[Show abstract][Hide abstract] ABSTRACT: In this study we explored the factors that affect assistive technology (AT) provision within the Navajo Nation using a qualitative approach to inquiry. Focus groups were held in which AT users discussed their awareness of AT and their need for, use of, and satisfaction with AT devices and services. Twenty-eight individuals who used wheelchairs, orthotics or prosthetics, hearing aids, communication aids, vision aids, and other AT participated in one of seven focus groups. Seven AT providers discussed the facilitators and barriers that affect AT provision. The findings revealed six themes common to both stakeholder groups and two additional themes for AT users. The central theme for AT users centered on (not) feeling understood; the central theme for AT providers revolved around the processes, activities, and roles the providers engaged in at times for different clients. Activities to increase awareness and to promote successful AT provision and satisfaction with AT devices were proposed.
Qualitative Health Research 08/2014; 24(11). DOI:10.1177/1049732314546755 · 2.19 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Study Design:Literature ReviewBackground:We estimate that over 29 million people worldwide in resource-limited environments (RLEs) are in need of orthotic and prosthetic (O&P) devices and services.Objectives:Our goal was to ascertain the current state of O&P provision in RLEs and identify factors that may lead to more successful O&P provision.Methods:We conducted a comprehensive scoping literature review of all information related to O&P provision in RLEs published from 2000 to 2010. We targeted Vietnam, Cambodia, Tanzania, Malawi, Colombia, and the Navajo Nation, but also included information about developing countries in general. We searched academic databases and grey literature. We extracted information from each article in the areas of design, manufacturing, distribution, service provision, and technology transfer.Results:We identified commonly reported considerations and strategies for O&P provision from 431 articles. Analysis of expert consensus documents revealed recurring themes for improving O&P provision. We found that some suggestions from the consensus documents are being followed, but many are overlooked or have not yet been implemented.Conclusions:Areas for improvement include conducting field testing during the design process, providing services to rural environments, offering follow-up services, considering government collaboration, and encouraging an active role of the orthosis/prosthesis user. Outcomes and research studies will be further discussed in Part Two.
[Show abstract][Hide abstract] ABSTRACT: Background:Despite the activities of many orthotic and prosthetic provision organizations in resource-limited environments, there is still a great need and there are several areas for improvement, as identified in Part One of this series.Objectives:Our goal was to examine outcomes and conclusions of research studies to produce an evidence base for determining factors that may lead to successful provision of orthoses and prostheses in resource-limited environments.Study design:Literature review.Methods:We conducted a scoping literature review of all information related to orthotic and prosthetic provision in resource-limited environments published from 2000 to 2010. We extracted measured outcomes reported in all types of articles and analyzed conclusions from research studies.Results:Reported outcomes included durability, cost, satisfaction, use/nonuse of device, amount of utilization, walking speed, discomfort, pain, fit, misalignment, capacity for service provision, number of devices produced or delivered, and number of graduates from training programs.Conclusions:There are many gaps in the evidence base, notably in measuring inclusion, participation, and quality of life for orthosis and prosthesis users in resource-limited environments. There is a paucity of reported outcomes for orthotics. Valid, reliable, and standard methods of data collection and reporting are needed to advance the field and enhance the evidence base.
[Show abstract][Hide abstract] ABSTRACT: The objectives of this study were to compare three á priori alignment methods and evaluate them based on initial gait quality and further alignment changes required to optimize gait. Á priori alignment is requisite for monolimbs, transtibial prostheses in which the socket and pylon are made from one piece of plastic, because monolimbs have no alignment adjustability.
The three methods investigated were traditional bench alignment (TRAD), vertical alignment axis (VAA) and anatomical based alignment (ABA). Endoskeletal components were utilized for the study, rather than monolimbs, so that alignment could be experimentally manipulated. Three endoskeletal prostheses were aligned, one according to each á priori method, for each of seven subjects. Gait and alignment data were captured, dynamic alignment was performed to optimize gait, and data were captured again.
VAA and TRAD methods required less change compared to ABA in socket flexion angle. Looking at subjects individually, VAA produced a better alignment and better gait for the greatest number of subjects.
A new refined method of á priori alignment is proposed based on the results of this study, and is applicable for á priori alignment of monolimbs or any type of transtibial prosthesis.
Disability and rehabilitation. Assistive technology 04/2012; 7(5):381-8. DOI:10.3109/17483107.2011.637284
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to transfer three simplified alignment techniques to prosthetic technicians in a developing country through training materials and a hands-on training workshop, and to subsequently evaluate the efficacy of the alignment systems in producing acceptably aligned monolimb prostheses.
Prosthetists utilized the anatomically-based-alignment (ABA)-standing, ABA-supine and vertical alignment axis (VAA) alignment systems to produce three monolimbs for each of 30 healthy and active transtibial amputees. Prosthetists assessed all three monolimbs for each subject in both static and gait conditions to determine which monolimb had the best alignment and produced the best functional gait. Subjects also selected the monolimb which they believed had the best alignment; subjects utilized each monolimb for a 1-month home assessment.
