“It Gives Me My Freedom”: Technology and Responding to Bodily Limitations in Motor Neuron Disease

Wheelchair-mounted robotic arms: a survey of occupational therapists' practices and perspectives

PURPOSE

Despite the benefits of wheelchair-mounted robotic arms (WMRAs), occupational therapists are not yet widely involved in the recommendation or implementation of these assistive devices. The purpose of this study was to investigate and compare the current practices and perspectives of occupational therapists who had and had not recommended a WMRA on the recommendation, training, and implementation of WMRAs.

METHODS

This was a descriptive cross-sectional study. An online survey was sent to Canadian, European, and American occupational therapists who had or had not worked with WMRAs. Respondents were asked close-ended questions about their experience, role, barriers, motivations, and future needs regarding WMRAs. We compared results between respondents who had and had not recommended WMRAs using descriptive statistics.

RESULTS

Ninety-three North American and European occupational therapists completed the survey. Of those, 29 (31.2%) had recommended a WMRA, mostly the JACO robotic arm (n = 26, 89.7%) in rehabilitation centres (n = 18, 62.1%). Their perspectives on their role and barriers related to WMRAs were similar to those who had never recommended a WMRA. All respondents recognised the relevance of occupational therapists' contribution, and most reported interest in WMRAs (n = 76, 81.7%). However, many barriers emerged, mainly related to limited funding (n = 49, 76.6%), lack of training and knowledge (n = 38, 59.4%), and resource constraints (n = 37, 54.4%). Future needs identified matched these barriers.

CONCLUSION

This survey provides novel insight into occupational therapists' perspectives on WMRAs. It highlights that health professionals need to have easier access to funding, formal training, and resources to support their involvement with WMRAs.Implications for rehabilitationMost occupational therapists are interested in working with WMRAs, considering the potential of these devices to support individuals with upper extremity impairments in their daily activities. They also recognise their unique contribution to the assessment, recommendation, and implementation process among multidisciplinary teams.WMRA recommendation is relevant in various clinical settings and with a wide range of client populations. Nevertheless, it appears that occupational therapists working with adults, in rehabilitation centres or specialised clinics, may have more opportunities to get involved in this process and to attend formal training on this technology, as compared to other settings.Many barriers remain, impeding occupational therapists' role in the recommendation and implementation of WMRAs. Addressing these barriers may increase the number of devices that are successfully adopted and utilised by individuals with upper extremity impairments. In particular, future research and health policies should focus on access to sufficient funding, formal training, and resources for occupational therapists relative to their role in recommending and implementing WMRAs.

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.

Perceptions and experiences of control among people living with motor neurone disease: a systematic review and thematic synthesis

PURPOSE

Current research suggests that feeling a lack of control is common among people living with Motor Neurone Disease (plwMND). This systematic review explores and synthesises evidence about: (1) What factors contribute towards perceptions of control in plwMND (2) How do plwMND attempt to maintain control in their daily lives?

METHODS

A systematic search from inception to January 2022 for peer-reviewed journal articles in English reporting qualitative and mixed-method primary studies or reviews of plwMND's perceptions or experiences of control was conducted on CINAHL, MEDLINE, PsycINFO, ASSIA, Embase and AMED. Eligible articles underwent quality appraisal, data extraction and a thematic synthesis was carried out.

RESULTS

Twenty publications, 19 primary studies and one review, from nine countries, reporting the views of 578 participants aged from 20 to 90 years were included. Two key analytical themes were identified (1) diagnosis can lead to a disruption of previously held control beliefs (2) plwMND use a range of control strategies to attempt to retain control in their lives.

CONCLUSION

This is the first systematic review and qualitative evidence synthesis to reveal the strategies plwMND use to regain control and that control beliefs about health, fate, identity and bodily control are significantly altered by the diagnosis. Implications for rehabilitationOutcome measures for plwMND should consider personal values and preferences as well as objective clinical measurements.plwMND use a range of control strategies which may alter and change over time therefore healthcare professionals may also need to review and adapt treatment decisions over time.The differing viewpoints of healthcare professionals and plwMND should be considered in clinical situations to reduce the potential for conflict.

Emotional distress and well-being among people with motor neurone disease (MND) and their family caregivers: a qualitative interview study

OBJECTIVE

We aimed to get an in-depth understanding of the emotions experienced by people with motor neurone disease (MND) and their caregivers, and to explore what impacts emotional distress and well-being.

DESIGN

Qualitative study using semi-structured interviews with people with MND and caregivers.

SETTING

Participants were recruited from across the UK and took part in interviews conducted either face to face, by telephone or email to accommodate for varying levels of disability.

PARTICIPANTS

25 people with MND and 10 caregivers took part. Participants were purposively sampled based on their MND diagnosis, symptoms and time since diagnosis.

DATA ANALYSIS

Data were analysed using inductive reflexive thematic analysis.

