Article

Providing assistive technology in Italy: The perceived delivery process quality as affecting abandonment

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Abstract

Purpose: The study brings together three aspects rarely observed at once in assistive technology (AT) surveys: (i) the assessment of user interaction/satisfaction with AT and service delivery, (ii) the motivational analysis of AT abandonment, and (iii) the management/design evaluation of AT delivery services. Methods: 15 health professionals and 4 AT experts were involved in modelling and assessing four AT Local Health Delivery Service (Centres) in Italy through a SWOT analysis and a Cognitive Walkthrough. In addition 558 users of the same Centres were interviewed in a telephone survey to rate their satisfaction and AT use. Results: The overall AT abandonment was equal to 19.09%. Different Centres' management strategies resulted in different percentages of AT disuse, with a range from 12.61% to 24.26%. A significant difference between the declared abandonment and the Centres' management strategies (p = 0.012) was identified. A strong effect on abandonment was also found due to professionals' procedures (p = 0.005) and follow-up systems (p = 0.002). Conclusions: The user experience of an AT is affected not only by the quality of the interaction with the AT, but also by the perceived quality of the Centres in support and follow-up. Implications for Rehabilitation AT abandonment surveys provide useful information for modelling AT assessment and delivery process. SWOT and Cognitive Walkthrough analyses have shown suitable methods for exploring limits and advantages in AT service delivery systems. The study confirms the relevance of person centredness for a successful AT assessment and delivery process.

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... All in all, 12 articles were included of which four [22,23,27,28] stemmed from two studies. Five studies were experimental [20,22,25,27,30]. ...
... All five experimental studies were assessed as RCT studies. Two studies were cohort studies [23,29], and five were cross-sectional studies [18,19,21,24,28]. Accordingly, the level of evidence [17] for four of the 12 studies was 1c [20,22,25,30], for one study 1d [27], for two studies 3e [23,29], and for the last five studies 4 b [18,19,21,24,28]. ...
... Two studies were cohort studies [23,29], and five were cross-sectional studies [18,19,21,24,28]. Accordingly, the level of evidence [17] for four of the 12 studies was 1c [20,22,25,30], for one study 1d [27], for two studies 3e [23,29], and for the last five studies 4 b [18,19,21,24,28]. ...
Article
Purpose: The objective of this systematic review was to investigate effects of different assistive technology service delivery processes (AT-SDPs) for people with functional limitations, including investigation of factors associated with positive outcomes. Materials and methods: The study was registered in PROSPERO, registration number CRD42018097030. Included were quantitative studies published in peer reviewed journals: randomized controlled trials, cohort, case-control and analytical cross-sectional studies investigating effects of different AT-SDPs or factors associated with the AT-SDP and with n ≥ 10 participants. A systematic literature search was carried out in the databases PsycINFO, CINAHL, SSCI and Medline from 1 January 2008 to 25 July 2018. Besides, four journals were hand searched. The Joanna Briggs Institute MAStARI Critical Appraisal Tools were utilized to assess the risk of bias. Results: The search resulted in a total of 2947 references of which 12 articles representing 10 studies were included. Five studies were experimental, two were cohort, and five were cross-sectional studies. Conclusions: This systematic review confirms previous findings that assistive technology users should be involved in the AT-SDP in order to achieve positive outcomes. The level of evidence is, however, low, and it is not clear which of the applied methods are most effective. The review also gives some indication that new technologies could be used to improve the AT-SDP and reduce costs and that training in using the assistive devices seems to be useful. Even though some evidence of effective AT-SDP methods has been identified, more research is still needed to give valid recommendations to AT-SDP practice. • Implications for rehabilitation • Assistive technology users should be involved in the AT-SDP in order to achieve positive outcomes, but it cannot be determined which methods are the most effective. • New digital technologies could be used to improve the AT-SDP and reduce costs. • Training of the users in using their devices is probably useful, but since no specific methods nor extent or dose can be recommended, the professionals still need to use their clinical experience and reasoning to assess the user’s needs for training.
... On top of that, researchers in Sweden have shown that having users take increased responsibility for their AT has revealed considerable differences among them in terms of their user knowledge, interests, and access to the technology [20]. Given the range of users, though ones who are informed and can choose appropriate AT for themselves positively affect the outcomes of the service delivery process [5,13,20,21]. A strongly consumer-oriented service delivery system could also threaten the opportunities of less informed users to participate in play, sport, and leisure-time physical activities. ...
... Testing is thus not only important to forecasting the outcomes of assistive activity technology but also for its effective implementation in terms of delivery, fitting, and training [30]. After testing, follow-up becomes another vital aspect of any successful service delivery process [5,14,20,21]. Social constructionism stresses the importance of historical and structural aspects in how social phenomena are understood [34,35]. The use of assistive activity technology shows that the understanding of this technology is linked to the experience of use that changes in different social contexts and over time. ...
... Last, the final step of management and follow-up (i.e., maintenance and periodic verification) [30] is also lacking in Norway's current service delivery process for assistive activity technology, in light of findings that it has no protocols for ensuring positive matches between assistive activity technology users and their devices. By not maintaining such protocols, the service delivery process risks the abandonment of assistive activity technology by users, which is a well-known phenomenon for a wide range of AT [21,50]. As revealed by earlier studies [20], gaps in follow-up services also adversely affect the use and reuse of technology, and distribution of inappropriate technology can cause environmental problems. ...
Article
Full-text available
Purpose: This article critically examines user-involvement in the service delivery process for assistive activity technology. Methodology: Data were collected in semi-structured interviews with 44 end users of assistive activity technology and in focus group interviews with 11 professionals at Norway’s Assistive Technology Centre. Data was analysed according to a stepwise deductive–inductive approach. Findings: Flawed organisational principles like division of responsibility, unclear regulations, and a lack of competence with assistive activity technology among service professionals have hindered user involvement in the service delivery process. Conclusion: A missing knowledge of assistive activity technology among professionals and the current organisation of services creates barriers for a positive collaboration with users in the service delivery process of assistive activity technology. • IMPLICATIONS FOR REHABILITATION • The spread of information among users and courses for professionals should be expanded to ensure the necessary competence with assistive activity technology within the service delivery process. • In developing the service delivery process for assistive activity technology, professionals should act less as guardians of traditional functional requirements and more as active providers of different technological solutions. • The service delivery process for assistive activity technology should allow long-term testing to identify relevant social and physical factors affecting the use of this type of technology, before delivery. • Guarantees and complaint systems should be established in the service delivery process for assistive activity technology.
... It clearly shows the importance of user involvement that the selection process of ATDs had a larger impact on their effects than the performance. Federici and Borci's [8] survey in Italy also revealed various factors related to professional intervention that leads to ATD abandonment. A survey in Germany indicated that case managers may play an important role in the provision process [9]. ...
... Client centeredness during the selection processes of ATDs is another fundamental factor that influences effectiveness of acquired ATDs. A number of quantitative studies have confirmed the importance of the client-centered approach [7,8,13]. User involvement and participation in the selection processes were proven to enhance the outcomes of ATDs while the lack of these factors can be a predictor of abandonment. ...
Article
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Selection of assistive technology devices (ATDs), which are imperative for persons with disabilities to improve their quality of life, requires collaboration of users and multidisciplinary professionals. However, it is still unknown how to design and implement an adequate collaborative work flow and a professional team. Under Japanese governmental ATD provision system, based on the application by clients, ATDs are mainly selected through collaborative processes with the clients and health professionals in public organizations, rehabilitation counseling centers (RCCs). By employing qualitative study methods in this study, we investigated the ATD selection process in which health professionals in RCCs collaboratively assess clients with physical disabilities so as to support them in selecting the adequate ATDs. To identify the perspectives required for ATD selection completely, the assessment processes were recorded and analyzed with a pseudo setting in two RCCs. Content analysis of the conversations between the client and professionals revealed the characteristics of the information exchanged in the assessment processes. A total of 760 assessment items were identified, thus indicating a broad array of interest. Despite the richness of information collected for the assessment, half of the assessment items did not have corresponding items in the documents that were employed during the prescription process. Thematic analysis of the interviews that followed revealed the common values and collaborative processes in ATD selection, which were shared and elaborated among the staff in daily social interactions. To facilitate implementation of ATD provision in various areas with few resources, it may be effective to convert this tacit-to-tacit knowledge sharing into a more explicit sharing by promoting analyses of good practices.
... In addition to the devices, services to support the selection, use and maintenance of devices are essential to avoid misuse, under-use or abandonment of the AT (Federici & Borsci, 2016). Similar to instructional technology, which requires appropriate pedagogy, teacher training and support to be utilised successfully in the classroom (Magana, 2019), successful AT use also requires that teachers are supported and assisted in ensuring it is used to best effect. ...
... Arthanat, Elsaesser and Bauer (2017), in a review of AT service providers in the USA, report that training is an area that requires attention, with many service providers rating their professional education in the area of AT as inadequate. Similarly, Federici and Borsci (2016) found that in Italy, AT service provider procedures, including follow up after consultation, impacted on the abandonment of AT devices. They advocate a person-centred approach to services to ensure that the individual is not only matched to the technology, but that the services are provided appropriately based on need. ...
Chapter
This chapter describes assistive technology (AT) and inclusive education and examines the juncture where AT works to support the inclusion of students with disabilities in mainstream settings, including classrooms, home and community settings. AT consists of a range of devices and services which work to support students to augment existing abilities, compensate for or bypass difficulties they may experience. Some AT has been specifically developed for functional use, while other, particularly emerging technology, can be adapted for, or used, in an assistive capacity. Where the AT promotes social interaction, curriculum access and the ability to express understanding, there is the potential for heightened inclusion in the classroom. © 2020 Emerald Publishing Limited All rights of reproduction in any form reserved
... In line with Federici and Borsci (2014), doworthiness and useworthiness, as well as usability and environments of use (Mirza, Gossett Zakrajsek, & Borsci, 2012), are factors that have to be considered by providers during the process of technology selection and delivery. In fact, a strong relationship was found between the quality of the delivery processes of providers and the likelihood of technology abandonment. ...
Article
Full-text available
This special issue focuses on assistive technologies for cognition/cognitive support technologies as well as the ways in which individuals are assessed and trained in their use. We provide eleven diverse articles that give information on products, why they are used and not used, and best professional practices in service provision. Our goal is to highlight a broad topic that has received limited research investigation and offer an insight into how different countries and programs are promoting access to and use of assistive technologies for cognition/cognitive support technologies.
... The most prevalent of these was a concern about costs, and poor follow-through in using the device at home and in the classroom. This theme reflects the issue of AT device disuse and abandonment that has been explored in many studies (Federici & Borsci, 2016;Leung, Brian, & Chau, 2013;Scherer & Federici, 2015;Van Schyndel, Furgoch, Previl, & Martini, 2014). Reasons found to be associated with disuse should be considered in the context of both the student device user and the school personnel supporting the student. ...
Article
This study explores broad issues associated with assistive technology (AT) service provision in rural school settings. The study was designed to explore the beliefs of practitioners working in rural schools about their role in AT service provision. This article includes an extensive review of the literature and findings from a naturalistic study of AT service provision experience in rural school settings. The study portion of this article involved completion of an open-ended questionnaire followed by semi-structured ethnographic interviews. The participants completing the questionnaires were 22 occupational therapy practitioners and seven individuals from a variety of professional backgrounds recognized as leaders in AT in the state of West Virginia. Data were collected over a 3-year period. Themes identified in the data emphasized concerns about the unclear role of potential AT providers resulting in the use of AT as a last resort, the lack of inclusion of AT in the core curriculum, and the limited collaboration and in-service education opportunities recognized by practitioners. This qualitative study is not generalizable. Findings can be viewed within the context of other research to help enrich the reader's understanding of AT service delivery.
... As previously stated, the health system and assistive products service provision themselves could be a barrier that prevent the use of assistive products [20,23]. In Brazil, the Public Healthcare System is the main provider of assistive products, what simplifies access to assistive products and services. ...
