A conceptual framework of outcomes for caregivers of assistive technology users

Positive and negative experiences of caregivers helping power wheelchair users: a mixed-method study

PURPOSE

This study aimed to better understand how the powered wheelchair (PWC) impacts the experiences of family caregivers of PWC users, and explore the strategies and resources used by caregivers to cope with their role.

MATERIALS AND METHODS

This mixed-methods study was part of a larger cross-sectional research study conducted in four Canadian cities. Twenty-three family caregivers of PWC users, who provided at least 2 h of support per week, completed the Power Mobility Caregiver Assistive Technology Outcome (PM-CATOM), an 18-item measure assessing PWC-related and overall burden experienced by family caregivers. We also conducted semi-structured interviews and analysed them using inductive content analysis.

RESULTS

From the quantitative PM-CATOM results, the caregivers perceived low level of burden for the wheelchair-related items, (Median:4.5; Range 3 to 5). Most perceived burden when physically helping the wheelchair user and when providing verbal hints. In terms of overall help, the caregivers experienced some level of burden (Median 3.5: Range 3 to 5). Most caregivers identified burden associated with the limitation to their recreational and/or leisure activities (52.2%) and feeling that they have more to do than they can handle. We identified 3 themes in the interviews: the burden experiences of caring for PWC users, the positive experiences of caregiving, and the coping strategies and resources used by caregivers of PWC users.

CONCLUSION

Our study showed that understanding the experiences of caregivers of AT users is central as they are directly and indirectly impacted by the PWC in their lives and caregiving roles.

Benefits and challenges of mobility and medical alert service dogs for caregivers of service dog recipients

PURPOSE

Mobility and medical alert service dogs are an assistive technology for individuals with disabilities or chronic conditions. Informal caregivers of individuals with disabilities are subject to physical and emotional stress due to their responsibilities. Understanding how service dogs, an increasingly common assistive technology, may add to or subtract from caregiver stress is crucial for promoting caregiver well-being. The purpose of this study was to analyze caregiver accounts to understand their perspective on benefits and challenges they face with mobility and medical alert service dogs.

MATERIALS AND METHODS

Open ended survey responses from 117 caregivers of service dog recipients (N = 72 with a service dog, N = 45 on the waitlist) were analysed through a conventional content analysis.

RESULTS

Four major themes were found regarding caregiver and service dog: Family Benefits, Caregiver Benefits, Assistance Through Service Dog's Training, and Drawbacks.

CONCLUSIONS

Findings suggest that benefits and challenges of mobility and medical service dogs extend beyond the service dog recipient, affecting the caregiver and other family members as well. Future studies should further explore this interaction to determine the best way to support caregivers of individuals with disabilities.IMPLICATIONS FOR REHABILITATIONMobility and medical alert service dogs are increasingly partnered with individuals with disabilities or chronic diseases as an assistive technology but few studies have focussed on the experience of the caregivers of service dog recipients. Caregivers of individuals with disabilities or chronic diseases may be subject to both psychological and physiological stressors as a result of their caregiver duties.Results found that caregivers perceive both benefits to themselves and to their families in terms building a bond with the animal that helps to reduce worry and offers emotional support. The most commonly mentioned drawbacks include general maintenance of the service dog, grooming needs and travel restrictions.This research is important in order to offer appropriate support to caregivers of individuals with disabilities.

Caregivers' Profiles Based on the Canadian Occupational Performance Measure for the Adoption of Assistive Technologies

The COPM (Canadian Occupational Performance Measure) is a tool that is based on the identification of self-perceived performance and satisfaction problems in the performance of occupations, allowing the creation of a hierarchy in the order of the interventions to be carried out, and speeding up the identification of the necessary AT (Assistive Technologies). Given the importance of the caregiver's perception about their own performance in the design of AT, this research examines the caregiver's profile through the COPM. A sample of 40 caregivers volunteered to participate in the study. A cluster analysis was carried out on the COPM scores. Two caregiver profiles were found in relation to the COPM measure, one with low scores on performance and satisfaction and another with high scores on both of these two variables. The main predictor was found to be the self-perception of performance. The structure was replicated through a hierarchical cluster analysis, where the role of caregivers was of interest. These results are relevant on both a theoretical and practical level.

