Background: People living with a severe disability suffer substantial personal and social consequences that reduce quality of life (QOL). One potential negative impact on the QOL of a disabled person is the loss of the ability to control devices in their immediate environment (such as the television, computer,telephones, lights, doors, etc.). Consequently, research and development has been conducted on technology designed to restore independence by providing some means of control over these devices.Technology that allows a severely disabled person to gain this type of control has been called an environmental control system (ECS). The aim of this review was to evaluate critically the status and effi cacy of ECS technology for the severely disabled.Materials/Methods: To achieve this, a omprehensive database search was conducted for relevant material on technical
and clinical aspects of ECS control.Results: The review demonstrated that there is an abundance of work conducted on ECS technology, resulting in a number of creative control systems that are designed to be used by the severely disabled.These include switching systems that utilize voice, muscle, brain activity, head motion, eye blink, breath, chin, and so on. However, the review also established that rarely has the effi cacy of these systems been scientifi cally established.
Conclusions: Severely disabled persons need access to ECS technology that has been shown to be effi cacious. While the severely disabled gain benefi ts from using ECS technology, challenges still exist before ECS technology for the severely disabled can provide highly reliable and user-friendly device control.

Keywords: Spinal Cord Injuries - psychology, Communication Aids for Disabled, Disabled Persons, Environment, Controlled, Quality of Life, Self-Help Devices, Spinal Cord Injuries - rehabilitation