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

Abstract\nIMPLICATIONS FOR REHABILITATIONThis study aimed to explore the effects of a four-week intensive eye-tracking intervention on children with dyskinetic cerebral palsy (DCP), focusing on goal attainment, communication competencies, stress levels, subjective workload, and caregivers’ perception of psychosocial impact. A multiple case study design with non-concurrent, staggered multiple baselines was employed, involving three children aged 7, 12, and 13 years. The study included a randomized baseline period of two or three weeks, an intensive eye-tracking intervention, and a six-month follow-up. Two individual eye-tracking goals were identified and assessed using the Goal Attainment Scale, while communication competencies were evaluated with the Augmentative and Alternative Communication Profile: A Continuum of Learning. Stress levels were monitored through Heart Rate Variability measured by the Bittium Faros 360° ECG Holter during eye-tracking tasks. Subjective workload and psychosocial impact were assessed using pictograms and the Psychosocial Impact of Assistive Devices Scale, respectively. Descriptive statistics were applied for analysis. All participants attained and retained their eye-tracking goals, regardless of their initial functional profiles or prior experience with eye-tracking technology. Post-intervention improvements in communication competencies were maintained at the six-month follow-up. Variations in stress levels, subjective workload, and psychosocial impact were observed among participants across different phases of the study, aiding the interpretation of the results. The study concludes that a structured, tailored, four-week intensive eye-tracking intervention can yield successful results in children with DCP, irrespective of their baseline communication abilities or functional profile. Recommendations for future research, including more robust methodologies and reliable computerized tests, are provided.A four-week intensive and structured eye-tracking intervention in children with dyskinetic cerebral palsy appears feasible and may lead to the acquisition and retention of meaningful eye-tracking goals, regardless of functional profile or prior eye-tracking experience.Objective measurement of baseline communication competencies could assist the clinical practice in identifying areas of difficulty, thereby facilitating a tailored goal-setting and goal-attainment approach.Cognition, effort, and motivation may influence intervention outcomes and should be strongly considered in future studies with more robust methodology.Reliable computerized versions of pen-paper assessments with eye-tracking as a response modality are needed to enable a better understanding of skill-acquisition processes in the goal group.A four-week intensive and structured eye-tracking intervention in children with dyskinetic cerebral palsy appears feasible and may lead to the acquisition and retention of meaningful eye-tracking goals, regardless of functional profile or prior eye-tracking experience.Objective measurement of baseline communication competencies could assist the clinical practice in identifying areas of difficulty, thereby facilitating a tailored goal-setting and goal-attainment approach.Cognition, effort, and motivation may influence intervention outcomes and should be strongly considered in future studies with more robust methodology.Reliable computerized versions of pen-paper assessments with eye-tracking as a response modality are needed to enable a better understanding of skill-acquisition processes in the goal group. [ABSTRACT FROM AUTHOR]

Background: Symbol communication aids are used by children with little or no intelligible speech as an Augmentative and Alternative Communication strategy. Graphic symbols are used to help support understanding of language and used in symbol communication aids to support expressive communication. The decision making related to the selection of a symbol communication aid for a child is poorly understood and little is known about what language and communication attributes are considered in this selection. Aim: To identify from the literature the language or communication attributes of graphic symbol communication aids that currently influence AAC practice. Method and Procedure: A search strategy was developed and searches were performed on a range of electronic databases for papers published since 1970. Quality appraisal was carried out using the CCAT tool and papers rated as weak were not included in the review. Results: Eleven studies were included in the review reporting data from 66 participants. Weaknesses were identified in most studies that would limit the validity of the results for application to practice. Included studies investigated aspects of vocabulary organization and design, the process of vocabulary selection, and the choice of the symbol system and encoding method. Two studies also evaluated innovative communication aid attributes. Conclusions: Information from studies reported in the research literature provides a sparse source of information about symbol communication aids from which clinicians, children or family members may make informed decisions. This review is the first to systematically appraise the literature to answer the question what evidence exists to inform clinical decision making in relation to the language or communication attributes of graphic symbol based communication aids? The review establishes that there is a paucity of evidence from studies and that these decisions must thus be based on other information and factors. The review does establish a small number of language or communication attributes of symbol communication aids, but no synthesis of the results of these studies was possible. This review thus suggests that vocabulary design and organization, symbol system and encoding method, and the choice of vocabulary selection method are attributes that clinicians may carefully review in order to inform decisions. Clinicians encountering symbol vocabulary packages claiming to be 'evidence based' should query the nature of this evidence. The rehabilitation research community should debate and develop appropriate research designs that will facilitate future robust studies investigating the effect of specific language or communication attributes of communication aids. [ABSTRACT FROM AUTHOR]

To address the data gap on efforts to assess use of assistive technology among children with disability in sub-Saharan Africa. Contribute towards efforts examining access to assistive technologies in sub-Saharan Africa. The paper uses data from the 2017 survey on Living conditions among persons with disabilities in Malawi and the 2015-16 Malawi Demographic and Health survey to address the objective of the study. The two datasets were statistically matched through random hot deck technique, by integrating the two datasets using randomly selected units from a subset of all available data donors. Results indicate that statistical matching technique produces a composite dataset with an uncertainty value of 2.2%. An accuracy assessment test of the technique also indicates that the marginal distribution of use of assistive technology in the composite dataset is similar to that of the donor dataset with an Overlap index value of close to 1 (Overlap = 0.997). The statistical matching procedure does enable generation of good data in data constrained contexts. In the current study, this approach enabled measurement of access to assistive products among children with disabilities, in situations where the variables of interest have not been jointly observed. Such a technique can be valuable in mining secondary data, the collection of which may have been funded from different sources and for different purposes. This is of significance for the efficient use of current and future data sets, allowing new questions to be asked and addressed by locally based researchers in poor settings. In resource-poor settings, the technique of statistical matching can be used to examine factors that predict the use of assistive technology among persons with disabilities. The statistical matching technique is of significance for the efficient use of current and future datasets, allowing new questions to be asked and addressed by locally based researchers. [ABSTRACT FROM AUTHOR]

