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Background: Children with congenital limb reduction deficiency live with the decisions made by their parents and healthcare professionals about treatments to be carried out during the first years of life. To understand better the meaning of treatment during childhood, it is necessary to listen to adolescents who have had this experience. The aim of this study was to investigate the perceptions of adolescents with congenital limb reduction deficiency concerning the treatment they received during childhood and what it meant to them currently and in the future. Methods: A descriptive design with a qualitative approach was used. Semi-structured interviews were conducted with 10 adolescents (six girls and four boys) with upper and/or lower limb reduction deficiency, median age 17.5 years (range 16–19). The interview data were analysed using a phenomenographic approach. Results: The treatment received during childhood had contributed to shaping the adolescents, as shown in the emerging description categories Creating opportunities, Choosing one's own path and Belonging in a context. Their current situation fell into three categories: A continuous journey, indicating that they still used the skills learned during childhood; Leaving the door open, indicating that they were not currently using the skills learned during childhood, but felt that there could be opportunities ahead; and Closing a chapter, indicating that they had stopped using their prosthesis or assistive devices and no longer needed those skills. Further, the adolescents' thoughts about the future are portrayed in the categories Uncertainty about the future and Confidence about the future. Conclusions: An understanding of the meaning of treatment received during childhood may help improve the delivery of treatment and continued support to meet the needs of children with congenital limb reduction deficiency in the short and long term., Funding agencies:Faculty of Medicine and Health, Örebro University, Örebro, SwedenResearch Committee, Region Örebro County, Sweden

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.

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.

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.

Musculoskeletal disorders may affect labor efficiency, cause disability, impair one’s work ability, and lower one’s quality of life. This consequently leads to a larger expenditure of medical resources. We aimed to design easy-to-open assistive devices for pneumatic tube systems to improve ergonomics and reduce musculoskeletal complaints of workers. We followed a design control process, including designs of motors, gears, sensors, and V-shaped connecting rods. Efficacy was evaluated by examining risks based on job strain index, user satisfaction, and musculoskeletal complaints of operators before and after the system’s implementation on a Nordic musculoskeletal questionnaire. We designed three assistive devices: two semiautomatic and one automatic. Each semiautomatic device costs about 300 US dollars and required space of 10 × 18 × 38 c m 3 . The automatic device costs about 3000 US dollars and required space of 28 × 38 × 50 c m 3 . The job strain index score decreased from 36 (very high risk) to 3 (low risk) with the semiautomatic devices and to 0 with the automatic device. Musculoskeletal complaints in the neck and upper limbs were reduced, with a significantly higher satisfaction rate for female operators. Our novel design of an automatic cap opening device for a pneumatic tube system was effective in improving ergonomics and reducing musculoskeletal complaints.

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.

BACKGROUND There are various tools and methods used for strength exercise. Elastic bands, one of the resistance exercise tools, have been used for various purposes, including muscle strengthening; however, there is very little evidence supporting their efficacy. The study was performed to investigate the effect of knee-ankle elastic bands on knee muscle strength-related parameters according to sex in healthy adults. MATERIAL AND METHODS This was a cross-sectional study. Twenty-one participants (11 female and 10 male) were studied using a cross-over design. Isokinetic concentric knee extension and flexion strength was measured at 60°/s and 180°/s with and without application of a therapeutic elastic band in the shape of an "8", with knee flexion and ankle dorsiflexion. The variables related to muscle power automatically calculated in the protocol of the isokinetic system were compared according to sex and angular velocity. RESULTS Peak moment (PM), PM/body weight, average power, total work, and the agonist/antagonist ratio, demonstrated significant improvement (P0.05) at both 60°/s and 180°/s "with" compared to "without" the elastic band according to sex. CONCLUSIONS The use of therapeutic elastic bands in the shape of a figure 8 with knee flexion and ankle dorsiflexion may be used as assistive devices for improving strength in muscles supporting the knee. Further high-quality studies are needed to assess the potential of elastic bands as assistive devices and not merely as exercise tools. Therapeutic elastic bands in the shape of an "8" with knee flexion and ankle dorsiflexion may be useful in sports activities.

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.

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.

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.

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.

