Employment issues and assistive technology use for persons with spinal cord injury

Authors: Hoffman, H., Jackel, D., Glauser, S., & Kupper, Z.
Year Published 2006
Publication Journal of Rehabilitation Research & Development
Volume 43
Number 2
Pages 185-198
Publisher United States Department of Veterans Affairs

Assistive technology (AT) improves the functional independence of persons with spinal cord injury (SCI/D) and affords them greater opportunity for societal participation and integration. These technologies are designed to circumvent environmental barriers, maximize independence, and increase activity participation among persons with physical disabilities. Logically, the improvements in functional independence, societal participation, and integration attributed to AT should also enhance the employability of persons with SCI/D. However, little is known about the extent of AT in the workplace and the role that AT may play in reducing employment-related barriers and enhancing employment outcomes for persons with SCI/D.


In this study, the authors examined the associations between assistive technology (AT) cost, underwriting, ownership, use, employment, and employer accommodations for two groups (civilian and veteran) of working age adults (18-64 yr) with spinal cord injury or dysfunction (SCI/D).


The sample included working-age adults (18-64 yr) with SCI/D. The first group of participants, civilians, was identified from the University of Illinois at Urbana-Champaign (UIUC) Disability Resources and Educational Services (DRES) Student Database. At initiation of the study, 170 alumni with SCI/D were in this database and valid addresses and phone numbers were available for 140 of them. The second group of participants, veterans with SCI/D, was identified with the VA Spinal Cord Dysfunction Registry. After identifying all veterans with SCI/D, the authors randomly selected a pool of 400 potential veteran participants from the national VA database maintained by the VA Allocation Resource Center (ARC). Of the 200 veterans, 98 agreed to participate in the survey (49% response rate), and 93 of the 140 UIUC alumni agreed to participate in the survey (66% response rate). Therefore, the overall project response rate was 56 percent (191/340).

Data Collection

Prospective and retrospective data were collected from the two groups. The prospective data were collected with a telephone survey. This included the following questions:

1. What AT devices are owned by individuals with SCI/D?
2. How much did these devices cost?
3. For individuals employed at time of survey, did device cost vary by disability severity, employer category, or importance of the device to work?
4. Who underwrites the purchase, maintenance, and replacement costs of the devices owned?
5. Which AT devices are identified as important to work?
6. Are there any unmet AT needs in terms of workplace accommodations, repair, and overall satisfaction?

In addition, the survey included information on disability, demographic, health status, and physical activity information. Descriptive and comparative analyses were conducted for the total sample, for each cohort separately, and by subgroup when sample sizes were large enough. In addition, logistic regression models were created with AT as a predictor of employment and U.S. Social Security Administration (SSA) benefits data for adjustment of potentially confounding factors, such as disability severity, health status, hospitalization, physical activity level, functional status, and comorbid conditions.


There were no control or comparison groups.


The average number of devices identified in the NPPD (mean ± SD = 10.53 ± 9.57) was significantly (p < 0.001) greater than the average number of devices reported by the veterans (mean ± SD = 2.57 ± 2.01) between 1998 and 2002 (Table 5). The most notable discrepancy between the two sources is the number of MMIL devices. A similar pattern was observed with regard to device repair history. Overall, as shown in Table 6, the number of repairs recorded in the NPPD was more than four times greater than the number of repairs self-reported by veterans. From 1998 to 2002, the average cost per device per person across all device categories was mean ± SD = $2,155.20 ± $2,210.90 for the civilians and $2,032.40 ± $2,559.90 for veterans. No significant differences were found between groups for disability severity, cost data for individuals with paraplegia and tetraplegia were combined across the civilian and the veteran groups. As expected, the total average cost per person for all devices was significantly greater for respondents with tetraplegia (mean ± SD = $2,972.29 ± $2463.70) compared with those with paraplegia ($1,621.90 ± $2,011.00), which corresponded to their ownership of more AT devices overall.

The civilians were significantly more likely to be working at the time of interview or to have worked for pay in the past 5 years compared with the veterans (91% and 30%, respectively. At the time of the interview, 73 percent of the civilians reported they were working at a job for pay compared with only 18 percent of the veterans. Further, of those respondents who were not currently employed, 18 percent of the civilians had worked for pay during the 5 years prior to the interview, while only 12 percent of the veterans had done so. The majority of veterans, 70 percent, reported that they had not worked in the 5 years prior to the interview compared with only 8.6 percent of the civilians. Although no significant predictors of employment were found in the logistic models for the civilians, several factors were found that potentially affect employment status for veterans. Specifically, one factor identified in multivariate logistic regression that increased the probability of employment was an education level of bachelor's degree or above (increased odds 15.4).

The civilians who were working at the time of interview or who had worked during the 5 years prior to the interview (n = 86) reported owning 400 different types of devices, 80 percent of which were subsequently identified as important to work. The majority (59%) of all devices identified by the civilians as being important to work were in the Manual Mobility and Independent Living (MMIL) device category. In addition, Powered Mobility and Independent Living (PMIL) devices accounted for 24 percent, Assistive Computer Technology (ACT) devices for 8 percent, and Prosthetics & Orthotics (P&O) devices for 6 percent. The specific devices identified as most important to work by the civilians were motorized wheelchairs, foot/leg braces and prosthetics, arm/hand braces and prosthetics, manual-exercise devices, manual computer input devices, powered environmental control devices, adjustable-height workstations, adaptive telephone equipment, and Augmentative and Alternative Communication Device (AACD).

The veterans who were employed or who reported working during the 5 years preceding the interview (n = 29) reported owning 88 different types of devices, 77 percent of which were characterized as being important to work. The majority of all devices identified by these veterans as important to work were MMIL devices (57%). The AT devices most frequently identified as being important to work by the veterans were manual wheelchairs, manual independent living devices, ambulatory support devices, motorized wheelchairs, and residential control devices. For total devices overall, 91 percent of ambulatory support devices (e.g., crutches, canes, walkers), 83 percent of manual independent living devices (e.g., reachers), 80 percent of residential control devices (e.g., power door operators), 71 percent of manual motor vehicle control devices, 50 percent of environmental control and magnification devices, and 43 percent of arm/hand prosthetics or braces were identified by civilians and veterans as being important to work.

Overall, the average cost of devices reported as important to work was significantly greater than the average cost of devices with little or no work importance (t(373) = 5.60; p < 0.001. AACD was the only device category for which the mean cost of devices reported as not important for work exceeded that of the AACD identified as important to work (t(127) = 2.40; p = 0.02).


The results indicate that AT ownership and use relates to and is important for employment success of persons with SCI/D. In terms of the cost of AT, devices identified as important to work were 3.5 times more expensive than other devices. However, research suggests that employers must recognize that these costs represent investments in that they serve to enhance employee retention and productivity. The more frequent use of AT and corresponding increase in AT expenditures by persons with greater disability severity may indicate that these individuals are endeavoring to compensate for functional limitations with AT. Since improved functional status is significantly associated with employment, future research efforts might investigate the extent to which individuals with SCI/D maximize their use of AT to ameliorate the limitations of their conditions and to pursue employment.

URL http://www.ncbi.nlm.nih.gov/pubmed/16847785
Populations Male & Female | Veterans
Outcomes Employment acquisition
Research Design Observational
Peer Reviewed Yes