VII. Independent Living Aids

A. General

[128] REMOTE REHABILITATION SERVICES NETWORK

Geb Verburg, MA; Anastasia Cheetham, MASc
Research in Cognitive Development Unit, Rehabilitation Engineering Department, Bloorview MacMillan Centre, Toronto, ON Canada M4G 1R8

Sponsor: the Bank of Montreal (mbanx) through the Bloorview MacMillan Children's Foundation

PURPOSE--This project will establish and evaluate a multimedia rehabilitation consultation network to allow clients and staff of remote Children's Treatment Centres and other rural community sites to share solutions and to consult with colleagues and professionals using multimedia telecommunication technology. The delivery of specialized services to rural or remote areas can be difficult, due to the large distances from specialized research and development facilities. The use of a telecommunications medium that incorporates two-way voice, video, and computer networking has tremendous potential to enhance services and reduce loss of work time for parents, school-time for clients, and travel costs for clients, parents, or professionals.

PROGRESS--In the first year of the Remote Rehabilitation Services Network (RRSNet) project, we carried out a survey of clinicians at Children's Treatment Centres in Ontario and at Bloorview MacMillan Centre to determine their needs for televideo technology; selected two sites in Northern Ontario (Laurentian Hospital in Sudbury and George Geoffrey's Children Treatment Centre in Thunder Bay) and one general rehabilitation Centre in Southern Ontario (K-W Ability Centre); actively promoted the concept of using televideo technology to provide or obtain (re)habilitation services within Bloorview MacMillan Centre and in children's rehabilitation centres in the province; and performed a thorough review of the literature and internet to determine the state of the art in the field of remote (re)habilitation services and to establish methods and applications of teletechnology.

FUTURE PLANS--From our limited experiences with the large-screen videconferencing or group system, it is clear that a number of current rehabilitation services and educational activities could be carried out using this technology. So far, the applications selected appear to remain very close to the activities professionals have been doing all along. Face-to-face meetings have become screen-to-screen meetings. The challenge for the next few years will be to realize the added value of the information and knowledge tools that can now be made available to clients and clinicians. We believe that it is possible to use this technology as a catalyst for an entirely new and more efficient means of service delivery.

[129] THE AUSMAP DATABASE: CUSTOMIZING MINSPEAK;tm VOCABULARY FOR AUSTRALIAN USE

Duane A. Stapleton, BEng; Jenny Faulks, BAppSc (SpPath); Rob Garrett, BTech
Regency Park Rehabilitation Engineering, Regency Park, SA 5942, Australia; email: rob_garrett@eol.ieaust.org.au

Sponsor: The Crippled Children's Association of South Australia Inc., Regency Park, SA 5942, Australia

PURPOSE--The AusMAP database is a computer-based tool for storing, organizing, and printing vocabulary for users of Minspeak;tm-based communication devices. AusMAP is particularly focused on vocabulary customized to suit Australian Minspeak users.

Minspeak-based communication devices have been used extensively with clients of The Crippled Children's Association (CCA) since 1993. During that time therapists have produced customized Australian versions of the IEP+ (called AusIEP) and, more recently, the UNITY Minspeak Application Programs (MAPs). As a result of the significant changes being made to the original MAPs, a need arose for professionally designed database in which the new vocabulary sequences could be recorded and printed out. The AusMAP database system is our response to that need.

METHODOLOGY--A formal specification was developed for the software tool with the following key features: a) A complete, user-friendly recording system of the AusIEP and AusUNITY vocabulary; b) the ability to selectively choose and print vocabulary and icon sequences in a range of sizes and layouts; c) the ability to store vocabulary specific to certain users; d) storage of multiple rationales, allowing choice of the most appropriate one for the client; e) the ability to add, delete, and edit the vocabulary; and f) the flexibility to run on a stand-alone computer without expensive additions.

PROGRESS--We have produced an initial version of the AusMAP database and are testing it. The software is centered around a large table of words/phrases and their corresponding Minspeak icon sequences. Each entry also allows storage of one or more rationales, one or more theme tags and one or more user tags. A theme tag is any word or short phrase denoting a distinguishing characteristic of a group of dictionary entries (e.g., "food," "sport," and so forth). It is also these tags that distinguish whether a vocabulary entry belongs to the AusIEP, AusUNITY, or other customized dictionary. A user tag is a name identifying a certain Minspeak user or group of users. User tags are a flexible scheme designed to link certain vocabulary to specific users. Besides this core dictionary, the software includes extensive facilities for extracting and printing subsets of the dictionary in the form of reports, dictionary listings, or therapy worksheets.

RESULTS--Although only in the initial stages of use, the AusMAP database has been seen to be a vast improvement over previous means of recording and organizing Minspeak vocabulary customized for Australian use.

FUTURE PLANS--The AusMAP database will be used by therapists and assistants of the CCA Speech Pathology Department, as well as by educators and families for the development of customized dictionaries, and the production of therapy and educational material. It is envisioned that clients in remote country areas will also have access to a version of the software, enabling more independent ownership of therapy programs by local therapists and teachers, with some support from the CCA.

RECENT PUBLICATIONS FROM THIS RESEARCH

The AusMAP database. Customising Minspeak;tm Vocabulary for Australian Use. Stapleton D, Garrett R, Faulks J. Proceedings of the 3rd Australian Conference on Technology for People with Disabilities; 1997, Canberra, Australia. Regency Park, SA: The Regency Park Centre. In press.

[130] DAILY: MAKES DAILY LIFE EASIER

Else Marie Hansen; Jessica Andersson; Massimo Ferrario; Matteo Moi; Paula Cuelhuso; Francisco Godinho
Danish Centre for Technical Aids for Rehabilitation and Education, Taastrup, Denmark; AmuHadar, Malmo, Sweden; SIVA: Fondazione Don Gnocchi Milano, Italy; CRPG: Centro de rehabilitacao profissional de GAIA, Arcozelo Norte-PT11, Portugal; email: e.m.hansen@hmi.dk; jessica.anderson@hadar.amu.se; massimo.ferrario@siva.it; matteo.moi@siva.it; inova@crpgaia.pt; jsousa@mail.telepac.pt

Sponsor: European Commission, Telematics Applications Programme, Sector Disabled and Elderly, and the participating facilities

PURPOSE--The aim of the project is to develop a multimedia application (DAILY) that supplies information about assistive devices to elderly people with minor motor impairments who want to continue managing daily activities on their own. DAILY will provide knowledge about which assistive devices exist, enabling the individual to take the initiative in defining his or her own needs, solving problems, and placing appropriate demands on the responsible institutions and agencies in society.

METHODOLOGY--DAILY is a computer program that gives information in pictures and sound about a subject area. The user can use a touch screen to choose among different subjects and problems that he wants to solve. When the user has chosen a subject of interest, he will be able to see a short video film that demonstrates the solution to a concrete problem, such as how to get in and out of the bathtub. DAILY will show how the assistive device works and possible uses. It will also give advice on furnishing the home in such a way that makes everyday living easier and safer. Through multimedia productions, one can add an extra dimension and give information in a way that cannot be done by printed media alone. This makes it possible to see the assistive device in action, how it works, and the different situations it can be used in.

PROGRESS--A prototype has been developed, showing which kind of assistive devices exist and how to use them in the home. Also a small pamphlet has been produced introducing our work.

[131] NEW EXPERIENCES FOR YOUNG CHILDREN WITH PHYSICAL DISABILITIES: DEVELOPING NEW PRODUCTS TO ACCESS EXISTING RECREATION TECHNOLOGIES

Steve Ryan, BESc, PEng; Michael Doell, AOCA
Bloorview MacMillan Centre, Toronto, ON Canada M4G 1R8

Sponsor: Lever Foundation

PURPOSE--Young children with disabilities have the same needs, desires, and rights to take part in the same recreational activities as their nonimpaired peers. However, since many activities require a participant to have good postural control, options are often limited for children who rely on custom seating devices for support. If a means for using custom seats during these activities could be developed, new recreational opportunities could open up for many young children with moderate to severe disabilities.

The goal of this project is to develop a standardized adapter/receiver system for customs seats to allow a child to take part in various recreational activities. This system would readily allow parents to take custom seats from wheelchairs to use as positioning devices on many commercial products such as swings, wagons, and toboggans. Issues such as safety, durability, projected cost, and usability of the system will be considered with consumers and others as it is developed.

METHODOLOGY--Our focus has been to develop an adapter/receiver system to connect custom seats to readily available commercial products. This will provide a low cost alternative to purchasing or borrowing special recreational equipment. We plan to partner with parents and recreational professionals from Bloorview MacMillan and Variety Village to be sure the proposed system is both practical and easy to use.

PROGRESS--Numerous concepts have been developed and informal technical reviews have been conducted. We are presently building working prototypes for evaluation by consumers and recreational professionals using focus group methods. Plans for modifying the prototypes will be created based on the outcome of these sessions.

[132] ASSESSING INDIVIDUALS' PREDISPOSITIONS TO THE USE, AVOIDANCE, OR ABANDONMENT OF ASSISTIVE TECHNOLOGIES

Marcia J. Scherer, PhD
The Institute for Matching Person & Technology, Inc., Webster, NY 14580; email: mjserd@rit.edu

Sponsor: National Science Foundation, Ethics and Values in Science and Technology, and Program for Persons with Disabilities, Arlington VA 22230

PURPOSE--Earlier research classified predispositions to AT use as depending upon characteristics within four major areas: a) the features and functions of a particular technology, b) the preferences and needs of the user, c) the nature of the need for the technology (i.e. disability type and severity), and d) both resources and disincentives in the person's physical and psychosocial environments. The Assistive Technology Device Predisposition Assessment (ATDPA) has subscales to separately assess characteristics of the device, the individual's preferences, the person's view of limitations, and the environments in which the person will use the AT. It is a consumer self-report checklist with 63 items of varied format, including 5-point Likert scales, developed to identify potential sources of person and technology mismatches for early targeted intervention. Side One of the consumer form consists of 53 questions given per consumer on preferences, psychosocial resources, and inquires into an individual's subjective satisfaction with current functioning in many areas and where he or she wants the most improvement to occur. Side Two contains 10 questions for consumers to complete about the technology: their views of and expectations for that particular AT. Companion professional forms are similarly constructed and allow the assessment of shared perspectives between consumer and professional.

