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In this paper, we highlight examples of how AT may play a role in realizing each of the fundamental rights affirmed in the UNCRPD.We conducted an indicative literature search for relevant literature to each of the substantive articles of the CRPD.Assistive technology plays a critical role in achieving the rights affirmed by the Convention on the Rights of Persons with Disabilities.Ensuring adequate provision of AT by states parties is critical to the progressive realization of the rights of persons with disabilities and to fulfilling commitments made by states parties upon ratification of the CRPD.Implications for rehabilitationAssistive technology (AT) is critical to enable full participation of persons with disability in society and the achievement of rights affirmed by the Convention on the Rights of Persons with Disabilities.Governments and other key stakeholders should endeavour to improve access to AT through inclusive, evidence-informed programs and services.Advocacy is required to improve access to AT through universal health coverage.

To describe rates of postpartum sterilization and indications for unfulfilled requests when Medicaid policy is not a limiting factor.We conducted a single-institution, retrospective review. Women who requested postpartum tubal ligation after vaginal delivery from August 2015 to March 2019 were studied. Select demographic characteristics were compared between those who did and did not undergo the procedure. Reasons for why the procedure was cancelled, alternate contraceptive plans, and subsequent pregnancies were collected. Statistical analysis included the t test and chi-squared test, with p0.05 considered significant.A total of 4103 patients requested postpartum tubal ligation following vaginal delivery. About 3670 (89.4%) procedures were performed and 433 (10.6%) were canceled. Of the 433, 423 (98%) were not performed at patient request; 10 (2 %) were cancelled based on physician recommendation. Of these, 3 were due to significant maternal anemia in the setting of refusal of blood products, 1 due to anesthesia concerns, 1 for increased body mass index, and 1 due to delivery events. Alternative contraception methods were offered; 72 (28% of patients not receiving a tubal ligation) received Depo Provera prior to discharge. One-fourth (n = 110, 25.4%) did not keep the postpartum follow-up appointment. 83 (19.2%) of the 433 patients had at least one subsequent pregnancy. Although over half expressed interest at the time of discharge in long-acting reversible contraceptives, only 20% obtained this method at the postpartum visit.Postpartum sterilization was predominantly achieved, among women whose requests were unfulfilled, the majority (98%) were at patient request with a minority by physician recommendation.When the availability of postpartum tubal ligation is independent of Medicaid reimbursement and the hospital system and providers are organized to support timely access to permanent postpartum contraception, the majority of tubal ligations requests can be fulfilled following vaginal delivery.

Myeloma cells are highly dependent on the unfolded protein response to assemble folded immunoglobulins correctly. Therefore, targeting protein handling within a myeloma cell by inhibiting the aminopeptidase enzyme system, which catalyses the hydrolysis of amino acids from the proteins NH2 terminus, represents a therapeutic approach. CHR-2797, a novel aminopeptidase inhibitor, is able to inhibit proliferation and induce growth arrest and apoptosis in myeloma cells, including cells resistant to conventional chemotherapeutics. It causes minimal inhibition of bone marrow stromal cell (BMSC) proliferation but is able to overcome the microenvironmental protective effects, inhibiting the proliferation of myeloma cells bound to BMSCs and the increase in vascular endothelial growth factor levels seen when myeloma cells and BMSCs are bound together. Additive and synergistic effects are seen with bortezomib, melphalan, and dexamethasone. Apoptosis occurs via both caspase-dependent and non-caspase-dependent pathways with an increase in Noxa, cleavage of Mcl-1, and activation of the unfolded protein response. Autophagy is also seen. CHR-2797 causes an up-regulation of genes involved in the proteasome/ubiquitin pathway, as well as aminopeptidases, and amino acid deprivation response genes. In conclusion, inhibiting protein turnover using the aminopeptidase inhibitor CHR-2797 results in myeloma cell apoptosis and represents a novel therapeutic approach that warrants further investigation in the clinical setting. [Mol Cancer Ther 2009;8(4):762–70]

Supplementary Table from Aminopeptidase inhibition as a targeted treatment strategy in myeloma

Global population growth and increasing longevity means that the need for Assistive Technology (AT) will continue to increase. The level of unmet need for AT is greatest in low-income settings. The aim of this study is to identify age-related increase in impairment and to estimate the AT needs.We analysed secondary data from the 2018 Malawi Population and Housing Census (MPHC) based on the Washington Group on Disability Statistics (WG) short-set of questions.Out of the 1,556,670 persons with one or more functional limitations or disabilities identified in the census, self-reported difficulties in all domains were markedly higher from age 40 and above. The proportion reporting one functional limitation is higher compared to two or more limitations, but at age 78-80 the proportion reporting two or more functional limitations increased above those reporting one functional limitation. Although 60.9% (60.7-61.0) and 63.5% (63.3-63.6) of those who reported difficulty in seeing and hearing were using glasses and hearing aids respectively, the estimated total need for glasses and hearing aids in this group was 98.9% (98.0-99.0) and 98.4% (98.3-98.5) respectively. The unmet need for glasses and hearing aids were therefore 38.1% and 34.9% respectively.The differential slope of impairment curves against age is a guide to the increasing demand for AT across the life course and across different domains of functioning. Country specific analysis of impairment across age and domains is essential to understand and plan for the growing need for AT globally.IMPLICATIONS FOR REHABILITATIONIt is important to estimate and plan for impairment across life course to address the age-related increase in impairment and the increasing need for AT with age.The Zomba curves show the cumulative nature of impairment with age and the need for age and need specific provision of AT across the life course through proactive policy level actions.The significant high unmet need for glasses and hearing aids attests to similar need for other assistive products and the need for setting specific interventions to address needs of affected persons.The differential slope of impairment curves against age is a guide to the differing and increasing demand for assistive technology across the life course and across different domains of functioning.

