Innovative solutions to support individuals with disabilities accessing public transportation: a case study.

Individuals with cognitive disabilities have challenges with personal navigation and wayfinding, especially when traveling on public transportation. The purpose of this case study is to describe the structure and implementation of the Personal Navigation for Individuals with Disabilities (PNID) education and training program, which is based on a socio-technical architecture for individuals with cognitive disabilities within a fixed-route public bus system. A case study methodology was used to describe preliminary findings of the skills, attributes, and experiences of three individuals with cognitive disabilities as it relates to transportation on fixed-route bus systems in a midsized urban setting. The three individuals completed five training activities: safety, public bus, smartphone, WayFinder App, and fixed-route bus system. The case study provided a preliminary mixed-methods overview of training travelers with cognitive disabilities to use the WayFinder system while accessing fixed-route public bus system. The insights and strategies identified through the case study demonstrate the potential opportunities for development, implementation, and sustainability of the PNID program in other midsized urban settings. The PNID program (i.e. AT service delivery process), in combination with the WayFinder system (i.e. assistive technology), has the potential to meet the unique needs of individuals with cognitive disabilities when accessing public transportation.

A retrospective chart review of the patient population accessing augmentative & alternative communication at an urban assistive technology center.

The purpose of this study was to 1) identify and describe the population seeking alternative and augmentative communication (AAC) evaluations at an assistive technology (AT) center in the Midwestern United States and 2) describe the AAC device features or services participants identify as most important at their initial AAC evaluations. Charts of 53 participants seeking AAC interventions at an AT center in the Midwestern United States were retrospectively reviewed. Information from the QUEST 2.0 was used to determine what AT features were identified as most important. The majority of participants seen at the AT center had progressive diseases. Across all of the participants, ease of use and effectiveness were identified as the "most important" aspects of an AAC device satisfaction. These findings highlight the importance of determining who is accessing AAC services across AT centers to determine whether barriers to AAC services exist. Moreover, patients report regarding what variables they deem as most important reflect the fact that excellent service-delivery may not overcome the importance of other variables, such as ease of use that impact AAC use.

Test-Retest Reliability of the Electronic Instrumental activities of daily living Satisfaction Assessment (EISA): A Cohort Study.

IMPORTANCE: Currently, no self-report instruments exist for assessing satisfaction with performing instrumental activities of daily living and occupations for people with disabilities using internet-connected assistive devices like accessible smartphones, tablets, laptops, and apps. OBJECTIVE: To assess the test-retest reliability and internal consistency of the Electronic Instrumental activities of daily living Satisfaction Assessment (EISA) self-report outcome tool. DESIGN: Repeated-measures cohort study with a time frame of 7 to 21 days. SETTING: Multicity online recruitment at assistive technology clinics, nongovernmental organizations, advocacy and peer support groups for people with disabilities, and higher education institutions. PARTICIPANTS: Eighty-four participants with disabilities, age 18 yr or older, with a mean age of 43.3 yr (range = 19-75 yr), and 57% female. INTERVENTION: Not applicable. OUTCOMES AND MEASURES: The a priori study hypotheses were that the EISA test-retest reliability scores would be above the minimum acceptable level (Rs > .80) and that internal consistency would be good (Cronbach's α = .70-.90). RESULTS: On the basis of the study data, the EISA, Version 1.0, demonstrated good test-retest reliability (Rs = .81) and excellent internal consistency (Cronbach's α = .88). CONCLUSIONS AND RELEVANCE: The results of the test-retest reliability and internal consistency analyses provide good support for the EISA to be used in clinical settings. What This Article Adds: This article documents the reliability and internal consistency of, to our knowledge, the first-ever self-report instrument for assessing satisfaction with performance of everyday occupations for people with disabilities using internet-connected assistive devices such as smartphones, tablets, laptops, and apps.

A scoping review of communication outcomes measures in augmentative and alternative communication.

