搜索结果：JMIR rehabilitation and assistive technologies

Leveraging digital technologies in health care is recognized as essential for effective and efficient services. However, significant challenges remain in implementing these technologies in stroke rehabilitation practice, and research on their influence is limited. This study aimed to explore the current influence of digital technologies on stroke rehabilitation practices and consider how these technologies could shape the future landscape of rehabilitation for multidisciplinary health care professionals in poststroke rehabilitation. A qualitative, exploratory design was used. Data were collected from 12 experienced multidisciplinary health care professionals at 2 Norwegian rehabilitation settings via semistructured interviews, and the data were analyzed using reflexive thematic analysis. Data analysis was guided by social practice theory. The 12 participants included experienced physiotherapists, occupational therapists, speech therapists, nurses, physicians, and social workers. The following three main themes were generated: (1) Outsourcing information about and to stroke survivors: coordination and continuity within and across services (subthemes on follow-up and interservice collaboration, and user-centered approaches); (2) Navigating the ambivalence of remaining human relations in digital psychosocial support conversations (highlighting multidisciplinary challenges in building relational depth and addressing sensitive topics); and (3) Enhancing digital supplements for assessment and engagement in motor rehabilitation (subthemes on progress monitoring and motor skills exercises). Overall, the use of digital technologies in specialized stroke rehabilitation practices was seen as an adjunct to practices. While digital technologies influenced rehabilitation practices, ambivalence and challenges were noted, particularly in digitalizing multidisciplinary psychological support and exercise programs. Systems for sharing medical records and goal-setting apps, which enhance coordination and involve stroke survivors, were emphasized as future digital technologies that can shape stroke rehabilitation. Health care professionals used various technologies in their daily specialist practices, as well as for the coordination and follow-up of stroke survivors after referral to community services. This study identified several organizational processes, roles, standards, and rules that can act as barriers or drivers to implementing digital technologies in practice. Viewing familiar digital technology as a supplement to existing practices, rather than as a singular solution for all areas of specialized stroke rehabilitation, offers significant potential for quality improvement. These findings provide valuable insights for technology developers, health care personnel, and user groups in specialized neurological rehabilitation settings.

Anterior cervical discectomy and fusion (ACDF) is a common treatment for degenerative cervical spine disease, yet its frequent postoperative follow-up places substantial demands on both patients and health care systems. A digital program integrating computer-vision-guided exercise, wearable posture monitoring, and cognitive behavioral therapy (CBT) could provide remote monitoring and rehabilitation to alleviate this burden. This study aims to evaluate the clinical effectiveness and compliance of a 12-week digital rehabilitation program after ACDF compared with conventional in-person therapy. In this prospective cohort study, 336 postoperative patients self-selected either a 12-week mobile-based program incorporating computer-vision-guided exercises, wearable posture sensors, and cognitive behavioral therapy (n=270), or in-person rehabilitation group (IRG, n=66) involving weekly therapist-supervised sessions and paper-based home exercises. Digital users were stratified into a digital rehabilitation completion group (DCG, n=192) and a digital rehabilitation noncompletion group (DNG, n=78). All participants were recruited at a single tertiary hospital and returned to the clinic for outcome assessments at 0, 12, and 24 weeks postoperatively. Outcomes-primarily pain (visual analog scale [VAS]) and disability (neck disability index [NDI]), as well as 36-item short form survey mental component summary (SF-36 MCS), 3-plane cervical range of motion (ROM), muscle endurance, and patient satisfaction-were recorded at 0, 12, and 24 weeks postoperatively. All statistical analyses were performed using SPSS (version 29.0; IBM Corporation). Results were reported as means, SDs, and 95% CIs. Both the DCG (n=192, who completed all digital sessions) and IRG (who completed 12 weeks of weekly in-person sessions and home exercises) demonstrated significant improvements in pain and disability at weeks 12 and 24, with no significant differences between groups (P>.05). At Week 12, VAS decreased by -2.5 (95% CI -3.0 to -2.0) in the DCG and -2.8 (-3.7 to -1.9) in the IRG; NDI decreased by -6.8 (-10.3 to -3.3) and -8.1 (-14.3 to -1.9), respectively. At Week 24, VAS and NDI reductions reached -4.0 (-4.5 to -3.5) and -13.3 (-17.4 to -9.2) in the DCG, and -4.1 (-5.0 to -3.2) and -14.2 (-21.3 to -7.1) in the IRG. In contrast, the DNG showed minimal improvements: VAS changes were -0.8 (-1.6 to 0.0) at week 12 and -1.3 (-2.1 to -0.5) at week 24; NDI changes were -2.2 (-8.2 to 3.8) and -6.4 (-13.0 to 0.2), respectively (P<.05 compared to DCG and IRG). The digital rehab program led to comparable improvements in pain, function, and mental health as conventional in-person rehab. Higher adherence was linked to better outcomes, supporting digital rehab as an effective, patient-centered approach after ACDF.

