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Artificial intelligence can support increasingly complex conversational interactions and also has the potential to interpret meanings from free text input and make recommendations based on patterns in data. There are important opportunities to apply this to real-world problems faced in access to education. In this paper, we summarise existing research and trends linking disability support and technology, then report on a survey conducted with students with disclosed disabilities (n = 138) to explore what systems might need to do to effectively understand disabled students in their own words, and provide suggestions of technologies, strategies and resources that could be relevant to overcoming barriers to learning. Through thematic analysis, five approaches that students used to talk about their disabilities are identified(medical, functional, support, experiential and administrative), and three major types of suggestions they make around what supported them and may be useful to others are also identified (external tools, university support and practices, concerns and solutions). The survey approach and the findings of the analysis provide a potential foundation for the effective design of systems that could crowdsource a knowledgebase around disabilities, hold conversations to understand disabilities and barriers and make relevant recommendations to individuals as to how they could overcome these barriers.

Administrative burden in education is a serious issue for disabled students. Form-filling and bureaucracy are ubiquitous in further and higher education, particularly for students who need to disclose a disability and arrange for accommodations and support for an equitable educational experience. Paradoxically, many of these processes are inherently inaccessible for disabled students, and yet completing them can be critical to their success. Artificial Intelligence has potential to alleviate some of the burden imposed by administration and bureaucracy; virtual assistants and chatbots can replace forms with dialogue, without placing additional strain on institutions. However, it is essential that solutions are designed in partnership with disabled students to ensure that students' needs are met, their concerns addressed, and the final solution is equitable for them. This paper explores a case study of participatory research with disabled students in a large UK distance learning institution, in which participatory research identified an issue of administrative burden for disabled students, and a virtual assistant was designed as a solution using participatory design. It shares the methodology and design process, explores findings from different phases of the research, and shares recurrent themes arising throughout the study. In doing so, it aims to provide a foundation for future participatory research to reduce barriers for disabled students.

Deaf and hard-of-hearing (DHH) children with cochlear implants (CwCIs) constitute a heterogeneous population. A multitude of factors influence their spoken language development. There is evidence that CwCIs follow similar trajectories in language development as typically developing (TD) children but there is a lack of research on specific types of skills. This study aimed to (1) map the trajectory of receptive and expressive language skill development of a representative group of CwCIs and (2) evaluate the impact of age at switch-on (ASO) on skill development. This paper presents a detailed analysis of the language outcomes of 44 CwCIs with ASO between 11 and 45 months (M = 26.02 SD = 8.31). These children were tracked for the first two years following implantation. Clustered bar charts were used to compare specific types of skills acquired by CwCIs with ASO [less than or equal to]2 years versus >2 years. The results suggest that CwCIs generally acquire receptive and expressive language skills along a similar sequence to TD children, but there is individual variability relating to specific skills. However, the language outcomes of CwCIs are ultimately the result of a complex interplay of demographic variables.

The focus of this paper is the history of how special needs technology in the UK was developed for people with special educational needs between 1970 and 1999. Despite the proclaimed potential of technology, this context and period has undergone very little historical examination. This paper will draw on interviews with 52 experienced professionals in order to illuminate this history. Analysis will attempt to extend our understanding of the perceived transformative potential of technologies and the factors that influenced the actual transformative potential of technologies. In particular the analysis will focus on three particular kinds of transformations: a transformation of the micro-technology industry; a transformation of teaching practice and a transformation of experience of special educational needs/disability. These three transformations and the potential tensions between them will be illuminated through two themes: 'Entrepreneurialism versus Creativity' and '"Miracle Cure" versus "Just a Tool"'.

Across the globe, students with disabilities have been increasing in prevalence in higher education settings. In the twenty-first century the struggle to include individuals with disabilities into nursing schools and workplaces continues in different parts of the world. Historically, entry criteria in nursing schools have been based on essential functions, which were primarily designed to be used in the workforce, rather than technical standards for education. In other health professions, such as medicine, this is not necessarily the case. For example, the American Association of Medical Colleges has worked over the past two decades to develop appreciation among medical schools for the need to admit and accommodate students with disabilities. We argue that nursing has not followed suit. This paper presents an integrative literature review, consisting of material from the United States, Ireland, United Kingdom, and Australia, investigating compelling stories, legal mandates, websites, and extant literature looking at essential functions or technical standards as entry criteria for nursing schools. The results show that, when essential functions for employment are used in nursing education, they may be a barrier to entry into that program. The paper concludes with recommendations for well-defined technical standards for nursing schools to be used primarily as entry criteria.

Scholarship on instructive technologies in higher education has emphasized the use of high-tech facilitative technologies for long-term use, and low-tech props to illustrate single topics. This paper, on the contrary, discusses the use of a long-term, low-tech instructional technology: Llewelyn the Lynx was a soft animal used to assist with discussions in first year seminars. In-class questionnaires and anonymous online reviews on RateYourLecturer show Llewelyn was popular, facilitated equal contribution to discussion, and made seminars less intimidating and more enjoyable. Llewelyn may have functioned as a tactual or kinaesthetic stimulus, and an assistive technology for students with learning difficulties. His use does not seem to have infantilized most of the students although there was some disagreement here.

This paper reports the findings of a thematic narrative review of peer‐reviewed articles exploring innovation in UK independent homecare services published between January 2009–August 2021. Our analysis of 15 papers reveals four broad innovation types: personalised funding, operational models, workforce development and assistive technology. We conclude that research focused on innovation in independent homecare offers important insights into the positive and negative outcomes of different types of innovation for providers, care workers and people receiving care. There are, however, also areas which are neglected and need further elaboration, including more robust evidence of outcomes and clearer articulation of innovation processes. [ABSTRACT FROM AUTHOR]

