paper discusses assistive technology product terminology and the dangers of focusing on products outside the context and rolling out products without a plan. Additionally, the paper reviews concepts and issues around technology transfer, particularly in relation to meeting global needs and among countries with limited resources. Several opportunities are highlighted including technology advancement and the world nearing a state of readiness through a developing capacity of nations across the world to successfully adopt and support the assistive technology products and applications.

The paper is optimistic about the future of assistive technology products reaching the people that can use it the most and the excitement across large and small nations in increasing their own capacities for implementing assistive technology. This is expressed as hope in future students as they innovate and in modern engineering that will enable assistive technology to pervade all corners of current and potential marketplaces. Importantly, the paper poses numerous topics where discussions are just superficially opened. The hope is that a set of sequels will follow to continue this critical dialog.

• Implications for Rehabilitation

• Successful assistive technology product interventions are complex and include much more than the simple selection of the right product.

• Assistive technology product use is highly context sensitive in terms of an individual user’s environment.

• The development of assistive technology products is tricky as it must be contextually sensitive to the development environment and market as well.

• As a field we have much to study and develop around assistive technology product interventions from a global perspective.

     

Multicase study on product design in the area of assistive technology in Brazil

Abstract

Purpose: The present research aims to contribute to the comprehension of the product development process (PDP) of Assistive Technology (AT) through methodological multi-case studies in Brazil. The following considerations presented in the study are part of a Master’s degree thesis, conducted from 2013 to 2015.

Methodology: The research adopted a multi-case study methodology by selecting four product developers from the Assistive technology field in Brazil, focusing on physical disability.

Results: According to the findings, this research discusses the possible influences of Emotional Collaborative Design on the process of Assistive Technology, aiming at enhancing new perspectives about such tools on the product development process. As a result, it was possible to set a delimitation of PDP of AT stages in the four cases approached, in most of the methodological steps empirically developed.

Conclusion: Final considerations of the study, collaborate with the comprehension of the assistive product development, stating there is still a little emphasis on the design concepts throughout these processes, also illustrates the necessity for further studies about the product development in the area.

• Implications for rehabilitation

• The visualization of a still scarce dialogue between the multiple areas that could contribute for AT development;

• The potential correlation between high dissatisfaction in several issues regarding use of ATs and the poor understanding of user needs;

• The predominance of a great functionality emphasis, and the negligence of the individual’s emotional in AT development;

• The understanding that product design maybe is still poorly applied/understood in this field.

     

Getting it “right”: how collaborative relationships between people with disabilities and professionals can lead to the acquisition of needed assistive technology

Abstract

Purpose: The purpose of this study was to examine the impact of a consumer-led equipment and device program [Equipment and Assistive Technology Initiative (EATI) in British Columbia, Canada] from the perspective of program participants. The importance of collaborative assessments for obtaining the right assistive technology (AT) for meeting an individual’s needs is discussed in light of the program’s participant-centered “Participation Model”, or philosophy by which the program is structured. Method: A cross-sectional survey with participants and semi-structured interviews were conducted with participants (≥18 years) who held a range of disabilities. The survey asked participants to rank their AT and to identify the method by which they obtained the technology [by self, prescribed by a health professional or collaborative (self and professional)]. Interviews addressed participants’ opinions about obtaining and using AT. Results: In total, 357 people responded to the survey (17% response rate) and 16 people participated in the interviews. The highest ranking AT was assigned to devices assessed via a collaborative method (self?=?31%, practitioner?=?26%, collaborative?=?43%; χ² (16,?180)?=?39.604, p?<?0.001). Conclusions: Shared decision-making between health professionals and people with disabilities within the assessment process for assistive technology leads to what participants perceive as the right AT.

• Implications for Rehabilitation

• Collaborative decision-making can lead to the selection of assistive technology that is considered needed and right for the individual.

• Person-centered philosophy associated with assistive technology assessment is contributing to attaining “the right” AT.

     

Enabling appropriate personnel skill-mix for progressive realization of equitable access to assistive technology

Abstract

Background and Methods: This paper reviews the current capacity of personnel in enabling access to assistive technology (AT) as well as the systems and processes within which they work, and was reviewed, discussed, and refined during and following the Global Research, Innovation, and Education in Assistive Technology (GREAT) Summit.

