Wheelchair satisfaction among elderly Arab and Jewish patients - a cross-sectional survey

PURPOSE

To evaluate patient satisfaction with their wheelchairs among Jewish and Arab older adults.

MATERIALS AND METHOD

A cross-sectional study based on personal interviews. Participants were confined to a wheelchair (WC) Level 3. The Quebec User Evaluation of Satisfaction (scales 1-5) evaluated patient satisfaction. T test evaluated differences between continuous variables and χ2 or a Fisher's exact test between categorical variables. The contribution of background variables to the overall satisfaction with the wheelchair and related service was evaluated by multivariate regression.

RESULTS

A total of 74 Jewish and 24 Arab (mean age 78.4 ± 14.1), participated in the study. The overall satisfaction score was moderate/high (3.97 ± 0.8) with no difference between the groups. The most important items for all participants were WC safety, comfort and weight. Participants from the Arab sector were less educated, had higher BMI and were less satisfied with the chair dimensions.

CONCLUSIONS

A WC Level 3 may be effective and meets most of the basic needs of both Jewish and Arab patients at older ages. Higher BMI may result in difficulty to adopt to WC dimensions and can explain the less satisfaction of Arab patients with this component. A routine initial phone call follow-up is recommended to all patients after receiving a wheelchair. Those with problems will be scheduled for home visit. It is recommended to perform a study that will include more types of assistive devices and other groups of patients.Implication For RehabilitationApparently, despite lack of home visit follow-up, overall satisfaction with wheelchaires is relatively high. Therefore, initial phone calls may be monitored to all patients and home visits may be scheduled only for those unsatisfied with their chair.Converting a home visit to phone call can reduce the costs associated with routine home visits for all patients as is currently the case in some counties. This counts for both Jewish and Arab patients.

An overview of assistive technology products and services provided in Malawi

BACKGROUND

Assistive technology is the products and services used by individuals with functional limitations to enable participation in society and realisation of rights afforded by the United Nations Convention on the Rights of Persons with Disabilities. The Assistive Product List is a comprehensive list of products identified as essential for access through universal health coverage. Key stakeholders, including organisations of persons with disabilities, civil service organisations, academic organisations and government ministries are collaborating to integrate assistive technology into policy and develop a priority assistive products list for Malawi.

OBJECTIVE

To understand the organisational characteristics of, and assistive products provided by, key stakeholders working in AT in Malawi.

STUDY DESIGN

Online survey of representatives from key stakeholder organisations.

METHODS

We surveyed representatives of key stakeholder organisations to gather information regarding assistive technology product and service provision in Malawi. Responses were analysed using counts for closed-ended questions, and conventional content analysis for open-ended questions.

RESULTS

A total of 36 of the 50 APL products were provided by eight organisations. Related services were provided for 36 of the 50 APL products by twelve organisations. Five organisations reported providing both products and services. Products and services are largely funded by donation and provided free to those who require them.

CONCLUSION

A range of organisations in Malawi play a role in assistive product delivery and related services. Coordinated AP delivery and service provision is required at a national level which is sustainable and inclusive, and is based on identified needs of the Malawian population.Implications for rehabilitationPolicies supporting assistive product and service provision must acknowledge the contextual needs of the communities where they are implemented.Coordination is required for assistive product and service provision at the national and subnational level.Existing and potential gaps in service provision must be addressed when implementing a national assistive products list.

Basic principles for the development of an AI-based tool for assistive technology decision making

INTRODUCTION

The impact of assistive technology use on the lives of people with disabilities has long been demonstrated in the literature. Despite the need for assistive technologies, and a wealth of innovative, afford-able, and accessible products, a low rate of assistive technology uptake is globally maintained. One of the reasons for this gap is related to data and knowledge formation and management. Low access to information and a lack of assessment services is evident. Fragmentation of data, inconsistency in assessment methodology and heterogeneity in the competence of assistive technology professionals, has led to a growing interest in the opportunities that data sciences, including AI, hold for the future of the assistive technology sector, as a supportive and constructive mechanism in any decision-making process.

OBJECTIVES

In this short paper, we seek to describe some of the principles that such an AI-based recommendation system should be built upon, using the Atvisor platform as a case study. Atvisor.ai is an AI-based digital platform that supports assistive technology assessments and the decision-making process.

