Smartphone accessibility: Understanding the lived experience of users with cervical spinal cord injuries

Purpose: To explore accessibility challenges encountered by smartphone users with cervical spinal cord injuries (C1-C8).To investigate the suitability of current technology and make recommendations to help future technology meet user needs. Methods: The study uses a mixed-method approach combining an inductive thematic analysis of nine semi-structured interviews with a quantitative analysis of thirty-nine questionnaires. Results: The analysis generated four themes: ’the drive for independence and self-efficacy’; ’trying to make it work’; ’getting the right technology for me’; ’using the phone as and when I want to’. These themes highlighted how unresolved access issues and situational barriers limited independence and created unwanted privacy compromises for effective communication. There was a lack of information or support on available smartphone accessibility features and assistive technology (AT). Smartphone AT was regarded as overpriced, poorly designed and lacking the voices of people with disabilities. Conclusions: The smartphone’s potential to improve quality of life, participation, and well-being is limited by accessibility challenges hindering independent and private smartphone use. Future design work should focus on improving accessibility, investigating reasons for AT’s poor quality and high cost, and removing barriers to end-user inclusion. To enhance user awareness of available technology, stakeholders should build and maintain an open platform to act as an information source for peer and professional support on assistive technology

Acceptance of Assistive Technology by Users with Motor Disabilities Due to Spinal Cord or Acquired Brain Injuries: A Systematic Review

: Acquired motor limits can be provoked by neurological lesions. Independently of the aetiologies, the lesions require patients to develop new coping strategies and adapt to the changed motor functionalities. In all of these occasions, what is defined as an assistive technology (AT) may represent a promising solution. The present work is a systematic review of the scientific AT-related literature published in the PubMed, Cinahl, and Psychinfo databases up to September 2022. This review was undertaken to summarise how the acceptance of AT is assessed in people with motor deficits due to neurological lesions. We review papers that (1) dealt with adults (≥18 years old) with motor deficits due to spinal cord or acquired brain injuries and (2) concerned user acceptance of hard AT. A total of 615 studies emerged, and 18 articles were reviewed according to the criteria. The constructs used to assess users' acceptance mainly entail people's satisfaction, ease of use, safety and comfort. Moreover, the acceptance constructs varied as a function of participants' injury severity. Despite the heterogeneity, acceptability was mainly ascertained through pilot and usability studies in laboratory settings. Furthermore, ad-hoc questionnaires and qualitative methods were preferred to unstandardized protocols of measurement. This review highlights the way in which people living with acquired motor limits greatly appreciate ATs. On the other hand, methodological heterogeneity indicates that evaluation protocols should be systematized and finely tuned

Multicentric investigation on the safety, feasibility and usability of the ABLE lower-limb robotic exoskeleton for individuals with spinal cord injury : a framework towards the standardisation of clinical evaluations

Robotic lower-limb exoskeletons have the potential to provide additional clinical benefits for persons with spinal cord injury (SCI). However, high variability between protocols does not allow the comparison of study results on safety and feasibility between different exoskeletons. We therefore incorporated key aspects from previous studies into our study protocol and accordingly conducted a multicentre study investigating the safety, feasibility and usability of the ABLE Exoskeleton in clinical settings. In this prospective pretest-posttest quasi-experimental study across two SCI centres in Germany and Spain, in- and outpatients with SCI were recruited into a 12-session training and assessment protocol, utilising the ABLE Exoskeleton. A follow-up visit after 4 weeks was included to assess after-training outcomes. Safety outcomes (device-related adverse events (AEs), number of drop-outs), feasibility and usability measures (level of assistance, donning/doffing-time) were recorded at every session together with changes in gait parameters and function. Patient-reported outcome measures including the rate of perceived exertion (RPE) and the psychosocial impact of the device were performed. Satisfaction with the device was evaluated in both participants and therapists. All 24 participants (45 ± 12 years), with mainly subacute SCI (< 1 year after injury) from C5 to L3, (ASIA Impairment Scale A to D) completed the follow-up. In 242 training sessions, 8 device-related AEs (pain and skin lesions) were reported. Total time for don and doff was 6:50 ± 2:50 min. Improvements in level of assistance and gait parameters (time, steps, distance and speed, p < 0.05) were observed in all participants. Walking function and RPE improved in participants able to complete walking tests with (n = 9) and without (n = 6) the device at study start (p < 0.05). A positive psychosocial impact of the exoskeleton was reported and the satisfaction with the device was good, with best ratings in safety (participants), weight (therapists), durability and dimensions (both). Our study results prove the feasibility of safe gait training with the ABLE Exoskeleton in hospital settings for persons with SCI, with improved clinical outcomes after training. Our study protocol allowed for consistent comparison of the results with other exoskeleton trials and can serve as a future framework towards the standardisation of early clinical evaluations. Trial Registration , DRKS00023503, retrospectively registered on November 18, 2020. The online version contains supplementary material available at 10.1186/s12984-023-01165-0