Article
Full-text available
Purpose: To investigate the levels and factors that influence the abandonment of assistive products by users of a local reference rehabilitation center. Methods: This observational study involved users who received services and assistive products provided by our center of rehabilitation. Users were identified using the records of the center and their responses about the abandonment were collected through face-to-face interviews. Results: The abandonment level of assistive products was 19.38%. 83.5% of the users use at least one of the assistive products they have received. Rigid and folding frame wheelchairs, with and without postural support devices, as well as shower wheelchairs, presented the lowest abandonment levels, followed by canes and lower limb orthoses. Upper limb orthoses, Knee Ankle Foot Orthosis(KAFO), walkers, crutches and lower and upper limb prostheses all presented higher abandonment levels. Conclusion: The simultaneous use of mutiple assistive products, users perception on the importance of using them, and completing the rehabilitation treatment were found to impact on the short and long-term use of products. The study offers inputs to decision making and planning for assistive technology provision in developing countries with regard to expected demand and service delivery. • Implications for Rehabilitation • Data about the abandonment of assistive products in Sao Paulo, Brazil, could assist informing decision making on provision and servicing of these products in similar settings. • The strong correlation found between abandonment levels and the simultaneous use of multiple devices should be taken into account by health professionals when prescribing assistive products and providing guidance to users. • The need for follow up on the use of assistive products after discharge from rehabilitation treatment becomes strikingly clear, as data show that completing treatment is significantly relevant when evaluating abandonment levels. • As assistive products users’ perception about the importance of using these devices is shown to be significant in explaining abandonment, it is mandatory that health and rehabilitation professionals take it into account when providing guidance and training users.
... This graphic was developed in line with the UK National Patient Safety Agency Guidelines [6,12] by using the software TaskArchitect v.3.1. A user focused approach [15,16] was then used with a group of five professionals, including nurses and clinicians, to revise the graphic representation of NG-tube and pH strips use. Professionals were invited to add/remove or amend steps in the procedure, to explain each step and to comment on issues they had encountered. ...
Article
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Aims (1) To model the process of use and usability of pH strips (2) to identify, through simulation studies, the likelihood of misreading pH strips, and to assess professional’s acceptance, trust and perceived usability of pH strips. Methods This study was undertaken in four phases and used a mixed method approach (an audit, a semi-structured interview, a survey and simulation study). The three months audit was of 24 patients, the semi-structured interview was performed with 19 health professionals and informed the process of use of pH strips. A survey of 134 professionals and novices explored the likelihood of misinterpreting pH strips. Standardised questionnaires were used to assess professionals perceived usability, trust and acceptance of pH strip use in a simulated study. Results The audit found that in 45.7% of the cases aspiration could not be achieved, and that 54% of the NG-tube insertions required x-ray confirmation. None of those interviewed had received formal training on pH strips use. In the simulated study, participants made up to 11.15% errors in reading the strips with important implications for decision making regarding NG tube placement. No difference was identified between professionals and novices in their likelihood of misinterpreting the pH value of the strips. Whilst the overall experience of usage is poor (47.3%), health professionals gave a positive level of trust in both the interview (62.6%) and the survey (68.7%) and acceptance (interview group 65.1%, survey group 74.7%). They also reported anxiety in the use of strips (interview group 29.7%, survey group 49.7%). Conclusions Significant errors occur when using pH strips in a simulated study. Manufacturers should consider developing new pH strips, specifically designed for bedside use, that are more usable and less likely to be misread.
... Adaptation of the home and installation of such equipment is carried out to accommodate functional changes, assist with ageing-in-place, and reduce fall risk factors [15]. A key strategy to mitigate the adverse impact of functional decline is to identify and accurately prescribe assistive equipment that will sustain independent living and quality of life [15][16][17][18]. Therefore, clinicians undertake home visits to assess functional abilities and take measurements from the patient, fittings, and key items of furniture that form the basis upon which assistive equipment and home adaptations are prescribed. ...
Article
Background In the field of occupational therapy, the assistive equipment provision process (AEPP) is a prominent preventive strategy used to promote independent living and to identify and alleviate fall risk factors via the provision of assistive equipment within the home environment. Current practice involves the use of paper-based forms that include 2D measurement guidance diagrams that aim to communicate the precise points and dimensions that must be measured in order to make AEPP assessments. There are, however, issues such as “poor fit” of equipment due to inaccurate measurements taken and recorded, resulting in more than 50% of equipment installed within the home being abandoned by patients. This paper presents a novel 3D measurement aid prototype (3D-MAP) that provides enhanced measurement and assessment guidance to patients via the use of 3D visualization technologies. Objective The purpose of this study was to explore the perceptions of older adults with regard to the barriers and opportunities of using the 3D-MAP application as a tool that enables patient self-delivery of the AEPP. Methods Thirty-three community-dwelling older adults participated in interactive sessions with a bespoke 3D-MAP application utilizing the retrospective think-aloud protocol and semistructured focus group discussions. The system usability scale (SUS) questionnaire was used to evaluate the application’s usability. Thematic template analysis was carried out on the SUS item discussions, think-aloud, and semistructured focus group data. Results The quantitative SUS results revealed that the application may be described as having “marginal-high” and “good” levels of usability, along with strong agreement with items relating to the usability (P=.004) and learnability (P<.001) of the application. Four high-level themes emerged from think-aloud and focus groups discussions: (1) perceived usefulness (PU), (2) perceived ease of use (PEOU), (3) application use (AU) and (4) self-assessment (SA). The application was seen as a useful tool to enhance visualization of measurement guidance and also to promote independent living, ownership of care, and potentially reduce waiting times. Several design and functionality recommendations emerged from the study, such as a need to manipulate the view and position of the 3D furniture models, and a need for clearer visual prompts and alternative keyboard interface for measurement entry. Conclusions Participants perceived the 3D-MAP application as a useful tool that has the potential to make significant improvements to the AEPP, not only in terms of accuracy of measurement, but also by potentially enabling older adult patients to carry out the data collection element of the AEPP themselves. Further research is needed to further adapt the 3D-MAP application in line with the study outcomes and to establish its clinical utility with regards to effectiveness, efficiency, accuracy, and reliability of measurements that are recorded using the application and to compare it with 2D measurement guidance leaflets.
... The matching between the selected assistive technology and the user is a major concern. To this end, the abandonment of selected assistive devices has been reported in numerous studies [6][7][8][9]. Abandonment may be due to assignment of inappropriate devices or failure to meet the user needs and expectations and is directly related to device characteristics. The end user perspective is important during all phases of a product cycle (i.e. ...
Chapter
This paper presents the early findings of a new psychometric scale called PYTHEIA. It was developed in Greek according to the most well known guidelines recommendations in order to assess the satisfaction of users with any assistive technology device (e.g. robotic, rehabilitation device, etc.). Field test studies were conducted with 147 subjects (inpatients and outpatients of a rehabilitation hospital) who were administered the original questionnaire. The scale is applicable in patients with different diseases, ages, and disabilities using various assistive devices. According to the inclusion criteria selected, all of them scored above 17 in the Mini Mental State Examination (MMSE). Intraclass correlation coefficient (ICC = 0.992), Pearson’s correlation (r = 0.984) and Cronbach’s α (α = 0.793) indicated sufficient reliability measures. Test-retest outcome showed great stability. The paired samples t-test between initial assessment and reassessment indicated no statistically significant differences (p value = 0.059). Various types of validity were also investigated. According to the results, PYTHEIA is a stable, valid and reliable instrument. Thus, it can be used to measure the satisfaction of patients with any assistive device. PYTHEIA uniqueness is that it can be used to assess not only the general satisfaction of the users with any assistive device, but also to evaluate independently any individual characteristic and functionality that the device may have. To this end, it can be used for evaluating also new and experimental developments (e.g. robotic assistive devices, etc.) in lab environment and can help researchers assess their products in terms of efficiency, comfort, quality, performance, ergonomics and usefulness as perceived by the end users.
... This highlights the need for follow-up to provide required support and make the necessary adjustments to resolve issues. The need for follow-up continues to be promoted in the literature as being essential to quality AT service delivery [8,[32][33][34], but the benefits of or barriers to undertaking follow-up have not been extensively researched. ...
Article
Full-text available
Abstract: (1) Background: Recent reforms in Australia, providing people with disability and older people with choice and control over allocated funding, have altered consumer expectations and transformed the landscape of assistive technology (AT) service provision. The purpose of this study is to report on the routine AT outcomes of people who accessed an AT consultation service and examine how well these capture the impact of AT on their lives; (2) Methods: This study, which uses mixed methods for concurrent triangulation of the data, reports on the outcomes for 127 people who acquired a range of assistive technology in 2015 and examines the adequacy of an existing service outcome framework in capturing the true value of these technologies to AT users. Outcome data was routinely collected by a community service 2–4 months following an AT consultation. A telephone or face-to-face interview gathered demographic information as well as AT outcomes, using two standardized tools, the Individualized Prioritised Problem Assessment (IPPA) and the EATS 6D. Qualitative comments relating to the impact of the AT on the person’s life were also documented; (3) Results: The acquired AT generally met or exceeded expectations of the person using the AT and the attending health professional. Overall, people experienced decreased difficulty and increased feelings of autonomy, with most of the reported improvements identified in mobility and usual activities; (4) Conclusion: Routine outcome data provide some evidence of the value of AT in addressing concerns as identified by clients. Qualitative data, which captured the impact of AT on people’s lives, suggest that the empowering and transformative aspects of AT are not currently being captured by existing measures.
... Lower abandonment rates are, as expected, related to high satisfactionmeasured using objective criteria (cost, usefulness, efficacy, availability, operability, etc.) [17][18][19][20] to demographic characteristics, [21] to the adequacy between the ATD and users' needs [15] and to higher quality of delivery process. [22] However, the effects of using ATD on participation restrictions may be more ambiguous. On the one hand, improvements in functioning on the two previous levels might increase the adequacy between the person with a disability and his environment. ...
Article
Full-text available
Purpose: It is widely accepted that social dimensions are crucial when facing a disability. More specifically, a normative incentive to conceal one’s disability, which can lead to abandonment of assistive technology devices (ATD), is often reported. This study seeks to examine this norm. Method: The expected consequences of having a disability were measured using a sample of 549 able-bodied students from three groups. Results: The results showed that the expected consequences of having a disability and therefore the descriptive norms associated with disability were less negative for the participants who were familiar with disability, but higher for sports students. Furthermore, the relation between objective and subjective consequences (having a disability and feeling disabled, respectively) and public and private use of ATD were modelled. The model shows that both higher objective and lower subjective consequences were linked to higher ATD use in public and, indirectly, in private. Conclusion: The present study contributes to the literature on the normative elements related to the use of ATD. Indeed, it shows that when a person makes his/her disability a part of him/herself, she/he is expected to hide it and therefore to avoid using ATD. However, this assessment proves to be context-dependent and calls for the implementation of handicap awareness programs. • Implications for Rehabilitation •If faced with a disability, expecting to feel disabled and expecting lower objective consequences are linked to lower ATD use. •Expected ATD use in private seems to be related to ATD use in public but not to the expected consequences of the disability. •Expectations and therefore social norms about having a disability are highly context-dependent which encourages the implementation of handicap awareness programs.
... For example, Federici and Borsci found that the user's choice is based both on the experience one has had while using or testing the AT, as well as on the perceived quality of the rehabilitation center or hospital providing the support and follow-up. [9] Another crucial issue that should be considered is why AT is abandoned. A thorough survey in Italy investigating the reasons why hearing and mobility devices are abandoned, has concluded upon the following: (i) the selected AT did not meet the user's needs and expectations, which is closely related to user satisfaction, and (ii) the AT delivery system needs to have a more patient-oriented approach. ...
