Enabling self-directed computer use for individuals with cerebral palsy: a systematic review of available assistive devices and technologies

Aim  The purpose of this study was to systematically review published evidence on the development, use, and effectiveness of devices and technologies that enable or enhance self-directed computer access by individuals with cerebral palsy (CP). Methods  Nine electronic databases were searched using keywords ‘computer’, ‘software’, ‘spastic’, ‘athetoid’, and ‘cerebral palsy’; the reference lists of articles thus identified were also searched. Thirty articles were selected for review, with 23 reports of development and usability testing of devices and seven evaluations of algorithms to increase computer recognition of input and cursor movements. Results  Twenty-four studies had fewer than 10 participants with CP, with a wide age range of 5 to 77 years. Computer task performance was usually tested, but only three groups sought participant feedback on ease and comfort of use. International standards exist to evaluate effectiveness of non-keyboard devices, but only one group undertook this testing. None of the study designs were higher than American Academy for Cerebral Palsy and Developmental Medicine level IV. Interpretation  Access solutions for individuals with CP are in the early stages of development. Future work should include assessment of end-user comfort, effort, and performance as well as design features. Engaging users and therapists when designing and evaluating technologies to enhance computer access may increase acceptance and improve performance

Using assistive robots to promote inclusive education

Purpose: This paper describes the development and test of physical and virtual integrated augmentative manipulation and communication assistive technologies (IAMCATs) that enable children with motor and speech impairments to manipulate educational items by controlling a robot with a gripper, while communicating through a speech generating device. Method: Nine children with disabilities, nine regular and nine special education teachers participated in the study. Teachers adapted academic activities so they could also be performed by the children with disabilities using the IAMCAT. An inductive content analysis of the teachers’ interviews before and after the intervention was performed. Results: Teachers considered the IAMCAT to be a useful resource that can be integrated into the regular class dynamics respecting their curricular planning. It had a positive impact on children with disabilities and on the educational community. However, teachers pointed out the difficulties in managing the class, even with another adult present, due to the extra time required by children with disabilities to complete the activities. Conclusions: The developed assistive technologies enable children with disabilities to participate in academic activities but full inclusion would require another adult in class and strategies to deal with the additional time required by children to complete the activities. Implications for Rehabilitation Integrated augmentative manipulation and communication assistive technologies are useful resources to promote the participation of children with motor and speech impairments in classroom activities. Virtual tools, running on a computer screen, may be easier to use but further research is needed in order to evaluate its effectiveness when compared to physical tools. Full participation of children with motor and speech impairments in academic activities using these technologies requires another adult in class and adequate strategies to manage the extra time the child with disabilities may require to complete the activities.info:eu-repo/semantics/acceptedVersio

Cerebral Palsy

Nowadays, cerebral palsy (CP) rehabilitation, along with medical and surgical interventions in children with CP, leads to better motor and postural control and can ensure ambulation and functional independence. In achieving these improvements, many modern practices may be used, such as comprehensive multidisciplinary assessment, clinical decision making, multilevel surgery, botulinum toxin applications, robotic ambulation applications, treadmill, and other walking aids to increase the quality and endurance of walking. Trainings are based on neurodevelopmental therapy, muscle training and strength applications, adaptive equipment and orthotics, communication, technological solves, and many others beyond the scope of this book. In the years of clinical and academic experiences, children with cerebral palsy have shown us that the world needs a book to give clinical knowledge to health professionals regarding these important issue. This book is an attempt to fulfill and to give “current steps” about CP. The book is intended for use by physicians, therapists, and allied health professionals who treat/rehabilitate children with CP. We focus on the recent concepts in the treatment of body and structure problems and describe the associated disability, providing suggestions for further reading. All authors presented the most frequently used and accepted treatment methods with scientifically proven efficacy and included references at the end of each chapter

Accommodation of Grade R learners with cerebral palsy by teachers and practitioners : a case study of two special schools

