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.

     

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.

     

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.

     

Engendering a conducive environment for university students with physical disabilities: assessing availability of assistive facilities in Nigeria

Purpose: This study assessed awareness and availability of assistive facilities in a Nigerian public university.

Methods: Study was conducted in Obafemi Awolowo University (OAU), Ile Ife Nigeria using a mixed methods approach. Fifty two students with disability (SWD) were interviewed with a semistructured, self-administered questionnaire. A checklist was used to assess assistive facilities on campus while in-depth interviews (IDI) were conducted with university officials, to assess their perspectives about the availability and use of assistive facilities in the university.

Results: Almost three-thirds (57.7%) of SWD were male while more than two-thirds were aged between 21 and 30?years. About seven in 10 (71.1%) respondents, had mobility impairment, while two-fifth had visual impairment (40.8%) and a few had hearing impairment. Only the university’s administrative building had a functioning elevator. Slightly more than half (54.5%) of the lecture theatres have public address systems, while only two have special entrances and exits with ramps for SWD. Almost all respondents were unaware of facilities that aid learning (96.2%) and facilities for library use (90.4%). University officials were aware of assistive facilities for SWD but do not know the actual number of SWD.

Conclusion: Assistive facilities for SWD on campus are limited. More assistive facilities need to be provided alongside increased awareness about these facilities and a disability register should be open for students on campus. Assistive facilities to aid learning and make SWD more comfortable are required.

• Implications for Rehabilitation

• Universities should have an official policy on students with disabilities and implement it, such a policy should address special considerations for disabled students, such as having an updated register for students with disability, having examination questions in large fonts for students with visual disabilities, giving them extra time for examinations and providing special counselling services for students with disabilities.

• Awareness about assistive facilities in tertiary institutions for students with disability should be increased so that they can utilize the ones available and demand for such if non-existent.

• The design of buildings on university campus should be made disability friendly.

• A disability register should be open for SWD on campus.

     

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.

     

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.

     

Opening the GATE: systems thinking from the global assistive technology alliance

Abstract

Purpose: This paper describes international actions to collaborate in the assistive technology (AT) arena and provides an update of programmes supporting AT globally.

Methods: The World Health Organisation (WHO) identifies the severe global uneven distribution of resources, expertise and extensive unmet need for AT, as well the optimistic substantial capability for innovations and developments in appropriate and sustainable AT design, development and delivery. Systems thinking and market shaping are identified as means to address these challenges and leverage the ingenuity and expertise of AT stakeholders.

Results: This paper is a ‘call to action’, showcasing emerging AT networks as exemplars of a distributed, but integrated mechanism for addressing AT needs globally, and describing the Global Alliance of Assistive Technology Organisations (GAATO) as a vehicle to facilitate this global networking.

Conclusion: Partners in this Global Alliance aim to advance the field of assistive technology by promoting shared research, policy advocacy, educating people and organisations within and outside the field, teaching, training and knowledge transfer by pulling together broad-based membership organisations.

• Implications for Rehabilitation

• Collegial, cross discipline and multi-stakeholder collaborations support assistive technology research and practice.

• Knowledge exchange within and across countries and regions is mutually beneficial.

• Self-organising assistive technology communities are emerging and supported by global movements such as WHO GATE and GAATO.

     

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.

     

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.

     

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.

     

Caregiver perspectives on a smart home-based socially assistive robot for individuals with Alzheimer’s disease and related dementia

Abstract

Purpose: Innovative assistive technology can address aging-in-place and caregiving needs of individuals with Alzheimer’s disease and related dementia (ADRD). The purpose of this study was to beta-test a novel socially assistive robot (SAR) with a cohort of ADRD caregivers and gather their perspectives on its potential integration in the home context.

Methods: The SAR involved a programmable research robot linked with commercially available Internet of things sensors to receive and respond to care recipient’s behaviour. Eight caregivers observed the SAR perform two care protocols concerning the care recipient’s daily routine and home safety, and then participated in a focus group and phone interview. The researchers used grounded theory and the Unified Theory of Acceptance and Use of Technology as a framework to gather and analyse the data.

