Assistive Technology Service Delivery Research Articles

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.

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.

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.

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.

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.

Processes of assistive technology service delivery in Bangladesh, India and Nepal: a critical reflection

Purpose This paper critically reviews and reflects on the processes for providing Assistive Technology (AT) services to Persons with Disabilities (PWD) in Bangladesh, India and Nepal. The aim is to investigate the AT service delivery systems in these countries and suggest improvements where weaknesses are identified. Materials and methods We carried out a descriptive qualitative exploratory study in Bangladesh, India and Nepal by conducting key informant interviews with policymakers (5), AT service providers (22) and mobility and hearing related AT service users (21). We used a directed content analysis approach guided by a seven-point AT service delivery process model to thematically analyse the existing processes for AT service delivery, from first contact through to follow-up and maintenance. Results AT service delivery processes are sub-optimal in all three countries, and improvements are needed. No common AT service delivery process was found, although there are common features. In general, it is easier for PWDs in India and Nepal to access AT than for those in Bangladesh, but all three countries are failing to live up to their commitments to uphold the human rights of PWDs. Conclusions Although good elements of AT service delivery processes can be identified, the systems in all three countries are fragmented and generally weak. A more holistic approach of looking at the process of AT service delivery, from first contact right through to follow-up and device maintenance, with a single door service delivery system, free of cost at the point of service is recommended in these countries. IMPLICATIONS FOR REHABILITATION Although we found significant weaknesses in AT delivery in all three countries, there are some good AT service delivery practices and opportunities for these countries to learn from one another. A systematic and stepwise approach to assessing current AT service delivery processes in the three countries – examining the delivery system as a whole, from initiation to repair and management – can help identify opportunities to improve the process for (prospective) AT users. A more coherent single door system of AT service delivery will increase the quality and efficiency of the fragmented AT service delivery practices in Bangladesh, India and Nepal.

Wheelchair Mounted Robotic Arms: Occupational Therapy Perceptions and Practices

<h3>Research Objectives</h3> To investigate the current practice habits and perspectives of occupational therapists relative to service delivery of Wheelchair Mounted Robotic Arms. <h3>Design</h3> Cross-sectional survey. <h3>Setting</h3> Community and clinic setting. <h3>Participants</h3> Occupational Therapists. <h3>Interventions</h3> This study investigates the current practices and viewpoints of occupational therapists relative to Wheelchair Mounted Robotic Arms (WMRA) via survey questionnaire. <h3>Main Outcome Measures</h3> A survey was developed for the purposes of this study. The web-based survey includes a series of questions on the perspectives and practice habits of occupational therapists relative to WMRAs. Survey items cover multiple components of the assistive technology service delivery process to include recommendation, implementation, and follow-up services. <h3>Results</h3> At present we have received 46 completed surveys, with 27 respondents working from Canada, 17 from France, 1 from the Netherlands, and 1 from Belgium. Respondents reported a mean of 14.98 (SD= 9.85) years in practice. Fifteen respondents reported involvement in the recommendation or prescription of a WMRA. In response to a question on the appropriate role of OT in WMRA provision, 19 respondents reported that OTs should work "Alongside the vendor", and 3 respondents felt OTs should work independently from the vendor. When asked about the stage at which OTs should be involved in the process of recommending a WMRA, respondents supported available options as follows: Needs assessment, N=22; Recommendation/prescription, N=21; Initial Training, N=21; When prescribing, acquiring, or changing a wheelchair, N=19; Installation on the wheelchair, N=18; Long term follow-up, N=17; Acquisition procedures from the vendor, N=10; and Search for funding, N=6. <h3>Conclusions</h3> Additional scrutiny of practice habits and perspectives are needed to ensure that clinicians are prepared to appropriately support clients who adopt WMRAs. <h3>Author(s) Disclosures</h3> This study is funded by Mitacs (partership with Kinova Robotics) and the Université Laval Cerebral Palsy Research Chair.

Part 2. The assistive technology service delivery process

Part 2. The assistive technology service delivery process

Influences on students’ assistive technology use at school: the views of classroom teachers, allied health professionals, students with cerebral palsy and their parents

Purpose: This study explored how classroom teachers, allied health professionals, students with cerebral palsy, and their parents view high-tech assistive technology service delivery in the classroom.Methods: Semi-structured interviews with six classroom teachers and six parents and their children were conducted. Additionally, two focus groups comprising 10 occupational therapists and six speech pathologists were carried out. Ethical and confidentiality considerations meant that the groups were not matched.Results: Results revealed that it is often untrained staff member who determine students’ educational needs. The participants’ experiences suggested that, particularly in mainstream settings, there is a need for support and guidance from a professional with knowledge of assistive technology who can also take a lead and guide classroom teachers in how to meet students’ needs. Students’ motivation to use the technology was also found to be critical for its successful uptake.Conclusions: The study points to the need for classroom teachers to be given sufficient time and skill development opportunities to enable them to work effectively with assistive technology in the classroom. The participants’ experiences suggest that such opportunities are not generally forthcoming. Only in this way can it be ensured that students with disabilities receive the education that is their right.Implications for RehabilitationClassroom teachers, allied health professionals, students, parents need ongoing support and opportunities to practise operational, strategic and linguistic skills with the assistive technology equipment.System barriers to the uptake of assistive technology need to be addressed.To address the lack of time available for training, programing and other support activities around assistive technology, dedicated administrative support is crucial.Professional development around the use of the quality low cost ICF-CY checklist is recommended for both school and allied health staff.

