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Appropriate paper-based technology (APT) is used to provide postural support for children with cerebral palsy (CP) in low-resourced settings. This pilot study aimed to evaluate the impact of APT on the children's and families' lives. A convenience sample of children with CP and their families participated. Inclusion was based on the Gross Motor Function Classification System levels IV and V. APT seating or standing frames were provided for six months. A mixed methods impact of APT devices on the children and families included the Family Impact Assistive Technology Scale for Adaptive Seating (FIATS-AS); the Child Engagement in Daily Life (CEDL) questionnaire; and a qualitative assessment from diary/log and semi-structured interviews. Ten children (median 3 years, range 9 months to 7 years). Baseline to follow-up median (IQR) FIATS-AS were: 22.7 (9.3) and 30.3 (10.2), respectively (p=.002). Similarly mean (SD) CEDL scores for "frequency" changed from 30.5 (13.2) to 42.08 (5.96) (p=.021) and children's enjoyment scores from 2.23 (0.93) to 2.91 (0.79) (p=.019). CEDL questionnaire for self-care was not discriminatory; seven families scored zero at both baseline and 6 months. Qualitative interviews revealed three key findings; that APT improved functional ability, involvement/interaction in daily-life situations, and a reduced family burden of care. APT devices used in Kenyan children with non-ambulant CP had a meaningful positive effect on both the children's and their families' lives. Assistive devices are often unobtainable for children with cerebral palsy (CP) in low-income countries. APT is a low cost and sustainable solution to make seating and standing devices for disabled children in Kenya. The regular use of a postural support device enhanced the children's motor skills, ability to function and participate in everyday activities, reduced the burden of care for the families and promoted the children's social interaction. The postural support devices were highly valued and utilised by the children and families in this study. [ABSTRACT FROM AUTHOR]

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]

Purpose: In this paper, the authors explore the use of mobile devices as assistive technology for students with visual impairments in resource-limited environments. This paper provides initial data and analysis from an ongoing project in Kenya using tablet devices to provide access to education and independence for university students with visual impairments in Kenya. Method: The project is a design-based research project in which we have developed and are refining a theoretically grounded intervention - a model for developing communities of practice to support the use of mobile technology as an assistive technology. We are collecting data to assess the efficacy and improve the model as well as inform the literature that has guided the design of the intervention. Results: In examining the impact of the use of mobile devices for the students with visual impairments, we found that the devices provide the students with (a) access to education, (b) the means to participate in everyday life and (c) the opportunity to create a community of practice. Conclusions: Findings from this project suggest that communities of practice are both a viable and a valuable approach for facilitating the diffusion and support of mobile devices as assistive technology for students with visual impairments in resource-limited environments. [ABSTRACT FROM AUTHOR]

Because outcomes studies are known to facilitate effective use of funds, economic realities in lower-resource countries increase the need for outcome measures for wheelchair effectiveness in these areas. Effective use of funds based on evidence is especially needed since the level of wheelchair provision is low, and many wheelchairs are inappropriate for their intended users. There are very few existing wheelchair specific assistive technology outcome measures. The Wheelchair Satisfaction Questionnaire (WSQ) was designed to be a snapshot of a wheelchair user's level of satisfaction with their wheelchair. The current studies examined the development of the WSQ and its initial face and content validity. The WSQ is comprised of 16 visual analogue scale questions; each question includes a qualitative explanatory comment. In study 1, 15 adult users of manual wheelchairs completed the WSQ and then the completed a follow-up questionnaire which collected feedback on each question. In study 2, 15 secondary school student users of manual wheelchairs in Kenya completed the same procedure used in study 1. High mean satisfaction scores on the follow-up questionnaire support face and content validity in both studies. The WSQ has the potential to give wheelchair users a quantifiable voice on wheelchair function. Data obtained from the WSQ also has the potential to provide data from wheelchair users to wheelchair manufacturers and providers, leading to better design and provision. Based upon the score of a specific item, manufacturers could improve design of wheelchairs for use in lower-and-middle-income countries, and providers could be better-informed as to models sent to specific environments. The WSQ could provide evidence-based information to support improved provision and design. The WSQ could be used in a clinical setting over time to identify the most common interface problems in that particular setting. [ABSTRACT FROM AUTHOR]

