Assessment of Gait Patterns during Crutch Assisted Gait through Spatial and Temporal Analysis.

The use of crutches is a common method of assisting people during recovery from musculoskeletal injuries in the lower limbs. There are several different ways to walk with crutches depending on the patient's needs. The structure of crutch gaits or crutch gait patterns varies based on the delay between the aid and foot placement, the number of concurrent points of contact, and laterality. In a rehabilitation process, the prescribed pattern may differ according to the injury, the treatment and the individual's condition. Clinicians may improve diagnosis, assessment, training, and treatment by monitoring and analyzing gait patterns. This study aimed to assess and characterize four crutch walking patterns using spatial and temporal parameters obtained from the instrumented crutches. For this purpose, 27 healthy users performed four different gait patterns over multiple trials. Each trial was recorded using a portable system integrated into the crutches, which measured force, position, and acceleration. Based on the data angle, an algorithm was developed to segment the trials into gait cycles and identify gait phases. The next step was to determine the most appropriate metrics to describe each gait pattern. Several metrics were used to analyze the collected data, including force, acceleration, angle, and stride time. Among 27 participants, significant differences were found between crutch gait patterns. Through the use of these spatial and temporal parameters, promising results were obtained for monitoring assisted gait with crutches. Furthermore, the results demonstrated the possibility of using instrumented crutches as a clinical tool.

All hands on deck: The multidisciplinary rehabilitation assessment and management of hand function in persons with neuromuscular disorders.

Hand function is important in every aspect of our lives. Across a wide range of neuromuscular disorders-inherited ataxias, motor neuron diseases, polyneuropathies, and myopathies-people can experience losses in hand strength, tone, movement, dexterity, joint range, and sensation. Such changes can adversely affect function and independence in daily activities, reducing participation and quality of life. People with neuromuscular disorders (pwNMD) known to involve the hand should be assessed at regular intervals for changes both clinically and using impairment, performance, function, and patient-reported outcome measures as appropriate. A patient-centered approach to management is recommended, with clinicians partnering with the individual, their caregivers and the interprofessional teams to create personalized solutions that can overcome barriers to participation and best meet the goals of individuals affected by neuromuscular disorders. Management strategies should be multifaceted, and may include exercise, orthoses, assistive devices, technological solutions, environmental or task adaptations, medications, and/or surgery. Exercise recommendations and orthoses should be individualized and evolve based on disease progression, impairments, and functional limitations. While medications and surgery have a small role for specific clinical situations, there is a plethora of assistive and technological solutions to assist with basic and instrumental activities of daily living, work/education, and leisure for pwNMD with reduced hand function. In addition, clinicians should advocate for appropriate accommodations for reduced hand function at work/school, and the development of and adherence to legislation supporting accessibility and inclusion.

Occupational therapists' perceptions of the feasibility of using tele-assessment for remote prescription of assistive devices in Singapore: A qualitative study.

BACKGROUND: Occupational therapists (OT) assess and prescribe assistive devices to older adults with limitations in performing daily living activities. Timely prescription of assistive devices to accommodate the rising demand has been affected by the COVID-19 pandemic. Tele-assessment allows for continuity of care, but its success depends on therapists' acceptance. OBJECTIVE: This study examined OTs' perceptions of the feasibility of conducting tele-assessment and developing a clinical practice guideline for remote prescription of assistive devices for older adults in Singapore. METHODS: Eligible OTs were recruited from purposive sampling. Semi-structured interviews were conducted via a virtual platform (Zoom). Audio recordings were transcribed verbatim. Inductive thematic analysis using a line-by-line coding method was used to identify common trends. RESULTS: Interviews with 10 participants revealed three main themes: (1) therapists' perceptions of the feasibility of tele-assessment, (2) criteria for safe and appropriate prescription of assistive devices via tele-assessment, and (3) practical considerations for the implementation of tele-assessment. Participants felt that tele-assessment increases efficiency with more older adults being more receptive towards technology. They also raised suggestions to address OTs' concerns regarding the safety and accuracy prescription of assistive devices following tele-assessment. This included establishing the client's suitability for assistive device prescription, characteristics of assistive devices, resources required, and considering the preferences of stakeholders involved. CONCLUSION: Tele-assessment for assistive device prescription by OTs appears feasible in Singapore. OTs should consider collaborating with other stakeholders to develop a tele-assessment clinical practice guideline for assistive device prescription. Further studies testing its clinical effectiveness during and/or post-pandemic are warranted.