Validating a measure to assess factors that affect assistive technology use by students with disabilities in elementary and secondary education

Purpose/Aim: The purpose of this study was to measure the predictive validity, internal consistency and clinical utility of the Matching Assistive Technology to Child & Augmentative Communication Evaluation Simplified (MATCH-ACES) assessment. Methods: Twenty-three assistive technology team evaluators assessed 35 children using the MATCH-ACES assessment. This quasi-experimental study examined the internal consistency, predictive validity and clinical utility of the MATCH-ACES assessment. Results: The MATCH-ACES assessment predisposition scales had good internal consistency across all three scales. A significant relationship was found between (a) high student perseverance and need for assistive technology and (b) high teacher comfort and interest in technology use (p = (0).002). Conclusions: Study results indicate that the MATCH-ACES assessment has good internal consistency and validity. Predisposition characteristics of student and teacher combined can influence the level of assistive technology use; therefore, assistive technology teams should assess predisposition factors of the user when recommending assistive technology.Implications for RehabilitationEducational and medical professionals should be educated on evidence-based assistive technology assessments.Personal experience and psychosocial factors can influence the outcome use of assistive technology.Assistive technology assessments must include an intervention plan for assistive technology service delivery to measure effective outcome use.

Implementing a routine outcome assessment procedure to evaluate the quality of assistive technology service delivery for children with physical or multiple disabilities: Perceived effectiveness, social cost, and user satisfaction

ABSTRACTThere is a lack of evidence on the effects and quality of assistive technology service delivery (ATSD). This study presents a quasi-experimental 3-months follow-up using a pre-test/post-test design aimed at evaluating outcomes of assistive technology (AT) interventions targeting children with physical and multiple disabilities. A secondary aim was to evaluate the feasibility of the follow-up assessment adopted in this study with a view to implement the procedure in routine clinical practice. Forty-five children aged 3–17 years were included. Parents were asked to complete the Individual Prioritised Problem Assessment (IPPA) for AT effectiveness; KWAZO (Kwaliteit van Zorg [Quality of Care]) and Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST) 2.0 for satisfaction with ATSD; Siva Cost Analysis Instrument (SCAI) for estimating the social cost of AT interventions. At follow-up, 25 children used the AT recommended. IPPA effect sizes ranged from 1.4 to 0.7, showing a large effect of AT interventions. Overall, parents were satisfied with ATSD, but Maintenance, Professional Services, and AT Delivery were rated not satisfactory. SCAI showed more resources spent for AT intervention compared to human assistance without technological supports. AT may be an effective intervention for children with disabilities. Issues concerning responsiveness and feasibility of the IPPA and the SCAI instruments are discussed with a view to inform routine clinical practice.

Enabling Environment

As stated by the ICF model of the World Health Organization (WHO, 2001), environmental factors may act as facilitators or barriers in the persons' life, leading to improved or reduced functioning respectively. Accessibility of public facilities and services, usability of mainstream products and goods, assistive technology products, individual home adaptations, worksite accommodations and personal assistance, are examples of environmental factors that contribute – if well designed, chosen, implemented and accepted by the person and his or her family – to build up an enabling environment. Indeed disability is often the consequence of inadequate design or lacking organization: "good design enables, bad design disables" (EIDD, 2004). Conversely, appropriate assistive solutions, i.e. proper combinations of well-designed environmental factor, lead to better functioning, according the so called "four 'A's equation" (Assistive technology, environmental Adaptation, personal Assistance = Autonomy) (Andrich et al, 2013). Autonomy – intended as ability to take control over one's own life, to establish relationships with others and actively participate in society – is a broad concept (EUSTAT, 1999). Whether the person wishes to lead an independent life, or live in a sheltered setting, or stay with his/her family, or establish his/her own family, autonomy is a prerequisite for free life choices. However, ensuring that all people with disabilities can access appropriate assistive solutions that able support autonomy in their life environment, is not an easy task. It requires the person's motivations, a wide range of professional competencies, practical trials with assistive products, and a careful assessment process leading to the recommendation or prescription of an individually-tailored assistive solution. It also involves financial support, as assistive solutions are often economically unaffordable for many people. Debates are underway in most countries on how to improve the national assistive technology service delivery systems within the available resources. Currently the systems in force in Europe are based on three main models: the medical, the social and the consumer model (Andrich et al, 2013). The availability of information on assistive products is a key factor in a service delivery system. It empowers people with disabilities and their families, by disseminating awareness, increasing knowledge, helping clarify needs and assisting decisions. Care professionals need it when helping users choose assistive products, training in their usage, designing care, rehabilitation, or education programs. Suppliers and manufacturers need it to know the market, discover opportunities and make their products known. Policy makers and officers of insurances and health authorities find evidence to efficiently allocate resources. Researchers and developers get to know what already exists, which needs are still unmet, what areas are admitting of developments. Today, well-established super-partes national information systems are publicly available on the Internet in many European Countries. Most of them systems take part in the EASTIN Association (European Assistive Technology Information Network) and make available their data also through the EASTIN portal (www.eastin.eu) to citizens from any Country in all languages of the European Union. Today the EASTIN system has become the European landmark for assistive technology information.

