Process Evaluation of the Optimized Provision of AT for Impaired Upper Extremity Function Within the OMARM Study.

A quality standard for the ICF-oriented provision of arm supports and robotic arms was designed. To facilitate this new working method, tools were developed in co-creation with all stakeholders. Professionals received training and were asked to apply the new working method among their clients who participated in the intervention group of the OMARM project. To find out whether the provision had changed following the introduction of the quality standard, and to gain insight into the usage of tools and the perceived added value, a process evaluation was conducted after 3, 6 and 9 months by an online survey. In sum, the new working method was applied to 43 of 137 clients, and tools were used 105 times. Opinions on perceived changes, benefit, and practicability varied widely. Although tools were developed in co-creation with all stakeholders, several professionals' satisfaction with the developed way of working is lower than expected and its adoption lags.

Assistive technology provision: towards an international framework for assuring availability and accessibility of affordable high-quality assistive technology.

PURPOSE: This is a position paper describing the elements of an international framework for assistive technology provision that could guide the development of policies, systems and service delivery procedures across the world. It describes general requirements, quality criteria and possible approaches that may help to enhance the accessibility of affordable and high quality assistive technology solutions. MATERIALS AND METHODS: The paper is based on the experience of the authors, an analysis of the existing literature and the inputs from many colleagues in the field of assistive technology provision. It includes the results of discussions of an earlier version of the paper during an international conference on the topic in August 2017. RESULTS AND CONCLUSION: The paper ends with the recommendation to develop an international standard for assistive technology provision. Such a standard can have a major impact on the accessibility of AT for people with disabilities. The paper outlines some the key elements to be included in a standard. Implications for Rehabilitation Assistive technology is a key element in rehabilitation, but many people have no access to affordable AT solutions. The recommendations in the paper aim to inform policies, systems and service delivery procedures on how to improve access to AT across the world.

Who said dialogue conversations are easy? The communication between communication vulnerable people and health-care professionals: A qualitative study.

OBJECTIVE: To gain insight into how communication vulnerable people and health-care professionals experience the communication in dialogue conversations, and how they adjust their conversation using augmentative and alternative communication (AAC) or other communication strategies. METHODS: Communication vulnerable clients and health-care professionals in a long-term care institution were observed during a dialogue conversation (n = 11) and subsequently interviewed (n = 22) about their experiences with the conversation. The clients had various communication difficulties due to different underlying aetiologies, such as acquired brain injury or learning disorder. Results from the observations and interviews were analysed using conventional content analysis. RESULTS: Seven key themes emerged regarding the experiences of clients and professionals: clients blame themselves for miscommunications; the relevance of both parties preparing the conversation; a quiet and familiar environment benefitting communication; giving clients enough time; the importance and complexity of nonverbal communication; the need to tailor communication to the client; prejudices and inexperience regarding AAC. The observations showed that some professionals had difficulties using appropriate communication strategies and all professionals relied mostly on verbal or nonverbal communication strategies. CONCLUSION: Professionals were aware of the importance of preparation, sufficient time, a suitable environment and considering nonverbal communication in dialogue conversations. However, they struggled with adequate use of communication strategies, such as verbal communication and AAC. There is a lack of knowledge about AAC, and professionals and clients need to be informed about the potential of AAC and how this can help them achieve equal participation in dialogue conversations in addition to other communication strategies.

Optimising Service Delivery of AAC AT Devices and Compensating AT for Dyslexia.

To promote successful use of Assistive Technology (AT) supporting Augmentative and Alternative Communication (AAC) and compensating for dyslexia, the last steps of their provision, delivery and instruction, use, maintenance and evaluation, were optimised. In co-creation with all stakeholders based on a list of requirements an integral method and tools were developed.

Implementing a routine outcome assessment procedure to evaluate the quality of assistive technology service delivery for children with physical or multiple disabilities: Perceived effectiveness, social cost, and user satisfaction.

There is a lack of evidence on the effects and quality of assistive technology service delivery (ATSD). This study presents a quasi-experimental 3-months follow-up using a pre-test/post-test design aimed at evaluating outcomes of assistive technology (AT) interventions targeting children with physical and multiple disabilities. A secondary aim was to evaluate the feasibility of the follow-up assessment adopted in this study with a view to implement the procedure in routine clinical practice. Forty-five children aged 3-17 years were included. Parents were asked to complete the Individual Prioritised Problem Assessment (IPPA) for AT effectiveness; KWAZO (Kwaliteit van Zorg [Quality of Care]) and Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST) 2.0 for satisfaction with ATSD; Siva Cost Analysis Instrument (SCAI) for estimating the social cost of AT interventions. At follow-up, 25 children used the AT recommended. IPPA effect sizes ranged from 1.4 to 0.7, showing a large effect of AT interventions. Overall, parents were satisfied with ATSD, but Maintenance, Professional Services, and AT Delivery were rated not satisfactory. SCAI showed more resources spent for AT intervention compared to human assistance without technological supports. AT may be an effective intervention for children with disabilities. Issues concerning responsiveness and feasibility of the IPPA and the SCAI instruments are discussed with a view to inform routine clinical practice.

