Assistive Technology Research Articles

Kiki – A Virtual AI Desktop Aider

The research“Kiki” is a voice-controlled virtual desktop assistant designed to enhance user productivity and streamline interaction with desktop environments. Leveraging natural language processing (NLP) techniques, Kiki enables users to perform various tasks through voice commands, ranging from opening applications to searching the web and playing music. The system employs state-of-the-art language models to understand user queries and generate contextually relevant responses, providing a seamless and personalized user experience. Key functionalities include task automation, information retrieval, and web search, allowing users to execute commands efficiently and effortlessly. By combining advanced NLP capabilities with intuitive voice interaction, Kiki represents a significant advancement in desktop assistant technology, promising to reshape the way individuals interact with their computers.

Desktop Voice Assistant

Abstract: Desktop voice assistants have become a popular interface for human-computer interaction because they allow users to speak with their computers in natural language. However, modern desktop voice assistants sometimes struggle to understand and respond to complex queries and context. Privacy concerns concerning the collection and use of user data also remain significant barriers. In order to enhance desktop voice assistants, we present a novel personalization and multimodal interaction technique in this research. By combining text, voice, and visual inputs, our approach improves the accuracy and relevance of the responses. By combining several modalities, our system is able to better understand context and user intent, leading to more meaningful interactions. Furthermore, we propose a user-centric personalization strategy whereby the voice assistant progressively learns each user's preferences and usage patterns. Because it depends less on centralized data collection and processing, this customized approach improves user experience while simultaneously addressing privacy concerns. Through a series of experiments and user surveys, we show how effective our approach is in improving the overall performance and user experience of desktop voice assistants. Our results show that the combination of multimodal interaction with personalization produces more accurate and contextually relevant responses, improving the user experience. All things considered, our research advances desktop voice assistant technology by addressing significant interface and personalization issues. Our approach has the potential to significantly improve desktop voice assistant usability and user acceptance, which could result in considerably more intuitive and natural human-computer interaction.

LipNet: End-to-End Lipreading

Lipreading is the task of decoding text from the movement of a speaker’s mouth. This research presents the development of an advanced end-to-end lipreading system. Leveraging deep learning architectures and multimodal fusion techniques, the proposed system interprets spoken language solely from visual cues, such as lip movements. Through meticulous data collection, annotation, preprocessing, model development, and evaluation, diverse datasets encompassing various speakers, accents, languages, and environmental conditions are curated to ensure robustness and generalization. Conventional methods divided the task into two phases: prediction and designing or learning visual characteristics. Most deep lipreading methods are trainable from end to end. In the past, lipreading has been tackled using tedious and sometimes unsatisfactory techniques that break down speech into smaller units like phonemes or visemes. But these methods often fail when faced with real-world problems, such contextual factors, accents, and differences in speech patterns. Nevertheless, current research on end-to-end trained models only carries out word classification; sentence-level sequence prediction is not included. LipNet is an end-to-end trained model that uses spatiotemporal convolutions, a recurrent network, and the connectionist temporal classification loss to translate a variable-length sequence of video frames to text. LipNet breaks from this traditional paradigm by using an all-encompassing, end-to-end approach supported by deep learning algorithms, Convolutional neural networks (CNNs) and recurrent neural networks (RNNs), which are skilled at processing sequential data and extracting high-level representations, are fundamental to LipNet's architecture.LipNet achieves 95.2% accuracy in sentence-level on the GRID corpus, overlapped speaker split task, outperforming experienced human lipreaders and the previous 86.4% word-level state-of-the-art accuracy.The results underscore the transformative potential of the lipreading system in real-world applications, particularly in domains such as assistive technology and human-computer interaction, where it can significantly improve communication accessibility and inclusivity for individuals with hearing impairments.