Purpose Modified ride-on cars have emerged as an early powered mobility option for young children with disabilities. The purpose of this study was to identify, extract, and synthesize perceived barriers of modified ride-on car use reported in previous studies. Methods This study was descriptive using a qualitative content analysis of previously published studies identified from a systematic literature search. Results Categories of perceived barriers were identified: device, environmental, child-related perceived barriers regarding health, tolerance, and abilities, and caregiver-related perceived barriers regarding physical requirements, time, and motivation. Device and environmental perceived barriers were the most reported. Conclusions Pediatric physical therapists play a critical role in working with families to promote their self-efficacy for using the modified ride-on car and their capacity for overcoming the inherent difficulties associated with use. Most of the reported perceived barriers are modifiable, at least to some degree, with likely effects on modified ride-on car use.

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.

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

Despite that various soft bending actuators have been presented in recent years, their widespread application in knee assistive devices is still hindered by their uncomfortable geometry, limited torque output, control complexity, and high cost to enhance the knee joint during various human movements. Inspired by accordion bellows, we proposed a novel design of foldable pneumatic bending actuators (FPBAs) in this study, which were fabricated with the thermoplastic polyurethane fabric materials. FPBAs could produce torque by the inflation or interactive compression of their interconnect air chambers with no airflow restriction occurring at any bending angle. General mechanical equations for FPBAs were derived to characterize their output torque as functions of their geometry and internal air pressure. To evaluate the feasibility of FPBAs, a specific prototype with rectangular chambers was constructed and tested by mechanical experiments. A knee exosuit equipped with the prototype was also designed, and five subjects were recruited to perform static postures in knee rehabilitation training with and without the assistance of the knee exosuit. Subjects' persistence time and knee extensors' surface electromyography signals were recorded and compared, which verified the assisting effects of the knee exosuit. Besides knee assistive devices, the FPBAs could also be applied to other soft robots thanks to their competitive advantages, such as flexibility, large torque output, low-pressure input, simple fabrication process, light weight, and low cost.

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.

Background: Due to declining birthrates and an increasing aging population, shortage of the caregiving labor force has become a global issue. Among various efforts toward the solution, introducing robotic products for assistance could provide an effective way to help older adults in their daily lives. As previous studies have indicated that older adults’ acceptance of robots is lower than that of younger adults, enhancing older adults’ acceptance of robots is imperative. Because older adults’ first impressions based on a robot’s appearance might affect their acceptance of the robot, we investigated the uncanny valley effect (UVE) here. The UVE refers to the phenomenon that people rate robots more positively as robots become more humanlike, but only up to a certain point; as robots approach a near-perfect similarity to human appearance, likeability drops and forms the uncanny valley. Nevertheless, evidence for the UVE came mainly from younger adults. Objective: The present study aimed to examine whether the UVE varies across different age groups and whether a robot’s appearance would affect participants’ acceptance of the robot’s service or companionship. Methods: An online questionnaire study was conducted with 255 participants, including younger (n = 77, age 18–39 years), middle-aged (n = 87, age 40–59 years), and older (n = 91, age 60–87 years) adults. Participants were asked to view each picture in a set selected from a total of 83 robot pictures and evaluate their impressions of each robot and the intention of use regarding robot function as a service provider or a companion. Results: The UVE was found in younger and middle-aged adults; however, older adults did not show the UVE. Older adults preferred humanlike over non-humanlike robots, regardless of robot function. Conclusion: The design of assistive robots should take the UVE into consideration by customizing robot appearance based on the age group of the intended user.

To provide an effective and safe therapy to persons with neurological impairments, accurate determination of their residual volitional ability is required. However, accurate measurement of the volitional ability, through non-invasive means (e.g., electromyography), is challenging due to signal interference from neighboring muscles or stimulation artifacts caused by functional electrical stimulation (FES). In this work, a new model-based intention detection method that combines signals from both surface electromyography (sEMG) and ultrasound (US) sonography to predict isometric volitional ankle dorsiflexion moment is proposed. The work is motivated by the fact that the US-derived signals, unlike sEMG, provide direct visualization of the muscle activity, and hence may enhance the prediction accuracy of the volitional ability, when combined with sEMG. The weighted summation of sEMG and US imaging signals, measured on the tibialis anterior muscle, is utilized as an input to a modified Hill-type neuromusculoskeletal model that predicts the ankle dorsiflexion moment. The effectiveness of the proposed model-based moment prediction method is validated by comparing the predicted and the measured ankle joint moments. The new modeling method has a better prediction accuracy compared to a prediction model that uses sole sEMG or sole US sonography. This finding provides a more accurate approach to detect movement intent in the lower limbs. The approach can be potentially beneficial for the development of US sonography-based robotic or FES-assisted rehabilitation devices.