Article
Purpose: To examine the Assistive Technology Device Predisposition Assessment scale and provide evidence of validity and reliability of the Greek version. Methods: We translated and adapted the original instrument in Greek according to the most well-known guidelines recommendations. Field test studies were conducted in a rehabilitation hospital to validate the appropriateness of the final results. Ratings of the different items were statistically analyzed. We recruited 115 subjects who were administered the Form E of the original questionnaire. Results: The experimental analysis conducted revealed a three subscales structure: (i) Adaptability, (ii) Fit to Use, and (iii) Socializing. According to the results of our study the three subscales measure different constructs. Reliability measures (ICC = 0.981, Pearson's correlation = 0.963, Cronbach's α = 0.701) yielded high values. Test-retest outcome showed great stability. Conclusions: This is the first study, at least to the knowledge of the authors, which focuses merely on measuring the satisfaction of the users from the used assistive device, while exploring the Assistive Technology Device Predisposition Assessment - Device Form in such depth. According to the results, it is a stable, valid and reliable instrument and applicable to the Greek population. Thus, it can be used to measure the satisfaction of patients with assistive devices. Implications for Rehabilitation The paper explores the cultural adaptability and applicability of ATD PA - Device Form. ATD PA - Device Form can be used to assess user satisfaction by the selected assistive device. ATD PA - Device Form is a valid and reliable instrument in measuring users' satisfaction in Greekreality.
... It is important to undertake research that supports service delivery practices. Previous studies have shown that, to be effective, assistive devices and services should match with the user's needs [11][12][13][14][15]. Research have also revealed that failure to take into consideration the user's needs during AT evaluation is a primary reason for abandonment [13,[16][17][18]. To improve AT services and users' functions and participation, it is essential to gain an understanding of user subjective needs and preferences. ...
Article
Full-text available
Assistive devices (ADs) can help individuals with disabilities achieve greater independence, and it can enhance the quality of their lives. This study investigated the use of and self-perceived need for ADs in individuals with disabilities, and determined the influence of gender, age as well as type and degree of disability on the use of and self-perceived need for ADs. This descriptive study utilized a cross-sectional survey design with a convenience sample of participants. A total of 1018 subjects with disabilities who visited an exhibition of assistive technology and two ADs research and development centers completed a questionnaires either by themselves or via a caregiver who completed the questionnaire on behalf of the subject or via interviewers trained specifically for this study. The Mann-Whitney U test and Kruskal-Wallis test were used to determine the influence of participant characteristics on the use of ADs. The results showed that 77.2% and 83.3% of the participants reported that they used and needed AD(s) to engage in activities of daily living. The mean quantity of the use of and self-perceived need for total types of ADs were 3.0 and 5.3, respectively. Participants with different disabilities reported different percentages of the use of various types of ADs. No difference was found between genders and among the age groups in the use of quantity of ADs. Individuals with different types and degrees of disability used different quantities of ADs. Participants with physical, visual and multiple disabilities used significantly more ADs compared to participants with intellectual disability. The total quantity of ADs used increased significantly with increased severity of disability. The mean use of assistive devices was lower compared to the mean need of individuals with disabilities. Further study is required to determine why patients feel the need for but not currently use a specific assistive device.
... 32 On the other hand, in contrast to the current study's finding, dissatisfaction with professional services has been found among parents of children with physical impairments using different ATs. 18,20 In addition, a survey study of adult users of AT found low satisfaction to be related to the abandonment of AT. 48 Therefore, the high satisfaction both with the gaze-based AT and with the services among parents found in this study at post-intervention might be a prerequisite for the results with sustained use of gaze-based AT over time. Nevertheless, a majority of parents were satisfied with all services at the end of gaze-based AT intervention, but only with the professional services at followup. ...
Article
Full-text available
Objective: To establish the impact of a gaze-based assistive technology (AT) intervention on activity repertoire, autonomous use, and goal attainment in children with severe physical impairments, and to examine parents' satisfaction with the gaze-based AT and with services related to the gaze-based AT intervention. Methods: Non-experimental multiple case study with before, after, and follow-up design. Ten children with severe physical impairments without speaking ability (aged 1-15 years) participated in gaze-based AT intervention for 9-10 months, during which period the gaze-based AT was implemented in daily activities. Results: Repertoire of computer activities increased for seven children. All children had sustained usage of gaze-based AT in daily activities at follow-up, all had attained goals, and parents' satisfaction with the AT and with services was high. Discussion: The gaze-based AT intervention was effective in guiding parents and teachers to continue supporting the children to perform activities with the AT after the intervention program.
... Many people with disabilities who do own computers do not take advantage of computer access technology (Stevenson &amp; McQuivey, 2015). Worst of all, up to a third of computer users who do receive computer access technology abandon it (Federici, 2014;Johnson, Inglebret, Jones, &amp; Ray, 2006;Riemer-Reiss &amp; Wacker, 2000), a statistic which unfortunately has been stable for 30 years despite advances in available assistive technology (Scherer, 2014). Telerehabilitation (TR) is a valuable clinical service delivery model that includes assessment, therapy, and follow-up services (Brennan et al., 2012). ...
Article
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Telerehabilitation (TR) services for assistive technology evaluation and training have the potential to reduce travel demands for consumers and assistive technology professionals while allowing evaluation in more familiar, salient environments for the consumer. Sixty-five consumers received TR services for augmentative and alternative communication or alternative computer access, and consumer satisfaction was compared with twenty-eight consumers who received exclusively in-person services. TR recipients rated their TR services at a median of 6 on a 6-point Likert scale TR satisfaction questionnaire, although individual responses did indicate room for improvement in the technology. Overall satisfaction with AT services was rated highly by both in-person (100% satisfaction) and TR (99% satisfaction) service recipients.
... A recognised framework is to understand AT use as an interaction between a person, the environment, and technology [3,29]. People's assumptions, expectations, and responses to using AT are highly individual and personal, and they are influenced by varying needs, opportunities, preferences, and past experiences with and exposure to such technology [30][31][32]. Studies have shown that a person with a disability is likely to accept AT if it helps maintain the person's self-image, conveys what the person wants to convey, or strengthens the efforts to maintain the user's social role [6,7,10,33]. ...
... Similarly, what consumers might want from their AT service delivery has often been inferred from studies focussed upon products or services, for example, the need for information, education, product range, context-appropriate products and service/maintenance [4,96]. However, emphasis on identifying and valuing user priorities and preferences around AT services and provision is growing [28,[97][98][99][100]. For example, De Jonge et al. [101] recently described nine priorities developed by and validated with Australian AT users ( Table 2). ...
Article
Assistive technology (AT) is a powerful enabler of participation. The World Health Organization’s Global Collaboration on Assistive Technology (GATE) programme is actively working towards access to assistive technology for all. Developed through collaborative work as a part of the Global Research, Innovation and Education on Assistive Technology (GREAT) Summit, this position paper provides a “state of the science” view of AT users, conceptualized as “People” within the set of GATE strategic “P”s. People are at the core of policy, products, personnel and provision. AT is an interface between the person and the life they would like to lead. People’s preferences, perspectives and goals are fundamental to defining and determining the success of AT. Maximizing the impact of AT in enabling participation requires an individualized and holistic understanding of the value and meaning of AT for the individual, taking a universal model perspective, focusing on the person, in context, and then considering the condition and/or the technology. This paper aims to situate and emphasize people at the centre of AT systems: we highlight personal meanings and perspectives on AT use and consider the role of advocacy, empowerment and co-design in developing and driving AT processes.
... The quality of the assessment will help determine the degree of 'fit' between need and telecare solution. Other research (Godwin, 2012;Federici and Borsci, 2016) has shown that telecare equipment is often rejected or abandoned when telecare does not meet individual needs of service users or carers. ...
Article
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This paper explores telecare manager and other ‘stakeholder’ perspectives on the nature, extent and impact of family and other unpaid/informal carers’ involvement in the provision of telecare equipment and services for older people. Data used in the paper are derived from a larger study on telecare provision by local councils in England. The paper aims to add to the growing evidence about carers’ engagement with electronic assistive technology and telecare, and considers this in the context of typologies of professionals’ engagement with carers. How carers are involved in telecare provision is examined primarily from the perspectives of senior managers responsible for telecare services who responded to an online survey and/or were interviewed in 2016 as part of a wider study. The perspectives of three unpaid carers were captured in a separate strand of the main study, which comprised more detailed case study interviews within four selected councils. Thematic and comparative analysis of both qualitative and quantitative survey data revealed the varied involvements and responsibilities that carers assumed during the telecare provision process, the barriers that they needed to overcome and their integration in local council strategies. Findings are discussed in the context of Twigg and Atkin's typology of carer support. They suggest that carers are mainly perceived as ‘resources’ and involvement is largely taken for granted. There are instances in which carers can be seen as ‘co-workers’: this is mainly around responding to alerts generated by the telecare user or by monitored devices, but only in those councils that fund response services. Though some participants felt that telecare devices could replace or ‘supersede’ hands-on care that involved routine monitoring of health and wellbeing, it was also acknowledged that its use might also place new responsibilities on carers. Furthermore, the study found that meeting carers’ own rights as ‘co-clients’ was little acknowledged.
... However, in Western countries, ATs' disuse after one year from purchase has been estimated as one-third. This is caused by multiple reasons: cultural differences of the users, variety of device types, and an unclear definition of abandonment and disuse (Federici and Borsci 2016). Older adults may be overloaded by the emotional and cognitive investment required to use and incorporate ATs in everyday life and a focus on clear communication about how to use new devices is instrumental (Spinelli 2015;Spinelli, Micocci, and Ajovalasit 2017). ...
Article
Full-text available
Currently, the assistive technologies (ATs) market is underdeveloped, which limits individual choices. Many people appear reconciled to using available products that, at best, match functionalities to compensate for physical deficiencies. Yet people express a desire for personalized, elegant, discreet and bold artefacts that match their lifestyle and provide opportunities for self-expression. This study adopts a materiality-inspired methodology to explore ATs and to elicit insights into the perceptions and emotions of the study participants towards them. A comparative exploratory study between the UK and Taiwan has been conducted to explore diverse and cross-cultural perceptions. The findings suggest that the design of ATs needs to go beyond traditional considerations, such as price and compliance, and instead focus on how these products enhance users’ positive sense of self. This in return may increase the rate of successful adoption of ATs in everyday life.
... An optimal match between the needs and characteristics of those with a disability and the most appropriate assistive technology requires a depth of professional knowledge and a comprehensive understanding of existing solutions in the market. Studies show that high levels of product abandonment are due to several factors related to the quality of solution matching [18][19][20]. ...
Article
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Introduction The impact of assistive technology use on the lives of people with disabilities has long been demonstrated in the literature. Despite the need for assistive technologies, and a wealth of innovative, afford-able, and accessible products, a low rate of assistive technology uptake is globally maintained. One of the reasons for this gap is related to data and knowledge formation and management. Low access to information and a lack of assessment services is evident. Fragmentation of data, inconsistency in assessment methodology and heterogeneity in the competence of assistive technology professionals, has led to a growing interest in the opportunities that data sciences, including AI, hold for the future of the assistive technology sector, as a supportive and constructive mechanism in any decision-making process. Objectives In this short paper, we seek to describe some of the principles that such an AI-based recommendation system should be built upon, using the Atvisor platform as a case study. Atvisor.ai is an AI-based digital platform that supports assistive technology assessments and the decision-making process. Recommendations Our recommendations represent the aggregated insights from two pilots held in Israel, testing the platform in multiple environments and with different stakeholders. These recommendations include ensuring the continuum of care and providing a full user journey, incorporating shared decision making and self-assessment features, providing data personalisation and a holistic approach, building a market network infrastructure and designing the tool within a wider service delivery model design. Assessment and decision-making processes, crucial to optimal uptake, cab be leveraged by technology to become more accessible and personalised. • IMPLICATIONS FOR REHABILITATION • Provides principles for the development of an AI-based recommendation system for assistive technology decision making. • Promotes the use of artificial intelligence to support users and professionals in the assistive technology decision making process. • Personalization of data regarding assistive technology, according to functional, holistic and client centered profiles of users, ensures optimal match and better use of assistive technology. • Self-assessment and professional assessment components are important for enabling multiple access points to the assistive technology decision making process, based on the preferences and needs of users.
... The definition of 'non-use' in ATs entails a complex interconnection of several elements that go beyond the mere usability and functionality of the device. As stressed in studies conducted by Federici and Borsci [33] with healthcare professionals and end users, the user experience of an assistive solution is affected not only by the quality of the interaction between the user and the solution itself but also by the perceived quality of the professional service provided. The interplay between personal related factors and factors related to the user's environment are explored in a comparative study [34] between young and older users demonstrating that while products for children may imbue a higher level of enjoyment, devices for older adults are perceived exclusively in relation to function, e.g. they predominantly convey the physical support they provide to a person with health decline. ...
