Prevalence of falls in frail elderly users of ambulatory assistive devices: a comparative study

Abstract

Aim: The aim of this study was to verify the prevalence of falls in frail users of ambulatory assistive devices (AAD) and compare with controls.

Materials and methods: Nineteen frail elderly users of AAD (G1) and 31 non-users (G2) participated in the study. The occurrence of falls, at the last 6 months, was collected by an interview with the patient and the caregiver. Cognitive status was assessed by the Mini Mental State Examination, functional capacity by the Pfeffer’s Questionnaire and Modified Barthel’s Index, the frail level by a functional stratification and the risk of falls by the Timed Up and Go (TUG) test. T-Student test was used to compare independent variables. The significance level was set at 5%.

Results: Both groups G1 and G2 were homogeneous in relation to the functional and sociodemographic variables. G1 reported more falls in the last 6 months, but most of the participants did not use AAD at the time of the fall. Transferences were the main reason for falls in G1 and stumble in the street in G2.

Conclusion: Elderly users of AAD fall out when they are not using the walk device.

• IMPLICATIONS FOR REHABILITATION

• Falling is the second leading cause of death from unintentional injuries in the world. Fall prevention programmes prescribe ambulatory assistive devices, such as walking sticks, crutches and walkers device and walking training with a physiotherapist to provide independence, safety, satisfaction, adherence and psychosocial benefits. However, studies have showed a higher prevalence of falls in frail elderly users of ambulatory-assistive devices.

• In our study, we verified if users of the ambulatory-assistive devices were using it at the moment of the fall. We found that frail elderly fall down when they are not using the walk device during their activities of day living. Thus, education strategies should be developed to encourage the use of ambulatory-assistive devices by the frail elderly previously evaluated by physiotherapists. Prevalence of falls in this population could reduce if frail elderly users of ambulatory assistive devices really use it during the activities of daily living.

     

Development of an unpowered ankle exoskeleton for walking assist

Abstract

Aim: Assistive technologies traditionally rely on either powered actuation or passive structures to provide increased strength, support or the ability to perform specific functions. At one end of the spectrum are powered exoskeletons, which significantly increase a user’s strength, but require powerful actuators, complex control systems and heavy power sources. At the other end are orthoses, which are generally unpowered and light in weight, relying on the mechanical properties of passive mechanical elements. Ideally, assistive technologies should combine the benefits of both systems and enhance human motion while remaining lightweight and efficient. This paper presents the development of a lightweight unpowered ankle exoskeleton that relies on the spring-like properties of a Pneumatic Artificial Muscle, which is inflated and sealed.

Methods: This flexible air-spring is used to harness gait energy and compliment the human ankle torque at push-off. To mechanically validate the proposed exoskeleton design, a prototype was fabricated and experimentally tested.

Results: Unlike other existing devices, the proposed unpowered exoskeleton was able to store a significant amount of energy and release it all at once. The timing mechanism worked as intended and triggered the release of 115?N?m of torque when the ankle reached a pre-determined angle.

Conclusion: Overall, the device demonstrated the ability to provide significant contribution to the ankle torque, timed to release precisely at the push-off phase of the gait cycle.

• Implications for Rehabilitation

• The currently proposed ankle exoskeleton makes use of an unpowered, fully mechanical system to provide walking assistance to users by providing additional torque to the ankle joint.

• The newly developed assistive device is devised as a solution for persons struggling with mobility issues, and can be used both as a means for rehabilitation or as a permanent assistive devices for patients struggling with long-term disabilities.

• The device also has potential to be used as a performance enhancing device for ablebodied users by reducing muscle fatigue during extended physical exertion.

     

The effects of assistive technology service delivery processes and factors associated with positive outcomes – a systematic review

Abstract

Purpose: The objective of this systematic review was to investigate effects of different assistive technology service delivery processes (AT-SDPs) for people with functional limitations, including investigation of factors associated with positive outcomes.

Materials and methods: The study was registered in PROSPERO, registration number CRD42018097030. Included were quantitative studies published in peer reviewed journals: randomized controlled trials, cohort, case-control and analytical cross-sectional studies investigating effects of different AT-SDPs or factors associated with the AT-SDP and with n?≥?10 participants. A systematic literature search was carried out in the databases PsycINFO, CINAHL, SSCI and Medline from 1 January 2008 to 25 July 2018. Besides, four journals were hand searched. The Joanna Briggs Institute MAStARI Critical Appraisal Tools were utilized to assess the risk of bias.

