Assistive/rehabilitation technology, disability, and service delivery models.

The United Nation's Millennium Development Goals do not explicitly articulate a focus on disability; similar failures in the past resulted in research, policy, and practice that are not generalizable and did not meet the needs of persons with disabilities since they were developed for an "average" population. Academics and professionals in health and other disciplines should have a knowledge base in evidence-based practices that improve well-being and participation of people with disabilities through effective service delivery of assistive technology. Grounded by a theoretical framework that incorporates a multivariate perspective of disability that is acknowledged in the convention on the rights of persons with disabilities and the World Health Organization's International Classification of Functioning, Disability and Health, we present a review of models of assistive technology service delivery and call for future syntheses of the fragmented evidence base that would permit a comparative effectiveness approach to evaluation.

Basic principles for the development of an AI-based tool for assistive technology decision making.

INTRODUCTION: The impact of assistive technology use on the lives of people with disabilities has long been demonstrated in the literature. Despite the need for assistive technologies, and a wealth of innovative, afford-able, and accessible products, a low rate of assistive technology uptake is globally maintained. One of the reasons for this gap is related to data and knowledge formation and management. Low access to information and a lack of assessment services is evident. Fragmentation of data, inconsistency in assessment methodology and heterogeneity in the competence of assistive technology professionals, has led to a growing interest in the opportunities that data sciences, including AI, hold for the future of the assistive technology sector, as a supportive and constructive mechanism in any decision-making process. OBJECTIVES: In this short paper, we seek to describe some of the principles that such an AI-based recommendation system should be built upon, using the Atvisor platform as a case study. Atvisor.ai is an AI-based digital platform that supports assistive technology assessments and the decision-making process. RECOMMENDATIONS: Our recommendations represent the aggregated insights from two pilots held in Israel, testing the platform in multiple environments and with different stakeholders. These recommendations include ensuring the continuum of care and providing a full user journey, incorporating shared decision making and self-assessment features, providing data personalisation and a holistic approach, building a market network infrastructure and designing the tool within a wider service delivery model design. Assessment and decision-making processes, crucial to optimal uptake, cab be leveraged by technology to become more accessible and personalised.IMPLICATIONS FOR REHABILITATIONProvides principles for the development of an AI-based recommendation system for assistive technology decision making.Promotes the use of artificial intelligence to support users and professionals in the assistive technology decision making process.Personalization of data regarding assistive technology, according to functional, holistic and client centered profiles of users, ensures optimal match and better use of assistive technology.Self-assessment and professional assessment components are important for enabling multiple access points to the assistive technology decision making process, based on the preferences and needs of users.

Standard terminology is critical to advancing rehabilitation and assistive technology: a call to action.

This perspective piece discusses inconsistencies in assistive technology (AT) language as a barrier to communication in AT provision, research, development, trade, and policy. The imperative to improve communication is explored in relation to AT stakeholder endeavours. This commentary is a call for action to develop a terminology standard through the aggregation of evidence-based concepts and terms to inform and optimize stakeholder outcomes. IMPLICATIONS FOR REHABILITATIONStandardized terminology supports the gathering, aggregation, analysis, and interpretation of valid data and the development of tools used for needs and outcomes assessment.Standardized terminology also supports effective and efficient documentation, practice, collaboration, and capacity building by stakeholders in both national and international contexts.

Translation and cross-cultural adaptation of the Educational Technology Device Predisposition Assessment into Brazilian-Portuguese language.

OBJECTIVE: The study aimed to translate and culturally adapt the Brazilian-Portuguese version of the instrument Educational Technology Device Predisposition Assessment in its Brazilian version for the student and version for the teacher. METHOD: It is a methodological study, focusing on the steps for preparing an adapted version of the assessment instruments. The following operational system was adopted: 1st) initial and reconciled translation into Brazilian-Portuguese language; 2nd) back-translation and adequacy of the instrument; 3nd) equivalence analysis of the instruments' items; 4nd) Pretest and cultural adequacy. RESULT: The translated and culturally adapted version has a high index of agreement and good acceptability by the study participants. CONCLUSION: The translated and adapted to Brazilian Portuguese instrument can be used in the Brazilian school settings to verify the predisposition to use technologies. Implications for rehabilitation Educational technologies enable students with many types of disability to receive instruction according to their learning needs and styles, assist them in communicating and participating more effectively, and increases self-confidence and motivation through the mastery of an educational program. Not all students benefit from the same type of educational technology and it is important to match them with the ones most appropriate for their use. The Educational Technology Predisposition Assessment assists in the selection of educational technologies based on a particular student's learning style, needs and preferences. The Educational Technology Predisposition Assessment is a validated measurement and it has been translated for use in Brazil and has been found to be a reliable tool.

