An assistive interface protocol for communication between visually and hearing-speech impaired persons in internet platform

PURPOSE

The article presents a design and development of a generic assistive system to establish an independent conversation-platform for hearing-speech impaired and visually impaired persons.

MATERIALS

The developed software system is accomplished through programming using python and html.

METHODS

Considering the constraints associated to the above mentioned impairments, the system implements both speech-to-text/gesture and text/gesture-to-speech conversion in its operation. In real-time hand-gesture to speech generation process is implemented using static image tracking, CNN based deep learning technique and MediaPipe hand-tracking solution. The software-prototype-terminals can be accessed through internet using MQTT protocol to accomplish the communicative conversation between visually impaired and hearing-speech impaired persons.

RESULTS

The software system exhibits an average prediction time of less than approximately 1 s and 2 s for a four-letter based audio-word and a single hand-gesture, respectively, which are commensurate to the average time-complexity during human-to-human conversation. The average accuracy and loss for the hand-gestures through the CNN based deep learning are 0.9996 and 0.0008, respectively. The confusion matrix related to the prediction of alphabet-specific hand-gestures shows its satisfactory performance in gesture recognition.

CONCLUSIONS

The software-prototype of the generic assistive device shows its potential to establish an exclusive communication between a visually impaired and a hearing-speech impaired person through the internet. The same software-interface can also be used to accomplish a communicative conversation between either only visually-impaired persons or only hearing-speech impaired persons. IMPLICATIONS FOR REHABILITATIONThe article presents a design and development of a generic assistive interface to establish an independent conversation-platform for hearing-speech impaired and visually impaired people via internet network.The same software-interface can also be used to accomplish a communicative conversation between either only visually-impaired persons or only hearing-speech impaired persons.The design can be further extended by incorporating multi-modal impairments to make a universal assistive device for all-in-one communication.

Understanding individuals with spinal cord injury's self-care practices: a technology probe study to promote pressure relief adherence

Pressure reliefs (PRs) are self-care practices essential for individuals with spinal cord injury (SCI) to prevent life-threatening pressure injuries (PIs). Despite the benefits, individuals often do not do these exercises at home, leading to increased patient morbidity and mortality. To examine how digital technology could improve this population's adherence to PR exercises, we conducted a technology probe study with five individuals with SCI over ten consecutive business days. A chat-based intervention was created to send user-scheduled PR reminders, which were personalized with visual elements and progress trackers. Participants were interviewed before and after interacting with the probe to better understand their experiences with PIs and PR practices. Results shed light on specific factors that may impact individuals with SCI's behaviours towards PRs and four considerations to design a customisable reminder intervention: (1) easy to use and friendly technology, (2) design-your-own- schedule feature, (3) communication style feature, and (4) dialogue support features. Personalisation supported with gamified visual progress tracking and motivational messages emerged as a strong strategy to increase PR adherence. Both sets of findings expand upon the human-computer interaction (HCI) literature for mobile health tools that encourage self-care practices; in particular, to the specific needs of individuals with SCI and the use of visual elements to increase engagement.

Technology for dementia care: what would good technology look like and do, from carers' perspectives?

BACKGROUND

The development of technology in dementia care has largely been without consultation with carers, and has primarily focused on safety, monitoring devices, and supporting activities of daily living. Further, while involving end-users in the design of technology has been recommended, this is yet to become common practice.

METHOD

We conducted a mixed methods study with the aim of investigating carers' values and priorities for technology development, including prior experiences, barriers to use, and what they would like technology to do. Importantly, we asked carers for their design ideas and bespoke technology solutions for future development.

RESULTS

Carers of people living with dementia (N = 127), including both unpaid (n = 102) and paid carers (n = 25) residing in Australia, completed an online survey. In addition, a subsample of carers (n = 23) participated in semi-structured interviews. Findings demonstrate that carers want technology to be person-centred, customisable, and to increase opportunities for meaningful social connection. Findings also demonstrate the ability of carers to generate creative design solutions for dementia care.

CONCLUSIONS

These findings and implications will be discussed in relation to the importance of co-design with carers and engineers during the design phase of assistive technology. Also, the importance of technology to enhance, not replace, human-to-human social interactions is highlighted.

