The Remote Controllable Electric Wheelchair System combined Human and Machine Intelligence for Caregivers and Care Receivers

Thesis (Master of Science in Informatics)--University of Tsukuba, no. 41280, 2019.3.2

The impact of the World Health Organization 8-steps in wheelchair service provision in wheelchair users in a less resourced setting: A cohort study in Indonesia Health systems and services in low and middle income settings

Background: For people who have a mobility impairment, access to an appropriate wheelchair is an important step towards social inclusion and participation. The World Health Organization Guidelines for the Provision of Manual Wheelchairs in Less Resourced Settings emphasize the eight critical steps for appropriate wheelchair services, which include: referral, assessment, prescription, funding and ordering, product preparation,fitting and adjusting, user training, and follow-up and maintenance/repairs. The purpose of this study was to investigate how the provision of wheelchairs according to the World Health Organization's service provision process by United Cerebral Palsy Wheels for Humanity in Indonesia affects wheelchair recipients compared to wait-listed controls. Methods: This study used a convenience sample (N = 344) of Children, Children with proxies, Adults, and Adults with proxies who were on a waiting list to receive a wheelchair as well as those who received one. Interviews were conducted at baseline and a 6 month follow-up to collect the following data: Demographics and wheelchair use questions, the World Health Organization Quality of Life-BREF, Functional Mobility Assessment, Craig Handicap Assessment Recording Technique Short Form. The Wheelchair Assessment Checklist and Wheelchair Skills Test Questionnaire were administered at follow up only. Results: 167 participants were on the waiting list and 142 received a wheelchair. Physical health domain in the World Health Organization Quality of Life-BREF improved significantly for women who received a wheelchair (p = 0.044) and environmental health improved significantly for women and men who received a wheelchair as compared to those on the waiting list (p < 0.017). Satisfaction with the mobility device improved significantly for Adults with proxies and Children with proxies as compared to the waiting list (p < 0.022). Only 11 % of Adults who received a wheelchair reported being able to perform a "wheelie". The condition of Roughrider wheelchairs was significantly better than the condition of kids wheelchairs for Children with proxies as measured by the Wheelchair Assessment Checklist (p = 0.019). Conclusions: Wheelchair provision according to World Health Organization's 8-Steps in a less-resourced setting has a range of positive outcomes including increased satisfaction with the mobility device and better quality of life. Wheelchair provision service could be improved by providing more hours of wheelchair skills training. There is a need for outcome measures that are validated across cultures and languages

Motion-Based Video Games for Older Adults in Long-Term Care

Older adults in residential care often lead sedentary lifestyles despite physical and cognitive activities being crucial for their well-being. Care facilities face the challenge of encouraging their residents to participate in leisure activities, but as the impact of age-related changes grows, few activities remain accessible. Video games in general – and motion-based games in particular – hold the promise of providing mental, physical and social stimulation for older adults. However, the accessibility of commercially available games for older adults is not considered during the development process. Therefore, many older adults are unable to obtain any of the benefits. In my dissertation, this issue is addressed through the development of motion-based game controls that specifically address the needs of older adults. The first part of this thesis lays the foundation by providing an overview of motion-based game interaction for older adults. The second part demonstrates the general feasibility of motion-based game controls for older adults, develops full-body motion-based and wheelchair-based game controls, and provides guidelines for accessible motion-based game interaction for institutionalized older adults. The third part of this thesis builds on these results and presents two case studies. Motion-based controls are applied and further evaluated in game design projects addressing the special needs of older adults in long-term care, with the first case study focusing on long-term player engagement and the role of volunteers in care homes, and the second case study focusing on connecting older adults and caregivers through play. The results of this dissertation show that motion-based game controls can be designed to be accessible to institutionalized older adults. My work also shows that older adults enjoy engaging with motion-based games, and that such games have the potential of positively influencing them by providing a physically and mentally stimulating leisure activity. Furthermore, results from the case studies reveal the benefits and limitations of computer games in long-term care. Fostering inclusive efforts in game design and ensuring that motion-based video games are accessible to broad audiences is an important step toward allowing all players to obtain the full benefits of games, thereby contributing to the quality of life of diverse audiences

Development, Validation and Feasibility Study of a Remote Basic Skills Assessment for Wheelchair Service Providers