The study explored how a practitioner and a teacher accommodated children living with cerebral palsy in Grade R, also referred to as the reception year, at two special schools, especially how they adapted the environment and used assistive devices. Cerebral Palsy is the most common form of a neurological disorder that appears in infancy or early childhood, permanently affecting body movement and muscle coordination. Research has illuminated that early specialist intervention such as assistive devices, augmentative and alternative commutation methods and assistive technology can make the world of difference to the future of the child. My research afforded me the opportunity to observe the children in Grade R living with cerebral palsy, with the practitioner and the teacher in their natural setting at school level. I followed the deductive paradigm, and adopted a case study design. The use of assistive devices and argumentative and alternative communication has historically been the domain of occupational-, speech- and physiotherapists. With the introduction of inclusive education and the new screening, identification, assessment and support policy to be conducted in all Grade R classes at all schools in South Africa, my research will be beneficial to mainstream and full-service schools, as well as special schools. Young children living with cerebral palsy will be included in all these schools and will need support from expert teachers and practitioners, who are knowledgeable about their requirements for an adapted environment and the use of assistive devices and augmentative and alternative communication methods. The study found that the Grade R staff at the special schools were knowledgeable, but their knowledge was superficial, their classrooms lacked adapted toys, and assistive technology was non-existent. Teachers and practitioners need practical training on the importance of movement for children living with cerebral palsy and the training should emphasize that experiencing the world through assistive devices alleviates barriers to learning and development.Inclusive EducationM. Ed. (Inclusive Education

The use of computers and augmentative and alternative communication devices by children and young with cerebral palsy

[Abstract] The purpose of the study was to determine the use of computers and assistive devices amongst children with cerebral palsy (CP) and establish the satisfaction level of both users and educational staff. The study was carried out with 30 children with cerebral palsy. A questionnaire was designed to characterize the use of new technologies and assistive devices. Some of the questions were reserved for the teachers. Even though 29 users show some type of communication difficulty, only 4 users dispose of a computer-aided communication device, with the static symbolic board being the most widely used device (4). More than half of the participants (17) regularly use a computer, 16 of them requiring some type of assistive device. The perception of the teachers with regard to the use of Information and Communications Technologies (ICTs) in the classrooms is positive in 5 out of 6 cases. ICTs only provide assistance if their application is accompanied by the involvement of professionals and the child's social environment. The low use of Augmentative and Alternative Communication techniques along with the absence of communication codes reveal the need to establish training protocols. The inclusion of social, physical, and personal factors is considered essential in order to evaluate the needs for assistive technology

Methods and metrics for the improvement of the interaction and the rehabilitation of cerebral palsy through inertial technology

