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Objective: To gather knowledge related to patient satisfaction and mobility with lower limb prosthetic and orthotic devices and to investigate satisfaction with services received. Another purpose of this study is to analyze potential differences between orthotic and prosthetic patients in relation to patient satisfaction and mobility. Design: Cross-sectional study Subjects: 21 participants with a mean age of 58 (SD 16) with an average duration of use of devices of 10 (SD 10) years. 12 out of the 21 participants were orthotic users and 9 were prosthetic users. Methods: Patients were asked to complete two questionnaires, one regarding satisfaction with assistive device and service (QUEST 2.0) and one regarding mobility. Results: Patients mean score regarding satisfaction with assistive device and service were 4.0 (SD 0.8) and 4.2 (SD 1.0) respectively. 91% reported that they had the ability to walk at least 100 meters with their assistive device. The areas where participants experienced most difficulties were walking on uneven ground (70%), walking up and down a hill (57%) and walking on stairs (57%). Conclusion: Overall this study demonstrates that participants were quite satisfied with their assistive device and the service received by the P&O clinic. No statistically significant differences regarding satisfaction with assistive device and service, or mobility, were found between prosthetic and orthotic participants.

This thesis presents the development and experimental testing of a lower-limb exoskeleton system. The device supplies assistive torque at the knee joint to alleviate the loading at the knee, and thus reduce the muscular effort required to perform activities of daily living. The hypothesis is that the added torque would facilitate the execution of these movements by people who previously had limited mobility. Only four specific movements were studied: level-waking, gradient-walking, sit-to-stand-to-sit and ascending stairs. All three major components of the exoskeleton system, i.e. the exoskeleton actuators and actuator control system, the user intention estimation algorithm, and the mechanical construction of the exoskeleton, were investigated in this work. A leg brace was fabricated in accordance with the biomechanics of the human lower-limb. A single rotational degree of freedom at the knee and ankle joints was placed to ensure that the exoskeleton had a high kinematic compliance with the human leg. The position of the pneumatic actuators and sensors were also determined after significant deliberation. The construction of the device allowed the real-world testing of the actuator control algorithm and the user intention estimation algorithms. Pneumatic artificial muscle actuators, that have high power to weight ratio, were utilized on the exoskeleton. An adaptive fuzzy control algorithm was developed to compensate for the inherent nonlinearities in the pneumatic actuators. Experimental results confirmed the effectiveness of the adaptive controller. The user intention estimation algorithm is responsible for interpreting the user's intended movements by estimating the magnitude of the torque exerted at the knee joint. To accomplish this, the algorithm utilizes biological signals that emanate from the knee extensor and flexor muscles when they are activated. These signals combined with the knee angle data are used as inputs to the estimation algorithm. The output is the magnitude and direction of the estimated torque. This value is then scaled by an assistance ratio, which determines the intensity of the assistive torque provided to the user. The experiments conducted verify the robustness and predictability of the proposed algorithms. Finally, experimental results from the four activities of daily living, affirm that the desired movements could be performed successfully in cooperation with the exoskeleton. Furthermore, muscle activity recorded during the movements show a reduction in effort when assisted by the exoskeleton.

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Hearing loss is a disability that affects thousands of people in the world. It is estimated that there is 400,000 people with hearing difficulties in New Zealand (New Zealand Audiological Society, 2007). People with hearing loss have the right to access to information and communication (United Nations Enable, 2003). Without access to information and communication, the hearing impaired may encounter problems with emotional and social functioning, and consequently suffer with decreased quality of life. Clinical experience and investigations have revealed success with assistive listening devices (ALDs) where use of hearing aids has been unsuccessful. ALDs are devices that improve the communication function for the hearing impaired. ALDs can be used with or without hearing aids to overcome the negative effects of poor room acoustics. Currently, in the literature, little is known about the use and maintenance of ALDs in community organizations. This study investigates the use and maintenance of ALDs in the Christchurch community of New Zealand. A list of community organizations that provide ALDs to the public of Christchurch was also made available to individuals who have hearing impairment. The study found there is a lack of ALDs within the Christchurch community. Also that current ALD technology within the Christchurch community is not necessarily compatible with current hearing aid technology and that most organizations rely too heavily on PA systems. PA systems do not necessarily meet the needs of the hearing impaired and an ALD specifically targeting their hearing loss would improve their speech perception. Community organizations are not advertising enough that they offer ALDs which adds to the lack of awareness in Christchurch. Results found that most ALDs in the Christchurch community are in working order, however, there is a need for organizations to be educated about their use and maintenance. Audiologists and other health professionals have a key role in providing appropriate recommendations in the use and benefits that ALDs have on speech perception. These will directly improve the listening situations that the hearing impaired have throughout their communities, thus improving their quality of life.

