An interdisciplinary approach to evaluating the need for assistive technology reduces equipment abandonment

Assistive devices non-use, abandonment, or non-adherence? Toward standard terminology for assistive devices outcomes

For individuals with disabilities, failure to use prescribed assistive technology devices (ATDs) according to professional recommendations can have detrimental health consequences. The literature has employed various terms to describe this phenomenon such as nonuse, abandonment, and non-adherence to characterize this behavior, lacking clear and standardized definitions. Consistent use of a standardized language is critical for advancing research in this area. This study aims to identify and describe the concepts related to the failure to use prescribed ATDs, along with the associated contexts, and proposes a framework for standardizing terminology in this domain. A narrative literature review encompassing studies from inception to June 2023 was conducted to elucidate these concepts. Out of 1029 initially identified articles, 27 were retained for in-depth analysis. The review unveiled a significant inconsistency in the use of terms like nonuse, abandonment, noncompliance, and non-adherence. Some articles even employed these terms interchangeably without clear definitions. Only 10 of the 27 reviewed articles provided definitions for the terminology they used. This highlights the crucial need for adopting valid conceptual models to select appropriate terms. Researchers are strongly encouraged to furnish operational definitions aligned with theoretical models and relevant to their research context to advance this field consistently.

Assistive technology in Korea: Findings from the 2017 National Disability Survey

PURPOSE

Explicitly monitoring the need, use and satisfaction of assistive product (AP) provision is essential to support population health and healthy longevity in ageing/aged countries, like Korea. We present findings from the 2017 Korea National Disability Survey (NDS) on AP access and compare them to international averages, introducing Korea's data into the wider coherence of global AP research.

MATERIALS AND METHODS

Using data from Korea's 2017 NDS, surveying 91,405 individuals, we extracted and calculated AP access indicators, including needing, having, using and being satisfied with 76 unique APs, by functional difficulty and product type. We compared satisfaction and unmet need between the National Health Insurance System (NHIS) and alternative provision services.

RESULTS

Prosthetics and orthotics had high rates of under-met need, and lower satisfaction rates, from 46.9% to 80.9%. Mobility APs overall had higher rates of under-met need. There was either low (<5%) or no reported need for most digital/technical APs. Among main products, those provided through the NHIS had lower unmet need (26.4%) than through alternative providers (63.1%), though satisfaction rates were similar (p < .001).

CONCLUSIONS

The Korean survey findings align with global averages calculated in the Global Report on Assistive Technology. Low reported needs for certain APs may reflect low awareness about how these products could benefit users, emphasizing the importance of data collection at each stage of the AP provision process. Recommendations to expand access to APs are given for people, personnel, provision, products, and policy.

A heuristic-based approach for assessing usability in electric powered wheelchairs: A preliminary investigation

OBJECTIVE

An important issue related to electric powered wheelchair (EPW) is usability. Recent studies did not use heuristic evaluation and did not consider users' and developers' participation in the usability evaluation process of the EPW, especially when it has to be driven using alternative commands. Thus, this study investigates the use of heuristics to evaluate the usability of EPW driven by alternative commands, considering the opinion of users and assistive technology (AT) development professionals.

METHODS

The study was carried out with 54 participants: 28 EPW users (Group I) and 26 AT developers (Group II). We built a set of 25 heuristics that affects EPW usability. Participants rated each of the 25 heuristics according to their importance for the usability of EPW using the five-point Likert scale. We used the R Software to perform the Wilcoxon Mann-Whitney test as a statistical comparisons test between Group I and II.

RESULTS

The results showed a statistically significant difference (p<0.05) between Group I and II in the evaluation of 16 heuristics. We identified an important set of heuristics that could help evaluate and improve the usability of EPW.

CONCLUSION

The findings highlighted the importance of considering users' and developers' points of view in developing an EPW and its evaluation criteria. It could help the design of the device match the user's needs and expectations. The set of heuristics in this study can be adapted to evaluate other devices' usability using the heuristic evaluation approach.

Rehabilitation counsellor perceived importance and competence in assistive technology

PURPOSE

Assistive technology (AT) has received much attention for its capacity to improve quality of life for individuals with disabilities. While AT can be promising, the high AT abandonment issue persists. Rehabilitation counsellors are considered important in solving such an issue. However, how to effectively prepare rehabilitation counsellors to provide AT services remain unclear. This study aims to investigate the field experience of rehabilitation counsellors and identify the most relevant AT knowledge and skills to the profession.

METHOD

A survey that explores rehabilitation counsellors perceived AT importance and competence was used. A total of 237 rehabilitation counsellors in the United States were recruited via the email listserv provided by Commission on Rehabilitation Counsellor Certification.

RESULTS

The results indicated that while rehabilitation counsellors considered AT important to them, they felt ill-prepared in providing such services. Of the three subscales, the ability to use AT was rated with the highest importance and the knowledge of AT was rated with the lowest competence.

CONCLUSION

Although it is impossible for rehabilitation counsellors to know every aspect of the AT services, five training areas were identified to be a priority. Specifically, these five areas include training to improve rehabilitation counsellors' (a) awareness of AT benefit, (b) knowledge and skill of AT assessment, (c) knowledge of computer based AT and the use of social media, (d) skill in using AT to increase service accessibility, and (e) ability to assist clients decision making that addresses both physical and psychological needs.IMPLICATIONS FOR REHABILITATION•Confirm the importance of AT in rehabilitation counselling practices.•Recognise the limited AT competence amongst rehabilitation counsellors.•Identify five areas for more AT training that improve rehabilitation counsellors'•Awareness of AT benefit,•Knowledge and skill of AT assessment,•Knowledge of computer based AT and the use of social media,•Skill in using AT to increase service accessibility, and•Ability to assist clients decision making that addresses both physical and psychological needs.

Physical therapist clinical reasoning in home care for walking assistive device prescription: A description of practice

BACKGROUND

Home care in the United States (US) provides rehabilitative care to people who are homebound after acute hospitalization. Patients with stroke and brain injury (BI) are commonly seen by physical therapists (PTs/PTAs), who often address the loss of walking independence. Clinical reasoning (CR) is required for walking assistive device (WAD) prescription within the home. There has never been a description of the home care PT CR process, which could inform entry-level training and health policy.

PURPOSE

To describe the homecare CR process by identifying factors used for prescription of WADs in patients with stroke and BI. Secondly, to describe any practice issues associated with WADs.

METHODS

Directors of 7 agencies affiliated with Nazareth College DPT program were recruited to identify PTs/PTAs to complete an online survey between March - July 2017. Quantitative and qualitative data were collected, and analyzed for frequencies or for common themes.

RESULTS

A total of 334 PTs/PTAs were enrolled from all agencies and 72 responses were analyzed. The CR process did not differ between stroke and BI. Safety was the primary factor, which was assessed by patient query, observation skills, and objective measures. PTs/PTAs also measured balance, strength, function, cognition, and patient preferences within the context of the home. WADs obtained prior to initiation of home care often weren't used.

CONCLUSION

A complex CR process has been described for WAD prescription in home care for patients with stroke and BI. Entry-level training and health policy implications are described.

Communication between persons with multiple sclerosis and their health care providers: A scoping review

OBJECTIVES

This study undertakes a scoping review of research about communication between persons with MS and their health care providers.

DESIGN

PubMed, PsycInfo, Communication Source, Socindex, Sociological Abstracts, Cinahl, and Proquest Dissertations and Theses were used to identify studies since each database's inception. Research team members engaged in study selection, coding for communication issues, and data extraction for descriptive information.

