A Global Public Health Perspective: Facilitating Access to Assistive Technology

Exploring rehabilitation providers' perspectives of assistive technology access after the implementation of a paediatric AT provision program in rural South India

A paediatric Assistive Technology (AT) Provision Program was implemented by a non-governmental rehabilitation facility in rural South India to support rehabilitation providers in providing needed AT access for children with disabilities. Capacity-building measures for providers and other supports based on the AT needs, barriers, and facilitators to AT access were implemented that aligned with the AT global report for low-middle income countries (LMIC). This study explores how the initiatives from the AT Provision Program have influenced the perspectives of rehabilitation providers on AT access.

Using a qualitative design eight paediatric rehabilitation providers were purposively sampled for virtual semi-structured interviews. Findings were analysed using thematic analysis.

Six overarching themes were identified: (1) Stigma associated with AT use, (2) Organisational response to changing needs, (3) Financial factors related to family socioeconomic status and the organisation providing AT services, (4) Inequity of AT service access in rural areas, (5) Provider AT awareness and confidence and, (6) Quality assurance. Rehabilitation providers' experiences informed future AT capacity-building strategies within a low-resource context. Our findings provide valuable insights for the development of comprehensive AT Provision Program initiatives to provide AT access for children with disabilities in LMIC settings.

Digital health interventions for improving access to primary care in India: A scoping review

Access to quality healthcare remains a challenge in low-and middle-income countries. Vulnerable populations with unmet needs face the greatest challenge in accessing primary care for appropriate and timely healthcare. The use of digital technologies can not only strengthen health systems but also improve access to health care, particularly for the vulnerable. This scoping review aims to assess the various digital health technologies and interventions available for improving access to primary care for the vulnerable in India. This scoping review employed the Joanna Brigg Institute's (JBI) guidelines and Arksey and O'Malley's methodological framework. The literature search was conducted in Medline/PubMed, Embase, Web of Science-Core Collection, Scopus, AgeLine, PsycINFO, CINAHL, ERIC, Cochrane CENTRAL, and Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register databases, using the keywords, such as 'Access', 'Healthcare', 'Assistive technology', 'Digital health' 'Vulnerable', 'India' and 'Healthcare technology'. A two-staged screening of titles and abstracts, followed by full-text was conducted independently by two reviewers, using the Rayyan software. Subsequently, the data was extracted from selected studies using a pre-designed and approved extraction form. The data was then synthesised and analysed narratively. The protocol for this review has been registered with open science forum (OSF) registries (https://osf.io/63pjw/). The search yielded about 3840 records, 3544 records were eligible for screening of titles and abstracts. We included seven studies after a two-round screening and identified seven different technological innovations developed to bridge gaps in access to primary care. The commonly used digital health interventions for improving access to primary care were virtual tele-health systems and mHealth applications in-built within an android smartphone or a tablet. Digital health interventions was either used as a standalone tele-health aid or a collaborative system for community workers, primary care physicians as well as the health service users. The purpose of these innovations was to increase awareness and knowledge to access support for specific aspects of healthcare. Virtual primary health care with the specialist in the hub supporting general physicians at the primary health centres in blocks and districts was another such model used for improving access to primary care. Digital health interventions was also used for mass community screening of disabilities, such as persons with hearing disability. To re-imagine a digitally empowered health systems in India, also inclusive of the vulnerable, it is important to inclusively conceptualise, systematically develop and rigorously evaluate any public health interventions including those that are enabled by digital health interventions to bridge the gaps in access to primary care in India. Such a strategy could address the paucity of evidence in public health interventions and provide sustainable strategies to strengthen health systems in India. Trial registration: Open Science Framework-Registration Link: https://osf.io/63pjw/.

