Linking the Psychosocial Impact of Assistive Devices Scale (PIADS) to the International Classification of Functioning, Disability, and Health.

PURPOSE: Assistive technologies are widely implemented in clinical and research settings. Despite their dissemination, the psychosocial impact of their adoption still deserves further consideration. The aim of the present study is to determine the degree of compatibility between the Psychosocial Impact of Assistive Devices Scale (PIADS) and the International Classification of Functioning, Disability, and Health (ICF). METHODS: Six health professionals (two neurologists, one neuro-rehabilitation technician, two psychologists, one university professor of rehabilitation) created a technical board to discuss upon the PIADS-ICF linking. The standardized linking methodology was applied, and a Delphi technique was used to examine consensus. RESULTS: Five Delphi sessions were required to reach 100% of consensus and to finalize the procedure. Of the 26 PIADS' items, 23 were linked to an ICF category: 9 items were endorsed at the 3rd ICF level, and 14 items at the 2nd ICF level. Two items were classified as "not defined" and 1 item as "not covered". CONCLUSION: The study highlighted the conceptual connection between the PIADS and the ICF framework and set a bio-psychosocial standpoint by which accounting the role of assistive devices in rehabilitation settings.

Cross-Cultural Adaptation of a Decision Support System for AT Selection.

Older adults may benefit from decision support systems for the selection of assistive technologies. We present a case study cross-cultural adaptation in Canada of a system developed in the United Kingdom. We describe a conceptual framework for examining challenges with cultural and literacy issues and ways to address them.

Issues for selection of outcome measures in stroke rehabilitation: ICF activity.

PURPOSE: To evaluate the psychometric and administrative properties of outcome measures in the WHO International Classification of Functioning, Disability and Health (ICF) Activity category used in stroke rehabilitation research and reported in the published literature. METHOD: Critical review and synthesis of measurement properties for nine commonly reported instruments in the stroke rehabilitation literature. Each instrument was rated using the eight evaluation criteria proposed by the UK Health Technology Assessment (HTA) programme. The instruments were also assessed for the rigour with which their reliability, validity and responsiveness were reported in the published literature. RESULTS: The reporting of specific measurement qualities for outcome instruments was relatively consistent across measures located within the same general ICF category. There was evidence to suggest that the measures were responsive to change as well as being valid and reliable tools. The best available instruments were associated with the assessment of activities of daily living, balance (static and dynamic), functional independence, and functional mobility. CONCLUSIONS: Given the diversity that exists among available measures, the reader is encouraged to examine carefully the nature and scope of outcome measurement used in reporting the strength of evidence for improved functional activity in stroke rehabilitation. However, there appears to be good consensus regarding the most important indicators of successful rehabilitation outcome, especially in the case of functional mobility.

Issues for selection of outcome measures in stroke rehabilitation: ICF Participation.

PURPOSE: To evaluate the psychometric and administrative properties of outcome measures in the ICF Participation category, which are used in stroke rehabilitation research and reported in the published literature. METHOD: Critical review and synthesis of measurement properties for six commonly reported instruments in the stroke rehabilitation literature. Each instrument was rated using the eight evaluation criteria proposed by the UK Health Technology Assessment (HTA) programme. The instruments were also assessed for the rigour with which their reliability, validity and responsiveness were reported in the published literature. RESULTS: Validity has been well reported for at least half of the measures reviewed. However, methods for reporting specific measurement qualities of outcome instruments were inconsistent. Responsiveness of measures has not been well documented. Of the three ICF categories, Participation seems to be most problematic with respect to: (a) lack of consensus on the range of domains required for measurement in stroke; (b) much greater emphasis on health-related quality of life, relative to subjective quality of life in general; (c) the inclusion of a mixture of measurements from all three ICF categories. CONCLUSIONS: The reader is encouraged to examine carefully the nature and scope of outcome measurement used in reporting the strength of evidence for improved participation associated with stroke rehabilitation. There is no consensus regarding the most important indicators of successful involvement in a life situation and which ones best represent the societal perspective of functioning. In particular, quality of life outcomes lack adequate conceptual frameworks to guide the process of development and validation of measures.

Exploring the comparative responsiveness of a core set of outcome measures in a school-based conductive education programme.

