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BACKGROUND: African Americans living with dementia are considered less likely to seek formal institutionalized elder care and more likely to be managed in the home by family-member caregivers. Assistive technologies (the use of smart visual devices like tablets and phones) can be used effectively to guide memory-impaired individuals with a sequence of pictures showing steps to complete activities of daily living, e.g., bathing, toileting, dressing. Assistive technology so far has not been generally embraced in African American communities. OBJECTIVES: Determine, if African American family caregivers, given the opportunity, would embrace the use of assistive technology and if they would perceive its use beneficial. METHODS: We assessed a group of eight family caregivers’ overall care-burden scores, and their user-satisfaction scores after using assistive technology for three months. RESULTS: We found significant reduction in caregiver burden, positive changes in behavior and emotion scores, and high ratings on user satisfaction. CONCLUSIONS: The findings reported here comprise the first systematic study of the use of assistive technology by caregivers in an underserved population. They set the stage for exploring meaningful strategies and variables that will better engage underserved populations to take advantage of assistive technologies available in healthcare.

Contains fulltext : 287123.pdf (Publisher’s version ) (Open Access) PURPOSE: Neuromuscular disorders are characterised by muscle weakness that limits upper extremity mobility, but can be alleviated with dynamic arm support devices. Current research highlights the importance and difficulties of evidence-based recommendations for device development. We aim to provide research recommendations primarily concerning upper extremity body functions, and secondarily activity and participation, environmental and personal factors. METHODS: Evidence was synthesised from literature, ongoing studies, and expert opinions and tabulated within a framework based on a combination of the International Classification of Functioning, Disability and Health (ICF) model and contextual constructs. RESULTS: Current literature mostly investigated the motor capacity of muscle function, joint mobility, and upper body functionality, and a few studies also addressed the impact on activity and participation. In addition, experts considered knowledge on device utilisation in the daily environment and characterising the beneficiaries better as important. Knowledge gaps showed that ICF model components and contextual constructs should be better integrated and more actively included in future research. CONCLUSIONS: It is recommended to, first, integrate multiple ICF model components and contextual constructs within one study design. Second, include the influence of environmental and personal factors when developing and deploying a device. Third, include short-term and long-term measurements to monitor adaptations over time. Finally, include user satisfaction as guidance to evaluate the device effectiveness.IMPLICATIONS ON REHABILITATIONSynthesized evidence will support future research and development of dynamic arm supports.Tabulated evidence stresses the importance of integrating ICF model components and contextual constructs to fill the knowledge gaps.Presented knowledge gaps and proposed steps guide the set up of future studies on dynamic arm supports.

Rehabilitation engineering is playing a more vital role in the field of healthcare for humanity. It is providing many assistive devices to diplegia patients (The patients whose conditions are weak in terms of muscle mobility on both sides of the body and their paralyzing effects are high either in the arms or in the legs). Therefore, in order to rehabilitate such types of patients, an intelligent healthcare system is proposed in this research. The electric sticks and chairs are also a type of this system which was used previously to facilitate the diplegia patients. It is worth noting that a voice recognition system along with wireless control feature has been integrated intelligently in the proposed healthcare system in order to replace the common and conventional assistive tools for diplegia patients. These features will make the proposed system more user friendly, convenient and comfortable. The voice recognition system has been used for movements of system in any desired direction along with the ultrasonic sensor and light detecting technology. These sensors detect the obstacles and low light environment intelligently during the movement of the wheelchair and then take the necessary actions accordingly.

Background Low vision affects over 300 million people worldwide and can compromise both activities of daily living and quality of life. Rehabilitative training and vision assistive equipment (VAE) may help, but some visually impaired people have limited resources to attend in-person visits at rehabilitation clinics. These people may be able to overcome barriers to care through remote, Internet-based consultation (i.e., telerehabilitation). Objectives To compare the effects of telerehabilitation with face-to-face (e.g., in-office or inpatient) vision rehabilitation services for improving vision-related quality of life and reading speed in people with visual function loss due to any ocular condition. Secondary objectives are to evaluate compliance with scheduled rehabilitation sessions, abandonment rates for visual assistive equipment devices, and patient satisfaction ratings. Search methods We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2015 Issue 5), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1980 to June 2015), EMBASE (January 1980 to June 2015), PubMed (1980 to June 2015), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any language restriction or study design filter in the electronic searches; however, we restricted the searches from 1980 onwards because the Internet was not introduced to the public until 1982. We last searched the electronic databases on 15 June 2015. Selection criteria We planned to include randomized controlled trials (RCTs) or controlled clinical trials (CCTs) in which participants were diagnosed with low vision and were undergoing low vision rehabilitation using an Internet, web-based technology compared with an approach based on in-person consultations. Data collection and analysis Two authors independently screened titles and abstracts, and then full-text articles against the eligibility criteria. We planned to have two authors independently abstract data from included studies. We resolved discrepancies by discussion. Main results We did not find any study that met the inclusion criteria for this review and, hence, we did not conduct a quantitative analysis. As a part of the background, we discussed review articles on telemedicine for facilitating communication with elderly individuals or for providing remote ophthalmological care. Authors' conclusions We did not find any evidence on whether the use of telerehabilitation is feasible or a potentially viable means to remotely deliver rehabilitation services to individuals with low vision. Given the disease burden and the growing interest in telemedicine, there is a need for future pilot studies and subsequent clinical trials to explore the potential for telerehabilitation as a platform for providing services to people with low vision.

This research paper seeks to examine the challenges and opportunities for wireless technologies and the Internet of Things (IoT) to improve access to education for students with disabilities (SwDs). As technology integration into educational content and learning environments occurs, it becomes paramount for scholars to consider how the needs of students with disabilities are incorporated into these learning spaces. This paper synthesizes existing literature via an integrative review that explores barriers to accessing technology-mediated learning and the classroom. It also assesses the potential for technology-mediated learning to progress forward over the last five years. Finally, this article provides targeted recommendations for actualizing wireless technologies' potential on improving students with disabilities' educational outcomes.

Background Assistive technologies have the potential to facilitate everyday life of people with dementia and their families. Close collaboration with affected people and interdisciplinary research are essential to understand and address the needs of prospective users. In this study, we present the results of the evaluation of such an assistive system prototype. Aims Challenges from the patient and caregiver side, technical and design problems and acceptance and usability with regard to our special target group were evaluated. Methods MEMENTO, a system of two e-ink tablets and a smartwatch, was tested in the domestic environment of dementia patients. Thirty participants from Italy, Spain and Austria took part in a 3-month field trial and compared the MEMENTO system to traditional strategies in everyday life. Quantitative and qualitative data were collected and frequency of use of the system was monitored. Results There were no significant changes in quantitative measurements, such as activities of daily living and caregiver burden over the duration of the 3-month field trial. More frequent usage was significantly correlated with positive attitude towards technology (r = 0.723, p Conclusion We show that a positive attitude towards technology is the essential variable for successful implementation of such systems, regardless of age. Participants showed great interest in digital solutions and agreed that technological systems will help in maintaining independency of persons with cognitive dysfunction in the future.

