Assistive Device Users Research Articles

Life situation of adults with congenital limb reduction deficiency in Sweden

Purpose: To describe the current life situation of adults with congenital limb reduction deficiencies (CLRD), living in Sweden, regarding their main daily occupation, leisure activities and self-reported general health. Methods: A cross-sectional survey was conducted using a study-specific questionnaire, sent by post. Hundred and seventeen persons with different extent, forms and levels of CLRD (mean age 33 years) responded to the questionnaire. Results: Work or study was the main occupation for 86% of the participants and 50% had completed a college or university education. About 7% were unemployed and 3% were on sick leave. The participants were highly involved in social and physical activities during leisure time. The majority reported good or very good general health. Conclusion: This study is the first investigation of the life situation of adults with CLRD described with a perspective from Swedish society. The participants were educated and worked to a great extent, which corresponds well to the Swedish population as a whole. Further research is needed, especially with a focus on the internal perspective of life situation, different aspects of work capacity, occurences of strain injuries and the benefit of assistive devices among adults with CLRD.Implications for RehabilitationPeople with CLRD require a health care system with a multi-professional rehabilitation team offering regular contact during their life time.Educational system offering study counselling on all education levels (from primary school to university) is an important type of support for people with any kind of deficiency, in order to find suitable education and profession.Work is of importance for an acceptable life situation. Rehabilitation for people with CLRD should emphasise facilitating their ability to work, through engagement in individual personal capacity and self-efficacy.The majority of people with CLRD are users of prostheses and assistive devices. The benefits of the devices are basic but the rehabilitation should also include aspects of usability and use worthiness for individuals in performing their daily activities.

Ambulation and complications related to assistive devices after spinal cord injury

ObjectiveTo evaluate long-term health outcomes including pain intensity, pain interference, and fatigue among ambulatory persons with spinal cord injury (SCI).DesignProspective cohort study.SettingData were analyzed at a major medical university in the southeast USA.ParticipantsParticipants included 783 ambulatory adults with SCI of traumatic origin, who were at least 1-year post-injury. Participants were identified through three sources of records at a large specialty hospital in the southeastern USA.InterventionsNot applicable.Outcome measuresPain intensity and interference (Brief Pain Inventory) and fatigue (Modified Fatigue Impact Scale Abbreviated Version 5).ResultsExamining assistive devices used for ambulation, 66% of the population used at least one device. In the logistic model, wheelchair and cane usage were significantly related to the outcomes after controlling for age, gender, and race. Wheelchair usage 50% of the time or less was significantly related to pain intensity (odds ratio (OR) 2.05, 95% confidence interval (CI) = 1.39–3.03), pain interference (OR 2.11, 95% CI = 1.43–3.12), and fatigue (OR 1.99, 95% CI = 1.12–1.43). Additionally, unilateral cane use was significantly related to the outcomes; pain intensity (OR 1.86, 95% CI = 1.35–2.56), pain interference (OR 2.11, 95% CI = 1.52–2.93), and fatigue (OR 2.49, 95% CI = 1.52–4.08).ConclusionsAmong ambulatory persons with SCI, increased pain intensity, pain interference, and fatigue are associated with minimal wheelchair usage (50% or less) and less supportive assistive device (unilateral cane) usage.

Usage Problems and Social Barriers Faced by Persons With a Wheelchair and Other Aids. Qualitative Study From the Ergonomics Perspective in Persons Disabled by Rheumatoid Arthritis and Other Conditions

ObjectiveThe objective of this study was to identify the usage and accessibility problems faced by the disabled (whether in pain or not) users of assistive devices (conventional wheelchairs), identify physical barriers that limit their mobility, and recognize the socio-cultural practices excluding them from the design process of such devices. Another main purpose of this paper is to improve the ergonomic criteria that influence the design and manufacture of assistive devices. Materials and methodsStudy population: 15 patients with any of the following diagnoses: ankylosing spondylitis, rheumatoid arthritis, or amputees using wheelchairs in Mexico and Colombia. DesignQualitative study. Thematic analysis with a theoretical industrial design approach for employing usability testing for ergonomic analysis. ResultsWe identified 6 issues associated with usability problems from the patient's standpoint: barriers for use of wheelchairs (usability and acceptability), creative adaptations, potential use of technical devices, independence, body perception and assistive devices, and architectural barriers. The ergonomic and usability requirements and the resulting level of independence vary across wheelchair users with chronic pain and those whose disability does not involve pain. The latter are more independent in their movements and decisions. ConclusionsUser input is essential in the design of assistive devices. The proposal of “design from and for the user” must rely on both engineering and medical perspective on the ergonomy as well as the user interpretation of the environment and the experience of the disease. Thus we can arrive at a “user-centered design”.

