Frank DeRuyter

Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association

Purpose— The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke. Methods— Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council’s Scientific Statement Oversight Committee and the AHA’s Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through 2014. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal and external peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. Results— Stroke rehabilitation requires a sustained and coordinated effort from a large team, including the patient and his or her goals, family and friends, other caregivers (eg, personal care attendants), physicians, nurses, physical and occupational therapists, speech-language pathologists, recreation therapists, psychologists, nutritionists, social workers, and others. Communication and coordination among these team members are paramount in maximizing the effectiveness and efficiency of rehabilitation and underlie this entire guideline. Without communication and coordination, isolated efforts to rehabilitate the stroke survivor are unlikely to achieve their full potential. Conclusions— As systems of care evolve in response to healthcare reform efforts, postacute care and rehabilitation are often considered a costly area of care to be trimmed but without recognition of their clinical impact and ability to reduce the risk of downstream medical morbidity resulting from immobility, depression, loss of autonomy, and reduced functional independence. The provision of comprehensive rehabilitation programs with adequate resources, dose, and duration is an essential aspect of stroke care and should be a priority in these redesign efforts. (Stroke.2016;47:e98-e169. DOI: 10.1161/STR.0000000000000098.)

Using mobile phones to write in air

Numerous sensors in modern mobile phones enable a range of people-centric applications. This paper envisions a system called PhonePoint Pen that uses the in-built accelerometer in mobile phones to recognize human writing. By holding the phone like a pen, a user should be able to write short messages or draw simple diagrams in the air. The acceleration due to hand gestures can be translated into geometric strokes, and recognized as characters. We prototype the PhonePoint Pen on the Nokia N95 platform, and evaluate it through real users. Results show that English characters can be identified with an average accuracy of 91.9%, if the users conform to a few reasonable constraints. Future work is focused on refining the prototype, with the goal of offering a new user-experience that complements keyboards and touch-screens.

Evaluating Outcomes in Assistive Technology: Do We Understand the Commitment?

Evaluating assistive technology (AT) services to demonstrate quality or to measure outcomes is the ethical obligation of the entire AT community. Accountability must be accepted by all stakeholders in order to evaluate all aspects of service delivery. Developing an integrated system will require addressing issues that the AT community has not previously had to face. These challenges have been highlighted.

Psychometric and Administrative Properties of Measures Used in Assistive Technology Device Outcomes Research

Although there have been numerous calls for increasing the quantity and quality of assistive technology outcomes research, no one has analyzed the nature of data that the field has been accumulating. This article summarizes our evaluation of 82 outcome studies, published between 1980 and 2001, addressing assistive technology devices (ATDs). Our data indicate that the “typical” ATD outcomes study published in the past 20 years is one that (a) used a sample population that was diverse in terms of age, disability population, and type of ATD being used; (b) measured user-reported dependent variables with instruments designed specifically for the study; (c) did not report adequate information on the reliability and validity for the measurement instruments that were used; (d) did not discuss the staff workload associated with learning, administering, and scoring its data collection tools; and (e) did not differentiate its findings in terms of distinguishable participant subgroups. Several suggestions are provided to guide future development of assistive technology outcome measures in the domains of usability, quality of life, and social role performance. In addition, seven recommendations are offered to outcomes researchers, policy makers, journal editors, and reviewers in order to improve the reporting of assistive technology outcomes research.

Powered Mobility for Middle-aged and Older Adults: Systematic Review of Outcomes and Appraisal of Published Evidence

Auger C, Demers L, Gélinas I, Jutai J, Fuhrer MJ, DeRuyter F: Powered mobility for middle-aged and older adults: systematic review of outcomes and appraisal of published evidence. Am J Phys Med Rehabil 2008;87:666–680. Objective:To identify the outcomes of power mobility devices for middle-aged and older adult users, and to critically appraise the research evidence. Design:Systematic review of primary source studies involving adults aged 50 and over using power mobility devices (1996–2007). Articles were (i) mapped to the Taxonomy of Assistive Technology Device Outcomes, which describes categories of impact of assistive devices from the vantages of effectiveness, social significance, and subjective well-being; and (ii) appraised using the Grading of Recommendations, Assessment, Development, and Evaluation criteria. Results:This review retained 19 studies and identified 52 different categories of impacts of power mobility devices spanning the three vantages of the taxonomy. The coverage of outcome dimensions was not as extensive for adults age 50 and over as it was for mixed-age groups. Most of the research designs were assigned very low evidence grades. Three studies were low to moderate in quality of evidence, among which one was a randomized trial. Conclusions:A vast array of potential impacts of powered mobility devices have been described in the last decade. The level of quality of this evidence is improving, but most of these studies were not designed to verify causal relationships, and this is largely responsible for the absence of unequivocal evidence for directly attributing benefits to devices themselves and for quantifying relationships between power mobility device intervention and outcome. To raise the level of evidence about power mobility device interventions in older adults, studies are needed that use prospective designs, better-defined user groups, and well-grounded conceptual frameworks for measuring interventions and outcomes.