The purpose of this study was to examine factors associated with variability in satisfaction with functional mobility (as measured by the Functional Mobility Assessment [FMA]) in users of mobility devices. Our primary hypothesis was that device type and Assistive Technology Professional (ATP) involvement will be the most significant predictors of FMA score. Our secondary hypothesis was that ATP involvement is associated with use of more custom-fitted manual wheelchairs and group 3 and 4 power wheelchairs.Retrospective cohort study.Data were collected from equipment suppliers who collaborate with clinicians to administer the FMA and associated Uniform Data Set within various settings (ie, rehabilitation clinic, school, supplier place of business).A data set of 4743 cases was included in the analysis (N=4743).Not applicable.FMA questionnaire collected at baseline, client age, gender, primary diagnosis, years since disability onset, device type, device age, living situation, ATP involvement, and geographic area.Ordinal logistic regression modeling showed that geographic area, device type, ATP involvement, primary diagnosis, gender, age, device age, and years since onset of disability significantly predicted the variance in FMA scores at P.05. Device type was the most significant predictor of variance in FMA score. Involvement of an ATP had a significant effect on the type of device that participants used (χThe relationship between ATP involvement and functional outcome supports the concept that ATP certification recognizes demonstrated competence in analyzing the needs of consumers with disabilities and selection of appropriate mobility assistive equipment with improved functional outcomes.

When providing health care services, clinicians should provide patient-centered and family-centered care. When providing care for medically complex patients, it is important to think about how health care teams are working together to care for patients. Health care providers need to think about how they can guide their patients to become more independent, have an improved quality of life, and have improved access to their homes and community environments when possible. Clinicians need to recognize the importance of caregivers and the burdens that are put on caregivers. Clinicians should provide support to caregivers whenever possible.

The field of robot-assisted physical rehabilitation and robotics technology for providing support to the elderly population is rapidly evolving. Lower limb robot aided rehabilitation and assistive technology have been a focus for the engineering community during the last three decades as several robotic lower limb exoskeletons have been proposed in the literature as well as some being commercially available. Numerous manufacturing techniques and materials have been developed for lower limb exoskeletons during the last two decades, resulting in the design of a variety of robot exoskeletons for gait assistance for elderly and disabled people. One of the most important aspects of developing exoskeletons is the selection of the most appropriate proper material. The material selection strongly influences the overall weight and performance of the exoskeleton robot. The most suitable fabrication method for material is also an important parameter for the development of lower limb robot exoskeletons. In addition to the materials and manufacturing methods, the actuation method plays a vital role in the development of these robot exoskeletons. Even though various materials, manufacturing methods and actuators are reported in the literature for these lower limb robot exoskeletons, there are still avenues of improvement in these three domains. In this review, we have examined various lower limb robotic exoskeletons, concentrating on the three main aspects of material, manufacturing, and actuation. We have focused on the advantages and drawbacks of various materials and manufacturing practices as well as actuation methods. A discussion on future directions of research is provided for the engineering community covering the material, manufacturing and actuation methods.

Human-machine interface (HMI) techniques use bioelectrical signals to gain real-time synchronised communication between the human body and machine functioning. HMI technology not only provides a real-time control access but also has the ability to control multiple functions at a single instance of time with modest human inputs and increased efficiency. The HMI technologies yield advanced control access on numerous applications such as health monitoring, medical diagnostics, development of prosthetic and assistive devices, automotive and aerospace industry, robotic controls and many more fields. In this paper, various physiological signals, their acquisition and processing techniques along with their respective applications in different HMI technologies have been discussed.

Elderly patients face difficulty in performing the sit-to-stand motion; hence, their dependency on assistive devices for activities of daily living is increasing. However, the existing devices do not provide support according to the individual's characteristics. This study aimed to develop a sit-to-stand motion assistive chair that detects the user's weight using a load sensor and assists them to stand up by adjusting the speed themselves as per their weight and preference. Additionally, we investigated the feasibility of the developed device. A device for assisting patients in the sit-to-stand motion in rising up from the chair by electrical motorization was developed. This device senses the load on the seat plate using the load sensor and transmits it to the display through which the users can control the speed themselves using the speed control device. To test its feasibility, the electromyographic muscle activation was analyzed for the erector spinae, quadriceps, tibialis anterior, and gastrocnemius muscles in the sit-to-stand motion using this device in five healthy adults. When compared with the non-use of the device, the use of the developed assistive chair device significantly decreased the muscle activation of the erector spinae, quadriceps, tibialis anterior, and gastrocnemius by 37.27%, 20.44%, 14.50%, and 10.56% on the left and by 17.98%, 24.48%, 32.61%, and 6.05% on the right, respectively. The assistive device with a pressure sensor can effectively assist elderly patients with reduced muscle strength and balance in performing the sit-to-stand motion.

Objective We conducted an intersectional analysis to explore how demographic characteristics and mobility device use were associated with psychological distress (depression and anxiety) and confidence negotiating physical and social environments. Design Cross-sectional data were collected using the Hospital Anxiety and Depression Scale, modified Wheelchair Use Confidence Scale and self-reported functional independence scale. Participants The sample included 105 participants. Primary mobility devices used included mobility scooters (27%), power wheelchairs (26%), manual wheelchairs (25%), walkers (11%), and cane or crutch (12%). The mean age of participants was 58 years, 53% were female, 52% lived alone and were functionally independent with the use of assistive technology. Results We were able to explain between 39% and 65% of the variance (adjusted R2) in the dependent variables with parsimonious regression models. Age was an independent predictor of all outcomes. Women were less confident negotiating the physical environment, and walker use was associated with depression and lower confidence negotiating physical environments, but increased confidence negotiating social environments. Conclusions Age is associated with psychosocial outcomes for assistive device users and those who use walkers may experience increased challenges with depression and negotiating the physical environment. Pending confirmatory research, the findings may have important implications for targeted interventions related to device provision.

BACKGROUND: Robots are gaining attention as a potential solution to aging. OBJECTIVE: The purpose of this study is to explore the attitude of robot assistance in Activities of Daily Living (ADLs) among elderly people living independently. METHODS: The one-on-one interview, buddy robot video and questionnaire survey were used to analyze mean, median, range, and the test results of non-parametric statistical methods such as Wilcoxon sign-rank test statistic and one-sample Wilcoxon sign-rank test statistic, so as to explore the attitude of the elderly living independently towards robot-assisted ADLs and the acceptance of the use of robots in 32 ADLs. RESULTS: The results showed that there were significant differences in the attitudes, usability and ease of use of elderly people towards robot assistance before and after watching the Buddy Robot video and they had a more positive attitude after watching the video. According to the results, the elderly was more receptive to the use of robots in activities such as “reminding to carry objects” and “reminding to take medicine”, while they were less receptive to the use of robots in the group or private activities such as “playing mahjong” and “taking a bath”. CONCLUSIONS: The results showed that the elderly had a positive attitude towards the use of robot-assisted ADLs, and there were differences in the acceptance of robot-assisted ADLs. The results are helpful to understand the assistance needs and attitudes of the elderly, and provide a reference for the design of assistive robots that meet user needs, and ultimately improve the ability of the elderly to live independently at home.