RECOMMENDATIONS

Our recommendations represent the aggregated insights from two pilots held in Israel, testing the platform in multiple environments and with different stakeholders. These recommendations include ensuring the continuum of care and providing a full user journey, incorporating shared decision making and self-assessment features, providing data personalisation and a holistic approach, building a market network infrastructure and designing the tool within a wider service delivery model design. Assessment and decision-making processes, crucial to optimal uptake, cab be leveraged by technology to become more accessible and personalised.IMPLICATIONS FOR REHABILITATIONProvides principles for the development of an AI-based recommendation system for assistive technology decision making.Promotes the use of artificial intelligence to support users and professionals in the assistive technology decision making process.Personalization of data regarding assistive technology, according to functional, holistic and client centered profiles of users, ensures optimal match and better use of assistive technology.Self-assessment and professional assessment components are important for enabling multiple access points to the assistive technology decision making process, based on the preferences and needs of users.

The right to assistive technology

In this paper, I argue that disabled people have a right to assistive technology (AT), but this right cannot be grounded simply in a broader right to health care or in a more comprehensive view like the capabilities approach to justice. Both of these options are plagued by issues that I refer to as the problem of constriction, where the theory does not justify enough of the AT that disabled people should have access to, and the problem of overextension, where the theory cannot adequately identify an upper limit on the AT that people have a right to. As an alternative to these justificatory frameworks, I argue that disabled people are owed access to AT at the expense of nondisabled people as a matter of compensatory justice. That is, I defend the position that disabled people are owed AT as part of due compensation for the harms they experience from being disadvantaged by society's dominant cooperative scheme and the violation of their right to equality of opportunity that such disadvantage entails. I also propose a method for identifying an upper limit to what this right to AT requires. In this way, I argue that compensatory justice avoids both the problem of constriction and the problem of overextension.

Detecting physical abilities through smartphone sensors: an assistive technology application

PURPOSE

It is important to promote assistive technologies to improve quality of life. The proposed SmartAbility Android Application recommends assistive technologies for people with reduced physical abilities, by focussing on actions that can be performed independently.

MATERIALS AND METHODS

The SmartAbility Application uses Android built-in sensors, e.g., accelerometer and gyroscope and application programming interfaces (APIs) to detect physical abilities, e.g., head movements and blowing and recommend suitable assistive technologies. This is supported by a MySQL database that stores assistive technologies and mappings between abilities. The underpinning research is the SmartAbility Framework that culminates the knowledge obtained during previously feasibility trials and usability evaluations.

RESULTS

The Application was evaluated by pupils (n = 18) at special educational needs schools with physical conditions, including cerebral palsy, autism and Noonan syndrome, and assessed through the NASA Task Load Index (TLX) and System Usability Scale (SUS). Analysis using the Adjective Rating Scale highlighted that the Application achieves "Good Usability".

CONCLUSION

The SmartAbility Application demonstrates that built-in sensors of Android devices and their APIs, can detect actions that users perform, e.g., head movements and speaking. The Application contains a database where assistive technologies are mapped to physical abilities, in order to provide suitable recommendations. It will be disseminated to assistive technology charities and manufacturers and be used by healthcare professionals as part of the rehabilitation process. Future developments of SmartAbility include the creation of a second Application designed specifically to recommend assistive technologies for the education sector, based on users' physical and cognitive abilities.IMPLICATIONS FOR REHABILITATIONAssistive technology is any item, equipment or piece of software designed to increase, maintain or improve the functional capabilities of people with disabilities.SmartAbility should be introduced into rehabilitation to promote awareness of assistive technologies that are suitable for the physical abilities of the user.Our research highlighted that physical abilities can be detected using built-in sensors of Android devices, e.g. accelerometer and gyroscope.Involvement of the intended user community during evaluations is essential to ensure that a smartphone application is suitable for people with reduced physical abilities.Assistive technologies can support the rehabilitation of people with reduced physical abilities by providing increased independence and improved quality of life.

[Gerontology, geriatric medicine and robot research : Look back to the future]

Assistive robotics as a gerontological geriatric field of research so far seem to be perceived more as "recalcitrant". Predominant is a reserved attitude as to whether this should be considered a research topic to be taken seriously. The reliability of research results and the scientific half-life period are questioned as digital technique generations change exceedingly rapidly and also only a few sustainable standards and guidelines are established. In this context there is a danger that essential developments will be missed in gerontology and geriatrics, then the momentum is active right now and can now be shaped. In the scientific gerontology and geriatrics these developments should not be missed out on but must be grasped with pioneering spirit and proactively co-created. This can be achieved by further research endeavors, public activities and the utilization of knowledge from clinical and nursing practice with each having feedback into development and research.

[Robotic assistance in activities of daily living exemplified by food intake]

Carrying out activities of daily living (ADL, also called basic activities) is limited or even no longer possible due to functional limitations and functional losses associated with aging, (chronic) illness and disabilities. Nowadays, there are a variety of assistive technologies/devices and even robotic products. The aim of this article is to give an exemplary overview of the existing products for the basic activity of food intake for people with tetraplegia caused by accidents or neurological disorders, such as multiple sclerosis or amyotrophic lateral sclerosis (ALS). The dissemination and implementation of these products seems to be relatively low in Germany. Inhibiting and promoting factors for the dissemination and utilization are discussed.

