Exploring the barriers to using assistive technology for individuals with chronic conditions: a meta-synthesis review

PURPOSE

Assistive technology can provide a key tool to enabling independence, greater inclusion and participation in society for individuals with chronic conditions. This potential is currently not always realized due to barriers to accessing and using assistive technology. This review aims to identify the common barriers to acquiring and using assistive technology for users with chronic conditions through a systematic meta-synthesis. This differs from other systematic reviews by applying a transdiagnostic approach to identify if barriers are common across chronic conditions.

MATERIALS AND METHODS

A systematic literature search of five scientific databases (PubMed, SCOPUS, PsycINFO, CINAHL and Medline) was conducted to identify relevant qualitative studies. The search was conducted in November 2019. For the identified articles, thematic content analysis was conducted and the methodological quality was evaluated using the Critical Appraisal Skills Programme (CASP) checklist for qualitative research.

RESULTS

Forty papers met the inclusion criteria and were included in the analysis. Fifty-one descriptive themes grouped into six overarching analytical themes were identified from the studies. The analytical themes identified were: the design and function of the assistive technology, service provision, information and awareness, psychological barriers, support network and societal barriers.

CONCLUSIONS

The barriers are interconnected and common across different health conditions. More involvement in personalized care for developing strategies, adaptation of home technologies and provision of assistive technology could overcome the service provision and design barriers to assistive technology. Accessible information and providing greater awareness will be important to overcoming information, psychological and societal barriers to assistive technology.Implications for rehabilitationIndividuals with chronic conditions face complex barriers to acquiring and using assistive technology as a result of the devices themselves, their individual context, the healthcare context where assistive technology is provided and wider societal barriers.The provision of assistive technology needs to change away from the traditional medical model of the "expert" clinician and instead focus on more user involvement to deliver personalised care that utilises the users lived knowledge and experiences.Assistive technology provision should be considered alongside how to adapt everyday mainstream technology to meet user needs; the provision of devices should encourage creative problem solving rather then relying on pre-defined prescription lists of assistive technology.

CyberLimb: a novel robotic prosthesis concept with shared and intuitive control

Background

Existing assistive technologies attempt to mimic biological functions through advanced mechatronic designs. In some occasions, the information processing demands for such systems require substantial information bandwidth and convoluted control strategies, which make it difficult for the end-user to operate. Instead, a practical and intuitive semi-automated system focused on accomplishing daily tasks may be more suitable for end-user adoption.

Methods

We developed an intelligent prosthesis for the Cybathlon Global Edition 2020. The device was designed in collaboration with the prosthesis user (pilot), addressing her needs for the competition and aiming for functionality. Our design consists of a soft robotic-based two finger gripper controlled by a force-sensing resistor (FSR) headband interface, automatic arm angle dependent wrist flexion and extension, and manual forearm supination and pronation for a shared control system. The gripper is incorporated with FSR sensors to relay haptic information to the pilot based on the output of a neural network model that estimates geometries and objects material.

Results

As a student team of the Munich Institute of Robotics and Machine Intelligence, we achieved 12th place overall in the Cybathlon competition in which we competed against state-of-the-art prosthetic devices. Our pilot successfully accomplished two challenging tasks in the competition. During training sessions, the pilot was able to accomplish the remaining competition tasks except for one. Based on observation and feedback from training sessions, we adapted our developments to fit the user’s preferences. Usability ratings indicated that the pilot perceived the prosthesis to not be fully ergonomic due to the size and weight of the system, but argued that the prosthesis was intuitive to control to perform the tasks from the Cybathlon competition.

Conclusions

The system provides an intuitive interface to conduct common daily tasks from the arm discipline of the Cybathlon competition. Based on the feedback from our pilot, future improvements include the prosthesis’ reduction in size and weight in order to enhance its mobility. Close collaboration with our pilot has allowed us to continue with the prosthesis development. Ultimately, we developed a simple-to-use solution, exemplifying a new paradigm for prosthesis design, to help assist arm amputees with daily activities.

An assistive technology program for enabling five adolescents emerging from a minimally conscious state to engage in communication, occupation, and leisure opportunities

BACKGROUND

Post-coma patients emerging from a minimally conscious state may have extensive motor disabilities and pose serious challenges to medical centers and home settings.

OBJECTIVES

To promote academic performance and communication skills of post-coma individuals with traumatic brain injuries emerging from a minimally conscious state through an Assistive Technology setup. To evaluate its effects on the participants' positive participation. To generalize the learning process. To assess the intervention's clinical and social validity.

