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Why people use and don’t use technologies: Introduction to the special issue on assistive technologies for cognition/cognitive support technologies

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Abstract

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.
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NeuroRehabilitation xx (20xx) x–xx
DOI:10.3233/NRE-151264
IOS Press
1
Guest Editorial1
Why people use and don’t use technologies:
Introduction to the special issue on assistive
technologies for cognition/cognitive support
technologies
2
3
4
5
Marcia J. Scherera,and Stefano Federicib
6
aInstitute for Matching Person & Technology, Webster, NY, USA7
bUniversity of Perugia, Perugia, Italy
8
Abstract. 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
9
10
11
12
13
Keywords: Assistive technology devices, assistive technology services, cognitive support technologies, nonuse, abandonment,
Matching Person and Technology Model, brain injury
14
15
Many neurorehabilitation professionals work with
16
individuals with a combination of cognitive, physical,
17
sensory or other disabilities and chronic health con-18
ditions and at various stages along the rehabilitation19
continuum. This special issue discusses the potential20
of a variety of devices for individuals ranging from21
those in a minimally conscious state to those partic-
22
ipating in education and the workplace. To illustrate23
this wide range of topics, we begin with a review arti-
24
cle by Federici., Meloni, Bracalenti and De Filippis that
25
examines the utility of current active, powered, wear-
26
able lower limb exoskeletons and their load on working27
memory and cognition for paraplegic patients with28
gait disorders resulting from central nervous system
Address for correspondence: Marcia J. Scherer, Institute for
Matching Person & Technology, 486 Lake Road, Webster, NY 14580,
USA. Tel./Fax: +1 585 671 3461; E-mail: IMPT97@aol.com.
lesions. The article by Lancioni, Singh, O’Reilly et 29
al. presents the positive effects found in the use of a 30
technology-aided approach to foster responding and 31
stimulation control in individuals in a post-coma min- 32
imally conscious state. The contribution by Bilancia, 33
Marazz and & Filippi discusses a treatment method 34
for an individual with a Specific Learning Disorder 35
involving reading and writing difficulties through an 36
intervention based on the integration of a sublexical 37
method and a neuropsychological approach along with 38
assistive technologies. Leslie, Kinyanjui, Bishop, et al. 39
conducted a large-scale analysis of workers in the USA 40
with multiple sclerosis and cognitive and functional 41
limitations. They addressed who utilizes workplace 42
accommodations, the types of accommodations most 43
frequently required, and differences in disease vari- 44
ables, job-related factors, and quality of life between 45
workers using and not using work accommodations. 46
1053-8135/15/$35.00 © 2015 – IOS Press and the authors. All rights reserved
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2M.J. Scherer and S. Federici / Introduction to the special issue on assistive technologies for cognition/cognitive support technologies
Support from technology can come from various47
mainstream or everyday technologies such as comput-48
ers and smartphones, as well as specialized products
49
that become an integral part of that person’s func-50
tioning, persona and self-image such as exoskeletons,51
wearable cuing devices, and wearable cameras.52
Assistive technology devices (ATDs) have a U.S. fed-
53
eral definition and are mandated to be considered in
54
several laws such as the Individuals with Disabilities
55
Education Act (IDEA). Specialized products or ATDs56
include wheelchairs, walkers, communication devices,
57
products to augment hearing and vision and many more.
