The impact of mobility assistive technology devices on participation for individuals with disabilities

Aim: This study aims to address the gap in research and contribute to the body of knowledge on the perspectives assistive technology device users have toward their devices. Method: Mixed methods were used to better understand the impact of mobility assistive technology devices (MATDs) on participation for individuals with disabilities. The Functional Mobility Assessment was administered in conjunction with two qualitative questions developed by the research team allowing participants to expound on the impact of their MATD experience. Participants were recruited online via the National Spinal Cord Injury Association website and in-person at Abilities Expo in Atlanta, Georgia, and the International Seating Symposium in Nashville, Tennessee. Results: Results are consistent with findings from prior research regarding accessibility for individuals with disabilities. Corresponding findings were found in both the quantitative and qualitative data and are categorized into several major themes: environment (indoor and outdoor), surface heights, transportation, dependence, independence, quality of life and participation. Conclusion: Quantitative data from this study indicate that users of MATD are satisfied with the way in which their devices enable maneuvering indoors, while qualitative data suggest otherwise. Implications for healthcare practitioners are described and future recommendations are provided.

• Implications for Rehabilitation

• Healthcare professionals should advocate for proper mobility assistive technology devices (MATDs) for their patients in order to enable increased independence, safety and efficiency.

• Healthcare professionals must be cognizant of the impact of the environment and/or environmental barriers when prescribing MATD.

• Additional areas of interest for future research may include investigating the impact of MATD in association with date of onset of disability, according to diagnoses, or specific to length of time since acquiring the device.

     

Emerging issues and current trends in assistive technology use 2007–2010: practising,assisting and enabling learning for all

Abstract

Following an earlier review in 2007, a further review of the academic literature relating to the uses of assistive technology (AT) by children and young people was completed, covering the period 2007–2011. As in the earlier review, a tripartite taxonomy: technology uses to train or practise, technology uses to assist learning and technology uses to enable learning, was used in order to structure the findings. The key markers for research in this field and during these three years were user involvement, AT on mobile mainstream devices, the visibility of AT, technology for interaction and collaboration, new and developing interfaces and inclusive design principles. The paper concludes by locating these developments within the broader framework of the Digital Divide.

• Implications for Rehabilitation

• The rapid move to mainstream mobile devices is challenging to providers of assistive learning technologies, to those who commission and advise on these technologies and to those who fund in this area.

• Recent research around assistive learning technologies is moving away from being solely oriented around product evaluation and towards a user-centred approach.

• Current and developing interfaces, such as brain control and eye gaze, offer potential for assistive learning technology support for those to whom no such devices were valid in the past.

• There is a need for longitudinal research related to the uses of assistive learning technologies.

     

Challenges of user-centred assistive technology provision in Australia: shopping without a prescription

Purpose: People with disability have a right to assistive technology devices and services, to support their inclusion and participation in society. User-centred approaches aim to address consumer dissatisfaction and sub-optimal outcomes from assistive technology (AT) provision, but make assumptions of consumer literacy and empowerment. Policy discourses about consumer choice prompt careful reflection, and this paper aims to provide a critical perspective on user involvement in assistive technology provision. Methods: User-centred approaches are considered, using literature to critically reflect on what user involvement means in AT provision. Challenges at the level of interactions between practitioners and consumers, and also the level of markets and policies are discussed, using examples from Australia. Results: There is no unanimous conceptual framework for user-centred practice. Power imbalances and differing perspectives between practitioners and consumers make it difficult for consumers to feel empowered. Online access to information and international suppliers has not surmounted information asymmetries for consumers or lifted the regulation of publicly funded AT devices. Conclusions: Ensuring access and equity in the public provision of AT is challenging in an expanding market with diverse stakeholders. Consumers require personalised information and support to facilitate their involvement and choice in AT provision.

• Implications for Rehabilitation

• Variations in approaches informing AT provision practices have a profound impact on equity of access and outcomes for consumers.

• An internationalised and online market for AT devices is increasing the need for effective information provision strategies and services.

• Power imbalances between practitioners and consumers present barriers to the realisation of user-centred practice.

     

Multiple stakeholder perceptions of assistive technology for individuals with cerebral palsy in New Zealand

Background: This study sought to gain an understanding of the experiences and perspectives of assistive technology from different stakeholders in technology adoption, in the New Zealand context.

Methods: A focus group was held with individuals with cerebral palsy (n?=?5), service providers (n?=?4), caregivers (n?=?3) and a biomechanical engineer. The data recordings from the focus group were transcribed and coded using thematic analysis.

