International Training and Research on the Impact of Assistive Technologies for People with Disabilities in India

Principal Investigator: Rory A. Cooper, PhD

Co-Investigator: Jonathan L. Pearlman, PhD

2007-2009

Our department and laboratories have had an ongoing five-year relationship with the Indian Spinal Injuries Center (ISIC) in New Delhi, India. Over these years, the scope of this relationship has slowly expanded, from one of casual exchange of information (curriculum, research ideas, etc.) between the directors of each facility, to formal training workshops where engineers and clinicians travel to ISIC (annually since 2004) to present the latest information on research, technology, and clinical service related to wheeled mobility for people with disabilities. Over the past year, we have broadened the scope further by collaborating on research studies related to the dissertation work of one of our doctoral students. The work, which focuses on developing improved strategies for design of assistive technologies (ATs) for people with disabilities in developing countries, has been fruitful for both facilities. For the ISIC, and India in general, it is helping to build research capacity in studying the impact of AT on people with disabilities in India; this will help address the overwhelming need for low-cost, high quality AT in India. For our laboratories, research in India, and especially at ISIC, offers a platform for us to test the impact of ATs on people with disabilities which is unencumbered by the funding structures in the United States (US) which can predispose individuals to certain devices. Thus, the outcomes of the studies can be useful to improve devices and service provision in India and the US.

The progress and preliminary outcomes of the first two collaborative research protocols we have worked on with ISIC have been highly successful and fruitful. The previously funded IREE, which supported a doctoral candidate’s research at ISIC was also successful and helped demonstrate the viability of a low-cost, novel power wheelchair design in India. This most recent IREE sent two graduate student trainees to perform research studies at ISIC for 3.5 months in 2008. These studies evaluated the impact of AT on the community participation, wheelchair skills, and technology satisfaction of wheelchair users treated at ISIC. The importance of evaluating the outcomes of AT provision has been emphasized by the United Nations and the World Health Organization, although no known researchers are currently collecting the data. Our collaboration with ISIC offered us a unique opportunity to initiate outcome studies research on individuals with spinal cord injury in an unstudied region.

Two research studies were performed during the IREE program. First, the trainees initiated a longitudinal outcome study on the community participation of AT recipients at ISIC’s department of Assistive Technology. This study used the PART survey to assess the community participation of an AT recipient from a baseline (when they received a new piece of AT from ISIC). Follow-ups at 6, 12, and 18 month time points are ongoing. Only the baseline time point was completed while the trainees were in India; follow-ups are being collected by the Department of AT’s director. Out of the original 26 subjects recruited for this study, 15 were retained at the 6-month follow-up. Preliminary follow-up data indicate a decrease in life satisfaction and an increase in community participation.

The second study investigated the wheelchair skills and technology satisfaction of ISIC clients before and after they received a fitted wheelchair. Participants were administered the wheelchair skills test (WST) and the Quebec User Evaluation of Satisfaction with assistive Technology (QUEST) while they used a wheelchair provided by the hospital, or the old one they came in with. Then ISIC provided them with new wheelchairs, which were often better fitting and lighter weight. The WST and QUEST were given again at this point. A comparison between the pre- and post-prescription performance scores indicate that after prescription, participants were more successful at completing wheelchair skills tasks and more satisfied overall with their wheelchair. Safety scores decreased, however, highlighting the importance of wheelchair skills training.

An additional study took place at ISIC to enhance efforts under the Quality of Life Technologies Engineering Research Center (QoLT ERC) at the University of Pittsburgh. One of the graduate students investigated factors leading to driver cessation and alternatives to independent transportation among socially active people with disabilities and senior citizens. Responses by questionnaire provided insight on the challenges to community participation in relation to driving status and other demographic or socioeconomic factors. The most intriguing result was to see that the proportion of transportation usage, at more than twice a day, was much lower among people with no driving experience as compared to people who continue to drive or have ceased driving.

The benefits of this extended stay were several-fold. First, it helped develop the international research skills and collaborations for the graduate students, which furthered their upcoming research careers in international rehabilitation research. Second, our collaborations with ISIC were expanded, ultimately offering more training opportunities for our growing graduate program in rehabilitation science, and for ISIC’s students, two of whom completed REU internships at the Human Engineering Research Laboratories (HERL) last summer. Finally, these two research protocols were the first of their kind (that we know of) in developing countries; they provided important pilot data to help streamline AT provision in these countries and also serve as a model for research at other sites.