Provision Of Assistive Devices Research Articles

Self-assessed use and provision of assistive devices in individuals with hereditary ataxia at the interface between development in childhood and adolescence and symptom progression

Assistive devices are essential in neuropediatrics, but the database on the self-assessed use by and supply of medical aids to those affected with hereditary ataxia is small. The present work aims to examine the individual perspective of those affected by the use and supply of aids and to discuss them in the field of tension between physiological and psychosocial development and symptom progression. The research project represents a cooperation with the German Heredo-Ataxia-Society following the "patients as partners in research" approach. The data was collected via online questionnaires and focus group surveys and analyzed quantitatively and qualitatively using a mixed methodological approach. Based on the present sample of affected adolescents and adults (n=47 online questionnaires, n=6 focus group surveys), a fundamentally positive assessment of the use of medical aids was evident. In contrast, for the individual evaluation of access and supply of assistive devices, four main problems were identified, some of which can be extrapolated to other diagnoses but amplified in children and adolescents due to the low prevalence of hereditary ataxia. Especially in these age groups, the lengthy process leading up to the diagnosis and the associated gap in the indication for assistive devices poses a serious problem. Moreover, there is lack of evidence for justifying prescription of age-group-specific assistive devices. In addition to the necessity of improvement in the care process, there are significant gaps in the knowledge about an association between self-confidence and coping with the disease, on the one hand, and the acceptance of aids, on the other, in children and adolescents with rare diseases characterized by symptom progression. In addition, there is an urgent need to improve the evidence base for specific tools, especially their importance for promoting independence according to age and developmental phase.

Equitable Access for Persons with Disabilities: Assessing the Effectiveness of Assistive Device Service Provision in San Mateo, Rizal

The Philippines is home to over 1.5 million Persons with Disabilities, with an estimated 0.33% or 5,157 of the population living in San Mateo, Rizal. The country recognizes ten (10) types of disabilities, but availability of assistive devices is only specific to the needs of three (3) types: deaf or hard of hearing, visual, and physical (orthopedic). Despite efforts to break barriers through assistive devices for a livable and sustainable living condition for Persons with Disabilities, access to equal opportunities in education, employment, health services, and meaningful participation in mainstream society remains a prominent limitation, rather than the disability itself. The study aims to assess the effectiveness of the Assistive Device Service Provision (ADSP) program for Persons with Disabilities, an umbrella program under the social welfare services of the Local Government of San Mateo, Rizal. The assessment is grounded in the principles of New Public Administration, focusing on the program’s relevance, value orientation, social equity and ability to drive change in protecting, promoting, and supporting the rights and well-being of all Persons with Disabilities. A mixed-methodology approach was employed to explore the relationship between Persons with Disabilities and the effective use of Assistive Devices, using surveys and open-ended data collection to quantify responses and deepen understanding. Findings showed that the ADSP is relevant, as it largely meets the needs of Persons with Disabilities in terms of access to mobility, though some devices could be better aligned by considering the specific requirements of each disability. While the ADSP is perceived by recipients as significant in demonstrating a strong value orientation, disparities in distribution—affected by socioeconomic status and type of disability—persist, indicating the need for more inclusive distribution strategies to ensure equitable access for all Persons with Disabilities. The program's ability to drive change varies among individuals, highlighting the need for continuous monitoring and support. The study focuses on assessing the effectiveness of a localized assistive device provision program based on its relevance, value orientation, social equity, and ability to drive change in promoting the rights and welfare of Persons with Disabilities (Union of Public Service Commission, 2024).

Impact evaluation of a cash-plus programme for children with disabilities in the Xiengkhouang Province in Lao PDR: study protocol for a non-randomised controlled trial

IntroductionMore than 170 countries have implemented disability-targeted social protection programmes, although few have been rigorously evaluated. Consequently, a non-randomised controlled trial is being conducted of a pilot ‘cash-plus’ programme implemented...

Effectiveness of occupational therapy interventions on function and occupational performance among adults with conditions of the hand, wrist, and forearm: A systematic review and meta-analysis.

