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Purpose: People with intellectual disabilities are deeply affected by health inequity, which is also reflected in their access to and use of assistive technology (AT) which could benefit them. Including the perspectives of adults with intellectual disabilities and their caregivers, together with the views of local health professionals, suppliers of AT and policy-makers, this paper aims to provide an overview of factors influencing access to AT and its use by people with intellectual disabilities in Bangalore, a southern region of India. Method: Face-to-face interviews were conducted with 15 adults with intellectual disabilities (ranging from mild to profound) and their caregivers, and with 16 providers of assistive technology. This helped to gain insight into the current use, needs, knowledge, awareness, access, customisation, funding, follow-up, social inclusion, stigma and policies around assistive technology and intellectual disability. Results: Access to assistive technology was facilitated by community fieldworkers and services to reach out and identify people with intellectual disability. Important barriers were stigma, and lack of knowledge and awareness among parents. Factors related to continued use were the substantial dependence on the care system to use assistive technology, and the importance of AT training and instructions for the user and the care system. Conclusion and Implications: The barriers and facilitators related to assistive technology for people with intellectual disability differ from other populations in need. The findings of this study can be used to inform and adjust country policies and frameworks whose aim is to improve access to AT and enhance the participation of people with intellectual disabilities within their communities.

textabstractBackground: Polypharmacy is common in people with intellectual disabilities. Using multiple medication may lead to unintended medication‐related problems (MRPs). Medication review may serve as a tool to reduce MRPs. This systematic review as‐ sessed the scientific evidence for the effectiveness of medication reviews in identify‐ ing and reducing MRPs in people with intellectual disabilities. Method: Literature databases were searched up to August 2017. Studies were se‐ lected that included the effect of medication reviews on identifying and/or reducing MRPs in people with intellectual disabilities with no restriction of type of medication, age and level of intellectual disabilities. Results: The eight studies that fulfilled the inclusion criteria report that systematic medication reviews appear to assist in the identification and reduction of MRPs. Conclusion: There is a lack of studies about the effect of medication reviews on iden‐ tification and reduction of MRPs, especially health outcomes for people with intel‐ lectual disabilities. Further studies with long‐term follow‐up are needed.

Polyfarmacie, langdurig gebruik van vijf of meer medicijnen tegelijk, komt veel voor bij mensen met een verstandelijke beperking. Polyfarmacie kan bij hen al op relatief jonge leeftijd tot problemen leiden. Huisartsen komen echter zelden toe aan een systematische medicatiebeoordeling voor deze patientengroep. Een pilotproject in Zuidwest-Nederland waarin huisartsen, apothekers en artsen voor verstandelijk gehandicapten (AVG) gezamenlijk de multidisciplinare STRIP-methodiek toepasten, bracht de opbrengsten en de knelpunten in kaart.

Contains fulltext : 245477.pdf (Publisher’s version ) (Open Access) BACKGROUND: Whilst assistive technology (AT) can play an important role to improve quality of life, health inequity regarding access to appropriate AT for people with intellectual disabilities (ID) is still very much present especially in low resource countries. OBJECTIVES: This study focused on exploring factors that influence access to and continued use of AT by people with ID in the Western Cape province of South Africa and to suggest potential implications of these findings and actions required to promote access to AT. METHOD: A qualitative approach was used to explore the experiences of people with ID and providers of AT. Face-to-face interviews with 20 adults with mild to profound ID, and 17 providers of AT were conducted and the data were analysed thematically. RESULTS: People with ID within the study setting faced many challenges when trying to access AT and for those who managed to acquire AT, its continued usage was influenced by both personal characteristics of the user and environmental factors. Important factors that influence AT access and use for people with ID found in this study were (1) attitudes from the community, (2) knowledge and awareness to identify AT need and (3) AT training and instructions to support the user and care network. CONCLUSION: With the perspectives of both the providers and users of AT, this study identified priority factors, which could be addressed to improve AT access and use for people with ID in the Western Cape province.

