Participation and Activity Limitation Survey of 2006: A Profile of Assistive Technology for People with Disabilities
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The nationwide Participation and Activity Limitation Survey (PALS) is designed to collect information on adults and children with disabilities—i.e., whose everyday activities are restricted because of a health condition or other limitation. Funded by Human Resources and Social Development Canada and carried out by Statistics Canada, PALS provides essential information on the prevalence of different disabilities, the types of support available to people with disabilities, their employment profile, income and participation in social activities. This information is used by all levels of government, associations, researchers and non-governmental organizations in planning the services needed by people with activity limitations to enable them to participate fully in all spheres of life.
The latest data on people with disabilities were gathered in 2006, following a previous PALS conducted in 2001. The 2006 PALS provides a measure of variability in the number of people with disabilities and, where possible, changes in their situation over the previous five years. New questions were also added to reflect technological developments and new policy and program data requirements.
This article, the third in a series of releases on PALS data, contains the survey results on specialized equipment and aids for children aged 5 to 14 and adults 15 and older with disabilities. The main themes explored are the use and requirements of such aids and equipment, funding sources, and related obstacles.
Other releases dealing with issues such as employment and income will be issued later in 2008.
The first results were published in December 2007, and examine the prevalence, type and severity of disability, by age and sex (see No. 89-628-X in the catalogue for further information).
Use of specialized equipment and aids
Specialized equipment and aids include those that allow people with disabilities to carry out their daily activities, for example by facilitating movement (wheelchairs, hand and arm supports) or helping them hear, see or communicate (aural prostheses, reading materials in Braille, communication keyboards). However, glasses and contact lenses are not included in this list, as they are commonly used vision aids and most people who wear them say their activities are not limited because of vision problems.
In order to assess the specialized-equipment requirements of people with activity limitations, the 2006 PALS asked respondents about their use of and need for specialized devices for hearing, vision, communication, mobility, agility, pain and learning disabilities, as well as all other specialized equipment or aids. These questions made it possible to distinguish between those individuals who had all the specialized support they needed, those who had some equipment but needed more, and those who did not have any specialised equipment and needed some.
As mentioned previously, the 2006 PALS targeted more than one type of disability. Due to the nature of certain types of disabilities and the structure of the questionnaire, only seven types of disabilities lent themselves to questions on the use and need of specialized equipment and aids. However, a section of the survey gave respondents the opportunity to provide information about other technical equipment and aids that had not been previously reported. Therefore, the results presented in this report refer only to the types of disabilities listed in text box 1 and not the entire PALS population.
Text box 1
Types of disability among adults and children
The Participation and Activity Limitation Survey (PALS) survey questions allow the identification of the following types of disabilities, for which aids are available, among adults and children:
Hearing: Difficulty hearing what is being said in a conversation with one other person, in a conversation with three or more persons, or in a telephone conversation.
Seeing: Difficulty seeing ordinary newsprint or clearly seeing someone's face from 4 metres away (12 feet).
Communication: Difficulty speaking and / or being understood.
Mobility: Difficulty walking half a kilometre or up and down a flight of stairs, about 12 steps without resting, moving from one room to another, carrying an object of 5 kg (10 pounds) for 10 metres (30 feet) or standing for long periods.
Agility: Difficulty bending, dressing and undressing oneself, getting into or out of bed, cutting own toenails, using fingers to grasp or handling objects, reaching in any direction (for example, above one's head) or cutting own food.
Pain*: Limited in the amount or kind of activities that one can do because of a long-term pain that is constant or reoccurs from time to time (for example, recurrent back pain).
Learning: Difficulty learning because of a condition, such as attention problems, hyperactivity or dyslexia.
Other: The survey also collected information on other needs for assistive devices that were not exclusive to a specific disability type. Respondents from any disability type could report any other assistive device needs or usage in this section.
* Applicable only to adult respondents
In 2006, 2.7 million Canadians 15 years and over with disabilities or nearly two-thirds of this population used or needed technical aids or specialized equipment to help them perform one or more daily activities.
Out of the entire adult population with disabilities who used assistive technology, six out of ten had all the equipment they needed (all needs were met), while three out of ten used such equipment but needed more aids (some needs met), and one out of ten had none of the equipment required (no needs met; see table 1).