Assistive technologies are critical to supporting the participation and engagement of persons with disabilities and others who experience functional difficulties in daily life. Assistive products have been demonstrated to be related to the achievement of the Sustainable Development Goals (SDGs); however, no previous research has explored the relationship between assistive technology (AT) and the SDGs from the perspective of stakeholder organisations working in the field of AT provision. In this study, we evaluated the relevance of AT and the SDGs to achieving the organisational missions of key stakeholders in AT ecosystem in Malawi. Key stakeholders (n = 36) in the AT field in Malawi were asked to rate the relevance of AT to achieving their organisational missions, and the relevance of AT to each of the 17 SDGs on a 5-point Likert scale. Stakeholders who participated were engaged in consultative meetings with the government and an action research team as part of a larger policy development project, and represented ministries and government agencies, organisations of persons with disabilities, and local and international non-governmental organisations. AT was rated as being relevant to all of the SDGs, albeit to varying degrees, and not surprisingly to achieving AT stakeholders' organisational missions. The cross-cutting nature of the relevance of AT underscores the importance of cross-ministerial cooperation and shared leadership in provision AT.

For many individuals who experience short- or long-term disability access to assistive products (APs) (e.g., glasses, communication aids, walking sticks) can improve quality of life by minimising or removing functional limitations and barriers to participation in society. However there is an estimated 1 billion people in need of APs globally and with aging populations this demand will continue to increase over time. Assistive technology (AT), which includes different types of APs and may incorporate various aspects of assistive technology systems (ATS), is delivered in diverse contexts, with differing resources, needs and capacity. This chapter will outline how use of a systems thinking approach for AT can address the complexity of how APs are perceived, designed, produced, manufactured, distributed, serviced, and financed, and may help in achieving greater access to APs for those who need them.

The gut microbiome plays an important role in autoimmunity including multiple sclerosis and its mouse model called experimental autoimmune encephalomyelitis (EAE). The gut-brain axis refers to the complex interactions between the gut microbiota and the nervous and immune systems linking brain and gut functions. Prior studies have demonstrated that the multiple sclerosis gut microbiota can contribute to disease hence making it a potential therapeutic target. Other studies have reported that long-term antibiotic therapy in multiple sclerosis patients reduces relapse rate and gadolinium enhancing lesions as well as improves measures of disability. In addition, antibiotic treatment has been shown to ameliorate disease in the EAE mouse model of multiple sclerosis. Yet, to this date, the mechanisms mediating these antibiotics effects are not understood. Furthermore, there is no consensus on the gut derived bacterial strains that drive neuroinflammation in multiple sclerosis. Hence, it remains unclear how the gut microbiota can be targeted for therapeutic purposes in multiple sclerosis patients. Here we characterized the gut microbiome of untreated and vancomycin treated EAE mice over time to identify bacteria with neuroimmunomodulatory potential. We observed alterations in the gut microbiota composition following EAE induction. We found that vancomycin treatment ameliorates EAE and that this protective effect is mediated via the microbiota. Notably, we observed increase abundance of bacteria known to be strong inducers of regulatory T cells including members of Clostridium clusters XIVa and XVIII in vancomycin-treated mice during the presymptomatic phase of EAE as well as at disease peak. We identified 50 bacterial taxa that correlate with EAE severity. Interestingly, several of these taxa exist in the human gut and some of them have been implicated in multiple sclerosis including Anaerotruncus colihominis which had a positive correlation with disease severity. Unexpectedly, we found that Anaerotruncus colihominis ameliorates EAE and this is associated with induction of RORγt+ regulatory T cells in the mesenteric lymph nodes. Together, our results identify vancomycin as a potent modulator of the gut-brain axis by promoting the proliferation of bacterial species that induce regulatory T cells. In addition, our findings reveal 50 gut commensals as regulator of the gut-brain axis that can be used to further characterize pathogenic and beneficial host-microbiota interactions in multiple sclerosis patients. Our findings suggest that elevated Anaerotruncus colihominis in multiple sclerosis patients may represent a protective mechanism associated with recovery from the disease.

Background. Occupational Therapists, among other healthcare decision makers, often need to make decisions within limited timeframes and cannot wait for the completion of large rigorous systematic reviews and meta-analyses. Rapid reviews are one method to increase the integration of research evidence into clinical decision making. Rapid reviews streamline the systematic review process to allow for the timely synthesis of evidence; however, there does not exist a single agreed upon guide for the methodology and reporting of rapid reviews. Purpose. This paper proposes a rapid review methodology that is customized to a professional organization practice which can feasibly be used by practice networks such as those of the Canadian Association for Occupational Therapy to conduct reviews. Implications. Practice networks provide a sustainable mechanism to integrate research evidence and foster communication amongst practitioners. This guide for conducting and reporting rapid reviews can be used across Occupational Therapy practice networks and similar groups to support the consistent and timely synthesis of evidence necessary to improve evidence-informed clinical decision making.