Treatment theory, intervention specification, and treatment fidelity in assistive technology outcomes research.

Recent reports in the rehabilitation literature have suggested that treatment theory, intervention specification, and treatment fidelity have important implications for the design, results, and interpretation of outcomes research. At the same time, there has been relatively little discussion of how these concepts bear on the quality of assistive technology (AT) outcomes research. This article describes treatment theory, intervention specification, and treatment fidelity as interconnected facets of AT outcome studies that fundamentally affect the interpretation of their findings. The discussion of each is elucidated using case examples drawn from the AT outcomes research literature. Recommendations are offered for strengthening these components of AT outcomes research.

The learning experiences of immigrants who are graduates of an entry-level baccalaureate nursing program: A hermeneutic phenomenological study.

International migration of individuals or families seeking to improve economic conditions or escape political oppression increases each year. With migrant movement, there is a need for appropriate health care to meet their health beliefs and cultural health traditions. Nurses comprise a large portion of the healthcare workforce and yet, the number of immigrant nurses educated in their adopted country remains low. The aim of this study was to understand the learning experiences of immigrant registered nurses who graduated from an entry-level baccalaureate nursing program in the United States. A hermeneutic phenomenological approach with a Gadamerian focus was utilized. Purposive sampling identified five immigrant graduates who were individually interviewed using several open-ended questions in a non-structured format. Analysis identified an overarching theme, "being on the outside." Five subthemes emerged: harsh realities, disruptions, nurturance, resilience, and propagation. Recommendations from the interviews include: recognition and appreciation of each student, the nurse educator coming to know oneself first, followed by dialoguing with each student to perpetuate deeper understanding. Rather than accommodating the ethnically diverse immigrant nursing student through targeted interventions, the nurse educator should maintain an all-inclusive learning environment.

Organizing future research and intervention efforts on the impact and effects of gender differences on disability and rehabilitation: the usefulness of the International Classification of functioning, Disability and Health (ICF).

The International Classification of Functioning, Disability and Health (ICF) is discussed as being relevant to research and service delivery for women with disabilities. The personal meaning a disability has for a woman is shaped largely by Personal Factors. These, in turn, have historically been affected strongly by Environmental Factors such as culture and attitudes. Too often both Personal Factors, and how they are shaped by Environmental Factors, are not adequately addressed in our intervention programs. The interaction of Personal and Environmental Factors is illustrated by examples from the technology use and non-use literature.

Three model curricula for teaching clinicians to use the ICF.

PURPOSE: Three systematic programmes to train health professionals to use the World Health Organization's International Classification of Functioning, Disability, and Health (ICF) are described, along with efforts to evaluate their effectiveness. METHODS: The first programme was a randomized study comparing the effects of a 2-hour instructor-led programme and a self-directed learning module on ICF-related knowledge, attitudes, and coding skills among occupational therapy graduate students. The second programme was a series of intensive 3.5-day workshops for public sector rehabilitation professionals in South Africa. The third programme involved a series of internet-based teaching modules regarding the ICF for graduate students in rehabilitation counselling. RESULTS: The first project found that both instructor-led and self-guided training formats were effective in improving basic ICF-related knowledge, but only instructor-led training led to a significant improvement in coding skill. It also had more positive effects on ICF-related attitudes. This approach to learning assessment was generalizable to multidisciplinary health professionals in South Africa, who achieved a relatively high degree of coding accuracy after the 3.5-day workshop. Participant evaluations supported the structure, content, and length of the training. Students in the third programme also reported a very positive learning experience and positive views of the ICF. CONCLUSIONS: An empirical basis is important for identifying the best and most efficient training methods for particular audiences and specific purposes. The length and format of training can be differentially related to specific training goals (i.e., knowledge, attitudes, and coding skills). Interactive distance learning methods may help to overcome the weaknesses of self-directed training in comparison to face-to-face training.

Tracking mobility-related assistive technology in an outcomes study.