Vestibular disorders impair balance, increase fall risk, and reduce quality of life due to dizziness and vertigo. They are frequently accompanied by heightened anxiety, which may further limit daily functioning and contribute to avoidance behaviors. Although vestibular rehabilitation has been extensively studied and shown to be effective in managing vestibular disorders, adherence to home-based exercises remains low for many dizzy patients. This is often attributed to uncertainty about correct performance, lack of feedback, or difficulty maintaining a structured routine. To help address these barriers, Vestibulon, a smartphone app co-designed with clinicians and patients, was developed to support rehabilitation practice by providing guided exercise, structured scheduling, progress monitoring, and clear instructions intended to promote confidence and engagement. We aim to evaluate the potential contribution of a smartphone-based app to vestibular rehabilitation outcomes and to explore the relationship between dizziness-related disability and anxiety during the intervention. This randomized 2-period crossover pilot trial included 20 adults with vestibular dysfunction (mean age 52, SD&#x202f;12 y) who completed 6 weeks of rehabilitation. Participants were randomized to begin with either app-supported or conventional treatment before crossing over to the alternate condition after 3 weeks. This design enabled each participant to experience both modes of rehabilitation. Assessments were conducted at baseline (T0), mid-study (after 3 wk; T1), and end of study (T2). Outcome measures included the Dizziness Handicap Inventory (DHI) to assess dizziness-related disability, the State-Trait Anxiety Inventory to evaluate anxiety, and the Instrumented Timed Up and Go test to quantify functional mobility. The primary outcome was the change in DHI scores across time points. Significant improvements in DHI were observed between T0 and T2 in both groups (median change: app first=34, IQR 6-35 points, P=.006; conventional first=18, IQR 10-19 points, P=.009). Improvement in Instrumented Timed Up and Go performance was observed only when the app-supported phase occurred first (Z=-2.45, P=.01), suggesting a potential early benefit of structured smartphone guidance. State-Trait Anxiety Inventory scores did not change significantly in either sequence. Across all time points, dizziness-related disability and state anxiety demonstrated a consistent and significant moderate correlation (r=0.64, P<.001), emphasizing the strong interplay between physical and psychological symptoms in individuals with vestibular disorders. This pilot study indicates that smartphone-supported vestibular rehabilitation has the potential to enhance functional outcomes for some patients. The consistent association between dizziness and anxiety underscores the relevance of considering psychological factors in vestibular rehabilitation. Given the preliminary nature of this study and the small sample size, these findings should be interpreted cautiously, and further research is needed to determine the app's effectiveness in larger randomized controlled trials.

Neurorehabilitation plays a key role in improving motor recovery for people with neurological conditions. Although 3D printing has emerged as a promising rehabilitation tool, little is known on how it is used for the rehabilitation of adults living with neurological conditions worldwide. We aimed to provide a comprehensive overview of 3D printing in neurorehabilitation and precisely explore how it is used to improve motor recovery for adults with neurological conditions living in higher- and lower-middle-income countries. We conducted a scoping review following the Joanna Briggs Institute guidelines. After searching 3 databases (MEDLINE, Web of Science, and Nursing and Allied Health Premium), 2 independent reviewers screened and selected English-language studies involving adults (&#x2265;18 years) published between 2019 and 2024 to capture the most recent advancements in this field. We extracted relevant information on neurological conditions, motor recovery outcomes, and types of 3D printing and offered a comparative analysis of 3D printing in physical neurorehabilitation from the perspective of national income levels using a modified Joanna Briggs Institute extraction form. We synthesized the findings narratively with tabular support. After screening 2752 titles and abstracts and 103 (3.7%) full texts, we included 13 (0.5%) studies based on our inclusion criteria. All included studies were conducted in upper-middle-income or high-income countries, and most studies (9/13, 69.2%) focused on stroke, followed by spinal cord injury (2/13, 15.4%), Parkinson disease (1/13, 7.7%), and central nerve disease (1/13, 7.7%). The 3D-printed rehabilitation tools included orthotics (7/13, 53.8% for the upper extremities [UEs]; 3/13, 23.1% for the lower extremities [LEs]), an exoskeleton (1/13, 7.7%; UEs), a modular assistive hand device (1/13, 7.7%; UEs), and an insole (1/13, 7.7%; LEs). In total, 69.2% (9/13) of the studies targeted UE rehabilitation, measured using the Action Research Arm Test, active range of motion, the box and block test, the Fugl-Meyer Assessment, the Modified Ashworth Scale, the manual function test, range of motion, and the Toronto Rehabilitation Institute Hand Function Test, and 30.8% (4/13) targeted LE rehabilitation, measured using the 10-m walk test, anteroposterior ground reaction force analysis, the Barthel index, the Tinetti scale, the RehaWatch system, and the GaitWatch system. Used as a rehabilitation tool, 3D printing technology has demonstrated significant potential in improving upper and lower motor recovery for people with certain neurological conditions in high-middle-income countries. Future research should explore the implementation feasibility and effectiveness of these technologies across different neurological conditions and income settings, particularly in low- and lower-middle-income countries.

Peripheral facial palsy causes significant functional and psychosocial impairments, requiring precise assessment and patient engagement for effective rehabilitation. However, conventional clinician-graded scales (eg, House-Brackmann Scale, Sunnybrook Facial Grading System, and Stennert Index) are subjective and prone to interobserver variability, limiting their reliability for tracking recovery. Smartphone-based computer vision solutions offer objective, standardized facial movement grading, and interactive home-based training to improve adherence and outcomes. This pilot study evaluated a novel iOS smartphone app (Apple Inc.) for facial palsy management. The app uses the iPhone TrueDepth 3D camera and on-device computer vision to compute a Digital Facial Index (DFI) for objective facial movement analysis, and provides guided neuromuscular facial exercises with real-time biofeedback. The study aimed to validate DFI against standard clinical grading scales and assess patient-reported outcomes and usability. A 4-week single-arm pilot included 21 patients with unilateral facial palsy. Participants used the app at home for daily facial exercises and periodic self-assessments with DFI. Clinicians, blinded to DFI, rated facial function from standardized video exams at baseline and 4 weeks using the House-Brackmann Scale, the Sunnybrook Facial Grading System, and the Stennert Index. DFI concurrent validity was evaluated via correlation with these clinician scores. Patient-reported outcomes included pre- and postintervention Facial Disability Index (FDI) physical and social scores, the System Usability Scale, and a poststudy user feedback questionnaire. During the study period, strong correlations were observed between DFI and conventional clinical scores. FDI physical and social showed significant functional improvement. Mean System Usability Scale was 88.3 (SD 15.4), indicating excellent usability, and participants reported high satisfaction, preferring the app over traditional paper-based exercises. The app's DFI provided objective facial function grading that correlated well with standard clinical scales. Patients' FDI scores improved significantly over 4 weeks. High usability and patient preference support the app's feasibility for home-based rehabilitation. This digital approach is promising for facial palsy management, and controlled studies are needed to confirm efficacy and improve long-term engagement.

