Mobile device accessibility with 3D printed devices for individuals with physical disabilities

PURPOSE

Disparities may disproportionately exist for those with disabilities when using mobile devices, which are critical for independence in activities such as socialization and leisure. Prior 3D printing studies in rehabilitation have not focused on mobile device access to everyday preferred activities.

METHODS

This study examined user satisfaction, self-rated performance and satisfaction with daily activities while using the mobile device, and the feasibility of customized 3D printed assistive devices. The design was a one-group, quantitative pre-test to post-test study of individuals (n = 10) residing in long-term care with a physical disability due to a neurological condition.

RESULTS

Satisfaction with the 3D printed device, as compared to the previously used assistive device, was significantly higher (p = 0.005), as well as improvements in self-rated daily activity performance (p = 0.016) and satisfaction (p = 0.037), with acceptability and satisfaction of the intervention.

CONCLUSIONS

Findings suggest that 3D printing is feasible with a potential increase in user satisfaction through a customization process that is client centred.

The Upper Extremity Functional Scale for Prosthesis Users (UEFS-P): subscales for one and two-handed tasks

PURPOSE

To develop a self-report measure of activity performance for upper limb prosthesis users that quantifies outcomes by level of amputation and prosthesis type.

MATERIALS AND METHODS

Telephone survey of 423 adults with major upper limb amputation (ULA) who used a prosthesis. Item generation, cognitive, and pilot testing were followed by field testing. Items were categorized as one- or two-handed. Factor and Rasch analyses evaluated unidimensionality, monotonicity, item fit, differential item functioning (DIF), and reliability. Test-retest reliability was evaluated with intraclass correlation coefficients (ICCs). Known group validity was assessed with ANOVAs.

RESULTS

Respondents with unilateral ULA utilized prosthesis for 24% of unilateral and 38% of bilateral tasks. Those with bilateral ULA utilized prostheses for 64% of unilateral and 46% of bilateral tasks. Factor analyses identified a One-handed Task factor (CFI = 0.963, TLI = 0.950, and RMSEA = 0.064) and a Two-Handed Task factor (CFI = 0.958, TLI = 0.953, and RMSEA = 0.053). Response categories were collapsed to address monotonicity. After DIF adjustment, person reliability was 0.49 and 0.82 for One-handed and Two-handed Task scales, respectively, and ICCs were 0.88 and 0.91. Both scales differed by amputation level (p < 0.001).

CONCLUSIONS

The Upper Extremity Functional Scale for Prosthesis Users (UEFS-P) measure of upper limb function of prosthesis users has promising psychometric properties.Implications for rehabilitationMeasurement of upper limb function in persons with amputation is challenging, given currently available measures which do not explicitly grade activity performance with a prosthesis.The Upper Extremity Functional Scale for Prosthesis Users (UEFS-P) builds upon the original Orthotics and Prosthetics User Survey (OPUS) UEFS Scale with modified instructions, a revised item set, response categories and scoring algorithm.The UEFS-P consists of two unidimensional scales, the One-handed Tasks scale and the Two-handed Tasks scale.The UEFS-P scales have clear advantages over existing self-report measures of upper limb function that ask about difficulty with performing functional activities without accounting for prosthesis use, and do not differentiate persons who use and do not use a prosthesis.

Pain, hand function, activity performance and apprehensiveness, in patients with surgically treated distal radius fractures

Distal radius fracture (DRF) is a common injury, affecting both function and activity performance. Postoperative rehabilitation is an essential part of the treatment of a surgically treated DRF. The study aims were to assess pain, hand function, activity performance and apprehensiveness and their association, during the first three months after a surgically treated DRF. Eighty-eight patients with a DRF were assessed for pain, hand function, activity performance and apprehensiveness three days and two, six and 12 weeks after surgery. The results indicated that pain, range of motion (ROM), grip strength, apprehensiveness, and activity performance (PRWE) improved significantly between follow-ups (p < .001-.01). Apprehensiveness correlated moderately with activity performance on all visits (0.40-0.47, p < .01), which implies a correlation between the variables, but the regression model showed that the differences in the PRWE at twelve weeks cannot be explained by the differences in apprehensiveness or range of motion at cast removal. At 12 weeks, the study participants had regained almost 70% of their grip strength and 74-96% of the ROM of the uninjured hand.The study shows that, during the study period, the participants improved in both pain, hand function and activity performance, and indicates that a simple question on apprehensiveness in terms of using the injured hand in daily life could be an important factor in distal radius fracture rehabilitation.

