TY - JOUR AU - Musson, Samantha Lucy AU - Mitic, Nina AU - Leigh-Valero, Victoria AU - Onambele-Pearson, Gladys AU - Knox, Liam AU - Steyn, J. Frederik AU - Holdom, J. Cory AU - Dick, JM Taylor AU - van Eijk, PA Ruben AU - van Unnik, WJ Jordi AU - Botman, CM Lianne AU - Beswick, Emily AU - Murray, Deirdre AU - Griffiths, Alys AU - McDermott, Christopher AU - Hobson, Esther AU - Chaouch, Amina AU - Hodson-Tole, Emma PY - 2025/4/17 TI - The Use of Digital Devices to Monitor Physical Behavior in Motor Neuron Disease: Systematic Review JO - J Med Internet Res SP - e68479 VL - 27 KW - motor neuron disease KW - amyotrophic lateral sclerosis KW - physical behavior KW - digital devices KW - remote monitoring KW - wearable technology N2 - Background: Motor neuron disease (MND) is a progressive and incurable neurodegenerative disease. The Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R) is the primary clinical tool for assessing disease severity and progression in MND. However, despite its widespread use, it does not adequately capture the extent of physical function decline. There is an urgent need for sensitive measures of disease progression that can be used to robustly evaluate new treatments. Measures of physical function derived from digital devices are beginning to be used to assess disease progression. There is value in establishing a consensus approach to standardizing the use of such devices. Objective: We aimed to explore how digital devices are being used to quantify free-living physical behavior in MND. We evaluated the feasibility and assessed the implications for monitoring physical behavior for future clinical trials and clinical practice. Methods: Systematic searches of 4 databases were performed in October 2023 and June 2024. Peer-reviewed English-language articles (including preprints) that examined how people living with MND used digital devices to assess their free-living physical behavior were included. Study reporting quality was assessed using a 22-item checklist (maximum possible score=44 points). Results: In total, 12 articles met the inclusion criteria for data extraction. All studies were longitudinal and observational in design, but data collection, analysis, and reporting protocols varied. Quality assessment scores ranged between 19 and 40 points. Sample sizes ranged between 10 and 376 people living with MND at baseline, declining over the course of the study. Most studies used an accelerometer device worn on the wrist, chest, hip, or ankle. Participants were typically asked to continuously wear devices for 1 to 8 days at 1- to 4-month intervals, with studies running for 12 weeks to 24 months. Some studies asked participants to wear the device continuously for the full duration. Studies derived traditional end points focusing on duration, intensity, and frequency of physical activity or nontraditional end points focusing on features of an individual?s movement patterns. The correlation coefficients (r) between physical behavior end points and ALSFRS-R ranged from 0.31 to 0.78. Greater monitoring frequencies and improved end point sensitivity were shown to provide smaller sample size requirements and shorter durations for hypothetical clinical trials. People living with MND found using devices acceptable and reported a low burden. Adherence assessed in 8 (67%) studies was good, ranging from approximately 86% to 96%, with differences evident between wear locations. The perspectives of other end users and implications on clinical practice were not explored. Conclusions: Remote monitoring of free-living physical behavior in MND is in its infancy but has the potential to quantify physical function. It is essential to develop a consensus statement, working toward agreed and standardized methods for data collection, analysis, and reporting. UR - https://www.jmir.org/2025/1/e68479 UR - http://dx.doi.org/10.2196/68479 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/68479 ER - TY - JOUR AU - Laverdière, Roxanne AU - Jackson, L. Philip AU - Banville, Frédéric PY - 2025/4/9 TI - A New Mobile App to Train Attention Processes in People With Traumatic Brain Injury: Logical and Ecological Content Validation Study JO - JMIR Form Res SP - e64174 VL - 9 KW - mobile app KW - attention training KW - cognitive remediation KW - mindfulness KW - psychometric properties KW - content validation N2 - Background: Attention is at the base of more complex cognitive processes, and its deficits can significantly impact safety and health. Attention can be impaired by neurodevelopmental and acquired disorders. One validated theoretical model to explain attention processes and their deficits is the hierarchical model of Sohlberg and Mateer. This model guides intervention development to improve attention following an acquired disorder. Another way to stimulate attention functions is to engage in the daily practice of mindfulness, a multicomponent concept that can be explained by the theoretical model of Baer and colleagues. Mobile apps offer great potential for practicing mindfulness daily as they can easily be used during daily routines, thus facilitating transfer. Laverdière and colleagues have developed such a mobile app called Focusing, which is aimed at attention training using mindfulness-inspired attentional exercises. However, this app has not been scientifically validated. Objective: This research aims to analyze the logical content validity and ecological content validity of the Focusing app. Methods: Logical content validation was performed by 7 experts in neuropsychology and mindfulness. Using an online questionnaire, they determined whether the content of the attention training app exercises is representative of selected constructs, namely the theoretical model of attention by Sohlberg and Mateer and the theoretical model of mindfulness by Baer and colleagues. A focus group was subsequently held with the experts to discuss items that did not reach consensus in order to change or remove them. Ecological content validation was performed with 10 healthy adults. Participants had to explore all sections of the app and assess the usability, relevance, satisfaction, quality, attractiveness, and cognitive load associated with each section of the app, using online questionnaires. Results: Logical content validation results demonstrated a high content validity index (CVI) of the attention training app. Excellent scores (CVI ?0.78) in both the attention and mindfulness models were obtained for all exercises in the app, except 2 exercises. One of these exercises was subsequently modified to include expert feedback, and one was removed. Regarding ecological content validation, the results showed that workload, quality, user experience, satisfaction, and relevance of the app were adequate. The Mobile Application Rating Scale questionnaire showed an average quality rating between 3.75/5 (SD 0.41) (objective quality) and 3.65/5 (SD 0.36) (subjective quality), indicating acceptable quality. The mean global attractiveness rating from the AttrakDiff questionnaire was 2.36/3 (SD 0.57), which represents one of the strengths of the app.  Conclusions: Logical and ecological content validation showed that Focusing is theoretically valid, with a high level of agreement among experts and healthy participants. This tool can be tested to train attention processes after a neurological insult such as traumatic brain injury. UR - https://formative.jmir.org/2025/1/e64174 UR - http://dx.doi.org/10.2196/64174 UR - http://www.ncbi.nlm.nih.gov/pubmed/40202789 ID - info:doi/10.2196/64174 ER - TY - JOUR AU - Lim, De Ming AU - Connie, Tee AU - Goh, Ong Michael Kah AU - Saedon, ?Izzati Nor PY - 2025/4/8 TI - Model-Based Feature Extraction and Classification for Parkinson Disease Screening Using Gait Analysis: Development and Validation Study JO - JMIR Aging SP - e65629 VL - 8 KW - model-based features KW - gait analysis KW - Parkinson disease KW - computer vision KW - support vector machine N2 - Background: Parkinson disease (PD) is a progressive neurodegenerative disorder that affects motor coordination, leading to gait abnormalities. Early detection of PD is crucial for effective management and treatment. Traditional diagnostic methods often require invasive procedures or are performed when the disease has significantly progressed. Therefore, there is a need for noninvasive techniques that can identify early motor symptoms, particularly those related to gait. Objective: The study aimed to develop a noninvasive approach for the early detection of PD by analyzing model-based gait features. The primary focus is on identifying subtle gait abnormalities associated with PD using kinematic characteristics. Methods: Data were collected through controlled video recordings of participants performing the timed up and go (TUG) assessment, with particular emphasis on the turning phase. The kinematic features analyzed include shoulder distance, step length, stride length, knee and hip angles, leg and arm symmetry, and trunk angles. These features were processed using advanced filtering techniques and analyzed through machine learning methods to distinguish between normal and PD-affected gait patterns. Results: The analysis of kinematic features during the turning phase of the TUG assessment revealed that individuals with PD exhibited subtle gait abnormalities, such as freezing of gait, reduced step length, and asymmetrical movements. The model-based features proved effective in differentiating between normal and PD-affected gait, demonstrating the potential of this approach in early detection. Conclusions: This study presents a promising noninvasive method for the early detection of PD by analyzing specific gait features during the turning phase of the TUG assessment. The findings suggest that this approach could serve as a sensitive and accurate tool for diagnosing and monitoring PD, potentially leading to earlier intervention and improved patient outcomes. UR - https://aging.jmir.org/2025/1/e65629 UR - http://dx.doi.org/10.2196/65629 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65629 ER - TY - JOUR AU - Rico-Olarte, Carolina AU - Lopez, M. Diego AU - Eskofier, M. Bjoern AU - Becker, Linda PY - 2025/4/7 TI - Electrophysiological Insights in Exergaming?Electroencephalography Data Recording and Movement Artifact Detection: Systematic Review JO - JMIR Serious Games SP - e50992 VL - 13 KW - exergaming KW - EEG KW - brain activity KW - motion artifact KW - artifact removal N2 - Background: Exergames are interactive solutions that require physical activity and are commonly used in learning or rehabilitation settings. For cognitive rehabilitation with exergames, the assessment of the intervention progress can be conducted by verifying the changes in brain activity. Electroencephalography (EEG) is a well-known method for this evaluation. However, motion artifacts due to large body movements can impede signal quality. No comprehensive guide on the artifact removal methods in the context of exergaming has been found. Objective: This paper aimed to identify studies that have assessed EEG signals while a user interacts with an exergame and the applied methods for data handling and analysis with a focus on dealing with movement artifacts. Methods: This review included studies on human participants while engaging in exergames, where the primary outcome was brain activity measured by EEG. A total of 5 databases were searched at 3 time points: March 2021, October 2022, and February 2024. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies assessed methodological quality, rating studies as ?good,? ?fair,? or ?poor.? Data were synthesized quantitatively to identify characteristics across studies, including sample demographics and intervention details, and basic statistics (mean [SD]) were calculated. Results: A total of 494 papers were screened, resulting in 17 studies having been included. All studies carried out EEG recordings during exergame interactions, primarily assessing attention and concentration, with the alpha wave being the most analyzed EEG band. Common motion artifact removal methods included visual inspection and independent component analysis. The review identified significant risks of bias, with 2 studies rated as ?good,? 7 as ?fair,? and 8 as ?poor.? Due to the small number of studies and their heterogeneity, a meta-analysis was not feasible. Conclusions: The study successfully identifies the feasibility of recording electrophysiological brain activity during exergaming and provides insights into EEG devices, analysis methods, and exergaming systems used in previous studies. However, limitations, such as the lack of sufficient detail on motion artifact removal and a focus on short-term effects, underscore the need for improved methodologies and reporting standards, with recommendations for enhancing reliability in cognitive rehabilitation with exergames. UR - https://games.jmir.org/2025/1/e50992 UR - http://dx.doi.org/10.2196/50992 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50992 ER - TY - JOUR AU - Huang, Jiaqi AU - Wei, Yixi AU - Zhou, Ping AU - He, Xiaokuo AU - Li, Hai AU - Wei, Xijun PY - 2025/4/4 TI - Effect of Home-Based Virtual Reality Training on Upper Extremity Recovery in Patients With Stroke: Systematic Review JO - J Med Internet Res SP - e69003 VL - 27 KW - stroke KW - upper extremity KW - virtual reality KW - home-based KW - rehabilitation KW - motor control KW - recovery N2 - Background: Stroke is a leading cause of long-term disability, often resulting in upper extremity dysfunction. Traditional rehabilitation methods often face challenges such as limited patient access to resources and lack of sustained motivation. Home-based virtual reality (VR) training is gaining traction as an innovative, sustainable, and interactive alternative. However, the effect of home-based VR, specifically for upper extremity recovery in patients with stroke, remains insufficiently explored. Objective: This systematic review aims to synthesize existing evidence to evaluate the impact of home-based VR interventions on upper extremity function recovery in patients with stroke. Methods: This systematic review followed the guidelines of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). A comprehensive literature search was conducted across PubMed, Web of Science, Scopus, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) Ultimate databases, targeting English-language randomized controlled trials (RCTs) published up to June 30, 2024. Eligible studies involved patients with stroke with upper extremity dysfunction who received home-based VR interventions. Data extraction was performed by 2 independent reviewers, and study quality was assessed using the Physiotherapy Evidence Database scale. Due to heterogeneity in study designs and outcome measures, a narrative synthesis was performed instead of a meta-analysis. Results: A total of 8 RCTs with 392 participants were included. This review shows that home-based VR training positively affects upper extremity function recovery in patients with stroke, especially in motor control improvement. Customized VR systems were more effective than commercial VR systems in patients with moderate to severe disorders. Although studies generally showed positive results, differences in intervention protocols and small sample sizes limited the validity of results. The effect of VR therapy also varied based on the VR system type, intervention intensity, and the functional level of patients. Conclusions: This systematic review shows that home-based VR training has a positive impact on upper extremity rehabilitation for patients with stroke, particularly in those with varying degrees of dysfunction. However, heterogeneity in study design and differences in outcome measures affect the reliability of the current conclusions. Future studies should include larger, standardized RCTs with long-term follow-up to assess their continued effects. Future research should explore how VR technology can be integrated into comprehensive rehabilitation programs, focusing on patient-centered approaches that incorporate sustainable, personalized technology, and support services to optimize recovery outcomes. Trial Registration: PROSPERO CRD42024526650; https://tinyurl.com/5dny5bhp UR - https://www.jmir.org/2025/1/e69003 UR - http://dx.doi.org/10.2196/69003 UR - http://www.ncbi.nlm.nih.gov/pubmed/40074365 ID - info:doi/10.2196/69003 ER - TY - JOUR AU - Spark, Jessica AU - Rowe, Elise AU - Alvarez-Jimenez, Mario AU - Bell, Imogen AU - Byrne, Linda AU - Dzafic, Ilvana AU - Ellinghaus, Carli AU - Lavoie, Suzie AU - Lum, Jarrad AU - McLean, Brooke AU - Thomas, Neil AU - Thompson, Andrew AU - Wadley, Greg AU - Whitford, Thomas AU - Wood, Stephen AU - Yuen, Pan Hok AU - Nelson, Barnaby PY - 2025/4/1 TI - Integrating Virtual Reality, Neurofeedback, and Cognitive Behavioral Therapy for Auditory Verbal Hallucinations (Hybrid): Protocol of a Pilot, Unblinded, Single-Arm Interventional Study JO - JMIR Res Protoc SP - e63405 VL - 14 KW - psychosis KW - first episode psychosis KW - schizophrenia KW - virtual reality KW - neurofeedback KW - EEG KW - auditory verbal hallucinations KW - voices KW - cognitive behavior therapy KW - youth mental health KW - pilot study KW - paracusias KW - paracusis KW - treatment KW - medication KW - psychotic disorder KW - efficacy KW - neuroscience KW - psychology KW - hybrid KW - adolescent KW - Australia N2 - Background: Current treatments for schizophrenia and other psychotic disorders have limited efficacy, with high rates of nonresponse to ?gold standard? treatments. New approaches are therefore urgently required. Objective: The aims of this pilot study are to investigate the feasibility, acceptability, safety, and usability of Hybrid treatment (primary aim); and to explore Hybrid?s treatment efficacy and engagement of treatment targets (secondary aim). The primary aim will be assessed via face-to-face user experience surveys on a (self-assessed) 5-point Likert scale (and qualitative open-ended questions) examining: (1) acceptability, (2) helpfulness, (3) engagement, and (4) perceived safety. We will also examine consent and completion rates, and the number of sessions attended. Our threshold for moving on to efficacy trials will be at least 70% of our participants to rate 3 and above (which corresponds to agree or strongly agree) that the intervention package was acceptable, feasible, and safe. The secondary aims will be assessed by observing whether individuals achieve self-directed modulation of high-? neurophysiological activity (neural target) and progression upwards through the VR-based exposure hierarchy (psychological target), and by assessing symptom change scores. This study developed a new treatment approach for auditory verbal hallucinations, a major symptom of psychotic disorders, that integrates advances in psychological therapy (cognitive behavioral therapy for psychosis), technology (virtual reality, VR), and neuroscience (electroencephalography-based neurofeedback). Methods: Hybrid takes a ?symptom capture? approach using individually tailored VR-based exposure exercises. Participants (N=10) will receive the intervention package weekly over 12 face-to-face sessions. Here, participants will be progressively exposed to symptom triggers and develop methods of downregulating neural activity associated with these symptoms (neurofeedback component) while concurrently receiving clinician-delivered cognitive behavioral therapy for psychosis. Results: As of February 2025, Hybrid has commenced (unblinded) recruitment activities from Orygen clinical services in Northwestern Melbourne, Australia. A total of 75 individuals have been approached and 64 individuals have been prescreened (41 individuals were deemed eligible, 15 individuals were ineligible, and 8 individuals declined or did not respond to contact attempts) and 5 individuals have been included in the study. Of the 5 individuals who have commenced the Hybrid treatment, 4 are actively engaged in the program and 1 individual has withdrawn. We expect recruitment to conclude in July 2025 and for the results to be published in 2026. Conclusions: The Hybrid study is piloting a novel approach that has the potential to address the shortcomings of current treatments for psychotic symptoms. If there is favorable evidence for the acceptability, feasibility, safety and usability of Hybrid, the study team will move on to efficacy trials. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12624000357550; https://tinyurl.com/24ey8hpy International Registered Report Identifier (IRRID): PRR1-10.2196/63405 UR - https://www.researchprotocols.org/2025/1/e63405 UR - http://dx.doi.org/10.2196/63405 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63405 ER - TY - JOUR AU - Sheehy, Lisa AU - Taillon-Hobson, Anne AU - Sveistrup, Heidi AU - Bilodeau, Martin AU - Yang, Christine AU - Welch, Vivian AU - Finestone, Hillel PY - 2025/3/28 TI - Home-Based Nonimmersive Virtual Reality Training After Discharge From Inpatient or Outpatient Stroke Rehabilitation: Parallel Feasibility Randomized Controlled Trial JO - JMIR Rehabil Assist Technol SP - e64729 VL - 12 KW - virtual reality KW - telerehabilitation KW - stroke KW - home KW - exercises KW - physical activity KW - physiotherapy KW - exergames KW - rehabilitation intensity KW - randomized controlled feasibility trial KW - motor KW - movement KW - patient care KW - patient engagement KW - health intervention KW - stroke rehabilitation KW - interactive games KW - game therapy KW - interactive therapy KW - rehabilitation N2 - Background: Nonimmersive virtual reality training (NIVRT) can be used to continue rehabilitative exercise for stroke recovery at home after discharge from inpatient or outpatient therapy. Objective: The objectives of this randomized controlled feasibility trial were to assess home-based NIVRT as telerehabilitation with patients living with stroke, and its potential to improve standing function and gait. Methods: Patients approaching discharge from inpatient or outpatient stroke rehabilitation were randomly allocated to NIVRT or iPad interventions. NIVRT provided interactive games and exercises designed to improve balance, stepping, and aerobic capacity. iPad apps addressed cognition and fine motor skills. Participants were visited in their homes by a physiotherapist, taught to use the program, and asked to do 30 minutes of exercise 5 days a week for 6 weeks, asynchronously. Feasibility was assessed by measuring recruitment, adherence, ability to set up and learn NIVRT, enjoyment, intent to continue, perception of impact, and safety. Participants completed assessments of standing balance, gait, and general function, before and after the intervention, by a blinded assessor. Results: NIVRT participants (n=11; 10 male participants; mean age 64, SD 12 years) did an average of 26 sessions (total 700 minutes), while iPad participants (n=9; 6 male participants; mean age 61, SD 20 years) did an average of 33 sessions (total 1241 minutes). Space was tight in 5 homes. All but 1 participant learned NIVRT and progressed. Most enjoyed it and felt that it improved their recovery. There were no serious adverse events. Most assessments showed improvement over time for both groups. Conclusions: Home-based NIVRT is safe and feasible to continue rehabilitative exercise after discharge. More research on efficacy and effectiveness in this population is required. Trial Registration: ClinicalTrials.gov NCT03261713; https://clinicaltrials.gov/study/NCT03261713 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-019-3438-9 UR - https://rehab.jmir.org/2025/1/e64729 UR - http://dx.doi.org/10.2196/64729 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64729 ER - TY - JOUR AU - Wu, Yanyun AU - Cheng, Yangfan AU - Xiao, Yi AU - Shang, Huifang AU - Ou, Ruwei PY - 2025/3/14 TI - The Role of Machine Learning in Cognitive Impairment in Parkinson Disease: Systematic Review and Meta-Analysis JO - J Med Internet Res SP - e59649 VL - 27 KW - Parkinson disease KW - cognitive impairment KW - machine learning KW - systematic review KW - meta-analysis N2 - Background: Parkinson disease (PD) is a common neurodegenerative disease characterized by both motor and nonmotor symptoms. Cognitive impairment often occurs early in the disease and can persist throughout its progression, severely impacting patients? quality of life. The utilization of machine learning (ML) has recently shown promise in identifying cognitive impairment in patients with PD. Objective: This study aims to summarize different ML models applied to cognitive impairment in patients with PD and to identify determinants for improving diagnosis and predictive power for early detection of cognitive impairment. Methods: PubMed, Cochrane, Embase, and Web of Science were searched for relevant articles on March 2, 2024. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). Bivariate meta-analysis was used to estimate pooled sensitivity and specificity results, presented as odds ratio (OR) and 95% CI. A summary receiver operator characteristic (SROC) curve was used. Results: A total of 38 articles met the criteria, involving 8564 patients with PD and 1134 healthy controls. Overall, 120 models reported sensitivity and specificity, with mean values of 71.07% (SD 13.72%) and 77.01% (SD 14.31%), respectively. Predictors commonly used in ML models included clinical features, neuroimaging features, and other variables. No significant heterogeneity was observed in the bivariate meta-analysis, which included 12 studies. Using sensitivity as the metric, the combined sensitivity and specificity were 0.76 (95% CI 0.67-0.83) and 0.83 (95% CI 0.76-0.88), respectively. When specificity was used, the combined values were 0.77 (95% CI 0.65-0.86) and 0.76 (95% CI 0.63-0.85), respectively. The area under the curves of the SROC were 0.87 (95% CI 0.83-0.89) and 0.83 (95% CI 0.80-0.86) respectively. Conclusions: Our findings provide a comprehensive summary of various ML models and demonstrate the effectiveness of ML as a tool for diagnosing and predicting cognitive impairment in patients with PD. Trial Registration: PROSPERO CRD42023480196; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023480196 UR - https://www.jmir.org/2025/1/e59649/ UR - http://dx.doi.org/10.2196/59649 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59649 ER - TY - JOUR AU - Touali, Rachid AU - Zerouaoui, Jamal AU - Chakir, Mahjoub El AU - Bui, Tien Hung AU - Leone, Mario AU - Allisse, Maxime PY - 2025/3/26 TI - Impact of a Sensorimotor Integration and Hyperstimulation Program on Global Motor Skills in Moroccan Children With Autism Spectrum Disorder: Exploratory Clinical Quasi-Experimental Study JO - JMIR Form Res SP - e65767 VL - 9 KW - classical physical education KW - children with a neurotypical profile KW - children with ASD KW - UQAC-UQAM test battery KW - University of Québec in Chicoutimi-University of Québec in Montréal KW - sensorimotor integration KW - hyperstimulation KW - Morocco KW - sensorimotor KW - integration KW - motor skill KW - Moroccan children KW - Moroccan KW - children KW - autism spectrum disorder KW - ASD KW - exploratory study KW - autism KW - mental health KW - young KW - youth KW - feasibility N2 - Background: Children with autism spectrum disorders (ASDs) often struggle with processing information, which can impact their coordination, balance, and other motor skills. Studies have demonstrated that intervention programs based on sensory integration can enhance motor performance in these children. Objective: The objective of this study is to evaluate the applicability of a standardized battery of gross motor skill tests for Moroccan children aged 6 to 12 years with ASD. The objective is to assess the potential efficacy of an innovative pedagogical approach focused on sensorimotor integration and hyperstimulation. This approach will be compared to traditional physical education (PE) sessions to determine its feasibility and potential to bridge the developmental gaps in motor skills between children with ASD and those with a neurotypical profile. Methods: A convenience sample of 14 Moroccan children with ASD aged 6 to 12 years participated in this exploratory study. Children with ASD were divided into an experimental group (n=7) and a control group (n=7) based on age, sex, motor performance, and socioeconomic status. The control group followed the standard PE program, while the experimental group underwent a specialized program combining sensorimotor integration and hyperstimulation for a period of 15 weeks. All participants were classified as level 2 (moderate) on the Autism Severity Rating Scale based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) criteria. Gross motor skills were measured at baseline and after 15 weeks of intervention using the UQAC-UQAM (University of Québec in Chicoutimi-University of Québec in Montréal) test battery protocol, which includes 10 items. Results: At baseline (T1), no significant difference was observed between the control and experimental groups of children with ASD. Following the 15-week intervention, the group participating in traditional PE showed an overall improvement in motor skills of approximately 14.5%. Conversely, the results of the ASD experimental group suggest a more substantial improvement of 44.5%. Additionally, the experimental group exhibited significant better performance across all motor skill variables compared to the control group (minimum P values of <.02) with large effect sizes (>0.80). In this regard, a 2-way repeated measures ANOVA confirms the efficiency of the program implemented within the experimental group, demonstrating significant effects associated with both group and time factors as well as a clinically highly significant group×time interaction across all measured variables (?2p>0.14). Conclusions: The results of this study suggest that the approach that emphasizes sensorimotor integration and management of hyperstimulation was more effective in improving motor skills in this population. However, other more exhaustive studies will need to be carried out in order to be able to more precisely measure the full potential of this approach. UR - https://formative.jmir.org/2025/1/e65767 UR - http://dx.doi.org/10.2196/65767 UR - http://www.ncbi.nlm.nih.gov/pubmed/40137439 ID - info:doi/10.2196/65767 ER - TY - JOUR AU - Kanitkar, Anuprita AU - Sepehri, Nariman AU - Lezen, Ariel AU - Parmar, Tejraj Sanjay AU - Hin, Kit-Fong Cherry AU - Szturm, Joseph Tony PY - 2025/3/19 TI - A Game-Based Mechatronic Device for Digital Rehabilitation of Hand Function After a Stroke: Design, Prototyping, and Feasibility Study JO - JMIR Neurotech SP - e67779 VL - 4 KW - stroke KW - manual dexterity KW - hand function KW - poststroke KW - fine motor KW - thumb KW - finger KW - wrist KW - movement KW - motor rehabilitation KW - assistive technology KW - smart monitoring KW - pilot KW - feasibility KW - prototyping KW - prototype KW - nervous system KW - nerve KW - motor neuron N2 - Background: This paper presents an easy-to-use, affordable robotic manipulandum device (RMD) equipped with smart monitoring and assistive technologies to engage in game-based exercise and repetitive task practice. The RMD has been designed to enhance a wide range of fine motor manual dexterity skills, including thumb, finger, and wrist movements. By focusing on finger and hand functions, it extends its utility beyond basic reaching or object transfer movements. Various interchangeable 3D-printed therapy handles of different shapes and sizes can be easily attached to the RMD drive shaft. These handle movements can be used to engage with numerous affordable, commercially available computer games, allowing patients to practice tasks that involve varying movement amplitudes, speeds, precision, and cognitive challenges. Additionally, the device is capable of automatically recording and storing the patient?s real-time performance data on any given computer, integrating assessment into treatment. Objective: A pilot study was conducted with 5 patients with stroke to examine the feasibility and benefits of a 6-week game-based exercise program using the proposed device. Methods: A feasibility study was conducted with 5 participants. Data were collected using the computer game?based upper extremity assessment of manual dexterity and Wolf Motor Function Test (WMFT) before and after the intervention lasting 6 weeks. Results: The pilot study demonstrated that clients? expectations related to manual dexterity were met. The average improvement in the functional ability score of the WMFT was 14 (SD 3) points, with all participants exceeding the minimal clinically important difference. The average reduction in total time was 30 (SD 14) seconds, with 4 of 5 participants surpassing the minimal clinically important difference. For the computer game?based upper extremity assessment, the average improvement in success rate was 23% (SD 12%), and the average decrease in response time was 105 (SD 44) milliseconds. Conclusions: Findings revealed acceptable, engaging, game-based, and task-oriented training with a high level of compliance. Substantial improvements from pre- to postintervention were observed using the WMFT and assessments of manual dexterity. Trial Registration: ClinicalTrials.gov NCT05071885; https://clinicaltrials.gov/study/NCT05071885 UR - https://neuro.jmir.org/2025/1/e67779 UR - http://dx.doi.org/10.2196/67779 ID - info:doi/10.2196/67779 ER - TY - JOUR AU - Esumi, Ryo AU - Funao, Hiroki AU - Kawamoto, Eiji AU - Sakamoto, Ryota AU - Ito-Masui, Asami AU - Okuno, Fumito AU - Shinkai, Toru AU - Hane, Atsuya AU - Ikejiri, Kaoru AU - Akama, Yuichi AU - Gaowa, Arong AU - Park, Jeong Eun AU - Momosaki, Ryo AU - Kaku, Ryuji AU - Shimaoka, Motomu PY - 2025/3/5 TI - Machine Learning?Based Prediction of Delirium and Risk Factor Identification in Intensive Care Unit Patients With Burns: Retrospective Observational Study JO - JMIR Form Res SP - e65190 VL - 9 KW - burns KW - delirium KW - intensive care unit KW - machine learning KW - prediction model KW - artificial intelligence KW - AI N2 - Background: The incidence of delirium in patients with burns receiving treatment in the intensive care unit (ICU) is high, reaching up to 77%, and has been associated with increased mortality rates. Therefore, early identification of patients at high risk of delirium onset is essential for improving treatment strategies. Objective: This study aimed to create a machine learning model for predicting delirium in patients with burns during their ICU stay using patient data from the first day of ICU admission and identify predictive factors for ICU delirium in patients with burns. Methods: This study focused on 82 patients with burns aged ?18 years who were admitted to the ICU at Mie University Hospital for ?24 hours between January 2015 and June 2023. In total, 70 variables were measured in patients upon ICU admission and used as explanatory variables in the ICU delirium prediction model. Delirium was assessed using the Intensive Care Delirium Screening Checklist every 8 hours after ICU admission. A total of 10 different machine learning methods were used to predict ICU delirium. Multiple receiver operating characteristic curves were plotted for various machine learning models, and the area under the curve (AUC) for each was compared. In addition, the top 15 risk factors contributing to delirium onset were identified using Shapley additive explanations analysis. Results: Among the 10 machine learning models tested, logistic regression (mean AUC 0.906, SD 0.073), support vector machine (mean AUC 0.897, SD 0.056), k-nearest neighbor (mean AUC 0.894, SD 0.060), neural network (mean AUC 0.857, SD 0.058), random forest (mean AUC 0.850, SD 0.074), adaptive boosting (mean AUC 0.832, SD 0.094), gradient boosting machine (mean AUC 0.821, SD 0.074), and naïve Bayes (mean AUC 0.827, SD 0.095) demonstrated the highest accuracy in predicting ICU delirium. Specifically, 24-hour urine output (from ICU admission to 24 hours), oxygen saturation, burn area, total bilirubin level, and intubation upon ICU admission were identified as the major risk factors for delirium onset. In addition, variables, such as the proportion of white blood cell fractions, including monocytes; methemoglobin concentration; and respiratory rate, were identified as important risk factors for ICU delirium. Conclusions: This study demonstrated the ability of machine learning models trained using vital signs and blood data upon ICU admission to predict delirium in patients with burns during their ICU stay. UR - https://formative.jmir.org/2025/1/e65190 UR - http://dx.doi.org/10.2196/65190 UR - http://www.ncbi.nlm.nih.gov/pubmed/39895101 ID - info:doi/10.2196/65190 ER - TY - JOUR AU - Everard, Gauthier AU - Declerck, Louise AU - Lejeune, Thierry AU - Edwards, Gareth Martin AU - Bogacki, Justine AU - Reiprich, Cléo AU - Delvigne, Kelly AU - Legrain, Nicolas AU - Batcho, Sebiyo Charles PY - 2025/3/3 TI - A Self-Adaptive Serious Game to Improve Motor Learning Among Older Adults in Immersive Virtual Reality: Short-Term Longitudinal Pre-Post Study on Retention and Transfer JO - JMIR Aging SP - e64004 VL - 8 KW - virtual reality KW - aged KW - learning KW - upper extremity KW - video games KW - kinematics N2 - Background: Despite their potential, the use of serious games within immersive virtual reality (iVR) for enhancing motor skills in older adults remains relatively unexplored. In this study, we developed a self-adaptive serious game in iVR called REAsmash-iVR. This game involves swiftly locating and striking a digital mole presented with various distractors. Objective: This short-term longitudinal pre-post study aims to evaluate REAsmash-iVR?s efficacy in promoting motor learning in older adults. Specifically, we seek to determine the transfer and retention of motor learning achieved through REAsmash-iVR to other iVR tasks. Methods: A total of 20 older adults participated in the study, engaging with REAsmash-iVR over 7 consecutive days. The evaluation included iVR tests such as KinematicsVR and a VR adaptation of the Box and Block Test (BBT-VR). KinematicsVR tasks included drawing straight lines and circles as fast and as accurately as possible, while BBT-VR required participants to move digital cubes as quickly as possible within 60 seconds. Assessments were conducted before and after the intervention, with a follow-up at 1 week post intervention. The primary outcome focused on evaluating the impact of REAsmash-iVR on speed-accuracy trade-off during KinematicsVR tasks. Secondary outcomes included analyzing movement smoothness, measured by spectral arc length, and BBT-VR scores. Results: Results revealed significant improvements in speed-accuracy trade-off post intervention compared to that before the intervention, with notable retention of skills for straight lines (t19=5.46; P<.001; Cohen d=1.13) and circle drawing (t19=3.84; P=.001; Cohen d=0.787). Likewise, there was a significant enhancement in spectral arc length, particularly for circle drawing (?²2=11.2; P=.004; ?2=0.23), but not for straight-line drawing (?²2=2.1; P=.35; ?2=0.003). Additionally, participants demonstrated transfer with significant improvement (q=5.26; P<.001; Cohen r=0.678) and retention (q=6.82; P<.001; Cohen r=0.880) in BBT-VR skills. Conclusions: These findings provide perspectives for the use of iVR to improve motor learning in older adults through delivering self-adaptive serious games targeting motor and cognitive functions. Trial Registration: ClinicalTrials.gov NCT04694833; https://clinicaltrials.gov/study/NCT04694833 UR - https://aging.jmir.org/2025/1/e64004 UR - http://dx.doi.org/10.2196/64004 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053708 ID - info:doi/10.2196/64004 ER - TY - JOUR AU - Corti, Claudia AU - Papini, Marta AU - Strazzer, Sandra AU - Borgatti, Renato AU - Romaniello, Romina AU - Poggi, Geraldina AU - Storm, Alexander Fabio AU - Urgesi, Cosimo AU - Jansari, Ashok AU - Wade, L. Shari AU - Bardoni, Alessandra PY - 2025/2/21 TI - Examining the Implementation of the Italian Version of the Teen Online Problem-Solving Program Coupled With Remote Psychological Support: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e64178 VL - 14 KW - telerehabilitation KW - acquired brain injury KW - executive functioning KW - pediatric KW - problem-solving KW - computer N2 - Background: Pediatric acquired brain injury (ABI) is frequently associated with cognitive and socioemotional alterations. Therefore, targeted rehabilitation to improve everyday functioning, particularly executive functioning (EF), is needed to limit the possible deterioration of cognitive abilities and behavior over time and the associated social and psychological costs. Objective: In this paper, we present the protocol for a phase-2 randomized controlled trial (RCT) aimed at examining the feasibility and efficacy of a web-based intervention (ie, the Italian version of the Teen Online Problem-Solving [I-TOPS] intervention) to improve problem-solving abilities versus an active-control, web-based intervention (ie, wellness intervention) providing health and wellness content. Methods: A double-blinded, phase-2 RCT will be conducted to guarantee controls on data quality and findings. In total, 42 adolescents will be recruited from a rehabilitation institute and individually randomly assigned in a 1:1 ratio to receive the I-TOPS intervention or the web-based wellness intervention. Both interventions will include 10 core sessions and will be delivered remotely using a web-based platform. Participants allocated to both interventions and their caregivers will independently complete the learning modules in an everyday setting using their computer. The I-TOPS intervention?s core sessions will target the EF domain (eg, planning, emotion regulation, and social skills), while all the contents of the wellness intervention will be aimed at providing psychoeducation on ABI sequelae and supporting health and wellness. Participants assigned to the I-TOPS intervention will also receive bimonthly direct training in problem-solving coupled with remote support from a psychologist. Feasibility data and efficacy outcomes on both adolescents? and parents? functioning will be assessed. Cognitive abilities in the EF domain and behavioral and psychological functioning (ie, internalizing and externalizing symptoms) of the adolescents will be evaluated via performance-based measures, administered remotely using the Google Meet platform, and paper-and-pencil questionnaires; parents? well-being will be assessed through paper-and-pencil questionnaires. Efficacy will be evaluated immediately after training and at 6-month follow-up. Results: This study started on February 26, 2021, and ended on February 28, 2023. A total of 42 adolescents were enrolled and randomly assigned to the 2 study groups, 34 (81%) completed the intervention and posttreatment evaluation (I-TOPS: n=19 and wellness intervention: n=15) and 31 performed follow-up evaluation (I-TOPS: n=18 and wellness intervention: n=13). Data analysis on feasibility and efficacy will be performed after protocol publication, and the results will be published in the form of a paper in a relevant journal in 2025. Conclusions: This double-blinded, phase-2 RCT could extend knowledge on the best rehabilitation practices to adopt with the survivors of pediatric ABI by providing evidence-based data currently lacking for the Italian context. If this study yields positive results, a larger, multicenter, phase-3 RCT could be planned and delivered to examine program cost-effectiveness in a larger sample. Trial Registration: ClinicalTrials.gov NCT05169788; https://clinicaltrials.gov/study/NCT05169788 International Registered Report Identifier (IRRID): DERR1-10.2196/64178 UR - https://www.researchprotocols.org/2025/1/e64178 UR - http://dx.doi.org/10.2196/64178 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64178 ER - TY - JOUR AU - Jornkokgoud, Khanitin AU - Makmee, Pattrawadee AU - Wongupparaj, Peera AU - Grecucci, Alessandro PY - 2025/2/21 TI - Tablet- and Group-Based Multicomponent Cognitive Stimulation for Older Adults With Mild Cognitive Impairment: Single-Group Pilot Study and Protocol for Randomized Controlled Trial JO - JMIR Res Protoc SP - e64465 VL - 14 KW - computerized cognitive stimulation KW - multisensory integration KW - cognitive decline KW - aging KW - electroencephalography KW - randomized controlled trial KW - RCT KW - protocol KW - cognitive stimulation KW - mild cognitive impairment KW - cognitive KW - cognition KW - cognitive simulation therapy KW - CST KW - MCI KW - tablet KW - effectiveness KW - pilot study KW - neuropsychological tests KW - behavioral KW - emotional N2 - Background: Cognitive stimulation therapy is a group-based psychological treatment for people with dementia as well as those with mild cognitive impairment (MCI) and is shown to improve both cognition and quality of life. Previous studies have indicated the potential to benefit from the use of technological devices in group interventions. Objective: The pilot study aimed to assess the effectiveness of a tablet- and group-based multicomponent cognitive stimulation therapy (MCST) for enhancing cognitive functions among older adults with MCI. The following study aims to report the protocol for a trial evaluating whether the MCST program is affecting individuals with MCI. Methods: In the first study, 30 individuals with MCI participated in 10 sessions of the tablet- and group-based MCST group. A subsequent protocol study will compare tablet-based MCST, tablet-based cognitive stimulation therapy, and control groups among 93 individuals with MCI. All participants will be recruited from older adults living in semiurban communities. Intervention groups will be facilitated by trained therapists, nurses, or psychologists. The study will be assessed by a pre- and posttest evaluation, including computer-based neuropsychological tests and electroencephalography assessment. The effects of several indicators, such as cognitive functions, behavioral, and emotional, will be analyzed as being indexed by their neurophysiological data. Results: The pilot study showed significant cognitive improvement (P<.001), reduced depression (P=.002), and decreased state anxiety (P=.001) post intervention. Quality of life remained unchanged (P=.18). The randomized controlled trial study was funded in March 2023. Enrolling began in August 2023 and was completed in December 2023. The data analysis was started, and the results are expected to be published by mid- to late-2025. Conclusions: The study is the first tablet-group?based MCST for older adults with MCI in middle-income countries. It will provide deeper insight into participants? neuropsychological data, thus identifying specific processes underlying physiologically measured positive outcomes. Furthermore, the project will deliver solid and integrative results to mental health professionals in terms of knowledge and guidance for implementing the tablet- and group-based MCST in people with MCI. Trial Registration: Thai Clinical Trials Registry TCTR20230829004; https://tinyurl.com/3wuaue3e International Registered Report Identifier (IRRID): DERR1-10.2196/64465 UR - https://www.researchprotocols.org/2025/1/e64465 UR - http://dx.doi.org/10.2196/64465 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64465 ER - TY - JOUR AU - Balloufaud, Maxime AU - Boujut, Arnaud AU - Marie, Romain AU - Guinaldo, Aurélie AU - Fourcade, Laurent AU - Hamonet-Torny, Julia AU - Perrochon, Anaick PY - 2025/2/19 TI - Augmented Reality Exergames for Upcoming Cognitive-Motor Rehabilitation: User-Centered Design Approach and User Experience of Healthy Children JO - JMIR Rehabil Assist Technol SP - e69205 VL - 12 KW - augmented reality KW - exergames KW - user experience KW - healthy children KW - cognitive-motor intervention N2 - Background: Traditional rehabilitation programs for children with cerebral palsy and acquired brain injuries aim to enhance motor and cognitive abilities through repetitive exercises, which are often perceived as tedious and demotivating. Extended reality technologies, including augmented reality (AR) and virtual reality, offer more engaging methods through exergames. However, to date, no AR exergames simultaneously integrate cognitive and motor aspects within navigational tasks. Developing these exergames necessitates rigorous methodological steps, especially when using emerging technologies such as AR. The MIDE (Multidisciplinary Iterative Design of Exergames) framework advocates a participatory design approach, involving users from the outset, the objective being to optimize the interface and validate game mechanics through user experience (UX) assessment. Some researchers initially test these mechanisms on healthy children before applying them to clinical populations. Objective: This study aims to evaluate the UX of our AR exergames, consisting of two games (AR Corsi and AR Zoo), in typically developing children. Methods: Typically developing children participated in two 1.5-hour sessions. During each session, they played one of two AR games using the Microsoft HoloLens 2 headset: AR Corsi and AR Zoo, both of which are designed to engage executive functions and motor skills through navigational capabilities. UX was assessed after each session using the following measures: System Usability Scale scores for usability, AttrakDiff for attractiveness and game quality, MeCue for emotional experience, and Rating scale of Perceived Exertion for Children for pre- and postsession mental and physical fatigue. Results: A total of 27 participants (mean age 11.9, SD 1.2 years) were included in the study. Mean System Usability Scale scores were 79.9 (SD 11.4) for AR Corsi and 76.3 (SD 12.1) for AR Zoo, indicating good usability. The AttrakDiff questionnaire yielded favorable results, with scores between 1 and 3 for overall attractiveness, pragmatic quality, and stimulation for both AR games. However, the hedonic quality ?identity? received neutral scores (mean 0.6, SD 0.5 for AR Corsi and mean 0.7, SD 0.8 for AR Zoo). The MeCue emotions module yielded average scores of 5.2 (SD 0.7) for AR Corsi and 5.3 (SD 0.8) for AR Zoo, significantly exceeding the theoretical mean of 4 (P<.001). We observed a significant effect of physical fatigue (P=.02) and mental fatigue (P=.002) after exposure to both games. A comparative analysis of UX between the two games showed no significant differences. Conclusions: This study demonstrates that our exergame, comprising two AR games, is user-friendly and well-received by typically developing children, eliciting positive emotions and overall appeal. Although some children reported fatigue, favorable UX evaluation confirms the validity of the game?s content and mechanisms, suggesting its suitability for use among children with cerebral palsy and acquired brain injuries. UR - https://rehab.jmir.org/2025/1/e69205 UR - http://dx.doi.org/10.2196/69205 UR - http://www.ncbi.nlm.nih.gov/pubmed/39970421 ID - info:doi/10.2196/69205 ER - TY - JOUR AU - Szekely, Raul AU - Holloway, Catherine AU - Bandukda, Maryam PY - 2025/2/13 TI - Understanding the Psychosocial Impact of Assistive Technologies for People With Visual Impairments: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e65056 VL - 14 KW - assistive technology KW - psychosocial impact KW - quality of life KW - visual impairment KW - scoping review protocol KW - mobile phone N2 - 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 UR - https://www.researchprotocols.org/2025/1/e65056 UR - http://dx.doi.org/10.2196/65056 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65056 ER - TY - JOUR AU - Binyamin-Netser, Reut AU - Handelzalts, Shirley AU - Goldhamer, Noy AU - Avni, Inbar AU - Tayer Yeshurun, Adi AU - Koren, Yogev AU - Bibas Levy, Ofri AU - Kramer, Shilo AU - Bar Haim, Simona AU - Shmuelof, Lior PY - 2025/2/13 TI - Neurotechnology-Based, Intensive, Supplementary Upper-Extremity Training for Inpatients With Subacute Stroke: Feasibility Study JO - JMIR Serious Games SP - e56397 VL - 13 KW - stroke KW - rehabilitation KW - neurotechnology N2 - Background: Upper-extremity hemiparesis is a common and debilitating impairment after stroke, severely restricting stroke survivors? ability to participate in daily activities and function independently. Alarmingly, only a small percentage of stroke patients fully recover upper extremity function. Animal models indicate that high-dose upper extremity training during the early poststroke phase can significantly enhance motor recovery. However, translating such programs for human patients remains challenging due to resource limitations, patient compliance issues, and administrative constraints. Objective: This study aimed to assess the feasibility and potential efficacy of an intensive, video game?based upper-extremity training protocol designed to improve movement quality during inpatient stroke rehabilitation. Additionally, it evaluated the resources required for this intervention. Specifically, the protocol provides high-intensity, high-dose training to facilitate motor recovery by engaging patients in targeted interactive exercises. Methods: Twelve patients with upper-extremity hemiparesis completed a 4-week intensive training program comprising 40 sessions of 60 minutes; the training was conducted for 2 hours per day, 5 days per week. This was delivered in addition to standard care, which included 3 therapeutic sessions daily. Two video game?based platforms were used: one platform (tech 1) targeted proximal movements involving the shoulder and elbow, while the second platform (tech 2) emphasized distal movements of the wrist and fingers. Feasibility was assessed using the measure of time on task and measures of patients? motivation and engagement. Potential effectiveness was assessed using the Fugl-Meyer Assessment of the upper extremity (FMA-UE) scale, Action Research Arm Test (ARAT), and Stroke Impact Scale (SIS). Results: Of the 12 patients, 8 completed the full protocol, 3 completed 34?38 sessions, and 1 completed 27 sessions. On average, patients actively engaged in exercises for 35 (SD 4) minutes per hour on the proximal platform (tech 1) and 37 (SD 2) minutes on the distal platform (tech 2). Patients reported high motivation and enjoyment throughout the sessions, with an Intrinsic Motivation Inventory enjoyment score of 6.49 (SD 0.66) out of 7. Pain levels were minimal, with a visual analogue scale (VAS) mean score of 2.00 (SD 2.32). Significant improvements were observed in motor function assessments: the mean improvement in FMA-UE score was 16.5 (SD 10.2) points, ARAT scores increased by 22.9 (SD 13.1) points, and the SIS Hand Function and Recovery score showed a mean delta of 1.23 (SD 0.80) points and a 23.33% (SD 21.5%) improvement, respectively. Conclusions: These findings demonstrate that a high-dose, high-intensity, video game?based training protocol is feasible and can be successfully integrated into subacute stroke rehabilitation. Additionally, preliminary evidence suggests that this supplementary intervention may be effective in enhancing motor recovery. This approach holds promise for future stroke rehabilitation protocols by offering an engaging, high-dose, and high-intensity program during early recovery. Trial Registration: Clinicaltrials.gov NCT04737395, https://clinicaltrials.gov/study/NCT04737395 UR - https://games.jmir.org/2025/1/e56397 UR - http://dx.doi.org/10.2196/56397 ID - info:doi/10.2196/56397 ER - TY - JOUR AU - Lee, Sol-Hee AU - Kim, Jiae AU - Kim, Han-Joon PY - 2025/2/13 TI - Smartphone Application?Based Voice and Speech Training Program for Parkinson Disease: Feasibility and Satisfaction Study With a Preliminary Rater-Blinded Single-Arm Pretest and Posttest Design JO - J Med Internet Res SP - e63166 VL - 27 KW - Parkinson disease KW - speech therapy KW - mHealth KW - home-based training KW - self-delivered KW - digital health care KW - app KW - feasibility KW - voice therapy KW - mobile phone KW - satisfaction KW - effectiveness KW - smartphone KW - apps KW - single-arm study KW - mobility KW - mobile health KW - acoustic analysis KW - self-training N2 - Background: Up to 75% of patients with Parkinson disease (PD) experience voice and speech impairments, such as breathy phonation and low speech volume, which worsen over time and negatively impact the quality of life. However, given their increasingly limited mobility, face-to-face speech therapy is often inaccessible. Mobile health (mHealth) apps offer accessible and cost-effective alternatives; yet, their application in PD-specific, self-delivered voice therapy remains underexplored. Objective: This study aimed to evaluate the feasibility, adherence, and satisfaction of a self-delivered smartphone app for voice therapy in patients with PD, designed to minimize speech-language pathologist involvement while promoting patient independence. In addition, it seeks to assess the preliminary therapeutic effectiveness of the app in addressing voice and speech problems in this population. Methods: A single-arm, rater-blinded, and pretest and posttest study was conducted between September to November 2023. Patients with PD with voice and speech problems who have no problem with using Android (Google) smartphones were recruited. Participants downloaded the researcher-developed mHealth app on their smartphone and participated in a patient-tailored 5-week home-based speech training program. Each session included 5 stages: breathing, oral motor exercises, loudness, prosody, and functional speaking. The training program consisted of 20 sessions, with participants completing 1 session per day, 4 days per week. Each session lasted approximately 20-30 minutes. Adherence was monitored through app logs, satisfaction was assessed through a phone survey, and therapeutic effectiveness was evaluated using acoustic analysis and auditory-perceptual assessments. Results: Out of 30 patients were initially recruited, but 2 of them withdrew. Out of 25 participants completed all the training sessions while 3 dropped out. The adherence was above 90% in 20 participants (80%, 20/25), 70% to 90% in 4 (16%, 4/25), and below 70% in 4 (16%, 4/25). Satisfaction was 75% (18/24) among the 24 people who participated in the survey. Significant improvements were observed in all acoustic measures: the maximum phonation time increased from 11.15 (SD 5.38) seconds to 14.01 (SD 5.64) seconds (P=.003), and vocal intensity increased from 71.59 (SD 4.39) dB to 73.81 (SD 3.48) dB (P<.001) across both sustained phonation and reading tasks. Voice quality scores on the GRBAS (grade, roughness, breathiness, asthenia, and strain) scale improved significantly (all components P<.001). Furthermore, 58.3% (14/24) of participants reported subjective improvements in their voice. Conclusions: This study demonstrates that home-based, self-training speech therapy delivered through a mHealth app is a feasible solution for patients with PD, suggesting that mHealth apps can serve as a convenient and effective alternative to face-to-face therapy by enhancing accessibility and empowering patients to actively manage their condition. UR - https://www.jmir.org/2025/1/e63166 UR - http://dx.doi.org/10.2196/63166 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63166 ER - TY - JOUR AU - Steinmetz, Carolin AU - Stenzel, Christina AU - Sylvester, Maj AU - Glage, Denis AU - Linke, Anne AU - Sadlonova, Monika AU - von Arnim, F. Christine A. AU - Schnieder, Marlena AU - Valentová, Miroslava AU - Heinemann, Stephanie PY - 2025/2/11 TI - Use of a Technology-Based Fall Prevention Program With Visual Feedback in the Setting of Early Geriatric Rehabilitation: Controlled and Nonrandomized Study JO - JMIR Form Res SP - e66692 VL - 9 KW - fall prevention KW - fall prevention program KW - early geriatric rehabilitation KW - gerontology KW - older adult KW - elder KW - aging KW - digital exercise intervention KW - digital activity KW - physical exercise KW - functional capacity KW - new technology KW - technology-based KW - digital intervention KW - feasibility N2 - Background: The Otago program (OP) is evidence-based and focuses on fall prevention in older people. The feasibility and usability of a short-term digital program modeled after the principles of the OP in the setting of early geriatric rehabilitation (EGR) are unclear. Objective: This study investigated the feasibility and usability of an additional technology-based fall prevention program (FPP) in the setting of EGR. Methods: We performed a feasibility study in the setting of EGR. A sample of 30 patients (mobility at least by walker; mini-mental status test score >17) was recruited between March and June 2024 and compared with a retrospective cohort (n=30, former EGR patients). All patients in the intervention group (IG) received a supervised, OP-modified FPP thrice/week for 20 minutes using a technology-based platform called ?Pixformance.? The device is a digital trainer and enables real-time corrections. The primary end point was the feasibility (given when 80% of the IG participated in 6 trainings within 2 weeks). Secondary outcomes were usability (patients? and facilitators? perspective; ?75%), risk of falls (Berg Balance Scale), mobility (Timed Up and Go Test), functional independence (Functional Independence Measure), and activities of daily living (Barthel Index). Several further exploratory end points were analyzed including anxiety and depression (Four-Item Patient Health Questionnaire; PH-Q4). Data were accessed at entry to EGR and after 2 weeks prior to discharge. To analyze the pre-posttest results, the dependent Student t test and the Wilcoxon test were applied. A mixed ANOVA with repeated measurements was used for statistical analyses of time-, group-, and interaction-related changes. Results: A cohort of 60 patients (mean 80.2, SD 6.1 y; 58% females, 35/60) was analyzed. The main indication for EGR was stroke (9/60, 15%). Patients were recruited into a prospective IG (n=30) and a retrospective control group (n=30). Of the 30 patients in the prospective IG, 11 patients (37%) completed 6 training sessions within 2 weeks. Reasons why participants did not complete 6 training sessions were diagnostic appointments (33%), pain/discomfort (33%), or fatigue (17%). EGR patients rated FPP usability at 84% and facilitators at 65% out of 100%. Pre-posttest analysis of the standard assessments showed a significant interaction in Berg Balance Scale (<.01). In both groups, a significant improvement over time was found in the Timed Up and Go Test (<.01), Barthel Index (<.01), and Functional Independence Measure (<.01). Likewise, in the IG, the PH-Q4 score (.02) improved. Conclusions: While the technology-based FPP in the EGR setting was generally well-accepted by patients, with high usability ratings, its feasibility was limited. Only 37% of participants completed the required additional training sessions. Further studies should test the technology-based FPP as an integrated part of the EGR complex therapy concept. Our findings suggest potential benefits of incorporating technology-based FPPs in EGR, but further refinement is needed to enhance participation and feasibility. UR - https://formative.jmir.org/2025/1/e66692 UR - http://dx.doi.org/10.2196/66692 ID - info:doi/10.2196/66692 ER - TY - JOUR AU - Cordillet, Sébastien AU - Drapier, Sophie AU - Leh, Frédérique AU - Dumont, Audeline AU - Bidet, Florian AU - Bonan, Isabelle AU - Jamal, Karim PY - 2025/2/6 TI - Detecting Freezing of Gait in Parkinson Disease Using Multiple Wearable Sensors Sets During Various Walking Tasks Relative to Medication Conditions (DetectFoG): Protocol for a Prospective Cohort Study JO - JMIR Res Protoc SP - e58612 VL - 14 KW - Parkinson KW - detection KW - freezing of gait KW - sensor KW - wearable KW - freezing KW - walk KW - neurodegenerative KW - movement N2 - Background: Freezing of gait (FoG) is one of the most disabling symptoms of Parkinson disease (PD). Detecting and monitoring episodes of FoG are important in the medical follow-up of patients to assess disease progression and functional impact and to adjust treatment accordingly. Although several questionnaires exist, they lack objectivity. Using wearable sensors such as inertial measurement units (IMUs) to detect FoG episodes offers greater objectivity and accuracy. There is no consensus on the number and location of IMU, type of algorithm, and method of triggering and scoring the FoG episodes. Objective: The objective of this study is to investigate the use of multiple wearable sensors sets to detect FoG in patients with PD during various walking tasks under different medication conditions. Methods: This single-center, prospective cohort study (DetectFoG) will include 18 patients with PD. Patients will be fitted with 7 IMUs and will walk a freezing-provoking path under different tasks??single task,? ?dual motor task,? or ?dual cognitive task??and medical conditions corresponding to levodopa medication (?on? or ?off?). Passages will be videotaped, and 2 movement disorder specialists will identify FoG episodes in the videos. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of the most effective combination of wearable sensors for detecting FoG episodes will be studied. Results: The study is currently in the data collection phase, having commenced recruitment in February 2024. Once all data have been gathered, the data analysis will commence. As of August 2024, 3 patients have been recruited. It is anticipated that the results will be published by the end of 2025. Conclusions: Detecting FoG episodes in various medical and clinical settings would provide a more comprehensive understanding of this phenomenon. Furthermore, it would enable reliable and objective monitoring of the progression of this symptom based on treatments and the natural course of the disease. This could serve as an objective tool for monitoring patients and assessing the severity and frequency of FoG. Trial Registration: Clinicaltrials.gov NCT05822258; https://www.clinicaltrials.gov/study/NCT05822258 International Registered Report Identifier (IRRID): DERR1-10.2196/58612 UR - https://www.researchprotocols.org/2025/1/e58612 UR - http://dx.doi.org/10.2196/58612 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58612 ER - TY - JOUR AU - McMullan, Christel AU - Turner, Grace AU - Retzer, Ameeta AU - Belli, Antonio AU - Davies, Haf Elin AU - Nice, Laura AU - Flavell, Luke AU - Flavell, Jackie AU - Calvert, Melanie PY - 2025/1/23 TI - Testing an Electronic Patient-Reported Outcome Platform in the Context of Traumatic Brain Injury: PRiORiTy Usability Study JO - JMIR Form Res SP - e58128 VL - 9 KW - usability study KW - usability KW - patient reported outcome KW - PRO KW - electronic patient reported outcome KW - ePRO KW - traumatic brain injury KW - TBI KW - think aloud KW - cognitive interviews KW - early warning KW - early detection KW - mobile phone N2 - Background: Traumatic brain injury (TBI) is a significant public health issue and a leading cause of death and disability globally. Advances in clinical care have improved survival rates, leading to a growing population living with long-term effects of TBI, which can impact physical, cognitive, and emotional health. These effects often require continuous management and individualized care. Traditional paper-based assessments can be cumbersome, potentially impeding regular monitoring of patient-reported outcomes (PROs). Electronic PROs (ePROs) offer a promising alternative by enabling real-time symptom tracking, which can facilitate early identification of issues, support shared decision-making, and improve outcomes for patients with TBI. Objective: This study evaluates the usability of an ePRO platform?Atom5?for individuals with TBI. By analyzing how patients use the system to report their symptoms, the study aims to identify usability issues, assess user satisfaction, and determine the potential of Atom5 to support ongoing patient-centered care. Methods: Atom5 was customized to enable individuals with TBI to report their symptoms. Usability testing was conducted through one-on-one sessions with participants recruited from Headway UK?an organization supporting brain injury survivors. Each participant took part in cognitive interviews using with the ?Think Aloud? method, encouraging them to verbalize their thoughts and experiences while using the platform. This approach provided qualitative insights into areas of difficulty, usability strengths, and accessibility barriers. User satisfaction was quantitatively assessed with a brief 4-item questionnaire based on the System Usability Scale. Usability outcomes were analyzed for critical and noncritical errors, focusing on user experience and overall satisfaction. Results: In total, 9 participants completed a single usability testing session using Atom5, including 4 men, 4 women, and 1 nonbinary individual; 4 participants were under 55 years old, and 6 had their TBI <10 years ago. Finally, 8 participants used an Android device. The platform included measures for anxiety (Generalized Anxiety Disorder-2 item), depression (Patient Health Questionnaire-2), posttraumatic stress disorder (Posttraumatic Stress Disorder checklist 2), and TBI-specific quality of life (Traumatic Brain Injury ? Quality of Life Short form) and a total of 26 questions. Overall, all participants were satisfied with the system, noting that it was easy to navigate and accessible despite difficulties in understanding some questions. Further, 6 participants encountered no errors, while 1 participant reported one critical error and 2 others reported one noncritical error each. The participants rated their overall satisfaction with the platform at an average score of 3.9 (SD 0.49) out of 5. Conclusions: This usability study suggests that individuals living with TBI can effectively report symptoms using the Atom5 ePRO platform, with generally high satisfaction and few usability issues, thereby enabling continuous monitoring and proactive symptom management. Future ePRO development should focus on inclusivity and adaptability to address the diverse needs of patients with TBI, ensuring these tools can effectively support a wide range of users. UR - https://formative.jmir.org/2025/1/e58128 UR - http://dx.doi.org/10.2196/58128 ID - info:doi/10.2196/58128 ER - TY - JOUR AU - Hadar Souval, Dorit AU - Haber, Yuval AU - Tal, Amir AU - Simon, Tomer AU - Elyoseph, Tal AU - Elyoseph, Zohar PY - 2025/1/15 TI - Transforming Perceptions: Exploring the Multifaceted Potential of Generative AI for People With Cognitive Disabilities JO - JMIR Neurotech SP - e64182 VL - 4 KW - generative artificial intelligence KW - cognitive disability KW - social participation KW - AI ethics KW - assistive technology KW - cognitive disorder KW - societal barriers KW - social inclusion KW - disability study KW - social mirror KW - cognitive partner KW - empowerment KW - user involvement KW - GenAI KW - artificial intelligence KW - neurotechnology KW - neuroinformatics KW - digital health KW - health informatics KW - neuroscience KW - mental health KW - computer science KW - machine learning N2 - Background: The emergence of generative artificial intelligence (GenAI) presents unprecedented opportunities to redefine conceptions of personhood and cognitive disability, potentially enhancing the inclusion and participation of individuals with cognitive disabilities in society. Objective: We aim to explore the transformative potential of GenAI in reshaping perceptions of cognitive disability, dismantling societal barriers, and promoting social participation for individuals with cognitive disabilities. Methods: This study is a critical review of current literature in disability studies, artificial intelligence (AI) ethics, and computer science, integrating insights from disability theories and the philosophy of technology. The analysis focused on 2 key aspects: GenAI as a social mirror reflecting societal values and biases, and GenAI as a cognitive partner for individuals with cognitive disabilities. Results: This paper proposes a theoretical framework for understanding the impact of GenAI on perceptions of cognitive disability. It introduces the concepts of GenAI as a ?social mirror? that reflects and potentially amplifies societal biases and as a ?cognitive copilot? providing personalized assistance in daily tasks, social interactions, and environmental navigation. This paper also presents a novel protocol for developing AI systems tailored to the needs of individuals with cognitive disabilities, emphasizing user involvement, ethical considerations, and the need to address both the opportunities and challenges posed by GenAI. Conclusions: Although GenAI has great potential for promoting the inclusion and empowerment of individuals with cognitive disabilities, realizing this potential requires a change in societal attitudes and development practices. This paper calls for interdisciplinary collaboration and close partnership with the disability community in the development and implementation of GenAI technologies. Realizing the potential of GenAI for promoting the inclusion and empowerment of individuals with cognitive disabilities requires a multifaceted approach. This involves a shift in societal attitudes, inclusive AI development practices that prioritize the needs and perspectives of the disability community, and ongoing interdisciplinary collaboration. This paper emphasizes the importance of proceeding with caution, recognizing the ethical complexities and potential risks alongside the transformative possibilities of GenAI technology. UR - https://neuro.jmir.org/2025/1/e64182 UR - http://dx.doi.org/10.2196/64182 ID - info:doi/10.2196/64182 ER - TY - JOUR AU - Bevilacqua, Roberta AU - Maranesi, Elvira AU - Benadduci, Marco AU - Cortellessa, Gabriella AU - Umbrico, Alessandro AU - Fracasso, Francesca AU - Melone, Giovanni AU - Margaritini, Arianna AU - La Forgia, Angela AU - Di Bitonto, Pierpaolo AU - Potenza, Ada AU - Fiorini, Laura AU - La Viola, Carlo AU - Cavallo, Filippo AU - Leone, Alessandro AU - Caroppo, Andrea AU - Rescio, Gabriele AU - Marzorati, Mauro AU - Cesta, Amedeo AU - Pelliccioni, Giuseppe AU - Riccardi, Renato Giovanni AU - Rossi, Lorena PY - 2025/1/14 TI - Exploring Dance as a Therapeutic Approach for Parkinson Disease Through the Social Robotics for Active and Healthy Ageing (SI-Robotics): Results From a Technical Feasibility Study JO - JMIR Aging SP - e62930 VL - 8 KW - Parkinson disease KW - rehabilitation KW - Irish dancing KW - balance KW - gait KW - socially interacting robot N2 - Background: Parkinson disease (PD) is a progressive neurodegenerative disorder characterized by motor symptoms. Recently, dance has started to be considered an effective intervention for people with PD. Several findings in the literature emphasize the necessity for deeper exploration into the synergistic impacts of dance therapy and exergaming for PD management. Moreover, socially engaging robotic platforms equipped with advanced interaction and perception features offer potential for monitoring patients? posture and enhancing workout routines with tailored cues. Objective: This paper presents the results of the Social Robotics for Active and Healthy Ageing (SI-Robotics) project, aimed at designing an innovative rehabilitation program targeted at seniors affected by (early-stage) PD. This study therefore aims to assess the usefulness of a dance-based rehabilitation program enriched by artificial intelligence?based exergames and contextual robotic assistance in improving motor function, balance, gait, and quality of life in patients with PD. The acceptability of the system is also investigated. Methods: The study is designed as a technical feasibility pilot to test the SI-Robotics system. For this study, 20 patients with PD were recruited. A total of 16 Irish dance?based rehabilitation sessions of 50 minutes were conducted (2 sessions per week, for 8 wks), involving 2 patients at a time. The designed rehabilitation session involves three main actors: (1) a therapist, (2) a patient, and (3) a socially interacting robot. To stimulate engagement, sessions were organized in the shape of exergames where an avatar shows patients the movements they should perform to correctly carry out a dance-based rehabilitation exercise. Results: Statistical analysis reveals a significant difference on the Performance-Oriented Mobility Assessment scale, both on balance and gait aspects, together with improvements in Short Physical Performance Battery, Unified Parkinson Disease Rating Scale?III, and Timed Up and Go test, underlying the usefulness of the rehabilitation intervention on the motor symptoms of PD. The analysis of the Unified Theory of Acceptance and Use of Technology subscales provided valuable insights into users? perceptions and interactions with the system. Conclusions: This research underscores the promise of merging dance therapy with interactive exergaming on a robotic platform as an innovative strategy to enhance motor function, balance, gait, and overall quality of life for patients grappling with PD. Trial Registration: ClinicalTrials.gov NCT05005208; https://clinicaltrials.gov/study/NCT05005208 UR - https://aging.jmir.org/2025/1/e62930 UR - http://dx.doi.org/10.2196/62930 ID - info:doi/10.2196/62930 ER - TY - JOUR AU - von Bosse, Alexa AU - König, Peter AU - Jansen, Eva PY - 2025/1/13 TI - Influence of Partnership Relationships on Long-Term Neurological Rehabilitation in Germany: Protocol for a Qualitative Retrospective Study JO - JMIR Res Protoc SP - e63949 VL - 14 KW - neurological rehabilitation KW - neurological injury KW - therapeutic alliance KW - relationship building KW - caregivers KW - family KW - partnership KW - health professionals KW - neurological KW - therapeutic KW - Germany KW - retrospective study KW - narrative interview KW - biopsychosocial KW - family-centered N2 - Background: Acquired neurological diseases entail significant changes and influence the relationship between a patient and their significant other. In the context of long-term rehabilitation, those affected collaborate with health care professionals who are expected to have a positive impact on the lives of the affected individuals. Objective: This study aims to examine the changes in the relationship between the patient and their loved ones due to acquired neurological disorders and the influence of health care professionals on this relationship. Methods: Through sociogenetic type building, we will identify different types of patient-caregiver dyads and their effects on health care professionals and vice versa. The results will then be integrated into a model based on the theory of symbolic interactionism and Baxter?s Relational Dialectics Theory. Results: This study is not funded and was approved by the ethics committee of the German Society for Nursing Science, and it complies with the Declaration of Helsinki. The data collection started in June 2024 based on narrative couple interviews and is running. We assume that patients and their relatives will demonstrate heterogeneity as individuals, as well as in their interactions within the dyad, regarding certain orientations such as coping with illness, motivation for therapy, and coping strategies. Conclusions: Our findings address a biopsychosocial perspective that enhances treatment approaches in neurological long-term care. Understanding the influence of professionals on dyadic couple relationships can improve rehabilitation effectiveness by tailoring therapeutic approaches to various patient types, relatives, and dyadic relationship constellations. This fosters patient- and family-centered therapy in line with holistic care. International Registered Report Identifier (IRRID): DERR1-10.2196/63949 UR - https://www.researchprotocols.org/2025/1/e63949 UR - http://dx.doi.org/10.2196/63949 UR - http://www.ncbi.nlm.nih.gov/pubmed/39804683 ID - info:doi/10.2196/63949 ER - TY - JOUR AU - De Silva, Upeka AU - Madanian, Samaneh AU - Olsen, Sharon AU - Templeton, Michael John AU - Poellabauer, Christian AU - Schneider, L. Sandra AU - Narayanan, Ajit AU - Rubaiat, Rahmina PY - 2025/1/13 TI - Clinical Decision Support Using Speech Signal Analysis: Systematic Scoping Review of Neurological Disorders JO - J Med Internet Res SP - e63004 VL - 27 KW - digital health KW - health informatics KW - digital biomarker KW - speech analytics KW - artificial intelligence KW - machine learning N2 - Background: Digital biomarkers are increasingly used in clinical decision support for various health conditions. Speech features as digital biomarkers can offer insights into underlying physiological processes due to the complexity of speech production. This process involves respiration, phonation, articulation, and resonance, all of which rely on specific motor systems for the preparation and execution of speech. Deficits in any of these systems can cause changes in speech signal patterns. Increasing efforts are being made to develop speech-based clinical decision support systems. Objective: This systematic scoping review investigated the technological revolution and recent digital clinical speech signal analysis trends to understand the key concepts and research processes from clinical and technical perspectives. Methods: A systematic scoping review was undertaken in 6 databases guided by a set of research questions. Articles that focused on speech signal analysis for clinical decision-making were identified, and the included studies were analyzed quantitatively. A narrower scope of studies investigating neurological diseases were analyzed using qualitative content analysis. Results: A total of 389 articles met the initial eligibility criteria, of which 72 (18.5%) that focused on neurological diseases were included in the qualitative analysis. In the included studies, Parkinson disease, Alzheimer disease, and cognitive disorders were the most frequently investigated conditions. The literature explored the potential of speech feature analysis in diagnosis, differentiating between, assessing the severity and monitoring the treatment of neurological conditions. The common speech tasks used were sustained phonations, diadochokinetic tasks, reading tasks, activity-based tasks, picture descriptions, and prompted speech tasks. From these tasks, conventional speech features (such as fundamental frequency, jitter, and shimmer), advanced digital signal processing?based speech features (such as wavelet transformation?based features), and spectrograms in the form of audio images were analyzed. Traditional machine learning and deep learning approaches were used to build predictive models, whereas statistical analysis assessed variable relationships and reliability of speech features. Model evaluations primarily focused on analytical validations. A significant research gap was identified: the need for a structured research process to guide studies toward potential technological intervention in clinical settings. To address this, a research framework was proposed that adapts a design science research methodology to guide research studies systematically. Conclusions: The findings highlight how data science techniques can enhance speech signal analysis to support clinical decision-making. By combining knowledge from clinical practice, speech science, and data science within a structured research framework, future research may achieve greater clinical relevance. UR - https://www.jmir.org/2025/1/e63004 UR - http://dx.doi.org/10.2196/63004 UR - http://www.ncbi.nlm.nih.gov/pubmed/39804693 ID - info:doi/10.2196/63004 ER - TY - JOUR AU - Cinotti, Raphael AU - Derouin, Yvan AU - Chenet, Amandine AU - Oujamaa, Lydia AU - Glize, Bertrand AU - Launey, Yoann AU - Dahyot-Fizelier, Claire AU - Cartron, Emmanuelle AU - Renvoise, Melodie AU - Sautenet, Benedicte AU - Sebille, Veronique PY - 2025/1/9 TI - Standardized Outcomes for Randomized Controlled Trials Targeting Early Interventions in Patients With Moderate-to-Severe Traumatic Brain Injury: Protocol for the Development of a Core Outcome Set JO - JMIR Res Protoc SP - e54525 VL - 14 KW - core outcome set KW - outcomes research KW - patient-centered outcomes KW - traumatic brain injury KW - patient outcome KW - head trauma KW - patient-centered N2 - Background: : With more than 60 million new cases around the world each year, traumatic brain injury (TBI) causes substantial mortality and morbidity. Managing TBI is a major human, social, and economic concern. In the last 20 years, there has been an increase in clinical trials in neurocritical care, leading mostly to negative results. The evaluation of neurological outcomes, predominantly as primary outcomes, using clinical scales (Glasgow Outcome Scale) has limitations that could explain these results. Moreover, patient-centered outcomes are seldom reported despite their recognized clinical relevance. Objective: : The aim of this project is to establish a core outcome set (COS) for patients with moderate-to-severe TBI in randomized control trials in neurocritical care research. Methods: This study will follow five distinct steps: (1) systematic review to identify outcomes that have been reported in trials; (2) semistructured interviews with patients and their families to identify their priorities after TBI and explore potential patient-centered outcomes; (3) health care stakeholder focus groups with clinicians, researchers, and policy makers to describe potential outcomes; (4) an eDelphi survey with stakeholder groups to make a list of previously identified core outcomes; and (5) a consensus workshop to establish a COS for moderate-to-severe TBI clinical trials. Results: : The systematic review was published in August 2024. Regarding Step 2, 30 semistructured interviews of patients and relatives were performed from July 2021 to December 2023, and analyses were completed in October 2024. Step 3 is currently under development, and Step 4 is planned for the end of 2025. Step 5 is expected to occur during fall/winter 2026.Conclusions: Establishing a COS, to be consistently measured and reported in TBI trials in neurocritical care will ensure rigorous reporting, avoid bias, and improve the integrity, transparency, and usability of clinical research. The French context of the study is the main limitation, but we are seeking international collaboration on the project. The results of each step of the project will be disseminated through abstracts, publications, and patient associations. Conclusions: Establishing a COS, to be consistently measured and reported in TBI trials in neurocritical care will ensure rigorous reporting, avoid bias, and improve the integrity, transparency, and usability of clinical research. The French context of the study is the main limitation, but we are seeking international collaboration on the project. The results of each step of the project will be disseminated through abstracts, publications, and patient associations. International Registered Report Identifier (IRRID): DERR1-10.2196/54525 UR - https://www.researchprotocols.org/2025/1/e54525 UR - http://dx.doi.org/10.2196/54525 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54525 ER - TY - JOUR AU - Turcott, Alyssa AU - Kang, Ruthine AU - Yao, Christopher AU - O'Melinn, Colleen AU - Mahoney, Patricia AU - Barlow, Susan AU - Schmidt, Julia PY - 2025/1/7 TI - The MyGuide Web-Based Self-Management Tool for Concussion Rehabilitation: Mixed Methods Cross-Sectional Study JO - JMIR Rehabil Assist Technol SP - e59181 VL - 12 KW - concussion KW - self-management KW - health information technology KW - perceptions KW - concussion recovery KW - concussion management KW - concussion rehabilitation KW - rehabilitation KW - self-management tool KW - perception KW - digital health KW - e-health KW - mobile app KW - mhealth KW - web-based tool N2 - 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. UR - https://rehab.jmir.org/2025/1/e59181 UR - http://dx.doi.org/10.2196/59181 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59181 ER - TY - JOUR AU - Chen, Jiayin AU - Or, Kalun Calvin AU - Li, Zhixian AU - Yeung, Kwong Eric Hiu AU - Chen, Tianrong PY - 2025/1/1 TI - Perceptions of Patients With Stroke Regarding an Immersive Virtual Reality?Based Exercise System for Upper Limb Rehabilitation: Questionnaire and Interview Study JO - JMIR Serious Games SP - e49847 VL - 13 KW - virtual reality KW - stroke KW - perception KW - rehabilitation KW - questionnaire KW - interview N2 - Background: With substantial resources allocated to develop virtual reality (VR)?based rehabilitation exercise programs for poststroke motor rehabilitation, it is important to understand how patients with stroke perceive these technology-driven approaches, as their perceptions can determine acceptance and adherence. Objective: This study aimed to examine the perceptions of patients with stroke regarding an immersive VR-based exercise system developed to deliver shoulder, elbow, forearm, wrist, and reaching exercises. Methods: A questionnaire was used to assess the perceptions of 21 inpatients who had experienced stroke (mean time from stroke onset: 37.2, SD 25.9 days; Brunnstrom stage of stroke recovery for the arm: 3-5) regarding the perceived usefulness of, ease of use of, attitude toward, intrinsic motivation for, and intention to use the exercise system. The measurement items were rated on a 7-point Likert scale ranging from 1 (very strongly disagree) to 7 (very strongly agree), with higher values indicating more positive perceptions. Descriptive statistics were used to summarize the responses. Moreover, we conducted semistructured interviews that were audio recorded, transcribed, and subjected to content analysis to identify thematic patterns. Results: The questionnaire results revealed that the patients? perceptions of the exercise system were positive (mean ratings >6). The content analysis revealed 6 positive themes from 73 statements about the exercise system: ease of use, usefulness, enjoyment, motivation, accessibility, and game design. Conversely, 15 statements reflected negative perceptions, which were clustered into 3 themes: difficulty in handling VR devices, uncomfortable experiences when using VR devices, and monotony. Conclusions: Integrating VR technology into poststroke functional exercises holds significant promise based on patient interests. However, patient preferences and adaptability must be considered to promote the technology?s success. VR-guided exercises should be user-friendly, health-promoting, engaging, and well-designed. Furthermore, addressing challenges, such as bulkiness, motion sickness, discomfort, and exercise monotony, is crucial for the widespread adoption and diffusion of this technology. UR - https://games.jmir.org/2025/1/e49847 UR - http://dx.doi.org/10.2196/49847 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/49847 ER - TY - JOUR AU - O'Mara, Ben AU - Harrison, Matthew AU - Harley, Kirsten AU - Dwyer, Natasha PY - 2024/12/23 TI - Making Video Games More Inclusive for People Living With Motor Neuron Disease: Scoping Review JO - JMIR Rehabil Assist Technol SP - e58828 VL - 11 KW - motor neuron disease KW - video games KW - inclusion KW - information technology KW - well-being KW - disability KW - mobile phone N2 - Background: Evidence suggests that individuals with motor neuron disease (MND), a terminal illness, find enjoyment and social connection through video games. However, MND-related barriers can make gaming challenging, exacerbating feelings of boredom, stress, isolation, and loss of control over daily life. Objective: We scoped the evidence to describe relevant research and practice regarding what may help reduce difficulties for people with MND when playing video games. Methods: A scoping review was conducted using the Arksey and O?Malley framework, recent scoping review guidance, and engaging with people with lived experience of MND. Peer-reviewed studies were sourced from PubMed and the Swinburne University of Technology Library. Gray literature was identified from government, not-for-profit, commercial, and community websites. Data were extracted and summarized from the collected literature. Results: The evidence base, consisting of quantitative and qualitative research, lived experience stories, information resources, reviews, and guidelines, included 85 documents. Only 8 (9%) directly addressed video games and people with MND; however, these studies were limited in depth and quality. The primary technologies examined included customized information and communications technology for communication and control of computing systems (including desktop, laptop, smartphone, tablet, and console systems) and video game software and hardware (including hand controllers and accessibility features, such as difficulty level, speed, and remappable buttons and controls). Common factors in the evidence base highlight barriers and enablers to enjoying video games for people with MND. These include technological, physical, social, and economic challenges. Addressing these requires greater involvement of people with MND in game and technology research and development. Changes to information and communications technology, game software and hardware, policies, and guidelines are needed to better meet their needs. Conclusions: There is a significant gap in understanding the lived experience of people with MND with video games and what makes playing them easier, including appropriate customization of technology and the social experience of games. This gap perpetuates exclusion from gaming communities and recreation, potentially worsening social isolation. Existing evidence suggesting viable options for future research and practice. Video game and information and communications technology research and development must prioritize qualitative and quantitative research with people with MND at an appropriate scale, with a focus on lived experience, use of improved participant engagement techniques, and user-focused design for more inclusive games. Practical work needs to increase awareness of what can help make games more inclusive, including incorporation of accessibility early in the game production process, early incorporation of accessibility in game production, and affordable options for customized interfaces and other devices to play games. UR - https://rehab.jmir.org/2024/1/e58828 UR - http://dx.doi.org/10.2196/58828 UR - http://www.ncbi.nlm.nih.gov/pubmed/39714921 ID - info:doi/10.2196/58828 ER - TY - JOUR AU - Bearss, A. Karolina AU - Barnstaple, E. Rebecca AU - Bar, J. Rachel AU - DeSouza, X. Joseph F. PY - 2024/12/13 TI - Impact of Weekly Community-Based Dance Training Over 8 Months on Depression and Blood Oxygen Level?Dependent Signals in the Subcallosal Cingulate Gyrus for People With Parkinson Disease: Observational Study JO - JMIRx Med SP - e44426 VL - 5 KW - depression KW - cingulate KW - GDS KW - Geriatric Depression Scale KW - neuroimaging KW - dancing KW - Parkinson disease KW - neurodegenerative KW - MRI KW - imaging KW - neurology KW - magnetic resonance imaging N2 - Background: Dance has emerged as a complementary treatment that may promote adaptive neural plasticity while improving symptoms of Parkinson disease (PD), such as balance, gait, posture, and walking. Understanding brain changes that arise from participation in dance interventions is important as these neural plastic changes play an important role in protecting and healing the brain. Although dance has been shown to improve PD motor and nonmotor symptoms, the neural mechanisms underlying these changes, specifically depression and mood, remain elusive. Further, many side effects of PD drug treatments can be exacerbated or even induced by dopaminergic drugs, particularly depression and anxiety, making these nonmotor symptoms more noticeable throughout the progression of the disease. Objective: In this study, we focused on the impact of dance interventions on PD nonmotor symptoms by conducting an 8-month observational study, tracking the relationship between depression scores and functional neuroimaging measures for people with PD. Methods: A total of 34 dancers?23 (68%) people with PD and 11 (32%) healthy controls?completed the Geriatric Depression Scale (GDS) before and after attending weekly community-based dance classes, referred to as Dance for PD classes. Specifically, we examined changes within the functional magnetic resonance imaging signal from the subcallosal cingulate gyrus (SCG), an important node within the depression network and a controversial target for deep brain stimulation in the treatment of major depressive disorder. Results: Depression scores on the GDS decreased in each preintervention to postintervention comparison (all P<.025). In addition, GDS scores also improved over the 8-month dance period (all P<.01). Blood oxygen level?dependent signals from frontal cortex brain region implicated for emotional regulation within the SCG decreased at each testing time point (all P<.05). Also, a significant decrease in depression scores (GDS) was correlated with reduced blood oxygen level?dependent signals from the SCG (P=.02). Conclusions: This study contributes to an improved understanding of the neural mechanisms that are involved in depression, as well as the beneficial contribution that longitudinal dance interventions have in reducing nonmotor symptoms associated with PD, particularly in depression symptoms. UR - https://xmed.jmir.org/2024/1/e44426 UR - http://dx.doi.org/10.2196/44426 ID - info:doi/10.2196/44426 ER - TY - JOUR AU - Barnes, Keely AU - Sveistrup, Heidi AU - Bayley, Mark AU - Egan, Mary AU - Bilodeau, Martin AU - Rathbone, Michel AU - Taljaard, Monica AU - Karimijashni, Motahareh AU - Marshall, Shawn PY - 2024/11/27 TI - Investigation of Study Procedures to Estimate Sensitivity and Reliability of a Virtual Physical Assessment Developed for Workplace Concussions: Method-Comparison Feasibility Study JO - JMIR Neurotech SP - e57661 VL - 3 KW - brain injury KW - virtual KW - assessment KW - remote KW - evaluation KW - concussion KW - adult KW - clinician review KW - in-person KW - comparison KW - sensitivity KW - reliability KW - acceptability survey KW - feasibility study KW - psychometric properties KW - vestibular/ocular motor screening KW - VOMS KW - workplace KW - clinician KW - hospital KW - rehabilitation center KW - brain KW - neurology KW - neuroscience KW - neurotechnology KW - technology KW - digital intervention KW - digital health KW - psychometrics KW - physical assessment KW - clinical assessment KW - workplace safety KW - mobile phone N2 - Background: Remote approaches to workplace concussion assessment have demonstrated value to end users. The feasibility of administering physical concussion assessment measures in a remote context has been minimally explored, and there is limited information on important psychometric properties of physical assessment measures used in remote contexts. Objective: The objectives of this feasibility study were to determine recruitment capability for a future larger-scale study aimed at determining sensitivity and reliability of the remote assessment, time required to complete study assessments, and acceptability of remote assessment to people with brain injuries and clinicians; document preliminary results of the sensitivity of the remote assessment when compared to the in-person assessment; and estimate the preliminary interrater and intrarater reliability of the remote assessments to inform procedures of a future larger-scale study that is adequately powered to reliably estimate these parameters of interest. Methods: People living with acquired brain injury attended 2 assessments (1 in-person and 1 remote) in a randomized order. The measures administered in these assessments included the finger-to-nose test; balance testing; and the Vestibular/Ocular Motor Screening (VOMS) tool, including documentation of change in symptoms and distance for near point convergence, saccades, cervical spine range of motion, and evaluation of effort. Both assessments occurred at the Ottawa Hospital Rehabilitation Center. After the assessments, a clinician different from the person who completed the original assessments then viewed and documented findings independently on the recordings of the remote assessment. The same second clinician viewed the recording again approximately 1 month following the initial observation. Results: The rate of recruitment was 61% (20/33) of people approached, with a total of 20 patient-participants included in the feasibility study. A total of 3 clinicians participated as assessors. The length of time required to complete the in-person and remote assessment procedures averaged 9 and 13 minutes, respectively. The majority of clinicians and patient-participants agreed or strongly agreed that they were confident in the findings on both in-person and remote assessments. Feedback obtained revolved around technology (eg, screen size), lighting, and fatigue of participants in the second assessment. Preliminary estimates of sensitivity of the remote assessment ranged from poor (finger-to-nose testing: 0.0) to excellent (near point convergence: 1.0). Preliminary estimates of reliability of the remote assessment ranged from poor (balance testing, saccades, and range of motion: ?=0.38?0.49) to excellent (VOMS change in symptoms: ?