The United Nations' third Sustainable Development Goal emphasizes ensuring healthy lives and promoting well-being (WB) for all, which requires effective assistive technology (AT) for persons with disabilities. In low- and middle-income countries (LMICs), however, AT remains largely inaccessible, and high abandonment rates indicate that many existing solutions fail to meet users' needs. To improve AT design and effectiveness, a deeper understanding of users' lived experiences and the ways AT influences WB is essential. This study aimed to explore how technology creates opportunities or barriers in the daily lives of persons with visual disabilities in LMICs and how it affects their WB. We conducted a qualitative narrative study guided by deductive qualitative analysis, using the capability approach (CA) and disadvantage theory (DT) as theoretical frameworks. Nineteen adults with visual disabilities from Cali, Colombia, participated in in-depth, semistructured interviews. A focus group (n=5) deepened the exploration of shared experiences. Data analysis followed three stages: (1) deductive coding using Nussbaum list of central capabilities and key CA constructs (functionings, conversion factors, and agency); (2) recoding through DT concepts (insecure functioning, corrosive disadvantages, and fertile functionings); and (3) inductive analysis to capture emergent sociocultural themes. AT shaped both opportunities and constraints in participants' lives. While functionings such as employment, mobility, and affiliation were highly valued, they often remained insecure due to systemic barriers. Corrosive disadvantages-such as unemployment, exclusion, and limited spatial autonomy-undermined multiple capabilities simultaneously. Conversely, fertile functionings such as equitable employment, adaptive sports, and access to well-designed AT supported agency and resilience. The inductive analysis revealed 3 interconnected themes: the aspiration to explore and expand movement, the desire to appear attractive, and the adoption of nonconfrontational strategies to maintain social harmony. These findings highlight how emotional, aesthetic, and cultural dimensions shape the experience and meaning of AT. While AT research in LMICs often emphasizes availability, it rarely addresses how social norms, structural violence, and fear affect meaningful use. The combined CA and DT lens reveals that AT can either enable or constrain WB depending on how it aligns with users' lived contexts. Designing for fertile functionings-those that support agency, safety, and resilience-is essential. Participatory, context-sensitive design must prioritize not only functionality, but also aesthetic dignity, cultural relevance, and emotional security. Including the voices-and silences-of persons with disabilities in the Global South is crucial for transforming AT from a mere tool into a catalyst for real freedom and WB.

Geographical and economic barriers limit access to health care services in rural regions of Colombia. In San Vicente del Cagu&#xe1;n, the lack of infrastructure and rehabilitation professionals forces patients to travel long distances. Asynchronous telerehabilitation using video broadcasting is a viable strategy to address these challenges. This study aims to design and validate a telerehabilitation model using asynchronous audiovisual content broadcasting for rural patients, evaluating functionality, usability, and clinical effectiveness. A 4-stage case study developed and validated the model in San Vicente del Cagu&#xe1;n: (1) analysis of telemedicine experiences and video-based therapy; (2) solution design including telecommunications infrastructure (radio links and Wi-Fi), mobile app (HSRehabiAPP), and web platform (HSRehabiWEB); (3) fieldwork with 7 patients receiving physical, occupational, or speech therapy, evaluating functionality (11 criteria), usability (8 criteria), and content quality (5 criteria); and (4) results analysis. The infrastructure connected San Rafael Hospital with remote centers in Los Pozos and Tres Esquinas. Participants (aged 7-68 years) from urban and rural areas had conditions including stroke, shoulder injuries, knee pathologies, hypertension, and attention-deficit hyperactivity disorder. All 7 patients achieved 100% compliance across functional, usability, and audiovisual content criteria. Functional evaluation covered login, navigation, therapy access, session viewing, exercise execution, pain assessment, therapist communication, and satisfaction surveys. Usability assessment evaluated initial access, content location, navigation comfort, instructional guidance, session organization, video playback, instruction clarity, and interface intuitiveness. Content criteria included exercise clarity, step-by-step instructions, visual quality, audio quality, and correct posture demonstration. Patients reported high satisfaction, noting reduced travel costs and time, family convenience, and effective outcomes. Offline functionality proved essential in areas with limited internet connectivity. The asynchronous audiovisual telerehabilitation model is an effective solution for improving access to rehabilitation services in rural areas. It successfully addressed geographical barriers and infrastructure limitations while maintaining clinical effectiveness across therapies. Implementation requires adequate technological infrastructure, user-friendly platforms with offline capabilities, and quality therapeutic content. Future work demands inclusive health policies, professional training, and research with larger sample sizes to assess long-term sustainability in diverse rural contexts.

