Designed by Those Who Don't Need It

Assistive technology (AT) — prosthetics, wheelchairs, communication devices, adaptive interfaces — is overwhelmingly designed by non-disabled engineers optimizing for clinical function metrics rather than the daily-life priorities of disabled users. The WHO estimates that 2.5 billion people need at least one assistive product, yet only 10% of those in need have access — and of those who do, abandonment rates are 30–50% within the first year. The abandonment is not primarily due to device malfunction but to design decisions that reflect clinician and engineer priorities (range of motion scores, grip strength, aesthetics that approximate "normal" bodies) rather than user priorities (social acceptability, ease of donning/doffing, compatibility with actual daily activities, repairability, customizability). The design process typically positions disabled users as passive recipients of expert assessment rather than as design authorities.

AT abandonment wastes an estimated $8–12 billion annually in unused devices globally and leaves disabled users without tools they need. The deeper cost is opportunity: well-designed AT can transform employment, education, and social participation, while poorly designed AT can reinforce dependence and marginalization. The growing DIY-AT and "crip technoscience" movements — in which disabled people design and fabricate their own assistive devices — demonstrate that when users control the design process, they produce solutions that professional designers miss entirely (e.g., adaptive gaming controllers, custom wheelchair accessories, 3D-printed utensil holders designed for specific grip patterns).

Co-design methodologies where disabled users hold decision-making authority throughout the design process — not as "user testers" at the end but as design leads from concept development. Modular AT platforms that users can customize without engineering expertise, enabling the DIY-AT innovation pattern at lower technical skill thresholds. Procurement reform that funds outcomes (participation, independence, user satisfaction) rather than product categories, enabling custom solutions. Integration of disability studies perspectives into engineering education, shifting the design lens from "fix the deficit" to "enable the person."

A team could partner with a disability advocacy organization to co-design an assistive device using a methodology where disabled co-designers lead the design process and engineering students provide technical expertise on demand, then document how the resulting design differs from what an engineer-led process would have produced. A design research team could study AT abandonment by interviewing disabled users about why they stopped using prescribed devices and identifying the design decisions that drove abandonment. Relevant disciplines: design, rehabilitation engineering, disability studies, human-computer interaction.