BACKGROUND: Evidence for the adoption and acceptance of assistive devices for ladder lifting tasks by workers is scarce. OBJECTIVE: This study aims to investigate the technology acceptance and usability of a powered and automated cargo management system (RazerLift®) used by workers who need to lift ladders as part of their daily duties, as compared to mechanical cargo management systems (traditional). METHODS: We used a one-way repeated measures design in this study. Our primary outcome variable was a usability performance measurement measured as time (in seconds) for unloading and loading ladders using both systems. Our secondary outcome was technology acceptance, measured using questionnaires with a 5-point Likert scale: “strongly disagree (1)” to “strongly agree (5)”. RESULTS: The participants conducted the combined unloading and loading time using the powered and automated system (RazerLift®) 20.85 seconds faster than the traditional system (p-value = 0.000, t-value (df) = –5.730 (6), d = 2.713). Overall, the RazerLift® system (mean = 44.28, SD 5.58) had a higher technology acceptance compared to the traditional system (mean = 30.00, SD 7.91), (p = 0.041, t-value (df) = 6.589 (6), d = 4.60). CONCLUSIONS: The RazerLift® was more time efficient compared with the traditional system, and (2) the RazerLift® was superior in terms of technology acceptance compared to the traditional system.

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. Funding Agencies|VR FORTE [2014-4100]; Region Ostergotland [LIO-815111]; Swedish Stroke Association (STROKE-Riksforbundet)

Paralympic sport is characterized by the pursuit of better performance in sports played by people with disabilities. In wheelchair rugby, assistive technology (AT) equipment is used to enhance athletic performance.Assess the AT requirements of wheelchair rugby players, identify the psychosocial factors that contribute to their performance and AT use and assess user satisfaction with the recommended and implemented AT.Descriptive explanatory case study with a quantitative approach that included four athletes from the Brazilian national wheelchair rugby squad, who answered the Athletes with Disabilities Questionnaire, the AT Device Predisposition Assessment (ATD PA-BR) and Quebec User Evaluation of Satisfaction with AT (QUEST version 2.0). Statistical analysis consisted of frequencies and percentages, as well as the scores for each instrument.Items required: harnesses, gloves and cooling vests. The AT improved athletic performance and increased the overall satisfaction score from 1.6 to 4.8 after intervention. The factors considered to determine AT success were safety, comfort and effectiveness, and the positive psychosocial factors identified were support from family and friends and sufficient income to participate in the sport.The study achieved its objectives and the use of a conceptual model, standardized assessments and working in conjunction with the athletes and their trainers were essential. It is hoped that the baseline presented in this study can be used in future research in the fields of AT or parasports.Implications for rehabilitationPresent the intervention of the occupational therapist in Assistive Technology (AT) for paralympic athletes;Identify personal and contextual factors in the use of AT in parasports (attitudes, support and services);Present satisfaction with the AT device in parasport before and after intervention;Present satisfaction with the AT service provided by the occupational therapist based on the Matching Person and Technology (MPT) model.Understand the objectives of AT in wheelchair rugby.Understand the use of the MPT conceptual model and application of the AT Predisposition Assessment (ATD PA-BR) to recommend and monitor AT use in the para-athlete population.Know the AT devices used and customized by wheelchair rugby athletes.

Purpose Society has progressed in universal design guidelines and assistive devices for individuals with disabilities yet challenges due to affordability and attractiveness concerns remain to incorporate them into existing residences. Repurposing (i.e., replacing or adapting problematic fixtures or spaces, with others not originally intended for that purpose) may be the action to address the concerns of consumers. The purpose of this study was to elicit information on problems and solutions regarding home modifications and identify ways that consumers and professionals implement repurposing, that residents deemed accessible, affordable, and attractive. Methods This convergent parallel design study consisted of focus groups who rated images of repurposed spaces. The focus groups included consumers with functional mobility and visual limitations (n = 8); and professionals who devised or recommended home modifications (n = 8). Participants reviewed three images of home modification solutions and completed a Likert-scale rating based on accessibility and attractiveness. Results Focus group data indicated that high contrast, heights of fixtures, doors, and flooring - all pose threats to accessibility in the home. Consumers placed more value on attractiveness than professionals. Participants were aware and receptive to repurposing as a home modification technique but focused their discussion on adaptations. Conclusion Overall, adoption and implementation of home modifications promote accessibility, but professionals need to consider individualized needs and preferences, before suggesting modifications.IMPLICATIONS FOR REHABILITATIONRepurposing existing spaces, features, and fixtures can serve as a method of home modification.Consumer home modification recommendations are perceived to be more effective when collaboratively and individually developed with professionals.Data gathered through focus groups can be valuable for informing practice and research in home modifications.

Physical problems caused by fractures, aging, stroke, and accidents can reduce foot power; these, in the long term, can dwindle the muscles of the waist, thighs, and legs. These conditions provide the basis for the invalidism of the harmed people. In this study, a saddle-walker was designed and evaluated to help people suffering from spinal cord injury and patients with lower limb weakness. This S-AD works based on body weight support against the previously report designs. This saddle-walker consisted of a non-powered four-wheel walker helping to walk and a powered mechanism for the sit-to-stand (STS) transfer. A set of experiments were done on the STS in the use of the standard walker and the saddle-assistive device(S-AD). A comparison of the results showed that this device could reduce the vertical ground reaction force (GRF) of the legs up to 70%. Using this device could help a wide range of patients with lower limb weakness and SCI patients in changing from sitting to standing.

PURPOSE To explore the usefulness of combining accelerometry, global positioning systems, and geographic information systems, to describe the time spent in different locations and physical activity (PA) duration/count levels by location for 4 children with cerebral palsy (CP) who use assistive devices (AD). METHODS A descriptive multiple-case study. RESULTS Combining the 3 instruments was useful in describing and differentiating duration by location, and amount and location of PA across differing functional levels and AD. For example, the child classified with a Gross Motor Function Classification System (GMFCS) level II exhibited large amounts of PA in community settings. In contrast, the child classified with a GMFCS level V had small amounts of PA and spent most measured time at home. CONCLUSIONS Combined accelerometry, global positioning system, and geographic information system have potential to capture time spent and amount/intensity of PA relative to locations within daily environments for children with CP who use AD.

Introduction Telehealth is an increasingly common approach to improve healthcare delivery, especially within the Veterans Health Administration and Department of Defense (DoD). Telehealth has diminished many challenges to direct access for clinical follow-up; however, the use of mobile telehealth for specialty rehabilitative care is emerging and is referred to as telerehabilitation. As early adopters of telehealth, the Veterans Affairs and DoD have supported collaborated efforts for programs designed to increase the access and quality of rehabilitative care while improving the functional ability of our service members (SMs) and veterans with lower limb amputation (LLA). The DoD and Veterans Health Administration collaborated on a Mobile Device Outcomes-based Rehabilitation Program (MDORP) to help injured SMs and veterans with LLA. The MDORP project utilized a mobile health system called the Rehabilitative Lower Limb Orthopedic Accommodating Device (ReLOAD) to assess walking quality. The ReLOAD system includes real-time auditory biofeedback to notify the user of their most prominent gait deviation and then recommends exercises that address specific balance and strength impairments. The purpose of this study was to describe the responses to a postintervention survey evaluating the feasibility and usability of ReLOAD completed by SMs and veterans with LLA who used the system for 5 months. Materials and Methods A link to an anonymous usability survey was emailed to all participants who completed MDORP. The survey was modeled after the System Usability Scale, with agreeableness to items rated on a 5-point Likert-style questionnaire in addition to open feedback. Data visualization of Likert-style questionnaires was conducted using ggplot2 and reshape2 statistical packages and was analyzed using R. We obtained institutional review board approval through both Miami Veterans Affairs Healthcare System and Walter Reed National Military Medical Center. Results The majority of participants reported that they would use the system again for home rehabilitation (65%) and that auditory biofeedback helped them walk better (59%). Participants also suggested that future work should include a greater variety of exercise options and the use of smart phones for the ReLOAD application in addition to the iPad tablet. Conclusions The participants provided positive and constructive feedback that will enhance the value and usability of telerehabilitation interventions like the ReLOAD system for future users.