Chapter
Products we purchase are much more than artefacts that fulfil functional needs in our life. We have grown to enact our consumer choices, even those regarding fast moving consumable goods, with careful considerations informed by numerous trials, recommendations and, growingly, environmental concerns in mind. Advanced manufacturing and progress in research and development are providing more choices for consumers even in quite specific and complex product markets. An exemption to this market trend is represented by assistive technologies (ATs). This is a relatively underdeveloped context despite the growing demands for assistive devices by those in later life who need either support in accomplishing everyday life to stay independent or have complex co-occurring conditions. In this chapter, we explore why ATs, especially for older adults, are underdeveloped by exploring issues related to design approaches and cultural and social perceptions that have contributed to making consumers more or less sensitive and demanding towards the role of ATs in their lives. The chapter will conclude with recommendations that may be able to shift the perception of assistive devices so as to facilitate the user’s emotional investment in the devices, attachment to them, which, in return, may lead to better adherence and faster adoption.
... While some qualitative guidelines and tools have emerged [1,12], it is still hard to find agreement on which factors should be tested. As argued by Park and Humphry [13], the implementation of these innovative systems should be based on a common framework for assessing the perceived interaction quality, in order to prevent chatbots from being regarded by their end-users as merely another source of social alienation, and being discarded in the same way as any other unreliable assistive technology [14,15]. A common framework and guidelines on how to determine the perceived quality of chatbot interaction are therefore required. ...
Conference Paper
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People with disabilities or special needs can benefit from AI-based conversational agents, which are used in competence training and well-being management. Assessment of the quality of interactions with these chatbots is key to being able to reduce dissatisfaction with them and to understand their potential long-term benefits. This will in turn help to increase adherence to their use, thereby improving the quality of life of the large population of end-users that they are able to serve. We systematically reviewed the literature on methods of assessing the perceived quality of interactions with chatbots, and identified only 15 of 192 papers on this topic that included people with disabilities or special needs in their assessments. The results also highlighted the lack of a shared theoretical framework for assessing the perceived quality of interactions with chatbots. Systematic procedures based on reliable and valid methodologies continue to be needed in this field. The current lack of reliable tools and systematic methods for assessing chatbots for people with disabilities and special needs is concerning, and may lead to unreliable systems entering the market with disruptive consequences for users. Three major conclusions can be drawn from this systematic analysis: (i) researchers should adopt consolidated and comparable methodologies to rule out risks in use; (ii) the constructs of satisfaction and acceptability are different, and should be measured separately; (iii) dedicated tools and methods for assessing the quality of interaction with chatbots should be developed and used to enable the generation of comparable evidence.
... While some qualitative guidelines and tools are emerging [1,14], it is still hard to find an agreement on what factors should be tested. As argued by Park and Humphry [15], the development of these innovative systems should proceed around a common framework for assessing the perceived quality of interaction, in order to prevent chatbots being viewed by their end-users as simply another source of social exclusion and being abandoned as quickly as any other inconsistent assistive technology would be [16,17]. Therefore, a common framework and guidelines on how to assess the perceived quality of interaction of chatbots are needed. ...
Article
Introduction: People with disabilities or special needs can benefit from AI-based conversational agents (i.e., chatbots) that are used for competence training and well-being management. Assessing the quality of interactions with these chatbots is key to being able to reduce dissatisfaction with them and to understanding their potential long-term benefit. This in turn will help to increase adherence to their use, thereby improving the quality of life of the large population of end-users that they are able to serve. Methods: Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) methodology, we systematically reviewed the literature on methods of assessing the perceived quality of interactions with chatbots using the from Scopus and the Web of Science electronic databases. Using the Boolean operators (AND/OR) the keywords chatbot*, conversational agent*, special needs, disability were combined. Results: Revealed that only 15 of 192 papers on this topic included people with disabilities or special needs in their assessments. The results also highlighted the lack of a shared theoretical framework for assessing the perceived quality of interactions with chatbots. Conclusion: Systematic procedures based on reliable and valid methodologies continue to be needed in this field. The current lack of reliable tools and systematic methods to assess chatbots for people with disabilities and special needs is concerning, and ultimately, it may also lead to unreliable systems entering the market with disruptive consequences for people. • Implications for rehabilitation • Chatbots applied in rehabilitation are mainly tested in terms of clinical effectiveness and validity with a minimal focus on measuring the quality of the interaction • The usability and interactive properties of chatbots applied in rehabilitation are not comparable as each tool is measured in different way • The lack of a common framework to assess chatbots exposes people with disability and special needs to the risk of using unreliable tools
Article
Background: Many individuals with traumatic brain injury (TBI) are young and could have many years of productivity ahead of them. However, cognitive impairments may hinder individuals' ability to perform daily tasks. Assistive technology for cognition (ATC) can be effective in helping compensate for cognitive impairments. Objective: This study examined the current state of the research on using ATCs to support daily activities for individuals with cognitive disabilities that are due to TBI. Methods: A comprehensive systematic literature search was performed to identify peer-reviewed articles published between 2000 and 2015. To evaluate the nature of the research, qualitative data were extracted pertaining to recruitment, participant characteristics, intervention design, type of ATCs and their functions, matching individuals with ATCs, training for using the ATC, and outcomes. Results: Research examining the effectiveness of ATCs as everyday compensatory tools for cognitive impairments that are due to TBI is limited. The majority of studies were case studies or quasi-experimental studies with small sample sizes. Studies showed positive associations between use of ATCs and individuals' abilities to perform tasks regardless of age, TBI severity, and time since injury. Conclusions: Future research should assess the match between the individual and the technology, study the impact of training on using ATCs, and analyze the usability of ATCs.
Article
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Background: Brain-computer interfaces (BCIs) allow persons with impaired mobility to communicate and interact with the environment, supporting goal-directed thinking and cognitive function. Ideally, a BCI should be able to recognize a user's internal state and adapt to it in real-time, to improve interaction. Objective: Our aim was to examine studies investigating the recognition of affective states from neurophysiological signals, evaluating how current achievements can be applied to improve BCIs. Methods: Following the PRISMA guidelines, we performed a literature search using PubMed and ProQuest databases. We considered peer-reviewed research articles in English, focusing on the recognition of emotions from neurophysiological signals in view of enhancing BCI use. Results: Of the 526 identified records, 30 articles comprising 32 studies were eligible for review. Their analysis shows that the affective BCI field is developing, with a variety of combinations of neuroimaging techniques, selected neurophysiological features, and classification algorithms currently being tested. Nevertheless, there is a gap between laboratory experiments and their translation to everyday situations. Conclusions: BCI developers should focus on testing emotion classification with patients in ecological settings and in real-time, with more precise definitions of what they are investigating, and communicating results in a standardized way.
Conference Paper
This paper introduces a new gaze-based Graphic User Interface (GUI) for Augmentative and Alternative Communication (AAC). In the state of the art, prediction methods to accelerate the production of textual, iconic and pictorial communication only by gaze control are still needed. The proposed GUI translates gaze inputs into words, phrases or symbols by the following methods and techniques: (i) a gaze-based information visualization technique, (ii) a prediction technique combining concurrent and retrospective methods, and (iii) an alternative prediction method based either on the recognition or morphing of spatial features. The system is designed for extending the communication function of individuals with severe motor disabilities, with the aim to allow end-users to independently hold a conversation without needing a human interpreter.
Article
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Background: This study was an extension of research which began in the Umbria region in 2009. Aim: To investigate the extent to which assistive technology (AT) has been abandoned by users of the Italian National Health Service (ULHS) and the reasons for this. Design: Observational study. Setting: Users who received a hearing device (HD) or mobility device (MD) by ULHS between 2010 and 2013. Population: 749 out of 3,791 ULHS users contacted via telephone completed the interview: 330 (44.06%) had a HD and 419 (55.94%) a MD. Methods: Data were collected using a specially developed telephone interview questionnaire including the Italian version of the Quebec User Evaluation of Satisfaction with AT (QUEST 2.0) and Assistive Technology Use Follow-up Survey (ATUFS). Results: 134 users (17.9%) were no longer using their assigned AT device within seven months of issue and 40% of this group reported that they had never used the device. Duration of use (for how long the AT device was used before abandonment) and satisfaction with service delivery did not predict AT abandonment. People who received a HD where more likely to abandon their device (22.4%) than those who received a MD (14.4%). Conclusions: Abandonment may be due to assignment of inappropriate devices or failure to meet user needs and expectations. These findings are consistent with previous data collected by Federici and Borsci in 2009. Utility of AT in use, reasons of abandonment, and importance of device and service satisfaction for the use or non-use of an AT are presented and discussed. Clinical rehabilitation impact: AT abandonment surveys provide useful information for modelling AT assessment and delivery process. The study confirms the relevance of person centredness approach for a successful AT assessment and delivery process.
Article
Purpose: Mainstream smart home technology (MSHT) is becoming increasingly powerful, affordable, and relevant to improving environment control, independence, and participation of people with disabilities. This study examined how MSHT is delivered as assistive technology (AT) by practitioners of various disciplines and roles and collected their perspectives on the challenges and important considerations during the delivery process. Methods: Practitioners with at least 1 year of experience providing MSHT as AT were interviewed individually or in small groups of 2-3 participants. Researchers developed guiding questions based on the AT service delivery process and applied an inductive qualitative analysis to generate common themes from the data. Results: While all 15 participants confirmed the potential benefits of MSHT to people with disabilities, most followed an informal service delivery process and encountered various challenges, including challenges related to technology updates and compatibility, difficulty in keeping up with technology changes and advancement, funding for MSHT and services, client Wi-Fi/Internet access and quality, and security and privacy concerns. Participants also emphasised the importance of assessment and technology trialling during the delivery process and shared strategies for device customisation and client training. Conclusions: This study provides first-hand information about the current practice of MSHT service delivery, as well as insights into areas where support is likely needed. The results could inform the development of new tools and resources to support MSHT service delivery. More research is required to develop and evaluate viable service delivery models for mainstream technologies to be used as AT.IMPLICATIONS FOR REHABILITATIONPractitioners who have experience delivering MSHT as AT confirmed the benefits of MSHT for improving independence, safety, and social connection of people with disabilities.Practitioners emphasised the importance of assessment prior to device selection even though MSHT can be readily purchased off the shelf.Practitioners need support for device trialling, installation, troubleshooting, and keeping up with constantly evolving MSHT.More research is needed to develop and evaluate service delivery models for mainstream technologies as AT for people with disabilities.
Chapter
There is a poorly addressed input area in the accessibility field that deals with the input of scientific elements including mathematical formulas. Few studies have addressed this issue although Word and Open Office editors offer input interfaces consisting of button bars associated with mathematical symbols and an “input sheet”. The analysis of input activity with these tools with disabled children has revealed that the use of these bars is complex and tiring. HandyMathKey is virtual keyboard co-designed by specialized teacher and human-interaction researchers to address the difficulties of numerical mathematical input tools. The purpose of this paper is to describe the observation method implemented in a 4th grade class at the Centre Jean Lagarde in Toulouse and to report few results on usability of HMK.