Technology for Adults with Intellectual Disability: Secondary Analysis of a Scoping Review

Background. Technologies are embedded in all daily life activities and are utilized by occupational therapy practitioners to facilitate participation; evidence on technology for adults with intellectual disability (ID) can support practice with the population. Purpose. Summarize the evidence on technology to support adults with ID. Method. Secondary analysis of a scoping review of articles published between 2002 and 2018. Articles in the original scoping review addressed participation, assessment, or interventions with adults with ID. Authors completed a secondary analysis of 159 articles to identify articles with information on technology. Findings. In total, 56 articles met the inclusion criteria. Technology categories were cognitive supports, mainstream technologies, supplemental communication, aids for daily living, seating and mobility, control interfaces, and preparatory technologies. Implications. This secondary analysis demonstrates the range of evidence identifying technology as a key support, the impacts of the proliferation of technologies, and the need for occupational therapy practitioners to advocate for accessible technologies.

Factors influencing the intention of trainee special education teachers to integrate assistive technology into teaching students with disabilities in the United Arab Emirates

Technology has been incorporated into the educational systems of many countries as a teaching and learning tool. Contemporary discourse has focused on how to prepare teachers to utilise technology in their teaching practice. Although most pre-service elementary school teachers in the United Arab Emirates are women, studies have not yet investigated their acceptance of or preparedness to use technology in the classroom. Therefore, it is necessary to investigate whether the training provided to pre-service special education teachers equips them with sufficient skills to support students with disabilities. The present study used the technology acceptance model (TAM) as a theoretical lens to examine the factors that impact female pre-service special education teachers' intention to incorporate assistive technology (AT) in teaching students with disabilities. A survey based on TAM was used to collect data from 138 participants and test four study hypotheses. Regarding data analysis, SPSS and AMOS version 28 software were used to conduct exploratory factor, confirmatory factor and path analyses. Two of the four hypotheses were supported. The results provide support for the four-factor TAM structure, with two predictors - perceived ease of use and computer self-efficacy - supporting pre-service teachers' intention to use AT to teach students with disabilities in the classroom. Teacher educators and policymakers should consider the TAM construct when preparing pre-service teachers to effectively support all students. Specifically, teacher development and stakeholder engagement with AT resources are needed to optimise the learning of children with disabilities.

Virtual Reality Game Selection for Traumatic Brain Injury Rehabilitation: A Therapist's Wish List for Game Developers

This project explored the selection process of commercially available virtual reality (VR) games for traumatic brain injury rehabilitation. Occupational therapy practitioners (OTPs) developed a classification framework that they used to evaluate VR games. The classification framework focused on movements required to effectively play the game, cognitive demand, position for game play, ease in menu navigation, and perceived therapeutic applications. OTPs used the ratings to aid in game selection and identified relevant game examples that allowed customizable settings and basic navigation with a game focus on functional activities. The OTPs and the research team identified the need for further work on accessibility and adaptability of game features (e.g., difficulty and limb usage) allowing for more individualization to optimize outcomes of VR-enhanced rehabilitation. The classification framework was useful in evaluating the potential therapeutic benefit of commercially available VR games. However, trial of the game by clinicians prior to use was still warranted.

Comparing technology with built-in decision-making on vocational skills for students with ASD and/or IDD

PURPOSE

The purpose of this study was to compare mobile technology devices (i.e., Tablets) with built-in decision prompts and branching to improve the independent vocational performance of four secondary students with autism spectrum disorder (ASD) and/or intellectual and developmental disability (IDD).

MATERIALS AND METHODS

An adapted alternating treatments design was used to compare the effectiveness of the prompting system presented on Apple iPads and Microsoft Windows-based tablets. The prompting system contained audio, video, and picture prompts. Further, we investigated the effectiveness of improving problem-solving through decision-making prompts and branching. Participants used the devices to make decisions on how to properly prepare a teacher's lounge including filling salt and pepper shakers, cleaning tables, and filling silverware containers.

RESULTS

Results indicated that both devices produced immediate and significant increases in independent responding for all participants. All participants also self-faded prompt dependence throughout the duration of the intervention as vocational skill acquisition increased.

