Disability and Rehabilitation-Assistive Technology最新文献

Introduction: The cushion microclimate is an important risk factor for pressure injury. To date, the microclimate responses to wheelchair cushions have not been assessed in warm environments where they are potentially most problematic. A cooling wheelchair cushion has been developed to minimise temperature and moisture accumulation; however, no independent research has been conducted on this cushion. This study aimed to evaluate the effect of wheelchair cushions and a novel cooling wheelchair cushion on temperature, moisture and perception during passive sitting in a warm environment.

Methods: A randomised crossover study was conducted to determine microclimate responses to three wheelchair cushions of differing properties. Eighteen able-bodied participants sat passively on each cushion for two hours in 28-30 °C. Tympanic temperature, skin and groin temperature, relative humidity and thermal perception were measured.

Results: The cooling cushion produced significantly lower temperatures at the ischial tuberosities and the groin. The air cushion produced significantly lower temperatures at the posterior thigh.

Conclusion: The novel cooling cushion was effective in reducing temperatures in the areas closest to the cooling element, while the air cushion effectively reduced the temperature at the posterior thigh where the comparator cushions had foam properties.

Purpose: Self-initiated mobility experiences are critical for young children with disabilities and may be augmented through powered mobility (PM). However, access to PM for young children (<3 years old), remains limited due to multiple environmental, design, and attitudinal factors. The purpose of this study was to understand caregiver perceptions of PM intervention following a 12-session trial of a novel PM device.

Materials and methods: Ten caregivers (4 M/6F) of children with cerebral palsy (Gross Motor Function Classification System IV-V) and other developmental disabilities (21.8 ± 5.9 months). Children participated in 12 in-lab driving sessions (exploratory or goal directed) using the Explorer Mini (Permobil AB, Sweden). Exit interviews were conducted with caregivers at the final visit, transcribed verbatim, coded inductively, and analysed until themes emerged.

Results: Four themes emerged from the data: (1) Changing views of capability and adaptability; (2) Emerging autonomy; new skills in and out of the device; (3) Clear need and benefit with some drawbacks; and (4) Lingering stigma and uncertainty.

Conclusion: PM trial positively shifted caregiver's perceptions of both PM in general and their child's capabilities, with a desire for greater access to PM at home to support development. These beliefs remained juxtaposed with lingering stigma for some caregivers about PM devices, and a stated desire for more modifiable PM options for children with different positioning or access needs.

Objective: This study examined (1) the feasibility and utility of a vision-based mobile application for assessing chopstick manipulation ability and (2) the preliminary effectiveness of newly developed assistive chopsticks designed to promote the traditional holding form among children.

Methods: An exploratory consecutive controlled case series was conducted with 15 children aged 6-12 years from two elementary schools in Japan. Each participant completed a baseline phase using standard chopsticks, followed by an intervention phase using co-developed assistive chopsticks. Daily performance was recorded through the Kuchibashi App, which used MediaPipe for hand posture estimation and YOLOv8 for chopstick detection. App-based scores were analysed using the Visual Aid Implying an Objective Rule (VAIOR). Qualitative data included questionnaires from children and parents and visual assessments of grip by two trained raters.

Results: Fourteen participants completed the study. VAIOR analysis showed that six children (42.86%) had higher app-based scores during the intervention phase, whereas qualitative assessments indicated that 13 of 14 children (92.86%) improved. Eight children (57.14%) achieved complete correction to the "Four Finger" grip, five (35.71%) showed partial improvement, and one (7.14%) showed no change. Most children (85.71%) wished to continue using the assistive chopsticks, and parents reported high satisfaction with usability and motivation.

Conclusions: Integrating a vision-based app with ergonomically designed assistive chopsticks proved feasible, usable, and culturally meaningful. Although qualitative improvements were seen in nearly all participants, quantitative metrics detected fewer changes, indicating the need to refine analytic sensitivity. This combined approach shows promise for technology-assisted rehabilitation.

Background: Manual wheelchairs (MWCs) are essential for individuals with mobility impairments, yet many users receive limited training, restricting mobility and participation. Innovative alternatives to therapist-led approaches, including eHealth and peer-led interventions, are emerging to address this gap.

