This study conducted a secondary analysis to objectively measure the effects of modified ride-on cars (MROCs) training in different postures on physical activity (PA) levels in children with motor delays. Data from 39 participants were analyzed in a randomized controlled trial. The participants included those using MROC in standing postures ( = 11, mean age = 22.87 months), MROC in sitting postures ( = 16, mean age = 19.53 months), and a control group that received conventional therapy ( = 12, mean age = 23.30 months). PA intensity was measured using an ActiGraph GT3X on the participants' wrists and right hip at weeks 1, 6, and 12 of the 12-week intervention period. This trial was registered at ClinicalTrials.gov (NCT02527356). The demographic data were similar across the groups. No significant differences were found in the interaction, group, or time effects for any of the positions ( > 0.05). The PA levels were consistent in at least light PA intensity range. MROC training may yield PA levels comparable to those of conventional therapy. Variations in activity and motor impairment severity could affect outcomes. Future studies should investigate factors such as task characteristics, motor delay severity, PA cutoff points, and training dosage that may influence PA intensity.

This study aimed to assess the development and usability of the Visually Impaired Masseur Assistance Application (VIMAA) designed to respond to signs of danger or instances of sexual harassment experienced by Visually Impaired Masseurs (VIMs). It harmonizes Rapid Application Development (RAD) method and qualitative in-depth interviews. RAD was implemented with emphasis on four core stages: requirement identification, design workshop, construction, and implementation, while Qualitative in-depth interviews were conducted utilizing thematic analysis for usability testing. Functionality testing also verifies the effectiveness of VIMAA features while requesting help, notification, and feedback. Pre-test identified four themes, including traumatic experiences and the need for protection. Post-test revealed themes such as ease of requesting assistance and switching to speech mode. VIMs perceive that VIMAA as user-friendly, practical, and acceptable. The requesting help, notification, and feedback features also work well. This study presents the effectiveness of VIMAA in establishing a framework that is accessible by a diverse spectrum of VIMs. The insights derived from this research also furnish valuable perspectives on the preferences of users reliant on mobile applications designed for VIMs, thus providing significant impetus for future research and development endeavors in this domain.

Wayfinding is the process of navigating from one's present location to their desired location. While wayfinding technologies are increasingly used by people with disabilities, there is little understanding of the barriers specific to wayfinding technology. The objective of this study was to understand the wayfinding technology barriers experienced by Canadians with disabilities. A total of 213 participants with varying disabilities (i.e. mobility, visual, hearing, memory and learning disabilities) completed a survey of open-ended questions about their personal experiences with different types of technologies. Technologies were categorized into public (i.e. digital and tactile interfaces) and personalized (i.e. mobile/website applications, wearable devices, smart assistive devices), and qualitative content analysis was used. Main themes were identified and either common across both groups (i.e. compatibility, demands on personal resources, information provision, interactability) or specific to one technology type (i.e. stigma, specific to personalized technology). Detailed subthemes provided greater specificity on the types of barriers encountered. For example, infection risk was noted as a barrier to public technology and high costs was a barrier for personalized technology. Results support the inclusion of wayfinding technology within accessibility standards and provide insights to clinicians on how to best support people with disabilities and their use of technology.

Access to powered mobility can support play and development for toddlers with disabilities. Using powered mobility in a standing posture has been theorized to support development of muscle coordination, balance, head and trunk stability, and transition to ambulation. The purpose of this study was to quantify and characterize joystick control, bodyweight support, and muscle activity while using the Permobil Explorer Mini in seated and supported standing postures. Nine children with mobility disabilities participated in four visits where they completed two, 15-20 minute play sessions, one in each posture, with a break between. We found that all toddlers engaged with the joystick in both postures, with individual differences in favored directions and control patterns. Participants had similar loading through their feet in both postures, but had slightly higher muscle activity in standing, especially while driving. These results demonstrate that young children with disabilities quickly engage with joystick-based powered mobility in seated and standing postures, with important individual differences that can inform future design of devices and interventions to support play and development.

Use of information and communication technology (ICT) (computers and smartphones) during everyday occupations is growing as rapidly as the older adult population. ICT is incorporated into occupational therapy (OT) interventions to improve performance in everyday activities. Limited competence in ICT can jeopardize wellness, autonomy, and contribute to isolation. This scoping review explores how ICT is incorporated into OT interventions and identifies knowledge gaps in the literature. Five databases were searched using a scoping review methodological framework. The included articles were peer-reviewed, written in English, focused on ICT in OT practice and include participants 65 and older. The results were summarized and reported with descriptive statistics and qualitative analysis. Twenty-three articles met the inclusion criteria. Findings include differences in participant characteristics, ICT devices, and outcome measures. Common themes identified benefits and barriers to ICT training, education, and occupational performance. Gaps in the literature include guidelines for intervention and the impact of specific health conditions on ICT performance. When incorporating ICT into OT interventions, consideration must be given to age-related deficits, perceptions of technology, and access to devices. Additional research is needed to establish evidence-based guidelines for OT interventions that incorporate ICT-mediated occupations with older adults.

