Sajay Arthanat

Assistive technology device classification based upon the World Health Organization's, International Classification of Functioning, Disability and Health (ICF)

Purpose. To develop an assistive technology device classification (ATDC) consistent with the Assistive Technology Act (ATA2004), Americans with Disabilities Act (ADA2008), International Classification System of Functioning, Disability and Health (ICF), International Classification of Disease, Ninth Revision-Clinical Modification (ICD-9-CM) and American Medical Associations Current Procedural Terminology (CPT). Background. Current assistive technology device (ATD) classifications include: the National Classification System for Assistive Technology Devices and ATSs (RTI/NCS) published in 2000; ISO 9999: technical aids for persons with disabilities – classification and terminology (ISO 9999) published in 1992, 1998, 2002 and 2007 and ICF-based AT classification (ICF/AT2007) published in 2009. Objectives. To derive ‘requirements’ for ATD classification from the ATA2004, ADA2008, ICF, ICD-9-CM and CPT. Review the ATD classifications and online databases against requirements. Construct the ATDC to be consistent with all requirements and demonstrate with examples. Results. Existing ATD classifications and online databases are inconsistent with requirements. The ATDC is consistent and has inclusion and exclusion criteria, classification rules, employs ICF coding, extendable hierarchy and language and uses standard device naming conventions. Conclusion. The ATDC has broad application to: provision of AT ATSs (ATSs), characterisation and analysis of AT industries, Federally sponsored research pertaining to AT development and commercialisation, and Federal health insurance scope of benefits.

Comparative Observations of Learning Engagement by Students with Developmental Disabilities Using an iPad and Computer: A Pilot Study.

This study examined the use of the Apple iPad for learning by children with developmental disabilities (DD), including those on the autism spectrum. A single case design was used to record the participation of four students with DD when taught with their standard computer at baseline, followed by the introduction of the iPad. A six-component participation scale was developed to quantify observations of these students during the learning sessions. Visual analysis of data indicated no differences in participation with the iPad as compared to the computer for three of the four subjects. One subject appeared to have notably higher participation with the iPad. Individual variations were identified in each student along with some common concerns with attention, task persistence, and goal directed behavior with use of the iPad. Student academic scores improved during the course of iPad use. Nevertheless, the findings drawn from this pilot study do not justify the use of the iPad over the computer (and vice versa) for achieving academic goals in students with DD. The need to document best practices and barriers in use of emerging touch-tablet devices to support individualized education was clearly evident.

A home-based individualized information communication technology training program for older adults: a demonstration of effectiveness and value

Abstract Purpose: To demonstrate the effectiveness and value of a home-based information communication technology (ICT) training program for older adults. Methods: Thirteen older adults were provided in-home ICT training by graduate occupational therapy students using an iPad. The breadth and frequency of ICT use, perspectives on technology, and perceived independence were recorded at baseline, during the 3-month training and at follow-up, along with an end-of-study questionnaire. Non-parametric Friedman analysis was conducted to verify trends in the outcome measures. The qualitative data were examined by content analysis. Results: Participants’ breadth of ICT activities showed a significant trend across 6 months. Leisure accounted for the significant increase, while health management and social connections activities increased modestly. A positive trend in participants’ perspectives on technology was evident along with a marginal increase in perceived independence. Participants’ perspectives were thematically categorized as technology experiences, interactions with coach, training approach, and specific activities. As reflection of the training program’s value, 12 of the 13 participants took ownership of the iPad at the end of the study. Conclusion: Building capacity of older adults to utilize the multifaceted potential of ICT is critical in addressing declines in health, impending disabilities, and social isolation. Implications for Rehabilitation A one-on-one home-based individualized information communication technology (ICT) training program for older adults could result in a progressive increase in the breadth of online activities carried out by them. Specifically, the increase in their usage of ICT could be expected in leisure-based online activities. Individualized training programs designed based on needs, priorities, and learning style of older adults could have a positive impact on their technological perspectives and intrinsic motivation to adopt ICT.

