Need and use of assistive devices for personal mobility by individuals with spinal cord injury

Provision and use of assistive products in patients after stroke and spinal cord injury in Germany: a qualitative interview study

PURPOSE

Mobility impairments are a common consequence of stroke and spinal cord injury (SCI). Assistive products (APs) such as wheelchairs are often needed for activities and participation. The aim of the study was to explore the provision and use of APs in Germany and to identify associated factors underlying this practice.

MATERIALS AND METHODS

Semi-structured interviews were conducted with 19 professionals from outpatient neurorehabilitation services (three general practitioners, five physical therapists, five occupational therapists, one speech therapist, one neuropsychologist, two outpatient nurses, one rehab technician and one social worker), two patient advocates (long-term survivors, each stroke and SCI) and 20 patients (10 each after stroke and SCI with mobility impairment, and first-ever affected). Analysis was performed by qualitative content analysis.

RESULTS

Reported experiences were mixed, varying from high satisfaction to unusable APs and unmet needs. Identified factors associated with these experiences were related to care pathways, care coordination, inter-professional collaboration, professionals' knowledge and patient information, cost coverage, and approval procedures.

CONCLUSION

Overall, patients seem satisfied with the APs they receive, but patients with more severe mobility impairments in particular experience deficits in the provision and use of APs. Further research is needed to develop and test strategies for the provision and use of APs.

A semi-structured interview to capture manual wheelchair use for mobility activities among individuals with spinal cord injury in real-life situations: development and content validity of the Wheelchair Mobility Activity Log (WC-MAL)

STUDY DESIGN

Mixed-method approach.

OBJECTIVES

To develop and assess the content validity of a semi-structured interview that captures the lived experience of using a manual wheelchair among individuals with SCI in the real world, the Wheelchair Mobility Activity Log (WC-MAL).

SETTING

SCIR-Group (UDESC)/Brazil.

METHODS

Developing the WC-MAL comprised five steps: (1) defining the construct-based on the International Classification of Functioning, Disability and Health (ICF); (2) identifying relevant activities from other assessment instruments and interviews with the end-users (14 Individuals with SCI and 13 rehabilitation professionals); (3) Selecting the items - activities were linked to ICF codes and grouped into sets; (4) developing the scoring scales based on interviews with the end-users; and, (5) evaluating content validity in accordance with the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). The content validity ratio (CVR) for each item and scale and the overall instrument content validity index (CVI) were calculated.

RESULTS

From an initial draft of 295 activities identified, a set of 222 activities was linked to the ICF domain of "Mobility (d4)" and further refined to generate the 23 items in the WC-MAL. Three scales were developed to assess Frequency (how often), Performance (how well), and Assistance (assistance needed) levels. The items and scales showed a CVR superior to the critical value established (≥0.64). The general CVI value was 0.96.

CONCLUSION

The WC-MAL is a promising clinical instrument with adequate content validity to assess the spontaneous use of the manual wheelchair in the real world among individuals with SCI.

Assistive technology needs, access and coverage, and related barriers and facilitators in the WHO European region: a scoping review

PURPOSE

Globally, assistive technology (AT) is used by over 1 billion people, but the prevalence of needs and access to AT in specific countries or regions is largely unknown. This scoping review summarises the evidence available on the prevalence of needs, access and coverage of AT in the World Health Organisation European Region and the barriers and facilitators to its use.

METHODS

Relevant publications were identified using a combination of two strategies: 1) a systematic search for AT publications in five scientific literature databases; and 2) consultations with 76 of the Region's AT experts.

RESULT

The search strategies yielded 103 publications, 62 of them identified by the systematic search. The included publications were predominantly from six countries, and 18 countries were unrepresented. Information on AT use for specific functional impairments was present in 57 publications: AT for hearing impairment in 14 publications; vision in 12; mobility, 12; communication, 11; self-care, 6; and cognition, 2. AT needs for vision and hearing impairment were more likely to be met (1-87% and 5-90%, respectively) compared with communication and cognition impairments (10-60% and 58%, respectively). The barriers and facilitators to AT access described were linked to accessibility, affordability and acceptability.