This commentary reflects on a series of published research articles, 1996-2013, that form a PhD thesis by publication. The articles offer evidence of research into best practice relating to Assistive Technology (AT) product design as a specialist section of Industrial Design (ID). The aim of the research has been to provide AT product developers with a methodology that ordered and prioritised the application of proven research methods, design methods and design heuristics; as well as, to highlight the fundamental concepts that underpin the methodology. This commentary provides a review of the methods applied and discussion of their efficacy within each case study. The series of articles, evaluated at a meta-analysis level in the second part of the commentary, address the following research questions: 1) What is the optimum order and priority of conventional design methods, heuristics and research methods when applied within a new product development process for assistive technology products?, 2) Through a meta-analysis of case studies, are there key aspects that underpin an optimum AT-ID process? From the review, 61 research methods, design methods and heuristics were defined. An order of methods and heuristics identified some methods that were used throughout all phases of a NPD process that included literature review, benchmarking, mixed methods and participatory research. The methods and heuristics used in all phases highlighted a user-centred approach and the close collaboration with end users and stakeholders. There was also a focus of methods and heuristics around phase 2 of the 5 design process phases defined by Martin and Hannington. The critical review also highlighted key underpinning aspects that helped optimise an Industrial Design approach to ID-AT NPD. These were 1) creating a format for dialogue within the constraints of perception and 2) previous experience and the application of ethically sound protocols for the whole process. Lastly the change of terminology and attitudes of those working the Assistive Technology industry highlighted the need for more research into social acceptance of all aspects of Assistive Technology and the perception of disability from those living with impairment and by UK society as a whole.

The study surveyed a sample of K-12 teachers who had used assistive technology (AT) in the classroom to determine answers to five research questions. These were, (1) why the teachers adopted AT, (2) their attitudes and perceptions about its value, (3) challenges they have experienced in adopting AT, (4) whether they have discontinued or decreased use of AT, and, if so, (5) the factors that led to this result. The study used both quantitative and qualitative methods. For the quantitative aspect, an online survey instrument was developed to answer five research questions. Participants were teachers who had used AT in the classroom and came from 19 Georgia school districts whose superintendents granted permission for them to participate and whose assistant technology coordinators agreed to inform teachers in their districts' schools of the study. A total of 174 teachers completed the online survey. Of these, 52 agreed to be interviewed by telephone by the researcher, and 10 of those were randomly selected to be interviewed. Telephone interviews were audio recorded with the interviewee's permission, then transcribed by the researcher. Analysis of quantitative results included factor analysis of replies to Likert-scaled items, compilation of frequency of responses, and determination of means for Likert items. For interview responses, qualitative methods were used to determine any themes in participants' replies. It was found that (1) the most prevalent reason teachers initially used AT is that they perceived that the technology has value for their students, (2) the teachers had a mostly positive attitude toward the value of AT, (3) most of the teachers reported needing more training in AT, (4) almost half felt that time constraints affected their use of AT, (5) about one-third of online responders and 9 of 10 interviewees agreed that technical problems affected their use of AT, and (6) less than half of online participants perceived that they had adequate AT support. It was also found that most of the teachers had neither decreased nor discontinued use of AT during the 2008-2009 school year. Reasons cited by those who had decreased or discontinued use included time constraints, technical problems, lack of training, and lack of support.