Covid-induced lockdowns have increased the importance of technology in education. Though access to technology as well as availability of the internet remain a major concern for a lot of children in the global south, children with intellectual disabilities are disadvantaged even more as most of the e-content is developed keeping in mind the average learner. Unstructured interviews were conducted with children with intellectual disabilities studying in government schools in Haryana as well as their teachers and parents. Thematic analysis of the interviews was conducted to understand the use-patterns of mobile phones by children with intellectual disabilities. Findings suggest that these children are learning to use mobile phones on their own or with some support and are able to navigate the complexities of these smartphones quite well. They use these devices mostly for their entertainment. This paper then reflects on the need and strategies to develop these technologies in ways that they can be used as effective tools for teaching children with intellectual disabilities, especially in the inclusive education system in developing countries. The paper reflects on the need to develop technology and tools using flexible and exploratory designs to enhance the learning processes for children with intellectual disabilities from the lower income strata. This study highlights the importance of being able to use mobile phones by children with intellectual disabilities belonging to low income families. Following this, the article argues for designing of mobile phones suitable for use by children with intellectual disabilities using playfulness and explorations, and Building e-content keeping the elements of playfulness and exploration which can enhance the learnings of this group of students which is often ignored. [ABSTRACT FROM AUTHOR]

Purpose: Activity-based locomotor training improves intrinsic trunk control in children with spinal cord injury (SCI). To reinforce these improvements, there is a need to develop community integration activities to allow a patient to apply the retrained nervous system at home. One activity that has been explored is rocking in a rocking chair. This paper describes the design, fabrication, and evaluation of a rocking chair for children with SCI. Materials and Methods: The Quality Function Deployment (QFD) design process was used. Fundamental needs and features for the rocking chair were defined in a focus group with experienced therapists, and needs were then rated for importance. A House of Quality (HOQ) matrix was developed to correlate needs with design features, and a prototype design was generated. Virtual motion studies and finite element analysis (FEA) were utilized to assess the design. The chair was fabricated and physical testing was performed, including tipping and static and dynamic load assessments. Results and Conclusions: The needs identified through the QFD process were categorized into (1) safety, (2) therapeutic, (3) practical and aesthetic, and (4) data to track chair use. Features selected to meet these needs include safety stops, padding, straps, a stable base, armrests, adjustable footrest, and sensors to capture rocking data. FEA showed a factor of safety (FOS) > 5. Physical testing confirmed physical integrity, load-bearing capacity, and stability of the prototype glider rocking chair. The prototype provides a safe tool for further investigation of rocking for promotion of trunk muscle activation in children with SCI. IMPLICATIONS FOR REHABILITATION: Rocking in a rocking chair promotes carryover of gained trunk control capacity, from clinic to home in a population that is non-ambulatory. Rocking provides opportunity for self-practice in population with severely compromised capacity. Rocking is a movement that may be performed when other types of movement cannot be readily performed, e.g., resistance exercise, movement against gravity. Rocking creates opportunity for repetitive, voluntary, self-directed movement that is inherently pleasurable and reinforcing. [ABSTRACT FROM AUTHOR]

To design and develop a mobile application for pre-school readiness of children with autism and also to identify their learning pattern. Based on strong foundation of functional academics, we have developed a mobile application for providing an early educational intervention program to the children with autism. Three successive software trials have been conducted among 31 children with autism of age group of three to 10 years. The mobile app has been provided to educators and parents and they have been allowed to supervise the children during their learning phase for eight to 10 weeks. The imprint of learning pattern is recorded and learning progress profile is generated for individual child. Data analysis of learning progress profile shows that 90% of the participants preferred drag and drop or simple touch approach over conventional methods practised during classroom teachings. More than 84% of the children are found to adapt pre-requisite skills for writing like scribbling, tracing, dots joining, copying, etc. after using the app on their tablet who are reluctant to hold pencil and paper otherwise. Twenty-five percent of the participants are reported to reciprocate the greeting etiquettes in class such as greeting teachers and their peers. The mobile application made a valuable contribution to early intervention program for children with autism by imparting appropriate learning opportunities readily available to them. Performance metrics underlying each activity form a strong base of identification of learning patterns and formulation of revised individualized education plan (IEP). Children with autism need the mobile application as an educational intervention program for it is readily available and user friendly. Educators need the mobile application to quantify the performance parameters and there by monitor/evaluate the progress of the child. Overall, the present research has aimed to develop an easy reach app by which educating as well as handling challenging behaviour of the children with autism would be easier. [ABSTRACT FROM AUTHOR]

The vulnerable children refer to the special group of children with deviation in the process of children's psychological development and personality formation due to growth dilemmas. This may incur a series of serious social and family problems. The vulnerable children mainly cover the children suffering from children's psychological problems, such as childhood autism, autism, social anxiety and hypersensitivity, fear, depression, and PTSD arising from other factors. At present, the research results at home and abroad mainly focus on the psychological dynamic correlation investigation and solution discussion of a certain kind of difficult factor in the children's psychological development based on statistical data by the experimental methods, such as scale and model, and there is a blind spot in the humanistic orientation theory construction of psychological treatment for vulnerable children, causing the social reflection on children's psychological predicament from the humanistic perspective cannot be performed in related researches and going against searching for universal and integral theoretical paradigm for solving related problems. Sophisticated technologies for the observations have emerged increasingly for enabling the psychological features of vulnerable children through developmental cognitive neuroscience experiments. This paper introduces humanistic art therapy theory, focuses on the construction of a theoretical paradigm, and verifies its effectiveness based on the experimental results on the psychological development of vulnerable children, with an efficient performance. This study mainly refers to children with difficulty in social inclusion and psychological development. The results showed that two kinds of art therapy can obviously improve the psychological disorders of vulnerable children. The goal was to enhance self-cognition, strengthen emotional interaction, and implement positive motivation. [ABSTRACT FROM AUTHOR]

