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Purpose: To investigate whether technology-assisted toilets (TATs) could be used to improve toileting hygiene and independence for geriatric rehabilitation patients. TATs are commercially available toilet seats that use a stream of warm water to clean the user, have a fan for drying and are operated by a remote control. Materials and methods: Twenty-five geriatric rehabilitation in-patients were recruited, six completed the study, and seven partially completed the study. Each participant had two trial bowel movements. One trial involved cleaning themselves with toilet paper; the other involved cleaning themselves with the TAT functions. After each trial, participants received a visual inspection for cleanliness and answered the Psychosocial Impact of Assistive Devices Scale (PIADS), a validated scale, to assess their sense of competence, adaptability and self-esteem in the bathroom. A toileting cleanliness scale, designed for this study, was completed by a nurse after TAT usage. Participants received a score from 1 (completely clean) to 4 (completely soiled) based on a visual inspection after cleaning. Results: TAT and toileting cleanliness scores were similar. PIADS scores showed a trend towards higher scores when using the TAT, but results were not statistically significant. Conclusions: TATs cleaned as well as standard toileting in geriatric rehabilitation inpatients. Participants indicated that TATs improved their sense of competence, adaptability and self-esteem. Geriatricians and rehabilitation professionals should consider prescribing TATs in their practice as an assistive device in order to promote patient independence and dignity and reduce the burden of care for patients requiring toileting assistance. Implications for rehabilitation: Technology-assisted toilets (TATs) are commercially-available toilet seats that could be used to allow rehabilitation patients to clean themselves more independently in the bathroom. Improved toileting independence can reduce burden of care of geriatric rehabilitation and reduce the impact of toileting assistance on patient dignity and self-esteem. Physiatrists should consider recommending TATs to their patients but should take into account whether a patient’s particular set of disabilities will allow them to use a TAT effectively. [ABSTRACT FROM AUTHOR]

The purpose of this article is to review the vision substitution devices based on computer vision and Image processing. The focus of this article is on reviewing devices that require coding and sensors mechanism. Review of existing and commercially available vision assistive devices has been done. Comparison is based on feedback mechanics, adaptability in the surrounding environment, and functionality of devices. The study extended to advanced researches based on computer science and image processing. The integration of object detection and face recognition techniques in assistive devices for visually impaired in specific applications has been studied. Comparative analyses were presented. The findings from this study suggest that a few assistive devices are available commercially. The commercially available assistive devices influenced by the mindsets of visually impaired and economical benefits. A combination of several devices can be fruitful in eliminating the limitation of an available device. Ample researches have been done for navigation, communication, object detection, and object recognition to assist visual impaired. The primary results might be promising, but most studies are not tested in actual conditions. Various assistive devices for visually impaired are available commercially and several studies indicate further advancement. However, adaptability and trustworthiness are major issues. The primary reason behind this is the low-performance level of the device, feedback, and testing. The secondary reason is commercial availability and poor knowledge of the end-user. Advancement in computer science and image processing has paved the way to assist sensory impaired in doing various activities. Assistive technologies play a pivotal role in daily activities of visually impaired by assisting them for communication, and mobility. Assistive technologies can lead visually impaired to make them self-sustained. Very few research and devices related to assistive technology had reached the stage of testing and commercialization. Researchers can utilize the study in providing better assistive technology for the visually impaired. [ABSTRACT FROM AUTHOR]

Purpose: The potential of service robots for seniors is given increasing attention as the ageing population in Western countries will continue to grow as well as the demand for home care. In order to capture the experience of living with a robot at home, a multi-perspective evaluation was conducted. Methods: Older adults (n = 10) were invited to execute an actual interaction scenario with the Care-O-bot® robot in a home-like environment and were questioned about their experiences. Additionally, interviews were conducted with the elderly participants, informal carers (n = 7) and professional caregivers (n = 11). Results: Seniors showed to be more keen to accept the robot than their caregivers and relatives. However, the robot in its current form was found to be too limited and participants wished the robot could perform more complex tasks. In order to be acceptable a future robot should execute these complex tasks based on the personal preferences of the user which would require the robot to be flexible and extremely smart, comparable to the care that is delivered by a human carer. Conclusions: Developing the functional features to perform activities is not the only challenge in robot development that deserves the attention of robot developers. The development of social behaviour and skills should be addressed as well. This is possible adopting a person-centred design approach, which relies on validation activities with actual users in realistic environments, similar to those described in this paper. Implications for rehabilitation: Attitude of older adults towards service robots Potential of service robotsfor older adults [ABSTRACT FROM AUTHOR]

Within the Paracanoeing discipline, it is important to ensure that appropriate control is achieved by a paddler with a disability. However, this Paralympic Games discipline has seen very little attention to date. The aims of this study were to understand the kinematic impact to a paracanoeist when not utilizing the use of a prosthetic lower-limb. A kayaker with a uni-lateral transfemoral amputation completed several 200 m maximal efforts both with and without their prosthesis. When the prosthetic limb was removed, there were significant differences found in stroke rate, stroke speed, stroke length and overall power output. Sagittal and frontal video analysis demonstrated the residual limb movements when paddling and indicated where support would be required to improve the kayak’s control. It is recommended that those with lower-limb absence wishing to paddle a kayak competitively utilize the use of a prostheses designed for the kayaking environment that supports the residual limb at both the upper and inner thigh and the distal end. Implications for rehabilitation: This paper is the first study to investigate both biomechanical and assistive technology-related issues in the new Paralympic Games sport of Paracanoeing. For participants possessing lower-limb absence, a prosthetic limb that is designed specifically for the kayaking environment is recommended when Paracanoeing to maximize efficient propulsion. Use of an ergometer and multiple 2D cameras provides practitioners the ability to optimize both the comfort and fit of a prosthetic limb. Use of an ergometer and multiple 2D cameras provides both athletes and practitioners the ability to optimize the points of human contact within a kayak to ensure comfort and control. [ABSTRACT FROM AUTHOR]

Background and Methods: This paper reviews the current capacity of personnel in enabling access to assistive technology (AT) as well as the systems and processes within which they work, and was reviewed, discussed, and refined during and following the Global Research, Innovation, and Education in Assistive Technology (GREAT) Summit. Findings: Key concepts addressed include a person-centred team approach; sustainability indicators to monitor, measure, and respond to needs for service design and delivery; education, research, and training for competent practice, using the six rehab-workforce challenges framework; and credentialing frameworks. We propose development of a competence framework and associated education and training programs, and development and implementation of a certification framework for AT personnel. Conclusions: There is a resolve to address the challenges faced by People globally to access assistive technology. Context specific needs assessment is required to understand the AT Personnel landscape, to shape and strengthen credentialing frameworks through competencies and certification, acknowledging both general and specific skill mix requirements. Implications for Rehabilitation: Personnel in assistive technology (AT) provision should be trained using a person-centred team approach, which emphasizes appropriate skill-mix to address multiple needs within the community. Sustainability indicators should be used which allow personnel to monitor, measure and respond to needs for service design and delivery. A competence framework with associated education and training program, coupled with the development and implementation of a certification framework for AT personnel needs, will promote quality in AT personnel training globally. [ABSTRACT FROM AUTHOR]

Purpose:To synthesize qualitative study findings on the meaning ascribed to wheelchairs and wheeled mobility devices (WMD) by WMD users. Method:Bibliographic databases were systematically searched up to January 2015 to identify relevant papers. Reviewers selected studies, assessed methodological quality and thematically synthesized findings using a metasynthesis process described by Thomas and Harden (2008). Results:Twenty articles were included. Four descriptive themes emerged: physical environment interaction; sociocultural experiences; participation in activities and occupations; and WMD–self relationship. WMD use was found to be a complex experience that can fluctuate through interaction with aspects of the environment and opportunities for participation. The analytic theme, dynamic duality of WMD experience, addressed the simultaneous enabling and disabling aspects of WMD use. Conclusions:Metasyntheses enable researchers to gain a deeper understanding of issues by examining findings across studies. Findings of this study provide a framework for understanding the complexity of WMD use. The framework has practical applications for clinicians and users of WMD in understanding the experience of WMD to be neither singular nor static.Implications for RehabilitationThe meaning of wheeled mobility device (WMD) use is dynamically influenced by the environment and opportunities afforded for occupational and social participation.A duality of experiences can emerge for WMD users, where wheeled mobility use can be at the same time positive and negative, based on the interaction with the environment.Clinicians need to determine the meaning that each individual user ascribes to the WMD, and to consider how that meaning may change over time.By understanding the meaning ascribed to WMD use by individuals, clinicians can be better prepared to work with the WMD users to address negative reinforcers of the experience in physical and sociocultural environments as well as highlighting the positive experiences. [ABSTRACT FROM PUBLISHER]