Relative infrequency of communication initiation, particularly initiations that involve attention-sharing or other social purposes, appears to negatively impact the later-life outcomes of children with autism. Strategies to improve or encourage initiation skills in autism are hampered by the need for the behaviour to be spontaneous (i.e. unprompted by a partner). One potential approach that addresses the spontaneity issue is to extrinsically motivate initiations by changing aspects of the child’s environment such that they merit, or even demand, initiating a communication. Detecting subjectively inconsistent (i.e. discrepant) aspects in game-like virtual contexts appears to be something that inherently interests young children with autism, and can motivate them to initiate spontaneous, positive communications. Initial evidence for discrepancy as a communicative motivator came from a study which re-analysed video data from an existing autism and technology project (ECHOES), illustrating that a heterogeneous group of children all reacted frequently and socially to naturally occurring (i.e. unintentional, non-designed) discrepant aspects within ECHOES. A set of high-level design principles was developed in order to capture “lessons learned” from ECHOES that might facilitate re-creation of a similar pattern of spontaneous, positive initiation around discrepancy. A second, proof-of-concept study implemented these design principles in a set of three new touch-screen games (Andy’s Garden) that sought to establish, and then deliberately violate, child expectations (i.e. provide discrepancy-detection opportunities: DDOs). Children reacted socially and positively to the new games and DDOs. The results of this study allow us to answer its overall questions affirmatively: it is possible to motivate children’s communication–specifically, their initiation–by including deliberately-designed DDOs in a set of games. These findings are the first step towards determining whether discrepancy-detection opportunities may form a component of a future technology-based communication skills intervention, capable of changing children’s initiation behaviour outside of a game context.

The purpose of this thesis is to determine assistive technology-based instructions in the area of Living for postsecondary education students with autism spectrum disorder and/ or intellectual and developmental disabilities for investigating the types of AT support in improving independent living skills. An electronic search was conducted using the following databases: ERIC (Education Source version), ERIC (EBSCO host version), ERIC (ProQuest version), PsycINFO, and Google Scholar. Seven peer-reviewed journals were searched between 2008 and 2018. The references identified and relevant articles were scanned to find additional relevant literature. Papers referring to an assistive-technology based intervention that targets the area of independent living and be taught within the postsecondary program were included. Participants were diagnosed with ASD and/ or IDD and were enrolled in a postsecondary program designed for individuals with developmental disabilities. Only single-case studies or experimental/quasi- experimental designed studies were included. A total of 155 articles were found. The references and abstracts were saved in Endnote reference manager software for the selection process. First, 19 duplicates were found and excluded. A selection process was then carried out with the remaining 136 articles. The articles were screened by title and abstract, and 32 articles were excluded. Subsequently, full-text screening was conducted, and eight peer-reviewed articles and two dissertations were left. To conclude, the types of assistive technology while teaching independent living skills to postsecondary students with disabilities were reported. The skills were taught by using assistive technology were diverse. Results indicated the positive effectiveness of using assistive technology-based instructional practices in teaching independent living skills.

In 2011, a team of senior engineering students at Utah State University, in connection with the university’s Center for Persons with Disabilities, designed and prototyped an assistive technician creeper. Building on successful features and resolving issues discovered in design validation testing of the initial prototype, this thesis includes the refined development of a fully assistive technician creeper with emphasis on improvement of kinematic functionality, overall manufacturability, and integration of system safety features. The final design solution is a creeper that transforms a user bi-directionally between the seated position, and a maneuverable supine position, while requiring only simple manual actuation. New design requirements were established including specifications for user height, weight, and body mass distribution, driven by census and medical data suitable for 95% of individuals. Using 3D modeling software, an iterative design approach was used in conjunction with kinematic, and structural analyses, to generate an improved feature set that can be easily manufactured and assembled. Of particular interest is the modification to the kinematic system, which produces multiple single-degree-of-freedom kinematic motions from a single multi-degree-of-freedom kinematic mechanism. This promotes the use of a single motor to produce separate motions for adjusting upper body inclination, and raising the seat surface. The revised design adheres to principles of design for manufacturability and assembly, by using common economical manufacturing processes, minimizing part asymmetry and maximizing part reuse. Employment of engineering analyses, including kinematic, finite element, and failure modes and effects analyses quantified design validation and risk mitigation. Static force analysis and computations of fatigue and life expectancy of critical components supplement the analysis set. Analysis suggests all structural components were designed to meet a safety factor of 3.0 or better. This combined with the addition of safety features and system protection redundancies provide confidence in structural integrity and system reliability. This creeper will contribute to the world of assistive technologies by providing new mobility opportunities, improving the quality of life of individuals with certain physical disabilities. It is also well suited for users of all abilities and has potential to become a premium creeper for professionals.