Motor speech and augmentative and alternative communication (AAC) interventions are commonly used with children with cerebral palsy (CP) but there is limited literature comparing the effectiveness of these interventions. The purpose of this study was to investigate the effectiveness of intensive AAC, Rapid Syllable Transition Treatment (ReST), and blended intervention, a combination of motor-speech and AAC, on speech accuracy and sentence length and complexity. A single case experimental design across participants with repeated measurements across phases (ABACADA design) was used. Four participants aged 8–14 years with CP who used a speech-generating device (SGD) received three 6-week intervention blocks that included ReST, AAC, and blended intervention. Measures were taken during intervention and baseline phases and at maintenance two and four weeks after the last intervention phase. Participants were randomized to starting with either ReST or AAC with the blended intervention delivered last. All participants improved their speech accuracy and sentence length and complexity in speech and with their SGD in all three interventions. The data demonstrated overall immediacy of the effect with all interventions and retention of gains across the whole sequence of phases. The order of AAC or ReST interventions or the severity of CP did not impact the intervention gains. This study suggests that intensive AAC, a multi-modal approach, and ReST improve speech accuracy and sentence length and complexity in children with moderate CP, but all require further investigation. In this paper intensive AAC intervention with a speech generating device (SGD), ReST treatment and multimodal blended intervention were effective in improving speech accuracy and sentence length and complexity in both verbal speech and on communication with the SGD. ReST treatment has not been used with children with CP before. This study established a proof of concept for its effectiveness in children with CP. Further research is warranted. [ABSTRACT FROM AUTHOR]

Learning disabilities or learning disorders are umbrella terms used for wide variety of learning problems like Dyslexia, Dyscalculia, Dysgraphia, and Dyspraxia. These disabilities are due to the neurological disorders which affects brain functions. Early diagnosis of these disabilities in kids from age 3 to 6 will help to start early medical treatments and get them back to the normal condition. we developed a software-based Learning Disability Evaluation Kit called YALU with computer Game Modules for kids targeting their learning disabilities. These Computer game-based modules of the YALU consist of different tasks for the different age levels to identify the symptoms of the disabilities mentioned above. The children's interaction results to each task of the game modules with the answers of the questioner about the children given by the parents will be evaluated with the threshold values given by a panel of consultant psychologist and paediatrician of the normal kids to identify the learning disabilities in kids aged 3–6 years. The result will be given to the respective parties and uploaded to the Website under the child's name. YALU has been tested using 50 students in age 3–5 in three preschools. The teachers have identified Fourteen students with some learning disability symptoms. Using YALU, twelve out of fourteen students had been clearly identified. Hence, the YALU Evaluation Kit to have an accuracy 85% in diagnosing the right disability. However, the accuracy could be increased with the accurate assessments of the parents about their kids. Learning disabilities are neurological disorders that affect the brain's ability to receive, process, store, respond to and communicate information; and there are four types (Dyslexia, Dyspraxia, Dysgraphia and Dyscalculia) In this paper, we present the extracted computational techniques targeting the Dyslexia, Dyspraxia, Dysgraphia and Dyscalculia and developed a software application (YALU Learning Disability Evaluation Kit) which consists of computer game modules for the kids for evaluation their learning disabilities. The developed game modules can screen the learning disabilities and these gamification modules (YALU) consists of tasks which are based on symptoms of the said disabilities. The outcomes of each module is evaluated these learning disabilities in kids age from 3 years to 6 years by analysing children's interactions to the each tasks, the child condition and then compare the result with the threshold values of the normal kids given by consultant psychologist and paediatrician. [ABSTRACT FROM AUTHOR]

Explore methods used in peer-reviewed literature for obtaining self-expression of well-being information from children with severe motor and communication impairment (SMCI). A comprehensive search was conducted on 22 August 2019 through academic databases: CINAHL; Embase; MEDLINE; PsycINFO; InSpec; Compendex. Search strategies were informed by keywords under the following areas: (1) population: children with SMCI, (2) assessment methods: alternative to natural speech, paper and pencil report or standardized keyboard use (e.g., eye gaze) and (3) target information: well-being (e.g., quality of life). Studies were excluded if they focused on individuals over 25-years old, exclusively autism or typically developing children. Non-duplicate studies of 10,986 were screened; 49 studies met inclusion criteria. Most studies used high-tech methods of self-expression in a single context (n = 17). Familiar partners play a significant role in self-expression; 18 studies required a familiar partner for children with SMCI to self-express. Thirty-five studies involved children self-expressing to solely adults, in comparison to 14 studies which involved peers. Findings highlight the advancement of high-tech communication devices restricted to application in single contexts. Familiar partner knowledge of children with SMCI has the potential to be shared with others (e.g., respite care providers), enhancing both caregiver and child well-being. Future research that would enhance the literature could explore the assessment of emotional well-being for application in various contexts using multimodal methods. Opportunities for children with SMCI to express their emotional well-being can further influence the understanding and enhancement of participation, social connections, and experiences. Use of lower tech methods of self-expression to obtain information directly from children with severe motor and communication impairment (SMCI) remain more feasible in home and school contexts. By utilizing familiar partners' experiences and knowledge of the child, respite care providers, novel support workers, and others involved in the lives of children with SMCI can become further informed. Current high-tech methods for obtaining the emotional expressions of children with SMCI may benefit from incorporating multimodal approaches including lower tech methods, to be feasibly applied in real world contexts where well-being takes place. Further research on this topic is imperative to enable children with SMCI to self-express their emotional well-being which can enhance participation, activities, social connections, and experiences. [ABSTRACT FROM AUTHOR]

