[Show abstract][Hide abstract] ABSTRACT: Assistive technology for cognition is technology which can be used to enable, enhance, or extend cognitive function. This book systematically examines how cutting-edge digital technologies can assist the cognitive function of people with cognitive impairments, with the potential to revolutionize rehabilitation. Technologies are reviewed which direct attention, remind, recognize, prompt, and generally guide people through activities of daily living. Written by experts in neuropsychology and technology development, Assistive Technology for Cognition provides a comprehensiveoverview ofthe efficacy of technologies to assist people with brain impairments. Based on the list provided by the International Classification of Function, each chapter covers a different cognitive function; namely, attention, memory, affect, perception, executive function, language, numeracy, sequencing, and navigation onto which existing and future assistive technologies for cognition are mapped. This structure provides in-depth research in an accessible way, and will allow practitioners to move from an assessment of cognitive deficits to the prescription of an appropriate assistive technology for cognition. The chapters also make suggestions for future developments.
[Show abstract][Hide abstract] ABSTRACT: Disability prevalence in older adults is increasing. Given the low rates of employment among people with disabilities, especially those aging with multiple sclerosis (MS), spinal cord injury (SCI), late effects of polio (LEP), and muscular dystrophy (MD), services from federal-state vocational rehabilitation (VR) programs could positively impact employment status.
To describe VR services for individuals aging with MS, SCI, LEP and MD and the impact of aging on employment status.PARTICIPANTS: Thirteen Washington State VR counselors and 26 individuals, 45 to 65 years old, with MS, MD, LEP or SCI.
We examined national Rehabilitation Services Administration data (2006, 2007), including case closure, service outcomes and other demographics. We then purposively selected Washington State for our study. Interviews provided consumer and counselor perspectives on the components of successful case closure (employed) and the impact of aging and disability on employment.
Washington State and national data were similar. Organizational and individual factors influence the effectiveness of VR services.
People who could benefit from VR services are not being served; those who are served, are getting neither comprehensive services nor high quality outcomes. Additional research is needed to understand the variables associated with effective use of VR services.
[Show abstract][Hide abstract] ABSTRACT: Abstract Purpose: We investigated the current use of off-the-shelf cognitive support technologies (CSTs) by individuals with traumatic brain injury (TBI), the challenges they and their caregivers face when using these technologies, the functional areas where support is needed, and their current experience in learning new technologies. Method: We conducted two focus groups with participants with TBI and their caregivers. Focus group interactions were captured using recordings and a court reporter. Transcripts were analyzed qualitatively. Results: We identified three core themes - consumer and caregiver self-reported needs for support, how support is used on a daily basis and consumer and caregiver attitudes towards the use of support by types of support. We also inferred implications for design of CSTs. Conclusions: Individuals with TBI use consumer available technologies to support cognition. The design of most of these devices is not targeted to meet the needs of people with TBI, and they can be challenging to use independently, but individuals and their caregivers still benefit from their use by embedding technology as one type of support within a broader support network that includes personal assistance. Implications for Rehabilitation People with traumatic brain injury (TBI) are attempting to use a wide range of consumer available technologies to support cognition, although not always successfully. One important role for rehabilitation providers could be helping people with TBI use these technologies with more accuracy and success. People with TBI note that an important element in adopting new technology is good training in its use. Cognitive support technologies (CSTs) are one part of broader network of supports. People with TBI and their caregivers desire independence but do not want to lose the human element that can be provided by a caregiver. New technologies should be implemented with an understanding of an individual's broader support network. Psychosocial aspects of TBI need to be considered when designing and implementing CSTs. In particular, rehabilitation providers need to address the anxiety that many people with TBI experience, including fear about forgetting and their need for early, repeated reminders so they can prepare for upcoming events.