RESULTS

Of the 419 empirical articles identified, 175 were included. Codes represented all elements of ecological and pathway models, emphasizing emerging technologies for facilitating communication, uncertainty and anxiety for persons with MS, and communication issues surrounding diagnosis, information seeking, and decision making.

CONCLUSION

This review synthesizes and organizes influences on communication, communication processes, and health outcomes of communication for persons with MS and their providers. Findings extend the ecological model with illness context and the pathway model with communication breakdowns and provider outcomes.

PRACTICE IMPLICATIONS

Health care providers should consider the complexity of communication when interacting with persons with MS, including the larger context in which it occurs, communication processes and their purposes, and short-term and long-term consequences of interactions. Ecological and pathway models can be frameworks for developing educational materials, as they succinctly capture key communication issues and outcomes.

Assistive devices among people living at home with advanced cancer: Use, non-use and who have unmet needs for assistive devices?

Objective

To investigate which assistive devices people with advanced cancer have and whether they are in use. In addition, to explore the characteristics of people with advanced cancer who have unmet needs for assistive devices.

Methods

This descriptive cross‐sectional study used data from a randomised controlled trial evaluating efficacy of an occupational therapy‐based intervention. Participants were 237 people with advanced cancer. Data were collected by means of instruments about demography, functioning and assistive devices.

Results

The most frequent assistive devices possessed by the participants were as follows: (1) small aids for dressing (47%), (2) Pillow for positioning (40%) and (3) electrically operated adjustable bed (39%). The prevalence of assistive devices was 92% (95% confidence interval [CI]: 88%–95%) with 14.2% non‐use, largest for trolley tables (50%). In all, 27.4% of the participants were found to have unmet needs for assistive devices. These participants had similar characteristics to the other participants except from lower activity of daily living (ADL) ability (p values = <0.001).

Conclusion

The assistive devices possessed by the participants were primarily for positioning and resting, and most were in use. More than a fourth of the participants had unmet needs for assistive devices and were characterised by lower ADL ability.

How is and how should healthcare for people with multiple sclerosis in Germany be designed?-The rationale and protocol for the mixed-methods study Multiple Sclerosis-Patient-Oriented Care in Lower Saxony (MS-PoV)

Background

Multiple sclerosis (MS) is the most common autoimmune inflammatory disease of the central nervous system in Europe, often causing severe physical, cognitive and emotional impairments. Currently, it is unclear whether the healthcare provisions of people with MS (PwMS) are in line with the recommendations for treatment based on guidelines or patients’ needs. The main objectives of the study are as follows: (a) to investigate how well PwMS are treated; and (b) to develop a needs-oriented, patient-centred care model.

Methods

This mixed-methods study focuses on adult PwMS living in Lower Saxony, a federal state in Germany. The qualitative study comprises focus groups with PwMS, physicians and people involved in the healthcare process as well as a future workshop. The quantitative study comprises a cross-sectional online survey and addresses the patient-relevant outcomes and needs, as previously determined by literature searches and focus groups. It will be administered to all PwMS who are insured by the statutory health insurance company involved in the project (n~7,000). The survey data will be linked to the longitudinal secondary data from the statutory health insurance company and data from the German MS registry where available. The linked and single data sources will be statistically analysed.

Discussion

By comprehensively comparing the current healthcare provisions with the needs and requirements of PwMS, the strengths and weaknesses of the overall healthcare process and provision of assistive devices can be identified. The barriers and facilitators of the health service providers and their impact on daily life will be explored (qualitative analyses). Reliable recommendations for improvements will be given based on a study population drawn from the largest statutory health insurance company in Lower Saxony (quantitative analyses). However, the inherent advantages and limitations of the qualitative and quantitative research approaches need to be considered.

Trial registration

The study is registered at German Clinical Trials Register DRKS00021741.

Matuto, Magbasa, Maglaro: Learning to read braille through play

In September 2016, Digital Learning for Development and All Children Reading released a "Grand Challenge for Development" urging researchers to explore the barriers that children with sensory disabilities in the Philippines face with respect to learning how to read. We sought to address one component of this challenge; engagement of persons with visual impairment in learning how to read in braille. The primary goal of this study was to engage in the co-design process to create a device to help young children with visual impairments learn to identify letters and short words in braille as a first step to reading.Participant questionnaires identified barriers of current reading devices including: accessibility, portability, durability, usability, and function. A design was prototyped based on results from a weighted evaluation matrix and feedback from partners who taught reading to persons with visual impairments. Usability testing showed that the device was easy to use and interactive. Suggestions for improvement included adding various learning modes and reducing the size, weight, and cost of the device.Results from this study highlight advantages of engaging in the co-design process and provide important data for other researchers developing devices for persons with visual impairments.

Joining semantic and augmented reality to design smart homes for assistance

Introduction

Smart homes for assistance help compensate cognitive deficits, thus favoring aging in place. However, to be effective, the assistance must be adapted to the abilities, deficits, and habits of the person. Beside the elder, caregivers are the ones who know the person’s needs best. This article presents a Do-it-Yourself approach for helping caregivers designing a smart home for assistance.

Methods

A co-construction process between a caregiver and a virtual adviser was designed. The knowledge of the virtual adviser about smart homes, activities of daily living and assistance is organized in an ontology. The caregiver interacts with the virtual adviser in augmented reality to describe the home and the resident’s habits inside it. The process is illustrated with an ordinary activity: ‘Drink water’.

Results

The proposed process highlights two main steps: describing the environment and determining the resident’s habits and the assistance required to improve activity performance. Visual guidance and feedback are provided to ease the process.

Conclusion

Designing a co-construction process with a virtual adviser allows interactive knowledge sharing with the caregivers who are experts of the person’s needs. Future work should focus on evaluating the prototype presented and providing deeper advice such as highlighting incomplete or incorrect scenarios, or navigation aid.

Usability, occupational performance and satisfaction evaluation of a smart environment controlled by infrared oculography by people with severe motor disabilities

A smart environment is an assistive technology space that can enable people with motor disabilities to control their equipment (TV, radio, fan, etc.) through a human-machine interface activated by different inputs. However, assistive technology resources are not always considered useful, reaching quite high abandonment rate. This study aims to evaluate the effectiveness of a smart environment controlled through infrared oculography by people with severe motor disabilities. The study sample was composed of six individuals with motor disabilities. Initially, sociodemographic data forms, the Functional Independence Measure (FIM^TM), and the Canadian Occupational Performance Measure (COPM) were applied. The participants used the system in their domestic environment for a week. Afterwards, they were reevaluated with regards to occupational performance (COPM), satisfaction with the use of the assistive technology resource (QUEST 2.0), psychosocial impact (PIADS) and usability of the system (SUS), as well as through semi-structured interviews for suggestions or complaints. The most common demand from the participants of this research was ‘control of the TV’. Two participants did not use the system. All participants who used the system (four) presented positive results in all assessment protocols, evidencing greater independence in the control of the smart environment equipment. In addition, they evaluated the system as useful and with good usability. Non-acceptance of disability and lack of social support may have influenced the results.

