Roles of assistive devices for home care staff in Sweden: A qualitative study

Purpose.?To explore home care staff experiences in relation to assistive devices and the use of assistive device at work.

Method.?Individual conversational interviews with 14 home care staff were used. Qualitative content analysis was used to analyse the data.

Results.?A broad meaning attached to the use of assistive devices at work emerged in three themes. In ‘staff's role at work in relation to assistive devices’, their different roles emerged in relation to knowledge and instruction as well as safeguarding the user. ‘Assistive devices as a product and their significance for staff’ showed that devices were an integrated part of staff work in the users' home. Devices influenced staff cooperation, feelings and were significant in relation to time and finance. Regarding ‘assistive devices and their significance for the user from the staff's perspective’, the staff felt that devices were a prerequisite for the user coping with everyday life and they also had an emotional significance.

Conclusion.?Assistive devices play a significant and important role for home care staff. An increased understanding among prescribers and other health care staff about home care staff knowledge about, work with and experience from assistive devices could contribute to a better care and rehabilitation for home care recipients.     

Children's perceptions of their use of assistive devices in home and school settings

Purpose.?The study aimed to explore how children with cerebral palsy (CP) perceived their disability and assistive devices and to consider the factors influencing their device use in home and school settings.

Method.?Semi-structured interviews were adopted as the main data collection instrument. There were 44 participants, which comprised of 15 Taiwanese children with CP as well as their mothers and teachers.

Results.?Most children associated their perceptions of disability with their experiences of lower physical performance. Consequently, they generally perceived assistive devices as having a positive effect on their disability. Their enthusiasm for using their devices in the home and school contexts, however, was markedly different. Four factors leading to such a difference were identified, namely the nature of the two environments, physical environmental factors, the children's desired level of independence and the mothers' attitudes.

Conclusions.?The results demonstrate the significance of child-environment interaction. The children's attitudes towards device usage are influenced by their perceptions of the contextual feature of both settings. Additionally, the results indicate that children's views about their assistive devices may be different from those of adult users due to their different developmental stages and unique personal experiences. The findings suggest the importance of children's active participation in the field of assistive device research.     

The use and impact of assistive devices and other environmental modifications on everyday activities and care in young children with cerebral palsy

Purpose.?The study describes use of assistive devices and other environmental modifications, and their impact on everyday activities and care in young children with cerebral palsy (CP).

Method.?Ninety-five children (55 boys, 40 girls; mean age 58 months, SD 18 months) and their parents were studied using a cross-sectional design. The Pediatric Evaluation of Disability Inventory (PEDI) was applied to assess daily activities using the three measurement scales: functional skills, caregiver assistance, and modifications of the environment. Use of modifications was described related to the five severity levels of the Gross Motor Function Classifications System (GMFCS). Impact was rated on the Caregiver Assistance scale of the PEDI and on a five-point Likert scale.

Results.?Out of the 1075 provided environmental modifications, 980 were in regular use to support mobility, self-care and social function among 84 children. The number increased with GMFCS levels; children at levels IV and V used 80% of the modifications, with large variations between the children at same level. Adaptations of housing and transportation facilitated effective use of assistive devices. Half of the parents rated the modifications to have moderate to very large effect on the child's mobility, 25% on self-care skills, and 20% on social function. Furthermore, 65% reported that the modifications lightened the caregiving for mobility, 75% for self-care and 25% for social function. Functional independence and care demands often benefited from different types of modifications.

Conclusion.?The variations in use and benefits of environmental modifications indicate need of comprehensive assistive technology assessments, including child factors, family factors, technology factors and service system factors.     

Objective and perceptual comparisons of two bluetooth hearing aid assistive devices

Purpose: With the advent of Bluetooth technology, many of the assistive listening devices for hearing have become manufacturer specific, with little objective information about the performance provided.

Method: Thirty native English-speaking adults (mean age 29.8) with normal hearing were tested pseudo-randomly with two major hearing aid manufacturers’ proprietary Bluetooth connectivity devices paired to the accompanying manufacturer’s specific hearing aids. Sentence recognition performance was objectively measured for each system with signals transmitted via a land-line to the same iPhone in two conditions.