Powered wheelchairs promote participation for people with mobility limitations. For older adults with cognitive impairment, existing training methods may not address learning needs, leading to difficulty with powered wheelchair skills. Error-minimized training, facilitated by shared control technology, may provide learning opportunities more suited to this population.The objective of this study was to evaluate the feasibility of an error-minimized approach to powered wheelchair skills training using shared control in residential care. Feasibility indicators were hypothesized a priori to be feasible for use in a definitive RCT.A 2 × 2 factorial RCT compared an error-minimized powered wheelchair skills training program (Co-pilot) to a control intervention at two doses (6 sessions vs. 12 sessions). Data were collected on the feasibility of study processes (e.g., recruitment), resources (e.g., participant time), management (e.g., technology reliability), and training outcomes (e.g., adverse events, clinical outcomes).Twenty-five older adults with cognitive impairment participated in the study. Technical issues were encountered in 14.5% of training sessions. Participants receiving 6 sessions of training adhered better to the treatment than those receiving 12 sessions. All participants learned the skills required for PWC use with minor errors, regardless of the training method or dose. Co-pilot participants and trainers reported feelings of safety and training benefits with the use of shared control technology.Individuals with mild to moderate cognitive impairment are able to learn the skills required to drive a powered wheelchair in as few as six training sessions. Further evaluation of the Co-pilot training program is required.IMPLICATIONS FOR REHABILITATIONShared control teleoperation technology may be used to augment learning in older adults with cognitive impairments.Evaluation of the feasibility of use of novel rehabilitation technologies is critical prior to engaging in large-scale clinical research.Individuals with cognitive impairment are able to learn the required skills for operation of a powered wheelchair.

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.

Background Assistive technologies promote participation and quality of life for people with disabilities and other functional limitations. There is a global call to develop and implement policies to improve access to assistive technologies. In response, a stakeholder led initiative in Malawi is working towards the development of such a policy. The objective of this study was to assess the existing network of stakeholders, and the strength of relationship between organizations who deliver assistive products and related services. We conducted a survey-based network analysis of assistive technology stakeholder organizations in Malawi.Results Stakeholders (n = 19) reported a range of connections, from no awareness to collaboration with organizations within the assistive technology network. No single organization or government ministry was most central to the network. International NGOs were less central to the network than local organizations for disabled people, service providers, and ministries.Conclusions The assistive technology stakeholder network in Malawi is distributed, with a range of responsibility across a variety of stakeholders, including three government ministries. An effective assistive technology policy must engage all stakeholders and may benefit from a collective leadership approach that spans the inter-sectoral need for a cohesive assistive technology system.

Powered wheelchair use promotes participation in individuals with limited mobility, however training is required for safe and effective use. There is limited evidence on the task demands of powered wheelchair use to inform an evidence-based skills training programme.To conduct a systematic exploration of the task demands of indoor powered wheelchair use to identify frequently used skills, abilities, and knowledge.We used a two-phased think aloud process to conduct a task analysis of powered wheelchair use with experienced powered wheelchair users (One-hundred and ten (110) distinct skills and abilities were identified and mapped to the ICF; 80 in the Body Structures and Functions domain, and 30 in the Activities and Participation domain. Approximately 50% of skills and abilities were mental functions. Four thematic knowledge domains were identified: knowledge of self, environment, wheelchair, and task.Powered wheelchair use is complex and requires a variety of skills and abilities from all areas of human functioning, in addition to a wide range of knowledge. Training programmes should address a range of areas of skill development.IMPLICATIONS FOR REHABILITATIONPowered wheelchair use is a complex skill; training should develop skills from all.Domains of the ICF, including mental and physical functions.A range of knowledge is used while operating a powered wheelchair; training programs.Should include the development and application of necessary knowledge.Clinicians may consider a range of factors when assessing suitability for powered.Wheelchair user, however should acknowledge that while the range of skills idenotified.May be useful, they may not be critical for success in powered wheelchair use.

Participation in sports is a fundamental right for persons with disabilities and is facilitated by the use of specialized Assistive Technology (AT). However, little is known about the role every-day AT plays in promoting sport participation. This study explores how the 50 priority assistive products on the World Health Organization’s Assistive Products List can promote participation in sports, using a mixed-methods online survey with AT users, caregivers, and coaches (n=96). We used a thematic analysis for qualitative responses describing the use of assistive products in facilitating sport participation. Results suggest every-day assistive products are required for participation in sport for persons with disabilities. We present a conceptual model of assistive product use for sport participation. We found persons with disability participate in a range of sports, contributing to community engagement. Access to every-day assistive products is therefore integral to achieving rights of persons with disabilities for participation in sport.

