Evaluation Of Assistive Devices Research Articles

P2E1-06 Consideration of human resource development method in monitoring evaluation of assistive devices for persons with disabilities

P2E1-06 Consideration of human resource development method in monitoring evaluation of assistive devices for persons with disabilities

Aspects determining adherence to wrist-hand orthoses in patients with peripheral neuropathies

BACKGROUND: People with peripheral neuropathies suffer significant sensorimotor impairment. Prescribed treatment includes the use of orthosis. However, a common obstacle to treatment efficacy is patient adherence. Given the limited information available, gathering evidence on adherence to orthotic treatment is essential. OBJECTIVE: This study aims to identify aspects that influence adherence to orthotic treatment in patients with peripheral neuropathies. METHODS: We applied a survey including items from the assistive device evaluation section of Quest 2.0 and self-developed questions to assess the importance and satisfaction of wrist-hand orthosis users. We used the principles of the Kano model to understand the nature of issues influencing adherence and prioritize opportunities for product improvement. RESULTS: User satisfaction with the ease of adjustment, weight, comfort, effectiveness, durability, dimensions, and appearance of orthoses influences treatment adherence. CONCLUSIONS: We found differences in estimating the importance of orthosis aspects from direct consultation and estimation from the satisfaction-adherence correlation. Satisfaction is an indirect measure of importance and an adequate predictor of adherence. The application of Kano’s model allows a more precise identification of the influence of orthosis attributes on adherence. This method describes relationships between aspects that are not discernible in linear models.

Left Ventricular Assist Device Evaluation for Congestive Heart Failure With Hypereosinophilic Syndrome in a 76-Year-Old Male

Hypereosinophilic syndrome, a rare condition, is characterized by eosinophilia with associated organ infiltration and organ failure. The most commonly involved sites include the cardiovascular, gastrointestinal, and central nervous systems. Infiltration of eosinophils into the myocytes may result in congestive heart failure warranting the use of a left ventricular assist device (LVAD). The authors describe a case of a 76-year-old male with dyspnea and a consistently elevated eosinophil count. Initially diagnosed with adult-onset asthma, he failed to improve despite his adherence to recommended pharmacological treatment. The exacerbation of dyspnea combined with the signs of congestive heart failure led to the evaluation of LVAD therapy in this patient.

Mock Circulation Loop for Ventricular Assist Device Evaluation

Mock Circulation Loop for Ventricular Assist Device Evaluation

Age-related injury risk curves for the lumbar spine for use in low-back-pain prevention in manual handling tasks

This study introduces injury risk curves for the lumbar spine for use in the risk assessment of low back pain (LBP) caused by manual lifting of heavy loads. LBP has been a longstanding problem among industrial workers, giving rise to the development of assistive devices. However, quantitative evaluation methods to verify the safety of such devices have not yet been established. The notable biomechanical criterion of 3.4 kN of lumbar compressive force, defined by the National Institute for Occupational Safety and Health, applies only to young, healthy workers with a fixed risk level. This study on injury risk curves clarified the risk level of injury to the lumbar spine due to lumbar compressive force for individuals within a wide age range. The findings can be applied for the design and evaluation of assistive devices as well as the design of ergonomic guidelines for manual work.

The Overlooked Outcome Measure for Spinal Cord Injury: Use of Assistive Devices.