Cerebral palsy (CP) is one of the most limiting disabilities in childhood, with 2.2 cases per 1000 1-year survivors. It is a disorder of movement and posture due to a defect or lesion of the immature brain during the pregnancy or the birth. These motor limitations appear frequently in combination with sensory and cognitive alterations generally result in great difficulties for some people with CP to manipulate objects, communicate and interact with their environment, as well as limiting their mobility. Over the last decades, instruments such as personal computers have become a popular tool to overcome some of the motor limitations and promote neural plasticity, especially during childhood. According to some estimations, 65% of youths with CP that present severely limited manipulation skills cannot use standard mice nor keyboards. Unfortunately, even when people with CP use assistive technology for computer access, they face barriers that lead to the use of typical mice, track balls or touch screens for practical reasons. Nevertheless, with the proper customization, novel developments of alternative input devices such as head mice or eye trackers can be a valuable solution for these individuals. This thesis presents a collection of novel mapping functions and facilitation algorithms that were proposed and designed to ease the act of pointing to graphical elements on the screen—the most elemental task in human-computer interaction—to individuals with CP. These developments were implemented to be used with any head mouse, although they were all tested with the ENLAZA, an inertial interface. The development of such techniques required the following approach: Developing a methodology to evaluate the performance of individuals with CP in pointing tasks, which are usually described as two sequential subtasks: navigation and targeting. Identifying the main motor abnormalities that are present in individuals with CP as well as assessing the compliance of these people with standard motor behaviour models such as Fitts’ law. Designing and validating three novel pointing facilitation techniques to be implemented in a head mouse. They were conceived for users with CP and muscle weakness that have great difficulties to maintain their heads in a stable position. The first two algorithms consist in two novel mapping functions that aim to facilitate the navigation phase, whereas the third technique is based in gravity wells and was specially developed to facilitate the selection of elements in the screen. In parallel with the development of the facilitation techniques for the interaction process, we evaluated the feasibility of use inertial technology for the control of serious videogames as a complement to traditional rehabilitation therapies of posture and balance. The experimental validation here presented confirms that this concept could be implemented in clinical practice with good results. In summary, the works here presented prove the suitability of using inertial technology for the development of an alternative pointing device—and pointing algorithms—based on movements of the head for individuals with CP and severely limited manipulation skills and new rehabilitation therapies for the improvement of posture and balance. All the contributions were validated in collaboration with several centres specialized in CP and similar disorders and users with disability recruited in those centres.La parálisis cerebral (PC) es una de las deficiencias más limitantes de la infancia, con un incidencia de 2.2 casos por cada 1000 supervivientes tras un año de vida. La PC se manifiesta principalmente como una alteración del movimiento y la postura y es consecuencia de un defecto o lesión en el cerebro inmaduro durante el embarazo o el parto. Las limitaciones motrices suelen aparecer además en compañía de alteraciones sensoriales y cognitivas, lo que provoca por lo general grandes dificultades de movilidad, de manipulación, de relación y de interacción con el entorno. En las últimas décadas, el ordenador personal se ha extendido como herramienta para la compensación de parte de estas limitaciones motoras y como medio de promoción de la neuroplasticidad, especialmente durante la infancia. Desafortunadamente, cerca de un 65% de las personas PC que son diagnosticadas con limitaciones severas de manipulación son incapaces de utilizar ratones o teclados convencionales. A veces, ni siquiera la tecnología asistencial les resulta de utilidad ya que se encuentran con impedimentos que hacen que opten por usar dispositivos tradicionales aun sin dominar su manejo. Para estas personas, los desarrollos recientes de ratones operados a través de movimientos residuales con la cabeza o la mirada podrían ser una solución válida, siempre y cuando se personalice su manejo. Esta tesis presenta un conjunto de novedosas funciones de mapeo y algoritmos de facilitaci ón que se han propuesto y diseñado con el ánimo de ayudar a personas con PC en las tareas de apuntamiento de objetos en la pantalla —las más elementales dentro de la interacción con el ordenador. Aunque todas las contribuciones se evaluaron con la interfaz inercial ENLAZA, desarrollada igualmente en nuestro grupo, podrían ser aplicadas a cualquier ratón basado en movimientos de cabeza. El desarrollo de los trabajos se resume en las siguientes tareas abordadas: Desarrollo de una metodología para la evaluación de la habilidad de usuarios con PC en tareas de apuntamiento, que se contemplan como el encadenamiento de dos sub-tareas: navegación (alcance) y selección (clic). Identificación de los tipos de alteraciones motrices presentes en individuos con PC y el grado de ajuste de éstos a modelos estándares de comportamiento motriz como puede ser la ley de Fitts. Propuesta y validación de tres técnicas de facilitación del alcance para ser implementadas en un ratón basado en movimientos de cabeza. La facilitación se ha centrado en personas que presentan debilidad muscular y dificultades para mantener la posición de la cabeza. Mientras que los dos primeros algoritmos se centraron en facilitar la navegación, el tercero tuvo como objetivo ayudar en la selección a través de una técnica basada en pozos gravitatorios de proximidad. En paralelo al desarrollo de estos algoritmos de facilitación de la interacción, evaluamos la posibilidad de utilizar tecnología inercial para el control de videojuegos en rehabilitación. Nuestra validación experimental demostró que este concepto puede implementarse en la práctica clínica como complemento a terapias tradicionales de rehabilitación de la postura y el equilibrio. Como conclusión, los trabajos desarrollados en esta tesis vienen a constatar la idoneidad de utilizar sensores inerciales para el desarrollo de interfaces de accesso alternativo al ordenador basados en movimientos residuales de la cabeza para personas con limitaciones severas de manipulación. Esta solución se complementa con algoritmos de facilitación del alcance. Por otra parte, estas soluciones tecnológicas de interfaz con el ordenador representan igualmente un complemento de terapias tradicionales de rehabilitación de la postura y el equilibrio. Todas las contribuciones se validaron en colaboración con una serie de centros especializados en parálisis cerebral y trastornos afines contando con usuarios con discapacidad reclutados en dichos centros.This thesis was completed in the Group of Neural and Cognitive Engineering (gNEC) of the CAR UPM-CSIC with the financial support of the FP7 Framework EU Research Project ABC (EU-2012-287774), the IVANPACE Project (funded by Obra Social de Caja Cantabria, 2012-2013), and the Spanish Ministry of Economy and Competitiveness in the framework of two projects: the Interplay Project (RTC-2014-1812-1) and most recently the InterAAC Project (RTC-2015-4327-1)Programa Oficial de Doctorado en Ingeniería Eléctrica, Electrónica y AutomáticaPresidente: Juan Manuel Belda Lois.- Secretario: María Dolores Blanco Rojas.- Vocal: Luis Fernando Sánchez Sante