Purpose: This follow-up study examined long-term retention of participation and related outcomes 6 months after an eHealth wheelchair skills training program. Secondary aims explored associations between participant demographics, program engagement and post-intervention outcomes.

Methods: A repeated-measures cohort design was used with intervention participants from a multi-site randomised trial conducted across three Canadian urban centres. Nineteen adults using MWCs completed the 4-week TEAM Wheels program, comprising a tablet-based app with 200+ instructional videos and three peer-led teleconferences. Outcomes included participation, wheelchair skills capacity and performance, self-efficacy and health-related quality of life (HRQoL).

Findings: At 6 months, participants (n = 18) maintained or improved statistically significant gains in participation, skills and self-efficacy but not HRQoL. Improvements were comparable across demographic groups, whereas meeting recommended engagement guidelines was linked to larger gains in skills and confidence.

Conclusion: TEAM Wheels benefits were largely retained at 6 months. eHealth and peer-led approaches offer promising, sustainable alternatives to traditional clinician-led MWC skills training.

Clinical Trial Registration No. NCT04090177.

Purpose: Increasing cochlear implant (CI) demand due to broader candidacy and an ageing population challenges in-clinic rehabilitation. Remote programming offers a promising alternative to improve accessibility. This study evaluates its non-inferiority and optimal timing during rehabilitation.

Materials and methods: Forty-three postlingually deafened adults were divided into three groups: standard in-clinic fitting (n = 21), remote fitting during the second session (n = 12), and remote fitting during the third session (n = 10). Auditory outcomes at the fourth session were assessed using speech perception phoneme score at 65 dB SPL (primary outcome measure), free-field tone audiometry and programming parameters (M- and T-levels). Patient experiences with remote programming were evaluated via a dedicated questionnaire. Non-inferiority of remote versus in-clinic fitting was assessed.

Results: Speech perception phoneme score at 65 dB SPL was 73% (SD = 11) in the remote group and 76% (SD = 11) in the in-clinic group, with a mean difference of -3% (95% CI: -9.4 to 3.9), meeting the pre-specified non-inferiority margin. Free-field tone audiometry thresholds were not significantly different (remote: 24 ± 5 dB HL; in-clinic: 25 ± 5 dB HL). Patients without remote experience expressed more negative perceptions about the concept, whereas those with firsthand experience reported high satisfaction, ease of use, and willingness to continue remote sessions.

Conclusions: Replacing one rehabilitation appointment with a remote fitting is non-inferior to standard in-clinic fitting for speech perception outcomes. Most patients reported high satisfaction, supporting its feasibility and accessibility.

Purpose: To develop a virtual reality (VR)-based restaurant simulation game targeting central auditory processing skills for children aged 10-18 with bilateral cochlear implants (CIs) and to evaluate its usability and effectiveness on speech understanding in noise.

Materials and methods: This randomized controlled study had two phases. In Phase 1, a six-level VR restaurant game was developed and usability tested. This stage involved children with normal hearing and CIs, parents, a game developer, audiologists. The usability was examined using expert opinions, observation, game evaluation forms, the System Usability Scale, interviews, group score comparisons. In Phase 2, the game's effectiveness was tested in 24 children with bilateral CIs randomly assigned to intervention (n = 12) and control (n = 12) groups. The intervention group continued traditional rehabilitation and additionally received VR-based training for four weeks. The control group continued traditional rehabilitation only for four weeks. All participants were administered the Turkish Hearing in Noise Test (HINT) pre- and post-intervention as the primary outcome measure of speech understanding in noise, results analysed via repeated-measures ANOVA.

Results: The game was usable and engaging. Normally hearing children scored higher than children with CIs on prototype levels (p<.05). Significant group × time effects were obtained in Turkish HINT under quiet and noise conditions (p<.05). The intervention group showed significantly greater improvement than controls (p<.05).