Background and Aim:Aging often results in a decline in somatosensory function, and such changes are associated with diminished motor performance. Input noise can enhance sensory and motor function through a mechanism known as stochastic resonance (SR). This paper describes the development and testing of a new vibrating shoe to possibly assist the elderly patients in controlling their balance and decreasing their falling risks. Technique:The new vibrating shoe was evaluated to ascertain its ability to generate appropriate random and nonlinear vibrations. The vibratory shoe performance in two young subjects with decreased foot sensation and two elderly subjects in different static and dynamic balance situations was also evaluated. The postural control, expressed by the stability index (SI), was significantly affected by SR in the older subjects. Discussion:The vibrating motors could be recommended as a suitable solution for dynamic balance situations. Moreover, the new vibrating shoe could improve the age-related balance impairments in elderly subjects with balance deficiencies and others with impaired foot sensations.Implications for rehabilitationsOlder adults exhibited decreased postural stability.Noise signal improves sensation and proprioception in older people.New shoe with vibrating motors can operate in different dynamic situations. [ABSTRACT FROM PUBLISHER]

Purpose:To analyse the effect of a six-month home-based phase III cardiac rehabilitation (CR) specific exercise program, performed in a virtual reality (Kinect) or conventional (booklet) environment, on executive function, quality of life and depression, anxiety and stress of subjects with coronary artery disease. Methods:A randomized controlled trial was conducted with subjects, who had completed phase II, randomly assigned to intervention group 1 (IG1), whose program encompassed the use of Kinect (n = 11); or intervention group 2 (IG2), a paper booklet (n = 11); or a control group (CG), only subjected to the usual care (n = 11). The three groups received education on cardiovascular risk factors. The assessed parameters, at baseline (M0), 3 (M1) and 6 months (M2), were executive function, control and integration in the implementation of an adequate behaviour in relation to a certain objective, specifically the ability to switch information (Trail Making Test), working memory (Verbal Digit Span test), and selective attention and conflict resolution ability (Stroop test), quality of life (MacNew questionnaire) and depression, anxiety and stress (Depression, Anxiety and Stress Scale 21). Descriptive and inferential statistical measures were used, significance level was set at .05. Results:The IG1 revealed significant improvements, in the selective attention and conflict resolution ability, in comparison with the CG in the variable difference M0 − M2 (p = .021) and in comparison with the IG2 in the variable difference M1 − M2 and M0 − M2 (p = .001 andp = .002, respectively). No significant differences were found in the quality of life, and depression, anxiety and stress. Conclusions:The virtual reality format had improved selective attention and conflict resolution ability, revealing the potential of CR, specifically with virtual reality exercise, on executive function.Implications for RehabilitationIn cardiac rehabilitation, especially in phase III, it is important to develop and to present alternative strategies, as virtual reality using the Kinect in a home context.Taking into account the relationship between the improvement of the executive function with physical exercise, it is relevant to access the impact of a cardiac rehabilitation program on the executive function.Enhancing the value of the phase III of cardiac rehabilitation. [ABSTRACT FROM PUBLISHER]

Purpose:The purpose of this study is to identify the objective physical activity (PA) measurement tools and outputs that are used within Multiple Sclerosis (MS) literature. Methods:A systematic search strategy on eight databases (2000–2016) using keywords associated with MS and PA. Results:This review includes 32 papers. Uni-axial accelerometers were the most popular objective PA tool in this review (68%). Pedometers (14%) and multi-sensor systems (3%) were the second and third most common. PA outputs included activity counts per day, steps per day, energy expenditure per day, minutes of moderate-vigorous PA (MVPA), minutes of light PA and daily dynamic activity. Both activity counts per day (n = 21 studies), and steps per day (n = 11 studies) were most commonly used representing 78%. Conclusion:Uni-axial accelerometers and pedometers are the most popular PA measurement tools used in MS literature. However, developments in the field mean that most new sensors are tri-axial, and multi-sensor systems are also available. Researchers should use devices with published validation information, and should utilize the detail on activity patterns available from accelerometer measurement instead of expressing a single unit such as activity counts or step counts per day. Attention to capturing the duration, frequency, intensity and energy expended during daily PA is warranted. Implications for RehabilitationThe review reports that accelerometers were the research tool most frequently reported in the literature, though there were differences in device type and in how activity data was extracted from the stored information.The majority of research studies of physical activity levels in Multiple Sclerosis fail to provide an adequate range of activity outcomes, frequently using outcomes which do not allow simple cross-comparisons with other populations. [ABSTRACT FROM PUBLISHER]

Lower-limb amputees typically require some form of prosthetic limb to ride a bicycle for recreation or when competing. At elite-level racing speeds, aerodynamic drag can represent the majority of the resistance acting against a cyclists’ forward motion. As a result, the reduction of such resistance is beneficial to an amputee whereby the form and function of the prosthetic limb can be optimized through engineering. To measure the performance of such limbs, field testing provides a cost-effective and context-specific method of aerodynamic drag measurement. However, few methods have been formally validated and none have been applied to amputees with lower-limb amputations. In this paper, an elite level para-cyclist wore two different prosthetic limb designs and had their total aerodynamic drag of a wind tunnel reference method statistically correlated against a velodrome-based virtual elevation field test method. The calculated coefficient of variation was in the range of 0.7–0.9% for the wind tunnel method and 2–3% for the virtual elevation method. A 0.03 m2difference was identified in the absolute values recorded between the two methods. Ultimately, both methods exhibited high levels of precision, yet relative results to each other. The virtual elevation method is proposed as a suitable technique to assess the aerodynamic drag of amputee para-cyclists.Implications for rehabilitationThis assessment method will provide practitioners a reliable means of assessing the impact of changes made to prosthetics design for cyclists with limb absence.The proposed method offers a low cost and geographically accessible solution compared to others proposed in the past.This assessment method has significant potential for impact among prosthetic limb users looking to improve their cycling performance whereas previous attention in this field has been extremely limited. [ABSTRACT FROM PUBLISHER]

Background:Clinical guidelines recommend that, in order to minimize upper limb injury risk, wheelchair users adopt a semi-circular pattern with a slow cadence and a large push arc. Objectives:To examine whether real time feedback can be used to influence manual wheelchair propulsion biomechanics. Review methods:Clinical trials and case series comparing the use of real time feedback against no feedback were included. A general review was performed and methodological quality assessed by two independent practitioners using the Downs and Black checklist. The review was completed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. Results:Six papers met the inclusion criteria. Selected studies involved 123 participants and analysed the effect of visual and, in one case, haptic feedback. Across the studies it was shown that participants were able to achieve significant changes in propulsion biomechanics, when provided with real time feedback. However, the effect of targeting a single propulsion variable might lead to unwanted alterations in other parameters. Methodological assessment identified weaknesses in external validity. Conclusions:Visual feedback could be used to consistently increase push arc and decrease push rate, and may be the best focus for feedback training. Further investigation is required to assess such intervention during outdoor propulsion. Implications for RehabilitationUpper limb pain and injuries are common secondary disorders that negatively affect wheelchair users’ physical activity and quality of life.Clinical guidelines suggest that manual wheelchair users should aim to propel with a semi-circular pattern with low a push rate and large push arc in the range in order to minimise upper limbs’ loading.Real time visual and haptic feedback are effective tools for improving propulsion biomechanics in both complete novices and experienced manual wheelchair users. [ABSTRACT FROM PUBLISHER]

