The psychosocial impact of eye-gaze assistive technology on everyday life of children and adults

PURPOSE

This study investigates the psychosocial impact of eye-gaze assistive technology (EGAT) in both children and adults with long-term experience using eye-gaze assistive technology in everyday life, as well as the psychosocial impact as related to duration of use.

METHODS

In this descriptive comparative study, 34 adult and 27 child EGAT users participated in a structured individual interview using the Psychosocial Impact of Assistive Devices Scale (PIADS).

RESULTS

The participants' age ranged from 5-74 years, 50% were female and 52% had been diagnosed with cerebral palsy. The EGAT had a positive psychosocial impact on competence, adaptability, and self-esteem among adult and child users. Competence was the only subscale with a higher value for adults (p = 0.038), compared to children. The items with the highest impact for the psychosocial aspects were quality of life, ability to participate, and self-esteem. The adults had longer duration of use than children, but for high-, medium-, and low-duration users, the device showed a positive psychosocial impact.

CONCLUSIONS

Participants considered EGAT to have high positive impacts for participation and quality of life. The study adds new knowledge in that high positive psychosocial impact may be found even among low-duration users of EGAT, which is important to consider for service providers.

Turn-taking and communication modes of students and staff in group activities at non-inclusive schools for students with intellectual disability

Most students with intellectual and communicative disability who rely on augmentative and alternative communication (AAC) attend non-inclusive school settings. Little is known about turn-taking and the use of various communication modes in groups of students and staff in this context. Previous studies on single students with intellectual disability in various school settings have found that staff tend to dominate interactions and augmented communication modes are used more during structured than unstructured activities. The present study explored turn-taking contributions and communication modes in whole groups of students and staff in non-inclusive school settings in Sweden. Video observations of 33 students and 30 school staff were conducted in seven classrooms during one structured activity (circle time) and one unstructured activity (leisure time). Turn-taking contributions and communication modes were examined when comparing students and staff and when comparing the two activities. Findings revealed that staff dominated the interactions and augmented communication modes were used less during leisure time than circle time. Notably, aided augmented communication modes, particularly speech-output technologies, were used sparsely. Findings of this study highlight the importance of supporting staff members in applying partner strategies and incorporating augmented input, especially aided augmented input, across various group activities at school.

Increasing participation in computer activities using eye-gaze assistive technology for children with complex needs

PURPOSE

Eye-gaze assistive technology offers children with severe motor and communication difficulties the opportunity to access and control a computer through eye movements. The aim of this study was to examine the impact of eye-gaze assistive technology intervention on participation in computer activities and technology usability among children with complex needs in Taiwan.

MATERIALS AND METHODS

This study involved a multiple baseline design across individuals. The participants were four children aged three to six years with severe motor and communication difficulties and low eye-control skills. The six-month intervention consisted of two collaborative team meetings and 12 individual supports to facilitate the use of eye-gaze assistive technology at home or in educational environments. Participation in computer activities (diversity, frequency, and duration) was repeatedly measured through a computer use diary. Other outcomes included assessments of goal achievements and parents/teachers' ratings on children's performance in computer activities.

RESULTS

The young children increased the diversity of their computer activities and their frequency and duration of computer use from baseline to the intervention phase. The children attained six of eight predefined goals related to play, communication, and school learning. Parents and teachers perceived the children's changes in performance as meaningful.

CONCLUSION

This study strengthens the evidence that eye-gaze assistive technology is useful in everyday contexts for children with complex needs in Taiwan. The findings add knowledge that children with weak eye-control skills increased participation in computer activities as a result of the eye-gaze assistive technology. Implications for RehabilitationEye-gaze assistive technology (EGAT) as an access method to control a computer can provide opportunities for children with severe motor and communication difficulties to participate in computer activities.Children with severe motor and communication difficulties and low eye-control skills with sufficient practice can learn to use EGAT for communication and learning, with support from stakeholders and collaborative service.EGAT could be introduced for children with complex needs at early ages as a means of using computers for play, communication, and school learning, which could be helpful for later education and learning.Stakeholders in educational environments could include EGAT in educational computer systems so that pupils with severe motor and communication difficulties could interact with a computer, thereby enhancing their engagement and learning.

Feasibility of an eye-gaze technology intervention for students with severe motor and communication difficulties in Taiwan

Eye-gaze technology provides access to a computer through the control of eye movements, thus allowing students with severe motor and communication difficulties to communicate and participate in curriculum activities and leisure; however, few studies have investigated whether any challenges exist to its implementation. This study examines the feasibility for teachers, parents, and therapists of applying an eye-gaze technology intervention for students with severe motor and communication difficulties in everyday settings. A mixed-method design was applied, focusing on the acceptability, demands, implementation, and practicality of the technology applications. Data was collected from 16 participants who assisted five students using eye-gaze technology in a previous 6-month intervention. The intervention comprised (a) use of eye-gaze devices with individualized content; and (b) services including training in use, team meetings, and bi-monthly support on implementation problems. The results showed that the participants perceived the technology as appropriate to enhance interaction and understanding of the students' learning and communication messages. Portable and easy-to-adjust systems were crucial to apply eye-gaze technology in different contexts. Improving eye-gaze services was required to afford in-service education, follow-up services, and loaning programs for sustainable implementation. The facilitators and barriers could guide researchers and practitioners to enhance the implementation of eye-gaze technology.

