Technology and Disability - Volume 25, issue 3

Authors: Andrich, Renzo | Mathiassen, Niels-Erik | Hoogerwerf, Evert-Jan | Gelderblom, Gert Jan

Article Type: Research Article

Abstract: The purpose of this paper is to indicate a framework for exploiting the potential role of assistive technology (AT) in supporting care and participation of people with disabilities and elderly people through appropriate service delivery systems (SDS). The paper is based on the findings of the AAATE/EASTIN workshop “Service Delivery Systems on Assistive Technology in Europe” (held in Copenhagen on May 21–22, 2012, under the patronage of the Danish EU Presidency), on the roadmaps indicated by the previous HEART Study published in 1995 by the European Commission, and on a consensus process within the Board of the AAATE …(Association for Advancement of Assistive Technology in Europe) and the EASTIN Association (European Assistive Technology Information Network). The first chapter Background) discusses the reasons why a position paper on this issue was deemed useful; it also summarises the key themes of the Copenhagen workshop and recalls the HEART Study. The second chapter (The scope of an AT SDS), discusses the concept of assistive solutions – intended as individualised interventions providing users with appropriate environmental facilitators (AT products, personalised environmental modifications, personal assistance) to overcome disability and enable participation in all aspects of life – and the mission of a SDS – ensuring that all people with disabilities can access appropriate assistive solutions that are able to support autonomy in their life environment. The paper also points out that AT service delivery policies should be well coordinated with accessibility policies i.e. those related to infrastructural interventions ensuring that the mainstream environment, products and services are usable by all people, including those with reduced function or who depend on assistive technology. The third chapter (Basic features of an AT SDS) discusses why public SDS are needed for AT, what the main AT SDS models are, and how a SDS process can be described and monitored in terms of quality. The discussion is organised into answers to eight recurring questions: 1) Are assistive technology products going to disappear in the future, due to the embodiment of accessibility features in mainstream products; 2) Why shouldn't assistive technology products be dealt with as common consumer goods, purchased directly by users without the intermediation of service delivery systems; 3) Are there different approaches for AT service delivery; 4) When can a medical model, or a social model, or a consumer model be considered appropriate; 5) Independently of the model and the Country or Region, is it possible to identify common steps in the service delivery process; 6) How does each step influence the costs and the outcomes of the whole process; 7) How can the SDS process be monitored by quality indicators; and 8) How can information support the service delivery process. The last chapter (Some recommendations) provides a number of useful recommendations for those who are engaged in the design, development and implementation of AT SDS policies. The recommendations are clustered round the six SDS quality indicators suggested by the HEART Study: Accessibility, Competence, Coordination, Efficiency, Flexibility, User Influence. Show more

Keywords: Assistive technology, accessibility, service delivery, quality assurance, disability policy

DOI: 10.3233/TAD-130381

Citation: Technology and Disability, vol. 25, no. 3, pp. 127-146, 2013

Authors: Andrich, Renzo | Caracciolo, Antonio | Johnson, Ingela

Article Type: Research Article

Abstract: Individual assessment for assistive technology solutions (AT) is often carried out as a specialist consultation in Assistive Technology Centres (ATCs), especially when inter-disciplinary competence and trial equipment are required. The SIVA service of the Don Gnocchi Foundation was the ATCs pioneer in Italy. SIVA stands for Servizio Informazione Valutazione Ausili (Assistive Technology Information and Assessment Service). In over 30 years of activity it offered about 23.000 individual consultations to clients from all over Italy, and developed methodologies and protocols for provision of this service. In parallel, it established a national AT information system – first as a local database, then …as a web Portal (Portale SIVA) that later was the initiator of the European Assistive Technology Information Network (EASTIN) – and various educational initiatives including a Postgraduate Course and a permanent education programme composed of monthly Seminars. These parallel activities helped disseminate AT knowledge among end-users, health care professionals, industrialists and policy makers; contributed indirectly to the establishment of other ATCs throughout Italy, most of them participating today in a national network called GLIC; and also led to a gradual change in the profile of clients who applied for individual consultation. As time evolved, the clients' requests tended to be more focused and complex, as answers to simpler problems could be more often found in their community services, or in local ATCs, or even online through the SIVA and the EASTIN portals. This article offers a retrospective look at this thirty-year experience, which in turn is divided into three ten-year phases: the “pioneer” age (1983–1992, in which the service gradually took shape), the “maturity” age (1993–2002, in which the service operated as a self-standing Unit with nation-wide scope) and the “integration” age (2003–2012, in which the service was up-taken by the clinical rehabilitation services of the Don Gnocchi Foundation). The evolutions of client profiles, topics addressed and organisational models are described; they are also correlated to the parallel evolution of the SIVA information system and educational activities. Show more