Wheelchair outcomes measures are useful to support evidence-based practice in wheelchair provision, especially in low- and middle-income countries (LMIC). The Wheelchair Interface Questionnaire (WIQ) was developed to provide a professional perspective on the quality of the interface between a wheelchair and its user. Studies conducted during the development of the WIQ indicated it has face validity and content validity. The objective of this field study was to conduct a subsequent investigation of the inter-rater reliability of the WIQ at a school for children with disabilities in Kenya. Eight practitioners with wheelchair experience from disparate cultural backgrounds participated in the study. They evaluated eight wheelchairs and the interface with their users. The interclass correlation coefficient (ICC) of the mean rating for the eight-item dataset was computed using SPSS. The ICC was found to be 0.911, indicating that the WIQ possesses inter-rater reliability. Common comment topics indicated that the qualitative data yielded by the WIQ is meaningful. Informal timing indicated that the WIQ is a brief measure. The WIQ is a reliable tool that can meet the need for a professional assessment of the wheelchair-user interface. The reliability of this questionnaire is important because the tool can be used to evaluate the interface between a wheelchair user and their wheelchair, strengthening evidence-based practice in wheelchair provision. Based on the score of a specific wheelchair interface, a rehabilitation professional could recommend more assessment, seating modification, or wheelchair replacement in order to maximize rehabilitation benefit for a client The WIQ could provide evidence-based information to support the need for wheelchair repair or replacement to funders. In large-scale studies involving many of the same wheelchair type in the same setting, the WIQ could be used to identify problems with the interface between that wheelchair type and its intended user population so that manufacturers can make responsive design changes. The WIQ could be used in a clinical setting over time to identify the most common wheelchair interface issues for that setting. [ABSTRACT FROM AUTHOR]

Purpose: The Wheelchair Components Questionnaire for Condition (WCQ-C) enables the collection of data on wheelchair maintenance condition and durability in resource-limited environments. It can be used in large studies to indicate typical patterns of wear at a location, or for a type of wheelchair. It can also be used in clinical settings as an evidence based indication that a wheelchair may need repair or replacement. This type of data can enable effective use of limited funds by wheelchair providers, manufacturers and users. The goal of this study was to investigate the inter-rater reliability of the WCQ-C. Methods: Two therapists from North America who have worked extensively in low-resource areas used the WCQ-C to independently evaluate 46 wheelchairs at a primary school for children with disabilities in Kenya. Results: Mean scores of ratings for each wheelchair by the two raters were used to calculate a two-way random interclass correlation coefficient. A value of 0.82 with a 95% confidence interval of 0.67-0.89 indicated good preliminary reliability. Conclusion: Preliminary results indicate that the WCQ-C is a reliable method of assessment. Additional studies are needed with larger and more diverse groups of raters. Because WCQ-C findings are specific to wheelchair wear and maintenance at each location, studies at other locations are also needed. Implications for rehabilitation: The importance of inter-rater reliability testing in confirming the reliability of an assessment tool such as the WCQ-C. The use of the WCQ-C to monitor wheelchair condition in low-resource settings and other field settings. If used at regular interval can produce data that can be used to describe typical changes over time at each individual setting. This could enable proactive planning at that setting to avoid typical breakdowns and the injuries or clinical complications that could result. The use of the WCQ-C to monitor the condition of groups of wheelchairs of the same type. It can describe typical patterns of wear and failure in a way that enables responsive change by manufacturers and designers. This enables more effective use of limited funds. On an individual basis, the use of the WCQ-C to alert users and health professionals of a need for repair or replacement. This could minimize the clinical problems and accidents that can result from wheelchair breakdown. Assessment of a wheelchair using the WCQ-C could provide evidence based data to insurance companies or wheelchair providers which indicates a need for wheelchair repair or replacement. [ABSTRACT FROM AUTHOR]

PurposeThe Lower Limb Function Questionnaire (LLFQ) was developed as a self-report assessment of lower-limb functional ability for orthotic and prosthetic (O&P) device users to be suitable for a wide range of conditions, cultures, and ages. The measure aims to address an existing gap in tools for the assessment of functional ability in this population. The purpose of this study is to evaluate LLFQ reliability and validity in a sample of young adult O&P users.MethodsAdolescents from a secondary school in Kenya completed the LLFQ twice, 6 d apart, and test–retest reliability was assessed using intra-class correlation coefficients. Validity evaluations involved Timed Up-and-Go, 6-min walk, 6-min obstacle course, and/or spatiotemporal gait assessments. Oxygen consumption was measured during walk tests. Associations between the LLFQ and each measure were evaluated using Pearson correlation coefficients for construct validity. ResultsLLFQ reliability was acceptable (ICC = 0.79, 95% CIs 0.64–0.89). Construct validity was demonstrated via moderate correlation (r >  0.60) with obstacle course distance, gait velocity, stride length, and stance/single support/double support percent of gait cycle.ConclusionsBoth LLFQ reliability and validity were acceptable in the sample of youth in Kenya. Further testing is required to determine applicability in other cultural contexts.Implications for RehabilitationThe LLFQ may be clinically useful across a variety of cultures and conditions to provide feedback on the effectiveness of rehabilitative treatment or assistive devices for youth with lower limb impairments.The LLFQ may enable specific strengths and challenges to lower limb function to be identified to enable planning of well-targeted rehabilitation. [ABSTRACT FROM PUBLISHER]