Information and communication technology to improve school participation among upper secondary school students with special educational needs

BACKGROUND

Evidence-based information and communication technology (ICT) interventions to enhance school participation among students with special educational needs (SEN) are required.

AIM

To evaluate the impact of an ICT intervention on school participation among upper secondary school students with special educational needs.

MATERIALS AND METHODS

Data on 300 students' assessments with the School Setting Interview (SSI), grades and school attendance were used in this quasi-experimental study, with a one-group pretest-posttest design. Descriptive and inferential statistics and effect size were used, as well as Rasch analysis to generate interval data on the students' ordinal SSI ratings.

RESULTS

In the ICT intervention (median time eight hours), 54% of the students received a tablet, and software concerned with planning and structure was received by 85%. After the ICT intervention, a significant decrease in perceived need for adjustments in school activities was found on a group level and 30% of the students improved their school attendance. Students who benefitted the most from the ICT intervention had few adjustment needs in school activities and no special educational support at baseline.

CONCLUSION

An ICT intervention is promising for improving school participation among upper secondary school students with SEN.

Establishment in productive occupations and perceived work ability among former students with special educational needs one year after upper secondary education

BACKGROUND

Establishment in productive occupations i.e. work and further studies, is challenging for students who experience special educational needs (SEN).

OBJECTIVE

The study aim was to investigate productive occupations and perceived work ability one year after upper secondary education among former students with SEN who had received a student-centred information and communication technology (ICT) intervention.

METHODS

Questionnaire data on productive occupations (n = 81) were complemented with the semi-structured Worker Role Interview (WRI) concerning perceived work ability (n = 20), in an embedded mixed methods design. Group comparisons between participants who were and were not established in productive occupations were performed. Written notes from the WRI were analysed with a deductive content analysis.

RESULTS

Findings demonstrated that almost two-thirds (63% n = 51) of the former students with SEN were established in productive occupations. The established group had to a higher extent obtained pass grades and had to a lesser extent received time-assisting ICT. Managing daily routines in combination with a productive role in a satisfactory manner was perceived as most challenging for the participants in relation to their work ability.

CONCLUSION

The results indicate that students with SEN need person-centred support to handle difficulties both in and outside upper secondary school to promote the transition from school to establishment in productive occupations.

The Impact of Eye-gaze Controlled Computer on Communication and Functional Independence in Children and Young People with Complex Needs - A Multicenter Intervention Study

INTRODUCTION

Children and young people with complex needs (severe motor impairments and without speech) have few opportunities to use alternative devices for communication. Eye-gaze controlled computers (EGCCs) might provide individuals with complex needs increased opportunities for communication and participation in society.

OBJECTIVE

To investigate the impact of EGCCs on communication, functional independence and participation in activities in children and young people with complex needs.

METHODS

A multicenter intervention study during seven months, measuring outcomes with or without EGCC at four time points, was conducted in Sweden, Dubai, and in USA. Seventeen participants (aged 3-26 years, diagnosis e.g. cerebral palsy, Rett syndrome) were provided with EGCC and services from an Assistive Technology center to implement EGCC in school and/or at home.

RESULTS

Participants significantly increased their expressive communication skills and functional independence with EGCC compared to baseline. All but one (16 of 17) increased their activity repertoire and computer use with EGCC. With EGCC, participation in computer activities averaged 4.1 performed activities (e.g. communication, play), with a duration of 70 minutes/day and a frequency of 76% of days.

DISCUSSION

The study strengthened the research evidence that EGCC can be an effective intervention in daily life for children and young people with complex needs. Communication and independence, common goals of intervention, were shown to be relevant EGCC outcomes.

Communicative Interaction with and without Eye-Gaze Technology between Children and Youths with Complex Needs and Their Communication Partners

Use of eye-gaze assistive technology (EGAT) provides children/youths with severe motor and speech impairments communication opportunities by using eyes to control a communication interface on a computer. However, knowledge about how using EGAT contributes to communication and influences dyadic interaction remains limited. Aim: By video-coding dyadic interaction sequences, this study investigates the impacts of employing EGAT, compared to the Non-EGAT condition on the dyadic communicative interaction. Method: Participants were six dyads with children/youths aged 4–19 years having severe physical disabilities and complex communication needs. A total of 12 film clips of dyadic communication activities with and without EGAT in natural contexts were included. Based on a systematic coding scheme, dyadic communication behaviors were coded to determine the interactional structure and communicative functions. Data were analyzed using a three-tiered method combining group and individual analysis. Results: When using EGAT, children/youths increased initiations in communicative interactions and tended to provide more information, while communication partners made fewer communicative turns, initiations, and requests compared to the Non-EGAT condition. Communication activities, eye-control skills, and communication abilities could influence dyadic interaction. Conclusion: Use of EGAT shows potential to support communicative interaction by increasing children’s initiations and intelligibility, and facilitating symmetrical communication between dyads.

An interactive digital calendar with mobile phone reminders (RemindMe) for people with cognitive impairment: a pilot randomized controlled trial

BACKGROUND

People with cognitive impairment often need support to perform everyday-life activities. Interventions are available, but evidence-based interventions are lacking.