Findings: Key concepts addressed include a person-centred team approach; sustainability indicators to monitor, measure, and respond to needs for service design and delivery; education, research, and training for competent practice, using the six rehab-workforce challenges framework; and credentialing frameworks. We propose development of a competence framework and associated education and training programs, and development and implementation of a certification framework for AT personnel.

Conclusions: There is a resolve to address the challenges faced by People globally to access assistive technology. Context specific needs assessment is required to understand the AT Personnel landscape, to shape and strengthen credentialing frameworks through competencies and certification, acknowledging both general and specific skill mix requirements.

• Implications for Rehabilitation

• Personnel in assistive technology (AT) provision should be trained using a person-centred team approach, which emphasizes appropriate skill-mix to address multiple needs within the community.

• Sustainability indicators should be used which allow personnel to monitor, measure and respond to needs for service design and delivery.

• A competence framework with associated education and training program, coupled with the development and implementation of a certification framework for AT personnel needs, will promote quality in AT personnel training globally.

     

Information and communication technology-based assistive technology to compensate for impaired cognition in everyday life: a systematic review

Abstract

Purpose: A systematic review was performed evaluating the effectiveness of Information and Communication Technology-based Assistive Technology (ICT-based-AT) to compensate for impaired cognition in everyday life activities.

Materials and methods: The study was registered in PROSPERO, registration number CRD42018114913. Six databases were searched (years 2008–2019).

Inclusion criteria: Randomized controlled trials (RCTs) or cohort studies; people with impaired cognition due to non-degenerative diseases; and evaluation of ICT-based-ATs’ effectiveness regarding activity and participation, including prospective memory, execution of tasks and satisfaction with task execution. Each study’s level of evidence and quality were assessed using “JBI Levels of Evidence” and the “JBI Meta-Analysis of Statistics Assessment and Review Instrument”, respectively.

Results: About 3,153 publications were located, of which 12 were included. The levels of evidence were: 1.c (RCT) (n?=?7), 1.d (pseudo-RCT) (n?=?1) and 3.e (observational study without control group) (n?=?4). Three studies had high quality (2 RCT/1 cohort), eight acceptable (5 RCT/3 cohort) and one low (RCT) quality.

Conclusions: Smartphones, personal digital assistants (PDAs), etc. with e.g. calendars and reminder alarms can improve prospective memory, especially for people with ABI. Furthermore, PDAs and similar products with prompts can improve execution of tasks for people with cognitive impairment due to different diagnoses. Products should be tailored to the users’ needs and the users trained in product use. Further studies concerning children, older people and people with intellectual and developmental disability are required; as well as studies on cost-effectiveness and the effectiveness of related services.

• Implications for rehabilitation

• In order to support activity and participation in everyday life for people with prospective memory problems, especially people with acquired brain injury, they should be offered information and communication technology-based products, such smart phones, mobile phones, personal digital assistants or similar mainstream products equipped with reminding software.

• People with cognitive impairment having difficulties executing tasks independently should be offered PDAs and mobile telephones and similar products with prompting software, e.g. audio-verbal, picture and video-based task-sequencing prompts.

• The ICT-based products should be individually tailored, and the person should be trained in using the selected product.

     

Assistive technology device classification based upon the World Health Organization's,International Classification of Functioning,Disability and Health (ICF)

Purpose.?To develop an assistive technology device classification (ATDC) consistent with the Assistive Technology Act (ATA2004), Americans with Disabilities Act (ADA2008), International Classification System of Functioning, Disability and Health (ICF), International Classification of Disease, Ninth Revision-Clinical Modification (ICD-9-CM) and American Medical Association's Current Procedural Terminology (CPT).

Background.?Current assistive technology device (ATD) classifications include: the National Classification System for Assistive Technology Devices and ATSs (RTI/NCS) published in 2000; ISO 9999: technical aids for persons with disabilities – classification and terminology (ISO 9999) published in 1992, 1998, 2002 and 2007 and ICF-based AT classification (ICF/AT2007) published in 2009.

Objectives.?To derive ‘requirements’ for ATD classification from the ATA2004, ADA2008, ICF, ICD-9-CM and CPT. Review the ATD classifications and online databases against requirements. Construct the ATDC to be consistent with all requirements and demonstrate with examples.

