Adaptive Aid Research Articles

The patient's experience of early discharge following total hip replacement

BackgroundStrategies within the public health system to curtail costs, increase efficiency and service utilisation have resulted in reduced hospital stays following elective orthopaedic procedures. Although there are advantages that support the concept of early discharge from hospital, very little is known about how patients manage the transition from hospital to home. AimThe aim of this qualitative study was to describe the post-discharge experience of elderly patients following primary total hip replacement (THR). MethodsTen patients, six women and four men, provided descriptions of their experience. Data were collected by face-to-face interviews and the analysis process was based on Giorgi's phenomenological scientific methodology (Giorgi, 1994, 1997, 2000). ResultsThe analysis of the data resulted in four themes, namely; an inadequate assessment of suitable adaptive aids and personal needs; personal frustration; coping with the physical and mobility and limited social interaction. ConclusionFindings from this study demonstrated a need to review the discharge process and implement strategies to prepare patients for the stressors that the participants in this study encountered as a result of their early discharge.

Adaptive Form of Elearning

Abstract Among classic and electronic forms of education, a new type is being considered - the individualised form of education. The main reasoning behind individualised education is to respect differences of individual students. This individualised form of education in connection with the ever-present ICT devices leads to a new form of education - adaptive eLearning: a form of educational process that is in harmony with individual needs of students. This article deals with the basic principles of creating adaptive learning environment; with the current conditions of this issue in the Czech Republic and abroad; and with the outline of possible solutions to the adaptive electronic teaching process. In the second half of the article, the structure of adaptive study aids is described in detail.

Adaptive Instructional Aids for Teaching a Blind Student in a Nonmajors College Chemistry Course

Adaptive tools and techniques for lecture instruction were developed for a blind student in a nonmajors college chemistry course. These adaptive instructional aids assisted the student in writing and balancing chemical reactions, calculating unit conversions and concentrations, drawing Lewis dot structures, understanding structural representations of molecules with three-dimensional models, and identifying organic functional groups.

The Role of Innate APOBEC3G and Adaptive AID Immune Responses in HLA-HIV/SIV Immunized SHIV Infected Macaques

The AID/APOBEC family (activation induced deaminase/apolipoprotein B mRNA editing cytokine deaminase) in B cells play important roles in adaptive and innate immunity. Whereas APOBEC3G has been studied in CD4+ T cells and myeloid cells its functional potential in B cells has received little attention. AID combines two critical functions of antibodies, class switching and affinity maturation and may serve as a functional surrogate of protection. These functions were studied following systemic immunization of rhesus macaques with recombinant HLA constructs, linked with HIV and SIV antigens and HSP70 to dextran. The results showed significant upregulation of AID in CD20+ B cells, APOBEC 3G in CD27+ memory B cells and CD4+ effector memory T cells. After immunization the upregulated APOBEC 3G and AID were directly correlated in B cells (p<0.0001). Following challenge with SHIV SF162.P4 the viral load was inversely correlated with AID in B cells and APOBEC 3G in B and T cells, suggesting that both deaminases may have protective functions. Investigation of major interactions between DC, T cells and B cells showed significant increase in membrane associated IL-15 in DC and CD40L in CD4+ T cells. IL-15 binds the IL-15 receptor complex in CD4+ T and B cells, which may reactivate the DC, T and B cell interactions. The overall results are consistent with AID inhibiting pre-entry SHIV by eliciting IgG and IgA antibodies, whereas APOBEC 3G may contribute to the post-entry control of SHIV replication and cellular spread.

On the measurement of directivity index for adaptive directional hearing aids

Adaptive directional microphone arrays have been widely utilized in hearing aids to help wearers understand speech in noisy environments. However, a practical and objective way of measuring the benefit of this technique is not obvious. One commonly used measure for directional microphone arrays is directivity index (DI), which evaluate the arrays' capability to attenuate a diffuse noise field. However, the DI has rarely been considered for the Adaptive directional microphone arrays because a truly diffuse noise field is required for the measurement. This paper investigates the feasibility of measuring the DI of adaptive directional hearing aids in a diffuse noise field generated by a loudspeaker array playing uncorrelated noise signals simultaneously. The requirement for the degree of diffuseness of the noise field is studied based on numerical simulations for first-order and second-order adaptive microphone arrays. The possibility of measuring the DI in both anechoic and non-anechoic conditions is investigated. The accuracy of the proposed approach is further discussed.

