Susan M. Nochajski

Conceptualization and measurement of assistive technology usability

Background. The concept of product usability has been discussed in several areas of product research and development. Usability, within the realm of assistive technology (AT) devices, determines how effectively and efficiently AT users with disabilities can function in different contexts and environments. Objectives. This article conceptualizes and proposes the significance of AT usability and its measurement in entirety from a human factors perspective. Conceptual models that characterize the interaction of the AT user, the AT device, the context and the involved activity is considered to be the hallmark of measurement of AT usability. On that basis, the article highlights the methodology and the initial progress of the development of an AT outcome tool, the Usability Scale for Assistive Technology (USAT), to measure self reported degree of AT usability. Methodology. In order to identify usability indicators for measurement, a qualitative study was conducted by exploring the experiences of AT users. Ten participants who used either wheeled mobility or computer based AT devices were interviewed with questions based on the theme of a usability framework. Results. The coded interview data generated more than 800 usability indicators specific to the two categories of AT devices. These indicators were mapped to a generic usability criteria list for construction of the USAT-Wheeled Mobility and the USAT-Computer Access. Implications. The USAT, when developed, is projected to be valid and useful for AT outcomes research as well as clinical practice. The use of the USAT will enable researchers and clinicians to comprehensively identify factors that underlie effectiveness and efficiency in AT device use and establish intervention protocols to optimize user-AT interaction.

Collaboration between team members in inclusive educational settings.

SUMMARY The inclusion of students with disabilities into general education settings and programs has necessitated the development of integrated, collaborative service delivery models that are compatible with the goals and purpose of inclusive education. Although there is considerable theoretical literature on collaboration, there is minimal empirical data available on the process or its outcomes. The purpose of this exploratory study was to gain insight on the perspectives of regular and special educators, and occupational, physical, and speech-language therapists towards collaboration. Using a semi-structured interview, participants (n = 51) responded to questions concerning the definition, nature, and extent of collaboration in their school setting. Participants also responded to questions related to the advantages of, barriers towards, and strategies to promote collaboration. Participants typically defined collaboration as not a problem-solving process, but in terms of activities associated with it. Results indicate that participants believed collaboration was mutually beneficial for both students and team members. However, implementing a collaborative approach was problematic. Lack of administrative approval for time for planning meetings was the most frequently cited barrier to collaboration. Although 51.6% of the participants reported time available for collaborative planning by regular and special educators, only 21.5% of the participants reported this time being available for therapists to meet with educators. Education about collaboration, either in professional/preservice education programs or as continuing education, was recommended as a strategy to facilitate a collaborative approach. Although a collaborative approach is being used by therapists and educators more and more frequently, there is a need for research to validate its efficacy.

Caregiver Involvement in the Use of Assistive Devices by Frail Older Persons

The population of persons over age 65 years is increasing, and with this trend there is an increase in number of older persons with disabilities, or frail elders. The importance of supportive environments for home-based frail elders has been recognized. Supportive environments include the presence of family caregivers and appropriate assistive devices. Assistive devices (AD) offer the potential to decrease frail elders need for personal assistance, and could reduce some of the burden expressed by caregivers. The inclusion of family caregivers in treatment planning and its implementation is a component of occupational therapy practice. Occupational therapists are also recognized as the lead professional in the provision of most assistive devices. However, there has been little research on the involvement of family caregivers in the use of assistive devices. The purpose of this study was to examine the relationship between caregiver involvement and the use of, and satisfaction with, assistive devices by frail elders. Interviews regarding assistive devices were conducted with 20 frail, cognitively intact elders who had a primary caregiver in their homes. Results indicate that elders regard assistive devices as very useful in saving time, conserving energy, reducing frustration, and providing a feeling of security. Caregivers were involved in the use of assistive devices when the device was first acquired (early caregiver involvement) and made suggestions for using the devices. They also encouraged, instructed, and assisted with the use of devices later, as necessary. There was a relationship between early caregiver involvement and involvement at the time of the interview (later caregiver involvement). Verbal encouragement and caregivers use of assistive devices to help perform tasks were strongly associated with both device use and satisfaction. The results reinforce the importance of caregiver involvement with assistive devices used by frail older persons.