AIM

This pilot RCT aimed to investigate use of an intervention with an interactive digital calendar with mobile phone reminders (RemindMe) in relation to change in outcomes and impact on occupational performance, independence, health-related quality of life, and psychosocial impact of the support for people with cognitive impairment.

METHOD

The study design was a multi-centre parallel-group pilot RCT [ClinicalTrails.gov, identifier: NCT04470219]. Fifteen participants from primary rehabilitation centres in Sweden were recruited and randomly assigned to intervention group (n = 8) receiving the intervention with RemindMe, or control group (n = 7) receiving usual treatment by an occupational therapist. Data were collected at baseline, after two- and four months, and analysed using descriptive and non-parametric statistics.

RESULT

The Canadian Occupational Performance Measure (COPM), and the Functional Independence Measure (FIM item n-r) showed significant differences. There were no significant differences in health-related quality of life nor in the psychosocial impact of the used support.

CONCLUSION

Plausible changes in outcome measures were found in COPM and FIM (items n-r). These instruments indicate change in outcome measures and impact on occupational performance and independence.

Internet opportunities and risks for adolescents with intellectual disabilities: A comparative study of parents' perceptions

Background: In contemporary society internet and digital competencies are used to perform activities.Aim: The aim of this study is to investigate opportunities and risks of internet use as perceived by the parents of adolescents with intellectual disabilities (ID) in comparison with a national reference group of parents of adolescents.Methods: This was a cross-sectional study with group comparisons using a national survey. Analyses were carried out using Fisher's exact test and logistic regression to control for confounding factors.Results: A significantly higher proportion of parents of adolescents with ID perceive opportunities associated with internet use and playing games, and a lower proportion perceive risks with negative consequences, compared with the reference group. Significantly more parents of adolescents with ID perceive their adolescent never use smartphones and social media compared with the reference group. Fewer parents of adolescents with ID have concerns about online risks for their adolescents compared with the reference group.Conclusion and Significance: The results provide new knowledge for occupational therapists to support positive risk-taking in internet-use for adolescents with ID, in collaboration with their parents, to enable the development of digital competencies and digital participation in everyday life in a digitalised society.

Feasibility of an Intervention for Patients with Cognitive Impairment Using an Interactive Digital Calendar with Mobile Phone Reminders (RemindMe) to Improve the Performance of Activities in Everyday Life

The aim of this study is to increase evidence-based interventions by investigating the feasibility of an intervention using an interactive digital calendar with mobile phone reminders (RemindMe) as support in everyday life. Qualitative and quantitative data were collected from participating patients (n = 8) and occupational therapists (n = 7) from three rehabilitation clinics in Sweden. The intervention consisted of delivering the interactive digital calendar RemindMe, receiving an individualized introduction, a written manual, and individual weekly conversations for two months with follow-up assessments after two and four months. Feasibility areas of acceptability, demand, implementation, practicality, and integration were examined. Patients expressed their interest and intention to use RemindMe and reported a need for reminders and individualized support. By using reminders in activities in everyday life their autonomy was supported. The study also demonstrated the importance of confirming reminders and the possible role of habit-forming. Occupational therapists perceived the intervention to be useful at the rehabilitation clinics and the weekly support conversations enabled successful implementation. This study confirmed the importance of basing and tailoring the intervention to patients' needs and thus being person-centered.

Usability of Eye-Gaze Controlled Computers in Sweden: A Total Population Survey

Eye-gaze technology allows individuals with severe physical disabilities and complex communication needs to control a computer or other devices with eye-gaze, thereby enabling them to communicate and participate in society. To date, most research on eye-gaze controlled devices related to persons with disabilities has focused on a single diagnosis in either adults or children and has included only a few participants. This current study utilized a total population survey to identify the prevalence and perceived usability of eye-gaze technology among adults and children in Sweden. Participants were 171 eye-gaze technology users with severe physical and communication impairments, ranging between 4 and 81 years. Cerebral palsy was the most common diagnosis. Daily usage was found in 63%, while 33% had weekly, and 4% had less frequent usage. Adults, compared with children, reported using their computers more frequently (65%/38%; p < 0.01), and for the activities they needed to perform (59%/31%; p < 0.01) and were more satisfied with services, indicating that service providers should prioritize and develop more effective services for children and their parents.

Hope and Technology: Other-Oriented Hope Related to Eye Gaze Technology for Children with Severe Disabilities

Introducing advanced assistive technology such as eye gaze controlled computers can improve a person's quality of life and awaken hope for a child's future inclusion and opportunities in society. This article explores the meanings of parents' and teachers' other-oriented hope related to eye gaze technology for children with severe disabilities. A secondary analysis of six parents' and five teachers' interview transcripts was conducted in accordance with a phenomenological-hermeneutic research method. The eye gaze controlled computer creates new imaginations of a brighter future for the child, but also becomes a source for motivation and action in the present. The other-oriented hope occurs not just in the future; it is already there in the present and opens up new alternatives and possibilities to overcome the difficulties the child is encountering today. Both the present situation and the hope for the future influence each other, and both affect the motivation for using the technology. This emphasises the importance of clinicians giving people opportunities to express how they see the future and how technology could realise this hope.

