Need For Assistive Technology Research Articles

Age related increase in impairment across the life course: the use of Zomba curves to estimate assistive technology needs in Malawi

Purpose Global population growth and increasing longevity means that the need for Assistive Technology (AT) will continue to increase. The level of unmet need for AT is greatest in low-income settings. The aim of this study is to identify age-related increase in impairment and to estimate the AT needs. Materials and Methods We analysed secondary data from the 2018 Malawi Population and Housing Census (MPHC) based on the Washington Group on Disability Statistics (WG) short-set of questions. Results Out of the 1,556,670 persons with one or more functional limitations or disabilities identified in the census, self-reported difficulties in all domains were markedly higher from age 40 and above. The proportion reporting one functional limitation is higher compared to two or more limitations, but at age 78–80 the proportion reporting two or more functional limitations increased above those reporting one functional limitation. Although 60.9% (60.7–61.0) and 63.5% (63.3–63.6) of those who reported difficulty in seeing and hearing were using glasses and hearing aids respectively, the estimated total need for glasses and hearing aids in this group was 98.9% (98.0–99.0) and 98.4% (98.3–98.5) respectively. The unmet need for glasses and hearing aids were therefore 38.1% and 34.9% respectively. Conclusion The differential slope of impairment curves against age is a guide to the increasing demand for AT across the life course and across different domains of functioning. Country specific analysis of impairment across age and domains is essential to understand and plan for the growing need for AT globally. IMPLICATIONS FOR REHABILITATION It is important to estimate and plan for impairment across life course to address the age-related increase in impairment and the increasing need for AT with age. The Zomba curves show the cumulative nature of impairment with age and the need for age and need specific provision of AT across the life course through proactive policy level actions. The significant high unmet need for glasses and hearing aids attests to similar need for other assistive products and the need for setting specific interventions to address needs of affected persons. The differential slope of impairment curves against age is a guide to the differing and increasing demand for assistive technology across the life course and across different domains of functioning

The informal economy as a provider of assistive technology: lessons from Indonesia and Sierra Leone.

Promoting the use of assistive technology (AT) is crucial for the health and well-being of users, but there is a huge global problem of unmet need for AT. In this context informal (unregulated) providers of AT play a significant role of meeting AT user need, particularly in less-resourced settings. This study draws on research into formal and informal AT provision in low-income urban communities in Indonesia and Sierra Leone to explore the potential of informal providers in addressing unmet need. Specifically, it looks at the different performance of formal and informal providers regarding the availability and the adequacy of AT that they provide. The study concludes by proposing further research into the scope for coproduction of AT between formal and informal providers.

Meeting AT needs in humanitarian crises: The current state of provision

ABSTRACT Humanitarian coordination systems increasingly recognize and aim to respond to the needs of people with disabilities within populations affected by crises, spurred on by the UN Convention on the Rights of Persons with Disabilities (CRPD) which was adopted in 2006. Many agencies state their aim to meet the requirements of the CRPD using a “twin track” approach: ensuring the inclusion of people with disabilities in mainstream provision, alongside targeted support for their needs, which may include the need for Assistive Technology (AT). However, there is very little evidence of AT provision in humanitarian settings, which is a specific and urgent need for many people including the elderly and people with disabilities, and an implicit requirement of Article 11 of the CRPD and World Health Assembly resolution on improving access to assistive technology. There is also little evidence of effective mechanisms for AT provision in humanitarian settings. This is despite high and growing levels of unmet AT need in crises, and despite the legally binding requirement in the CRPD to provide AT for those who need it. AT provision faces unique challenges in humanitarian settings. This paper discusses the evidence available in the literature for the scale and quality of AT provision interventions in crises, and what is known about the challenges and facilitators of provision. We conducted a search of the academic literature and retained literature that reported on any form of AT provision following crisis, where international humanitarian response was in place, published in English between January 2010 and June 2020. We found very few examples in that academic literature of systematic and coordinated AT provision at the acute stage of crisis, and even less in the preparedness and post-acute stages. However, it is difficult to assess whether this is the result of insufficient academic attention or reflects a lack of provision. The small body of academic literature that describes AT provision in humanitarian settings paints a picture of small-scale provision, specialized to single types of impairments, and delivered by predominantly by NGOs. We also conducted a search of the gray literature, using the same inclusion criteria, in two countries: Afghanistan and South Sudan (case studies forthcoming). This gray literature provided supplementary evidence of the types of AT providers and AT provision available in those protracted crises. There are very few examples of how AT services can be scaled up (from a very low baseline) and maintained sustainably within a strengthened health system. The literature also describes more examples of provision of assistive products for mobility over assistive products for other impairments. If the paucity of literature on AT provision in humanitarian settings is a reflection of the scale of provision, this implies a deficiency in humanitarian response when it comes to providing people with AT needs with the essential products and services to which they have a right, and which will enable their access to basic, life-saving assistance. We conclude by providing recommendations for urgent actions that the AT and humanitarian community must take to fill this critical gap in the provision of essential products and services for a potentially marginalized and excluded group.

