Enactive methods towards situational learning - engaging people with intellectual and developmental disability in design

In this paper we explore how enactive methods may support and enhance the design of mobile solutions for people with intellectual and developmental disabilities. Our project deals with supporting independent public transport and applies enactive methods in order to account for the interdependent nature of technology, disability, and environment. We staged three iterations of a bus workshop and one theatre workshop where real, everyday scenarios were acted out to gain tacit yet crucial insights. These enactive workshops and the prototype testing showed that transport activities are context dependent and unique to each individual. In our case, enactive methods revealed that independent public transport goes beyond a need for reminders, time management and communication, towards the management of unforeseen events. Our work shows how a closer realistic setting may provide more nuanced, personal, and detailed design insights that support emotional and situational understandings of user experiences.publishedVersionPaid open acces

Everyday mobile/assistive technology supporting adults with intellectual &/or developmental disabilities in the community setting

Twelve pilot project participants with intellectual and/or developmental disabilities used mobile devices (smartwatch and smartphone technology) and individualized apps focused on time management, coping, budgeting, exercise, and safety, to support independence and community engagement. Ten participants with Intellectual and/or Developmental Disabilities (IDD) and five front-line Coordinators participated in post-project focus groups in which common patterns of responses and salient findings were noted, including the emergence of a peer technology expert. Five themes emerged from focus group data, which were then developed into five broad technological, clinical, and methodological recommendations for phase two, that will follow this pilot project. Duration data showed variable change in pre-post duration of supports; related changes were part of these recommendations. The small sample size and current pilot study status suggests cautious interpretation and application of results beyond the immediate context of this project; however, this pilot project has developed a foundation for a more comprehensive intervention

Barriers Experienced by Individuals with IDD when Interacting with Digital Technology and Online Content

Prior to the pandemic there was clear evidence that people with intellectual and developmental disabilities (IDD) had less access to digital technologies and services than other groups of individuals with disabilities, and mainstream users. The expectation seemed to be that the transition to online delivery would be relatively seamless and that essential (e.g., e-health services like online appointments and therapy sessions) services would be easy to access. However, that is not the experience of all individuals with disabilities, particularly individuals with IDD, as that population retains a preference for face-to-face delivery of certain services during the pandemic. There are existing accessibility guidelines that designers can use to create content or software, for example, the Web Content Accessibility Guidelines (WCAG) 2.1. These guidelines focus primarily on the needs of a population of individuals with a single disability and most often those with a sensory (e.g., visual, hearing) or mobility issue. Relying solely on standards like the WCAG 2.1 seems unlikely to address the needs of people with IDD, a very heterogeneous population. The first stage of this research project was a scoping review of literature published between 2007 and the present that dealt barriers that individuals with IDD had using Information and Communication Technology (ICT). The second part involved consultations with six individuals with an IDD around their ICT use. The third part of the project involved the creation of a decision tree. The decision tree is intended to act as a tool that can be used by designers and others when they make decisions about how to create ICT that supports users with IDD

Autonomous indoor wayfinding for individuals with cognitive impairments

<p>Abstract</p> <p>Background</p> <p>A challenge to individuals with cognitive impairments in wayfinding is how to remain oriented, recall routines, and travel in unfamiliar areas in a way relying on limited cognitive capacity. While people without disabilities often use maps or written directions as navigation tools or for remaining oriented, this cognitively-impaired population is very sensitive to issues of abstraction (e.g. icons on maps or signage) and presents the designer with a challenge to tailor navigation information specific to each user and context.</p> <p>Methods</p> <p>This paper describes an approach to providing distributed cognition support of travel guidance for persons with cognitive disabilities. A solution is proposed based on passive near-field RFID tags and scanning PDAs. A prototype is built and tested in field experiments with real subjects. The unique strength of the system is the ability to provide unique-to-the-user prompts that are triggered by context. The key to the approach is to spread the context awareness across the system, with the context being flagged by the RFID tags and the appropriate response being evoked by displaying the appropriate path guidance images indexed by the intersection of specific end-user and context ID embedded in RFID tags.</p> <p>Results</p> <p>We found that passive RFIDs generally served as good context for triggering navigation prompts, although individual differences in effectiveness varied. The results of controlled experiments provided more evidence with regard to applicabilities of the proposed autonomous indoor wayfinding method.</p> <p>Conclusions</p> <p>Our findings suggest that the ability to adapt indoor wayfinding devices for appropriate timing of directions and standing orientation will be particularly important.</p

