Feeling valued: the interplay of assistive technology and identity

PURPOSE

The aim of this study was to explore the impact of AT in identity for students with disabilities in higher education and if/how this changes over time.

METHODS

Using a longitudinal qualitative research design, semi-structured interviews were conducted with students with disabilities (n = 13) in higher education in Ireland on two occasions during an academic year. A trajectory approach to longitudinal analysis was employed. This involved the use of matrices and identification of a through line for the study, which connects participant change over time.

RESULTS

The through line identified was feeling valued, which was central in the negotiation of identity over time across three themes: feelings of autonomy and competence; claiming disability; and feeling like you belong as a student. AT impacted experiences across the three themes which subsequently promoted or undermined students' sense of value. Reciprocally, feeling valued influenced use and perceptions of AT. Factors specific to a higher education context were also identified which influenced meanings attached to AT over time.

CONCLUSION

Creating an environment where students feel valued is key in promoting use of and positive perceptions of AT. This should form an integral part of AT and disability policy in higher education.

Factors Influencing Intention to Technological Use in Older Adults. The TAM Model Aplication

The use of digital technology by older adults has improved in recent years in response to the need for their functional adaptation to an increasingly technological social context. Understanding this type of technological adaptation has recently become an important field of inquiry in both social and gerontological studies. Working within this framework, the aim of this study is to identify the main determinants that influence the intention of older people to use digital technology in their daily lives, using the Technological Acceptance Model. A study was carried out with the participation of 1155 people over 65 years of age in Spain. Confirmatory Factor Analysis and structural equation models (SEM) were performed. The results show that the TAM is a useful model to explain the intention of older adults to use Digital Technology, showing a high predictive power, highlighting Perceived Usefulness and Perceived Ease of Use as the main predictor variables.

Developing Design Solutions for Smart Homes Through User-Centered Scenarios

The success of smart homes is fundamentally dependent on their adoption and use by people in the context of daily life. This study investigated ways to control and adapt the technology to fulfill user daily needs, which are the active drivers of smart housing technology adoption. A framework of smart home services was developed by focusing on the practicability of each variable from the perspective of supporting user experience. By developing scenarios based on previous studies, we identified residents' behaviors and intentions regarding smart home technology and its use. Their issues were identified through the health problems and daily activities identified in the scenarios, and customized smart home services were developed for each resident based on technical solutions, space requirements, and design solutions. The main strength of this study is the adoption of user-centered methods to build a rich picture of the issues that affect households and the community related to the design, installation, and use of technology.

‘That's for old so and so's!’: does identity influence older adults’ technology adoption decisions?

The role of identity in older adults’ decision-making about assistive technology adoption has been suggested but not fully explored. This scoping review was conducted to understand better how older adults’ self-image and their desire to maintain this influence their decision-making processes regarding assistive technology adoption. Using the five-stage scoping review framework by Arksey and O'Malley, a total of 416 search combinations were run across nine databases, resulting in a final yield of 49 articles. From these 49 articles, five themes emerged: (a) resisting the negative reality of an ageing and/or disabled identity; (b) independence and control are key; (c) the aesthetic dimension of usability; (d) assistive technology as a last resort; and (e) privacy versus pragmatics. The findings highlight the importance of older adults’ desire to portray an identity consistent with independence, self-reliance and competence, and how this desire directly impacts their assistive technology decision-making adoption patterns. These findings aim to support the adoption of assistive technologies by older adults to facilitate engagement in meaningful activities, enable social participation within the community, and promote health and wellbeing in later life.

Perceptions of Existing Wearable Robotic Devices for Upper Extremity and Suggestions for Their Development: Findings From Therapists and People With Stroke

Background

Advances in wearable robotic technologies have increased the potential of these devices for rehabilitation and as assistive devices. However, the utilization of these devices is still limited and there are questions regarding how well these devices address users’ (therapists and patients) needs.

Objective

The aims of this study were to (1) describe users’ perceptions about existing wearable robotic devices for the upper extremity; (2) identify if there is a need to develop new devices for the upper extremity and the desired features; and (3) explore obstacles that would influence the utilization of these new devices.

Methods

Focus groups were held to collect data. Data were analyzed thematically.

