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Appropriate Assistive Technology for Developing Countries
Abstract
Access to appropriate and affordable assistive technology is a human right, and a public health and development priority. This article elaborates on these aspects and illustrates the various opportunities and barriers to achieving equitable access to assistive technology through 4 specific country snapshots. In Brazil, mobility aids are provided through universal health coverage in rehabilitation reference centers in urban areas. A community-based rehabilitation pilot project in Argentina demonstrates how to reach an excluded indigenous community. A rapidly developing national legal framework in Colombia with imminent implementation challenges is showcased, as is a technology transfer model in India.
... Falhas na escolha dos produtos podem estar relacionadas à falta de capacitação dos profissionais responsáveis pela indicação da cadeira de rodas ou falta de diversidade dos produtos. A formação inadequada dos prestadores de serviços pode resultar numa prestação inapropriada, tendo impactos negativos na saúde, segurança e direitos humanos 25 . ...
This research sought to verify the satisfaction of wheelchair users with the device and the service provided in the Rehabilitation Centers (CER) of the Unified Health System (SUS) in the city of Maceió. This is a cross-sectional quantitative study, carried out with users of two RECs in Maceió, over 18 years of age, who requested the device during 2018 and who had been using the CR for at least two months at the time of collection. The Brazilian Economic Classification Criteria (ABEP) and the Quebec User Satisfaction Assessment with Assistive Technology (QUEST 2.0) were applied. 20 users between 18 and 70 years old, with acquired pathology, participated, of which 13 (65%) were male. The educational level was 7 (35%) in primary and secondary education. According to ABEP, 8 (40%) are in class C2 and 7 (35%) in class D. The level of satisfaction of the participants with CR obtained between 1.75 and 5 with an average of 4.1 and with the service 2.5 and 5. with an average of 4.3. The importance of including in care protocols the use of instruments that evaluate the assistive technology resources offered to users was highlighted.
... Social and economic changes worldwide necessitate significant investments in research and innovation, particularly in healthcare and nursing (1). Leadership has been inherent in mankind O N L I N E F I R S T since its inception as conscious and thinking beings, embodying strength, determination, courage, desires, ambitions, and the individual's will to effect change in themselves and others (2). ...
In the pursuit of a competent and competitive healthcare system, nurses and healthcare technicians, as key figures in the healthcare process and scientific discipline of nursing, should possess not only professional knowledge but also managerial abilities and skills. This includes the effective management of human and material resources within the healthcare system. Leadership in nursing practice can be understood as the influence of head nurses on the quality and effectiveness of all activities within their domain. By reviewing the literature on research concerning leadership in nursing and the factors influencing its development in nursing practice, which have not yet been definitively defined, we aim to provide an overview for the professional community in the fields of biomedicine and health, especially in healthcare where nurses operate at all levels. To achieve the goals necessary for developing leadership in nursing practice, the implementation of appropriate strategies, methods, and tools within the healthcare system is crucial for human resources, a key factor in improving healthcare delivery. The role of the head nurse, or nursing leader, is of paramount importance in enhancing the organization and quality of healthcare at all levels.
... 28 Potential barriers to the above gaps in prosthetic care present in Ecuador, such as other developing countries, can range from individual barriers to systemic barriers: awareness of care, access to transportation for follow-up care, prosthetic component availability, or appropriately trained personnel. 1,2,29,30 Regardless, disability is associated with lower socioeconomic status and poverty in LMIC, 31,32 while rehabilitative services for this population are fundamental to physical independence, psychosocial wellbeing, and vocational ability. 33 This context is important when considering health care policy and the impact of amputation on personal and state factors in LMICs. ...
Background
Individuals with disabilities in low- and middle-income countries face barriers to rehabilitation services, including prosthetic care. Many countries, such as Ecuador, have adapted policies toward achieving universal health care coverage. For optimal functional outcomes, understanding the physical potential of prosthetic users is critical for appropriate prosthetic services.
Objective
To determine the association between the functional level of Ecuadorians with lower-limb amputations and the functional level of their prosthetic componentry.
Study design
Retrospective study.
Methods
A data set containing functional level (K-Level) of Ecuadorians with lower-limb amputations and the K-Level of their prosthesis was analyzed.
Results
A diverse cohort of 164 participants with unilateral lower-limb amputation was recruited. Most participants were male (76.8%) with transfemoral amputations (56.1%) due to traumatic causes (51.2%). There was a small, positive, and statistically significant correlation between participants’ functional levels and prosthetic componentry. Participants's functional levels were typically superior (median = 3) to their prostheses’ functional abilities (median = 1), and 37.2% of participants did not have a prosthesis at the time of assessment.
Conclusions
These data indicated that participants whose physical ability exceeded basic ambulation lacked access to prostheses to match their functional abilities. The detailed disparity between physical potential and prosthetic access derived from the study’s analysis supports investment into high functioning prosthetic componentry and further investigation into where gaps in care exist.
... There are countless benefits that AT can provide to people with disabilities or reduced mobility. Several authors, such as Toro-Hernández et al. (2019) and Tao et al. (2020), agree that the objective of AT is the search for an independent life, social inclusion and quality of life, while aiming to transform the social reality of this layer of society through the elimination of physical, environmental, urban and social barriers, allowing carrying out daily activities with greater autonomy and active access to public spaces, education, work and leisure. For this, AT provides resources and services that promote the expansion of the individual's functional capacity. ...
Assistive Technology is not widespread in Brazil. Advances have occurred gradually through achievements in the legal area and the promotion of research and development. The proposition of policies in this area can contribute to overcoming the social inequalities of a significant segment of the population that represents a real and expanding market. However, the low optimization of these resources by their users and the difficulty in finding them in the market and public agencies are worrying factors. This study addresses the impact of the demand for Assistive Technology on Brazilian public policies aiming to identify the relationship between the optimization of these resources and services and the formulation of targeted policies in the country. Through bibliographic, exploratory and qualitative research, a survey was conducted on the Brazilian legislation and the existing actions in the area of Assistive Technology, as well as an analysis of Brazilian public policies based on the normative evaluation criteria, applying the deductive method and the Bardin’s content analysis technique. The scientific literature shows that, despite the gradual advancement in legislation and initiatives to promote projects in this area, factors that hinder the access, use, and application of assistive products, such as the scarcity of innovative technologies, entail difficulties for the formatting of effective policies and the adequate configuration of fostering actions in the area of Assistive Technology, which is essential to the process of social inclusion.
... However, which specific products and services are available and accessible through national provision infrastructure vary substantially between (and often within) countries [15][16][17][18]. The WHO promotes the development of national priority assistive product lists (APLs) which clearly define the most relevant AT for a specific country context, based on the unique needs of its population [19,20]. Measuring and monitoring access to AT in a population is critical to support healthy longevity. ...
Functional limitations become more prevalent as populations age, emphasising an increasingly urgent need for assistive technology (AT). Critical to meeting this need trajectory is understanding AT access in older ages. Yet few publications examine this from a longitudinal perspective.
This review aims to identify and collate what data exist globally, seeking all population-based cohorts and repeated cross-sectional surveys through the Maelstrom Research Catalogue (searched May 10, 2022) and the Disability Data Report (published 2022), respectively. Datasets incorporating functional limitations modules and question(s) dedicated to AT, with a wave of data collection since 2009, were included.
