Method: Data were collected and analysed according to Grounded Theory procedures, involving interviews with 24 participants, 17 weblogs, 17 autobiographical texts, and posts from 4 online forums.
Results: Prosthesis users are primarily concerned with being “just normal”: the condition of being and living in ways that persons variously perceive are “about right”; that are sufficient, fair, and generally how things “ought to be” for them. This concern is acted upon through: (i) “preserving”, where persons foresee and manage threats to being “just normal”, (ii) “redressing”, involving rectifying things judged not to be “just normal”, and (iii) “persevering”, where persons keep living “just normally” despite accompanying difficulties.
Conclusions: “Just normal” is a new means for rehabilitation practitioners to better understand a key concern of prosthesis users and the motivations underlying behaviours in their prosthesis use. It is also relevant and transferable to broader fields of assistive technology use and disability.
- Implications for Rehabilitation
The grounded theory of “just normal” invites practitioners to discover a key concern in prosthesis use, enabling a richer understanding of the needs and desires of service users.
Being “just normal” is presented as an important motivator underlying a range of diverse actions within prosthesis use.
The theory is relevant and transferable to broader areas of assistive technology use and disability.
Materials and methods: Twenty-five geriatric rehabilitation in-patients were recruited, six completed the study, and seven partially completed the study. Each participant had two trial bowel movements. One trial involved cleaning themselves with toilet paper; the other involved cleaning themselves with the TAT functions. After each trial, participants received a visual inspection for cleanliness and answered the Psychosocial Impact of Assistive Devices Scale (PIADS), a validated scale, to assess their sense of competence, adaptability and self-esteem in the bathroom. A toileting cleanliness scale, designed for this study, was completed by a nurse after TAT usage. Participants received a score from 1 (completely clean) to 4 (completely soiled) based on a visual inspection after cleaning.
Results: TAT and toileting cleanliness scores were similar. PIADS scores showed a trend towards higher scores when using the TAT, but results were not statistically significant.
Conclusions: TATs cleaned as well as standard toileting in geriatric rehabilitation inpatients. Participants indicated that TATs improved their sense of competence, adaptability and self-esteem. Geriatricians and rehabilitation professionals should consider prescribing TATs in their practice as an assistive device in order to promote patient independence and dignity and reduce the burden of care for patients requiring toileting assistance.
- Implications for rehabilitation
Technology-assisted toilets (TATs) are commercially-available toilet seats that could be used to allow rehabilitation patients to clean themselves more independently in the bathroom.
Improved toileting independence can reduce burden of care of geriatric rehabilitation and reduce the impact of toileting assistance on patient dignity and self-esteem.
Physiatrists should consider recommending TATs to their patients but should take into account whether a patient’s particular set of disabilities will allow them to use a TAT effectively.
Materials and methods: Eleven adolescents and adults were interviewed using Talking Mats and interview data was analyzed qualitatively with systematic text condensation.
Results: The use of remote communication varies between the participants. The participants also value remote communication differently. Having the possibility to choose between different means of remote communication is important. Being able to determine whether to communicate independently or with support from another person is also valued as relevant. Strategies used to manage remote communication include facilitating for the communication partner and preparing for future communication situations. Those who are able to use writing as an alternative to problematic spoken remote communication like phone calls, for example by using chat or text messaging. Decisions regarding means of communication and human support relate to the concept of self-determination.
Conclusion: Better access to remote communication trough assistive technology such as speech synthesis and picture symbols would make remote communication easier and facilitate participation for people with communicative and cognitive disabilities.
- Implications for rehabilitation
People with communicative and cognitive disabilities face challenges with access to remote communication.
Access to communication technology including remote communication is important for self-determination, for personal safety and for overall participation in society.
Communication technology should be considered in the rehabilitation process and training is crucial.
To understand the possible benefits of remote communication, people with communicative and cognitive disability need to get the possibility to practice.
Professionals play a key role in the assessment and intervention of remote communication for their patients.
Methodology and case content: This paper uses a single case derived from a larger ethnographic study of stroke survivors in rural Malaysia to demonstrate the role of assistive devices in shaping stroke recovery and how existing structures can be modified. Second, the concept of affordances in relation to structures within the environment, issues of affordability and accessibility of assistive devices for individuals in LMIC are discussed.
Findings and conclusions: Stroke recovery involves adapting to new limitations and discovering the support necessary to live life. These changes are influenced by a range of environmental factors. Healthcare professionals need to support stroke patients in identifying challenges and work to find innovative ways to address them. Stroke survivors may benefit from the use of an assistive device beyond its clinical function to participate purposefully in activities of daily living.
- Implications for Rehabilitation
Stroke is a cause of disability that limits everyday activities and reduces social participation.