Purpose:This paper outlines the development and content validation of the power mobility training tool (PMTT), an observational tool designed to assist therapists in developing power mobility training programs for children who have multiple, severe impairments. Methods:Initial items on the PMTT were developed based on a literature review and in consultation with therapists experienced in the use of power mobility. Items were trialled in clinical settings, reviewed, and refined. Items were then operationalized and an administration manual detailing scoring for each item was created. Qualitative and quantitative methods were used to establish content validity via a 15 member, international expert panel. The content validity ratio (CVR) was determined for each possible item. Results:Of the 19 original items, 10 achieved minimum required CVR values and were included in the final version of the PMTT. Items related to manoeuvring a power mobility device were merged and an item related to the number of switches used concurrently to operate a power mobility device were added to the PMTT. Conclusions:The PMTT may assist therapists in developing training programs that facilitate the acquisition of beginning power mobility skills in children who have multiple, severe impairments.Implications for RehabilitationThe Power Mobility Training Tool (PMTT) was developed to help guide the development of power mobility intervention programs for children who have multiple, severe impairments.The PMTT can be used with children who access a power mobility device using either a joystick or a switch.Therapists who have limited experience with power mobility may find the PMTT to be helpful in setting up and conducting power mobility training interventions as a feasible aspect of a plan of care for children who have multiple, severe impairments. [ABSTRACT FROM PUBLISHER]

The focus of research using technological innovations such as robotic devices has been on interventions to improve upper extremity function in neurologic populations, particularly patients with stroke. There is a growing body of evidence describing rehabilitation programs using various types of supportive/assistive and/or resistive robotic and virtual reality-enhanced devices to improve outcomes for patients with neurologic disorders. The most promising approaches are task-oriented, based on current concepts of motor control/learning and practice-induced neuroplasticity. Based on this evidence, we describe application and feasibility of virtual reality-enhanced robotics integrated with current concepts in orthopaedic rehabilitation shifting from an impairment-based focus to inclusion of more intense, task-specific training for patients with upper extremity disorders, specifically emphasizing the wrist and hand. The purpose of this paper is to describe virtual reality-enhanced rehabilitation robotic devices, review evidence of application in patients with upper extremity deficits related to neurologic disorders, and suggest how this technology and task-oriented rehabilitation approach can also benefit patients with orthopaedic disorders of the wrist and hand. We will also discuss areas for further research and development using a task-oriented approach and a commercially available haptic robotic device to focus on training of grasp and manipulation tasks.Implications for RehabilitationThere is a growing body of evidence describing rehabilitation programs using various types of supportive/assistive and/or resistive robotic and virtual reality-enhanced devices to improve outcomes for patients with neurologic disorders.The most promising approaches using rehabilitation robotics are task-oriented, based on current concepts of motor control/learning and practice-induced neuroplasticity.Based on the evidence in neurologic populations, virtual reality-enhanced robotics may be integrated with current concepts in orthopaedic rehabilitation shifting from an impairment-based focus to inclusion of more intense, task-specific training for patients with UE disorders, specifically emphasizing the wrist and hand.Clinical application of a task-oriented approach may be accomplished using commercially available haptic robotic device to focus on training of grasp and manipulation tasks. [ABSTRACT FROM PUBLISHER]

Stroke is the main cause of long-term disability and happens mostly in the older population. Stroke affected patients experience either of the cognitive, visual or motor losses and recovery requires time and patience as they have to do physical exercises every day and at times repetitively. There are various types of stroke rehabilitation exercises focussing on technological solutions that include therapies performed using games. Motion-based games are popular in encouraging participants to perform repetitive tasks without being getting bored. Therefore, in this study, we have explored studies that included the use of games for stroke rehabilitation to understand the design principles and characteristics of the games used for these purposes. A number of medical respositories were searched for relevant articles in a window of 2008-2018. 18 studies were chosen for the scoping review depending on the inclusion criteria, and design principles used in these studies are analysed and evaluated. We present main findings from our review concerning the attributes of existing games for stroke rehabilitation such as meaningful play, handling of failures, emphasising challenge, and the value of feedback. We conclude with a list of design recommendations that future serious game developers can consider while designing interfaces for stroke patients. This review exhibits that the usage of gaming technologies is a very effective interactive mechanism for stroke based rehabilitation. Further our review also shows that serious games provide an avenue and opportunity for customized and highly contextualized gameplay Our review also suggests that effective features to incorporate into serious games for rehabilitation includes; facilitating challenge and recovery from errors. [ABSTRACT FROM AUTHOR]

To review the rating scales used to evaluate usability and quality of mobile health applications, and to compare their purpose, content, and intended target users (i.e., patients, caregivers, or researchers). We conducted a systematic review of the literature in accordance with the PRISMA statement on Medline, CINAHL, PsycINFO, IEEE Explore databases, as well as a review of the grey literature to identify rating scales used to evaluate usability and quality of mobile health applications (m-health apps), between January 1, 2000 and July 31, 2018. Two researchers screened the titles and abstracts of articles that met inclusion criteria, and retrieved usability and quality rating scales from the articles. We identified 24 usability scales and 25 quality rating scales in 87 peer-reviewed articles. We identified only one quality rating scale designed for non-expert users (i.e., patients or caregivers). None of the studies used a theoretical framework for app evaluation to support the scales. The validity of existing quality rating scales is yet to be investigated. Existing usability and quality rating scales are targeted at professionals, not end users who are patients or caregivers. Rating scales that are usable by all end-users would make mobile health apps accessible and meaningful to consumers. The number of mobile health applications on app stores that can be used for rehabilitation is increasing. Most healthcare providers lack the training to identify m-health apps with high quality to be used in rehabilitation. This study has reviewed the current rating scales that can help clinicians and care providers rate the quality of m-health apps and identify the ones that are most appropriate for their practice. [ABSTRACT FROM AUTHOR]

Purpose: To examine the Assistive Technology Device Predisposition Assessment scale and provide evidence of validity and reliability of the Greek version.Methods: We translated and adapted the original instrument in Greek according to the most well-known guidelines recommendations. Field test studies were conducted in a rehabilitation hospital to validate the appropriateness of the final results. Ratings of the different items were statistically analyzed. We recruited 115 subjects who were administered the Form E of the original questionnaire.Results: The experimental analysis conducted revealed a three subscales structure: (i) Adaptability, (ii) Fit to Use, and (iii) Socializing. According to the results of our study the three subscales measure different constructs. Reliability measures (ICC = 0.981, Pearson's correlation = 0.963, Cronbach's α = 0.701) yielded high values. Test-retest outcome showed great stability.Conclusions: This is the first study, at least to the knowledge of the authors, which focuses merely on measuring the satisfaction of the users from the used assistive device, while exploring the Assistive Technology Device Predisposition Assessment - Device Form in such depth. According to the results, it is a stable, valid and reliable instrument and applicable to the Greek population. Thus, it can be used to measure the satisfaction of patients with assistive devices.Implications for RehabilitationThe paper explores the cultural adaptability and applicability of ATD PA – Device Form.ATD PA – Device Form can be used to assess user satisfaction by the selected assistive device.ATD PA – Device Form is a valid and reliable instrument in measuring users’ satisfaction in Greekreality. [ABSTRACT FROM PUBLISHER]

Purpose: This paper describes the development and test of physical and virtual integrated augmentative manipulation and communication assistive technologies (IAMCATs) that enable children with motor and speech impairments to manipulate educational items by controlling a robot with a gripper, while communicating through a speech generating device. Method: Nine children with disabilities, nine regular and nine special education teachers participated in the study. Teachers adapted academic activities so they could also be performed by the children with disabilities using the IAMCAT. An inductive content analysis of the teachers’ interviews before and after the intervention was performed. Results: Teachers considered the IAMCAT to be a useful resource that can be integrated into the regular class dynamics respecting their curricular planning. It had a positive impact on children with disabilities and on the educational community. However, teachers pointed out the difficulties in managing the class, even with another adult present, due to the extra time required by children with disabilities to complete the activities. Conclusions: The developed assistive technologies enable children with disabilities to participate in academic activities but full inclusion would require another adult in class and strategies to deal with the additional time required by children to complete the activities. Implications for RehabilitationIntegrated augmentative manipulation and communication assistive technologies are useful resources to promote the participation of children with motor and speech impairments in classroom activities.Virtual tools, running on a computer screen, may be easier to use but further research is needed in order to evaluate its effectiveness when compared to physical tools.Full participation of children with motor and speech impairments in academic activities using these technologies requires another adult in class and adequate strategies to manage the extra time the child with disabilities may require to complete the activities. [ABSTRACT FROM PUBLISHER]

