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Concept: Assistive technology


Stroke-induced hemiparetic gait is characteristically slow and metabolically expensive. Passive assistive devices such as ankle-foot orthoses are often prescribed to increase function and independence after stroke; however, walking remains highly impaired despite-and perhaps because of-their use. We sought to determine whether a soft wearable robot (exosuit) designed to supplement the paretic limb’s residual ability to generate both forward propulsion and ground clearance could facilitate more normal walking after stroke. Exosuits transmit mechanical power generated by actuators to a wearer through the interaction of garment-like, functional textile anchors and cable-based transmissions. We evaluated the immediate effects of an exosuit actively assisting the paretic limb of individuals in the chronic phase of stroke recovery during treadmill and overground walking. Using controlled, treadmill-based biomechanical investigation, we demonstrate that exosuits can function in synchrony with a wearer’s paretic limb to facilitate an immediate 5.33 ± 0.91° increase in the paretic ankle’s swing phase dorsiflexion and 11 ± 3% increase in the paretic limb’s generation of forward propulsion (P < 0.05). These improvements in paretic limb function contributed to a 20 ± 4% reduction in forward propulsion interlimb asymmetry and a 10 ± 3% reduction in the energy cost of walking, which is equivalent to a 32 ± 9% reduction in the metabolic burden associated with poststroke walking. Relatively low assistance (~12% of biological torques) delivered with a lightweight and nonrestrictive exosuit was sufficient to facilitate more normal walking in ambulatory individuals after stroke. Future work will focus on understanding how exosuit-induced improvements in walking performance may be leveraged to improve mobility after stroke.

Concepts: Better, Improve, Metabolism, Walking, Assistive technology, Ankle-foot orthosis


Computer vision-based assistive technology solutions can revolutionise the quality of care for people with sensorimotor disorders. The goal of this work was to enable trans-radial amputees to use a simple, yet efficient, computer vision system to grasp and move common household objects with a two-channel myoelectric prosthetic hand.

Concepts: Implants, Artificial intelligence, Prosthetics, Prosthesis, Hand, Artificial limb, Assistive technology, Computer vision


The Tongue Drive System (TDS) is a wireless and wearable assistive technology, designed to allow individuals with severe motor impairments such as tetraplegia to access their environment using voluntary tongue motion. Previous TDS trials used a magnetic tracer temporarily attached to the top surface of the tongue with tissue adhesive. We investigated TDS efficacy for controlling a computer and driving a powered wheelchair in two groups of able-bodied subjects and a group of volunteers with spinal cord injury (SCI) at C6 or above. All participants received a magnetic tongue barbell and used the TDS for five to six consecutive sessions. The performance of the group was compared for TDS versus keypad and TDS versus a sip-and-puff device (SnP) using accepted measures of speed and accuracy. All performance measures improved over the course of the trial. The gap between keypad and TDS performance narrowed for able-bodied subjects. Despite participants with SCI already having familiarity with the SnP, their performance measures were up to three times better with the TDS than with the SnP and continued to improve. TDS flexibility and the inherent characteristics of the human tongue enabled individuals with high-level motor impairments to access computers and drive wheelchairs at speeds that were faster than traditional assistive technologies but with comparable accuracy.

Concepts: Better, Spinal cord, Improve, The Trial, Disability, Assistive technology, Taste bud, Tongue piercing


: This technology uses remote monitoring, videoconferencing, and much more to extend the reach of nurses and improve care.

Concepts: Case study, Innovation, Assistive technology, Disruptive technology


Abstract Purpose: To identify and explore factors that influence adoption, implementation and continued use of telecare technologies. Method: As part of the Assistive Technologies for Healthy Living in Elders: Needs Assessment by Ethnography (ATHENE) project, 16 semi-structured interviews were conducted with key participants from organisations involved in developing and providing telecare technologies and services. Data were analysed thematically, using a conceptual model of diffusion of innovations. Results: Participants identified numerous interacting factors that facilitated or hindered adoption and use. As predicted by the model, these related variously to the technology, individual adopters, the process of social influence, the innovativeness and readiness of organisations, implementation and routinisation processes following initial adoption, and the nature and strength of linkages between these elements. Key issues included (i) the complexity and uniqueness of the “user system”, (ii) the ongoing work needed to support telecare use beyond initial adoption, and (iii) the relatively weak links that typically exist between users of telecare technologies and the organisations who design and distribute them. Conclusions: Telecare is not merely a technology but a complex innovation requiring input from, and coordination between, people and organisations. To promote adoption and use, these contextual factors must be specified, understood and addressed. Implications for Rehabilitation Telecare should not be thought of as a “plug and play” technology but as a complex innovation requiring input from, and coordination between, people and organisations. To promote adoption and use of telecare, a number of contextual factors must be specified, understood and addressed. End users and other stakeholders should be linked at the earliest stages of design and development. Such co-production should aim to identify how technologies might better fit with users' material surroundings, social networks and desired lifestyles, rather than being technology-driven and focused on proof of concept or usability.

