A Step in the Right Direction: Evaluating the Effectiveness of Customized Stepping Game Software and Balance Boards for Balance Rehabilitation Therapy and Measurement.

The incidence of falls significantly increases with age in older populations. Traditionally, exercise interventions have been effective in improving balance and strength, thereby reducing the number and risk of falls. To minimize costs, to make exercise more engaging, and to reduce the burden on therapists, the use of serious gaming using virtual reality technologies has become more common. These gaming systems allow the evaluation of compensatory strategies to reduce falls. One of the easiest compensatory strategies to reduce falls is to step forward. To evaluate stepping, the time it takes to step, response times, and reaction times, a stepping game was developed using two Nintendo Wii Balance Boards™.The objective of this study was to investigate the stepping game system for its efficacy as a supplemental balance therapy by evaluating functional outcomes and participant satisfaction. The game was able to identify changes in performance measures (response time, reaction time and step time) for some participants over the span of the exercise program; however, a larger sample size and a stricter protocol is necessary to evaluate the clinical significance.Clinical Relevance- The stepping game appears to be more sensitive to detecting change in balance related measures including step time, reaction time, response time, than the Berg Balance Scale.

Emotion differentiation through features of eye-tracking and pupil diameter for monitoring well-being.

Emotions are an important contributor to human self-expression and well-being. However, many populations express their emotions differently from what is considered "typical". Previous literature has indicated a possible relationship between emotion and eye-movement. The objective of this paper is to further explore this proposed relationship by identifying specific features of eye-movement that relate to six emotion categories: joy, surprise, indifference, disgust, sadness, and fear. Features of eye-movement are extracted from measurements of pupil diameter, saccades, and fixations. These measurements are collected as participants view images from the International Affective Picture System, a validated image deck used to evoke known levels of pleasure, arousal, and dominance. Example features of eye-movement measurements such as pupil diameter include maximum or minimum values, means, and standard deviations. Statistical analyses indicate that the extracted features of eye-tracking in this paper can identify fear and sadness with relative accuracy, while more work is needed to differentiate among joy, indifference, disgust, and surprise. Future work aims to understand differences between typically developing populations such as the individuals included in this analysis, and clinical populations such as individuals with cerebral palsy.Clinical Relevance- This pilot study suggests a link between emotion and features of eye-movement. The information will later be used to develop assistive communication devices that better meet the self-expression needs of individuals with motor and communication challenges.

Voices from the field: exploring service providers' insights into service delivery and AAC use in Canada.

Use of augmentative and alternative communication (AAC) often relies on the involvement of AAC service providers; however little is known about how AAC services are delivered across Canada. This study aimed to explore AAC service provision and factors influencing use of AAC from the perspectives of service providers across Canada who are involved in providing and/or supporting use of AAC systems. The 22 participants from nine (of the 10) provinces participated in online focus groups. Participants were speech-language pathologists, occupational therapists, communicative disorders assistants, and a teacher. Transcripts of the audio recordings were analyzed using reflexive thematic analysis. Four themes were generated that reflect service-related factors contributing to the use of AAC in Canada: Support of Organizational Structures, Concordant Relationships and Goals, Making the Right Decisions, and Influence of Knowledge and Attitudes. These themes highlight how government systems, key stakeholders, assessment practices, and knowledge of AAC influence service provision and use of AAC. Voices from across Canada highlighted shared experiences of services providers as well as revealed variability in service delivery processes. The findings bring to attention a need for further research and development of service provision guidelines to support consistency, quality in practice, and equity in AAC services.

Canadian manufacturer and technician perspectives on the design and use of augmentative and alternative communication technology.

PURPOSE: Device manufacturers and technicians (MaTs) of augmentative and alternative communication (AAC) systems play key roles in the design and successful uptake of communication devices. This study aims to investigate MaT perspectives on AAC device design and effective use. MATERIALS AND METHODS: To investigate their perspectives, a focus group of MaTs within Canada was conducted. Reflexive thematic analysis was used to analyze data. FINDINGS: Three major themes resulted from analysis, which reflect MaT's views: AAC hardware and software flexibility, AAC knowledge and implementation, and social good versus financial resources. CONCLUSIONS: This study provides insights into the complexities faced by MaTs in balancing technical support of system end-users and the financial resources necessary for that support. These insights indicate a need for increased financial resources and the expansion of individuals who qualify for AAC system candidacy. MaTs suggest that an increase in resources and candidacy could lead to more successful AAC implementation and a greater understanding of AAC for all stakeholders.

