The most advanced assistive technology is not always the most useful.
A device may look ideal during a demonstration yet remain untouched once it reaches the client’s home. It may require too many steps, feel uncomfortable, interrupt an established routine or solve a problem the client does not consider important.
For occupational therapists, choosing assistive technology is therefore about more than comparing product specifications. It requires understanding the person, the activity, the environment and the support available after the product is delivered.
The goal is not simply to provide equipment. It is to find a solution the client can—and wants to—use in everyday life.
Why Good Assistive Technology Sometimes Goes Unused
The World Health Organization defines assistive technology broadly as assistive products and the related services and systems that support their use. These products can help people with mobility, self-care, cognition, communication, hearing and vision.
However, access to a product does not automatically lead to a successful outcome.
Assistive technology may be abandoned or underused when:
- The client was not involved in choosing it
- It does not address a meaningful personal goal
- It is uncomfortable, bulky or difficult to operate
- It requires physical or cognitive abilities the client does not have
- It does not fit the home or community environment
- The client feels embarrassed using it
- Family members expect it to solve more than it can
- Training was too brief or too technical
- Charging, cleaning or maintenance is difficult
- There is no follow-up after delivery
The occupational therapist’s role is to look beyond whether a product can perform a function and consider whether it will become a realistic part of the person’s life.
1. Start With the Occupation, Not the Product
Before comparing equipment, define what the client wants or needs to do.
Ask:
- What activity is currently difficult, unsafe or impossible?
- When and where does the difficulty occur?
- Why is this activity important to the client?
- How is the person managing it now?
- What has already been tried?
- What would a successful outcome look like?
- Is the goal increased independence, reduced effort, improved safety or continued participation?
A broad goal such as “improve safety” is difficult to use when comparing products.
A more useful goal might be:
- Get in and out of the shower without relying on a family member
- Prepare a simple meal while managing hand weakness
- Contact help from the garden or community
- Remember to take medication at the correct time
- Move from the bedroom to the bathroom safely at night
- Continue communicating with family despite changes in hearing or vision
Write the goal in the client’s own words whenever possible. This keeps the recommendation connected to something the person values.
2. Observe the Real Task
A clinic-based discussion may not reveal what happens during the activity itself. When possible, observe the task in the environment where the technology will be used.
Look at:
- The sequence of steps involved
- The person’s posture, movement and reach
- The amount of effort required
- Where hesitation or risk occurs
- Objects already being used for support
- Lighting, noise and available space
- Furniture placement
- Internet or mobile connectivity
- The presence of stairs, thresholds or uneven surfaces
- How family members or carers currently assist
- What happens on a difficult day, not only a good day
The same product can work very differently across environments. A walking aid suitable for a wide clinic corridor may be difficult to manoeuvre in a small bathroom. A voice-controlled device may struggle in a noisy household. A mobile safety device may be of limited use where network coverage is unreliable.
Understanding the context helps distinguish a good product from a good product for this client.
3. Identify the Actual Cause of the Difficulty
Do not assume that the most visible problem is the main problem.
Difficulty getting out of a chair, for example, may involve:
- Reduced leg strength
- Pain
- A seat that is too low
- Poor foot placement
- A slippery floor
- Fear of losing balance
- Dizziness after standing
Each cause may require a different response. Raising the chair may help one person, while strengthening exercises, pain management or a different transfer technique may be more appropriate for another.
Before recommending technology, consider whether the barrier can be addressed through:
- Task modification
- Environmental changes
- Skill development
- Rehabilitation
- Assistance from another person
- A combination of approaches
Assistive technology should form part of the intervention plan rather than automatically becoming the entire plan.
4. Understand the Client’s Priorities and Preferences
A product selected without the client’s genuine involvement is less likely to be accepted.
Ask:
- How does the client feel about using technology?
- What products do they already use successfully?
- Do they prefer buttons, touchscreens, voice commands or automatic functions?
- Would they be comfortable wearing the product?
- Does its appearance matter to them?
- Are there cultural, religious or personal factors to consider?
- What concerns do they have about privacy?
- Who do they want to receive alerts or information?
- What level of assistance feels acceptable?
- What would make them decide not to use the product?
Some clients value simplicity above everything else. Others enjoy technology and want more control or customisation. Neither preference should be assumed based on age.
If the client says no, explore the reason. Resistance may reflect discomfort, stigma, cost, fear of surveillance or a previous negative experience. These concerns may lead to a better option—or show that technology is not currently the right solution.
