Abstract
Assistive technology (AT) is any piece of equipment or software that helps people, particularly people with disabilities, function more independently by increasing their functional capabilities. These can include physical objects such as prosthetics, canes, stair lifts, and adapted tools, or software such as screen readers, closed captioning, and magnification software.
My technical project focuses on a specific type of AT, shoe insoles, which are commonly used to help reduce foot pain and improve biomechanical alignment and stability of the foot and ankle. Shoe insoles are mostly used by people with plantar fasciitis, arthritis, metatarsalgia, or other medical conditions that cause discomfort to the feet or trouble walking, and can help with activities like walking, running, or standing for long periods of time. The price of shoe insoles can range from $10 to $20 USD for generic off-the-shelf insoles that offer personalized support and adaptability, or $300 to $800 USD for insoles that are more customized for the specific patient but are still not modifiable for various activities, and can impose a financial burden. The goal of my technical project was to create an adaptable 3D-printed shoe insole that uses pressure sensors to detect force recordings at different areas of the foot, and then uses an inflation mechanism to adjust the level of support based on the pressure recordings. By having a shoe insole that can adjust the level of arch support it gives the user based on where the user needs to shift to have more or less pressure on various areas of the foot, this shoe insole functions as an all-in-one insole that can be modified to help people with different foot shapes and physical activities. The end goal of this project is to minimize the costs of shoe insoles by having an insole that is not custom-made, but is still able to be modified for the user based on their individual needs.
My STS research paper focuses on AT from a broader perspective, analyzing how factors that influence the affordability and out-of-pocket costs of AT can exacerbate the socioeconomic inequity of these technologies for people with disabilities. From a Social Construction of Technology (SCOT) framework, I was able to understand how competing interpretations of AT by medical providers, insurance companies, and AT users can cause access to AT to be unequal among people of different class levels and socioeconomic backgrounds. I examine U.S. healthcare and insurance policies, peer-reviewed research on AT access and affordability, and compare international healthcare models from Norway and Japan to identify alternative policy approaches that could improve equity and expand access in the U.S. My findings lead me to the conclusion that definitions of medical necessity in the U.S. are too narrow to adequately cover AT for the people who need them, leading to worse socioeconomic outcomes for people with disabilities and fewer opportunities for independence and integration into society.
My technical and STS papers both discuss access to AT, one with the focus of creating a more affordable version of an existing AT product, and the other with the focus of analyzing how to increase the affordability of AT in general, specifically within the context of economic access and healthcare coverage. Together, my technical and sociotechnical work highlight that expanding the benefits of assistive technology requires both innovation in design and changes to the policies and systems that shape access.
