To tilt or not to tilt; the decision-making process.

PURPOSE: This study's aim was to explore the complexities of how power tilt use is integrated within the context of daily life. Other studies have used mobility-type metrics of frequency, duration, and amplitude as measures of power tilt use in the context of daily life but results lack depth in explaining the complex interplay of participating in daily activities and power tilt use. METHODS: This grounded theory study explored how power tilt was used in daily life from the perspectives of people experienced with using power tilt and therapists experienced with prescribing power tilt. Data collected from 22 in-depth interviews and five 3-day journals were analysed using a constant comparative approach. RESULTS: The resultant substantive theory offers an avenue for examining the complex, iterative relationships of person, environment, technology and occupation that comprise daily life, influencing how power tilt is used at any point during the course of the day. CONCLUSIONS: The knowledge generated from this research contributes to the advancement of understanding of how the decision to use tilt is integrated in daily life occupations. The theory can inform clinical practice related to individualizing power tilt use within the context of the person's own reality of daily life. IMPLICATIONS FOR REHABILITATION The decision to use tilt or not use tilt at any point during the day, is made contingent on the iterative transaction between environmental, functional and personal contexts at that point in time. Feedback from each experience where power tilt was used generates learning and knowledge about the context of power tilt use, informing subsequent occurrences where tilt use may be an option. The substantive theory generated in this study can provide an avenue to explore how and why context influences the decision-making process to foster an in-depth understanding of why tilt is chosen or not chosen to affect problems/issues/situations occurring in day-to-day life.

Reasons for using power tilt: perspectives from clients and therapists.

PURPOSE: A power tilt wheelchair allows independence in changing body position to address a variety of needs throughout the day; however, literature and clinical practice suggest that actual use varies greatly. This grounded theory study examined how power tilt was used in daily life from the perspectives of adults who used power tilt and therapists who prescribed this technology. METHODS: A constant comparative approach was used to collect and analyze interview data from five people who use power tilt and six therapists who prescribe this technology. RESULTS: This paper presents the findings specific to understanding the reasons why power tilt was used, focusing on the relationships between tilt use and (1) the reasons for use, (2) the reasons for prescribing power tilt and (3) the associated amplitudes of tilt. CONCLUSIONS: This study advances knowledge related to how power tilt is used in daily life by elucidating that how the reasons for use are conceptualized is complex. The three relationships related to the reason for power tilt use identified in this paper have the potential to influence the quality of communication about power tilt use in clinical practice between therapist and client and in research between researcher and participant. Implications for Rehabilitation: Understanding the inconsistencies and variations in how power tilt is used in daily life is dependent on exploring the reasons beyond the words or terms expressed to describe use. Reasons for tilt use are context dependent, particularly the activity occurring at the time of tilt use, the associated amplitude of tilt and the influence of other reasons occurring at the same time.

Principles for fostering the transdisciplinary development of assistive technologies.

Developing useful and usable assistive technologies often presents complex (or "wicked") challenges that require input from multiple disciplines and sectors. Transdisciplinary collaboration can enable holistic understanding of challenges that may lead to innovative, impactful and transformative solutions. This paper presents generalised principles that are intended to foster transdisciplinary assistive technology development. The paper introduces the area of assistive technology design before discussing general aspects of transdisciplinary collaboration followed by an overview of relevant concepts, including approaches, methodologies and frameworks for conducting and evaluating transdisciplinary working and assistive technology design. The principles for transdisciplinary development of assistive technologies are presented and applied post hoc to the COACH project, an ambient-assisted living technology for guiding completion of activities of daily living by older adults with dementia as an illustrative example. Future work includes the refinement and validation of these principles through their application to real-world transdisciplinary assistive technology projects. Implications for rehabilitation Transdisciplinarity encourages a focus on real world 'wicked' problems. A transdisciplinary approach involves transcending disciplinary boundaries and collaborating with interprofessional and community partners (including the technology's intended users) on a shared problem. Transdisciplinarity fosters new ways of thinking about and doing research, development, and implementation, expanding the scope, applicability, and commercial viability of assistive technologies.