58
Individuals with cognitive disabilities may use any59
of these as well as specialized software and apps for
60
memory, executive functioning, and so on in combina-61
tion with personal assistance and cognitive/behavioral62
strategies.63
An ATD is what the person uses. How they obtain and
64
maintain it and master its use falls under the purview65
of assistive technology services. Professionals increas-66
ingly are better able to respond to consumers’ different
67
needs and preferences because the variety of technol-
68
ogy options continues to expand. However, as noted in69
the review article by Leopold, the increased availability70
of technology options has made the process of matching71
a person with the most appropriate device more com-72
plex because people’s predisposition to, expectations73
for, and reactions to and benefit from technologies and
74
their features are highly individualized and personal.75
In addition to the needs and preferences of the user, a 76
good match of person and technology requires attention 77
to aspects of the environments in which the technology 78
will be used and the various functions and features of 79
the technology. If the match is not a quality one from 80
the standpoint of the consumer, the technology may 81
not be used, or will not be used optimally. Such varied 82
outcomes are (Scherer, 2005a): 83
1. optimal use under all recommended conditions 84
and situations, 85
2. partial use, where it is used in some situations but 86
not others or part of the time, 87
3. non-use, where the technology was once used but 88
is set aside perhaps because it is no longer needed, 89
4. avoidance of use, where use is not even consid- 90
ered, 91
5. reluctant use, where the individual uses it but does 92
so with displeasure, 93
6. abandonment, or permanently giving up use usu- 94
ally out of frustration or annoyance. 95
Categories 1–3 can be considered a successful out- 96
come of the process if the individual reports realization 97
of benefit from using or having used the technology. 98
Categories 4–6, however, indicate a failure of the pro- 99
cess to serve that individual well. Indeed, the overall 100
non-use or abandonment rate has been approximately 101
30% for the past thirty years (Scherer, 2014). 102
Table 1
Factors associated with device non-use according to characteristics of the characteristics of the environment, person, and technology
Environment Person Technology
Non use Lack of a user-centered
process for technology
selection
Unrealistic expectations of benefit Discomfort/strain in use
Little or no support for use
from
family/peers/employer
Embarrassed or self-conscious
about using device
Obtrusive and intrusive
to use
Setting/environment
discourages use or makes
use difficult or
uncomfortable
Resistant to help from technology Is incompatible with the
use of other devices
Requires support that is not
available
Doesn’t like a device’s discipline Is too unwieldly, heavy
Device choice made by
someone else
Many changes in lifestyle with
device use
Is complex and difficult
to use
Lacks skills to use device and
training not available
Device is inefficient
Repairs/service not
timely or affordable
Other and preferred
options are available
Doesn’t trust
technology
Source: Institute for Matching Person & Technology as adapted from Scherer (2005a).
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M.J. Scherer and S. Federici / Introduction to the special issue on assistive technologies for cognition/cognitive support technologies 3
We know that there are highly individualized rea-
103
sons for AT non-use and abandonment. In addition104
to the nature of the functional need for the AT and
105
related functional capabilities/limitations of the per-106
son, these reasons arise from consumer (1) personal107
factors, including preferences and expectations, and108
(2) judgments of the subjective useworthiness of the
109
device and doworthiness of the task that directly impact
110
device use and non-use. Research conducted by the
111
authors has revealed factors common to people who112
later stopped using and abandoned their device (see the
113
recent study on assistive technology abandonment by
114
Federici, Meloni, and Borsci (in press)). These factors115
are summarized in Table 1 according to three primary
116
influences: of the characteristics of the environment,117
person, and technology (Scherer, 2005a).118
Persons with disabilities differ as much personally as119
they do functionally. They bring expectationsto the sup-
120
portselectionprocessthatareinternalandexternal.They121
carry the expectations of parents, teachers, employers,122
peers, and society in general that reflect varying values
123
and cultural priorities. Individuals also place expecta-
124
tions on themselves that have evolved from their prior125
history with support use, the educational system and so126
on. Their particular level of motivation, judgment, and127
outlook,andmany otherfactorsserve tocombineina way128
that defines each as a unique individual. It is important to129
note that these influences interact and affect one another,
130
and can change with the passage of time and accumula-131
tion of experience. Thus, at a given point in time, each
132
person has a predisposition to view technology use as
133
being favorable or not for certain purposes and in par-134
ticularsettings or environments.Thisiswellexemplified
135
in the contribution by Adolfsson, Lindstedt and Janesl¨
att
136
who conducted a qualitative examination of the experi-137
encesoftwelve individualswhousedelectronic planning138