CONCLUSION

Data on AT prevalence and coverage are limited in both quantity and quality. Agreed-upon definitions of functional impairment and assistive product categories and standards for data collection are needed to facilitate data comparisons and to build a more representative picture of AT needs and coverage.Implications for rehabilitationComprehensive and disaggregated data concerning the prevalence of needs and coverage of AT is needed to enable the development of responsive policies and actions.The literature available on the prevalence of needs and coverage of AT in the WHO European Region is primarily focussed on a small subset of countries and comparisons between studies are limited due to the use of different data collection strategies.Evidence concerning barriers and facilitators to AT access across countries is more consistent and can be organised across the key themes of accessibility, affordability and acceptability of AT.There is a need for consensus among multiple AT actors on standardised definitions for functional impairment and assistive product categories and standards for data collection to enable a more representative picture to be built of AT needs and coverage across the WHO European Region and globally.

Association Between the Availability of Mobility Assistive Products and Participation Outcomes in Individuals With Spinal Cord Injury in Switzerland

Objectives

This study investigated the association between the reported availability of mobility assistive products and the perceived frequency, restriction, and satisfaction of participation in individuals with spinal cord injury in Switzerland.

Methods

This study was based on a cross-sectional analysis based on questionnaire data collected from the Swiss SCI Cohort Study community survey in 2012 (N = 492). The availability of 12 mobility assistive products were analyzed as the main predictor variable. The outcomes of interest were the frequency, restriction, and satisfaction of participation scales as measured by the 32-item Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P). The association between availability of mobility assistive products and participation was investigated using linear regressions analyses. All mobility assistive products were ranked in terms of relevance to improve participation by means of an importance performance plot.

Results

The availability of a sports wheelchair or a hand bike were both significant in reducing the restriction to participation. Having an adapted car increased the frequency of participation.

Conclusion

The availability of a sports wheelchair or a hand bike was significantly associated with less restriction in participation. With an unmet need of up to 36%, the known health benefits of regular physical activity and thereby cost-saving potential for the health care system, external support in the acquiring or use of these sports-related mobility assistive products could be an easy target for intervention.

Perceived impact of the COVID-19 pandemic among people with spinal cord injury: A descriptive study

Objective

To describe the self-reported impact of the COVID-19 pandemic on the lives of persons with spinal cord injury (SCI).

Design

Cross sectional study.

Participants

There were a total of 382 adult participants with traumatic SCI of at least one-year duration, all of whom were identified through a state-based surveillance registry in the Southeastern United States. The majority of participants were male (68.4%) and 72% were ambulatory. The average age at the time of the study was 57.7.

Main Outcome Measures

Participants completed a self-report assessment (SRA) online or by mail on the impact of COVID-19 on quality-of-life, ability to get daily necessities, and access to healthcare.

Results

Over half of the participants (58.9%) reported a negative impact of the pandemic in at least one of five life areas, with community participation being the primary area affected (51.4%). A small portion of individuals had trouble obtaining necessities, with approximately 12% reporting difficulties getting enough or quality food and 8.2% reporting difficulty getting prescription medications. However, 25% reported delaying healthcare procedures because of fear of catching COVID-19. Among those requiring personal assistance, 32% reported a decrease in quality of care and 51.9% relied more on family to assist with their care.

Conclusions

The COVID-19 pandemic had multiple negative impacts. Of particular importance were reduced access to healthcare and declines in quality and stability of attendant care, with greater reliance on family. Fear of contracting COVID-19 when accessing routine medical procedures needs to be addressed in future outbreaks.

[Identification and Prioritization of Research Questions on Paraplegia Caused by Traumatic Spinal Cord Injury with Those Affected, Their Relatives and Health Care Professionals]

BACKGROUND

Objective With expertise based on experience, paraplegics, their relatives and health care professionals can contribute to the development of research questions relevant for those affected and those in health care practice. For this purpose, the James Lind Alliance (JLA) has provided a methodological approach. The aim of this study was to develop a research agenda for paraplegia resulting from traumatic spinal cord injury with an adapted JLA approach.

METHODS

Four consecutive online surveys of people with paraplegia caused by traumatic spinal cord injury, their relatives and caregivers were conducted. In the first survey, the respondents freely formulated research questions unanswered from their point of view. These were synthesized and checked to see if they can already be answered by available evidence. The unresolved questions were prioritized stepwise in the subsequent surveys. In the second survey, the relevance of questions was rated on a five-point rating scale (1-5). Questions with a mean value of 4 or higher were taken up in the third survey, in which the 10 most relevant questions were determined. These were ranked in the fourth survey as a top-10 list.

RESULTS

Based on the first survey (n=52), 38 unresolved research questions were identified. Of these, 26 questions were rated as important (2nd survey; n=53), from which 10 questions were selected (3rd survey; n=17) and ranked (4th survey; n=12) as a top-10 list. Four prioritized questions related to treatment of spinal cord injury or associated health issues, three to aspects of the health care system with regard to assistive devices and the implementation of new therapies, two to possibilities of those affected to improve their own situation, and one to research on the course of disease.