Expanding Occupational Therapy Perspectives with Family Caregivers

Background. Family caregivers are ever-present and crucial collaborators in the work of occupational therapists but are rarely the focus of their efforts. Purpose. This lecture will discuss the greater inclusion of family caregivers in occupational therapy and the exciting possibilities that emerge from this change. Key issues. Family caregivers are a unique client population. This position statement is supported by recent research on occupational therapists’ values and shifts towards an occupational participation approach in the profession. Working with this client population requires a nuanced understanding of their experience. Caregiving can be burdensome, but it can also create positive effects many of which can be identified and understood through a relational lens. Implications. Through a three-fold approach, occupational therapists can work with caregivers to locate and mitigate negative caregiving effects, discover, and build on positive effects, and further develop positive outcomes by encouraging and balancing caregiving and non-caregiving occupations.

Customized Power Wheelchair Joysticks Made by Three-Dimensional Printing Technology: A Pilot Study on the Environmental Adaptation Effects for Severe Quadriplegia

Background: Power wheelchair joysticks are often available as standardized ready-made products for patients with severe hand dysfunction. However, standardized joysticks have limitations in accommodating the individualized features of hand dysfunctions. Three-dimensional (3D) printing technology has facilitated active research on the development of joysticks that can overcome such limitations. Methods: Four subjects participated in the study to evaluate driving abilities and satisfaction after using the customized joystick for two weeks. Modified power-mobility indoor driving assessment (PIDA), National Aeronautics and Space Administration task load index (NASA-TLX), and psychosocial impact of assistive devices scale (PIADS; Korean version) were employed for evaluation. Results: In patients 1–3, the modified PIDA scores had the highest values in the pre-test and post-test. In patient 4, the modified PIDA score had a higher value in the post-test (mean value = 4) compared to the pre-test (mean value = 3.33). In all patients, the modified PIDA time was lower in the post-test compared to the pre-test. The NASA-TLX and PIADS values indicate that greater satisfaction was achieved through the usage of customized joysticks in the post-test. Conclusions: All patients can improve their power wheelchair driving abilities and achieve greater satisfaction. Clinical Relevance: Three-dimensional printed customized power wheelchair joysticks can offer enhanced driving abilities and satisfaction to patients with limited hand function owing to severe spinal cord injury.

Noninvasive Electroencephalography Equipment for Assistive, Adaptive, and Rehabilitative Brain-Computer Interfaces: A Systematic Literature Review

Humans interact with computers through various devices. Such interactions may not require any physical movement, thus aiding people with severe motor disabilities in communicating with external devices. The brain-computer interface (BCI) has turned into a field involving new elements for assistive and rehabilitative technologies. This systematic literature review (SLR) aims to help BCI investigator and investors to decide which devices to select or which studies to support based on the current market examination. This examination of noninvasive EEG devices is based on published BCI studies in different research areas. In this SLR, the research area of noninvasive BCIs using electroencephalography (EEG) was analyzed by examining the types of equipment used for assistive, adaptive, and rehabilitative BCIs. For this SLR, candidate studies were selected from the IEEE digital library, PubMed, Scopus, and ScienceDirect. The inclusion criteria (IC) were limited to studies focusing on applications and devices of the BCI technology. The data used herein were selected using IC and exclusion criteria to ensure quality assessment. The selected articles were divided into four main research areas: education, engineering, entertainment, and medicine. Overall, 238 papers were selected based on IC. Moreover, 28 companies were identified that developed wired and wireless equipment as means of BCI assistive technology. The findings of this review indicate that the implications of using BCIs for assistive, adaptive, and rehabilitative technologies are encouraging for people with severe motor disabilities and healthy people. With an increasing number of healthy people using BCIs, other research areas, such as the motivation of players when participating in games or the security of soldiers when observing certain areas, can be studied and collaborated using the BCI technology. However, such BCI systems must be simple (wearable), convenient (sensor fabrics and self-adjusting abilities), and inexpensive.

