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Purpose: Suitable assistive devices for children with cerebral palsy (CP) in low-income countries are often unavailable. Devices made from APT are in use in several countries but are unevaluated. Materials and methods: A 2-week training course focused on APT principles, measuring children and constructing postural support devices. Twenty-three Kenyans attended the course. The host organization identified four local children with CP who attended for assessment and measurement. Participants made the devices and children returned for fitting and necessary adjustment. Completion of post-course forms, action plans, visits after 14 months and contact 3 years later comprised the evaluation. Results: All participants found the course beneficial and valued the networking opportunity provided. They appreciated the practicality and utility of locally manufactured cost effective devices. The trainees planned further implementation to provide assistive devices for children with CP in their localities. Follow-up visits revealed several challenges to local ongoing production. Conclusions: Training people in low-income communities to make bespoke assistive devices for children with CP is straightforward, and the course was positively evaluated. However, maintaining device production is limited without local group support and stable leadership, ideally as part of an existing programme. Assistive devices are often unobtainable for children with cerebral palsy (CP) in low-income countries. APT is a cost effective way of fulfilling this need and it is relatively straightforward to train people who care for or work with those with CP to make devices using APT. Feedback from APT training suggests participants find the technique a practical way of producing assistive equipment for individuals with CP in their community. Maintaining device production requires support, leadership and increased public awareness of the use of APT at a local level. [ABSTRACT FROM AUTHOR]

For children with mobility impairments, without cognitive delays, who want to participate in outdoor activities, existing assistive technology (AT) to support their needs is limited. In this review, we investigate the control and design of a selection of robotic walkers while exploring a selection of legged robots to develop solutions that address this gap in robotic AT. We performed a comprehensive literature search from four main databases: PubMed, Google Scholar, Scopus, and IEEE Xplore. The keywords used in the search were the following: "walker", "rollator", "smart walker", "robotic walker", "robotic rollator". Studies were required to discuss the control or design of robotic walkers to be considered. A total of 159 papers were analyzed. From the 159 papers, 127 were excluded since they failed to meet our inclusion criteria. The total number of papers analyzed included publications that utilized the same device, therefore we classified the remaining 32 studies into groups based on the type of robotic walker used. This paper reviewed 15 different types of robotic walkers. The ability of many-legged robots to negotiate and transition between a range of unstructured substrates suggests several avenues of future consideration whose pursuit could benefit robotic AT, particularly regarding the present limitations of wheeled paediatric robotic walkers for children's daily outside use. Children with lower limb disabilities can benefit from assistive technology designed for daily usage in outdoor surroundings. An extension of existing robotic assistive technology that allows the user to travel safely on irregular surfaces both indoors and outdoors is needed. Approaches used to solve research problems in the field of robotics (outside of the rehabilitation area) can be used to address problems that robotic assistive technology currently faces. There is a need for more research on the development of robotic assistive technology for children with mobility impairments without cognitive delays. [ABSTRACT FROM AUTHOR]

This is the second of two papers summarizing studies reporting on the design of electronic graphic symbol-based augmentative and alternative communication (AAC) systems. The aim of this paper was to describe the design approaches used and to determine to what extent the principles of human-centred design (HCD) were reflected in the design approaches and processes used. A scoping review was conducted. A multifaceted search resulted in the identification of 28 studies meeting the selection criteria. Data were extracted relating to four areas of interest, namely, (1) the general characteristics of the studies, (2) features of the systems designed, (3) availability of the systems to the public and (4) the design processes followed. In this paper, findings related to the last area are presented. Design approaches were often inconsistently described. User-centred design was mentioned more often than HCD. Even so, various HCD principles were considered in most studies. Notably, stakeholders were involved in the design process in all studies. However, users were not involved in all studies and stakeholder roles were predominantly informative rather than collaborative. Prototype and product evaluations focussed mostly on usability rather than user experience. Although many design teams were multidisciplinary, engineers and computer scientists predominated. There is a need for designers to be more transparent about the type of design approach used to guide the system design and also to clearly report on design approaches and processes used. The application of HCD to the design of graphic symbol-based AAC systems is still limited. Human-centred design approaches can productively guide the design of electronic graphic symbol-based augmentative and alternative communication (AAC) systems. Creative methods are needed to involve stakeholders with complex communication needs in all phases of the design process. Evaluation of electronic graphic symbol-based AAC systems should consider both usability and user experience. [ABSTRACT FROM AUTHOR]

This paper considers the possibilities of analysing children's own designs to contribute to the design of inclusive paediatric mobility interventions. The aim of this paper is threefold: (1) to develop a framework for child-centred design analysis, (2) to analyse children's designs to explore both quantitative and qualitative insights and (3) to explore how children's voice could be elevated through design research. A Child-centred Design Analysis Framework is developed in an interdisciplinary manner, comprising four dimensions including Child, Content, Context and Format. It is used as a vehicle to analyse and code 130 "Dream Wheelchair" designs by children. The children's "Dream Wheelchair" designs reference a range of features and priorities, which are gathered into themes through the framework, providing insights into children's individual and collective mobility narratives, values and requirements. Themes are explored through a qualitative interdisciplinary lens to understand the nature of children's lived experiences. The framework promotes child-centred framing through extracting meaning from children's own designs. It is suggested that child-centred framing and a rights-respecting approach to assistive technology design research can lead to more appropriate design outcomes and improved user experiences for children with disabilities. The design analysis framework developed and presented in this paper facilitates child-centred framing to elevate children's voice in a design process. Analysis of 130 children's visual and textual designs elicited narratives, values, and requirements around their "Dream Wheelchairs"; these findings contribute insights which can be used for designing inclusive paediatric mobility interventions. This paper invites industry practitioners and design researchers to use a child-centred and rights-respecting approach when designing with or for children. [ABSTRACT FROM AUTHOR]

Only 1 in 10 people with disabilities can access assistive devices, underlining the critical need for low-cost assistive products. This paper describes the design evolution of a manual user-operated standing wheelchair (SWC), translating from prototype to product. The SWC design has been refined over 5 years through multiple iterations based on comments from user trials. The SWC product, Arise, provides standing functionality, facile outdoor mobility, affordability, customisability, and is aesthetically pleasing. A one-time fitting and training ensure optimal effort for operation, correct posture, and comfortable user experience. The SWC accommodates users of different sizes and body weights (up to 110 kg) and minimises user effort with the use of a gas spring. Incorporating discrete adjustments enables customisation while retaining the advantages of mass manufacturing, which is necessary for ensuring affordability. The SWC has been field-tested and well received by over 100 wheelchair users, and Arise was launched recently by the industry partner. It should be noted that RESNA cautions on the use of any standing device without medical consultation. Nevertheless, with appropriate dissemination and awareness, it is anticipated that the affordable SWC product, Arise, will immensely benefit the eligible users and make a difference in their quality of life. Provides standing functionality, outdoor mobility, affordability and customisability Accommodates users of different sizes and body weights in a mass-manufacturable design Ergonomic design reduces net user effort during sit-to-stand, stand-to-sit activity Design iterated and refined based on feedback from over 100 user trials [ABSTRACT FROM AUTHOR]

This paper presents a low cost solar powered vehicle for physically challenged persons. Generally, the persons with physical disabilities restrict their movement within a house or building due to their dependence on other people for their outdoor work. The disabled people use their limbs to drive the wheelchairs which physically stress them. There are electrical wheelchairs which are operated by hands, by mouth or any other functioning body part. The high cost and its limitation for outdoor environment restrict its usage for rich people and hospitals. This often makes the poor disabled person to be unemployed and depend on others for their daily life. In this regard, developing a low cost self-driven electric wheel chair can improve the life of the person. This paper presents a low cost vehicle for physically challenged people that can be used as a mobile shop to sell products at any place independently. The self-driven vehicle motivates the persons to become an entrepreneur. A cost effective and user friendly prototype has been developed for the benefit the poor disabled people and the cost analysis is presented. The purpose of developing the vehicle is satisfied as they no longer depend on others for their living. The movement of physically challenged persons is often restricted within a building due to their dependence on other people for their outdoor work. The high cost of the assist vehicles and the difficulty encountered in using the vehicles in outdoor environment decreases their standard of living. The developed low cost vehicle can be used by physically challenged people as a mobile shop to sell products at any place independently. The self-driven vehicle motivates the physically challenged persons to become an entrepreneur. [ABSTRACT FROM AUTHOR]