When we develop wearable assistive devices, comfort and support are two main issues that need to be considered. In conventional design approaches, the degree of freedom of the wearer’s joint movements tends to be oversimplified. Accordingly, the wearer’s motion becomes restrained and bone/ligament injuries might occur in case of an unexpected fall. To mitigate these issues, this paper proposes a novel joint link mechanism inspired by a human spine structure as well as functionalities. The key feature of the proposed spine-like joint link mechanism is that hemispherical blocks are concatenated via flexible synthetic fiber lines so that their concatenation stiffness can be adjusted according to a tensile force. This feature has a great potentiality for designing a wearable assistive device that can support aged people’s sit-to-stand action or augment spinal motion by regulating the concatenation stiffness. In addition, the concatenated hemispherical blocks enable the wearer to move his/her joint with full freedom, which in turn increases the wearer’s mobility and prevents joint misalignment. The experimental results with a testbed and a pilot wearer substantiated that the spine-like joint link mechanism can serve as a key component in the design of wearable assistive devices for better mobility.

Objective: To investigate which assistive devices people with advanced cancer have and whether they are in use. In addition, to explore the characteristics of people with advanced cancer who have unmet needs for assistive devices. Methods: This descriptive cross-sectional study used data from a randomised controlled trial evaluating efficacy of an occupational therapy-based intervention. Participants were 237 people with advanced cancer. Data were collected by means of instruments about demography, functioning and assistive devices. Results: The most frequent assistive devices possessed by the participants were as follows: (1) small aids for dressing (47%), (2) Pillow for positioning (40%) and (3) electrically operated adjustable bed (39%). The prevalence of assistive devices was 92% (95% confidence interval [CI]: 88%–95%) with 14.2% non-use, largest for trolley tables (50%). In all, 27.4% of the participants were found to have unmet needs for assistive devices. These participants had similar characteristics to the other participants except from lower activity of daily living (ADL) ability (p values =

Assistive exoskeletons can reduce the metabolic cost of walking, and recent advances in exoskeleton device design and control have resulted in large metabolic savings. Most exoskeleton devices provide assistance at either the ankle or hip. Exoskeletons that assist multiple joints have the potential to provide greater metabolic savings, but can require many actuators and complicated controllers, making it difficult to design effective assistance. Coupled assistance, when two or more joints are assisted using one actuator or control signal, could reduce control dimensionality while retaining metabolic benefits. However, it is unknown which combinations of assisted joints are most promising and if there are negative consequences associated with coupled assistance. Since designing assistance with human experiments is expensive and time-consuming, we used musculoskeletal simulation to evaluate metabolic savings from multi-joint assistance and identify promising joint combinations. We generated 2D muscle-driven simulations of walking while simultaneously optimizing control strategies for simulated lower-limb exoskeleton assistive devices to minimize metabolic cost. Each device provided assistance either at a single joint or at multiple joints using massless, ideal actuators. To assess if control could be simplified for multi-joint exoskeletons, we simulated different control strategies in which the torque provided at each joint was either controlled independently or coupled between joints. We compared the predicted optimal torque profiles and changes in muscle and whole-body metabolic power consumption across the single joint and multi-joint assistance strategies. We found multi-joint devices–whether independent or coupled–provided 50% greater metabolic savings than single joint devices. The coupled multi-joint devices were able to achieve most of the metabolic savings produced by independently-controlled multi-joint devices. Our results indicate that device designers could simplify multi-joint exoskeleton designs by reducing the number of torque control parameters through coupling, while still maintaining large reductions in metabolic cost.