METHOD

Study I included five adolescents exposed to an Assistive Technology setup enabling them with targeted adaptive behaviors. Study II involved fifty external raters in a social validation assessment.

RESULTS

Data evidenced an improved performance of all the participants during the intervention, assessed through a concurrent multiple baseline design across participants. Social raters favorably scored the use of the technology.

CONCLUSION

An Assistive Technology setup may be helpful to enhance the performance and positive participation of adolescents with traumatic brain injuries emerging from a minimally conscious state.

COVID-19 and challenges of assistive technology use in Iran

PURPOSE

Assistive technology users may encounter challenges and inequality in having an access to health information and care during the emergency or in a crisis time. This issue seems to be understudied in most developing countries. The aim of this study was to explore the challenges faced by Iranian people with disabilities faced during the COVID-19 pandemic as far as the use of assistive technology is concerned.

METHOD

A thematic analysis approach was employed to collect and analyse the data. We interviewed 10, 12 and 20 participants with physical, visual, and hearing disability, respectively during the pandemic between May to July 2020. A six-step thematic analysis method was used to identify categories and main themes.

RESULTS

The results revealed that people with disability were faced with some challenges in accessing information or receiving it on time during the emergency time. The lack of clear information may increase uncertainty about providing, using or maintaining assistive products. With no clear information or instruction, increased fear of infection, as well as the lack of necessary infrastructure for using available online applications, people with a disability had to rely more on others and seemed to feel disempowered.

CONCLUSION

Assistive technology (AT) users may not receive enough care and attention during health crisis, nor may be included in crisis management programs. Actions to create preparedness plans to meet the needs of AT users in possible future crisis seem to be necessary.IMPLICATIONS FOR REHABILITATIONAssistive technology users' voice and needs should be given priority in crisis management programs.Web accessibility barriers and information accessibility challenges need more research attention in order to create effective and timely information dissemination programs.There seems to be a research gap about AT users during health crisis, and more research in this area is needed.

Effects of an 8-Week Virtual Reality Training Program on Pain, Fall Risk, and Quality of Life in Elderly Women with Chronic Low Back Pain: Double-Blind Randomized Clinical Trial

Objective: Low back pain (LBP) and falls are among the major problems experienced by the elderly population. The present study investigated the effectiveness of an 8-week virtual reality training (VRT) program in helping relieve pain, minimize fall risk, and improve quality of life (QoL) in elderly women suffering from chronic LBP (CLBP). Materials and Methods: Twenty-five elderly women (VRT/intervention group = 13, control group = 12) with CLBP and aged 65 to 75 years were recruited. The VRT involved three 30-minute weekly sessions of exercises that were carried out using the Xbox Kinect headset. Pain intensity, fall risk, and QoL were assessed via the Visual Analog Scale, the Biodex Balance System, and the 36-Item Short Form Health Survey, respectively. Results: The outcomes of a one-way analysis of covariance indicated that the pain intensity score of the intervention group significantly decreased after participation in the VRT program (P = 0.001). The intervention group also showed reduced fall risk (P = 0.001) and elevated QoL (P = 0.001). Conclusion: The results confirmed that the VRT program can be regarded as a valid therapeutic intervention that helps reduce patients' symptoms and increase the effectiveness of exercises in the elderly by teaching pain-related insight as well as enhancing QoL and reduce fall risk through various movements.

Mini-review: Robotic wheelchair taxonomy and readiness

Robotic wheelchair research and development is a growing sector. This article introduces a robotic wheelchair taxonomy, and a readiness model supported by a mini-review. The taxonomy is constructed by power wheelchair and, mobile robot standards, the ICF and, PHAATE models. The mini-review of 2797 articles spanning 7 databases produced 205 articles and 4 review articles that matched inclusion/exclusion criteria. The review and analysis illuminate how innovations in robotic wheelchair research progressed and have been slow to translate into the marketplace.

Assistive Technology for Students with Intellectual Disability: Examining Special Education Teachers ' Perceptions in Saudi Arabia

Individuals with an intellectual disability (ID) have complex learning needs, and often experience difficulty acquiring new skills that rely solely on traditional teaching materials. Assistive technology (AT) is a powerful tool that plays an important role in addressing many of the issues encountered by those with ID, via the integration of technology in their learning process. This study explores teachers' views of AT facilities in different special education programs for students with ID in the Makkah province of Saudi Arabia, in order to identify the uses of the AT tools used to teach them. The study employs semi-structured interviews as the data collection method, seeking to determine the current state of AT integration in this field. The data is analyzed using qualitative methods, and the findings reveal that the teachers interviewed incorporate AT into the academic setting, and agree that such technology can foster student learning, assignment completion, and engagement.