Results

A total of 16 participants took part in the focus group discussions. Our analysis identified three main themes: (1) “They exist, but...” described participants’ perceptions about existing devices for upper extremity; (2) “Indeed, we need more, can we have it all?” reflected participants’ desire to have new devices for the upper extremity and revealed heterogeneity among different participants; and (3) “Bumps on the road” identified challenges that the participants felt needed to be taken into consideration during the development of these devices.

Conclusions

This study resonates with previous research that has highlighted the importance of involving end users in the design process. The study suggests that having a single solution for stroke rehabilitation or assistance could be challenging or even impossible, and thus, engineers should clearly identify the targeted stroke population needs before the design of any device for the upper extremity.

Older adults' perspectives on the process of becoming users of assistive technology: a qualitative systematic review and meta-synthesis

PURPOSE

To identify, synthesize, and evaluate existing literature concerning the process of becoming a user of assistive technology (AT).

METHOD

A systematic review and meta-synthesis were carried out. Five bibliographic databases (MEDLINE via PubMed, CINAHL, Web of Science, PsycINFO and SocINDEX) were systematically searched up to 13^th of March 2017, using two sets of search terms: (i) elderly and synonyms and (ii) assistive technology and similar words, and combined with a qualitative research filter. Articles were screened, read and critically assessed. The meta-synthesis was guided by Ricoeur's theory of interpretation.

RESULTS

Seventeen out of 4645 articles were included. Five phases emerged relating to the process of becoming a user of AT: phase A: Evaluating need, phase B: Acknowledging need, phase C: Incorporating the AT into daily life, phase D: Using the AT, and phase E: Future use. Three transitions, describing factors essential to moving from one phase to the next, were identified; from phase A-B: Valued activities are threatened, from phase B-C: Obtaining the AT and from phase C-D: Trust in the AT. No transition was identified from phase D-E.

CONCLUSION

The meta-synthesis led to a deeper understanding of the process of older adults becoming users of AT, by exploring findings across the included articles. The identified phases and transitions in the systematic review serve as an analytical framework for understanding the process from the older adult's perspective. This review advocates for using a client-centred approach throughout the entire delivery process. Implications for rehabilitation The process of the older adult becoming a user of AT involves an individualized time factor, and this supports the practice of individualized follow-up. The process of becoming a user of AT is closely related to self-image; healthcare professionals should support not only the use of AT but also the older adult's emotional adjustment to a new self-image. The process is highly influenced by the older adult's social context; healthcare professionals should consider involving the client's social network in the AT delivery process.

Sensor technology more than a support

BACKGROUND

This interview study is a part of a project that evaluated sensor technology as a support in everyday activities for patients with memory impairment.

AIM

To explore patients with memory impairment and their partners' experiences of using sensor technology in their homes.

METHODS AND MATERIAL

Five patients with memory impairment after stroke and three partners were interviewed. Individual semi-structured interviews were analyzed with qualitative content analysis.

RESULTS

Installing sensor technology with individually prerecorded voice reminders as memory support in the home had a broad impact on patients' and their families' lives. These effects were both positive and negative. The sensor technology not only supported activities but also influenced the patients by changing behavior, providing a sense of security, independence and increased self-confidence. For the partners, the sensor technology eased daily life, but also gave increased responsibility for maintenance. Technical problems led to frustration and stress for the patients.

CONCLUSION

The results indicate that sensor technology has potential to increase opportunities for persons with memory impairment to perform and participate in activities and to unburden their partners. The results may promote an understanding of how sensor technology can be used to support persons with memory impairment in their homes.

The benefits and barriers to technology acquisition: Understanding the decision-making processes of older adults with age-related vision loss (ARVL)

Introduction

While research has investigated the factors influencing acquisition and use of technologies/assistive devices by older adults, few studies have addressed the decision-making processes regarding technology adoption of older adults with age-related vision loss.

Method

This critical ethnography engaged 10 older adults with age-related vision loss in narrative interviews, participant observation sessions, and semi-structured in-depth interviews to understand their decision-making processes related to the acquisition and use of low vision assistive devices to support occupational engagement.

Findings

Study findings focused on the benefits and barriers to technology acquisition and use. Benefits of technology acquisition included: enhanced occupational engagement; independence; safety; insurance; and validation of the disability, while the barriers to technology acquisition included: cost; training; usability; lack of awareness of low vision rehabilitation services; fear of being taken advantage of; and desire to preserve a preferred self-image.

