Adaptive assistive technologies for people with disabilities

''Assistive technologies'' (AT) have developed rapidly in recent years, allowing people with motor disabilities to live more independent and comfortable lives.

Now assistive technology systems that can open a door, turn on a light or connect to the internet at the blink of an eye, a head movement or even a thought, are being made more flexible and customisable for individual users - thanks to the work of EU-funded researchers.

An estimated 2.6 million people in Europe have mobility problems affecting their upper limbs, and around 1.3 million of them require assistive technologies, or the help of human carers, to be able to perform everyday tasks. Across developed countries, the figure rises to 2.5 million.

They include people suffering from a range of diseases, including multiple sclerosis and amyotrophic lateral sclerosis, as well as varying degrees of paralysis, among them locked-in syndrome in which a person may only be able to move their eyes.

While many people already make use of assistive technologies -an umbrella term that includes assistive, adaptive and rehabilitative devices for people with disabilities - in most cases the systems and applications are designed to perform one specific function or assist someone with a specific form of disability.

''What I would call the "old" AT-market is dominated by isolated applications and devices, each addressing a specific disability or focusing on a specific ability of the user. This is in principle good, since it means that each device can be brilliantly optimised in its functionality,'' explains Stefan Parker, a project coordinator and researcher at KI-I in Austria.

''The trouble is that in most actual use cases these devices only manage to take advantage of a part of the user''s abilities or, in other cases, are not properly adaptable to the user''s needs, leaving him or her with a device that is merely semi-optimal for their use case.''

The problem is that disabilities cannot be categorised. Every person is different and even two people suffering from the same disease will often have very different degrees and types of impairment, or a combination of different disabilities at the same time.

Additionally, an individual sufferer will usually need systems to be adjusted, or new devices to be used, as their symptoms evolve over time.

To address the issue, a consortium of research institutes, universities and private companies from seven countries have developed an affordable and scalable platform to implement AT in a much more personalised and flexible way.

Their system, developed over two years in the ''Assistive technology rapid integration and construction set'' (ASTERICS) project with the support of EUR 2.65 million in funding from the European Commission, has already gone into commercial production.And on-going research is set to enhance it further.

Assistive systems, centred on the user
''The AT market is currently subject to great change. On the one hand, mobile devices like smart phones and tablet PCs are conquering the world, and this has a great influence on the AT market.

On the other hand, more user-centred and more flexible approaches towards AT are being generated - ASTERICS being the first and therefore most important,''says Mr Parker, who helped coordinate the project.

Unlike traditional AT systems, the ASTERICS platform can be configured to meet the specific needs of individual users.

It is possible to choose from a wide variety of sensors, from simple switches or webcams to advanced ''brain-computer interfaces'' (BCI), for interaction with the system depending on the requirements and abilities of each person.

The input data, no matter how it is generated, is processed by the ''ASTERICS Runtime Environment'' (ARE).

The software can easily be installed on a Windows-based machine and uses so-called ''models'', configured for each user, to process and execute user commands on any device in order to use their smart phone or computer,and to control their air conditioning or open a window in their home.

The models are built and configured via a dedicated configuration programme, the ''ASTERICS Configuration Suite'' (ACS) in which, through a graphical interface, it is possible to combine several plug-ins for input, signal processing and output and connect them via data-channels and event-channels.

Once completed, a model is simply uploaded to the ARE, where several models can be stored, so the user can have different options for different use cases.

There are also extension modules for the connection of sensors, which can be connected either to the platform or to any other computer via a standard USB cable, along with a HID actuator - a small USB-interface that acts like a standard wireless plug-and-play device, emulating mouse, keyboard or joystick.

''The approach results in a completely user-centred on-site development of AT - the user no longer needs to adapt to the device, it''s the other way round. This goes so far that users can even make small adaptations themselves, or their carer can make them for them, to react to changes in the daily situation,'' Mr Parker notes.

''Also the system can be adapted every time a user''s condition changes for better or worse - usersno longer need to buy a new device every time their condition changes - or use the old one despite having a hard time doing so - they can continue to use the system they are accustomed to and like, but with a new means of input or just with refined settings.''

People suffering from motor disabilities, as well as specialised carers and AT experts, were consulted by the ASTERICS team throughout the design and development process, and prototype platforms received overwhelmingly positive feedback in trials.

''ASTERICS was really appreciated by users and during the course of the user tests we were able to give possibilities to people that they wouldn''t have had without the system. Some users have continued to use the ASTERICS system since the user tests and are very happy with it,'' Mr Parker says.

''Crucially, the system is relatively cheap to install, and can make use of users'' existing devices, such as the webcam on their laptop, to reduce costs further.

Mr Parker estimates that most people would need to spend around EUR 500, excluding the cost of buying a laptop or home PC, for a suitable set up, though it could run to several thousand euro if more expensive equipment such as a brain-computer interface is required.

IMA, a project partner based in the Czech Republic, is currently producing commercial hardware, including input/output modules for use with the system, while Harpo in Poland, another partner, is the prime distributor of the complete system and provides adaptation and customisation services.

The team's goal now is to continue their research and launch a follow-up project to extend the system to mobile devices such as smart phones and tablets.

Children With Sleep Apnea Have Higher Risk of Behavioral, Adaptive and Learning Problems

A new study found that obstructive sleep apnea, a common form of sleep-disordered breathing (SDB), is associated with increased rates of ADHD-like behavioural problems in children as well as other adaptive and learning problems.

