@Article{info:doi/10.2196/65056,
author="Szekely, Raul
and Holloway, Catherine
and Bandukda, Maryam",
title="Understanding the Psychosocial Impact of Assistive Technologies for People With Visual Impairments: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2025",
month="Feb",
day="13",
volume="14",
pages="e65056",
keywords="assistive technology",
keywords="psychosocial impact",
keywords="quality of life",
keywords="visual impairment",
keywords="scoping review protocol",
keywords="mobile phone",
abstract="Background: There has been a rapid growth in the literature on the design and evaluation of assistive technologies for people with visual impairments; yet, there is a lack of a comprehensive analysis of the existing literature on the classification of immediate-, short-, medium-, and long-term psychosocial impact of assistive technologies on the quality of life of people with visual impairments. Objective: This protocol outlines the methodology for a scoping review aimed at identifying and synthesizing the existing literature on the psychosocial impact of assistive technologies on the quality of life of people with visual impairments. Methods: The review will include primary research studies published in English between 2019 and 2024 that focus on the psychosocial outcomes of assistive technologies for people with visual impairments. Eligible studies will involve participants with visual impairments, of all ages and across various settings, examining psychological (eg, emotional well-being and self-esteem) and social outcomes (eg, social participation and support). Searches will be conducted across 7 electronic research databases: CINAHL (EBSCO), PsycINFO (EBSCO), ACM Digital Library, IEEE Xplore, Scopus, Web of Science, and Google Scholar (first 100 records). Studies will undergo screening and selection based on predefined eligibility criteria, with data extraction focusing on publication details, study design, population characteristics, type of assistive technology, and psychosocial impacts. Results will be summarized using descriptive statistics, charts, and narrative synthesis. Results: The database search, conducted in July 2024, identified 1145 records, which will be screened and analyzed in subsequent stages of the review process. This protocol outlines the planned approach for identifying, categorizing, and synthesizing evidence. The study findings are anticipated to be finalized and submitted for publication in a peer-reviewed journal by February 2025. Conclusions: This study will synthesize the recent body of work on the psychosocial impact of assistive technologies for people with visual impairments and recommendations for researchers and designers interested in this research area. Trial Registration: Open Science Framework 10.17605/OSF.IO/SK7N8; https://osf.io/4gc5t International Registered Report Identifier (IRRID): DERR1-10.2196/65056 ",
doi="10.2196/65056",
url="https://www.researchprotocols.org/2025/1/e65056"
}


@Article{info:doi/10.2196/58713,
author="Klatt, N. Brooke
and Hovareshti, Pedram
and Holt, S. Lisa
and Dunlap, M. Pamela
and Zalkin, Chad
and Tolani, Devendra
and Whitney, L. Susan",
title="A Tablet-Based Technology for Objective Exercise Monitoring in Vestibular Rehabilitation: Mixed Methods Study",
journal="JMIR Rehabil Assist Technol",
year="2025",
month="Feb",
day="4",
volume="12",
pages="e58713",
keywords="technology",
keywords="rehabilitation",
keywords="vestibular",
keywords="physical therapy",
keywords="vestibulo-ocular reflex",
keywords="ocular",
keywords="physiotherapy",
keywords="vision",
keywords="feasibility",
keywords="exercises",
keywords="mHealth",
keywords="mobile health",
keywords="app",
keywords="tablet",
keywords="digital health",
keywords="telerehabilitation",
keywords="e-health",
keywords="web-based",
keywords="clinical use",
keywords="physiotherapist",
keywords="home exercise",
keywords="usability study",
keywords="mobile app",
abstract="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. ",
doi="10.2196/58713",
url="https://rehab.jmir.org/2025/1/e58713"
}


@Article{info:doi/10.2196/63384,
author="Zhu, Wenqing
and Gu, Shuneng
and Li, Jian
and Lin, Jin
and Hu, Chanling
and Liu, Rui",
title="Transformative Gamified Binocular Therapy for Unilateral Amblyopia in Young Children: Pilot Prospective Efficacy and Safety Study",
journal="JMIR Serious Games",
year="2025",
month="Jan",
day="16",
volume="13",
pages="e63384",
keywords="amblyopia",
keywords="binocular treatment",
keywords="digital therapy",
keywords="game",
keywords="stereoacuity",
keywords="visual acuity",