The immediate effect of thumb orthoses on upper extremity's movement: A kinematic analysis of five unique devices

BACKGROUND

Thumb orthoses are a standard treatment modality, with substantial evidence to support its usage for multiple conditions affecting the upper extremity. Despite commonly prescribed, little is known about the immediate impact of such devices on the upper extremity, including potential modifications on motor patterns.

RESEARCH QUESTION

We aimed to determine the changes in the upper limb kinematics during the usage of thumb orthotics, comparing differences in orthotic design, length, and fabrication materials.

METHODS

In this cross-sectional study, subjects performed a standardized reaching task and the placing subtest of the Minnesota Manual Dexterity Test (MMDT) while wearing five unique thumb orthoses. Besides the active range of motion of the shoulder, elbow, wrist and hand joints, movement smoothness (Number of Movement Units-NMU), speed, and motion control strategies were analyzed through eight Qualisys Oqus 300 cameras (Qualisys AB, Göteborg, Sweden).

FINDINGS

Ten non-disabled, university students participated in this study. Despite differences in fabrication materials, all orthotics reduced thumb's abduction (13.3° to 4.3°), and metacarpophalangeal flexion (11.5° to 4.2°). Although orthotics impacted movement smoothness and hand function during its usage, forearm-based devices further increased the NMUs and the time required for the MMDT performance (Control: NMU = 4.8, MMDT = 58.1; Long Orthotics: NMU = 6.6, MMDT = 78.2), while short, flexible orthoses provided thumb stabilization without significant impact on upper extremity movement strategies.

SIGNIFICANCE

Although joint stabilization was similar among orthotics fabricated with rigid and flexible materials, the improved hand dexterity observed during the use of flexible devices suggests an advantage of flexible orthotics for enhanced stability and hand function. These results can assist healthcare professionals during the selection and prescription of thumb orthotics, providing information not only on the range of motion but other sensorimotor aspects involved in upper extremity movement patterns that may be affected by orthotics usage.

User-centred design, evaluation, and refinement of a wireless power wheelchair charging system

PURPOSE

To enable power wheelchair users with limited mobility to safely and independently charge their wheelchairs.

METHODS

Stakeholders of multiple roles - including potential users, their caregivers, and clinicians with specifically relevant expertise - were engaged in a user-centred design process. Initial informal interviews, focus groups, online surveys, prototype demonstrations, semi-structured interviews, and expert reviews were utilized to guide development and iteratively evaluate prototypes.

RESULTS

The resulting wireless charging system enables independent charging while also significantly increasing capacity and charging speed. Autonomous positioning and remote control features further address the particular use cases of the target population, and vital features of existing power wheelchairs are retained according to stakeholder input. Pertinent topics emerging from stakeholder input are discussed.

CONCLUSIONS

Careful application of user-centred design principles is essential to the successful development of usable assistive technology devices, particularly for target populations with complex disabilities. The diverse perspectives of all relevant stakeholders must be considered and synthesized to produce a practical and usable solution.Implications for rehabilitationBattery charge is a constant and critical concern for power wheelchair users.Many power wheelchair users cannot independently use and monitor existing chargers.A wireless wheelchair charging system was developed to alleviate this issue.Sustained user engagement is crucial in the effective development of such assistive technology.

Smart home and communication technology for people with disability: a scoping review

PURPOSE

The links between disability, activity limitation and participation restriction are well established. Recent and continued advancement of technology, particularly smart home and communication technologies, presents new ways in which some of the limitations and restrictions experienced by people with disabilities can be overcome. The aim of this scoping review was to explore the impact of smart home and communication technology on the outcomes of people with disabilities and complex needs.

METHOD

This review involved systematic searching of four databases, hand searches and data extraction. Eligibility criteria included [1] participant outcomes of [2] technology used within the home [3] among adults with a disability and complex needs.

RESULTS

Of the 2400 studies identified, 21 met our inclusion criteria. Studies were characterized by significant diversity in relation to disability and type of technology. Overall, technology appeared to improve independence, participation and quality of life among people with a disability and complex needs. Despite this, ethical considerations were raised given the vulnerability of this population, including potential risks through social participation and privacy concerns of using monitoring technology.

CONCLUSIONS

Smart home and communication technology can improve outcomes for people living with disabilities and complex needs. However, a number of factors impact the successful implementation of technology, including personalization, flexibility and ongoing support to the person with a disability and their close others. Future research should utilize high-quality study designs and established measures of important outcomes for this group.IMPLICATIONS FOR REHABILITATIONThere is a broad range of smart home and communication technology devices and systems available that may support the independence and participation of people with disabilities and complex needs; however, high-quality evidence documenting the impact of technology is lacking.Soft-technology supports, including assessment, training and evaluation of technology implementation, may play just as important a role in shaping outcomes as the technology itself.Systematic research is required to ensure there is quality evidence to inform investment in both technologies, and the soft-technology supports that promote its successful use.