The ATDPA is one set of assessment instruments in the Matching Person and Technology (MPT) Model and process. Other instruments are the Worksheet for the MPT Model, Survey of Technology Use (SOTU) and the Educational Technology Predisposition Assessment (ETPA).

METHODOLOGY--To determine the usefulness of the ATDPA in determining reasons for device nonuse or abandonment, 47 persons with mixed diagnoses discharged from an acute inpatient rehabilitation unit completed the instrument at the time of discharge and at 3-mo postdischarge.

To test the value of the MPT process in helping consumers identify the most appropriate technology for their use (and to become more self-determining and independent in the acquisition and use of technology), peer mentors were trained in the MPT process at the Rochester Center for Independent Living. To date, over 25 consumers have been paired with a trained peer mentor.

RESULTS--Among all participants, 128 devices were prescribed; of these, 86 were still used at 3-mo follow-up. For those abandoned, the most frequent reason given was the device was no longer needed, although functional improvement (as measured by the FIM) corresponded with device nonuse for just half the devices. The results from the ATDPA indicated that consumers have positive expectations of devices and, if actual performance falls short of expectations, the response may be to discard use of the device. When consumers seem to over-expect gain from AT use, an appropriate early intervention may be longer trial periods with devices in a variety of situations.

As a means of testing the usefulness of the MPT process in developing a more realistic awareness of AT (both in terms of positive aspects and limitations of technologies), a consumer education program conducted by trained peer mentors has consistently resulted in good person and technology matches, and the MPT mentoring process has been shown to be a cost-effective means of service delivery that has brought more self-aware and knowledgeable consumers into partnership with providers. This has maximized professional time and expertise while yielding an effective, technology-based, higher quality of life for the consumer.

IMPLICATIONS--The results of research and training efforts to date consistently confirm the importance of consumer perceptions and psychosocial factors on decisions to use (or not use) a technology. Early involvement of consumers in technology selection and evaluation determines desirable device characteristics/usability to ensure that a device is a realistic and appealing match for that particular user.

RECENT PUBLICATIONS FROM THIS RESEARCH

A functional approach to psychological and psychosocial factors and their assessment in rehabilitation. Scherer MJ, Cushman LA. In: Dittmar SS, Gresham GE, editors. Functional assessment and outcome measures for the rehabilitation health professional. Gaithersburg, MD: Aspen Publishers; 1997. p. 57-67.

A functional approach to technological factors and their assessment in rehabilitation. Scherer MJ, Vitaliti LT. In: Dittmar SS, Gresham GE, editors. Functional assessment and outcome measures for the rehabilitation health professional. Gaithersburg, MD: Aspen Publishers; 1997. p. 69-88.

Outcomes of assistive technology use on quality of life. Scherer MJ. Disabil Rehabil 1996;18(9)439-48.

Evaluating, selecting, and using appropriate assistive technology. Galvin JC, Scherer MJ, editors. Gaithersburg, MD: Aspen Publishers; 1996.

Living in the state of stuck: how technology impacts the lives of people with disabilities (2nd ed). Scherer MJ. Cambridge, MA: Brookline Books; 1996.

Measuring the relationship of assistive technology use, functional status over time, and consumer-therapist perceptions of ATs. Cushman LA, Scherer MJ. Assist Technol 1996;8:103-9.

[133] AN ADAPTIVE TOILETING SYSTEM FOR YOUNG CHILDREN

Steve Ryan, BESc, PEng; Michael Doell, AOCA; Gloria Leibel, BScPT; Dianna Lee, MA, OT(C); Jan Polgar, PhD, OT(C)
Bloorview MacMillan Centre, Toronto, ON Canada M4G 1R8; University of Western Ontario, Department of Occupational Therapy, London, Ontario, Canada

Sponsor: Ontario Rehabilitation Technology Consortium funded by the Ontario Ministry of Health

PURPOSE--Toileting is an area of concern for many parents of children with physical disabilities. Unless appropriate postural support is provided on a secure base, this event can be frightening for a child and disconcerting for the parent. Our review of commercially available options suggests that many devices are available, but inadequate, because they lack appropriate postural support. A few products have features that can be adapted to seat the child but are beyond the financial means of many families and do not effectively position the child for this activity. Research was conducted to develop a toileting system that would position children better and address issues raised by parents and clinicians.

METHODOLOGY--A take-home prototype was built and used by children in eight families for 1 week each. At the end of the trial period, parents and children were interviewed to understand their views about the performance of the toileting prototype. Families who took the device home were generally very positive about its effectiveness and suggested the incorporation of some minor design improvements to improve its consumer appeal. Suggested changes included increasing hip width, reducing the weight, and modifying the shape of the foot support.

PROGRESS--A final wooden prototype was built and "dry tested" with children to verify the size and geometry of the commercial version of the toilet seat. During this phase, locating pads in two sizes were designed to position the hips of smaller children more effectively. A simple, inexpensive form for the footrest was developed to offer two heights for children. We worked with local contractors to translate our design into an aluminum rotational mould. The mould will be used to create hollow plastic parts for the commercial unit.

FUTURE PLANS--We hope to finalize the manufacturing details and consumer instructions and release the product to market fall 1997.

[134] VIDEO, DESIGN, AND REHABILITATION ENGINEERING

Gilbert Logan; David Radcliffe
Department of Biomechanical Engineering, Royal Brisbane Hospital, Brisbane, Australia 4029; Mechanical Engineering Department, University of Queensland, Australia; email: logang@health.qld.gov.au; logan@mech.uq.edu.au; radcliffe@mech.uq.edu.au

Sponsor: Royal Brisbane Hospital, Brisbane, Australia 4029

PURPOSE--We seek to understand the purposeful use of various artefacts (including seat components and wheelchairs) in relation to utterances by participants in a client assessment and design/manufacturing process providing customized seating for people with severe physical disabilities. The value of this work is in developing techniques that will enable an assessment and design group remote from the client to manufacture customized devices via video conferencing technology. The development of these techniques will expand the availability of specialized assistive technology services to people with disabilities living in remote locations and reduce the cost, inconvenience, and trauma of people with disabilities having to travel to large cities to receive specialized services.

METHODOLOGY--The activities of a rehabilitation engineering team have been observed over a 3-yr period. Videotapes of team practice are being analyzed to explore the relationship of, and the use of, action in association with talk to communicate design ideas.

PROGRESS--We have found that purposeful actions, such as using hands to locate design intent, creating mock-ups of ideas using simple components, and shaping hands convey more design information for manufacture than oral utterances of the team members. There appears to be reliance on visual representation as the main communication medium. Work is continuing on techniques to capture the visual data and make it available quickly to guide manufacture.

RECENT PUBLICATIONS FROM THIS RESEARCH

Potential for use of a house of quality matrix technique in rehabilitation engineering. Logan GD, Radcliffe DF. IEEE Trans Rehabil Eng 1997;5(1):106-15.

[135] AN EVALUATION OF THE ACCESS GLIDE SYSTEM FOR MOUNTING AUGMENTATIVE COMMUNICATION DEVICES: A PILOT STUDY

Jim Wighton; Tamzin Cathers, MA; Sandra Aylward, PhD, Ann Siess, CA, MPA; Elizabeth Mackinnon, MClSc
Thames Valley Children's Centre, London, ON, Canada, N6B 5Y6

Sponsor: Thames Valley Children's Centre, London, ON, Canada, N6B 5Y6

PURPOSE--There are times, such as when driving a wheelchair or toileting, when users of augmentative communication devices do not need their devices to be positioned in front of them. Accidental damage to equipment can result when devices must be removed from wheelchairs, causing inconvenience to the user. The Access Glide System (AGS) has been designed to address the issue of equipment placement. Mounting hardware that incorporates a linear motion system allows for storage of the device behind the wheelchair canes without physically removing the equipment from the chair. The system is designed to be operated manually by caregivers. This pilot study evaluated the effectiveness of the AGS from the perspective of both clients and caregivers. Specifically, nine consumer-based criteria for the evaluation of assistive devices were examined: effectiveness, operability, dependability, personal acceptability, the extent to which the consumer can easily learn to use the device, physical security, physical comfort, portability, and securability.

METHODOLOGY--Four clients needing augmentative communication devices and 13 individuals who interact with the clients on a regular basis (e.g., parents, therapists, educational assistants, and friends) participated in the study. Clients represented a range of ages and living situations. They used the AGS for a period of at least 6 wks before giving feedback to the researchers in home interviews. Clients distributed questionnaires to other individuals they felt would have enough interaction with the AGS to provide useful feedback.

RESULTS--The AGS was found to be an effective and useful mounting system. All clients reported using the system several times a day. The system allowed clients and caregivers to store their augmentative communication devices safely and efficiently behind their wheelchairs. Moreover, the system increased clients' access to their devices. Caregivers found it took a matter of seconds to slide the device to a position in front of clients for use. The system was easier for caregivers to operate, compared to previous equipment, because they did not have to detach and reattach the device to the chair for each change in functional activity. As a result, clients reported that their independence had increased.

FUTURE PLANS--Feedback from the study participants will be included in further design refinements of the system. We next will demonstrate the AGS at augmentative and alternative communication centers across Ontario. A questionnaire is currently being designed to gather feedback from therapists and technicians on other evaluation criteria such as: ease of assembly, compatibility with other devices, durability, and ease of maintenance. Further steps include the development of a broader marketing plan.