Background: Global participation at the Paralympic Games has been steadily growing in the past 60 years. However, inequities in relation to geographic representation of Paralympians, sex representation, access to assistive technology and medal success remain. Understanding the relationship between these determinants is important to inform strategies to increase future participation from everywhere, and promote a level playing field. The objectives of this research are to describe and compare trends in Paralympians’ participation in the summer Paralympic Games by income level and sex, trends in participation in events requiring assistive products (wheelchairs, hand cycles/trikes, and prostheses) by income level, and medal achievement by income level in all sport events, and events requiring assistive technology. Methods: A retrospective secondary analysis of publicly available data was conducted. Participation, sex, and medal tally data were extracted from data available on the International Paralympic Committee website and archives. Data regarding income (income level, GDP) and population were collected from publicly available data available from the World Bank website. Findings: Participation in the Summer Paralympic Games differs significantly by income level (p=0.000) with high- income countries sending, on average, more Paralympians than low-and middle-income countries. There is a significant difference between male and female participation (p=0.00), with approximately 29% of all Paralympians being female. High income countries demonstrate significantly higher achievement than low-and middle-income countries (p=0.000), including in events requiring assistive products (p=0.007). Interpretation: Despite growth in overall participation, low- and middle-income countries remain severely underrepresented in both participation and achievement at the Paralympic Games, especially in the events that require high quality assistive products to succeed. Funding: None to declare. Declaration of Interest: None to declare.

Cognition is an important factor affecting power mobility device (PMD) use. However, a gap in knowledge on the role of cognition in PMD use limits evidence of best practices for screening, assessment, and training. The overall goal of this research activity was to identify strategic research priorities to delineate the next steps in research. Following the Collaborative Prioritized Planning Process (CP3), a 1.5-day meeting was held with an interdisciplinary and international team of assistive technology users, clinicians, service providers, and researchers with expertise in PMD use and cognition. Our four-stage process included: knowledge synthesis; identification and prioritization of challenges; identification, consolidation, and prioritization of solutions; and action planning. Five of 14 challenges for research on cognition and PMD use were prioritized, and five solutions (of the 100 generated) perceived to be the most impactful were selected as the focus for the remainder of the meeting. The resulting prioritized solutions included, improving knowledge translation of existing and new evidence, profiling and addressing individualized needs, creating and evaluating training tools, development of practice guidelines, and validating and developing evaluation tools or toolkit. Preliminary action planning facilitated discussion of potential future projects, initiated new research collaborations and partnerships, and provided a foundation to build a program of research for investigating the role of cognition in PMD use.

Empirical research and data are necessary for policy, planning and provision of services for persons with disabilities. Research data may be available but still not used by researchers and policy makers. The aim of this study is to explore existing empirical research and sources of data on Assistive Technology (AT) in Malawi in order to facilitate the development of an AT policy and Assistive Product List (APL). A two-stage process using a scoping review methodology was adopted to identify (1) empirical research on AT in Malawi and (2) sources of existing data on AT in Malawi. Following a narrative synthesis, 12 heterogenous studies that reported on the use, availability, sources and knowledge about AT in Malawi were identified. Identified studies suggest that there is high unmet need for AT and services in Malawi. Five major sources of data on disability and AT were Identified. Only 2 out of the 12 studies had used existing sources of data. The high unmet need for AT and services in Malawi have substantial implications for persons with disabilities. Developing mechanisms that will improve the use of existing data on AT in all countries is pivotal for the efficient and effective development of AT ecosystems.

Assistive technology is a critical component of maintaining health, wellbeing, and the realization of rights for persons with disabilities. Assistive technologies, and their associated services, are also paramount to ensuring individuals with functional limitations have access to important health and social service information, particularly during a pandemic where they may be at higher risk than the general population. Social isolation and physical distancing have further marginalized many within this population. We have an opportunity to learn from the COVID-19 response to develop more inclusive and resilient systems that will serve people with disabilities more effectively in the future. In this Current Issues piece, we present a starting point for discussion, based on our experiences working to promote access to assistive technologies through inclusive and sustainable systems and policies.

Background: Assistive technology is the products and services used by individuals with functional limitations to enable participation in society and realisation of rights afforded by the United Nations Convention on the Rights of Persons with Disabilities. The Assistive Product List is a comprehensive list of products identified as essential for access through universal health coverage. Key stakeholders, including organisations of persons with disabilities, civil service organisations, academic organisations and government ministries are collaborating to integrate assistive technology into policy and develop a priority assistive products list for Malawi. Objective: To understand the organisational characteristics of, and assistive products provided by, key stakeholders working in AT in Malawi. Study Design: Online survey of representatives from key stakeholder organisations. Methods: We surveyed representatives of key stakeholder organisations to gather information regarding assistive technology product and service provision in Malawi. Responses were analysed using counts for closed-ended questions, and conventional content analysis for open-ended questions. Results: A total of 36 of the 50 APL products were provided by eight organisations. Related services were provided for 36 of the 50 APL products by twelve organisations. Five organisations reported providing both products and services. Products and services are largely funded by donation and provided free to those who require them. Conclusion: A range of organisations in Malawi play a role in assistive product delivery and related services. Coordinated AP delivery and service provision is required at a national level which is sustainable and inclusive, and is based on identified needs of the Malawian population. Implications for rehabilitation: *Policies supporting assistive product and service provision must acknowledge the contextual needs of the communities where they are implemented. * Coordination is required for assistive product and service provision at the national and subnational level. * Existing and potential gaps in service provision must be addressed when implementing a national assistive products list.

