Severe Physical Impairments Research Articles

Soliciting BCI user experience feedback from people with severe speech and physical impairments

Brain–computer interface (BCI) researchers have shown increasing interest in soliciting user experience (UX) feedback, but the severe speech and physical impairments (SSPI) of potential users create barriers to effective implementation with existing feedback instruments. This article describes augmentative and alternative communication (AAC)-based techniques for obtaining feedback from this population, and presents results from administration of a modified questionnaire to 12 individuals with SSPI after trials with a BCI spelling system. The proposed techniques facilitated successful questionnaire completion and provision of narrative feedback for all participants. Questionnaire administration required less than 5 minutes and minimal effort from participants. Results indicated that individual users may have very different reactions to the same system, and that ratings of workload and comfort provide important information not available through objective performance measures. People with SSPI are critical stakeholders in the future development of BCI, and appropriate adaptation of feedback questionnaires and administration techniques allows them to participate in shaping this assistive technology.

Eye gaze performance for children with severe physical impairments using gaze-based assistive technology—A longitudinal study

ABSTRACTGaze-based assistive technology (gaze-based AT) has the potential to provide children affected by severe physical impairments with opportunities for communication and activities. This study aimed to examine changes in eye gaze performance over time (time on task and accuracy) in children with severe physical impairments, without speaking ability, using gaze-based AT. A longitudinal study with a before and after design was conducted on 10 children (aged 1–15 years) with severe physical impairments, who were beginners to gaze-based AT at baseline. Thereafter, all children used the gaze-based AT in daily activities over the course of the study. Compass computer software was used to measure time on task and accuracy with eye selection of targets on screen, and tests were performed with the children at baseline, after 5 months, 9–11 months, and after 15–20 months. Findings showed that the children improved in time on task after 5 months and became more accurate in selecting targets after 15–20 months. This study indicates that these children with severe physical impairments, who were unable to speak, could improve in eye gaze performance. However, the children needed time to practice on a long-term basis to acquire skills needed to develop fast and accurate eye gaze performance.

Language Development of Individuals Who Require Aided Communication: Reflections on State of the Science and Future Research Directions

Language acquisition theories differ in the importance they assign to production as a learning mechanism. This review summarizes some of the theoretical issues linked to this debate and considers their implications for children with severe speech and physical impairments. The unique aspects of the language-learning contexts of these children are explored. Drawing largely on papers published within the journal Augmentative and Alternative Communication, this review summarizes features of language development that have been described over the past 3 decades and considers how these findings might illuminate our understanding of language development across both spoken and aided modalities. Implications for assessment, intervention and for further research are suggested.

User Testing of the Self-Referenced Personal Orthotic Omni-Purpose Control Interface (SPOOCI): An Innovative Power Wheelchair Control Device

Abstract Date Presented 4/17/2015 Individuals who are candidates for power mobility but whose severe physical impairments prevent them from operating commercial wheelchair controls are more independent driving a power wheelchair controller that is user-referenced (worn) rather than wheelchair-referenced (traditional joystick).

Initial constructs for patient-centered outcome measures to evaluate brain–computer interfaces

Purpose: The authors describe preliminary work toward the creation of patient-centered outcome (PCO) measures to evaluate brain–computer interface (BCI) as an assistive technology (AT) for individuals with severe speech and physical impairments (SSPI). Method: In Phase 1, 591 items from 15 existing measures were mapped to the International Classification of Functioning, Disability and Health (ICF). In Phase 2, qualitative interviews were conducted with eight people with SSPI and seven caregivers. Resulting text data were coded in an iterative analysis. Results: Most items (79%) were mapped to the ICF environmental domain; over half (53%) were mapped to more than one domain. The ICF framework was well suited for mapping items related to body functions and structures, but less so for items in other areas, including personal factors. Two constructs emerged from qualitative data: quality of life (QOL) and AT. Component domains and themes were identified for each. Conclusions: Preliminary constructs, domains and themes were generated for future PCO measures relevant to BCI. Existing instruments are sufficient for initial items but do not adequately match the values of people with SSPI and their caregivers. Field methods for interviewing people with SSPI were successful, and support the inclusion of these individuals in PCO research.Implications for RehabilitationAdapted interview methods allow people with severe speech and physical impairments to participate in patient-centered outcomes research.Patient-centered outcome measures are needed to evaluate the clinical implementation of brain–computer interface as an assistive technology.

Relaxation Techniques for People with Chronic Obstructive Pulmonary Disease: A Systematic Review and a Meta-Analysis.