Of 81 cohorts and 202 surveys identified, 47 and 62 meet inclusion criteria, respectively. Over 40% of cohorts were drawn from high-income countries which have already experienced significant population ageing. Cohorts often exclude participants based on pre-existing support needs. For surveys, Africa is the most represented region (40%). Globally, 73% of waves were conducted since 2016. ’Use’ is the most collected AT access indicator (69% of cohorts and 85% of surveys). Glasses (78%) and hearing aids (77%) are the most represented AT. While gaps in data coverage and representation are significant, collating existing datasets highlights current opportunities for analyses and methods for improving data collection across the sector.
... As Article 25 of the UN Convention on the Rights of Persons with Disabilities states [13], it is the right of individuals with a disability to achieve the highest standard of health care without discrimination. Article 25 also recognizes access to appropriate and affordable assistive technology as a human right, which has resulted in increased awareness and advocacy worldwide [14]. Assistive technologies are tools designed to help people with disabilities to be as autonomous as possible, and recent years have been characterized by research and innovation in the fields of design and technology. ...
People with disabilities often face physical, political, and societal barriers in expressing their sexuality. The lack of inclusivity in the sex toy market does not support an autonomous experience for impaired individuals who cannot operate toys without external assistance. Lovewear is a collaborative art-science project that combines usercentered design principles with soft robotics integrated into textiles. The aim is to offer an autonomous experience through haptic feedback, allowing self-exploration of intimate sensations and sexual pleasure to females with motor impairments. A pillow interface activates an underwear garment: While caressing and touching the pillow, the wearer triggers the underwear’s inflatable i actuators. This transdisciplinary project used a mixed-methods research design; the objective is to promote the embedment of technology into everyday garments, to improve the wearer’s quality of life.
... There is a growing need for assistive robots and devices that support the independent life of elderly and disabled people. In recent years, wheelchair-mounted robotic arms and other physically assistive robotic devices have provided a promising solution to assist individuals with upper limb impairments who cannot perform simple daily tasks such as eating and drinking a cup of water independently (Tangcharoensathien et al., 2018;Toro-Hernández et al., 2019;Valk et al., 2019). However, to be effective, these assistive robots must be easily controllable by their users and have a user-friendly interface (Jiang et al., 2013;Rabhi et al., 2013;Rabhi et al., 2015;Craig et al., 2016;Penkert et al., 2021). ...
Throughout the last decade, many assistive robots for people with disabilities have been developed; however, researchers have not fully utilized these robotic technologies to entirely create independent living conditions for people with disabilities, particularly in relation to activities of daily living (ADLs). An assistive system can help satisfy the demands of regular ADLs for people with disabilities. With an increasing shortage of caregivers and a growing number of individuals with impairments and the elderly, assistive robots can help meet future healthcare demands. One of the critical aspects of designing these assistive devices is to improve functional independence while providing an excellent human-machine interface. People with limited upper limb function due to stroke, spinal cord injury, cerebral palsy, amyotrophic lateral sclerosis, and other conditions find the controls of assistive devices such as power wheelchairs difficult to use. Thus, the objective of this research was to design a multimodal control method for robotic self-assistance that could assist individuals with disabilities in performing self-care tasks on a daily basis. In this research, a control framework for two interchangeable operating modes with a finger joystick and a chin joystick is developed where joysticks seamlessly control a wheelchair and a wheelchair-mounted robotic arm. Custom circuitry was developed to complete the control architecture. A user study was conducted to test the robotic system. Ten healthy individuals agreed to perform three tasks using both (chin and finger) joysticks for a total of six tasks with 10 repetitions each. The control method has been tested rigorously, maneuvering the robot at different velocities and under varying payload (1-3.5 lb) conditions. The absolute position accuracy was experimentally found to be approximately 5 mm. The round-trip delay we observed between the commands while controlling the xArm was 4 ms. Tests performed showed that the proposed control system allowed individuals to perform some ADLs such as picking up and placing items with a completion time of less than 1 min for each task and 100% success.
... In recent days, the growing rate of the elderly population and the dire influence of a variety of chronic diseases have been considered as a leading cause of increasing disability in our society [1]. To combat the disability-related outcome on daily basis, technological intervention in the healthcare sector has now become inevitable [2]. Recent reports of the World Health Organisation (WHO) categorically confirm that by 2030, over two billion people around the world will need at least one assistive tool [3]. ...
Different forms of human expressions are now being extensively used in present-day human–machine interfaces to provide assistive support to the elderly and disabled population. Depending on the subject condition, expressions conveyed in terms of eye movements are often found to provide the most efficient way of communication. Nowadays, standard Electroencephalogram (EEG) based arrangements, normally used to analyze neurological states are also being adopted for the detection of eye movements. Although, EEG-based recent state-of-the-arts researches are lagging as the majority of the works either detects eye movements in a lesser direction or uses a higher feature dimension with limited classification accuracy. In this study, a robust, simple and automated algorithm is proposed that exploits the analysis of the EEG signal to classify eye movements in six different directions. The algorithm uses discrete wavelet transformation to denoise the EEG signals acquired from six different leads. Then, from the reconstructed wavelet coefficients of each lead, two features are extracted and combined to form a binary feature map. The obtained binary feature map itself facilitates distinct visual classification of the eye movements. Finally, a unique value generated from the calculated weighted sum of the binary map is used to classify six different types of eye movements via a threshold-based classification technique. The algorithm presents high average accuracy, sensitivity, specificity of 95.85%, 95.83% and 95.83% respectively, using a single value only. Compared to other state-of-the-art methods, the adopted unique binarization methodology and the obtained results indicate the immense potential of the proposed algorithm to be implemented in personal assistive applications.
... Working with assistive technologies and upgrading them for better usage is becoming a newer trend [4] and caught the interest of clinics, research, and industry [19]. Different types of research work are going on to improve assistive technology [20][21][22]. In particular, assistive robotics appeared as an exciting research topic that can enhance people's quality of life with motor dysfunctionalities. ...
Background
Building control architecture that balances the assistive manipulation systems with the benefits of direct human control is a crucial challenge of human–robot collaboration. It promises to help people with disabilities more efficiently control wheelchair and wheelchair-mounted robot arms to accomplish activities of daily living.
Methods
In this study, our research objective is to design an eye-tracking assistive robot control system capable of providing targeted engagement and motivating individuals with a disability to use the developed method for self-assistance activities of daily living. The graphical user interface is designed and integrated with the developed control architecture to achieve the goal.
Results
We evaluated the system by conducting a user study. Ten healthy participants performed five trials of three manipulation tasks using the graphical user interface and the developed control framework. The 100% success rate on task performance demonstrates the effectiveness of our system for individuals with motor impairments to control wheelchair and wheelchair-mounted assistive robotic manipulators.
Conclusions
We demonstrated the usability of using this eye-gaze system to control a robotic arm mounted on a wheelchair in activities of daily living for people with disabilities. We found high levels of acceptance with higher ratings in the evaluation of the system with healthy participants.
... This recognition has resulted in publications discussing implications, implementation and sobering reality-checks in numerous LMICs. [10][11][12][13][14][15] Alarming needs and low supply are a well-known reality for global actors playing a key role in advocating for and providing rehabilitation in fragile settings including the International Committee of the Red Cross (ICRC), Humanity and Inclusion and the WHO. Guidelines, training resources and advocacy papers by such actors, often issued collectively, are specifically pointing out the importance and interdependence of early rehabilitation, AT and rehabilitation across the continuum of care. ...
Objectives
Limb amputation incidence is particularly high in fragile contexts due to conflict, accidents and poorly managed diabetes. The study aim was to analyse (1) demographic and amputation characteristics of persons with any type of acquired amputation (PwA) and (2) time between amputation and first access to rehabilitation in five conflict and postconflict countries.
