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.

Assistive technology (AT) is a powerful enabler of participation. The World Health Organization's Global Collaboration on Assistive Technology (GATE) programme is actively working towards access to assistive technology for all. Developed through collaborative work as a part of the Global Research, Innovation and Education on Assistive Technology (GREAT) Summit, this position paper provides a "state of the science" view of AT users, conceptualized as "People" within the set of GATE strategic "P"s. People are at the core of policy, products, personnel and provision. AT is an interface between the person and the life they would like to lead. People's preferences, perspectives and goals are fundamental to defining and determining the success of AT. Maximizing the impact of AT in enabling participation requires an individualized and holistic understanding of the value and meaning of AT for the individual, taking a universal model perspective, focusing on the person, in context, and then considering the condition and/or the technology. This paper aims to situate and emphasize people at the centre of AT systems: we highlight personal meanings and perspectives on AT use and consider the role of advocacy, empowerment and co-design in developing and driving AT processes.

Education and training is required for all stakeholders involved in wheelchair provision. Advocating for programme development to enhance personnel skills, build capacity and ensure best practice is a priority. Pilot sites, delivering and credentialing appropriate wheelchair provision education and training within context should be considered. Measuring outcomes and transferable skills should be part of education programme delivery structures. Considering a new discipline responsible for oversight of wheelchair provision should be investigated. Implications for rehabilitation Education and training is an essential step in the wheelchair provision process in the bid to obtain an appropriate wheelchair via appropriate provision services. However, it is more than education and training; its a human rights issue. Mandatory education and training needs to be a requirement for all stakeholders involved in wheelchair provision. Key wheelchair personnel need to establish their central role in this arena. The study raises awareness as to the importance of working with governments to commit to building sustainable wheelchair provision infrastructures.

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.

BACKGROUND: Concepts of sustainability are beginning to emerge in relation to appropriate provision of wheelchair and seating assistive technology (WSAT) from design to follow up and management. OBJECTIVES: 1. Raising awareness and understanding of and actively considering the complex nature of stakeholders' participation in the wheelchair and seating provision. 2. Establishing a consensus regarding key goals and sustainability indicators when developing an action plan for sustainable wheelchair and seating provision systems, that would allow for effective process monitoring and measurement. METHOD: Qualitative research design, involving key stakeholder perspectives by utilising a soft systems methodological framework including organisational ethnography and critical participatory action research was chosen to study this complex system. Research processes involved participant observation, individual interviews and a series of collaborative workshops. These processes were made up of four main pillars: 1) stakeholder identification, 2) understanding perspectives, 3) meaningful collaboration and 4) strategy development. Pillars 2 and 3, sought to understand stakeholder perspectives individually and collectively, are addressed in this article. RESULTS: Pillar 2 presents rich pictures which were created to represent collective experiences of wheelchair and seating provision. Pillar 3 presents solutions for building sustainable systems. Findings identified the complexity of the system and key areas for development. Specific concerns reported to exist related to individual and nationwide organisational roles, responsibilities and regulation which appeared to influence the disproportionate rhythm of the wheelchair and seating provision system. CONCLUSIONS: A better understanding of this primary need is required to set provision of WSAT for prioritisation at a public and policy level both nationally and internationally.

Introduction: Every aspect of the wheelchair and seating provision process has an impact on overall outcomes for service users. This critical appraisal sought to identify outcome measures suitable for evaluation of wheelchair and seating provision, considering activity, participation, and impact of the service delivery on quality of life. Method: Outcome measures were identified using databases: Medline, CINHAL, PsychInfo, and Google Scholar. An evaluation was conducted to establish those that were particularly useful and a critical appraisal was completed. Findings: Five outcome measures identified as relevant for critical appraisal included: Wheelchair Outcome Measure; Functioning Every day in a Wheelchair; Goal Attainment Scale; Psychosocial Impact of Assistive Devices Scales; and the Quebec User Evaluation of Satisfaction with Assistive Technology. The strengths and limitations of each were identified. Conclusion: No single outcome measure captures all necessary information; trade-offs are inevitable. When choosing an outcome measure, the specific goals of the service evaluation and the resources available need to be considered within context. Critical appraisal of five outcome measures deemed appropriate for the evaluation highlighted some areas for consideration to inform decision making. A move towards sustainability indicators is suggested to monitor, measure, and respond to the provision processes and outcomes required to meet this primary need.

The study identified several areas that can be targeted to bring about improvements in meeting primary needs. Education and research at public, policy, and practice levels need to be prioritized. It is imperative that citizens move beyond an awareness that EB exists and demonstrate a consciousness about the importance of advocating and enabling seamless and sustainable support services through collective action.

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