Purpose: The concept of a vibrating wristband, to improve dextrous hand function of stroke survivors, was recently proposed with clinical results and is referred to as ‘TheraBracelet’ in this paper. The purpose of this study was to demonstrate feasibility of a portable, wearable TheraBracelet, and to apply usability evaluation techniques to assess potential demands of TheraBracelet and to identify critical improvement needs of the prototype.Method: A prototype was developed with a vibrating element housed in an elastic wristband and connected to a wearable electronics box via a cable. Expectation for TheraBracelet and evaluation of the prototype were obtained from 10 chronic stroke survivors using surveys before and after using the prototype and House of Quality analysis.Results: The survey for expectation showed stroke survivors’ willingness to try out TheraBracelet at a low cost. The survey evaluating the prototype showed that the current prototype was overall satisfactory with a mean rating of 3.7 out of 5. The House of Quality analysis revealed that the priority improvement needs for the prototype are to improve clinical knowledge on long-term effectiveness, reduce cost, ease donning/doffing and waterproof. Conclusions: This study presents a potential for a low-cost wearable hand orthotic likable by stroke survivors.Implications for RehabilitationFeasibility for a portable wearable wristband-type hand orthotic was demonstrated.The survey showed stroke survivors are willing to try such an orthotic at low cost.The current prototype was rated overall satisfactory by stroke survivors.This study provides a potential for a low-cost wearable hand orthotic likable by stroke survivors. [ABSTRACT FROM PUBLISHER]

Purpose:Measurements play a vital role in providing devices that meet the individual needs of users. There is increasing evidence of devices being abandoned. The reasons for this are complex but one key factor that plays a role in non-use of equipment is the lack of fit between the device, environment and person. In addition, the abandonment of devices can be seen as a waste of public money. The aim of this paper is to examine the type, the readability, and the content of existing guidance in relation to measuring home furniture. Method:An online national survey involving health and social care trusts in the UK. We conducted a synthesis of leaflets associated with measurement of furniture to identify existing guidance. The content and readability of this guidance was then evaluated. Results:From the 325 responses received, 64 therapists reported using guidance. From the 13 leaflets that were analysed, 8 leaflets were found to meet Level 3 Adult Literacy Standards (age 9–11). There were differences in the way in which the measurement of furniture items occurred within the leaflets with no measurement guidance reported for baths. Conclusion:There is a need to standardize guidance to ensure that measurements are reliable.Implications for RehabilitationOur research has highlighted the need to confirm and agree measurement techniques for home furniture in the provision of assistive devices.Inaccurate guidance can lead to abandonment of devices.Inaccurate guidance could prevent service users from not participating within the self-assessment process for devices. [ABSTRACT FROM PUBLISHER]

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]

Purpose: This paper presents a new cognitive assistive technology, nonlinear contextually aware prompting system (N-CAPS) that uses advanced sensing and artificial intelligence to monitor and provide assistance to workers with cognitive disabilities during a factory assembly task.Methods: The N-CAPS system was designed through the application of various computer vision and artificial intelligence algorithms that allows the system to track a user during a specific assembly task, and then provide verbal and visual prompts to the worker as needed. A pilot study was completed with the N-CAPS solution in order to investigate whether it was an appropriate intervention. Four participants completed the required assembly task five different times, using the N-CAPS system.Results: The participants completed all of the trials that they attempted with 85.7% of the steps completed without assistance from the job coach. Of the 85.7% of steps completed independently, 32.5% of these were completed in response to prompts given by N-CAPS. Overall system accuracy was 83.3%, the overall sensitivity was 86.2% and the overall specificity was 82.4%.Conclusions: The results from the study were positive in that they showed that this type of technology does have merit with this population.Implications for RehabilitationIt provides a concise summary of the importance of work in the lives of people with intellectual disabilities and how technology can support this life goal.It describes the first artificially intelligent system designed to support workers with intellectually disabilities.It provides evidence that individuals with intellectual disabilities can perform a work task in response to technology. [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]

Over one billion people with disabilities (PWDs) and older adults with mobility impairment are currently in need of assistive technology devices (ATDs) and only 10% of those population have ordinarily access to them. The need for advancement in mobility-assistive technology is growing to address the gap in ATDs provision globally. The purpose of this review is to identify potential future areas of development and research in mobility-assistive technology. Publications were identified using scientific and medical electronic databases. Also, a limited grey literature search was conducted to muster a variety of sources. A combination of keyword search terms was used, corresponding to the medical subject heading (MeSH) terms. A total of 392 articles were identified, of which 75 were selected for detailed review. Twenty-eight articles were identified that met the review's inclusion criteria. Future areas of research for mobility-assistive technology were identified by grouping the publications into four main categories. The findings of this review identified several areas of research and development in ATDs in general and mobility-assistive technology, in particular, with special attention to the importance of engaging users and stakeholders in the process of research and design. It is apparent that users' needs and priorities vary between regions within countries. The majority of studies were noted to mainly identify consumers' perspectives on a national basis. The authors, therefore, suggest that further research should be conducted on a global level to determine the knowledge and perspectives concerning future research and development needs and priorities in mobility-assistive technologies. Despite the benefits derived from the use of ATDs, only 10% of people with disabilities have access to them. Increasing access, quality and affordable ATDs in all countries is global demand. Identifying mobility consumers' needs and priorities would help in enhancing their quality of life by translating research into new technologies that meet their environment and culture needs. Users' involvement in research and design process is a crucial approach to re-shape the future research agenda. [ABSTRACT FROM AUTHOR]

Novel developments in the robotics field have produced systems that can support person wheelchair transfers, maximize safety and reduce caregiver burden. The purpose of this study was to identify and describe these systems, their usability (or satisfaction), the context for which they have been or can be used and how they have been evaluated to determine evidence for their effectiveness. Available research on Person Transfer Assist Systems (PTAS) was systematically gathered using similar standards to the PRISMA guidelines. The search terms were derived from common terms and via exploring similar review articles. Initial search terms displayed 1330 articles and by using the inclusion/exclusion criteria 96 articles were selected for abstract review. After full- text reviewing 48 articles were included. 29 articles concerned research in robotic transfer systems, 10 articles used both ceiling and floor-mounted lifts and 9 articles used only floor-mounted lifts as an intervention/control group. The results of this analysis identified a few usability evaluations for robotic transfer prototypes, especially ones comparing prototypes to existing marketed devices. Robotic device research is a recent development within assistive technology. Whilst usability evaluations provided evidence that a robotic device will provide better service to the user, the sample number of subjects used are minimal in comparison to any of the intervention/control group articles. Experimental studies between PTASs are required to support technological advancements. Caregiver injury risk has been the focus for most of the comparison articles; however, few articles focus on the implications to the person. Ceiling mounted lifts are preferred over floor-based lifts due to lower injury rates. Many robotic transfer systems have been developed; however, there is a paucity of quantitative and qualitative studies. Based on the results of this review, rehabilitation settings are recommended to use ceiling over floor assist systems, and it is recommended to provide training on using devices to assist with patient transfers to lower the risk of injuries. [ABSTRACT FROM AUTHOR]