Acquired brain injury (ABI) is a heterogeneous umbrella term encompassing traumatic and nontraumatic etiologies and is frequently associated with persistent cognitive dysfunction. Conventional neuropsychological assessment remains central to clinical evaluation, but feasibility and measurement precision may be limited in individuals with motor impairment, aphasia, reduced stamina, or fluctuating arousal. Eye tracking offers an objective, low-burden approach that can quantify gaze behavior during task engagement and may provide complementary process-level markers of cognition. This study aimed to systematically synthesize the evidence on eye-tracking paradigms used as a primary approach for cognitive assessment in ABI and to summarize findings by cognitive domain, paradigm, and clinical interpretability. We conducted a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020-compliant systematic review and registered the protocol in PROSPERO (CRD420251038768). PubMed, Web of Science, the Cochrane Library, Embase, EBSCOhost, PsycINFO, and Scopus were searched from inception to April 10, 2025. We included peer-reviewed English-language studies enrolling children or adults with ABI in which eye tracking was the primary assessment modality used to quantify at least one cognitive domain or clinically relevant cognitive-communication process. Two reviewers independently screened studies, extracted data, and assessed methodological quality using design-appropriate tools (Risk of Bias 2, Risk of Bias in Non-Randomized Studies of Interventions, Quality Assessment of Diagnostic Accuracy Studies 2, and the Newcastle-Ottawa Scale). A structured narrative synthesis was performed because of heterogeneity in paradigms and outcome definitions. Twenty-seven studies met the inclusion criteria (N=872 participants; females: n=354 and males: n=518), with most evidence derived from mild traumatic brain injury cohorts, and fewer studies involving stroke, mixed etiologies, and disorders of consciousness. Across domains, antisaccade and related paradigms were commonly associated with differences in inhibitory control and executive function, while predictive tracking, smooth pursuit, and target-blanking paradigms frequently captured alterations in attentional prediction and timing. Virtual reality (VR) free-viewing paradigms identified visuospatial exploration asymmetries in stroke-related neglect, and gaze-based human-computer interface approaches demonstrated above-chance task performance in a subset of patients with disorders of consciousness. Evidence for incremental validity beyond conventional assessment was mixed and often indirect, and safety reporting was uncommon. Overall certainty of evidence was generally low and limited by small sample sizes, cross-sectional designs, and heterogeneity in acquisition procedures, metrics, and analytic pipelines. Eye tracking shows potential as an adjunctive, process-level approach for quantifying specific cognition-relevant behaviors after ABI, particularly within paradigms targeting inhibitory control and predictive attention. Current evidence is insufficient to support broad diagnostic claims or the routine replacement of conventional neuropsychological assessment. Future research should prioritize harmonized paradigms and reporting standards, external validation of classification models, longitudinal designs, and explicit feasibility and safety reporting to clarify when eye tracking provides incremental clinical value for precision neurorehabilitation.

The global incidence of spinal cord injury (SCI) is between 10 and 80 new cases per million people each year. This equates to between 250,000 and 500,000 injuries worldwide per year. In the United Kingdom, approximately 4400 people per year sustain an SCI. People with tetraplegia report upper limb function as their highest priority for improvement after SCI. Using immersive virtual reality (VR) headsets, physical rehabilitation exercises can be completed in engaging digital environments. Immersive VR therefore has the potential to increase the amount of therapy undertaken, leading to improvements in arm and hand function. There is little evidence supporting immersive VR as exercise in SCI, especially while patients with SCI are undergoing acute rehabilitation. In SCI research, co-design of new interventions is not a widely adopted approach, yet people with tetraplegia want to contribute with their expert knowledge on their experiences of SCI. This study aims to explore the lived experiences of people with tetraplegia and specialist SCI therapists related to acute upper limb rehabilitation and identify design considerations for VR-based interventions targeting the upper limb. We conducted 7 online focus groups using Microsoft Teams: 4 with people with tetraplegia (n=15; age range, 36-65 years) and 3 with occupational therapists and physiotherapists specializing in SCI rehabilitation (n=11). Participants were asked to discuss their experiences and expertise about acute SCI upper limb rehabilitation and their opinions and ideas on the use of VR for upper limb rehabilitation. The transcripts were analyzed using content analysis, enabling the proposition of design characteristics of a VR-based intervention for upper limb exercise. The study identified 5 major themes describing the clinical features, treatment, and recovery of people with SCI during the acute stage of SCI, their motivations for participating in therapy, and suggestions for the design of a VR intervention in treating the upper limbs following SCI. The themes identified in this study allow the elicitation of software requirements for a bespoke immersive VR platform for upper limb rehabilitation following SCI. They can also contribute to a better understanding of the advantages of using VR as an adjunct to upper limb rehabilitation. Additionally, participants used their expertise to suggest factors that would enable the development of a usable and effective intervention, as well as identifying potential pitfalls and software features to avoid during intervention development. These findings can be used to design accessible VR applications for use by people with tetraplegia and their therapists.

Stroke remains a primary cause of long-term disability worldwide, with upper-limb deficits affecting up to 80% of survivors acutely and 40% chronically. These deficits lead to considerable effects on their independence and overall quality of life. Conventional rehabilitation therapies are most effective when initiated shortly after a stroke, yet many patients face barriers to ongoing therapy post discharge. Recent advancements in low-cost rehabilitation systems, particularly those using virtual reality (VR) technologies, offer promising alternatives for enhancing upper-limb recovery. Given the burden on health care systems and the limitations in access to high-intensity postdischarge rehabilitation, this study aimed to evaluate the feasibility, acceptability, and usability of an upper-limb adaptive mirror therapy using VR and myoelectric control for the rehabilitation of patients with chronic stroke developed through a user-centered design approach. In this study, a total of 12 community-dwelling survivors of chronic stroke (mean age 52.9, SD 16.0 years; 4 female) with moderate to severe upper-limb impairments were enrolled. Participants were stratified by age (young: 18-55 years; older: 56-80 years) and impairment level (Fugl-Meyer Assessment-Upper Extremity score: 18-36=severe; 37-54=moderate). Acceptability was assessed for each session by patient self-evaluation of satisfaction and motivation through a visual analog scale, while the therapist assessed the patient's participation in therapy using the Pittsburgh Participation Rehabilitation Scale. Usability was measured with the User Satisfaction Evaluation Questionnaire scale and feasibility through the NASA (National Aeronautics and Space Administration) Task Load Index cognitive workload indices. Patients reported a significant increase in satisfaction from the intermediate to the final assessment (T1: 72% vs T2: 85%; P=.01) and stable high motivation levels. Differences in participation and motivation were observed based on impairment levels, with no effect of age. Usability ratings remained high (>80%) throughout the intervention, with no significant differences between baseline and end line (P=.56). Cognitive workload assessments showed a significant reduction over time, in perceived cognitive (P=.04), performance (P=.007), and effort demands (P<.001). Impairment level significantly influenced perceived workload, with participants with more severe impairment reporting higher cognitive, physical, temporal, and effort demands (all P<.001), while age did not contribute to variability in acceptability, usability, or workload measures. VR therapy was found to be feasible, under adaptive task conditions, ensuring stable performance across patients. The protocol was usable and acceptable among patients with chronic stroke, especially those with moderate impairment, supporting its potential as a user-centered digital rehabilitation tool, warranting further investigation in controlled and home-based settings. ClinicalTrials.gov NCT07103122; https://clinicaltrials.gov/study/NCT07103122.