=1.0). Conclusions: The results of this feasibility study indicate that our study procedures are feasible and acceptable to participants. Certain measures show promising psychometric properties (reliability and sensitivity); however, wide CIs due to the small sample size limit the ability to draw definitive conclusions. A planned follow-up study will expand on this work and include a sufficiently large sample to estimate these important properties with acceptable precision. International Registered Report Identifier (IRRID): RR2-10.2196/57663 UR - https://neuro.jmir.org/2024/1/e57661 UR - http://dx.doi.org/10.2196/57661 ID - info:doi/10.2196/57661 ER - TY - JOUR AU - Rose, K. Dorian AU - Brunetti, Gina AU - Cavka, Kathryn AU - Hoisington, Brooke J. AU - Snyder, Hannah AU - Xue, Wei AU - Smith, K. Barbara PY - 2024/11/27 TI - Respiratory Strength Training Versus Respiratory Relaxation Training in the Rehabilitation of Physical Impairment, Function, and Return to Participation After Stroke: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e59749 VL - 13 KW - stroke KW - rehabilitation KW - exercise KW - clinical trial KW - respiration KW - wellness KW - community based N2 - Background: Persistent disability in chronic stroke survivors is often attributed to arm or leg weakness; however, respiratory muscle weakness also impedes poststroke rehabilitation, reduces quality of life, and increases the risk of health complications. Respiratory complications are common after stroke and place patients at risk for both prolonged functional disability and mortality. In addition, stroke survivors face ongoing cardiovascular disease that places them at risk for recurrent stroke. Objective: The study aims to compare the effects of 2 respiratory training programs, paired with individualized flexibility, strengthening, and cardiovascular exercise programs, on physiologic, activity, and societal participation outcomes in chronic stroke survivors. Methods: This study will be a randomized controlled trial. Participants are 80 community-dwelling adults with chronic stroke. In conjunction with a 24-session (3 times/week for 8 weeks), American Heart Association?informed, whole-body exercise program, participants will be randomized to receive either respiratory strength training or respiratory relaxation training. Study intervention will be directed by a physical therapist and take place in a community fitness center. Outcome assessments will occur in a clinical research center. The primary outcome measure is maximal respiratory pressure. Secondary outcome measures include airway clearance, walking endurance, spatial-temporal gait characteristics, community walking, functional strength and fatigue, depression, and societal participation measures. Longer-term societal participation is a complex domain that may be influenced by other factors beyond physical function. Participants? health status will be monitored for 1 year following the intervention for falls, respiratory illness, and hospitalizations. Additional subanalyses will evaluate the effect of smoke exposure on short- and long-term outcomes. Outcome assessors are blinded to group assignments. Respiratory relaxation training is an active comparator, but no pure control group is included. Results: This study was funded in March 2020 with enrollment commencing in November 2020. Completion of enrollment is projected for May 2025 with a study projected end date of April 2026. Published results are anticipated in Fall 2026. Conclusions: Results from this study will improve our understanding of the additive benefits of respiratory exercises on short- and long-term physiologic, functional, and societal gains for these individuals. These data will be instructive to meet a current unmet rehabilitative need to promote patient-centered care and contribute to decreasing morbidity and mortality in chronic stroke survivors. Trial Registration: ClinicalTrials.gov: NCT05819333; https://clinicaltrials.gov/study/NCT05819333 International Registered Report Identifier (IRRID): DERR1-10.2196/59749 UR - https://www.researchprotocols.org/2024/1/e59749 UR - http://dx.doi.org/10.2196/59749 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59749 ER - TY - JOUR AU - Morrow, L. Emily AU - Nelson, A. Lyndsay AU - Duff, C. Melissa AU - Mayberry, S. Lindsay PY - 2024/11/26 TI - An Ecological Momentary Assessment and Intervention Tool for Memory in Chronic Traumatic Brain Injury: Development and Usability of Memory Ecological Momentary Intervention JO - JMIR Rehabil Assist Technol SP - e59630 VL - 11 KW - chronic traumatic brain injury KW - rehabilitation KW - memory KW - ecological momentary intervention KW - text messaging KW - mobile health KW - mobile application KW - digital health KW - digital intervention N2 - Background: Memory and learning deficits are among the most impactful and longest-lasting symptoms experienced by people with chronic traumatic brain injury (TBI). Despite the persistence of post-TBI memory deficits and their implications for community reintegration, memory rehabilitation is restricted to short-term care within structured therapy sessions. Technology shows promise to extend memory rehabilitation into daily life and to increase the number and contextual diversity of learning opportunities. Ecological momentary assessment and intervention frameworks leverage mobile phone technology to assess and support individuals? behaviors across contexts and have shown benefits in other chronic conditions. However, few studies have used regular outreach via text messaging for adults with chronic TBI, and none have done so to assess and support memory. Objective: This study aimed to develop and test the usability of memory ecological momentary intervention (MEMI), a text message?based assessment and intervention tool for memory in daily life. MEMI is designed to introduce new information, cue retrieval of the information, and assess learning across time and contexts. We tested MEMI via an iterative, user-centered design process to ready it for a future trial. Methods: We developed MEMI by leveraging automated text messages for prompts using a REDCap (Research Electronic Data Capture)/Twilio interface linking to the Gorilla web-based behavioral experimental platform. We recruited 14 adults with chronic, moderate-severe TBI from the Vanderbilt Brain Injury Patient Registry to participate in 3 rounds of usability testing: one round of ThinkAloud sessions using the platform and providing real-time feedback to an experimenter (n=4) and 2 rounds of real-world usability testing in which participants used MEMI in their daily lives for a week and provided feedback (n=5/round). We analyzed engagement and quantitative and qualitative user feedback to assess MEMI?s usability and acceptability. Results: Participants were highly engaged with MEMI, completing an average of 11.8 out of 12 (98%) possible sessions. They rated MEMI as highly usable, with scores on the System Usability Scale across all rounds equivalent to an A+ on a standardized scale. In semistructured interviews, they stated that MEMI was simple and easy to use, that daily retrieval sessions were not burdensome, and that they perceived MEMI as helpful for memory. We identified a few small issues (eg, instruction wording) and made improvements between usability testing rounds. Conclusions: Testing MEMI with adults with chronic TBI revealed that this technology is highly usable and favorably rated for this population. We incorporated feedback regarding users? preferences and plan to test the efficacy of this tool in a future clinical trial. UR - https://rehab.jmir.org/2024/1/e59630 UR - http://dx.doi.org/10.2196/59630 ID - info:doi/10.2196/59630 ER - TY - JOUR AU - Santamaría-Vázquez, Montserrat AU - Ortiz-Huerta, Hilario J. AU - Martín-Odriozola, Aitor AU - Saiz-Vazquez, Olalla PY - 2024/11/22 TI - Improvement of Motor Imagination and Manual Ability Through Virtual Reality and Selective and Nonselective Functional Electrical Stimulation: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e63329 VL - 13 KW - electric stimulation therapy KW - motor imagery KW - virtual reality exposure therapy KW - hand strength KW - hand injuries N2 - Background: Motor imagery (MI) is a cognitive process that has been shown to be useful in the rehabilitation process after brain injury. Moreover, functional electrical stimulation (FES) and virtual reality (VR) have also been shown to be effective interventions in many parameters, and there is some evidence of their contribution to the improvement of MI capacity. Objective: This study aimed to compare the improvements in MI parameters, grip strength, and manual dexterity obtained using VR, FES, and selective FES based on multifield electrodes in healthy people. Methods: This clinical randomized controlled trial (RCT)with 4 branches will involve 80 healthy university students, with blinded third-party assessment. Participants will be divided into 4 groups: control (no intervention), selective FES (Fesia Grasp), traditional FES (Globus Elite), and Virtual Rehab Hands (Leap Motion sensor). Each group will receive 5 daily sessions, and assessments will be conducted at baseline, postintervention, and follow-up. The Movement Imagery Questionnaire-Revised (MIQ-RS) and chronometry will be used to assess MI, strength will be measured with a digital dynamometer, and manual dexterity will be evaluated with the Nine Hole Peg Test (NHPT) and the Box and Block Test (BBT). Statistical analyses will include 2-way repeated-measures ANOVA with post hoc Bonferroni correction to compare group differences over time, with nonparametric tests (eg, Kruskal-Wallis) being used if normality or variance assumptions are violated. The study will be organized into 3 phases: preparation, data collection, and analysis. The preparation phase will involve finalizing project protocols and obtaining ethical approvals. The data collection phase will consist of recruiting participants, randomizing them into 4 intervention groups, and conducting baseline assessments, followed by intervention sessions. Finally, the analysis phase will focus on evaluating the data collected from all groups and compiling the results for presentation. Results: The study received approval in July 2023, with recruitment and data collection starting in September 2023. The recruitment phase was expected to conclude by July 2024, and the entire study, including the 2-week follow-up, was set to finish in September 2024. As of July 2024, we had enrolled 100% of the sample (N=80 students). We plan to publish the study findings by the end of 2024. Conclusions: Improvements in MI and upper limb functionality are expected, particularly in the selective FES group. This RCT will identify which intervention is most effective in enhancing these skills, with potential benefits for patients with neurological motor disorders. Trial Registration: ClinicalTrials.gov NCT06109025; https://clinicaltrials.gov/study/NCT06109025 International Registered Report Identifier (IRRID): DERR1-10.2196/63329 UR - https://www.researchprotocols.org/2024/1/e63329 UR - http://dx.doi.org/10.2196/63329 UR - http://www.ncbi.nlm.nih.gov/pubmed/39576986 ID - info:doi/10.2196/63329 ER - TY - JOUR AU - C Areias, Anabela AU - G Moulder, Robert AU - Molinos, Maria AU - Janela, Dora AU - Bento, Virgílio AU - Moreira, Carolina AU - Yanamadala, Vijay AU - P Cohen, Steven AU - Dias Correia, Fernando AU - Costa, Fabíola PY - 2024/11/19 TI - Predicting Pain Response to a Remote Musculoskeletal Care Program for Low Back Pain Management: Development of a Prediction Tool JO - JMIR Med Inform SP - e64806 VL - 12 KW - telerehabilitation KW - predictive modeling KW - personalized medicine KW - rehabilitation KW - clinical decision support KW - machine learning KW - artificial intelligence N2 - Background: Low back pain (LBP) presents with diverse manifestations, necessitating personalized treatment approaches that recognize various phenotypes within the same diagnosis, which could be achieved through precision medicine. Although prediction strategies have been explored, including those employing artificial intelligence (AI), they still lack scalability and real-time capabilities. Digital care programs (DCPs) facilitate seamless data collection through the Internet of Things and cloud storage, creating an ideal environment for developing and implementing an AI predictive tool to assist clinicians in dynamically optimizing treatment. Objective: This study aims to develop an AI tool that continuously assists physical therapists in predicting an individual?s potential for achieving clinically significant pain relief by the end of the program. A secondary aim was to identify predictors of pain nonresponse to guide treatment adjustments. Methods: Data collected actively (eg, demographic and clinical information) and passively in real-time (eg, range of motion, exercise performance, and socioeconomic data from public data sources) from 6125 patients enrolled in a remote digital musculoskeletal intervention program were stored in the cloud. Two machine learning techniques, recurrent neural networks (RNNs) and light gradient boosting machine (LightGBM), continuously analyzed session updates up to session 7 to predict the likelihood of achieving significant pain relief at the program end. Model performance was assessed using the area under the receiver operating characteristic curve (ROC-AUC), precision-recall curves, specificity, and sensitivity. Model explainability was assessed using SHapley Additive exPlanations values. Results: At each session, the model provided a prediction about the potential of being a pain responder, with performance improving over time (P<.001). By session 7, the RNN achieved an ROC-AUC of 0.70 (95% CI 0.65-0.71), and the LightGBM achieved an ROC-AUC of 0.71 (95% CI 0.67-0.72). Both models demonstrated high specificity in scenarios prioritizing high precision. The key predictive features were pain-associated domains, exercise performance, motivation, and compliance, informing continuous treatment adjustments to maximize response rates. Conclusions: This study underscores the potential of an AI predictive tool within a DCP to enhance the management of LBP, supporting physical therapists in redirecting care pathways early and throughout the treatment course. This approach is particularly important for addressing the heterogeneous phenotypes observed in LBP. Trial Registration: ClinicalTrials.gov NCT04092946; https://clinicaltrials.gov/ct2/show/NCT04092946 and NCT05417685; https://clinicaltrials.gov/ct2/show/NCT05417685 UR - https://medinform.jmir.org/2024/1/e64806 UR - http://dx.doi.org/10.2196/64806 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64806 ER - TY - JOUR AU - Zhou, Wu AU - Feng, HaiXia AU - Tao, Hua AU - Sun, Hui AU - Zhang, TianTian AU - Wang, QingXia AU - Zhang, Li PY - 2024/11/19 TI - Factors Influencing Poststroke Cognitive Dysfunction: Cross-Sectional Analysis JO - JMIR Form Res SP - e59572 VL - 8 KW - stroke KW - cognitive dysfunction KW - analysis of associated factors KW - MMSE KW - Mini-Mental State Examination KW - status survey KW - cognitive KW - survey KW - cognitive impairment KW - cross-sectional study KW - cross sectional KW - stroke patients KW - cognition KW - education N2 - Background: Poststroke cognitive impairment (PSCI) is a common and debilitating complication that affects stroke survivors, impacting memory, attention, and executive function. Despite its prevalence, the factors contributing to PSCI remain unclear, with limited insights into how demographic and clinical variables influence cognitive outcomes. Objective: This study investigates the incidence of cognitive impairment in patients with stroke and examines key demographic and clinical factors, such as age, gender, and education level, which contribute to cognitive decline. The aim is to provide a deeper understanding of PSCI to inform early intervention strategies for improving patient outcomes. Methods: A cross-sectional study was conducted on 305 patients with ischemic stroke admitted to Zhongda Hospital, Southeast University, from January 2019 to September 2022. Cognitive function was assessed using the Mini-Mental State Examination (MMSE) within 72 hours of hospital admission. Demographic information, including age, gender, and education level, were collected. Statistical analyses were performed using chi-square tests, independent t tests, and multivariate regression to assess the relationship between cognitive function and key variables. Pearson correlation analysis explored associations among age, education, and MMSE scores. Results: Among the 305 patients with stroke, 16.7% (n=51) were diagnosed with cognitive impairment based on MMSE scores. The prevalence of cognitive impairment was slightly higher in males (17.6%, n=159) than females (15.8%, n=146), but this difference was not statistically significant. A strong negative correlation was found between MMSE scores and age (r=?0.32; P<.01), indicating that older patients had lower cognitive function. Education level showed a positive correlation with MMSE scores (r=0.41; P<.01), with patients with higher educational attainment demonstrating better cognitive outcomes. Cognitive function showed a marked decline in patients older than 60 years, particularly in domains such as memory, attention, and language skills. Conclusions: This study confirms that age and education are significant factors in determining cognitive outcomes after stroke. The results align with existing literature showing that cognitive function declines with age, while higher educational attainment serves as a protective factor. The findings suggest that individuals with greater cognitive reserve, often linked to higher education, are better equipped to cope with the impact of brain injury. However, the study?s reliance on MMSE may have limited its ability to detect domain-specific impairments. Future studies should consider using more sensitive cognitive tools, such as the Montreal Cognitive Assessment (MoCA), to provide a more comprehensive evaluation of PSCI. Cognitive impairment is prevalent among stroke survivors, with age and education level being key factors influencing outcomes. These findings underscore the importance of early detection and targeted interventions to mitigate cognitive decline. Further research with larger samples and more sensitive cognitive assessments is needed to fully understand PSCI and improve rehabilitation strategies for patients with stroke. UR - https://formative.jmir.org/2024/1/e59572 UR - http://dx.doi.org/10.2196/59572 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59572 ER - TY - JOUR AU - Fahr, Annina AU - Kläy, Andrina AU - Coka, S. Larissa AU - van Hedel, A. Hubertus J. PY - 2024/11/18 TI - Effectiveness of Game-Based Training of Selective Voluntary Motor Control in Children With Upper Motor Neuron Lesions: Randomized Multiple Baseline Design Study JO - JMIR Form Res SP - e47754 VL - 8 KW - neurorehabilitation KW - single-case design KW - interactive computer play KW - cerebral palsy KW - surface electromyography KW - motor control KW - mirror movements KW - involuntary movements N2 - Background: Selective voluntary motor control (SVMC) is the ability to control joint movements independently. Impairments in SVMC can affect functional activities, but only a few interventions directly target SVMC. Therefore, we developed a game-based intervention for children with upper motor neuron lesions to improve SVMC. The intervention trained selective activation of a muscle or joint movement while providing immediate feedback about involuntarily occurring muscle activations or movements in another joint. The intervention was provided in a playful manner with a custom-made game environment and a technology-based interface to capture muscle activation or joint movements. Objective: This study aimed to investigate the effectiveness of this game-based intervention and explore treatment response?related factors in children with impaired SVMC undergoing inpatient neurorehabilitation. Methods: We conducted a single-case research study with a randomized, nonconcurrent, multiple baseline design. The study consisted of a random-length baseline phase where no SVMC-specific intervention was provided and an intervention phase with additional SVMC training. Concurrently in both phases, children attended their individual multimodal rehabilitation program at our clinic, Swiss Children?s Rehab. During the intervention phase, participants completed ten 45-minute sessions with our game-based SVMC training. SVMC was measured repeatedly throughout both phases and at the 3-month follow-up with a short custom-made assessment. Results: Eighteen children with reduced SVMC from upper motor neuron lesions participated in the study. The mean age of the children was 12.7 (SD 2.9) years, and they mostly had spastic cerebral palsy. A linear mixed-effects model revealed a significant trend (P<.001) for improved SVMC already in the baseline phase. This trend did not change significantly (P=.15) when the game-based SVMC training was introduced in the intervention phase, suggesting no additional improvements due to the SVMC training. Although we could not find an overall treatment effect, we could explain 89.4% of the total random variation of the treatment effect by patient and therapy characteristics. Children with spasticity in the trained movement (20.1%), and those who trained the more affected side (23.5%) benefited most from the intervention. At the 3-month follow-up, SVMC had deteriorated compared to the end of the intervention but was still better than at the beginning of the study. Conclusions: The regular concomitant rehabilitation program already yielded improvements in SVMC, while the game-based SVMC training showed no additional effects. Although the intervention did not show a group effect, we could identify patient and therapy characteristics that determine who is likely to profit from the intervention. Trial Registration: German Clinical Trials Register DRKS00025184; https://tinyurl.com/msnkek9b UR - https://formative.jmir.org/2024/1/e47754 UR - http://dx.doi.org/10.2196/47754 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/47754 ER - TY - JOUR AU - Wei, Xijun AU - Zhou, Ping AU - Wei, Yixi AU - Wu, Dashuang AU - Qin, Ping AU - Zhang, Yingying AU - Zhu, Jing AU - Ren, Zhanbing AU - Li, Hai AU - Zhang, Yumei PY - 2024/11/15 TI - Comparison of Occupational Performance in Immersive Virtual and Real Environments Among Patients With Stroke: Observational Randomized Crossover Pilot Study JO - JMIR Serious Games SP - e58388 VL - 12 KW - instrumental activities of daily living KW - immersive virtual reality KW - occupational performance KW - stroke rehabilitation KW - occupational therapy N2 - Background: Conventional rehabilitation approaches involve therapists simulating various occupational tasks in health care settings or recreating real-life situations to assess and train patients in instrumental activities of daily living (IADLs). As an alternative, immersive virtual reality (IVR) has been widely used in stroke rehabilitation for years, but research comparing occupational performance between virtual and real environments is limited. Objective: This study aims to introduce a novel IVR shopping system designed for patients with stroke and to investigate the correlation of occupational performance in virtual and real environments among patients with stroke. Methods: Ten patients with stroke were recruited from the Department of Rehabilitation Medicine, Shenzhen Hospital, Southern Medical University, who met the inclusion and exclusion criteria for this observational, randomized crossover study; the patients were predominantly male (n=7), had experienced ischemic stroke (n=9), were aged 14 to 73 years, and had a time since stroke of 1 to 42 months. All patients attempted shopping tasks in virtual and real environments. The Mini-Mental State Examination (MMSE), Timed Up and Go Test (TUGT), modified Barthel index (MBI), and Lawton index (LI) were used to assess cognition, ambulation, and activities of daily living. Memory capacity and duration in the virtual and real environments were recorded as the primary parameters of occupational performance. The Wilcoxon test and Spearman correlation coefficients were used to analyze the differences and correlations between the 2 environments. Results: The Wilcoxon test showed no significant differences between the virtual and real environments in memory capacity and duration of task completion (P>.99 and P=.99), and memory capacity in both environments correlated with the LI (?=0.81; P=.005). Memory duration had a relationship with the TUGT in the virtual environment (?=0.68; P=.03) and a borderline negative correlation with MMSE in the real environment (?=?0.58; P=.08). Conclusions: Considering the small sample size used in this study and the study?s limitations, despite the significant correlation between shopping performance in IVR and the real world, it is still too early to conclude that IVR is a noninferior approach, but it presents the potential to be an alternative for assessment and training in IADLs when resources are limited. However, further research is needed to investigate the psychometric properties, clinical effects, and impact of virtual training on real-world performance. The implications for practice might include the following: (1) occupational performance in virtual shopping might be the same as real-world shopping, and more virtual IADLs could thus be developed; (2) virtual IADL assessment and training systems could be used in remote locations or locations with limited resources; and (3) more objective parameters of IADLs could be extracted from virtual environments. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000041058; https://www.chictr.org.cn/showprojEN.html?proj=65714 UR - https://games.jmir.org/2024/1/e58388 UR - http://dx.doi.org/10.2196/58388 ID - info:doi/10.2196/58388 ER - TY - JOUR AU - Barnes, Keely AU - Sveistrup, Heidi AU - Karimijashni, Motahareh AU - Bayley, Mark AU - Egan, Mary AU - Bilodeau, Martin AU - Rathbone, Michel AU - Taljaard, Monica AU - Marshall, Shawn PY - 2024/11/13 TI - Barriers and Facilitators Associated With Remote Concussion Physical Assessments From the Perspectives of Clinicians and People Living With Workplace Concussions: Focus Group Study JO - J Med Internet Res SP - e56158 VL - 26 KW - remote care KW - mild traumatic brain injury KW - telehealth KW - assessment KW - workplace injury KW - concussion KW - telemedicine KW - brain injury N2 - Background: Evaluating the clinical status of concussions using virtual platforms has become increasingly common. While virtual approaches to care are useful, there is limited information regarding the barriers and facilitators associated with a virtual concussion assessment. Objective: This study aims to identify the barriers and facilitators associated with engaging in virtual concussion assessments from the perspective of people living with workplace concussions; identify the barriers and facilitators to completing virtual concussion assessments from the perspectives of clinicians; and identify the clinical measures related to 4 clinical domains that would be most appropriate in virtual practice: general neurological examination and vestibular, oculomotor, and cervical spine assessment. We also evaluated effort. Methods: Separate online focus groups were conducted with expert concussion clinicians and people living with workplace concussions. A moderator led the focus groups using a semistructured interview guide that targeted a discussion of participants? experiences with virtual assessments. The discussions were recorded, transcribed, and analyzed by 2 reviewers using content analysis. Barriers and facilitators associated with completing the physical concussion examination were categorized based on the domain of the concussion examination and more general barriers and facilitators. Clinician-selected measures believed to work best in a virtual practice were described using frequency counts. Results: A total of 4 focus groups with 15 people living with workplace concussions and 3 focus groups with 14 clinicians were completed using Microsoft Teams. Barriers were identified, such as triggering of symptoms associated with completing an assessment over video (mentioned 13/162 (8%) and 9/201 (4%) of the time for patient and clinician participants, respectively); challenges with location and setup (mentioned 16/162 (10%) of the time for patient participants); communication (mentioned 34/162 (21%) and 9/201 (4%) of the time for patient and clinician participants, respectively); and safety concerns (mentioned 11/162 (7%) of the time for patient and 15/201 (7%) for clinician participants). Facilitators were identified, such as having access to support (mentioned 42/154 (27%) and 21/151 (14%) of the time for patient and clinician participants, respectively); implementing symptom management strategies throughout the assessment (mentioned 11/154 (7%) of the time for patient participants); and having access to resources (mentioned 25/151 (17%) of the time for clinician participants). From the perspective of the clinician participants included in this study, the clinical measures recommended most for a virtual practice were finger to nose testing; balance testing; the Vestibular/Ocular Motor Screening tool; saccades; and cervical spine range of motion within their respective domains (ie, neurological examination, vestibular, oculomotor, and cervical spine assessment). Conclusions: Virtual assessments appear to be useful for both people living with workplace concussions and clinicians. While barriers were identified, such as challenges associated with exposure to screens, virtual assessments have benefits such as improved access to care. The clinician-selected measures that were considered best in a virtual practice will be investigated in an upcoming evaluative study. International Registered Report Identifier (IRRID): RR2-10.2196/40446 UR - https://www.jmir.org/2024/1/e56158 UR - http://dx.doi.org/10.2196/56158 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56158 ER - TY - JOUR AU - Mao, Qian AU - Zhao, Zhen AU - Yu, Lisha AU - Zhao, Yang AU - Wang, Hailiang PY - 2024/11/12 TI - The Effects of Virtual Reality?Based Reminiscence Therapies for Older Adults With Cognitive Impairment: Systematic Review JO - J Med Internet Res SP - e53348 VL - 26 KW - virtual reality KW - reminiscence therapy KW - cognitive impairment KW - older adults KW - mobile phone N2 - Background: Reminiscence therapy (RT) is a commonly used nonpharmaceutical treatment for cognitive impairment. Artifacts or conversations are used in RT to recall individuals? memories and past experiences. Virtual reality (VR) has increasingly been used as an assistive technology during RT. However, the effects of VR-based RT (VR-RT) methods remain unclear, and insights into the related benefits and challenges are urgently needed. Objective: The study aims to systematically review the effects of VR-RTs for older adults with cognitive impairment. Methods: Seven databases (MEDLINE, Academic Search Premier, CINAHL, Web of Science, PubMed, the Cochrane Central Register of Controlled Trials, and ScienceDirect) were searched to identify relevant articles published from inception to August 10, 2023. Peer-reviewed publications that assessed the effect of VR-RTs (ie, using virtual clues to evoke participants? memories or past experiences) on cognitive-related outcomes were included. Two independent researchers conducted the literature search, review, and data extraction processes. A narrative synthesis approach was used to analyze the extracted data. Results: Of the 537 identified articles, 22 were ultimately included in the data analysis. The results revealed that VR-RTs could maintain cognitive status (4/4, 100%) and reduce anxiety (2/2, 100%) in older adults with cognitive impairment. Nevertheless, one study found a cognitive improvement after VR-RTs, whereas cognitive degradation was observed at a 3- to 6-month follow-up measure. Around 88% (7/8) of the included studies indicated that VR-RTs improved memory; however, the evidence regarding the beneficial effects of VR-RTs was limited in improving quality of life (1/4, 25%) and reducing apathy (0/2, 0%) and depression (1/3, 33%). The results indicated that VR-RTs are safe, engaging, acceptable, and satisfying for older adults with cognitive impairment. In VR scenarios, personalized stimulus materials related to the users? youth experiences were more effective for treating cognitive impairment than other stimulus materials. Conclusions: The results of this systematic review demonstrate the potential benefits of VR-RT for older adults with cognitive impairment, especially in improving emotion and memory and maintaining cognitive status. VR-RT is also safe and enjoyable for older adults. However, due to the trial heterogeneity of included studies, we can only provide qualitative results instead of performing meta-analysis to quantify the effect size of VR-RTs. Thus, more randomized controlled trials are required to examine the designs and effects of VR-RTs for groups of older adults with specific needs. UR - https://www.jmir.org/2024/1/e53348 UR - http://dx.doi.org/10.2196/53348 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53348 ER - TY - JOUR AU - Scaramozza, Matthew AU - Ruet, Aurélie AU - Chiesa, A. Patrizia AU - Ahamada, Laïtissia AU - Bartholomé, Emmanuel AU - Carment, Loïc AU - Charre-Morin, Julie AU - Cosne, Gautier AU - Diouf, Léa AU - Guo, C. Christine AU - Juraver, Adrien AU - Kanzler, M. Christoph AU - Karatsidis, Angelos AU - Mazzà, Claudia AU - Penalver-Andres, Joaquin AU - Ruiz, Marta AU - Saubusse, Aurore AU - Simoneau, Gabrielle AU - Scotland, Alf AU - Sun, Zhaonan AU - Tang, Minao AU - van Beek, Johan AU - Zajac, Lauren AU - Belachew, Shibeshih AU - Brochet, Bruno AU - Campbell, Nolan PY - 2024/11/8 TI - Sensor-Derived Measures of Motor and Cognitive Functions in People With Multiple Sclerosis Using Unsupervised Smartphone-Based Assessments: Proof-of-Concept Study JO - JMIR Form Res SP - e60673 VL - 8 KW - multiple sclerosis KW - sensor-derived measure KW - smartphone KW - cognitive function KW - motor function KW - digital biomarkers KW - mobile phone N2 - Background: Smartphones and wearables are revolutionizing the assessment of cognitive and motor function in neurological disorders, allowing for objective, frequent, and remote data collection. However, these assessments typically provide a plethora of sensor-derived measures (SDMs), and selecting the most suitable measure for a given context of use is a challenging, often overlooked problem. Objective: This analysis aims to develop and apply an SDM selection framework, including automated data quality checks and the evaluation of statistical properties, to identify robust SDMs that describe the cognitive and motor function of people with multiple sclerosis (MS). Methods: The proposed framework was applied to data from a cross-sectional study involving 85 people with MS and 68 healthy participants who underwent in-clinic supervised and remote unsupervised smartphone-based assessments. The assessment provided high-quality recordings from cognitive, manual dexterity, and mobility tests, from which 47 SDMs, based on established literature, were extracted using previously developed and publicly available algorithms. These SDMs were first separately and then jointly screened for bias and normality by 2 expert assessors. Selected SDMs were then analyzed to establish their reliability, using an intraclass correlation coefficient and minimal detectable change at 95% CI. The convergence of selected SDMs with in-clinic MS functional measures and patient-reported outcomes was also evaluated. Results: A total of 16 (34%) of the 47 SDMs passed the selection framework. All selected SDMs demonstrated moderate-to-good reliability in remote settings (intraclass correlation coefficient 0.5-0.85; minimal detectable change at 95% CI 19%-35%). Selected SDMs extracted from the smartphone-based cognitive test demonstrated good-to-excellent correlation (Spearman correlation coefficient, |?|>0.75) with the in-clinic Symbol Digit Modalities Test and fair correlation with Expanded Disability Status Scale (EDSS) scores (0.25?|?|<0.5). SDMs extracted from the manual dexterity tests showed either fair correlation (0.25?|?|<0.5) or were not correlated (|?|<0.25) with the in-clinic 9-hole peg test and EDSS scores. Most selected SDMs from mobility tests showed fair correlation with the in-clinic timed 25-foot walk test and fair to moderate-to-good correlation (0.5<|?|?0.75) with EDSS scores. SDM correlations with relevant patient-reported outcomes varied by functional domain, ranging from not correlated (cognitive test SDMs) to good-to-excellent correlation (|?|>0.75) for mobility test SDMs. Overall, correlations were similar when smartphone-based tests were performed in a clinic or remotely. Conclusions: Reported results highlight that smartphone-based assessments are suitable tools to remotely obtain high-quality SDMs of cognitive and motor function in people with MS. The presented SDM selection framework promises to increase the interpretability and standardization of smartphone-based SDMs in people with MS, paving the way for their future use in interventional trials. UR - https://formative.jmir.org/2024/1/e60673 UR - http://dx.doi.org/10.2196/60673 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60673 ER - TY - JOUR AU - Gutman, Barak AU - Shmilovitch, Amit-Haim AU - Aran, Dvir AU - Shelly, Shahar PY - 2024/11/8 TI - Twenty-Five Years of AI in Neurology: The Journey of Predictive Medicine and Biological Breakthroughs JO - JMIR Neurotech SP - e59556 VL - 3 KW - neurology KW - artificial intelligence KW - telemedicine KW - clinical advancements KW - mobile phone UR - https://neuro.jmir.org/2024/1/e59556 UR - http://dx.doi.org/10.2196/59556 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59556 ER - TY - JOUR AU - Becker, Elizabeth Molly AU - Stratton Levey, Nadine AU - Yeh, Y. Gloria AU - Giacino, Joseph AU - Iverson, Grant AU - Silverberg, Noah AU - Parker, A. Robert AU - McKinnon, Ellen AU - Siravo, Caitlin AU - Shah, Priyanca AU - Vranceanu, Ana-Maria AU - Greenberg, Jonathan PY - 2024/11/8 TI - Preliminary Feasibility of a Novel Mind-Body Program to Prevent Persistent Concussion Symptoms Among Young Adults With Anxiety: Nonrandomized Open Pilot Study JO - JMIR Form Res SP - e64540 VL - 8 KW - concussions KW - mind-body KW - preventions KW - young adults KW - feasibility KW - persistence KW - open pilot KW - mind-body program KW - preliminary feasibility KW - mild traumatic brain injuries KW - United States KW - adults KW - psychological factors KW - mind-body interventions N2 - Background: Concussions are common, particularly among young adults, and often are associated with persistent, debilitating, and hard-to-treat symptoms. Anxiety and concussion symptoms often amplify each other, and growing evidence indicates that anxiety plays a key role in symptoms persistence after concussion. Targeting anxiety early after concussion may be a promising means of helping prevent persistent concussion symptoms in this population. We developed the Toolkit for Optimal Recovery after Concussion (TOR-C), the first mind-body program tailored for young adults with a recent concussion and anxiety, aiming to prevent persistent concussion symptoms. Objective: This study aims to conduct an open pilot of TOR-C to test preliminary feasibility, signal of change in measures, and treatment perceptions. Methods: Five young adults (aged 18-24 years) attended 4 weekly one-on-one live video sessions with a clinician. Participants completed questionnaires measuring treatment targets (ie, pain catastrophizing, mindfulness, fear avoidance, limiting behaviors, and all-or-nothing behaviors) and outcomes (ie, postconcussive symptoms, physical function, anxiety, depression, and pain) at baseline, immediately following the intervention, and 3 months after intervention completion. At the conclusion of the program, participants attended a qualitative interview and provided feedback about the program to help optimize study content and procedures. Results: Feasibility markers were excellent for credibility and expectancy (5/5, 100% of participants scored above the credibility and expectancy scale midpoint), client satisfaction (4/5, 80% of participants scored above the Client Satisfaction Questionnaire midpoint), therapist adherence (97% adherence), acceptability of treatment (5/5, 100% of participants attended 3 or more sessions), adherence to homework (87% home practice completion), and feasibility of assessments (no measures fully missing). The feasibility of recruitment was good (5/7, 71% of eligible participants agreed to participate). There were preliminary signals of improvements from pre-post comparisons in treatment targets (d=0.72-2.20) and outcomes (d=0.41-1.38), which were sustained after 3 months (d=0.38-2.74 and d=0.71-1.63 respectively). Exit interviews indicated overall positive perceptions of skills and highlighted barriers (eg, busyness) and facilitators (eg, accountability) to engagement. Conclusions: TOR-C shows preliminary feasibility, is associated with a signal of improvement in treatment targets and outcomes, and has the potential to support recovery from concussion. The quantitative findings along with the qualitative feedback obtained from the exit interviews will help optimize TOR-C in preparation for an upcoming randomized controlled trial of TOR-C versus an active control condition of health education for concussion recovery. International Registered Report Identifier (IRRID): RR2-10.2196/25746 UR - https://formative.jmir.org/2024/1/e64540 UR - http://dx.doi.org/10.2196/64540 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64540 ER - TY - JOUR AU - Chien, Shih-Ying AU - Wu, Ching-Yi AU - Wong, May-Kuen Alice AU - Chen, Chih-Kuang AU - Beckman, L. Sara PY - 2024/10/24 TI - Exploring the Impact of an Interactive Electronic Pegboard on Manual Dexterity and Cognitive Skills of Patients With Stroke: Preliminary Analysis JO - JMIR Form Res SP - e55481 VL - 8 KW - interactive electronic pegboard KW - stroke KW - hand dexterity KW - cognitive rehabilitation KW - system N2 - Background: As individuals age, the incidence and mortality rates of cerebrovascular accidents significantly rise, leading to fine motor impairments and cognitive deficits that impact daily life. In modern occupational therapy, assessing manual dexterity and cognitive functions typically involves observation of patients interacting with physical objects. However, this pen-and-paper method is not only time-consuming, relying heavily on therapist involvement, but also often inaccurate. Digital assessment methods, therefore, have the potential to increase the accuracy of diagnosis, as well as decrease the workload of health care professionals. Objective: This study examined the feasibility of an interactive electronic pegboard for the assessment and rehabilitation of patients with stroke. Methods: We explored the pegboard?s clinical applicability by examining the relationship among stages, timing, and difficulty settings, as well as their alignment with patient capabilities. In total, 10 participants used a prototype of the pegboard for functional and task assessments; questionnaire interviews were conducted simultaneously to collect user feedback. Results: Patients with stroke consistently required more time to complete tasks than expected, significantly deviating from the initial time frames. Additionally, the participants exhibited a slight reduction in performance levels in both manual dexterity and cognitive abilities. Insights from questionnaire responses revealed that the majority of participants found the prototype interface easy and enjoyable to use, with good functionality. Conclusions: This preliminary investigation supports the efficacy of interactive electronic pegboards for the rehabilitation of the hand functions of patients with stroke, as well as training their attentional and cognitive abilities. This digital technology could potentially alleviate the burden of health care workers, positioning it as a valuable and intelligent precision health care tool. UR - https://formative.jmir.org/2024/1/e55481 UR - http://dx.doi.org/10.2196/55481 UR - http://www.ncbi.nlm.nih.gov/pubmed/39446480 ID - info:doi/10.2196/55481 ER - TY - JOUR AU - Gee, Brioney AU - Teague, Bonnie AU - Laphan, Andrew AU - Clarke, Tim AU - Coote, Georgianna AU - Garner, Jessica AU - Wilson, Jon PY - 2024/10/22 TI - Outcomes of Providing Children Aged 7-12 Years With Access to Evidence-Based Anxiety Treatment Via a Standalone Digital Intervention Using Immersive Gaming Technology: Real-World Evaluation JO - JMIR Ment Health SP - e52866 VL - 11 KW - anxiety KW - children KW - young people KW - exposure therapy KW - graded exposures KW - cognitive behavioural therapy KW - digital intervention KW - mobile app KW - gaming KW - real-world evaluation KW - gaming technology KW - real-world implementation N2 - Background: Anxiety disorders are among the most common mental health conditions in childhood, but most children with anxiety disorders do not access evidence-based interventions. The delivery of therapeutic interventions via digital technologies has been proposed to significantly increase timely access to evidence-based treatment. Lumi Nova (BfB Labs Limited) is a digital therapeutic intervention designed to deliver evidence-based anxiety treatment for those aged 7?12 years through a mobile app incorporating immersive gaming technology. Objective: We aimed to evaluate the real-world impact of providing access to Lumi Nova through UK National Health Service?funded mental health services. Methods: We analyzed precollected anonymized data routinely captured through the implementation of Lumi Nova from children aged 7?12 years, who lived in the United Kingdom and had the opportunity to use the intervention for at least 1 week over an 18-month period. Engagement indices included whether the game key was activated, number of unique sessions, time spent engaging, and number of ?challenges? completed. Clinical outcomes were assessed using the Goal-Based Outcomes measure and Child Outcome Rating Scale. Demographic data were analyzed to assess the health equality implications of Lumi Nova. Results: Of 1029 eligible families invited to use Lumi Nova, 644 (62.5%) activated their game key, of whom 374 (58.1%) completed at least one in-game graded exposure challenge. The median number of unique sessions was 6 (IQR 3?12) and the median time spent engaging with the intervention was 42 (IQR 15?79) minutes. For the subset of young people with paired outcomes, there were statistically significant small to medium improvements in goal-based outcome scores (n=224; t223=5.78, P<.001; d=0.37, 95% CI 0.25?0.52) and Child Outcome Rating Scale scores (n=123; t122=5.10, P<.001; d=0.46, 95% CI 0.27?0.65) between the first and last data points. Two in 5 young people?s scores reflected a change that would be considered reliable. Analysis of demographic characteristics tentatively suggested that children from ethnic minority backgrounds and those living in the most deprived neighbourhoods may be less likely to access Lumi Nova, but children from socioeconomically deprived areas were more likely to successfully complete a challenge once they accessed the intervention (P=.02). However, the level of missing data and small number of children in some demographic groups limited meaningful statistical comparisons. Conclusions: This study provides initial evidence that Lumi Nova may be associated with improved outcomes for those aged 7?12 years seeking anxiety treatment in real-world settings. However, the lack of a control comparator group and information about concurrent treatments accessed by the young people, in addition to substantial attrition, limited the analysis that could be conducted and confidence in the conclusions drawn. UR - https://mental.jmir.org/2024/1/e52866 UR - http://dx.doi.org/10.2196/52866 ID - info:doi/10.2196/52866 ER - TY - JOUR AU - Ortiz-Barrios, Miguel AU - Cleland, Ian AU - Donnelly, Mark AU - Gul, Muhammet AU - Yucesan, Melih AU - Jiménez-Delgado, Isabel Genett AU - Nugent, Chris AU - Madrid-Sierra, Stephany PY - 2024/10/22 TI - Integrated Approach Using Intuitionistic Fuzzy Multicriteria Decision-Making to Support Classifier Selection for Technology Adoption in Patients with Parkinson Disease: Algorithm Development and Validation JO - JMIR Rehabil Assist Technol SP - e57940 VL - 11 KW - Parkinson disease KW - technology adoption KW - intuitionistic fuzzy analytic hierarchy process KW - intuitionistic fuzzy decision-making trial and evaluation laboratory KW - combined compromise solution N2 - Background: Parkinson disease (PD) is reported to be among the most prevalent neurodegenerative diseases globally, presenting ongoing challenges and increasing burden on health care systems. In an effort to support patients with PD, their carers, and the wider health care sector to manage this incurable condition, the focus has begun to shift away from traditional treatments. One of the most contemporary treatments includes prescribing assistive technologies (ATs), which are viewed as a way to promote independent living and deliver remote care. However, the uptake of these ATs is varied, with some users not ready or willing to accept all forms of AT and others only willing to adopt low-technology solutions. Consequently, to manage both the demands on resources and the efficiency with which ATs are deployed, new approaches are needed to automatically assess or predict a user?s likelihood to accept and adopt a particular AT before it is prescribed. Classification algorithms can be used to automatically consider the range of factors impacting AT adoption likelihood, thereby potentially supporting more effective AT allocation. From a computational perspective, different classification algorithms and selection criteria offer various opportunities and challenges to address this need. Objective: This paper presents a novel hybrid multicriteria decision-making approach to support classifier selection in technology adoption processes involving patients with PD. Methods: First, the intuitionistic fuzzy analytic hierarchy process (IF-AHP) was implemented to calculate the relative priorities of criteria and subcriteria considering experts? knowledge and uncertainty. Second, the intuitionistic fuzzy decision-making trial and evaluation laboratory (IF-DEMATEL) was applied to evaluate the cause-effect relationships among criteria/subcriteria. Finally, the combined compromise solution (CoCoSo) was used to rank the candidate classifiers based on their capability to model the technology adoption. Results: We conducted a study involving a mobile smartphone solution to validate the proposed methodology. Structure (F5) was identified as the factor with the highest relative priority (overall weight=0.214), while adaptability (F4) (D-R=1.234) was found to be the most influencing aspect when selecting classifiers for technology adoption in patients with PD. In this case, the most appropriate algorithm for supporting technology adoption in patients with PD was the A3 - J48 decision tree (M3=2.5592). The results obtained by comparing the CoCoSo method in the proposed approach with 2 alternative methods (simple additive weighting and technique for order of preference by similarity to ideal solution) support the accuracy and applicability of the proposed methodology. It was observed that the final scores of the algorithms in each method were highly correlated (Pearson correlation coefficient >0.8). Conclusions: The IF-AHP-IF-DEMATEL-CoCoSo approach helped to identify classification algorithms that do not just discriminate between good and bad adopters of assistive technologies within the Parkinson population but also consider technology-specific features like design, quality, and compatibility that make these classifiers easily implementable by clinicians in the health care system. UR - https://rehab.jmir.org/2024/1/e57940 UR - http://dx.doi.org/10.2196/57940 ID - info:doi/10.2196/57940 ER - TY - JOUR AU - Pogrebnoy, Dina AU - Ashton, Lee AU - Beh, A. Brian AU - Burke, Meredith AU - Cullen, Richard AU - Czerenkowski, Jude AU - Davey, Julie AU - Dennett, M. Amy AU - English, Kevin AU - Godecke, Erin AU - Harper, Nicole AU - Lynch, Elizabeth AU - MacDonald-Wicks, Lesley AU - Patterson, Amanda AU - Ramage, Emily AU - Schelfhaut, Ben AU - Simpson, B. Dawn AU - Zacharia, Karly AU - English, Coralie PY - 2024/10/22 TI - Adapting a Telehealth Physical Activity and Diet Intervention to a Co-Designed Website for Self-Management After Stroke: Tutorial JO - J Med Internet Res SP - e58419 VL - 26 KW - stroke KW - secondary prevention KW - co-design KW - how-to guide, website development KW - accessibility KW - navigation KW - self-management UR - https://www.jmir.org/2024/1/e58419 UR - http://dx.doi.org/10.2196/58419 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58419 ER - TY - JOUR AU - DeMatteo, Carol AU - Randall, Sarah AU - Jakubowski, Josephine AU - Stazyk, Kathy AU - Obeid, Joyce AU - Noseworthy, Michael AU - Mazurek, Michael AU - Timmons, W. Brian AU - Connolly, John AU - Giglia, Lucia AU - Hall, Geoffrey AU - Lin, Chia-Yu AU - Perrotta, Samantha PY - 2024/10/9 TI - Fact or Fiction?Accelerometry Versus Self-Report in Adherence to Pediatric Concussion Protocols: Prospective Longitudinal Cohort Study JO - JMIR Pediatr Parent SP - e57325 VL - 7 KW - pediatric concussion KW - guidelines KW - adherence KW - return to school KW - return to sport KW - actigraphy N2 - Background: Concussion, or mild traumatic brain injury, is a growing public health concern, affecting approximately 1.2% of the population annually. Among children aged 1?17 years, concussion had the highest weighted prevalence compared to other injury types, highlighting the importance of addressing this issue among the youth population. Objective: This study aimed to assess adherence to Return to Activity (RTA) protocols among youth with concussion and to determine if better adherence affected time to recovery and the rate of reinjury. Methods: Children and youth (N=139) aged 5?18 years with concussion were recruited. Self-reported symptoms and protocol stage of recovery were monitored every 48 hours until symptom resolution was achieved. Daily accelerometry was assessed with the ActiGraph. Data were collected to evaluate adherence to the RTA protocol based on physical activity cutoff points corresponding to RTA stages. Participants were evaluated using a battery of physical, cognitive, and behavioral measures at recruitment, upon symptom resolution, and 3 months post symptom resolution. Results: For RTA stage 1, a total of 13% of participants were adherent based on accelerometry, whereas 11% and 34% of participants were adherent for stage 2 and 3, respectively. The median time to symptom resolution was 13 days for participants who were subjectively reported adherent to the RTA protocol and 20 days for those who were subjectively reported as nonadherent (P=.03). No significant agreement was found between self-report of adherence and objective actigraphy adherence to the RTA protocol as well as to other clinical outcomes, such as depression, quality of life, and balance. The rate of reinjury among the entire cohort was 2% (n=3). Conclusions: Overall, adherence to staged protocols post concussion was minimal when assessed with accelerometers, but adherence was higher by self-report. More physical activity restrictions, as specified in the RTA protocol, resulted in lower adherence. Although objective adherence was low, reinjury rate was lower than expected, suggesting a protective effect of being monitored and increased youth awareness of protocols. The results of this study support the move to less restrictive protocols and earlier resumption of daily activities that have since been implemented in more recent protocols. UR - https://pediatrics.jmir.org/2024/1/e57325 UR - http://dx.doi.org/10.2196/57325 ID - info:doi/10.2196/57325 ER - TY - JOUR AU - Jeter, Russell AU - Greenfield, Raymond AU - Housley, N. Stephen AU - Belykh, Igor PY - 2024/10/7 TI - Classifying Residual Stroke Severity Using Robotics-Assisted Stroke Rehabilitation: Machine Learning Approach JO - JMIR Biomed Eng SP - e56980 VL - 9 KW - stroke KW - rehabilitation robotics KW - machine learning KW - artificial intelligence KW - physical therapy KW - neuroplasticity N2 - Background: Stroke therapy is essential to reduce impairments and improve motor movements by engaging autogenous neuroplasticity. Traditionally, stroke rehabilitation occurs in inpatient and outpatient rehabilitation facilities. However, recent literature increasingly explores moving the recovery process into the home and integrating technology-based interventions. This study advances this goal by promoting in-home, autonomous recovery for patients who experienced a stroke through robotics-assisted rehabilitation and classifying stroke residual severity using machine learning methods. Objective: Our main objective is to use kinematics data collected during in-home, self-guided therapy sessions to develop supervised machine learning methods, to address a clinician?s autonomous classification of stroke residual severity?labeled data toward improving in-home, robotics-assisted stroke rehabilitation. Methods: In total, 33 patients who experienced a stroke participated in in-home therapy sessions using Motus Nova robotics rehabilitation technology to capture upper and lower body motion. During each therapy session, the Motus Hand and Motus Foot devices collected movement data, assistance data, and activity-specific data. We then synthesized, processed, and summarized these data. Next, the therapy session data were paired with clinician-informed, discrete stroke residual severity labels: ?no range of motion (ROM),? ?low ROM,? and ?high ROM.? Afterward, an 80%:20% split was performed to divide the dataset into a training set and a holdout test set. We used 4 machine learning algorithms to classify stroke residual severity: light gradient boosting (LGB), extra trees classifier, deep feed-forward neural network, and classical logistic regression. We selected models based on 10-fold cross-validation and measured their performance on a holdout test dataset using F1-score to identify which model maximizes stroke residual severity classification accuracy. Results: We demonstrated that the LGB method provides the most reliable autonomous detection of stroke severity. The trained model is a consensus model that consists of 139 decision trees with up to 115 leaves each. This LGB model boasts a 96.70% F1-score compared to logistic regression (55.82%), extra trees classifier (94.81%), and deep feed-forward neural network (70.11%). Conclusions: We showed how objectively measured rehabilitation training paired with machine learning methods can be used to identify the residual stroke severity class, with efforts to enhance in-home self-guided, individualized stroke rehabilitation. The model we trained relies only on session summary statistics, meaning it can potentially be integrated into similar settings for real-time classification, such as outpatient rehabilitation facilities. UR - https://biomedeng.jmir.org/2024/1/e56980 UR - http://dx.doi.org/10.2196/56980 UR - http://www.ncbi.nlm.nih.gov/pubmed/39374054 ID - info:doi/10.2196/56980 ER - TY - JOUR AU - Kwan, Cho Rick Yiu AU - Liu, Justina AU - Sin, Kan Olive Suk AU - Fong, K. Kenneth N. AU - Qin, Jing AU - Wong, Yin Joe Chi AU - Lai, Claudia PY - 2024/9/11 TI - Effects of Virtual Reality Motor-Cognitive Training for Older People With Cognitive Frailty: Multicentered Randomized Controlled Trial JO - J Med Internet Res SP - e57809 VL - 26 KW - virtual reality KW - motor-cognitive training KW - cognitive frailty KW - gamification N2 - Background: Cognitive frailty refers to a clinical syndrome in which physical frailty and mild cognitive impairment coexist. Motor-cognitive training and virtual reality (VR) have been used to launch various therapeutic modalities to promote health in older people. The literature advocates that motor-cognitive training and VR are effective in promoting the cognitive and physical function of older people. However, the effects on older people with cognitive frailty are unclear. Objective: This study examined the effects of VR motor-cognitive training (VRMCT) on global cognitive function, physical frailty, walking speed, visual short-term memory, inhibition of cognitive interference, and executive function in older people with cognitive frailty. Methods: This study used a multicentered, assessor-blinded, 2-parallel-group randomized controlled trial design. Participants were recruited face-to-face in 8 older adult community centers. Eligible participants were aged ?60 years, were community dwelling, lived with cognitive frailty, had no dementia, and were not mobility restricted. In the intervention group, participants received VRMCT led by interventionists with 16 one-hour training sessions delivered twice per week for 8 weeks. In the control group, participants received the usual care provided by the older adult community centers that the investigators did not interfere with. The primary outcome was global cognitive function. The secondary outcomes included physical frailty, walking speed, verbal short-term memory, inhibition of cognitive interference, and executive function. Data were collected at baseline (T0) and the week after the intervention (T1). Generalized estimating equations were used to examine the group, time, and interaction (time × group) effects on the outcomes. Results: In total, 293 eligible participants enrolled in the study. The mean age of the participants was 74.5 (SD 6.8) years. Most participants were female (229/293, 78.2%), had completed primary education (152/293, 52.1%), were married (167/293, 57.2%), lived with friends (127/293, 43.3%), and had no VR experience (232/293, 79.5%). In the intervention group, 81.6% (119/146) of participants attended >80% (13/16, 81%) of the total number of sessions. A negligible number of participants experienced VR sickness symptoms (1/146, 0.7% to 5/146, 3%). VRMCT was effective in promoting global cognitive function (interaction effect: P=.03), marginally promoting executive function (interaction effect: P=.07), and reducing frailty (interaction effect: P=.03). The effects were not statistically significant on other outcomes. Conclusions: VRMCT is effective in promoting cognitive functions and reducing physical frailty and is well tolerated and accepted by older people with cognitive frailty, as evidenced by its high attendance rate and negligible VR sickness symptoms. Further studies should examine the efficacy of the intervention components (eg, VR vs non-VR or dual task vs single task) on health outcomes, the effect of using technology on intervention adherence, and the long-term effects of the intervention on older people with cognitive frailty at the level of daily living. Trial Registration: ClinicalTrials.gov NCT04730817; https://clinicaltrials.gov/study/NCT04730817 UR - https://www.jmir.org/2024/1/e57809 UR - http://dx.doi.org/10.2196/57809 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57809 ER - TY - JOUR AU - Bevilacqua, Roberta AU - Benadduci, Marco AU - Barbarossa, Federico AU - Amabili, Giulio AU - Di Donna, Valentina AU - Martella, Clotilda AU - Pelliccioni, Giuseppe AU - Riccardi, Renato Giovanni AU - Maranesi, Elvira PY - 2024/9/9 TI - Effectiveness of Technological Interventions for Older Adults With Parkinson Disease: Systematic Review JO - JMIR Serious Games SP - e53431 VL - 12 KW - technological intervention KW - Parkinson disease KW - randomized controlled trail KW - older adults KW - efficacy N2 - Background: Among the older population, Parkinson disease (PD) stands out as a leading contributor to disability. Clinically, the foremost objectives in managing PD involve proactively delaying and preventing disability. Understanding the pivotal role of gait and balance in daily functionality holds substantial clinical significance, signaling imminent disability and prompting a reevaluation of management approaches. A key priority lies in identifying novel and effective interventions for symptoms that substantially contribute to disability. Objective: This paper presents a systematic review that critically examines the existing body of literature on the use of technology in the rehabilitation of older patients with PD. By synthesizing current evidence, we aim to provide insights into the state of the field, identify gaps in knowledge, and offer recommendations for future research and clinical practice. Methods: A systematic review of the literature was conducted in September 2023 analyzing manuscripts and papers of the last 5 years from the PubMed, Scopus, Embase, Web of Science, and CINAHL databases following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 14 papers were included. The inclusion criteria are as follows: (1) randomized controlled trial, (2) PD in people aged 65 years and older, and (3) use of technology in the rehabilitation training in the older population. Results: A large portion of effective interventions relies on the incorporation of technology, particularly through virtual reality exergames. This technology appears to have effects not only on the cognitive aspect but also on the physical domain. The analysis of the results clearly indicates that, in terms of gait and balance performance, the technological intervention outperforms the traditional approach, irrespective of the specific technology employed. Conclusions: This systematic review seeks to shed light on the evolving landscape of technology-assisted rehabilitation for older individuals with PD. As we delve into the available evidence, we will assess the extent to which technology can serve as a valuable adjunct to conventional therapy, offering new avenues for optimized care and improved outcomes in this growing patient demographic. As we sift through the existing evidence, our goal is to evaluate the potential of technology as a valuable supplement to traditional therapy, presenting fresh opportunities for enhanced care and better outcomes in this expanding patient demographic. UR - https://games.jmir.org/2024/1/e53431 UR - http://dx.doi.org/10.2196/53431 UR - http://www.ncbi.nlm.nih.gov/pubmed/39250193 ID - info:doi/10.2196/53431 ER - TY - JOUR AU - Fonseca, Olivia Ana AU - Gomes, Silveira July AU - Novaes, Barros Rafael Angulo Condoretti AU - Dias, Lopes Cíntia AU - Rodrigues, Alves Maria Eva de Miranda AU - Gadelha, Ary AU - Noto, Cristiano PY - 2024/9/6 TI - Feuerstein Instrumental Enrichment Program for People With Schizophrenia After the First Episode of Psychosis: Protocol for an Open-Label Intervention Study JO - JMIR Res Protoc SP - e57031 VL - 13 KW - schizophrenia KW - Feuerstein Instrumental Enrichment program KW - cognitive intervention KW - functionality KW - first-episode psychosis KW - early stages KW - Feuerstein Instrumental Enrichment KW - FIE KW - psychotic disorder KW - psychotic disorders KW - neurocognitive deficits KW - economic burden KW - cognitive rehabilitation KW - quality of life KW - daily living KW - cognitive assessment KW - maze task KW - mental disorder KW - cognitive deficits KW - mental health KW - psychosis N2 - Background: Schizophrenia is a disorder associated with neurocognitive deficits that adversely affect daily functioning and impose an economic burden. Cognitive rehabilitation interventions, particularly during the early phases of illness, have been shown to improve cognition, functionality, and quality of life. The Feuerstein Instrumental Enrichment (FIE) program, based on the Mediated Learning Experience and the Structural Cognitive Modifiability theory, has been applied in various disorders, but its applicability in schizophrenia has not yet been clarified. Objective: This study aims to investigate the effects of the FIE program on the functionality of patients with first-episode schizophrenia. Methods: In total, 17 patients will be recruited for an open-label intervention consisting of twice-weekly sessions for 10 weeks. The primary outcome measure will be changes in the Goal Achievement Scale score. Maze task performance from the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) battery will serve as a secondary outcome measure. At the same time, changes in Positive and Negative Syndrome Scale scores and other MATRICS domains will be analyzed as exploratory outcomes. Assessments will be administered before and after the intervention, with a follow-up period of 6 months. Results: This trial was preregistered in The Brazilian Registry of Clinical Trials (RBR-4gzhy4s). By February 2024, 11 participants were enrolled in the training. Recruitment is expected to be completed by May 2024. Data analysis will be conducted between May and September 2024. The results are expected to be published in January 2025. Conclusions: This study may establish a protocol for the FIE program that uses mediation techniques for individuals in the early stages of schizophrenia. The results will add to the knowledge about strategies to promote cognitive skills and functional impairment in daily life. International Registered Report Identifier (IRRID): DERR1-10.2196/57031 UR - https://www.researchprotocols.org/2024/1/e57031 UR - http://dx.doi.org/10.2196/57031 UR - http://www.ncbi.nlm.nih.gov/pubmed/39240685 ID - info:doi/10.2196/57031 ER - TY - JOUR AU - Vidas, Dianna AU - Carrasco, Romina AU - Kelly, M. Ryan AU - Waycott, Jenny AU - Tamplin, Jeanette AU - McMahon, Kate AU - Flynn, M. Libby AU - Stretton-Smith, A. Phoebe AU - Sousa, Vieira Tanara AU - Baker, A. Felicity PY - 2024/8/27 TI - Everyday Uses of Music Listening and Music Technologies by Caregivers and People With Dementia: Survey and Focus Group Study JO - J Med Internet Res SP - e54186 VL - 26 KW - dementia KW - dementia care KW - technology KW - music technology KW - mobile phone N2 - Background: Music has long been identified as a nonpharmacological tool that can provide benefits for people with dementia, and there is considerable interest in designing technologies to support the use of music in dementia care. However, to ensure that music technologies are appropriately designed for supporting caregivers and people living with dementia, there remains a need to better understand how music is currently used in everyday dementia care at home. Objective: This study aims to understand how people living with dementia and their caregivers use music and music technologies in everyday caring, as well as the challenges they experience using music and technology. Methods: This study used a mixed methods design. First, a survey was administered to 13 people living with dementia and 64 caregivers to understand their use of music and technology. Subsequently, 18 survey respondents (family caregivers: n=12, 67%; people living with dementia: n=6, 33%) participated in focus groups regarding their experiences of using music and technology in care. Interview transcripts were analyzed using reflexive thematic analysis. Results: Most of the survey respondents (people living with dementia: 9/13, 69%; family caregivers: 47/63, 75%) reported using music often or very often in their daily lives. Participants reported a range of technologies used for listening to music, such as CDs, radio, and streaming services. Focus groups highlighted the benefits and challenges of using music and music technologies in everyday care. Participants identified using music and music technologies to regulate mood, provide joy, facilitate social interaction and connection, encourage reminiscence, provide continuity of music use before and after the dementia diagnosis, and make caregiving easier. The challenges of using music technology in everyday caring included difficulties with staying up to date with evolving technology and low self-efficacy with technology for people living with dementia. Conclusions: This study shows that people with a dementia diagnosis and their caregivers already use music and music technologies to support their everyday care needs. The results suggest opportunities to design technologies that enable easier access to music and to support people living with dementia with recreational and therapeutic music listening as well as music-based activities. UR - https://www.jmir.org/2024/1/e54186 UR - http://dx.doi.org/10.2196/54186 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54186 ER - TY - JOUR AU - Sun, Jia AU - Ma, Liang AU - Miao, Xiao AU - Sun, Hui AU - Zhu, SuSu AU - Zhang, Ran AU - Fan, LeLe AU - Hu, TingTing PY - 2024/8/26 TI - Current Status of Outcomes Reported by Patients With Stroke and an Analysis of Influencing Factors: Cross-Sectional Questionnaire Study JO - JMIR Form Res SP - e58330 VL - 8 KW - stroke KW - patient-reported outcomes KW - blood lipids KW - influence factor KW - correlation analysis KW - nursing care N2 - Background: Stroke is the leading cause of acquired disability and the second leading cause of death worldwide. Its rate of incidence, disability, mortality, and recurrence is high, and the patients experience various symptoms of discomfort, which not only affect their rehabilitation function but also reduce their ability to perform daily activities and their quality of life. Nowadays, with the improvement of China?s medical standards, patients are increasingly attentive to their quality of life and health status. However, diagnostic techniques and effective treatments for patients with stroke are still limited but urgently required. Objective: This study aimed to evaluate the quality of life during hospitalization using a stroke patient-reported outcomes (PROs) scale and additionally to recognize potential factors and risk indicators that may impact recurrent events, facilitating early intervention measures. Methods: This is a registry-based, retrospective observational cross-sectional study on patients with stroke. A convenient sampling method was used to select various indicators of patients. The Stroke-PRO scale was then used to assess patients? conditions across physical, psychological, social, and therapeutic domains. Multiple linear regression analysis was applied to identify factors influencing stroke PROs, while correlation analysis was conducted to explore the relationship between these outcomes and blood lipid levels. Results: The mean Stroke-PRO score in this study was 4.09 (SD 0.29) points. By multiple linear regression analysis, residence, occupation, physical exercise, Barthel index, Braden scale, National Institutes of Health Stroke Scale scores at admission, and stroke type were the risk factors for reported outcomes of patients with stroke (P<.05). Correlation analysis showed that serum triglyceride, total cholesterol, and low-density lipoprotein were negatively correlated with Stroke-PRO scores in patients with stroke (P<.05), while high-density lipoprotein was positively correlated with patients with stroke (P<.05). The 95% CI was ?0.31 to ?0.03 for triglyceride, 0.17-0.44 for high-density lipoprotein, ?0.29 to ?0.01 for cholesterol, ?0.30 to ?0.02 for low-density lipoprotein, and ?0.12 to 0.16 for blood glucose. Conclusions: Patients with stroke have a low level of health, and their reported outcomes need to be improved. Accordingly, nursing staff should pay attention to the quality of life and blood lipid indexes of patients with stroke, actively assess their actual health status, and take early intervention measures to promote their recovery. UR - https://formative.jmir.org/2024/1/e58330 UR - http://dx.doi.org/10.2196/58330 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58330 ER - TY - JOUR AU - Barcheus, Ida-Maria AU - Ranner, Maria AU - Månsson Lexell, Eva AU - Jacobsson, Lars AU - Larsson-Lund, Maria PY - 2024/8/15 TI - The Internet-Based Intervention Strategies for Empowering Activities in Everyday Life: Qualitative Study of Experiences of Clients With Stroke JO - JMIR Form Res SP - e56189 VL - 8 KW - internet-based rehabilitation KW - occupational therapy intervention KW - rehabilitation KW - self-management KW - stroke KW - active everyday life KW - activity-based intervention N2 - Background: There is a need to enhance access to and support for self-management of activities in everyday life after a stroke. Internet-based solutions have the potential to contribute to this development. Consequently, an internet-based intervention called Strategies for Empowering Activities in Everyday Life (SEE) was developed. The intervention aims to assist clients in developing management strategies that promote a healthy distribution and balanced engagement in various activities performed in different places and with other people. To further support the development and feasibility of this intervention, more knowledge is needed about clients? experiences during the intervention process. Objective: This study aims to explore and describe how clients with stroke experienced the SEE intervention process and whether participation in SEE influenced their experience of everyday life. Methods: Overall, 9 clients with stroke who received SEE participated in the study?4 (44%) women and 5 (56%) men aged 37 to 73 years. Qualitative interviews about experiences with SEE were conducted twice during the intervention process with each participant. The data were analyzed using the constant comparative method of grounded theory. Results: The participants? experiences with the intervention process of SEE formed the core category, conceptualized as The relevance of and readiness for entering a change process in activities of everyday life differ among clients, constituting of two main categories: (1) an eye-opener providing agency for a change process and (2) never beginning a change process in activities in everyday life. The results showed that the relevance of and readiness for SEE differed between the participants. The experiences of 78% (7/9) of the participants reflected that the intervention process provided them with an agency to drive their own change process for activities in everyday life to promote health. Overall, 22% (2/9) of the participants refrained from entering a change process during SEE as they did not recognize any need for changes in their activities. When SEE was relevant and adopted as expected, the participants described it as an eye-opener for how they can alter their health based on how they distribute and spend their time on various activities. Conclusions: SEE has the potential to support clients? development of self-management and to take an active role in influencing their engagement in activities in everyday life and health. This study identified necessary improvements in the educational program for professionals to enhance delivery and strengthen the therapeutic mechanisms of SEE for future research. To effectively implement internet-based interventions such as SEE, it is crucial to identify clients who express a need for self-management in activities and are ready to invest the effort required to adopt a change process. Furthermore, it is indicated that participants? self-analysis of their everyday activities empowers them to adopt new self-management strategies, which can also benefit other interventions. UR - https://formative.jmir.org/2024/1/e56189 UR - http://dx.doi.org/10.2196/56189 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56189 ER - TY - JOUR AU - Perrin, B. Paul AU - Haun, N. Jolie AU - Klyce, W. Daniel AU - Melillo, Christine AU - Nakase-Richardson, Risa AU - Seel, T. Ronald AU - Martindale-Adams, Jennifer AU - Nichols, O. Linda AU - Perera, A. Robert AU - Xia, Bridget AU - Hahm, Bridget AU - Zuber, Jeffrey PY - 2024/8/15 TI - Efficacy and Implementation Planning Across the Veterans Affairs Polytrauma System of Care: Protocol for the REACH Intervention for Caregivers of Veterans and Service Members With Traumatic Brain Injury JO - JMIR Res Protoc SP - e57692 VL - 13 KW - traumatic brain injury KW - telehealth KW - caregiver KW - methodology KW - veterans KW - service members N2 - Background: The responsibility of care for Veterans and Service Members (V/SMs) with traumatic brain injury (TBI) often defaults to informal family caregivers. Caregiving demands considerable knowledge, skill, and support to facilitate the health and well-being of V/SMs and themselves. Persistent and common TBI caregiver issues include strain, depression, and anxiety. While evidence-based, brief interventions have been developed and implemented for family caregivers in Veteran neurodegenerative populations, few interventions have been developed, adapted, or tested to support the unique needs of caregivers of V/SMs with TBI. Objective: This study will adapt and test an evidence-based, personalized, 6-session telehealth caregiver intervention, ?Resources for Enhancing All Caregivers? Health? (REACH), to meet the unique needs of caregivers of V/SMs with TBI. If successful, a community-based participatory research team will develop an implementation plan to roll out REACH TBI across the national Veterans Affairs Polytrauma System of Care. Methods: This mixed methods, crossover waitlist control clinical trial will use a Type 1 Hybrid Effectiveness-Implementation approach to adapt and then test the effects of REACH TBI on key TBI caregiver outcomes. Results: This study was funded by the Department of Defense in September 2023. Participant enrollment and data collection will begin in 2024. Conclusions: If effective, REACH TBI will be the first evidence-based intervention for caregivers of V/SMs with TBI that can be scaled to implement across the Veterans Affairs Polytrauma System of Care and fill a notable gap in clinical services. International Registered Report Identifier (IRRID): PRR1-10.2196/57692 UR - https://www.researchprotocols.org/2024/1/e57692 UR - http://dx.doi.org/10.2196/57692 UR - http://www.ncbi.nlm.nih.gov/pubmed/39145996 ID - info:doi/10.2196/57692 ER - TY - JOUR AU - Jeyasingh-Jacob, Julian AU - Crook-Rumsey, Mark AU - Shah, Harshvi AU - Joseph, Theresita AU - Abulikemu, Subati AU - Daniels, Sarah AU - Sharp, J. David AU - Haar, Shlomi PY - 2024/8/6 TI - Markerless Motion Capture to Quantify Functional Performance in Neurodegeneration: Systematic Review JO - JMIR Aging SP - e52582 VL - 7 KW - markerless motion capture KW - motion analysis KW - movement analysis KW - motion KW - neurodegeneration KW - neurodegenerative KW - systematic review KW - movement KW - body tracking KW - tracking KW - monitoring KW - clinical decision making KW - decision KW - decision making KW - dementia KW - neurodegenerative disease KW - mild cognitive impairment KW - Parkinson's disease KW - tool KW - mobility N2 - Background: Markerless motion capture (MMC) uses video cameras or depth sensors for full body tracking and presents a promising approach for objectively and unobtrusively monitoring functional performance within community settings, to aid clinical decision-making in neurodegenerative diseases such as dementia. Objective: The primary objective of this systematic review was to investigate the application of MMC using full-body tracking, to quantify functional performance in people with dementia, mild cognitive impairment, and Parkinson disease. Methods: A systematic search of the Embase, MEDLINE, CINAHL, and Scopus databases was conducted between November 2022 and February 2023, which yielded a total of 1595 results. The inclusion criteria were MMC and full-body tracking. A total of 157 studies were included for full-text screening, out of which 26 eligible studies that met the selection criteria were included in the review.? Results: Primarily, the selected studies focused on gait analysis (n=24), while other functional tasks, such as sit to stand (n=5) and stepping in place (n=1), were also explored. However, activities of daily living were not evaluated in any of the included studies. MMC models varied across the studies, encompassing depth cameras (n=18) versus standard video cameras (n=5) or mobile phone cameras (n=2) with postprocessing using deep learning models. However, only 6 studies conducted rigorous comparisons with established gold-standard motion capture models. Conclusions: Despite its potential as an effective tool for analyzing movement and posture in individuals with dementia, mild cognitive impairment, and Parkinson disease, further research is required to establish the clinical usefulness of MMC in quantifying mobility and functional performance in the real world. UR - https://aging.jmir.org/2024/1/e52582 UR - http://dx.doi.org/10.2196/52582 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52582 ER - TY - JOUR AU - Zuo, Xinyi AU - Tang, Yong AU - Chen, Yifang AU - Zhou, Zhimiao PY - 2024/7/31 TI - Effects of Electronic Serious Games on Older Adults With Alzheimer?s Disease and Mild Cognitive Impairment: Systematic Review With Meta-Analysis of Randomized Controlled Trials JO - JMIR Serious Games SP - e55785 VL - 12 KW - digital serious games KW - cognitive ability KW - daily behavioral capacity KW - mental health KW - depression KW - older adults with AD and MCI KW - AD KW - Alzheimer?s disease KW - MD KW - mild cognitive impairment KW - systematic review KW - meta-analysis N2 - Background: Serious games (SGs) are nonpharmacological interventions that are widely applied among older adults. To date, no evidence has been published regarding the effect of digital SGs on cognitive ability, daily behavioral capacity, or depression in older adults with Alzheimer?s disease (AD) and mild cognitive impairment (MCI). Objective: This study aimed to assess the effect of SGs on older adults with AD and MCI by summarizing and pooling the results of previous studies. Methods: This meta-analysis examined the effectiveness of digital SGs in improving cognitive ability, enhancing daily behavioral capacity, and alleviating depression in older adults with AD and MCI. We searched the following databases up to December 31, 2023, to identify relevant high-quality randomized controlled trials (RCTs): PubMed, Embase, Web of Science, Scopus, and Cochrane Library. Stata 15.1 and Review Manager 5.3 were used to screen the 14 studies, extract data, code the data, and perform meta-analysis. Mean differences and standardized mean differences (SMDs) with 95% CIs were used to calculate continuous variables. The Cochrane risk-of-bias assessment tool was used to evaluate the risk of bias. Eligibility criteria were developed in accordance with the Population, Intervention, Comparison, Outcomes, and Study Design framework: (1) population (older adults with AD and MCI), (2) intervention (digital SG intervention), (3) comparison (digital SG intervention vs routine health care), (4) outcomes (cognitive ability, daily behavioral capacity, and depression), and (5) study or research design (RCT). Sensitivity analysis was performed, and a funnel plot was constructed. Results: From January 2017 to December 2023, we enrolled 714 individuals across 14 RCTs, with 374 (52.4%) in the severe game group using digital SGs and 340 (47.6%) in the control group using traditional methods. The results of our meta-analysis indicated that using digital SGs in older adults with AD and MCI is more effective than traditional training methods in several key areas. Specifically, digital SG therapy signi?cantly increased cognitive ability, as found in the Mini-Mental State Examination (SMD 2.11, 95% CI 1.42-2.80; P<.001) and the Montreal Cognitive Assessment (SMD 2.75, 95% CI 1.98-3.51; P<.001), significantly increased daily behavioral capacity (SMD 0.53, 95% CI 0.06-0.99; P=.03), and significantly reduced depression (SMD ?2.08, 95% CI ?2.94 to ?1.22; P<.001) in older adults with AD and MCI. No publication bias was detected based on the results of Begg and Egger tests. Conclusions: Digital SGs offer a viable and effective nonpharmacological approach for older adults with AD and MCI, yielding better results compared to traditional formats. However, caution is warranted in interpreting these findings due to limited RCTs, small sample sizes, and low-quality meta-analyzed evidence. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews: CRDCRD42023486090; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=486090 UR - https://games.jmir.org/2024/1/e55785 UR - http://dx.doi.org/10.2196/55785 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55785 ER - TY - JOUR AU - Johnson, K. Joshua AU - Longhurst, K. Jason AU - Gevertzman, Michael AU - Jefferson, Corey AU - Linder, M. Susan AU - Bethoux, Francois AU - Stilphen, Mary PY - 2024/7/31 TI - The Use of Telerehabilitation to Improve Movement-Related Outcomes and Quality of Life for Individuals With Parkinson Disease: Pilot Randomized Controlled Trial JO - JMIR Form Res SP - e54599 VL - 8 KW - rehabilitation KW - physical therapy KW - PT KW - physiotherapy KW - telehealth KW - Parkinson disease KW - tele-rehabilitation KW - telerehabilitation KW - TR KW - exercise KW - physical activity KW - exercise therapy KW - tele-health KW - mHealth KW - mobile health KW - app KW - apps KW - application KW - applications KW - digital health KW - smartphone KW - smartphones KW - Parkinson?s disease KW - Parkinson KW - Parkinsons KW - Parkinsonism KW - PD N2 - Background: Individuals with Parkinson disease (PD) can improve their overall mobility and participation in daily activities as they engage in frequent exercise. Despite the need for individually tailored exercises, persons with PD often face barriers to accessing physical rehabilitation professionals who can provide them. Telerehabilitation (TR) may facilitate access to necessary and individually tailored rehabilitation for individuals with PD. Objective: The purpose of this study was to assess the feasibility of TR for individuals with PD and explore clinical outcomes compared to in-person care. Methods: This was a pilot randomized controlled trial conducted at 2 outpatient neurorehabilitation clinics with 3 study groups: clinic+TR, TR-only, and usual care (UC). TR was administered using a web-based application with a mobile app option. One-hour interventions were performed weekly for 4 weeks, in-person for the clinic+TR and UC groups and virtually for the TR-only group. Home exercises were provided on paper for the UC group and via the web-based platform for the clinic+TR and TR-only groups. Feasibility was assessed by recruitment and retention success and patient and therapist satisfaction, as rated in surveys. Clinical outcomes were explored using performance and patient-reported measures in between- and within-group analyses. Results: Of 389 patients screened, 68 (17.5%) met eligibility criteria, and 20 (29.4% of those eligible) were enrolled (clinic+TR, n=6; TR-only, n=6; and UC, n=8). One patient (TR-only) was withdrawn due to a non?study-related injurious fall. Regardless of group allocation, both patients and therapists generally rated the mode of care delivery as ?good? or ?very good? across all constructs assessed, including overall satisfaction and safety. In the analysis of all groups, there were no differences in clinical outcomes at the discharge visit. Within-group differences (from baseline to discharge) were also generally not significant except in the UC group (faster 5-time sit-to-stand time and higher mini balance evaluation systems test balance score) and clinic+TR group (higher mini balance evaluation systems test balance score). Conclusions: High satisfaction amongst patients and clinicians regardless of group, combined with nonsignificant between-group differences in clinical outcomes, suggest that TR is feasible for individuals with PD in early-moderate stages. Future trials with a larger sample are necessary to test clinical effectiveness. As larger trials enroll patients with diverse characteristics (eg, in terms of age, disease progression, caregiver support, technology access and capacity, etc), they could begin to identify opportunities for matching patients to the optimal utilization of TR as part of the therapy episode. Trial Registration: ClinicalTrials.gov NCT06246747; https://clinicaltrials.gov/study/NCT06246747 UR - https://formative.jmir.org/2024/1/e54599 UR - http://dx.doi.org/10.2196/54599 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54599 ER - TY - JOUR AU - Elf, Marie AU - Norin, Lizette AU - Meijering, Louise AU - Pessah-Rasmussen, Hélène AU - Suhonen, Riitta AU - Zingmark, Magnus AU - Kylén, Maya PY - 2024/7/23 TI - Rehabilitation at Home With the Development of a Sustainable Model Placing the Person?s Needs and Environment at Heart: Protocol for a Multimethod Project JO - JMIR Res Protoc SP - e56996 VL - 13 KW - co-design KW - early supported discharge KW - home KW - integrated care KW - life space mobility KW - multi-methods KW - physical environment KW - person-centered care KW - social environment KW - stroke rehabilitation N2 - Background: Each year, more than 1.5 million people in Europe have a stroke, and many experience disabilities leading to activity and participation restrictions. Home-based rehabilitation is the recommended approach for stroke rehabilitation, in line with the international shift to integrated care. Despite this, rehabilitation often focuses on the person?s physical functions, not the whole life situation and opportunities to live an active life. Given that rehabilitation today is often provided in the person?s home, there is a need to develop new models that consider the rehabilitation process as situated in the everyday living environment of persons with stroke. This project is grounded in experiences from our ongoing research, where we study the importance of the home environment for health and participation among persons with stroke, rehabilitated at home. This research has shown unmet needs, which lead to suboptimal rehabilitation outcomes. There is a need for studies on how to use environmental resources to optimize stroke rehabilitation in the home setting. Objective: The overarching objective of the project is to develop a new practice model for rehabilitation where the needs of the person are the starting point and where the environment is considered. Methods: The project will be conducted in partnership with persons with stroke, significant others, health care professionals, and care managers. Results from a literature review will form the base for interviews with the stakeholders, followed by co-designing workshops aiming to create a new practice model. Focus groups will be held to refine the outcome of the workshops to a practice model. Results: This 4-year project commenced in January 2023 and will continue until December 2026. The results of the literature review are, as of April 2024, currently being analyzed. The ethics application for the interviews and co-design phase was approved in October 2023 and data collection is ongoing during spring 2024. We aim to develop a practice model with stakeholders and refine it together with care managers and decision makers. The outcome is a new practice model and implementation plan, which will be achieved in autumn 2026. Conclusions: The project contributes with a prominent missing puzzle to optimize the rehabilitation process by adding a strong focus on user engagement combined with integrating different aspects of the environment. The goal is to improve quality of life and increase reintegration in society for the large group of people living with the aftermath of a stroke. By co-designing with multiple stakeholders, we expect the model to be feasible and sustainable. The knowledge from the project will also contribute to an increased awareness of the importance of the physical environment for sustainable health care. The findings will lay the foundation for future upscaling initiatives. International Registered Report Identifier (IRRID): DERR1-10.2196/56996 UR - https://www.researchprotocols.org/2024/1/e56996 UR - http://dx.doi.org/10.2196/56996 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56996 ER - TY - JOUR AU - Chien, Shih-Ying AU - Wong, MK Alice AU - Wu, Ching-Yi AU - Beckman, L. Sara PY - 2024/6/21 TI - Interactive Electronic Pegboard for Enhancing Manual Dexterity and Cognitive Abilities: Instrument Usability Study JO - JMIR Hum Factors SP - e56357 VL - 11 KW - interactive electronic pegboard KW - stroke KW - hand dexterity KW - cognitive rehabilitation KW - system N2 - Background: Strokes pose a substantial health burden, impacting 1 in 6 people globally. One-tenth of patients will endure a second, often more severe, stroke within a year. Alarmingly, a younger demographic is being affected due to recent lifestyle changes. As fine motor and cognitive issues arise, patient disability as well as the strain on caregivers and health care resources is exacerbated. Contemporary occupational therapy assesses manual dexterity and cognitive functions through object manipulation and pen-and-paper recordings. However, these assessments are typically isolated, which makes it challenging for therapists to comprehensively evaluate specific patient conditions. Furthermore, the reliance on one-on-one training and assessment approaches on manual documentation is inefficient and prone to transcription errors. Objective: This study examines the feasibility of using an interactive electronic pegboard for stroke rehabilitation in clinical settings. Methods: A total of 10 patients with a history of stroke and 10 healthy older individuals were recruited. With a limit of 10 minutes, both groups of participants underwent a series of challenges involving tasks related to manual operation, shape recognition, and color discrimination. All participants underwent the Box and Block Test and the Purdue Pegboard Test to assess manual dexterity, as well as an array of cognitive assessments, including the Trail Making Test and the Mini-Mental Status Examination, which served as a basis to quantify participants? attention, executive functioning, and cognitive abilities. Results: The findings validate the potential application of an interactive electronic pegboard for stroke rehabilitation in clinical contexts. Significant statistical differences (P<.01) were observed across all assessed variables, including age, Box and Block Test results, Purdue Pegboard Test outcomes, Trail Making Test-A scores, and Mini-Mental Status Examination performance, between patients with a history of stroke and their healthy older counterparts. Functional and task testing, along with questionnaire interviews, revealed that patients with a history of stroke demonstrated prolonged completion times and slightly inferior performance. Nonetheless, most patients perceived the prototype as user-friendly and engaging. Thus, in the context of patient rehabilitation interventions or the evaluation of patient cognition, physical functioning, or manual dexterity assessments, the developed pegboard could potentially serve as a valuable tool for hand function, attention, and cognitive rehabilitation, thereby mitigating the burden on health care professionals. Conclusions: Health care professionals can use digital electronic pegboards not only as a precise one-on-one training tool but also as a flexible system that can be configured for online or offline, single-player or multiplayer use. Through data analysis, a more informed examination of patients? cognitive and functional issues can be conducted. Importantly, patient records will be fully retained throughout practices, exercises, or tests, and by leveraging the characteristics of big data, patients can receive the most accurate rehabilitation prescriptions, thereby assisting them in obtaining optimal care. UR - https://humanfactors.jmir.org/2024/1/e56357 UR - http://dx.doi.org/10.2196/56357 UR - http://www.ncbi.nlm.nih.gov/pubmed/38904991 ID - info:doi/10.2196/56357 ER - TY - JOUR AU - Podda, Jessica AU - Tacchino, Andrea AU - Ponzio, Michela AU - Di Antonio, Federica AU - Susini, Alessia AU - Pedullà, Ludovico AU - Battaglia, Alberto Mario AU - Brichetto, Giampaolo PY - 2024/6/20 TI - Mobile Health App (DIGICOG-MS) for Self-Assessment of Cognitive Impairment in People With Multiple Sclerosis: Instrument Validation and Usability Study JO - JMIR Form Res SP - e56074 VL - 8 KW - cognitive assessment KW - cognitive impairment KW - digital health KW - mHealth app KW - multiple sclerosis KW - self-management KW - usability N2 - Background: Mobile health (mHealth) apps have proven useful for people with multiple sclerosis (MS). Thus, easy-to-use digital solutions are now strongly required to assess and monitor cognitive impairment, one of the most disturbing symptoms in MS that is experienced by almost 43% to 70% of people with MS. Therefore, we developed DIGICOG-MS (Digital assessment of Cognitive Impairment in Multiple Sclerosis), a smartphone- and tablet-based mHealth app to self-assess cognitive impairment in MS. Objective: This study aimed to test the validity and usability of the novel mHealth app with a sample of people with MS. Methods: DIGICOG-MS includes 4 digital tests assumed to evaluate the most affected cognitive domains in MS (visuospatial memory [VSM], verbal memory [VM], semantic fluency [SF], and information processing speed [IPS]) and inspired by traditional paper-based tests that assess the same cognitive functions (10/36 Spatial Recall Test, Rey Auditory Verbal Learning Test, Word List Generation, Symbol Digit Modalities Test). Participants were asked to complete both digital and traditional assessments in 2 separate sessions. Convergent validity was analyzed using the Pearson correlation coefficient to determine the strength of the associations between digital and traditional tests. To test the app?s reliability, the agreement between 2 repeated measurements was assessed using intraclass correlation coefficients (ICCs). Usability of DIGICOG-MS was evaluated using the System Usability Scale (SUS) and mHealth App Usability Questionnaire (MAUQ) administered at the conclusion of the digital session. Results: The final sample consisted of 92 people with MS (60 women) followed as outpatients at the Italian Multiple Sclerosis Society (AISM) Rehabilitation Service of Genoa (Italy). They had a mean age of 51.38 (SD 11.36) years, education duration of 13.07 (SD 2.74) years, disease duration of 12.91 (SD 9.51) years, and a disability level (Expanded Disability Status Scale) of 3.58 (SD 1.75). Relapsing-remitting MS was most common (68/92, 74%), followed by secondary progressive (15/92, 16%) and primary progressive (9/92, 10%) courses. Pearson correlation analyses indicated significantly strong correlations for VSM, VM, SF, and IPS (all P<.001), with r values ranging from 0.58 to 0.78 for all cognitive domains. Test-retest reliability of the mHealth app was excellent (ICCs>0.90) for VM and IPS and good for VSM and SF (ICCs>0.80). Moreover, the SUS score averaged 84.5 (SD 13.34), and the mean total MAUQ score was 104.02 (SD 17.69), suggesting that DIGICOG-MS was highly usable and well appreciated. Conclusions: The DIGICOG-MS tests were strongly correlated with traditional paper-based evaluations. Furthermore, people with MS positively evaluated DIGICOG-MS, finding it highly usable. Since cognitive impairment poses major limitations for people with MS, these findings open new paths to deploy digital cognitive tests for MS and further support the use of a novel mHealth app for cognitive self-assessment by people with MS in clinical practice. UR - https://formative.jmir.org/2024/1/e56074 UR - http://dx.doi.org/10.2196/56074 UR - http://www.ncbi.nlm.nih.gov/pubmed/38900535 ID - info:doi/10.2196/56074 ER - TY - JOUR AU - Hooshmand Zaferanieh, Mohammad AU - Shi, Lu AU - Jindal, Meenu AU - Chen, Liwei AU - Zhang, Lingling AU - Lopes, Snehal AU - Jones, Karyn AU - Wang, Yucheng AU - Meggett, Kinsey AU - Walker, Beth Cari AU - Falgoust, Grace AU - Zinzow, Heidi PY - 2024/6/18 TI - Web-Based Mindfulness-Based Cognitive Therapy for Adults With a History of Depression: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e53966 VL - 13 KW - mindfulness-based cognitive therapy KW - MBCT KW - mindfulness-based interventions KW - depression KW - depressive symptoms KW - virtual delivery KW - mindfulness KW - mental health KW - depressive KW - distress KW - stress KW - remote KW - randomized KW - controlled trial KW - controlled trials KW - RCT KW - psychotherapy KW - cognitive therapy N2 - Background: Depression poses a major threat to public health with an increasing prevalence in the United States. Mindfulness-based interventions, such as mindfulness-based cognitive therapy (MBCT), are effective methods for managing depression symptoms and may help fortify existing efforts to address the current disease burden. The in-person group format of MBCT, however, incurs barriers to care such as expenses, childcare needs, and transportation issues. Alternate delivery modalities such as MBCT delivered via the web can be investigated for their capacity to overcome these barriers and still reduce symptoms of depression with adequate feasibility and efficacy. Objective: This study protocol aims to examine the feasibility and efficacy of MBCT delivered via the web for the treatment of depression. Methods: To attain study aims, 2 phases will be implemented using a waitlist control design. A total of 128 eligible participants will be randomized into either an 8-week MBCT intervention group plus treatment as usual (MBCT + TAU; group 1) or an 8-week waitlist control group (group 2). In phase I (8 weeks), group 1 will complete the intervention and group 2 will proceed with TAU. In phase II (8 weeks), group 2 will complete the intervention and group 1 will continue with TAU until reaching an 8-week follow-up. TAU may consist of receiving psychotherapy, pharmacotherapy, or combined treatment. Data collection will be completed at baseline, 8 weeks (postintervention for group 1 and preintervention for group 2), and 16 weeks (follow-up for group 1, postintervention for group 2). The primary outcomes will include (1) current, residual, or chronic depression symptoms and (2) psychiatric distress. Secondary outcomes will include perceived stress and facets of mindfulness. The feasibility will be measured by assessing protocol adherence, retention, attendance, and engagement. Finally, the extent of mindfulness self-practice and executive functioning skills will be assessed as mediators