Functional Digital Literacy: Improving Email Skills with Adolescents with Intellectual Disabilities

Technology continues to permeate many areas of daily life. This has become more apparent during the current pandemic. Many services innovatively moved to hybrid or technology-based methods of service. However, not all individuals accessed technology with the same opportunities. Persistent inequities remain for individuals with disabilities, stemming from several variables, but most noticeably a lack education-based planning to include skills required to access technology necessary to improve post-secondary outcomes. A multiple probe design across three behaviors replicated across six participants investigated the use of direct instruction and the use of systematic prompting to increase basic email skills in adolescents with intellectual and developmental disabilities (IDD)

The prevalence and rehabilitation needs of individuals with locomotor disability in Mitchell's Plain

Locomotor disability is a problem, reported prevalence ranging from 1% to 8.6%. Only a limited number of studies have been done in South Africa. They used different methodologies and definitions, thus leading to the variation in prevalence reported. A further factor influencing prevalence is that some locomotor disabilities are area-specific. This study aimed to determine the prevalence and rehabilitation needs of individuals with locomotor disability in Mitchell's Plain, for planning intervention strategies as part of this community based rehabilitation service. A cross sectional study design was employed. A stratified proportional cluster sampling technique was used to select 36 clusters resulting in a sample size of2424 people. Screening questions recommended by the WHO were used to identify people with impairments (Phase I). Further screening (Phase II), of those identified with impairments, using a questionnaire based on the ICIDH categories, identified people with disabilities. People with locomotor disabilities were grouped together and qualitative analysis through case studies was done on sub-groups where common themes manifested. 12.9% reported some form of impairment; 3.9% adults could be classified as having disabilities. Amongst adults with disabilities, 2.7% had locomotor disabilities. Consistent with the literature, disability increased with age, was more frequently reported amongst females, and was associated with lower socio-economic class. Multiple impairments were frequently reported, with the most common impairment being musculo-skeletal conditions. Use of health services occurred in the public sector with the local Day Hospital used as frequently as more distant tertiary hospitals. The study revealed the need for improved and accessible medical and rehabilitation services in the community. Their poor ability to integrate functionally and economically into the community, was reflected in the high proportion of people with mobility and occupational handicap categories. Low levels of education worsened the impact on occupational handicap. It was further evident that multiple impairments amongst the elderly lead to greater dependence of people with locomotor disability on their care-givers. Even though the need for assistive equipment was high, much of assistive equipment owned was not being used. A further handicapping factor for the disabled using assistive equipment was their environment which restricted the use of assistive equipment. High locomotor disability prevalence was confirmed in this study. Major unmet needs were identified in the handicap categories of physical mobility and economic self-sufficiency. Domiciliary based intervention was recommended as the most appropriate rehabilitative intervention for the severely physically disabled persons

The Effect of Constant Time Delay and Sentence Frames on Correct Word Selection for Sentences Constructed Using Technology-Aided Instruction During a Story-Based Lesson