The manual user-operated Arise Standing Wheelchair (SWC) is the end-result of multiple design iterations based on comments from user trials. The Arise SWC provides standing functionality, outdoor mobility, affordability, and customizability. This paper describes a user experience study of the Arise SWC's pre-commercial version. Thirty participants (N = 30, 25 Male, 5 Female) were recruited for the study. All the participants were people with spinal cord injury. The study was conducted over a period of six weeks (five participants per week) within the hospital premises under the supervision of clinical personnel. A 30 min interactive training session involved thirteen activities. During the trial period, the participants were trained to perform twenty-two activities to familiarize themselves with the SWC. The participants were also trained to perform four functional usage activities with the SWC. At the end of the study, participant responses to ten outcome measures were captured using a smiley-based Likert-scale questionnaire. A majority of the participants (93.3%) felt happy when they stood in the SWC. The majority participants (83.3%) preferred the Arise SWC over their current wheelchair. Also, 80% participants anticipated that they could get more work done at home using the standing function of the wheelchair. A one-time fitting and training ensured optimal effort for the SWC operation, correct posture, and comfortable user experience. With proper dissemination and awareness, it is believed that the Arise SWC will benefit eligible users and improve their quality of life. The Arise wheelchair provides standing functionality, outdoor mobility, affordability, and customizability. Study confirms that incorporating standing functionality can improve the quality of life for wheelchair users. The majority of users were happy, felt safe and expected to do more with the standing functionality. Study results support further testing in real world conditions beyond the hospital setting. [ABSTRACT FROM AUTHOR]

Assistive devices like Standing Wheelchairs (SWC) have remained out of reach of the economically underprivileged even before the pandemic-induced financial downturn, and more so now. This paper describes the mechanical design of a manual user-actuated SWC that is cost-effective (equivalent of USD 210 in India, ex-factory) and has special features that minimise user effort and accommodates varying body weights (50–110 kg) and dimensions (1.52–1.83 m height). The design includes a six-bar mechanism and spring balancing to optimise user effort during operation. The optimised gas spring incorporates adjustability to minimise each user's force for sit-stand-sit transitions. The handle shape is ergonomically designed using kinematic analysis to provide convenient gripping positions for actuation. The design has been customised based on parametric studies to suit varying body weights. Overall, the SWC design provides standing functionality with ease of operation, safety locks, customisability, affordability, outdoor mobility and is aesthetically pleasing. Customisability and the low cost of the device would enhance the accessibility of the SWC to a larger group of eligible users. Manual user-operated standing wheelchair design using a six-bar mechanism Spring balancing used to reduce user effort to self-lift to the standing position Kinematic analysis used to determine convenient handle location for user ease Customisability for wide range of users to ensure correct posture, optimal effort Design refined through multiple iterations using inputs from users and clinicians Design commercialised at an affordable cost, making it accessible to a larger population [ABSTRACT FROM AUTHOR]

This article showcases the adaptability of existing mobility devices for the Algerian disabled population. It aims to develop a behavior model of disabled Algerian persons through (1) development of a theoretical model based on literature review and (2) improvement of this model by using local collected data from our developed questionnaire. The majority of existing mobility devices for disabled persons are adapted developed countries context. The Algerian context (people and environment) has its own specifications and needs. Researchers does not address the disabled people behavior modelling in Algeria, due to the unavailability of data and the difficulty of their collection. In order to overcome this problem and develop adapted mobility devices for this particular population, the deployment of a questionnaire to collect local data, becomes necessary. First, a behavior model is deduced from the literature review then a questionnaire is developed and deployed to complete the missing field of this model. The deployment questionnaire panel is composed of 260 persons including users, their families and staff working in disabled person's aid organization. The main result of this paper consist in a specific behavior model of Algerian disabled persons. This population are looking for reliable and smart wheelchair (97%) to be able to overcome their daily mobility difficulties due to the infrastructure and the global economic context. The proposed model can generate adapted wheelchair for Algerian context. The results of the questionnaire are an important step to understand disabilities in Algeria and developing countries. Development of a behavior model for the disabled persons displacement. Development and deployment of questionnaire for disabled persons in Algeria. Review of disabled person situation and existing wheelchair in Algeria. Identification of Algerian disabled persons requirement and demonstrate that are different from European one. Definition of recommendation set for the design of wheelchair adapted to Algerian context. [ABSTRACT FROM AUTHOR]

The solution described in this paper allows wheelchair users with reduced mobility or physical disabilities to move independently throughout an aircraft and to board and disembark autonomously. A motorized aircraft seat was developed to substitute current aircraft aisle wheelchairs. The real-scale functional prototype was evaluated in a focus group. The results show that the proposed solution is considered superior to current solutions in nine of twenty requirements and neutral in one of them. There was low agreement among the focus group participants in ten requirements, even though the focus group discussion brought interesting reflections, including positive feedback, critics, and suggestions for further research and development in the field. The design concept consists of a motorized wheelchair that becomes the seat of the aircraft when anchored on a docking platform attached to the aircraft fuselage via a seat track. The manoeuvring is allowed by a rotating mechanism, which solves a critical function that is to enable wheelchair manoeuvring in the narrow aisles of aircraft. A parking assistant system aids the control of the motorized wheelchair. The main benefits of this solution are to reduce seat transfers during the flight experience and to provide more autonomy and comfort for passengers during flights. A motorized aircraft seat was developed to replace traditional aircraft aisle wheelchairs. A real-scale functional prototype was built, tested in an aircraft mockup, and evaluated in a focus group. The main benefits of the proposed solution are to reduce the number of chair transfers during the flight experience and to provide more autonomy for passengers. Additional benefits are to allow the passengers to experience less physical and emotional stresses, to enter the aircraft corridor looking ahead, and to sit in any aisle position in the aircraft. [ABSTRACT FROM AUTHOR]

The current study sought to identify decisions speech-language pathologists (SLPs) make and their rationale for those decisions when designing an AAC display for a hypothetical school-aged child who was a beginning communicator. Augmentative and alternative communication (AAC) displays support communicative interactions for children who are unable to use spoken language to meet their communication needs. Children who are at the early stages of learning language, often termed beginning or emerging communicators, may rely heavily on the AAC display to support comprehension and expression. Thus, it is important for speech-language pathologists (SLPs) to design a display that facilitates beginning communicators' communication development. This paper reports on the answers related to a specific case study presented in an online survey completed by 77 SLPs with experience in AAC. Data illustrated design decisions driven by child-specific characteristics and informed by research regarding type of layout, representation, and the importance of various design features. Suggestions for future research are provided, including identifying goals and communicative functions best supported by different types of displays, clinicians' challenges/successes growing a system with the child, and determining the importance of symbol arrangement and organisation in communicative tasks by AAC users. Identification of current practices reported by speech-language pathologists given a case study to develop and implement future research. A gap between research and practice suggests the need for better dissemination and application of research supporting the inclusion of people engaged in the event depicted in a visual scene display. Foundations for future research to provide guidance regarding best design of and communication goals supported by visual scene displays and grid-based displays. [ABSTRACT FROM AUTHOR]

Systematic evaluation and meta-analysis of the effects of digital noise reduction (DNR) algorithms on speech intelligibility, sound quality and listening effort in adult populations. Systematic review and meta-analysis. Six databases were searched for experimental studies published from 2000 to 2017 in English using the following search terms: "hearing aid" and "noise reduction". A total of 264 unique hits were obtained; out of which, 16 studies were included. The population effect was estimated for speech intelligibility and other subjective measures. From six studies, the population effect estimated for speech intelligibility measures was small (r = 0.28) with zero population variance. Sample size variance accounted for all the effect size variations found across studies. The population effect for subjective measures was medium (r = 0.46 ± 0.10) as calculated from seven studies. Based on a criterion of moderate evidence, this meta-analysis did not reveal a consistent improvement in speech intelligibility with DNR in adult population. The subjective outcome measures (e.g., acceptable noise level and sound quality judgment) showed a moderate positive effect of DNR. The findings of the study will provide useful clinical information in follow up visits in audiologic rehabilitation. The meta-analysis of DNR informs clinicians to create realistic expectations in hearing aid users. This paper summarizes the available data on different outcome measures such as speech intelligibility, listening effort and sound quality. The results of this meta-analysis will help clinical audiologists in devising hearing aid orientation and counseling. [ABSTRACT FROM AUTHOR]

Aim: This paper presents the study, design and prototyping of a manual wheelchair, named handwheelchair.q, with an innovative propulsion's system. The research is based on a novel system of propulsion that is more efficient and ergonomic than the hand rim one. The main goal of the designed prototype is to facilitate the mobility and to extend the reachable areas while reducing the required time. Methods: The propulsion is realised through a rowing-inspired gesture. Results: This gesture avoids the damages caused on shoulders by the compressive force of the hand rim and lever systems. Conclusion: The prototyping allowed the analysis of the project parameters and their influence on the kinematic characteristics of the prototype and the biomechanical characteristics of the gesture. The same propulsion's system can be adopted on wheelchairs devoted to sport activities, representing the starting point for a future prototype of racing wheelchairs. In this regard, the wheelchair's braking system has been redesigned in order to improve efficiency and safety. The use of the Handwheelchair.q may have positive impacts in terms of the quality of life, in order to reduce the shoulder pain caused by the handrim and lever system. In addition, it can be a good tool for rehabilitation because the activity can be performed outdoor. [ABSTRACT FROM AUTHOR]