Background: Assistive technologies (ATs) are resources to promote the independence and participation of people with a disability. The use of standardized tools, based on outcome measures, is essential for guaranteeing high-quality rates. The Quebec User Evaluation of Satisfaction with AT–2.0 (QUEST) is a scale to assess the satisfaction of people using any AT. Objectives: To translate and culturally validate the QUEST–2.0 for the Spanish population (QUEST 2.0-ES). Methods: A validation cross-design and descriptive study. The test–retest reliability, validity, and internal consistency of QUEST 2.0-ES were studied. It was divided into two phases: Sample 1 was formed by 26 persons; in sample 2, 30 persons participated. The conditions included neurological conditions, amputations, rare diseases, and deafness. Results: Thirty-five men and 21 women participated in total. The majority of AT used were those for mobility. QUEST 2.0-ES analysis showed internal consistency values between the test ( = 0.87) and retest versions ( = 0.89). The internal consistency was high for AT (test, = 0.83; retest, = 0.87) and Service (test, = 0.80; retest, = 0.80). The temporal reliability (1–2 weeks) for test–retest was 0.88. Conclusion: QUEST 2.0-ES showed good psychometric properties in terms of validity and test–retest reliability, and it is a good tool to assess the user’s satisfaction with ATs and services., This research had support for its publication by the National Program of R+D+i oriented to the Challenges of Society 2019 (coordinated research), Grant number: PID2019-104323RB-C33. The Ministry of Science and Innovation. The APC was funded by CITIC as a Research Center of the Galician University System, and is financed by the Consellería de Education, Universidades y Formación Profesional (Xunta de Galicia) through the ERDF (80%), Operational Program ERDF Galicia 2014–2020, and the remaining 20% by the Secretaria Xeral de Universidades (Ref. ED431G 2019/01).

Objective To identify and describe the contextual factors that influence the participation of people with deafblindness in India. Design Qualitative study, using directed content analysis approach and the International Classification of Functioning, Disability and Health (ICF) as a framework to analyze the data. Setting Community and social participation settings. Participants Community-dwelling individuals with deafblindness (N=16). Age ranges from 18-45 years. Interventions Not applicable. Main Outcome Measures Personal and environmental factors that influence the participation of individuals with deafblindness using the ICF framework. Results Results indicate that the age of onset and nature of impairment (deafblindness) and willingness to explain the condition (functional consequences of deafblindness) emerged as important personal factors. Access to resources such as assistive technology, social support, and deafblind-specific services were found to be enablers of participation. Lack of services, systems, and policies specific to deafblindness along with negative societal attitude toward disability were highly perceived environmental barriers that influence participation of people with deafblindness in India. Conclusions Professionals must acknowledge aspects of the environment in conducting assessments and delivering interventions and understand the dynamic interactions between environment of the individual and his/her concurrent vision and hearing impairments. Approaches to enable participation require rehabilitation professionals to work with those with deafblindness to advocate for removal of environmental barriers and ensure provision of appropriate resources from the government to facilitate their participation. Social policy and government must ensure emphasis on awareness about deafblindness, access to deafblind-specific services, positive societal attitude, and opportunities for full participation for people with deafblindness in society.

Objective To investigate the association between insurance provider and reported assistive technology (AT) use to access computers and electronic devices 1 year after sustaining tetraplegia. Design Multicenter cross-sectional study. Setting Participants enrolled in the Spinal Cord Injury Model Systems (SCIMS) National Database. Interventions Not applicable. Participants Men and women with tetraplegia (N=498) enrolled in the SCIMS National Database were included in the analysis. Main Outcome Measures The primary study outcome was the use of AT when operating a computer or other mobile electronic device. The primary predictor was the subject’s principal health insurance provider, which was grouped into the 3 categories: government (Medicare, Medicaid, and other government), private (private insurance, private funds, and other), and workers’ compensation. Results Overall, 34.7% of participants reported using AT to access computers and electronic devices. Results of logistic regression analysis revealed sex, injury level, injury completeness, self-perceived health status, and 12-month history of pressure ulcer were all significantly associated with AT use. After adjusting for these factors, participants with workers’ compensation were more likely to report AT use than individuals with either government or private insurance. Conclusions Despite significant technological advances, AT is not readily available to the people who might benefit most from its use. Findings from the present study are the first to shed light on AT funding sources and reveal that individuals with workers’ compensation are more likely use AT than individuals with either government or private insurance. Additional work focused on AT use and functional outcomes is needed to assess the effect of barriers to use. Collectively, this work may inform insurers of the importance of having AT available for this unique population to potentially improve quality of life and participation.

The aim of this paper was to explore the psychosocial determinants that lead to acceptability and willingness to interact with a service robot, starting with an analysis of older users’ behaviors toward the Robot-Era platform, in order to provide strategies for the promotion of social assistive robotics. A mixed-method approach was used to collect information on acceptability, usability, and human–robot interaction, by analyzing nonverbal behaviors, emotional expressions, and verbal communication. The study involved 35 older adults. Twenty-two were women and thirteen were men, aged 73.8 (±6) years old. Video interaction analysis was conducted to capture the users’ gestures, statements, and expressions. A coded scheme was designed on the basis of the literature in the field. Percentages of time and frequency of the selected events are reported. The statements of the users were collected and analyzed. The results of the behavioral analysis reveal a largely positive attitude, inferred from nonverbal clues and nonverbal emotional expressions. The results highlight the need to provide robotic solutions that respect the tasks they offer to the users It is necessary to give older consumers dedicated training in technological literacy to guarantee proper, long-lasting, and successful use.