abstract="Background: Amblyopia is a common cause of visual impairment in children. Compliance with traditional treatments for amblyopia is challenging due to negative psychosocial impacts. Recent shifts in amblyopia treatment have moved from suppressing the dominant eye to enhancing binocular visual function. Binocular digital therapy has become a promising approach. Objective: The aim of this study was to evaluate the effects of binocular gamified digital therapy on visual acuity and stereoacuity (SA) in children with unilateral amblyopia. Methods: This pilot prospective study enrolled 11 children aged 4-6 years with unilateral amblyopia. Following at least 8 weeks of refractive correction, participants underwent binocular gamified digital therapy for 60 minutes per day, 5 days a week. The therapy used a roguelike shooting game delivered under binocular conditions through two independent channels with a real-time artificial intelligence visual engine. Assessments of distance visual acuity (DVA), near visual acuity (NVA), and SA were conducted at baseline and again at 4, 8, and 12 weeks. Results: At 12 weeks, the following significant improvements were noted: amblyopic eye DVA improved by 1.0 line (P=.01; d=0.77), binocular DVA improved by 0.7 lines (P=.006; d=1.00), and SA improved by 0.3 logarithm (log) arcseconds (P=.01; d=0.97). At 8 weeks, improvements included amblyopic eye DVA by 0.9 lines (P=.046; d=1.00) and SA by 0.28 log arcseconds (P=.02; d=0.90). No significant adverse events were observed, although one participant developed progressive esotropia. Conclusions: Binocular gamified digital therapy is effective and safe for improving visual outcomes in children aged 4-6 years with unilateral amblyopia. Trial Registration: Chinese Clinical Trial Registry ChiCTR2300072066; https://www.chictr.org.cn/showproj.html?proj=198625 ",
doi="10.2196/63384",
url="https://games.jmir.org/2025/1/e63384"
}


@Article{info:doi/10.2196/55776,
author="Ricci, Sofia Fabiana
and Liguori, Lorenzo
and Palermo, Eduardo
and Rizzo, John-Ross
and Porfiri, Maurizio",
title="Navigation Training for Persons With Visual Disability Through Multisensory Assistive Technology: Mixed Methods Experimental Study",
journal="JMIR Rehabil Assist Technol",
year="2024",
month="Nov",
day="18",
volume="11",
pages="e55776",
keywords="assistive technology",
keywords="human-computer interaction",
keywords="multisensory feedback",
keywords="virtual reality",
keywords="visual impairment",
keywords="haptic",
abstract="Background: Visual disability is a growing problem for many middle-aged and older adults. Conventional mobility aids, such as white canes and guide dogs, have notable limitations that have led to increasing interest in electronic travel aids (ETAs). Despite remarkable progress, current ETAs lack empirical evidence and realistic testing environments and often focus on the substitution or augmentation of a single sense. Objective: This study aims to (1) establish a novel virtual reality (VR) environment to test the efficacy of ETAs in complex urban environments for a simulated visual impairment (VI) and (2) evaluate the impact of haptic and audio feedback, individually and combined, on navigation performance, movement behavior, and perception. Through this study, we aim to address gaps to advance the pragmatic development of assistive technologies (ATs) for persons with VI. Methods: The VR platform was designed to resemble a subway station environment with the most common challenges faced by persons with VI during navigation. This environment was used to test our multisensory, AT-integrated VR platform among 72 healthy participants performing an obstacle avoidance task while experiencing symptoms of VI. Each participant performed the task 4 times: once with haptic feedback, once with audio feedback, once with both feedback types, and once without any feedback. Data analysis encompassed metrics such as completion time, head and body orientation, and trajectory length and smoothness. To evaluate the effectiveness and interaction of the 2 feedback modalities, we conducted a 2-way repeated measures ANOVA on continuous metrics and a Scheirer-Ray-Hare test on discrete ones. We also conducted a descriptive statistical analysis of participants' answers to a questionnaire, assessing their experience and preference for feedback modalities. Results: Results from our study showed that haptic feedback significantly reduced collisions (P=.05) and the variability of the pitch angle of the head (P=.02). Audio feedback improved trajectory smoothness (P=.006) and mitigated the increase in the trajectory length from haptic feedback alone (P=.04). Participants reported a high level of engagement during the experiment (52/72, 72\%) and found it interesting (42/72, 58\%). However, when it came to feedback preferences, less than half of the participants (29/72, 40\%) favored combined feedback modalities. This indicates that a majority preferred dedicated single modalities over combined ones. Conclusions: AT is crucial for individuals with VI; however, it often lacks user-centered design principles. Research should prioritize consumer-oriented methodologies, testing devices in a staged manner with progression toward more realistic, ecologically valid settings to ensure safety. Our multisensory, AT-integrated VR system takes a holistic approach, offering a first step toward enhancing users' spatial awareness, promoting safer mobility, and holds potential for applications in medical treatment, training, and rehabilitation. Technological advancements can further refine such devices, significantly improving independence and quality of life for those with VI. ",
doi="10.2196/55776",
url="https://rehab.jmir.org/2024/1/e55776"
}


@Article{info:doi/10.2196/53805,
author="Liu, Ming
and Wu, Xiaoqian
and Li, Ziyu
and Tan, Dongmei