Although several outcome measures are used to assess various areas of interest regarding spinal cord injuries (SCIs), little is known about the frequency of their use, and the ways in which they transform shared knowledge into implemented practices. Herein, 800 professionals from the International Spinal Cord Society, especially trained for caring in patients with SCI, were invited to respond to an Internet survey collecting information on the use of standardized measures in daily clinical practices. We asked both clinicians and researchers with different areas of interest about their use of functional outcome measures, and, in particular, which scales they habitually use to assess various aspects of clinical practice and rehabilitation. We selected a set of rating scales, which were validated for measuring SCIs (http://www.scireproject.com/outcome-measures). The results show that the areas of interest assessed by most of the participants were neurological status, upper limb, lower limb gait, pain, spasticity, self-care, and daily living. The most widely used rating scales were the spinal cord independence measure, the functional independence measure and the International Standards for Neurological Classification of Spinal Cord Injury. Instead, the majority of respondents did not evaluate the use of assistive technology. Despite the availability of several outcome scales, the practice of evaluating SCIs with standardized measures for assistive technologies and wheelchair mobility is still not widespread, even though it is a high priority in the rehabilitation of SCI patients. The results emphasize the need for a more thorough knowledge and use of outcome scales, thus improving the quality of assistive device evaluation.

Abstract 26: Left Ventricular Assist Device Evaluation and Education Processes Across Six Programs: Commonalities and Differences

Objective: To offer patients a left ventricular assist device (LVAD), programs complete a formal evaluation of the patient’s eligibility. While basic components of the evaluation are mandated by Centers for Medicare and Medicaid Services, the full process has never been systematically compared across sites. Methods: We conducted semi-structured interviews with multiple team members at 6 diverse LVAD programs. The interviews were audio recorded, transcribed, inductively coded, and analyzed with a team-based approach. Results: We interviewed 31 participants: 9 cardiologists, 3 surgeons, 3 nurse practitioners, 9 nurse coordinators, and 7 social workers (a total of 4-7 participants at each program). The formal LVAD evaluation process consisted of 3 main components: the medical/psychosocial evaluation to determine patient eligibility, educating the patient about the LVAD, and the multidisciplinary committee meeting to formally decide patients’ eligibility. While the basic tenants of the processes were similar across programs, 4 major differences emerged: (1) Standardization: some programs had a formal prescriptive pattern for how the process unfolded, such as order sets and timing of specific assessments, while others appeared to operate more sporadically; (2) Timing: some programs conducted patient education before the team’s decision on LVAD eligibility to assess patients’ interest in an LVAD as part of the final decision, whereas others did it after the committee meeting to prevent “false hopes” and wasted personnel time; (3) Location: programs conducted the LVAD evaluation process primarily inpatient following decompensation, or in both inpatient and outpatient settings which resulted in evaluating some patients earlier in the disease progression; (4) Personnel: some programs included certain team members’ assessments—particularly palliative care and social work—as integral in the eligibility decision, whereas other programs saw such input as peripheral. These differences affected how the medical teams and patients made decisions. The environment, attitude, speed, and personalities of the program shaped the way decisions were presented and made. Despite the variability, all programs reported similar challenges due to the complex patient population and the intricate relationships within the multidisciplinary teams. Overall, all programs expressed a universal goal of striving to implant the “appropriate patient”. Conclusion: Despite similar medical challenges and team structure, large variability was observed across LVAD programs, affecting how medical teams and patients made decisions. Standardization of the process at a higher level and communication between programs may help identify best practices and keep programs consistent. In turn, this could lead to better internal communication and education processes and ultimately improve patient care.

Catch Me if You Can: A Quality Improvement Initiative to Decrease Fall Rates among Nursing Home Residents

Falls are prevalent among nursing home (NH) residents, with approximately 1.5 falls per NH bed-years. Most of these falls are benign but 10-25% result in hospital admission and/or fractures. 3.3% of long term care residents nationally experienced one or more falls with major injury in the past year Several studies have examined the efficacy of multi-faceted interventional programs on reducing falls in the NH with varied results. These programs included environmental assessments, assistive device evaluation and modification, medication changes, gait assessment and training, staff education, exercise programs, hip protectors, and blood pressure evaluation.