[136] SPECIAL PROJECTS AND DEMONSTRATION: APPLICATIONS OF TECHNOLOGY TO ENHANCE QUALITY OF LIFE--A COMMUNITY MODEL

Ian R. Pumpian, PhD; Andrew Y.J. Szeto, PhD; Caren L. Sax, MSEd
San Diego State University, Interwork Institute, San Diego, CA 92182-5313

U.S. Department of Education, Department of Special Education and Rehabilitation, Washington DC 20202

PURPOSE--The project focuses on demonstrating that the education and rehabilitation planning processes for individuals with significant disabilities can be enhanced by appropriate applications of technology. The project intends to demonstrate that persons with severe disabilities using customized adaptations (assistive devices) can participate more meaningfully in integrated work, school, and other community settings; to involve educators, rehabilitation counselors, case managers, teachers, parents, employers, future engineers, and community members with technical expertise in the development of adaptations; and to develop a replicable approach for enhancing the applications of assistive technology through direct service, information collection and dissemination, and referrals.

PROGRESS--To identify individuals who could benefit from customized technical adaptations, the project staff worked closely with teachers and resource specialists of the San Diego Unified School District as well as staff from local supported employment and supported living agencies. The project targeted transition-aged students (18-22 years) and young adults who, with suitable individualized assistive technology, could become more active participants in school, work, and community settings. Resources were utilized to build up the technical capabilities of local schools and service agencies, expanding the network of rehabilitation and assistive technology professionals, and reducing possible duplication. The project successfully exceeded its goals in terms of number of persons helped and technical adaptations completed.

One key component of the project was the use of multidisciplinary tech teams, individually focused on the specific needs of the consumer. These teams included friends, family members, interested volunteers, and employers, in addition to the special educators, engineering students, OTs/PTs, speech therapists, and community-based rehabilitation professionals who were enrolled in a special seminar jointly taught by the Departments of Special Education and Electrical Engineering. In addition to providing valuable hands-on experience of designing and fabricating a customized assistive device, the seminar facilitated exchanges of ideas and diverse viewpoints. The Interwork Technology Mini-center coordinated various demonstration, training, research, and dissemination activities associated with the project while also serving as a repository of numerous reference materials available for use by the community and the teams. Information about on-going projects and completed projects have been disseminated in print and via the Internet at http://www.interwork.sdsu.edu/projects/.

RESULTS--Major accomplishments after 48 months include: 1) better collaboration with the school district, supported employment, and supported living agencies through better utilization of each others' assistive technology resources and expertise; 2) expanded key intra-state and inter-state linkages; 3) design, fabrication, and delivery of over 40 customized technical adaptations; 4) documentation of individualized adaptations using photographs, videotape, technical drawings, and case study descriptions; 5) presentations at the local, state, and national levels; 6) evaluation of the completed projects; and 7) establishment and maintenance of a local web site that describes project activities and accomplishments.

Recently completed customized adaptations include: a wheelchair-mounted laptray with a hinged plexiglass cover that prevented the unwanted removal or destruction of instructional and communication materials placed there. Modification of a bicycle to permit independent mobility by an undersized 4-year-old girl; to accommodate her physical limitations, the bicycle's seat was lowered, its handlebars were bent backwards, the pedal cranks were shortened, and the gear ratio was changed. A substitute custom-made universal remote control with large buttons and labels that enabled an 11-year-old sixth grader to control the TV, VCR, and radio in his classroom. A front-mountable shopping/utility bag for a powered wheelchair, to enable an elderly woman to carry groceries: the bag was made of industrial grade mesh cloth, the support frame and wheelchair brackets of aluminum. A customized tiltable laptray to hold papers and other school work for a 10-year-old boy with congenital myotubular myopathy; the laptray was fitted to a reclining, powered wheelchair that had bilateral joystick controllers and ventilation equipment.

RECENT PUBLICATIONS FROM THIS RESEARCH

Assistive technology and inclusion. Sax C, Pumpian I, Fisher D. CISP Issue Brief 1997;2(1):1-5.

From snake lights to power drills: Using adaptive devices to support students with disabilities in schools. Sax C. Proceedings of the 20th Annual RESNA Conference; 1997 Jun 20-24, Pittsburgh, PA. Washington, DC: RESNA Press; 1997.

Improving oral medication compliance with an electronic aid. Szeto AYJ, Giles Jr, JA. IEEE Eng Med Biol Mag 1997;16(3):48-54,58.

Including all students in the high school reform agenda. Fisher D, Sax C, Pumpian I, Rodifer K, Kreikemeirer P. Educ Treat Child 1997;20(1):59-67.

Outcomes for students with severe disabilities: Case studies on the use of assistive technology in inclusive classrooms. Sax C, Fisher D, Pumpian I. Technol Disabil 1996;5:327-34.

[137] TRANS-TRAIN: TRANSDISCIPLINARY TRAINING OF REHABILITATION PERSONNEL IN ASSISTIVE TECHNOLOGY

Ian R. Pumpian, PhD; Andrew Y.J. Szeto, PhD; Caren L. Sax, MSEd
San Diego State University, Interwork Institute, San Diego, CA 92182-5313

U.S. Department of Education, Department of Special Education and Rehabilitation, Washington DC 20202

PURPOSE--Project TRANS-TRAIN seeks to provide preservice and inservice training to rehabilitation personnel in Assistive Technology. It is a university-based program that combines academic classroom instruction with experiential field activities. Although discipline specific training will occur, TRANS-TRAIN fundamentally is a transdisciplinary project that establishes a series of courses, guided design projects, and internships that focus on the development and use of assistive technology. Six- to nine-unit curricula sequences are being offered and co-listed in the Departments of Special Education and Rehabilitation graduate degree and certificate programs and in the Electrical and Computer Engineering undergraduate and graduate degree programs. To complement an existing certificate program in Supported Employment and Transition, a specialization area in Rehabilitation Technology is being developed.

METHODOLOGY--Because students enter from various educational and vocational backgrounds, such as engineering, special education, rehabilitation counseling, communicative disorders, and social work, the certificate program will be customized to fit their backgrounds, skills, interests, and intended application areas. In addition to the six- to nine-unit curricula, students seeking a "Certificate in Assistive Technology" complete six units of formalized, discipline-specific coursework from their home departments and three to six units of transdisciplinary seminars covering a broad range of rehabilitation technology competencies and knowledge. For hands-on experience, students participate in a number of internships, off-campus and on-campus, under the supervision of professors and practicing professionals in rehabilitation engineering, special education and rehabilitation, and communicative disorders, by working at local agencies.

PROGRESS--During Fall 1996 and Spring 1997, 20 undergraduate and 1 graduate engineering students, 14 graduate students in special education, 3 graduate students in rehabilitation counseling, 1 physical therapist, 2 assistive technology suppliers, and 2 technically proficient community members participated in the transdisciplinary seminar.

Tech teams were formed around individuals with disabilities who needed some sort of adaptations. Some of the adaptations designed, fabricated, field tested, and delivered include:

A powered jump rope turner was adapted for a fifth grader with cerebral palsy (CP). The adaptation included a battery power drill mounted on the arm of her wheelchair, a joystick controller, and a large wheel that spun the jump rope.
Teacher attention-getter for a 7-year old boy with CP. A snake light was attached to the power chair and operated by the boy using an on/off switch mounted to a movable bar.
Off-Road walker for an 11-year old with CP. The device can be fitted with either two or four oversized plastic wheels and was carried on his wheelchair by a pair of Quickie armrests, turned backwards.
Revamped walker with carrier to enable a high school student with CP to transport his lunch and to work in an office. A modified bike bag was attached to a swing-away bar, clamped across the front-opening walker.
A more functional lap tray to enable a 6th grader to manipulate the drive wheel of his manual wheelchair while also use his laptray as a communication board and desktop.

RECENT PUBLICATIONS FROM THIS RESEARCH

From snake lights to power drills: using adaptive devices to support students with disabilities in schools. Sax C. Proceedings of the 20th Annual RESNA Conference; 1997 Jun 20-24, Pittsburgh, PA. Washington, DC: RESNA Press; 1997.

[138] A MUSICAL INSTRUMENT DIGITAL INTERFACE FOR CHILDREN WITH PHYSICAL DISABILITES

Isaac Kurtz, MHSc; Roger Knox, PhD; Anne Bindernagel, MTA; Gilbert Chau, EEngT
Bloorview MacMillan Centre, Toronto, ON Canada M4G 1R8

Sponsor: None listed

PURPOSE--Recreation is part of every child's growth and development, but children with severe physical disabilities are limited in the activities they can pursue independently and with their peers. The proposed project aims to broaden the scope of possibilities for recreation and social interaction for such children through the creation of a single switch interface for a Musical Instrument Digital Interface (MIDI) keyboard, and addressing how to best integrate music into education, therapy, and play. MIDI is a universal standard that allows musical keyboards and instruments to communicate electronically.

PROGRESS--A prototype device that allows children to play music independently with a single switch has been developed. The device will consist of an LCD display, adapted switch inputs, a MIDI connection for electronic keyboards, and a removable cartridge containing a microprocessor with software to play music. Initially, two demonstartion cartridges have been produced. One cartridge will allow users to play individual notes, chords, and arpeggiated chords from one, two, or three switches, with a fourth switch for the control of tempo and the fundamental note being played. This cartridge will allow individuals or groups to play harmony and accompany virtually any song or melody. Virtually any instrument, or even choral music can be played. The second cartridge is a melody cartridge to allow children using single switches to play from a choice of approximately 10 melodies. The tempo and timing of the music will be controllable by the user.

FUTURE PLANS--Music cartridges containing approximately 20 songs each will be created for a variety ages and musical tastes. Age- and ability-appropriate activities and programs will be developed for using the new technology, and musical activities, rhythm games, and songs for individuals, pairs, and larger groups will be developed and evaluated. Emphasis will be on identifying and developing music that is varied and interesting, while requiring only a limited number of chords and notes to play. Activities that emphasize rhythm, playing sounds on cue and alternating play between individuals will be developed and piloted as part of this project. A manual for Occupational, Physical and Music therapists outlining the activities developed in this project will be produced. The development of a methodology for measuring the psychosocial benefits of the musical activities made possible by this project is planned for the coming year.

