Samuel N. Markowitz, MD, FRCS(C), Associate Professor of Ophthalmology, Faculty of Medicine, University of Toronto; Director, Low Vision Rehabilitation Program, Department of Ophthalmology, University of Toronto; Staff, Toronto Western Hospital, University Health Network, Toronto, ON.

Low vision can result from loss of macular function, with loss of peripheral vision or from loss of hemi-fields of vision such as in cases with stroke. Low vision rehabilitation (LVR) is the continuation of care after all other means for restoration of vision were used and failed. Modern LVR is a multidisciplinary endeavour responsible for providing assessment, prescribing devices, and conducting training sessions for individuals with low vision. Ontario recognizes the diverse needs of individuals requiring LVR interventions, covers LVR assessments and LVR training sessions, and provides financial subsidies for the purchase of low vision devices.
Key words: low vision rehabilitation, low vision, age-related macular degeneration, assistive devices, vision therapy.

Pooja Viswanathan, BMath, MSc Candidate, Department of Computer Science, University of British Columbia, Vancouver, BC.
Jennifer Boger, MASc, Research Manager, Intelligent Assistive Technology and Systems Lab, Department of Occupational Science and Occupational Therapy, University of Toronto; Toronto Rehabilitation Institute, Toronto, ON.
Jesse Hoey, PhD, Lecturer, School of Computing, University of Dundee, Dundee, Scotland; Toronto Rehabilitation Institute, Toronto, ON.
Pantelis Elinas, MSc, PhD Candidate, Department of Computer Science, University of British Columbia, Vancouver, BC.
Alex Mihailidis, PhD, PEng, Assistant Professor and Head of Intelligent Assistive Technology and Systems Lab, Department of Occupational Science and Occupational Therapy, University of Toronto; Toronto Rehabilitation Institute, Toronto, ON.

Mobility and independence are essential components of a high quality of life. Although they lack the strength to operate manual wheelchairs, most physically disabled older adults with cognitive impairment are also not permitted to use powered wheelchairs due to concerns about their safety. The resulting restriction of mobility often leads to frustration and depression. To address this need, the authors are developing an intelligent powered wheelchair to enable safe navigation and encourage interaction between the driver and his/her environment. The assistive technology described in this article is intended to increase independent mobility, thereby improving the quality of life of older adults with cognitive impairments.
Key words: mobility, artificial intelligence, assistive technology, wheelchairs, cognitive impairment.

Mary Beth Jennings, PhD, Reg. CASLPO, Aud(C), FAAA, Audiologist, Assistant Professor, National Centre for Audiology, Faculty of Health Sciences, University of Western Ontario, London, ON.
Frances Richert, MSc, Reg. CASLPO, Audiologist, H.A. Leeper Speech and Hearing Clinic, School of Communication Sciences and Disorders; National Centre for Audiology, Faculty of Health Sciences, University of Western Ontario, London, ON.

Older adults are the fastest-growing age group in Canada. Hearing loss is highly prevalent among this population. Of those persons who would benefit from the use of hearing aids, only a small number actually own and use them. Digital hearing aids now constitute the majority of hearing aids on the market. Technological advances in hearing aids and hearing assistive technologies have expanded the range of options available to improve the success of device use. Matching the needs and optimizing performance of older adults with the broad range of devices available requires appropriate assessment, selection, verification, and follow-up by the audiologist.
Key words: hearing aids, hearing assistive technologies (HATS), rehabilitation services, older adults.

Meera George, JD, Postgraduate Fellow, Houston Center for Quality of Care and Utilization Studies, Michael E. DeBakey VA Medical Center, Houston,TX, USA.
Aanand D. Naik,MD, Assistant Professor, Health Services Research and Geriatrics, Baylor College of Medicine; Houston Center for Quality of Care and Utilization Studies, Michael E. DeBakey VA Medical Center, Houston,TX, USA.

Many older adults have difficulty bathing.Those unable to bathe are more likely to need formal home care and to be admitted to long-term care than those who can bathe without help. Disability with bathing function is complex, involving multiple subtasks; inability to perform those subtasks has many attributable causes. Bathing disability can be remediated through timely diagnosis and prescription of appropriate assistive devices and adaptations to the home bathing environment. Clinicians have an important role in the diagnosis of bathing disability, and collaborative planning of bathing remediation with patients, caregivers, and allied health providers is key.
Keywords: activities of daily living, assessment, disability, assistive devices.

Robert W. Teasell, MD, FRCPC, Physical Medicine and Rehabilitation, Lawson Health Research Institute, University of Western Ontario, London, ON.
Jeffrey W. Jutai, PhD, Cpsych, Physical Medicine and Rehabilitation, Lawson Health Research Institute, University of Western Ontario, London, ON.

Stroke rehabilitation is best provided by a specialized interdisciplinary team, and the benefits of such a program in improving functional outcomes and reducing disability have been well established in multiple randomized controlled trials (RCTs). There is also evidence that the intensity of therapy is important. The risk of not providing stroke rehabilitation, established in one RCT, is a marked increase in death and dependency for moderate to severe stroke patients. Rehabilitation is best provided early to take advantage of post-stroke brain plasticity. Increasing age has an impact on stroke recovery, and very old patients respond better to a slower, less intensive approach to rehabilitation. Insufficient attention is often given to the importance of assistive devices.

Key words: stroke rehabilitation, interdisciplinary stroke rehabilitation unit, older adult, assistive devices.

Doron Milstein, PhD, Hofstra University, Long Island, NY, USA.
Barbara E. Weinstein, PhD, Graduate School and University Center, CUNY, New York, NY, USA.

Hearing loss diminishes quality of life. The elderly rely on auditory input to maintain social contact and awareness of their environment, such that hearing loss in this age group can lead to isolation and withdrawal from the community. Most elderly individuals do not take advantage of available audiological services nor do they use hearing aids (HAs), the treatment of choice for their hearing loss. Modern HAs utilise digital technology and computer software to improve speech intelligibility. Current research reveals that HAs are effective in minimising the negative consequences of hearing loss in the daily functioning of the elderly. The availability of sophisticated technology allows for more efficient HA fitting, and allows the audiologist to spend more time counseling.
Key words: presbycusis, hearing aid technologies, rehabilitation, assistive listening devices.

Eleanor Brownridge

Since access to assistive devices is not a federally-mandated program, financial assistance for canes, wheel chairs and braces for patients with arthritis varies considerably from province to province. In fact, the majority of provincial health plans cover none of these aids.

The Ontario Ministry of Health does have an Assistive Devices Program (ADP) which covers a portion of the cost of manual and power wheelchairs, scooters and walkers, back supports, and specialized canes for people with long-term disabilities. ADP pays up to 75 percent of a predetermined price, with the patient paying the remaining 25 percent directly to the vendor at the time of purchase. For those on social assistance, the program will cover 100 percent of the cost. "To access this program, your patient must have a valid Health Card and the device must be authorized by a physiotherapist or occupational therapist registered with the program," says Robert Jankowski, a public information officer with ADP. There are currently over 5,000 registered authorizers working in hospitals, home care agencies or private practice. Physicians or patients can call 1-800-268-6021 to obtain the name of local health professionals authorized to access this program or speak with the local CCAC/Home Care Coordinator for further information.