RESULTS

Eight broad themes were generated (20 subthemes). Participants described the emotional distress of losing physical function and having a threatened future because of poor prognosis. Keeping up with constant changes in symptoms and feeling unsupported by the healthcare system added to emotional distress. Finding hope and positivity, exerting some control, being kinder to oneself and experiencing support from others were helpful strategies for emotional well-being.

CONCLUSION

The study provides a broad understanding of what impacts emotional distress and well-being and discusses implications for psychological interventions for people with MND and caregivers. Any communication and support provided for people with MND and their caregivers, needs to pay attention to concepts of hope, control and compassion.

Variation in assistive technology use in Motor Neuron Disease according to clinical phenotypes and ALS Functional Rating Scale - Revised Score: A prospective observational study

BACKGROUND

Assistive devices enhance independence and quality of life for people living with motor neuron disease (MND), but prescription can be challenging.

OBJECTIVE

Improved prescription of assistive devices, through improved understanding of the relationship between clinical phenotypes, Amyotrophic Lateral Sclerosis Functional Rating Scale - Revised (ALSFRS-R) functional domain sub-scores and assistive technology required by people living with MND.

METHODS

Prospective, observational consecutive-sample study of 269 patients with MND diagnosis.

MAIN OUTCOME MEASURES

MND phenotype, ALSFRS-R scores and assistive technology devices in use.

RESULTS

A statistically significant difference in total concurrent assistive technology item use was found between phenotypes (p = 0.001), with those with ALS Bulbar onset using the least. There was also a statistically significant difference in assistive technology usage in five of seven assistive technology categories across the clinical phenotypes, namely orthoses (p < 0.000), mobility devices (p < 0.000), transfer devices (p < 0.000), communication devices (p < 0.000), and activities of daily living devices (p = 0.016). Correlations between ALSFRS-R sub-score items and assistive technology count confirmed the utility of this outcome measure for equipment prescription.

CONCLUSIONS

Clinicians need to consider MND phenotype and/or ALSFRS-R domain sub-score in clinical decision-making regarding assistive technology, as this will determine the pattern of disease and its progression, and hence assistive technology required.

Impacts of robotic arm use on individuals with upper extremity disabilities: A scoping review

BACKGROUND.

Robotic arms may help users perform various activities. Even though robotic arms are commercially available, their impacts are still poorly understood.

PURPOSE.

This scoping review aimed to identify the potential impacts of using robotic arms for individuals with upper-extremity disabilities and appraise the scientific quality of the selected studies.

METHOD.

A search for studies published between 1970 and 2016 was conducted in PubMed, Embase, Compendex, and Scopus. The Canadian Model of Occupational Performance and Engagement was used to classify activities in which impacts were evaluated. The quality of each study was rated using McMaster University's critical review form for quantitative studies.

FINDINGS.

Thirty-six studies were reviewed, which evaluated self-care (21), productivity (33), and leisure (8). The short-term impacts were more commonly documented than long-term impacts. The impacts identified were mostly positive. The studies' mean quality score was 8.8/15.

IMPLICATIONS.

Additional studies with more rigorous conditions are needed to produce higher-quality scientific evidence of the long-term impacts of robotic arm use.

Long-term use of the JACO robotic arm: a case series

PURPOSE

Past research with JACO has principally focused on the short-term impacts on new users. Therefore, this study aims to document the long-term impacts of this assistive device on users and their family caregivers following prolonged use.

METHODS

Users' characteristics, caregivers' characteristics and expenses related to JACO were documented with questionnaires designed for this study. Upper extremity performance was measured with an adaptation of an upper extremity performance test, the TEMPA, and accomplishment of life habits was documented in an interview based on the LIFE-H questionnaire. Satisfaction with JACO and psychosocial impacts of its use were measured with validated questionnaires, namely the QUEST and the PIADS-10. Impacts of JACO on family caregivers were documented with a validated questionnaire, the CATOM. Descriptive statistics were used to report the results.

RESULTS

Seven users and five caregivers were recruited. One user had expenses related to JACO in the past two months. Users had a better upper extremity performance with JACO than without it and they used their robotic arm to accomplish certain life habits. Most users were satisfied with JACO and the psychosocial impacts were positive. Impacts on family caregivers were slight.

CONCLUSIONS

JACO increased performance in manipulation and facilitated the accomplishment of certain life habits. Users' increased participation in their life habits may slightly decrease the amount of caregiver assistance required. Future studies are needed to clarify its economic potential, its impact on caregivers' burden, including paid caregivers, and the variability in the tasks performed using JACO. Implications for Rehabilitation The use of JACO may have positive impacts on its users in terms of upper extremity performance, accomplishment of life habits, satisfaction with the device and psychosocial impacts. More research is needed to quantify more accurately the economic potential of the long-term use of JACO, to explore the factors related to the variability in the tasks performed using JACO, and to clarify the impact of JACO on caregivers' burden, including paid caregivers.