JMIR Rehabilitation and Assistive Technologies最新文献

Background: Upper-limb impairments following conditions such as stroke and spinal cord injury contribute significantly to long-term disability. Many survivors of stroke face limited access to rehabilitation due to geographical, financial, or scheduling barriers, leaving unmet therapeutic needs.

Objective: This study conducted a preliminary evaluation of the usability of a novel telerehabilitation platform integrating a portable, desktop-mounted robot (DMRbotV3) with a mixed reality HoloLens 2 application to support accessible and adaptive upper-limb neurorehabilitation.

Methods: This was a pilot usability study. Six participants, 3 (50%) stroke survivors (≥3 months after the event) recruited from a hospital stroke registry and 3 (50%) occupational therapists (≥1 year of clinical experience) recruited through convenience sampling in the Greater Milwaukee region, completed a single 2-hour session using the telerehabilitation platform in the BioRobotics laboratory at the University of Wisconsin-Milwaukee. Participants tried out the system, which delivered passive, active, and resistive exercises through DMRbotV3 combined with interactive mixed reality displays, and then completed a customized usability questionnaire. Data collected included (1) robotic parameters from onboard sensors (joint position, velocity, and interaction forces); (2) participant usability feedback from questionnaires to assess usability, satisfaction, and user engagement; and (3) documentation of adverse events and safety concerns. Descriptive statistics (mean scores and ranges) were used to analyze usability ratings and performance parameters.

Results: The system was safe and well tolerated, with no adverse events reported. All participants completed the session, and usability scores averaged ≥4.0 across all items, reflecting high satisfaction and engagement with mixed reality integration. The robotic system demonstrated smooth performance, with controlled joint velocity profiles (-10 m/s to +10 m/s) and adaptive interaction forces up to approximately 25 N.

Conclusions: This preliminary study supports the usability of combining robotics and mixed reality technologies into a telerehabilitation platform for upper-limb neurorehabilitation. Participant feedback also identified opportunities for refinement to enhance adaptability and personalization of therapy.

Background: People with moderate to severe intellectual disability can have difficulties accessing leisure stimuli and engaging in basic cognitive and physical activity independently. These difficulties may be even more marked in individuals with a combination of intellectual disability and sensory or sensory-motor impairments.

Objective: This study assessed a new program relying on touch screen technology, which was set up to support access to leisure stimuli and the performance of a simple form of cognitive activity and basic physical exercise for adults with intellectual or intellectual and hearing disabilities, lack of functional speech, and poor motor dexterity.

Methods: The program alternated access to preferred stimuli (ie, songs, comic sketches, or cartoons) with cognitive activity (ie, matching-to-sample tasks) and physical exercise (ie, body movements). The touch screen technology was modified to ensure that people with poor motor dexterity would be effective in their responding regardless of the accuracy of their responses. The program was implemented with 7 participants. Its impact was assessed through the use of single-case research methodology.

Results: During the baseline (when standard technology was used), the mean percentage of songs, comic sketches, or cartoons accessed; match-to-sample responses provided; and body movements performed correctly and independent of research assistants' help was 0% for all participants with a single exception. During the intervention (when the new program with modified touch screen technology was used), the participants' mean percentage of songs, comic sketches, or cartoons accessed correctly and independent of research assistants' help per session was virtually 100%. Their mean percentage for correct match-to-sample responses provided and correct body movements performed independent of research assistants' help was within the 90% to 100% range.

Conclusions: The findings suggest that the program may constitute a useful tool for helping people with intellectual and multiple disabilities access leisure stimuli and engage in cognitive and physical activity.

Background: The high incidence and prevalence of upper limb impairment post stroke highlights the need for advancements in rehabilitation. Brain-computer interfaces (BCIs) represent a promising technology by directly training the central nervous system. The integration of motor imagery (MI) and motor observation through virtual reality (VR) using BCIs provides valuable opportunities for rehabilitation. However, the diversity in intervention designs demonstrates the lack of guiding recommendations integrating neurorehabilitation principles for BCIs.

Objective: This study aims to develop recommendations for BCI interventions using task specificity and ecological validity through simulated VR tasks for upper limb stroke survivors by gathering tacit knowledge from neurorehabilitation experts, patients' experiences, and engineers' expertise to ensure a comprehensive approach.

Methods: A multiperspective qualitative study was conducted through collaborative design workshops involving stroke survivors (n=17), neurorehabilitation experts (n=13), and biomedical engineers (n=3), totaling 33 participants. This innovative approach aimed to actively engage stakeholders in developing multifaceted solutions for complex health interventions.