Characterizing Optical Turbulence at the GMT Site with MooSci and MASS-DIMM

ABSTRACTIn order to guide the adaptive optics design and aid in performance predictions, optical turbulence at the site of the future Giant Magellan Telescope (GMT) is characterized using MooSci, a lunar scintillometer, and MASS-DIMM, a combination differential image motion monitor and multiaperture scintillation sensor. As a new instrument, MooSci, is verified as a reliable ground-layer turbulence profiler. The GMT can expect an improvement of approximately 0.1″ over the site testing results as measured with a DIMM. Turbulence below 30 m is horizontally nonhomogeneous, dependent on wind speed and direction, and on average accounts for 60% of the full ground-layer (up to 500 m) turbulence.

Clinical attention and assistance profile of patients with amyotrophic lateral sclerosis

To evaluate the functional status of amyotrophic lateral sclerosis (ALS) patients diagnosed at this institution; to analyze hospital and palliative care; to identify patients' knowledge about home care and supportive resources. Twenty-nine patients were evaluated on the ALSFRS-R scale and two semi-structured questionnaires, at the start of the study and every four months thereafter for 1 year. ALSFRS-R score was 30.1±11.5 initially and 24.4±10.5 at 1 year. There was an increase in use of physiotherapeutic care and adaptive aids. The primary caregivers were spouses (55.2%), parents/children/cousins (20.7%), friends (10.3%) and private nurses (3.5%); 10.3% of patients had no caregivers. Basic ALS patient care was provided by the public health system. ALS patients' multidisciplinary care was provided by UNICAMP hospital and its outpatient clinics and, in some patients, complemented by a private health plan or personal expenditure. Few ALS patients were aware of the possibility of home nursing. It is necessary to implement national and regional public home nursing in addition to multidisciplinary specialized care of ALS patients.

Direct Cost-Modeling of Rheumatoid Arthritis According to Disease Activity Categories in France

The objective of this cost-of-illness study was to assess the use of direct medical resources, excluding drug costs, by patients with rheumatoid arthritis (RA) in France, and to construct cost estimates according to level of disease activity. Three categories of RA disease activity were defined according to Disease Activity Score 28-joint count (DAS28) thresholds: remission (DAS28 < 2.6), low disease activity state (LDAS; i.e., DAS28 ≤ 3.2), and moderate to high disease activity (MHDAS; i.e., DAS28 > 3.2). Eight resource utilization items were defined: medical visits, laboratory tests, hospitalization, imaging, physiotherapy, nursing, adaptive aids, and transportation. Resource utilization and unit costs from the national-payer perspective were estimated through expert opinion and simulated using distribution ranges for each item. Cost distributions were computed by Monte-Carlo simulations estimating overall costs per 6 months over a 2-year period. For patients achieving remission, costs were estimated at a mean of €771 (SD 199) for the first 6 months and at €511 (SD 162) for each subsequent 6-month period. For patients achieving LDAS, costs were estimated at €905 (SD 263) for the first 6 months and €696 (SD 240) for each subsequent 6-month period. For patients in MHDAS, costs were estimated at €1215 per 6 months (SD 405). This cost-of-illness assessment provided current estimates of direct medical costs for RA according to disease activity in France. The findings suggest that achieving remission or LDAS is associated with substantially lower medical costs for RA versus being in MHDAS.

Botulinum Toxin Type a for Rehabilitation after a Spinal Cord Injury: A Case Report

A 56-year-old man became quadriplegic, bed bound, and carer-dependent secondary to cervical osteomyelitis. Three years later, he presented with generalised spasticity, crouched posture, and a large sacral pressure sore. The severe spasticity in his hips and knees prevented ischial sitting. Injections of botulinum toxin type A to both hamstrings and gastrosoleuii controlled the flexor spasticity of his lower limbs and facilitated rehabilitation and wound healing through proper positioning, wound care, stretching, and weight-bearing exercises. A few weeks later, the patient could better position himself in bed (prone lying) and on his wheelchair (ischial sitting). His spasm-related pain lessened and his mobility and activities of daily living improved. The sacral pressure sore healed completely a few months later. The patient could sleep better, feed with set-up and adaptive aids, groom, dress, and transfer himself with minimal assistance. The effects of botulinum toxin extended beyond just spasticity reduction. His upper extremity function, mobility, and social well-being were all improved through better positioning.