Psychosocial Impact of Assistive Devices and Other Technologies on Deaf and Hard of Hearing People

Deaf and hard of hearing people use a variety of assistive devices and technologies as a strategy to mitigate, counter or compensate for life difficulties resulting from hearing loss. Although outcome measures are commonly used with hearing aids, few studies have explored the perceived psychosocial impact of other assistive devices and technologies or the factors leading to their abandonment or lack of use. Therefore, the main aim of this study was to assess the psychosocial impact of different assistive devices on deaf and hard of hearing people using the Psychosocial Impact of Assistive Devices Scale. The sample was made up of 291 individuals, 176 women and 115 men, with an average age of 56.12 years (standard deviation (SD) = 25.11), who were all users of different assistive devices. Overall, the results of the study showed that the use of assistive devices had a positive psychosocial impact, although this impact varied slightly depending on the specific type of device. Moreover, a relationship was identified between the psychosocial impact and the probability of future abandonment of a hearing aid or a cochlear implant. The results point to the importance of considering the psychosocial impact derived from the use of a device as a relevant variable in the adoption process of assistive technologies for deaf and hard of hearing people.

Biomechanical analysis of an unpowered hip flexion orthosis on individuals with and without multiple sclerosis

BACKGROUND

Gait impairment is a common complication of multiple sclerosis (MS). Gait limitations such as limited hip flexion, foot drop, and knee hyperextension often require external devices like crutches, canes, and orthoses. The effects of mobility-assistive technologies (MATs) prescribed to people with MS are not well understood, and current devices do not cater to the specific needs of these individuals. To address this, a passive unilateral hip flexion-assisting orthosis (HFO) was developed that uses resistance bands spanning the hip joint to redirect energy in the gait cycle. The purpose of this study was to investigate the short-term effects of the HFO on gait mechanics and muscle activation for people with and without MS. We hypothesized that (1) hip flexion would increase in the limb wearing the device, and (2) that muscle activity would increase in hip extensors, and decrease in hip flexors and plantar flexors.

METHODS

Five healthy subjects and five subjects with MS walked for minute-long sessions with the device using three different levels of band stiffness. We analyzed peak hip flexion and extension angles, lower limb joint work, and muscle activity in eight muscles on the lower limbs and trunk. Single-subjects analysis was used due to inter-subject variability.

RESULTS

For subjects with MS, the HFO caused an increase in peak hip flexion angle and a decrease in peak hip extension angle, confirming our first hypothesis. Healthy subjects showed less pronounced kinematic changes when using the device. Power generated at the hip was increased in most subjects while using the HFO. The second hypothesis was not confirmed, as muscle activity showed inconsistent results, however several subjects demonstrated increased hip extensor and trunk muscle activity with the HFO.

CONCLUSIONS

This exploratory study showed that the HFO was well-tolerated by healthy subjects and subjects with MS, and that it promoted more normative kinematics at the hip for those with MS. Future studies with longer exposure to the HFO and personalized assistance parameters are needed to understand the efficacy of the HFO for mobility assistance and rehabilitation for people with MS.

Trekking Poles to Aid Multiple Sclerosis Walking Impairment: An Exploratory Comparison of the Effects of Assistive Devices on Psychosocial Impact and Walking

Background

Walking dysfunction is reported by two-thirds of persons with multiple sclerosis (MS). Assistive devices are frequently recommended to improve walking; however, it is uncommon to consider their psychosocial impact, although many users abandon their assistive devices. The psychosocial impact, walking, balance, and fatigue associated with three assistive devices were compared to guide clinical decision making.

Methods

Twenty-five persons with MS (median Expanded Disability Status Scale score, 4.0; range, 2.5-6.0) who reported walking difficulty were trained in the use of three assistive devices-a single-point cane (SPC), a four-point cane (FPC), and a trekking pole (TP)-at 1- to 2-week intervals, then used the assistive device for their usual activities. Outcome measures included the Psychosocial Impact of Assistive Devices Scale (PIADS), the 6-Minute Walk Test (6MWT), walking speed, cadence, stride length, stride time, the 12-item Multiple Sclerosis Walking Scale (MSWS-12), the Activities-specific Balance Confidence (ABC) scale, the 5-item Modified Fatigue Impact Scale (MFIS-5), and a visual analogue scale of fatigue (VAS-F).

Results

The SPC and TP were more positive in the PIADS adaptability, competence, and self-esteem subscales. The SPC and TP resulted in higher 6MWT, walking speed, cadence, stride length, stride time, and MSWS-12 scores compared with the FPC. No differences were found in ABC scale, MFIS-5, or VAS-F scores.

Conclusions

Participants reported more positive psychosocial impact, and walked faster and with higher quality, with the SPC and TP than with the FPC. Clinicians should consider suggesting an SPC or TP to patients who may benefit from assistive device use and for whom psychosocial impact is an important consideration.

Personalized Telerehabilitation for a Head-mounted Low Vision Aid: A Randomized Feasibility Study

SIGNIFICANCE

A recent trend in low vision rehabilitation has been the use of portable head-mounted displays to enhance residual vision. Our study confirms the feasibility of telerehabilitation and informs the development of evidence-based recommendations to improve telerehabilitation interventions to reduce device abandonment.

PURPOSE

To develop evidence-based recommendations for telerehabilitation, we conducted a feasibility study in preparation for a future randomized trial on the use of head-mounted displays.

METHODS

We recruited novice eSight Eyewear users, randomized 1:1: the experimental group received telerehabilitation by a low vision therapist using video conferencing; the control group completed at home self-training provided by the device manufacturer. The primary feasibility outcomes were whether the recruitment goal of 60 participants (30/group) was attainable within 1 year and how participants judged the accessibility and acceptability of the telerehabilitation. An exploratory outcome was the impact of telerehabilitation on eSight Eyewear use behavior.

RESULTS

Among 333 eSight users, 57 participants were enrolled, of which 35% withdrew from the study, whereas the remainder completed the 6-month follow-up. The withdrawal rate was higher in the control group but did not differ significantly from the experimental group. High accessibility (93% of participants accessed the platform) and global acceptability (100% overall satisfaction) were reported among those who completed the telerehabilitation protocol. The therapist had no difficulty judging the participants' reading performances qualitatively while participants used their device to read their eSkills and VisExc guides. Most participants improved their daily activities, based on qualitative reports of the attained goals. Seventy-nine percent of individuals declined to participate, whereas 16% of participants decided not to use eSight Eyewear anymore.

CONCLUSIONS

The data demonstrated the feasibility of a randomized controlled telerehabilitation study for people with low vision using a head-mounted display. Positive feedback from the participants and the therapist suggests the potential value of this modality for low vision services.

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.

Perspectives of Multidisciplinary Professional Teams during Assessment Processes for ATD Selection in the Japanese Public Provision System

Selection of assistive technology devices (ATDs), which are imperative for persons with disabilities to improve their quality of life, requires collaboration of users and multidisciplinary professionals. However, it is still unknown how to design and implement an adequate collaborative work flow and a professional team. Under Japanese governmental ATD provision system, based on the application by clients, ATDs are mainly selected through collaborative processes with the clients and health professionals in public organizations, rehabilitation counseling centers (RCCs). By employing qualitative study methods in this study, we investigated the ATD selection process in which health professionals in RCCs collaboratively assess clients with physical disabilities so as to support them in selecting the adequate ATDs. To identify the perspectives required for ATD selection completely, the assessment processes were recorded and analyzed with a pseudo setting in two RCCs. Content analysis of the conversations between the client and professionals revealed the characteristics of the information exchanged in the assessment processes. A total of 760 assessment items were identified, thus indicating a broad array of interest. Despite the richness of information collected for the assessment, half of the assessment items did not have corresponding items in the documents that were employed during the prescription process. Thematic analysis of the interviews that followed revealed the common values and collaborative processes in ATD selection, which were shared and elaborated among the staff in daily social interactions. To facilitate implementation of ATD provision in various areas with few resources, it may be effective to convert this tacit-to-tacit knowledge sharing into a more explicit sharing by promoting analyses of good practices.