5. Match the Product to the Person’s Abilities
Consider whether the client can operate the product reliably during real-life conditions.
Physical Abilities
Check:
- Hand strength and dexterity
- Range of movement
- Ability to reach buttons or controls
- Sitting and standing balance
- Walking ability
- Fatigue
- Pain
- Tremor
- Skin integrity
- Ability to put on, remove or position the product
A button that feels easy during a demonstration may be difficult to press when the person is frightened, tired or experiencing pain.
Vision and Hearing
Consider:
- Button size and contrast
- Screen brightness
- Font size
- Glare
- Volume and sound quality
- Whether alerts use sound, vibration, light or a combination
- Whether instructions can be understood without relying on one sensory channel
Cognition and Communication
Assess:
- Memory
- Attention
- Problem-solving
- Ability to follow a sequence
- Understanding of symbols and prompts
- Recognition of alerts
- Ability to learn and retain a new routine
- Communication needs in an emergency
The client should not be expected to remember a complex sequence during stress if the same sequence is difficult during training.
6. Compare Simple and Advanced Options
More features do not necessarily produce a better outcome.
For each option, ask:
- Which features directly support the client’s goal?
- Which features add unnecessary complexity?
- Can the main function be reached quickly?
- Can settings be simplified or locked?
- Does the product rely on menus, passwords or frequent updates?
- What happens if it loses power or connectivity?
- Is there a low-technology option that would work equally well?
- Could a combination of simple solutions be more reliable?
A basic device used consistently is often more valuable than an advanced system the client finds confusing.
At the same time, simplicity should not be confused with lack of capability. Automatic reminders, voice access or remote support may make a product easier for a particular client. The best level of technology depends on the person and the task.
7. Check Safety, Reliability and Limitations
No assistive product should be recommended without discussing what it can and cannot do.
Review:
- Product safety and quality requirements
- Weight or size limits
- Water resistance
- Battery life and charging
- Network requirements
- Alert range
- Compatibility with other equipment
- Safe positioning and installation
- Cleaning and infection-control needs
- False alarms or missed activations
- Backup arrangements during power or network failure
- Manufacturer support and warranty
- Local repair and replacement options
For personal alarms and automatic detection systems, explain that no device can prevent every fall or guarantee that every event will be detected. The client should know how to activate help manually and what will happen after an alert is sent.
Avoid describing technology as a complete replacement for appropriate care, clinical review or human contact.
8. Consider Privacy and Consent
Connected technology may collect information about movement, location, medication routines, health or activity within the home.
Before recommending it, ask:
- What information does the product collect?
- Where is the information stored?
- Who can view it?
- Can access be restricted?
- Does the client understand and consent to the monitoring?
- Can the client pause or disable particular functions?
- Who owns and manages the account?
- What happens if the client changes providers?
- How will passwords and software updates be managed?
Family members may value detailed monitoring, while the older person experiences it as intrusive. The client’s autonomy and informed consent should remain central unless local laws or formal decision-making arrangements require otherwise.
9. Calculate the Full Cost of Use
The purchase price is only one part of the cost.
Confirm whether the client will also need to pay for:
- Assessment or prescription
- Delivery
- Installation
- Customisation
- Training
- Mobile or internet service
- Monitoring
- Replacement batteries
- Accessories
- Maintenance
- Repairs
- Software subscriptions
- Future replacement
Funding arrangements vary between countries and programmes. Confirm eligibility and approval requirements before ordering, rather than assuming that a clinically useful product will automatically be funded.
A lower-cost product is not good value if it fails quickly or cannot be repaired locally. Likewise, an expensive product may not be worthwhile if the client uses only one basic function.
10. Trial the Product in the Real Environment
Whenever possible, arrange a trial before a final recommendation.
A meaningful trial should reproduce the conditions in which the product will actually be used.
Ask the client to:
- Complete the relevant task
- Use the product in more than one location
- Operate it with their usual footwear, clothing or glasses
- Try it when seated and standing, if applicable
- Practise charging, cleaning and storage
- Respond to prompts or alerts
- Use it with the people who will normally assist them
Observe rather than immediately correcting every difficulty. Where does the client hesitate? What do they forget? Do they create their own workaround? Does a family member take over?
After the trial, ask:
- What felt easy?
- What felt awkward?
- Would you use this when no one else is present?
- What would stop you from using it?
- What would you change?
- Do you prefer this to your current method?
The client’s response should influence the final recommendation—not simply be recorded after the decision has already been made.
