Engineering for Disability

GURU MADHAVAN

Picture a wheelchair user navigating city streets, their movement made fluid by advanced materials and thoughtful design. Imagine someone with hearing loss, experiencing music through the precision of cochlear implants. The link between disability and technology tells a complex story. One that challenges our perspectives, expands possibilities, and probes profound questions about the human experience. Yet, as we celebrate these advances, we must confront the shadow of techno ableism, the flawed assumption that technology should fix disability rather than embrace human diversity. When we see disability only as a problem for technology to solve, we miss the rich, complex experiences of those living with disabilities.

ASHLEY SHEW

I'm always really impressed and surprised by the conversations that we have, where disabled people often notice different things about the built environment. That non disabled people wouldn't.

RORY COOPER

You know, my wheelchair is more or less like somebody else's shoes. If you go jogging or dancing, you know, one set of shoes. I've a racing chair and I have a hand cycle and I'm on my everyday chair. And to me, they're just tools

GURU MADHAVAN

I am Guru Madhavan. Join me in a conversation with professors Rory Cooper from the University of Pittsburgh and Ashley Shew from Virginia Tech to explore the landscape of disability and technology and how we can and should reshape our understanding of human potential and the potential of engineering. Rory and Ashley. Let’s start with how assistive technology helps you navigate daily life.

RORY COOPER

Thank you. It's a pleasure to speak with you today. I was injured while serving in the army in Europe many years ago, it was a beautiful summer day and I was exercising using my bicycle. As I was riding down the bike lane there was a cut out for a bus stop and I started to pass the bus and the bus driver apparently didn't see me when he decided to pull out in the traffic and he pushed me head on into a truck coming in the opposite direction. We collided, as you might expect, I bounced off the front of the truck and was laying on the street and I was actually conscious and realised I couldn't walk and that was because of the spinal cord injury that resulted from the accident. I had to undergo several months of treatment before I was able to get into rehab. But after I was into rehab, I got introduced to adaptive sports pretty quickly, since I was an athlete in high school and in the Army. That was attractive to me, and I learned a lot of my life skills and mobility skills from veterans and other fellow athletes, and eventually wound up to compete in the Paralympic Games. Pretty much everything I do involves some form of technology. There might be a modified bed that my wife and I sleep on. I get up in the morning and get into my wheelchair. My wheelchair has really become sort of an extension of me. It fits me very carefully. And it helps provide good postural support as well as reduce my risk of pressure injuries. I have a driver car with hand controls, because I don't have use of my legs. I actually have an accessible office, accessible workstation at my office. And, depending on the day, our lab and shop facilities are also accessible. So I can use various pieces of equipment or machinery.

GURU MADHAVAN

Thank you, Rory. So Ashley, we'll go to you. So if you want to talk a little bit about your personal story and then get to how assistive technology helps you in your daily life.

ASHLEY SHEW

You know, I feel fine talking about my origin story, I'm an amputee and some of what happened to people you're asking them to relive the worst day of their life … for some amputees it’s the best day of their life, right? If they're getting rid of a leg that has given them hell for a long period of time, the amputation isn't the bad thing. It's getting rid of that leg that tried to kill them. That's something I think about a lot. I actually knew I was going to be an amputee three months ahead of my amputation. I had a type of bone cancer. I have disabilities from my treatment for cancer that include hearing loss, tinnitus, I have chemo brain, so things are a little bit disorganized, as you might have noticed by my answer so far. If you're asking about disability related technologies, I'm wearing hearing aids. I, like Rory, wake up each day disabled in a particular way, which is to say, I get in my platform walker and I roll to my shower and I use my grab bars and my shower chair before I, you know, seal myself into a leg. Things that I'll rely on for the rest of the day.

GURU MADHAVAN

So both of you have spoken about the idea of fixing disability as problematic. Could you explain why and maybe what it means or how we should actually think about technology?