Design
A retrospective, observational study analysing differences in demographic and clinical factors and time to access rehabilitation between users with traumatic and non-traumatic amputations.
Setting
Five countries with the highest numbers of PwA in the global International Committee of the Red Cross database (Afghanistan, Cambodia, Iraq, Myanmar, Sudan). Cleaned and merged data from 2009 to 2018 were aggregated by sex; age at amputation and registration; cause, combination and anatomical level of amputation(s); living environment.
Participants
All PwA newly attending rehabilitation.
Results
Data for 28 446 individuals were included (4329 (15.2%) female). Most were traumatic amputations (73.4%, 208 90); of these, 48.6% (138 01) were conflict related. Average age at traumatic amputation for men and women was 26.9 and 24.1 years, respectively; for non-traumatic amputation it was 49.1 years and 45.9 years, respectively. Sex differences in age were statistically significant for traumatic and non-traumatic causes (p<0.001, p=0.003). Delay between amputation and rehabilitation was on average 8.2 years for those with traumatic amputation, significantly higher than an average 3 years for those with non-traumatic amputation (p<0.001).
Conclusions
Young age for traumatic and non-traumatic amputations indicates the devastating impact of war and fragile health systems on a society. Long delays between amputation and rehabilitation reveal the mismatch of needs and resources. For rehabilitation service providers in fragile settings, it is an enormous task to manage the diversity of PwA of various causes, age, sex and additional conditions. Improved collaboration between primary healthcare, surgical and rehabilitation services, a prioritisation of rehabilitation and increased resource provision are recommended to ensure adequate access to comprehensive rehabilitation care for PwA.
... Access to an appropriate wheelchair remains a global challenge where an estimated 115 million people are in need in primarily less-resourced settings 1,2,3,4,5,6 . When a person receives a wheelchair that is not fit for one's needs, there is a greater risk of secondary complications related to one's health, education, employment, community participation, and abandonment of the device 7,8,9,10,11 . ...
Objective
To explore global trends in manual wheelchair service provision knowledge across geographic, professional, and socioeconomic domains.
Design
A secondary analysis of a dataset from the International Society of Wheelchair Professionals’ Wheelchair Service Provision Basic Knowledge Test was conducted.
Setting
The dataset included test takers from around the world and was extracted from Test.com and International Society of Wheelchair Professionals’ Wheelchair International Network.
Participants
2,467 unique test takers from 86 countries
Interventions
Not applicable
Main Outcome Measures
International Society of Wheelchair Professionals’ Wheelchair Service Provision Basic Knowledge Test
Results
We identified significant inverse associations between pass rate and the following variables: education (high school and some college), test taker motivation (required by academic program or employer), and country income setting (low and middle). There were significant positive associations between pass rate and the following variables: training received (offered by Mobility India or ‘other NGO’), and age group served (early childhood).
Conclusion
Global wheelchair knowledge trends related to key variables such as training, occupation, and income setting have been preliminarily explored. Future work includes further validation of the primary outcome measure and recruitment of a larger sample size to further explore significant associations between additional test taker variables.
... At present there is limited robust economic evidence to inform the design of posture and mobility services, or to guide the provision of mobility aids and other mobility-enhancing interventions in an evidence-based manner [4]. This is true across the world, particularly in developing countries where the economic evidence base for assistive technology is particularly limited [5]. Globally, 20 million people with mobility impairments do not have access to adequate mobility aids [6], which has a major impact on their fundamental freedoms and equality of opportunity [7]. ...
Purpose
Generic preference-based measures often lack validity in states of impaired mobility. Our aim was to derive a novel health state classification system from the MobQoL tool, for the purpose of preference-based measurement of states of impaired mobility.
Materials and methods
Data were collected through online and postal surveys. Respondents were recruited through the NHS, charitable organisations and HealthWise Wales. Statistical and psychometric analyses were used to assess the validity and reliability of the MobQoL tool. Exploratory factor analysis and Rasch analysis were used to determine dimensional structure and to select items for the MobQoL health state classification system.
Results
Three hundred and forty-two respondents completed the survey. Respondents had a wide range of different mobility impairments. Nine of the MobQoL items demonstrated adequate validity and reliability. Exploratory factor analysis and Rasch analysis confirmed two sub-scales within the item structure: 1) physical and role functioning, and 2) mental wellbeing. Seven items were found to have adequate model fit and were retained in the final health state classification system, called the MobQoL-7D.
Conclusions
The MobQoL-7D contains seven dimensions of mobility-related quality of life: accessibility, contribution, pain/discomfort, independence, self-esteem, mood/emotions and anxiety. Population level preference weights are now needed for different states of mobility impairment.
•
IMPLICATIONS FOR REHABILITATION
• Mobility impairment has distinct impacts on mental wellbeing and physical/role functioning.
• The MobQoL-7D will facilitate accurate preference-based outcome measurement in populations with impaired mobility, which in turn will promote methods of economic evaluation in this context.
• MobQoL-7D offers a concise and valid tool for rehabilitation professionals to measure and monitor mobility-related quality of life as part of routine clinical practice.
... Hospital transport chairs not intended for long-term use are often used inappropriately long term. Other chairs that have deteriorated, broken, or are not appropriate for the user's disability are often also in use [2]. Without mobility-related independence, people experience health consequences and diminished community involvement [3]. ...
Purpose
Economic realities in lower-and-middle-income countries (LMICs) present an increased need for outcome measures for wheelchair efficacy, as these measures enable optimized use of funds. As the provision level of wheelchairs is low in these areas, and many wheelchairs are inappropriate for their intended users, use of funds based on evidence is especially necessary. The Wheelchair Satisfaction Questionnaire (WSQ) was designed to be a snapshot of a wheelchair user’s level of satisfaction with their wheelchair. The WSQ is comprised of 16 visual analogue scale questions. Each question includes an option for a qualitative explanatory comment. The current study examined initial test-retest reliability of the WSQ.
Materials and methods
The WSQ was administered twice to the same set of wheelchair users who were secondary students at a school for students with disabilities. A demonstration was given to the participants to explain how to mark the analogue scale. Participants were instructed to answer each item honestly and without peer input. A one-week time span separated test and retest. Scores for both sessions were entered into SPSS. An interclass coefficient of 0.70 or above indicates acceptable test-retest reliability
Results
The ages of participants ranged from 13 to 24, with a mean age of 17.86 years. Sixty-five participants completed the questionnaire fully in both test and retest and were included in this study. A high degree of reliability was found between scores from both tests. The interclass coefficient was r(63) = .863, p = .01, indicating statistically significant agreement between test and retest.
Conclusion
The results support the WSQ as a reliable measure, confirming the WSQ as a reliable tool for user feedback on wheelchair function. Because the WSQ is designed to provide user feedback with enough granularity to give data on particular aspects of wheelchair structure and function, data can facilitate repair and modifications to wheelchair parts. Studies using the WSQ to assess specific wheelchair types could indicate consistent patterns of user satisfaction and dissatisfaction, revealing relevant design issues. The WSQ is designed to give wheelchair users a voice that can empower user centred modification and design changes to facilitate improved health, opportunity, and social interaction.
•
Implications for Rehabilitation
• Results from the WSQ could enable manufacturers to utilize user feedback to improve the design of wheelchairs for use in LMIC’s, and providers could be better-informed in the selection of wheelchair types for specific environments.
• The WSQ could provide immediate user feedback to inform wheelchair modification and selection to best serve a particular user.
• The WSQ could be used in clinical settings over time to collect longitudinal data from wheelchair users, which could identify the most commonly perceived reasons for user dissatisfaction in a particular clinical setting.
