Inclusive education: The case for early identification and early intervention in assistive technology

Physiotherapy-assisted overground exoskeleton use: mixed methods feasibility study protocol quantifying the user experience, as well as functional, neural, and muscular outcomes in children with mobility impairments

Background

Early phase research suggests that physiotherapy paired with use of robotic walking aids provides a novel opportunity for children with severe mobility challenges to experience active walking. The Trexo Plus is a pediatric lower limb exoskeleton mounted on a wheeled walker frame, and is adjustable to fit a child's positional and gait requirements. It guides and powers the child's leg movements in a way that is individualized to their movement potential and upright support needs, and can provide progressive challenges for walking within a physiotherapy-based motor learning treatment paradigm.

Methods

This protocol outlines a single group mixed-methods study that assesses the feasibility of physiotherapy-assisted overground Trexo use in school and outpatient settings during a 6-week physiotherapy block. Children ages 3-6 years (n = 10; cerebral palsy or related disorder, Gross Motor Function Classification System level IV) will be recruited by circle of care invitations to participate. Study indicators/outcomes will focus on evaluation of: (i) clinical feasibility, safety, and acceptability of intervention; (ii) pre-post intervention motor/functional outcomes; (iii) pre-post intervention brain structure characterization and resting state brain connectivity; (iv) muscle activity characterization during Trexo-assisted gait and natural assisted gait; (v) heart rate during Trexo-assisted gait and natural assisted gait; and (vi) user experience and perceptions of physiotherapists, children, and parents.

Discussion

This will be the first study to investigate feasibility indicators, outcomes, and experiences of Trexo-based physiotherapy in a school and outpatient context with children who have mobility challenges. It will explore the possibility of experience-dependent neuroplasticity in the context of gait rehabilitation, as well as associated functional and muscular outcomes. Finally, the study will address important questions about clinical utility and future adoption of the device from the physiotherapists' perspective, comfort and engagement from the children's perspective, and the impressions of parents about the value of introducing this technology as an early intervention.

Clinical trial registration

https://clinicaltrials.gov, identifier NCT05463211.

Implementation of information and communication technology to facilitate participation in high school occupations for students with neurodevelopmental disorders

PURPOSE

Information and communication technology (ICT) has been proposed to enable an inclusive learning environment and increased participation for students with special educational needs. The aim of this study was to investigate the perceived need for ICT before and after an individualized ICT intervention among high school students with neurodevelopmental disorders and describe how the ICT was used to improve participation in school activities.

MATERIALS AND METHODS

This mixed-method study, with a one-group pre- and post-test design, included 99 high school students with neurodevelopmental disorders. Data from questionnaires and assessments using the School Setting Interview (SSI) were analyzed using descriptive statistics and the Wilcoxon signed-rank test. Deductive content analysis was performed on written notes in the SSI assessment.

RESULTS

The results showed that students' median number of perceived needs for ICT in school activities had decreased from six needs at baseline to one need at follow-up (t16.5 df(98), p<.001). There were five SSI items for which over 50% of the students perceived a need for ICT, with most students (95%) needing support in the item Remember things. Students received a laptop, tablet or smartphone (95%), software for planning or structure (84%) and ICT for writing and reading (66%). The ICT facilitated participation in multiple school activities, providing reminders and structure, facilitating notetaking and improving spelling. After the ICT intervention, students (61%) experienced improved study results and improved ability to manage difficult school situations (68%).

CONCLUSION

To conclude, an individualized ICT intervention as support to increase school participation is promising among high school students with neurodevelopmental disorders.