B. Robotics

[139] DEVELOPMENT OF AN ASSISTIVE ROBOT FOR EFFECTIVE HEALTH CARE DELIVERY

H.F. Machiel Van der Loos
VA Palo Alto Health Care System, Palo Alto, CA 94304-1200; Department of Functional Restoration, School of Medicine, Stanford University, Palo Alto, CA 94305; email: vdl@roses.stanford.edu

Sponsor: Department of Veterans Affairs, VA Rehabilitation Research and Development Service, Washington, DC 20420
(Project #B899-2DA)

PURPOSE--Over the past 7 years, veterans with high level quadriplegia have been testing the ability of the DeVAR robotic workstation to replace an attendant for independent execution of vocational tasks. These tests have proven feasibility, and along with the recent VA Technology Transfer Section (TTS) evaluation, have clarified the next necessary phase of development that will advance the workstation to successful commercialization. The primary goals for this phase are more functionality per dollar, easier operator control, and higher system reliability.

The research plan involves 1 year of intensive design and low-level development, including evaluation methods and materials, 1 year of iterative development and evaluation cycles of subsystems, and a third year of in-clinic full system evaluation at this facility's Spinal Cord Injury Center.

METHODOLOGY--Increased functionality will be achieved by refining the current DeVAR interface so that users will be able to design their own robot tasks without having to become programmers of the robot to do so. Adding force and touch sensors that detect surfaces and objects will then allow the robot to make adjustments when needed, and verify that tasks are done correctly and safely. The combination of the new interface and the sensors is the key to a successful implementation, since neither advance alone will meet the challenge of providing effective user control of robot programming.

The reliability of the robot will be increased by a commercial control system that integrates motion, sensing, and communication functions. The controller will be networked to the interface computer, with a link to the Internet. This modular approach will enhance reliability, and will provide a rich, multimedia communication path for troubleshooting, training, and information exchange between the user, the robot manufacturer, therapists, and other users. The TTS evaluation demonstrated the tremendous importance of communication to system maintenance and downtime reduction. We will customize network-based software for remote diagnostics and troubleshooting that will allow for fast response to problems that arise.

PROGRESS--The start-up phase is complete. We have identified, specified, and procured the necessary hardware and software for adaptive access, robot controller, user interface, networking, and sensor subsystems. We have specified critical communication and modeling protocols. Interface and controller programming is ongoing. Evaluation methods and materials from previous DeVAR evaluations are being used to develop augmented data instruments. Collaboration with Spinal Cord Injury Center clinical staff is ongoing to develop task lists, user profiles, and staff clinical needs.

A suite of adaptive access equipment for a Windows environment has been chosen to allow operators to use head motion, speech, and residual arm motion to operate a keyboard, pointing device, and other communication equipment. The interface design is based on WWW standards for modeling and communication. VRML and JAVA-based standards have been chosen for their platform-independence and for the support they will continue to receive in the future by the computer industry. General concepts for the design of the interface have been prototyped. The controller software is based on a real-time operating system and code developed for full dynamic control of a PUMA robot.

[140] CUSTOMIZATION OF A SPACEBALL INTERFACE FOR THE MANUS ROBOT ARM

Anjum Chagpar, BASc; Geb Verburg, MA; Alf Dolan, PEng
Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada; Bloorview MacMillan Centre, Toronto, ON Canada M4G 1R8

Sponsor: None listed

PURPOSE--Rehabilitation robots, such as the Manus, can enable children to independently explore and manipulate their environments, provided that the robot is simple and intuitive to control. Traditional controllers like joysticks or keyboards are too limited, or too nonintuitive to allow for obvious control of a robot arm. They require the user to switch among many different modes. In addition, these controllers are difficult to use for people with tremors or spasticity. The Spaceball is a ball-shaped computer input device that remains stationary while a user exerts light pressure to push (left/right, forward/backward), pull (up/down) and twist and turn it in different directions. Because it allows for motion in 6 independent directions, there is no need for mode switching when using it to control the robot arm. The Spaceball is also programmable, which enables it to be customized according to different user needs.

The primary objective of this research is to enable children and young adults with variable strength and control of their hands and limbs to use the Spaceball as an interface to the Manus robot arm so that they may independently explore and manipulate their environment.

METHODOLOGY--We must first determine which groups of physically challenged children can derive the most benefit from the Spaceball-Manus manipulator combination, along with the prerequisite conditions that these groups would require for successful use of it. Then we must design a system that allows these parameters to be easily configured and adjusted such that children and young adults with different characteristics may use the conbination with equal effectiveness. Finally, we shall evaluate the designed system by comparing its performance with that of the standard Manus interfaces of keyboard and joystick.

PROGRESS--The hardware interface has been reconfigured and is currently being tested. Participants are currently being recruited for the clinical trials.

FUTURE PLANS--Two studies will be conducted: In the first, eight expert users will use the Manus with three different interfaces (keyboard, joystick, and Spaceball) to perform three tasks. Time to completion and number of successfully completed steps in each task will be used as measures to determine whether there is improved performance with the Spaceball. In the second study, participants between the ages of 12 and 18 with cerebral palsy, spina bifida, arthritis, and muscular dystrophy will perform the same three tasks with the Spaceball with and without customizations and the same performance measures will be recorded. Data collected will be analyzed and a final report of the results prepared.

[141] ALTERNATIVE CONTROLLERS FOR THE MYOELECTRIC QUADRAPLEGIC ASSISTIVE DEVICE (MYQUAD)

Omar Silva-Zapata; Paul Barrie; Anastasia Cheetham, John Hancock; Geb Verburg
Marc Garneau, Collegiate Institute, East York, Ontario, Canada; Bloorview MacMillan Centre, Toronto, ON Canada M4G 1R8

Sponsor: None listed

PURPOSE--This project proposes a four-position analog joystick as an alternative controller for the Myoelectric Quadraplegic Assistive Device (MyQuad).

METHODOLOGY--The myoelectric quadraplegic assistive device is a wheelchair-mounted robot designed for the high-level quadriplegic group. Five degrees of freedom (DOF) are offered: axial rotation, height, telescopic, terminal device rotation, and terminal device prehension. The existing myolectrical controllers allow movement in either positive or negative direction in a single axis, in conjunction with a head switch, and require five modes each controlling one degree of freedom. (5 modes×1 DOF=5 DOF).

An analog four-position joystick allows intuitive control in the x-y axis but not for the remaining three functions of the MyQuad, thus a switch between modes during control is needed. Indeed one of its functions has to occur in more than one mode in order to use the six possible DOF offered by an x-y axis joystick (3 modes×2 DOF=6 DOF).

Compared to the five modes used by the myoelectrical controller, a joystick offers a more effective and intuitive means for controlling the MyQuad. People with high-level quadriplegic injuries are unable to use this technology. However, for people with muscular dystrophy, the joystick may be a suitable alternative controller.

PROGRESS--In order to minimize the number of times that the user changes mode by pressing a switch, eight experiments were done to find out what functions should be paired in the three modes. Other experiments show that with the proper strategy, reaching and grasping an object can be achieved in less time. Also it was found that the functionality of the Myquad depends on the size, weight, and the shape of the object. Also, the time taken to get an object is reduced as the user is familiarized with the MyQuad. It is likely a learning process.

Currently, an interface is being developed between the MyQuad and a four-position joystick.

FUTURE PLANS--Future work may include controlling the arm through a computer program.

C. Communication Methods and Systems

[142] DEVELOPMENT OF AN ASSISTIVE MEMORY DEVICE FOR PATIENTS WITH SEVERE AMNESIA: A PILOT STUDY

Gerald Goldstein, PhD
VA Pittsburgh Healthcare System, Highland Drive Division, Pittsburgh, PA 15206

Sponsor: Department of Veterans Affairs, VA Rehabilitation Research and Development Service, Washington, DC 20420
(Pilot Project #F471-5PA)

PURPOSE--The specific purpose of this investigation was to evaluate whether an assistive device shown to be effective with persons with pure amnesic disorders (Korsakoff's syndrome) can be productively applied to brain-damaged persons with multiple deficits including, but not restricted to, memory. The study planned was concerned with densely amnesic individuals, and with the evaluation of a small, portable device that subjects can use to access ADL relevant information. Training to use the device involved a conditioning procedure shown to be effective in previous research. The major goal of the study was that of determining whether subjects could be successfully trained to use the device, and whether such training substantially improved memory function in everyday life.

METHODOLOGY--Subjects were recruited on the basis of presence of severe memory disorder associated with Alzheimer's disease, or other neurological illness associated with severe dementia and amnesia. A neuropsychological assessment was used to determine eligibility for the study. Subjects meeting inclusion and exclusion criteria were to be introduced to the training device and engage in the conditioning program that involved teaching subjects to use the device with increasing independence in order to access information. The goal of the program was to teach the subject to independently use the device upon a verbal request for information that the device contained. Learning curve data would be accumulated and various measures, administered before and after training, were to be used to assess outcome.

PROGRESS--Substantial effort has been made to recruit subjects for this study. Of 13 persons approached who met the criteria of severe amnesia and other cognitive deficits, mainly patients with Alzheimer's disease, all either did not meet psychometric inclusion criteria, could not cooperate for psychometric testing, or could not understand the requirements of the training. We were unable to enter any subjects with diagnosed Alzheimer's disease who could cooperate for the program. Our conclusion from this pilot work is that training to use an assistive memory device, while effective with patients with severe but pure amnesic disorders, is unlikely to be effective for patients with progressive dementia.

FUTURE PLANS--We remain committed to finding effective methods for improving functional capacity and quality of life for brain-damaged persons. However, we appear to have convincing evidence that a method shown to be remarkably effective for patients with a neurobehavioral disorder involving a single domain, in this case memory, was not found to be effective in patients with more generalized cognitive dysfunction. Perhaps usage of "smart" technologies in these patients' environments would be more productive.

RECENT PUBLICATIONS FROM THIS RESEARCH

An assisitive device for severely amnesic patients. Goldstein G, Beers SR, Shemansky WJ, Longmore S. J Rehabil Res Dev. In press.