Text entry rate of access interfaces used by people with physical disabilities: A systematic review

ABSTRACT This study systematically reviewed the research on assistive technology (AT) access interfaces used for text entry, and conducted a quantitative synthesis of text entry rates (TER) associated with common interfaces. We searched 10 databases and included studies in which: typing speed was reported in words per minute (WPM) or equivalent; the access interface was available for public use; and individuals with physical impairments were in the study population. For quantitative synthesis, we used only the TER reported for individuals with physical impairments. Studies also had to report the sample size, and the average and standard deviation for the TER data. Thirty-nine studies met the criteria for quantitative synthesis. Studies involved seven interface types: standard keyboard typing, on-screen keyboard (OSK) with cursor selection, OSK with scanning selection, automatic speech recognition (ASR), Morse code, brain–computer interface (BCI), and other. ASR, standard keyboard, cursor OSK, and scanning OSK had at least four studies and 30 subjects, with TER averaging 15.4, 12.5, 4.2, and 1.7 WPM, respectively. When combined with measurements of a particular client’s text entry performance, the TER from this review can be used within an evidence-based decision-making process for selecting control interfaces.

Consumer perspectives on the usability and value of the iBOT® wheelchair: findings from a case series

Purpose: The iBOT® is an advanced power wheelchair introduced in 2003 for people with mobility impairments to enhance their independence and community access. Although this innovation soon gained popularity, the production of this wheelchair was recently stopped owing to the lower-than-expected sale figures. In this scenario, this study examines the impact of this wheelchair on current consumers by highlighting its usability in multiple contexts and verifying the value associated with its ownership. Method: Seven active consumers of the iBOT® were interviewed using a mixed method approach. Participants discussed and rated the iBOT’s usability in relation to their standard power wheelchair and shared their perceived value for it. A content analysis was used to elucidate the qualitative data, whereas the quantitative data was analyzed using descriptive and non-parametric comparisons to compute differences in consumer ratings for the two wheelchairs. Result: Results, although statistically non-significant (α < 0.05), indicated the iBOT® to be a highly multi-functional wheelchair with relatively superior usability in workplace (p = 0.15), community (p = 0.18) and outdoors (p = 0.1). Participants greatly valued its capability to expand their mobility in otherwise inaccessible environments and to enhance their social participation through eye level communication. Conclusion: The iBOT® serves as an exemplar to promote interest and funding for advanced AT devices for people with disabilities. Implications for Rehabilitation The iBOT was designed and developed as an advanced multi-utility wheelchair with innovative functions such as stair climbing, seat elevation and four-wheel drive. Compared to a standard power wheelchair, a small cohort of iBOT users reported the iBOT to have better usability in workplace and outdoor environments. Most importantly, the users highly valued using the iBOT to enhance their community access and social interaction. However, the production and sales of this wheelchair was called off in 2009 owing to its high cost and limited commercial viability.

Multi-stakeholder perspectives on information communication technology training for older adults: implications for teaching and learning

Abstract Objectives: The objective of this research was to identify and conceptualize barriers and strategies for effective implementation of information communication technology (ICT) training for older adults. Methods: A grounded theory approach was used to collect and analyze qualitative data from 61 participants in three stakeholder groups: older-adult ICT trainees, care providers and ICT trainers. Results: Care providers expressed older adults’ reluctance, lack of affinity, fears and socio-contextual attributes as barriers to overcome with ICT training. ICT trainers highlighted motivation, trainer–trainee relationship, patience, self-reliance and mutual value as strategic themes. ICT trainees elucidated occupational accomplishment, challenges and a sense of competence as themes from their experience with training. Discussion: While digital literacy and skill building have traditionally been the key focus of ageing-centred ICT training, a deeper approach to address internal (personal) and external (socio-contextual) barriers, as conceptualized in the study finding, is vital in yielding successful outcomes. Implications for rehabilitation Information communication technology (ICT) is a vital resource for older adults to age-in-place and for health professionals in delivery of tele-rehabilitation. Family members and care providers realize the scope of ICT for ageing-in-place but raise doubts on the inherent motivation and abilities of older adults to adopt ICT. On the other hand, older adults who engage in one-on-one ICT training value their new-found sense of accomplishment and competence in using the Internet and social media. Graduate students who provided the training greatly appreciate their own learning experience, and stress the need for mutual trust, patience and simplicity in teaching ICT. A major precursor to imparting digital literacy and skills in older adults who lack ICT exposure is to help them overcome deep-seated attitudinal and socio-contextual barriers through a one-on-one approach.

