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The International Classification of Functioning, Disability, and Health (ICF) consists of 34 codes per person at the one digit level and, at more detailed levels, the number of codes can reach 1424 items. This degree of complexity has led research groups to develop core sets of ICF codes for specific health conditions and disabilities. The ICF core sets typically include the least number of domains to be practical, but as many as required to sufficiently characterize a specific condition. The purpose of this article is to present an ICF core set addressed to older adults with dementia in the process of receiving Assistive Technology (AT) for their functioning and well-being. The ICF Core Set development involved a formal decision-making and consensus process, integrating evidence gathered from preliminary studies that included focus groups of health professionals, a systematic review of the literature, and empirical data collected from patients and caregivers. In the ICF core set for older adults with dementia in an AT selection process, the body functions and structures codes are decreased but those related to activities and participation and personal and environmental factors are increased. To further achieve a biopsychosocial and user-driven Core Set that can be applied internationally, ICF categories have been supplemented with items in a measure of AT predisposition and use that is used in many countries. The combination is named the ICF core set for Matching Older Adult with Dementia and Technology (MOADT).
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... Based on the iCF ontologies, case representation was built, which contributed to applying a case retrieval algorithm and improving the accuracy of the recommendation systems that detect and predict the needs of informal caregivers for persons with dementia. Another study developed an iCF core set for functioning and disability assessment of dementia in collaborations with multiple stakeholders in italy and the USA (Scherer et al., 2012). A total of 188 s-level categories were involved in the iCF core set by a user-driven process and provided a common language for operationalizing the Assistive Technology Assessment process in a Center for Technical Aid. ...
... The Studies covered a spectrum of topics such as assessing functioning status by developing iCF-based instruments (Cornelis et al., 2017;De vriendt et al., 2013;Luttenberger et al., 2016;Schmiedeberg-Sohn et al., 2015), linking existing instruments to iCF (Badarunisa et al., 2015;De vriendt et al., 2012;Kirch et al., 2018), describing dementia-related functioning and disabilities (Lomax et al., 2004;A. Malara et al., 2005;Muò et al., 2005) and developing the iCF core set (Scherer et al., 2012). All of those contributed to a better understanding of a person living with dementia and improved communication in caregiving. ...
... Some studies classified dementia associated-disability into iCF domains by conducting narrative reviews without empirical data (Byrne & Orange, 2005;Hopper, 2007), some studies identified iCF categories by interviews or mixed methods, whereas their sample sizes were very limited, that it was insufficient to form a sole set to clarify dementia-related disability in a multidisciplinary perspective (Lomax et al., 2004;Muò et al., 2005). Only Scherer et al. (2012) proposed 'core set' for older adults with dementia. A consensus process, combined with an evidence-based approach and empirical data analysis was involved in the selection of essential iCF categories. ...
Article
Objectives: The International Classification of Functioning, Disability and Health (ICF) endorsed by the World Health Organization provides a conceptual framework for describing functioning and disability based on a biopsychosocial model. Although dementia is one of the leading causes of disability, yet little is known on the extent to how the ICF has been utilized in dementia research and practice. The study aimed to examine and map the current applications of the ICF with dementia from a body of earlier studies and to explore the potential use in person-centred dementia care. Methods: The Arksey and O'Malley framework was used to guide the searching, selecting, and synthesizing process. The scoping review was reported following The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Review (PRISMA-ScR) guidelines. Results: A total of 34 studies were included. The applications of ICF were classified into 4 themes: (1) in clinical practice and the education of health professionals (n = 20); (2) community support services and income support (n = 3); (3) population-based, census, or survey data (n = 10); (4) advocacy and empowerment purposes (n = 1). Conclusion: The ICF has made a major impact on dementia in clinical settings. Findings strongly support applying the ICF to person-centered dementia care. In the future, more empirical studies are needed to expand the scope of ICF use in dementia research and practice.