An integrated personalized assistive devices approach to reduce the risk of foot ulcer recurrence in diabetes (DIASSIST): study protocol for a multicenter randomized controlled trial.

BACKGROUND: Preventing foot ulcers in people with diabetes can increase quality of life and reduce costs. Despite the availability of various interventions to prevent foot ulcers, recurrence rates remain high. We hypothesize that a multimodal treatment approach incorporating various footwear, self-management, and education interventions that matches an individual person's needs can reduce the risk of ulcer recurrence with beneficial cost-utility. The aim of this study is to assess the effect on foot ulcer recurrence, footwear adherence, and cost-utility of an integrated personalized assistive devices approach in high-risk people with diabetes. METHODS: In a parallel-group multicenter randomized controlled trial, 126 adult participants with diabetes mellitus type 1 or 2, loss of protective sensation based on the presence of peripheral neuropathy, a healed plantar foot ulcer in the preceding 4 years, and possession of any type of custom-made footwear will be included. Participants will be randomly assigned to either enhanced therapy or usual care. Enhanced therapy consists of usual care and additionally a personalized treatment approach including pressure-optimized custom-made footwear, pressure-optimized custom-made footwear for indoor use, at-home daily foot temperature monitoring, and structured education, which includes motivational interviewing and personalized feedback on adherence and self-care. Participants will be followed for 12 months. Assessments include barefoot and in-shoe plantar pressure measurements; questionnaires concerning quality of life, costs, disease, and self-care knowledge; physical activity and footwear use monitoring; and clinical monitoring for foot ulcer outcomes. The study is powered for 3 primary outcomes: foot ulcer recurrence, footwear adherence, and cost-utility, the primary clinical, patient-related, and health-economic outcome respectively. DISCUSSION: This is the first study to integrate multiple interventions for ulcer prevention into a personalized state-of-the-art treatment approach and assess their combined efficacy in a randomized controlled trial in people with diabetes at high ulcer risk. Proven effectiveness, usability, and cost-utility will facilitate implementation in healthcare, improve the quality of life of high-risk people with diabetes, and reduce treatment costs. TRIAL REGISTRATION: ClinicalTrials.gov NCT05236660. Registered on 11 February 2022.

Simulating Muscle-Level Energetic Cost Savings When Humans Run with a Passive Assistive Device.

Connecting the legs with a spring attached to the shoelaces, called an exotendon, can reduce the energetic cost of running, but how the exotendon reduces the energetic burden of individual muscles remains unknown. We generated muscle-driven simulations of seven individuals running with and without the exotendon to discern whether savings occurred during the stance phase or the swing phase, and to identify which muscles contributed to energy savings. We computed differences in muscle-level energy consumption, muscle activations, and changes in muscle-fiber velocity and force between running with and without the exotendon. The seven of nine participants who reduced energy cost when running with the exotendon reduced their measured energy expenditure rate by 0.9 W/kg (8.3%). Simulations predicted a 1.4 W/kg (12.0%) reduction in the average rate of energy expenditure and correctly identified that the exotendon reduced rates of energy expenditure for all seven individuals. Simulations showed most of the savings occurred during stance (1.5 W/kg), though the rate of energy expenditure was also reduced during swing (0.3 W/kg). The energetic savings were distributed across the quadriceps, hip flexor, hip abductor, hamstring, hip adductor, and hip extensor muscle groups, whereas no changes were observed in the plantarflexor or dorsiflexor muscles. Energetic savings were facilitated by reductions in the rate of mechanical work performed by muscles and their estimated rate of heat production. By modeling muscle-level energetics, this simulation framework accurately captured measured changes in whole-body energetics when using an assistive device. This is a useful first step towards using simulation to accelerate device design by predicting how humans will interact with assistive devices that have yet to be built.