Access or assessment accommodations and arrangements exist to enable students with disabilities to be included in high stakes examinations, and to comply with Equality legislation and the Convention on the Rights of Persons with Disabilities. This article explores the accessibility of digital versions of Question Papers offered by UK awarding bodies for high stakes externally assessed examinations. It raises concerns that question papers from five out of six providers are not adequately accessible for candidates with visual impairment who use screen reader technologies and so asks broader questions about ways in which, even in high income countries with a strong espoused commitment to equality, disadvantage can be compounded rather than addressed. Access arrangements offered by awarding bodies should reflect candidates' 'normal way of working'; this article presents original and unique data from a survey of Qualified Teachers of the Visually Impaired in respect of technologies and strategies used by 325 students with visual impairment and finds that up to 16% of these learners are using screen reader tools in school. These candidates may, therefore, be disadvantaged in examinations because the technology they use to access learning resources cannot be successfully utilised to access assessments. The article concludes with recommendations for regulators and providers of assessments. [ABSTRACT FROM AUTHOR]

This paper will explore the effect that creative, non-traditional uses of audio description (AD) have on the audience during a performance, and how they trouble normative understandings of aesthetics and representation. This will be done by analysing two pieces created by Extant Theatre, the UK's only professional theatre company of visually impaired people. Both pieces use highly visual forms of performance in order to highlight the necessity of descriptive access for both practitioners and spectators experiencing these pieces, as well as the effect that description can have on the comprehension of an image. I will dissect these performances by juxtaposing my experience as a practitioner in these pieces with some of the methodological structures inherent within disability studies and identity politics, such as Rosemary Garland-Thomson's research on staring. AD, in its standard form, is an access tool for blind and visually impaired spectators that is almost always placed on top of an already completed performance, and hidden from the view of those not using the service. When that dynamic is shifted to allow for everyone, performer and audience alike, to experience and potentially contribute to the descriptions being given, regardless of visual status, the perceptions around the performance can change. This paper argues that the creative input of AD into a theatrical piece can open up wider questions around how aesthetics are viewed by performer and audience alike. Also, by making an access tool into a collaboration between audience and performer, the story that is communicated and the way the characters within that story are represented can break away from normative methods of performance. This then opens up possibilities for new ways of thinking about and perceiving how performance is made, why it is done and what it might become.

This paper describes accessible collaborative learning using mobile devices with mobile enhancements to Synote, the freely available, award winning, open source, web based application that makes web hosted recordings easier to access, search, manage, and exploit for all learners, teachers and other users. Notes taken live during lectures using Twitter on any mobile device can be automatically uploaded into Synote and synchronised with a recording of the lecture. Syntalk, a mobile speech recognition application enables synchronized live verbal contributions from the class to also be captured on Synote through captions. Synote Mobile has been developed as an accessible cross device and cross browser HTML5 version of Synote. Synote Discussion supports commenting on Synote's Synmark notes stored as discussions in its own database and published as Linked data so they are available for Synote or other systems to use.

This paper focuses on the singing activity of prelingually deaf children under four years of age who are using cochlear implants (CIs) and presents a strand of a larger study that aimed to observe, record and analyse the musical activity of seven profoundly deaf children using CIs in the UK, for a period of one calendar year. The singing activity of deaf children has been the focus of only a limited number of studies. This paper presents the singing behaviour of very young deaf children viewed as a holistic, communicative experience and part of their general music-making that develops in time and in the company of others. In this paper, I analyse one example from the data and discuss various parameters that are involved in song openings of deaf children: the presence of significant others, preference for song material, reproduction of the structural aspects of song, kinesthetic and emotional involvement in singing and re-enactment of song experiences in the children's own private spaces. (Contains 4 figures and 11 notes.)

This paper makes the case that if e-learning research and development projects are to be successfully adopted in real-world teaching and learning contexts, then they must effectively address accessibility and usability issues; and that these need to be integrated throughout the project. As such, accessibility and usability issues need to be made explicit in project documentation, along with allocation of appropriate resources and time. We argue that accessibility and usability are intrinsically inter-linked. An integrated accessibility and usability evaluation methodology that we have developed is presented and discussed. The paper draws on a series of mini-case studies from e-learning projects undertaken over the past 10 years at the Open University. (Contains 19 notes.)

Since at least 2012, UK housing providers (and policy makers) have introduced policies aimed at developing autonomy and independence among service users, through an agenda sometimes referred to as 'responsibilisation'. This paper considers the role that technologies play in this agenda, through an analysis of how wellbeing and independence are facilitated amongst older social housing tenants. Based on case studies of four supported housing schemes in England, the research considers the capacity to exercise agency amongst older persons, through their willingness and ability to accept technological interventions, and the role of support networks to facilitate independent living. Using the concept of modalities of agency, the research examines the impact of implementing 'low-level' assistive technologies in the home, based on the perspectives of residents and staff. The interventions studied were designed to improve social relationships, promote self-sufficiency and support self-managed care (based on the principle that the most effective projects facilitate individual agency). The research findings identified that residents responded differentially to technology, based on their levels of capability, motivation, reluctance and resistance. Whilst the study demonstrated that small technological innovations could have disproportionately positive impacts in improving wellbeing, the research demonstrates the complex nature of agency and limits of responsibility. The paper argues that responsibilisation is part of a wider neoliberal project, where choice and agency are manufactured to create an idealised notion of the autonomous actor (in this case through technology-enabled care). The article argues that a collaborative approach to service provision in which responsibility is shared, via co-managed care, is a more effective means of enhancing agency, than one which advocates a withdrawal of support (in the guise of autonomy). [ABSTRACT FROM AUTHOR]

The relationship that disabled university students have with both their technologies and institutions is poorly understood. This paper seeks to illuminate this relationship using the conceptual lens of digital capital. The results from a study that explored the technology experiences of 31 disabled students studying in one university were analysed with a view to revealing evidence for both cultural and social digital capital. The analysis suggests that disabled students possess significant levels of both cultural and social capital, but that there are times when this capital is compromised or insufficient to enable students to fully benefit from technologies. Possessing digital capital does not appear to guarantee complete inclusion into university life.

The golden summer of sport is now over, but what is the legacy of London 2012 for disabled people? Nadia Ahmed, a disabled student, discusses the difficulties she has faced in finding accessible accommodation in London. She argues that while the Games are over, the United Kingdom still has lots of hurdles to leap when it comes to disability. The article focuses on her own personal experience of not being able to get wheelchair-accessible accommodation in Tower Hamlets, a London borough that is a close neighbour of Stratford where the Olympic and Paralympic games were held. The article raises questions about disability equality following the Paralympics.