BACKGROUND: Conductive education (CE) is a holistic educational system that uses an active cognitive approach to teach individuals with motor disorders to become more functional participants in daily activities. While CE's popularity continues to grow in North America and Europe, its effectiveness has not been established. The lack of definition of responsive outcome measures for evaluation of CE programmes has limited the interpretability of conclusions from earlier studies evaluating effectiveness. OBJECTIVE: To determine which measures from a core set were most responsive to physical, functional and psychosocial changes associated with a school-based CE programme. METHODS: This was a one-group before and after data collection design using an 8-month follow-up period. We enrolled a referral sample of nine children with cerebral palsy in Kindergarten or Grade 1 (Gross Motor Function Classification System levels 3, 4 or 5). The study took place within a school-based CE programme at a Canadian children's rehabilitation centre. Children participated in a CE full-day class for an entire school year. Physical, functional, psychosocial and participation measures included: Gross Motor Function Measure (GMFM), Quality of Upper Extremity Skills Test (QUEST), Peabody Developmental Motor Scales, Paediatric Evaluation of Disability Inventory (PEDI), Pictorial Scale of Perceived Competence and Social Acceptance for Young Children, Individualized Educational Plan, and Goal Attainment Scaling (GAS). Four children from the study's second year were also evaluated on the Impact on Family Scale (IFS), GAS and School Function Assessment. RESULTS: The Gross Motor Function Measure, QUEST, PEDI (Caregiver Assistance) and IFS were most responsive to change. GAS was useful in documenting and quantifying goals. Problems were encountered in evaluating self-esteem and school participation. CONCLUSIONS: Several strong measures of outcome were identified. Further work is needed to find valid and sensitive psychosocial and school participation measures for these young children.

Issues for selection of outcome measures in stroke rehabilitation: ICF Body Functions.

PURPOSE: To evaluate the psychometric and administrative properties of outcome measures assigned to the ICF Body Functions category, and commonly used in stroke rehabilitation research. METHOD: Critical review and synthesis of measurement properties for five commonly reported instruments in the stroke rehabilitation literature. Each instrument was rated using the eight evaluation criteria proposed by the UK Health Technology Assessment (HTA) programme. The instruments were also assessed for the rigour with which their reliability, validity and responsiveness were reported in the published literature. RESULTS: The reporting of specific measurement qualities for outcome instruments was relatively consistent across measures located within the same general ICF category. Far less information was available on the responsiveness of measures, compared with reliability and validity. The best available instruments were associated with the following body functions: cognitive impairment, depression and motor recovery. CONCLUSIONS: The reader is encouraged to examine carefully the nature and scope of outcome measurement used in reporting the strength of evidence for improved body functions in stroke rehabilitation since there is significant diversity. However there appears to be good consensus about what are the most important indicators of successful rehabilitation outcome in each domain of body function.

A framework for the conceptual modelling of assistive technology device outcomes.

PURPOSE: A key step in planning assistive technology outcomes research is formulation of a conceptual model, specific to a particular type of device, that provides a rationale for the expected outcomes. This paper reflects the conviction that the development of device-specific causal models will be facilitated by having available an overarching framework that is potentially applicable to multifarious types of devices and their outcomes. METHOD: A literature review identified the critical, unmet needs for a conceptual framework. The assumptions underlying the framework were specified preparatory to describing it and discussing its implications. RESULTS: The outcomes of assistive technology devices are depicted as resulting from the interaction among characteristics of a specific device-type, its users, and their environment. Initial junctures include procurement of a type of device and a period of introductory use that, interacting with various moderating co-factors, result in a variety of shorter-term outcomes, possible longer-term use, and its outcomes. CONCLUSIONS: The framework has the potential of facilitating the development of device-specific causal models. It also may contribute to developing a research agenda for assistive technology outcomes research by highlighting measures that need to be developed and by identifying testable hypotheses concerned, for example, with the manner and duration of devices' usage.

Toward a comprehensive evaluation of the impact of electronic aids to daily living: evaluation of consumer satisfaction.