Collaborative engagement of Hispanic communities in the planning, conducting, and dissemination of assistive technology research

Introduction

Community engagement (CE) is critical for research on the adoption and use of assistive technology (AT) in many populations living in resource-limited environments. Few studies have described the process that was used for engaging communities in AT research, particularly within low-income communities of older Hispanic with disabilities where limited access, culture, and mistrust must be navigated. We aimed to identify effective practices to enhance CE of low-income Hispanic communities in AT research.

Methods

The community stakeholders included community-based organizations, the community healthcare clinic, the local AT project, and residents of the Caño Martín Peña Community in San Juan, Puerto Rico. The CE procedures and activities during the Planning the Study Phase comprised working group meetings with stakeholders to cocreate the funding proposal for the study and address the reviewers' critiques. During the Conducting the Study Phase, we convened a Community Advisory Board to assist in the implementation of the study. During the Disseminating the Study Results Phase, we developed and implemented plans to disseminate the research results.

Results

We identified seven distinct practices to enhance CE in AT research with Hispanic communities: (1) early and continuous input; (2) building trusting and warm relationships through personal connections; (3) establishing and maintaining presence in the community; (4) power sharing; (5) shared language; (6) ongoing mentorship and support to community members; and (7) adapting to the changing needs of the community.

Conclusion

Greater attention to CE practices may improve the effectiveness and sustainability of AT research with low-income communities.

The value of powered mobility scooters from the perspective of elderly spouses of the users - a qualitative study

PURPOSE

To explore spouses' experiences of the value of mobility scooters prescribed to their partner.

MATERIAL AND METHODS

A descriptive design with a qualitative approach was used. Thirteen spouses (11 females) aged 65-86 years participated. Semi-structured interviews were conducted when the spouse's partner had had the mobility scooter for 4-6 months. The interviews were analysed using qualitative content analysis.

RESULTS

The interviews showed primarily that the spouses experienced that their everyday lives and life situation had improved since their partner had received a mobility scooter. They reported that they could engage in activities of their own choice to a greater extent. The prescription of a mobility scooter to their partner had also yielded a sense of freedom related to shared activities. On the other hand, the spouses described some of the scooter's limitations. Three categories emerged: a sense of freedom related to the spouse's own activities, a sense of freedom related to shared activities and a somewhat restricted freedom.

CONCLUSION

Prescription of a powered mobility scooter was of value to the users' spouses because it facilitated independent and shared activities and participation in the community. The value was mainly expressed as a sense of freedom when doing things on their own or together with their partner. Spouses are key persons in the rehabilitation of people with mobility restrictions. Their views on the assistive device may influence the rehabilitation process. Knowledge of spouses' experiences is thus crucial, as this may influence the future rehabilitation outcome.IMPLICATIONS FOR REHABILITATIONA powered mobility scooter prescribed to one partner eases everyday life and increases activity and participation for the spouse, which in turn may further improve the quality of life for the scooter user.The spouses' perspectives on their partners' mobility scooter use could be helpful in developing the design of the mobility device and in the prescription process.A mobility scooter has an added value by giving a sense of freedom and freedom to choose for the spouse as well as the scooter user.

Usability evaluation of attitude control for a robotic wheelchair for tip mitigation in outdoor environments

Tips and falls are the most prominent causes of wheelchair accidents that occur when driving on uneven terrains and less accessible environments. The Mobility Enhancement Robotic Wheelchair (MEBot) was designed to improve the stability of Electric Powered Wheelchairs (EPW) when driving over these environments. MEBot offers six independently height-adjustable wheels to control attitude of its seat over uneven and angled terrains. Its attitude control application uses an inertial measurement unit to detect seat angles changes to adjust each wheel-height accordingly. MEBot was compared to commercial EPWs in terms of EPW performance (seat angle changes and response time) and participant perception (satisfaction and task-load demand) towards each device. Ten participants drove their own EPW and MEBot for five trials each through driving tasks that replicated outdoor environments. Results showed less change in the pitch angle when driving up and down a 10° slope using MEBot (5.6 ± 1.6°, 6.6 ± 0.5°) compared to the participants' own EPW (14.6 ± 2.6°, 12.1 ± 2.6°). However, MEBot required 7.8 ± 3.0 s to self-adjust to the minimum angle when driving over the tasks. Participants reported no difference in satisfaction and task load demand between EPWs due to similarities in comfort and ease-of-use. Improving the speed and efficiency of MEBot's attitude control application will be addressed in future work based upon participants' feedback.