This systematic review aimed to explore comprehensive evidence on the efficacy of the 3D-printed ankle-foot orthoses (AFOs) on gait parameters in individuals with neuromuscular and/or musculoskeletal ankle impairments. Electronic databases including PubMed, Scopus, Web of Science, Embase, ProQuest, Cochrane, and EBSCOhost were searched from inception to August 2023. Ten studies that had participants with ankle impairments, as a result of stroke, cerebral palsy, mechanical trauma, muscle weakness, or Charcot-Marie-Tooth disease, investigated the immediate effects of the 3D-printed AFOs on gait parameters were included. Methodological rigor was evaluated using the modified Downs & Black index. The gait parameters included lower extremity joint angles, moments, and work/power, plantar pressures, spatiotemporal measures, and patient satisfaction were improved with the 3D-printed AFOs when compared to the no-AFO (i.e. barefoot, or shoe-only) conditions. 3D-printed AFOs revealed similar functional efficacy as conventional AFOs. Notably, the level of patient satisfaction regarding fitting and comfort was higher with the 3D-printed AFOs. Although the study on the effects of the 3D-printed AFOs are limited, emerging evidence indicates their effectiveness in improving gait biomechanics and functions. To further confirm their effects, rigorous randomized control studies with larger sample sizes and longer follow-ups on the effects are warranted in the future.

A "no-lift" policy in healthcare discourages manual patient lifting to reduce worker injuries. This study explores modifications to a floor lift (NEAR-1) to align with this policy. NEAR-1 features a shorter lower lifting arm and a redesigned sling, enabling patients to (a) transfer in a sitting position, unlike a floor lift's semi-reclining position, and (b) feel more in control by removing the sling's rotational degree of freedom and letting the patient's feet rest on the lifter base. The device also reduced patient weight-bearing, compared to sit-to-stand lifts. Biomechanical analysis was done to map the risk to the nurses and capture the patient's experience with the modified lift (NEAR-1). Thirteen subjects carried out patient transfer tasks using both the NEAR-1 and the manual transfer approach, and this comparison will provide the baseline data for future systematic reviews. From the results, NEAR-1 significantly reduced the L5-S1 compression, the mediolateral shear forces, and the anteroposterior shear forces, with the exception of the muscle activities in the lower back, the shoulder, and the biceps. Moreover, patients felt safer and more comfortable with the device. Overall, the NEAR-1 lifter presents a biomechanically beneficial and user-friendly option for patients with limited weight-bearing capability.

The operations of a specialty wheelchair (WC) seating center can influence the evaluation to delivery timeframe in days for a complex rehab technology (CRT) WC. Operations at one facility improved due to departmental process improvement (PI) project with evaluation of the delivery workflow and implementation of changes. A retrospective chart audit gathered baseline data on the evaluation to delivery timeframe in days of a CRT WC for 50 individuals prior to PI changes. Standard departmental workflow collected 745 individuals' post-PI changes. The interventions took place from March 25, 2017, to April 5, 2018, and included defining and educating stakeholders on their roles and expectations, revisions of the electronic medical record, weekly and quarterly meetings with supplier leadership, paperwork completion goals, and follow-up paperwork centralization. Mean pre- and post-intervention evaluation to delivery timeframes in days was significantly different (162.2 versus 127.4 days,  < 0.0001). Overall, a reduction in the mean evaluation to delivery timeframe in days of CRT WC by 21.5% or 34.8 days occurred. Systematic change takes time as well as the commitment of all key players. PI changes resulted in evaluation to delivery timeframe reduction for patients to receive their CRT WCs.

This case report examined the impact of computer programmed assistive technology developed, using ChatGPT as a tool when designing an occupational therapy intervention on a client's independence in activities of daily living. A 66-year-old female client with mild cognitive impairment consulted an occupational therapist due to difficulties with activities of daily living. The occupational therapist developed two activity assistance computer programs using ChatGPT as a resource. The client did not interact directly with ChatGPT; instead, the occupational therapist used the technology to design and implement the intervention. A computer programmed assistive technology-based occupational therapy intervention was completed for eight weeks. The occupational therapist trained the client to use these programs in the clinical setting and at home. As a result of the intervention, the client's performance and independence in daily activities improved. The results of this study emphasize that ChatGPT may help occupational therapists as a tool to design simple computer programmed assistive technology interventions without requiring additional professional input.