Background The World Health Organisation has launched a programme to promote Global Cooperation on Assistive Technology. Its aim is to increase access to high-quality affordable assistive products (AP) for everybody in need. People with intellectual disabilities (ID) are a specific group that could benefit from AP, but use less AP compared to their non-intellectual disabled peers. Method A systematic literature search was carried out to identify barriers and potential facilitators for access to AP for people with ID globally. The search strategy terms were ‘Intellectual Disability’ and ‘Assistive Technology’ with the following electronic literature databases PubMed, Embase, ASSIA, Web of Science, Medline, CINAHL complete, PsycInfo, Scopus and ERIC. The quality and relevance of the studies were assessed. Factors associated with access were identified thematically, categorised into barriers and facilitators and mapped into themes. Results In all, 22 key studies were retrieved, describing 77 barriers and 56 facilitators. The most frequently reported barriers were related to lack of funding and cost of AP, lack of awareness about AP and inadequate assessment. An increase of knowledge and awareness about AP and the need of AP for people with ID were most often extracted as factors that could potentially facilitate access. Conclusions This review proposes actions linked to the barriers and facilitators that have a particular importance for people with ID to access AP. Yet, only limited research is available describing factors that influence access to AP for people with ID in low and middle income countries and rural areas.

This paper is based on work from the Global Research, Innovation, and Education on Assistive Technology (GREAT) Summit that was coordinated by WHO's Global Cooperation on Assistive Technology (GATE). The purpose of this paper is to describe the needs and opportunities embedded in the assistive product lifecycle as well as issues relating to the various stages of assistive product mobilization worldwide. The paper discusses assistive technology product terminology and the dangers of focusing on products outside the context and rolling out products without a plan. Additionally, the paper reviews concepts and issues around technology transfer, particularly in relation to meeting global needs and among countries with limited resources. Several opportunities are highlighted including technology advancement and the world nearing a state of readiness through a developing capacity of nations across the world to successfully adopt and support the assistive technology products and applications. The paper is optimistic about the future of assistive technology products reaching the people that can use it the most and the excitement across large and small nations in increasing their own capacities for implementing assistive technology. This is expressed as hope in future students as they innovate and in modern engineering that will enable assistive technology to pervade all corners of current and potential marketplaces. Importantly, the paper poses numerous topics where discussions are just superficially opened. The hope is that a set of sequels will follow to continue this critical dialog. Implications for Rehabilitation Successful assistive technology product interventions are complex and include much more than the simple selection of the right product. Assistive technology product use is highly context sensitive in terms of an individual user's environment. The development of assistive technology products is tricky as it must be contextually sensitive to the development environment and market as well. As a field we have much to study and develop around assistive technology product interventions from a global perspective.

The World Health Organization has launched a program to promote Global Cooperation on Assistive Technology (GATE). The objective of the GATE program is to improve access to high quality, affordable assistive technology for people with varying disabilities, diseases, and age-related conditions. As a first step, GATE has developed the assistive products list, a list of priority assistive products based on addressing the greatest need at population level. A specific group of people who can benefit from user appropriate assistive technology are people with intellectual disabilities. However, the use of assistive products by people with intellectual disabilities is a neglected area of research and practice, and offers considerable opportunities for the advancement of population health and the realization of basic human rights. It is unknown how many people with intellectual disabilities globally have access to appropriate assistive products and which factors influence their access. We call for a much greater focus on people with intellectual disabilities within the GATE program. We present a framework for understanding the complex interaction between intellectual disability, health and wellbeing, and assistive technology.