PURPOSE: It is generally accepted that electronic aids to daily living (EADLs) play an important role in the lives of many people with severe disabilities by providing the means to access and control devices for daily living activities. Despite this, little proof exists to support the contention that consumers are satisfied with relevant aspects of these assistive devices. The purpose of this study was to explore consumer satisfaction with EADLs and investigate the value that people with degenerative neuromuscular conditions place on these technologies. METHOD: Interviews were conducted with 40 EADL users and non-users to compare their views about these devices and their daily life experiences. Users were interviewed twice, six months apart, to establish the stability of their views and experiences with EADLs. The Functional Independence Measure (FIM instrument), the personal profile and Quebec User Evaluation of Satisfaction with assistive Technology (QUEST) were administered to determine functional levels of participants, gather personal data pertinent to the study of device utility and explore user satisfaction with EADLs. RESULTS: Results suggest that overall consumers were quite satisfied with their EADLs and that this was relatively stable over time. However, some consumers expressed concerns regarding the cost of these technologies and their associated services. Both users and non-users rated EADLs similarly in relation to relative degree of importance ascribed to them. CONCLUSIONS: Combining the QUEST with outcome measurement tools that explore other important dimensions such as the effect on quality of life and psychosocial impact will help service providers to justify the costs associated with the prescription of sophisticated, costly assistive devices such as EADLs.

Development of a scale to measure the psychosocial impact of assistive devices: lessons learned and the road ahead.

PURPOSE: In this paper the history of the development and validation of the PIADS is reviewed. Assistive devices (ADs) are extremely prevalent forms of health care intervention for persons who have a disability. There is a consensus that the AD field needs a reliable and valid measure of how users perceive the impact of ADs on their quality of life (QoL) and sense of well-being. The Psychosocial Impact of Assistive Devices Scale (PIADS) is a 26 item self-rating scale designed to fill this measurement gap. The challenges that we encountered are described in attempting to adequately conceptualize QOL impact, and operationalize it in a measure suitable for use with virtually all forms of AD. Current efforts to extend the validation of the PIADS are summarized. CONCLUSIONS: The study concludes by suggesting directions for future research and development of the scale. They include a richer examination of its conceptual relationships to other health care and rehabilitation outcome measures, and further investigation of its clinical utility. The PIADS is a reliable and valid tool that appears to have very significant power to predict AD abandonment and retention. It can and should be used both deductively and inductively to build, discover and test theory about the psychosocial impact of assistive technology.

The stability of impact of assistive devices.

PURPOSE: Abandonment of an assistive device (AD) is a frustrating issue yet is very common. An important reason for abandonment is that the device fails to improve the quality of life of the adopter. METHOD: By means of a new questionnaire, the Psychosocial Impact of Assistive Devices Scale (PIADS) the impact on quality of life of any AD can be measured. This study tested the hypothesis that the impact of the adoption of an AD would wane with time, as the user becomes more adapted to the AD. The study attempted to do a one year follow up on all patients at a leading Canadian clinic who had received first-time prescriptions for eyeglasses. RESULTS: The results showed that the positive impact, present on adoption, did not diminish significantly for those who retained the use of the device. CONCLUSION: The PIADS provides clinicians with a reliable and economical method for assessing the role of psychosocial factors in the retention or abandonment of an AD.

The Prosthetic Upper Extremity Functional Index: development and reliability testing of a new functional status questionnaire for children who use upper extremity prostheses.

The Prosthetic Upper Extremity Functional Index (PUFI) was developed by the authors' clinical research group to evaluate the extent to which a child actually uses a prosthetic limb for daily activities, the comparative ease of task performance with and without the prosthesis, and its perceived usefulness. The PUFI's test-retest and interrater reliability were evaluated with 24 children. Intraclass coefficients (ICCs) were calculated for each of four subscales of the PUFI--specifically, method of performance, ease of prosthetic use, usefulness of the prosthesis, and ease of performance without the prosthesis. The ICCs were greater than 0.65, indicating good test-retest reliability for the older-child respondents (n = 10) and fair to good reliability (ICCs, 0.40 to 0.84) for the parent respondents overall (n= 21). Interrater (child-parent) reliability was lower, with ICCs from 0.30 to 0.77. This finding was not unexpected, since a child and parent may rate in the context of different functional environments. The prosthesis was used 53% of the time by older children and more than 75% of the time by younger children. The results provide evidence that the PUFI has good test-retest reliability overall as a measure of a child's ability to perform upper extremity activities with a prosthesis.

Psychosocial impact of electronic aids to daily living.