No preview · Article · Aug 2013 · Disability and rehabilitation. Assistive technology
[Show abstract][Hide abstract] ABSTRACT: Abstract Purpose: The goal of the study was to investigate the accuracy, feasibility and acceptability of implementing an embedded assessment system in the homes of individuals aging with disabilities. Method: We developed and studied a location tracking system, UbiTrack, which can be used for both indoor and outdoor location sensing. The system was deployed in the homes of five participants with spinal cord injuries, muscular dystrophy, multiple sclerosis and late effects of polio. We collected sensor data throughout the deployment, conducted pre and post interviews and collected weekly diaries to measure ground truth. Results: The system was deployed successfully although there were challenges related to system installation and calibration. System accuracy ranged from 62% to 87% depending upon room configuration and number of wireless access points installed. In general, participants reported that the system was easy to use, did not require significant effort on their part and did not interfere with their daily lives. Conclusions: Embedded assessment has great potential as a mechanism to gather ongoing information about the health of individuals aging with disabilities; however, there are significant challenges to its implementation in real-world settings with people with disabilities that will need to be resolved before it can be practically implemented. Implications for Rehabilitation Technology-based embedded assessment has the potential to promote health for adults with disabilities and allow for aging in place. It may also reduce the difficulty, cost and intrusiveness of health measurement. Many new commercial and non-commercial products are available to support embedded assessment; however, most products have not been well-tested in real-world environments with individuals aging with disability. Community settings and diverse population of people with disabilities pose significant challenges to the implementation of embedded assessment systems.
No preview · Article · Jun 2013 · Disability and rehabilitation. Assistive technology
[Show abstract][Hide abstract] ABSTRACT: Technologies are being developed and promoted with the aim of improving the health and quality of life of older adults, but
often without analyzing or planning around the human needs of users. Abraham Maslow’s model of the hierarchy of needs proposes
that people seek to satisfy progressively higher human needs, starting with physical needs like food and shelter, and advancing
through safety and security, belonging and love, esteem, and self-actualization. Each of these levels of need has relevance
for aging-related technologies. Lack of attention to user needs may be one factor that explains the limited adoption of many
aging-related technologies. It is important to consider the users’ current levels of need, the different needs of patients
and caregivers, the degrees of behavioral change expected at different levels of need, and the unintended consequences of
technologies. Insights from Maslow’s model can help developers, researchers, providers, and consumers in the process of producing,
evaluating, recommending, and purchasing technologies for older adults. One particular challenge is that assistive technologies
may undermine esteem needs by limiting independence. Scales to measure levels of need can help characterize which needs are
most relevant for different individuals, and can be used to ensure that technologies address users’ needs.
KeywordsAging–Gerontechnology–Technology–Assistive technology–Abraham Maslow–Human needs–Smart homes
No preview · Article · Dec 2011 · Ageing International
[Show abstract][Hide abstract] ABSTRACT: Consequences of major burn injuries often include losing the ability to engage in basic life functions such as work or employment. As this is a developing area of importance in burn care, the goal of this study was to perform a systematic review of the burn literature to ascertain a comprehensive view of the literature and identify return to work (RTW) factors where possible. A search was conducted and peer-reviewed studies that investigated predictors and barriers of returning to work of those with burn injuries, published since 1970 and written in English, were examined. From the 216 articles initially identified in the search, 26 studies were determined to meet inclusion criteria. Across studies, the mean age was 33.63 years, the mean TBSA was 18.94%, and the average length of stay was 20 days. After 3.3 years (41 months) postburn, 72.03% of previously employed participants had returned to some form of work. Important factors of RTW were identified as burn location, burn size, treatment variables, age, pain, psychosocial factors, job factors, and barriers. This systematic review suggests multiple conclusions. First, there is a significant need for attention to this area of study given that nearly 28% of all burn survivors never return to any form of employment. Second, the RTW literature is in need of coherent and consistent methodological practices, such as a sound system of measurement. Finally, this review calls for increased attention to interventions designed to assist survivors' ability to function in an employed capacity.
No preview · Article · Dec 2011 · Journal of burn care & research: official publication of the American Burn Association
[Show abstract][Hide abstract] ABSTRACT: To validate a single item self-report of satisfaction with participation in two groups with differing patterns of symptoms and disease progress, multiple sclerosis (MS) and spinal cord injury (SCI).