Safety profiles of offspring born from early-follicular long-acting GnRH agonist protocol and daily mid-luteal GnRH agonist protocol: a retrospective study

BackgroundThe gonadotropin hormone-releasing hormone agonists (GnRH-a) have been widely used for controlled ovarian stimulation in assisted reproductive technology (ART). The early-follicular long-acting GnRH-a long protocol (EFL) and the luteal phase short-acting GnRH-a long protocol (LPS) are commonly used GnRH agonist protocols. We conducted a retrospective analysis to assess and compare the rates of congenital abnormalities and safety profiles in offspring born from the EFL and LPS protocols.MethodsWe conducted a retrospective cohort study to analyze and compare neonatal data from patients who using EFL or LPS protocols at our center between January 1, 2014, and June 30, 2017. The study ultimately included 1810 neonates from 1401 cycles using the EFL protocol and 2700 neonates from 2129 cycles using the LPS protocol.The main outcome measures are gestational age at delivery, birth weight, and congenital anomaly rate.To assess the influence of various factors on congenital abnormalities, a random-effects logistic regression model was employed.ResultsThe EFL and LPS protocols led to similar congenital anomaly rates (1.64% vs. 2.35%, P = 0.149). No significant differences were found between the two groups regarding birth weight and its categories, newborn gender and congenital anomaly rate. The results of the multivariate logistic regression model indicated no association between congenital anomaly and BMI, duration of infertility, treatment protocol, fertilization method, or embryo transfer stage. Compared with singleton pregnancies, the probability of congenital defects in multiple pregnancies was 2.64 times higher (OR: 2.64, 95% CI: 1.72–4.05, P < 0.0001). Newborns with congenital defects were born with a lower gestational age compared with full-term pregnancies.ConclusionIn conclusion, the EFL protocol is considered a safe option for ensuring offspring safety, comparable with the LPS protocol; however, multiple pregnancies represent an independent risk factor for congenital abnormalities. This approach can be widely adopted; however, prioritizing single embryo transfers is strongly recommended to minimize the potential risks associated with multiple pregnancies in offspring.

Understanding the Role of Female Genital Tract Microbiome in Recurrent Implantation Failure

The realization of the role of the microbiome of the female reproductive tract in health and disease has opened numerous possibilities for the scientific examination of the intertwining role between the human host and its microbiota. The imbalance in the composition of the microbial communities of the vagina and uterus is now recognized as a risk factor for many complications in pregnancy and according to the data from numerous studies, it is possible for this imbalance to play a crucial role in creating a hostile endometrial environment, and therefore, contributing to the etiology of recurrent implantation failure. Nevertheless, our current understanding of these complicated biological phenomena is far from complete, and in the future, there needs to be a systematic and thorough investigation of the diagnosis and therapy of this condition. This will enable scientists who engage in the field of assisted reproduction technologies to accurately identify and cure women in whom dysbiosis hinders the achievement of a healthy pregnancy.

Efficacy of endometrial receptivity testing for recurrent implantation failure in patients with euploid embryo transfers: study protocol for a randomized controlled trial

BackgroundEmbryo implantation remains a critical barrier in assisted reproductive technologies. One of the main causes of unsuccessful embryo implantation is window of implantation (WOI) displacement, particularly in patients with recurrent implantation failure (RIF). Therefore, a reliable diagnostic tool for identifying the optimal WOI is essential. Previous data has suggested that a novel RNA-Seq-based endometrial receptivity testing (ERT) can diagnose WOI, guide personalized embryo transfer (pET), and improve pregnancy outcomes in patients with RIF compared to standard embryo transfer (sET). However, there is still a lack of evidence from randomized controlled trials (RCT) with sufficient power to determine whether pET based on ERT can increase the rate of live births as the primary outcome.MethodsThis trial is a prospective, single-blind, parallel-group RCT (1:1 ratio of pET versus sET). Infertile women with RIF who intend to undergo frozen-thawed embryo transfer (FET) after preimplantation genetic testing for aneuploidy (PGT-A) with the availability of at least one euploid blastocyst for transfer will be enrolled and assigned into two parallel groups randomly. Participants in the intervention group will undergo ERT and then pET based on the results of ERT, while those in the control group will undergo sET. The primary outcome is live birth rate.DiscussionThe findings of this study will provide evidence for the effect of pET guided by ERT on pregnancy outcomes in patients with RIF.Trial registrationChinese Clinical Trial Registry ChiCTR2100049041. Registered on 20 July 2021.

Management strategies for POSEIDON patients with poor ovarian response to ovarian stimulation: а literature review

A poor ovarian response to ovarian stimulation is a factor that significantly reduces the effectiveness of in vitro fertilization programs. Managing these patients remains an unresolved issue in assisted reproductive technology programs. The difficulties are largely determined by the heterogeneity of groups of patients with a poor ovarian response and the need for a personalized approach to ovarian stimulation. This review covers the data from the global literature on the management tactics of patients with a poor ovarian response according to the POSEIDON classification, with the aim of increasing the quantity and quality of retrieved oocytes and clinical pregnancy rates.