Augmentative and Alternative Communication (AAC):• AAC technology provides individuals with communication disabilities a form of alternative communication.• The success of AAC systems is dependent on multiple factors including AAC stakeholders, system design, and system implementation.• This study explores AAC manufacturers and technicians perspectives on how to make AAC systems as effective and widely accessible as possible.

Assistive technology use and its associated factors among university students with disabilities: a case study in a developing country-mixed study design.

PURPOSE: Despite the recognized benefits, access to assistive technology (AT) remains limited. Identifying the current usage patterns and unmet needs of AT users could help address the challenges of students with disabilities. Thus, this study aimed to investigate AT use and its associated factors. METHODS: An institution-based cross-sectional mixed study was conducted on higher education students with disabilities in Ethiopia. An interviewer-administered questionnaire and an in-depth interview technique were used to collect data. Descriptive statistics and binary logistic regression models were used to analyse the quantitative data, while inductive thematic analysis was undertaken for the qualitative data. RESULTS: A total of 233 (74.68%) with (95% CI: 70%-80%) students with disabilities used at least one form of AT. Four themes emerged which include experiences of AT use and disability, benefits and challenges of using AT, perception of the community towards AT, and responsibility for the provision of AT. Students with vision problems or those with severe disability types were most likely to be AT users. CONCLUSION AND RECOMMENDATIONS: A significant proportion of students with disabilities had unmet needs for AT. Capacity at universities or rehabilitation centres would enhance access, usage of AT, and the unmet needs of students with disabilities.

Will help to solve the barriers to accessing assistive technology and associated factors in the access and provision of assistive technology.Will help policymakers and stakeholders to design evidence-based rehabilitation strategies in the provision of assistive technology to persons with disabilities.Provide insight into the role of assistive technology in an educational platform to engage people with disabilities in education, improve their quality of life and lead them to become part of a productive society.

Home-based upper limb stroke rehabilitation mechatronics: challenges and opportunities.

Interest in home-based stroke rehabilitation mechatronics, which includes both robots and sensor mechanisms, has increased over the past 12 years. The COVID-19 pandemic has exacerbated the existing lack of access to rehabilitation for stroke survivors post-discharge. Home-based stroke rehabilitation devices could improve access to rehabilitation for stroke survivors, but the home environment presents unique challenges compared to clinics. The present study undertakes a scoping review of designs for at-home upper limb stroke rehabilitation mechatronic devices to identify important design principles and areas for improvement. Online databases were used to identify papers published 2010-2021 describing novel rehabilitation device designs, from which 59 publications were selected describing 38 unique designs. The devices were categorized and listed according to their target anatomy, possible therapy tasks, structure, and features. Twenty-two devices targeted proximal (shoulder and elbow) anatomy, 13 targeted distal (wrist and hand) anatomy, and three targeted the whole arm and hand. Devices with a greater number of actuators in the design were more expensive, with a small number of devices using a mix of actuated and unactuated degrees of freedom to target more complex anatomy while reducing the cost. Twenty-six of the device designs did not specify their target users' function or impairment, nor did they specify a target therapy activity, task, or exercise. Twenty-three of the devices were capable of reaching tasks, 6 of which included grasping capabilities. Compliant structures were the most common approach of including safety features in the design. Only three devices were designed to detect compensation, or undesirable posture, during therapy activities. Six of the 38 device designs mention consulting stakeholders during the design process, only two of which consulted patients specifically. Without stakeholder involvement, these designs risk being disconnected from user needs and rehabilitation best practices. Devices that combine actuated and unactuated degrees of freedom allow a greater variety and complexity of tasks while not significantly increasing their cost. Future home-based upper limb stroke rehabilitation mechatronic designs should provide information on patient posture during task execution, design with specific patient capabilities and needs in mind, and clearly link the features of the design to users' needs.