Electronic aids to daily living (EADLs) allow persons who have a degenerative neuromuscular condition such as Duchenne's muscular dystrophy to operate a wide variety of household and workplace appliances without assistance (independent of family members or other caregivers). There is very little published research to describe how well EADLs are perceived by users to enhance their sense of personal autonomy, functional independence, and psychological well being. Psychosocial impact is a significant determinant of how users perceive the benefit of assistive devices to their quality of life. This study compared the perceived psychosocial impact of EADLs on a group of device users with the anticipated impact of EADLs reported by a group who were eligible for, but had not yet received, these devices. The perceptions of the user group were measured at two points in time, approximately 6 to 9 months apart, to examine the stability of psychosocial impact. The Psychosocial Impact of Assistive Devices Scale was the instrument used to assess perceived impact. EADLs were found to produce similar degrees of positive impact on users and positive perceptions of anticipated impact on those without devices. The psychosocial impact on users was stable over time. The results indicate that the perceived benefits of EADLs to the autonomy, functional independence, and psychological well being of both users and nonusers are positive and strikingly similar. The study is an important first step in attempting to quantify psychosocial outcomes for EADLs in a way that might facilitate economic analysis of these devices in the future.

Adolescents with physical disabilities: some psychosocial aspects of health.

PURPOSE: To examine the psychosocial issues related to growing up with a physical disability. METHODS: Adolescents with physical disabilities aged 11-16 years were compared with a Canadian national sample of adolescents using the Health Behaviours in School-Aged Children (HBSC), a World Health Organization Cross-National Study survey. RESULTS: Adolescents with physical disabilities reported good self-esteem, strong family relationships, and as many close friends as adolescents in the national sample. However, adolescents with physical disabilities participated in fewer social activities and had less intimate relationships with their friends. They had more positive attitudes toward school, teachers, and their fellow classmates than the national sample, but fewer had plans for postsecondary education. The majority of adolescents with physical disabilities reported that they had not received information on parenthood, birth control, and sexually transmitted diseases. CONCLUSIONS: There are a number of critical areas of risk for adolescents with physical disabilities to which health promotion efforts should be directed. These include lower levels of peer integration, heightened adult orientation, low educational aspirations, and poor knowledge of sexuality.

Outcomes measurement of assistive technologies: an institutional case study.

The assistive technology (AT) community has been challenged to effectively measure the outcomes of AT services. There has been much discussion recently in the literature about how to conceptualize and respond to this challenge. In this paper, we suggest that these objectives are best accomplished when AT services are understood within the contexts of the total rehabilitation of AT users and the institutional culture in which services are delivered. We provide examples of outcome priorities we have identified and the tools and approaches we have used. These include projects in the areas of clinical, functional, and psychosocial outcomes assessment of ATs.

Cerebral asymmetries and stimulus intensity relationships in EEG spectra of VEPs in unmedicated schizophrenic patients: relationships with Active and Withdrawn syndromes.

Active and Withdrawn syndromes in schizophrenia have been associated with different patterns of lateral asymmetry: higher left than right hemisphere activity in the Active syndrome and the opposite pattern in the Withdrawn syndrome. Here validation was explored with a power spectral analysis of the visual evoked potential recorded to flashes of five different intensities from primary sensory occipital cortex (O1, O2) and from temporal (T3, T4) cortex. Unmedicated schizophrenic patients were categorised as Active or Withdrawn syndrome by clinical ratings. Pattern of lateral asymmetry of electrodermal orienting responses was recorded and was found to be as predicted: larger on the left than right hand in the Active syndrome with the opposite pattern in the Withdrawn syndrome. Normal controls were also examined. At occipital placements the main results were in beta (18-22 Hz) in which (1), syndromes showed opposite asymmetry patterns consistent with predictions: higher power on the left in the Active syndrome and on the right in the Withdrawn syndrome and (2), there was an absence of normal stimulus intensity/beta power relations in the Withdrawn syndrome. The Active syndrome showed abnormal relations at the temporal location, reflected in high alpha activity (10-14 Hz), together with an abnormal asymmetry in 2-6 Hz activity in the direction of more slow wave activity in the right hemisphere, a lateral asymmetry consistent with the model. When compared with the controls the Withdrawn syndrome was dysfunctional at lower, sensory cortex, levels of processing while the Active syndrome was dysfunctional at higher, temporal cortex, stages of processing. Schizophrenic patients as a group were characterised by abnormal desynchronisation of left temporal activity.