Results: Themes emerged around barriers imposed by the assessment process and training in assistive technology procedures, the influence of family members, the environment that assistive technology is used in, and psychosocial aspects of being able to participate and integrate into society.

Conclusion: The results are similar to other literature, suggesting new innovations and changes are in dire need, to improve assistive technology experiences for all stakeholders.

• Implications for Research

• Service providers for assistive technology desire more effective training and support of existing and emerging technologies.

• Although the set procedure for acquiring assistive technology in New Zealand is comprehensive, incorporating multiple perspectives, it is difficult to follow through in practice. More innovative procedures are needed.

• The movement of Universal Design is significantly improving the perception of individuals with disabilities, and has enabled greater social inclusion. More assistive technology developers need to ensure that they incorporate these principles in their design process.

     

Validating a measure to assess factors that affect assistive technology use by students with disabilities in elementary and secondary education

Purpose/Aim: The purpose of this study was to measure the predictive validity, internal consistency and clinical utility of the Matching Assistive Technology to Child & Augmentative Communication Evaluation Simplified (MATCH-ACES) assessment. Methods: Twenty-three assistive technology team evaluators assessed 35 children using the MATCH-ACES assessment. This quasi-experimental study examined the internal consistency, predictive validity and clinical utility of the MATCH-ACES assessment. Results: The MATCH-ACES assessment predisposition scales had good internal consistency across all three scales. A significant relationship was found between (a) high student perseverance and need for assistive technology and (b) high teacher comfort and interest in technology use (p?=?(0).002). Conclusions: Study results indicate that the MATCH-ACES assessment has good internal consistency and validity. Predisposition characteristics of student and teacher combined can influence the level of assistive technology use; therefore, assistive technology teams should assess predisposition factors of the user when recommending assistive technology.

• Implications for Rehabilitation

• Educational and medical professionals should be educated on evidence-based assistive technology assessments.

• Personal experience and psychosocial factors can influence the outcome use of assistive technology.

• Assistive technology assessments must include an intervention plan for assistive technology service delivery to measure effective outcome use.

     

Principles for fostering the transdisciplinary development of assistive technologies

Developing useful and usable assistive technologies often presents complex (or “wicked”) challenges that require input from multiple disciplines and sectors. Transdisciplinary collaboration can enable holistic understanding of challenges that may lead to innovative, impactful and transformative solutions. This paper presents generalised principles that are intended to foster transdisciplinary assistive technology development. The paper introduces the area of assistive technology design before discussing general aspects of transdisciplinary collaboration followed by an overview of relevant concepts, including approaches, methodologies and frameworks for conducting and evaluating transdisciplinary working and assistive technology design. The principles for transdisciplinary development of assistive technologies are presented and applied post hoc to the COACH project, an ambient-assisted living technology for guiding completion of activities of daily living by older adults with dementia as an illustrative example. Future work includes the refinement and validation of these principles through their application to real-world transdisciplinary assistive technology projects.

• Implications for rehabilitation

• Transdisciplinarity encourages a focus on real world ‘wicked’ problems.

• A transdisciplinary approach involves transcending disciplinary boundaries and collaborating with interprofessional and community partners (including the technology's intended users) on a shared problem.

• Transdisciplinarity fosters new ways of thinking about and doing research, development, and implementation, expanding the scope, applicability, and commercial viability of assistive technologies.

     

Exploring assistive technology and post-school outcomes for students with severe disabilities

Purpose: This study sought to understand the extent to which students with severe disabilities receive assistive technology in school and out-of-school, and the relationship between receipt of assistive technology in school and post-school outcomes for these students. Method: This study was a secondary analysis of the National Longitudinal Transition Study-2 (NLTS2) from the USA. To analyze the data in this correlational study, researchers conducted frequency distributions, Chi Square Tests of Associations, significance tests and logistic regressions. Results: The main results suggest (a) receipt of assistive technology in school varied greatly by disability identification; (b) receipt of assistive technology post-school also varied by disability identification, but receipt was generally lower; and (c) few statistically significant post-school outcome differences existed between students who received assistive technology and those who did not. Conclusion: An under-utilization of assistive technology exists in practice in the USA for students with severe disabilities.

• Implications for Rehabilitation

• An under-utilization of assistive technology for secondary students and adults with severe disabilities likely exists.

