Manufacturers perceptions of the barriers and facilitators of designing and producing accessible fitness equipment: A qualitative study.

A descriptive qualitative study was conducted to learn manufacturer perceptions of the barriers and facilitators of designing and producing accessible fitness equipment. Eight participants familiar with the ASTM International (formally the American Society for Testing and Materials) Universal Design of Fitness Equipment standards were interviewed via a virtual platform. Audio recorded interviews were transcribed verbatim and independently coded by two investigators using thematic analysis. Two primary themes emerged from the data, 1) Challenges and 2) Tipping the Scale. Challenges included a humanitarian versus a business model view, application of the ASTM International standards, lack of a market analysis, and safety and liability. Facilitators deemed appropriate to tip the scale include consideration of a carrot (reward) versus a stick (punitive measures), availability of a market analysis, ASTM International standard modifications and enlisting activism for cultural change and development of laws and policies to mandate inclusion of accessible fitness space and equipment. Legislative action appears to be a primary facilitator to increase the design, development, and availability of accessible equipment in fitness centers.

Physical Activity Self-Efficacy in Older Adults with Vision Loss: A Grounded Theory Study.

The purpose of this study was to develop a model describing the process of how older adults with age-related macular degeneration develop physical activity self-efficacy. The primary aim of this research was to determine how adults with age-related macular degeneration living in a southeastern metropolitan area develop physical activity self-efficacy. Sixteen older adults with age-related macular degeneration participated in face-to-face interviews and observations of their regular physical activity. Grounded theory approach was used to identify emerging themes and a model describing the development of physical activity self-efficacy in this cohort. Five themes related to the development of physical activity self-efficacy emerged: 1) physical activity engagement, 2) self-management behaviors, 3) physical activity determinants, 4) strategies, and 5) self-perceived benefits. These themes were analyzed to produce a preliminary model describing the development of physical activity self-efficacy in older adults with age-related macular degeneration. Findings provide a preliminary model, which practitioners can use to facilitate self-efficacy and participation in physical activity in older adults with age-related macular degeneration.

Exploring the uptake and implementation of tele-monitored home-exercise programmes in adults with Parkinson's disease: A mixed-methods pilot study.

BACKGROUND: People with Parkinson's disease experience numerous barriers to exercise participation at fitness facilities. Advances in tele-monitoring technologies create alternative channels for managing and supervising exercise programmes in the home. However, the success of these programmes will depend on participants' perceptions of using the technology and their exercise adherence. Thus, this pilot explored the uptake and implementation of two common methods of Internet-exercise training in Parkinson's disease. METHODS: Twenty adults with Parkinson's disease were randomized into either: telecoach-assisted exercise (TAE) or self-regulated exercise (SRE) groups. Both groups received the same eight-week exercise prescription (combined strength and aerobic exercise) and telehealth system that streamed and recorded vital signs and exercise data. TAE participants exercised under a telecoach's supervision via videoconferencing. SRE participants independently managed their exercise training. Quantitative data were described and qualitative data underwent thematic analysis. RESULTS: Quantitative results demonstrated that TAE participants achieved strong attendance (99.2%), whereas SRE participants demonstrated 35.9% lower attendance, 48% less total time exercising, and 74.5% less time exercising at moderate intensity. Qualitatively, TAE participants reported overtly favourable programme experiences and that assistance from a telecoach enhanced their exercise motivation. SRE participants noted several challenges that impeded adherence. CONCLUSION: Findings demonstrate that adults with Parkinson's disease acknowledge benefits of exercising through a telehealth system and are open to utilizing this channel as a means of exercise. However, human-interactive support may be required to overcome unique impediments to participation. Study findings warrant validation in larger trials that can transfer the success of TAE towards more scalable methods of delivery.

Effectiveness of the International Symbol of Access and inclusivity of other disability groups.

BACKGROUND: The International Symbol of Access (ISA) is recognized world-wide for designating and identifying areas which are wheelchair accessible, however its meaning has evolved to include both restricted use and universal accessibility. OBJECTIVE: This study seeks to investigate the effectiveness of the ISA in representing individuals of all impairment types. METHODS: A mixed-method survey was disseminated in the U.S. and internationally to persons without self-identified impairment and individuals of various impairment group types, including mobility, vision, hearing, and cognitive impairments, using convenience sampling (n = 981). Quantitative data was analyzed using ranking patterns and regression analysis. Qualitative data was analyzed using thematic analysis and triangulation. RESULTS: Participants with self-identified mobility impairments rated the ISA more favorably than other disability groups (p = 0.002). In addition, there is a significant correlation between age and effectiveness of the ISA, with participants rating the symbol more favorably as age increases. Common themes included association of the ISA with a mobility impairment, implications for restricted use or reserved space, and physical accessibility. CONCLUSIONS: The ISA is not effective in representing individuals with non-mobility impairments and its ambiguous nature leads to confusion for both persons with and without impairment.

Examining perceptions of existing and newly created accessibility symbols.

