Disability and Rehabilitation-Assistive Technology最新文献

Purpose: An assistive technology ecosystem requires co-ordinated collaboration between policy, products, provision processes, and personnel. A needs assessment was conducted of the assistive technology sector in Queensland to examine these components from the perspective of all key stakeholders. Materials and Methods: This paper reports the findings of the expressed needs of the assistive technology sector as experienced by the AT advisors and suppliers. A sequential mixed methods design supported completion of a quantitative online survey (n = 29) followed by qualitative exploration with assistive technology advisors (n = 9) and suppliers (n = 6).

There was an identified need to address the processes that led to delays or unfavourable outcomes for AT. Despite reporting confidence in the quality of services delivered, the advisors were worried about reduced access to expert consultation and a need to better build capacity and capability in the sector. Access to AT for hire or trial was problematic with conflicting tensions identified by the advisors and suppliers. However, both worried about the impact on the agency of the AT recipient in the process.

Conclusions: There are opportunities to enhance the personnel, provision, and policy aspects of the assistive technology ecosystem in Queensland. Pressure points are: workforce capacity and capability to meet the growing need; finding ways to support the trial of assistive technology required to ensure appropriate recommendations for assistive technology that is fit for purpose; and improving information from the bodies that manage funding to reduce the waste in the provision process.

This study explores the integration of telerehabilitation, virtual reality, and serious games technologies in addressing physical disabilities. Specifically, it focuses on game-based telerehabilitation for patients with stroke, Parkinson's disease, and multiple sclerosis undergoing home-based rehabilitation. Utilising the PICO approach, a search in Scopus and PubMed until February 21st, 2024, identified 31 relevant English articles out of 258 initially considered. The study employed three independent reviewers to select, extract data, and analyse studies based on the research question. The final included studies were analysed to extract and categorise the most critical items, including rehabilitation tools, opportunities, and challenges. Of the 258 studies, 31 met the eligibility criteria, with the majority conducted in the United States and the United Kingdom. Key opportunities identified include the effectiveness of telerehabilitation and the use of new, engaging, user-friendly, and affordable technologies. However, challenges such as motivation, usability, exercise adherence, and technical barriers were significant. The Wii gaming console emerged as the most commonly used telerehabilitation device. This systematic review offers a comprehensive analysis of telerehabilitation features, opportunities, and challenges. It highlights the importance of tailored remote rehabilitation programs, potentially leading to more effective patient services. The study suggests that sustained use of these systems is crucial for positive clinical outcomes and emphasises the impact of affordability and engagement on long-term patient adherence to treatment plans in remote rehabilitation systems.

Purpose: Work-related musculoskeletal disorders (WMSDs) during bed-to-wheelchair and wheelchair-to-commode transfers are a significant concern, yet prior assessments often focused on specific subtasks, overlooking potential cumulative risks.

Methods: This study employed Xsens Inertial Measurement Units (IMUs) and force plates integrated with an automated Rapid Entire Body Assessment (REBA) system to provide a continuous and comprehensive evaluation of WMSDs risks associated with the use of a walking belt and a floor lift.

Results: The continuous assessment revealed peak REBA scores ranging from 8.81 to 9.19, categorizing tasks such as applying the sling, repositioning the patient from supine to sitting, and adjusting the wheelchair footrest as high-risk. During bed-to-wheelchair transfers, the floor lift significantly reduced the mean peak REBA score by 1.73 points (95% CI [1.23, 2.24], p < 0.001) and the mean vertical force by 14.68 N (95% CI [10.15, 19.22], p < 0.001) compared to the walking belt.

Conclusion: These findings highlight the value of a continuous risk assessment approach in identifying high-risk tasks and informing targeted ergonomic interventions. The results underscore the need for optimizing patient handling practices and developing advanced assistive devices to enhance caregiver safety and efficiency.

Introduction: The wheelchair service delivery process (SDP) is a large complex system and therefore has many potential points of failure; determining priorities for improvement is challenging. The complexities introduce several barriers to accessing and maintaining wheelchairs for individuals with mobility impairments. Given the breadth and depth of the barriers, it is important to know in which areas to focus future policy reform efforts.

Purpose:The purpose is to explore the perceptions of stakeholders regarding the performance of the wheelchair SDP in the United States and guide future policy reforms.