How to Accomplish the Assistive Technology Service Delivery Process for Adults in Order to Obtain the Best Outcomes - A Literature Review.

In order to gain knowledge about which methods in the assistive technology service delivery process or parts hereof that result in positive outcomes, a literature review was accomplished. 20 publications were included. Some evidence was found that user involvement in the service delivery process and training in assistive device use had a positive impact on outcomes. Also professionals' higher assistive device expertise seems to result in better outcomes. More research within the field is needed, especially studies that compare the effectiveness and cost-effectiveness of specific methods applying controlled study designs.

Satisfaction of users with assistive technology service delivery: An exploratory analysis of experiences of parents of children with physical and multiple disabilities

Objective: To describe experience of assistive technology service delivery (ATSD) by parents of children with physical or multiple disabilities (aged 3–18 years). Method: Forty-seven of 115 parents participated in a postal survey assessing satisfaction with the ATSD process, employing the QUEST 2.0 and the KWAZO scales. Six of these participated in two focus groups. Descriptive statistics were used for satisfaction scores. The focus group transcripts were coded and combined with survey results by two independent researchers. Results: Low satisfaction scores were reported for follow-up, AT delivery, maintenance services, access to services, coordination, and efficiency of ATSD. Several barriers to and facilitators of ATSD were mentioned and solutions to improve ATSD quality were identified. Conclusion: Evaluation of parents’ service experience is central for identifying shortcomings in ATSD. Health professionals are advised to utilize validated instruments and strategies to assess effectiveness of technological interventions and to assure ATSD quality.

Development of a Team-Based Method for Assuring the Quality of Assistive Technology Documentation

Good practice in assistive technology (AT) service delivery targeting children with disabilities has come increasingly to include providing AT stakeholders with a final text record that documents the rationale and procedures behind the recommendations made during the AT assessment process (AT documentation). In the present case study of one AT service provider, we developed a team-based approach for conducting an evaluation of the quality of the AT documentation. A service-specific scale for the evaluation of AT documentation was developed following a five-step approach. The scale was employed to review AT documentation utilizing specific review criteria in order to evaluate the quality of AT documentation practices with regard to the service investigated. Two independent reviewers examined the AT documentation for 130 cases of AT service provision. Weighted kappa and Intraclass correlation coefficients (ICC) were employed as a measure of inter-rater agreement. The results of the documentation evaluation allowed AT professionals to objectively assess the quality of the AT documentation produced by the service under investigation, identify shortcomings in the documentation process, and make related corrections. AT services may benefit from the employment of strategic approaches for the evaluation of service provision. Possible applications to other AT service providers are discussed.

Promoting a standard for assistive technology service delivery

BACKGROUND: The Assistive Technology Service Method (ATSM) is an innovative evidence-based process standard to support the provision of person centered, evidence-based, and interdisciplinary assistive technology services. OBJECTIVE: This paper defines challenges with adoption of innovative practices and discusses strategies to diffuse the ATSM for training, education, and gathering knowledge. METHOD: Important central components for the diffusion of innovations are reviewed to include strategies for transferring the evidence into practice and other outcomes of the process. RESULTS: This paper discusses key issues and challenges to professional practice for assistive technology services, presents data on the current state of practice, and delivers strategies to promote innovative interventions and techniques. CONCLUSION: Strategies to implement the adoption of an interdisciplinary service delivery method must consider provider knowledge and awareness of need with development of tools for effective use of the innovation.

Assessing children with multiple disabilities for assistive technology: A framework for quality assurance

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

Assistive Technology Service Delivery in Rural School Districts

Little is known about the implementation of assistive technology (AT) services for students in rural areas. This study investigated the AT service delivery in 10 rural districts across six states. The results indicated that students use AT across functional areas, but considerably fewer number of devices than do those not living in rural areas. AT experts attended a low percentage of IEP meetings, and the AT expertise of related service personnel is rated highly. Teachers reported that rural students have access to the technology they need; however, they also indicated they needed more training on available technology for their students.

Assistive/rehabilitation technology, disability, and service delivery models

The United Nation's Millennium Development Goals do not explicitly articulate a focus on disability; similar failures in the past resulted in research, policy, and practice that are not generalizable and did not meet the needs of persons with disabilities since they were developed for an "average" population. Academics and professionals in health and other disciplines should have a knowledge base in evidence-based practices that improve well-being and participation of people with disabilities through effective service delivery of assistive technology. Grounded by a theoretical framework that incorporates a multivariate perspective of disability that is acknowledged in the convention on the rights of persons with disabilities and the World Health Organization's International Classification of Functioning, Disability and Health, we present a review of models of assistive technology service delivery and call for future syntheses of the fragmented evidence base that would permit a comparative effectiveness approach to evaluation.