Conclusion: This study demonstrated the usability of Cooklear, the first Turkish VR-based aural rehabilitation game for paediatric bilateral CI users, showing short-term improvements in speech understanding in noise. Further studies should examine broader auditory processing skills.

Clinical trial registration: ClinicalTrials.gov, NCT06788184.

Purpose: The demand and popularity of online higher education programmes has increased dramatically, with a sectoral shift to funding, resourcing and increasing options for remote study. Thus, it is important to understand disabled students' experiences in an online learning environment and how they navigate their assistive technology (AT) use. The pivot to online learning during the COVID-19 pandemic provided an opportunity to explore the opportunities and challenges of AT use and identify best practices for disabled students who are studying remotely. The aim of this paper is to present key learnings from AT use in an online, higher education environment during this period.

Methods: Semi-structured interviews were conducted with disabled students (n = 13) in higher education in Ireland during the COVID-19 pandemic, when all students were engaged in online learning. Reflexive thematic analysis was employed to identify themes of interest.

Results: Three themes with related subthemes were identified: (1) the critical role of inclusive support systems, (2) fostering more inclusive and collaborative spaces and (3) the need for systemic attitudinal change.

Conclusion: This paper highlights key learnings from AT use in an online, higher education environment which should be considered and implemented to address inequity. A flexible approach to the delivery of supports and services, which is co-designed with disabled students, should be employed to maximise participation and inclusion, ensuring that students can access the same quality assistance regardless of mode of study. This should form an integral part of widening participation initiatives in higher education institutions and national disability strategies.

Purpose: Emerging technologies, ranging from robotics and artificial intelligence to assistive innovations, hold transformative potential for improving the quality of life among people with disabilities. Yet, despite decades of research, systematic evidence on their adoption intentions, attitudes, and accessibility barriers remains fragmented.

Materials and methods: This study conducts a systematic literature review of 46 studies published over the past two decades, synthesising key determinants influencing technology adoption.

Results: The findings reveal that perceived usefulness is the strongest predictor of adoption intentions, while significant barriers persist. These include usability challenges arising from limited accessibility caused by physical and cognitive constraints, high financial costs, inadequate training and support, and persistent digital inequalities. Psychosocial concerns, such as fear of safety risks, social stigma, and reduced human interaction, further shape negative attitudes towards adoption.

Conclusion: The study highlights the need for inclusive and user-centered design approaches that prioritise accessibility, affordability, and trust. By integrating evidence across disciplines, this review provides a comprehensive framework to guide future research, policy development, and innovation strategies aimed at fostering equitable technology adoption among people with disabilities.

Purpose: To estimate the proportion and timing of assistive technology (AT) device delivery during paediatric inpatient rehabilitation and identify factors associated with delivery rates.

Materials and methods: We conducted a retrospective cohort study at a neurorehabilitation centre in Argentina, including patients <22 years with hospital stays >20 days, discharged between January and December 2024, and with at least one mobility- or participation-related AT prescription. The primary outcome was time from prescription to documented delivery during hospitalisation. Delivery probabilities were estimated with Kaplan-Meier curves and compared using the log-rank test. Factors associated with delivery were analysed with multivariate Cox regression, with clustered standard errors by patient.

Results: Thirty-three patients were included (mean age 10.6 years; 39.4% female). Sixty devices were prescribed; 41 (68.3%) were delivered during the inpatient stay. Median delivery time after prescription was 27 days (IQR 10-64). Cumulative delivery probabilities at 30, 60, and 90 days were 45%, 64.3%, and 72.8%, respectively. In the multivariate model, postural or self-propelled wheelchairs had a lower delivery rate than other devices (adjusted HR 0.32, 95% CI 0.12-0.86; p = 0.02). Devices processed through provincial public health insurance were delivered more slowly compared with social security, private coverage, or out-of-pocket payment (adjusted HR 0.41, 95% CI 0.22-0.76; p < 0.01). No significant associations were observed for prescription timing or clinical priority classification.

Conclusion: Nearly one-third of prescribed AT devices for mobility and participation were not delivered before discharge, and delivery times were often prolonged, particularly for wheelchairs and devices processed through provincial public insurance.