Supported standing devices are often used to maintain a standing position by people with difficulty or inability to ambulate or stand for a period of time. Supported standing programs are first implemented by healthcare professionals with goals to impact health and function. This paper intends to update previous position on wheelchair standing devices by the Rehabilitation Engineering and Assistive Technology Association of North America, and was written in conjunction with the Clinician Task Force. The current paper expands the previous focus on wheelchair standing devices to all types of supported standing devices. A scoping review methodology found 42 studies examining outcomes of supported standing programs in the International Classification of Functioning, Disability, and Health framework in five areas of body functions, seven areas of activities and participation, and one body structure. Patterns in outcomes related to standing device type, as dynamic, or mobile, standing devices contributed to independent daily activity performance and static standing devices impacted neuromuscular capacity. Studies support engaging consistently in supported standing from nine months of age, or as soon after onset of ambulatory disability as possible, to maximize benefits. Clinical reasoning is required to apply the information in this document to unique individual cases.

This study examines the effects of technology-assisted instruction with teacher prompts on the ability to visualize and solve fraction multiplication word problems for four middle school students with learning disabilities. A multiple-probe design across participants, a type of single-case design, showed a functional relationship between the intervention and the targeted mathematical outcomes. Although there were some fluctuations over time, students demonstrated improvements from the baseline to intervention phases (Tau ranged from 0.76 to 1.00 for visualization and was 1.00 for problem-solving). Researchers employed Bayesian cumulative link mixed effects models to examine the moderating effects of word problem question types. Students showed greater maintenance effects on problem-solving than on visualization tasks, as reflected in changes in level (logit coefficient = 2.6) and trend (logit coefficient = 0.22). Students and teachers perceived vocabulary and multiplication fact practices, as well as the cognitive and metacognitive features embedded in the technology-assisted intervention, to be useful in learning targeted mathematics concepts. This study underscores the role of technology integration in enhancing teachers' instructional approach and in aiding students' acquisition and retention of mathematical concepts and skills.

Visually impaired individuals actively utilize devices like computers, tablets, and smartphones, due to advancements in screen reader technologies. Integrating freely available deep learning models, image captioning can further enhance these readers, providing an affordable assistive tech solution. This research outlines the critical software requirements necessary for image captioning tools to effectively serve this demographic. Two qualitative investigations were conducted to determine these requirements. An online survey was first conducted to identify the main preferences of visually impaired users in relation to audio descriptive software, with findings visualized using word clouds. A subsequent study evaluated the proficiency of existing deep learning captioning models in addressing these stipulated requirements. Emphasizing the need for comprehensive image data, the results highlighted three primary areas: 1) characteristics of individuals, 2) color specifics of objects, and 3) the overall context of images. The research indicates that current captioning tools are not entirely effective for the visually impaired. Based on the delineated requirements and suggested future research paths, there is potential for the development of improved image captioning systems, advancing digital accessibility for the visually impaired.

Augmentative and alternative communication (AAC) supports offer communication aids for individuals with severe speech and physical impairments. This study presents the development and proof of concept for an iPad application designed to evaluate the design preferences of both adults and children for AAC scanning and emerging P300-brain-computer interface access to AAC (BCI-AAC), both of which utilize item highlighting. Developed through a multidisciplinary and iterative process, the application incorporates customizable highlighting methods and display options for spelling-based and pictorial symbol interfaces. Initial testing involved five participants, including two adults with physical impairments and three children without physical impairments. Participants created unique interface displays using picture overlays, motion, and other highlighting methods. Feedback indicated strong usability and enjoyment during application use. Recommendations included expanded sound options and pre-made templates. This study demonstrates preliminary proof of concept for the application and supports the need for further research to explore user preferences and optimize communication outcomes across various AAC modalities. While BCI-AAC technology remains in its early stages, its integration into this application helps promote user-centered BCI-AAC development.

The entitlement to access assistive technology (AT) is fundamental for all individuals. However, challenges encountered during societal crises can significantly impact opportunities for participation and engagement among AT users. Understanding the implications of crises and disasters on AT provision along with their repercussions for end users is crucial. This research endeavors to investigate the experiences of managers overseeing AT provision during crises, using the first wave of the COVID-19 pandemic as a case study. An open-ended questionnaire was distributed to health care managers ( = 18) within AT organizations in Sweden. The responses were analyzed using qualitative content analysis, and four categories derived: . The findings indicate that AT organizations have demonstrated remarkable resilience and adaptability in the face of reduced consultations and growing care burden. Despite these challenges, managers have gained valuable insights into developing AT provision more efficiently and sustainably, particularly in digitization. The lessons learned will be critical in ensuring AT provision remains responsive to the needs of patients and society in the future.