Purpose:The purpose of this study is to examine the extent and type of robots used for the rehabilitation and education of children and young people with CP and ASD and the associated outcomes. Methods:The scholarly literature was systematically searched and analyzed. Articles were included if they reported the results of robots used or intended to be used for the rehabilitation and education of children and young people with CP and ASD during play and educative and social interaction activities. Results:We found 15 robotic systems reported in 34 studies that provided a low level of evidence. The outcomes were mainly for children with ASD interaction and who had a reduction in autistic behaviour, and for CP cognitive development, learning, and play. Conclusion:More research is needed in this area using designs that provide higher validity. A centred design approach is needed for developing new low-cost robots for this population. Implications for rehabilitationIn spite of the potential of robots to promote development in children with ASD and CP, the limited available evidence requires researchers to conduct studies with higher validity.The low level of evidence plus the need for specialized technical support should be considered critical factors before making the decision to purchase robots for use in treatment for children with CP and ASD.A user-entered design approach would increase the chances of success for robots to improve functional, learning, and educative outcomes in children with ASD and CP. We recommend that developers use this approach.The participation of interdisciplinary teams in the design, development, and implementation of new robotic systems is of extra value.We recommend the design and development of low-cost robotic systems to make robots more affordable. [ABSTRACT FROM PUBLISHER]

Purpose: To evaluate the effectiveness of two instructional techniques in teaching electronic row-column scanning to children with cerebral palsy. Method: Two case series involving four participants each. Eight children, four boys and four girls (ages 3-13 years), were assigned to one of two intervention groups and completed three baseline and five intervention sessions. One intervention ( n == 4) consisted of computer-based activities alone, while the other intervention ( n == 4) consisted of a sequential approach starting with paper-based activities and then shifting to computer-based activities. Results: Participants within both groups demonstrated varying degrees of skill mastery (80% accuracy or better) of linear and, for some, electronic row-column scanning within the training phases of the intervention sessions. However, there was no clinically important change in test scores between baseline and outcome measures for either group. Conclusions: Significant challenges exist when studying the effectiveness of instructional techniques for teaching electronic row-column scanning to children with cerebral palsy. These case series provide information regarding the importance of selecting the most appropriate scanning technique to ensure reliable switch activation, carefully structuring the teaching environment to optimize learning, and being cognizant of the impact of fatigue and motivation on performance. [ABSTRACT FROM AUTHOR]

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]

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]

This case study follows a single participant with cerebral palsy through 15 years of wheelchair seating interventions. Positioning challenges within the wheelchair seating system included significantly increased muscle tone, extension patterns, extraneous movement, loss of body position in relation to the seating system, loss of alignment with other assistive technologies, high energy expenditure, client injury and pain, and equipment damage. The purpose of this article is to present clinical changes seen in this participant during a progression of dynamic seating interventions. includes four separate seating and wheeled mobility evaluations over an eight-year time frame and subsequent equipment recommendations. A key intervention was the application of dynamic seating. No standardized assessments for wheeled seating and mobility evaluation are available, at this time. the recommended interventions resulted in reduced extension patterns, extraneous movement, loss of position and alignment with other assistive technologies, energy expenditure, client injury and pain, and equipment damage. Further, functional gains and increased seating tolerance were noted. dynamic seating may address numerous positioning challenges in clients with increased muscle tone in conjunction with an appropriate seating system and mobility base. Dynamic seating may: •Dissipate client forces to reduce active extension. •Protect a client from injury by reducing intermittent and sustained forces. •Protect wheelchair seating, mounting hardware, and the frame from loss of alignment and damage. •Provide movement to decrease agitation and increase alertness. [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]

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]

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]

To measure and compare progression in children's power mobility skill among process and task-based measures following a loan of one of four early power mobility devices. Additionally, to explore different power mobility learner groups and skill development trajectories. In this pre-post study, children were purposefully sampled and power mobility skill was measured from video taken pre-post several months' experience (mean 192.40; SD 42.79 days) using the Assessment of Learning Powered mobility use (ALP) and two task-based measures. Associations among power mobility skill measures were examined. Child and environmental factors influencing ALP phase at loan-end were explored. Forty-six children aged 13 − 68 months (mean 40.40; SD 15.60) participated, with cerebral palsy being the most common condition (n = 33; 71.74%). ALP change scores ranged from −2 to +4 ALP phases (median 1.0). Wilcoxon signed rank test was significant for pre-post differences with a large effect size (z = 5.50, p < 0.001; r = 0.57). End-of-loan Spearman correlations between ALP and two task-based paediatric measures were excellent (rs = 0.92). Kruskal-Wallis test revealed significant effect of device, access method, diagnostic group and communication abilities on loan-end ALP phase. Positive change was demonstrated with most children (n = 39; 84.78%) changing at least one ALP phase during the study. Positive change was seen with children at all phases of tool-use, using all devices and access methods. Process and task-based measures were highly correlated, but differed in application for different learner groups. Different trajectories of skill development may be associated with different child profiles and access abilities. Children at all phases of tool-use can demonstrate positive change in power mobility skill using different devices and switch as well as joystick access methods The Assessment of Learning Powered mobility use (ALP) is useful for assessing tool-use and learning process skills for young children across the power mobility skill continuum. Task-based measures may also be helpful for guiding training and recording progress; The Power Mobility Training Tool (PMTT) is most useful for children exploring cause-effect and direction (ALP Phases 1–5), while the Power Mobility Program (PMP) is most useful for functional learners and those progressing from exploring direction to functional use (ALP Phases 5–8). Access method may influence power mobility learning trajectory and training [ABSTRACT FROM AUTHOR]