This paper discusses the experiences of parents of deaf children with additional complex needs (ACN) in accessing cochlear implant (CI) services and achieving ongoing support. Of a total study group of fifty-one children with ACN, twelve had been fitted with a CI. The parental accounts provide a rich and varied picture of service access. For some families accessing audiological assessment for CI was problematic, for others expectations, access to a qualified teacher of the deaf to FM amplification were problematic. Where services were similar in quality and quantity to typically developing deaf children who had received a CI there were high levels of satisfaction. For all the children implantation was delayed, the level of communication skills prior to implantation was very low, and expectations were uncertain and unclear. Deaf children with ACN require at least the same access to services as typically developing children. It can be argued that this group requires a higher level of input from qualified specialists, yet findings from this study suggest some children are likely to be receiving substantially less input, and in some cases no specialist input. Recommendations for audiological and educational management are also made. (Contains 3 tables.)

A sign bilingual approach to the education of deaf children was first introduced in the UK in 1990. This paper reviews the growth of sign bilingual education in the UK and documents significant milestones in the development of sign bilingual policy and practice since the 1980s. This overview demonstrates how key issues in sign bilingual education have evolved and how priorities have changed over time and enables comparisons with contexts beyond the UK to be drawn. Current issues in sign bilingual education are analysed within our twenty-first century educational context in which both the advancing technology and medical understanding are providing new opportunities for deaf pupils and changing their learning and communication needs. Particular themes addressed include research into early literacy and also the role of sign language for deaf children with cochlear implants. From this analysis, new directions for sign bilingual education are suggested in terms of learning and teaching and a future research agenda.

Speech technology--especially automatic speech recognition--has now advanced to a level where it can be of great benefit both to able-bodied people and those with various disabilities. In this paper we describe an application "TalkMaths" which, using the output from a commonly-used conventional automatic speech recognition system, enables the user to dictate mathematical expressions in a relatively straightforward way. These then get converted into electronic formats, so that they can be embedded in a document and/or displayed in an editor or web browser. This process can be used for preparing teaching material, assignments, or entering mathematical content for online tests. Our system does not require the user to have extensive knowledge of the syntax of any markup language or mathematical document specification language, so that learning to use it should be relatively straightforward for non-specialists. The way in which our system analyses, converts and encodes the spoken mathematical expressions is a novel approach. (Contains 4 figures.)

This paper assesses the expressive spoken grammar skills of young deaf children using cochlear implants who are beginning formal education, compares it with that achieved by normally hearing children and considers possible implications for educational management. Spoken language grammar was assessed, three years after implantation, in 45 children with profound deafness who were implanted between ten and 36 months of age (mean age = 27 months), using the South Tyneside Assessment of Syntactic Structures (Armstrong and Ainley, 1983) which is based on the Language Assessment and Remediation Screening Procedure (Crystal et al., 1976). Of the children in this study aged between four and six years, 58 per cent (26) were at or above the expressive spoken language grammatical level of normally hearing three year olds after three years of consistent cochlear implant use: however, 42 per cent (19) had skills below this level. Aetiology of deafness, age at implantation, educational placement, mode of communication and presence of additional disorders did not have a statistically significant effect (accepted at p less than or equal to 0.05) on the development of expressive spoken grammar skills. While just over half of the group had acquired spoken language grammar skills equivalent to or above those of a normally hearing three year old, there remains a sizeable group who, after three years of cochlear implant use, had not attained this level. Spoken language grammar therefore remains an area of delay for many of the children in this group. All the children were attending school with hearing children whose language skills are likely to be in the normal range for four to six year olds. We therefore need to ensure that the ongoing educational management of these deaf children with implants addresses their spoken grammar delay in order that they can benefit more fully from formal education. (Contains 7 figures and 2 tables.)

A wide range of tools is now available to enable teaching practitioners to create web-based educational materials from PowerPoint presentations, adding a variety of different digital media, such as audio and animation. The pilot study described in this paper compared three different systems for producing multimedia presentations from existing PowerPoint files. The resulting resources were tested by a group of disabled students and a group of non-disabled students. Our findings show that there were statistically significant differences between the two groups in relation to their interaction with the resources. In particular, the students with disabilities were significantly more active in using the available controls to customise the running of the presentations. The data suggest that future work on why students with accessibility issues made different uses of these resources could encourage practitioners' deployment of multimedia resources for the benefit of all learners. (Contains 4 figures, 2 tables, and 1 note.)

Augmentative and alternative communication (AAC) holds the potential to enable people with severe oral communication impairments to participate more fully in society. However, despite the development of increasingly sophisticated communication aids, as well as recent UK policy initiatives aimed at improving access to them, some major obstacles stand in the way of the inclusory potential of AAC being realized to any significant degree. Drawing on findings of a research study that explored the experiences of people who use AAC, this paper looks at the various problems that people encounter in using communication aids. It identifies the lack of consistent, structured support as a key overarching issue. The author goes on to argue that for the potential of AAC to be realized attention needs to be given to the development of coordinated systems of support within the policy domains of education, health and social services. (Contains 1 note.)

The UK's 2001 Special Educational Needs and Disability Act has charged learning technologists with the responsibility of ensuring that electronic teaching materials can be accessed by disabled students. In an attempt to explore how learning technologists are developing practices to produce accessible electronic materials this paper will present a review of the accessibility literature and identify key issues that may influence the "accessibility" practices of learning technologists. These emerging issues are interpreted using Wenger's theory of communities of practice, with a particular emphasis on the development of accessibility practices that may be shared by a number of related communities of practices and on how the focus of accessibility practices may soon shift from the product to the process of accessibility. (Contains 3 notes.)