In this study, we assessed the physical burden on professional caregivers when using a transfer support robot, "Hug," to transfer and move a care recipient. We compared heart rate (HR), heart rate variability (HRV), and the time-series synchronization between HRV and respiration in caregivers using the robot or a normal wheelchair as control. Under both conditions, a commercial wearable device was used to simultaneously obtain electrocardiogram and respiration signals while performing care tasks, which comprised transfer from a bed to a wheelchair or to the robot, movement to a remote location, and transfer to a chair. We found that HR was significantly higher and HRV and wavelet coherence were significantly lower in the control than with Hug during at least the first 30 seconds of rest after the task ( < 0.05). This suggests that Hug could reduce the increase in HR and thereby maintain a more constant rhythm between HRV and respiration during care tasks. A post-task questionnaire also revealed that caregivers felt the physical burden of the tasks was reduced using Hug. Our results suggest that the introduction of transfer support robots can reduce the physical burden for caregivers of daily transfer assistance tasks.

Drop foot is a common consequence of Multiple Sclerosis (MS), which may be improved somewhat by an ankle-foot orthosis (AFO). This study aimed to examine the immediate effect of using the recently developed Novel Hybrid Passive Spring Damper AFO (the novel HPSDAFO) on the kinetic and kinematic parameters of patients with MS (PwMS) in the sagittal plane. Twelve PwMS who suffered a unilateral drop foot participated in this study and fitted with the novel HPSDAFO. They walked with the novel HPSDAFO on the affected side and shoe on the affected side at a self-selected speed. Walking by the novel HPSDAFO, the symmetry of all of the evaluated sagittal kinetic and kinematic parameters improved noticeably. The range of ankle plantarflexion and knee flexion increased significantly at the stance phase. Power generation increased at all three joints. The peak of ankle dorsiflexion at early stances and the first peak of knee extension moments increased significantly but decreased at the hip joint. Changes in sagittal ROM, moment, and power generation in the plane and the improved symmetry revealed a more normal walking by using the novel HPSDAFO on the affected limb of PwMS.

Sleep problems are highly prevalent in autism and negatively impact the physical and mental health of children and their caregivers. Sleep education programs are often recommended as a first line-treatment to help parents implement healthy sleeping habits and a bedtime routine at home; however, the accompanying paper-based toolkits used in the bedtime routines have limitations related to engagement and adherence. To address these gaps, we iteratively developed and tested the usability of an augmented reality (AR) bedtime routine application. Our single participant design study ( = 7 child/parent dyads) found 86% compliance with the program and suggested good-excellent usability of the app with a trend toward increased willingness and faster completion of children's bedtime routines. This work supports the feasibility of using technology-based tools in sleep education programs and informs future clinical studies examining the effectiveness of these approaches for mitigating sleep difficulties.

The paper describes the development of an open-source, low-cost, wearable hand myoelectrical orthosis (neuro-orthosis) device for people with hand disabilities. The device uses functional electrical stimulation (FES) driven by myoelectrical signals (MES) to assist hand movements, enabling users to perform daily activities with greater ease and independence. The device comprises a forearm-wearable device developed using the 3D additive manufacturing principle, allowing user customization. Fixed non-disposable electrodes are attached to the myoelectrical orthosis, aiding the correct positioning for the user. The whole control system is stand-alone, and parameters can be controlled by Bluetooth communication, making the device wireless. The paper describes the MES-FES device's design, development, and testing, including its technical specifications, usability, and effectiveness. The open-source project aims to provide an accessible and affordable solution for people with spinal cord lesions while contributing to the growing research on noninvasive muscle-machine interfaces.

Capturing the outcomes of assistive technology (AT) is essential to know what works and what is needed. People across the globe are working to close the gap of unmet need for AT, and to enable access to quality AT products and services. Inconsistent terminology, measures and a lack of coordinated systems prevent the sharing of knowledge, and the lack of articulated global priorities limit the usefulness of data for policymakers and resource allocation decisions. This paper provides methods of a global "Grand Challenge" project, run by the Global Alliance of Assistive Technology Organizations, and describes the resulting challenges. A multiphase, mixed method approach founded on participatory principles sought to capture multi-country and multi-stakeholder perspectives "from the ground up." A collaborative consensus method was adapted to document and distil AT challenge data from global regions, to refine this data with global stakeholder organizations, and to publish a shortlist of AT Grand Challenges. The 2022 Grand Challenges in Outcomes and Impact are 1) measuring need, 2) documenting inputs, 3) measuring outcomes, 4) measure impacts, 5) sharing data, and 6) informing policy. The challenge now remains to work together to resolve them.