Purpose: This paper proposes a novel system (using the Nintendo Wii remote) that offers customised, non-immersive, virtual reality-based, upper-limb stroke rehabilitation and reports on promising preliminary findings with stroke survivors.Method: The system novelty lies in the high accuracy of the full kinematic tracking of the upper limb movement in real-time, offering strong personal connection between the stroke survivor and a virtual character when executing therapist prescribed adjustable exercises/games. It allows the therapist to monitor patient performance and to individually calibrate the system in terms of range of movement, speed and duration.Results: The system was tested for acceptability with three stroke survivors with differing levels of disability. Participants reported an overwhelming connection with the system and avatar. A two-week, single case study with a long-term stroke survivor showed positive changes in all four outcome measures employed, with the participant reporting better wrist control and greater functional use. Activities, which were deemed too challenging or too easy were associated with lower scores of enjoyment/motivation, highlighting the need for activities to be individually calibrated.Conclusions: Given the preliminary findings, it would be beneficial to extend the case study in terms of duration and participants and to conduct an acceptability and feasibility study with community dwelling survivors.Implications for RehabilitationLow-cost, off-the-shelf game sensors, such as the Nintendo Wii remote, are acceptable by stroke survivors as an add-on to upper limb stroke rehabilitation but have to be bespoked to provide high-fidelity and real-time kinematic tracking of the arm movement.Providing therapists with real-time and remote monitoring of the quality of the movement and not just the amount of practice, is imperative and most critical for getting a better understanding of each patient and administering the right amount and type of exercise.The ability to translate therapeutic arm movement into individually calibrated exercises and games, allows accommodation of the wide range of movement difficulties seen after stroke and the ability to adjust these activities (in terms of speed, range of movement and duration) will aid motivation and adherence – key issues in rehabilitation.With increasing pressures on resources and the move to more community-based rehabilitation, the proposed system has the potential for promoting the intensity of practice necessary for recovery in both community and acute settings. [ABSTRACT FROM PUBLISHER]

Purpose: Efficacy of treatment to improve upper-limb activity of children with cerebral palsy (CP) is typically evaluated outside clinical/laboratory environments through functional outcome measures (e.g. ABILHAND kids). This study evaluates CPKAT, a new portable laptop-based tool designed to objectively measure upper-limb kinematics in children with CP.Methods: Seven children with unilateral CP (2 females; mean age 10 years 2 months (SD 2 years 3 months), median age 9 years 6 months, range 6 years 5 months, MACS II–IV) were evaluated on copying, tracking and tracing tasks at their homes using CPKAT. CPKAT recorded parameters relating to spatiotemporal hand movement: path length, movement time, smoothness, path accuracy and root mean square error. The Wilcoxon signed ranks test explored whether CPKAT could detect differences between the affected and less-affected limb.Results: CPKAT detected intra-limb differences for movement time and smoothness (aiming), and path length (tracing). No intra-limb tracking differences were found, as hypothesised. These findings are consistent with other studies showing that movements of the impaired upper limb in unilateral CP are slower and less smooth.Conclusion: CPKAT provides a potential solution for home-based assessment of upper limb kinematics in children with CP to supplement other measures and assess functional intervention outcomes. Further validation is required.Implications for RehabilitationThis paper demonstrates the feasibility of evaluating upper limb kinematics in home using CPKAT, a portable laptop-based evaluation tool.We found that CPKAT is easy to set-up and use in home environments and yields useful kinematic measures of upper limb function.CPKAT can complement less responsive patient reported or subjectively evaluated functional measures for a more complete evaluation of children with cerebral palsy.Thus, CPKAT can help guide a multi-disciplinary team to more effective intervention and rehabilitation for children with cerebral palsy. [ABSTRACT FROM PUBLISHER]

Purpose: People with disability have a right to assistive technology devices and services, to support their inclusion and participation in society. User-centred approaches aim to address consumer dissatisfaction and sub-optimal outcomes from assistive technology (AT) provision, but make assumptions of consumer literacy and empowerment. Policy discourses about consumer choice prompt careful reflection, and this paper aims to provide a critical perspective on user involvement in assistive technology provision.Methods: User-centred approaches are considered, using literature to critically reflect on what user involvement means in AT provision. Challenges at the level of interactions between practitioners and consumers, and also the level of markets and policies are discussed, using examples from Australia.Results: There is no unanimous conceptual framework for user-centred practice. Power imbalances and differing perspectives between practitioners and consumers make it difficult for consumers to feel empowered. Online access to information and international suppliers has not surmounted information asymmetries for consumers or lifted the regulation of publicly funded AT devices.Conclusions: Ensuring access and equity in the public provision of AT is challenging in an expanding market with diverse stakeholders. Consumers require personalised information and support to facilitate their involvement and choice in AT provision.Implications for RehabilitationVariations in approaches informing AT provision practices have a profound impact on equity of access and outcomes for consumers.An internationalised and online market for AT devices is increasing the need for effective information provision strategies and services.Power imbalances between practitioners and consumers present barriers to the realisation of user-centred practice. [ABSTRACT FROM PUBLISHER]

Purpose: Universal design (UD) provides an explanation of good design based on the user perspective, which are outlined through its principles, goals, and related frameworks. The aim of this paper is to provide an overview of the frameworks and methods for UD building evaluations and to describe how close they have come to describing what auniversally designedbuilding is.Methods: Evaluation approaches are reviewed from the existing literature across a number of spatial disciplines, including UD, human geography and urban studies.Results: Four categories of UD evaluation methods are outlined, including (1) checklist evaluations, (2) value-driven evaluations, (3) holistic evaluations, and (4) invisible evaluations.Conclusions: A number of suggestions are made to aid research aimed at developing UD evaluation in buildings. (1) Design standards and guidelines should be contested or validated where possible; (2) evaluation criteria should be contextual; (3) it may be more practical to have separate methodologies for contextualising UD to allow for the creation of an evaluating tool that is practical in use. Additionally, there is a difficulty in establishing a clear basis for evaluating how empathetic buildings are without expanding the methodological horizons of UD evaluation.Implications for RehabilitationFor universal design (UD) evaluation to address human need requires methods that are culturally, temporally, and typologically specific.Practical instruments for measuring UD need to be divorced from but contingent upon methods than can address local specificities.The process of evaluation can provide knowledge that can contest or validate the literature based sources such as design guidelines, or standards.UD evaluation requires constant renewal by searching for new, flexible strategies that can respond to socio-cultural change. [ABSTRACT FROM PUBLISHER]

Purpose: Based on the bioecological model by Bronfenbrenner, this paper will provide a broad perspective on factors that need to be taken into account in order to facilitate communication and participation in preliterate children making use of electronic Augmentative and Alternative Communication (AAC) systems accessed through eye gaze. Method: Two case studies of children who have been provided with the technology described are presented. The case studies were analysed using the four nested systems of the ecology as a framework to describe not only the environment, but also the processes and interactions between the persons and their context. Results: Risk and opportunity factors are evident at all levels of the ecology. Conclusions: While a good fit between the person and the technology is an essential starting point, additional factors pertaining to the partner, the immediate environment as well as meso-, exo- and macrosystemic issues (such as societal attitudes and funding sources) have a significant influence on benefits derived. In resource-limited environments, the lack of support at more distal levels of the ecology (meso-, exo- and marosystemic levels) seems to be a factor that differentiates these environments from more resourced ones. [ABSTRACT FROM AUTHOR]

This article describes the development and dissemination of an evidence-based Policy Statement and Background Papers by the Australian Rehabilitation and Assistive Technology Association (ARATA). An experienced project team was engaged to conduct literature reviews and member consultations, develop resources and implement a targeted advocacy strategy that included a policy launch and meetings with government officials. The Policy Statement and Background Papers have enabled ARATA to represent the views of Assistive Technology (AT) Practitioners in consultations around the National Disability Insurance Scheme and other AT-related inquiries. In ARATA's experience, developing a policy statement and disseminating it through a targeted advocacy strategy is an effective way for a not-for-profit professional organisation to influence government policy. [ABSTRACT FROM AUTHOR]

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]

Purpose: This paper presents the Rehab@home system, a tool specifically developed for helping neurological patients performing rehabilitation exercises at home, without the presence of a physiotherapist. It is centred on the rehabilitation of balance and on the sit-to-stand (STS) movement. Method: Rehab@home is composed of two Wii balance boards, a webcam and a computer, and it has two main software applications: one for patients to perform rehabilitation exercises and another one for therapists to visualize the data of the exercises. During the exercises, data from the boards and the webcam are processed in order to automatically assess the correctness of movements. Results: Rehab@home provides exercises for the rehabilitation of balance (in sitting and in standing positions), and for the execution of the STS movement. It gives automatic feedback to the patient and data are saved for future analysis. The therapist is able to adapt the difficulty of the exercises to match with each patient's needs. A preliminary study with seven patients was conducted for evaluating their feedback. They appreciated using the system and felt the exercises more engaging than conventional therapy. Conclusions: Feedback from patients gives the hope that Rehab@home can become a great tool for complementing their rehabilitation process. [ABSTRACT FROM AUTHOR]