Using an interactive digital calendar with mobile phone reminders by senior people - a focus group study

Background

New technologies such as mobile/smartphones have the potential to help senior people perform everyday activities. However, senior people may find it difficult using mobile/smartphones, especially the digital calendar and short text message features. Therefore, senior people might need user-friendly, flexible, and interactive digital calendars that provide them with active reminders about their everyday activities. This study focuses on community dwelling seniors’ experiences learning and using RemindMe, an interactive digital calendar with active reminders, as part of customizing an intervention appropriate for senior people with cognitive impairments.

Methods

Four focus groups were conducted with 20 community dwelling seniors (11 men and 9 women) who all had used RemindMe for six weeks. The focus groups were tape recorded, transcribed verbatim, and analysed using content analysis.

Results

For participants in this study, using a calendar was an essential part of their everyday lives, but only a few had experiences using a digital calendar. Although the participants described RemindMe as easy to use, they had a difficult time incorporating RemindMe into their daily routines. In part, these difficulties were the result of the participants needing to change their mobile/smartphone routines. Some participants felt that using an interactive digital calendar was a sign of modernity allowing them to take part in the society at large, but others felt that their inability to use the technology was due to their age, dependence, and loss of function. Participants found that receiving active reminders through short text messages followed by actively acknowledging the reminder helped them perform more everyday life activities. This feature gave them a higher sense of independence and control.

Conclusions

Community dwelling seniors found that RemindMe was easy to learn and to use, although they also found it challenging to integrate into their everyday lives. For senior people to make the effort to develop new routines for mobile/smartphone use, a prerequisite for using a digital calendar, they need to be motivated and believe that the technology will make their lives better.

Rett syndrome: Teenagers' and young adults' activities, usage of time and responses during an ordinary week - a diary study

Background: Little is known about the everyday life of individuals with Rett syndrome.Aim/Objective: To describe ten participants' (teenagers/young adults) activities during a period of seven days, the time-use, where and with whom the activities were performed and the participants' responses in the form of visible/audible reactions during activities.Material and method: A time-geographic self-administered diary was filled in by 63 informants (parents/support staff) and analysed using the software, DAILY LIFE 2011.Results/Findings: The most frequently reported activities were hygiene/toilet, moving around indoors, eating and getting dressed. Most time was spent in sleeping, daily care, medical health care and travel/transportation. Little time remained for receptive activities, daytime rest, physical, social/creative, communication, school/daily work and domestic chore activities, especially for the young adults. Most time was spent with staff, thereafter with families and the least time was spent with friends. The most reported response was "interested", and "opposed" was the least reported.Conclusions: Daily and medical health care activities were time consuming. Improved communication between all parties may increase participation and well-being and provide solutions for handling unpleasant activities and sedentary time.Significance: A more varied range of activities may improve the everyday life for individuals with Rett syndrome.

Internet Activities During Leisure: A Comparison Between Adolescents With ADHD and Adolescents From the General Population

OBJECTIVE

Adolescents' leisure activities are increasingly focusing on Internet activities, and today, these coexist with traditional leisure activities such as sport and meeting friends. The purpose of the present study was to investigate leisure activities, particularly Internet activities, among boys and girls with ADHD, and compare these with boys and girls from the general population. The objective was also to explore how traditional leisure activities and Internet activities interrelate among adolescents with ADHD.

METHOD

Adolescents with ADHD ( n = 102) were compared with adolescents from the general population on leisure activities and Internet use.

RESULTS

Leisure activities among adolescents with ADHD tended to focus on Internet activities, particularly online games. Internet activities were broadening leisure activities among adolescents with ADHD, rather than being a substitute for traditional leisure activities.

CONCLUSION

Internet activities may provide adolescents with ADHD accessible means of social interaction.

Validity of the school setting interview for students with special educational needs in regular high school - a Rasch analysis

BACKGROUND

Participation in education is a vital component of adolescents' everyday life and a determinant of health and future opportunities in adult life. The School Setting Interview (SSI) is an instrument which assesses student-environment fit and reflects the potential needs for adjustments to enhance students' participation in school activities. The aim of the study was to investigate the psychometric properties of the SSI for students with special educational needs in regular high school.

METHODS

A sample of 509 students with special educational needs was assessed with the SSI. The polytomous unrestricted Rasch model was used to analyze the psychometric properties of the SSI regarding targeting, model fit, differential item functioning (DIF), response category functioning and unidimensionality.

RESULTS

The SSI generally confirmed fit to assumptions of the Rasch model. Reliability was acceptable (0.73) and the SSI scale was able to separate students into three different levels of student-environment fit. DIF among gender was detected in item "Remember things" and in item "Homework" DIF was detected among students with or without diagnosis. All items had disordered thresholds. The SSI demonstrated unidimensionality and no response dependence was present among items.

CONCLUSION

The results suggest that the SSI is valid for use among students with special educational needs in order to provide and evaluate environmental adjustments. However, the items with the detected DIF and the SSI rating scale with its disordered thresholds needs to be further scrutinized.