CONCLUSION

Teachers and students have enhanced access to powerful devices capable of providing individual support for vocational skills. This study indicates that a multimedia prompting system with multiple prompt mediums can improve independent completion of targeted vocational skills while decreasing the reliance on technological support.Implications for rehabilitationTechnology offers an effective and personalized support to encourage independent vocational skills in secondary participants with autism spectrum disorder (ASD) and/or intellectual and developmental disability (IDD).A technology support system that is universally designed with built-in decision-making offers a more authentic approach to transition support.The results have demonstrated that participants with ASD and/or IDD were successful completing a vocational task utilizing the universally designed prompting system, regardless of device.The results suggest that utilizing this approach to vocational support will not only improve independent success, but participants will also self-fade technology use as mastery is gained.

Supported standing and stepping device use in young children with cerebral palsy, gross motor function classification system III, IV and V: a descriptive study

This study described and compared use of supported-standing and stepping devices by young children with cerebral palsy, Gross-Motor Function Classification System (GMFCS) levels III-V following power mobility introduction. Data was collected at two time-points, 5-6 months apart, for 42 participants, aged 18-80 months, using the Home Use of Technology for CHildren (HUTCH). Supported-standing and stepping device choice, and time in each device remained stable over 6 months. Associations between device use and three functional classifications were examined. Children with more impaired motor, postural and manual abilities were more likely to use a supine stander rather than a prone/upright stander or no stander. Children at GMFCS V tended to use hands-free stepping devices, while support-arms stepping devices were more common for children at GMFCS IV. Only children at GMFCS III used convertible stepping devices. Using power mobility, standers and supported-stepping devices was feasible and 19/34 classified at GMFCS IV/V used all three devices over 6 months. A key finding was that introduction of power mobility did not reduce use of supported-stepping devices at any GMFCS level. Use of multiple upright positioning and mobility devices may assist children with limited mobility to be actively engaged and participate in daily life.

Mobile device accessibility with 3D printed devices for individuals with physical disabilities

PURPOSE

Disparities may disproportionately exist for those with disabilities when using mobile devices, which are critical for independence in activities such as socialization and leisure. Prior 3D printing studies in rehabilitation have not focused on mobile device access to everyday preferred activities.

METHODS

This study examined user satisfaction, self-rated performance and satisfaction with daily activities while using the mobile device, and the feasibility of customized 3D printed assistive devices. The design was a one-group, quantitative pre-test to post-test study of individuals (n = 10) residing in long-term care with a physical disability due to a neurological condition.

RESULTS

Satisfaction with the 3D printed device, as compared to the previously used assistive device, was significantly higher (p = 0.005), as well as improvements in self-rated daily activity performance (p = 0.016) and satisfaction (p = 0.037), with acceptability and satisfaction of the intervention.

CONCLUSIONS

Findings suggest that 3D printing is feasible with a potential increase in user satisfaction through a customization process that is client centred.

Evaluation and intention to use the interactive robotic kitchen system AuRorA in older adults

BACKGROUND

The number of older adults in need of care and living at home is increasing in Europe. At the same time, the number of professional caregivers is decreasing. This development reinforces the need for assistive technology to support care recipients in their own homes and promote their independence. One of the main challenges of independent living is the preparation of food. Interactive robots could assist older adults with difficulties performing physically demanding tasks. Within the project AuRorA (full German project title: Wiederverwendbare, interaktive Verhalten für proaktive Roboter im Smart Home), an interactive voice-controlled robot arm was developed as an assistance system in the kitchen.

OBJECTIVE

The aim of the study was to assess how older adults evaluate the AuRorA system and to collect data on actual willingness to use the technology. Older adults were asked to evaluate the system in terms of usefulness, usability, accessibility and intention to use.

MATERIAL AND METHODS

Due to the ongoing coronavirus disease 2019 (COVID-19) pandemic, the older adults evaluated the system via an online survey. The validated questionnaire Technology Usage Inventory (short: TUI) was used in conjunction with self-developed questionnaires to collect data on study population characteristics.

RESULTS

A total of 106 participants were included in the analysis. The acceptance, usability and usefulness of the system were rated as medium, while the intention to use was rated as low. A significant strong correlation was found between the TUI subscales intention to use and usefulness.

CONCLUSION

It can be assumed that the actual need of the individual participant for such a robotic assistive system had an influence on the evaluation of the system. The perceived usefulness may have been a crucial influence on the intention to use and the overall assessment of the system.