Results: There was a significant effect of participant’s performance according to listening condition. There was no significant effect between device manufacturers according to listening condition, but there was a significant effect in participant’s perception of “quality of sound”.

Conclusions: Despite differences in signal transmission for each devise, when worn by participants both the systems performed equally. In fact, participants expressed personal preferences for specific technology that was largely due to their perceived quality of sound while listening to recorded signals. While further research is necessary to investigate other measures of benefit for Bluetooth connectivity devices, preliminary data suggest that in order to ensure comfort and compatibility, not only should objective measures of the patient benefit be completed, but also assessing the patient’s perception of benefit is equally important.

• Implications for Rehabilitation

• All professionals who work with individuals with hearing loss, become aware of the differences in the multiple choices for assistive technology readily available for hearing loss.

• With the ever growing dispensing of Bluetooth connectivity devices coupled to hearing aids, there is an increased burden to determine whether performance differences could exist between manufacturers.

• There is a growing need to investigate other measures of benefit for Bluetooth hearing aid connectivity devices that not only include objective measures, but also patient perception of benefit.

     

辅助器具在提高类风湿关节炎活动期患者日常生活活动能力中的作用

目的探讨辅助器具对提高类风湿关节炎(RA)活动期住院患者的日常生活活动能力(ADL)的作用。方法采用类实验研究方法,将49例RA患者随机分为实验组23例和对照组26例,实验组给予辅助器具,对照组按RA护理常规进行护理。分别在入院当日、住院第7天、第14天对两组进行ADL评分。结果两组入院当日ADL评分差异无明显统计学意义(P>0.05),实验组住院第7天和第14天随住院时间的延长,其ADL评分逐渐增加(P均<0.01)。两组干预前后ADL评分差值的组间比较,实验组明显高于对照组,差异有统计学意义(P<0.05或P<0.01)。结论辅助器具的使用能显著提高类风湿关节炎活动期住院患者的日常生活活动能力。     

Provision of assistive technology services method (ATSM) according to evidence-based information and knowledge management

Purpose.?This article develops a standardised method for assistive technology service (ATS) provision and a logical basis for research to improve health care quality. The method is ‘interoperable’ across disabilities, disciplines, assistive technology devices and ATSs.

Background.?Absence of a standardised and interoperable method for ATS provision results in ineffective communication between providers, manufacturers, researchers, policy-makers and individuals with disabilities (IWD), a fragmented service delivery system, inefficient resource allocation and sub-optimal outcomes.

Objectives.?Synthesise a standardised, interoperable AT service method (ATSM) fully consistent with key guidelines, systems, models and Federal legislation. Express the ATSM using common and unambiguous language.

Results.?Guidelines, systems, models and Federal legislation relevant to ATS provision are reviewed. These include the RESNA Guidelines for Knowledge and Skills for Provision of Assistive Technology Products and Services (RESNA Guidelines), IMPACT2 model, international classification of functioning, disability and health (ICF) and AT device classification (ATDC). Federal legislation includes the Assistive Technology Act of 2004, Americans with Disabilities Act of 2008 and Social Security Act. Based on these findings, the ATSM is synthesised and translated into common and accessible language.

Conclusion.?ATSM usage will improve communication between stakeholders, service delivery coherence, resource allocation and intervention outcomes.     

The relationship of personal factors and subjective well-being to the use of assistive technology devices

Purpose.?To describe a measure and its performance specific to the relationship of personal factors and subjective well-being (SWB) to the use of assistive technology devices (ATDs). The primary hypothesis is that responses to a 33-item personal factors scale and a 12-item SWB scale are good indicators of an individual's predisposition for using, and subsequent match with, a given ATD.

Methods.?Data analyses from a number of studies using the 33-item personal factors and the 12-item SWB scales of the Assistive Technology Device Predisposition Assessment with persons of various ages and types of disabilities.