Results: The caregivers’ asserted the potential of the SAR to relieve care burden and envisioned it as a next-generation technology for caregivers. Adoption of the SAR, as an identified theme, was subject to the SAR’s navigability, care recipient engagement, adaptability, humanoid features, and interface design. In contrast, barriers leading to potential rejection were technological complexity, system failure, exasperation of burden, and failure to address digital divide.

Conclusion: From a broader outlook, success of SARs as a home-health technology for ADRD is reliant on the timing of their integration, commercial viability, funding provisions, and their bonding with the care recipient. Long-term research in the home settings is required to verify the usability and impact of SARs in mediating aging-in-place of individuals with ADRD.

• IMPLICATIONS FOR REHABILITATION

• Socially assistive robots (SARs), an emerging domain of assistive technology, are projected to have a crucial role in supporting aging-in-place of individuals with Alzheimer's disease and related dementia (ADRD).

• Caregivers of individuals with ADRD who observed and interacted with a novel SAR asserted their acceptance of the technology as well as its scope and feasibility for the upcoming generation of caregivers.

• Navigability, care recipient engagement, adaptability, humanoid features, and interface design were stated to be critical factors for SAR's acceptance by caregiver and care recipient dyads.

• In contrast, technological complexity, system failure, exasperation of burden, and failure to address digital divide are detrimental to SAR's adoption.

• Several design and implementation requirements must be considered towards the full-scale development and deployment of the SARs in the home context.

     

Effects of bilateral swing-away grab bars on the biomechanics of stand-to-sit and sit-to-stand toilet transfers

Purpose: Kinetic characteristics of transfers to and from a toilet performed using bilateral grab bars are not fully quantified to inform grab bar design and configuration. The purpose of this study was to (1) determine effects of bilateral swing-away grab bars on peaks of ankle, knee and hip joint moments during grab bar assisted stand-to-sit and sit-to-stand transfers; and (2) determine effects of three different heights and widths of swing-away grab bars on the same kinetic characteristics.

Methods: Healthy subjects (N?=?11, age 25–58?years) performed stand-to-sit and sit-to-stand transfers with and without grab bars. In transfers with grab bars, 9 grab bar configurations were tested by varying their height from the floor (0.787?m, 0.813?m, 0.838?m; 31″–33″) and width, the distance of each grab bar from the toilet’s centerline (0.330?m, 0.356?m, 0.381?m; 13″–15″). Motion capture, force plate and inverse dynamics analysis were used to determine lower limb joint moments.

Results: The use of bilateral grab bars generally reduced the peak magnitude of extension moments at lower limb joints during stand-to-sit and sit-to-stand transfers (p?Conclusion: The obtained results suggest that the studied ranges of grab bar configurations reduce moment demands on the leg joints and thus decrease difficulty and required lower limb muscle effort to perform the transfers.

• Implications for Rehabilitation

• Maximizing the benefits of assistive technology in the built environment requires a careful assessment of their spatial and configurational dimensions, especially in respect to the needs and abilities of the intended users.

• Examining the kinetic characteristics of transfers to and from a toilet using the swing-away grab bars is useful for informing grab bar design and configuration recommendations for assisted living and skilled nursing facilities.

• Our findings suggest that the swing-away grab bars located at certain ranges are a reasonable alternative to the grab bars mandated by the current Americans with Disabilities Act (ADA) Accessibility Guidelines.

• Future research investigating the effects of grab bars on transfer performance should consider additional factors, such as a wider range of abilities and transfer methods of the users.

     

Pain,fatigue, function and participation among long-term manual wheelchair users partnered with a mobility service dog

Purpose: To assess the effects of a mobility service dog (MSD) on pain, fatigue, wheelchair-related functional tasks, participation and satisfaction among manual wheelchair users over a nine-month period.

Method: A longitudinal study with repeated assessment times before and three, six and nine months after intervention was achieved. Intervention consisted in partnering each participant with a MSD. The setting is a well-established provincial service dog training school and participants homes. A convenience sample of 24 long-term manual wheelchair users with a spinal cord injury was involved. Outcome measures were: Wheelchair User’s Shoulder Pain Index (WUSPI), Rate of Perceived Exertion (RPE), vitality scale from the SF-36, grip strength, Wheelchair Skills Test (WST), Canadian Occupational Performance Measure (COPM), Reintegration to Normal Living Index (RNLI), Life Space Assessment, Psychosocial Impact of Assistive Devices Scale (PIADS) and Quebec User Evaluation of Satisfaction with assistive Technology (QUEST 2.0).