Telerehabilitation is a safe and effective means of delivering physiotherapy services, but implementation in clinical practice has not been widespread. This study aimed to explore the shifts in telerehabilitation use throughout the COVID-19 pandemic and the key factors that influenced telerehabilitation caseload after restrictions were eased. Between September and November 2023, physiotherapists practicing in Australian private practice, hospital outpatient, or community settings completed an online survey. Data were collected regarding participants' use of telerehabilitation before, during, and after the COVID-19 pandemic restrictions to in-person physiotherapy. Qualitative content analysis of open-text questions was performed to garner more nuanced information about the use of telerehabilitation in clinical practice, and quantitative data were analyzed descriptively. The proportion of participants using telerehabilitation rose from 30% (44/148) before the pandemic to 94% (138/147) when restrictions to in-person physiotherapy were in place. Although 82% (118/144) of the sample continued to deliver telerehabilitation after COVID-19 restrictions were eased, telerehabilitation accounted for only 14% of the total caseload. Exploratory analyses suggest that despite increased confidence, satisfaction, and perceptions about the effectiveness of telerehabilitation, reduced patient demand, physiotherapists' perceptions about patient preference for in-person consultations, and the perception that in-person physiotherapy is easier continue to influence the use of telerehabilitation in the post-COVID era. Despite increased uptake during the pandemic, telerehabilitation caseload after restrictions were eased was low. Physiotherapists' perceptions about telerehabilitation in clinical practice remain a substantial barrier to sustained adoption.

While smart speakers are emerging as a novel health care technology, people with Parkinson's Disease (PwPD) and speech and language therapists (SaLTs) have reported difficulties using smart speakers with speech and voice impairments in research. To date, PwPD have identified frustration with having to repeat themselves to be understood, devices timing out before they had finished speaking, and being unable to have a conversation with smart speakers. SaLTs have reported technical and practical challenges in implementing voice-assisted technology tools. Both PwPD and SaLTs indicated a lack of knowledge about what smart speakers could do, as well as concerns about privacy and the listening nature of the devices. This study aims to co-design solutions that support the use of smart speakers for speech and voice difficulties experienced by PwPD. Based on the Design Thinking framework, a multistage design process was conducted, involving a lay steering group and 2 online co-design workshops. Twenty participants, including PwPD, carers, SaLTs, design and technology experts, and third-sector staff, collaborated during the co-design workshops. The ideate phase included brainstorming and ranking, and conventional content analysis was used to specify prototypes. Two main prototypes were created: (1) education and guidance, including privacy and therapeutic usage guides for PwPD and SaLTs to address troubleshooting and delivery considerations; and (2) new speech and language therapy (SLT)-specific features for smart speakers. Participants provided feedback on their experiences of co-design, highlighting feeling valued, the balance of perspectives, and making improvement suggestions. Feedback aligned with the UK standards for public involvement. Smart speakers could enhance accessibility, therapy engagement, and long-term speech outcomes, offering scalable, cost-effective solutions to support SLT services, patient independence, and reduced service demand. Smart speaker solutions with a SLT focus enable PwPD to self-manage speech and voice difficulties at home and reinforce therapy gains between clinic visits. Co-designed with users, these prototypes are intended to address health disparities and relieve pressure on SLT services, offering a scalable and sustainable solution that enhances efficiency and supports ongoing rehabilitation within health care systems.