Changes in the PALS target population – 2001 to 2006
Adult population with disabilities, by the extent of met needs for specialized equipment or aids, Canada, 2006
The level of needs that had been met varied considerably across for the different types of disabilities. Requirements and use were not the same across all disabilities. Individuals using equipment specific to mobility, vision and pain limitations were among the most likely to report having all the equipment they needed, with seven out of ten respondents aged 15 and over reporting their needs had been met (see table 2). Although relatively small in absolute numbers, seven out of ten respondents with communication disabilities (18,800) had none of the technical equipment or aids they required.
Adult population with disabilities, by use of need for specialized equipment or aids and type of disability, Canada, 2006
Age also affected the likelihood of needs being met. People aged 65 and over were the most likely to have all the equipment they needed (68.3%). This proportion falls to about 56% for both people 40 to 64 and those aged 15 to 39 (see table 3). Accordingly, among respondents who stated they had none of the specialized equipment or aids required there was a higher prevalence in the 15 to 39 age group than those aged 65 and over (12.1% vs. 7.0%, respectively).
Adult population with disabilities, by use of need for specialized equipment or aids and age group, Canada, 2006
There were no differences for all needs being met based on gender. Despite an overrepresentation of women (about four hundred thousand more), among those respondents 15 and over needing specialized equipment or aids, the figures for men (60.8%) and women (61.6%) whose requirements had all been met were very similar (see table 4). It should be noted however that women outnumbered men by approximately four hundred thousand. There were important differences, however, among respondents whose requirements for specialized equipment had not been met at all, women represented about half the figure for men (7.5% vs. 13.0% respectively).
Adult population with disabilities, by use of need for specialized equipment or aids and by sex, Canada, 2006
The severity of a disability also revealed some important differences as the level of met needs for technical equipment decreased as severity increased. More than three quarters of people with mild disabilities had all of their needs met (75.9%) compared to less than half of people with very severe disabilities (41.3%) reporting that they had all the assistive technology they needed (see table 5). In fact, people with very severe disabilities were the only group where more people had some met needs than completely met needs (51.9% vs. 41.3%). Also, individuals with a very severe disability are less likely to have no met needs as compared to those with mild or moderate degree of disability.
Adult population with disabilities, by use of need for specialized equipment or aids and severity of disability, Canada, 2006
There was minimal variation among the provinces in the reporting of having needs met. The only exception was residents of the Territories who trailed the national average in terms of having all of their needs met for assistive devices or aids (see table 6).
However, a distinction must be made for unmet needs. As mentioned previously, someone could still have unmet needs, whether or not he or she already used one or more technical devices because they need even more assistive devices — a distinction that likely underlies the different characteristics among people whose requirements have not been met.
Adult population with disabilities, by use of need for specialized equipment or aids and severity of disability, Canada, 2006
People with learning disabilities used the most assistive devices
The average number of assistive devices used by each type of activity limitation is presented in chart 1. People with learning disabilities used far more assistive devices than any other type of disability at 3.8 different types of assistive technology per person. People with mobility limitations used on average the second highest number of assistive devices per person (2.5) followed by those with seeing (2.0). People with communication limitations used the fewest assistive devices at just 1.1 aids per person.
Magnifiers were the most common assistive device for people with seeing limitations
The types of assistive devices also vary dramatically by the type of disability. Some types of disability showed clear patterns where the vast majority of people used the same type of assistive device. For example, 91.3% of people with seeing limitations use magnifiers and 88.0% of people reporting pain limitations used hot or cold aids. Conversely, just 53.3% of people with communication limitations used a computer or keyboard device to communicate and 54.6% of people with agility limitations used grasping tools or reach extenders (see table 7).
People with learning limitations have more unmet needs for assistive devices
There was little variation between the average numbers of unmet needs across the different types of disability; every type of disability needed at least one more assistive device on average. People with learning disabilities needed, on average, 1.6 assistive devices compared to 1.4 aids needed by people with communication limitations and 1.3 aids needed by people with mobility limitations (see chart 2). People with hearing or agility limitations reported very few unmet needs for assistive devices at 1.1 additional aids needed per person.