Assistive technology unmet need in Indonesia: challenges and opportunities for enhancing equitable access.

PURPOSE: To analyze the rapid Assistive Technology Assessment (rATA) data and identify challenges and opportunities for improving access to assistive technology products (AP) in Indonesia. MATERIALS AND METHODS: An explanatory sequential mixed-methods design consisting of a quantitative survey and a qualitative interview study was used. The rATA survey was administered to households in two randomly sampled provinces to collect data on AP met and unmet need. Descriptive statistics was used to analyze the survey data. Qualitative data were collected from unstructured videorecorded interviews with rATA policymakers. Interview transcripts were coded and analyzed using thematic analysis. RESULTS: On average, data from rATA respondents (n = 11,300) revealed 60% of AP unmet need. A high proportion of funding sources came from the private sector, and contributions from the government remained low. Affordability and funding were the main barriers to access. From the policymaker interviews (n = 5), four essential themes emerged, i.e., "resources and workforce", "funding", "laws and policies", and "guidelines and standards". From each theme, key challenges and opportunities were identified. CONCLUSIONS: Affordability remained a major challenge, in part because government-sponsored funding was still inadequate, forcing people with low financial status to self-produce AP. One potential opportunity would be to localize AP production and improve local workforce training. Integrated national funding schemes and intersectoral coordination could accelerate improvement in meeting AP unmet need. This study may provide evidence of current challenges and opportunities to help improve the field of rehabilitation through enhanced access to AP services in Indonesia.

IMPLICATIONS FOR REHABILITATIONA high assistive technology product (AP) unmet need due to low affordability and limited funding may prevent people with disabilities from receiving appropriate rehabilitation with the goal of improved quality of life.Evidence shows key barriers to AP service provision, and such evidence can be viewed as an opportunity for stakeholders to develop actionable strategies to improve access nationwide.Potential strategies such as local workforce capacity building, integrated national funding schemes, and improved government coordination may help enhance equitable access to AP for all.

Family Needs Assessment of Patients with Cerebral Palsy Attending Two Hospitals in Accra, Ghana.

BACKGROUND: The family represents the most essential and supportive environment for children with cerebral palsy (CP). To improve children's outcomes, it is crucial to consider the needs of families in order to offer family-centered care, which tailors services to these needs. OBJECTIVE: We conducted a needs assessment to identify the family needs of patients with CP attending two hospitals in Accra. METHODS: The study was a cross-sectional study involving primary caregivers of children with CP attending neurodevelopmental clinics. Structured questionnaires were used to collect data spanning an 8-month period. The data were summarized, and statistical inference was made. RESULTS: Service needs identified were childcare, counseling, support groups, financial assistance, and recreational facilities. Information needs included adult education, job training/employment opportunities, education, health and social programs, knowledge about child development, and management of behavioral and feeding/nutrition problems. Reducing extensive travel time was desirable to improve access to healthcare. With the increasing severity of symptoms came the need for improved accessibility in the home to reduce the child's hardship, as well as assistive devices, recreational facilities, and respite for the caregiver(s). CONCLUSION: Families of children with CP have information, service, and access needs related to their disease severity and family context.

Hand-worn devices for assessment and rehabilitation of motor function and their potential use in BCI protocols: a review.

Introduction: Various neurological conditions can impair hand function. Affected individuals cannot fully participate in activities of daily living due to the lack of fine motor control. Neurorehabilitation emphasizes repetitive movement and subjective clinical assessments that require clinical experience to administer. Methods: Here, we perform a review of literature focused on the use of hand-worn devices for rehabilitation and assessment of hand function. We paid particular attention to protocols that involve brain-computer interfaces (BCIs) since BCIs are gaining ground as a means for detecting volitional signals as the basis for interactive motor training protocols to augment recovery. All devices reviewed either monitor, assist, stimulate, or support hand and finger movement. Results: A majority of studies reviewed here test or validate devices through clinical trials, especially for stroke. Even though sensor gloves are the most commonly employed type of device in this domain, they have certain limitations. Many such gloves use bend or inertial sensors to monitor the movement of individual digits, but few monitor both movement and applied pressure. The use of such devices in BCI protocols is also uncommon. Discussion: We conclude that hand-worn devices that monitor both flexion and grip will benefit both clinical diagnostic assessment of function during treatment and closed-loop BCI protocols aimed at rehabilitation.

