@Article{info:doi/10.2196/20406,
author="Szczepura, Ala
and Holliday, Nikki
and Neville, Catriona
and Johnson, Karen
and Khan, Khan Amir Jahan
and Oxford, W. Samuel
and Nduka, Charles",
title="Raising the Digital Profile of Facial Palsy: National Surveys of Patients' and Clinicians' Experiences of Changing UK Treatment Pathways and Views on the Future Role of Digital Technology",
journal="J Med Internet Res",
year="2020",
month="Oct",
day="5",
volume="22",
number="10",
pages="e20406",
keywords="Bell palsy",
keywords="facial nerve paralysis",
keywords="patient experience",
keywords="treatment pathway",
keywords="facial exercise therapy",
keywords="neuromuscular retraining",
keywords="treatment adherence",
keywords="digital technology",
keywords="outcome measures",
keywords="telerehabilitation",
keywords="biosensors",
keywords="COVID-19",
abstract="Background: Facial nerve palsy leaves people unable to move muscles on the affected side of their face. Challenges exist in patients accessing facial neuromuscular retraining (NMR), a therapy used to strengthen muscle and improve nerve function. Access to therapy could potentially be improved through the use of digital technology. However, there is limited research available on patients' and clinicians' views about the potential benefits of such telerehabilitation based on their lived experiences of treatment pathways. Objective: This study aims to gather information about facial palsy treatment pathways in the United Kingdom, barriers to accessing NMR, factors influencing patient adherence, measures used to monitor recovery, and the potential value of emerging wearable digital technology. Methods: Separate surveys of patients with facial palsy and facial therapy specialists were conducted. Questionnaires explored treatment pathways and views on telerehabilitation, were co-designed with users, and followed a similar format to enable cross-referencing of responses. A follow-up survey of national specialists investigated methods used to monitor recovery in greater detail. Analysis of quantitative data was conducted allowing for data distribution. Open-text responses were analyzed using thematic content analysis. Results: A total of 216 patients with facial palsy and 25 specialist therapists completed the national surveys. Significant variations were observed in individual treatment pathways. Patients reported an average of 3.27 (SD 1.60) different treatments provided by various specialists, but multidisciplinary team reviews were rare. For patients diagnosed most recently, there was evidence of more rapid initial prescribing of corticosteroids (prednisolone) and earlier referral for NMR therapy. Barriers to NMR referral included difficulties accessing funding, shortage of specialist therapists, and limited awareness of NMR among general practitioners. Patients traveled long distances to reach an NMR specialist center; 9\% (8/93) of adults reported traveling ?115 miles. The thematic content analysis demonstrates positive attitudes to the introduction of digital technology, with similar incentives and barriers identified by both patients and clinicians. The follow-up survey of 28 specialists uncovered variations in the measures currently used to monitor recovery and no agreed definitions of a clinically significant change for any of these. The main barriers to NMR adherence identified by patients and therapists could all be addressed by using suitable real-time digital technology. Conclusions: The study findings provide valuable information on facial palsy treatment pathways and views on the future introduction of digital technology. Possible ways in which emerging sensor-based digital technology can improve rehabilitation and provide more rigorous evidence on effectiveness are described. It is suggested that one legacy of the COVID-19 pandemic will be lower organizational barriers to this introduction of digital technology to assist NMR delivery, especially if cost-effectiveness can be demonstrated. ",
doi="10.2196/20406",
url="https://www.jmir.org/2020/10/e20406",
url="http://www.ncbi.nlm.nih.gov/pubmed/32763890"
}


@Article{info:doi/10.2196/17822,
author="LaPiana, Nina
and Duong, Alvin
and Lee, Alex
and Alschitz, Leon
and Silva, L. Rafael M.