The purpose of this study was to develop, validate and conduct a feasibility study of three remote basic skills assessment modalities for wheelchair service providers (WSP) including an online mock-client case study quiz (m1), an in-person skills assessment (m2) and a video conference skills assessment (m3). Prior to this study, we were unaware of a validated remote basic skills assessment for WSP that reflects all WHO 8 wheelchair service provision steps. Such a test may be an asset to training or professional organizations like the International Society of Wheelchair Professionals (ISWP) as a way to test provider competency or to warrant certification. Currently, we are unaware of any certification that includes a skills test as a requirement. Our first hypothesis was that all three modalities are comparable as evidenced by the mean score of ISWP Basic Knowledge Test (i.e., within one SD). Our second hypothesis was that all modalities were feasible according to seven defined feasibility criteria. Inclusion criteria included passing the ISWP Basic Knowledge Test. We recruited a total of 12 participants; all completed m1. Five completed m2 at the 35th International Seating Symposium and five completed m3 via Adobe Connect. Two participants dropped out of the study prior to completing a second testing modality. The results show that our first hypothesis was rejected because only m1 mean score was comparable to the ISWP Basic Knowledge Test (SD = .44). This is in contrast with the Wilcoxon signed-rank test results that show a statistically significant difference between these two. Hypothesis two was not rejected. The feasibility results reveal that all three modalities met the minimum criteria (86% success). Thus, based on this finding, m1, 2 and 3 have the potential to serve as remote basic skills assessments through ISWP or other training or credentialing organizations. However, according to both test performance and feasibility criteria, the study team and participants encountered the fewest challenges with m2, and therefore, we believe this assessment has the highest potential to be included in the ISWP WSP basic skills certification process to ensure fidelity to practice

Toward a New Understanding of Maternal Self-Care During Family Crisis: Initiating a Shared Legacy of Strength and Hope

This narrative explores the author’s experience of suddenly ecoming a caregiver for a spouse while also caring for minor children. The author uses reflection and research to describe what she learned about self-care, how she integrated her needs with the needs of her children, and why prevailing concepts of self-care as an individual construct can undermine its effective conceptualization and practice. The importance of self-care for caregivers is well documented, as is the failure of most caregivers to successfully achieve it. This failure carries particular poignancy for mothers of minor children. Studies document the academic, social, and emotional challenges that children experience when families face the upheaval associated with serious health problems. The children’s need to navigate new ways of being within their families requires the support of their mother, which can be difficult if she becomes too overburdened by her caregiving role. Avoiding this cycle requires better education for families in caregiving situations and the adoption of a new understanding of self-care for mothers. This article combines the experiences of one family with research about caregivers, the effect of paternal brain injury on children, and typical recovery phases. It shares insights about the importance of modelling effective self-care as a healthy maternal legacy

Occupational Therapy Caregiver\u27s Guide to Spinal Cord Injury

In 2006, it was estimated that there were 253,000 Americans living with spinal cord injuries (SCI) (Spinal Cord Injury Information Network, 2003, p. 1). Current literature suggests that individuals are transitioning into the community earlier with the majority of care being provided by informal caregivers (Boschen, Tonack, & Gargaro, 2005). These caregivers are often unprepared for the major role they will be assuming in the care of their loved one and often their health and well-being is compromised due to the overwhelming nature of caregiving. A comprehensive literature review was conducted to explore and identify the needs of caregivers. Topics researched included spinal cord injury (SCI), treatments, caregiving, caregiver needs and interventions, and caregiver resources. In addition, the literature was reviewed regarding best practice strategies to deal with the changing needs and lifestyles the family may experience. The literature review revealed that there were few resources examining caregivers of individuals with SCI, many of the needs of the caregiver were identified and shown to be underserved. Based upon the literature review, the Occupational Therapy Caregiver\u27s Guide to Spinal Cord Injll1Y has been developed to assist caregivers in performing their new role of primary caregiver. It provides them with information on basic patient care guidelines as well as information on the caregiver\u27s physical and psychosocial wellbeing. The guide also provides the caregiver with information on the importance of continuing their prior occupations along with their new occupations. Lastly, the guide will provide the caregiver with a list of resources that may be useful in trying times such as the benefits of respite care. The authors hope that the guide will begin to bridge the gap faced by caregivers of individuals with spinal cord injury. It is hoped that unifying the resources and strategies in the guide will decrease the caregivers stress so he or she can be in a more healthy and supportive role during the recovery process