Results: The search resulted in a total of 2947 references of which 12 articles representing 10 studies were included. Five studies were experimental, two were cohort, and five were cross-sectional studies.

Conclusions: This systematic review confirms previous findings that assistive technology users should be involved in the AT-SDP in order to achieve positive outcomes. The level of evidence is, however, low, and it is not clear which of the applied methods are most effective. The review also gives some indication that new technologies could be used to improve the AT-SDP and reduce costs and that training in using the assistive devices seems to be useful. Even though some evidence of effective AT-SDP methods has been identified, more research is still needed to give valid recommendations to AT-SDP practice.

• Implications for rehabilitation

• Assistive technology users should be involved in the AT-SDP in order to achieve positive outcomes, but it cannot be determined which methods are the most effective.

• New digital technologies could be used to improve the AT-SDP and reduce costs.

• Training of the users in using their devices is probably useful, but since no specific methods nor extent or dose can be recommended, the professionals still need to use their clinical experience and reasoning to assess the user’s needs for training.

     

Maintaining stable transfemoral amputee gait on level,sloped and simulated uneven conditions in a virtual environment

Purpose: Describe and quantify how people with transfemoral amputations (TFA) maintain stable gait over a variety of surfaces; including, downhill and uphill, top and bottom-cross-slopes, medial-lateral translations, rolling hills and simulated rocky surfaces.

Methods: Ten TFA and ten matched people without amputations (NA) walked in a virtual environment with level, sloped and simulated uneven surfaces on a self-paced treadmill. Stability was quantified using medial-lateral margin of stability (ML-MoS), step parameters, and gait variability (standard deviations for speed, temporal-spatial parameters, foot clearance and root-mean-square of medial-lateral trunk acceleration).

Results and conclusions: TFA and NA adapted to non-level conditions by changing their walking speed, step width, and foot clearance. Variability for most parameters increased across conditions, compared to level. TFA walked slower than NA with shorter, wider and longer duration steps (most differences related to speed). ML-MoS did not change compared to level; however, ML-MoS was greater on the prosthetic side than both intact side and NA limbs. Foot clearance and root-mean-square of medial-lateral trunk acceleration were greater on the prosthetic side than the intact side and NA limbs. This research provides a comprehensive analysis of the different adaptations made by people without amputations compared to people with transfemoral amputations over non-level conditions and establishes significant differences between slopes and simulated uneven surfaces for TFA.

• Implications for Rehabilitation

• Transfemoral amputation and no amputation groups adapted walking biomechanics when traversing non-level surfaces.

• Greatest temporal-spatial gait adaptations were walking speed, step width and foot clearance.

• Gait parameter variability typically increased from the level condition in both groups.

• Transfemoral amputation group walked slower than no amputation group with shorter, wider steps and longer duration steps. This was related to speed.

• Transfemoral amputation group had more trunk motion variability on the prosthetic side than no amputation group; could be related to prosthetic fit.

     

Validation of assistive technology on psychoactive substances for visually impaired people

Purpose: To validate the assistive technology “Drugs: reflection for prevention” to be used with visually impaired people.

Method: Quantitative and quasi-experimental study, contrasting knowledge before and after the use of the assistive technology with 140 visually impaired people in institutes and associations for people with visual impairment. A questionnaire with identification data, a pre-test, a post-test and a questionnaire to assess the assistive technology were applied. Data were described through means and standard deviations, and analyses included the McNemar test, the exact binomial distribution test, and the intraclass correlation coefficient.

Results: Participants were male (65.7%), 84.3% were blind, aged 37.1?years on average and with schooling of 10.1?years on average. There were more correct answers in the post-test (p?<.001). The attributes of the assistive technology were considered adequate: objectives, access, clarity, structure and presentation, relevance and efficacy, and interactivity (p?<.001).

Conclusions: The assistive technology “Drugs: reflection for prevention” was considered valid and reliable to inform visually impaired people about psychoactive substance abuse.

• Implications for rehabilitation

• Created new tool for prevention substance abuse that can be accessed easily.

• Improved information about substance psychoactive for users of the assistive technology.

• Improved quality of life for its users.