and Early, Jody
and Bunnell, Aaron
and Mourad, Pierre",
title="Acceptability of a Mobile Phone--Based Augmented Reality Game for Rehabilitation of Patients With Upper Limb Deficits from Stroke: Case Study",
journal="JMIR Rehabil Assist Technol",
year="2020",
month="Sep",
day="2",
volume="7",
number="2",
pages="e17822",
keywords="augmented reality",
keywords="stroke",
keywords="upper limb rehabilitation",
keywords="gamification",
keywords="motor rehabilitation",
keywords="motivation",
keywords="participation",
abstract="Background: Upper limb functional deficits are common after stroke and result from motor weakness, ataxia, spasticity, spatial neglect, and poor stamina. Past studies employing a range of commercial gaming systems to deliver rehabilitation to stroke patients provided short-term efficacy but have not yet demonstrated whether or not those games are acceptable, that is, motivational, comfortable, and engaging, which are all necessary for potential adoption and use by patients. Objective: The goal of the study was to assess the acceptability of a smartphone-based augmented reality game as a means of delivering stroke rehabilitation for patients with upper limb motor function loss. Methods: Patients aged 50 to 70 years, all of whom experienced motor deficits after acute ischemic stroke, participated in 3 optional therapy sessions using augmented reality therapeutic gaming over the course of 1 week, targeting deficits in upper extremity strength and range of motion. After completion of the game, we administered a 16-item questionnaire to the patients to assess the game's acceptability; 8 questions were answered by rating on a scale from 1 (very negative experience) to 5 (very positive experience); 8 questions were qualitative. Results: Patients (n=5) completed a total of 23 out of 45 scheduled augmented reality game sessions, with patient fatigue as the primary factor for uncompleted sessions. Each patient consented to 9 potential game sessions and completed a mean of 4.6 (SE 1.3) games. Of the 5 patients, 4 (80\%) completed the questionnaire at the end of their final gaming session. Of note, patients were motivated to continue to the end of a given gaming session (mean 4.25, 95\% CI 3.31-5.19), to try other game-based therapies (mean 3.75, 95\% CI 2.81-4.69), to do another session (mean 3.50, 95\% CI 2.93-4.07), and to perform other daily rehabilitation exercises (mean 3.25, 95\% CI 2.76-3.74). In addition, participants gave mean scores of 4.00 (95\% CI 2.87-5.13) for overall experience; 4.25 (95\% CI 3.31-5.19) for comfort; 3.25 (95\% CI 2.31-4.19) for finding the study fun, enjoyable, and engaging; and 3.50 (95\% CI 2.52-4.48) for believing the technology could help them reach their rehabilitation goals. For each of the 4 patients, their reported scores were statistically significantly higher than those generated by a random sampling of values (patient 1: P=.04; patient 2: P=.04; patient 4: P=.004; patient 5: P=.04). Conclusions: Based on the questionnaire scores, the patients with upper limb motor deficits following stroke who participated in our case study found our augmented reality game motivating, comfortable, engaging, and tolerable. Improvements in augmented reality technology motivated by this case study may one day allow patients to work with improved versions of this therapy independently in their own home. We therefore anticipate that smartphone-based augmented reality gaming systems may eventually provide useful postdischarge self-treatment as a supplement to professional therapy for patients with upper limb deficiencies from stroke. ",
doi="10.2196/17822",
url="http://rehab.jmir.org/2020/2/e17822/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32876580"
}


@Article{info:doi/10.2196/16286,
author="Munsell, Michael
and De Oliveira, Emily
and Saxena, Sadhvi
and Godlove, Jason
and Kiran, Swathi",
title="Closing the Digital Divide in Speech, Language, and Cognitive Therapy: Cohort Study of the Factors Associated With Technology Usage for Rehabilitation",
journal="J Med Internet Res",
year="2020",
month="Feb",
day="11",
volume="22",
number="2",
pages="e16286",
keywords="aphasia",
keywords="stroke",
keywords="traumatic brain injury",
keywords="technology",