[143] COMPUTER ACCESS SELECTOR AND VOCASELECT

Rob Garrett, BTech; Hugh Stewart, BAppSc (OT); Duane A. Stapleton, BEng; Paul Davies, BEng; Barry Seeger, PhD
Regency Park Rehabilitation Engineering, Regency Park, SA 5942, Australia; email: rob_garrett@ieaust.org.au

Sponsor: The Crippled Children's Association of South Australia, Inc., Regency Park, SA 5942, Australia

PURPOSE--Computer Access Selector and VOCAselect are computer programs that aim to assist in the selection of alternative computer access and voice output communication devices respectively, a process that, for an individual with a disability involves a compromise of many different parameters. Professional assessment is generally required to determine his or her the needs and abilities, and selection of specific products is not necessarily straightforward, due to the number available. Computer Access Selector and VOCAselect narrow down the large number of products, on the basis of feature selections made by the user.

METHODOLOGY--The user specifies the requirements of the computer access system or voice output device he or she is looking for by selecting from a series of parameters, and the programs use expert knowledge to suggest potentially suitable products. The suggestions are dynamically adjusted as user selections are changed. This provides a means for the user to explore different possibilities and trade-offs. A click of the mouse reveals details about a product and shows a picture of it on-screen. Manufacturer and Australian supplier contact information is provided in the product details. The software can be instructed to generate a report of the user's findings for printing or inclusion in a word processing document.

PROGRESS--Computer Access Selector version 1.0, a Windows-compatible program, was released in 1995 and offered free for evaluation purposes; it has now been distributed to a large number of interested individuals, professionals, and organizations. VOCAselect version 1.0, a Macintosh-compatible program was also released in 1995, and has now been distributed widely. Following suggestions from the users of the Macintosh version of VOCAselect v1.0, VOCAselect version 1.9 (Windows-compatible) was released in 1996. All programs have undergone alpha and beta testing prior to release, and are available for A$50 each, +A$10 postage and handling.

RESULTS--Feedback and responses have been sought from users, primarily via a survey questionnaire sent with the software. The survey results have been used to assist in the development of the next versions of the programs.

FUTURE PLANS--Refinements based on user response will continue to be made to ensure that the programs continue to be relevant and valuable tools for all who need to choose alternative access and voice output technology. The product information contained in both software packages is expected to be updated annually. Version 2.0 of both packages with updated product information will be available by late 1997.

RECENT PUBLICATIONS FROM THIS RESEARCH

Computer access selector: a tool to assist in the selection of computer access devices. Stapleton D, Garrett R, Stewart H, Seeger B. Proceedings of the 2nd Australian Conference on Technology for People with Disabilities; 1995, Adelaide, Australia. Regency Park, SA: The Regency Park Centre; 1995. p. 128-30.

VOCAselect version 1.0: an AAC device selection tool. Stapleton D, Garrett R. Proceedings of the 2nd Australian Conference on Technology for People with Disabilities; 1995, Adelaide, Australia. Regency Park, SA: The Regency Park Centre; 1995. p. 114-6.

[144] CELLINK, CELLULAR TELEPHONE INTERFACE

Ed Snell, CET; Paul O'Brien, BTech; Ivy Lo
Bloorview MacMillan Centre, Toronto, ON Canada M4G 1R8

Sponsor: Industry Canada, Ottawa, ON Canada K2H 8S2; Bloorview Foundation, Mitsubishi Canada, OKI Telecom, Nokia Products Limited, Bell Mobility

PURPOSE--Access to a cellular telephone allows for immediate communication whenever and wherever a person wishes to place a call. Many commercial telephone devices address the needs of personal communication for persons with disabilities only when they are used in their home environment. This important communication link is lost outside the home. The community is increasingly becoming more accessible to people with severe disabilities, resulting in additional vocational and recreational time spent outside the home. Personal safety and security can be enhanced by cellular telephone technologies. Persons with more severe disabilities could have their personal communication needs accommodated through wheelchair-mounted cellular telephones requiring minimal physical input to operate.

PROGRESS--Manufacturing prototypes of the CELLINK, cellular telephone interface, have been constructed. A consumer focus group was established to identify important adapted telephone features and to perform its field evaluation. All consumers used powered wheelchairs and had normal visual acuity and hearing. Three controlled their wheelchairs using proportional joysticks, one with a Peach Tree head control, and one a SIP&PUFF control. Two used portable ventilators and one used a phrenic nerve pacer.

A criterion for inclusion in the field evaluations was that there be no observable electromagnetic compatibility issues between the cellular telephone and any of their assistive technology (AT). An empirical test was performed with each subject's AT to verify compatibility. None observed any unusual dysfunction of their AT while using the device. It was strongly advised that they should not operate the phone while driving their wheelchair.

RESULTS--All had used their phones for between 2 and 5 mo before the follow-up evaluation was conducted. Typically, the CELLINK was used for personal calls to stay in touch with friends and family. The second most frequent use was for somewhat essential community calls to reschedule transportation bookings. One consumer needed to dial 911 for a personal medical emergency.

All felt that the phone increased their independence, ability to get help in a timely manner, personal safety, and their ability to acquire transportation. Some felt that having the CELLINK gave them the security to spontaneously go places with their wheelchair where they normally would only have gone with organized transportation. They were less concerned with becoming stranded in the community, which promoted more outings.

The features that they found most effective were the dialing directory, last number redial, and the priority dial. When asked what other features they would like, they responded: connect to home computer, control land line telephone, and control home entertainment equipment. Three felt that it was a convenience to have cellular telephone access, while two felt that it was a necessity. All felt that they would use a cellular telephone in conjunction with their land line home dialer.

FUTURE PLANS--Further investigation is required with a larger consumer population to determine the significance of personal cellular communications to greater community independence and safety. A collaborative quality-of-life investigation is planned to include 40 consumers with severe disabilities who use powered wheelchairs for mobility and who are unable to use commercial cellular telephones.

[145] FRENCH WIVIK

Deborah Fels, PhD, PEng; Fraser Shein, MEng, PEng; Anastasia Cheetham, MASc; Gilbert Belilse; Dale Szlamkowicz BScOT(C)
Ryerson Polytechnic University, Toronto, Ontario, Canada; Bloorview MacMillan Centre, Toronto, ON Canada M4G 1R8 Gilbert Belilse Inc.; Centre de Réadaptation Lucie Bruneau

Sponsor: Industry Canada, Ottawa, ON Canada K2H 8S2

PURPOSE--WiViK and KeyREP are compatible with all international (foreign language) keyboards supported by Windows. However, the user interface and on-line and printed documentation are in English only. As a start to providing full support in other languages, a French version of the software and documentation has been produced. The immediate markets are persons in Quebec and other French-speaking Canadians, as well as persons in Europe. To ensure that the French products are of high quality, a formal evaluation was held with participants in Quebec and Europe.

PROGRESS--The interfaces for WiViK and KeyREP have been completely translated into French. New standard and macro keyboards were designed to incorporate accented characters and different country layouts. During this process we learned a great deal about the real complexities of providing a simple-to-use keyboard when accented characters are involved. Sample French word prediction dictionaries and abbreviation-expansion sets were also created.

Some improvements in the software were made to facilitate translation. This should make translation into other languages easier. The layout structure for the manual was standardized so that the document design task was considerably simplified.

FUTURE PLANS--Our translated WiViK and KeyREP products were released in 1997. Future work may include translation into French of other products such as WiVox and upcoming product upgrades.

[146] EVALUATION OF OVERDRIVE SCANNING

Fraser Shein, MEng, PEng; Mark Chignell, PhD
Bloorview MacMillan Centre, Toronto, ON Canada M4G 1R8; University of Toronto, Toronto, Ontario, Canada

Sponsor: National Health Research and Development Programme, Health and Welfare Canada; Ontario Rehabilitation Technology Consortium funded by the Ontario Ministry of Health; IBM Canada Ltd.

PURPOSE--Overdrive scanning was evaluated as an enhancement to text scanning strategies to potentially reduce scanning time. Overdrive scanning allows subjects to control a faster scanning rate through the use of a second switch. It attempts to reduce the time that the user must wait as scanning proceeds across many items. This time may be viewed as wasted.

METHODOLOGY--Two methods for overdrive have been designed and programmed into WiViK. One method takes advantage of a second switch with a timed hold and release action. As long as this second switch is held, the scan interval is shortened by some factor, thus increasing scan rate. When the switch is released, the scan interval returns to its original value. Recognizing that some users may not be able to perform such an action, another method has been designed to take advantage of a second switch with a discrete activation to toggle the original scan rate to a faster rate. A second activation toggles the rate back to its original value.

A between-subjects design was employed utilizing two groups of 10 nondisabled subjects each in this experiment. Each group used one of the two overdrive methods in four sets of trials. Each of the four sets of trials performed by each group included 30 test trials in which each of the 15 target items were tested twice.

PROGRESS--With both methods, there was a clear tradeoff function associated with using overdrive. There were three target distance zones in which subjects demonstrated overdrive usage: a 'no' zone in which the user would definitely not choose overdrive; a 'maybe' zone in which the user might use overdrive; and a 'yes' zone in which overdrive would always be used. The maybe zone had questionable benefit in terms of time savings and greater errors. The yes zone had significant time savings in the order of 40-60 percent which can translate into several seconds. With the first method, this zone began after the fifth or sixth item (depending on overdrive speed). With the second method, this zone began later after the eighth or ninth item, which can be attributed to the state of tension over toggling the overdrive on and off. In both cases overdrive was initiated almost immediately and maintained as long as possible before releasing to return to the regular scan interval to select the target.

Although an overdrive function has the potential for significant time savings, it is only useful when the dimension of the scanned items lies in the yes zone and if the user has the physical ability to use it. Generally, overdrive is not useful while moving across text objects. Only when scanning across many words in a line is the advantage of overdrive obvious, although words could be scanned in groups of several words and overdrive would not be used at all. However there are circumstances in which it is faster to scan with overdrive across many items than it is to scan in groups. Overdrive has potential benefit when targeting items near the end of a larger group, and little or no benefit when targeting items at the start of a group.

