Ebook: Challenges for Assistive Technology

On behalf of the Association for the Advancement of Assistive technology in Europe (AAATE) we are honoured to publish the proceedings of the 9th European Conference of the Advancement of Assistive Technology in Europe.

Every two years, the AAATE conference provides a time to reflect, to review results from previous years and to plan the future of Assistive Technology field for the coming years. The exercise for the 9th edition of the conference led us to recognize, opportunity, challenges and responsibility as keywords.

In the XXIst century Assistive Technology (AT) should be defined as a scientific & technologic approach to the development of products and services oriented to support the elderly and people with disabilities in their daily activities, maximizing their personal autonomy, independence, health and quality of life. Therefore, AT should be an instrument for the improvement of the well-being, social participation, and the quality of life of people with disabilities, their families and professionals involved in their care.

The AT field, should bring this theoretical definition to reality more than ever, in order to counteract one of the main challenges that advanced societies will face during the coming years; the population ageing. There is no doubt that ageing represents one of the major topics in European policies; Europe is the most aged population in the world along with Japan. The natural association between ageing and disability is evident, and the number of people with disabilities is thus increasing as consequence of population ageing. It is estimated that the percentage of people with some kind of disability in Europe is 11%, and these numbers will presumably increase to 18% in 2020, mainly because of the mentioned population ageing.

Because of the rapid ageing of the population, new tools are required for assuring the sustainability of health-care system, and the AT field will be one of those fundamental tools. In effect, AT plays a fundamental role in equalising opportunities and in improving quality of life of people with disabilities, since it provides solutions oriented to the rehabilitation or compensation of functional abilities, helping to eliminate barriers in every kind of environment. The satisfactory use of this tool enables a greater inclusion of people with disabilities into modern society, and therefore relieves some of the strain placed on health care and other public services.

During the past few years, the AT field has developed quickly, mainly because of the technological revolution. There are better solutions now than there were 20, 10 or 5 years ago. And furthermore we foresee solutions that were unimaginable a few years ago, such as neuroprosthetics for urinary control in people with spinal cord injury or the cochlear implant for people with hearing impairments. This development is evident in “high tech” products (e-health, computer based systems…) and also in traditional products such as the wheelchair.

Despite such technological development and the opportunity it opens, the AT field is not as advanced as desired and there is still a long way to cover.

As demonstrated by the study carried out by the EU Commission “Access to Assistive Technology in the European Union”, the AT field is still an unstructured market with a lack of transparency, which derives in poor communication channels. As a consequence, the end user of AT products is dealing with a lack of information when deciding about the most suitable product to purchase. Additionally, AT assessment processes still do not integrate the required interdisciplinary vision and are carried out by single persons who, in most of the cases, do not have suitable education. This scenario leads to situations where the provided solution is not the most suitable one from the integral point of view, generating unsatisfactory and even delicate situations.

Overall, despite great technological development, AT offer has not been developed as much as it should have been during the last 30 years. The AT products are still mainly oriented to mobility, and the actual offer does not consider the epidemiologic trend, thereby missing high prevalence disabilities such as those related to neurodegenerative disorders (i.e. Alzheimer, Parkinson…). Moreover, AT does not consider at all prevention and rehabilitation stages, which are as important as compensation.

We are, therefore, in a situation of necessity but also in front of an opportunity. An opportunity to create a new economic scenario comparable to those related to main sectors; an economic scenario where AT in close link to health technologies, can become one of the engines of the new society. The early baby-boomers are already over 60 and will represent the most important social movement in advanced societies during next 20 years, gathering for example the 50% of the American purchase capacity. We need to look at AT and accessibility not just from a social point of view, but from an economic view as well. Only by making this jump will we be able to succeed and get a real market, providing solutions for real needs.

But this opportunity presents challenges; challenges that we will have to face, in order to take advantage of the situation and to achieve the objectives, in terms of market volume and in terms of quality of life. We are thus responsible for our own future, and this responsibility means that the scientific community should look strategically to AT and moreover, university system should provide appropriate AT professionals.

The 9th AAATE Conference addresses five main challenges, which have motivated most of the papers published in this proceeding book.

New Technologies: technological development is still ongoing and AT needs to be aware of all new opportunities this development raises. Besides mechanics and electronics, also ambient intelligence, smart and advance materials, nanoelectronics, biomechatronics and even bionics can offer important options for suitable solutions for people with disabilities and elderly people.