Problemas con el uso de sillas de ruedas y otras ayudas técnicas y barreras sociales a las que se enfrentan las personas que las utilizan. Estudio cualitativo desde la perspectiva de la ergonomía en personas discapacitadas por enfermedades reumáticas y otras condiciones

ObjectiveThe objective of this study was to identify the usage and accessibility problems faced by the disabled (whether in pain or not) users of assistive devices (conventional wheelchairs), identify physical barriers that limit their mobility, and recognize the socio-cultural practices excluding them from the design process of such devices. Another main purpose of this paper is to improve the ergonomic criteria that influence the design and manufacture of assistive devices. Materials and methodStudy population: 15 patients with any of the following diagnoses: ankylosing spondylitis, rheumatoid arthritis, or amputees using wheelchairs in Mexico and Colombia. Design: Qualitative study. Thematic analysis with a theoretical industrial design approach to employing usability testing for ergonomic analysis. ResultsWe identified 6 issues associated with usability problems from the patient's standpoint: barriers for use of wheelchairs (usability and acceptability), creative adaptations, potential use of technical devices, independence, body perception and assistive devices, and architectural barriers. The ergonomic and usability requirements and the resulting level of independence vary across wheelchair users with chronic pain and those whose disability does not involve pain. The latter are more independent in their movements and decisions. ConclusionsUser input is essential in the design of assistive devices. The proposal of “design from and for the user” must rely on both engineering and medical perspective on the ergonomy as well as the user interpretation of the environment and the experience of the disease. Thus we can arrive at a “user-centered design”.

Assistive Device Usage in Elderly People and Evaluation of Mobility Level

This study examined assistive device usage and mobility level among elderly people. The inclusion criterion was age 65 years or older; all participants were volunteers. Participants were investigated in terms of their the sociodemographic characteristics and their levels of mobility device usage in everyday life, as assessed by the Rivermead Mobility Index and the Physical Mobility Scale. The study included 58 (35.6%) women (mean age = 73.18 ± 6.62) and 105 (64.4%) men (mean age = 73.31 ± 6.59). It was found that 31% of women and 19% of men used an assistive device in their everyday life; there was no significant difference in device usage according to gender (P > .05). The most common device among men and women was a walking stick. There were no significant differences between men and women in terms of Rivermead Mobility Index and Physical Mobility Scale scores; the mobility level of men was higher than women (P < .05). Assistive device usage is important for elderly people in maintaining indoor and outdoor mobility in everyday life. Our results should be taken into consideration in the rehabilitation of elderly people, especially elderly women. The use of mobility assistive devices reduces injury risk and becomes an important factor in increasing life quality in elderly people.

Tai Chi intervention for older adults using assistive devices in a senior living community: a pilot study

Aim: To examine whether a 6-form Tai Chi (TC) programme is effective in improving balance among older adults using an assistive device (walker or cane) for daily mobility. Method: Seventeen qualified subjects participated in a 12-week study (3 times a week, 60 minutes each session). The outcomes measured were the Fall Efficacy Scale (FES), Tinetti Performance Oriented Mobility Assessment (POMA), Single Leg Stance (SLS), and Chair Stand Test (CST). Findings: Thirteen subjects completed the whole programme and performed significantly better on the post test than the pre test in FES (P=.001), POMA (P=.001), and SLS (P=.001), but no difference identified in CST (P=.131) after Bonferroni adjustment. Conclusion: These results indicate that the 6-form TC programme can benefit older assistive device users by reducing fear of falling and improving balance, but offers no clear improvement in lower extremity strength.