How Connecting the Legs with a Spring Improves Human Running Economy.

Connecting the legs with a spring attached to the shoelaces reduces the energy cost of running, but how the spring reduces the energy burden of individual muscles remains unknown. We generated muscle-driven simulations of seven individuals running with and without the spring to discern whether savings occurred during the stance phase or the swing phase, and to identify which muscles contributed to energy savings. We computed differences in muscle-level energy consumption, muscle activations, and changes in muscle-fiber velocity and force between running with and without the spring. Across participants, running with the spring reduced the measured rate of energy expenditure by 0.9 W/kg (8.3%). Simulations predicted a 1.4 W/kg (12.0%) reduction in the average rate of energy expenditure and correctly identified that the spring reduced rates of energy expenditure for all participants. Simulations showed most of the savings occurred during stance (1.5 W/kg), though the rate of energy expenditure was also reduced during swing (0.3 W/kg). The energetic savings were distributed across the quadriceps, hip flexor, hip abductor, hamstring, hip adductor, and hip extensor muscle groups, whereas no changes in the rate of energy expenditure were observed in the plantarflexor or dorsiflexor muscles. Energetic savings were facilitated by reductions in the rate of mechanical work performed by muscles and their estimated rate of heat production. The simulations provide insight into muscle-level changes that occur when utilizing an assistive device and the mechanisms by which a spring connecting the legs improves running economy.

Biomimetic Tendon-Based Mechanism for Finger Flexion and Extension in a Soft Hand Exoskeleton: Design and Experimental Assessment.

This study proposes a bioinspired exotendon routing configuration for a tendon-based mechanism to provide finger flexion and extension that utilizes a single motor to reduce the complexity of the system. The configuration was primarily inspired by the extrinsic muscle-tendon units of the human musculoskeletal system. The function of the intrinsic muscle-tendon units was partially compensated by adding a minor modification to the configuration of the extrinsic units. The finger kinematics produced by this solution during flexion and extension were experimentally evaluated on an artificial finger and compared to that obtained using the traditional mechanism, where one exotendon was inserted at the distal phalanx. The experiments were conducted on nine healthy subjects who wore a soft exoskeleton glove equipped with the novel tendon mechanism. Contrary to the traditional approach, the proposed mechanism successfully prevented the hyperextension of the distal interphalangeal (DIP) and the metacarpophalangeal (MCP) joints. During flexion, the DIP joint angles produced by the novel mechanism were smaller than the angles generated by the traditional approach for the same proximal interphalangeal (PIP) joint angles. This provided a flexion trajectory closer to the voluntary flexion motion and avoided straining the interphalangeal coupling between the DIP and PIP joints. Finally, the proposed solution generated similar trajectories when applied to a stiff artificial finger (simulating spasticity). The results, therefore, demonstrate that the proposed approach is indeed an effective solution for the envisioned soft hand exoskeleton system.

History of assistive devices and home modification services under long-term care insurance system in Japan across 20 years: A narrative review.

In this aging society, support services for older adults through the social welfare system have been introduced in many countries; in Japan, the long-term care insurance (LTCI) system was introduced in 2000. This review examined research of the past 20 years to investigate the history of assistive devices and home modification services and discussed future directions for health professionals through a narrative review. We selected 86 Japanese papers and six English papers: a total of 92 papers were analyzed by three researchers. This review revealed that assistive devices and home modification services contributed to helping users and decreased caregiver burden. Many studies have shown the importance of appropriate and sufficient cooperation among professionals. However, some issues related to LTCI were identified such as the regulation of subsidies and little flexibility considering local area conditions. The effectiveness and issues of assistive devices and home modification services were shown, and adjustments were suggested for the system and professional education according to the changes in a social situation. In addition, systematic research seems to be a small number; hence, studies with reliable research methods and analyses are needed to show the effectiveness of services and examine intervention by professionals.