Brain–computer interface (BCI)-controlled assistive robotic systems have been developed with increasing success with the aim to rehabilitation of patients after brain injury to increase independence and quality of life. While such systems may use surgically implanted invasive sensors, non-invasive alternatives can be better suited due to the ease of use, reduced cost, improvements in accuracy and reliability with the advancement of the technology and practicality of use. The consumer-grade BCI devices are often capable of integrating multiple types of signals, including Electroencephalogram (EEG) and Electromyogram (EMG) signals. This paper summarizes the development of a portable and cost-efficient BCI-controlled assistive technology using a non-invasive BCI headset "OpenBCI" and an open source robotic arm, U-Arm, to accomplish tasks related to rehabilitation, such as access to resources, adaptability or home use. The resulting system used a combination of EEG and EMG sensor readings to control the arm. To avoid risks of injury while the device is being used in clinical settings, appropriate measures were incorporated into the software control of the arm. A short survey was used following the system usability scale (SUS), to measure the usability of the technology to be trialed in clinical settings. From the experimental results, it was found that EMG is a very reliable method for assistive technology control, provided that the user specific EMG calibration is done. With the EEG, even though the results were promising, due to insufficient detection of the signal, the controller was not adequate to be used within a neurorehabilitation environment. The survey indicated that the usability of the system is not a barrier for moving the system into clinical trials. For the rehabilitation of patients suffering from neurological disabilities (particularly those suffering from varying degrees of paralysis), it is necessary to develop technology that bypasses the limitations of their condition. For example, if a patient is unable to walk due to the unresponsiveness in their motor neurons, technology can be developed that used an alternate input to move an exoskeleton, which enables the patient to walk again with the assistance of the exoskeleton. This research focuses on neuro-rehabilitation within the framework of the NHS at the Kent and Canterbury Hospital in UK. The hospital currently does not have any system in place for self-driven rehabilitation and instead relies on traditional rehabilitation methods through assistance from physicians and exercise regimens to maintain muscle movement. This paper summarises the development of a portable and cost-efficient BCI controlled assistive technology using a non-invasive BCI headset "OpenBCI" and an open source robotic arm, U-Arm, to accomplish tasks related to rehabilitation, such as access to resources, adaptability or home use. The resulting system used a combination of EEG and EMG sensor readings to control the arm, which could perform a number of different tasks such as picking/placing objects or assist users in eating. [ABSTRACT FROM AUTHOR]

Educational Technology (EdTech) plays a significant role in enabling learners with disabilities to access learning at school and reduce educational and social exclusion. It also enables them to enjoy the benefits of a full school curriculum and to participate in activities in different educational arrangements. The purpose of this review was to address the existing evidence of how EdTech is being used to support learners with disabilities in order to inform future research and policymaking. It sought to contribute to an evidence base of ways to reduce barriers to learning drawing on a systematic methodology to gather evidence pertaining to access to EdTech for primary school learners with disabilities aged 6–12 years. After a thorough examination of the literature, the final sample comprised 51 published articles (43 peer-review and 8 conference papers). The review revealed examples of positive outcomes of EdTech interventions being used, particularly in special schools; however, the evidence of their efficacy is weak. The use of EdTech for learners with disabilities in low- and middle-income countries requires further, robust and long-term research that considers the involvement of learners, pedagogy and curriculum design in order to understand its impact on improving educational experiences of children with disabilities. [ABSTRACT FROM AUTHOR]

Children on the autism spectrum (AS) often struggle with writing tasks at school. They commonly experience difficulty with two key aspects of writing: the skills required for handwriting (fine motor and perceptual) and the conceptual and language skills required for written composition. Specialist intervention to assist with written expression is, therefore, often needed for students on the AS to succeed academically. This research evaluated the impact of using self‐regulated strategy development (SRSD) in combination with assistive technology on the quality and length of written compositions of students on the AS. It also investigated how students felt about using the SRSD writing strategy. Eight primary school students on the AS between the ages of 9 and 12 participated in this single‐subject study. An ABAC study design was used to evaluate student writing performance across three conditions. Baseline handwriting measurements were collected during condition A. During condition B students used assistive technology alone; in condition C, students applied their understanding of SRSD while using assistive technology. Results from this study show that, in many cases, the quality and/or length of written compositions and feelings of self‐efficacy towards persuasive writing of students on the AS improved when they received physical and/or conceptual writing supports. This paper presents the research design, methods and results from this single‐subject study followed by a discussion of the results and final thoughts and areas for future research. Practitioner NotesWhat is already known about this topic? There is limited research about how the persuasive writing of students on the autism spectrum (AS) can be supported in a socially inclusive way.Research has shown that the use of assistive technologies like keyboards and writing‐support software can improve the writing outcomes of students on the AS.Research has shown that the use of self‐regulated strategy development (SRSD) writing strategies can improve the persuasive writing outcomes of diverse students.What this paper adds? A single‐subject study using an ABAC study design showed that persuasive writing outcomes improved in quality or length for some students when they used an app that combined the two strategies.Implications for policy and practice SRSD combined with writing‐support software appeared to improve the writing outcomes of some students on the AS. It can, therefore, be used as a tool to support teachers in developing strategies for inclusive classrooms. [ABSTRACT FROM AUTHOR]

Background and aim: A Society's view of disability may influence the perception and use of Assistive Technology (AT) products. Semantic cues or cultural coding provide the viewer with a series of visual stimuli to be given or ascribed meaning. Previous research has shown cognitive approaches to visual perception and assignment of meaning vary between diverse cultures. This study reviews the influence of contextual settings on perception, to provide the basis for a debate on the societal perception of communicative content (semantic/meaning) of an AT product; and, the relevance of different cultural cognitive styles. The paper explores, from a cultural viewpoint, the overall understanding of disability internationally. Method: A Semantic Differential (SD) scale was used to obtain views on the image of an attendant wheelchair from nine hundred and ninety-one (991) young adults from the United Kingdom (UK) and Pakistan (PAK), reflecting the individualist and collectivist societies, respectively. This survey follows a previous paper-based study using the same image and protocol. Comparing the two surveys, a consensus of views from the two groups was achieved. Results and conclusion: The responses from the UK group were skewed towards a negative view of disability compared to the Pakistan group. This inferred greater social stigma associated with this AT product in the UK. The combined findings from both surveys provide insights into societal perception of AT products and disability. Areas for future research are suggested, including what visual components of an AT product (graphemes) appear to be associated with positive or negative responses for collectivist and individual societal groups. Assistive Technology (AT) product designers, academics, professionals and stakeholders need to be aware of challenges which are originated from one's socio-cultural environment. AT products convey certain meanings, semantics, which are interpreted by the society and are subjective to a specific cultural setting. •For the effective communication of meanings and values an AT product relies on the visual clues and design features embedded within the design. However, there have been a limited number of studies reviewing this aspect of product semantics. •The survey and associated testing has highlighted the differences in cultural perception towards AT products and demonstrated the importance of effectively designing the semantic attributes of an AT product as well as its function. •The demonstration of the efficacy of methods within the study for exploring the interpretation of semantic attributes of AT products will help designers and developers better understand the perceptions of individual cultures and societal groups. •A better understanding of different cultures and societies will enable designers and clinicians who specify AT products to reduce AT product abandonment; and, the associated stigma around disability. [ABSTRACT FROM AUTHOR]