A Framework for a New Approach to Empower Users Through Low-Cost and Do-It-Yourself Assistive Technology

Background: Assistive Technology (AT) refers to “assistive products and related systems and services developed for people to maintain or improve functioning and thereby to promote well-being”. Improving the process of design and creation of assistive products is an important step towards strengthening AT provision. Purpose: (1) to present a framework for designing and creating Low-Cost AT; (2) to display the preliminary results and evidence derived from applying the framework. Methodology: First, an evidence-based process was applied to develop and conceptualize the framework. Then, a pilot project to validate the framework was carried out. The sample was formed by 11 people with disabilities. The measure instruments were specific questionnaire, several forms of the Matching Person-Technology model, the Psychosocial Impact of Assistive Device Scale, and a tool to assess the usability and universal design of AT. Results: The framework integrates three phases: Identification (Design), Creation (Making the prototype), and Implementation (Outcome Measures), based on the principles of Design Thinking, and with a user-centered perspective. The preliminary results showed the coherence of the entire process and its applicability. The matching between person and device was high, representing the importance of involving the user in the design and selection of AT. Conclusions: The framework is a guide for professionals and users to apply a Low-Cost and Do-It-Yourself perspective to the provision of AT. It highlights the importance of monitoring the entire procedure and measuring the effects, by applying the outcome measures.

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.

Spotlight on Siblings: Considering Social Context in Home Modification Practice

The United Nations Convention on the Rights of Persons with Disabilities (CRPD) recognizes the role of Assistive Technologies (AT) in enabling independent living and inclusion of people with disabilities. Research into the provision of AT and disability services in general has highlighted the importance of social context and its influence on individual outcomes. However, there is little recognition of sibling roles, relationships and rights in the guidance available for practitioners. This paper explores the socio-technical context of home modification practice and the importance of involving siblings. The international context and concepts behind AT provision, including home modifications, and issues emerging from practice in Australia’s new National Disability Insurance Scheme (NDIS) are discussed. Based on extensive practical experience and peer review, the “5 S’s for Siblings” is presented as a practice approach for involving siblings in the home modification process. Policy and practice implications are presented, including communication strategies for working in partnership with individuals and their families, and alignment with national standards and human rights principles. Involving siblings in the home modification process recognizes the important role they play in the lives of people with disabilities, both now and in the future.

Marketing of surveillance technology in three ageing countries

Purpose

The purpose of this paper is to review marketing materials of surveillance products for people with dementia and their carers in three ageing countries, as part of a dementia-technology media analysis.

Design/methodology/approach

An online environmental scan was conducted using search terms for surveillance technologies (STs) and dementia through a Google search focussed on the UK, Sweden and the Netherlands. Data were extracted on the products’ and websites’ marketing messages from consumer and marketer perspectives.

Findings

Information was gathered for 382 product websites, of which 242 met eligibility criteria. The majority of products come from the UK. In the UK and Sweden, the companies behind the websites appeared to be mainly “cottage industries” which focus on selling ST. In contrast, sellers in the Netherlands included a more balanced mixture of small, medium and large companies. In all three countries, the website messaging focussed on the need to manage safety concerns, without considering privacy or consent.

Social implications

Contrary to the perception of future dependence on technology, the ST sector seems to be a niche market. The media messages, equating people with dementia with animals and children, are at odds with initiatives that strive for dignity and dementia friendliness.

Originality/value

No previous study is known to have explored media messages from websites that market ST for people with dementia.