devices.139
The attitudes of providers and their expectations of
140
the individual can have a profound influence on persons141
with disabilities and their expectations of themselves.142
What may seem to be a vital task to the individual
143
may be given little attention by the provider, and vice144
versa. Thus, to achieve a good match of person and145
technology, it is important that the potential tech-146
nology user be paired with a well-informed and147
person-centered provider and that the degree to which148
consumer and provider perspectives are shared is149
addressed.150
The most important influence on an individual’s use151
of the selected support is how well it actually serves152
that person. That is, how much it helps the individual153
accomplish desired goals and activities, fits with his 154
or her lifestyle, routines, and preferences and does not 155
result in stress and frustration, and enhances well-being. 156
Therefore, also considering individual’s affective and 157
emotional states can improve the process of matching 158
person and technology. To this end, Liberati, Fed- 159
erici and Pasqualotto performed a systematic review of 160
studies investigating the recognition of emotions from 161
neurophysiological signals, in order to improve the use 162
of brain-computer interfaces (BCIs), by adapting them 163
to the user’s needs. 164
When the goal involves support from technologies, 165
key factors for consideration are motor skills, moti- 166
vation and psychological readiness for use. For many 167
users of assistive technologies, their devices become an 168
extension of the self, not just to themselves but also to 169
other persons. The device, then, is incorporated into the 170
individual’s identity. But this process can be difficult for 171
some, thus leading to underutilization or nonuse. 172
1. Technology factors 173
The individual’s use of an AT will be affected sig- 174
nificantly by characteristics of the device itself as well 175
as the priorities and preferences of the person. Accord- 176
ing to Oskar Krantz (2012), device usability (that is, its 177
size, weight, durability, etc.) may or may not correlate 178
with the subjective determination of its “useworthi- 179
ness.” Krantz illustrates the differences in these terms, 180
as well as task doability and doworthiness, as follows: 181
A wheelchair with mechanical properties match- 182
ing the user (usability) increases the mobility of 183
the user, allowing for a greater number of activi- 184
ties (doability). However, the wheelchair has to be 185
worth using in order to be utilized (useworthiness) 186
and the activity has to be worth performing in order 187
to be performed (doworthiness) (p. 193). 188
Once the device is usable by the person, then the per- 189
son has to value the task or purpose for which the device 190
is intended. Thus, useworthiness is related to individ- 191
ual value and judgement whereas usability can be more 192
objectively measured. Useworthiness and usability both 193
need to be present for a good match of person and 194
device. AAC devices provide a good example. A per- 195
son may be able to use one very proficiently. But if the 196
person prefers to have a caregiver speak for them to 197
conserve energy then it lacks useworthiness. 198
In line with Federici and Borsci (2014), dowor- 199
thiness and useworthiness, as well as usability and 200
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4M.J. Scherer and S. Federici / Introduction to the special issue on assistive technologies for cognition/cognitive support technologies
Table 2
Condensed options consumers can choose to indicate why they stopped using an assistive technology device
Assistive Technology Device Predisposition Assessment Follow-up Consumer Form
Reasons for Not Using One or More Devices
a. *It broke and I can’t use it1g. *#I felt self-conscious using it3
b. *#%&It was too inconvenient to use1h. *I didn’t get the training I needed to use it well2
c. *#It wasn’t the right device for me1i. #&It didn’t fit with my needs/preferences/lifestyle3
d. *#%It didn’t help as much as I hoped3j. *#I replaced it with a different device or support. 1What?
e. *#&It was too complicated to use1k. I no longer need to use it because:4
f. *#&It costs too much money to use1l. Other:
g. #&The purpose for using the device isn‘t important to me
1characteristics of the device and its selection for the person. That is, it was a poor selection and decision-making process. 2training for use.
3characteristics and preferences of the person. 4could be due to the person getting better but regardless, it is a body functions and structures item.
*usability; # useworthiness; % doability; & doworthiness.
environments of use (Mirza, Gossett Zakrajsek, &201
Borsci, 2012), are factors that have to be considered202
by providers during the process of technology selec-
203
tion and delivery. In fact, a strong relationship was204
found between the quality of the delivery processes of
205
providers and the likelihood of technology abandon-206
ment. The more the providers applied a user-centered207
approach and took into account key personal factors,
208
the more likely it was that people used the technology
209
(Federici & Borsci, 2011, 2014).210
Table 2 depicts a section of the Assistive Technol-
211
ogy Device Predisposition Assessment, one form in the212
Matching Person and Technology Model and Assess-213
ment Process (Scherer, 2005b). The Matching Person
214
and Technology (MPT) Model has been described in a
215
trilogy of books (Scherer, 2004, 2005a, 2014) as well
216