Results.?Existing ATD classifications and online databases are inconsistent with requirements. The ATDC is consistent and has inclusion and exclusion criteria, classification rules, employs ICF coding, extendable hierarchy and language and uses standard device naming conventions.

Conclusion.?The ATDC has broad application to: provision of AT ATSs (ATSs), characterisation and analysis of AT industries, Federally sponsored research pertaining to AT development and commercialisation, and Federal health insurance scope of benefits.     

Attitudes faced by young adults using assistive technology as depicted through photovoice

Abstract

Purpose: To explore how the attitudinal environment influences the participation experiences of young adults with disabilities who use assistive technology.

Methods: In this qualitative study, twenty young adults using assistive technology completed individual interviews before and after engaging in a photovoice process. Ten of the participants then took part in a focus group. Data were analyzed inductively using a thematic analysis approach.

Results: Analysis yielded three primary themes “seen and treated as different, assumptions made and impatience”. A fourth theme emerged through focus group discussion “photos as a means of consciousness-raising”. Findings suggest that young adults with disabilities who use assistive technology regularly encounter negative societal attitudes that hinder participation. The photovoice process promoted consciousness-raising at the individual, interpersonal and societal level for the participants.

Conclusion: Many young adults with disabilities use assistive technology to facilitate participation in everyday activities. However, the usefulness of assistive technology is susceptible to the environment in which it is used. Further actions are needed toward resolving this challenging participation barrier; these actions should draw on the perspectives and creativity of young adult assistive technology users.

• IMPLICATIONS FOR REHABILITATION

• Young adults with disabilities who use assistive technology describe how other people’s negative attitudes can make it challenging to participate in their important activities.

• Participants took photographs that represented the negative attitudes they face on a daily basis and saw their photos as a way to raise awareness of the negative attitudes.

• This research highlights the importance of addressing negative attitudes toward people using assistive technology: young adults with disabilities have expertise and creative ideas about how to do this, so their voices should guide future research projects.

     

Assistive technology as a pillar of universal health coverage: qualitative analysis of stakeholder responses to the world health assembly resolution on assistive technology

Abstract

Purpose: The importance of assistive technology (AT) as a pillar of universal health coverage was recognized at the 71st World Health Assembly (WHA) through the passing of Resolution 71.8 on improving access to AT (May 2018). A systematic analysis was conducted on the responses made to the Resolution by Member States and non-state actors, in order to provide a snapshot of global intent.

Methods: Qualitative content analysis was conducted on over 40 written “Statements” made by Member States and non-state actors in response to Resolution 71.8.

Results: The Resolution provides tangible guidance to the World Health Organisation (WHO) and its member states in order for them to meet commitments within the Convention on the Rights of Persons with Disabilities (CRPD). Statements made in response to the Resolution offer a unique plethora of multi-stakeholder views from differing global perspectives. Analysis identified a range of themes within two overarching themes: intersection of health, human rights and sustainable development; and international collaboration and support within an international agenda framework.

Conclusion: The content analysis synthesises complex global data and identifies directions to positively influence national and regional AT policy and delivery. The complexity of factors demonstrates the importance of an AT systems-thinking approach; that is, the development and application of organised knowledge, skills, procedures and policies related to assistive products. AT systems thinking will be essential for AT to be effectively deployed as a pillar of universal health coverage.

• IMPLICATIONS FOR REHABILITATION

• Assistive technology is a key facilitator of health and well-being, playing a critical role in global efforts to improve population health outcomes and strengthening health systems

• Access to assistive technology is a public health priority and is an essential health product to be covered under Universal Health Coverage

• Effective action on access to assistive technology must encompass the reality of diverse contexts yet common purposes expressed by global actors

• This analysis demonstrates the intersection of the health, human rights and sustainable development agendas, and the importance of international collaboration and support in achieving effective access

     

Provision of assistive technology services method (ATSM) according to evidence-based information and knowledge management

Purpose.?This article develops a standardised method for assistive technology service (ATS) provision and a logical basis for research to improve health care quality. The method is ‘interoperable’ across disabilities, disciplines, assistive technology devices and ATSs.