Activity Performance, Participation, and Quality of Life Among Adults in the Chronic Stage After Acquired Brain Injury-The Feasibility of an Occupation-Based Telerehabilitation Intervention

Objective: Acquired brain injury (ABI) is a leading cause of long-term disability. This calls for effective and accessible interventions to support participation in the community over time. One promising avenue to answer this need is telerehabilitation. Prior to conducting a larger trial, the main objective of this pilot study is to explore the feasibility, acceptability, and preliminary efficacy of a metacognitive occupation-based intervention in a telerehabilitation format with adults and older adults in the chronic phase after ABI.

Methods: Five community dwelling participants (ages 65–72), 6–10 months post-ABI, with scores 2–4 on the modified Rankin scale and without dementia, completed the teleintervention. The intervention included ~10 weekly videoconferencing sessions administered by an occupational therapist using the Cognitive Orientation to Daily Occupational Performance approach. Each participant defined five functional goals and three were trained and two were not trained during the intervention. Evaluations were conducted at pre, post, and 3-month follow-up. The primary outcome measures included activity performance (The Canadian Occupational Performance Measure; COPM), participation (the Mayo-Portland Adaptability Inventory-4 Participation Index; MPAI-4-P), and quality of life (QoL) (stroke impact scale; SIS). Other measures included a feedback interview, satisfaction questionnaire, field notes, and a treatment fidelity checklist.

Results: The teleintervention was found to be feasible and the participants expressed a high degree of satisfaction with the intervention and the technology use. A Wilcoxon Signed-Ranks test indicated statistically significant improvements post intervention in COPM performance (z = −2.023, p = 0.043) and satisfaction (z = −2.023, p = 0.043) ratings. Additionally, clinically significant improvements (≥2 points) in both performance and satisfaction with performance were found for each participant in at least three of their five defined functional goals. Trends toward significant improvement were found in MPAI-4-P ratings post intervention (z = −1.826, p = 0.068). Furthermore, clinically significant improvements (≥15 points) post intervention were found for each participant in some subscales of the SIS. Results were partially maintained at 3-month follow-up.

Conclusions: This pilot study demonstrated the feasibility of a metacognitive occupation-based telerehabilitation intervention and its potential benefits in activity performance, participation, and QoL for older adults coping with long-term disability following ABI.

Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03048708.

A Paradigm Shift: Rehabilitation Robotics, Cognitive Skills Training, and Function After Stroke

Introduction: Robot-assisted therapy for upper extremity (UE) impairments post-stroke has yielded modest gains in motor capacity and little evidence of improved UE performance during activities of daily living. A paradigm shift that embodies principles of motor learning and exercise dependent neuroplasticity may improve robot therapy outcomes by incorporating active problem solving, salience of trained tasks, and strategies to facilitate the transfer of acquired motor skills to use of the paretic arm and hand during everyday activities.

Objective: To pilot and test the feasibility of a novel therapy protocol, the Active Learning Program for Stroke (ALPS), designed to complement repetitive, robot-assisted therapy for the paretic UE. Key ALPS ingredients included training in the use of cognitive strategies (e.g., STOP, THINK, DO, CHECK) and a goal-directed home action plan (HAP) to facilitate UE self-management and skill transfer.

Methods: Ten participants with moderate impairments in UE function >6 months after stroke received eighteen 1-h treatment sessions 2–3/x week over 6–8 weeks. In addition to ALPS training, individuals were randomly assigned to either robot-assisted therapy (RT) or robot therapy and task-oriented training (RT-TOT) to trial whether the inclusion of TOT reinforced participants' understanding and implementation of ALPS strategies.

