Technology and Disability

Studies reveal healthcare disparities for people with disabilities (PwD) due to various barriers. Digital health offers promise but raises concerns about the digital divide. To address that, health Information and Communication Technologies (ICTs) should follow inclusive design principles for accessibility to all, including PwD.

We examine the design of ICTs in healthcare to address the needs of people with disabilities. Three research questions guide the study: (i) how health technologies contribute to healthcare accessibility and inclusion; (ii) what the main challenges are in implementing these technologies; (iii) how health ICTs are structured to meet users’ limitations and enhance performance.

Research questions are addressed through a scoping review and critical literature analysis, drawing from seven databases and grey literature. The analysis of research question (iii) uses the accessibility fundamentals recommended by the Web Accessibility Initiative as starting point.

Our research reveals a predominant focus on the elderly, with cognitive impairment as the most studied limitation, followed by mobility, reach and dexterity, vision, and hearing.

We emphasize the need for inclusive design for all health technologies and investigate their potential to improve user and healthcare system performance. We also propose four promising research directions for further investigation.

Studies reveal healthcare disparities for people with disabilities (PwD) due to various barriers. Digital health offers promise but raises concerns about the digital divide. To address that, health Information and Communication Technologies (ICTs) should follow inclusive design principles for accessibility to all, including PwD.

We examine the design of ICTs in healthcare to address the needs of people with disabilities. Three research questions guide the study: (i) how health technologies contribute to healthcare accessibility and inclusion; (ii) what the main challenges are in implementing these technologies; (iii) how health ICTs are structured to meet users’ limitations and enhance performance.

Research questions are addressed through a scoping review and critical literature analysis, drawing from seven databases and grey literature. The analysis of research question (iii) uses the accessibility fundamentals recommended by the Web Accessibility Initiative as starting point.

Our research reveals a predominant focus on the elderly, with cognitive impairment as the most studied limitation, followed by mobility, reach and dexterity, vision, and hearing.

We emphasize the need for inclusive design for all health technologies and investigate their potential to improve user and healthcare system performance. We also propose four promising research directions for further investigation.

Non-verbal persons with intellectual disabilities (ID) may suffer from pain or discomfort, but caregivers may not notice this because of the communication difficulties. Previously, we conducted a study in which professional caregivers used heart rate (HR) monitoring to identify situations that cause acute pain or distress in the everyday life of non-verbal persons with ID.

To explore professional caregivers’ experience with using HR monitors to better understand non-verbal persons with ID.

Fifteen professional caregivers and 30 final-year students of social education were recruited as informants based on their experience with HR monitoring in non-verbal persons. The informants were interviewed, and they responded to a questionnaire with open-ended questions. The qualitative data were analysed thematically.

Caregivers reported that HR monitoring provided information about acute pain, acute or prolonged distress, occurrence of epileptic seizures, and the non-verbal persons’ preferences and dislikes. HR data had to be interpreted contextually to be meaningful. Some informants found HR monitoring time-consuming or the interpretation of HR data challenging due to multiple possible causes of increased HR.

Caregivers experience HR monitoring as a potentially important source of information that may help them better understand non-verbal persons with ID.

Non-verbal persons with intellectual disabilities (ID) may suffer from pain or discomfort, but caregivers may not notice this because of the communication difficulties. Previously, we conducted a study in which professional caregivers used heart rate (HR) monitoring to identify situations that cause acute pain or distress in the everyday life of non-verbal persons with ID.

To explore professional caregivers’ experience with using HR monitors to better understand non-verbal persons with ID.

Fifteen professional caregivers and 30 final-year students of social education were recruited as informants based on their experience with HR monitoring in non-verbal persons. The informants were interviewed, and they responded to a questionnaire with open-ended questions. The qualitative data were analysed thematically.

Caregivers reported that HR monitoring provided information about acute pain, acute or prolonged distress, occurrence of epileptic seizures, and the non-verbal persons’ preferences and dislikes. HR data had to be interpreted contextually to be meaningful. Some informants found HR monitoring time-consuming or the interpretation of HR data challenging due to multiple possible causes of increased HR.

Caregivers experience HR monitoring as a potentially important source of information that may help them better understand non-verbal persons with ID.

Work-related musculoskeletal disorders are common among care professionals in elderly care. Exoskeletons showed effectiveness in preventing and reducing low back pain in other sectors. However, the potential of using an exoskeleton in elderly care is unclear.

To document the experiences of care professionals using an exoskeleton in elderly care.

A descriptive qualitative study with individual semi-structured interviews among professionals from two elderly care institutes, facing low back pain.

Twenty-two care professionals used the exoskeleton mainly at peak loads during morning and evening care. Their experiences were described in four main themes: wearing and adjusting, movement and comfort, appearance, integration into work, and perceived effects. Those who experienced (predominantly) positive effects reported having less or even no back pain, partly due to the relief of the lower back, but also to a more conscious posture and attention to ergonomically sound movement.