A descriptive study of children with cerebral palsy at Chris Hani Baragwanath academic hospital

A research report Submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg in partial fulfilment of the requirements for the Degree Of Master of Medicine in the branch of Paediatrics. Johannesburg, April 2015Cerebral Palsy is a motor disability that is due to a non-progressive insult to the motor brain that is still developing. The term thus describes a group of disorders that are due to the insult. The motor disturbances present are often accompanied by seizures together with impairment in sensation, communication, cognition, and perception. There is limited knowledge about the demographics of children with CP seen at Chris Hani Baragwanath Academic Hospital CP clinic, this study was aimed at describing these demographics, to expand on what is currently known about these patients. The study was a retrospective descriptive study of clinic files of new CP patients seen at CP clinic from 1st January to 31st December 2012. The objectives of the study were: to determine the age at presentation; to establish the commonest types of CP seen at the clinic; to determine imaging abnormalities; and to assess the level of functional capabilities of patients using the Gross Motor Functional Classification Scale. The data was collected from 145 patient’s clinic files, and managed using REDCap and a statistical programme: STATA 12.0. 145 patients files were reviewed, 92 were males, 53 were females. The average age at presentation was 34.17 months (2.8 years); most patients had moderate type of CP (46.2%), predominately mixed spastic diplegia (20.7%). The most common imaging modality used was a CT scan (60.7%); it revealed hypoxic ischemic brain injury in 42% of cases. The level of severity as described by the GMFCS was level III in most cases (37.50%). Cerebral palsy is a common, debilitating disorder; this study has highlighted some of the demographics of these patients at Chris Hani Baragwanath Academic Hospital, CP clinic

technology aided programs for persons with severe profound and multiple disabilities a selective review

This paper represents a brief, selective review of technology-aided programs for persons with severe/profound and multiple disabilities. Specifically, the paper provides detailed summaries of a number of illustrative studies conducted by these authors for the assessment of (a) microswitch-based programs aimed at promoting response engagement and control of environmental stimulation, (b) speech-generating devices and computer-aided programs directed at promoting communication and stimulus choice, (c) orientation technology solutions for promoting indoor travel, and (d) visual- and verbal-instruction technology for promoting performance of complex, multi-step tasks. The studies included in the review provide a specific picture of the technological instruments adopted within the programs, of the participants involved, and of the outcomes obtained. Questions of practical importance left unanswered by those studies and others in the field are also discussed as possible targets of new research