and Huang, Cheng",
title="Assessment of Eye Care Apps for Children and Adolescents Based on the Mobile App Rating Scale: Content Analysis and Quality Assessment",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Sep",
day="13",
volume="12",
pages="e53805",
keywords="Mobile apps",
keywords="Eye care",
keywords="Myopia",
keywords="MARS",
keywords="Children",
keywords="Adolescent",
keywords="Quality Assessment",
keywords="Content Analysis",
keywords="mhealth",
keywords="China",
abstract="Background: In China, the current situation of myopia among children and adolescents is very serious. Prevention and control of myopia are inhibited by the lack of medical resources and the low awareness about eye care. Nevertheless, mobile apps provide an effective means to solve these problems. Since the health app market in China is still immature, it has become particularly important to conduct a study to assess the quality of eye-care apps to facilitate the development of better eye-care service strategies. Objective: This study aimed to evaluate the quality, functionality, medical evidence, and professional background of eye-care apps targeting children and adolescents in the Chinese app stores. Methods: A systematic search on iOS and Android app stores was performed to identify eye-care apps for children and adolescents. The general characteristics, development context, and functional features of the apps were described. Quality assessment of the apps was completed by 2 independent researchers using the Mobile App Rating Scale. Results: This study included 29 apps, of which 17 (59\%) were developed by commercial organizations and 12 (41\%) had a design with relevant scientific basis. The main built-in functions of these apps include self-testing (18/29, 62\%), eye exercises (16/29, 55\%), and eye-care education (16/29, 55\%). The mean overall quality of eye-care apps was 3.49 (SD 0.33), with a score ranging from 2.89 to 4.39. The overall Mobile App Rating Scale score exhibited a significant positive correlation with the subscale scores (r=0.81-0.91; P<.001). In addition, although most apps provided basic eye-care features, there are some deficiencies. For example, only a few apps were developed with the participation of medical organizations or professional ophthalmologists, and most of the apps were updated infrequently, failing to provide the latest eye-care information and technology in a timely manner. Conclusions: In general, the quality of eye-care apps for children and teenagers in Chinese app stores is good. These apps fulfill users' needs for eye-care services to a certain extent, but they still suffer from insufficient medical background, low user engagement, and untimely updates. In order to further improve the effectiveness of eye-care apps, cooperation with medical institutions and professional ophthalmologists should be strengthened to enhance the scientific and authoritative nature of the apps. At the same time, interactive features and regular updates should be added to enhance user participation and the continuity of the apps. This study provides a reference for future development or improvement of eye-care apps, which can help promote myopia prevention and control. ",
doi="10.2196/53805",
url="https://mhealth.jmir.org/2024/1/e53805"
}


@Article{info:doi/10.2196/59315,
author="Lancioni, E. Giulio
and Singh, N. Nirbhay
and O'Reilly, F. Mark
and Sigafoos, Jeff
and Alberti, Gloria
and Orlando, Isabella
and Chiariello, Valeria
and Desideri, Lorenzo",
title="Enabling People With Intellectual and Sensory Disabilities to Trigger a Tablet's Delivery of Task Instructions by Walking to the Tablet: Proof-of-Concept Study",
journal="JMIR Rehabil Assist Technol",
year="2024",
month="Jun",
day="12",
volume="11",
pages="e59315",
keywords="technology",
keywords="tablet",
keywords="task",
keywords="instructions",
keywords="intellectual disability, visual impairment, hearing impairment",
abstract="Background: People with intellectual and sensory or sensory-motor disabilities tend to have problems performing multistep tasks. To alleviate their problems, technological solutions have been developed that provide task-step instructions. Instructions are generally delivered at people's request (eg, as they touch an area of a computer or tablet screen) or automatically, at preset intervals. Objective: This study carried out a preliminary assessment of a new tablet-based technology system that presented task-step instructions when participants with intellectual and sensory disabilities walked close to the tablet (ie, did not require participants to perform fine motor responses on the tablet screen). Methods: The system entailed a tablet and a wireless camera and was programmed to present instructions when participants approached the tablet, that is, when the camera positioned in front of the tablet detected them. Two instructions were available for each task step. One instruction concerned the object(s) that the participants were to collect, and the other instruction concerned the ``where'' and ``how'' the object(s) collected would need to be used. For 3 of the six participants, the two instructions were presented in succession, with the second instruction presented once