Building an ontology for assistive technology using the Delphi method.

The aim of this study was to use the Delphi method to develop and validate an ontology for one class of assistive technology (AT), namely physically controllable pointing devices. A three-round, structured process consisting of responses to a series of questionnaires was used to identify items and categories of importance to pointing device prescription from six occupational therapists with AT expertise. The intraclass correlation coefficient (ICC) was used to assess the interrater reliability of items included in categories related to the pointing devices and to the user profile by the six experts during each Delphi round. During the first round, the ICC ranged from 0.19 to 0.97; this improved to ICCs ranging from 0.72 to 1.0 during the second round. A full consensus was reached by the experts during the final round which included 218 items, divided into five categories, for the pointing device list, and 168 items, divided into six categories, for the user profile list. This ontology is expected to help achieve a more systematic regulation of the AT field, leading to greater standardization and increased knowledge sharing, which may help novice clinicians to achieve a level of competence in matching AT to a person with special needs.

Assessment of computer task performance (ACTP) of children and youth with intellectual and developmental disability.

The aims of this study were to assess the reliability and validity of the Arabic translation of the Assessment of Computer Task Performance (ACTP) when used for children with Intellectual and Developmental Disabilities (IDD) and to determine the relationship between participants' performance when using an adapted pointing device and the teacher's satisfaction of their performance. Thirty boys and girls, Arabic speakers, 6- 21 years old, who had moderate IDD, participated in the study. Two expert occupational therapists used the ACTP to evaluate the performance of five standardized timed computer tasks. The Quebec User Evaluation of Satisfaction with Assistive Technology was used to evaluate the teachers' satisfaction with the prescribed pointing device. The sample in the current study performed slower than typically developing children and youth, and slower than participants with motor impairments, examined in previous studies. Differences were found in performance time between girls and boys, and between three diagnostic subgroups. The participants' success scores of computer performance correlated significantly with the teacher's satisfaction with the prescribed pointing device. Demonstration of the validity and reliability of the Arabic version of the ACTP-Child enables wider use of this tool which is now available in four languages and diverse cultural settings and disability populations, including children and youth with significant IDD.

Prolonged exposure and virtual reality-enhanced imaginal exposure for PTSD following a terrorist bulldozer attack: a case study.

In this case study, virtual reality was used to augment imaginal exposure in a protocol based on prolonged exposure. A 29-year-old male patient developed posttraumatic stress disorder after surviving a deadly terrorist bulldozer attack on two civilian buses and several cars in Jerusalem; the traumas witnessed by the survivor included a decapitation. The crowded bus in which the patient was riding was pushed over onto its side by the terrorist, injuring, trapping, and terrifying the passengers and causing gasoline to leak. Guided by his therapist, the patient entered an immersive computer-generated virtual world to go "back" to the scene of the traumatic event to help him gain access to his memories of the event, process and reduce the intensity of the emotions (fear/anger) associated with his pathological memories, and change unhealthy thought patterns. Traumatic memories of childhood abuse and traumatic memories of the bulldozer terrorist attack were treated using imaginal exposure while the patient was in the virtual environment BusWorld. The patient showed large posttreatment reductions in PTSD symptoms, and his Clinician-Administered PTSD Scale (CAPS) scores dropped from 79 pretreatment to zero immediately posttreatment, and CAPS was still at zero 6 months later. Although case studies are inconclusive by nature, these encouraging preliminary results suggest that further exploration of the use of virtual reality during modified prolonged exposure for PTSD is warranted. As terrorist attacks increase in frequency and severity worldwide, research is needed on how to minimize the psychological consequences of terrorism.

Evaluating functional decline in patients with Multiple Sclerosis.

Multiple Sclerosis (MS) is a disease with a wide-ranging impact on functional status. The aim of the study was to examine the added value of simultaneously evaluating fatigue, personal ADL and handwriting performance as indicators for functional decline among patients with MS. Participants were 50 outpatients with MS and 26 matched healthy controls. Data collection instruments included a disability status scale, the Fatigue Severity Scale (FSS), and the Physical Self-Maintenance Scale (PSMS). Handwriting performance was evaluated by objective computerized measures of the handwriting process (ComPET). Significant differences were found between patients with MS and control subjects in their fatigue level, their PSMS score and In-air time per stroke while writing. The FSS together with specific PSMS items and handwriting measures achieved correct classification of 87.7% of the participants. These results are the first step towards demonstrating the added value of evaluating body function outcomes (fatigue) together with activity performance (handwriting and ADL) to document functional decline among patients with MS. These results may contribute to the development of practical intervention strategies targeted at improving performance abilities among patients with MS.

The influence of seat adjustment and a thoraco-lumbar-sacral orthosis on the distribution of body-seat pressure in children with scoliosis and pelvic obliquity.

PURPOSE: To determine the effect of a thoraco-lumbar-sacral orthosis (TLSO) on the distribution of body-seat interface pressure in children with concomitant scoliosis and pelvic obliquity and to determine the effects of two methods commonly used in customized seating--elevation (push up) of the lower side of the pelvis or a wedge insertion beneath the raised pelvis--on the distribution of body-seat interface pressure. METHODS: The study population comprised 15 children with an underlying neuromuscular disorder. All had scoliosis and pelvic obliquity when seated, and used a TLSO during sitting. Body-seat interface pressure was measured using the QA Pad. Maximum pressure, mean pressure and contact area were recorded at baseline and at 10 degrees 'push up' and 10 degrees wedge insertion, with and without the TLSO. X-rays were performed with and without the orthosis at baseline position. RESULTS: The TLSO reduced the scoliosis deformity by a mean of 5.3 degrees and significantly (p < 0.05) reduced the mean pressure and contact area in the sub-group of patients whose pelvic obliquity was contralateral to the side of the curve. Seat adjustment did not have any significant effect on pressure readings. CONCLUSION: Application of a TLSO in a child with scoliosis and contralateral pelvic obliquity significantly reduced the spinal curvature and interface sitting pressure. Manipulation of sitting by use of wedges under the pelvis had no significant effect on pressure distribution.