ASHLEY SHEW

Yeah, so disability is lots of things, but if you're thinking we need to fix disability and you're very non specific with that, you are probably being pretty ableist with how you view people, right? If your idea of disability is that disability represents a wrong way to be in the world, represents some sort of incompleteness on the part of another human being, requires intervention and monitoring and sort of paternalism about how people's bodies and minds are oriented in the world, then you might be headed down a rocky pathway where the people you think you're helping, you're actually insulting along the way. By which I mean something like … A lot of the ways in which we think about technologies for disability, tell us something about how we think about disability, right? Say something about what we think is the right way to exist in the world. And if your approach to disability as a big concept is that disabled people all need fixing, it's sort of in denial of the sort of complicated bodies and minds we all have, right? Even for those of us who might be interested in cure type things, we have to live with the bodies and the minds that we have now. And we're complete people with rich lives. And we want lots of things. And a lot of us aren't fixated on a cure. What I think about in terms of technology for people with disabilities is often sort of the structural ways in which we are excluded. And a lot of it's in the way we build things, the way we plan things. The way we have certain expectations of people, the way we care about communicating in particular ways. I want more ways of being in the world and being good. And so much of this impetus to always fix disability suggests that there's no way to be good in this world and be disabled at the same time.

RORY COOPER

So I'm an engineer, so I'm a little more of a pragmatist, maybe. You know, technology is a tool, right? And so if we're using, you know, microphones and cameras, and you're sitting in a chair … they're just tools. That's how I sort of think about it. When I'm using my hand cycle on the bike trail, and somebody asks me, whoa, what is that? I said, really, it's basically, just a bicycle, you know, for me, right? So I think to me, it's more that just people sort of medicalise technology in some ways for people with disabilities. I try to give the people the example, you know, my wheelchair is more or less like somebody else's shoes. If you go jogging or dancing, you know, one set of shoes. Depending on where your work place is, different pair of shoes. And so, you know, I have a racing chair and I have a hand cycle and I have my everyday chair and I have a chair that I use in the shop or in the garden and to me they're just tools. Of course, a lot of people in the United States, and more so around the world, don't have access to appropriate technologies so they can fully participate in society. So I really would like to see technology more looked at two things. One, to design technology so that it becomes integrated with the user and sort of an extension itself, and that could be not only from function but also from form and how it looks and how it appears because it also will let people express themselves that way. And then make sure that we have access to appropriate technologies so people can fully participate in society. So whether that's such things as closed captioning, or alternative text descriptions, or text on cell phones, automated communication devices, computer access devices, they're all tools. But the real goal is to provide people with function and to be able to participate in society. They're not really that much different in some way than, you know, a hammer or a screwdriver or a computer or a mouse or any one of those things for everybody else, right? The difference being that the impact on people's life is tremendous.

GURU MADHAVAN

So, Rory, which makes me ask, what are some examples where innovations for disability have unexpectedly shaped mainstream technology?

RORY COOPER

Probably the one that's on everybody's mind right now is AI, generative AI. The first customers and first adopters of generative AI were people with disabilities. So it started out really as sort of spell check, word prediction, sentence prediction, or phrase prediction. Texting … almost everybody in the world has a mobile phone. I've joked in other presentations where, you know, probably more kids and youths are texting than hearing impaired individuals, although it was originally intended as an accommodation for hearing impaired individuals. But there's other stippler technologies that people see every day and don't necessarily think about, like curb cuts. Probably more people with strollers and delivery people use curb cuts than wheelchair users. Myself, when I go down the street, I notice almost everybody likes to use the curb cut. You have to sort of navigate your way around the pedestrians to get to the curb cut for your wheelchair user. I mean, there's other simple things you don't even think about. They're not necessarily considered assistive technologies, but they could be, even as just a knife, a fork, and a spoon, right? So you're not eating your food with your bare hands or, you know, off a skewer, right?

GURU MADHAVAN

So, Ashley, you argued that disability fosters unique forms of creativity in engineering. So how do we inspire innovations that go beyond their initial purpose?