Introduction. Chronic Obstructive Pulmonary Disease (COPD) people suffer from severe physical impairments, which often elicit significant psychological distress and impact their quality of life. This meta-analysis aimed to assess evidence from the scientific literature on the effects of relaxation techniques. Methods. We investigated 9 databases to select 25 RCTs. Studies included both inpatients and outpatients with COPD. Both respiratory and psychological outcomes were considered. Results. Relaxation techniques showed a little positive effect on the value of the percentage of predicted FEV1 (d = 0.20; 95% Cl: 0.40–−0.01) as well as a slight effect on levels of both the anxiety (d = 0.26; 95% Cl: 0.42–0.10) and depression (d = 0.33; 95% Cl: 0.53–0.13). The higher effect size was found in the quality of life value (d = 0.38; 95% Cl: 0.51–0.24). The assessed quality of the studies, based on the PEDro Scale, was generally medium/high. Conclusion. Relaxation training can have a moderate impact on both psychological well-being and respiratory function, resulting in noticeable improvements in both. Although higher quality research is required, our results sustain the importance of relaxation techniques as a tool to manage COPD.

Teaching mindfulness meditation to adults with severe speech and physical impairments: An exploratory study

People with severe speech and physical impairments may benefit from mindfulness meditation training because it has the potential to enhance their ability to cope with anxiety, depression and pain and improve their attentional capacity to use brain-computer interface systems. Seven adults with severe speech and physical impairments (SSPI) – defined as speech that is understood less than 25% of the time and/or severely reduced hand function for writing/typing – participated in this exploratory, uncontrolled intervention study. The objectives were to describe the development and implementation of a six-week mindfulness meditation intervention and to identify feasible outcome measures in this population. The weekly intervention was delivered by an instructor in the participant's home, and participants were encouraged to practise daily using audio recordings. The objective adherence to home practice was 10.2 minutes per day. Exploratory outcome measures were an n-back working memory task, the Attention Process Training-II Attention Questionnaire, the Pittsburgh Sleep Quality Index, the Perceived Stress Scale, the Positive and Negative Affect Schedule, and a qualitative feedback survey. There were no statistically significant pre–post results in this small sample, yet administration of the measures proved feasible, and qualitative reports were overall positive. Obstacles to teaching mindfulness meditation to persons with SSPI are reported, and solutions are proposed.

Minimal mutual advantage: How the social contract can do justice to the disabled

In this work we address the proposition that because it emerges from the contract tradition and so relies upon the assumption of mutual advantage, John Rawls' theory of “Justice as Fairness” cannot accommodate persons with severe mental and/or physical impairments. We respond to this criticism by proposing a revision to Rawls' contracting situation, the Original Position (OP). Specifically, we propose to supplant the traditional understanding of mutual advantage—which we agree does constitute the necessary and sufficient condition for deliberation to come about in the OP, as it stands—with a more modest alternative: a Hobbes-inspired concept that we call minimal mutual advantage. We argue that when this revision is introduced into Justice as Fairness, it reconciles admirably the seeming tension between contractarianism’s insistence on the rational, self-interested actor and the reality of societies in which not all members are capable of meeting a standard of reciprocity understood in terms of productive contributions to the general well-being. In so doing, minimal mutual advantage renders indistinguishable the disabled from the able in the OP, allowing Justice as Fairness to capture successfully problems of disability while leaving intact the more appealing aspects of liberalism that other approaches would dismiss.

Teaching Mindfulness Meditation to Adults with Severe Speech and Physical Impairments: An Exploratory Study

The Journal of Alternative and Complementary MedicineVol. 20, No. 5 Clinical ResearchTeaching Mindfulness Meditation to Adults with Severe Speech and Physical Impairments: An Exploratory StudyElena Goodrich, Helane Wahbeh, Aimee Mooney, Meghan Miller, and Barry OkenElena GoodrichSearch for more papers by this author, Helane WahbehSearch for more papers by this author, Aimee MooneySearch for more papers by this author, Meghan MillerSearch for more papers by this author, and Barry OkenSearch for more papers by this authorPublished Online:7 May 2014https://doi.org/10.1089/acm.2014.5167.abstractAboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Teaching Mindfulness Meditation to Adults with Severe Speech and Physical Impairments: An Exploratory Study." The Journal of Alternative and Complementary Medicine, 20(5), p. A64FiguresReferencesRelatedDetails Volume 20Issue 5May 2014 InformationCopyright 2014, Mary Ann Liebert, Inc.To cite this article:Elena Goodrich, Helane Wahbeh, Aimee Mooney, Meghan Miller, and Barry Oken.Teaching Mindfulness Meditation to Adults with Severe Speech and Physical Impairments: An Exploratory Study.The Journal of Alternative and Complementary Medicine.May 2014.A64-A64.http://doi.org/10.1089/acm.2014.5167.abstractPublished in Volume: 20 Issue 5: May 7, 2014PDF download

Noninvasive brain-computer interfaces for augmentative and alternative communication.