Keywords: AT assessment, AT centres, AT information systems, AT education

DOI: 10.3233/TAD-130379

Citation: Technology and Disability, vol. 25, no. 3, pp. 147-158, 2013

Authors: Desideri, Lorenzo | Mingardi, Alberto | Stefanelli, Brunella | Tanzini, Daniela | Bitelli, Claudio | Roentgen, Uta | de Witte, Luc

Article Type: Research Article

Abstract: The design of public assistive technology (AT) service delivery systems in Europe varies according to each country's culture, disability policy, socio-economic context, health care system organization and history. Though it is recognized by the AT community that it is impossible and not useful to develop a “perfect” or “standard” model for AT service delivery, a way to reduce the fragmentation and increase the collaboration among AT providers has been recently highlighted by the AAATE Position Paper on Service Delivery Systems in Europe. In particular, this document emphasizes the importance for AT providers to share their practices of service delivery in …order to “understand to which extent good practices could be exported from one country to another”; and implement common strategies for the evaluation of the quality of the service delivery. In keeping with these recommendations, the present paper illustrates an interdisciplinary AT assessment model targeting children with multiple disabilities which is grounded on the experience of the Centre for Assistive Technology (CAT) operating in the municipality of Bologna, Italy. In addition, a proposal for a conceptual framework for evaluating the quality of service delivery is developed. Show more

Keywords: Children, multiple disabilities, assistive technology, service delivery, model, quality assessment

DOI: 10.3233/TAD-130378

Citation: Technology and Disability, vol. 25, no. 3, pp. 159-166, 2013

Authors: Malinowsky, Camilla | Kottorp, Anders | Nygård, Louise

Article Type: Research Article

Abstract: Background: Older adults may have difficulties in using everyday technologies, ET, e.g. micros, computers, particularly those with cognitive impairment. To guide supportive interventions, more knowledge of how to best assess ET use is needed. Objective: To provide new knowledge of perceived and observed levels of difficulty of ETs in older adults with and without cognitive impairment. Methods: Two samples of older adults (n=118 and 116) with and without cognitive impairment were assessed. One was interviewed with the Everyday Technology Use Questionnaire (ETUQ) about perceived difficulties in ET use. The other sample’s observed ability to manage ET …was assessed with the Management of Everyday Technology (META). Data was analyzed using a Rasch measurement model and rank-ordered hierarchies of perceived and observed levels of ET difficulty were identified, correlated and examined. Results: Findings demonstrated a correlation of 0.63 (p < 0.001 ). The upper range of both hierarchies contained more complex ETs like cell phones and computers while the lower comprised more home maintenance ETs. Conclusions: Perceived and observed levels of ET difficulty appear as similar, yet not identical constructs. In self-reports, though, ETUQ to a great extent seems to capture levels of ET difficulty. However, in clinical practice observations of actions may guide interventions, as they can identify why an ET is difficult. Show more

Keywords: Dementia, mild cognitive impairment, ADL, assessment, self-report, observation

DOI: 10.3233/TAD-130380

Citation: Technology and Disability, vol. 25, no. 3, pp. 167-176, 2013

Authors: Franck, Johan A. | Timmermans, Annick A.A. | Seelen, Henk A.M.

Article Type: Research Article

Abstract: Objective: To investigate the usability and the effects of a dynamic spring-loaded orthosis, adjunct to therapy-as-usual (TAU), on functional use of the impaired hand in moderately/severely impaired sub-acute stroke patients. Design: Single case experiment (A-B-A′-design). Subjects: Eight sub-acute stroke patients. Methods: The orthosis was used for six weeks, five days/week, 45′/day, and adjunct to TAU. Outcome measures: Action Research Arm Test (ARAT), ABILHAND, Intrinsic Motivation Inventory (IMI). Results: At group level, patients improved on ARAT (p = 0.001 ) and ABILHAND (p = 0.005 ). After detrending for …baseline trends (caused by e.g. spontaneous recovery and/or TAU), such improvement was only found for ARAT (p = 0.009 ). At individual level, three patients whose baseline ARAT changed little (0–3 points), had improved at follow-up, and four remained constant regarding detrended ARAT results. In four patients mean detrended ABILHAND results were higher during follow-up relative to baseline (p ⩽ 0.036 ). Average IMI sub-scores were between 5.4 and 6.6 (of 7), except for ‘pressure/tension’ (2.1). Conclusion: Patients, who, in the early sub-acute phase after stroke, display only little/modest improvement on their capacity to perform activities or their perceived level of daily performance, seem to benefit most from training with a dynamic arm orthosis. Patients perceived a high intrinsic motivation and sense of self-regulation. Show more

