Caregiver-reported impact of access to switch-adapted toys on play for children with complex medical conditions.

BACKGROUND: Play is essential for children's development of motor, social-emotional and cognitive skills. Traditional play activities are often difficult for children with complex medical conditions to access, which threatens their ability to maximize their developmental potential. Switch-adapted toys are a common strategy for expanding the play repertoire of children with disabilities by lowering the barrier to play with electronic toys. The aim of this study is to investigate the relationship between providing switch-adapted toys to children with disabilities and the children's total and self-initiated play time and access to a variety of cognition-appropriate toys, age-appropriate toys and independently accessible toys as reported by their caregivers. METHODS: Caregivers and their children with complex medical conditions were provided switch-adapted toys at a giveaway event. At the giveaway event and 6 months later, caregivers completed a survey that included questions about each child's current participation in play and their type of play, child's access to toys and questions specific to switches and switch-adapted toys. Data were analysed using Wilcoxon signed-rank tests with a Benjamini-Hochberg procedure to control for multiple comparisons. RESULTS: Nineteen caregivers completed both the pre- and post-surveys. The increases in the variety of toys and the number of independently accessibly and cognitively appropriate toys were statistically significant. The change in number of age-appropriate toys and the amount of total and active play time were not statistically significant. CONCLUSIONS: Providing switch-adapted toys may be an effective way to increase the number of independently accessible and cognitively appropriate toys for children with complex medical conditions. However, increasing the number of such toys may not be sufficient to increase active and total play time. Further research is needed to identify variables impacting play time and distal outcomes associated with switch-adapted toy access.

Feasibility of customized 3D-printed assistive technology within an existing multidisciplinary amyotrophic lateral sclerosis clinic.

PURPOSE: Three-dimensional (3 D) printing of assistive technology (AT) is an emerging intervention in rehabilitation sciences. Existing research primarily considers narrow applications of this technology with most studies focussing on a single type of assistive device. Individuals with amyotrophic lateral scleroses (ALS) have high abandonment rates of prefabricated AT. Therefore, the goal of this project was to determine the implementation and acceptability feasibility of meeting AT needs through the creation of customized, 3D-printed devices within an existing multidisciplinary ALS clinic. METHODS: Implementation feasibility was measured using descriptive statistics about the research team's ability to fulfil device requests. Acceptability was evaluated using semi-structured patient satisfaction interviews after AT device provision. The study utilized thematic analysis to identify patterns in the qualitative data collected from participant interviews. RESULTS: Nine participants identified at least one need for 3D-printed assistive devices customized to their unique performance abilities and needs. Seven participants received 3D-printed devices, four of whom completed the follow-up interview. The research team was able to fulfil 20 of 34 device requests, supporting implementation feasibility. Thematic analysis revealed three themes from the interviews: Satisfaction with Devices and Services, Value of Training as a Service, and Increased Participation and Choice. CONCLUSIONS: These findings demonstrate implementation feasibility and participant satisfaction with the process of receiving devices, supporting acceptability feasibility. Future research into the efficacy of customized 3D-printed AT is recommended.Implications for rehabilitationIndividuals with ALS have unmet needs in assistive technology.Custom AT development using 3D printing can be implemented within an existing, multidisciplinary ALS clinic.Future 3D printing research should rigorously investigate methods to meet the unique needs and challenges of individuals in this setting.

Online Journal Clubs to Enhance Fieldwork Educator Competency in Support of Student Experiential Learning.

IMPORTANCE: Fieldwork educators receive little or no formal training for student supervision and have sought inexpensive, flexible, online options for role-specific continuing education. OBJECTIVE: To investigate the use of online journal clubs to enhance fieldwork educator role competency. DESIGN: Mixed-methods study with a prospective cohort design; 5-wk intervention with 6-mo follow-up. SETTING: Online asynchronous message board system distributed to fieldwork educators affiliated with two occupational therapy programs. PARTICIPANTS: Academic fieldwork coordinators from two universities facilitated online journal clubs for fieldwork educators. Fourteen fieldwork educators participated in the 5-wk journal club, which included reading an article, engaging in online discussion, and creating a personal application plan. RESULTS: Participants demonstrated strong engagement in the online journal club. Postsurvey results revealed strong and positive feedback related to ease of use, relevance of learning, and satisfaction with the experience. At the 6-mo follow-up, 11 of the 14 participants reported implementing a new strategy to support the fieldwork education process, and all reported that the strategy had been helpful. CONCLUSIONS AND RELEVANCE: The use of an online journal club was effective as a method for sharing evidence about the fieldwork educator role and supporting knowledge translation. WHAT THIS ARTICLE ADDS: Online journal clubs can be an effective tool for providing role-specific training in diverse practice settings and parts of the country.

Methodology and feasibility of a 3D printed assistive technology intervention.

