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D. Mezir, MD

Co-Director, University of Connecticut School of Medicine

Universities across the globe offer courses and sometimes complete programmes that relate to designing innovative, usable and useworthy assistive technology products. In several countries, international and national nongovernment organizations offer formal and informal courses on different aspects of the provision of assistive technology. Sources of funding Every child who needs assistive technology is entitled to it, regardless of the ability to pay for it. Funding mechanisms to ensure this include (24): Income generation by selling other products or services that subsidize the provision of assistive technology Voucher system to the value of Government, insurance, donor or assistive technology that meets charity funding minimum standards. If the child and the family want more expensive Assistive technology fund (which assistive technology they have to may channel above mentioned funds) arrange to pay the additional funds Contributions from families themselves. Financial barriers the costs of purchasing, maintaining and replacing assistive products, and associated services and traveling costs constitute a major barrier (3, 26, 59). Costs can be especially prohibitive in the case of children, as they need their assistive products replaced or adjusted as they grow (2). In the global survey among 114 countries, 36% had not allocated financial resources for developing and supplying assistive technology (58). Addressing the need for research and development Users, services and products are three intertwined dimensions of assistive technology research, which are undertaken by governments, universities, non-government and private actors. To be able to plan and implement cost-effective services, governments find research on users and services particularly relevant. However, there are also instances when they support product related research and development through grants to universities and product developers. In resource-limited settings, national and international organizations often play an instrumental role in developing knowledge about assistive technology users, services and products. In Thailand, for example, a government organization undertakes research to address the needs for assistive technology for education among children ( In Qatar, a public private partnership established a non-profit organization that provides assistive technology services as well as undertakes assistive technology research (mada. In yet another country-Sweden, the government supported a special initiative to promote the development of assistive technology for children, and a touring exhibition of assistive technology for children has been taken to dozens of countries in Europe and Asia ( The current major bottlenecks are recognition of assistive technology in national and organizational plans/policies, and resourcing of assistive technology in practice (73, 74). Research and development in the field of assistive technology is also very beneficial (see box 8). It also means that they should be safe and durable, and, when applicable, they provide proper fit and support. Finally, they should be available, obtainable and maintainable, and the services sustained in the country at the most economical and affordable price (24). Strategies for providing assistive technology need to consider the principles of 5A&Q - availability, accessibility, affordability, adaptability, acceptability and quality (26). Their delivery should be equitable to avoid discrepancies between genders, impairment groups, socioeconomic groups and geographic regions. Physical accessibility means that, for example, buildings are accessible, lighting is appropriate, signs are available in Braille, and noise levels are low. Cognitive accessibility means that verbal and written information and instructions are clear and simple, language and symbols are concrete rather than abstract, and products are intuitive and easy to use-all from the perspective of children. Affordability Services and products are affordable to the family of every child who needs them. Many of them will not afford assistive technology unless it is provided free of charge or subsidized (54). Adaptability Services and products are adapted and modified to ensure they are appropriate to the needs and requirements of individual children. They need to accommodate differences in terms of individual factors (for example, health condition, body structure, body function, capacity, gender, age, * Provision of assistive technology includes the design, production and supply of products and delivery of services (24). In addition, physical changes of children as they grow and develop need to be accommodated. How often a child should change an assistive product depends on how fast he or she develops and grows, which will vary over time as well as between children.

Neonates with sickle cell disease are often asymptomatic as long as fetal hemoglobin persists. Infants with Tay-Sachs disease show progressive neurodegeneration, cherry red spots on the retina, and developmental delay. There is, however, no known association between Tay-Sachs disease and Hirschsprung disease. However, the bicarbonate level is substantially elevated, about 11 mEq/L above normal. Normally with this level of bicarbonate elevation alone, a higher pH would be expected. This implies that a normal respiratory compensation has occurred in order to normalize the pH by retaining acid by the formation of carbonic acid from carbon dioxide. Vomiting typically induces a metabolic alkalosis due to a loss of hydrogen ions from the stomach, leading to an increase in pH. This leaves an increased bicarbonate concentration (generally >24 mEq/L) in the bloodstream; therefore this patient does indeed have a metabolic alkalosis. However, some patients present with more than one condition causing an acid-base imbalance, which is known as a complicated or mixed condition. If a metabolic acidosis were occurring simultaneously (such as in ketoacidosis or diarrhea), the bicarbonate level would be closer to normal because the two processes would have opposing effects on bicarbonate levels and effectively cancel each other out. This patient has a metabolic alkalosis, as evidenced by the increased pH with increased bicarbonate level. So if carbon dioxide levels increase by more than that, a coexistent respiratory acidosis should be suspected. This patient has an alkalosis, as evidenced by the elevated pH with increased bicarbonate. About 80% of gallstones are made of cholesterol; these occur when solubilizing bile acids and lecithin are overwhelmed by excess cholesterol. The remaining 20% are pigment stones containing mainly calcium bilirubinate; these can occur during periods of increased hemolysis. No clear relationship has been established between gallstone formation and diet, but it has been suggested that low-fiber and high-cholesterol diets are contributing factors. However, endoscopic retrograde cholangiopancreatography would reveal "beading," or alternating strictures and dilation of the biliary tree due to intra- and extrahepatic inflammation and fibrosis of the bile ducts. Dilated loops of small intestines on x-ray of the abdomen and a clinical history of anorexia, vomiting, and abdominal pain are usually sufficient to make the diagnosis. In the United States, the leading cause of small bowel obstructions is adhesion formation, which obstructs the lumen of the small bowel. These adhesions are formed during the healing process secondary to abdominal sur- gery. Other conditions that predispose patients to small bowel obstructions are hernias and intraluminal cancers of the small intestine. Dermatitis herpetiformis is a dermatologic manifestation of gluten insensitivity that presents with erythematous, grouped, pruritic papules. Infection with Helicobacter pylori is limited to gastric and duodenal mucosa and is not known to cause strictures or adhesions. Therefore even chronic infections have no potential to cause small bowel obstructions. Although smoking has multiple detrimental effects on health, it has no correlation to the progression of small bowel obstructions. Ulcerative colitis does not predispose patients to small bowel obstruction because this inflammatory disease process is limited to mucosa and submucosa. Crohn disease, on the other hand, can lead to small bowel obstruction, as it can cause transmural inflammatory and bowel strictures. Examples of autosomal recessive conditions include cystic fibrosis, sickle cell anemia, and hemochromatosis. Examples of X-linked recessive conditions include hemophilia A and B, glucose-6-phosphate dehydrogenase deficiency, and Lesch-Nyhan syndrome.

Syndromes

• Growth of fatty tissue cells (lipomas)
• Decreased consciousness
• Electrolytes - urine
• Dizziness
• Enlarged liver and spleen
• Very painful, sharp electric-like spasms that usually last a few seconds or minutes, but can become constant
• Fluids by IV