the required object(s) had been collected. For the other 3 participants, the two instructions were presented simultaneously. Instructions consisted of pictorial representations combined with brief verbal phrases. The impact of the system was assessed for each of the 2 groups of participants using a nonconcurrent multiple baseline design across individuals. Results: All participants were successful in using the system. Their mean frequency of correct task steps was close to or above 11.5 for tasks including 12 steps. Their level of correct performance tended to be much lower during the baseline phase when they were to receive the task-step instructions from a regular tablet through scrolling responses. Conclusions: The findings, which need to be interpreted with caution given the preliminary nature of the study, suggest that the new tablet-based technology system might be useful for helping people with intellectual and sensory disabilities perform multistep tasks. ",
doi="10.2196/59315",
url="https://rehab.jmir.org/2024/1/e59315",
url="http://www.ncbi.nlm.nih.gov/pubmed/38865701"
}


@Article{info:doi/10.2196/42923,
author="Miller, Kamilla
and Jerome, J. Gerald",
title="Self-Monitoring Physical Activity, Diet, and Weight Among Adults Who Are Legally Blind: Exploratory Investigation",
journal="JMIR Rehabil Assist Technol",
year="2022",
month="Dec",
day="12",
volume="9",
number="4",
pages="e42923",
keywords="blindness",
keywords="visually impaired",
keywords="obesity",
keywords="weight loss",
keywords="weight management",
keywords="physical activity",
keywords="digital health intervention",
keywords="telehealth",
keywords="health support",
keywords="mobile phone",
abstract="Background: Obesity is a global pandemic. Lifestyle approaches have been shown effective for weight loss and weight loss maintenance. Central to these evidence-based approaches are increased physical activity, decreased caloric intake, regular self-weighing, and the tracking of these behaviors. Objective: This exploratory descriptive study surveyed adults who are legally blind to identify strategies related to tracking physical activity, diet, and weight. These health behaviors are essential components to evidence-based weight loss programs. We also identified areas where we can better support adults who are legally blind in their independent efforts to change these behaviors and improve their health. Methods: Participants (?18 years of age) who self-identified as being legally blind were recruited using email announcements in low vision advocacy groups. They completed an interviewer-administered survey on the telephone and an in-person visit for standardized assessment of height and weight. Results: The participants (N=18) had an average age of 31.2 (SD 13.4) years; 50\% (9/18) had normal weight (BMI 18.5 to <25); 44\% (8/18) were female; 44\% (8/18) were Black; and 39\% (7/18) were Non-Hispanic White. Most participants (16/18, 89\%) used their smartphone to access the internet daily, and 67\% (12/18) had at least 150 mins of exercise per week. Although 78\% (14/18) of the participants indicated tracking their weight, only 61\% (11/18) could indicate how they tracked their weight, and 22\% (4/18) indicated they tracked it mentally. Providing individuals with a talking scale was the most consistent recommendation (12/18, 67\%) to facilitate independence in managing weight through lifestyle changes. Even though 50\% (9/18) of the participants indicated using an app or electronic notes to track some portion of their diet, participants reported challenges with determining portion size and corresponding calorie counts. Most participants (17/18, 94\%) reported using apps, electronic notes, smartphones, or wearable devices to track their physical activity. Although strategies such as using wearables and smartphones could provide measurements (eg, step counts) as well as recording data, they also pose financial and technology literacy barriers. Conclusions: Technology-based solutions were identified for tracking weight, diet, and physical activity for weight management. These strategies have financial and technology literacy barriers. A range of strategies for adopting and tracking health behaviors will be needed to assist individuals with varying skills and life experiences. ",
doi="10.2196/42923",
url="https://rehab.jmir.org/2022/4/e42923",
url="http://www.ncbi.nlm.nih.gov/pubmed/36508250"
}


@Article{info:doi/10.2196/26283,
author="Luo, Gang
and Pundlik, Shrinivas",
title="Influence of COVID-19 Lockdowns on the Usage of a Vision Assistance App Among Global Users With Visual Impairment: Big Data Analytics Study",
journal="J Med Internet Res",
year="2021",
month="May",
day="12",
volume="23",
number="5",
pages="e26283",
keywords="assistance",
keywords="assistive technology",
keywords="COVID-19",
keywords="development",
keywords="eye",
keywords="low vision",
keywords="needs",
keywords="smartphone apps",
keywords="usage",
keywords="vision assistance",
keywords="vision",
keywords="visual impairment",