Eye gaze performance for children with severe physical impairments using gaze-based assistive technology-A longitudinal study

Gaze-based assistive technology (gaze-based AT) has the potential to provide children affected by severe physical impairments with opportunities for communication and activities. This study aimed to examine changes in eye gaze performance over time (time on task and accuracy) in children with severe physical impairments, without speaking ability, using gaze-based AT. A longitudinal study with a before and after design was conducted on 10 children (aged 1–15 years) with severe physical impairments, who were beginners to gaze-based AT at baseline. Thereafter, all children used the gaze-based AT in daily activities over the course of the study. Compass computer software was used to measure time on task and accuracy with eye selection of targets on screen, and tests were performed with the children at baseline, after 5 months, 9–11 months, and after 15–20 months. Findings showed that the children improved in time on task after 5 months and became more accurate in selecting targets after 15–20 months. This study indicates that these children with severe physical impairments, who were unable to speak, could improve in eye gaze performance. However, the children needed time to practice on a long-term basis to acquire skills needed to develop fast and accurate eye gaze performance.

The Occupational Transition Process to Upper Secondary School, Further Education and/or Work in Sweden: As Described by Young Adults with Asperger Syndrome and Attention Deficit Hyperactivity Disorder

The aim was to describe the occupational transition process to upper secondary school, further education and/or work, and to discover what support influences the process from the perspectives of young adults with Asperger syndrome or attention deficit/hyperactivity disorder. This qualitative study was performed in Sweden and comprised interviews with 15 young adults recruited from community based day centres. Support influencing the process included: occupational transition preparation in compulsory school, practical work experience in a safe environment, and support beyond the workplace. The overall understanding shows that the occupational transition process was a longitudinal one starting as early as in middle school, and continuing until the young adults obtained and were able to remain in employment or further education.

Gaze-based assistive technology used in daily life by children with severe physical impairments - parents' experiences

OBJECTIVE

To describe and explore parents' experiences when their children with severe physical impairments receive gaze-based assistive technology (gaze-based assistive technology (AT)) for use in daily life.

METHODS

Semi-structured interviews were conducted twice, with one year in between, with parents of eight children with cerebral palsy that used gaze-based AT in their daily activities. To understand the parents' experiences, hermeneutical interpretations were used during data analysis.

RESULTS

The findings demonstrate that for parents, children's gaze-based AT usage meant that children demonstrated agency, provided them with opportunities to show personality and competencies, and gave children possibilities to develop. Overall, children's gaze-based AT provides hope for a better future for their children with severe physical impairments; a future in which the children can develop and gain influence in life.

CONCLUSION

Gaze-based AT provides children with new opportunities to perform activities and take initiatives to communicate, giving parents hope about the children's future.

Children's and teachers' perspectives on adjustments needed in school settings after acquired brain injury

BACKGROUND

Children with acquired brain injury (ABI) often present with functional deficits that influence their societal participation and well-being. Successful reintegration into school calls for individual support to meet each child's adjustment needs. The adjustment needs of children with ABI in school settings have not previously been explored.

AIM

The objectives of the present study were (a) to describe adjustment needs in school settings for children with ABI and (b) to explore differences and similarities between reports from the children and their teachers.

METHODS

In this cross-sectional study, 20 children with ABI (mean age 12.8 ± 3.4 years; class grade 1-10) and their teachers were interviewed individually, using the School Setting Interview (SSI). Data were analyzed with descriptive and with non-parametric statistics.

RESULTS

(a) In the overall group, children rated that 55.6% of the 16 activities in the SSI needed no adjustment. The corresponding percentage for teachers was 48.4%. (b) In the child-teacher pairs, there was a positive relationship between teachers' and children's responses only in 3 out of 16 school activities and agreement varied strongly according to the activity in question.

CONCLUSIONS AND SIGNIFICANCE

It is important for occupational therapists and other professionals to specifically consider adjustment needs relating to school activities from various perspectives when aiming to provide individualized interventions.

Gaze-based assistive technology in daily activities in children with severe physical impairments-An intervention study

OBJECTIVE

To establish the impact of a gaze-based assistive technology (AT) intervention on activity repertoire, autonomous use, and goal attainment in children with severe physical impairments, and to examine parents' satisfaction with the gaze-based AT and with services related to the gaze-based AT intervention.

METHODS

Non-experimental multiple case study with before, after, and follow-up design. Ten children with severe physical impairments without speaking ability (aged 1-15 years) participated in gaze-based AT intervention for 9-10 months, during which period the gaze-based AT was implemented in daily activities.

RESULTS

Repertoire of computer activities increased for seven children. All children had sustained usage of gaze-based AT in daily activities at follow-up, all had attained goals, and parents' satisfaction with the AT and with services was high.

DISCUSSION

The gaze-based AT intervention was effective in guiding parents and teachers to continue supporting the children to perform activities with the AT after the intervention program.

Gaze-Based Assistive Technology - Use in Everyday Life for Individuals with Impairments

This session focuses on the latest developments of gaze-based assistive technology (AT) and the impact of gaze-based AT interventions in the home and at school. In particular, for play, communication, assessments and early intervention. The discussion focuses on how research findings can advance future developments.