Virtual keyboard with the prediction of words for children with cerebral palsy

One in every 200 people worldwide cannot express orally because of cognitive, motor, neurological, or emotional problems. Assistive technologies can help people with impairments to use computers to perform their daily life activities independently and to communicate with others. This paper presents a Hidden Markov Model-based word prediction method that allows keyboard emulation software to predict words so that children with disabilities can type texts more quickly. The proposed system involved the development of a keyboard emulator, the construction and processing of a corpus, as well as a word prediction algorithm. Children with different cognitive profiles had to produce a text and type it twice: first with free typing, second using the virtual keyboard's word prediction. Results indicated the word prediction of the keyboard emulator software reduced typing efforts. However, the software initially increased the typing time when the corpus was not well adapted to users. The total amount of clicks with word prediction decreased by around 26.2%. Regarding execution time using prediction, 61% typed the text in less time. The tests performed with literate volunteers indicated a reduction in the number of clicks by up to 51.3%. This result surpasses the 15% achieved in the previous study by Free Virtual Keyboard with word prediction based on pure statistics. Moreover, all volunteers required fewer clicks to perform the task. People with impairments, especially children, could use the system and demonstrate their knowledge and abilities. The entire system is available on the Internet and users have unrestricted and free access to it.

Designing ApplTree: usable scheduling software for people with cognitive impairments

BACKGROUND

Smartphone reminding applications can help overcome memory difficulties experienced by people with acquired brain injury (ABI). Cognitive difficulties with memory and attention make entering reminders into a device, and remembering to set reminders, challenging for this group. ApplTree is a reminding app with features that aim to address challenges. One app feature was push notifications (asking "Do you need to set any reminders?") to support people to initiate use of the app to set reminders. Another app feature was a customisable user interface design to support attention and short term memory during reminder setting.

METHODS

In a mixed-methods user study, five people with self or other reported memory impairment following ABI used ApplTree for at least 4 months. They received push notifications for at least 2 months and no push notifications for at least 2 months. Monthly participant interviews provided insight into user interface preference, app use, and push notification acceptability.

RESULTS

Receiving four Push notifications per day doubled number of daily reminders set and four of the five participants found receiving them to be acceptable. This long-term field study uncovered issues relevant for clinicians and designers, including insights into the potential benefits of different user interface designs, the impact of family members on app use, and the importance of perceived need influencing use and acceptance.

CONCLUSIONS

Feedback provided insight into future considerations when designing reminding apps and using them in neuropsychological rehabilitation. This work highlights the benefit of user-led research into accessible design and use of assistive technologies.IMPLICATIONS FOR REHABILITATION"Unsolicited" push prompts are an easy to implement feature of reminding technology that is useful and acceptable for people with ABI in community rehabilitation.Observations provide insights about how people with ABI make use of reminding apps over time. This can inform those designing apps or providing reminding technology as part of neuropsychological rehabilitation.Participants differed on their preference of the two user-interface designs available in ApplTree. This highlights an area for future research because currently available reminding apps have a broad-shallow design which may not always be appropriate for people with ABI.

Evolving dynamic self-adaptation policies of mHealth systems for long-term monitoring

Tele-rehabilitation can complement traditional rehabilitation therapies by providing valuable information that can help in the evaluation, monitoring, and treatment of patients. Many patient tele-monitoring systems that integrate wearable technology are emerging as an effective tool for the long-term surveillance of rehabilitation progression, enabling continuous sampling of patient real-time movement in a non-invasive way, without affecting the normal daily activity of the outpatient, who, therefore, will not need to make frequent clinic visits. One of the main challenges of tele-rehabilitation systems is to pay special attention to the diversity of dysfunctions in patients by offering devices with customized behaviours adaptable to the physical conditions of each patient at the different stages of the rehabilitation therapy. Long-term monitoring systems need an adaptation policy to autonomously reconfigure their behaviour according to vital signs read during the physical activity of the patient, the remaining battery level, or the required accuracy of collected data. However, it would alsobe desirable to adjust such adaptation policies over time, according to the patient's evolution. This work presents a wearable patient-monitoring system for tele-rehabilitation that is able to dynamically self-configure its internal behaviour to the current context of the outpatient according to a set of adaptation policies that optimize battery consumption, taking into account other QoS parameters at the same time. Our system is also able to self-adapt its internal adaptation policies as a patient's condition improves, while maintaining the system's efficiency. We illustrate our proposal with a real mHealth case study. The results of the experiments show that the system updates the adaptation policies, taking into account specific indicators of the disease. The validation results show that the evolution of the self-adaptation policies correlates with the progression of different patients.