Telemedicine and e-HealthVol. 26, No. 9 OpinionFree AccessTechnology Literacy as a Barrier to Telehealth During COVID-19Austin J. Triana, Roman E. Gusdorf, Kaustav P. Shah, and Sara N. HorstAustin J. TrianaVanderbilt University School of Medicine, Nashville, Tennessee, USA.Search for more papers by this author, Roman E. GusdorfVanderbilt University School of Medicine, Nashville, Tennessee, USA.Search for more papers by this author, Kaustav P. ShahVanderbilt University School of Medicine, Nashville, Tennessee, USA.Search for more papers by this author, and Sara N. HorstAddress correspondence to: Sara N. Horst, MD, MPH, Department of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, 1211 21st Avenue South, Medical Arts Building Suite 220, Nashville, TN 37232, USA E-mail Address: [email protected]Department of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA.Search for more papers by this authorPublished Online:10 Sep 2020https://doi.org/10.1089/tmj.2020.0155AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookXLinked InRedditEmail During the ongoing COVID-19 pandemic, there have been many fundamental changes to the health care system, one of which has been the rapid adoption of telehealth.1 Despite technological capability for widespread implementation before the pandemic, telehealth remained limited in many areas of the United States due to state regulations and poor insurance reimbursement.2 When these policies changed in March 2020 with national widespread coverage for telemedicine, traditional clinical workflows attempted to rapidly shift to a virtual format to increase social distancing and protect vulnerable patients. At our institution alone, the number of telehealth visits increased from ∼15 per day to >2,000 per day in a matter of weeks.As the health care system rapidly reorganized and trained physicians on how to host videoconference visits, some patients have struggled to keep up. During these changes, providers reported that many patients were struggling to access their telemedicine appointments. Patients may have difficulty navigating their devices and entering the health care system virtually. Others simply do not have devices or a stable Wi-Fi to connect with providers from home. Technology literacy and access should be viewed as a major driver of health and needs to be on a large scale.As an example, Ms. P is a 70-year-old woman with diabetes and hypertension who knows she is high risk for complications from COVID-19. Taking extra precautions, she cancelled her in-person appointments and scheduled a telehealth visit with one of her providers. She spent an entire afternoon preparing her technology for the visit, but she could not connect to the virtual appointment. Despite a proactive mindset, she had difficulty downloading the necessary software. Recognizing this barrier to care Ms. P and other patients face, we started a medical student-led volunteer initiative to help patients set up and test devices for their telemedicine appointments. We rapidly created systematic processes for recruitment, volunteer training, clinic coverage, and operational support. A standardized phone script helped students guide patients as they downloaded the proper software and understood what to expect at the time of the visit.Within a month, we have had 135 medical student volunteers commit 1,300 h and assist >5,000 patients in preparing for upcoming telehealth visits. Along the way, we have seen a wide range of patient comfort with technology that has advanced our understanding of technology literacy. One patient, a computer programmer, initially scoffed when asked whether he needed help. However, he still appreciated the tip that he received about which web browser to use to access his visit, avoiding a glitch that kept some patients from connecting. For patients low self-reported technology literacy, our impact can be great. Many patients had never downloaded a smartphone application or used videoconferencing software before their first virtual appointment. Wary of hackers and scammers, another patient was strongly opposed to telehealth and wanted to cancel his visit, but after talking about the safety of the process with a student, he downloaded the software and had a successful telemedicine visit with his provider.If a patient cannot connect to the videoconference, the provider is forced to call the patient to troubleshoot over the phone, reschedule the appointment, or simply proceed without video. Prior work has shown that the video component significantly contributes to quality and satisfaction of the visit.3 In addition to the technology itself, patients need to know what to expect for their telehealth appointments. Ideally, a patient will have a medication list and be in a quiet and private location at the time of the visit. Therefore, it is important to communicate these expectations beforehand to avoid a visit that takes place from the grocery store or in the car.With the ability to see patients in their own environments, we also gain insight into their lives. Using videoconferencing, it is possible to see a patient's home, to contextualize their experiences, and to better utilize the biopsychosocial model of health. One patient was blind but wanted to use videoconferencing so that the provider could see him. A volunteer helped the patient and his able-sighted daughter navigate the telehealth process using accessibility features for blindness. As medical students who grew up immersed in technology, we have been humbled by the complexity of teaching others to navigate smartphones, web browsers, and applications, and we have seen the tremendous technology gaps in various patient populations.Outside the context of direct patient care, widespread adoption of telehealth has the potential to improve quality of life and health outcomes through additional synergies. Although many older adults perceive benefits from technology, common barriers include self-efficacy, cost, and privacy concerns.4 Prior research has shown that technology adoption can be improved through education and increasing perceived self-efficacy.5 If patients can better navigate their web browsers and applications, they may feel empowered to message their providers through the patient portal or look up healthy recipes online.Among the drastic changes in health care, we hope that updated regulations and improved insurance coverage will be permanent, improving access for patients by addressing issues related to distance, mobility, or health concerns. Licensure across state lines remains a big question that could drastically impact access for many patients. In addition, it is imperative to further understand and address how to help our patients access and use technology. The transition to telehealth requires time, patience, and resources—an investment that is crucial for patients who are at risk of being left behind.AcknowledgmentsWe thank Drs. Michelle Griffith and Eiman Jahangir for organizational support of this project as well as reviewing and editing drafts.Disclosure StatementNo competing financial interests exist.Funding InformationNo funding was received for this article.References1. Smith A, Thomas E, Snoswell C, Haydon H, Mehrotra A, Clemensen J, Caffery Lj. Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID-19). J Telemed Telecare. 2020. Available at: https://doi.org/10.1177/1357633X20916567 (last accessed May 15, 2020). Google Scholar2. Dorsey ER, Topol EJ. State of telehealth. N Engl J Med 2016;375:154–161. Crossref, Medline, Google Scholar3. McLendon SF. Interactive video telehealth models to improve access to diabetes specialty care and education in the rural setting: A systematic review. Diabetes Spectr 2017;30:124–136. Crossref, Medline, Google Scholar4. Scott Kruse C, Karem P, Shifflett K, Vegi L, Ravi K, Brooks M. Evaluating barriers to adopting telemedicine worldwide: A systematic review. J Telemed Telecare 2018;24:4–12. Crossref, Medline, Google Scholar5. Gatti FM, Brivio E, Galimberti C. "The future is ours too": A training process to enable the learning perception and increase self-efficacy in the use of tablets in the elderly. Educ Gerontol 2017;43:209–224. 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Triana, Roman E. Gusdorf, Kaustav P. Shah, and Sara N. Horst.Technology Literacy as a Barrier to Telehealth During COVID-19.Telemedicine and e-Health.Sep 2020.1118-1119.http://doi.org/10.1089/tmj.2020.0155Published in Volume: 26 Issue 9: September 10, 2020Online Ahead of Print:May 19, 2020 TopicsCOVID-19e-health and telehealth careTelehealth devices PDF download