Update on recent advances in amyotrophic lateral sclerosis.

In the last few years, our understanding of disease molecular mechanisms underpinning ALS has advanced greatly, allowing the first steps in translating into clinical practice novel research findings, including gene therapy approaches. Similarly, the recent advent of assistive technologies has greatly improved the possibility of a more personalized approach to supportive and symptomatic care, in the context of an increasingly complex multidisciplinary line of actions, which remains the cornerstone of ALS management. Against this rapidly growing background, here we provide an comprehensive update on the most recent studies that have contributed towards our understanding of ALS pathogenesis, the latest results from clinical trials as well as the future directions for improving the clinical management of ALS patients.

Talking Hands &amp; D and D (Dump &amp; Deaf) Assistant

The largest issue facing the deaf and dumb community these days is communication with both the general public and fellow deaf and dumb people. Ordinary individuals can learn new information from spoken language, everyday conversations, and surrounding sounds. Individuals who are hard of hearing or deaf do not enjoy this luxury. These people will gain from this approach since it provides a means of communication. The term "assistive technology" describes gadgets that are rehabilitative, adaptive, and made for people with disabilities. This project aims to develop a system that can recognize sign language, bridging the communication gap by enabling those with speech impairments to interact with others who do not. Hand gestures are important because, in contrast to other techniques, they enable people to express their ideas rapidly. The current work aims to recognize signs using an image processing-based gesture recognition module and convert the corresponding speech to text using a text-to-speech synthesizer

Object Detection for the Visually Impaired

This paper presents the design and development of a mobile application, built using Flutter, that leverages object detection to enhance the lives of visually impaired individuals. The application addresses a crucial challenge faced by this community – the lack of real-time information about their surroundings. We propose a solution that utilizes pre-trained machine learning models, potentially through TensorFlow Lite for on-device processing, to identify objects within the user's field of view captured by the smartphone camera. The application goes beyond simple object recognition. Detected objects are translated into natural language descriptions through text-to-speech functionality, providing crucial auditory cues about the environment. This real-time information stream empowers users to navigate their surroundings with greater confidence and independence. Accessibility is a core principle of this project. The user interface will be designed with compatibility for screen readers, ensuring seamless interaction for users who rely on assistive technologies. Haptic feedback mechanisms will be incorporated to provide non-visual cues and enhance the user experience. The ultimate goal of this project is to create a user-friendly and informative application that empowers visually impaired people to gain greater independence in their daily lives. The application has the potential to improve spatial awareness, foster a sense of security, and promote overall inclusion within society

Human circBOULE RNAs as potential biomarkers for sperm quality and male infertility.

Reliable molecular biomarkers to predict fertility remain scarce. The current study explored the potential of testis-specific circBOULE RNAs as biomarkers for male infertility and sperm quality. Using RT-PCR and RT-qPCR assays, we identified seven circular RNAs from the human BOULE gene in human sperm. We found that sperm circEx3-6 RNA exhibited a significantly decreased expression in asthenozoospermia while circEx2-6 and circEx2-7 expression decreased in teratozoospermia, compared with the controls. Furthermore, circEx2-6 expression exhibited a negative correlation with sperm DNA Fragmentation Index (DFI), and circEx2-7 levels were correlated with both fertilization and cleavage rates involving assisted reproductive technologies. Further functional analyses in a transgenic fly model lent support for the roles of circBOULE RNAs in sperm development and human fertility. Collectively, our findings support that sperm circBOULE RNAs may serve as diagnostic biomarkers for assessing sperm motility and DNA quality. Hence clinical application and significance of sperm circular RNAs in assisted reproductive technologies warrant further investigation.

Improvement Future Candidate of Teachers’ Abilities To Assist Students With Hearing Impairment In The Classroom

Study to equip future educators with the necessary skills and tactics to proficiently assist children with hearing impairments in educational settings. This study holds significant importance for institutions that provide training for teachers, educators specializing in special needs, and policymakers in the field of education. The focus is on promoting effective communication with students who have hearing impairments, highlighting the significance of utilizing assistive devices such as hearing aids and cochlear implants. Curriculum modifications are crucial to ensuring we can obtain educational resources. The study uses academic literature and practical instances to uncover efficacious approaches that instructors can embrace. The results indicate that by employing suitable strategies, utilizing technology, and making necessary modifications to the curriculum, teachers can improve the educational experience and academic achievement of students with hearing impairments. Teachers must possess the necessary knowledge to properly teach, with a focus on teaching tactics, assistive technologies, and curricular changes.