Results: Statistically significant group differences were found for the upper limb subtest of the Fugl-Meyer Assessment (FMA-UE) at discharge and one-month follow-up favoring the RT group. Analyses to examine overall effects of the ALPS protocol in addition to RT and RT-TOT showed significant and moderate to large effects on the FMA-UE, Motor Activity Log, Wolf Motor Function Test, and hand portion of the Stroke Impact Scale.

Conclusion: The ALPS protocol was the first to extend cognitive strategy training to robot-assisted therapy. The intervention in this development of concept pilot trial was feasible and well-tolerated, with good potential to optimize paretic UE performance following robot-assisted therapy.

Brief activity performance measure for upper limb amputees: BAM-ULA

BACKGROUND

Measures of activity performance for adults with upper limb amputation are needed. The purposes of this study were to evaluate the measurement properties of a new measure of activity performance for adults with upper limb amputation, which we call the Brief Activity Measure for Upper Limb Amputees (BAM-ULA) and to compare BAM-ULA scores for users of different types of prostheses.

METHODS

In all, 35 persons with upper limb amputation were administered the BAM-ULA, twice within 1 week. Internal consistency and test-retest reliability were evaluated. Construct validity was examined by comparing scores by amputation level. Concurrent validity was evaluated by examining correlations with other measures. Exploratory analyses using linear regression compared sub-group scores for users of myoelectric and body-powered devices, and for users of single-degree-of-freedom and multi-articulating devices, controlling for amputation level.

RESULTS

The scale alpha was 0.83; intraclass correlation coefficient was 0.91. Item scores differed by amputation level and device type. Persons with transradial amputation completed more items than those with amputations at the transhumeral or shoulder level ( p < 0.05). Users of myoelectric devices completed more items than users of body-powered devices ( p < 0.05). The BAM-ULA strongly correlated with the Activities Measure for Upper Limb Amputees; R = 0.86) and three modified Jebsen-Taylor Hand Function Tests ( R = 0.62-0.68) and moderately correlated with one Jebsen-Taylor Hand Function Test ( R = 0.46) as well as with the Wong-Baker FACES Pain Rating Scale. No differences in scores were found by degree of freedom of the terminal device after controlling for amputation level.

CONCLUSION

Analyses support reliability, construct validity, and concurrent validity of the Brief Activity Measure for Upper Limb Amputees. This new briefer measure is easier to score than the Activities Measure for Upper Limb Amputees. Clinical relevance This article reported on the development and evaluation of a brief 10-item measure of activity performance for persons with upper limb impairment, the BAM-ULA. The BAM-ULA takes 10 min to administer and has a simple scoring method, which may facilitate its adoption by clinicians in the field.

Accelerometry-Based Activity Recognition and Assessment in Rheumatic and Musculoskeletal Diseases

One of the important aspects to be considered in rheumatic and musculoskeletal diseases is the patient's activity capacity (or performance), defined as the ability to perform a task. Currently, it is assessed by physicians or health professionals mainly by means of a patient-reported questionnaire, sometimes combined with the therapist's judgment on performance-based tasks. This work introduces an approach to assess the activity capacity at home in a more objective, yet interpretable way. It offers a pilot study on 28 patients suffering from axial spondyloarthritis (axSpA) to demonstrate its efficacy. Firstly, a protocol is introduced to recognize a limited set of six transition activities in the home environment using a single accelerometer. To this end, a hierarchical classifier with the rejection of non-informative activity segments has been developed drawing on both direct pattern recognition and statistical signal features. Secondly, the recognized activities should be assessed, similarly to the scoring performed by patients themselves. This is achieved through the interval coded scoring (ICS) system, a novel method to extract an interpretable scoring system from data. The activity recognition reaches an average accuracy of 93.5%; assessment is currently 64.3% accurate. These results indicate the potential of the approach; a next step should be its validation in a larger patient study.