Aesthetics and the perceived stigma of assistive technology for visual impairment

Purpose: The aim of this study was to identify factors that influence the perceived stigma of two assistive devices for visual impairment, namely the white cane and smart glasses.Method: Face-to-face semi-structured interviews with eight European students were conducted to probe their experiences and knowledge related to disability, assistive technology, visual impairment, as well as handheld and wearable devices.Results: Close relationships with disabled people seems to have a positive influence on participants perceptions about stigma, disability, and assistive technology. Academic background seems to not have any influence. The aesthetics of assistive devices was observed as an important factor that influences the adoption or abandonment of the device.Conclusion: Device without negative symbolism but with modern aesthetics (smart glasses) were positively accepted by the participants than the device with traditional aesthetics and symbolisms of visual impairment (white cane). Designers should, therefore, consider aesthetics in addition to functionality in order to avoid the perceived stigma, thereby reducing the chances of device abandonment.IMPLICATIONS FOR REHABILITATIONUnderstanding the factors that influence the perceived stigma associated with assistive technology can help designers and developers to reduce assistive technology abandonment and perceived stigma.Designers need to consider both functionality and aesthetics. While functionality is crucial for the users' adaptation, aesthetics is important for the users' positive perceptions.

Factors related to the use of a head-mounted display for individuals with low vision

AIM

The decision-making process around the (non-)use of assistive technologies is multifactorial. The goal of the present study was to identify which factors predict or correlate with the use of a head-mounted magnification device for low vision (LV) (eSight Eyewear), by applying this multifactorial paradigm in order to tailor LV rehabilitation interventions to reduce device abandonment.

METHODS

Using a cross-sectional design, participants were recruited from 567 eSight Eyewear owners to complete a 45-min survey online including questions from standardized questionnaires classified into four families: personal, device-related, environmental, and interventional. Using current device use/nonuse as a binary outcome, logistic regression analyses were performed to identify the variables that predicted the highest percentage of variance in eSight use.

RESULTS

The 109 (19.2%) respondents with complete data had a mean age of 47.7 years (SD = 25.4, range: 9-96), 51% self-reported a central visual impairment. The final regression model alternatives accounted for 84.7%, 68.7%, 83.7%, and 64.7% (Nagelkerke's pseudo R²) of the variance in eSight use. The most consistently predictive variables of sustained device use across models were: higher scores on the Psychological Impact of Assistive Devices Scale (PIADS) and the Quebec User Evaluation of Satisfaction with assistive Technology (QUEST) scale, and participants' lack of experiencing headaches while using the device.

CONCLUSIONS

None of the traditional clinical variables (demographics, ocular, or general health), or LV rehabilitation experience was predictive of sustained use of a head-mounted LV display. However, the administration of standardized device-impact questionnaires may be able to identify device users that could benefit from individualized attention during LV rehabilitation provision to reduce the probability of device abandonment.Implications for rehabilitationInvestigating the factors predicting (non-)use of head-mounted magnification devices for low vision (LV) is important to identify patients with a higher risk of device nonuse and to provide evidence for interventions designed to improve use.The optimal combinations of our statistical analysis models highlighted the importance of individualized attention focusing on the user during LV rehabilitation provision of, and training with, head-mounted devices.Standardized device-related quality of life measures were robust predictors of device use and may be able to identify individuals that could benefit from individualized attention during LV rehabilitation.The absence of headaches while using a head-mounted magnification device was a robust predictor of continued use.User follow-up service satisfaction strongly predicted continued devices use, indicating that manufacturers and rehabilitation service organizations need to maintain a high level of service.

Quality of Deaf and Hard-of-Hearing Mobile Apps: Evaluation Using the Mobile App Rating Scale (MARS) With Additional Criteria From a Content Expert

BACKGROUND

The spread of technology and dissemination of knowledge across the World Wide Web has prompted the development of apps for American Sign Language (ASL) translation, interpretation, and syntax recognition. There is limited literature regarding the quality, effectiveness, and appropriateness of mobile health (mHealth) apps for the deaf and hard-of-hearing (DHOH) that pose to aid the DHOH in their everyday communication and activities. Other than the star-rating system with minimal comments regarding quality, the evaluation metrics used to rate mobile apps are commonly subjective.

OBJECTIVE

This study aimed to evaluate the quality and effectiveness of DHOH apps using a standardized scale. In addition, it also aimed to identify content-specific criteria to improve the evaluation process by using a content expert, and to use the content expert to more accurately evaluate apps and features supporting the DHOH.

METHODS

A list of potential apps for evaluation was generated after a preliminary screening for apps related to the DHOH. Inclusion and exclusion criteria were developed to refine the master list of apps. The study modified a standardized rating scale with additional content-specific criteria applicable to the DHOH population for app evaluation. This was accomplished by including a DHOH content expert in the design of content-specific criteria.

RESULTS

The results indicate a clear distinction in Mobile App Rating Scale (MARS) scores among apps within the study's three app categories: ASL translators (highest score=3.72), speech-to-text (highest score=3.6), and hard-of-hearing assistants (highest score=3.90). Of the 217 apps obtained from the search criteria, 21 apps met the inclusion and exclusion criteria. Furthermore, the limited consideration for measures specific to the target population along with a high app turnover rate suggests opportunities for improved app effectiveness and evaluation.

CONCLUSIONS

As more mHealth apps enter the market for the DHOH population, more criteria-based evaluation is needed to ensure the safety and appropriateness of the apps for the intended users. Evaluation of population-specific mHealth apps can benefit from content-specific measurement criteria developed by a content expert in the field.

Guidetomeasure-OT: A mobile 3D application to improve the accuracy, consistency, and efficiency of clinician-led home-based falls-risk assessments

BACKGROUND

A key falls prevention intervention delivered within occupational therapy is the home environment falls-risk assessment process. This involves the clinician visiting the patient's home and using a 2D paper-based measurement guidance booklet to ensure that all measurements are taken and recorded accurately. However, 30% of all assistive devices installed within the home are abandoned by patients, in part as a result of the inaccurate measurements being recorded as part of the home environment falls-risk assessment process. In the absence of more appropriate and effective guidance, high levels of device abandonment are likely to persist.

AIM

This study presents guidetomeasure-OT, a mobile 3D measurement guidance application designed to support occupational therapists in carrying out home environment falls-risk assessments. Furthermore, this study aims to empirically evaluate the performance of guidetomeasure-OT compared with an equivalent paper-based measurement guidance booklet.

METHODS

Thirty-five occupational therapists took part in this within-subjects repeated measures study, delivered within a living lab setting. Participants carried out the home environment falls-risk assessment process under two counterbalanced treatment conditions; using 3D guidetomeasure-OT; and using a 2D paper-based guide. Systems Usability Scale questionnaires and semi-structured interviews were completed at the end of both task. A comparative statistical analysis explored performance relating to measurement accuracy, measurement accuracy consistency, task completion time, and overall system usability, learnability, and effectiveness of guidance. Interview transcripts were analysed using inductive and deductive thematic analysis, the latter was informed by the Unified Theory of Acceptance and Use of Technology model.

RESULTS

The guidetomeasure-OT application significantly outperformed the 2D paper-based guidance in terms task efficiency (p <  0.001), learnability (p <  0.001), system usability (p <  0.001), effectiveness of guidance (p =  0.001). Regarding accuracy, in absolute terms, guidetomeasure-OT produced lower mean error differences for 11 out of 12 items and performed significantly better for six out of 12 items (p = < 0.05). In terms of SUS, guidetomeasure-OT scored 83.7 compared with 70.4 achieved by the booklet. Five high-level themes emerged from interviews: Performance Expectancy, Effort Expectancy, Social Influence, Clinical Benefits, and Augmentation of Clinical Practice. Participants reported that guidetomeasure-OT delivered clearer measurement guidance that was more realistic, intuitive, precise and usable than the paper-based equivalent. Audio instructions and animated prompts were seen as being helpful in reducing the learning overhead required to comprehend measurement guidance and maintain awareness of task progression.