Although outcomes are a critical component of evidence-based practice, measuring augmentative and alternative communication (AAC) outcomes remains problematic. This is, in part, because there is no consensus on how to operationally define AAC communication outcomes. To gain greater insight into AAC communication outcomes, we used the communicative competence framework to determine which areas of AAC intervention have received the greatest attention and how these outcomes are being measured. The following data were charted from the 77 studies that met the inclusion criteria for the scoping review: study design, study participants, study communication target (e.g., language, word learning, etc.), and communication outcome measurements. Across the included studies, researchers used a variety of standardized and non-standardized measures to assess outcomes. Seventy-seven percent of the studies assessed social skills and 62% assessed linguistic skills. A limited number of studies measured operational (14%), strategic (4%), and psychosocial (18%) skills. Using the communicative competence framework enabled us to identify gaps in the research that has been conducted to date.

Rehabilitation engineers, technologists, and technicians: Vital members of the assistive technology team.

The rehabilitation engineering professions include rehabilitation engineers, rehabilitation technologists / assistive technologists and rehabilitation technicians. The purpose of this white paper is to define the rehabilitation engineering professions, describe educational pathways for the field of rehabilitation engineering, and describe the role of the rehabilitation engineering professions in a multitude of professional settings. An ad-hoc committee was convened by the Rehabilitation Engineering and Technologists (RE&T) Professional Standards Group (PSG) at the 2013 annual meeting, RESNA Conference in Seattle, Washington. The ad-hoc committee reviewed over 80 different sources in preparing the white paper, which included peer reviewed journal articles, conference proceedings, professional organization websites. Based on this review, in addition to expert opinion and stakeholder feedback, the committee developed the following definitions.Rehabilitation Engineer (RE) uses the innovative and methodical application of scientific knowledge and technology to design and develop a device, system or process, which is intended to satisfy the human needs of an individual with a disability.Rehabilitation Technologist / Assistive Technologist (RT/AT) combines scientific and engineering knowledge and methods with technical skills to complement engineering activities for an individual with a disability.Rehabilitation Technician (RTn) works with equipment, primarily assembling and testing component parts of devices or systems that have been designed by others for individuals with disabilities; usually under direct supervision of a rehabilitation engineer or rehabilitation technologist / assistive technologist. Their preferences are given to assembly, repair, or evolutionary improvements to technical equipment by learning its characteristics, rather than by studying the scientific or engineering basis for its original design.This whitepaper provides a framework for future discussions on the advancement of the rehabilitation engineering professions with the goal of improving the quality of life of individuals with disabilities through the application of science and technology.

Common reasons for non-participation during the outcome measurement process: wheeled mobility service delivery quality improvement reporting.

OBJECTIVE: The purpose of this paper is to describe non-participation during the outcome measurement step of the wheeled mobility service delivery process (WMSDP) based on the Functional Mobility Assessment (FMA)-Uniform Dataset (UDS) Registry. INTRODUCTION: The WMSDP is a standard framework for the provision of wheeled mobility devices, and several factors influence the client's experience throughout the process. Patient-reported outcomes are one way to measure the client's experience as part of a quality improvement program. METHODS: A retrospective descriptive study was conducted on the FMA-UDS Registry to measure the response rate during the outcome measurement step of the WMSDP and describe the reasons an individual did not complete the FMA-UDS. The FMA-UDS was examined at two time points: pre-delivery and post-delivery of the wheeled mobility device. RESULTS: As of September 2, 2021, 10,253 cases have been entered into the FMA-UDS Registry. 2,247 cases were no longer participating pre-delivery, and an additional 3,905 cases were no longer participating post-delivery. The most common reasons for non-participation in the FMA-UDS pre-delivery and post-delivery included: equipment not delivered; provider no longer participating in the FMA-UDS; funding issues; no new equipment; client opted out; loss in contact; deceased; returned equipment; and other. DISCUSSION: The type and frequency of non-participation in the outcome measurement step of the WMSDP is critical to understanding why individuals participate in outcome measures and provides insight into the barriers and facilitators for the implementation of quality improvement programs.