Parental/caregiver adherence has been identified as a barrier to implementation of early power mobility programs. Motivational interviewing (MI) may help in addressing this barrier. Two scoping reviews were conducted to gather concepts pertaining to parent-based or rehabilitation-based MI interventions and to develop a parent-based MI intervention to address parental/caregiver adherence to home-based early power mobility interventions for infants and young children. Separate literature searches for parent-based MI and rehabilitation-based MI were conducted in PubMed, CINAHL Complete, PsycInfo, and Web of Science Core Collection. Inclusion criteria were [1]: focussed on/use of either a parent-based or a rehabilitation-based MI intervention and [2] MI interventions described in sufficient detail to be reproduced. Articles focussed on vaccinations, child abuse and neglect, mental health, or technology-based MI were excluded. Data regarding MI interventions and strategies were extracted from included articles. A total of 1130 unique titles were screened and 150 full-text articles were assessed for inclusion. Nineteen articles met the inclusion/exclusion criteria. Using a collaborative, consensus-based approach, a parent-based MI intervention incorporating specific MI strategies identified in the review was developed in collaboration with a psychologist. Future research exploring the application of this parent-based MI intervention is indicated. The parent-based MI interventions developed in this project may help to increase parental adherence to home-based early power mobility programs, thereby potentially addressing an identified barrier to implementation of early power mobility programs. To our knowledge, this is the first study to develop MI scripts for the purpose of increasing parental/caregiver adherence to a power mobility training program for children. The MI interventions developed in this study are consistent with published suggestions to address perceived barriers to the implementation of early power mobility programs. Given the strategies of collaboration, autonomy, and empowerment embedded within the spirit of MI, parent-based MI interventions are congruous with and inclusive of the principles of family-centered care. [ABSTRACT FROM AUTHOR]

The present study was conducted to determine the extent of exposure to and use of mobile devices by children (aged 0–60 months) with a diagnosed neurodevelopmental disability. A self-report survey-based design was employed. Questionnaires were administered at a tertiary care hospital in Mumbai, India The study included a convenience sample of 423 children with a neurodevelopmental disability (aged 0–60 months). The self-report survey was administered to the parents of the children. Analyses showed that 92.7% (n = 392) of all respondents have smartphones. 61% (n = 258) of the respondents stated that their children used mobile devices before 2 years of age. 58% (n = 246) of the parents gave children devices while feeding. A statistically significant difference was found in the mobile media usage between groups of children with different diagnoses (p < 0.001). Children diagnosed with ASD appeared to spend the largest amount of time on mobile media (m = 180.44 mins), as compared to children included with other diagnoses. Of the diagnosed children, only 13.4% (n = 57) of parents were informed about the possible negative effects of media use by their paediatricians. The results suggest premature mobile media habits, frequent use and lack of awareness about the effects of mobile media usage among children diagnosed with a neurodevelopmental disability. We suggest there is a need to update recommendations for caregivers on the use of mobile media by young children with disability. The usage and consequences of mobile media use differ based on the type of neurodevelopmental disorder diagnosis. Parents of children with neurodevelopmental disorders often use mobile media as a distraction while engaging in various activities themselves, this information helps identify times at which mobile media might be purposefully used by parents as distractors There is an urgent need for clinical guidelines regarding mobile media usage among young children with neurodevelopmental disorders [ABSTRACT FROM AUTHOR]

Purpose: To motivate children with intellectual disabilities (ID) to learn handwashing and improve their performance by using computer-assisted teaching method. Method: A teaching program was implemented using a computerized teaching station with faucet, soap dispenser and towel dispenser as user interface. In response to the children's actions, animations were shown on the computer screen of the teaching station. A controlled study was conducted to compare the effectiveness of the proposed method (study group) with that of the convention teaching method (control group). Both groups of subjects attended a 30-min handwashing lesson twice per week for 2 months. Their performance was evaluated using a handwashing task checklist and a learning motivation questionnaire, and by measuring the completion time and assessing their hand cleanliness. Results: The computer-assisted teaching program improved the handwashing performance and learning motivation of the subjects. The study group appeared to outperform the control group. Observations reflected that the subjects were highly motivated to learn handwashing with the computerized teaching station. Conclusion: The proposed method has the potential to facilitate the teaching and learning of handwashing skills for children with ID. [ABSTRACT FROM AUTHOR]

This commentary explores the issues raised in the original article and seeks to suggest how the systems and processes that the professionals utilize shape the challenges and issues they face. Furthermore, it asks the question as to the extent to which self-determination in the selection of many forms of assistive technology would address and resolve the barriers identified. The implications of the study and experiences of the professionals are highly relevant for the planning of future rehabilitation services. With increasing global demand for service, and an associated understanding that the client carries significant knowledge and experience it could be suggested that the underlying client/provider relationship is changing and will continue to change. There is potential for a shift from community-based rehabilitation services, to community led rehabilitation services, where the self-determination of solutions to need is led by the individual, with curated input from the professional, mediated through machine learning and artificial intelligence. Such a model of delivery could effectively support many of those with a disability, where the client has extensive experience, allowing the professional to spend increased resources on those who lack the experience to engage confidently in decision making. The recognition and validation of the knowledge held by clients, against which options can be mapped could ensure extended reach and reduce the cost and efficiency of future services. [ABSTRACT FROM AUTHOR]

Children with Down syndrome (DS) may have limited opportunities to engage in self-directed mobility and play due to motor delays. A recent modified ride-on car innovation is the sit-to-stand (STS) model, which incorporates functional standing and walking training with the experience of powered mobility. This study aimed to: (1) describe total dosage and daily usage of three modified ride-on car modes (seated, standing, and power-push) by young children with DS; (2) examine the ability of young children with DS to independently activate the modified ride-on car in seated and standing modes; (3) describe the age of onset of selected motor milestones of the sample in comparison to DS norms. Eight young children with DS (8.6 ± 2.0 months) used three modes of the modified ride-on car over a 9-month intervention. All eight children independently activated the modified ride-on car in seated and standing modes. Most motor milestones were achieved earlier in this sample than expected for DS norms, including the onset of independent walking. The developmentally progressive nature of the intervention and high dosage may have been instrumental in encouraging the onset of independent activation and earlier motor milestones. Young children with Down syndrome were able to achieve independent activation in seated and standing modified ride-on cars. Developmentally progressive modified ride-on car interventions may facilitate motor skill development, but future work utilizing a randomized control group is needed to examine the potential motor developmental benefits of the STS model and power-push mode. The developmentally progressive nature of the intervention may have been instrumental in encouraging the onset of independent switch activation in both seated and standing modes, as well as the high dosage and adherence rates compared to previous studies. [ABSTRACT FROM AUTHOR]