In this paper, we wanted to verify the hypothesis that extruding cartographic symbols on tactile maps to different heights might allow reducing the minimum (suggested in the literature) horizontal distances between them, without impacting the overall map’s legibility. This approach might allow preparing tactile maps in smaller scales and thus, reducing production cost, or putting additional spatial information on the same map sheet that would not fit otherwise. To verify the hypothesis we have prepared 6 different stimuli variants with or without height differentiation applied and different horizontal distances between tactile symbols adopted (1 mm, 2 mm and 3 mm). In the controlled study sessions with 30 participants with visual impairments we have measured the times required for solving 3 different spatial tasks on 3D printed tactile stimuli. We have also performed qualitative analysis to learn participants’ opinions about the proposed design and materials used. It turns out that applying height differentiation not only results in shorter times required for solving spatial tasks but is also considered by blind individuals as a convenient improvement in terms of use comfort and allows reduction of recommended minimum horizontal distances between symbols on tactile maps.

Objective: To compare the effectiveness of single, multiple, and multifactorial interventions to prevent falls and fall-related fractures in community-dwelling older persons. Methods: MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were systematically searched for randomized controlled trials (RCTs) evaluating the effectiveness of fall prevention interventions in communitydwelling adults aged ≥65 years, from inception until February 27, 2019. Two large RCTs (published in 2020 after the search closed) were included in post hoc analyses. Pairwise meta-analysis and network meta-analysis (NMA) were conducted. Results: NMA including 192 studies revealed that the following single interventions, compared with usual care, were associated with reductions in number of fallers: exercise (risk ratio [RR] 0.83; 95% confidence interval [CI] 0.77–0.89) and quality improvement strategies (e.g., patient education) (RR 0.90; 95% CI 0.83–0.98). Exercise as a single intervention was associated with a reduction in falls rate (RR 0.79; 95% CI 0.73–0.86). Common components of multiple interventions significantly associated with a reduction in number of fallers and falls rate were exercise, assistive technology, environmental assessment and modifications, quality improvement strategies, and basic falls risk assessment (e.g., medication review). Multifactorial interventions were associated with a reduction in falls rate (RR 0.87; 95% CI 0.80– 0.95), but not with a reduction in number of fallers (RR 0.95; 95% CI 0.89– 1.01). The following single interventions, compared with usual care, were associated with reductions in number of fall-related fractures: basic falls risk assessment (RR 0.60; 95% CI 0.39–0.94) and exercise (RR 0.62; 95% CI 0.42–0.90). Conclusions: In keeping with Tricco et al. (2017), several single and multiple fall prevention interventions are associated with fewer falls. In addition to Tricco, we observe a benefit at the NMA-level of some single interventions on preventing fall-related fractures.

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

Many individuals need a mobility assistive device as they age. These devices include canes, crutches, walkers, and wheelchairs. Clinicians should understand how to select the appropriate device and size for individual patients (or work with a physical therapist) and prescribe the device using the patient's health insurance plan. Canes can improve standing tolerance and gait by off-loading a weak or painful limb; however, they are the least stable of all assistive devices, and patients must have sufficient balance, upper body strength, and dexterity to use them safely. Older adults rarely use crutches because of the amount of upper body strength that is needed. Walkers provide a large base of support for patients who have poor balance or who have bilateral lower limb weakness and thus cannot always bear full weight on their legs. A two-wheel rolling walker is more functional and easier to maneuver than a standard walker with no wheels. A four-wheel rolling walker (rollator) can be used by higher-functioning individuals who do not need to fully off-load a lower limb and who need rest breaks for cardiopulmonary endurance reasons, but this is the least stable type of walker. Wheelchairs should be considered for patients who lack the lower body strength, balance, or endurance for ambulation. Proper sizing and patient education are essential to avoid skin breakdown. To use manual wheelchairs, patients must have sufficient upper body strength and coordination. Power chairs may be considered for patients who cannot operate a manual wheelchair or if they need the features of a power wheelchair.