A Content Analysis of Common Concerns of Persons with Physical Disabilities

A content analysis was conducted of letters to the editor of two physical disability-related magazines: New Mobility and Paraplegia News. Over 160 letters to the editor published from February 2001 through March 2007 were reviewed. Results indicated that despite the over 18 year old Americans with Disabilities Act, the most frequently categorized issue addressed in the letters pertained to accessibility. Adaptive aid equipment was the second most frequently cited issue, with contributors inquiring or providing information regarding low- and high-end cost adaptive aids/assistive technology. The third most frequent concern was health issues, with letter writers inquiring or providing information about treating secondary conditions for persons with physical disabilities. The implications for these and other related concerns for persons with physical disabilities are explored. Recommendations to rehabilitation counselors for engaging in advocacy efforts are provided.

Many factors are involved in optimizing environmentally adaptive hearing aids

The author reports on research findings from Australia's National Acoustic Laboratories on the abilities and limitations of hearing aids in automatically providing the appropriate amplification across a wide range of changing listening environments.

Do You See What I See? Effects of Communication on Scanning Strategies in Change Detection by Individuals and Teams of Observers

Change blindness results from the absence of attention from the source of a change. Unsurprisingly, change blindness worsens in dual task and high workload conditions. Such is the environment in which teams of operators in military command and control missions operate, yet little is known about change blindness susceptibility in these conditions. A flicker task required individuals and dyads to detect changes under high and low task difficulty. Reaction time, accuracy, and eye movements were examined. Scan path analyses showed that communicating dyads were more efficient at change detection than individuals and non-communicating dyads, but are just as blind to no change. Eye movement data also indicate differences in attention allocation and scan strategies among individuals, communicating, and non-communicating dyads. Implications for adaptive aids and tasks such as tactical command and control are discussed.

Using a signal cancellation technique to assess adaptive directivity of hearing aids

The directivity of an adaptive directional microphone hearing aid (DMHA) cannot be assessed by the method that calls for presenting a "probe" signal from a single loudspeaker to the DMHA that moves to different angles. This method is invalid because the probe signal itself changes the polar pattern. This paper proposes a method for assessing the adaptive DMHA using a "jammer" signal, presented from a second loudspeaker rotating with the DMHA, that simulates a noise source and freezes the polar pattern. Measurement at each angle is obtained by two sequential recordings from the DMHA, one using an input of a probe and a jammer, and the other with an input of the same probe and a phase-inverted jammer. After canceling out the jammer, the remaining response to the probe signal can be used to assess the directivity. In this paper, the new method is evaluated by comparing responses from five adaptive DMHAs to different jammer intensities and locations. This method was shown to be an accurate and reliable way to assess the directivity of the adaptive DMHA in a high-intensity-jammer condition.

Binaural adaptive hearing aid

A system and method for processing an acoustic input signal and providing at least one output acoustic signal to a user of a hearing-aid system. The hearing-aid system includes first and second channels with one of the channels having an adaptive delay. The first channel includes a directional unit for receiving the acoustic input signal and providing a directional signal; a correlative unit for receiving the directional signal and providing a noise reduced signal by utilizing correlative measures for identifying a speech signal of interest in the directional signal; and, a compensator for receiving the noise reduced signal and providing a compensated signal for compensating for a hearing loss of the user.

Primary therapist model for patients referred for rheumatoid arthritis rehabilitation: A cost‐effectiveness analysis

To estimate the incremental cost-effectiveness (ICE) of services from a primary therapist compared with traditional physical therapists and/or occupational therapists for managing rheumatoid arthritis (RA), from the societal perspective. Patients with RA were randomly assigned to the primary therapist model (PTM) or traditional treatment model (TTM) for approximately 6 weeks of rehabilitation treatment. Health outcomes were expressed in terms of quality-adjusted life years (QALYs), measured with the EuroQol instrument at baseline, 6 weeks, and 6 months. Direct and indirect costs, including visits to health professionals, use of investigative tests, hospital visits, use of medications, purchases of adaptive aids, and productivity losses incurred by patients and their caregivers, were collected monthly. Of 144 consenting patients, 111 remained in the study after the baseline assessment: 63 PTM (87.3% women, mean age 54.2 years, disease duration 10.6 years) and 48 TTM (79.2% women, mean age 56.8 years, disease duration 13.2 years). From a societal perspective, PTM generated higher QALYs (mean +/- SD 0.068 +/- 0.22) and resulted in a higher mean cost ($6,848 Canadian, interquartile range [IQR] $1,984-$9,320) compared with TTM (mean +/- SD QALY -0.017 +/- 0.24; mean costs $6,266, IQR $1,938-$10,194) in 6 months, although differences were not statistically significant. The estimated ICE ratio was $13,700 per QALY gained (95% nonparametric confidence interval -$73,500, $230,000). The PTM has potential to be an alternative to traditional physical/occupational therapy, although it is premature to recommend widespread use of this model in other regions. Further research should focus on strategies to reduce costs of the model and assess the long-term economic consequences in managing RA and other rheumatologic conditions.