as an edited volume on assistive technology assessment217
(Federici & Scherer, 2012) and a journal article (Scherer218
& Craddock, 2002).219
Fundamentally,theMPTModel has threecrucialareas220
of foci that represent the primary biopsychosocial com-221
ponents that most influence use of assistive technologies
222
(see Table 1): (a) The needs, preferences and character-223
istics of the unique person (b) the milieu/environment(s)
224
in which the user will interact with the technology,
225
and (c) the functions and features of the most desir-226
able and appropriate technology. The MPT model
227
was operationalized by developing an evidence-based,228
client-centered assessment for determining the match of229
individuals with the most appropriate technologies for230
their use. The assessment process consists of a series of231
measures that provide a person-centered and individu-232
alized approach to matching individuals with the most
233
appropriate technologies for their use. It has been the
234
foundation for research by others internationally and has
235
been translated into multiple languages. Examples of its
236
use in the USA are provided by the contributions from
237
researchers associated with Project Career, an effort to238
assess and address the needs of adults enrolled in college 239
across multiple institutions. These articles were writ- 240
ten by Hendricks, Sampson, Rumrill et al. and Nardone, 241
Sampson, Stauffer, et al. An example of its use in acute 242
and outpatient cognitive rehabilitation is provided by 243
Fleeman, Stavisky, Carson, et al. It has also been found 244
helpful in training individuals in the use of assistivetech- 245
nologies for cognition/cognitive support technologies 246
(Powell, Glang, Pinkelman, et al.,). 247
Successfully treating, supporting and empower- 248
ing consumers and their families to live with 249
neurological disability involves more than medi- 250
cal intervention. As Williams and Edwards (2003) 251
have claimed in the special issue on Biopsychoso- 252
cial Approaches in Neurorehabilitation, much of what 253
happens in neurorehabilitation requires understanding 254
the complex interaction of biological, psychologi- 255
cal and social influences on affect and behavior. 256
In this special issue, we intend to provide insights 257
to neurorehabilitation professionals and experts in 258
how different countries and programs are promot- 259
ing access to and use of assistive technologies for 260
cognition according to a biopsychological approach. 261
Overcoming a neurological issue through the use of an 262
assistive technology requires more than just a device. 263
It requires matching that device or support to the per- 264
son’s preferences and characteristics, and to evaluate 265
the interaction of the device with the family and the 266
environments of everyday life. 267
Acknowledgments 268
The development and validation of the Matching Per- 269
son and Technology Model and assessments were made 270
possible by funding from the following sources: 271
Centers for Disease Control and Prevention, Grant 272
number DD000219 to the Institute for Matching Person 273
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M.J. Scherer and S. Federici / Introduction to the special issue on assistive technologies for cognition/cognitive support technologies 5
& Technology, Inc. for the project, Matching Assistive
274
Technology and CHild (MATCH).275
National Institutes of Health, National Institute of
276
Child Health and Human Development, National Cen-277
ter for Medical Rehabilitation Research. Grant number278
HD052310 to The Institute for Matching Person &279
Technology, Inc. for the project, Improving the Match
280
of Person and Assistive Cognitive Technology.
281
National Institutes of Health, National Institute of
282
Child Health and Human Development, National Cen-283
ter for Medical Rehabilitation Research. Grant number
284
HD38220 to The Institute for Matching Person & Tech-
285
nology, Inc. for the project, Improving the Match of286
Person and Mobility Technology.
287
National Science Foundation, Ethics and Values288
in Science and Technology and Biotechnology &289
Research to Aid the Handicapped. Grant number RII-290
8512418 for research project, Improving Technological
291
Innovations for People with Physical Disabilities.292
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... A personalised approach to online support corresponds with what various authors from the research field of disability studies and the use of assistive technology have stressed, namely the importance of matching technologies with the needs, preferences and expectations of individual persons and their environments (e.g. Federici, Scherer, and Borsci 2014;Krantz 2012;Leopold et al. 2015;Scherer and Federici 2015). ...
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... Hence, help with processing the emotional burden of being affected by HD may be important in the earlier phases of the disease, to help them see the worth of learning to use a tool that could be useful for them later on. When introducing information about AACs to an individual with HD, considering how and when this should be suggested is crucial, and how the person best can be helped to accept an increased need for support (Patourel 1987, Scherer 2005, Scherer and Federici, 2015. The patient's attitudes regarding the potential use of AACs is important if its implementation is going to be successful, and needs to be followed up by the development of good strategies of how its use may fit into the patient's everyday life. ...
