Assistive Technology Services Research Articles

Feasibility of a Customized Assistive Technology Service in Outpatient Rehabilitation

Abstract Date Presented 03/23/24 A university-based assistive technology (AT) makerspace housed in an OT department created custom assistive devices requested by outpatient OTs and physical therapists. This poster details the service and provides first-year feasibility results. Primary Author and Speaker: Kial-Ann M. Rasmussen Additional Authors and Speakers: William E. Janes

Assistive technology: Occupational therapy assessment and services for people with dementia

Introduction: Research suggests that services are not effectively providing suitable assistive technology for people with dementia. There is a need to understand the challenges facing practitioners to identify where service changes should be focussed to improve this situation. Method: This study used an online survey to explore the experiences of 41 occupational therapists working with people with dementia, and/or assistive technology. Eight participants subsequently agreed to participate in online discussion groups. Group discussions were transcribed and checked. Data responses from group discussions and open questions in the survey were analysed thematically using the person-centred framework to identify domains supporting or obstructing effective assistive technology service delivery. Results: Forty-one occupational therapist participants described challenges to providing person-centred assistive technology services. These included restricted access to assistive technology interventions, limited knowledge regarding developments in the field, variable funding, unsupportive systems, limited relevant training and difficulties working across health and social care sectors. Conclusion: There is a need to revise the systems surrounding the provision of assistive technology for people with dementia. Occupational therapists need access to training relative to this field, and systems need to be adapted to support the provision of person-centred care by widening access to assistive technology.

Guidelines for assistive technology service provision – A scoping review

Purpose: Despite the high unmet need for effective AT provision, multiple service delivery models across different countries, and a shortage of personnel trained in this field, no widely useable and accepted Assistive Technology (AT) service provision guidelines currently exist. This review aims to provide an overview of the literature regarding AT service provision guidelines to inform the development of globally useable AT provision guidance, aligned with contemporary global initiatives to improve access to AT. Materials and Methods: The rapid scoping review method used a two-tiered approach to identifying relevant publications: (1) systematic search of academic databases (Medline, CINAHL, SCOPUS, and Google Scholar); (2) consultation with international AT organisations and experts. The search was conducted in March 2023 with no date limitations. Analysis was guided by the TIDE-funded HEART research on quality AT provision and service delivery processes in Europe, as well as the WHO-GATE 5 P framework for strengthening access to AT. Results: 35 publications were identified from various countries, and directed at differing assistive products, personnel, and provision contexts. No established guidelines for AT service provision currently exist. However, despite the variety in contexts, the range of assistive products and the range of stakeholders to whom guidelines are directed, several key service delivery steps were identified that may form part of such guidelines. Conclusions: This review offers a strong starting point for developing guidance for AT provision to meet global needs. Careful consideration of vocabulary, process, and application to the diversity of assistive products is recommended in systematizing globally applicable guidance.

Identifying causes of vision loss and assistive technology needs among patients attending rehabilitation clinic of a tertiary care center in North India.

Investigating the causes of visual loss and the best corrected visual acuity (BCVA) is crucial for identifying avoidable eye problems and planning appropriate rehabilitation and assistive technology (AT) services. The study aimed to identify various causes of vision loss and determine AT required for vision rehabilitation (VR). The electronic records of patients who attended the VR clinic at a tertiary eyecare for the past 2 years were reviewed. Information such as demographics, BCVA, and causes of visual impairment were retrieved from the records. BCVA was categorized into better than or equal to 1/60 and less than <1/60 for AT services. In total, 1723 patients, mostly male (71.2%), visited the rehabilitation clinic from 2018 to 2019. Around 58.6% of patients belonged to the age group 16-49 years, whereas 25.6% were less than 15 years old. The most frequent eye problems were retinal disorders (63.5%), followed by retinitis pigmentosa (15.2%) and rod-cone dystrophy (4.7%). In contrast, congenital disorders were the most common cause of vision loss among younger groups. Approximately 36.0% of patients had <1/60 blindness and 16.6% had ≥1/60. Around 17.1% of patients would benefit from large prints (near vision acuity N18-N12). Early detection and timely management will prevent a significant proportion of patients from developing irreversible vision loss. Around one-third of patients would benefit from visual substitution AT.

