The UK Parliament’s 2014 Care Act instituted a two-tier system to provide Augmentative Alternative Communication (AAC) Environmental Control (EC) systems for a diverse population of people recruited from patients with Cerebral Palsy, Stroke, Motor Neuron Disease (ALS) and other conditions. Provision became a statutory duty for local authorities, and regional Assistive Technology Hubs were established to meet the needs of clients with the most complex needs and to offer professional support for local services.
This thesis is based on ethnographic fieldwork into the practices of assistive technology professionals at one of the newly established Regional Service Centres. It provides insight into the ways in which distributed assistive technology systems are commissioned, evaluated, designed, customised and delivered to meet the needs of a highly diverse and low-prevalence population of clients within one of England’s nine administrative regions. Assistive devices and systems are often seen as a distinct class of technologies, which specifically serve dis/abled people. Nevertheless, this thesis argues that to accommodate clients with complex needs, healthcare professionals had to problematise and rework some dominant assumptions about design, devices and users. Their efforts went into devising novel ways to circulate technologies, different from that of mainstream, commercial provision. This was all the more necessary because studying the clinicians’ work made evident implicit assumptions about the figures of design, device and use in relation to non-disabled individual and groups of users. The work of the Centre further revealed market relations entangled in technological figures of design, user and device, and the ways that those relations required reconfiguration throughout the process of assistive technology provision. By tracing these transformations, the thesis offers a study of the workings and limits of pervasive technological imaginaries and rationalities.
The thesis contributes to Social Studies of Science and Technology and Disability Studies, by presenting a detailed case study of technological products and systems designed to promote the social participation and well-being of dis/abled people. Further, by linking and comparing mainstream and assistive technology practices, the thesis situates design and use in the wider relations of dis/ability and the market. This widens the theoretical and practical toolkit to comprehensively evaluate technological products and services and to better appreciate processes and effects of sociotechnical change, and opens the space to reimagine and transform practices of design to accommodate dis/abled and non-disabled people.