ASHLEY SHEW

Yeah. So I like this question because a lot of times disabled people are talked over by non disabled people who are poised as experts about disability, right? We often engage with the medical system that sorts us, diagnoses us, you know, the ways in which scientists and engineers often think about disabled people is not necessarily in conversation with disabled people. And I think one of the things that I really enjoy in the sort of work I do is having sort of a diverse set of disabled people having conversations about technology amongst themselves. And I'm always really impressed and surprised by the conversations that we have, where disabled people often notice different things about the built environment that non disabled people wouldn't, or they notice different things about how they can use a technology, the sort of affordances a technology has or doesn't have that might be more desirable in its design. I think Rory points to all of these great examples of, you know, technologies that were created with disabled people in mind. But benefit a wide variety of people that aren't disabled as well. This is called the curb cut effect. It's so consistent that they have a whole name for it based on curb cuts. You know, when I think about what it is to make interesting and creative designs and to think a little bit differently, like having a different perspective on the world, understanding that some curb cuts are better than others, the sort of affordances and the different angles things are at, like you've had to move your body over a surface in a way that, you know, you're going to notice things about architectural design. As an amputee, I can tell you about the flooring of every place that I've been in the past 10 years. And part of that is I'm always looking down. I'm very worried about tripping. But also I notice if a floor is slightly slanted or off, I can tell you. If a floor is going to be slippery under particular conditions, I can tell you, especially when it comes to like construction and building design. There's so much that I think people with mobility disabilities notice. I also think about, you know, as someone who is hard of hearing the acoustics of a space matter in ways that we don't often talk about. Like I think about how popular closed captioning has become, in part because so many of our television shows have poorer audio quality than they used to, right? We're noticing things about the world. I think about my friends who are neurodivergent in various ways. So people who are autistic or have ADHD, they often notice things about lighting design that wouldn't have occurred to me, right? That there are fluorescent lights and those are really hard to sit under for eight hours a day and that they make this buzzing noise that's very distracting to particular types of people and that they can set off things like migraine and, you know, cause eye strain. Like noticing all of these sort of design elements in the world actually helps you create better spaces to exist in. One of the things I get to do in my work is not think about any one particular type of disability. I'm always thinking about cross disability research. Engaging other disabled people in conversations about, like, how do we make something that works for all of us? I think about the ways in which deaf people and blind people have contributed to so many of our internet technologies in ways we barely even think about anymore. Andrew Leland has a wonderful chapter in his book about the sort of history of blind people, their role in forging the computer technologies we have today. And it blows me away.

GURU MADHAVAN

So Rory, how do we ensure that technology enhances independence rather than replacing it?

RORY COOPER

I mean, the best technology is that it helps enhance independence for everybody. So I like the term autonomy better than independence. Frankly, I don't think it's a desire of most humans to go and live on an isolated island by themselves to make their own fire and utensils and food. And autonomy really means that we are self directed, right? So, one of the things I had to learn very early on was to accept assistance from others. I think that actually is a strength of people with disabilities often is that you learn … you actually learn two things, sort of time management and learning assistance from others. But the environment's really important to that as well. The London cabs are a perfectly good example. The metro system or the subway system in London is not totally accessible. Washington D. C. started out not being accessible and has become largely accessible and you can just see how that changes mobility patterns of everybody and makes the city more inclusive to people with disabilities. London, you see the same thing. The solution was to modify all the cabs. They're not totally accessible, but they are a pretty good step in the right direction, I would say. It's a partial solution to overcome another problem, right? You know, the advantage is it helps, again, like the curb cut situation, right? You've got packages, or you've got a stroller or multiple kids, or maybe even a small refrigerator like a lot of Europeans have, you've got to squeeze that in a London cab. Really, like, the goal is, I think, to enable people to have autonomy and be included in society so they can make decisions. I think one of the things that we haven't talked about that's really important is spontaneity. So the ability to sort of like, you know, if a friend calls and says, how would you like to go to dinner? Having the ability to do that without having to plan days in advance. How am I going to get there? How am I going to get back? Is the restaurant going to be accessible? Am I going to be able to get to a seat? So the more we think about it in those terms, that we allow people autonomy and spontaneity, then we can create societies that are more inclusive as one another. Another part of it is also attitudes. When I was first injured, kids would run up to me and they'd want to, a lot of them, they'd want to grab the back of my wheelchair and sort of push me along or ride along on the back of the wheelchair, and then you had parents that say, oh, please don't bother the poor man. So I usually try to use that as an educational moment to explain that it's okay, right? Kids want to learn. It should be just part of exploring life. It'd be no different than if you were walking down the street with a cute dog or, you know, had a cat with you or something like that. It’s just something that's going to be attractive because it's a little bit different. I think that is an opportunity to explain to kids. Oh, this is a guy who uses a wheelchair to get around. It's just like you walking on your legs, but just a bit different. And it helps them get from point A to point B. And since this is about engineering, I also think it's important that we do get people out that are role models and can be mentors as well, because people with disabilities themselves also need to see themselves included in different fields. So it's a lot easier to be it if you can see it.

