Purchase and use of home healthcare devices for the elderly: a pilot study in Shanghai, China.

BACKGROUND: In China, home-based healthcare/rehabilitation has always been advocated by the government and is the most prevalent healthcare pattern. However, there is currently no data on how many each product has been purchased, and it is not clear what factors are associated with their use. The research aims to clarify the current practices and attitudes of the elderly on such matters, and further analyze their influence factors. METHODS: This pilot study consisted of two-round regional survey, conducted from July 25 to August 3, 2015 and July 20 to August 10, 2018 respectively. Both surveys released on-site paper questionnaires and collected after filling out in different communities. RESULTS: Two hundred forty-four valid questionnaires from 52 communities were collected. Compared with 2015 (30.8%), the number of people who did not purchase home healthcare devices in the same area decreased in 2018 (28.2%). Hemopiezometer (44.3%), glucometer (18.4%), massager (21.3%) and walking devices (19.3%) are the four main types of products that urbanites are most willing to buy. In addition, users' age group, education level, and income level were significantly correlated with the purchase of certain products. CONCLUSIONS: The types of home healthcare devices purchased by respondents are consistent with the distribution of chronic diseases of urban residents in China. The analysis of product brands also revealed the existing problems and huge growth space of the industry market, which also requires the government to introduce relevant policies and measures to regulate the market and accelerate the development of the industry.

Healthcare provision in amyotrophic lateral sclerosis: procedures, queries and pitfalls in Germany and Poland.

There are a number of physical restrictions that develop in the course of amyotrophic lateral sclerosis (ALS). While loss of speech and motor control may be partially compensated by the support of assistive devices, swallowing difficulty and respiratory insufficiency require medical interventions (percutaneous endoscopic gastrostomy, noninvasive, and invasive ventilation). Based on the data collected within the NEEDSinALS study, we found major differences in personal satisfaction with the financing, healthcare provision, medical infrastructure, and regulations of German and Polish ALS patients, despite minor differences in economic burden caused by the disease. In order to explain this phenomenon, we thoroughly reviewed the legal basis, structure and organization of the healthcare systems in Germany and Poland to determine the range of obstacles in the everyday lives of patients and their caregivers that are attempting to attain an assistive device or care after the start of medical interventions.

Do online applications for free assistive technology devices by individuals with disabilities introduce moral hazard? Evidence from Shanghai, China.

OBJECTIVES: To examine whether moral hazard may exist under unsupervised home-based online applications, leading to more assistive technology devices (ATDs) and larger per capita expenditures on ATDs than under supervised community center-based online applications. METHODS: Using the data from the Assistive Devices Resource Centre in Shanghai, descriptive statistics were estimated for the sociodemographics of applicants. Multiple linear regression and logistic regression were used to test the effect of the introduction of home-based online applications. RESULTS: In 2015-2016, there were marked increases of 22.3% in the total number of ATDs and 27.2% in the total expenditure on ATDs compared with 2013-2014. The per capita number and expenditure also demonstrated an increasing trend. More devices were applied for in 2015-2016 than in 2013-2014, yielding a higher expenditure per capita (P < .001). Interestingly, with an invisible price, more devices were applied for at home than in community centers (P < .001), but the expenditure per capita was smaller (P < .001). CONCLUSIONS: The introduction of online applications increased the number of ATDs per capita. The home-based applications induced the purchase of more ATDs but not higher expenditures on ATDs. Individuals with disabilities tend to request the maximum number of ATDs allowed by the application rules, which is an indicator of moral hazard. The prices of ATDs were not visible for individuals with disabilities, which may cause individuals to order costlier ATDs when applying at home. Stricter review may be needed to reign in the potential moral hazard among online applicants with disabilities.

Republication of The Technology-Related Assistance to Individuals with Disabilities Act: Relevance to Individuals with Learning Disabilities and Their Advocates.

Assistive technology (AT) was recognized by Congress as a viable need for people with disabilities when it passed the Tech Act in 1988. The legislation, which was reauthorized in 1994, has resulted in numerous programs and services that have helped people with disabilities access and use AT devices. The Tech Act's implications for people with learning disabilities is discussed in this article.

Proof of Concept of an Assistive Robotic Arm Control Using Artificial Stereovision and Eye-Tracking.