Impact of Apps as Assistive Devices for Visually Impaired Persons

The pervasiveness of mobile devices and other associated technologies has affected all aspects of our daily lives. People with visual impairments are no exception, as they increasingly tend to rely on mobile apps for assistance with various visual tasks in daily life. Compared to dedicated visual aids, mobile apps offer advantages such as affordability, versatility, portability, and ubiquity. We have surveyed hundreds of mobile apps of potential interest to people with vision impairments, either released as special assistive apps claiming to help in tasks such as text or object recognition (n = 68), digital accessibility (n = 84), navigation (n = 44), and remote sighted service (n = 4), among others, or marketed as general camera magnification apps that can be used for visual assistance (n = 77). While assistive apps as a whole received positive feedback from visually impaired users, as reported in various studies, evaluations of the usability of every app were typically limited to user reviews, which are often not scientifically informative. Rigorous evaluation studies on the effect of vision assistance apps on daily task performance and quality of life are relatively rare. Moreover, evaluation criteria are difficult to establish, given the heterogeneity of the visual tasks and visual needs of the users. In addition to surveying literature on vision assistance apps, this review discusses the feasibility and necessity of conducting scientific research to understand visual needs and methods to evaluate real-world benefits.

Towards Robot-Assisted Therapy for Children With Autism—The Ontological Knowledge Models and Reinforcement Learning-Based Algorithms

Robots are more and more present in our lives, particularly in the health sector. In therapeutic centers, some therapists are beginning to explore various tools like video games, Internet exchanges, and robot-assisted therapy. These tools will be at the disposal of these professionals as additional resources that can support them to assist their patients intuitively and remotely. The humanoid robot can capture young children’s attention and then attract the attention of researchers. It can be considered as a play partner and can directly interact with children or without a third party’s presence. It can equally perform repetitive tasks that humans cannot achieve in the same way. Moreover, humanoid robots can assist a therapist by allowing him to teleoperated and interact from a distance. In this context, our research focuses on robot-assisted therapy and introduces a humanoid social robot in a pediatric hospital care unit. That will be performed by analyzing many aspects of the child’s behavior, such as verbal interactions, gestures and facial expressions, etc. Consequently, the robot can reproduce consistent experiences and actions for children with communication capacity restrictions. This work is done by applying a novel approach based on deep learning and reinforcement learning algorithms supported by an ontological knowledge base that contains relevant information and knowledge about patients, screening tests, and therapies. In this study, we realized a humanoid robot that will assist a therapist by equipping the robot NAO: 1) to detect whether a child is autistic or not using a convolutional neural network, 2) to recommend a set of therapies based on a selection algorithm using a correspondence matrix between screening test and therapies, and 2) to assist and monitor autistic children by executing tasks that require those therapies.

Barriers to Low-Vision Rehabilitation Services for Visually Impaired Patients in a Multidisciplinary Ophthalmology Outpatient Practice

Low-vision rehabilitation (LVR) has significant benefit in improving the quality of life of visually impaired patients. However, these services are highly underutilized in ophthalmology practices. A quality improvement study was performed to investigate barriers to LVR services for patients at the University of Texas Medical Branch (UTMB) between 2010 and 2020. Low vision was defined as the best corrected visual acuity of 20/70 or worse in the better-seeing eye or a visual field less than 20 degrees. Potential subjects were screened (n = 577) from the electronic medical record using International Classification of Disease (ICD) codes for legal blindness, impaired vision, and low vision. Chart review identified 190 subjects who met criteria for low-vision analysis. Patients who received LVR referrals to attend at least one LVR service visit from the eligible subjects were contacted for participation in phone interviews regarding their LVR experience. Practicing eye care providers (ECPs) at UTMB completed a questionnaire to capture their referral patterns. Of the eligible subjects, 64% were referred to LVR services by ECPs. Reported patient barriers included mental health issues (76%), denial of need for low-vision aid (71%), poor physical health (67%), lack of transportation (57.1%), and lack of referrals (36%). EPCs reported patient's overall health (67%), older age (44%), lack of social support (44%), poor cognitive function (44%), and low likelihood of follow-up (44%) as barriers to referring patients to LVR. This study identified several modifiable barriers that can be addressed to access LVR services for low-vision patients. Changing referral patterns, eliminating variations in referral criteria, and increasing patient awareness and knowledge of LVR resources may tremendously improve the quality of life of low-vision patients.

