Lessons from Expert Focus Groups on how to Better Support Adults with Mild Intellectual Disabilities to Engage in Co-Design

Co-design techniques generally rely upon higher-order cognitive skills, such as abstraction and creativity, meaning they may be inaccessible to people with intellectual disabilities (ID). Consequently, investigators must adjust the methods employed throughout their studies to ensure the complex needs of people with ID are appropriately catered to. Yet, there are a lack of guidelines to support researchers in this process, with previous literature often neglecting to discuss the decisions made during the development of their study protocols. We propose a new procedure to overcome this lack of support, by utilizing the knowledge of “experts” in ID to design a more accessible workshop for the target population. 12 experts across two focus groups were successful in identifying accessibility barriers throughout a set of typical early co-design activities. Recommendations to overcome these barriers are discussed along with lessons on how to better support people with ID to engage in co-design

Mobile support for adults with mild learning disabilities during clinical consultations

Some of the factors that explain poor health outcomes for people with learning disabilities (LDs) include multi-morbidity and underdiagnosed health conditions. Previous studies have suggested that this population face significant communication barriers when interacting with health professionals and this is a major contributing factor to such diagnosis complications. Consequently, such health barriers are often preventable. However, there is a surprising lack of research-based technologies available that intend to promote this communication. We aim to address this gap by investigating the potential of using mobile technologies to support adults with mild LDs during clinical consultations. To achieve this, we interviewed a number of domain experts including government advisors, academics, support workers and General Practitioners. We then developed a technology probe to inform the information extracted and subsequently created a set of design guidelines for the development of Augmentative and Communicative technologies that target the clinical needs of adults with mild LDs

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

A comparison of schematic and taxonomic iPad® AAC systems for teaching multistep navigational AAC requests to children with ASD

textThe variety of augmentative and alternative communication (AAC) applications available on devices such as the Apple iPad®, necessitates research comparing different application components. AAC applications can include a variety of display formats such as: visual scene displays (VSDs; with vocabulary embedded into images of a scene or context), grid displays (with rows and columns of symbol buttons representing vocabulary), and hybrid formats (combining elements of VSDs and grids). To navigate through multiple pages of vocabulary, VSDs and hybrids are often organized schematically (i.e., by context or location) and grids are commonly organized taxonomically (i.e., by category). This study compared how four young children (ages 4 to 8) with autism spectrum disorder (ASD) acquired two-step navigational requesting with an iPad® AAC application using a schematic VSD, or hybrid pop-up grid, and a taxonomic grid. Using a multielement design, acquisition was compared across two settings (e.g., living room, kitchen), and three categories of preferred items (e.g., drinks, food, toys). Intervention involved behaviorally-based strategies (e.g., time delay, least-to-most prompting). During intervention, three participants mastered the schematic systems (VSD or hybrid), but did not master the taxonomic grid. Two of these participants also generalized requesting with schematic systems to an untrained location with a new preferred item, and maintained responding across all three settings. A fourth participant mastered both a schematic VSD and a taxonomic grid during training. During generalization, she rapidly acquired requesting in the new environment with the schematic VSD, but did not meet mastery criterion with the taxonomic grid. Across participants, the most common error with schematic systems was selecting the wrong scene (i.e., selecting an image of a location that did not match the location of the given session). In contrast, all participants showed a greater variety of error types with the taxonomic grid (including selecting the wrong category symbol, pressing the screen multiple times, trying to activate the screen with the wrong motion, and selecting the wrong item symbol). Differences in the types of errors observed suggest possible advantages and disadvantages with each system. Results have important implications for the development of AAC assessment and implementation protocols.Special Educatio

Guidelines for supporting children with disabilities' play: methodologies, tools, and contexts

All children want to play. This is also true for children with disabilities. Facilitating their engagement in play, whatever children’s capacities, is a central premise of people who view play as fundamental for their development and well-being. Play for the sake of play, just for recreational pleasure and enjoyment, without any secondary goal. In this book you’ll find guidelines to support children with disabilities’ play. They can be a useful tool for ensuring that children with disabilities can fully enjoy their right to play, for improving the quality of children’s play, enhancing their play satisfaction and participation, and reducing play deprivation. Written in a lay-person language, providing ready-to-use information, this book is for parents, teachers, rehabilitation professionals, toy manufacturers, policy makers and in general for all of those interested in the topic of play for children with disabilities. This publication results from the research and work of a transdisciplinary team, all participants in the COST Action “LUDI - Play for Children with Disabilities”.info:eu-repo/semantics/publishedVersio

Training Needs and Development of Online AT Training for Healthcare Professionals in UK and France