     

Transtibial amputee gait with the unity suspension system

Abstract

Study Design: Experimental study.

Objectives: Research is lacking on the Unity suspension system’s effect on gait performance. The purpose of this study was to evaluate the effects of the Unity elevated vacuum system on level walking performance while the vacuum was active (ON) and inactive (OFF).

Methods: Twelve unilateral transtibial amputees were fit with the Ossur elevated vacuum suspension system (Unity) and Pro-flex XC foot. After one month accommodation period, 3D motion analysis was performed using the CAREN-Extended system. Temporal-spatial, kinematics, and kinetics were examined during level walking to understand the effect of the elevated vacuum, separate trials were completed with the vacuum active (ON) or inactive (OFF).

Results: Significant differences were found between vacuum conditions (ON and OFF) for some temporal-spatial gait parameters, but differences were very small and may not be clinically significant. Differences between vacuum conditions on most kinetic and kinematic gait parameters were also low. However, step length symmetry between intact and prosthetic limbs improved with active elevated vacuum (ON).

Conclusions: Elevated vacuum suspension’s effect on level walking gait is small if a well-fitting liner-based socket is provided.

• Implications for rehabilitation

• Step length symmetry between intact and prosthetic limbs improved with an active vacuum system.

• Differences between vacuum conditions on most gait parameters were small during level walking.

• Subjective feedback showed improved proprioception and comfort with an active vacuum system.

     

Identification and analysis of knee–ankle–foot orthosis design requirements based on a feedback survey of orthosis users in India

Purpose: The world is advancing towards a technological revolution in various fields, yet the assistive devices available for people with disability, especially in developing countries, are in the most primitive stage. For many years, lower limb orthotics has been a neglected area of research and there is an urgent need to address the problems faced by lower limb orthosis users to enable them to lead an independent life. This work is a first step in this direction and aims to identify and analyse the needs of knee–ankle–foot orthosis (KAFO) users in India.

Method: A structured feedback survey of 29 KAFO users was conducted at three rehabilitation centres located in South India. A feedback questionnaire and a novel outcome measure tool (trigger cards) were used as means to assess user satisfaction about their existing KAFOs. The results of the survey were analysed to obtain quantitative and qualitative outcomes.

Results: The survey identifies various biomechanical and functional issues associated with lower limb orthosis design. The results of the survey imply that there is an urgent need to solve issues, especially related to locked orthotic knee joint design. Additionally, it sheds light on the lifestyle and socio-economic issues of KAFO users that are likely prevalent in many other low- and middle-income countries.

Conclusions: The outcomes of this survey can motivate and guide researchers to design improved orthotic solutions to meet the needs of lower limb orthosis users all over the world.

• Implications for Rehabilitation

• ???This is a first of its kind survey that brings forth the needs of lower limb orthosis users in India, and is an important step towards rehabilitation and empowerment of people with lower limb disability.

• ???The pilot survey helps to identify critical areas for design improvements in a knee–ankle–foot orthosis.

• ???The outcomes of this survey can help researchers to design functionally improved assistive devices that better meet the needs of users than currently available technology in developing countries such as India.

     

Influences on selection of assistive technology for young children in South Africa: perspectives from rehabilitation professionals

Abstract: Selection of assistive technology for young children is a complex process. Within a context with limited resources, such as South Africa, research is needed to determine the factors influencing the assistive technology selection process, as these could ultimately either facilitate or hinder the availability and accessibility of affordable, adaptable, acceptable, and high quality assistive technology for this age group.

Method: Two asynchronous online focus groups were conducted with 16 rehabilitation professionals to identify the factors they perceived to influence the selection and provision of assistive technology to young children within the South African context.

Data analysis: A process of deductive thematic analysis was followed by inductive analysis of the data. Components of the Assistive Technology Device Selection Framework were used as themes to guide the deductive analysis, followed by inductive analysis to create subthemes.

Discussion: The important role of the professional was highlighted in negotiating all the factors to consider in the assistive technology selection and provision process. Adaptation of the Assistive Technology Device Selection Framework is suggested in order to facilitate application to low resourced contexts, such as South Africa.

• Implications for rehabilitation

• Assistive technology selection is a complex process with factors pertaining to the users (child and family) of the assistive technology, as well as the rehabilitation professional recommending the assistive technology influencing the process.