Using AAC Technology to Access the World

ABSTRACT This paper describes the monumental shift in the nature of augmentative and alternative communication (AAC) access that has occurred over the past three decades. In its earliest days AAC technology was directed at enabling interpersonal face-to-face interactions mainly for persons with physical impairment. Contemporary AAC access attempts to mirror the access needs of a broader population. Accordingly AAC access to todays mainstream technologies expands the focus from interpersonal communication to access of information and services over the expanding World Wide Web. With this expanded view comes a new range of challenges and opportunities. At the same time AAC has expanded its reach to include more people with a wider range of complex communication needs.

Enhancing AAC connections with the world

The availability of new technologies has changed how we control devices, exchange information, and communicate with others. Significant barriers, however, have prevented many individuals who use augmentative and alternative communication (AAC) from accessing the technology and computer-based activities available in todays “Information Society.” In this paper we discuss the benefits and challenges to increased interoperability between AAC and mainstream technologies. We outline suggested roles and activities for six stakeholder groups: (a) individuals who use AAC, (b) individuals who assist in selecting and supporting use of AAC devices, (c) AAC researchers, (d) AAC device manufacturers, (e) mainstream application developers and technology manufacturers, and (f) public policy makers. We also provide suggestions for future research, public policy, and technical development.

Development of a French-Canadian version of the Life-Space Assessment (LSA-F): content validity, reliability and applicability for power mobility device users

Purpose. To examine the measurement properties of the French-Canadian version of the Life-Space Assessment questionnaire (LSA-F) for power mobility device (PMD) users. Methods. Content validity, test–retest reliability of telephone interviews (2-week interval) and applicability were examined with PMD users presenting neurological, orthopedic or medically complex conditions. Translation/back-translation from English to French and cultural adaptation was performed and pretested with five bilingual users. Test–retest reliability was examined with 40 French-speaking users, age 50 and over, who had been using a subsidised PMD for 2–15 months. Audio-taped interviews were coded to judge content validity and applicability. Results. Content validity results confirmed equivalent meaning for most questions. The test–retest reliability was excellent for the composite score (intra-class correlation coefficient = 0.87) and revealed moderate to substantial concordance for 18/20 items (k = 0.47–0.73; Pa > 57.5%). The applicability of the LSA-F is satisfactory considering an acceptable burden of assessment, low refusal of the telephone interview format (8%; n = 4), reasonable administration time (9.2 ± 3.9 min) and a normally distributed composite score. Conclusions. The LSA-F is a valid measure with regards to its content, stable over a period of 2 weeks and applicable for a population of middle-aged and older French-Canadian speaking adults who use PMDs.

Effects of an assistive technology intervention on older adults with disabilities and their informal caregivers: an exploratory randomized controlled trial.

ObjectiveThe aim of this study was to demonstrate experimentally that an assistive technology (AT) intervention improves older AT users’ activity performance and satisfaction with activity performance and decreases their caregivers’ sense of burden. DesignThis study was a delayed intervention, randomized control trial. Baseline data were collected on 44 community-dwelling AT user-caregiver dyads in Vancouver, British Columbia, and Montreal, Quebec. The primary outcome measures for AT users were the satisfaction and accomplishment scales from the Assessment of Life Habits. The primary outcome measure for caregivers was the Caregiver Assistive Technology Outcome Measure, which assessed burden associated with dyad-identified problematic activities. ResultsAfter the intervention, assistance users in the immediate intervention group reported significantly increased satisfaction with activity performance (P < 0.001) and improved accomplishment scores (P = 0.014). Informal caregivers in the immediate intervention group experienced significantly decreased burden with the dyad-identified problematic activity (P = 0.013). Participants in the delayed intervention group experienced similar benefits after the intervention. Improvements for both groups were mostly maintained 4 mos after the conclusion of the intervention. ConclusionsThis is the first experimental study to demonstrate that the provision of AT decreases caregiver burden. If confirmed and extended by subsequent research, the findings have significant policy and practice implications and may enable health care providers to advocate for improved access to AT provision and the related follow-up services.

How assistive technology use by individuals with disabilities impacts their caregivers: a systematic review of the research evidence.

ABSTRACTInformal caregivers are a critical yet frequently unacknowledged part of the healthcare system. It is commonly presumed that providing assistive technology will decrease the burden of their care provision; however, no review has evaluated the evidence behind this assumption. Therefore, a systematic review was undertaken to evaluate evidence of the impact of assistive technology use by care recipients on their informal caregivers. Data sources included EMBASE, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Web of Science, PsychINFO, PubMed, and active researchers in this area. Twenty-two studies met the specified inclusion criteria. Collectively, the findings suggest that assistive technology use helps caregivers by diminishing some of the physical and emotional effort entailed in supporting individuals with disability. However, confidence in this causal connection is limited because of the study designs that were used. This undermines the understanding of the impacts of assistive technology use on the users’ informal caregivers.