The objective of this follow-up study was to describe changes in the mobility-related assistive technology devices (ATDs) that are used from shortly after discharge from a hospital setting until 5-6 months later. One hundred and thirty-nine participants who had one or more mobility ATDs (canes, crutches, walkers, and wheelchairs) that had been recommended during hospitalization were interviewed an average of 5.5 weeks after discharge and an average of 23.2 weeks later. Information about mobility ATD usage was obtained by questionnaire during face-to-face interviews. The SF-36 was used to assess perceived health status, both physical and mental, as an additional outcome. Results show that at follow-up, only 23.3% of participants were using the ATD provided at baseline as their primary aid. Seven distinct groups of participants were noted based on individual experience with ATD use from the time of discharge to follow-up. Those groups varied according to continued versus discontinued use of an ATD, single versus multiple ATD use across time, and primary versus secondary importance attributed to the ATD. The groups also differed in terms of their differential association with rehabilitation diagnosis, age, as well as physical and mental perceived health status. The findings have implications for designing ATD outcome studies and for interpreting the relationship of ATD outcomes to other variables. The information about changes in mobility-related ATDs can also help rehabilitation specialists at the point of device referral target their patients for interventions that will either increase their adherence to device prescriptions or support nondevice strategies for managing disabilities.

Systems thinking for assistive technology: a commentary on the GREAT summit.

The area of assistive technology has a long history of technological ingenuity and innovation. In order to ensure that the benefits of assistive technology are equitably distributed across the population and life course, it is necessary to adopt a systemic approach to the area. We describe examples of systems thinking and non-systems thinking across 10 Ps. These Ps are People (or users, as the primary beneficiaries of assistive technology), Policy, Products, Personnel, Provision (as key strategic drivers at systems level); and Procurement, Place, Pace, Promotion and Partnership (as key situational factors for systems). Together these Ps should constitute a framework for an "open" system that can evolve and adapt, that empowers users, inter-connects key components and locates these in the reality of differing contexts. The adoption of a stronger systems thinking perspective within the assistive technology field should allow for more equitable, more resilient and more sustainable assistive technology across high, middle- and low-income contexts and countries. Implications for Rehabilitation The progress of assistive technology provison has been hampered by disconnected initiatives and activities and this needs to be corrected. Systems thinking is a way of thinking about the connections between things and how these are influenced by contextual and other factors. By encouraging the providers and users of assitive technology to think more systemically we can provide a more cohesive and resilient systems. The user experience is the central component of systems thinking in assistive technologies.

Assistive technology products: a position paper from the first global research, innovation, and education on assistive technology (GREAT) summit.

This paper is based on work from the Global Research, Innovation, and Education on Assistive Technology (GREAT) Summit that was coordinated by WHO's Global Cooperation on Assistive Technology (GATE). The purpose of this paper is to describe the needs and opportunities embedded in the assistive product lifecycle as well as issues relating to the various stages of assistive product mobilization worldwide. The paper discusses assistive technology product terminology and the dangers of focusing on products outside the context and rolling out products without a plan. Additionally, the paper reviews concepts and issues around technology transfer, particularly in relation to meeting global needs and among countries with limited resources. Several opportunities are highlighted including technology advancement and the world nearing a state of readiness through a developing capacity of nations across the world to successfully adopt and support the assistive technology products and applications. The paper is optimistic about the future of assistive technology products reaching the people that can use it the most and the excitement across large and small nations in increasing their own capacities for implementing assistive technology. This is expressed as hope in future students as they innovate and in modern engineering that will enable assistive technology to pervade all corners of current and potential marketplaces. Importantly, the paper poses numerous topics where discussions are just superficially opened. The hope is that a set of sequels will follow to continue this critical dialog. Implications for Rehabilitation Successful assistive technology product interventions are complex and include much more than the simple selection of the right product. Assistive technology product use is highly context sensitive in terms of an individual user's environment. The development of assistive technology products is tricky as it must be contextually sensitive to the development environment and market as well. As a field we have much to study and develop around assistive technology product interventions from a global perspective.

Assistive technology and people: a position paper from the first global research, innovation and education on assistive technology (GREAT) summit.