• Although it may be an important factor, the availability of financial resources to purchase assistive technology is not the only determining factor in providing appropriate assistive technology to young children in contexts with limited resources.

• Formalized support, such as reflective supervision or mentorship programs should be facilitated and utilized by recommending professionals.

• Home and school visits during assessment ensure a good match between assistive technology and users within the particular context.

• Facilitating the availability of assistive technology for trial during assessment and/or for a period afterwards will increase the likelihood that appropriate recommendations for assistive technology are made.

     

An electronic travel guide for visually impaired – vehicle board recognition system through computer vision techniques

Abstract

Purpose: In the context of assistive technology, mobility takes the meaning of “moving safely, gracefully, and comfortably”.The aim of this article is to provide a system which will be a convenient means of navigation for the Visually Impaired people, in the public transport system.

Method: A blind regular commuter who travels by public transport facility finds difficulty in identifying the vehicle that is nearing the stop. Hence, a real-time system that dynamically identifies the nearing vehicle and informs the commuters is necessary. This paper proposes such a system namely the “Vehicle Board Recognition System” (VBRS). Computer Vision techniques such as segmentation, object recognition, text detection and optical character recognition are utilized to build the system, which will detect, analyze, derive and communicate the information to the passengers.

Results: Thanks to the rapid development in technology, there are several navigation systems both hand held and wearable, available to help visually impaired (VI) people move comfortably both indoor and outdoor. Many blind people are not comfortable in using these devices or they are not affordable for them. Thus the proposed system gives them the comfort of navigation.

Conclusion: This system can be installed in the bus stop to assist the Visually Impaired, from externally rather than their hand held or wearable assistive devices.

• Implications for rehabilitation

• This proposed system will help the visually impaired to

• ensure secure navigation

• be independent of the others

• develop self confidence.

• overcome the training, affordability of wearable/ handheld devices.

     

Attitudes faced by young adults using assistive technology as depicted through photovoice

Abstract

Purpose: To explore how the attitudinal environment influences the participation experiences of young adults with disabilities who use assistive technology.

Methods: In this qualitative study, twenty young adults using assistive technology completed individual interviews before and after engaging in a photovoice process. Ten of the participants then took part in a focus group. Data were analyzed inductively using a thematic analysis approach.

Results: Analysis yielded three primary themes “seen and treated as different, assumptions made and impatience”. A fourth theme emerged through focus group discussion “photos as a means of consciousness-raising”. Findings suggest that young adults with disabilities who use assistive technology regularly encounter negative societal attitudes that hinder participation. The photovoice process promoted consciousness-raising at the individual, interpersonal and societal level for the participants.

Conclusion: Many young adults with disabilities use assistive technology to facilitate participation in everyday activities. However, the usefulness of assistive technology is susceptible to the environment in which it is used. Further actions are needed toward resolving this challenging participation barrier; these actions should draw on the perspectives and creativity of young adult assistive technology users.

• IMPLICATIONS FOR REHABILITATION

• Young adults with disabilities who use assistive technology describe how other people’s negative attitudes can make it challenging to participate in their important activities.

• Participants took photographs that represented the negative attitudes they face on a daily basis and saw their photos as a way to raise awareness of the negative attitudes.

• This research highlights the importance of addressing negative attitudes toward people using assistive technology: young adults with disabilities have expertise and creative ideas about how to do this, so their voices should guide future research projects.

     

Methods to evaluate perspectives of safety,independence, activity,and participation in older persons using welfare technology. A systematic review

Abstract

Purpose: To conduct a systematic review of existing methods to evaluate the individual aspects of welfare technology from the perspectives of independence, safety, activity, and participation. Furthermore, the study aimed to describe outcomes that have been the focus of previous research to evaluate individual aspects of welfare technology in older persons living in ordinary housing. Materials and methods: A systematic literature review in PubMed, CINAHL Plus, PsycINFO, Scopus, and Web of Science. Studies selected were those that explored the use of assistive and welfare technology devices from older persons’ perspectives, and which considered the concepts of independence, safety, activity and participation, and quality of life. Results: A broad spectrum of instruments was applied in the studies. For independence, three questionnaires were used in the identified studies. For safety, one instrument was used in two versions. To study activity and participation as well as quality of life, several scales were used. Additionally, several studies included qualitative approaches for evaluation, such as interviews, or posed one or more questions regarding the effects of welfare technology. Conclusions: The integration of digital assistive and welfare technology should be based on the needs of older persons, and those needs must be assessed using reliable and relevant instruments. The heterogeneity of the target group, i.e., older persons, together with the fact that assessments must give consideration to identifying goals, obstacles, and risks as well as users’ preferences, implies a person-centred approach.