Analysis of Community Participation Levels of Individuals Who Are Physically Disabled and Working in Industrial Environments

The purpose of this study was to determine quality of life, leisure time satisfaction, activity performance, and community participation and analyze the relationship between these determinants and community participation in both physically disabled individuals working in industrial environments and nonworking individuals who are physically disabled. Sociodemographic data was registered into a sociodemographic form. World Health Organization Disability Assessment Schedule 2.0 was used to assess community participation. Activity performance was evaluated with Canadian Occupational Performance Measure. Leisure Satisfaction Scale was used to determine leisure time satisfaction. Short Form-36 was used for evaluating quality of life. When the participants were compared in terms of working status, a significant difference according to their WHO-DAS-II total scores were found (p < 0.05). When all participants were compared in terms of activity performance, lesisure time satisfaction, quality of life a significant differences according to their WHO-DAS-II total scores were found (p>0.05). This study shows that community participation was affected by working status, disability level, activity performance, leisure time satisfaction and quality of life. In this regard, occupational therapy and physiotherapy approaches were found necessary for developing community participation. We conclude that this study's results can be used as a guide for community participation in disabled people in community based rehabilitation politics.

Musculoskeletal Discomfort, Physical Demand, and Caregiving Activities in Informal Caregivers

OBJECTIVES

To characterize the burden of care and musculoskeletal discomfort associated with caring for adults with chronic physical disability among informal caregivers and to describe the most physically demanding caregiving activities and contributing factors, as perceived by informal caregivers of adults with physical disabilities.

METHODS

A mixed methods approach was used for the study. Forty-six informal caregivers of adults with physical disability participated.

RESULTS

Most caregivers were classified as "high burden" caregivers. They reported high levels of physical strain and musculoskeletal discomfort. Caregivers identified several activities related to mobility and self-care as the most physically demanding. Factors affecting physical demand included caregiver and care-recipient characteristics, activity requirements, and the physical environment.

CONCLUSION

Interventions that target high-demand caregiving activities, including all three aspects of caregiving activity performance, are necessary to support adults with disabilities in the home and their caregivers.

A systematic review protocol to evaluate the psychometric properties of measures of function within adult neuro-rehabilitation

BACKGROUND

Spasticity in the upper limb is common after acquired brain impairment and may have a significant impact on the ability to perform meaningful daily activities. Traditionally, outcome measurement in spasticity rehabilitation has focused on impairment, however, improvements in impairments do not necessarily translate to improvements in an individual's ability to perform activities or engage in life roles. There is an increasing need for outcome measures that capture change in activity performance and life participation.

METHODS/DESIGN

We will conduct a systematic review of the psychometric properties of instruments used to measure upper limb functional outcomes (activity performance and participation) in patients with spasticity. Assessments (n = 27) will be identified from a recently published systematic review of assessments that measure upper limb function in neurological rehabilitation for adults with focal spasticity, and a systematic review of each assessment will then be conducted. The databases MEDLINE, CINAHL and EMBASE will be searched from inception. Search strategies will include the name of the assessment and the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) published search strategy for identifying studies of measurement properties. The methodological rigour of the testing of the psychometric quality of instruments will be undertaken using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. International Classification of Functioning, Disability and Health (ICF) definitions of impairment, activity and participation will be used for content analysis of items to determine the extent to which assessments are valid measures of activity performance and life participation. We will present a narrative synthesis on the psychometric properties and utility of all instruments and make recommendations for assessment selection in practice.

DISCUSSION

This systematic review will present a narrative synthesis on the psychometric properties and utility of assessments used to evaluate function in adults with upper limb focal spasticity. Recommendations for assessment selection in practice will be made which will aid clinicians, managers and funding bodies to select an instrument fit for purpose. Importantly, appropriate assessment selection will provide a mechanism for capturing how applicable to everyday life the outcomes from individualised rehabilitation programs for the upper limb really are.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42014013190.