abstract="Background: Millions of individuals with visual impairment use vision assistance apps to help with their daily activities. The most widely used vision assistance apps are magnifier apps. It is still largely unknown what the apps are used for. Lack of insight into the visual needs of individuals with visual impairment is a hurdle for the development of more effective assistive technologies. Objective: This study aimed to investigate how needs for visual aids may vary with social activities, by observing the changes in the usage of a smartphone magnifier app when many users take breaks from work. Methods: The number of launches of the SuperVision Magnifier app was determined retrospectively from 2018 to 2020 from among active users worldwide. The fluctuation in app usage was examined by comparing weekday vs weekend periods, Christmas and new year vs nonholiday seasons, and COVID-19 lockdowns vs the easing of restriction during the pandemic. Results: On average, the app was used 262,466 times by 38,237 users each month in 2020 worldwide. There were two major trough points on the timeline of weekly app usage, one aligned with the COVID-19 lockdowns in April 2020 and another aligned with the Christmas and new year week in 2018 and 2019. The app launches declined by 6947 (11\% decline; P<.001) during the lockdown and by 5212 (9\% decline; P=.001) during the holiday weeks. There was no significant decline during March to May 2019. App usage compensated for seasonal changes was 8.6\% less during weekends than during weekdays (P<.001). Conclusions: The need for vision assistance technology was slightly lower during breaks and lockdowns, probably because the activities at home were different and less visually demanding. Nevertheless, for the entire user population, the needs for visual aids are still substantial. ",
doi="10.2196/26283",
url="https://www.jmir.org/2021/5/e26283",
url="http://www.ncbi.nlm.nih.gov/pubmed/33945492"
}


@Article{info:doi/10.2196/22099,
author="Hwang, Youjin
and Shin, Donghoon
and Eun, Jinsu
and Suh, Bongwon
and Lee, Joonhwan",
title="Design Guidelines of a Computer-Based Intervention for Computer Vision Syndrome: Focus Group Study and Real-World Deployment",
journal="J Med Internet Res",
year="2021",
month="Mar",
day="29",
volume="23",
number="3",
pages="e22099",
keywords="computer-based intervention",
keywords="computer vision syndrome",
keywords="system interface",
keywords="deployment study",
abstract="Background: Prolonged time of computer use increases the prevalence of ocular problems, including eye strain, tired eyes, irritation, redness, blurred vision, and double vision, which are collectively referred to as computer vision syndrome (CVS). Approximately 70\% of computer users have vision-related problems. For these reasons, properly designed interventions for users with CVS are required. To design an effective screen intervention for preventing or improving CVS, we must understand the effective interfaces of computer-based interventions. Objective: In this study, we aimed to explore the interface elements of computer-based interventions for CVS to set design guidelines based on the pros and cons of each interface element. Methods: We conducted an iterative user study to achieve our research objective. First, we conducted a workshop to evaluate the overall interface elements that were included in previous systems for CVS (n=7). Through the workshop, participants evaluated existing interface elements. Based on the evaluation results, we eliminated the elements that negatively affect intervention outcomes. Second, we designed our prototype system LiquidEye that includes multiple interface options (n=11). Interface options included interface elements that were positively evaluated in the workshop study. Lastly, we deployed LiquidEye in the real world to see how the included elements affected the intervention outcomes. Participants used LiquidEye for 14 days, and during this period, we collected participants' daily logs (n=680). Additionally, we conducted prestudy and poststudy surveys, and poststudy interviews to explore how each interface element affects participation in the system. Results: User data logs collected from the 14 days of deployment were analyzed with multiple regression analysis to explore the interface elements affecting user participation in the intervention (LiquidEye). Statistically significant elements were the instruction page of the eye resting strategy (P=.01), goal setting of the resting period (P=.009), compliment feedback after completing resting (P<.001), a mid-size popup window (P=.02), and CVS symptom-like effects (P=.004). Conclusions: Based on the study results, we suggested design implications to consider when designing computer-based interventions for CVS. The sophisticated design of the customization interface can make it possible for users to use the system more interactively, which can result in higher engagement in managing eye conditions. There are important technical challenges that still need to be addressed, but given the fact that this study was able to clarify the various factors related to computer-based interventions, the findings are expected to contribute greatly to the research of various computer-based intervention designs in the future. ",
doi="10.2196/22099",
url="https://www.jmir.org/2021/3/e22099",
url="http://www.ncbi.nlm.nih.gov/pubmed/33779568"