Feasibility of customized 3D-printed assistive technology within an existing multidisciplinary amyotrophic lateral sclerosis clinic

PURPOSE

Three-dimensional (3 D) printing of assistive technology (AT) is an emerging intervention in rehabilitation sciences. Existing research primarily considers narrow applications of this technology with most studies focussing on a single type of assistive device. Individuals with amyotrophic lateral scleroses (ALS) have high abandonment rates of prefabricated AT. Therefore, the goal of this project was to determine the implementation and acceptability feasibility of meeting AT needs through the creation of customized, 3D-printed devices within an existing multidisciplinary ALS clinic.

METHODS

Implementation feasibility was measured using descriptive statistics about the research team's ability to fulfil device requests. Acceptability was evaluated using semi-structured patient satisfaction interviews after AT device provision. The study utilized thematic analysis to identify patterns in the qualitative data collected from participant interviews.

RESULTS

Nine participants identified at least one need for 3D-printed assistive devices customized to their unique performance abilities and needs. Seven participants received 3D-printed devices, four of whom completed the follow-up interview. The research team was able to fulfil 20 of 34 device requests, supporting implementation feasibility. Thematic analysis revealed three themes from the interviews: Satisfaction with Devices and Services, Value of Training as a Service, and Increased Participation and Choice.

CONCLUSIONS

These findings demonstrate implementation feasibility and participant satisfaction with the process of receiving devices, supporting acceptability feasibility. Future research into the efficacy of customized 3D-printed AT is recommended.Implications for rehabilitationIndividuals with ALS have unmet needs in assistive technology.Custom AT development using 3D printing can be implemented within an existing, multidisciplinary ALS clinic.Future 3D printing research should rigorously investigate methods to meet the unique needs and challenges of individuals in this setting.

'When I use the electric wheelchair, I can be myself' - real-life stories about occupational identity construction

BACKGROUND

Young and adult users of electric wheelchairs (EWs) describe how EWs have personal, functional, emotional, and symbolic values and are considered by some to be part of the self.

AIM

The aim of this study was to increase our understanding of how occupational identity is constructed in the daily practices of EW users.

MATERIAL AND METHODS

Context-based, in-depth oral stories and filmed sequences of daily practice enactments of persons who have used an EW since childhood were the basis for the narrative analysis.

FINDINGS

The findings elucidate how the informants enact and tell about their identity-development in response to daily and relational practices, and its relevance to the informant's sense of self, belonging, competence, life-prospects, conduct, and awareness of shifting values, and this was likewise demonstrated in different appearances and roles related to social recognition. A model illustrating the findings is proposed.

CONCLUSIONS AND SIGNIFICANCE

Contextual values and exploring experiences, such as possibilities to develop competences and roles, along with encountering social recognition, but also hindering regulations and adversities, influence the development of occupational identities. Findings in this study can contribute to increased understanding, conscious political decisions, as well as a more person-centred approach within healthcare.

Bicycle balance assist system reduces roll and steering motion for young and older bicyclists during real-life safety challenges

Bicycles are more difficult to control at low speeds due to the vehicle's unstable low-speed dynamics. This issue might be exacerbated by factors such as aging, disturbances, and multi-tasking. To address this issue, we developed a prototype 'balance assist system' with Royal Dutch Gazelle and Bosch eBike Systems at Delft University of Technology, which includes an electric motor capable of providing additional steering torque. We implemented a speed-adaptive feedback controller to generate the additional steering torque to that of the rider. We conducted a study with 18 older and 14 younger cyclists to first examine the effect of aging, disturbances, and multi-tasking on cycling at lower forward speeds, and evaluate the effectiveness of the system in improving the stability of the rider-bicycle system while facing these challenges. The study consisted of two scenarios: a single-task scenario where participants rode the bicycle on a marked narrow straight-line track, and a multi-task scenario where participants performed a shoulder check task and followed visual cues while tracking the straight-line. We introduced handlebar disturbances using the steer motor in half of the trials in both scenarios. All trials were repeated with and without the balance assist system. We calculated the bicycle mean magnitude of roll and steering rate-as indicators of bicycle balance control and required steering actions, respectively-and the rider's mean magnitude of lean rate with respect to the ground to investigate the effect of the balance assist system on rider's lateral motion. Our results showed that aging, disturbances, and multi-tasking increased the roll rate, and the balance assist system was able to significantly reduce it. The effect size of the balance assist system in reducing the roll rate across all conditions was found to be larger in older cyclists, indicating a more substantial impact compared to younger cyclists. Disturbances and multi-tasking increased the steering rate, which was successfully reduced by the balance assist system. Aging did not significantly affect the steering rate. The rider's lean rate was not significantly affected by age, disturbances, or the balance assist, indicating that the upper body plays a minor role when riders have good steering control authority. Overall, our findings suggest that lateral motion and required steering action can be affected by age, multi-tasking, and handlebar disturbances which can endanger cyclists' safety, and the balance assist system has the potential to improve cycling safety and reduce the incidence of single-actor crashes. Further investigation on riders' contribution to control actions is required.

