Exploring the psychosocial impact of wheelchair and contextual factors on quality of life of people with neuromuscular disorders

[Abstract] Neuromuscular disorders (NMDs) are a group of heterogeneous diseases that show differences in incidence, hereditary, etiology, prognosis, or functional impairments. Wheelchair use (manual or powered) is influenced by several factors, including personal and contextual factors, and comprehensive evaluation of their impact is required in order to optimize prescription and provision of wheelchairs. The authors therefore assessed the influence of wheelchair use on the quality of life (QoL) of 60 participants with NMD using the Psychosocial Impact of Assistive Devices Scale (PIADS). The Functional Independence Measure (FIM) and a specially developed questionnaire were used to obtain information about contextual factors and participants’ activity profile of activities of the participants. The results showed that using a wheelchair has psychosocial benefits, with the main determinants of benefit being type of wheelchair (powered), non-ambulation ability, and independence in mobility. Ensuring a good match between user and assistive technology (AT; e.g., wheelchair), as well as the effectiveness of the particular device, will increase the likelihood that the user will adopt it and use it effectively in daily life. Clinical prescription of AT would be improved by making appropriate use of outcome measures

Powered attendant-propelled wheelchair with assist-as-needed control based on individual physical capabilities

This paper discussed if a powered attendant propelled wheelchairs (PAPW) with assist-as-needed control reduces energy consumption and maximise attendant's physical activity in powered system use. This study introduced a PAPW with force velocity assist control (FVAC) based on individual capability of pushing force velocity relationship. This PAPW assists attendant pushing when more pushing force is needed over usual range of individual physical capabilities of pushing. With the PAPW, we investigated the performance of the FVAC and compared it with proportional assist control (PAC) on a flat level surface and a longitudinal slope (6.5%) with three participants. The experimental results showed that the PAPW with the FVAC reduced 50% of pushing force on the slope and this was similar performance of the PAC in terms of assisting. The FVAC also reduced 79% of mean mechanical assisting power on the flat against the PAC. These results support that the PAPW with the FVAC has flexibilities to adapt to individual physical capabilities and provides certain level of physical activities with sufficient assisting when needed, and low energy consumption for long time and distance operations for attendants

Mobility on Demand in the United States

The growth of shared mobility services and enabling technologies, such as smartphone apps, is contributing to the commodification and aggregation of transportation services. This chapter reviews terms and definitions related to Mobility on Demand (MOD) and Mobility as a Service (MaaS), the mobility marketplace, stakeholders, and enablers. This chapter also reviews the U.S. Department of Transportation’s MOD Sandbox Program, including common opportunities and challenges, partnerships, and case studies for employing on-demand mobility pilots and programs. The chapter concludes with a discussion of vehicle automation and on-demand mobility including pilot projects and the potential transformative impacts of shared automated vehicles on parking, land use, and the built environment

Assistive technology based on client-centered for occupational performance in neuromuscular conditions

[Abstract] Knowledge of the patient’s own perception of functioning and dependence, and of environmental factors, is of significant value. The main goals of this study are (1) to obtain a general profile of the occupational performance of persons with neuromuscular disorders (NMD) and their needs related to that performance and (2) to determine the support resources (assistive technologies [AT], adjustment, and/or caregiver) required to improve or maintain their level of independence. This cross-sectional study involved 24 persons with NMD. The functional independence measure (FIM), the checklist of a home’s accessibility level, and a specific questionnaire were administered. The sample included 14 women (58.3%) and 10 men (41.7%). A mean of 61.7 (standard deviation=17.2) was obtained for FIM motor, over 91, indicating a moderate level of dependence. The AT most frequently used was a wheelchair (70.8%). Architectural barriers were detected in the majority of users’ homes (87.5%). Concise assessment of the independence needs of people with NMD, according to their occupational performance, and prescription of resources to meet those needs are required. This procedure should be implemented in healthcare programs, including care to a caregiver

介助者の自律駆動規範モデルを用いた介助用車いすの補助動力制御

関西大

Description and measurement of visual scanning training in Occupational Therapy for patients with visual search deficits following stroke

Executive SummaryBackgroundVisual search is a process which is integral for carrying out most activities of daily living; for example for finding utensils needed in preparing a meal or for avoiding hazards when crossing the road. This essential process is commonly disrupted by visual impairments and reduced spatial attention after stroke. Affected individuals can experience long term limitations in everyday activities due to inefficiencies in observation and visual searching. Occupational Therapists working in stroke services include visual scanning and search training within their treatment. However it is not known if the intervention is effective for improving occupational performance and visual functioning. Before the intervention can be properly evaluated for its effectiveness some essential development work is needed AimsThis project aimed to prepare for an evaluation of effectiveness of visual scanning and search training in Occupational Therapy by achieving three important steps: 1.A detailed and systematic description of the intervention delivered in the community setting2.Development and pilot testing of a process measure to quantify search performance in the home context 3.A feasibility study of the intervention delivered intensively over three weeks.MethodsTo obtain a description of the intervention a specialist Occupational Therapist in stroke, working in a community service, made video recordings of her treatment sessions delivered to five participants with visual field deficits after stroke. The recordings were analysed using a framework approach. The findings were presented to a reference group of Occupational Therapists interested in vision after stroke for validation of the description as good clinical practice. A timed room search task using keys placed in different parts of a living room over 16 trials was designed to measure search performance. Point of regard during the searches was recorded from a digital video camera worn on the participant’s head.Feasibility of the defined intervention delivered three times a week for three weeks and of the room search task administered in the home before and after the intervention was tested with nine participants. In addition a patient reported outcome measure, the Visual Functioning Questionnaire (VFQ25), was administered before and after the intervention.Summary of key findings•A detailed description of Occupational Therapy intervention for training visual scanning and search has been developed. The intervention is task specific to participants’ goal occupations and trains strategies for search using remedial activities and real tasks. The intervention was endorsed as good clinical practice by the reference group of Occupational Therapists with special interest and experience in training scanning and search in people with visual impairments after stroke.•The treatment was found to be feasible and acceptable to participants treated intensively over three weeks.•A room search task for assessing search performance proved to be feasible and demonstrated changes in the distribution and starting point of search after the intervention. However these changes in search behaviour did not always lead to increased speed or accuracy. Participants with more severe visual impairments were more efficient in searching after the treatment while some more mildly affected participants took longer to find the object.•A patient reported outcome measure was tested and found to be responsive in the sample suggesting it may be a good primary outcome measure for a clinical trial. The participants reported better visual functioning on the visual functioning questionnaire after the intervention.Recommendations for researchFurther work is needed before the intervention is evaluated in a clinical trial:Some experimental work is needed to determine the efficacy of search strategies used in the intervention. The results from our small sample suggest that strategies should be tailored to individuals’ baseline performance. For example starting the search in the blind field may be helpful in some cases, but a hindrance in others. Further work is needed to identify the most effective strategies for improving search performance in different individuals and to understand the mechanisms of the intervention for improving patients’ perceptions of their visual functioning. A measure of search performance in real world tasks would be helpful to determine the mechanism for improving function, and for understanding which patients benefit. The room search task goes some way towards this, but further work is recommended to investigate the use of new technologies to achieve more flexible and more accurate recording of point of regard during real activities of daily living.The visual functioning questionnaire,(VFQ25) would appear have potential as a primary outcome measure in a trial of clinical effectiveness of the intervention. Further research into its responsiveness and internal consistency in a larger sample of stroke participants is recommended