Value-based design for the elderly: An application in the field of mobility aids

In the aging society, the need for the elderly to remain mobile and independent is higher than ever. However, many aids supporting mobility often fail to target real needs and lack acceptance. The aim of this study is to demonstrate how value-based design can contribute to the design of mobility aids that address real needs and thus, lead to high acceptance. We elicited values, facilitators, and barriers of mobility of older adults via ten in-depth interviews. Next, we held co-creation sessions, resulting in several designs of innovative mobility aids, which were evaluated for acceptance via nine in-depth interviews. The interviews resulted in a myriad of key values, such as “independence from family” and “doing their own groceries.” Design sessions resulted in three designs for a wheeled walker. Their acceptance was rather low. Current mobility device users were more eager to accept the designs than non-users. The value-based approach offers designers a close look into the lives of the elderly, thereby opening up a wide range of innovation possibilities that better fit their actual needs. Product service systems seem to be a promising focus for targeting human needs in mobility device design.     

Low vision and mobility scooters: the experiences of individuals with low vision who use mobility scooters

Abstract

Purpose: Older adults with low vision are a growing population with rehabilitation needs including support with community mobility to enable community participation. Some older adults with low vision choose to use mobility scooters to mobilize within their community, but there is limited research about the use by people with low vision. This paper describes a pilot study and asks the question: what are the experiences of persons with low vision who use mobility scooters?

Methods: This study gathered the experiences of four participants with low vision, aged 51 and over, who regularly use mobility scooters. Diverse methods were used including a go-along, a semi-structured interview and a new measure of functional vision for mobility called the vision-related outcomes in orientation and mobility (VROOM).

Findings: Four themes were found to describe experiences: autonomy and well-being, accessibility, community interactions and self-regulation.

Discussion and implications: This study was a pilot for a larger study examining self-regulation in scooter users. However, as roles emerge for health professionals and scooters, the findings also provide evidence to inform practice, because it demonstrates the complex meaning and influences on performance involved in low vision mobility scooter use.

• Implications for rehabilitation

• Scooter use supports autonomy and well-being and community connections for individuals with both mobility and visual impairments.

• Low vision scooter users demonstrate self-regulation of their scooter use to manage both their visual and environmental limitations.

• Issues of accessibility experienced by this sample affect a wider community of footpath users, emphasizing the need for councils to address inadequate infrastructure.

• Rehabilitators can support their low vision clients’ scooter use by acknowledging issues of accessibility and promoting self-regulation strategies to manage risks and barriers.

     

A Pilot Study: examining the effects and tolerability of structured dance intervention for individuals with multiple sclerosis

Purpose: The aims of this pilot were to examine dance as a feasible intervention for persons with multiple sclerosis (MS), specifically to examine issues of tolerability and its longitudinal effects on participants. Dance is an enjoyable physical activity that has been investigated in other neurodegenerative populations but has yet to be studied in MS. Method: A 4-week, two 60-min classes per week, pilot salsa dance intervention was administered to eight individuals with MS. The outcomes measured were effects on gait, balance, self-efficacy, motivation, physical activity and MS symptoms. They were administered at baseline, immediately post-intervention and at 3- and 6-month follow-ups. Results: Statistically significant pre–post intervention gains were found for the Timed Up and Go Test (TUG), Dynamic Gait Index (DGI), Activities-specific Balance Confidence Scale and Godin Leisure Time Questionnaire. Significant improvements were also found for the TUG, DGI and MS Walking Scale between baseline and 3-month follow-up assessments. Participants did not report any problems with fatigue or intolerability with the 60-min suggestions, further supporting the feasibility for the concept of a dance intervention. Conclusions: This study suggests that dance for persons with MS may have promise for improving physical activity, gait and balance.

• Implications for Rehabilitation

• Although structured dance has reported benefits in elderly populations and in individuals with cardiovascular and neurological impairments, there is virtually nothing known regarding dance in the MS population.