[147] EVALUATION OF TEXT SELECTION STRATEGIES

Fraser Shein, MEng, PEng; Mark Chignell, PhD
Bloorview MacMillan Centre, Toronto, ON Canada M4G 1R8; Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada

Sponsor: National Health Research and Development Programme, Health and Welfare Canada; Ontario Rehabilitation Technology Consortium funded by the Ontario Ministry of Health; IBM Canada Ltd.

PURPOSE--Three new strategies for positioning the insertion point by scanning the text were compared with each other, and with a standard keystrokes strategy. First, a predictive analysis was used to estimate error-free performances. Second, an experiment was conducted with subjects to gain knowledge of user strategies, short-term learning, errors, and perceptions that cannot be predicted.

METHODOLOGY--The scanning-text-keys strategy uses repeating text keys to engage the cursor in scanning across text objects. Sequential scanning text keys links text keys to permit the user to scan to a target point in a single operation through a sequence from large to small groups (paragraphs, lines, words, characters) allowing him/her to focus on the target location and to activate the select switch whenever it is highlighted.

A between-subjects design was employed, utilizing four groups of five nonimpaired control subjects. Each group used one strategy in five sets of trials. Each set included 25 trials of selecting blocks of text.

PROGRESS--As expected, the standard keystrokes strategy was the slowest, used the most on-screen keys, required the greatest number of select switch activations, and resulted in constant attention switching between the text area and the on-screen keyboard.

The scanning-text-keys strategy significantly reduced the number of key selections and switch activations. It was easy to use, and subjects had control over all cursor movements. Time was reduced by approximately one-fifth. A particular usability problem was confusion between repeating and nonrepeating keys available on the on-screen keyboard.

The sequential-scanning-text-keys strategy substantially reduced user demands. A drawback was that the users did not have control over the direction of movement, resulting in some inefficient movements and a feeling of some loss of control. Planning and attention switching between the text area and on-screen keyboard were minimized. Time savings were, however, equivalent to the repeating keystrokes strategy. This strategy had some specific difficulties including: extra vigilance to constantly compare the location of the text cursor with the target location; confusion regarding the current scanning level; and error correction.

The text-scanning strategy had similar efficiencies as the previous strategy with fewer errors of over and undershooting because of the easier selection rule and the visual feedback of the highlighting block that indicated movement size. However, time performance was poorer because it was more difficult to stop scanning after overshooting the target and it took longer to make corrections. Although consistent with scanning the on-screen keyboard, subjects felt loss of control over the cursor as they retained a text cursor mental model.

It is not suggested that any one strategy is best. All strategies work within the task transparency concept. The observed improvements can have a significant impact in minimizing the physical and cognitive demands of switch-based scanning.

[148] TOWARD TASK TRANSPARENCY IN ALTERNATIVE COMPUTER ACCESS: SELECTION OF TEXT THROUGH SWITCH-BASED SCANNING

Fraser Shein, MEng, PEng; Mark Chignell, PhD
Bloorview MacMillan Centre, Toronto, ON Canada M4G 1R8; Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada

Sponsor: National Health Research and Development Programme, Health and Welfare Canada; Ontario Rehabilitation Technology Consortium funded by the Ontario Ministry of Health; IBM Canada Ltd.

PURPOSE--We refined the interpretation of transparent computer access for people with physical disabilities, called task transparency. The goal was to derive new knowledge and understanding of the interactions that arise through a number of strategies that apply switch-based scanning to text selection in a task-transparent fashion. The results should provide valuable directions toward the design of access systems that enable users of indirect scanning access methods to not just achieve equal access, but to achieve equal productivity.

METHODOLOGY--Our research demonstrated that, in the case of selecting text, directness to the task can be achieved with minimal effort by applying scanning within the text area itself. The concepts are readily extended across other GUI objects, including menus, buttons, and window controls. These objects can be incorporated within the access system so that they are directly engaged in the scanning.

PROGRESS--It is proposed that the concept of transparency be revised so that alternate access systems follow a design allowing the user to directly access the underlying tasks and data without requiring the performance of equivalent functions to the standard input devices. This task transparency approach maintains the original concept of transparency, but focuses attention on what the user wants to accomplish by working at the application task level, rather than the operational tasks associated with standard input devices.

Text scanning was implemented using repeating keys injected by an on-screen keyboard so that the user perceived scanning in the text area. Two test applications were developed and used to evaluate a number of proposed text scanning strategies. In addition, predictive performance models were derived to predict performance measures under error-free conditions.

Design guidelines for scanning in a task-transparent fashion have been formulated. Although further work is required, these provide a foundation: sufficient knowledge is provided that a developer of access systems could extend the concepts in new ways with scanning and other access methods, and we have mapped future areas of research that may improve overall productivity and identified areas of concern.

[149] EFFECTIVENESS OF USING VOICE RECOGNITION SYSTEMS

Ava-Lee Kotler, MS; Cynthia Tam, BSc; Pat Stoddart, BA
Bloorview MacMillan Centre, Toronto, ON Canada M4G 1R8

Sponsor: Ontario Ministry of Health's Neurodevelopmental Clinical Research Unit

PURPOSE--The purpose of this pilot study is to evaluate the use of voice recognition to create text and the effects of discrete utterance speech on participants' voices.

METHODOLOGY--Participants are clients between the ages of 19 and 35 who have been prescribed voice recognition systems to use as writing aids. Six have been recruited for this preliminary study and asked to complete various typing tasks and to answer questions regarding the use of their system. Speed and accuracy of text generation, and the voice recognition system's accuracy will be calculated. Tape recordings of each participant's speech will be obtained in order to evaluate voice quality. Responses to interview questions will be analyzed descriptively.

PROGRESS--All six have completed the above protocol. Each has a different diagnosis (e.g., muscular dystrophy, upper motor neuron disease, scleroderma, and thoracic output syndrome). An additional participant will be recruited since one of the above participants had not been using her system and therefore various tasks were difficult for her.

PRELIMINARY RESULTS--Results from four participants have been analyzed:

Speed of Text Generation and Accuracy
Relative speed of text generation for the various tasks generally showed similar patterns for each participant. Dictation of numbers resulted in the slowest rate (a group average of 5.2 wpm), whereas dictation from a copy of the participant's previous work resulted in the fastest rate of text generation (a group average of 19.4 wpm). There was individual variation. For example Participant D's slowest dictation rate was for dictation of her name and address (5 wpm). For Participant A, dictation of a letter was the fastest task (10.8 wpm). Individual recognition accuracy scores ranged from 59 to 100 percent. Average recognition accuracy for the group ranged from 68 percent for copy dictation to 80 percent for copy dictation of previous work. There were individual variations. Participant D was recognized least on the name and address dictation task (53 percent) and Participant A was best recognized on dictation of numbers (100 percent)

Client Satisfaction and Manipulation of Applications
One out of the four participants reported that the voice recognition system allowed her to complete the tasks required to be done. All commented that the advantage of their voice recognition system was that it allowed them to write without using their hands. For some, voice recognition was reported to be faster than other methods of computer access (e.g., on-screen keyboard). Each reported at least one of the following problems with use of voice recognition: fatigue (both physical and mental), poor recognition, slow speed of text generation, limited access to applications other than word processing, and the need to produce consistent speech. Some did not find the system easy to use because of the tedious procedures required to correct voice recognition errors. Other problems were lack of confidentiality and privacy, and interference with recognition from noisy environments.

Voice Problems
Three out of four reported voice-related problems subsequent to using their voice recognition systems. Specific problems reported included hoarseness, vocal fatigue, sore throats, coughing, increase in mucus and decrease in loudness. A referral to an otolaryngologist was recommended for two; this assessment did not reveal any abnormalities for one of them, and the second had not been examined at this writing. The two who followed the vocal hygiene recommendations did not report any of the above problems except vocal fatigue.

[150] COMPUTER SOFTWARE TO ASSESS VISUAL LEARNING PROBLEMS

Jeffrey Jutai, PhD, CPsych; Denise Reid, PhD, OT(C); Carol Blackwell, BA; Tanya Gerber, BA; William Woolrich, BA
Bloorview MacMillan Centre, Toronto, ON Canada M4G 1R8 Department of Occupational Therapy, The University of Toronto, Toronto, Ontario, Canada

Sponsor: Ontario Rehabilitation Technology Consortium (ORTC) funded by the Ontario Ministry of Health, and the Spina Bifida and Hydrocephalus Association of Canada.

PURPOSE--The Componential Assessment of Visual Perception (CAVP) is a Windows product for measuring the visual-perceptual skills of people aged 8 years to adult. It measures visual-perceptual skills in discrimination, memory, selective attention, and search. With young children, the CAVP can be used to help identify children quickly who are at risk for visual and perceptual problems. With adults, the CAVP can be used to help identify treatment options for clinical professionals. In many instances, treatment options include assistive technologies, such as computer programs to improve reading and writing skills, whose effective prescription will improve because of the assessment and diagnosis capabilities of the CAVP.

The CAVP is designed for use by psychologists, therapists, teachers, and educational specialists in clinical and school settings, and on home visits. Research studies are underway to develop normative data. In the meantime, the CAVP can be used as a supplement to other, standardized clinical tests, to provide a more detailed analysis of visual-perceptual skills.

PROGRESS--The CAVP's computerized presentation format automates many of the administration requirements of popular measures like the Test of Visual-Perceptual Skills (TVPS) and the Motor-Free Visual Perception Test (MVPT). This helps to standardize test administration, and frees the professional to be a more effective observer of the client during test performance. Response times and accuracy are measured reliably and precisely. The CAVP records the strategies used by the client to solve visual-perceptual problems, under a variety of environmental conditions. Unique report features allow the professional to identify ways to improve personal strategies or modify the visual environment, as needed, to benefit visual-perceptual performance in the real world. The CAVP can accommodate a variety of pointing devices, including hands-free devices such as a head pointer. This makes it a valuable tool for assessing visual-perceptual abilities without involving motor skills. This is an especially important feature for professionals who assess clients with learning disabilities, motor impairments, or physical disabilities.