A review of struvite crystallization for nutrient source recovery from wastewater

Nutrient recovery from wastewater not only reduces the nutrient load on water resources but also alleviates the environmental problems in aquatic ecosystems, which is a solution to achieve a sustainable society. Besides, struvite crystallization technology is considered a potential nutrient recovery technology because the precipitate obtained can be reused as a slow-release fertilizer. This review presents the basic properties of struvite and the theory of the basic crystallization process. In addition, the possible influencing variables of the struvite crystallization process on the recovery efficiency and product purity are also examined in detail. Then, the advanced auxiliary technologies for facilitating the struvite crystallization process are systematically discussed. Moreover, the economic and environmental benefits of the struvite crystallization process for nutrient recovery are introduced. Finally, the shortcomings and inadequacies of struvite crystallization technology are presented, and future research prospects are provided. This work serves as the foundation for the future use of struvite crystallization technology to recover nutrients in response to the increasingly serious environmental problems and resource depletion.

Use and benefit of information, communication, and assistive technology among community-dwelling older adults - a cross-sectional study

BACKGROUND

Technology can support healthy aging and empower older adults to live independently. However, technology adoption by older adults, particularly assistive technology (AT), is limited and little is known about the types of AT used among older adults. This study explored the use of key information and communication technologies (ICT) and AT among community-dwelling adults aged ≥ 65.

METHODS

A cross-sectional study was conducted among community-dwelling adults aged ≥ 65 in southern Germany using a paper-based questionnaire. The questionnaire included questions on the three domains sociodemographic aspects, health status, and technology use. Technology use was considered separately for key ICT (smartphone, computer/laptop, and tablet) and a range of 31 different AT. Data were analyzed using descriptive statistics, univariate analyses, and Bernoulli Naïve Bayes modelling.

RESULTS

The questionnaire was answered by 616 participants (response rate: 24.64%). ICT were used by 497 (80.68%) participants and were associated with lower age, higher level of education, living together with someone, availability of internet connection, higher interest in technology, and better health status (p < .05). No association was found with sex and size of the hometown. The most frequently owned AT were a landline phone, a body scale, and a blood pressure monitor. Several AT related to functionality, (instrumental) activities of daily living- (IADL), and morbidity were used more frequently among non-ICT users compared to ICT-users: senior mobile phone (19.33% vs. 3.22%), in-house emergency call (13.45% vs. 1.01%), hearing aid (26.89% vs. 16.7%), personal lift (7.56% vs. 1.61%), electronic stand-up aid (4.2% vs. 0%). Those with higher interest in technology reported higher levels of benefit from technology use.

CONCLUSIONS

Despite the benefits older adults can gain from technology, its use remains low, especially among those with multimorbidity. Particularly newer, more innovative and (I)ADL-related AT appear underutilized. Considering the potential challenges in providing adequate care in the future, it may be crucial to support the use of these specific AT among older and frailer populations. To focus scientific and societal work, AT with a high impact on autonomy ((I)ADL/disease-related) should be distinguished from devices with a low impact on autonomy (household-/ comfort-related).

Rehabilitation counsellor perceived importance and competence in assistive technology

PURPOSE

Assistive technology (AT) has received much attention for its capacity to improve quality of life for individuals with disabilities. While AT can be promising, the high AT abandonment issue persists. Rehabilitation counsellors are considered important in solving such an issue. However, how to effectively prepare rehabilitation counsellors to provide AT services remain unclear. This study aims to investigate the field experience of rehabilitation counsellors and identify the most relevant AT knowledge and skills to the profession.