Mean number of unmet needs for assistive devices by type of disability for adults, Canada, 2006
One third of people with seeing limitations have unmet needs for large print reading materials
There was considerable variation in the unmet needs of people with disabilities between the various disability types. Only about one quarter of people with mobility (23.6%), learning (26.5%), communication (26.6 %) and seeing limitations (29.7%) required the same type of assistive technology. People with hearing limitations reported the most consistent technology needs, with nearly three quarters (72.0%) reporting a need for a hearing aid. The most common assistive technology needs for each disability type are presented in table 8.
Most people with disabilities pay for their assistive devices themselves
For people with disabilities, paying for assistive devices can be a significant additional expense, over and above the necessities such as food, shelter and clothing. The costs of assistive technology can vary dramatically from a few dollars to tens of thousands of dollars. The 2006 Participation and Activity Limitation Survey (PALS) results indicate that most people with disabilities (or their immediate family) had paid for the assistive devices themselves.
When examining who paid the most costs for each assistive device across Canada and by the province or territory of residence, the most striking result was the discrepancy between the sources of payment among the provinces. The largest difference was between Newfoundland and Labrador and British Columbia (see table 9). Newfoundland and Labrador residents were the least likely of all the provinces to have paid for their aids themselves (61.6%) and second to the Territories (58.6%). Conversely, a larger percentage of British Columbia (79.5%) and Ontario (71.9%) residents had paid for their assistive devices themselves. According to the survey results, the Territories (25.2%), Quebec (18.2%) and Alberta (16.5%) had the highest levels of public sector funding of assistive devices while British Columbia trailed the national average significantly (6.9%).
People with learning limitations likely to have paid for their aids
Turning to specific disability types reveals that people with learning limitations were very likely to have paid for their assistive devices themselves (85.9%). People with seeing and mobility limitations were less likely to have done so, at 58.0% and 64.2%, respectively.
Cost is the most frequently cited reason for unmet needs for assistive devices
The cost of purchasing or maintaining assistive devices was the most frequently cited reason for unmet needs, accounting for 56.1% of all unmet needs for assistive devices (see table 10). The "other" category was also a common response for unmet needs (22.3%) and primarily included responses such as not having time to get the aid or currently going through the acquisition process. Not knowing where to get the assistive device accounted for 9.2% of all unmet needs.
Reasons for unmet needs varied considerably by type of disability
There was considerable variation within the specific disability types in terms of the reasons for unmet needs. Cost was the most common reason ranging from a low of 38.0% for people with seeing limitations to a high of 70.3% for people with pain limitations. There was also considerable variation between the disability types for people who did not know where to get the assistive device they needed. People who reported communication, agility and learning limitations were the most likely to be unsure where to obtain their assistive devices (20.0%, 16.2%, and 14.6% respectively) while people with mobility limitations were far more likely to know where to obtain their aids with only 5.9% unsure where to obtain them.
As noted previously, the use of specialized equipment is critical because it can offset barriers to full participation in everyday activities by reducing the impact of – and, in some cases, eliminating – barriers and activity limitations.
The importance of specialized equipment and aids for people with disabilities is highlighted in chart 3. Even with the use of assistive technology, slightly more than half of all people with disabilities (50.8%) experienced difficulty participating in everyday activities at least once per week or more due to their activity limitation (see chart 3).
The proportion of adults who experience difficulty participating in everyday activities, by frequency, for all limitation types, Canada, 2006
Looking at the amount of difficulty experienced in everyday activities by the type of activity limitation also reveals some important differences. Compared to the other types of disability, adults with mobility, agility or pain limitations formed a group with much higher frequencies of difficulty (55.0%, 53.1% and 59.3% respectively), on a daily or weekly basis (see table 11).
Frequency of experiencing difficulty participating in everyday activities for adults with limitations, by limitation type, Canada, 2006
Examining the frequency of difficulty only tells half the story. The other half of the story is the intensity of the difficulty. Slightly more than two out of five adults with activity limitations who experienced difficulty with everyday activities (42.4%) reported that they experienced a lot of difficulty or were completely unable to participate. Only a handful of people reported that their participation was not affected in any way (see chart 4).
