Phys Med Rehab Kuror 2015; 25 - IS16
DOI: 10.1055/s-0035-1554829

Enabling Environment

R Andrich 1
  • 1IRCCS Fondazione Don Carlo Gnocchi, Milano, IT

As stated by the ICF model of the World Health Organization (WHO, 2001), environmental factors may act as facilitators or barriers in the persons' life, leading to improved or reduced functioning respectively. Accessibility of public facilities and services, usability of mainstream products and goods, assistive technology products, individual home adaptations, worksite accommodations and personal assistance, are examples of environmental factors that contribute – if well designed, chosen, implemented and accepted by the person and his or her family – to build up an enabling environment. Indeed disability is often the consequence of inadequate design or lacking organization: "good design enables, bad design disables" (EIDD, 2004). Conversely, appropriate assistive solutions, i.e. proper combinations of well-designed environmental factor, lead to better functioning, according the so called "four 'A's equation" (Assistive technology, environmental Adaptation, personal Assistance = Autonomy) (Andrich et al, 2013). Autonomy – intended as ability to take control over one's own life, to establish relationships with others and actively participate in society – is a broad concept (EUSTAT, 1999). Whether the person wishes to lead an independent life, or live in a sheltered setting, or stay with his/her family, or establish his/her own family, autonomy is a prerequisite for free life choices. However, ensuring that all people with disabilities can access appropriate assistive solutions that able support autonomy in their life environment, is not an easy task. It requires the person's motivations, a wide range of professional competencies, practical trials with assistive products, and a careful assessment process leading to the recommendation or prescription of an individually-tailored assistive solution. It also involves financial support, as assistive solutions are often economically unaffordable for many people. Debates are underway in most countries on how to improve the national assistive technology service delivery systems within the available resources. Currently the systems in force in Europe are based on three main models: the medical, the social and the consumer model (Andrich et al, 2013). The availability of information on assistive products is a key factor in a service delivery system. It empowers people with disabilities and their families, by disseminating awareness, increasing knowledge, helping clarify needs and assisting decisions. Care professionals need it when helping users choose assistive products, training in their usage, designing care, rehabilitation, or education programs. Suppliers and manufacturers need it to know the market, discover opportunities and make their products known. Policy makers and officers of insurances and health authorities find evidence to efficiently allocate resources. Researchers and developers get to know what already exists, which needs are still unmet, what areas are admitting of developments. Today, well-established super-partes national information systems are publicly available on the Internet in many European Countries. Most of them systems take part in the EASTIN Association (European Assistive Technology Information Network) and make available their data also through the EASTIN portal ( to citizens from any Country in all languages of the European Union. Today the EASTIN system has become the European landmark for assistive technology information.

Andrich R, Mathiassen N E, Hoogerwerf E J, Gelderblom G J (2013): Service delivery systems for assistive technology in Europe. Technology and Disability 25(3):127 – 146. DOI 10.3233/TAD-130381 EIDD (2004). The EEID Stockholm declaration. (retrieved 21.4.2015) EUSTAT (1999). Empowering Users through Assistive Technology. Milano: European Commission. World Health Organization (2001). ICF.