abstract="Background: For stroke, traumatic brain injury (TBI), and other neurologic conditions associated with speech-language disorders, speech and language therapy is the standard of care for promoting recovery. However, barriers such as clinician time constraints and insurance reimbursement can inhibit a patient's ability to receive the support needed to optimize functional gain. Although digital rehabilitation has the potential to increase access to therapy by allowing patients to practice at home, the clinical and demographic characteristics that impact a patient's level of engagement with technology-based therapy are currently unknown. Objective: This study aimed to evaluate whether the level of engagement with digital therapy differs by various patient characteristics, including age, gender, diagnosis, time from disease onset, and geographic location (urban vs rural). Methods: Data for patients with stroke or TBI that initiated the use of Constant Therapy, a remotely delivered, cloud-based rehabilitation program for patients with speech-language disorders, were retrospectively analyzed. Only data from therapeutic sessions completed at home were included. The following three activity metrics were evaluated: (1) the number of active weeks of therapy, (2) the average number of active therapy days per week, and (3) the total number of therapeutic sessions completed during the first 20 weeks of program access. An active day or week was defined as having at least one completed therapeutic session. Separate multiple linear regression models were performed with each activity measure as the dependent variable and all available patient demographics as model covariates. Results: Data for 2850 patients with stroke or TBI were analyzed, with the average patient completing 8.6 weeks of therapy at a frequency of 1.5 days per week. Contrary to known barriers to technological adoption, older patients were more active during their first 20 weeks of program access, with those aged 51 to 70 years completing 5.01 more sessions than patients aged 50 years or younger (P=.04). Similarly, patients living in a rural area, who face greater barriers to clinic access, were more digitally engaged than their urban counterparts, with rural patients completing 11.54 more (P=.001) sessions during their first 20 weeks of access, after controlling for other model covariates. Conclusions: An evaluation of real-world data demonstrated that patients with stroke and TBI use digital therapy frequently for cognitive and language rehabilitation at home. Usage was higher in areas with limited access to clinical services and was unaffected by typical barriers to technological adoption, such as age. These findings will help guide the direction of future research in digital rehabilitation therapy, including the impact of demographics on recovery outcomes and the design of large, randomized controlled trials. ",
doi="10.2196/16286",
url="https://www.jmir.org/2020/2/e16286"
}


@Article{info:doi/10.2196/10424,
author="Offermann-van Heek, Julia
and Ziefle, Martina",
title="They Don't Care About Us! Care Personnel's Perspectives on Ambient Assisted Living Technology Usage: Scenario-Based Survey Study",
journal="JMIR Rehabil Assist Technol",
year="2018",
month="Sep",
day="24",
volume="5",
number="2",
pages="e10424",
keywords="Ambient Assisted Living technologies",
keywords="assistive technologies",
keywords="care professionals",
keywords="diverse care contexts",
keywords="web-based survey",
keywords="quantitative scenario-based approach",
keywords="technology acceptance",
keywords="user diversity",
abstract="Background: Demographic change represents enormous burdens for the care sectors, resulting in high proportions of (older) people in need of care and a lack of care staff. Ambient Assisted Living (AAL) technologies have the potential to support the bottlenecks in care supply but are not yet in widespread use in professional care contexts. Objective: The objective of our study was to investigate professional caregivers' AAL technology acceptance and their perception regarding specific technologies, data handling, perceived benefits, and barriers. In particular, this study focuses on the perspectives on AAL technologies differing between care professionals working in diverse care contexts to examine the extent to which the care context influences the acceptance of assistive technologies. Methods: A Web-based survey (N=170) was carried out focusing on professional caregivers including medical, geriatric, and disabled people's caregivers. Based on a scenario, the participants were asked for their perceptions concerning specific technologies, specific types of gathered data, and potential benefits of and barriers to AAL technology usage. Results: The care context significantly impacted the evaluations of AAL technologies (F14,220=2.514; P=.002). Professional caregivers of disabled people had a significantly more critical attitude toward AAL technologies than medical and geriatric caregivers, indicated (1) by being the only caregiver group that rejected evaluations of AAL technology acceptance (F2,118=4.570; P=.01) and specific technologies (F2,118=11.727; P<.001) applied for gathering data and (2) by the comparatively lowest agreements referring to the evaluations of data types (F2,118=4.073, P=.02) that are allowed to be gathered. Conclusions: AAL technology acceptance is critical because of technology implementation reasons, especially in the care of people with disabilities. AAL technologies in care contexts have to be tailored to care professional's needs and concerns (``care about us''). The results contribute to a broader understanding of professional caregivers' needs referring to specific data and technology configurations and enclose major differences concerning diverse care contexts. Integrating these findings into user group-tailored technology concepts and communication strategies will support a sustainable adoption of AAL systems in professional care contexts. ",