Models and frameworks for guiding assessment for aided Augmentative and Alternative communication (AAC): a scoping review.

BACKGROUND: Augmentative and Alternative Communication (AAC) supports individuals with complex communication needs. Conceptual models and frameworks exist to evaluate, implement, and assess the needs of persons with communication disabilities, however, it is unknown which models were grounded in previous evidence-based research. OBJECTIVE: What are the models and frameworks grounded in empirical or conceptual research that enable communication outcomes for persons who require aided AAC systems? ELIGIBILITY CRITERIA: The study had to be the original publication of a defined model or framework that included aided AAC and the model had to be developed through research, either conceptual or empirical. SOURCES OF EVIDENCE: Eleven databases were searched using terms associated with AAC devices, conceptual models, and assessment processes. Fifteen articles presenting 14 independent assessment models were included. CHARTING METHODS: A custom data extraction form included model development using existing models and research evidence, the model's input parameters, and explicit outcome measures. RESULTS: Four models were specific to AAC while ten models were general evaluations for assistive technology systems. Models used a variety of descriptive traits during assessment including: person, technology, environment and context, and the activity or task. Only nine models sought to iteratively assess the client. Eleven of the models identified the inclusion of members from different disciplines in the assessment process. CONCLUSIONS: There is a need to standardize descriptive traits: personal abilities, environmental characteristics, potential assistive technology, and contextual factors. Models should include teams of different disciplines to provide holistic assessments. Models should include outcomes and include iterative solutions.Implications for RehabilitationStandardizing the definitions of descriptive traits used in the assessment of the personal abilities, environmental characteristics, potential assistive technology, and contextual factors would enable better evaluation of outcomes across disciplines and abilities.By identifying what factors are instrumental in the successful recommendation of assistive technology, professionals may achieve a well-organized and efficient assessment tool.An assessment model tailored specifically to individuals who may benefit from Augmentative and Alternative Communication (AAC) should be considered that are rooted in existing theories, research evidence, and the experiences of those in the AAC community.An AAC specific model would allow for consistent outcome tracking across individuals or assessment teams and the comparison of the effectiveness of various models for research purposes.

Development of BrailleBunny: a device to enhance braille learning.

PURPOSE: Braille use has been linked to higher rates of employment, education, financial self-sufficiency, and self-esteem. One area of the world particularly impacted by braille illiteracy is the Philippines. In 2016, Digital Learning for Development and All Children Reading released a "Grand Challenge for Development" that challenged researchers to address the need for assistive technologies to help children with sensory disabilities learn to read in the Philippines. The purpose of this research was to identify technical specifications, and then co-design and test a device that could be used both in developed and developing countries, specifically Canada and the Philippines. METHODS: An iterative, co-design process was undertaken to develop a prototypical device, BrailleBunny. The extent to which the device fulfilled the design criteria and directions for future development were determined through a series of case studies with 25 end-users. RESULTS: The prototypical device requires improvement in financial accessibility, durability and reliability. All other criteria were met. CONCLUSIONS: Despite identified areas for improvement, the user feedback was positive, with the majority of users identifying that this device could provide transferrable learning to standard-size braille. With improvements, BrailleBunny, could be a valuable tool to increase the uptake of learning braille in the Philippines.Implications for RehabilitationAn inexpensive device, BrailleBunny was developed to promote transferable braille literacy skills including writing with a slate and stylus for children learning to read.The BrailleBunny provides real-time auditory and tactile feedback, and functions in either English or Tagalog (the languages which are taught in the Filipino curriculum).Feedback from 25 children and adults indicated the potential for use within schools in both Canada and the Philippines.

Barriers and facilitators to accommodations in the workplace for adults who use augmentative and alternative communication (AAC): a systematic review.