Objective: To identify predictors of the 5-year uptake of hearing aids (HAs) and hearing assistive technology (HAT) in a sample of Dutch employees eligible for HAs and/or HAT. The potential predictors included demographic factors (age, sex, marital status, and living situation), education, hearing factors (ability to recognize speech in noise and self-reported hearing disability), distress, self-efficacy, and work-related factors (job demand, job control, and need for recovery). Design: Five-year follow-up data of the Netherlands Longitudinal Study on Hearing (NL-SH) collected until January 2019 were included. An online digit-triplet in noise test, the National Hearing Test (NHT), was used to assess speech-recognition-in-noise ability. In addition, online questionnaires on demographic, socioeconomic, self-reported hearing disability, health, and work-related characteristics were administered. Adults who worked over 12 hours per week, who had not yet taken up HAs or HAT, but who would be eligible for HAs/HAT based on their NHT score (insufficient or poor hearing ability), were included in the study. The 5-year uptake of HAs/HAT was defined as a dichotomous variable of self-reported HA/HAT use reported 5 years later. Generalized Estimating Equations analyses were performed to analyze the associations between potential predicting factors and the 5-year uptake of HAs/HAT, taking into account the repeated measurements of the predicting factors and the 5-year uptake of HAs/HAT. Results: Data of 218 participants were included. The cumulative incidence of the 5-year uptake of HAs/HAT was 15 to 33%, of which 52 employees took up HAs and 11 employees took up HAT. Married participants had increased odds for 5-year uptake of HAs/HAT compared with unmarried participants (odds ratio [OR] = 2.13, 95% confidence interval [CI] = 1.05 to 4.35). Higher self-reported hearing disability (per one unit, scale range 0 to 74) was associated with increased odds for 5-year uptake of HAs/HAT (OR = 1.05, 95% CI = 1.03 to 1.07). Job demand showed a significant interaction with sex (p = 0.002), and therefore, stratified analyses were performed. In male participants, participants with higher job demand scores (per one unit, scale range 12 to 48) had increased odds for 5-year uptake of HAs/HAT (OR = 1.18, 95% CI = 1.05 to 1.35). No difference was seen in females. Conclusion: This study confirms that factors predicting the uptake of HAs/HAT in the general or older populations, including marital status and self-reported hearing disability, also extend to the working population. The identification of job demand as a predictor of the uptake of HAs/HAT (in males only) was a novel finding. It demonstrates the importance of considering work-related factors in aural rehabilitation.

The development of welfare assistive devices for frail elderly people has attracted significant attention for its effort to improve the quality of life and reduce the burden on caregivers. However, it is challenging to conduct multiple user tests because of the significant burden on the elderly; thus, we need efficient ways to extract insight through different approaches. In this study, we aim to elucidate real-time transitions in users’ emotions and achievement motivation while using such a device. We synthesize an utterance analysis method based on attribution theory, in which all users’ utterances are attributed to four categories (ability, effort, task difficulty, and luck) that follow the developed coding rules. Knowing the transitions in causal attribution allows us to extract salient experiences for users, especially by extracting shifts from them and analyzing why the shift occurred and what exactly was happening before and after the shift. If only salient user experiences can be referenced from the aggregate data, useful information can be extracted in a short time to improve system characteristics and the environment. We discussed the validity and reliability of the proposed method by conducting a user test of an electric-assisted four-wheeled cycle for frail elderly people in Kakegawa city in Shizuoka, Japan. We also succeeded in marking the points that need attention, which is about 33% of the total amount of utterance data (1626 utterances), and thus confirmed the potential of the proposed method. Future research should examine how the developed methodology can help designers improve assistive device development, as well as how it can contribute to other fields such as education and social assistance.

Background Upper limb assistive devices can compensate for muscular weakness and empower the user in the execution of daily activities. Multiple devices have been recently proposed but there is still a lack in the scientific comparison of their efficacy. Methods We conducted a cross-over multi-centric randomized controlled trial to assess the functional improvement at the upper limb level of two arms supports on 36 patients with muscular dystrophy. Participants tested a passive device (i.e., Wrex by Jaeco) and a semi-active solution for gravity compensation (i.e., Armon Ayura). We evaluated devices’ effectiveness with an externally-assessed scale (i.e., Performance of the Upper Limb-PUL-module), a self-perceived scale (i.e., Abilhand questionnaire), and a usability scale (i.e., System Usability Scale). Friedman’s test was used to assess significant functional gain for PUL module and Abilhand questionnaire. Moreover, PUL changes were compared by means of the Friedman’s test. Results Most of the patients improved upper limb function with the use of arm supports (median PUL scores increase of 1–3 points). However, the effectiveness of each device was related to the level of residual ability of the end-user. Slightly impaired patients maintained the same independence without and with assistive devices, even if they reported reduced muscular fatigue for both devices. Moderately impaired patients enhanced their arm functionality with both devices, and they obtained higher improvements with the semi-active one (median PUL scores increase of 9 points). Finally, severely impaired subjects benefited only from the semi-active device (median PUL scores increase of 12 points). Inadequate strength was recognized as a barrier to passive devices. The usability, measured by the System Usability Scale, was evaluated by end-users “good” (70/100 points) for the passive, and “excellent” (80/100 points) for the semi-active device. Conclusions This study demonstrated that assistive devices can improve the quality of life of people suffering from muscular dystrophy. The use of passive devices, despite being low cost and easy to use, shows limitations in the efficacy of the assistance to daily tasks, limiting the assistance to a predefined horizontal plane. The addition of one active degree of freedom improves efficacy and usability especially for medium to severe patients. Further investigations are needed to increase the evidence on the effect of arm supports on quality of life and diseases’ progression in subjects with degenerative disorders. Trial registration clinicaltrials.gov, NCT03127241, Registered 25th April 2017. The clinical trial was also registered as a post-market study at the Italian Ministry of Health.

Novel technologies such as the Nino® two-wheeled powered mobility device are promoted as offering an intuitive improved experience compared to conventional wheelchair mobility use. The Nino® has a smaller footprint than a power wheelchair, a zero-degree turning radius, tiller-based steering, and relies on the user leaning forwards and back to move and brake. This study aimed to evaluate manual wheelchair users' ability to use the Nino® to complete a variety of wheelchair skills, and also investigated task demand, user confidence, and user perceptions. Twelve participants with a mean of 22 years of experience using a wheelchair completed the study; most had spinal cord injuries and one had multiple sclerosis. Our findings indicate that Wheelchair Skills Test scores were significantly higher for individuals in their manual wheelchair than in the Nino®. Results from the Wheelchair Use Confidence Scale showed that confidence scores increased significantly after completing Nino® training, and that participants were significantly more confident using their manual chair than the Nino®. Cognitive workload, as measured by the NASA-Task Load Index, was significantly higher in the Nino® than in participants' manual wheelchairs. Findings from qualitative interviews suggest that the Nino® is unlikely to be suitable as a functional replacement of an individual's manual wheelchair. Most participants felt unsafe during braking. Other perceptions included that the Nino may be a good alternative for use as a recreational outdoor mobility device, a powered mobility option to help prevent upper extremity overuse injuries, have a positive impact on social interactions, but that a high degree of focus was required during use. In addition to needing to address safety, usability, and functional concerns, the data suggests a clinical focus on training individuals to use these new devices may be necessary for effective community use.