Background/Purpose: Visual impairment is a disability more commonly caused by diseases that lead to several disadvantages to the daily activities amongst those blind. For almost a century since the white cane was first introduced, the cane has remained as the most reliable tool for those affected by blindness. Methods: By using a combination of the capabilities of Internet of Things (IoT) and existing devices, such as mobile phones, an InWalker system is proposed to expand the functionality of the typical white cane, so as to introduce several new features that enhance the safety and confidence amongst people who are blind. As such, this paper explores the existing works and projects to comprehend the motivation and the standard practices for each proposed feature. Each of the strength and drawback has been assessed thoroughly to refine the scope of this project. Results: The proposed project, InWalker, is an intelligent system that has an embedded board system with various sensors to enhance the usability of white cane. The inputs from the sensor are processed on a microcontroller, which then pass the data to a smartphone via Bluetooth for additional features, such as global positioning system (GPS) tracking and SMS services. Conclusions: Based on the initial user testing, the proposed system has successfully fulfilled most of the users' need. Visual impairment is a disability more commonly caused by diseases that lead to several disadvantages amongst those blind. The white cane has been seen as the most reliable tool for the visual impaired. This tool could be further improved with the integration of additional sensors that works with today's mobile devices. The proposed system, InWalker, is able to improve the overall quality of life among people who are blind through several features: obstacle detection, GPS tracking and a light illumination in dark environments for increased safety. [ABSTRACT FROM AUTHOR]

Assistive Technology (AT) product use occurs within a socio-cultural setting. The growth internationally in the AT product market suggests that designers need to be aware of the influences that diverse cultures may have on the societal perception of an AT product through its semantic attributes. The study aimed to evaluate the visual interaction with an AT product by young adults from Pakistan, a collectivist society, and the United Kingdom (UK), an individualist society. A paper-based questionnaire survey was carried out with 281 first-year undergraduate students from the UK and Pakistan to evaluate their perception towards the visual representation of a generic conventional wheelchair image. A semantics differential (SD) scale method was used involving a seven-point bipolar SD scale incorporating sixteen pairs of adjectives defining functional, meaning, and usability attributes of the product. The mean (M) and standard deviation (sd) values were obtained for each pair of adjectives and compared between both groups by employing appropriate parametric tests. The results show that having a diverse cultural background did not appear to have overtly influenced the meanings ascribed to the generic manual wheelchair, which was unexpected. The University 'Internationalist' environment may have influenced the results. Some minor but critical differences were found for some pairs of adjectives (bulky-compact, heavy-light), having p-value less than.05 (p <.05) that related to previous experience of wheelchairs and/or their use. Further studies are planned to investigate and validate outcomes with other student and non-student groups. The semantic attributes of assistive technologies highlight a number of aspects that have implications for those involved in Assistive Technology (AT) product development, manufacturing and marketing. • For online sales, the AT products rely on the web page image to communicate the purpose and attributes of the product. There are limited explorations related to the semantic/communicative attributes of AT product presented in images, as perceived by individuals from diverse cultural backgrounds. • The knowledge towards semantic meaning ascribed to the AT product is important to investigate to provide a perspective that goes beyond practical functions of the AT product towards the communicative function. • Information of comprehending semantics and significance of the AT product from a social (non-users) viewpoint may benefits manufacturers in the development of AT products that best meet the societal needs, preferences and expectations. • A model of best practice, with a focus on semantic manipulation will offer Industrial Designers (ID) internationally with the suitable process and tools to reframe perceptions of disability and enhance acceptance of AT products not only for users, but also for the society around them. [ABSTRACT FROM AUTHOR]

Aim: Assistive technologies traditionally rely on either powered actuation or passive structures to provide increased strength, support or the ability to perform specific functions. At one end of the spectrum are powered exoskeletons, which significantly increase a user's strength, but require powerful actuators, complex control systems and heavy power sources. At the other end are orthoses, which are generally unpowered and light in weight, relying on the mechanical properties of passive mechanical elements. Ideally, assistive technologies should combine the benefits of both systems and enhance human motion while remaining lightweight and efficient. This paper presents the development of a lightweight unpowered ankle exoskeleton that relies on the spring-like properties of a Pneumatic Artificial Muscle, which is inflated and sealed. Methods: This flexible air-spring is used to harness gait energy and compliment the human ankle torque at push-off. To mechanically validate the proposed exoskeleton design, a prototype was fabricated and experimentally tested. Results: Unlike other existing devices, the proposed unpowered exoskeleton was able to store a significant amount of energy and release it all at once. The timing mechanism worked as intended and triggered the release of 115 N m of torque when the ankle reached a pre-determined angle. Conclusion: Overall, the device demonstrated the ability to provide significant contribution to the ankle torque, timed to release precisely at the push-off phase of the gait cycle. The currently proposed ankle exoskeleton makes use of an unpowered, fully mechanical system to provide walking assistance to users by providing additional torque to the ankle joint. The newly developed assistive device is devised as a solution for persons struggling with mobility issues, and can be used both as a means for rehabilitation or as a permanent assistive devices for patients struggling with long-term disabilities. The device also has potential to be used as a performance enhancing device for ablebodied users by reducing muscle fatigue during extended physical exertion. [ABSTRACT FROM AUTHOR]

A "kneeling" ultralight wheelchair prototype has been developed that allows users to adjust seat position "on the fly" for different activities throughout the day. The wheelchair includes independent adjustment functions for rear seat height, front seat height ("kneeling") and backrest angle. Aim: This work aimed to gather feedback about the wheelchair's functionality and performance through end user evaluation trials. Methods: Eight manual wheelchair users evaluated the prototype Kneeling Wheelchair for a range of activities. User perspectives on parameters such as usability, comfort, stability and effectiveness were obtained through both open-ended and Likert-scale rating questions. Results: Results indicate several potential benefits of the adjustment functions of the Kneeling Wheelchair. Rear seat height adjustment may facilitate a number of activities of daily living, as well as provide benefits for comfort and social interactions. Back rest adjustment may increase comfort and stability on slopes. Front seat height adjustment may be beneficial for transfers and conducting sustained low-to-the-ground activities. While benefits of this adjustment function were described by many participants, some struggled with usability of the kneeling mechanism and rated this function less favourably than the other two. Conclusion: The findings of this study will inform future iterations of the Kneeling Wheelchair design and may spur future developments in wheeled mobility. In the long-term, it is anticipated that novel wheelchair solutions, such as the one described in this paper, may support improved health, quality of life and community participation for people with mobility impairments. Wheelchairs that allow users to easily adjust seat and backrest position "on the fly" to better suit different tasks throughout the day may provide benefits such as facilitating activities of daily living. A front seat height adjustment feature on a new wheelchair prototype may be beneficial for transfers and conducting sustained low-to-the ground activities. End user evaluations can provide valuable insight to direct future design modifications and innovation. [ABSTRACT FROM AUTHOR]

Purpose: The telehealthcare sector has been expanding steadily in the UK. However, confusing, complex and unwieldy designs of telehealthcare devices are at best, less effective than they could be, at worst, they are potentially dangerous to the users. Method: This study investigated the factors within the new product development process that hindered satisfactory product design outcomes, through working collaboratively with a leading provider based in the UK. Results: This study identified that there are too many costly late-stage design changes; a critical and persistent problem area ripe for improvement. The findings from analyzing 30 recent devices, interviewing key stakeholders and observing on-going projects further revealed that one major cause of the issue was poor practice in defining and communicating the product design criteria and requirements. Conclusions: Addressing the characteristics of the telehealthcare industry, such as multiple design commissioners and frequent deployment of design subcontracts, this paper argues that undertaking a robust process of creating the product design brief is the key to improving the outcomes of telehealthcare device design, particularly for the small and medium-sized enterprises dominating the sector. Implications for rehabilitation: Product design criteria and requirements are frequently ill-defined and ineffectively communicated to the designers within the processes of developing new telehealthcare devices. The absence of a (robust) process of creating the design brief is the root cause of the identified issues in defining and communicating the design task. Deploying a formal process of creating the product design brief is particularly important for the telehealthcare sector. [ABSTRACT FROM AUTHOR]

Background: Stroke is a leading cause of disability that limits everyday activities and reduces social participation. Provision of assistive devices helps to achieve independence and social inclusion. However, due to limited resources or a lack of suited objects for their needs, individuals with disabilities in low and middle income countries (LMIC) often do not have access to assistive devices. This has resulted in the creation of purpose built innovative solutions. Methodology and case content: This paper uses a single case derived from a larger ethnographic study of stroke survivors in rural Malaysia to demonstrate the role of assistive devices in shaping stroke recovery and how existing structures can be modified. Second, the concept of affordances in relation to structures within the environment, issues of affordability and accessibility of assistive devices for individuals in LMIC are discussed. Findings and conclusions: Stroke recovery involves adapting to new limitations and discovering the support necessary to live life. These changes are influenced by a range of environmental factors. Healthcare professionals need to support stroke patients in identifying challenges and work to find innovative ways to address them. Stroke survivors may benefit from the use of an assistive device beyond its clinical function to participate purposefully in activities of daily living. Implications for Rehabilitation: Stroke is a cause of disability that limits everyday activities and reduces social participation. Assistive devices help achieve independence, social inclusion and shape stroke recovery. Individuals with disabilities in low and middle income countries often do not have access to assistive devices and resort to innovative solutions that are purpose built. Stroke recovery involves adapting to new limitations and discovering the support necessary to live life as best as possible. [ABSTRACT FROM AUTHOR]