Purpose:Youth with disabilities are under-represented in science, technology, engineering, and math (STEM) in school and in the workforce. One encouraging approach to engage youth’s interest in STEM is through robotics; however, such programs are mostly for typically developing youth. The purpose of this study was to understand the development and implementation of an adapted robotics program for children and youth with disabilities and their experiences within it. Method:Our mixed methods pilot study (pre- and post-workshop surveys, observations, and interviews) involved 41 participants including: 18 youth (aged 6–13), 12 parents and 11 key informants. The robotics program involved 6, two-hour workshops held at a paediatric hospital. Results:Our findings showed that several adaptations made to the robotics program helped to enhance the participation of children with disabilities. Adaptations addressed the educational/curriculum, cognitive and learning, physical and social needs of the children. In regards to experiences within the adapted hospital program, our findings highlight that children enjoyed the program and learned about computer programming and building robots. Conclusions:Clinicians and educators should consider engaging youth with disabilities in robotics to enhance learning and interest in STEM. Implications for RehabilitationClinicians and educators should consider adapting curriculum content and mode of delivery of LEGO® robotics programs to include youth with disabilities.Appropriate staffing including clinicians and educators who are knowledgeable about youth with disabilities and LEGO® robotics are needed.Clinicians should consider engaging youth with disabilities in LEGO® to enhance learning and interest in STEM. [ABSTRACT FROM PUBLISHER]

Aims:The aim of this randomized controlled trial was to assess the effectiveness of interventions using iPad applications compared to traditional occupational therapy on visual-motor integration (VMI) in school-aged children with poor VMI skills. Methods:Twenty children aged 4y0m to 7y11m with poor VMI skills were randomly assigned to the experimental group (interventions using iPad apps targeting VMI skills) or control group (traditional occupational therapy intervention sessions targeting VMI skills). The intervention phase consisted of two 40-min sessions per week, over a period of 10 weeks. Participants were required to attend a minimum of 8 and a maximum of 12 sessions. The subjects were tested using the Beery-VMI and the visual-motor subscale of the M-FUN, at baseline and follow-up. Results:Results from a 2-way mixed design ANOVA yielded significant results for the main effect of time for the M-FUN total raw score, as well as in the subscales Amazing Mazes, Hidden Forks, Go Fishing and VM Behavior. However, gains did not differ between intervention types over time. No significant results were found for the Beery-VMI. Conclusions:This study supports the need for further research into the use of iPads for the development of VMI skills in the pediatric population.Implications for RehabilitationThis is the first study to look at the use of iPads with school-aged children with poor visual-motor skills.There is limited literature related to the use of iPads in pediatric occupational therapy, while they are increasingly being used in practice.When compared to the traditional occupational therapy interventions, participants in the iPad intervention appeared to be more interested, engaged and motivated to participate in the therapy sessions.Using iPad apps as an adjunct to therapy in intervention could be effective in improving VMI skills over time. [ABSTRACT FROM PUBLISHER]

PurposeTo identify from a health-care professionals’ perspective whether smartphones are used by children and adolescents with acquired brain injury as memory aids; what factors predict smartphone use and what barriers prevent the use of smartphones as memory aids by children and adolescents.MethodA cross-sectional online survey was undertaken with 88 health-care professionals working with children and adolescents with brain injury.ResultsChildren and adolescents with brain injury were reported to use smartphones as memory aids by 75% of professionals. However, only 42% of professionals helped their clients to use smartphones. The only factor that significantly predicted reported smartphone use was the professionals’ positive attitudes toward assistive technology. Several barriers to using smartphones as memory aids were identified, including the poor accessibility of devices and cost of devices.ConclusionMany children and adolescents with brain injury are already using smartphones as memory aids but this is often not facilitated by professionals. Improving the attitudes of professionals toward using smartphones as assistive technology could help to increase smartphone use in rehabilitation.Implications for RehabilitationSmartphones could be incorporated into rehabilitation programs for young people with brain injury as socially acceptable compensatory aids.Further training and support for professionals on smartphones as compensatory aids could increase professionals’ confidence and attitudes in facilitating the use of smartphones as memory aids.Accessibility could be enhanced by the development of a smartphone application specifically designed to be used by young people with brain injury. [ABSTRACT FROM PUBLISHER]

Introduction: We investigated the feasibility of using computer-assisted arm rehabilitation (CAAR) computer games in schools. Outcomes were children's preference for single player or dual player mode, and changes in arm activity and kinematics.Method: Nine boys and two girls with cerebral palsy (6–12 years, mean 9 years) played assistive technology computer games in single-user mode or with school friends in an AB–BA design. Preference was determined by recording the time spent playing each mode and by qualitative feedback. We used the ABILHAND-kids and Canadian Occupational Performance Measure to evaluate activity limitation, and a portable laptop-based device to capture arm kinematics.Results: No difference was recorded between single-user and dual-user modes (median daily use 9.27 versus 11.2 min,p = 0.214). Children reported dual-user mode was preferable. There were no changes in activity limitation (ABILHAND-kids,p = 0.424; COPM,p = 0.484) but we found significant improvements in hand speed (p = 0.028), smoothness (p = 0.005) and accuracy (p = 0.007).Conclusion: School timetables prohibit extensive use of rehabilitation technology but there is potential for its short-term use to supplement a rehabilitation program. The restricted access to the rehabilitation games was sufficient to improve arm kinematics but not arm activity.Implications for RehabilitationSchool premises and teaching staff present no obstacles to the installation of rehabilitation gaming technology.Twelve minutes per day is the average amount of time that the school time table permits children to use rehabilitation gaming equipment (without disruption to academic attendance).The use of rehabilitation gaming technology for an average of 12 minutes daily does not appear to benefit children's functional performance, but there are improvements in the kinematics of children's upper limb. [ABSTRACT FROM PUBLISHER]