Results.?Regardless of type of disability or age of respondent, the ATD PA personal factors and the SWB scales identified important differences in predispositions to use an ATD as well as the subsequent quality of the match of person and device.

Conclusions.?A quantifiable relationship exists between the ATD PA's measure of personal factors and the SWB such that it is possible to characterise an individual's predisposition to use a particular ATD. Results also show that the scales are predictive of the quality of the ATD and user match at follow-up. Rehabilitation practitioners who use the ATD PA may achieve enhanced assistive technology service delivery outcomes by using this evidence-based measure.     

基于可穿戴式步行引导仪的可视化步行训练对帕金森病冻结步态患者步行能力的影响

目的：探讨基于可穿戴式步行引导仪的可视化步行训练对帕金森病冻结步态患者步行能力的影响。方法：选取23例帕金森病冻结步态患者为试验组,同时选取20例性别、年龄等匹配的健康者为对照组。试验组给予利用可穿戴式步行引导仪的可视化步行训练,20min/次,2次/日,训练1周。利用Vicon三维步态分析系统收集试验组训练前后和对照组时空参数、非优势侧及优势侧运动学参数、非优势侧及优势侧地面反作用力参数(包括前-后侧峰值、内-外侧峰值及纵向第一峰值)。结果：(1)训练后,试验组患者步速及双侧步长均明显增加,步频、双支撑期明显减小,与训练前相比,差异均有显著性意义(P<0.05);训练后,试验组患者优势侧步长、步频及双支撑期与对照组比较,差异均无显著性意义(P>0.05)。(2)训练后,试验组患者双侧髋关节着地角度、踝背屈及跖屈最大角度及下肢关节活动范围均明显增加,膝关节着地角度减小,踝关节第一峰值出现的阶段延迟,与训练前相比,差异均有显著性意义(P<0.05);训练后,试验组患者双侧(膝关节着地角度、踝背屈最大角度、踝关节第一峰值出现阶段、下肢关节活动范围)和优势侧(髋关节着地角度...     

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

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

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

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

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

Comparison of three definitions of the mid-stance and mid-swing events of the gait cycle in children

Purpose. Different criteria are used to define the terms mid-stance (MST) and mid-swing (MSW) when describing the gait cycle. None of these definitions is universally accepted. This causes difficulties with the interpretation of gait analysis data and hinders the comparison between the different studies. The aim of the present study was to compare three definitions of MST and MSW by examining the gait of a group of healthy children.

Method. A prospective comparison of three commonly used definitions of the MST and MSW events of the gait cycle.

Outcome measures. The timing of the temporal, kinematic and kinetic MST and MSW of the gait cycle.

Results. Thirty healthy 8 – 10-year-old children were studied. There was no consistent correlation between the timing of the chosen definitions of MST and MSW. However, there was a tendency for the timing of the temporal and kinetic MST and MSW to occur, respectively, at approximately 30 and 80% of the gait cycle.

Conclusions. The temporal definition of MST and MSW as the midpoints in time of the respective phases of the gait cycle appears to be more appropriate than other definitions. The use of this definition may prevent misunderstanding and permit comparison of the results of the different gait analysis studies.     

Comparison of three definitions of the mid-stance and mid-swing events of the gait cycle in children

Purpose. Different criteria are used to define the terms mid-stance (MST) and mid-swing (MSW) when describing the gait cycle. None of these definitions is universally accepted. This causes difficulties with the interpretation of gait analysis data and hinders the comparison between the different studies. The aim of the present study was to compare three definitions of MST and MSW by examining the gait of a group of healthy children.

Method. A prospective comparison of three commonly used definitions of the MST and MSW events of the gait cycle.

Outcome measures. The timing of the temporal, kinematic and kinetic MST and MSW of the gait cycle.

Results. Thirty healthy 8 - 10-year-old children were studied. There was no consistent correlation between the timing of the chosen definitions of MST and MSW. However, there was a tendency for the timing of the temporal and kinetic MST and MSW to occur, respectively, at approximately 30 and 80% of the gait cycle.