Assistive devices help achieve independence, social inclusion and shape stroke recovery.
Individuals with disabilities in low and middle income countries often do not have access to assistive devices and resort to innovative solutions that are purpose built.
Stroke recovery involves adapting to new limitations and discovering the support necessary to live life as best as possible.
- 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.
Method: An uncontrolled pre- and post-assessment design was employed to study the use of unmodified, low-cost, off-the-shelf smartphones combined with Internet-calendars as a compensatory memory strategy in community-dwelling patients with traumatic brain injury. Thirteen participants received a 6-week group-based intervention with pre-, post- and 2-month follow-up-assessments by questionnaires and by daily assessment of target behaviors for 2-week periods.
Results: Participants reported significantly fewer retro- and prospective memory problems on questionnaires after the intervention and at follow-up with large effect sizes. The performance of target behaviors, however, improved insignificantly with moderate effect sizes. There were no changes in quality of life or symptoms of emotional distress.
Conclusions: This study adds to a growing body of evidence that smartphones are a useful compensatory aid in rehabilitation of prospective memory that should routinely be considered in rehabilitation of traumatic brain injury patients.
- Implication for rehabilitation
Smartphones are easy-to-use and accessible assistive technology for compensatory memory rehabilitation to most traumatic brain injury patients.
By using low-cost, off-the-shelf devices, the technology becomes available to a broader range of patients.
By combining smartphones with Internet-based and cross-platform services (e.g., calendars, contacts) the participants are less device-dependent and less vulnerable to data loss.
Smartphones should routinely be considered as compensatory aid in rehabilitation of prospective memory of traumatic brain injured patients.
Methods: Focus groups of individuals with disabilities and rehabilitation healthcare professionals were provided with video illustration of the technology and asked to provide quantitative and qualitative feedback through a semistructured interview process. Qualitative methods were employed to analyse transcribed comments to develop themes supporting ongoing development of the technology.
Results: Both end-user streams rated the original design features of the sensor access system (alternative interface to assistive technologies, having wireless capabilities and not requiring batteries) as having high potential value. Both groups identified a need for the future design of the sensor technology to be able to capture minimal/reduced movements for those with severe physical impairments. Themes included (1) the sensor technology could be individualized/customized to accommodate the user, (2) minimal positioning and set-up requirement and (3) technology that alleviated problems encountered with touch-based solutions.
Conclusions: Inclusion of end-user feedback provided the research team with valuable information that supported the initial conceptualization of the design features of the technology and provided valuable data to support development of a new prototype that can capture more reduced/minimal movements.
- Implication for Rehabilitation
User-centered design of assistive technology is essential to the development of technology that can meet the unique needs of those with the most severe physical impairments.
New sensor technology may alleviate some of the access challenges faced by individuals with severe physical impairments.
Collaboration between all key stakeholders (individuals with disabilities, rehabilitation professionals, researchers, and developers) is an essential component in the iterative assistive technology design process.
Methods: Eight randomized controlled trials were selected from online databases pertaining to the scientific use of AT devices for people with brain injury. The Jadad scale was used to analyse the subjects qualitatively, and Comprehensive Meta-Analysis 2.0 was used to test the statistical heterogeneity, effect size, sensitivity and publication bias of each of the selected studies.
Results: All selected studies were assigned a score of three on the Jadad scale, which could classify them as high-quality studies. The total number of participants in the studies was 385. The effect size of activities of daily living was 0.72, which is a medium effect size and that of cognitive function was 0.30, which is a small effect size.
Conclusion: Assistive devices are effective in improving the activities of daily living and relatively less effective in enhancing the cognitive function of people with brain injury. This meta-analysis is evidence that assistive devices could be an effective intervention method for people with brain injury.
- Implications for Rehabilitation
The purpose of this study is to demonstrate the effectiveness of this approach and to generalize the use of assistive devices. We aim to provide a basis for popularizing assistive devices as a therapeutic intervention method.
Method: The medical history of two HIV-positive patients with PML was reviewed; information on their neurological impairments, rehabilitation treatment and outcome was gathered.
Results: The patients, a 47-year-old married man and a 34-year-old single man, both suffered from dense right hemiplegia and motor aphasia. Their rehabilitation course was delayed and prolonged: they were suitable for intensive multidisciplinary rehabilitation only 8 months or more after the initial presentation. Their treatment in outpatient rehabilitation daycare three times a week, that lasted 7 months on average, resulted in slow and steady functional improvement. At the end of the rehabilitation treatment, both patients were living at home, able to express themselves, and able to walk independently with an assistive device. They remained with moderate disability (modified Rankin scale of 3).
