How a Diverse Research Ecosystem Has Generated New Rehabilitation Technologies: Review of NIDILRR’s Rehabilitation Engineering Research Centers

Over 50 million United States citizens (1 in 6 people in the US) have a developmental, acquired, or degenerative disability. The average US citizen can expect to live 20% of his or her life with a disability. Rehabilitation technologies play a major role in improving the quality of life for people with a disability, yet widespread and highly challenging needs remain. Within the US, a major effort aimed at the creation and evaluation of rehabilitation technology has been the Rehabilitation Engineering Research Centers (RERCs) sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research. As envisioned at their conception by a panel of the National Academy of Science in 1970, these centers were intended to take a “total approach to rehabilitation”, combining medicine, engineering, and related science, to improve the quality of life of individuals with a disability. Here, we review the scope, achievements, and ongoing projects of an unbiased sample of 19 currently active or recently terminated RERCs. Specifically, for each center, we briefly explain the needs it targets, summarize key historical advances, identify emerging innovations, and consider future directions. Our assessment from this review is that the RERC program indeed involves a multidisciplinary approach, with 36 professional fields involved, although 70% of research and development staff are in engineering fields, 23% in clinical fields, and only 7% in basic science fields; significantly, 11% of the professional staff have a disability related to their research. We observe that the RERC program has substantially diversified the scope of its work since the 1970’s, addressing more types of disabilities using more technologies, and, in particular, often now focusing on information technologies. RERC work also now often views users as integrated into an interdependent society through technologies that both people with and without disabilities co-use (such as the internet, wireless communication, and architecture). In addition, RERC research has evolved to view users as able at improving outcomes through learning, exercise, and plasticity (rather than being static), which can be optimally timed. We provide examples of rehabilitation technology innovation produced by the RERCs that illustrate this increasingly diversifying scope and evolving perspective. We conclude by discussing growth opportunities and possible future directions of the RERC program

Protocol for a randomized controlled trial examining multilevel prediction of response to behavioral activation and exposure-based therapy for generalized anxiety disorder.

BACKGROUND:Only 40-60% of patients with generalized anxiety disorder experience long-lasting improvement with gold standard psychosocial interventions. Identifying neurobehavioral factors that predict treatment success might provide specific targets for more individualized interventions, fostering more optimal outcomes and bringing us closer to the goal of "personalized medicine." Research suggests that reward and threat processing (approach/avoidance behavior) and cognitive control may be important for understanding anxiety and comorbid depressive disorders and may have relevance to treatment outcomes. This study was designed to determine whether approach-avoidance behaviors and associated neural responses moderate treatment response to exposure-based versus behavioral activation therapy for generalized anxiety disorder. METHODS/DESIGN:We are conducting a randomized controlled trial involving two 10-week group-based interventions: exposure-based therapy or behavioral activation therapy. These interventions focus on specific and unique aspects of threat and reward processing, respectively. Prior to and after treatment, participants are interviewed and undergo behavioral, biomarker, and neuroimaging assessments, with a focus on approach and avoidance processing and decision-making. Primary analyses will use mixed models to examine whether hypothesized approach, avoidance, and conflict arbitration behaviors and associated neural responses at baseline moderate symptom change with treatment, as assessed using the Generalized Anxiety Disorder-7 item scale. Exploratory analyses will examine additional potential treatment moderators and use data reduction and machine learning methods. DISCUSSION:This protocol provides a framework for how studies may be designed to move the field toward neuroscience-informed and personalized psychosocial treatments. The results of this trial will have implications for approach-avoidance processing in generalized anxiety disorder, relationships between levels of analysis (i.e., behavioral, neural), and predictors of behavioral therapy outcome. TRIAL REGISTRATION:The study was retrospectively registered within 21 days of first participant enrollment in accordance with FDAAA 801 with ClinicalTrials.gov, NCT02807480. Registered on June 21, 2016, before results

Expert perspectives on using mainstream mobile technology for school-age children who require augmentative and alternative communcation (AAC): a Policy Delphi study

Despite legislation in the U.S.A requiring the use of assistive technology in special education, there remains an underutilization of technology-based speech intervention for young students who require augmentative and alternative communication (AAC). The purpose of this Policy Delphi study was to address three guiding research questions that relate to the feasibility of using mainstream mobile technology, facilitative actions, and stakeholder roles for implementation and utilization of AAC in elementary school settings. Data were collected in two rounds of questionnaires given to experts in special education, assistive technology and speech and language pathology, with experience in AAC. Round 1 included 19 participants, 14 of whom also completed the Round 2 questionnaire. The results indicated that a very strong case can be made that mainstream mobile devices have several advantages over traditional AAC systems, not only in their affordability, but also transparency and social acceptance by providing an ideal medium for inclusion in mainstream settings. A challenge that confronts AAC innovations is the tendency to focus on the technology instead of pedagogical, social and therapeutic goals. Until a perfect AAC system becomes available for mainstream mobile devices that meet individuals’ communicative, educational and physical needs and personal preferences, it is apparent that multimodality will continue to be the model. The utilization of mainstream mobile technology for AAC necessitates certain facilitative actions and stakeholder responsibilities. Team collaboration is essential in supporting AAC use and, when applicable, facilitating the inclusion and mainstreaming of students who use AAC in the general education setting

Sustainable forest management using decision theaters : rethinking participatory planning

Involving stakeholders in the decision-making process can be very complex and time consuming. Decision theater (DT), which enables the combination of visualization and decision modeling capabilities together with human capacity of insight and interaction, is proposed for addressing this challenging problem in the forest sector. A generic framework for designing DTs to support participatory planning in the forest sector is proposed. To enable DT implementation and support decision-making in the DT in the province of Québec, Canada, the conceptual design of a decision-support system called Forest Community-DSS (FC-DSS) has been developed. Implementing FC-DSS along with other technologies in a DT environment can contribute to engage the stakeholders in the decision-making process by increasing participation frequency, collecting more inputs from the stakeholders, supporting the development and evaluation of alternative options and the selection of preferred alternatives. A DT-based collaboration approach would contribute to address the multiple issues of the stakeholders involved in participatory planning in Québec. Other Canadian provinces and other countries facing similar issues can benefit from the proposed approach