Impact of COVID-19 on People with Disabilities in Nepal: A Preview into Assistive Technology Use during Pandemic

This article is related to a desk study on the impact of COVID-19 on the lives of people with disabilities and the use of assistive technology together with the impact of assistive technology use by people with disabilities during the pandemic in Nepal. Along with the impact on the global economy, food security, and mental health, COVID-19 has devastating effects on the healthcare systems, shifting resources from disease treatments to the management of COVID-19. In such crises, marginalized groups such as people with disabilities are often neglected. An intensive literature search was performed in PubMed and Google Scholar with a thorough search of all possible government and non-government reports on the research interests. The situation was found to be devastating in a low-income country like Nepal where the majority of the people with disabilities were not provided with government social protection assistance. People with disabilities experienced an increased level of anxiety and depression because of the pandemic and lockdowns in the country. Many people with disabilities heavily depend on assistive technology to perform their daily activities but due to the pandemic delivery of assistive technology services has reduced drastically. A disability-inclusive response is recommended to empower people with disabilities to handle their lives in difficult circumstances, and increase access to health care, and assistive technology use.

IMPROVING REHABILITATION OUTCOMES FOR PEOPLE AGING WITH LONG-TERM HAND IMPAIRMENTS

Abstract Despite the importance of hand and upper extremity function in ADL performance and successful aging-in-place, contextual and engaging in-home rehabilitation interventions that promote use, feedback of progress, and long-term monitoring of changes in functional ability among individuals with chronic upper limb deficits are lacking. This presentation will present the findings from three TechSAge pilot projects focused on the use of technology to support in-home rehabilitation for individuals aging with long-term upper extremity disabilities. DigiHand, is a smartphone-based application combined with sensor-embedded objects used in daily activities (e.g., coffee cup) that enables users to self-manage their own rehabilitation, obtain feedback on progress to refine movements, and allow remote monitoring by therapists. Similarly, KeyStroke is an in-home piano training mobile app that provides engaging music exercises to promote long-term rehabilitation and therapists’ monitoring of progress of stroke survivors. Finally, 3DP for AT is generating design requirements to support the development of an open-source software tool that would allow assistive technology service providers, who are novice users of 3D printers, to create and fabricate highly customized 3D-printed assistive devices that are more durable, aesthetic, and will better meet the unique needs of people aging with long-term hand impairments.

Assistive technology services: user experiences from the Faroe Islands, a small-scale society

Purpose In the Faroe Islands, an Assistive Technology (AT) Centre allocates and finances AT for all AT users. This study aimed to provide a preliminary evaluation of the Faroese AT services from a user perspective by using recommendations from the Horizontal European Activity on Rehabilitation Technology (HEART) study. Method The study enrolled 101 persons aged 8–95 (mean 69 years) using a study-specific questionnaire. The AT service delivery process (AT-SDP) questions included questions about the application and the implementation. User satisfaction was assessed with KWAZO and the service subscale of QUEST with seven and four questions, respectively. The sample and the steps in the AT-SDP were described with frequency distribution. The KWAZO and QUEST results were analysed item-by-item and grouped in “Satisfied” and “Not fully satisfied”. A threshold of 33% was used to identify items rated “Not fully satisfied”. Associations between items rated "Not fully satisfied” and the AT-SDP were assessed with statistical analysis. Results The participants were mostly satisfied, but Instruction, Professional services and Follow-up were rated “not fully satisfied”. The AT centre helped with application and implementation in 9.6% and 12% of the cases, respectively, and other institutions in 62.3% and 43.7% of the cases. No contact had been with professionals in 28.7% and 37.6% of the cases. Conclusions There was a low degree of satisfaction in different quality parameters. The role of the AT-center seemed reduced to delivering AT and the whole service delivery process appeared to be fragmented and not in line with HEART recommendations.