Community-dwelling adults with MS (N = 1,271) or SCI (N = 620) completed a battery of self-report questionnaires covering demographic information, disease specific measures, symptoms, psychological distress, social-environmental issues, and overall well-being. They were also asked to rate satisfaction with participation: How satisfied are you with your ability to take part in activities that are important to you: not satisfied, somewhat satisfied, satisfied, or very satisfied. Kendall's tau rank correlation coefficient and χ(2) tests were used to examine the strength and direction of associations between demographic and symptom variables and responses to the participation item.
Although the demographics of the MS and SCI differed in predictable ways, younger participants and those employed report more satisfaction with participation. Ratings of satisfaction with participation were also consistently associated with a number of variables including less fatigue, pain, depression, stress, anxiety, as well as higher overall measures of well-being across the two populations.
More research is needed to better understand the multiple dimensions that comprise participation and to develop robust and sensitive measurement tools. A global rating of satisfaction with participation using one item has a number of potentially useful applications including description of case mix in clinical trials.
No preview · Article · Oct 2011 · Disability and Rehabilitation
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to elucidate the experience of self-management among people with multiple sclerosis (MS) and gather their input to inform a self-management intervention. Twelve people with MS participated in focus groups in which they were asked open-ended questions about MS symptoms, challenges, overcoming challenges, symptom management, and treatment preferences. The results suggest four major themes: 1) "The Everyday Experience of MS," including comments about symptoms and their impact on functioning; 2) "Motivation for Self-Management," including descriptions of motivation originating from physical necessity, success with other management techniques, and external sources; 3) "Coping Strategies and Skills," including descriptions of changing behaviors, expanding social support networks, finding resources, utilizing medical treatment, and monitoring symptoms; and 4) "Vision for a Self-Management Intervention," including suggestions that an intervention be individualized, be motivating, and provide resources. The results of this study can inform the design and implementation of self-management interventions. Experiences described by participants are consistent with other qualitative reports suggesting the active role people with MS play in managing their condition. Intervention approaches must consider the complex constellation of symptoms associated with MS and provide individualized treatments that enhance the person's ability to manage their symptoms, barriers presented by such symptoms, and their health care.
No preview · Article · Aug 2011 · International Journal of MS Care
[Show abstract][Hide abstract] ABSTRACT: As part of the planning process for a larger survey study to examine factors affecting employers' intention to hire and hiring of people with disabilities, a series of three semi-structured focus groups were held with key hiring decision makers, such as Human Resources directors, Chief Operating Officers (COOs), or Chief Executive Officers (CEOs) of small, medium, and large Seattle area companies.
The chief goals of the focus groups were to elicit and refine the participants' beliefs, normative influences, and perceived control relative to hiring workers with disabilities.
Narrative data obtained from the focus group discussion were examined using the Theory of Planned Behavior (TPB) to identify themes expressed by the focus group participants within the context of company size.
Themes did vary by company size, but a prevailing concern across all companies related to questions about the efficiency/effectiveness of contact with vocational rehabilitation agencies. For both small- and mid-sized companies, there was a belief that people with disabilities could not do the work or were somehow less qualified. For large companies, convincing departmental and team managers that outreaching workers with disabilities would be a worthwhile hiring practice remained a challenge.
The themes derived from this study can be used to help occupational rehabilitation professionals develop educational and marketing interventions to improve employers' attitudes toward hiring and retaining individuals with disabilities.
Full-text · Article · Nov 2010 · Journal of Occupational Rehabilitation
[Show abstract][Hide abstract] ABSTRACT: The process and importance of Knowledge Translation (KT) for the field of rehabilitation counseling is described. One element of the KT process, systematic reviews of the literature, is described along with several strategies for grading evidence. Practicing clinicians, as do consumers, encounter a number of barriers to using primary source research. Rehabilitation counselors need access to the best evidence available to inform their clinical practice. Consumers of rehabilitation counseling services require high quality accessible information about evidence to support their informed decision making about participating in rehabilitation programs.