This systematic review and meta-analysis examines the effectiveness of occupational therapy interventions for adults with conservatively managed conditions of the hand, wrist, and forearm. Searches were carried out in CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews, MEDLINE (OVID), EMBASE, and PubMed. Grey literature was searched for via Google Scholar. A systematic literature search was undertaken for randomised studies that examined occupational therapy interventions for treatment of hand, wrist, and forearm conditions. The primary outcome was function, with secondary outcomes of occupational performance, satisfaction with occupational performance, pain, and quality of life. Meta-analyses were completed, and GRADE was used to determine the certainty of evidence. Twelve studies with 1429 participants were identified. Interventions included combinations of occupation-based intervention, assistive device provision, education, orthosis provision, and exercise programmes for arthritis, carpal tunnel syndrome, and fracture and tendon injuries of the hand, wrist, and forearm. Occupational therapy resulted in an improvement of function (REM, SMD -0.27, 95% CI -0.00 to -0.53, I2 = 69%, low certainty evidence) (p = 0.05), occupational performance (REM, SMD 0.83, 95% CI 1.61-0.06, I2 = 91%, low certainty evidence) (p = 0.04), satisfaction with occupational performance (REM, SMD 0.74, 95% CI 1.42-0.05, I2 = 89%, low certainty evidence) (p = 0.03), and pain reduction (FEM, MD -1.35, 95% CI -0.84 to -1.86, I2 = 0%, moderate certainty evidence) (p < 0.00001). Further high-quality research is recommended to determine the effects of occupational therapy interventions on specific upper limb conditions, inclusive of a broader range of clinical and patient reported outcome measures.

Guideline “Motor neuron diseases” of the German Society of Neurology (Deutsche Gesellschaft für Neurologie)

IntroductionIn 2021, the Deutsche Gesellschaft für Neurology published a new guideline on diagnosis and therapy of motor neuron disorders. Motor neuron disorders affect upper motor neurons in the primary motor cortex and/or lower motor neurons in the brain stem and spinal cord. The most frequent motor neuron disease amyotrophic lateral sclerosis (ALS) is a rapidly progressive disease with an average life expectancy of 2–4 years with a yearly incidence of 3.1/100,000 in Central Europe (Rosenbohm et al. in J Neurol 264(4):749–757, 2017. https://doi.org/10.1007/s00415-017-8413-3). It is considered a rare disease mainly due to its low prevalence as a consequence of short disease duration.RecommendationsThese guidelines comprise recommendations regarding differential diagnosis, neuroprotective therapies and multidisciplinary palliative care including management of respiration and nutrition as well as provision of assistive devices and end-of-life situations.ConclusionDiagnostic and therapeutic guidelines are necessary due the comparatively high number of cases and the aggressive disease course. Given the low prevalence and the severe impairment of patients, it is often impossible to generate evidence-based data so that ALS guidelines are partially dependent on expert opinion.

Inclusive innovation: World health organization (WHO) task-shifting principles in community health workers living with disabilities through women’s cancer screening in the EMPOWER Program.

e22512 Background: The W.H.O estimates that people with disabilities make up 15% of the world’s population. In the Horn of Africa (Djibouti, Kenya, Ethiopia &amp; Uganda) there have been several disability inclusion programs in Education, livelihoods and empowerment through the Development Response to Displacement Impacts Project (DRDIP). In Kenya, the Government has continued to leverage on the private sector to accelerate progress towards inclusion. A strategic partnership with Safaricom enabled provision of Assistive devices and medical cover exceptional approval to a tune of USD 223,000 to Persons with Disabilities in the formal and informal economy in Kenya. Women CHVs were selected to reduce cultural barriers because many women in the communities are more comfortable being screened by a fellow woman. Objectives: To identify and deploy women living with disabilities as community health volunteers in the county EMPOWER Clinics; To build capacity of women living with disabilities and enable them to accurately screen for breast and cervical cancer. Methods: A total of 25 women living with disabilities and 7 able-bodied women from Meru and Kisumu counties were selected for the training program through county disability coordinators. The training program consisted of a basic community health volunteer (CHV) module and focused on Breast and cervical cancer awareness topics. The CHVs were equipped with mobile phones with assistive technology (AT) features such as braille keyboards, magnifiers, and text-to-speech technology. The training was delivered through Amref Health Innovations' (AHI) LEAP platform in collaboration with 5 county community health assistants. The CHVs' understanding of the material was evaluated through performance tracking on the LEAP platform. The CHVs were also given regular feedback on their progress, and any areas of difficulty were addressed through additional support and guidance. Results: The trained CHVs demonstrated an increased understanding of breast and cervical cancer screening, as well as the skills necessary to perform medical tactile breast exams. The trained CHVs were then commissioned to be integrated into the community health workforce, with a focus on breast and cervical cancer screening and awareness. Conclusions: The deployment of inclusion-centered learning for women Community Health Volunteers (CHVs) living with disabilities is a promising approach for improving access to health services for this marginalized group. This program provides a model for promoting disability inclusion in health services and underscores the need for continued investment in disability-inclusive programs. The findings of this program can inform the development of similar programs in other regions and contribute to the achievement of universal health coverage and health for all.