Article
Purpose: A systematic review was performed evaluating the effectiveness of Information and Communication Technology-based Assistive Technology (ICT-based-AT) to compensate for impaired cognition in everyday life activities. Materials and methods: The study was registered in PROSPERO, registration number CRD42018114913. Six databases were searched (years 2008–2019). Inclusion criteria: Randomized controlled trials (RCTs) or cohort studies; people with impaired cognition due to non-degenerative diseases; and evaluation of ICT-based-ATs’ effectiveness regarding activity and participation, including prospective memory, execution of tasks and satisfaction with task execution. Each study’s level of evidence and quality were assessed using “JBI Levels of Evidence” and the “JBI Meta-Analysis of Statistics Assessment and Review Instrument”, respectively. Results: About 3,153 publications were located, of which 12 were included. The levels of evidence were: 1.c (RCT) (n = 7), 1.d (pseudo-RCT) (n = 1) and 3.e (observational study without control group) (n = 4). Three studies had high quality (2 RCT/1 cohort), eight acceptable (5 RCT/3 cohort) and one low (RCT) quality. Conclusions: Smartphones, personal digital assistants (PDAs), etc. with e.g. calendars and reminder alarms can improve prospective memory, especially for people with ABI. Furthermore, PDAs and similar products with prompts can improve execution of tasks for people with cognitive impairment due to different diagnoses. Products should be tailored to the users’ needs and the users trained in product use. Further studies concerning children, older people and people with intellectual and developmental disability are required; as well as studies on cost-effectiveness and the effectiveness of related services. • Implications for rehabilitation • In order to support activity and participation in everyday life for people with prospective memory problems, especially people with acquired brain injury, they should be offered information and communication technology-based products, such smart phones, mobile phones, personal digital assistants or similar mainstream products equipped with reminding software. • People with cognitive impairment having difficulties executing tasks independently should be offered PDAs and mobile telephones and similar products with prompting software, e.g. audio-verbal, picture and video-based task-sequencing prompts. • The ICT-based products should be individually tailored, and the person should be trained in using the selected product.
Article
Purpose: The primary objective of this systematic review was to examine the effectiveness of eye-gaze control technology for facilitating communication across different social contexts for people with cerebral palsy and significant physical disability. Methods: Systematic review. Results: The search identified 756 potentially eligible articles, of which two, low level articles were eligible. One study reported positive results for achieving communication goals for children with cerebral palsy. The second concluded that eye-gaze control technology resulted in greater quality of life and less depression for adults with late stage amyotrophic lateral sclerosis when compared to non-users. Discussion: Research regarding the effectiveness of eye-gaze control technology used to access a laptop, tablet or computer on communication outcomes, participation, quality of life and self-esteem in children, adolescents and adults with cerebral palsy and significant physical disability is sparse. A scoping review to fully identify issues to inform clinical practice and future research is required.
Article
Objective: Assistive technologies (ATs) support independence and well-being in people with cognitive, perceptual, and physical limitations. Given the increasing availability and diversity of ATs, evaluating the usefulness of current and emerging ATs is crucial for informed comparison. We aimed to chart the landscape and development of AT evaluation tools (ETs) across disparate fields in order to improve the process of AT evaluation and development. Data sources: We performed a scoping review of AT-ETs through database searching of MEDLINE, Embase, CINAHL, HaPI, PsycINFO, Cochrane Reviews, and Compendex as well as citation mining. Study selection: Articles explicitly referencing AT-ETs were retained for screening. We included ETs if they were designed to specifically evaluate ATs. Data extraction: We extracted five attributes of AT-ETs: AT-category, construct evaluated, conceptual frameworks, type of end-user input used for AT-ET development, and presence of validity testing. Data synthesis: From screening 23 434 records, we included 159 AT-ETs. Specificity of tools ranged from single to general ATs across 40 AT-categories. Satisfaction, functional performance, and usage were the most common constructs of 103 identified. We identified 34 conceptual frameworks across 53 ETs. Finally, 36% incorporated end-user input and 80% showed validation testing. Conclusions: We characterized a wide range of AT-categories with diverse approaches to their evaluation based on varied conceptual frameworks. Combining these frameworks in future AT-ETs may provide more holistic views of AT usefulness. AT-ET selection may be improved with guidelines for conceptually reconciling results of disparate AT-ETs. Future AT-ET development may benefit from more integrated approaches to end-user engagement.
Book
Full-text available
Features Proposes an international evidence-based ideal model of the assistive technology assessment based on experimental research and experiences in assistive products service delivery Brings together in one handbook all the assessment tools needed in an assistive technology service delivery center Describes the professional profiles, skills, and interactions of the multidisciplinary and integrated team members involved in the assessment process Identifies the needed role of professionals of psychotechnology and assessment Reviews all forms of technologies, including recent technologies such as brain–computer interfaces, robotics, and exoskeletons Comes with supplemental material containing the Matching Person and Technology tools in multiple languages. Summary Assistive Technology Assessment Handbook, Second Edition, proposes an international ideal model for the assistive technology assessment process, outlining how this model can be applied in practice to re-conceptualize the phases of an assistive technology delivery system according to the biopsychosocial model of disability. The model provides reference guidelines for evidence-based practice, guiding both public and private centers that wish to compare, evaluate, and improve their ability to match a person with the correct technology model. This second edition also offers a contribution to the Global Cooperation on Assistive Technology (GATE) initiative, whose activities are strongly focused on the assistive products service delivery model. Organized into three parts, the handbook: gives readers a toolkit for performing assessments; describes the roles of the assessment team members, among them the new profession of psychotechnologist; and reviews technologies for rehabilitation and independent living, including brain–computer interfaces, exoskeletons, and technologies for music therapy. Edited by Stefano Federici and Marcia J. Scherer, this cross-cultural handbook includes contributions from leading experts across five continents, offering a framework for future practice and research.
Chapter
Full-text available
Features Proposes an international evidence-based ideal model of the assistive technology assessment based on experimental research and experiences in assistive products service delivery Brings together in one handbook all the assessment tools needed in an assistive technology service delivery center Describes the professional profiles, skills, and interactions of the multidisciplinary and integrated team members involved in the assessment process Identifies the needed role of professionals of psychotechnology and assessment Reviews all forms of technologies, including recent technologies such as brain–computer interfaces, robotics, and exoskeletons Comes with supplemental material containing the Matching Person and Technology tools in multiple languages. Summary Assistive Technology Assessment Handbook, Second Edition, proposes an international ideal model for the assistive technology assessment process, outlining how this model can be applied in practice to re-conceptualize the phases of an assistive technology delivery system according to the biopsychosocial model of disability. The model provides reference guidelines for evidence-based practice, guiding both public and private centers that wish to compare, evaluate, and improve their ability to match a person with the correct technology model. This second edition also offers a contribution to the Global Cooperation on Assistive Technology (GATE) initiative, whose activities are strongly focused on the assistive products service delivery model. Organized into three parts, the handbook: gives readers a toolkit for performing assessments; describes the roles of the assessment team members, among them the new profession of psychotechnologist; and reviews technologies for rehabilitation and independent living, including brain–computer interfaces, exoskeletons, and technologies for music therapy. Edited by Stefano Federici and Marcia J. Scherer, this cross-cultural handbook includes contributions from leading experts across five continents, offering a framework for future practice and research.
Chapter
We faced a twofold open question regarding the measurement of individual functioning, i.e., what individual functioning measures and how it should be measured. These issues arise from the nature of the concept of disability; in other words, it is a complex construct and a “multidimensional experience [that] poses several challenges for measurement.” The present chapter is divided into three main sections. The first focuses on what individual functioning measures should be used, with a focus on the principle stating that disability is a multidimensional construct and does not have an underlying principle of measurement valid for every assessment. Additionally, the only guiding principle for a proper measurement is the clarity of the purpose of the measurement. The second section focuses on how to measure individual functioning by both pointing out some guiding principles for choosing and applying a set of measures and by suggesting some tools that fit these principles. The third section suggests some measurement tools for an assistive technology assessment process used in a center for technical aid.
Chapter
This chapter introduces the reader to brain-computer interfaces (BCIs), providing an overview of the different applications of these systems as assistive technology for different patient populations. First, we provided a definition and description of BCI systems, and we described different electrophysiological and neuroimaging techniques through which brain activity can be recorded for BCI applications. Furthermore, we described different practical uses of BCIs, particularly for restoring communication and for motor rehabilitation of patients with impaired mobility. Finally, we tackled the issue of BCI usability and the need to develop BCIs that adapt to the user’s affective and cognitive state.
Chapter
The present chapter deals with the role and the competencies of the psychologist in a center for technical aid. The lapse of the psychologist’s role in assistive technology (AT) assessment is probably due to the non-coding of personal factors in the ICF. In viewing the psychologist as the “specialist” on personal factors, the authors call for a revision of the ICF, so that in the biopsychosocial model, “psycho” does not continue as merely a prefix. The psychologist in a center for AT evaluation and provision has the goal of supporting the user’s request in the user-driven process, as well as acting as a mediator for users. The psychologist also acts to build a team spirit and enhance the relationship between the client and the home environment. Finally, an original study closes the chapter, focusing on the psychologists’ and professionals’ representations of disabled users and AT.
Article
The importance of adaptive seating system on body structure and function is widely accepted, but its impact on psychosocial aspects needs more consideration by health professionals. This article describes the Italian validation of the Psychosocial Impact of Assistive Device Scale (IT-PIADS) for non-ambulant people with neuromotor disorders. Once agreement has been given by the original authors, the scale was translated and adapted to the Italian culture. The IT-PIADS was administered to different wheelchairs users with heterogeneous diagnosis. The internal consistency and test-retest reliability were examined. Its concurrent validity was evaluated with the Italian version of the WheelCon-M-SF. The IT-PIADS was administered to 87 subjects. Cronbach’s α was 0.92 (p < 0.05), and the testretest reliability (ICC) for competence, adaptability and self-esteem subscales were 0.96, 0.90, 0.93 respectively. The Pearson correlation coefficient of the IT-PIADS with the WheelCon-M-I-SF scores showed significant data for competence and adaptability subscales. Psychosocial perception on assistive devices can be reliably measure. The IT-PIADS showed good psychometric properties and it is possible to confirm its validity for clinical and research purposes. Nevertheless, before using this measure with greater confidence, further psychometric properties tests of the IT-PIADS are recommended.
Article
Computer-assisted instruction (CAI) gives students with visual impairment (VI) immediate access to information and enables direct collaboration with sighted educators and peers. This systematic review examined interventions addressing the impact of CAI interventions on school-age children with VI. Twenty-eight studies examined CAI interventions implemented with 339 students with VI. The CAI interventions fell into five categories: digital texts, word processors, haptic simulations, educational platforms, and serious games. Findings from this review highlight the need for: (a) addressing students’ preparation or mastery for technology skills needed to participate in CAI; (b) more diverse recruitment of participants with VI; and (c) incorporating educators as implementers of CAI. Implications for practice and research are also addressed.
Article
Purpose: Providing care to older adults using assistive technology can be challenging for family caregivers. To inform the development of an Internet-based intervention, this study aimed to identify older assistive technology users and family caregivers’ needs related to assistive technology procurement, and to explore how to offer remote support through an Internet-based intervention. Methods: Based on an iterative user-centered design approach, 30 semi-structured interviews were conducted with stakeholders about their experiences with assistive technology procurement/attribution and their perceptions of a proposed intervention. A modified content analysis approach was used, with a mix of emerging and a priori concepts. Results: Participants view assistive technology procurement as an ongoing cyclical process, with potential unmet needs at key moments before and after assistive technology procurement. Assistive technology user-family caregiver dyads needs focus on assistive technology information, access, assistive technology-person-context match, training and support. While participants felt there were benefits to the proposed intervention they also identified potential implementation barriers. Conclusion: Assistive technology Internet-based interventions dedicated to family caregivers should ensure systematic and tailored follow-up while integrating some form of human support. This study guides the prototype design of the proposed intervention towards a graded support approach, empowering assistive technology users and family caregivers to resolve assistive technology-related challenges. • Implication for rehabilitation • Providing home-based care to older adults using assistive technology (e.g., mobility aids, communication aids) can be challenging for family caregivers. • Using a user-centered design approach, an Internet-based intervention is under development to support older assistive technology users and their family caregivers. • Through interviews with diverse stakeholders, this study explores unmet needs related to assistive technology procurement and perceptions about the proposed intervention.
Article
This study explores validity, reliability, and factor analysis of the Quebec User Evaluation of Satisfaction with Assistive Technology (IT-QUEST) for users of assistive technology devices in an Italian population. It was administered to 75 people to determine which of the 24 original items were relevant to the Italian context using exploratory and confirmatory factor analyses (EFAs and CFAs) were conducted with internal consistency and test-retest reproducibility also evaluated. The EFA and CFA showed that the 24-item survey may have limited relevance to the Italian context. We individuated 12 significative items, divided into two subscales, as well as the original validation. The test-retest showed high values of the Intraclass Correlation Coefficient (ICC) (0.7–0.9), with a 0.812 ICC for the total scale providing support and evidence for Italian professionals to evaluate user satisfaction with assistive technology devices. This research also lays the foundation for developing a validation study of the IT-QUEST 2.0 that is relevant to the Italian culture. Further research may investigate psychometric properties involving more participants and different users of assistive technology devices.