CONCLUSIONS

Nine priorities focus on research that could help improve the life and health care situation of paraplegic patients and one on curative treatment. The prioritized questions should be taken up by researchers and research funders for the benefit of patients and to help health care providers. For some priorities, a need for research was consistently identified in present guidelines or systematic reviews.

Comparison of anterior and posterior wheeled walkers based on body weight support in improving gait function a subjects with spinal cord injury: A case study

The majority of people with muscle weakness or paralysis lose their ability to walk and require various assistive devices like a walker to walk. Although various studies have examined the effect of different types of anterior and posterior walkers on different walking variables, so far no studies compare anterior versus posterior walker on forces and torques applied to the lower extremities. This paper presents a novel approach of using a passive saddle-assistive device (S-AD) to investigate the effect of this device on the torques of the joints. To measure the effectiveness of the device, a volunteer with spinal cord injury (SCI) participated to walk in four modes; including the use of a standard walker, anterior, and posterior mobility S-AD with and without body weight support, in the gait laboratory. The forces and torques applied to the lower and upper limbs were measured and examined. The result demonstrated a reduction in the vertical force on the lower limb in the anterior S-AD in supporting the patient’s weight compared to the standard walker up to 42.8% and to the posterior S-AD with weight support up to 12%. According to the results, the anterior S-AD has a greater effect compared to posterior S-AD and standard walkers on lower and upper limb torque and forces during walking of a SCI patient while using knee ankle-foot orthoses.

Machine-Learning-Aided Self-Powered Assistive Physical Therapy Devices

An expanding elderly population and people with disabilities pose considerable challenges to the current healthcare system. As a practical technology that integrates systems and services, assistive physical therapy devices are essential to maintain or to improve an individual's functioning and independence, thus promoting their well-being. Given technological advancements, core components of self-powered sensors and optimized machine-learning algorithms will play innovative roles in providing assistive services for unmet global needs. In this Perspective, we provide an overview of the latest developments in machine-learning-aided assistive physical therapy devices based on emerging self-powered sensing systems and a discussion of the challenges and opportunities in this field.

[Patient-centered approach using COPM, GAS scores in medical rehabilitation of patients with tetraplegia after spinal cord injury]

OBJECTIVE

To study the efficacy of the patient- and task-oriented approach and specific therapeutic exercises (TE) for the arms in patients after spinal cord injury at the cervical level.

MATERIAL AND METHODS

The study included 119 patients with a history of spinal injury of more than one year. They were divided into three demographically comparable groups. Group 1 patients (control) received standard of care: TE, physiotherapeutic treatment, social adaptation (SA), and massage; Group 2-standard of care and specific TE for the arms as part of the SA; Group 3-the same as Group 2 combined with the patient- and task-oriented approach (patient-selected activities were trained). Outcomes were assessed at the beginning (T₁), end (T₂), and at 1 year (T₃) after a 30-day medical rehabilitation course.

RESULTS

No statistically significant differences between the groups in demographic, neurological (ISCSCI score), motor (FIMm, VLT scores), psychological parameters (depression, anxiety), quality of life (WHOQOL-BREF score) before the medical rehabilitation (T₁) were observed. At the end of the medical rehabilitation course (T₂), the increase in functional scores was 6.0±5.4 points of FIMm score, 6.0±4.6 points of VLT score in group 1; 8.0±7.6 points of FIMm score, 7.0±7.1 points of VLT score in group 2; 9.0±6.9 points of FIMm score, 8.0±7.6 points of VLT in group 3. Significant differences were found between groups 1 and 2 and 3 on the domains of «finger I» (13.6±9.64 points vs. 15.2±9.40 and 15.3±9.21 points respectively), «fingers II-V» (9.4±6.76 points vs. 11.3±6.41 and 11.6±6.76 points respectively) of VLT score; between groups 3 and 1 on the domains «self-care» (25.9±9.67 points vs. 23.1±9.8 points), «transfer» (11.7±6.21 points vs. 10.6±6.1 points) of the FIMm score, and also the group 3 patients had a higher quality of life by 3.0±1.8 points. At delayed follow-up (T₃-T₂), no changes of the FIMm and VLT scores were detected within groups. In group 3, 69% of problems were identified in self-care (COPM); subjective assessment of functional improvement for COPM (T₂-T₁) was as follows: «performance» 4.7±1.27 points, «satisfaction» 3.8±1.63 points; for GAS the T-score at the end of rehabilitation was 1.3±0.55 points, and the greatest significance of change was noted for COPM under «performance» (ES=0.73), with the correlation coefficient between FIMm and COPM being 0.55 and 0.63 for «performance» and «satisfaction» domains, respectively.