Results: Shoulder and wrist pain as well as fatigue decreased significantly over time with the use of a MSD as evidenced by scores from WUSPI, RPE and SF-36 (feeling less worn out). Manual wheelchair propulsion skills (steep slopes, soft surfaces and thresholds) improved significantly over time as confirmed by the WST. Participation increased significantly over time as revealed by the COPM (for five occupations) and the RNLI (for five items). Satisfaction with the MSD was high over time (QUEST: nine items) and with a high positive psychosocial impact (PIADS: 10 items).

Conclusion: MSD represents a valuable mobility assistive technology option for manual wheelchair users.

• IMPLICATIONS FOR REHABILITATION

• For manual wheelchair users partenered with mobility service dog ??Shoulder pain and fatigue significantly decreased and continued to decrease between the third and sixth month and the ninth month.

• ??Performance with propelling the wheelchair up steep slopes increased from 41 to 88% and on soft surfaces increased from 53 to 100% after 3 months, respectively.

• ??Occupational performance satisfaction was significantly increased for mobility in relation with the transfers, navigating in a natural environment and picking up objects.

• ??High satisfaction towards psychosocial competency, psychosocial adequacy and self-esteem were reported at months three, six and nine.

     

Assistive technology as a pillar of universal health coverage: qualitative analysis of stakeholder responses to the world health assembly resolution on assistive technology

Abstract

Purpose: The importance of assistive technology (AT) as a pillar of universal health coverage was recognized at the 71st World Health Assembly (WHA) through the passing of Resolution 71.8 on improving access to AT (May 2018). A systematic analysis was conducted on the responses made to the Resolution by Member States and non-state actors, in order to provide a snapshot of global intent.

Methods: Qualitative content analysis was conducted on over 40 written “Statements” made by Member States and non-state actors in response to Resolution 71.8.

Results: The Resolution provides tangible guidance to the World Health Organisation (WHO) and its member states in order for them to meet commitments within the Convention on the Rights of Persons with Disabilities (CRPD). Statements made in response to the Resolution offer a unique plethora of multi-stakeholder views from differing global perspectives. Analysis identified a range of themes within two overarching themes: intersection of health, human rights and sustainable development; and international collaboration and support within an international agenda framework.

Conclusion: The content analysis synthesises complex global data and identifies directions to positively influence national and regional AT policy and delivery. The complexity of factors demonstrates the importance of an AT systems-thinking approach; that is, the development and application of organised knowledge, skills, procedures and policies related to assistive products. AT systems thinking will be essential for AT to be effectively deployed as a pillar of universal health coverage.

• IMPLICATIONS FOR REHABILITATION

• Assistive technology is a key facilitator of health and well-being, playing a critical role in global efforts to improve population health outcomes and strengthening health systems

• Access to assistive technology is a public health priority and is an essential health product to be covered under Universal Health Coverage

• Effective action on access to assistive technology must encompass the reality of diverse contexts yet common purposes expressed by global actors

• This analysis demonstrates the intersection of the health, human rights and sustainable development agendas, and the importance of international collaboration and support in achieving effective access

     

A rapid review of the effect of assistive technology on the educational performance of students with impaired hearing

Abstract

Purpose: To review the knowledge base regarding assistive technology (AT) and the education of people with a hearing impairment. Also, evaluating to what extent has the use and/or impact of AT for individuals with a hearing impairment been determined through evidence-based research in post-school education.

Materials and method: Literature pertaining to the effect of AT on the educational performance of students with impaired hearing in the post-school sector was examined for the period from 1998 to 2018 (20 years). A total of 477 articles that contained evidence-based research and reports on the effect of AT in practice were located and reviewed.

Results: It was found that, of the 20 studies that met all the inclusion criteria, only seven provided promising, evidence-based reports on the impact of assistive hearing technology on educational performance.

Conclusion: This review concluded that the limited research speaks to the positive impact of AT on educational outcomes. Additionally, for students with a hearing impairment to be able to receive high-quality AT that will enhance their educational success, more evidence-based research on the efficacy of hearing AT needs to be conducted, especially as newer technologies emerge in this technological era.

• Implications for rehabilitation

• The use of appropriate hearing assistive technology (AT) is a key facilitator within the educational environment and has a positive impact on the educational outcomes for students studying at college or university.