Purpose: The African Disability Scooter (ADS) was developed for lower limb amputees, to improve mobility and provide access to different terrains. The aim of this study was to test the efficiency of the ADS in Africa over different terrains.Method: Eight subjects with a mean age of 12 years participated. Energy expenditure and speed were calculated over different terrains using the ADS, a prosthetic limb, and crutches. Repeated testing was completed on different days to assess learning effect.Results: Speed was significantly faster with the ADS on a level surface compared to crutch walking. This difference was maintained when using the scooter on rough terrain. Oxygen cost was halved with the scooter on level ground compared to crutch walking. There were no significant differences in oxygen consumption or heart rate. There were significant differences in oxygen cost and speed between days using the scooter over level ground, suggesting the presence of a learning effect.Conclusions: This study demonstrates that the ADS is faster and more energy efficient than crutch walking in young individuals with amputations, and should be considered as an alternative to a prosthesis where this is not available. The presence of a learning effect suggests supervision and training is required when the scooter is first issued.Implications for RehabilitationThe African Disability Scooter:is faster than crutch walking in amputees;is more energy efficient than walking with crutches;supervised use is needed when learning to use the device;is a good alternative/adjunct for mobility. [ABSTRACT FROM PUBLISHER]

Purpose: The purpose of the study was to evaluate the effectiveness of speech-generating devices (SGDs) on the communication and language development of a 2-year-old boy with severe childhood apraxia of speech (CAS).Methods: An A-B design was used over a treatment period of 1 year, followed by three additional follow-up measurements, in order to evaluate the implementation of SGDs in the speech therapy of a 2;7-year-old boy with severe CAS. In total, 53 therapy sessions were videotaped and analyzed to better understand his communicative (operationalized asmeans of communication) and linguistic (operationalized asintelligibility and consistency of speech-productions, lexical and grammatical development) development. The trend-lines of baseline phase A and intervention phase B were compared and percentage of non-overlapping data points were calculated to verify the value of the intervention.Results: The use of SGDs led to an immediate increase in the communicative development of the child. An increase in all linguistic variables was observed, with a latency effect of eight to nine treatment sessions.Conclusions: The implementation of SGDs in speech therapy has the potential to be highly effective in regards to both communicative and linguistic competencies in young children with severe CAS.Implications for RehabilitationChildhood apraxia of speech (CAS) is a neurological speech sound disorder which results in significant deficits in speech production and lead to a higher risk for language, reading and spelling difficulties.Speech-generating devices (SGD), as one method of augmentative and alternative communication (AAC), can effectively enhance the communicative and linguistic development of children with severe CAS. [ABSTRACT FROM PUBLISHER]

Purpose: The study aimed to explore the lived experiences of children and young people who use an Electric Powered Indoor/Outdoor wheelchair (EPIOC). Method: To allow for the individual lived experiences of the children to be explored, an exploratory study was designed using Interpretative Phenomenological Analysis (IPA). Nine children aged 7-16 years were recruited and their views explored through semi-structured interviews. Results: Children appeared to be working to achieve an adequate fit between self, the EPIOC and the environment. Where an adequate fit was achieved the child experienced positive consequences of using an EPIOC including increased participation and positive feelings. However an inadequate fit led to negative experiences including reduced participation, fear and anxiety. The changing interface between self, EPIOC and environment appeared to be important in shaping these experiences. Conclusions: This study adds to understanding the ambiguous experience of being a child EPIOC user and the need for ongoing support from services especially around stages of transition. It also contributes to the development of the social model of disability from a child's perspective. [ABSTRACT FROM AUTHOR]

Purpose. This pilot study assesses the suitability of three electronic instruments for the potential to objectively and consistently measure the effectiveness of adaptive seating for children with neuromotor disorders such as cerebral palsy and muscular dystrophy. Method. A MiniMicroactigraph, an XSens accelerometer and an Xsensor pressure mapping system were assessed for their ability to measure change in five participants' stability, movement and posture when seating in a flat CAPS II chair and a contoured CAPS II chair. Results. The accelerometer and pressure mapping system showed a difference in amount of movement and body/seat interface between two contrasting seated surfaces on all children, demonstrating potential for use in future research. The results of the actigraph were inconclusive, but did highlight the importance of instrument placement for future studies that utilise this technology. Conclusion. The three instruments have potential suitability for use in future, more comprehensive studies of adaptive seating. It is recommended that future studies explore the additional features of these instruments for their potential to provide objective data regarding the effects of adaptive seating on children's postural alignment and support, pressure management, stability, functional ability and comfort. [ABSTRACT FROM AUTHOR]

The Individuals with Disabilities Act was implemented in 1975 to assure that all children aged 0--21 years old have access and the right to an equal education. However, young children with disabilities continue to need additional support to meet the reading readiness standards as outlined in The No Child Left Behind legislation (2004). Although all children benefit from readiness skills, it is essential for children with special needs. With the technology boom of the past decade, assistive technology (AT) has been used increasingly to enhance emerging literacy skills. In order to identify current trends in the use of AT as a means to enhance emergent literacy skills in young children with disabilities, a systematic review of the literature was undertaken. The findings from this review support the scarcity of empirical research demonstrating the benefit of AT to promote emergent literacy with young children with disabilities. We also found a need for evidence supporting education approaches for the proper use of AT in early childhood literacy as well as little family knowledge regarding the implementation and instructional use of AT. [ABSTRACT FROM AUTHOR]