Conclusion: PML patients require prolonged multidisciplinary rehabilitation treatment; however, considerable progress can be achieved.
- Implications for Rehabilitation
Progressive multifocal leukoencephalopathy (PML) is a disabling disease occurring in particular in the context of Human Immunodeficiency Virus (HIV).
Presently a growing number of HIV-positive PML patients eventually survive the disease and remain with severe neurological impairments.
PML patients require prolonged multidisciplinary rehabilitation treatment, and considerable progress can be achieved.
Methods: Studies identified in a previous systematic review published on 2016 on the methodology of studies evaluating RRs by the user perspective were re-screened for eligibility based on the following inclusion criteria: evaluation of the human–robot interaction from the user perspective, use of standardized outcome measurements, and quantitative presentation of study results.
Results: Seventeen studies were eligible for inclusion. Due to the clinical and methodological heterogeneity across studies, a narrative synthesis of study results was conducted. We found conflicting results concerning the effectiveness of the robotic functionalities of the RRs. Only a few studies reported superior user performance or reduced physical demands with the RRs compared to unassisted conditions or conventional assistive mobility devices; however, without providing statistical evidence. The user perception of the RRs was found to be generally positive.
Conclusions: There is still no sufficient evidence on the effectiveness of RRs from the user perspective. More well-designed, high-quality studies with adequate study populations, larger sample sizes, appropriate assessment strategies with outcomes specifically tailored to the robotic functionalities, and statistical analyses of results are required to evaluate RRs at a higher level of evidence.
- Implications for Rehabilitation
RRs cover intelligent functionalities that focus on gait assistance, obstacle avoidance, navigation assistance, sit-to-stand transfer, body weight support or fall prevention.
The evaluation from the user perspective is essential to ensure that RRs effectively address users’ needs, requirements and preferences.
The evidence on the effectiveness of RRs is severely hampered by the low methodological quality of most of the available studies.
RRs seem generally to be perceived as positive by the users.
There is very limited evidence on the effectiveness and benefits of RRs compared to conventional assistive mobility devices.
Further research with high methodological quality needs to be conducted to reach more robust conclusions about the effectiveness of RRs.
Method: An online national survey involving health and social care trusts in the UK. We conducted a synthesis of leaflets associated with measurement of furniture to identify existing guidance. The content and readability of this guidance was then evaluated.
Results: From the 325 responses received, 64 therapists reported using guidance. From the 13 leaflets that were analysed, 8 leaflets were found to meet Level 3 Adult Literacy Standards (age 9–11). There were differences in the way in which the measurement of furniture items occurred within the leaflets with no measurement guidance reported for baths.
Conclusion: There is a need to standardize guidance to ensure that measurements are reliable.
- Implications for Rehabilitation
Our research has highlighted the need to confirm and agree measurement techniques for home furniture in the provision of assistive devices.
Inaccurate guidance can lead to abandonment of devices.
Inaccurate guidance could prevent service users from not participating within the self-assessment process for devices.
Methods: Two therapists from North America who have worked extensively in low-resource areas used the WCQ-C to independently evaluate 46 wheelchairs at a primary school for children with disabilities in Kenya.
Results: Mean scores of ratings for each wheelchair by the two raters were used to calculate a two-way random interclass correlation coefficient. A value of 0.82 with a 95% confidence interval of 0.67–0.89 indicated good preliminary reliability.
Conclusion: Preliminary results indicate that the WCQ-C is a reliable method of assessment. Additional studies are needed with larger and more diverse groups of raters. Because WCQ-C findings are specific to wheelchair wear and maintenance at each location, studies at other locations are also needed.
- Implications for rehabilitation
The importance of inter-rater reliability testing in confirming the reliability of an assessment tool such as the WCQ-C.
The use of the WCQ-C to monitor wheelchair condition in low-resource settings and other field settings. If used at regular interval can produce data that can be used to describe typical changes over time at each individual setting. This could enable proactive planning at that setting to avoid typical breakdowns and the injuries or clinical complications that could result.
The use of the WCQ-C to monitor the condition of groups of wheelchairs of the same type. It can describe typical patterns of wear and failure in a way that enables responsive change by manufacturers and designers. This enables more effective use of limited funds.
On an individual basis, the use of the WCQ-C to alert users and health professionals of a need for repair or replacement. This could minimize the clinical problems and accidents that can result from wheelchair breakdown.
Assessment of a wheelchair using the WCQ-C could provide evidence based data to insurance companies or wheelchair providers which indicates a need for wheelchair repair or replacement.
Method: We conducted empirical evaluations with actual head-mounted mouse emulator users from two different groups: individuals with spinal cord injury (SCI) and individuals with cerebral palsy (CP), comparing each group’s performance and satisfaction level on pointing tasks with the circling interface to performance on the same tasks when using dwell-clicking software.
