Writing Good-Quality Assistive Technology Assessment Reports.

The study reported in this paper developed criteria and guidelines for writing up a good-quality AT Assessment Report - a document which is often required to activate an assistive technology intervention for an individual client. The Report should provide precise recommendations about the assistive solutions that best meet the client's needs, explain the underlying reasoning, provide evidence of appropriateness for the funding agency and set the baseline for later measurement of the outcomes of the intervention. Within this study, forty-eight clients with severe disability conditions were recruited in nine rehabilitation Centers in various regions of Italy. They were assessed for assistive solutions by their rehabilitation teams according to a common protocol; assessment Reports were produced for each client according to the same template, and individual AT interventions were activated following the recommendations. Then the Reports underwent a blind peer-review exercise involving over fifty professionals, who evaluated their quality against ten criteria; based on the findings, the template of the AT Assessment Report was revised and good-practice guidelines were inferred for the contents of each field. Now the final version is freely downloadable and is being used routinely in the Centers that participated in the study.

A Robotic Solution for Assisting People with MCI at Home: Preliminary Tests of the ENRICHME System.

Robots have the potential to support care and independence of older adults. The ENRICHME project is developing an integrated system composed of a robot, sensors and a networking care platform, aiming at assisting older adults with MCI in their home environment. This paper reports findings of the tests performed on a sample of MCI users and their caregivers, with the first version of the ENRICHME system, in a controlled environment.

An observational study of powered wheelchair provision in Italy.

Powered wheelchairs are complex and expensive assistive devices that must be selected and configured on the basis of individual user needs, lifestyle, motivation, driving ability, and environment. Providing agencies often require evidence that their financial investment will lead to a successful outcome. The authors surveyed a sample of 79 users who had obtained powered wheelchairs from a Regional Health Service in Italy in the period 2008-2013. Follow-up interviews were conducted at the users' homes in order to collect information about wheelchair use, and its effectiveness, usefulness, and economic impact. The instruments used in the interviews included an introductory questionnaire, QUEST (Quebec User Evaluation of Satisfaction with Assistive Technology), PIADS (Psychosocial Impact of Assistive Devices Scale), FABS/M (Facilitators and Barriers Survey/Mobility), and SCAI (Siva Cost Analysis Instrument). The results indicated positive outcomes, especially in relation to user satisfaction and psychosocial impact. A number of barriers were identified in various settings that sometimes restrict user mobility, and suggest corrective actions. The provision of a powered wheelchair generated considerable savings in social costs for most users: an average of about $38,000 per person over a projected 5-year period was estimated by comparing the cost of the intervention with that of non-intervention.

Cost-effectiveness of powered wheelchairs: findings of a study.

This study surveyed a sample of 79 wheelchair users who had obtained powered wheelchairs from the National Health Service in an Italian Region in the period 2008-2013. The wheelchair prescriptions had been done on the basis of an assessment protocol agreed with the Local Health Authority. Follow-up interviews were carried out at the users' homes, in order to collect information about the wheelchair use and its effectiveness, usefulness and economic impact. The instruments used in the interviews included an introductory questionnaire (describing the wheelchair use), the QUEST (measuring the user's satisfaction), the PIADS (measuring the psychosocial impact, in terms of perceived changes in ability, adaptability and self-esteem), the FABS/M (detecting environmental facilitators and barriers) and the SCAI (estimating the economic impact). Overall, positive outcomes were detected for most users, especially in relation to their satisfaction and the psychosocial impact. A number of barriers were identified in various settings (at home, in public places, in natural spaces, in public transportation) that sometimes restrict the user mobility and thus may claim for corrective actions. Several environmental factors acting as facilitators were also identified. In relation to the economic impact, the provision of a powered wheelchair generated remarkable savings in social costs for most of the users, on average about 36.000 Euros per person on a projected 5-years span. This estimate results from the comparison between the social cost of the intervention (sum of the costs of all material and human resources involved in the provision and usage of the wheelchair) and the cost of non-intervention (the presumed social cost incurred in case no powered wheelchair had been provided and the user had to carry on with just a manual wheelchair). The study was also an opportunity to develop and try out a follow-up method that proved applicable within service delivery practice.

Progress of the European Assistive Technology Information Network.

The European Assistive Technology Information Network (EASTIN), launched in 2005 as the result of a collaborative EU project, provides information on Assistive Technology products and related material through the website www.eastin.eu. In the past few years several advancements have been implemented on the EASTIN website thanks to the contribution of EU funded projects, including a multilingual query processing component for supporting non expert users, a user rating and comment facility, and a detailed taxonomy for the description of ICT based assistive products. Recently, within the framework of the EU funded project Cloud4All, the EASTIN information system has also been federated with the Unified Listing of assistive products, one of the building blocks of the Global Public Inclusive Infrastructure initiative.