Purpose: The WheelSense project aims to develop a system for assessing the stability and performance of wheelchairs through a user-centred design process. This study sought to capture user needs and define the specification for the system.Method: A mixed methods approach was adopted. An online survey was completed by 98 participants working in wheelchair provision. The results were built upon through 10 semi-structured interviews and one focus group (n = 5) with professionals working in wheelchair provision in three NHS Trusts in the UK.Results: The results provided a picture of the current UK practice in stability testing. Issues with the reliability and usefulness of the existing methods used to assess the stability and performance of wheelchairs were highlighted. Requirements for a new system were ascertained. These included improved accuracy of tipping angles, features to support record keeping, improved client/carer education support and ability to model or predict client–wheelchair system performance in different configurations. Conclusions: The paper concludes that there is a need for improved tools to determine the stability of the client–wheelchair system and support the prescription process, to ensure client safety and optimum equipment performance. A list of requirements has been produced to guide the future development of WheelSense.Implications for RehabilitationThe results of this survey and interview-based study present a picture of wheelchair stability testing practices in the UK, and highlight the need for new, more informative methods for guiding wheelchair prescription.The requirements for the design of a new system, or further development of existing tools to support the stability testing and prescription of wheelchairs have been established. [ABSTRACT FROM PUBLISHER]

Purpose: Rehabilitation professionals have little information concerning lower limb exoskeletons for people with paraplegia. This study has four objectives: (1) Outline the characteristics of the exoskeletons’ design and their usefulness evidence as assistive mobility devices in the community for the Rewalk™, Mina, Indego®, Ekso™ (previously known as the eLEGS™) and Rex®; (2) document functional mobility outcomes of using these exoskeletons; (3) document secondary skills and benefits achieved with these exoskeletons, safety, user satisfaction and applicability in the community; and (4) establish level of scientific evidence of the selected studies.Method: A systematic review of the literature (January 2004 to April 2014) was done using the databases PubMed, CINAHL and Embase and groups of keywords associated with “exoskeleton”, “lower limb” and “paraplegia”.Results: Seven articles were selected. Exoskeleton use is effective for walking in a laboratory but there are no training protocols to modify identified outcomes over the term usage (ReWalk™: 3 months, Mina: 2 months and Indego®: 1 session). Levels of evidence of selected papers are low.Conclusions: The applicability and effectiveness of lower limb exoskeletons as assistive devices in the community have not been demonstrated. More research is needed on walking performance with these exoskeletons compared to other mobility devices and other training contexts in the community.Implications for rehabilitationCharacteristics of the exoskeletons’ design and their usefulness evidence as assistive mobility devices in the community are addressed for the Rewalk™, Mina, Indego®, Ekso™ and Rex® ReWalk™, Indego® and Mina lower limb exoskeletons are effective for walking in a laboratory for individuals with complete lower-level SCI.The ReWalk™ has the best results for walking, with a maximum speed of 0.51 m/s after 45 sessions lasting 60 to 120 min; it is comparable to the average speed per day or per week in a manual wheelchair.The level of scientific evidence is low. Other studies are needed to provide more information about performance over the longer term when walking with an exoskeleton, compared to wheelchair mobility, the user’s usual locomotion, the use of different exoskeletons or the training context in which the exoskeleton is used. [ABSTRACT FROM PUBLISHER]

The changes in cognitive abilities that accompany dementia can make it difficult to use everyday products that are required to complete activities of daily living. Products that are inherently more usable for people with dementia could facilitate independent activity completion, thus reducing the need for caregiver assistance. The objectives of this research were to: (1) gain an understanding of how water tap design impacted tap usability and (2) create an automated computerized tool that could assess tap usability. 27 older adults, who ranged from cognitively intact to advanced dementia, completed 1309 trials on five tap designs. Data were manually analyzed to investigate tap usability as well as used to develop an automated usability analysis tool. Researchers collaborated to modify existing techniques and to create novel ones to accomplish both goals. This paper presents lessons learned through the course of this research, which could be applicable in the development of other usability studies, automated vision-based assessments and the development of assistive technologies for cognitively impaired older adults. Collaborative interdisciplinary teamwork, which included older adult with dementia participants, was key to enabling innovative advances that achieved the projects' research goals.Implications for RehabilitationProducts that are implicitly familiar and usable by older adults could foster independent activity completion, potentially reducing reliance on a caregiver.The computer-based automated tool can significantly reduce the time and effort required to perform product usability analysis, making this type of analysis more feasible.Interdisciplinary collaboration can result in a more holistic understanding of assistive technology research challenges and enable innovative solutions. [ABSTRACT FROM PUBLISHER]

Ankle rehabilitation robots can play an important role in improving outcomes of the rehabilitation treatment by assisting therapists and patients in number of ways. Consequently, few robot designs have been proposed by researchers which fall under either of the two categories, namely, wearable robots or platform-based robots. This paper presents a review of both kinds of ankle robots along with a brief analysis of their design, actuation and control approaches. While reviewing these designs it was observed that most of them are undesirably inspired by industrial robot designs. Taking note of the design concerns of current ankle robots, few improvements in the ankle robot designs have also been suggested. Conventional position control or force control approaches, being used in the existing ankle robots, have been reviewed. Apparently, opportunities of improvement also exist in the actuation as well as control of ankle robots. Subsequently, a discussion on most recent research in the development of novel actuators and advanced controllers based on appropriate physical and cognitive human-robot interaction has also been included in this review. [ABSTRACT FROM AUTHOR]

This literature review aims to find the current state of the art in self-help devices (SHD) available for people with quadriplegia. We searched original articles, technical and case studies, conference articles, and literature reviews published between 2014 to 2019 with the keywords ("Self-help devices" OR "Assistive Devices" OR "Assistive Product" OR "Assistive Technology") AND "Quadriplegia" in Science Direct, Pubmed, IEEE Xplore digital library and Web of Science. Total 222 articles were found. After removing duplicates and screening these articles based on their title and abstracts 80 articles remained. After this, we reviewed the full text, and articles unrelated to SHD development or about the patients who require mechanical ventilation or where the upper limb is functional (C2 or above and T2 or below injuries) were discarded. After the exclusion of articles using the above-mentioned criterion 75 articles were used for further review. The abandonment rate of SHD currently available in the literature is very high. The major requirement of the people was independence and improved quality of life. The situation in India is very bad as compared to the developed countries. The people with spinal cord injury in India are uneducated and very poor, with an average income of 3000 ₹ (41$). They require SHDs and training specially designed for them, keeping their needs in mind. People with quadriplegia are totally dependent on caregivers. Assistive devices not only help these people to do day-to-day tasks but also provides them self-confidence. Even though there are a lot of self-help devices currently available, still they are not able to fulfil the requirements of people with quadriplegia, hence there is a very high abandonment rate of such devices. This study provides an evidence that developing devices after understanding the functional and non-functional requirements of these subjects will decrease the abandonment rate and increase the effectiveness of the device. The results of this study can be used for planning and developing assistive devices which are more focussed on fulfilling the requirements of people with quadriplegia [ABSTRACT FROM AUTHOR]

Children with severe, multiple disabilities often need to use switches to control their assistive technology. We developed the Switch Access Measure (SAM) to address the lack of validated functional activity-based measures to evaluate children's success using their prescribed switch(es). This goal-based performance measure evaluates switching ability on 16 skills items (6 motor, 2 visual, and 8 process). This study investigated SAM's reliability and confidence in scoring. Two occupational therapists with switch access intervention experience were trained as SAM study assessors. They independently scored SAM (inter-rater reliability) while viewing 20 study assessment videos where each child undertook at least one goal-based switching activity with their technology, and rated confidence in scoring for each SAM item. The SAM's two developers independently scored these videos as an inter-rater reliability benchmark. Each study assessor re-scored a subset of 10 videos 2–3 weeks later (intra-rater reliability). SAM Total score inter-rater reliability was excellent for the two study assessors (ICC =0.82) and the two SAM developers (ICC = 0.95). Inter-rater reliability was lowest (moderate) for Motor Subsection for the assessors, but still excellent for the developers. Intra-reliability for both groups of raters was excellent for Total and Subsection scores. Assessors' confidence in scoring was high (mean of 84.7% and 86.8% respectively) across items/participants. SAM is sufficiently reliable for clinical use, permitting clinicians, after SAM training and certification, to include it in their assessments and in development of switch access intervention plans for children with severe, multiple disabilities. For practitioners new to the field of switching technology, the SAM will provide a comprehensive understanding of all the components of successful switch use that need consideration when working with those needing switch access technologies. For all practitioners in this area, the SAM offers a consistent language to support clear communication among professionals, families, clients and their support networks. The SAM also gives quantifiable and reliable data to back clinical decision making, particularly important to support the case for funding of these technologies. Use of the SAM will prompt discussions with clients, families and carers and lead to better understanding of strengths and challenges, thus enhancing collaborative working relationships in the pursuit of achieving the best possible outcomes for those needing to use switch access technologies. [ABSTRACT FROM AUTHOR]