Background Equity and inclusion are important principles in policy development and implementation. The aim of this study is to explore the extent to which equity and inclusion were considered in the development of Malawi’s National Disability Mainstreaming Strategy and Implementation Plan. Methods We applied an analytical methodology to review the Malawi’s National Disability Mainstreaming Strategy and Implementation Plan using the EquIPP (Equity and Inclusion in Policy Processes) tool. The EquIPP tool assesses 17 Key Actions to explore the extent of equity and inclusion. Results The development of the Malawi National Disability Mainstreaming Strategy and Implementation Plan was informed by a desire to promote the rights, opportunities and wellbeing of persons with disability in Malawi. The majority (58%) of the Key Actions received a rating of three, indicating evidence of clear, but incomplete or only partial engagement of persons with disabilities in the policy process. Three (18%) of the Key Actions received a rating of four indicating that all reasonable steps to engage in the policy development process were observed. Four (23%) of the Key Actions received a score five indicating a reference to Key Action in the core documents in the policy development process. Conclusions The development of disability policies and associated implementation strategies requires equitable and inclusive processes that consider input from all stakeholders especially those whose wellbeing depend on such policies. It is pivotal for government and organisations in the process of policy or strategy development and implementation, to involve stakeholders in a virtuous process of co-production – co-implementation – co-evaluation, which may strengthen both the sense of inclusion and the effectiveness of the policy life-cycle.

IntroductionAssistive technology (AT) is important for the achievement of the sustainable development goals (SDGs) for persons with disabilities (PWD). Increasingly, studies suggest a significant gap between the need for and demand for and provisions of AT for PWD in low-income and middle-income settings. Evidence from high income countries highlights the importance of robust AT policies to the achievement of the recommendations of the World Health Assembly on AT. In Malawi, there is no standalone AT policy. The objectives of the Assistive Product List Implementation Creating Enablement of inclusive SDGs (APPLICABLE) project, are to propose and facilitate the development of a framework for creating effective national AT policy and specify a system capable of implementing such policies in low-income countries such as Malawi.Method and analysisWe propose an action research process with stakeholders in AT in Malawi. APPLICABLE will adopt an action research paradigm, through developing a shared research agenda with stakeholders and including users of AT. This involves the formation of an Action Research Group that will specify the priorities for practice—and policy-based evidence, in order to facilitate the development of contextually realistic and achievable policy aspirations on AT in Malawi and provide system strengthening recommendations that will ensure that the policy is implementable for their realisation. We will undertake an evaluation of this policy by measuring supply and support for specific AT prior to, and following the implementation of the policy recommendations.Ethics and disseminationThe study protocol was approved by Maynooth University Research Ethics Committee (SRESC-2019-2378566) and University of Malawi Research Ethics Committee (P.01/20/10). Findings from the study will be disseminated by publication in peer-reviewed journals, presentations to stakeholders in Malawi, Ireland and international audiences at international conferences.

Diamond-Blackfan anemia (DBA) is an inherited bone marrow failure disorder in which pure red blood cell aplasia is associated with physical malformations and a predisposition to cancer. Twentyfive percent of patients with DBA have mutations in a gene encoding ribosomal protein S19 (RPS19). Our previous proof-of-concept studies demonstrated that DBA phenotype could be successfully treated using lentiviral vectors in Rps19-deficient DBA mice. In our present study, we developed a clinically applicable single gene, self-inactivating lentiviral vector, containing the human RPS19 cDNA driven by the human elongation factor 1a short promoter, which can be used for clinical gene therapy development for RPS19-deficient DBA. We examined the efficacy and safety of the vector in a Rps19-deficient DBA mouse model and in human primary RPS19-deficient CD34+ cord blood cells. We observed that transduced Rps19-deficient bone marrow cells could reconstitute mice long-term and rescue the bone marrow failure and severe anemia observed in Rps19-deficient mice, with a low risk of mutagenesis and a highly polyclonal insertion site pattern. More importantly, the vector can also rescue impaired erythroid differentiation in human primary RPS19-deficient CD34+ cord blood hematopoietic stem cells. Collectively, our results demonstrate the efficacy and safety of using a clinically applicable lentiviral vector for the successful treatment of Rps19-deficient DBA in a mouse model and in human primary CD34+ cord blood cells. These findings show that this vector can be used to develop clinical gene therapy for RPS19-deficient DBA patients.

OBJECTIVE To evaluate the association of increasing body mass index (BMI) on postpartum tubal ligation safety and estimate the rates of procedure complication. METHODS We conducted a single-institution, retrospective review. Women undergoing postpartum permanent contraception after vaginal delivery from August 2015 to March 2019 were studied. Our primary outcome included a composite morbidity of intraoperative complications (bleeding requiring additional surgery, and extension of incision), blood transfusion, aborted procedure, anesthetic complication, readmission, wound infection, venous thromboembolism, ileus or small bowel obstruction, incomplete transection, and subsequent pregnancy. Statistical analysis included t test, χ test, and Wilcoxon rank-sum test, with P