}


@Article{info:doi/10.2196/17436,
author="White, Judith
and Knight, Laura
and da Cruz, Lyndon
and Stanga, E. Paulo
and Patrick, Hannah
and Powell, Helen
and Berry, Lee
and Withers, Kathleen
and Carolan-Rees, Grace
and Jackson, L. Timothy",
title="Effects of the Argus II Retinal Prosthesis System on the Quality of Life of Patients With Ultra-Low Vision Due to Retinitis Pigmentosa: Protocol for a Single-Arm, Mixed Methods Study",
journal="JMIR Res Protoc",
year="2021",
month="Jan",
day="20",
volume="10",
number="1",
pages="e17436",
keywords="patient-reported outcomes",
keywords="quality of life",
keywords="qualitative methods",
keywords="artificial vision",
keywords="visual function",
keywords="functional vision",
keywords="ultra-low vision",
keywords="low vision",
keywords="visual function questionnaire",
abstract="Background: Retinitis pigmentosa is an incurable, degenerative retinal condition causing progressive sight loss, significantly affecting patients' quality of life. The Argus II Retinal Prosthesis is a surgically implanted medical device that delivers electrical stimulation to the retina. It is intended to produce a form of artificial vision for blind people with severe-to-profound retinitis pigmentosa by stimulating the remaining viable retinal cells to induce visual perception. This study has been initiated by National Health Service England's Commissioning through Evaluation program and funded through the National Institute of Health Research of the United Kingdom. Objective: The aim of this study was to assess the effect of the Argus II device on patient's daily activities and quality of life. Methods: This protocol is a prospective, single-arm, open-label, mixed methods study on 10 consecutive participants receiving the Argus II device. The patient representatives played an integral role in the design of this study. Eligibility criteria include ultra-low vision in both eyes as a result of end-stage retinitis pigmentosa and a willingness and capacity to complete the postimplantation rehabilitation program. Participants will be interviewed by independent researchers at baseline and 12 months later by using a semistructured, in-depth approach, alongside validated questionnaires (Impact of Vision Impairment-Very Low Vision, 5-level EuroQoL-5 dimensions scale, EuroQoL-visual analog scale, and Hospital Anxiety and Depression Scale) and a bespoke device-related questionnaire, which includes questions about users' experiences with the procedure, the device, and rehabilitation. The effect of the device on patients' functional vision and activities of daily living will be assessed by vision rehabilitation specialists using a set of tests measured on an ordinal scale (eg, ability to locate objects and avoid obstacles). Clinical outcomes include full-field stimulus light threshold, square localization, direction of motion, grating visual acuity, Landolt-C, procedural success, and adverse events. Qualitative and quantitative outcomes will be linked in a single database to enable individual participant measures to be considered in toto, comparing baseline to the final review. Results: This study was approved by the local ethics committee on April 24, 2019 (London-Camberwell St. Giles Research Ethics Committee, reference 19/LO/0429). It has also been approved by the Health Research Authority and Health and Care Research Wales. At the time of protocol writing, Argus II was available for use in the United Kingdom; however, the manufacturer recently withdrew the Argus II device from sale in the United Kingdom. Therefore, the study is not going ahead at this time. Conclusions: The mixed methods approach provides a rich and in-depth assessment of the effect of the device on participants' quality of life. Despite the work not going ahead, the publication of this publicly funded protocol is important for researchers planning similar work. International Registered Report Identifier (IRRID): PRR1-10.2196/17436 ",
doi="10.2196/17436",
url="http://www.researchprotocols.org/2021/1/e17436/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33470946"
}


@Article{info:doi/10.2196/16805,
author="Chaudhary, Shikha
and Saywell, Nicola
and Kumar, Arun
and Taylor, Denise",
title="Visual Fixations and Motion Sensitivity: Protocol for an Exploratory Study",
journal="JMIR Res Protoc",
year="2020",
month="Jul",
day="27",
volume="9",
number="7",
pages="e16805",
keywords="motion sensitivity",
keywords="vestibular disorder",
keywords="complex environments",
keywords="visual fixations",
keywords="postural control",
keywords="posture",
keywords="kinematics",
keywords="inner ear",
keywords="visual",