Conclusions. The temporal definition of MST and MSW as the midpoints in time of the respective phases of the gait cycle appears to be more appropriate than other definitions. The use of this definition may prevent misunderstanding and permit comparison of the results of the different gait analysis studies.     

Comparison of distinctive gait variables using two different biomechanical models for knee joint kinematics in subjects with knee osteoarthritis and healthy controls

Background

Gait analysis is an important instrument in clinical research and results should be objective. The purpose of this study was to quantify clinical outcomes of two biomechanical models with different anatomical coordinate systems and angle decomposition strategies for knee joint kinematics.

Methods

The study was designed to compare a functional approach and a predictive approach with a single comprehensive marker set. 10 healthy subjects and 12 subjects with knee osteoarthritis were analysed. Distinctive gait variables were averaged across five trials. Agreement between methods was illustrated with the so-called levels of agreement. Differences between models were quantified using a paired t-test or Wilcoxon-Signed Rank test in case of non-normality (Shapiro–Wilk test). Unpaired t-tests/Wilcoxon tests were used to compare gait variables between healthy subjects and subjects with knee osteoarthritis, and to examine whether statistical analysis of this comparison would yield different data interpretations when using different models.

Findings

Outcome variables differed between the functional and predictive approaches in the sagittal plane (0.1–3.1°), and transverse plane (1.0–3.7°). With respect to the range of motion in the given movement plane, variables in the sagittal plane of the knee were more consistent between methods. The functional approach was more sensitive for detecting differences between groups for sagittal plane kinematics. Statistical analysis for transverse plane kinematics differed substantially between models.

Interpretation

Sensitivity to detect differences of kinematic data between population groups can vary between biomechanical models. Rotational gait variables are inconsistent between models and should not be used as clinical outcome variables in daily routine.     

Effects of different heel-raise-lower exercise interventions on the strength of plantarflexion,balance, and gait parameters in stroke survivors

The objective of this study was to investigate the effects of Heel-Raise-Lower Exercise (HRLE) interventions on the strength of plantarflexion, balance, and gait parameters in people with stroke. Specifically, this study compared the two different HRLEs to identify whether heels raise-lower with forefoot on a block (HRB) is more effective or ineffective to enhance strength and functional capacities than heels raise-lower on a level floor (HRL) exercise in people with stroke. Repetitive heel raise-lower is a common exercise for improving the strength and power of ankle plantarflexors. It is a simple movement, requires no equipment, and can be performed at home. Each group of 10 people with stroke was given either HRB training or HRL training. The subjects performed the exercise 100 times per day, 5 days per week for 6 weeks. The strength of plantarflexors, static/dynamic balance, and gait parameters were measured using the manual muscle test (MMT), a Biodex Balance System (BBS) SD, and the GAITRite system. After 6 weeks of treatment, there were significant increases in the plantarflexors strength in both groups: by 34% in the HRB group and by 21% in the HRL group. Static and dynamic balance and gait speed also increased significantly in both groups. However, cadence, the paretic side single limb support period (SLSP), paretic side step length, and paretic side stride length significantly increased only in the HRB group. The HRB improved significantly the plantar flexor strength of the paretic side, gait speed, and cadence compared to the HRL.     

The influence of social context on the perception of assistive technology: using a semantic differential scale to compare young adults’ views from the United Kingdom and Pakistan

Abstract

Background and aim: A Society's view of disability may influence the perception and use of Assistive Technology (AT) products. Semantic cues or cultural coding provide the viewer with a series of visual stimuli to be given or ascribed meaning. Previous research has shown cognitive approaches to visual perception and assignment of meaning vary between diverse cultures. This study reviews the influence of contextual settings on perception, to provide the basis for a debate on the societal perception of communicative content (semantic/meaning) of an AT product; and, the relevance of different cultural cognitive styles. The paper explores, from a cultural viewpoint, the overall understanding of disability internationally.

Method: A Semantic Differential (SD) scale was used to obtain views on the image of an attendant wheelchair from nine hundred and ninety-one (991) young adults from the United Kingdom (UK) and Pakistan (PAK), reflecting the individualist and collectivist societies, respectively. This survey follows a previous paper-based study using the same image and protocol. Comparing the two surveys, a consensus of views from the two groups was achieved.