CONCLUSIONS

This study reveals that guidetomeasure-OT enables occupational therapists to carry out significantly more accurate and efficient home environment falls-risk assessments, whilst also providing a measurement guide tool that is considered more usable compared with the paper-based measurement guide that is currently used by clinicians in practice. These results are significant as they indicate that mobile 3D visualisation technologies can be effectively deployed to improve clinical practice, particularly within the home environment falls-risk assessment context. Furthermore, the empirical findings constitute overcoming the challenges associated with the digitisation of health care and delivery of new innovative and enabling technological solutions that health providers and policy makers so urgently need to ease the ever-increasing burden on existing public resources. Future work will focus on the development and empirical evaluation of a mobile 3D application for patient self-assessment and automated assistive equipment prescription. Furthermore, broader User Experience aspects of the application design and the interaction mechanisms that are made available to the user could be considered so as to minimize the effect of cognitive overloading and optimise user performance.

Every person is an individual: physical therapist clinical reasoning used in inpatient rehabilitation for walking assistive device prescription in patients with stroke and brain injury

PURPOSE

A complete description of the process of physical therapy clinical reasoning for walking assistive devices in patients with stroke and brain injury has never been undertaken. Describing the clinical reasoning process used in post-acute inpatient rehabilitation is important to shed light on the clinical activities and factors used in practice, prevent device abandonment, and, inform entry-level clinical training. The two purposes were first, to describe the clinical reasoning process used during inpatient rehabilitation for walking assistive devices in patients with stroke and brain injury, and second, to determine whether clinical reasoning differed by two facility types and by diagnosis.

METHODS

A mixed methods study of 67 participants in either an online survey or focus groups.

RESULTS

A consistent and comprehensive method to determine the need and justification for a walking assistive device regardless of diagnosis or facility type was found. The clinical reasoning process included five primary factors, considered throughout the rehabilitation stay (safety, balance, cognition, strength, and function). The three therapist-related factors (experience/preference, training parameters, and use of objective tools), and seven patient-related factors (experience/preference, fluctuations, fear, age, diagnosis/comorbidities, discharge environment, and payer) individualized care. Definitions of the five primary factors were derived from participants' responses.

CONCLUSIONS

Results from this study revealed complexity in the clinical reasoning process used in physical therapy practice to determine the best walking assistive device for patients with stroke and brain injury during inpatient rehabilitation. Information from this study can inform post-acute physical therapy practice and education, and may reduce device abandonment. Implications for rehabilitation Clinical reasoning (CR) is a complex process in which a clinician must consider multiple factors, which requires non-linear and iterative thinking, and involves many people, making it shared among the patient, caregivers, and the healthcare team. Describing the actual CR process used by physiotherapists when prescribing a walking assistive device (WAD) will identify the factors considered, thus more accurately explain the process of care. Such a description could lead to better justification of rehabilitation for patients with stroke and brain injury, and furthermore, determine whether treatments are rendered consistently and when, if ever, divergent approaches occur. Better understanding of the CR process of WAD prescription may also reduce the possibility of device abandonment.

A conceptual framework for orthotic and prosthetic education

BACKGROUND

Variables that influence orthotic and prosthetic patient outcomes beyond direct care are poorly conceptualized for orthotic and prosthetic students. Restructuring educational curricula around important clinical reasoning variables (i.e. factors that may influence outcomes) could improve teaching, learning, and clinical practice.

OBJECTIVES

To propose an orthotic and prosthetic education framework to enhance the development of orthotic and prosthetic students' clinical reasoning skills.

STUDY DESIGN

Scoping review.

METHODS

We conducted a scoping review, identified variables of orthotic and prosthetic usability, and performed a qualitative thematic analysis through the lens of orthotic and prosthetic clinical educators to develop a conceptual framework for orthotic and prosthetic education.

RESULTS

Sorting of variables identified from the literature resulted in three thematic areas: (1) the state of functioning, disability, and health (International Classification of Functioning, Disability and Health); (2) orthotic and prosthetic technical properties, procedures, and appropriateness; and (3) professional service as part of orthotic and prosthetic interventions. The proposed orthotic and prosthetic education framework includes these three areas situated within the context of patient-centered care.

CONCLUSIONS

A conceptual framework was developed from variables identified in peer-reviewed literature. This orthotic and prosthetic education framework provides a structure to explore orthotic and prosthetic clinical reasoning and advance our teaching and assessment of students' clinical reasoning skills.

CLINICAL RELEVANCE

The proposed orthotic and prosthetic (O&P) education framework is intended to promote conversation about variables (e.g. health condition, procedures, services, and O&P principles) that influence O&P clinical practice outcomes and further advance our teaching and assessment of students' clinical reasoning skills.

Identification of clinically related requirements of a novel assistive device for people with a high spinal cord injury

People with spinal cord injuries (SCI), and particularly with high level lesions, can potentially lose the ability to effectively operate computers. The Multimedia Authoring and Management using your Eyes and Mind (MAMEM) project aims to design and produce a novel assistive device to support computer use by individuals with SCI and other disabilities. The solution harnesses eye tracking and brain waves, as measured by encephalography (EEG), to manipulate common computer functions. This paper describes the first step in the project, during which we defined clinically related requirements of the assistive device. These definitions were based on data from three sources: (1) a narrative review; (2) a focus group of SCI rehabilitation professionals; and (3) structured questionnaires administrated to potential computer users with SCI, addressing computer-use habits, barriers, and needs. We describe both the collection of data from each source and the clinically related requirements extracted. The novel three-source requirement assessment method is discussed, and the advantages and disadvantages of each data source are reported. In conclusion, we suggest that this approach makes it possible to organize, discuss, and prioritize the requirements, and to create a work program while planning the device. This increases our level of certainty that the efficacy and adequacy of the assistive device will be maximized, in terms of the clinical needs of users.

A Qualitative Metasynthesis of Reasons for the Use or Nonuse of Assistive Technologies in the Aging Population

Abstract. Models of the use of assistive technologies (ATs) have only moderate value for predicting older people’s actual use of ATs. To find further predictors, we performed a systematic literature review and – applying an action-theoretical approach – a metasynthesis of seven qualitative studies about the reasons older people use or fail to use ATs. We found 25 reasons referring to user’s beliefs and desires (e.g., related to demand, act of using ATs, its consequences), 18 of which were not contained in existing AT use models. Some reasons generalized across ATs (e.g., perceived unreliability), whereas others (e.g., privacy concerns, desire to avoid burden to others) appeared specific to telealarm or smart-home technology. We discuss findings with respect to improving AT use models and developmental counseling.

The clinical- and cost-effectiveness of functional electrical stimulation and ankle-foot orthoses for foot drop in Multiple Sclerosis: a multicentre randomized trial

OBJECTIVE

To compare the clinical- and cost-effectiveness of ankle-foot orthoses (AFOs) and functional electrical stimulation (FES) over 12 months in people with Multiple Sclerosis with foot drop.

DESIGN

Multicentre, powered, non-blinded, randomized trial.

SETTING

Seven Multiple Sclerosis outpatient centres across Scotland.