Digital Support for Persons with Cognitive Impairment

Cognitive impairment may cause difficulties in planning and initiating daily activities, as well as remembering to do what is scheduled. This study investigates the effectiveness of an interactive web-based mobile reminder calendar that sends text messages to the users mobile phone as support in everyday life, for persons with cognitive impairment due to neurological injury/diagnoses. The study has a randomised controlled trail design with data collection at baseline and at follow-up sessions after two and four months. Data collection started in August 2016 and continues until December 2017. The interactive web-based mobile reminder calendar may give the needed support to remind the person and thus increase the ability to perform activities and to be independence in everyday life. Preliminary results will be presented regarding what effect the interactive web-based mobile reminder calendar have for the participants performance of everyday life activities as well as perceived quality of life.

The Benefits of Gaze-Based Assistive Technology in Daily Activities for Children with Disabilities

This article reports research findings on how gaze-based assistive technology contributed to performance of daily activities for a group of children with severe physical impairments and without speech.

Gaze-Based Assistive Technology for a Toddler with Tetraplegia and Without Speech

This is a case study exploring gaze-based AT as early intervention, for a ten-month-old non-verbal child with severe physical impairments. Data was collected repeatedly over time through questionnaires, videos clips, and field observations until the child was three years old.

Elderly people's perceptions of using Wii sports bowling - A qualitative study

The Nintendo Wii is a gaming console with motion-sensitive controls that is making inroads into health care and rehabilitation. However, there is still limited knowledge on how elderly people perceive the use of such a product. The aim of this study was to examine how the use of the Wii Sports Bowling in an activity group was perceived by elderly people. The data consisted of observations and interviews with participants who used Wii Sports Bowling and was analysed with content analysis. The findings are described in three themes; 'The use of the Wii Sports game', 'Engagement in the game' and 'Social interaction around the activity'. Wii Sports Bowling was described as easier to play compared to real-life bowling and was enjoyable and a social activity. The opportunity to meet the group each week was important for the participants. Playing the game resulted in signs of immersion and a flow-like state. The Wii was perceived to be easy to use, to provide a way to socialize with peers and to give opportunities to participate in activities in a new way. More studies regarding elderly people's experiences and apprehensions regarding new technology such as gaming consoles and virtual reality are needed.

Participation in School: School Assistants Creating Opportunities and Obstacles for Pupils with Disabilities

This study addresses how help is provided for pupils with physical disabilities and how school assistants influence their participation in school. Data were collected through field observations and interviews with seven pupils between 7 and 15 years old and with each pupil's teacher and assistant. The analysis resulted in a description of features that influenced how help was provided and the consequences in school for the pupil with disabilities. A major finding was that the assistants could both facilitate and hinder participation. We concluded that an awareness of the priority the pupils place on social participation with their peers is needed to ensure effective and flexible support is made available to pupils with disabilities.

The Client-Clinician Assessment Protocol (C-CAP): Evaluation of its Psychometric Properties for Use with People Aging with Disabilities in Need of Home Modifications

The objective of this study was to evaluate aspects of the validity and reliability of the Client-Clinician Assessment Protocol (C-CAP) Part I. C-CAP data for 103 people aging with disabilities in need of home modification services were analyzed using the Rasch rating scale model. The C-CAP Part I consists of a client self-report of ability in daily life tasks comprising three scales (independence, difficulty, and safety). The analysis demonstrated support for internal scale validity, person response validity, and person separation reliability of the C-CAP Part I, although the results differed among the three scales. The results of this study indicated that the C-CAP Part I has psychometric strengths and limitations. The instrument has the potential to be used in the home environment with people who are aging with disabilities. The C-CAP could complement already existing tools that are used to assess functioning in activities of daily living, especially regarding the focus on the clients' self-report of difficulty and safety in daily life at home and in the community.

Agreements and disagreements between children and their parents in health-related assessments

PURPOSE

To systematically review research concerning parent-child agreement in health-related assessments to reveal overall agreement, directions of agreement, and the factors that affect agreement in ratings.

METHOD

The Uni-Search and five additional databases were searched. Children's health issues were grouped into psychosocial issues including autism and ADHD, and physical and performance issues including pain. Measures used for comparison were those addressing (a) psychosocial functioning, (b) physical and performance functioning, and (c) health-related quality of life.

RESULTS

Totally, 39 studies met the inclusion criteria, comprising 44 analyses in all since four studies contained more than one analyses. Moderate child-parent agreement was demonstrated in 23 analyses and poor agreement in 20 analyses. Several analyses found more agreement on observable/external than on non-observable/internal domains. Overall, parents considered their children had more difficulties than did the children themselves, although there were indications that for children with physical performance issues, parents may underreport their children's difficulties in emotional functioning and pain. There were no consistencies in differences between children's and parent's ratings on levels of agreement with respect to the children's health issue, age or gender.

CONCLUSIONS

Discrepancies between child and parent reports seem to reflect their different perspectives and not merely inaccuracy or bias. Implications for Rehabilitation In general, parents consider their children to have more difficulties - or more extensive difficulties - than the children themselves think they have. The perspectives of the child and his or her parents should be sought whenever possible since both constitute important information concerning the child´s health and well-being. Children with physical and performance issues reported more difficulties than their parents concerning the children's emotional functioning and pain. Clinicians should prioritize obtaining children's views on subjective aspects such as emotional issues as well as on pain.