abstract="Background: Motion sensitivity after vestibular disorders is associated with symptoms of nausea, dizziness, and imbalance in busy environments. Dizziness and imbalance are reported in places such as supermarkets and shopping malls which have unstable visual backgrounds; however, the mechanism of motion sensitivity is poorly understood. Objective: The main aim of this exploratory observational study is to investigate visual fixations and postural sway in response to increasingly complex visual environments in healthy adults and adults with motion sensitivity. Methods: A total of 20 healthy adults and 20 adults with motion sensitivity will be recruited for this study. Visual fixations, postural sway, and body kinematics will be measured with a mobile eye tracker device, force plate, and 3D motion capture system, respectively. Participants will be exposed to experimental tasks requiring visual fixation on letters, projected on a range of backgrounds on a large screen during quiet stance. Descriptive statistics (mean and standard deviation) will be calculated for each of the variables. One-way independent-measures analyses of variance will be performed to investigate the differences between groups for all variables. Results: Data collection was started in May 2019 and was completed by February 2020. It was approved by Health and Disability Ethics Committees, Ministry of Health, New Zealand on November 2, 2018 (Ethics ref: 18/CEN/193). We are currently processing the data and will begin data analysis in July 2020. We expect the results to be available for publication by the end of 2020. The trial was funded by the Neurology Special Interest Group, Physiotherapy New Zealand, and the Eisdell Moore Centre in November 2018. Conclusions: This study will provide a detailed investigation of visual fixations in response to increasingly complex visual environments. Investigating characteristics of visual fixations in healthy adults and those with motion sensitivity will provide insight into this disabling condition and may inform the development of new intervention strategies which explicitly cater to the needs of this population. Trial Registration: Australian New Zealand Clinical Trials Registry, ACTRN12619000254190; https://tinyurl.com/yxbn7nks International Registered Report Identifier (IRRID): PRR1-10.2196/16805 ",
doi="10.2196/16805",
url="http://www.researchprotocols.org/2020/7/e16805/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32716003"
}


@Article{info:doi/10.2196/resprot.8334,
author="Rasmussen, Skovgaard Rune
and Schaarup, Heltoft Anne Marie
and Overgaard, Karsten",
title="Therapist-Assisted Rehabilitation of Visual Function and Hemianopia after Brain Injury: Intervention Study on the Effect of the Neuro Vision Technology Rehabilitation Program",
journal="JMIR Res Protoc",
year="2018",
month="Feb",
day="27",
volume="7",
number="2",
pages="e65",
keywords="stroke",
keywords="vision",
keywords="rehabilitation",
keywords="brain injury",
abstract="Background: Serious and often lasting vision impairments affect 30\% to 35\% of people following stroke. Vision may be considered the most important sense in humans, and even smaller permanent injuries can drastically reduce quality of life. Restoration of visual field impairments occur only to a small extent during the first month after brain damage, and therefore the time window for spontaneous improvements is limited. One month after brain injury causing visual impairment, patients usually will experience chronically impaired vision and the need for compensatory vision rehabilitation is substantial. Objective: The purpose of this study is to investigate whether rehabilitation with Neuro Vision Technology will result in a significant and lasting improvement in functional capacity in persons with chronic visual impairments after brain injury. Improving eyesight is expected to increase both physical and mental functioning, thus improving the quality of life. Methods: This is a prospective open label trial in which participants with chronic visual field impairments are examined before and after the intervention. Participants typically suffer from stroke or traumatic brain injury and will be recruited from hospitals and The Institute for the Blind and Partially Sighted. Treatment is based on Neuro Vision Technology, which is a supervised training course, where participants are trained in compensatory techniques using specially designed equipment. Through the Neuro Vision Technology procedure, the vision problems of each individual are carefully investigated, and personal data is used to organize individual training sessions. Cognitive face-to-face assessments and self-assessed questionnaires about both life and vision quality are also applied before and after the training. Results: Funding was provided in June 2017. Results are expected to be available in 2020. Sample size is calculated to 23 participants. Due to age, difficulty in transport, and the time-consuming intervention, up to 25\% dropouts are expected; thus, we aim to include at least 29 participants. Conclusions: This investigation will evaluate the effects of Neuro Vision Technology therapy on compensatory vision rehabilitation. Additionally, quality of life and cognitive improvements associated to increased quality of life will be explored. Trial Registration: ClinicalTrials.gov NCT03160131; https://clinicaltrials.gov/ct2/show/NCT03160131 (Archived by WebCite at http://www.webcitation.org/6x3f5HnCv) ",
doi="10.2196/resprot.8334",
url="http://www.researchprotocols.org/2018/2/e65/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29487042"
}


@Article{info:doi/10.2196/games.7923,
author="Tobler-Ammann, C. Bernadette
and Surer, Elif
and de Bruin, D. Eling
and Rabuffetti, Marco
and Borghese, Alberto N.