Due to the structural constraints of wheelchairs for users with motor disabilities, it is essential to understand and ensure their proper functioning for the quality of life of these users. The main objective of this study is to analyze the stresses and displacements in a wheelchair using the finite element method to evaluate its functional and structural aspects though simulations. Influenced by normative techniques that consider ergonomic, anthropometric and biomechanical, factors were considered to verify the compliance of this equipment considering current standards. Results were compared with experimental analyses performed by the Brazilian National Institute of Metrology, Quality and Technology (INMETRO). Results showed that von Mises stress limit values were exceeded in the chair frame by 6.5%, in the collision analysis by 72.1%, and in the footrest by 189.4%. This indicated that the structure of the analyzed wheelchair is not adequated based on simulation results, same as INMETRO reports. [ABSTRACT FROM AUTHOR]

People with Type 2 diabetes exhibit peripheral neuropathy that results in the progressive loss of sensation in their feet. This may adversely affect their ability to drive as there is the potential for their foot to slip off the accelerator or brake pedals, with unwanted consequences including traffic accidents. This research aimed to develop a prototype for an adaptive haptic foot device for diabetic drivers experiencing peripheral neuropathy that can serve as an early warning system for foot slip during driving. A prototype system was designed in the laboratory which consisted of four force sensing resistors, four light emitting diodes and an eccentric rotating mass all connected and programmed through an Arduino Uno. The prototype was tested under controlled conditions and validated against recommended specifications. The system was then installed in a Ford Falcon GT 2005 and tested under controlled road conditions. The results indicated that the haptic device was effective in sensing foot locations and providing instant audio and video feedback to the driver. This research has successfully designed and fabricated a haptic feedback device that can be used as an early warning system for diabetic automobile drivers with peripheral neuropathy. A haptic foot prototype device capable of generating warning signals to diabetic drivers whose foot could slip off the brake or accelerator pedals has been developed. The prototype includes force sensing receivers integrated with eccentric rotating mass system, a haptic controller breakout board, and Arduino software. The system is very easy to use and provides highly reliable audio and visual feedback which are good alerting mechanisms for older automobile drivers. [ABSTRACT FROM AUTHOR]

For persons with disabilities in low-resource and tropical settings, barriers to mobility and physical activity are steep. The aim of this study was to develop and test two low-cost, durable, sustainable, purpose-built wheelchair prototypes to support wheelchair users in low-resource and tropical settings. These bamboo wheelchairs, nicknamed African Chairs by Ghanaian daily manual wheelchair users who tested the devices, adopt two designs: an urban-targeted and a rural-targeted design. The rural-targeted design incorporated stability as its key design property for the purpose of navigating variable terrain. The urban-targeted design adopted a sleeker, more portable profile for environments that require wheelchair transport in vehicles and the navigation of elevators and ramps. Both designs integrated bamboo-rod skeletons, bonded by hot-glue gun, jointed and wrapped with epoxy-soaked fibers, then upholstered by a local tailor, with basic standard wheel components. An iterative design process incorporated expert consultation as well as user feedback. The final prototypes received positive testing reviews from daily manual wheelchair users in Ghana. These locally-built, safe, economical bamboo wheelchairs have the potential to improve accessibility, provide more independence and reduce immobility-related health risks for many. Persons with disabilities have a right to mobility, maximum independence, and the psychological, emotional, and physical health benefits of physical activity those rights confer. For persons with disabilities in low-resource settings, barriers to mobility and physical activity are steep, due to social stigmatization and the cost and adaptability of equipment. Bamboo wheelchairs have the potential to increase access to mobility and physical activity by allowing wheelchairs to be efficiently produced at cost, according to the user's needs. The aesthetics of bamboo wheelchairs can help reduce social stigma by avoiding the "medicalization" of wheelchairs and other traditional mobility devices. [ABSTRACT FROM AUTHOR]

Functional electrical stimulation (FES), through repetitive training (FES-therapy) or continuous assistance (neuro-prosthesis), can restore motor function after paralysis due to spinal cord injury or stroke. With current technology, patients are often incapable of independently applying FES, thereby limiting its use. Novel FES-garments with embedded stimulation electrodes were developed in collaboration with Myant, Canada, to address this problem. The purpose of this study was to collect the views of future end-users to inform the refinement of the device design and to obtain insights on subsequent commercialization of this rehabilitation and assistive technology. A qualitative study was undertaken to determine the needs of potential users (patients and clinicians; n = 19). Participant took part in interviews or focus groups after a presentation of the garments. An inductive content analysis was used to generate the themes from the data and identify data saturation. The identified themes and sub-themes were: (1) User Perspectives: users' characteristics (needs, limitations), expected benefits (beliefs), and anticipated problems (fears); (2) Device Design: technical features, usability, and disadvantages of the garment, cables, stimulator, software, and interface; (3) Acquisition Process: organizational procedures (acquisition and adoption steps); and (4) Business Model: financial and strategic aspects to facilitate commercialization and support users. The insights obtained from end-users and clinicians provide guidelines to optimize the development of novel FES-garments, and strategies for bringing the device to the market. The themes identified can serve to inform other rehabilitation and assistive technology developers with processes and ideas on how to meet these groups' needs. Participants with neurological paralysis have interest and critical views on new rehabilitation and assistive technology, and the repercussions of using new technologies to address their function, health and wellbeing. The FES-garment design presented appeared acceptable to the end-users, pending resolution of certain shortcomings (wiring, operating duration, robustness, easiness to don and doff). End-users and clinicians had specific views regarding the acquisition process of new technologies (training, customization, and follow-up/support), which are important to take into consideration to ensure broad stakeholders uptake. [ABSTRACT FROM AUTHOR]

Background: Dental chairs are a vital tool in modern dentistry. Their design has paved the way for increasing improvement in dental treatment. Since the 1900's, the dental chair design has continuously evolved and transformed from manually operated mechanisms to recently automated mechanism, in spite of advancements a common obstacle faced by these wheelchair bound populations in using present dental chair is transfer. Wheelchair users need to be transferred from the wheelchair to other places many times a day. In most of the cases the wheelchair user does not possess the capability of transferring to a dental chair independently. Therefore assistance is needed either from dental clinic staff or from family and friends. This transfer of patients from wheelchair not just requires manpower but also creates unnecessary anxiety among the wheel chair bound patients. Solution: Thus a modified dental chair was constructed which would accommodate the wheelchair bound patients to the dental chair without any transfer. This study highlights the mechanism of action of the modified dental chair. Improve access among wheelchair bound patients to dental care services Decreases anxiety among the disadvantaged population in clinical set up [ABSTRACT FROM AUTHOR]

Purpose: The present research aims to contribute to the comprehension of the product development process (PDP) of Assistive Technology (AT) through methodological multi-case studies in Brazil. The following considerations presented in the study are part of a Master's degree thesis, conducted from 2013 to 2015. Methodology: The research adopted a multi-case study methodology by selecting four product developers from the Assistive technology field in Brazil, focusing on physical disability. Results: According to the findings, this research discusses the possible influences of Emotional Collaborative Design on the process of Assistive Technology, aiming at enhancing new perspectives about such tools on the product development process. As a result, it was possible to set a delimitation of PDP of AT stages in the four cases approached, in most of the methodological steps empirically developed. Conclusion: Final considerations of the study, collaborate with the comprehension of the assistive product development, stating there is still a little emphasis on the design concepts throughout these processes, also illustrates the necessity for further studies about the product development in the area. The visualization of a still scarce dialogue between the multiple areas that could contribute for AT development; The potential correlation between high dissatisfaction in several issues regarding use of ATs and the poor understanding of user needs; The predominance of a great functionality emphasis, and the negligence of the individual's emotional in AT development; The understanding that product design maybe is still poorly applied/understood in this field. [ABSTRACT FROM AUTHOR]

Carbon fibre-reinforced polymers have been used in the sporting goods industry for decades, and wheelchairs have incorporated the material since the late 1980s. There is no independently collected data available on carbon fibre-reinforced polymer wheelchairs' performance on the ANSI/RESNA testing standards, however. This study evaluated three full carbon fibre wheelchair specimens to determine their performance versus similar wheelchairs. Testing determined that while the frames survived more testing cycles than any other wheelchair, the casters and rear tires failed similarly to other devices. Overall, due to the purchase cost, the cost benefit of the tested wheelchair model was similar to aluminium wheelchairs. Carbon fibre wheelchair construction is a viable alternative to aluminium, titanium, or steel construction, and decreasing costs will continue to improve the benefits of carbon fibre over these models Carbon fibre wheelchair found to be more durable than aluminium models, but are also much more expensive. The additional cost may be justified for some users that need the increased durability, however Increased durability will reduce the number of repairs and warranty claims, potentially reducing the burden on a wheelchair user, and also improving their ability to travel and participate in their community The low weight of carbon fibre wheelchairs may increase the mobility of some users by allowing them to transfer more easily into and out of vehicles and manoeuvre throughout the environment [ABSTRACT FROM AUTHOR]