Purpose: In light of the increasing elderly population and the growing demand for home care, the potential of robot support is given increasing attention. In this paper, an inventory of activities was made that threaten independent living of elderly when becoming problematic. Results will guide the further development of an existing service robot, the Care-O-bot®. Method: A systematic literature search of PubMed was performed, focused on the risk factors for institutionalization. Additionally, focus group sessions were conducted in the Netherlands, United Kingdom and France. In these focus group sessions, problematic activities threatening the independence of elderly people were discussed. Three separate target groups were included in the focus group sessions: (1) elderly persons ( n = 41), (2) formal caregivers ( n = 40) and (3) informal caregivers ( n = 32). Results: Activities within the International Classification of Functioning domains mobility, self-care, and interpersonal interaction and relationships were found to be the most problematic. Conclusions: A distinct set of daily activities was identified that may threaten independent living, but no single activity could be selected as the main activity causing a loss of independence as it is often a combination of problematic activities that is person-specific. Supporting the problematic activities need not involve a robotic solution. [ABSTRACT FROM AUTHOR]

Purpose: CBM is an international Christian development organisation, committed to improving the quality of life of persons with disabilities in disadvantaged societies. CBM aims at achieving this in partnership with local organisations and in cooperation with stakeholders at regional and international levels. This article aims at sharing CBM's holistic approach for successful engagement in the work area of ear care, deafness, hard of hearing and deafblindness. Methods: Review of CBM supporting documents, including strategies, position papers, technical guidelines, criteria of success and information related to partners, centres of excellence and model projects. Results: Description of how partner programmes use participatory methods of planning and implementation, involving persons with disabilities and the community. Recommendations on how to develop national or sub-national strategies to impact the lives, and advocate with governments for the rights and inclusion, of persons with disabilities. Conclusions: CBM's holistic approach to work in the area of ear care; deafness; hard of hearing and deafblindness includes intervention at all levels of health care provision, Education, CBR and Audiological, Speech Therapy and other interdisciplinary services. This article presents CBM's core principles and shares specific strategic planning and results, together with lessons learnt while searching a sustainable engagement for field work. [ABSTRACT FROM AUTHOR]

Purpose: This paper presents the case study of the project EARS Ind developed in the Dominican Republic (DR) with the purpose of increasing access and affordability of hearing aid technology for the hearing impaired. This case study demonstrates how a program can fit hearing aids to patients with hearing impairments can be developed in low and middle income countries. Methods: The project planning documents and project statistics and reports were reviewed. A questionnaire and follow-up interviews were used to gain a clear understanding of the situation in the EARS Inc. DR hearing aid project. Results: The case study is presented of the development and services in the DR with a particular focus on the choices made in regard to hearing aid services including manufacturer choices, procurement, distribution, pricing and service delivery. The development of these services included the simultaneous development of a training program, ear mould laboratory, hearing aid repair services, also sales of batteries and accessories as well as the development of calibration services. Conclusions: The development of comprehensive diagnostic and rehabilitation services requires equipping and training local staff. [ABSTRACT FROM AUTHOR]

Background: The idea of product usability has been discussed in several research areas including product research and development. Usability, in telecare monitoring systems, determines how much the system is effective and efficient for the telecare users. Usability has been considered an important factor in the acceptance of telecare monitoring systems by individuals who encounter challenges in the use of such systems and who possess a limited knowledge of their use. Objectives: The purpose of this study is to explore the relevant usability issues and identify possible solutions to improve the usability of telecare monitoring systems. Method: The study is based on eight research questions and to find the answers to those research questions, a systematic literature is performed. Results: The research findings highlight various usability issues, including the complexity of the interface, difficulty in reading the text, and insufficient provision of instructions. These studies have also suggested solutions to enhance the usability of systems, including development of the technical skills of users, explanations of usability evaluation techniques for telecare monitoring systems, and engaging the appropriate users during the development of telecare monitoring systems. Successful implementation of telecare monitoring systems can increase the chances of acceptance of telecare monitoring systems by the users. Implementing an efficient and effective system will make telecare users more independent at their homes. The development of usable telecare monitoring systems can significantly contribute to a basis for clinical and home-based implementation of the telehealth technology to promote remote monitoring for elderly and people with disabilities. Considering the usability issues and solutions identified in this study, it will go a long way towards aiding subsequent researchers and developers in the implementation of more usable and valid telecare monitoring systems. [ABSTRACT FROM AUTHOR]

Aim: To propose a system for convenience in using CAPTCHA by the Visually Impaired person. Method: To make this access secure CAPTCHA ("Completely Automated Public Turing test to tell Computers and Humans Apart") was invented. This form of CAPTCHA requires that the user type the letters of a distorted image, sometimes with the addition of an obscured sequence of letters or digits that appears on the screen. This traditional method receives many criticism from the disable people. Hence a finger print based CAPTCHA is introduced. Result: A CAPTCHA MONSTER, a convenient system of breaking CAPTCHA for the Visually Impaired is Proposed. Conclusion: Thus in this proposed system, it is possible to access the web services on websites for various day to day applications by effective authentication procedure. [ABSTRACT FROM AUTHOR]

Objective: Some adults with acquired communication disorders are faced with an inability to communicate coherently through verbal speech with their communication partners. Despite the fact that a variety of augmentative and alternative communication (AAC) aided systems is available to assist them in communicating, not all adults accept them. In Cyprus, there is scant research focusing on the factors that are linked to AAC system acceptance and abandonment. Methods: To address this gap, this research involves exploring the experiences of six speech and language therapists supporting adults with acquired communication disorders, who could benefit from the use of AAC systems. The main research question is: What are the factors that influence AAC system acceptance or abandonment? The method used for data collection, was semi-structured interviews and the transcripts were analyzed thematically. Results: The findings show that a number of factors influence the acceptance of AAC systems. These include the time since onset and acceptance of disability, the person's attitude towards communication facilitators, and the perceptions about AAC systems. These findings indicate that the process of accepting an AAC system is multi-layered and these layers are interrelated. Conclusions: More research is warranted focusing directly on the experiences of people with acquired communication disorders and their communication partners. The different myths about AAC systems need to be challenged such that awareness about their usefulness is raised. AAC specialists need to find ways to spread the message that AAC systems can actually support language, speech and communication through different dissemination avenues, such as articles in newspapers and talks through the media. [ABSTRACT FROM AUTHOR]

Purpose: College students with mild traumatic brain injury (mTBI) may experience chronic cognitive deficits necessitating use of external supports for daily task completion. The purpose of this study was to explore cognitive support system selection and use by students with histories of mTBI when completing novel prospective memory tasks. Materials and methods: We implemented a multiple case study, sequential explanatory mixed-methods design with three participants. Participants completed four experimental phases: (1) background history collection, cognitive assessment completion, pre-trial interview, and selection of two external supports for trial phase use; (2) trial Phase 1 (i.e., 10-days); (3) trial Phase 2 (i.e., 10 days); and (4) post-trial exit interview. We examined participants' support type and characteristic preferences and evaluated task execution accuracy when implementing differing supports. Results: Participants expressed both collective and unique cognitive aid preferences before trial completion. Trial phase results revealed that task completion accuracy did not alter substantially between trials; however, personal preferences and perceived usefulness of trialled cognitive aid systems appeared to impact support implementation and effectiveness. Themes emerged from post-trial interview relating to the (a) necessity for differing functions of individual systems and (b) importance of trialling devices prior to selection. Conclusions: Results emphasize the necessity of person-centred approaches to treatment due to the variability of performance accuracy and system preferences. The cognitive aid selection and implementation intervention protocol piloted in this study appears beneficial for understanding unique strengths and challenges for college students following mTBI and may be useful for clinicians working with individuals with mTBI. College-aged students with mild traumatic brain injury report unique preferences for no- and high-tech cognitive aids; however, similar patterns emerge relating to preferred system characteristics. Facilitating several trial periods prior to selection and implementation of external cognitive supports for individuals with mild traumatic brain injury is essential given the preference changes that occur post-trial. Implementing a three-phase external cognitive aid selection process appears beneficial for young adults with mild brain injuries. [ABSTRACT FROM AUTHOR]

