Disability and Rehabilitation-Assistive Technology最新文献

Purpose of the Article: To (1) summarise the personal and clinical characteristics of persons with disabilities (PwDs) in the US who were evaluated for mobility assistive equipment (MAE) in the functional mobility assessment and uniform dataset (FMA/UDS) and (2) stratify subpopulations of PwD who reported falling versus those who do not report a fall.

Materials and Methods: This study was a retrospective, descriptive cohort analysis of adults with disabilities using the FMA/UDS. Data are collected during a user's initial evaluation for a new mobility device. The sample is intentionally general to be inclusive of all mobility device users. The primary variable of interest was a patient-reported fall within the 3 months leading up to their evaluation for a new mobility device. Subpopulation characteristics were stratified by this binary fall variable.

Results and Conclusions: This study provides descriptions of PwDs being evaluated for a new mobility device. There were 11,084 PwDs with 31 different primary diagnoses. During their new mobility device evaluation, 52.2% of PwDs reported at least one fall in the last 3 months. For those who reported a fall, 46.6% of PwDs were using a walking aid or no device at all before the new mobility device evaluation. Additionally, persons with progressively acquired disabilities (i.e., Parkinson's disease, osteoarthritis and cardiopulmonary disease) reported higher rates of falls than those with congenital disabilities (i.e., cerebral palsy and spina bifida). These findings will influence future studies comparing different types of devices and their influence on falls and user satisfaction.

Wheelchair users (WCUs) face additional challenges than non-WCU to multi-tasking (i.e. open doors, cook, use a cell-phone) while navigating their environments. While assistive devices have attempted to provide WCUs with mobility solutions that enable multi-tasking capabilities, current devices have been developed without the input of end-users and have proven to be non-usable. More balanced approaches that integrate the end-users' voices may improve current assistive technology usability trends. This study sought to empathically understand the lived experience of WCUs, their needs towards a mobility device, and their perceptions towards hands-free mobility. Full-time WCUs and care providers participated in semi-structured interviews examining wheelchair use and perceptions towards current and future mobility devices. Thematic analysis was used to analyze interview data. 9 WCUs (aged 32.1 ± 7.0 years; wheelchair experience 17.9 ± 11.6 years) and five care providers (years caring for WCU 3.75 ± 0.96 years) participated in the study. The most common disability type was spinal cord injury (WCUs: n = 3; care providers: n = 3). Qualitative analysis revealed four key themes: (1) Current wheelchair usage, (2) WCU and care provider perspectives, (3) Future wheelchair, and (4) Hands-free wheelchair. Accordingly, participants desire bespoke, light-weight mobility devices that can through tight spaces, access uneven terrain, and free the hands during navigation. This study provides meaningful insight into the needs of WCUs and care providers that assistive technology innovators can use to develop more usable assistive technologies. Amongst study participants, the concept of a hands-free mobility device appears to be usable and desirable.

Purpose: Device manufacturers and technicians (MaTs) of augmentative and alternative communication (AAC) systems play key roles in the design and successful uptake of communication devices. This study aims to investigate MaT perspectives on AAC device design and effective use.

Materials and methods: To investigate their perspectives, a focus group of MaTs within Canada was conducted. Reflexive thematic analysis was used to analyze data.

Findings: Three major themes resulted from analysis, which reflect MaT's views: AAC hardware and software flexibility, AAC knowledge and implementation, and social good versus financial resources.

Conclusions: This study provides insights into the complexities faced by MaTs in balancing technical support of system end-users and the financial resources necessary for that support. These insights indicate a need for increased financial resources and the expansion of individuals who qualify for AAC system candidacy. MaTs suggest that an increase in resources and candidacy could lead to more successful AAC implementation and a greater understanding of AAC for all stakeholders.

Purpose: To investigate the practices of repair that exist for users of mobility assistive products in low resource settings, as well as the psychosocial impact that the repair, or non-repair, of these devices has on users' lives.