doi="10.2196/10424",
url="http://rehab.jmir.org/2018/2/e10424/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30249592"
}


@Article{info:doi/10.2196/rehab.8783,
author="Kim, Ji Eun
and Yuan, Yiyang
and Liebschutz, Jane
and Cabral, Howard
and Kazis, Lewis",
title="Understanding the Digital Gap Among US Adults With Disability: Cross-Sectional Analysis of the Health Information National Trends Survey 2013",
journal="JMIR Rehabil Assist Technol",
year="2018",
month="Mar",
day="16",
volume="5",
number="1",
pages="e3",
keywords="disability",
keywords="health information",
keywords="Internet",
keywords="health care provider",
keywords="trust",
keywords="psychosocial factors",
abstract="Background: Disabilities affect more than 1 in 5 US adults, and those with disabilities face multiple barriers in accessing health care. A digital gap, defined as the disparity caused by differences in the ability to use advanced technologies, is assumed to be prevalent among individuals with disabilities. Objective: This study examined the associations between disability and use of information technology (IT) in obtaining health information and between trust factors and IT use. We hypothesized that compared to US adults without disabilities, those with disabilities are less likely to refer to the internet for health information, more likely to refer to a health care provider to obtain health information, and less likely to use IT to exchange medical information with a provider. Additionally, we hypothesized that trust factors, such as trust toward health information source and willingness to exchange health information, are associated with IT use. Methods: The primary database was the 2013 Health Information National Trends Survey 4 Cycle 3 (N=3185). Disability status, the primary study covariate, was based on 6 questions that encompassed a wide spectrum of conditions, including impairments in mobility, cognition, independent living, vision, hearing, and self-care. Study covariates included sociodemographic factors, respondents' trust toward the internet and provider as information sources, and willingness to exchange medical information via IT with providers. Study outcomes were the use of the internet as the primary health information source, use of health care providers as the primary health information source, and use of IT to exchange medical information with providers. We conducted multivariate logistic regressions to examine the association between disability and study outcomes controlling for study covariates. Multiple imputations with fully conditional specification were used to impute missing values. Results: We found presence of any disability was associated with decreased odds (adjusted odds ratio [AOR] 0.65, 95\% CI 0.43-0.98) of obtaining health information from the internet, in particular for those with vision disability (AOR 0.27, 95\% CI 0.11-0.65) and those with mobility disability (AOR 0.51, 95\% CI 0.30-0.88). Compared to those without disabilities, those with disabilities were significantly more likely to consult a health care provider for health information in both actual (OR 2.21, 95\% CI 1.54-3.18) and hypothetical situations (OR 1.80, 95\% CI 1.24-2.60). Trust toward health information from the internet (AOR 3.62, 95\% CI 2.07-6.33), and willingness to exchange via IT medical information with a provider (AOR 1.88, 95\% CI 1.57-2.24) were significant predictors for seeking and exchanging such information, respectively. Conclusions: A potential digital gap may exist among US adults with disabilities in terms of their recent use of the internet for health information. Trust toward health information sources and willingness play an important role in people's engagement in use of the internet for health information. Future studies should focus on addressing trust factors associated with IT use and developing tools to improve access to care for those with disabilities. ",
doi="10.2196/rehab.8783",
url="http://rehab.jmir.org/2018/1/e3/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29549074"
}


@Article{info:doi/10.2196/games.5088,
author="Vugts, P. Miel A.
and Joosen, W. Margot C.
and van Bergen, M. Alfonsus H. M.