... Structured goal-assessment As the ICF was found to be a helpful tool to identify and structure health problems from a patient's perspective in other studies in the rehabilitation setting [22,[46][47][48], we applied an ICF-oriented framework for the structured goal assessment, too. For description and assessment of patients`problems, there exists a comprehensive ICF Core Set, which includes 123 categories, relevant for functioning in patients in geriatric postacute rehabilitation facilities [49,50]. ...
... To explore patients`insight in functional deficits we identified clinical assessment instruments matching the items of motor function and self-care according to established linking rules and literature reviews [44,45,48,52,53]. Deficits in "fine hand use" was not assessed by clinical measurements for all patients and could therefore not be taken into account. ...
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Abstract Background: Setting meaningful, individualized rehabilitation goals is an essential part of the rehabilitation process. Even though patients with dementia are a drastically increasing patient group, empirical data about meaningful rehabilitation goals and collaborative goal-setting in this target group is missing. Cognitive impairment and lack of insight in current deficits have been discussed as barriers for participation in goal-setting, but require empirical examination. This study investigated the feasibility of a semi-structured versus a structured goal-setting approach and the types of goals, rehabilitation patients with mild to moderate dementia perceive as personally relevant. Insights in acute functional and motor deficits, differentiated by cognitive status were explored. Methods: Cohort study in a geriatric rehabilitation center. Semi-structured and ICF-based, structured interviews were applied to explore patients` rehabilitation goals. Insight in deficits was operationalized as the relationship of self-ratings and objective measures of linked clinical assessments for the same functional construct. Results: Patients (n= 101, MMSE 222.6, age 83.95.9 years) stated improving mobility-related functions and self-care activities (>70%) but also psychological well-being such as handling stress or mood (>38%) as most important rehabilitation goals. The structured interview facilitated goal-setting and provided a broader view of rehabilitation needs. Correlations between self-ratings and clinical assessments were medium to high (rho=0.29 to 0.83) with highest associations for key motor features. Trend tests identified a significant trend between values of the clinical assessment and categories of self-ratings (p≤0.01) with lower cognitive status derogating this relationship. Conclusions: Collaborative goal-setting was feasible, especially when supported by a structured approach and yielded a large spectrum of functional but also psychological rehabilitation needs from the patients` perspective. Patients showed sustained insight in their actual functional impairments, limited in a subgroup of patients with more advanced cognitive impairment.
... All patients reported 3 Target Outcomes, while 5 family members only reported 2. Four domains were identified: (1) cognitive functioning, (2) physical functioning, (3) emotional functioning, and (4) social functioning and participation (see Table 4). Furthermore, Verbal learning and memory Body functions; b144 21 Delis-Kaplan Executive Function System (D-KEFS) 38 Psychomotor speed and executive functioning Body functions; b140, b164 21,31,39 Abbreviations: ICF, International Classification of Functioning, Disability and Health; TBI, traumatic brain injury; VAS, visual analog scale. a All items marked in italics are linked by the authors. ...