of intervention outcomes. Results: This study began screening and recruitment in December 2022. Data collection from the first cohort occurred in January 2023. By November 2023, a total of 30 participants were enrolled out of 224 who received screening. Data analysis began in February 2024, with an approximate publication of results by August 2024. Institutional review board approval took place on September 11, 2019. Conclusions: This trial will contribute to examining mindfulness-based interventions, delivered via the web, for improving current, residual, or chronic depression symptoms. It will (1) address the feasibility of MBCT delivered via the web; (2) contribute evidence regarding MBCT?s efficacy in reducing depression symptoms and psychiatric distress; and (3) assess the impact of MBCT on several important secondary outcomes. Findings from this study will develop the understanding of the causal pathways between MBCT delivered via the web and depression symptoms further, elucidating the potential for future larger-scale designs. Trial Registration: ClinicalTrials.gov NCT05347719; https://www.clinicaltrials.gov/ct2/show/NCT05347719 International Registered Report Identifier (IRRID): DERR1-10.2196/53966 UR - https://www.researchprotocols.org/2024/1/e53966 UR - http://dx.doi.org/10.2196/53966 UR - http://www.ncbi.nlm.nih.gov/pubmed/38888958 ID - info:doi/10.2196/53966 ER - TY - JOUR AU - Morita, Kentaro AU - Miura, Kenichiro AU - Toyomaki, Atsuhito AU - Makinodan, Manabu AU - Ohi, Kazutaka AU - Hashimoto, Naoki AU - Yasuda, Yuka AU - Mitsudo, Takako AU - Higuchi, Fumihiro AU - Numata, Shusuke AU - Yamada, Akiko AU - Aoki, Yohei AU - Honda, Hiromitsu AU - Mizui, Ryo AU - Honda, Masato AU - Fujikane, Daisuke AU - Matsumoto, Junya AU - Hasegawa, Naomi AU - Ito, Satsuki AU - Akiyama, Hisashi AU - Onitsuka, Toshiaki AU - Satomura, Yoshihiro AU - Kasai, Kiyoto AU - Hashimoto, Ryota PY - 2024/5/30 TI - Tablet-Based Cognitive and Eye Movement Measures as Accessible Tools for Schizophrenia Assessment: Multisite Usability Study JO - JMIR Ment Health SP - e56668 VL - 11 KW - schizophrenia KW - cognitive function KW - eye movement KW - diagnostic biomarkers KW - digital health tools N2 - Background: Schizophrenia is a complex mental disorder characterized by significant cognitive and neurobiological alterations. Impairments in cognitive function and eye movement have been known to be promising biomarkers for schizophrenia. However, cognitive assessment methods require specialized expertise. To date, data on simplified measurement tools for assessing both cognitive function and eye movement in patients with schizophrenia are lacking. Objective: This study aims to assess the efficacy of a novel tablet-based platform combining cognitive and eye movement measures for classifying schizophrenia. Methods: Forty-four patients with schizophrenia, 67 healthy controls, and 41 patients with other psychiatric diagnoses participated in this study from 10 sites across Japan. A free-viewing eye movement task and 2 cognitive assessment tools (Codebreaker task from the THINC-integrated tool and the CognitiveFunctionTest app) were used for conducting assessments in a 12.9-inch iPad Pro. We performed comparative group and logistic regression analyses for evaluating the diagnostic efficacy of the 3 measures of interest. Results: Cognitive and eye movement measures differed significantly between patients with schizophrenia and healthy controls (all 3 measures; P<.001). The Codebreaker task showed the highest classification effectiveness in distinguishing schizophrenia with an area under the receiver operating characteristic curve of 0.90. Combining cognitive and eye movement measures further improved accuracy with a maximum area under the receiver operating characteristic curve of 0.94. Cognitive measures were more effective in differentiating patients with schizophrenia from healthy controls, whereas eye movement measures better differentiated schizophrenia from other psychiatric conditions. Conclusions: This multisite study demonstrates the feasibility and effectiveness of a tablet-based app for assessing cognitive functioning and eye movements in patients with schizophrenia. Our results suggest the potential of tablet-based assessments of cognitive function and eye movement as simple and accessible evaluation tools, which may be useful for future clinical implementation. UR - https://mental.jmir.org/2024/1/e56668 UR - http://dx.doi.org/10.2196/56668 UR - http://www.ncbi.nlm.nih.gov/pubmed/38815257 ID - info:doi/10.2196/56668 ER - TY - JOUR AU - Adhikari, Prasad Shambhu AU - Stranges, N. Tori AU - Tehrani, Zadeh Setareh Nouri AU - Porter, Shaun AU - Mason, Karen AU - van Donkelaar, Paul PY - 2024/5/24 TI - Investigating the Efficacy of a Community Support Network Rehabilitation Intervention for Improving Resiliency, Quality of Life, and Neurocognitive Function in Survivors of Intimate Partner Violence?Caused Brain Injury: Protocol for a Feasibility Study JO - JMIR Res Protoc SP - e54605 VL - 13 KW - brain injury KW - cognitive functions KW - community support network KW - intimate partner violence KW - quality of life KW - rehabilitation N2 - Background: Globally, approximately 1 in 3 women experience intimate partner violence (IPV) in their lifetime. Brain injury (BI) is a common, yet often unrecognized, consequence of IPV. BIs caused by IPV tend to be mild, occur repetitively over the course of months or years, are remote in time, and result in chronic symptoms. Similar to BI from other causes, therapeutic treatment for women with IPV-caused BI (IPV-BI) is crucial to help resolve any physical or cognitive impairments, enhance the quality of life (QoL), and minimize longer-term neurodegeneration. Objective: This study aims to investigate the feasibility and efficacy of a community support network (CSN) rehabilitation intervention regarding its impact on resiliency, QoL, and neurocognitive function. Methods: In this pre- and postexperimental design, women (aged 18 to 50 years) who are survivors of IPV and IPV-BI will be recruited from various community organizations serving survivors of IPV. Exclusion criteria will include current pregnancy and any diagnosed neurological disorder known to affect cerebrovascular, neurocognitive, or sensorimotor function. A CSN rehabilitation intervention that includes aerobic exercise, cognitive training, mindfulness meditation, and counseling will be administered. A trauma-informed approach will be integrated into the design and implementation of the program. Furthermore, the program will include a participant navigator who will provide trauma- and violence-informed advocacy and systems navigation support to participants, in addition to facilitating a monthly peer support group. The intervention will be provided for 2.5 hours a day and 2 days a week for 3 months. Participants will complete psychological assessments and provide clinic-demographic information in the first assessment. In the second (before intervention), third (after intervention), and fourth (at follow-up) sessions, they will complete tests of resiliency, QoL, and neurocognition. The estimated sample size is 100. The objective of this study will be accomplished by quantitatively measuring resiliency, QoL, and neurocognition before and immediately after the intervention. A follow-up assessment will occur 3 months after the completion of the intervention to evaluate the maintenance of any improvements in function. One-way ANOVAs will be used to evaluate the intervention outcome across the testing times. Relationships among various variables will be explored using regression analysis. Results: We anticipate that the CSN rehabilitation intervention will be effective in improving resiliency, QoL, and neurocognitive function in women who have experienced IPV-BI. Furthermore, we anticipate that this intervention will be feasible in terms of study recruitment, adherence, and retention. Conclusions: The CSN rehabilitation intervention will have a positive impact on resiliency, QoL, and neurocognitive functions in survivors of IPV-BI. Subsequently, a comparative study will be conducted by recruiting a control group receiving usual care. International Registered Report Identifier (IRRID): PRR1-10.2196/54605 UR - https://www.researchprotocols.org/2024/1/e54605 UR - http://dx.doi.org/10.2196/54605 UR - http://www.ncbi.nlm.nih.gov/pubmed/38788207 ID - info:doi/10.2196/54605 ER - TY - JOUR AU - Tabashum, Thasina AU - Snyder, Cooper Robert AU - O'Brien, K. Megan AU - Albert, V. Mark PY - 2024/5/17 TI - Machine Learning Models for Parkinson Disease: Systematic Review JO - JMIR Med Inform SP - e50117 VL - 12 KW - Parkinson disease KW - machine learning KW - systematic review KW - deep learning KW - clinical adoption KW - validation techniques KW - PRISMA KW - Preferred Reporting Items for Systematic Reviews and Meta-Analyses N2 - Background: With the increasing availability of data, computing resources, and easier-to-use software libraries, machine learning (ML) is increasingly used in disease detection and prediction, including for Parkinson disease (PD). Despite the large number of studies published every year, very few ML systems have been adopted for real-world use. In particular, a lack of external validity may result in poor performance of these systems in clinical practice. Additional methodological issues in ML design and reporting can also hinder clinical adoption, even for applications that would benefit from such data-driven systems. Objective: To sample the current ML practices in PD applications, we conducted a systematic review of studies published in 2020 and 2021 that used ML models to diagnose PD or track PD progression. Methods: We conducted a systematic literature review in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines in PubMed between January 2020 and April 2021, using the following exact string: ?Parkinson?s? AND (?ML? OR ?prediction? OR ?classification? OR ?detection? or ?artificial intelligence? OR ?AI?). The search resulted in 1085 publications. After a search query and review, we found 113 publications that used ML for the classification or regression-based prediction of PD or PD-related symptoms. Results: Only 65.5% (74/113) of studies used a holdout test set to avoid potentially inflated accuracies, and approximately half (25/46, 54%) of the studies without a holdout test set did not state this as a potential concern. Surprisingly, 38.9% (44/113) of studies did not report on how or if models were tuned, and an additional 27.4% (31/113) used ad hoc model tuning, which is generally frowned upon in ML model optimization. Only 15% (17/113) of studies performed direct comparisons of results with other models, severely limiting the interpretation of results. Conclusions: This review highlights the notable limitations of current ML systems and techniques that may contribute to a gap between reported performance in research and the real-life applicability of ML models aiming to detect and predict diseases such as PD. UR - https://medinform.jmir.org/2024/1/e50117 UR - http://dx.doi.org/10.2196/50117 ID - info:doi/10.2196/50117 ER - TY - JOUR AU - Müller-Bardorff, Miriam AU - Schulz, Ava AU - Paersch, Christina AU - Recher, Dominique AU - Schlup, Barbara AU - Seifritz, Erich AU - Kolassa, Tatjana Iris AU - Kowatsch, Tobias AU - Fisher, Aaron AU - Galatzer-Levy, Isaac AU - Kleim, Birgit PY - 2024/5/14 TI - Optimizing Outcomes in Psychotherapy for Anxiety Disorders Using Smartphone-Based and Passive Sensing Features: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e42547 VL - 13 KW - cognitive behavioral therapy KW - CBT KW - transdiagnostic KW - anxiety KW - digital KW - ecological momentary assessment KW - EMA KW - passive sensing N2 - Background: Psychotherapies, such as cognitive behavioral therapy (CBT), currently have the strongest evidence of durable symptom changes for most psychological disorders, such as anxiety disorders. Nevertheless, only about half of individuals treated with CBT benefit from it. Predictive algorithms, including digital assessments and passive sensing features, could better identify patients who would benefit from CBT, and thus, improve treatment choices. Objective: This study aims to establish predictive features that forecast responses to transdiagnostic CBT in anxiety disorders and to investigate key mechanisms underlying treatment responses. Methods: This study is a 2-armed randomized controlled clinical trial. We include patients with anxiety disorders who are randomized to either a transdiagnostic CBT group or a waitlist (referred to as WAIT). We index key features to predict responses prior to starting treatment using subjective self-report questionnaires, experimental tasks, biological samples, ecological momentary assessments, activity tracking, and smartphone-based passive sensing to derive a multimodal feature set for predictive modeling. Additional assessments take place weekly at mid- and posttreatment and at 6- and 12-month follow-ups to index anxiety and depression symptom severity. We aim to include 150 patients, randomized to CBT versus WAIT at a 3:1 ratio. The data set will be subject to full feature and important features selected by minimal redundancy and maximal relevance feature selection and then fed into machine leaning models, including eXtreme gradient boosting, pattern recognition network, and k-nearest neighbors to forecast treatment response. The performance of the developed models will be evaluated. In addition to predictive modeling, we will test specific mechanistic hypotheses (eg, association between self-efficacy, daily symptoms obtained using ecological momentary assessments, and treatment response) to elucidate mechanisms underlying treatment response. Results: The trial is now completed. It was approved by the Cantonal Ethics Committee, Zurich. The results will be disseminated through publications in scientific peer-reviewed journals and conference presentations. Conclusions: The aim of this trial is to improve current CBT treatment by precise forecasting of treatment response and by understanding and potentially augmenting underpinning mechanisms and personalizing treatment. Trial Registration: ClinicalTrials.gov NCT03945617; https://clinicaltrials.gov/ct2/show/results/NCT03945617 International Registered Report Identifier (IRRID): DERR1-10.2196/42547 UR - https://www.researchprotocols.org/2024/1/e42547 UR - http://dx.doi.org/10.2196/42547 UR - http://www.ncbi.nlm.nih.gov/pubmed/38743473 ID - info:doi/10.2196/42547 ER - TY - JOUR AU - Zhu, Dian AU - Zhao, Jianan AU - Wang, Mingxuan AU - Cao, Bochen AU - Zhang, Wenhui AU - Li, Yunlong AU - Zhang, Chenqi AU - Han, Ting PY - 2024/5/2 TI - Rehabilitation Applications Based on Behavioral Therapy for People With Knee Osteoarthritis: Systematic Review JO - JMIR Mhealth Uhealth SP - e53798 VL - 12 KW - knee osteoarthritis KW - digital application KW - behavioral therapy KW - behavior change therapy KW - cognitive behavioral therapy N2 - Background: The development of digital applications based on behavioral therapies to support patients with knee osteoarthritis (KOA) has attracted increasing attention in the field of rehabilitation. This paper presents a systematic review of research on digital applications based on behavioral therapies for people with KOA. Objective: This review aims to describe the characteristics of relevant digital applications, with a special focus on the current state of behavioral therapies, digital interaction technologies, and user participation in design. The secondary aim is to summarize intervention outcomes and user evaluations of digital applications. Methods: A systematic literature search was conducted using the keywords ?Knee Osteoarthritis,? ?Behavior Therapy,? and ?Digitization? in the following databases (from January 2013 to July 2023): Web of Science, Embase, Science Direct, Ovid, and PubMed. The Mixed Methods Assessment Tool (MMAT) was used to assess the quality of evidence. Two researchers independently screened and extracted the data. Results: A total of 36 studies met the inclusion criteria and were further analyzed. Behavioral change techniques (BCTs) and cognitive behavioral therapy (CBT) were frequently combined when developing digital applications. The most prevalent areas were goals and planning (n=31) and repetition and substitution (n=27), which were frequently used to develop physical activity (PA) goals and adherence. The most prevalent combination strategy was app/website plus SMS text message/telephone/email (n=12), which has tremendous potential. This area of application design offers notable advantages, primarily manifesting in pain mitigation (n=24), reduction of physical dysfunction (n=21), and augmentation of PA levels (n=12). Additionally, when formulating design strategies, it is imperative to consider the perspectives of stakeholders, especially in response to the identified shortcomings in application design elucidated within the study. Conclusions: The results demonstrate that ?goals and planning? and ?repetition and substitution? are frequently used to develop PA goals and PA behavior adherence. The most prevalent combination strategy was app/website plus SMS text message/telephone/email, which has tremendous potential. Moreover, incorporating several stakeholders in the design and development stages might enhance user experience, considering the distinct variations in their requirements. To improve the efficacy and availability of digital applications, we have several proposals. First, comprehensive care for patients should be ensured by integrating multiple behavioral therapies that encompass various aspects of the rehabilitation process, such as rehabilitation exercises and status monitoring. Second, therapists could benefit from more precise recommendations by incorporating additional intelligent algorithms to analyze patient data. Third, the implementation scope should be expanded from the home environment to a broader social community rehabilitation setting. UR - https://mhealth.jmir.org/2024/1/e53798 UR - http://dx.doi.org/10.2196/53798 UR - http://www.ncbi.nlm.nih.gov/pubmed/38696250 ID - info:doi/10.2196/53798 ER - TY - JOUR AU - Cangussu, Izabel Anna AU - Lucarini, Beatriz AU - Melo, Freitas Igor de AU - Diniz, Araújo Paula AU - Mancini, Marisa AU - Viana, Mattos Bernardo de AU - Romano-Silva, Aurélio Marco AU - Miranda, de Débora Marques PY - 2024/4/30 TI - Motor Effects of Intervention With Transcranial Direct Current Stimulation for Physiotherapy Treatment in Children With Cerebral Palsy: Protocol for a Randomized Clinical Trial JO - JMIR Res Protoc SP - e52922 VL - 13 KW - cerebral palsy KW - tDCS KW - motor KW - development KW - randomized clinical trial KW - RCT KW - clinical trial KW - randomized KW - transcranial direct current stimulation KW - stimulation KW - children KW - child KW - brain stimulation KW - physical therapy KW - quality of life KW - researchers KW - researcher KW - neurological injuries KW - injury KW - injuries KW - gait KW - patient KW - patients N2 - Background: Children diagnosed with cerebral palsy (CP) often experience various limitations, particularly in gross motor function and activities of daily living. Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that has been used to improve movement, gross motor function, and activities of daily living. Objective: This study aims to evaluate the potential additional effects of physiotherapy combined with tDCS in children with CP in comparison with physiotherapy only. Methods: This is a 2-arm randomized controlled trial that will compare the effects of tDCS as an adjunctive treatment during rehabilitation sessions to rehabilitation without tDCS. Children with CP classified by the Gross Motor Function Classification System as levels I and II will be randomly assigned to either the sham + rehabilitation group or the tDCS + rehabilitation group. The primary outcome will be the motor skills assessed using the Gross Motor Function Measure domain E scores, and the secondary outcome will be the measurement scores of the children?s quality of life. The intervention will consist of a 10-day stimulation protocol with tDCS spread over 2 weeks, with stimulation or sham tDCS administered for 20 minutes at a frequency of 1 Hz, in combination with physiotherapy. Physical therapy exercises will be conducted in a circuit based on each child?s baseline Gross Motor Function Measure results. The participants? changes will be evaluated and compared in both groups. Intervenient features will be tested. Results: Data collection is ongoing and is expected to be completed by January 2025. A homogeneous sample and clear outcomes may be a highlight of this protocol, which may allow us to understand the potential use of tDCS and for whom it should or should not be used. Conclusions: A study with good evidence and clear outcomes in children with CP might open an avenue for the potential best use of neurostimulation. Trial Registration: Brazilian Registry of Clinical Trials RBR-104h4s4y; https://tinyurl.com/47r3x2e4 International Registered Report Identifier (IRRID): PRR1-10.2196/52922 UR - https://www.researchprotocols.org/2024/1/e52922 UR - http://dx.doi.org/10.2196/52922 UR - http://www.ncbi.nlm.nih.gov/pubmed/38687586 ID - info:doi/10.2196/52922 ER - TY - JOUR AU - Lee, J. Edmund W. AU - Tan, W. Warrick AU - Pham, Phat Ben Tan AU - Kawaja, Ariffin AU - Theng, Yin-Leng PY - 2024/4/24 TI - Addressing Data Absenteeism and Technology Chauvinism in the Use of Gamified Wearable Gloves Among Older Adults: Moderated Usability Study JO - JMIR Serious Games SP - e47600 VL - 12 KW - wearables KW - exergames KW - older adults KW - active aging KW - rehabilitation KW - stroke N2 - Background: Digital health technologies have the potential to improve health outcomes for older adults, especially for those recovering from stroke. However, there are challenges to developing these technologies, such as data absenteeism (where older adults? views are often underrepresented in research and development) and technology chauvinism (the belief that sophisticated technology alone is the panacea to addressing health problems), which hinder their effectiveness. Objective: In this study, we aimed to address these challenges by developing a wearable glove integrated with culturally relevant exergames to motivate older adults to exercise and, for those recovering from stroke, to adhere to rehabilitation. Methods: We conducted a moderated usability study with 19 older adults, of which 11 (58%) had a history of stroke. Our participants engaged in a 30-minute gameplay session with the wearable glove integrated with exergames, followed by a quantitative survey and an in-depth interview. We used descriptive analysis to compare responses to the System Usability Scale between those who had a history of stroke and those who did not. In addition, we analyzed the qualitative interviews using a bottom-up thematic analysis to identify key themes related to the motivations and barriers regarding the use of wearable gloves for rehabilitation and exercise. Results: Our study generated several key insights. First, making the exergames exciting and challenging could improve exercise and rehabilitation motivation, but it could also have a boomerang effect, where participants may become demotivated if the games were very challenging. Second, the comfort and ease of use of the wearable gloves were important for older adults, regardless of their stroke history. Third, for older adults with a history of stroke, the functionality and purpose of the wearable glove were important in helping them with specific exercise movements. Conclusions: Our findings highlight the importance of providing contextual support for the effective use of digital technologies, particularly for older adults recovering from stroke. In addition to technology and usability factors, other contextual factors such as gamification and social support (from occupational therapists or caregivers) should be considered to provide a comprehensive approach to addressing health problems. To overcome data absenteeism and technology chauvinism, it is important to develop digital health technologies that are tailored to the needs of underserved communities. Our study provides valuable insights for the development of digital health technologies that can motivate older adults recovering from stroke to exercise and adhere to rehabilitation. UR - https://games.jmir.org/2024/1/e47600 UR - http://dx.doi.org/10.2196/47600 UR - http://www.ncbi.nlm.nih.gov/pubmed/38656778 ID - info:doi/10.2196/47600 ER - TY - JOUR AU - Howdle, Charlotte AU - Wright, Alexander William James AU - Mant, Jonathan AU - De Simoni, Anna PY - 2024/4/16 TI - Factors Influencing Recovery From Pediatric Stroke Based on Discussions From a UK-Based Online Stroke Community: Qualitative Thematic Study JO - J Med Internet Res SP - e49409 VL - 26 KW - child KW - stroke KW - rehabilitation KW - barriers KW - facilitators KW - internet-based intervention KW - self-help group KW - thematic analysis N2 - Background: The incidence of stroke in children is low, and pediatric stroke rehabilitation services are less developed than adult ones. Survivors of pediatric stroke have a long poststroke life expectancy and therefore have the potential to experience impairments from their stroke for many years. However, there are relatively few studies characterizing these impairments and what factors facilitate or counteract recovery. Objective: This study aims to characterize the main barriers to and facilitators of recovery from pediatric stroke. A secondary aim was to explore whether these factors last into adulthood, whether they change, or if new factors impacting recovery emerge in adulthood. Methods: We performed a qualitative thematic analysis based on posts from a population of participants from a UK-based online stroke community, active between 2004 and 2011. The analysis focused on users who talked about their experiences with pediatric stroke, as identified by a previous study. The posts were read by 3 authors, and factors influencing recovery from pediatric stroke were mapped into 4 areas: medical, physical, emotional, and social. Factors influencing recovery were divided into short-term and long-term factors. Results: There were 425 posts relating to 52 survivors of pediatric stroke. Some survivors of stroke posted for themselves, while others were talked about by a third party (mostly parents; 31/35, 89% mothers). In total, 79% (41/52) of survivors of stroke were aged ?18 years and 21% (11/52) were aged >18 years at the time of posting. Medical factors included comorbidities as a barrier to recovery. Medical interventions, such as speech and language therapy and physiotherapy, were also deemed useful. Exercise, particularly swimming, was deemed a facilitator. Among physical factors, fatigue and chronic pain could persist decades after a stroke, with both reported as a barrier to feeling fully recovered. Tiredness could worsen existing stroke-related impairments. Other long-standing impairments were memory loss, confusion, and dizziness. Among emotional factors, fear and uncertainty were short-term barriers, while positivity was a major facilitator in both short- and long-term recovery. Anxiety, grief, and behavioral problems hindered recovery. The social barriers were loneliness, exclusion, and hidden disabilities not being acknowledged by third parties. A good support network and third-party support facilitated recovery. Educational services were important in reintegrating survivors into society. Participants reported that worrying about losing financial support, such as disability allowances, and difficulties in obtaining travel insurance and driving licenses impacted recovery. Conclusions: The lived experience of survivors of pediatric stroke includes long-term hidden disabilities and barriers to rehabilitation. These are present in different settings, such as health care, schools, workplaces, and driving centers. Greater awareness of these issues by relevant professional groups may help ameliorate them. UR - https://www.jmir.org/2024/1/e49409 UR - http://dx.doi.org/10.2196/49409 UR - http://www.ncbi.nlm.nih.gov/pubmed/38625726 ID - info:doi/10.2196/49409 ER - TY - JOUR AU - Paul, Lorna AU - Thomson, Katie AU - Asibey, Osei Shadrack AU - Brady, Marian AU - van Wijck, Frederike AU - Antwi, Derrick AU - Opoku, Nkansah Eric AU - Sarfo, Stephen Fred PY - 2024/3/27 TI - Views of Service Users, Their Family or Carers, and Health Care Professionals on Telerehabilitation for People With Neurological Conditions in Ghana: Qualitative Study JO - JMIR Mhealth Uhealth SP - e49501 VL - 12 KW - telerehabilitation KW - low- to middle-income country KW - LMIC KW - service user KW - health care professional KW - qualitative study KW - caregiver KW - neurorehabilitation KW - barriers KW - facilitators KW - eHealth KW - focus group KW - thematic analysis N2 - Background: Up to 50% of people in low- and middle-income countries do not receive the rehabilitation they require. Telerehabilitation has the potential to improve access to neurorehabilitation services especially in low- and middle-income countries. Although there are reports of the barriers and facilitators to telerehabilitation in such settings, almost all are anecdotal. Furthermore, family or carers have a significant influence on the adoption and success of telerehabilitation, but their views have not been reported. Objective: This study aimed to investigate the views of service users, their family or carers, and health care professionals (HCPs) on telerehabilitation for people with neurological conditions in Ghana. Methods: Two focus groups were held at Komfo Anokye Hospital in Kumasi, Ghana: one in person for service users (n=11) and their family or carers (n=9), conducted in the Ghanaian language of Twi, and one hybrid for HCPs (n=18) conducted in English. The mean (SD) age of the service users was 59.8 (8.6) years; 5 users had a stroke and 6 had Parkinson disease. The HCP group consisted of 7 speech and language therapists, 3 physiotherapists, 3 occupational therapists, 3 medical staff, 1 nurse, and 1 industry representative. Focus groups were semi-structured and explored previous experiences of telerehabilitation, perceived benefits and challenges, and solutions to overcome these challenges. Focus groups were audio transcribed, and the service user transcript was translated into English. The resulting transcripts were analyzed using thematic analysis. Results: Overall, participants were positive about the role of telerehabilitation but recommended hybrid delivery, with in-person rehabilitation in the early stages and telerehabilitation in the later stages. In relation to telerehabilitation in Ghana, there were 3 main themes: benefits, challenges or barriers, and implementation. Benefits included the convenience and lower cost for service users, the higher dose of therapy possible, and increased access for people in remote areas. However, challenges included lack of a stable internet connection, cost of phones and data packages, and low levels of literacy. Implementation issues included cultural relevance, information governance, and the platform used to deliver telerehabilitation, with most participants being familiar with WhatsApp. Conclusions: Telerehabilitation has the potential to be a useful method of delivering rehabilitation to people with neurological conditions in Ghana, especially in a hybrid rehabilitation model with telerehabilitation augmenting in-person sessions. However, many people were unaware of telerehabilitation, and challenges such as a reliable internet connection, cultural relevance, and costs need to be addressed. Clinical trials of low-cost telerehabilitation interventions contextualized to the specific user group are required. UR - https://mhealth.jmir.org/2024/1/e49501 UR - http://dx.doi.org/10.2196/49501 UR - http://www.ncbi.nlm.nih.gov/pubmed/38536218 ID - info:doi/10.2196/49501 ER - TY - JOUR AU - Sharma, Nikita AU - Grotenhuijs, Karen AU - Gemert-Pijnen, van J. E. W. C. AU - Oinas-Kukkonen, Harri AU - Braakman-Jansen, A. L. M. PY - 2024/3/22 TI - Low-Fidelity Prototype of a Sensor-Dependent Interaction Platform: Formative Evaluation With Informal Caregivers of Older Adults With Cognitive Impairment JO - JMIR Form Res SP - e53402 VL - 8 KW - older adult care KW - informal caregivers KW - cognitive impairment KW - sensing solutions KW - information communication platform KW - low-fidelity KW - lo-fi prototype N2 - Background: Unobtrusive sensing technologies developed for monitoring deviant behaviors in older adult care require integration with an interaction platform to facilitate the flow of information between older adults and their caregivers. However, the continuous monitoring capabilities generate a considerable amount of data that must be interpreted, filtered, and personalized before being communicated to the informal caregivers based on their specific care needs and requirements. Objective: For the effective implementation of unobtrusive sensing solutions (USSs) in the care of older adults with cognitive impairment, we aimed to explore the expectations and preconditions regarding the implementation of USSs from the perspective of informal caregivers. Subsequently, we designed and evaluated a low-fidelity prototype of an interaction platform for its conceptual workflow and usability, incorporating persuasive system design features based on the needs and requirements of informal caregivers. Methods: Overall, 6 informal caregivers of older adults with cognitive impairment living alone participated in this qualitative interview study. We explored the expectation and preconditions regarding implementation through open-ended questions and conducted a formative evaluation (usability study with a think-aloud approach) to evaluate the conceptual workflow and used persuasive system design features in the interaction platform. Overall, a combination of inductive and thematic analyses was used to analyze the interviews. Results: The results of this study present both positive and negative outcome expectations regarding the implementation of USSs, highlighting benefits such as objective decision-making and peace of mind and concerns about information overload and the potential substitution of human contact. Strategic information communication agreements between informal and formal caregivers were deemed crucial for the successful implementation of USSs in care. Overall, informal caregivers had a positive experience with the low-fidelity prototype of the interaction platform, particularly valuing the personalization feature. Conclusions: In conclusion, to achieve successful implementation, a holistic design approach is necessary, and equal consideration should be given to the personalization-privacy paradox to balance users? needs and privacy. UR - https://formative.jmir.org/2024/1/e53402 UR - http://dx.doi.org/10.2196/53402 UR - http://www.ncbi.nlm.nih.gov/pubmed/38517461 ID - info:doi/10.2196/53402 ER - TY - JOUR AU - Haag, Susan AU - Kepros, John PY - 2024/3/19 TI - Head Protection Device for Individuals at Risk for Head Injury due to Ground-Level Falls: Single Trauma Center User Experience Investigation JO - JMIR Hum Factors SP - e54854 VL - 11 KW - health care interventions and technologies KW - user experience research KW - usability KW - brain injury KW - ground-level fall (GLF) KW - head protection device (HPD) KW - fall risk KW - patient compliance N2 - Background: Falls represent a large percentage of hospitalized patients with trauma as they may result in head injuries. Brain injury from ground-level falls (GLFs) in patients is common and has substantial mortality. As fall prevention initiatives have been inconclusive, we changed our strategy to injury prevention. We identified a head protection device (HPD) with impact-resistant technology, which meets head impact criteria sustained in a GLF. HPDs such as helmets are ubiquitous in preventing head injuries in sports and industrial activities; yet, they have not been studied for daily activities. Objective: We investigated the usability of a novel HPD on patients with head injury in acute care and home contexts to predict future compliance. Methods: A total of 26 individuals who sustained head injuries, wore an HPD in the hospital, while ambulatory and were evaluated at baseline and 2 months post discharge. Clinical and demographic data were collected; a usability survey captured HPD domains. This user experience design revealed patient perceptions, satisfaction, and compliance. Nonparametric tests were used for intragroup comparisons (Wilcoxon signed rank test). Differences between categorical variables including sex, race, and age (age group 1: 55-77 years; age group 2: 78+ years) and compliance were tested using the chi-square test. Results: Of the 26 patients enrolled, 12 (46%) were female, 18 (69%) were on anticoagulants, and 25 (96%) were admitted with a head injury due to a GLF. The median age was 77 (IQR 55-92) years. After 2 months, 22 (85%) wore the device with 0 falls and no GLF hospital readmissions. Usability assessment with 26 patients revealed positive scores for the HPD post discharge regarding satisfaction (mean 4.8, SD 0.89), usability (mean 4.23, SD 0.86), effectiveness (mean 4.69, SD 0.54), and relevance (mean 4.12, SD 1.10). Nonparametric tests showed positive results with no significant differences between 2 observations. One issue emerged in the domain of aesthetics; post discharge, 8 (30%) patients had a concern about device weight. Analysis showed differences in patient compliance regarding age (?12=4.27; P=.04) but not sex (?12=1.58; P=.23) or race (?12=0.75; P=.60). Age group 1 was more likely to wear the device for normal daily activities. Patients most often wore the device ambulating, and protection was identified as the primary benefit. Conclusions: The HPD intervention is likely to have reasonably high compliance in a population at risk for GLFs as it was considered usable, protective, and relevant. The feasibility and wearability of the device in patients who are at risk for GLFs will inform future directions, which includes a multicenter study to evaluate device compliance and effectiveness. Our work will guide other institutions in pursuing technologies and interventions that are effective in mitigating injury in the event of a fall in this high-risk population. UR - https://humanfactors.jmir.org/2024/1/e54854 UR - http://dx.doi.org/10.2196/54854 UR - http://www.ncbi.nlm.nih.gov/pubmed/38502170 ID - info:doi/10.2196/54854 ER - TY - JOUR AU - Prats-Bisbe, Alba AU - López-Carballo, Jaume AU - García-Molina, Alberto AU - Leno-Colorado, David AU - García-Rudolph, Alejandro AU - Opisso, Eloy AU - Jané, Raimon PY - 2024/3/18 TI - Virtual Reality?Based Neurorehabilitation Support Tool for People With Cognitive Impairments Resulting From an Acquired Brain Injury: Usability and Feasibility Study JO - JMIR Neurotech SP - e50538 VL - 3 KW - acquired brain injury KW - virtual reality KW - head-mounted display KW - neurorehabilitation KW - usability KW - feasibility KW - co-design KW - multidisciplinary experiences KW - immersive serious games N2 - Background: Acquired brain injury (ABI) is a prominent cause of disability globally, with virtual reality (VR) emerging as a promising aid in neurorehabilitation. Nonetheless, the diversity among VR interventions can result in inconsistent outcomes and pose challenges in determining efficacy. Recent reviews offer best practice recommendations for designing and implementing therapeutic VR interventions to evaluate the acceptance of fully immersive VR interventions. Objective: This study aims to evaluate the usability and feasibility of a co-designed VR-based neurorehabilitation support tool by conducting multiple proof-of-concept trials in a sample of patients with ABI within a hospital setting. Methods: A single session deploying custom immersive serious games to train cognitive functions using a new-generation head-mounted display was conducted among a sample of inpatients with ABI. Structured questionnaires were administered at the end of the session to evaluate the usability of the system and the intervention, participants? familiarity with the technology, and any adverse effects related to cybersickness. Additionally, the training duration while wearing the headset and the demographic characteristics of the participants were considered. Results: A total of 20 patients with ABI participated in a 1-hour proof-of-concept trial. The mean usability score was 37 (SD 2.6) out of 40, the technology familiarity level was 9.2 (SD 2.9) out of 12, and the Simulator Sickness Questionnaire total score was 1.3 (SD 2). On average, participants wore the headset for approximately 25.6 (SD 4.7) minutes during the intervention. There were no substantial differences in usability and technology familiarity levels based on patients? etiology or age, with no notable symptoms of cybersickness reported. Significantly strong correlations were noted between cybersickness symptoms and various usability categories, including exposure, motivation, interactivity, task specificity, and immersion aspects. Further, there was a significant association between the intervention time and the number of tasks performed (P<.001). Furthermore, patients who derived enjoyment from VR sessions expressed a heightened interest in incorporating VR into their daily neurorehabilitation practice (P<.001). Moreover, oculomotor issues were found to be highly sensitive to the onset of disorientation sickness symptoms (P<.001). Conclusions: Through a collaborative approach, this study showcases the usability and feasibility of a VR-based support tool for cognitive rehabilitation among inpatients with ABI. Key components of such interventions encompass a multidisciplinary array of immersive experiences integrating neurorehabilitation principles and serious games techniques. UR - https://neuro.jmir.org/2024/1/e50538 UR - http://dx.doi.org/10.2196/50538 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50538 ER - TY - JOUR AU - Chew, Ann Kimberly AU - Ponsford, Jennie AU - Gould, Rachel Kate PY - 2024/1/29 TI - Addressing Cyberscams and Acquired Brain Injury (?I Desperately Need to Know What to Do?): Qualitative Exploration of Clinicians? and Service Providers? Perspectives JO - J Med Internet Res SP - e51245 VL - 26 KW - cyberscam KW - cyberscams KW - fraud KW - cybercrime KW - cybersafety KW - brain injury KW - disability KW - neurorehabilitation KW - interventions KW - treatment KW - qualitative N2 - Background: People with acquired brain injury (ABI) may be more susceptible to scams owing to postinjury cognitive and psychosocial consequences. Cyberscams result in financial loss and debilitating psychological impacts such as shame and mistrust, interference with neurorehabilitation, and reduced independence. Despite these significant consequences, there are no psychological treatments to support cyberscam survivors. There is limited evidence regarding how the current workforce is addressing post-ABI cyberscams. Objective: This study aims to understand the perspectives and needs of clinicians and service providers in addressing post-ABI cyberscams. Methods: Overall, 20 multidisciplinary clinicians and service providers were recruited through purposive sampling across Australia. Semistructured interviews explored post-ABI scam experiences and vulnerabilities, treatments and their efficacy, and recommendations for future cybersafety recovery interventions. Reflexive thematic analysis was used. Results: In total, 8 themes encompassing a biopsychosocial understanding of scam vulnerabilities and impacts were identified: ?genuine lack of awareness: cognitive-executive difficulties?; ?not coping with the loss of it all?; ?needing trust and connection?; ?strong reactions of trusted others?; ?nothing structured to do?; ?financial stress and independence?; ?cyberability?; and ?scammer persuasion.? Each theme informed clinical recommendations including the need to provide psychological and cognitive support, enhance financial and cybersafety skills, promote meaningful social engagement, and foster collaboration between families and clinical support teams. Conclusions: The multifaceted range of scam vulnerabilities and impacts highlighted the need for individualized, comprehensive, and targeted treatments using a biopsychosocial approach to enable cyberscam recovery among people with ABI. These findings will guide the development of a co-designed intervention. UR - https://www.jmir.org/2024/1/e51245 UR - http://dx.doi.org/10.2196/51245 UR - http://www.ncbi.nlm.nih.gov/pubmed/38285489 ID - info:doi/10.2196/51245 ER - TY - JOUR AU - Wang, Zeyu AU - He, Kang AU - Sui, Xin AU - Yi, Jiang AU - Yang, Zhaoyun AU - Wang, Kai AU - Gao, Yan AU - Bian, Linfang AU - Jiang, Junjie AU - Zhao, Lijing PY - 2023/12/25 TI - The Effect of Web-Based Telerehabilitation Programs on Children and Adolescents With Brain Injury: Systematic Review and Meta-Analysis JO - J Med Internet Res SP - e46957 VL - 25 KW - acquired brain injury KW - web-based KW - telerehabilitation KW - motor function KW - physical activity level KW - lower limb strength KW - children KW - adolescents KW - meta-analysis N2 - Background: Acquired brain injury (ABI) in children and adolescents can lead to motor and executive impairments that often require long-term treatment. The implementation of web-based telerehabilitation therapy at home is a method to improve the functional status of patients. Therefore, we performed a systematic review of the effects of web-based telerehabilitation programs on functional outcomes in children and adolescents with brain injury and supplemented the findings with a meta-analysis. Objective: This study evaluated the therapeutic effect of web-based telerehabilitation training on children and adolescents with brain injury to determine whether web-based telerehabilitation therapy improved motor function, executive function, physical activity level, lower limb strength, hand and upper limb function, visual processing skills, and occupational functional performance in children and adolescents with brain injury. Methods: PubMed, Embase, Scopus, Web of Science, and the Cochrane Library were searched for randomized controlled trials on web-based telerehabilitation programs in children and adolescents with brain injury until December 2022, and the risk of bias was evaluated using the Cochrane Collaboration Tool. Relevant data were extracted, and a meta-analysis was performed using RevMan5.3 software. Results: Overall, 17 studies involving 848 patients were included. Web-based telerehabilitation therapy improved the motor function (standardized mean difference [SMD] 0.29, 95% CI 0.01-0.57; P=.04), physical activity level (SMD 0.42, 95% CI 0.11-0.73; P=.007), lower limb strength (SMD 0.52, 95% CI 0.13-0.90; P=.009), and visual processing skills (SMD 0.26, 95% CI 0.02-0.50; P=.04) of children and adolescents with brain injury. It also improved executive function in letter-number sequencing (SMD 1.26, 95% CI 0.26-2.26; P=.01), attention (SMD 0.38, 95% CI 0.09-0.66; P=.009), and symbol search (SMD 1.18, 95% CI 0.43-1.93, P=.002). Conclusions: Web-based telerehabilitation therapy improved motor function, physical activity level, lower limb strength, letter-number sequencing, attention, and symbol search, which improved the quality of life in children and adolescents with brain injury. Web-based telerehabilitation programs provide great convenience for children and adolescents with ABI who need long-term treatment and allow them to exercise at home for rehabilitation training. The widespread implementation of remote interventions also provides children and adolescents in remote areas with better access to rehabilitation services. This review provides evidence for the effectiveness of web-based telerehabilitation therapy, but there was heterogeneity in some of the results because of different disease types and intervention programs. Future studies can expand the sample size according to disease type and increase follow-up time according to different exercise prescriptions to further refine the long-term effects of this intervention on various functions of children and adolescents with ABI. Trial Registration: PROSPERO CRD42023421917; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=421917 UR - https://www.jmir.org/2023/1/e46957 UR - http://dx.doi.org/10.2196/46957 UR - http://www.ncbi.nlm.nih.gov/pubmed/38145485 ID - info:doi/10.2196/46957 ER - TY - JOUR AU - Alder, Gemma AU - Taylor, Denise AU - Rashid, Usman AU - Olsen, Sharon AU - Brooks, Thonia AU - Terry, Gareth AU - Niazi, Khan Imran AU - Signal, Nada PY - 2023/12/11 TI - A Brain Computer Interface Neuromodulatory Device for Stroke Rehabilitation: Iterative User-Centered Design Approach JO - JMIR Rehabil Assist Technol SP - e49702 VL - 10 KW - user-centered design KW - stroke KW - rehabilitation technology KW - wearable technology KW - brain computer interface KW - BCI KW - mobile app KW - think-aloud KW - near live KW - semistructured interviews N2 - Background: Rehabilitation technologies for people with stroke are rapidly evolving. These technologies have the potential to support higher volumes of rehabilitation to improve outcomes for people with stroke. Despite growing evidence of their efficacy, there is a lack of uptake and sustained use in stroke rehabilitation and a call for user-centered design approaches during technology design and development. This study focuses on a novel rehabilitation technology called exciteBCI, a complex neuromodulatory wearable technology in the prototype stage that augments locomotor rehabilitation for people with stroke. The exciteBCI consists of a brain computer interface, a muscle electrical stimulator, and a mobile app. Objective: This study presents the evaluation phase of an iterative user-centered design approach supported by a qualitative descriptive methodology that sought to (1) explore users? perspectives and experiences of exciteBCI and how well it fits with rehabilitation, and (2) facilitate modifications to exciteBCI design features. Methods: The iterative usability evaluation of exciteBCI was conducted in 2 phases. Phase 1 consisted of 3 sprint cycles consisting of single usability sessions with people with stroke (n=4) and physiotherapists (n=4). During their interactions with exciteBCI, participants used a ?think-aloud? approach, followed by a semistructured interview. At the end of each sprint cycle, device requirements were gathered and the device was modified in preparation for the next cycle. Phase 2 focused on a ?near-live? approach in which 2 people with stroke and 1 physiotherapist participated in a 3-week program of rehabilitation augmented by exciteBCI (n=3). Participants completed a semistructured interview at the end of the program. Data were analyzed from both phases using conventional content analysis. Results: Overall, participants perceived and experienced exciteBCI positively, while providing guidance for iterative changes. Five interrelated themes were identified from the data: (1) ?This is rehab? illustrated that participants viewed exciteBCI as having a good fit with rehabilitation practice; (2) ?Getting the most out of rehab? highlighted that exciteBCI was perceived as a means to enhance rehabilitation through increased engagement and challenge; (3) ?It is a tool not a therapist,? revealed views that the technology could either enhance or disrupt the therapeutic relationship; and (4) ?Weighing up the benefits versus the burden? and (5) ?Don?t make me look different? emphasized important design considerations related to device set-up, use, and social acceptability. Conclusions: This study offers several important findings that can inform the design and implementation of rehabilitation technologies. These include (1) the design of rehabilitation technology should support the therapeutic relationship between the patient and therapist, (2) social acceptability is a design priority in rehabilitation technology but its importance varies depending on the use context, and (3) there is value in using design research methods that support understanding usability in the context of sustained use. UR - https://rehab.jmir.org/2023/1/e49702 UR - http://dx.doi.org/10.2196/49702 UR - http://www.ncbi.nlm.nih.gov/pubmed/38079202 ID - info:doi/10.2196/49702 ER - TY - JOUR AU - Smayda, Elisabeth Kirsten AU - Cooper, Hodsdon Sarah AU - Leyden, Katie AU - Ulaszek, Jackie AU - Ferko, Nicole AU - Dobrin, Annamaria PY - 2023/11/20 TI - Validating the Safe and Effective Use of a Neurorehabilitation System (InTandem) to Improve Walking in the Chronic Stroke Population: Usability Study JO - JMIR Rehabil Assist Technol SP - e50438 VL - 10 KW - chronic stroke KW - walking KW - InTandem KW - MR-001 KW - neurorehabilitation KW - human factors engineering KW - usability KW - rhythmic auditory stimulation KW - validation KW - neurotherapeutic N2 - Background: Persistent walking impairment following a stroke is common. Although rehabilitative interventions exist, few exist for use at home in the chronic phase of stroke recovery. InTandem (MedRhythms, Inc) is a neurorehabilitation system intended to improve walking and community ambulation in adults with chronic stroke walking impairment. Objective: Using design best practices and human factors engineering principles, the research presented here was conducted to validate the safe and effective use of InTandem. Methods: In total, 15 participants in the chronic phase of stroke recovery (?6 months after stroke) participated in this validation study. Participants were scored on 8 simulated use tasks, 4 knowledge assessments, and 7 comprehension assessments in a simulated home environment. The number and types of use errors, close calls, and operational difficulties were evaluated. Analyses of task performances, participant behaviors, and follow-up interviews were conducted to determine the root cause of use errors and difficulties. Results: During this validation study, 93% (14/15) of participants were able to successfully complete the critical tasks associated with the simulated use of the InTandem system. Following simulated use task assessments, participants? knowledge and comprehension of the instructions for use and key safety information were evaluated. Overall, participants were able to find and correctly interpret information in the materials in order to answer the knowledge assessment questions. During the comprehension assessment, participants understood warning statements associated with critical tasks presented in the instructions for use. Across the entire study, 3 ?use errors? and 1 ?success with difficulty? were recorded. No adverse events, including slips, trips, or falls, occurred in this study. Conclusions: In this validation study, people in the chronic phase of stroke recovery were able to safely and effectively use InTandem in the intended use environment. This validation study contributes to the overall understanding of residual use?related risks of InTandem in consideration of the established benefits. UR - https://rehab.jmir.org/2023/1/e50438 UR - http://dx.doi.org/10.2196/50438 UR - http://www.ncbi.nlm.nih.gov/pubmed/37983080 ID - info:doi/10.2196/50438 ER - TY - JOUR AU - Kylén, Maya AU - Sturge, Jodi AU - Lipson-Smith, Ruby AU - Schmidt, M. Steven AU - Pessah-Rasmussen, Hélène AU - Svensson, Tony AU - de Vries, Laila AU - Bernhardt, Julie AU - Elf, Marie PY - 2023/11/9 TI - Built Environments to Support Rehabilitation for People With Stroke From the Hospital to the Home (B-Sure): Protocol for a Mixed Method Participatory Co-Design Study JO - JMIR Res Protoc SP - e52489 VL - 12 KW - stroke rehabilitation KW - built environment KW - person-centered KW - participation KW - self-efficacy KW - meaningful activities KW - accessibility KW - participatory co-design KW - good quality and local care N2 - Background: A global trend is to move rehabilitation closer to people's neighborhoods and homes. Still, little attention has been given to how the built environment outside the hospital setting might impact rehabilitation and recovery for stroke survivors. Objective: The overarching objective of this project is to develop conceptual models of built environments that support stroke rehabilitation and recovery outside the hospital setting. Specifically, the project will explore factors and characteristics of the built environment that support people with stroke and their families and identify innovative built environments that can be designed for local health care. The project will examine facilitators and obstacles for implementing built environmental solutions and evaluate the potential benefits, feasibility, and acceptability. Methods: The project uses a mixed methods design approach with 3 phases. In phase 1, factors and characteristics of the built environment for rehabilitation will be identified. Based on the results from phase 1, phase 2 will involve co-designing prototypes of environments to support the rehabilitation process for people with stroke. Finally, the prototypes will be evaluated in phase 3. Qualitative and quantitative methods will include a literature review, a concept mapping (CM) study, stakeholder interviews, prototype development, and testing. The project will use multidimensional scaling, hierarchical cluster analysis, descriptive statistics for quantitative data, and content analysis for qualitative data. Location analysis will rely on the location-allocation model for network problems, and the rule-based analysis will be based on geographic information systems data. Results: As of the submission of this protocol, ethical approval for the CM study and the interview study has been obtained. Data collection is planned to start in September 2023 and the workshops later in the same year. The scoping review is ongoing from January 2023. The CM study is ongoing and will be finalized in the spring of 2024. We expect to finish the data analysis in the second half of 2024. The project is a 3-year project and will continue until December 2025. Conclusions: We aim to determine how new environments could better support a person?s control over their day, environment, goals, and ultimately control over their recovery and rehabilitation activities. This ?taking charge? approach would have the greatest chance of transferring the care closer to the patient's home. By co-designing with multiple stakeholders, we aim to create solutions with the potential for rapid implementation. The project?s outcomes may target other people with frail health after a hospital stay or older persons in Sweden and anywhere else. The impact and social benefits include collaboration between important stakeholders to explore how new environments can support the transition to local health care, co-design, and test of new conceptual models of environments that can promote health and well-being for people post stroke. International Registered Report Identifier (IRRID): DERR1-10.2196/52489 UR - https://www.researchprotocols.org/2023/1/e52489 UR - http://dx.doi.org/10.2196/52489 UR - http://www.ncbi.nlm.nih.gov/pubmed/37943590 ID - info:doi/10.2196/52489 ER - TY - JOUR AU - Devittori, Giada AU - Ranzani, Raffaele AU - Dinacci, Daria AU - Romiti, Davide AU - Califfi, Antonella AU - Petrillo, Claudio AU - Rossi, Paolo AU - Gassert, Roger AU - Lambercy, Olivier PY - 2023/11/9 TI - Progressive Transition From Supervised to Unsupervised Robot-Assisted Therapy After Stroke: Protocol for a Single-Group, Interventional Feasibility Study JO - JMIR Res Protoc SP - e48485 VL - 12 KW - technology-assisted rehabilitation KW - unsupervised therapy KW - self-directed therapy KW - stroke KW - neurorehabilitation KW - neurocognitive rehabilitation KW - robot-assisted therapy KW - rehabilitation technology KW - robot. N2 - Background: Increasing the dose of therapy delivered to patients with stroke may improve functional outcomes and quality of life. Unsupervised technology-assisted rehabilitation is a promising way to increase the dose of therapy without dramatically increasing the burden on the health care system. Despite the many existing technologies for unsupervised rehabilitation, active rehabilitation robots have rarely been tested in a fully unsupervised way. Furthermore, the outcomes of unsupervised technology-assisted therapy (eg, feasibility, acceptance, and increase in therapy dose) vary widely. This might be due to the use of different technologies as well as to the broad range of methods applied to teach the patients how to independently train with a technology. Objective: This paper describes the study design of a clinical study investigating the feasibility of unsupervised therapy with an active robot and of a systematic approach for the progressive transition from supervised to unsupervised use of a rehabilitation technology in a clinical setting. The effect of unsupervised therapy on achievable therapy dose, user experience in this therapy setting, and the usability of the rehabilitation technology are also evaluated. Methods: Participants of the clinical study are inpatients of a rehabilitation clinic with subacute stroke undergoing a 4-week intervention where they train with a hand rehabilitation robot. The first week of the intervention is supervised by a therapist, who teaches participants how to interact and train with the device. The second week consists of minimally supervised therapy, where the therapist is present but intervenes only if needed as participants exercise with the device. If the participants properly learn how to train with the device, they proceed to the unsupervised phase and train without any supervision during the third and fourth weeks. Throughout the duration of the study, data on feasibility and therapy dose (ie, duration and repetitions) are collected. Usability and user experience are evaluated at the end of the second (ie, minimally supervised) and fourth (ie, unsupervised) weeks, allowing us to investigate the effect of therapist absence. Results: As of April 2023, 13 patients were recruited and completed the protocol, with no reported adverse events. Conclusions: This study will inform on the feasibility of fully unsupervised rehabilitation with an active rehabilitation robot in a clinical setting and its effect on therapy dose. Furthermore, if successful, the proposed systematic approach for a progressive transition from supervised to unsupervised technology-assisted rehabilitation could serve as a benchmark to allow for easier comparisons between different technologies. This approach could also be extended to the application of such technologies in the home environment, as the supervised and minimally supervised sessions could be performed in the clinic, followed by unsupervised therapy at home after discharge. Trial Registration: ClinicalTrials.gov NCT04388891; https://clinicaltrials.gov/study/NCT04388891 International Registered Report Identifier (IRRID): DERR1-10.2196/48485 UR - https://www.researchprotocols.org/2023/1/e48485 UR - http://dx.doi.org/10.2196/48485 UR - http://www.ncbi.nlm.nih.gov/pubmed/37943580 ID - info:doi/10.2196/48485 ER - TY - JOUR AU - Vaezipour, Atiyeh AU - Aldridge, Danielle AU - Koenig, Sebastian AU - Burns, Clare AU - Baghaei, Nilufar AU - Theodoros, Deborah AU - Russell, Trevor PY - 2023/10/31 TI - Rehabilitation Supported by Immersive Virtual Reality for Adults With Communication Disorders: Semistructured Interviews and Usability Survey Study JO - JMIR Rehabil Assist Technol SP - e46959 VL - 10 KW - communication disorders KW - speech and language therapy KW - rehabilitation KW - virtual reality KW - human-computer interaction KW - technology acceptance KW - acceptance KW - communication KW - therapy KW - usefulness KW - usability KW - survey KW - barrier KW - mobile phone N2 - Background: Individuals who have acquired communication disorders often struggle to transfer the skills they learn during therapy sessions to real-life situations. Immersive virtual reality (VR) technology has the potential to create realistic communication environments that can be used both in clinical settings and for practice at home by individuals with communication disorders. Objective: This research aims to enhance our understanding of the acceptance, usefulness, and usability of a VR application (SIM:Kitchen), designed for communication rehabilitation. Additionally, this research aims to identify the perceived barriers and benefits of using VR technology from the perspective of individuals with acquired communication disorders. Methods: Semistructured interviews and usability surveys were conducted with 10 individuals with acquired neurogenic communication disorders aged 46-81 (mean 58, SD 9.57) years after trialing an immersive VR application. The audio-recorded interviews were transcribed and analyzed to identify themes. Results: The quantitative data regarding the usability of the system associated with participants? immersion experience in the VR application were promising. Findings from semistructured interviews are discussed across five key thematic areas including (1) participant?s attitude toward VR, (2) perceived usefulness of the VR system, (3) perceived ease of use of the VR system, (4) their willingness to continue using VR, and (5) the factors they perceived as challenges or facilitators to adopting this VR technology. Conclusions: Overall, participants in this study found the VR experience to be enjoyable and were impressed by the realism of the VR application designed for communication rehabilitation. This study highlighted personally relevant, immersive VR interventions with different levels of task difficulty that could enhance technology uptake in the context of communication rehabilitation. However, it is essential that VR hand controller technology is refined to be more naturalistic in movement and able to accommodate user capabilities. UR - https://rehab.jmir.org/2023/1/e46959 UR - http://dx.doi.org/10.2196/46959 UR - http://www.ncbi.nlm.nih.gov/pubmed/37906228 ID - info:doi/10.2196/46959 ER - TY - JOUR AU - Ramdeo, R. Karishma AU - Fahnestock, Margaret AU - Gibala, Martin AU - Selvaganapathy, Ravi Ponnambalam AU - Lee, Justin AU - Nelson, Jennifer Aimee PY - 2023/10/18 TI - The Effects of Exercise on Synaptic Plasticity in Individuals With Mild Cognitive Impairment: Protocol for a Pilot Intervention Study JO - JMIR Res Protoc SP - e50030 VL - 12 KW - mild cognitive impairment KW - exercise KW - brain-derived neurotrophic factor KW - cognition KW - brain plasticity KW - repetitive transcranial magnetic stimulation KW - transcranial magnetic stimulation KW - magnetic stimulation KW - aging KW - interval training KW - intermittent theta-burst stimulation KW - ageing KW - gerontology KW - geriatric KW - cognitive KW - physical activity KW - fitness KW - neurology KW - neuroscience KW - synapse KW - synaptic KW - plasticity KW - brain KW - neurotrophic KW - hormone KW - hormones KW - endocrinology N2 - Background: Mild cognitive impairment (MCI) is a syndrome preceding more severe impairment characterized by dementia. MCI affects an estimated 15% to 20% of people older than 65 years. Nonpharmacological interventions including exercise are recommended as part of overall MCI management based on the positive effects of exercise on cognitive performance. Interval training involves brief intermittent bouts of exercise interspersed with short recovery periods. This type of exercise promotes cognitive improvement and can be performed in individuals with MCI. Synaptic plasticity can be assessed in vivo by the neurophysiological response to repetitive transcranial magnetic stimulation (rTMS). A method to assess synaptic plasticity uses an intermittent theta burst stimulation (iTBS), which is a patterned form of rTMS. Individuals with MCI have decreased responses to iTBS, reflecting reduced synaptic plasticity. It is unknown whether interval training causes changes in synaptic plasticity in individuals living with MCI. Objective: This research will determine whether interval training performed using a cycle ergometer enhances synaptic plasticity in individuals with MCI. The three aims are to (1) quantify synaptic plasticity after interval training performed at a self-determined intensity in individuals with MCI; (2) determine whether changes in synaptic plasticity correlate with changes in serum brain-derived neurotrophic factor, osteocalcin, and cognition; and (3) assess participant compliance to the exercise schedule. Methods: 24 individuals diagnosed with MCI will be recruited for assignment to 1 of the 2 equally sized groups: exercise and no exercise. The exercise group will perform exercise 3 times per week for 4 weeks. Synaptic plasticity will be measured before and following the 4-week intervention. At these time points, synaptic plasticity will be measured as the response to single-pulse TMS, reflected as the percent change in the average amplitude of 20 motor-evoked potentials before and after an iTBS rTMS protocol, which is used to induce synaptic plasticity. In addition, individuals will complete a battery of cognitive assessments and provide a blood sample from the antecubital vein to determine serum brain-derived neurotrophic factor and osteocalcin. Results: The study began in September 2023. Conclusions: The proposed research is the first to assess whether synaptic plasticity is enhanced after exercise training in individuals with MCI. If exercise does indeed modify synaptic plasticity, this will create a new avenue by which we can study and manipulate neural plasticity in these individuals. Trial Registration: ClinicalTrials.gov NCT05663918; https://clinicaltrials.gov/study/NCT05663918 International Registered Report Identifier (IRRID): PRR1-10.2196/50030 UR - https://www.researchprotocols.org/2023/1/e50030 UR - http://dx.doi.org/10.2196/50030 UR - http://www.ncbi.nlm.nih.gov/pubmed/37851488 ID - info:doi/10.2196/50030 ER - TY - JOUR AU - Pinos Cisneros, Veronica Tamara AU - Brons, Annette AU - Kröse, Ben AU - Schouten, Ben AU - Ludden, Geke PY - 2023/10/16 TI - Playfulness and New Technologies in Hand Therapy for Children With Cerebral Palsy: Scoping Review JO - JMIR Serious Games SP - e44904 VL - 11 KW - technology KW - cerebral palsy KW - play KW - children KW - hand therapy N2 - Background: Innovative technologies such as game consoles and smart toys used with games or playful approaches have proven to be successful and attractive in providing effective and motivating hand therapy for children with cerebral palsy (CP). Thus, there is an increased interest in designing and implementing interventions that can improve the well-being of these children. However, to understand how and why these interventions are motivating children, we need a better understanding of the playful elements of technology-supported hand therapy. Objective: This scoping review aims to identify the playful elements and the innovative technologies currently used in hand therapy for children with CP. Methods: We included studies that design or evaluate interventions for children with CP that use innovative technologies with game or play strategies. Data were extracted and analyzed based on the type of technology, description of the system, and playful elements according to the Lenses of Play, a play design toolkit. A total of 31 studies were included in the analysis. Results: Overall, 54 papers were included in the analysis. The results showed high use of consumer technologies in hand therapy for children with CP. Although several studies have used a combination of consumer technologies with therapeutic-specific technologies, only a few studies focused on the exclusive use of therapeutic-specific technologies. To analyze the playfulness of these interventions that make use of innovative technologies, we focused our review on 3 lenses of play: Open-ended Play, where it was found that the characteristics of ludus, such as a structured form of play and defined goals and rules, were the most common, whereas strategies that relate to paidia were less common. The most commonly used Forms of Play were physical or active form and games with rules. Finally, the most popular Playful experiences were control, challenge, and competition. Conclusions: The inventory and analysis of innovative technology and playful elements provided in this study can be a starting point for new developments of fun and engaging tools to assist hand therapy for children with CP. UR - https://games.jmir.org/2023/1/e44904 UR - http://dx.doi.org/10.2196/44904 UR - http://www.ncbi.nlm.nih.gov/pubmed/37843886 ID - info:doi/10.2196/44904 ER - TY - JOUR AU - Vidal, Elizabeth AU - Castro-Gutierrez, Eveling AU - Arisaca, Robert AU - Paz-Valderrama, Alfredo AU - Albiol-Pérez, Sergio PY - 2023/10/3 TI - Serious Game for Fine Motor Control Rehabilitation for Children With Epileptic Encephalopathy: Development and Usability Study JO - JMIR Form Res SP - e50492 VL - 7 KW - serious game KW - virtual motor rehabilitation KW - ecologic virtual system KW - fine motor rehabilitation KW - virtual reality KW - rare diseases KW - children with epileptic encephalopathy N2 - Background: Epileptic encephalopathy (EE) is defined as the presence of frequent epileptiform activity that adversely impacts development, typically causing the slowing or regression of developmental skills, and is usually associated with frequent seizures. One of the main disturbances in EE is in the coordination of the upper extremities and hands. Traditional rehabilitation for this type of pathology focuses on the alleviation of gross or fine motor disability. In the last few years, the use of low-cost devices together with customized serious games has shown improvements in motor disorders and enrichments in activities of daily living. Objective: This study aims to explore the feasibility of a new serious game for improving fine motor control in children with EE. Methods: The participants were 4 children with EE (male: n=2, 50%; female: n=2, 50%) who were classified as belonging to level 1 in the Gross Motor Classification System. The children were tested over 10 sessions during the intervention period (before and after treatment). The clinical tests performed were the Bruininks-Oseretsky Test of Motor Proficiency, 2nd edition and Pittsburgh Rehabilitation Participation Scale. The subscales of the Bruininks-Oseretsky Test of Motor Proficiency, 2nd edition were fine motor precision, fine motor integration, manual dexterity, and upper-limb coordination. At the end of the first session, we used the User Satisfaction Evaluation Questionnaire to analyze user satisfaction. Results: The significance outcomes for a Student t test (1-tailed) were as follows: P=.009 for fine motor precision, P=.002 for fine motor integration, P=.56 for manual dexterity, and P=.99 for upper-limb coordination. The participation rate as measured using the Pittsburgh Rehabilitation Participation Scale was between good and very good, which means that, based on the therapist?s evaluation, interest, independence, and motivation were achieved by each participant. The mean User Satisfaction Evaluation Questionnaire score was close to 30, which is the maximum value. Conclusions: The results support the use of the proposed serious game as a complement in therapeutic sessions during the rehabilitation processes for children with EE. Significant improvements in fine motor control and activities of daily living revealed that the proposed serious game is beneficial for fine motor disorders of this pathology. UR - https://formative.jmir.org/2023/1/e50492 UR - http://dx.doi.org/10.2196/50492 UR - http://www.ncbi.nlm.nih.gov/pubmed/37788071 ID - info:doi/10.2196/50492 ER - TY - JOUR AU - Kilcioglu, Seyma AU - Schiltz, Benoît AU - Araneda, Rodrigo AU - Bleyenheuft, Yannick PY - 2023/9/12 TI - Short- to Long-Term Effects of Virtual Reality on Motor Skill Learning in Children With Cerebral Palsy: Systematic Review and Meta-Analysis JO - JMIR Serious Games SP - e42067 VL - 11 KW - cerebral palsy KW - virtual reality KW - motor skill learning KW - long-term effect KW - daily life activities KW - motor functions N2 - Background: Many studies have started integrating virtual reality (VR) into neurorehabilitation for children with cerebral palsy (CP). The results of the effects of VR on motor skill learning, including the short- to long-term results of relevant studies, must be pooled in a generic framework. Objective: This systematic review and meta-analysis aimed to investigate the short- to long-term effects of therapies including VR on motor skill learning in children with CP. Methods: Two examiners followed the inclusion and exclusion criteria of the ?Participant, Intervention, Control, and Outcome? framework. Randomized controlled trials (RCTs) and non-RCTs were considered if they compared VR-included interventions with control groups on motor functions and daily life activities in children with CP. PubMed, ScienceDirect, Embase, and IEEE Xplore databases were searched. The modified Downs and Black assessment was used to assess the methodological quality of the included studies. Meta-analyses and subgroup analyses for RCTs were conducted whenever possible. Results: A total of 7 RCTs, 2 non-RCTs, and 258 children with CP were included. The priority focus of 78% (7/9) of the studies was upper limb functions. There was a significant short-term effect of adding VR to conventional therapies on upper limb functions when compared with conventional therapies (P=.04; standardized mean difference [SMD]=0.39, 95% CI 0.01-0.76). The overall medium- to long-term effects showed a trend toward favoring the VR group, although the difference was not statistically significant (P=.06; SMD=0.37, 95% CI ?0.02 to 0.77). For balance (P=.06; SMD=1.04, 95% CI ?0.04 to 2.12), gross motor functions (P=.30; SMD=2.85, 95% CI ?2.57 to 8.28), and daily life activities outcomes (P=.21; SMD=0.29, 95% CI ?0.16 to 0.74), the overall effect in the short term also showed a trend toward favoring the VR group, but these results were not statistically significant. Conclusions: VR seems to have additional benefits for motor skill learning in children with CP. Studies with follow-up outcomes of VR training focusing on balance and gross motor functions in patients with CP were quite limited. Future research on balance and gross motor function outcomes should target particularly long-term results of therapies including VR on motor skill learning. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021227734; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021227734 UR - https://games.jmir.org/2023/1/e42067 UR - http://dx.doi.org/10.2196/42067 UR - http://www.ncbi.nlm.nih.gov/pubmed/37698895 ID - info:doi/10.2196/42067 ER - TY - JOUR AU - Calabrò, Salvatore Rocco AU - Bonanno, Mirjam AU - Torregrossa, William AU - Cacciante, Luisa AU - Celesti, Antonio AU - Rifici, Carmela AU - Tonin, Paolo AU - De Luca, Rosaria AU - Quartarone, Angelo PY - 2023/8/21 TI - Benefits of Telerehabilitation for Patients With Severe Acquired Brain Injury: Promising Results From a Multicenter Randomized Controlled Trial Using Nonimmersive Virtual Reality JO - J Med Internet Res SP - e45458 VL - 25 KW - telerehabilitation KW - teleneuro-VRRS KW - virtual reality rehabilitation system KW - SABI KW - severe acquired brain injury KW - acquired brain injury KW - virtual reality KW - rehabilitation KW - neurorehabilitation KW - brain injury KW - neurology N2 - Background: In neurorehabilitation, the use of innovative technologies offers many opportunities to monitor and improve the health status of patients with severe acquired brain injury (SABI). Telerehabilitation allows for continuity of service through the entire rehabilitation cycle, including assessment, intervention, consultation, and education, affording early reintegration and positively enhancing the quality of life (QoL). Objective: The main purpose of this multicenter randomized controlled trial was to test the effectiveness of advanced training provided using a nonimmersive virtual reality rehabilitation system (ie, the VRRS HomeKit device) in improving functional outcomes in patients with SABI. Methods: In total, 40 patients with SABI and their 40 caregivers visiting 2 Italian rehabilitation centers were enrolled in the study protocol and randomized into 2 groups. Of the 40 patients, 20 (50%) underwent the experimental training using the VRRS HomeKit (teleneuro-VRRS group), whereas the other 20 (50%) were administered usual territorial rehabilitative treatments (UTRTs; control group). To investigate motor and neuropsychological functioning, patients with SABI were evaluated before (T0) and at the end of (T1) each training session by a multispecialist team through a complete clinical and psychometric battery: the Barthel Index (BI), the Tinetti Scale (TS), the Modified Ashworth Scale (MAS), the Montreal Cognitive Assessment (MoCa), the Frontal Assessment Battery (FAB), the Beck Depression Inventory II (BDI-II), the Short Form Health Survey 36 (SF-36), and the Psychological General Well-Being Index (PGWBI). In addition, the Caregiver Burden Inventory (CBI) was administered to each caregiver to investigate the emotional burden status. Results: The teleneuro-VRRS group achieved a statistically significant improvement in both general and motor outcomes, as well as psychological well-being and QoL, compared to the control group. In particular, the BI (P<.001), FAB (P<.001), and BDI-II (P<.001) were the outcome scales with the best improvement. The burden of caregivers also significantly improved in the teleneuro-VRRS group (CBI; P<.004). Between-group analysis showed statistical differences in the anxiety (effect size [ES]=0.85, P<.02) and self-control (ES=0.40, P<.03) subtests of the PGWBI and in the social role functioning (ES=0.85, P<.02) subtest of the SF-36, confirmed by quite medium and large ESs. Conclusions: Our results suggest that the VRRS is a suitable alternative tool or complementary tool or both to improve motor (level of functional independence) and cognitive (frontal/executive abilities) outcomes, reducing behavioral alterations (anxiety and depression symptoms) in patients with SABI, with a beneficial impact also on the caregivers? burden distress management, mitigating distress and promoting positive aspects of caring. Trial Registration: ClinicalTrials.gov NCT03709875; https://classic.clinicaltrials.gov/ct2/show/NCT03709875 UR - https://www.jmir.org/2023/1/e45458 UR - http://dx.doi.org/10.2196/45458 UR - http://www.ncbi.nlm.nih.gov/pubmed/37490017 ID - info:doi/10.2196/45458 ER - TY - JOUR AU - Ryzer, Danielle AU - Bhatti, Bushra AU - Streicher, Alana AU - Weinberg, Paula AU - Hanna, Fady AU - Moretto, Jessica AU - Brooks, Dina AU - Quach, Shirley AU - Oliveira, Ana PY - 2023/7/28 TI - Cognitive Interventions in Individuals With Chronic Respiratory Diseases: Protocol for a Systematic Review JO - JMIR Res Protoc SP - e48235 VL - 12 KW - chronic pulmonary disease KW - cognitive therapy KW - memory training KW - brain exercise KW - cognitive function KW - pulmonary KW - lung KW - COPD KW - review methodology KW - systematic review KW - cognitive KW - cognition KW - memory KW - CRD KW - respiratory N2 - Background: Chronic respiratory diseases (CRDs) may cause reduced oxygen availability to organs and body tissues, leading to an increased risk for ischemic damage, which can result in brain tissue injury. This damage can lead to a myriad of neurological symptoms contributing to cognitive decline. Cognitive interventions may attenuate cognitive deficits in people with CRDs; however, the effects have not yet been systematically summarized in the literature. Objective: The purpose of this systematic review is to assess the effects of cognitive interventions (including cognitive behavioral therapy and transcranial brain stimulation) on cognitive function (primary outcome), HRQL, self-management, symptoms, physical activity, physical function, ability to complete activities of daily living (ADLs), hospital admissions, functional capacity, functional performance, psychological and social outcomes, exacerbations, healthcare utilization, and survival in individuals with CRDs. Methods: This review will be conducted in accordance with the Cochrane handbook for systematic reviews of interventions and reported following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Searches will be performed in MEDLINE, Embase, Emcare, PsycINFO, Scopus, and CINAHL. Articles will be included if they focus on the effects of cognitive interventions on adults with CRDs, are published in peer-reviewed journals, and are written in English, French, or Portuguese. Risk of bias will be evaluated with the Cochrane Risk of Bias 2 tool for randomized controlled trials, and the Risk of Bias in Non-randomized Studies of Interventions tool for nonrandomized studies. Meta-analyses will be performed if at least 2 studies provided sufficient data for a specific outcome. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) assessment will be used to evaluate the overall quality of the evidence. Results: This systematic review was initiated in November 2022 and registered with PROSPERO in February 2023, prior to title and abstract screening. Full-text screening of articles will be completed in June 2023. Data extraction and drafting of the manuscript will occur from July 2023 to August 2023, with expected publication in February 2024. Conclusions: This systematic review will summarize the effects of cognitive interventions on cognitive function in people with CRDs. It will guide health care professionals in selecting evidence-based strategies to enhance cognitive well-being and overall health outcomes for individuals with CRDs. Additionally, it will identify research gaps and highlight areas for future exploration, supporting researchers in advancing knowledge in this field. Trial Registration: PROSPERO CRD42023396234; https://tinyurl.com/mwjrfbxv International Registered Report Identifier (IRRID): PRR1-10.2196/48235 UR - https://www.researchprotocols.org/2023/1/e48235 UR - http://dx.doi.org/10.2196/48235 UR - http://www.ncbi.nlm.nih.gov/pubmed/37505801 ID - info:doi/10.2196/48235 ER - TY - JOUR AU - Specht, Julian AU - Stegmann, Barbara AU - Gross, Hanna AU - Krakow, Karsten PY - 2023/7/21 TI - Cognitive Training With Head-Mounted Display Virtual Reality in Neurorehabilitation: Pilot Randomized Controlled Trial JO - JMIR Serious Games SP - e45816 VL - 11 KW - cognitive rehabilitation KW - virtual reality KW - neurorehabilitation KW - psychology KW - stroke N2 - Background: Neurological rehabilitation is technologically evolving rapidly, resulting in new treatments for patients. Stroke, one of the most prevalent conditions in neurorehabilitation, has been a particular focus in recent years. However, patients often need help with physical and cognitive constraints, whereby the cognitive domain in neurorehabilitation does not technologically exploit existing potential. Usually, cognitive rehabilitation is performed with pen and paper or on a computer, which leads to limitations in preparation for activities of daily living. Technologies such as virtual reality (VR) can bridge this gap. Objective: This pilot study investigated the use of immersive VR in cognitive rehabilitation for patients undergoing inpatient neurorehabilitation. The goal was to determine the difference in rehabilitation effectiveness between a VR serious game that combines everyday activities with cognitive paradigms and conventional computerized cognitive training. We hypothesized the superiority of the VR serious game regarding cognitive abilities and patient-reported outcomes as well as transfer to daily life. Methods: We recruited 42 patients with acute brain affection from a German neurorehabilitation clinic in inpatient care with a Mini Mental Status Test score >20 to participate in this randomized controlled trial. Participants were randomly assigned to 2 groups, with 1 receiving the experimental VR treatment (n=21). VR training consisted of daily life scenarios, for example, in a kitchen, focusing on treating executive functions such as planning and problem-solving. The control group (n=21) received conventional computerized cognitive training. Each participant received a minimum of 18 treatment sessions in their respective group. Patients were tested for cognitive status, subjective health, and quality of life before and after the intervention (Alters-Konzentrations-Test, Wechsler Memory Scale?Revised, Trail Making Test A and B, Tower of London?German version, Short Form 36, European Quality of Life 5 Dimensions visual analog scale, and Fragebogen zur Erfassung der Performance in VR). Results: Repeated-measures ANOVA revealed several significant main effects in the cognitive tests: Tower of London?German version (P=.046), Trail Making Test A (P=.01), and Wechsler Memory Scale?Revised (P=.006). However, post hoc tests revealed that the VR group showed significant improvement in the planning, executive control, and problem-solving domains (P=.046, Bonferroni P=.02). In contrast, no significant improvement in the control group between t0 and t1 was detected (all P>.05). Furthermore, a nonsignificant trend was observed in visual speed in the VR group (P=.09, Bonferroni P=.02). Conclusions: The results of this pilot randomized controlled trial showed that immersive VR training in cognitive rehabilitation had greater effectiveness than the standard of care in treating patients experiencing stroke in some cognitive domains . These findings support the further use and study of VR training incorporating activities of daily living in other neurological disorders involving cognitive dysfunction. Trial Registration: Federal Registry of Clinical Trials of Germany (DRKS) DRKS00023605; https://drks.de/search/de/trial/DRKS00023605 UR - https://games.jmir.org/2023/1/e45816 UR - http://dx.doi.org/10.2196/45816 UR - http://www.ncbi.nlm.nih.gov/pubmed/37477957 ID - info:doi/10.2196/45816 ER - TY - JOUR AU - Noble, Sandra-Carina AU - Woods, Eva AU - Ward, Tomas AU - Ringwood, V. John PY - 2023/7/5 TI - Adaptive P300-Based Brain-Computer Interface for Attention Training: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e46135 VL - 12 KW - ADHD KW - attention KW - BCI KW - brain-computer interface KW - cognitive deficit KW - cognitive disease KW - cognitive training KW - dementia KW - EEG KW - electroencephalography KW - ERP KW - event-related potential KW - neurodegeneration KW - neurofeedback training KW - P300 speller KW - stroke N2 - Background: The number of people with cognitive deficits and diseases, such as stroke, dementia, or attention-deficit/hyperactivity disorder, is rising due to an aging, or in the case of attention-deficit/hyperactivity disorder, a growing population. Neurofeedback training using brain-computer interfaces is emerging as a means of easy-to-use and noninvasive cognitive training and rehabilitation. A novel application of neurofeedback training using a P300-based brain-computer interface has previously shown potential to improve attention in healthy adults. Objective: This study aims to accelerate attention training using iterative learning control to optimize the task difficulty in an adaptive P300 speller task. Furthermore, we hope to replicate the results of a previous study using a P300 speller for attention training, as a benchmark comparison. In addition, the effectiveness of personalizing the task difficulty during training will be compared to a nonpersonalized task difficulty adaptation. Methods: In this single-blind, parallel, 3-arm randomized controlled trial, 45 healthy adults will be recruited and randomly assigned to the experimental group or 1 of 2 control groups. This study involves a single training session, where participants receive neurofeedback training through a P300 speller task. During this training, the task?s difficulty is progressively increased, which makes it more difficult for the participants to maintain their performance. This encourages the participants to improve their focus. Task difficulty is either adapted based on the participants? performance (in the experimental group and control group 1) or chosen randomly (in control group 2). Changes in brain patterns before and after training will be analyzed to study the effectiveness of the different approaches. Participants will complete a random dot motion task before and after the training so that any transfer effects of the training to other cognitive tasks can be evaluated. Questionnaires will be used to estimate the participants? fatigue and compare the perceived workload of the training between groups. Results: This study has been approved by the Maynooth University Ethics Committee (BSRESC-2022-2474456) and is registered on ClinicalTrials.gov (NCT05576649). Participant recruitment and data collection began in October 2022, and we expect to publish the results in 2023. Conclusions: This study aims to accelerate attention training using iterative learning control in an adaptive P300 speller task, making it a more attractive training option for individuals with cognitive deficits due to its ease of use and speed. The successful replication of the results from the previous study, which used a P300 speller for attention training, would provide further evidence to support the effectiveness of this training tool. Trial Registration: ClinicalTrials.gov NCT05576649; https://clinicaltrials.gov/ct2/show/NCT05576649 International Registered Report Identifier (IRRID): DERR1-10.2196/46135 UR - https://www.researchprotocols.org/2023/1/e46135 UR - http://dx.doi.org/10.2196/46135 UR - http://www.ncbi.nlm.nih.gov/pubmed/37405822 ID - info:doi/10.2196/46135 ER - TY - JOUR AU - Rochette, Annie AU - Thomas, Aliki AU - Salbach, M. Nancy AU - Vachon, Brigitte AU - Menon, Anita AU - Poissant, Lise AU - Boutin, Maurane AU - Grad, Roland AU - Pluye, Pierre PY - 2023/5/8 TI - Expected Health Benefits as the Ultimate Outcome of Information Available on Stroke Engine, a Knowledge Translation Stroke Rehabilitation Website: Web-Based Survey JO - JMIR Rehabil Assist Technol SP - e44715 VL - 10 KW - crowdsourcing KW - health-related information KW - internet KW - knowledge translation KW - rehabilitation KW - stroke N2 - Background: Electronic knowledge resources are readily available and typically target different audiences, including health professionals and the public, that is, those with lived experience and their relatives. The knowledge-to-action framework, in combination with the information assessment method (IAM), considering both the value-of-information construct and the conceptual model of acquisition-cognition-application, can be used to support the evaluation process of such resources. As an example, Stroke Engine is an evidence-based knowledge translation resource in stroke rehabilitation (assessments and interventions) for health professionals and students as well as individuals who have sustained a stroke and their relatives. According to Google Analytics, the website is perused >10,000 times per week. Objective: With the overall aim to improve the content available on Stroke Engine, we documented Stroke Engine users? perceptions of situational relevance, cognitive impact, intention to use, and expected patient and health benefits regarding the information consulted. Methods: A web-based survey anchored in the IAM was made available via an invitation tab. The IAM is a validated questionnaire that is designed to assess the value of information. Sociodemographic characteristics were also collected, and a space for free-text comments was provided. Descriptive statistics were used, and thematic analysis was used for the free-text comments. Results: The sample consisted of 6634 respondents. Health professionals (3663/6634, 55.22%) and students (2784/6634, 41.97%) represented 97.18% (6447/6634) of the total responses. The remaining 2.82% (187/6634) of the responses were from individuals who had sustained a stroke (87/6634, 1.31%) and their relatives (100/6634, 1.51%). Regarding situational relevance, assessments (including selecting, obtaining, and interpreting results from a test) was the main topic searched by health professionals (1838/3364, 54.64%) and students (1228/2437, 50.39%), whereas general information on stroke rehabilitation was the top-ranked topic for nearly two-thirds of the individuals with stroke (45/76, 59%) and their relatives (57/91, 63%). Cognitive impact was characterized by learning something new. Intention to use was high (4572/6379, 71.67%) among the respondents and varied in context (eg, refine a topic, research, class assignments, teaching, and education). Respondents commented on ways to improve content. Expected patient and health benefits such as improvement in health and well-being was the top-ranked category for all 4 subgroups, followed by the avoidance of unnecessary or inappropriate treatment for health professionals (183/623, 29.4%) and a feeling of being reassured for individuals with stroke (26/75, 35%) and their relatives (28/97, 29%). Conclusions: Valuable feedback on Stroke Engine was obtained in terms of its accessibility, relevance for informational needs and retrieval, accuracy, and applicability; however, of utmost importance is the potential implementation of its evidence-based content in clinical practice and the perceived expected impact on patients, their relatives, and their health professionals. The feedback received allowed for corrections and the identification of key topics for further development. UR - https://rehab.jmir.org/2023/1/e44715 UR - http://dx.doi.org/10.2196/44715 UR - http://www.ncbi.nlm.nih.gov/pubmed/37155228 ID - info:doi/10.2196/44715 ER - TY - JOUR AU - Guérin, Mathias AU - Sijobert, Benoit AU - Zaragoza, Benjamin AU - Cambon, Flore AU - Boyer, Laurence AU - Patte, Karine PY - 2023/5/3 TI - Combining Intensive Rehabilitation With a Nonfunctional Isokinetic Strengthening Program in Adolescents With Cerebral Palsy: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e43221 VL - 12 KW - isokinetic KW - cerebral palsy KW - gait analysis KW - spasticity KW - muscle strength N2 - Background: Cerebral palsy is the most common brain injury in the pediatric population. Patients with cerebral palsy present different affectations such as decreased muscle strength, gait deviations, impaired proprioception, and spasticity. Isokinetic strengthening programs combined with intensive rehabilitation may improve muscle strength and therefore gait efficiency. Objective: The primary aim of this randomized controlled trial is to compare the effect of an intensive rehabilitation combined with a nonfunctional isokinetic progressive strengthening program to an intensive rehabilitation alone on gait parameters and muscle strength in patients with cerebral palsy. Another goal of this study is to determine whether adding an isokinetic program to intensive rehabilitation is more effective than intensive rehabilitation alone at decreasing spasticity and improving joint position sense in patients with cerebral palsy. Methods: A total of 30 adolescents with spastic diplegia cerebral palsy (Gross Motor Function Classification System levels I to III) will be randomized, by an independent researcher, into a 3-week intensive rehabilitation and isokinetic progressive strengthening group or an intensive rehabilitation control group. Gait parameters, muscle strength, spasticity, and knee joint position sense will be assessed. These variables will be evaluated at baseline (T0) and at the end of the intervention (T1). The intensive rehabilitation will consist of physiotherapy sessions twice a day and hydrotherapy and virtual reality gait training once a day. The isokinetic training group will have a total of 9 supervised isokinetic strength training sessions focusing on knee flexors and extensors with different execution speeds. Results: The protocol has been accepted by the French National Ethics Committee in October 2022. The inclusion of patients will start in November 2022. Conclusions: The combination of intensive rehabilitation with an isokinetic program on knee flexors and extensors has not been studied yet. The findings of this study may determine if an isokinetic strength training program of knee flexors and extensors is beneficial for the improvement of gait parameters, muscle strength, spasticity, and joint position sense in adolescents with spastic diplegia. International Registered Report Identifier (IRRID): PRR1-10.2196/43221 UR - https://www.researchprotocols.org/2023/1/e43221 UR - http://dx.doi.org/10.2196/43221 UR - http://www.ncbi.nlm.nih.gov/pubmed/36790338 ID - info:doi/10.2196/43221 ER - TY - JOUR AU - Pike, Kerryn AU - Moller, I. Carl AU - Bryant, Christina AU - Farrow, Maree AU - Dao, P. Duy AU - Ellis, A. Kathryn PY - 2023/4/20 TI - Examination of the Feasibility, Acceptability, and Efficacy of the Online Personalised Training in Memory Strategies for Everyday Program for Older Adults: Single-Arm Pre-Post Trial JO - J Med Internet Res SP - e41712 VL - 25 KW - cognition KW - learning KW - internet-based intervention KW - social support KW - subjective cognitive decline KW - mobile phone N2 - Background: Memory strategy training for older adults helps maintain and improve cognitive health but is traditionally offered face-to-face, which is resource intensive, limits accessibility, and is challenging during a pandemic. Web-based interventions, such as the Online Personalised Training in Memory Strategies for Everyday (OPTIMiSE) program, may overcome such barriers. Objective: We report on OPTIMiSE?s feasibility, acceptability, and efficacy. Methods: Australians aged ?60 years reporting subjective cognitive decline participated in this single-arm pre-post web-based intervention. OPTIMiSE is a 6-module web-based program offered over 8-weeks with a 3-month booster. It has a problem-solving approach to memory issues, focusing on psychoeducation about memory and aging, knowledge and practice of compensatory memory strategies, and personalized content related to individual priorities. We examined the feasibility (recruitment, attrition, and data collection), acceptability (recommendation to others, suggestions for improvement, and withdrawal reasons), and efficacy (change in goal satisfaction, strategy knowledge and use, self-reported memory, memory satisfaction and knowledge, and mood; thematic content analysis of the most significant change; and the application of knowledge and strategies in daily life) of OPTIMiSE. Results: OPTIMiSE was feasible, demonstrated by strong interest (633 individuals screened), a satisfactory level of attrition (158/312, 50.6%), and minimal missing data from those completing the intervention. It was acceptable, with 97.4% (150/154) of participants agreeing they would recommend OPTIMiSE, the main suggestion for improvement being more time to complete modules, and withdrawal reasons similar to those in in-person interventions. OPTIMiSE was also efficacious, with linear mixed-effects analyses revealing improvements, of moderate to large effect sizes, across all primary outcomes (all P<.001): memory goal satisfaction (Cohen d after course=1.24; Cohen d at 3-month booster=1.64), strategy knowledge (Cohen d after course=0.67; Cohen d at 3-month booster=0.72) and use (Cohen d after course=0.79; Cohen d at 3-month booster=0.90), self-reported memory (Cohen d after course=0.80; Cohen d at 3-month booster=0.83), memory satisfaction (Cohen d after course=1.25; Cohen d at 3-month booster=1.29) and knowledge (Cohen d after course=0.96; Cohen d at 3-month booster=0.26), and mood (Cohen d after course=?0.35; nonsignificant Cohen d at booster). Furthermore, the most significant changes reported by participants (strategy use, improvements in daily life, reduced concern about memory, confidence and self-efficacy, and sharing and shame busting with others) reflected the course objectives and were consistent with themes arising from previous in-person interventions. At the 3-month booster, many participants reported continued implementation of knowledge and strategies in their daily lives. Conclusions: This feasible, acceptable, and efficacious web-based program has the potential to enable access to evidence-based memory interventions for older adults worldwide. Notably, the changes in knowledge, beliefs, and strategy use continued beyond the initial program. This is particularly important for supporting the growing number of older adults living with cognitive concerns. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620000979954; https://tinyurl.com/34cdantv International Registered Report Identifier (IRRID): RR2-10.3233/ADR-200251 UR - https://www.jmir.org/2023/1/e41712 UR - http://dx.doi.org/10.2196/41712 UR - http://www.ncbi.nlm.nih.gov/pubmed/37079356 ID - info:doi/10.2196/41712 ER - TY - JOUR AU - Tropea, Peppino AU - Infarinato, Francesco AU - Sterpi, Irma AU - Ottaviani, Marco AU - Antoniotti, Paola AU - Romano, Paola AU - Picardi, Michela AU - Goffredo, Michela AU - Re, Riccardo AU - Pournajaf, Sanaz AU - Seregni, Agnese AU - Caronni, Antonio AU - Franceschini, Marco AU - Corbo, Massimo PY - 2023/4/20 TI - Action Observation Treatment for Upper Limb Rehabilitation in Patients With Stroke: Protocol for a Multicenter Randomized Controlled Trial JO - JMIR Res Protoc SP - e42094 VL - 12 KW - action observation treatment KW - stroke rehabilitation KW - upper limb kinematics KW - EEG KW - electroencephalography KW - qEEG KW - quantitative electroencephalography N2 - Background: In the last few years, new noninvasive strategies have emerged as rehabilitative treatments for patients with stroke. Action observation treatment (AOT) is a rehabilitation approach based on the properties of the mirror neuron system with a positive impact on modifying cortical activation patterns and improving the upper limb kinematics. AOT involves the dynamic process of observing purposeful actions with the intention of imitating and then practicing those actions. In recent years, several clinical studies suggested the effectiveness of AOT in patients with stroke to improve motor recovery and autonomy in activities of daily living. However, a deeper knowledge of the behavior of the sensorimotor cortex during AOT seems to be essential. Objective: The aim of this clinical trial, conducted in 2 neurorehabilitation centers and in patients? homes, is to investigate the effectiveness of AOT in patients with stroke, confirming the translational power of a tailored treatment. Particular emphasis will be placed on the predictive value of neurophysiological biomarkers. In addition, the feasibility and impact of a home-based AOT program will be investigated. Methods: A 3-arm, assessor-blinded, randomized controlled trial will be performed by enrolling patients with stroke in the chronic stage. A total of 60 participants will be randomly allocated to receive 15 sessions of AOT with different protocols (AOT at the hospital, AOT at home, and sham AOT), 3 sessions per week. The primary outcome will be assessed using the Fugl-Meyer Assessment-Upper Extremity scores. Secondary outcomes will be clinical, biomechanical, and neurophysiological assessment. Results: The study protocol is part of a project (project code GR-2016?02361678) approved and funded by the Italian Ministry of Health. The study began with the recruitment phase in January 2022, and enrollment was expected to end in October 2022. Recruitment is now closed (December 2022). The results of this study are expected to be published in spring 2023. Upon completion of the analyses, we will examine the preliminary effectiveness of the intervention and neurophysiological outcomes. Conclusions: This study will be used to evaluate the effectiveness of 2 different AOT scenarios (ie, AOT at the hospital and AOT at home) in patients with chronic stroke and to assess the predictive value of neurophysiological biomarkers. Specifically, we will attempt to induce the functional modification of the cortical components by exploiting the features of the mirror neuron system, demonstrating relevant clinical, kinematic, and neurophysiological changes after AOT. With our study, we also want to provide, for the first time in Italy, the AOT home-based program while assessing its feasibility and impact. Trial Registration: ClinicalTrials.gov NCT04047134; https://clinicaltrials.gov/ct2/show/NCT04047134 International Registered Report Identifier (IRRID): DERR1-10.2196/42094 UR - https://www.researchprotocols.org/2023/1/e42094 UR - http://dx.doi.org/10.2196/42094 UR - http://www.ncbi.nlm.nih.gov/pubmed/37079364 ID - info:doi/10.2196/42094 ER - TY - JOUR AU - Mee, Harry AU - Castaño-Leon, M. Ana AU - Timofeev, Ivan AU - Adeleye, Amos AU - Devi Bhagavatula, Indira AU - Marklund, Niklas AU - Muehlschlegel, Susanne AU - Bond, Katie AU - Clement, Clare AU - Grieve, Kirsty AU - Owen, Nicola AU - Whiting, Gemma AU - Turner, Carole AU - Rubiano Escobar, Mariano Andres AU - Shukla, Dhaval AU - Paul, Maria AU - Allanson, Judith AU - Pomeroy, Valerie AU - Viaroli, Edoardo AU - Warburton, Elizabeth AU - Wells, Adam AU - Hawryluk, Gregory AU - Helmy, Adel AU - Anwar, Fahim AU - Honeybul, Stephen AU - Hutchinson, Peter AU - Kolias, Angelos PY - 2023/4/17 TI - Standardizing Cranioplasty Outcomes Following Stroke or Traumatic Brain Injury: Protocol for the Development of a Core Outcome Set JO - JMIR Res Protoc SP - e37442 VL - 12 KW - cranioplasty KW - TBI KW - stroke KW - core outcome set KW - domains KW - COMET KW - health Interventions KW - recovery KW - traumatic brain injury KW - neurological KW - neurology KW - reporting KW - outcome N2 - Background: Core outcome sets (COSs) are important and necessary as they help standardize reporting in research studies. Cranioplasty following traumatic brain injury (TBI) or stroke is becoming increasingly common, leading to an ever-growing clinical and research interest, especially regarding the optimal material, cost-effectiveness, and timing of cranioplasty concerning neurological recovery and complications. Consequently, heterogeneous reporting of outcomes from such diverse studies has led to limited meta-analysis ability and an ongoing risk of outcome reporting bias. This study aims to define a standardized COS for reporting in all future TBI and stroke cranioplasty studies. Objective: This study has four aims: (1) undertake a systematic review to collate the most current outcome measures used within the cranioplasty literature; (2) undertake a qualitative study to understand better the views of clinicians, patients' relatives, and allied health professionals regarding clinical outcomes following cranioplasty; (3) undertake a Delphi survey as part of the process of gaining consensus for the COS; and (4) finalize consensus through a consensus meeting resulting in the COS. Methods: An international steering committee has been formed to guide the development of the COS. In addition, recommendations from other clinical initiatives such as COMET (Core Outcomes and Effectiveness Trials) and OMERACT (Outcome Measures in Rheumatology) have been adhered to. Phase 1 is data collection through a systematic review and qualitative study. Phase 2 is the COS development through a Delphi survey and consensus meetings with consensus definitions decided and agreed upon before the Delphi survey begins to avoid bias. Results: Phase 1 started at the end of 2019, following ethical approval in December 2019, and the project completion date is planned for the end of 2022 or beginning of 2023. Conclusions: This study should result in a consensus on a COS for cranioplasty, following TBI or stroke, to help standardize outcome reporting for future studies, which can be applied to future research and clinical services, help align future studies, build an increased understanding of cranioplasty and its impact on a patient?s function and recovery, and help standardize the evidence base. International Registered Report Identifier (IRRID): DERR1-10.2196/37442 UR - https://www.researchprotocols.org/2023/1/e37442 UR - http://dx.doi.org/10.2196/37442 UR - http://www.ncbi.nlm.nih.gov/pubmed/35759752 ID - info:doi/10.2196/37442 ER - TY - JOUR AU - Bianchini, Edoardo AU - Warmerdam, Elke AU - Romijnders, Robbin AU - Stürner, Hanja Klarissa AU - Baron, Ralf AU - Heinzel, Sebastian AU - Pontieri, Ernesto Francesco AU - Hansen, Clint AU - Maetzler, Walter PY - 2023/3/30 TI - Turning When Using Smartphone in Persons With and Those Without Neurologic Conditions: Observational Study JO - J Med Internet Res SP - e41082 VL - 25 KW - turning KW - turning coordination KW - smartphone KW - dual task KW - dual task cost KW - Parkinson disease KW - Parkinson KW - stroke KW - multiple sclerosis KW - low back pain KW - neurology KW - neurological KW - movement KW - biomechanics KW - gait KW - balance KW - walk KW - kinesiology KW - fall N2 - Background: Turning during walking is a relevant and common everyday movement and it depends on a correct top-down intersegmental coordination. This could be reduced in several conditions (en bloc turning), and an altered turning kinematics has been linked to increased risk of falls. Smartphone use has been associated with poorer balance and gait; however, its effect on turning-while-walking has not been investigated yet. This study explores turning intersegmental coordination during smartphone use in different age groups and neurologic conditions. Objective: This study aims to evaluate the effect of smartphone use on turning behavior in healthy individuals of different ages and those with various neurological diseases. Methods: Younger (aged 18-60 years) and older (aged >60 years) healthy individuals and those with Parkinson disease, multiple sclerosis, subacute stroke (<4 weeks), or lower-back pain performed turning-while-walking alone (single task [ST]) and while performing 2 different cognitive tasks of increasing complexity (dual task [DT]). The mobility task consisted of walking up and down a 5-m walkway at self-selected speed, thus including 180° turns. Cognitive tasks consisted of a simple reaction time test (simple DT [SDT]) and a numerical Stroop test (complex DT [CDT]). General (turn duration and the number of steps while turning), segmental (peak angular velocity), and intersegmental turning parameters (intersegmental turning onset latency and maximum intersegmental angle) were extracted for head, sternum, and pelvis using a motion capture system and a turning detection algorithm. Results: In total, 121 participants were enrolled. All participants, irrespective of age and neurologic disease, showed a reduced intersegmental turning onset latency and a reduced maximum intersegmental angle of both pelvis and sternum relative to head, thus indicating an en bloc turning behavior when using a smartphone. With regard to change from the ST to turning when using a smartphone, participants with Parkinson disease reduced their peak angular velocity the most, which was significantly different from lower-back pain relative to the head (P<.01). Participants with stroke showed en bloc turning already without smartphone use. Conclusions: Smartphone use during turning-while-walking may lead to en bloc turning and thus increase fall risk across age and neurologic disease groups. This behavior is probably particularly dangerous for those groups with the most pronounced changes in turning parameters during smartphone use and the highest fall risk, such as individuals with Parkinson disease. Moreover, the experimental paradigm presented here might be useful in differentiating individuals with lower-back pain without and those with early or prodromal Parkinson disease. In individuals with subacute stroke, en bloc turning could represent a compensative strategy to overcome the newly occurring mobility deficit. Considering the ubiquitous smartphone use in daily life, this study should stimulate future studies in the area of fall risk and neurological and orthopedic diseases. Trial Registration: German Clinical Trials Register DRKS00022998; https://drks.de/search/en/trial/DRKS00022998 UR - https://www.jmir.org/2023/1/e41082 UR - http://dx.doi.org/10.2196/41082 UR - http://www.ncbi.nlm.nih.gov/pubmed/36995756 ID - info:doi/10.2196/41082 ER - TY - JOUR AU - Fan, Ting AU - Wang, Xiaobei AU - Song, Xiaoxi AU - Zhao, Gang AU - Zhang, Zhichang PY - 2023/3/6 TI - Research Status and Emerging Trends in Virtual Reality Rehabilitation: Bibliometric and Knowledge Graph Study JO - JMIR Serious Games SP - e41091 VL - 11 KW - mobility KW - rehabilitation KW - virtual reality KW - bibliometric KW - technology KW - training KW - interactive KW - research KW - exercise KW - resources KW - cerebral palsy KW - adult KW - video games N2 - Background: Virtual reality (VR) technology has been widely used in rehabilitation training because of its immersive, interactive, and imaginative features. A comprehensive bibliometric review is required to help researchers focus on future directions based on the new de?nitions of VR technologies in rehabilitation, which reveal new situations and requirements. Objective: Herein, we aimed to summarize effective research methods for and potential innovative approaches to VR rehabilitation by evaluating publications from various countries to encourage research on efficient strategies to improve VR rehabilitation. Methods: The SCIE (Science Citation Index Expanded) database was searched on January 20, 2022, for publications related to the application of VR technology in rehabilitation research. We found 1617 papers, and we created a clustered network, using the 46,116 references cited in the papers. CiteSpace V (Drexel University) and VOSviewer (Leiden University) were used to identify countries, institutions, journals, keywords, cocited references, and research hot spots. Results: A total of 63 countries and 1921 institutes have contributed publications. The United States of America has taken the leading position in this field; it has the highest number of publications; the highest h-index; and the largest collaborative network, which includes other countries. The reference clusters of SCIE papers were divided into the following nine categories: kinematics, neurorehabilitation, brain injury, exergames, aging, motor rehabilitation, mobility, cerebral palsy, and exercise intensity. The research frontiers were represented by the following keywords: video games (2017-2021), and young adults (2018-2021). Conclusions: Our study comprehensively assesses the current research state of VR rehabilitation and analyzes the current research hot spots and future trends in the field, with the aims of providing resources for more intensive investigation and encouraging more researchers to further develop VR rehabilitation. UR - https://games.jmir.org/2023/1/e41091 UR - http://dx.doi.org/10.2196/41091 UR - http://www.ncbi.nlm.nih.gov/pubmed/36877556 ID - info:doi/10.2196/41091 ER - TY - JOUR AU - Stammler, Britta AU - Flammer, Kathrin AU - Schuster, Thomas AU - Lambert, Marian AU - Karnath, Hans-Otto PY - 2023/2/27 TI - Negami: An Augmented Reality App for the Treatment of Spatial Neglect After Stroke JO - JMIR Serious Games SP - e40651 VL - 11 KW - spatial neglect KW - gamification KW - augmented reality KW - visual exploration training KW - stroke rehabilitation KW - serious games KW - rehabilitation KW - stroke N2 - Background: A widely applied and effective rehabilitation method for patients experiencing spatial neglect after a stroke is ?visual exploration training.? Patients improve their ipsilesional bias of attention and orientation by training exploration movements and search strategies toward the contralesional side of space. In this context, gamification can have a positive influence on motivation for treatment and thus on the success of treatment. In contrast to virtual reality applications, treatment enhancements through augmented reality (AR) have not yet been investigated, although they offer some advantages over virtual reality. Objective: This study aimed to develop an AR-based app (Negami) for the treatment of spatial neglect that combines visual exploration training with active, contralesionally oriented rotation of the eyes, head, and trunk. Methods: The app inserts a virtual element (origami bird) into the real space surrounding the patient, which the patient explores with the camera of a tablet. Subjective reports from healthy elderly participants (n=10) and patients with spatial neglect after stroke (n=10) who trained with the new Negami app were analyzed. Usability, side effects, and game experience were assessed by various questionnaires. Results: Training at the highest defined difficulty level was perceived as differently challenging but not as frustrating by the group of healthy elderly participants. The app was rated with high usability, hardly any side effects, high motivation, and entertainment. The group of patients with spatial neglect after stroke consistently evaluated the app positively on the dimensions of motivation, satisfaction, and fun. Conclusions: The Negami app represents a promising extension by adding AR to traditional exploration training for spatial neglect. Through participants? natural interaction with the physical surrounding environment during playful tasks, side effects as symptoms of cybersickness are minimized and patients? motivation appeared to markedly increase. The use of AR in cognitive rehabilitation programs and the treatment of spatial neglect seems promising and should receive further investigation. UR - https://games.jmir.org/2023/1/e40651 UR - http://dx.doi.org/10.2196/40651 UR - http://www.ncbi.nlm.nih.gov/pubmed/36848215 ID - info:doi/10.2196/40651 ER - TY - JOUR AU - Manser, Patrick AU - Adcock-Omlin, Manuela AU - de Bruin, D. Eling PY - 2023/1/5 TI - Design Considerations for an Exergame-Based Training Intervention for Older Adults With Mild Neurocognitive Disorder: Qualitative Study Including Focus Groups With Experts and Health Care Professionals and Individual Semistructured In-depth Patient Interviews JO - JMIR Serious Games SP - e37616 VL - 11 KW - cognition KW - exercise KW - exergame KW - design KW - development KW - neurosciences KW - technology KW - training N2 - Background: Exergames have attracted growing interest in the prevention and treatment of neurocognitive disorders. The most effective exergame and training components (ie, exercise and training variables such as frequency, intensity, duration, or volume of training and type and content of specific exergame scenarios) however remain to be established for older adults with mild neurocognitive disorders (mNCDs). Regarding the design and development of novel exergame-based training concepts, it seems of crucial importance to explicitly include the intended users? perspective by adopting an interactive and participatory design that includes end users throughout different iterative cycles of development. Objective: This study aimed to determine the capabilities, treatment preferences, and motivators for the training of older adults with mNCD and the perspectives of individuals on training goals and settings and requirements for exergame and training components. Methods: A qualitative study including expert focus groups and individual semistructured in-depth patient interviews was conducted. Data were transcribed to a written format to perform qualitative content analysis using QCAmap software. Results: In total, 10 experts and health care professionals (80% females) and 8 older adults with mNCD (38% females; mean age 82.4, SD 6.2 years) were recruited until data saturation was observed. Conclusions: The psychosocial consequences of patients? self-perceived cognitive deterioration might be more burdensome than the cognitive changes themselves. Older adults with mNCD prefer integrative forms of training (such as exergaming) and are primarily motivated by enjoyment or fun in exercising and the effectiveness of the training. Putting the synthesized perspectives of training goals, settings, and requirements for exergames and training components into context, our considerations point to opportunities for improvement in research and rehabilitation, either by adapting existing exergames to patients with mNCDs or by developing novel exergames and exergame-based training concepts specifically tailored to meet patient requirements and needs. UR - https://games.jmir.org/2023/1/e37616 UR - http://dx.doi.org/10.2196/37616 UR - http://www.ncbi.nlm.nih.gov/pubmed/36602851 ID - info:doi/10.2196/37616 ER - TY - JOUR AU - Ding, Huitong AU - Mandapati, Amiya AU - Karjadi, Cody AU - Ang, Alvin Ting Fang AU - Lu, Sophia AU - Miao, Xiao AU - Glass, James AU - Au, Rhoda AU - Lin, Honghuang PY - 2022/12/22 TI - Association Between Acoustic Features and Neuropsychological Test Performance in the Framingham Heart Study: Observational Study JO - J Med Internet Res SP - e42886 VL - 24 IS - 12 KW - mild cognitive impairment KW - digital voice KW - neuropsychological test KW - association KW - prediction N2 - Background: Human voice has increasingly been recognized as an effective indicator for the detection of cognitive disorders. However, the association of acoustic features with specific cognitive functions and mild cognitive impairment (MCI) has yet to be evaluated in a large community-based population. Objective: This study aimed to investigate the association between acoustic features and neuropsychological (NP) tests across multiple cognitive domains and evaluate the added predictive power of acoustic composite scores for the classification of MCI. Methods: This study included participants without dementia from the Framingham Heart Study, a large community-based cohort with longitudinal surveillance for incident dementia. For each participant, 65 low-level acoustic descriptors were derived from voice recordings of NP test administration. The associations between individual acoustic descriptors and 18 NP tests were assessed with linear mixed-effect models adjusted for age, sex, and education. Acoustic composite scores were then built by combining acoustic features significantly associated with NP tests. The added prediction power of acoustic composite scores for prevalent and incident MCI was also evaluated. Results: The study included 7874 voice recordings from 4950 participants (age: mean 62, SD 14 years; 4336/7874, 55.07% women), of whom 453 were diagnosed with MCI. In all, 8 NP tests were associated with more than 15 acoustic features after adjusting for multiple testing. Additionally, 4 of the acoustic composite scores were significantly associated with prevalent MCI and 7 were associated with incident MCI. The acoustic composite scores can increase the area under the curve of the baseline model for MCI prediction from 0.712 to 0.755. Conclusions: Multiple acoustic features are significantly associated with NP test performance and MCI, which can potentially be used as digital biomarkers for early cognitive impairment monitoring. UR - https://www.jmir.org/2022/12/e42886 UR - http://dx.doi.org/10.2196/42886 UR - http://www.ncbi.nlm.nih.gov/pubmed/36548029 ID - info:doi/10.2196/42886 ER - TY - JOUR AU - Domingos, Josefa AU - Dean, John AU - Fernandes, Belo Júlio AU - Godinho, Catarina PY - 2022/12/22 TI - An Online Dual-Task Cognitive and Motor Exercise Program for Individuals With Parkinson Disease (PD3 Move Program): Acceptability Study JO - JMIR Aging SP - e40325 VL - 5 IS - 4 KW - Parkinson disease KW - dual-task training KW - exercise KW - digital intervention KW - online intervention KW - physical activity KW - physical therapy KW - elder KW - older adult KW - geriatric KW - neurodegenerative KW - adherence KW - acceptability KW - community based KW - group program KW - online program KW - physiotherapy KW - cognitive training online exercise KW - Parkinson's KW - neuromuscular KW - task training KW - physiotherapist KW - motor KW - movement KW - cognitive KW - cognition KW - vocal KW - voice KW - speech N2 - Background: Dual-task training is an emerging field used for people with Parkinson disease (PD) to improve their physical and cognitive well-being, but the patients? acceptability, safety, and adherence to such training in online settings are unknown. Objective: This study aims to evaluate the acceptability of a dual-task cognitive and motor online training program for people with PD as a group online community program. Methods: People with PD were invited to participate in an online program (PD3 Move) consisting of physical and vocal exercises in response to different cognitive challenges displayed as dynamic backgrounds on Zoom. The program ran twice per week for 16 weeks. Patient acceptability was assessed at 4 months by monitoring attendance rates and feedback from an exit questionnaire emailed to all participants assessing satisfaction, perceived benefit, safety, and willingness to continue and recommend to others. Results: The online program was delivered to 15 participants (n=9, 60%, females) with a diagnosis of PD, a mean age of 69.4 (SD 9.3) years, and Hoehn and Yahr (H&Y) stages I-IV. The attendance rate was high, with participants coming to more than 13 (81%) of the sessions. Participants were very satisfied (n=8, 53%) or satisfied (n=7, 47%) with the program. Participants reported that what they most liked were the new cognitive physical challenges. The 3 main facilitators to participating were perceiving the benefits, instructor?s flexibility and engagement, and the social interaction moments with others. The 3 main difficulties were dealing with motor fluctuations (n=3, 20%), difficulties in using technology (n=2, 13%), and difficulty hearing instructions due to hearing loss (n=2, 13%). Patients had favorable perceived benefits of the program, with 14 (93%) considering it very useful for the current management of health and 1 (7%) moderately useful. No adverse events were reported, and all participants said that they were willing to continue the program and recommend it to others. Conclusions: Our findings suggest that the online cognitive and motor program was well received, safe, and perceived to be of benefit to this group of medically stable people with PD in H&Y stages I-IV. Access to specialized care and enhancement of long-term adherence to regular exercise can be achieved with online community group programs. UR - https://aging.jmir.org/2022/4/e40325 UR - http://dx.doi.org/10.2196/40325 UR - http://www.ncbi.nlm.nih.gov/pubmed/36548037 ID - info:doi/10.2196/40325 ER - TY - JOUR AU - Ahmadi, Reihaneh AU - Lim, Hajin AU - Mutlu, Bilge AU - Duff, Melissa AU - Toma, Catalina AU - Turkstra, Lyn PY - 2022/12/16 TI - Facebook Experiences of Users With Traumatic Brain Injury: A Think-Aloud Study JO - JMIR Rehabil Assist Technol SP - e39984 VL - 9 IS - 4 KW - traumatic brain injury KW - rehabilitation KW - disability KW - cognitive communication KW - social media N2 - Background: A critical gap in our knowledge about social media is whether we can alleviate accessibility barriers and challenges for individuals with traumatic brain injury (TBI), to improve their social participation and health. To do this, we need real-time information about these barriers and challenges, to design appropriate aids. Objective: The aim of this study was to characterize the ways people with TBI accessed and used social media websites and understand unique challenges they faced. Methods: We invited 8 adults with moderate to severe TBI to log onto their own Facebook page and use it as they regularly would while thinking aloud. Their comments were recorded and transcribed for qualitative analysis. We first analyzed participants? utterances using a priori coding based on a framework proposed by Meshi et al to classify adults? motives for accessing social media. We next used an open coding method to understand the challenges that people with TBI faced while using Facebook. In other words, we analyzed participants? needs for using Facebook and then identified Facebook features that made it challenging for them to meet those needs. Results: Participants used all categories of codes in the framework by Meshi et al and provided detailed feedback about the Facebook user interface. A priori coding revealed 2 dimensions that characterized participants? Facebook use: whether they were active or passive about posting and self-disclosure on Facebook and their familiarity and fluency in using Facebook. The open coding analysis revealed 6 types of challenges reported by participants with TBI, including difficulty with language production and interpretation, attention and information overload, perceptions of negativity and emotional contagion, insufficient guidance to use Facebook, concerns about web-based scams and frauds, and general accessibility concerns. Conclusions: Results showed that individuals with TBI used Facebook for the same reasons typical adults do, suggesting that it can help increase social communication and reduce isolation and loneliness. Participants also identified barriers, and we propose modifications that could improve access for individuals with brain injury. On the basis of identified functions and challenges, we conclude by proposing design ideas for social media support tools that can promote more active use of social media sites by adults with TBI. UR - https://rehab.jmir.org/2022/4/e39984 UR - http://dx.doi.org/10.2196/39984 UR - http://www.ncbi.nlm.nih.gov/pubmed/36525296 ID - info:doi/10.2196/39984 ER - TY - JOUR AU - Fahr, Annina AU - Balzer, Julia AU - Keller, W. Jeffrey AU - van Hedel, A. Hubertus J. PY - 2022/12/16 TI - Playfully Assessing Lower Extremity Selective Voluntary Motor Control in Children With Cerebral Palsy: Psychometric Study JO - JMIR Rehabil Assist Technol SP - e39687 VL - 9 IS - 4 KW - selective motor control KW - mirror movements KW - neurorehabilitation KW - validity KW - reliability KW - interactive computer play KW - eHealth KW - digital health KW - rehabilitation KW - cerebral palsy KW - movement KW - child KW - pediatric KW - game KW - accelerometer KW - motor KW - avatar KW - assessment KW - limb KW - joint KW - physiotherapy KW - physiotherapist KW - lower extremity KW - lower extremities N2 - Background: Objective measures specifically assessing selective voluntary motor control are scarce. Therefore, we have developed an interval-scaled assessment based on accelerometers. Objective: This study provided a preliminary evaluation of the validity and reliability of this novel gamelike assessment measuring lower limb selective voluntary motor control in children with cerebral palsy (CP). Methods: Children with CP and their neurologically intact peers were recruited for this psychometric evaluation of the assessgame. The participants played the assessgame and steered an avatar by selective hip, knee, or ankle joint movements captured with accelerometers. The assessgame?s scores provide information about the accuracy of the selective movement of the target joint and the amplitude and frequency of involuntary movements occurring in uninvolved joints. We established discriminative validity by comparing the assessgame scores of the children with CP with those of the neurologically intact children, concurrent validity by correlations with clinical scores and therapists? opinions, and relative and absolute test-retest reliability. Results: We included 20 children with CP (mean age 12 years and 5 months, SD 3 years and 4 months; Gross Motor Function Classification System levels I to IV) and 31 neurologically intact children (mean age 11 years and 1 month, SD 3 years and 6 months). The assessgame could distinguish between the children with CP and neurologically intact children. The correlations between the assessgame?s involuntary movement score and the therapist?s rating of the occurrence of involuntary movements during the game were moderate (Spearman ?=0.56; P=.01), whereas the correlations of the assessgame outcomes with the Selective Control Assessment of the Lower Extremity and Gross Motor Function Classification System were low and not significant (|?|?0.39). The intraclass correlation coefficients were >0.85 and indicated good relative test-retest reliability. Minimal detectable changes amounted to 25% (accuracy) and 44% (involuntary movement score) of the mean total scores. The percentage of children able to improve by the minimal detectable change without reaching the maximum score was 100% (17/17) for the accuracy score and 94% (16/17) for the involuntary movement score. Conclusions: The assessgame proved reliable and showed discriminative validity in this preliminary evaluation. Concurrent validity was moderate with the therapist?s opinion but relatively poor with the Selective Control Assessment of the Lower Extremity. We assume that the assessment?s gamelike character demanded various other motor control aspects that are less considered in current clinical assessments. UR - https://rehab.jmir.org/2022/4/e39687 UR - http://dx.doi.org/10.2196/39687 UR - http://www.ncbi.nlm.nih.gov/pubmed/36525299 ID - info:doi/10.2196/39687 ER - TY - JOUR AU - Lam, Ka-Hoo AU - Twose, James AU - Lissenberg-Witte, Birgit AU - Licitra, Giovanni AU - Meijer, Kim AU - Uitdehaag, Bernard AU - De Groot, Vincent AU - Killestein, Joep PY - 2022/11/7 TI - The Use of Smartphone Keystroke Dynamics to Passively Monitor Upper Limb and Cognitive Function in Multiple Sclerosis: Longitudinal Analysis JO - J Med Internet Res SP - e37614 VL - 24 IS - 11 KW - multiple sclerosis KW - smartphone KW - mobile app KW - digital technology KW - keystroke dynamics KW - typing KW - upper extremity KW - cognition KW - outpatient monitoring N2 - Background: Typing on smartphones, which has become a near daily activity, requires both upper limb and cognitive function. Analysis of keyboard interactions during regular typing, that is, keystroke dynamics, could therefore potentially be utilized for passive and continuous monitoring of function in patients with multiple sclerosis. Objective: To determine whether passively acquired smartphone keystroke dynamics correspond to multiple sclerosis outcomes, we investigated the association between keystroke dynamics and clinical outcomes (upper limb and cognitive function). This association was investigated longitudinally in order to study within-patient changes independently of between-patient differences. Methods: During a 1-year follow-up, arm function and information processing speed were assessed every 3 months in 102 patients with multiple sclerosis with the Nine-Hole Peg Test and Symbol Digit Modalities Test, respectively. Keystroke-dynamics data were continuously obtained from regular typing on the participants? own smartphones. Press-and-release latency of the alphanumeric keys constituted the fine motor score cluster, while latency of the punctuation and backspace keys constituted the cognition score cluster. The association over time between keystroke clusters and the corresponding clinical outcomes was assessed with linear mixed models with subjects as random intercepts. By centering around the mean and calculating deviation scores within subjects, between-subject and within-subject effects were distinguished. Results: Mean (SD) scores for the fine motor score cluster and cognition score cluster were 0.43 (0.16) and 0.94 (0.41) seconds, respectively. The fine motor score cluster was significantly associated with the Nine-Hole Peg Test: between-subject ? was 15.9 (95% CI 12.2-19.6) and within-subject ? was 6.9 (95% CI 2.0-11.9). The cognition score cluster was significantly associated with the Symbol Digit Modalities Test between subjects (between-subject ? ?11.2, 95% CI ?17.3 to ?5.2) but not within subjects (within-subject ? ?0.4, 95% CI ?5.6 to 4.9). Conclusions: Smartphone keystroke dynamics were longitudinally associated with multiple sclerosis outcomes. Worse arm function corresponded with longer latency in typing both across and within patients. Worse processing speed corresponded with higher latency in using punctuation and backspace keys across subjects. Hence, keystroke dynamics are a potential digital biomarker for remote monitoring and predicting clinical outcomes in patients with multiple sclerosis. Trial Registration: Netherlands Trial Register NTR7268; https://trialsearch.who.int/Trial2.aspx?TrialID=NTR7268 UR - https://www.jmir.org/2022/11/e37614 UR - http://dx.doi.org/10.2196/37614 UR - http://www.ncbi.nlm.nih.gov/pubmed/36342763 ID - info:doi/10.2196/37614 ER - TY - JOUR AU - O'Keefe, Sophie AU - Radford, Kathryn AU - Farrin, Amanda AU - Oakman, Jodi AU - Alves-Stein, Serena AU - Cloud, Geoffrey AU - Douglas, Jacinta AU - Stanley, Mandy AU - Lannin, A. Natasha PY - 2022/10/31 TI - A Tailored Occupational Therapist?Led Vocational Intervention for People With Stroke: Protocol for a Pilot Randomized Controlled Trial JO - JMIR Res Protoc SP - e40548 VL - 11 IS - 10 KW - return to work KW - vocational rehabilitation KW - acquired brain injury KW - stroke KW - traumatic brain injury KW - neuroscience KW - rehabilitation KW - intervention KW - feasibility KW - stroke recovery KW - resume work N2 - Background: Resuming work after stroke is a common goal of working-age adults, yet there are few vocational rehabilitation programs designed to address the unique challenges faced following stroke. The Work intervention was developed to address these gaps. Objective: This paper presents a protocol that outlines the steps that will be undertaken to pilot both the intervention and trial processes for the Work trial. Methods: The Work trial is a 2-arm, prospective, randomized, blinded-assessor study with intention-to-treat analysis. A total of 54 adults of working age who have experienced a stroke <4 months prior will be randomized 1:1 to either (1) an experimental group who will receive a 12-week early vocational intervention (Work intervention) plus usual clinical rehabilitation or (2) a control group who will receive only their usual clinical rehabilitation. Results: Outcomes include study and intervention feasibility and intervention benefit. In addition to evaluating the feasibility of delivering vocational intervention early after stroke, benefit will be assessed by measuring rates of vocational participation and quality-of-life improvements at the 3- and 6-month follow-ups. Process evaluation using data collected during the study, as well as postintervention individual interviews with participants and surveys with trial therapists, will complement quantitative data. Conclusions: The results of the trial will provide details on the feasibility of delivering the Work intervention embedded within the clinical rehabilitation context and inform future trial processes. Pilot data will enable a future definitive trial to determine the clinical effectiveness of vocational rehabilitation when delivered in the early subacute phase of stroke recovery. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619001164189; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378112&isReview=true International Registered Report Identifier (IRRID): DERR1-10.2196/40548 UR - https://www.researchprotocols.org/2022/10/e40548 UR - http://dx.doi.org/10.2196/40548 UR - http://www.ncbi.nlm.nih.gov/pubmed/36315220 ID - info:doi/10.2196/40548 ER - TY - JOUR AU - He, Danni AU - Cao, Shihua AU - Le, Yuchao AU - Wang, Mengxin AU - Chen, Yanfei AU - Qian, Beiying PY - 2022/10/19 TI - Virtual Reality Technology in Cognitive Rehabilitation Application: Bibliometric Analysis JO - JMIR Serious Games SP - e38315 VL - 10 IS - 4 KW - virtual reality KW - cognitive rehabilitation KW - bibliometric analysis KW - CiteSpace KW - gCLUTO KW - rehabilitation KW - cognitive disorder KW - visual content analysis N2 - Background: In recent years, with the development of computer science and medical science, virtual reality (VR) technology has become a promising tool for improving cognitive function. Research on VR-based cognitive training has garnered increasing attention. Objective: This study aimed to investigate the application status, research hot spots, and emerging trends of VR in cognitive rehabilitation over the past 20 years. Methods: Articles on VR-based cognitive rehabilitation from 2001 to 2021 were retrieved from the Web of Science Core Collection. CiteSpace software was used for the visual analysis of authors and countries or regions, and Scimago Graphica software was used for the geographic visualization of published countries or regions. Keywords were clustered using the gCLUTO software. Results: A total of 1259 papers were included. In recent years, research on the application of VR in cognitive rehabilitation has been widely conducted, and the annual publication of relevant literature has shown a positive trend. The main research areas include neuroscience and neurology, psychology, computer science, and rehabilitation. The United States ranked first with 328 papers, and Italy ranked second with 140 papers. Giuseppe Riva, an Italian academic, was the most prolific author with 29 publications. The most frequently cited reference was ?Using Reality to Characterize Episodic Memory Profiles in Amnestic Mild Cognitive Impairment and Alzheimer?s Disease: Influence of Active and Passive Encoding.? The most common keywords used by researchers include ?virtual reality,? ?cognition,? ?rehabilitation,? ?performance,? and ?older adult.? The largest source of research funding is from the public sector in the United States. Conclusions: The bibliometric analysis provided an overview of the application of VR in cognitive rehabilitation. VR-based cognitive rehabilitation can be integrated into multiple disciplines. We conclude that, in the context of the COVID-19 pandemic, the development of VR-based telerehabilitation is crucial, and there are still many problems that need to be addressed, such as the lack of consensus on treatment methods and the existence of safety hazards. UR - https://games.jmir.org/2022/4/e38315 UR - http://dx.doi.org/10.2196/38315 UR - http://www.ncbi.nlm.nih.gov/pubmed/36260388 ID - info:doi/10.2196/38315 ER - TY - JOUR AU - Pagaki-Skaliora, Marina AU - Morrow, Eileen AU - Theologis, Tim PY - 2022/10/17 TI - Telehealth and Remote Interventions for Children With Cerebral Palsy: Scoping Review JO - JMIR Rehabil Assist Technol SP - e36842 VL - 9 IS - 4 KW - cerebral palsy KW - CP KW - assistive technology KW - scoping review KW - software KW - application KW - telehealth KW - telerehabilitation KW - rehabilitation KW - COVID-19 KW - children KW - health intervention KW - health care KW - digital intervention N2 - Background: Remote treatment, or telehealth, has shown promise for children with cerebral palsy (CP) prior to 2020; however, the beginning of the global COVID-19 pandemic limiting access to hospitals for face-to-face treatments has driven the need for telehealth and led to a surge in its development. Due to the recent developments, there has been limited synthesis of the available evidence of telehealth for children with CP. Objective: This study aimed to analyze and summarize the existing evidence for telehealth interventions for the treatment of children with CP and identify any areas requiring further research. Methods: A scoping review was performed. A systematic search of available literature in MEDLINE and PubMed was performed during July 2021. Inclusion criteria for articles were primary research and systematic reviews that investigated telehealth, included children with CP, were published between 2010-2021, and were written in English. Exclusion criteria were secondary research other than systematic reviews; interventions that did not meet the World Health Organization definition of telehealth; or studies where all participants were aged >18 years, children?s results were not reported separately, or there were no results reported for children with CP. A scoping review was chosen due to the expected heterogeneity of the participants, as well as the expected small sample sizes and inconsistency of measured outcomes; therefore, a narrative reporting of the results was considered appropriate. Results: In all, 5 papers were identified, which included the results of 11 studies?2 of the included articles were systematic reviews, which included the results of 3 studies each. These 6 studies, together with 5 primary research articles, were included in this scoping review. The existing evidence is of low methodological quality, primarily consisting of case series. There is some evidence that the requirements of telehealth differ depending on the children?s developmental stage and functional level. Telehealth is reported to reduce caregiver burden. There is mixed evidence on children?s compliance with telehealth. Overall, the results of telehealth interventions for the treatment of children with CP were positive, indicating either comparable or improved results compared with children receiving usual face-to-face care. Conclusions: The evidence base is lacking in breadth and methodological quality to provide robust clinical recommendations. Most studies investigated hand function only, indicating the limited scope of existing research. However, this review shows that telehealth has demonstrated potential to improve function for children with CP while making health care services more accessible and reducing caregiver burden. Areas requiring further research include telehealth interventions for the lower limb, postural management, and pain control and the barriers to implementing telehealth. UR - https://rehab.jmir.org/2022/4/e36842 UR - http://dx.doi.org/10.2196/36842 UR - http://www.ncbi.nlm.nih.gov/pubmed/36041012 ID - info:doi/10.2196/36842 ER - TY - JOUR AU - Barisch-Fritz, Bettina AU - Bezold, Jelena AU - Scharpf, Andrea AU - Trautwein, Sandra AU - Krell-Roesch, Janina AU - Woll, Alexander PY - 2022/9/26 TI - Usability and Effectiveness of an Individualized, Tablet-Based, Multidomain Exercise Program for People With Dementia Delivered by Nursing Assistants: Protocol for an Evaluation of the InCoPE-App JO - JMIR Res Protoc SP - e36247 VL - 11 IS - 9 KW - institutionalization KW - institutionalized KW - sport KW - physical activity KW - fitness KW - exercise KW - dementia KW - digital application KW - cognitive performance KW - physical performance KW - cognitive function KW - physical function KW - cognitive decline KW - nursing home KW - long-term care KW - usability KW - effectiveness KW - mHealth KW - mobile health KW - health app N2 - Background: The COVID-19 pandemic has had drastic consequences on everyday life in nursing homes. Limited personnel resources and modified hygiene and safety measures (eg, no external exercise instructors, no group settings) have often led to interrupted physical exercise treatments. As a consequence, people with dementia benefiting from individualized exercise programs are affected by the pandemic?s impact. Objective: Our goal is to develop an easily applicable mobile application (Individualized Cognitive and Physical Exercise [InCoPE] app) allowing nursing assistants to test cognitive function and physical performance and subsequently train people with dementia through a multidomain, individualized exercise program. Methods: We will evaluate the usability and effectiveness of the InCoPE-App by applying a mixed method design. Nursing assistants will use the InCoPE-App for 18 weeks to assess the cognitive function and physical performance of 44 people with dementia every 3 weeks and apply the individualized exercise program. We will record overall usability using questionnaires (eg, Post-Study System Usability and ISONORM 9241/10), log events, and interviews. Perceived hedonic and pragmatic quality will be assessed using the AttrakDiff questionnaire. Effectiveness will be evaluated by considering changes in quality of life as well as cognitive function and physical performance between before and after the program. Results: Enrollment into the study will be completed in the first half of 2022. We expect an improvement in the quality of life of people with dementia accompanied by improvements in cognitive function and physical performance. The usability of the InCoPE-App is expected to be rated well by nursing assistants. Conclusions: To date, there is no scientifically evaluated app available that enables nursing assistants without expertise in sports science to deliver an individualized exercise program among people with dementia. A highly usable and effective InCoPE-App allows nursing assistants to test cognitive function and physical performance of people with dementia and, based thereon, select and deliver an appropriate individualized exercise program based on the cognitive and physical status of an individual, even in times of a pandemic. Trial Registration: German Register of Clinical Trials DRKS00024069; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00024069 International Registered Report Identifier (IRRID): DERR1-10.2196/36247 UR - https://www.researchprotocols.org/2022/9/e36247 UR - http://dx.doi.org/10.2196/36247 UR - http://www.ncbi.nlm.nih.gov/pubmed/36156463 ID - info:doi/10.2196/36247 ER - TY - JOUR AU - Mena-Moreno, Teresa AU - Munguía, Lucero AU - Granero, Rosario AU - Lucas, Ignacio AU - Sánchez-Gómez, Almudena AU - Cámara, Ana AU - Compta, Yaroslau AU - Valldeoriola, Francesc AU - Fernandez-Aranda, Fernando AU - Sauvaget, Anne AU - Menchón, M. José AU - Jiménez-Murcia, Susana PY - 2022/9/9 TI - Cognitive Behavioral Therapy Plus a Serious Game as a Complementary Tool for a Patient With Parkinson Disease and Impulse Control Disorder: Case Report JO - JMIR Serious Games SP - e33858 VL - 10 IS - 3 KW - Parkinson disease KW - impulse control disorder KW - hypersexuality KW - multidisciplinary approach KW - serious game N2 - Background: Impulse control disorders (ICDs) are commonly developed among patients who take dopamine agonist drugs as a treatment for Parkinson disease (PD). Gambling disorder and hypersexuality are more frequent in male patients with PD, with a prevalence over 4% in dopamine agonists users. Although impulsive-compulsive behaviors are related to antiparkinsonian medication, and even though ICD symptomatology, such as hypersexuality, often subsides when the dopaminergic dose is reduced, sometimes ICD persists in spite of drug adjustment. Consequently, a multidisciplinary approach should be considered to address these comorbidities and to explore new forms of complementary interventions, such as serious games or therapies adapted to PD. Objective: The aim of this study is to present the case of a patient with ICD (ie, hypersexuality) triggered by dopaminergic medication for PD. A combined intervention was carried out using cognitive behavioral therapy (CBT) for ICD adapted to PD, plus an intervention using a serious game?e-Estesia?whose objective is to improve emotion regulation and impulsivity. The aim of the combination of these interventions was to reduce the harm of the disease. Methods: After 20 CBT sessions, the patient received the e-Estesia intervention over 15 sessions. Repeated measures, before and after the combined intervention, were administered to assess emotion regulation, general psychopathology, and emotional distress and impulsivity. Results: After the intervention with CBT techniques and e-Estesia, the patient presented fewer difficulties to regulate emotion, less emotional distress, and lower levels of impulsivity in comparison to before the treatment. Moreover, the frequency and severity of the relapses also decreased. Conclusions: The combined intervention?CBT and a serious game?showed positive results in terms of treatment outcomes. UR - https://games.jmir.org/2022/3/e33858 UR - http://dx.doi.org/10.2196/33858 UR - http://www.ncbi.nlm.nih.gov/pubmed/36083621 ID - info:doi/10.2196/33858 ER - TY - JOUR AU - Kubben, Pieter PY - 2022/8/11 TI - JMIR Neurotechnology: Connecting Clinical Neuroscience and (Information) Technology JO - JMIR Neurotech SP - e41122 VL - 1 IS - 1 KW - neurotechnology KW - neurological disorders KW - treatment tools KW - chronic neurological disease KW - information technology UR - https://neuro.jmir.org/2022/1/e41122 UR - http://dx.doi.org/10.2196/41122 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/41122 ER - TY - JOUR AU - Abd-alrazaq, Alaa AU - Alhuwail, Dari AU - Al-Jafar, Eiman AU - Ahmed, Arfan AU - Shuweihdi, Farag AU - Reagu, Mohd Shuja AU - Househ, Mowafa PY - 2022/8/9 TI - The Effectiveness of Serious Games in Improving Memory Among Older Adults With Cognitive Impairment: Systematic Review and Meta-analysis JO - JMIR Serious Games SP - e35202 VL - 10 IS - 3 KW - serious games KW - cognitive training KW - exergames KW - mild cognitive impairment KW - Alzheimer disease KW - dementia KW - memory KW - systematic reviews KW - meta-analysis KW - mobile phone N2 - Background: Memory, one of the main cognitive functions, is known to decline with age. Serious games have been used for improving memory in older adults. The effectiveness of serious games in improving memory has been assessed by many studies. To draw definitive conclusions about the effectiveness of serious games, the findings of these studies need to be pooled and aggregated. Objective: This study aimed to assess the effectiveness of serious games in improving memory in older adults with cognitive impairment. Methods: A systematic review of randomized controlled trials was carried out. The search sources included 8 databases, the reference lists of the included studies and relevant reviews, and the studies that cited the included studies. In total, 2 reviewers (AA and MH) independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence appraisal. Extracted data were synthesized using a narrative approach and a statistical approach (ie, multilevel meta-analysis), as appropriate. Results: Of the 618 citations retrieved, 18 (2.9%) met the eligibility criteria for this review. Of these 18 studies, 15 (83%) randomized controlled trials were included in 10 multilevel meta-analyses. We found that serious games were more effective than no or passive interventions in improving nonverbal memory (P=.02; standardized mean difference [SMD]=0.46, 95% CI 0.09-0.83) and working memory (P=.04; SMD=0.31, 95% CI 0.01-0.60) but not verbal memory (P=.13; SMD=0.39, 95% CI ?0.11 to 0.89). The review also showed that serious games were more effective than conventional exercises in improving verbal memory (P=.003; SMD=0.46, 95% CI 0.16-0.77) but not nonverbal memory (P=.30; SMD=?0.19, 95% CI ?0.54 to 0.17) or working memory (P=.99; SMD=0.00, 95% CI ?0.45 to 0.45). Serious games were as effective as conventional cognitive activities in improving verbal memory (P=.14; SMD=0.66, 95% CI ?0.21 to 1.54), nonverbal memory (P=.94; SMD=?0.01, 95% CI ?0.32 to 0.30), and working memory (P=.08; SMD=0.37, 95% CI ?0.05 to 0.78) among older adults with cognitive impairment. Finally, the effect of adaptive serious games on working memory was comparable with that of nonadaptive serious games (P=.08; SMD=0.18, 95% CI ?0.02 to 0.37). Conclusions: Serious games have the potential to improve verbal, nonverbal, and working memory in older adults with cognitive impairment. However, our findings should be interpreted cautiously given that most meta-analyses were based on a few studies (?3) and judged to have a low quality of evidence. Therefore, serious games should be offered as a supplement to existing proven and safe interventions rather than as a complete substitute until further, more robust evidence is available. Future studies should investigate the short- and long-term effects of serious games on memory and other cognitive abilities among people of different age groups with or without cognitive impairment. UR - https://games.jmir.org/2022/3/e35202 UR - http://dx.doi.org/10.2196/35202 UR - http://www.ncbi.nlm.nih.gov/pubmed/35943792 ID - info:doi/10.2196/35202 ER - TY - JOUR AU - Pinard, Stéphanie AU - Bottari, Carolina AU - Laliberté, Catherine AU - Pigot, Hélène AU - Olivares, Marisnel AU - Couture, Mélanie AU - Aboujaoudé, Aline AU - Giroux, Sylvain AU - Bier, Nathalie PY - 2022/8/4 TI - Development of an Assistive Technology for Cognition to Support Meal Preparation in Severe Traumatic Brain Injury: User-Centered Design Study JO - JMIR Hum Factors SP - e34821 VL - 9 IS - 3 KW - user-centered design KW - needs assessment KW - assistive technology KW - brain injury KW - activities of daily living KW - cognitive rehabilitation KW - meal preparation KW - mobile phone N2 - Background: Although assistive technology for cognition (ATC) has enormous potential to help individuals who have sustained a severe traumatic brain injury (TBI) prepare meals safely, no ATC has yet been developed to assist in this activity for this specific population. Objective: This study aims to conduct a needs analysis as a first step in the design of an ATC to support safe and independent meal preparation for persons with severe TBI. This included identifying cooking-related risks to depict future users? profiles and establishing the clinical requirements of the ATC. Methods: In a user-centered design study, the needs of 3 future users were evaluated in their real-world environments (supported-living residence) using an ecological assessment of everyday activities, a review of their medical files, a complete neuropsychological test battery, individual interviews, observational field notes, and log journals with the residents, their families, and other stakeholders from the residence (eg, staff and health professionals). The needs analysis was guided by the Disability Creation Process framework. Results: The results showed that many issues had to be considered for the development of the ATC for the 3 residents and other eventual users, including cognitive issues such as distractibility and difficulty remembering information over a short period of time and important safety issues, such as potential food poisoning and risk of fire. This led to the identification of 2 main clinical requirements for the ATC: providing cognitive support based on evidence-based cognitive rehabilitation to facilitate meal preparation and ensuring safety at each step of the meal preparation task. Conclusions: This needs analysis identified the main requirements for an ATC designed to support meal preparation for persons with severe TBI. Future research will focus on implementing the ATC in the residence and evaluating its usability. UR - https://humanfactors.jmir.org/2022/3/e34821 UR - http://dx.doi.org/10.2196/34821 UR - http://www.ncbi.nlm.nih.gov/pubmed/35925663 ID - info:doi/10.2196/34821 ER - TY - JOUR AU - Yaddaden, Amel AU - Spalla, Guillaume AU - Gouin-Vallerand, Charles AU - Briskie-Semeniuk, Patricia AU - Bier, Nathalie PY - 2022/7/20 TI - A Mixed Reality Cognitive Orthosis to Support Older Adults in Achieving Their Daily Living Activities: Focus Group Study With Clinical Experts JO - JMIR Rehabil Assist Technol SP - e34983 VL - 9 IS - 3 KW - cognitive orthosis KW - mixed reality KW - older adults KW - daily activities KW - qualitative study KW - focus group KW - mobile phone KW - smartphone N2 - Background: Mixed reality is an emerging technology that allows us to blend virtual objects into the actual user?s environment. This can be realized using head-mounted displays. Many recent studies have suggested the possibility of using this technology to support cognition in people with neurodegenerative disorders (NDs). However, most studies have explored improvements in cognition rather than in independence and safety during the accomplishment of daily living activities. Therefore, it is crucial to document the possibility of using mixed reality to support the independence of older adults in their daily lives. Objective: This study is part of a larger user-centered study of a cognitive orthosis using pure mixed reality to support the independence of people living with NDs. This study aimed to explore (the difficulties encountered by older adults with NDs in their daily life to ensure that pure mixed reality meets their needs, (the most effective interventions with this population to determine what types of assistance should be provided by pure mixed reality technology, how the pure mixed reality technology should provide assistance to promote aging in place, and the main facilitators of and barriers to the use of this technology. Methods: We conducted a descriptive, qualitative study. A total of 5 focus groups were completed with occupational therapists who had expertise in the disease and its functional impacts (N=29) to gather information. Each focus group met once for a 1-hour period. All sessions were held over a 3-month period. A semistructured interview guide was used. All group interviews were audiotaped with the consent of each participant to facilitate the data analysis. We conducted inductive qualitative analysis in four stages using a thematic analysis approach: full transcription of the audio recordings, first-order coding of the transcribed data, second-order coding from the first-order code list, and data reduction and matrix development. Results: The results suggested that the main difficulties encountered by this population were in remembering to complete tasks, initiating the tasks, and planning the tasks. Several interventions are used to improve the independence of this population, such as prevention, simplification or facilitation, adaptation, and compensation. The use of pure mixed reality in older adults with NDs to promote independence and safety at home is promising and may respond to several clinical functions identified by the participants. Finally, pure mixed reality has good potential for use in this population and involves certain facilitators and obstacles, such as resources, technical aspects, and social considerations. Conclusions: The cognitive orthosis that will be developed in light of this study will act as a proof of concept for the possibility of supporting people with NDs using pure mixed reality. UR - https://rehab.jmir.org/2022/3/e34983 UR - http://dx.doi.org/10.2196/34983 UR - http://www.ncbi.nlm.nih.gov/pubmed/35857354 ID - info:doi/10.2196/34983 ER - TY - JOUR AU - Ammann-Reiffer, Corinne AU - Kläy, Andrina AU - Keller, Urs PY - 2022/7/14 TI - Virtual Reality as a Therapy Tool for Walking Activities in Pediatric Neurorehabilitation: Usability and User Experience Evaluation JO - JMIR Serious Games SP - e38509 VL - 10 IS - 3 KW - rehabilitation KW - pediatric KW - child KW - adolescent KW - walking KW - feasibility study KW - virtual reality KW - head-mounted display KW - therapy KW - tool KW - user KW - usability KW - visual KW - auditory KW - feedback KW - youth N2 - Background: Many essential walking activities in daily life, such as crossing a street, are challenging to practice in conventional therapeutic settings. Virtual environments (VEs) delivered through a virtual reality (VR) head-mounted display (HMD) would allow training such activities in a safe and attractive environment. Furthermore, the game-like character and high degree of immersion in these applications might help maintain or increase children?s motivation and active participation during the rehabilitation process. Objective: This study aimed to investigate the usability, user experience, and acceptability of an immersive VE experienced through a VR HMD to train everyday life walking activities in pediatric neurorehabilitation. Methods: In a cross-sectional study, 21 youths (median age 12.1 years; range 6.8-17.7 years) with a neuromotor impairment undergoing inpatient or outpatient neurorehabilitation tested a VE experienced through the VR HMD Oculus Quest. The participants, accompanied by their physiotherapists, moved freely around a 4.4 by 10-meter VE, displaying a magical forest and featuring various gamified everyday activities in different game designs. Using their hands, represented in the VE, the participants could interact with the virtual objects placed throughout the VE and trigger visual and auditory feedback. Symptoms of cybersickness were checked, and usability, user experience, and acceptability were evaluated using customized questionnaires with a visual analog scale for youths and a 5-point Likert scale for their therapists. Results: None of the participants reported any signs of cybersickness after 20 minutes of VR HMD exposure time. They rated comfort (median 10/10) and movement ability (median 10/10) with the VR HMD as high. The VE was perceived as being really there by the majority (median 8/10), and the participants had a strong feeling of spatial presence in the VE (median 9.5/10). They enjoyed exploring the virtual world (median 10/10) and liked this new therapy approach (median 10/10). Therapists? acceptance of the VR HMD was high (4/5). There were 5 patients that needed more support than usual, mainly for supervision, when moving around with the VR HMD. Otherwise, therapists felt that the VR HMD hardly affected their patients? movement behavior (median 4.75/5), whereas it seemed to increase their level of therapy engagement (median 4/5) compared to conventional physiotherapy sessions. Conclusions: This study demonstrates the usability of an immersive VE delivered through a VR HMD to engage youths in the training of everyday walking activities.The participants? and therapists? positive ratings on user experience and acceptance further support the promising application of this technology as a future therapeutic tool in pediatric neurorehabilitation. UR - https://games.jmir.org/2022/3/e38509 UR - http://dx.doi.org/10.2196/38509 UR - http://www.ncbi.nlm.nih.gov/pubmed/35834316 ID - info:doi/10.2196/38509 ER - TY - JOUR AU - Chang, Chien-Hsiang AU - Yeh, Chung-Hsing AU - Chang, Chien-Cheng AU - Lin, Yang-Cheng PY - 2022/7/14 TI - Interactive Somatosensory Games in Rehabilitation Training for Older Adults With Mild Cognitive Impairment: Usability Study JO - JMIR Serious Games SP - e38465 VL - 10 IS - 3 KW - dementia KW - elderly KW - usability KW - gesture recognition KW - card recognition rehabilitation KW - interactive somatosensory game N2 - Background: In aging societies, dementia risk increases with advancing age, increasing the incidence of dementia-related degenerative diseases and other complications, especially fall risk. Dementia also escalates the care burden, impacting patients, their families, social welfare institutions, and the social structure and medical system. Objective: In elderly dementia, traditional card recognition rehabilitation (TCRR) does not effectively increase one?s autonomy. Therefore, from the usability perspective, we used the Tetris game as a reference to develop an interactive somatosensory game rehabilitation (ISGR) with nostalgic style for elders with mild cognitive impairment (MCI). Through intuitive gesture-controlled interactive games, we evaluated subjective feelings concerning somatosensory game integration into rehabilitation to explore whether the ISGR could improve the willingness to use and motivation for rehabilitation among elders with MCI. Methods: A total of 15 elders with MCI (7 males and 8 females with an average age of 78.4 years) underwent 2 experiments for 15 minutes. During experiment 1, TCRR was performed, followed by completing the questionnaire of the System Usability Scale (SUS). After 3-5 minutes, the second experiment (the ISGR) was conducted, followed by completing another SUS. We used SUS to explore differences in impacts of TCRR and ISGR on willingness to use among elders with MCI. In addition, we further investigated whether the factor of gender or prior rehabilitation experience would affect the rehabilitation willingness or not. Results: The novel ISGR made the elderly feel interested and improved their willingness for continuous rehabilitation. According to the overall SUS score, the ISGR had better overall usability performance (73.7) than the TCRR (58.0) (t28=?4.62, P<.001). Furthermore, the ISGR individual item scores of ?Willingness to Use? (t28=?8.27, P<.001), ?Easy to Use? (t28=?3.17, P<.001), ?System Integration? (t28=?5.07, P<.001), and ?Easy to Learn? (t28=?2.81, P<.001) were better than TCRR. The somatosensory game was easier to learn and master for females than for males (t13=2.71, P=.02). Besides, the ISGR was easier to use (t12=?2.50, P=.02) and learn (t14=?3.33, P<.001) for those without prior rehabilitation experience. The result indicates that for elders with no rehabilitation experience ISGR was easier to use and simpler to learn than TCRR. Conclusions: Regardless of prior rehabilitation experience, the ISGR developed in this study was easy to learn and effective in continuously improving willingness to use. Furthermore, the adoption of a nostalgic game design style served the function of cognitive training and escalated interest in rehabilitation. The ISGR also improved user stickiness by introducing different game scenarios and difficulties, increasing long-term interest and motivation for rehabilitation. For future research on the adoption of interactive somatosensory games in rehabilitation, additional rehabilitation movements can be developed to benefit the elderly with MCI. UR - https://games.jmir.org/2022/3/e38465 UR - http://dx.doi.org/10.2196/38465 UR - http://www.ncbi.nlm.nih.gov/pubmed/35834303 ID - info:doi/10.2196/38465 ER - TY - JOUR AU - Chen, Jiayin AU - Or, Kalun Calvin AU - Chen, Tianrong PY - 2022/6/20 TI - Effectiveness of Using Virtual Reality?Supported Exercise Therapy for Upper Extremity Motor Rehabilitation in Patients With Stroke: Systematic Review and Meta-analysis of Randomized Controlled Trials JO - J Med Internet Res SP - e24111 VL - 24 IS - 6 KW - virtual reality KW - stroke KW - rehabilitation KW - upper extremity KW - meta-analysis N2 - Background: In recent years, efforts have been made to implement virtual reality (VR) to support the delivery of poststroke upper extremity motor rehabilitation exercises. Therefore, it is important to review and analyze the existing research evidence of its effectiveness. Objective: Through a systematic review and meta-analysis of randomized controlled trials, this study examined the effectiveness of using VR-supported exercise therapy for upper extremity motor rehabilitation in patients with stroke. Methods: This study followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The CINAHL Plus, MEDLINE, Web of Science, Embase, and Cochrane Library databases were searched on December 31, 2021. Changes in outcomes related to impairments in upper extremity functions and structures, activity limitations, and participation restrictions in life situations from baseline to after intervention, after intervention to follow-up assessment, and baseline to follow-up assessment were examined. Standardized mean differences (SMDs) were calculated using a random-effects model. Subgroup analyses were performed to determine whether the differences in treatment outcomes depended on age, stroke recovery stage, VR program type, therapy delivery format, similarities in intervention duration between study groups, intervention duration in VR groups, and trial length. Results: A total of 42 publications representing 43 trials (aggregated sample size=1893) were analyzed. Compared with the control groups that used either conventional therapy or no therapy, the intervention groups that used VR to support exercise therapy showed significant improvements in upper extremity motor function (Fugl-Meyer Assessment-Upper Extremity; SMD 0.45, 95% CI 0.21-0.68; P<.001), range of motion (goniometer; SMD 1.01, 95% CI 0.50-1.52; P<.001), muscle strength (Manual Muscle Testing; SMD 0.79, 95% CI 0.28-1.30; P=.002), and independence in day-to-day activities (Functional Independence Measure; SMD 0.23, 95% CI 0.06-0.40; P=.01, and modified Rankin Scale; SMD 0.57, 95% CI 0.01-1.12; P=.046). Significant subgroup differences were observed in hand dexterity (Box and Block Test), spasticity (Ashworth Scale or modified Ashworth Scale), arm and hand motor ability (Wolf Motor Function Test and Manual Function Test), hand motor ability (Jebsen Hand Function Test), and quality of life (Stroke Impact Scale). There was no evidence that the benefits of VR-supported exercise therapy were maintained after the intervention ended. Conclusions: VR-supported upper extremity exercise therapy can be effective in improving motor rehabilitation results. Our review showed that of the 12 rehabilitation outcomes examined during the course of VR-based therapy, significant improvements were detected in 2 (upper extremity motor function and range of motion), and both significant and nonsignificant improvements were observed in another 2 (muscle strength and independence in day-to-day activities), depending on the measurement tools or methods used. Trial Registration: PROSPERO CRD42021256826; https://tinyurl.com/2uarftbh UR - https://www.jmir.org/2022/6/e24111 UR - http://dx.doi.org/10.2196/24111 UR - http://www.ncbi.nlm.nih.gov/pubmed/35723907 ID - info:doi/10.2196/24111 ER - TY - JOUR AU - Krese, A. Kelly AU - Donnelly, Z. Kyla AU - Etingen, Bella AU - Bender Pape, L. Theresa AU - Chaudhuri, Sarmistha AU - Aaronson, L. Alexandra AU - Shah, P. Rachana AU - Bhaumik, K. Dulal AU - Billups, Andrea AU - Bedo, Sabrina AU - Wanicek-Squeo, Terese Mary AU - Bobra, Sonia AU - Herrold, A. Amy PY - 2022/6/15 TI - Feasibility of a Combined Neuromodulation and Yoga Intervention for Mild Traumatic Brain Injury and Chronic Pain: Protocol for an Open-label Pilot Trial JO - JMIR Res Protoc SP - e37836 VL - 11 IS - 6 KW - concussion KW - mild traumatic brain injury KW - chronic pain KW - neuromodulation KW - transcranial magnetic stimulation N2 - Background: Mild traumatic brain injury (mTBI) and chronic pain often co-occur and worsen rehabilitation outcomes. There is a need for improved multimodal nonpharmacologic treatments that could improve outcomes for both conditions. Yoga is a promising activity-based intervention for mTBI and chronic pain, and neuromodulation through transcranial magnetic stimulation is a promising noninvasive, nonpharmacological treatment for mTBI and chronic pain. Intermittent theta burst stimulation (iTBS) is a type of patterned, excitatory transcranial magnetic stimulation. iTBS can induce a window of neuroplasticity, making it ideally suited to boost the effects of treatments provided after it. Thus, iTBS may magnify the impacts of subsequently delivered interventions as compared to delivering those interventions alone and accordingly boost their impact on outcomes. Objective: The aim of this study is to (1) develop a combined iTBS+yoga intervention for mTBI and chronic pain, (2) assess the intervention?s feasibility and acceptability, and (3) gather preliminary clinical outcome data on quality of life, function, and pain that will guide future studies. Methods: This is a mixed methods, pilot, open-labeled, within-subject intervention study. We will enroll 20 US military veteran participants. The combined iTBS+yoga intervention will be provided in small group settings once a week for 6 weeks. The yoga intervention will follow the LoveYourBrain yoga protocol?specifically developed for individuals with TBI. iTBS will be administered immediately prior to the LoveYourBrain yoga session. We will collect preliminary quantitative outcome data before and after the intervention related to quality of life (TBI-quality of life), function (Mayo-Portland Adaptability Index), and pain (Brief Pain Inventory) to inform larger studies. We will collect qualitative data via semistructured interviews focused on intervention acceptability after completion of the intervention. Results: This study protocol was approved by Edward Hines Jr Veterans Administration Hospital Institutional Review Board (Hines IRB 1573116-4) and was prospectively registered on ClinicalTrials.gov (NCT04517604). This study includes a Food and Drug Administration Investigational Device Exemption (IDE: G200195). A 2-year research plan timeline was developed. As of March 2022, a total of 6 veterans have enrolled in the study. Data collection is ongoing and will be completed by November 2022. We expect the results of this study to be available by October 2024. Conclusions: We will be able to provide preliminary evidence of safety, feasibility, and acceptability of a novel combined iTBS and yoga intervention for mTBI and chronic pain?conditions with unmet treatment needs. Trial Registration: ClinicalTrials.gov NCT04517604; https://www.clinicaltrials.gov/ct2/show/NCT04517604 International Registered Report Identifier (IRRID): DERR1-10.2196/37836 UR - https://www.researchprotocols.org/2022/6/e37836 UR - http://dx.doi.org/10.2196/37836 UR - http://www.ncbi.nlm.nih.gov/pubmed/35704372 ID - info:doi/10.2196/37836 ER - TY - JOUR AU - Anwar, Naveed AU - Karimi, Hossein AU - Ahmad, Ashfaq AU - Gilani, Amir Syed AU - Khalid, Kehkshan AU - Aslam, Sohaib Ahmed AU - Hanif, Asif PY - 2022/6/13 TI - Virtual Reality Training Using Nintendo Wii Games for Patients With Stroke: Randomized Controlled Trial JO - JMIR Serious Games SP - e29830 VL - 10 IS - 2 KW - stroke KW - virtual reality KW - Fugl-Meyer score KW - rehabilitation KW - training KW - physical therapy KW - therapy KW - balance KW - function KW - randomized controlled trial N2 - Background: Stroke is a leading cause of disability. It is difficult to devise an optimal rehabilitation plan once stroke survivors are back home. Conventional rehabilitative therapies are extensively used in patients with stroke to recover motor functioning and disability, but these are arduous and expensive. Virtual reality (VR) video games inspire patients to get involved in their therapeutic exercise routine in a fun way. VR in the form of games provides a fruitful, secure, and challenging learning environment for motor control and neural plasticity development in rehabilitation. The effects of upper limb sensorimotor functioning and balance are the main focus of this trial. Objective: The aim of this study is to compare the effects of VR training and routine physical therapy on balance and upper extremity sensorimotor function in patients with stroke. Methods: It was a single assessor-blinded randomized clinical trial. A total of 74 participants with their first chronic stroke were included and rehabilitated in a clinical setting. The lottery method was used to randomly assign patients to either the VR group (n=37) or the routine physical therapy group (n=37). The VR group received a 1-hour session of VR training for 3 weekdays over 6 weeks, and the routine physical therapy group received different stretching and strengthening exercises. The outcome measuring tools were the Berg Balance Scale for balance and the Fugl-Meyer Assessment (upper extremity) scale for sensorimotor, joint pain, and range assessment. The assessment was done at the start of treatment and after the 6 weeks of intervention. Data analysis was done using SPSS 22. Results: The trial was completed by 68 patients. A significant difference between the two groups was found in the Berg Balance Scale score (P<.001), Fugl-Meyer Assessment for motor function (P=.03), and Fugl-Meyer Assessment for joint pain and joint range (P<.001); however, no significant difference (P=.19) in the Fugl-Meyer Assessment for upper extremity sensation was noted. Conclusions: VR training is helpful for improving balance and function of the upper extremities in the routine life of patients with stroke; although, it was not found to be better than conventional training in improving upper limb sensation. VR training can be a better option in a rehabilitation plan designed to increase functional capability. Trial Registration: Iranian Registry of Clinical Trials RCT20190715044216N1; https://www.irct.ir/user/trial/40898/view UR - https://games.jmir.org/2022/2/e29830 UR - http://dx.doi.org/10.2196/29830 UR - http://www.ncbi.nlm.nih.gov/pubmed/35699989 ID - info:doi/10.2196/29830 ER - TY - JOUR AU - Knobel, Johannes Samuel Elia AU - Kaufmann, Charlotte Brigitte AU - Geiser, Nora AU - Gerber, Moreno Stephan AU - Müri, M. René AU - Nef, Tobias AU - Nyffeler, Thomas AU - Cazzoli, Dario PY - 2022/5/25 TI - Effects of Virtual Reality?Based Multimodal Audio-Tactile Cueing in Patients With Spatial Attention Deficits: Pilot Usability Study JO - JMIR Serious Games SP - e34884 VL - 10 IS - 2 KW - virtual reality KW - search task KW - stroke KW - neglect, multimodal cueing KW - bird search task N2 - Background: Virtual reality (VR) devices are increasingly being used in medicine and other areas for a broad spectrum of applications. One of the possible applications of VR involves the creation of an environment manipulated in a way that helps patients with disturbances in the spatial allocation of visual attention (so-called hemispatial neglect). One approach to ameliorate neglect is to apply cross-modal cues (ie, cues in sensory modalities other than the visual one, eg, auditory and tactile) to guide visual attention toward the neglected space. So far, no study has investigated the effects of audio-tactile cues in VR on the spatial deployment of visual attention in neglect patients. Objective: This pilot study aimed to investigate the feasibility and usability of multimodal (audio-tactile) cueing, as implemented in a 3D VR setting, in patients with neglect, and obtain preliminary results concerning the effects of different types of cues on visual attention allocation compared with noncued conditions. Methods: Patients were placed in a virtual environment using a head-mounted display (HMD). The inlay of the HMD was equipped to deliver tactile feedback to the forehead. The task was to find and flag appearing birds. The birds could appear at 4 different presentation angles (lateral and paracentral on the left and right sides), and with (auditory, tactile, or audio-tactile cue) or without (no cue) a spatially meaningful cue. The task usability and feasibility, and 2 simple in-task measures (performance and early orientation) were assessed in 12 right-hemispheric stroke patients with neglect (5 with and 7 without additional somatosensory impairment). Results: The new VR setup showed high usability (mean score 10.2, SD 1.85; maximum score 12) and no relevant side effects (mean score 0.833, SD 0.834; maximum score 21). A repeated measures ANOVA on task performance data, with presentation angle, cue type, and group as factors, revealed a significant main effect of cue type (F30,3=9.863; P<.001) and a significant 3-way interaction (F90,9=2.057; P=.04). Post-hoc analyses revealed that among patients without somatosensory impairment, any cue led to better performance compared with no cue, for targets on the left side, and audio-tactile cues did not seem to have additive effects. Among patients with somatosensory impairment, performance was better with both auditory and audio-tactile cueing than with no cue, at every presentation angle; conversely, tactile cueing alone had no significant effect at any presentation angle. Analysis of early orientation data showed that any type of cue triggered better orientation in both groups for lateral presentation angles, possibly reflecting an early alerting effect. Conclusions: Overall, audio-tactile cueing seems to be a promising method to guide patient attention. For instance, in the future, it could be used as an add-on method that supports attentional orientation during established therapeutic approaches. UR - https://games.jmir.org/2022/2/e34884 UR - http://dx.doi.org/10.2196/34884 UR - http://www.ncbi.nlm.nih.gov/pubmed/35612894 ID - info:doi/10.2196/34884 ER - TY - JOUR AU - Yuan, Jing AU - Au, Rhoda AU - Karjadi, Cody AU - Ang, Fang Ting AU - Devine, Sherral AU - Auerbach, Sanford AU - DeCarli, Charles AU - Libon, J. David AU - Mez, Jesse AU - Lin, Honghuang PY - 2022/4/15 TI - Associations Between the Digital Clock Drawing Test and Brain Volume: Large Community-Based Prospective Cohort (Framingham Heart Study) JO - J Med Internet Res SP - e34513 VL - 24 IS - 4 KW - Clock Drawing Test KW - digital KW - neuropsychological test KW - cognitive KW - technology KW - Boston Process Approach KW - neurology KW - Framingham Heart Study KW - dementia KW - Alzheimer N2 - Background: The digital Clock Drawing Test (dCDT) has been recently used as a more objective tool to assess cognition. However, the association between digitally obtained clock drawing features and structural neuroimaging measures has not been assessed in large population-based studies. Objective: We aimed to investigate the association between dCDT features and brain volume. Methods: This study included participants from the Framingham Heart Study who had both a dCDT and magnetic resonance imaging (MRI) scan, and were free of dementia or stroke. Linear regression models were used to assess the association between 18 dCDT composite scores (derived from 105 dCDT raw features) and brain MRI measures, including total cerebral brain volume (TCBV), cerebral white matter volume, cerebral gray matter volume, hippocampal volume, and white matter hyperintensity (WMH) volume. Classification models were also built from clinical risk factors, dCDT composite scores, and MRI measures to distinguish people with mild cognitive impairment (MCI) from those whose cognition was intact. Results: A total of 1656 participants were included in this study (mean age 61 years, SD 13 years; 50.9% women), with 23 participants diagnosed with MCI. All dCDT composite scores were associated with TCBV after adjusting for multiple testing (P value <.05/18). Eleven dCDT composite scores were associated with cerebral white matter volume, but only 1 dCDT composite score was associated with cerebral gray matter volume. None of the dCDT composite scores was associated with hippocampal volume or WMH volume. The classification model for differentiating MCI and normal cognition participants, which incorporated age, sex, education, MRI measures, and dCDT composite scores, showed an area under the curve of 0.897. Conclusions: dCDT composite scores were significantly associated with multiple brain MRI measures in a large community-based cohort. The dCDT has the potential to be used as a cognitive assessment tool in the clinical diagnosis of MCI. UR - https://www.jmir.org/2022/4/e34513 UR - http://dx.doi.org/10.2196/34513 UR - http://www.ncbi.nlm.nih.gov/pubmed/35436225 ID - info:doi/10.2196/34513 ER - TY - JOUR AU - Bu, Xiaofan AU - Ng, HF Peter AU - Tong, Ying AU - Chen, Q. Peter AU - Fan, Rongrong AU - Tang, Qingping AU - Cheng, Qinqin AU - Li, Shuangshuang AU - Cheng, SK Andy AU - Liu, Xiangyu PY - 2022/4/7 TI - A Mobile-based Virtual Reality Speech Rehabilitation App for Patients With Aphasia After Stroke: Development and Pilot Usability Study JO - JMIR Serious Games SP - e30196 VL - 10 IS - 2 KW - virtual reality KW - speech rehabilitation KW - stroke KW - app KW - Delphi N2 - Background: Stroke has the highest disability-adjusted life-years lost in any disease, and approximately one-third of the patients get aphasia. Computers and tablets are innovative and aid in intensive treatments in speech rehabilitation for patients with aphasia. However, mechanical training limits the help to patients. Objective: This study aims to provide a framework for an integrated virtual reality (VR) app to provide speech rehabilitation for patients with aphasia. Methods: The content was generated through an in-depth literature review and discussion with experienced rehabilitation physicians and occupational therapists. We then conducted a 2-round Delphi study with 15 experts from hospitals and universities to rate the content using a 5-point Likert scale. The app was developed by an interdisciplinary team involving VR, medical science of rehabilitation, and therapeutic rehabilitation. Pilot usability testing of this novel app was conducted among 5 patients with aphasia, 5 healthy volunteers, 5 medical staff, and 2 VR experts. Results: We designed 4 modules of speech rehabilitation: oral expression, auditory comprehension, cognition, and comprehensive application. Our VR-based interactive and intelligent app was developed to provide an alternative option for patients with aphasia. Pilot usability testing revealed user satisfaction with the app. Conclusions: This study designed and tested a novel VR-based app for speech rehabilitation specifically adapted to patients with aphasia. This will guide other studies to develop a similar program or intelligent system in a clinical setting. UR - https://games.jmir.org/2022/2/e30196 UR - http://dx.doi.org/10.2196/30196 UR - http://www.ncbi.nlm.nih.gov/pubmed/35389349 ID - info:doi/10.2196/30196 ER - TY - JOUR AU - Shore, Josh AU - Nalder, Emily AU - Hutchison, Michael AU - Reed, Nick AU - Hunt, Anne PY - 2022/4/4 TI - Tele-Active Rehabilitation for Youth With Concussion: Evidence-Based and Theory-Informed Intervention Development JO - JMIR Pediatr Parent SP - e34822 VL - 5 IS - 2 KW - concussion KW - pediatrics KW - active rehabilitation KW - telehealth KW - exercise KW - mobile phone N2 - Background: Active rehabilitation involving subsymptom threshold exercise combined with education and support promotes recovery in youth with concussion but is typically delivered in person, which may limit accessibility for families because of a lack of services in their communities or logistical challenges to attending in-person sessions. Objective: This paper describes the evidence-based and theory-informed development of the Tele-Active Rehabilitation (Tele-AR) intervention for pediatric concussion, which was specifically designed for remote service delivery. Methods: The intervention was designed by clinician-researchers with experience in pediatric concussion rehabilitation following the Medical Research Council guidance for developing complex interventions. Development involved a critical review of the literature to identify existing evidence, the expansion of the theoretical basis for active rehabilitation, and the modeling of the intervention process and outcomes. Results: Tele-AR is a 6-week home exercise and education and support program facilitated through weekly videoconferencing appointments with a clinician. Exercise consists of low- to moderate-intensity subsymptom threshold aerobic activity and coordination drills that are individualized to participant needs and interests (prescribed for 3 days per week). Education includes the evidence-supported Concussion & You self-management program, which covers topics related to energy management, nutrition, hydration, sleep hygiene, and return to activity. Elements of self-determination theory are incorporated to support motivation and engagement. We present a logic model describing predicted intervention effects using a biopsychosocial conceptualization of outcomes after concussion. Conclusions: The Tele-AR intervention may help to increase access to care that improves recovery and promotes a timely return to activity in youth with concussion. Future research is needed to evaluate the feasibility and efficacy of this approach. UR - https://pediatrics.jmir.org/2022/2/e34822 UR - http://dx.doi.org/10.2196/34822 UR - http://www.ncbi.nlm.nih.gov/pubmed/35377326 ID - info:doi/10.2196/34822 ER - TY - JOUR AU - Kleschnitzki, Marina Jana AU - Beyer, Luzi AU - Beyer, Reinhard AU - Großmann, Inga PY - 2022/4/1 TI - The Effectiveness of a Serious Game (MemoreBox) for Cognitive Functioning Among Seniors in Care Facilities: Field Study JO - JMIR Serious Games SP - e33169 VL - 10 IS - 2 KW - serious game KW - cognitive function KW - mental health KW - seniors KW - care facilities KW - aging KW - cognitive impairments KW - health technology N2 - Background: Serious games have been found to have enhancing and preventative effects on cognitive abilities in healthy older adults. Yet, there are few results on the effects in older seniors with age-related low cognitive impairments. Their special needs were considered when designing and using innovate technology in the area of prevention, which is especially relevant owing to the continuously aging population. Objective: The objective of this study was to evaluate the impact of a serious game on the cognitive abilities of seniors in order to potentially implement innovative resource-oriented technological interventions that can help to meet future challenges. Methods: In this controlled trial, we tested the serious game MemoreBox, which features modules specifically designed for seniors in nursing homes. Over a period of 1 year, we tested the cognitive abilities of 1000 seniors at 4 time points using the Mini-Mental Status Test. Only half of the participating seniors engaged with the serious game. Results: The study included an intervention group (n=56) and a control group (did not play; n=55). Based on the in-game data collection, a second intervention group (n=38) was identified within the original intervention group, which exactly followed the planned protocol. There were no noteworthy differences between the demographic and main variables of the overall sample. The large reduction in the sample size was due to the effects of the COVID-19 pandemic (drop-out rate: 88.9%). The CI was set at 5%. Mixed analysis of variance (ANOVA) between the cognitive abilities of the intervention and control groups did not show a statistically significant difference between time and group (F2.710,295.379=1.942; P=.13; partial ?²=0.018). We noted approximately the same findings for mixed ANOVA between the cognitive abilities of the second intervention and control groups (F3,273=2.574; P=.054; partial ?