Socio-Economic Issues: making AT products affordable to end users is definitely one of the big challenges for the coming years.

Universal design and its engagement with Assistive Technology: Integrating Design for All philosophy in the development of regular products and even AT products will speed up the integration process, reducing the gap between context requirements and functional abilities of people with disability.

Evidence based Practice: business opportunities for AT will only be realized with a sound knowledge and understanding of the use of AT solutions in real practice.

Ageing and disability: Europe, as all other developed regions in the World, is facing a new social challenge: population ageing. This issue will introduce new type of needs and demands in terms of care, support and prevention, which AT will have to face.

This publication brings together the main contributions from the whole AT community, during the 9th edition of the AAATE conference, from more than 250 contributions. Unfortunately it was not possible to include all the contributions but these numbers show clearly the active role the community is taking, which created for the scientific committee a heavy but pleasured work. We would like to thank all scientific committee members and specially the support of the AAATE president Gerald Craddock. Last but not least, we want to thank sponsors and collaborators who made possible the edition of this book and the conference organization.

Gorka Eizmendi, Chairman AAATE07 Conference

Jose Miguel Azkoitia, Co-Chairman AAATE07 Conference

Population ageing is one of the main problems of the advanced countries, which are defining tools to face the challenges derived from it. Technology development is opening new market opportunities and is presenting its candidature as one of the key tools to face consequences derived from this evolution. This paper presents FIK project as an example of this approach and as an initiative aiming to transform this challenge into an economic opportunity.

Technology is an important component in the integration of people with disabilities and older people into society. Traditional assistive devices have been a tremendous positive influence, and there is still room for improvement. However, advances in artificial intelligence, machine learning and robotics offer opportunities to transform the abilities of people with physical, sensory, or cognitive impairments. There also exist the need for unprecedented levels of collaboration of between engineers, clinicians, scientists, and consumers.

In recent years, functional assessment has become an alternative to the traditional medical method of evaluating disabilities. This discipline stands out because of its global approach towards the individual, analysing aspects related to the physical, social, emotional and behavioural dimensions of the patient. In contrast to subjective tests which offer only limited information to clinical professionals, biomechanical techniques are proposed as a complementary tool, being characterised by their objectivity and rigour in evaluation procedures. This allows the study of how pathology and pain affect the functional state of the patient, at the same time it serves as a tool for checking the effectiveness of the most appropriate treatments for the patient.

On this communication the work carried out in order to develop a new electrical powered wheelchair concept is described. The main objective is to develop a complete electric powered indoor-outdoor wheelchair, open and modular. Important innovations come from the mechatronic point of view and new technologies related to Ambient Intelligence. An special effort has been done to develop an indoor-outdoor wheelchair, solving the contrary characteristics that are for indoor use the small size (width-length) required to pass through doors, elevators, turn in reduced spaces and for the outdoor use the good stability, certain obstacles climbing capacity (kerbs mainly).This wheelchair includes a special system that allows the vertical movement of the seat from the driving position to higher positions, providing the user to have conversations at different heights, access to objects that placed higher than accessible from the driving position, access to counters, .. Besides this, the user can go down from the driving position to use standard tables, to eat or work at a more ergonomic posture, to take objects from the floor. The combination of this movements, gives the opportunity to make lateral transfers at different heights, reducing the risk and the physical effort of the user and/or the assistant. Security and safety issues have been carefully addressed in the design of the wheelchair. A security centred methodological approach is used to analyse risk situations. Adequate measures are also defined in order to optimise the design of the wheelchair. Apart from that, the wheelchair includes some safety related functionalities such as user fall detection, GPS localization and automatic emergency calls (to emergency services or relatives).In addition, a kerb assistive system and a collision avoidance system are also integrated to improve wheelchair manoeuvrability and navigational aspects. Finally, according to usability and comfort criteria, a voice control system is integrated in order to control secondary functions such as sitting position control, domotic control, etc.

Accessible mounting and positioning technology has been developed which increases the independence and mobility of people with disabilities, improving their ability to easily access or transport essential devices attached to a wheelchair, bed or workstation. The universal design may also be used in offices or manufacturing environments to improve work station ergonomics.