In the United States, wheeled mobility devices (WMD) are classified as durable medical equipment (DME). Consistent with the definition of DME, wheeled mobility devices are typically covered by health insurance when deemed medically necessary. Despite the number of persons using wheelchairs, little knowledge is available about the types of wheelchairs provided, user's specific diagnoses and the costs associated with WMD provision. The objective of this analysis was to define the number and types of wheelchairs and associated seating and mobility (S&M) accessories provided in the calendar year 2017. The analysis focused on user demographics, categories of WMDs and associated S&M equipment as well as cost accounting according to the type of insurance and contributions by beneficiaries. Analysis of over 81,000 wheelchair acquisitions found that manual wheelchairs accounted for nearly 90% with standard manual wheelchairs accounting for 86% of all wheelchairs provided. Wheelchair recipients tended to be older with the majority being female. Based upon ICD-10 diagnostic categories over 50% of captured ICD-10 codes came from three classifications, musculoskeletal (M), circulatory (I) and a general category of not otherwise classified disorders (R). Costs associated with seating and mobility equipment were fairly large, exceeding $79 million over a single calendar year.

The WHO Rehabilitation 2030 agenda recognises the importance of rehabilitation in the value chain of quality health care. Developing and delivering cost-effective, equitable-access rehabilitation services to the right people at the right time is a challenge for health services globally. These challenges are amplified in low-income and middle-income countries (LMICs), in which the unmet need for rehabilitation and recovery treatments is high. In this Series paper, we outline what is happening more broadly as part of the WHO Rehabilitation 2030 agenda, then focus on the specific challenges to development and implementation of effective stroke rehabilitation services in LMICs. We use stroke rehabilitation clinical practice guidelines from both high-income countries and LMICs to highlight opportunities for rapid uptake of evidence-based practice. Finally, we call on educators and the stroke rehabilitation clinical, research, and not-for-profit communities to work in partnership for greater effect and to accelerate progress.

Objectives To evaluate the effects of a home-based disability prevention program on life-space and falls efficacy among low-income older adults. Design Single-blind two-arm randomized controlled trial. Setting Participants' homes. Participants Participants were low-income cognitively intact older adults (≥65 years old) with restricted daily activities. Our analytic sample for life-space (n = 194) and falls efficacy (n = 233) varied as the life-space measure was introduced 4 months after the trial began. Intervention Up to six 1-hour home visits with an occupational therapist; up to four 1-hour home visits with a registered nurse; and up to $1,300 worth of home repairs, modifications, and assistive devices with a handyman, during a course of 4 months. Measurements Life-space was measured by the Homebound Mobility Assessment; falls efficacy was measured using the 10-item Tinetti Falls Efficacy Scale at baseline and 5 months. Results Participants were on average 75 years old, predominantly Black (86%) and female (85%-86%). Compared with participants in the control group, participants receiving the intervention were more likely to have improved versus decreased life-space in areas of bathroom (adjusted odds ratio (OR) = 3.95; 95% confidence interval (CI) = 1.20-12.97), front or back porch, patio, or deck (adjusted OR = 2.67; 95% CI = 1.05-6.79), stairs (adjusted OR = 4.09; 95% CI = 1.34-12.48), leaving the house for any reason other than for health care (adjusted OR = 2.40; 95% CI = 1.01-5.73), and overall life-space (adjusted OR = 2.15; 95% CI = 1.10-4.19). Participants who received the intervention also had an 11% improvement in falls efficacy in performing daily activities (exponentiated coefficient = 1.12; 95% CI = 1.04-1.21). Conclusion Life-space and falls efficacy were improved through a multicomponent, person-directed, home-based disability prevention intervention. Findings suggest that this intervention should be translated into different settings to promote independent aging.

Objective: Binge-eating disorder (BED) is characterized by recurrent episodes of binge eating, accompanied by a lack of control and feelings of shame. Online intervention is a promising, accessible treatment approach for BED. In the current study, we compared completers with noncompleters in a 10-session guided internet-based treatment program (iBED) based on cognitive behavioral therapy. Methods: Adults (N = 75) with mild to moderate BED participated in iBED with weekly written support from psychologists. Participants were compared on the Eating Disorder Examination Questionnaire (EDE-Q), diagnostic criteria for BED (BED-Q), major depression inventory (MDI), quality of life (EQ-5D-5L), body mass index (BMI) and sociodemographic variables. Results: Minor differences were observed between completers and noncompleters on depression. No differences were found in BED-symptoms, BMI, and sociodemographic variables. Participants who completed treatment showed large reductions in eating disorder pathology. Discussion: More research is needed to determine risk factors for attrition or treatment outcome in internet-based interventions for BED. It is suggested that iBED is an efficient intervention for BED. However, more studies of internet-interventions are needed.

Background Mobility aids are commonly prescribed to offload an injured lower extremity. Device selection may impact stance foot loading patterns and foot health in clinical populations at risk of foot ulceration. Research questions Two questions motivated this study: How does device selection influence peak plantar and regional (rearfoot, mid foot and forefoot) foot forces on the stance foot? Does device selection influence peak, cumulative, and regional plantar forces within a 200 m walking trial? Methods Twenty-one older adults walked 200 m at self-selected pace in four randomized conditions for this prospective crossover study. Participants used a walker, crutches, wheeled knee walker (WKW), and no assistive device (control condition). Plantar forces were measured using a wireless in-shoe system (Loadsol, Novel Inc., St. Paul, MN). Repeated measures analyses of variance were used to determine differences in peak and cumulative total and regional forces among walking conditions. Paired sample t-tests compared forces during first and last 30 s epochs of each condition to determine device influence over time. Results The WKW reduced peak net forces by 0.29 and 0.35 bodyweight (BW) when compared to the walker or control condition with similar trends in all foot regions. Crutch use had similar peak forces as control. There were no differences in the number of steps taken within devices comparing first and last epochs. Crutches had a 0.04 and 0.07 BW increase in peak net and forefoot forces during the last epoch. Walker use had 66.44 BW lower cumulative forefoot forces in the last epoch. Significance Crutches had similar stance foot loading as normal walking while a walker lowered forefoot forces at the expense of increased steps. A WKW may be the best choice to ‘protect’ tissues in the stance foot from exposure to peak and cumulative forces in the forefoot region.

Neuromuscular disorders cause progressive muscular weakness, which limits upper extremity mobility and performance during activities of daily life. A dynamic arm support can improve mobility and quality of life. However, their use is often discontinued over time for unclear reasons. This study aimed to evaluate whether users of dynamic arm supports demonstrate and perceive quantifiable mobility benefits over a period of two months. Nine users of dynamic arm supports were included in this observational study. They had different neuromuscular disorders and collectively used four different arm supports. They were observed for three consecutive weeks during which they were equipped with a multi-sensor network of accelerometers to assess the actual use of the arm support and they were asked to provide self-reports on the perceived benefits of the devices. Benefits were experienced mainly during anti-gravity activities and the measured use did not change over time. The self-reports provided contextual information in domains such as participation to social life, in addition to the sensor system. However self-reports overestimated the actual use by up to three-fold compared to the accelerometer measures. A combination of objective and subjective methods is recommended for meaningful and quantifiable mobility benefits during activities of daily life.