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Background: Huntington's disease (HD) is a neurodegenerative disease characterized by a triad of motor, cognitive and psychological symptoms, leading to a gradual breakdown of communication skills. Few studies have investigated how people affected by HD and their professional caregivers, for example, medical doctors, physiotherapists and nurses, experience the patients' gradual loss of speech and language. Aims: To examine communication-related experiences of patients and professional caregivers. Experiences with speech therapy and the use of augmentative and alternative communication aids (AAC) were also investigated. Methods & procedures: Seven individuals with HD and seven professional caregivers were interviewed individually, using a semi-structured interview guide. Transcripts were analysed using a conventional content analysis, and the results presented in three main categories. Outcomes & results: Most individuals with HD were aware of having communication difficulties, struggling with understanding others as well as being understood. This was confirmed by professional caregivers, who also raised ethical issues encountered when patients struggled with communication. Both groups talked about external factors (such as noise or crowded social settings) as disrupting communication, and shared recommendations on how people in general, and speech and language therapists (SLTs) in particular, could optimize communication. Very few patients had received information about communication aids, and none was using AACs. Professional caregivers underlined the importance of interdisciplinary collaborations, including SLTs, in order to optimize care. Conclusions & implications: Findings shed a light on everyday communication challenges faced by people with HD and their professional caregivers, and the lack of implementation of communication aids in this group. The dramatic impact of HD on patients' communication skills underscores the need to include SLTs in the follow-up of this patient group, ideally from the early stages of the disease, while the patient is still capable of voicing his/her own wishes and thoughts. Future research that explores how to optimize communication and implement the use of AACs for individuals with HD is needed. What this paper adds What is already known on this subject Although the ability to communicate gradually deteriorates in individuals affected by Huntington's disease (HD), there is little knowledge about how affected individuals experience the loss of speech and language skills. Interdisciplinary care is recognised as essential for this patient group. However, professional caregivers' thoughts and experiences of communicating with their patients have not been fully explored. Recent years have seen a rapid growth of available communication supporting technologies that could potentially be helpful for individuals with HD, but limited attention has been given to this subject. What this paper adds to existing knowledge What do we now know as a result of this study that we did not know before the results highlight that patients are aware of problems with speech and language even in early phases of the disease, and include patients' personal outlook on problems with communication. Professional caregivers raised ethical issues encountered when patients struggled with communication. Both groups described specific strategies that could facilitate communication. There was a significant lack of experience and knowledge about augmentative and alternative communication aids (AACs). What are the potential or actual clinical implications of this work? Clinical implications of this study. The introduction of communication aids in the follow-up of patients with HD needs to be discussed with the patients in the early phases of the disease, and implemented while the individual still has the capacity to learn and take advantage of alternative communication support. Results underline the importance of including speech and language therapists (SLTs) into multidisciplinary care of patients with HD. SLTs should be available also for professional caregivers who need advice on how to facilitate conversations and social interactions, in order to optimise care of patients with HD.
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Assistive technologies (AT) are essential in the daily life of elderly and people with disabilities. However, a growing demand for AT around the world remains unmet. The second-hand market has the potential to meet some of these unmet needs while reducing the amount of AT disposed of in landfills. The French government has recently engaged in financially supporting AT reuse programs. The current research aims at developing framework tools for project initiators. It was based on the literature on waste management and AT reuse and on a detailed analysis of seven innovative French local AT reused programs. Using a qualitative approach, the work resulted in an evaluation grid and a matrix scorecard of indicators for the management of future AT reuse programs. The aim of this tool is to consolidate the development of AT reuse programs to promote their access to people with disabilities while reducing waste production.
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Facilitation of universal access to Assistive Technology (AT) is an entitlement enshrined in the United Nations’ Convention on the Rights of Persons with Disabilities (UNCRPD). Access to an appropriate, effective and timely delivery of AT, has been identified as a key driver to the realization of the United Nation’s (UN) Sustainable Development Goals (SDG) and an essential right for empowering and supporting the needs of the population. To promote effective access to AT, an AT passport was proposed as a tool aimed at promoting access to AT products and services. This paper presents a review of literature of the concept ‘passport’ as a user led-system in use within the health and social care setting. The findings from the review are aimed at informing the conceptualization of the AT passport and recommendations for further research and development. Approach: The paper utilised a scoping literature search of the health passport concept followed by a descriptive review of data presented in a matrix table. The matrix table presented data from 29 identified sources under the following headings; source of document, the title, population and type of document, the main concept/purpose of the passport, the format/mode of the passport and its attributes, reported and/or anticipated outcomes and the implication of the individually reviewed document on the AT passport conceptualization. Emergent recurring themes across the reviewed documents were thematically identified. Findings: Eight themes emerged from the review articles that are of relevance to AT passport conceptualization. These were enhancing communication, participatory service development process, transition management, within and between agencies; promotion of continuity of care; selfadvocacy and personal empowerment; person-centred, contextual and personal social needs; user-led systems operating within existing wider system and effective and timely access to Services. Conclusion: The application of the systems thinking approach to the themes emerging from the review offers an important and pragmatic conceptualisation of the AT passport, rooted in a framework of user ownership and empowerment. The idea of an AT passport should to be researched and developed for application within what are likely 490 to be changing and diverse community contexts, supported by national policy and that also reflects global AT policy recommendations.