The Use and Satisfaction with Assistive Devices by Older Persons with Cognitive Impairments: A Pilot Intervention Study

Frail older persons with cognitive impairments use fewer, and are less satisfied with, assistive devices than frail older persons who are not cognitively impaired. This study sought reasons for device dissatisfaction among older adults with cognitive impairments and assessed the impact of professional intervention on the use of, satisfaction with, and effectiveness of assistive devices. Twenty persons with cognitive impairments received a comprehensive assessment, individualized interventions, training, and follow-up. Results indicated that devices for physical impairments were more readily accepted and used than devices that addressed cognitive impairments. However, participants were more satisfied with cognitive devices. User satisfaction with physical devices appeared to increase with training and support. However, dissatisfaction with cognitive devices appeared to be more related to user limitations than training and support. The need for early intervention for persons with cognitive impairments is discussed, as is the need for further research on the effectiveness of assistive devices for these individuals.

The Impact of Age-Related Changes on the Functioning of Older Adults with Developmental Disabilities

This paper discusses age-related changes that have an impact on functional abilities and societal participation of older adults with mental retardation. A description of changes that affect all older individuals is presented as well as the additional impact these changes may have on older persons with developmental disabilities. Information on age-related changes unique to persons with Down Syndrome and cerebral palsy are also presented. The role of occupational and physical therapists in helping to maintain the functional abilities of aging persons with developmental disabilities is discussed.

Development of the Usability Scale for Assistive Technology-Wheeled Mobility: A preliminary psychometric evaluation

The article describes the methodology and psychometric evaluation of an assistive technology (AT) outcomes measure- ment tool, the Usability Scale for Assistive Technology-Wheeled Mobility module (USAT-WM), as a tool to capture user-centered usability of wheeled-mobility devices. The construction of the USAT-WM was driven by a qualitative inquiry focusing on the experiences of users of wheeled mobility devices. The interview content was coded and nearly 400 indicators pertaining to usability of wheeled-mobility devices were assimilated to construct a preliminary version of the USAT-WM. The content validity of the USAT-WM was evaluated by a panel of clinicians in the field of wheeled-mobility. The findings from the content validation process were utilized to revise the USAT-WM. A field-test of the USAT-WM was conducted by administering it to 70 individuals who used power wheelchairs (PWCs) for mobility. A preliminary principal component analysis of the instrument sections was performed, and based on the item loading a subsequent factor analysis was conducted to establish a 50-item version of the USAT-WM with seven subscales: home usability; workplace/school usability; community usability; outdoor usability; ease of use; seating; and safety. Internal consistency Cronbachs alpha values for the seven subscales ranged from 0.77 to 0.91 and 0.90 for the total score of the USAT-WM. The test- retest and alternate-form reliability of the USAT-WM scores correlated at 0.85 ( p< 0.01). The convergent validity correlations of the USAT-WM with the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST2.0) and the Psychosocial Impact of Assistive Devices Scale (PIADS) were found to be 0.55 ( p< 0.01) and 0.30 ( p< 0.01) respectively.

Using Smart Home Technology and Health-Promoting Exercise

Falls have a very high prevalence in older adults (aged 65 and older) and are probable causes of decreased physical activities, function, and quality of life, as well as increased depression and nursing home placement. Home exercise is an effective way to reduce fall risk factors, but there is often low adherence. The use of smart home technology with health-promoting exercise can be a new method for occupational therapists to reduce fall risks through encouraging an active lifestyle.

Promoting school to work transition for students with emotional/behavioral disorders.

BACKGROUND The successful transition of students from high school to adult occupations, including work and independent living, has been a major focus of the educational reform movement in the United States. However, despite good intentions, students with disabilities have less favorable transition outcomes than do students in the general population and employment opportunities are even less promising for students with emotional/behavioral disorders (EBD). OBJECTIVE The purpose of this model demonstration project, funded by the US Department of Education, was to develop a program based on identified best practices to facilitate successful school to work transition for students with EBD. PARTICIPANTS 47 students with EBD between the ages of 14 and 19 were participants in this project. The majority of participants in the project were white males with a generic diagnosis of a disruptive personality disorder. METHODS Five cohort groups of students participated in a four phase program; Phase 1 - School-based Learning, Phase 2 - Community Involvement, Phase 3 - Paid, Supported Work Experience, and Phase 4 - Competitive Employment and Follow-Up. RESULTS At the conclusion of the project, 30% of the project participants were competitively employed. Students had the most difficulty in Phase 3, but 81% of those who successfully completed Phase 3 obtained and retained competitive employment for a least one year. Four case studies are presented to illustrate findings. CONCLUSIONS The School to Work Transition Program model shows promise for providing interventions to promote successful transition for students with EBD. Further research on the effectiveness of the overall model, as well as specific components of the model, is needed.