Assistive technology (AT) is a powerful enabler of participation. The World Health Organization's Global Collaboration on Assistive Technology (GATE) programme is actively working towards access to assistive technology for all. Developed through collaborative work as a part of the Global Research, Innovation and Education on Assistive Technology (GREAT) Summit, this position paper provides a "state of the science" view of AT users, conceptualized as "People" within the set of GATE strategic "P"s. People are at the core of policy, products, personnel and provision. AT is an interface between the person and the life they would like to lead. People's preferences, perspectives and goals are fundamental to defining and determining the success of AT. Maximizing the impact of AT in enabling participation requires an individualized and holistic understanding of the value and meaning of AT for the individual, taking a universal model perspective, focusing on the person, in context, and then considering the condition and/or the technology. This paper aims to situate and emphasize people at the centre of AT systems: we highlight personal meanings and perspectives on AT use and consider the role of advocacy, empowerment and co-design in developing and driving AT processes.

Cross-cultural adaptation of the assistive technology device - Predisposition assessment (ATD PA) for use in Brazil (ATD PA Br).

PURPOSE: The purpose of this study is to conduct a cross-cultural adaptation of the Assistive Technology Device Predisposition Assessment (ATD PA) for use in Brazil. METHOD: The selection of the Assistive Technology Device Predisposition Assessment (ATD PA) was determined by previous literature reviews of articles published in 2014 and 2016 in six databases with the terms "assistive device" or "assistive technology" or "self-help device" combined with "evidence-based practice" or "framework" or "measurement scale" or "model and outcome assessment". This review indicated that the conceptual model of Assistive Technology (AT) most discussed in the literature was the Matching Person and Technology (MPT) model, and this finding determined the selection of ATD PA as an assessment within the MPT portfolio of measures. The procedures for cross-cultural adaptation were as follows: Equivalence of Concept, Semantic and Operational. Five experts were asked to translate 725 items and these translations were evaluated and a high level of agreement was demonstrated. RESULTS: The Portuguese version, Avaliação de Tecnologia Assistiva - Predisposição ao Uso - ATD PA Br, was derived from the original version in English (ATD PA). CONCLUSION: The ATD PA Br will support professionals and people with disabilities in Brazil to better select AT devices according to the clients' needs. Implications for rehabilitation Provides a systematic way of selecting assistive technology devices for the use of individuals with disabilities according to the Brazilian reality. A systematic way of selecting the assistive technology that can help decrease the abandonment of the assistive technology use. The use of the Matching Person and Technology theorical model and of the assessment ATD PA Br is essential to guide the researches and clinical practice in Brazil.

Project Career: An individualized postsecondary approach to promoting independence, functioning, and employment success among students with traumatic brain injuries.

BACKGROUND: Project Career is a five-year interdisciplinary demonstration project funded by NIDILRR. It provides technology-driven supports, merging Cognitive Support Technology (CST) evidence-based practices and rehabilitation counseling, to improve postsecondary and employment outcomes for veteran and civilian undergraduate students with traumatic brain injury (TBI). GOAL: Provide a technology-driven individualized support program to improve career and employment outcomes for students with TBI. OBJECTIVES: Project staff provide assessments of students' needs relative to assistive technology, academic achievement, and career preparation; provide CST training to 150 students; match students with mentors; provide vocational case management; deliver job development and placement assistance; and maintain an electronic portal regarding accommodation and career resources. METHODS: Participating students receive cognitive support technology training, academic enrichment, and career preparatory assistance from trained professionals at three implementation sites. Staff address cognitive challenges using the 'Matching Person with Technology' assessment to accommodate CST use (iPad and selected applications (apps)). JBS International (JBS) provides the project's evaluation. RESULTS: To date, 117 students participate with 63% report improved life quality and 75% report improved academic performance. CONCLUSION: Project Career provides a national model based on best practices for enabling postsecondary students with TBI to attain academic, employment, and career goals.

Qualitative case studies of professional-level workers with traumatic brain injuries: A contextual approach to job accommodation and retention.

BACKGROUND: Traumatic brain injury (TBI) is a multi-systemic disability that causes a wide range of difficulties with personal and social functioning. METHODS: Four individuals with TBI participated in an evaluation of barriers to their continued employment following graduation from college. A trained interviewer completed the Work Experience Survey (WES) in teleconsultation sessions with each participant. RESULTS: Researchers applied a qualitative case study research design. Participants reported a wide range of difficulties in performing essential functions of their jobs (3 to 24) that have the potential to significantly affect their productivity. Career mastery problems reflected outcomes associated with TBI such as 'believing that others think I do a good job' and 'having the resources (e.g., knowledge, tools, supplies, and equipment) needed to do the job.' Indicative of their wish to continue their current employment, participants reported high levels of job satisfaction. CONCLUSIONS: The WES is a cost-effective needs assessment tool to aid health and rehabilitation professionals in providing on-the-job supports to workers with TBI.