CONCLUSION

Patient- and task-oriented approach implemented by using COPM questionnaire and GAS score together with specific TE for arms is an effective method of motor medical rehabilitation of patients with posttraumatic cervical tetraplegia. This approach improves their quality of life, while parameters of subjective scores (COPM, GAS) have the same sensitivity in comparison with the conventional motor scores (FIMm, VLT).

A perspective on adverse health outcomes after breast cancer treatment in women with spinal cord injury

Aging women face increased risks of both breast cancer and spinal cord injury (SCI). Unique treatment challenges for this population warrant consideration. Despite advances in breast cancer treatments, significant adverse health outcomes continue to occur. Cancer treatments can be detrimental to the quality of life of able-bodied women, but more so for women living with pre-existing SCI. The goal of this Perspective Paper is to inform rehabilitation professionals about the needs of women with SCI treated for breast cancer. Specific objectives were: (1) give an overview of breast cancer treatment-related adverse outcomes that need special attention in women with SCI; and (2) inspire researchers to study the consequences of breast cancer-related health conditions in women with SCI. We identified SCI-specific considerations for undergoing breast cancer surgery, chemotherapy, radiation and endocrine therapy. This paper attempts to raise awareness regarding these issues due to the lack of research attention they have received.

"Unknown world of wheelchairs" A mixed methods study exploring experiences of wheelchair and seating assistive technology provision for people with spinal cord injury in an Irish context

AIM

This study explores people living with spinal cord injury (SCI) experiences and perspectives of wheelchair and seating assistive technology service provision within an Irish context. There are few studies that examine the process of wheelchair and seating provision and the connection between satisfaction, performance, and participation.

METHOD

This mixed methods study explores participant experiences in two parts. Part one presents a thematic analysis of eight in-depth semi-structured interviews with wheelchair service users living with SCI. Part two presents the results content and frequency analysis of an on-line survey of wheelchair service user's experience and satisfaction with wheelchair and seating service provision from respondents with SCI (n = 117) taken from a larger national survey from respondents with various diagnoses (n = 273).

RESULTS

Findings from the interviews and survey revealed the meaning of wheelchair and seating assistive technology provision as essential to life following SCI. Barriers within the provision system such as wait times and funding were found to impede people's rights and freedom from initial assessment through to follow up, maintenance and repair.

CONCLUSIONS

The current implementation of wheelchair and seating assistive technology provision as described in this paper impacts the ability of individuals living with an SCI to participate as equal members of society. A review of wheelchair provision is essential to optimize access to services for appropriate wheelchairs.IMPLICATIONS FOR REHABILITATIONAs a basic human right, appropriate wheelchair and seating assistive technology provision facilitates people's optimal independence, health and well-being, social engagement, and participation in everyday life.The development of adequate wheelchair services should be a priority area for individuals with SCI who use wheelchair and seating assistive technology.National wheelchair and seating assistive technology provision policies in alignment with internationally developed best practice guidelines to provide equal access to services which include assessment, delivery, training, maintenance, and follow-up are essential.

Clinical features of electric powered indoor/outdoor wheelchair users with spinal cord injuries: A cross-sectional study

This article aims to describe the characteristics of those with a primary diagnosis of spinal cord injury (SCI) attending a specialist wheelchair service providing electric powered indoor/outdoor chairs (EPIOCs). This cross-sectional study, with retrospective review of electronic and case note records, explores the complexities of additional clinical features associated with SCI and disability influencing prescription. Data were extracted under three themes; demographics, diagnostic/clinical information and wheelchair factors. There were 57 participants (35 men, 22 women) (mean age 53.51 ± 11.93, range 29-79 years) comprising 20 with paraplegia, 34 with tetraplegia and 3 with undocumented level. Paraplegics were significantly older than tetraplegics (p < 0.05). Thirty users had a complete SCI (mean age 49.87 ± 12.27 years) and 27 had another SCI lesion (mean age 57.56 ± 10.32 years). Those with a complete SCI were significantly younger than the rest (p < 0.02). Only 10 (9 tetraplegic) had SCI as the sole diagnosis. Twenty (15 tetraplegic) had one additional clinical feature, 14 had 2-3 (6 tetraplegic) and 13 (4 tetraplegic) had 4 or more. Ten users required specialised seating, 22 needed tilt-in-space EPIOCs while six required complex controls. The range and complexity of wheelchair and seating needs benefitted from a holistic assessment and prescription by a specialist multidisciplinary team.