Background.?Absence of a standardised and interoperable method for ATS provision results in ineffective communication between providers, manufacturers, researchers, policy-makers and individuals with disabilities (IWD), a fragmented service delivery system, inefficient resource allocation and sub-optimal outcomes.

Objectives.?Synthesise a standardised, interoperable AT service method (ATSM) fully consistent with key guidelines, systems, models and Federal legislation. Express the ATSM using common and unambiguous language.

Results.?Guidelines, systems, models and Federal legislation relevant to ATS provision are reviewed. These include the RESNA Guidelines for Knowledge and Skills for Provision of Assistive Technology Products and Services (RESNA Guidelines), IMPACT2 model, international classification of functioning, disability and health (ICF) and AT device classification (ATDC). Federal legislation includes the Assistive Technology Act of 2004, Americans with Disabilities Act of 2008 and Social Security Act. Based on these findings, the ATSM is synthesised and translated into common and accessible language.

Conclusion.?ATSM usage will improve communication between stakeholders, service delivery coherence, resource allocation and intervention outcomes.     

Cross-cultural adaptation of the assistive technology device – Predisposition assessment (ATD PA) for use in Brazil (ATD PA Br)

Purpose: The purpose of this study is to conduct a cross-cultural adaptation of the Assistive Technology Device Predisposition Assessment (ATD PA) for use in Brazil.

Method: The selection of the Assistive Technology Device Predisposition Assessment (ATD PA) was determined by previous literature reviews of articles published in 2014 and 2016 in six databases with the terms "assistive device" or "assistive technology" or "self-help device" combined with "evidence-based practice" or "framework" or "measurement scale" or "model and outcome assessment". This review indicated that the conceptual model of Assistive Technology (AT) most discussed in the literature was the Matching Person and Technology (MPT) model, and this finding determined the selection of ATD PA as an assessment within the MPT portfolio of measures. The procedures for cross-cultural adaptation were as follows: Equivalence of Concept, Semantic and Operational. Five experts were asked to translate 725 items and these translations were evaluated and a high level of agreement was demonstrated.

Results: The Portuguese version, Avaliação de Tecnologia Assistiva – Predisposição ao Uso – ATD PA Br, was derived from the original version in English (ATD PA).

Conclusion: The ATD PA Br will support professionals and people with disabilities in Brazil to better select AT devices according to the clients’ needs.

• Implications for rehabilitation

• Provides a systematic way of selecting assistive technology devices for the use of individuals with disabilities according to the Brazilian reality.

• A systematic way of selecting the assistive technology that can help decrease the abandonment of the assistive technology use.

• The use of the Matching Person and Technology theorical model and of the assessment ATD PA Br is essential to guide the researches and clinical practice in Brazil.

     

Strategies that facilitate participation in family activities of children and adolescents with profound intellectual and multiple disabilities: parents’ and personal assistants’ experiences

Abstract

Purpose: Participation throughout one’s life plays a significant role for development and emotional well-being. For this reason, there is a need to identify ways to facilitate participation in family activities for children and adolescents with profound intellectual and multiple disabilities (PIMD). Methods: The study design was qualitative and explorative, based on semi structured interviews with 11 parents and 9 personal assistants of children with PIMD. Results: The interviews revealed participation-facilitating strategies relating to the children’s/adolescent’s proximal environment, such as “Availability and acceptability of the activity”, “Good knowledge about the child” and a “A positive attitude of people close to the child”, as well as strategies related to the children/adolescents themselves: “Sense of belonging”, “Possible for the child/adolescent to understand”, “Opportunities to influence” and “Feeling of being needed”. Conclusions: Children and adolescents with PIMD are dependent on support obtained through their environment. The identified strategies, individually adapted through awareness and knowledge by the parents and the personal assistants, provide important evidence to assist our understanding in gaining understanding about how to improve participation in family activities of children and adolescents with PIMD.

• Implications for Rehabilitation

• Participation-facilitating strategies related to the child/adolescent and his or her proximal environments are identified to improve participation in children and adolescents with profound intellectual and multiple disabilities (PIMD).

• Examples of strategies for the child’s/adolescents’ proximal environment include “good knowledge about the child/adolescent”, and, for the child/adolescent, include creating “sense of belonging” and “opportunities to influence”.