²=0.028). However, we did observe clear tendencies and a statistically significant difference between the 2 groups after 9 months of the intervention (t88.1=?2.394; P=.02). Conclusions: The results of this study show similarities with the current research situation. Moreover, the data indicate that the intervention can have an effect on the cognitive abilities of seniors, provided that they regularly play the serious game of MemoreBox. The small sample size means that the tendency toward improvement cannot be proven as statistically significant. However, the tendency shown warrants further research. Establishing an effective prevention tool as part of standard care in nursing homes by means of an easy-to-use serious game would be a considerable contribution to the weakened health care system in Germany as it would offer a means of activating senior citizens in partially and fully inpatient care facilities. Trial Registration: German Clinical Trials Register DRKS00016633; https://tinyurl.com/2e4765nj UR - https://games.jmir.org/2022/2/e33169 UR - http://dx.doi.org/10.2196/33169 UR - http://www.ncbi.nlm.nih.gov/pubmed/35172959 ID - info:doi/10.2196/33169 ER - TY - JOUR AU - Wiskerke, Evelyne AU - Kool, Jan AU - Hilfiker, Roger AU - Sattelmayer, Martin Karl AU - Verheyden, Geert PY - 2022/3/22 TI - Determining the Optimal Virtual Reality Exergame Approach for Balance Therapy in Persons With Neurological Disorders Using a Rasch Analysis: Longitudinal Observational Study JO - JMIR Serious Games SP - e30366 VL - 10 IS - 1 KW - digital therapeutics KW - virtual reality KW - exergaming KW - balance KW - stroke KW - multiple sclerosis KW - neurorehabilitation KW - Rasch analysis N2 - Background: Virtual reality (VR) exergames have gained popularity in the rehabilitation of persons with neurological disorders as an add-on therapy to increase intensity of training. Intensity is strongly dependent on the motivation of the patient. Motivation can be increased by delivering variation within training and challenging exercises. However, patients are often underchallenged, as exergame difficulty often does not match the patient?s ability. A Rasch analysis can establish hierarchy of exergame items in order to assist the delivery of patient-centered therapy. Objective: The aim of this study was to apply the Rasch model to create a hierarchical order of existing VR balance exergames and to relate these exergames to the abilities of persons with neurological disorders, in order to deliver challenge and variation. Methods: A total of 30 persons with stroke and 51 persons with multiple sclerosis (MS) were included in the study. All participants performed a training program, lasting 3 weeks for persons with MS and 4 weeks for persons with stroke, in which they performed VR balance exergames with a movement recognition?based system (MindMotion GO; MindMaze SA). VR exercise scores, Berg Balance Scale scores, and clinical descriptive data were collected. Berg Balance Scale and device scores were analyzed with the Rasch model using a repeated-measures approach to examine whether the distribution of exercise scores fitted the Rasch model. Secondly, a person-item map was created to show the hierarchy of exercise difficulty and person ability. Results: Participants completed a selection of 56 balance exercises (ie, items), which consisted of a combination of various balance tasks and levels (ie, exercises). Using repeated measures, this resulted in a count of 785 observations. Analysis showed strong evidence for unidimensionality of the data. A total of 47 exercises (ie, items) had a sufficiently good fit to the Rasch model. Six items showed underfit, with outfit mean square values above 1.5. One item showed underfit but was kept in the analysis. Three items had negative point-biserial correlations. The final model consisted of 47 exercises, which were provided for persons with low to moderate balance ability. Conclusions: The VR exercises sufficiently fitted the Rasch model and resulted in a hierarchical order of VR balance exercises for persons with stroke and MS with low to moderate balance ability. In combination with the Berg Balance Scale, the results can guide clinical decision-making in the selection of patient-focused VR balance exercises. Trial Registration: ClinicalTrials.gov NCT03993275; https://clinicaltrials.gov/ct2/show/NCT03993275 UR - https://games.jmir.org/2022/1/e30366 UR - http://dx.doi.org/10.2196/30366 UR - http://www.ncbi.nlm.nih.gov/pubmed/35315785 ID - info:doi/10.2196/30366 ER - TY - JOUR AU - du Plessis, Sané AU - Oni, K. Ibukunoluwa AU - Lapointe, P. Andrew AU - Campbell, Christina AU - Dunn, F. Jeff AU - Debert, T. Chantel PY - 2022/3/22 TI - Treatment of Persistent Postconcussion Syndrome With Repetitive Transcranial Magnetic Stimulation Using Functional Near-Infrared Spectroscopy as a Biomarker of Response: Protocol for a Randomized Controlled Clinical Trial JO - JMIR Res Protoc SP - e31308 VL - 11 IS - 3 KW - concussion KW - mild traumatic brain injury KW - persistent postconcussion syndrome KW - repetitive transcranial magnetic stimulation KW - functional near-infrared spectroscopy KW - traumatic brain injury KW - TBI KW - brain injury KW - brain KW - symptom burden KW - mental health KW - quality of life KW - neuroscience KW - neurology N2 - Background: Approximately one-third of all concussions lead to persistent postconcussion syndrome (PPCS). Repetitive transcranial magnetic stimulation (rTMS) is a form of noninvasive brain stimulation that has been extensively used to treat refractory major depressive disorder and has a strong potential to be used as a treatment for patients with PPCS. Functional near-infrared spectroscopy (fNIRS) has already been used as a tool to assess patients with PPCS and may provide insight into the pathophysiology of rTMS treatment in patients with PPCS. Objective: The primary objective of this research is to determine whether rTMS treatment improves symptom burden in patients with PPCS compared to sham treatment using the Rivermead postconcussion symptom questionnaire. The secondary objective is to explore the neuropathophysiological changes that occur following rTMS in participants with PPCS using fNIRS. Exploratory objectives include determining whether rTMS treatment in participants with PPCS will also improve quality of life, anxiety, depressive symptoms, cognition, posttraumatic stress, and function secondary to headaches. Methods: A total of 44 adults (18-65 years old) with PPCS (>3 months to 5 years) will participate in a double-blind, sham-controlled, concealed allocation, randomized clinical trial. The participants will engage in either a 4-week rTMS treatment protocol or sham rTMS protocol (20 treatments). The left dorsolateral prefrontal cortex will be located through Montreal Neurologic Institute coordinates. The intensity of the rTMS treatment over the left dorsolateral prefrontal cortex will be 120% of resting motor threshold, with a frequency of 10 Hz, 10 trains of 60 pulses per train (total of 600 pulses), and intertrain interval of 45 seconds. Prior to starting the rTMS treatment, participant and injury characteristics, questionnaires (symptom burden, quality of life, depression, anxiety, cognition, and headache), and fNIRS assessment will be collected. Repeat questionnaires and fNIRS will occur immediately after rTMS treatment and at 1 month and 3 months post rTMS. Outcome parameters will be analyzed by a 2-way (treatment × time) mixed analysis of variance. Results: As of May 6, 2021, 5 participants have been recruited for the study, and 3 have completed the rTMS protocol. The estimated completion date of the trial is May 2022. Conclusions: This trial will expand our knowledge of how rTMS can be used as a treatment option of PPCS and will explore the neuropathophysiological response of rTMS through fNIRS analysis. Trial Registration: ClinicalTrials.gov NCT04568369; https://clinicaltrials.gov/ct2/show/NCT04568369 International Registered Report Identifier (IRRID): DERR1-10.2196/31308 UR - https://www.researchprotocols.org/2022/3/e31308 UR - http://dx.doi.org/10.2196/31308 UR - http://www.ncbi.nlm.nih.gov/pubmed/35315783 ID - info:doi/10.2196/31308 ER - TY - JOUR AU - Gulde, Philipp AU - Rieckmann, Peter PY - 2022/3/17 TI - The Association Between Actigraphy-Derived Behavioral Clusters and Self-Reported Fatigue in Persons With Multiple Sclerosis: Cross-sectional Study JO - JMIR Rehabil Assist Technol SP - e31164 VL - 9 IS - 1 KW - multiple sclerosis KW - actigraphy KW - cluster analysis KW - fatigue KW - physical activity KW - neurology KW - neurorehabilitation KW - rehabilitation KW - digital health KW - health technology KW - digital tools N2 - Background: Persons with multiple sclerosis frequently report increased levels of fatigue and fatigability. However, behavioral surrogates that are strongly associated with self-reports are lacking, which limits research and treatment. Objective: The aim of this study was to derive distinct behavioral syndromes that are reflected by self-reports concerning fatigue and fatigability. Methods: We collected actigraphic data of 30 persons with multiple sclerosis over a period of 1 week during an inpatient stay at a neurorehabilitation facility. Further, participants completed the German fatigue severity scale. A principal component analysis of actigraphic parameters was performed to extract the latent component levels of behaviors that reflect fatigue (quantity of activity) and fatigability (fragmentation of activity). The resulting components were used in a cluster analysis. Results: Analyses suggested 3 clusters, one with high activity (d=0.65-1.57) and low clinical disability levels (d=0.91-1.39), one with high levels of sedentary behavior (d=1.06-1.58), and one with strong activity fragmentation (d=1.39-1.94). The cluster with high levels of sedentary behavior further revealed strong differences from the other clusters concerning participants? reported levels of fatigue (d=0.99-1.28). Conclusions: Cluster analysis data proved to be feasible to meaningfully differentiate between different behavioral syndromes. Self-reports reflected the different behavioral syndromes strongly. Testing of additional domains (eg, volition or processing speed) and assessments during everyday life seem warranted to better understand the origins of reported fatigue symptomatology. UR - https://rehab.jmir.org/2022/1/e31164 UR - http://dx.doi.org/10.2196/31164 UR - http://www.ncbi.nlm.nih.gov/pubmed/35297774 ID - info:doi/10.2196/31164 ER - TY - JOUR AU - Behrens, Anders AU - Berglund, Sanmartin Johan AU - Anderberg, Peter PY - 2022/3/11 TI - CoGNIT Automated Tablet Computer Cognitive Testing in Patients With Mild Cognitive Impairment: Feasibility Study JO - JMIR Form Res SP - e23589 VL - 6 IS - 3 KW - internet KW - cognitive testing KW - software KW - testing KW - impairment KW - cognition KW - feasibility KW - diagnosis KW - app KW - assessment KW - cognitive impairment N2 - Background: Early diagnosis of cognitive disorders is becoming increasingly important. Limited resources for specialist assessment and an increasing demographical challenge warrants the need for efficient methods of evaluation. In response, CoGNIT, a tablet app for automatic, standardized, and efficient assessment of cognitive function, was developed. Included tests span the cognitive domains regarded as important for assessment in a general memory clinic (memory, language, psychomotor speed, executive function, attention, visuospatial ability, manual dexterity, and symptoms of depression). Objective: The aim of this study was to assess the feasibility of automatic cognitive testing with CoGNIT in older patients with symptoms of mild cognitive impairment (MCI). Methods: Patients older than 55 years with symptoms of MCI (n=36) were recruited at the research clinic at the Blekinge Institute of Technology (BTH), Karlskrona, Sweden. A research nurse administered the Mini-Mental State Exam (MMSE) and the CoGNIT app on a tablet computer. Technical and testing issues were documented. Results: The test battery was completed by all 36 patients. One test, the four-finger?tapping test, was performed incorrectly by 42% of the patients. Issues regarding clarity of instructions were found in 2 tests (block design test and the one finger-tapping test). Minor software bugs were identified. Conclusions: The overall feasibility of automatic cognitive testing with the CoGNIT app in patients with symptoms of MCI was good. The study highlighted tests that did not function optimally. The four-finger?tapping test will be discarded, and minor improvements to the software will be added before further studies and deployment in the clinic. UR - https://formative.jmir.org/2022/3/e23589 UR - http://dx.doi.org/10.2196/23589 UR - http://www.ncbi.nlm.nih.gov/pubmed/35275064 ID - info:doi/10.2196/23589 ER - TY - JOUR AU - Abd-alrazaq, Alaa AU - Alajlani, Mohannad AU - Alhuwail, Dari AU - Toro, T. Carla AU - Giannicchi, Anna AU - Ahmed, Arfan AU - Makhlouf, Ahmed AU - Househ, Mowafa PY - 2022/3/10 TI - The Effectiveness and Safety of Serious Games for Improving Cognitive Abilities Among Elderly People With Cognitive Impairment: Systematic Review and Meta-Analysis JO - JMIR Serious Games SP - e34592 VL - 10 IS - 1 KW - serious games KW - cognitive training KW - exergames KW - mild cognitive impairment KW - Alzheimer disease KW - dementia KW - global cognition KW - systematic review KW - meta-analysis N2 - Background: Cognitive impairment is a mental disorder that commonly affects elderly people. Serious games, which are games that have a purpose other than entertainment, have been used as a nonpharmacological intervention for improving cognitive abilities. The effectiveness and safety of serious games for improving cognitive abilities have been investigated by several systematic reviews; however, they are limited by design and methodological weaknesses. Objective: This study aims to assess the effectiveness and safety of serious games for improving cognitive abilities among elderly people with cognitive impairment. Methods: A systematic review of randomized controlled trials (RCTs) was conducted. The following 8 electronic databases were searched: MEDLINE, Embase, CINAHL, PsycINFO, ACM Digital Library, IEEE Xplore, Scopus, and Google Scholar. We also screened reference lists of the included studies and relevant reviews, as well as checked studies citing our included studies. Two reviewers independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence appraisal. We used a narrative and statistical approach, as appropriate, to synthesize the results of the included studies. Results: Fifteen studies met the eligibility criteria among 466 citations retrieved. Of those, 14 RCTs were eventually included in the meta-analysis. We found that, regardless of their type, serious games were more effective than no intervention (P=.04) and conventional exercises (P=.002) for improving global cognition among elderly people with cognitive impairment. Further, a subgroup analysis showed that cognitive training games were more effective than no intervention (P=.05) and conventional exercises (P<.001) for improving global cognition among elderly people with cognitive impairment. Another subgroup analysis demonstrated that exergames (a category of serious games that includes physical exercises) are as effective as no intervention and conventional exercises (P=.38) for improving global cognition among elderly people with cognitive impairment. Although some studies found adverse events from using serious games, the number of adverse events (ie, falls and exacerbations of pre-existing arthritis symptoms) was comparable between the serious game and control groups. Conclusions: Serious games and specifically cognitive training games have the potential to improve global cognition among elderly people with cognitive impairment. However, our findings remain inconclusive because the quality of evidence in all meta-analyses was very low, mainly due to the risk of bias raised in the majority of the included studies, high heterogeneity of the evidence, and imprecision of total effect sizes. Therefore, psychologists, psychiatrists, and patients should consider offering serious games as a complement and not a substitute to existing interventions until further more robust evidence is available. Further studies are needed to assess the effect of exergames, the safety of serious games, and their long-term effects. UR - https://games.jmir.org/2022/1/e34592 UR - http://dx.doi.org/10.2196/34592 UR - http://www.ncbi.nlm.nih.gov/pubmed/35266877 ID - info:doi/10.2196/34592 ER - TY - JOUR AU - Bernaerts, Sylvie AU - De Witte, J. Nele A. AU - Van der Auwera, Vicky AU - Bonroy, Bert AU - Muraru, Luiza AU - Bamidis, Panagiotis AU - Frantzidis, Christos AU - Kourtidou-Papadeli, Chrysoula AU - Azevedo, Nancy AU - Garatea, Jokin AU - Muñoz, Idoia AU - Almeida, Rosa AU - Losada, Raquel AU - Fung, Joyce AU - Kehayia, Eva AU - Lamontagne, Anouk AU - de Guise, Elaine AU - Duclos, Cyril AU - Higgins, Johanne AU - Nadeau, Sylvie AU - Beaudry, Lucie AU - Konstantinidis, Evdokimos PY - 2022/3/10 TI - Rehabilitation Supported by Technology: Protocol for an International Cocreation and User Experience Study JO - JMIR Res Protoc SP - e34537 VL - 11 IS - 3 KW - cocreation KW - harmonization KW - living lab KW - rehabilitation KW - small-scale real-life testing KW - technology N2 - Background: Living labs in the health and well-being domain have become increasingly common over the past decade but vary in available infrastructure, implemented study designs, and outcome measures. The Horizon 2020 Project Virtual Health and Wellbeing Living Lab Infrastructure aims to harmonize living lab procedures and open living lab infrastructures to facilitate and promote research activities in the health and well-being domain in Europe and beyond. This protocol will describe the design of a joint research activity, focusing on the use of innovative technology for both rehabilitation interventions and data collection in a rehabilitation context. Objective: With this joint research activity, this study primarily aims to gain insight into each living lab?s infrastructure and procedures to harmonize health and well-being living lab procedures and infrastructures in Europe and beyond, particularly in the context of rehabilitation. Secondarily, this study aims to investigate the potential of innovative technologies for rehabilitation through living lab methodologies. Methods: This study has a mixed methods design comprising multiple phases. There are two main phases of data collection: cocreation (phase 1) and small-scale pilot studies (phase 2), which are preceded by a preliminary harmonization of procedures among the different international living labs. An intermediate phase further allows the implementation of minor adjustments to the intervention or protocol depending on the input that was obtained in the cocreation phase. A total of 6 small-scale pilot studies using innovative technologies for intervention or data collection will be performed across 4 countries. The target study sample comprises patients with stroke and older adults with mild cognitive impairment. The third and final phases involve Delphi procedures to reach a consensus on harmonized procedures and protocols. Results: Phase 1 data collection will begin in March 2022, and phase 2 data collection will begin in June 2022. Results will include the output of the cocreation sessions, small-scale pilot studies, and advice on harmonizing procedures and protocols for health and well-being living labs focusing on rehabilitation. Conclusions: The knowledge gained by the execution of this research will lead to harmonized procedures and protocols in a rehabilitation context for health and well-being living labs in Europe and beyond. In addition to the harmonized procedures and protocols in rehabilitation, we will also be able to provide new insights for improving the implementation of innovative technologies in rehabilitation. International Registered Report Identifier (IRRID): PRR1-10.2196/34537 UR - https://www.researchprotocols.org/2022/3/e34537 UR - http://dx.doi.org/10.2196/34537 UR - http://www.ncbi.nlm.nih.gov/pubmed/35266874 ID - info:doi/10.2196/34537 ER - TY - JOUR AU - Wu, Jinlong AU - Zhang, Hui AU - Chen, Ziyan AU - Fu, Ruijia AU - Yang, Hao AU - Zeng, Hongfa AU - Ren, Zhanbing PY - 2022/3/1 TI - Benefits of Virtual Reality Balance Training for Patients With Parkinson Disease: Systematic Review, Meta-analysis, and Meta-Regression of a Randomized Controlled Trial JO - JMIR Serious Games SP - e30882 VL - 10 IS - 1 KW - virtual reality KW - Parkinson disease KW - balance KW - systematic review KW - meta-analysis KW - meta-regression KW - serious games KW - VR KW - rehabilitation KW - VR training N2 - Background: Virtual reality (VR) balance training is increasingly being pursued in biomedical research, specifically with respect to investigating balance ability with VR. However, existing systematic reviews have found inconsistent conclusions about the efficacy of VR in improving balance in Parkinson disease (PD) patients. Objective: The goal of the research was to evaluate the impact of VR balance training on the balance ability of patients with PD. Methods: All major databases, including Web of Science, PubMed, Scopus, China National Knowledge Infrastructure, and Wanfang, were searched to identify all relevant studies published in English or Chinese since September 15, 2010. Two researchers independently conducted document retrieval, study selection, data extraction, and methodological quality evaluation. Results: A total of 16 randomized controlled trials were analyzed (n=583 patients with PD), with the methodological quality evaluation score ranging from 5 to 8 points. A random effects model was selected to combine effect sizes. Meta-analysis showed that the balance ability of PD was significantly improved after VR training compared with the control group (standardized mean difference [SMD] 2.127, 95% CI 1.202 to 3.052, P<.001, I2=95.1, df=15). It is worth noting that the intervention platform may be the main reason for heterogeneity. Meta regression analysis showed that no training program could predict the impact of VR training (P=.57 to .94) on PD balance ability. Subgroup result showed that a single training time of 0 to 20 minutes (SMD 6.446), 4 to 6 times per week (SMD 4.067), training for 3 to 5 weeks (SMD 62.478), training course reached more than 30 times (SMD 4.405), and 201 to 300 minutes per week (SMD 4.059) maybe have more benefit. Conclusions: A systematic review and meta-analysis confirmed that VR balance training is a highly effective means to improve balance performance with large effects in PD. In addition, we preliminarily extracted dose-effect relationships for training volume, informing clinicians and practitioners to design effective VR balance training for balance ability. Further research is needed to reveal optimal dose-response relationships following VR balance training. UR - https://games.jmir.org/2022/1/e30882 UR - http://dx.doi.org/10.2196/30882 UR - http://www.ncbi.nlm.nih.gov/pubmed/35230242 ID - info:doi/10.2196/30882 ER - TY - JOUR AU - Zhu, KaiYan AU - Zhang, QiongYao AU - He, BingWei AU - Huang, MeiZhen AU - Lin, Rong AU - Li, Hong PY - 2022/2/21 TI - Immersive Virtual Reality?Based Cognitive Intervention for the Improvement of Cognitive Function, Depression, and Perceived Stress in Older Adults With Mild Cognitive Impairment and Mild Dementia: Pilot Pre-Post Study JO - JMIR Serious Games SP - e32117 VL - 10 IS - 1 KW - cognitive intervention KW - dementia KW - immersive virtual reality KW - mild cognitive impairment KW - cognitive impairment KW - virtual reality KW - VR KW - older patients KW - usability KW - memory KW - stress N2 - Background: The incidence of dementia is increasing annually, resulting in varying degrees of adverse effects for individuals, families, and society. With the continuous development of computer information technology, cognitive interventions are constantly evolving. The use of immersive virtual reality (IVR) as a cognitive intervention for older adults with mild cognitive impairment (MCI) and mild dementia (MD) is promising, although only few studies have focused on its use. Objective: The Chinese virtual supermarket (CVSM) IVR system was developed to provide a comprehensive and individual cognitive intervention program for older patients with MCI and MD. The aim of this study was to explore the feasibility and clinical effectiveness of this 5-week IVR-based cognitive intervention. Methods: A pretest-posttest study design was conducted with 31 older adults with MCI and MD from August 2020 to January 2021. All participants participated in a 5-week immersive virtual cognitive training program using the CVSM system. Feasibility was assessed as the incidence and severity of cybersickness symptoms and participant satisfaction based on questionnaires conducted after the intervention. Clinical effectiveness was evaluated using neuropsychological assessments, including several commonly used measures of cognitive function, depression, perceived stress, and activities of daily living. Measurements were obtained at baseline and after the intervention period. Results: A total of 18 patients with MCI (mean age 82.94 [SD 5.44] years; 12 females) and 13 patients with MD (mean age 85.7 [SD 4.67] years, 10 females) participated in this pilot study. Both groups showed significant improvements in all cognitive function measurements (P<.001). The MD group had a significantly greater improvement in general cognitive function compared to the MCI group in Montreal Cognitive Assessment Scale, Symbol Digit Modalities Test, Shape Trail Test, and Auditory Verbal Learning Test. Furthermore, an intervention effect was observed in the improvement of perceived stress (P=.048 for MD group, P=.03 for MCI group ). Conclusions: The use of the CVSM system may be effective in enhancing the cognitive function of patients with MCI and MD, including general cognitive function, memory, executive function, and attention. IVR technology enriches cognitive intervention approaches and provides acceptable, professional, personalized, and interesting cognitive training for older adults with cognitive impairment. Trial Registration: ClinicalTrials ChiCTR2100043753; https://trialsearch.who.int/Trial2.aspx?TrialID=ChiCTR2100043753 UR - https://games.jmir.org/2022/1/e32117 UR - http://dx.doi.org/10.2196/32117 UR - http://www.ncbi.nlm.nih.gov/pubmed/35188466 ID - info:doi/10.2196/32117 ER - TY - JOUR AU - García-Muñoz, Cristina AU - Cortés-Vega, María-Dolores AU - Hernández-Rodríguez, Juan-Carlos AU - Fernández-Seguín, M. Lourdes AU - Escobio-Prieto, Isabel AU - Casuso-Holgado, Jesús María PY - 2022/2/16 TI - Immersive Virtual Reality and Vestibular Rehabilitation in Multiple Sclerosis: Case Report JO - JMIR Serious Games SP - e31020 VL - 10 IS - 1 KW - immersive virtual reality KW - vestibular rehabilitation KW - multiple sclerosis KW - exergames N2 - Background: Dizziness and imbalance are common and disabling symptoms in patients with multiple sclerosis (MS) and are caused by a central, peripheral, or mixed vestibulopathy. Central vestibular disorder is the most frequently reported vestibular problem in the MS population due to demyelination. Vestibular rehabilitation ameliorates these symptoms and their repercussions and improves quality of life. Immersive virtual reality (VRi) is an emerging tool in this field; however, no previous research has been performed studying its effects in MS. Objective: The aim of this study was to apply a VRi vestibular training protocol to a patient with MS and assess the effects induced by the experimental intervention. Methods: This case study included a 54-year-old woman with relapsing-remitting MS. We developed a standardized VRi exercise protocol for vestibular rehabilitation based on the gold-standard Cawthorne-Cooksey vestibular training protocol. The 20-session intervention was made up of 10 initial sessions and 10 advanced sessions. Each 50-minute session was performed two to three times per week for 7 weeks. Four evaluations were carried out over the study period: at baseline (T0), between initial and advances phases (T1), postintervention (T2), and 1 month after the experimental procedure (T3). The research outcomes were dizziness, balance, gait, impact of fatigue, quality of life, repercussions in muscular tone, and usability of the head-mounted display device. Results: After implementing the VRi vestibular protocol, improvements were seen in the following patient parameters: Dizziness Handicap Inventory score (62 points at T0; 4 points at T2); Berg Balance Scale score (47 points at T0; 54 points at T2); instrumented Timed Up and Go time (8.35 seconds at T0; 5.57 seconds at T2); muscular tone of the erector spinae, rectus femoris, and soleus; Modified Fatigue Impact Scale score (61 points at T0; 37 points at T2); and Multiple Sclerosis Quality of Life-54 values (67.16% in the physical health area at T2; 33.56% in the mental health area at T2). The patient rated the usability of the system as 90%, based on the System Usability Scale, and gave the system a grade of A. Conclusions: Although further research is needed, this study provided initial evidence that the first VRi vestibular protocol for the MS population can improve dizziness, balance, gait, impact of fatigue, quality of life, and muscular tone through an exergame intervention. This study may help establish a standardized VRi protocol for vestibular rehabilitation. UR - https://games.jmir.org/2022/1/e31020 UR - http://dx.doi.org/10.2196/31020 UR - http://www.ncbi.nlm.nih.gov/pubmed/34766551 ID - info:doi/10.2196/31020 ER - TY - JOUR AU - Connors, Catherine AU - McNeill, Stephanie AU - Hrdlicka, Charles Henry PY - 2022/2/10 TI - Occupational and Physical Therapy Strategies for the Rehabilitation of COVID-19-Related Guillain-Barré Syndrome in the Long-term Acute Care Hospital Setting: Case Report JO - JMIR Rehabil Assist Technol SP - e30794 VL - 9 IS - 1 KW - Gullian-Barre syndrome KW - COVID-19 KW - SARS-CoV-2 KW - occupational therapy KW - physical therapy KW - long-term acute care hospital KW - rehabilitation KW - case report KW - treatment KW - diagnosis N2 - Background: Although several reports have described the diagnosis and treatment of patients with COVID-19-associated Guillain-Barré syndrome (GBS), there is a paucity of literature describing the occupational and physical therapy (OT and PT) strategies used in the long-term acute care hospital (LTACH) setting to rehabilitate these patients. Objective: To expand this body of literature, we present a case report highlighting the treatment strategies used to rehabilitate and discharge an individual from an independent LTACH facility, following diagnosis and treatment of COVID-19-related GBS at a regional ACH. Methods: A 61-year-old male was admitted to an LTACH for the rehabilitation of GBS following COVID-19 infection and intravenous immunoglobulin treatment. Rehabilitation in the LTACH setting uses a variety of skilled treatment interventions to meet patient-driven goals and maximize their function to the highest level possible in preparation of their discharge to a subacute or homecare setting. In this case, this was accomplished through individual OT and PT sessions, OT/PT cotreatment sessions, and targeted group therapy sessions focused on leg, arm, and fine motor coordination exercises. Results: With the OT and PT standard of care, the patient?s improvement was demonstrated by several outcome measures, including manual muscle testing, range of motion, grip strength, and the activity measure for postacute care. The patient was successfully rehabilitated and returned to the community after presenting with COVID-19-associated GBS. Conclusions: This report highlights the complex rehabilitation needs patients require to regain independence after diagnosis of COVID-19-associated GBS. UR - https://rehab.jmir.org/2022/1/e30794 UR - http://dx.doi.org/10.2196/30794 UR - http://www.ncbi.nlm.nih.gov/pubmed/35023838 ID - info:doi/10.2196/30794 ER - TY - JOUR AU - Blanc, Margaux AU - Roy, Anne-Laure AU - Fraudet, Bastien AU - Piette, Patrice AU - Le Toullec, Elodie AU - Nicolas, Benoit AU - Gallien, Philippe AU - Leblong, Emilie PY - 2022/2/7 TI - Evaluation of a Digitally Guided Self-Rehabilitation Device Coupled With Telerehabilitation Monitoring in Patients With Parkinson Disease (TELEP@RK): Open, Prospective Observational Study JO - JMIR Serious Games SP - e24946 VL - 10 IS - 1 KW - Parkinson's disease KW - telerehabilitation KW - serious games KW - UTAUT KW - physiotherapist KW - acceptability KW - acceptance N2 - Background: Parkinson disease is a neurodegenerative disease causing a progressive loss of autonomy. This requires long-term rehabilitation care. Currently, new technologies are being developed for use in daily life, and there is a progressive implementation of telerehabilitation. Objective: The aim of this study (the TELEP@RK study) is to evaluate the uses of a digital self-rehabilitation device in patients with Parkinson disease and their independent physiotherapists on the scale of a health territory. Methods: A total of 10 independent physiotherapists and 31 patients with Parkinson disease were followed for 1 year to evaluate the use of a telerehabilitation tool (digital tablet and inertial sensor) via questionnaires of the Unified Theory of Acceptance and Use of Technology (UTAUT). The questionnaires were submitted to participants at 0, 2, and 12 months from the start of follow-up. The averages of the scores of the different determinants and constructs of the UTAUT questionnaires were compared at the different follow-up times. Results: Among professionals, the averages of the various determinants were generally high at the beginning of the study with an average (out of 5) performance expectancy of 4.19, effort expectancy of 3.88, social influence of 3.95, facilitating conditions of 4, and intention to use of 3.97. These averages decreased over time. Conclusions: Acceptability, acceptance, and appropriation of the tool were very high among the physiotherapists as well as the patients, despite the tool?s lack of evolution during the study. In the current health care context, these results allow us to envision a new organization of the care pathway for patients with chronic diseases, with the increased use of new technologies associated with telecare. UR - https://games.jmir.org/2022/1/e24946 UR - http://dx.doi.org/10.2196/24946 UR - http://www.ncbi.nlm.nih.gov/pubmed/35129449 ID - info:doi/10.2196/24946 ER - TY - JOUR AU - Eastman, A. Jennifer AU - Kaup, R. Allison AU - Bahorik, L. Amber AU - Butcher, Xochitl AU - Attarha, Mouna AU - Marcus, M. Gregory AU - Pletcher, J. Mark AU - Olgin, E. Jeffrey AU - Barnes, E. Deborah AU - Yaffe, Kristine PY - 2022/2/2 TI - Remote Assessment of Cardiovascular Risk Factors and Cognition in Middle-Aged and Older Adults: Proof-of-Concept Study JO - JMIR Form Res SP - e30410 VL - 6 IS - 2 KW - mHealth KW - internet KW - mobile health KW - digital health KW - eHealth KW - cardiovascular KW - risk factors KW - cognition KW - cognitive impairment KW - remote cognitive assessment KW - aging N2 - Background: Adults with cardiovascular disease risk factors (CVRFs) are also at increased risk of developing cognitive decline and dementia. However, it is often difficult to study the relationships between CVRFs and cognitive function because cognitive assessment typically requires time-consuming in-person neuropsychological evaluations that may not be feasible for real-world situations. Objective: We conducted a proof-of-concept study to determine if the association between CVRFs and cognitive function could be detected using web-based, self-administered cognitive tasks and CVRF assessment. Methods: We recruited 239 participants aged ?50 years (mean age 62.7 years, SD 8.8; 42.7% [n=102] female, 88.7% [n=212] White) who were enrolled in the Health eHeart Study, a web-based platform focused on cardiac disease. The participants self-reported CVRFs (hypertension, high cholesterol, diabetes, and atrial fibrillation) using web-based health surveys between August 2016 and July 2018. After an average of 3 years of follow-up, we remotely evaluated episodic memory, working memory, and executive function via the web-based Posit Science platform, BrainHQ. Raw data were normalized and averaged into 3 domain scores. We used linear regression models to examine the association between CVRFs and cognitive function. Results: CVRF prevalence was 62.8% (n=150) for high cholesterol, 45.2% (n=108) for hypertension, 10.9% (n=26) for atrial fibrillation, and 7.5% (n=18) for diabetes. In multivariable models, atrial fibrillation was associated with worse working memory (?=-.51, 95% CI -0.91 to -0.11) and worse episodic memory (?=-.31, 95% CI -0.59 to -0.04); hypertension was associated with worse episodic memory (?=-.27, 95% CI -0.44 to -0.11). Diabetes and high cholesterol were not associated with cognitive performance. Conclusions: Self-administered web-based tools can be used to detect both CVRFs and cognitive health. We observed that atrial fibrillation and hypertension were associated with worse cognitive function even in those in their 60s and 70s. The potential of mobile assessments to detect risk factors for cognitive aging merits further investigation. UR - https://formative.jmir.org/2022/2/e30410 UR - http://dx.doi.org/10.2196/30410 UR - http://www.ncbi.nlm.nih.gov/pubmed/35107430 ID - info:doi/10.2196/30410 ER - TY - JOUR AU - Nweke, Martins AU - Mshunqane, Nombeko AU - Govender, Nalini AU - Akinpelu, Aderonke AU - Ogunniyi, Adesola PY - 2022/1/31 TI - Aerobic Exercise in HIV-Associated Neurocognitive Disorders: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e29230 VL - 11 IS - 1 KW - HIV KW - neurocognitive disorder KW - exercise KW - rehabilitation KW - quality of life KW - activity limitation N2 - Background: Since the introduction of antiretroviral therapy (ART), the incidence of HIV-associated dementia has drastically fallen. Despite using ART, people living with HIV continue to experience less severe but limiting forms of HIV-associated neurocognitive disorder (HAND). People living with HIV who are on ART and experiencing symptoms of HAND may benefit from aerobic exercise. Objective: This protocol describes a randomized controlled trial designed to determine the effects of a 12-week aerobic exercise program on HAND in Southeastern Nigeria. Methods: At least 68 patients diagnosed with HAND will be randomly placed into either an aerobic exercise group or control group. Patients in the aerobic exercise group will perform a moderate intensity workout on a stationary bicycle ergometer, 3 times a week for 12 weeks. We will measure the primary outcomes including neurocognitive performance, prevalence of HAND, viral load, and CD4 count. We will evaluate postexercise neurocognitive performance using reliable neuropsychological tests relevant to people living with HIV, in line with the Frascati criteria. We will assess secondary outcomes such as quality of life, activity limitation, and social participation using the World Health Organization Quality of Life (WHOQOL)-Brief, and the Oxford Participation and Activities questionnaire. We will use exploratory statistics to test the data for normality and homogeneity. We will analyze the effect of the exercise program on HAND using relative risk (RR) and absolute risk reduction (number needed to treat). Analysis of covariance will be run to estimate the effect of exercise on quality of life and activity and participation level. Results: This funded trial was approved by the Institutional Review Board in May 2020. The protocol was approved on June 15, 2020. Enrollment commenced in January 2021 and was completed in May 2021. Over 60% of the participants were recruited at the time of first submission to JMIR Mental Health. Data curation is still ongoing; hence, data analysis is yet to be executed. Study outcomes are expected to be published in March 2022. Conclusions: This is a protocol for a randomized controlled trial that aims to evaluate the effect of a 12-week aerobic exercise program on HAND in Southeastern Nigeria. Trial Registration: Pan African Clinical Trials Registry PACTR202009483415745; https://tinyurl.com/2p97zpu9 International Registered Report Identifier (IRRID): PRR1-10.2196/29230 UR - https://www.researchprotocols.org/2022/1/e29230 UR - http://dx.doi.org/10.2196/29230 UR - http://www.ncbi.nlm.nih.gov/pubmed/35099405 ID - info:doi/10.2196/29230 ER - TY - JOUR AU - Ahmedy, Fatimah AU - Mohamad Hashim, Natiara AU - Lago, Herwansyah AU - Plijoly, Protasius Leonard AU - Ahmedy, Ismail AU - Idna Idris, Yamani Mohd AU - Gani, Abdullah AU - Sybil Shah, Syahiskandar AU - Chia, Kang Yuen PY - 2022/1/28 TI - Comparing Neuroplasticity Changes Between High and Low Frequency Gait Training in Subacute Stroke: Protocol for a Randomized, Single-Blinded, Controlled Study JO - JMIR Res Protoc SP - e27935 VL - 11 IS - 1 KW - neuroplasticity KW - gait training KW - stroke rehabilitation KW - electroencephalogram signals N2 - Background: Walking recovery post stroke can be slow and incomplete. Determining effective stroke rehabilitation frequency requires the assessment of neuroplasticity changes. Neurobiological signals from electroencephalogram (EEG) can measure neuroplasticity through incremental changes of these signals after rehabilitation. However, changes seen with a different frequency of rehabilitation require further investigation. It is hypothesized that the association between the incremental changes from EEG signals and the improved functional outcome measure scores are greater in higher rehabilitation frequency, implying enhanced neuroplasticity changes. Objective: The purpose of this study is to identify the changes in the neurobiological signals from EEG, to associate these with functional outcome measures scores, and to compare their associations in different therapy frequency for gait rehabilitation among subacute stroke individuals. Methods: A randomized, single-blinded, controlled study among patients with subacute stroke will be conducted with two groups: an intervention group (IG) and a control group (CG). Each participant in the IG and CG will receive therapy sessions three times a week (high frequency) and once a week (low frequency), respectively, for a total of 12 consecutive weeks. Each session will last for an hour with strengthening, balance, and gait training. The main variables to be assessed are the 6-Minute Walk Test (6MWT), Motor Assessment Scale (MAS), Berg Balance Scale (BBS), Modified Barthel Index (MBI), and quantitative EEG indices in the form of delta to alpha ratio (DAR) and delta-plus-theta to alpha-plus-beta ratio (DTABR). These will be measured at preintervention (R0) and postintervention (R1). Key analyses are to determine the changes in the 6MWT, MAS, BBS, MBI, DAR, and DTABR at R0 and R1 for the CG and IG. The changes in the DAR and DTABR will be analyzed for association with the changes in the 6MWT, MAS, BBS, and MBI to measure neuroplasticity changes for both the CG and IG. Results: We have recruited 18 participants so far. We expect to publish our results in early 2023. Conclusions: These associations are expected to be positive in both groups, with a higher correlation in the IG compared to the CG, reflecting enhanced neuroplasticity changes and objective evaluation on the dose-response relationship. International Registered Report Identifier (IRRID): DERR1-10.2196/27935 UR - https://www.researchprotocols.org/2022/1/e27935 UR - http://dx.doi.org/10.2196/27935 UR - http://www.ncbi.nlm.nih.gov/pubmed/35089146 ID - info:doi/10.2196/27935 ER - TY - JOUR AU - Gagnon-Roy, Mireille AU - Pinard, Stéphanie AU - Bottari, Carolina AU - Le Morellec, Fanny AU - Laliberté, Catherine AU - Ben Lagha, Rym AU - Yaddaden, Amel AU - Pigot, Hélène AU - Giroux, Sylvain AU - Bier, Nathalie PY - 2022/1/26 TI - Smart Assistive Technology for Cooking for People With Cognitive Impairments Following a Traumatic Brain Injury: User Experience Study JO - JMIR Rehabil Assist Technol SP - e28701 VL - 9 IS - 1 KW - usability testing and evaluation KW - user experience KW - qualitative methods KW - assistive technologies KW - rehabilitation KW - patient safety N2 - Background: User experience (UX), including usability, should be formally assessed multiple times throughout the development process to optimize the acceptability and integration of a new technology before implementing it within the home environment of people living with cognitive impairments. Objective: The aim of this study is to identify UX issues, notably usability issues, and factors to consider for the future implementation of the COOK (Cognitive Orthosis for Cooking) within the home of individuals with traumatic brain injury (TBI) to identify modifications to improve the technology. Methods: This study comprised two rounds of UX evaluations, including extensive usability testing, which were completed in a laboratory context: 3 sessions with 5 experts and, after improvement of COOK, 2 sessions with 10 participants with TBI. Each session included the use of scenarios and questionnaires on UX and usability. Results: Both rounds demonstrated good usability outcomes and hedonic qualities. Various usability issues were identified by participants, such as navigation inconsistencies, technical bugs, and the need for more feedback. Factors to consider in the future implementation of COOK were also mentioned by participants with TBI, including environmental (eg, space available and presence of pets) and personal factors (eg, level of comfort with technology, presence of visual deficits, and preferences). Conclusions: By evaluating UX, including usability, various times throughout the development process and including experts and end users, our research team was able to develop a technology that was perceived as usable, pleasant, and well-designed. This research is an example of how and when people with cognitive impairments (ie, people with TBI) can be involved in evaluating the UX of new technology. UR - https://rehab.jmir.org/2022/1/e28701 UR - http://dx.doi.org/10.2196/28701 UR - http://www.ncbi.nlm.nih.gov/pubmed/35080496 ID - info:doi/10.2196/28701 ER - TY - JOUR AU - Lee, Jaegyeong AU - Lim, Min Jung PY - 2022/1/14 TI - Factors Associated With the Experience of Cognitive Training Apps for the Prevention of Dementia: Cross-sectional Study Using an Extended Health Belief Model JO - J Med Internet Res SP - e31664 VL - 24 IS - 1 KW - cognitive training apps KW - dementia knowledge KW - health belief model KW - middle-aged KW - logistic regression analysis KW - dementia KW - Alzheimer disease KW - cognition KW - mobile apps KW - health apps N2 - Background: The prevalence and economic burden of dementia are increasing dramatically. Using information communication technology to improve cognitive functions is proven to be effective and holds the potential to serve as a new and efficient method for the prevention of dementia. Objective: The aim of this study was to identify factors associated with the experience of mobile apps for cognitive training in middle-aged adults. We evaluated the relationships between the experience of cognitive training apps and structural variables using an extended health belief model. Methods: An online survey was conducted on South Korean participants aged 40 to 64 years (N=320). General characteristics and dementia knowledge were measured along with the health belief model constructs. Statistical analysis and logistic regression analysis were performed. Results: Higher dementia knowledge (odds ratio [OR] 1.164, P=.02), higher perceived benefit (OR 1.373, P<.001), female gender (OR 0.499, P=.04), and family history of dementia (OR 1.933, P=.04) were significantly associated with the experience of cognitive training apps for the prevention of dementia. Conclusions: This study may serve as a theoretical basis for the development of intervention strategies to increase the use of cognitive training apps for the prevention of dementia. UR - https://www.jmir.org/2022/1/e31664 UR - http://dx.doi.org/10.2196/31664 UR - http://www.ncbi.nlm.nih.gov/pubmed/35029540 ID - info:doi/10.2196/31664 ER - TY - JOUR AU - Miao, Melissa AU - Power, Emma AU - Rietdijk, Rachael AU - Debono, Deborah AU - Brunner, Melissa AU - Salomon, Alexander AU - Mcculloch, Ben AU - Wright, Rebecca Meg AU - Welsh, Monica AU - Tremblay, Bastian AU - Rixon, Caleb AU - Williams, Liz AU - Morrow, Rosemary AU - Evain, Jean-Christophe AU - Togher, Leanne PY - 2022/1/10 TI - Coproducing Knowledge of the Implementation of Complex Digital Health Interventions for Adults with Acquired Brain Injury and their Communication Partners: Protocol for a Mixed Methods Study JO - JMIR Res Protoc SP - e35080 VL - 11 IS - 1 KW - priority setting KW - public involvement KW - implementation science KW - internet interventions KW - acquired brain injury KW - delivery of health care KW - caregivers KW - speech-language pathology KW - brain injury KW - mobile phone N2 - Background: The Social Brain Toolkit, conceived and developed in partnership with stakeholders, is a novel suite of web-based communication interventions for people with brain injury and their communication partners. To support effective implementation, the developers of the Social Brain Toolkit have collaborated with people with brain injury, communication partners, clinicians, and individuals with digital health implementation experience to coproduce new implementation knowledge. In recognition of the equal value of experiential and academic knowledge, both types of knowledge are included in this study protocol, with input from stakeholder coauthors. Objective: This study aims to collaborate with stakeholders to prioritize theoretically based implementation targets for the Social Brain Toolkit, understand the nature of these priorities, and develop targeted implementation strategies to address these priorities, in order to support the Social Brain Toolkit?s implementation. Methods: Theoretically underpinned by the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework of digital health implementation, a maximum variation sample (N=35) of stakeholders coproduced knowledge of the implementation of the Social Brain Toolkit. People with brain injury (n=10), communication partners (n=11), and clinicians (n=5) participated in an initial web-based prioritization survey based on the NASSS framework. Survey completion was facilitated by plain English explanations and accessible captioned videos developed through 3 rounds of piloting. A speech-language pathologist also assisted stakeholders with brain injury to participate in the survey via video teleconference. Participants subsequently elaborated on their identified priorities via 7 web-based focus groups, in which researchers and stakeholders exchanged stakeholder perspectives and research evidence from a concurrent systematic review. Stakeholders were supported to engage in focus groups through the use of visual supports and plain English explanations. Additionally, individuals with experience in digital health implementation (n=9) responded to the prioritization survey questions via individual interview. The results will be deductively analyzed in relation to the NASSS framework in a coauthorship process with people with brain injury, communication partners, and clinicians. Results: Ethical approval was received from the University of Technology Sydney Health and Medical Research Ethics Committee (ETH20-5466) on December 15, 2020. Data were collected from April 13 to November 18, 2021. Data analysis is currently underway, with results expected for publication in mid-2022. Conclusions: In this study, researchers supported individuals with living experience of acquired brain injury, of communicating with or clinically supporting someone post injury, and of digital health implementation, to directly access and leverage the latest implementation research evidence and theory. With this support, stakeholders were able to prioritize implementation research targets, develop targeted implementation solutions, and coauthor and publish new implementation findings. The results will be used to optimize the implementation of 3 real-world, evidence-based interventions and thus improve the outcomes of people with brain injury and their communication partners. International Registered Report Identifier (IRRID): DERR1-10.2196/35080 UR - https://www.researchprotocols.org/2022/1/e35080 UR - http://dx.doi.org/10.2196/35080 UR - http://www.ncbi.nlm.nih.gov/pubmed/35006082 ID - info:doi/10.2196/35080 ER - TY - JOUR AU - Bouldin, D. Erin AU - Delgado, Roxana AU - Peacock, Kimberly AU - Hale, Willie AU - Roghani, Ali AU - Trevino, Y. Amira AU - Viny, Mikayla AU - Wetter, W. David AU - Pugh, Jo Mary PY - 2022/1/5 TI - Military Injuries?Understanding Posttraumatic Epilepsy, Health, and Quality-of-Life Effects of Caregiving: Protocol for a Longitudinal Mixed Methods Observational Study JO - JMIR Res Protoc SP - e30975 VL - 11 IS - 1 KW - epilepsy KW - military personnel KW - veterans KW - caregiver KW - traumatic brain injury KW - quality of life KW - health status KW - longitudinal studies KW - ecologic momentary assessment KW - qualitative research N2 - Background: Veterans with posttraumatic epilepsy (PTE), particularly those with comorbidities associated with epilepsy or traumatic brain injury (TBI), have poorer health status and higher symptom burden than their peers without PTE. One area that has been particularly poorly studied is that of the role of caregivers in the health of veterans with PTE and the impact caring for someone with PTE has on the caregivers themselves. Objective: In this study, we aim to address the following: describe and compare the health and quality of life of veterans and caregivers of veterans with and without PTE; evaluate the change in available supports and unmet needs for services among caregivers of post-9/11 veterans with PTE over a 2-year period and to compare support and unmet needs with those without PTE; and identify veteran and caregiver characteristics associated with the 2-year health trajectories of caregivers and veterans with PTE compared with veterans without PTE. Methods: We conducted a prospective cohort study of the health and quality of life among 4 groups of veterans and their caregivers: veterans with PTE, nontraumatic epilepsy, TBI only, and neither epilepsy nor TBI. We will recruit participants from previous related studies and collect information about both the veterans and their primary informal caregivers on health, quality of life, unmet needs for care, PTE and TBI symptoms and treatment, relationship, and caregiver experience. Data sources will include existing data supplemented with primary data, such as survey data collected at baseline, intermittent brief reporting using ecological momentary assessment, and qualitative interviews. We will make both cross-sectional and longitudinal comparisons, using veteran-caregiver dyads, along with qualitative findings to better understand risk and promotive factors for quality of life and health among veterans and caregivers, as well as the bidirectional impact of caregivers and care recipients on one another. Results: This study was approved by the institutional review boards of the University of Utah and Salt Lake City Veterans Affairs and is under review by the Human Research Protection Office of the United States Army Medical Research and Development Command. The Service Member, Veteran, and Caregiver Community Stakeholders Group has been formed and the study questionnaire will be finalized once the panel reviews it. We anticipate the start of recruitment and primary data collection by January 2022. Conclusions: New national initiatives aim to incorporate the caregiver into the veteran?s treatment plan; however, we know little about the impact of caregiving?both positive and negative?on the caregivers themselves and on the veterans for whom they provide care. We will identify specific needs in this understudied population, which will inform clinicians, patients, families, and policy makers about the specific impact and needs to equip caregivers in caring for veterans at home. International Registered Report Identifier (IRRID): PRR1-10.2196/30975 UR - https://www.researchprotocols.org/2022/1/e30975 UR - http://dx.doi.org/10.2196/30975 UR - http://www.ncbi.nlm.nih.gov/pubmed/34989689 ID - info:doi/10.2196/30975 ER - TY - JOUR AU - Hsu, Wan-Yu AU - Rowles, William AU - Anguera, A. Joaquin AU - Anderson, Annika AU - Younger, W. Jessica AU - Friedman, Samuel AU - Gazzaley, Adam AU - Bove, Riley PY - 2021/12/30 TI - Assessing Cognitive Function in Multiple Sclerosis With Digital Tools: Observational Study JO - J Med Internet Res SP - e25748 VL - 23 IS - 12 KW - cognition KW - digital health KW - mHealth KW - multiple sclerosis KW - cognitive assessment N2 - Background: Cognitive impairment (CI) is one of the most prevalent symptoms of multiple sclerosis (MS). However, it is difficult to include cognitive assessment as part of MS standard care since the comprehensive neuropsychological examinations are usually time-consuming and extensive. Objective: To improve access to CI assessment, we evaluated the feasibility and potential assessment sensitivity of a tablet-based cognitive battery in patients with MS. Methods: In total, 53 participants with MS (24 [45%] with CI and 29 [55%] without CI) and 24 non-MS participants were assessed with a tablet-based cognitive battery (Adaptive Cognitive Evaluation [ACE]) and standard cognitive measures, including the Symbol Digit Modalities Test (SDMT) and the Paced Auditory Serial Addition Test (PASAT). Associations between performance in ACE and the SDMT/PASAT were explored, with group comparisons to evaluate whether ACE modules can capture group-level differences. Results: Correlations between performance in ACE and the SDMT (R=?0.57, P<.001), as well as PASAT (R=?0.39, P=.01), were observed. Compared to non-MS and non-CI MS groups, the CI MS group showed a slower reaction time (CI MS vs non-MS: P<.001; CI MS vs non-CI MS: P=.004) and a higher attention cost (CI MS vs non-MS: P=.02; CI MS vs non-CI MS: P<.001). Conclusions: These results provide preliminary evidence that ACE, a tablet-based cognitive assessment battery, provides modules that could potentially serve as a digital cognitive assessment for people with MS. Trial Registration: ClinicalTrials.gov NCT03569618; https://clinicaltrials.gov/ct2/show/NCT03569618 UR - https://www.jmir.org/2021/12/e25748 UR - http://dx.doi.org/10.2196/25748 UR - http://www.ncbi.nlm.nih.gov/pubmed/34967751 ID - info:doi/10.2196/25748 ER - TY - JOUR AU - Carlozzi, E. Noelle AU - Choi, Won Sung AU - Wu, Zhenke AU - Miner, A. Jennifer AU - Lyden, K. Angela AU - Graves, Christopher AU - Wang, Jitao AU - Sen, Srijan PY - 2021/12/9 TI - An App-Based Just-in-Time Adaptive Self-management Intervention for Care Partners (CareQOL): Protocol for a Pilot Trial JO - JMIR Res Protoc SP - e32842 VL - 10 IS - 12 KW - caregivers KW - quality of life KW - spinal cord injuries KW - Huntington disease KW - hematopoietic stem cell transplantation KW - feasibility studies KW - self-management KW - mobile apps KW - outcome assessment KW - mobile phone N2 - Background: Care partners (ie, informal family caregivers) of individuals with health problems face considerable physical and emotional stress, often with a substantial negative impact on the health-related quality of life (HRQOL) of both care partners and care recipients. Given that these individuals are often overwhelmed by their caregiving responsibilities, low-burden self-management interventions are needed to support care partners to ensure better patient outcomes. Objective: The primary objective of this study is to describe an intensive data collection protocol that involves the delivery of a personalized just-in-time adaptive intervention that incorporates passive mobile sensor data feedback (sleep and activity data from a Fitbit [Fitbit LLC]) and real time self-reporting of HRQOL via a study-specific app called CareQOL (University of Michigan) to provide personalized feedback via app alerts. Methods: Participants from 3 diverse care partner groups will be enrolled (care partners of persons with spinal cord injury, care partners of persons with Huntington disease, and care partners of persons with hematopoietic cell transplantation). Participants will be randomized to either a control group, where they will wear the Fitbit and provide daily reports of HRQOL over a 3-month (ie, 90 days) period (without personalized feedback), or the just-in-time adaptive intervention group, where they will wear the Fitbit, provide daily reports of HRQOL, and receive personalized push notifications for 3 months. At the end of the study, participants will complete a feasibility and acceptability questionnaire, and metrics regarding adherence and attrition will be calculated. Results: This trial opened for recruitment in November 2020. Data collection was completed in June 2021, and the primary results are expected to be published in 2022. Conclusions: This trial will determine the feasibility and acceptability of an intensive app-based intervention in 3 distinct care partner groups: care partners for persons with a chronic condition that was caused by a traumatic event (ie, spinal cord injury); care partners for persons with a progressive, fatal neurodegenerative disease (ie, Huntington disease); and care partners for persons with episodic cancer conditions that require intense, prolonged inpatient and outpatient treatment (persons with hematopoietic cell transplantation). Trial Registration: ClinicalTrials.gov NCT04556591; https://clinicaltrials.gov/ct2/show/NCT04556591 International Registered Report Identifier (IRRID): DERR1-10.2196/32842 UR - https://www.researchprotocols.org/2021/12/e32842 UR - http://dx.doi.org/10.2196/32842 UR - http://www.ncbi.nlm.nih.gov/pubmed/34889775 ID - info:doi/10.2196/32842 ER - TY - JOUR AU - Miao, Melissa AU - Power, Emma AU - Rietdijk, Rachael AU - Brunner, Melissa AU - Debono, Deborah AU - Togher, Leanne PY - 2021/12/9 TI - A Web-Based Service Delivery Model for Communication Training After Brain Injury: Protocol for a Mixed Methods, Prospective, Hybrid Type 2 Implementation-Effectiveness Study JO - JMIR Res Protoc SP - e31995 VL - 10 IS - 12 KW - implementation science KW - patient-outcome assessment KW - internet interventions KW - acquired brain injury KW - delivery of health care KW - caregivers KW - speech-language pathology N2 - Background: Acquired brain injuries (ABIs) commonly cause cognitive-communication disorders, which can have a pervasive psychosocial impact on a person?s life. More than 135 million people worldwide currently live with ABI, and this large and growing burden is increasingly surpassing global rehabilitation service capacity. A web-based service delivery model may offer a scalable solution. The Social Brain Toolkit is an evidence-based suite of 3 web-based communication training interventions for people with ABI and their communication partners. Successful real-world delivery of web-based interventions such as the Social Brain Toolkit requires investigation of intervention implementation in addition to efficacy and effectiveness. Objective: The aim of this study is to investigate the implementation and effectiveness of the Social Brain Toolkit as a web-based service delivery model. Methods: This is a mixed methods, prospective, hybrid type 2 implementation-effectiveness study, theoretically underpinned by the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework of digital health implementation. We will document implementation strategies preemptively deployed to support the launch of the Social Brain Toolkit interventions, as well as implementation strategies identified by end users through formative evaluation of the Social Brain Toolkit. We will prospectively observe implementation outcomes, selected on the basis of the NASSS framework, through quantitative web analytics of intervention use, qualitative and quantitative pre- and postintervention survey data from all users within a specified sample frame, and qualitative interviews with a subset of users of each intervention. Qualitative implementation data will be deductively analyzed against the NASSS framework. Quantitative implementation data will be analyzed descriptively. We will obtain effectiveness outcomes through web-based knowledge tests, custom user questionnaires, and formal clinical tools. Quantitative effectiveness outcomes will be analyzed through descriptive statistics and the Reliable Change Index, with repeated analysis of variance (pretraining, posttraining, and follow-up), to determine whether there is any significant improvement within this participant sample. Results: Data collection commenced on July 2, 2021, and is expected to conclude on June 1, 2022, after a 6-month sample frame of analytics for each Social Brain Toolkit intervention. Data analysis will occur concurrently with data collection until mid-2022, with results expected for publication late 2022 and early 2023. Conclusions: End-user evaluation of the Social Brain Toolkit?s implementation can guide intervention development and implementation to reach and meet community needs in a feasible, scalable, sustainable, and acceptable manner. End user feedback will be directly incorporated and addressed wherever possible in the next version of the Social Brain Toolkit. Learnings from these findings will benefit the implementation of this and future web-based psychosocial interventions for people with ABI and other populations. Trial Registration: Australia and New Zealand Clinical Trials Registry ACTRN12621001170819; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12621001170819, Australia and New Zealand Clinical Trials Registry ACTRN12621001177842; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12621001177842, Australia and New Zealand Clinical Trials Registry ACTRN12621001180808; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12621001180808 International Registered Report Identifier (IRRID): DERR1-10.2196/31995 UR - https://www.researchprotocols.org/2021/12/e31995 UR - http://dx.doi.org/10.2196/31995 UR - http://www.ncbi.nlm.nih.gov/pubmed/34889770 ID - info:doi/10.2196/31995 ER - TY - JOUR AU - Medina, Rafael AU - Bouhaben, Jaime AU - de Ramón, Ignacio AU - Cuesta, Pablo AU - Antón-Toro, Luis AU - Pacios, Javier AU - Quintero, Javier AU - Ramos-Quiroga, Antoni Josep AU - Maestú, Fernando PY - 2021/11/26 TI - Electrophysiological Brain Changes Associated With Cognitive Improvement in a Pediatric Attention Deficit Hyperactivity Disorder Digital Artificial Intelligence-Driven Intervention: Randomized Controlled Trial JO - J Med Internet Res SP - e25466 VL - 23 IS - 11 KW - ADHD KW - cognitive stimulation KW - magnetoencephalography KW - artificial intelligence KW - Conners continuous performance test KW - KAD_SCL_01 KW - AI KW - cognitive impairment KW - attention deficit hyperactivity disorder KW - pediatrics KW - children KW - rehabilitation N2 - Background: Cognitive stimulation therapy appears to show promising results in the rehabilitation of impaired cognitive processes in attention deficit hyperactivity disorder. Objective: Encouraged by this evidence and the ever-increasing use of technology and artificial intelligence for therapeutic purposes, we examined whether cognitive stimulation therapy implemented on a mobile device and controlled by an artificial intelligence engine can be effective in the neurocognitive rehabilitation of these patients. Methods: In this randomized study, 29 child participants (25 males) underwent training with a smart, digital, cognitive stimulation program (KAD_SCL_01) or with 3 commercial video games for 12 weeks, 3 days a week, 15 minutes a day. Participants completed a neuropsychological assessment and a preintervention and postintervention magnetoencephalography study in a resting state with their eyes closed. In addition, information on clinical symptoms was collected from the child´s legal guardians. Results: In line with our main hypothesis, we found evidence that smart, digital, cognitive treatment results in improvements in inhibitory control performance. Improvements were also found in visuospatial working memory performance and in the cognitive flexibility, working memory, and behavior and general executive functioning behavioral clinical indexes in this group of participants. Finally, the improvements found in inhibitory control were related to increases in alpha-band power in all participants in the posterior regions, including 2 default mode network regions of the interest: the bilateral precuneus and the bilateral posterior cingulate cortex. However, only the participants who underwent cognitive stimulation intervention (KAD_SCL_01) showed a significant increase in this relationship. Conclusions: The results seem to indicate that smart, digital treatment can be effective in the inhibitory control and visuospatial working memory rehabilitation in patients with attention deficit hyperactivity disorder. Furthermore, the relation of the inhibitory control with alpha-band power changes could mean that these changes are a product of plasticity mechanisms or changes in the neuromodulatory dynamics. Trial Registration: ISRCTN Registry ISRCTN71041318; https://www.isrctn.com/ISRCTN71041318 UR - https://www.jmir.org/2021/11/e25466 UR - http://dx.doi.org/10.2196/25466 UR - http://www.ncbi.nlm.nih.gov/pubmed/34842533 ID - info:doi/10.2196/25466 ER - TY - JOUR AU - Kim, Euisung AU - Han, Jieun AU - Choi, Hojin AU - Prié, Yannick AU - Vigier, Toinon AU - Bulteau, Samuel AU - Kwon, Hyun Gyu PY - 2021/11/24 TI - Examining the Academic Trends in Neuropsychological Tests for Executive Functions Using Virtual Reality: Systematic Literature Review JO - JMIR Serious Games SP - e30249 VL - 9 IS - 4 KW - virtual reality KW - neuropsychological test KW - executive function KW - cognitive ability KW - brain disorder KW - immersive KW - digital health KW - cognition KW - academic trends KW - neurology N2 - Background: In neuropsychology, fully immersive virtual reality (VR) has been spotlighted as a promising tool. It is considered that VR not only overcomes the existing limitation of neuropsychological tests but is also appropriate for treating executive functions (EFs) within activities of daily living (ADL) due to its high ecological validity. While fully immersive VR offers new possibilities of neuropsychological tests, there are few studies that overview the intellectual landscape and academic trends in the research related to mainly targeted EFs with fully immersive VR. Objective: The objective of this study is to get an overview of the research trends that use VR in neuropsychological tests and to analyze the research trends using fully immersive VR neuropsychological tests with experimental articles. Methods: This review was carried out according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles were searched in three web databases using keywords related to VR, EFs, and cognitive abilities. The study was conducted in two steps, keyword analysis and in-depth systematic review. In the web database search from 2000 to 2019, 1167 articles were initially collected, of which 234 articles in the eligibility phase were used to conduct keyword analysis and a total of 47 articles were included for systematic review. Results: In keyword analysis, the number of articles focused on dementia including the keywords ?MCI,? ?SCD,? and ?dementia? were highlighted over the period, rather than other symptoms. In addition, we identified that the use of behavioral and physiological data in virtual environments (VEs) has dramatically increased in recent studies. In the systematic review, we focused on the purpose of study, assessment, treatment, and validation of usability and structure. We found that treatment studies and uncategorized studies including presence and cybersickness issues have emerged in the recent period. In addition, the target symptoms and range of participants were diversified. Conclusions: There has been a continuously increasing interest in dealing with neuropsychology by using fully immersive VR. Target cognitive abilities have been diversified, as well as target symptoms. Moreover, the concept of embodied cognition was transplanted in this research area. UR - https://games.jmir.org/2021/4/e30249 UR - http://dx.doi.org/10.2196/30249 UR - http://www.ncbi.nlm.nih.gov/pubmed/34822341 ID - info:doi/10.2196/30249 ER - TY - JOUR AU - Li, Chong AU - Song, Xinyu AU - Chen, Shugeng AU - Wang, Chuankai AU - He, Jieying AU - Zhang, Yongli AU - Xu, Shuo AU - Yan, Zhijie AU - Jia, Jie AU - Shull, Peter PY - 2021/11/23 TI - Long-term Effectiveness and Adoption of a Cellphone Augmented Reality System on Patients with Stroke: Randomized Controlled Trial JO - JMIR Serious Games SP - e30184 VL - 9 IS - 4 KW - stroke KW - augmented reality KW - serious game KW - upper limb motor function KW - cognitive function KW - home-based rehabilitation N2 - Background: A serious game?based cellphone augmented reality system (CARS) was developed for rehabilitation of stroke survivors, which is portable, convenient, and suitable for self-training. Objective: This study aims to examine the effectiveness of CARS in improving upper limb motor function and cognitive function of stroke survivors via conducting a long-term randomized controlled trial and analyze the patient?s acceptance of the proposed system. Methods: A double-blind randomized controlled trial was performed with 30 poststroke, subacute phase patients. All patients in both the experimental group (n=15) and the control group (n=15) performed a 1-hour session of therapy each day, 5 days per week for 2 weeks. Patients in the experimental group received 30 minutes of rehabilitation training with CARS and 30 minutes of conventional occupational therapy (OT) each session, while patients in the control group received conventional OT for the full 1 hour each session. The Fugl-Meyer Assessment of Upper Extremity (FMA-UE) subscale, Action Research Arm Test (ARAT), manual muscle test and Brunnstrom stage were used to assess motor function; the Mini-Mental State Examination, Add VS Sub, and Stroop Game were used to assess cognitive function; and the Barthel index was used to assess activities of daily living before and after the 2-week treatment period. In addition, the User Satisfaction Evaluation Questionnaire was used to reflect the patients? adoption of the system in the experimental group after the final intervention. Results: All the assessment scores of the experimental group and control group were significantly improved after intervention. After the intervention. The experimental group?s FMA-UE and ARAT scores increased by 11.47 and 5.86, respectively, and were both significantly higher than the increase of the control group. Similarly, the score of the Add VS Sub and Stroop Game in the experimental group increased by 7.53 and 6.83, respectively, after the intervention, which also represented a higher increase than that in the control group. The evaluation of the adoption of this system had 3 sub-dimensions. In terms of accessibility, the patients reported a mean score of 4.27 (SD 0.704) for the enjoyment of their experience with the system, a mean 4.33 (SD 0.816) for success in using the system, and a mean 4.67 (SD 0.617) for the ability to control the system. In terms of comfort, the patients reported a mean 4.40 (SD 0.737) for the clarity of information provided by the system and a mean 4.40 (SD 0.632) for comfort. In terms of acceptability, the patients reported a mean 4.27 (SD 0.884) for usefulness in their rehabilitation and a mean 4.67 (0.617) in agreeing that CARS is a suitable tool for home-based rehabilitation. Conclusions: The rehabilitation based on combined CARS and conventional OT was more effective in improving both upper limb motor function and cognitive function than was conventional OT. Due to the low cost and ease of use, CARS is also potentially suitable for home-based rehabilitation. Trial Registration: Chinese Clinical Trial Registry ChiCTR1800017568; https://tinyurl.com/xbkkyfyz UR - https://games.jmir.org/2021/4/e30184 UR - http://dx.doi.org/10.2196/30184 UR - http://www.ncbi.nlm.nih.gov/pubmed/34817390 ID - info:doi/10.2196/30184 ER - TY - JOUR AU - Cabral, F. Danylo AU - Hinchman, A. Carrie AU - Nunez, Christina AU - Rice, Jordyn AU - Loewenstein, A. David AU - Cahalin, P. Lawrence AU - Rundek, Tatjana AU - Pascual-Leone, Alvaro AU - Gomes-Osman, Joyce PY - 2021/11/23 TI - Harnessing Neuroplasticity to Promote Brain Health in Aging Adults: Protocol for the MOVE-Cog Intervention Study JO - JMIR Res Protoc SP - e33589 VL - 10 IS - 11 KW - exercise KW - neuroplasticity KW - cognition KW - brain health KW - cardiorespiratory fitness KW - cardiovascular function KW - trophic factors KW - telehealth KW - aging adult N2 - Background: Extensive evidence supports a link between aerobic exercise and cognitive improvements in aging adults. A major limitation with existing research is the high variability in cognitive response to exercise. Our incomplete understanding of the mechanisms that influence this variability and the low adherence to exercise are critical knowledge gaps and major barriers for the systematic implementation of exercise for promoting cognitive health in aging. Objective: We aimed to provide an in-person and remotely delivered intervention study protocol with the main goal of informing the knowledge gap on the mechanistic action of exercise on the brain by characterizing important mechanisms of neuroplasticity, cardiorespiratory fitness response, and genetics proposed to underlie cognitive response to exercise. Methods: This is an open-label, 2-month, interventional study protocol in neurologically healthy sedentary adults. This study was delivered fully in-person and in remote options. Participants underwent a total of 30 sessions, including the screening session, 3 pretest (baseline) assessments, 24 moderate-to-vigorous aerobic exercise sessions, and 3 posttest assessments. We recruited participants aged 55 years and above, sedentary, and cognitively healthy. Primary outcomes were neuroplasticity, cognitive function, and cardiorespiratory fitness. Secondary outcomes included genetic factors, endothelium function, functional mobility and postural control, exercise questionnaires, depression, and sleep. We also explored study feasibility, exercise adherence, technology adaptability, and compliance of both in-person and remote protocols. Results: The recruitment phase and data collection of this study have concluded. Results are expected to be published by the end of 2021 or in early 2022. Conclusions: The data generated in these studies will introduce tangible parameters to guide the development of personalized exercise prescription models for maximal cognitive benefit in aging adults. Successful completion of the specific aims will enable researchers to acquire the appropriate expertise to design and conduct studies by testing personalized exercise interventions in person and remotely delivered, likely to be more effective at promoting cognitive health in aging adults. Trial Registration: ClinicalTrials.gov NCT03804528; http://clinicaltrials.gov/ct2/show/NCT03804528 International Registered Report Identifier (IRRID): RR1-10.2196/33589 UR - https://www.researchprotocols.org/2021/11/e33589 UR - http://dx.doi.org/10.2196/33589 UR - http://www.ncbi.nlm.nih.gov/pubmed/34817393 ID - info:doi/10.2196/33589 ER - TY - JOUR AU - Zhang, Qi AU - Fu, Yu AU - Lu, Yanhui AU - Zhang, Yating AU - Huang, Qifang AU - Yang, Yajie AU - Zhang, Ke AU - Li, Mingzi PY - 2021/11/17 TI - Impact of Virtual Reality-Based Therapies on Cognition and Mental Health of Stroke Patients: Systematic Review and Meta-analysis JO - J Med Internet Res SP - e31007 VL - 23 IS - 11 KW - virtual reality KW - stroke KW - cognition KW - depression KW - mental health N2 - Background: Stroke remains one of the major chronic illnesses worldwide that health care organizations will need to address for the next several decades. Individuals poststroke are subject to levels of cognitive impairment and mental health problems. Virtual reality (VR)-based therapies are new technologies used for cognitive rehabilitation and the management of psychological outcomes. Objective: This study performed a meta-analysis to evaluate the effects of VR-based therapies on cognitive function and mental health in patients with stroke. Methods: A comprehensive database search was performed using PubMed, MEDLINE (Ovid), Embase, Cochrane Library, and APA PsycINFO databases for randomized controlled trials (RCTs) that studied the effects of VR on patients with stroke. We included trials published up to April 15, 2021, that fulfilled our inclusion and exclusion criteria. The literature was screened, data were extracted, and the methodological quality of the included trials was assessed. Meta-analysis was performed using RevMan 5.3 software. Results: A total of 894 patients from 23 RCTs were included in our meta-analysis. Compared to traditional rehabilitation therapies, the executive function (standard mean difference [SMD]=0.88, 95% confidence interval [CI]=0.06-1.70, P=.03), memory (SMD=1.44, 95% CI=0.21-2.68, P=.02), and visuospatial function (SMD=0.78, 95% CI=0.23-1.33, P=.006) significantly improved among patients after VR intervention. However, there were no significant differences observed in global cognitive function, attention, verbal fluency, depression, and the quality of life (QoL). Conclusions: The findings of our meta-analysis showed that VR-based therapies are efficacious in improving executive function, memory, and visuospatial function in patients with stroke. For global cognitive function, attention, verbal fluency, depression, and the QoL, further research is required. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021252788; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=252788 UR - https://www.jmir.org/2021/11/e31007 UR - http://dx.doi.org/10.2196/31007 UR - http://www.ncbi.nlm.nih.gov/pubmed/34787571 ID - info:doi/10.2196/31007 ER - TY - JOUR AU - Garcia-Rudolph, Alejandro AU - Opisso, Eloy AU - Tormos, M. Jose AU - Madai, Istvan Vince AU - Frey, Dietmar AU - Becerra, Helard AU - Kelleher, D. John AU - Bernabeu Guitart, Montserrat AU - López, Jaume PY - 2021/11/10 TI - Toward Personalized Web-Based Cognitive Rehabilitation for Patients With Ischemic Stroke: Elo Rating Approach JO - JMIR Med Inform SP - e28090 VL - 9 IS - 11 KW - cognitive rehabilitation KW - Elo rating KW - predictors KW - stroke rehabilitation KW - web-based tasks N2 - Background: Stroke is a worldwide cause of disability; 40% of stroke survivors sustain cognitive impairments, most of them following inpatient rehabilitation at specialized clinical centers. Web-based cognitive rehabilitation tasks are extensively used in clinical settings. The impact of task execution depends on the ratio between the skills of the treated patient and the challenges imposed by the task itself. Thus, treatment personalization requires a trade-off between patients? skills and task difficulties, which is still an open issue. In this study, we propose Elo ratings to support clinicians in tasks assignations and representing patients? skills to optimize rehabilitation outcomes. Objective: This study aims to stratify patients with ischemic stroke at an early stage of rehabilitation into three levels according to their Elo rating; to show the relationships between the Elo rating levels, task difficulty levels, and rehabilitation outcomes; and to determine if the Elo rating obtained at early stages of rehabilitation is a significant predictor of rehabilitation outcomes. Methods: The PlayerRatings R library was used to obtain the Elo rating for each patient. Working memory was assessed using the DIGITS subtest of the Barcelona test, and the Rey Auditory Verbal Memory Test (RAVLT) was used to assess verbal memory. Three subtests of RAVLT were used: RAVLT learning (RAVLT075), free-recall memory (RAVLT015), and recognition (RAVLT015R). Memory predictors were identified using forward stepwise selection to add covariates to the models, which were evaluated by assessing discrimination using the area under the receiver operating characteristic curve (AUC) for logistic regressions and adjusted R2 for linear regressions. Results: Three Elo levels (low, middle, and high) with the same number of patients (n=96) in each Elo group were obtained using the 50 initial task executions (from a total of 38,177) for N=288 adult patients consecutively admitted for inpatient rehabilitation in a clinical setting. The mid-Elo level showed the highest proportions of patients that improved in all four memory items: 56% (54/96) of them improved in DIGITS, 67% (64/96) in RAVLT075, 58% (56/96) in RAVLT015, and 53% (51/96) in RAVLT015R (P<.001). The proportions of patients from the mid-Elo level that performed tasks at difficulty levels 1, 2, and 3 were 32.1% (3997/12,449), 31.% (3997/12,449), and 36.9% (4595/12,449), respectively (P<.001), showing the highest match between skills (represented by Elo level) and task difficulties, considering the set of 38,177 task executions. Elo ratings were significant predictors in three of the four models and quasi-significant in the fourth. When predicting RAVLT075 and DIGITS at discharge, we obtained R2=0.54 and 0.43, respectively; meanwhile, we obtained AUC=0.73 (95% CI 0.64-0.82) and AUC=0.81 (95% CI 0.72-0.89) in RAVLT075 and DIGITS improvement predictions, respectively. Conclusions: Elo ratings can support clinicians in early rehabilitation stages in identifying cognitive profiles to be used for assigning task difficulty levels. UR - https://medinform.jmir.org/2021/11/e28090 UR - http://dx.doi.org/10.2196/28090 UR - http://www.ncbi.nlm.nih.gov/pubmed/34757325 ID - info:doi/10.2196/28090 ER - TY - JOUR AU - Gagnon Shaigetz, Vincent AU - Proulx, Catherine AU - Cabral, Anne AU - Choudhury, Nusrat AU - Hewko, Mark AU - Kohlenberg, Elicia AU - Segado, Melanie AU - Smith, D. Michael S. AU - Debergue, Patricia PY - 2021/11/3 TI - An Immersive and Interactive Platform for Cognitive Assessment and Rehabilitation (bWell): Design and Iterative Development Process JO - JMIR Rehabil Assist Technol SP - e26629 VL - 8 IS - 4 KW - virtual reality KW - clinical psychology KW - cognitive assessment KW - neuropsychology KW - mental health KW - cognitive rehabilitation KW - digital therapeutics KW - mobile phone KW - cognitive training N2 - Background: Immersive technologies like virtual reality can enable clinical care that meaningfully aligns with real-world deficits in cognitive functioning. However, options in immersive 3D environments are limited, partly because of the unique challenges presented by the development of a clinical care platform. These challenges include selecting clinically relevant features, enabling tasks that capture the full breadth of deficits, ensuring longevity in a rapidly changing technology landscape, and performing the extensive technical and clinical validation required for digital interventions. Complicating development, is the need to integrate recommendations from domain experts at all stages. Objective: The Cognitive Health Technologies team at the National Research Council Canada aims to overcome these challenges with an iterative process for the development of bWell, a cognitive care platform providing multisensory cognitive tasks for adoption by treatment providers. Methods: The team harnessed the affordances of immersive technologies while taking an interdisciplinary research and developmental approach, obtaining active input from domain experts with iterative deliveries of the platform. The process made use of technology readiness levels, agile software development, and human-centered design to advance four main activities: identification of basic requirements and key differentiators, prototype design and foundational research to implement components, testing and validation in lab settings, and recruitment of external clinical partners. Results: bWell was implemented according to the findings from the design process. The main features of bWell include multimodal (fully, semi, or nonimmersive) and multiplatform (extended reality, mobile, and PC) implementation, configurable exercises that pair standardized assessment with adaptive and gamified variants for therapy, a therapist-facing user interface for task administration and dosing, and automated activity data logging. bWell has been designed to serve as a broadly applicable toolkit, targeting general aspects of cognition that are commonly impacted across many disorders, rather than focusing on 1 disorder or a specific cognitive domain. It comprises 8 exercises targeting different domains: states of attention (Egg), visual working memory (Theater), relaxation (Tent), inhibition and cognitive control (Mole), multitasking (Lab), self-regulation (Butterfly), sustained attention (Stroll), and visual search (Cloud). The prototype was tested and validated with healthy adults in a laboratory environment. In addition, a cognitive care network (5 sites across Canada and 1 in Japan) was established, enabling access to domain expertise and providing iterative input throughout the development process. Conclusions: Implementing an interdisciplinary and iterative approach considering technology maturity brought important considerations for the development of bWell. Altogether, this harnesses the affordances of immersive technology and design for a broad range of applications, and for use in both cognitive assessment and rehabilitation. The technology has attained a maturity level of prototype implementation with preliminary validation carried out in laboratory settings, with next steps to perform the validation required for its eventual adoption as a clinical tool. UR - https://rehab.jmir.org/2021/4/e26629 UR - http://dx.doi.org/10.2196/26629 UR - http://www.ncbi.nlm.nih.gov/pubmed/34730536 ID - info:doi/10.2196/26629 ER - TY - JOUR AU - Goh, Lina AU - Allen, E. Natalie AU - Ahmadpour, Naseem AU - Ehgoetz Martens, A. Kaylena AU - Song, Jooeun AU - Clemson, Lindy AU - Lewis, G. Simon J. AU - MacDougall, G. Hamish AU - Canning, G. Colleen PY - 2021/11/3 TI - A Video Self-Modeling Intervention Using Virtual Reality Plus Physical Practice for Freezing of Gait in Parkinson Disease: Feasibility and Acceptability Study JO - JMIR Form Res SP - e28315 VL - 5 IS - 11 KW - Parkinson disease KW - freezing of gait KW - action observation KW - video self-modelling KW - virtual reality N2 - Background: Despite optimal medical and surgical intervention, freezing of gait commonly occurs in people with Parkinson disease. Action observation via video self-modeling, combined with physical practice, has potential as a noninvasive intervention to reduce freezing of gait. Objective: The aim of this study is to determine the feasibility and acceptability of a home-based, personalized video self-modeling intervention delivered via a virtual reality head-mounted display (HMD) to reduce freezing of gait in people with Parkinson disease. The secondary aim is to investigate the potential effect of this intervention on freezing of gait, mobility, and anxiety. Methods: The study was a single-group pre-post mixed methods pilot trial for which 10 participants with Parkinson disease and freezing of gait were recruited. A physiotherapist assessed the participants in their homes to identify person-specific triggers of freezing and developed individualized movement strategies to overcome freezing of gait. 180° videos of the participants successfully performing their movement strategies were created. Participants watched their videos using a virtual reality HMD, followed by physical practice of their strategies in their own homes over a 6-week intervention period. The primary outcome measures included the feasibility and acceptability of the intervention. Secondary outcome measures included freezing of gait physical tests and questionnaires, including the Timed Up and Go Test, 10-meter walk test, Goal Attainment Scale, and Parkinson Anxiety Scale. Results: The recruitment rate was 24% (10/42), and the retention rate was 90% (9/10). Adherence to the intervention was high, with participants completing a mean of 84% (SD 49%) for the prescribed video viewing and a mean of 100% (SD 56%) for the prescribed physical practice. One participant used the virtual reality HMD for 1 week and completed the rest of the intervention using a flat-screen device because of a gradual worsening of his motion sickness. No other adverse events occurred during the intervention or assessment. Most of the participants found using the HMD to view their videos interesting and enjoyable and would choose to use this intervention to manage their freezing of gait in the future. Five themes were constructed from the interview data: reflections when seeing myself, my experience of using the virtual reality system, the role of the virtual reality system in supporting my learning, developing a deeper understanding of how to manage my freezing of gait, and the impact of the intervention on my daily activities. Overall, there were minimal changes to the freezing of gait, mobility, or anxiety measures from baseline to postintervention, although there was substantial variability between participants. The intervention showed potential in reducing anxiety in participants with high levels of anxiety. Conclusions: Video self-modeling using an immersive virtual reality HMD plus physical practice of personalized movement strategies is a feasible and acceptable method of addressing freezing of gait in people with Parkinson disease. UR - https://formative.jmir.org/2021/11/e28315 UR - http://dx.doi.org/10.2196/28315 UR - http://www.ncbi.nlm.nih.gov/pubmed/34730537 ID - info:doi/10.2196/28315 ER - TY - JOUR AU - Bond, Jessica AU - Robotham, Dan AU - Kenny, Alexandra AU - Pinfold, Vanessa AU - Kabir, Thomas AU - Andleeb, Humma AU - Larkin, Michael AU - Martin, L. Jennifer AU - Brown, Susan AU - Bergin, D. Aislinn AU - Petit, Ariane AU - Rosebrock, Laina AU - Lambe, Sinéad AU - Freeman, Daniel AU - Waite, Felicity PY - 2021/10/25 TI - Automated Virtual Reality Cognitive Therapy for People With Psychosis: Protocol for a Qualitative Investigation Using Peer Research Methods JO - JMIR Res Protoc SP - e31742 VL - 10 IS - 10 KW - virtual reality KW - therapy KW - schizophrenia KW - agoraphobia KW - peer research KW - qualitative methods KW - implementation KW - mental health KW - psychosis KW - cognitive therapy N2 - Background: Many people with psychosis experience difficulties in everyday social situations. Anxiety can make life challenging, leading to withdrawal. Cognitive therapy, using active in vivo learning, enables people to overcome fears. These treatments are not readily available to people with psychosis. Automated virtual reality (VR) therapy is a potential route to increase accessibility. The gameChange automated VR cognitive therapy is designed to help people overcome anxious avoidance and build confidence in everyday social situations. A virtual coach guides the person through the treatment. Understanding user experience is key to facilitating future implementation. Peer research methods, in which people with lived experience of the issues being studied are involved in collecting and analyzing data, may be useful in developing this understanding. This encourages researchers to draw on their lived experience to explore participant perspectives and co-create knowledge. Objective: The primary objective is to use a peer research approach to explore the participant experience of a novel automated VR therapy for anxious social avoidance. This includes understanding (1) the experience of anxious social avoidance in people with psychosis, (2) the experience of the gameChange automated VR cognitive therapy, and (3) any potential impact of the therapy in people?s lives. This will inform future implementation strategies. The secondary objective is to explore how peer research can be used to co-create knowledge. Methods: Semistructured interviews will be conducted with approximately 25 people with psychosis participating in the gameChange trial (ISRCTN17308399). Participants will be recruited from the five trial centers based in National Health Service mental health trusts across England. Interviews will be conducted by two researchers. One is a peer researcher with similar lived experience to the trial participants. The other has lived experiences of mental health issues that do not directly overlap with those of the trial participants. Interview questions will focus on an individual?s experience of anxious social avoidance, experiences of participating in the gameChange VR therapy, and any changes or impact following therapy. The interview schedule was developed in collaboration with the gameChange Lived Experience Advisory Panel (LEAP), comprising 10 project advisors with lived experience of psychosis. Interpretative phenomenological analysis and template analysis will be used to explore individual accounts. The LEAP will contribute to the analysis. Results: Data collection will be conducted from April to September 2021, and analysis will be conducted from June to October 2021. As of September 28, 2021, 20 participants had been interviewed, and coding is underway. Conclusions: The study, employing a peer research approach, may provide a unique insight into the experiences of anxious social avoidance in people with psychosis and its treatment using automated VR therapy. This will inform potential future implementation of VR automated therapies in mental health services. International Registered Report Identifier (IRRID): DERR1-10.2196/31742 UR - https://www.researchprotocols.org/2021/10/e31742 UR - http://dx.doi.org/10.2196/31742 UR - http://www.ncbi.nlm.nih.gov/pubmed/34694236 ID - info:doi/10.2196/31742 ER - TY - JOUR AU - Kelleher, Jessica AU - Zola, Stuart AU - Cui, Xiangqin AU - Chen, Shiyu AU - Gerber, Caroline AU - Parker, Willis Monica AU - Davis, Crystal AU - Law, Sidney AU - Golden, Matthew AU - Vaughan, P. Camille PY - 2021/10/19 TI - Personalized Visual Mapping Assistive Technology to Improve Functional Ability in Persons With Dementia: Feasibility Cohort Study JO - JMIR Aging SP - e28165 VL - 4 IS - 4 KW - aging KW - ageing KW - impaired memory KW - assistive technology KW - assistive technologies KW - function KW - assistive devices KW - cognition KW - cognitive KW - activities of daily living KW - mobile technology KW - mobile technologies KW - dementia KW - Alzheimer N2 - Background: Mobile health (mHealth) apps using novel visual mapping assistive technology can allow users to develop personalized maps that aid people living with cognitive impairment in the recall of steps needed to independently complete activities of daily living (ADLs), such as bathing, toileting, and dressing. Objective: This study aims to determine the feasibility and preliminary impact of an mHealth assistive technology app providing guidance to aid individuals living with cognitive impairment in the recall of steps to independently complete ADLs. Methods: A total of 14 Veterans (mean age 65 SD 9.5 years; 14/14, 100% male; 10/14, 71.4% Black) and 8 non-Veterans (mean age 78, SD 10.3 years; 5/8, 62.5% male; 8/8, 100% Black) were recruited and enrolled from the Department of Veterans Affairs (VA) and non-VA cognitive care clinics. A visual mapping software program, MapHabit, was used to generate a series of personalized visual map templates focused on ADLs created within the MapHabit app. The visual maps were accessed through a tablet device. A 19-item exit questionnaire was administered to the participants to assess perceived improvement in their functional ability after using the MapHabit system for 3 months. Results: A total of 13 (93%) VA clinic participants and 8 (100%) non-VA clinic participants completed the 3-month study. Baseline cognitive testing indicated impaired to significantly impaired cognitive function. After 3 months of using the MapHabit system, VA clinic participants reported perceived improvement in social engagement (P=.01) and performance of ADLs (P=.05) compared to the baseline, whereas non-VA clinic participants reported improvements in the performance of ADLs (P=.02), mood (P=.04), social engagement (P=.02), and memory (P=.02). All study participants reported they would recommend the MapHabit system to a colleague, and 85% (11/14) of VA and 100% (8/8) of non-VA clinic participants reported a willingness to participate in a future study. Conclusions: Older VA and non-VA clinic participants with cognitive impairment were willing to use an mHealth app to assist with the completion of ADLs, and they reported positive preliminary effects. A larger study is warranted to assess the efficacy in the setting of a randomized controlled trial. UR - https://aging.jmir.org/2021/4/e28165 UR - http://dx.doi.org/10.2196/28165 UR - http://www.ncbi.nlm.nih.gov/pubmed/34269690 ID - info:doi/10.2196/28165 ER - TY - JOUR AU - Reuter, Katja AU - Liu, Chang AU - Le, NamQuyen AU - Angyan, Praveen AU - Finley, M. James PY - 2021/10/13 TI - General Practice and Digital Methods to Recruit Stroke Survivors to a Clinical Mobility Study: Comparative Analysis JO - J Med Internet Res SP - e28923 VL - 23 IS - 10 KW - clinical trial KW - stroke KW - falls KW - digital media KW - social media KW - advertising KW - participant recruitment KW - Facebook KW - Google KW - clinical research KW - research methods KW - recruitment practices KW - enrollment N2 - Background: Participant recruitment remains a barrier to conducting clinical research. The disabling nature of a stroke, which often includes functional and cognitive impairments, and the acute stage of illness at which patients are appropriate for many trials make recruiting patients particularly complex and challenging. In addition, people aged 65 years and older, which includes most stroke survivors, have been identified as a group that is difficult to reach and is commonly underrepresented in health research, particularly clinical trials. Digital media may provide effective tools to support enrollment efforts of stroke survivors in clinical trials. Objective: The objective of this study was to compare the effectiveness of general practice (traditional) and digital (online) methods of recruiting stroke survivors to a clinical mobility study. Methods: Recruitment for a clinical mobility study began in July 2018. Eligible study participants included individuals 18 years and older who had a single stroke and were currently ambulatory in the community. General recruiting practice included calling individuals listed in a stroke registry, contacting local physical therapists, and placing study flyers throughout a university campus. Between May 21, 2019, and June 26, 2019, the study was also promoted digitally using the social network Facebook and the search engine marketing tool Google AdWords. The recruitment advertisements (ads) included a link to the study page to which users who clicked were referred. Primary outcomes of interest for both general practice and digital methods included recruitment speed (enrollment rate) and sample characteristics. The data were analyzed using the Lilliefors test, the Welch two-sample t test, and the Mann-Whitney test. Significance was set at P=.05. All statistical analyses were performed in MATLAB 2019b. Results: Our results indicate that digital recruitment methods can address recruitment challenges regarding stroke survivors. Digital recruitment methods allowed us to enroll study participants at a faster rate (1.8 participants/week) compared to using general practice methods (0.57 participants/week). Our findings also demonstrate that digital and general recruitment practices can achieve an equivalent level of sample representativeness. The characteristics of the enrolled stroke survivors did not differ significantly by age (P=.95) or clinical scores (P=.22; P=.82). Comparing the cost-effectiveness of Facebook and Google, we found that the use of Facebook resulted in a lower cost per click and cost per enrollee per ad. Conclusions: Digital recruitment can be used to expedite participant recruitment of stroke survivors compared to more traditional recruitment practices, while also achieving equivalent sample representativeness. Both general practice and digital recruitment methods will be important to the successful recruitment of stroke survivors. Future studies could focus on testing the effectiveness of additional general practice and digital media approaches and include robust cost-effectiveness analyses. Examining the effectiveness of different messaging and visual approaches tailored to culturally diverse and underrepresented target subgroups could provide further data to move toward evidence-based recruitment strategies. UR - https://www.jmir.org/2021/10/e28923 UR - http://dx.doi.org/10.2196/28923 UR - http://www.ncbi.nlm.nih.gov/pubmed/34643544 ID - info:doi/10.2196/28923 ER - TY - JOUR AU - Zhang, Bo AU - Robb, Nigel PY - 2021/10/12 TI - Immersion Experiences in a Tablet-Based Markerless Augmented Reality Working Memory Game: Randomized Controlled Trial and User Experience Study JO - JMIR Serious Games SP - e27036 VL - 9 IS - 4 KW - augmented reality KW - markerless augmented reality KW - immersion experience KW - cognitive training games KW - working memory KW - markerless augmented reality n-back game N2 - Background: In recent years, augmented reality (AR), especially markerless augmented reality (MAR), has been used more prevalently to create training games in an attempt to improve humans' cognitive functions. This has been driven by studies claiming that MAR provides users with more immersive experiences that are situated in the real world. Currently, no studies have scientifically investigated the immersion experience of users in a MAR cognitive training game. Moreover, there is an observed lack of instruments on measuring immersion in MAR cognitive training games. Objective: This study, using two existing immersion questionnaires, investigates students? immersion experiences in a novel MAR n-back game. Methods: The n-back task is a continuous performance task that taps working memory (WM) capacity. We compared two versions of n-back training. One was presented in a traditional 2D format, while the second version used MAR. There were 2 experiments conducted in this study that coordinated with 2 types of immersion questionnaires: the modified Immersive Experiences Questionnaire (IEQ) and the Augmented Reality Immersion (ARI) questionnaire. Two groups of students from two universities in China joined the study, with 60 participants for the first experiment (a randomized controlled experiment) and 51 participants for the second. Results: Both groups of students experienced immersion in the MAR n-back game. However, the MAR n-back training group did not experience stronger immersion than the traditional (2D) n-back control group in the first experiment. The results of the second experiment showed that males felt deeply involved with the AR environment, which resulted in obtaining higher levels of immersion than females in the MAR n-back game. Conclusions: Both groups of students experienced immersion in the MAR n-back game. Moreover, both the modified IEQ and ARI have the potential to be used as instruments to measure immersion in MAR game settings. Trial Registration: UMIN Clinical Trials Registry UMIN000045314; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000051725 UR - https://games.jmir.org/2021/4/e27036 UR - http://dx.doi.org/10.2196/27036 UR - http://www.ncbi.nlm.nih.gov/pubmed/34636738 ID - info:doi/10.2196/27036 ER - TY - JOUR AU - McLaren, Ruth AU - Smith, F. Paul AU - Lord, Sue AU - Kaur, Kamal Preet AU - Zheng, Yiwen AU - Taylor, Denise PY - 2021/10/5 TI - Noisy Galvanic Vestibular Stimulation Combined With a Multisensory Balance Program?in Older Adults With Moderate to High Fall Risk: Protocol for a Feasibility Study for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e32085 VL - 10 IS - 10 KW - older adult KW - balance KW - rehabilitation KW - noisy galvanic vestibular stimulation KW - nGVS KW - brain stimulation N2 - Background: Reduced mobility and falls are common among older adults. Balance retraining programs are effective in reducing falls and in improving balance and mobility. Noisy galvanic vestibular stimulation is a low-level electrical stimulation used to reduce the threshold for the firing of vestibular neurons via a mechanism of stochastic resonance. Objective: This study aims to determine the feasibility of using noisy galvanic vestibular stimulation to augment a balance training program for older adults at risk of falls. We hypothesize that noisy galvanic vestibular stimulation will enhance the effects of balance retraining in older adults at risk of falls Methods: In this 3-armed randomized controlled trial, community dwelling older adults at risk of falling will be randomly assigned to a noisy galvanic vestibular stimulation plus balance program (noisy galvanic vestibular stimulation group), sham plus balance program (sham group), or a no treatment group (control). Participants will attend the exercise group twice a week for 8 weeks with assessment of balance and gait pretreatment, posttreatment, and at 3 months postintervention. Primary outcome measures include postural sway, measured by center of pressure velocity, area and root mean square, and gait parameters such as speed, step width, step variability, and double support time. Spatial memory will also be measured using the triangle completion task and the 4 Mountains Test. Results: Recruitment began in November 2020. Data collection and analysis are expected to be completed by December 2022. Conclusions: This study will evaluate the feasibility of using noisy galvanic vestibular stimulation alongside balance retraining in older adults at risk of falls and will inform the design of a fully powered randomized controlled trial. Trial Registration: New Zealand Clinical Trials Registry (ACTRN12620001172998); https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379944 International Registered Report Identifier (IRRID): DERR1-10.2196/32085 UR - https://www.researchprotocols.org/2021/10/e32085 UR - http://dx.doi.org/10.2196/32085 UR - http://www.ncbi.nlm.nih.gov/pubmed/34609323 ID - info:doi/10.2196/32085 ER - TY - JOUR AU - Allegue, Rakia Dorra AU - Kairy, Dahlia AU - Higgins, Johanne AU - Archambault, S. Philippe AU - Michaud, Francois AU - Miller, C. William AU - Sweet, N. Shane AU - Tousignant, Michel PY - 2021/8/31 TI - A Personalized Home-Based Rehabilitation Program Using Exergames Combined With a Telerehabilitation App in a Chronic Stroke Survivor: Mixed Methods Case Study JO - JMIR Serious Games SP - e26153 VL - 9 IS - 3 KW - stroke KW - rehabilitation KW - virtual reality KW - video games KW - telerehabilitation KW - upper extremity KW - motivation N2 - Background: In Canada, only 11% of stroke survivors have access to outpatient and community-based rehabilitation after discharge from inpatient rehabilitation. Hence, innovative community-based strategies are needed to provide adequate postrehabilitation services. The VirTele program, which combines virtual reality exergames and a telerehabilitation app, was developed to provide stroke survivors with residual upper extremity deficits, the opportunity to participate in a personalized home rehabilitation program. Objective: This study aims to determine the feasibility of VirTele for remote upper extremity rehabilitation in a chronic stroke survivor; explore the preliminary efficacy of VirTele on upper extremity motor function, the amount and quality of upper extremity use, and impact on quality of life and motivation; and explore the determinants of behavioral intention and use behavior of VirTele along with indicators of empowerment. Methods: A 63-year-old male stroke survivor (3 years) with moderate upper extremity impairment participated in a 2-month VirTele intervention. He was instructed to use exergames (5 games for upper extremity) for 30 minutes, 5 times per week, and conduct videoconference sessions with a clinician at least once per week. Motivational interviewing was incorporated into VirTele to empower the participant to continue exercising and use his upper extremities in everyday activities. Upper extremity motor function (Fugl-Meyer Assessment?upper extremity), amount and quality of upper extremity use (Motor Activity Log-30), and impact on quality of life (Stroke Impact Scale-16) and motivation (Treatment Self-Regulation Questionnaire-15) were measured before (T1), after (T2) VirTele intervention, and during a 1- (T3) and 2-month (T4) follow-up period. Qualitative data were collected through logs and semistructured interviews. Feasibility data (eg, number and duration of videoconference sessions and adherence) were documented at the end of each week. Results: The participant completed 48 exergame sessions (33 hours) and 8 videoconference sessions. Results suggest that the VirTele intervention and the study protocol could be feasible for stroke survivors. The participant exhibited clinically meaningful improvements at T2 on the Fugl-Meyer and Stroke Impact Scale-16 and maintained these gains at T3 and T4. During the follow-up periods, the amount and quality of upper extremity use showed meaningful changes, suggesting more involvement of the affected upper extremity in daily activities. The participant demonstrated a high level of autonomous motivation, which may explain his adherence. Performance, effort, and social influence have meaningful weights in the behavioral intention of using VirTele. However, the lack of control of technical and organizational infrastructures may influence the long-term use of technology. At the end of the intervention, the participant demonstrated considerable empowerment at both the behavioral and capacity levels. Conclusions: VirTele was shown to be feasible for use in chronic stroke survivors for remote upper extremity rehabilitation. Meaningful determinants of behavioral intention and use behavior of VirTele were identified, and