This study led to valuable insights into experiences of using an exoskeleton in elderly care, such as the potential of mitigating and preventing low back pain, and suggestions for further development of exoskeletons to improve their usability in the context of elderly care. The latter should be followed by studies into long-term effects.

Work-related musculoskeletal disorders are common among care professionals in elderly care. Exoskeletons showed effectiveness in preventing and reducing low back pain in other sectors. However, the potential of using an exoskeleton in elderly care is unclear.

To document the experiences of care professionals using an exoskeleton in elderly care.

A descriptive qualitative study with individual semi-structured interviews among professionals from two elderly care institutes, facing low back pain.

Twenty-two care professionals used the exoskeleton mainly at peak loads during morning and evening care. Their experiences were described in four main themes: wearing and adjusting, movement and comfort, appearance, integration into work, and perceived effects. Those who experienced (predominantly) positive effects reported having less or even no back pain, partly due to the relief of the lower back, but also to a more conscious posture and attention to ergonomically sound movement.

This study led to valuable insights into experiences of using an exoskeleton in elderly care, such as the potential of mitigating and preventing low back pain, and suggestions for further development of exoskeletons to improve their usability in the context of elderly care. The latter should be followed by studies into long-term effects.

To develop a checklist that guides the requirements necessary for public digital platforms in providing AT, based on the WHO-proposed “The WHO-GATE 5P framework” and the Global Report on Assistive Technology.

A qualitative descriptive research approach was employed consisting of 4 stages: 1) Construction of the checking tool, 2) Discussion of the checklist by a group of three researchers until a final proposal was reached, 3) Analysis of the checklist by two external researchers with experience in AT research and services, 4) Analysis of the suggestions and formatting of the final version of the checklist. Three of the authors/researchers conducted a documental analysis of the “WHO-GATE 5P framework” and Global Report on Assistive Technology, and two experts in research and AT services, performed the checklist analysis independently.

The final version of the checklist with 25 items was created and made available in English and Portuguese version. Conclusion: This checklist based on the fundamentals of the assistive technology model centred on people, the “WHO-GATE 5P framework” and the Global Report on Assistive Technology provides direction for digital AT service delivery, delivery practices and data science in digital services aimed at addressing the needs of AT consumers, while supporting advancements in the provision of digital AT services.

To develop a checklist that guides the requirements necessary for public digital platforms in providing AT, based on the WHO-proposed “The WHO-GATE 5P framework” and the Global Report on Assistive Technology.

A qualitative descriptive research approach was employed consisting of 4 stages: 1) Construction of the checking tool, 2) Discussion of the checklist by a group of three researchers until a final proposal was reached, 3) Analysis of the checklist by two external researchers with experience in AT research and services, 4) Analysis of the suggestions and formatting of the final version of the checklist. Three of the authors/researchers conducted a documental analysis of the “WHO-GATE 5P framework” and Global Report on Assistive Technology, and two experts in research and AT services, performed the checklist analysis independently.

The final version of the checklist with 25 items was created and made available in English and Portuguese version. Conclusion: This checklist based on the fundamentals of the assistive technology model centred on people, the “WHO-GATE 5P framework” and the Global Report on Assistive Technology provides direction for digital AT service delivery, delivery practices and data science in digital services aimed at addressing the needs of AT consumers, while supporting advancements in the provision of digital AT services.

Facial expressions are critical for conveying emotions and facilitating social interaction. Yet, little is known about how accurately sighted individuals recognize emotions facially expressed by people with visual impairments in online communication settings.

This study aimed to investigate sighted individuals’ ability to understand facial expressions of six basic emotions in people with visual impairments during Zoom calls. It also aimed to examine whether education on facial expressions specific to people with visual impairments would improve emotion recognition accuracy.

Sighted participants viewed video clips of individuals with visual impairments displaying facial expressions. They then identified the emotions displayed. Next, they received an educational session on facial expressions specific to people with visual impairments, addressing unique characteristics and potential misinterpretations. After education, participants viewed another set of video clips and again identified the emotions displayed.

Before education, participants frequently misidentified emotions. After education, their accuracy in recognizing emotions improved significantly.

This study provides evidence that education on facial expressions of people with visual impairments can significantly enhance sighted individuals’ ability to accurately recognize emotions in online settings. This improved accuracy has the potential to foster more inclusive and effective online interactions between people with and without visual disabilities.

Facial expressions are critical for conveying emotions and facilitating social interaction. Yet, little is known about how accurately sighted individuals recognize emotions facially expressed by people with visual impairments in online communication settings.

This study aimed to investigate sighted individuals’ ability to understand facial expressions of six basic emotions in people with visual impairments during Zoom calls. It also aimed to examine whether education on facial expressions specific to people with visual impairments would improve emotion recognition accuracy.

Sighted participants viewed video clips of individuals with visual impairments displaying facial expressions. They then identified the emotions displayed. Next, they received an educational session on facial expressions specific to people with visual impairments, addressing unique characteristics and potential misinterpretations. After education, participants viewed another set of video clips and again identified the emotions displayed.