Methods: A cross-sectional, observational, online questionnaire was deployed. Questions were positive statements regarding the wheelchair SDP and participants rated their agreement with the statements on a standard six-point Likert scale. A snowball sampling strategy was used and consisted of emailing 42 organisations representing 5 stakeholder groups: (1) consumers/caregivers; (2) clinicians; (3) manufacturers; (4) payers; and (5) suppliers.

Results: 1,052 responses were collected: 41% clinicians, 30% suppliers, 24% consumers/caregivers, 3% manufacturers, 2% payers. Stakeholders view the wheelchair SDP as not performing well. Less than 18% of all responses indicate a positive perception. Funding and procurement was viewed in the least positive light, with 5% positive responses. Follow-up, maintenance, and repair was the second least positive component with 9% positive responses. Fitting, training, and delivery was viewed most positively with over 42% positive responses.

Conclusion: The wheelchair SDP is not viewed as performing well by its stakeholders. Funding, procurement, maintenance, and repairs are viewed particularly negatively, representing opportunities for focused system reform efforts.

Purpose: There is insufficient information on whether the use of assistive devices is associated with a lower burden on caregivers of individuals with disabilities. This study was conducted (1) to examine how care recipient-level factors, caregiver-level factors, and the use of assistive devices were associated with caregiver burden, and (2) to investigate the assistive device needs of caregivers.

Materials and methods: This cross-sectional descriptive study used surveys. The participants were caregivers of people with disabilities living in Korea (n = 499). The independent variables were care recipient-level factors, caregiver-level factors, and utilization of assistive devices. The outcome variable, caregiver burden, was measured using the Korean Caregiver Burden Scale. For the data analysis, multivariate logistic regression models were built on the caregiver burden using variables that showed statistical significance in the univariate analysis.

Results: Model 1 included care recipient-level factors. Model 2 included caregiver-level factors in addition to care-recipient factors to examine caregiver factors associated with burden. Model 3 included the utilization of care devices, in addition to the variables used in Model 2, to investigate whether the use of care devices was associated with a lower burden. Caregivers who were married, were informal caregivers, or experienced greater psychological stress had an increased probability of experiencing caregiver burden. Moreover, not using assistive devices increases the odds of experiencing caregiver burden. The most desirable properties of devices are transfer, mobility, and bathing.

Conclusion: As the use of assistive devices is associated with caregiver burden, such care devices should be developed and provided to caregivers based on their individual needs.

Purpose:Pressure injuries (PrI) are a prevalent and serious health issue for wheelchair users. This study aims to identify the personal factors associated with PrI occurrence and their significance by synthesizing existing literature.

Materials and methods:We conducted an umbrella review, systematically searching four databases for reviews published from 2007 to May 2024. The search terms were selected by an independent, experienced librarian. To evaluate the risk of bias and methodological quality of the included studies, we applied the ROBIS tool and the GROOVE procedure. Identified risk factors were categorized into relevant groups.

Results:After an assessment of 5,797 potential articles, 21 studies met the inclusion criteria. Among these, 43% were systematic reviews, 24% meta-analyses, 19% literature reviews, 9% scoping reviews, and 5% narrative reviews. The findings revealed 33 individual personal factors, categorized into the general health, clinical condition, initial pathology, environment/lifestyle, person-related, and combined risk factor groups. Key individual risk factors frequently encountered among wheelchair users included advanced age, obesity, spinal cord injury (SCI), higher levels of SCI, diabetes, infections, incontinence, immobility, respiratory and perfusion impairments, sensory perception issues, and low physical activity.

Conclusions:This study is the first to synthesize literature on internal risk factors associated with PrI among wheelchair users. It confirmed well-established factors such as SCI, diabetes, and aging. The findings provide healthcare professionals and decision-makers with critical information for the prevention and management of PrI in this population, offering new insights into adopting a holistic approach to assessing and addressing individual risks factors.