The outcome measurement system provides a structured mechanism for consistent communication between the client and the professionals providing the service, thereby identifying issues earlier in the process and mitigating frustration throughout the wheeled mobility service delivery process.The role of a credentialed professional, specifically an Assistive Technology Professional, in the wheeled mobility service delivery process could emphasize the importance of the follow-up and outcome measurement steps, which may increase the consumers' participation rate and demonstrate the effectiveness of devices and services.Clients who no longer participate in the outcome measurement process do not have the sustained support of the interprofessional team, and possess an increased chance that they will not get their mobility needs met through the health care system.

Service delivery for complex rehabilitation technology: a scoping review.

PURPOSE: Complex rehabilitation technologies (CRT) support independence for individuals with disabilities by enabling mobility for function, employment, education, and independent living. CRT service delivery is evolving, with changes to funding, provider qualifications, consumer needs, and technological advances. This scoping review investigated service delivery processes for individuals with disabilities who have a mobility impairment, while specifically identifying best practices, barriers, and unique features of health delivery policies and practices. METHODS: We used a framework described by Colquhoun et. al. for conducting scoping reviews, a six-step process that includes: 1) identifying the research question, 2) identifying studies, 3) selecting studies 4) data charting, 5) reporting results and 6) consultation. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) was also used for reporting results of the review. RESULTS: Common categories were identified and organised into a hierarchical structure of four categories and 16 sub-categories. The primary categories included "policy", "consumer", "service delivery", and "wheeled mobility devices". The sub-categories described funding sources, consumer and professional populations, service delivery guidelines, and types of mobility devices. Analysis indicated the data were from 21 countries and 14 combinations of funding sources, and the articles were primarily descriptive studies. CONCLUSION: This scoping review identified evidence from various countries, health systems, and stakeholder. Currently, this process does not proactively address the needs of individuals with mobility disabilities. The scoping review provides the foundation for the development of a novel policy on the provision of CRT services and devices to address these needs.Implications for RehabilitationExamination of national and international service delivery practices in diverse clinical and funding environments indicate various challenges and opportunities for improvement.CRT consumers are negatively impacted by current service delivery practices, including long wait times, lack of specialised clinical expertise, and limited consumer education opportunities.More consistent and widespread research is needed within the CRT provision industry to grow evidence-based practice related to complex rehabilitation technology and individuals with disabilities.

Mhealth interventions to improve health and quality of life related outcomes for informal dementia caregivers: A scoping review.

BACKGROUND: The devastating effects of dementia extend to the health and well-being of informal dementia caregivers. The physical and mental requirements of serving as a dementia caregiver are evidenced in the negative health effects that this population experiences. There is a present need for effective interventions to improve health and quality of life in informal dementia caregivers. OBJECTIVE: To investigate the health and well-being related outcomes following mHealth use in dementia caregiver and care recipient populations. METHODS: A scoping review was undertaken to investigate mHealth use in dementia caregivers. Searches spanning four databases yielded 172 articles. Following screening procedures, 12 articles were included for data extraction.. RESULTS: Articles were organized into three major themes: social and indirect support, health education, and technology-supported monitoring. Social and indirect support apps may be valuable for caregiver stress relief, confidence, and fatigue. Health education apps were found to 1) assist with the organization of user's health information, and 2) impact depressive symptoms. Monitoring apps provided caregivers with methods of observing both physical and emotional well-being.. CONCLUSION: Currently, the limited evidence on the usability and usefulness of mHealth within dementia caregiver populations indicates that mHealth holds promise as an intervention platform and warrants continued investigation.Abbreviations: AD: Alzheimer's Disease; CANE: Camberwell Assessment of Need for the Elderly; CCS: Caregiver Competence Scale, CDN: COGKNOW Day Navigator; CES-D: Center for Epidemiologic Studies Depression Scale; CG: Caregivers; CQoL-AD: Carer's Overall Quality of Life in Alzheimer's Disease; Dx: Diagnosis; ESM: experience sampling methodology; FB: Facebook; PA: Positive Affect; Pss-14: Perceived Stress Scale; QOL: Quality of Life; RCSS: Revised Caregiving Satisfaction Scale; SSCQ: Short Sense of Competence Questionnaire.