Understanding the use and benefits of assistive devices among young children with cerebral palsy and their families in Norway: a cross-sectional population-based registry study

Purpose Assistive technology intervention has become an important strategy in enhancing function in young children with cerebral palsy. This study aimed to provide an in-depth knowledge of the use of assistive devices by describing their purposes, the environments in which they are used, frequency of use and perceived benefits from the caregiver’s perspective. Material and methods This is a cross-sectional population-based study using data from national cerebral palsy registers in Norway. Of a total of 202 children, 130 participated (mean age 49.9 months, SD 14.0 months). Results The 130 children and their families used a median of 2.5 assistive devices (range 0–12) to support positioning, mobility, self-care and training, stimulation and play. Devices most commonly had one or two main purposes and were used both at home and in kindergarten/school. The usage rate varied from less than twice a week to several times a day. The majority of parents reported significant benefits for caregiving and/or the child’s functioning. Total use increased in accordance with the level of the child’s gross motor limitations and was associated with restrictions imposed by housing concerns. Conclusions The frequent use of a wide range of devices, and the intended and perceived benefits, demonstrates that early provision of assistive devices can be an effective function-enhancing strategy in young children with cerebral palsy. However, the findings also indicate that factors others than the child’s motor abilities must be considered when integrating the use of devices into the child’s daily routines and activities. Implications for Rehabilitation Early provision of assistive devices can be a powerful strategy to support everyday functioning and facilitate care in young children with cerebral palsy. Assistive devices seems to be most effective when they are well integrated into the child’s daily routines and activities across environments. The clinical classifications of motor abilities (Gross Motor Function Classification System and Manual Ability Classification System) can be used to estimate the need for assistive devices, however, factors others than the child’s motor function seem to be critical for optimum effectiveness, such as type of equipment, its physical and social environment and the intended benefits of use.

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.

Users’ satisfaction and experiences in using assistive devices distributed by a rehabilitation centre in Bangladesh: a cross-sectional study

Purpose This study aimed to understand Bangladeshi users’ satisfaction with their assistive devices, including (a) device characteristics, e.g., size, weight, safety, ease of use, comfort, and effectiveness, and (b) availability of parts and repair services. We also described how frequently individuals with disabilities living in the community used assistive devices in their daily activities and how the use of assistive devices promoted individuals’ wellbeing. Method We conducted a cross-sectional survey with assistive device users or their guardians (if under 18) in Bangladesh about their experience and satisfaction with their assistive device 6 months after receiving it. The research team developed a survey questionnaire consisting of both closed and open-ended questions. All data were collected via telephone interviews. We employed descriptive statistics to analyse quantitative data and inductive analysis for the qualitative data. Results We found that out of the 376 participants, nearly 95% used assistive devices on a regular basis, and their satisfaction with the devices was high. Participants reported that assistive devices improved mobility, independence, and wellbeing of persons with disabilities. A few participants (6.4%) reported that their devices were damaged. Some participants identified concerns with their assistive devices, including (i) inappropriate size of ankle-foot orthoses, manual self-propelled wheelchairs, and prostheses, (ii) back slabs (a type of brace) being too short, and (iii) walking frames being too large. Several participants noted pain and discomfort when they used their assistive device. Additionally, some participants stated that environmental factors (e.g., muddy roads) contributed to the disrepair of their assistive devices. Finally, participants recounted that repair services were limited in rural areas of Bangladesh. Conclusion These findings indicate that the provision of assistive devices requires accommodating individuals’ needs and ensuring appropriate environments in which to function. The results support the need for follow-up services after distributing assistive devices. Further research could explore the impact of assistive devices on the family quality of life of persons with disabilities. IMPLICATIONS FOR REHABILITATION It is essential for rehabilitation professionals to conduct follow-up services after distributing assistive devices among persons with disabilities. There is a need for the government of Bangladesh to revisit the Rights and Protection of Persons with Disability Act of 2013 and provide further clarity about their commitment to the provision of assistive devices and associated services (e.g., repair services) and its subsequent implementation. Policymakers in Bangladesh must be proactive to translate policy commitments into practice, as it relates to building an accessible environment for people using assistive devices. Further, government efforts are needed to educate policy implementers in all relevant ministries so that all responsible bodies are fully familiar with their national and international commitments regarding the rights of persons with disabilities. Future research could (i) include user’s satisfaction with the service delivery process and (ii) measure the impact of assistive devices on family quality of life of persons with disabilities.