preliminary efficacy results are promising. International Registered Report Identifier (IRRID): RR2-10.2196/14629 UR - https://games.jmir.org/2021/3/e26153 UR - http://dx.doi.org/10.2196/26153 UR - http://www.ncbi.nlm.nih.gov/pubmed/34132649 ID - info:doi/10.2196/26153 ER - TY - JOUR AU - Morrow, L. Emily AU - Zhao, Fangyun AU - Turkstra, Lyn AU - Toma, Catalina AU - Mutlu, Bilge AU - Duff, C. Melissa PY - 2021/8/27 TI - Computer-Mediated Communication in Adults With and Without Moderate-to-Severe Traumatic Brain Injury: Survey of Social Media Use JO - JMIR Rehabil Assist Technol SP - e26586 VL - 8 IS - 3 KW - traumatic brain injury KW - social media KW - disability KW - rehabilitation KW - cognitive communication N2 - Background: Individuals with a history of traumatic brain injury (TBI) report fewer social contacts, less social participation, and more social isolation than noninjured peers. Cognitive-communication disabilities may prevent individuals with TBI from accessing the opportunities for social connection afforded by computer-mediated communication, as individuals with TBI report lower overall usage of social media than noninjured peers and substantial challenges with accessibility and usability. Although adaptations for individuals with motor and sensory impairments exist to support social media use, there have been no parallel advances to support individuals with cognitive disabilities, such as those exhibited by some people with TBI. In this study, we take a preliminary step in the development process by learning more about patterns of social media use in individuals with TBI as well as their input and priorities for developing social media adaptations. Objective: This study aims to characterize how and why adults with TBI use social media and computer-mediated communication platforms, to evaluate changes in computer-mediated communication after brain injury, and to elicit suggestions from individuals with TBI to improve access to social media after injury. Methods: We conducted a web-based survey of 53 individuals with a chronic history of moderate-to-severe TBI and a demographically matched group of 51 noninjured comparison peers. Results: More than 90% of participants in both groups had an account on at least one computer-mediated communication platform, with Facebook and Facebook Messenger being the most popular platforms in both groups. Participants with and without a history of TBI reported that they use Facebook more passively than actively and reported that they most frequently maintain web-based relationships with close friends and family members. However, participants with TBI reported less frequently than noninjured comparison participants that they use synchronous videoconferencing platforms, are connected with acquaintances on the web, or use social media as a gateway for offline social connection (eg, to find events). Of the participants with TBI, 23% (12/53) reported a change in their patterns of social media use caused by brain injury and listed concerns about accessibility, safety, and usability as major barriers. Conclusions: Although individuals with TBI maintain social media accounts to the same extent as healthy comparisons, some may not use them in a way that promotes social connection. Thus, it is important to design social media adaptations that address the needs and priorities of individuals with TBI, so they can also reap the benefits of social connectedness offered by these platforms. By considering computer-mediated communication as part of individuals? broader social health, we may be able to increase web-based participation in a way that is meaningful, positive, and beneficial to broader social life. UR - https://rehab.jmir.org/2021/3/e26586 UR - http://dx.doi.org/10.2196/26586 UR - http://www.ncbi.nlm.nih.gov/pubmed/34448727 ID - info:doi/10.2196/26586 ER - TY - JOUR AU - Wiley, Katelyn AU - Robinson, Raquel AU - Mandryk, L. Regan PY - 2021/8/9 TI - The Making and Evaluation of Digital Games Used for the Assessment of Attention: Systematic Review JO - JMIR Serious Games SP - e26449 VL - 9 IS - 3 KW - cognitive assessment KW - attention KW - serious games KW - gamification KW - systematic review KW - mobile phone N2 - Background: Serious games are now widely used in many contexts, including psychological research and clinical use. One area of growing interest is that of cognitive assessment, which seeks to measure different cognitive functions such as memory, attention, and perception. Measuring these functions at both the population and individual levels can inform research and indicate health issues. Attention is an important function to assess, as an accurate measure of attention can help diagnose many common disorders, such as attention-deficit/hyperactivity disorder and dementia. However, using games to assess attention poses unique problems, as games inherently manipulate attention through elements such as sound effects, graphics, and rewards, and research on adding game elements to assessments (ie, gamification) has shown mixed results. The process for developing cognitive tasks is robust, with high psychometric standards that must be met before these tasks are used for assessment. Although games offer more diverse approaches for assessment, there is no standard for how they should be developed or evaluated. Objective: To better understand the field and provide guidance to interdisciplinary researchers, we aim to answer the question: How are digital games used for the cognitive assessment of attention made and measured? Methods: We searched several databases for papers that described a digital game used to assess attention that could be deployed remotely without specialized hardware. We used Rayyan, a systematic review software, to screen the records before conducting a systematic review. Results: The initial database search returned 49,365 papers. Our screening process resulted in a total of 74 papers that used a digital game to measure cognitive functions related to attention. Across the studies in our review, we found three approaches to making assessment games: gamifying cognitive tasks, creating custom games based on theories of cognition, and exploring potential assessment properties of commercial games. With regard to measuring the assessment properties of these games (eg, how accurately they assess attention), we found three approaches: comparison to a traditional cognitive task, comparison to a clinical diagnosis, and comparison to knowledge of cognition; however, most studies in our review did not evaluate the game?s properties (eg, if participants enjoyed the game). Conclusions: Our review provides an overview of how games used for the assessment of attention are developed and evaluated. We further identified three barriers to advancing the field: reliance on assumptions, lack of evaluation, and lack of integration and standardization. We then recommend the best practices to address these barriers. Our review can act as a resource to help guide the field toward more standardized approaches and rigorous evaluation required for the widespread adoption of assessment games. UR - https://games.jmir.org/2021/3/e26449 UR - http://dx.doi.org/10.2196/26449 UR - http://www.ncbi.nlm.nih.gov/pubmed/34383674 ID - info:doi/10.2196/26449 ER - TY - JOUR AU - Moussavi, Zahra AU - Koski, Lisa AU - Fitzgerald, B. Paul AU - Millikin, Colleen AU - Lithgow, Brian AU - Jafari-Jozani, Mohammad AU - Wang, Xikui PY - 2021/8/9 TI - Repeated Transcranial Magnetic Stimulation for Improving Cognition in Alzheimer Disease: Protocol for an Interim Analysis of a Randomized Controlled Trial JO - JMIR Res Protoc SP - e31183 VL - 10 IS - 8 KW - interim analysis, treatment efficacy, repetitive transcranial magnetic stimulation KW - Alzheimer disease KW - double blind KW - treatment KW - placebo controlled KW - randomized N2 - Background: Many clinical trials investigating treatment efficacy require an interim analysis. Recently we have been running a large, multisite, randomized, placebo-controlled, double-blind clinical trial investigating the effect of repetitive transcranial magnetic stimulation (rTMS) treatment for improving or stabilizing the cognition of patients diagnosed with Alzheimer disease. Objective: The objectives of this paper are to report on recruitment, adherence, and adverse events (AEs) to date, and to describe in detail the protocol for interim analysis of the clinical trial data. The protocol will investigate whether the trial is likely to reach its objectives if continued to the planned maximum sample size. Methods: The specific requirements of the analytic protocol are to (1) ensure the double-blind nature of the data while doing the analysis, (2) estimate the predictive probabilities of success (PPoSs), (3) estimate the numbers needed to treat, (4) re-estimate the initial required sample size. The initial estimate of sample size was 208. The interim analysis will be based on 150 patients who will be enrolled in the study and finish at least 8 weeks of the study. Our protocol for interim analysis, at the very first stage, is to determine the response rate for each participant to the treatment (either sham or active), while ensuring the double-blind nature of the data. The blinded data will be analyzed by a statistician to investigate the treatment efficacy. We will use Bayesian PPoS to predict the success rate and determine whether the study should continue. Results: The enrollment has been slowed significantly due to the COVID-19 pandemic and lockdown. Nevertheless, so far 133 participants have been enrolled, while 22 of these have been withdrawn or dropped out for various reasons. In general, rTMS has been found tolerable with no serious AE. Only 2 patients dropped out of the study due to their intolerability to rTMS pulses. Conclusions: Overall, the study with the same protocol is going as expected with no serious AE or any major protocol deviation. Trial Registration: ClinicalTrials.gov NCT02908815; https://clinicaltrials.gov/ct2/show/NCT02908815 International Registered Report Identifier (IRRID): DERR1-10.2196/31183 UR - https://www.researchprotocols.org/2021/8/e31183 UR - http://dx.doi.org/10.2196/31183 UR - http://www.ncbi.nlm.nih.gov/pubmed/34383681 ID - info:doi/10.2196/31183 ER - TY - JOUR AU - Kwan, Cho Rick Yiu AU - Liu, Wa Justina Yat AU - Fong, Kuen Kenneth Nai AU - Qin, Jing AU - Leung, Kwok-Yuen Philip AU - Sin, Kan Olive Suk AU - Hon, Yuen Pik AU - Suen, W. Lydia AU - Tse, Man-Kei AU - Lai, KY Claudia PY - 2021/8/6 TI - Feasibility and Effects of Virtual Reality Motor-Cognitive Training in Community-Dwelling Older People With Cognitive Frailty: Pilot Randomized Controlled Trial JO - JMIR Serious Games SP - e28400 VL - 9 IS - 3 KW - virtual reality KW - motor-cognitive training KW - cognitive frailty KW - game KW - feasibility KW - VR KW - training KW - older adults KW - frail KW - pilot study KW - randomized controlled trial N2 - Background: Cognitive frailty refers to the coexistence of physical frailty and cognitive impairment, and is associated with many adverse health outcomes. Although cognitive frailty is prevalent in older people, motor-cognitive training is effective at enhancing cognitive and physical function. We proposed a virtual reality (VR) simultaneous motor-cognitive training program, which allowed older people to perform daily activities in a virtual space mimicking real environments. Objective: We aimed to (1) explore the feasibility of offering VR simultaneous motor-cognitive training to older people with cognitive frailty and (2) compare its effects with an existing motor-cognitive training program in the community on the cognitive function and physical function of older people with cognitive frailty. Methods: A two-arm (1:1), assessor-blinded, parallel design, randomized controlled trial was employed. The eligibility criteria for participants were: (1) aged ?60 years, (2) community dwelling, and (3) with cognitive frailty. Those in the intervention group received cognitive training (ie, cognitive games) and motor training (ie, cycling on an ergometer) simultaneously on a VR platform, mimicking the daily living activities of older people. Those in the control group received cognitive training (ie, cognitive games) on tablet computers and motor training (ie, cycling on the ergometer) sequentially on a non-VR platform. Both groups received a 30-minute session twice a week for 8 weeks. Feasibility was measured by adherence, adverse outcomes, and successful learning. The outcomes were cognitive function, physical frailty level, and walking speed. Results: Seventeen participants were recruited and randomized to either the control group (n=8) or intervention group (n=9). At baseline, the median age was 74.0 years (IQR 9.5) and the median Montreal Cognitive Assessment score was 20.0 (IQR 4.0). No significant between-group differences were found in baseline characteristics except in the number of chronic illnesses (P=.04). At postintervention, the intervention group (Z=?2.67, P=.01) showed a significantly larger improvement in cognitive function than the control group (Z=?1.19, P=.24). The reduction in physical frailty in the intervention group (Z=?1.73, P=.08) was similar to that in the control group (Z=?1.89, P=.06). Improvement in walking speed based on the Timed Up-and-Go test was moderate in the intervention group (Z=?0.16, P=.11) and greater in the control group (Z=?2.52, P=.01). The recruitment rate was acceptable (17/33, 52%). Both groups had a 100% attendance rate. The intervention group had a higher completion rate than the control group. Training was terminated for one participant (1/9, 11%) due to minimal VR sickness (Virtual Reality Sickness Questionnaire score=18.3/100). Two participants (2/8, 25%) in the control group withdrew due to moderate leg pain. No injuries were observed in either group. Conclusions: This study provides preliminary evidence that the VR simultaneous motor-cognitive training is effective at enhancing the cognitive function of older people with cognitive frailty. The effect size on frailty was close to reaching a level of significance and was similar to that observed in the control group. VR training is feasible and safe for older people with cognitive frailty. Trial Registration: ClinicalTrials.gov NCT04467216; https://clinicaltrials.gov/ct2/show/NCT04467216 UR - https://games.jmir.org/2021/3/e28400 UR - http://dx.doi.org/10.2196/28400 UR - http://www.ncbi.nlm.nih.gov/pubmed/34383662 ID - info:doi/10.2196/28400 ER - TY - JOUR AU - Brassel, Sophie AU - Power, Emma AU - Campbell, Andrew AU - Brunner, Melissa AU - Togher, Leanne PY - 2021/7/30 TI - Recommendations for the Design and Implementation of Virtual Reality for Acquired Brain Injury Rehabilitation: Systematic Review JO - J Med Internet Res SP - e26344 VL - 23 IS - 7 KW - virtual reality KW - acquired brain injury KW - traumatic brain injury KW - rehabilitation KW - systematic review KW - recommendations KW - cognitive communication KW - mobile phone N2 - Background: Virtual reality (VR) is increasingly being used for the assessment and treatment of impairments arising from acquired brain injuries (ABIs) due to perceived benefits over traditional methods. However, no tailored options exist for the design and implementation of VR for ABI rehabilitation and, more specifically, traumatic brain injury (TBI) rehabilitation. In addition, the evidence base lacks systematic reviews of immersive VR use for TBI rehabilitation. Recommendations for this population are important because of the many complex and diverse impairments that individuals can experience. Objective: This study aims to conduct a two-part systematic review to identify and synthesize existing recommendations for designing and implementing therapeutic VR for ABI rehabilitation, including TBI, and to identify current evidence for using immersive VR for TBI assessment and treatment and to map the degree to which this literature includes recommendations for VR design and implementation. Methods: This review was guided by PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). A comprehensive search of 11 databases and gray literature was conducted in August 2019 and repeated in June 2020. Studies were included if they met relevant search terms, were peer-reviewed, were written in English, and were published between 2009 and 2020. Studies were reviewed to determine the level of evidence and methodological quality. For the first part, qualitative data were synthesized and categorized via meta-synthesis. For the second part, findings were analyzed and synthesized descriptively owing to the heterogeneity of data extracted from the included studies. Results: In the first part, a total of 14 papers met the inclusion criteria. Recommendations for VR design and implementation were not specific to TBI but rather to stroke or ABI rehabilitation more broadly. The synthesis and analysis of data resulted in three key phases and nine categories of recommendations for designing and implementing VR for ABI rehabilitation. In the second part, 5 studies met the inclusion criteria. A total of 2 studies reported on VR for assessment and three for treatment. Studies were varied in terms of therapeutic targets, VR tasks, and outcome measures. VR was used to assess or treat impairments in cognition, balance, and anxiety, with positive outcomes. However, the levels of evidence, methodological quality, and inclusion of recommendations for VR design and implementation were poor. Conclusions: There is limited research on the use of immersive VR for TBI rehabilitation. Few studies have been conducted, and there is limited inclusion of recommendations for therapeutic VR design and implementation. Future research in ABI rehabilitation should consider a stepwise approach to VR development, from early co-design studies with end users to larger controlled trials. A list of recommendations is offered to provide guidance and a more consistent model to advance clinical research in this area. UR - https://www.jmir.org/2021/7/e26344 UR - http://dx.doi.org/10.2196/26344 UR - http://www.ncbi.nlm.nih.gov/pubmed/34328434 ID - info:doi/10.2196/26344 ER - TY - JOUR AU - Fahr, Annina AU - Kläy, Andrina AU - Keller, W. Jeffrey AU - van Hedel, A. Hubertus J. PY - 2021/7/28 TI - An Interactive Computer Game for Improving Selective Voluntary Motor Control in Children With Upper Motor Neuron Lesions: Development and Preliminary Feasibility Study JO - JMIR Serious Games SP - e26028 VL - 9 IS - 3 KW - virtual reality KW - game therapy KW - rehabilitation KW - augmented feedback KW - motivation KW - mobile phone N2 - Background: Computer game?based interventions are emerging in pediatric neurorehabilitation, as they can provide two key elements for motor learning?motivating environments that enable long-term compliance, which is particularly relevant for children, and augmented feedback for improving movement performance. Objective: The overall aim of this study is to develop an interactive computer play for children with upper motor neuron lesions to train selective voluntary motor control and give particular attention to motivation and feedback. We also aim to determine features that make games engaging, investigate which sensory feedback modality is noticed the fastest during play, develop an interactive game, and evaluate its feasibility. Methods: We identified engaging game features by interviewing 19 children and adolescents undergoing rehabilitation. By using a test version of the game, we determined the response times of 10 patients who had to react to visual, auditory, or combined feedback signals. On the basis of the results of these two subprojects, we developed and designed a game environment. Feasibility was studied in terms of the practicability and acceptability of the intervention among 5 children with upper motor neuron lesions. Results: The game features deemed the most important by pediatric patients were strategic gameplay (13/29, 45% of answers) and choice (6/29, 21%). While playing the game, an acoustic alarm signal (reaction time: median 2.8 seconds) was detected significantly faster (P=.01) than conditions with other feedback modalities (avatar velocity reduction: median 7.8 seconds; color desaturation: median 5.7 seconds). Most children enjoyed playing the game, despite some technical issues. Conclusions: The careful identification of game features that increase motivation and feedback modalities that inform children quickly led to the development of an interactive computer play for training selective voluntary motor control in children and adolescents with upper motor neuron lesions. UR - https://games.jmir.org/2021/3/e26028 UR - http://dx.doi.org/10.2196/26028 UR - http://www.ncbi.nlm.nih.gov/pubmed/34319236 ID - info:doi/10.2196/26028 ER - TY - JOUR AU - Boughen, Keaton AU - Neil, Tyler AU - Dullemond, Shayan AU - Lutowicz, Kevin AU - Bilgasem, Ahmed AU - Hastings, Tyler AU - Brooks, Dina AU - Vaughan-Graham, Julie PY - 2021/7/28 TI - Cranial Nerve Noninvasive Neuromodulation in Adults With Neurological Conditions: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e29965 VL - 10 IS - 7 KW - cranial nerve KW - neurological conditions KW - neurology KW - neuromodulation KW - neurorehabilitation KW - physical therapy KW - portable neuromodulation stimulation device KW - rehabilitation KW - scoping review KW - translingual neurostimulation N2 - Background: Cranial nerve noninvasive neuromodulation (CN-NINM) via translingual nerve stimulation (TLNS) is a promising new intervention combined with neurological rehabilitation to improve outcomes for persons with neurological conditions. A portable neuromodulation stimulation (PoNS) device rests on the tongue and stimulates cranial nerves V and VII (trigeminal and facial nerves, respectively). Emerging evidence suggests that CN-NINM using the PoNS device, combined with targeted physical therapy, improves balance and gait outcomes but has not yet been comprehensively reviewed. Objective: This review will describe CN-NINM via TLNS and its applications, effects, and implications for rehabilitation science in adult populations with neurological conditions. We will identify how CN-NINM via TLNS is currently being incorporated into neurological rehabilitation and identify gaps in evidence with respect to this novel technology. Methods: Joanna Briggs Institute methodology will be used to conduct this scoping review. Electronic databases MEDLINE, AMED, CINAHL, Embase, and Web of Science will be searched, as well as gray literature databases ProQuest, DuckDuckGo, and Google. Studies published in English and French between 2000 and 2021 will be included. Two reviewers will independently screen all titles and abstracts and full-text papers that meet the inclusion criteria. Data will be extracted and collated in a table to synthesize the results. Extracted data will be reported in a comprehensive summary. Results: The final manuscript is intended for submission to an indexed journal in September 2021. Conclusions: This scoping review will be the first, to our knowledge, to address the current evidence on CN-NINM. The results will inform the use of CN-NINM in neurological rehabilitation and the development of recommendations for future research. Trial Registration: Open Science Framework 10.17605/OSF.IO/XZQFM; https://osf.io/xzqfm International Registered Report Identifier (IRRID): PRR1-10.2196/29965 UR - https://www.researchprotocols.org/2021/7/e29965 UR - http://dx.doi.org/10.2196/29965 UR - http://www.ncbi.nlm.nih.gov/pubmed/34319251 ID - info:doi/10.2196/29965 ER - TY - JOUR AU - Brehon, Katelyn AU - Carriere, Jay AU - Churchill, Katie AU - Loyola-Sanchez, Adalberto AU - O'Connell, Petra AU - Papathanassoglou, Elisavet AU - MacIsaac, Rob AU - Tavakoli, Mahdi AU - Ho, Chester AU - Pohar Manhas, Kiran PY - 2021/7/23 TI - Evaluating Community-Facing Virtual Modalities to Support Complex Neurological Populations During the COVID-19 Pandemic: Protocol for a Mixed Methods Study JO - JMIR Res Protoc SP - e28267 VL - 10 IS - 7 KW - telehealth KW - evaluation KW - rehabilitation KW - musculoskeletal KW - neurological KW - COVID-19 KW - spinal cord injury KW - advice line KW - webinar KW - artificial intelligence KW - machine learning KW - community engagement N2 - Background: The COVID-19 pandemic and concomitant governmental responses have created the need for innovative and collaborative approaches to deliver services, especially for populations that have been inequitably affected. In Alberta, Canada, two novel approaches were created in Spring 2020 to remotely support patients with complex neurological conditions and rehabilitation needs. The first approach is a telehealth service that provides wayfinding and self-management advice to Albertans with physical concerns related to existing neurological or musculoskeletal conditions or post-COVID-19 recovery needs. The second approach is a webinar series aimed at supporting self-management and social connectedness of individuals living with spinal cord injury. Objective: The study aims to evaluate the short- and long-term impacts and sustainability of two virtual modalities (telehealth initiative called Rehabilitation Advice Line [RAL] and webinar series called Alberta Spinal Cord Injury Community Interactive Learning Seminars [AB-SCILS]) aimed at advancing self-management, connectedness, and rehabilitation needs during the COVID-19 pandemic and beyond. Methods: We will use a mixed-methods evaluation approach. Evaluation of the approaches will include one-on-one semistructured interviews and surveys. The evaluation of the telehealth initiative will include secondary data analyses and analysis of call data using artificial intelligence. The evaluation of the webinar series will include analysis of poll questions collected during the webinars and YouTube analytics data. Results: The proposed study describes unique pandemic virtual modalities and our approaches to evaluating them to ensure effectiveness and sustainability. Implementing and evaluating these virtual modalities synchronously allows for the building of knowledge on the complementarity of these methods. At the time of submission, we have completed qualitative and quantitative data collection for the telehealth evaluation. For the webinar series, so far, we have distributed the evaluation survey following three webinars and have conducted five attendee interviews. Conclusions: Understanding the impact and sustainability of the proposed telehealth modalities is important. The results of the evaluation will provide data that can be actioned and serve to improve other telehealth modalities in the future, since health systems need this information to make decisions on resource allocation, especially in an uncertain pandemic climate. Evaluating the RAL and AB-SCILS to ensure their effectiveness demonstrates that Alberta Health Services and the health system care about ensuring the best practice even after a shift to primarily virtual care. International Registered Report Identifier (IRRID): DERR1-10.2196/28267 UR - https://www.researchprotocols.org/2021/7/e28267 UR - http://dx.doi.org/10.2196/28267 UR - http://www.ncbi.nlm.nih.gov/pubmed/34101610 ID - info:doi/10.2196/28267 ER - TY - JOUR AU - Prior, Katrina AU - Salemink, Elske AU - Wiers, W. Reinout AU - Teachman, A. Bethany AU - Piggott, Monique AU - Newton, C. Nicola AU - Teesson, Maree AU - Baillie, J. Andrew AU - Manning, Victoria AU - McLellan, F. Lauren AU - Mahoney, Alison AU - Stapinski, A. Lexine PY - 2021/7/7 TI - A Web-Based Cognitive Bias Modification Intervention (Re-train Your Brain) for Emerging Adults With Co-occurring Social Anxiety and Hazardous Alcohol Use: Protocol for a Multiarm Randomized Controlled Pilot Trial JO - JMIR Res Protoc SP - e28667 VL - 10 IS - 7 KW - alcohol KW - anxiety KW - cognitive bias modification KW - interpretation bias KW - approach bias KW - emerging adults N2 - Background: Alcohol use and anxiety disorders commonly co-occur, resulting in a more severe clinical presentation and poorer response to treatment. Research has shown that approach bias modification (ApBM) and interpretation bias modification (IBM) cognitive retraining interventions can be efficacious adjunctive treatments that improve outcomes for alcohol use and social anxiety, respectively. However, the acceptability, feasibility, and clinical utility of combining ApBM and IBM programs to optimize treatments among comorbid samples are unknown. It is also unclear whether integrating ApBM and IBM within each training session or alternating them between each session is more acceptable and efficacious. Objective: This paper describes the protocol for a randomized controlled pilot trial investigating the feasibility, acceptability, and preliminary efficacy of the Re-train Your Brain intervention?an adjunct web-based ApBM+IBM program?among a clinical sample of emerging adults with hazardous alcohol use and social anxiety. Methods: The study involves a three-arm randomized controlled pilot trial in which treatment-seeking emerging adults (18-30 years) with co-occurring hazardous alcohol use and social anxiety will be individually randomized to receive the Re-train Your Brain integrated program, delivered with 10 biweekly sessions focusing on both social anxiety and alcohol each week, plus treatment as usual (TAU; ie, the model of care provided in accordance with standard practice at their service; n=30); the Re-train Your Brain alternating program, delivered with 10 biweekly sessions focusing on social anxiety one week and alcohol the next week, plus TAU (n=30); or TAU only (n=30). Primary outcomes include feasibility (uptake, follow-up rates, treatment adherence, attrition, and adverse events) and acceptability (system usability, client satisfaction, user experience, and training format preference). Secondary efficacy outcomes include changes in alcohol approach and interpretation biases, social anxiety, and alcohol use (eg, drinks per day, binge drinking, drinking motives, severity of dependence, and cravings). The primary end point will be posttreatment (6 weeks postbaseline), with a secondary end point at 3 months postbaseline. Descriptive statistics will be conducted for primary outcomes, whereas intention-to-treat, multilevel mixed effects analysis for repeated measures will be performed for secondary outcomes. Results: This study is funded from 2019 to 2023 by Australian Rotary Health. Recruitment is expected to be completed by mid-2022 to late 2022, with follow-ups completed by early 2023. Conclusions: This study will be the first to evaluate whether an ApBM+IBM program is acceptable to treatment-seeking, emerging adults and whether it can be feasibly delivered via the web, in settings where it will ultimately be used (eg, at home). The findings will broaden our understanding of the types of programs that emerging adults will engage with and whether the program may be an efficacious treatment option for this comorbidity. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620001273976; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364131 International Registered Report Identifier (IRRID): PRR1-10.2196/28667 UR - https://www.researchprotocols.org/2021/7/e28667 UR - http://dx.doi.org/10.2196/28667 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255726 ID - info:doi/10.2196/28667 ER - TY - JOUR AU - Kim, S. Esther AU - Laird, Laura AU - Wilson, Carlee AU - Bieg, Till AU - Mildner, Philip AU - Möller, Sebastian AU - Schatz, Raimund AU - Schwarz, Stephanie AU - Spang, Robert AU - Voigt-Antons, Jan-Niklas AU - Rochon, Elizabeth PY - 2021/7/2 TI - Implementation and Effects of an Information Technology?Based Intervention to Support Speech and Language Therapy Among Stroke Patients With Aphasia: Protocol for a Virtual Randomized Controlled Trial JO - JMIR Res Protoc SP - e30621 VL - 10 IS - 7 KW - aphasia KW - rehabilitation KW - speech-language pathology KW - app-based therapy KW - user-centered design KW - mHealth KW - adaptive software N2 - Background: Mobile app?based therapies are increasingly being employed by speech-language pathologists in the rehabilitation of people with aphasia as adjuncts or substitutes for traditional in-person therapy approaches. These apps can increase the intensity of treatment and have resulted in meaningful outcomes across several domains. Objective: VoiceAdapt is a mobile therapy app designed with user and stakeholder feedback within a user-centered design framework. VoiceAdapt uses two evidence-based lexical retrieval treatments to help people with aphasia in improving their naming abilities through interactions with the app. The purpose of the randomized controlled trial (RCT) proposed here is to examine the feasibility and clinical efficacy of training with VoiceAdapt on the language and communication outcomes of people with aphasia. Methods: A multicenter RCT is being conducted at two locations within Canada. A total of 80 people with aphasia will be recruited to participate in a two-arm, waitlist-controlled, crossover group RCT. After baseline assessment, participants will be randomized into an intervention group or a waitlist control group. The intervention group participants will engage in 5 weeks of training with the app, followed by posttreatment and follow-up assessments after an additional 5 weeks. Those in the waitlist control group will have no training for 5 weeks; this is followed by pretreatment assessment, training for 5 weeks, and posttreatment assessment. All trial procedures are being conducted remotely given the COVID-19 pandemic. Results: Recruitment of participants started in September 2020, and the study is expected to be completed by March 2022. Publication of results is expected within 6 months of study completion. Conclusions: The results of the RCT will provide information on evidence-based practice using technology-based solutions to treat aphasia. If positive results are obtained from this RCT, the VoiceAdapt app can be recommended as an efficacious means of improving lexical retrieval and communicative functioning in people with aphasia in an easily accessible and a cost-effective manner. Moreover, the implementation of this RCT through remote assessment and delivery can provide information to therapists on telerehabilitation practices and monitoring of app-based home therapy programs. Trial Registration: ClinicalTrials.gov NCT04108364; https://clinicaltrials.gov/ct2/show/NCT04108364 International Registered Report Identifier (IRRID): DERR1-10.2196/30621 UR - https://www.researchprotocols.org/2021/7/e30621 UR - http://dx.doi.org/10.2196/30621 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255727 ID - info:doi/10.2196/30621 ER - TY - JOUR AU - Louw, Gidion Jacobus AU - van Heerden, Alastair AU - Olivier, Leana AU - Lambrechts, Tersius AU - Broodryk, Mandi AU - Bunge, Liska AU - Vosloo, Martlé AU - Tomlinson, Mark PY - 2021/7/2 TI - Executive Function After Prenatal Alcohol Exposure in Children in a South African Population: Cross-sectional Study JO - JMIR Form Res SP - e20658 VL - 5 IS - 7 KW - fetal alcohol spectrum disorders KW - FASD KW - cognitive KW - executive function KW - experimental games KW - brain drug effects KW - child development KW - serious games KW - games KW - alcohol KW - training N2 - Background: Alcohol is a teratogen; its consumption during pregnancy can lead to negative birth outcomes, collectively referred to as fetal alcohol spectrum disorders. Neurodevelopmental delays in higher-order cognitive functions that affect development of executive functions are a common feature. Studies on executive function in children have focused on children diagnosed with fetal alcohol spectrum disorder, and there is a lack of information on the impact on children not diagnosed with fetal alcohol spectrum disorder but who had been exposed to alcohol. Objective: The aim of this study was to compare the development of executive function in children between 4 and 6 years of age with and without prenatal exposure to alcohol. Methods: Children both exposed and not exposed to alcohol were recruited as part of a feasibility RCT evaluating a computer-based cognitive training program for improving executive function development. The study was conducted in a low?socioeconomic status community in South Africa with a high prevalence of fetal alcohol spectrum disorder. Neurodevelopment was assessed in participating children; NEPSY-II standardized scores for executive function domains were compared using a multivariate analysis of variance with group membership as the predictor variable. Results: No significant differences in executive functions assessments (P=.39) were found between children in the alcohol-exposed group (n=76) and those in the nonexposed group (n=40). Both groups showed moderate to severe delays in domains. In all but one subtest, the average score for both groups was below the 25th percentile of expected norms. Conclusions: We expected that alcohol exposure would have a measurable impact on executive function development. The lack of differences highlights the prevalence of developmental delays in low?socioeconomic status communities in South Africa and suggests that children are exposed to various threats to cognitive development. International Registered Report Identifier (IRRID): RR2-10.2196/14489 UR - https://formative.jmir.org/2021/7/e20658 UR - http://dx.doi.org/10.2196/20658 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255647 ID - info:doi/10.2196/20658 ER - TY - JOUR AU - Rennick-Egglestone, Stefan AU - Mawson, Sue PY - 2021/6/17 TI - Homes of Stroke Survivors Are a Challenging Environment for Rehabilitation Technologies JO - JMIR Rehabil Assist Technol SP - e12029 VL - 8 IS - 2 KW - domestic rehabilitation technology KW - brain injury KW - stroke KW - research through design UR - https://rehab.jmir.org/2021/2/e12029 UR - http://dx.doi.org/10.2196/12029 UR - http://www.ncbi.nlm.nih.gov/pubmed/34137728 ID - info:doi/10.2196/12029 ER - TY - JOUR AU - Israsena, Pasin AU - Jirayucharoensak, Suwicha AU - Hemrungrojn, Solaphat AU - Pan-Ngum, Setha PY - 2021/6/15 TI - Brain Exercising Games With Consumer-Grade Single-Channel Electroencephalogram Neurofeedback: Pre-Post Intervention Study JO - JMIR Serious Games SP - e26872 VL - 9 IS - 2 KW - neurofeedback KW - serious gaming KW - serious game KW - brain exercise KW - cognition training KW - EEG KW - aging KW - cognition KW - cognitive KW - brain game N2 - Background: The aging population is one of the major challenges affecting societies worldwide. As the proportion of older people grows dramatically, so does the number of age-related illnesses such as dementia-related illnesses. Preventive care should be emphasized as an effective tool to combat and manage this situation. Objective: The aim of this pilot project was to study the benefits of using neurofeedback-based brain training games for enhancing cognitive performance in the elderly population. In particular, aiming for practicality, the training games were designed to operate with a low-cost consumer-grade single-channel electroencephalogram (EEG) headset that should make the service scalable and more accessible for wider adoption such as for home use. Methods: Our training system, which consisted of five brain exercise games using neurofeedback, was serviced at 5 hospitals in Thailand. Participants were screened for cognitive levels using the Thai Mental State Examination and Montreal Cognitive Assessment. Those who passed the criteria were further assessed with the Cambridge Neuropsychological Test Automated Battery (CANTAB) computerized cognitive assessment battery. The physiological state of the brain was also assessed using 16-channel EEG. After 20 sessions of training, cognitive performance and EEG were assessed again to compare pretraining and posttraining results. Results: Thirty-five participants completed the training. CANTAB results showed positive and significant effects in the visual memory (delayed matching to sample [percent correct] P=.04), attention (median latency P=.009), and visual recognition (spatial working memory [between errors] P=.03) domains. EEG also showed improvement in upper alpha activity in a resting state (open-eyed) measured from the occipital area (P=.04), which similarly indicated improvement in the cognitive domain (attention). Conclusions: Outcomes of this study show the potential use of practical neurofeedback-based training games for brain exercise to enhance cognitive performance in the elderly population. UR - https://games.jmir.org/2021/2/e26872 UR - http://dx.doi.org/10.2196/26872 UR - http://www.ncbi.nlm.nih.gov/pubmed/34128816 ID - info:doi/10.2196/26872 ER - TY - JOUR AU - Beresford, Thomas AU - Ronan, J. Patrick AU - Hipp, Daniel PY - 2021/6/14 TI - A 5-Minute Cognitive Assessment for Safe Remote Use in Patients With COVID-19: Clinical Case Series JO - JMIR Form Res SP - e26417 VL - 5 IS - 6 KW - cognition KW - COVID-19 KW - safety KW - remote use KW - delirium KW - brain injury, brain KW - diagnosis KW - assessment KW - test KW - telehealth KW - telemedicine N2 - Background: Early clinical experience during the COVID-19 pandemic has begun to elucidate that the disease can cause brain function changes that may result in compromised cognition both acutely and during variable recovery periods. Reports on cognitive assessment of patients with COVID-19 are often limited to orientation alone. Further assessment may seem to create an inappropriate burden for patients with acute COVID-19, which is characterized by fatigue and confusion, and may also compromise examiner safety. Objective: The aims of this study were to assess cognition in patients with COVID-19 as comprehensively as possible in a brief format, while observing safety precautions, and to establish a clear face value of the external validity of the assessment. Methods: We adapted a brief cognitive assessment, previously applied to liver transplant candidates and medical/surgical inpatients, for remote use in patients hospitalized for COVID-19 treatment. Collecting quality assurance data from telephone-administered assessments, this report presents a series of 6 COVID-19 case vignettes to illustrate the use of this 5-minute assessment in the diagnosis and treatment of brain effects. Primary medical teams referred the cases for neuropsychiatric consultation. Results: The age of the patients varied over four decades, and none of them were able to engage meaningfully with their surroundings on admission. On follow-up examination 6 to 10 days later, 4 of the 6 patients had recovered working memory, and only 1 had recovered calculation ability. Of the 6 patients, 2 were capable of complex judgment responses, while none of the cases completed frontal executive function testing in the normal range. Conclusions: Cognitive assessment in patients with COVID-19 using this remote examination reveals patterns of cognitive recovery that vary among cases and are far more complex than loss of orientation. In this series, testing of specific temporal, parietal, and frontal lobe functions suggests that calculation ability, judgment, and especially frontal executive functions may characterize the effects of COVID-19 on the brain. Used widely and serially, this examination method can potentially inform our understanding of the effects of COVID-19 on the brain and of healing from the virus. UR - https://formative.jmir.org/2021/6/e26417 UR - http://dx.doi.org/10.2196/26417 UR - http://www.ncbi.nlm.nih.gov/pubmed/34010137 ID - info:doi/10.2196/26417 ER - TY - JOUR AU - Wang, Gubing AU - Albayrak, Armagan AU - Kortuem, Gerd AU - van der Cammen, JM Tischa PY - 2021/5/28 TI - A Digital Platform for Facilitating Personalized Dementia Care in Nursing Homes: Formative Evaluation Study JO - JMIR Form Res SP - e25705 VL - 5 IS - 5 KW - human-centered design KW - data visualizations KW - person-centered care KW - people with dementia KW - assistive technology KW - health care design KW - care management KW - internet of things KW - data-driven design KW - data-enabled design N2 - Background: Care personalization is key to the well-being of people with dementia according to person-centered care. With the development of the internet of things, a large quantity of personal data can be collected securely and reliably, which has the potential to facilitate care personalization for people with dementia. Yet, there are limited assistive technologies developed for this purpose, and the user acceptance of assistive technologies is low in nursing homes. Therefore, through a data-enabled design approach, a digital platform was developed for helping the care team in a nursing home to personalize dementia care, specifically in the management of behavioral and psychological dementia symptoms. Objective: This study aimed to evaluate the digital platform in a real-life context with potential users from the following two aspects: (1) to explore if the digital platform could help with generating insights on the current state of each person with dementia and (2) to gather feedback on the digital platform from the care team. Methods: The digital platform was deployed in the nursing home for 7 weeks and the data collected were visualized and presented to the care team via the digital platform. The visualizations were analyzed by the researchers for pattern detection. Meanwhile, the care team was asked to examine the visualizations and were interviewed for the following: (1) if any insights and actions were generated from the examination, (2) the usefulness of the digital platform, and (3) the improvements they would like to see. Results: The data collected on the digital platform demonstrated its potential for pattern detection. Insights were generated by the care team and categorized into ?client level,? ?ward level,? and ?team level.? The corresponding actions taken by the care team were classified into ?investigation? and ?implementation.? User acceptance varied across the care team, and three aspects of improvement for the digital platform were identified. Conclusions: By evaluating the digital platform, this study gained insights on applying data-enabled design for personalizing dementia care; besides, it offers future researchers some recommendations on how to integrate assistive technologies in the nursing home context. UR - https://formative.jmir.org/2021/5/e25705 UR - http://dx.doi.org/10.2196/25705 UR - http://www.ncbi.nlm.nih.gov/pubmed/34047703 ID - info:doi/10.2196/25705 ER - TY - JOUR AU - Jones, Chelsea AU - Miguel-Cruz, Antonio AU - Brémault-Phillips, Suzette PY - 2021/5/13 TI - Technology Acceptance and Usability of the BrainFx SCREEN in Canadian Military Members and Veterans With Posttraumatic Stress Disorder and Mild Traumatic Brain Injury: Mixed Methods UTAUT Study JO - JMIR Rehabil Assist Technol SP - e26078 VL - 8 IS - 2 KW - NCAT KW - PTSD KW - cognitive assessment KW - cognition KW - executive function KW - technology acceptance KW - UTAUT KW - Canadian Armed Forces KW - mTBI KW - concussion KW - digital health KW - neuropsychology KW - neurology KW - post concussive symptoms KW - military N2 - Background: Canadian Armed Forces service members (CAF-SMs) and veterans exhibit higher rates of injuries and illnesses, such as posttraumatic stress disorder (PTSD) and traumatic brain injury, which can cause and exacerbate cognitive dysfunction. Computerized neurocognitive assessment tools have demonstrated increased reliability and efficiency compared with traditional cognitive assessment tools. Without assessing the degree of technology acceptance and perceptions of usability to end users, it is difficult to determine whether a technology-based assessment will be used successfully in wider clinical practice. The Unified Theory of Acceptance and Use of Technology model is commonly used to address the technology acceptance and usability of applications in five domains. Objective: This study aims to determine the technology acceptance and usability of a neurocognitive assessment tool, which was titled BrainFx SCREEN, among CAF-SMs and veterans with PTSD by using the Unified Theory of Acceptance and Use of Technology model. Methods: This mixed methods embedded pilot study included CAF-SMs and veterans (N=21) aged 18-60 years with a diagnosis of PTSD who completed pre- and postquestionnaires on the same day the BrainFx SCREEN was used. A partial least squares structural equation model was used to analyze the questionnaire results. Qualitative data were assessed using thematic analysis. Results: Facilitating conditions, which were the most notable predictors of behavioral intention, increased after using the BrainFx SCREEN, whereas effort expectancy decreased. Performance expectancy, effort expectancy, and social interaction were not factors that could predict behavioral intention. Participants who reported a previous mild traumatic brain injury were significantly more likely to report current symptoms of cognitive impairment. The BrainFx SCREEN is a feasible, usable, and accepted assessment tool for CAF-SMs and veterans who experience PTSD. Conclusions: As military health care systems integrate technological innovations to improve the services and care provided, research must continue to address the acceptability and use of these novel assessments and interventions. UR - https://rehab.jmir.org/2021/2/e26078 UR - http://dx.doi.org/10.2196/26078 UR - http://www.ncbi.nlm.nih.gov/pubmed/33983125 ID - info:doi/10.2196/26078 ER - TY - JOUR AU - Tran, E. Johanna AU - Fowler, A. Christopher AU - Delikat, Jemy AU - Kaplan, Howard AU - Merzier, M. Marie AU - Schlesinger, R. Michelle AU - Litzenberger, Stefan AU - Marszalek, M. Jacob AU - Scott, Steven AU - Winkler, L. Sandra PY - 2021/5/10 TI - Immersive Virtual Reality to Improve Outcomes in Veterans With Stroke: Protocol for a Single-Arm Pilot Study JO - JMIR Res Protoc SP - e26133 VL - 10 IS - 5 KW - stroke KW - immersive virtual reality KW - feasibility KW - veterans affairs KW - veterans KW - pilot KW - recovery KW - upper extremity N2 - Background: Over the last decade, virtual reality (VR) has emerged as a cutting-edge technology in stroke rehabilitation. VR is defined as a type of computer-user interface that implements real-time simulation of an activity or environment allowing user interaction via multiple sensory modalities. In a stroke population, VR interventions have been shown to enhance motor, cognitive, and psychological recovery when utilized as a rehabilitation adjunct. VR has also demonstrated noninferiority to usual care therapies for stroke rehabilitation. Objective: The proposed pilot study aims to (1) determine the feasibility and tolerability of using a therapeutic VR platform in an inpatient comprehensive stroke rehabilitation program and (2) estimate the initial clinical efficacy (effect size) associated with the VR platform using apps for pain distraction and upper extremity exercise for poststroke neurologic recovery. Methods: This study will be conducted in the Comprehensive Integrated Inpatient Rehabilitation Program at the James A Haley Veterans? Hospital. Qualitative interviews will be conducted with 10 clinical staff members to assess the feasibility of the VR platform from the clinician perspective. A prospective within-subject pretest-posttest pilot design will be used to examine the tolerability of the VR platform and the clinical outcomes (ie, upper extremity neurologic recovery, hand dexterity, pain severity) in 10 veteran inpatients. A VR platform consisting of commercially available pain distraction and upper extremity apps will be available at the participants? bedside for daily use during their inpatient stay (approximately 4-6 weeks). Clinician interviews will be analyzed using qualitative descriptive analysis. Cohen d effect sizes with corresponding 95% CIs will be calculated for upper extremity neurologic recovery, hand dexterity, and pain. The proportion of participants who achieve minimal clinically important difference after using the VR platform will be calculated for each clinical outcome. Results: This study was selected for funding in August 2020. Institutional review board approval was received in October 2020. The project start date was December 2020. The United States Department has issued a moratorium on in-person research activities secondary to COVID-19. Data collection will commence once this moratorium is lifted. Conclusions: Our next step is to conduct a large multi-site clinical trial that will incorporate the lessons learned from this pilot feasibility study to test the efficacy of a VR intervention in inpatient rehabilitation and transition to home environments. When VR is used in patients? rooms, it serves to provide additional therapy and may reduce clinician burden. VR also presents an opportunity similar to home-based practice exercises. VR can be implemented in both clinical settings and people?s own homes, where engagement in ongoing self-management approaches is often most challenging. This unique experience offers the potential for seamless transition from inpatient rehabilitation to the home. International Registered Report Identifier (IRRID): PRR1-10.2196/26133 UR - https://www.researchprotocols.org/2021/5/e26133 UR - http://dx.doi.org/10.2196/26133 UR - http://www.ncbi.nlm.nih.gov/pubmed/33970110 ID - info:doi/10.2196/26133 ER - TY - JOUR AU - Capizzi, Riley AU - Fisher, Melissa AU - Biagianti, Bruno AU - Ghiasi, Neelufaer AU - Currie, Ariel AU - Fitzpatrick, Karrie AU - Albertini, Nicholas AU - Vinogradov, Sophia PY - 2021/5/6 TI - Testing a Novel Web-Based Neurocognitive Battery in the General Community: Validation and Usability Study JO - J Med Internet Res SP - e25082 VL - 23 IS - 5 KW - cognition KW - normative KW - remote KW - digital KW - online KW - web-based KW - BrainHQ KW - Posit Science Corporation N2 - Background: In recent years, there has been increased interest in the development of remote psychological assessments. These platforms increase accessibility and allow clinicians to monitor important health metrics, thereby informing patient-centered treatment. Objective: In this study, we report the properties and usability of a new web-based neurocognitive assessment battery and present a normative data set for future use. Methods: A total of 781 participants completed a portion of 8 tasks that captured performance in auditory processing, visual-spatial working memory, visual-spatial learning, cognitive flexibility, and emotional processing. A subset of individuals (n=195) completed a 5-question survey measuring the acceptability of the tasks. Results: Between 252 and 426 participants completed each task. Younger individuals outperformed their older counterparts in 6 of the 8 tasks. Therefore, central tendency data metrics were presented using 7 different age bins. The broad majority of participants found the tasks interesting and enjoyable and endorsed some interest in playing them at home. Only 1 of 195 individuals endorsed not at all for the statement, ?I understood the instructions.? Older individuals were less likely to understand the instructions; however, 72% (49/68) of individuals over the age of 60 years still felt that they mostly or very much understood the instructions. Conclusions: Overall, the tasks were found to be widely acceptable to the participants. The use of web-based neurocognitive tasks such as these may increase the ability to deploy precise data-informed interventions to a wider population. UR - https://www.jmir.org/2021/5/e25082 UR - http://dx.doi.org/10.2196/25082 UR - http://www.ncbi.nlm.nih.gov/pubmed/33955839 ID - info:doi/10.2196/25082 ER - TY - JOUR AU - Chau, Hing Pui AU - Kwok, Jojo Yan Yan AU - Chan, Maggie Mee Kie AU - Kwan, Daniel Ka Yu AU - Wong, Lun Kam AU - Tang, Ho Ying AU - Chau, Peter Kan Lung AU - Lau, Matthew Sheung Wa AU - Yiu, Yannex Yan Yan AU - Kwong, Fanny Mei Yan AU - Lai, Thomas Wai Ting AU - Leung, Kit Mun PY - 2021/5/4 TI - Feasibility, Acceptability, and Efficacy of Virtual Reality Training for Older Adults and People With Disabilities: Single-Arm Pre-Post Study JO - J Med Internet Res SP - e27640 VL - 23 IS - 5 KW - virtual reality KW - rehabilitation KW - older adults, people with disabilities KW - evaluation N2 - Background: Unlike most virtual reality (VR) training programs that are targeted at homogenous populations, a set of VR games for rehabilitation purposes targeted at a heterogeneous group of users was developed. The VR games covered physical training, cognitive training (classification and reality orientation), community-living skills training, and relaxing scenery experiences. Special considerations for local older adults and people with disabilities were made in terms of hardware choice and software design. Objective: This study aimed to evaluate the feasibility, acceptance, and efficacy of VR training among users with varying abilities. Methods: A single-arm pretest-posttest evaluation study was conducted. The participants of the evaluation study were encouraged to undergo 30-minute VR training three times a week for 6 weeks. The 30-minute session consisted of 10 minutes of upper-limb motion games, 10 minutes of lower-limb motion games, and 10 minutes of cognitive games/community-living skills training/relaxing scenery experiences, as appropriate. On completion of each session, usage statistics were documented via the built-in VR software, whereas feedback on the experience of the VR games and adverse events was collected via self-reports and staff observations. Feasibility was reflected by usage statistics, and acceptance was reflected by positive feedback. In addition, health outcomes, including upper-limb dexterity, functional mobility, cognitive function, and happiness, were assessed at baseline, as well as 6 weeks and 3 months after baseline. The primary outcomes were upper-limb dexterity and acceptance of playing VR games. Results: A total of 135 participants with a mean age of 62.7 years (SD 21.5) were recruited from May 2019 to January 2020, and 124 (91.9%) completed at least one follow-up. Additionally, 76.3% (103/135) of the participants could attend at least 70% of the proposed 18 sessions, and 72.5% (1382/1906) of the sessions had a training time of at least 20 minutes. Linear mixed effect models showed statistically significant effects in terms of upper-limb dexterity (small effect) and cognitive function (moderate effect). Among the 135 participants, 88 provided positive comments. Additionally, 10.4% (14/135) reported mild discomfort, such as dizziness, and none reported severe discomfort. Conclusions: A set of VR training games for rehabilitation could be applied to users with heterogeneous abilities. Our VR games were acceptable to local older adults and those with different disabilities. Benefits in upper-limb dexterity and cognitive function were observed despite partial compliance to the training protocol. Service providers could refer to our experiences when developing VR training systems for their clients. UR - https://www.jmir.org/2021/5/e27640 UR - http://dx.doi.org/10.2196/27640 UR - http://www.ncbi.nlm.nih.gov/pubmed/33944795 ID - info:doi/10.2196/27640 ER - TY - JOUR AU - Yeo, Shi Pei AU - Nguyen, Ngoc Tu AU - Ng, Ern Mary Pei AU - Choo, Munn Robin Wai AU - Yap, Kiat Philip Lin AU - Ng, Pin Tze AU - Wee, Liang Shiou PY - 2021/4/27 TI - Evaluation of the Implementation and Effectiveness of Community-Based Brain-Computer Interface Cognitive Group Training in Healthy Community-Dwelling Older Adults: Randomized Controlled Implementation Trial JO - JMIR Form Res SP - e25462 VL - 5 IS - 4 KW - group-based computerized cognitive training KW - cognition KW - gait KW - community program implementation KW - healthy older adults KW - cognitive KW - community program KW - cognitive training KW - elderly KW - aging N2 - Background: Cognitive training can improve cognition in healthy older adults. Objective: The objectives are to evaluate the implementation of community-based computerized cognitive training (CCT) and its effectiveness on cognition, gait, and balance in healthy older adults. Methods: A single-blind randomized controlled trial with baseline and follow-up assessments was conducted at two community centers in Singapore. Healthy community-dwelling adults aged 55 years and older participated in a 10-week CCT program with 2-hour instructor-led group classes twice a week. Participants used a mobile app to play games targeting attention, memory, decision making, visuospatial abilities, and cognitive flexibility. Implementation was assessed at the participant, provider, and community level (eg, reach, implementation, and facilitators and barriers). Effectiveness measures were the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Color Trails Test 2 (CTT-2), Berg Balance Scale, and GAITRite walkway measures (single and dual task gait speed, dual task cost, and single and dual task gait variability index [GVI]). Results: A total of 94 healthy community-dwelling adults participated in the CCT program (mean age 68.8 [SD 6.3] years). Implementation measures revealed high reach (125/155, 80.6%) and moderate adherence but poor penetration of sedentary older adults (43/125, 34.4%). The effectiveness data were based on intention-to-treat (ITT) and per-protocol (PP) analysis. In the ITT analysis, single task GVI increased (b=2.32, P=.02, 95% CI [0.30 to 4.35]) and RBANS list recognition subtest deteriorated (b=?0.57, P=.01, 95% CI [?1.00 to ?0.14]) in both groups. In the PP analysis, time taken to complete CTT-2 (b=?13.5, P=.01, 95% CI [?23.95 to ?3.14]; Cohen d effect size = 0.285) was faster in the intervention group. Single task gait speed was not statistically significantly maintained in the intervention group (b=5.38, P=.06, 95% CI [?0.30 to 11.36]) and declined in the control group (Cohen d effect size = 0.414). PP analyses also showed interaction terms for RBANS list recall subtest (b=?0.36, P=.08, 95% CI [?0.75 to 0.04]) and visuospatial domain (b=0.46, P=.08, 95% CI [?0.05 to 0.96]) that were not statistically significant. Conclusions: CCT can be implemented in community settings to improve attention and executive function among healthy older adults. Findings help to identify suitable healthy aging programs that can be implemented on a larger scale within communities. Trial Registration: ClinicalTrials.gov NCT04439591; https://clinicaltrials.gov/ct2/show/NCT04439591 UR - https://formative.jmir.org/2021/4/e25462 UR - http://dx.doi.org/10.2196/25462 UR - http://www.ncbi.nlm.nih.gov/pubmed/33904819 ID - info:doi/10.2196/25462 ER - TY - JOUR AU - Drijver, Josephine A. AU - Reijneveld, C. Jaap AU - Wesselman, P. Linda M. AU - Klein, Martin PY - 2021/4/26 TI - A Web-Based Lifestyle Intervention Aimed at Improving Cognition in Patients With Cancer Returning to Work in an Outpatient Setting: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e22670 VL - 10 IS - 4 KW - cancer KW - cognitive functioning KW - lifestyle KW - web-based intervention KW - RCT KW - cancer-related cognitive impairment N2 - Background: A high percentage of patients with cancer experience cognitive impairment after cancer treatment, resulting in a decreased health-related quality of life and difficulty returning to work. Consequently, there is a need for effective treatment options to improve cognitive functioning in these patients. In a healthy aging population, multidomain web-based lifestyle interventions have been found to be effective in preventing cognitive decline and improving cognitive functioning. Objective: This study aims to investigate the feasibility and effectiveness of the web-based lifestyle intervention Mijn Fitte Brein (My Fit Brain [MFB]) on cognitive functioning in patients with cancer returning to work. Methods: The study consists of a feasibility study (N=10), followed by a randomized controlled trial (RCT; N=220). Patients will be recruited by their occupational physicians after their return to work following cancer treatment. Mijn Fitte Brein is organized into 4-week cycles in which patients set a lifestyle goal using the Goal Attainment Scale, receive weekly tips and support, and finally evaluate whether they succeeded in achieving this goal. Lifestyle goals are based on 6 domains: physical exercise, diet, sleep, stress, alcohol use, and smoking. In the feasibility study, data on user experience (structured interview) and usability, assessed with the Post-Study System Usability Scale, will be collected and used to optimize Mijn Fitte Brein. In the RCT, patients will be randomized 1:1 between an intervention group and a control group. Patients will be assessed at baseline, 3 months, and 6 months. The primary outcome measure is subjective cognitive functioning, assessed with the Functional Assessment of Cancer Therapy?Cognitive Function (FACT-Cog). Secondary outcome measures are lifestyle, objective cognitive functioning, and work and psychosocial factors. Results: Recruitment for the feasibility study has started in February 2020. As of July 2020, however, no patients have been enrolled (due to COVID-19 restrictions). The findings of the feasibility study will be used to optimize the Mijn Fitte Brein intervention. Enrollment for the RCT will continue when possible. The feasibility study will take 6 months (including making adjustments to the intervention), and the RCT will take 2 years. The final results are expected in 2024. The results of the feasibility study and the RCT will be published in peer-reviewed journals. Conclusions: This is the first time the feasibility and efficacy of a multidomain web-based lifestyle intervention will be studied in patients with cancer. If Mijn Fitte Brein is found to be effective in decreasing cognitive complaints in these patients returning to work, it will be a promising treatment option because of being both affordable and accessible. Trial Registration: Netherlands Trial Register NL8407; https://www.trialregister.nl/trial/8407 International Registered Report Identifier (IRRID): DERR1-10.2196/22670 UR - https://www.researchprotocols.org/2021/4/e22670 UR - http://dx.doi.org/10.2196/22670 UR - http://www.ncbi.nlm.nih.gov/pubmed/33900201 ID - info:doi/10.2196/22670 ER - TY - JOUR AU - Rai, Kaur Harleen AU - Schneider, Justine AU - Orrell, Martin PY - 2021/4/8 TI - An Individual Cognitive Stimulation Therapy App for People With Dementia and Their Carers: Protocol for a Feasibility Randomized Controlled Trial JO - JMIR Res Protoc SP - e24628 VL - 10 IS - 4 KW - dementia KW - cognitive stimulation therapy KW - touchscreen technology KW - feasibility trial KW - quality of life KW - mHealth KW - apps N2 - Background: There is a need for more resources to support the cognition and quality of life of people with dementia. The individual cognitive stimulation therapy (iCST) app aims to provide cognitive stimulation and social interaction to people with dementia and carers through interactive touchscreen technology. The iCST app has been developed according to the principles of CST and iCST, which have previously shown to improve the cognition and quality of life of people with dementia and benefit the relationship between the person with dementia and his/her carer. The iCST app has also shown to improve the quality of the carer?s life. Objective: The aim of this study is to evaluate the usability of the iCST app intervention and the feasibility of conducting a full-scale randomized controlled trial (RCT) to assess the clinical effectiveness of the iCST app intervention compared to that of treatment-as-usual for people with mild-to-moderate dementia. Methods: We aim to recruit 60 people with mild-to-moderate dementia and their informal carers as dyads in a multi-center feasibility RCT with a treatment-as-usual control group. Both parties must be able to provide informed consent and participate in the intervention. Dyads will complete a baseline assessment that will include cognition and quality of life measures and they will subsequently be randomized (1:1) to the iCST app intervention in addition to usual care or to usual care only. All participants will be followed up at 5 weeks and at 11 weeks after the baseline assessments. A range of feasibility outcomes will be assessed, including recruitment and retention rates, intervention fidelity and usability, and acceptability of the outcome measures. A sample of the experimental group will be invited to a semistructured posttrial interview to further examine the experience of using the iCST app. Results: This study received funding in May 2015 and obtained ethical approval in March 2018. Data collection began in November 2018 and was completed in March 2020 with a total of 61 dyads recruited. Data analyses are in progress and the final results are expected to be available in the spring of 2021. Conclusions: This study will investigate whether it is feasible to conduct a full-scale RCT to evaluate the clinical effectiveness of the iCST app in comparison to that of usual care alone. In addition, this study will examine the usability of the iCST app. The data will provide information on potential modifications to be made to the intervention, study design, and study process. Trial Registration: ClinicalTrials.gov NCT03282877; https://clinicaltrials.gov/ct2/show/NCT03282877 International Registered Report Identifier (IRRID): DERR1-10.2196/24628 UR - https://www.researchprotocols.org/2021/4/e24628 UR - http://dx.doi.org/10.2196/24628 UR - http://www.ncbi.nlm.nih.gov/pubmed/33830058 ID - info:doi/10.2196/24628 ER - TY - JOUR AU - Demers, Marika AU - Fung, Karen AU - Subramanian, K. Sandeep AU - Lemay, Martin AU - Robert, T. Maxime PY - 2021/4/7 TI - Integration of Motor Learning Principles Into Virtual Reality Interventions for Individuals With Cerebral Palsy: Systematic Review JO - JMIR Serious Games SP - e23822 VL - 9 IS - 2 KW - virtual rehabilitation KW - upper limb KW - brain damage KW - feedback KW - active video games KW - learning N2 - Background: Increasing evidence supports the use of virtual reality systems to improve upper limb motor functions in individuals with cerebral palsy. While virtual reality offers the possibility to include key components to promote motor learning, it remains unclear if and how motor learning principles are incorporated into the development of rehabilitation interventions using virtual reality. Objective: The objective of this study was to determine the extent to which motor learning principles are integrated into virtual reality interventions targeting upper limb function in individuals with cerebral palsy. Methods: A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search was performed in 10 databases using a combination of keywords related to cerebral palsy, virtual reality, video games, and rehabilitation. Studies were divided into 2 categories: commercial video game platforms and devices and custom virtual reality systems. Study quality was assessed using the modified Downs and Black checklist. Results: The initial search yielded 1497 publications. A total of 26 studies from 30 publications were included, with most studies classified as ?fair? according to the modified Downs and Black checklist. The majority of studies provided enhanced feedback and variable practice and used functionally relevant and motivating virtual tasks. The dosage varied greatly (total training time ranged from 300 to 3360 minutes), with only 6 studies reporting the number of movement repetitions per session. The difficulty progression and the assessment of skills retention and transfer were poorly incorporated, especially for the commercial video games. Conclusions: Motor learning principles should be better integrated into the development of future virtual reality systems for optimal upper limb motor recovery in individuals with cerebral palsy. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020151982; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020151982 UR - https://games.jmir.org/2021/2/e23822 UR - http://dx.doi.org/10.2196/23822 UR - http://www.ncbi.nlm.nih.gov/pubmed/33825690 ID - info:doi/10.2196/23822 ER - TY - JOUR AU - Zeghari, Radia AU - König, Alexandra AU - Guerchouche, Rachid AU - Sharma, Garima AU - Joshi, Jyoti AU - Fabre, Roxane AU - Robert, Philippe AU - Manera, Valeria PY - 2021/3/31 TI - Correlations Between Facial Expressivity and Apathy in Elderly People With Neurocognitive Disorders: Exploratory Study JO - JMIR Form Res SP - e24727 VL - 5 IS - 3 KW - apathy KW - action units KW - assessment KW - ICT KW - facial video analysis KW - neurocognitive disorders KW - neurocognitive KW - facial analysis N2 - Background: Neurocognitive disorders are often accompanied by behavioral symptoms such as anxiety, depression, and/or apathy. These symptoms can occur very early in the disease progression and are often difficult to detect and quantify in nonspecialized clinical settings. Objective: We focus in this study on apathy, one of the most common and debilitating neuropsychiatric symptoms in neurocognitive disorders. Specifically, we investigated whether facial expressivity extracted through computer vision software correlates with the severity of apathy symptoms in elderly subjects with neurocognitive disorders. Methods: A total of 63 subjects (38 females and 25 males) with neurocognitive disorder participated in the study. Apathy was assessed using the Apathy Inventory (AI), a scale comprising 3 domains of apathy: loss of interest, loss of initiation, and emotional blunting. The higher the scale score, the more severe the apathy symptoms. Participants were asked to recall a positive and a negative event of their life, while their voice and face were recorded using a tablet device. Action units (AUs), which are basic facial movements, were extracted using OpenFace 2.0. A total of 17 AUs (intensity and presence) for each frame of the video were extracted in both positive and negative storytelling. Average intensity and frequency of AU activation were calculated for each participant in each video. Partial correlations (controlling for the level of depression and cognitive impairment) were performed between these indexes and AI subscales. Results: Results showed that AU intensity and frequency were negatively correlated with apathy scale scores, in particular with the emotional blunting component. The more severe the apathy symptoms, the less expressivity in specific emotional and nonemotional AUs was displayed from participants while recalling an emotional event. Different AUs showed significant correlations depending on the sex of the participant and the task?s valence (positive vs negative story), suggesting the importance of assessing male and female participants independently. Conclusions: Our study suggests the interest of employing computer vision-based facial analysis to quantify facial expressivity and assess the severity of apathy symptoms in subjects with neurocognitive disorders. This may represent a useful tool for a preliminary apathy assessment in nonspecialized settings and could be used to complement classical clinical scales. Future studies including larger samples should confirm the clinical relevance of this kind of instrument. UR - https://formative.jmir.org/2021/3/e24727 UR - http://dx.doi.org/10.2196/24727 UR - http://www.ncbi.nlm.nih.gov/pubmed/33787499 ID - info:doi/10.2196/24727 ER - TY - JOUR AU - Hassandra, Mary AU - Galanis, Evangelos AU - Hatzigeorgiadis, Antonis AU - Goudas, Marios AU - Mouzakidis, Christos AU - Karathanasi, Maria Eleni AU - Petridou, Niki AU - Tsolaki, Magda AU - Zikas, Paul AU - Evangelou, Giannis AU - Papagiannakis, George AU - Bellis, George AU - Kokkotis, Christos AU - Panagiotopoulos, Rafail Spyridon AU - Giakas, Giannis AU - Theodorakis, Yannis PY - 2021/3/24 TI - ? Virtual Reality App for Physical and Cognitive Training of Older People With Mild Cognitive Impairment: Mixed Methods Feasibility Study JO - JMIR Serious Games SP - e24170 VL - 9 IS - 1 KW - virtual reality KW - elderly KW - mild cognitive impairment KW - combined physical and cognitive function KW - dual task N2 - Background: Therapeutic virtual reality (VR) has emerged as an effective treatment modality for cognitive and physical training in people with mild cognitive impairment (MCI). However, to replace existing nonpharmaceutical treatment training protocols, VR platforms need significant improvement if they are to appeal to older people with symptoms of cognitive decline and meet their specific needs. Objective: This study aims to design and test the acceptability, usability, and tolerability of an immersive VR platform that allows older people with MCI symptoms to simultaneously practice physical and cognitive skills on a dual task. Methods: On the basis of interviews with 20 older people with MCI symptoms (15 females; mean age 76.25, SD 5.03 years) and inputs from their health care providers (formative study VR1), an interdisciplinary group of experts developed a VR system called VRADA (VR Exercise App for Dementia and Alzheimer?s Patients). Using an identical training protocol, the VRADA system was first tested with a group of 30 university students (16 females; mean age 20.86, SD 1.17 years) and then with 27 older people (19 females; mean age 73.22, SD 9.26 years) who had been diagnosed with MCI (feasibility studies VR2a and VR2b). Those in the latter group attended two Hellenic Association Day Care Centers for Alzheimer?s Disease and Related Disorders. Participants in both groups were asked to perform a dual task training protocol that combined physical and cognitive exercises in two different training conditions. In condition A, participants performed a cycling task in a lab environment while being asked by the researcher to perform oral math calculations (single-digit additions and subtractions). In condition B, participants performed a cycling task in the virtual environment while performing calculations that appeared within the VR app. Participants in both groups were assessed in the same way; this included questionnaires and semistructured interviews immediately after the experiment to capture perceptions of acceptability, usability, and tolerability, and to determine which of the two training conditions each participant preferred. Results: Participants in both groups showed a significant preference for the VR condition (students: mean 0.66, SD 0.41, t29=8.74, P<.001; patients with MCI: mean 0.72, SD 0.51, t26=7.36, P<.001), as well as high acceptance scores for intended future use, attitude toward VR training, and enjoyment. System usability scale scores (82.66 for the students and 77.96 for the older group) were well above the acceptability threshold (75/100). The perceived adverse effects were minimal, indicating a satisfactory tolerability. Conclusions: The findings suggest that VRADA is an acceptable, usable, and tolerable system for physical and cognitive training of older people with MCI and university students. Randomized controlled trial studies are needed to assess the ef?cacy of VRADA as a tool to promote physical and cognitive health in patients with MCI. UR - https://games.jmir.org/2021/1/e24170 UR - http://dx.doi.org/10.2196/24170 UR - http://www.ncbi.nlm.nih.gov/pubmed/33759797 ID - info:doi/10.2196/24170 ER - TY - JOUR AU - Xu, Yangfan AU - Tong, Meiqinzi AU - Ming, Wai-Kit AU - Lin, Yangyang AU - Mai, Wangxiang AU - Huang, Weixin AU - Chen, Zhuoming PY - 2021/3/24 TI - A Depth Camera?Based, Task-Specific Virtual Reality Rehabilitation Game for Patients With Stroke: Pilot Usability Study JO - JMIR Serious Games SP - e20916 VL - 9 IS - 1 KW - virtual reality KW - rehabilitation KW - stroke KW - lower extremity KW - rehabilitation game N2 - Background: The use of virtual reality is popular in clinical rehabilitation, but the effects of using commercial virtual reality games in patients with stroke have been mixed. Objective: We developed a depth camera?based, task-specific virtual reality game, Stomp Joy, for poststroke rehabilitation of the lower extremities. This study aims to assess its feasibility and clinical efficacy. Methods: We carried out a feasibility test for Stomp Joy within representative user groups. Then, a clinical efficacy experiment was performed with a randomized controlled trial, in which 22 patients with stroke received 10 sessions (2 weeks) of conventional physical therapy only (control group) or conventional physical therapy plus 30 minutes of the Stomp Joy intervention (experimental group) in the clinic. The Fugl-Meyer Assessment for Lower Extremity (FMA-LE), Modified Barthel Index (MBI), Berg Balance Scale (BBS) score, single-leg stance (SLS) time, dropout rate, and adverse effects were recorded. Results: This feasibility test showed that Stomp Joy improved interest, pressure, perceived competence, value, and effort using the Intrinsic Motivation Inventory. The clinical efficacy trial showed a significant time-group interaction effect for the FMA-LE (P=.006), MBI (P=.001), BBS (P=.004), and SLS time (P=.001). A significant time effect was found for the FMA-LE (P=.001), MBI (P<.001), BBS (P<.001), and SLS time (P=.03). These indicated an improvement in lower extremity motor ability, basic activities of daily living, balance ability, and single-leg stance time in both groups after 2 weeks of the intervention. However, no significant group effects were found for the FMA-LE (P=.06), MBI (P=.76), and BBS (P=.38), while a significant group interaction was detected for SLS time (P<.001). These results indicated that the experimental group significantly improved more in SLS time than did the control group. During the study, 2 dropouts, including 1 participant who fell, were reported. Conclusions: Stomp Joy is an effective depth camera?based virtual reality game for replacing part of conventional physiotherapy, achieving equally effective improvement in lower extremity function among stroke survivors. High-powered randomized controlled studies are now needed before recommending the routine use of Stomp Joy in order to confirm these findings by recruiting a large sample size. UR - https://games.jmir.org/2021/1/e20916 UR - http://dx.doi.org/10.2196/20916 UR - http://www.ncbi.nlm.nih.gov/pubmed/33759795 ID - info:doi/10.2196/20916 ER - TY - JOUR AU - Bhattacharjya, Sutanuka AU - Cavuoto, Anne Lora AU - Reilly, Brandon AU - Xu, Wenyao AU - Subryan, Heamchand AU - Langan, Jeanne PY - 2021/3/22 TI - Usability, Usefulness, and Acceptance of a Novel, Portable Rehabilitation System (mRehab) Using Smartphone and 3D Printing Technology: Mixed Methods Study JO - JMIR Hum Factors SP - e21312 VL - 8 IS - 1 KW - stroke KW - rehabilitation KW - smart technology KW - 3-dimensional printing KW - usability N2 - Background: Smart technology use in rehabilitation is growing and can be used remotely to assist clients in self-monitoring their performance. With written home exercise programs being the commonly prescribed form of rehabilitation after discharge, mobile health technology coupled with task-oriented programs can enhance self-management of upper extremity training. In the current study, a rehabilitation system, namely mRehab, was designed that included a smartphone app and 3D-printed household items such as mug, bowl, key, and doorknob embedded with a smartphone. The app interface allowed the user to select rehabilitation activities and receive feedback on the number of activity repetitions completed, time to complete each activity, and quality of movement. Objective: This study aimed to assess the usability, perceived usefulness, and acceptance of the mRehab system by individuals with stroke and identify the challenges experienced by them when using the system remotely in a home-based setting. Methods: A mixed-methods approach was used with 11 individuals with chronic stroke. Following training, individuals with stroke used the mRehab system for 6 weeks at home. Each participant completed surveys and engaged in a semistructured interview. Participants? qualitative reports regarding the usability of mRehab were integrated with their survey reports and quantitative performance data. Results: Of the 11 participants, 10 rated the mRehab system between the 67.5th and 97.5th percentile on the System Usability Scale, indicating their satisfaction with the usability of the system. Participants also provided high ratings of perceived usefulness (mean 5.8, SD 0.9) and perceived ease of use (mean 5.3, SD 1.5) on a 7-point scale based on the Technology Acceptance Model. Common themes reported by participants showed a positive response to mRehab with some suggestions for improvements. Participants reported an interest in activities they perceived to be adequately challenging. Some participants indicated a need for customizing the feedback to be more interpretable. Overall, most participants indicated that they would like to continue using the mRehab system at home. Conclusions: Assessing usability in the lived environment over a prolonged duration of time is essential to identify the match between the system and users? needs and preferences. While mRehab was well accepted, further customization is desired for a better fit with the end users. Trial Registration: ClinicalTrials.gov NCT04363944; https://clinicaltrials.gov/ct2/show/NCT04363944 UR - https://humanfactors.jmir.org/2021/1/e21312 UR - http://dx.doi.org/10.2196/21312 UR - http://www.ncbi.nlm.nih.gov/pubmed/33749608 ID - info:doi/10.2196/21312 ER - TY - JOUR AU - Krebs, Christine AU - Falkner, Michael AU - Niklaus, Joel AU - Persello, Luca AU - Klöppel, Stefan AU - Nef, Tobias AU - Urwyler, Prabitha PY - 2021/3/22 TI - Application of Eye Tracking in Puzzle Games for Adjunct Cognitive Markers: Pilot Observational Study in Older Adults JO - JMIR Serious Games SP - e24151 VL - 9 IS - 1 KW - eye tracking KW - puzzle games KW - aging KW - cognitive assessment KW - cognition, attention, executive functions, visual search, fixations N2 - Background: Recent studies suggest that computerized puzzle games are enjoyable, easy to play, and engage attentional, visuospatial, and executive functions. They may help mediate impairments seen in cognitive decline in addition to being an assessment tool. Eye tracking provides a quantitative and qualitative analysis of gaze, which is highly useful in understanding visual search behavior. Objective: The goal of the research was to test the feasibility of eye tracking during a puzzle game and develop adjunct markers for cognitive performance using eye-tracking metrics. Methods: A desktop version of the Match-3 puzzle game with 15 difficulty levels was developed using Unity 3D (Unity Technologies). The goal of the Match-3 puzzle was to find configurations (target patterns) that could be turned into a row of 3 identical game objects (tiles) by swapping 2 adjacent tiles. Difficulty levels were created by manipulating the puzzle board size (all combinations of width and height from 4 to 8) and the number of unique tiles on the puzzle board (from 4 to 8). Each level consisted of 4 boards (ie, target patterns to match) with one target pattern each. In this study, the desktop version was presented on a laptop computer setup with eye tracking. Healthy older subjects were recruited to play a full set of 15 puzzle levels. A paper-pencil?based assessment battery was administered prior to the Match-3 game. The gaze behavior of all participants was recorded during the game. Correlation analyses were performed on eye-tracking data correcting for age to examine if gaze behavior pertains to target patterns and distractor patterns and changes with puzzle board size (set size). Additionally, correlations between cognitive performance and eye movement metrics were calculated. Results: A total of 13 healthy older subjects (mean age 70.67 [SD 4.75] years; range 63 to 80 years) participated in this study. In total, 3 training and 12 test levels were played by the participants. Eye tracking recorded 672 fixations in total, 525 fixations on distractor patterns and 99 fixations on target patterns. Significant correlations were found between executive functions (Trail Making Test B) and number of fixations on distractor patterns (P=.01) and average fixations (P=.005). Conclusions: Overall, this study shows that eye tracking in puzzle games can act as a supplemental source of data for cognitive performance. The relationship between a paper-pencil test for executive functions and fixations confirms that both are related to the same cognitive processes. Therefore, eye movement metrics might be used as an adjunct marker for cognitive abilities like executive functions. However, further research is needed to evaluate the potential of the various eye movement metrics in combination with puzzle games as visual search and attentional marker. UR - https://games.jmir.org/2021/1/e24151 UR - http://dx.doi.org/10.2196/24151 UR - http://www.ncbi.nlm.nih.gov/pubmed/33749607 ID - info:doi/10.2196/24151 ER - TY - JOUR AU - Van de Winckel, Ann AU - Nawshin, Tanjila AU - Byron, Casey PY - 2021/3/18 TI - Combining a Hudl App With Telehealth to Increase Home Exercise Program Adherence in People With Chronic Diseases Experiencing Financial Distress: Randomized Controlled Trial JO - JMIR Form Res SP - e22659 VL - 5 IS - 3 KW - chronic disease KW - spinal cord injury KW - stroke KW - telehealth KW - telemedicine KW - traumatic brain injury N2 - Background: Patients with chronic diseases often need to adhere to long-term individualized home exercise programs (HEPs). Limited adherence to long-term exercise given during physical therapy (PT) visits reduces the capacity of exercise to manage or improve symptoms related to chronic disease. In addition, a lower socioeconomic status negatively impacts exercise adherence. To mitigate this, apps that motivate people to exercise could be a viable option. Using an app through telehealth may help adults with chronic diseases to achieve long-term HEP adherence. However, because apps for rehabilitation are an emerging field, the feasibility of the app needs to be evaluated. Objective: To address HEP adherence in participants with chronic diseases who are experiencing financial distress, we aim to evaluate the feasibility of and satisfaction with the Hudl Technique app and telehealth and satisfaction with PT care and to monitor HEP adherence and compliance (ie, percentage of participant-recorded videos sent) in participants using the app with telehealth compared with those using standard HEPs on paper. Methods: We recruited patients scheduled for outpatient PT. We performed a randomized controlled trial in which the experimental group received weekly HEP demonstrations through app videos on a tablet with feedback on their self-recorded HEP video performance from the telehealth physical therapist. The control group received HEPs on paper without feedback, as is customary in PT practice. Demographic, clinical, and health coverage information was collected for screening and baseline measurements. Adherence and compliance were evaluated. Both groups completed surveys at 8 and 24 weeks on their satisfaction with PT care, and the experimental group also completed a survey on their satisfaction with the app with telehealth use. Descriptive and nonparametric statistics were used for within-group and between-group comparisons and analyzed with JMP, version 13. Results: Overall, 45 adults with chronic diseases who were experiencing financial distress were randomized into experimental (23/45, 51%) and control (22/45, 49%) groups, with 74% (17/23) and 86% (19/22) participants completing the 24-week HEP, respectively. The experimental group had an HEP adherence frequency of 4 (SD 2) to 5 (SD 2) times per week at 8 and 24 weeks (P=.14), whereas HEP adherence decreased in the control group from 4 (SD 2) to 3 (SD 2) times per week (P=.07), with a significant difference (P=.01) between groups at 24 weeks. Of the total participants, 68% (15/22) sent videos. They sent 68% (16/24) of the requested number of videos on average. The average score for PT care satisfaction was maintained at 87% in the experimental group (P=.99), whereas it decreased from 89% at 8 weeks to 74% at 24 weeks (P=.008) in the control group. App-related adverse events were not observed. Conclusions: The Hudl app/telehealth platform is feasible for delivering HEPs and maintaining HEP adherence in participants with chronic diseases who are experiencing financial distress. Trial Registration: ClinicalTrials.gov NCT02659280; https://clinicaltrials.gov/ct2/show/NCT02659280 UR - https://formative.jmir.org/2021/3/e22659 UR - http://dx.doi.org/10.2196/22659 UR - http://www.ncbi.nlm.nih.gov/pubmed/33640865 ID - info:doi/10.2196/22659 ER - TY - JOUR AU - Suleman, Raheem AU - Tucker, V. Benjamin AU - Dursun, M. Serdar AU - Demas, L. Michael PY - 2021/3/17 TI - The Neurostimulation of the Brain in Depression Trial: Protocol for a Randomized Controlled Trial of Transcranial Direct Current Stimulation in Treatment-Resistant Depression JO - JMIR Res Protoc SP - e22805 VL - 10 IS - 3 KW - neuromodulation KW - neurostimulation KW - transcranial direct current stimulation KW - electrical stimulation therapy KW - psychiatric somatic therapies KW - depression KW - depressive disorder KW - major depressive disorder KW - depressive disorder, treatment resistant KW - randomized controlled trial KW - therapeutics KW - clinical trial protocol N2 - Background: Major depressive disorder (MDD) is the second highest cause of disability worldwide. Standard treatments for MDD include medicine and talk therapy; however, approximately 1 in 5 Canadians fail to respond to these approaches and must consider alternatives. Transcranial direct current stimulation (tDCS) is a safe, noninvasive method that uses electrical stimulation to change the activation pattern of different brain regions. By targeting those regions known to be affected in MDD, tDCS may be useful in ameliorating treatment-resistant depression. Objective: The objective of the Neurostimulation of the Brain in Depression trial is to compare the effectiveness of active versus sham tDCS in treating patients with ultraresistant MDD. The primary outcome will be the improvement in depressive symptoms, as measured by the change on the Mongtomery-Asberg Depression Rating Scale. Secondary outcomes will include changes in the Quick Inventory of Depressive Symptomatology Scale (subjective assessment), the World Health Organization Disability Assessment Schedule 2.0 (functional assessment), and the Screen for Cognitive Impairment in Psychiatry (cognitive assessment). Adverse events will be captured using the Young Mania Rating Scale; tDCS Adverse Events Questionnaire; Frequency, Intensity, and Burden of Side Effects Rating Scale; and Patient-Rated Inventory of Side Effects Scale. A parallel component of the study will involve assaying for baseline language function and the effect of treatment on language using an exploratory acoustic and semantic corpus analysis on recorded interviews. Participant accuracy and response latency on an auditory lexical decision task will also be evaluated. Methods: We will recruit inpatients and outpatients in the city of Edmonton, Alberta, and will deliver the study interventions at the Grey Nuns and University of Alberta Hospitals. Written informed consent will be obtained from all participants before enrollment. Eligible participants will be randomly assigned, in a double-blinded fashion, to receive active or sham tDCS, and they will continue receiving their usual pharmacotherapy and psychotherapy throughout the trial. In both groups, participants will receive 30 weekday stimulation sessions, each session being 30 minutes in length, with the anode over the left dorsolateral prefrontal cortex and the cathode over the right. Participants in the active group will be stimulated at 2 mA throughout, whereas the sham group will receive only a brief period of stimulation to mimic skin sensations felt in the active group. Measurements will be conducted at regular points throughout the trial and 30 days after trial completion. Results: The trial has been approved by the University of Alberta Research Ethics Board and is scheduled to commence in June 2021. The target sample size is 60 participants. Conclusions: This is a protocol for a multicenter, double-blinded, randomized controlled superiority trial comparing active versus sham tDCS in patients with treatment-resistant MDD. Trial Registration: ClinicalTrials.gov NCT04159012; http://clinicaltrials.gov/ct2/show/NCT04159012. International Registered Report Identifier (IRRID): PRR1-10.2196/22805 UR - https://www.researchprotocols.org/2021/3/e22805 UR - http://dx.doi.org/10.2196/22805 UR - http://www.ncbi.nlm.nih.gov/pubmed/33729165 ID - info:doi/10.2196/22805 ER - TY - JOUR AU - Wittich, Walter AU - Pichora-Fuller, Kathleen M. AU - Johnson, Aaron AU - Joubert, Sven AU - Kehayia, Eva AU - Bachir, Vanessa AU - Aubin, Gabrielle AU - Jaiswal, Atul AU - Phillips, Natalie PY - 2021/3/11 TI - Effect of Reading Rehabilitation for Age-Related Macular Degeneration on Cognitive Functioning: Protocol for a Nonrandomized Pre-Post Intervention Study JO - JMIR Res Protoc SP - e19931 VL - 10 IS - 3 KW - low vision KW - rehabilitation KW - cognition KW - aging KW - dementia KW - reading N2 - Background: Age-related vision impairments and dementia both become more prevalent with increasing age. Research into the mechanisms of these conditions has proposed that some of their causes (eg, macular degeneration/glaucoma and Alzheimer?s disease) could be symptoms of an underlying common cause. Research into sensory-cognitive aging has provided data that sensory decline may be linked to the progression of dementia through reduced sensory stimulation. While hearing loss rehabilitation may have a beneficial effect on cognitive functioning, there are no data available on whether low vision rehabilitation, specifically for reading, could have a beneficial effect on cognitive health. Objective: The research questions are: (1) Does low vision rehabilitation reduce reading effort? (2) If so, does reduced reading effort increase reading activity, and (3) If so, does increased reading activity improve cognitive functioning? The primary objective is to evaluate cognition before, as well as at 6 months and 12 months after, 3 weeks of low vision reading rehabilitation using magnification in individuals with age-related macular degeneration, with or without coexisting hearing impairments. We hypothesize that improvements postrehab will be observed at 6 months and maintained at 12 months for participants with vision loss and less so for those with dual sensory loss. The secondary objective is to correlate participant characteristics with all cognitive outcomes to identify which may play an important role in reading rehabilitation. Methods: We employ a quasiexperimental approach (nonrandomized, pre-post intervention study). A 3x3 design (3 groups x 3 time points) allows us to examine whether cognitive performance will change before and after 6 months and 12 months of a low vision reading intervention, when comparing 75 low vision and 75 dual sensory impaired (vision & hearing) participants to 75 age-matched healthy controls. The study includes outcome measures of vision (eg, reading acuity and speed), cognition (eg, short-term and long-term memory, processing speed), participant descriptors, demographics, and clinical data (eg, speech perception in noise, mental health). Results: The study has received approval, and recruitment began on April 24, 2019. As of March 4, 2021, 38 low vision and 7 control participants have been enrolled. Lockdown forced a pause in recruitment, which will recommence once the COVID-19 crisis has reached a point where face-to-face data collection with older adults becomes feasible again. Conclusions: Evidence of protective effects caused by reading rehabilitation will have a considerable impact on the vision rehabilitation community and their clients as well as all professionals involved in the care of older adults with or without dementia. If we demonstrate that reading rehabilitation has a beneficial effect on cognition, the demand for rehabilitation services will increase, potentially preventing cognitive decline across groups of older adults at risk of developing macular degeneration. Trial Registration: ClinicalTrials.gov NCT04276610; Unique Protocol ID: CRIR-1284-1217; https://clinicaltrials.gov/ct2/show/NCT04276610 International Registered Report Identifier (IRRID): DERR1-10.2196/19931 UR - https://www.researchprotocols.org/2021/3/e19931 UR - http://dx.doi.org/10.2196/19931 UR - http://www.ncbi.nlm.nih.gov/pubmed/33704074 ID - info:doi/10.2196/19931 ER - TY - JOUR AU - Naqvi, Ali Imama AU - Montiel, Casameni Tahani AU - Bittar, Yazan AU - Hunter, Norma AU - Okpala, Munachi AU - Johnson, Constance AU - Weiner, G. Mark AU - Savitz, Sean AU - Sharrief, Anjail AU - Beauchamp, Sanner Jennifer Elizabeth PY - 2021/3/8 TI - Internet Access and Usage Among Stroke Survivors and Their Informal Caregivers: Cross-sectional Study JO - JMIR Form Res SP - e25123 VL - 5 IS - 3 KW - internet access KW - stroke KW - caregivers KW - surveys KW - questionnaires KW - mobile phone N2 - Background: Web-based interventions have shown promise for chronic disease management but have not been widely applied to populations with stroke. Existing barriers may inhibit the adoption of web-based interventions among stroke survivors and necessitate the involvement of informal caregivers. However, limited information is available on internet accessibility and usability among stroke survivors and their caregivers. Objective: This study aims to investigate internet access and usage in a cohort of stroke survivors and their caregivers. Methods: A cross-sectional survey was conducted with 375 participants (248 stroke survivors and 127 caregivers). Descriptive statistics were generated using cross-tabulation. Comparisons with categorical data were conducted using the chi-square test, whereas the Mann-Whitney U test was used for comparisons involving ordinal variables. Results: Overall, 86.1% (323/375) of the participants reported having internet access. Caregivers were more likely than stroke survivors to access the internet (N=375, ?21=18.5, P<.001) and used text messaging (n=321, ?21=14.7, P<.001). Stroke survivors and caregivers with internet access were younger than stroke survivors and caregivers without internet access. The highest number of participants who reported internet access were non-Hispanic White. Smartphones were the most common devices used to access the internet. Email was the most common type of internet usage reported. Patients who survived for >12 months after a stroke reported higher internet access than those who survived <3 months (P<.001). The number of hours per week spent using the internet was higher for caregivers than for stroke survivors (P<.001). Conclusions: Future feasibility and acceptability studies should consider the role of the informal caregiver, participant age, race and ethnicity, the use of smartphone apps, email and text correspondence, and the amount of time elapsed since the stroke event in the design and implementation of web-based interventions for populations with stroke. UR - https://formative.jmir.org/2021/3/e25123 UR - http://dx.doi.org/10.2196/25123 UR - http://www.ncbi.nlm.nih.gov/pubmed/33683206 ID - info:doi/10.2196/25123 ER - TY - JOUR AU - Jones, Chelsea AU - Harasym, Jessica AU - Miguel-Cruz, Antonio AU - Chisholm, Shannon AU - Smith-MacDonald, Lorraine AU - Brémault-Phillips, Suzette PY - 2021/2/22 TI - Neurocognitive Assessment Tools for Military Personnel With Mild Traumatic Brain Injury: Scoping Literature Review JO - JMIR Ment Health SP - e26360 VL - 8 IS - 2 KW - military KW - rehabilitation KW - head injury KW - posttraumatic stress disorder KW - cognition KW - neurocognitive assessment tool KW - traumatic brain injury KW - assessment KW - brain concussion KW - mobile phone N2 - Background: Mild traumatic brain injury (mTBI) occurs at a higher frequency among military personnel than among civilians. A