• This rapid review revealed the need to develop a body of scientifically based research that examines the relationship between academic achievement of participation by deaf learners and the use of AT – this is needed to develop a more comprehensive understanding of the benefits and limitations of educational technologies, especially as newer technologies emerge in this technological era.

• This study further highlights the need for more concrete research on the effectiveness of hearing-related AT so that the case can be made for students with hearing impairment to receive high quality, appropriate AT that will enhance their educational success.

• Ultimately, it is hoped that this article elicits the need for much more investigation into this topic to work towards finding solutions that lead to increased participation of deaf learners in the higher education arena, as well as providing evidence-based results to inform future policy and practice.

     

The future of the provision process for mobility assistive technology: a survey of providers

Purpose: The purpose of this study was to evaluate the opinions of providers of mobility assistive technologies to help inform a research agenda and set priorities.

Materials and methods: This survey study was anonymous and gathered opinions of individuals who participate in the process to provide wheelchairs and other assistive technologies to clients. Participants were asked to rank the importance of developing various technologies and rank items against each other in terms of order of importance. Participants were also asked to respond to several open-ended questions or statements.

Results: A total of 161 providers from 35 states within the USA consented to participation and completed the survey.

Conclusions: This survey revealed themes of advanced wheelchair design, assistive robotics and intelligent systems, human machine interfaces and smart device applications. It also outlined priorities for researchers to provide continuing education to clients and providers. These themes will be used to develop research and development priorities.

• Implications for Rehabilitation

• ??Research in advanced wheelchair design is needed to facilitate travel and environmental access with wheelchairs and to develop alternative power sources for wheelchairs.??New assistive robotics and intelligent systems are needed to help wheelchairs overcome obstacles or self-adjust, assist wheelchair navigation in the community, assist caregivers and transfers, and aid ambulation.??Innovations in human machine interfaces may help advance the control of mobility devices and robots with the brain, eye movements, facial gesture recognition or other systems.??Development of new smart devices is needed for better control of the environment, monitoring activity and promoting healthy behaviours.

     

A motor learning therapeutic intervention for a child with cerebral palsy through a social assistive robot

Abstract

Background: Children with cerebral palsy have difficulty to sit, stand, walk, run and jump independently. Therapy is an important factor in improving these aspects, and if applied in early intervention treatments, when the child is growing, it could have many benefits. These therapies require intensive and extended sessions, which in turn demand dedication and effort. New strategies that provide interesting and motivating interventions are often incorporated to improve the participation and performance of the children in the therapies. Therapies using social assistive robots can be alternative and complementary methods to promote the participation and motivation of children with cerebral palsy.

Methods: The objective of this work is to validate the effectiveness of a 16-session physical therapy program to improve the participation and fulfillment of therapeutic objectives on an 8 year-old boy with dyskinetic cerebral palsy for motor learning to walk using a social assistive robot. The therapy program was carried out through a methodological proposal that uses SMART objectives (Specific, Measurable, Achievable, Realistic and Timed), Goal-Directed Therapy (GDT) and its evaluation through Goal Attainment Scaling (GAS). Results: A NAO robot was used as a social assistive robot to support a physical therapy for a child with cerebral palsy. In this work, it was observed that the motivation generated by the interaction with the social assistive robot facilitated the persistence in the walking and the fulfillment of the objectives. Conclusion: Using humanoid robots as social assistive robots may benefit therapeutic processes on children with motor disabilities. The methodology developed provides a formal way to achieve objectives in therapeutic processes for children with cerebral palsy.

• Implications for rehabilitation

• It requires researchers to conduct more studies to validate the potential of the use of social robots in therapeutic interventions that promote development in children with motor disabilities, such as cerebral palsy.

• Promoting the use of new technologies in therapeutic processes such as humanoid robots allows us to create new strategies to know the impact of this technology in the area of rehabilitation.

• The use of formal methodologies focused on the patient, along with multidisciplinary teams, could increase the possibilities of using social robots to improve cognitive and motor outcomes in children with cerebral palsy.

• The formulation of SMART objectives and their quantification through the GAS scale can be used as recommendations to improve the formulation of goals in therapeutic interventions for children with cerebral palsy.

     

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.

     

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.