Health App Review Tool: Matching mobile apps to Alzheimer's populations (HART Match).

Aim: This brief report provides an overview of the development and structure of the Health App Review Tool. Methods: The Health App Review Tool has been designed to assess smart phone health apps according to their compatibility to individuals within the Alzheimer's disease community. Specifically, app features and functions are characterized according to their appropriateness to the needs, abilities, and preferences of potential users. The Health App Review Tool is comprised of two components, the App and User Assessment; each component includes four complementary domains. Items in these domains can be compared between App and User assessments using a scoring key that will produce a match score. The score indicates the level of appropriateness in reference to the app's ability to meet the user's needs. Discussion: The Health App Review Tool was designed using available evidence and stakeholder preference data to ensure a user-centered design. The result was the development of a tool built on evidence and informed by the perceptions and preferences of those within and working with the Alzheimer's disease population. App and User domains include usefulness, complexity, accessibility, and external variables. This unique matching approach is anticipated to significantly impact individualized, client-centered care. We anticipate that this study will serve as a model for future development of technology matching tools for other diagnostic populations. Discussion: The Health App Review Tool was designed using available evidence and stakeholder preference data to ensure a user-centered design. The result was the development of a tool built on evidence and informed by the perceptions and preferences of those within and working with the Alzheimer's disease population. App and User domains include usefulness, complexity, accessibility, and external variables. This unique matching approach is anticipated to significantly impact individualized, client-centered care. We anticipate that this study will serve as a model for future development of technology matching tools for other diagnostic populations.

Evaluation of the Functional Mobility Assessment Through Rasch Analysis.

OBJECTIVE: To determine the effectiveness of the Functional Mobility Assessment (FMA) when measuring an individual's satisfaction with functional mobility. DESIGN: Secondary analysis of cross-sectional self-report data. SETTING: Assistive technology center within an academic medical center in the Midwestern United States. PARTICIPANTS: Individuals with a disability that use or plan to use a mobility device (N=871). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: FMA. RESULTS: All FMA items (10/10) contributed to a single unidimensional construct with good to strong fit to a unidimensional confirmatory factor model. Rasch analysis revealed that the rating scale, majority of persons (>90%), and all items fit the Rasch measurement model. The FMA demonstrated adequate reliability (person reliability=0.85) and separated persons into 3 strata: those with high, medium, and low satisfaction with functional mobility. CONCLUSIONS: The FMA is an appropriate measure for use in research and clinical settings to quantify satisfaction with functional mobility among mobility device users.

Evaluation of Service Delivery Effectiveness Through Patient-Reported Outcome Measures.

OBJECTIVE: The aims of the study were to report the demographic characteristics and functional mobility for individuals accessing an academic medical center mobility device clinic and to compare functional mobility data across demographic characteristics and mobility device type. DESIGN: This study used a retrospective, cross-sectional design. Demographic, mobility type, and patient-reported outcome measure data for 833 clients were analyzed. The Functional Mobility Assessment was used as the patient-reported outcome measure to determine satisfaction. RESULTS: The mean (SD) baseline Functional Mobility Assessment score was 0.59 (0.25) on a 0-1 scale. Significant differences with the Functional Mobility Assessment scores were found across the mobility device types, with scooter and power wheelchair groups reporting higher satisfaction scores than those in the cane/crutch/walker or manual wheelchair groups. Device type, sex, and age were each found to be significant predictors of satisfaction scores (P < 0.01). CONCLUSIONS: Mobility device type is associated with satisfaction level. Mobility devices that offer higher levels of assistance are associated with increased satisfaction. The Functional Mobility Assessment, mobility device type, and demographic data provide baseline information for evaluating the effectiveness of an academic medical center mobility device clinic.

Manual wheelchair propulsion on ramp slopes encountered when boarding public transit buses.