SUBJECTS

Eighty-five treatment-naïve people with Multiple Sclerosis with persistent (>three months) foot drop.

INTERVENTIONS

Participants randomized to receive a custom-made, AFO (n = 43) or FES device (n = 42).

OUTCOME MEASURES

Assessed at 0, 3, 6 and 12 months; 5-minute self-selected walk test (primary), Timed 25 Foot Walk, oxygen cost of walking, Multiple Sclerosis Impact Scale-29, Multiple Sclerosis Walking Scale-12, Modified Fatigue Impact Scale, Euroqol five-dimension five-level questionnaire, Activities-specific Balance and Confidence Scale, Psychological Impact of Assistive Devices Score, and equipment and National Health Service staff time costs of interventions.

RESULTS

Groups were similar for age (AFO, 51.4 (11.2); FES, 50.4(10.4) years) and baseline walking speed (AFO, 0.62 (0.21); FES 0.73 (0.27) m/s). In all, 38% dropped out by 12 months (AFO, n = 21; FES, n = 11). Both groups walked faster at 12 months with device (P < 0.001; AFO, 0.73 (0.24); FES, 0.79 (0.24) m/s) but no difference between groups. Significantly higher Psychological Impact of Assistive Devices Scores were found for FES for Competence (P = 0.016; AFO, 0.85(1.05); FES, 1.53(1.05)), Adaptability (P = 0.001; AFO, 0.38(0.97); FES 1.53 (0.98)) and Self-Esteem (P = 0.006; AFO, 0.45 (0.67); FES 1 (0.68)). Effects were comparable for other measures. FES may offer value for money alternative to usual care.

CONCLUSION

AFOs and FES have comparable effects on walking performance and patient-reported outcomes; however, high drop-outs introduces uncertainty.

Enabling older adults to carry out paperless falls-risk self-assessments using guidetomeasure-3D: A mixed methods study

BACKGROUND

The home environment falls-risk assessment process (HEFAP) is a widely used falls prevention intervention strategy which involves a clinician using paper-based measurement guidance to ensure that appropriate information and measurements are taken and recorded accurately. Despite the current use of paper-based guidance, over 30% of all assistive devices installed within the home are abandoned by patients. This is in part due to poor fit between the device, the patient, and the environment in which it is installed. Currently HEFAP is a clinician-led process, however, older adult patients are increasingly being expected to collect HEFAP measurements themselves as part of the personalisation agenda. Without appropriate patient-centred guidance, levels of device abandonment to are likely to rise to unprecedented levels. This study presents guidetomeasure-3D, a mobile 3D measurement guidance application designed to support patients in carrying out HEFAP self-assessments.

AIM

The aim of this study is to present guidetomeasure-3D, a web-enabled 3D mobile application that enables older-adult patients to carry out self-assessment measurement tasks, and to carry out a mixed-methods evaluation of its performance, and associated user perceptions of the application, compared with a 2D paper-based equivalent.

METHODS

Thirty-four older adult participants took part in a mixed-methods within-subjects repeated measures study set within a living lab. A series of HEFAP self-assessment tasks were carried out according to two treatment conditions: (1) using the 3D guidetomeasure-3D application; (2) using a 2D paper-based guide. SUS questionnaires and semi-structured interviews were completed at the end of the task. A comparative statistical analysis explored performance with regards to measurement accuracy, accuracy consistency, task efficiency, and system usability. Interview transcripts were analysed using inductive and deductive thematic analysis (informed by UTAUT).

RESULTS

The guidetomeasure-3D application outperformed the 2D paper-based guidance in terms of accuracy (smaller mean error difference in 11 out of 12 items), accuracy consistency (p < 0.05, for 6 out of 12 items), task efficiency (p = 0.003), system usability (p < 0.00625, for two out of 10 SUS items), and clarity of guidance (p < 0.0125, for three out of four items). Three high-level themes emerged from interviews: Performance Expectancy, Effort Expectancy, and Social Influence. Participants reported that guidetomeasure-3D provided improved visual quality, clarity, and more precise guidance overall. Real-time audio instruction was reported as being particularly useful, as was the use of the object rotation and zoom functions which were associated with improving user confidence particularly when carrying out more challenging tasks.

CONCLUSIONS

This study reveals that older adults using guidetomeasure-3D achieved improved levels of accuracy and efficiency along with improved satisfaction and increased levels of confidence compared with the 2D paper-based equivalent. These results are significant and promising for overcoming HEFAP equipment abandonment issue. Furthermore they constitute an important step towards overcoming challenges associated with older adult patients, the digitisation of healthcare, and realising the enablement of patient self-care and management via the innovative use of mobile technologies. Numerous opportunities for the generalisability and transferability of the findings of this research are also proposed. Future research will explore the extent to which mobile 3D visualisation technologies may be utilised to optimise the clinical utility of HEFAP when deployed by clinicians.

An exploration of the experiences and utility of functional electrical stimulation for foot drop in people with multiple sclerosis

Purpose: Functional electrical stimulation (FES) is effective in improving walking in people with multiple sclerosis (MS) with foot drop. There is limited research exploring people's experiences of using this device. This study aims to explore the utility, efficacy, acceptability, and impact on daily life of the device in people with MS.Methods: An interpretative phenomenological approach was employed. Ten participants who had used FES for 12 months were interviewed. Transcripts were analysed, and emergent themes identified.Results: Nine participants continued to use the device. Three relevant super-ordinate themes were identified; impact of functional electrical stimulation, sticking with functional electrical stimulation, and autonomy and control. Participants reported challenges using the device; however, all reported positive physical and psychological benefits. Intrinsic and external influences such as; access to professional help, the influence of others, an individual's ability to adapt, and experiences using the device, influenced their decisions to continue with the device. A thematic model of these factors was developed.Conclusions: This study has contributed to our understanding of people with MS experiences of using the device and will help inform prescribing decisions and support the continued, appropriate use of FES over the longer term.Implications for RehabilitationPeople with multiple sclerosis using functional electrical stimulation report benefits in many aspects of walking, improved psychological well-being and increased engagement in valued activities.A number of challenges impact on functional electrical stimulation use. Factors such as; a positive experience using the device, access to professional help, the influence of others, a strong sense of personal autonomy and an individual's ability to adapt, influence an individual's decision to continue using functional electrical stimulation.Clinicians prescribing functional electrical stimulation should be aware of these factors so that the right support and guidance can be provided to people with multiple sclerosis, thus improving outcomes and compliance over the long term.

Is there a standard procedure for assessing and providing assistive devices for people with neuro-disabling conditions in United Kingdom? A nation-wide survey

BACKGROUND

Assistive devices are currently provided to people with neuro-disabling conditions to promote or maintain independence in activities of daily living. However, it is unclear whether assessment procedures performed by health care professionals to guide the provision of assistive devices are standardized.

OBJECTIVE

To explore the assessment and service-delivery processes of assistive devices for people with multiple sclerosis, cerebrovascular disease and Parkinson's disease experiencing physical disability by health care professionals in the United Kingdom.

METHODS

A survey was conducted among UK health care professionals working with people with neuro-disabling conditions. Descriptive and content analyses were used to code survey data.

RESULTS

In total, 231 health care professionals completed the survey: 93 occupational therapists, 136 physiotherapists and 2 assistant practitioners. Less than half of the respondents (46%) reported use of local, national, or combined guidelines when assessing a service user's suitability or need for assistive devices. When guidelines were used, they were not consistent and not specifically for assistive devices. The respondents stated that when users were allocated small and portable assistive devices, they were supplied within four weeks. This period increased for large equipment, major home adaptions or if external specialist services and/or funding was needed.