Assistive Technology: Bridging End-users and Technology / 中国康复理论与实践

One of the basic aspects that determines the success or failure in the use of assistive technologies on the part of people with disabilities is constituted by the ability that provide a disabled person with the technology that corresponds effectively to his needs and to his capabilities,thus to interpret correctly the problems and to find the right ways of transferring this technological knowledge.If the aids answer the effective needs and capabilities of the person he can achieve significant improvement to reach the goals of his individual rehabilitative project.The article highlights the key factors of success.

Detecting changes following the provision of assistive devices: utility of the WHO-DAS II.

The World Health Organization Disability Assessment Schedule II (WHO-DAS II) is a non-disease-specific International Classification of Functioning, Disability, and Health-based disability assessment instrument developed to measure activity limitations and restrictions to participation. The aim of this pilot study is to evaluate WHO-DAS II responsiveness in detecting short-time changes following the provision of an Assistive Technology,which is important to define its utility in performing daily activities. Adult inpatients with a diagnosis of Disease of the Nervous System (included in Chapter VI of the ICD-10),who were prescribed an Assistive Technology to be used in the household settings, were enrolled. The WHO-DAS II was administered in individual interview at baseline and at a 2 months follow-up: in this period patients were transitioning from the hospital to home. Changes in disability profiles were detected by calculating the effect size (ES) for each WHO-DAS II domain. Ten patients with different neurological diseases were enrolled. Few longitudinal changes in disability level are reported: mild improvement is observed in the household activities (ES0.28), whereas mild worsening is reported in self-care and participation in society domains (ES ­ 0.27 and ­ 0.26,respectively). Our study shows that the WHO-DAS II is responsive in detecting domain-specific changes over a short-term period and provides preliminary encouraging evidence for the utility of its utilization in clinical settings.However, changes in setting between baseline and follow up could have an impact on the findings and interpretation of this study.

Analysing the cost of individual assistive technology programmes.

The state-of-the-art in cost-outcome analysis of assistive technology (AT) is first reviewed, and then the article focuses particularly on the cost aspects of such technology. It elaborates on the concept of 'social cost' as the main indicator of AT economic impact, and proposes methods to compare alternative AT solutions in terms of social cost. A specific instrument for social cost analysis--Siva Cost Assessment Instrument (SCAI)--was designed to help clinicians estimate the economic aspects of providing individual users with AT solutions. The use of the instrument involves: (1) a description of the objectives of the individual AT programme, (2) the establishment of the sequence and timing of all the interventions forming the programme, and (3) the compiling of a cost calculation table for each AT solution. Such a table distinguishes social costs (the sum of all material and human resources mobilised by the intervention) from the financial plan (the actual disbursement of money over time by involved actors). The SCAI tool is not intended as a decision-maker, it is just an informative instrument that, used during clinical assessment, makes clinicians and users aware of the economic consequences of their decisions. The article also explores the possibility of using SCAI to compare different individual AT programmes. Based on a survey of 31 individual AT programmes carried out over a number of years, a first attempt has been made to infer social cost indicators for various categories of AT equipment. The first clear finding is that--not surprisingly--most AT solutions, though very expensive in terms of initial purchase price, lead to considerable savings in social costs due to the reduced assistance burden. In some cases, the savings detected in social costs were in the range 150,000 euros over 5 years. The second major finding is the marked variation in the social costs of different individual cases where similar AT solutions were implemented, suggesting difficulty in establishing repeatable social cost figures for a given device: such figures also depend on the individual context of the implemented AT solution, and on its inter-relationship with the other AT solutions composing the whole programme.

Being informed, demanding and responsible consumers of assistive technology: an educational issue.

PURPOSE: Awareness and knowledge of Assistive Technology (AT) are key factors in supporting empowerment of people with disabilities. They also greatly contribute to the success of AT solutions. Based on the findings of the EUSTAT study--an international project within the Telematics Application Programme of the European Commission--this paper offers a synthesis of the guidelines developed for those who organize educational activities on AT addressed towards end-users. RESULTS: The educational process is looked at within an empowerment perspective rather that as a mere transmission of notions. The effectiveness of education should be evaluated in relation to the increased ability of end users to make use of AT knowledge for improving their quality of life, and becoming informed, demanding and responsible consumers of AT products and services. CONCLUSION: To such end a number of critical factors are identified, and ways to address them are discussed. Finally, a case study is reported as an example of an effective AT educational curriculum for end-users.