Laurence Clift

Assessing service delivery systems for assistive technology in Brazil using HEART study quality indicators

BACKGROUND: recently in Brazil, there have been investments and improvements in the service delivery system for assistive technology provision. However, there is little documentation of this process, or evidence that users are being involved appropriately. OBJECTIVE: to understand how assistive technology service provision currently functions in Belo Horizonte city, Brazil, in order to provide context-specific interventions and recommendations to improve services. METHOD: Qualitative research design, including visits to key institutions and semi-structured interviews with key stakeholders. Interview questions were divided with two purposes: 1) Exploratory, aiming to understand present service functioning; 2) Evaluative, aiming to assess staff difficulties in applying best existing best practices. RESULTS: Assistive Technology services in Belo Horizonte fall under the ‘medical model’ definition of service delivery developed by AAATE. It was also found that staff lack training and knowledge support to assess user requirements and involve them during the decision process. Additionally, there is no follow up stage after the device is delivered. CONCLUSIONS: The study clearly defines the service provision function and the staff difficulties at Belo Horizonte city, providing information for further studies.

How reasonable is reasonable use? The search for safer stepladders

Stepladder accidents continue to be a major cause of injury at home and at work. Despite this, few changes have been seen in their design or their labelling. Many of the accidents occurring appear to be whilst the stepladder is being utilised in a manner which the user considers reasonable, but the manufacturer considers abuse. This work, sponsored by the Health and Safety Executive, investigates whether this mismatch can be eliminated in order to improve safety. The research combines user profiling with dynamic trials to establish what behaviour stepladders need to sustain. Through innovative measuring techniques, the demands on the stepladder system are quantified and the margin of safety calculated. Extensive dynamic trials generated data for over 4000 user, stepladder and task combinations. Individuals were given demanding tasks, but permitted to undertake them in a manner they considered reasonable and the resulting data can be considered as representative of the demands they would place on stepladders in everyday use. From this data, the stepladder and user system has been modelled, allowing manipulation of the stepladder parameters such that a virtual stepladder can be created which provides sufficient stability to tolerate all reasonably foreseeable use. In addition this model is used to generate predictive software which can determine the level of safety provided by real, or theoretical, stepladders. In conclusion, a specification for a simple test is given which could be routinely conducted to determine whether any given stepladder will offer the minimum level of stability considered necessary for safe use.

Evaluating the fit of operating theatre tables – using basic ergonomics to help improve procurement of medical technology:

This paper discusses an appraisal of the fit of operating theatre tables to the surgical staff who have to use them. In total 55 tables were evaluated in 70 configurations. By identifying the ethnic profile of the surgical population, appropriate anthropometric data was obtained which provided a user-centred focus for the evaluation. Using basic dimensional data the range of adjustment of the height of each table was scrutinised to see if it was appropriate to accommodate the needs of the user in terms of reach for open and laparoscopic surgery as well as sight lines. It was found that the majority of tables failed to provide adequate adjustment to accommodate the needs of the users, with smaller users suffering the poorest fit. By converting the data comparison to a simple star rating scheme, a relatively complex ergonomic investigation could be made readily available to procurement professionals and help guide them into appropriate choices to enable them to secure best value in equipment selection and help prevent ongoing occupational ill health.

Consumers and self-assembly products: problems and solutions

Abstract Children sometimes have accidents when using large items of play equipment, and whilst many are due to poor design or lack of supervision, some are due to inadequate or incorrect assembly. OBJECTIVES To examine the possibility of incorrect assembly and identify the consequences of errors and the resultant increase in hazards. METHODS The study collected accident statistics, surveyed the market and reviewed the literature. A variety of equipment was purchased and the instructions evaluated. Finally, trials with users were completed where the assembly procedure, time taken, errors made and subjective ratings were recorded. RESULTS Little literature was found but accident data from the UK, US and Australia showed minor injuries possibly attributable to assembling the product. Expert appraisals were conducted on 40 products to assess the instructions, assembly process and design, as well as the hazards presented during assembly and in use. Trials involving 100 representative subjects allowed observat...