The impact of assistive living technology on perceived independence of people with a physical disability in executing daily activities:A systematic review

PurposePeople with physical disabilities often require lifetime support and experience challenges to maintain or (re)define their level of independence. Assistive living technologies (ALT) are promising to increase independent living and execution of activities of daily living (ADL). This paper provides a systematic literature review that aims to analyse the present state of the literature about the impact of ALT on perceived independence of people with a physical disability receiving long-term care. Materials and methodsDatabases Embase, Medline, and Web of Science were searched for eligible studies from 2010 or later. ResultsNine studies were included, of which seven qualitative, one quantitative, and one mixed methods. Quality was generally high. ALT enabled participants to execute ADL. We found six themes for the impact of ALT on perceived independence: feeling enabled, choice and control, feeling secure, time alone, feeling less needy, and participation. ConclusionsALT appears to impact perceived independence in many ways, exceeding merely the executional aspect of independence. Existing research is limited and quite one-sided. More large-scale studies are needed in order to inform care organisations how to implement ALT, especially considering societal developments and challenges impacting long-term care

Combining brain-computer interfaces and assistive technologies: state-of-the-art and challenges

In recent years, new research has brought the field of EEG-based Brain-Computer Interfacing (BCI) out of its infancy and into a phase of relative maturity through many demonstrated prototypes such as brain-controlled wheelchairs, keyboards, and computer games. With this proof-of-concept phase in the past, the time is now ripe to focus on the development of practical BCI technologies that can be brought out of the lab and into real-world applications. In particular, we focus on the prospect of improving the lives of countless disabled individuals through a combination of BCI technology with existing assistive technologies (AT). In pursuit of more practical BCIs for use outside of the lab, in this paper, we identify four application areas where disabled individuals could greatly benefit from advancements in BCI technology, namely,“Communication and Control”, “Motor Substitution”, “Entertainment”, and “Motor Recovery”. We review the current state of the art and possible future developments, while discussing the main research issues in these four areas. In particular, we expect the most progress in the development of technologies such as hybrid BCI architectures, user-machine adaptation algorithms, the exploitation of users’ mental states for BCI reliability and confidence measures, the incorporation of principles in human-computer interaction (HCI) to improve BCI usability, and the development of novel BCI technology including better EEG devices

Social Construction of Technical Aids - Personal Meaning and Interactional Effects of Disability and Assistive Devices in Everyday Life

This thesis concerns the role of disability and assistive devices in everyday life among persons with, for instance, impairments related to mobility (e.g. wheelchair users) and bodily shape and configuration (e.g. dysmelia). Assistive devices are seen as both includators (assisting participation and emancipation) and excludators (limiting participation, restraining empowerment, and stigmatizing). Perspectives include, for instance, stigmatisation, body-image, coping, empowerment, agency, motivation, needs, and everyday life. Use of assistive devices is discussed from the ValMO-model: Value and Meaning in Human Occupations. The discussion concerns the useworthiness, as opposed to usability, of assistive devices from a perspective of not only physics-based effectiveness (Newton), but also from a self-image and agency perspective based on habitus (Bourdieu). In study I, the experience of prescription of active rigid-frame ultra light-weight wheelchairs was reported, using data on 278 prescribers in Sweden. Prescribers emphasised self-image, design, appearance and aesthetics. Even though prescribers want to prescribe an optimal wheelchair, they may lack the possibility to do so due to: (1) lack of practice and specialized knowl-edge; and (2) narrow regulations, both pertaining to municipal political decisions. Study II describes the experience of active wheelchairs and societal provision thereof utilizing thematic qualitative content analysis of eleven interviews with experienced users in Sweden. Results showed users experiencing injustice and unfairness negoti-ating wheelchair needs in terms of physical and social functioning (agency); changes of attitudes/organization are suggested. Study III was grounded theory study that showed an adaptation of stigma-handling strategies to situations in everyday life by women aged 20 to 30 with dysmelia, i.e. upper limb reduction deficiency. Strategies were comprehensive patterns of action aimed at controlling information about one’s status as deviating from a contextual normality. A proofing or being attitude consti-tuted a contextual adaptation understood in terms of a concealing or revealing tactic, aiming at delaying or promoting exposure to contextual attitudes and possible prejudices. If exposure was delayed, a person with dysmelia blended in. Exposure could be voluntary or imposed. After exposure, the relative importance of TULRD in the specific context could decrease, thus a boost of an amplification or altering of the attitude, i.e. boost was the interactional outcome enforcing the choice of strategy in another context