Assistive technology for people with intellectual and developmental disabilities in the United States in Home- and Community-Based Services

Purpose Unmet needs for assistive technology (AT) contribute to health and quality of life disparities among people with intellectual and developmental disabilities (IDD) [1–4]. The biggest barrier people with IDD face accessing technology is affordability and a lack of funding [1,3–6]. The purpose of this study was to examine how AT were provided to people with IDD in Medicaid Home- and Community-Based Services (HCBS) in the United States, the largest funding source for Long-Term Services and Supports for people with IDD. Materials and methods We analysed Medicaid HCBS 1915(c) waivers for people with IDD from across the USA in fiscal year (FY) 2021 using content analysis and descriptive statistics. Results and conclusions In FY2021, 31 states and the District of Columbia provided AT (stand-alone and combined services) through 68 waivers for people with IDD to improve functioning, communication, independence, and community integration. In total, $63.3 million was projected for the AT services for 23,753 people with IDD. Average spending per person on AT services was $2,663. We found significant variability in terms of how states allocated AT to people with IDD in their HCBS programs. Not only were less than 3% of people with IDD with HCBS projected to receive assistive technology services, there was also large variance across services and states. Assistive technology promotes the health, safety, quality of life, independence, and community integration of people with IDD – they align with the very aims of HCBS, and thus, should be expanded.

지체, 뇌병변 장애인의 보조기기 필요 요인 분석: 인간, 활동, 환경 요인을 중심으로

It is important to consider the individual characteristics of Assistive Technology Device&#x0D; (ATD) for assisting people with disabilities in their daily activities. A representative method&#x0D; is to consider the four basic elements of Human, Activity, Assistive Technology Device,&#x0D; and Environment when providing assistive technology services (HAAT model, Cook &amp;&#x0D; Hussey, 2002). In this study, the factors affecting the ATDs required by the people with&#x0D; disabilities in Korea were analyzed by applying to the HAAT model. The top five ATDs&#x0D; with high need were extracted, and the factors influencing the need for the top five ATDs&#x0D; among people, activities, and environmental factors were analyzed by conducting binomial&#x0D; logistic regression analysis. As a result of the analysis, the top 5 ATDs most needed by&#x0D; the people with disabilities in Korea are cane, safety handle, powered wheelchair, electric scooter, and home modification. These results indicate that they mostly require ATDs for&#x0D; activities of daily living related to mobility and movement. Age, disability grade, and whether&#x0D; or not to use public transportation were analyzed as factors that had a statistically significant&#x0D; effect on the need for ATDs. The limitation of this study is that there is a limitation in&#x0D; generalizing the analysis results of this study because there is a possibility that sufficient&#x0D; information on ATDs may not be provided when conducting a fact-finding survey of the&#x0D; people with disabilities. Nevertheless, the results of this study suggest that it is necessary&#x0D; to apply appropriate ATDs considering factors such as disability type, living environment,&#x0D; and age. The results of this study are expected to be used as basic data for the application&#x0D; of assistive devices suitable for the characteristics of the people with disabilities in Korea.

Evaluation of providers' assistive technology service delivery practices in Pakistan.