Investigating socially assistive systems from system design and evaluation: a systematic review

Purpose The development of assistive technologies that support people in social interactions has attracted increased attention in HCI. This paper presents a systematic review of studies of Socially Assistive Systems targeted at older adults and people with disabilities. The purpose is threefold: (1) Characterizing related assistive systems with a special focus on the system design, primarily including HCI technologies used and user-involvement approach taken; (2) Examining their ways of system evaluation; (3) Reflecting on insights for future design research. Methods A systematic literature search was conducted using the keywords "social interactions" and "assistive technologies" within the following databases: Scopus, Web of Science, ACM, Science Direct, PubMed, and IEEE Xplore. Results Sixty-five papers met the inclusion criteria and were further analyzed. Our results showed that there were 11 types of HCI technologies that supported social interactions for target users. The most common was cognitive and meaning understanding technologies, often applied with wearable devices for compensating users' sensory loss; 33.85% of studies involved end-users and stakeholders in the design phase; Four types of evaluation methods were identified. The majority of studies adopted laboratory experiments to measure user-system interaction and system validation. Proxy users were used in system evaluation, especially in initial experiments; 42.46% of evaluations were conducted in field settings, primarily including the participants' own homes and institutions. Conclusion We contribute an overview of Socially Assistive Systems that support social interactions for older adults and people with disabilities, as well as illustrate emerging technologies and research opportunities for future work.

Digital personal assistants are smart ways for assistive technology to aid the health and wellbeing of patients and carers

Background

Digital health solutions such as assistive technologies create significant opportunities to optimise the effectiveness of both health and social care delivery. Assistive technologies include ‘low-tech’ items, such as memory aids and digital calendars or ‘high-tech’ items, like health tracking devices and wearables. Depending on the type of assistive devices, they can be used to improve quality of life, effect lifestyle improvements and increase levels of independence. Acceptance of technology among patients and carers depends on various factors such as perceived skills and competencies in using the device, expectations, trust and reliability. This service evaluation explored the impact of a pilot service redesign focused on improving health and wellbeing by the use of a voice-activated device ‘smart speaker’, Alexa Echo Show 8.

Methods

A service evaluation/market research was conducted for a pilot service redesign programme. Data were collected via a survey in person or telephone and from two focus groups of patients (n = 44) and informal carers (n = 7). The age of the study participants ranged from 50 to 90 years. Also, the participants belonged to two types of cohort: one specifically focused on diabetes and the other on a range of long-term health conditions such as multiple sclerosis, dementia, depression and others.

Results

The device had a positive impact on the health and social well-being of the users; many direct and indirect benefits were identified. Both patients and carers had positive attitudes towards using the device. Self-reported benefits included: reminders for medications and appointments improved adherence and disease control; increased independence and productivity; and for those living alone, the device helped combat their loneliness and low mood.

Conclusion

The findings from the study help to realise the potential of assistive technology for empowering supporting health/social care. Especially, the season of COVID-19 pandemic has highlighted the need for remote management of health, the use of assistive technology could have a pivotal role to play with the sustainability of health/social care provision by promoting shared care between the care provider and service user. Further evaluation can explore the key drivers and barriers for implementing assistive technologies, especially in people who are ageing and with long-term health conditions.

"It's no good but at least I've always got it round my neck": A postphenomenological analysis of reassurance in assistive technology use by older people

The provision of reassurance is seen as a goal and benefit of the use of assistive technology (AT) in supporting people to manage their health and care needs at a distance. Conceptually, reassurance in health and care settings remains under-theorised with the benefits of experiencing reassurance through technology use assumed rather than understood. UK health and social care service goals of managing safety and risk have largely been equated with providing reassurance to users of AT and their carers. What has not been explored is how reassurance is experienced variably by users of different types of technology-enabled care. We present data from 3 case studies of different technologies in use in health and social care provision, analysed through a postphenomenology and sociomaterial lens. Our findings point to reassurance as an important facet of AT provision but the intended functions and uses of technological devices alone did not account for people's experiences of reassurance. Participant narratives referred variously to the comfort of being monitored, having their illness/wellness verified by the device, feeling reassured by the promise of help if needed, and imbuing the device with symbolic meaning (when the user associated the device with meanings and functions other than its technical capabilities). The different ways in which reassurance was experienced provides a useful way of understanding the potential tensions with AT policy goals as well as the positive meaning attributed to devices in some cases. This study reaffirms the importance of AT implementation being anchored in what matters to the user.