• Implications for rehabilitation

• The integration of digital assistive and welfare technology should be based on older persons’ needs, and those needs must be assessed using reliable and relevant instruments.

• The heterogeneity of the target group, i.e. older persons, together with the fact that assessments must give consideration to identifying goals, obstacles and risks as well as users’ preferences, implies a person-centred approach.

• The ideal would be one coherent model that explores the use of digital assistive and welfare technology from the individual, economic as well as organisational dimensions. This would cover the different needs and expectations of various stakeholders, including economic and organisational, but also the needs of the older person.

     

Use of single-subject research designs in seating and wheeled mobility research: a scoping review

Abstract

Background: Evidence-based practice (EBP) in seating and wheeled mobility practice is often hindered by a dearth of published research.

Purpose: The purpose of this review was to explore and critically appraise the use of single-subject research designs (SSRDs) in seating and wheeled mobility studies published between January 1995 and May 2018.

Study Selection: Primary source, peer-reviewed SSRDs focused on exploring the impact of a seating and wheeled mobility intervention were included in the review.

Data Extraction: Relevant data extraction, determination of level of evidence, evaluation of methodological rigor, and assessment of the risk of bias were each independently performed.

Data Synthesis: The review yielded 19 studies (2 Level III, 15 Level IV, and 2 Level V). A majority of these studies incorporated a withdrawal-type of SSRD and involved subjects representing patient populations with seating and wheeled mobility needs. Methodological rigor/quality features most commonly absent in the included studies included: blinding/masking, inter-rater or intra-rater reliability, >5 data points in each phase, planned replication (≥3 subjects), procedural fidelity methods, randomization, stability of the data during baseline, statistical analyses and use of subject selection criteria. The limited number of published SSRDs, combined with the lower levels of evidence (Levels III–V) provided by these studies, indicates that the use of SSRDs in seating and wheeled mobility research is in the early stages of development.

Conclusions: Increasing the methodological quality and rigor as well as reporting methods in future SSRDs involving seating and wheeled mobility interventions may help to support EBP in this area.

• Implications for Rehabilitation

• Single-subject research designs (SSRDs) offer both researchers and clinicians the opportunity to contribute to the existing knowledge base in ways that reflect actual clinical practice.

• SSRDs provide flexibility in adapting and modifying seating and wheeled mobility-related assistive technology devices to meet the individual needs of specific subjects.

• SSRDs preserve individual responses to seating and wheeled mobility-related assistive technology devices.

• SSRDs may help to enhance evidence-based practice (EBP) in seating and wheeled mobility practice by spanning the divide between research and practice.

• Increasing the methodological quality and rigor as well as reporting methods in future SSRDs may help to support EBP in seating and wheeled mobility practice.

     

Methodology and feasibility of a 3D printed assistive technology intervention

Abstract

Three-dimensional (3D) printing now allows rehabilitation professionals to design and manufacture assistive technologies in a few hours. However, there is limited guidance for researchers and clinicians for implementing 3D printing assistive technology interventions and measuring their outcomes. The goal of this study was to develop a standardized 3D printing assistive technology intervention and a research methodology, using pillboxes as an example. Fourteen pillbox users engaged in a study comparing their use of an off-the-shelf pillbox to a customized 3D printed pillbox. Study outcomes were evaluated on feasibility (recruitment capability, study procedures and outcome measures, acceptability of the study procedures, the research team’s ability to manage and implement the study, and the participant’s preliminary response to intervention). Participant outcomes were measured on satisfaction with the device and medication adherence. Fourteen participants completed the study and received customized 3D printed pillboxes. The study design performed well on all aspects of feasibility except the research team’s ability to manage and implement the study, as they experienced several technical issues. Notably, the participants reported improved device satisfaction and medication adherence with the 3D printed device with large effect sizes. The 3D printed assistive technology intervention is a replicable process that supports professionals in printing their own assistive technologies. Recommendations are made to further enhance feasibility of 3D printing assistive technology studies. Future research is warranted.