Low Prevalence of Left Ventricular Thrombus in Patients Undergoing Ventricular Assist Device Evaluation

International mechanical circulatory support guidelines recommend pre-operative screening for intracardiac thrombus prior to placement of a left ventricular assist device (LVAD). No data exists on the prevalence of left ventricular (LV) thrombus in advanced heart failure patients referred for LVAD evaluation. LV thrombus has a high prevalence in patients with advanced heart failure undergoing evaluation for LVAD. A retrospective chart review of all patients with advanced heart failure referred for LVAD evaluation at a tertiary care center from 7/2007 to 11/2013 was performed. All patients underwent a contrast transthoracic echocardiogram to evaluate specifically for LV thrombus as part of a standardized LVAD evaluation. A standardized LVAD evaluation was performed on 172 patients with advanced heart failure. Mean age was 51.2 +/- 13.4 years and 66% of patients were male. Ischemic cardiomyopathy was the etiology of the heart failure in 28% of patients. Mean ejection fraction was 11.4 +/- 4.6% and 41% of patients had a history of atrial fibrillation. Contrast echocardiogram during pre-operative screening visualized LV thrombus in 8 patients (4.6%). Of these 8 patients, 4 died without implantation of an LVAD. Follow-up contrast echocardiogram revealed resolution on the LV thrombus in 2 patients who subsequently underwent LVAD implantation. In these patients, no LV thrombus was identified by the surgeon at the time of implant. LV thrombus is infrequently encountered in advanced heart failure patients undergoing LVAD evaluation. Because of the uncommon occurrence of LV thrombus, routine performance of a pre-operative contrast echocardiogram may not be necessary.

Falls in the Nursing Home: Are They Preventable?

Falls are prevalent in elderly patients residing in nursing homes, with approximately 1.5 falls occurring per nursing home bed-years. Although most are benign and injury-free, 10% to 25% result in hospital admission and/or fractures. Primary care providers for nursing home residents must therefore aim to reduce both the fall rate as well as the rate of fall-related morbidity in the long-term care setting. Interventions have been demonstrated to be successful in reducing falls in community-dwelling elderly patients. However, less evidence supports the efficacy of fall prevention in nursing home residents. The authors conducted a Medline search using the key words Falls and Nursing Homes. Several studies examined the efficacy of multifaceted intervention programs on reducing falls in nursing homes with varied results. Components of these intervention programs include: environmental assessment, assistive device evaluation and modification, medication changes, gait assessment and training, staff education, exercise programs, hip protector use, and blood pressure evaluation. Current literature supports the use of environmental assessment and intervention in reducing falls in nursing homes, and demonstrates an association between certain medications and falls. However, there are no studies that examine the effect of medication adjustments on fall rates. Also, the literature does not strongly suggest that exercise programs are effective in fall reduction. Although not effective in reducing fall rates, the use of hip protectors appears to result in less fall-related morbidity. More studies must be done to clarify the effects of high-risk medication reduction, the optimal nature and intensity of exercise programs, and patient targeting criteria to maximize the effectiveness of nursing home fall prevention programs. Based on the current literature, an effective multifaceted fall prevention program for nursing home residents should include risk factor assessment and modification, staff education, gait assessment and intervention, assistive device assessment and optimization, as well as environmental assessment and modification. Although there is no association between the use of hip protectors and fall rates, their use should be encouraged because the ultimate goal of any fall prevention program is to prevent fall-related morbidity.