METHOD

A survey that explores rehabilitation counsellors perceived AT importance and competence was used. A total of 237 rehabilitation counsellors in the United States were recruited via the email listserv provided by Commission on Rehabilitation Counsellor Certification.

RESULTS

The results indicated that while rehabilitation counsellors considered AT important to them, they felt ill-prepared in providing such services. Of the three subscales, the ability to use AT was rated with the highest importance and the knowledge of AT was rated with the lowest competence.

CONCLUSION

Although it is impossible for rehabilitation counsellors to know every aspect of the AT services, five training areas were identified to be a priority. Specifically, these five areas include training to improve rehabilitation counsellors' (a) awareness of AT benefit, (b) knowledge and skill of AT assessment, (c) knowledge of computer based AT and the use of social media, (d) skill in using AT to increase service accessibility, and (e) ability to assist clients decision making that addresses both physical and psychological needs.IMPLICATIONS FOR REHABILITATION•Confirm the importance of AT in rehabilitation counselling practices.•Recognise the limited AT competence amongst rehabilitation counsellors.•Identify five areas for more AT training that improve rehabilitation counsellors'•Awareness of AT benefit,•Knowledge and skill of AT assessment,•Knowledge of computer based AT and the use of social media,•Skill in using AT to increase service accessibility, and•Ability to assist clients decision making that addresses both physical and psychological needs.

A scoping review of literature using speech recognition technologies by individuals with disabilities in multiple contexts

PURPOSE

Speech recognition technology (SRT) is increasingly available and may provide opportunities for individuals with disabilities to participate in necessary activities and meaningful occupations. This inquiry methodically collects and reports on research related to SRT for individuals with disabilities and impairments.

MATERIALS AND METHODS

Using the Arksey and O'Malley framework and PRISMA guidelines, five databases were queried and indexes of 11 journals were hand-searched for relevant articles. Articles were included if they were published after 2005, involved SRT, written in English, and participants(s) had a disability. Articles were charted, categorised for level of evidence, and findings were summarised.

RESULTS AND CONCLUSIONS

Of the 78 articles that were retrieved, 13 met inclusion criteria and were organised into 4 categories: SRT in primary and secondary education, in post-secondary education, for daily living, and without a specified context. No included articles considered SRT in vocational contexts. It was determined that SRT is a tool that may improve participation and independence of individuals with disabilities in multiple contexts. Most studies reviewed were non-empirical. Opportunities exist for providers to continue to develop a rigorous body of knowledge for the use of SRT to meet educational, vocational and daily living needs.IMPLICATIONS FOR REHABILITATIONSpeech recognition technology (SRT) provides a method of access that is widely available in mainstream technology devices such as personal computers, smartphones and mobile devices, and smart speakers/daily living aids.SRT may improve participation and independence of individuals with disabilities in contexts such as primary and secondary education, post-secondary education, and with independent living tasks.Many studies examining SRT are non-empirical, and there is an opportunity for assistive technology professionals and other providers who use assistive technology to continue to develop a rigorous body of knowledge.

Impact of text-to-speech features on the reading comprehension of children with reading and language difficulties

This study investigated the reading comprehension scores of students with reading and language difficulties after reading a passage with and without text-to-speech (TTS). Students, ages 8 to 12 years, read five passages under the following conditions: (a) silent read, (b) read aloud, (c) listen only, (d) TTS with no highlighting, and (e) TTS with highlighting. Students answered multiple-choice comprehension questions following each condition. Mixed ANOVAs were performed to determine whether TTS improved reading comprehension. TTS significantly improved comprehension in comparison to no TTS, and specifically, TTS with no highlighting and TTS with highlighting resulted in significantly higher comprehension scores compared to silent read. No other significant differences were found across conditions including between the presentational features of TTS, specifically TTS with no highlighting and TTS with highlighting conditions. Students were grouped as dyslexia only or reading and language impairment based on their test results. Findings suggested that students with dyslexia only scored significantly higher on reading comprehension questions in all reading conditions and derived significantly more benefit in reading comprehension from TTS and the listen only condition compared to students with Reading and Language Impairment. Overall, TTS may be a helpful tool for supporting the reading comprehension of students with reading and language difficulties, particularly for students with dyslexia only; however, further studies are needed to explore the benefits of TTS' presentational features such as highlighting with students with reading and language difficulties.