Intensity of limitation experienced by adults with disabilities who have difficulties participating in everyday activities, for all limitation types, Canada, 2006
The most frequent types of disability to experience a lot of difficulty or be completely prevented from participating were mobility (45.7%), pain (45.4%), learning (43.4%) and agility (42.5%). This situation indicates the importance, for people with disabilities, of having specialized equipment and aids to carry out everyday activities and fully participate in society (see table 12).
Limitation experienced by adults with disabilities who have difficulties to participate in everyday activities, by all limitation types, Canada, 2006
A small percentage of adults with hearing or communication limitations use sign language
For people with hearing or communication limitations, another important aid to facilitate social participation is the use of sign language. There were approximately 35,500 adults in Canada in 2006 with a hearing or a communication limitation who used sign language, representing less than 1% of all adults with disabilities in Canada, and only 2.3% of all adults with a hearing or a communication limitation. Given their small numbers, the results for provinces and territories should be used with caution. Nevertheless, Ontario had the largest population of adults using sign language (13,500 persons), with 38.1% of all sign language users in Canada residing in Ontario. Although the smallest proportion of Canadian sign language users resided in one of the three territories (0.8E%) they constituted 3.4% of the total population with disabilities in the territories which is higher than any other region in Canada. There also appears to be regional clusters of sign language users. For instance, British Columbia alone had nearly the same number of sign language users as in Manitoba, Saskatchewan and Alberta combined (see table 13).
Adults with a hearing or communication limitations who use sign language by Regions, Canada, 2006
Almost half of sign language users use American Sign Language
There were 1,266,120 adults in Canada in 2006 who reported a hearing limitation but not necessarily a communication limitation. This group consisted of 25,370 (2.0%) people who reported using sign language. American Sign Language (ASL) users constituted nearly half of this group (49.8%) while approximately one quarter (27.1%) used another type of sign language aside from LSQ to communicate. These other types of sign language included a language specific to the geographical region of residence, body language and gestures, and some reported inventing their own form of sign language.
60% of adults with a hearing limitation experience only some hearing loss
The degree and duration of hearing loss in adults can vary dramatically so the 2006 Participation and Activity Limitation Survey (PALS) collected data for people who considered themselves to be deaf, deafened, hard of hearing or experiencing some hearing loss.
The largest proportion (60.8%) of adults with a hearing limitation reported they experience some hearing loss and more than one quarter (28.2%) are hard of hearing. In absolute numbers, Ontario and Quebec were home to most deafened adults in Canada. Together, these two provinces accounted for approximately three-quarters of all deafened adults in Canada.
Among respondents with a hearing limitation, 2.0% did not believe they belonged to one of the given categories. Many of those people reported having difficulties with specific tones, having different degrees of limitation in each ear, or experience a hearing limitation due to a diagnosed health condition (see table 14).
Half of the sign language users with a hearing limitation never use a language interpreter
Nearly one half of all people with a hearing limitation in Canada in 2006 who used sign language said they never used the services of a language interpreter. Those who did use the services were split evenly among the two frequency categories, 16.7% used the services at least once per week or more and 16.3% said they use the services from at least once a month to less than once every 6 months (see table 15).
The frequency of using a language interpreter by adults with a hearing limitation, Canada, 2006
The latter half of this report focuses exclusively on children aged 5 to 14 who have an activity limitation and use assistive aids and devices. It should be noted that children's use and need for assistive devices specifically to help with their education is covered in a separate report titled 'Profile of Education for Children with Disabilities in Canada' to be released in May 2008.
In 2006, 90,480 children aged 5 to 14 used or needed assistive technology to help them participate in their daily activities, representing slightly more than half (51.8%) of all children with disabilities in that age group in Canada.
Slightly less than half of all children's needs for assistive technology were met completely
Considering all of the needs for assistive technology reported by children needing or using this technology, Participation and Activity Limitation Survey (PALS) 2006 found that slightly less than half of all children's needs for assistive technology were met completely (45.3%), one quarter had none of the assistive technology they needed, (24.6%) and the remaining third had some of the equipment they required but needed more (30.1%; see table 16).