[Show abstract][Hide abstract] ABSTRACT: Semi-structured interviews were conducted with eight couples, each with one partner diagnosed with Multiple Sclerosis (MS). The purpose of the interviews was to examine how couples adapt to the challenges of MS, and to explore how participants defined and identified the strengths and challenges in their relationship, negotiated role changes and received external support. Conceptual frameworks on how families adapt to chronic illness guided within and across case analyses. We identified patterns in the couples' current responses to the demands and stressors of MS.
Two patterns of adaptation to MS were identified as being in-sync' or out-of-sync'. Characteristics of the four couples currently in-sync included having a relapsing-remitting type of MS, which proceeded at a pace that enabled both partners to maintain their social roles and identity, and a collaborative problem solving style. The four couples currently out-of-sync had a rapid progression of MS, loss of employment before retirement age, differences in personal styles that shifted from being complementary to oppositional in the face of increased demands, and struggles with parenting adolescent children.
Clinicians can use these data to assess possible relational strain in couples with MS and identify families who might benefit from referrals to family therapy or other relational support. Interventions can be targeted at couples at risk for becoming out-of-sync in order to increase the social support, health, and well-being of both the individual with MS and his/her partner.
No preview · Article · Apr 2010 · Disability and Health Journal
[Show abstract][Hide abstract] ABSTRACT: The Patient Reported Outcomes Measurement Information System (PROMIS) is an NIH roadmap initiative to develop and test banks of items measuring patient reported outcomes for public use. This goal of this study was to adapt items from the PROMIS physical function (PF) domain bank so that they are appropriate and relevant to individuals who use wheelchairs, mobility aids, and other assistive technology (AT). Items were reviewed by experts and those determined not appropriate or relevant to AT users were removed or adapted when possible. Additional items were created to fill gaps in the domain. Cognitive interviews with users of AT (N=31) were completed such that each new or adapted item was reviewed by at least eight individuals with varying AT needs. Based on these results a candidate item bank was developed and administered to 400 individuals with multiple sclerosis and spinal cord injury. A subset of unchanged domain items was also administered to allow for calibration along the same metric as the original PF item bank. Preliminary data analyses suggest that the Chronbach alpha for the new items was 0.986. Several items had low information and required response categories be collapsed for analysis. Comparisons of test information functions for new and original items indicate that the new AT adapted items extend the PROMIS PF domain at the lower end of the scale, as was expected. After additional analysis adapted items will be included in the publically available PF item bank, extending its usability in populations with varying AT needs.
No preview · Article · Apr 2010 · Disability and Health Journal
[Show abstract][Hide abstract] ABSTRACT: To examine the experiences of people with chronic disabling conditions as they communicate with health care providers about pain and fatigue.
Twenty-three adults with a variety of chronic disabling conditions participated in 5 focus groups. The following issues were raised: tell me about your pain/fatigue; what things go along with pain/fatigue? how do you talk about pain/fatigue with your health care provider (HCP)? What should your HCP know that they do not ask you about?
Results of qualitative analysis suggested two major themes. The first theme was labeled "Putting it in words" and suggests that both pain and fatigue are described in many ways, including the dimensions of type, intensity, level of interference and temporal aspects. Participants reported difficulty with responding to a single question that asked them to assign a number to their level of pain or fatigue. The second theme was labeled, "Let's talk about it" and suggested that participants wanted HCPs "to listen and believe me when I describe my experience". They wanted to be asked about how pain or fatigue interferes with life and about compensatory strategies rather than being asked to rate symptom intensity. Participants wished to be viewed as experts and to be actively involved in decisions about their health care.
Pain and fatigue were viewed as having many facets that are associated in complex ways with other aspects of the health/disability condition. From the participants' perspective, assignment of a pain intensity rating does not represent the complexity of their pain experience. Suggestions are provided for HCPs when communicating about pain and fatigue with people with chronic conditions.