Brain-computer interfaces (BCIs) promise to provide a novel access channel for assistive technologies, including augmentative and alternative communication (AAC) systems, to people with severe speech and physical impairments (SSPI). Research on the subject has been accelerating significantly in the last decade and the research community took great strides toward making BCI-AAC a practical reality to individuals with SSPI. Nevertheless, the end goal has still not been reached and there is much work to be done to produce real-world-worthy systems that can be comfortably, conveniently, and reliably used by individuals with SSPI with help from their families and care givers who will need to maintain, setup, and debug the systems at home. This paper reviews reports in the BCI field that aim at AAC as the application domain with a consideration on both technical and clinical aspects.

Focus groups as a requirements gathering method with adults with severe speech and physical impairments

Technological supports have the potential to greatly improve the quality of life and independence of adults with severe speech and physical impairments (SSPI). In particular, augmentative and alternative communication (AAC) devices can enable people with little or no speech to communicate with others. However, the rate of rejection of AAC devices is estimated to be as high as 53.3%. It is suggested that a major reason for this rejection is a lack of user-centred design in the development of these devices. As part of a wider study looking at involving adults with SSPI in all stages of user-centred design, this paper looks at the use of focus groups in requirements gathering with this user group.

Who’s In and Who Is Out? Legitimate Bodies Within the Paralympic Games

This paper explores issues surrounding the inclusion of impaired bodies within the Paralympic Games. To achieve this aim we use empirical data gathered from semistructured interviews held with a range of Paralympic stakeholders. The background upon which this data are analyzed is a critical analysis of the International Paralympic Committee’s (IPC’s) current vision and mission. Pierre Bourdieu’s concepts of habitus and capital (Bourdieu, 1997, 1984) provide the theoretical foundation upon which the analysis takes place. Discussion centers on Paralympic stakeholders’ articulations of issues surrounding individuals with cerebral palsy and/or severe physical impairments, emanating, in part, from a desire for aesthetically pleasing sporting performances. This paper gives Paralympic stakeholders a voice, upon which the IPC and broader sporting community may choose to reflect.

Range of Influence and Impact of Physical Impairments in Long-Haul DWDM Systems

In long-haul dense wavelength-division multiplexing (DWDM) systems with periodic dispersion compensation and amplification, system performance is adversely affected by severe physical impairments due to fiber losses, dispersion and nonlinearity. Fiber modeling is a prerequisite for the development of physical impairment mitigation techniques to improve system performance. The distance between two interacting symbols in time and wavelength, i.e., the range of influence (RoI) of each physical impairment, plays an important role in the development of these mitigation techniques. In this paper, we use the Volterra series transfer function (VSTF) method to define impairment characteristic coefficients that capture intersymbol interference (ISI), self phase modulation (SPM), intrachannel cross phase modulation (IXPM), intrachannel four wave mixing (IFWM), cross phase modulation (XPM) and four wave mixing (FWM), to characterize the impact of these impairments individually on the system output. We then investigate the impact of system parameters, namely, duty cycle, spectral efficiency, frequency chirp, and span length, on the RoI for long-haul DWDM systems.

S.P.16 Egen classification scale (Ek) for Duchenne Muscular Dystrophy and Spinal Muscular Atrophy: Validity and reliability study of the Turkish version

<h2>Abstract</h2> EK scale was developed to assess detailed functional ability of non-ambulatory Duchenne Muscular Dystrophy (DMD) patients who have severe physical impairments by Steffensen et al. in 2002. EK total score was found to distinguish the different functional levels and show the prognosis of the nonambulatory DMD and Spinal Muscular Atrophy (SMA) patients. The aim of this study was to make the cultural adaptation and investigate the validity and intra/inter-tester reliability of Turkish Version of EK scale on non-ambulatory DMD and SMA patients The original English version of EK scale was translated into Turkish and necessary arrangements were made after the consensus by the researchers. After the arrangements and cultural adaptation; the pre-test study was made on five patients, inter-tester and intra-tester reliability studies were made on totally 34 patients. Brooke Functional Classification Scale for Upper and Lower Extremities (BFC), Barthel's Index for Activities of Daily Living and Pulmonary Dysfunction Test (PDT) were used as gold standards to investigate the validity of the scale in Turkish DMD and SMA population. 11 SMA and 23 DMD patients (Mean age: 13.71±4.25) with non-ambulatory functional status were included in the study. Intra-tester reliability of the EK scale was 0.979 (ICC) with % 95 Confidence Interval [0.930; 0.994] and inter-tester was 0.916 (ICC) with % 95 Confidence Interval [0.407; 0.990]. There were correlations between Turkish version of EK scale and Barthel Index (<i>r</i>=−0.716, it p<0.01) and PDT (it r=0.541, it p<0.05) and BFC for Upper Extremities (it r=0.576, it p<0.05). The Turkish version of the EK scale has excellent inter and intra-tester reliability and validity on Turkish DMM and SMA patients. EK scale is an adequate and useful instrument to assess functional status and predict the prognosis of non-ambulatory DMD and SMA patients in Turkish population.