Before education, participants frequently misidentified emotions. After education, their accuracy in recognizing emotions improved significantly.

This study provides evidence that education on facial expressions of people with visual impairments can significantly enhance sighted individuals’ ability to accurately recognize emotions in online settings. This improved accuracy has the potential to foster more inclusive and effective online interactions between people with and without visual disabilities.

While it has been broadly agreed that there is a need for consolidated information about assistive technology, previous attempts have not been sufficient for detailed consumer demands.

Researchers sought consumer feedback to determine what should be included in a comprehensive, accessible database of AT.

We conducted focus groups with different stakeholder groups (people with diverse disabilities, practitioners, and circles of support). We used a framework analysis to map participant responses to the research questions using focus group transcripts and notes.

AT users are looking for quick access to certain information such as the cost versus benefit, reliability, funding, and compatibility. They expect to find this in a variety of formats (video, audio, text) with a collaborative element (reviews and recommendations) from other users.

In an AT product database, users want the option to search by activity rather than only disability category, as disability can fluctuate. Accessibility of the database is key, with people preferring modifiable and flexible formats for both adding and consuming information. A community of practice will foster the connections people require to confirm their decisions prior to purchase.

While it has been broadly agreed that there is a need for consolidated information about assistive technology, previous attempts have not been sufficient for detailed consumer demands.

Researchers sought consumer feedback to determine what should be included in a comprehensive, accessible database of AT.

We conducted focus groups with different stakeholder groups (people with diverse disabilities, practitioners, and circles of support). We used a framework analysis to map participant responses to the research questions using focus group transcripts and notes.

AT users are looking for quick access to certain information such as the cost versus benefit, reliability, funding, and compatibility. They expect to find this in a variety of formats (video, audio, text) with a collaborative element (reviews and recommendations) from other users.

In an AT product database, users want the option to search by activity rather than only disability category, as disability can fluctuate. Accessibility of the database is key, with people preferring modifiable and flexible formats for both adding and consuming information. A community of practice will foster the connections people require to confirm their decisions prior to purchase.

A better understanding of the relationship between eye movements required for reading and central visual field loss may facilitate the design of more effective personalized visual rehabilitation programs to improve access to information and quality of life.

To determine the impact of central vision loss due to maculopathy on the oculomotor skills required for reading and tasks of varying complexity, eye-tracking technology was used.

Case-control study. Participants were 17 cases (61.7 years (SD = 8.8), 12 females and 5 males) and 17 controls, matched for age and sex. Three computer-based tests were administered, analyzing eye fixations, saccadic movements, and visual search, measured with a 60 Hz eye-tracking device.

Central vision loss due to maculopathy increases the number of fixations and saccadic movements, indicating more instability in and out of the region of interest. Visual search required more fixations (16.2 ± 10.2 vs. 6.7 ± 1.9), more saccades (11.7 ± 6.4 vs. 3.3 ± 1.9), longer latency (701.3 ± 191.4 ms vs. 315.9 ± 56.0 ms), and longer time to find the target (113.1 ± 76.6 s vs. 18.5 ± 10.1 s). All comparisons between the two groups showed a statistically significant difference ( P < 0.05).

The results revealed the significant impact of central vision loss due to maculopathy on reading by increasing patterns of eye fixations, saccadic movements, and visual search strategies, as measured by eye-tracking technology. This technology may have high potential to improve the assessment and rehabilitation of people with maculopathy, and this may become key information for designing personalized interventions to improve the quality of life and autonomy of individuals with central vision loss.

A better understanding of the relationship between eye movements required for reading and central visual field loss may facilitate the design of more effective personalized visual rehabilitation programs to improve access to information and quality of life.

To determine the impact of central vision loss due to maculopathy on the oculomotor skills required for reading and tasks of varying complexity, eye-tracking technology was used.

Case-control study. Participants were 17 cases (61.7 years (SD = 8.8), 12 females and 5 males) and 17 controls, matched for age and sex. Three computer-based tests were administered, analyzing eye fixations, saccadic movements, and visual search, measured with a 60 Hz eye-tracking device.

Central vision loss due to maculopathy increases the number of fixations and saccadic movements, indicating more instability in and out of the region of interest. Visual search required more fixations (16.2 ± 10.2 vs. 6.7 ± 1.9), more saccades (11.7 ± 6.4 vs. 3.3 ± 1.9), longer latency (701.3 ± 191.4 ms vs. 315.9 ± 56.0 ms), and longer time to find the target (113.1 ± 76.6 s vs. 18.5 ± 10.1 s). All comparisons between the two groups showed a statistically significant difference ( P < 0.05).

The results revealed the significant impact of central vision loss due to maculopathy on reading by increasing patterns of eye fixations, saccadic movements, and visual search strategies, as measured by eye-tracking technology. This technology may have high potential to improve the assessment and rehabilitation of people with maculopathy, and this may become key information for designing personalized interventions to improve the quality of life and autonomy of individuals with central vision loss.