Objective: To compare the kinetics of manual wheelchair (MWC) propulsion on ramps of varying slopes that may be encountered when accessing large accessible transit vehicles (LATVs). Design: Observational study. Setting: Biomechanics research laboratory. Participants: A convenience sample of able-bodied adults (n = 7) having no propulsion experience propelled a MWC on ramps of slope 3.5°, 9.5° and 15°. Interventions: Not applicable. Main outcome measures: Resultant (Fres), radial (Fr) and tangential (Ft) forces applied to the wheelchair pushrim, rate of rise of resultant force (ROR), peak power output (P), temporal characteristics and thigh to trunk angle were analyzed across three ramp slopes. Results: Pushrim forces and power output significantly increased with increasing slope, with peak Fres more than doubling from 107 N on a 3.5° slope to 230 N on a 15° slope. ROR was 1.76 times higher at 9.5° and 2.47 times higher at 15° compared to a 3.5° slope. Minimum thigh to trunk angle decreased sharply from 80° (3.5° slope) to 50° (9.5° slope) and then to 30° (15° slope) as ramp slope increased. Conclusions: Ascending bus ramps require greater power and pushrim force on steeper ramp slopes, presenting a potential barrier to transportation accessibility. Given this finding, it is imperative that bus operators minimize ramp slope to assure MWC users are able to access LATVs. Implications for Rehabilitation Although transit bus ramps are intended to provide wheelchair access to public transportation, limitations in MWC user physical strength and function may prevent safe access. Transit bus ramp slopes encountered during ingress can present a challenge to MWC users given power output and pushrim force requirements to ascend the ramp. MWC users and therapists should be aware of ramp slopes that may be encountered when boarding transit buses; wheelchair training should incorporate skills needed to ascend transit bus ramps.

The need for updated clinical practice guidelines for preservation of upper extremities in manual wheelchair users: a position paper.

The purposes of this article were to examine the existing 2005 Clinical Practice Guidelines for preservation of the upper extremities in spinal cord injury and explore the literature to determine what might need to be included in an update. This is a consensus position article based on a literature review and the expertise of the authors. The findings support the original recommendations of the Clinical Practice Guidelines and provide evidence that suggests that information regarding equipment and skills training as well as impact to caregivers is needed.

Multisite comparison of wheelchair propulsion kinetics in persons with paraplegia.

A multisite collaborative study is being conducted on the association between propulsion biomechanics and upper-limb injuries. This substudy compared subject characteristics and pushrim kinetics across three sites and identified early on in the main study any differences that could affect interpretation of the findings or data pooling. A total of 42 manual wheelchair users with paraplegia (14 from each site) performed 0.9 m/s and 1.8 m/s steady state propulsion trials and an acceleration-brake-coastdown trial on a wheelchair dynamometer while propulsion forces and moment about the hub were measured with a SmartWheel. Significant differences between two sites were found in peak and average resultant force (p < 0.05), peak and average moment at the slower steady state speed (p < 0.005), and peak and average torque at the faster steady state speed (p = 0.06). Subjects at the site with significantly lower forces and torques had a slower deceleration rate during coastdown compared with the subjects at the other two sites (p < 0.001). These results imply that rolling resistance is lower at one of the sites and likely due to differences in dynamometer properties. A mechanical method was used to site-normalize the data and enable data pooling for future analyses.

Using the absorbed power method to evaluate effectiveness of vibration absorption of selected seat cushions during manual wheelchair propulsion.

Although wheelchair users are frequently subjected to oscillatory and shock vibrations, little research has been conducted to assess the whole-body vibration exposure of wheelchair users. The purpose of this study was to determine if selected wheelchair cushions alter potentially harmful whole-body vibrations transferred to wheelchair users. Thirty-two participants, who use wheelchairs as their primary mode of mobility, contributed to this study. Four of the most commonly prescribed wheelchair cushions were selected. Participants were asked to propel their wheelchair over a simulated activities of daily living (ADL) course while acceleration and force data were recorded. A repeated measures ANOVA showed no significant differences between the different cushions for the total averaged absorbed power (p = 0.190), the 50 mm curb drop (p = 0.234), or the rumble strip (p = 0.143). A repeated measure ANOVA for the peak curb drop absorbed power revealed a significant difference in the cushions (p = 0.043). The cushions that were most effective in this testing appear to be the Invacare Pindot and the Varilite Solo. Not only did those cushions appear to have the lowest values much of the time but also they did not display the highest values. When comparing results from a similar study, absorbed power appears to be as effective in determining vibration effects in the time domain as the methods in the ISO 2631 Standard.