Around the world, variations and inequities in access to assistive technology (AT) are evident. Development of legislation, policies, and programmes has not kept pace with the increasing demand for AT. Therefore, context-specific needs assessment is required, which can assist in anticipating the accessibility and human support needs of individuals with impairments, and in turn, inform resource allocation and prioritisation of services. The purpose of this cross-sectional study was to describe the current use and unmet needs of AT use in community-dwelling Canadians experiencing activity limitation or participation restriction (disability).Bootstrapping was used to estimate the prevalence of AT use and unmet needs using data from the 2012 Canadian Survey on Disability (CSD). The total sample size for the CSD was 45,443 individuals.Among the estimated 3,775,920 Canadians with a disability (13.7% of the Canadian population), 3,579,580 used some form of AT. Among these individuals, 3,050,750 use glasses or contact lenses and 1,109,060 use bathroom aids. The results of the study showed that the most common unmet need was for hearing aids (0.86% of the total population), followed by bathroom aids (0.36%).This study comes at a time when global attention is focussed on research on access to AT. This study using data from the CSD will serve disability and social policy analysts at all levels of government, as well as associations for persons with disabilities and researchers working in the field of disability policy and programmes.Implication for RehabilitationThe current initiatives on assistive technology, including the World Health Organization's Global Cooperation on Assistive Technology (GATE) project, recognize the substantial gap between the need for and provision of assistive devices. In Canada, for example, as well as in other countries, despite rapid growth in innovation, unmet needs for assistive devices persist and multiple barriers have been reported by individuals in accessing needed assistive devices. A better understanding of the met and unmet needs of assistive technology users can assist in anticipating accessibility and human support needs of individuals with disabilities, and in turn, inform resource allocation and prioritization of services. • The study estimates the prevalence of assistive device use in community dwelling Canadians and describes the unmet needs for assistive devices of Canadians with activity limitation (disability).• This study provides evidence on the use and unmet assistive technology needs for disability and social policy analysts at all levels of government, as well as associations for persons with disabilities and researchers working in the field of disability policy and programmes.• The results of this study can be used for planning and evaluating services, programmes and policies for Canadian adults with disabilities to help enable their full participation in society.

Importance: Powered wheelchairs provide independence for people with mobility impairments; however, current training practices may not meet the needs of those with cognitive impairments. Shared-control teleoperation may have utility in a clinical setting when developing training suited to this population. Objective: To explore the clinical utility of a shared-control teleoperation device for powered wheelchair assessment and training. Design: In this qualitative study, we used two sequential semistructured interviews conducted a minimum of 2 wk apart. Thematic analyses were used with member checking, reflexive journaling, and triangulation of researchers to establish trustworthiness of the data. Setting: Rehabilitation center and residential care and community settings. Participants: Using purposive sampling, we recruited occupational therapists and physical therapists who were mostly female and who had a range of practice experience. Results: Fifteen participants were interviewed, and two primary themes were identified: (1) “A big enabler” described how shared control provides opportunities to train people who may otherwise be denied powered mobility, and (2) “changing the learner experience” described how shared control may promote success in skill development through an alternative learning experience. Conclusions and Relevance: Shared-control technology may have the potential to broaden the scope of therapeutic intervention by reducing risk to the driver and others in the environment and by facilitating alternative training approaches. What This Article Adds: Technological advances that allow more control over a powered wheelchair by a clinician, known as shared control, may provide learning opportunities for people who are otherwise denied access to powered mobility. Shared control may also allow the use of new instructional techniques, increase safety in the training process, and reduce anxiety associated with learning.

To address the data gap on efforts to assess use of assistive technology among children with disability in sub-Saharan Africa. Contribute towards efforts examining access to assistive technologies in sub-Saharan Africa.The paper uses data from the 2017 survey on Living conditions among persons with disabilities in Malawi and the 2015-16 Malawi Demographic and Health survey to address the objective of the study. The two datasets were statistically matched through random hot deck technique, by integrating the two datasets using randomly selected units from a subset of all available data donors.Results indicate that statistical matching technique produces a composite dataset with an uncertainty value of 2.2%. An accuracy assessment test of the technique also indicates that the marginal distribution of use of assistive technology in the composite dataset is similar to that of the donor dataset with an Overlap index value of close to 1 (Overlap = 0.997).The statistical matching procedure does enable generation of good data in data constrained contexts. In the current study, this approach enabled measurement of access to assistive products among children with disabilities, in situations where the variables of interest have not been jointly observed. Such a technique can be valuable in mining secondary data, the collection of which may have been funded from different sources and for different purposes. This is of significance for the efficient use of current and future data sets, allowing new questions to be asked and addressed by locally based researchers in poor settings.Implications for RehabilitationIn resource-poor settings, the technique of statistical matching can be used to examine factors that predict the use of assistive technology among persons with disabilities.The statistical matching technique is of significance for the efficient use of current and future datasets, allowing new questions to be asked and addressed by locally based researchers.