Our aim is to define the design and procedure of a 3D printed assistive device and to produce a prototype assistive device for an individual with quadriplegia in order to enable him/her to independently conduct daily living activities. For the design and production of the 3D assistive device, we followed six steps. In the first step-determination of problematic activity/client-centered approach-writing activity was determined as the most problematic activity as a result of the interview with a paraplegic patient. Then, 2D drawings of the assistive device were created as the second step. For the third step the 3D scan of the individual's right hand was obtained. 3D scan of the right hand was transferred to CATIA program and the 3D printer is used in the manufacturing process for the fourth step. In the fifth step, we produced a low-cost novel writing assistive device. The writing device was introduced to the disabled individual and training was given regarding its practical use in the final step teaching the use of the device. As 3D printing technology progresses and becomes more reliable, we believe that the production of assistive devices will become much easier and their use will become more prevalent.

Background Falls cause approximately 80% of traumatic brain injuries in older adults, and nearly one third of falls by residents in long-term care (LTC) result in head impact. Holding objects during falls, such as mobility aids, may affect the ability of LTC residents to avoid head impact by arresting the fall with their upper limbs. We examined the prevalence of holding objects and their effect on risk for head impact during real-life falls in older adults living in LTC. Methods We analyzed videos of 1105 real-life falls from standing height by 425 LTC residents, using a validated questionnaire to characterize the occurrence of head impact and whether the resident held objects during descent and impact. We classified objects as either “weight-bearing” (via contact to the fixed environment, eg, chairs and walkers) or “non-weight-bearing” (eg, cups) and tested their effect on odds for head impact with generalized estimating equations. Results Residents held objects in more than 60% of falls. The odds for head impact were reduced for falls where weight-bearing objects were held or grasped during descent (odds ratio = 0.52; 95% confidence interval = 0.39–0.70) or maintained throughout the fall (odds ratio = 0.34; 95% confidence interval = 0.23–0.49). The most commonly held objects were chairs/wheelchairs (23% of cases), tables/counters (10% of cases), and walkers/rollators (22% of cases); all reduced the odds of head impact when held during descent. Holding non-weight-bearing objects did not affect the odds of head impact (odds ratio = 1.00; 95% confidence interval = 0.64–1.55). Conclusion Our results show that older adults in LTC use held, weight-bearing objects to reduce their risk for head impact during falls.

The literature review presents a conceptual participatory design through accessibility technology solutions, considering the design experience to be an essential factor in communication processes. Technologies must assess a wide range of disabilities based on characterisations that helps daily activities. This work includes collaboration concepts to assist in the development of accessible technology. Collaborative design requires the fostering of communication between actors involved in the design process.This work implemented with a protocol of guidelines developed by a group of experts in disability research. The relevant literature is included and assessed based on three categories: accessibility, assistive technologies, and participatory design.A knowledge gap can be identified: the development of assistive technology processes should enhance the voice of participants and consider their ideas, desires and needs.Multidisciplinary communication is necessary to identify problems and propose solutions, and it is essential that people with disabilities collaborate with experts from a range of disciplines to identify problem-solving patterns.Implications for rehabilitationA participatory design can develop a holistic understanding of the participant's motivation and rehabilitation needs. This has provided a grounded basis to offer information about the assistive technology design.A participatory work provides information about the technology design which may finally result in a better understanding of rehabilitation, other types of home-based healthcare or the gamification for rehabilitation.The rehabilitation professionals can explore requirements of a customised technology for users, which allows to transfer knowledge about disabilities and skills in rehabilitation to people with disabilities, their families and communities.The notion of a research problem in rehabilitation can be re-evaluated through a participatory design process that attempts to capture the subjective experiences of persons with disability.

Introduction: People with disabilities or special needs can benefit from AI-based conversational agents (i.e., chatbots) that are used for competence training and well-being management. Assessing the quality of interactions with these chatbots is key to being able to reduce dissatisfaction with them and to understanding their potential long-term benefit. This in turn will help to increase adherence to their use, thereby improving the quality of life of the large population of end-users that they are able to serve. Methods: Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) methodology, we systematically reviewed the literature on methods of assessing the perceived quality of interactions with chatbots using the from Scopus and the Web of Science electronic databases. Using the Boolean operators (AND/OR) the keywords chatbot*, conversational agent*, special needs, disability were combined. Results: Revealed that only 15 of 192 papers on this topic included people with disabilities or special needs in their assessments. The results also highlighted the lack of a shared theoretical framework for assessing the perceived quality of interactions with chatbots. Conclusion: Systematic procedures based on reliable and valid methodologies continue to be needed in this field. The current lack of reliable tools and systematic methods to assess chatbots for people with disabilities and special needs is concerning, and ultimately, it may also lead to unreliable systems entering the market with disruptive consequences for people.Implications for rehabilitationChatbots applied in rehabilitation are mainly tested in terms of clinical effectiveness and validity with a minimal focus on measuring the quality of the interactionThe usability and interactive properties of chatbots applied in rehabilitation are not comparable as each tool is measured in different wayThe lack of a common framework to assess chatbots exposes people with disability and special needs to the risk of using unreliable tools Chatbots applied in rehabilitation are mainly tested in terms of clinical effectiveness and validity with a minimal focus on measuring the quality of the interaction The usability and interactive properties of chatbots applied in rehabilitation are not comparable as each tool is measured in different way The lack of a common framework to assess chatbots exposes people with disability and special needs to the risk of using unreliable tools

Purpose: To review the knowledge base regarding assistive technology (AT) and the education of people with a hearing impairment. Also, evaluating to what extent has the use and/or impact of AT for individuals with a hearing impairment been determined through evidence-based research in post-school education.Materials and method: Literature pertaining to the effect of AT on the educational performance of students with impaired hearing in the post-school sector was examined for the period from 1998 to 2018 (20 years). A total of 477 articles that contained evidence-based research and reports on the effect of AT in practice were located and reviewed.Results: It was found that, of the 20 studies that met all the inclusion criteria, only seven provided promising, evidence-based reports on the impact of assistive hearing technology on educational performance.Conclusion: This review concluded that the limited research speaks to the positive impact of AT on educational outcomes. Additionally, for students with a hearing impairment to be able to receive high-quality AT that will enhance their educational success, more evidence-based research on the efficacy of hearing AT needs to be conducted, especially as newer technologies emerge in this technological era.Implications for rehabilitationThe use of appropriate hearing assistive technology (AT) is a key facilitator within the educational environment and has a positive impact on the educational outcomes for students studying at college or university.This rapid review revealed the need to develop a body of scientifically based research that examines the relationship between academic achievement of participation by deaf learners and the use of AT - this is needed to develop a more comprehensive understanding of the benefits and limitations of educational technologies, especially as newer technologies emerge in this technological era.This study further highlights the need for more concrete research on the effectiveness of hearing-related AT so that the case can be made for students with hearing impairment to receive high quality, appropriate AT that will enhance their educational success.Ultimately, it is hoped that this article elicits the need for much more investigation into this topic to work towards finding solutions that lead to increased participation of deaf learners in the higher education arena, as well as providing evidence-based results to inform future policy and practice.