Assistive robotic arms have become popular to help users with upper limb disabilities achieve autonomy in their daily tasks, such as drinking and grasping objects in general. Usually, these robotic arms are controlled with an adapted joystick. Joysticks are user-friendly when it comes to a general approach to an object. However, they are not as intuitive when having to accurately approach an object, especially when obstacles are present. Alternatively, the combined use of artificial stereovision and eye-tracking seems to be a promising solution, as the user's vision is usually dissociated from their upper limb disability. Hence, the objective of this study was to develop a proof of concept for the control of an assistive robotic arm using a low-cost combination of stereovision and eye-tracking. Using the developed control system, a typically developed person was able to control the robotic arm successfully reaching and grasping an object for 92% of the trials without obstacles with an average time of 13.8 seconds. Then, another set of trials with one obstacle had a success rate of 91% with an average time of 17.3 seconds. Finally, the last set of trials with two obstacles had a success rate of 98% with an average time of 18.4 seconds. Furthermore, the cost of an eye-tracker and stereovision remains below 400$.

Appropriate Assistive Technology for Developing Countries.

Access to appropriate and affordable assistive technology is a human right, and a public health and development priority. This article elaborates on these aspects and illustrates the various opportunities and barriers to achieving equitable access to assistive technology through 4 specific country snapshots. In Brazil, mobility aids are provided through universal health coverage in rehabilitation reference centers in urban areas. A community-based rehabilitation pilot project in Argentina demonstrates how to reach an excluded indigenous community. A rapidly developing national legal framework in Colombia with imminent implementation challenges is showcased, as is a technology transfer model in India.

The Financial Hardship Faced by Older Americans Needing Long-Term Services and Supports.

Issue: In addition to medical care, individuals with functional or cognitive impairment often require long-term services and supports (LTSS), which Medicare does not cover. Little is known about the additional out-of-pocket expenses that individuals and their families incur to meet these needs. Goal: To analyze medical and LTSS spending among older Medicare beneficiaries, particularly the costs of assistive devices and personal care and the ways those costs are met. Methods: Descriptive analyses of the National Health and Aging Trends Study (NHATS), 2015. Key Findings and Conclusions: Beneficiaries with high LTSS needs have higher Medicare and out-of-pocket spending than those without such needs and are more likely to report that medical care makes up part of their credit card debt. Those with high LTSS needs are also more likely to report trouble paying for food, rent, utilities, medical care, and prescription drugs. Many older Medicare beneficiaries using LTSS are vulnerable to incurring substantial costs. Without an affordable, sustainable financing solution, Medicare beneficiaries with LTSS needs will continue to be at greater risk of delaying necessary care, being placed in a nursing home prematurely, and having to "spend down" into the Medicaid program.

Dementia Care Frameworks and Assistive Technologies for Their Implementation: A Review.

In this review, we focus on the various integrated care models that have been applied for the management of dementia patients. We explore the different types of assistive technologies (mobile, wearable, and home-based systems) for dementia care, with a special emphasis on technologies that involve or target the informal caregiver as end user. In an attempt to reveal the needs for information sharing, communication, and collaboration between people with dementia and caregivers involved in the effective and integrated management of the disease, we analyze the trends in research and development to date, we seek to understand and reflect upon the state of the art in assistive technologies for dementia, and we highlight domains that appear underexplored, in order to guide future research. We also explore the cost effectiveness of such technologies and integrated care models for the management of dementia patients and comment on current limitations and future trends and directions. Findings indicate the urgent need and the current lack of a comprehensive and cost-effective solution that will incorporate information system technologies for the provision of integrated care services to dementia patients and their informal caregivers.

Influences on selection of assistive technology for young children in South Africa: perspectives from rehabilitation professionals.

Selection of assistive technology for young children is a complex process. Within a context with limited resources, such as South Africa, research is needed to determine the factors influencing the assistive technology selection process, as these could ultimately either facilitate or hinder the availability and accessibility of affordable, adaptable, acceptable, and high quality assistive technology for this age group. METHOD: Two asynchronous online focus groups were conducted with 16 rehabilitation professionals to identify the factors they perceived to influence the selection and provision of assistive technology to young children within the South African context. DATA ANALYSIS: A process of deductive thematic analysis was followed by inductive analysis of the data. Components of the Assistive Technology Device Selection Framework were used as themes to guide the deductive analysis, followed by inductive analysis to create subthemes. DISCUSSION: The important role of the professional was highlighted in negotiating all the factors to consider in the assistive technology selection and provision process. Adaptation of the Assistive Technology Device Selection Framework is suggested in order to facilitate application to low resourced contexts, such as South Africa. Implications for rehabilitation Assistive technology selection is a complex process with factors pertaining to the users (child and family) of the assistive technology, as well as the rehabilitation professional recommending the assistive technology influencing the process. Although it may be an important factor, the availability of financial resources to purchase assistive technology is not the only determining factor in providing appropriate assistive technology to young children in contexts with limited resources. Formalized support, such as reflective supervision or mentorship programs should be facilitated and utilized by recommending professionals. Home and school visits during assessment ensure a good match between assistive technology and users within the particular context. Facilitating the availability of assistive technology for trial during assessment and/or for a period afterwards will increase the likelihood that appropriate recommendations for assistive technology are made.