Materials and methods: This article collates data on repair practices and the responses from participants on the topic of repair from studies conducted by the authors across four different low resource settings in Kenya, Uganda, Sierra Leone, and Indonesia. This data was then analyzed to identify the common themes found across geographies.

Results: Three major models of repair practice emerged from the data: "Individual or Informal Repair in the Community"; "Local Initiatives"; and "Specialist AT Workshop Repair". Additionally, the wider impact on the participants' lives of "Problems & Concerns with Repair"; "Experiences of Breakages & Frequencies of Repair" and the "Impact of Broken Devices" are explored.

Conclusions: The results of this analysis demonstrate the paramount importance of community-based repair of devices, and how despite this importance, repair is often overlooked in the planning and design of assistive products and services. There is a need to further incorporate and support these informal contributions as part of the formal provision systems of assistive device.

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.

Background: The increasing number of wheelchair users and their risk of medical complications such as pressure ulcers (PU) make it important to have a better understanding of their seating characteristics. However, while most studies tackling this issue are based on static measurements, wheelchair users are active in their wheelchairs when performing daily life activities. This suggests the need to assess the mechanical loads at the wheelchair user's body-seat interface during dynamic activities.

Objectives: A scoping review was conducted to explore the existing data (shear load and pressure) and highlight significant parameters, relevant conditions and methodological strategies when studying wheelchair users performing a dynamic task.

Materials and methods: The literature search was performed by applying the PRISMA methodology.

Results: A total of 11 articles met the inclusion criteria. Differences between static and dynamic data were found in the literature for peak pressure values, pressure distribution and the location of peak pressure. None measured tangential load at the seat/body interface, although two studies measured the shift of the ischial region. A significant impact of the type of pathology has been quantified, showing the need to perform experimental studies on diverse populations. The protocol and the pressure parameters studied were very diverse.

Conclusion: Further studies carefully choosing interface pressure mapping parameters and investigating a broader range of pathologies are required. Additionally, researchers should focus on finding a way to measure seated tangential load.

Purpose: College students with concussion experience academic, cognitive and psychosocial challenges, yet frequently lack supports necessary for successful reintegration into school. Success in College after Concussion with Effective Student Supports (SUCCESS) is a virtual peer mentoring program designed to provide education, support and connection through a mobile application. The purpose of this study was to describe use of personas as components of mobile app development and conduct preliminary testing of SUCCESS using personas.

Methods: Personas were developed from case studies and portrayed by college students trained as fictitious mentees. Mentors were blinded to use of personas. Eleven mentors completed measures pre and post a 4-week mentoring cycle. Mentors and personas interacted in the app via chat, video calls and sharing of educational materials. Measures included the Post-Concussion Symptom Scale (PCSS); PROMIS Self-Efficacy; Depression, Anxiety and Stress Scale (DASS); and a series of focus groups.

Results: Mentors suggested improvements to resolve instability of video calls, expand educational materials to address psychosocial functioning, and add structure to the mentoring relationship. Some preferences around communication, like groups chats and emoji keyboards, were not able to be addressed. As expected, PCSS scores were stable. DASS score (p = .04), especially depression (p = .03), decreased. PROMIS scores showed a trend towards growth (p = .057), although were not statistically significant.

Conclusions: Use of personas allowed technical challenges and program refinements to be addressed before including students with subacute concussion in testing. Although continued development will address enhancement of communication modalities preferred by students, future efficacy testing of SUCCESS is warranted.

Purpose: Children who use a manual wheelchair (WC) or a power WC may not receive adequate WC skills training. Clinicians report knowledge as a barrier to the provision of paediatric WC skills training. The purpose of this study was to explore the breadth and depth of specific factors clinicians consider when providing WC skills training for children.