Use and need for assistive technology for children aged 5 to 14 with disabilities, in Canada, 2006
Overall, the provinces were relatively similar in terms of needs for assistive technology being met but there was some variation. For example, Prince Edward Island had a rather low rate of completely met needs for any province or territory (37.6%) and also a relatively low rate of completely unmet needs (19.6%), leaving 42.8% of people in this province with some met needs. Percentages of those with completely met needs are relatively even across the country ranging from 37.5% to 53.2%. Saskatchewan (53.2%), Nova Scotia (52.3%) and Newfoundland and Labrador (52.2%) are the provinces on the higher end of this range. Manitoba (33.8%) and Quebec (30.2%) are the only two provinces where more than 30% of all disabled children have completely unmet needs while in other provinces and territories in Canada less than a quarter of children with disabilities have completely unmet needs (see table 17).
Use and need for assistive technology for children aged 5 to 14 with disabilities, by province and territories, Canada, 2006
Many children with communication or seeing limitations have only partially met needs
A high proportion of children with communication limitations (51.5%) and seeing limitations (49.1%) have only partially met needs in terms of disability aids (see table 18). Previous Participation and Activity Limitation Survey (PALS) releases have noted that mobility and agility limitations are related, which is further supported by the fact that they follow a similar pattern in terms of needs. A high proportion of children with either of these two limitations had their needs fully satisfied by the aids that they used (61.7% and 76.4%) and a low proportion of them had completely unmet needs (18.0% and 17.3%). The share of children with an agility-related limitation whose needs were only partially met was very small (6.4%).
The proportions of children reporting a learning limitation are equally distributed among the three groups. Nevertheless, it should be noted that when considering the total rate of unmet need, (either some met needs or completely unmet needs), children with learning disabilities were second only to children with communication limitations in terms of having some type of unmet need (59.4% learning, 72.2% communication). This could be explained by the fact that the definition of learning limitations covers many conditions that require different types of aids. In addition, previous Participation and Activity Limitation Survey (PALS) releases have noted that learning disabilities are the fastest growing type of disability, possibly faster than the needs can be accommodated.
Use and need for assistive technology for children aged 5 to 14 with disabilities, by disability type, Canada, 2006
Nearly half of children with partially met needs have a very severe disability
Of all children with disabilities who reported some unmet needs, 46.7% had a very severe disability. The number of children with partially met needs increased significantly as the degree of severity increased. The number of children who had completely met needs did not seem to depend on the degree of severity and were quite evenly split among mild, moderate, severe or very severe degrees of disability. The same can be said for children who have completely unmet needs except for those with a mild disability where there are only 13.2% of them (see table 19).
Use of and need for assistive aids and services for children aged 5 to 14 with disabilities, by degree of severity, Canada, 2006
In terms of gender differences, girls had a significantly higher rate of met needs regarding the use of assistive technology. More specifically, 48.7% of girls were already using all the aids that they needed compared to 43.4% of boys who reported the same. Consequently, boys experienced higher levels of unmet need than girls (27.0% and 20.4%, respectively; see table 20).
Use and need for assistive technology for children aged 5 to 14 with disabilities, by gender, Canada 2006
Majority of children with seeing or learning limitations use more than three different aids
Most children were using less than three different aids for assistance with their limitation. This is apparent for all disability aid types with the exception of seeing and learning where significantly more children were using 3 or more different assistive aids or services (70.0% and 66.7% respectively for each disability aid type). This general pattern was also observed for children who reported that they need aids. The majority indicated that they needed one or two different aids for assistance with their limitation regardless of whether they were using some aids already or did not have any (see table 21).
Home computers were the most commonly used assistive devices for children with learning limitations
The type of assistive devices used by children with disabilities varied by the type of disability but for each type of limitation children tended to use the same assistive devices. Table 22 shows that more than seven out of ten (72.4%) children with seeing limitations use large print reading materials and a similar proportion of children with hearing limitations used implants as hearing aids (69.8%). For other limitation types, the numbers fluctuate, for example, 57.4% of children with mobility limitations used a manual wheelchair and 65.1% of children with communication limitations used a picture board.
Most commonly used assistive device by type of disability for children aged 5 to 14, Canada, 2006
Parents and family contribute most for children's aids
Similar to adult respondents, Participation and Activity Limitation Survey (PALS) 2006 results show that the burden of paying for a child's aids mostly fell on the child's parents and / or family members. Across Canada, parents or family members were the main contributors for children's aids (60.7%). Examining these rates by province reveals that there was no significant difference between provinces and the national rate in terms of familial contributions towards aids.