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From March 11 to April 26, 2020, the Italian government imposed a nationwide COVID-19 lockdown, a quarantine that resulted in significant restrictions on the movement and social contacts of the population, with a view to limiting the pandemic outbreak. The quarantine forced people to experience distorted social distance in two contrasting ways. For some people, it resulted in social distancing and isolation, for example by separating noncohabiting couples into different dwellings. For others, however, quarantine increased and imposed social closeness, forcing couples and families into constant, daily, and prolonged cohabitation. The aim of this study was to investigate the sexual health and behaviors of Italian adults during the lockdown period using a multimethod research. An open- and a closed-ended e-questionnaire were administered immediately after the end of the lockdown. A total of 465 Italian adults completed the digital questionnaire (female = 78.7%). Participants recognized their lived sexual experience with generally positive characteristics (related to openness, unproblematic relationship with the body, and awareness and self-reflection about one’s sexuality), while negative thoughts such as worry and pain were quite scarce. Participants with a disability (5.6%) showed a marked inversion compared to the mean of respondents, recognizing themselves mainly in negative thoughts related to low self-esteem, inadequacy, and feelings of suffering, yet reporting a higher than mean level of arousal. In the qualitative analysis, the TF-IDF index was measured to extract the salient words employed by respondents to answer the five open-ended questions; this revealed a generally depressed emotional experience associated with the experience of lockdown, both in terms of desire, which seemed to be shifted more to the level of imagination and fantasies, and the actual possibility of experiencing sexual activity as usual. Nevertheless, the participants emphasized an opening to new possibilities in terms of expressing sexuality, accompanied by a rediscovery of the value of tenderness and affectivity as well as a clearer awareness of their sexual life, needs, and desires.
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Objective The purpose of this study was to examine factors associated with variability in satisfaction with functional mobility (as measured by the Functional Mobility Assessment (FMA)) in users of mobility devices. Our primary hypothesis was that device type and Assistive Technology Professional (ATP) involvement will be the most significant predictors of FMA score. Our secondary hypothesis was that ATP involvement is associated with use of more custom-fitted manual wheelchairs and Group 3 and 4 power wheelchairs. Design Retrospective cohort study Setting Data were collected from equipment suppliers who collaborate with clinicians to administer the FMA and associated Uniform Data Set (UDS) within various settings (i.e., rehabilitation clinic, school, or supplier place of business). Participants A dataset of 4743 cases was included in the analysis. Intervention Not applicable Main Outcome Measure FMA questionnaire collected at baseline, client age, gender, primary diagnosis, years since disability onset, device type, device age, living situation, ATP involvement, and geographic area. Results Ordinal logistic regression modeling showed that geographic area, device type, ATP involvement, primary diagnosis, gender, age, device age, and years since onset of disability significantly predicted the variance in FMA scores at p<.05. Device type was the most significant predictor of variance in FMA score. Involvement of an ATP had a significant effect on the type of device that subjects used, χ² (20) = 1739.18 p < .001; Odds Ratio (OR) = 0.589, 95% CI [0.49,0.708]. If an ATP was involved, there were significantly higher proportions (all p<.05) of people using custom-fitted manual wheelchair and high-end Groups 3 and 4 power wheelchairs prescribed, as compared to when no ATP was involved or when involvement was uncertain. Conclusion The relationship between ATP involvement and functional outcome supports the concept that ATP certification recognizes demonstrated competence in analyzing the needs of consumers with disabilities and selection of appropriate mobility assistive equipment with improved functional outcomes
Chapter
With the growth of the special education population and the advancement of technology and accessible instruments and devices, teachers require an understanding of both mandated and available tools to integrate them into the educational environment appropriately. This chapter examines three specific aspects of the accessibility process. First, it explores the need to provide assistive technology to students in all educational environments and the compounding issues that affect that access. Second, it discusses the principles and prevalence of AT in schools. Third, it describes instructional approaches and stakeholder responsibilities when incorporating AT into educational settings. With a grasp on AT and its components, as well as issues of access and equity, teachers can better serve all of their students.
