Assistive Technology for Persons with Physical Disabilities: Evaluation and Outcomes

This thesis presents a compilation of published studies that evaluated assistive technology interventions for children and adults with physical disabilities. The first chapter introduces the need for and the challenges involved in studying the outcomes of assistive technology interventions. The person-environment-occupation model, together with the International Classification of Functioning, Disability and Health (ICF) and a client-centered philosophy provided the conceptual underpinnings for this research. The purpose of this thesis was to evaluate the impact of specific assistive technology devices (ATDs) on activity performance, quality of life and caregiver assistance in order to advance knowledge about: a) the impact of assistive technology on outcomes that are both clinically relevant, and are meaningful to persons with disabilities; and b) the usefulness of specific outcome measures for assistive technology research and clinical practice. The chapters are organized into two sections. Section one studies focused on how adaptive seating technologies for children with cerebral palsy impact on activity performance and level of caregiver assistance. In these studies, parents of children with cerebral palsy used the Canadian Occupational Performance Measure (COPM) to identify activities they wanted their child to do, but the child was having difficulty doing. An ABA research design was used, and results showed that the children made significant improvements in activity performance and performance satisfaction when they used the adaptive seating devices. The level of Caregiver assistance the children needed was also less for some of the activities when the study devices were used. The COPM was found to be particularly useful for studying outcomes of ATD interventions, and the caregiver assistance scale shows promise, but requires further testing. The focus of section two was the evaluation of the impact of electronic aids to daily living (EADLs) on activity performance and quality of life of adults with tetraplegia. This technology is designed to enable persons with severe motor impairments to use electronic devices such as phones, door openers and personal entertainment systems to do various daily activities from their bed or wheelchair. Two new outcome measures for assistive technology were used in the Chapter 5 study, which demonstrated that EADL had a positive impact on functional performance and quality of life. However, there were limitations with these measures. Thus, in Chapter 6 we established preliminary content validity, discriminant validity, and test-retest reliability for a new device-specific functional outcome measure for EADL. Study results showed that EADL users had significantly better functional performance and satisfaction with performance than a comparison group of nonusers of this technology. The EADL users also rated their subjective quality of life significantly higher than the comparison group of non-users. The participants in the thesis studies had positive outcomes when they used the ATDs, and this can help predict continued usage and satisfaction with these technologies. This is important considering the high cost of ATDs and the evidence of technology abandonment reported in the literature. Several of the outcome measures used in these studies can help to ensure that the needs and expectations of those who use the technology are met