Inclusive education: The case for early identification and early intervention in assistive technology

ABSTRACT This paper starts by presenting the argument that inclusive education for learners with disabilities is often not possible without their access to fit-for-purpose assistive technology (AT), as the barriers to their education are often environmental. The paper will argue that, if assistive technology is an enabler for learning, then the processes by which children with disabilities are identified as users of assistive technology must take place as early as possible in the lifecycle. Mechanisms associated with Early Identification and Early Intervention (EI/EI) must be outfitted with all necessary resources for identifying and addressing the unique assistive technology needs of each individual child, but also have a prospective view of the use of the assistive technology in order to ensure school-age children start benefiting from assistive technology as early as possible. A further argument will be made that, when adequate identification of the need for assistive technology has not taken place early, education systems must be prepared to – in collaboration with other ministries or departments – identify, assess and provide the necessary assistive technology not only as it relates to education use, but to all-inclusive and holistic use. The argument will be made for adequately resourcing “support services for inclusion” and creating transdisciplinary teams of professionals that can effectively ensure equitable access and participation of all children with disabilities in inclusive education. Throughout, some examples of good practices will support the narrative, and the paper will close with recommendations for stakeholders involved in developing policies and practices for inclusive education.

The relationship between unmet need for home and community-based services and health and community living outcomes

BackgroundFew studies have examined user-reported perspectives about the quality and sufficiency of home and community-based services (HCBS) and their relationship to key health and community living outcomes. ObjectiveTo examine the association between unmet need for HCBS and health and community living outcomes in a multi-state, multi-program sample of Medicaid HCBS users. MethodsWe used data from the 2017–2018 National Core Indicators-Aging and Disability (NCI-AD) survey, collected among older adults and adults with physical disabilities who were receiving Medicaid HCBS across 13 states (N = 10,263). We conducted descriptive analysis on the demographic, functional, and health characteristics of the sample, and examined the prevalence of unmet need for HCBS across five domains: 1) assistance with daily activities, 2) assistive technology, 3) home modifications, 4) transportation, and 5) sufficiency of services for meeting user needs and goals. We used logistic regressions to estimate adjusted odds ratios for the association between unmet need for HCBS and health care utilization (ED visits, hospital/rehab stays, preventative care) and community living outcomes (active in the community, interacting with family/friends, satisfaction, control). ResultsAcross the five domains, prevalence of unmet need ranged from 21% (unmet need for assistance with self-care or other daily activities) to 54% (unmet need for assistive technology). Individuals who experienced unmet need had consistently worse health and community living outcomes than those who reported no unmet need, after adjusting for key user demographic, functional, and social characteristics (p < 0.05). ConclusionsUnmet need for HCBS is consistently and significantly associated with poor health and community living outcomes among Medicaid users.

Assistive Technology for Dyslexia Students in Elementary School

Technological advances require collaboration in classroom learning practices by providing accessibility to optimize student learning. Classroom learning should be able to accommodate all student learning needs, including students with dyslexia. The purpose of this study was to analyze the need for assistive technology for learning innovation in one of the students who experienced dyslexia in elementary school. This research is qualitative research, using case study method. Data was collected by using interview, observation, and documentation methods. The instruments used in collecting data include: interview guidelines, observation sheets, and documentation guidelines. Data analysis was carried out in a qualitative descriptive manner. The results showed that one of the dyslexic students who is currently in fifth grade elementary school has a phonological deficit and needs learning media to help him practice increasing phonological awareness. Therefore, assistive technology-based learning media is needed to improve the quality of education for dyslexic students, especially in the training process to increase their phonological awareness.

Designing Inclusion: Using 3D Printing to Maximize Adapted Physical Education Participation

While assistive technology is often suggested as a way to increase, maintain, or improve functional ability for individuals with disabilities within physical activity (PA) settings, cost and availability of such items are often noted as barriers. In recent years, 3D printing has become available to the general public through the adoption of 3D printers in schools, libraries, and universities. Through individual design and rapid prototyping, 3D printing can support physical educators in accommodating student need for assistive technology through a multitude of modification possibilities. This article will highlight the capacity for 3D printed assistive technology within educational settings, and will illustrate how teachers, APE specialists, and other related service personnel can utilize this technology to support student success in PE and PA settings. This article will also assist practitioners with locating, uploading, and utilizing existing collections of 3D assistive technology models from open-source websites, such as Thingiverse.