Workplace accommodations can reduce barriers to employment for people who use augmentative and alternative communication (AAC), however, the lack of accommodations continues to challenge participation in employment. This systematic review identified and analyzed barriers and facilitators to implementing workplace accommodations for adults (19 years and over) who use AAC. A systematic search of nine databases was conducted to identify relevant studies using the search terms "AAC" and "workplace accommodations" and variations of each term. Results were imported into Covidence. Seventeen studies met the inclusion criteria. Results were presented using the International Classification of Functioning, Disability, and Health (ICF) framework. The Oxford levels of evidence and Confidence in Evidence from Review of Qualitative Research (GRADE-CERQual) were used to assess the quality of the studies and confidence in findings, respectively. Environmental barriers related mainly to attitudes and technology, and personal barriers related to job qualifications, education, and work-related skills. A combination of facilitators such as personal strengths, access to technology, and supportive relationships contributed to successful implementation of accommodations. The findings of this review suggest that implementing workplace accommodations for adults who use AAC strategies is complex and further research is needed to advance practices and policies that support the implementation of workplace accommodations.

On the road again! Tricycle adaptation with the design of a universal rig.

Cerebral palsy is the most common childhood disability impacting motor function. The International Classification of Functioning, Disability and Health defines outcomes that should be achieveable within the Activities and Participation domain. However, many children with cerebral palsy have significant difficulties in achieving activity goals within a typical recreational environment. Despite the well documented benefits of cycling for persons with cerebral palsy for example, it is often difficult to access commercially available adaptive tricycles due to prohibitive costs and varying needs. Even commercially available adaptive tricycles sometimes need to be customized. This paper outlines the design and implementation of a custom tricycle adaptation for a teenager with cerebral palsy, who was previously unable to complete a pedal rotation on any of the many adaptive tricycles she tried. The first phase of the project was the design and implementation of a "test rig" system that allowed different tricycle adaptations to be tested with the client, and could be used with any client. The second stage included two iterations of the design and implementation of adaptations to the tricycle. The final modifications enabled the client to ride independently. Challenges, successes, and recommendations for helping similar clients gain access to cycling are highlighted.

Understanding the Development of a Design Thinking Mindset During a Biomedical Engineering Third-Year Course.

As students gain more experience with design concepts, they should progress from novice to expert design thinkers. The purpose of this research was to identify the constructs of growth in design thinking (DT) over short- (one weekend) and long-term (10 weeks) design challenges. A DT mindset questionnaire was completed by students in a third-year undergraduate biomedical design course at the beginning of the course, after a one-weekend design challenge, and on completion of the course. After the short design challenge, an improvement in 15 of the 19 constructs was observed relative to baseline. Six of these constructs: mindfulness and awareness of the process, embracing risk, abductive thinking, envisioning new things, creative confidence, and optimism to make an impact, were sustained over the course of the semester indicating that a prolonged period of experiential learning can maintain short-term gains in DT. Three of the constructs: holistic views (considering the problem as a whole), diversity, and curiosity showed improvement following the short-term design challenge, then deterioration suggesting that situational circumstances are significant contributors to these constructs of DT. DT generally improves with the opportunity to collaborate, communicate, and design for a specific outcome. However, situational factors including team diversity, instructor expertise, dedicated time for team collaboration, and prior experiences can affect changes in the DT skillset.

The Use of Conductive Lycra Fabric in the Prototype Design of a Wearable Device to Monitor Physiological Signals.

Wearable technology has become commonplace for the measurement of heart rate, steps taken, and monitoring exercise regimes. However, wearables can also be used to enable or enhance the lives of persons living with disabilities. This paper discusses the design of a wearable device that aims to facilitate the assessment of physiological signals using conductive Lycra fabric. The device will be applicable for daily use within diverse contexts including the evaluation of emotional experiences of children with Severe Motor and Communication Impairment and the detection of Obstructive Sleep Apnea in children with Down Syndrome. The Lycra fabric sensors are used to acquire electrocardiographic signals, galvanic skin response, and respiratory signals. Articulated design requirements include constraints related to the ability to fit children of all sizes, and meeting medical device standards and biocompatibility, and criteria related to low costs, comfortability, and maintainability. Upon prototyping and preliminary testing, this device was found to offer an affordable, comfortable, and accessible solution to the monitoring of physiological signals. Clinical Relevance- This research provides initial knowledge and momentum towards an affordable wearable device using conductive Lycra to effectively monitor and assess physiological signals in children with disabilities.

