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Technology and Disability communicates knowledge about the field of assistive technology devices and services, within the context of the lives of end users - persons with disabilities and their family members. While the topics are technical in nature, the articles are written for broad comprehension despite the reader's education or training.
Technology and Disability's contents cover research and development efforts, education and training programs, service and policy activities and consumer experiences.
The term Technology refers to assistive devices and services.
- The term Disability refers to both permanent and temporary functional limitations experienced by people of any age within any circumstance.
- The term and underscores the editorial commitment to seek for articles which see technology linked to disability as a means to support or compensate the person in daily functioning.
The Editor also attempts to link the themes of technology and disability through the selection of appropriate basic and applied research papers, review articles, case studies, programme descriptions, letters to the Editor and commentaries. Suggestions for thematic issues and proposed manuscripts are welcomed.
Abstract: The wheelchair and its seating system has been evolving since the sixth century. Much of this evolution has been driven by social attitudes, medical capabilities, and technological innovations. Recently, wheelchairs and seating have developed into devices designed to provide empowerment for their users. In some cases, this has increased the complexity of the devices themselves, and in most cases, this has increased the complexity of matching the user's needs and desires with the appropriate mobility and seating devices. This paper provides an historical overview of seating and mobility issues and practices. The reader is taken from the sixth century to…what we perceive as the state-of-practice in the twenty-first century. This paper addresses issues of assessment, credentialing, education, design, and standards.
Abstract: It is critical that suppliers of assistive technology do outcome studies that indicate whether or not the technology which they provide actually assists the consumer. Assistive technology practitioners have begun to do this, but most durable medical equipment suppliers have not yet participated in outcome studies. The role of rehabilitation technology suppliers (RTS) is often unknown by clinicians and funding agencies. Many third party payers do not understand the value of the service provided by the RTS, and will award equipment approvals based on discount pricing to suppliers who are not involved in the actual assessment process for that consumer.…Therefore, outcome studies are needed to support the role of the RTS. However, the durable medical equipment firms who should perform these studies do not feel they have the necessary expertise to perform them. As part of their QA/CQI procedures, Dynamic Medical Equipment, Ltd. developed three questionnaires to measure outcomes at three times during the provision of mobility equipment: post-assessment, post-delivery, and 6 months after delivery of mobility device. An initial survey was sent to 60 customers with a 75% rate of return. Two subsequent surveys had 80% and 43% return rates, respectively. Nearly all of the respondents (37/44 or 84%) indicated being satisfied or very satisfied with the assessment process. A slightly greater percentage of respondents who indicated being very satisfied with the assessment process worked with an RTS compared to respondents who indicated being satisfied (95% vs. 76%). Most respondents who worked with the RTS indicated that they were offered equipment choices, were shown pictures of equipment, and were able to try products before purchase. Respondents who were very satisfied with the assessment had a higher goal attainment post-delivery (94%:73%) and at 6 months (89%:60%) compared to respondents who indicated being satisfied. The results indicate the benefits of a comprehensive assessment. Future studies are planned to better document the usefulness of RTS participation in the provision of mobility devices.
Abstract: Quality assurance (QA) and continuous quality improvement (CQI) are hot topics in rehabilitation technology (RT) these days. While most industries have focused on QA and CQI practices for many years, the RT service industry is just beginning to address issues related to quality. The lack of QA or CQI integration into the RT services does not imply a slowness of the industry to respond to quality issues and needs. Rather it reflects the youth of the industry and, more importantly, the interdisciplinary nature of RT and assistive technology (AT) service delivery. Recognizing the importance of quality in the delivery…of services and devices, several AT /RT programs have been practicing quality assessment and improvement (QA&I) in a formal manner for years. The University of Virginia's Rehabilitation Engineering Service Program (UVA-RES) is one such example. UV A-RES has been, and continues to be, keenly interested in objectively assessing and improving the quality of the services and devices it provides. Since 1989, the program staff have worked with QA&I specialists to develop, implement, and regularly update a QA&I plan and practice that yields compliance with accreditation standards and, more importantly, looks for opportunities to improve the quality of the services and products provided by UVA-RES staff. The UVA-RES QA&I program is not on the innovative threshold of QA&I. Rather, it is a solid program, pragmatic in design, that is based upon the guidelines established by key healthcare accrediting bodies. A survey of 35 rehabilitation engineering programs in the United States found that only 14 actually possessed a distinct QA&I plan and undertake specific quality improvement activities. Because so few engineering and technology programs practice QA&I in a formal manner, the UVA-RES program represents a basic model that can be replicated by any AT/RT practitioner who is new to the QA&I arena and who desires to develop their own program.
Keywords: Quality assurance, Quality assessment and improvement, Rehabilitation technology, Assistive technology, Rehabilitation engineering, Service delivery
Abstract: Under the present grant in aid system for Medicaid, states are required by the federal government to provide a minimum level of services in order to receive federal matching funds. Although this system may be subject to change resulting from political shifts, prior grants have allowed states some flexibility in administering Medicaid programs. This flexibility has caused states to develop policies that are inherently different in the types of services covered and the means by which those services may be covered under Medicaid. One of the areas that highlights the discrepancies in state policies is the varying purchase processes, rental…and repair of wheelchairs. States differ in the types of wheelchairs they will cover, how they make determinations for coverage and the process through which persons must be subject to in order to receive approval for funding of a wheelchair. The differences in these processes, procedures and decisions are discussed.