Purpose: Ambulation is an important objective for people with pathological gaits. Exoskeleton robots can assist these people to complete their activities of daily living. There are exoskeletons that have been presented in literature to assist the elderly and other pathological gait users. This article presents a review of the degree of support required in the elderly and neurological gait disorders found in the human population. This will help to advance the design of robot-assisted devices based on the needs of the end users. Methods: The articles included in this review are collected from different databases including Science Direct, Springer Link, Web of Science, Medline and PubMed and with the purpose to investigate the gait parameters of elderly and neurological patients. Studies were included after considering the full texts and only those which focus on spatiotemporal, kinematic and kinetic gait parameters were selected as they are most relevant to the scope of this review. A systematic review and meta-analysis were conducted. Results: The meta-analysis report on the spatiotemporal, kinematic and kinetic gait parameters of elderly and neurological patients revealed a significant difference based on the type and level of impairment. Healthy elderly population showed deviations in the gait parameters due to age, however, significant difference is observed in the gait parameters of the neurological patients. Conclusion: A level of agreement was observed in most of the studies however the review also noticed some controversies among different studies in the same group. The review on the spatiotemporal, kinematics and kinetic gait parameters will provide a summary of the fundamental needs of the users for the future design and development of robotic assistive devices. The support requirements provide the foundation for designing assistive devices. The findings will be crucial in defining the design criteria for robot assistive devices. [ABSTRACT FROM AUTHOR]

Three-dimensional (3D) printing now allows rehabilitation professionals to design and manufacture assistive technologies in a few hours. However, there is limited guidance for researchers and clinicians for implementing 3D printing assistive technology interventions and measuring their outcomes. The goal of this study was to develop a standardized 3D printing assistive technology intervention and a research methodology, using pillboxes as an example. Fourteen pillbox users engaged in a study comparing their use of an off-the-shelf pillbox to a customized 3D printed pillbox. Study outcomes were evaluated on feasibility (recruitment capability, study procedures and outcome measures, acceptability of the study procedures, the research team's ability to manage and implement the study, and the participant's preliminary response to intervention). Participant outcomes were measured on satisfaction with the device and medication adherence. Fourteen participants completed the study and received customized 3D printed pillboxes. The study design performed well on all aspects of feasibility except the research team's ability to manage and implement the study, as they experienced several technical issues. Notably, the participants reported improved device satisfaction and medication adherence with the 3D printed device with large effect sizes. The 3D printed assistive technology intervention is a replicable process that supports professionals in printing their own assistive technologies. Recommendations are made to further enhance feasibility of 3D printing assistive technology studies. Future research is warranted. 3D printing is an increasingly feasible approach allowing for the design and manufacture of customized assistive technology Evaluation for assistive technology that will be 3D printed should include information about the person's activities, routines, skills, abilities, and preferences. Evaluation of outcomes should include satisfaction with the device and a functional measure. 3D printed assistive technology interventions should include the collaboration between the assistive technology professional and client. It should also include device training. Future 3D printing research studies should report pragmatic data including printing device, time to print, and number of errors. [ABSTRACT FROM AUTHOR]

Purpose: The assistive knee exoskeleton device is used for supporting the surrounding ligaments, tendons, and muscles of the injured knee joint. Various knee exoskeletons have been discussed; however, their shape synthesis is not reported. This study aims to present the shape synthesis of the assistive knee device. Moreover, four-bar linkage is used for the knee exoskeleton, in this study. Methods: Clinical biomechanical data are adapted from gait database for one gait cycle. Using the clinical gait data, position and static force analyses are performed to obtain a set of orientations and unknown forces. Simultaneously, CAD models are prepared, and the obtained forces are applied to the CAD models of the four-bar linkage knee exoskeleton. Consequently, the threshold is obtained for each component of the knee exoskeleton and the unwanted material below the threshold is removed. Results: A reduction of 45% in the peak actuating force is observed in comparison with the literature. Besides, a total reduction of 21% in the mass of four-bar knee exoskeleton is observed in contrast to the base models when shape synthesis is performed. Conclusions: An assistive knee exoskeleton is developed using the shape synthesis methodology in which four-bar linkage is used. New shapes of thigh and shank attachments are obtained. The developed knee exoskeleton can be used by persons with the injured knee for supporting the ligaments, tendons, and muscles. Besides, control technology can be implemented to make it useful for persons with monoplegia. Assistive knee exoskeleton devices proved to be an important tool for providing support to injured knee joints. Typically single axis joints are observed in the lower limb exoskeletons which can be replaced with linkage mechanisms to obtain the desired range of motion. In this study, four-bar linkages are used for the knee exoskeleton in which cranks and rockers are connected to the lateral and medial sides of the knee joint, for connecting shank and thigh attachments. Shape synthesis is performed on the components of four-bar exoskeleton through the evaluated reaction forces. The components are assembled to form an assistive knee exoskeleton which can be used by any person with injured knee joint. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this research is to identify stakeholder views with regard to the development of effective powered wheelchair assistive technologies more suited to the user and carer needs, whilst also meeting the requirements for other stakeholders, such that developers can be better guided towards producing solutions which have a better chance of getting to the market place and hence to the end user. Method: A questionnaire was designed to collect the views of all stakeholders and circulated to a statistically representative number of them. The question rating data were then checked for correlation between groups, and within groups, to establish validity. Results: The 74 stakeholders across the eight classes who responded had a good correlation between each other, with a cross class "Pearson's correlation" ranging between 0.7 and 0.95, and the "Fleiss's Kappa reliability of agreement" within each class ranging between 0.07 and 0.36. Conclusions: This research has identified that all stakeholders should be involved in the development of the technology and that some may benefit in 'role-reversal' to help understand user problems and stakeholder concerns more clearly. Cost was a significant barrier to the uptake of appropriate technology, and training of users and carers was a major issue. Furthermore, development should not increase user isolation and the impact on the user must be monitored for 'quality of life'. Technical support and training should be given to the user and their carers, and equipment must be adaptive to meet the changing needs of the user. Improved acceptance and use of technology by the user and their carers. Reduced rejection of appropriate provision. Improved mobility and interaction with others. Improved quality of life for users and carers. [ABSTRACT FROM AUTHOR]

Purpose: For off-road mobility, some manual or power assisted devices were conceived to be self-driven by paraplegics while for tetraplegics non power-assisted devices were conceived. These devices require one or more conductors who are subjected to a high physical demand thus potentially creating: precarious safety condition for the user an elevated physical demand of conductors could reduce the care and the attention to give to the user; the time of the outdoor adventure experience of the user could be limited. Methods: To address these issues, an innovative user-centered power assisted off-road wheelchair for the transportation of tetraplegics along mountain trails was developed. The device, structured like a trike, is driven by two healthy conductors; the user is placed in the middle of the frame. A movable seat provides for the transfer from the standard to the off-road wheelchair. An electrical motor, powered by a battery pack, provides for the actuation. All the design and prototype aspects, the control system and experimental tests are detailed. Results: The prototype satisfies mechanical, safety and duration requirements. No physical demand while using the device and for the transfer of the user to the device was identified. Fun and engaging tests were carried out and all the participants were involved. The device has the potential to enhance the quality of life of tetraplegics in terms of new life experiences. The device revealed the real possibility of a full recreational experience, an enhanced participation and a better social integration of tetraplegics. [ABSTRACT FROM AUTHOR]

Title: Survey of the functional priorities in patients with disability due to neuromuscular disorders. Objective: This study attempts to determine the functional priorities for patients with neuromuscular disorders. Methods: A survey asking about functional priorities with respect to activities of daily living, ankle foot orthotic design, and assistive device design, was distributed to patients with neuromuscular disorders to assess the needs of patients from their perspectives. Descriptive statistics were used to analyse answers. Results: A total of 171 subjects with neuromuscular disorders responded to the questionnaire. Of the respondents with weakness in both the upper and lower extremities, 45% stated that if they had to choose between correction of one or the other, they would prefer that of their lower extremities. Activities that patients most frequently wanted to gain independence with were mobility and transfers (46%), followed by toilet use and hygiene (32%). The most popular control mechanism of an assistive device was voice activation (35%). Conclusion: This study assessed the functional priorities of those with neuromuscular disorders. Although such individuals can experience a range of weakness in the upper and/or lower extremities, common functional priorities were reported: independence with mobility, transfers, toilet use and hygiene. Knowledge of these priorities will help guide development of assistive devices that will restore function in the future. Neuromuscular Disorders • Neuromuscular disorders result in disabling weakness; there are few cures and many are unable to carry out activities of daily living. • Information that would be helpful in determining functional priorities is limited. • In a survey of 171 patients with neuromuscular disorders, functional priorities included mobility and transfers (46%), followed by toilet use and hygiene (32%). • Of the respondents with weakness in both the upper and lower extremities, 45% stated that if they had to choose between correction of one or the other, they would prefer that of their lower extremities. • If an assistive device were to be created to help those with neuromuscular disorders, the most popular control mechanism would be voice activation (35%). [ABSTRACT FROM AUTHOR]