BACKGROUND: Symbols are used to convey messages in a clear, understandable manner, without the use of written language. The most widely recognized symbol used to denote access for persons with disabilities is the International Symbol of Access. This symbol has been criticized for its inadequate representation of disability diversity poorly representing universal design of space and products. OBJECTIVE: This descriptive study explored individual comprehension and perceptions of nine existing and newly created accessibility pictograph symbols and identified one that represented universal access to fitness equipment. METHODS: A survey was disseminated electronically and face-to-face to individuals, groups and organizations affiliated with inclusive fitness equipment, space and programming. Quantitative data was analyzed for descriptive statistics, rank order of symbols and group comparisons of rankings. Thematic analysis of open-ended question results revealed themes to enhance understanding of symbol rank order. RESULTS: 981 participants completed the survey. Symbol four, shaped as a Venn diagram containing three icons representing individuals with varying ability levels, was ranked highest with no significant differences in group comparisons between participants with and without a disability and U.S. residents versus non-U.S. residents. 85.4% of participants demonstrated accurate comprehension of this symbol. Though symbol five had the same symbol rank median value, this symbol's distribution of scores was lower. CONCLUSIONS: Participants accurately comprehended symbol four and it was identified as the highest ranked symbol representing universal access to fitness equipment. Because of symbol unfamiliarity, adoption will require education and consistency of use and placement.

Lighting as a Compensatory Strategy for Acquired Visual Deficits After Stroke: Two Case Reports.

OBJECTIVE: The objective of this article was to explore the effects of enhanced lighting on the function of people with an acquired visual deficit resulting from cerebrovascular accident (CVA) in an inpatient rehabilitation facility (IRF). METHOD: An ABAB design was used with two cases to assess how a short-term intervention involving lighting changes affected clients' grooming performance in an IRF. Analysis consisted of scores on the grooming section of the FIM®, times for each grooming task, and light meter readings. RESULTS: Both participants demonstrated improvements in function as measured by the FIM and in time to complete grooming tasks with enhanced lighting. CONCLUSION: These results suggest that individualized lighting can lead to improved grooming function in clients with CVA.

Teleexercise for Persons With Spinal Cord Injury: A Mixed-Methods Feasibility Case Series.

BACKGROUND: Spinal cord injury (SCI) results in significant loss of function below the level of injury, often leading to restricted participation in community exercise programs. To overcome commonly experienced barriers to these programs, innovations in technology hold promise for remotely delivering safe and effective bouts of exercise in the home. OBJECTIVE: To test the feasibility of a remotely delivered home exercise program for individuals with SCI as determined by (1) implementation of the intervention in the home; (2) exploration of the potential intervention effects on aerobic fitness, physical activity behavior, and subjective well-being; and (3) acceptability of the program through participant self-report. METHODS: Four adults with SCI (mean age 43.5 [SD 5.3] years; 3 males, 1 female; postinjury 25.8 [SD 4.3] years) completed a mixed-methods sequential design with two phases: an 8-week intervention followed by a 3-week nonintervention period. The intervention was a remotely delivered aerobic exercise training program (30-45 minutes, 3 times per week). Instrumentation included an upper body ergometer, tablet, physiological monitor, and custom application that delivered video feed to a remote trainer and monitored and recorded exercise data in real time. Implementation outcomes included adherence, rescheduled sessions, minutes of moderate exercise, and successful recording of exercise data. Pre/post-outcomes included aerobic capacity (VO2 peak), the Physical Activity Scale for Individuals with Physical Disabilities (PASIPD), the Satisfaction with Life Scale (SWLS), and the Quality of Life Index modified for spinal cord injury (QLI-SCI). Acceptability was determined by participant perceptions of the program features and impact, assessed via qualitative interview at the end of the nonintervention phase. RESULTS: Participants completed all 24 intervention sessions with 100% adherence. Out of 96 scheduled training sessions for the four participants, only 8 (8%) were makeup sessions. The teleexercise system successfully recorded 85% of all exercise data. The exercise program was well tolerated by all participants. All participants described positive outcomes as a result of the intervention and stated that teleexercise circumvented commonly reported barriers to exercise participation. There were no reported adverse events and no dropouts. CONCLUSION: A teleexercise system can be a safe and feasible option to deliver home-based exercise for persons with SCI. Participants responded favorably to the intervention and valued teleexercise for its ability to overcome common barriers to exercise. Study results are promising but warrant further investigation in a larger sample.

Client and therapist perspectives on the influence of low vision and chronic conditions on performance and occupational therapy intervention.

OBJECTIVE: We explored how vision loss and comorbid chronic conditions influence occupational therapy intervention by gathering perspectives from occupational therapists treating clients with low vision and from older adults with low vision. METHOD: We surveyed 59 occupational therapists on the frequency of comorbidities in their clients and their influence on low vision intervention. Eight older adults with low vision participated in in-depth interviews and observations on the influence of low vision and comorbidities on their occupational performance. Conclusions reflect data analysis from both methods. RESULTS: The occupational therapists modified low vision interventions to address the added effect of each comorbidity. Modifications included more treatment sessions, home visits, referrals to other professions, and provision of strategies to address comorbidities. The older adults viewed vision loss as a stronger influence than comorbidities on independence in daily occupations. CONCLUSION: Both vision loss and comorbidities influence occupational performance, supporting the need for interventions to address both conditions.

Perspectives on home safety: do home safety assessments address the concerns of clients with vision loss?

PURPOSE: We explored the occupational performance and home safety perspectives of older adults with vision loss. Our study focused on the person-environment interaction to ascertain whether participants' concerns are addressed by three commonly used home safety assessments. METHOD: Twenty-two older adults with vision loss participated in face-to-face interviews regarding their perspectives on home safety. We compared categories generated from a content analysis of the data with the contents of three standardized home safety assessments. RESULTS: Five categories of home safety emerged from the analysis: (1) lighting, (2) contrast, (3) visual distractions, (4) glare, and (5) compensation strategies. Comparisons of content in the three home safety assessments with emerged categories revealed that study participants had specific concerns about home safety that were not thoroughly addressed in the selected assessments. CONCLUSION: The findings provide preliminary content areas that should be included in the development of a home assessment specific to the low vision population.