Aim. This study explored the experience of children with physical disabilities using assistive technology for participation with schoolwork to gain a greater understanding of their perspectives and subjective experiences. Method. A qualitative study involving thematic analysis of in-depth interviews of the child with a parent or significant adult. Purposeful sampling from a larger study recruited five children aged between 10 and 14 years, with differing physical disabilities who attended mainstream schools. All children used computer-based assistive technology. Results. All of the children recognised that assistive technology enabled them to participate and reduced the impact of their physical disability, allowing independent participation, and facilitated higher learning outcomes. Issues related to ease of use, social implications and assistive technology systems are discussed. [ABSTRACT FROM AUTHOR]

Purpose. Assessment and training of young children using powered mobility tends to be based on expert opinion although research in this area has recently been completed. This review critiques available research and discusses the studies in relation to theory and expert opinion. Method. A literature review was completed to identify research regarding powered mobility training for children with developmental disabilities. Two recent qualitative studies were identified and their models and assessment tools were compared and discussed with recommendations for clinical practice and research. Results. The focus of the two studies is on a continuum of learning, the reciprocal relationship of trainer and trainee, and impact of the social and attitudinal environment on powered mobility skill development. The assessment tools and training protocols are backed up by motor learning principles and expert opinion. Further research is required to incorporate the tools into clinical practice and to examine additional psychometric properties. Conclusions. Rather than focusing on readiness skills or pass/fail tests, clinicians should explore early mobility options for clients at the beginning of the continuum of learning, reflect on how they relate to and impact on their clients' learning, and set up the environment to facilitate independent learning and exploration. [ABSTRACT FROM AUTHOR]

Purpose. Access to assistive devices is critical for most children with disabilities to function in society. Despite this, there remain high levels of unmet needs and an underutilisation of augmentative and alternative communication (AAC) devices. Yet, relatively little is known about the challenges that clinicians encounter in prescribing AAC devices. Method. In-depth qualitative semi-structured interviews were conducted with 11 speech language pathologists and occupational therapists who are current authorisers for AAC devices. Results. The findings suggest that there are several barriers (technical, social and political) influencing clinicians' decision to prescribe AAC devices. Technical challenges include the complexity of devices and viewing technology as a cure. Social barriers involve socio-demographic differences, readiness to use a device, social acceptance, attitudes, family's view of technology, and the priority of communication. Finally, several political barriers such as a shortage of speech pathologists, a complex prescription review process, inconsistent follow-up procedures, limitations of the consultative model, and gaps in funding and policy influenced clinicians' ability to prescribe AAC devices. Differences in philosophy of technology also influenced health providers' decision to prescribe AAC devices. Conclusions. Service providers and policy makers should be cognizant of the contextual factors influencing health provider's decision to prescribe AAC devices. [ABSTRACT FROM AUTHOR]

Purpose. To identify best practice in children's seating assessment in the UK and Ireland. Method. The researchers observed six children's seating assessments performed by four therapists at three regional centres, to capture routine seating assessment practice. Observed assessment components were recorded on an 83-item checklist derived from existing published literature, and supported by video-recording. A Delphi technique obtained opinions on best practice seating assessment from seven expert therapists using three rounds of questionnaires. Themes were rated by respondents on ‘importance’, ‘desirability’ and ‘feasibility’. Consensus of 70% was sought on all rated sub-themes. Results. Observation: two assessment items (problem identification and prescription) were observed on every occasion. All other items occurred zero to five times. Standardised assessment methods were not observed. Delphi: themes identified were ‘assessment process’, ‘assessment approach’ and ‘broader issues’. Consensus was reached on importance and desirability of ‘assessment process’ and ‘assessment approach’ sub-themes. Conclusions. Variation in seating assessment practice occurred between regions, yet there was agreement on theoretical best practice components. This may reflect the complexity of seating assessment in reality. The need for, and benefits of, a consistent approach was clearly identified. Future research should be directed toward developing a best practice assessment tool, which links assessment findings to appropriate seating solutions. [ABSTRACT FROM AUTHOR]

Purpose. An evaluation of the current research evaluating the impact of seat inclinations upon postural control, muscle activity and upper extremity function in children with cerebral palsy. Method. A literature review searching 13 electronic databases was undertaken. Inclusion criteria were applied to abstracts found; full text research articles were retrieved and a critical review of the eligible articles completed. Results. Ten studies were reviewed which investigated the effect of seat inclinations. Improved postural control and a reduction in pathological movements were achieved in anterior tilt; reduced postural sway was evident for children with spastic cerebral palsy sitting on anterior incline, and increased sway for those with hypotonia; extensor thrust was evoked when in posterior incline; and there was evidence of improved arm and hand function whilst seated in the functional sitting position as opposed a posterior seat incline. Conclusions. (i) The current literature is inconclusive, however there are indications that neutral and anterior seat inclines do positively affect function for children with cerebral palsy; (ii) Individual assessment of seating ability and need is advocated for these children rather than the adoption of a universal seat incline. [ABSTRACT FROM AUTHOR]

Purpose. To evaluate a walking device, the David Hart Walker Orthosis (HW), that was designed to allow children with severe cerebral palsy to ambulate with hands-free support.Method. A pre-/post-test prospective one-group study evaluated outcomes three years after receiving the HW. Physical therapy assessment, parent interview and satisfaction questionnaire provided details on outcomes.Results. The HW remained the sole walking device for 13 of 20 children at 3 years. Six of seven children who discontinued use were over 12 years old and had outgrown its maximum size. Twelve of 13 children who still used the HW were assessed. GMFM Stand and Walk Dimension mean score increases of about 3% points for the 1 – 3-year follow-up were not significant (P > 0.16). Timed walk scores were unchanged. Steering ability gains were demonstrated on a directional mobility assessment (from 12.0 to 27.9% [P = 0.02]). Despite its eventual height limitations, parents considered HW use to be worthwhile (mean satisfaction = 8.2/10).Conclusions. Sixty-five percent of the children continued to use the HW as their sole walking device, and demonstrated improved ability overall to manoeuvre it during functional ambulation. The primary reason for discontinuation was inability to accommodate taller children. [ABSTRACT FROM AUTHOR]