Falls in the Nursing Home

<h3>Introduction</h3> Falls are prevalent in elderly patients residing in nursing homes, with approximately 1.5 falls occurring per nursing home bed-years. Although most are benign and injury-free, 10% to 25% result in hospital admission and/or fractures. Primary care providers for nursing home residents must therefore aim to reduce both the fall rate as well as the rate of fallrelated morbidity in the long-term care setting. Interventions have been demonstrated to be successful in reducing falls in community-dwelling elderly patients. However, less evidence supports the efficacy of fall prevention in nursing home residents. <h3>Methods</h3> The authors conducted a Medline search using the key words Falls and Nursing Homes. <h3>Results</h3> Several studies examined the efficacy of multifaceted intervention programs on reducing falls in nursing homes with varied results. Components of these intervention programs include: environmental assessment, assistive device evaluation and modification, medication changes, gait assessment and training, staff education, exercise programs, hip protector use, and blood pressure evaluation. Current literature supports the use of environmental assessment and intervention in reducing falls in nursing homes, and demonstrates an association between certain medications and falls. However, there are no studies that examine the effect of medication adjustments on fall rates. Also, the literature does not strongly suggest that exercise programs are effective in fall reduction. Although not effective in reducing fall rates, the use of hip protectors appears to result in less fall-related morbidity. <h3>Conclusion</h3> More studies must be done to clarify the effects of high-risk medication reduction, the optimal nature and intensity of exercise programs, and patient targeting criteria to maximize the effectiveness of nursing home fall prevention programs. Based on the current literature, an effective multifaceted fall prevention program for nursing home residents should include risk factor assessment and modification, staff education, gait assessment and intervention, assistive device assessment and optimization, as well as environmental assessment and modification. Although there is no association between the use of hip protectors and fall rates, their use should be encouraged because the ultimate goal of any fall prevention program is to prevent fall-related morbidity.

Falls in the Nursing Home: Are They Preventable?

Falls are prevalent in elderly patients residing in nursing homes, with approximately 1.5 falls occurring per nursing home bed-years. Although most are benign and injury-free, 10% to 25% result in hospital admission and/or fractures. Primary care providers for nursing home residents must therefore aim to reduce both the fall rate as well as the rate of fallrelated morbidity in the long-term care setting. Interventions have been demonstrated to be successful in reducing falls in community-dwelling elderly patients. However, less evidence supports the efficacy of fall prevention in nursing home residents. The authors conducted a Medline search using the key words Falls and Nursing Homes. Several studies examined the efficacy of multifaceted intervention programs on reducing falls in nursing homes with varied results. Components of these intervention programs include: environmental assessment, assistive device evaluation and modification, medication changes, gait assessment and training, staff education, exercise programs, hip protector use, and blood pressure evaluation. Current literature supports the use of environmental assessment and intervention in reducing falls in nursing homes, and demonstrates an association between certain medications and falls. However, there are no studies that examine the effect of medication adjustments on fall rates. Also, the literature does not strongly suggest that exercise programs are effective in fall reduction. Although not effective in reducing fall rates, the use of hip protectors appears to result in less fall-related morbidity. More studies must be done to clarify the effects of high-risk medication reduction, the optimal nature and intensity of exercise programs, and patient targeting criteria to maximize the effectiveness of nursing home fall prevention programs. Based on the current literature, an effective multifaceted fall prevention program for nursing home residents should include risk factor assessment and modification, staff education, gait assessment and intervention, assistive device assessment and optimization, as well as environmental assessment and modification. Although there is no association between the use of hip protectors and fall rates, their use should be encouraged because the ultimate goal of any fall prevention program is to prevent fall-related morbidity.

Falls in the Nursing Home: Are They Preventable?

