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.

Measuring subjective quality of life following spinal cord injury: a validation study of the assistive technology device predisposition assessment.

PURPOSE: Assesses the validity of a subset of items of the Assistive Technology Device Predisposition Assessment (ATD PA) as a measure of quality of life (QOL) for persons with new spinal cord injury. METHOD: Subjects completed the ATD PA QOL subset, Satisfaction with Life Scale (SWLS), and Brief Symptom Inventory (BSI) while in acute rehabilitation. The internal reliability of the QOL subset of the ATD PA was assessed. Concurrent validity of the ATD PA's QOL subset with the SWLS and construct validity with the BSI depression subscale was assessed using Spearman correlations. Subjects were recruited while acute rehabilitation inpatients in a general hospital and consisted of twenty persons with newly acquired SCI (10 males and 10 females). RESULTS: Significant positive correlations between the ATD PA's QOL subset and SWLS (and significant negative correlations with the BSI depression subscale) suggest the QOL subset has concurrent and construct validity. CONCLUSIONS: The ATD PA's QOL subset appears to be a valid measure and, thus, it can be useful both in identifying subjective quality of life and predispositions to AT use early in rehabilitation.

Predicting satisfaction with assistive technology for a sample of adults with new spinal cord injuries.

To assess the validity of the Assistive Technology Device Predisposition Assessment-Consumer Form for persons with a new spinal cord injury, 10 men and 10 women completed the scale and the Satisfaction with Life Scale and the Brief Symptom Inventory while in acute rehabilitation. One month postdischarge, subjects completed the Perceived Needs Inventory and rated their satisfaction with assistive technology. Significant positive correlations between items of the Assistive Technology Device Predisposition Assessment and Satisfaction with Life Scale (and their significant negative correlations with scores on the Brief Symptom Inventory-Depression) suggest the selected Assistive Technology Device Predisposition Assessment items measure quality of life (concurrent validity). Only Assistive Technology Device Predisposition Assessment scores predicted satisfied use 1-mo. postdischarge as measured by the Perceived Needs Inventory.

Virtual reality: consumer perspectives.

This commentary extends the discussion of the applications of virtual reality to persons with disabilities by focusing on: (a) the use of virtual reality for stimulating residential features for persons being deinstitutionalized into four-person community residences; and (b) the involvement of consumers in key decisions regarding their residence and personal assistive technologies.

Characteristics associated with marginal hearing loss and subjective well-being among a sample of older adults.

The influence of marginal hearing loss on subjective well-being was studied in order to assess the audiological rehabilitation needs of older individuals. Behavioral and audiological data were obtained from 40 subjects 61-81 years of age. Group A included 20 subjects with normal audiometric thresholds. Group B included 20 subjects with mild-to-moderate degrees of high-frequency hearing loss. Each subject completed a hearing loss screening survey, an Assistive Technology Device Predisposition Assessment (ATD PA) and a Profile of Hearing Aid Performance (PHAP). The PHAP and hearing loss screen were adequate assessments of self-reported hearing loss, as was the subjective rating of hearing section of the ATD PA. People with high-frequency marginal hearing loss reported on the ATD PA less satisfaction with their independence, reduced emotional well-being, and more limitation from their hearing loss than those with normal hearing. It is concluded that marginal degrees of hearing loss in older persons can influence subjective well-being, which suggests the importance of a renewed emphasis on audiological rehabilitation for this population.

The voice of the customer: consumers define the ideal battery charger.

The Rehabilitation Engineering Research Center on Technology Evaluation and Transfer is exploring how the users of assistive technology devices define the ideal device. This work is called the Consumer Ideal Product program. The results show what device characteristics are most and least important, indicating where to place the priority on product features and functions from the consumer's perspective. The "voice of the customer" can be used (1) to define the ideal characteristics of a product, (2) to make trade-offs in product design and function improvements based on their relative importance to the consumer, (3) to compare the characteristics of existing products against the characteristics of the ideal product, or (4) to generate a product checklist for consumers to use when making a purchase decision. This paper presents the results of consumers' defining the ideal battery charger. Four focus groups generated the survey's content, then 100 experienced users rated 159 characteristics organized under 11 general evaluation criteria. The consumers placed the highest importance on characteristics from the general evaluation criteria of product reliability, effectiveness, and physical security/safety. The findings should help manufacturers and vendors improve their products and services and help professionals and consumers make informed choices.

Assessing consumer profiles of 'ideal' assistive technologies in ten categories: an integration of quantitative and qualitative methods.

This paper focuses on two trends in the field of disability and rehabilitation: (a) the desire to conserve resources and yet provide consumers with the highest quality assistive technologies that they find personally appealing and useful; and (b) the involvement of the consumers of rehabilitation services in key decisions regarding the products and services they receive. The Rehabilitation Engineering Research Center on Technology Evaluation and Transfer (Buffalo, NY, USA) has endeavoured to accomplish both by employing a mixed methods approach to consumer-identified needs and preferences regarding several categories of assistive technology. The purpose of this paper is to describe the methods used in sufficient detail for replication by other researchers.

Outcomes of assistive technology use on quality of life.

The results from many research efforts on the use of assistive devices are reviewed and summarized. Further, conceptual and methodological issues related to the use and abandonment of assistive technologies are discussed. Overall, this review should be helpful to professionals making device recommendations, documenting the need for a device, and assessing short- and long-term device utilization. The available literature lends support to a model of matching person and technology that considers environments of device use, characteristics of the user's preferences and expectations, and device features and functions. To ensure that assistive technologies enhance users' quality of life, future emphases should focus on consumer involvement in the selection and evaluation of appropriate assistive technology, and ways to make technologies more widely available and affordable.

Measuring the relationship of assistive technology use, functional status over time, and consumer-therapist perceptions of ATs.

Two consecutive studies addressed device use post-discharge in relation to functional status among 47 persons with mixed diagnoses discharged from an acute inpatient rehabilitation unit. Telephone interviews were used to ascertain device use; functional status was obtained using the telephone version of the Functional Independence Measure (FIM). Among all participants, 128 devices were prescribed; of these, 86 devices were still used at 3-month follow-up. The four types of devices most frequently abandoned were adapted grooming aids (55% nonuse), quad canes (43%), walkers (36%), and manual wheelchairs (36%). The most frequent reason given for nonuse was that the device was no longer needed. In study two, it was found that functional improvement (at follow-up) corresponded with device nonuse for about half the devices. The study also documented discrepancies in perception between therapists and consumers regarding utility and aesthetic aspects of devices. Strategies to maximize appropriate use of devices are presented.