Manual wheelchair users are more vulnerable, in situations such as road crossings, hazardous sidewalks or curbs and crossing of buildings and facilities threshold. Geospatial assistive technology (GAT) can help with route planning. However, it is important to ensure the usability of such products, as well as the satisfaction of persons with reduced mobility. The study's aim was (1) to develop and validate a questionnaire on the satisfaction of GAT, in English and French, and to (2) assess satisfaction, efficacy and efficiency of a GAT with manual wheelchair users following a filmed trial in a dense urban area.A methodological study was conducted (development of the questionnaire, assessment of its content validity, feasibility and practicability) followed by a trial and post-observations with the videos. Two questionnaires (English, French) were concurrently validated by two groups of experts (The Evaluation of satisfaction with geospatial assistive technology (ESGAT) consists in a user profile and their experience with the technology, followed by 12 satisfaction criteria rated from 1-not satisfied to 5-very satisfied. Both questionnaires were rated as feasible and practicable to complete. The usability of Google Maps Pedestrian routeing tool was measured as "moderate" by manual wheelchairs since the total satisfaction score at the ESGAT was 3.9/5 (quite satisfied). The items with the lowest score were navigation assistance, hands-free function and security. The GAT was effective (87.5% have completed their destination) but not efficient (37.5% needed help).IMPLICATIONS FOR REHABILITATIONFor manual wheelchair users paired with geospatial assistive technology:• A 10 minutes questionnaire was developed and validated to assess their satisfaction after testing aid in an urban area.• Satisfaction criteria to address are ease of access (service), learnability, hands-free function, ease of use for planning as well for navigating, transportability/ appearance, content, geographic information, effectiveness, efficiency, navigation assistance and security• A field test is necessary to ensure the effectiveness of the technology in avoiding or announcing potential obstacles such as sidewalk crossing ramp, damaged and congested sidewalk; sidewalk tilt (side slopes); thresholds at destination; verbal indication too soon or too late; incorrect indication; the arrow does not indicate the right direction; readjustment of the route needed; a lack of indication; and human intervention needed.

Purpose: Unmet needs for assistive technologies (ATs) exist and the need for ATs is growing owing to demographic changes worldwide. Little comprehensive research has examined equity of access to ATs in Canada. Our study elucidates perspectives of policymakers and stakeholders on challenges and solutions for enhancing equitable access to ATs to advance policy discussions.Methods: We conducted a qualitative interview study with a purposive sample of policymakers and stakeholders. Stakeholders were from non-profit organisations; private insurance companies; ageing or technology industries; and advocacy, consumer, and support groups. We used thematic analysis to develop themes that summarised and facilitated data interpretation.Results: We conducted 24 interviews involving 32 participants. We present three themes: (1) User experiences, detailing challenges experienced by AT system users; (2) System characteristics: Challenges and solutions, outlining governance, financial, and delivery arrangements that create challenges for accessing AT, as well as participants' proposed solutions; and (3) Shifts in models and principles, for approaches that may foster equitable access to ATs. We consolidate results into a set of valued qualities of a system that can enhance equitable AT access, and relate results to relevant national and international activities.Conclusions: This is the most comprehensive study of Canadian policymaker and stakeholder views on AT access to date. Identified challenges and solutions point to opportunities for policy action and to support work to create a national vision for AT access that strengthens the potential for ATs to enable daily activity participation, independence, and societal inclusion of seniors and people with disabilities.IMPLICATIONS FOR REHABILITATIONAT use supports daily activity participation, independence, and societal inclusion of seniors and people with disabilities.There is an urgent need to ensure that those who need ATs have access to them, considering the benefits of their use, current unmet needs for ATs, and the anticipated demand for ATs because of the ageing population and increased prevalence of chronic disease and disability.A comprehensive understanding of policymakers' and stakeholders' perspectives on challenges and potential solutions for enhancing equitable access to ATs is critical to support development of evidence- and values-informed policies.Understanding challenges and solutions identified by diverse policymakers and stakeholders can lead to national and local opportunities for policy action and support work to create a national vision for enhancing equitable access to AT.

A previous randomised controlled trial demonstrated the effects of a telephone-assisted self-help (TASH) intervention for parents of pharmacologically treated children with attention-deficit/hyperactivity disorder (ADHD) on ADHD symptoms, oppositional symptoms, functional impairment, and negative parenting behaviour (per-protocol analyses). In the current study, we examined whether changes in positive and negative parenting behaviour mediated the effects on symptoms and impairment. Parents in an enhancement group (n = 51) participated in a 12-month TASH intervention (eight booklets plus up to 14 telephone consultations) as an adjunct to routine clinical care, whereas parents in a waitlist control group (n = 52) received routine clinical care only. Parents completed measures of child symptoms, child functional impairment, and parenting behaviour at baseline, at 6 months, and at 12 months. The mediating effects of parenting behaviour were examined using regression analyses. Per-protocol analyses (n = 74) revealed a significant indirect intervention effect on functional impairment through negative parenting behaviour at 6 months as well as indirect intervention effects on oppositional symptoms and functional impairment through negative parenting behaviour at 12 months. The indirect effect on ADHD symptoms through negative parenting behaviour at 12 months just failed to reach significance. The analyses yielded no indirect intervention effects through positive parenting behaviour. The study provides some, albeit limited, support for the importance of changes in negative parenting behaviour to achieve changes in symptoms and functional impairment during parent training. In consideration of the inconsistent results of previous studies concerning the mediating role of positive and negative parenting behaviour, further research is required to better understand the mechanisms of change during parent training, also including other possible mediators like parenting stress and parental self-efficacy.

Background: Echolocation is a technique whereby the location of objects is determined via reflected sound. Currently, some visually impaired individuals use a form of echolocation to locate objects and to orient themselves. However, this method takes years of practice to accurately utilize. Aims: This paper presents the development of a sensory substitution device for visually impaired users, which gauged distances and the placement of objects. Methods: Using ultrasonic technology, the device employed a method of echolocation to increase the user's independence and mobility. The main components of this device are an ultrasound transceiver and a miniaturized Arduino board. Through research and prototyping, this technology was integrated into a biomedical application in a watch form factor which provides feedback to the user regarding the measured distance by the ultrasonic transducer. Results: The output of this process is a tactile feedback that varies in intensity proportional to the distance of the detected object. We tested the device in different scenarios including different distances from a different material. The difference between the device reading and the actual distance, from 0 to 400 cm was statistically insignificant. Conclusion: It is believed this device will boost the confidence of the user in navigation.

Purpose: This paper describes international actions to collaborate in the assistive technology (AT) arena and provides an update of programmes supporting AT globally. Methods: The World Health Organisation (WHO) identifies the severe global uneven distribution of resources, expertise and extensive unmet need for AT, as well the optimistic substantial capability for innovations and developments in appropriate and sustainable AT design, development and delivery. Systems thinking and market shaping are identified as means to address these challenges and leverage the ingenuity and expertise of AT stakeholders. Results: This paper is a 'call to action', showcasing emerging AT networks as exemplars of a distributed, but integrated mechanism for addressing AT needs globally, and describing the Global Alliance of Assistive Technology Organisations (GAATO) as a vehicle to facilitate this global networking. Conclusion: Partners in this Global Alliance aim to advance the field of assistive technology by promoting shared research, policy advocacy, educating people and organisations within and outside the field, teaching, training and knowledge transfer by pulling together broad-based membership organisations.Implications for RehabilitationCollegial, cross discipline and multi-stakeholder collaborations support assistive technology research and practice.Knowledge exchange within and across countries and regions is mutually beneficial.Self-organising assistive technology communities are emerging and supported by global movements such as WHO GATE and GAATO.