Rehabilitation for participation in life after spinal cord injury - clinician responses to a preliminary conceptual framework

PURPOSE

To explore face validity of a preliminary conceptual framework for rehabilitation (the HEAR Framework), which is grounded in the narratives of people with spinal cord injury.

METHODS

Using a quantitative online survey, experienced spinal cord injury rehabilitation practitioners were asked to compare the overall Framework, and its three components and nine elements, against usual practice. Participants rated the helpfulness and ease of implementation of each component. Perceived training needs, to support the implementation of the Framework were also explored. Respondents were given the opportunity to provide qualitative feedback about the Framework.

RESULTS

Thirty-four participants completed the survey. Median rating of congruence of the Framework with usual practice was 6 (out of 10). The Help component of the Framework was rated as more like usual practice than the Encourage and Accept components. Median rating of the potential helpfulness to practice, of all the elements of the Framework was 5 (out of 5). Participants rated the elements within the Help component of the Framework as easiest to implement. Teaching assertiveness, promoting flexible thinking and fostering responsive communication were the highest rated training topics related to implementation of the Framework.

CONCLUSIONS

Face validity testing suggests the preliminary HEAR Framework is promising as a basis for spinal cord injury rehabilitation theory. Broad-based testing is required to progress the promise of the Framework.IMPLICATIONS FOR REHABILITATIONSpinal cord injury rehabilitation lacks conceptual frameworks to guide practice.This validity study suggests moderate alignment between the preliminary HEAR Framework and usual practice (based on the perceptions of professionals in a spinal cord injury service).The Framework may be useful to individual rehabilitation practitioners as a basis for clinical reflection.The Framework may be useful as a practice development tool for teams of rehabilitation practitioners.

[Need and use of assistive devices and architectural facilitators in a dependent population]

Objetivo

Describir la utilización y percepción de la necesidad de productos de apoyo e identificar su asociación con instrumentos para medir la dependencia y la sobrecarga de cuidados.

Diseño

Estudio transversal.

Emplazamiento

Atención Primaria del área sur de Pontevedra.

Participantes

Un total de 112 personas cuidadoras informales que atienden a 125 personas dependientes.

Mediciones principales

Mediante entrevista personal se recogen datos sobre la utilización y percepción de necesidad de estos productos. Además, se obtienen datos sociodemográficos e información referida al tiempo dedicado al cuidado diario, la sobrecarga del cuidador, el Baremo de Valoración de Dependencia y el indicador de dependencia DEP-6D. Se ha utilizado un contraste de medias para identificar si existen diferencias significativas en dichos indicadores en función de si utilizan o no los productos facilitadores. Se ha calculado una regresión logística para identificar aquellas variables asociadas con tener una necesidad no cubierta.

Resultados

Un 60% (IC 95%: 50,9-68,7) de las personas dependientes tienen necesidades no cubiertas de estos dispositivos. Estas necesidades se asocian, principalmente, con una renta familiar baja, un mayor grado de dependencia y una mejor salud del cuidador, aunque en situaciones de gran dependencia y muy mala salud del cuidador estas carencias se suavizan.

Conclusiones

Existe una fuerte asociación entre grado de dependencia y utilización de estos productos. Sin embargo, también hay un elevado porcentaje de la muestra con necesidades no cubiertas de estos productos que están asociadas tanto con la situación socioeconómica del hogar como con las características del dependiente y de la persona cuidadora.

Development of Wheeled Mobility indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project