The rising demand for health and social care, and around the clock monitoring services, is increasing and are unsustainable under current care provisions. Consequently, a safe and independent living environment is hard to achieve; yet the detection of sudden or worsening changes in a patient's condition is vital for early intervention. The use of smart technologies in primary care delivery is increasing significantly. However, substantial research gaps remain in non-invasive and cost effective monitoring technologies. The inability to learn the unique characteristics of patients and their conditions seriously limits the effectiveness of most current solutions. The smart metering infrastructure provides new possibilities for a variety of applications that are unachievable using the traditional energy grid. By 2020, UK energy suppliers will install 50 million smart meters, therefore, providing access to a highly accurate sensing network. Each smart meter records the electrical load for a given property at 30 minute intervals. This granular data captures detailed habits and routines through the occupant's interactions with electrical devices, enabling the detection and identification of alterations in behaviour. The research presented in this paper explores how this data could be used to achieve a safe living environment for people living with progressive neurodegenerative disorders. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to present design research investigating the development of sensory textiles with embedded electronics to support the wellbeing of people with late stage dementia in residential care. Design/methodology/approach – The research presented is qualitative and uses a mixed method approach informed by grounded practical theory and positive design methodologies. It uses an inclusive and participatory co-design process involving people with dementia and their families with an interdisciplinary team of experts. Findings – Both the co-design process and the artefacts developed have been beneficial in supporting wellbeing. The textile artefacts have been found to soothe, distract and comfort people with dementia. They have also been shown to facilitate in the moment conversational bridges between family members and carers with persons with dementia. Research limitations/implications – The findings are based on a small cohort of participants, observational reports and descriptive accounts from family members and carers. Practical implications – The paper proposes ways in which simple hand-crafted textiles can be used beneficially to support the wellbeing of people with late stage dementia. It provides examples of how technology can be used to personalise and extend the sensory properties of the artefacts created. Social implications – It promotes an inclusive co-design methodology involving care professionals, carers and people with dementia with designers and technologists. Originality/value – The paper describes new ways of extending sensory properties of textiles through the integration of technology. [ABSTRACT FROM AUTHOR]

Background: Assistive Technology (AT) supports persons with dementia and their carers (family, friends and neighbours), yet little is known about experiences and the impact of AT on carers. We report on an exploratory survey that examined the types, uses, costs and impact of AT on carers as well as their quality of life.Methods: A cross-sectional survey using the Carers Assistive Technology Experience Questionnaire collected data from carers in the UK, who used at least one AT in the previous year and provided more than 10 h of care for a person with dementia, living at home. Carers completed the questionnaire online or on paper and information on AT, socio-demographic details, and Short-Form Health Survey (SF-12) data were collected. Descriptive and inferential statistics were used to report results and draw conclusions.Results: Data from 201 carers was analysed. Smartphones and tablet computers were the most frequently used AT. AT were used predominantly for safety, communication, and reminders. Carers usually make decisions on buying and continued use of AT. Multiple AT devices were used in the care of persons with dementia and number of AT used was associated with perceived satisfaction. Satisfaction with AT was not related to age, living arrangements and relationship of carers. From the SF-12, Mean Physical Component Score was 49.19 (95%CI- 47.75 to 50.63) and Mental Component Score was 45.37 (95%CI- 43.93 to 46.80). Women, carers in the 46-65 age group and carers who were not extremely satisfied with AT had lower MCS scores. Carers who lived with the person with dementia and older carers had lower PCS scores.Conclusions: Carers report that AT has a beneficial impact. Carers use multiple ATs, perceive AT to be satisfactory and recommend AT use to others. To support carers, we recommend establishment of centrally funded information sources and a loan store for AT. Further research on incremental addition of AT and changes to formal/paid care because of using AT should be undertaken. Practitioners, academics, manufactures and policy makers should consider the experiences of carers in research, development and use of AT to facilitate improved community living of people with dementia. [ABSTRACT FROM AUTHOR]

Presents information on the 2nd Cambridge Workshop on Universal Access and Assistive Technology which will be held at the University of Cambridge in Great Britain from March 22 to 24, 2004. Goals of the workshop; Advantages of the workshop to computer scientists, designers and engineers; Topics for plenary discussions.

In this article, the author talks about functional electrical stimulation in children and adolescents with cerebral palsy. Functional electrical stimulation (FES) is defined as the electrical stimulation of muscles that have impaired motor control, in order to produce a contraction to obtain functionally useful movement. It was first proposed in the 1980s as a treatment option in children with cerebral palsy (CP). The most common application, at least in the adult stroke population, is FES applied to the dorsiflexors during the swing phase to prevent drop foot which could lead to tripping and falls. A 2009 UK National Institute for Health and Clinical Excellence (NICE) guidance states that current evidence on safety and efficacy of FES for improving drop foot of central neurological origin is adequate to support the use of this procedure. However, the studies reviewed for this guidance were mainly on the adult stroke population.