common symptom of mTBIs is cognitive dysfunction. Health care professionals use neuropsychological assessments as part of a multidisciplinary and best practice approach for mTBI management. Such assessments support clinical diagnosis, symptom management, rehabilitation, and return-to-duty planning. Military health care organizations currently use computerized neurocognitive assessment tools (NCATs). NCATs and more traditional neuropsychological assessments present unique challenges in both clinical and military settings. Many research gaps remain regarding psychometric properties, usability, acceptance, feasibility, effectiveness, sensitivity, and utility of both types of assessments in military environments. Objective: The aims of this study were to explore evidence regarding the use of NCATs among military personnel who have sustained mTBIs; evaluate the psychometric properties of the most commonly tested NCATs for this population; and synthesize the data to explore the range and extent of NCATs among this population, clinical recommendations for use, and knowledge gaps requiring future research. Methods: Studies were identified using MEDLINE, Embase, American Psychological Association PsycINFO, CINAHL Plus with Full Text, Psych Article, Scopus, and Military & Government Collection. Data were analyzed using descriptive analysis, thematic analysis, and the Randolph Criteria. Narrative synthesis and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews) guided the reporting of findings. The psychometric properties of NCATs were evaluated with specific criteria and summarized. Results: Of the 104 papers, 33 met the inclusion criteria for this scoping review. Thematic analysis and NCAT psychometrics were reported and summarized. Conclusions: When considering the psychometric properties of the most commonly used NCATs in military populations, these assessments have yet to demonstrate adequate validity, reliability, sensitivity, and clinical utility among military personnel with mTBIs. Additional research is needed to further validate NCATs within military populations, especially for those living outside of the United States and individuals experiencing other conditions known to adversely affect cognitive processing. Knowledge gaps remain, warranting further study of psychometric properties and the utility of baseline and normative testing for NCATs. UR - https://mental.jmir.org/2021/2/e26360 UR - http://dx.doi.org/10.2196/26360 UR - http://www.ncbi.nlm.nih.gov/pubmed/33616538 ID - info:doi/10.2196/26360 ER - TY - JOUR AU - Cyr, Andrée-Ann AU - Romero, Kristoffer AU - Galin-Corini, Laura PY - 2021/2/1 TI - Web-Based Cognitive Testing of Older Adults in Person Versus at Home: Within-Subjects Comparison Study JO - JMIR Aging SP - e23384 VL - 4 IS - 1 KW - web-based testing KW - aging KW - cognition KW - neuropsychology KW - mobile phone N2 - Background: Web-based research allows cognitive psychologists to collect high-quality data from a diverse pool of participants with fewer resources. However, web-based testing presents unique challenges for researchers and clinicians working with aging populations. Older adults may be less familiar with computer usage than their younger peers, leading to differences in performance when completing web-based tasks in their home versus in the laboratory under the supervision of an experimenter. Objective: This study aimed to use a within-subjects design to compare the performance of healthy older adults on computerized cognitive tasks completed at home and in the laboratory. Familiarity and attitudes surrounding computer use were also examined. Methods: In total, 32 community-dwelling healthy adults aged above 65 years completed computerized versions of the word-color Stroop task, paired associates learning, and verbal and matrix reasoning in 2 testing environments: at home (unsupervised) and in the laboratory (supervised). The paper-and-pencil neuropsychological versions of these tasks were also administered, along with questionnaires examining computer attitudes and familiarity. The order of testing environments was counterbalanced across participants. Results: Analyses of variance conducted on scores from the computerized cognitive tasks revealed no significant effect of the testing environment and no correlation with computer familiarity or attitudes. These null effects were confirmed with follow-up Bayesian analyses. Moreover, performance on the computerized tasks correlated positively with performance on their paper-and-pencil equivalents. Conclusions: Our findings show comparable performance on computerized cognitive tasks in at-home and laboratory testing environments. These findings have implications for researchers and clinicians wishing to harness web-based testing to collect meaningful data from older adult populations. UR - http://aging.jmir.org/2021/1/e23384/ UR - http://dx.doi.org/10.2196/23384 UR - http://www.ncbi.nlm.nih.gov/pubmed/33522972 ID - info:doi/10.2196/23384 ER - TY - JOUR AU - Gamito, Pedro AU - Oliveira, Jorge AU - Matias, Marcelo AU - Cunha, Elsa AU - Brito, Rodrigo AU - Lopes, Ferreira Paulo AU - Deus, Alberto PY - 2021/1/29 TI - Virtual Reality Cognitive Training Among Individuals With Alcohol Use Disorder Undergoing Residential Treatment: Pilot Randomized Controlled Trial JO - J Med Internet Res SP - e18482 VL - 23 IS - 1 KW - alcohol use disorder KW - cognitive training KW - virtual reality N2 - Background: Alcohol use disorder (AUD) has been associated with diverse physical and mental morbidities. Among the main consequences of chronic and excessive alcohol use are cognitive and executive deficits. Some of these deficits may be reversed in specific cognitive and executive domains with behavioral approaches consisting of cognitive training. The advent of computer-based interventions may leverage these improvements, but randomized controlled trials (RCTs) of digital interactive-based interventions are still scarce. Objective: The aim of this study is to explore whether a cognitive training approach using VR exercises based on activities of daily living is feasible for improving the cognitive function of patients with AUD undergoing residential treatment, as well as to estimate the effect size for this intervention to power future definitive RCTs. Methods: This study consisted of a two-arm pilot RCT with a sample of 36 individuals recovering from AUD in a therapeutic community; experimental group participants received a therapist-guided, VR-based cognitive training intervention combined with treatment as usual, and control group participants received treatment as usual without cognitive training. A comprehensive neuropsychological battery of tests was used both at pre- and postassessments, including measurement of global cognition, executive functions, attention, visual memory, and cognitive flexibility. Results: In order to control for potential effects of global cognition and executive functions at baseline, these domains were controlled for in the statistical analysis for each individual outcome. Results indicate intervention effects on attention in two out of five outcomes and on cognitive flexibility in two out of six outcomes, with effect sizes in significant comparisons being larger for attention than for cognitive flexibility. Patient retention in cognitive training was high, in line with previous studies. Conclusions: Overall, the data suggest that VR-based cognitive training results in specific contributions to improving attention ability and cognitive flexibility of patients recovering from AUD. Trial Registration: ClinicalTrials.gov NCT04505345; https://clinicaltrials.gov/show/NCT04505345 UR - http://www.jmir.org/2021/1/e18482/ UR - http://dx.doi.org/10.2196/18482 UR - http://www.ncbi.nlm.nih.gov/pubmed/33512329 ID - info:doi/10.2196/18482 ER - TY - JOUR AU - Taeger, Johannes AU - Bischoff, Stefanie AU - Hagen, Rudolf AU - Rak, Kristen PY - 2021/1/26 TI - Utilization of Smartphone Depth Mapping Cameras for App-Based Grading of Facial Movement Disorders: Development and Feasibility Study JO - JMIR Mhealth Uhealth SP - e19346 VL - 9 IS - 1 KW - facial nerve KW - facial palsy KW - app development KW - medical informatics KW - eHealth KW - mHealth KW - Stennert?s index KW - depth mapping camera KW - smartphone sensors N2 - Background: For the classification of facial paresis, various systems of description and evaluation in the form of clinician-graded or software-based scoring systems are available. They serve the purpose of scientific and clinical assessment of the spontaneous course of the disease or monitoring therapeutic interventions. Nevertheless, none have been able to achieve universal acceptance in everyday clinical practice. Hence, a quick and precise tool for assessing the functional status of the facial nerve would be desirable. In this context, the possibilities that the TrueDepth camera of recent iPhone models offer have sparked our interest. Objective: This paper describes the utilization of the iPhone?s TrueDepth camera via a specially developed app prototype for quick, objective, and reproducible quantification of facial asymmetries. Methods: After conceptual and user interface design, a native app prototype for iOS was programmed that accesses and processes the data of the TrueDepth camera. Using a special algorithm, a new index for the grading of unilateral facial paresis ranging from 0% to 100% was developed. The algorithm was adapted to the well-established Stennert index by weighting the individual facial regions based on functional and cosmetic aspects. Test measurements with healthy subjects using the app were performed in order to prove the reliability of the system. Results: After the development process, the app prototype had no runtime or buildtime errors and also worked under suboptimal conditions such as different measurement angles, so it met our criteria for a safe and reliable app. The newly defined index expresses the result of the measurements as a generally understandable percentage value for each half of the face. The measurements that correctly rated the facial expressions of healthy individuals as symmetrical in all cases were reproducible and showed no statistically significant intertest variability. Conclusions: Based on the experience with the app prototype assessing healthy subjects, the use of the TrueDepth camera should have considerable potential for app-based grading of facial movement disorders. The app and its algorithm, which is based on theoretical considerations, should be evaluated in a prospective clinical study and correlated with common facial scores. UR - http://mhealth.jmir.org/2021/1/e19346/ UR - http://dx.doi.org/10.2196/19346 UR - http://www.ncbi.nlm.nih.gov/pubmed/33496670 ID - info:doi/10.2196/19346 ER - TY - JOUR AU - Sturge, Jodi AU - Meijering, Louise AU - Jones, Allyson C. AU - Garvelink, Mirjam AU - Caron, Danielle AU - Nordin, Susanna AU - Elf, Marie AU - Légaré, France PY - 2021/1/21 TI - Technology to Improve Autonomy and Inform Housing Decisions for Older Adults With Memory Problems Who Live at Home in Canada, Sweden, and the Netherlands: Protocol for a Multipronged Mixed Methods Study JO - JMIR Res Protoc SP - e19244 VL - 10 IS - 1 KW - aging in place KW - co-design KW - cross-country comparison KW - electronic decision support intervention KW - housing decisions KW - memory problems KW - mixed methods KW - mobility patterns KW - shared decision making KW - technology N2 - Background: Understanding the mobility patterns and experiences of older adults with memory problems living at home has the potential to improve autonomy and inform shared decision making (SDM) about their housing options. Objective: We aim to (1) assess the mobility patterns and experiences of older adults with memory problems, (2) co-design an electronic decision support intervention (e-DSI) that integrates users? mobility patterns and experiences, (3) explore their intention to use an e-DSI to support autonomy at home, and (4) inform future SDM processes about housing options. Methods: Informed by the Good Reporting of A Mixed Methods Study (GRAMMS) reporting guidelines, we will conduct a 3-year, multipronged mixed methods study in Canada, Sweden, and the Netherlands. For Phase 1, we will recruit a convenience sample of 20 older adults living at home with memory problems from clinical and community settings in each country, for a total of 60 participants. We will ask participants to record their mobility patterns outside their home for 14 days using a GPS tracker and a travel diary; in addition, we will conduct a walking interview and a final debrief interview after 14 days. For Phase 2, referring to results from the first phase, we will conduct one user-centered co-design process per country with older adults with memory issues, caregivers, health care professionals, and information technology representatives informed by the Double Diamond method. We will ask participants how personalized information about mobility patterns and experiences could be added to an existing e-DSI and how this information could inform SDM about housing options. For Phase 3, using online web-based surveys, we will invite 210 older adults with memory problems and/or their caregivers, split equally across the three countries, to use the e-DSI and provide feedback on its strengths and limitations. Finally, in Phase 4, we will triangulate and compare data from all phases and countries to inform a stakeholder meeting where an action plan will be developed. Results: The study opened for recruitment in the Netherlands in November 2018 and in Canada and Sweden in December 2019. Data collection will be completed by April 2021. Conclusions: This project will explore how e-DSIs can integrate the mobility patterns and mobility experiences of older adults with memory problems in three countries, improve older adults? autonomy, and, ultimately, inform SDM about housing options. Trial Registration: ClinicalTrials.gov NCT04267484; https://clinicaltrials.gov/ct2/show/NCT04267484 International Registered Report Identifier (IRRID): DERR1-10.2196/19244 UR - http://www.researchprotocols.org/2021/1/e19244/ UR - http://dx.doi.org/10.2196/19244 UR - http://www.ncbi.nlm.nih.gov/pubmed/33475512 ID - info:doi/10.2196/19244 ER - TY - JOUR AU - Greenberg, Jonathan AU - Singh, Tanya AU - Iverson, L. Grant AU - Silverberg, D. Noah AU - Macklin, A. Eric AU - Parker, A. Robert AU - Giacino, T. Joseph AU - Yeh, Y. Gloria AU - Vranceanu, Ana-Maria PY - 2021/1/14 TI - A Live Video Mind-Body Treatment to Prevent Persistent Symptoms Following Mild Traumatic Brain Injury: Protocol for a Mixed Methods Study JO - JMIR Res Protoc SP - e25746 VL - 10 IS - 1 KW - mild traumatic brain injury KW - anxiety KW - mixed methods KW - intervention development N2 - Background: Every year, approximately 42 million people sustain a mild traumatic brain injury (mTBI, also known as concussion), with particularly high rates among college-aged individuals. A substantial proportion of these people (44%-64%) develop persistent symptoms that are challenging to treat, costly, and associated with significant disability. Anxiety has emerged as a risk factor for progression from acute to persistent mTBI symptoms. Objective: This study aims to develop, adapt, and establish the feasibility of the Toolkit for Optimal Recovery after Concussions (TOR-C), an innovative mind-body program aimed at preventing persistent symptoms among young adults with mTBI and comorbid anxiety. Here, we describe the proposed study design, methodology, measurement, and treatment manuals. Methods: In phase 1, we will conduct individual, live video qualitative interviews (up to n=20) with college-aged individuals with mTBI and comorbid anxiety to inform adaptation of the intervention and study procedures. In phase 2, an open pilot of the live video TOR-C (n=5) with exit interviews will be conducted to explore the initial feasibility, acceptability, and credibility of the program and to refine the study procedures. Phase 3 will involve conducting a feasibility randomized controlled trial (N=50) of the TOR-C versus a health education control (Health Enhancement for Concussions; HE-C), both delivered via live video, to establish feasibility of recruitment procedures (screening, eligibility, and enrollment) and data collection; feasibility, credibility, and acceptability of the live video TOR-C and HE-C (adherence, retention, fidelity, and satisfaction) following prespecified benchmarks; and a signal of improvement in outcomes. Results: Phase 1 of the study has been approved by the Massachusetts General Hospital Institutional Review Board. Study completion is anticipated by early 2025. Conclusions: We will develop and test the first mind-body intervention focused on prevention of persistent symptoms following mTBI in young adults with comorbid anxiety problems. This will allow us to establish feasibility markers in postconcussive symptoms, anxiety, disability, and fear avoidance to inform a future efficacy trial of the TOR-C versus HE-C. International Registered Report Identifier (IRRID): PRR1-10.2196/25746 UR - https://www.researchprotocols.org/2021/1/e25746 UR - http://dx.doi.org/10.2196/25746 UR - http://www.ncbi.nlm.nih.gov/pubmed/33443484 ID - info:doi/10.2196/25746 ER - TY - JOUR AU - Quilico, Enrico AU - Swaine, Bonnie AU - Alarie, Christophe AU - Colantonio, Angela PY - 2021/1/13 TI - Community-Based Physical Activity Interventions for Individuals with Moderate to Severe Traumatic Brain Injury: Scoping Review Protocol JO - JMIR Res Protoc SP - e24689 VL - 10 IS - 1 KW - traumatic brain injury KW - community KW - physical activity KW - exercise KW - sex KW - gender N2 - Background: Long-term physical, cognitive, and psychosocial problems resulting from moderate to severe traumatic brain injury (TBI) can prevent individuals from returning to preinjury lifestyles because of significant challenges with employment, leisure, and relationships. While physical activity (PA) is proposed as a cost-effective method to alleviate problems after moderate to severe TBI, there is no review to date that synthesizes the evidence for PA in the community-based context. Further, although sex- and gender-based considerations in research are considered requisite to good science, there is no review on PA and TBI that has included this explicit focus. Objective: The purpose of this review is to map and synthesize the current evidence identified through a systematic search of community-based PA interventions for individuals of all ages with moderate to severe TBI and provide an overview of that evidence by asking the following research questions: (1) what are the characteristics of community-based PA programs for individuals with moderate to severe TBI, (2) what are the reported health-related outcomes and measurement tools used to evaluate them, and (3) what considerations have been given to sex and/or gender? Methods: Searches will be conducted of six academic databases for peer-reviewed articles. Two reviewers will independently screen the articles for inclusion and extract data for the analysis. The extracted data will be coded according to the Consensus on Exercise Reporting Template checklist and the Template for Intervention Description and Replication checklist to provide sufficient detail for replication. Results: The abstract screening was completed by two reviewers and the extracted data were analyzed. A qualitative synthesis and description of community-based PA interventions for individuals with moderate to severe TBI will be provided. Conclusions: This scoping review will generate new knowledge from published and publicly available literature. Dissemination of the results will include activities related to knowledge transfer for community-based PA after moderate to severe TBI for future research and practice. Evidence-based recommendations, future directions, potential limitations, use of online/digital components, and the possible need for a systematic review will be discussed as well. International Registered Report Identifier (IRRID): DERR1-10.2196/24689 UR - http://www.researchprotocols.org/2021/1/e24689/ UR - http://dx.doi.org/10.2196/24689 UR - http://www.ncbi.nlm.nih.gov/pubmed/33439145 ID - info:doi/10.2196/24689 ER - TY - JOUR AU - Moussavi, Zahra AU - Rutherford, Grant AU - Lithgow, Brian AU - Millikin, Colleen AU - Modirrousta, Mandana AU - Mansouri, Behzad AU - Wang, Xikui AU - Omelan, Craig AU - Fellows, Lesley AU - Fitzgerald, Paul AU - Koski, Lisa PY - 2021/1/8 TI - Repeated Transcranial Magnetic Stimulation for Improving Cognition in Patients With Alzheimer Disease: Protocol for a Randomized, Double-Blind, Placebo-Controlled Trial JO - JMIR Res Protoc SP - e25144 VL - 10 IS - 1 KW - repetitive transcranial magnetic stimulation KW - Alzheimer disease KW - double blind KW - treatment KW - placebo controlled KW - randomized N2 - Background: Alzheimer disease has no known cure. As existing pharmacologic interventions only modestly slow cognitive decline, there is a need for new treatments. Recent trials of repetitive transcranial magnetic stimulation (rTMS) have reported encouraging results for improving or stabilizing cognition in patients diagnosed with Alzheimer dementia. However, owing to small samples and lack of a well-controlled double-blind design, the results to date are inconclusive. This paper presents the protocol for a large placebo-controlled double-blind study designed with sufficient statistical rigor to measure the efficacy of rTMS treatment in patients with Alzheimer dementia. Objective: The objectives are to (1) recruit and enroll up to 200 eligible participants, (2) estimate the difference in treatment effects between active treatment and sham treatment, (3) estimate the difference in treatment effects between two doses of rTMS applications, (4) estimate the duration of treatment effects among responders to active rTMS treatment, and (5) estimate the effect of dementia severity on treatment outcomes among patients receiving active rTMS treatment. Methods: We have designed our study to be a double-blind, randomized, placebo-controlled clinical trial investigating the short- and long-term (up to 6 months) benefits of active rTMS treatment at two doses (10 sessions over 2 weeks and 20 sessions over 4 weeks) compared with sham rTMS treatment. The study will include patients aged ?55 years who are diagnosed with Alzheimer disease at an early to moderate stage and have no history of seizures and no major depression. The primary outcome measure is the change in the Alzheimer Disease Assessment Scale-Cognitive Subscale score from pretreatment to posttreatment. Secondary outcomes are changes in performance on tests of frontal lobe functioning (Stroop test and verbal fluency), changes in neuropsychiatric symptoms (Neuropsychiatric Inventory Questionnaire), and changes in activities of daily living (Alzheimer Disease Co-operative Study-Activities of Daily Living Inventory). Tolerability of the intervention will be assessed using a modification of the Treatment Satisfaction Questionnaire for Medication. We assess participants at baseline and 3, 5, 8, 16, and 24 weeks after the intervention. Results: As of November 1, 2020, we have screened 523 individuals, out of which 133 were eligible and have been enrolled. Out of the 133 individuals, 104 have completed the study. Moreover, as of November 1, 2020, there has been no serious adverse event. We anticipate that rTMS will considerably improve cognitive function, with effects lasting up to 3 months. Moreover, we expect rTMS to be a well-tolerated treatment with no serious side effect. Conclusions: This protocol design will allow to address both the rTMS active treatment dose and its short- and long-term effects compared with sham treatment in large samples. Trial Registration: ClinicalTrials.gov NCT02908815; https://clinicaltrials.gov/ct2/show/NCT02908815 International Registered Report Identifier (IRRID): DERR1-10.2196/25144 UR - http://www.researchprotocols.org/2021/1/e25144/ UR - http://dx.doi.org/10.2196/25144 UR - http://www.ncbi.nlm.nih.gov/pubmed/33416500 ID - info:doi/10.2196/25144 ER - TY - JOUR AU - Georgiou, Theodoros AU - Holland, Simon AU - van der Linden, Janet PY - 2020/11/24 TI - Rhythmic Haptic Cueing for Gait Rehabilitation of People With Hemiparesis: Quantitative Gait Study JO - JMIR Biomed Eng SP - e18649 VL - 5 IS - 1 KW - hemiparetic gait KW - stroke KW - technology assisted rehabilitation KW - quantitative study KW - gait analysis KW - gait asymmetry KW - gait KW - neurology KW - hemiparesis KW - rehabilitation KW - brain injury N2 - Background: Rhythm, brain, and body are closely linked. Humans can synchronize their movement to auditory rhythms in ways that can improve the regularity of movement while reducing perceived effort. However, the ability to perform rhythmic movement may be disrupted by various neurological conditions. Many such conditions impair mechanisms that control movement, such as gait, but typically without rhythmic perception being affected. This paper focuses on hemiparetic stroke, a neurological condition that affects one side of the body. Hemiparetic stroke can cause severe asymmetries in gait, leading to numerous physical problems ranging from muscle degeneration to bone fractures. Movement synchronization via entrainment to auditory metronomes is known to improve asymmetry and related gait problems; this paper presents the first systematic study of entrainment for gait rehabilitation via the haptic modality. Objective: This paper explores the gait rehabilitation of people with hemiparesis following a stroke or brain injury, by a process of haptic entrainment to rhythmic cues. Various objective measures, such as stride length and stride time, are considered. Methods: This study is a quantitative gait study combining temporal and spatial data on haptically cued participants with hemiparetic stroke and brain injury. We designed wearable devices to deliver the haptic rhythm, called Haptic Bracelets, which were placed on the leg near the knee. Spatial data were recorded using a Qualisys optical motion capturing system, consisting of 8 optoelectronic cameras, and 20 markers placed on anatomical lower limb landmarks and 4 additional tracking clusters placed on the right and left shank and thigh. Gait characteristics were measured before, during, and after cueing. Results: All 11 successfully screened participants were able to synchronize their steps to a haptically presented rhythm. Specifically, 6 participants demonstrated immediate improvements regarding their temporal gait characteristics, and 3 of the 6 improved their gait in terms of spatial characteristics. Conclusions: Considering the great variability between survivors of stroke and brain injury and the limited number of available participants in our study, there is no claim of statistical evidence that supports a formal experimental result of improved gait. However, viewing this empirical gait investigation as a set of 11 case studies, more modest empirical claims can be made. All participants were able to synchronize their steps to a haptically presented rhythm. For a substantial proportion of participants, an immediate (though not necessarily lasting) improvement of temporal gait characteristics was found during cueing. Some improvements over baseline occurred immediately after, rather than during, haptic cueing. Design issues and trade-offs are identified, and interactions between perception, sensory deficit, attention, memory, cognitive load, and haptic entrainment are noted. UR - http://biomedeng.jmir.org/2020/1/e18649/ UR - http://dx.doi.org/10.2196/18649 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/18649 ER - TY - JOUR AU - Evers, JW Luc AU - Raykov, P. Yordan AU - Krijthe, H. Jesse AU - Silva de Lima, Lígia Ana AU - Badawy, Reham AU - Claes, Kasper AU - Heskes, M. Tom AU - Little, A. Max AU - Meinders, J. Marjan AU - Bloem, R. Bastiaan PY - 2020/10/9 TI - Real-Life Gait Performance as a Digital Biomarker for Motor Fluctuations: The Parkinson@Home Validation Study JO - J Med Internet Res SP - e19068 VL - 22 IS - 10 KW - digital biomarkers KW - remote patient monitoring KW - wearable sensors KW - real-life gait KW - Parkinson disease KW - biomarker KW - patient monitoring KW - wearables KW - gait N2 - Background: Wearable sensors have been used successfully to characterize bradykinetic gait in patients with Parkinson disease (PD), but most studies to date have been conducted in highly controlled laboratory environments. Objective: This paper aims to assess whether sensor-based analysis of real-life gait can be used to objectively and remotely monitor motor fluctuations in PD. Methods: The Parkinson@Home validation study provides a new reference data set for the development of digital biomarkers to monitor persons with PD in daily life. Specifically, a group of 25 patients with PD with motor fluctuations and 25 age-matched controls performed unscripted daily activities in and around their homes for at least one hour while being recorded on video. Patients with PD did this twice: once after overnight withdrawal of dopaminergic medication and again 1 hour after medication intake. Participants wore sensors on both wrists and ankles, on the lower back, and in the front pants pocket, capturing movement and contextual data. Gait segments of 25 seconds were extracted from accelerometer signals based on manual video annotations. The power spectral density of each segment and device was estimated using Welch?s method, from which the total power in the 0.5- to 10-Hz band, width of the dominant frequency, and cadence were derived. The ability to discriminate between before and after medication intake and between patients with PD and controls was evaluated using leave-one-subject-out nested cross-validation. Results: From 18 patients with PD (11 men; median age 65 years) and 24 controls (13 men; median age 68 years), ?10 gait segments were available. Using logistic LASSO (least absolute shrinkage and selection operator) regression, we classified whether the unscripted gait segments occurred before or after medication intake, with mean area under the receiver operator curves (AUCs) varying between 0.70 (ankle of least affected side, 95% CI 0.60-0.81) and 0.82 (ankle of most affected side, 95% CI 0.72-0.92) across sensor locations. Combining all sensor locations did not significantly improve classification (AUC 0.84, 95% CI 0.75-0.93). Of all signal properties, the total power in the 0.5- to 10-Hz band was most responsive to dopaminergic medication. Discriminating between patients with PD and controls was generally more difficult (AUC of all sensor locations combined: 0.76, 95% CI 0.62-0.90). The video recordings revealed that the positioning of the hands during real-life gait had a substantial impact on the power spectral density of both the wrist and pants pocket sensor. Conclusions: We present a new video-referenced data set that includes unscripted activities in and around the participants? homes. Using this data set, we show the feasibility of using sensor-based analysis of real-life gait to monitor motor fluctuations with a single sensor location. Future work may assess the value of contextual sensors to control for real-world confounders. UR - https://www.jmir.org/2020/10/e19068 UR - http://dx.doi.org/10.2196/19068 UR - http://www.ncbi.nlm.nih.gov/pubmed/33034562 ID - info:doi/10.2196/19068 ER - TY - JOUR AU - Garcia-Rudolph, Alejandro AU - Garcia-Molina, Alberto AU - Opisso, Eloy AU - Tormos Muñoz, Jose PY - 2020/10/6 TI - Personalized Web-Based Cognitive Rehabilitation Treatments for Patients with Traumatic Brain Injury: Cluster Analysis JO - JMIR Med Inform SP - e16077 VL - 8 IS - 10 KW - cluster analysis KW - traumatic brain injury KW - web-based rehabilitation N2 - Background: Traumatic brain injury (TBI) is a leading cause of disability worldwide. TBI is a highly heterogeneous disease, which makes it complex for effective therapeutic interventions. Cluster analysis has been extensively applied in previous research studies to identify homogeneous subgroups based on performance in neuropsychological baseline tests. Nevertheless, most analyzed samples are rarely larger than a size of 100, and different cluster analysis approaches and cluster validity indices have been scarcely compared or applied in web-based rehabilitation treatments. Objective: The aims of our study were as follows: (1) to apply state-of-the-art cluster validity indices to different cluster strategies: hierarchical, partitional, and model-based, (2) to apply combined strategies of dimensionality reduction by using principal component analysis and random forests and perform stability assessment of the final profiles, (3) to characterize the identified profiles by using demographic and clinically relevant variables, and (4) to study the external validity of the obtained clusters by considering 3 relevant aspects of TBI rehabilitation: Glasgow Coma Scale, functional independence measure, and execution of web-based cognitive tasks. Methods: This study was performed from August 2008 to July 2019. Different cluster strategies were executed with Mclust, factoextra, and cluster R packages. For combined strategies, we used the FactoMineR and random forest R packages. Stability analysis was performed with the fpc R package. Between-group comparisons for external validation were performed using 2-tailed t test, chi-square test, or Mann-Whitney U test, as appropriate. Results: We analyzed 574 adult patients with TBI (mostly severe) who were undergoing web-based rehabilitation. We identified and characterized 3 clusters with strong internal validation: (1) moderate attentional impairment and moderate dysexecutive syndrome with mild memory impairment and normal spatiotemporal perception, with almost 66% (111/170) of the patients being highly educated (P<.05); (2) severe dysexecutive syndrome with severe attentional and memory impairments and normal spatiotemporal perception, with 49.2% (153/311) of the patients being highly educated (P<.05); (3) very severe cognitive impairment, with 45.2% (42/93) of the patients being highly educated (P<.05). We externally validated them with severity of injury (P=.006) and functional independence assessments: cognitive (P<.001), motor (P<.001), and total (P<.001). We mapped 151,763 web-based cognitive rehabilitation tasks during the whole period to the 3 obtained clusters (P<.001) and confirmed the identified patterns. Stability analysis indicated that clusters 1 and 2 were respectively rated as 0.60 and 0.75; therefore, they were measuring a pattern and cluster 3 was rated as highly stable. Conclusions: Cluster analysis in web-based cognitive rehabilitation treatments enables the identification and characterization of strong response patterns to neuropsychological tests, external validation of the obtained clusters, tailoring of cognitive web-based tasks executed in the web platform to the identified profiles, thereby providing clinicians a tool for treatment personalization, and the extension of a similar approach to other medical conditions. UR - https://medinform.jmir.org/2020/10/e16077 UR - http://dx.doi.org/10.2196/16077 UR - http://www.ncbi.nlm.nih.gov/pubmed/33021482 ID - info:doi/10.2196/16077 ER - TY - JOUR AU - Szczepura, Ala AU - Holliday, Nikki AU - Neville, Catriona AU - Johnson, Karen AU - Khan, Khan Amir Jahan AU - Oxford, W. Samuel AU - Nduka, Charles PY - 2020/10/5 TI - 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 JO - J Med Internet Res SP - e20406 VL - 22 IS - 10 KW - Bell palsy KW - facial nerve paralysis KW - patient experience KW - treatment pathway KW - facial exercise therapy KW - neuromuscular retraining KW - treatment adherence KW - digital technology KW - outcome measures KW - telerehabilitation KW - biosensors KW - COVID-19 N2 - 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. UR - https://www.jmir.org/2020/10/e20406 UR - http://dx.doi.org/10.2196/20406 UR - http://www.ncbi.nlm.nih.gov/pubmed/32763890 ID - info:doi/10.2196/20406 ER - TY - JOUR AU - Frost, Emily AU - Porat, Talya AU - Malhotra, Paresh AU - Picinali, Lorenzo PY - 2020/9/30 TI - A Novel Auditory-Cognitive Training App for Delaying or Preventing the Onset of Dementia: Participatory Design With Stakeholders JO - JMIR Hum Factors SP - e19880 VL - 7 IS - 3 KW - cognitive decline KW - mobile phone KW - hearing loss N2 - Background: Multiple gaming apps exist under the dementia umbrella for skills such as navigation; however, an app to specifically investigate the role of hearing loss in the process of cognitive decline is yet to be designed. There is a demonstrable gap in the utilization of games to further the knowledge of the potential relationship between hearing loss and dementia. Objective: This study aims to identify the needs, facilitators, and barriers in designing a novel auditory-cognitive training gaming app. Methods: A participatory design approach was used to engage key stakeholders across audiology and cognitive disorder specialties. Two rounds, including paired semistructured interviews and focus groups, were completed and thematically analyzed. Results: A total of 18 stakeholders participated, and 6 themes were identified to inform the next stage of app development. These included congruence with hobbies, life getting in the way, motivational challenge, accessibility, addictive competition, and realism. Conclusions: The findings can now be implemented in the development of the app. The app will be evaluated against outcome measures of speech listening in noise, cognitive and attentional tasks, quality of life, and usability. UR - http://humanfactors.jmir.org/2020/3/e19880/ UR - http://dx.doi.org/10.2196/19880 UR - http://www.ncbi.nlm.nih.gov/pubmed/32996884 ID - info:doi/10.2196/19880 ER - TY - JOUR AU - Campbell, M. Laura AU - Paolillo, W. Emily AU - Heaton, Anne AU - Tang, Bin AU - Depp, A. Colin AU - Granholm, Eric AU - Heaton, K. Robert AU - Swendsen, Joel AU - Moore, J. David AU - Moore, C. Raeanne PY - 2020/9/24 TI - Daily Activities Related to Mobile Cognitive Performance in Middle-Aged and Older Adults: An Ecological Momentary Cognitive Assessment Study JO - JMIR Mhealth Uhealth SP - e19579 VL - 8 IS - 9 KW - ecological momentary assessment KW - daily functioning KW - telemedicine KW - digital health KW - neuropsychological test KW - cognition KW - HIV KW - aging KW - mobile phone N2 - Background: Daily activities have been associated with neurocognitive performance. However, much of this research has used in-person neuropsychological testing that requires participants to travel to a laboratory or clinic, which may not always be feasible and does not allow for the examination of real-time relationships between cognition and behavior. Thus, there is a need to understand the real-time relationship between activities in the real world and neurocognitive functioning to improve tracking of symptoms or disease states and aid in the early identification of neurocognitive deficits among at-risk individuals. Objective: We used a smartphone-based ecological momentary cognitive assessment (EMCA) platform to examine real-time relationships between daily activities and neurocognitive performance (executive functioning and verbal learning) in the everyday environment of middle-aged and older adults with and without HIV. Methods: A total of 103 adults aged 50-74 years (67 persons with HIV; mean age 59 years, SD 6.4) were recruited from the University of California, San Diego HIV Neurobehavioral Research Program and the San Diego community. Participants completed our EMCA protocol for 14 days. Participants reported their current daily activities 4 times per day; following 2 of the 4 daily ecological momentary assessment (EMA) surveys, participants were administered the mobile Color-Word Interference Test (mCWIT) and mobile Verbal Learning Test (mVLT), each once per day. Activities were categorized into cognitively stimulating activities, passive leisure activities, and instrumental activities of daily living (IADLs). We used multilevel modeling to examine the same-survey and lagged within-person and between-person effects of each activity type on mobile cognitive performance. Results: On average, participants completed 91% of the EMA surveys, 85% of the mCWIT trials, and 80% of the mVLT trials, and they reported engaging in cognitively stimulating activities on 17% of surveys, passive leisure activities on 33% of surveys, and IADLs on 20% of surveys. Adherence and activity percentages did not differ by HIV status. Within-persons, engagement in cognitively stimulating activities was associated with better mCWIT performance (?=?1.12; P=.007), whereas engagement in passive leisure activities was associated with worse mCWIT performance (?=.94; P=.005). There were no lagged associations. At the aggregate between-person level, a greater percentage of time spent in cognitively stimulating activities was associated with better mean mVLT performance (?=.07; P=.02), whereas a greater percentage of time spent in passive leisure activities was associated with worse mean mVLT performance (?=?.07; P=.01). IADLs were not associated with mCWIT or mVLT performance. Conclusions: Smartphones present unique opportunities for assessing neurocognitive performance and behavior in middle-aged and older adults? own environment. Measurement of cognition and daily functioning outside of clinical settings may generate novel insights on the dynamic association of daily behaviors and neurocognitive performance and may add new dimensions to understanding the complexity of human behavior. UR - http://mhealth.jmir.org/2020/9/e19579/ UR - http://dx.doi.org/10.2196/19579 UR - http://www.ncbi.nlm.nih.gov/pubmed/32969829 ID - info:doi/10.2196/19579 ER - TY - JOUR AU - Middleton, M. Rod AU - Pearson, R. Owen AU - Ingram, Gillian AU - Craig, M. Elaine AU - Rodgers, J. William AU - Downing-Wood, Hannah AU - Hill, Joseph AU - Tuite-Dalton, Katherine AU - Roberts, Christopher AU - Watson, Lynne AU - Ford, V. David AU - Nicholas, Richard AU - PY - 2020/9/23 TI - A Rapid Electronic Cognitive Assessment Measure for Multiple Sclerosis: Validation of Cognitive Reaction, an Electronic Version of the Symbol Digit Modalities Test JO - J Med Internet Res SP - e18234 VL - 22 IS - 9 KW - cognition KW - multiple sclerosis KW - eHealth KW - electronic assessment KW - patient reported outcomes KW - neurology N2 - Background: Incorporating cognitive testing into routine clinical practice is a challenge in multiple sclerosis (MS), given the wide spectrum of both cognitive and physical impairments people can have and the time that testing requires. Shortened paper and verbal assessments predominate but still are not used routinely. Computer-based tests are becoming more widespread; however, changes in how a paper test is implemented can impact what exactly is being assessed in an individual. The Symbol Digit Modalities Test (SDMT) is one validated test that forms part of the cognitive batteries used in MS and has some computer-based versions. We developed a tablet-based SDMT variant that has the potential to be ultimately deployed to patients? own devices. Objective: This paper aims to develop, validate, and deploy a computer-based SDMT variant, the Cognition Reaction (CoRe) test, that can reliably replicate the characteristics of the paper-based SDMT. Methods: We carried out analysis using Pearson and intraclass correlations, as well as a Bland-Altman comparison, to examine consistency between the SDMT and CoRe tests and for test-retest reliability. The SDMT and CoRe tests were evaluated for sensitivity to disability levels and age. A novel metric in CoRe was found: question answering velocity could be calculated. This was evaluated in relation to disability levels and age for people with MS and compared with a group of healthy control volunteers. Results: SDMT and CoRe test scores were highly correlated and consistent with 1-month retest values. Lower scores were seen in patients with higher age and some effect was seen with increasing disability. There was no learning effect evident. Question answering velocity demonstrated a small increase in speed over the 90-second duration of the test in people with MS and healthy controls. Conclusions: This study validates a computer-based alternative to the SDMT that can be used in clinics and beyond. It enables accurate recording of elements of cognition relevant in MS but offers additional metrics that may offer further value to clinicians and people with MS. UR - http://www.jmir.org/2020/9/e18234/ UR - http://dx.doi.org/10.2196/18234 UR - http://www.ncbi.nlm.nih.gov/pubmed/32965240 ID - info:doi/10.2196/18234 ER - TY - JOUR AU - Lunardini, Francesca AU - Luperto, Matteo AU - Romeo, Marta AU - Basilico, Nicola AU - Daniele, Katia AU - Azzolino, Domenico AU - Damanti, Sarah AU - Abbate, Carlo AU - Mari, Daniela AU - Cesari, Matteo AU - Borghese, Alberto Nunzio AU - Ferrante, Simona PY - 2020/9/21 TI - Supervised Digital Neuropsychological Tests for Cognitive Decline in Older Adults: Usability and Clinical Validity Study JO - JMIR Mhealth Uhealth SP - e17963 VL - 8 IS - 9 KW - aging KW - Bells Test KW - computerized testing KW - dementia KW - early diagnosis KW - eHealth KW - mild cognitive impairment KW - neuropsychological assessment KW - Trail Making Test N2 - Background: Dementia is a major and growing health problem, and early diagnosis is key to its management. Objective: With the ultimate goal of providing a monitoring tool that could be used to support the screening for cognitive decline, this study aims to develop a supervised, digitized version of 2 neuropsychological tests: Trail Making Test and Bells Test. The system consists of a web app that implements a tablet-based version of the tests and consists of an innovative vocal assistant that acts as the virtual supervisor for the execution of the test. A replay functionality is added to allow inspection of the user?s performance after test completion. Methods: To deploy the system in a nonsupervised environment, extensive functional testing of the platform was conducted, together with a validation of the tablet-based tests. Such validation had the two-fold aim of evaluating system usability and acceptance and investigating the concurrent validity of computerized assessment compared with the corresponding paper-and-pencil counterparts. Results: The results obtained from 83 older adults showed high system acceptance, despite the patients? low familiarity with technology. The system software was successfully validated. A concurrent validation of the system reported good ability of the digitized tests to retain the same predictive power of the corresponding paper-based tests. Conclusions: Altogether, the positive results pave the way for the deployment of the system to a nonsupervised environment, thus representing a potential efficacious and ecological solution to support clinicians in the identification of early signs of cognitive decline. UR - http://mhealth.jmir.org/2020/9/e17963/ UR - http://dx.doi.org/10.2196/17963 UR - http://www.ncbi.nlm.nih.gov/pubmed/32955442 ID - info:doi/10.2196/17963 ER - TY - JOUR AU - Seo, Minseok AU - Shin, Myung-Jun AU - Park, Sung Tae AU - Park, Jong-Hwan PY - 2020/9/10 TI - Clinometric Gait Analysis Using Smart Insoles in Patients With Hemiplegia After Stroke: Pilot Study JO - JMIR Mhealth Uhealth SP - e22208 VL - 8 IS - 9 KW - stroke KW - hemiplegia KW - gait KW - smart insole KW - medical informatics KW - rehabilitation KW - observational KW - wearable KW - assessment N2 - Background: For effective rehabilitation after stroke, it is essential to conduct an objective assessment of the patient?s functional status. Several stroke severity scales have been used for this purpose, but such scales have various limitations. Objective: Gait analysis using smart insole technology can be applied continuously, objectively, and quantitatively, thereby overcoming the shortcomings of other assessment tools. Methods: To confirm the reliability of gait analysis using smart insole technology, normal healthy controls wore insoles in their shoes during the Timed Up and Go (TUG) test. The gait parameters were compared with the manually collected data. To determine the gait characteristics of patients with hemiplegia due to stroke, they were asked to wear insoles and take the TUG test; gait parameters were calculated and compared with those of control subjects. To investigate whether the gait analysis accurately reflected the patients? clinical condition, we analyzed the relationships of 22 gait parameters on 4 stroke severity scales. Results: The smart insole gait parameter data were similar to those calculated manually. Among the 18 gait parameters tested, 14 were significantly effective at distinguishing patients from healthy controls. The smart insole data revealed that the stance duration on both sides was longer in patients than controls, which has proven difficult to show using other methods. Furthermore, the sound side in patients showed a markedly longer stance duration. Regarding swing duration, that of the sound side was shorter in patients than controls, whereas that of the hemiplegic side was longer. We identified 10 significantly correlated gait parameters on the stroke severity scales. Notably, the difference in stance duration between the sound and hemiplegic sides was significantly correlated with the Fugl-Meyer Assessment (FMA) lower extremity score. Conclusions: This study confirmed the feasibility and applicability of the smart insole as a device to assess the gait of patients with hemiplegia due to stroke. In addition, we demonstrated that the FMA score was significantly correlated with the smart insole data. Providing an environment where stroke patients can easily measure walking ability helps to maintain chronic functions as well as acute rehabilitation. Trial Registration: UMIN Clinical Trials Registry UMIN000041646, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000047538 UR - http://mhealth.jmir.org/2020/9/e22208/ UR - http://dx.doi.org/10.2196/22208 UR - http://www.ncbi.nlm.nih.gov/pubmed/32909949 ID - info:doi/10.2196/22208 ER - TY - JOUR AU - Shen, Jiabin AU - Xiang, Henry AU - Luna, John AU - Grishchenko, Alice AU - Patterson, Jeremy AU - Strouse, V. Robert AU - Roland, Maxwell AU - Lundine, P. Jennifer AU - Koterba, H. Christine AU - Lever, Kimberly AU - Groner, I. Jonathan AU - Huang, Yungui AU - Lin, Deborah En-Ju PY - 2020/8/25 TI - Virtual Reality?Based Executive Function Rehabilitation System for Children With Traumatic Brain Injury: Design and Usability Study JO - JMIR Serious Games SP - e16947 VL - 8 IS - 3 KW - traumatic brain injury KW - virtual reality KW - neurological rehabilitation KW - executive function KW - cognitive rehabilitation N2 - Background: Traumatic brain injury (TBI) poses a significant threat to children?s health. Cognitive rehabilitation for pediatric TBI has the potential to improve the quality of life following the injury. Virtual reality (VR) can provide enriched cognitive training in a life-like but safe environment. However, existing VR applications for pediatric TBIs have primarily focused on physical rehabilitation. Objective: This study aims to design and develop an integrative hardware and software VR system to provide rehabilitation of executive functions (EF) for children with TBI, particularly in 3 core EF: inhibitory control, working memory, and cognitive flexibility. Methods: The VR training system was developed by an interdisciplinary team with expertise in best practices of VR design, developmental psychology, and pediatric TBI rehabilitation. Pilot usability testing of this novel system was conducted among 10 healthy children and 4 children with TBIs. Results: Our VR-based interactive cognitive training system was developed to provide assistive training on core EF following pediatric TBI. Pilot usability testing showed adequate user satisfaction ratings for both the hardware and software components of the VR system. Conclusions: This project designed and tested a novel VR-based system for executive function rehabilitation that is specifically adapted to children following TBI. UR - http://games.jmir.org/2020/3/e16947/ UR - http://dx.doi.org/10.2196/16947 UR - http://www.ncbi.nlm.nih.gov/pubmed/32447275 ID - info:doi/10.2196/16947 ER - TY - JOUR AU - Backx, Rosa AU - Skirrow, Caroline AU - Dente, Pasquale AU - Barnett, H. Jennifer AU - Cormack, K. Francesca PY - 2020/8/4 TI - Comparing Web-Based and Lab-Based Cognitive Assessment Using the Cambridge Neuropsychological Test Automated Battery: A Within-Subjects Counterbalanced Study JO - J Med Internet Res SP - e16792 VL - 22 IS - 8 KW - reliability KW - mobile health KW - neuropsychological tests KW - CANTAB KW - cognition N2 - Background: Computerized assessments are already used to derive accurate and reliable measures of cognitive function. Web-based cognitive assessment could improve the accessibility and flexibility of research and clinical assessment, widen participation, and promote research recruitment while simultaneously reducing costs. However, differences in context may influence task performance. Objective: This study aims to determine the comparability of an unsupervised, web-based administration of the Cambridge Neuropsychological Test Automated Battery (CANTAB) against a typical in-person lab-based assessment, using a within-subjects counterbalanced design. The study aims to test (1) reliability, quantifying the relationship between measurements across settings using correlational approaches; (2) equivalence, the extent to which test results in different settings produce similar overall results; and (3) agreement, by quantifying acceptable limits to bias and differences between measurement environments. Methods: A total of 51 healthy adults (32 women and 19 men; mean age 36.8, SD 15.6 years) completed 2 testing sessions, which were completed on average 1 week apart (SD 4.5 days). Assessments included equivalent tests of emotion recognition (emotion recognition task [ERT]), visual recognition (pattern recognition memory [PRM]), episodic memory (paired associate learning [PAL]), working memory and spatial planning (spatial working memory [SWM] and one touch stockings of Cambridge), and sustained attention (rapid visual information processing [RVP]). Participants were randomly allocated to one of the two groups, either assessed in-person in the laboratory first (n=33) or with unsupervised web-based assessments on their personal computing systems first (n=18). Performance indices (errors, correct trials, and response sensitivity) and median reaction times were extracted. Intraclass and bivariate correlations examined intersetting reliability, linear mixed models and Bayesian paired sample t tests tested for equivalence, and Bland-Altman plots examined agreement. Results: Intraclass correlation (ICC) coefficients ranged from ?=0.23-0.67, with high correlations in 3 performance indices (from PAL, SWM, and RVP tasks; ??0.60). High ICC values were also seen for reaction time measures from 2 tasks (PRM and ERT tasks; ??0.60). However, reaction times were slower during web-based assessments, which undermined both equivalence and agreement for reaction time measures. Performance indices did not differ between assessment settings and generally showed satisfactory agreement. Conclusions: Our findings support the comparability of CANTAB performance indices (errors, correct trials, and response sensitivity) in unsupervised, web-based assessments with in-person and laboratory tests. Reaction times are not as easily translatable from in-person to web-based testing, likely due to variations in computer hardware. The results underline the importance of examining more than one index to ascertain comparability, as high correlations can present in the context of systematic differences, which are a product of differences between measurement environments. Further work is now needed to examine web-based assessments in clinical populations and in larger samples to improve sensitivity for detecting subtler differences between test settings. UR - https://www.jmir.org/2020/8/e16792 UR - http://dx.doi.org/10.2196/16792 UR - http://www.ncbi.nlm.nih.gov/pubmed/32749999 ID - info:doi/10.2196/16792 ER - TY - JOUR AU - Signal, June Nada Elizabeth AU - McLaren, Ruth AU - Rashid, Usman AU - Vandal, Alain AU - King, Marcus AU - Almesfer, Faisal AU - Henderson, Jeanette AU - Taylor, Denise PY - 2020/7/29 TI - Haptic Nudges Increase Affected Upper Limb Movement During Inpatient Stroke Rehabilitation: Multiple-Period Randomized Crossover Study JO - JMIR Mhealth Uhealth SP - e17036 VL - 8 IS - 7 KW - stroke KW - rehabilitation KW - physical activity KW - movement KW - disability KW - technology KW - upper limb KW - wearable KW - haptic KW - nudge N2 - Background: As many as 80% of stroke survivors experience upper limb (UL) disability. The strong relationships between disability, lost productivity, and ongoing health care costs mean reducing disability after stroke is critical at both individual and society levels. Unfortunately, the amount of UL-focused rehabilitation received by people with stroke is extremely low. Activity monitoring and promotion using wearable devices offer a potential technology-based solution to address this gap. Commonly, wearable devices are used to deliver a haptic nudge to the wearer with the aim of promoting a particular behavior. However, little is known about the effectiveness of haptic nudging in promoting behaviors in patient populations. Objective: This study aimed to estimate the effect of haptic nudging delivered via a wrist-worn wearable device on UL movement in people with UL disability following stroke undertaking inpatient rehabilitation. Methods: A multiple-period randomized crossover design was used to measure the association of UL movement with the occurrence of haptic nudge reminders to move the affected UL in 20 people with stroke undertaking inpatient rehabilitation. UL movement was observed and classified using movement taxonomy across 72 one-minute observation periods from 7:00 AM to 7:00 PM on a single weekday. On 36 occasions, a haptic nudge to move the affected UL was provided just before the observation period. On the other 36 occasions, no haptic nudge was given. The timing of the haptic nudge was randomized across the observation period for each participant. Statistical analysis was performed using mixed logistic regression. The effect of a haptic nudge was evaluated from the intention-to-treat dataset as the ratio of the odds of affected UL movement during the observation period following a ?Planned Nudge? to the odds of affected limb movement during the observation period following ?No Nudge.? Results: The primary intention-to-treat analysis showed the odds ratio (OR) of affected UL movement following a haptic nudge was 1.44 (95% CI 1.28-1.63, P<.001). The secondary analysis revealed an increased odds of affected UL movement following a Planned Nudge was predominantly due to increased odds of spontaneous affected UL movement (OR 2.03, 95% CI 1.65-2.51, P<.001) rather than affected UL movement in conjunction with unaffected UL movement (OR 1.13, 95% CI 0.99-1.29, P=.07). Conclusions: Haptic nudging delivered via a wrist-worn wearable device increases affected UL movement in people with UL disability following stroke undertaking inpatient rehabilitation. The promoted movement appears to be specific to the instructions given. Trial Registration: Australia New Zealand Clinical Trials Registry 12616000654459; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370687&isReview=true UR - https://mhealth.jmir.org/2020/7/e17036 UR - http://dx.doi.org/10.2196/17036 UR - http://www.ncbi.nlm.nih.gov/pubmed/32723718 ID - info:doi/10.2196/17036 ER - TY - JOUR AU - Dimaguila, Luis Gerardo AU - Gray, Kathleen AU - Merolli, Mark PY - 2020/7/28 TI - Enabling Better Use of Person-Generated Health Data in Stroke Rehabilitation Systems: Systematic Development of Design Heuristics JO - J Med Internet Res SP - e17132 VL - 22 IS - 7 KW - person-generated health data KW - patient-reported outcome measures KW - heuristics KW - stroke rehabilitation KW - consumer health informatics KW - evidence-based practice KW - information technology N2 - Background: An established and well-known method for usability assessment of various human-computer interaction technologies is called heuristic evaluation (HE). HE has been adopted for evaluations in a wide variety of specialized contexts and with objectives that go beyond usability. A set of heuristics to evaluate how health information technologies (HITs) incorporate features that enable effective patient use of person-generated health data (PGHD) is needed in an era where there is a growing demand and variety of PGHD-enabled technologies in health care and where a number of remote patient-monitoring technologies do not yet enable patient use of PGHD. Such a set of heuristics would improve the likelihood of positive effects from patients? use of PGHD and lower the risk of negative effects. Objective: This study aims to describe the development of a set of heuristics for the design and evaluation of how well remote patient therapeutic technologies enable patients to use PGHD (PGHD enablement). We used the case of Kinect-based stroke rehabilitation systems (K-SRS) in this study. Methods: The development of a set of heuristics to enable better use of PGHD was primarily guided by the R3C methodology. Closer inspection of the methodology reveals that neither its development nor its application to a case study were described in detail. Thus, where relevant, each step was grounded through best practice activities in the literature and by using Nielsen?s heuristics as a basis for determining the new set of heuristics. As such, this study builds on the R3C methodology, and the implementation of a mixed process is intended to result in a robust and credible set of heuristics. Results: A total of 8 new heuristics for PGHD enablement in K-SRS were created. A systematic and detailed process was applied in each step of heuristic development, which bridged the gaps described earlier. It is hoped that this would aid future developers of specialized heuristics, who could apply the detailed process of heuristic development for other domains of technology, and additionally for the case of PGHD enablement for other health conditions. The R3C methodology was also augmented through the use of qualitative studies with target users and domain experts, and it is intended to result in a robust and credible set of heuristics, before validation and refinement. Conclusions: This study is the first to develop a new set of specialized heuristics to evaluate how HITs incorporate features that enable effective patient use of PGHD, with K-SRS as a key case study. In addition, it is the first to describe how the identification of initial HIT features and concepts to enable PGHD could lead to the development of a specialized set of heuristics. UR - http://www.jmir.org/2020/7/e17132/ UR - http://dx.doi.org/10.2196/17132 UR - http://www.ncbi.nlm.nih.gov/pubmed/32720901 ID - info:doi/10.2196/17132 ER - TY - JOUR AU - Wang, Max AU - Ge, Wenbo AU - Apthorp, Deborah AU - Suominen, Hanna PY - 2020/7/27 TI - Robust Feature Engineering for Parkinson Disease Diagnosis: New Machine Learning Techniques JO - JMIR Biomed Eng SP - e13611 VL - 5 IS - 1 KW - machine learning KW - mobile phone KW - nonlinear dynamics KW - Parkinson disease KW - signal processing, computer-assisted KW - speech KW - biomarkers N2 - Background: Parkinson disease (PD) is a common neurodegenerative disorder that affects between 7 and 10 million people worldwide. No objective test for PD currently exists, and studies suggest misdiagnosis rates of up to 34%. Machine learning (ML) presents an opportunity to improve diagnosis; however, the size and nature of data sets make it difficult to generalize the performance of ML models to real-world applications. Objective: This study aims to consolidate prior work and introduce new techniques in feature engineering and ML for diagnosis based on vowel phonation. Additional features and ML techniques were introduced, showing major performance improvements on the large mPower vocal phonation data set. Methods: We used 1600 randomly selected /aa/ phonation samples from the entire data set to derive rules for filtering out faulty samples from the data set. The application of these rules, along with a joint age-gender balancing filter, results in a data set of 511 PD patients and 511 controls. We calculated features on a 1.5-second window of audio, beginning at the 1-second mark, for a support vector machine. This was evaluated with 10-fold cross-validation (CV), with stratification for balancing the number of patients and controls for each CV fold. Results: We showed that the features used in prior literature do not perform well when extrapolated to the much larger mPower data set. Owing to the natural variation in speech, the separation of patients and controls is not as simple as previously believed. We presented significant performance improvements using additional novel features (with 88.6% certainty, derived from a Bayesian correlated t test) in separating patients and controls, with accuracy exceeding 58%. Conclusions: The results are promising, showing the potential for ML in detecting symptoms imperceptible to a neurologist. UR - https://biomedeng.jmir.org/2020/1/e13611 UR - http://dx.doi.org/10.2196/13611 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/13611 ER - TY - JOUR AU - Weizenbaum, Emma AU - Torous, John AU - Fulford, Daniel PY - 2020/7/23 TI - Cognition in Context: Understanding the Everyday Predictors of Cognitive Performance in a New Era of Measurement JO - JMIR Mhealth Uhealth SP - e14328 VL - 8 IS - 7 KW - smartphone KW - mobile phone KW - neuropsychology KW - individualized medicine N2 - Background: Research suggests that variability in attention and working memory scores, as seen across time points, may be a sensitive indicator of impairment compared with a singular score at one point in time. Given that fluctuation in cognitive performance is a meaningful metric of real-world function and trajectory, it is valuable to understand the internal state-based and environmental factors that could be driving these fluctuations in performance. Objective: In this viewpoint, we argue for the use of repeated mobile assessment as a way to better understand how context shapes moment-to-moment cognitive performance. To elucidate potential factors that give rise to intraindividual variability, we highlight existing literature that has linked both internal and external modifying variables to a number of cognitive domains. We identify ways in which these variables could be measured using mobile assessment to capture them in ecologically meaningful settings (ie, in daily life). Finally, we describe a number of studies that have already begun to use mobile assessment to measure changes in real time cognitive performance in people?s daily environments and the ways in which this burgeoning methodology may continue to advance the field. Methods: This paper describes selected literature on contextual factors that examined how experimentally induced or self-reported contextual variables (ie, affect, motivation, time of day, environmental noise, physical activity, and social activity) related to tests of cognitive performance. We also selected papers that used mobile assessment of cognition; these papers were chosen for their use of high-frequency time-series measurement of cognition using a mobile device. Results: Upon review of the relevant literature, it is evident that contextual factors have the potential to meaningfully impact cognitive performance when measured in laboratory and daily life environments. Although this research has shed light on the question of what gives rise to real-life variability in cognitive function (eg, affect and activity), many of the studies were limited by traditional methods of data collection (eg, involving retrospective recall). Furthermore, cognition has often been measured in one domain or in one age group, which does not allow us to extrapolate results to other cognitive domains and across the life span. On the basis of the literature reviewed, mobile assessment of cognition shows high levels of feasibility and validity and could be a useful method for capturing individual cognitive variability in real-world contexts via passive and active measures. Conclusions: We propose that, through the use of mobile assessment, there is an opportunity to combine multiple sources of contextual and cognitive data. These data have the potential to provide individualized digital signatures that could improve diagnostic precision and lead to meaningful clinical outcomes in a wide range of psychiatric and neurological disorders. UR - https://mhealth.jmir.org/2020/7/e14328 UR - http://dx.doi.org/10.2196/14328 UR - http://www.ncbi.nlm.nih.gov/pubmed/32706680 ID - info:doi/10.2196/14328 ER - TY - JOUR AU - Langan, Jeanne AU - Bhattacharjya, Sutanuka AU - Subryan, Heamchand AU - Xu, Wenyao AU - Chen, Baicheng AU - Li, Zhengxiong AU - Cavuoto, Lora PY - 2020/7/22 TI - In-Home Rehabilitation Using a Smartphone App Coupled With 3D Printed Functional Objects: Single-Subject Design Study JO - JMIR Mhealth Uhealth SP - e19582 VL - 8 IS - 7 KW - stroke KW - rehabilitation KW - smart technology KW - 3D printing KW - usability N2 - Background: Stroke is a major cause of long-term disability. While there is potential for improvements long after stroke onset, there is little to support functional recovery across the lifespan. mHealth solutions can help fill this gap. mRehab was designed to guide individuals with stroke through a home program and provide performance feedback. Objective: To examine if individuals with chronic stroke can use mRehab at home to improve upper limb mobility. The secondary objective was to examine if changes in limb mobility transferred to standardized clinical assessments. Methods: mRehab consists of a smartphone coupled with 3D printed household items: mug, bowl, key, and doorknob. The smartphone custom app guides task-oriented activities and measures both time to complete an activity and quality of movement (smoothness/accuracy). It also provides performance-based feedback to aid the user in self-monitoring their performance. Task-oriented activities were categorized as (1) object transportation, (2) prehensile grip with supination/pronation, (3) fractionated finger movement, and (4) walking with object. A total of 18 individuals with stroke enrolled in the single-subject experimental design study consisting of pretesting, a 6-week mRehab home program, and posttesting. Pre- and posttesting included both in-laboratory clinical assessments and in-home mRehab recorded samples of task performance. During the home program, mRehab recorded performance data. A System Usability Scale assessed user?s perception of mRehab. Results: A total of 16 participants completed the study and their data are presented in the results. The average days of exercise for each mRehab activity ranged from 15.93 to 21.19 days. This level of adherence was sufficient for improvements in time (t15=2.555, P=.02) and smoothness (t15=3.483, P=.003) in object transportation. Clinical assessments indicated improvements in functional performance (t15=2.675, P=.02) and hand dexterity (t15=2.629, P=.02). Participant?s perception of mRehab was positive. Conclusions: Despite heterogeneity in participants? use of mRehab, there were improvements in upper limb mobility. Smartphone-based portable technology can support home rehabilitation programs in chronic conditions such as stroke. The ability to record performance data from home rehabilitation offers new insights into the impact of home programs on outcomes. Trial Registration: ClinicalTrials.gov NCT04363944; https://clinicaltrials.gov/ct2/show/NCT04363944 UR - http://mhealth.jmir.org/2020/7/e19582/ UR - http://dx.doi.org/10.2196/19582 UR - http://www.ncbi.nlm.nih.gov/pubmed/32706702 ID - info:doi/10.2196/19582 ER - TY - JOUR AU - Bashir, Ayisha PY - 2020/7/17 TI - Stroke and Telerehabilitation: A Brief Communication JO - JMIR Rehabil Assist Technol SP - e18919 VL - 7 IS - 2 KW - telerehabilitation KW - rehabilitation KW - nursing KW - stroke KW - telehealth UR - https://rehab.jmir.org/2020/2/e18919 UR - http://dx.doi.org/10.2196/18919 UR - http://www.ncbi.nlm.nih.gov/pubmed/32706739 ID - info:doi/10.2196/18919 ER - TY - JOUR AU - Saredakis, Dimitrios AU - Keage, AD Hannah AU - Corlis, Megan AU - Loetscher, Tobias PY - 2020/6/26 TI - Using Virtual Reality to Improve Apathy in Residential Aged Care: Mixed Methods Study JO - J Med Internet Res SP - e17632 VL - 22 IS - 6 KW - reminiscence KW - head-mounted display KW - apathy KW - cognitive aging KW - dementia KW - residential facilities KW - virtual reality N2 - Background: Apathy is a common symptom in neurological disorders, including dementia, and is associated with a faster rate of cognitive decline, reduced quality of life, and high caregiver burden. There is a lack of effective pharmacological treatments for apathy, and nonpharmacological interventions are a preferred first-line approach to treatment. Virtual reality (VR) using head-mounted displays (HMDs) is being successfully used in exposure- and distraction-based therapies; however, there is limited research on using HMDs for symptoms of neurological disorders. Objective: This feasibility study aimed to assess whether VR using HMDs could be used to deliver tailored reminiscence therapy and examine the willingness to participate, response rates to measures, time taken to create tailored content, and technical problems. In addition, this study aimed to explore the immediate effects between verbal fluency and apathy after exposure to VR. Methods: A mixed methods study was conducted in a sample of older adults residing in aged care, and 17 participants were recruited. Apathy was measured using the Apathy Evaluation Scale (AES), and verbal fluency was used as a proxy measure of improvements in apathy and debriefing interviews to assess feedback from participants. Side effects that can occur from using HMDs were also measured. Results: We recruited participants from a high socioeconomic status setting with a high education level, and the participation rate was 85% (17/20); most responses to measures were positive. Access to a wide range of freely available content and the absence of technical difficulties made the delivery of a VR reminiscence intervention highly feasible. Participants had improved semantic scores (t14=?3.27; P=.006) but not phonemic fluency scores (t14=0.55; P=.59) immediately after the intervention. Those with higher levels of apathy demonstrated the greatest cognitive improvements after a VR reminiscence experience, which was indicated by a strong positive relationship between the AES and semantic verbal fluency change scores postminus pre-VR (r=0.719; 95% CI 0.327 to 0.900; P=.003). All participants enjoyed the experience despite 35% (6/17) of participants experiencing temporary side effects. Conclusions: This study provides initial evidence that it is feasible to use VR with HMDs for therapy to treat symptoms of apathy in older adults in residential aged care. However, there is a need to closely monitor the side effects of HMD use in older adults. Further research is needed using an active control group to compare the use of VR with traditional forms of reminiscence therapy. UR - http://www.jmir.org/2020/6/e17632/ UR - http://dx.doi.org/10.2196/17632 UR - http://www.ncbi.nlm.nih.gov/pubmed/32469314 ID - info:doi/10.2196/17632 ER - TY - JOUR AU - Masurovsky, Alexander PY - 2020/6/26 TI - Controlling for Placebo Effects in Computerized Cognitive Training Studies With Healthy Older Adults From 2016-2018: Systematic Review JO - JMIR Serious Games SP - e14030 VL - 8 IS - 2 KW - computerized cognitive training KW - brain training KW - placebo KW - active control KW - elderly KW - older adults N2 - Background: Computerized cognitive training has been proposed as a potential solution to age-related cognitive decline. However, published findings from evaluation studies of cognitive training games, including metastudies and systematic reviews, provide evidence both for and against transferability from trained tasks to untrained cognitive ability. There continues to be no consensus on this issue from the scientific community. Some researchers have proposed that the number of results supporting the efficacy of cognitive training may be inflated due to placebo effects. It has been suggested that placebo effects need to be better controlled by using an active control and measuring participant expectations for improvement in outcome measures. Objective: This review examined placebo control methodology for recent evaluation studies of computerized cognitive training programs with older adult subjects, specifically looking for the use of an active control and measurement of expectations. Methods: Data were extracted from PubMed. Evaluation studies of computerized cognitive training with older adult subjects (age ?50 years) published between 2016 and 2018 were included. Methods sections of studies were searched for (1) control type (active or passive) and subtype (active: active-ingredient or similar-form; passive: no-contact or passive-task); (2) if expectations were measured, how were they measured, and whether they were used in analysis; and (3) whether researchers acknowledged a lack of active control and lack of expectation measurement as limitations (where appropriate). Results: Of the 19 eligible studies, 4 (21%) measured expectations, and 9 (47%) included an active control condition, all of which were of the similar-form type. The majority of the studies (10/19, 53%) used only a passive control. Of the 9 studies that found results supporting the efficacy of cognitive training, 5 were for far transfer effects. Regarding the limitations, due to practical considerations, the search was limited to one source (PubMed) and to search results only. The search terms may have been too restrictive. Recruitment methods were not analyzed, although this aspect of research may play a critical role in systematically forming groups with different expectations for improvement. The population was limited to healthy older adults, while evaluation studies include other populations and cognitive training types, which may exhibit better or worse placebo control than the studies examined in this review. Conclusions: Poor placebo control was present in 47% (9/19) of the reviewed studies; however, the studies still published results supporting the effectiveness of cognitive training programs. Of these positive results, 5 were for far transfer effects, which form the basis for broad claims by cognitive training game makers about the scientific validity of their product. For a minimum level of placebo control, future evaluation studies should use a similar-form active control and administer a questionnaire to participants at the end of the training period about their own perceptions of improvement. Researchers are encouraged to think of more methods for the valid measure of expectations at other time points in the training. UR - http://games.jmir.org/2020/2/e14030/ UR - http://dx.doi.org/10.2196/14030 UR - http://www.ncbi.nlm.nih.gov/pubmed/32589159 ID - info:doi/10.2196/14030 ER - TY - JOUR AU - Templeton, Michael John AU - Poellabauer, Christian AU - Schneider, Sandra PY - 2020/6/24 TI - Enhancement of Neurocognitive Assessments Using Smartphone Capabilities: Systematic Review JO - JMIR Mhealth Uhealth SP - e15517 VL - 8 IS - 6 KW - mobile phone KW - mobile health KW - neurocognitive tests KW - neurodegenerative disease KW - neurocognitive disorders N2 - Background: Comprehensive exams such as the Dean-Woodcock Neuropsychological Assessment System, the Global Deterioration Scale, and the Boston Diagnostic Aphasia Examination are the gold standard for doctors and clinicians in the preliminary assessment and monitoring of neurocognitive function in conditions such as neurodegenerative diseases and acquired brain injuries (ABIs). In recent years, there has been an increased focus on implementing these exams on mobile devices to benefit from their configurable built-in sensors, in addition to scoring, interpretation, and storage capabilities. As smartphones become more accepted in health care among both users and clinicians, the ability to use device information (eg, device position, screen interactions, and app usage) for subject monitoring also increases. Sensor-based assessments (eg, functional gait using a mobile device?s accelerometer and/or gyroscope or collection of speech samples using recordings from the device?s microphone) include the potential for enhanced information for diagnoses of neurological conditions; mapping the development of these conditions over time; and monitoring efficient, evidence-based rehabilitation programs. Objective: This paper provides an overview of neurocognitive conditions and relevant functions of interest, analysis of recent results using smartphone and/or tablet built-in sensor information for the assessment of these different neurocognitive conditions, and how human-device interactions and the assessment and monitoring of these neurocognitive functions can be enhanced for both the patient and health care provider. Methods: This survey presents a review of current mobile technological capabilities to enhance the assessment of various neurocognitive conditions, including both neurodegenerative diseases and ABIs. It explores how device features can be configured for assessments as well as the enhanced capability and data monitoring that will arise due to the addition of these features. It also recognizes the challenges that will be apparent with the transfer of these current assessments to mobile devices. Results: Built-in sensor information on mobile devices is found to provide information that can enhance neurocognitive assessment and monitoring across all functional categories. Configurations of positional sensors (eg, accelerometer, gyroscope, and GPS), media sensors (eg, microphone and camera), inherent sensors (eg, device timer), and participatory user-device interactions (eg, screen interactions, metadata input, app usage, and device lock and unlock) are all helpful for assessing these functions for the purposes of training, monitoring, diagnosis, or rehabilitation. Conclusions: This survey discusses some of the many opportunities and challenges of implementing configured built-in sensors on mobile devices to enhance assessments and monitoring of neurocognitive functions as well as disease progression across neurodegenerative and acquired neurological conditions. UR - http://mhealth.jmir.org/2020/6/e15517/ UR - http://dx.doi.org/10.2196/15517 UR - http://www.ncbi.nlm.nih.gov/pubmed/32442150 ID - info:doi/10.2196/15517 ER - TY - JOUR AU - Bonnechère, Bruno AU - Bier, Jean-Christophe AU - Van Hove, Olivier AU - Sheldon, Sally AU - Samadoulougou, Sékou AU - Kirakoya-Samadoulougou, Fati AU - Klass, Malgorzata PY - 2020/6/12 TI - Age-Associated Capacity to Progress When Playing Cognitive Mobile Games: Ecological Retrospective Observational Study JO - JMIR Serious Games SP - e17121 VL - 8 IS - 2 KW - cognitive performance KW - brain training KW - cognitive monitoring KW - mobile games KW - aging KW - serious games N2 - Background: The decline of cognitive function is an important issue related to aging. Over the last few years, numerous mobile apps have been developed to challenge the brain with cognitive exercises; however, little is currently known about how age influences capacity for performance improvement when playing cognitive mobile games. Objective: The objective of this study was to analyze the score data of cognitive mobile games over a period of 100 gaming sessions to determine age-related learning ability for new cognitive tasks by measuring the level of score improvement achieved by participants of different ages. Methods: Scores from 9000 individuals of different ages for 7 cognitive mobile games over 100 gaming sessions were analyzed. Scores from the first session were compared between age groups using one-way analysis of variance. Mixed models were subsequently used to investigate the progression of scores over 100 sessions. Results: Statistically significant differences were found between age groups for the initial scores of 6 of the 7 games (linear trend, P<.001). Cognitive mobile game scores increased for all participants (P<.001) suggesting that all participants were able to improve their performance. The rate of improvement was, however, strongly influenced by the age of the participant with slower progression for older participants (P<.001). Conclusions: This study provides evidence to support two interesting insights?cognitive mobile game scores appear to be sensitive to the changes in cognitive ability that occur with advancing age; therefore, these games could be a convenient way to monitor cognitive function over long-term follow-up, and users who train with the cognitive mobile games improve regardless of age. UR - http://games.jmir.org/2020/2/e17121/ UR - http://dx.doi.org/10.2196/17121 UR - http://www.ncbi.nlm.nih.gov/pubmed/32530432 ID - info:doi/10.2196/17121 ER - TY - JOUR AU - van Beek, Willemijn Judith Jantine AU - van Wegen, Henri Erwin Everardus AU - Rietberg, Berend Marc AU - Nyffeler, Thomas AU - Bohlhalter, Stephan AU - Kamm, Philipp Christian AU - Nef, Tobias AU - Vanbellingen, Tim PY - 2020/6/9 TI - Feasibility of a Home-Based Tablet App for Dexterity Training in Multiple Sclerosis: Usability Study JO - JMIR Mhealth Uhealth SP - e18204 VL - 8 IS - 6 KW - dexterity KW - feasibility KW - multiple sclerosis KW - rehabilitation KW - app KW - home-based training N2 - Background: Persons with multiple sclerosis (MS) often experience dexterous difficulties during the performance of activities of daily living, such as fastening buttons, handling coins, or writing, therefore impacting their health-related quality of life. Mobile health (mHealth) solutions, such as tablet apps, may be used to train impaired dexterous skills. The feasibility of a tablet app?based dexterity home-based intervention in MS (TAD-MS) has not been explored yet in persons with MS. Objective: The aim of this pilot study was to evaluate the feasibility and usability of home-based dexterity training with a tablet app in both persons with MS and healthy subjects. Methods: A total of 9 persons with MS, aged 35-71 years, with an Expanded Disability Status Scale score between 2 and 7.5, performed the TAD-MS for 4 weeks, five times a week, with each training session lasting approximately 30 minutes. Participants? impaired dexterity was measured by the Nine-Hole Peg Test. A total of 10 age-matched healthy subjects also tested and rated the usability of the app. Outcome measures were the adherence rate as well as usability measured by the System Usability Scale and a Custom User Engagement Questionnaire (CUEQ). Results: High feasibility of the tablet app?based dexterity training program was shown by a 97% adherence rate to the training protocol (ie, mean 19.4/20 sessions completed, SD 0.8). High system usability scores (ie, mean 85.39%, SD 11.67) and overall high scores given in the CUEQ (ie, mean 8.2/10, SD 1.4) further point to high usability of the app. Neither demographic variables nor dexterity levels affected the use of the app. Conclusions: This pilot study is the first to demonstrate high feasibility and usability of a new tablet app?based dexterity home-based training program among both persons with MS and healthy individuals. Whether this kind of training improves dexterity will need to be evaluated in a randomized controlled trial. UR - http://mhealth.jmir.org/2020/6/e18204/ UR - http://dx.doi.org/10.2196/18204 UR - http://www.ncbi.nlm.nih.gov/pubmed/32515747 ID - info:doi/10.2196/18204 ER - TY - JOUR AU - Guzman-Parra, Jose AU - Barnestein-Fonseca, Pilar AU - Guerrero-Pertiñez, Gloria AU - Anderberg, Peter AU - Jimenez-Fernandez, Luis AU - Valero-Moreno, Esperanza AU - Goodman-Casanova, Marian Jessica AU - Cuesta-Vargas, Antonio AU - Garolera, Maite AU - Quintana, Maria AU - García-Betances, I. Rebeca AU - Lemmens, Evi AU - Sanmartin Berglund, Johan AU - Mayoral-Cleries, Fermin PY - 2020/6/1 TI - Attitudes and Use of Information and Communication Technologies in Older Adults With Mild Cognitive Impairment or Early Stages of Dementia and Their Caregivers: Cross-Sectional Study JO - J Med Internet Res SP - e17253 VL - 22 IS - 6 KW - aging KW - mild cognitive impairment KW - dementia eHealth KW - information and communication technology KW - technophilia N2 - Background: Information and communication technologies are promising tools to increase the quality of life of people with dementia or mild cognitive impairment and that of their caregivers. However, there are barriers to their use associated with sociodemographic factors and negative attitudes, as well as inadequate knowledge about technologies. Objective: The aim of this study was to analyze technophilia (attitudes toward new technologies) and the use of smartphones and tablets along with associated factors in people with dementia/mild cognitive impairment and their caregivers. Methods: Data from the first visit of the Support Monitoring and Reminder for Mild Dementia (SMART4MD) randomized multicenter clinical trial were used for this analysis. Data were obtained from two European countries, Spain and Sweden, and from three centers: Consorci Sanitari de Terrassa (Catalonia, Spain), Servicio Andaluz de Salud (Andalusia, Spain), and the Blekinge Institute of Technology (Sweden). Participants with a score between 20 and 28 in the Mini Mental State Examination, with memory problems (for more than 6 months), and who were over the age of 55 years were included in the study, along with their caregivers. The bivariate Chi square and Mann-Whitney tests, and multivariate linear and logistic regression models were used for statistical analysis. Results: A total of 1086 dyads were included (N=2172). Overall, 299 (27.53%) of people with dementia/mild cognitive impairment had a diagnosis of dementia. In addition, 588 (54.14%) of people with dementia/mild cognitive impairment reported using a smartphone almost every day, and 106 (9.76%) used specific apps or software to support their memory. Among the caregivers, 839 (77.26%) used smartphones and tablets almost every day, and 181 (16.67%) used specific apps or software to support their memory. The people with dementia/mild cognitive impairment showed a lower level of technophilia in comparison to that of their caregivers after adjusting for confounders (B=0.074, P=.02) with differences in technology enthusiasm (B=0.360, P<.001), but not in technology anxiety (B=?0.042, P=.37). Technophilia was associated with lower age (B=?0.009, P=.004), male gender (B=?0.160, P<.001), higher education level (P=.01), living arrangement (living with children vs single; B=?2.538, P=.01), country of residence (Sweden vs Spain; B=0.256, P<.001), lower depression (B=?0.046, P<.001), and better health status (B=0.004, P<.001) in people with dementia/mild cognitive impairment. Among caregivers, technophilia was associated with comparable sociodemographic factors (except for living arrangement), along with a lower caregiver burden (B=?0.005, P=.04) and better quality of life (B=0.348, P<.001). Conclusions: Technophilia was associated with a better quality of life and sociodemographic variables in people with dementia/mild cognitive impairment and caregivers, suggesting potential barriers for technological interventions. People with dementia/mild cognitive impairment frequently use smartphones and tablets, but the use of specific apps or software to support memory is limited. Interventions using these technologies are needed to overcome barriers in this population related to sociodemographic characteristics and the lack of enthusiasm for new technologies. Trial Registration: ClinicalTrials.gov NCT03325699; https://clinicaltrials.gov/ct2/show/NCT03325699 UR - https://www.jmir.org/2020/6/e17253 UR - http://dx.doi.org/10.2196/17253 UR - http://www.ncbi.nlm.nih.gov/pubmed/32442136 ID - info:doi/10.2196/17253 ER - TY - JOUR AU - Hafiz, Pegah AU - Bardram, Eyvind Jakob PY - 2020/6/1 TI - The Ubiquitous Cognitive Assessment Tool for Smartwatches: Design, Implementation, and Evaluation Study JO - JMIR Mhealth Uhealth SP - e17506 VL - 8 IS - 6 KW - cognition KW - memory KW - response time KW - attention KW - Stroop task KW - wearable devices KW - mobile phone N2 - Background: Cognitive functioning plays a significant role in individuals? mental health, since fluctuations in memory, attention, and executive functions influence their daily task performance. Existing digital cognitive assessment tools cannot be administered in the wild and their test sets are not brief enough to capture frequent fluctuations throughout the day. The ubiquitous availability of mobile and wearable devices may allow their incorporation into a suitable platform for real-world cognitive assessment. Objective: The aims of this study were threefold: (1) to evaluate a smartwatch-based tool for the assessment of cognitive performance, (2) to investigate the usability of this tool, and (3) to understand participants? perceptions regarding the application of a smartwatch in cognitive assessment. Methods: We built the Ubiquitous Cognitive Assessment Tool (UbiCAT) on a smartwatch-based platform. UbiCAT implements three cognitive tests?an Arrow test, a Letter test, and a Color test?adapted from the two-choice reaction-time, N-back, and Stroop tests, respectively. These tests were designed together with domain experts. We evaluated the UbiCAT test measures against standard computer-based tests with 21 healthy adults by applying statistical analyses significant at the 95% level. Usability testing for each UbiCAT app was performed using the Mobile App Rating Scale (MARS) questionnaire. The NASA-TLX (Task Load Index) questionnaire was used to measure cognitive workload during the N-back test. Participants rated perceived discomfort of wearing a smartwatch during the tests using a 7-point Likert scale. Upon finishing the experiment, an interview was conducted with each participant. The interviews were transcribed and semantic analysis was performed to group the findings. Results: Pearson correlation analysis between the total correct responses obtained from the UbiCAT and the computer-based tests revealed a significant strong correlation (r=.78, P<.001). One-way analysis of variance (ANOVA) showed a significant effect of the N-back difficulty level on the participants' performance measures. The study also demonstrated usability ratings above 4 out of 5 in terms of aesthetics, functionality, and information. Low discomfort (<3 out of 7) was reported by our participants after using the UbiCAT. Seven themes were extracted from the transcripts of the interviews conducted with our participants. Conclusions: UbiCAT is a smartwatch-based tool that assesses three key cognitive domains. Usability ratings showed that participants were engaged with the UbiCAT tests and did not feel any discomfort. The majority of the participants were interested in using the UbiCAT, although some preferred computer-based tests, which might be due to the widespread use of personal computers. The UbiCAT can be administered in the wild with mentally ill patients to assess their attention, working memory, and executive function. UR - https://mhealth.jmir.org/2020/6/e17506 UR - http://dx.doi.org/10.2196/17506 UR - http://www.ncbi.nlm.nih.gov/pubmed/32478664 ID - info:doi/10.2196/17506 ER - TY - JOUR AU - Held, Oskar Jeremia Philipp AU - Yu, Kevin AU - Pyles, Connor AU - Veerbeek, Marieke Janne AU - Bork, Felix AU - Heining, Sandro-Michael AU - Navab, Nassir AU - Luft, Rüdiger Andreas PY - 2020/5/26 TI - Augmented Reality?Based Rehabilitation of Gait Impairments: Case Report JO - JMIR Mhealth Uhealth SP - e17804 VL - 8 IS - 5 KW - HoloLens 2 KW - gait KW - rehabilitation KW - stroke KW - augmented reality KW - sensors N2 - Background: Gait and balance impairments are common in neurological diseases, including stroke, and negatively affect patients? quality of life. Improving balance and gait are among the main goals of rehabilitation. Rehabilitation is mainly performed in clinics, which lack context specificity; therefore, training in the patient?s home environment is preferable. In the last decade, developed rehabilitation technologies such as virtual reality and augmented reality (AR) have enabled gait and balance training outside clinics. Here, we propose a new method for gait rehabilitation in persons who have had a stroke in which mobile AR technology and a sensor-based motion capture system are combined to provide fine-grained feedback on gait performance in real time. Objective: The aims of this study were (1) to investigate manipulation of the gait pattern of persons who have had a stroke based on virtual augmentation during overground walking compared to walking without AR performance feedback and (2) to investigate the usability of the AR system. Methods: We developed the ARISE (Augmented Reality for gait Impairments after StrokE) system, in which we combined a development version of HoloLens 2 smart glasses (Microsoft Corporation) with a sensor-based motion capture system. One patient with chronic minor gait impairment poststroke completed clinical gait assessments and an AR parkour course with patient-centered performance gait feedback. The movement kinematics during gait as well as the usability and safety of the system were evaluated. Results: The patient changed his gait pattern during AR parkour compared to the pattern observed during the clinical gait assessments. He recognized the virtual objects and ranked the usability of the ARISE system as excellent. In addition, the patient stated that the system would complement his standard gait therapy. Except for the symptom of exhilaration, no adverse events occurred. Conclusions: This project provided the first evidence of gait adaptation during overground walking based on real-time feedback through visual and auditory augmentation. The system has potential to provide gait and balance rehabilitation outside the clinic. This initial investigation of AR rehabilitation may aid the development and investigation of new gait and balance therapies. UR - http://mhealth.jmir.org/2020/5/e17804/ UR - http://dx.doi.org/10.2196/17804 UR - http://www.ncbi.nlm.nih.gov/pubmed/32452815 ID - info:doi/10.2196/17804 ER - TY - JOUR AU - Li, Li AU - Huang, Jia AU - Wu, Jingsong AU - Jiang, Cai AU - Chen, Shanjia AU - Xie, Guanli AU - Ren, Jinxin AU - Tao, Jing AU - Chan, H. Chetwyn C. AU - Chen, Lidian AU - Wong, K. Alex W. PY - 2020/5/13 TI - A Mobile Health App for the Collection of Functional Outcomes After Inpatient Stroke Rehabilitation: Pilot Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e17219 VL - 8 IS - 5 KW - telemedicine KW - cell phone KW - stroke KW - rehabilitation KW - activities of daily living KW - outcome and process assessment KW - health care N2 - Background: Monitoring the functional status of poststroke patients after they transition home is significant for rehabilitation. Mobile health (mHealth) technologies may provide an opportunity to reach and follow patients post discharge. However, the feasibility and validity of functional assessments administered by mHealth technologies are unknown. Objective: This study aimed to evaluate the feasibility, validity, and reliability of functional assessments administered through the videoconference function of a mobile phone?based app compared with administration through the telephone function in poststroke patients after rehabilitation hospitalization. Methods: A randomized controlled trial was conducted in a rehabilitation hospital in Southeast China. Participants were randomly assigned to either a videoconference follow-up (n=60) or a telephone follow-up (n=60) group. We measured the functional status of participants in each group at 2-week and 3-month follow-up periods. Half the participants in each group were followed by face-to-face home visit assessments as the gold standard. Validity was assessed by comparing any score differences between videoconference follow-up and home visit assessments, as well as telephone follow-up and home visit assessments. Reliability was assessed by computing agreements between videoconference follow-up and home visit assessments, as well as telephone follow-up and home visit assessments. Feasibility was evaluated by the levels of completion, satisfaction, comfort, and confidence in the 2 groups. Results: Scores obtained from the videoconference follow-up were similar to those of the home visit assessment. However, most scores collected from telephone administration were higher than those of the home visit assessment. The agreement between videoconference follow-up and home visit assessments was higher than that between telephone follow-up and home visit assessments at all follow-up periods. In the telephone follow-up group, completion rates were 95% and 82% at 2-week and 3-month follow-up points, respectively. In the videoconference follow-up group, completion rates were 95% and 80% at 2-week and 3-month follow-up points, respectively. There were no differences in the completion rates between the 2 groups at all follow-up periods (X21=1.6, P=.21 for 2-week follow-up; X21=1.9, P=.17 for 3-month follow-up). Patients in the videoconference follow-up group perceived higher confidence than those in the telephone follow-up group at both 2-week and 3-month follow-up periods (X23=6.7, P=.04 for 2-week follow-up; X23=8.0, P=.04 for 3-month follow-up). The videoconference follow-up group demonstrated higher satisfaction than the telephone follow-up group at 3-month follow-up (X23=13.9; P=.03). Conclusions: The videoconference follow-up assessment of functional status demonstrates higher validity and reliability, as well as higher confidence and satisfaction perceived by patients, than the telephone assessment. The videoconference assessment provides an efficient means of assessing functional outcomes of patients after hospital discharge. This method provides a novel solution for clinical trials requiring longitudinal assessments. Trial Registration: chictr.org.cn: ChiCTR1900027626; http://www.chictr.org.cn/edit.aspx?pid=44831&htm=4. UR - https://mhealth.jmir.org/2020/5/e17219 UR - http://dx.doi.org/10.2196/17219 UR - http://www.ncbi.nlm.nih.gov/pubmed/32401221 ID - info:doi/10.2196/17219 ER - TY - JOUR AU - Habets, Jeroen AU - Heijmans, Margot AU - Herff, Christian AU - Simons, Claudia AU - Leentjens, FG Albert AU - Temel, Yasin AU - Kuijf, Mark AU - Kubben, Pieter PY - 2020/5/11 TI - Mobile Health Daily Life Monitoring for Parkinson Disease: Development and Validation of Ecological Momentary Assessments JO - JMIR Mhealth Uhealth SP - e15628 VL - 8 IS - 5 KW - ecological momentary assessment KW - experience sampling method KW - electronic diary KW - Parkinson?s disease monitoring N2 - Background: Parkinson disease monitoring is currently transitioning from periodic clinical assessments to continuous daily life monitoring in free-living conditions. Traditional Parkinson disease monitoring methods lack intraday fluctuation detection. Electronic diaries (eDiaries) hold the potential to collect subjective experiences on the severity and burden of motor and nonmotor symptoms in free-living conditions. Objective: This study aimed to develop a Parkinson disease?specific eDiary based on ecological momentary assessments (EMAs) and to explore its validation. Methods: An observational cohort of 20 patients with Parkinson disease used the smartphone-based EMA eDiary for 14 consecutive days