A caregiver educational program: A video program to promote aging services technologies awareness

Research demonstrated that aging services technologies (ASTs) can reduce caregiver burden. However, ASTs are underutilized by caregivers due to poor awareness. This study evaluated the effectiveness of a video-based educational program to increase caregiver AST knowledge among 43 caregivers. Paired sample t-tests showed positive change in AST knowledge, stigma, and intention to engage in AST activities post-program. Caregivers endorsed highly positive AST views pre- and post-program without statistically significant change. Group by time repeated measures ANOVAs showed younger caregivers (<65 years old) had better knowledge and were more open to ASTs (improved attitude and stigma scores) than older caregivers (>65 years old). A significant interaction revealed caregivers of individuals who had fewer, but not more, domains of functional limitation reported a positive change in AST attitude post-program. The video program appeared to be beneficial to all caregivers, who provided vastly positive program feedback.

Psychometric properties of a Power Mobility Caregiver Assistive Technology Outcome Measure

Caregiver burnout is a serious concern among informal caregivers, especially for those who provide care to individuals with more severe limitations such as power mobility users. The Power Wheelchair Caregiver Assistive Technology Outcome Measure tool measures device specific and overall burden experienced by informal caregivers of power mobility users. A one-month, test-retest study was conducted to examine the reliability, internal consistency, and construct validity of the Power Wheelchair Caregiver Assistive Technology Outcome Measure. Two construct validity measures were administered: the Hospital Anxiety and Depression Scale and the Late Life Disability Index. The test-retest-reliabilities of part 1 (power wheelchair specific burden) and part 2 (general caregiving burden) were 0.769 and 0.843 respectively. Scores on part 1 were moderately and positively correlated with part 2 and with frequency of participation. Scores on part 2 were moderately and negatively correlated with anxiety, depression, and positively with perceived limitation of participation. The strength and direction of these correlations provide support for the construct validity of the measure and suggest part 1 and part 2 provide complementary information. Further testing is needed to assess the clinical utility and responsiveness of the measure.

Effect of a tailored assistive technology intervention on older adults and their family caregiver: a pragmatic study protocol

BACKGROUND

Many older adults with mobility limitations use assistive technology to help them perform daily activities. However, little attention has been paid to the impact on their family caregivers. This neglect produces an incomplete portrayal of the outcomes of assistive technology provision. This paper describes the protocol for a study that examines the impact of a tailored assistive technology intervention that is inclusive of assistance users and their family caregivers.

METHODS/DESIGN

This research will use a combination of quantitative and qualitative methods. The quantitative portion will be an experimental, single-blinded study in which participants are randomly assigned to either an experimental assistive technology intervention or a standard care group. We will enroll 240 participants (120 dyads) into the study from three Canadian sites. Participants will include older adults (>55) and family caregivers who provide ≥4 h per week of assistance with daily activities and social participation. The primary outcome measure for the older adults will be the Functional Autonomy Measurement System, and the primary outcome measure for the caregivers will be the Caregiver Assistive Technology Outcomes Measure. Qualitative data will be collected through detailed records of the therapists' interventions, as well as through interviews with dyads and therapists following the interventions. Data collection will occur at baseline (T0) with follow-ups at 6 weeks (T1), 22 weeks (T2), and 58 weeks (T3) after baseline evaluation.

DISCUSSION

The findings from this study will help service providers and clinicians to move forward with assistive technology recommendations that are more attuned to the needs of both older adults with mobility limitations and their family caregivers. Additionally, the study's findings will enhance our conceptual understanding of the spectrum of assistive technology outcomes and set the stage for econometric studies assessing cost-effectiveness.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT01640470 . Registered 11/21/2011.

Initial constructs for patient-centered outcome measures to evaluate brain-computer interfaces

PURPOSE

The authors describe preliminary work toward the creation of patient-centered outcome (PCO) measures to evaluate brain-computer interface (BCI) as an assistive technology (AT) for individuals with severe speech and physical impairments (SSPI).

METHOD

In Phase 1, 591 items from 15 existing measures were mapped to the International Classification of Functioning, Disability and Health (ICF). In Phase 2, qualitative interviews were conducted with eight people with SSPI and seven caregivers. Resulting text data were coded in an iterative analysis.