Technology for improving cognitive function. A workshop sponsored by the US Interagency Committee on Disability Research (ICDR): reports from working groups.

The U.S. federal Interagency Committee on Disability Research (ICDR) and its Subcommittee on Technology (IST) sponsored a state of the art workshop on "Technology for Improving Cognitive Function", from 29-30 June 2006 in Washington, D.C. This paper summarizes the content of the working groups charged with providing strategic direction for the future of technology for persons with cognitive disabilities.

Validating a measure to assess factors that affect assistive technology use by students with disabilities in elementary and secondary education.

PURPOSE/AIM: The purpose of this study was to measure the predictive validity, internal consistency and clinical utility of the Matching Assistive Technology to Child & Augmentative Communication Evaluation Simplified (MATCH-ACES) assessment. METHODS: Twenty-three assistive technology team evaluators assessed 35 children using the MATCH-ACES assessment. This quasi-experimental study examined the internal consistency, predictive validity and clinical utility of the MATCH-ACES assessment. RESULTS: The MATCH-ACES assessment predisposition scales had good internal consistency across all three scales. A significant relationship was found between (a) high student perseverance and need for assistive technology and (b) high teacher comfort and interest in technology use (p = (0).002). CONCLUSIONS: Study results indicate that the MATCH-ACES assessment has good internal consistency and validity. Predisposition characteristics of student and teacher combined can influence the level of assistive technology use; therefore, assistive technology teams should assess predisposition factors of the user when recommending assistive technology. Implications for Rehabilitation Educational and medical professionals should be educated on evidence-based assistive technology assessments. Personal experience and psychosocial factors can influence the outcome use of assistive technology. Assistive technology assessments must include an intervention plan for assistive technology service delivery to measure effective outcome use.

Assessing the benefits of using assistive technologies and other supports for thinking, remembering and learning.

PURPOSE: Planning assistive technologies and other supports for individuals with cognitive disabilities requires a comprehensive and individualized assessment of current goals, past experiences with the use of technologies and other supports, and the person's predisposition to the use of alternative or additional supports. This paper discusses a foundation for the refinement of an existing assessment process to match technologies to individuals with cognitive disabilities. METHOD: Prior research and a literature review identified the critical needs for an assessment process that would serve to identify key elements known to influence the success use of assistive technology and other supports by persons with cognitive disabilities. RESULTS: The components of successful, effective and satisfied support use result from a good match of device and support features, user goals and preferences, and environmental resources. The relationship to the World Health Organization's International Classification of Functioning, Disability and Health and the International Standardization Organization's international standard ISO DIS 9999 is discussed. CONCLUSIONS: As the number of assistive technology options increase, individualized interventions for individuals with cognitive disabilities will be easier to accomplish. The key to successful and optimal use of these products will be an appropriate and comprehensive assessment of consumer needs and preferences and the identification of additional accommodations and supports.

Predictors of assistive technology use: the importance of personal and psychosocial factors.

OBJECTIVE: To validate an assistive technology (AT) baseline and outcomes measure and to quantify the measure's value in determining the best match of consumer and AT considering consumer ratings of their subjective quality of life, mood, support from others, motivation for AT use, program/therapist reliance, and self-determination/self-esteem. DESIGN: Prospective multi-cohort study. SETTING: Vocational rehabilitation offices and community. PARTICIPANTS: Over 150 vocational rehabilitation counselors in 25 U.S. states with one consumer each receiving new AT. INTERVENTIONS: Counselor training in the Matching Person and Technology (MPT) Model and consumer completion of the MPT measure, Assistive Technology Device Predisposition Assessment (ATD PA). MAIN OUTCOME MEASURES: Total and subscale scores on the ATD PA as well as counselor-completed questionnaires. RESULTS: ATD PA items differentiated consumer predispositions to AT use as well as AT and user match. There were no significant differences due to gender, physical locality, or age within this sample of working-age adult consumers. Vocational rehabilitation counselors exposed to training in the MPT Model achieved enhanced AT service delivery outcomes. CONCLUSIONS: The ATD PA is a valid measure of predisposition to use an AT and the subsequent match of AT and user. Rehabilitation practitioners who use the ATD PA will achieve evidence-based practice and can expect to see enhanced AT service delivery outcomes.