Assistive technology: autonomous wheelchair in obstacle-ridden environment

The benefits for the advancement and enhancement of assistive technology are manifold. However, improving accessibility for persons with disabilities (PWD) to ensure their social and economic inclusion makes up one of the major ones in recent times. This paper presents a set of new nonlinear time-invariant stabilizing controllers for safe navigation of an autonomous nonholonomic rear-wheel drive wheelchair. Autonomous wheelchairs belong to the category of assistive technology, which is most sought in current times due to its usefulness, especially to the less abled (physically and/or cognitively), hence helping create an inclusive society. The wheelchair navigates in an obstacle-ridden environment from its start to final configuration, maintaining a robust obstacle avoidance scheme and observing system restrictions and dynamics. The velocity-based controllers are extracted from a Lyapunov function, the total potentials designed using the Lyapunov based Control Scheme (LbCS) falling under the classical approach of the artificial potential field method. The interplay of the three central pillars of LbCS, which are safety, shortness, and smoothest course for motion planning, results in cost and time effectiveness and the velocity controllers' efficiency. Using the Direct Method of Lyapunov, the stability of the wheelchair system has been proved. Finally, computer simulations illustrate the effectiveness of the set of new controllers.

Factors associated with access to assistive technology and telecare in home-dwelling people with dementia: baseline data from the LIVE@Home.Path trial

Background

There is a knowledge gap regarding factors that may influence the access to different devices for home-dwelling people with dementia (PwD). The aim of this study was to identify different assistive technology and telecare (ATT) devices installed in the home and key factors associated with access to such technology.

Methods

The baseline data came from the LIVE@Home.Path trial, a 24-month multi-component intervention including PwDs and their informal caregivers (dyads) and were collected through semi-quantitative questionnaires in three Norwegian municipalities between May and November of 2019. Regression models were applied to detect demographic and clinical factors associated with access to ATT.

Results

Of 438 screened dyads, 276 were included at baseline. The mean ages of the PwDs and caregivers were 82 ± 7.0 and 66 ± 12 years, respectively, and 62.8% of the PwD were female and 73.5% had access to any type of ATT. The majority had traditional equipment such as stove guards (43.3%) and social alarms (39.5%) or everyday technology, e.g. calendar support and door locks (45.3%). Multivariate regression analyses revealed that access to a social alarm was more often available for females than males, at increased age, and when the PwD lived alone, while tracking devices (14.9%) were more often accessible at lower age. Everyday technology was more often available for females, at increased age of the PwD and the caregiver, higher comorbidity, and poor IADL (instrumental activities of daily living) function. For PwDs with severe dementia, access to ATT was significantly associated with poor IADL function, having their children as the main caregiver (61.3%), and having caregivers who contributed 81–100% to their care (49.5%).

Conclusions

Home-dwelling PwDs mainly had access to traditional and obligated devices, followed by everyday technology. There is unmet potential for communication, tracking, and sensing technology, especially for devices not offered by the municipalities. Gender, ages of the PwD and caregiver, cohabitation status, and physical function were the main associated factors for access to ATT.

Trial registration: ClinicalTrials.gov NCT04043364.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12911-021-01627-2.

An Assistive Coughing Device for Post-Laryngectomy Patients

People who have undergone total laryngectomy typically have difficulties speaking and coughing. Coughing, the protective reflex action where air is rapidly expelled from the lungs to clear the airway, is crucial in everyday life. Insufficiency in coughing can lead to serious chest infections. In this research we present a bionic assistive coughing device (RoboCough) to improve coughing efficacy among laryngectomy patients by increasing pressure and flow rate. RoboCough was designed to mimic the function of the glottis and trachea in the upper respiratory system. Experimental results show a significant increase (t(64) = 4.9, p < 0.0001) in peak cough flow rate and peak cough pressure (t(64) = 12.6, p < 0.0001) among 33 control participants using RoboCough. A pilot study with a smaller cohort of laryngectomy patients shows improvement in peak cough pressure (p = 0.0159) using RoboCough. Preliminary results also show that post-laryngectomy coughs achieved similar peak cough flow (Z = -0.9933, p = 0.32) to the control group’s natural cough. Coughing capabilities could be improved through using RoboCough. Applications of RoboCough include simulation of vocal folds and respiratory conditions, rehabilitation of ineffective coughs from laryngeal and respiratory diseases and as a test-bed for the development of medical devices for respiratory support.