Public funds - another significant contributor towards children's aids
Another common payment source for children's aids came from public funds such as the health care system and other government programs. For all of Canada, 21.4% of assistive devices were paid for through public funds. There was no significant difference between provinces and the national rate in terms of public contributions towards children's aids except for Nova Scotia, who had a significantly lower rate (8.0%).
Nearly one tenth of aids used by Canadian children involved a payment plan
Nearly one in ten (7.6%) aids used by Canadian children aged 5 to 14 were rented or purchased with a payment plan. No differences existed between the provinces and combined territories.
Costs preventing children from getting the aids that they need
The most commonly cited reason for children not having the aids they needed was cost. More specifically, 56.6% of respondents, across Canada, stated cost as the main reason for unmet needs. Cost was a more common barrier in Prince Edward Island (77.3%) compared to the national average. However, the rates did not differ significantly for the other provinces and territories.
Four out of ten children with disabilities experience daily difficulties participating in everyday activities
Difficulty participating in everyday activities occurred on a daily basis for four out of ten (40.5%) children with disabilities in Canada in 2006. Moreover, 18.0% of children experienced difficulties weekly and 7.1% experienced difficulties monthly as a result of their disability. About one in five children did not experience any problems participating in everyday activities (21.9%; see chart 5).
Proportion of children aged 5 to 14 who experience difficulty participating in everyday activities, by frequency, Canada, 2006
Half of children with mobility limitations experience difficulty with everyday activities on a daily basis
Experiencing difficulty on a daily basis fluctuated from nearly one half of children with mobility (46.6%) and agility (47.2%) limitations to a low of less than one third with seeing (29.7%) or hearing (29.2%) limitations. At the other end of the spectrum we find that approximately one in three persons with seeing limitations (37.4%) never experience limitations compared to the much lower rate of one in ten (10.1 %) for persons with mobility limitations (see table 23). Knowing that children experienced difficulty with their everyday activities is only one side of the story, studying the effect of these difficulties is also important.
Frequency of experiencing difficulty participating in everyday activities by children aged 5 to 14 with disabilities, by disability type
The effects of experiencing difficulty with everyday activities could range from mild participation difficulties to a complete inability to participate. Over half of the children who reported having difficulties experienced some difficulty (60.1%), approximately one quarter reported a lot of difficulty participating (28.2%) and about one tenth (9.7%) indicated that they were completely unable to participate in everyday activities.
One in five children with mobility limitations were completely prevented from participating in everyday activities
The 2006 Participation and Activity Limitation Survey (PALS) found that approximately one in five children with mobility limitations (20.5%) experienced such high levels of difficulty with their everyday activities that they were completely prevented from participating (see chart 6). The proportions of children with other disability types who were unable to participate were all significantly lower at less than 10%.
Inability to participate for children aged 5 to 14 in everyday activities, by limitation type, 2006
About one in ten children with hearing limitations use sign language
There were 20,020 children between ages of 5 and 14 with a hearing limitation in Canada in 2006. About one in ten of these children (13.1% or 2,620 children) reported using sign language to communicate. Overall, children using sign language represented 1.3% of all Canadian children with disabilities. More than half of all children who used sign language (54.0%) lived in Ontario or Quebec and slightly less than one quarter (22.8%) lived in Manitoba, Saskatchewan or Alberta (see table 24). Of all child sign language users, 78.5% reported using American Sign Language (ASL).
Children aged 5 to 14 with a hearing limitation who use sign language by geographical regions, Canada, 2006
Two fifths of children using sign language used a sign language interpreter at least once per week or more
There was a similar proportion of children who use sign language who reported never using a sign language interpreter (41.4%) and those who said they use this service at least once a week or more (42.0%).
More than half of children with a hearing limitation are hard of hearing or experience some hearing loss
The categories of hearing loss in children, like in adults, included being deaf, deafened, hard of hearing or experiencing some hearing loss. Nationwide, the largest proportion of children with a hearing limitation indicated they were hard of hearing or experienced some hearing loss (78.2%), 8.7% reported being deaf or deafened 9.8% felt they did not belong to any of the above categories (see table 25).
Degree of hearing limitation in children aged 5 to 14, by geographical region, Canada, 2006
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