An upper extremity inverse dynamics model for pediatric Lofstrand crutch-assisted gait

The objective of this study was to develop an instrumented Lofstrand crutch system, which quantifies three-dimensional (3-D) upper extremity (UE) kinematics and kinetics using an inverse dynamics model. The model describes the dynamics of the shoulders, elbows, wrists, and crutches and is compliant with the International Society of Biomechanics (ISB) recommended standards. A custom designed Lofstrand crutch system with four, six-degree-of-freedom force transducers was implemented with the inverse dynamics model to obtain triaxial UE joint reaction forces and moments. The crutch system was validated statically and dynamically for accuracy of computing joint reaction forces and moments during gait. The root mean square (RMS) error of the system ranged from 0.84 to 5.20%. The system was demonstrated in children with diplegic cerebral palsy (CP), incomplete spinal cord injury (SCI), and type I osteogenesis imperfecta (OI). The greatest joint reaction forces were observed in the posterior direction of the wrist, while shoulder flexion moments were the greatest joint reaction moments. The subject with CP showed the highest forces and the subject with SCI demonstrated the highest moments. Dynamic quantification may help to elucidate UE joint demands in regard to pain and pathology in long-term assistive device users.

Getting used to assistive devices: Ambivalent experiences by frail elderly persons

The aim was to learn how frail elderly people experienced becoming assistive device users and how assistive devices affected their independence in daily activities. Focus-group methodology was used, including people 80 and older with multiple health problems. Five group discussions were conducted with a total of 18 people including 14 women and four men. Each group met once, for 90–120 minutes, and all discussions were audiotaped. Two themes emerged: Confidence in knowledge and experience and getting used to assistive devices in daily activities. Confidence in knowledge and experience was formed by two categories of experiences from the prescription procedure: trust the expert and trust yourself, and to have confidence in having the right information about assistive devices. Getting used to assistive devices in daily activities was formed by five categories of ambivalent experiences when using assistive devices in daily activities: creates opportunities and limitations; provides security but also raises concerns; the need is seen as transient or permanent; the social environment both encourages and restricts; the physical environment both facilitates and complicates, with less extreme experiences in between. This study indicates that frail elderly people need specifically developed support in the process of becoming assistive device users.

Low vision assistive technology device usage and importance in daily occupations

When selected, accepted and used appropriately, low vision assistive technology devices (ATDs) have the potential to facilitate the performance of occupations that lead to positive outcomes. This paper identifies some low vision ATDs currently used and explores their relative importance for the performance of daily occupation from participants' perspectives. 17 adults (M=56 years old, SD=15.8) with low vision we0re recruited through a purposeful sampling strategy. Through one-on-one semi-structured telephone interviews, ATD usage data, ranking of perceived importance of ATDs and verbal data were collected from the participants. A total of 124 devices were identified by the participants of which 104 (83.9%) were used and 20 (16.1%), mostly adaptive computer technologies, were not. 22 (21%) mainstream aids to daily living were identified (large monitor, large screen TV, DVD player) and they ranked high in terms of perceived importance by the participants for daily activities. Verbal feedback from participants supplemented this finding. Concepts related to usage and ranking of importance of ATDs for daily occupations are multi-faceted and complex(e.g. combination of devices used, multiple equal rankings, etc.). The authors suggested future research opportunities to examine these concepts through qualitative means.

Cross-cultural adaptation and validation of the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST 2.0): the development of the Taiwanese version

Objective: To develop and validate a cross-cultural version of the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST 2.0) for users of assistive technology devices in Taiwan. Design: A cross-sectional survey. Procedures: The standard cultural adaptation procedure was used for questionnaire translation and cultural item design. A field test was then conducted for item selection and psychometric properties testing. Subjects: One hundred and five volunteer assistive device users in community. Main outcome measures: A questionnaire comprising 12 items of the QUEST 2.0 and 16 culture-specific items. Results: One culture-specific item, ‘Cost’, was selected based on eight criteria and added to the QUEST 2.0 (12 items) to formulate the Taiwanese version of QUEST 2.0 (T-QUEST). The T-QUEST consisted of 13 items which were classified into two domains: device (8 items) and service (5 items). The internal consistencies of the device, service and total T-QUEST scores were 0.87, 0.84 and 0.90, respectively. The device, services and total T-QUEST scores achieved good test-retest stability (intraclass correlation coefficient (ICC) 0.90, 0.97, 0.95). Exploratory factor analysis revealed that T-QUEST had a two-factor structure for device and service in the construct of user satisfaction (53.42% of the variance explained). Conclusions: Users of assistive device in different culture may have different concerns regarding satisfaction. T-QUEST is the first published version of QUEST with culture-specific items added to the original translated items of QUEST 2.0. T-QUEST was a valid and reliable tool for measuring user satisfaction among Mandarin-speaking individuals using various kinds of assistive devices.