In this paper, we describe the development of electric powered wheelchairs for persons with severe disability unable to drive currently commercialized wheelchairs. One of the important approaches of this development involves closing the gap between persons with severe disability and advanced technologies; e.g. via voice recognition, image recognition, EMG detection, stereo vision technologies. Each of the advanced technologies was incorporated into the human interface and security system of the electric powered wheelchairs and all were evaluated by actual users in the real world during use. In order to ensure the successful development of orphan products, it emerged that user participation is important.

This paper aims to develop a new operation device with less physical burden than standard joysticks, considering the physical characteristics among those who feel difficulty in operating standard joysticks. A muscular dystrophy was selected for the interview and system validation as the subject. An input device with small displacement is needed because of the subject cannot operate a standard joystick satisfactorily. Unlike the displacement-input method of standard joystick, the force detecting method developed an interface which does not input displacement at all. However, force input method tends to directly influenced with respect to disturbance. We proposed a disturbance removal method for extracting an operating intention using experimental results on the road including shock or vibration. Finally, muscular dystrophy subjects are employed to examine the validity of the developed force detecting interface.

Kerbs are one of the main architectural barriers that people with disabilities, especially wheelchair users, encounter in urban areas. Accordingly, this paper's main aim is to present a solution to kerb detection that will be integrated as an assistive function on a motorized wheelchair.

Development of caster-wheel with vibration absorption function is one of solutions for many wheelchair users' ease and comfort. We have tried to develop comfortable and an inexpensive caster-wheel for wheelchair. The purpose of this study was to clarify the basic characteristic of the caster-wheel we developed.

The caster-wheel we developed and four casters on the market were applied to simulating test, such as passing over passageways of inside of buildings and stone paved roads. All casters were also exposed to running endurance test (200,000 machine's drum revolutions; about 157km).

The Maximum Amplitude of Accelerations (MAA) was calculated to compare at each speed. The developed caster-wheel absorbed the vibration about 50 to 60% or more against normal solid caster at each condition. The results of running endurance test were also all right. The developed caster absorbed the vibration about 15 to 35% against normal solid caster.

The gaps and steps between platforms and trains reduce the accessibility and mobility of people with wheelchair. Using an experimental platform, the observations were performed how gaps and steps influence their capabilities for wheelchair users with spinal cord injuries. A quantity of Normalized Driving Force (NDF) was introduced to evaluate the abilities of getting on/off trains. Dynamic wheelchair driving force was measured by using torque meter equipped on the wheelchair to analyze the power boarding on trains. To improve practical accessibility of persons with wheelchair, an assistive device for boarding trains was designed and verified.

Electric Wheelchair (hereinafter “EWC”) is one of the welfare tools (technical aide) that have been most widely used for person of the physically disability and the elderly person to do the social life smoothly, but if the person of the physically disability, etc. want to lead comfortable and safe life with EWC, they are requested to have the “ability to run EWC safely.” However, it is not necessarily clear what the operation “ability to run EWC safely” is, or how this can be understood. Then in this study, mainly targeting for the users of EWC run by the joystick manipulation, we tried to estimate the ability to operate EWC safely by means of using the “computerized intelligence test” and the program to understand the “response time to the speed.” As a result, the regular users of EWC showed an equal or more advanced mental work ability and response time to the speed compared to those of person of the mentally disorder whose intelligence age is estimated to be around 10-12 years old, and non-EWC users could not reach this level. We think that with this mental work ability and the response to the speed as the indices, the decision on wrong/right of the EWC use would become possible by estimating if a user has an ability to run EWC steadily or not.

The Wheelchair Skills Program (WSP) is a training and testing program that includes the Wheelchair Skills Test (WST), the questionnaire version of the WST (WST-Q), and the Wheelchair Skills Training Program (WSTP). The WSP version 3.2 allows one to evaluate 57 representative manual wheelchair skills objectively, simply and inexpensively. The aim of this topic review is to describe the WSP and to realize its clinical and research potential through dissemination. Good measurement properties of the WST and the WST-Q, and the clinical efficacy of the WSTP in various contexts had been demonstrated. Experiences with the French-Canadian, Indian and Bosnian populations are also supportive in terms of the translation process of the WSP and its cultural adaptation. In North America, the WSP is increasingly being used in rehabilitation institutes and research centres. The WSP is a “low tech, high impact” program that appears to have promise for implementation in European countries.