... This concept has been present in humanity since Prehistory, when, for example, after a fractured leg, a man used a tree branch to support himself, making this adapted cane allow him to resume a function.t This gait was prevented by the accidental fracture because when we use any tool or resource to help someone who has a limitation, we are using assistive technology [10][11]. ...
The theme of this paper about Assistive Technology intends to reduce the mobility of people that have the amputation of his lower limbs. The project had as main objective the development of support in the field of mechanical engineering for crutches. Bound within the highway buses, to facilitate the movement of people who use crutches, providing support for the crutches, the time when the user stays within the city bus, and with this crutch, users will have greater accessibility to the use the coaches. In this project, the researchers undertook a visit to Central company to analyze the urban bus models available and chose the model company Mega Neobus to projection and scale of support. It was possible to conclude the assembly of the screening, the responses of the crutches users, and the tensor analysis in the Inventor. The researchers found that the objectives outlined achieved and that support is fully functional.
Purpose:
The objectives of this study(1) were threefold: to identify the main topics related to the international debate on Assistive Technology (AT) public policies, to analyze the Brazilian case in light of these topics, and to extract lessons that could be applied in Brazil and other countries to advance progress in the field.
Methodology:
A qualitative study was conducted through a critical literature review, involving the search for, selection, and analysis of articles indexed in two information source portals and four databases from 2007 to 2023. International and Brazilian laws, reports, and other publications specifically related to AT policies were also included.
Results:
The analysis of 186 articles and Brazilian documents facilitated the examination of four themes: AT policies from a human rights perspective, public procurement, service delivery systems, and national plans. A subset of 107 publications was then selected for detailed analysis.
Discussion:
Initiatives such as implementing a national plan, establishing an AT research center, and creating a product catalog are considered virtuous. Enhancing the freedom of choice for products and developing public procurement mechanisms are identified as additional strategies to reinforce protections of human rights in Brazil.
Conclusions:
Policy dynamics and national and international experiences suggest the potential for expanding initiatives and creating new solutions in Brazil. Universities and other scientific institutions emerge as promising loci for generating new knowledge to support the formulation of AT policies and facilitate their debate and further development.
Purpose:
In 2016 WHO launched the priority assistive products list (APL) consisting of 50 products and recommended that using this as a reference, countries should develop their own contextually relevant national APLs. This paper describes the development of Malawi's APL.
Methods:
Two hundred and ninety-six persons with disabilities participated in a rapid Assistive Technology Assessment (rATA) survey. Six focus group discussions (FGDs) with people with various types of disabilities were conducted. The rATA questionnaire and FGDs collected data on assistive products (APs) participants used, APs they needed and the challenges they experienced. Data collection was done in six districts spread across the three regions in Malawi. All age groups were included in the survey. Persons with disabilities aged less than 18 participated but went with their guardians. All persons who participated in this study provided consent. Survey and FGDs results were presented at an APL consensus meeting with policymakers, service providers, disabled peoples' organizations and development partners in the disability sector. Based on the results and further discussions, a consensus was reached on the priority APs for Malawi.
Results:
More than a third of respondents used wheelchairs (32%), followed by auxiliary crutches (25%), walking sticks (13%), reading glasses (11%), prosthesis (10%), elbow crutches (9%) and orthosis (8%). There is also a high demand for products such as pull-up underwear (incontinence products) (79%), hearing aids (70%), reading glasses (59%) and diapers (63%). After intensive discussions during a consensus meeting, an agreement was reached on the 22 priority APs for Malawi.
Conclusion:
There is a wide range of APs being used by people with different functional limitations in Malawi. There is also a demand for APs that are not readily available. When developing an APL, the list should include products in use, those in demand, and those recommended by service providers.Implications for rehabilitationFollowing the development of the priority assistive products list (APL) by WHO, member states should develop their own contextually based APL.The development of the APL should be based on research evidence.All key stakeholders including persons with disabilities and other functional limitations, government, and development partners should participate in this process.The APL should be part of the national health system or community services.The Department of Disability and Elderly Affairs in the Ministry of Gender, Community Development, being the Government of Malawi line ministry coordinating disability issues participated actively in this study including inviting participants in the stakeholders' validation workshop.
Resumo A Tecnologia Assistiva é pouco disseminada no Brasil. Avanços têm ocorrido gradativamente por meio de conquistas na área jurídica e do fomento à pesquisa e desenvolvimento. A proposição de políticas nessa área pode contribuir para superar as desigualdades sociais de um significativo segmento da população que representa um mercado real e em expansão. No entanto, a baixa otimização desses recursos por seus usuários e a dificuldade em buscá-los no mercado e nos órgãos públicos são fatores preocupantes. Este estudo vem, portanto, abordar a repercussão da demanda por Tecnologia Assistiva nas políticas públicas brasileiras com o objetivo identificar a relação existente entre a otimização desses recursos e serviços e a formulação de políticas direcionadas no país. Por meio de pesquisa bibliográfica, com característica exploratória e abordagem qualitativa, foi realizado um levantamento da legislação brasileira e ações existentes na área da Tecnologia Assistiva, bem como a análise de políticas públicas brasileiras com base nos critérios da avaliação normativa, aplicando-se o método dedutivo e a técnica de análise de conteúdo de Bardin. Verificou-se na literatura científica que, apesar do avanço gradativo da legislação e das iniciativas de fomento a projetos nessa área, fatores de entrave ao acesso, utilização e aproveitamento dos produtos assistivos, como a escassez na oferta de tecnologias inovadoras, acarretam dificuldades para a formatação de políticas eficazes e a configuração adequada às ações de fomento na área de Tecnologia Assistiva – essenciais ao processo de inclusão social.
This chapter analyses workplace provisions, such as information technology and assistive devices and whether and the extent to which, they are likely to provide the support required by persons with disabilities, such that their duties towards the organisation’s goals are achieved and any obstacles to productivity and job satisfaction are mediated (Vornholt et al., 2018). Extant Caribbean laws which prohibit discrimination against persons with disabilities, require employers to make accommodations for persons with disabilities, where needed. Whether or not organisations are willing to make accommodations, may be one of the most fundamental considerations for persons with disabilities, with respect to obtaining and retaining seeking employment. It is important to note that organisations are not mandated by law to make any changes that will be unduly financially burdensome. Continued innovations in technology have facilitated the ongoing development of software applications (apps) and devices that adapt the physical environment such that the limitations which were previously faced by persons with disabilities can be overcome (Blanck et al., 2007; Morris, 2018; Wehmeyer et al., 2006).KeywordsAssistive devicesAccommodationsAccessible technologiesSocietal barriersMobility impairmentsUniversal designDisclosure
Disabled People deal with a series of barriers that limit their inclusion, empowerment, well-being, and role in society with a special emphasis in low and medium-income countries. One of these barriers is concerning the accessibility and affordability of assistive technologies (ATs) that help to enhance the quality of life of these persons. In this context, this systematic literature review (SLR) analyzes and describes how free and open-source hardware (OSHW) and open software (OSS) are employed in the design, development, and deployment of low-cost ATs. In the SLR process, different ATs were analyzed for disabilities such as visual, mobility, upper body, prostheses, hearing & speaking, daily living, and participation in society. The ATs were designed with diverse OSHW and OSS technologies such as Arduino, Raspberry Pi, NVidia Jetson, OpenCV, YOLO, MobileNet, EEG and EMG signal conditioning devices, actuators, and sensors such as ultrasonic, LiDar, or flex. 809 studies were collected and analyzed from the database Web of Science, GitHub, and the specialized journals in OSHW
HardwareX
and the
Journal of Open Hardware
during the years 2013-2022. In the first part of the SLR, the bibliometric trends and topic clusters regarding the selected studies are described. Secondly, the ATs identified with open source technologies, e.g., sensor-based or computer vision-based, are described along with a complete state-of-art about these based on each disability recognized. Finally, the issues and challenges to this approach are explored including technical factors, documentation, government policies, and the inclusion of disabled people in open source co-creation. The purpose of this study is to inform practitioners, designers, or stakeholders about low-cost (frugal) ATs with OSHW and OSS, and thus promote their development, accessibility, and affordability, contributing to benefit the community of disabled people.