Whole-body vibration during manual wheelchair propulsion with selected seat cushions and back supports.

Although the exposure to whole-body vibrations (WBV) has been shown to be detrimental to seated humans, the effects of wheelchairs and seating systems on the transmission of vibration to an individual have not been thoroughly examined. The purpose of this study was to determine if the selected wheelchair seat cushions and back supports minimize the transmission of vibrations. Thirty-two wheelchair users traversed an activities of daily living course three times using 16 randomly selected seating systems as well as their own. Vibrations were measured using triaxial accelerometers at the seat and participant's head. The weighted fore-to-aft (Tx), vertical (Tz), and resultant (Tr) transmissibility based on the vibrational-dose-value (VDV) were used to determine if differences existed among the four seat cushions and back supports. The obstacles that seem to have the largest effect on the transmission of WBV are the single event shocks and the repeated event shocks. Comparisons between the individuals own seating system and the tested seating systems suggest that the individuals are not using the most appropriate seating system in terms of the reduction of vibration transmission.

Analysis of whole-body vibration during manual wheelchair propulsion: a comparison of seat cushions and back supports for individuals without a disability.

Whole-body vibration exposure has been found to be detrimental to the health of humans owing to effects such as degraded comfort, disc degeneration, and lower back pain. The purpose of this study was to determine if selected seat cushions and back supports minimize the transmission of vibrations during manual wheelchair propulsion. Ten unimpaired participants traversed an activities of daily living course using four seat cushions and four back supports. Vibrations were measured using triaxial accelerometers. The time domain and frequency domain transmissibility was used to determine if differences exist among seat cushions and back supports. Differences were found among the four seat cushions and four back supports. Seat cushion and back support manufacturers should concentrate on single-event shocks and repeated shocks, as opposed to oscillatory motions and self-generated vibrations, because the vibrations generated by these events tend to reside in the range of frequencies most sensitive to humans. Vibrations in this range of frequencies have the greatest effect on the transmission of whole-body vibration during manual wheelchair propulsion. Differences among the seat cushions and back supports appear to be due to the seat cushion/back support design and postural support. From a clinical perspective, the time domain transmissibility best describes the transmission of whole-body vibration.

Filter frequency selection for manual wheelchair biomechanics.

Wheelchair locomotion is an important form of mobility for many individuals with spinal cord injury. However, manual wheelchair propulsion can lead to upper-limb pain and can be very inefficient. This has led investigators to apply biomechanics to the study of wheelchair use. The objectives of this study were (1) to determine the frequency content of the motion of both hands during two speeds of wheelchair propulsion, (2) to obtain the filter frequencies necessary to remove noise from wheelchair motion data, and (3) to provide signal-to-noise ratio data for wheelchair kinematics. The participants in this study were a random sample of manual wheelchair users with paraplegia caused by spinal cord injury. Subjects propelled their personal wheelchairs on a computer-controlled dynamometer at speeds of 0.9 m/s and 1.8 m/s. Motion data were collected at 60 Hz with the use of a commercial infrared marker-based system. The main outcome measures were arm motions and noise frequency spectra, filter cutoff frequencies, and signal-to-noise ratio. Our results indicate that there is no useful signal power above 6 Hz during manual wheelchair propulsion at the speeds that we analyzed. In many cases, there was no useful signal power above 4 Hz. This would indicate that the frequency content of manual wheelchair propulsion is similar to that of human gait. The mean signal-to-noise ratio varied from a high of 91 dB to a low of 21.8 dB. The signal-to-noise ratio was greatest in the x direction (along the line of progression) and lowest in the z direction (medial-lateral). Manual wheelchair propulsion kinematic data should be low-pass filtered at approximately 6 Hz for speeds at or below 1.8 m/s. The data presented in the archival literature appear to have been filtered at an appropriate frequency.