The aim of this study was to quantify processing of different types of coherent motion in terms of ocular motor response times in a group of normally-developing children (age 0-12+ years old) using remote eye tracking. Motion coherence was applied in three different types of Random Dot Kinematograms (RDKs): vertical (RDK1) and diagonal (RDK2) motion and expansion (RDK3). Orienting eye movements were quantified using the Reaction Time to the first Fixation (RTF). The children were divided into two groups: the "youngest group" between 0-3+ years and the "oldest group" between 4-12+ years old. The results showed that RTF was significantly prolonged in the "youngest group" compared to the "oldest group" for each RDK. In the "oldest group", RTF was significantly affected by the type of RDK shown. The presented results suggest that, based on ocular motor responses, age-dependence of processing different types of coherent motion may be revealed.

It is generally assumed that children with intellectual disabilities (ID) have an increased risk of impaired visual information processing due to brain damage or brain development disorder. So far little evidence has been presented to support this assumption. Abnormal visual orienting behavior is a sensitive tool to evaluate impaired visual information processing. Therefore, the main objective of this study was to investigate possible correlations between the children's characteristics (age, gender, level of ID, mobility, gestational age, cerebral palsy, Down syndrome, visual acuity, strabismus, nystagmus, and epilepsy), and abnormal visual orienting behavior. We quantified data on visual orienting behavior, in terms of visual processing time and ocular motor fixations, in 88 children with ID aged 4-14 years. These visual parameters were combined with data collected from the children's medical records (predictors) and were put in a Pearson bivariate correlation analysis. A predictor was included for multiple regression analysis if the Pearson's correlation coefficient had a level of significance of p < 0.05. As shown by multiple regression analysis, age, level of ID, and Down syndrome significantly affected visual processing time. Mobility, strabismus, and nystagmus significantly affected fixation quality. Using a systematic approach, we confirmed the hypothesis that children with ID have an increased risk of impaired visual information processing which is related to a low IQ. (C) 2012 Elsevier Ltd. All rights reserved.

Aim: The aim of this study was to compare visually guided ocular motor behaviour in children with visual processing and/or motor deficits with an age-matched comparison group and an adult group. Method: Visual stimuli were shown to 28 children with visual processing and/or motor deficits (11 females, 17 males; mean age 7y 5mo, SD 2y 9mo, range 2-14y;) and an age-matched comparison group of 213 typically developing children (115 females, 98 males; mean age 5y 8mo, SD 3y 5mo, range 0-12y). The adult group consisted of nine females and two males with (mean age of 24y 4mo, SD 4y 8mo). Individuals who had a likely diagnosis of cerebral visual impairment (CVI), an opticopathy with unknown location, nystagmus, glaucoma, or a cataract were included in the study. Exclusion criteria were a visual acuity below 0.2, a developmental age under 1year, and the presence of brain tumours, autism, and anxiety disorders. Orientating eye movements to large cartoons were quantified using the reaction time to fixation (RTF) and gaze fixation area (GFA). A Mann-Whitney U test was used to compare the differences between groups and Bonferroni post-hoc testing was used to analyse age dependence of RTF and GFA values within the comparison group. Results: Individuals with CVI showed significantly prolonged RTF values; those with congenital nystagmus showed significantly increased GFA values. In the comparison group, RTF was significantly longer in children under the age of 2years than in children aged 4years and older (290 and 200ms respectively; p

Quantification of orienting responses can be used to differentiate between children with cerebral visual impairment and infantile nystagmus syndrome. To further improve the sensitivity of this method, we compared orienting responses to a Cartoon stimulus, which contains all sorts of visual information, to stimuli that contain only Contrast, Form coherence, Motion coherence, Color and Motion detection. The stimuli were shown on an eye tracker monitor using a preferential looking paradigm. We found that both groups of children showed general slowing in orienting responses compared to controls. The children with cerebral visual impairment had significantly prolonged responses to Cartoon compared to the children with nystagmus, whereas the children with nystagmus had prolonged responses to Motion detection and larger fixation areas. Previously reported differences in orienting responses to Cartoon were replicated. Application of specific visual information did not alter the sensitivity of the method to distinguish between children with visual processing deficits.