Article
Objective: The aims of this study were to (1) assess self-reported main problem areas reported by patients with traumatic brain injury (TBI) and their family members in the chronic phase, and (2) compare the self-prioritized problems with difficulties captured by questionnaires and neuropsychological screening through linking to the International Classification of Functioning, Disability and Health (ICF). Setting: Outpatient clinic at the Oslo University Hospital, Norway. Participants: In total, 120 patients with TBI were recruited, of whom, 78 had a participating family member. Eligibility criteria were a clinical TBI diagnosis with verified intracranial injury, living at home, aged 18 to 72 years, 2 years or more postinjury, and experiencing perceived TBI-related difficulties, reduced physical and mental health, or difficulties with participation in everyday life. Patients with severe psychiatric or neurological disorders or inability to participate in goal-setting processes were excluded. Design: Cross-sectional. Main measures: Target Outcomes, that is, 3 main TBI-related problem areas reported by patients and family members, collected in a semistructured interview; standardized questionnaires of TBI-related symptoms, anxiety, depression, functioning, and health-related quality of life; neuropsychological screening battery. Results: Target Outcomes were related to cognitive, physical, emotional, and social difficulties. Target Outcomes were linked to 12 chapters and 112 distinct categories in the ICF, while standardized measures only covered 10 chapters and 28 categories. Some aspects of post-TBI adjustment were found to be insufficiently covered by the ICF classification, such as identity issues, lack of meaningful activities, and feeling lonely. Conclusion: The Target Outcomes approach is a useful assessment method in a population with chronic TBI. The standardized questionnaires capture the spectrum of problems, whereas the Target Outcomes approach captures the prioritized individual problems hindering everyday life after TBI. While the standardized measures are an irreplaceable part of the assessment, Target Outcomes ensures patient involvement and may help clinicians better tailor relevant rehabilitation efforts.
... The variability between and within people with dementia (i.e., fluctuations hour-to-hour and a longer-term progression of the condition) often prevents a "one-fits-all" approach [55,77] and even challenges "one-size-fits one" for technology. Research with people who have other cognitive disabilities suggests that adjustable devices [55,69], personalization, or individually configured technology may also benefit people with dementia [49]. ...
Article
People with dementia may miss out on the benefits of using technology, because they often find it difficult to use. Usability testing is one method to identify barriers and areas for improvement in technology. Unfortunately, usability testing is often not conducted with people with dementia, independent of their caregivers. Difficulty recruiting local participants with dementia who regularly use technology further compounds the problem. Remote methods have been proposed as one approach to recruiting hard-to-reach populations. Currently, it is unclear how to effectively conduct remote summative usability testing with people with dementia. We recruited 15 participants. Five took part in the pilot study and 10 participated in the main study. We identify best practices and make suggestions for remote summative usability tests with people who have mild to moderate dementia, independent of caregivers. We discuss our findings in three sections: (1) logistics for planning remote summative usability testing, (2) approaches for conducting remote summative usability testing, including modifications of research methods, and (3) considerations when evaluating findings from remote summative usability sessions. We also present modified usability testing methods we developed to meet the unique needs of users with mild to moderate dementia, and summarize lessons learned and new directions for research on this topic.
... memo minders, information and communication technologies) or help caregivers organise and coordinate their caring responsibilities (e.g. care coordination apps, messenger services) [9,10]. However, the range of evidence for each technological category varies widely with relatively few technologies evaluated through randomised controlled trials or systematic reviews (Moyle, 2019) [11]. ...
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Background Policy makers and care providers see assistive technology and telecare as potential products to support people with dementia to live independently in their homes and communities. Previous research rarely examined how people with dementia and their caregivers actually use such technology. The study examined how and why people living with dementia and their caregivers used assistive technology and telecare in their own homes. Methods This study used an ethnographic design embedded within the NIHR-funded Assistive Technology and Telecare to maintain Independent Living At home for people with dementia (ATTILA) randomised controlled trial. We collected 208 h of observational data on situated practices of ten people with dementia and their ten caregivers. We used this data to construct extended cases to explain how technologies supported people with dementia in home and community settings. Results We identified three themes: placing technology in care, which illustrates how people with dementia and caregivers ‘fit’ technology into their homes and routines; replacing care with technology, which shows how caregivers replaced normal care practices with ones mediated through technologies; and technology displacing care and everyday life, which highlights how technologies disrupted the everyday lives of people with dementia. Discussion This study exemplifies unintended and unanticipated consequences for assistive technology and telecare uptake in ‘real world’ community-based dementia care. It underlines the need to identify and map the context of technological provision over time within the changing lives of people with dementia and their caregivers.