Article
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RESUMO: O modelo conceitual Matching, Person & Technology (MPT) propõe uma abordagem centrada no usuário e no ambiente para prescrição de tecnologia assistiva, por meio de instrumentos padronizados, para facilitar o processo de correspondência entre usuário e tecnologia. O estudo teve como objetivo traduzir e adaptar culturalmente para o Português do Brasil os instrumentos Initial Worksheet for the Matching Person & Technology Process; History of Support e Healthcare Technology Device Predisposition Assessment - HCT PA que compõem o modelo MPT. O estudo contou com a participação de dois tradutores juramentados, três pesquisadores cujo idioma nativo era o português e tinham fluência em inglês com domínio na área de tecnologia assistiva, um tradutor cujo idioma nativo era o inglês e tinha fluência em português, o coordenador do projeto, a autora do instrumento original, cinco juízes com experiência na área de tecnologia assistiva e Mestrado ou Doutorado em Educação com ênfase em Educação Especial e seis profissionais da educação e saúde com experiência no fornecimento de tecnologia assistiva para pessoas com deficiência. A pesquisa foi dividida em 5 etapas, sendo elas: 1) tradução do instrumento; 2) tradução conciliada; 3) retrotradução; 4) análise de equivalência dos itens e adequação do instrumento; e 5) pré-teste. Os resultados indicaram um alto índice de concordância entre os participantes e uma boa equivalência cultural dos instrumentos. Conclui-se que as versões em português do Brasil dos instrumentos têm uma boa aceitabilidade e são adequados para serem utilizados para a prescrição de tecnologia para usuários brasileiros.
Article
Purpose: The objective of this research was to explore the experiences of 11 hemiplegic users with their manual wheelchairs. Method: The phenomenological approach explored the subjective experiences of Brazilian hemiplegic manual wheelchair users in order to identify and describe the factors that affected their relationship with their wheelchair. Using in depth semistructured interviews. The data were analysed using thematic analysis. The health records from the physiotherapy service of the Health Department of Itajaí were reviewed to identify hemiplegic wheelchair users. Results: The results identified 4 key themes: heteronomy, inadequate/inappropriateness of wheelchair design, poor state of the pavements and roads prohibiting wheelchair use and lack of suitable wheelchair provision. Conclusion: The findings confirm that current manual wheelchair provision, both new and secondhand, for this group of users is inadequate and they highlighted the issues and problems arising from the current provision. A novel finding was the identification of heteronomy that resulted from the provision of unsuitable equipment. • Implication for rehabilitation • Adding into physiotherapy and occupational therapy education, the importance of matching technology to the user in their environment. • The importance of involving the user in decisions made about wheelchair provision. • Sharing findings with wheelchair manufacturers to improve manual wheelchair design for hemiplegic users.
Article
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Cross-cultural adaptation for use in Brazil of Survey of Technology Use (SOTU Br) Adaptación transcultural para uso en Brasil del Instrumento Survey of Technology Use (SOTU Br) RESUMO A taxa de abandono ou não uso de recursos de tecnologia assistiva adquirido é considerada alta, apesar dos esforços dos profissionais no momento da prescrição. A literatura tem apontado que o uso de instrumentos de avaliação padronizados e baseados em modelos conceituais tem contribuído para maior aceitabilidade desses recursos. O estudo teve como objetivo traduzir e adequar culturalmente o instrumento Survey of Technology Use (SOTU) que compõe o modelo conceitual Matching Person and Technology (MPT) para utilização no Brasil (SOTU Br). Trata-se de uma pesquisa do tipo metodológica. Participaram do estudo profissionais especialista em dispensação de recursos de tecnologia assisitiva e pessoas com deficiência que fazem uso de tecnologia assistiva. O estudo foi dividido em cinco etapas: 1) tradução para o português; 2) tradução conciliada; 3) retrotradução; 4) análise de equivalência de itens; 5) pré-teste. Os resultados indicaram que a versão traduzida e adaptada para o português do Brasil teve um alto índice de concordância e uma
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Purpose: This paper critically reviews and reflects on the processes for providing Assistive Technology (AT) services to Persons with Disabilities (PWD) in Bangladesh, India and Nepal. The aim is to investigate the AT service delivery systems in these countries and suggest improvements where weaknesses are identified. Materials and methods: We carried out a descriptive qualitative exploratory study in Bangladesh, India and Nepal by conducting key informant interviews with policymakers (5), AT service providers (22) and mobility and hearing related AT service users (21). We used a directed content analysis approach guided by a seven-point AT service delivery process model to thematically analyse the existing processes for AT service delivery, from first contact through to follow-up and maintenance. Results: AT service delivery processes are sub-optimal in all three countries, and improvements are needed. No common AT service delivery process was found, although there are common features. In general, it is easier for PWDs in India and Nepal to access AT than for those in Bangladesh, but all three countries are failing to live up to their commitments to uphold the human rights of PWDs. Conclusions: Although good elements of AT service delivery processes can be identified, the systems in all three countries are fragmented and generally weak. A more holistic approach of looking at the process of AT service delivery, from first contact right through to follow-up and device maintenance, with a single door service delivery system, free of cost at the point of service is recommended in these countries. IMPLICATIONS FOR REHABILITATIONAlthough we found significant weaknesses in AT delivery in all three countries, there are some good AT service delivery practices and opportunities for these countries to learn from one another.A systematic and stepwise approach to assessing current AT service delivery processes in the three countries - examining the delivery system as a whole, from initiation to repair and management - can help identify opportunities to improve the process for (prospective) AT users.A more coherent single door system of AT service delivery will increase the quality and efficiency of the fragmented AT service delivery practices in Bangladesh, India and Nepal.
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In this chapter, the assistive technology assessment (ATA) model has been presented. The ATA model outlines an ideal process that provides reference guidelines for both public and private centers for technical aid provision, allowing them to compare, evaluate, and improve their own matching model. The actions required by the ATA model to centers for technical aid can be divided into four fundamental steps: access to the structure and activation of the process, evaluation and activation of the aid/AT selection, delivery, and follow-up. The ATA is a user-driven process through which the selection of one or more aids/ AT is facilitated by the utilization of comprehensive clinical measures, functional analysis, and psycho-socio-environmental evaluations that address, in a specific context of use, the personal well-being of the user through the best matching of user/client and assistive solution (Scherer et al. Early Online). Because the ATA process and the MPT model and accompanying measures share a user-driven working methodology and embrace the ICF biopsychosocial model, they can be integrated within a path aiming for the best combination of AT to promote user/customer’s personal well-being.
Technical Report
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There are currently approximately 45 million people in Europe who report a long standing health problem or disability. Further, the aging population means that more people will have to live with some sort of disability. Recent figures from the 2008-based national population projections EUROPOP2008 show that the share of people aged 65 years or over in the total population is projected to increase from 17.1% to 30.0% and the number is projected to rise from 84.6 million in 2008 to 151.5 million in 2060. Many assistive technology devices are allocated to the elderly and the needs will not be smaller with an aging population. For example, in Sweden, around 70% of assistive devices prescribed go to people aged over 65. These demographic shifts are going to be an important driver behind increases in demand, as well as increases, or changes in the types of demands for more accessible products, including some forms of assistive technology. This report represents the final report of the study, “Analysis of the Assistive Technologies Information and Communication Technologies (AT ICT) industry in Europe” for the European Commission. The global objective of the study has been to gain information as to the state of the EU AT ICT industry and develop conclusions and recommendations to what steps can be taken to improve the competitiveness of the companies which form this industry. To carry out this study, the study team employed a variety of techniques and sources of information in order to gain as complete and accurate a view as possible on the AT ICT industry in the 27 Member States of the EU
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Purpose: Community-based rehabilitation (CBR) must prove that it is making a significant difference for people with disabilities in low- and middle-income countries. Yet, evaluation is not a common practice and the evidence for its effectiveness is fragmented and largely insufficient. The objective of this article was to review the literature on best practices in program evaluation in CBR in relation to the evaluative process, the frameworks, and the methods of data collection. Method: A systematic search was conducted on five rehabilitation databases and the World Health Organization website with keywords associated with CBR and program evaluation. Two independent researchers selected the articles. Results: Twenty-two documents were included. The results suggest that (1) the evaluative process needs to be conducted in close collaboration with the local community, including people with disabilities, and to be followed by sharing the findings and taking actions, (2) many frameworks have been proposed to evaluate CBR but no agreement has been reached, and (3) qualitative methodologies have dominated the scene in CBR so far, but their combination with quantitative methods has a lot of potential to better capture the effectiveness of this strategy. Conclusions: In order to facilitate and improve evaluations in CBR, there is an urgent need to agree on a common framework, such as the CBR matrix, and to develop best practice guidelines based on the literature available and consensus among a group of experts. These will need to demonstrate a good balance between community development and standards for effective evaluations. Implications for Rehabilitation In the quest for evidence of the effectiveness of community-based rehabilitation (CBR), a shared program evaluation framework would better enable the combination of findings from different studies. The evaluation of CBR programs should always include sharing findings and taking action for the sake of the local community. Although qualitative methodologies have dominated the scene in CBR and remain highly relevant, there is also a call for the inclusion of quantitative indicators in order to capture the progress made by people participating in CBR programs. The production of best practice guidelines for evaluation in CBR could foster accountable and empowering program evaluations that are congruent with the principles at the heart of CBR and the standards for effective evaluations.
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Background Knowledge about the relation between user involvement in the provision of assistive technology and outcomes of assistive technology use is a prerequisite for the development of efficient service delivery strategies. However, current knowledge is limited, particularly from low-income countries where affordability is an issue. The objective was therefore to explore the relation between outcomes of assistive technology use and user involvement in the service delivery process in Bangladesh. Methods Using structured interviews, data from 136 users of hearing aids and 149 users of manual wheelchairs were collected. Outcomes were measured using the International Outcome Inventory for Hearing Aids (IOI-HA), which was adapted for wheelchair users. Predictors of user involvement included preference, measurement and training. Results Users reported outcomes comparable to those found in other high- and low-income countries. User involvement increased the likelihood for reporting better outcomes except for measurement among hearing aid users. Conclusions The findings support the provision of assistive technology as a strategy to improve the participation of people with disabilities in society. They also support current policies and guidelines for user-involvement in the service delivery process. Simplified strategies for provision of hearing aids may be explored.
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The purpose of this article was to qualitatively analyse the extent to which community based rehabilitation programmes have been evaluated over the past thirty years. A framework of strengths, weaknesses, opportunities and threats analysis was used in conducting this analysis. Using an extensive search of MEDLINE, 22 articles were located that described and evaluated one or more dimensions of CBR. Three studies each from Australia, India, Zimbabwe and two studies each from England, Philippines, Vietnam and one each from Finland, Guyana, Jamaica, Japan, Pakistan, Papua New Guinea, Thailand, and United States were included in the analysis. A variety of methods used, most evaluations conducted in community settings, focus on mobility related evaluations by most programmes, and development of new instruments were the strengths of CBR evaluations. Some of the weaknesses were lack of consistency in outcome measures, lack of cost benefit and cost effectiveness studies, small sample size of many studies, and lack of focus on other than mobility related disabilities by most projects. The opportunities for CBR evaluations pertain to training assessments, use of mixed models, using indicators from a standard taxonomy, and focusing on medical rehabilitation. The threats to CBR evaluations are a need to prioritise from multifarious activities and having limited resources for evaluation.
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. The Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST 2.0) is a 12-item outcome measure that assesses user satisfaction with two components, Device and Services. Psychometric properties have been tested with respect to test-retest stability. alternate-form equivalence. internal consistency, factorial composition and nomological validity. Examples of results obtained with the first version of the tool in outcome studies in Europe and North America support the importance and relevance of the satisfaction measure.