Effectiveness of technology for braille literacy education for children: a systematic review.

PURPOSE: Despite the well-documented importance of braille for people who are blind or visually impaired, few studies explore technology for facilitating braille literacy education. Evaluations of the impact of using assistive devices on academics for children and youth who are blind or visually impaired are needed. This systematic review aimed to evaluate the effectiveness of technology used to support braille literacy education for children and youth. MATERIALS AND METHODS: The population of interest was defined as children and youth aged 0-21 years who were blind or visually impaired, learning literacy through braille as their primary medium, and had not previously learned to read through sighted methods. Sixteen academic education, health sciences, multidisciplinary, rehabilitation, and engineering databases were searched. RESULTS: Twelve peer-reviewed, English-language articles were included in the review evaluating a total of 176 participants. In general, the quality of research was low with little evidence to support the use of current technology for braille literacy education. CONCLUSIONS: Standards of technology evaluation for braille literacy must be developed. Furthermore, assistive technologies for braille literacy education for children and youth should provide real-time auditory and tactile feedback, enable independent study/practice and editing of work, and be easy to use, motivational, and engaging. IMPLICATIONS FOR REHABILITATIONStandards must be developed to ensure technology evaluation is consistent among researchers and clinicians to achieve the best outcomes.Technologies for braille literacy education for children and youth should provide real-time auditory and tactile feedback, enable independent study/practice and editing of work, and be easy to use, motivational, and engaging.

Differentiating Motor Coordination in Children with Cerebral Palsy and Typically Developing Populations Through Exploratory Factor Analysis of Robotic Assessments.

General motor and executive functions are integral for tasks of daily living and are typically assessed when quantifying impairment of an individual. Robotic tasks offer highly repeatable and objective measures of motor and cognitive function. Additionally, robotic tasks and measures have been used successfully to quantify impairment of children with cerebral palsy (CP). Many robotic tasks include multiple performance parameters, so interpretation of results and identification of impairment can be difficult, especially when multiple tasks are completed. This study used exploratory factor analysis to investigate a potential set of quantitative models of motor and cognitive function in children, and compare performance of participants with CP to these models. The three calculated factors achieved strong differentiation between participants with mild CP and the typically developing population. This demonstrates the feasibility of these factors to quantify impairment and track improvements related to therapies.Clinical Relevance- This establishes a method to differentiate atypical motor performance related to CP using a robotic reversed visually guided reaching task.

EEG Electrode Selection for a Two-Class Motor Imagery Task in a BCI Using fNIRS Prior Data.

This study investigated the possibility of using functional near infrared spectroscopy (fNIRS) during right- and left-hand motor imagery tasks to select an optimum set of electroencephalography (EEG) electrodes for a brain computer interface. fNIRS has better spatial resolution allowing areas of brain activity to more readily be identified. The ReliefF algorithm was used to identify the most reliable fNIRS channels. Then, EEG electrodes adjacent to those channels were selected for classification. This study used three different classifiers of linear and quadratic discriminant analyses, and support vector machine to examine the proposed method.Clinical Relevance- Reducing the number of sensors in a BCI makes the system more usable for patients with severe disabilities.

Matuto, Magbasa, Maglaro: Learning to read braille through play.

In September 2016, Digital Learning for Development and All Children Reading released a "Grand Challenge for Development" urging researchers to explore the barriers that children with sensory disabilities in the Philippines face with respect to learning how to read. We sought to address one component of this challenge; engagement of persons with visual impairment in learning how to read in braille. The primary goal of this study was to engage in the co-design process to create a device to help young children with visual impairments learn to identify letters and short words in braille as a first step to reading.Participant questionnaires identified barriers of current reading devices including: accessibility, portability, durability, usability, and function. A design was prototyped based on results from a weighted evaluation matrix and feedback from partners who taught reading to persons with visual impairments. Usability testing showed that the device was easy to use and interactive. Suggestions for improvement included adding various learning modes and reducing the size, weight, and cost of the device.Results from this study highlight advantages of engaging in the co-design process and provide important data for other researchers developing devices for persons with visual impairments.