Monitoring height and weight: Findings from a developmental paediatric service

To assess the recording of weight and height in children with disabilities and identify subgroups at risk of being either underweight or overweight. A retrospective clinical audit was undertaken within the Department of Developmental Medicine at The Royal Children's Hospital, Melbourne. Most recent weight and height measurements and data about the child's underlying condition were collected from the medical records of children attending a clinical appointment over a 3-month period. Primary medical diagnosis, age, gender, mode of feeding and ability to ambulate were recorded. Body mass index was calculated and corrected for age and gender. Study sample size was 583 (356 males), mean age was 8.25 years (range 2.8-17.4 years). Body mass index could be calculated for 48%. Height was less commonly measured in those with severe physical impairments. A survey of barriers to weight and height measurement showed that the main barrier to measuring height was practical difficulties. The percentage of children classified as overweight/obese was 26.6% and this was associated with intellectual disabilities, moderately impaired ambulation, older age and female gender; 13.5% of the study group was underweight, the majority of whom were non-ambulant. Although significant rates of underweight and overweight were identified in children with a range of disabilities within our service, monitoring of weight status was suboptimal. Despite this, data indicate that specific subgroups of children with disability appear at risk of being either overweight or underweight. Where height cannot be measured, other anthropometric measures such as waist circumference may be useful in the assessment of children with disabilities.

A 2-D Discrete-Time Model of Physical Impairments in Wavelength-Division Multiplexing Systems

Dense wavelength-division multiplexing (DWDM) is a promising approach to design ultrahigh-capacity fiber-optic communication systems ( >; nn50 Tb/s). However, DWDM gives rise to severe physical impairments that adversely affect system performance. To mitigate various physical impairments in DWDM systems and exploit their system capacity, there is a need to develop a 2-D (time and wavelength) discrete-time input-output model of physical impairments that can become the foundation of signal processing for optical communications. This paper develops such a model based on the Volterra series transfer function (VSTF) method. We overcome the well-known triple integral problem associated with the VSTF method and reduce it to a simple integral. This model takes into account multiple channel effects, fiber losses, frequency chirp, optical filtering, and photo detection, which are ignored in the current literature. The model is in excellent agreement with results obtained by split-step Fourier simulation. Furthermore, with this model, we define coefficients that capture intersymbol interference, interchannel interference, self-phase modulation, intrachannel cross-phase modulation (XPM), intrachannel four-wave mixing (FWM), XPM, and FWM to characterize the impact of these effects individually on the system performance. We also apply this model to analyze the effects of varying system parameters and pulse shapes on the individual physical impairments.

Patterns of communicative interaction between a child with severe speech and physical impairments and her caregiver during a mealtime activity

Background Interaction between caregivers and children with severe impairments is closely related to the demands of daily activities. This study examines the relationship between interaction and the routine mealtime activity at home.Method Patterns of interaction between a child (aged 6 years and 6 months) with severe speech and physical impairments and her caregiver (focus dyad) and a child without impairments (aged 6 years and 6 months) and her caregiver (comparison dyad) were analysed using video recordings and activity-based communication analysis.Results The focus dyad's interaction was unaided. The dyad did not use the Blissymbol board but communicated using words, vocalisations, word approximations, and body communication. Interaction in the focus dyad included relatively few pauses and frequent interchanges of short and sometimes simultaneous communicative contributions. Strong relations between patterns of interaction and immediate activity management goals such as assisting with eating, eating and drinking were found and compared for the two dyads. Results were discussed with regard to child development and communication intervention.Conclusions The focus dyad showed interactive efficiency and the fulfilment of goals relating to basic understanding and closeness, but mainly with regard to immediate mealtime issues. The comparison child and caregiver were more independent in the activity which made it possible for them to reach more extensive, and from a child perspective, age-adequate goals than the focus dyad.