Since the implementation of the Americans with Disabilities Act (ADA), efforts have been made to increase access to public services, businesses, education, and public spaces for all members of the community. However, digital accessibility to information online is regularly an afterthought or applied retroactively, rather than a standard consideration integrated into the creation, instruction, and dissemination of information resources. Libraries can serve as advocates for increasing digital accessibility to information resources. This column will investigate what technologies are currently being utilized for digital accessibility, discuss concerns related to digital accessibility, and consider methods for libraries to become more involved with supporting and integrating digital accessibility into online library services.

3D printing is often discussed in the field of hand rehabilitation, yet many hand therapists are unaware of this technology and how it either is used or could potentially be used in rehabilitation. To shed some light on the state of 3D printing in hand rehabilitation, we sought insight from a rehabilitation engineer, occupational therapy educator, clinician, and hospital administrator to provide a comprehensive look at the state of 3D printing today.

This article critically examines user-involvement in the service delivery process for assistive activity technology.Data were collected in semi-structured interviews with 44 end users of assistive activity technology and in focus group interviews with 11 professionals at Norway's Assistive Technology Centre. Data was analysed according to a stepwise deductive-inductive approach.Flawed organisational principles like division of responsibility, unclear regulations, and a lack of competence with assistive activity technology among service professionals have hindered user involvement in the service delivery process.A missing knowledge of assistive activity technology among professionals and the current organisation of services creates barriers for a positive collaboration with users in the service delivery process of assistive activity technology.IMPLICATIONS FOR REHABILITATIONThe spread of information among users and courses for professionals should be expanded to ensure the necessary competence with assistive activity technology within the service delivery process.In developing the service delivery process for assistive activity technology, professionals should act less as guardians of traditional functional requirements and more as active providers of different technological solutions.The service delivery process for assistive activity technology should allow long-term testing to identify relevant social and physical factors affecting the use of this type of technology, before delivery.Guarantees and complaint systems should be established in the service delivery process for assistive activity technology.

Background Independent walking is important for individuals who have undergone lower limb amputation. Recently, robot-assisted gait training has been widely used for individuals with abnormal gait. However, no study has evaluated the effect of the Honda Walking Assist Device® (HWA) on the gait of patients who have undergone transfemoral (TF) amputation. Objective This study aimed to investigate the safety, feasibility, and effect of gait training using the HWA for individuals who underwent lower limb amputation. Methods This study included two elderly patients who underwent TF amputation due to a nontraumatic reason. Gait training interventions using the HWA were performed for a week (5 training sessions). Self-selected walking speed (SWS), step length, cadence, hip kinematic parameters, and symmetricity of single support time ratios during SWS were measured before and after the HWA interventions. Results SWS, step length, cadence, and hip angle range improved after the HWA interventions in both patients. Symmetricity of single support time ratios and maximum hip extension angle improved in patient 1, but not in patient 2. There were no adverse events in either patient. Conclusions Gait training using the HWA was safe and effective for improving the gait of two TF amputees.

In recent years, assistive technologies have gained acceptance as tools for supporting chronically ill patients in achieving improvements in physical activity. However, various healthcare and sociological studies show contradicting results regarding the physical and social impact of using such devices. This paper explores real-time user appropriation of an assistive monitoring/tracking device, the pedometer, in a healthcare intervention, with a particular focus on the technology identities users attribute to the pedometer. The study site was a rehabilitation programme at a local Danish health centre supporting patients with chronic obstructive pulmonary disease. As part of this empirical study, six focus-group interviews were conducted with patients before and after they used pedometers. The analysis of respondents' accounts shows that monitoring devices become part of users' complex socio-technical ensembles in which the use of the device and its tracking of activity is constantly negotiated through experimentation with type and frequency of use; interpretation of knowledge and experience gained via the device; and negotiation of expectations, wellbeing, and the value of quantified knowledge for the management of chronic illness. On the basis of these findings the paper brings together and advances sociological scholarship on chronic illness, embodiment, the quantified self and technology adoption.

Objective To assess the relationship between real-world walking activity in children and adolescents with myelomeningocele (MMC) and gross measures of lower extremity strength, range of motion, demographics, and medical history. Design Prospective study. Setting Participants recruited in outpatient clinics; data collected in a hospital-based motion analysis laboratory and in the community. Participants Children and adolescents (N=52) with daily step count data available from a larger study of ambulatory children and adolescents with MMC. Interventions Not applicable. Main Outcome Measure Univariate and multivariate regression was used to assess which participant characteristics and clinical factors were related to average number of steps per day. Results Univariate analysis showed a lower number of steps per day correlated with older age, male sex, higher body mass index, higher lesion level, use of assistive devices for ambulation, history of shunt placement, more television (TV) watched per week, lower hip extension and abduction strength, knee flexion strength, and ankle dorsiflexion and plantarflexion strength, and decreased knee and hip range of motion. Only assistive device usage and hours of TV watched per week remained in the final multivariate model predicting number of steps per day. Conclusions Walking activity in children and adolescents with MMC was best predicted by assistive device use and amount of sedentary activity. Other predictors of walking activity from univariate analysis were related to assistive device use. This information can help tailor rehabilitation efforts and educate patients and families. Interventions targeting early prevention of strength loss and contractures may be important to retain or increase walking activity in children and adolescents with MMC.

AIM The primary aim of this study was to examine the impact of age, gender and the stage of dementia on the results of an assistive technology intervention that make use of communication robots (com-robots). The intervention was designed to improve the social participation and interactions of nursing home residents. While our previous study showed that the overall effects of com-robot intervention were positive, it was unknown what impact age, gender and the stage of dementia of participants had on such an intervention. METHODS This was a non-randomized, multicenter quasi-experimental intervention study conducted in residential care homes in Japan. Two types of com-robots were introduced for 8 weeks after baseline evaluation. The World Health Organization's ICF was used for evaluating any changes present after the 8-week intervention. In total, 78 residents (68 women, 10 men, 86.5 ± 7.7 years old) participated in the study. The Degree of Daily Life Independence Score for People with Dementia (DDLIS-PD) was employed for measuring the stage of dementia. RESULTS The results showed that the older participants aged ≥80 benefited more from the intervention than the younger cohort did (P

Digital technologies have the potential to assist people with dementia to monitor day to day activities and mitigate the risks of living independently. This purposive pilot study surveyed participants for frailty, wellbeing, and perceived carer burden using the 3Rings™ digital plug. 30 paired participants used the digital device for four months. People with dementia reported a decline in wellbeing and increased frailty. Family carers reported a decline in wellbeing but 18 reported a reduction in burden. The use of digital monitoring by family carers demonstrated a reduction in their perceived burden and the device was acceptable to people with mild dementia living alone.

We evaluated the influence of organization, eldercare worker and care situation on the use of assistive devices during resident handling in eldercare work. We conducted a multi-level study among 20 nursing homes, 126 wards within the nursing homes, 549 eldercare workers within the wards, who performed a total of 1306 care episodes including 3695 resident handlings. The influence of organization (i.e. nursing home and ward), eldercare worker and care situation (i.e. care episode and resident handling) on the use of assistive devices was evaluated using variance components analysis and multivariate generalized linear mixed model. Nursing homes, wards, eldercare workers, care episodes and ‘within care episode’ all contributed to the total variance in use of assistive devices. Organizational factors and care situation factors were significantly associated with use of assistive devices. All levels of the nursing homes, but in particular care situation, influence the use of assistive devices during resident handling.