Globally, one in three individuals needs at least one assistive product. The primary objective of this study was to conduct a survey of Pakistani rehabilitation service providers to determine what proportion provide assistive technology and if their characteristics (including geographical region, education, and experience) are associated with adherence to the service delivery process. The secondary objective was to determine if individuals that provide assistive technology adhere to a standard assistive technology service delivery process. The tertiary objective was to determine if the providers that adhered to a standard delivery process had characteristics that differed from the rest of the service providers. An online survey composed of multiple-choice questions was distributed to physiotherapists, community-based healthcare workers, and related rehabilitation professions through a convenience sampling method. SPSS Statistics was used to develop correlation matrices to determine Pearson's coefficient of number of steps, education level, experience level and continuing education received. There were 71 respondents from 4 Pakistani provinces. 53.5% of respondents stated they provide assistive technology. There was participation in most steps of the service delivery process. There is weak correlation between number of steps and education level, number of steps and experience level, and number of steps and continuing education received. While the majority of respondents provide assistive technology, a significant proportion (46.5%) don't. This may suggest there is a need for additional advocacy and awareness raising of the benefits of and how to access assistive technology in Pakistan.

The Right to Assistive Technology and Accessible Instructional Materials for U.S. Students Does Not Consistently Translate into Predictable Access and Effective Use.

Students in the United States have federally-established rights regarding access to assistive technology (AT) devices and services, yet those rights are not consistently upheld for a variety of reasons acknowledged in the literature. We conducted a interview-based study with 48 education professionals, family members and students to analyze the facilitators and barriers that influence AT access for students in the State of Delaware. Study results were consistent with the extant literature, and revealed numerous violations of student rights guaranteed under U.S. special education law. Some barriers were attitudinal, yet most arose from the inadequacy of infrastructures: professionals lacked training, funding was inadequate or difficult to access and, in most areas, there was no definitive guidance relative to the processes that should be followed and how decisions regarding AT-related decisions regarding devices and services should be documented. Elements revealed to facilitate AT access and use were the availability of resources - highly-qualified personnel, time, training, funds, and access to devices - and persistence among educators and family members in pursuing AT solutions for students.

A User’s Perspective on the Factors Influencing the Satisfaction of Assistive Technology Resources Centers’ Built Environment Services

Taiwan will move into a super-aged society by 2025. The government is actively establishing assistive technology resources centers (ATR Centers) throughout Taiwan to provide assistive technology services such as display, evaluation, rental, and maintenance services; they also recycle unused assistive devices, disinfect and clean them, and then rent them to people in need to achieve sustainable development. This study investigates the users’ perceptions about receiving services from the ATR Center in Yunlin and explores their satisfaction. “Service convenience”, “service quality”, “user experience” and “corporate social responsibility (CSR)” were used as the overall research framework and hypotheses are based on the mediating role of “CSR”; data are collected through questionnaires, and structural equation modeling (SEM) is used to test the model and hypotheses. A total of 532 valid questionnaires were collected from the users and caregivers who had used the services of the center in the past two years. The statistical analysis was conducted in three stages: sample data analysis, measurement model validation, and structural equation model analysis. According to the research findings, service convenience, service quality, and user experience all have a significant positive impact on CSR. Additionally, service convenience, service quality, user experience, and CSR have a positive impact on user satisfaction. Moreover, service quality and user experience indirectly affect user satisfaction through CSR. Finally, based on the research results, suggestions are proposed for addressing issues related to assistive service promotion and future adjustments.

Establishing the normative and comparative needs of assistive technology provision in Queensland from the agency and funding scheme perspective.

Assistive technology services and devices support the participation and inclusion of people living with disability. In Australia, the regulatory bodies, agencies and schemes that manage assistive technology provision are governed by national and / or state-based Acts and Legislation. This study examined the assistive technology sector from the perspective of the regulatory bodies, agencies and schemes. Regulatory bodies, agencies and schemes that manage funding for assistive technology in Australia were identified by the research team. A website audit reviewed publicly available documents and information. Semi-structured interviews with representatives from the agencies and schemes were audio-recorded and transcribed verbatim. The audit (n =17) found that the range and level of information publicly available was variable. The availability of assistive technology for driving and transport, design and building for access and safety, and mobility was most often promoted. The qualitative findings (n = 11) indicated variability and challenges within four themes: operationalising the legislation; internal assistive technology processes; reasonable and necessary; and risks in the assistive technology pathway. Regulatory bodies, agencies and schemes are critical to the effectiveness of the sector. The findings identified opportunities for the organisations to review how internal processes are communicated publicly, and for the sector to address the perceived risks related to health professional availability, knowledge and skills, and limited accessibility to trial assistive technology. Subsequent studies explored the perspectives of the assistive technology advisors and suppliers and the recipients of assistive technology services and devices.