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Objective: This review examines the utility of current active, powered, wearable lower limb exoskeletons as aids to rehabilitation in paraplegic patients with gait disorders resulting from central nervous system lesions. Methods: The PRISMA guidelines were used to review literature on the use of powered and active lower limb exoskeletons for neurorehabilitative training in paraplegic subjects retrieved in a search of the electronic databases PubMed, EBSCO, Web of Science, Scopus, ProQuest, and Google Scholar. Results: We reviewed 27 studies published between 2001 and 2014, involving a total of 144 participants from the USA, Japan, Germany, Sweden, Israel, Italy, and Spain. Seventy percent of the studies were experimental tests of safety or efficacy and 29% evaluated rehabilitative effectiveness through uncontrolled (22%) or controlled (7%) clinical trials. Conclusions: Exoskeletons provide a safe and practical method of neurorehabilitation which is not physically exhausting and makes minimal demands on working memory. It is easy to learn to use an exoskeleton and they increase mobility, improve functioning and reduce the risk of secondary injury by reinstating a more normal gait pattern. A limitation of the field is the lack of experimental methods for demonstrating the relative effectiveness of the exoskeleton in comparison with other rehabilitative techniques and technologies.
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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.
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Background: Interdisciplinary cognitive rehabilitation is emerging as the expected standard of care for individuals with mild to moderate degrees of cognitive impairment for a variety of etiologies. There is a growing body of evidence in cognitive rehabilitation literature supporting the involvement of multiple disciplines, with the use of cognitive support technologies (CSTs), in delivering cognitive therapy to individuals who require cognitive rehabilitative therapies. This article provides an overview of the guiding theories related to traditional approaches of cognitive rehabilitation and the positive impact of current theoretical models of an interdisciplinary approach in clinical service delivery of this rehabilitation. Objective: A theoretical model of the Integrative Cognitive Rehabilitation Program (ICRP) will be described in detail along with the practical substrates of delivering specific interventions to individuals and caregivers who are living with mild to moderate cognitive impairment. The ultimate goal of this article is to provide a clinically useful resource for direct service providers. It will serve to further clinical knowledge and understanding of the evolution from traditional silo based treatment paradigms to the current implementation of multiple perspectives and disciplines in the pursuit of patient centered care. Methods: The article will discuss the theories that contributed to the development of the interdisciplinary team and the ICRP model, implemented with individuals with mild to moderate cognitive deficits, regardless of etiology. The development and implementation of specific assessment and intervention strategies in this cognitive rehabilitation program will also be discussed. Results: The assessment and intervention strategies utilized as part of ICRP are applicable to multiple clinical settings in which individuals with cognitive impairment are served. Conclusions: This article has specific implications for rehabilitation which include: (a) An Interdisciplinary Approach is an effective method for cognitive rehabilitation; and (b) Recent theories offer beneficial evaluation and intervention techniques for cognitive rehabilitation.
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Background: Assistive technology for cognition (ATC) can be an effective means of compensating for cognitive impairments following acquired brain injury (ABI). Systematic instruction is an evidence-based approach to training a variety of skills and strategies, including the use of ATC. Objective: This study experimentally evaluated systematic instruction applied to assistive technology for cognition (ATC) in a vocational setting. Methods: The study used a single-case, multiple-probe design across behaviors design. The participant was a 50-year old female with cognitive impairments following an acquired brain injury (ABI). As a part-time employee, she was systematically instructed on how to operate and routinely use selected applications (apps) on her iPod Touch to support three work-related skills: (a) recording/recalling the details of work assignments, (b) recording/recalling work-related meetings and conversations, and (c) recording/performing multi-step technology tasks. The experimental intervention was systematic instruction applied to ATC. The dependent measures were: (a) the use of ATC at work as measured by an ATC routine task analysis; and (b) recall of work-related tasks and information. Results: Treatment effects were replicated across the three work-related skills and were maintained up to one year following the completion of intensive training across behaviors with periodic review (booster sessions). Conclusions: Systematic instruction is a critical component to teaching the routine use of ATC to compensate for cognitive challenges following ABI.
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Background: Cognitive symptoms and other functional limitations associated with multiple sclerosis (MS) have a significant negative impact on employment status. Work accommodations positively impact the ability of a person with MS to obtain and retain employment, however, current understanding of the role of accommodations in the careers of adults with MS is limited. Objective: To analyze the percentage of American workers with MS who utilize workplace accommodations as per Title I of the ADA, the types of accommodations most frequently required, and differences in disease variables, job-related factors, and quality of life between workers using and not using work accommodations. Methods: Data from 746 employed adult members of the National MS Society surveyed about career concerns were analyzed. Descriptive and inferential statistics were used as appropriate to address the research questions. Results: Approximately 25% reported having requested accommodations, and 87.7% reported receiving the requested accommodation. Participants with progressive MS, cognitive impairment, higher number of MS symptoms and greater symptom severity were more likely to use work accommodations. Participants with accommodations reported poorer job match and career optimism than those using no accommodations. Conclusion: This large-scale analysis addresses several outstanding questions concerning work accommodations among workers with MS. Cognitive symptoms and disease severity are strongly associated with need for accommodations, however accommodations do not appear to promote job satisfaction or longevity. The accommodation request process and the impact of accommodations on employment retention remain important research foci.