Socio-Demographic Factors Influencing the Use of Assistive Technology among Children with Disabilities in Malawi.

This paper aims to address the information gap on the influence of socio-demographic factors on access and utilization of Assistive Technology (AT) among children with disabilities in Malawi. Thus, it contributes towards the realization of the recommendations of the UN Convention on the Rights of Persons with disabilities and the development of a framework for creating an effective national AT policy. The paper used two statistically matched datasets, namely, the 2017 survey on Living conditions among persons with disabilities in Malawi and the 2015-16 Malawi Demographic and Health survey. Logistic regression and structural equation modeling techniques were utilized to assess the influence of socio-demographic factors on the use of AT among children with disabilities. The results indicate that there is a high level of unmet need for AT among young children aged 2 to 9 and those living in urban areas. The results further indicate that children with multiple disabilities have lower odds (OR = 0.924) of using AT for personal mobility compared to children with a single functional difficulty. These results entail that AT needs for children with multiple disabilities are not adequately addressed. Therefore, when developing policies on AT, younger children and those with multiple disabilities need to be specifically targeted.

Perspectives on access and usage of assistive technology by people with intellectual disabilities in the Western Cape province of South Africa: Where to from here?

BackgroundWhilst assistive technology (AT) can play an important role to improve quality of life, health inequity regarding access to appropriate AT for people with intellectual disabilities (ID) is still very much present especially in low resource countries.ObjectivesThis study focused on exploring factors that influence access to and continued use of AT by people with ID in the Western Cape province of South Africa and to suggest potential implications of these findings and actions required to promote access to AT.MethodA qualitative approach was used to explore the experiences of people with ID and providers of AT. Face-to-face interviews with 20 adults with mild to profound ID, and 17 providers of AT were conducted and the data were analysed thematically.ResultsPeople with ID within the study setting faced many challenges when trying to access AT and for those who managed to acquire AT, its continued usage was influenced by both personal characteristics of the user and environmental factors. Important factors that influence AT access and use for people with ID found in this study were (1) attitudes from the community, (2) knowledge and awareness to identify AT need and (3) AT training and instructions to support the user and care network.ConclusionWith the perspectives of both the providers and users of AT, this study identified priority factors, which could be addressed to improve AT access and use for people with ID in the Western Cape province.

Device abandonment in deafblindness: a scoping review of the intersection of functionality and usability through the International Classification of Functioning, Disability and Health lens

ObjectivesAbandonment of vision, hearing or mobility aids suggests common barriers and facilitators to ongoing device use. However, the possible interactive effects of combined hearing and vision disabilities on device use...

Development of Smartphone-Controlled Hand and Arm Exoskeleton for Persons with Disability

Abstract This study addresses the need for assistive technology of people who lost control of their upper limbs as well as people who are undergoing rehabilitation. Loss of upper limb control causes lack of functionality and social acceptability especially for many people in developing countries with fewer available technology. The study develops a modern but low-cost prosthetic device that can be controlled by users using a smartphone and can be rapidly manufactured using three-dimensional printing (3D printing) of plastic materials. The development of the prosthetic device includes designing the mechanical and electronic parts, programming the Arduino board and Android application for control, simulation and analysis of 3D printed parts most subjected to stress, and 3D printing the parts under different settings. The device was tested in terms of time spent and capacity of lifting varying loads when not worn and when worn by users. The device can effectively lift 500 grams of load in one second for a person weighing between 50 to 60 kilograms.

Design Centrado no Usuário: Uso do User-Capacity Toolkit na obtenção de dados de sujeito com Artrite Reumatoide

A Artrite Reumatoide (AR) é uma doença crônica de origem autoimune, que atinge em sua maioria mulheres de 40 a 70 anos de idade. Pensando no bem-estar e qualidade de vida dessa população, e na busca pela satisfação das necessidades humanas, a pesquisa em questão possui o objetivo de levantar as capacidades/limitações físicas e cognitivas de um sujeito com AR por meio do User-Capacity Toolkit (UCT). Este conjunto de ferramentas visa guiar as etapas de levantamento, organização e análise de dados em projetos de Tecnologia Assistiva (TA). Os resultados demonstram que as principais limitações do sujeito estão relacionadas a realização de atividades simples da vida diária, devido à redução da força e destreza causadas pela AR. Essas dificuldades reduzem a autonomia do sujeito, que acaba necessitando do auxílio de outra pessoa. Contudo, torna-se evidente a necessidade de TAs que possam reduzir essa dependência, possibilitando autonomia, conforto e segurança ao usuário.