Energy Expenditure and Substrate Utilization with Hands-Free Crutches Compared to Conventional Lower-Extremity Injury Mobility Devices.

Background: A Hands-Free crutch (HFC) is a relatively new device that can be used during the nonweightbearing period to increase mobility. The primary aim of this investigation was to examine aerobic oxygen consumption (V.o2) and substrate utilization with HFC compared to conventional ambulation devices as well as normal ambulation. A secondary purpose was to quantify perceived exertion, pain, and performance during each ambulation condition. Methods: Forty participants completed 4 separate 10-minute ambulation conditions around a rectangular course. The order of the ambulation conditions was randomized and consisted of (1) walking, (2) medical knee scooter (MKS), (3) HFC, and (4) axillary crutch (AC). Indirect calorimetry was used to determine V.o2 and the respiratory exchange ratio (RER), an indicator of substrate utilization. Perceived exertion and pain were also assessed using questionnaires. Results: All mobility devices significantly elevated V.o2 (+35%) compared to walking (13.14 ± 1.70 mL/kg/min; P < .001). AC had significantly greater V.o2 requirements (20.26 ± 2.62 mL/kg/min) compared to both the MKS (15.28 ± 2.29 mL/kg/min; P < .001) and HFC (15.88 ± 2.03 mL/kg/min; P < .001). There was no difference in average V.o2 between MKS and HFC (P = .368). Compared to walking (0.78 ± 0.43), RER was significantly elevated in MKS (0.81 ± 0.05, P < .001) and AC (0.84 ± 0.06, P < .001), but not in HFC (0.79 ± 0.04, P = .350). RPE and pain were elevated in all ambulatory conditions (all P values <.001). Pain was significantly greater in AC compared with MKS (P < .001) and HFC (P < .001). Conclusion: HFC and MKS share similar V.o2 requirements over a 10-minute ambulation interval and are below those needed in AC. Substrate utilization in HFC was similar to regular walking with a greater reliance on lipid utilization for energy as evidenced by a lower RER. Exertion and pain scores were the most tolerable in HFC and MKS. Level of Evidence: Level II, prospective comparative study.

A Systematic Review of Low-Cost Actuator Implementations for Lower-Limb Exoskeletons: a Technical and Financial Perspective.

A common issue with many commercial rehabilitative exoskeletons and orthoses are that they can be prohibitively expensive for an average individual to afford without additional financial support. Due to this a user may have limited to the usage of such devices within set rehabilitation sessions as opposed to a continual usage. The purpose of this review is therefore to find which actuator implementations would be most suitable for a simplistic, low-cost powered orthoses capable of assisting those with pathologic gait disorders by collating literature from Web of Science, Scopus, and Grey Literature. In this systematic review paper 127 papers were selected from these databases via the PRISMA guidelines, with the financial costs of 25 actuators discovered with 11 distinct actuator groups identified. The review paper will consider a variety of actuator implementations used in existing lower-limb exoskeletons that are specifically designed for the purpose of rehabilitating or aiding those with conditions inhibiting natural movement abilities, such as electric motors, hydraulics, pneumatics, cable-driven actuators, and compliant actuators. Key attributes such as technical simplicity, financial cost, power efficiency, size limitations, accuracy, and reliability are compared for all actuator groups. Statistical findings show that rotary electric motors (which are the most common actuator type within collated literature) and compliant actuators (such as elastic and springs) would be the most suitable actuators for a low-cost implementation. From these results, a possible actuator design will be proposed making use of both rotary electric motors and compliant actuators. Supplementary Information: The online version contains supplementary material available at 10.1007/s10846-022-01695-0.

A Systematic Review on Evaluation Strategies for Field Assessment of Upper-Body Industrial Exoskeletons: Current Practices and Future Trends.

