Roger O. Smith

Measuring the outcomes of assistive technology: challenge and innovation.

Documenting outcomes is becoming an essential function in assistive technology. Successfully documenting outcomes, however, depends on having appropriate measurement instruments and methodologies available. This is a challenge, as few measures are available which target the measurement of assistive technology outcomes. New instrumentation and approaches may need to be created or older measures radically adapted for assistive technology applications. This paper reviews measurement issues specifically relevant to assistive technology outcomes assessment. Many of the issues relate to measurement theory, as it is important to understand how instruments based on traditional psychometric concepts may not be the most appropriate for applications of assistive technology outcomes assessment. Fortunately, the assistive technology field also has innovative ideas being developed and tested. These may hold some promise as we all pursue better ways to document the outcomes of our assistive technology devices and services.

Consumer perspectives on assistive technology outcomes

Abstract Purpose: The current study explored domains of assistive technology (AT) device outcomes that are most valued by AT users. A secondary objective was to identify elements in the device acquisition process that affect outcomes. Method: Focus groups were conducted at geographically dispersed locations within the USA. The groups were moderated by experienced AT practitioners who followed a detailed procedure emphasizing a nominal group facilitation technique. Results: Twenty-four adult AT users, representing a range of ages and disability populations, participated in four focus groups. Many had over 15 years of experience with multiple device types. Qualitative analysis yielded 13 threads that embodied salient outcome domains (e.g. independence, subjective well-being, participation in work and school, cost-effectiveness) and key factors associated with the device acquisition process (e.g. lengthy periods of frustration, variable quality of service providers). Ironically, these data were evoked only after the term “outcomes” was omitted from focus group questions. Conclusions: AT outcomes studies are needed that report data regarding (a) the impact of AT on participation, (b) costs of AT provision and (c) key elements in the AT service delivery process. Future studies will be further strengthened to the extent that their methodologies actively assimilate consumer perspectives. Implications for Rehabilitation Consumers highly value the impact of AT devices on their independence, subjective well-being and participation in work and school. The process of acquiring assistive technology devices is often lengthy and frustrating for consumers. Future AT outcomes research should report descriptive data regarding service delivery processes, as well as long-term impacts for consumers. Practitioners and researchers should avoid the use of potentially confusing professional jargon when administering surveys to consumers.

Assistive technology in the measurement of rehabilitation and health outcomes: A review and analysis of instruments

Rust KL, Smith RO: Assistive technology in the measurement of rehabilitation and health outcomes: A review and analysis of instruments. Am J Phys Med Rehabil 2005;84:780–793. This article examines the scoring of assistive technology (AT) in health and rehabilitation outcome scales and delineates implications. Searches of MEDLINE, CINAHL, and PsychINFO databases and relevant functional assessment textbooks provided the basis for this investigation of 100 widely used health and rehabilitation outcomes instruments. Each of the 100 instruments was assessed to the nature and degree in which AT was included in the instrument scales, content, and scoring procedures. We classified instruments into categories according to the methods used to consider AT in the scoring. We found that 30% of the instruments ignored AT. When instruments included AT, 44% of the instruments lowered the score, 22% of the instruments allowed AT use for the highest score, and 4% of the instruments provided a mix. Analysis also revealed whether the 100 instruments isolated the effect of AT as a contribution to outcome. The results indicate that rehabilitation and health outcomes instruments inconsistently consider AT as an intervention for people with disabilities. This inconsistency in scoring leads to muddled and potentially invalid assessments of rehabilitation outcomes. Due to the common concurrent use of AT in rehabilitation intervention, if AT use is not documented or controlled within outcomes study research designs or by the instrumentation, the outcomes of any targeted intervention may be confounded by the contribution of AT in the overall assessment of the persons function, participation, or quality of life.

Measuring Assistive Technology Outcomes in Education.

Providing assistive technology in educational settings can be a positive educational intervention. However, it is often difficult to measure assistive technology outcomes because interventions possess many attributes, outcomes affect many domains, and few measurement instruments are available. This paper reviews relevant theory and the practical implications of measuring assistive technology outcomes. Investigations and resources relating to assistive technology not often found in educational literature are also reviewed and future research directions are recommended.

A multi-sensor approach for fall risk prediction and prevention in elderly

Scientific research on smartphone-based fall detection systems has recently been stimulated due to the growing elderly population and their risk of falls. Even though these systems are helpful for fall detection, the best way to reduce the number of falls and their consequences is to predict and prevent them from happening in the first place. To address the issue of fall prevention, in this paper, we propose a fall prediction system by integrating the sensor data of smartphones with a smartshoe. In our previous research, we designed and implemented a pair of sensing shoes (smartshoe) that contained four pressure sensors with a Wi-Fi communication module in each shoe to unobtrusively collect data in any environment. After assimilating the smartshoe and smartphone sensor data, we performed an extensive set of experiments in the lab environment to evaluate normal and abnormal walking patterns. In the smartphone, the system can generate an alert message to warn the user about the high-risk gait patterns and potentially save them from a forthcoming fall. We validated our approach using a decision tree with 10-fold cross validation and found 97.2% accuracy in gait abnormality detection.

smartPrediction: a real-time smartphone-based fall risk prediction and prevention system