Design, Development, and Testing of an Intelligent Wearable Robotic Exoskeleton Prototype for Upper Limb Rehabilitation

Neuromotor rehabilitation and recovery of upper limb functions are essential to improve the life quality of patients who have suffered injuries or have pathological sequels, where it is desirable to enhance the development of activities of daily living (ADLs). Modern approaches such as robotic-assisted rehabilitation provide decisive factors for effective motor recovery, such as objective assessment of the progress of the patient and the potential for the implementation of personalized training plans. This paper focuses on the design, development, and preliminary testing of a wearable robotic exoskeleton prototype with autonomous Artificial Intelligence-based control, processing, and safety algorithms that are fully embedded in the device. The proposed exoskeleton is a 1-DoF system that allows flexion-extension at the elbow joint, where the chosen materials render it compact. Different operation modes are supported by a hierarchical control strategy, allowing operation in autonomous mode, remote control mode, or in a leader-follower mode. Laboratory tests validate the proper operation of the integrated technologies, highlighting a low latency and reasonable accuracy. The experimental result shows that the device can be suitable for use in providing support for diagnostic and rehabilitation processes of neuromotor functions, although optimizations and rigorous clinical validation are required beforehand.

Preliminary test-retest reliability of the Wheelchair Satisfaction Questionnaire

PURPOSE

Economic realities in lower-and-middle-income countries (LMICs) present an increased need for outcome measures for wheelchair efficacy, as these measures enable optimized use of funds. As the provision level of wheelchairs is low in these areas, and many wheelchairs are inappropriate for their intended users, use of funds based on evidence is especially necessary. The Wheelchair Satisfaction Questionnaire (WSQ) was designed to be a snapshot of a wheelchair user's level of satisfaction with their wheelchair. The WSQ is comprised of 16 visual analogue scale questions. Each question includes an option for a qualitative explanatory comment. The current study examined initial test-retest reliability of the WSQ.

MATERIALS AND METHODS

The WSQ was administered twice to the same set of wheelchair users who were secondary students at a school for students with disabilities. A demonstration was given to the participants to explain how to mark the analogue scale. Participants were instructed to answer each item honestly and without peer input. A one-week time span separated test and retest. Scores for both sessions were entered into SPSS. An interclass coefficient of 0.70 or above indicates acceptable test-retest reliability.

RESULTS

The ages of participants ranged from 13 to 24, with a mean age of 17.86 years. Sixty-five participants completed the questionnaire fully in both test and retest and were included in this study. A high degree of reliability was found between scores from both tests. The interclass coefficient was r(63) = .863, p = .01, indicating statistically significant agreement between test and retest.

CONCLUSION

The results support the WSQ as a reliable measure, confirming the WSQ as a reliable tool for user feedback on wheelchair function. Because the WSQ is designed to provide user feedback with enough granularity to give data on particular aspects of wheelchair structure and function, data can facilitate repair and modifications to wheelchair parts. Studies using the WSQ to assess specific wheelchair types could indicate consistent patterns of user satisfaction and dissatisfaction, revealing relevant design issues. The WSQ is designed to give wheelchair users a voice that can empower user centred modification and design changes to facilitate improved health, opportunity, and social interaction.Implications for RehabilitationResults from the WSQ could enable manufacturers to utilize user feedback to improve the design of wheelchairs for use in LMIC's, and providers could be better-informed in the selection of wheelchair types for specific environments.The WSQ could provide immediate user feedback to inform wheelchair modification and selection to best serve a particular user.The WSQ could be used in clinical settings over time to collect longitudinal data from wheelchair users, which could identify the most commonly perceived reasons for user dissatisfaction in a particular clinical setting.

Socially Assistive Robots for Older Adults and People with Autism: An Overview

Over one billion people in the world suffer from some form of disability. Nevertheless, according to the World Health Organization, people with disabilities are particularly vulnerable to deficiencies in services, such as health care, rehabilitation, support, and assistance. In this sense, recent technological developments can mitigate these deficiencies, offering less-expensive assistive systems to meet users’ needs. This paper reviews and summarizes the research efforts toward the development of these kinds of systems, focusing on two social groups: older adults and children with autism.