Assistive technology (AT) professionals are in pressing need with nowadays growing aged/disabled population, so as well-designed higher education programs in this field. This study designed and implemented a case-based active learning approach within an undergraduate course related to AT in Hong Kong, and assessed its impact on enhancing student engagement over two academic years. A total of twelve multimedia patient case dossiers on six major physical disabilities were created. Two cohorts of students enrolled in course "Rehabilitation Engineering and Assistive Technology" were instructed to utilize the case dossiers to facilitate their learning, understanding, and application of ATs for aged/disabled individuals. The Revised Two-Factor Study Process Questionnaire was employed to evaluate the student feedback on their learning experience, engagement, and learning approaches (i.e., Deep Approach, DA; and Surface Approach, SA) before and after the course. Upon completing the course, students' DA scores significantly increased from 29.4 ± 6.9 to 31.4 ± 8.9 (p = 0.013). Additionally, significantly moderate positive correlations were found between the DA-SA value and students' individual written report grades (p = 0.004) and overall grades (p = 0.048). In contrast, a significantly moderate negative correlation was identified between students' individual report grades and SA scores (p = 0.019). These findings support the feasibility and effectiveness of implementing case-based active learning in higher education within the field of AT, supporting future large-scale implementation and optimization of such case-based active learning and teaching strategy in the AT field.

Purpose: Assistance from artefacts and humans are traditionally viewed as separate, and it is often up to the individual to try to combine the different kinds of assistance to suit their needs and preferences. The purpose of this study was to gain new insights into the co-existence of and synergies between artefactual and human assistance in the everyday lives of persons with physical and cognitive impairments, through exploring and analysing narratives of individuals who have first-hand knowledge and experience.

Methods: Seven individuals took part in semi-structured interviews, which were then analysed with qualitative content analysis, grounded in cultural-historical activity theory.

Result: The participants were active agents with agendas, dreams, and needs, who shaped and made use of many different combinations of human and artefactual assistance, both formal and informal. They did this in ways that suited each person's preferences and circumstances and were often seen as complementary and synergistical. Flexible assistance could make limited energy resources last throughout the day, while less flexible or not individually tailored assistance was found to be less useful or appreciated. Assistance that was well integrated into a person's routines could become invisible and make the person feel independent despite severe impairments.

Conclusions: This study contributes new knowledge regarding how persons with disabilities utilize and mould artefactual and human assistance according to the activities they engage in as part of everyday life. When synergistical assistance works, different kinds of assistance flow seamlessly into one another and adjustment of plans and improvisations happen in the moment.

Purpose: This exploratory qualitative study examines the challenges faced by manual wheelchair (MWC) users and their clinicians, with a focus on mobility difficulties in both outdoor and indoor environments, as well as training priorities.

Methods: The study involved semi-structured interviews with 18 clinicians and 25 MWC users from various rehabilitation centres. The interviews, lasting between 30 and 60 minutes, explored specific aspects of MWC use, including mobility challenges, training needs, and psychological factors.

Results: Thematic analysis of the data revealed key patterns, such as indoor and outdoor navigation issues, had difficulty with basic propulsion skills, and the psychological impact of using an MWC. Participants emphasized the need for comprehensive training programs, addressing safety concerns, and ensuring proper MWC adjustments to improve mobility and comfort.

Conclusion: The study highlights the importance of psychological support and public awareness campaigns to reduce stigma and promote inclusivity. The findings are crucial for developing a tailored training program for new MWC users, addressing both physical and psychological challenges to enhance their overall quality of life and independence.

The purpose of this study was to evaluate the effectiveness of custom seating and mobility services provided via an international service learning (ISL) model on the occupational performance of individuals with disabilities in Guatemala. A one-group prospective pretest-posttest design was implemented using the standardized Wheelchair Outcome Measure (WhOM - Spanish) administered on the day of wheelchair fitting, and at 3- and 6-month intervals after receiving seating and mobility services. A two-tailed t-test demonstrated a statistically significant (p < 0.001) improvement in satisfaction for in-home and out-of-home occupations for all participants (n = 71) at 3-months with a huge effect size (d > 2) and this improvement was maintained at the 6-month interval. The results were consistent for various areas of occupational performance (e.g. activities of daily living). The provision of customized seating and mobility services by occupational therapists through an ISL model demonstrated effectiveness at improving satisfaction with occupational performance for individuals with disabilities in Guatemala. Cultural humility, customization of equipment based on personal and environmental factors, inclusion of education and training, and collaboration with in-country partners were identified as contributors to positive outcomes.