Access to augmentative and alternative communication: New technologies and clinical decision-making

Children with severe physical impairments require a variety of access options to augmentative and alternative communication (AAC) and computer technology. Access technologies have continued to develop, allowing children with severe motor control impairments greater independence and access to communication. This article will highlight new advances in access technology, including eye and head tracking, scanning, and access to mainstream technology, as well as discuss future advances. Considerations for clinical decision-making and implementation of these technologies will be presented along with case illustrations.

Psychosoziale Einflussfaktoren für die Inanspruchnahme medizinischer Rehabilitationsmaßnahmen bei Patienten mit einer Prostatakrebserkrankung

Prostate cancer patients often suffer from treatment-associated morbidities which lead to severe physical and mental impairments. Nevertheless, only a relatively small percentage of this patient population uses medical rehabilitation services; there is still a lack of evidence concerning possible factors causing use and non-use of services. Therefore, this study exploratively aims at the identification of predictors of the use of rehabilitation services in a cohort of prostate cancer patients. In a prospective multicentre study to evaluate outpatient oncological rehabilitation services, n=242 prostate cancer patients who used outpatient or inpatient rehabilitation services ("users") were compared with n=253 prostate cancer patients who did not use rehabilitation ("non-users") at measure point 1. At the beginning of the rehabilitation programme and at the end of primary treatment, respectively, patients completed a self-report questionnaire consisting of standardized instruments designed to assess the following independent variables: autonomy striving (TPF), self-efficacy expectancy (GSE), distress (distress thermometer), anxiety and depression (HADS-D), quality of life (SF-8), social support (SSUK), rehabilitation motivation: readiness to change, knowledge, scepticism regarding rehabilitation services (PAREMO-20). Illness- and treatment-related variables (tumour state, comorbidity, primary therapies) were documented by the attending oncologists. Only few significant and effective differences between rehabilitation users and non-users are observed: Non-users are suffering more often from gastrointestinal comorbidities (18% vs. 2%, w=0.25). Both patient groups report severe quality-of-life impairments, particularly with respect to their physical functioning. Non-users achieve significantly higher scores on the scale "scepticism" (PAREMO-20) than users (eta²=0.19). The scale "scepticism" is also identified as the dominant predictor of utilization of rehabilitation services (R²=0.23). Suffering from comorbid diseases of the digestive system, self-efficacy expectation and employment status emerge as further significant predictors (R²=0.12, and R²=0.02 each). With increasing scepticism and in case of comorbidity the probability of rehabilitation utilization was decreasing. Besides illness-related variables prostate cancer patients' expectancies regarding the effectiveness of rehabilitation services to alleviate their medical conditions seem to be more relevant for rehabilitation utilization than sociodemographic variables or psychosocial distress. Further studies should investigate the replicability of these results and should focus on the doctor-patient-communication and the amount of information about goals and concepts of rehabilitation services prostate cancer patients are told. For clinical practice of information-giving about rehabilitation services it can be recommended not only to assess patients' physical and mental conditions but also to explore their expectations and concerns about rehabilitative treatment options in order to remove any doubts and to be able to optimize oncological care.

Effects of Nordic walking on health‐related quality of life in overweight individuals with Type 2 diabetes mellitus, impaired or normal glucose tolerance

AimsTo assess the effects of 4 months of increased physical activity on health-related quality of life in overweight individuals with Type 2 diabetes mellitus, normal or impaired glucose tolerance.MethodsWe included 212 individuals without severe physical or cardiovascular impairments aged 61 (57–64) years, with BMI of 29 (27.5–32) kg/m2. Numbers are median (25th–75th percentile). Subjects were stratified based on normal glucose tolerance (n = 128), impaired glucose tolerance (n = 34) or Type 2 diabetes mellitus (n = 50). They were randomized into either a control group (n = 125), who maintained unaltered habitual lifestyle, or an exercise intervention group (n = 87), who were directed to engage in Nordic walking with walking poles, 5 h per week over 4 months. Self-reported physical activity and health-related quality of life was assessed at the time of inclusion and after 4 months.ResultsBaseline health-related quality of life of this study cohort was similar to, or better than, an age- and sex-matched Swedish population sample, for 12 of 13 scales. Quality of sleep and BMI were improved for participants with normal glucose tolerance after 4 months of Nordic walking, with little or no musculoskeletal pain as compared with control subjects. No correlation was evident between improved quality of sleep and improved BMI.ConclusionsQuality of sleep improved in the group with normal glucose tolerance following 4 months of Nordic walking. BMI reduction did not account for this improvement. Nordic walking can be introduced in a primary health care setting as a low-cost mode of exercise that promotes weight loss and improved health satisfaction.