Analysis of ADL in using Assistive Devices Users at a Rehabilitation Counseling Center for Persons with Disabilities

当センターにおいて過去1年間に行われた7種目の補装具直接判定について，申請者393 人の機能的自立度評価法（FIM）を用いた日常生活活動（ADL）評価値と処方内容との関連を調べ，更生相談所において補装具処方を受けた者のADL分析を行った．因子間の解析により，補装具処方の際のいくつかのADLパターンが明らかとなった．義手と義足ではADL全般が良好であった．重度障害者用意思伝達装置では表出を除く認知評点のみが良好であるという固有のパターンを示した．下肢装具では運動面と認知面のADL組合せによるいくつかのパターンを示した．座位保持装置・車いす・電動車いすでは3 つが重複した群分けがなされ，移動手段として積極的に使用される群，身辺動作や認知評点が低い中での使用，ほかのパターンが見られた．ADLから見たいくつかの処方根拠が明らかとなり，補装具適応を判断する際の1 つの目安になるものと考えられた．

Assistive devices: usage in patients with rheumatoid arthritis

We describe the usage of various assistive devices and identify factors associated with usage in patients with rheumatoid arthritis (RA). A cross-sectional, multicentre study was performed in three outpatient rheumatology clinics in the Netherlands. Two hundred forty patients with RA participated in the study. The main measures were questionnaires and a semi-structured interview regarding the possession and usage of 21 common assistive devices in the ISO9999 categories orthopaedic footwear, personal care, mobility, household and adaptations for housing. Potential factors associated with usage included sociodemographic variables, health status, quality of life, coping strategies, self-efficacy, outcome expectations and satisfaction. Out of 240 patients, 213 (89%) had one or more assistive devices in possession (median number of devices 3.0, interquartile range 3.0). The proportions of patients never using a device in possession varied between 8% for orthopaedic insoles and 23% for grab bars. The main factors related to usage varied among categories, but common determinants were a specific impairment or disability, satisfaction with the device or related services, self-efficacy and the number of devices in possession. In conclusion, in patients with RA, possession rates are high, with 23% or less of the devices in possession being abandoned. Overall, satisfaction rates were high. Factors associated with usage varied among categories and comprised, apart from the number of devices in possession and variables related to health status, also aspects of satisfaction with the device or related services or self-efficacy. The latter findings underline the need for a systematic evaluation of the outcomes of assistive devices by prescribing health professionals or suppliers in every individual case.

Implementation of an evidence-based safe patient handling and movement mobility curriculum in an associate degree nursing program

Nurses are at an increased risk for work-related musculoskeletal injuries as a result of the cumulative effects of manual patient-handling tasks. An evidence-based mobility curriculum was implemented in an associate degree nursing program designed to teach student nurses safe patient handling and movement using the principles of ergonomics and usage of mechanical assistive devices to decrease future incidence of work-related musculoskeletal injuries.

Use of assistive devices – a reality full of contradictions in elderly persons' everyday life

Purpose. The aim was to explore very old persons' use and experience of assistive devices in daily occupations and changes over a ten-year period.Method. This study focuses on 86-year olds (n = 201) and following a retrospective longitudinal design, reviews their situation at the age of 76 (n = 199). Data were collected by structured and open-ended interviews during home visits and subjected to statistical and content analysis.Results. A significantly higher proportion (69%) used assistive devices at the age of 86 than at age 76 (43%). During the interval about one third became new users, 35% were permanent users and 23% did not use assistive devices at all. Among those being dependent on personal help in ADL a higher proportion were users of assistive devices (81%) than among those being independent (55%) (p = 0.00013). The result regarding the usefulness, reason for use and experience of using assistive devices showed that very old persons' perspectives on personal, practical and social aspects varied greatly and were often contradictory.Conclusions. An assistive device is generally regarded as an enabler in daily occupation, but it can also become a ‘disabler’. There is a need for a deeper and broader understanding of these ambivalent perspectives and an ethical discussion of subtle factors that might influence the use and experience of assistive devices.