Insights on an automated fall detection device designed for older adult wheelchair and scooter users: A qualitative study

BACKGROUND

Falls are a concern for older adults who use wheelchairs and scooters. Many wheelchair and scooter users require assistance to recover from a fall and often lie on the ground waiting for assistance for 10 min or more. An automated fall detection device may facilitate communication with care partners and expedite recovery; however, there is limited research on the specifications and features of an automated fall detection device preferred by older adults who use wheelchair and scooter.

OBJECTIVE

To examine the desired specifications, perceived ease of use and perceived usefulness of an automated fall detection device desired by older adults who use a wheelchair or scooter through semi-structured interviews.

METHODS

Fifteen full-time wheelchair and scooter users (9 females; age: 68 ± 5 years) were interviewed from July to November 2020. Interviews were transcribed, coded, and analyzed.

RESULTS

Preferred features include wireless charging, a watch form, ability to change the individual who is contacted in the event of a fall, and the ability to disable a notification in the event of a false alarm. Participants felt that an automated fall detection device would be useful and easy to use.

CONCLUSIONS

Older adults who use a wheelchair or scooter indicated the need for an automated fall detection device to facilitate recovery from a fall. Participants reported challenges with previous fall detection devices and the need for specific design requirements to facilitate ongoing use. Participants' insights inform the design of a fall detection device to maximize usability and prevent technology abandonment.

HELF (Haptic Encoded Language Framework): a digital script for deaf-blind and visually impaired

PURPOSE

Digital media has brought a revolution, making the world a global village. For people who are visually impaired and people with visual and hearing impairment, navigating through the digital world can be as precarious as moving through the real world. To enable them to connect with the digital world, we propose a solution, Haptic Encoded Language Framework (HELF), that uses haptic technology to enable them to write digital text using swiping gestures and understand the text through vibrations.

METHOD

We developed an Android application to present the concept of HELF and evaluate its performance. We tested the application on 13 users (five visually impaired and eight sighted individuals).

RESULTS

The preliminary exploratory analysis of the proposed framework using the Android application developed reveals encouraging results. Overall, the reading accuracy has been found to be approximately 91%, and the average CPM is found to be 25.7.

CONCLUSION

The volunteering users of the HELF Android application found it useful as a means of using the digital media and recommended its usage as an assistive technology for the visually challenged. The results of their performance of using the application motivate further research and development in the proposed work to make HELF more usable by people who are visually impaired and people with visual and hearing impairment.

Carers' experiences of assistive technology use in dementia care: a cross sectional survey

Background

Assistive Technology (AT) supports persons with dementia and their carers (family, friends and neighbours), yet little is known about experiences and the impact of AT on carers. We report on an exploratory survey that examined the types, uses, costs and impact of AT on carers as well as their quality of life.

Methods

A cross-sectional survey using the Carers Assistive Technology Experience Questionnaire collected data from carers in the UK, who used at least one AT in the previous year and provided more than 10 h of care for a person with dementia, living at home. Carers completed the questionnaire online or on paper and information on AT, socio-demographic details, and Short-Form Health Survey (SF-12) data were collected. Descriptive and inferential statistics were used to report results and draw conclusions.

Results

Data from 201 carers was analysed. Smartphones and tablet computers were the most frequently used AT. AT were used predominantly for safety, communication, and reminders. Carers usually make decisions on buying and continued use of AT. Multiple AT devices were used in the care of persons with dementia and number of AT used was associated with perceived satisfaction. Satisfaction with AT was not related to age, living arrangements and relationship of carers. From the SF-12, Mean Physical Component Score was 49.19 (95%CI- 47.75 to 50.63) and Mental Component Score was 45.37 (95%CI- 43.93 to 46.80). Women, carers in the 46–65 age group and carers who were not extremely satisfied with AT had lower MCS scores. Carers who lived with the person with dementia and older carers had lower PCS scores.

Conclusions

Carers report that AT has a beneficial impact. Carers use multiple ATs, perceive AT to be satisfactory and recommend AT use to others. To support carers, we recommend establishment of centrally funded information sources and a loan store for AT. Further research on incremental addition of AT and changes to formal/paid care because of using AT should be undertaken. Practitioners, academics, manufactures and policy makers should consider the experiences of carers in research, development and use of AT to facilitate improved community living of people with dementia.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02417-1.

Three-dimensional printed assistive devices for addressing occupational performance issues of the hand: A case report

STUDY DESIGN

This is a case report.