The development of assistive technologies has an important impact on user's activities of daily living and social participation. However, assistive technology identifies persons with disabilities. In this paper, the psychological effects of using a mobility aid were considered before forming the concept of a new device. To identify the detrimental factors, a qualitative research approach was adopted in a study on 12 older persons. The investigation revealed that older persons had a dilemma in using mobility aids between maintaining body functions and extending mobility activities. In addition, there are two sides to the dilemma, namely the function and the appearance of the body. The process to reducing these dilemmas was clarified and a psychological model was constructed. The generation process of the psychological conflict obtained from qualitative data was revealed by modeling details and taking movement, body function and body appearance into consideration. Based on this model we propose and develop a new concept of mobility aid, “Tread-Walk,” is four-wheeled, permitting the user to walk naturally while a servo motor amplifies the normal walking speed. Preliminary evaluations suggest that this device is both safe and effective for use by middle aged and older adults.

This paper describes preliminary results from the test-retest of the NAME 1.0. Four scales were tested: Mobility-related participation frequency; Mobility ease/difficulty; Mobility dependence; Extent of assistance in mobility. The test was conducted in the five Nordic countries. In all 147 mobility device users took part in the study, mean age 60 years (range 19 - 93). Each participant was interviewed twice by means of the NAME 1.0 with seven days' interval (SD 4) by interviewers trained in using the instrument. The reliability of two scales was good, and the reliability of one scale became good after it had been regrouped into fewer grades. The reliablity of the Mobility ease/difficulty scale was only moderate. Possible reasons for this are discussed. There is a need for further research.

The percentage of elderly and people with disabilities is increasing; consequently the demand for an independent living is gaining importance. This article focuses on the threefold composition that consists of automation, multimedia and assistive technology components. Based on studies of specific users' needs and best practice, a design for a demonstrative Slovenian smart home environment is presented. We propose an improved concept, where three evident segments are presented: automation segment, connecting segment (gateway) and the Internet segment. Furthermore we present the architecture of the concept, where the elements of automation are defined, integrated with the assistive technologies and services, based on the broadband Internet connection. The aim of the designed smart home environment is to introduce new possibilities of better quality of life and the level of independence to the potential users in Slovenia, provided by the combined modern technologies, above all, the information and communication technologies. With the demonstrative smart home we plan to promote and increase e-inclusion of people with disabilities and elderly into the information society.

A Smart home is an intelligent environment able to perform several tasks, from the simple door-window automation, to the secure-safety functions, to the most advanced telecare services. But if we join the technological point of view with the social, educational and experimental ones, a smart home can become a multipurpose environment. This is the case of the two domotic apartments in the city of Ferrara, recently renewed. One of them is dedicated to a permanent domotics show and a disability help desk (called Centro H, where H stays for handicap), the other serves as a real smart home, where patients from the near San Giorgio Rehabilitation Hospital can spend a period of two weeks, together with a relative, to test the technology, acquire a certain level of independence and autonomy, eventually referring about possible improvements of the smart home system or of the apartment structure (furniture, spaces, lighting and so on). The first smart home is also used from the University of Electronic Engineering as a laboratory for students, to test experimental projects, in collaboration with the INAIL Prosthetic Centre, a very important partner in the domotic research field. The aim of the paper is then to illustrate the structure of the two domotic apartments, realized with two different commercial systems with two different purposes, and the educational project associated with them.

In the everyday life of a disabled person, computer tools are more and more often present. Softwares allow the design of adapted houses, the mobility assistance, the task planning…In all these fields, collect and process the environment data can be simplified by a server simulating the habitat arrangement, the activities of the occupants, the operation of the consumer appliances…In this paper we present an application deriving from this simulation: a virtual visit to explore the new habitats.

During a two-year trial, experience was gained with installation on the basis of individual applications of simple wireless domotica in an existing district with different types of homes in Amsterdam. The occupants could individually opt for installation of the functions personal alarm, fire alarm, burglar alarm, movement detection and remote door opening. Alarm response by the neighbourhood care team. Initial handling by an urban control room. Nearly one-third of the target group of elderly persons showed interest and well over 100 households took part. In this article, the research data is summarised with respect to experiences of occupants, housing associations and service providers with the trial: neighbourhood-oriented, demand-oriented and individually modifiable. The participants give a positive assessment and appear to score significantly higher on increased feeling of safety in comparison with non-participants. All types of homes can be connected to the system.