"Back into Life-With a Power Wheelchair": Learning from People with Severe Stroke through a Participatory Photovoice Study in a Metropolitan Area in Germany.

Severe stroke leads to permanent changes in everyday life. Many stroke survivors depend on support in community mobility (CM). This leads to restrictions and limited social participation. A power wheelchair (PWC) can enable independent CM and reduce such restrictions. This participatory study focused on how people with severe stroke experience their CM in a PWC in Berlin/Germany and what changes they want to initiate. A research team of five severe stroke survivors and two occupational therapists examined the question using photovoice. Stroke survivors took photos of their environment, presented, discussed, and analyzed them at group meetings to identify themes, and disseminated their findings at exhibitions and congresses. The photos emphasize the significance of and unique relationship to the PWC for the self-determined expression of personal freedom. As a complex, individualized construct, CM requires an accessible environment and diverse planning strategies by PWC users to arrive at their destination and overcome suddenly occurring obstacles. Desired changes stress CM independent of external help, increased social esteem, and active involvement in the provision of assistive devices. Voices of severe stroke survivors need to be heard more in healthcare and research to ensure the possibility of equal social participation.

Circumstances Precipitating Rural Older Adults for Co-Residential Family Care Arrangements in Central Ethiopia.

This study aims to explore circumstances that precipitate rural older adults for co-residential family care arrangements employing a phenomenological study method. Data from in-depth interviews with 12 rural older adults were inductively coded and developed into themes. Physical limitations and health problems, separation and divorce, death of a spouse, economic problem, neglect, inheritance dispute, and inaccessible locations are the circumstances that precipitate older adults to give up their independent living and start living with their children in the study area. The study points out to policymakers and other concerned bodies that actions must be geared toward maintaining a positive living environment for rural older adults and tackling challenges that are decisive in co-residential family care setting. Increasing health care accessibility, expanding senior/adult care centers and community health insurance programs, training geriatric social workers, enhancing collaboration between family caregivers and formal services, and provision of assistive devices for debilitating health conditions and subsequent disability will enhance the quality of life of rural older adults in co-residential family care arrangement.

How is and how should healthcare for people with multiple sclerosis in Germany be designed?-The rationale and protocol for the mixed-methods study Multiple Sclerosis-Patient-Oriented Care in Lower Saxony (MS-PoV).

BackgroundMultiple sclerosis (MS) is the most common autoimmune inflammatory disease of the central nervous system in Europe, often causing severe physical, cognitive and emotional impairments. Currently, it is unclear whether the healthcare provisions of people with MS (PwMS) are in line with the recommendations for treatment based on guidelines or patients’ needs. The main objectives of the study are as follows: (a) to investigate how well PwMS are treated; and (b) to develop a needs-oriented, patient-centred care model.MethodsThis mixed-methods study focuses on adult PwMS living in Lower Saxony, a federal state in Germany. The qualitative study comprises focus groups with PwMS, physicians and people involved in the healthcare process as well as a future workshop. The quantitative study comprises a cross-sectional online survey and addresses the patient-relevant outcomes and needs, as previously determined by literature searches and focus groups. It will be administered to all PwMS who are insured by the statutory health insurance company involved in the project (n~7,000). The survey data will be linked to the longitudinal secondary data from the statutory health insurance company and data from the German MS registry where available. The linked and single data sources will be statistically analysed.DiscussionBy comprehensively comparing the current healthcare provisions with the needs and requirements of PwMS, the strengths and weaknesses of the overall healthcare process and provision of assistive devices can be identified. The barriers and facilitators of the health service providers and their impact on daily life will be explored (qualitative analyses). Reliable recommendations for improvements will be given based on a study population drawn from the largest statutory health insurance company in Lower Saxony (quantitative analyses). However, the inherent advantages and limitations of the qualitative and quantitative research approaches need to be considered.Trial registrationThe study is registered at German Clinical Trials Register DRKS00021741.