• This pilot salsa dance study shows that structured dance demonstrates promise of being well-tolerated, safe and effective at promoting physical activity in people with MS without increased fatigue.

• A 12-week study has been initiated to test the robustness of initial observations and further examine factors influencing participants’ physical activity adherence and behavioral change.

     

Predictors of unmet needs for communication and mobility assistive devices among youth with a disability: the role of socio-cultural factors

Purpose.?Despite the importance of ensuring access to assistive technology, high rates of underutilization remain. Relatively little is known about the characteristics of young people reporting unmet needs for assistive devices, so our study examined this further.

Method.?Data were analyzed using the 2006 Participation and Activity Limitation Survey. Youth aged 15–24 were selected to explore the characteristics associated with those currently using or reporting unmet needs for communication or mobility devices (n?=?15,817).

Results.?Family structure and language spoken influenced the likelihood of using a communication device for two age subgroups. Meanwhile, language spoken influenced the likelihood of reporting unmet needs for communication assistive devices. The following factors influenced the likelihood of using a mobility device: age, gender, language spoken, income, family structure, and severity of impairment. Gender, geographic location, language spoken, family structure, duration and severity of impairment and presence of other impairments influenced the likelihood of reporting unmet needs for mobility devices.

Conclusions.?Clinicians need to pay particular attention to the socio-cultural factors of young clients transitioning to adult care.     

An intensive intervention for improving gait, balance, and mobility in individuals with chronic incomplete spinal cord injury: a pilot study of activity tolerance and benefits

Fritz SL, Merlo-Rains AM, Rivers ED, Peters DM, Goodman A, Watson ET, Carmichael BM, McClenaghan BA. An intensive intervention for improving gait, balance, and mobility in individuals with chronic incomplete spinal cord injury: a pilot study of activity tolerance and benefits.

Objective

To determine the tolerance to and benefits of an intensive mobility training (IMT) approach for individuals with incomplete spinal cord injury (ISCI).

Design

Prospective pretest-posttest study with 6-month follow-up.

Setting

University research laboratory.

Participants

A volunteer sample of individuals with ISCI (N=15; >6mo postinjury and able to walk at least 3.05m with or without assistance). Follow-up data were collected for 10 of the participants.

Interventions

Participants received IMT for 3h/d for 10 weekdays, participating in activities that encouraged repetitive, task-specific training of their lower extremities in a massed practice schedule.

Main Outcome Measures

Amount of time spent in therapeutic activities and rest was used to assess participants' tolerance to the intervention. Treatment outcomes were assessed pretest, posttest, and 6 months after the intervention and included the Berg Balance Scale (BBS), Dynamic Gait Index (DGI), 6-minute walk test, gait speed, and Spinal Cord Injury Functional Ambulation Inventory.

Results

Individuals in the higher functioning ISCI group (BBS score ≥45 and gait speed ≥0.6m/s) spent more time in the intensive therapy on average than individuals in the lower functioning ISCI group. Effect sizes were comparable for changes in balance and mobility assessments between the lower and higher functioning groups, with the largest effect sizes observed for the DGI.

Conclusions

This dosage of IMT may be a more appropriate treatment approach for higher functioning ISCI individuals, as they were better able to tolerate the length of the session and demonstrated higher effect sizes postintervention.     

Clinic-based needs assessment of individuals with multiple sclerosis and significant others: implications for program planning--psychological needs.

The purpose of this study was to identify the psychological/psychosocial needs of patients with multiple sclerosis (MS) and their significant others (SOs) who attended an MS clinic. A quantitative questionnaire, developed from focus groups, consisted of 23 needs statements in the psychological/psychosocial needs category. Participants were randomly selected from the clinic's database. The questionnaire was completed by 353 MS patients and 240 significant others. Content analysis of the psychological category produced four themes: general psychological needs, psychological needs related to specific resource needs, psychological needs related to interaction with the medical community, and psychological needs statements displaying a difference between MS and SO responses. The data indicate the importance of psychological intervention in the care of MS patients and its implications for program planning.