Access to and interest in assistive technology for home-dwelling people with dementia during the COVID-19 pandemic (PAN.DEM).

The COVID-19 restrictions affect daily living in Norway, including home-dwelling people with dementia, and researchers conducting clinical trials in dementia care. In this paper, we 1) describe the development of a pandemic cohort (PAN.DEM) incorporated in the LIVE@Home.Path, an ongoing clinical intervention trial on resource utilisation including home-dwelling people with dementia and their caregivers (N = 438 dyads), 2) describe pre-pandemic use of assistive technology and 3) explore the extent to which COVID-19 restrictions increase caregivers interest in innovation in the PAN.DEM cohort (N = 126). Our main finding is that assistive technology is available to 71% pre-pandemic; the vast majority utilise traditional stove guards and safety alarms, only a few operate sensor technology, including GPS, fall detectors or communication aids. In response to COVID-19, 17% show increased interest in technology; being less familiar with operating a telephone and having higher cognitive functioning are both associated with increased interest. We conclude that wearable and sensor technology has not yet been fully implemented among people with dementia in Norway, and few caregivers show increased interest under the restrictions. Clinicaltrials.gov (NCT0404336).

Stroke rehabilitation in low-income and middle-income countries: a call to action.

The WHO Rehabilitation 2030 agenda recognises the importance of rehabilitation in the value chain of quality health care. Developing and delivering cost-effective, equitable-access rehabilitation services to the right people at the right time is a challenge for health services globally. These challenges are amplified in low-income and middle-income countries (LMICs), in which the unmet need for rehabilitation and recovery treatments is high. In this Series paper, we outline what is happening more broadly as part of the WHO Rehabilitation 2030 agenda, then focus on the specific challenges to development and implementation of effective stroke rehabilitation services in LMICs. We use stroke rehabilitation clinical practice guidelines from both high-income countries and LMICs to highlight opportunities for rapid uptake of evidence-based practice. Finally, we call on educators and the stroke rehabilitation clinical, research, and not-for-profit communities to work in partnership for greater effect and to accelerate progress.

Are there differences in factors influencing access and continued use of assistive products for people with intellectual disabilities living in group homes?

Background: The World Health Organization has launched a program to promote Global Cooperation on Assistive Technology (GATE) to implement those parts of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) referring to assistive technology and products. A particular vulnerable group deeply affected by health inequity affecting access to assistive products are people with intellectual disabilities.Objective: The objective of this study is to understand the barriers and facilitators to effectively access and continuously use essential assistive products for people with intellectual disabilities.Materials and methods: Face-to-face interviews with 15 adults with a mild to profound intellectual disability and 15 providers of assistive products were conducted to gain insights about current use, needs, knowledge, awareness, access, customization, funding, follow-up, social inclusion, stigma and policies around assistive products and intellectual disability. The technique of constant comparative analysis was used to analyze the data.Results and conclusion: An overview of factors is presented that fit within seven domains for access and eight domains for continuous use of assistive products for people with intellectual disabilities. It illustrates that access and continuous use are influenced by different barriers and facilitators. These different influences should be taken into account in country policies and frameworks that seek to implement the UNCRPD through assistive technology.Implications for rehabilitationProactive assessment for assistive products by health professionals is rare and the vast majority of people with intellectual disabilities depend on carers to signal the need .A lack of education for carers around available assistive products and the benefits of assistive products for people with intellectual disabilities may lead to an underutilization for this group.The paternalistic attitude of care providers towards people with intellectual disabilities limits access and use to certain (high-tech) assistive products.The segmented and disjointed aspect of public funding to support assistive products found in this study is a key issue for policymakers who aspire to adhere to implementing the UNCRPD equally in all areas of their country.

Need and availability of assistive devices to compensate for impaired hand function of individuals with tetraplegia.

Context/Objective: To evaluate the availability and self-declared unmet need of assistive devices to compensate for impaired hand function of individuals with tetraplegia in Switzerland.Design: Cross-sectional survey.Setting: Community.Participants: Individuals with tetraplegia, aged 16 years or older, living in Switzerland.Interventions: not applicable.Outcome Measures: The self-report availability and unmet need of 18 assistive devices for impaired hand function was analyzed descriptively. The availability of devices was further evaluated stratified by sex, age, SCI severity, independence in grooming, time since injury, living situation, working status, and income. Associations between availability of devices and person characteristics were investigated using logistic regression analysis.Results: Overall 32.7% of participants had any assistive device for impaired hand function at their disposal. The most frequent devices were adapted cutlery (14.8%), type supports (14.1%), environmental control systems (11.4%), and writing orthosis (10.6%). In the bivariate analysis several factors showed significant associations with at least one assistive device. Nevertheless, when controlling for potential confounding in multivariate analysis only independence in grooming (adapted cutlery, environmental control systems, type support, speech recognition software), SCI severity (writing orthosis, type support), and sex (adapted kitchenware) remained significantly associated with the availability of the mentioned assistive devices. The self-declared unmet need was generally low (0.7% - 4.3%), except for adapted kitchenware with a moderate unmet need (8.9%).Conclusion: This study indicates that most individuals with tetraplegia in Switzerland are adequately supplied with assistive devices to compensate for impaired hand function. The availability depends mainly on SCI severity and independence in grooming.

