JMIR Rehabilitation and Assistive Technologies最新文献

Background: Chest injuries are a leading cause of death and disability, accounting for 10% of hospital admissions and 25% of injury-related deaths. About two-thirds of patients with thoracic injuries experience complications such as blood or air in the pleural space, causing lung deflation and poor gas exchange. Proper breathing management, using tools like incentive spirometers, improves lung function and recovery. However, there is a gap in mobile-based gaming apps designed for lung exercise, which could benefit both the general population and patients recovering from lung injuries.

Objective: This research aimed to develop and evaluate a mobile app game for practicing lung exercises, accompanied by a prototype device called the Pulmo device.

Methods: The study involved a sample group of 110 participants from the general public. It followed a research and development methodology comprising 4 steps. The research instruments included a mobile app game, a prototype lung exercise device, and questionnaires to assess users' satisfaction and the feasibility of both the app and the device.

Results: The findings revealed that the participants demonstrated a high level of overall satisfaction with both the mobile app game and the prototype lung exercise device (mean 4.4, SD 0.4). The feasibility for the mobile app game and the prototype lung exercise device connected to the game was evaluated. The results indicated that the sample group perceived the overall feasibility to be at a high level (mean 4.4, SD 0.5).

Conclusions: The research results reflected that the sample group believed the mobile app game for practicing lung exercises and the prototype device developed in this project have a high potential for practical application in promoting lung rehabilitation through gameplay. The mobile app game and the Pulmo device prototype received positive user feedback, indicating potential practical use; however, further validation is required among patients in need of pulmonary rehabilitation.

Background: A low-cost home exercise system called VestAid has been developed to assist participants during vestibulo-ocular reflex gaze stabilization exercises outside of clinic visits. The system includes a tablet-based app for the participant and a web-based portal for the physical therapist that provides data to make judgments about exercise accuracy and performance.

Objective: The purpose of this study was to assess the feasibility and acceptability of VestAid in a pilot study of 10 participants (mean age 45 [SD 19] years; 6 women) with various vestibular diagnoses.

Methods: All participants completed twelve 30-second horizontal vestibulo-ocular reflex exercises in a seated position (6 "easy" and 6 "hard" exercises). The exercises differed by variations in the background color, pattern, and movement. One of the exercises was repeated to assess the test-retest reliability of the measure of gaze stability accuracy and head motion compliance during the exercise. Participants rated the difficulty of the exercises (0-10 where 0=easy, 10=difficult) and completed usability surveys.

Results: Participants completed the VestAid session without adverse events. The responses from the usability survey demonstrate the acceptability of VestAid. The mean rating of the "easy" exercises was 2.7/10 (SD 1.9). The mean rating for the "difficult" exercises across participants was 4.8/10 (SD 2.1).

Conclusions: The consistency of the mean ratings of the participants with the exercise classifications ("easy" and "difficult") suggests that VestAid has clinical utility.

Background: Forearm, wrist, and hand impairments affect many individuals and impose a significant economic burden on health care systems. The FEPSim (flexion, extension, pronation, and supination) is designed for hand and wrist rehabilitation. It could become part of the standard care for upper extremity rehabilitation, aiming to improve range of motion, dexterity, and strength during therapeutic activities. However, the FEPSim has not yet been tested in a health care setting, highlighting the need for a trial to assess its effectiveness in upper extremity rehabilitation.

Objective: We aim to assess the feasibility of conducting a definitive trial investigating the effectiveness of adding a new device for hand therapy exercises, the FEPSim, to standard care for patients with impairments of the hand, wrist, and forearm.

Methods: Thirty-eight patients with impairments of distal upper extremities were randomly assigned either to the intervention group (FEPSim and standard care, n=19) or to the control group (standard care, n=19). Therapeutic activities to increase strength, range of motion, resistance, and dexterity were delivered by treating hand therapists using the FEPSim device for the intervention group. Outcome measures included wrist passive and active range of motion, grip strength, pinch grip force, and the Patient-Rated Wrist Evaluation.

Results: The trial retention rate (36/38, 95%) and compliance (control group: 100%; intervention group: 89%) were high. The comparisons of the change-from-baseline between groups revealed that in 63.2% (12/19) of the outcome variables, the change was in favor of the FEPSim, with statistically significant improvements in passive wrist flexion (t34=-0.335, P=.008) and grip strength (t34=-1.841, P=.04).

Conclusions: The FEPSim was accepted as part of standard care by therapists and patients at 2 hospitals. The trial design was feasible for hand intervention using the FEPSim device. The FEPSim positively affected grip strength, an objective measure of hand functioning.

Background: Spinal cord injuries (SCIs) cause debilitating secondary conditions such as severe muscle deterioration, cardiovascular, and metabolic dysfunctions, significantly impacting patients' quality of life. Functional electrical stimulation (FES) combined with cycling exercise (FES-cycling) has shown promise in improving muscle function and health in individuals with SCI.

Objective: This pilot study aimed to investigate the potential role of multiparametric magnetic resonance imaging (MRI) to assess muscle health during and after an FES-cycling rehabilitation program.

Methods: Four male participants with chronic SCI underwent a 6-month FES-cycling training program, consisting of two 30-minute sessions per week. MRI scans were performed at baseline (T0), after 3 months (T1), at the end of the training (T2), and 1-month posttraining (T3). The MRI protocol included T1-weighted imaging for volume quantification, Dixon imaging for fat fraction, multi-echo spin echo for T2 relaxation times, and diffusion tensor imaging to assess diffusion parameters.