On the Relation between Assistive Technology System Elements and Access to Assistive Products Based on 20 Country Surveys.

The objective of this study was to explore the relationship between assistive technology system elements and access to assistive products. Data on assistive technology system elements and self-reported survey data on access to assistive products from 20 countries were analyzed using multivariate statistical methods, including orthogonal partial least squares analyses. Access to assistive products was primarily associated with the geographic coverage of assistive technology services in a country, followed by system elements related to policy and personnel. To achieve universal access to assistive technology, geographic coverage of assistive technology services is an instrumental system element. However, it requires the implementation of appropriate policies along with sufficient funding, recruitment of adequately trained personnel, and availability of assistive products in need.

Assistive technology services for adults with disabilities in state-federal vocational rehabilitation programs

Purpose Prior research indicates that the provision of assistive technology (AT) services positively predicts successful employment outcomes in vocational rehabilitation (VR) programs. While AT services can be promising, they are underutilized overall, and there are apparent disparities in AT service utilization. The purpose of this study was to identify sociodemographic factors which may act as barriers to receiving AT services in VR programs. Recognizing potential disparities is the first step in improving equity in access to beneficial services. Materials and methods This study is a retrospective analysis of national data collected by the Rehabilitation Service Administration’s Case Service Report from fiscal years 2017–2019. The sample included 788,173 cases that reported having a disability, were aged ≥18 years old, was deemed eligible for VR services, and had a complete set of data. Results Less than 9% of VR clients received AT services. We ran a multiple logistic regression analysis to examine the independent effects of various sociodemographic variables on the likelihood of receiving AT services through VR programs. The following client characteristics were associated with a lower likelihood of receiving AT services: men, unemployed, minority, low income, significant disability, non-enrolled in post-secondary education, mental or cognitive disability, less education, and younger age (all p < .001). Conclusion The findings emphasize the need for more research to identify underlying mechanisms and potential solutions to these apparent disparities in access to AT services for adults with disabilities. Future research and implications are provided. IMPLICATIONS FOR REHABILITATION Increasing assistive technology (AT) training in counsellor education and offering more AT training for in-service rehabilitation counsellors to increase their competence to serve individuals with diverse disabilities, particularly those with cognitive and mental disabilities. Counsellors should be encouraged to use a team approach to ensure the most effective AT solutions are provided, and improve access to age-appropriate AT for younger individuals. Counsellors should identify alternative funding sources and refine eligibility criteria for low-income individuals, and develop effective means for educating less-informed individuals about the benefits of AT, and recognise the limited access of minority groups to receive services within vocational rehabilitation programs.

SAKLAY: A Guide to an Assistive Technology Service Delivery Process in the Philippines

SAKLAY: A Guide to an Assistive Technology Service Delivery Process in the Philippines

Barriers and facilitators of assistive technology service delivery process (AT-SDP) in South Korea

Purpose To describe the barriers and facilitators of the assistive technology service delivery process (AT-SDP), based on the perspectives of assistive technology service professionals (ATPs) and assistive technology (AT) service users. Methods We conducted semi-structured interviews with nine AT users and eight ATPs in South Korea. The data were analyzed using a constant comparative approach based on the grounded theory. Results AT users and ATPs identified common barriers in the assessment, matching, and implementation of the AT-SDP. In the assessment process, the preparation of detailed selection criteria was suggested for assistive technology devices (ATDs). Insufficient linkages on assessments among institutions providing AT services was a reported barrier, and standardized evaluation tools were suggested to address this issue. In the matching process, to meet users’ needs, versatility in the characteristics or type of ATD was highlighted. In the implementation process, participants emphasized the need to shorten the time required during the delivery process. Along with these facilitators, institutional support, including staffing securement, the establishment of AT centres, and funding policies were recommended to facilitate the AT-SDP. Conclusions Our results highlight the importance of government support and considering realistic funding levels to overcome the barriers reported by AT users and ATPs.