Assistive technologies for improving the oral hygiene of leprosy patients residing in a former leprosy colony in Betim, Minas Gerais, Brazil.

BACKGROUND: This study deals with management of a group of elderly patients with a history of leprosy and hand deformities by a multidisciplinary team of dentists and occupational therapists. Assistive technology devices have been developed to allow such patients to obtain independence in oral self-care and can be a cost-effective approach to improving oral care in this population. The objective of this study was to describe the development of assistive devices to facilitate daily oral hygiene in older people with enduring leprosy-related impairments. METHODOLOGY: Case study realized among elders with a history of leprosy residents in a former isolation colony in Betim, Minas Gerais, Brazil. The elders were evaluated for dependence on others for denture hygiene and mouthwash using the Daily Oral Hygiene Activity Index (ADOH). Those deemed partially or completely dependent on others were eligible for an intervention based on assistive technology. We adopted a personalized approach to each case, taking into account medical history, physical impairment and living environment. Six months after the intervention, the participants were assessed again using the ADOH and an unstructured interview about use of the devices. PRINCIPAL FINDINGS: Assistive devices for denture hygiene and mouthwash were developed for 16 elders. These devices facilitated oral hygiene in most patients and there was no worsening in any of the cases. Patients' report suggested they were satisfied with the devices provided. CONCLUSIONS: This study demonstrated that assistive devices can facilitate oral hygiene activities in leprosy patients. It also reinforces the importance of using a multidisciplinary team for the rehabilitation of these patients.

Access to social security benefits among multiple sclerosis patients in Italy: A cross-sectional study.

BACKGROUND: Knowledge concerning the predictors of social security benefits and the proportion of Multiple Sclerosis (MS) patients receiving these benefits is very limited. OBJECTIVE: To estimate the likelihood of receiving social security benefits for Italian MS patients. METHODS: From September 2014 to November 2015, we interviewed MS outpatients from two Italian MS clinics to collect information regarding their personal data, clinical and working history, and access to social security benefits. We performed both univariate and multivariable analyses to evaluate the predictors for receiving social security benefits. RESULTS: We interviewed 297 patients, with a mean age of 49.5 (±â€¯10.7) years; 71.4% were females. About 73% of patients had a relapsing-remitting (RR) course and the median EDSS score was 2.5 (IQR 1.5-6). About 75% of MS patients received a full exemption from co-payments, while the proportions of people who enjoyed each of the other social security benefits were lower, ranging from 8.8% (car adaptation) to 32% (disable badge). At multivariable analysis, the probability of obtaining each of the benefits was significantly associated with the EDSS score: walking aids (OR 3.9), care allowance (OR 3.6), disabled badge (OR 2.4), exemption from co-payment (OR 1.6) and allowed off work permit (OR 1.7). Only the probability of obtaining an allowed off work permit was also influenced by comorbidities (OR 2.9) and a higher education (OR 2.2). CONCLUSION: Except for full exemption from co-payments, the proportions of MS patients who enjoyed social security benefits seem to be limited in our study sample. The EDSS score is the strongest predictor of the probability of receiving all the benefits. Only a small proportion of patients received care allowance and working permits, probably because such benefits are only granted to people with a high level of disability. On the other hand, the low proportion of patients who enjoyed fiscal benefits for home and car adaptations could have been influenced by the way such benefits are granted in our country.

Access to assistive technology for people with intellectual disabilities: a systematic review to identify barriers and facilitators.