FUTURE PLANS--The CAVP is being prepared for commercial release in a research version. This is similar to other cognitive rehabilitation tests for which complete normative data are not yet available, but which can be used immediately for research purposes, and to enhance the interpretation of results obtained from other, standardized assessment tests. Proposed upgrades include: improved reporting capabilities and compatibility with other popular software products; new sets of stimulus materials, such as pictures and photographs of familiar objects; new options for use with pointing devices; normative data from normal and special populations, as they become available; and greater facility for user customization.

[151] WIVIK 2 ON-SCREEN KEYBOARD

Gil Hamann, MASc, PEng; Russell Galvin, BSc; Paul Marshall; Tom Nantais, BSc; Rose Nishiyama, BSc; Fraser Shein, MEng, PEng; Pat Stoddart, BA; Cynthia Tam, BScOT
Microcomputer Applications Program, Bloorview MacMillan Centre, Toronto, ON Canada M4G 1R8

Sponsor: Ontario Rehabilitation Technology Consortium funded by the Ontario Ministry of Health; Industry Canada; IBM Canada Ltd.; IBM Corporation; University Research Incentive Fund of the Ontario Ministry of Colleges and Universities; National Research Council of Canada

PURPOSE--WiViK 2 enables people with physical disabilities to use Windows applications for school, work, and play. WiViK displays a customizable keyboard on the computer screen. Users type with any pointing device including a mouse, trackball, joystick, pointing pad, touchscreen, pen, or advanced devices, such as headpointers and eye-gaze. Simply clicking or dwelling on the desired key's image activates that key's function. Those with greater physical limitations may use a single switch.

People who benefit include those with cerebral palsy, spinal cord injuries, muscular dystrophy, multiple sclerosis and ALS (Lou Gehrig's disease). People without disabilities working in mobile or harsh environments can also use WiViK with pen-based computers or touchscreens when standard keyboard input becomes difficult or awkward.

METHODOLOGY--WiViK has been designed in modules. A basic module supports the display of keyboards and selection with pointing devices. An additional module provides rate enhancement, including word prediction and abbreviation-expansion. A third module provides scanning access with 1 to 5 switches.

PROGRESS--In the past year, WiViK was upgraded and commercially released to work with Windows 95 as well as v. 3.1, and it has been translated into French. A number of incremental improvements that provide greater control of the interface are included. Updates take into consideration feedback from users. We are currently working on a major improvement to WiViK which will be a full 32-bit application for Windows 95 and NT. Modularity will also be enhanced in the future. Versions in foreign languages are also planned, including Japanese.

[152] WIVIK 2 SCAN: 1-5 SWITCH SCANNING ACCESS

PURPOSE--WiViK 2 Scan is a module that adds switch-based scanning capabilities to WiViK 2 on-screen keyboard. This enables individuals who cannot use a keyboard or any pointing device to access a computer. Scanning involves the successive highlighting of items and selection by the activation of a switch when a desired item is highlighted.

METHODOLOGY--WiViK 2 Scan solves a particularly difficult problem of controlling Windows usually done with a pointing device such as a mouse. A typical solution is to emulate the mouse with a scanning mouse cursor. Our approach is to apply the scanning directly to the objects typically manipulated with the mouse: windows, menus, scroll bars, and other such objects. Menu choices are highlighted or scanned in succession. Similarly, the text cursor scans for easy editing. Future work will emphasize approaches that provide greater direct control and take better advantage of the users' skills, such as imprecise pointing.

PROGRESS--Three basic scanning methods are available using one to five switches: automatic, inverse, and directed. When automatic scan is selected, a highlight moves sequentially across successively smaller groups of items until the desired key is highlighted for selection. With inverse scanning, the highlight is moved manually by repeated or maintained switch activation. Directed scanning uses separate switches for each direction.

Automatic and inverse scanning support several patterns of movement. The function of each switch is individually adjustable in all methods, along with the speed of the moving highlight, to match the abilities of the user. Several keyboard layouts specifically designed for the various scan methods are available.

[153] KEYREP: WIVIK/KEYBOARD RATE ENHANCEMENT

Tom Nantais, BSc; Gil Hamann, MASc, PEng; Agnes Lisowska; Paul Marshall; Rose Nishiyama, BSc; Fraser Shein, MEng, PEng; Pat Stoddart, BA; Cynthia Tam, BScOT
Microcomputer Applications Program, Bloorview MacMillan Centre, Toronto, ON Canada M4G 1R8

PURPOSE--The purpose of rate-enhancement software is to increase typing efficiency. Typing is relatively slow when using a single finger or stylus to type on a keyboard or when using WiViK. Two versions of software had previously been developed featuring word prediction and abbreviation-expansion: KeyREP (keyboard rate enhancement package) and WiViK 2 REP. Efforts this past year have been on merging these.

METHODOLOGY--When used with WiViK, predicted words are displayed within the WiViK window. When used standalone as in KeyREP, predicted words are displayed in a floating window and selected by typing a number key. Word prediction completes words that the user begins typing. Its frequency-of-use dictionary adapts to the user's writing style. Separate custom dictionaries are easily created by reading in the user's own files or from other sources such as Internet a great help when writing about specific topics. This also allows the creation of foreign language dictionaries. Dictionaries may be viewed or edited at any time.

Punctuation is handled intelligently. Spaces are automatically added after predicted words. Punctuation characters are positioned correctly and a space is automatically added when appropriate. In addition, following a period, question mark, or exclamation mark, the next letter typed is capitalized.

Abbreviation-expansion saves time by allowing frequently used words, phrases, sentences or other sequences to be replaced with abbreviations. Typed abbreviations are instantly converted into their corresponding, user pre-programmed expansion. All characters and functions of the standard keyboard may be used when creating expansions. Several sets of abbreviation-expansion may be created.

PROGRESS--In the past year, KeyREP was upgraded and commercially released to work with Windows 95 as well as v. 3.1. A further update is planned for spring 1997 to include a key new feature linking WiVox to provide auditory prompting of predicted words. The design for our next major release of KeyREP has also been completed. This future 32-bit application will include next word prediction and will fully integrate speech output. Research is underway to further enhance this tool to facilitate writing by new learners through appropriate queing and relevant dictionaries.

[154] WIVOX: VOICE OUTPUT FOR WINDOWS

Stephen Farr, DIT, DCT; Gil Hamann, MASc; Paul Marshall; Rose Nishiyama, BSc; Fraser Shein, MEng, PEng; Pat Stoddart, BA; Cynthia Tam, BScOT
Microcomputer Applications Program, Bloorview MacMillan Centre, Toronto, ON Canada M4G 1R8

Sponsor: Ontario Rehabilitation Technology Consortium funded by the Ontario Ministry of Health; IBM Canada Ltd.; IBM Corporation; University Research Incentive Fund of the Ontario Ministry of Colleges and Universities; National Research Council of Canada

PURPOSE--WiVox provides auditory feedback of typing when using any Windows application. As a separate product it is intended to augment the standard visual presentation and enhance interaction by users who are learning to read or who have slight visual impairments. Wivox can also be used with WiViK and KeyREP as a means to communicate through a computer. It is not a screen-reading package.

METHODOLOGY--WiVox provides a small on-screen window to turn speech on or off as required. When turned on, WiVox speaks the typed text. Choices may be made for speaking letters, words, partial words (up to the current character), complete sentences, or menus. WiVox also speaks text highlighted in any window. When used with the latest version of KeyREP, predicted words can be spoken as auditory cues.

A simple on-screen menu is provided for specifying the synthesizer and its settings. A word exceptions editor is included to allow the user to specify correct pronunciation of unusual or proper names.

PROGRESS--In the past year, ViVox was upgraded and commercially released to work with Windows 95 in addition to v 3.1, and support for software text-to-speech output through standard sound cards has been added.

FUTURE PLANS--WiVox will become closely integrated with WiViK and KeyREP as part of solutions-based packaging when new versions are released late in 1997. Example solution packages include: a writing aids package for users learning to read and write; an auditory scanning access package; and an augmentative communication package. Additional functions will be necessary to support these packages including auditory review of text for writing, and a pop-up window to quickly retrieve and output communication phrases.

[155] A BIOTELEMETRIC EMG TRANSCEIVER SYSTEM FOR ASSISTIVE DEVICES

Raphael C. Wong, BASc; Stephen Naumann, PhD, PEng; Elvino S. Sousa, PhD; Isaac Kurtz, MHSc, PEng
Bloorview MacMillan Centre, Toronto, ON Canada M4G 1R8 The Communications Group, Electrical and Computer Engineering Department, University of Toronto, Toronto, Ontario, Canada

Sponsor: None listed

PURPOSE--The objective of this project is the design and construction of a wireless EMG transmitter and receiver system. Potential users of this device are people with ALS (Amyotrophic Lateral Sclerosis), and individuals with extremely limited muscle control. The transmitted EMG may be used for communications purposes or for device operation. Such a wireless link provides increased user mobility and improved user safety, resulting from removal of loose wiring, as well as improved cosmetic appearance, leading to better user acceptance.

PROGRESS--This project is at the stage where the hardware components required have been identified. Two designs have been produced, the first using analog, and the second digital, modulation techniques. Based on an investigation of each design's feasibility within power and size constraints, one design will be prototyped. Other design specifications are transmission distance (3-5 m), and capability for additional EMG channels.

IMPLICATIONS--Wireless EMG transmitter systems previously designed have been fairly large and cumbersome. This transmitter's small size will be especially advantageous when used in rehabilitation applications. Possible future applications include modification for transmission of ECG, EEG, and other physiological parameters.

FUTURE PLANS--Additional issues to be resolved include safety and interference. Any possible health risks due to RF transmission (especially near the head) must be examined. Also, possible interference from sources such as cellular telephones, radios, and microwaves will be investigated. The fabrication of a prototype and clinical testing of the device will follow, once the above issues are solved.