Abstract: While early independent mobility may have positive effects on a child's development, it is still difficult for a clinician to determine when a child is developmentally ready to operate a powered wheelchair. The Rehabilitation Engineering Research Center at Rancho Los Amigos Medical Center in Downey, California has undertaken a project to develop a cognitive assessment battery to predict a young child's functional performance in a wheelchair. The first phase of this project – the development of a powered mobility program (PMP) – is presented here. A 34-item assessment battery was developed through a task analysis and input from professionals who…train children in mobility skills. The battery includes basic, structured and unstructured wheelchair skills. A flexible approach for administering the PMP is presented, as well as findings from twenty-four children between the ages of 18 and 36 months who were evaluated using the PMP.
Keywords: Powered mobility program, Young children, Cognitive readiness, Wheelchair training
Abstract: The CALL Smart Wheelchair is an augmentative mobility aid, designed for children who cannot operate conventional powered wheelchairs. This article focuses on how the chairs are used for developing children's driving skills. The Smart Wheelchair and its functions are reviewed, and the approach to training outlined. Three cases studies are described: two of children who used the chair to develop full control of conventional, joystick controlled chairs, and one of a child who still relics on the Smart facilities. To finish, we look in more detail at individual driving skills, and how different Smart Tools can be used to promote…their development.
Abstract: The use of a single input device to operate more than one piece of assistive technology – known as ‘integrated control’ – can be useful to some persons with disabilities. In contrast, separate ‘distributed’ input devices can also be used to access individual assistive devices. Since integrated controllers are relatively new, few guidelines exist to indicate to clinicians when they are appropriate to recommend. A 3-year study was conducted to compare and evaluate the use of systems configured with integrated and distributed controls. The study consisted of a retrospective review of clients at a rehabilitation technology center and case study…evaluations of access performance using both integrated and distributed controls. This paper presents the findings of the case studies. Overall, integrated control appeared to be useful for persons with very few access sites and for those for whom the ‘best’ access methods for each assistive device are the same. Some individuals also preferred integrated control for personal (e.g. aesthetics) or performance (e.g. reduction in fatigue) reasons.
Abstract: In the United States, each year there are over 36000 wheelchair-related injuries that are serious enough to require the wheelchair user to seek attention at an emergency room, and there are about 50 wheelchair-related deaths. Most of these injuries are due to tips and falls. Of non-institutionalized users of manually propelled wheelchairs, 47% will have sustained injuries due to instability incidents by the time they have used their wheelchairs for 11 years. Static stability can be simply measured using a tilting platform and the procedures of the International Organization for Standardization. Dynamic stability can be evaluated by observing the user…negotiate an obstacle course, using an ordinal scale to score each task. A number of easily modifiable parameters that affect wheelchair stability have been documented. The challenge for clinicians, researchers and manufacturers is to find ways to enhance wheelchair safety without unduly interfering with performance or maneuverability.
Abstract: Wheelchair users who drive must overcome the dynamic vehicle environment to maintain stability. Proper stability might increase functional ability and improve the driving ability of wheelchair users. This project investigated a dynamic environment by measuring the accelerations experienced by individuals with spinal cord injury during vehicle acceleration, deceleration and curve maneuvers. RMS accelerations along three axes were measured at the sternum of the subjects and the floor of the vehicle. The subjects sat both passively and while grasping a structure to simulate gripping driving controls. Trunk stability was measured by contact switches secured to the wheelchair backrest. Seated stability was…greater when the subjects grasped the structure. Stability was also positively correlated with increasing the rate of change of velocity (vehicle accelerations) during decelerations and curves and negatively correlated during acceleration maneuvers. Vehicle and subject responses varied greatly. This variability underscores the complexity involved when researching the functional abilities of the spinal cord injured population within a complex dynamic environment.
Abstract: Wheelchair headrests arc currently designed so they arc not easily moved once they arc adjusted to the optimal position. This is the preferred design in most cases because it would be detrimental to the user for the headrest to accidentally move from its optimal position. However, there may be times, such as when headrests arc used in conjunction with adjustable position wheeled mobility bases and seating systems, that the user would prefer to change his headrest position. When a person who uses a tilt-in-space or reclining wheelchair changes his orientation, he may prefer to change the position of his head…in relation to the rest of his body so he can continue to maintain visual attention with current activities. Evidence of research examining this phenomenon is limited. A a preliminary study, non-disabled adults were seated in a tilt-in-space seating system and positioned in three orientations. To simulate a passive activity requiring visual attention, they were asked to watch a videotape. In each position, the preferred headrest position was determined. Data regarding the preferred position of the headrest was collected and analyzed to determine the relationships between changes in body position and changes in preferred headrest angles. Findings indicate that the sample tested preferred to change their headrest angle in response to changes in orientation. The results of this study indicate that further investigation is warranted to determine if people who ordinarily use such devices would benefit from adjustable angle headrests.
Keywords: Head position, Wheelchairs, Seating and positioning
Abstract: Home based frail elders experience significant difficulty with mobility. Many turn to mobility aids such as canes and walkers to provide support. Others use wheelchairs for all or part of their mobility needs. This study followed up on a finding from an earlier report that frail elders experience a high rate of problems with their wheelchairs. In the present study we found that 31.4% of frail elders used a wheelchair, and 40% of these wheelchair users report at least one problem. Problems were grouped into these categories: ‘maintenance and repair, such as broken wheels, flat tires, (33% of problems); ‘fit…between user and the chair,’ such as uncomfortable to sit in, unable to propel self (41%); and ‘physical characteristics,’ such as too heavy, too wide of the wheelchair, (26%). There were a significantly higher percentage of elders with wheelchair problems among those who selected their own wheelchair, than among elders whose chair selection involved a health professional. Two primary reasons for not resolving the wheelchair problems in a timely manner relate to the consumer's limited financial resources and their need for more information on maintaining and repairing wheelchairs.
Keywords: Assistive devices, Mobility, Aging, Community, Home care