Systematic review: Investigating the effectiveness of assistive technology to enable internet access for individuals with deafblindness.

The purpose of this study is to systematically review published evidence regarding the development, use, and effectiveness of assistive devices and technol ogies that enable internet access for individuals who are deafblind. Eight electronic research databases (CINAHL, Embase, Engineering Village MEDLINE, PsycINFO, PubMed, Cochrane Library, and Web of Science) and three clinical trials registries (ISRCTN Registry, WHO ICTRP, and ClinicalTrials.gov) were searched.Seven articles met the inclusion criteria for this systematic review. The assistive technologies described were in the preliminary stages of development, with only three of the technologies having undergone any testing. The effectiveness of all seven assistive technologies was quantified in this review based on the proposed impacts of internet access on the domains of the World Health Organization's International Classification of Functioning, Disability and Health framework.Internet access technologies for individuals with deafblindness are in the early stages of development and are targeted toward specific functions of the internet. It is imperative that future device development and evaluation seek input from persons who are deafblind. There is also a need to address the gap between academic research, which seeks to develop assistive technology to access the internet and the translation into real-world use of this technology.

Unmet Needs and Use of Assistive Products in Two Districts of Bangladesh: Findings from a Household Survey.

Access to assistive products (AP) is an under-researched public health issue. Using an adaptation of a draft World Health Organization tool-the 'Assistive Technology Assessment-Needs (ATA-N)' for measuring unmet needs and use of AP, we aimed to understand characteristics of AP users, self-reported needs and unmet needs for AP, and current access patterns in Bangladesh. The ATA-N was incorporated in a Rapid Assessment of Disability (RAD), a population-based survey to estimate prevalence and correlates of disability. In each of two unions of Kurigram and Narsingdi districts, 60 clusters of 50 people each aged two years and older were selected using a two-staged cluster random sampling process, of whom, 4250 (59% Female; 41% Male) were adults, including 333 using AP. We estimate 7.1% of the studied population used any AP. AP use is positively associated with age and self-reported functional difficulty. The proportion of people using AP is higher for mobility than for sensory and cognitive difficulties. Of all people with any functional difficulty, 71% self-reported an unmet need for AP. Most products were home or self-made, at low cost, but provided benefits. Needs and unmet needs for AP are high, especially for people with greater functional difficulties. Assessing unmet needs for AP revealed important barriers to scale that can inform policy and practice.

Access to assistive technology in two Southern African countries.

BACKGROUND: Millions of people in Southern Africa are deprived of basic human rights such as the right to education and work because of the large and growing unmet demand for assistive technologies (AT). Evidence is needed to better characterize the lack of AT access. METHODS: This study serves to identify the sociodemographic factors that are associated with access to AT in two countries in Southern Africa, Botswana and Swaziland. To achieve this aim, logistics regression was applied to a subset of variables from two Living Conditions Studies, nationally representative surveys that were conducted in Southern Africa (2014 and 2010). RESULTS: In Botswana, 44% of people who needed AT did not receive it, while in Swaziland the unmet need was 67%. Among the sociodemographic variables tested, the type of disability was the most important factor in determining AT access in both countries. The likelihood of AT access was highest in both countries for those who had mobility limitations (i.e., difficulty walking/climbing stairs) [Botswana: 6.4 odds ratio (OR) = 6.4., 95% confidence internal (CI) (3.6-11.3); Swaziland: OR = 3.2, CI (1.4-7.3)], in comparison to those with non-mobility types of disabilities. CONCLUSIONS: These findings provide support for governments and other stakeholders in the AT sector to prioritize AT to address the large unmet demand, and expand the range of AT products provided so that people with hearing, seeing, self-care, communication and cognition difficulties have equal access to AT as those with mobility impairments. A step toward achieving these aims is to inventory AT product types that are commonly covered through the public sector in each country, and identify common gaps (e.g., daily living aids). Advancing the AT sector as a whole within Southern Africa will require large scale qualitative studies that achieve a comprehensive understanding of the bottlenecks in regional AT supply, procurement, and delivery systems.