• A need exists for improved collaboration between professionals in rehabilitation and professionals in schools to ensure continuation of needed services or aids, such as assistive technology.

• Additional research is needed to better understand the adult life (or post-school) outcomes of individuals with severe disabilities, factors from PK-12 schooling or post-school services that positively and negative impact those outcomes.

     

A plug-and-play brain-computer interface to operate commercial assistive technology

Abstract

Purpose: To determine if a brain-computer interface (BCI) could be used as a plug-and-play input device to operate commercial assistive technology (AT), and to quantify the performance impact of such operation. Method: Using a hardware device designed in our lab, participants (11 with amyotrophic lateral sclerosis, 22 controls) were asked to operate two devices using a BCI. Results were compared to traditional BCI operation by the same users. Performance was assessed using both accuracy and BCI utility, a throughput metric. 95% confidence bounds on performance differences were developed using a linear mixed model. Results: The observed differences in accuracy and throughput were small and not statistically significant. The confidence bounds indicate that if there is a performance impact of using a BCI to control an AT device, the impact could easily be overcome by the benefits of the AT device itself. Conclusions: BCI control of AT devices is possible, and the performance difference appears to be very small. BCI designers are encouraged to incorporate standard outputs into their design to enable future users to interface with familiar AT devices.

• Implications for Rehabilitation

• Brain-computer interface (BCI) control of assistive technology (AT) devices is possible.

• The performance impact of such control is low when BCIs are commercially available, AT providers can use a BCI as an input device to existing AT devices already in use by their clients.

     

The use of mobile devices as assistive technology in resource-limited environments: access for learners with visual impairments in Kenya

Purpose: In this paper, the authors explore the use of mobile devices as assistive technology for students with visual impairments in resource-limited environments. This paper provides initial data and analysis from an ongoing project in Kenya using tablet devices to provide access to education and independence for university students with visual impairments in Kenya. Method: The project is a design-based research project in which we have developed and are refining a theoretically grounded intervention – a model for developing communities of practice to support the use of mobile technology as an assistive technology. We are collecting data to assess the efficacy and improve the model as well as inform the literature that has guided the design of the intervention. Results: In examining the impact of the use of mobile devices for the students with visual impairments, we found that the devices provide the students with (a) access to education, (b) the means to participate in everyday life and (c) the opportunity to create a community of practice. Conclusions: Findings from this project suggest that communities of practice are both a viable and a valuable approach for facilitating the diffusion and support of mobile devices as assistive technology for students with visual impairments in resource-limited environments.

• Implications for Rehabilitation

• The use of mobile devices as assistive technology in resource-limited environments provides students with visual impairments access to education and enhanced means to participate in everyday life.

• Communities of practice are both a viable and a valuable approach for facilitating the diffusion and support of mobile devices as assistive technology for students with visual impairments in resource-limited environments.

• Providing access to assistive technology early and consistently throughout students’ schooling builds both their skill and confidence and also demonstrates the capabilities of people with visual impairments to the larger society.

     

Conceptual issues in the measurement of participation among wheeled mobility device users

Purpose. To review current measurement approaches to activity and participation among wheeled mobility users and suggest key factors researchers should consider as they continue to develop and refine both the concept of participation and its measurement.

Methods. Literature review and expert opinion.

Results. Four issues are reviewed:

1. Participation as a concept and as a key domain of the revised International Classification of Functioning, Disability and Health (ICF).

2. The ‘perspective’ of current participation self-reports as they reflect the underlying cultural values of autonomy and independence.

3. The lack of sensitivity in current participation measures to assistive technology.

4. The significance of the ICF qualifiers ‘capacity’ and ‘performance’ to the accurate assessment of activity and participation among wheeled mobility users.

Conclusions. The following suggestions are offered as researchers continue to develop increasingly sophisticated instruments and methods: (1) participation measures need to be device-specific; (2) measures ought to capture both ‘capacity’ and ‘performance’; (3) methods need to be sensitive to those factors that impact mobility device use over time; (4) methods need to be sensitive to the complexities of both the social and physical environment as they impact device use; and (5) measures need to reflect the impact of multiple mobility device use.     