With rising manual work demands, physical assistance at the workplace is crucial, wherein the use of industrial exoskeletons (i-EXOs) could be advantageous. However, outcomes of numerous laboratory studies may not be directly translated to field environments. To explore this discrepancy, we conducted a systematic review including 31 studies to identify and compare the approaches, techniques, and outcomes within field assessments of shoulder and back support i-EXOs. Findings revealed that the subjective approaches [i.e., discomfort (23), usability (22), acceptance/perspectives (21), risk of injury (8), posture (3), perceived workload (2)] were reported more common (27) compared to objective (15) approaches [muscular demand (14), kinematics (8), metabolic costs (5)]. High variability was also observed in the experimental methodologies, including control over activity, task physics/duration, sample size, and reported metrics/measures. In the current study, the detailed approaches, their subject-related factors, and observed trends have been discussed. In sum, a new guideline, including tools/technologies has been proposed that could be utilized for field evaluation of i-EXOs. Lastly, we discussed some of the common technical challenges experimenters face in evaluating i-EXOs in field environments. Efforts presented in this study seek to improve the generalizability in testing and implementing i-EXOs.

Comparison of outpatient coverage in Canada: Assistive and medical devices.

Outpatient technologies are important for maintaining health and overall quality of life, yet the degree of access and coverage of these technologies remains variable within and across jurisdictions. In Canada, assistive technologies are not included in universal health coverage, and are not subject to the Canada Health Act's criteria and conditions that provinces and territories must fulfill to receive the full federal cash contribution under the Canada Health Transfer. As such, the thirteen Canadian provincial and territorial governments make separate decisions on programs and coverage. Drawing on the WHO Universal Coverage Cube we compare who gets access, the types of technologies that can be accessed, and the level of coverage (total costs covered) in Canada. Overall, each Canadian jurisdiction had at least one publicly supported program. All relied on a 'health assessment' of an individual's need to determine eligibility. Income and eligibility for social assistance was used as eligibility criteria in 6 of the 13 jurisdictions. Mobility aids as well as audio, visual, and communication aids were included in all jurisdictions. While some programs offered full financial support for some technologies, forms of cost sharing were common. The results are discussed in the context of international experiences, demographic changes, and health system trends to highlight areas for policy learning.

Feasibility of Frailty Assessment Integrated with Cardiac Implantable Electronic Device Clinic Follow-up: A Pilot Investigation.

Background: The concept of frailty was originally created to explain why individuals of the same age have differing risk of disease, and it has since been found to be negatively associated with outcomes for a wide range of medical conditions, including cardiovascular disease and cardiac procedures. Although numerous risk scores and assessment tools have been proposed, opportunities for practical assessment of frailty remain limited. In this pilot study, we examine the feasibility of using routine follow-up of patients with cardiac implantable electronic devices (CIEDs) for assessment of frailty. Methods: From September 2017 through March 2018, 49 consecutive patients seen in CIED clinic were enrolled. Among the frailty assessments performed at the clinic visit included a 4-meter walk time, FRAIL scale calculation, Rockwood Frailty score assessment by another treating provider, mini-cog assessment, and analysis of daily activity measures on the CIED. Results: Among the three device manufacturers of patients' CIEDs, only Boston Scientific released analyzable activity time series data. On nine patients in whom daily activity data could be analyzed, there was no difference in mean daily activity (148.3 ± 31.9 vs. 100.1 ± 25.1 min/day, p = .27) between patients with and without an abnormal frailty or cognitive assessment, although interestingly, those with an abnormal assessment had a higher standard deviation of activity per day (52.6 ± 5.9 vs. 31.4 ± 4.7 min/day, p = .03). Conclusion: It is possible that a higher variation in daily activity over the course of a year could be a better indicator of frailty or cognitive impairment than average daily activity.

The Economics of Innovation in the Prosthetic and Orthotics Industry.

Innovation is an important part of the prosthetic and orthotics (P&O) industry. Innovation has the potential to improve health care services and outcomes, however, it can also be a burden to the system if misdirected. This paper explores the interaction of innovation and economics within the P&O industry, focusing on its current state and future opportunities. Technological advancement, industry competition and pursuit of better patient outcomes drive innovation, while challenges in ensuring better P&O health care include lagging clinical evidence, limited access to data, and existing funding structures. There exists a greater need for inclusive models and frameworks for rehabilitation care, that focus on the use of appropriate technology as supported by research and evidence of effectiveness and cost-effectiveness. Additionally, innovative business models based on social entrepreneurism could open access to untapped and underserved markets and provide greater access to assistive technology.