Purpose
Complex rehabilitation technologies (CRT) support independence for individuals with disabilities by enabling mobility for function, employment, education, and independent living. CRT service delivery is evolving, with changes to funding, provider qualifications, consumer needs, and technological advances. This scoping review investigated service delivery processes for individuals with disabilities who have a mobility impairment, while specifically identifying best practices, barriers, and unique features of health delivery policies and practices.
Methods
We used a framework described by Colquhoun et. al. for conducting scoping reviews, a six-step process that includes: 1) identifying the research question, 2) identifying studies, 3) selecting studies 4) data charting, 5) reporting results and 6) consultation. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) was also used for reporting results of the review.
Results
Common categories were identified and organised into a hierarchical structure of four categories and 16 sub-categories. The primary categories included “policy”, “consumer”, “service delivery”, and “wheeled mobility devices”. The sub-categories described funding sources, consumer and professional populations, service delivery guidelines, and types of mobility devices. Analysis indicated the data were from 21 countries and 14 combinations of funding sources, and the articles were primarily descriptive studies.
Conclusion
This scoping review identified evidence from various countries, health systems, and stakeholder. Currently, this process does not proactively address the needs of individuals with mobility disabilities. The scoping review provides the foundation for the development of a novel policy on the provision of CRT services and devices to address these needs.
•
Implications for Rehabilitation
• Examination of national and international service delivery practices in diverse clinical and funding environments indicate various challenges and opportunities for improvement.
• CRT consumers are negatively impacted by current service delivery practices, including long wait times, lack of specialised clinical expertise, and limited consumer education opportunities.
• More consistent and widespread research is needed within the CRT provision industry to grow evidence-based practice related to complex rehabilitation technology and individuals with disabilities.
The aim of our research and development is the promotion of technology embedment in everyday garments to augment their functionality, thereby increasing the wearer’s quality of life, with a special focus on inclusivity. The device (which combines user-centred design principles with soft-robotics integrated to textile) described in this article addresses the needs and desires of movement-impaired individuals with regard to their sexuality. Although sexuality is a human right, it is often neglected in research on disabled individuals. To promote a new sensibility towards this issue and make pleasure accessible to anyone, we have designed a device that allows autonomous sensual experience, enabling the wearer to self-explore intimacy and sexuality through a pillow-interface that activates inflatable components embedded into underwear. The findings and principles that guided the development of the project are also outlined. This transdisciplinary project used a mixed-methods research design. It commenced with identifying the barriers to intimacy for individuals with specific types of disability (including movement impairments) through questionnaires, interviews and focus groups. The participants were prompted to openly discuss difficulties in experiencing sexuality and their perceptions of sex toys. In addition, we examined available literature sources to map the current sex toy market and identify solutions that would be viable for individuals with disabilities. Moreover, we analysed the physiology of genitals and pleasure patterns, and identified design principles that could lead to the development of new solutions. Although sexuality is recognized as a human right, many individuals are deprived of a healthy sexual life because of physical, political and societal barriers. These obstacles are perpetuated by the sex toy market, as its lack of innovation and inclusivity prevents disabled individuals from using sex toys that can be operated without external assistance. The design principles presented in this work can be adopted to design products that can be used by disabled and non-disabled individuals to enjoy sexual pleasure. This work addresses the needs and desires of movement-impaired individuals with regard to their sexuality, which is an insufficiently examined topic. We further present the design principles that can be used for developing products that support independence and well-being of individuals with a wide range of impairments.
Background: Building control architecture that balances the assistive manipulation systems with the benefits of direct human control is a crucial challenge of human-robot collaboration. It promises to help people with disabilities more efficiently control wheelchair and wheelchair-mounted robot arms to accomplish activities of daily living.
Methods: In this paper, our research objective is to design an eye-tracking assistive robot control system capable of providing targeted engagement and motivating individuals with a disability to use the developed method for self-assistance activities of daily living. The graphical user interface is designed and integrated with the developed control architecture to achieve the goal.
Results: We evaluated the system by conducting a user study. Ten healthy participants performed five trials of three manipulation tasks using the graphical user interface and the developed control framework. The 100% success rate on task performance demonstrates the effectiveness of our system for individuals with motor impairments to control wheelchair and wheelchair-mounted assistive robotic manipulators.
Conclusions: We demonstrated the usability of using this eye-gaze system to control robotic arm mounted on wheelchair in activities of daily living for the people with disabilities. We found high levels of acceptance with higher ratings in evaluation of the system with healthy participants.
Trial registration: Not applicable.
International experts in assistive technology from five global regions (South America, Asia Pacific, Europe, Africa, and Australia) and with affiliation to the World Health Organization (WHO) Global Cooperation on Assistive Technology (GATE) community were invited to share their perspectives on the delivery of assistive technology and provision of assistive products in their regions. Four common topics emerged from the experts: (a) user and environmental barriers; (b) policy, funding, and product access; (c) professional training, collaboration, and service delivery; and (d) occupational justice (i.e., empowerment, participation, and progress).
This paper is based on work from the Global Research, Innovation, and Education on Assistive Technology (GREAT) Summit that was coordinated by WHO’s Global Cooperation on Assistive Technology (GATE). The purpose of this paper is to describe the needs and opportunities embedded in the assistive product lifecycle as well as issues relating to the various stages of assistive product mobilization worldwide.
The paper discusses assistive technology product terminology and the dangers of focusing on products outside the context and rolling out products without a plan. Additionally, the paper reviews concepts and issues around technology transfer, particularly in relation to meeting global needs and among countries with limited resources. Several opportunities are highlighted including technology advancement and the world nearing a state of readiness through a developing capacity of nations across the world to successfully adopt and support the assistive technology products and applications.
The paper is optimistic about the future of assistive technology products reaching the people that can use it the most and the excitement across large and small nations in increasing their own capacities for implementing assistive technology. This is expressed as hope in future students as they innovate and in modern engineering that will enable assistive technology to pervade all corners of current and potential marketplaces. Importantly, the paper poses numerous topics where discussions are just superficially opened. The hope is that a set of sequels will follow to continue this critical dialog.
• Implications for Rehabilitation
• Successful assistive technology product interventions are complex and include much more than the simple selection of the right product.
• Assistive technology product use is highly context sensitive in terms of an individual user’s environment.
• The development of assistive technology products is tricky as it must be contextually sensitive to the development environment and market as well.
• As a field we have much to study and develop around assistive technology product interventions from a global perspective.
Introduction
Disability and poverty are believed to operate in a cycle, with each reinforcing the other. While agreement on the existence of a link is strong, robust empirical evidence substantiating and describing this potential association is lacking. Consequently, a systematic review was undertaken to explore the relationship between disability and economic poverty, with a focus on the situation in low and middle income countries (LMICs).