Among other limitations, people with neurological conditions often experience problems with functional mobility. One of the intervention strategies employed to mitigate or compensate this limitation is the use of mobility assistive technology such as manual and electric wheelchairs, walkers, canes, crutches, etc. Although assistive technology is a commonly used intervention strategy among disabled people, the use of this technology is sometimes discontinued or abandoned due to a failure to meet the user's needs or a lack of training, among other reasons.The sample used in this study comprises 80 users of mobility assistive technology, 14 of whom have abandoned or discontinued their use of Assistive Technology. The study variables include the Psychosocial Impact of Assistive Devices Scale for outcome measurement, as well as specific sociodemographic variables relating to the sample and the assistive device used.Significant values were obtained in the three subscales of the Psychosocial Impact of Assistive Devices Scale. 50% of abandonments of assistive technology occurred among people diagnosed with stroke.The Psychosocial Impact of Assistive Devices Scale can be a useful tool for assessing potential abandonment or non-use of Assistive Technology. More longitudinal studies are required to avoid this limitation on the use of assistive technology.Interrupción o abandono en el uso de productos de apoyo para la movilidad en personas con afectación neurológica.Introducción. Las personas con afectación neurológica suelen presentar, entre otras limitaciones, problemas en la movilidad funcional. Por ello, una estrategia de intervención para mitigar o compensar esta limitación es el uso de productos de apoyo para la movilidad, como sillas de ruedas tanto manuales como eléctricas, andadores, bastones, muletas, etc. Aunque los productos de apoyo son una estrategia habitual de intervención en personas con discapacidad, en ocasiones su uso es interrumpido o abandonado por no cubrir las necesidades del usuario o por falta de entrenamiento, entre otras causas. Pacientes y métodos. La muestra del análisis está formada por 80 usuarios de productos de apoyo para la movilidad, de los cuales 14 abandonaron o interrumpieron el uso del producto de apoyo. Las variables del estudio incluyen la escala Psychosocial Impact of Assistive Devices Scale (PIADS) como medida de resultados, además de variables sociodemográficas específicas de la muestra y del producto de apoyo empleado. Resultados. Se obtienen valores significativos en las tres subescalas de la PIADS. Un 50% de los productos de apoyo abandonados corresponde a personas con diagnóstico de ictus. Conclusiones. La PIADS puede ser una herramienta adecuada para evaluar el posible abandono o la falta de uso de los productos de apoyo. Aunque los productos de apoyo son una correcta estrategia de intervención para mitigar las limitaciones en la movilidad, algunos usuarios abandonan o interrumpen su uso por diferentes factores. Es necesario realizar más estudios longitudinales para evitar esta limitación en el uso de productos de apoyo.

Purpose: This study was aimed at assessing a smartphone-based intervention to help 11 individuals with moderate Alzheimer's disease and ambulation problems to manage goal-directed, walker-assisted ambulation and object use (i.e., to reach specific destinations and put away objects at those destinations independently).Method: The study was carried out according to a non-concurrent multiple baseline design across participants. Two measures were recorded, that is, the number of target responses performed correctly (with each target response consisting of reaching a destination and putting away an object), and the number of observation intervals with indices of enjoyment/appreciation (e.g., smiles and positive comments). During baseline, the participants were provided with a walker and three objects that were to be transported to and put away at specific destinations. During the intervention, the participants also had the smartphone-based technology that provided them with instructions about the destinations and objects, praise, and preferred stimulation.Results: During baseline, the mean frequency of correct target responses was virtually zero. The mean frequency of intervals with indices of enjoyment/appreciation ranged from zero to close to one. During the intervention, the mean frequencies for the two measures were slightly below three and just over three, respectively. The maximum frequencies possible were three and four, respectively.Conclusions: A smartphone-based intervention may be suitable to foster goal-directed, walker-assisted ambulation and object use as well as enjoyment/appreciation in participants like those involved in this study.IMPLICATIONS FOR REHABILITATIONA smartphone-based intervention may be used to promote goal-directed, walker-assisted ambulation and object use as well as indices of enjoyment/appreciation in persons with moderate Alzheimer disease.The technology for such intervention might involve (a) a smartphone with Android operating system, light sensor, Bluetooth v4.0, and MacroDroid, (b) Bluetooth headphones or earpieces, and (c) battery-powered light sources.The technology may provide the participants with instructions about the destinations to reach and the objects to put away at those destinations, and with praise and brief periods of preferred stimulation at the target destinations.The technology may be considered easy to access, friendly for the participants, and suitable for use by staff within daily contexts.