Three-dimensional (3D) printing now allows rehabilitation professionals to design and manufacture assistive technologies in a few hours. However, there is limited guidance for researchers and clinicians for implementing 3D printing assistive technology interventions and measuring their outcomes. The goal of this study was to develop a standardized 3D printing assistive technology intervention and a research methodology, using pillboxes as an example. Fourteen pillbox users engaged in a study comparing their use of an off-the-shelf pillbox to a customized 3D printed pillbox. Study outcomes were evaluated on feasibility (recruitment capability, study procedures and outcome measures, acceptability of the study procedures, the research team's ability to manage and implement the study, and the participant's preliminary response to intervention). Participant outcomes were measured on satisfaction with the device and medication adherence. Fourteen participants completed the study and received customized 3D printed pillboxes. The study design performed well on all aspects of feasibility except the research team's ability to manage and implement the study, as they experienced several technical issues. Notably, the participants reported improved device satisfaction and medication adherence with the 3D printed device with large effect sizes. The 3D printed assistive technology intervention is a replicable process that supports professionals in printing their own assistive technologies. Recommendations are made to further enhance feasibility of 3D printing assistive technology studies. Future research is warranted.IMPLICATIONS FOR REHABILITATION3D printing is an increasingly feasible approach allowing for the design and manufacture of customized assistive technologyEvaluation for assistive technology that will be 3D printed should include information about the person's activities, routines, skills, abilities, and preferences. Evaluation of outcomes should include satisfaction with the device and a functional measure.3D printed assistive technology interventions should include the collaboration between the assistive technology professional and client. It should also include device training.Future 3D printing research studies should report pragmatic data including printing device, time to print, and number of errors.

Robotics and gaming to improve ankle strength, motor control, and function in children with cerebral palsy--a case study series.

The objective of this study was to investigate the feasibility of game-based robotic training of the ankle in children with cerebral palsy (CP). The design was a case study, 12 weeks intervention, with no follow-up. The setting was a university research laboratory. The participants were a referred sample of three children with cerebral palsy, age 7-12, all male. All completed the intervention. Participants trained on the Rutgers Ankle CP system for 36 rehabilitation sessions (12 weeks, three times/week), playing two custom virtual reality games. The games were played while participants were seated, and trained one ankle at-a-time for strength, motor control, and coordination. The primary study outcome measures were for impairment (DF/PF torques, DF initial contact angle and gait speed), function (GMFM), and quality of life (Peds QL). Secondary outcome measures relate to game performance (game scores as reflective of ankle motor control and endurance). Gait function improved substantially in ankle kinematics, speed and endurance. Overall function (GMFM) indicated improvements that were typical of other ankle strength training programs. Quality of life increased beyond what would be considered a minimal clinical important difference. Game performance improved in both games during the intervention. This feasibility study supports the assumption that game-based robotic training of the ankle benefits gait in children with CP. Game technology is appropriate for the age group and was well accepted by the participants. Additional studies are needed however, to quantify the level of benefit and compare the approach presented here to traditional methods of therapy.

Identification of three movement phases of the hand during lateral and pulp pinches using video motion capture.

BACKGROUND: Hand injuries affect a person's ability to engage successfully in activities of daily living (ADLs). Video motion capture (VMC) facilitates measurement of dynamic movement. No study to date has used VMC as a means of quantifying the simultaneous movement patterns of all joints of all digits of the hand during active purposeful movement. METHOD: The purpose of this study was to analyze all joints of all five digits during active completion of the lateral and pulp pinches. VMC data were collected from four participants during completion of two pinches. Joint angles were plotted to facilitate identification of movement patterns. RESULTS: Range of motion recorded in all joints with VMC, excluding flexion of the thumb carpometacarpal of both pinches, coincided with the normative goniometric data. Three phases were observed: initiation, preshaping, and pinch phases. Patterns of movement in all digits were identified for the two pinches. CONCLUSION: VMC is a feasible and valid method for objectively quantifying dynamic movement of multiple joints simultaneously. The results provide new insight to the dynamics of hand movement as well as a basis for subsequent evaluations of movement patterns performed in ADLs and instrumental ADLs.

Development of a method for analyzing three-dimensional scapula kinematics.

BACKGROUND: Scapula mobility complicates upper extremity kinematics assessment. Existing methods are diverse, providing inconsistent results. The current gold standard (bone pins) is prohibitively invasive. The purposes of the current study are to describe a virtual projection alternative to surface markers for video motion capture (VMC) of the scapula and to compare the results of the projection and surface marker methods to the results of similar existing methods. METHODS: Ten participants were evaluated using VMC. Surface markers were applied to the trunk and arm in accordance with existing guidelines. Three markers were affixed to plastic base on the skin over the acromion process. Other scapular landmarks were digitized in a neutral position. These landmarks' locations were defined in reference to the acromion cluster and used to generate the projection. Humerothoracic, glenohumeral, and scapulothoracic kinematics were evaluated during shoulder abduction, flexion, and scaption. Joint angles produced by the surface markers and the projection were compared by Bonferroni-adjusted t tests. The results were compared to prior findings in the literature. RESULTS: The projection resulted in greater scapulothoracic upward rotation, internal rotation, and anterior-posterior tilt and less glenohumeral elevation (p < .0055) than did surface markers. The virtual scapula produced greater estimates of scapular mobility than did surface markers, corresponding to pre-existing results from similar methodologies. CONCLUSIONS: The result is a noninvasive measurement tool that produces different and superior results than do scapula surface markers. Measuring scapula kinematics via VMC without bone pins will facilitate future investigations into interactions between upper extremity injury, kinematics, and activity performance.