Beginning power mobility: An exploration of factors associated with child use of early power mobility devices and parent device preference

Objectives

Describe and compare young children's use of four early power mobility devices and examine associations between child and environmental factors that may influence power mobility use and parent device preference.

Design

Cross-sectional observational study.

Methods

Power Mobility Days introduced four devices: Wizzybug, Bugzi, Tiger Cub, and a switch-adapted ride-on toy car in a single 60-90 min, play-based session.

Results

A convenience sample of 74 children, aged 9-68 months (mean: 32.45, SD: 14.08) with mobility limitations, and their parents participated. Children had a range of motor, postural and communication profiles, with cerebral palsy being the most common condition (n = 55; 73.33%). Assessment of Learning Powered mobility use phase achieved ranged from 1 to 6; mean: 2.34; median: 2. For children who tried all four devices (n = 51), Friedman test (χ²: 8.27, p = 0.04) suggests Assessment of Learning Powered mobility use phase differs across devices. Of 73 parents who identified a device preference, 43 (59%) chose Wizzybug. Regression analyses suggest that access method and communication function may influence children's power mobility use, while age, access and postural support requirements may influence parent device choice.

Discussion

Parent impressions of an early power mobility device may be influenced by many factors, yet be less influenced by child performance.

Item development, internal consistency, and known-groups validity of the Self-Directed Mobility Scale

Purpose: The aims of the current study include to: (1) describe the item development; and (2) begin the process of establishing the internal consistency and known-groups validity of the Self-Directed Mobility Scale. The purpose of the scale is to assess paediatric physical and occupational therapists' views towards self-directed mobility and their perceived ability and intentions to advocate for children's access to self-directed mobility.Methods: Three individuals with expertise in kinesiology, psychology, paediatric rehabilitation, and disability studies served as the expert panel for item development. Four samples were included to determine internal consistency and known-groups validity: 350 physical therapists, 89 occupational therapists, 279 kinesiology undergraduate students, and 528 health and wellness undergraduate students.Results: The internal consistency was above the acceptable level of 0.70 (range = 0.72-0.77) for all samples when two items regarding promoting other motor skills prior to powered mobility use and the temporary use of a mobility device were removed. Known-groups validity was established between all samples.Conclusions: The Self-Directed Mobility Scale appears to be a valid tool for assessing views of self-directed mobility and mobility advocacy intentions in paediatric physical and occupational therapists, as well as undergraduate students. Future work should examine the internal consistency based on study sample to ensure the (> 0.70) acceptable Cronbach's alpha level is met.Implications for rehabilitationThe Self-Directed Mobility Scale is a viable measurement tool to assess views of self-directed mobility and mobility advocacy intentions of pediatric physical and occupational therapists.In combination with other measures, the Self-Directed Mobility Scale may be used in future rehabilitation research to evaluate factors associated with provision of mobility technology to children with disabilities.

Significant challenges when introducing care robots in Swedish elder care

Introduction: Care robots are machines, operating partly or completely autonomously, that are intended to assist older people and their caregivers. Care robots are seen as one part of the solution to the aging population, allowing fewer professional caregivers to provide the necessary assistance and care. Despite the potential benefits, the dissemination of care robots, and welfare technology in general, is limited in Swedish elder care.Purpose: To explore the challenges of introducing welfare technology, particularly care robots, in elder care.Materials and methods: Twenty-one individual interviews with key actors at the societal level, analysed by thematic analysis.Results: The challenges, from the societal actors' perspectives, were related to; the beliefs in technology, attitudes, ethics, collaboration, and the need for knowledge and skills regarding care robots (individual and group challenges). Challenges of a national character were: national governance, infrastructure, laws and regulations, economics, and procurement (systemic and societal challenges). In addition, the necessary preconditions for successful introduction were revealed as: the utility of the technology, implementation, evaluation and safety, security, and integrity (preconditional challenges).Conclusions: The introduction of care robots in elder care services seems to be more challenging than that of welfare technology in general, given the context and prevailing attitudes and preconceptions about robotics. Significant challenges need to be managed, at all levels of the society, before care robots can become an integral part of daily care and assist older people and their caregivers in activities and rehabilitation.IMPLICATION FOR REHABILITATIONThe challenges described by the societal actors', are partly similar to those of the end users', in terms of attitudes, ethics, knowledge and skills, and collaboration. This consensus should provide a solid foundation for the conceptualization and introduction of care robots in elderly care.The challenges follow the pattern of an ecosystem involving all sections of society, which are intertwined and require consideration before the expected benefits can be realised.A user-centred approach is necessary to support the design, implementation, and usefulness of care robots and their suitability for meeting the real needs of older persons and professional caregivers.