Purpose: To profile and compare the seating and powered characteristics and functions of electrically powered wheelchairs (EPWs) in a general user population including equipment costs. Method: Case notes of adult EPW users of a regional NHS service were reviewed retrospectively. Seating equipment complexity and type were categorized using the Edinburgh classification. Powered characteristics and functions, including control device type, were recorded. Results: 482 cases were included; 53.9% female; mean duration EPW use 8.1 years (SD 7.4); rear wheel drive 88.0%; hand joystick 94.8%. Seating complexity: low 73.2%, medium 18.0%, high 8.7%. Most prevalent diagnoses: multiple sclerosis (MS) 25.3%, cerebral palsy (CP) 18.7%, muscular dystrophy (8.5%). Compared to CP users, MS users were significantly older at first use, less experienced, more likely to have mid-wheel drive and less complex seating. Additional costs for muscular dystrophy and spinal cord injury users were 3-4 times stroke users. Conclusions: This is the first large study of a general EPW user population using a seating classification. Significant differences were found between diagnostic groups; nevertheless, there was also high diversity within each group. The differences in provision and the equipment costs across diagnostic groups can be used to improve service planning. Implications for Rehabilitation: At a service planning level, knowledge of a population's diagnostic group and age distribution can be used to inform decisions about the number of required EPWs and equipment costs. At a user level, purchasing decisions about powered characteristics and functions of EPWs and specialised seating equipment need to be taken on a case by case basis because of the diversity of users' needs within diagnostic groups. The additional equipment costs for SCI and MD users are several times those of stroke users and add between 60 and 70% of the cost of basic provision. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the levels and factors that influence the abandonment of assistive products by users of a local reference rehabilitation center. Methods: This observational study involved users who received services and assistive products provided by our center of rehabilitation. Users were identified using the records of the center and their responses about the abandonment were collected through face-to-face interviews. Results: The abandonment level of assistive products was 19.38%. 83.5% of the users use at least one of the assistive products they have received. Rigid and folding frame wheelchairs, with and without postural support devices, as well as shower wheelchairs, presented the lowest abandonment levels, followed by canes and lower limb orthoses. Upper limb orthoses, Knee Ankle Foot Orthosis(KAFO), walkers, crutches and lower and upper limb prostheses all presented higher abandonment levels. Conclusion: The simultaneous use of mutiple assistive products, users perception on the importance of using them, and completing the rehabilitation treatment were found to impact on the short and long-term use of products. The study offers inputs to decision making and planning for assistive technology provision in developing countries with regard to expected demand and service delivery. Implications for Rehabilitation: Data about the abandonment of assistive products in Sao Paulo, Brazil, could assist informing decision making on provision and servicing of these products in similar settings. The strong correlation found between abandonment levels and the simultaneous use of multiple devices should be taken into account by health professionals when prescribing assistive products and providing guidance to users. The need for follow up on the use of assistive products after discharge from rehabilitation treatment becomes strikingly clear, as data show that completing treatment is significantly relevant when evaluating abandonment levels. As assistive products users’ perception about the importance of using these devices is shown to be significant in explaining abandonment, it is mandatory that health and rehabilitation professionals take it into account when providing guidance and training users. [ABSTRACT FROM AUTHOR]

Purpose: This article aims to clarify the current state-of-the-art of robotic/mechanical devices for post-stroke thumb rehabilitation as well as the anatomical characteristics and motions of the thumb that are crucial for the development of any device that aims to support its motion. Methods: A systematic literature search was conducted to identify robotic/mechanical devices for post-stroke thumb rehabilitation. Specific electronic databases and well-defined search terms and inclusion/exclusion criteria were used for such purpose. A reasoning model was devised to support the structured abstraction of relevant data from the literature of interest. Results: Following the main search and after removing duplicated and other non-relevant studies, 68 articles (corresponding to 32 devices) were left for further examination. These articles were analyzed to extract data relative to (i) the motions assisted/permitted - either actively or passively - by the device per anatomical joint of the thumb and (ii) mechanical-related aspects (i.e., architecture, connections to thumb, other fingers supported, adjustability to different hand sizes, actuators - type, quantity, location, power transmission and motion trajectory). Conclusions: Most articles describe preliminary design and testing of prototypes, rather than the thorough evaluation of commercially ready devices. Defining appropriate kinematic models of the thumb upon which to design such devices still remains a challenging and unresolved task. Further research is needed before these devices can actually be implemented in clinical environments to serve their intended purpose of complementing the labour of therapists by facilitating intensive treatment with precise and repeatable exercises. Implications for Rehabilitation: Post-stroke functional disability of the hand, and particularly of the thumb, significantly affects the capability to perform activities of daily living, threatening the independence and quality of life of the stroke survivors. The latest studies show that a high-dose intensive therapy (in terms of frequency, duration and intensity/effort) is the key to effectively modify neural organization and recover the motor skills that were lost after a stroke. Conventional therapy based on manual interaction with physical therapists makes the procedure labour intensive and increases the costs. Robotic/mechanical devices hold promise for complementing conventional post-stroke therapy. Specifically, these devices can provide reliable and accurate therapy for long periods of time without the associated fatigue. Also, they can be used as a means to assess patients? performance and progress in an objective and consistent manner. The full potential of robot-assisted therapy is still to be unveiled. Further exploration will surely lead to devices that can be well accepted equally by therapists and patients and that can be useful both in clinical and home-based rehabilitation practice such that motor recovery of the hand becomes a common outcome in stroke survivors. This overview provides the reader, possibly a designer of such a device, with a complete overview of the state-of-the-art of robotic/mechanical devices consisting of or including features for the rehabilitation of the thumb. Also, we clarify the anatomical characteristics and motions of the thumb that are crucial for the development of any device that aims to support its motion. Hopefully, this?combined with the outlined opportunities for further research?leads to the improvement of current devices and the development of new technology and knowledge in the field. [ABSTRACT FROM AUTHOR]

Introduction: The concept of assistive technology covers several areas of action; one of them is communication with the elaboration of accessible solutions to overcome daily difficulties. It contributes to the resumption of functional abilities, expanding and facilitating inclusion and independent living. Objective: To analyze the usability of a low cost prototype device to support educational activities of adolescents with cerebral palsy. Methods: A descriptive observational study. The evaluation of a prototype device was made through a validated questionnaire, Quest Version 2.0, on the level of the user’s satisfaction with an assistive technology, composed of 12 evaluation items. The questionnaire was filled out by the educator based on the observation of four wheelchair-bound participants diagnosed with cerebral palsy according to the international classification of diseases and health-related problems, ICD-10, who attend a coexistence and teaching institution in the state of São Paulo, Brazil. Results: The device developed was considered an assistive technology, which provided an experience with a positive level of satisfaction for the participants. Conclusion: The tested prototype contributes to communication and interaction allowing adolescents with cerebral palsy to participate in educational activities. Implications for Rehabilitation: The device assists the individual in the educational activities and can positively influence their development, observe the individual number 5, who has an important limitation in coordination and fine movements, placing the role of the task in the vertical position offers a new perspective to perform the task, this stimulates him to try to perform the work, so the challenge was adjusted to the demands of each individual which can contribute to its neuromotor development, the amplitude of the distal movements and the manual ability, since it must look for alternatives to complete the task requested. [ABSTRACT FROM AUTHOR]

Purpose: This article illustrates user-centred design of a novel sensor access system for environmental control in the concept stage of development.Methods: Focus groups of individuals with disabilities and rehabilitation healthcare professionals were provided with video illustration of the technology and asked to provide quantitative and qualitative feedback through a semistructured interview process. Qualitative methods were employed to analyse transcribed comments to develop themes supporting ongoing development of the technology.Results: Both end-user streams rated the original design features of the sensor access system (alternative interface to assistive technologies, having wireless capabilities and not requiring batteries) as having high potential value. Both groups identified a need for the future design of the sensor technology to be able to capture minimal/reduced movements for those with severe physical impairments. Themes included (1) the sensor technology could be individualized/customized to accommodate the user, (2) minimal positioning and set-up requirement and (3) technology that alleviated problems encountered with touch-based solutions.Conclusions: Inclusion of end-user feedback provided the research team with valuable information that supported the initial conceptualization of the design features of the technology and provided valuable data to support development of a new prototype that can capture more reduced/minimal movements. Implication for Rehabilitation User-centered design of assistive technology is essential to the development of technology that can meet the unique needs of those with the most severe physical impairments.New sensor technology may alleviate some of the access challenges faced by individuals with severe physical impairments.Collaboration between all key stakeholders (individuals with disabilities, rehabilitation professionals, researchers, and developers) is an essential component in the iterative assistive technology design process. [ABSTRACT FROM AUTHOR]