Chapter
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Purpose: The present pilot study aims to analyse the relationship between the reasons of the use/non-use of assistive technology (AT) and levels of user satisfaction of Italian user/patient in order to identify which features of the Italian AT assessment process in the Italian Territorial Health Service Providers (THSPs) better predict AT non-use. Method: Between November 2010 and January 2011, a telephonic structured interview with open- and closed-ended questions was administrated to 104 THSP users who have received an AT at least one year before. Results: Findings show that there is a 25% of AT non-use that is strictly related to the user satisfaction of AT and to the lacks percept by the users in the assignation process. personal opinion considered in selection.
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The chapter focuses on the Bootstrap statistical technique for assigning measures of accuracy to sample estimates, here adopted for the first time to obtain an effective and efficient interaction evaluation. After introducing and discussing the classic debate on p value (i.e., the discovery detection rate) about estimation problems, the authors present the most used model for the estimation of the number of participants needed for an evaluation test, namely the Return On Investment model (ROI). Since the ROI model endorses a monodimensional and economical perspective in which an evaluation process, composed of only an expert technique, is sufficient to identify all the interaction problems-without distinguishing real problems (i.e., identified both experts and users) and false problems (i.e., identified only by experts)- they propose the new Bootstrap Discovery Behaviour (BDB) estimation model. Findings highlight the BDB as a functional technique favouring practitioners to optimize the number of participants needed for an interaction evaluation. Finally, three experiments show the application of the BDB model to create experimental sample sizes to test user experience of people with and without disabilities.
Book
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The process of matching a person who has a disability with the most appropriate assistive technology requires a series of assessments, typically administered by multidisciplinary teams at specialized centers for technical aid. Assistive Technology Assessment Handbook fills the need for a reference that helps assistive technology experts perform assessments that more effectively connect the person and the technology. Emphasizing the well-being of the individual with a disability, the book proposes an ideal model of the assistive technology assessment process and outlines how this model can be applied in practice internationally. Organized into three parts, the handbook: Gives readers a toolkit for performing assessments Describes the roles of the assessment team members, among them the new profession of the psychotechnologist, who is skilled in understanding individuals and their psychosocial and technological needs and preferences Reviews cutting-edge technologies for rehabilitation and independent living, including brain–computer interfaces and microswitches The book synthesizes information scattered throughout the international literature, focusing on aspects that are particularly representative or innovative. It also addresses the challenges posed by the variety of health and social care systems and the different ways that individuals who need aid are defined—are they users, patients, clients, or consumers, and how does that affect the assessment?
Conference Paper
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The value of theoretical analyses in user interface design has been hotly debated. All sides agree that it is difficult to apply current theoretical models within the constraints of real-world development projects. We attack this problem in the context of bringing the theoretical ideas within a model of exploratory learning [19] to bear on the evaluation of alternative interfaces for walk-up-and-use systems. We derived a “cognitive walkthrough” procedure for systematically evaluating features of an interface in the context of the theory. Four people independently applied this procedure to four alternative interfaces for which we have empirical usability data. Consideration of the walkthrough sheds light on the consistency with which such a procedure can be applied as well as the accuracy of the results.
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To present the results of a strengths, weaknesses, opportunities and threats (SWOT) analysis used as part of a process aimed at reorganising services provided within a pediatric rehabilitation programme (PRP) in Quebec, Canada and to report the perceptions of the planning committee members regarding the usefulness of the SWOT in this process. Thirty-six service providers working in the PRP completed a SWOT questionnaire and reported what they felt worked and what did not work in the existing model of care. Their responses were used by a planning committee over a 12-month period to assist in the development of a new service delivery model. Committee members shared their thoughts about the usefulness of the SWOT. Current programme strengths included favourable organisational climate and interdisciplinary work whereas weaknesses included lack of psychosocial support to families and long waiting times for children. Opportunities included working with community partners, whereas fear of losing professional autonomy with the new service model was a threat. The SWOT results helped the planning committee redefine the programme goals and make decisions to improve service coordination. SWOT analysis was deemed as a very useful tool to help guide service reorganisation. SWOT analysis appears to be an interesting evaluation tool to promote awareness among service providers regarding the current functioning of a rehabilitation programme. It fosters their active participation in the reorganisation of a new service delivery model for pediatric rehabilitation.
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To obtain insight into the prevalence of the non-use of assistive technology in The Netherlands. Relationships between non-use and possible determinants were also investigated. The results of the study might lead to improvement of products and of the service delivery system for assistive technology. A study was performed into user satisfaction and the non-use of 14 categories of assistive technology provided by health care insurers. The design was a survey among a stratified sample of users who had received an assistive device, recruited through a sample of health insurance companies. Two independent samples were selected: one in 2001 and one in 2003. Three aspects of non-use were measured. The total number of respondents was 2272. Ninety-two percent of the respondents used the assistive device at the time of the survey. Less than 1% of the respondents never used the device. A majority of the respondents used the assistive device (about) as much as expected and 6% used the assistive device less than expected. Relationships between non-use and other investigated aspects were found. The average level of non-use of assistive technology found in this study is less than often reported in the literature and varies between the various categories of assistive technology. Improving the quality of the assistive technology and the services, and providing assistive technology that solves the users' problem as much as possible, could enhance the use of assistive technology provided.
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Disease management (DM) program evaluations are somewhat limited in scope because of typically small sample sizes comprising important subsets of the treated population. Identifying subsets of the data that have differing results from the aggregate of the whole program can lend insight into where, when, and how the program achieves its results. Additionally, there is a very limited set of classical tools available for the smaller sample sizes typically encountered in DM. Without readily available standard error and confidence interval (CI) calculations, the analyst may be fooled by specious details. A method called the ‘bootstrap’ is introduced as a suitable technique for allowing DM program evaluators to use a broader array of quantities of interest and to extend inferences to the population based on results achieved in the program. The bootstrap uses the power of modern computers to generate many random samples from a given data set, allowing the use of repeated samples’ statistic (e.g. mean, proportion, and median). Using a congestive heart failure (CHF) program as an example, the bootstrap technique is used to extend a DM program evaluation beyond questions addressed using classical statistical inference: (i) how much of a median cost decrease can be expected as a result of the program?; (ii) did the program impact the highest and lowest costing members equally; and (iii) how much of a decrease in the proportion of patients experiencing a hospitalization can be expected as a result of the program? The potential advantages of the bootstrap technique in DM program evaluation were clearly illustrated using this small CHF program example. A more robust understanding of program impact is possible when more tools and methods are available to the evaluator. This is particularly the case in DM, which is inherently biased in case-mix (e.g. strive to enroll sickest first), often has skewed distributions or outliers, and may suffer from small sample sizes. The bootstrap technique creates distributions that allow for a more accurate method of drawing statistical inferences of a population. Moreover, since classical statistical inference techniques were designed specifically for parametric statistics (i.e. assuming a normal distribution), the bootstrap can be used for measures that have no convenient statistical formulae. Additionally, CIs can be defined around this statistic, making it a viable option for evaluating DM program effectiveness.
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Two consecutive studies addressed device use post-discharge in relation to functional status among 47 persons with mixed diagnoses discharged from an acute inpatient rehabilitation unit. Telephone interviews were used to ascertain device use; functional status was obtained using the telephone version of the Functional Independence Measure (FIM). Among all participants, 128 devices were prescribed; of these, 86 devices were still used at 3-month follow-up. The four types of devices most frequently abandoned were adapted grooming aids (55% nonuse), quad canes (43%), walkers (36%), and manual wheelchairs (36%). The most frequent reason given for nonuse was that the device was no longer needed. In study two, it was found that functional improvement (at follow-up) corresponded with device nonuse for about half the devices. The study also documented discrepancies in perception between therapists and consumers regarding utility and aesthetic aspects of devices. Strategies to maximize appropriate use of devices are presented.
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Technology abandonment may have serious repercussions for individuals with disabilities and for society. The purpose of this study was to determine how technology users decide to accept or reject assistive devices. Two hundred twenty-seven adults with various disabilities responded to a survey on device selection, acquisition, performance, and use. Results showed that 29.3% of all devices were completely abandoned. Mobility aids were more frequently abandoned than other categories of devices, and abandonment rates were highest during the first year and after 5 years of use. Four factors were significantly related to abandonment--lack of consideration of user opinion in selection, easy device procurement, poor device performance, and change in user needs or priorities. These findings suggest that technology-related policies and services need to emphasize consumer involvement and long-term needs of consumers to reduce device abandonment and enhance consumer satisfaction.
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To validate an assistive technology (AT) baseline and outcomes measure and to quantify the measure's value in determining the best match of consumer and AT considering consumer ratings of their subjective quality of life, mood, support from others, motivation for AT use, program/therapist reliance, and self-determination/self-esteem. Prospective multi-cohort study. Vocational rehabilitation offices and community. Over 150 vocational rehabilitation counselors in 25 U.S. states with one consumer each receiving new AT. Counselor training in the Matching Person and Technology (MPT) Model and consumer completion of the MPT measure, Assistive Technology Device Predisposition Assessment (ATD PA). Total and subscale scores on the ATD PA as well as counselor-completed questionnaires. ATD PA items differentiated consumer predispositions to AT use as well as AT and user match. There were no significant differences due to gender, physical locality, or age within this sample of working-age adult consumers. Vocational rehabilitation counselors exposed to training in the MPT Model achieved enhanced AT service delivery outcomes. The ATD PA is a valid measure of predisposition to use an AT and the subsequent match of AT and user. Rehabilitation practitioners who use the ATD PA will achieve evidence-based practice and can expect to see enhanced AT service delivery outcomes.
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Delphi surveys with panels of experts in a particular area of interest have been widely utilized in the fields of clinical medicine, nursing practice, medical education and healthcare services. Despite this wide applicability of the Delphi methodology, there is no clear identification of what constitutes a sufficient number of Delphi survey participants to ensure stability of results. The study analyzed the response characteristics from the first round of a Delphi survey conducted with 23 experts in healthcare quality and patient safety. The panel members had similar training and subject matter understanding of the Malcolm Baldrige Criteria for Performance Excellence in Healthcare. The raw data from the first round sampling, which usually contains the largest diversity of responses, were augmented via bootstrap sampling to obtain computer-generated results for two larger samples obtained by sampling with replacement. Response characteristics (mean, trimmed mean, standard deviation and 95% confidence intervals) for 54 survey items were compared for the responses of the 23 actual study participants and two computer-generated samples of 1000 and 2000 resampling iterations. The results from this study indicate that the response characteristics of a small expert panel in a well-defined knowledge area are stable in light of augmented sampling. Panels of similarly trained experts (who possess a general understanding in the field of interest) provide effective and reliable utilization of a small sample from a limited number of experts in a field of study to develop reliable criteria that inform judgment and support effective decision-making.
Article
Over the years, several studies have been performed on the subject of non-use of provided assistive technology. All of them report high rates of non-use. In this literature overview the determinants mentioned in literature that affect the degree of non-use will be discussed. They will be compared to the determinants that affect adherence with medical interventions. First, the various definitions of non-use used in literature will be compared. Next, an overview of the determinants of non-use of assistive technology will be given, categorized under personal factors, factors related to the assistive device, factors related to the user's environment and factors related to the intervention. After comparing these factors to the factors found in literature related to adherence with medical interventions, the strategies used to reduce non-adherence with medical interventions will be "translated" into the field of assistive technology provision.
Article
In this book, leading experts explore ways psychologists and other helping professionals can collaborate with users of assistive technology to help them get the most out of these devices. Thanks in large part to the past century's advances in technology, people with disabilities can live independent lives, contribute to their communities, attend regular schools, and work in professional careers. This technological evolution has fomented a shift from a medical to a social model of technology delivery, an approach that puts as much emphasis on users' community reintegration as it does on their physical capabilities. This change means that those in the field can no longer focus on the delivery of technology as an end in itself, but must go one step further and partner with consumers and communities to ensure that assistive devices are put to their best possible use. This interdisciplinary book provides research-based guidance for finding the perfect match between device and consumer, including key information on personality assessment, the influence of pain, coping skills, and the power of new technology and social programs. This volume will be of interest to rehabilitation psychologists, researchers, and anyone working with or using assistive technology. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
This exploratory study examined the relationships between consumers' involvement in the pre-purchase decision-making process, their perceptions of feeling informed, and their degree of being satisfied with and use of assistive technology (AT). Does consumer information and participation in decision-making process lead to improved satisfaction and use of AT? A link to an project-specific web-based survey, sent to several online disability forums and independent living centres, resulted in a sample of 145 individuals with a range of disabilities, who used a range of AT and were geographically dispersed. There is a significant relationship between being feeling informed and being satisfied with an AT device (F(13,278) = 27.79, p = 0.000). Feeling that personal needs were not assessed led to lower satisfaction (β = -0.15, p < 0.07), while feeling informed resulted from a number of different factors. Lack of consumer involvement in the pre-purchase decision-making process led to somewhat greater rates of abandonment in some categories of AT (some with small n's). Talking with other users, auditioning the device and searching the Internet are important ways for consumers to gather information. When consumers feel informed, they are more likely to be satisfied with the AT and retain it.