Modified ride-on cars (MROC) are a low-cost option to provide self-directed mobility to children with mobility limitations, in lieu of or as a precursor to other powered mobility devices. We appraised evidence to (1) describe and categorize MROC study characteristics, (2) synthesize existing knowledge of children's use of MROCs and (3) frame outcomes within the International Classification of Functioning, Disability and Health (ICF) framework. Articles were identified through four electronic databases: Medline, CINAHL, PsycNET, and Web of Science. We included all published, peer-reviewed studies involving MROC use. Relevant data were extracted, and articles were appraised using the American Academy of Cerebral Palsy and Developmental Medicine criteria for group and single-subject designs. 23 studies met inclusion criteria of 204 titles identified from 1980 to 2021. Study designs included case studies, case series, group designs, and qualitative research, but only three studies were rated evidence level III or higher. Children with a range of disabilities used MROCs across multiple settings, including the home, hospital, and community, though use and adherence varied widely. Positive impacts were reported on a range of outcomes related to the ICF framework, with an emphasis on activity and participation. MROC studies have primarily addressed activity and participation, with most studies suggesting increased functional mobility and social interactions due to MROC use. More robust research designs with larger samples are needed in order to develop evidence-based strategies for MROC use. Physical and occupational therapists may consider using MROCs as a therapeutic tool or accessible play opportunity as part of a multi-modal approach to increase children's mobility, family engagement, and participation in community life. Personal (e.g., child's enjoyment) and environmental factors (e.g., caregiver attitudes and stress) must be considered when developing plans of MROC use. [ABSTRACT FROM AUTHOR]

This study aimed to investigate: (1) the characteristics of people using, or had previously used, assistance animals within community living in Australia; (2) positive and/or negative experiences of these users; and (3) educational resources that may aid public awareness. An online survey was distributed through Australian assistance animal organisations and social media channels. Past/current assistance animal users (n = 112) responded to questions on demographic and types of animal supports used, experience of assistance animal use, community attitudes experienced, and perspectives about the need for public education. Data were analysed with descriptive and inferential statistics. Content analysis provided additional insights of the positive and/or negative experiences assistance animal users had faced. Nearly all participants used an assistance dog (n = 111), and 37 (33%) used the animal for more than one type of support. Seventy percent reported experiencing both positive and negative community attitudes/reactions. Length of time of having an assistance animal was associated with significantly higher prevalence of positive attitudes/reactions, whilst users who received medical support from the animal tended to experience more negative community attitudes/reactions than other users. The majority (90%) agreed that more public education is needed regarding assistance animal public access rights. This study is the first in Australia to undertake a large-scale survey of assistance animal users with a range of disability types. It highlights the benefits and challenges of assistance animals, which could be useful to consider when determining the most appropriate support for an individual. There are a range of possible benefits, but also challenges, in the use of assistance animals that should be considered when a person with disability or health conditions, or people advising them, are determining if an animal is the most appropriate support. Assistance animals can provide multiple types of support to one user, so could offer a potential cost-benefit beyond traditional assistive devices or other types of support. To ensure better inclusion of assistance animal users, public education is needed to promote community awareness of the types of animals that meet the definition of an 'assistance animal', and thus have public access rights. In Australia, a nationally consistent government approach to the regulation, accreditation and funding of assistance animals should be established with the aim to address the current fragmented or unfair investment approach and/or discrimination experienced by some individuals. [ABSTRACT FROM AUTHOR]

Although studies addressing barriers to and facilitators of implementation of welfare technology have been published, no systematic review synthesising evidence on such factors has been found. The purpose of this study was therefore to identify and synthesise existing primary research on facilitators and barriers that influence the implementation of welfare technology for older people, people with disabilities and informal caregivers. A systematic search in 11 databases was performed using predefined inclusion and exclusion criteria to identify empirical studies that assess the implementation of welfare technology for older people, people with disabilities or informal caregivers. The search identified 33 publications with quantitative, qualitative and mixed method designs. The reported findings were thematically synthesised and conceptualised into themes. Six themes of facilitators and barriers that influence the implementation of welfare technology emerged: capacity, attitudes and values, health, expectations, participation and identity and lifestyle. These were presented from five perspectives: older persons and persons with disabilities, informal caregivers, health and care personnel, organisation and infrastructure and technology. The findings may be used as a means to structure the planning and evaluation of implementation processes of welfare technologies for older persons and persons with disabilities and to understand the complexities of implementation. This knowledge generates deepened insights and structures to guide and evaluate the implementation processes of welfare technologies and engenders an understanding of the complexities of implementation. When planning for the implementation of welfare technology for older people and persons with disabilities, it is important to consider capacity, attitudes and values, health, expectations, participation, and identity and lifestyle. Using the result from the study facilitates deepened insights and structures for evaluation of implementation processes of welfare technologies and brings an understanding of the complexities of implementation. Welfare technology should be available, safe, usable and fit the user's daily lives. Implementable welfare technology should focus on needs, but also consider design and possible experienced stigma related to the identity of being a welfare technology user. [ABSTRACT FROM AUTHOR]

To demonstrate the potential role of virtual game personalisation for use as a therapeutic modality to improve upper extremity function in children with cerebral palsy (CP). The study tested a convenience sample of 60 typically developing children (TD) aged 6–10 years and 20 children with CP aged 7–11 years. Children participated in a single 30-min session when they played the game in accuracy mode (virtual targets are hit as they become progressively larger or smaller) or dwell mode (virtual targets are hit when the users remains on them for progressively shorter or longer durations). These two modes can be played in conventional (non-personalised), personalised and with and without arm weights conditions; weights were used for the TD group in order to ensure that game play would be sufficiently challenging as to require personalisation. We measured performance variables (frequency of changes in game level difficulty and accuracy as measured by percent success of hitting the virtual targets) in each condition and usability variables (self-reported perceived effort and enjoyment). Comparisons between the usability of the conventional and personalised conditions among typically developing children showed that although children self-reported significantly more effort while playing the personalised game, the level of enjoyment remained high (no significant differences between conventional and personalised game play conditions). In addition, comparisons between playing the personalised game with and without weights by typically developing children, indicated that percent success was significantly higher for the game played without weights, suggesting that the system is sensitive to dynamic changes in performance. Comparisons between the TD and CP groups showed that when the game was played in personalised dwell mode (hovering over the target for several seconds) children with CP progressed significantly less quickly through different difficulty levels compared to typically developing children. In contrast, no significant differences were found in accuracy mode (immediate response on target hit), between the TD and CP groups in any of the experimental conditions. The personalised game approach was shown to be enjoyable for both groups of users and able to change the level of difficulty in real time. The results suggest that this approach to gaming can provide motor challenges while preserving a high level of enjoyment. Personalised virtual therapy shows promise as a tool for upper extremity therapy for children with motor impairment. In recent years, there has been an increase in the use of assistive technologies including virtual gaming in the general area of health care and clinical practice. Virtual gaming provides an interactive, real-time experiences that are flexible and ecologically valid ways to improve specific cognitive and motor abilities. Personalisation of virtual games entails dynamic adaptation of the parameters in real time according to the user's functional level). The results have demonstrated that personalised virtual gaming is enjoyable and feasible for typically developing children and children with cerebral palsy. The results suggest that this approach to gaming can provide motor challenges while preserving a high level of enjoyment. [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]