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

Purpose: To review the knowledge base regarding assistive technology (AT) and the education of people with a hearing impairment. Also, evaluating to what extent has the use and/or impact of AT for individuals with a hearing impairment been determined through evidence-based research in post-school education.Materials and method: Literature pertaining to the effect of AT on the educational performance of students with impaired hearing in the post-school sector was examined for the period from 1998 to 2018 (20 years). A total of 477 articles that contained evidence-based research and reports on the effect of AT in practice were located and reviewed.Results: It was found that, of the 20 studies that met all the inclusion criteria, only seven provided promising, evidence-based reports on the impact of assistive hearing technology on educational performance.Conclusion: This review concluded that the limited research speaks to the positive impact of AT on educational outcomes. Additionally, for students with a hearing impairment to be able to receive high-quality AT that will enhance their educational success, more evidence-based research on the efficacy of hearing AT needs to be conducted, especially as newer technologies emerge in this technological era.Implications for rehabilitationThe use of appropriate hearing assistive technology (AT) is a key facilitator within the educational environment and has a positive impact on the educational outcomes for students studying at college or university.This rapid review revealed the need to develop a body of scientifically based research that examines the relationship between academic achievement of participation by deaf learners and the use of AT - this is needed to develop a more comprehensive understanding of the benefits and limitations of educational technologies, especially as newer technologies emerge in this technological era.This study further highlights the need for more concrete research on the effectiveness of hearing-related AT so that the case can be made for students with hearing impairment to receive high quality, appropriate AT that will enhance their educational success.Ultimately, it is hoped that this article elicits the need for much more investigation into this topic to work towards finding solutions that lead to increased participation of deaf learners in the higher education arena, as well as providing evidence-based results to inform future policy and practice.

The effect of tuning ankle foot orthoses-footwear combinations on gait kinematics of children with cerebral palsy: A case series

STUDY DESIGN

Case series.

BACKGROUND

AFOs are a commonly prescribed medical device given to children with cerebral palsy (CP) in an attempt to improve their gait. The current literature is equivocal on the effects AFOs have on the gait of children with CP. The vast majority of AFOs issued are not subject to AFO-FC tuning. There are emerging studies investigating the effects tuning AFO-FCs has on the gait of children with CP. However, the research is limited, and there is a lack of quantitative data.

OBJECTIVE

To compare the kinematics of tuned versus non-tuned gait in children with CP.

METHODS

Gait analysis assessment of five children aged between 7-11 years with a diagnosis of CP (one hemiplegic and four diplegic participants, two female, three male, with a Gross Motor Functional Classification System (GMFCS) of 2) at a Gait Analysis Laboratory.

RESULTS

In comparison to barefoot and non-tuned gait, walking with a tuned AFO-FC produced improvements in several key gait parameters. Including hip flexion and extension, posterior pelvic tilt and knee extension. Results also indicated that the type of gait pattern demonstrated by the participant affected the outcomes of tuning.

CONCLUSIONS

Tuning the AFO-FC of children with CP has the potential to improve hip function, pelvic function, knee extension in stance phase and knee flexion during swing phase and that a non-tuned AFO-FC can potentially decrease hip function, posterior pelvic tilt and increase knee extension.

CLINICAL RELEVANCE

Whilst AFO-FC tuning has been recommended for routine clinical practice, there still remains a paucity of research on the kinematic effects of using a tuned AFO-FC compared to a non-tuned. This paper provides a comparison of kinematics on children with CP, during barefoot, non-tuned and tuned AFO-FC walking with a view to inform clinical practice.

Adaptive Eating Device: Performance and Satisfaction of a Person with Parkinson's Disease

BACKGROUND.

Individuals with Parkinson's disease (PD) can experience motor impairments related to their hand-use that restrict participation in daily activities. Feeding is one activity impacted by this health condition. The use of adapted utensils can improve performance and independence in this activity.

PURPOSE.

To investigate if a locally designed and made eating-adaptive device helps a person with PD to improve their feeding performance.

METHOD.

Single-case ABC-type experimental design. Performance and satisfaction of a 60-year-old man with PD were assessed during feeding tasks in 70 sequential days in three phases. Celeration Line, Two-Standard Deviation Band, and Visual Analysis were the methods used for data analysis.

FINDINGS.

Performance and satisfaction increased significantly after the introduction of the adaptive eating device. The addition of weight also contributed to the increase in the participant's performance.

IMPLICATIONS.

Adaptive eating device with low production costs and possibility of customized adjustments improves performance of people with PD.

Expounding the rehabilitation service for acquired visual impairment contingent on assistive technology acceptance

PURPOSE

Globally, approximately 285 million people have visual impairments, with over 39 million people having full blindness. Beginning in the late nineteenth century, assistive devices such as service dogs, braille reading devices, and white canes have aided those with visual impairments. From the immense development of technology over the past two decades, traditional assistive devices have been supplemented with more technologically innovative assistive technologies. Despite this technological growth, many people with visual impairments have chosen to forgo the use of assistive technologies and continue to use traditional assistive devices instead.

