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Barriers in Using Assistive Devices among a Group of Community-dwelling Persons with Lower Limb Disabilities in Sri Lanka

WEERASINGHE, Inoka E
FONSEKA, P
DHARMARATNE, S D
JAYATILAKE, J A M S
GIELEN, A C
2015

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Purpose: Rehabilitation with assistive devices is of great benefit to people with limb disabilities, enabling them to lead independent and productive lives. While assistive devices improve the quality of life of persons with lower limb disabilities by facilitating activities of daily living, there are also many barriers to their use. This study aims to describe these barriers among community-dwelling persons with lower limb disabilitiesin central Sri Lanka.

 

Methods: A community survey was conductedmong adults between 18 and 59 years of age, to find persons with lower limb disabilities in Kandy Municipal Council area, in the central province of Sri Lanka. This was followed by purposive sampling to select a sub-sample of 12 individuals with unilateral lower limb disabilities for a qualitative study using in-depth interviews. Unilateral lower limb disabilities were identified using a clinical examination and World Health Organisation Disability Assessment Schedule 2.0 (WHODAS 2.0). A qualitative thematic content analysis was used to evaluate the interview text.

 

Results: Participants described several barriers in using assistive devices, such as unaffordable assistive technology like wheelchairs and artificial limbs, unavailability of appropriate assistive technology, difficulties associated with repair and maintenance, and problems in accessibility. Limited knowledge of modern technology also restricted their choice of better devices. Psychological barriers and stigma in using assistive devices directly affected their social lives and day-to-day activities as well.

 

Conclusion and Implications: People with lower limb disabilities face multiple barriers in using assistive devices. These barriers need to be addressed by improving local infrastructure and accessibility facilities, public awareness and funding, and ensuring continuous supply and maintenance services.

The African disability scooter: efficiency testing in paediatric amputees in Malawi

BECKLES, Verona
MCCAHILL, Jennifer L
STEBBINS, Julie
MKANDAWIRE, Nyengo
CHURCH, John C T
LAVY, Chris
2014

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Purpose:

The African Disability Scooter (ADS) was developed for lower limb amputees, to improve mobility and provide access to different terrains. The aim of this study was to test the efficiency of the ADS in Africa over different terrains.

 

Method: 

Eight subjects with a mean age of 12 years participated. Energy expenditure and speed were calculated over different terrains using the ADS, a prosthetic limb, and crutches. Repeated testing was completed on different days to assess learning effect. 

 

Results:

Speed was significantly faster with the ADS on a level surface compared to crutch walking. This difference was maintained when using the scooter on rough terrain. Oxygen cost was halved with the scooter on level ground compared to crutch walking. There were no significant differences in oxygen consumption or heart rate. There were significant differences in oxygen cost and speed between days using the scooter over level ground, suggesting the presence of a learning effect. 

 

Conclusions:

This study demonstrates that the ADS is faster and more energy efficient than crutch walking in young individuals with amputations, and should be considered as an alternative to a prosthesis where this is not available. The presence of a learning effect suggests supervision and training is required when the scooter is first issued.

Developing the Content of a New Quality of Life Questionnaire for Children with Hearing Loss

RAJ, L J
SWARNAKUMARI, P
MARTINA, T
2014

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Habilitation and rehabilitation call for a paradigm shift from the traditional intervention programmes which focus on physical functioning to programmes that include aspects of physical, psychological and social wellbeing.

 

Purpose: To develop a quality of life instrument, using focus group discussions to assess the outcomes of interventions for school-going children with hearing loss.

 

Methods: Separate focus group discussions were held with children with hearing loss between 8 and 18 years of age, special educators and mothers. Focus group discussions were conducted separately for boys and girls. Each focus group had 8–10 participants. In-depth interviews were conducted with the heads of institutions and rehabilitation professionals. Fathers had to complete self-administered questionnaires. The focus group discussions were guided by topics and probes drawn from literature reviews, and were audio recorded, transcribed and analysed.

 

Results: Around 421 problem statements were classified under 7 themes: Educational implications; Social integration; Psycho-social wellbeing; Family relationships; Speech, language and communication; Leisure and recreation; and General functioning. Education and career aspirations were considered to be most important. The problem statements revealed that the primary focus of training was on improving academics. Integration and feeling comfortable with social situations were cited as limitations; as also, the preference for friendship with people of similar abilities. For the majority of children, leisure and recreation was limited to watching television. Parents and siblings were considered vital to their progress and achievements.

 

Conclusions: Multidimensional and varied perspectives of different stakeholders, especially family members, are necessary for a comprehensive analysis of the impact of hearing loss on the quality of life of school-going children.

 

The psychosocial impact on standing devices

NORDSTRÖM, Birgitta
NYBERG, Lars
EKENBERG, Lilly
NÄSLUND, Annika
2013

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Purpose:

The aim of this study was to explore the psychosocial impact of standing devices as experienced by users. 