Results and conclusion: The responses from the UK group were skewed towards a negative view of disability compared to the Pakistan group. This inferred greater social stigma associated with this AT product in the UK. The combined findings from both surveys provide insights into societal perception of AT products and disability. Areas for future research are suggested, including what visual components of an AT product (graphemes) appear to be associated with positive or negative responses for collectivist and individual societal groups.

• Implications for rehabilitation

• Assistive Technology (AT) product designers, academics, professionals and stakeholders need to be aware of challenges which are originated from one's socio-cultural environment. AT products convey certain meanings, semantics, which are interpreted by the society and are subjective to a specific cultural setting.

• ?For the effective communication of meanings and values an AT product relies on the visual clues and design features embedded within the design. However, there have been a limited number of studies reviewing this aspect of product semantics.

• ?The survey and associated testing has highlighted the differences in cultural perception towards AT products and demonstrated the importance of effectively designing the semantic attributes of an AT product as well as its function.

• ?The demonstration of the efficacy of methods within the study for exploring the interpretation of semantic attributes of AT products will help designers and developers better understand the perceptions of individual cultures and societal groups.

• ?A better understanding of different cultures and societies will enable designers and clinicians who specify AT products to reduce AT product abandonment; and, the associated stigma around disability.

     

Preservation of the first rocker is related to increases in gait speed in individuals with hemiplegia and AFO

Background

Changes in impulse during the first rocker (braking force) and third rocker (propulsion force) may affect changes in gait speed after orthotic intervention. The purpose of this investigation was to objectively measure changes in impulse during double support and correlate those findings to changes in gait speed with and without ankle foot orthosis in individuals with hemiplegia.

Methods

Fifteen adults with stroke-related hemiplegia walked with and without ankle foot orthosis while foot pressure data was collected bilaterally. Outcome measures included: gait cycle time (s), mean force (N), and impulse (Ns) in the wholefoot, hindfoot, forefoot, and toe box during initial double support and terminal double support.

Findings

Time significantly decreased during the entire gait cycle, initial double support, and terminal double support, with the ankle foot orthosis. During initial double support, affected limb impulse significantly decreased with the ankle foot orthosis in the wholefoot (P = 0.016), and hindfoot (P = 0.006), and hindfoot impulse % change and gait speed % change were significantly correlated (P = 0.007). During terminal double support, affected limb impulse was not significantly different in the wholefoot or forefoot and these changes were not significantly correlated to gait speed.

Interpretation

Previous research found that orthotics increase gait speed in individuals with hemiplegia. This research suggests that the increase in speed is not due to increased propulsive forces at the end of terminal double support, but due to decreased braking forces during initial double support. Therefore, the orthosis preserved the first ankle rocker and provided a more efficient weight acceptance which positively affected gait speed.     

Comparison of the inertial properties and forces required to initiate movement for three gait trainers

The purpose of this study was to evaluate the inertial properties and forces required to initiate movement on two different surfaces in a sample of three commonly prescribed gait trainers. Tests were conducted in a laboratory setting to compare the Prime Engineering KidWalk, Rifton Pacer, and Snug Seat Mustang with and without a weighted anthropometric test dummy configured to the weight and proportions of a 4-year-old child. The Pacer was the lightest and the KidWalk the heaviest while footprints of the three gait trainers were similar. Weight was borne fairly evenly on the four casters of the Pacer and Mustang while 85% of the weight was borne on the large wheels of the mid-wheel drive KidWalk. These differences in frame style, wheel, and caster style and overall mass impact inertial properties and forces required to initiate movement. Test results suggest that initiation forces on tile were equivalent for the Pacer and KidWalk while the Mustang had the highest initiation force. Initiation forces on carpet were lowest for the KidWalk and highest for the Mustang. This initial study of inertia and movement initiation forces may provide added information for clinicians to consider when selecting a gait trainer for their clients.