Representações sociais da cadeira de rodas para a pessoa com lesão da medula espinhal

In seeking to understand the social representation of the use of the wheelchair through the analysis of interviews with ten people who have suffered spinal cord injury, the construction of five representations was elaborated. The phenomenon experienced regarding the wheelchair provided a route of meanings and symbologies: essential equipment, after the person perceive the inability to walk; a symbol of disability when the person experienced functional dependence; means of locomotion and transport after the rescue of their potential functional; becoming an integral part or all of their body and, finally, the concept of autonomy on four wheels by adjusting to their new ability to walk emerges. The wheelchair as an extension of the modified body for spinal cord injury, returns them the right of locomotion, presents them not only with autonomy for various acts of life, but also restores their dignity, so essential to human life.Buscando comprender la representación social del uso de la silla de ruedas a través del análisis de entrevistas con diez personas que sufrieron lesión de la médula espinal, elaboramos la construcción de cinco representaciones. El fenómeno experimentado sobre la silla de ruedas posibilitó una trayectoria de significados y simbologías: es un equipamiento indispensable, después de la persona percibir la incapacidad para andar; es símbolo de deficiencia, cuando siente la dependencia funcional; es un medio de locomoción y transporte, después del rescate de sus potenciales funcionales; pasa a integrar parte de su cuerpo; y por último, emerge la concepción de autonomía bajo cuatro ruedas, al adaptarse a su nueva capacidad de locomoción. La silla de ruedas como extensión del cuerpo modificado por la lesión medular, al devolverle el derecho de locomoción, le ofrece autonomía para varios actos de la vida y le devuelve la dignidad, tan esencial a la vida humana.Na busca por compreender a representação social do uso da cadeira de rodas, através da análise de entrevistas com dez pessoas que sofreram lesão da medula espinhal, elaborou-se a construção de cinco representações. O fenômeno vivenciado sobre a cadeira de rodas possibilitou uma trajetória de significados e simbologias: equipamento indispensável, após a pessoa perceber a incapacidade para andar, símbolo de deficiência quando vivencia a dependência funcional; meio de locomoção e transporte após o resgate de seus potenciais funcionais, passa a integralizar parte ou todo o seu corpo e, por fim, emerge a concepção de autonomia sob quatro rodas, pela adaptação à sua nova capacidade de locomoção. A cadeira de rodas, como extensão do corpo modificado pela lesão medular, ao devolver-lhe o direito de locomoção, presenteia-o não só com a autonomia para vários atos da vida, como lhe devolve a dignidade, tão essencial à vida humana

Patients, Partners, and Practitioners: Interactions and Meaning- Making Following Spinal Cord Injury

Sustaining a Spinal Cord Injury at any point in time is life altering – physically, emotionally, and financially – for all persons affected by the injury, but it can place unique challenges on younger married couples. This study examines the transition to injury for 18 couples (ages 21-55). Data were collected using individual interviews with each partner at three time points following injury, as well as observation in the rehabilitation setting (Creekview). This resulted in 96 individual interviews and 300 hours of observation. Using a combination of the life course perspective and cognitive sociology as guiding theoretical frameworks and grounded theory analysis, I examined how the health care institution influenced the couples’ relationships during their rehabilitation stay and the subsequent transition home. Overall, this study found that Creekview shaped a thought community that emphasizes a return to walking and high levels of physical recovery. Patients who achieved these goals constructed positive narratives about the future while those with lower levels of recovery constructed negative narratives over time. Additionally, because of the dominant medical narrative of wait and see regarding physical recovery, many respondents constructed fuzzy narratives about the future that reflect ambiguity about what life would look like following injury. Additionally, Creekview staff and couples accepted and reinforced the dominant cultural narrative that women are natural caregivers, but larger social structures of class, gender, and the division of paid and unpaid labor work together to push some women into caregiving faster or prevent other women from engaging in caregiving. Expanding on Aneshensel et al.’s (1995) caregiving career, this study examines how younger couples move through the caregiving career when the expected outcome is not long-term care placement or death. This study identified three main types of caregivers, each with their own path of caregiving – Naturalized, Constrained, and Resistant caregivers. Overall, the transition to injury is complex for patients and partners and this study highlights some of the ways the marital relationship is affected by a non-normative, unexpected transition