Improving access to assistive technologies: challenges and solutions in low- and middle-income countries.

Assistive technologies can benefit a wide range of people, including those with disabilities; those with age-related frailties; those affected by noncommunicable diseases; and those requiring rehabilitation. Access to these technologies is limited in low- and middle-income countries but the already-high need will inevitably rise further because of demographic and epidemiological transitions. Four key gaps contribute to limited access. First, although need is high, demand is low, not least because of widespread lack of awareness among potential beneficiaries, their caregivers, and their health-care providers. Second, product designs are insufficiently informed by users' and caregivers' preferences and environments, and transfer of technologies to low-resource settings is limited. Third, barriers to supply include low production quality, financial constraints and a scarcity of trained personnel. Fourth, there is a dearth of high-quality evidence on the effectiveness of different types of technology. Adoption of the World Health Assembly Resolution WHA71.8 in 2018 marked convergence of, commitment to and strengthening of efforts to close these gaps and improve access to assistive devices. The Global Cooperation on Assistive Technology workplan identifies four overarching, interlinked solutions for countries to improve access. First, a national policy framework for assistive technology is needed. Second, product development should be encouraged through incentive schemes that support and promote affordable assistive products. Third, capacity-building of personnel is needed, through undergraduate and in-service training. Fourth, provision needs to be enhanced, especially through integration of services with the health system. These actions need to be underpinned by government leadership, a multisectoral approach and adequate funding.

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.

Inclusion of Assistive Technologies in a Basic Package of Essential Healthcare Service.

This paper outlines the potential and necessity of the development of assistive technologies (AT) for people with intellectual disabilities (IDs). We analyse a policy recommendation designed to determine the contents of a basic health package supplied by the state, known as the Dunning Funnel. We contend that the Dunning Funnel is a useful methodology, but is weakened by a potentially relativistic understanding of "necessity" in relation to the requirements of people with IDs (i.e., community standards will determine whether AT are necessary). We remedy this defect by using the capabilities approach as outlined by Martha Nussbaum. We argue that this approach provides a strong normative case for ensuring that communities provide help to people with IDs, if those communities are to achieve a minimal standard of justice. However, the capabilities approach does not offer much specific guidance on how AT ought to be distributed, nor does it offer guidance on risks, like the bottomless pit problem. We propose that the Dunning Funnel used in combination with the capabilities approach will provide a suitable heuristic for determining the distribution of AT in a basic health package.

Ethical challenges related to assistive product access for older adults and adults living with a disability: a scoping review protocol.

BACKGROUND: Despite the surge of research and development in assistive products for older adults and/or people living with disabilities, policies on access and procurement have lagged in responding to the growing demand from users. Developing policies to address these concerns require an understanding of the ethical challenges underlying approaches for providing assistive products. The purpose of this scoping review is to identify and map the literature pertaining to ethical challenges related to assistive product access and procurement to inform policy development. METHODS/DESIGN: We will use established approaches to conducting scoping reviews which include five stages: (1) conducting broad searches to identify potentially relevant literature, (2) refining selection criteria, (3) reviewing search results, (4) mapping literature according to conceptual areas of interest, and (5) summarizing results. We will analyze data by thematically grouping the descriptions of assistive products identified in the included articles and conducting a content analysis to iteratively develop a targeted synthesis of literature focused on ethical challenges in relation to assistive product access and procurement by older adults and/or adults living with disabilities. DISCUSSION: Our scoping review findings will focus on and provide insight about the models, frameworks, and principles that have been used to understand ethical challenges related to technology access and procurement. We will use the findings to help inform a series of citizen panels in Canada to identify Canadians' values and preferences for enhancing equitable access to assistive products.

Operationalizing workplace accommodations for individuals with disabilities: A scoping review.

BACKGROUND: The provision of workplace accommodations is a proven strategy in supporting individuals with disabilities at work. Accommodations include a wide range of supports and strategies that are not very well defined beyond the Americans with Disabilities Act in the United States. Understanding the landscape of accommodations is important to measure the impact of programs that support employment of individuals with disabilities. OBJECTIVE: To conduct a scoping review and thematic analysis of research literature to identify how workplace accommodations are operationalized and to identify knowledge gaps in its conceptualization. METHODS: Keywords searches were conducted in seven electronic databases. Title, abstract, and full text screening was conducted followed by a thematic analysis of the content to identify how workplace accommodations are operationalized. RESULTS: Overall, 47 studies were selected for review. 433 different types of accommodations were identified, of which assistive technology and specialized equipment represented the most frequently reported type of accommodation (40%). A very small percentage of studies included policy changes (9%) and human assistance (5%) as an accommodation strategy. CONCLUSIONS: This scoping review aims to clarify how accommodations are operationalized in the research literature. Key knowledge gaps identified include the systematic exclusion of certain types of supports or disability types.