Effect of diagnosis, body site and experience on text entry rate of individuals with physical disabilities: a systematic review

Abstract Objective: This study systematically reviewed the research on computer text entry by people with physical disabilities, and conducted a quantitative synthesis of text entry rates associated with individuals’ diagnosis, body site used with the interface and their level of experience. Method: We searched 10 databases and included studies in which: typing speed was reported; the access interface was available for public use; and individuals with physical impairments were in the study population. For quantitative synthesis, we used only the text entry rates (TER) reported for individuals with physical impairments; studies also had to report the sample size, and the average and standard deviation for the text entry rates. Results: Thirty-nine studies involving 248 subjects met the criteria for quantitative synthesis. Cerebral palsy was associated with significantly slower TER, at 5.5 wpm, than muscular dystrophy (12.5 wpm), spina bifida (10.4 wpm), SCI high cervical (10.1 wpm) and SCI low cervical (13.3 wpm). Among the 19 body sites represented, the Fingers bilateral category had the highest average, at 17.72 wpm. Head (2.92 wpm) and Hand (non-typing) (3.95 wpm) were each associated with significantly slower TER than Hands unspecified, Fingers bilateral, Hand with control enhancer, Voice and Mouth. The three levels of experience examined, LowPlus, Medium and High, provided very similar TER. Conclusion: This study contributes external evidence for service providers who provide computer access interventions for individuals with disabilities. The analyzed text entry performances serve as benchmarks to be used as guidelines during interface selection and training. Implications for Rehabilitation The median text entry rate (TER) across the literature for individuals with physical disabilities is 7.0 wpm. TER is affected by a user’s diagnosis and the body site used for typing. These TER data can serve as diagnostic norms and benchmarks to be used as guidelines during interface selection and training. We recommend that practitioners measure text entry rate with clients, to place their performance in the context of these results and provide a baseline against which to measure effectiveness of an intervention.

A survey of assistive technology service providers in the USA

Abstract This study investigates perspectives of assistive technology service (ATS) providers regarding their education and training, interdisciplinary standards of practice, use of a common language framework, funding policies, utilization of evidence and outcomes measurement. A survey underpinned by AT legislations and established guidelines for practice was completed by 318 certified AT providers. More than 30% of the providers reported their education and training as inadequate to fulfil four of the seven primary roles of ATS. Nearly 90% of providers expressed awareness of the International Classification of Functioning, Disability and Health (ICF) domains for interdisciplinary communication. However, only 45% felt that they could effectively utilize the ICF in their documentation. About 75% of the providers acknowledged the lack of a recognized standard for the provision of services. Prevailing inadequacies in funding were negatively impacting the quality of ATS, as expressed by 88% of respondents. Translation of evidence to practice was identified as a major challenge by 41% of service providers. Providers were predominantly documenting outcomes through informal interviews (54%) or non-standard instruments (26%). Findings support the need for strengthening professional curriculum, pre-service and in-service training and an established standard to support effective, interdisciplinary AT services and data collection to support public policy decisions. Implications for Rehabilitation This study validates the need to strengthen education and training of AT service providers by enhancing professional curriculum as well as their engagement in pre-service and in-service training activities. This study draws attention to health care funding policies and practices that critically impact the quality of AT services. This study signifies the need for an established interdisciplinary standard among AT professionals to support effective communication, service coordination and outcomes measurement.

An Evaluation Protocol for Selection of Educational Technologies for Students with Developmental Disabilities: A Demonstration Study Using iPad Apps

Mainstream technologies are widely being employed in inclusive and special education classrooms to accommodate the learning needs of students. As the evidence of their effectiveness evolves, educators and school-based therapists need tools and documentable strategies for their implementation. This research presents an evaluation protocol to guide the selection of technologies for special education needs and demonstrates its application with iPad-based learning applications for students with developmental disabilities (DD). The learning engagement of six students with DD was compared using a single-subject design when using a computer, an iPad app “chosen” through the protocol and a “random” app. A blinded reviewer observed and rated student engagement in all three learning conditions. Analysis of data indicated that three students engaged better in learning with the chosen app than with the computer and a popular random app. The engagement of five students declined when the random app was implemented. The protocol demonstrates merit in systematic selection of educational technology for students with DD.