Technology, trends, and the future for people with spinal cord injury.

Technology is one of the most powerful tools that can be provided to people with spinal cord injuries (SCI). It is widely accepted among user and clinical communities that wheelchairs can be tremendously empowering when properly selected, fitted, and the users are adequately trained. Unfortunately, wheelchair users are being negatively impacted by misguided changes in reimbursement for wheelchairs and associated technology resulting in them obtaining lower quality products. To make matters worse, newly injured people rarely receive sufficient training in wheelchair skills and maintenance, leading to premature wheelchair failure, injuries and down-time for users, and higher barriers to community participation. Conversely, new technologies show promise to increase the capabilities of people with SCI, but will trends change and make these technologies available and reimbursable? Science must push ahead and show the possibilities, while advocacy must drive policy to catch up. Participatory action design (ie. the inclusion of end-users extensively throughout the research, design and development process) is a growing trend and will likely become a de facto norm over time. At some point, engineering, science, clinical service, and public policy will embrace the "Screams of Nothing About Us Without Us" from people with SCI and the advocacy community. People with SCI rely heavily on a wide variety of technology to maintain health and to participate in life's activities. Some technology is obvious to the casual observer, such as wheelchairs, whereas others are incorporated in universal design, such as curb-cuts, automated doors openers, and computer-operating systems. As the world has become more technologically advanced, it has become more accessible for people with SCI in many regards. For example, cellular phones provide ready communication, help make people safer, and will likely become a standard means of providing education, coaching performance, and helping to maintain health. Many new technologies are emerging or improving at a substantial rate, which is a hopeful sign in light of declining state and federal research expenditures. A bright spot is the growing interest from industry, and the perspective that people with SCI are a viable commercial market. With successful employment initiatives, more will become employed, thus increasing their discretionary income, and expanding their voice for positive change. Some clear patterns seem to be emerging: wearable or wheelchair mounted sensors are becoming ubiquitous, which will expand the use of the “medical home model” and “rehabilitation in the natural environment”; robotic and intelligent systems are likely to transform the quality of life and independence of people with SCI in years to come; flexible manufacturing and additive fabrication (e.g. 3D printing) will transform practice, manufacturing, and research; wheelchairs remain essential means of mobility and support for people with SCI, with much that remains to be understood and translated into practice; and sports are an essential, yet under-utilized modality of rehabilitation, community reintegration, and long-term health. Scientists, engineers, and clinicians with SCI are growing in number and gradually, but steadily, changing the research landscape. Ideally, in the future, we will see more teams of scientists, engineers, and clinicians that include people with and without SCI working together to conduct pioneering research, to create transformational technology, and to establish model clinical programs. Assuredly, technology will play a major role to make this vision of the future become reality.