Examining the Availability and Accessibility of Rehabilitation Services in a Rural District of South Africa: A Mixed-Methods Study.

Introduction: Rehabilitation services aim to optimise individuals’ functioning and reduce disability. However, people with disabilities, who represent a key population of users of rehabilitation services, continue to have unmet needs for rehabilitation services that include the provision of assistive devices. This paper examines the availability and accessibility of rehabilitation services in a rural district of South Africa in order to explore why unmet needs for rehabilitation services persist. Methods: All nine district hospitals in a rural district of South Africa were included in the study. Rehabilitation services capacity was assessed by examining the available assistive devices, consumables and human resources at the level of the health facility. Data collection was conducted using the Global Co-operative Assistive Technology [GATE] Assistive Products List, AT2030’s ATScale priority list and the South African National Catalogue of Commodities for Primary Health Care Facilities. Descriptive statistics were then used for the analysis. For the qualitative component, semi-structured interviews were conducted with adults with physical disabilities at household level to explore barriers to accessing assistive device inclusive rehabilitation services and the consequences thereof in the same rural district. An interview guide based on the WHO health system building blocks was used. Thematic content analysis guided the analysis of the interview transcripts. Findings: The findings of the research demonstrate that rehabilitation service capacity in the district was constrained as a result of low availability of assistive devices [2–22%] and consumables [2–47%], as well as, possibly, a shortage of rehabilitation providers [n = 30] with an unequal distribution across health facilities [n = 9]. In addition, people with physical disabilities reported poor referral pathways, financial constraints, transport and road consideration and equipment unavailability as barriers to accessing rehabilitation services. Moreover, these barriers to access predisposed individuals to finance-, health- and person-related harm. Conclusion: Rehabilitation service availability is constrained by a lack of service capacity in rural South Africa. In addition, the rehabilitation services in district hospitals are not adequately accessible because of existing barriers to enable key populations to achieve optimised functioning.

Provision of Assistive Technology for Students with Disabilities in South African Higher Education.

This paper used the Critical Disability Theory (CDT) to analyse the provision of assistive technology (AT) and assistive devices at an institution of higher education in South African. In this empirical study, data were collected through interviews with students with disabilities and Disability Rights Centre staff members. The paper sought to explore the effectiveness of the provision of AT and assistive devices, in terms of enabling students with disabilities’ learning. The provision was deemed inadequate, and a specific AT and assistive device was inaccessible to one category of disability, consequently limiting learning. The paper concludes that the provision of assistive devices at the institution enabled students with disabilities’ learning, however, there was a need for improvement by way of the Universal Design for Learning (UDL). The UDL will help all diverse students, including students with disabilities in all their categories of disability, to be assisted to learn through the provision of AT and assistive devices. It is hoped that the paper will contribute to contemporary debates on the provision of AT and assistive devices for people with disabilities in low-resource settings, from a South African context specifically, and in higher education broadly.

A review of South African Public Healthcare policies addressing Service Delivery for wheelchairs through a Primary Health Care lens

ABSTRACT INTRODUCTION: In some areas of South Africa, people with impaired mobility are known to have difficulty accessing wheelchairs. This study aimed to critically appraise public healthcare policies addressing service delivery in terms of assistive devices in general, and more specifically wheelchairs within primary health care METHOD: South African public healthcare policies that address assistive device service delivery were identified and thematically analysed using retrospective deductive document analysis. The themes used correspond to the WHO guidelines for the provision of wheelchairs within the context of the guiding principles of primary health care i.e., accessibly, affordability, acceptability, appropriateness, and availability. An analysis was undertaken on how the provision of assistive devices under these principles was addressed RESULTS: Three policies were identified addressing assistive device service delivery i.e. The National Rehabilitation Policy, The Policy Framework and Strategy for Disability and Rehabilitation Services in South Africa 2015 - 2020, and the National Health Insurance Policy. The National Rehabilitation Policy addressed the majority of the WHO guiding principles on wheelchair provision. Guidelines for non-discriminatory and evidence-based service delivery and the availability of assistive devices were identified in all the documents. Scant attention was paid to service delivery of assistive devices for people residing in urban or peri-urban areas. There was a paucity of guidance on service delivery to people with impaired mobility who were unable to access health services, those unaware of the services available and those who were not aware of the benefits of an assistive device CONCLUSION: The policies, viewed together, addressed all the WHO guiding principles, although some gaps were observed in each policy. A proposal emanating from this review was that an update of the National Rehabilitation Policy would address these deficiencies Keywords: assistive devices, health policy, impaired mobility, disability, rehabilitation