Background: Assistive Technology (AT) solutions for people with disabilities has become part of mainstream care provision. Despite advantages of AT on offer, abandonment and non-compliance are challenges for healthcare professionals (HCPs), introducing this technology to clients. Studies of abandonment reveal that 1/3 of all devices provided to service users end up stored unused. Key need is training to make informed decisions about AT tailored to individual needs and circumstances. In an online survey undertaken by the ADAPT project, HPCs identified AT training needs and barriers. Currently, a programme is being developed aimed at introducing AT concepts and enhancing practices to a wide range of HCPs. Method: Survey questions explored gaps, availability, qualifications and barriers to AT training in England and France. A series of consultation meetings with ADAPT partners took place. An advisory group consisting of longstanding AT users and their formal/informal carers and HCPs (occupational therapist, speech and language therapist, psychologist and biomedical engineer) contributed to the discussions on survey findings, development and evaluation of AT training for HCPs, key content areas and means of delivery. Key results: HCPs had no AT specific qualifications (UK 94.6%; FR 81.3%) nor in-service AT training (UK 65.1%; FR 66.4%). They either did not know of AT courses (UK 63.3%) or knew that none existed (FR 72.5%). Barriers to AT training were mainly local training (UK 62.7%, FR 50%) and funding (UK 62.7%, FR 55.7%). Some training priorities were clearer for French HCPs – overall knowledge of AT devices (82.1%, UK 45.8%), customization of AT (65.3%, UK 30.1%), assessing patient holistically (53.4%, UK 25.3%), educating patient/carers (56.5%, UK 28.3%) (p < 0.001). Variances may be due to differing country-specific HCP education approach. A third of both groups highlighted also abandonment, client follow-up, powered wheelchair training and prescribing AT. To bridge gaps in knowledge and identified training needs of HCPs, the online interactive training programme starts by introducing foundations of AT, including definitions, types/uses of AT, legislation/policies and AT in practice. More specialist units build and expand on specific areas, e.g. AT for mobility, communication, assessment and evidence-based practice. The biopsychosocial model of Health and World Health Organisation’s (WHO) International Classification of Functioning, Disability and Health (ICF) framework underpin development of content. ICF shifts focus from disability to health and functioning, in line with a social model of rehabilitation. E-learning comprises existing videos, AT textbook material and bespoke animated presentations. Selfassessment and evaluation of training are embedded and learners receive certificate of completion. Training was piloted to a group of HCPs trainees and postregistration HCPs who commented on relevance of AT content, clarity, accessibility of presentation, and usefulness. Users found training very useful, especially legislation/policies and AT literature. Conclusion: Overall, survey results suggest that both UK and French HCPs’ training on AT solutions is limited and highly variable. There is need for crosschannel AT professional competencies, availability of work-based training and funding support. Development of online, interactive training aims to increase professional confidence and competence in this area as well as the evidence base for AT

A Survey of Assistive Technology (AT) Knowledge and Experiences of Healthcare Professionals in the UK and France: Challenges and Opportunities for Workforce Development

Background: Assistive Technologies (AT) in healthcare can increase independence and quality of life for users. Concurrently, new AT devices offer opportunities for individualised care solutions. Nonetheless, AT remains under-utilised and is poorly integrated in practice by healthcare professionals (HCPs). Although occupational therapists (OTs), physiotherapists and speech and language therapists (SLTs) consider that AT solutions can offer problem-solving approaches to personalised care, they have a lesser understanding of application of AT in their practice. In this paper, we report findings of a survey on AT knowledge and experiences of HCPs in UK and France. Training needs also explored in the survey are presented in a separate paper on development of online training for the ADAPT project. Method: A survey of 37 closed/open questions was developed in English and French by a team of healthcare researchers. Content was informed by published surveys and studies. Email invitations were circulated to contacts in Health Trusts in UK and France ADAPT regions and the survey was hosted on an online platform. Knowledge questions addressed AT understanding and views of impact on user’s lives. Experience questions focussed on current practices, prescription, follow-up, abandonment and practice standards. 429 HCPs completed the survey (UK = 167; FR = 262) between June and November 2018. Key results: Participants were mainly female (UK 89.2%; FR 82.8%) and qualified 10+ years (UK 66.5%; FR 62.2%). A key group in both countries were OTs (UK 34.1%; FR 46.6%), with more physiotherapists and SLTs in UK (16.8%, 16.8%; vs. FR 6.5%, 2.3%), and more nurses in France (22.1% Vs. UK 10.8%). More HCPs were qualified to degree level in France (75.2%; UK 48.5%, p < 0.001). In terms of knowledge, all HCPs agreed that AT helps people complete otherwise difficult or impossible tasks (UK 86.2%; FR 94.3%) and that successful AT adoption always depends on support from carers, family and professionals (UK 52.7%; FR 66.2%). There were some notable differences between countries that require further exploration. For example, more French HCPs thought that AT is provided by trial and error (84.7%, UK 45.5%, p < 0.001), while more UK HCPs believed that AT promotes autonomous living (93.4%; FR 42.8%, p < 0.001). Also, more French HCPs considered that AT refers exclusively to technologically advanced electronic devices (71.8%, UK 28.8%, p <0.001). In both countries, top AT prescribers were OTs, physiotherapists and SLTs. Respondents had little/no knowledge in comparing/choosing AT (UK 86.8%; FR 76.7%) and stated they would benefit from interdisciplinary clinical standards (UK 80.8%; FR 77.1%). A third of HCPs did not know if AT users had access to adequate resources/support (UK 34.1%; FR 27.5%) and rated themselves as capable to monitor continued effective use of AT (UK 38.9%; FR 34.8%). Conclusion: Knowledge and application of AT was varied between the two countries due to differences in health care provision and support mechanisms. Survey findings suggest that HCPs recognised the value of AT for users’ improved care, but had low confidence in their ability to choose appropriate AT solutions and monitor continued use, and would welcome AT interdisciplinary clinical standards