Conclusion

Considering the low uptake of vision rehabilitation services, the study findings are important to occupational therapy. A better understanding of the perceived benefits and barriers to technology adoption from the perspective of older adults will help occupational therapists maximize treatment planning designed to enhance the occupational engagement of older adults aging with vision loss.

Equipment provision after stroke: A scoping review of the use of personal care and mobility aids in rehabilitation

Introduction

The aim of this scoping review was to examine and synthesise literature on adaptive equipment use for personal care and mobility after stroke.

Method

We searched databases including Medline, EMBASE, AMED, CINAHL and Scopus to February 2016. Two authors independently screened 789 titles, identifying 28 studies for inclusion in the review.

Results

Findings were grouped into four themes: (1) stroke-specific impairments and consequences for equipment use and training; (2) meaning of equipment for people with stroke; (3) cost of equipment after stroke; and (4) conflicts between equipment provision and models of stroke rehabilitation.

Conclusion

The wide range of impairments after stroke increases complexity of how people use equipment. Nonetheless, training needs and the relationship between social context, identity and equipment use are increasingly better understood,. The findings highlight a tension between practice that seeks to re-train function by ‘normal’ movement without equipment and restoration of function by using compensation strategies involving use of equipment. However, there is no evidence that compensation strategies impede recovery of physical abilities. High-quality evidence about costs of equipment after stroke, which could inform policy decisions, is urgently needed.

Policy in Action: Stories on the Workplace Accommodation Process

Workplace accommodation is an important measure to ensure equal employment opportunities for people with disabilities. Substantial research has investigated workplace accommodations in the United States. This article represents a first step in exploring the complexities of workplace accommodation from a cross-national perspective. Drawing on 29 qualitative interviews with employed Americans and Norwegians with mobility disabilities, we investigated similarities and differences in experiences with accommodation provision. Two main similarities emerged: Many of the American and Norwegian interviewees made use of accommodations, and the employer played an important role in the provision process in both countries. Concerning the particular role of the employer, two main differences emerged: American interviewees’ accounts of obstacles to a smooth accommodation process were related to the redistribution agent (i.e., the employer). In Norway, employers can either provide the accommodation themselves or make use of subsidized public services. When the employer chose to make use of public services, Norwegian interviewees reported a slow process and obstacles that were related to the recognition of eligibility, which rests on medical assessment. The article reveals a common vulnerability among people with disabilities when dependent on the recognition of their needs and effective provision of workplace accommodation to be competitive employees.

Readiness for Technology Use With People With Dementia

Technology is believed to have a potential for supporting significant others of people with dementia but little is known of their experiences and views of technology. The aim of this study is to explore how significant others relate to technology and to their relatives with dementia as technology users. The focus is on both their own use of technology as significant others and the use of technology by their relatives with dementia. Individual interviews and focus group discussions were undertaken and analyzed using a grounded theory approach. The significant others showed an overall readiness toward using technology in their present roles. Technology use in daily activities was perceived to be an important means to keeping retained abilities exercised but could also be perceived as a possible threat to health if activities were oversimplified. The significant others asked for flexible technology not perceived as stigmatizing, to be integrated into existing habits.

Occupational Adaptation in People with Multiple Sclerosis

The aim of this study was to gain an enhanced understanding of how people with multiple sclerosis experience their occupational adaptation. Ten people with multiple sclerosis were interviewed and the constant comparative method was used to analyze the data. Their occupational adaptation was experienced as a constant struggle and non-linear, and served as the means of achieving either a desired self or a desired family life. Adaptations of occupations differed according to the evolving goals of the participants. The findings showed that the participants often selected occupational adaptations to meet their family needs over their own. These findings can help professionals to establish where their clients with multiple sclerosis are in the adaptation process and offer appropriate client-centered interventions.

Adjustment to severe disability: constructing and examining a cognitive and occupational performance model

Ninety adults with severe physical disabilities were tested with respect to their adjustment to severe disabilities in their adapted computerized work environment 1 year following occupational therapy consultation. The research goal was to examine a model that incorporates variables from the cognitive coping model (self-esteem, appraisal and social support) and variables from the occupational performance model (engagement in activities, involvement in work/study, time of typing performance and environmental adaptations). Findings showed goodness of fit between the observed and the proposed research models, although few changes in positions and relations were found. Self-esteem and time of performance were found to be core variables connecting cognitive and functional variables. Age and activities of daily living were the only background variables that contributed to the model. Research and rehabilitation clinical implications are discussed.