Background Assessment of higher visual processing functions mostly requires active cooperation of participants, which is problematic in children with intellectual disabilities (ID). To circumvent this, we applied remote eye tracking to quantify (ab)normal visual orienting responses in children with ID in terms of reaction times to visual stimuli. Methods We presented visual stimuli (cartoon, coherent form, and coherent motion) to 127 children (2–14 years) with developmental and/or ID (risk group) and simultaneously measured their orienting ocular motor responses. Reaction times to fixation (RTF) in the risk group were compared with RTF values of an age-matched control group. Results Overall, in 72% of the children in the risk group, RTF values to cartoon were delayed, in 47% to form, and in 38% to motion. The presence of delayed reaction times was highest in the group of children >4 years with ID. Conclusion Our data show that a majority of children with developmental and/or ID have delayed visual orienting responses. This suggests that this group has increased risk for higher visual processing dysfunctions. Future studies are planned to correlate abnormal orienting responses to type of brain damage and to dissociate the responses from ocular motor disorders.

PURPOSE. Brain damage or brain development disorders can affect (the maturation of) visual processing functions, such as form and motion detection. The aim of our study was to investigate visual orienting responses of children to a coherent form and motion stimulus as a measure for maturation of visual information processing. METHODS. The 213 typically developing children aged 0-12 years included in this study were shown a 100% coherent form and motion expansion stimulus on a remote eye tracking monitor. Orienting eye movements were quantified in terms of ocular motor reaction time to fixation (RTF). Children were divided in age groups, and their performance was compared to 30 healthy adults with a mean age of 24.49 years (SD 3.62 years). RESULTS. The RTF values of coherent form in children up to six years old were significantly higher compared to the adult group (P < 0.05, Dunnett post-hoc test). For motion, mature levels were reached at eight years old. RTF values depended on stimulus type (F-1,F-168 = 240.8, P < 0.001) and age (F-11,F-168 = 25.8, P < 0.001), and there was a significant age by stimulus type interaction (F-11,F-168 = 2.2, P < 0.05). CONCLUSIONS. Remote eye tracking may provide objective insight into the maturation of visual information processing of coherent form and motion without complex instructions or active cooperation. The quantification of typical visual orienting behavior in childhood may be used as a reference for children with brain dysfunction. (Invest Ophthalmol Vis Sci. 2012;53:2708-2714) DOI:10.1167/iovs.11-8893

The current definition of Cerebral Visual Impairment (CVI) includes all visual dysfunctions caused by damage to, or malfunctioning of, the retrochiasmatic visual pathways in the absence of damage to the anterior visual pathways or any major ocular disease. CVI is diagnosed by exclusion and the existence of many different causes and symptoms make it an overall non-categorized group. To date, no discrimination is made within CVI based on types of perceptive visual dysfunctions. The aim of this review was to outline which perceptive visual dysfunctions are to be expected based on a number of etiologies of brain damage and brain development disorders with their onset in the pre-, peri- or postnatal period. For each period two etiologies were chosen as the main characteristic brain damage. For each etiology a main search was performed. The selection of the articles was based on the following criteria: age, etiology, imaging, central pathology and perceptive visual function test. The perceptive visual functions included for this review were object recognition, face recognition, visual memory, orientation, visual spatial perception, motion perception and simultaneous perception. Our search resulted in 11 key articles. A diversity of research history is performed for the selected etiologies and their relation to perceptive visual dysfunctions. Periventricular Leukomalacia (PVL) was most studied, whereas the main tested perceptive visual function was visual spatial perception. As a conclusion, the present status of research in the field of CVI does not allow to correlate between etiology, location and perceptive visual dysfunctions in children with brain damage or a brain development disorder. A limiting factor could be the small number of objective tests performed in children experiencing problems in visual processing. Based on recent insights in central visual information processing, we recommend an alternative approach for the definition of CVI that is based on functional visual processing, rather than anatomical landmarks. This could be of benefit in daily practice to diagnose CVI. (C) 2010 Elsevier Ltd. All rights reserved.