Assistive technology use and unmet need in Canada

Background Around the world, variations and inequities in access to assistive technology (AT) are evident. Development of legislation, policies, and programmes has not kept pace with the increasing demand for AT. Therefore, context-specific needs assessment is required, which can assist in anticipating the accessibility and human support needs of individuals with impairments, and in turn, inform resource allocation and prioritisation of services. The purpose of this cross-sectional study was to describe the current use and unmet needs of AT use in community-dwelling Canadians experiencing activity limitation or participation restriction (disability). Data and methods Bootstrapping was used to estimate the prevalence of AT use and unmet needs using data from the 2012 Canadian Survey on Disability (CSD). The total sample size for the CSD was 45,443 individuals. Results Among the estimated 3,775,920 Canadians with a disability (13.7% of the Canadian population), 3,579,580 used some form of AT. Among these individuals, 3,050,750 use glasses or contact lenses and 1,109,060 use bathroom aids. The results of the study showed that the most common unmet need was for hearing aids (0.86% of the total population), followed by bathroom aids (0.36%). Interpretations This study comes at a time when global attention is focussed on research on access to AT. This study using data from the CSD will serve disability and social policy analysts at all levels of government, as well as associations for persons with disabilities and researchers working in the field of disability policy and programmes. Implication for Rehabilitation The current initiatives on assistive technology, including the World Health Organization’s Global Cooperation on Assistive Technology (GATE) project, recognize the substantial gap between the need for and provision of assistive devices. In Canada, for example, as well as in other countries, despite rapid growth in innovation, unmet needs for assistive devices persist and multiple barriers have been reported by individuals in accessing needed assistive devices. A better understanding of the met and unmet needs of assistive technology users can assist in anticipating accessibility and human support needs of individuals with disabilities, and in turn, inform resource allocation and prioritization of services. • The study estimates the prevalence of assistive device use in community dwelling Canadians and describes the unmet needs for assistive devices of Canadians with activity limitation (disability). • This study provides evidence on the use and unmet assistive technology needs for disability and social policy analysts at all levels of government, as well as associations for persons with disabilities and researchers working in the field of disability policy and programmes. • The results of this study can be used for planning and evaluating services, programmes and policies for Canadian adults with disabilities to help enable their full participation in society.

Utilization of assistive devices in occupational therapy practice in Tamil Nadu, India: A statewide survey

Background: The provision of assistive devices (ADs) to enable function is a well-established component of occupational therapy (OT) practice. However, multiple client and therapist factors prevent the utilization of ADs in practice. Objectives: This study aimed to explore the utilization of ADs in OT practice in Tamil Nadu (TN). Study Design: The survey research design was used to conduct this study. A ten-item electronic survey was developed based on the research question. Methods: The survey was E-mailed to 295 occupational therapists in TN identified through convenience sampling. The survey link was also shared on four WhatsApp Messenger groups (Tamil Nadu Branch of All India Occupational Therapists' Association Official Group, OTist Group, Clinic OT, and Santosh Alumni) with many occupational therapists belonging to TN (snowball sampling). Data were collected between August 29, 2019, and September 20, 2019. Results: Thirty-five occupational therapists responded to the survey. Writing and eating utensils were the commonly prescribed ADs in TN OT practice. Client factors, cultural factors, lack of availability, cost, and therapists' skill may contribute to the limited usage of ADs in Indian OT practice. Innovating low-cost culturally acceptable ADs, educating stakeholders, and training practitioners on how to prescribe/utilize ADs in practice may mitigate the barriers related to ADs use. Conclusion: The usage of ADs in TN OT practice is limited. Multiple factors affect the utilization of ADs in the Indian context of practice. A multipronged approach focusing on innovative device development, advocacy, and skill development is needed to promote the utilization of ADs in Indian OT practice.