Support for learning goes beyond academic support: Voices of students with Asperger’s disorder and attention deficit hyperactivity disorder

The purpose of this study was to describe and explore the experiences of support at school among young adults with Asperger’s disorder and attention deficit hyperactivity disorder and also to examine what support they, in retrospect, described as influencing learning. Purposive sampling was used to enroll participants. Data were collected through semi-structured interviews with 13 young adults aged between 20 and 29 years. A qualitative analysis, based on interpreting people’s experiences, was conducted by grouping and searching for patterns in data. The findings indicate that the participants experienced difficulties at school that included academic, social, and emotional conditions, all of which could influence learning. Support for learning included small groups, individualized teaching methods, teachers who cared, and practical and emotional support. These clusters together confirm the overall understanding that support for learning aligns academic and psychosocial support. In conclusion, academic support combined with psychosocial support at school seems to be crucial for learning among students with Asperger’s disorder and attention deficit hyperactivity disorder.

E-inclusion: Digital equality - young people with disabilities

The United Nations' position is that digital access is a matter involving equality between groups of people, the securing of democratic rights, and equal opportunities for all citizens. This study investigates digital equality in school and leisure between young people with and without disabilities. A cross-sectional design with group comparisons was applied. Participants were young people (10-18 years of age) with disabilities (n=389) and a reference group in about the same ages. Data were collected by a survey focusing on access to and engagement in ICT activities in school and during leisure time. The results demonstrated young people with disabilities had restricted participation in computer use in educational activities, in comparison to young people in general. During leisure time young people with disabilities had a leading position compared to the reference group with respect to internet use in a variety of activities. Beneficial environmental conditions at home (and the reverse in schools) are discussed as parts of the explanation for the differing engagement levels at home and in school, and among young people with disabilities and young people in general.

CONCLUSION

Schools need to prioritise use of ICT by young people with disabilities.

Usability of RemindMe - An Interactive Web-Based Mobile Reminder Calendar: A Professional's Perspective

AIM

The aim of the study was to examine the usability of an interactive web-based mobile reminder calendar (RemindMe) developed for supporting individuals in organizing, planning and executing activities in everyday life, from the perspectives of professionals.

METHODS AND MATERIAL

Eleven professionals working in community services evaluated the usability of RemindMe in their clinical practice. Data were collected using semi-structured interviews and analysed with inductive qualitative analysis.

RESULTS

The professionals perceived that RemindMe was useful, easy to use, and intuitive. There was a need among professionals for a web-based reminder calendar that requires the active acknowledgement of reminders. RemindMe's feedback system offering self-monitored information based on the user's interaction with the system supported the professionals in discussions, evaluation, and follow-up based on the needs of the persons with cognitive impairments.

CONCLUSION

The results indicate that RemindMe may be potentially useful to professionals who provide support to individuals with cognitive impairments. However, further research is needed to evaluate experience of using RemindMe from the perspective of individuals with cognitive impairments.

Parents of children with physical disabilities - perceived health in parents related to the child's sleep problems and need for attention at night

BACKGROUND

Approximately half of all children with moderate to severe physical disabilities have persistent sleep problems and many of these children need parental attention at night.

AIM

To study whether sleep problems and need for night-time attention among children with physical disabilities are associated with perceived parental health, headache, psychological exhaustion, pain due to heavy lifting, night-time wakefulness and disrupted sleep.

METHODS

We asked parents of 377 children with physical disabilities aged 1-16 years to complete a questionnaire about their own health. The children all lived at home with both parents.

RESULTS

Both parents reported poor health, psychological exhaustion, more night-time wakefulness and disrupted sleep when the child had sleep problems (P < 0.05). Mothers also reported more headache when the child had sleep problems (P = 0.001). Both parents reported more night-time wakefulness and disrupted sleep when the child needed night-time attention (P < 0.01). In general, mothers reported significantly poorer health, more night-time wakefulness, disrupted sleep, headache and psychological exhaustion than fathers (P < 0.001).

CONCLUSIONS

Sleep problems need to be acknowledged within the paediatric setting in order to prevent psychological exhaustion and poor health in mothers and fathers of children with physical disabilities.

Evaluating the Psychometric Properties of a Clinical Vocational Rehabilitation Outcome Measurement: The Assessment of Work Performance (AWP)

This study examined the validity and reliability of the Assessment of Work Performance (AWP) using Rasch analysis. The AWP was administered to 365 clients with a variety of work-related problems. Rasch analysis and principal component analysis were used to examine the appropriateness of the rating scales and unidimensionality of AWP items. The person-response validity, internal consistency, targeting appropriateness, and differential item function were also analyzed. The Rasch analysis confirmed the 4-point rating scale, and the item set met the criteria of unidimensionality. The AWP exhibited satisfactory person-response validity and internal consistency. Among the three subdomains, the targeting of item-difficulty was sufficient in the motor skills and process skills subdomains. Differential item functioning was found across gender and diagnoses. This study presented evidence to support that the AWP functioned as a reliable and valid assessment in assessing work performance. [OTJR: Occupation, Participation and Health 2013;33(3):125-133.].

Benefits of the use of ICT in school activities by students with motor, speech, visual, and hearing impairment: a literature review

OBJECTIVE

Information and communication technology (ICT) has the potential to enhance participation in educational activities for students with physical disabilities. Even though incorporating ICTs into teaching and learning in education has become an important issue, it is unclear what evidence research has provided. The aim of this study was to investigate types of ICT items and how ICT is being used by students with physical disabilities, and describe the benefits of ICT use in school activities.