This paper examines the perceptions of staff within a university in the UK, of the role of teaching assistants and centrally located disability services. Staff were generally positive about support available although when communication had broken down this led to a lack of trust with centrally organised support. Staff were happy for support staff to be available within the classroom although this role was misunderstood. At times tensions arose around adjustments to classroom practices which were recommended by centrally located staff. Paradoxically, centrally organised support may have acted as a barrier to more inclusive teaching practice: whilst teaching staff often disagreed with recommendations for adjustments to teaching practice made by central staff they were nonetheless reluctant to take on the role of acting as the expert in these situations. Implications for practice and service delivery are discussed alongside suggestions for future research. [ABSTRACT FROM AUTHOR]

Objective: This paper describes the development of a novel mobile health (mHealth) educational intervention, called m2Hear, designed for first-time hearing aid users based on previously developed educational multimedia videos, or reusable learning objects (RLOs), branded C2Hear. Design: The development of m2Hear used theoretical and ecologically valid approaches. The COM-B model and associated Theoretical Domains Framework were employed to identify specific components (or "active ingredients") of the original RLOs that facilitate hearing aid use. An mHealth platform was then developed following an iterative, user-centred and participatory design approach. Study sample: Fifteen existing hearing aid users completed synchronous, real-time Think Aloud interviews. A sub-group of these participants (n = 5), along with patient and public involvement panel members (n = 4), subsequently reviewed the usability of the mHealth platform. Results: While factors associated with Capability featured strongly across all RLOs, topics relating to Opportunity and Motivation were also incorporated. The RLOs were broken-down into 42 shorter mobile-enhanced RLOs (or mRLOs). Each mRLO was labelled with a specific user-centred question generated from the Think Aloud interviews. The final mHealth platform was developed following four separate usability iterations. Conclusions: Overall, m2Hear provides greater opportunities for individualised learning and encourages greater interaction to facilitate self-management in first-time hearing aid users. [ABSTRACT FROM AUTHOR]

Assistive Technology (AT) product use occurs within a socio-cultural setting. The growth internationally in the AT product market suggests that designers need to be aware of the influences that diverse cultures may have on the societal perception of an AT product through its semantic attributes. The study aimed to evaluate the visual interaction with an AT product by young adults from Pakistan, a collectivist society, and the United Kingdom (UK), an individualist society. A paper-based questionnaire survey was carried out with 281 first-year undergraduate students from the UK and Pakistan to evaluate their perception towards the visual representation of a generic conventional wheelchair image. A semantics differential (SD) scale method was used involving a seven-point bipolar SD scale incorporating sixteen pairs of adjectives defining functional, meaning, and usability attributes of the product. The mean (M) and standard deviation (sd) values were obtained for each pair of adjectives and compared between both groups by employing appropriate parametric tests. The results show that having a diverse cultural background did not appear to have overtly influenced the meanings ascribed to the generic manual wheelchair, which was unexpected. The University 'Internationalist' environment may have influenced the results. Some minor but critical differences were found for some pairs of adjectives (bulky-compact, heavy-light), having p-value less than.05 (p <.05) that related to previous experience of wheelchairs and/or their use. Further studies are planned to investigate and validate outcomes with other student and non-student groups. The semantic attributes of assistive technologies highlight a number of aspects that have implications for those involved in Assistive Technology (AT) product development, manufacturing and marketing. • For online sales, the AT products rely on the web page image to communicate the purpose and attributes of the product. There are limited explorations related to the semantic/communicative attributes of AT product presented in images, as perceived by individuals from diverse cultural backgrounds. • The knowledge towards semantic meaning ascribed to the AT product is important to investigate to provide a perspective that goes beyond practical functions of the AT product towards the communicative function. • Information of comprehending semantics and significance of the AT product from a social (non-users) viewpoint may benefits manufacturers in the development of AT products that best meet the societal needs, preferences and expectations. • A model of best practice, with a focus on semantic manipulation will offer Industrial Designers (ID) internationally with the suitable process and tools to reframe perceptions of disability and enhance acceptance of AT products not only for users, but also for the society around them. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to review marketing materials of surveillance products for people with dementia and their carers in three ageing countries, as part of a dementia-technology media analysis.Design/methodology/approach An online environmental scan was conducted using search terms for surveillance technologies (STs) and dementia through a Google search focussed on the UK, Sweden and the Netherlands. Data were extracted on the products' and websites' marketing messages from consumer and marketer perspectives.Findings Information was gathered for 382 product websites, of which 242 met eligibility criteria. The majority of products come from the UK. In the UK and Sweden, the companies behind the websites appeared to be mainly "cottage industries" which focus on selling ST. In contrast, sellers in the Netherlands included a more balanced mixture of small, medium and large companies. In all three countries, the website messaging focussed on the need to manage safety concerns, without considering privacy or consent.Social implications Contrary to the perception of future dependence on technology, the ST sector seems to be a niche market. The media messages, equating people with dementia with animals and children, are at odds with initiatives that strive for dignity and dementia friendliness.Originality/value No previous study is known to have explored media messages from websites that market ST for people with dementia. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to devise a general solution that allows a policy-based (i.e. rule-based) management system to explain its operation. In particular, a solution has been developed and evaluated in the context of an automated home care system. Design/methodology/approach - The work has built on an existing policy-based management system called Advanced Component Control Enhancing Network Technologies (ACCENT). This includes automated management of home care using two forms of rules: higher-level (user) goals and lower-level (system) policies. These rules can be defined by users (typically carers) to personalise how the system should support the resident. In new work, the system has been extended to include an explanation facility that allows the user to understand the past and future behaviour of the system. Findings -An explanation facility has been created to explain the past and future behaviour of the system. An initial evaluation of this has been carried out with carers. The participants in this evaluation found the facility to be understandable and were able to use it effectively. Research limitations/implications -The work has made a useful extension to the design of policy-based systems in general. The initial evaluation with a limited group of users identified small weaknesses in the explanation facility that will be addressed in future work. The updated approach will then be evaluated with a larger group of users. Practical implications - The enhanced home care system is now more usable and comprehensible, and so will be easier to deploy and maintain. Social implications - The explanation facility has made the home care system more usable and comprehensible for users, and so will enhance its acceptability in future deployment. Originality/value - Although expert systems have long been able to explain their operation, this kind of solution has not previously been attempted for policy-based management systems. The value to end users is that the approach makes automated support of home care more understandable and thus more acceptable and usable. [ABSTRACT FROM AUTHOR]

Reminiscence activity is commonplace as an activity that is widely recognized as beneficial to people with dementia. It can offer alleviation of the burden of care for those who look after people with this disease. In reminiscence activities, people may use items including photographs representing their lives, in some form. Reminiscence systems are the use of technology to support reminiscence work. This paper describes a study that carried out an evaluation of card-based versus device-based reminiscing using photographic images. The outcome of the study demonstrated no difference between traditional and device-based reminiscing of photographic images, indicating no barriers to the use of systems for reminiscing activities. [ABSTRACT FROM AUTHOR]

