Disability and Rehabilitation-Assistive Technology最新文献

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.

Additive manufacturing (3D printing) is increasingly utilized in healthcare. Some rehabilitation professionals employ 3D printing for orthoses, prostheses, and assistive technologies (AT). However, anecdotal evidence suggests that many practitioners have reservations about adopting 3D printing into their practices, and empirical research in this area is limited. The aim of the study was to document my experience while learning 3D printing. In this autoethnographic study, journal entries and photos of the artifacts were collected during the process of learning 3D printing. These data were analyzed using reflexive thematic analysis. Three themes were identified: Being motivated to learn 3D printing, Experiencing challenges and implementing possible solutions, and Achieving developmental milestones in learning 3D printing. These milestones offered practical insights and solutions for new learners by providing a roadmap for navigating the journey of learning 3D printing. This personal experience offered opportunities and posed challenges in the context of learning to use 3D printing in the rehabilitation field. It is hoped that this study will inspire others to explore 3D printing and potentially contribute to the development of 3D printing training programs for students and rehabilitation professionals.

Purpose: To conduct a systematic review on the impacts of using mechanical assistive devices on function, performance in activities and participation of persons with upper extremity impairments, and to synthesize the strengths and limitations of these devices.

Method: Three independent reviewers conducted systematic searches of articles published between 2003 and 2023 in Compendex, Inspec, Embase, PubMed/Medline, IEEE Xplore, and Web of Science, as well as manual searches on the RESNA website for conference papers over the same period. The methodological quality of articles was appraised using the QualSyst tool.

Results: From the 34 retained studies, 28 mechanical devices were identified and classified into two categories: (1) mobile arm supports (MASs) designed to perform multiple activities, and (2) devices used to assist with a specific activity of daily living (ADL). Overall, MASs helped users to perform manual activities in elevation and/or against gravity. Specific ADL devices allowed users to perform unique activities requiring fine motor skills such as opening a medicine container. Some of these devices have advantages like portability, adaptability, low cost, and ease of use. Limitations most often reported included interference or mobility restraints.

Conclusion: This review synthesizes the impacts of mechanical devices on the three domains of the International Classification of Functioning, Disability and Health (ICF) for individuals with upper extremity impairments. Impacts regarding function and performance in activities were more often measured than participation. Future studies should include outcomes related to participation, as taking this aspect into account might favor successful continued use of assistive devices.

Background: When selecting a manual wheelchair frame, the choice between rigid and folding frames carries significant implications. Traditional folding frames are expected to have more rolling resistance and power dissipation caused by frame deformation, while they are more convenient for transportation, such as in a car. A new hybrid frame, designed to be more rigid, aims to minimize power dissipation while still retaining foldability.

Aim: This study aimed to assess rolling resistance, power output, propulsion technique and physiological demands of handrim wheelchair propulsion across three different frames: a rigid frame, a hybrid frame and a conventional folding frame.

Materials and methods: Forty-eight able-bodied participants performed coast-down tests using inertial measurement units to determine rolling resistance. Subsequently, four-minute submaximal exercise block under steady-state conditions at 1.11 m/s were performed on a wheelchair ergometer (n = 24) or treadmill (n = 24) to determine power output, propulsion technique and physiological demands.

Results: Repeated measures ANOVA revealed that the hybrid frame exhibited the lowest rolling resistance (7.0 ± 1.5N, p ≤ 0.001) and required less power output (8.3 ± 1.0W, p ≤ 0.001) at a given speed, compared to both the folding (9.3 ± 2.2N, 10.8 ± 1.4W) and rigid frame (8.0 ± 1.9N, 9.4 ± 1.6W). Subsequently, this resulted in significantly lower applied forces and push frequency for the hybrid frame. The folding frame had the highest energy expenditure (hybrid: 223 ± 44 W, rigid: 234 ± 51 W, folding: 240 ± 46 W, p ≤ 0.001).

Conclusion: The hybrid frame demonstrated to be a biomechanically and physiologically beneficial solution compared to the folding frame, exhibiting lower rolling resistance, reduced power output, and consequently minimizing force application and push frequency, all while retaining its folding mechanism.

Multi-Modality Aphasia Treatment (M-MAT) is an effective group intervention for post-stroke aphasia. M-MAT employs interactive card games and the modalities of gesture, drawing, reading, and writing to improve spoken language. However, there are challenges to implementation of group interventions such as M-MAT, particularly for those who cannot travel or live in rural areas. To maximise access to this effective treatment, we aimed to adapt M-MAT to telehealth format (M-MAT Tele). The Human-Centred Design Framework was utilized to guide the adaptation approach. We identified the intended context of use (outpatient/community rehabilitation) and the stakeholders (clinicians, people with aphasia, health service funders). People with aphasia and practising speech pathologists were invited to co-design M-MAT Tele in a series of iterative workshops, to ensure the end product was user-friendly and clinically feasible. The use of co-design allowed us to understand the hardware, software and other constraints and preferences of end users. In particular, clinicians (n = 3) required software compatible with a range of telehealth platforms and people with aphasia (n = 3) valued solutions with minimal technical demands and costs for participants. Co-design within the Human-Centred Design Framework led to a telehealth solution compatible with all major telehealth platforms, with minimal hardware or software requirements. Pilot testing is underway to confirm acceptability of M-MAT Tele to clinicians and people with aphasia, aiming to provide an effective, accessible tool for aphasia therapy in telehealth settings.