Life After Amputation: A Case Study

In the Philippines, the National Council on Disability made a survey revealing a prevalence of43.367 disabled who lost one or both legs and/or feet. This study explored the challengesencountered and coping mechanisms an amputee manifests, and the assistance that they getfrom their expected support system. This case study was anchored on Dorothea Orem’s SelfCare Theory of Nursing. Four purposively sampled amputee informants were interviewed andobserved. Primary and secondary data were gathered and triangulation with the relatives wasdone to ensure the validity and depth of the results. Data were encoded and analyzed usingthematic analysis. Results revealed that the informants experienced physical, psychological,emotional, socio-economic, and spiritual challenges. Physical challenges involved mobilityproblem and lack of gait balance, physical deformity, adjustment to the new body, alteredphysical appearance, a sedentary behavior, and phantom pain. Psychological challengesinvolved suicidal tendency, loss of libido, self-pity, and depression. Emotional challengesincluded fear and hopelessness. Socio-economic challenges involved the development of antisocial behavior, dissociative behavior, fear of losing a job, problem with money, and fear ofrejection. Spiritual challenges involved loss of faith. Coping mechanism included support fromfamily and friends, mastery of gait and balance, proper practice in using assistive devices,hastened adjustment to the new body, wearing of prosthesis, medication and mobility, and trustin God. Although they get strong support from the family and friends, there is very limitedassistance from the government and the community. There is a need to increase familyawareness in anticipating the needs of the amputees. Likewise, full support must be given tothem. Health education campaign may be formulated by the local health leaders and provisionof assistive devices and equipment to achieve the equalization and opportunities for personswith disabilities may also be done.

Significance of social factors for efficient provision of assistive devices and technologies for the disabled persons. Automating the process of customized selection of a wheelchair

Objective: to develop an algorithm for customized selection of a wheelchair for the disabled persons with limited mobility followed by design of a software allowing to automate the process of wheelchair selection. Materials and methods. Analytical review of English literature was performed to address the issues in prescription and utilization of the assistive devices and technologies (ADT). The regulatory documents governing the ADT prescription in the Russian Federation (RF) were studied. Russian market of the wheelchairs for the disabled persons was analyzed. Ten disabled persons with traumatic spinal cord injury to the department of medical rehabilitation of the Centre were examined to pilot the software for automated wheelchair selection. Results. After the literature review results were structured, the major groups of factors that should be considered when selecting a wheelchair were identified: 1) anthropometric measurement, 2) physical and functional capabilities of the disabled person, 3) level of everyday activity, 4) availability and physical capabilities of the caregivers, 5) particularities of the environmental factors. The algorithm for customized selection of wheelchair was designed. The database comprising the technical characteristics of 141 wheelchair models that are taken as a basis of the software was developed. IBM-compatible computer was used to develop the software. Programming language: Delphi, data base management system: Microsoft Access 2013. Piloting results showed the effectiveness of the software. In all cases appropriate wheelchairs were selected. Conclusion. Within current study the software for automated process of customized wheelchair selection was piloted. The software takes into consideration the level of activities and participation of the disabled persons and significant environmental factors which allows to customize the ADT prescription.

Paradigm of Rehabilitation of People with Disability

Background. Disability is part of human condition. The number of people with disabilities is growing. Every epoch has faced the moral and political issue of how to include and support people with disabilities best. This issue will become more acute as the demographics of societies change and more people live to an old age. There is a global increase in chronic health conditions such as diabetes, cardiovascular diseases and mental disorders, which will influence the nature and prevalence of disability. Establishment of a complex rehabilitation system of disabled people is a great challenge. The aim of this article is to discuss issues concerning the provision of help for people with disabilities and devising effective rehabilitation system for them. Discussion. Help for people with disabilities should be understood as a versatile system of legal, medical, economical, organizational, etc., means, which help people regain their disturbed biopsychosocial functions, compensate them and adapt them to society. The article further calls to organise, strengthen, and extend comprehensive rehabilitation services and programmes for disabled people and start them as early as possible based on multidisciplinary assessment of individual needs and strengths, including the provision of assistive devices and technologies using ICF. Conclusion. Multidisciplinary teams can convey many rehabilitation benefts to patients. International cooperation can help share good and promising practices and provide technical assistance to countries that are introducing and expanding rehabilitation services.Keywords: rehabilitation, persons with disabilities, biopsychosocial function, the ICF.