A survey of assistive technology service providers in the USA.

This study investigates perspectives of assistive technology service (ATS) providers regarding their education and training, interdisciplinary standards of practice, use of a common language framework, funding policies, utilization of evidence and outcomes measurement. A survey underpinned by AT legislations and established guidelines for practice was completed by 318 certified AT providers. More than 30% of the providers reported their education and training as inadequate to fulfil four of the seven primary roles of ATS. Nearly 90% of providers expressed awareness of the International Classification of Functioning, Disability and Health (ICF) domains for interdisciplinary communication. However, only 45% felt that they could effectively utilize the ICF in their documentation. About 75% of the providers acknowledged the lack of a recognized standard for the provision of services. Prevailing inadequacies in funding were negatively impacting the quality of ATS, as expressed by 88% of respondents. Translation of evidence to practice was identified as a major challenge by 41% of service providers. Providers were predominantly documenting outcomes through informal interviews (54%) or non-standard instruments (26%). Findings support the need for strengthening professional curriculum, pre-service and in-service training and an established standard to support effective, interdisciplinary AT services and data collection to support public policy decisions. Implications for Rehabilitation This study validates the need to strengthen education and training of AT service providers by enhancing professional curriculum as well as their engagement in pre-service and in-service training activities. This study draws attention to health care funding policies and practices that critically impact the quality of AT services. This study signifies the need for an established interdisciplinary standard among AT professionals to support effective communication, service coordination and outcomes measurement.

Assistive Technology and Older Adults in Disasters: Implications for Emergency Management.

This article identifies concepts, trends, and policy gaps in the availability and service delivery of assistive technology utilized by older adults in disasters, as well as implications for emergency management planning and shelter administration. Definitions of types of assistive technology, as well as views of older adults using technology as at-risk individuals for emergency management service provision, are provided. An overview of peer-reviewed articles and gray literature is conducted, focusing on publications from 2001 to the present in the United States. Analytical frameworks used by emergency management organizations as well as regulations such as the Americans with Disabilities Act and recent court decisions on emergency shelter accessibility in disasters are reviewed. Research on the use of assistive technology by older adults during disasters is a neglected issue. The current and potential benefits of defining standards for provision and use of assistive technology for older adults during disasters has received limited recognition in emergency management planning. Older adults with disabilities utilize assistive technology to maintain their independence and dignity, and communities as well as emergency services managers need to become more aware of the needs and preferences of these older adults in their planning processes and drills as well as in service delivery during actual events. (Disaster Med Public Health Preparedness. 2017;11:135-139).

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.

Commentary on WHO GATE Initiative.

Assistive technology is essential to people with spinal cord injuries (SCI) for living and participating in their communities. However, many people with SCI do not have access to adequate assistive technology and qualified services. The World Health Organization (WHO) is addressing this need through the Global Cooperation on Assistive Technology (GATE). The GATE initiative is focused on improving access to high-quality affordable AT world-wide. GATE working to meet the AT sector needs in response to the call by WHO to increase access to essential, high-quality, safe, effective and affordable medical devices, which is one of the six WHO leadership priorities.

A description of assistive technology sources, services and outcomes of use in a number of African settings.

Purpose statement: The article explores assistive technology sources, services and outcomes in South Africa, Namibia, Malawi and Sudan. METHODS: A survey was done in purposively selected sites of the study countries. Cluster sampling followed by random sampling served to identify 400-500 households (HHs) with members with disabilities per country. A HH questionnaire and individual questionnaire was completed. Country level analysis was limited to descriptive statistics. RESULTS: Walking mobility aids was most commonly bought/provided (46.3%), followed by visual aids (42.6%). The most common sources for assistive technology were government health services (37.8%), "other" (29.8%), and private health services (22.9%). Out of the participants, 59.3% received full information in how to use the device. Maintenance was mostly done by users and their families (37.3%). Devices helped a lot in 73.3% of cases and improved quality of life for 67.9% of participants, while 39.1% experienced functional difficulties despite the devices. CONCLUSION: Although there is variation between the study settings, the main impression is that of fragmented or absent systems of provision of assistive technology. Implications for rehabilitation Provision of assistive technology and services varied between countries, but the overall impression was of poor provision and fragmented services. The limited provision of assistive technology for personal care and handling products is of concern as many of these devices requires little training and ongoing support while they can make big functional differences. Rural respondents experienced more difficulties when using the device and received less information on use and maintenance of the device than their urban counterparts. A lack of government responsibility for assistive device services correlated with a lack of information and/or training of participants and maintenance of devices.