Within the United Kingdom (UK), assisted living technologies are mostly provided through statutory health and social care services following assessment of individual need and application of eligibility criteria. This paper describes the first UK study to explore and develop business approaches and innovations required to make electronic assisted living technologies more accessible to consumers in their fifties and sixties. A robust mixed-method approach was used including a large sample size for a consumer survey, triangulation of methods and confirmation of research findings through validation workshops. This three-year study makes significant and original contributions to understanding consumer needs in this rapidly changing market and offers unique insights into the needs and wants of people aged 50-70. Analysis shows significant differences between consumer and business perceptions, indicating that marketing is not closely aligned to consumers' needs and is affecting the development of the market. New approaches to consumer-led business models are presented to improve information and marketing aimed at 50-70-year-old consumers. A 'Broker/Independent Advisor' business model showed most potential for meeting the needs of both consumer and business stakeholders. Findings support future development of an assisted living consumer market to meet growing levels of need and demand, and to offer greater consumer choice of mainstream technologies to enable people to age in place. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the guest editors discuss various reports within the issue on topics including telecare, one arm operated manual wheelchairs, and phenome recognition in binaural cochlear implants.

Visual impairment (V.I.) has been associated with a negative impact on activities of daily living (ADL) and navigation outside the home. Adults from minority ethnic communities are projected to make up an increasing proportion of the V.I. population in the UK, yet the evidence relating to their experiences of living with V.I. is limited. This article uses data collected by the V.I. Lives Survey, between December 2019 and November 2020. Using secondary analysis of anonymised survey data, this article explores self-reported functioning relating to ADL, navigation outside of the home, and use of technology to access information in a matched control sample of adults from minority ethnic (MEC) and white communities (WC). The findings showed that most issues relating to self-efficacy, accessibility of public environments, and technology were significantly more important to MEC than WC participants. A significantly higher proportion of MEC participants required frequent help with cooking, received support for ADL from siblings and other family members, and had their shopping delivered. WC participants were significantly more likely to receive help with shopping from their spouse/partner and use public transport as much as they liked. Future research will need to confirm these findings in a larger sample and explore the reasons for them. [ABSTRACT FROM AUTHOR]

The ageing of populations is increasing pressure on health and social care systems. Potentially, assistive technologies are a way to support the independence of older adults in their daily activities. Among existing assistive technologies, ambient sensing technologies have received less attention than wearable systems. Moreover, there has been little research into cheaper technologies capable of using multiple modalities. A systematic review of the acceptability of assisted living or smart homes in the United Kingdom and the simultaneous use of sounds and vibrations in remote monitoring of assisted living or smart homes will inform and encourage the use of digital monitoring technologies. The acceptability of sensing technologies depends on whether there is any social stigma about their use, for example, the extent to which they invade privacy. The United Kingdom studies reviewed suggest a lack of measurements of the perceived efficacy or effectiveness of the monitoring devices. The primary use of vibration or acoustic technologies has been for detecting falls rather than monitoring health. The review findings suggest the need for further exploration of the acceptability and applicability of remote monitoring technologies, as well as a need for more research into the simultaneous use of sounds and vibrations in health monitoring. [ABSTRACT FROM AUTHOR]

Background: There is a political drive in the UK to use assistive technologies such as telehealth and telecare as an innovative and efficient approach to healthcare delivery. However, the success of implementation of such services remains dependent on the ability to engage the wider population to adopt these services. It has been widely acknowledged that low acceptance of technology, forms a key barrier to adoption although findings been mixed. Further, it remains unclear what, if any barriers exist between patients and how these compare to those who have declined or withdrawn from using these technologies. This research aims to address this gap focusing on the UK based Cambridgeshire Community Services Assistive Telehealth and Telecare service, an integrated model of telehealth and telecare.Methods: Qualitative semi-structured interviews were conducted between 1st February 2014 and 1st December 2014, to explore the views and experiences of 'users' and 'non-users' using this service. 'Users' were defined as patients who used the service (N = 28) with 'non-users' defined as either referred patients who had declined the service before allocation (N = 3) or had withdrawn after using the ATT service (N = 9). Data were analysed using the Framework Method.Results: This study revealed that there are a range of barriers and facilitators that impact on the decision to adopt and continue to engage with this type of service. Having a positive attitude and a perceived need that could be met by the ATT equipment were influential factors in the decision to adopt and engage in using the service. Engagement of the service centred on 'usability', 'usefulness of equipment', and 'threat to identity and independence'.Conclusions: The paper described the influential role of referrers in decision-making and the need to engage with such agencies on a strategic level. The findings also revealed that reassurance from the onset was paramount to continued engagement, particularly in older patients who appeared to have more negative feelings towards technology. In addition, there is a clear need for continued product development and innovation to not only increase usability and functionality of equipment but also to motivate other sections of the population who could benefit from such services. Uncovering these factors has important policy implications in how services can improve access and patient support through the application of assistive technology which could in turn reduce unnecessary cost and burden on overstretched health services. [ABSTRACT FROM AUTHOR]

The ageing population is presenting an economic challenge in the United Kingdom (UK). Electronic Assisted Living Technology (eALT) is purported to be one potential solution to this problem, as it offers an opportunity to help people remain independent and age in place. The provision of eALT within the UK has traditionally been dominated by statutory provision, leading to a lack of choice of commercial products and services for those whom it might benefit. With increased need for support for the ageing population, and rationalisation of statutory service provision, older people will increasingly be looking toward privately purchased eALT to support their health and independence. However, previous work has identified that there are numerous barriers to the development of a consumer eALT market. This paper describes a series of cocreation workshops which were held to explore solutions to these barriers with younger older people, aged 50-70 years old, which sought to explore the development of a consumer eALT market. A number of solutions were found for all stages of the eALT consumer journey, including how to help people recognise they have a need, how to find eALT information, how to help consumers make the decision to purchase, where to place eALT for consumer access and purchase, and how to encourage continued use of the product or service and repeat sales. The results of this study will be of interest to the UK, European and worldwide consumer eALT markets, to encourage older consumers to maintain their independence and lifestyle and offers insights for the eALT industry in how to reach these consumers. [ABSTRACT FROM AUTHOR]