User Based Development and Test of the EXOTIC Exoskeleton:Empowering Individuals with Tetraplegia Using a Compact, Versatile, 5-DoF Upper Limb Exoskeleton Controlled through Intelligent Semi-Automated Shared Tongue Control

This paper presents the EXOTIC- a novel assistive upper limb exoskeleton for individuals with complete functional tetraplegia that provides an unprecedented level of versatility and control. The current literature on exoskeletons mainly focuses on the basic technical aspects of exoskeleton design and control while the context in which these exoskeletons should function is less or not prioritized even though it poses important technical requirements. We considered all sources of design requirements, from the basic technical functions to the real-world practical application. The EXOTIC features: (1) a compact, safe, wheelchair-mountable, easy to don and doff exoskeleton capable of facilitating multiple highly desired activities of daily living for individuals with tetraplegia; (2) a semi-automated computer vision guidance system that can be enabled by the user when relevant; (3) a tongue control interface allowing for full, volitional, and continuous control over all possible motions of the exoskeleton. The EXOTIC was tested on ten able-bodied individuals and three users with tetraplegia caused by spinal cord injury. During the tests the EXOTIC succeeded in fully assisting tasks such as drinking and picking up snacks, even for users with complete functional tetraplegia and the need for a ventilator. The users confirmed the usability of the EXOTIC

Comparing walking with knee-ankle-foot orthoses and a knee-powered exoskeleton after spinal cord injury: a randomized, crossover clinical trial

Recovering the ability to stand and walk independently can have numerous health benefits for people with spinal cord injury (SCI). Wearable exoskeletons are being considered as a promising alternative to conventional knee-ankle-foot orthoses (KAFOs) for gait training and assisting functional mobility. However, comparisons between these two types of devices in terms of gait biomechanics and energetics have been limited. Through a randomized, crossover clinical trial, this study compared the use of a knee-powered lower limb exoskeleton (the ABLE Exoskeleton) against passive orthoses, which are the current standard of care for verticalization and gait ambulation outside the clinical setting in people with SCI. Ten patients with SCI completed a 10-session gait training program with each device followed by user satisfaction questionnaires. Walking with the ABLE Exoskeleton improved gait kinematics compared to the KAFOs, providing a more physiological gait pattern with less compensatory movements (38% reduction of circumduction, 25% increase of step length, 29% improvement in weight shifting). However, participants did not exhibit significantly better results in walking performance for the standard clinical tests (Timed Up and Go, 10-m Walk Test, and 6-min Walk Test), nor significant reductions in energy consumption. These results suggest that providing powered assistance only on the knee joints is not enough to significantly reduce the energy consumption required by people with SCI to walk compared to passive orthoses. Active assistance on the hip or ankle joints seems necessary to achieve this outcome.Peer ReviewedPostprint (published version

Learning new movements after paralysis: Results from a home-based study

open8siBody-machine interfaces (BMIs) decode upper-body motion for operating devices, such as computers and wheelchairs. We developed a low-cost portable BMI for survivors of cervical spinal cord injury and investigated it as a means to support personalized assistance and therapy within the home environment. Depending on the specific impairment of each participant, we modified the interface gains to restore a higher level of upper body mobility. The use of the BMI over one month led to increased range of motion and force at the shoulders in chronic survivors. Concurrently, subjects learned to reorganize their body motions as they practiced the control of a computer cursor to perform different tasks and games. The BMI allowed subjects to generate any movement of the cursor with different motions of their body. Through practice subjects demonstrated a tendency to increase the similarity between the body motions used to control the cursor in distinct tasks. Nevertheless, by the end of learning, some significant and persistent differences appeared to persist. This suggests the ability of the central nervous system to concurrently learn operating the BMI while exploiting the possibility to adapt the available mobility to the specific spatio-temporal requirements of each task.openPierella, Camilla; Abdollahi, Farnaz; Thorp, Elias; Farshchiansadegh, Ali; Pedersen, Jessica; Seanez-Gonzalez, Ismael; Mussa-Ivaldi, Ferdinando A.; Casadio, MauraPierella, Camilla; Abdollahi, Farnaz; Thorp, Elias; Farshchiansadegh, Ali; Pedersen, Jessica; Seanez-Gonzalez, Ismael; Mussa-Ivaldi, Ferdinando A.; Casadio, Maur