Clinical changes as a result of dynamic seating in a young adult with cerebral palsy

PURPOSE

This case study follows a single participant with cerebral palsy through 15 years of wheelchair seating interventions. Positioning challenges within the wheelchair seating system included significantly increased muscle tone, extension patterns, extraneous movement, loss of body position in relation to the seating system, loss of alignment with other assistive technologies, high energy expenditure, client injury and pain, and equipment damage. The purpose of this article is to present clinical changes seen in this participant during a progression of dynamic seating interventions.

CASE DESCRIPTION

includes four separate seating and wheeled mobility evaluations over an eight-year time frame and subsequent equipment recommendations. A key intervention was the application of dynamic seating. No standardized assessments for wheeled seating and mobility evaluation are available, at this time.

OUTCOMES

the recommended interventions resulted in reduced extension patterns, extraneous movement, loss of position and alignment with other assistive technologies, energy expenditure, client injury and pain, and equipment damage. Further, functional gains and increased seating tolerance were noted.

CONCLUSION

dynamic seating may address numerous positioning challenges in clients with increased muscle tone in conjunction with an appropriate seating system and mobility base.IMPLICATIONS FOR REHABILITATIONDynamic seating may:•Dissipate client forces to reduce active extension.•Protect a client from injury by reducing intermittent and sustained forces.•Protect wheelchair seating, mounting hardware, and the frame from loss of alignment and damage.•Provide movement to decrease agitation and increase alertness.

Speech pathologists' perspectives on the use of augmentative and alternative communication devices with people with acquired brain injury and reflections from lived experience

BACKGROUND

Communication changes following acquired brain injury (ABI) may necessitate use of augmentative and alternative communication (AAC). Speech pathologists regularly assist people with ABI and their families with AAC assessment and recommendations, as well as education and training on AAC use. To date, there has been no Australian research investigating the perspectives of speech pathologists working in the field of ABI and AAC. This research aimed to 1) Explore speech pathologists' insights regarding enablers and barriers to considerations and uptake, and ongoing use, of AAC by people with ABI and 2) Understand their perspectives on AAC acceptance, abandonment and rejection.

METHOD

A qualitative research design, with semi-structured interviews, was used with seven speech pathologists working across three Australian states. Interviews were transcribed verbatim, and thematically analysed. To triangulate results, the lived experience reflections of one co-author, who has an ABI and uses AAC, were drawn on.

RESULTS

Seven themes were identified, relating to four of the five domains of the World Health Organization's assistive technology model. These included that AAC should be person-centred, with consideration of both products and personnel required, and with effective policy aiding AAC trial, uptake and use.

CONCLUSION

This research has highlighted considerations for AAC use by people with ABI, from the perspective of speech pathologists and aided by lived experience reflections. Speech pathologists need to understand the breadth of products, and good practice service steps, to ensure successful AAC use and skill development. Listening to the perspectives of people with ABI is central to that understanding.

The Right to Assistive Technology and Accessible Instructional Materials for U.S. Students Does Not Consistently Translate into Predictable Access and Effective Use

Students in the United States have federally-established rights regarding access to assistive technology (AT) devices and services, yet those rights are not consistently upheld for a variety of reasons acknowledged in the literature. We conducted a interview-based study with 48 education professionals, family members and students to analyze the facilitators and barriers that influence AT access for students in the State of Delaware. Study results were consistent with the extant literature, and revealed numerous violations of student rights guaranteed under U.S. special education law. Some barriers were attitudinal, yet most arose from the inadequacy of infrastructures: professionals lacked training, funding was inadequate or difficult to access and, in most areas, there was no definitive guidance relative to the processes that should be followed and how decisions regarding AT-related decisions regarding devices and services should be documented. Elements revealed to facilitate AT access and use were the availability of resources - highly-qualified personnel, time, training, funds, and access to devices - and persistence among educators and family members in pursuing AT solutions for students.

Assistive technology unmet need in Indonesia: challenges and opportunities for enhancing equitable access

PURPOSE

To analyze the rapid Assistive Technology Assessment (rATA) data and identify challenges and opportunities for improving access to assistive technology products (AP) in Indonesia.