D. Private and Public Programs

[156] VIOLENCE AGAINST WOMEN WITH PHYSICAL DISABILITIES

Margaret A. Nosek, PhD; Mary Ellen Young, PhD; Carol A. Howland, MPH(c); Laurie J. Walter, PhD
The Department of Physical Medicine and Rehabilitation, The Southwest Regional Brain Injury Rehabilitation & Prevention Center, and The Center for Research on Women with Disabilities, Baylor College of Medicine, Houston, TX 77046

Sponsor: Centers for Disease Control, Atlanta, GA 30333

PURPOSE--The purpose of this study is to identify and measure risk factors for secondary conditions brought on by violence in the lives of women with physical disabilities and to develop an intervention to reduce violence in their lives. The specific aims of this study are to evaluate the dynamics of violence against such women to determine risks and protective factors, barriers to seeking help, and the effectiveness of available interventions; develop and test the validity of an abuse assessment instrument designed specifically for these women, in comparison to standard abuse assessments; develop and pilot test an intervention for these persons that will decrease their risk of abuse; and disseminate information about this violence and our study to women with disabilities, programs for battered women, disability service providers, medical practitioners, and researchers.

METHODOLOGY--We shall recruit through the Houston Area Women's Center 15 women with physical disabilities who have successfully resolved physical or sexual abuse in their lives and conduct and analyze semi-structured interviews with them to identify the determinants of behaviors effective in resolving abusive relationships and the helpfulness of available community resources. Then we shall develop and test an abuse intervention with a systematic process called Intervention Mapping. Through this process, we will develop a screening tool to identify abused women with disabilities that is based on existing instruments. We shall test this tool for reliability and validity on a sample of 438 women with disabilities recruited through the chronic care clinics of the Harris County Hospital District and Baylor College of Medicine.

PROGRESS--This 3-year project has just begun. Recruitment of participants is underway, and staff have been participating in abuse awareness training at the Houston Area Women's Center.

[157] BREAST CANCER SCREENING AMONG WOMEN WITH DISABILITIES

Margaret A. Nosek, PhD; Mary Ellen Young, PhD; Carol A. Howland, MPH(c); Laurie J. Walter, PhD; Ellen W. Grabois, JD, LLM
The Department of Physical Medicine and Rehabilitation, The Southwest Regional Brain Injury Rehabilitation & Prevention Center, and The Center for Research on Women with Disabilities, Baylor College of Medicine, Houston, TX 77046

Sponsor: Centers for Disease Control, Atlanta, GA 30333

PURPOSE--The purpose of this project is to explore, through a series of focus groups, the nature of perceived risk for breast cancer, concerns associated with mammography screening, preventive orientation, and environmental barriers to participation in mammography screening among women with disabilities aged 40 and older. The information obtained will be used to develop a model for predicating screening among this population and suggest strategies for preventive interventions.

METHODOLOGY--Women with a variety of physical disabilities will be recruited for focus group participation to discuss concerns associated with mammography screening, including environmental barriers they have encountered.

PROGRESS--This project begins fall 1997.

[158] HEALTH PROMOTION FOR WOMEN WITH PHYSICAL DISABILITIES

Margaret A. Nosek, PhD; Mary Ellen Young, PhD; Carol A. Howland, MPH(c); Catherine Clubb Foley, PhD; Laurie J. Walter, PhD
The Department of Physical Medicine and Rehabilitation and The Center for Research on Women with Disabilities, Baylor College of Medicine, Houston, TX 77046

Sponsor: National Institutes of Health, Bethesda, MD 20892

PURPOSE--The purpose of this project is to develop an intervention to enhance wellness among women with disabilities, one based on expanded theoretical models and measures of health-promoting behaviors that accommodate some of the circumstances of this population. Segments of this population are at a higher risk for certain acute and chronic conditions. They often have limited access to preventive health services and face negative social attitudes toward their potential for fitness and wellness, and they tend to have reduced motivation affecting health-promoting behaviors. The specific aims of this study are to identify the psychological, physical, social, and environmental factors that contribute to health-promoting behaviors of this population, develop and test methods for measuring their health-promoting behaviors and attitudes toward them, develop and pilot-test an intervention to inform and motivate such women to take action to improve their psychological, social, and physical health, and develop and pilot-test a theory-driven, multicomponent program to promote wellness among this population that targets increased self-efficacy related to health-promoting behaviors.

METHODOLOGY--To accomplish the aims of this study, we began with qualitative focus groups and individual interviews to understand how such women define wellness and practice health-promoting behaviors.

PROGRESS--Results have been analyzed from the focus groups and individual interviews and, based on these findings, a health promotion model has been developed that is guiding construction of the questionnaire. More than 200 participants have been recruited nationally to date. Development of the survey is underway. The content and format of the newsletter has been developed.

FUTURE PLANS--In the next phase, we shall establish a baseline of the perceived health status, health-promoting behaviors, and stage of change of a sample of 400 women with a range of physical disabilities and severity levels. We will then develop a motivational intervention of a newsletter, a wellness hotline, a fax-on-demand service, and a home page on the World Wide Web, to offer information and encourage action for women who may be in early stages of change or believe that their disability prevents them from engaging in health-promoting activities. In the final phase, we will develop and test the feasibility of a wellness action group program that will focus on individualized goal-setting, peer support, and enhanced self-efficacy for pursuing healthier living.

[159] REDUCING RISK FACTORS FOR ABUSE AMONG LOW-INCOME, MINORITY WOMEN WITH DISABILITIES

Margaret A. Nosek, PhD; Mary Ellen Young, PhD; Carol A. Howland, MPH(c); Laurie J. Walter, PhD
The Department of Physical Medicine and Rehabilitation, The Southwest Regional Brain Injury Rehabilitation & Prevention Center and The Center for Research on Women with Disabilities, Baylor College of Medicine, Houston, TX 77046

Sponsor: National Institute on Disability and Rehabilitation Research, Washington, DC 22202

PURPOSE--The purpose of this project is to identify risk factors for emotional, physical, and sexual abuse experienced by women with disabilities and to develop and test strategies for reducing those risk factors, particularly among those from low-income, minority backgrounds where the incidence of abuse is the highest. In developing program models for reducing the risk of abuse of such women, it is important to consider cultural attitudes toward violent behaviors and family values. Another critical issue is the woman's perception of her situation and her readiness to seek help. In this project, we will pursue strategies to reach these women at all stages of change in resolving abusive situations. We will work not only with programs that help battered women, but also those that have contact with disabled women in various community contexts.

METHODOLOGY--We will pursue a broad-based program of training and dissemination activities to increase the capacity of communities to assist this population in abusive situations. By targeting community-based organizations, disability service programs, and the media, we hope to reach persons who may not realize that they are in abusive situations or who may never have contact with battered women's programs. By offering training to disability-related service providers on how to recognize and assist women in abusive situations, and to battered women's programs on how to meet the needs of their participants with disabilities, we hope to expand the resources available to women trapped in abusive situations.

PROGRESS--A written survey on abuse and women with disabilities was developed and sent to vocational rehabilitation and independent living service providers across the country; more than 600 of them responded, and the data have been analyzed. A written survey of programs delivering abuse intervention services to this population has been developed and will be sent to programs specializing in abuse intervention across the country.

FUTURE PLANS--A directory of programs delivering abuse intervention services to women with disabilities will be developed.

RECENT PUBLICATIONS FROM THIS RESEARCH

Abuse of women with disabilities: policy implications. Nosek MA, Howland C, Young ME. J Disabil Pol Stud 1997;8(1-2):157-76.

Breast and cervical cancer screening among women with physical disabilities. Nosek MA, Howland C. Arch Phys Med Rehabil 1997;78(12 Suppl 5):S39-44.

Introduction: Women with disabilities and the delivery of empowerment medicine. Nosek MA. Arch Phys Med Rehabil 1997;78(12 Suppl 5):S1-2.

Prevalence of abuse of women with physical disabilities. Young ME, Nosek MA, Howland C, Chanpong G, Rintala DH. Arch Phys Med Rehabil 1997;78(12 Suppl 5):S34-8.

Sexual abuse and people with disabilities. Nosek MA, Howland C. In: Alexander CJ, Sipski ML, editors. Sexual function in people with disability and chronic illness: a health professional's guide. Gaithersburg, MD: Aspen Publishers, Inc.; 1997. p. 577-94.

[160] MANAGED CARE EXPERIENCES OF PERSONS WITH PHYSICAL DISABILITIES

Ellen W. Grabois, JD, LLM; Mary Ellen Young, PhD
The Center for Research on Women with Disabilities and The Southwest Regional Brain Injury Rehabilitation & Prevention Center, Baylor College of Medicine, Houston, TX 77046

Sponsor: National Institutes of Health, Bethesda, MD 20892

PURPOSE--The purpose of this study was to examine the experiences of individuals with disabilities in managed care organizations (MCOs).

METHODOLOGY--Sixteen individuals with various physical disabilities, who had received health care in a health maintenance organization (HMO) or a preferred provider organization (PPO) participated in open-ended, qualitative interviews. They were asked a variety of questions about their experiences with their primary care physicians for any disability-related illnesses, such as how the managed care organization handled their care, the effectiveness of their primary care physicians, their ability to get referrals to specialists, denials of beneficial treatment and communication problems between their primary care physicians and specialists. All interviews were transcribed and analyzed using a software program called QSR NUD*IST to generate a system of topics from the text of the interviews.

RESULTS--A majority of those interviewed said they joined an MCO because of employer requirements or lower out-of-pocket costs. Participants were pleased with the low cost of included medications and preventive care such as mammograms, pap smears, and general checkups. They reported difficulty in making appointments and were not satisfied with the brief length of primary care physician office visits. They also reported not getting referrals to specialists at all or within a reasonable time and finding inaccessible equipment in providers' offices. Those reporting the most success in getting necessary treatment were those who could pay expenses out of their own pockets, those who had additional insurance through other family members, and those who were able to obtain additional services through state agencies and charitable clinics. Individuals with years of experience in working within a managed care system or who were skilled in advocating for their own health care needs were also more satisfied with their HMOs and PPOs.

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