Results: Muscle hypertrophy was observed, with an average increase in muscle volume of 22.3% at T1 and 36.7% at T2 compared with baseline. One month posttraining, muscle volume remained 23.2% higher than baseline. Fat fraction decreased from 11.1% at T0 to 9.1% at T2, with a rebound to 10.9% at T3. T2 relaxation times showed a reduction even though this was not consistent among participants. Diffusion tensor imaging parameters revealed subtle changes in muscle tissue microstructure, with a decrease in fractional anisotropy mainly associated to an increase of radial diffusivity.

Conclusions: Although preliminary, this study provides evidence that 6 months of low-intensity FES-bike training can increase muscle volume and decrease fat infiltration in individuals with SCI. The study demonstrates that the use of a multiparametric MRI provides comprehensive insights into both macroscopic and microscopic changes within muscle tissues, supporting its integration into clinical practice for assessing the efficacy of rehabilitation interventions.

Background: Health care is shifting toward 5 proactive approaches: personalized, participatory, preventive, predictive, and precision-focused services (P5 medicine). This patient-centered care leverages technologies such as artificial intelligence (AI)-powered robots, which can personalize and enhance services for users with disabilities. These advancements are crucial given the World Health Organization's projection of a global shortage of up to 10 million health care workers by 2030.

Objective: This study aimed to investigate the acceptance of a humanoid assistive robot among users with physical disabilities during (1) AI-powered (using a Wizard of Oz methodology) robotic performance of predefined personalized assistance tasks and (2) operator-controlled robotic performance (simulated distant service).

Methods: An explorative qualitative design was used, involving user testing in a simulated home environment and individual interviews. Directed content analysis was based on the Almere model and the model of domestic social robot acceptance.

Results: Nine participants with physical disabilities aged 27 to 78 years engaged in robot interactions. They shared their perceptions across 7 acceptance concepts: hedonic attitudes, utilitarian attitudes, personal norms, social norms, control beliefs, facilitating conditions, and intention to use. Participants valued the robot's usefulness for practical services but not for personal care. They preferred automation but accepted remote control of the robot for some tasks. Privacy concerns were mixed.

Conclusions: This study highlights the complex interplay of functional expectations, technological readiness, and personal and societal norms affecting the acceptance of physically assistive robots. Participants were generally positive about robotic assistance as it increases independence and lessens the need for human caregivers, although they acknowledged some current shortcomings. They were open to trying more home testing if future robots could perform most tasks autonomously. AI-powered robots offer new possibilities for creating more adaptable and personalized assistive technologies, potentially enhancing their effectiveness and viability for individuals with disabilities.

Background: Web-based concussion self-management education programs for adolescents can improve functional outcomes, reduce concussion symptoms, and increase self-efficacy. However, there are a limited number of studies examining the perceptions and acceptance of these programs and the use of these tools in the adult concussion population.

Objective: This study aimed to investigate the perceptions and acceptance of clinicians and adults with concussions using MyGuide Concussion (Vancouver Coastal Health), a web-based concussion self-management tool.

Methods: Using a mixed methods sequential explanatory design, a convenience sample of 8 adults with concussions and 8 clinicians who used MyGuide Concussion over a 2-year period were interviewed, and their responses were analyzed.

Results: Participants reported two key benefits of using the web-based self-management tool: (1) the tool's emphasis on the interconnectedness of physical and psychological symptoms, and (2) the ability to provide reassurance that symptom being experienced were a normal part of the concussion experience. Clinicians described the tool as being useful as a supplementary source of information for clients in addition to clinical sessions and believed the content was useful for increasing clients' independence in managing their own recovery.

Conclusions: Overall, the evaluation of the MyGuide tool is an acceptable and well-perceived tool for adults with concussions who require a basic understanding of concussion recovery, particularly in the early stages of recovery. Future research may include optimizing MyGuide by targeting promotional strategies and addressing other barriers to use.

Background: Stationary bikes are used in numerous rehabilitation settings, with most offering limited functionalities and types of training. Smart technologies, such as artificial intelligence and robotics, bring new possibilities to achieve rehabilitation goals. However, it is important that these technologies meet the needs of users in order to improve their adoption in current practice.

Objective: This study aimed to collect professionals' perspectives on the use of smart stationary bikes in rehabilitation.

Methods: Twelve health professionals (age: mean 43.4, SD 10.1 years) completed an online questionnaire and participated in a semistructured interview regarding their needs and expectations before and after a 30-minute session with a smart bike prototype.

Results: A content analysis was performed with inductive coding. Seven main themes emerged: (1) bike functionalities (cycling assistance, asymmetric resistance, and forward and backward cycling), (2) interface between bike and users (simple, user-friendly, personalized, with written reminders during training), (3) feedback to users (user and performance data), (4) training programs (preprogrammed and personalized, and algorithmic programs), (5) user engagement (telerehabilitation, group sessions, music, and automatic suggestion of training), (6) the bike as a physical device (dimensions, comfort, setup, screen, etc), and (7) business model (various pricing strategies, training for professionals, and after-sales service).

Conclusions: This study provides an interpretive understanding of professionals' perspectives regarding smart stationary bikes and is the first to identify the expectations of health professionals regarding the development of future bikes in rehabilitation.