... memo minders, information and communication technologies) or help caregivers organise and coordinate their caring responsibilities (e.g. care coordination apps, messenger services) [9,10]. However, the range of evidence for each technological category varies widely with relatively few technologies evaluated through randomised controlled trials or systematic reviews (Moyle, 2019) [11]. ...
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Background: Policy makers and care providers see assistive technology and telecare as potential products to support people with dementia to live independently and safely in their homes and communities. Little research has examined how people with dementia and their caregivers actually use these technologies. The study aimed to examine how and why people with dementia and their caregivers used assistive technology and telecare in their own homes. Methods: This study used an ethnographic design embedded within the NIHR-funded Assistive Technology and Telecare to maintain Independent Living At home for people with dementia (ATTILA) randomized controlled trial. We collected 208 hours of observational data on situated practices of ten people with dementia and their ten caregivers. We used this data to construct extended cases to explain how technologies supported people with dementia in home and community settings. Results: We identified three themes: placing technology in care, which illustrates how people with dementia and caregivers ‘fit’ technology into their homes and routines; replacing care with technology, which shows how caregivers replaced normal care practices with ones mediated through technologies; and technology displacing care and everyday life, which highlights how technologies disrupted the everyday lives of people with dementia. Discussion: This study exemplifies unintended and unanticipated consequences for assistive technology and telecare uptake in ‘real world’ community-based dementia care. It underlines the need to identify and map the context of technological provision over time within the changing lives of people with dementia and their caregivers.
... In fact, "once the person is stabilized medically, they may receive medical rehabilitation designed to strengthen the remaining capabilities and compensate for those that have been lost." [2]. ...
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In a complex case of speech disorder, the communication is entrusted to systems equipped with a speech synthesizer. When the user has a motor disability, in addition, hardware and software interfaces are personalized to make technology more accessible. Interaction design methods can be applied to develop improved assistive systems and, particularly, for Augmentative and Alternative Communication (AAC). Interaction design methods and usability evaluation could have a positive impact in reducing product barriers and improving performances as the effort state associated to its use can be reduced. Minimizing cognitive and physical efforts through the development of new solutions and interface optimization can be challenging. A usability test and an interface optimization of a personalized AAC system developed for a student of the University of Naples Federico II with complex communication needs due to a traumatic injury and motor impairment are discussed to fix usability issues, highlight critical areas and design new prototypes.
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The population of Korea is aging rapidly, and this has led to a care burden for caregivers. Without adequate caregivers to address the increased burden, people with significant disabilities and older adults with disabilities who have greatly reduced mobility are at risk. The aim of this study was to determine suitable types of care robots for care applications in Korea and formulate a strategy for a future care robot R&D plan through a user participation study. We categorized nine types of care robots that are suitable for the care needs in Korea. By adopting a mixed research methodology involving user participation, we conducted discussions with caregivers, care receivers, and other stakeholders under a public-private-people partnership model. We also identified five primary strategies for care robot R&D: (1) intensive investment to match the needs of people with very severe disabilities to care robot technologies, particularly for transfer, repositioning, toileting, and feeding; (2) translational research and technology development; (3) realization of smart-care through fourth industrial revolution (i.e., digital) technologies; (4) user-centered research with stakeholders; and (5) building of a care robot ecosystem. The formulated plan would be shared with other developers and clinical experts to drive development of suitable care robots.
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Health outcome measurement is a growth industry. Thousands of behavioural assessment instruments, developed for neurological populations alone, are available for diagnosis, prediction and evaluation of interventions. The task of selecting the best instrument for the purpose at hand is thus a daunting one for the clinician and researcher. Fortunately, there are guides that make the task easier. This presidential address covers three interrelated themes that inform assessment in neurorehabilitation: First, it reviews current concepts and the status of behavioural assessment in neurorehabilitation. It then examines evidence-based clinical practice as applied to assessment of function, along with methods to benchmark the scientific quality of assessment instruments. Finally, the article considers the need to move beyond outcome measurement in the neurorehabilitation setting.
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