Policymaker and stakeholder perspectives on access to assistive technologies in Canada: challenges and proposed solutions for enhancing equitable access

Purpose Unmet needs for assistive technologies (ATs) exist and the need for ATs is growing owing to demographic changes worldwide. Little comprehensive research has examined equity of access to ATs in Canada. Our study elucidates perspectives of policymakers and stakeholders on challenges and solutions for enhancing equitable access to ATs to advance policy discussions. Methods We conducted a qualitative interview study with a purposive sample of policymakers and stakeholders. Stakeholders were from non-profit organisations; private insurance companies; ageing or technology industries; and advocacy, consumer, and support groups. We used thematic analysis to develop themes that summarised and facilitated data interpretation. Results We conducted 24 interviews involving 32 participants. We present three themes: (1) User experiences, detailing challenges experienced by AT system users; (2) System characteristics: Challenges and solutions, outlining governance, financial, and delivery arrangements that create challenges for accessing AT, as well as participants’ proposed solutions; and (3) Shifts in models and principles, for approaches that may foster equitable access to ATs. We consolidate results into a set of valued qualities of a system that can enhance equitable AT access, and relate results to relevant national and international activities. Conclusions This is the most comprehensive study of Canadian policymaker and stakeholder views on AT access to date. Identified challenges and solutions point to opportunities for policy action and to support work to create a national vision for AT access that strengthens the potential for ATs to enable daily activity participation, independence, and societal inclusion of seniors and people with disabilities. IMPLICATIONS FOR REHABILITATION AT use supports daily activity participation, independence, and societal inclusion of seniors and people with disabilities. There is an urgent need to ensure that those who need ATs have access to them, considering the benefits of their use, current unmet needs for ATs, and the anticipated demand for ATs because of the ageing population and increased prevalence of chronic disease and disability. A comprehensive understanding of policymakers’ and stakeholders’ perspectives on challenges and potential solutions for enhancing equitable access to ATs is critical to support development of evidence- and values-informed policies. Understanding challenges and solutions identified by diverse policymakers and stakeholders can lead to national and local opportunities for policy action and support work to create a national vision for enhancing equitable access to AT.

Wishes and needs of older persons who have experienced a fall: A qualitative study.

AimThe aim of this study was to explore the needs and wishes in everyday life of older persons who have experienced a fall.DesignA hermeneutic‐phenomenological design with semi‐structured interviews.MethodInterviews were analysed using systematic text condensation.ResultsNine patients (5 women, 4 men) were included. The participants were between 67–95 years old. Seven of the nine participants had suffered from recurrent falls. The analysis revealed four themes: “To maintain meaningfulness in everyday life after experiencing a fall”, “Contact with professionals can be a prerequisite for feeling well and motivated after a fall”, “A need for assistive technology and aids in everyday life” and “Asking for help can be a challenge”. Our findings highlight that older‐person‐centred care and treatment are essential to address the complex variations in needs and wishes of older persons who have experienced a fall.

Enhancing Equitable Access to Assistive Technologies in Canada: Insights from Citizens and Stakeholders.

ABSTRACTThe need for assistive technologies in Canada is increasing, but access is inconsistent and fragmented which can result in unmet needs. We aimed to identify citizens' values and preferences for how to enhance equitable access to assistive technologies and to engage policymakers, stakeholders, and researchers in deliberations to spark action. In spring 2017, we convened three citizen panels and a stakeholder dialogue. Key panel findings were included in an evidence brief that informed dialogue participants. Thirty-seven citizens participated in panels and emphasized the need for access to reliable information, equitable access to assistive technologies regardless of ability to pay, and the need for collaboration. Twenty-two dialogue participants focused on the need for a guiding framework that supports fundamental change across the country. The proposed policy framework can enhance access to assistive technologies through enabling simplified policies and programs, along with fostering robust data collection and evaluation to support countrywide innovation and accountability.

Assistive Technology for the Upper Extremities After Stroke: Systematic Review of Users' Needs.

