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Abstract\nIMPLICATIONS FOR REHABILITATIONPurpose: In less-resourced settings, 80% of people with spinal cord injuries die from pressure ulcer complications within two years. Appropriately constructed wheelchair cushions are effective in reducing incidence and severity of pressure ulcers. The Tuball is an inexpensive wheelchair cushion designed for users in less-resourced settings, which can be reproduced by local clinicians using locally sourced materials. This paper aimed to assess whether different individuals with limited knowledge of cushion construction could reliably construct the Tuball cushion.Materials and Methods: A convenience sample of eleven occupational therapy students were randomly assigned to one of two groups. Six participants constructed a Tuball and completed a subjective workload assessment. Five different participants sat on each cushion while pressure distributions were mapped. Intraclass correlation coefficients (ICC) with 95% confidence intervals were calculated for reliability of construction of each cushion using data from a range of pressure indices: dispersion index (primary outcome), peak pressure index, contact area, and seat pressure index (secondary outcomes) across all six cushions.Results and Conclusions: The ICC across all cushions was 0.745 (95% CI 0.103–0.970) for dispersion index. ICCs across cushions for secondary outcomes ranged from 0.879 to 0.951. Good-moderate reliability was found for the reliability in cushion construction as measured by the dispersion index. Excellent reliability in cushion construction was found as measured by peak pressure index, contact area, and seat pressure index. Data indicates individuals can reliably construct the Tuball given equivalent materials and instructions.The Tuball cushion offers a low-cost, locally sourced alternative for pressure relief, increasing accessibility of appropriate wheelchair seating in less-resourced settings.The Tuball cushion can be constructed reliably by individuals with no prior experience.The Tuball cushion offers a low-cost, locally sourced alternative for pressure relief, increasing accessibility of appropriate wheelchair seating in less-resourced settings.The Tuball cushion can be constructed reliably by individuals with no prior experience. [ABSTRACT FROM AUTHOR]

Policy development and implementation are key to improving access to Assistive Technology (AT). In this paper, we describe a strength-based framework for doing this at national level. We used an action research approach, with the United Nations Conventions on the Rights of Persons with Disability (UNCRPD) as the primary frame of reference. Primary data were collected using the World Health Organisation's rapid Assistive Technology Assessment (rATA). We describe the process of applying our emergent framework and how our findings support it. We identified seven guiding principles for effective policy process: Participatory, Resource aware, Outcomes focused, Collaborative, Evidence-informed, supporting good practices, and System strengthening – which can be summarized by the acronym PROCESS. Five crucial building blocks for effective AT policy development emerged: Identification of the assistive technology ecosystem, Demography of disability and AT use, Evaluation of inclusion and participation in existing policy, Alignment with UNCRPD and Sustainable Development Goals (SDGs), and Locality of implementation – which can be summarized with the acronym IDEAL. The IDEAL PROCESS incorporates key content building blocks and core process principles, constituting a systematic framework for guiding the development of context sensitive AT policy and a strength-based pathway to improving access AT. [ABSTRACT FROM AUTHOR]

In 2016 WHO launched the priority assistive products list (APL) consisting of 50 products and recommended that using this as a reference, countries should develop their own contextually relevant national APLs. This paper describes the development of Malawi's APL. Two hundred and ninety-six persons with disabilities participated in a rapid Assistive Technology Assessment (rATA) survey. Six focus group discussions (FGDs) with people with various types of disabilities were conducted. The rATA questionnaire and FGDs collected data on assistive products (APs) participants used, APs they needed and the challenges they experienced. Data collection was done in six districts spread across the three regions in Malawi. All age groups were included in the survey. Persons with disabilities aged less than 18 participated but went with their guardians. All persons who participated in this study provided consent. Survey and FGDs results were presented at an APL consensus meeting with policymakers, service providers, disabled peoples' organizations and development partners in the disability sector. Based on the results and further discussions, a consensus was reached on the priority APs for Malawi. More than a third of respondents used wheelchairs (32%), followed by auxiliary crutches (25%), walking sticks (13%), reading glasses (11%), prosthesis (10%), elbow crutches (9%) and orthosis (8%). There is also a high demand for products such as pull-up underwear (incontinence products) (79%), hearing aids (70%), reading glasses (59%) and diapers (63%). After intensive discussions during a consensus meeting, an agreement was reached on the 22 priority APs for Malawi. There is a wide range of APs being used by people with different functional limitations in Malawi. There is also a demand for APs that are not readily available. When developing an APL, the list should include products in use, those in demand, and those recommended by service providers. Following the development of the priority assistive products list (APL) by WHO, member states should develop their own contextually based APL. The development of the APL should be based on research evidence. All key stakeholders including persons with disabilities and other functional limitations, government, and development partners should participate in this process. The APL should be part of the national health system or community services. The Department of Disability and Elderly Affairs in the Ministry of Gender, Community Development, being the Government of Malawi line ministry coordinating disability issues participated actively in this study including inviting participants in the stakeholders' validation workshop. [ABSTRACT FROM AUTHOR]

Assistive technology (AT) outcomes research sits across different fields of practice and uses, diverse measures and methodologies. Instruments have been developed to measure AT outcomes, but data are not routinely collected nor published in most settings. This impedes the evaluation and development of policy in the field and prevents the sharing of best practices across settings and countries. Aiming to summarize existing knowledge about assistive technology outcomes and propose directions for the future, we provide a broad narrative synthesis of existing literature about AT outcomes conceptualized through the peoplecentered 5P model of the WHO Global Cooperation on Assistive Technology initiative and the GAATO Assistive Technology Outcomes and Impacts Model. We conclude that the 5P system model operates as a viable, integrative framework which supports a holistic understanding of the challenges associated with measuring AT outcomes. The development of a process to measure AT outcomes is proposed. [ABSTRACT FROM AUTHOR]

Assistive technologies (ATs) promote participation and inclusion in society, and support access to health, social services, education, work and other important life experiences for persons with disabilities, older people and those with chronic conditions. The Global Report on Assistive Technology, launched in May 2022 by WHO and UNICEF, calls for concrete actions to improve access to AT globally, and recognizes AT as both a means to, and an end itself, in the achievement of rights of persons with disabilities. The UN Convention on the Rights of Persons with Disabilities (CRPD, 2006) is the most widely ratified human rights convention, affirming the right to participation in society on an equal basis with others. 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. Assistive 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. [ABSTRACT FROM AUTHOR]

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. It 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 [ABSTRACT FROM AUTHOR]

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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. To understand the organisational characteristics of, and assistive products provided by, key stakeholders working in AT in Malawi. Online survey of representatives from key stakeholder organisations. 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. 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. 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. 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. [ABSTRACT FROM AUTHOR]

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. In 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. [ABSTRACT FROM AUTHOR]

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. Shared 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. [ABSTRACT FROM AUTHOR]