MATERIALS AND METHODS

We have devised a series of surveys and questionnaires to study the views of those with visual impairments towards assistive technologies. Our survey was given to 568 visually impaired people in Taiwan both in person and electronically; the data was cross-referenced with the demographic information of the surveyors to find the disparities in user-preferences amongst different levels of visual impairment, age, household income, and other demographic factors.

RESULTS

Results drawn from the data concluded that while there was a large variation in whether or not participants used assistive technology, those that did indicated that assistive technologies were purchased to help them live life more independently.

CONCLUSIONS

While assistive technology provides a beacon of hope for the visually impaired to live more independent lives, the data indicated that many visually impaired people were not aware of the new assistive technologies and devices that have been entering the market; furthermore, many visually impaired people are of lower income, and therefore cannot afford the technology.Implications for rehabilitationDetermining differences between congenital and acquired visual impairments, and comparing how the two types of visually impaired users have preferences over the assistive technology and devices that they utilise.Experience of life without visual impairment disincentivizes visually impaired people from purchasing new assistive technologies, whereas the appeal of an independent lifestyle incentivizes it.The visually impaired tend to purchase assistive technologies to operate rehabilitation more effectively, and the use of assistive technology and assistive devices, respectively, encourage future participation in rehabilitation.Marketability and cost of assistive technologies are the largest deterrents from visually impaired users from buying new technologies.

Incidental bilateral calcaneal fractures following overground walking with a wearable robotic exoskeleton in a wheelchair user with a chronic spinal cord injury: is zero risk possible?

Many individuals with spinal cord injury (SCI) rely on wheelchairs as their primary mode of locomotion leading to reduced weight-bearing on the lower extremities, which contributes to severe bone loss and increased risk of fragility fractures. Engaging in a walking program may reverse this vicious cycle, as this promotes lower extremity weight-bearing and mobility, which may reduce bone loss and fragility fracture risk. However, fragility fracture risk associated with the use of wearable robotic exoskeletons (WREs) in individuals with SCI needs consideration. A 35-year-old man with chronic complete sensorimotor SCI (neurological level = T₆) and low initial bone mineral density enrolled in a 6- to 8-week WRE-assisted walking program after successfully completing an initial clinical screening process and two familiarization sessions with the WRE. However, after the first training session with the WRE, he developed bilateral localized ankle edema. Training was suspended, and a CT-scan revealed bilateral calcaneal fractures, which healed with conservative treatment over a 12-week period. Opportunities for improving clinical screening and WRE design are explored. The relevance of developing clinical practice guidelines for safe initiation and progression of intensity during WRE-assisted walking programs is highlighted. This case of bilateral calcaneal fractures illustrates that aiming for "zero risk" during WRE-assisted walking programs may not be realistic. Although WREs are a relatively new technology, current evidence confirms their potential to greatly improve health and quality of life in individuals with chronic SCI. Hence, ensuring their safe use remains a key priority.

Access to assistive technology (AT) information in Spanish on state and territory program websites: United States, 2018

BACKGROUND

Compared to non-Hispanic white individuals, assistive technology (AT) utilization is lower among Hispanic individuals.^1-7 In the US, Spanish is the 2nd most frequently spoken language. Greater than one-fifth of Spanish-speaking households are limited English proficiencty (LEP) households (i.e., all individuals over age 14 in the household speak English less than "very well").⁸ Availability of AT materials in Spanish is one factor influencing knowledge about and utilization of AT among Spanish-speakers.

OBJECTIVE

To examine the availability of Spanish-language AT information on state AT program websites and to assess the relationship between availability and state demographic and linguistic characteristics.

METHODS

In 2018, we evaluated 56 state and territory AT program websites for the availability of AT information in Spanish. We calculated 4 measures (US Hispanic population in the state/territory; Hispanic individuals as a proportion of state population; overall Spanish-speaking households, and Spanish-speaking, limited English proficient households) from the 2016 American Community Survey and created ranked lists for each measure. Point biserial (r_pb) correlations were calculated to test associations between each measure and availability of AT information in Spanish on each program's website.

RESULTS

Sixteen program websites (15 states, 1 territory) provided access to Spanish-language AT information. None of the 4 measures were strongly associated with this outcome (r_pb ranged from 0.30 to 0.42). For any of the 4 measures, no more than half of states in the top 10 ranks offered online access to AT information in Spanish.

CONCLUSIONS

Improving the online availability of AT information in Spanish is necessary to increase equity in AT utilization among Spanish-speaking people with disabilities.