CONCLUSIONS

Standardized operating procedures for assistive device provision are not being carried out within the UK. Variable access to assistive devices supplied by the state indicates inequity across regions. Future research should explore potential benefits of developing standardized assessment procedures for the provision of assistive devices and devise methods to reduce current variability in service delivery.

Assistive technologies for improving the oral hygiene of leprosy patients residing in a former leprosy colony in Betim, Minas Gerais, Brazil

BACKGROUND

This study deals with management of a group of elderly patients with a history of leprosy and hand deformities by a multidisciplinary team of dentists and occupational therapists. Assistive technology devices have been developed to allow such patients to obtain independence in oral self-care and can be a cost-effective approach to improving oral care in this population. The objective of this study was to describe the development of assistive devices to facilitate daily oral hygiene in older people with enduring leprosy-related impairments.

METHODOLOGY

Case study realized among elders with a history of leprosy residents in a former isolation colony in Betim, Minas Gerais, Brazil. The elders were evaluated for dependence on others for denture hygiene and mouthwash using the Daily Oral Hygiene Activity Index (ADOH). Those deemed partially or completely dependent on others were eligible for an intervention based on assistive technology. We adopted a personalized approach to each case, taking into account medical history, physical impairment and living environment. Six months after the intervention, the participants were assessed again using the ADOH and an unstructured interview about use of the devices.

PRINCIPAL FINDINGS

Assistive devices for denture hygiene and mouthwash were developed for 16 elders. These devices facilitated oral hygiene in most patients and there was no worsening in any of the cases. Patients' report suggested they were satisfied with the devices provided.

CONCLUSIONS

This study demonstrated that assistive devices can facilitate oral hygiene activities in leprosy patients. It also reinforces the importance of using a multidisciplinary team for the rehabilitation of these patients.

Assistive technologies to overcome sarcopenia in ageing

Sarcopenia is an age-related decline in skeletal muscle mass and function that results in disability and loss of independence. It affects up to 30% of older adults. Exercise (particularly progressive resistance training) and nutrition are key strategies in preventing and reversing declines in muscle mass, strength and power during ageing, but many sarcopenic older adults fail to meet recommended levels of both physical activity and dietary nutrient intake. Assistive technology (AT) describes devices or systems used to maintain or improve physical functioning. These may help sarcopenic older adults to maintain independence, and also to achieve adequate physical activity and nutrition. There is a paucity of research exploring the use of AT in sarcopenic patients, but there is evidence that AT, including walking aids, may reduce functional decline in other populations with disability. Newer technologies, such as interactive and virtual reality games, as well as wearable devices and smartphone applications, smart homes, 3D printed foods, exoskeletons and robotics, and neuromuscular electrical stimulation also hold promise for improving engagement in physical activity and nutrition behaviours to prevent further functional declines. While AT may be beneficial for sarcopenic patients, clinicians should be aware of its potential limitations. In particular, there are high rates of patient abandonment of AT, which may be minimised by appropriate training and monitoring of use. Clinicians should preferentially prescribe AT devices which promote physical activity. Further research is required in sarcopenic populations to identify strategies for effective use of current and emerging AT devices.

An observational study of powered wheelchair provision in Italy

Powered wheelchairs are complex and expensive assistive devices that must be selected and configured on the basis of individual user needs, lifestyle, motivation, driving ability, and environment. Providing agencies often require evidence that their financial investment will lead to a successful outcome. The authors surveyed a sample of 79 users who had obtained powered wheelchairs from a Regional Health Service in Italy in the period 2008-2013. Follow-up interviews were conducted at the users' homes in order to collect information about wheelchair use, and its effectiveness, usefulness, and economic impact. The instruments used in the interviews included an introductory questionnaire, QUEST (Quebec User Evaluation of Satisfaction with Assistive Technology), PIADS (Psychosocial Impact of Assistive Devices Scale), FABS/M (Facilitators and Barriers Survey/Mobility), and SCAI (Siva Cost Analysis Instrument). The results indicated positive outcomes, especially in relation to user satisfaction and psychosocial impact. A number of barriers were identified in various settings that sometimes restrict user mobility, and suggest corrective actions. The provision of a powered wheelchair generated considerable savings in social costs for most users: an average of about $38,000 per person over a projected 5-year period was estimated by comparing the cost of the intervention with that of non-intervention.

Assistive Technology in Pre-Service Rehabilitation Counselor Education: A New Approach to Team Collaboration

Purpose: Recognizing a perceived lack of assistive technology/adaptive equipment (AT/AE) competence on the part of counselors and educators (Kuo, 2013), this article provides an overview of assistive technology concepts and accreditation standards, and introduces a training model intended to improve rehabilitation counselor readiness to address client AT/AE needs.

Method: Drawing on the extant literature, professional scopes of practice, and interdisciplinary clinical experience, the authors conceptualize AT/AE service delivery along a biopsychosocial continuum.

Results: The resultant model of AT/AE team collaboration can be taught by counselor educators and understood by students without specialty certification or preexisting knowledge of AT. The model spans the continuum of care from medical to psychosocial, details the roles of rehabilitation disciplines, and offers a pedagogical tool for infusing AT concepts across the curriculum.

Conclusion: Ultimately, this article advocates for increased rehabilitation counselor engagement and entry-level competence in addressing the psychosocial aspects of AT/AE. Future research should be conducted to validate the constructs of this model.

The use of evidence-based guidance to enable reliable and accurate measurements of the home environment

Introduction

High quality guidance in home strategies is needed to enable older people to measure their home environment and become involved in the provision of assistive devices and to promote consistency among professionals. This study aims to investigate the reliability of such guidance and its ability to promote accuracy of results when measurements are taken by both older people and professionals.

Method

Twenty-five health professionals and 26 older people participated in a within-group design to test the accuracy of measurements taken (that is, person's popliteal height, baths, toilets, beds, stairs and chairs). Data were analysed with descriptive analysis and the Wilcoxon test. The intra-rater reliability was assessed by correlating measurements taken at two different times with guidance use.

Results

The intra-rater reliability analysis revealed statistical significance (P < 0.05) for all measurements except for the bath internal width. The guidance enabled participants to take 90% of measurements that they were not able to complete otherwise, 80.55% of which lay within the acceptable suggested margin of variation. Accuracy was supported by the significant reduction in the standard deviation of the actual measurements and accuracy scores.

Conclusion

This evidence-based guidance can be used in its current format by older people and professionals to facilitate appropriate measurements. Yet, some users might need help from carers or specialists depending on their impairments.

Fall Prevention Self-Assessments Via Mobile 3D Visualization Technologies: Community Dwelling Older Adults' Perceptions of Opportunities and Challenges

BACKGROUND

In the field of occupational therapy, the assistive equipment provision process (AEPP) is a prominent preventive strategy used to promote independent living and to identify and alleviate fall risk factors via the provision of assistive equipment within the home environment. Current practice involves the use of paper-based forms that include 2D measurement guidance diagrams that aim to communicate the precise points and dimensions that must be measured in order to make AEPP assessments. There are, however, issues such as "poor fit" of equipment due to inaccurate measurements taken and recorded, resulting in more than 50% of equipment installed within the home being abandoned by patients. This paper presents a novel 3D measurement aid prototype (3D-MAP) that provides enhanced measurement and assessment guidance to patients via the use of 3D visualization technologies.

OBJECTIVE

The purpose of this study was to explore the perceptions of older adults with regard to the barriers and opportunities of using the 3D-MAP application as a tool that enables patient self-delivery of the AEPP.