INTRODUCTION

Persons with rheumatoid arthritis frequently use assistive devices as a compensatory strategy to enhance occupational performance when client factors such as hand weakness, pain, and/or limited range of motion interfere with activity performance. Computer-aided design software and 3D printers are increasingly being used to design and make assistive devices.

PURPOSE OF THE STUDY

This case report describes a client-centered approach in the selection, three-dimensional (3D) printing, and evaluation of outcomes for three assistive devices to enhance occupational performance in a subject with rheumatoid arthritis.

METHODS

Outcome measures used in this study included the Patient-Specific Functional Scale, Numeric Pain Rating Scale, and Quebec User Evaluation of Satisfaction with Assistive Technology V2.0. Activity analysis along with the subject input informed a client-centered approach in the selection, color, and design modifications of 3D printed assistive devices made for the study.

RESULTS

The subject reported decreased pain, improved occupational performance, and satisfaction with use of 3D printed assistive devices to open plastic beverage bottles, unlock/lock doors, and write.

DISCUSSION

3D printing offers therapists a means to design and make assistive devices that can be cost-effective, customizable, and client-centered.

CONCLUSION

Assistive devices made with 3D printing resulted in positive outcomes in a subject with rheumatoid arthritis.

Regulation of the global orthotist/prosthetist workforce, and what we might learn from allied health professions with international-level regulatory support: a narrative review

BACKGROUND

By 2050, the global demand for orthotic and prosthetic services is expected to double. Unfortunately, the orthotic/prosthetic workforce is not well placed to meet this growing demand. Strengthening the regulation of orthotist/prosthetists will be key to meeting future workforce demands, however little is known about the extent of orthotist/prosthetist regulation nor the mechanisms through which regulation could best be strengthened. Fortunately, a number of allied health professions have international-level regulatory support that may serve as a model to strengthen regulation of the orthotic/prosthetic profession. The aims of this study were to describe the national-level regulation of orthotist/prosthetists globally, and the international-level regulatory support provided to allied health professions.

METHOD

Two environmental scans benchmarked the national-level regulation of the orthotist/prosthetist workforce, and the regulatory support provided by international allied health professional bodies using a set of nine core practitioner standards (core standards) including: Minimum Training/Education, Entry-level Competency Standards, Scope of Practice, Code of Conduct and/or Ethics, Course Accreditation, Continuing Professional Development, Language Standard, Recency of Practice, and Return-to-Practice. Each identified country was categorised by income status (i.e. High-, Upper-Middle-, Lower-Middle-, and Low-Income countries).

RESULTS

Some degree of regulation of the orthotist/prosthetist workforce was identified in 30 (15%) of the world's 197 countries. All core standards were present in 6 of these countries. Countries of higher economic status had more core standards in place than countries of lower economic status. International-level professional bodies were identified for 14 of 20 allied health professions. International bodies for the physical therapy (8 core standards) and occupational therapy (5 core standards) professions provided regulatory support to help national associations meet most of the core standards.

CONCLUSION

Given the small proportion of countries that have national practitioner regulatory standards in place, most orthotist/prosthetists are working under little-to-no regulation. This presents an opportunity to develop rigorous national-level regulation that can support workforce growth to meet future workforce demands. Given the financial and expertise barriers that hinder the development of a more regulated orthotist/prosthetist workforce, particularly for Low- and Lower-Middle-Income countries, we recommend the establishment of an international professional body with the express purpose to support national-level regulation of orthotist/prosthetists, and thereby build the regulatory capacity of national orthotic/prosthetic associations.

Overcoming barriers to the adoption of locating technologies in dementia care: a multi-stakeholder focus group study

Background

Locating technologies are a subtype of assistive technology that aim to support persons with dementia by helping manage spatial orientation impairments and provide aid to care partners by intervening when necessary. Although a variety of locating devices are commercially available, their adoption has remained low in the past years. Several studies have explored barriers to the adoption of assistive technologies from the perspective of professional stakeholders, but in-depth explorations for locating technologies are sparse. Additionally, the inputs of business professionals are lacking. The aim of this study was to expand knowledge on barriers to the adoption of locating technologies from a multi-stakeholder professional perspective, and to explore strategies to optimize adoption.

Methods

In total, 22 professionals working in business (n = 7), healthcare (n = 6) and research (n = 9) fields related to gerontology and gerontechnology participated in our focus group study. Perceptions on the value of using locating technologies for dementia care, barriers to their adoption, as well as salient services and information dissemination strategies were explored. After verbatim transcription, transcripts were analysed following an inductive data-driven content analysis approach in MAXQDA.