ASHLEY SHEW

I really appreciate this answer about autonomy and spontaneity going together, right? I think about what it is to like roll out with a group of disabled friends with different types of food allergies and different types of mobility and different, you know, needs in terms of lighting and acoustics. And I don't think every disabled get together should be this arduous to form. You know, we end up going to the same place all the time where we know we can each access. You know, I think in terms of the question about enhancing independence, I'm going to probably give you a more anxiety producing answer. I would love it if our bodies weren't so tied to corporations. By which I mean, disabled people often have less autonomy over technological choices in certain regards, right? If I want to get a new leg, I have to talk to a surgeon I used 10 years ago to write the prescription, and then it has to be approved by my insurance agent, and if I want two devices, you can forget about it. It costs time and energy to do all of these things. The way in which a lot of technologies are structured, how to get them, how to use them, even like what we're supposed to be giving up in terms of data. So Rory mentions generative AI and the way some disabled people are using it. I think about the ways in which so many social media platforms like gather all this data on us and then can sell advertising space and we're the product, we're the product. And disabled people so often, we're caught up in these larger structures that everyone is, but that press on us particularly hard. And I'm really worried about the use of AI, where it comes to like determining benefits assessments, not all disabled people can work. Not all disabled people can work full time. I think we should still be allowed to live and have good lives, even in the absence of being able to work or work full time. And I think we should be able to get the technologies we need. And there are so many different insurance companies, they're going to be using AI in ways that make it easier for them to dismiss claims. I know friends in the UK who are very worried about benefits assessments and how those are going to be automated with AI. When I talk about, you know, my friends having these hard technological choices … when we are using these technologies, we are actually made more vulnerable. And yes, they are enabling. I can do lots of things with a particular type of technology, but what if it fails? What if I need maintenance? This sort of system for maintenance of wheelchairs in the United States is an atrocity. The amount of time people have to wait for basic repairs to wheelchairs. It's hard for me to get super excited about new disabled innovations when I know most people won't be able to afford them. And even if they can afford them, getting them maintained is a second project beyond that, that takes a lot of time and money and privilege to be able to navigate so many of these systems. I worry about people who are getting, you know, devices implanted where corporations stop working on that line of technologies. We had a recent case in India where the cochlear implants, a U S based company had sold at low cost to the Indian government. They decided not to do any tech support or maintenance. And they stopped carrying that line of cochlear implants and it meant that kids who'd gotten the cochlear implants in low income Indian families, they can't afford to replace the thing that's surgically implanted in their kid's head. I think about the Argus 2 retinal implant case where Second Sight decided they weren't going to maintain or even do anything with retinal plants anymore after 250 people had the retinal implants. I love that we can make these choices, but these choices often commit us to technological systems that don't have our best interests at heart. And I feel like that is something a lot of non disabled people don't recognize about this experience of disability, especially, you know, when it's something that is implanted in your body, especially when it's these high tech devices that everyone wants to sell us and is so excited about. Our lives are at stake in so many of these things in ways that I think it's really hard for non disabled people to have an awareness about in the way they should.

GURU MADHAVAN

For millions living with disabilities, each interaction with their environment is a testament to the promise and pitfalls of innovation. Technology has the power to liberate, to connect, to empower. But it also has the potential to marginalise, stigmatise, and perpetuate limiting definitions of what we call normal. The real question before us isn't just about what technology can do, but about its purpose. Are we genuinely serving diverse human needs? Or are we simply reinforcing narrow ideas about how bodies and minds should function? And importantly, what it means to be human in an increasingly technological world. Thanks for listening to Create The Future, a podcast from the Queen Elizabeth Prize for Engineering and Peanut & Crumb. Look out for new episodes every two weeks and follow QEPrize on social channels, Instagram, Facebook, and X. This show was produced by Eva Krysiak and until next time, this is your host, Guru Madhavan.