Methods: Data in this modified Think Aloud study were gathered via one-on-one, Zoom-based, audio-recorded Think Aloud Sessions. Sessions consisted of participants viewing four videos, each of different children performing a different WC skill while thinking aloud (verbally expressing) about the factors they recognized, observed, and considered while watching the video. After each video, participants also responded to questions regarding the specific WC skill and the provision of WC skills training for the child in the video. Factors participants reported were independently identified by three researchers through a deductive process of directed content analysis and categorized using the International Classification of Functioning, Disability and Health (ICF) coding system.

Results: Twenty-eight English-speaking clinicians participated in the study. A total of 1246 distinct factors were mapped to 352 unique ICF codes spanning all four ICF Domains. The largest number of identified factors mapped to codes within the Activities and participation Domain (42.25%).

Conclusion: Participants reported considering multiple factors across the ICF in the provision of WC skills training for children. Providing paediatric WC skills training is a complex activity requiring clinicians to consider a wide range of factors that go beyond a child's motor abilities.

Purpose: The Wheelchair Skills Test (WST) is commonly conducted in a simulated setting. Although the WST can be done in the community setting, its usefulness in this setting has not been systematically evaluated. The purpose of this study was to compare the WST in the simulated versus community settings, and to explore participants' perceptions of performing in each environment.

Methods: For this mixed-methods study, we studied 20 motorized mobility scooter users who had used their devices for ≥ 3 months. Each participant completed the WST Version 4.3 twice in random order - once in a simulated setting and once in their community within a two-week period. Semi-structured interviews were conducted after completion of the WST in both environments. A self-report version of the WST (WST-Q) was also completed that measured perceived capacity, frequency of skill performance, and confidence.

Results: The mean (SD) total WST score in the simulated setting was 88.9% (8.6) and 92.7% (7.8) in the community setting. The two WST scores were moderately correlated (r = 0.306, p = 0.190). Community-setting WST scores were moderately correlated with WST-Q confidence scores. Simulated-setting scores were moderately correlated with WST-Q frequency scores. Although most participants preferred performing the WST in their communities due to convenience and familiarity, they perceived the simulated setting to be reflective of their community settings.

Conclusion: Despite challenges, community-based testing may provide a better reflection of everyday performance for scooter users than testing in a simulated environment.

Purpose: To characterize the relationship among rolling resistance (RR), preferred speed, and propulsion mechanics.

Methods: N = 11 non-disabled individuals (mean (SD)); Age 24 years (2), BMI 23.8 kg/m² (4.3) completed a submaximal graded wheelchair exercise test (GXT_submax, fixed speed, terminated at Rating of Perceived Effort (RPE)=8 (0-10 scale)) and a single-blind, within-subject repeated measures wheelchair propulsion experiment (RME). RR at RPE = 10 (estimated maximum workload, Max_estimated) was estimated from the GXT_submax RPE-RR relationship. RME consisted of N = 19 1-minute trials (self-selected speed) each followed by 2-minutes rest. The trials included N = 16 unique RR between 25-100% of Max_estimated. Averages of all pushes in N = 16 unique 1-minute trials were computed for average RR (N), speed (m/s), peak force (F_peak (N)), force rate of rise (F_ror (N/s)), push frequency (PF (pushes/min)), and push length (PL (deg)).

Results: Repeated measures correlation assessed relationships among outcome variables (α = 0.05). RR was associated with decreased speed (r=-0.81, p < 0.001), increased F_peak (r = 0.92), F_ror (r = 0.26), and PL (r = 0.32) (all p > 0.001), and unrelated to PF (r = 0.02, p = 0.848). Increased speed was associated with increased F_ror (r = 0.23, p = 0.003) and PF (r = 0.27, p < 0.001) and decreased F_peak (r=-0.66, p < 0.001) and PL (r=-0.25, p < 0.001).

Conclusion: Increasing RR increases F_peak despite reducing self-selected speed. RR and speed were strongly and moderately related to F_peak, respectively, but weakly related to other propulsion mechanics. These results suggest that reducing user-system RR may confer dual benefits of improved mobility and decreased upper extremity loading. Further testing among wheelchair users is required. Clinical trial registration number: NCT04987177.