Results

Six key adoption barriers centering on: (1) awareness-, (2) technological-, (3) product characteristic- and (4) capital investment-based limitations, (5) unclear benefits, as well as (6) ethical concerns emerged. The interplay between barriers was high. Five core themes on services and information dissemination strategies centering on: (1) digital autonomy support, (2) emergency support, (3) information dissemination actors, (4) product acquisition, and (5) product advertising were extracted.

Conclusions

Our study with interdisciplinary stakeholders expands knowledge on barriers to the adoption of locating technologies for dementia care, and reinforces recommendations that an interdisciplinary strategy is needed to optimize adoption. Also, our findings show that focusing on services to increase digital autonomy and on information dissemination strategies has been largely overlooked and may be particularly effective.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02323-6.

Reimagining robotic walkers for real-world outdoor play environments with insights from legged robots: a scoping review

PURPOSE

For children with mobility impairments, without cognitive delays, who want to participate in outdoor activities, existing assistive technology (AT) to support their needs is limited. In this review, we investigate the control and design of a selection of robotic walkers while exploring a selection of legged robots to develop solutions that address this gap in robotic AT.

METHOD

We performed a comprehensive literature search from four main databases: PubMed, Google Scholar, Scopus, and IEEE Xplore. The keywords used in the search were the following: "walker", "rollator", "smart walker", "robotic walker", "robotic rollator". Studies were required to discuss the control or design of robotic walkers to be considered. A total of 159 papers were analyzed.

RESULTS

From the 159 papers, 127 were excluded since they failed to meet our inclusion criteria. The total number of papers analyzed included publications that utilized the same device, therefore we classified the remaining 32 studies into groups based on the type of robotic walker used. This paper reviewed 15 different types of robotic walkers.

CONCLUSIONS

The ability of many-legged robots to negotiate and transition between a range of unstructured substrates suggests several avenues of future consideration whose pursuit could benefit robotic AT, particularly regarding the present limitations of wheeled paediatric robotic walkers for children's daily outside use.IMPLICATIONS FOR REHABILITATIONChildren with lower limb disabilities can benefit from assistive technology designed for daily usage in outdoor surroundings.An extension of existing robotic assistive technology that allows the user to travel safely on irregular surfaces both indoors and outdoors is needed.Approaches used to solve research problems in the field of robotics (outside of the rehabilitation area) can be used to address problems that robotic assistive technology currently faces.There is a need for more research on the development of robotic assistive technology for children with mobility impairments without cognitive delays.

A Novel Marker Detection System for People with Visual Impairment Using the Improved Tiny-YOLOv3 Model

BACKGROUND AND OBJECTIVE

Daily activities such as shopping and navigating indoors are challenging problems for people with visual impairment. Researchers tried to find different solutions to help people with visual impairment navigate indoors and outdoors.

METHODS

We applied deep learning to help visually impaired people navigate indoors using markers. We propose a system to help them detect markers and navigate indoors using an improved Tiny-YOLOv3 model. A dataset was created by collecting marker images from recorded videos and augmenting them using image processing techniques such as rotation transformation, brightness, and blur processing. After training and validating this model, the performance was tested on a testing dataset and on real videos.

RESULTS

The contributions of this paper are: (1) We developed a navigation system to help people with visual impairment navigate indoors using markers; (2) We implemented and tested a deep learning model to detect Aruco markers in different challenging situations using Tiny-YOLOv3; (3) We implemented and compared several modified versions of the original model to improve detection accuracy. The modified Tiny-YOLOv3 model achieved an accuracy of 99.31% in challenging conditions and the original model achieved an accuracy of 96.11 %.

CONCLUSION

The training and testing results show that the improved Tiny-YOLOv3 models are superior to the original model.

Transfer of mode switching performance: from training to upper-limb prosthesis use

BACKGROUND

Current myoelectric prostheses are multi-articulated and offer multiple modes. Switching between modes is often done through pre-defined myosignals, so-called triggers, of which the training hardly is studied. We evaluated if switching skills trained without using a prosthesis transfer to actual prosthesis use and whether the available feedback during training influences this transfer. Furthermore we examined which clinically relevant performance measures and which myosignal features were adapted during training.

METHODS

Two experimental groups and one control group participated in a five day pre-test-post-test design study. Both experimental groups used their myosignals to perform a task. One group performed a serious game without seeing their myosignals, the second group was presented their myosignal on a screen. The control group played the serious game using the touchpad of the laptop. Each training session lasted 15 min. The pre- and post-test were identical for all groups and consisted of performing a task with an actual prosthesis, where switches had to be produced to change grip mode to relocate clothespins. Both clinically relevant performance measures and myosignal features were analysed.