BackgroundTechnical innovations have the potential to compensate for loss of upper-limb motor functions after stroke. However, majority of the designs do not completely meet the needs and preferences of the end users. User-centered design methods have shown that the attention to user perspectives during development of assistive technology leads to devices that better suit the needs of the users.ObjectiveTo get more insight into the factors that can bring the design of assistive technology to higher levels of satisfaction and acceptance, studies about user perspectives on assistive technology for the upper limb after stroke are systematically reviewed.MethodsA database search was conducted in PubMed, EMBASE, CINAHL, PsycINFO, and Scopus from inception to August 2017, supplemented with a search of reference lists. Methodological quality of the included studies was appraised. User perspectives of stroke survivors, carers, and health care professionals were extracted. A total of 35 descriptive themes were identified, from which 5 overarching themes were derived.ResultsIn total, 9 studies with information gathered from focus groups, questionnaires, and interviews were included. Barriers and enablers influencing the adoption of assistive technology for the upper limb after stroke emerged within 5 overarching but highly interdependent themes: (1) promoting hand and arm performance; (2) attitude toward technology; (3) decision process; (4) usability; and (5) practical applicability.ConclusionsExpected use of an assistive technology is facilitated when it has a clear therapeutic base (expected benefit in enhancing function), its users (patients and health care professionals) have a positive attitude toward technology, sufficient information about the assistive technology is available, and usability and practical applicability have been addressed successfully in its design. The interdependency of the identified themes implies that all aspects influencing user perspectives of assistive technology need to be considered when developing assistive technology to enhance its chance of acceptance. The importance of each factor may vary depending on personal factors and the use context, either at home as an assistive aid or for rehabilitation at a clinic.

A review-classification of electrooculogram based human computer interfaces

Today there is an increasing need for assistive technology to help people with disabilities to attain some level of autonomy in terms of communication and movement. People with disabilities, especially total paralysis is often unable to use the biological communication channels such as voice and gestures hence digital communication channels are required. Research on Human Computer Interaction (HCI) is striving to help such individuals to convert human intentions into control signals to operate devices. The technique of measuring cornea retinal potential associated with eye movement is called Electrooculography. Eye movements are behaviors that can be measured and their measurements provide the sensitive means of learning about cognitive and visual stimuli. A human eye conveys a great deal of information with regards to the direction of the eye movements. Further, the direction in which an individual is looking shows where his or her attention is focused. Eye movements are naturally divided into three categories one is the saccades in which eyes quickly change the point of fixation and another is a smooth pursuit movement in which eyes to closely follow a moving object at a steady coordinated velocity, rather than in saccades and the other is a vergence movement in which eye rotates in the opposite direction. By tracking the position of the eye movement useful interfaces can be developed that permit the user to commune and control in a more general way. This paper convey some basic idea about various feature extraction techniques and classification techniques used to categorize the eye movement tasks and also it gives a vision on different issues associated in the field of Electrooculography based Human Computer Interface.

An Industrial Social Network for Sharing Knowledge Among Operators

Due to the increasing complexity of modern automatic machines typically used in several industrial applications, the need for assistive technologies is becoming very relevant. Typical approaches consist in designing advanced and adaptive human-machine interfaces (HMIs) that can be effectively used by any operator and that provide guided procedures for the most common situations. However, when dealing with complex systems, infrequent and unforeseen situations may happen, whose solution require the experience owned by a limited number of skilled operators. To this end, in this paper we propose an industrial social network concept to allow an effective exchange of information among the operators and to facilitate the solution of unforeseen events, such as unscheduled maintenance activities or troubleshooting.

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.

Preliminary development of an advanced modular pressure relief cushion: Testing and user evaluation

Study aimEffective pressure relief cushions are identified as a core assistive technology need by the World Health Organization Global Cooperation on Assistive Technology. High quality affordable wheelchair cushions could provide effective pressure relief for many individuals with limited access to advanced assistive technology. MaterialsValue driven engineering (VdE) principles were employed to develop a prototype modular cushion. Low cost dynamically responsive gel balls were arranged in a close packed array and seated in bilayer foam for containment and support. Two modular cushions, one with high compliance balls and one with moderate compliance balls were compared with High Profile and Low Profile Roho® and Jay® Medical 2 cushions. MethodsISO 16480-2 biomechanical standardized tests were applied to assess cushion performance. A preliminary materials cost analysis was carried out. A prototype modular cushion was evaluated by 12 participants who reported satisfaction using a questionnaire based on the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST 2.0) instrument. ResultsOverall the modular cushions performed better than, or on par with, the most widely prescribed commercially available cushions under ISO 16480-2 testing. Users rated the modular cushion highly for overall appearance, size and dimensions, comfort, safety, stability, ease of adjustment and general ease of use. Cost-analysis indicated that every modular cushion component a could be replaced several times and still maintain cost-efficacy over the complete cushion lifecycle. ConclusionA VdE modular cushion has the potential provide effective pressure relief for many users at a low lifetime cost.