Background Mobility limitations represent the third most prevalent cause of disability, affecting more than 1.9 million community-dwelling Canadians. Walking aids are often prescribed to reduce the impacts of mobility impairments. There are limited data on walking aids since 2004. Objective The objectives of this study were to investigate the prevalence of walking aid use in Canada and to explore demographic characteristics among users of walking aids. Design The design used was a secondary analysis of a cross-sectional national survey. Methods Data were obtained from the 2012 Canadian Survey on Disability from community-dwelling individuals who were 15 years old or older, had a self-identified activity limitation, and indicated that they used at least 1 walking aid (cane/walking stick/crutches or walker). Prevalence estimates were calculated as weighted frequencies. Analytic variables included walking aid type, sex, age, province/territory of residence, and main cause of activity limitation. Results Approximately 1,125,000 community-dwelling individuals who were 15 years old or older used walking aids, representing 4.1% of the Canadian population. Of these individuals, 962,290 used canes/walking sticks/crutches, and 465,340 used a walker. Users of walking aids were predominantly female, with a mean age of 68 years. Limitations Self-reported results reflect only the perceptions of individuals living in Canadian communities. Analyses excluded individuals in residential or long-term care settings and individuals living on First Nations reserves. Conclusions Since 2004, there has been a 2% increase in the prevalence of walking aid use by the Canadian population, which is likely related to the aging of the population. The high prevalence of walking aid use highlights the need for better use of existing resources to ensure that individuals are receiving the correct devices. Results of this study suggest a need to evaluate the impact of device use to better understand how resources should be allocated for prescription and maintenance of walking aids and training of users.

The aim of this study was to evaluate the internal consistency, test-retest reliability and responsiveness of the Self-Efficacy in Assessing, Training and Spotting manual wheelchair skills (SEATS-M) and Self-Efficacy in Assessing, Training and Spotting power wheelchair skills (SEATS-P).A 2-week test-retest design was used with a convenience sample of occupational and physical therapists who worked at a provincial rehabilitation centre (inpatient and outpatient services). Sixteen participants completed the SEATS-M and 18 participants completed the SEATS-P.For the SEATS-M assessment, training, spotting and documentation sections, Cronbach's alpha coefficients ranged from 0.90 to 0.97, the 2-week intraclass correlation coefficients (ICCThere is preliminary evidence that both the SEATS-M and the SEATS-P have high internal consistency, good test-retest reliability and support for responsiveness. These tools can be used in evaluating clinician self-efficacy with assessing, training, spotting and documenting wheelchair skills included on the Wheelchair Skills Test. Implications for Rehabilitation There is preliminary evidence that the SEATS-M and SEATS-P are reliable and responsive outcome measures that can be used to evaluate the self-efficacy of clinicians to administer the Wheelchair Skills Program. Measurement of clinicians' self-efficacy in this area of practice may enable an enhanced understanding of the areas in which clinicians lack self-efficacy, thereby informing the development of improved knowledge translation interventions.

We are witnessing growth and maturation in the field of assistive technology (AT), fueled by increasing global awareness of the role of AT in facilitating access to rights of persons with disabilit...

To determine if older adult, novice wheelchair users who drive a power wheelchair with a JoyBar control complete maneuverability tasks in less time and with less error than those who drive a power wheelchair with a standard joystick control.A parallel randomized controlled trial design conducted at a medical rehabilitation and research centre with ambulatory older adults aged 60 and above (n = 27). The intervention was the JoyBar alternative wheelchair control. The primary outcome measure was total time to complete each of the two maneuverability tasks. The secondary outcome measure was total number of errors during each of the maneuverability tasks.An independent, two sampled t-test was conducted and revealed that the JoyBar group took a greater amount of time to complete both maneuverability tasks than the control group (p .05). No significant differences (p .05) were found in rates of error on either task between the JoyBar and joystick groups.Maneuverability of a powered wheelchair by novice wheelchair users was not improved through the use of the JoyBar when compared to a standard wheelchair joystick, as measured by rates of error and time to complete maneuverability tasks. Implications for rehabilitation Clients who are new to powered wheelchair use may perform maneuverability tasks faster, with equivalent accuracy, using a standard joystick versus the JoyBar. Clients who use a JoyBar may require adjustments to the programming of their wheelchair to ensure optimal performance. Additional training may be required to achieve proficiency in maneuverability tasks with a JoyBar versus a standard joystick.

Objectives: To determine the influence of a bootcamp training approach on students’ self-efficacy for assessing, training, spotting, documenting, and performing manual and power wheelchair skills.M...

Background. Powered-wheelchair use improves participation for people with mobility limitations; however, many individuals do not receive powered-wheelchair skills training that meets their learning needs. Purpose. The aim of this work is to evaluate the feasibility of a powered-wheelchair training program for older adults with cognitive impairment, using errorless learning strategies facilitated by shared control technology. Method. A feasibility 2 × 2 factorial randomized controlled trial will recruit 32 older adults in residential care with mild to moderate cognitive impairment who are new powered-wheelchair use. The intervention consists of six or 12 training sessions, facilitated by shared control technology, using errorless learning techniques. Control participants will receive six or 12 training sessions using trial-and-error methods. Feasibility and clinical outcomes data (primary outcome: powered-wheelchair skills) will be collected. Implications. Errorless learning facilitated by shared control technology may be an alternative to meet the powered-wheelchair learning needs of older adults with cognitive impairments.