RESULTS

Most items (79%) were mapped to the ICF environmental domain; over half (53%) were mapped to more than one domain. The ICF framework was well suited for mapping items related to body functions and structures, but less so for items in other areas, including personal factors. Two constructs emerged from qualitative data: quality of life (QOL) and AT. Component domains and themes were identified for each.

CONCLUSIONS

Preliminary constructs, domains and themes were generated for future PCO measures relevant to BCI. Existing instruments are sufficient for initial items but do not adequately match the values of people with SSPI and their caregivers. Field methods for interviewing people with SSPI were successful, and support the inclusion of these individuals in PCO research. Implications for Rehabilitation Adapted interview methods allow people with severe speech and physical impairments to participate in patient-centered outcomes research. Patient-centered outcome measures are needed to evaluate the clinical implementation of brain-computer interface as an assistive technology.

Challenges of user-centred assistive technology provision in Australia: shopping without a prescription

PURPOSE

People with disability have a right to assistive technology devices and services, to support their inclusion and participation in society. User-centred approaches aim to address consumer dissatisfaction and sub-optimal outcomes from assistive technology (AT) provision, but make assumptions of consumer literacy and empowerment. Policy discourses about consumer choice prompt careful reflection, and this paper aims to provide a critical perspective on user involvement in assistive technology provision.

METHODS

User-centred approaches are considered, using literature to critically reflect on what user involvement means in AT provision. Challenges at the level of interactions between practitioners and consumers, and also the level of markets and policies are discussed, using examples from Australia.

RESULTS

There is no unanimous conceptual framework for user-centred practice. Power imbalances and differing perspectives between practitioners and consumers make it difficult for consumers to feel empowered. Online access to information and international suppliers has not surmounted information asymmetries for consumers or lifted the regulation of publicly funded AT devices.

CONCLUSIONS

Ensuring access and equity in the public provision of AT is challenging in an expanding market with diverse stakeholders. Consumers require personalised information and support to facilitate their involvement and choice in AT provision. Implications for Rehabilitation Variations in approaches informing AT provision practices have a profound impact on equity of access and outcomes for consumers. An internationalised and online market for AT devices is increasing the need for effective information provision strategies and services. Power imbalances between practitioners and consumers present barriers to the realisation of user-centred practice.

The potential for technology to enhance independence for those aging with a disability

Technologies of all kinds can sustain and accelerate improvements in health and quality of life for an aging population, and enhance the independence of persons with disabilities. Assistive technologies are widely used to promote independent functioning, but the aging of users and their devices produces unique challenges to individuals, their families, and the health care system. The emergence of new "smart" technologies that integrate information technology with assistive technologies has opened a portal to the development of increasingly powerful, individualized tools to assist individuals with disabilities to meet their needs. Yet, issues of access and usability remain to be solved for their usefulness to be fully realized. New cohorts aging with disabilities will have more resources and more experience with integrated technologies than current elders. Attention to technological solutions that help them adapt to the challenges of later life is needed to improve quality of life for those living long lives with disabilities.

Effects of an assistive technology intervention on older adults with disabilities and their informal caregivers: an exploratory randomized controlled trial

OBJECTIVE

The aim of this study was to demonstrate experimentally that an assistive technology (AT) intervention improves older AT users' activity performance and satisfaction with activity performance and decreases their caregivers' sense of burden.

DESIGN

This study was a delayed intervention, randomized control trial. Baseline data were collected on 44 community-dwelling AT user-caregiver dyads in Vancouver, British Columbia, and Montreal, Quebec. The primary outcome measures for AT users were the satisfaction and accomplishment scales from the Assessment of Life Habits. The primary outcome measure for caregivers was the Caregiver Assistive Technology Outcome Measure, which assessed burden associated with dyad-identified problematic activities.