Here we present a study of two new Assistive Technology (AT) accessible digital assessments which were developed to address the current paucity of (English) spoken language comprehension assessments accessible to individuals who are both non-verbal and have profound motor impairments. Such individuals may rely heavily upon AT for communication and control. However, many assessments require that responses are given either verbally, by physical pointing or manipulating physical objects. A further problem with many assessments is their reliance upon static images to represent language components involving temporal, spatial or movement concepts. These new assessments aim to address some of these issues.The assessments were used with 2 young people who are non-verbal and have profound motor impairments (GMFCS level IV/V) and who use eye gaze as their primary method of communication and access. One assessment uses static images and the other short video clips to represent concepts containing temporal, spatial or movement elements. The assessments were carried out with each participant, both before and after an intervention, as part of a larger study.The assessments were accessible using AT (eye gaze) for both participants, although assessment scores varied. The design of the assessments particularly suited one participant who scored near maximum, but they appeared less suitable for the other participant.Making assessments AT accessible removes a barrier to assessing aspects of the spoken language comprehension abilities of some. Video may be a better medium for representing certain concepts within assessments compared with static images.IMPLICATIONS FOR REHABILITATIONThe new assessments provided a deeper understanding of two members of a group who are traditionally difficult to assess, using two alternative physically accessible methods of assessing the spoken language comprehension of the target group;Accessible assessments are important for assessing complex individuals in order to identify knowledge limitations and set therapy (and education) goals;The alternative access features of communication software can provide a "wrapper" for providing accessibility features to assessments;Video clips may be a better means of representing certain concepts in assessments compared to their static equivalents;Ensuring that assessments are physically accessible is sufficient for the assessment of some individuals, but for some "cognitive" accessibility also needs to be considered.

Traumatic brain injury in childhood (TBI) is a chronic health condition. As decreased memory, language, and rapid psychomotor impairments are known to accompany pediatric TBI (Babikian et al., 2011), students who have experienced a moderate-to-severe TBI are at particular risk for academic deficits, including writing difficulties. The purpose of this study was to measure the effects of a speech-to-text assistive technology (AT) accommodation that was implemented to bypass the impaired handwriting and spelling (i.e., transcription) skills resulting from TBI. Three African American male students (Grades 4, 8, and 9) who received formal special education services under the category of TBI participated in this study. With the application of the speech-to-text AT accommodation, all participants' total words written (TWW), words spelled correctly (WSC), and correct writing sequences (CWS) significantly increased compared to the handwriting control condition. One hundred percent nonoverlapping data points across participants and dependent variables was achieved. Implications of the findings for the school-based treatment of TBI, study limitations, and future avenues of study are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Objectives: People with motor neurone disease (pwMND) experience communication impairments due to speech and motor dysfunction. Communication support in the form of Augmentative and Alternative Communication (AAC) in conjunction with Assistive Technology (AT) access methods are available, however, variation in provision care pathways exists across Scotland. We conducted a baseline study of communication support for pwMND in Scotland to inform and improve future service provision. Methods: A cross-sectional population-based study was undertaken. Anonymised demographic and clinical phenotypic data for all pwMND in Scotland were extracted from the Care Audit Research Evaluation of MND (CARE-MND) platform, the National MND Register for Scotland. Additional information for AT loans was provided by the third sector charitable organization MND Scotland (MNDS). Results: In total, 371 pwMND were included, 43% of all pwMND were recorded as having impaired speech (recent ALSFRS-R score assessment ≤3) and 69% had been referred to Speech and Language Therapist (SLT) services, although there was variation in referral time from diagnosis date. AAC equipment had been acquired by 17.3% of all pwMND; most commonly iPads and the LightwriterTM speech generating device. Conclusions: Our data highlight a high prevalence of speech impairment in pwMND irrespective of the subtype diagnosis. We therefore recommend standardized care pathways and earlier access to coordinated SLT and Occupational Therapist services to enable prospective and personalized decision making. Our findings further highlight the need for qualitative research to understand the preferences and impact of such interventions from the perspective of the user and their communication partners.

