Enhancement of QOL is an accepted goal of rehabilitation, and its study is becoming very important in the field of rehabilitation psychology. Originally, QOL was an area that had been dominated by economists, sociologists, and some other social scientists. The first public mention of QOL was in a speech by an early spokesperson for President Johnson in which it was stated:
The task of the Great Society is to ensure our people the environment, the capacities, and the social structures that will give them a meaningful chance to pursue their individual happiness. Thus the Great Society is concerned not with how much, but with how good—not with the quantity of the goods, but with the quality of our lives.
But a close reading of the speech suggests that what was really discussed was standard of life rather than its quality, as noted in the emphasis on the interaction between the person and the environment. In fact, the people assigned to assess whether people were getting what was being promised were economists and sociologists, and they defined QOL in terms of the nature of the environment and the assets that people possessed. Thus they would include "domains," such as "number and quality of parks in the district," "the number of robberies in the community," and "the number of television sets in the home." Different people chose to include different domains in their final indices of QOL, and so the index varied with the researcher. Although this seemed to them to be an acceptable way of conceptualizing and measuring QOL, it was rejected by others in different countries who argued that one could have an equally high QOL without the greater abundance of goods and conditions found in the United States. In fact, comparisons of QOL of people in different communities generally failed to indicate significant differences.
Psychologists also argued that one should avoid concentration on being "well-off' and focus on a concern of "well-being." Furthermore, they argued that personal satisfaction with one's standard of life was the key to understanding the meaning of QOL and that one might possess very little but be satisfied or dissatisfied with whatever one had.
If we are to understand the impact of AT on a consumer, we must be aware that there are different impacts, each of which depends on the nature of the consumer and that of the device or program. The best analogy is probably that of the pyramid postulated by Maslow to illustrate the hierarchy of needs. In the bottom levels, he argued, are found the biological needs, and these must be gratified before the next levels become potent. The middle levels are the personenvironment interactions in which the individual strives to gain reward from the surrounding world, including both external and internal environments. Finally, at the peak, which Maslow termed self-actualization, is the need for inner satisfaction from life as a whole and the search for fulfillment of the needs for satisfaction in life experience.
Similarly, AT impacts on comparable levels. At the lowest level we find that the impact is biological and serves to extend life biologically. This can be termed quantity of life. Mechanical ventilation for people with ALS disease is an example of where AT has its strongest impact. At the intermediate level one finds that the impact is mainly on the standard of life. Wheelchairs, for example, impact on consumers so that they can interact more easily with the environment. At the peak of the pyramid, the impact is on the QOL, a term that should be reserved to denote the inner satisfaction derived from the assessment of the whole life process. Consumers find that by utilizing AT they are more satisfied with their lives and have greater self-confidence in their actions. Although AT can impact on all three levels, most AT devices impact on both the standard of life and the QOL levels.
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