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.

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Access to appropriate and affordable assistive technology is a human rights, a public health, and a development priority. This chapter elaborates on these aspects and illustrates the various opportunities and barriers to achieving equitable access to assistive technology through four specific country snapshots. In Brazil, mobility aids are provided through the universal health coverage in rehabilitation reference centers in urban areas. A community-based rehabilitation pilot project in Argentina demonstrates how to reach to an excluded indigenous community. A rapidly developing national legal framework in Colombia with imminent implementation challenges is showcased, as well as a technology transfer model in India.

This article considers the lives of disabled people requiring assistive technology who live in contexts of urban poverty. Provision is often constrained by a range of contextual factors which seem outside the scope of health and rehabilitation services. We critically reflect on health, rehabilitation, and capabilities approaches. We explore both rehabilitation and capabilities approaches with posture and mobility practice in an area of urban poverty in Argentina. Contrasting rehabilitation and capabilities approaches to a composite posture and mobility case provides a range of insights. Rehabilitation approaches start with the individual as the locus for intervention. Capabilities approaches reframe interventions such as posture and mobility in terms of the freedoms they offer, and highlight the barriers or capability gaps that must be addressed to achieve outcomes. We conclude that capabilities approaches give practitioners the scope to go beyond posture and mobility processes and attend to the other factors, across the ecosystem, that prevent people from realizing their freedoms. To address capability gaps, a broader scope of practice for health practitioners may include consumer empowerment strategies; partnering with the community; and systemic advocacy with duty holders able to address systemic barriers.

Introduction Valid and reliable scores from measurement tools to test competency in basic manual wheelchair-service-provision are needed to promote good practice and support capacity building. The International Society of Wheelchair Professionals’ (ISWP) Basic Test Version 1 in English, launched in 2015, is the most frequently used outcome measure tool to test basic manual wheelchair-service-provision knowledge and is part of an international certification process. Despite the wide acceptance and use of the test, its psychometric properties have not yet been established. The objectives of this study were 1) to evaluate the test’s psychometric properties, 2) to develop the test’s Version 2, and 3) to evaluate the content validity of the new version. Methods For Objective 1, methods from the Classical Test Theory were used to obtain items’ difficulty, item discrimination index and domains’ reliability. For Objective 2, a team of experts in wheelchair service delivery and education conducted a systematic qualitative review of the questions’ text and answers and updated them using evidence-based guidelines. For Objective 3, an external team reviewed the clarity, relevance and domain allocation of the developed items using a 4-point Likert scale. Descriptive statistics were used to describe and characterize the results for each objective. Item-content (I-CVI) and Scale-content (S-CVI) validity indexes were calculated to compute content validity. Results For Objective 1, all domains in the test were below the threshold for acceptable internal consistency reliability; 80% of the total test pool (116 items from the total pool of 145) did not meet the thresholds for item difficulty and index of discrimination suggested in the literature. Of the items in the Test, 78% could be responded to intuitively and 66% did not distinguish between test-takers who were knowledgeable in the content area and those who were not. For Objective 2, experts found concerns such as items being grouped in the wrong domain, being repeated, not using person-first language, and using terms inconsistently. Thirty-four (23.4%) items were dropped and 111 (76.5%) were updated. In addition, 61 new items were developed. Members re-categorized the items and proposed a new classification of subdomains. For Objective 3, good agreement between subject-matter experts was found; the S-CVI calculated using the I-CVIs related to item clarity was 84% while using the I-CVIs related to item relevance was 98%. Only 7 items (4.1%) were deemed to be in the wrong domain and 4 items (2.3%) were considered irrelevant and dropped. Conclusion The psychometric evidence in support of ISWP Basic Test Version 1 in English is suboptimal. A new set of items developed by experts in the field has shown excellent content validity. Ongoing assessments will be needed as ISWP Basic Test Version 2 is implemented and monitored.