Concepts: Sociology, Diffusion, Technology, Innovation, Assistive technology, Diffusion of innovations, Opinion leadership, Everett Rogers


OBJECTIVE: The aim of this paper was to review traditional approaches to habilitation of unilateral hearing losses as well as new research concerning management of unilateral hearing loss. DATA SOURCES: Literature review/systematic review. REVIEW METHODS: A PubMed search was performed for articles pertaining to unilateral hearing loss and academic loss and academic performance. Articles ranged in date from 1986 to 2012. Five resources were reviewed for content to determine the pertinence of the materials to the understanding of the history of diagnosis of unilateral hearing loss, the traditional treatment methods and their advantages and disadvantages, and more recent publications concerning academic outcomes for patients with unilateral hearing loss with and without treatment. RESULTS: Unilateral hearing loss scan be detrimental to the academic success of children. Effects encompass not only auditory effects such as difficulty hearing in noise, but also self esteem and exhaustion. Although assistive devices were traditionally not offered as options, more recent literature suggests that devices such as BAHA, hearing aids, or FM systems may provide aids in the classroom and that early intervention may provide more favorable outcomes. CONCLUSION: Since the 1980s, the approach to management of unilateral hearing losses has evolved. In order to maximize academic potential, treatment options should be discussed and implemented.

Concepts: Hearing impairment, Otology, Performance, Self-esteem, Unilateral hearing loss, Tradition, PubMed, Assistive technology


Study design:one group pre- and post-test design.Objectives:The primary aim was to examine both the short- and long-term effects of an oral home telecare program on improving gingival health among adults with tetraplegia.Methods:Eight adults with tetraplegia participated. The oral home telecare program consisted of individualized oral hygiene training in the use of assistive devices (powered toothbrush and adapted flosser and/or oral irrigator) using personal computer-based videoconferencing between each participant and an occupational therapist. Training was conducted on an average of five 15-30 min sessions across 3 months. During these training sessions, supervised practice of oral hygiene, and provision of immediate corrective feedback and positive reinforcement in the use of adaptive oral hygiene devices was emphasized. Gingival health assessment using the Löe-Silness gingival index (LSGI) was conducted at baseline, 6 and 12 months.Results:From baseline to 6 months, participants showed statistically significant differences (that is, improvement with less gingival inflammation) in their LSGI scores (z=2.18, P=.03). From baseline to 12 months, participants also showed a statistically significant difference (that is, improvement, z=2.03; P=0.04) in their LSGI scores.Conclusion:This study indicates that preventive oral home telecare with repeated oral hygiene training in the use of adaptive devices improved gingival health at 6 and 12 months among adults with tetraplegia.Spinal Cord advance online publication, 15 January 2013; doi:10.1038/sc.2012.176.

Concepts: Better, Improve, Statistical significance, Periodontitis, Oral hygiene, Assistive technology, Gingivitis, Dental floss


Assistive technology has the potential to enhance the level of independence of people with dementia, thereby increasing the possibility of supporting home-based care. In general, people with dementia are reluctant to change; therefore, it is important that suitable assistive technologies are selected for them. Consequently, the development of predictive models that are able to determine a person’s potential to adopt a particular technology is desirable. In this paper, a predictive adoption model for a mobile phone-based video streaming system, developed for people with dementia, is presented. Taking into consideration characteristics related to a person’s ability, living arrangements, and preferences, this paper discusses the development of predictive models, which were based on a number of carefully selected data mining algorithms for classification. For each, the learning on different relevant features for technology adoption has been tested, in conjunction with handling the imbalance of available data for output classes. Given our focus on providing predictive tools that could be used and interpreted by healthcare professionals, models with ease-of-use, intuitive understanding, and clear decision making processes are preferred. Predictive models have, therefore, been evaluated on a multi-criterion basis: in terms of their prediction performance, robustness, bias with regard to two types of errors and usability. Overall, the model derived from incorporating a k-Nearest-Neighbour algorithm using seven features was found to be the optimal classifier of assistive technology adoption for people with dementia (prediction accuracy 0.84 ± 0.0242).

Concepts: Scientific method, Decision making, Prediction, Data, Model, Data mining, Das Model, Assistive technology


Outcomes with hearing aids (HAs) can be assessed using various speech tests, but many tests are not sensitive to changes in high-frequency audibility.

Concepts: Tests, Assistive technology


The objective was to develop evidence -based recommendations and a research and educational agenda for the non-pharmacological management of hip and knee osteoarthritis (OA). The multidisciplinary task force comprised 21 experts: nurses, occupational therapists, physiotherapists, rheumatologists, orthopaedic surgeons, general practitioner, psychologist, dietician, clinical epidemiologist and patient representatives. After a preliminary literature review, a first task force meeting and five Delphi rounds, provisional recommendations were formulated in order to perform a systematic review. A literature search of Medline and eight other databases was performed up to February 2012. Evidence was graded in categories I-IV and agreement with the recommendations was determined through scores from 0 (total disagreement) to 10 (total agreement). Eleven evidence-based recommendations for the non-pharmacological core management of hip and knee OA were developed, concerning the following nine topics: assessment, general approach, patient information and education, lifestyle changes, exercise, weight loss, assistive technology and adaptations, footwear and work. The average level of agreement ranged between 8.0 and 9.1. The proposed research agenda included an overall need for more research into non-pharmacological interventions for hip OA, moderators to optimise individualised treatment, healthy lifestyle with economic evaluation and long-term follow-up, and the prevention and reduction of work disability. Proposed educational activities included the required skills to teach, initiate and establish lifestyle changes. The 11 recommendations provide guidance on the delivery of non-pharmacological interventions to people with hip or knee OA. More research and educational activities are needed, particularly in the area of lifestyle changes.

Concepts: Medicine, Obesity, Evidence-based medicine, Systematic review, Rheumatology, Osteoarthritis, Orthopedic surgery, Assistive technology