Falls are prevalent in elderly patients residing in nursing homes, with approximately 1.5 falls occurring per nursing home bed-years. Although most are benign and injury-free, 10% to 25% result in hospital admission and/or fractures. Primary care providers for nursing home residents must therefore aim to reduce both the fall rate as well as the rate of fall-related morbidity in the long-term care setting. Interventions have been demonstrated to be successful in reducing falls in community-dwelling elderly patients. However, less evidence supports the efficacy of fall prevention in nursing home residents. The authors conducted a Medline search using the key words Falls and Nursing Homes. Several studies examined the efficacy of multifaceted intervention programs on reducing falls in nursing homes with varied results. Components of these intervention programs include: environmental assessment, assistive device evaluation and modification, medication changes, gait assessment and training, staff education, exercise programs, hip protector use, and blood pressure evaluation. Current literature supports the use of environmental assessment and intervention in reducing falls in nursing homes, and demonstrates an association between certain medications and falls. However, there are no studies that examine the effect of medication adjustments on fall rates. Also, the literature does not strongly suggest that exercise programs are effective in fall reduction. Although not effective in reducing fall rates, the use of hip protectors appears to result in less fall-related morbidity. More studies must be done to clarify the effects of high-risk medication reduction, the optimal nature and intensity of exercise programs, and patient targeting criteria to maximize the effectiveness of nursing home fall prevention programs. Based on the current literature, an effective multifaceted fall prevention program for nursing home residents should include risk factor assessment and modification, staff education, gait assessment and intervention, assistive device assessment and optimization, as well as environmental assessment and modification. Although there is no association between the use of hip protectors and fall rates, their use should be encouraged because the ultimate goal of any fall prevention program is to prevent fall-related morbidity.

Biomechanical evaluation of assistive devices for transferring residents

This is the first of two articles to report a biomechanical evaluation and psychophysical assessment of nine battery-powered lifts, a sliding board, a walking belt, and a baseline manual method for transferring nursing home residents from a bed to a chair. The objectives of the biomechanical evaluation were: (1) to investigate the effects of transfer method and resident weight on the biomechanical stress to nursing assistants performing the transferring task, and (2) to identify resident-transferring methods that could reduce the biomechanical stress to the nursing assistants. Nine nursing assistants served as test subjects; two elderly persons participated as residents. A four-camera motion analysis system, two force platforms, and a three-dimensional biomechanical model were used to measure biomechanical load. The results indicate that transfer method and resident weight affect a nursing assistant’s low-back loading. The basket-sling and overhead lift devices significantly reduced the nursing assistants’ back-compressive forces during the preparation phase of a resident transfer. In addition, the use of basket-sling, overhead, and stand-up lifts removed about two-thirds of the exposure to low-back stress (lifting activities per transfer) as compared to the baseline manual method. Thus, the use of these devices reduces biomechanical stress, and thereby will decrease the occurrence of resident-handling-related low-back injuries. Furthermore, lifting device maneuvering forces were found to be significantly different and a number of design/use problems were identified with various assistive devices. The second article will detail the psychophysical assessment of the same resident-transferring methods.

Evaluation of Assistive Devices after a Course in Joint Protection

This study assessed a joint protection education program and investigated the costs and effects of assistive devices. Fifty-three women with seropositive rheumatoid arthritis, whose ages ranged from 29 to 65 years, attended a standardized joint protection course (13 hours). A self-report questionnaire was constructed listing the most common devices, and the subjects were asked to check which devices they had received, which ones they used and did not use, and why. Pain during activities of daily living and when using assistive devices was measured using the visual analogue scale. Results show that the subjects reported great benefits from the joint protection course, assistive devices, and wrist orthosis. The women had tried 663 devices, 91% of which were still being used. Pain decreased significantly (p < .001) when using assistive devices. The utility of 11 devices at a cost of SEK 1,683 per person can be described as increased capacity and ability to work at home, work outside the home, and perform leisure activities with less pain.

Issues involved in the evaluation of assistive devices

Issues involved in the evaluation of assistive devices

Toward the development of consumer-based criteria for the evaluation of assistive devices

The most important basis for evaluating an assistive device is whether it satisfies the needs of the disabled consumer. However, the factors that consumers consider in determining whether a device meets their needs are not well understood. This preliminary study applied a small focus group process to identify and prioritize factors used by long-term users of assistive technology in assessing their devices. A modified version of the Delphi Method was applied to two groups of long-term users--a Panel of Consumer Experts with Mobility Impairments and a Panel of Consumer Experts with Sensory Impairments. In total, the panels identified and prioritized 17 general factors for 11 types of assistive technologies. This study constitutes an initial step toward the development of design, engineering, and selection criteria based on the specific concerns of consumers.