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Background: People with cognitive disabilities have difficulties in accomplishing everyday tasks. Electronic planning devices (EPDs) may compensate for the gap between a person's capacity and everyday challenges. However, the devices are not always used as intended. Despite that, cognitive assistive technology has been investigated in several studies, knowledge regarding when and what makes adults decide to use EPDs is incomplete. Objective: The aim was to explore the subjective experiences of people with cognitive disabilities in relation to the use of EPDs. Methods: A qualitative approach was applied with a qualitative content analysis. Twelve respondents were interviewed with support from a study specific guide. Results: A model representing the respondents' experiences in the use of EPDs, comprising one theme, Possibility to master my daily life, four categories, Degree of fit to my needs, I am aware of my cognitive disability, I get help to structure my everyday life and The EPD improves my volition and ten subcategories, was developed. Conclusions: EPDs allow people with cognitive disabilities the possibility to deal with daily challenges; those who find EPDs beneficial tend to use them. EPDs can help people with cognitive disabilities in organisation, managing time and improve volition.
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Background: Specific Learning Disorders (SLD) therefore represent chronic, not temporary disorders with varying degrees of expression throughout life. The beginning of imaging, anatomy and genetics studies have made it possible to investigate the brain organization of individuals suffering from SLD (Deheane, 2009). Objectives: The purpose of this paper is to describe a treatment method for reading and writing disorders through an intervention based on the integration of a sublexical method and a neuropsychological approach, with assistive technologies in the study of a single case. Methods: The protocol is based on the modularization theory (Karmiloff-Smith, 1990). The data presented in this paper with a A-B-A basic experimental drawing. Results: This study confirms the degree of effectiveness of the treatments based on the automated identification of syllables and words together with the integrated enhancement of neuropsychological aspects such as visual attention and phonological loop (Benso, 2008), although in the follow-up condition only some abilities maintain the progress achieved. Conclusions: As previously mentioned, the SLD represents a chronic disorder, consequently the treatment does not solve the root cause of the problem, but can grant a use of the process decidedly more instrumental to everyday life.
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Background: Post-coma persons in a minimally conscious state (MCS) and with extensive motor impairment and lack of speech tend to be passive and isolated. Objective: This study aimed to (a) further assess a technology-aided approach for fostering MCS participants' responding and stimulation control and (b) carry out a social validation check about the approach. Methods: Eight MCS participants were exposed to the aforementioned approach according to an ABAB design. The technology included optic, pressure or touch microswitches to monitor eyelid, hand or finger responses and a computer system that allowed those responses to produce brief periods of positive stimulation during the B (intervention) phases of the study. Eighty-four university psychology students and 42 care and health professionals were involved in the social validation check. Results: The MCS participants showed clear increases in their response frequencies, thus producing increases in their levels of environmental stimulation input, during the B phases of the study. The students and care and health professionals involved in the social validation check rated the technology-aided approach more positively than a control condition in which stimulation was automatically presented to the participants. Conclusions: A technology-aided approach to foster responding and stimulation control in MCS persons may be effective and socially desirable.
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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.
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Background: Project Career is an interprofessional five-year development project designed to improve the employment success of undergraduate college and university students with traumatic brain injury (TBI). The case study information was collected and synthesized by the project's Technology and Employment Coordinators (TECs) at each of the project's three university sites. The project's evaluation is occurring independently through JBS International, Inc. Objective: Five case studies are presented to provide an understanding of student participants' experiences within Project Career. Each case study includes background on the student, engagement with technology, vocational supports, and interactions with his/her respective TEC. Methods: A qualitative analysis from the student's case notes is provided within each case study, along with a discussion of the overall qualitative analysis. Results: Across all five students, the theme Positive Outcomes was mentioned most often in the case notes. Of all the different type of challenges, Cognitive Challenges were most often mentioned during meetings with the TECs, followed by Psychological Challenges, Physical Challenges, Other Challenges, and Academic Challenges, respectively. Conclusion: Project Career is providing academic enrichment and career enhancement that may substantially improve the unsatisfactory employment outcomes that presently await students with TBI following graduation.