Satisfaction of users with assistive technology service delivery: An exploratory analysis of experiences of parents of children with physical and multiple disabilities.

OBJECTIVE: To describe experience of assistive technology service delivery (ATSD) by parents of children with physical or multiple disabilities (aged 3-18 years). METHOD: Forty-seven of 115 parents participated in a postal survey assessing satisfaction with the ATSD process, employing the QUEST 2.0 and the KWAZO scales. Six of these participated in two focus groups. Descriptive statistics were used for satisfaction scores. The focus group transcripts were coded and combined with survey results by two independent researchers. RESULTS: Low satisfaction scores were reported for follow-up, AT delivery, maintenance services, access to services, coordination, and efficiency of ATSD. Several barriers to and facilitators of ATSD were mentioned and solutions to improve ATSD quality were identified. CONCLUSION: Evaluation of parents' service experience is central for identifying shortcomings in ATSD. Health professionals are advised to utilize validated instruments and strategies to assess effectiveness of technological interventions and to assure ATSD quality.

Development of a team-based method for assuring the quality of assistive technology documentation.

Good practice in assistive technology (AT) service delivery targeting children with disabilities has come increasingly to include providing AT stakeholders with a final text record that documents the rationale and procedures behind the recommendations made during the AT assessment process (AT documentation). In the present case study of one AT service provider, we developed a team-based approach for conducting an evaluation of the quality of the AT documentation. A service-specific scale for the evaluation of AT documentation was developed following a five-step approach. The scale was employed to'review AT documentation utilizing specific review criteria in order to evaluate the quality of AT documentation practices with regard to the service investigated. Two independent reviewers examined the AT documentation for 130 cases of AT service provision. Weighted kappa and Intraclass correlation coefficients (ICC) were employed as a measure of inter-rater agreement. The results of the documentation evaluation allowed AT professionals to objectively assess the quality of the AT documentation produced by the service under investigation, identify shortcomings in the documentation process, and make related corrections. AT services may benefit from the employment of strategic approaches for the evaluation of service provision. Possible applications to other AT service providers are discussed.

The development of an indoor mobility course for the evaluation of electronic mobility aids for persons who are visually impaired.

PURPOSE: To develop a suitable mobility course for the assessment of mobility performance as part of a user evaluation of Electronic Mobility Aids (EMA) aimed at obstacle detection and orientation. METHOD: A review of the literature led to a list of critical factors for the assessment of mobility performance of persons who are visually impaired. Based upon that list, method, test situations, and determining elements were selected and presented to Dutch orientation and mobility experts. Due to expert advice and a pilot study, minor changes were made and the final version was used for the evaluation of two EMA by eight persons who are visually impaired. RESULTS: The results of the literature study are summarized in an overview of critical factors for the assessment of the mobility performance of persons who are visually impaired. Applied to the requirements of the above mentioned user evaluation a replicable indoor mobility course has been described in detail and tested. CONCLUSION: Based upon evidence from literature an indoor mobility course has been developed, which was sensitive to assess differences in mobility incidents and obstacle detection when using an EMA compared to the regular mobility aid. Experts' opinion confirmed its face and content validity.

User evaluation of two electronic mobility aids for persons who are visually impaired: a quasi-experimental study using a standardized mobility course.

This study was conducted to enhance insight into the functionality, usability, and efficacy of two systematically selected Electronic Mobility Aids (EMA) aimed at obstacle detection and orientation. Eight persons who are visually impaired participated in a user evaluation of the UltraCane and the Miniguide. The participants' mobility performance was observed while completing a standardized indoor mobility course with their regular mobility aid, then with each EMA, and assessed in terms of speed, Percentage Preferred Walking Speed (PPWS), type and number of mobility incidents made. Interviews were administered to ascertain users' satisfaction with the functionality, effectiveness and specific features of the assistive devices. Walking speed and PPWS declined when using an EMA compared to the long cane. The mean total number of previously defined mobility incidents decreased significantly and also the type of mobility incidents changed. Generally, participants were quite satisfied with the use of the EMA, and detailed advantageous as well as disadvantageous aspects concerning functionality and certain features of both devices. The UltraCane and the Miniguide have proven to be effective on an indoor mobility course. Individual users' characteristics and preferences appear to be critical for their appraisal of the devices.