Purpose:Multipurpose robots that can perform a range of useful tasks have the potential to increase the quality of life for many people living with disabilities. Owing to factors such as high system complexity, as-yet unresolved research questions and current technology limitations, there is a need for effective strategies to coordinate the development process. Method:Integrating established methodologies based on human-centred design and universal design, a framework was formulated to coordinate the robot design process over successive iterations of prototype development. Results:An account is given of how the framework was practically applied to the problem of developing a personal service robot. Application of the framework led to the formation of several design goals which addressed a wide range of identified user needs. The resultant prototype solution, which consisted of several component elements, succeeded in demonstrating the performance stipulated by all of the proposed metrics. Conclusions:Application of the framework resulted in the development of a complex prototype that addressed many aspects of the functional and usability requirements of a personal service robot. Following the process led to several important insights which directly benefit the development of subsequent prototypes.Implications for RehabilitationThis research shows how universal design might be used to formulate usability requirements for assistive service robots.A framework is presented that guides the process of designing service robots in a human-centred way.Through practical application of the framework, a prototype robot system that addressed a range of identified user needs was developed. [ABSTRACT FROM PUBLISHER]

Wheelchair breakdowns increase the risk of injury and limit the mobility of wheelchair users. In the endeavour to meet the enormous global need for wheelchairs, manufacturers of wheelchairs for low-resource settings face a cost–benefit tension between affordability and durability. Field studies are needed to provide feedback on durability. Four manufacturers provided cadres of wheelchairs to the organization providing rehabilitation to students at a boarding school for children with disabilities in a low-resource area. The Wheelchair Components Questionnaire for Condition was used to evaluate wheelchair maintenance condition at several time intervals after fitting. Because the maintenance regime was not identical for the four wheelchair types, wheelchair types were not compared. Analysis of variance indicated differences in condition across time and between wheelchair components. Tukey’s simultaneous comparison of means indicated that across the entire group, brakes, seats, casters and foot rests received lower ratings than frame. Preliminary data after each iteration of this study were provided to manufactures and resulted in responsive design changes.Implications for RehabilitationLongitudinal studies with the Wheelchair Components Questionnaire for Condition (WCQc) have enabled manufacturers to make responsive design improvements. Additional studies could be done with other wheelchair types to result in responsive positive design changes for those wheelchairs as well.The WCQc can be used in studies on wheelchair condition even when records of repair history are not reliably available, a situation which is not uncommon in low-resource areas.Data sets collected at an individual clinic uses the WCQc could focus attention on wheelchair components needing regular repair. With that data in mind, the maintenance regime could be modified to respond and in so doing improve wheelchair condition and reduce loss of mobility or risk of injury.Organizations involved in funding wheelchairs for a particular location could use data from longitudinal studies done with the WCQc at that location to inform purchasing decisions. [ABSTRACT FROM PUBLISHER]

Summative content analysis was used to define methods and heuristics from each case study. The review process was in two parts: (1) A literature review to identify conventional research methods and (2) a summative content analysis of published case studies, based on the identified methods and heuristics to suggest an order and priority of where and when were used. Over 200 research and design methods and design heuristics were identified. From the review of the 20 case studies 42 were identified as being applied. The majority of methods and heuristics were applied in phase two, market choice. There appeared a disparity between the limited numbers of methods frequently used, under 10 within the 20 case studies, when hundreds were available.Implications for RehabilitationThe communication highlights a number of issues that have implication for those involved in assistive technology new product development:•The study defined over 200 well-established research and design methods and design heuristics that are available for use by those who specify and design assistive technology products, which provide a comprehensive reference list for practitioners in the field;•The review within the study suggests only a limited number of research and design methods are regularly used by industrial design focused assistive technology new product developers; and,•Debate is required within the practitioners working in this field to reflect on how a wider range of potentially more effective methods and heuristics may be incorporated into daily working practice. [ABSTRACT FROM PUBLISHER]

We all do this. We personalize things. We buy leopard-printed seat covers and fuzzy dice for our cars, and display action figures and photographs in our offices. Studying older adults who have extended this process of personalization to their mobility devices, the purpose of the mobility aid personalization (MAPx) project is to examine MAPx and its impact on the health and mobility of older adults. Using a qualitative research design, field observations and interviews were conducted with 72 older adults to gain an in-depth understanding of device customization from an emic (insider’s) perspective. Findings illustrate that older adults personalize their devices for reasons offun,functionandfashion. MAPx – the process of purposefully selecting or modifying a mobility device to suit individual needs and preferences – was also found to promote health and mobility by encouraging device acceptance, increasing social participation, enhancing joy and preserving identity. MAPx makes an important contribution to our understanding of the complex relationship between older adults and assistive devices and provides anewapproach to someoldproblems including falls, inactivity and social isolation. Encouraging MAPx is a promising rehabilitation strategy for promoting health and community mobility among the older adult population.Implications for RehabilitationPersonalizing an assistive device facilitates device acceptance, promotes health and well-beingand should be supported and encouraged in rehabilitative care.Choice, variety and access are critical aspects of assistive devices; vendors, manufacturers andpractitioners should work together to provide clients with a greater range of affordable optionsfor new devices.Function is more than mechanical or physical; social factors including social identity, stigma andsocial roles must be adequately considered and explicit in rehabilitative practice. [ABSTRACT FROM PUBLISHER]

Purpose: Using a commercial electroencephalography (EEG)-based brain–computer interface (BCI), the training and testing protocol for six individuals with spastic quadriplegic cerebral palsy (GMFCS and MACS IV and V) was evaluated.Method: A customised, gamified training paradigm was employed. Over three weeks, the participants spent two sessions exploring the system, and up to six sessions playing the game which focussed on EEG feedback of left and right arm motor imagery.Results: The participants showed variable inconclusive results in the ability to produce two distinct EEG patterns. Participant performance was influenced by physical illness, motivation, fatigue and concentration.Conclusions: The results from this case study highlight the infancy of BCIs as a form of assistive technology for people with cerebral palsy. Existing commercial BCIs are not designed according to the needs of end-users.Implications for RehabilitationMood, fatigue, physical illness and motivation influence the usability of a brain–computer interface.Commercial brain–computer interfaces are not designed for practical assistive technology use for people with cerebral palsy.Practical brain–computer interface assistive technologies may need to be flexible to suit individual needs. [ABSTRACT FROM PUBLISHER]

Purpose: The purpose of this study is to describe the results of focus groups held during the Independent Wheelchair Transfer (IWT) Workgroup. The aims were to facilitate exchange of ideas on (1) the impact of the built environment on the wheelchair transfer process within the community (i.e. moving from wheelchair to and from other surfaces (e.g. furniture, toilet seat, bath bench, car seat) to participate in daily activities), (2) wheelchair users' needs during transfers in the built environment, and (3) future research directions.Method: Live web-based conferencing using Adobe Connect technology (Clarix Technologies, Inc., Pittsford, NY) was utilized to conduct three focus groups composed of experts in the field of assistive technology. Investigators independently reviewed focus group meeting transcripts and used qualitative methods to identify main themes.Result: Thirty-one experts in assistive technology and related fields participated in focus groups. Nine main themes were found including the effect of transfer skills training, space considerations in the built environment, wheelchair configuration, and the interaction between the built environment, user preferences, and transfer techniques. All groups raised issues about the transfer process in areas of the built environment with limited access, the effect of wheelchair users' transfer techniques, and user preferences during transfers.Conclusions: The area of independent transfers is multi-faceted and several factors require consideration when contemplating environmental changes to improve accessibility for wheelchair users. Obvious opportunity exists for research which could lead to advances in transfer technology, environments, and techniques for wheelchair users.Implications for RehabilitationTremendous opportunities for research collaborations in the field of assistive technology:To develop new terminology to describe wheelchair transfers.To improve the design of the built environment for wheelchair users.To investigate wheelchair transfer training techniques. [ABSTRACT FROM PUBLISHER]

Purpose: The present study aimed to improve the design of an interface that may help disabled children to play a musical instrument. The main point is to integrate human motion capture in the design process. Method: The participant performed 20 pointing movements toward four selected locations. A three one-way analysis of variance (ANOVA) was performed in order to determine the most efficient input location. For each button position, we compared (1) the reaction time (RT), (2) the movement time (MT), and (3) the spatial variability of the movements. Results: According to the results obtained for RT and MT, one position was the most efficient button location in order to produce efficient movements. Conclusions: As the case study showed, combining the 3D motion capture system and the statistical analysis led to help the designers their design methodology and crucial choices. [ABSTRACT FROM AUTHOR]