This study explored the impact of assistive technology on the well-being of legally blind adults. In this mixed-method study, a convenience sample of 86 legally blind adults took an electronic survey. The questionnaire was comprised of demographics, use patterns, and an instrument called TENS-Interface that measured the impact of technology on well-being categories of autonomy, competence, and relatedness. Descriptive statistics, reliability, power analysis and bivariate correlations were calculated using SPSS statistical software. Three participants completed follow up semi-structured interviews, which were analysed for themes of technological mediation using NVivo 12 software. The TENS-Interface was validated for use with a legally blind population. Descriptive statistics showed a higher mean for autonomy than competence or relatedness. Braille was positively correlated to both autonomy and competence, while screen reader proficiency was related to competence. Daily use of social media, email, instant messaging, and video calls were correlated to relatedness. The technological devices used by interview participants were analysed for technological mediation. Training was identified as an additional theme. Recommendations for practice include providing training to legally blind adults in screen reader use and braille use to support well-being via competence and autonomy. Training is also recommended for this population in the use of social media, email, and video calls to promote well-being through opportunities for relatedness. Further research is recommended to explore instructional methods that are not only efficient, but also meaningful for older adults in the position of losing their vision. Providing access to braille instruction and braille assistive technology equipment can promote legally blind adults' well-being by supporting their basic needs for both competence and autonomy. Providing training in screen reader use can promote legally blind adults' well-being by supporting their basic need for competence. Providing training in use of email, social media, video calls, and instant messaging can promote legally blind adults' well-being by supporting their basic need for relatedness. A consideration of technological mediation can allow practitioners to make recommendations that take into account not only efficient task completion, but issues related to meaning and social context. Instruction for adults losing their vision adventitiously needs to address not only efficient task performance, but also meaning and social context. [ABSTRACT FROM AUTHOR]

The purpose of this exploratory case series was to describe the outcomes for both a child-learner and a child-peer after a single manual wheelchair (MWC) skills training session involving child-based peer training techniques, followed by related home-based skills practice. Participants were a 9-year-old with L4–L5 spina bifida (pseudonym: Amari) and a 3-year-old with T10 spina bifida (pseudonym: Mary). Pre-intervention examination included administration of the Wheelchair Skills Test Questionnaire (WST-Q), the MWC short scale within the Mobility domain of the Paediatric Evaluation of Disability – Computer Adapted Test (MWC PEDI-CAT), and the Canadian Occupational Performance Measure (COPM). The peer training session, facilitated by a physical therapy team, involved games and activities involving MWC use. When appropriate, Amari was asked to talk aloud and verbally describe the components of the skills she was performing. Each child and her mother were instructed in specific MWC skills to practice at home over a 3-week period. Both participants' post-intervention WST-Q capacity, confidence, and performance scores increased. Increases in parent-proxy COPM scores indicated clinically meaningful change in all identified occupational performance problems. Mary's total MWC PEDI-CAT post-intervention score increased by 11 points. Both mothers reported that the participation in the activities helped also to improve their child's self-esteem and self-image. Both the participants in this exploratory case appeared to demonstrate improvements in MWC skills, self-esteem, and self-image following a single child-based MWC skills peer training session and related home-based skills practice. Future research involving such peer training methods is warranted. [ABSTRACT FROM AUTHOR]

Route planning is key support, which can be provided by navigation tools for the blind and visually impaired (BVI) persons. No comprehensive analysis has been reported in the literature on this topic. The main objective of this study is to examine route planning approaches used by indoor navigation tools for BVI persons with respect to the route determination criteria, how user context is integrated, algorithms adopted, and the representation of the environment for route planning. A systematic review was conducted covering the period 1982–July 2018 and thirteen databases. From the 1709 articles that resulted from the initial search, 131 were selected for the study. Route length was the sole factor used to determine the best route in the majority of the studies. Routes with less obstacles, less turns, more landmarks and close to walls were selected by the other studies. User variations were considered in few studies. Unique needs of the BVI persons were addressed by few novel algorithms which had integrated multiple parameters and BVI-friendly route modelling. Differences between the navigation capabilities of the sighted and the BVI community were not a major concern when deciding the optimum routes in the majority of BVI indoor navigation tools. How to trade-off between factors affecting optimum routes, and how to model suitable routes in complex buildings needs to be studied further, looking from the user perspective. Navigation differences between sighted and blind and vision-impaired (BVI) communities are not concerned frequently when planning routes in indoor navigation tools of BVI persons. Selecting routes avoiding areas difficult to traverse, close to walls, having landmarks, and less turns are some approaches used to address the unique needs of the BVI community. Assisting for recovery from veering and real-time obstacle detouring are useful features offered by these tools. Identifying and prioritizing different factors contributing to better routes, concerning user variations, and adopting multi-objective route optimization will help to develop improved route planning methodologies for BVI indoor navigation tool [ABSTRACT FROM AUTHOR]

The aim of this study was to assess wheelchair skills of persons with physical disabilities who attended the first Wheelchair Skills and Empowerment Camp in Morocco and their satisfaction with manual wheelchairs provided for the camp activities. 19 persons (13 male and 6 female) with physical disabilities took part in the project. The average time since injury or illness was 24 years. To assess wheelchair skills/user satisfaction, the researchers used the Queensland Evaluation of Wheelchair Skills test and the Quebec User Evaluation of Satisfaction with assistive Technology. Study participants improved their overall wheelchair mobility skills (p = 0.002; d = 0.20), especially their ability to ascend and descend a ramp (p = 0.012; d = 0.67). The participants reported significantly greater satisfaction with the new provided wheelchairs in comparison to their own wheelchairs in regard to five satisfaction items; i.e., ease in adjusting (p = 0.011; d = 0.96), safety and security (p = 0.014; d = 0.97), durability (p = 0.037; d = 0.81), ease to use (p = 0.045; d = 0.87), and comfort (p = 0.006; d = 1.03). Findings of this study indicate that persons with physical disabilities in Morocco need structured training in wheelchair skills and better-quality wheelchairs. The study also confirmed that community peer-based programmes in low-resource countries can play a significant role in rehabilitation of persons with physical disabilities, even many years after their injury or illness. The One World project educated local persons with disabilities and government officials about the need for buying appropriate wheelchairs and for providing them according to the World Health Organization guidelines. 19 persons who use wheelchairs participated in 6-days of wheelchair skills training sessions, which were led by three peer mentors who use a wheelchair: two with spinal cord injury, and one with polio complications. The 19 participants, who had lived with their disabilities on average for 24 years, advanced their general wheelchair mobility skills, which was assessed through a practical test. The results confirmed that community peer-based programmes in low-resource countries are important for improving wheelchair skills not only when beginning rehabilitation but even after individuals live many years with a disability. [ABSTRACT FROM AUTHOR]

Children with physical disabilities commonly use mobility devices. There is a lack of studies on the use and impact of mobility devices on activities and participation. Research is needed on satisfaction with the service delivery process of mobility devices. To examine the use and impact of mobility devices among children with physical disabilities and the satisfaction with the properties of their mobility devices and related services. A web-based survey was sent to parents of 6 − 18 years old children with physical disabilities who used mobility devices in Iceland. The use and effectiveness of mobility devices were assessed with a questionnaire designed for this study. The satisfaction was measured with Quebec user evaluation of satisfaction with assistive technology (QUEST) 2.0. The survey was sent to 55 families and 36 replied. Most of the children used mobility devices in social activities. The number of participants who reported positive effects of devices on activities and participation, depended on environmental settings. There was no significant difference in participants' satisfaction between types of mobility devices. Also, there was no significant difference in participants' satisfaction with the properties of the device and the related service (for wheeled walkers p = 0.47, manual wheelchairs p = 0.08, powered wheelchairs p = 1.00). The results indicate the importance of mobility devices for activities and participation and can guide healthcare workers when providing mobility devices where environmental factors across settings must be kept in mind. Stakeholders should be aware of the value of satisfaction with the devices and related services. Children with physical disabilities use mobility devices across different environmental settings and need to have more than one type of equipment. This study confirms results from earlier research that mobility devices are important for the activities and participation of children with disabilities. It is important to understand how the delivery process of devices is perceived by those who receive them. High satisfaction is an indicator of high quality of service. Environmental factors across settings must be kept in mind in the delivery process of assistive devices. [ABSTRACT FROM AUTHOR]