Twenty-eight subjects completed the study. Eighty-four monolimbs were evaluated by the prosthetists and the subjects. A few monolimbs had minor socket fitting and alignment issues, but none prevented evaluation in the laboratory or during the 1-month home assessment. Only three monolimbs had poor alignment and could not be worn by the subjects.
All three systems captured acceptable alignments, although the two systems that incorporate weight bearing, the ABA-standing and VAA alignment systems, produced slightly better outcomes. The alignment ratings between these two systems were statistically insignificant.
Disability and rehabilitation. Assistive technology 11/2009; 4(6):393-405. DOI:10.3109/17483100903125860
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to evaluate three alignment systems based on two alignment theories that can be utilized in the fabrication of monolimb prostheses that have acceptable alignment. A second goal was to assess the feasibility of technology transfer for providing prosthetic services to remote areas of landmine-affected countries.
Five prosthetists and five healthy transtibial amputees participated in the study. Each prosthetist was trained and then used each of the three systems to capture alignment measurements for one subject. Three monolimbs identified as X, Y and Z were fabricated for each subject and assessed during clinical static and dynamic gait conditions. Training materials and methods were also evaluated.
All three systems captured acceptable alignments fairly well, although the two systems that incorporated weight-bearing into the alignment process had slightly better outcomes. Each system has its own advantages in terms of ease of use, required equipment, and ease of technology transfer.
All three systems have the potential for application in outreach prosthetic services and warrant continued evaluation. Minor changes need to be incorporated into the alignment systems and procedures to make them easier to use and more effective.
Disability and Rehabilitation 07/2009; 29(11-12):863-72. DOI:10.1080/09638280701240243 · 1.99 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This paper describes a new casting system for transtibial socket fabrication. Like the earlier CIR Sand Casting System, the CIR Casting System is based on the 'dilatancy' principle that is similar to the packaging process for coffee beans by which loose beans become a solid mass when a vacuum is applied. The main difference from the CIR Sand Casting System is that the CIR Casting System uses light-weight, polystyrene beads in place of silica sand as the primary material for casting the negative mold. The formed negative mold can be converted into a positive sand model for modification and socket formation. With the new plaster-less casting system, the prosthetist can fabricate a transtibial prosthesis in about one hour. It reduces the set-up cost, overall weight and size of the casting system, and increases portability for service in remote areas. The System also creates minimal waste and is energy-conserving and environmentally-friendly.
[Show abstract][Hide abstract] ABSTRACT: This review covers a range of topics related to lower-extremity prostheses (LEP) and wheelchair technology and service provision. A description on how recent advances in LEP technology for low-income countries have come about through research and field studies is presented and a discussion on the required technical advances and associated research that would increase LEP production capacity is given. The paper also discusses several approaches used for designing, manufacturing, and providing WCs to and in low-income countries; there is also a discussion on past research and highlight current efforts to build research capacity in the field. Last, the paper includes an in-depth description of the social, societal, economic, and physical constraints in India to demonstrate the difficulties in successfully applying this technology.
IEEE Engineering in Medicine and Biology Magazine 04/2008; 27(2-27):12 - 22. DOI:10.1109/EMB.2007.907372 · 26.30 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The Center for International Rehabilitation (CIR) developed a wheelchair provision strategy that combines central fabrication with regional distribution and local service provision by trained practitioners. A field study was initiated in Kabul, Afghanistan to evaluate this plan.
The CIR-Whirlwind Wheelchair (study wheelchair) is an adult size, manual wheelchair designed to be adjustable to accommodate the individual user and durable to withstand rugged terrain. Manufactured in India, the study wheelchairs, with seat cushions, were packaged as kits and shipped to Afghanistan. Local practitioners in Kabul were trained on user assessment, fitting and training, and wheelchair assembly, maintenance and repair. One hundred subjects with previous experience of independently propelling a manual wheelchair participated in the study. This 4-month study entailed three subject visits for initial wheelchair fitting and training and then follow-up at 3 and 10 weeks. Subject training included wheelchair use and maintenance, and wheelchair skill activities.
The study wheelchair was rated favorably by the subjects in all of five categories. Adjustments made to the wheelchairs during the study were typical for maintaining or improving the fit or function of a manual wheelchair. With the exception of brake handles, the need to repair or replace components on the wheelchairs was minimal. The subjects' proficiency at wheelchair skill activities increased throughout the study.
Data collected indicates that the study wheelchair performed very well. The data also served to identify those aspects of the wheelchair that may require additional development and testing prior to further production. To gain additional information on long term wheelchair use and performance, the CIR plans to extend this study by interviewing the same subjects at nine and fifteen months from the date they originally received the study wheelchair.
Disability and Rehabilitation 01/2007; 29(11-12):935-48. DOI:10.1080/09638280701240615 · 1.99 Impact Factor