RESULTS

After the intervention, assistance users in the immediate intervention group reported significantly increased satisfaction with activity performance (P < 0.001) and improved accomplishment scores (P = 0.014). Informal caregivers in the immediate intervention group experienced significantly decreased burden with the dyad-identified problematic activity (P = 0.013). Participants in the delayed intervention group experienced similar benefits after the intervention. Improvements for both groups were mostly maintained 4 mos after the conclusion of the intervention.

CONCLUSIONS

This is the first experimental study to demonstrate that the provision of AT decreases caregiver burden. If confirmed and extended by subsequent research, the findings have significant policy and practice implications and may enable health care providers to advocate for improved access to AT provision and the related follow-up services.

How assistive technology use by individuals with disabilities impacts their caregivers: a systematic review of the research evidence

Informal caregivers are a critical yet frequently unacknowledged part of the healthcare system. It is commonly presumed that providing assistive technology will decrease the burden of their care provision; however, no review has evaluated the evidence behind this assumption. Therefore, a systematic review was undertaken to evaluate evidence of the impact of assistive technology use by care recipients on their informal caregivers. Data sources included EMBASE, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Web of Science, PsychINFO, PubMed, and active researchers in this area. Twenty-two studies met the specified inclusion criteria. Collectively, the findings suggest that assistive technology use helps caregivers by diminishing some of the physical and emotional effort entailed in supporting individuals with disability. However, confidence in this causal connection is limited because of the study designs that were used. This undermines the understanding of the impacts of assistive technology use on the users' informal caregivers.

Access to environmental stimulation via eyelid responses for persons with acquired brain injury and multiple disabilities: a new microswitch arrangement

This study assessed a new microswitch arrangement for eyelid responses using an optic sensor placed above the cheekbone and a small sticker on the person's eyelid. This new arrangement, which was designed to avoid interference of the microswitch with the person's visual functioning, was tested on three adults with acquired brain injury and multiple (consciousness, communication, and motor) disabilities. The study was carried out according to a non-concurrent multiple baseline design across participants. Data showed the new microswitch arrangement was suitable for all three participants, who increased their responding during the intervention phase of the study when their responses allowed them to access preferred stimulation. Practical implications of the findings are discussed.

Impact of assistive technology on family caregivers of children with physical disabilities: a systematic review

PURPOSE

To systematically review the literature on the effects of assistive technology (AT) on family caregivers of children with physical disabilities.

METHOD

Electronic searches of Medline, CINAHL Plus, PubMed, and PsychInfo were conducted. The main search terms were AT, caregiver, physical disability, cerebral palsy and quality of life. Studies were included if they related to the impact of AT on the family caregiver of children with physical impairment. Data extraction and quality assessments were conducted by three reviewers.

RESULTS

Five articles were eligible for inclusion. Two studies rated weak quality of evidence (level 5), two studies rated moderate quality of evidence (level 3), and one article was a systematic review, rating high level of quality (level 1). A paucity of literature, small sample sizes, descriptive study designs and weak methodological quality meant a narrative review was possible. Three articles reported that AT lightened caregiver assistance in the areas of mobility, self- care and social function.

CONCLUSIONS

Evidence suggests that AT has a positive impact on children with physical impairments and their caregivers. Future studies in this area could include valid and reliable outcome measures of AT use and the psychological impacts of AT on caring for a child with physical impairments.

Treatment theory, intervention specification, and treatment fidelity in assistive technology outcomes research

Recent reports in the rehabilitation literature have suggested that treatment theory, intervention specification, and treatment fidelity have important implications for the design, results, and interpretation of outcomes research. At the same time, there has been relatively little discussion of how these concepts bear on the quality of assistive technology (AT) outcomes research. This article describes treatment theory, intervention specification, and treatment fidelity as interconnected facets of AT outcome studies that fundamentally affect the interpretation of their findings. The discussion of each is elucidated using case examples drawn from the AT outcomes research literature. Recommendations are offered for strengthening these components of AT outcomes research.