Results: Across all operations, for both subjects with SCI and with CP, the circling interface showed faster performance than the dwell-clicking interface. For the single-click operation, the circling interface showed slower performance than dwell selection, but for both double-click and drag-and-drop operations, the circling interface produced faster performance. Subjects with CP required much longer time to complete the tasks compared to subjects with SCI. If errors caused by circling on an area with no target and unintentional circling caused by jerky movements and an abnormally tiny circle are automatically corrected by the circling interface, their performance accuracy with the circling interface outperformed existing solutions without a steep learning curve.
Conclusions: Circling interface can be used in conjunction with existing techniques and this kind of combined approach achieve more effective mouse use for some individuals with pointing problems. It is also expected to be useful for both computer access and augmentative communication software.
- Implications for Rehabilitation
A circling interface will improve clinical practice by providing an alternative pointing method that does not require physically activating mouse buttons and is more efficient than dwell-clicking.
Being used in conjunction with existing techniques, some individuals who are head mouse users can achieve more effective mouse use.
The Circling interface can also work with AAC devices.
Method: Twenty-two participants including 16 rehabilitation clinicians and 6 persons living with a disability participated in four nominal group sessions. Participants were questioned on current or potential rehabilitation strategies carried out to enhance participation in shopping malls for persons living with a disability. Discussions were audio-recorded and qualitative content analysis was conducted.
Results: Participants mentioned strategies that were either carried out by the clinician, or in collaboration with other parties. The latter type of strategies was either carried out with the collaboration of the client, the interdisciplinary team, the relatives, or community organizations.
Conclusions: Rehabilitation clinicians have a role to play in preparing persons living with a disability to resume activities in a shopping mall. Additionally, therapeutic interventions in community settings may enhance the participation of rehabilitation clients in their everyday activities.
- Implications for rehabilitation
Many strategies are currently used in rehabilitation to prepare persons living with a disability to resume shopping activities.
Clinicians could implement shopping-oriented rehabilitation strategies with the client and/or with other rehabilitation partners.
Involving clients in activities related to shopping might enhance their participation in shopping malls after rehabilitation.
Rehabilitation clinicians can be facilitators for people living with a disability to reach optimal participation.
Materials and methods: Surveys were sent via mail, email and online postings to over 500 therapists, 107 responded.
Results: Conventional equipment such as stopwatches are more frequently used compared to newer technology like Wii and Kinect games. Still, less than 25% of therapists’ report using a stopwatch five or more times per week. Notably, feedback to patients is based upon objective data less than 50% of the time by most therapists. At the end of clinical rehabilitation, patients typically receive a written home exercise program and non-technological equipment, like theraband and/or theraputty to continue rehabilitation efforts independently.
Conclusions: The use of technology is not pervasive in the continuum of stroke rehabilitation.
- Implications for Rehabilitation
The patient care experience is a priority in healthcare, so when patients report feeling bored and desiring greater fostering of autonomy in stroke rehabilitation, it is troubling.
Research examining the use of technology has shown positive results for improving motor performance and engaging patients through entertainment and use of objective feedback.
Physical and occupational therapists do not widely use technology in stroke rehabilitation.
Therapists should consider using technology in stroke rehabilitation to better meet the needs of the patient.
Method: Two independent expert teams analyzed medical records on 299 consecutive patients admitted for CSS or DSS rehabilitation. One team provided a golden standard for the patient referrals, and the other team provided RCS-E scores. Models for predicting referrals from RCS-E scores were developed on data for 149 patients and tested on the remaining 150 patients.
Results: The optimal RCS-E sum score threshold for referral prediction was 11, predicting the golden standard for patient referral with sensitivity 88%, specificity 78% and correct classification rate 81%. Improved referral prediction performance was achieved by using RCS-E item-wise score thresholds (sensitivity 81%, specificity 89%, correct classification rate 87%). The RCS-E sum score range for patients referred CSS and DSS by the item-wise model was, respectively, 0–12 and 2–22 suggesting strong non-linear interaction of the RCS-E items.
Conclusions: We found excellent referral decision support in the RCS-E and the item specific threshold model, when patients with acquired brain injury are to be referred to CSS or DSS as their primary rehabilitation.
- Implications for Rehabilitation
Efficient rehabilitation after acquired brain injury requires rehabilitation settings that meet patient needs.
Validated tools for referral decision support make the process more transparent.
Patient rehabilitation complexity can be stratified by the RCS-E with high sensitivity, specificity and predictive value of positive test.
RCS-E is an excellent tool for referral decision support.