Driving after a stroke: What helps Grandma drive safely?

Crashes involving elderly drivers hitting pedestrians are increasing at an alarming rate. With the graying of America, the impact of driving impairment is being reported more commonly. In the year 2000 (according to US Census data), people over the age of 65 equaled 13% of the United States population yet were involved in 18% of all traffic fatalities. Many medical conditions may lead to problems with driving, including the process of normal aging. These may include conditions that affect the brain and its connections, the heart, eyes, ears, muscles, and even bones. But what can be done to ensure that people with these conditions can drive safely? New research reported in this issue of Neurology suggests that people who have had a recent stroke may benefit from special driving training that takes place in a car modified with a driving simulator. In this study by Akinwuntan et al., the authors used a full-sized Ford Fiesta car which remains stationary. The car was equipped with adaptive aids such as a left-sided accelerator pedal, right-sided indicator stick, as well as a steering wheel coupled to a simulator. The stimulator projected life-sized images generated by a computer that portrayed a driving scenario that lasted about 25 minutes. Akinwuntan et al. divided 83 patients who had had a stroke within the past 3 months into two groups for the study.1 In one group, there were 42 people who were chosen at random to use the driving simulator. The other group of 41 people, called the control group, received standardized training by performing driving-related thinking …

Diffuse field directivity index measurements of hearing aids operating with adaptive gain algorithms

In the summer and autumn of 2004, two hearing aids were used in a round robin study of 3‐D directionality as per the test protocol in ANSI S3.35. This protocol required a simulated diffuse field in an anechoic environment by sequentially positioning a loudspeaker along the surface of a 1‐m radius sphere circumscribing the device under test. The aids contained both an omni mic and a gradient directional mic, and operational switching between each mic was done with a pushbutton memory. Recently, these aids were brought into Riverbank Labs in Geneva, IL to investigate a different measurement protocol utilizing a simulated diffuse field in a reverberation chamber. The test protocol will be described, and measured results of the 3‐D directivity index in this simulated diffuse field will be compared to results from the original round robin study. Finally, this new protocol will be used to measure the 3‐D directivity index of hearing aids having an adaptive gain algorithm; these results will be compared to the results of the same adaptive aids as measured with the original ANSI S3.35 protocol even though this protocol specifically requires all adaptive settings to be disengaged.

Managing patients with multiple sclerosis through a new multidisciplinary program: MS eye center for analysis, research and education

Patients with multiple sclerosis (MS) demonstrate complex and varied visual functional deficits and therapeutic outcomes. Visual acuity, contrast sensitivity and visual field may be compromised. This paper presents three patients with different visual deficits and goals. Low vision rehabilitation assessment may include adaptive aids and training for magnification, filters and field enhancement systems. Successful low vision rehabilitation can restore function and independence.

Intelligent walkers for the elderly: performance and safety testing of VA-PAMAID robotic walker.

A walker that could help navigate and avoid collisions with obstacles could help reduce health costs and increase the quality of care and independence of thousands of people. This study evaluated the safety and performance of the Veterans Affairs Personal Adaptive Mobility Aid (VA-PAMAID). We performed engineering tests on the VA-PAMAID to determine safety factors, including stability, energy consumption, fatigue life, and sensor and control malfunctions. The VA-PAMAID traveled 10.9 km on a full charge and avoided obstacles while traveling at a speed of up to 1.2 m/s. No failures occurred during static stability, climatic, or fatigue testing. Some problems were encountered during obstacle climbing and sensor and control testing. The VA-PAMAID has good range, has adequate reaction time, and is structurally sound. Clinical trials are planned to compare the device to other low-technical adaptive mobility devices.

Adaptive skill learning aid system based on force-display of teaching manipulated variable in human-machine systems.

Adaptive skill learning aid system based on force-display of teaching manipulated variable in human-machine systems.