Background: Wheeled mobility is critical for individuals with Spinal Cord Injury or Disease (SCI/D) related paralysis. The World Health Organization (WHO) developed guidelines highlighting eight steps in wheelchair service delivery: (1) referral and appointment; (2) assessment; (3) prescription; (4) funding and ordering; (5) product preparation; (6) fitting; (7) user training; and, (8) follow-up maintenance/repairs. This article describes the processes used to develop structure, process and outcome indicators that reflect the WHO guidelines within the Domain of Wheeled Mobility rehabilitation for Canadians. Methods: Wheeled mobility experts within the SCI-High Project Team used the WHO guideline to inform the Construct refinement and development of a Driver diagram. Following seven meetings, the Driver diagram and review of outcome measures and literature synthesis regarding wheelchair service delivery informed indicator selection and group consensus. Results: The structure indicator examines the proportion of SCI/D service providers within a rehabilitation program who have specialized wheelchair training to ensure prescription, preparation, fitting, and maintenance quality. The process indicator evaluates the average number of hours of wheelchair service delivery provided per patient during rehabilitation. The intermediary outcome indicator (rehabilitation discharge), is a target capacity score on the Wheelchair Skills Test Questionnaire (WST-Q). The final outcome indicators (at 18 months post rehabilitation admission) are the Life Space Assessment (LSA) and the Wheelchair Use Confidence Scale (WheelCon) short form mean scores. Conclusion: Routine implementation of the selected Wheeled Mobility structure, process and outcome indicators should measurably advance care within the Wheeled Mobility Domain for Canadians living with SCI/D by 2020.

Postural and Metabolic Benefits of Using a Forearm Support Walker in Older Adults With Impairments

OBJECTIVE

To investigate the postural and metabolic benefits a walker with adjustable elbow support (LifeWalker [LW]) can provide for ambulation in population with impairment. The clinical outcomes from the elbow support walker will be compared with standard rollator (SR) and participants predicate device (PD).

DESIGN

Case-crossover study design.

SETTING

Clinical laboratory.

PARTICIPANTS

Individuals aged between 18 and 85 years using a rollator walker as primary mode of assistance and certified as medically stable by their primary physician. Participants (N=30; 80% women [n=24]) recruited from a convenient sample provided voluntary consent and completed the study.

INTERVENTION

Not applicable.

MAIN OUTCOME MEASURES

The trunk anterior-posterior (AP) sway (during the 10-meter walk test), oxygen consumption (during the 6-minute walk test), the mean forearm load offloaded to the elbow support as percentage of body weight, and mean peak hand grip load (during the 25-meter walk test) were measured.

RESULTS

Ambulating with a LW led to (1) reduced trunk sway in the AP direction [(Z_{LW vs PD}= -2.34, P=.018); (Z_{LW vs SR}= -3.461, P=.001)]; (2) reduced erector spinae muscle activation at the left lumbar L3 level [(Z_{LW vs PD}= -2.71, P=.007); (Z_{LW vs SR}= -1.71, P=.09)]; and (3) improved gait efficiency [(Z_{LW vs PD}= -2.66, P=.008) _{Oxygen cost}; (Z_{LW Vs. SR}= -2.66, P=.008) _{Oxygen cost}]. Participants offloaded between 39% and 46% of their body weight through the elbow support armrest while ambulating with the LW. Irrespective of the walker used, participants exerted ∼5%-6% of their body weight in gripping the walker handles during walking.

CONCLUSIONS

Using the forearm support-based LW led to upright body posture, offloaded portions of body weight from the lower extremity, and improved gait efficiency during ambulation in comparison to the SR and the participants' own PD. Further studies focusing on population-specific benefits are recommended.

Need and availability of assistive devices to compensate for impaired hand function of individuals with tetraplegia

Context/Objective: To evaluate the availability and self-declared unmet need of assistive devices to compensate for impaired hand function of individuals with tetraplegia in Switzerland.Design: Cross-sectional survey.Setting: Community.Participants: Individuals with tetraplegia, aged 16 years or older, living in Switzerland.Interventions: not applicable.Outcome Measures: The self-report availability and unmet need of 18 assistive devices for impaired hand function was analyzed descriptively. The availability of devices was further evaluated stratified by sex, age, SCI severity, independence in grooming, time since injury, living situation, working status, and income. Associations between availability of devices and person characteristics were investigated using logistic regression analysis.Results: Overall 32.7% of participants had any assistive device for impaired hand function at their disposal. The most frequent devices were adapted cutlery (14.8%), type supports (14.1%), environmental control systems (11.4%), and writing orthosis (10.6%). In the bivariate analysis several factors showed significant associations with at least one assistive device. Nevertheless, when controlling for potential confounding in multivariate analysis only independence in grooming (adapted cutlery, environmental control systems, type support, speech recognition software), SCI severity (writing orthosis, type support), and sex (adapted kitchenware) remained significantly associated with the availability of the mentioned assistive devices. The self-declared unmet need was generally low (0.7% - 4.3%), except for adapted kitchenware with a moderate unmet need (8.9%).Conclusion: This study indicates that most individuals with tetraplegia in Switzerland are adequately supplied with assistive devices to compensate for impaired hand function. The availability depends mainly on SCI severity and independence in grooming.