Michelle Perfect

"This study provides some helpful information for medical professionals consulting with parents about treatment options for children with SDB that, although it may remit, there are considerable behavioral risks associated with continued SDB," said Michelle Perfect, PhD, the study's lead author and assistant professor in the school psychology program in the Department of disability and psychoeducational studies at the University of Arizona in Tucson.

"School personnel should also consider the possibility that SDB contributes to difficulties with hyperactivity, learning and behavioural and emotional dysregulation in the classroom."

The five-year study, which appears in the April issue of the journal SLEEP, utilised data from a longitudinal cohort, the Tucson Children's Assessment of Sleep Apnea Study (TuCASA).

The TuCASA study prospectively examined Hispanic and Caucasian children between 6 and 11 years of age to determine the prevalence and incidence of SDB and its effects on neurobehavioral functioning.

The study involved 263 children who completed an overnight sleep study and a neuro-behavioral battery of assessments that included parent and youth reported rating scales.

Results show that 23 children had incident sleep apnea that developed during the study period, and 21 children had persistent sleep apnea throughout the entire study.

Another 41 children who initially had sleep apnea no longer had breathing problems during sleep at the five-year follow-up.

The odds of having behavioral problems were four to five times higher in children with incident sleep apnea and six times higher in children who had persistent sleep apnea.

Compared to youth who never had SDB, children with sleep apnea were more likely to have parent-reported problems in the areas of hyperactivity, attention, disruptive behaviors, communication, social competency and self-care.

Children with persistent sleep apnea also were seven times more likely to have parent-reported learning problems and three times more likely to have school grades of C or lower.

The authors report that this is the first sleep-related study to use a standardized questionnaire to assess adaptive functioning in typically developing youth with and without SDB.

"Even though SDB appears to decline into adolescence, taking a wait and see approach is risky and families and clinicians alike should identify potential treatments," said Perfect.

Reference
Risk of Behavioral and Adaptive Functioning Difficulties in Youth with Previous and Current Sleep Disordered Breathing. SLEEP, 2013; DOI: 10.5665/sleep.2536

Adaptive and Maladaptive Behaviour Assessments

Clinical and psychological assesments of our children are more commonplace now than they have ever been. This is because early intervention and recognition of detrimental conditions can be very successful in preventing further deterioration of the child's learning potential and ability to enjoy a full and happy life.

Adaptive behaviour assessments are very popular in the United States and their rise in popularity is owed largely to their usefulness and accuracy to psychologists and educators.

Adaptive Behaviour Assessments
The issue for parents and children with Adaptive Behaviour Assessments is that it sounds scary and even if we have been given a very full explanation, we are not always so sure what's happening.

Let's have a look at 2 of the terms used in this assessment and try to dissipate the mystery behind them and make themn less scary.

Adaptive Behaviours
Adaptive behaviours are simply the everyday skills you need in living today; walking, talking, getting dressed, going to school, going to work, preparing a meal, cleaning the house, etc. They are skills that a person learns in the process of 'adapting to' his or her everyday surroundings.


Adaptive behaviours are for the most part learned or developmental, so they are very much to do with how we are growing and learning things as we grow. It is about how we are developing as a child.


So, from that, it is possible to describe or rate, a person's adaptive behaviour as an age-equivalent score. An 'average' five-year-old, is such a child existed, would be expected to have an adaptive behavior score similar to that of other five-year-olds.

Maladaptive Behaviours
This is the other side of the coin. Maladaptive behaviours are more often called 'behaviour problems', because they are behaviours that interfere with the child's learning, development and their everyday activities.


Positive or good adaptive behaviour and a lack of behaviour problems promote independence at home, at school, and in the community.


Negative or Maladaptive Behaviours are much more difficult to quantify than the more positive adaptive behaviors, because they are not about learning and developing, in a positive way. Negative behaviours express themselves differently and are often dependent on opportunity, circumstances, the presence or otherwise of adults or other people.


Part of any observation and assessment will need to determine if their is a particular triger point or person that sets off the behaviour. Negative behaviours may of course simply vary from moment-to-moment, day-to-day and from setting-to-setting.


The good news. Behaviour problems do not increase or decrease steadily with age. Nevertheless a qualified person can measure the levels of behaviour, consistantly and reliably, which is useful in detecting any and every, positive change in the child's behaviour and encouraging it.


Measuring Mental Development
One of the reasons you would measure adaptive and maladaptive behaviours is for diagnosis and for planning a program that promotes positive change. The diagnosis of mental develpment, for example, requires deficits in both cognitive ability and adaptive behavior, occurring before the age of 18.


By the age of 18 the 'child' is an adult, set in their ways and can determine their own future. This is why early intervention and support is so important.


Determining Type of Support
The outcome of an Adaptive behaviour assessment will also be used to determine the type and amount of special assistance that people with disabilities may need, if any. This assistance might be in the form of home-based support services for infants and children and their families, special education and vocational training for young people, and supported work or special living arrangements such as personal care attendants, group homes, or nursing homes for adults.


Early assessments
Adaptive behaviour assessments are most often used in preschool and special education programs for determining eligibility, for program planning, and for assessing outcomes.


Summary
Remember in all this that the parent has the biggest responsibility and the most emotional role to play in supporting the child. To be able to do the best you can for your child, you must be feeling confident, positive and fully aware of what's happening. So, ask plenty of 'what, how, why?...' questions and take the most positive outcome from this and build on it.


I wish you every possible success!