Preview · Article · Mar 2010 · Quality of Life Research
[Show abstract][Hide abstract] ABSTRACT: To determine the information needs, level of Internet access, and current and preferred formats and sources of information of adults with spinal cord injuries (SCIs). Individuals with SCIs have a high lifetime risk for medical complications and other health conditions secondary to their injury. Many secondary conditions can be prevented or mitigated through appropriate self-care and/or self-management. People with SCIs need timely, high-quality information about health and medical issues after discharge and throughout their lifetime to improve self-care and maximize quality of life.
A survey was administered as part of the third time point of a longitudinal research study on individuals with SCI.
A total of 80.2% of the 277 respondents reported having Internet access. The most frequently selected format used currently and preferred by respondents for receiving SCI information was "Web pages/Internet". The top-ranked current and preferred source of SCI information was from a "Physician: SCI Expert/Rehabilitation Specialist". Respondents reported needing information on medical issues the most. Significantly higher percentages of individuals identified as "white" and with higher education levels had access to the Internet and ranked the selection of Web pages/Internet as their top choice.
Results confirm that, although people with SCI prefer to receive SCI information from SCI experts, the Internet is a more accessible and more currently used source. Educational level and race predicted current and preferred use of the Internet for obtaining SCI information, suggesting that Internet distribution of SCI information will exclude subgroups.
Full-text · Article · Nov 2009 · The journal of spinal cord medicine
[Show abstract][Hide abstract] ABSTRACT: Individuals with cognitive impairments would prefer to live independently, however issues in wayfinding prevent many from fully living, working, and participating in their com munity. Our research has focused on designing, prototyp ing, and evaluating a mobile wayfinding system to aid such individuals. Building on the feedback gathered from po tential users, we have implemented the system's automated direction selection functionality. Using a decision-theoretic approach, we believe we can create better wayfinding ex perience that assists users to reach their destination more intuitively than traditional navigation systems. This paper describes the system and results from a study using system generated directions that inform us of key customization fac tors that would provide improved wayfinding assistance for individual users.
[Show abstract][Hide abstract] ABSTRACT: Assistive technology for wayfinding will significantly improve the quality of life for many individuals with cognitive impairments. The user interface of such a system is as crucial as the underlying implementation and localisation technology. We studied the user interface of an indoor navigation system for individuals with cognitive impairments.
We built a system using the Wizard-of-Oz technique that let us experiment with many guidance strategies and interface modalities. Through user studies, we evaluated various configurations of the user interface for accuracy of route completion, time to completion, and user preferences. We used a counter-balanced design that included different modalities (images, audio, and text) and different routes.
We found that although users were able to use all types of modalities to find their way indoors, they varied significantly in their preferred modalities. We also found that timing of directions requires careful attention, as does providing users with confirmation messages at appropriate times.
Our findings suggest that the ability to adapt indoor wayfinding devices for specific users' preferences and needs will be particularly important.
Full-text · Article · Feb 2008 · Disability and rehabilitation. Assistive technology
[Show abstract][Hide abstract] ABSTRACT: To evaluate a modified version of the Roland-Morris Disability Questionnaire for differential item functioning (DIF) related to several covariates.
DIF occurs in an item when, after controlling for the underlying trait measured by the test, the probability of endorsing the item varies across groups.
Secondary data analysis of two studies of participants with back pain (total n = 875). We used a hybrid item response theory/ logistic regression approach for detecting DIF. We obtained scores that accounted for DIF. We evaluated the impact of DIF on individual and group scores, and compared scores that ignored or accounted for DIF in terms of the strength of association with SF-36 subscale scores.
DIF was found in 18/23 items. Salient scale-level differential functioning was found related to age, education, and employment. Overall 24 participants (3%) had salient scale-level differential functioning. Mean scores across demographic groups differed minimally when accounting for DIF. The strength of association of scores with SF-36 scores was similar for scores that ignored and scores that accounted for DIF.
The modified version of the Roland-Morris Disability Questionnaire appears to have largely negligible DIF related to the covariates assessed here.
No preview · Article · Sep 2007 · Quality of Life Research