METHODS

Thirty-three community-dwelling older adults participated in interactive sessions with a bespoke 3D-MAP application utilizing the retrospective think-aloud protocol and semistructured focus group discussions. The system usability scale (SUS) questionnaire was used to evaluate the application's usability. Thematic template analysis was carried out on the SUS item discussions, think-aloud, and semistructured focus group data.

RESULTS

The quantitative SUS results revealed that the application may be described as having "marginal-high" and "good" levels of usability, along with strong agreement with items relating to the usability (P=.004) and learnability (P<.001) of the application. Four high-level themes emerged from think-aloud and focus groups discussions: (1) perceived usefulness (PU), (2) perceived ease of use (PEOU), (3) application use (AU) and (4) self-assessment (SA). The application was seen as a useful tool to enhance visualization of measurement guidance and also to promote independent living, ownership of care, and potentially reduce waiting times. Several design and functionality recommendations emerged from the study, such as a need to manipulate the view and position of the 3D furniture models, and a need for clearer visual prompts and alternative keyboard interface for measurement entry.

CONCLUSIONS

Participants perceived the 3D-MAP application as a useful tool that has the potential to make significant improvements to the AEPP, not only in terms of accuracy of measurement, but also by potentially enabling older adult patients to carry out the data collection element of the AEPP themselves. Further research is needed to further adapt the 3D-MAP application in line with the study outcomes and to establish its clinical utility with regards to effectiveness, efficiency, accuracy, and reliability of measurements that are recorded using the application and to compare it with 2D measurement guidance leaflets.

Emotional Self-Regulation of Individuals with Autism Spectrum Disorders: Smartwatches for Monitoring and Interaction

In this paper, we analyze the needs of individuals with Autism Spectrum Disorders (ASD) to have a pervasive, feasible and non-stigmatizing form of assistance in their emotional self-regulation, in order to ease certain behavioral issues that undermine their mental health throughout their life. We argue the potential of recent widespread wearables, and more specifically smartwatches, to achieve this goal. Then, a smartwatch system that implements a wide range of self-regulation strategies and infers outburst patterns from physiological signals and movement is presented, along with an authoring tool for smartphones that is to be used by caregivers or family members to create and edit these strategies, in an adaptive way. We conducted an intensive experiment with two individuals with ASD who showed varied, representative behavioral responses to their emotional dysregulation. Both users were able to employ effective, customized emotional self-regulation strategies by means of the system, recovering from the majority of mild stress episodes and temper tantrums experienced in the nine days of experiment in their classroom.

Matching and accepting assistive technology in multiple sclerosis: A focus group study with people with multiple sclerosis, carers and occupational therapists

To explore experiences and perceptions of assistive technology, 14 people with multiple sclerosis, 5 carers and 4 occupational therapists participated in focus groups. Transcripts were analysed thematically drawing from illness self-regulation theory. Identified themes are as follows: critical multiple sclerosis events (developing symptoms/disability, delayed diagnosis and coping, public reaction and multiple sclerosis progression to assistive technology), matching assistive technology for continued use (acceptance of multiple sclerosis and assistive technology, realistic expectations, occupational therapist responsiveness, timing is crucial and carers and others) and impact of assistive technology (promoting or losing independence, stigma and embarrassment and redefining the carer). Acceptance and communication among those involved ensures assistive technology matches needs and maximises health and psychosocial outcomes.

Improving training for sensory augmentation using the science of expertise

Sensory substitution and augmentation devices (SSADs) allow users to perceive information about their environment that is usually beyond their sensory capabilities. Despite an extensive history, SSADs are arguably not used to their fullest, both as assistive technology for people with sensory impairment or as research tools in the psychology and neuroscience of sensory perception. Studies of the non-use of other assistive technologies suggest one factor is the balance of benefits gained against the costs incurred. We argue that improving the learning experience would improve this balance, suggest three ways in which it can be improved by leveraging existing cognitive science findings on expertise and skill development, and acknowledge limitations and relevant concerns. We encourage the systematic evaluation of learning programs, and suggest that a more effective learning process for SSADs could reduce the barrier to uptake and allow users to reach higher levels of overall capacity.

Evaluation of two cane instruments in older adults with knee osteoarthritis

The objectives of this study were to describe the psychometric properties of the Cane Cognitive Mediator Scale (CCMS) and the Psychosocial Impact of Assistive Devices Scale (PIADS) in adults with knee osteoarthritis (OA) and to determine the feasibility of applying these instruments as screening tools to identify patients with the propensity to use a cane. Data from a randomized crossover trial were analyzed for 53 older adults with knee OA. Perceptions on using a cane were measured at baseline using the CCMS and PIADS. The CCMS was repeated 1 wk later. At 6 mo, subjects rated their intention to use a cane. The findings indicated that 1 wk test-retest reliability was acceptable for the CCMS Attitudes and Subjective Norms subscales (r = 0.48 to 0.93) and low for the CCMS Perceived Behavioral Control subscale (r = 0.15). Internal consistency reliability was good for each CCMS and PIADS subscale. The CCMS Subjective Norms subscale demonstrated acceptable predictive validity across all subgroups (r = 0.53 to 0.88). The PIADS Adaptability subscale demonstrated acceptable predictive validity for the 45 to 64 yr-old age group (r = 0.54). The findings indicate that the CCMS Subjective Norms subscale exhibits good psychometric properties and has potential application as a screening tool.

Participatory action research designs in applied disability and rehabilitation science: protecting against threats to social validity

Researchers and disability advocates have been debating consumer involvement in disability and rehabilitation science since at least 1972. Despite the length of this debate, much confusion remains. Consumer involvement may represent a spirit of democracy or even empowerment, but as a tool of science, it is necessary to understand how to judge its application. To realize consumer involvement as a design element in science, researchers need a framework for understanding how it can contribute to the scientific process. The thesis of this article is that a primary scientific function of consumer involvement is to reduce threats to the social validity of research, the extent to which those expected to use or benefit from research products judge them as useful and actually use them. Social validity has traditionally not been treated with the same rigor as concerns for internal and external validity. This article presents a framework that describes 7 threats to social validity and explains how 15 forms of consumer involvement protect against those threats. We also suggest procedures for reporting and reviewing consumer involvement in proposals and manuscripts. This framework offers tools familiar to all scientists for identifying threats to the quality of research, and for judging the effectiveness of strategies for protecting against those threats. It may also enhance the standing of consumer involvement strategies as tools for protecting research quality by organizing them in a way that allows for systematic criticism of their effectiveness and subsequent improvement.

Occupational therapists' perceptions about the clinical utility of the 3D interior design software

PURPOSE

The 3D interior design software (3DIDS) is a technology, which primarily allows users to simulate their homes and visualize any changes prior to implementing them. This feasibility study aimed to examine occupational therapists' perceptions about the clinical utility of the 3DIDS. A secondary aim was to explore the attitudes of occupational therapists towards technology in general.

METHOD

Three focus groups were conducted with 25 occupational therapists working with older people in the UK. The qualitative data were analysed using inductive thematic analysis.

RESULTS

The three main themes that were identified were usage and attitudes of technology, opportunities for realistic application of the 3DIDS and related threats and benefits for the occupational therapy profession. Occupational therapists had a positive attitude towards technology. They suggested that the 3DIDS could be used in discharge planning and in rehabilitation. They viewed it as a tool that could enhance their status within the health care profession and improve communication, but not as a tool that should replace the role of the occupational therapist.

CONCLUSIONS

This research offers new and important findings about the utilization of the 3DIDS by occupational therapists and provides information as to where this technology should be trialled.