Exploring the experience of clients with tetraplegia utilizing assistive technology for computer access

Purpose: Assistive technology for computer access can be used to facilitate people with a spinal cord injury to utilize mainstream computer applications, thereby enabling participation in a variety of meaningful occupations. The aim of this study was to gain an understanding of the experiences of clients with tetraplegia trialing assistive technologies for computer access during different stages in a public rehabilitation service. Method: In order to explore the experiences of clients with tetraplegia trialing assistive technologies for computer use, qualitative methodology was selected. Data were collected from seven participants using semi-structured interviews, which were audio-taped, transcribed and analyzed thematically. Results: Three main themes were identified. These were: getting back into life, assisting in adjusting to injury and learning new skills. Conclusions: The findings from this study demonstrated that people with tetraplegia can be assisted to return to previous life roles or engage in new roles, through developing skills in the use of assistive technology for computer access. Being able to use computers for meaningful activities contributed to the participants gaining an enhanced sense of self-efficacy, and thereby quality of life.

• Implications for Rehabilitation

• Findings from this pilot study indicate that people with tetraplegia can be assisted to return to previous life roles, and develop new roles that have meaning to them through the use of assistive technologies for computer use.

• Being able to use the internet to socialize, and complete daily tasks, contributed to the participants gaining a sense of control over their lives.

• Early introduction to assistive technology is important to ensure sufficient time for newly injured people to feel comfortable enough with the assistive technology to use the computers productively by the time of discharge.

• Further research into this important and expanding area is indicated.

     

Methodological challenges confronting researchers of wheeled mobility aids and other assistive technologies

Purpose. To identify gaps in assistive technology (AT) research and solutions, with a focus on wheeled mobility.

Methods. Literature review.

Results. AT researchers have identified a need to move beyond determining whether a device works well in the laboratory or is perceived favorably by users. The vital next step in AT research is to determine the effects of AT when used for day-to-day activities by typical consumers. Four challenges affect AT research on everyday mobility:

1. the heterogeneity of the population using AT, the environments in which AT is used, and the devices themselves;

2. the dependency of empirical research on objective data for valid causal inference;

3. the need for detailed information to capture the interaction between the person, the device, and the environment in which it is used; and

4. the extent to which success or failure of AT is dependent on the personal perspectives of the individual using the device.

These challenges are being addressed by AT researchers through use of new measures, novel data collection methods, and by linking quantitative with qualitative data.

Conclusions. AT researchers are adapting traditional research designs and analytic methods to examine that effects of AT on everyday life.     

MAPx (Mobility Aid Personalization): examining why older adults “pimp their ride” and the impact of doing so

We all do this. We personalize things. We buy leopard-printed seat covers and fuzzy dice for our cars, and display action figures and photographs in our offices. Studying older adults who have extended this process of personalization to their mobility devices, the purpose of the mobility aid personalization (MAPx) project is to examine MAPx and its impact on the health and mobility of older adults. Using a qualitative research design, field observations and interviews were conducted with 72 older adults to gain an in-depth understanding of device customization from an emic (insider’s) perspective. Findings illustrate that older adults personalize their devices for reasons of fun, function and fashion. MAPx – the process of purposefully selecting or modifying a mobility device to suit individual needs and preferences – was also found to promote health and mobility by encouraging device acceptance, increasing social participation, enhancing joy and preserving identity. MAPx makes an important contribution to our understanding of the complex relationship between older adults and assistive devices and provides a new approach to some old problems including falls, inactivity and social isolation. Encouraging MAPx is a promising rehabilitation strategy for promoting health and community mobility among the older adult population.

• Implications for Rehabilitation

• Personalizing an assistive device facilitates device acceptance, promotes health and well-beingand should be supported and encouraged in rehabilitative care.

• Choice, variety and access are critical aspects of assistive devices; vendors, manufacturers andpractitioners should work together to provide clients with a greater range of affordable optionsfor new devices.

• Function is more than mechanical or physical; social factors including social identity, stigma andsocial roles must be adequately considered and explicit in rehabilitative practice.

     

The order and priority of research and design method application within an assistive technology new product development process: a summative content analysis of 20 case studies

Summative content analysis was used to define methods and heuristics from each case study. The review process was in two parts: (1) A literature review to identify conventional research methods and (2) a summative content analysis of published case studies, based on the identified methods and heuristics to suggest an order and priority of where and when were used. Over 200 research and design methods and design heuristics were identified. From the review of the 20 case studies 42 were identified as being applied. The majority of methods and heuristics were applied in phase two, market choice. There appeared a disparity between the limited numbers of methods frequently used, under 10 within the 20 case studies, when hundreds were available.