Bilateral auditory-evoked potentials in conditions of hypnosis and focused attention.

Brain event-related potentials (ERPs) evoked by auditory stimulation were used to study cerebral hemispheric activity during hypnosis. ERPs were recorded from bilateral central (C3 and C4) and temporal (T3 and T4) scalp locations in response to tone pips in 6 medium-high and 6 low-susceptible subjects in three conditions: baseline (tones only), hypnosis (tones plus hypnotic induction), and a focused attention control (tones plus a newspaper story read by the hypnotist). Task asymmetries were individually adjusted for baseline asymmetries. Responses from central locations did not differentiate hypnosis from focused attention for either group. The same was true of temporal locations for the low-susceptible group. The predominant temporal lobe pattern for both conditions and groups was larger left than right responses. The exception was the hypnosis condition for the medium-high susceptible group where there was an increase in responses in the right temporal lobe.

Baseline and reactivity measures of blood pressure and negative affect in borderline hypertension.

Measures of blood pressure (BP) and negative affect were taken prior to, immediately following, and ten minutes after a cognitive stressor in groups of normotensive (group N; n = 15) and borderline hypertensive (group B; n = 15) young adults. Two testing sessions, one week apart, involved performance of a simple, congruent color-word ("easy") and a cognitive stress-inducing, incongruent color-word ("difficult") version of the Stroop test. In both sessions, group B showed significantly higher baseline systolic and diastolic BP, higher systolic responses to the difficult Stroop task, and higher recovery measures of systolic and diastolic BP than group N. In general, group B had significantly elevated baseline and reactivity scores on state measures of negative affect in both sessions. Correlations revealed strong positive associations between blood pressure and mood reactivity only for borderline subjects. Depressed mood was more strongly and consistently related to blood pressure reactivity than was hostility. Borderline hypertension appears to be associated with stable, perhaps clinically significant elevations in negative affect, and with dysphoric response to mild cognitive stress.

Psychopathy and P3 amplitude: a commentary on Raine.

Raine (1989) reviewed the literature on event-related potentials (ERPs) in psychopathic adults and antisocial adolescents and concluded that findings support an extended sensation-seeking model of psychopathy. Specifically, he suggested that P3 findings were indicative of unusually enhanced attentional processing in psychopaths. It will be argued in this paper that evidence from recent ERP studies is insufficient to challenge notions of information processing deficit in psychopathy, and that an extended 'cortical immaturity' hypothesis can better account for psychopathic behaviour than the model proposed by Raine.

Spatial attention in hypothetically psychosis-prone college students.

This study tested the hypothesis that psychosis-prone individuals show patterns of visual search that suggest a lateralized cerebral hemispheric abnormality, similar to one hypothesized by Venables (1980) to underlie cognitive dysfunction in schizophrenia. Self-report measures of psychiatric vulnerability were completed by 881 college students. Experimental subjects (n = 73) were those with high scores on one of four psychosis-proneness scales. Control subjects (n = 33) scored within 0.5 SD of the mean on all scales. Subjects were tested using verbal and nonverbal visual search tasks designed to detect abnormalities in the spatial distribution of attention. When searching random arrays of nonverbal stimuli, 53% of the experimental subjects used an erratic search strategy similar to that typically observed in right-brain-damaged patients, compared with 23% of controls. The most deviant search patterns were shown by subjects who scored high on Physical Anhedonia and Perceptual Aberration-Magical Ideation. The results suggest that early development of schizophrenic disorder might be associated with dysfunction of right-hemispheric mechanisms of attentional control.

Schizophrenia and spectral analysis of the visual evoked potential.

Power spectral analysis was performed on the visual evoked potentials (VEPs) recorded in response to flashes of different intensity in both unmedicated schizophrenic and normal subjects. At occipital locations (O1, O2), schizophrenics showed less power than normals in the 10-14 Hz frequency range. In the 18-22 Hz range, schizophrenics showed under-activation in the left hemisphere and over-activation in the right. At temporal locations (T3, T4), schizophrenics showed abnormal (left greater than right) hemisphere patterns of activation in 10-14 Hz and 18-22 Hz ranges. There were no group differences in relationships between power and intensity changes at vertex (Cz). The results suggest abnormal cortical-subcortical interactions during analysis of visual information in schizophrenia.