BACKGROUND: The World Health Organisation has launched a programme to promote Global Cooperation on Assistive Technology. Its aim is to increase access to high-quality affordable assistive products (AP) for everybody in need. People with intellectual disabilities (ID) are a specific group that could benefit from AP, but use less AP compared to their non-intellectual disabled peers. METHOD: A systematic literature search was carried out to identify barriers and potential facilitators for access to AP for people with ID globally. The search strategy terms were 'Intellectual Disability' and 'Assistive Technology' with the following electronic literature databases PubMed, Embase, ASSIA, Web of Science, Medline, CINAHL complete, PsycInfo, Scopus and ERIC. The quality and relevance of the studies were assessed. Factors associated with access were identified thematically, categorised into barriers and facilitators and mapped into themes. RESULTS: In all, 22 key studies were retrieved, describing 77 barriers and 56 facilitators. The most frequently reported barriers were related to lack of funding and cost of AP, lack of awareness about AP and inadequate assessment. An increase of knowledge and awareness about AP and the need of AP for people with ID were most often extracted as factors that could potentially facilitate access. CONCLUSIONS: This review proposes actions linked to the barriers and facilitators that have a particular importance for people with ID to access AP. Yet, only limited research is available describing factors that influence access to AP for people with ID in low and middle income countries and rural areas.

Assistive technology provision: towards an international framework for assuring availability and accessibility of affordable high-quality assistive technology.

PURPOSE: This is a position paper describing the elements of an international framework for assistive technology provision that could guide the development of policies, systems and service delivery procedures across the world. It describes general requirements, quality criteria and possible approaches that may help to enhance the accessibility of affordable and high quality assistive technology solutions. MATERIALS AND METHODS: The paper is based on the experience of the authors, an analysis of the existing literature and the inputs from many colleagues in the field of assistive technology provision. It includes the results of discussions of an earlier version of the paper during an international conference on the topic in August 2017. RESULTS AND CONCLUSION: The paper ends with the recommendation to develop an international standard for assistive technology provision. Such a standard can have a major impact on the accessibility of AT for people with disabilities. The paper outlines some the key elements to be included in a standard. Implications for Rehabilitation Assistive technology is a key element in rehabilitation, but many people have no access to affordable AT solutions. The recommendations in the paper aim to inform policies, systems and service delivery procedures on how to improve access to AT across the world.

Assistive technology pricing in Australia: is it efficient and equitable?

Objective To examine available systematically collected evidence regarding prices for assistive technology (AT; e.g. disability aids and equipment) in Australia with other comparable countries. Issues of appropriate AT pricing are coming to the fore as a consequence of efforts to move to consumer-centric purchasing decisions with the National Disability Insurance Scheme (NDIS) and also in the recent aged care reforms. Methods We identified and present three sets of AT price comparisons. Two comparisons were based solely on the lowest prices advertised on the internet, and one comparison examined recommended retail prices. Variables essential to ensuring accurate comparisons, as well as significant supply-chain issues were also examined and considered in the analyses. Results The first internet-only price comparison found that overall AT prices were 38% higher in Australia compared to other countries, but did not factor in shipping and other related costs that are essential to include given that most AT is imported. The second internet-only price comparison found that overall Australian prices were 24% lower when shipping and related costs were included. The recommended retail price comparisons found that Australian prices were between 14% and 27% lower. Prices for internet-only retailers (those with no bricks-and-mortar presence) are consistently lower for all products than those sold by retailers with actual shop-fronts. Further, there is no evidence of suppliers earning supranormal profits in Australia. Conclusions The results indicate that AT prices in Australia are efficient and equitable, with no significant indicators of market failure which would require government intervention. Efforts to reduce prices through the excessive use of large-scale government procurement programs are likely to reduce diversity and innovation in AT and raise AT prices over time. Open markets and competition with centralised tracking of purchases and providers to minimise possible over-servicing/over-charging align well with the original intention of the NDIS, and are likely to yield the best outcomes for consumers at the lowest costs. What is known about the topic? Government-funded programs are used extensively to purchase AT because it is a primary enabler for people of all ages with disabilities. Perceptions of unreasonably high prices for AT in Australia are resulting in the widespread adoption of bulk purchasing and related strategies by governments. What does this paper add? Carefully undertaken systematic price comparisons between Australia and comparable Organization For Economic Cooperation and Development countries indicate that, on average, Australian prices are lower than elsewhere when delivery to Australia is taken into account. It was also found that prices at brick-and-mortar shops, with all the services they provide to ensure the appropriateness of the products provided to meet the consumers' needs and goals, are substantially higher than Internet purchases in which the consumer bears all the risks and responsibilities for outcomes. What are the implications? Overuse of government bulk purchasing and similar arrangements will lead to less diversity in the available AT products, related services and retail outlets, resulting in less choice for consumers and higher risks of poor outcomes through less focus on matching consumers with the 'right' products for their needs and goals, and ultimately higher AT prices over time as competition is reduced to a few major suppliers.