Methods
Ten electronic databases were searched to retrieve studies of any epidemiological design, published between 1990-March 2016 with data comparing the level of poverty between people with and without disabilities in LMICs (World Bank classifications). Poverty was defined using economic measures (e.g. assets, income), while disability included both broad assessments (e.g. self-reported functional or activity limitations) and specific impairments/disorders. Data extracted included: measures of association between disability and poverty, population characteristics and study characteristics. Proportions of studies finding positive, negative, null or mixed associations between poverty and disability were then disaggregated by population and study characteristics.
Results
From the 15,500 records retrieved and screened, 150 studies were included in the final sample. Almost half of included studies were conducted in China, India or Brazil (n = 70, 47%). Most studies were cross-sectional in design (n = 124, 83%), focussed on specific impairment types (n = 115, 77%) and used income as the measure for economic poverty (n = 82, 55%). 122 studies (81%) found evidence of a positive association between disability and a poverty marker. This relationship persisted when results were disaggregated by gender, measure of poverty used and impairment types. By country income group at the time of data collection, the proportion of country-level analyses with a positive association increased with the rising income level, with 59% of low-income, 67% of lower-middle and 72% of upper-middle income countries finding a positive relationship. By age group, the proportion of studies reporting a positive association between disability and poverty was lowest for older adults and highest for working-age adults (69% vs. 86%).
Conclusions
There is strong evidence for a link between disability and poverty in LMICs and an urgent need for further research and programmatic/policy action to break the cycle.
Primary health care workers (HCWs) in low- and middle-income settings (LMIC) often work in challenging conditions in remote, rural areas, in isolation from the rest of the health system and particularly specialist care. Much attention has been given to implementation of interventions to support quality and performance improvement for workers in such settings. However, little is known about the design of such initiatives and which approaches predominate, let alone those that are most effective. We aimed for a broad understanding of what distinguishes different approaches to primary HCW support and performance improvement and to clarify the existing evidence as well as gaps in evidence in order to inform decision-making and design of programs intended to support and improve the performance of health workers in these settings. We systematically searched the literature for articles addressing this topic, and undertook a comparative review to document the principal approaches to performance and quality improvement for primary HCWs in LMIC settings. We identified 40 eligible papers reporting on interventions that we categorized into five different approaches: (1) supervision and supportive supervision; (2) mentoring; (3) tools and aids; (4) quality improvement methods, and (5) coaching. The variety of study designs and quality/performance indicators precluded a formal quantitative data synthesis. The most extensive literature was on supervision, but there was little clarity on what defines the most effective approach to the supervision activities themselves, let alone the design and implementation of supervision programs. The mentoring literature was limited, and largely focused on clinical skills building and educational strategies. Further research on how best to incorporate mentorship into pre-service clinical training, while maintaining its function within the routine health system, is needed. There is insufficient evidence to draw conclusions about coaching in this setting, however a review of the corporate and the business school literature is warranted to identify transferrable approaches. A substantial literature exists on tools, but significant variation in approaches makes comparison challenging. We found examples of effective individual projects and designs in specific settings, but there was a lack of comparative research on tools across approaches or across settings, and no systematic analysis within specific approaches to provide evidence with clear generalizability. Future research should prioritize comparative intervention trials to establish clear global standards for performance and quality improvement initiatives. Such standards will be critical to creating and sustaining a well-functioning health workforce and for global initiatives such as universal health coverage.
The Sustainable Development Goals (SDGs) have placed great emphasis on the need for much greater social inclusion, and on making deliberate efforts to reach marginalized groups. People with disabilities are often marginalized through their lack of access to a range of services and opportunities. Assistive products can help people overcome impairments and barriers enabling them to be active, participating and productive members of society. Assistive products are vital for people with disabilities, frailty and chronic illnesses; and for those with mental health problems, and gradual cognitive and physical decline characteristic of aging populations. This paper illustrates how the achievement of each of the 17 SDGs can be facilitated by the use of assistive products. Without promoting the availability of assistive products the SDGs cannot be achieved equitably. We highlight how assistive products can be considered as both a mediator and a moderator of SDG achievement. We also briefly describe how the Global Cooperation on Assistive Technology (GATE) is working to promote greater access to assistive products on a global scale.
Developing countries are suffering from increasing burdens presented by both non-communicable and emerging infectious diseases. Health education is an important step to fight against these mostly preventable diseases. E-learning has been shown to be one of the tools that address some of the training challenges experienced in developing countries by supporting efficient content delivery, decreasing costs and increasing access. Massive open online courses (MOOCs) are a recent innovative presentation of online learning that have attracted millions of learners from all over the world. In this commentary, we propose MOOCs as a potential tool to offer a tremendous opportunity to fulfil the unmet training needs of the health sector in developing countries in two complementary ways: as a resource for training healthcare professionals; and as a resource for the general public. Potential barriers to accessing MOOCs and possible solutions are also discussed.
Purpose: It is estimated that only 5–15% of people in low and middle income countries (LMICs) who need assistive technologies (AT) have access to them. This scoping review was conducted to provide a comprehensive picture of the current evidence base on AT within LMICs and other resource limited environments.
Method: The scoping review involved locating evidence, extracting data, and summarizing characteristics of all included research publications.
Results: Of the 252 publications included, over 80% focused on types of AT that address mobility (45.2%) and vision (35.5%) needs, with AT types of spectacles and prosthetics comprising over 50% of all publications. Evidence on AT that addresses hearing, communication, and cognition is the most underrepresented within the existing evidence base. The vast majority of study designs are observational (63%).
Conclusions: Evidence on AT in resource-limited environments is limited in quantity and quality, and not evenly distributed across types of AT. To advance this field, we recommend using appropriate evidence review approaches that allow for heterogeneous study designs, and developing a common language by creating a typology of AT research focus areas. Funders and researchers must commit much greater resources to the AT field to ameliorate the paucity of evidence available.
•
Implications for Rehabilitation
•An increase in the quality and quantity of research is required in resource limited environments, where 80% of the global population of people with disabilities reside. Improved and increased evidence is needed to identify and understand needs, inform policy and practice, and assess progress made in increasing access to and availability of appropriate AT.
•Over 80% of the existing research publications on assistive technologies in resource limited environments address mobility and vision. More research is needed on AT that address hearing, communication and cognition.
•The use of a common language would facilitate the advancement of the global AT research field. Specifically there is a need for researchers to use a common definition of AT (i.e., ISO 9999) and typology of AT research focus areas.
For people who have a mobility impairment, access to an appropriate wheelchair is an important step towards social inclusion and participation. The World Health Organization Guidelines for the Provision of Manual Wheelchairs in Less Resourced Settings emphasize the eight critical steps for appropriate wheelchair services, which include: referral, assessment, prescription, funding and ordering, product preparation,fitting and adjusting, user training, and follow-up and maintenance/repairs. The purpose of this study was to investigate how the provision of wheelchairs according to the World Health Organization’s service provision process by United Cerebral Palsy Wheels for Humanity in Indonesia affects wheelchair recipients compared to wait-listed controls.
Methods
This study used a convenience sample (N = 344) of Children, Children with proxies, Adults, and Adults with proxies who were on a waiting list to receive a wheelchair as well as those who received one. Interviews were conducted at baseline and a 6 month follow-up to collect the following data: Demographics and wheelchair use questions, the World Health Organization Quality of Life-BREF, Functional Mobility Assessment, Craig Handicap Assessment Recording Technique Short Form. The Wheelchair Assessment Checklist and Wheelchair Skills Test Questionnaire were administered at follow up only.