Results: Six themes emerged from the thematic analysis: (1) importance of patient-centered approach, (2) clinical evaluation and patient selection, (3) recommendations for task design, (4) guidelines for structuring BCI intervention, (5) key factors influencing motivation, and (6) technology features. From these themes, the following recommendations (R) are established: (R1) MI-based VR-BCI interventions must be conducted through a patient-centered approach, based on individualized preferences, needs, and goals of the user, by an interdisciplinary team; (R2) selection criteria must include upper limb impairment, cognitive and communication assessment, and clinical traits, such as MI capacity, neglect, and depression must be assessed since they might influence intervention outcomes; (R3) tasks to perform should preferably be based on daily living activities, including unilateral and bilateral tasks, and a variety of tasks must be available for selection to ensure meaningfulness for the user and suitability to clinical traits; (R4) intervention must be structured by different progressing levels starting with simple, gross movements and adding complexity through additional movement features, cognitive demand, or MI difficulty; (R5) optimal levels of motivation must be sustained through task variability, gamification elements, and task demand adequacy; and (R6) multisensorial potential of MI-based VR-BCI must be effectively harnessed through the adequate adjustment of visual, haptic, and proprioceptive feedback modalities to the patient.

Conclusions: Current results contribute to establishing clear guidelines on patien

Background: Digitalization is seen as a way to reduce the negative environmental impacts of health care production, but research is still limited.

Objective: This study focuses on the assessment of the sustainability aspects of digital services in home care and health care. It demonstrates the approach to identify the climate impacts and social impacts-both positive and negative-on a selection of digital home care and health care services, such as medicine robot services for older home care clients, through 2 Finnish case studies.

Methods: Impacts are identified from interviews and statistical data collected from public service providers and technology suppliers using both quantitative and qualitative assessments.

Results: While a well-planned and well-implemented digital service is likely to be a climate-friendly option, every digitalization action carries at least some negative impacts. The design, architecture, and practical implementation of these services greatly affect their climate and social impacts.

Conclusions: This study uses a novel combination of impact assessment methods, highlighting the importance of qualitative understanding alongside quantitative approaches for interpreting results, especially when numerical data are limited. Advocating for multimethod impact assessments is crucial to properly capturing the service context and promoting holistic sustainability thinking.

Background: Freezing of gait (FOG) is a common and debilitating symptom of parkinsonism. Although visual cues have proven efficacy in alleviating FOG, most current visual cues are fixed in place, restricting their use to controlled environments such as clinics or homes. Mobile open-loop cueing devices have been developed to address this limitation; however, they typically require manual activation to deliver the visual cues, which can be particularly challenging for patients with attention or cognitive impairments, leading to equivocal results in improving gait performance.

Objective: The aim of the study is to assess the efficacy of an ankle bracelet laser, a new mobile visual cue designed for practical use, in improving gait performance in patients with parkinsonism and FOG.

Methods: A randomized controlled 2-period crossover trial was conducted from June 15, 2020, to October 1, 2020, at Ramathibodi Hospital. In total, 10 patients with parkinsonism and FOG were enrolled in 2 conditions: walking with laser-off first and walking with laser-on first. Gait speed, the timed up and go test, stride length, and the locomotor rehabilitation index were assessed twice in each trial with a 10-minute washout period.

Results: The results showed favorable improvement in all parameters. Gait speed and stride length improved by 0.07 m/s (95% CI 0.04-0.09 m/s; P<.001) and 0.17 m (95% CI 0.11-0.23 m; P<.001), respectively, with laser-on. The timed up and go test duration was reduced by 7.69 seconds (95% CI 2.82-12.55 seconds; P=.002). The locomotor rehabilitation index improved by 4.46% (95% CI 2.56%-6.36%; P<.001). When using the device, there were no adverse effects, such as dizziness or blurred vision.

Conclusions: The ankle bracelet laser cue produced immediate improvements in gait speed, stride length, and balance in patients with parkinsonism and FOG, suggesting that the device can acutely enhance gait performance. Further research is needed to determine whether these benefits are sustained and applicable to daily life activities.

Trial registration: Thai Clinical Trials Registry TCTR20210511001; https://www.thaiclinicaltrials.org/show/TCTR20210511001.

Background: The rising prevalence of Parkinson disease and the growing demand on the health care system underscore the need for accessible and innovative care solutions, such as Reality Digital Therapeutics (Reality DTx)-an augmented reality neurorehabilitation program that delivers remotely prescribed gait and balance exercises for people with Parkinson disease to perform at home.

Objective: At a preimplementation stage, this qualitative study aimed to explore the acceptability of Reality DTx.

Methods: An exploratory qualitative study design was used. We conducted semistructured interviews, guided by the theoretical framework of acceptability, with 22 people with Parkinson disease who used Reality DTx at home for 6 weeks as part of a feasibility trial. We conducted a reflexive thematic analysis using an inductive, semantic approach informed by critical realism.