Assistive Technology: Sensor Bike Programmed (Propesor) as an Accommodative Aid for Children with Hearing Impairment

This research discusses the design of assistive technology, especially the Sensor Bike Program (Propesor) as an accommodative aid for children with hearing impairments, this tool is a follow-up to the child's inability to listen to sounds or sounds around him. This puts them in a dangerous situation when driving, therefore an innovative tool is needed that can help them to recognise sounds or sounds around them. The research method used is descriptive qualitative with data collection techniques through observation, interviews, assessments, and documentation studies to collect comprehensive data as a basis for developing tools that suit the needs of children. The result of this research is a hypothetical design of the Sensor Bike Program (Propesor) and is ready to be realised into a valid tool.

Role of Age as a Major Determinant of Assisted Reproductive Technologies Outcome

The aim of the present study was to determine the influence of age on the prediction of the outcome of assisted reproductive technologies. The study included data of 1992 women who had performed ovarian stimulation according to a protocol with a gonadoliberin antagonist or a long protocol and underwent a follicular puncture. Patients were divided into four age groups, where numbers of oocytes collected, number of atretic oocytes and percentage of clinical pregnancies were evaluated. We found significantly reduced average number of oocytes collected with increase of age. In patients with poor ovarian reserve the average age is higher than in patients with good response, i.e. normal ovarian reserve. We have found clear tendency of decreased clinical pregnancy rate with the increase of women's age. In conclusion, our data show convincingly that age is a strong prognostic marker of ovarian reserve in both quantitative and qualitative terms, estimated by the clinical pregnancies achieved.

Predictors of Pregnancy Outcome for Libyan Infertile Women Underwent Intracytoplasmic Sperm Injection Cycle at Tripoli Infertility Center

Intracytoplasmic Sperm Injection (ICSI) is a crucial treatment approach in assisted reproduction technology (ART) for infertility clinics. However, low pregnancy rates in ICSI cycles are a problem. Despite its potential, ICSI can be expensive, time-consuming, and cause concerns about gametes and newborn health. The study aims to identify factors predicting pregnancy rates among infertile couples undergoing Intracytoplasmic Sperm Injection cycle at Tripoli Infertility Center in Libya. This retrospective study reviewed all infertile couples' medical files at the Infertility Tripoli Centre from January to December 2023. A structured case sheet was used to collect data on female patients' age, causes of infertility, duration of infertility, previous pregnancy, antral follicles count, endometrial thickness, number of embryos transferred, and pregnancy outcomes. The study was divided into two groups based on pregnancy test results. Statistical analysis involved simple descriptive statistics, Chi square, and independent sample t-test. This study involved 90 women, with 35.6% having a positive pregnancy test. The pregnancy rate was 59.4% in women under 35, and decreased to 9.4% in those 40 or older. No significant differences were found in infertility duration or previous pregnancy (all P &gt; 0.05). Partner analysis revealed that 64.2% had asthenospermia, while endocrinopathies were reported by 41.8% of women. No significant differences were found in antral follicle count, endometrial thickness, oocyte number, or quality between pregnant and non-pregnant women (all P &gt; 0.05). Our findings suggest that Maternal age has a significant impact on the success of ICSI, with advanced age in women negatively affecting ICSI outcomes.

Klinefelter syndrome: Etiology and clinical considerations in male infertility.