In 2022, over 18,000 patients aged &#x2265;70 years were hospitalized in the Netherlands for a hip fracture, with 50% requiring geriatric rehabilitation after surgery. Increasing geriatric rehabilitation patient numbers, staff shortages, and rising pressure on health care budgets make adequate care challenging. To make geriatric rehabilitation more future-proof, a stronger focus on home-based rehabilitation is needed. Early identification of patients likely to be discharged soon enables timely discharge planning and coordination of support at home. Early geriatric rehabilitation discharge planning may help organize home-based rehabilitation more effectively by arranging home care services in advance. This can facilitate smoother transitions toward home and prevent discharge delays, which is important to ensure optimal bed occupancy. This study aims to develop machine learning (ML) models to predict a geriatric rehabilitation stay of 4 weeks or less in a skilled nursing home for older patients after hip fracture surgery, using continuously monitored physical activity data from the first week of geriatric rehabilitation and patient characteristics. This prospective cohort study (January 2019-August 2024) included 100 patients. Patient characteristics and physical activity data from the MOX1 accelerometer (Maastricht Instruments BV) were collected during the first rehabilitation week. Principal component analysis was used to reduce the physical activity features. ML models were developed using Bayesian hyperparameter optimization and refined if necessary. The performance of the single best-performing configuration per remaining ML model type was evaluated, and the most important features for predicting the length of geriatric rehabilitation stay were identified. Of the 3 ML models evaluated (support vector machine [SVM], ensemble of decision trees, and neural network), the SVM achieved the highest performance, with 19 out of 20 correct predictions (accuracy=0.95, 95% CI 0.85-1.00; precision=0.91, 95% CI 0.71-1.00; recall=1.00, 95% CI 1.00-1.00; F1-score=0.95238, 95% CI 0.83-1.00; area under the curve [AUC]=0.97, 95% CI 0.83-1.00). The most important features for predicting the length of geriatric rehabilitation stay across the best-performing ML models included the continuously monitored physical activity data, time in the emergency room, functional ambulation category (FAC) at hospital discharge, age, Katz Index of Independence in Activities of Daily Living-6 (Katz-ADL6) at hospital discharge, Montreal Cognitive Assessment (MoCA), availability of nonprofessional help, surgery type, Charlson Comorbidity Index (CCI), gender, and hemoglobin level at hospital admission. This study developed several ML models to predict a geriatric rehabilitation stay of &#x2264;4 weeks in a skilled nursing home for older patients after hip fracture surgery. Among these models, the SVM proved to be highly accurate in its predictions with an accuracy of 0.95 (95% CI 0.85-1.00), precision of 0.91 (95% CI 0.71-1.00), recall of 1.00 (95% CI 1.00-1.00), F1-score of 0.95 (95% CI 0.83-1.00), and AUC of 0.97 (95% CI 0.88-1.00).

Communication is an essential component of participation. Communication impairment restricts full participation for children who have unintelligible speech. A vocal cord vibration switch offers an avenue for meaningful interaction to children who cannot rely on speech or voluntary limb movement but have some control of their vocal cords. Previous evaluations of the vocal cord vibration switch have been conducted primarily with adults and adolescents. However, implementation of a vocal cord vibration switch with younger, school-aged children in their natural environmental contexts can potentially foster the development of early communication skills. This case series evaluated the appropriateness and impact of a vocal cord vibration switch, the "Hummingbird" (Holland Bloorview) with school-aged children who have complex communication needs and their mothers and teachers, using an individualized, collaborative, and iterative assistive device implementation protocol. The Hummingbird was evaluated with 3 school-aged children, across educational and health-related contexts, over a 2-year period. Baseline, midterm, and final assessments took place at home or school in the first year with a follow-up assessment in the second year. In addition to field observations and device performance assessments by the research team, feedback from mothers and teachers was collected via questionnaires (Pictorial Children's Effort Rating Table, Quebec User Evaluation of Satisfaction with Assistive Technology, and the Family Impact of Assistive Technology Scale) to ascertain the Hummingbird's appropriateness and its impact. Appropriateness data indicated the suitability of the Hummingbird across settings. Compared to the child's prestudy devices, mother and teacher participants reported that the physical effort required by all 3 children to use the Hummingbird was lower (scores on the Pictorial Effort Rating Table decreased from 8 and 11 to scores of 4-6). The switch efficacy assessment of the Hummingbird indicated moderate-to-high specificity and high sensitivity at midterm and high sensitivity (0.91-0.94) and specificity (0.92-1) at final assessments. Total satisfaction scores increased from baseline (prestudy device) to the 2-year assessment for all 3 children. While data on the impact on family and communication were incomplete for 1 participant, generally favorable effects were reported. The field notes underscored the value of an individualized protocol, where the implementation and evaluation phases were adapted to accommodate the health-related characteristics (eg, seizure disorder and sleep deprivation), evolving school contextual factors (new school and teacher), and unique family environments (involving the child participant's toddler-sibling in Hummingbird sessions). Overall, the Hummingbird was appropriate across home and school settings for our case study participants, all of whom had complex communication needs. The device was well-received by children and their mothers or teachers, providing an effective, setting-agnostic option for communication support. Modifications to both the device and its implementation process were required to address unanticipated health, family, and school challenges.