Purpose: In light of the increasing elderly population and the growing demand for home care, the potential of robot support is given increasing attention. In this paper, an inventory of activities was made that threaten independent living of elderly when becoming problematic. Results will guide the further development of an existing service robot, the Care-O-bot®. Method: A systematic literature search of PubMed was performed, focused on the risk factors for institutionalization. Additionally, focus group sessions were conducted in the Netherlands, United Kingdom and France. In these focus group sessions, problematic activities threatening the independence of elderly people were discussed. Three separate target groups were included in the focus group sessions: (1) elderly persons ( n = 41), (2) formal caregivers ( n = 40) and (3) informal caregivers ( n = 32). Results: Activities within the International Classification of Functioning domains mobility, self-care, and interpersonal interaction and relationships were found to be the most problematic. Conclusions: A distinct set of daily activities was identified that may threaten independent living, but no single activity could be selected as the main activity causing a loss of independence as it is often a combination of problematic activities that is person-specific. Supporting the problematic activities need not involve a robotic solution. [ABSTRACT FROM AUTHOR]

Aim To report a novel review to develop a health systems model of successful transition of children with complex healthcare needs from hospital to home. Background Children with complex healthcare needs commonly experience an expensive, ineffectual and prolonged nurse-led discharge process. Children gain no benefit from prolonged hospitalization and are exposed to significant harm. Research to enable intervention development and process evaluation across the entire health system is lacking. Design Novel mixed-method integrative review informed by health systems theory. Data sources CINAHL, PsychInfo, EMBASE, PubMed, citation searching, personal contact. Review methods Informed by consultation with experts. English language studies, opinion/discussion papers reporting research, best practice and experiences of children, parents and healthcare professionals and purposively selected policies/guidelines from 2002-December 2012 were abstracted using Framework synthesis, followed by iterative theory development. Results Seven critical factors derived from thirty-four sources across five health system levels explained successful discharge (new programme theory). All seven factors are required in an integrated care pathway, with a dynamic communication loop to facilitate effective discharge (new programme logic). Current health system responses were frequently static and critical success factors were commonly absent, thereby explaining ineffectual discharge. Conclusion The novel evidence-based model, which reconceptualizes 'discharge' as a highly complex longitudinal health system intervention, makes a significant contribution to global knowledge to drive practice development. Research is required to develop process and outcome measures at different time points in the discharge process and future trials are needed to determine the effectiveness of integrated health system discharge models. [ABSTRACT FROM AUTHOR]

This study is concerned with evaluating cystic fibrosis (CF) annual review practice. More precisely, we wanted to know if we are utilizing genetic counseling services and identifying poor knowledge of sexual reproductive health at annual review. We conducted short interviews with 21 CF patients at annual review regarding genetic counseling knowledge and perception. Patient responses were documented, analyzed and coded using a simple thematic analysis to précis the content. Immediately post-interview, patients were asked to complete a CF questionnaire comprised of nine questions, testing knowledge of the science of Mendelian genetics, contraceptive needs and fertility. Knowledge was then compared to responses documented at annual review. Emerging themes from interviews included: poor knowledge and a need for more information regarding what genetic counseling involves, a positive perception and experience of genetic counseling for those who had attended, and partner anxiety related to carrier testing. The percentage of patients who reported they were aware of the CF fertility and genetic issues was 95%, however, questionnaire scores ranged from 0 to 9/9 (mean 4.8 SD [2.2]). 57% of patients had received genetic counseling. These patients had a statistically significantly higher score 6.2 (1.5) versus those who had not 2.9 (1.3) p < 0.001. The All Wales Adult CF Centre annual review practice is insufficient to identify patients who may benefit from further education on reproductive health. Traditionally these domains have been granted less significance. However, as life expectancy, quality of life and reproductive assistive techniques improve, ensuring appropriate patient knowledge is of greater importance. [ABSTRACT FROM AUTHOR]

The development of telecare services in the UK has been supported by grants from the respective governments of Scotland and Wales, and by the Department of Health in England. New services are being established, sometimes to operate alongside existing community equipment services and community alarm services. Elsewhere they are embracing a wider range of services including rehabilitation, intermediate care and health services designed to reduce use of unscheduled care services. This paper discusses the difficulties in understanding the scope of telecare services, and the definitions of services that will need to be confirmed if service users are to be able to choose appropriately if offered direct payments. Two service models are offered, one of which uses telehealth as an umbrella term to cover all telecare, e-care and m-care, and telemedicine, where the former includes all such services offered in the service user's home, including those of a medical nature. The second model views telecare alongside assistive technologies and telemedicine as one of three technology groups designed to make people more independent, or to bring care closer to home. There is significant overlap between the three groups, which justifies the introduction of a new term - ARTS (assistive and remote technology services) - to describe this area of support. [ABSTRACT FROM AUTHOR]

Telecare services are now available across the UK but few have the technical expertise necessary to prescribe and provide the bespoke solutions that may be required to support more complex cases. This paper describes a range of innovative approaches to extending the application of existing telecare systems to cater for the needs of people facing different physical or cognitive challenges. They include new, easy-to-operate alarm switches, interfaces for bed/chair occupancy and property exit alarms, and a range of hybrid arrangements that can result in automatic alarms for the management of various environmental emergencies. Examples are provided for hypothermia, hyperthermia, poor air quality and noise alarms. [ABSTRACT FROM AUTHOR]

The development of telecare services across the UK has been supported by grants from the respective governments of Scotland and Wales, and by the DH in England. New services are being established to sometimes operate alongside existing community equipment services and community alarm services. Elsewhere they are embracing a wider range of services including rehabilitation, intermediate care and health services designed to reduce the use of unscheduled care services. This paper discusses the difficulties in understanding the scope of telecare services, and the definitions of services that will need to be confirmed so that service users can choose appropriately if offered direct payments. Two different service models are offered, one of which uses telehealth as an umbrella term to cover all telecare, e-care and m-care, and telemedicine where the former includes all such services offered in the service user's home, including those of a medical nature. The second model views telecare alongside assistive technologies and telemedicine as one of three different technology groups designed to make people more independent or to bring care closer to home. There is significant overlap between the three groups, which justifies the introduction of a new term -- ARTS (assistive and remote technology services) -- to describe this area of support. [ABSTRACT FROM AUTHOR]