11. Fit and Customise the Product
A suitable product can still fail when it is poorly fitted or configured.
Depending on the technology, fitting may involve:
- Adjusting height, width or angle
- Changing straps or controls
- Setting volume, font size or screen contrast
- Choosing appropriate alert contacts
- Simplifying menus
- Removing unused features
- Programming reminders
- Setting up charging and storage locations
- Positioning equipment within safe reach
- Confirming compatibility with the person’s home and other devices
The World Health Organization’s assistive technology training approach emphasises four key stages: selecting the product, fitting it, teaching the person how to use it and following up.
Product delivery should not be mistaken for completion of the intervention.
12. Teach Through Practice, Not Only Explanation
Long verbal instructions or a product manual may not be enough.
Training should be:
- Paced according to the client
- Broken into manageable steps
- Conducted using the actual product
- Repeated when necessary
- Provided in the client’s preferred language and format
- Practised within normal routines
- Extended to family members or carers—with the client’s agreement
Use teach-back rather than asking, “Do you understand?”
For example:
- “Please show me how you would call for help.”
- “What will you do when this light starts flashing?”
- “Can you show me where you will charge it?”
- “What will you do if the device does not respond?”
Written or visual instructions should be short, clear and placed where the task happens. A charging guide is most useful beside the charger, not stored in an office folder.
13. Plan Maintenance and Backup Support
Before the product is put into regular use, confirm:
- Who will charge it
- Who will clean it
- How often it should be checked
- Who will arrange repairs
- Whether replacement parts are locally available
- What the client should do if it stops working
- Whether a backup method is available
- Who will help with updates, accounts or passwords
- How changing needs will be identified
A device may be technically functional but practically unusable if no one knows how to replace a worn part, update the software or contact the supplier.
14. Schedule Follow-Up
Follow-up is essential because performance during an assessment does not always predict use at home.
Arrange a review after the client has had time to establish a routine. Follow-up may occur in person, by phone or through another appropriate service.
Ask:
- Is the client using the product?
- How often and during which activities?
- Has it improved the original goal?
- Is it causing discomfort, frustration or new safety risks?
- Have any workarounds developed?
- Does the client need more training?
- Have the person’s abilities or environment changed?
- Does the product need adjustment, repair or replacement?
- Does the client still want to use it?
Document non-use without blaming the client. An unused product is information. It may indicate that the original goal was incorrect, the environment was overlooked or another solution is needed.
Quick Assistive Technology Selection Checklist
Before finalising a recommendation, confirm:
Person and Goal
- The client’s meaningful goal is clearly defined.
- The client has been involved in the decision.
- Preferences, routines and concerns have been discussed.
- Physical, sensory, cognitive and communication abilities have been considered.
Activity and Environment
- The actual task has been observed where possible.
- The product fits the client’s home and community environment.
- Space, surfaces, lighting, noise and connectivity have been checked.
- Family or carer involvement reflects the client’s wishes.
Product
- The necessary features are easy to access.
- Unnecessary complexity has been avoided.
- Safety limitations have been explained.
- Privacy and data use have been discussed.
- Total ongoing costs are understood.
- Maintenance, repair and backup arrangements are available.
Implementation
- The client has trialled the product where possible.
- The product has been correctly fitted and customised.
- Training includes hands-on practice and teach-back.
- Instructions are available in an accessible format.
- A follow-up date and responsible person have been identified.
Signs That a Product May Not Be Used
Pause before recommending when:
- The product was chosen mainly by someone other than the client
- The client cannot explain why they need it
- It solves a hypothetical rather than current problem
- It requires more steps than the existing routine
- The client dislikes wearing or displaying it
- The controls are difficult to see, hear or operate
- It depends on unreliable connectivity
- No realistic trial has occurred
- Training is limited to a manual or short demonstration
- No one is responsible for maintenance
- The client has clearly said they do not want it
These signs do not always mean rejecting the product. They indicate that further discussion, modification or trial is needed.
Final Thoughts
Successful assistive technology begins with a meaningful occupation, not a product catalogue.
Occupational therapists are well placed to connect the client’s abilities and priorities with the demands of the task and the realities of the environment. That process includes assessment, collaborative selection, trial, fitting, training and follow-up.
A product that remains in its box has not achieved its purpose, no matter how advanced it is. The right technology is the one that fits naturally enough into everyday life that the client chooses to keep using it.
This article provides general professional information. Occupational therapists should apply their clinical judgement, professional scope, local regulations, funding requirements and relevant product standards when recommending assistive technology.