Technology-based interventions in the field of disability and rehabilitation, which serve assistive, therapeutic, and/or service delivery functions, are considered complex due to the skills required of providers and recipients, degree of individual tailoring, and diversity of use settings. Feasibility studies are an important step in the evolution of complex interventions that can help refine the intervention, inform implementation, and prevent wasted resources. However, guidance is lacking regarding specific considerations for feasibility studies of technology-based interventions in disability and rehabilitation, which leaves researchers and developers reliant on resources from other fields that do not address important technology properties. To advance the field, context-specific definitions, considerations, and evaluation dimensions must be explicitly outlined to ensure that feasibility studies are constructively designed to meet the unique needs of these interventions. In this viewpoint article, we (1) propose a definition and framework for feasibility studies within the specific context of technology-based disability and rehabilitation interventions, (2) highlight important and unique imperatives for feasibility studies of these interventions, and (3) articulate relevant feasibility dimensions and associated evaluation criteria for these interventions. Building on previous work, we distinguish between feasibility studies, wherein we focus on iterative intervention refinement by addressing key development questions (eg, usability), and pilot studies, which are small-scale versions of a larger study that will evaluate intervention outcomes. Integrating previous typologies, we present 13 feasibility dimensions relevant to technology-based interventions and provide sample evaluation criteria, focusing on the intervention itself rather than study design considerations (eg, trial management). This information may be useful for research and development communities (academic, clinical, or industry) to inform comprehensive feasibility studies that examine unique aspects of technology-based interventions to promote real-world impact. This contribution encourages greater harmonization of terminology and evaluation methods to streamline interpretation and comparison across studies.

Postoperative rehabilitation is essential to improve quality of life (QoL), pain control, and upper limb function in women undergoing surgery for breast cancer (BC). Telerehabilitation has emerged as a promising alternative to conventional rehabilitation, especially in patients with limited access to care, but its comparative efficacy remains uncertain. This study aimed to evaluate the effectiveness of telerehabilitation compared with standard care or no treatment in improving QoL, pain, handgrip strength, and upper limb function in women undergoing BC surgery. We conducted a systematic review and meta-analysis following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. We included 11 randomized controlled trials, of which 5 were eligible for quantitative synthesis. Risk of bias was assessed using the Cochrane risk-of-bias tool for randomized trials version 2 (RoB2), and the certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. Outcomes assessed included QoL, pain, grip strength, and upper limb function. Telerehabilitation significantly improved QoL (standardized mean difference [SMD] 0.59; 95% CI 0.24-0.95; moderate certainty) and grip strength (mean difference [MD] 2.93; 95% CI 0.82-5.04 kg; low certainty), and significantly reduced pain (SMD -0.50; 95% CI -0.79 to -0.22; low certainty). No significant difference was observed for upper limb function (SMD -0.86; 95% CI -2.02 to 0.31; low certainty). Telerehabilitation is an effective and viable intervention for improving QoL, reducing pain, and enhancing grip strength in women following BC surgery. However, its impact on upper limb function remains inconclusive and requires further investigation. PROSPERO CRD42024545075; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024545075.

An increasing number of rehabilitation technologies are being developed to support upper limb rehabilitation after stroke, with smart textile solutions for surface electromyography (sEMG) emerging as a promising approach. Early end-user involvement is crucial for developing user-friendly and clinically valid rehabilitation tools. This study aims to refine and evaluate the prototype design and usability of a smart textile biofeedback system for self-administered upper limb training after stroke. The training system includes a knitted smart textile sleeve with integrated electrodes over the forearm muscles, an sEMG unit, and tablet-based biofeedback software. An iterative co-design process was followed, including initial testing, demonstration sessions with end users (9 clinicians and 10 individuals with stroke), and a final evaluation of the co-design process. Participants' experiences were gathered through semistructured interviews, analyzed using content analysis, and the User Experience Questionnaire. The co-design team included experts in stroke rehabilitation, textile engineering, biomedical engineering, software development, and human factors, as well as a research partner with lived experience after stroke. The perspectives of the end users and the expert team were collectively integrated into prototype refinements of the sleeve and training software to meet the needs of the intended target group. The experiences of end users formed 2 main categories: "This could be an exciting new training tool for stroke rehabilitation" and "The tool works well, but some changes could enhance independent training." End users found the smart textile sleeve and biofeedback system easy to use and saw potential for integrating it into their training routines. Both end-user groups rated the system as attractive, stimulating, and novel. The results of this study establish a necessary ground toward the development of a smart textile sEMG biofeedback system for self-administered upper limb training after stroke. Findings from the co-design process support the continued development and evaluation of the system as a self-administered upper limb training tool for individuals living with stroke.

Enhancing rehabilitation methods for patients with stroke is essential, particularly during the transition from inpatient to outpatient care. Digital applications are being developed to provide telerehabilitation programs. The existing virtual blended care platform Blended Clinic (Blended Clinic AI GmbH) offers app-based training for patients after a stroke and comprises 3 main components, including training, coaching, and monitoring. This study assesses the usability and user experience of the novel Swiss Tele-Assisted Rehabilitation and Training (START) program within the Blended Clinic platform in patients after stroke and therapists. The START program was developed within 3 workshops and an online survey. It contains 10 6-week exercise programs tailored to the levels of the modified Rankin Scale (mRS), 5 infographics, and 5 podcasts. Eight patients after stroke and 10 therapists took part in a single-center usability study. All participants were introduced to the Blended Clinic app and subsequently used it independently. The Blended Clinic platform, including the START program, was evaluated by both user groups based on the System Usability Scale (SUS) and the Mobile App Rating Scale (MARS-G). Additionally, feedback was collected, observations were documented, and program adherence metrics were calculated. The mean SUS scores were 87.2 (SD 10.8) for 8 patients and 83.3 (SD 11.3) for 10 therapists. The MARS-G scores were 3.9 (SD 0.5) for patients and 4.1 (SD 0.4) for therapists for categories A-D. User experience was rated 4.1 (SD 0.5) for patients, while device usability was 3.8 (SD 0.8) for patients and 4.2 (SD 0.5) for therapists. Adherence to the training schedule varied among patients (16.7%-80% of the planned sessions) and was rather low for many of the patients. The START program, delivered via the Blended Clinic platform, was considered user-friendly and received good usability ratings from patients with stroke and therapists. Recommendations to enhance compliance are provided.