Results: The results of the reflexive thematic analysis are described in 3 themes and 9 subthemes. The 3 themes are "there was considerable interindividual variation," "the intervention is complementary to supervised physical therapy," and "adherence in the long term is crucial." Participants reported variable perceptions of effectiveness and variable experiences of effort to complete the Reality DTx program. They viewed Reality DTx as a valuable complement to supervised physical therapy and emphasized the indispensable role of the physical therapist for external control of long-term exercise adherence and for meaningful feedback on motor performance, as well as the desire for social connection. Flexibility in time and location was mentioned as a very important program characteristic, supporting long-term exercise adherence. Suggestions for improvement included enhanced visibility of progression in scores, increased variation in games, and the integration of competitive elements.

Conclusions: Remotely prescribed, gamified, augmented reality exercises at home, complementary to supervised physical therapy, are acceptable to people with Parkinson disease. The findings inform future Reality DTx development and implementation from the perspective of people with Parkinson disease, which should be weighted with the perspectives of other stakeholders such as clinicians and other key decision-makers.

Background: Falls and fear of falling adversely affect the quality of life and independence of older adults. Although various robotic systems have been developed for fall prevention, their psychological effects, particularly on self-efficacy, remain underexplored. A ceiling-mounted fall impact mitigation robot offers continuous protection with almost no limitations on the range of movement; however, its impact on users' psychological state and functional performance is unclear.

Objective: This study aimed to evaluate the effect of a fall impact mitigation robot on psychological reassurance and task performance during dynamic balance tasks in healthy young adults, with a focus on self-efficacy and functional reach capacity.

Methods: Twenty-four healthy adults (age: mean 28.9, SD 7.9 years) were randomly assigned to experimental (n=12) or control (n=12) groups. All participants performed a baseline functional reach test, followed by a series of progressively challenging reach tasks (starting at 98% of maximum reach and increasing by 2% until failure). The experimental group performed tasks while wearing the fall impact mitigation robot; the control group performed without it. Self-efficacy ratings (-5 to +5 scale) were recorded before each trial. Center of pressure (COP) data were continuously collected. Statistical analyses included Mann-Whitney U tests for self-efficacy, Kaplan-Meier survival analysis for task performance, and t tests for functional reach test and COP changes.

Results: During reach trials ≥102% of baseline, the experimental group (median 1.0, IQR 0.0 to 3.0) reported significantly higher self-efficacy ratings than did the control group (median 0.0, IQR -1.0 to 2.0; U=1292.5; P=.047). However, no significant differences were observed in changes in functional reach capacity (experimental: mean 104.2%, SD 3.8%; control: mean 103.6%, SD 2.5%; P=.62) or COP displacement (experimental: mean 108.9%, SD 10.4%; control: mean 114.1%, SD 9.8%; P=.23). Survival analysis revealed a nonsignificant trend toward greater task persistence in the experimental group (χ²₁=0.36, P=.55).

Conclusions: The fall impact mitigation robot significantly improved self-efficacy during challenging balance tasks, despite providing no active physical support. These findings underscore the role of psychological reassurance in modulating balance-related behavior and suggest that robotic safety systems may influence motor performance through psychological mechanisms. Integrating psychological support into robotic fall prevention strategies may enhance their effectiveness.

Trial registration: UMIN Clinical Trials Registry UMIN000049284; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000056126.

Background: Videoconference combines the convenience of home-based physical exercise (PE) with group interaction and supervision of exercise in the community and could be useful for facilitating PE practice among older adults.

Objective: This scoping review aims to assess the evidence regarding the usability of videoconferencing technologies. Specifically, it explores whether tele-exercise solutions based on videoconferencing are usable for older adults and professionals, and how the heterogeneity of evaluation tools influences the generalization of results.

Methods: Electronic searches were conducted in databases Pubmed-Ovid Medline, Science Direct, Scopus, and CINAHL from January 2000 to March 2025 for identifying articles on measures of usability (ie, effectiveness, efficiency, and satisfaction of technology).

Results: A total of 14 studies out of 2506 unique records were included. The results showed that videoconferencing strategies can effectively deliver synchronous exercise interventions. However, their effectiveness, efficiency, and user satisfaction vary depending on the technological medium used. Despite widespread use among older adults, there is a notable gap in studies evaluating usability, particularly regarding remote PE interventions.

Conclusions: The review highlights that videoconferencing can be an effective tool for delivering synchronous exercise interventions to older adults. However, the effectiveness and user satisfaction depend on the technology used and the individual's characteristics. Further studies using standardized evaluation tools are needed to better assess usability. These findings underscore the importance of continued research to evaluate the effectiveness and acceptability of videoconferencing technologies for exercise interventions and to develop customized solutions to optimize the efficacy of these interventions for this population.