GRID: a model for the development of assistive devices in developing countries.

PURPOSE: An" Appropriate Assistive Device" is accessible, affordable and standardised in terms of quality and safety, and most importantly, has the functionality to satisfy the user needs. The cost of research and development (R&D) of such assistive products for a market that has limited purchasing power is a significant hurdle and traditional models of R&D may not work effectively in this case. This paper presents an experience-based viable model for the R&D of assistive devices for users in developing countries. METHOD: The model presented here has been evolved from the functioning of the TTK Centre for Rehabilitation Research and Device Development (R2D2) in IIT Madras, Chennai, India. The model is based on the four pillars of Grants-Research-Industry-Dissemination, hence the name GRID model. We have been effectively using this model involving academia, funding agencies, industry partners and users to develop appropriate assistive devices. Three case studies of assistive device development based on the GRID model are presented in this paper to elucidate practical implementation of the model. RESULTS: Using the GRID model, we have successfully accomplished the development of appropriate assistive devices and two of these devices will be launched in the coming months. CONCLUSIONS: The proposed GRID model is a viable model for the development of appropriate assistive devices in developing countries, and could likely be replicated in other parts of the world as well.IMPLICATIONS FOR REHABILITATIONThe GRID model is practically viable and provides a systematic approach for the development of high-quality, functional and affordable assistive devices.Implementation of the GRID model to develop assistive devices could attract more funding and committed stakeholders to this space, with the potential to change the assistive device landscape in developing countries by making available more functional and affordable devices.In effect, the model will benefit users of assistive devices by giving them a greater choice of available devices and empowering them to lead a quality life.

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 RehabilitationThe 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.

Burden of Illness in Adults With Hypophosphatasia: Data From the Global Hypophosphatasia Patient Registry.

Hypophosphatasia (HPP) is a rare, inherited, metabolic disease caused by deficient tissue non-specific alkaline phosphatase activity. This study aims to assess patient-reported pain, disability and health-related quality of life (HRQoL) in a real-world cohort of adults with HPP who were not receiving asfotase alfa during the analysis. Adults (≥18 years old) with HPP (confirmed by ALPL gene mutation and/or low serum alkaline phosphatase activity for age/sex) were identified from the Global HPP Registry (NCT02306720). Demographics, clinical characteristics, and data on patient-reported pain, disability, and HRQoL (assessed by Brief Pain Inventory Short Form [BPI-SF], Health Assessment Questionnaire Disability Index [HAQ-DI], and 36-Item Short-Form Health Survey version 2 [SF-36v2], respectively) were stratified by pediatric- and adult-onset HPP and summarized descriptively. Of the 304 adults included (median [min, max] age 48.6 [18.8, 79.8] years; 74% women), 45% had adult-onset HPP and 33% had pediatric-onset HPP (unknown age of onset, 22%). Of those with data, 38% had experienced ≥5 HPP manifestations and 62% had a history of ≥1 fracture/pseudofracture. Median (Q1, Q3) BPI-SF scores were 3.5 (1.5, 5.3) for pain severity and 3.3 (0.9, 6.2) for pain interference. Median (Q1, Q3) disability on the HAQ-DI was 0.3 (0.0, 0.7). Median (Q1, Q3) physical and mental component summary scores on the SF-36v2 were 42.4 (32.7, 49.9) and 45.3 (36.3, 54.8), respectively. Greater numbers of HPP manifestations experienced/body systems affected correlated significantly with poorer scores on the BPI-SF, HAQ-DI, and SF-36v2 (all p < 0.05). No significant differences between adults with pediatric- and adult-onset HPP were observed for patient-reported outcomes, except for disability and the BPI-SF question "pain at its worst," which were significantly higher among adults with pediatric- versus adult-onset HPP (p = 0.03 and 0.04, respectively). These data from the Global HPP Registry show that adults with HPP have a substantial burden of illness that is associated with reduced patient-reported HRQoL, regardless of age of disease onset. © 2020 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).