Changes in Dual-task Voice Reaction Time Among Elders Who Use Assistive Devices

Assistive devices are prescribed for a variety of reasons and have the obvious benefit of enhancing gait performance for some individuals. However, the use of an assistive device may make walking a more complex and cognitively challenging task. The purpose of this study was to use a dual-task voice reaction time (VRT) paradigm to examine the attentional demands of walking with an assistive device in a group of elderly adults. Standing and walking VRTs were measured in a sample of 105 elderly adults who ambulated independently with either a rolling walker (RW; mean age = 87.8 +/- 5.5 yrs), a straight cane (SC; mean age = 84.1 +/- 5.6 yrs), or used no device (ND; mean age = 79. 9 +/- 4.5 yrs). A 3 (group) by 2 (task condition) ANOVA with repeated measures on the last factor was used to examine between and within group differences in VRTs. The main effects of group (p = 0.004) and task (P < 0.001) and the interaction of group with task (P = 0.025) were all statistically significant. There were no statistically significant between group differences in standing VRT. Between group differences appeared during the walking task, VRT for the RW group was significantly longer than for the ND group. When examining within group difference, walking VRT was significantly longer than standing VRT for the SC and RW groups. The results demonstrated that there is an increase in the attentional demands of walking for elderly adults who are experienced assistive device users. The increased attention required to walk with an assistive device may be a factor leading to increased fall risk.

Short-Term Recovery After Anterior Cruciate Ligament Reconstruction: A Prospective Comparison of Three Autografts

Sixty-four patients with three different autografts were prospectively evaluated following anterior cruciate ligament (ACL) reconstruction for motion return, thigh girth, quadriceps activity, assistive device usage, and duration of pain medication usage. The quadriceps tendon group achieved knee extension sooner than the patellar tendon group. The hamstring group used assistive devices for less time than the patellar tendon group. The quadriceps group required less pain medication than either of the groups. There are significant differences in short-term pain medication requirements and restoration of function among patients following ACL reconstruction using different autografts.

Assistive devices in activities of daily living used by persons with age-related macular degeneration: A population study of 85-year-olds living at home

The purpose of this study was to investigate the overall use of assistive devices among persons with age-related macular degeneration (ARMD) and how it is related to dependence in daily activities. This was a retrospective, descriptive, cross-sectional population study of 85-year-olds. The most common category of assistive devices was bathing devices followed by mobility devices. The overall use of assistive devices was 82%, and around 80% of the device users were independent in activities of daily living. They were multiple device users (57%) and used more mobility devices and personal assistance in mobility. In conclusion, the ARMD group comprises very frequent users of assistive devices and uses assistive devices to remain independent. This implies that health services should provide assistive devices at an early stage in the disablement process to avoid the development of dependence and should consider the likelihood of multiple health problems when assessing the needs of assistive devices among persons with ARMD.

User Satisfaction with Mobility Assistive Devices

In Sweden, the most common assistive devices are related to mobility. A study was undertaken to evaluate users’ opinions on prescription of mobility devices and their satisfaction with devices and services using a cross-sectional design. A random sample of adult users of mobility assistive devices living in three county councils of Sweden was selected. A postal package comprising a questionnaire and QUEST 2.0 was sent out to 400 users of manual wheelchairs, powered wheelchairs, or walkers. Included in the analysis were 208 questionnaires, a response rate of 52%. Most devices were used on a daily basis and satisfaction with the device was high. Satisfaction with the service was scored lower than satisfaction with the device. Follow-up was the single item with the lowest mean score, and 69% of the users reported that they had not received any follow-up. A positive effect especially on users’ ability to be active, transport oneself, feel secure, and to take part in social activities was found. Owing to the low response rate the results have to be interpreted with caution. However, follow-up seems to be an area that needs to be improved. The majority of users are satisfied with the device but not with service.

Use of assistive devices in daily activities among 85-year-olds living at home focusing especially on the visually impaired

Purpose: The purpose was to investigate the use of assistive devices in daily activities and its relation to daily activities. Method: 85-year-old persons (n = 617) were studied in a descriptive, cross-sectional population study. Results: The overall use of assistive devices was 77% in the total population of 85-year-old persons and the results show that persons who have visual impairment use more assistive devices. The most common category of assistive devices in the population was connected with bathing followed by mobility devices. The majority of the assistive device users in all groups were independent in both instrumental (I-ADL) and personal daily activities (P-ADL). There was a statistically significant higher proportion of device users who were independent in daily activities in the normal vision group compared to the visual impairment groups. There was already a significant difference in the use of assistive devices at a visual acuity level of 0.7 - 0.5 compared to participants with normal vision. Conclusion: The results show that it is imperative to provide intervention such as assistive devices in P and I-ADL earlier in the disablement process in order to slow down the progression of decline, as persons with visual impairment are at high risk of developing disability.

Music to the Impaired or Implanted Ear

Music to the Impaired or Implanted Ear