MATERIALS AND METHODS

An explanatory sequential mixed-methods design consisting of a quantitative survey and a qualitative interview study was used. The rATA survey was administered to households in two randomly sampled provinces to collect data on AP met and unmet need. Descriptive statistics was used to analyze the survey data. Qualitative data were collected from unstructured videorecorded interviews with rATA policymakers. Interview transcripts were coded and analyzed using thematic analysis.

RESULTS

On average, data from rATA respondents (n = 11,300) revealed 60% of AP unmet need. A high proportion of funding sources came from the private sector, and contributions from the government remained low. Affordability and funding were the main barriers to access. From the policymaker interviews (n = 5), four essential themes emerged, i.e., "resources and workforce", "funding", "laws and policies", and "guidelines and standards". From each theme, key challenges and opportunities were identified.

CONCLUSIONS

Affordability remained a major challenge, in part because government-sponsored funding was still inadequate, forcing people with low financial status to self-produce AP. One potential opportunity would be to localize AP production and improve local workforce training. Integrated national funding schemes and intersectoral coordination could accelerate improvement in meeting AP unmet need. This study may provide evidence of current challenges and opportunities to help improve the field of rehabilitation through enhanced access to AP services in Indonesia.

Digital Enabling Assistive Technology Through the Provision Lens - A Global Perspective in a Nordic Context

The Nordic healthcare system is well-established, taxation-based, and locally administered, featuring person-centered care as a social welfare pillar. Public provision of assistive technology and welfare technology within healthcare systems means every citizen has equal access to services. But how well are policies and procedures keeping pace with demographic changes and technology developments?. This study critically analyses qualitative data from 24 stakeholders involved in municipal-level procurement and allocation of assistive and welfare technology in Sweden with a specific focus on emerging digital technology. An extant analysis framework was used: the World Health Organization-GATE 5P framework for strengthening access to AT. Recommendations are made for agile procurement and an outcome-based decision frame. The voice of the AT user may be a valuable addition to inform policy.

Promoting disability employment with avail® - a pilot study for feasibility and preliminary efficacy

PURPOSE

Supported employment is a promising vocational rehabilitation intervention for improving disability employment. Its implementation, however, is not without challenges. Lack of funding and the heavy caseload of job coaches significantly constrain its impacts. A mobile software, avail® by CentralReach, was created based on the individual placement and support model for assisting individuals with disabilities to perform their job tasks. The purpose of this pilot study was to explore the feasibility and preliminary efficacy of avail.

METHOD

A total of 17 participants with disabilities were recruited in a Midwestern state from the United States to try avail for a period of time ranging from 40 to 348 days. Participants' experiences, including perceived usability, acceptance, and satisfaction, were collected to determine the feasibility of avail. In addition, a pre- and post-intervention analysis was conducted to identify its effects on users' job satisfaction, self-efficacy, and self-determination.

RESULTS

Participants of this study expressed positive user experience for avail. Specifically, they felt that avail was helpful for their job performance. The results also showed a statistically significant result for improving participants' self-determination.

CONCLUSION

avail is a feasible and potentially promising application for assisting workers with disabilities in their job performance. Directly available on mobile devices, avail has several advantages, such as real-time support and good portability. Suggestions and future directions were discussed for further software development.

Smart Nursing: The Use of Technology to Support Homecare Nurses with Their Care of the Elderly

The demand for homecare services is on the rise, while simultaneously there is a shortage of homecare nurses who are burdened with increasingly heavier workloads. The introduction of assistive technologies has the potential to assist elderly individuals as well as (informal) caregivers. This study aims to facilitate nursing care with technology, within the framework of a proper daily structure for elderly people. Initially, a needs assessment was performed with homecare nurses to identify the most relevant daily structure patterns. Subsequently, a prototype comprising of a test setup and a mobile application was developed, followed by a case study involving participation from homecare nurses, informal caregivers, and patients. Both subjective experiences and standardized outcome measures (System Usability Scale, Usefulness Satisfaction and Ease of Use Scale and User Experience Questionnaire) revealed highly positive attitudes towards the test setup and application. Future research endeavours should focus on scaling up the technology and expanding its availability to other caregivers.