Introduction Traumatic brain injury (TBI) is a chronic medical condition with life-long consequences. Meal preparation is one of the most significant activities impacted by TBI even after more than 10 years post-trauma. However, substantial gaps exist in our understanding of how exactly it is affected. This study examines the perceived needs and difficulties regarding meal preparation in individuals with severe TBI living in the community. This is done in an effort to justify long-term community-based interventions offered to the TBI population with regard to a task involving many safety issues. Methods The study used a descriptive qualitative design where five adults (28-50 years old) living with a severe TBI (9-37 years post-injury) were interviewed. Data analysis was completed using an inductive method. Results Participants living alone were all involved in meal preparation to diverse levels. Only two participants lived with a family member. Six categories of perceived needs were identified, of which two emerged as priorities: (i) Need for recipes to be compatible with cognitive abilities, knowledge and energy level to optimise motivation and (ii) Need to adapt complexity of grocery shopping to cognitive abilities and knowledge. The main difficulty expressed by participants was to manage their motivation to cook when tired, as it tends to diminish and fade when the person is exhausted. Conclusion Many situations were considered difficult for our participants, which calls for adaptation of the tasks and of their environment. Considering these unmet needs in the interventions offered will help individualise follow-up and ultimately optimise the social integration of individuals living with severe TBI.

Objectives: Evaluation and characterization of hand function in patients with rheumatoid (RA) arthritis and, secondarily, identification of the use of adaptive equipments. Material and methods: Firstly, a written informed consent was obtained and then an anonymous questionnaire was filled by RA outpatients after observation at the rheumatology consultation with no other musculoskeletal or neuromuscular disorders that would determine major functional impairment of hand function. Sociodemographic and clinical variables were collected and the Cochin Hand Functional Scale (CHFS) was applied. Classical deformities of hand and/or wrist were observed and recorded by the attending physician. Results: A total of 79 patients were enrolled. In the overall sample, most patients were female A sample of 79 patients, mostly female (69.60%), with a mean age of 59.72 ± 11.77 years and with a mean diagnosis duration of 11.72 ± 8.29 years. The majority (73.40%) had at least one hand or wrist deformity, the most frequent being atrophy of the interosseous muscles followed by ulnar deviation of the metacarpophalangeal joints and piano key deformity of the wrist. The mean CHFS score was 17.94 ± 18.26 points with a minimum and maximum value recorded of 0 and 80 points, respectively. The presence of hand deformities, Health Assessment Questionnaire score (HAQ), hand pain and diagnosis duration were correlated with the CHFS score. Six patients had assistive devices and only in one case it was used to overcome hand’s functional impairment. Conclusions: Most patients presented at least one classic RA deformity after a mean diagnosis duration of approximately 12 years and under pharmacological treatment. Despite this, most patients scored significantly below CHFS maximum score, but only 18 reported no difficulty in any of the tasks mentioned in the scale. The fact that only a minority of these patients had assistive devices should alerts us to the need for a more thorough functional assessment and identification of needs among RA patients.

Assisting human locomotion with exoskeletons is challenging, largely due to the complexity of the neuromusculoskeletal system, the time-varying dynamics that accompany motor learning, and the uniqueness of every individual’s response to device assistance. Assistance strategies designed to keep the human “in-the-loop” can help overcome many of these challenges. The purpose of this study was to develop a human-in-the-loop assistance strategy that uses co-adaptive control to slowly and continuously respond to biomechanical changes thought to encode the user’s needs. Online measurements of muscle activity and joint kinematics were used to guide the evolution of an exoskeleton torque pattern based on the following heuristics: 1) muscle activity that acts cooperatively with the exoskeleton indicates the user wants more torque; 2) muscle activity that acts antagonistically to the exoskeleton indicates the user wants less torque; and 3) torque should stop increasing if the user is not adapting. We applied our controller to tethered, bilateral ankle exoskeletons worn by naive participants as they walked on a treadmill at 1.25 m $\cdot$ s−1 for 30 minutes. The evolved torque profiles reduced the root-mean-square of soleus muscle activity by 35±12% and metabolic rate by 22±8% compared to walking with the exoskeletons while they provided no torque. This was equivalent to a 9±12% reduction in metabolic rate when compared to normal walking. Furthermore, the algorithm was responsive to changes in each user’s coordination patterns. These results confirm the effectiveness of the controller and suggest a new approach to exoskeleton assistance aimed at fostering co-adaptation with the user. This technique might particularly benefit individuals with age-related muscle weakness.