RESULTS

10 participants trained using the serious game, 10 participants trained with the visual myosignal and 8 the control task. All participants were unimpaired. Both experimental groups showed significant transfer of skill from training to prosthesis use, the control group did not. The degree of transfer did not differ between the two training groups. Clinically relevant measure 'accuracy' and feature of the myosignals 'variation in phasing' changed during training.

CONCLUSIONS

Training switching skills appeared to be successful. The skills trained in the game transferred to performance in a functional task. Learning switching skills is independent of the type of feedback used during training. Outcome measures hardly changed during training and further research is needed to explain this. It should be noted that five training sessions did not result in a level of performance needed for actual prosthesis use. Trial registration The study was approved by the local ethics committee (ECB 2014.02.28_1) and was included in the Dutch trial registry (NTR5876).

Co-creating an assistive technology peer-support community: learnings from AT Chat

PURPOSE

Inclusion is a core philosophy for health practitioners and human service users, and co-production is a way to achieve inclusion. Australia's assistive technology (AT) community seeks to include and amplify the voices of service and product users at multiple levels. Implementation of genuine partnerships for inclusion is however challenging. This paper describes the iterative co-design process undertaken to structure and deliver a peer-led information and support program, enabling AT users and supporters to build their AT decision making capability and share their expertise with each other and the broader community.

METHODS

A living labs approach was grounded in co-design principles and drew on the peer education, AT competency and capability-building knowledge base. Methods included embedding intersectional capabilities within the service, and the engagement of over 600 people in design thinking and program iterations through surveys, focus groups, journey mapping and think tanks.

RESULTS

A national, peer-led, co-designed online community for AT users was established and has been running since 2017. The community of 5000 users contribute to a peer-led information and support initiative geared to share expertise and build AT decision making capability.

CONCLUSIONS

Service delivery by the AT user community and for the AT user community requires a commitment to co-design, and an engagement with concepts of risk, competency, scope of practice and capability. The learnings from AT Chat have implications for AT services on this journey everywhere.Implications for rehabilitationActive co-design of AT services meets human rights and good practice benchmarks required by contemporary services.Foregrounding AT users within program design and delivery, brings a range of positive outcomes and possibilities for the way services are delivered.AT users have substantial untapped potential which brings tangible outcomes for other AT users, health professionals, service provider organizations and for society.Development of paid roles and pathways to recognize the skills of AT users, and indeed AT communities has potential to improve AT user self-efficacy as well as to contribute to the AT workforce.

Involving older adults in technology research and development discussions through dialogue cafés

BACKGROUND

Citizen involvement is important for ensuring the relevance and quality of many research and innovation efforts. Literature shows that inadequate citizen involvement poses an obstacle during the research, development, and implementation of assistive technology. Previous studies have addressed the advantages and disadvantages of citizen engagement in health research and technology development, and there is concern about how to ensure valuable engagement to avoid situations where they don't have influence. Frail older adults are often excluded from being active partners in research projects. The overall objective of this commentary is to describe a case where dialogue cafés was used as a method for involving assisted living residents in technology discussions, elaborating on the following research question: In what ways are dialogue cafés useful for directing research and development and for engaging residents in assisted living facilities in assistive technology discussions?

METHOD

Six dialogue cafés with assisted living residents as participants were carried out over a period of 3 years (2016-19). Reports that were written after each café by the group leaders and rapporteurs provide the material for the analyses in this paper.

RESULTS

This study demonstrates an example of facilitating user involvement where the participants felt useful by contributing to research and discussions on assistive technology and where this contribution in fact directed the research and development in the overall Assisted Living Project.

CONCLUSION

This study demonstrated that dialogue cafés enable older residents at an assisted living facility to contribute with opinions about their needs and perspectives on assistive technologies. This negates the view of older adults as too frail to participate and demonstrates the importance of including and collaborating with older adults in research.

Potential for Digital Monitoring to Enhance Wellbeing at Home for People with Mild Dementia and Their Family Carers

Digital technologies have the potential to assist people with dementia to monitor day to day activities and mitigate the risks of living independently. This purposive pilot study surveyed participants for frailty, wellbeing, and perceived carer burden using the 3Rings™ digital plug. 30 paired participants used the digital device for four months. People with dementia reported a decline in wellbeing and increased frailty. Family carers reported a decline in wellbeing but 18 reported a reduction in burden. The use of digital monitoring by family carers demonstrated a reduction in their perceived burden and the device was acceptable to people with mild dementia living alone.