Abstract: Finding solutions to the seating problems of nursing home wheelchair users is challenging due to the lack of data regarding the pressure-relieving and comfort performance of wheelchair cushions for this population. This study's goal was to determine whether commercially available seat cushions provide better pressure relief and comfort than do traditionally provided or “makeshift” cushions or pads. Using a repeated measures design, 21 nursing home wheelchair users were enlisted to help evaluate two traditionally provided or “makeshift” cushions or pads and two selected commercially available seat cushions. The peak sitting pressures for 20 subjects were recorded using an Oxford pressure monitor. Twenty-one subjects were asked to score the test cushions' comfort. Due to the somewhat surprising results for the traditionally provided eggcrate cushion, the results fell short of supporting our initial hypothesis. Nevertheless, the study did identify three cushions, the eggcrate, the gel/foam, and the foam, whi...

Abstract: Measuring the shape of the buttock–cushion interface has been used successfully in research to study tissue loading and as a means to fabricate custom contoured cushions. Seat contours are also able to provide useful clinical information on the weight-bearing surface of the cushion, which can be used to address posture. This article offers specific case studies that demonstrate how the analysis of seat contours can be used to identify pelvic tilt, pelvic obliquity, and areas of high loading. Seat contour measurements complement other clinical measures, such as seat interface pressures and general postural assessments, to form a more complete picture of the buttock–cushion interface. They have become useful in the clinical management of various pressure and posture problems experienced by individuals with spinal cord injury and other wheelchair users.

Abstract: In order to develop and maintain a viable service delivery program, the realities of cost effectiveness and cost efficiency in providing assistive technology must be addressed. Cost effectiveness relates to value of the outcome compared to the expenditures. Cost efficiency analyzes how a provider uses available resources to supply goods and services. This paper describes how basic business principles of benefit/cost analysis can be used to determine cost effectiveness. In addition, basic accounting principles are used to illustrate methods of evaluating a program's cost efficiency. Service providers are encouraged to measure their own program's effectiveness and efficiency (and potential viability) in light of current trends. This paper is meant to serve as a catalyst for continued dialogue on this topic.

Abstract: Single-subject design methodology is a research technique useful in demonstrating the effects of treatment. The technique is described here using the effects of tilt-in-space on the ability to maintain head control. The subject is a 9-year-old child with cerebral palsy. The tilt-in-space angles used are 0 degrees , 15 degrees , and 30 degrees . Data are collected for the three different tilt angles in 10 sessions using an alternating rapid treatment design. Visual analysis of the results indicate that the subject displays greater head control when the wheelchair is placed at 15 degrees or 30 degrees tilt rather than at 0 degrees . This study shows how clinicians can complete single-subject studies to support recommendations for their clients and document the effects of their treatments.

Abstract: For over 5 years now, the National Institute on Disability and Rehabilitation Research (NIDRR) has not had a well-defined, written long-range plan. A new plan is needed to establish a research agenda for NIDRR. This article outlines steps taken in the development of the long-range plan. As well, it describes outcome areas, goals, and objectives underlying the plan's overall focus: empowering persons with disabilities to achieve maximum freedom and independence. Dissemination connects research and empowerment. The use of disseminated knowledge is a key factor in the long-range plan's elements. NIDRR and its grantees employ four basic dissemination strategies: spread, choice, exchange, and implementation. These strategies, with examples of their application, are briefly discussed. The article also defines “participatory research,” a practice in which those who will benefit from the research are deeply involved throughout the process. As well, the article defines participatory research's importance in the lo...

Abstract: This article reviews the fields of assistive technology in general and augmentative and alternative communication (AAC) in particular from the perspective of a manufacturer and service provider. Issues that could facilitate the greater use of assistive technology by people with disabilities are identified, which include awareness, professional preparation and ethics, service delivery, and funding. The current situation is described, a desired situation is presented, and the reader is challenged with action to move in that direction.

Abstract: This article presents the results of a 4-year project to develop and test a model for integrating technology into a multi-agency community human services delivery system. "Technology" in this sense refers to both information technology and assistive technology. The project focused on systems change rather than on the creation of comprehensive assistive technology services. Several strategies of the model were developed and tested by the project. The project developed an information/communication tier that lay on top of the existing service delivery system. The information/communication tier was provided to agencies through an electronic network and searchable database, assistive technology advice-giving software, a public awareness campaign, and professional training. The results of these strategies are used to illustrate the Community Assistive Technology Services Network (CATSN) model. The model consists of five modules: 1) client assessment and technology examination, 2) professional and client training and technical assistance, 3) information and referral and needs analysis, 4) special projects, and 5) central coordination and facilitation--the hub. This model is important given recent nationwide initiatives for using assistive technology to provide people with disabilities opportunities for maximum independence, productivity, and integration.

Abstract: A good understanding of the needs, desires, and capabilities of individuals with disabilities is critical if rehabilitation workers are to promote optimum quality of life. This survey was undertaken to determine the needs of a population of adults with disabilities as a result of neurological trauma or disease. We looked at communication, seating, mobility, environmental control, education, and leisure. Consideration of assistive technology's role in meeting these needs was achieved by an experienced Technology Access Team comprising a physiotherapist, occupational therapist, and speech pathologist in screening consenting residents. The initial needs survey identified that 37% of clients in the study had problems with verbal communication, 62% with cognition, and 52% with seating. Assessments for electric wheelchairs were required by 21.5% of clients while 30.7% had problems with hand function for accessing. Further assessment for equipment and/or training was recommended in 123 (70%) of the 163 participa...

Abstract: Children with cerebral palsy (CP) often have weak hip extensor muscles and gait-related difficulties. Current therapeutic techniques do not provide sufficient exercise for this muscle group. In addition to calisthenics, therapists use a traditional tricycle to strengthen leg muscles, yet the mechanics of traditional tricycles are not effective in exercising hip extensor muscles. A new therapeutic tricycle was designed specifically to exercise the hip extensor muscles, and tests compared the traditional tricycle to the new hip extensor tricycle in effectiveness of promoting hip extensor activity in two subjects without CP. The tests demonstrated that the hip extensor tricycle was more effective in promoting hip extensor activity. Tests are underway to investigate the effect of the hip extensor tricycle in improving hip extensor strength and gait in patients with cerebral palsy. This paper describes the design of the hip extensor tricycle and a preliminary investigation of its effectiveness.

Abstract: Wheelchair pressure mapping devices used in the prescription of seat cushions and postural supports have been limited in durability, data presentation, and/or clinical efficiency. This project sought to establish the ideal specifications for clinically useful pressure mapping systems, and to use these specifications to influence the design of an innovative wheelchair pressure mapping system (Tekscan “Seat”). Technology, previously developed for measurement of forces of dental occlusion and of the foot during gait, was applied to wheelchair seat mapping. Tests were designed to compare the performance of three pressure mapping systems: the Tekscan system, the FSA system, and the Talley TPM3. Bench tests were done to measure reproducibility, hysteresis, and creep of each of the pressure mapping systems. A contoured loader gauge was developed to test for the influence of hammocking. Tests were also performed using spinal cord-injured subjects to demonstrate the relative performance of the pressure mapping sys...