This is exactly correct (I worked in AAC and BCI for years, and still collaborate with the group that I used to work closely with). To elaborate a little bit on your excelelnt answer: In addition to being enormously expensive and requiring heavy customization and personalization, assistive technology has other issues that go well beyond the core technical functionality. It also often requires significant up-front investment in configuration and training for the user, which needs to be done by a professional in the field, and then --- crucially --- also requires ongoing maintenance and re-training by skilled practitioners, which means there are ongoing operational expenses.
One of the reasons for this last bit is that many users of assistive technologies have very dynamic situations. For example, if they have a progressive condition like ALS, their mobility and other capabilities and needs will change over time; even if the user doesn't have a progressive condition, their living situation very likely will change over time, which may involve needing to re-work their setup. This might involve something as major as moving from one care facility to another, or having to adjust to the presence of a new pump or something that causes EM interference with your device.
Even for somebody with a very static medical condition and very stable living situation, their computing setup won't be static, so will need ongoing maintenance; or, alternatively, their computing setup will become static if they end up dependent on a particular piece of assistive technology, which can lead to a whole other set of issues (which is how you get people running ancient versions of Windows for years and years and years, because it's what their eye-tracker works on, and the vendor is long out of business and so never got it working on Windows 10).
The other piece to the puzzle is that, speaking as a gross generalization, users of assistive technologies tend not to be wealthy people (many speech and motor disabilities make it challenging to work). So, you've got an expensive product, often involving ongoing operational costs, with zero economy of scale, for a small and relatively poor customer base; this all adds up to what may fairly be described as "a very challenging business". Adding another layer of complexity, the economics of commercial assistive tech in the US have a lot to do with insurance Medicaid rules; the only reason there is any commercial activity at all in assistive technology and AAC is because under some circumstances Medicaid will pay for a device, within certain very rigid and complicated boundaries. So now your business also is going to have to juggle that problem in order to keep the lights on, which will add another layer of constraint to what is already a complicated situation.
On the other hand, when the right technology is paired with the right user and the right support, the impact on the quality of life for the user and their family can be truly enormous. Which is what keeps people working in the space...
At least one company I know of (though this was 15 years ago) had ridiculously high prices for their products. But they had extensive after-sales support, and the warranty was such that you could basically run over the unit with a car, and they'd still repair / replace it under warranty for free.
We're currently building a new AAC device which allows users to write/speak quite a bit faster, and we're encountering exactly the hurdles you mention. Would you be willing to exchange some helpful pointers about how to bring an AAC device to market? Contact info in my profile.
One of the reasons for this last bit is that many users of assistive technologies have very dynamic situations. For example, if they have a progressive condition like ALS, their mobility and other capabilities and needs will change over time; even if the user doesn't have a progressive condition, their living situation very likely will change over time, which may involve needing to re-work their setup. This might involve something as major as moving from one care facility to another, or having to adjust to the presence of a new pump or something that causes EM interference with your device.
Even for somebody with a very static medical condition and very stable living situation, their computing setup won't be static, so will need ongoing maintenance; or, alternatively, their computing setup will become static if they end up dependent on a particular piece of assistive technology, which can lead to a whole other set of issues (which is how you get people running ancient versions of Windows for years and years and years, because it's what their eye-tracker works on, and the vendor is long out of business and so never got it working on Windows 10).
The other piece to the puzzle is that, speaking as a gross generalization, users of assistive technologies tend not to be wealthy people (many speech and motor disabilities make it challenging to work). So, you've got an expensive product, often involving ongoing operational costs, with zero economy of scale, for a small and relatively poor customer base; this all adds up to what may fairly be described as "a very challenging business". Adding another layer of complexity, the economics of commercial assistive tech in the US have a lot to do with insurance Medicaid rules; the only reason there is any commercial activity at all in assistive technology and AAC is because under some circumstances Medicaid will pay for a device, within certain very rigid and complicated boundaries. So now your business also is going to have to juggle that problem in order to keep the lights on, which will add another layer of constraint to what is already a complicated situation.
On the other hand, when the right technology is paired with the right user and the right support, the impact on the quality of life for the user and their family can be truly enormous. Which is what keeps people working in the space...