Results
167 participants were on the waiting list and 142 received a wheelchair. Physical health domain in the World Health Organization Quality of Life-BREF improved significantly for women who received a wheelchair (p = 0.044) and environmental health improved significantly for women and men who received a wheelchair as compared to those on the waiting list (p
Despite the benefits derived from the use of assistive technologies (AT), some parts of the world have minimal or no access to AT. In many low-income and middle-income countries (LMIC), only 5–15% of people who require AT have access to them. Rapid demographic changes will exacerbate this situation as populations over 60 years of age, as well as functional limitations among older populations, in LMIC are expected to be higher than in high-income countries in the coming years. Given both these trends, AT are likely to be in high demand and provide many benefits to respond to challenges related to healthy and productive ageing. Multiple databases were searched for English literature. Three groups of keywords were combined: those relating to AT, ageing population and LMIC selected for this study, namely Brazil, Cambodia, Egypt, India, Turkey and Zimbabwe. These countries are expected to see the most rapid growth in the 65 and above population in the coming years. Results indicate that all countries had AT designed for older adults with existing impairment and disability, but had limited AT that are designed to prevent impairment and disability among older adults who do not currently have any disabilities. All countries have ratified the UN Convention on the Rights of Persons with Disabilities. The findings conclude that AT for ageing populations have received some attention in LMIC as attested by the limited literature results. Analysis of review findings indicate the need for a comprehensive, integrated health and social system approach to increase the current availability of AT for ageing populations in LMIC. These would entail, yet not be limited to, work on: (1) promoting initiatives for low-cost AT; (2) awareness raising and capacity building on AT; (3) bridging the gap between AT policy and practice; and (4) fostering targeted research on AT.
Background: Wheelchairs allow users to realise basic human rights and improved quality of
life. South African and international documents guide rehabilitation service delivery and thus
the provision of wheelchairs. Evidence indicates that rehabilitation policy implementation
gaps exist in rural South Africa.
Objectives: The aim of this article was to explore the extent to which wheelchair service
delivery in a rural, remote area of South Africa was aligned with the South African National
Guidelines on Provision of Assistive Devices, The United Nations Convention on the Rights
of Persons with Disabilities and The World Health Organization Guidelines on Provision of
Wheelchairs in Less-Resourced Settings.
Method: Qualitative methods were used. Data were collected through semi-structured
interviews with 22 participants who were identified through purposive sampling. Content
analysis of data was preformed around the construct of wheelchair service delivery.
Results: Study findings identified gaps between the guiding documents and wheelchair
service delivery. Areas where gaps were identified included service aspects such as referral,
assessment, prescription, user and provider training, follow up, maintenance and repair
as well as management aspects such as staff support, budget and monitoring. Positive
findings related to individual assessments, enthusiastic and caring staff and the provision of
wheelchairs at no cost.
Conclusion: The gaps in policy implementation can have a negative impact on users and
the service provider. Inappropriate or no wheelchairs limit user function, participation and
quality of life. In addition, an inappropriate wheelchair will have a shorter lifespan, requiring
frequent repairs and replacements with cost implications for the service provider.
Amputees living in developing countries have a profound need for affordable and reliable lower limb prosthetic devices. The World Health Organization estimates there are approximately 30 million amputees living in low-income countries, with up to 95% lacking access to prosthetic devices. Effective prosthetics can significantly affect the lives of these amputees by increasing opportunity for employment and providing improvements to long-term health and well-being. However, current solutions are inadequate: state-of-the-art solutions from the US and Europe are cost-prohibitive, while low-cost devices have been challenged by poor quality and/or unreliable performance, and have yet to achieve large scale impact. The introduction of new devices is hampered by the lack of a cohesive prosthetics industry in low-income areas; the current network of low-cost prosthetic clinics is informal and loosely organized with significant disparities in geography, patient volume and demographics, device procurement, clinical and logistical infrastructure, and funding. At D-Rev (Design Revolution) we are creating the ReMotion Knee, which is an affordable polycentric prosthetic knee joint that performs on par with devices in more industrialized regions, like the US and Europe. As of September 2012, over 4200 amputees have been fitted with the initial version of the ReMotion Knee through a partnership with the JaipurFoot Organization, with an 79% compliance rate after 2 years. We are currently scaling production of the ReMotion Knee using centralized manufacturing and distribution to serve the existing clinics in low-income countries and increase the availability of devices for amputees without access to appropriate care. At D-Rev, we develop products that target these customers through economically-sustainable models and provide a measurable impact in the lives of the world's amputees.
Background
In the face of severe faculty shortages in resource-constrained countries, medical schools look to e-learning for improved access to medical education. This paper summarizes the literature on e-learning in low- and middle-income countries (LMIC), and presents the spectrum of tools and strategies used.
Methods
Researchers reviewed literature using terms related to e-learning and pre-service education of health professionals in LMIC. Search terms were connected using the Boolean Operators “AND” and “OR” to capture all relevant article suggestions. Using standard decision criteria, reviewers narrowed the article suggestions to a final 124 relevant articles.
Results
Of the relevant articles found, most referred to e-learning in Brazil (14 articles), India (14), Egypt (10) and South Africa (10). While e-learning has been used by a variety of health workers in LMICs, the majority (58%) reported on physician training, while 24% focused on nursing, pharmacy and dentistry training. Although reasons for investing in e-learning varied, expanded access to education was at the core of e-learning implementation which included providing supplementary tools to support faculty in their teaching, expanding the pool of faculty by connecting to partner and/or community teaching sites, and sharing of digital resources for use by students. E-learning in medical education takes many forms. Blended learning approaches were the most common methodology presented (49 articles) of which computer-assisted learning (CAL) comprised the majority (45 articles). Other approaches included simulations and the use of multimedia software (20 articles), web-based learning (14 articles), and eTutor/eMentor programs (3 articles). Of the 69 articles that evaluated the effectiveness of e-learning tools, 35 studies compared outcomes between e-learning and other approaches, while 34 studies qualitatively analyzed student and faculty attitudes toward e-learning modalities.
Conclusions
E-learning in medical education is a means to an end, rather than the end in itself. Utilizing e-learning can result in greater educational opportunities for students while simultaneously enhancing faculty effectiveness and efficiency. However, this potential of e-learning assumes a certain level of institutional readiness in human and infrastructural resources that is not always present in LMICs. Institutional readiness for e-learning adoption ensures the alignment of new tools to the educational and economic context.
To produce a historical account of rehabilitation actions in the context of the Brazilian Unified Health Care System (SUS).
Search of SciELO, LILACS, and MEDLINE databases for literature published between 1980 and 2009. The following Portuguese search terms were used: Sistema Unico de Saúde, reabilitação, políticas de saúde, assistência médica, história. The English terms "rehabilitation" and "public health" were also used. Federal laws and Ministry of Health manuals available at the city of Rio de Janeiro Coordinating Office for Rehabilitation Programs, Fundação Instituto Oswaldo Cruz library, and in BIREME database were also surveyed.
Only a small number of publications were recovered (four books, three Health Ministry manuals, four articles published in Brazil, one master's thesis, and one doctoral dissertation). Nevertheless, analysis of these materials revealed that since many municipalities are still incapable of ensuring the right to universal and comprehensive health care, rehabilitation actions are often carried out in a precarious manner, unsupported by an adequate and comprehensive policy. On the other hand, there have been real improvements in terms of expanding care to the population with special needs.
There still are factors hindering the achievement of optimal results in the care to people with special needs. The challenge of action planning must be undertaken especially by municipal governments to ensure an adequate supply of services and thus equity of access and comprehensive health care.