The purpose of this study was to investigate the effect of an intervention package that included constant time delay (CTD) and sentence frames on correct word selection for sentences constructed using technology-aided instruction (TAI) during and following a story-based lesson (SBL) for participants ages 6-8 who have intellectual disability, developmental delays, and autism (IDD). A multiple probe across participants design was used to evaluate the efficacy of the intervention. Probes were conducted during baseline, intervention, generalization, and maintenance phases to determine the effectiveness of the intervention on correct word selection for sentence construction. Results indicate a functional relation between the intervention package on correct word selection for sentence construction during a shared story. Additionally, the Percent of Nonoverlapping Data (PND) indicate overall strong effects. Finally, students were able to demonstrate both generalization and maintenance of skills

A COMPREHENSIVE ASSESSMENT OF CRISIS IN INDIVIDUALS WITH INTELLECTUAL DISABILITIES AND ITS IMPLICATIONS FOR PHYSICAL THERAPY

Advancements in medicine, policy, and societal attitudes have improved life expectancy, socialization, and participation for individuals with intellectual and developmental disabilities (IDD). However, inconsistent or a lack of services may drive healthcare utilization toward expensive emergency care services. This can negatively impact health outcomes and disrupt physical therapy treatment plans, limiting their effectiveness and further placing individuals with IDD at risk for crisis episodes. Because of its subjective nature, quantifying crisis is challenging using current definitions. Rehabilitation professionals are often active members of the care team for individuals with IDD, however no evidence currently exists regarding how the profession can positively impact crisis intervention. Because these clinicians often develop long-term relationships with patients and work with them on a consistent basis, they are well-positioned to recognize early signs of crisis and make timely referrals to the appropriate health and social service providers but currently lack resources to guide in this decision-making. A better understanding of characteristics of this population related to crisis is needed in order to develop accessible and useful screening tools and to improve clinical reasoning. The purpose of this dissertation was to identify pertinent risk factors related to crisis for individuals with IDD using a novel, objective crisis definition. Using a mixed methods approach, a revised definition of crisis was developed through surveying of expert clinicians and healthcare administrators at a specialty care clinic for individuals with IDD. The addition of four crisis-related events were included in the definition: (1) unplanned hospital utilization; (2) involvement with the criminal justice system; (3) abuse/victimization; (4) unplanned change in living environment. Using retrospective chart review, these four crisis-related events were further analyzed and validated by comparing their occurrence in patients who did (N=41) and did not (N=144) receive formal crisis intervention services at the clinic between January 1, 2014 and March 1, 2019. The risk for unplanned hospital utilization was 3.4 times higher for crisis patients. The risk for involvement with the police or criminal justice system was 13.86 times higher for crisis patients. The risk for abuse and/or victimization was 6.21 times higher for crisis patients. The risk for unplanned change(s) in living environment was 12.7 times higher for crisis patients. Overall, 90% of crisis patients experienced at least one of the four crisis-related events during the study period, compared to 54.2% of non-crisis patients. Five additional risk factors were identified that increased crisis risk: hypothyroidism, bipolar disorder, intermittent explosive disorder, personality disorder, and have multiple psychiatric disorders. No statistically significant differences were found between crisis and non-crisis patients for intellectual disability severity level, mobility status, communication status, neurodevelopmental diagnosis, age, race/ethnicity, or living environment. To the best of our knowledge, the identification of hypothyroidism as a potential crisis risk factor was a novel discovery not previously reported in the literature. The findings of this dissertation have multiple implications for clinical practice and add to the body of knowledge regarding crisis experiences for individuals with IDD. First and foremost, over a fifth of our study sample (22%) utilized formal crisis management services during the study period. This suggests that crisis episodes are common in the IDD population. As the majority of individuals with IDD are community-dwelling and life expectancy continues to increase, the likelihood of physical therapists encountering adults with IDD in clinical practice will subsequently increase. However, physical therapists and physical therapy students routinely report feeling unconfident and uncomfortable treating individuals with disabilities, including individuals with IDD. There is a need, then, to improve clinician confidence and skills to ensure that individuals with IDD receive optimal care, especially into adulthood. The findings of these studies provide foundational knowledge and point toward trends in crisis experiences that can help guide physical therapists and other rehabilitation clinicians