• Identifying and making these strategies explicit may assist in enhancing the participation of children and adolescents with PIMD in family activities.

• People in the child’s/adolescent’s proximal environment need to set the scene for participation.

     

“Big Sister” Wisdom: How might non-Indigenous speech-language pathologists genuinely,and effectively,engage with Indigenous Australia?

Abstract

Speech Pathology Australia, through its landmark project for the profession, “Speech Pathology 2030 - making futures happen” (SP 2030), calls for speech-language pathologists to “respond (to presenting clients) in ways that respect each person’s culture, language, life experiences, and preferences” (Speech Pathology Australia, 2016, p. viii). Such engagement, it holds, is central to successful practice. Meeting the needs of Aboriginal and/or Torres Strait Islander (Indigenous) clients and communities, however, requires a skilled response to client wholeness, to their indissoluble, and unique, immersion in their: indigeneity; lived cultural experience; and the social, geographical, economic and political realities that surround them. Equally, the achievement of a truly-effective engagement, one able to engender desired outcomes, is also dependent on the challenging achievement of culturally-safe practice. Given that the relevant literature is, historically, based on a privileging of western purviews, this article asserts the validity of incorporating (pan-)Indigenous epistemologies and perspectives. As well as the Indigenous health and cultural safety literature, then, this article draws on particular Indigenous professional experience as a locus of good-practice evidence, one capable of contributing additional insights to best address the question: “How might Non-Indigenous speech-language pathologists really engage, effectively, with Indigenous Australia?”. It introduces a guiding rubric, “Meet People in their Own Reality”, as a tool with which to examine how engagement, in the service of more-effective practice, can be optimised in four exemplar domains of SP 2030.     

Delivering an AT service: a client-focused,social and participatory service delivery model in assistive technology in Ireland

Purpose : This article outlines the development of an Assistive Technology (AT) service delivery model and suggests that a client-focused social and participatory service delivery model in AT can achieve the best results for people with disabilities and their carers. Method : It draws on case studies, which are part of the final evaluation report of the Aphrodite (European Horizon funded project 1998-2000) project to illustrate the success of a client-focused service. The aim of the project was to provide people with disabilities access to a local technical resource in the form of Technology Liaison Officers (TLOs). Conclusion : TLO's are people with physical disabilities, who have been trained in AT and who have achieved a certificate in AT, to act as a liaison between users and potential users of AT and the Central Remedial Clinic's (CRC) Client Technical Services (CTS) Department.     

Benefits and burdens: family caregivers’ experiences of assistive technology (AT) in everyday life with persons with young-onset dementia (YOD)

Abstract

Background: People with dementia and their family caregivers may benefit from assistive technology (AT), but knowledge is scarce about family carers’ (FC) experiences and involvement in the use of AT in everyday life.

Aim: To examine the FC roles and experiences with AT as means of supporting people with young onset-dementia (YOD).

Method: Qualitative interview study with follow-up design. Repeated semi-structured interviews were conducted with 13 FC of people with YOD, participating in an ongoing intervention study investigating the families’ use and experiences of AT in everyday life.

Results: Six main themes emerged: (1) timely information about AT; (2) waiting times; (3) AT incorporated into everyday living; (4) AT experienced as a relief and burden; (5) appraisal of AT qualities and (6) the committed caregiver.

Conclusions: The study found benefits for the FC, especially with simply designed AT, but also several barriers for successful use. A committed caregiver is vital throughout the process. Users will need professional advice and support, and occupational therapists may have a significant role in the process. Interventions implementing AT must be based on analysis of the needs of the person with YOD and the carers: their capabilities, preferences, embodied habits, and coping strategies.

• Implications for Rehabilitation

• Committed family carers (FC) play an important, often decisive, role in providing support for the person with young-onset dementia (YOD, onset <65 years) to use and benefit from the AT.

• The simpler the AT, the better. The AT should be introduced at “the right time”, before the cognitive and adaptive reduction is too great. The “window” for implementation may be short.

• AT has potential to ease caregiving and give relief for FC. However, many barriers, difficulties and problems must be attended to.

• A system for individualized support over time is necessary for implementing AT for this group.