The Measurement of Experience and Satisfaction with Public Provision of Assistive Technology Services for Workers with Disabilities in Korea

The Korean government has been providing AT services for workers with disabilities and is increasing its provision every year. However, there are request for improvement from individuals with disabilities regarding service process, eligibility, and quality of services. In response to those requests, this study was created to more accurately identify the process to be improved and to collect opinions from workers with disabilities for improvement of public AT services. The survey consisted of respondents' demographic information, experiences with the public AT service process, and opinions on improving public AT service. The request to participate in the survey was conducted for 3 weeks, and the responses of 158 disabled workers were used for analysis. This study used descriptive statistics and analysis of variance and planned follow-up testing in case a significant difference was found. The results indicated a low satisfaction with early stages of AT service process, such as information acquisition. Respondents also hoped that the application process would be changed to be simpler and more direct to take into account workers with disabilities, and that the provision of assistive devices would be expanded and diversified. The government is leading positive changes in line with the needs of workers with disabilities identified in this study. In the future, it is necessary to gradually expand the application eligibility for public AT services and to improve service system and provide government support for them.

Occupational therapists’ perspectives on an evidence-based, client-centered assistive technology intervention

Introduction: Reviews within the field of assistive technology have shown that a client-centered approach is important for user satisfaction, and that assistive technology service delivery should be evidence-based, systematic, and structured. However, client-centered instruments and systematic, structured models are not used consistently. As part of a larger research project, an evidence-based, client-centered assistive technology service delivery process was developed and piloted. The purpose of this study was to investigate occupational therapists’ perspectives on this evidence-based, client-centered assistive technology intervention. Method: Ten occupational therapists, from two Danish municipalities, participated in focus groups. Data were analyzed based on a hermeneutic approach. Results: Three themes emerged from the analysis: a more refined collaboration with clients; advantages of using theoretical frameworks, structured models and instruments and challenges in using the intervention. Conclusion: By using the evidence-based, client-centered intervention, the occupational therapists found that the collaboration with the clients was refined—more emphasis was placed on shared responsibility. They found that the intervention was time-efficient in the long run; however, there seems to be a particular challenge in designing services that are inclusive of clients with cognitive limitations.

Ações em tecnologia assistiva com mulheres hospitalizadas

Abstract Introduction Hospitalization can render women’s health more fragile for a variety of reasons, potentially impacting their autonomy and independence. Within this scenario, interventions using assistive technology can enhance women’s occupational performance. Objective To discern the assistive technology actions undertaken by occupational therapists for women in hospital settings. Method This descriptive, retrospective, and exploratory study with a quantitative approach was conducted from August to December 2021. It utilized secondary data from 155 medical records of women who received occupational therapy in neurology, oncology, and mental health wards at a university hospital in Recife, state of Pernambuco, Brazil. Instruments included a structured questionnaire for characterization and a checklist to trace assistive technology actions. Data analysis was performed using Microsoft Excel. Results Out of 155, 48 patients benefited from assistive technology interventions by occupational therapists. These interventions included evaluation services, prescription, manufacturing, use guidance, and training. The primary devices were orthoses for upper limbs and aids for activities of daily living in the neurology sector, with cushions being prominent in the oncology sector. A common goal was the enhancement of occupational performance. Conclusion Most assistive technology actions occurred in the oncology and neurology wards, focusing on low-cost products. There is a recognized need to refine the monitoring process for assistive technology use, invest more in assistive technology services, and promote research in this field to generate further evidence.