Differentiating Motor Coordination and Position Sense in Children with Cerebral Palsy and Typically Developing Populations Through Robotic Assessments.

Motor function and coordination improve as children age. Robotic assessments of motor function and coordination have been shown to be repeatable, objective, and accurate. Additionally, robotic assessments have been used to measure and quantify deficits in motor function and coordination in children with cerebral palsy (CP). Normative models of motor function and coordination based on age have not been used widely to differentiate impaired performance from typical performance. This study presents preliminary results of identifying deficits in motor function and coordination assessed with a robotic reaching task and using a normative model of typical performance that accounts for age, sex, and handedness. The models were compared with data from three participants with CP to evaluate whether the models could be used to identify deficits in motor function. The models indicated motor deficits in one participant when performing a visually guided reaching task with respect to initial speed and distance ratios. There was no evidence of motor control deficits in the other two participants. Future work will refine the models to be able to better identify and quantify motor control impairments with the potential to target therapy around quantifiable goals.

Discrimination of Two-Class Motor Imagery in a fNIRS Based Brain Computer Interface.

The purpose of this study was to discriminate between left- and right-hand motor imagery tasks. We recorded the brain signals from two participants using a fNIRS system and compared different feature extraction (mean, peak, minimum, skewness and kurtosis) and classification techniques (linear (LDA) and quadratic discriminant analysis (QDA), support vector machine (SVM), logistic regression, K-nearest-neighbor (KNN), and neural networks with Levenberg-Marquardt (LMA), Bayesian Regularization (BRANN) and Scaled Conjugate Gradient (SCGA) training algorithms). The results showed poor classification accuracies (<; 58%) when skewness and kurtosis were used. When mean, peak, and minimum were used as features, QDA, SVM and KNN produced higher classification accuracies relative to LDA and logistic regression. Overall, BRANN led to the highest accuracies (>98%) when mean, peak and minimum were used as features.

A systematic review investigating outcome measures and uptake barriers when children and youth with complex disabilities use eye gaze assistive technology.

Children with complex disabilities sometimes have difficulty communicating with their parents, caregivers, and teachers. For these children, eye gaze assistive technology can be used to facilitate communication. Eye gaze assistive technology outcomes for children and youth were analyzed in this systematic review. Database and hand-searches yielded 4412 unduplicated results, of which 11 articles were eligible for this review. Outcome measures, as well as environmental and personal factors, were mapped to the World Health Organization's International Classification of Functioning, Disability and Health framework. Communication outcomes were most prevalent and co-occurred with outcomes in all reported activities and participation domains. Environmental and personal factors were classified as either facilitators or as barriers in relation to device uptake and success. Although comprehensive professional and caregiver support was the primary facilitator for success, barriers could lead to rejection of the technology even when children were successful using the system.

Systematic review: Investigating the effectiveness of assistive technology to enable internet access for individuals with deafblindness.

The purpose of this study is to systematically review published evidence regarding the development, use, and effectiveness of assistive devices and technol ogies that enable internet access for individuals who are deafblind. Eight electronic research databases (CINAHL, Embase, Engineering Village MEDLINE, PsycINFO, PubMed, Cochrane Library, and Web of Science) and three clinical trials registries (ISRCTN Registry, WHO ICTRP, and ClinicalTrials.gov) were searched.Seven articles met the inclusion criteria for this systematic review. The assistive technologies described were in the preliminary stages of development, with only three of the technologies having undergone any testing. The effectiveness of all seven assistive technologies was quantified in this review based on the proposed impacts of internet access on the domains of the World Health Organization's International Classification of Functioning, Disability and Health framework.Internet access technologies for individuals with deafblindness are in the early stages of development and are targeted toward specific functions of the internet. It is imperative that future device development and evaluation seek input from persons who are deafblind. There is also a need to address the gap between academic research, which seeks to develop assistive technology to access the internet and the translation into real-world use of this technology.