and Vrijhoef, M. Hubertus J.",
title="Feasibility of Applied Gaming During Interdisciplinary Rehabilitation for Patients With Complex Chronic Pain and Fatigue Complaints: A Mixed-Methods Study",
journal="JMIR Serious Games",
year="2016",
month="Apr",
day="01",
volume="4",
number="1",
pages="e2",
keywords="behavioral medicine",
keywords="therapy",
keywords="computer-assisted",
keywords="computer games",
keywords="mind-body therapies",
keywords="patient acceptance of health care",
keywords="feasibility studies",
keywords="fatigue syndrome, chronic",
keywords="fibromyalgia",
keywords="musculoskeletal pain",
abstract="Background: Applied gaming holds potential as a convenient and engaging means for the delivery of behavioral interventions. For developing and evaluating feasible computer-based interventions, policy makers and designers rely on limited knowledge about what causes variation in usage. Objective: In this study, we looked closely at why and by whom an applied game (LAKA) is demanded and whether it is feasible (with respect to acceptability, demand, practicality, implementation, and efficacy) and devised a complementary intervention during an interdisciplinary rehabilitation program (IRP) for patients with complex chronic pain and fatigue complaints. Methods: A mixed-methods design was used. Quantitative process analyses and assessments of feasibility were carried out with patients of a Dutch rehabilitation center who received access to LAKA without professional support during a 16-week interdisciplinary outpatient program. The quantitative data included records of routinely collected baseline variables (t0), additional surveys to measure technology acceptance before (t1) and after 8 weeks of access to LAKA (t2), and automatic log files of usage behavior (frequency, length, and progress). Subsequently, semistructured interviews were held with purposively selected patients. Interview codes triangulated and illustrated explanations of usage and supplemented quantitative findings on other feasibility domains. Results: Of the 410 eligible patients who started an IRP during the study period, 116 patients participated in additional data collections (108 with problematic fatigue and 47 with moderate or severe pain). Qualitative data verified that hedonic motivation was the most important factor for behavioral intentions to use LAKA (P<.001). Moreover, quotes illustrated a positive association between usage intentions (t1) and baseline level (t0) coping by active engagement (Spearman $\rho$=0.25; P=.008) and why patients who often respond by seeking social support were represented in a group of 71 patients who accessed the game (P=.034). The median behavioral intention to use LAKA was moderately positive and declined over time. Twenty patients played the game from start to finish. Behavioral change content was recognized and seen as potentially helpful by interview respondents who exposed themselves to the content of LAKA. Conclusions: Variation in the demand for applied gaming is generally explained by perceived enjoyment and effort and by individual differences in coping resources. An applied game can be offered as a feasible complementary intervention for more patients with complex chronic pain or fatigue complaints by embedding and delivering in alignment with patient experiences. Feasibility, effectiveness, and cost-effectiveness can be evaluated in a full-scale evaluation. New observations elicit areas of further research on the usage of computer-based interventions. ",
doi="10.2196/games.5088",
url="http://games.jmir.org/2016/1/e2/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27036094"
}


@Article{info:doi/10.2196/rehab.4776,
author="Shubert, E. Tiffany
and Basnett, Jeanna
and Chokshi, Anang
and Barrett, Mark
and Komatireddy, Ravi",
title="Are Virtual Rehabilitation Technologies Feasible Models to Scale an Evidence-Based Fall Prevention Program? A Pilot Study Using the Kinect Camera",
journal="JMIR Rehabil Assist Technol",
year="2015",
month="Nov",
day="05",
volume="2",
number="2",
pages="e10",
keywords="aging, fall prevention, technology, evidence-based, Kinect, falls",
abstract="Background: Falls in older adults are a significant public health issue. Interventions have been developed and proven effective to reduce falls in older adults, but these programs typically last several months and can be resource intensive. Virtual rehabilitation technologies may offer a solution to bring these programs to scale. Off-the-shelf and custom exergames have demonstrated to be a feasible adjunct to rehabilitation with older adults. However, it is not known if older adults will be able or willing to use a virtual rehabilitation technology to participate in an evidence-based fall prevention program. To have the greatest impact, virtual rehabilitation technologies need to be acceptable to older adults from different backgrounds and level of fall risk. If these technologies prove to be a feasible option, they offer a new distribution channel to disseminate fall prevention programs. Objective: Stand Tall (ST) is a virtual translation of the Otago Exercise Program (OEP), an evidence-based fall prevention program. Stand Tall was developed using the Virtual Exercise Rehabilitation Assistant (VERA) software, which uses a Kinect camera and a laptop to deliver physical therapy exercise programs. Our purpose in this pilot study was to explore if ST could be a feasible platform to deliver the OEP to older adults from a variety of fall risk levels, education backgrounds, and self-described level of computer expertise. Methods: Adults age 60 and over were recruited to participate in a one-time usability study. The study included orientation to the program, navigation to exercises, and completion of a series of strength and balance exercises. Quantitative analysis described participants and the user experience. Results: A diverse group of individuals participated in the study. Twenty-one potential participants (14 women, 7 men) met the inclusion criteria. The mean age was 69.2 ({\textpm} 5.8) years, 38\% had a high school education, 24\% had a graduate degree, and 66\% classified as ``at risk for falls''. Eighteen participants agreed they would like to use ST to help improve their balance, and 17 agreed or strongly agreed they would feel confident using the system in either the senior center or the home. Thirteen participants felt confident they could actually set up the system in their home. The mean System Usability Scale (SUS) score was 65.5 {\textpm} 21.2 with a range of 32.5 to 97.5.  Ten participants scored ST as an above average usability experience compared to other technologies and 5 participants scored a less than optimal experience. Exploratory analysis revealed no significant relationships between user experience, education background, self-described computer experience, and fall risk. Conclusions: Results support the virtual delivery of the OEP by a Kinect camera and an avatar may be acceptable to older adults from a variety of backgrounds. Virtual technologies, like Stand Tall, could offer an efficient and effective approach to bring evidence-based fall prevention programs to scale to address the problem of falls and fall-related injuries.  Next steps include determining if similar or better outcomes are achieved by older adults using the virtual OEP, Stand Tall, compared to the standard of care. ",
doi="10.2196/rehab.4776",
url="http://rehab.jmir.org/2015/2/e10/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28582244"
}


@Article{info:doi/10.2196/rehab.3484,
author="Lam, Y. Melanie
and Tatla, K. Sandy
and Lohse, R. Keith
and Shirzad, Navid
and Hoens, M. Alison
and Miller, J. Kimberly
and Holsti, Liisa
and Virji-Babul, Naznin
and Van der Loos, Machiel H. F.",
title="Perceptions of Technology and Its Use for Therapeutic Application for Individuals With Hemiparesis: Findings From Adult and Pediatric Focus Groups",
journal="JMIR Rehabil Assist Technol",
year="2015",
month="Feb",
day="10",
volume="2",
number="1",
pages="e1",
keywords="cerebral palsy",
keywords="stroke",
keywords="hemiplegia",
keywords="rehabilitation",
keywords="gaming",
keywords="social media",
keywords="technology adoption",
keywords="qualitative research",
abstract="Background: Digital technology is becoming an increasingly popular means of delivering meaningful therapy to individuals with neurological impairments. An understanding of clients' technology use and their perspectives on incorporating technology into rehabilitation can provide researchers and designers with valuable information to inform development of technologies and technology-based rehabilitation programs. Objective: This study was designed to establish the current use and perceptions of gaming, social media, and robotics technologies for rehabilitative purposes from the perspective of adults and children with upper limb impairments to identify barriers and enablers to their adoption and use. Methods: We conducted three focus groups consisting of pediatric (n=7, mean age 11.0 years) and adult (n=8, mean age 60.8 years) participants with hemiparesis affecting their upper limb. We applied thematic analysis methods to the resulting data. Results: We identified three key themes: (1) clients' use of technology in everyday life and rehabilitation, (2) barriers to use, and (3) enablers to therapy. Participants had limited exposure to technology for therapeutic purposes, but all acknowledged the potential benefits in providing motivation and interest for the performance of repetitive task practice. Adult participants requested efficacious, simple, and easy-to-use technology for rehabilitation with programs that could be individualized for them and expressed that they wanted these programs to provide a motivating means of repeated practice of therapeutic movements. In contrast, pediatric participants emphasized a desire for technology for rehabilitation that offered opportunities for social interaction and interactive games involving their whole body and not only their affected limb. Perceived safety and privacy were concerns for both groups. Conclusions: Our findings highlight that all participants were open to the integration of technology into rehabilitation. Adult participants were more pragmatically motivated by potential recovery gains, whereas pediatric participants were more intrinsically motivated by access to games. ",
doi="10.2196/rehab.3484",
url="http://rehab.jmir.org/2015/1/e1/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28582236"
}