• IMPLICATIONS FOR REHABILITATION

• 3D printing is an increasingly feasible approach allowing for the design and manufacture of customized assistive technology

• Evaluation for assistive technology that will be 3D printed should include information about the person’s activities, routines, skills, abilities, and preferences. Evaluation of outcomes should include satisfaction with the device and a functional measure.

• 3D printed assistive technology interventions should include the collaboration between the assistive technology professional and client. It should also include device training.

• Future 3D printing research studies should report pragmatic data including printing device, time to print, and number of errors.

     

Are there differences in factors influencing access and continued use of assistive products for people with intellectual disabilities living in group homes?

Abstract

Background: The World Health Organization has launched a program to promote Global Cooperation on Assistive Technology (GATE) to implement those parts of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) referring to assistive technology and products. A particular vulnerable group deeply affected by health inequity affecting access to assistive products are people with intellectual disabilities.

Objective: The objective of this study is to understand the barriers and facilitators to effectively access and continuously use essential assistive products for people with intellectual disabilities.

Materials and methods: Face-to-face interviews with 15 adults with a mild to profound intellectual disability and 15 providers of assistive products were conducted to gain insights about current use, needs, knowledge, awareness, access, customization, funding, follow-up, social inclusion, stigma and policies around assistive products and intellectual disability. The technique of constant comparative analysis was used to analyze the data.

Results and conclusion: An overview of factors is presented that fit within seven domains for access and eight domains for continuous use of assistive products for people with intellectual disabilities. It illustrates that access and continuous use are influenced by different barriers and facilitators. These different influences should be taken into account in country policies and frameworks that seek to implement the UNCRPD through assistive technology.

• Implications for rehabilitation

• Proactive assessment for assistive products by health professionals is rare and the vast majority of people with intellectual disabilities depend on carers to signal the need .

• A lack of education for carers around available assistive products and the benefits of assistive products for people with intellectual disabilities may lead to an underutilization for this group.

• The paternalistic attitude of care providers towards people with intellectual disabilities limits access and use to certain (high-tech) assistive products.

• The segmented and disjointed aspect of public funding to support assistive products found in this study is a key issue for policymakers who aspire to adhere to implementing the UNCRPD equally in all areas of their country.

     

Appraisals of robotic locomotor exoskeletons for gait: focus group insights from potential users with spinal cord injuries

Abstract

Purpose: To describe appraisals of robotic exoskeletons for locomotion by potential users with spinal cord injuries, their perceptions of device benefits and limitations, and recommendations for manufacturers and therapists regarding device use.

Materials and methods: We conducted focus groups at three regional rehabilitation hospitals and used thematic analysis to define themes.

Results: Across four focus groups, 35 adults participated; they were predominantly middle-aged, male, and diverse in terms of race and ethnicity, well educated, and not working. Participants had been living with SCI an average of two decades. Most participants were aware of exoskeletons. Some were enthusiastic about the usability of the devices while others were more circumspect. They had many questions about device affordability and usability, and were discerning in their appraisal of benefits and suitability to their particular circumstances. They reflected on device cost, the need for caregiver assistance, use of hands, and environmental considerations. They weighed the functional benefits relative to the cost of preferred activities. Their recommendations focused on cost, battery life, and independent use.

Conclusions: Potential users’ appraisals of mobility technology reflect a nuanced appreciation of device costs; functional, social, and psychological benefits; and limitations. Results provide guidance to therapists and manufacturers regarding device use.

• Implications for Rehabilitation

• Potential users of robotic locomotor exoskeletons with spinal cord injuries appreciate the functional, social, and psychological benefits that these devices may offer.

• Their appraisals reflect nuanced consideration of device cost and features, and the suitability of the assistive technology to their circumstances.

• They recommend that manufacturers focus on reducing cost, extending battery life, and features that allow independent use.

     

Assistive technology for students with visual disability in schools for the blind in Delhi

Abstract

Background: To understand the awareness and utilization of assistive technology in students at schools for the blind in Delhi.

Methods: A cross sectional study was conducted among 250 students selected randomly from 10 blind schools in Delhi. Binocular distance presenting and pinhole vision acuity were assessed using Snellen “E” chart and a multiple pinhole occluder. Students were also interviewed using a questionnaire about 42 assistive devices to understand their awareness and use.

