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This Special Issue considers two core facilitators of functioning: assistive technology and environmental intervention [...]

If human rights begin in small places close to home, technologies that enable people with disability to access and control their home environments are an important human rights instrument. Smart homes exemplify recent advances in design, building construction, and integration of technologies within the built environment. They draw on multiple social and technical disciplines that share a broad vision but lack a common language, creating ambiguity and limiting the usefulness of the evidence base in determining optimal ways to integrate technologies and housing design to meet diverse needs. The convergence of mainstream and assistive technologies offers the potential of accessible and affordable strategies for inclusion, but also risks further exclusion of marginalized sections of the population. Coordination of efforts might accelerate translation of knowledge and diffusion of innovations into the practices of planning, designing, building, and sustaining housing that promotes independent living. This conceptual paper reviews the theoretical frameworks and terminology from fields of research involved in the design and use of technologies in the home environment to enable people with disability and older people. It considers approaches to design and interventions that could inform policies and practices as well as further research and development activities.

This article is an open letter to assistive technology stakeholders from an assistive technology user perspective. Contemporary systems thinking in assistive technology identifies the interlinking themes of people, products, personnel, policy and provision. We add to the current discourse on these five themes through the voice of an expert assistive technology user, who states that "As a disabled person and as a long-time expert assistive technology user, this is everything that I wish you knew and everything I wish you would do." Our objective is to provide a user-centered commentary upon current trends and innovations in assistive technology, illuminating real impacts and outcomes from a social perspective and adding a rarely-heard voice to the literature.

Contemporary discourses which challenge the notion of health as the "absence of disease" are prompting changes in health policy and practice. People with disability have been influential in progressing our understanding of the impact of contextual factors in individual and population health, highlighting the impact of environmental factors on functioning and inclusion. The World Health Organization's (WHO) more holistic definition of health as "wellbeing" is now applied in frameworks and legislation, and has long been understood in occupational therapy theory. In practice, however, occupational therapists and other professionals often address only local and individual environmental factors to promote wellbeing, within systems and societies that limit equity in population health and restrict inclusion in communities. This paper presents an in-depth analysis of the supports and accommodations identified by a cohort of individuals (n-100) living with disability. A range of environmental facilitators and barriers were identified in peoples' experience of "inclusive community environs" and found to influence inclusion and wellbeing. The roles and responsibilities of individuals, professionals, and society to enact change in environments are discussed in light of these findings. Recommendations include a focus on the subjective experience of environments, and application of theory from human rights and inclusive economics to address the multiple dimensions and levels of environments in working towards inclusion and wellbeing. ; Full Text

Contemporary discourses which challenge the notion of health as the "absence of disease" are prompting changes in health policy and practice. People with disability have been influential in progressing our understanding of the impact of contextual factors in individual and population health, highlighting the impact of environmental factors on functioning and inclusion. The World Health Organization's (WHO) more holistic definition of health as "wellbeing" is now applied in frameworks and legislation, and has long been understood in occupational therapy theory. In practice, however, occupational therapists and other professionals often address only local and individual environmental factors to promote wellbeing, within systems and societies that limit equity in population health and restrict inclusion in communities. This paper presents an in-depth analysis of the supports and accommodations identified by a cohort of individuals (n-100) living with disability. A range of environmental facilitators and barriers were identified in peoples' experience of "inclusive community environs" and found to influence inclusion and wellbeing. The roles and responsibilities of individuals, professionals, and society to enact change in environments are discussed in light of these findings. Recommendations include a focus on the subjective experience of environments, and application of theory from human rights and inclusive economics to address the multiple dimensions and levels of environments in working towards inclusion and wellbeing.

Contemporary discourses which challenge the notion of health as the "absence of disease" are prompting changes in health policy and practice. People with disability have been influential in progressing our understanding of the impact of contextual factors in individual and population health, highlighting the impact of environmental factors on functioning and inclusion. The World Health Organization's (WHO) more holistic definition of health as "wellbeing" is now applied in frameworks and legislation, and has long been understood in occupational therapy theory. In practice, however, occupational therapists and other professionals often address only local and individual environmental factors to promote wellbeing, within systems and societies that limit equity in population health and restrict inclusion in communities. This paper presents an in-depth analysis of the supports and accommodations identified by a cohort of individuals (n-100) living with disability. A range of environmental facilitators and barriers were identified in peoples' experience of "inclusive community environs" and found to influence inclusion and wellbeing. The roles and responsibilities of individuals, professionals, and society to enact change in environments are discussed in light of these findings. Recommendations include a focus on the subjective experience of environments, and application of theory from human rights and inclusive economics to address the multiple dimensions and levels of environments in working towards inclusion and wellbeing.

Background: For people living with or affected by Huntington's Disease (HD) to experience a good quality of life, tailored support is required to meet physical, cognitive-behavioral, psychological, and social support needs. Substantial service and knowledge gaps regarding HD exist across support providers and service systems. Measuring unmet needs and what quality of life looks like is a fundamental step required to determine the social impact of service investment and provision. The objectives of this study were to validate and map a draft set of HD Social Impact Domains (HD-SID) against existing national and international outcome frameworks; and evaluate and finalize the HD-SID set using a co-design approach with people with lived experience of, and expertise in, HD. Methods: This research used a qualitative co-design process, with 39 participants across four stakeholder groups (people who were HD gene-positive, gene-negative family members, academics, peak organizations, and service providers) to: (i) map and verify the social life areas impacted by HD; (ii) undertake a rigorous three-phased, qualitative process to critically evaluate the draft HD-SID; and (iii) seek feedback on and endorsement of the HD-SID through this co-design process, with a final set of HD-SID identified. Results: Endorsed HD-SID comprised risks and safety (including housing stability, and economic sustainability) and social inclusion (including health and symptom management, physical wellbeing, emotional wellbeing, and building resilient relationships). Conclusions: Effective measurement of the impacts and outcomes for people with HD is informed by both extant measures and an understanding of the specific population needs. This qualitative co-design research demonstrates that HD-SID resonate with the HD community.

This manuscript considers the drivers towards inclusive research in the field of disability and rehabilitation; including some of the tools and frameworks that may support its realisation. We, a group of researchers engaged in rehabilitation research from lived experience and 'conventional' (non-lived experience) positions, reflect on our collective endeavours to bring about inclusion in research and specify the systemic factors constraining inclusion in research. We conclude by asking the following: how might we reimagine systems where the mechanisms of research production are in the hands of those impacted by the research, and where are intersectionalities both sought and valued?

Aiming to compare capability across persons with impairments using and not using assistive products and persons without impairments in Bangladesh for 16 different functionings, we contrast two sets of self-reported cross-sectional data from eight districts of Bangladesh: (i) data from persons with hearing impairment not using hearing aids, persons with hearing impairment using hearing aids and persons without impairments (N = 572); and (ii) data from persons with ambulatory impairment not using manual wheelchairs, persons with ambulatory impairment using manual wheelchairs and persons without impairments (N = 598). Kruskal–Wallis tests were used to compare levels of capability across the three groups in each data set. Results showed that, for all functionings in both data sets, the levels of capability were statistically significantly highest for persons without impairments. Compared to persons with hearing impairment not using hearing aids, persons with hearing impairment using hearing aids scored higher in all functionings, with statistical significance at the .05 level for 12 of them. Persons with ambulatory impairment using manual wheelchairs scored higher than persons with ambulatory impairment not using manual wheelchairs for 11 of the functionings, but none of the comparisons between the two groups were significant at the .05 level. Assistive products—hearing aids more than manual wheelchairs—enhance capabilities but do not fully equalize opportunities between people with and without impairments.