METHODS

A systematic literature search, covering the period 2000-May 2012, was performed in the databases AMED, CINAHL, Eric, OTseeker, Psych Info, PubMed, and Scopus. Data analysis entailed extracting, editing, grouping, and abstracting findings.

RESULTS

A total of 32 articles were included, 16 of which were intervention studies. More than half of the studies concerned students with motor impairments. Type of ICT used differed among impairment groups, and ICT seemed to be especially beneficial for writing, spelling, and communication.

CONCLUSIONS

Even though the review found heterogeneity across the studies students seemed to benefit from ICT use regardless of the type. For future research it is important to highlight intervention studies, especially for students with visual, hearing, and communication impairments.

Improving computer usage for students with physical disabilities through a collaborative approach: a pilot study

OBJECTIVE

The aim of this study was to evaluate the effect of an assistive technology (AT) intervention to improve the use of available computers as assistive technology in educational tasks for students with physical disabilities during an ongoing school year.

METHODS

Fifteen students (aged 12-18) with physical disabilities, included in mainstream classrooms in Sweden, and their teachers took part in the intervention. Pre-, post-, and follow-up data were collected with Goal Attainment Scaling (GAS), a computer usage diary, and with the Psychosocial Impact of Assistive Devices Scale (PIADS). Teachers' opinions of goal setting were collected at follow-up.

RESULTS

The intervention improved the goal-related computer usage in educational tasks and teachers reported they would use goal setting again when appropriate. At baseline, students reported a positive impact from computer usage with no differences over time regarding the PIADS subscales independence, adaptability, or self-esteem.

DISCUSSION

The AT intervention showed a positive effect on computer usage as AT in mainstream schools. Some additional support to teachers is recommended as not all students improved in all goal-related computer usage. A clinical implication is that students' computer usage can be improved and collaboratively established computer-based strategies can be carried out by teachers in mainstream schools.

Experiences of handwriting and using a computerized ATD in school: adolescents with Asperger's syndrome

Adolescents with Asperger's syndrome (AS), often have handwriting difficulties that affect their academic performance. The purpose of this descriptive multiple-case mixed-method study was to highlight how adolescents with AS experience writing in the school setting when writing by hand and when using a computerized Assistive Technology Device (ATD), for writing. A qualitative content analysis approach was used, including interviews with five adolescents, their parents, and their teachers. This was complemented by asking the adolescents to rate their perceived performance and satisfaction of writing with and without the ATD. All adolescents described handwriting difficulties, but a reduced ability to express oneself in writing was also common. Initiating and completing writing tasks was often so demanding that it caused resistance to the activity. Several advantages when using the ATD were described by the participants and the self-ratings showed higher scores for performance of and satisfaction with writing when the ATD was used. The results show that teachers' encouragement seemed to be important for the initiation and continuation of use of the ATD.

Parents' actions, challenges, and needs while enabling participation of children with a physical disability: a scoping review

Background

Pediatric rehabilitation considers Family-centered service (FCS) as a way to increase participation of children with a physical disability in daily life. An important principal is that parents greatly contribute to their child’s participation at school, at home, and in the community. However, it is unclear what kind of information is available from literature about what parents actually do to support their child’s participation and what problems and needs they experience? Hence, the aim of this study was to provide an overview of the actions, challenges, and needs of parents in enabling participation of their child with a physical disability that is neurological and non-progressive in nature.

Methods

Scoping review with extensive literature search (September 2011) and a thematic analysis to synthesize findings.

Results

Fourteen relevant articles revealed two major themes: ‘parents enable and support performance of meaningful activities’ and ‘parents enable, change and use the environment’. Each theme holds a number of actions (e.g. choosing the right type of meaningful activities for facilitating social contacts) and challenges (e.g. negative attitudes of other people). Less information is available about the needs of parents.

Conclusions

This study indicates that parents apply a broad range of strategies to support participation of their children. They experience many challenges, especially as a result of constraints in the social and physical environments. However, this review also shows that little is known about needs of parents in facilitating participation. As Family-centered service (FCS) philosophy is all about the needs of the child and the family, it is essential to further investigate the needs of the parents and to understand if and to what extent they wish to be supported in enabling their child’s participation in daily life.

Computer-based assistive technology device for use by children with physical disabilities: a cross-sectional study

OBJECTIVE

To investigate the prevalence of children with physical disabilities who used a computer-based ATD, and to examine characteristics differences in children and youths who do or do not use computer-based ATDs, as well as, investigate differences that might influence the satisfaction of those two groups of children and youths when computers are being used for in-school and outside school activities.

METHOD

A cross-sectional survey about computer-based activities in and outside school (n = 287) and group comparisons.

RESULTS

The prevalence of using computer-based ATDs was about 44 % (n = 127) of the children in this sample. These children were less satisfied with their computer use in education and outside school activities than the children who did not use an ATD.

CONCLUSION

Improved coordination of the usage of computer-based ATDs in school and in the home, including service and support, could increase the opportunities for children with physical disabilities who use computer-based ATDs to perform the computer activities they want, need and are expected to do in school and outside school.