Cheap or Robust? The practical realization of self-driving wheelchair technology.

To date, self-driving experimental wheelchair technologies have been either inexpensive or robust, but not both. Yet, in order to achieve real-world acceptance, both qualities are fundamentally essential. We present a unique approach to achieve inexpensive and robust autonomous and semi-autonomous assistive navigation for existing fielded wheelchairs, of which there are approximately 5 million units in Canada and United States alone. Our prototype wheelchair platform is capable of localization and mapping, as well as robust obstacle avoidance, using only a commodity RGB-D sensor and wheel odometry. As a specific example of the navigation capabilities, we focus on the single most common navigation problem: the traversal of narrow doorways in arbitrary environments. The software we have developed is generalizable to corridor following, desk docking, and other navigation tasks that are either extremely difficult or impossible for people with upper-body mobility impairments.

Stakeholders' views of the introduction of assistive technology in the classroom: How family-centred is Australian practice for students with cerebral palsy?

BACKGROUND: With family-centred care widely recognized as a cornerstone for effective assistive technology service provision, the current study was undertaken to investigate to what extent such approaches were used by schools when assistive technology assessments and implementation occurred in the classroom. METHOD: In this cross-sectional study, we compare survey results from parents (n = 76), school staff (n = 33) and allied health professionals (n = 65) with experience in the use of high-tech assistive technology. Demographic characteristics and the stakeholders' perceived helpfulness and frequency attending assessment and set-up sessions were captured. To evaluate how family-centred the assistive technology services were perceived to be, the parents filled out the Measure of Processes of Care for Caregivers, and the professionals completed the Measure of Processes of Care for Service Providers. Descriptive statistics and one-way analysis of variance were used to conduct the data analysis. RESULTS: Findings show that parents are more involved during the assessment stage than during the implementation and that classroom teachers are often not involved in the initial stage. Speech pathologists in particular are seen to be to a great extent helpful when implementing assistive technology in the classroom. This study found that family-centred service is not yet fully achieved in schools despite being endorsed in early intervention and disability services for over 20 years. No statistically significant differences were found with respect to school staff and allied health professionals' roles, their years of experience working with students with cerebral palsy and the scales in the Measure of Processes of Care for Service Providers. CONCLUSION: To enhance the way technology is matched to the student and successfully implemented, classroom teachers need to be fully involved in the whole assistive technology process. The findings also point to the significance of parents' involvement, with the support of allied health professionals, in the process of selecting and implementing assistive technology in the classroom.

Assistive technology in resource-limited environments: a scoping review.

PURPOSE: It is estimated that only 5-15% of people in low and middle income countries (LMICs) who need assistive technologies (AT) have access to them. This scoping review was conducted to provide a comprehensive picture of the current evidence base on AT within LMICs and other resource limited environments. METHOD: The scoping review involved locating evidence, extracting data, and summarizing characteristics of all included research publications. RESULTS: Of the 252 publications included, over 80% focused on types of AT that address mobility (45.2%) and vision (35.5%) needs, with AT types of spectacles and prosthetics comprising over 50% of all publications. Evidence on AT that addresses hearing, communication, and cognition is the most underrepresented within the existing evidence base. The vast majority of study designs are observational (63%). CONCLUSIONS: Evidence on AT in resource-limited environments is limited in quantity and quality, and not evenly distributed across types of AT. To advance this field, we recommend using appropriate evidence review approaches that allow for heterogeneous study designs, and developing a common language by creating a typology of AT research focus areas. Funders and researchers must commit much greater resources to the AT field to ameliorate the paucity of evidence available. Implications for Rehabilitation An increase in the quality and quantity of research is required in resource limited environments, where 80% of the global population of people with disabilities reside. Improved and increased evidence is needed to identify and understand needs, inform policy and practice, and assess progress made in increasing access to and availability of appropriate AT. Over 80% of the existing research publications on assistive technologies in resource limited environments address mobility and vision. More research is needed on AT that address hearing, communication and cognition. The use of a common language would facilitate the advancement of the global AT research field. Specifically there is a need for researchers to use a common definition of AT (i.e., ISO 9999) and typology of AT research focus areas.