Klinefelter syndrome (KS) is the most prevalent chromosomal disorder occurring in males. It is defined by an additional X chromosome, 47,XXY, resulting from errors in chromosomal segregation during parental gametogenesis. A major phenotype is impaired reproductive function, in the form of low testosterone and infertility. This review comprehensively examines the genetic and physiological factors contributing to infertility in KS, in addition to emergent assisted reproductive technologies, and the unique ethical challenges KS patients face when seeking infertility treatment. The pathology underlying KS is increased susceptibility for meiotic errors during spermatogenesis, resulting in aneuploid or even polyploid gametes. Specific genetic elements potentiating this susceptibility include polymorphisms in checkpoint genes regulating chromosomal synapsis and segregation. Physiologically, the additional sex chromosome also alters testicular endocrinology and metabolism by dysregulating interstitial and Sertoli cell function, collectively impairing normal sperm development. Additionally, epigenetic modifications like aberrant DNA methylation are being increasingly implicated in these disruptions. We also discuss assisted reproductive approaches leveraged in infertility management for KS patients. Application of assisted reproductive approaches, along with deep comprehension of the meiotic and endocrine disturbances precipitated by supernumerary X chromosomes, shows promise in enabling biological parenthood for KS individuals. This will require continued multidisciplinary collaboration between experts with background of genetics, physiology, ethics and clinical reproductive medicine.

Assistive Technology for Higher Education Students with Disabilities: A Qualitative Research

The objective of this qualitative investigation is to identify the assistive technology recognized by students with disabilities and to determine the assistive technology (software apps and devices) they require both at university and at home. A total of forty-two students, comprising 20 males and 22 females, were recruited from four different countries (Germany, Greece, Italy, and Spain) for participation in this study. The sample encompassed 10 students with visual impairments, 11 with hearing impairments, 11 with mobility impairments, and 10 with specific learning disabilities. Semi-structured interviews were conducted with the students either online or in person. Content analysis was employed to scrutinize the data obtained from these interviews. The outcomes of this analysis shed light on the assistive technology acknowledged, utilized, or desired by students with disabilities in both academic and domestic settings. The findings from this study carry practical implications for fostering inclusive and accessible education within higher education institutions, benefiting accessibility units/offices staff as well as teaching personnel.

Micronutrient Antioxidants for Men (Menevit®) Improve Sperm Function by Reducing Oxidative Stress, Resulting in Improved Assisted Reproductive Technology Outcomes

Oxidative stress (OS) affects men’s health and impairs spermatogenesis. Micronutrient antioxidants are available for male infertility as complemental support; however, their efficacy remains debatable. This study aimed to investigate whether antioxidants can help to reduce sperm OS and improve semen analysis and quality. We included 171 male partners of couples planning to undergo assisted reproductive technology (ART). Male partners, aged 29–41 years, of couples intending to conceive were self-selected to take daily antioxidants (n = 84) containing folic acid and zinc, or not to take antioxidants (n = 52) for 6 months. We analyzed the alterations in serum oxidant levels, sperm parameters, OS, and deoxyribonucleic acid fragmentation after 3 and 6 months. Additionally, implantation, clinical pregnancy, and miscarriage rates after vitrified–warmed embryo transfer were compared between those taking antioxidants and those not taking them after 6 months. In men with high static oxidation–reduction potential (sORP), we observed a significant improvement in sperm concentration and sORP. The high-quality blastocyst rate tended to increase, and implantation and clinical pregnancy rates also significantly increased after 6 months of intervention. The micronutrient antioxidants could improve sperm function by reducing OS and improving ART outcomes. Therefore, micronutrient antioxidants may be a viable treatment option for male infertility.