The high risk of falls and the substantial increase in the elderly population have recently stimulated scientific research on Smartphone-based fall detection systems. Even though these systems are helpful for fall detection, the best way to reduce the number of falls and their consequences is to predict and prevent them from happening in the first place. To address the issue of fall prevention, in this paper, we propose a fall prediction system by integrating the sensor data of Smartphones and a Smartshoe. We designed and implemented a Smartshoe that contains four pressure sensors with a Wi-Fi communication module to unobtrusively collect data in any environment. By assimilating the Smartshoe and Smartphone sensors data, we performed an extensive set of experiments to evaluate normal and abnormal walking patterns. The system can generate an alert message in the Smartphone to warn the user about the high-risk gait patterns and potentially save them from an imminent fall. We validated our approach using a decision tree with 10-fold cross validation and found 97.2% accuracy in gait abnormality detection.

RSSI Based Indoor Localization for Smartphone Using Fixed and Mobile Wireless Node

Nowadays with the dispersion of wireless networks, smartphones and diverse related services, different localization techniques have been developed. Global Positioning System (GPS) has a high rate of accuracy for outdoor localization but the signal is not available inside of buildings. Also other existing methods for indoor localization have low accuracy. In addition, they use fixed infrastructure support. In this paper, we present a novel system for indoor localization, which also works well outside. We have developed a mathematical model for estimating location (distance and direction) of a mobile device using wireless technology. Our experimental results on Smartphones (Android and iOS) show good accuracy (an error less than 2.5 meters). We have also used our developed system in asset tracking and complex activity recognition.

Using assistive technology outcomes research to inform policy related to the employment of individuals with disabilities.

We know that work is recognized as a central component of life for individuals with and without disabilities. It yields many physical and psychological benefits to the individual while simultaneously contributing numerous benefits to society. Lawmakers have enacted a plethora of laws designed to prevent discrimination, provide incentives for employers to hire individuals with disabilities, and facilitate job training/career preparation. Assistive technology figures prominently in disability employment law as a critical strategy for gaining access and supporting employment and upward mobility in the workplace. However, little systematic effort has been devoted to examining assistive technology use and outcomes as they relate to the employment of individuals with disabilities. The purpose of this article is to articulate a series of issues that permeate assistive technology outcome measurement in employment settings and subsequently affect the use of research knowledge for federal and state policy makers. For each issue, the authors pose three questions for critical analysis: Does the law compel the provision of assistive technology? Does outcome data play any part in the operation of the law? When it does, what kind of data would be useful to collect and where could it be found? Finally, the authors provide a brief glimpse of the current and future research efforts concerning the RSA-911 database. The recent database summaries exemplify the importance of such a national data collection system for informing federal policy, particularly concerning the contributions of assistive technology device use and services on improving the employment of individuals with disabilities.

Task-oriented and Purposeful Robot-Assisted Therapy

Robot-assisted therapy devices are available for rehabilitation of persons after stroke, which is the leading cause of disability among adults in the United States (AHA 2006, Volpe et al. 2002). Improving upper extremity function after stroke is critical for performance of one’s life-role and the completion of unilateral and bilateral activities of daily living (ADLs). Carryover to real-life activities after rehabilitation training cannot be assumed (Sterr et al. 2000; Maclean et al. 2000; Ma and Trombly 2002; Trombly and Ma 2002; Prange et al. 2006). For example, the existence of learned non-use behavior indicates that motor gains after rehabilitation therapies may not transfer to long-term functioning on ADLs (Taub et al. 1994; Taub et al. 1999; Sterr et al. 2000). This behavior is present when persons with hemiparesis due to strokes demonstrate significant differences between residual movement capabilities and spontaneous use of the impaired arm in real world. There is a need to address barriers to the carryover of motor gains during training to stroke function in real life. This chapter reviews examples of current upper arm robot-assisted therapy environments and present findings from case study experiments with a new task-oriented, robot therapy system focused on improving carryover of motor improvements to functional activities of daily living. We draw attention to influence of function on arm movements during robot training and explore how future environments can be more functional and engaging. Robot-assisted therapy devices are now being used more frequently in the rehabilitation of persons with physical disabilities due to neurological trauma caused by stroke and spinal cord injury. These therapy robots provide semi- or fully-autonomous training and permit patients using them to engage in repeated and intense practice of goal-directed tasks (Volpe et al 2002; Prange et al 2006; Burgar et al. 2000; Loureiro et al. 2003; Patton et al. 2006; Krebs et al. 2003; MacClellan et al. 2005, Kahn et al. 2006). Typically, the automation of therapeutic exercises involves generating trajectories that guide reaching movements and the application of forces directly or indirectly to the impaired arm to assist, resist, and/or passively support it during the reaching exercise. For example, the MIT-MANUS (Krebs et

Measuring Assistive Technology Outcomes in Schools Using Functional Assessment

Assistive technology is used to help maximize the educational outcomes of students with disabilities. However, few schools or districts effectively measure the outcomes of assistive technology. This article describes activities of Project OATS (Outcomes of Assistive Technology in the Schools), including identification and piloting of existing assessment instruments for possible use as an outcome measure; examining the validity of an existing instrument called the School Function Assessment (SFA), and field testing the School Function Assessment-Assistive Technology Version, an adaptation of the SFA.