• Implications for Rehabilitation

• The communication highlights a number of issues that have implication for those involved in assistive technology new product development:

• ?The study defined over 200 well-established research and design methods and design heuristics that are available for use by those who specify and design assistive technology products, which provide a comprehensive reference list for practitioners in the field;

• ?The review within the study suggests only a limited number of research and design methods are regularly used by industrial design focused assistive technology new product developers; and,

• ?Debate is required within the practitioners working in this field to reflect on how a wider range of potentially more effective methods and heuristics may be incorporated into daily working practice.

     

Recognition of familiar people with a mobile cloud architecture for Alzheimer patients

Purpose: This article aims to the evaluation of a prototypal assistive technology for Alzheimer’s disease (AD) patients that helps them to remember personal details of familiar people they meet in their daily lives. Method: An architecture is proposed for a personal information system powered by face recognition, where the main AD patient’s interaction is performed in a smart watch device and the face recognition is carried out on the Cloud. A prototype was developed to perform some tests in a real-life scenario. Results: The prototype showed correct results as a personal information system based on face recognition. However, usability flaws were identified in the interaction with the smart watch. Conclusions: Our architecture showed correct performance and we realized that it could be introduced in other fields, apart from assistive technology. However, when being targeted to patients with dementia some usability problems appeared, such as difficulties to read information in a small screen or take a proper photo. These problems should be addressed in further research.

• Implications for Rehabilitation

• This article presents a prototypal assistive technology for Alzheimer’s disease (AD) patients.

• It targets AD patients to recognize their familiars, especially in medium-advanced stages of the disease.

• Analysing pictures taken by a smart watch, which the patient carries, the person in front is recognized and information about him is sent to the watch.

• This technology enables patients to have all the information of any close person, as a remainder, easing their daily lives, improving their self-esteem and stimulating the patient with novel technology.

     

Enabling appropriate personnel skill-mix for progressive realization of equitable access to assistive technology

Abstract

Background and Methods: This paper reviews the current capacity of personnel in enabling access to assistive technology (AT) as well as the systems and processes within which they work, and was reviewed, discussed, and refined during and following the Global Research, Innovation, and Education in Assistive Technology (GREAT) Summit.

Findings: Key concepts addressed include a person-centred team approach; sustainability indicators to monitor, measure, and respond to needs for service design and delivery; education, research, and training for competent practice, using the six rehab-workforce challenges framework; and credentialing frameworks. We propose development of a competence framework and associated education and training programs, and development and implementation of a certification framework for AT personnel.

Conclusions: There is a resolve to address the challenges faced by People globally to access assistive technology. Context specific needs assessment is required to understand the AT Personnel landscape, to shape and strengthen credentialing frameworks through competencies and certification, acknowledging both general and specific skill mix requirements.

• Implications for Rehabilitation

• Personnel in assistive technology (AT) provision should be trained using a person-centred team approach, which emphasizes appropriate skill-mix to address multiple needs within the community.

• Sustainability indicators should be used which allow personnel to monitor, measure and respond to needs for service design and delivery.

• A competence framework with associated education and training program, coupled with the development and implementation of a certification framework for AT personnel needs, will promote quality in AT personnel training globally.

     

Caregivers’ experiences with the selection and use of assistive technology

Qualitative data from a mixed-methods clinical trial are used to examine caregivers’ experiences with the selection and use of assistive technology to facilitate care recipients’ independence. Through a thematic analysis of interviews from 27 caregivers, three broad themes were identified. “A partial peace of mind” described the generally positive psychological impacts from assistive technology, mainly reduced stress and a shift in caregiving labour from physical tasks to a monitoring role. “Working together” explored the caregivers’ experiences of receiving assistive technology and the sense of collaboration felt by caregivers during the intervention process. Finally, “Overcoming barriers“ addressed two impediments to accessing assistive technology: lack of funding and appointment wait times for service providers. The findings suggest that assistive technology provision by prescribers plays a beneficial role in the lives of caregivers, but access to such benefits can be hampered by contextual constraints.

• Implications for rehabilitation

• The study findings have a number of implications for rehabilitation practice:

• Family caregivers can be instrumental in determining what assistive technology is needed and then procured. Their involvement in the selection process is desirable because assistive technology may have both positive and negative impacts on them, and they themselves may use the devices chosen.

• Involving family caregivers as more active partners in the process of assistive technology provision may represent a greater time investment in the short term, but may contribute to better long-term outcomes for care recipients and caregivers as well.

• Limited access to funding and long appointment wait times are potential barriers to obtaining necessary assistive technologies.