Results: Male participants were 72.8%. Of the total, 27.6% students had best corrected visual acuity <6/18 to 1/60, and the rest had <1/60 vision. The awareness about tactile and sound-based technology was good among students: Braille books (98%), Braille slate and stylus (99.2%), handheld audio recorders (77.6%) and screen readers (77.2%). Good awareness was reported for abacus (88.8%), walking long canes (94.4%) and smart cane (89.6%), audible balls (96%), Braille chess (82.8%) and talking watch (98%). Among the students with <6/18 to 1/60 vision, the awareness of visual based technology ranged from 0.8% (typoscope) to 43.6% (video magnifiers). Braille technology was used for reading by 96.4% (books) and for writing by 96.8% (Braille slate and stylus) irrespective of visual status. Other devices were poorly used ranging from nil (typoscope) to 55% (screen readers). The use of math and science learning devices was poor (<20%). Walking canes were used by 59% of students whereas 87.2% students used audible ball for games.

Conclusion: The results showed that majority of students used tactile based technology irrespective of visual status.

• Implications for rehabilitation

• Students with visual disability need assistive technology for a wide range of activities including academic learning.

• Students in schools for the blind who have binocular best corrected vision acuity of 1/60 or better should be encouraged to use visual based assistive technology instead of tactile based.

• Students with binocular best corrected vision acuity less than1/60 should be encouraged to use other available tactile and sound-based assistive technologies as well as Braille books and Braille slate and stylus for their academic activities including maths and sciences.

• Teachers should be trained in the use of various assistive technologies for reading, writing, maths, sciences, sports, mobility and activities of daily living.

     

Gait changes with walking devices in persons with Parkinson’s disease

Purpose: To study immediate gait changes in persons with PD when walking with different assistive walking devices. Methods: Ten individuals with idiopathic PD participated in the study. Gait parameters were recorded while walking with a cane and a wheeled walker, and were compared to a free walk without a walking device. Results: Persons with PD walked with slower gait speed when using a cane and a wheeled walker compared to walking without any device (p?=?0.007, p?=?0.002, respectively). Stride length reduced significantly when walking with a wheeled walker (p?=?0.001). Walking with the assistive devices did not affect cadence, double support phase, heel to heel base of support, stride time, and stance period. Conclusion: Persons with PD immediately walked with slower gait speed when using either a cane or a wheeled walker, and with shorter stride length when walking with a wheeled walker. The results may lead to more cautious clinical practice in gait rehabilitation using ambulatory assisted devices.

Implications for Rehabilitation

• Persons with PD immediately walked with slower gait speed when using either a cane or a wheeled walker, and with shorter stride length when walking with a wheeled walker.

• Clinicians should be cognizant of these modifications during gait rehabilitation using ambulatory assisted devices.

     

Everyday technology use among older deaf adults

Purpose: Technology holds great potential to support Deaf individuals as they age into older adulthood. However, it is unclear to what extent Deaf seniors are using technology in everyday life or whether they experience challenges in using technology. The current study explored technology use among older Deaf adults with regard to attitudes, adoption style, and frequency of use for a wide range of technologies, including assistive technologies (ATs) for persons with hearing loss and general, everyday technologies.

Materials and methods: We developed a questionnaire that assessed older Deaf adults’ use of and experiences with technology. The questionnaire was made available in online and paper versions. Participants (N?=?109) were recruited from national conferences and organizations for the Deaf.

Results: Overall, we found that the older Deaf adults were technology adopters and regularly use and feel comfortable with a variety of devices. However, we also identified a number of technologies that are not being used by this population, including an AT that appears to have become obsolete and technologies that use sound-based alerts.

Conclusions: Insights on how older Deaf adults are embracing technology and which devices they are actually using can help policy makers, technology developers, and a range of aging services professionals, better meet the needs of this understudied population.

• Implications for Rehabilitation:

• Older Deaf adults use a variety of assistive and everyday technologies and must be considered as consumers and included in the design process.

• Older Deaf adults are generally positive in their attitudes towards technologies but they are infrequent users of potentially beneficial health technologies, highlighting opportunities for future research and development.

• Assistive technology for the Deaf (TTY/TTD) appears to have become obsolete with advances in modern communication technologies, which has implications for policy decisions.