Keywords: Stroke, rehabilitation, upper extremity, orthotic devices, single case experimental design, motor skills

DOI: 10.3233/TAD-130374

Citation: Technology and Disability, vol. 25, no. 3, pp. 177-187, 2013

Authors: Lexis, Monique | Everink, Irma | van der Heide, Loek | Spreeuwenberg, Marieke | Willems, Charles | de Witte, Luc

Article Type: Research Article

Abstract: Background: Independent living may become a threat for frail elderly persons when their situation deteriorates. Formal and informal caregivers often worry about the safety of the elderly person living alone. Activity monitoring may be assistive in home care delivery. Objective: A pilot study was conducted to examine potential effects of the activity monitoring system ‘QuietCare’ on clients, formal and informal caregivers. Methods: QuietCare registers activities of daily living. Questionnaires were used to assess amongst others the degree of experienced independence, quality of life and health status among clients (n = 19 ) at T0, …three (T1) and six months of follow-up (T2). Informal caregivers (n = 16 ) completed questionnaires on objective and subjective burden. Formal caregivers (n = 16 ) completed questionnaires on labour satisfaction and experiences with QuietCare. Results: No significant changes were found on the client questionnaires. A significant decrease in subjective burden of informal caregivers was found between T0 and T2 (p = 0.03 ). Formal caregivers stated that QuietCare enabled them to provide more tailored care. Conclusion: Activity monitoring may be effective in supporting informal caregivers in care delivery to frail elderly people living alone by reducing subjective burden. Activity monitoring is a promising assistive technology to support frail elderly people to live longer independently. Show more

Keywords: Technology, activity monitoring, independent living, elderly, frail, formal and informal care

DOI: 10.3233/TAD-130377

Citation: Technology and Disability, vol. 25, no. 3, pp. 189-197, 2013

Authors: Jubril, A.M. | Emechete, A.A.I. | Somuyiwa, S. | Iki, V. | Obembe, A. | Olaogun, M.O.B.

Article Type: Research Article

Abstract: People with visual impairment have problems detecting obstacles when walking. New technologies have been used to improve their mobility. This paper presents an obstacle detection system that is compact, flexible and wearable. It utilizes ultrasonic sensors to detect obstacles and provide auditory feedback. The system is composed of two separate parts that communicate wirelessly. One part can be conveniently fitted on the users' footwear, and the other part on the ear, for audio cue. It is calibrated such that the user gets an idea of the distance from obstacles. Usability test results show that users can navigate around …obstacles with minimal training. Show more

Keywords: Visually impairment, obstacle detection, ultrasonic sensor, usability testing, mobility, wireless

DOI: 10.3233/TAD-130382

Citation: Technology and Disability, vol. 25, no. 3, pp. 199-205, 2013

Authors: Cheung, Jessica | Maron, Melissa | Tatla, Sandy | Jarus, Tal

Article Type: Research Article

Abstract: Background: Balance impairments are common in children with acquired brain injury (ABI) and a need exists to explore motivating interventions with this population. Xbox Kinect is a gaming system that might assist therapists in providing meaningful rehabilitation. Objective: To explore the effect of Kinect on improving balance and motivation in one child with ABI. Methods: Using an A-B design, the participant received traditional balance therapy for five days, followed by 15 days of Kinect rehabilitation. Balance and motivation were measured daily; function measured weekly. Baseline and intervention trend lines were visually analyzed to assess changes in …balance and motivation. Results: Participant was unable to follow protocol; intervention was modified to use Nintendo Wii at day 14. While Kinect data showed greater improvement in balance when compared to traditional and Wii rehabilitation, Wii showed greater improvement in dynamic balance involving the body’s affected side. Motivation remained high between baseline and intervention. Conclusions: Kinect may be challenging to use therapeutically early in rehabilitation for improving balance in children with ABI. However, Kinect might improve balance more than traditional or Wii rehabilitation when used with the appropriate child at the right stage of rehabilitation. Motivation results remain inconclusive. Further research is warranted. Show more

Keywords: Pediatrics, brain injury, balance, virtual reality rehabilitation, Xbox Kinect, Nintendo Wii

DOI: 10.3233/TAD-130383

Citation: Technology and Disability, vol. 25, no. 3, pp. 207-219, 2013