and Mainetti, Renato
and Pirovano, Michele
and Wittwer, Lia
and Knols, H. Ruud",
title="Exergames Encouraging Exploration of Hemineglected Space in Stroke Patients With Visuospatial Neglect: A Feasibility Study",
journal="JMIR Serious Games",
year="2017",
month="Aug",
day="25",
volume="5",
number="3",
pages="e17",
keywords="exergames",
keywords="eye tracking",
keywords="virtual reality",
keywords="visuospatial neglect",
keywords="feasibility",
abstract="Background: Use of exergames can complement conventional therapy and increase the amount and intensity of visuospatial neglect (VSN) training. A series of 9 exergames---games based on therapeutic principles---aimed at improving exploration of the neglected space for patients with VSN symptoms poststroke was developed and tested for its feasibility. Objectives: The goal was to determine the feasibility of the exergames with minimal supervision in terms of (1) implementation of the intervention, including adherence, attrition and safety, and (2) limited efficacy testing, aiming to document possible effects on VSN symptoms in a case series of patients early poststroke. Methods: A total of 7 patients attended the 3-week exergames training program on a daily basis. Adherence of the patients was documented in a training diary. For attrition, the number of participants lost during the intervention was registered. Any adverse events related to the exergames intervention were noted to document safety. Changes in cognitive and spatial exploration skills were measured with the Z{\"u}rich Maxi Mental Status Inventory and the Neglect Test. Additionally, we developed an Eye Tracker Neglect Test (ETNT) using an infrared camera to detect and measure neglect symptoms pre- and postintervention. Results: The median was 14 out of 15 (93\%) attended sessions, indicating that the adherence to the exergames training sessions was high. There were no adverse events and no drop-outs during the exergame intervention. The individual cognitive and spatial exploration skills slightly improved postintervention (P=.06 to P=.98) and continued improving at follow-up (P=.04 to P=.92) in 5 out of 7 (71\%) patients. Calibration of the ETNT was rather error prone. The ETNT showed a trend for a slight median group improvement from 15 to 16 total located targets (+6\%). Conclusions: The high adherence rate and absence of adverse events showed that these exergames were feasible and safe for the participants. The results of the amount of exergames use is promising for future applications and warrants further investigations---for example, in the home setting of patients to augment training frequency and intensity. The preliminary results indicate the potential of these exergames to cause improvements in cognitive and spatial exploration skills over the course of training for stroke patients with VSN symptoms. Thus, these exergames are proposed as a motivating training tool to complement usual care. The ETNT showed to be a promising assessment for quantifying spatial exploration skills. However, further adaptations are needed, especially regarding calibration issues, before its use can be justified in a larger study sample. ",
doi="10.2196/games.7923",
url="http://games.jmir.org/2017/3/e17/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28842388"
}


@Article{info:doi/10.2196/resprot.4743,
author="Szturm, Tony
and Hochman, Jordan
and Wu, Christine
and Lisa, Lix
and Reimer, Karen
and Wonneck, Beth
and Giacobbo, Andrea",
title="Games and Telerehabilitation for Balance Impairments and Gaze Dysfunction: Protocol of a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2015",
month="Oct",
day="21",
volume="4",
number="4",
pages="e118",
keywords="balance-exercises",
keywords="gaze-exercises",
keywords="home therapy",
keywords="telerehabilitation",
keywords="therapeutic-gaming",
keywords="vestibular rehabilitation",
abstract="Background: Digital media and gaming have received considerable interest from researchers and clinicians as a model for learning a broad range of complex tasks and facilitating the transfer of skills to daily life. These emerging rehabilitation technologies have the potential to improve clinical outcomes and patient participation because they are engaging, motivating, and accessible. Our research goal is to develop preventative and therapeutic point-of-care eHealth applications that will lead to equivalent or better long-term health outcomes and health care costs than existing programs. We have produced a novel computer-aided tele-rehabilitation platform that combines computer game-based exercises with tele-monitoring. Objective: Compare the therapeutic effectiveness of an in-home, game-based rehabilitation program (GRP) to standard care delivered in an outpatient physical therapy clinic on measures of balance, gaze control, dizziness, and health-related quality of life. Methods: A randomized, controlled, single-blind pilot trial will be conducted. Fifty-six participants with a diagnosis of peripheral vestibular disorder will be randomly assigned to either usual physical therapy (comparator group) or to a game-based intervention (experimental group). Measures to be assessed will include gaze control, dynamic balance, and self-reported measures of dizziness. Results: The project was funded and enrollment was started in August 2014. To date, 36 participants have been enrolled. There have been 6 drop-outs. It is expected that the study will be completed January 2016 and the first results are expected to be submitted for publication in Spring of 2016. Conclusions: A successful application of this rehabilitation program would help streamline rehabilitation services, leverage therapist time spent with clients, and permit regular practice times at the client's convenience. Trial Registration: Clinicaltrials.gov: NCT02134444; https://clinicaltrials.gov/ct2/show/NCT02134444 (Archived by WebCite at http://www.webcitation.org/6cE18bqqY) ",
doi="10.2196/resprot.4743",
url="http://www.researchprotocols.org/2015/4/e118/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26490109"
}