El artículo hace un recuento del desarrollo de la acción de tutela en Colombia a partir de su consagración como mecanismo de protección de derechos fundamentales incluida en el Título II, Capítulo 4 de la Constitución Política expedida en 1991 en su Artículo 86 y la forma cómo ha incidido en la protección del derecho a la salud bajo los lineamientos de la Ley 100/93 y su normatividad reglamentaria. Explora el verdadero alcance del derecho a la salud de acuerdo con los desarrollos jurisprudenciales de la Corte Constitucional, las tesis que han orientado su protección y cómo en muchas ocasiones, se han emitido fallos contrariando los preceptos legales y reglamentarios, pero en todo caso consultando el espíritu de la Carta Constitucional en procura de la protección del derecho a la salud, sobre todo cuando, por conexidad con derechos de carácter fundamental, pueden estos últimos ser vulnerados. Se plantea también si con el porcentaje cada vez creciente de las acciones de tutela instauradas por los usuarios para invocar la protección del derecho a la salud, esta acción se ha convertido en un mecanismo alterno de acceso a servicios de salud y si, en tal caso, sería éste el procedimiento adecuado para asegurar el cumplimiento de los principios que orientan su ejercicio, sobre todo los que hacen referencia a la universalidad y a la protección integral.
Estimating preferences for states of health has been an active area of research in recent years. Unlike psychophysical approaches, which discriminate levels of health status, preference-based approaches incorporate values or utilities for health outcomes and can be used in cost-effectiveness analyses to aid resource allocation decisions. This chapter considers issues and controversies involved in using preference-based measures in economic evaluation in health care, with a particular emphasis on cost-utility analysis and the estimation of quality-adjusted life years. Topics considered include techniques for measuring preferences, the use of preference-based classification systems, the relationship between patient and community preferences, methods for obtaining utilities from clinical trials, mapping health status from health utilities, the development of "off-the-shelf" preference weights, and proposed alternatives to quality-adjusted life years. We also consider applications of cost-utility analyses to public health interventions. Although cost-utility analyses have become more popular recently, many challenges remain for the field. Widespread acceptance of the methodology likely awaits more consensus on measurement techniques, as well as educational efforts in the public health and medical communities on the usefulness of the approach.
Facilitating access is concerned with helping people to command appropriate health care resources in order to preserve or improve their health. Access is a complex concept and at least four aspects require evaluation. If services are available and there is an adequate supply of services, then the opportunity to obtain health care exists, and a population may 'have access' to services. The extent to which a population 'gains access' also depends on financial, organisational and social or cultural barriers that limit the utilisation of services. Thus access measured in terms of utilisation is dependent on the affordability, physical accessibility and acceptability of services and not merely adequacy of supply. Services available must be relevant and effective if the population is to 'gain access to satisfactory health outcomes'. The availability of services, and barriers to access, have to be considered in the context of the differing perspectives, health needs and material and cultural settings of diverse groups in society. Equity of access may be measured in terms of the availability, utilisation or outcomes of services. Both horizontal and vertical dimensions of equity require consideration.
Assistive technologies can benefit a wide range of people, including those with disabilities; those with age-related frailties; those affected by noncommunicable diseases; and those requiring rehabilitation. Access to these technologies is limited in low- and middle-income countries but the already-high need will inevitably rise further because of demographic and epidemiological transitions. Four key gaps contribute to limited access. First, although need is high, demand is low, not least because of widespread lack of awareness among potential beneficiaries, their caregivers, and their health-care providers. Second, product designs are insufficiently informed by users' and caregivers' preferences and environments, and transfer of technologies to low-resource settings is limited. Third, barriers to supply include low production quality, financial constraints and a scarcity of trained personnel. Fourth, there is a dearth of high-quality evidence on the effectiveness of different types of technology. Adoption of the World Health Assembly Resolution WHA71.8 in 2018 marked convergence of, commitment to and strengthening of efforts to close these gaps and improve access to assistive devices. The Global Cooperation on Assistive Technology workplan identifies four overarching, interlinked solutions for countries to improve access. First, a national policy framework for assistive technology is needed. Second, product development should be encouraged through incentive schemes that support and promote affordable assistive products. Third, capacity-building of personnel is needed, through undergraduate and in-service training. Fourth, provision needs to be enhanced, especially through integration of services with the health system. These actions need to be underpinned by government leadership, a multisectoral approach and adequate funding.
Purpose: Improving access to education and training for those providing wheelchair and seating assistive technology to meet personal posture and mobility requirements, as a basic human right, is a priority. This review considers education and training available to personnel within low and lower middle income countries (LLMIC), to ascertain where gaps in knowledge exist and identify human resource education priorities.
Method: A scoping review, mapping out existing scientific and grey literature within the field between 1993 and 2017 was conducted. The search strategy included use of online databases, manual analogue searches and key stakeholder informant advice. A content analysis process was applied to organize the literature retrieved and extract key themes.
Results: Education and training in LLMIC appears ad hoc and limited, however, there is growing recognition as to its importance, notably by the World Health Organization and nongovernmental organizations, delivering education initiatives to a number of countries, along with the development of a credentialing test. Inconsistency exists regarding personnel responsible for wheelchair provision, with no specific professional clearly recognized to oversee the system within many LLMIC.
Conclusions: Education and training is required for all stakeholders involved in wheelchair provision. Advocating for programme development to enhance personnel skills, build capacity and ensure best practice is a priority. Pilot sites, delivering and credentialing appropriate wheelchair provision education and training within context should be considered. Measuring outcomes and transferable skills should be part of education programme delivery structures. Considering a new discipline responsible for oversight of wheelchair provision should be investigated.
• Implications for rehabilitation
• Education and training is an essential step in the wheelchair provision process in the bid to obtain an appropriate wheelchair via appropriate provision services. However, it is more than education and training; its a human rights issue.
• Mandatory education and training needs to be a requirement for all stakeholders involved in wheelchair provision.
• Key wheelchair personnel need to establish their central role in this arena.
• The study raises awareness as to the importance of working with governments to commit to building sustainable wheelchair provision infrastructures.
Despite its facilitating role in creating opportunities for people with disabilities to exercise human rights, access to assistive technology is limited in many countries. It is therefore promising that the Convention on Rights of Persons with Disabilities (CRPD) addresses this area. The purpose of this study was to analyse the assistive technology content of the CRPD from a basic human rights perspective in order to clarify its limitations and opportunities for formulation of policies and implementation strategies. Data were collected through a content analysis of the CRPD. It is concluded that a non‐discriminatory interpretation of the provisions entitles all people with disabilities to a right to demand available and affordable assistive technology. Ensuring this right is a national as well as an international responsibility.
Assistive technology (AT) describes any device or other solution that is used by people with disabilities to assist in performing tasks or activities. While potentially useful, the availability of appropriate AT for people with disabilities can be problematic due to high costs, limited funding sources, and a lack of expertise on what solutions might exist for their needs. This paper explores the potential power of technical volunteers in collaboration with the education sector to address the problem of high AT costs for certain classes of assistive devices by providing a volunteer force of skilled engineers, designers, and other technicians who donate their time and goodwill to building appropriate, low-cost assistive devices. It presents a number of case studies on AT-related volunteer organizations and post-secondary educational initiatives, and discusses the possible growth of such initiatives. We propose a path forward to build a social movement of volunteers, modeled after the success of organizations such as Engineers Without Borders (EWB) Canada, Teach for America, and CanAssist at the University of Victoria to improve the quality of life of people with disabilities.
2009 Decreto No 6.949
- Presidencia da República
Estado nutricional de escolares y sus variables socioeconómicas
- Rossi
Gaceta Constitucional No. 116 de 20 de julio de
- Asamble Nacional
Disability and rehabilitation in Tajikistan: development of a multisectoral national programme to leave no one behind
- Mishra