#2403 Impact of pregnancy on kidney transplant recipients

Abstract Background and Aims Kidney transplantation (KT) provides an opportunity to increase fertility in women with chronic kidney disease and gestational desire. Lack of knowledge about obstetric complications and implications for the graft may lead to discourage pregnancy for these women. Although the incidence of pregnancy is rising in women receiving KT, the impact that it may have on the graft function is unknown. Method We conducted an observational, retrospective, single-centre study of a cohort of kidney transplant recipients (KTR) who became pregnant between 2007 and 2022. Clinical and analytical parameters were evaluated before, during and after pregnancy. The main aim was to assess the long-term impact of pregnancy on the graft by analysing renal function 3 years after pregnancy. Results We included 25 women receiving a KT between 1990 and 2018, among which 72% (n = 18) were transplanted from a deceased donor. 2 women (8%) received a combined liver-kidney transplant and 2 women (8%) a simultaneous pancreas-kidney transplant. Maintenance immunosuppression before conception included teratogenic drugs in 68% of cases [12 of them (48%) received mycophenolate mofetil and 5 of them (20%), mTOR inhibitors]. Planned withdrawal was only applied in 50.0% of pregnancies (n = 15). 30 pregnancies were identified (5 patients had 2 post-transplant pregnancies). Median age at gestation was 35 years [interquartile range (IQR) 33-39]. 5 conceptions required assisted reproductive technology. The main complications were gestational hypertension in 4 KTR (13.3%) and preeclampsia in 7 pregnancies (23.3%). 60% of neonates (n = 18) were preterm births (36 [IQR 34-37] weeks of pregnancy at birth) and 44% (n = 12) had low birth weight (2530 [IQR 2283-2950] grams). No foetal malformations were described. Due to physiological changes, a significant increase in estimated glomerular filtration rate (eGFR) was observed in the first and the second trimester of pregnancy (61 [IQR 50-91] ml/min and 70 [IQR 50-90] ml/min, respectively vs. baseline eGFR 59 [IQR 47-77] ml/min; p 0.001]. However, eGFR was equal to the previous one in the third trimester of pregnancy (60 [IQR 44-69] ml/min vs. 59 [IQR 47-77] ml/min; p 0.322). Median proteinuria remained below 0.5 g/day throughout pregnancy, without significant variation. Immunosuppression regimen during pregnancy was mainly based on a combined therapy of steroids, calcineurin inhibitors and azathioprine (21 KTR, 70%). Tacrolimus dose increase (median 63.6% [IQR 33.3-90.0%]) was necessary to maintain proper drug levels throughout gestation. Kidney graft function showed a decline in the first and second year after pregnancy compared to baseline function (54 [IQR 35-77] ml/min and 55 [IQR 36-75] ml/min vs. 59 [IQR 47-77] ml/min; p 0.018 and p 0.021, respectively]. Nevertheless, by the third year post-pregnancy, eGFR was similar to the baseline function (62 [IQR 43-73] ml/min vs. 59 [IQR 47-77] ml/min; p 0.365]. Likewise, annual eGFR variation was comparable during 3 years before (+1.0 ml/min/year) and 3 years after pregnancy (−0.9 ml/min/year), hence no worsening was observed after gestation (p 0.78). No differences were observed in proteinuria either (baseline proteinuria 0.17 [IQR 0.13-0.3] g/day vs. third-year proteinuria 0.21 [IQR 0.15-0.34] g/day; p 0.938). Only 5 women had a baseline serum creatinine above current recommendations for pregnancy (&amp;gt;1.5 mg/dl) and only 3 women presented baseline proteinuria &amp;gt; 0.5 g/day. In this group (n = 7), pregnancy occurred later after KT (96.0 [IQR 80.9-213.0] vs. 46.0 [IQR 16.0-67.5] months; p 0.024). The only 2 graft losses in the cohort were in this group. Both were attributed to transplant glomerulopathy, and they occurred at years 3 and 5 after pregnancy. On the other side, in this group there were no other baseline differences or obstetrical complications [Table 1]. Conclusion Pregnancy does not normally affect graft function and it stabilises within 3 years after gestation. It is important to increase data on women with suboptimal graft function to determine the direct implications that pregnancy may have on these KTRs.

Supported Standing and Supported Stepping Devices for Children with Non-Ambulant Cerebral Palsy: An Interdependence and F-Words Focus

Children functioning at Gross Motor Function Classification System (GMFCS) levels IV–V cannot maintain an aligned standing position or take steps without support. Upright positioning and mobility devices have psycho-social significance for these children and their families, enhancing use of vision, communication, functioning and emotional well-being. Standers and supported stepping devices facilitate opportunities for biomechanical loading, potentially helping to build and maintain muscle and bone integrity, and they promote physical development. However, families are often required to choose between these two devices for their young child. This study aims to synthesize evidence for use and benefits of both supported standing and stepping devices through the lens of two contemporary theoretical frameworks to support clinical reasoning and implementation. The F-words for childhood development (functioning, family, fitness, fun, friends, future) and the interdependence-Human Activity Assistive Technology (iHAAT) models were combined to illustrate the complex interactions between the child, family, caregivers, peers and contextual factors when implementing standing and stepping devices with children at GMFCS levels IV and V. Supported standing and stepping devices provide complementary benefits, and both may be necessary starting at 9–15 months. We propose they both be included ON-Time, along with other age-appropriate positioning and mobility devices, to promote more equitable developmental opportunities for children with non-ambulant cerebral palsy.