This paper aims to address the information gap on the influence of socio-demographic factors on access and utilization of Assistive Technology (AT) among children with disabilities in Malawi. Thus, it contributes towards the realization of the recommendations of the UN Convention on the Rights of Persons with disabilities and the development of a framework for creating an effective national AT policy. The paper used two statistically matched datasets, namely, the 2017 survey on Living conditions among persons with disabilities in Malawi and the 2015-16 Malawi Demographic and Health survey. Logistic regression and structural equation modeling techniques were utilized to assess the influence of socio-demographic factors on the use of AT among children with disabilities. The results indicate that there is a high level of unmet need for AT among young children aged 2 to 9 and those living in urban areas. The results further indicate that children with multiple disabilities have lower odds (OR = 0.924) of using AT for personal mobility compared to children with a single functional difficulty. These results entail that AT needs for children with multiple disabilities are not adequately addressed. Therefore, when developing policies on AT, younger children and those with multiple disabilities need to be specifically targeted.

Background Mobility impairments are the third leading cause of disability for community-dwelling Canadians. Wheelchairs and scooters help compensate for these challenges. There are limited data within the last decade estimating the prevalence of wheelchair and scooter use in Canada. Objective The aims of this study were: (1) to estimate the prevalence of wheelchair and scooter use in Canada and (2) to explore relevant demographic characteristics of wheelchair and scooter users. Design This study was a secondary analysis of a cross-sectional national survey. Methods The Canadian Survey on Disability (2012) collected data on wheelchair and scooter use from community-dwelling individuals aged 15 years and over with a self-identified activity limitation on the National Household Survey. Prevalence estimates were calculated as weighted frequencies, with cross-tabulations to determine the number of wheelchair and scooter users in Canada, by province, and demographic characteristics (ie, age, sex) and bootstrapping to estimate the variance of all point estimates. Results There were approximately 288,800 community-dwelling wheelchair and scooter users aged 15 years and over, representing 1.0% of the Canadian population. The sample included 197,560 manual wheelchair users, 42,360 powered wheelchair users, and 108,550 scooter users. Wheelchair and scooter users were predominantly women, with a mean age of 65 years. Approximately 50,620 individuals used a combination of 2 different types of devices. Limitations The results are representative of individuals living in the community in Canada and exclude individuals in residential or group-based settings; estimates do not represent the true population prevalence. Conclusion This analysis is the first in more than 10 years to provide a prevalence estimate and description of wheelchair and scooter users in Canada. Since 2004, there has been an increase in the proportion of the population who use wheelchairs and scooters, likely related to an aging Canadian population. These new prevalence data have potential to inform policy, research, and clinical practice.

PRISMA guided systematic review. To summarize and characterize the literature pertaining to the nature of and factors associated with caregiving services provided to individuals with spinal cord injury (SCI) and identify areas for interventional research to address the needs of care recipients. PUBMED/Medline, CINAHL, PsycINFO, EMBASE, Social Services Abstracts and Social Work Abstracts databases. Qualitative and quantitative peer-reviewed publications that were written in English were included if they described the nature of caregiving services in SCI, factors influencing the use of and access to caregiving services or described interventions to address caregiving needs of individuals with SCI. Sixteen papers were selected. The level of evidence for included studies ranged from 2 (highest) to 5 (lowest). Eleven studies described the nature of caregiving services, demographics of caregivers and recipients and factors associated with requiring care. Five studies described caregiving interventions. Caregiving services in SCI are predominantly provided by informal caregivers who are female. Quality of care from informal caregivers matches or exceeds quality of formal care. Total hours of care are dependent on the injury level and severity and care needs of the individual. Caregiver training is an important theme and has positive preliminary results on the quality of care provided. Intervention-based research is limited; further research to increase independence in activities of daily living and instrumental activities of daily living would reduce the need for caregiving hours.

Summary box Social empathy is ‘the ability to more deeply understand people by perceiving or experiencing their life situations and as a result gain insight into structural inequalities and disparities’.1 Social empathy comprises three elements: individual empathy, contextual understanding and social responsibility.1 COVID-19 has created a population-wide experience of exclusion that is only usually experienced by subgroups of the general population.2 Notably, persons with disability, in their everyday lives, commonly experience many of the phenomena that have only recently been experienced by members of the general population. Although about 1 billion people or approximately 15% of the world’s population, have some form of disability, ignorance and fear about disability and discrimination towards people with disability still persists.3 Public understanding of disability is shaped by a medical model of individual deficit, ignoring societal barriers that transpose the attribute of some type of psychological or bodily impairment into the social experience of …

Wheelchairs, scooters, and related equipment are essential for the well-being of individuals with limited mobility and impact participation, health, and quality of life.Our objective was to identify and evaluate policies governing equipment funding for Canadian adults. We reviewed funding legislation and program documentation for adult Canadians (≥18 years of age) covered by their provincial, territorial, or federal health care plan. Documents were obtained online or through administrative staff. Policy evaluation was guided by the Disability Policy Lens from the Canadian Disability Policy Alliance.Coverage ranges from full funding for all individuals within the jurisdiction to programs limited by strict eligibility criteria. Each jurisdiction defines "disability" or "basic/essential need" differently, contributing to further funding disparities.Funding policies differ substantially across Canada, resulting in unequal access to equipment dependent on province or territory. We identified eligibility, funding, definitions of mobility, repair and replacement, and prescriber requirement benchmarks that represent policy targets for improved access.