 

Method:

This is the second part of a comprehensive survey in five counties in Sweden where all the subjects with standing devices were invited to participate. The impact of standing devices on functional independence, quality of life and wellbeing was assessed using a questionnaire, Psychosocial Impact of Assistive Devices Scale (PIADS).

 

Results:

The psychosocial impact of the standing devices was perceived as positive. The highest PIADS scores in relation to age were found in the oldest group, aged 65 years and older. The ability to walk and independence in ambulation resulted in higher scores than the use of a wheelchair and/or dependence on others. Those who stood often awarded higher scores in the PIADS questionnaire compared to those who used the device less frequently. When standing was integrated in various activities, its psychosocial impact received high scores. 

 

Conclusion:

The psychosocial impact of standing devices was generally experienced positively. The main results indicated that standing in a standing device had a value and we as professionals should ask the users about the intended purpose of their standing in order to prescribe the optimal device.

Quantitative Exploratory Evaluation of the Frequency, Causes and Consequences of Rehabilitation Wheelchair Breakdowns delivered at a Paediatric Clinic in Mexico

TORO, M L
GARCIA, Y
OJEDA, A M
DAUSEY, D J
PEARLMAN, J
2012

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Purpose: The United Nations Convention on the Rights of Persons with Disabilities recognises assistive technology such as wheelchairs (WCs) as a tool for social inclusion for this population. In less resourced settings, organisations lack information about effective models of WC service provision. The goal of this study was to investigate the lifespan of WCs and whether they provided reliable mobility, at one clinic in Mexico.

 

Methods: Caregivers of children, who had requested replacements for their WCs from a clinic in Mexico, were interviewed in Spanish. Among others, the questions pertained to repairs/modifications, adverse events and WC usage characteristics. The owners exchanged their WCs for new ones at the clinic, and the maintenance status of each returned WC was evaluated using the WC Assessment Checklist (WAC).

 

Results: Twenty-three donated WCs, used by children aged 3 to 14 years for an average of 19 months, were evaluated. Brakes (n=18), seat and back-sling upholstery (n=11 and 7 respectively), and armrests (n=14) were the components that failed most frequently. A total of 26 adverse events due to WC failure were reported. Adverse events were significantly associated with poor WAC scores (rs=-0.544, p=0.007).

 

Conclusions: Poor WC reliability, associated with adverse events which could undermine social engagement, indicates the need for a stronger WC and for regular maintenance. For instance, brake failures which were most often associated with adjustment issues, could have been resolved with maintenance, while seat and back-sling upholstery and armrest failures suggest that the WC may not be appropriate for the environment. Future work should investigate the robustness of these WCs using standardised methods (ISO 7176), as well as the impact of maintenance interventions on WC reliability.

Assistive Technologies in a Workplace Environment: Barriers for the Employment of People with Disabilities

JAKOVLJEVIC, M
BUCKLEY, S
2011

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Purpose: The employment equity policies and implementation of technology- specific guidelines within the South African ‘Code of Good Practice on the Employment of People with Disabilities’, was created to encourage employment equity for employees with disabilities, by companies in Johannesburg.

 

This study reports on the results of the investigation in assistive technologies in a workplace environment, and barriers for the employment of persons with disabilities in the South African environment.

 

Method: Qualitative data, collected from two retail and service companies in the form of semi-structured individual and focus group interviews, was analysed using a constant comparative method, identifying major themes and sub-themes.

 

Results: A surprisingly small number of persons with disabilities were found to be employed by participating companies, which tended not to focus on these people when formulating their policies and plans. In addition, technological aspects of the Code were largely unacknowledged, with little effort being made to accommodate the needs of persons with disabilities. An even lower incidence of assistive technology usage was found, along with a large number of conceptual and perceived barriers that hinder the employment of persons with disabilities and the implementation of appropriate technology.

‘Welcome to My Life!’ Photovoice: Needs Assessment of, and by, Persons with Physical Disabilities in the Kumasi Metropolis, Ghana

TIJM, M M
CORNIELJE, H
EDUSEI, A K
2011

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Persons with physical disabilities face many architectural and social barriers to community participation. This research employed the ‘Photovoice’ method. The aim was to gain insight into the daily lives of persons with physical disabilities, and to assess their needs in the Kumasi metropolis. Participants in this study were trained and instructed to photograph their everyday activities, so as to document their struggles and concerns, to promote critical dialogue and to reach policymakers. Results indicated a number of concerns, such as poor accessibility to public toilets, transport and buildings, as well as a need for attitudinal change and equal opportunities. Other needs which were raised by theparticipants included economic empowerment, marketable vocational training, accident prevention, affordable and quality rehabilitation, and the establishment of emergency shelters. It was concluded that the most pressing needs of persons with disabilities were related to overall social, employment and accessibility issues. Finally, the ‘Photovoice’ methodology offered a suitable, structured, and participatory way to assess the needs of persons with disabilities. It gave this marginalised group a voice through photographs, and formed an excellent way of disseminating the findings of this study to the stakeholders involved.

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