Article
To assess the home-situation of the oldest old regarding the ownership, use, and need for intervention of assistive devices and community-based services. A research nurse and an occupational therapist, who evaluated the current situation regarding ownership and use of assistive devices, visited a representative group of 147 Dutch community-dwelling 85-year-olds in their own homes. Furthermore, the occupational therapist assessed whether an intervention was indicated. Assistance in purchasing devices, information, and instruction were provided when necessary. 94% of the subjects owned one or more assistive devices, with a mean of 4.5 (SD 2.7) assistive devices. Most frequently owned were grab rails. Of the total number of 591 assistive devices, 74 (13%) were not in use. In 66 of the 147 (45%) subjects at least one intervention was indicated. A total number of 23 subjects received information and instruction on mobility-related issues, while 17 subjects received information and instruction on personal care-related issues. Moreover, for 19 subjects an application procedure was started for a total of 25 assistive devices and five community-based services in the mobility category while for 19 subjects an application procedure was started for a total of 31 devices and four services in the personal care category. Based on detailed information from occupational therapists, the home situation of community-dwelling elderly regarding the presence and use of assistive devices and community-based services is not optimal.
Article
A crucial need in assistive technology delivery is follow-up to determine device performance and satisfaction from the individual with a disability's perception. As part of an overall research project on technology transfer, this investigation was designed to measure and document service delivery outcomes, first in a pilot study at the Rehabilitation Engineering Center (REC), Lucile Salter Packard Children's Hospital at Stanford (LSPCH) with 60 consumers and then in a replication study in four other service delivery centers providing devices to 103 clients. One hundred sixty-three devices were delivered to 163 consumers by five service delivery centers. The results of this investigation indicate that user feedback can be documented through prospective and standardized data collection forms; outcome measures can be helpful in determining user satisfaction and device performance; user responses, compared with clinician evaluations, are reliable perceptions of device performance; provision of the selected assistive devices was demonstrably positive for the majority of device users; and for those individuals not initiating return visits, the phone-call follow-up provided information that would not have been available otherwise to the service providers.
Article
To investigate the measurement properties of the Quebec User Evaluation of Satisfaction with assistive Technology (QUEST 2.0) with respect to test-retest stability, alternate form reliability, construct validity and applicability. Data on satisfaction and quality of life impacts of mobility devices were obtained from 81 community-based adults with Multiple Sclerosis, using the QUEST 2.0 and the Psychosocial Impact of Assistive Devices Scale (PIADS). Subjects were assigned to four groups and a second QUEST 2.0 was administered one week later. Groups differed with respect to the format and the order in which alternate forms were presented. Measures of association were calculated between QUEST 2.0 and PIADS (n = 81) and between QUEST 2.0 alternate forms (n = 48). Respondents' reactions were considered. The device subscale, services subscale, and total QUEST 2.0 scores achieved good test-retest stability (ICC 0.82, 0.82, 0.91). Alternate-form equivalence (ICC 0.89, 0.76, 0.91) was lower for services. The positive correlations between QUEST 2.0 and the three PIADS dimensions were fair to moderate for device and total QUEST 2.0 (r(p) 0.34 to 0.45) and fair with services (r(p) 0.27 to 0.30). The tool was positively received, with some restrictions for the services subscale. These findings on the psychometric properties of the QUEST 2.0 reinforce the relevance of the device subscale as an important outcome measure for assistive technology MS users. Further assessment of the services subscale is needed.
Article
This study was conducted to identify factors which influence individuals with a spinal cord injury to abandon their first wheelchair before five years of use. It aims to provide prescribing therapists and manufacturers with insights which may assist in facilitating better outcomes for wheelchair users, thereby reducing abandonment rates and containing replacement costs. A descriptive, qualitative design was used to gather the perceptions of three individuals with a spinal cord injury. Thematic analysis yielded five themes: 'Participants' experience of the first prescription'; 'The physical issues with the wheelchair have functional implications'; 'Gaining experience is so important'; 'Participants' experience of the second prescription'; and 'Participants' suggestions'. Factors influencing manual wheelchair abandonment for these participants were consistent with findings from the literature concerning dissatisfaction and abandonment of assistive technology. For these three individuals the lack of experience in wheelchair use and selection, the functional limitations encountered with the design of the wheelchair and the manner and timing of the prescription process combined to lead to dissatisfaction and ultimately abandonment. Suggestions for changes to wheelchair prescription practices were made.
Article
To investigate whether active intervention using a compiled checklist for wheelchair check-ups increases user satisfaction and/or decreases accidents, near accidents and pressure sores. A randomized controlled trial comparing active intervention versus standard intervention for prescribed, manually propelled wheelchairs. Patients within primary health care of Borås and Bollebygd municipalities, a mixed urban and rural population. Users of manually propelled wheelchairs over 16 years of age. The accident rate, extent of pressure sores, number and extent of repairs, reconditioning, adjustments as well as user satisfaction were measured initially and at one year. In the standard intervention, the user and carer were encouraged to initiate contact when necessary. In the active intervention, an occupational therapist performed a scheduled, thorough check-up of the wheelchair, following a compiled checklist for safety, comfort and positioning, manoeuvrability and transportation. Of 253 registered wheelchair users, 216 were suitable and randomized. In the active intervention group, 99% (95% confidence interval 96-100%) of the inspected wheelchairs required maintenance. The incidence of accidents was unchanged in the standard intervention group, but decreased to 'no accidents' in the active intervention group (p = 0.03). User satisfaction was not affected by the active intervention. Most wheelchair users are unable to determine on their own when adjustments are needed. An active check-up on manually propelled wheelchairs seems to reduce accidents. More information is available at http://www.wheelchair.se
Article
Assistive technology makes up a substantial portion of the direct cost of multiple sclerosis (MS). Equipment abandonment results in the needs of the disabled individual being unmet and places stress on the resources available for the funding of such equipment. The aim of the study was to demonstrate whether an interdisciplinary approach to evaluating and prescribing assistive technology reduces equipment abandonment in persons with MS. Data concerning assistive devices acquired by patients being followed at a rehabilitation centre in northern Italy from January 1997 to December 2002, were included in the study. Through December 1999, a physician in physical medicine and rehabilitation prescribed equipment based on a recommendation from the physical therapist. From 2000 to 2002, patients were evaluated following a standardized protocol implemented by an interdisciplinary team comprised of a physical therapist, occupational therapist, physician in physical medicine and rehabilitation and psychologist. Assistive technology obtained during the study period was divided into two datasets based on the year that the aid was obtained: pre-intervention (January 1997 to December 1999) and intervention (January 2000 to December 2002). The analysis included a comparison of the two datasets on number and types of equipment abandoned, timing of abandonment and reasons why devices were abandoned. Fifty-four subjects obtained 151 assistive devices during the study period, 67 devices during pre-intervention and 84 with the intervention. The majority of devices were abandoned immediately or within the first year following obtainment in both groups. A comparison of the number of devices obtained during pre-intervention with those obtained during the intervention showed that the rate of equipment abandonment decreased significantly from 37.3 to 9.5%. An interdisciplinary approach to evaluating assistive technology needs does decrease the risk of equipment abandonment, although it does not completely solve the problem.
Article
The definition and aims of rehabilitation are both topics of frequent debate. Recently several authors have suggested defining rehabilitation and its goals in terms of 'person-centredness'. However such attempts to define rehabilitation in this way have not occurred without running into their own difficulties and criticisms. Consequently, one may question whether person-centredness is a good candidate to characterize and define rehabilitation. The purpose of this article is to reflect upon the historical background and conceptual underpinnings of this term and their relevance for understanding contemporary person-centred rehabilitation. We conducted a conceptual and historical analysis of the notion of person-centredness in relation to rehabilitation. We ask first whether person-centredness has a consistent and fixed definition and meaning? Secondly, where does person-centredness come from, what is its conceptual history and does an historical approach enable us to identify a unique source for person-centredness? In the context of rehabilitation, we have identified four main understandings or interpretations of the term person-centredness, each of which denotes several ideas that can be, in turn, interpreted in quite different ways. Thus the concept of person-centredness in rehabilitation has multiple meanings. The conceptual history indicates that person-centredness has diverse meanings and that it has been used in a variety of contexts somewhat unrelated to disability and rehabilitation. Moreover, there does not seem to be any strict relationship between person-centredness as it is used in the context of rehabilitation and these prior uses and meanings. Person-centredness has an ancient pedigree, but its application in the field of rehabilitation raises both practical and theoretical difficulties. It may be that rehabilitation might get a better sense of what it should be and should do by focusing less on the rhetoric of person-centredness and by putting more emphasis on the investigation and operationalization of its key conceptual components.
Piano sanitario regionaleAtto num. 298 del 28-04-2009) [Umbria Region Health Care Plan
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Regione Umbria. Piano sanitario regionale 2009/2011 (Atto num. 298 del 28-04-2009) [Umbria Region Health Care Plan 2009–2011]. Bollettino Ufficiale 2009;25:1–428.
Service delivery systems for assistive technology in Europe: Position Paper
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Linden A, Adams JL, Roberts N. Evaluating disease management program effectiveness. Dis-Manage-Health-Outcomes 2005;13: 159–67.
The bootstrap discovery behaviour model: why five users are not enough to test user 4. The users, going through the delivery process, may face a multiple set of evaluation meetings with different specialists (never in a team). (iv) – Delivery and follow-up
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Borsci S, Federici S, Mele ML, et al. The bootstrap discovery behaviour model: why five users are not enough to test user 4. The users, going through the delivery process, may face a multiple set of evaluation meetings with different specialists (never in a team). (iv) – Delivery and follow-up
Early Online: 1–10 Disabil Rehabil Assist Technol Downloaded from informahealthcare
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Europe with free choice of assistive technology. The provision of assistive devices in specific European countries. Vällingby: Swedish Institute of Assistive Technology
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Estreen M. Europe with free choice of assistive technology. The provision of assistive devices in specific European countries. Vällingby: Swedish Institute of Assistive Technology; 2010.
Assistive products for persons with disability – Classification and terminology
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ISO. ISO 9999:2011 Assistive products for persons with disability – Classification and terminology. Brussels: CEN 2011.
World Bank Geneva: WHO; 2011 Available from: http://www. who.int/disabilities
World Health Organization (WHO), World Bank. World Report on Disability. Geneva: WHO; 2011. Available from: http://www. who.int/disabilities/world_report/2011/en/index.html.
The assessment of the environments of use: accessibility, sustainability, and universal design
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Mirza M, Gossett Zakrajsek A, Borsci S. The assessment of the environments of use: accessibility, sustainability, and universal design. In: Federici S, Scherer MJ, eds. Assistive technology assessment handbook. Boca Raton (FL): CRC Press; 2012:67-81.
Systemic user experience Assistive technology assessment handbook
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Borsci S, Kurosu M, Mele ML, Federici S. Systemic user experience. In: Federici S, Scherer MJ, eds. Assistive technology assessment handbook. Boca Raton (FL): CRC Press; 2012:337–59.
AAATE position paper: a 2003 view on Technology and Disability. 2003 -Available from: http://www.aaate.net/ [last accessed
AAATE. AAATE position paper: a 2003 view on Technology and Disability. 2003 -Available from: http://www.aaate.net/ [last accessed 10 April 2012].
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The bootstrap discovery behaviour model: why five users are not enough to test user experience Cognitively informed intelligent interfaces: systems design and development