without adjusting free-living routines. The eDiary app presented an identical questionnaire consisting of questions regarding affect, context, motor and nonmotor symptoms, and motor performance 7 times daily at semirandomized moments. In addition, patients were asked to complete a morning and an evening questionnaire. Results: Mean affect correlated moderate-to-strong and moderate with motor performance (R=0.38 to 0.75; P<.001) and motor symptom (R=0.34 to 0.50; P<.001) items, respectively. The motor performance showed a weak-to-moderate negative correlation with motor symptoms (R=?0.31 to ?0.48; P<.001). Mean group answers given for on-medication conditions vs wearing-off-medication conditions differed significantly (P<.05); however, not enough questionnaires were completed for the wearing-off-medication condition to reproduce these findings on individual levels. Conclusions: We presented a Parkinson disease?specific EMA eDiary. Correlations between given answers support the internal validity of the eDiary and underline EMA?s potential in free-living Parkinson disease monitoring. Careful patient selection and EMA design adjustment to this targeted population and their fluctuations are necessary to generate robust proof of EMA validation in future work. Combining clinical Parkinson disease knowledge with practical EMA experience is inevitable to design and perform studies, which will lead to the successful integration of eDiaries in free-living Parkinson disease monitoring. UR - https://mhealth.jmir.org/2020/5/e15628 UR - http://dx.doi.org/10.2196/15628 UR - http://www.ncbi.nlm.nih.gov/pubmed/32339999 ID - info:doi/10.2196/15628 ER - TY - JOUR AU - Tsolaki, C. Anthoula AU - Tsolaki, Magda AU - Pandria, Niki AU - Lazarou, Eftychia AU - Gkatzima, Olymbia AU - Zilidou, Vasiliki AU - Karagianni, Maria AU - Iakovidou-Kritsi, Zafiroula AU - Kimiskidis, K. Vasilios AU - Bamidis, D. Panagiotis PY - 2020/5/7 TI - Web-Based Intervention Effects on Mild Cognitive Impairment Based on Apolipoprotein E Genotype: Quasi-Experimental Study JO - J Med Internet Res SP - e14617 VL - 22 IS - 5 KW - mild cognitive impairment KW - APOE ?4 KW - computerized training KW - exergaming KW - Alzheimer disease N2 - Background: Apolipoprotein E (APOE) ?4 allele is a major genetic risk factor for Alzheimer disease and mild cognitive impairment (MCI). Computer-based training programs can improve cognitive performance in elderly populations. However, the effects of computer-based interventions on MCI APOE ?4 carriers have never been studied before. Objective: The effects of different web-based interventions and the APOE isoform-specific differences in training outcomes are investigated. Methods: Using a quasi-experimental study design, 202 participants with MCI aged 60 years and older took part in three different intervention programs (physical and cognitive [Long-Lasting Memories, or LLM], cognitive [Active Control, or AC], or physical intervention [Physical Training Control, or PTC]) via an innovative information and communication technologies exergaming platform. Participants in each interventional group were subdivided into APOE ?4 carriers and non?APOE ?4 carriers. All participants underwent an extensive neuropsychological evaluation before and after the training, blood tests, and brain imaging. Results: All interventions resulted in multiple statistically significant cognitive benefits after the intervention. Verbal learning (California Verbal Learning Test: immediate recall test score?LLM: P=.04; AC: P<.001), working memory (digit span forward and backward test scores?AC: P=.03; PTC: P=.02 and P=.006, respectively), and long-term memory (California Verbal Learning Test: delayed recall test score?LLM: P=.02; AC: P=.002; and PTC: P=.02) were improved. There was no statistically significant difference among the intervention effects. APOE ?4 presence moderates intervention effects as the LLM intervention improved only their task-switching processing speed (Trail Making Test, Part B: P=.03) and the PTC intervention improved only the working memory (digit span backward: P=.03). No significant performance alteration was noted for the APOE ?4+ cognitive AC training group. Conclusions: None of the applied interventions could be identified as the optimal one; it is suggested, however, that combined cognitive and physical training and physical training via exergaming may be more effective for the high-risk MCI ?POE ?4+ subgroup. UR - https://www.jmir.org/2020/5/e14617 UR - http://dx.doi.org/10.2196/14617 UR - http://www.ncbi.nlm.nih.gov/pubmed/32379048 ID - info:doi/10.2196/14617 ER - TY - JOUR AU - Tacchino, Andrea AU - Veldkamp, Renee AU - Coninx, Karin AU - Brulmans, Jens AU - Palmaers, Steven AU - Hämäläinen, Päivi AU - D'hooge, Mieke AU - Vanzeir, Ellen AU - Kalron, Alon AU - Brichetto, Giampaolo AU - Feys, Peter AU - Baert, Ilse PY - 2020/4/16 TI - Design, Development, and Testing of an App for Dual-Task Assessment and Training Regarding Cognitive-Motor Interference (CMI-APP) in People With Multiple Sclerosis: Multicenter Pilot Study JO - JMIR Mhealth Uhealth SP - e15344 VL - 8 IS - 4 KW - tablet KW - mobile device KW - cognitive rehabilitation KW - cognitive impairment KW - dual-task training KW - cognitive-motor interference KW - dual-task cost KW - adherence KW - multiple sclerosis KW - walking N2 - Background: Dual tasking constitutes a large portion of most activities of daily living; in real-lifesituations, people need to not only maintain balance and mobility skills, but also perform other cognitive or motor tasks at the same time. Interest toward dual-task training (DTT) is increasing as traditional interventions may not prepare patients to adequately face the challenges of most activities of daily living. These usually involve simultaneous cognitive and motor tasks, and they often show a decline in performance. Cognitive-motor interference (CMI) has been investigated in different neurological populations, but limited evidence is present for people with multiple sclerosis (MS). The use of computerized tools is mandatory to allow the application of more standardized assessment and rehabilitation intervention protocols and easier implementation of multicenter and multilanguage studies. Objective: To describe the design and development of CMI-APP, an adaptive and interactive technology tablet-based app, and to present the preliminary results of a multicenter pilot study involving people with MS performed in several European centers for evaluating the feasibility of and adherence to a rehabilitation program based on CMI-APP. Methods: CMI-APP includes user-friendly interfaces for personal data input and management, assessment of CMI, and DTT. A dedicated team developed CMI-APP for Android tablets above API level 14 (version 4.0), using C# as the programming language and Unity and Visual Studio as development tools. Three cognitive assessment tests for working memory, information processing speed, and sustained attention and four motor assessment tests for walking at different difficulty levels were implemented. Dual cognitive-motor tasks were performed by combining single cognitive and motor tasks. CMI-APP implements exercises for DTT involving the following 12 cognitive functions: sustained attention, text comprehension, verbal fluency, auditory discrimination, visual discrimination, working memory, information processing speed, auditory memory, visual memory, verbal analog reasoning, visual analog reasoning, and visual spatial planning, which can be performed during walking or stepping on the spot. Fifteen people with MS (mean age 52.6, SD 8.6 years; mean disease duration 9.4, SD 8.4 years; mean Expanded Disability Status Scale score 3.6, SD 1.1) underwent DTT (20 sessions). Adherence to the rehabilitation program was evaluated according to the percentage of performed sessions, perceived exertion during the training (Borg 15-point Ratings of Perceived Exertion [RPE] Scale), and subjective experience of the training (Intrinsic Motivation Inventory [IMI]). Results: The adherence rate was 91%. DTT was perceived as ?somewhat difficult? (mean RPE Scale score 12.6, SD 1.9). IMI revealed that participants enjoyed the training and felt that it was valuable and, to some extent, important, without feelings of pressure. They felt competent, although they did not always feel they could choose the exercises, probably because the therapist chose the exercises and many exercises had few difficulty levels. Conclusions: CMI-APP is safe, highly usable, motivating, and well accepted for DTT by people with MS. The findings are fundamental for the preparation of future large-sample studies examining CMI and the effectiveness of DTT interventions with CMI-APP in people with MS. UR - http://mhealth.jmir.org/2020/4/e15344/ UR - http://dx.doi.org/10.2196/15344 UR - http://www.ncbi.nlm.nih.gov/pubmed/32343258 ID - info:doi/10.2196/15344 ER - TY - JOUR AU - Krohn, Stephan AU - Tromp, Johanne AU - Quinque, M. Eva AU - Belger, Julia AU - Klotzsche, Felix AU - Rekers, Sophia AU - Chojecki, Paul AU - de Mooij, Jeroen AU - Akbal, Mert AU - McCall, Cade AU - Villringer, Arno AU - Gaebler, Michael AU - Finke, Carsten AU - Thöne-Otto, Angelika PY - 2020/4/27 TI - Multidimensional Evaluation of Virtual Reality Paradigms in Clinical Neuropsychology: Application of the VR-Check Framework JO - J Med Internet Res SP - e16724 VL - 22 IS - 4 KW - virtual reality KW - neuropsychology KW - cognition KW - research design UR - https://www.jmir.org/2020/4/e16724 UR - http://dx.doi.org/10.2196/16724 UR - http://www.ncbi.nlm.nih.gov/pubmed/32338614 ID - info:doi/10.2196/16724 ER - TY - JOUR AU - Khalili-Mahani, Najmeh AU - Assadi, Atousa AU - Li, Kate AU - Mirgholami, Mahsa AU - Rivard, Marie-Eve AU - Benali, Habib AU - Sawchuk, Kim AU - De Schutter, Bob PY - 2020/3/26 TI - Reflective and Reflexive Stress Responses of Older Adults to Three Gaming Experiences In Relation to Their Cognitive Abilities: Mixed Methods Crossover Study JO - JMIR Ment Health SP - e12388 VL - 7 IS - 3 KW - silver gaming KW - serious games KW - stress KW - cognitive training KW - brain training games KW - exercise games KW - ICT N2 - Background: The gamification of digital health provisions for older adults (eg, for rehabilitation) is a growing trend; however, many older adults are not familiar with digital games. This lack of experience could cause stress and thus impede participants? motivations to adopt these technologies. Objective: This crossover longitudinal multifactorial study aimed to examine the interactions between game difficulty, appraisal, cognitive ability, and physiological and cognitive responses that indicate game stress using the Affective Game Planning for Health Applications framework. Methods: A total of 18 volunteers (mean age 71 years, SD 4.5; 12 women) completed a three-session study to evaluate different genres of games in increasing order of difficulty (S1-BrainGame, S2-CarRace, and S3-Exergame). Each session included an identical sequence of activities (t1-Baseline, t2-Picture encode, t3-Play, t4-Stroop test, t5-Play, and t6-Picture recall), a repeated sampling of salivary cortisol, and time-tagged ambulatory data from a wrist-worn device. Generalized estimating equations were used to investigate the effect of session×activity or session×activity×cognitive ability on physiology and cognitive performance. Scores derived from the Montreal Cognitive Assessment (MoCA) test were used to define cognitive ability (MoCA-high: MoCA>27, n=11/18). Kruskal-Wallis tests were used to test session or session×group effects on the scores of the postgame appraisal questionnaire. Results: Session×activity effects were significant on all ambulatory measures (?210>20; P<.001) other than cortisol (P=.37). Compared with S1 and S2, S3 was associated with approximately 10 bpm higher heart rate (P<.001) and approximately 5 muS higher electrodermal activity (P<.001), which were both independent of the movement caused by the exergame. Compared with S1, we measured a moderate but statistically significant drop in the rate of hits in immediate recall and rate of delayed recall in S3. The low-MoCA group did not differ from the high-MoCA group in general characteristics (age, general self-efficacy, and perceived stress) but was more likely to agree with statements such as digital games are too hard to learn. In addition, the low-MoCA group was more likely to dislike the gaming experience and find it useless, uninteresting, and visually more intense (?21>4; P<.04). Group differences in ambulatory signals did not reach statistical significance; however, the rate of cortisol decline with respect to the baseline was significantly larger in the low-MoCA group. Conclusions: Our results show that the experience of playing digital games was not stressful for our participants. Comparatively, the neurophysiological effects of exergame were more pronounced in the low-MoCA group, suggesting greater potential of this genre of games for cognitive and physical stimulation by gamified interventions; however, the need for enjoyment of this type of challenging game must be addressed. UR - http://mental.jmir.org/2020/3/e12388/ UR - http://dx.doi.org/10.2196/12388 UR - http://www.ncbi.nlm.nih.gov/pubmed/32213474 ID - info:doi/10.2196/12388 ER - TY - JOUR AU - Marier-Deschênes, Pascale AU - Gagnon, Marie-Pierre AU - Déry, Julien AU - Lamontagne, Marie-Eve PY - 2020/3/18 TI - Traumatic Brain Injury and Sexuality: User Experience Study of an Information Toolkit JO - J Participat Med SP - e14874 VL - 12 IS - 1 KW - user-centered design KW - user experience KW - traumatic brain injury KW - sexuality KW - health information N2 - Background: After having sustained a traumatic brain injury (TBI), individuals are at risk of functional impairments in information processing, abstract reasoning, executive functioning, attention, and memory. This affects different aspects of communicative functioning. Specific strategies can be adopted to improve the provision of health information to individuals with TBI, including the development of written materials and nonwritten media. Objective: A user-centered design was adopted to codevelop four audiovisual presentations, a double-sided information sheet, and a checklist aimed at informing individuals about post-TBI sexuality. The last phase of the project was the assessment of the user experience of the information toolkit, based on the User Experience Honeycomb model. Methods: Overall, two small group discussions and one individual semistructured interview were conducted with individuals with moderate to severe TBI. Results: The participants mentioned that the toolkit was easily usable and would have fulfilled a need for information on post-TBI sexuality during or after rehabilitation. They mostly agreed that the minimalist visual content was well-organized, attractive, and relevant. The information was easily located, the tools were accessible in terms of reading and visibility, and the content was also considered credible. Conclusions: Aspects such as usability, usefulness, desirability, accessibility, credibility, and findability of information were viewed positively by the participants. Further piloting of the toolkit is recommended to explore its effects on the awareness of the potential sexual repercussions of TBI in individuals and partners. UR - https://jopm.jmir.org/2020/1/e14874 UR - http://dx.doi.org/10.2196/14874 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/14874 ER - TY - JOUR AU - Robert, Philippe AU - Manera, Valeria AU - Derreumaux, Alexandre AU - Ferrandez Y Montesino, Marion AU - Leone, Elsa AU - Fabre, Roxane AU - Bourgeois, Jeremy PY - 2020/3/11 TI - Efficacy of a Web App for Cognitive Training (MeMo) Regarding Cognitive and Behavioral Performance in People With Neurocognitive Disorders: Randomized Controlled Trial JO - J Med Internet Res SP - e17167 VL - 22 IS - 3 KW - neurocognitive disorders KW - Alzheimer disease KW - cognition KW - motivation KW - apathy KW - intervention N2 - Background: Cognitive and behavioral symptoms are the clinical hallmarks of neurocognitive disorders. Cognitive training may be offered to reduce the risks of cognitive decline and dementia and to reduce behavioral symptoms, such as apathy. Information and communication technology approaches, including serious games, can be useful in improving the playful aspect of computerized cognitive training and providing motivating solutions in elderly patients. Objective: The objective of this study was to assess the effectiveness of employing the MeMo (Memory Motivation) Web app with regard to cognitive and behavioral symptoms in patients with neurocognitive disorders. Methods: MeMo is a Web app that can be used on any Web browser (computer or tablet). The training activities proposed in MeMo are divided into the following two parts: memory and mental flexibility/attention. The study included 46 individuals (mean age 79.4 years) with a diagnosis of neurocognitive disorders at the Institut Claude Pompidou Memory Center in Nice. This randomized controlled study compared the evolution of cognition and behavior between patients not using MeMo (control group) and patients using MeMo (MeMo group) for 12 weeks (four sessions per week). Patients underwent memory and attention tests, as well as an apathy assessment at baseline, week 12 (end of the training period), and week 24 (12 weeks after the end of the training sessions). In addition, to assess the impact of high and low game uses, the MeMo group was divided into patients who used MeMo according to the instructions (about once every 2 days; active MeMo group) and those who used it less (nonactive MeMo group). Results: When comparing cognitive and behavioral scores among baseline, week 12, and week 24, mixed model analysis for each cognitive and behavioral score indicated no significant interaction between testing time and group. On comparing the active MeMo group (n=9) and nonactive MeMo group (n=13), there were significant differences in two attention tests (Trial Making Test A [P=.045] and correct Digit Symbol Substitution Test items [P=.045]) and in the Apathy Inventory (AI) (P=.02). Mixed analysis (time: baseline, week 12, and week 24 × number of active days) indicated only one significant interaction for the AI score (P=.01), with a significant increase in apathy in the nonactive MeMo group. Conclusions: This study indicates that the cognitive and behavioral efficacies of MeMo, a Web-based training app, can be observed only with regular use of the app. Improvements were observed in attention and motivation. Trial Registration: ClinicalTrials.gov NCT04142801; https://clinicaltrials.gov/ct2/show/NCT04142801 UR - https://www.jmir.org/2020/3/e17167 UR - http://dx.doi.org/10.2196/17167 UR - http://www.ncbi.nlm.nih.gov/pubmed/32159519 ID - info:doi/10.2196/17167 ER - TY - JOUR AU - Øksnebjerg, Laila AU - Woods, Bob AU - Ruth, Kathrine AU - Lauridsen, Annette AU - Kristiansen, Susanne AU - Holst, Dalsgaard Helle AU - Waldemar, Gunhild PY - 2020/1/17 TI - A Tablet App Supporting Self-Management for People With Dementia: Explorative Study of Adoption and Use Patterns JO - JMIR Mhealth Uhealth SP - e14694 VL - 8 IS - 1 KW - dementia KW - technology KW - information technology KW - self-help devices KW - app KW - self-management KW - rehabilitation KW - memory KW - caregivers N2 - Background: Assistive technology (AT) is rapidly emerging within dementia care and support. One area of AT application is support of people with dementia in compensating for cognitive symptoms and thereby promoting their self-management. There is, however, little evidence for the applicability, usability, and effectiveness of AT for people with dementia, and there is a need to identify factors that can promote adoption. Objective: This study aimed to (1) evaluate the applicability and usability of an app, tailor-made for people with dementia; (2) explore factors affecting adoption; (3) explore the possible influence of caregiver involvement; and (4) contribute to process evaluation of the intervention. Methods: The ReACT (Rehabilitation in Alzheimer's disease using Cognitive support Technology) app was designed as a holistic solution to support memory and structure in daily living. Persons with dementia had access to a personal user account, and family caregivers were given a parallel login. Written and Web-based materials were provided to support self-applied implementation. A mixed methods design was applied to explore adoption and use patterns, including background and disease-related data, qualitative data from a survey, and log data. Adoption was defined as the use of the app over a period of ?90 days. Results: Data from 112 participants and 98 caregivers were included. Shorter time from diagnosis (U=595; P=.046; r=0.19) and caregiver activating the app (P=.02) had a significant impact on the participant adoption status. Logistic regression analysis showed that if caregivers had activated the app, the participant was five times more likely to become an adopter (odds ratio 5.1, 95% CI 1.29-19.99; P=.02). However, the overall predictive power was low, and there was a wide variation in background and disease-related characteristics among adopters. The level of experience and skills in tablet use were not significantly different between adopters and nonadopters. Adopters generally rated the app high on usefulness, satisfaction, and ease of use (rated on the USEdem questionnaire). Their scores were significantly higher compared with nonadopters (U=5.5; P=.02; r=0.64). Analysis of use patterns showed that all functionalities of the app were used among adopters. Conclusions: For participants who became adopters, the ReACT app and the methods for self-applied implementation were applicable. However, the results were also in accordance with the well-known challenges of nonadoption and nonadherence to digital health interventions. The study provided insight into the importance of timely introduction and caregiver support for adoption of AT among people with dementia. It also underlined the high complexity of personal and contextual factors that influence adoption. These complex factors need to be considered when designing and implementing AT for people with dementia. UR - https://mhealth.jmir.org/2020/1/e14694 UR - http://dx.doi.org/10.2196/14694 UR - http://www.ncbi.nlm.nih.gov/pubmed/31951217 ID - info:doi/10.2196/14694 ER - TY - JOUR AU - Charalambous, Pavlina Anna AU - Pye, Annie AU - Yeung, Kent Wai AU - Leroi, Iracema AU - Neil, Malcolm AU - Thodi, Chryssoula AU - Dawes, Piers PY - 2020/1/17 TI - Tools for App- and Web-Based Self-Testing of Cognitive Impairment: Systematic Search and Evaluation JO - J Med Internet Res SP - e14551 VL - 22 IS - 1 KW - telemedicine KW - eHealth KW - mHealth KW - dementia KW - mild cognitive impairment KW - self-assessment N2 - Background: Tools for app- and Web-based self-testing for identification of cognitive impairment are widely available but are of uncertain quality. Objective: The objective of this study was to undertake a scoping review of app- and Web-based self-tests for cognitive impairment and determine the validity of these tests. Methods: We conducted systematic searches in electronic databases, including Google search, Google Play Store, and iPhone Operating System App Store, using the search terms ?Online OR Internet-based AND Memory OR Brain OR Dementia OR mild cognitive impairment OR MCI AND Test OR Screen OR Check.? Results: We identified 3057 tools, of which 25 were included in the review. Most tools meeting the inclusion criteria assessed multiple cognitive domains. The most frequently assessed domains were memory, attention, and executive function. We then conducted an electronic survey with the developers of the tools to identify data relating to development and validation of each tool. If no response to the survey was received, Google (to identify gray literature), Google Scholar, and Medical Literature Analysis and Retrieval System Online were searched using key terms ?(name of developer, if available)? AND ?(the name of the tool)? to identify any additional data. Only 7 tools had any information concerning psychometric quality, and only 1 tool reported data on performance norms, reliability, validity, sensitivity, and specificity for the detection of cognitive impairment. Conclusions: The number of cognitive self-assessment electronic health tools for cognitive impairment is increasing, but most are of uncertain quality. There is a need for well-validated tools and guidance for users concerning which tools provide reliable information about possible cognitive impairment that could warrant further investigation. UR - https://www.jmir.org/2020/1/e14551 UR - http://dx.doi.org/10.2196/14551 UR - http://www.ncbi.nlm.nih.gov/pubmed/31951218 ID - info:doi/10.2196/14551 ER - TY - JOUR AU - Gerber, M. Stephan AU - Jeitziner, Marie-Madlen AU - Sänger, D. Simon AU - Knobel, J. Samuel E. AU - Marchal-Crespo, Laura AU - Müri, M. René AU - Schefold, C. Joerg AU - Jakob, M. Stephan AU - Nef, Tobias PY - 2019/11/15 TI - Comparing the Relaxing Effects of Different Virtual Reality Environments in the Intensive Care Unit: Observational Study JO - JMIR Perioper Med SP - e15579 VL - 2 IS - 2 KW - virtual reality KW - critical illness KW - intensive care unit KW - neurocognitive late effects KW - nature KW - urban KW - stimulation N2 - Background: After a prolonged intensive care unit (ICU) stay, approximately 50%-75% of all critically ill patients suffer from neurocognitive late effects and a reduction of health-related quality of life. It is assumed that the noisy and stressful ICU environment leads to sensory overload and deprivation and potentially to long-term cognitive impairment. Objective: In this study, we investigated three different virtual reality environments and their potentially restorative and relaxing effects for reducing sensory overload and deprivation in the ICU. Methods: A total of 45 healthy subjects were exposed to three different environments, each 10 minutes in length (dynamic, virtual, natural, and urban environments presented inside the head-mounted display, and a neutral video on an ICU TV screen). During the study, data was collected by validated questionnaires (ie, restoration and sickness) and sensors to record physiological parameters (240 hertz). Results: The results showed that the natural environment had the highest positive and restorative effect on the physiological and psychological state of healthy subjects, followed by the urban environment and the ICU TV screen. Conclusions: Overall, virtual reality stimulation with head-mounted display using a dynamic, virtual and natural environment has the potential, if directly used in the ICU, to reduce sensory overload and deprivation in critically ill patients and thus to prevent neurocognitive late effects. UR - http://periop.jmir.org/2019/2/e15579/ UR - http://dx.doi.org/10.2196/15579 UR - http://www.ncbi.nlm.nih.gov/pubmed/33393906 ID - info:doi/10.2196/15579 ER - TY - JOUR AU - Mubin, Omar AU - Alnajjar, Fady AU - Jishtu, Nalini AU - Alsinglawi, Belal AU - Al Mahmud, Abdullah PY - 2019/9/8 TI - Exoskeletons With Virtual Reality, Augmented Reality, and Gamification for Stroke Patients? Rehabilitation: Systematic Review JO - JMIR Rehabil Assist Technol SP - e12010 VL - 6 IS - 2 KW - stroke KW - robot KW - exoskeleton KW - virtual reality KW - augmented reality KW - gamification KW - rehabilitation N2 - Background: Robot-assisted therapy has become a promising technology in the field of rehabilitation for poststroke patients with motor disorders. Motivation during the rehabilitation process is a top priority for most stroke survivors. With current advancements in technology there has been the introduction of virtual reality (VR), augmented reality (AR), customizable games, or a combination thereof, that aid robotic therapy in retaining, or increasing the interests of, patients so they keep performing their exercises. However, there are gaps in the evidence regarding the transition from clinical rehabilitation to home-based therapy which calls for an updated synthesis of the literature that showcases this trend. The present review proposes a categorization of these studies according to technologies used, and details research in both upper limb and lower limb applications. Objective: The goal of this work was to review the practices and technologies implemented in the rehabilitation of poststroke patients. It aims to assess the effectiveness of exoskeleton robotics in conjunction with any of the three technologies (VR, AR, or gamification) in improving activity and participation in poststroke survivors. Methods: A systematic search of the literature on exoskeleton robotics applied with any of the three technologies of interest (VR, AR, or gamification) was performed in the following databases: MEDLINE, EMBASE, Science Direct & The Cochrane Library. Exoskeleton-based studies that did not include any VR, AR or gamification elements were excluded, but publications from the years 2010 to 2017 were included. Results in the form of improvements in the patients? condition were also recorded and taken into consideration in determining the effectiveness of any of the therapies on the patients. Results: Thirty studies were identified based on the inclusion criteria, and this included randomized controlled trials as well as exploratory research pieces. There were a total of about 385 participants across the various studies. The use of technologies such as VR-, AR-, or gamification-based exoskeletons could fill the transition from the clinic to a home-based setting. Our analysis showed that there were general improvements in the motor function of patients using the novel interfacing techniques with exoskeletons. This categorization of studies helps with understanding the scope of rehabilitation therapies that can be successfully arranged for home-based rehabilitation. Conclusions: Future studies are necessary to explore various types of customizable games required to retain or increase the motivation of patients going through the individual therapies. UR - https://rehab.jmir.org/2019/2/e12010 UR - http://dx.doi.org/10.2196/12010 UR - http://www.ncbi.nlm.nih.gov/pubmed/31586360 ID - info:doi/10.2196/12010 ER - TY - JOUR AU - Garcia-Rudolph, Alejandro AU - Laxe, Sara AU - Saurí, Joan AU - Bernabeu Guitart, Montserrat PY - 2019/08/26 TI - Stroke Survivors on Twitter: Sentiment and Topic Analysis From a Gender Perspective JO - J Med Internet Res SP - e14077 VL - 21 IS - 8 KW - stroke KW - emotions KW - Twitter KW - infodemiology KW - infoveillance KW - sentiment analysis KW - topic models KW - gender N2 - Background: Stroke is the worldwide leading cause of long-term disabilities. Women experience more activity limitations, worse health-related quality of life, and more poststroke depression than men. Twitter is increasingly used by individuals to broadcast their day-to-day happenings, providing unobtrusive access to samples of spontaneously expressed opinions on all types of topics and emotions. Objective: This study aimed to consider the raw frequencies of words in the collection of tweets posted by a sample of stroke survivors and to compare the posts by gender of the survivor for 8 basic emotions (anger, fear, anticipation, surprise, joy, sadness, trust and disgust); determine the proportion of each emotion in the collection of tweets and statistically compare each of them by gender of the survivor; extract the main topics (represented as sets of words) that occur in the collection of tweets, relative to each gender; and assign happiness scores to tweets and topics (using a well-established tool) and compare them by gender of the survivor. Methods: We performed sentiment analysis based on a state-of-the-art lexicon (National Research Council) with syuzhet R package. The emotion scores for men and women were first subjected to an F-test and then to a Wilcoxon rank sum test. We extended the emotional analysis, assigning happiness scores with the hedonometer (a tool specifically designed considering Twitter inputs). We calculated daily happiness average scores for all tweets. We created a term map for an exploratory clustering analysis using VosViewer software. We performed structural topic modelling with stm R package, allowing us to identify main topics by gender. We assigned happiness scores to all the words defining the main identified topics and compared them by gender. Results: We analyzed 800,424 tweets posted from August 1, 2007 to December 1, 2018, by 479 stroke survivors: Women (n=244) posted 396,898 tweets, and men (n=235) posted 403,526 tweets. The stroke survivor condition and gender as well as membership in at least 3 stroke-specific Twitter lists of active users were manually verified for all 479 participants. Their total number of tweets since 2007 was 5,257,433; therefore, we analyzed the most recent 15.2% of all their tweets. Positive emotions (anticipation, trust, and joy) were significantly higher (P<.001) in women, while negative emotions (disgust, fear, and sadness) were significantly higher (P<.001) in men in the analysis of raw frequencies and proportion of emotions. Happiness mean scores throughout the considered period show higher levels of happiness in women. We calculated the top 20 topics (with percentages and CIs) more likely addressed by gender and found that women?s topics show higher levels of happiness scores. Conclusions: We applied two different approaches?the Plutchik model and hedonometer tool?to a sample of stroke survivors? tweets. We conclude that women express positive emotions and happiness much more than men. UR - http://www.jmir.org/2019/8/e14077/ UR - http://dx.doi.org/10.2196/14077 UR - http://www.ncbi.nlm.nih.gov/pubmed/31452514 ID - info:doi/10.2196/14077 ER - TY - JOUR AU - Martens, Kris AU - Takano, Keisuke AU - Barry, J. Tom AU - Goedleven, Jolien AU - Van den Meutter, Louise AU - Raes, Filip PY - 2019/05/14 TI - Remediating Reduced Autobiographical Memory in Healthy Older Adults With Computerized Memory Specificity Training (c-MeST): An Observational Before-After Study JO - J Med Internet Res SP - e13333 VL - 21 IS - 5 KW - memory specificity training KW - autobiographical memory KW - cognitive aging KW - online KW - depression KW - memory KW - telemedicine KW - rumination, cognitive N2 - Background: The ability to retrieve specific autobiographical memories decreases with cognitive aging. This decline is clinically relevant due to its association with impairments in problem solving, daily functioning, and depression. A therapist-delivered group training protocol, Memory Specificity Training (MeST), has been shown to enhance the retrieval of specific memories while ameliorating the impairments and negative outcomes associated with reduced specificity. The therapist-delivered nature of this intervention means it is relatively expensive to deliver and difficult for people with mobility impairments, such as older people, to receive. Objective: The objective of this study was to test if a novel, Web-based computerized version of a group training protocol called Memory Specificity Training, has the potential to increase autobiographical memory specificity and impact associated secondary psychological processes. Methods: A total of 21 participants (13 female; mean age 67.05, SD 6.55) who experienced a deficit in retrieving specific autobiographical memory were trained with c-MeST. We assessed memory specificity at preintervention and postintervention, as well as secondary processes such as depressive symptoms, rumination, and problem-solving skills. Results: Memory specificity increased significantly after participants completed c-MeST (r=.57). Session-to-session scores indicated that autobiographical memory specificity improved most from the online baseline assessment to the first Web-based session. Symptoms or secondary processes such as problem-solving skills did not change significantly. Conclusions: A Web-based automated individual version of MeST is a feasible, low-cost intervention for reduced memory specificity in healthy older adults. Future studies should clarify the preventive impact of c-MeST in other at-risk sample populations with longer follow-up times. UR - https://www.jmir.org/2019/5/e13333/ UR - http://dx.doi.org/10.2196/13333 UR - http://www.ncbi.nlm.nih.gov/pubmed/31094362 ID - info:doi/10.2196/13333 ER - TY - JOUR AU - van de Weijer, CF Sjors AU - Kuijf, L. Mark AU - de Vries, M. Nienke AU - Bloem, R. Bastiaan AU - Duits, A. Annelien PY - 2019/05/07 TI - Do-It-Yourself Gamified Cognitive Training: Viewpoint JO - JMIR Serious Games SP - e12130 VL - 7 IS - 2 KW - cognitive remediation KW - Parkinson disease KW - video games UR - http://games.jmir.org/2019/2/e12130/ UR - http://dx.doi.org/10.2196/12130 UR - http://www.ncbi.nlm.nih.gov/pubmed/31066713 ID - info:doi/10.2196/12130 ER - TY - JOUR AU - Hanna-Pladdy, Brenda AU - Gullapalli, Rao AU - Chen, Hegang PY - 2019/04/29 TI - Functional Magnetic Resonance Imaging Biomarkers Predicting Cognitive Progression in Parkinson Disease: Protocol for a Prospective Longitudinal Cohort Study JO - JMIR Res Protoc SP - e12870 VL - 8 IS - 4 KW - Parkinson disease KW - cognition KW - disease progression KW - dementia KW - mild cognitive impairment KW - biomarkers KW - functional neuroimaging N2 - Background: Cardinal features of Parkinson disease (PD) are motor symptoms, but nonmotor features such as mild cognitive impairment (MCI) are common early in the disease process. MCI can progress and convert to dementia in advanced stages, creating significant disability and reduced quality of life. The primary pathological substrate for cognitive decline in PD is unclear, and there are no reliable biomarkers predicting the risk of conversion to dementia. A subgroup of PD patients with visual hallucinations may display more rapid conversion to dementia, suggesting that regional markers of visuoperceptual dysfunction may be sensitive to pathologic density in posterior cortical regions. Objective: The purpose of this project is to characterize PD-MCI and evaluate the utility of genetic and neuroimaging biomarkers in predicting cognitive outcomes with a prospective longitudinal study. We will evaluate whether accelerated cognitive progression may be reflected in biomarkers of early posterior cortical changes reflective of ?-synuclein deposition. Methods: We will evaluate a cohort of early-stage PD patients with the following methods to predict cognitive progression: (1) serial neuropsychological evaluations including detailed visuoperceptual functioning across 4 years; (2) genetic analysis of SNCA (?-synuclein), MAPT (microtubule-associated tau), and APOE (apolipoprotein E); (3) an event-related functional magnetic resonance imaging paradigm of object recognition memory; and (4) anatomical and regional brain activation changes (resting-state functional magnetic resonance imaging) across 4 years. Results: The project received funding from the National Institutes of Health in August 2017, and data collection began in February 2018. Enrollment is ongoing, and subjects will be evaluated annually for 4 years extended across a 5-year project including data analysis and image processing. Conclusions: Cognitive, genetic, and structural and functional magnetic resonance imaging will characterize neural network changes predictive of cognitive progression in PD across 4 years. Identification of biomarkers with sensitivity for early prediction and estimation of risk for conversion to dementia in PD will pave the way for effective intervention with neuroprotective therapies during the critical stage when treatment can have the greatest impact. International Registered Report Identifier (IRRID): DERR1-10.2196/12870 UR - http://www.researchprotocols.org/2019/4/e12870/ UR - http://dx.doi.org/10.2196/12870 UR - http://www.ncbi.nlm.nih.gov/pubmed/31033450 ID - info:doi/10.2196/12870 ER - TY - JOUR AU - Vergani, Laura AU - Marton, Giulia AU - Pizzoli, Maria Silvia Francesca AU - Monzani, Dario AU - Mazzocco, Ketti AU - Pravettoni, Gabriella PY - 2019/03/19 TI - Training Cognitive Functions Using Mobile Apps in Breast Cancer Patients: Systematic Review JO - JMIR Mhealth Uhealth SP - e10855 VL - 7 IS - 3 KW - cognitive impairment KW - breast cancer KW - cognitive training KW - intervention KW - mobile-based interventions N2 - Background: Breast cancer is an invalidating disease and its treatment can bring serious side effects that have a physical and psychological impact. Specifically, cancer treatment generally has a strong impact on cognitive function. In recent years, new technologies and eHealth have had a growing influence on health care and innovative mobile apps can be useful tools to deliver cognitive exercise in the patient?s home. Objective: This systematic review gives an overview of the state-of-the-art mobile apps aimed at training cognitive functions to better understand whether these apps could be useful tools to counteract cognitive impairment in breast cancer patients. Methods: We searched in a systematic way all the full-text articles from the PubMed and Embase databases. Results: We found eleven studies using mobile apps to deliver cognitive training. They included a total of 819 participants. App and study characteristics are presented and discussed, including cognitive domains trained (attention, problem solving, memory, cognitive control, executive function, visuospatial function, and language). None of the apps were specifically developed for breast cancer patients. They were generally developed for a specific clinical population. Only 2 apps deal with more than 1 cognitive domain, and only 3 studies focus on the efficacy of the app training intervention. Conclusions: These results highlight the lack of empirical evidence on the efficacy of currently available apps to train cognitive function. Cognitive domains are not well defined across studies. It is noteworthy that no apps are specifically developed for cancer patients, and their applicability to breast cancer should not be taken for granted. Future studies should test the feasibility, usability, and effectiveness of available cognitive training apps in women with breast cancer. Due to the complexity and multidimensionality of cognitive difficulties in this cancer population, it may be useful to design, develop, and implement an ad hoc app targeting cognitive impairment in breast cancer patients. UR - https://mhealth.jmir.org/2019/3/e10855/ UR - http://dx.doi.org/10.2196/10855 UR - http://www.ncbi.nlm.nih.gov/pubmed/30888326 ID - info:doi/10.2196/10855 ER - TY - JOUR AU - Gibson, Colin Ryan AU - Bouamrane, Matt-Mouley AU - Dunlop, Mark PY - 2019/03/04 TI - Design Requirements for a Digital Aid to Support Adults With Mild Learning Disabilities During Clinical Consultations: Qualitative Study With Experts JO - JMIR Rehabil Assist Technol SP - e10449 VL - 6 IS - 1 KW - learning disabilities KW - intellectual disability KW - communicative disorder KW - augmentative and alternative communications systems KW - primary care N2 - Background: Adults with mild learning disabilities (MLDs) face a plethora of obstacles when accessing effective health care. Central to many of these barriers is communication, with medical practitioners often remaining untrained on how to interact with patients who have learning disabilities (LDs). To date, research on how to promote this communication has largely centered on the development of low-tech aids. Objective: The objective of this study was to assess the feasibility of utilizing tablet technologies to promote communication between general practitioners and patients with MLDs. We achieved this by identifying a set of design requirements from experts in LDs. Methods: A set of design guidelines was formed during a 2-phase process. Phase 1 involved conducting a series of requirements-gathering interviews with 10 experts in LDs?the protocol of which emerged from the results of a separate scoping review. The interviews were subjected to a framework analysis to discern the key requirements discussed by the experts, and these were embedded within a technology probe. In phase 2, this probe was presented to a subset (n=4) of the experts during a round of usability studies, and the feedback received was used to update the requirements identified in phase 1. Results: An initial set of design requirements has been produced that may assist in the development of clinical Alternative and Augmentative Communication technologies for adults with MLDs. Factors that must be considered range from the health, physical and cognitive needs of stakeholders, to the more individual needs of users. Conclusions: The experts involved in the study were optimistic about the proposed app. They believe that such technologies can help to alleviate time constraints and promote communication by presenting information in a form understood by both practitioners and patients. UR - http://rehab.jmir.org/2019/1/e10449/ UR - http://dx.doi.org/10.2196/10449 UR - http://www.ncbi.nlm.nih.gov/pubmed/30829575 ID - info:doi/10.2196/10449 ER - TY - JOUR AU - Swank, Chad AU - Wang-Price, Sharon AU - Gao, Fan AU - Almutairi, Sattam PY - 2019/01/14 TI - Walking With a Robotic Exoskeleton Does Not Mimic Natural Gait: A Within-Subjects Study JO - JMIR Rehabil Assist Technol SP - e11023 VL - 6 IS - 1 KW - electromyography KW - gait KW - kinematics KW - lower extremity KW - muscle activation KW - range of motion KW - robotic exoskeleton N2 - Background: Robotic exoskeleton devices enable individuals with lower extremity weakness to stand up and walk over ground with full weight-bearing and reciprocal gait. Limited information is available on how a robotic exoskeleton affects gait characteristics. Objective: The purpose of this study was to examine whether wearing a robotic exoskeleton affects temporospatial parameters, kinematics, and muscle activity during gait. Methods: The study was completed by 15 healthy adults (mean age 26.2 [SD 8.3] years; 6 males, 9 females). Each participant performed walking under 2 conditions: with and without wearing a robotic exoskeleton (EKSO). A 10-camera motion analysis system synchronized with 6 force plates and a surface electromyography (EMG) system captured temporospatial and kinematic gait parameters and lower extremity muscle activity. For each condition, data for 5 walking trials were collected and included for analysis. Results: Differences were observed between the 2 conditions in temporospatial gait parameters of speed, stride length, and double-limb support time. When wearing EKSO, hip and ankle range of motion (ROM) were reduced and knee ROM increased during the stance phase. However, during the swing phase, knee and ankle ROM were reduced when wearing the exoskeleton bionic suit. When wearing EKSO, EMG activity decreased bilaterally in the stance phase for all muscle groups of the lower extremities and in the swing phase for the distal muscle groups (tibialis anterior and soleus) as well as the left medial hamstrings. Conclusions: Wearing EKSO altered temporospatial gait parameters, lower extremity kinematics, and muscle activity during gait in healthy adults. EKSO appears to promote a type of gait that is disparate from normal gait in first-time users. More research is needed to determine the impact on gait training with EKSO in people with gait impairments. UR - http://rehab.jmir.org/2019/1/e11023/ UR - http://dx.doi.org/10.2196/11023 UR - http://www.ncbi.nlm.nih.gov/pubmed/31344681 ID - info:doi/10.2196/11023 ER - TY - JOUR AU - McNish, Nicole Reika AU - Chembrammel, Pramod AU - Speidel, Christopher Nathaniel AU - Lin, Jwchun Julian AU - López-Ortiz, Citlali PY - 2019/01/14 TI - Rehabilitation for Children With Dystonic Cerebral Palsy Using Haptic Feedback in Virtual Reality: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e11470 VL - 8 IS - 1 KW - cerebral palsy KW - child KW - dystonia KW - motor skills KW - muscle spasticity KW - randomized controlled trial KW - rehabilitation KW - robotics KW - sensory feedback KW - virtual reality N2 - Background: Cerebral palsy (CP) is the most common developmental motor disorder in children. Individuals with CP demonstrate abnormal muscle tone and motor control. Within the population of children with CP, between 4% and 17% present dystonic symptoms that may manifest as large errors in movement tasks, high variability in movement trajectories, and undesired movements at rest. These symptoms of dystonia typically worsen with physical intervention exercises. Objective: The aim of this study is to establish the effect of haptic feedback in a virtual reality (VR) game intervention on movement outcomes of children with dystonic CP. Methods: The protocol describes a randomized controlled trial that uses a VR game-based intervention incorporating fully automated robotic haptic feedback. The study consists of face-to-face assessments of movement before, after, and 1 month following the completion of the 6-session game-based intervention. Children with dystonic CP, aged between 7 and 17 years, will be recruited for this study through posted fliers and laboratory websites along with a group of typically developing (TD) children in the same age range. We anticipate to recruit a total of 68 participants, 34 each with CP and TD. Both groups of children will be randomly allocated into an intervention or control group using a blocked randomization method. The primary outcome measure will be the smoothness index of the interaction force with the robot and of the accelerometry signals of sensors placed on the upper limb segments. Secondary outcomes include a battery of clinical tests and a quantitative measure of spasticity. Assessors administering clinical measures will be blinded. All sessions will be administered on-site by research personnel. Results: The trial has not started and is pending local institutional review board approval. Conclusions: Movement outcomes will be examined for changes in muscle activation and clinical measures in children with dystonic CP and TD children. Paired t tests will be conducted on movement outcomes for both groups of children independently. Positive and negative results will be reported and addressed. Trial Registration: ClinicalTrials.gov NCT03744884; https://clinicaltrials.gov/ct2/show/NCT03744884 (Archived by WebCite at http://www.webcitation.org/74RSvmbZP) International Registered Report Identifier (IRRID): PRR1-10.2196/11470 UR - https://www.researchprotocols.org/2019/1/e11470/ UR - http://dx.doi.org/10.2196/11470 UR - http://www.ncbi.nlm.nih.gov/pubmed/31344678 ID - info:doi/10.2196/11470 ER - TY - JOUR AU - Faria, Lúcia Ana AU - Pinho, Salomé Maria AU - Bermúdez i Badia, Sergi PY - 2018/12/06 TI - Capturing Expert Knowledge for the Personalization of Cognitive Rehabilitation: Study Combining Computational Modeling and a Participatory Design Strategy JO - JMIR Rehabil Assist Technol SP - e10714 VL - 5 IS - 2 KW - stroke rehabilitation KW - attention KW - memory KW - executive function KW - language KW - cognition KW - community-based participatory research KW - patient-specific modeling N2 - Background: Cognitive impairments after stroke are not always given sufficient attention despite the critical limitations they impose on activities of daily living (ADLs). Although there is substantial evidence on cognitive rehabilitation benefits, its implementation is limited because of time and human resource?s demands. Moreover, many cognitive rehabilitation interventions lack a robust theoretical framework in the selection of paper-and-pencil tasks by the clinicians. In this endeavor, it would be useful to have a tool that could generate standardized paper-and-pencil tasks, parameterized according to patients' needs. Objective: In this study, we aimed to present a framework for the creation of personalized cognitive rehabilitation tasks based on a participatory design strategy. Methods: We selected 11 paper-and-pencil tasks from standard clinical practice and parameterized them with multiple configurations. A total of 67 tasks were assessed according to their cognitive demands (attention, memory, language, and executive functions) and overall difficulty by 20 rehabilitation professionals. Results: After assessing the internal consistency of the data?that is, alpha values from .918 to .997?we identified the parameters that significantly affected cognitive functions and proposed specific models for each task. Through computational modeling, we operationalized the tasks into their intrinsic parameters and developed a Web tool that generates personalized paper-and-pencil tasks?the Task Generator (TG). Conclusions: Our framework proposes an objective and quantitative personalization strategy tailored to each patient in multiple cognitive domains (attention, memory, language, and executive functions) derived from expert knowledge and materialized in the TG app, a cognitive rehabilitation Web tool. UR - http://rehab.jmir.org/2018/2/e10714/ UR - http://dx.doi.org/10.2196/10714 UR - http://www.ncbi.nlm.nih.gov/pubmed/30522994 ID - info:doi/10.2196/10714 ER - TY - JOUR AU - Mizuno, Katsuhiro AU - Abe, Takayuki AU - Ushiba, Junichi AU - Kawakami, Michiyuki AU - Ohwa, Tomomi AU - Hagimura, Kazuto AU - Ogura, Miho AU - Okuyama, Kohei AU - Fujiwara, Toshiyuki AU - Liu, Meigen PY - 2018/12/06 TI - Evaluating the Effectiveness and Safety of the Electroencephalogram-Based Brain-Machine Interface Rehabilitation System for Patients With Severe Hemiparetic Stroke: Protocol for a Randomized Controlled Trial (BEST-BRAIN Trial) JO - JMIR Res Protoc SP - e12339 VL - 7 IS - 12 KW - brain-computer interfaces KW - neurofeedback KW - neural plasticity KW - electroencephalography KW - hemiplegia KW - electric stimulation KW - robotics N2 - Background: We developed a brain-machine interface (BMI) system for poststroke patients with severe hemiplegia to detect event-related desynchronization (ERD) on scalp electroencephalogram (EEG) and to operate a motor-driven hand orthosis combined with neuromuscular electrical stimulation. ERD arises when the excitability of the ipsi-lesional sensorimotor cortex increases. Objective: The aim of this study was to evaluate our hypothesis that motor training using this BMI system could improve severe hemiparesis that is resistant to improvement by conventional rehabilitation. We, therefore, planned and implemented a randomized controlled clinical trial (RCT) to evaluate the effectiveness and safety of intensive rehabilitation using the BMI system. Methods: We conducted a single blind, multicenter RCT and recruited chronic poststroke patients with severe hemiparesis more than 90 days after onset (N=40). Participants were randomly allocated to the BMI group (n=20) or the control group (n=20). Patients in the BMI group repeated 10-second motor attempts to operate EEG-BMI 40 min every day followed by 40 min of conventional occupational therapy. The interventions were repeated 10 times in 2 weeks. Control participants performed a simple motor imagery without servo-action of the orthosis, and electrostimulation was given for 10 seconds for 40 min, similar to the BMI intervention. Overall, 40 min of conventional occupational therapy was also given every day after the control intervention, which was also repeated 10 times in 2 weeks. Motor functions and electrophysiological phenotypes of the paretic hands were characterized before (baseline), immediately after (post), and 4 weeks after (follow-up) the intervention. Improvement in the upper extremity score of the Fugl-Meyer assessment between baseline and follow-up was the main outcome of this study. Results: Recruitment started in March 2017 and ended in July 2018. This trial is currently in the data correcting phase. This RCT is expected to be completed by October 31, 2018. Conclusions: No widely accepted intervention has been established to improve finger function of chronic poststroke patients with severe hemiparesis. The results of this study will provide clinical data for regulatory approval and novel, important understanding of the role of sensory-motor feedback based on BMI to induce neural plasticity and motor recovery. Trial Registration: UMIN Clinical Trials Registry UMIN000026372; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi? recptno=R000030299 (Archived by WebCite at http://www.webcitation.org/743zBJj3D) International Registered Report Identifier (IRRID): DERR1-10.2196/12339 UR - http://www.researchprotocols.org/2018/12/e12339/ UR - http://dx.doi.org/10.2196/12339 UR - http://www.ncbi.nlm.nih.gov/pubmed/30522993 ID - info:doi/10.2196/12339 ER - TY - JOUR AU - Clunne, Jane Stephanie AU - Ryan, Jade Brooke AU - Hill, Jane Annie AU - Brandenburg, Caitlin AU - Kneebone, Ian PY - 2018/12/04 TI - Accessibility and Applicability of Currently Available e-Mental Health Programs for Depression for People With Poststroke Aphasia: Scoping Review JO - J Med Internet Res SP - e291 VL - 20 IS - 12 KW - aphasia KW - stroke KW - depression KW - mental health KW - internet KW - technology KW - access to health care N2 - Background: Depression affects approximately 60% of people with aphasia 1 year post stroke and is associated with disability, lower quality of life, and mortality. Web-delivered mental health (e-mental health) programs are effective, convenient, and cost-effective for the general population and thus are increasingly used in the management of depression. However, it is unknown if such services are applicable and communicatively accessible to people with poststroke aphasia. Objective: The aim of this study was to identify freely available e-mental health programs for depression and determine their applicability and accessibility for people with poststroke aphasia. Methods: A Web-based search was conducted to identify and review freely available e-mental health programs for depression. These programs were then evaluated in terms of their (1) general features via a general evaluation tool, (2) communicative accessibility for people with aphasia via an aphasia-specific communicative accessibility evaluation tool, and (3) empirical evidence for the general population and stroke survivors with and without aphasia. The program that met the most general evaluation criteria and aphasia-specific communicative accessibility evaluation criteria was then trialed by a small subgroup of people with poststroke aphasia. Results: A total of 8 programs were identified. Of these, 4 had published evidence in support of their efficacy for use within the general population. However, no empirical evidence was identified that specifically supported any programs? use for stroke survivors with or without aphasia. One evidence-based program scored at least 80% (16/19 and 16/20, respectively) on both the general and aphasia-specific communicative accessibility evaluation tools and was subject to a preliminary trial by 3 people with poststroke aphasia. During this trial, participants were either unable to independently use the program or gave it low usability scores on a post-trial satisfaction survey. On this basis, further evaluation was considered unwarranted. Conclusions: Despite fulfilling majority of the general evaluation and aphasia-specific evaluation criteria, the highest rated program was still found to be unsuitable for people with poststroke aphasia. Thus, e-mental health programs require substantial redevelopment if they are likely to be useful to people with poststroke aphasia. UR - https://www.jmir.org/2018/12/e291/ UR - http://dx.doi.org/10.2196/jmir.9864 UR - http://www.ncbi.nlm.nih.gov/pubmed/30514696 ID - info:doi/10.2196/jmir.9864 ER - TY - JOUR AU - Kumar, Shefali AU - Tran, LA Jennifer AU - Moseson, Heidi AU - Tai, Caroline AU - Glenn, M. Jordan AU - Madero, N. Erica AU - Krebs, Caitlyn AU - Bott, Nicholas AU - Juusola, L. Jessie PY - 2018/11/09 TI - The Impact of the Virtual Cognitive Health Program on the Cognition and Mental Health of Older Adults: Pre-Post 12-Month Pilot Study JO - JMIR Aging SP - e12031 VL - 1 IS - 2 KW - cognitive impairment KW - dementia KW - Alzheimer disease KW - mental health N2 - Background: Face-to-face multidomain lifestyle interventions have shown to be effective for improving or maintaining cognitive function in older adults at risk for dementia. Remotely delivered interventions could increase access to such solutions but first require evidence to support that these programs can successfully impact health outcomes. Objective: The objective of this study was to evaluate the impact of a remotely delivered multidomain lifestyle intervention, the virtual cognitive health (VC Health) program, on the cognitive function and mental health of older adults with subjective cognitive decline (SCD). Methods: A 52-week, prospective, single-arm, pre-post, remote nationwide clinical trial was conducted to measure the change in cognitive function, depression, and anxiety levels for older adults at risk of developing dementia who participated in the VC Health program. A Web-based study platform was used to screen, consent, and enroll participants across the United States. Participants completed the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) test and Web-based assessments (which included the Patient Health Questionnaire [PHQ-9] and Generalized Anxiety Disorder [GAD-7] surveys) at baseline and weeks 12, 24, and 52; all data were collected remotely. Changes in RBANS, PHQ-9, and GAD-7 were assessed using 2-tailed paired t tests and nonparametric signed-rank tests. Results: Participants (N=82) were, on average, aged 64 years (range 60.0-74.9 years), 74% (61/82) female, 88% (72/82) white, and 67% (55/82) had a college degree or higher. At baseline, participants had a mean and median RBANS Total Index score of 95.9 (SD 11.1) and 95.5 (interquartile range, IQR=13). Participants experienced a mean and median increase of 5.8 (SD 7.4) and 6 (IQR=11) in RBANS Total Index score from baseline to week 52 (P<.001). Participants had a mean and median PHQ-9 score of 8.5 (SD 4.9) and 8 (IQR=6) at baseline and experienced a mean and median decrease of 3.8 (SD 4.1) and 4 (IQR=6) units in PHQ-9 score from baseline to week 52 (P<.001). At baseline, participants had a mean and median GAD-7 score of 6.2 (SD 4.5) and 5.5 (IQR=6) and experienced a mean and median decrease of 2.9 (SD 4.1) and 2 (IQR=5) units in GAD-7 score from baseline to week 52 (P<.001). Participants were engaged and very satisfied with various program components. Conclusions: In this study, older adults with SCD who were at risk for dementia experienced statistically significant improvements in their cognitive function, depression, and anxiety levels. These findings serve as initial evidence for the overall feasibility and effectiveness of the VC Health program to improve or maintain cognitive function in older adults who are experiencing SCD. Further research should be conducted to understand the degree to which the improvements are attributable to specific components of the intervention. Trial Registration: ClinicalTrials.gov NCT02969460; https://clinicaltrials.gov/ct2/show/NCT02969460 (Archived by WebCite at http://www.webcitation.org/73XOph9Qm) UR - http://aging.jmir.org/2018/2/e12031/ UR - http://dx.doi.org/10.2196/12031 UR - http://www.ncbi.nlm.nih.gov/pubmed/31518248 ID - info:doi/10.2196/12031 ER - TY - JOUR AU - Jamwal, Rebecca AU - Callaway, Libby AU - Winkler, Di AU - Farnworth, Louise AU - Tate, Robyn PY - 2018/11/08 TI - Evaluating the Use of Smart Home Technology by People With Brain Impairment: Protocol for a Single-Case Experimental Design JO - JMIR Res Protoc SP - e10451 VL - 7 IS - 11 KW - assistive technology KW - clinical research protocol KW - disabled persons KW - housing KW - mobile phone N2 - Background: Smart home technologies are emerging as a useful component of support delivery for people with brain impairment. To promote their successful uptake and sustained use, focus on technology support services, including training, is required. Objective: The objective of this paper is to present a systematic smart home technology training approach for people with brain impairment. In addition, the paper outlines a multiple-baseline, single-case experimental design methodology to evaluate training effectiveness. Methods: Adult participants experiencing acquired brain impairment who can provide consent to participate and who live in housing where smart home technology is available will be recruited. Target behaviors will be identified in consultation with each participant based on his or her personal goals for technology use. Target behaviors may include participant knowledge of the number and type of technology functions available, frequency of smart home technology use, and number of function types used. Usage data will be gathered via log-on smart home technology servers. A smart technology digital training package will also be developed and left on a nominated device (smartphone, tablet) with each participant to use during the trial and posttrial, as desired. Measures of the target behavior will be taken throughout the baseline, intervention, and postintervention phases to provide the evidence of impact of the training on the target behaviors and ascertain whether utilization rates are sustained over time. In addition, trial results will be analyzed using structured visual analysis, supplemented with statistical analysis appropriate to single-case methodology. Results: While ascertaining the effectiveness of this training protocol, study results will offer new insights into technology-related training approaches for people with brain impairment. Preliminary data collection has been commenced at one supported housing site, with further scoping work continuing to recruit participants from additional sites. Conclusions: Evaluation evidence will assist in planning for the smart technology set-up as well as training and support services necessary to accompany the provision of new devices and systems. International Registered Report Identifier (IRRID): RR1-10.2196/10451 UR - https://www.researchprotocols.org/2018/11/e10451/ UR - http://dx.doi.org/10.2196/10451 UR - http://www.ncbi.nlm.nih.gov/pubmed/30409766 ID - info:doi/10.2196/10451 ER - TY - JOUR AU - Thirkettle, Martin AU - Lewis, Jennifer AU - Langdridge, Darren AU - Pike, Graham PY - 2018/10/30 TI - A Mobile App Delivering a Gamified Battery of Cognitive Tests Designed for Repeated Play (OU Brainwave): App Design and Cohort Study JO - JMIR Serious Games SP - e10519 VL - 6 IS - 4 KW - cognitive psychology KW - gamification KW - mobile app KW - Morningness-Eveningness KW - mobile phone N2 - Background: Mobile phone and tablet apps are an increasingly common platform for collecting data. A key challenge for researchers has been participant ?buy-in? and attrition for designs requiring repeated testing. Objective: The objective of this study was to develop and assess the utility of 1-2 minute versions of both classic and novel cognitive tasks using a user-focused and user-driven mobile phone and tablet app designed to encourage repeated play. Methods: A large sample of app users (N=13,979 at first data collection) participated in multiple, self-paced sessions of classic working memory (N-back), spatial cognition (mental rotation), sustained attentional focus (persistent vigilance task), and split attention (multiple object tracking) tasks, along with the implementation of a comparatively novel action-learning task. The ?OU Brainwave? app was designed to measure time-of-day variation in cognitive performance and did not offer any training program or promise any cognitive enhancement. To record participants? chronotype, a full Morningness-Eveningness questionnaire was also included, which measures whether a person's circadian rhythm produces peak alertness in the morning, in the evening, or in between. Data were collected during an 18-month period. While the app prompted re-engagement at set intervals, participants were free to complete each task as many times as they wished. Results: We found a significant relationship between morningness and age (r=.298, n=12,755, P<.001), with no effect of gender (t13,539=?1.036, P=.30). We report good task adherence, with ~4000 participants repeatedly playing each game >4 times each?our minimum engagement level for analysis. Repeated plays of these games allowed us to replicate commonly reported gender effects in gamified spatial cognition (F1,4216=154.861, P<.001, ?2?=.035), split attention (F1,4185=11.047, P=.001, ?2?=.003), and sustained attentional focus (F1,4238=15.993, P<.001, ?2?=.004) tasks. We also report evidence of a small gender effect in an action-learning task (F1,3988=90.59, P<.001, ?2?=.022). Finally, we found a strong negative effect of self-reported age on performance, when controlling for number of plays, in sustained attentional focus (n=1596, F6,1595=30.23, P<.001, ?2=.102), working memory (n=1627, F6,1626=19.78, P<.001, ?2=.068), spatial cognition (n=1640, F6,1639=23.74, P<.001, ?2=.080), and split attention tasks (n=1616, F6,1615=2.48, P=.02, ?2=.009). Conclusions: Using extremely short testing periods and permitting participants to decide their level of engagement?both in terms of which gamified task they played and how many sessions they completed?we were able to collect a substantial and valid dataset. We suggest that the success of OU Brainwave should inform future research oriented apps?particularly in issues of balancing participant engagement with data fidelity. UR - http://games.jmir.org/2018/4/e10519/ UR - http://dx.doi.org/10.2196/10519 UR - http://www.ncbi.nlm.nih.gov/pubmed/30377140 ID - info:doi/10.2196/10519 ER - TY - JOUR AU - Laird, A. Elizabeth AU - Ryan, Assumpta AU - McCauley, Claire AU - Bond, B. Raymond AU - Mulvenna, D. Maurice AU - Curran, J. Kevin AU - Bunting, Brendan AU - Ferry, Finola AU - Gibson, Aideen PY - 2018/09/11 TI - Using Mobile Technology to Provide Personalized Reminiscence for People Living With Dementia and Their Carers: Appraisal of Outcomes From a Quasi-Experimental Study JO - JMIR Ment Health SP - e57 VL - 5 IS - 3 KW - dementia KW - evaluation KW - mobile apps KW - reminiscence KW - research KW - technology KW - mobile phone N2 - Background: Dementia is an international research priority. Reminiscence is an intervention that prompts memories and has been widely used as a therapeutic approach for people living with dementia. We developed a novel iPad app to support home-based personalized reminiscence. It is crucial that technology-enabled reminiscence interventions are appraised. Objective: We sought to measure the effect of technology-enabled reminiscence on mutuality (defined as the level of ?closeness? between an adult living with dementia and their carer), quality of carer and patient relationship, and subjective well-being. Methods: A 19-week personalized reminiscence intervention facilitated by a program of training and a bespoke iPad app was delivered to people living with dementia and their family carers at their own homes. Participants (N=60) were recruited in dyads from a cognitive rehabilitation team affiliated with a large UK health care organization. Each dyad comprised a person living with early to moderate dementia and his or her family carer. Outcome measurement data were collected at baseline, midpoint, and intervention closure. Results: Participants living with dementia attained statistically significant increases in mutuality, quality of carer and patient relationship, and subjective well-being (P<.001 for all 3) from baseline to endpoint. Carers attained nonsignificant increases in mutuality and quality of carer and patient relationship and a nonsignificant decrease in subjective well-being. Conclusions: Our results indicate that individual-specific reminiscence supported by an iPad app may be efficient in the context of early to moderate dementia. A robust randomized controlled trial of technology-enabled personalized reminiscence is warranted. UR - http://mental.jmir.org/2018/3/e57/ UR - http://dx.doi.org/10.2196/mental.9684 UR - http://www.ncbi.nlm.nih.gov/pubmed/30206053 ID - info:doi/10.2196/mental.9684 ER - TY - JOUR AU - Martínez-Alcalá, I. Claudia AU - Rosales-Lagarde, Alejandra AU - Hernández-Alonso, Esmeralda AU - Melchor-Agustin, Roberto AU - Rodriguez-Torres, E. Erika AU - Itzá-Ortiz, A. Benjamín PY - 2018/08/21 TI - A Mobile App (iBeni) With a Neuropsychological Basis for Cognitive Stimulation for Elderly Adults: Pilot and Validation Study JO - JMIR Res Protoc SP - e172 VL - 7 IS - 8 KW - mobile application KW - cognitive stimulation KW - cognitive impairment KW - older adults KW - neuropsychological evaluation. N2 - Background: Cognitive impairment is considered one of the most feared chronic conditions among the older adult population since its incidence is approximately twice more frequent than that of dementia. In Mexico, no studies or reports of older adults using technology for cognitive interventions have been published, given that institutions usually frame cognitive stimulation tasks in paper and pencil (ie, in the traditional manner). Objective: The objective of this study was to create and analyze the effect, viability, and impact of a mobile app for cognitive stimulation implemented among a group of elderly adults (over 60 years of age) from the state of Hidalgo in Mexico. Methods: This study was a nonprobabilistic pilot trial using convenience sampling. An intervention was implemented among a group of 22 older adults between 60 and 80 years of age over 12 weeks. Half of the older adults were stimulated with the mobile app (experimental group) and the other half followed the traditional paper and pencil training (control group). Assessments with the Mini-Mental State Examination (MMSE) and the Neuropsi, a neuropsychological test validated in Mexico, were done before and after both cognitive stimulations. Results: According to the analyzed data, 6/11 (55%) participants from the experimental group obtained better results in their cognitive skills, and 5 (45%) of the adults maintained their score, given that the participants were able to execute the exercises repetitively. Meanwhile, for the control group, only 3/11 (27%) participants obtained better results in the postevaluation. Significant values for results of the MMSE were obtained in the postevaluation for the experimental group compared to the control group, while results did not show significant differences in the Neuropsi. Regarding the validation of the app, all the participants evaluated its pertinence positively. Conclusions: The intervention data show that the experimental group obtained better results in the postevaluation given that the participants were able to execute the exercises repetitively. The control group could not accomplish this since they had to respond on the manual and no further attempts were provided. However, both groups increased their score in the neuropsychological evaluations. This suggests that a longer and more frequent intervention is required. Registered Report Identifier: RR1-10.2196/9603 UR - http://www.researchprotocols.org/2018/8/e172/ UR - http://dx.doi.org/10.2196/resprot.9603 UR - http://www.ncbi.nlm.nih.gov/pubmed/30131319 ID - info:doi/10.2196/resprot.9603 ER - TY - JOUR AU - Kerr, Andrew AU - Smith, Mark AU - Reid, Lynn AU - Baillie, Lynne PY - 2018/08/17 TI - Adoption of Stroke Rehabilitation Technologies by the User Community: Qualitative Study JO - JMIR Rehabil Assist Technol SP - e15 VL - 5 IS - 2 KW - stroke KW - rehabilitation KW - technology KW - priorities N2 - Background: Using technology in stroke rehabilitation is attractive. Devices such as robots or smartphones can help deliver evidence-based levels of practice intensity and automated feedback without additional labor costs. Currently, however, few technologies have been adopted into everyday rehabilitation. Objective: This project aimed to identify stakeholder (therapists, patients, and caregivers) priorities for stroke rehabilitation technologies and to generate user-centered solutions for enhancing everyday adoption. Methods: We invited stakeholders (n=60), comprising stroke survivors (20/60, 33%), therapists (20/60, 33%), caregivers, and technology developers (including researchers; 20/60, 33%), to attend 2 facilitated workshops. Workshop 1 was preceded by a national survey of stroke survivors and therapists (n=177) to generate an initial list of priorities. The subsequent workshop focused on identifying practical solutions to enhance adoption. Results: A total of 25 priorities were generated from the survey; these were reduced to 10 nonranked priorities through discussion, consensus activities, and voting at Workshop 1: access to technologies, ease of use, awareness of available technologies, technologies focused on function, supports self-management, user training, evidence of effectiveness, value for money, knowledgeable staff, and performance feedback. The second workshop provided recommendations for improving the adoption of technologies in stroke rehabilitation: an annual exhibition of commercially available and developing technologies, an online consumer-rating website of available technologies, and a user network to inspire and test new technologies. Conclusions: The key outcomes from this series of stakeholder workshops provides a starting point for an integrated approach to promoting greater adoption of technologies in stroke rehabilitation. Bringing technology developers and users together to shape future and evaluate current technologies is critical to achieving evidence-based stroke rehabilitation. UR - http://rehab.jmir.org/2018/2/e15/ UR - http://dx.doi.org/10.2196/rehab.9219 UR - http://www.ncbi.nlm.nih.gov/pubmed/30120086 ID - info:doi/10.2196/rehab.9219 ER - TY - JOUR AU - Bott, Nicholas AU - Madero, N. Erica AU - Glenn, Jordan AU - Lange, Alexander AU - Anderson, John AU - Newton, Doug AU - Brennan, Adam AU - Buffalo, A. Elizabeth AU - Rentz, Dorene AU - Zola, Stuart PY - 2018/07/24 TI - Device-Embedded Cameras for Eye Tracking?Based Cognitive Assessment: Validation With Paper-Pencil and Computerized Cognitive Composites JO - J Med Internet Res SP - e11143 VL - 20 IS - 7 KW - eye tracking KW - visual paired comparison KW - preclinical Alzheimer?s disease KW - neuropsychological testing N2 - Background: As eye tracking-based assessment of cognition becomes more widely used in older adults, particularly those at risk for dementia, reliable and scalable methods to collect high-quality data are required. Eye tracking-based cognitive tests that utilize device-embedded cameras have the potential to reach large numbers of people as a screening tool for preclinical cognitive decline. However, to fully validate this approach, more empirical evidence about the comparability of eyetracking-based paradigms to existing cognitive batteries is needed. Objective: Using a population of clinically normal older adults, we examined the relationship between a 30-minute Visual Paired Comparison (VPC) recognition memory task and cognitive composite indices sensitive to a subtle decline in domains associated with Alzheimer disease. Additionally, the scoring accuracy between software used with a commercial grade eye tracking camera at 60 frames per second (FPS) and a manually scored procedure used with a laptop-embedded web camera (3 FPS) on the VPC task was compared, as well as the relationship between VPC task performance and domain-specific cognitive function. Methods: A group of 49 clinically normal older adults completed a 30-min VPC recognition memory task with simultaneous recording of eye movements by a commercial-grade eye-tracking camera and a laptop-embedded camera. Relationships between webcam VPC performance and the Preclinical Alzheimer Cognitive Composite (PACC) and National Institutes of Health Toolbox Cognitive Battery (NIHTB-CB) were examined. Inter-rater reliability for manually scored tests was analyzed using Krippendorff?s kappa formula, and we used Spearman?s Rho correlations to investigate the relationship between VPC performance scores with both cameras. We also examined the relationship between VPC performance with the device-embedded camera and domain-specific cognitive performance. Results: Modest relationships were seen between mean VPC novelty preference and the PACC (r=.39, P=.007) and NIHTB-CB (r=.35, P=.03) composite scores, and additional individual neurocognitive task scores including letter fluency (r=.33, P=.02), category fluency (r=.36, P=.01), and Trail Making Test A (?.40, P=.006). Robust relationships were observed between the 60 FPS eye tracker and 3 FPS webcam on both trial-level VPC novelty preference (r=.82, P<.001) and overall mean VPC novelty preference (r=.92 P<.001). Inter-rater agreement of manually scored web camera data was high (kappa=.84). Conclusions: In a sample of clinically normal older adults, performance on a 30-minute VPC task correlated modestly with computerized and paper-pencil based cognitive composites that serve as preclinical Alzheimer disease cognitive indices. The strength of these relationships did not differ between camera devices. We suggest that using a device-embedded camera is a reliable and valid way to assess performance on VPC tasks accurately and that these tasks correlate with existing cognitive composites. UR - http://www.jmir.org/2018/7/e11143/ UR - http://dx.doi.org/10.2196/11143 UR - http://www.ncbi.nlm.nih.gov/pubmed/30042093 ID - info:doi/10.2196/11143 ER - TY - JOUR AU - Feenstra, EM Heleen AU - Vermeulen, E. Ivar AU - Murre, MJ Jaap AU - Schagen, B. Sanne PY - 2018/05/30 TI - Online Self-Administered Cognitive Testing Using the Amsterdam Cognition Scan: Establishing Psychometric Properties and Normative Data JO - J Med Internet Res SP - e192 VL - 20 IS - 5 KW - cognition KW - neuropsychological tests KW - self-assessment KW - internet KW - reproducibility of results KW - reference standards N2 - Background: Online tests enable efficient self-administered assessments and consequently facilitate large-scale data collection for many fields of research. The Amsterdam Cognition Scan is a new online neuropsychological test battery that measures a broad variety of cognitive functions. Objective: The aims of this study were to evaluate the psychometric properties of the Amsterdam Cognition Scan and to establish regression-based normative data. Methods: The Amsterdam Cognition Scan was self-administrated twice from home?with an interval of 6 weeks?by 248 healthy Dutch-speaking adults aged 18 to 81 years. Results: Test-retest reliability was moderate to high and comparable with that of equivalent traditional tests (intraclass correlation coefficients: .45 to .80; .83 for the Amsterdam Cognition Scan total score). Multiple regression analyses indicated that (1) participants? age negatively influenced all (12) cognitive measures, (2) gender was associated with performance on six measures, and (3) education level was positively associated with performance on four measures. In addition, we observed influences of tested computer skills and of self-reported amount of computer use on cognitive performance. Demographic characteristics that proved to influence Amsterdam Cognition Scan test performance were included in regression-based predictive formulas to establish demographically adjusted normative data. Conclusions: Initial results from a healthy adult sample indicate that the Amsterdam Cognition Scan has high usability and can give reliable measures of various generic cognitive ability areas. For future use, the influence of computer skills and experience should be further studied, and for repeated measurements, computer configuration should be consistent. The reported normative data allow for initial interpretation of Amsterdam Cognition Scan performances. UR - http://www.jmir.org/2018/5/e192/ UR - http://dx.doi.org/10.2196/jmir.9298 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/jmir.9298 ER - TY - JOUR AU - Jie, Li-Juan AU - Kleynen, Melanie AU - Meijer, Kenneth AU - Beurskens, Anna AU - Braun, Susy PY - 2018/05/24 TI - The Effects of Implicit and Explicit Motor Learning in Gait Rehabilitation of People After Stroke: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e142 VL - 7 IS - 5 KW - motor learning KW - implicit learning KW - explicit learning KW - analogy KW - analogy learning KW - gait KW - physiotherapy KW - rehabilitation KW - stroke KW - CVA N2 - Background: A significant part of neurological rehabilitation focuses on facilitating the learning of motor skills. Training can adopt either (more) explicit or (more) implicit forms of motor learning. Gait is one of the most practiced motor skills within rehabilitation in people after stroke because it is an important criterion for discharge and requirement for functioning at home. Objective: The aim of this study was to describe the design of a randomized controlled study assessing the effects of implicit motor learning compared with the explicit motor learning in gait rehabilitation of people suffering from stroke. Methods: The study adopts a randomized, controlled, single-blinded study design. People after stroke will be eligible for participation when they are in the chronic stage of recovery (>6 months after stroke), would like to improve walking performance, have a slow walking speed (<1 m/s), can communicate in Dutch, and complete a 3-stage command. People will be excluded if they cannot walk a minimum of 10 m or have other additional impairments that (severely) influence gait. Participants will receive 9 gait-training sessions over a 3-week period and will be randomly allocated to an implicit or explicit group. Therapists are aware of the intervention they provide, and the assessors are blind to the intervention participants receive. Outcome will be assessed at baseline (T0), directly after the intervention (T1), and after 1 month (T2). The primary outcome parameter is walking velocity. Walking performance will be assessed with the 10-meter walking test, Dynamic Gait Index, and while performing a secondary task (dual task). Self-reported measures are the Movement Specific Reinvestment Scale, verbal protocol, Stroke and Aphasia Quality of Life Scale, and the Global Perceived Effect scale. A process evaluation will take place to identify how the therapy was perceived and identify factors that may have influenced the effectiveness of the intervention. Repeated measures analyses will be conducted to determine significant and clinical relevant differences between groups and over time. Results: Data collection is currently ongoing and results are expected in 2019. Conclusions: The relevance of the study as well as the advantages and disadvantages of several aspects of the chosen design are discussed, for example, the personalized approach and choice of measurements. Trial Registration: Netherlands Trial Register NTR6272; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=6272 (Archived by WebCite http://www.webcitation.org/6ytA937m5) Registered Report Identifier: RR1-10.2196/9595 UR - http://www.researchprotocols.org/2018/5/e142/ UR - http://dx.doi.org/10.2196/resprot.9595 UR - http://www.ncbi.nlm.nih.gov/pubmed/29793902 ID - info:doi/10.2196/resprot.9595 ER - TY - JOUR AU - Elnady, Ahmed AU - Mortenson, Ben W. AU - Menon, Carlo PY - 2018/05/15 TI - Perceptions of Existing Wearable Robotic Devices for Upper Extremity and Suggestions for Their Development: Findings From Therapists and People With Stroke JO - JMIR Rehabil Assist Technol SP - e12 VL - 5 IS - 1 KW - qualitative research KW - focus group KW - wearable devices KW - rehabilitation KW - upper extremity N2 - Background: Advances in wearable robotic technologies have increased the potential of these devices for rehabilitation and as assistive devices. However, the utilization of these devices is still limited and there are questions regarding how well these devices address users? (therapists and patients) needs. Objective: The aims of this study were to (1) describe users? perceptions about existing wearable robotic devices for the upper extremity; (2) identify if there is a need to develop new devices for the upper extremity and the desired features; and (3) explore obstacles that would influence the utilization of these new devices. Methods: Focus groups were held to collect data. Data were analyzed thematically. Results: A total of 16 participants took part in the focus group discussions. Our analysis identified three main themes: (1) ?They exist, but...? described participants? perceptions about existing devices for upper extremity; (2) ?Indeed, we need more, can we have it all?? reflected participants? desire to have new devices for the upper extremity and revealed heterogeneity among different participants; and (3) ?Bumps on the road? identified challenges that the participants felt needed to be taken into consideration during the development of these devices. Conclusions: This study resonates with previous research that has highlighted the importance of involving end users in the design process. The study suggests that having a single solution for stroke rehabilitation or assistance could be challenging or even impossible, and thus, engineers should clearly identify the targeted stroke population needs before the design of any device for the upper extremity. UR - http://rehab.jmir.org/2018/1/e12/ UR - http://dx.doi.org/10.2196/rehab.9535 UR - http://www.ncbi.nlm.nih.gov/pubmed/29764799 ID - info:doi/10.2196/rehab.9535 ER - TY - JOUR AU - Dimaguila, Luis Gerardo AU - Gray, Kathleen AU - Merolli, Mark PY - 2018/05/08 TI - Person-Generated Health Data in Simulated Rehabilitation Using Kinect for Stroke: Literature Review JO - JMIR Rehabil Assist Technol SP - e11 VL - 5 IS - 1 KW - health care information systems KW - Kinect KW - patient-generated health data KW - person-generated health data KW - review KW - simulated rehabilitation KW - stroke KW - stroke rehabilitation KW - video games KW - virtual rehabilitation N2 - Background: Person- or patient-generated health data (PGHD) are health, wellness, and clinical data that people generate, record, and analyze for themselves. There is potential for PGHD to improve the efficiency and effectiveness of simulated rehabilitation technologies for stroke. Simulated rehabilitation is a type of telerehabilitation that uses computer technologies and interfaces to allow the real-time simulation of rehabilitation activities or a rehabilitation environment. A leading technology for simulated rehabilitation is Microsoft?s Kinect, a video-based technology that uses infrared to track a user?s body movements. Objective: This review attempts to understand to what extent Kinect-based stroke rehabilitation systems (K-SRS) have used PGHD and to what benefit. Methods: The review is conducted in two parts. In part 1, aspects of relevance for PGHD were searched for in existing systematic reviews on K-SRS. The following databases were searched: IEEE Xplore, Association of Computing Machinery Digital Library, PubMed, Biomed Central, Cochrane Library, and Campbell Collaboration. In part 2, original research papers that presented or used K-SRS were reviewed in terms of (1) types of PGHD, (2) patient access to PGHD, (3) PGHD use, and (4) effects of PGHD use. The search was conducted in the same databases as part 1 except Cochrane and Campbell Collaboration. Reference lists on K-SRS of the reviews found in part 1 were also included in the search for part 2. There was no date restriction. The search was closed in June 2017. The quality of the papers was not assessed, as it was not deemed critical to understanding PGHD access and use in studies that used K-SRS. Results: In part 1, 192 papers were identified, and after assessment only 3 papers were included. Part 1 showed that previous reviews focused on technical effectiveness of K-SRS with some attention on clinical effectiveness. None of those reviews reported on home-based implementation or PGHD use. In part 2, 163 papers were identified and after assessment, 41 papers were included. Part 2 showed that there is a gap in understanding how PGHD use may affect patients using K-SRS and a lack of patient participation in the design of such systems. Conclusions: This paper calls specifically for further studies of K-SRS?and for studies of technologies that allow patients to generate their own health data in general?to pay more attention to how patients? own use of their data may influence their care processes and outcomes. Future studies that trial the effectiveness of K-SRS outside the clinic should also explore how patients and carers use PGHD in home rehabilitation programs. UR - http://rehab.jmir.org/2018/1/e11/ UR - http://dx.doi.org/10.2196/rehab.9123 UR - http://www.ncbi.nlm.nih.gov/pubmed/29739739 ID - info:doi/10.2196/rehab.9123 ER - TY - JOUR AU - Naidu, Avantika AU - Brown, David AU - Roth, Elliot PY - 2018/05/03 TI - A Challenge-Based Approach to Body Weight?Supported Treadmill Training Poststroke: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e118 VL - 7 IS - 5 KW - stroke KW - rehabilitation KW - falls KW - walking KW - hemiparesis KW - body weight support treadmill training KW - balance KW - robotics KW - mobility KW - walking challenges N2 - Background: Body weight support treadmill training protocols in conjunction with other modalities are commonly used to improve poststroke balance and walking function. However, typical body weight support paradigms tend to use consistently stable balance conditions, often with handrail support and or manual assistance. Objective: In this paper, we describe our study protocol, which involved 2 unique body weight support treadmill training paradigms of similar training intensity that integrated dynamic balance challenges to help improve ambulatory function post stroke. The first paradigm emphasized walking without any handrails or manual assistance, that is, hands-free walking, and served as the control group, whereas the second paradigm incorporated practicing 9 essential challenging mobility skills, akin to environmental barriers encountered during community ambulation along with hands-free walking (ie hands-free + challenge walking). Methods: We recruited individuals with chronic poststroke hemiparesis and randomized them to either group. Participants trained for 6 weeks on a self-driven, robotic treadmill interface that provided body weight support and a safe gait-training environment. We assessed participants at pre-, mid- and post 6 weeks of intervention-training, with a 6-month follow-up. We hypothesized greater walking improvements in the hands-free + challenge walking group following training because of increased practice opportunity of essential mobility skills along with hands-free walking. Results: We assessed 77 individuals with chronic hemiparesis, and enrolled and randomized 30 individuals poststroke for our study (hands-free group=19 and hands-free + challenge walking group=20) from June 2012 to January 2015. Data collection along with 6-month follow-up continued until January 2016. Our primary outcome measure is change in comfortable walking speed from pre to post intervention for each group. We will also assess feasibility, adherence, postintervention efficacy, and changes in various exploratory secondary outcome measures. Additionally, we will also assess participant responses to a study survey, conducted at the end of training week, to gauge each group's training experiences. Conclusions: Our treadmill training paradigms, and study protocol represent advances in standardized approaches to selecting body weight support levels without the necessity for using handrails or manual assistance, while progressively providing dynamic challenges for improving poststroke ambulatory function during rehabilitation. Trial Registration: ClinicalTrials.gov NCT02787759; https://clinicaltrials.gov/ct2/show/NCT02787759 (Archived by Webcite at http://www.webcitation.org/6yJZCrIea) UR - http://www.researchprotocols.org/2018/5/e118/ UR - http://dx.doi.org/10.2196/resprot.9308 UR - http://www.ncbi.nlm.nih.gov/pubmed/29724706 ID - info:doi/10.2196/resprot.9308 ER - TY - JOUR AU - Cogollor, M. José AU - Rojo-Lacal, Javier AU - Hermsdörfer, Joachim AU - Ferre, Manuel AU - Arredondo Waldmeyer, Teresa Maria AU - Giachritsis, Christos AU - Armstrong, Alan AU - Breñosa Martinez, Manuel Jose AU - Bautista Loza, Anabelle Doris AU - Sebastián, María José PY - 2018/03/26 TI - Evolution of Cognitive Rehabilitation After Stroke From Traditional Techniques to Smart and Personalized Home-Based Information and Communication Technology Systems: Literature Review JO - JMIR Rehabil Assist Technol SP - e4 VL - 5 IS - 1 KW - cognition KW - rehabilitation KW - stroke KW - eHealth KW - activities of daily living KW - delivery of health care N2 - Background: Neurological patients after stroke usually present cognitive deficits that cause dependencies in their daily living. These deficits mainly affect the performance of some of their daily activities. For that reason, stroke patients need long-term processes for their cognitive rehabilitation. Considering that classical techniques are focused on acting as guides and are dependent on help from therapists, significant efforts are being made to improve current methodologies and to use eHealth and Web-based architectures to implement information and communication technology (ICT) systems that achieve reliable, personalized, and home-based platforms to increase efficiency and level of attractiveness for patients and carers. Objective: The goal of this work was to provide an overview of the practices implemented for the assessment of stroke patients and cognitive rehabilitation. This study puts together traditional methods and the most recent personalized platforms based on ICT technologies and Internet of Things. Methods: A literature review has been distributed to a multidisciplinary team of researchers from engineering, psychology, and sport science fields. The systematic review has been focused on published scientific research, other European projects, and the most current innovative large-scale initiatives in the area. A total of 3469 results were retrieved from Web of Science, 284 studies from Journal of Medical Internet Research, and 15 European research projects from Community Research and Development Information Service from the last 15 years were reviewed for classification and selection regarding their relevance. Results: A total of 7 relevant studies on the screening of stroke patients have been presented with 6 additional methods for the analysis of kinematics and 9 studies on the execution of goal-oriented activities. Meanwhile, the classical methods to provide cognitive rehabilitation have been classified in the 5 main techniques implemented. Finally, the review has been finalized with the selection of 8 different ICT?based approaches found in scientific-technical studies, 9 European projects funded by the European Commission that offer eHealth architectures, and other large-scale activities such as smart houses and the initiative City4Age. Conclusions: Stroke is one of the main causes that most negatively affect countries in the socioeconomic aspect. The design of new ICT-based systems should provide 4 main features for an efficient and personalized cognitive rehabilitation: support in the execution of complex daily tasks, automatic error detection, home-based performance, and accessibility. Only 33% of the European projects presented fulfilled those requirements at the same time. For this reason, current and future large-scale initiatives focused on eHealth and smart environments should try to solve this situation by providing more complete and sophisticated platforms. UR - http://rehab.jmir.org/2018/1/e4/ UR - http://dx.doi.org/10.2196/rehab.8548 UR - http://www.ncbi.nlm.nih.gov/pubmed/29581093 ID - info:doi/10.2196/rehab.8548 ER - TY - JOUR AU - Arroyo-Gallego, Teresa AU - Ledesma-Carbayo, J. María AU - Butterworth, Ian AU - Matarazzo, Michele AU - Montero-Escribano, Paloma AU - Puertas-Martín, Verónica AU - Gray, L. Martha AU - Giancardo, Luca AU - Sánchez-Ferro, Álvaro PY - 2018/03/26 TI - Detecting Motor Impairment in Early Parkinson?s Disease via Natural Typing Interaction With Keyboards: Validation of the neuroQWERTY Approach in an Uncontrolled At-Home Setting JO - J Med Internet Res SP - e89 VL - 20 IS - 3 KW - eHealth KW - machine learning KW - telemedicine N2 - Background: Parkinson?s disease (PD) is the second most prevalent neurodegenerative disease and one of the most common forms of movement disorder. Although there is no known cure for PD, existing therapies can provide effective symptomatic relief. However, optimal titration is crucial to avoid adverse effects. Today, decision making for PD management is challenging because it relies on subjective clinical evaluations that require a visit to the clinic. This challenge has motivated recent research initiatives to develop tools that can be used by nonspecialists to assess psychomotor impairment. Among these emerging solutions, we recently reported the neuroQWERTY index, a new digital marker able to detect motor impairment in an early PD cohort through the analysis of the key press and release timing data collected during a controlled in-clinic typing task. Objective: The aim of this study was to extend the in-clinic implementation to an at-home implementation by validating the applicability of the neuroQWERTY approach in an uncontrolled at-home setting, using the typing data from subjects? natural interaction with their laptop to enable remote and unobtrusive assessment of PD signs. Methods: We implemented the data-collection platform and software to enable access and storage of the typing data generated by users while using their computer at home. We recruited a total of 60 participants; of these participants 52 (25 people with Parkinson?s and 27 healthy controls) provided enough data to complete the analysis. Finally, to evaluate whether our in-clinic-built algorithm could be used in an uncontrolled at-home setting, we compared its performance on the data collected during the controlled typing task in the clinic and the results of our method using the data passively collected at home. Results: Despite the randomness and sparsity introduced by the uncontrolled setting, our algorithm performed nearly as well in the at-home data (area under the receiver operating characteristic curve [AUC] of 0.76 and sensitivity/specificity of 0.73/0.69) as it did when used to evaluate the in-clinic data (AUC 0.83 and sensitivity/specificity of 0.77/0.72). Moreover, the keystroke metrics presented a strong correlation between the 2 typing settings, which suggests a minimal influence of the in-clinic typing task in users? normal typing. Conclusions: The finding that an algorithm trained on data from an in-clinic setting has comparable performance with that tested on data collected through naturalistic at-home computer use reinforces the hypothesis that subtle differences in motor function can be detected from typing behavior. This work represents another step toward an objective, user-convenient, and quasi-continuous monitoring tool for PD. UR - http://www.jmir.org/2018/3/e89/ UR - http://dx.doi.org/10.2196/jmir.9462 UR - http://www.ncbi.nlm.nih.gov/pubmed/29581092 ID - info:doi/10.2196/jmir.9462 ER - TY - JOUR AU - Allin, Sonya AU - Shepherd, John AU - Tomasone, Jennifer AU - Munce, Sarah AU - Linassi, Gary AU - Hossain, Noreen Saima AU - Jaglal, Susan PY - 2018/03/21 TI - Participatory Design of an Online Self-Management Tool for Users With Spinal Cord Injury: Qualitative Study JO - JMIR Rehabil Assist Technol SP - e6 VL - 5 IS - 1 KW - health education KW - internet KW - spinal cord injuries KW - self-management N2 - Background: Rehospitalization rates resulting from secondary conditions in persons with spinal cord injuries (SCI) are high. Self-management programs for many chronic conditions have been associated with decreases in hospital readmissions. However, in the SCI community, evidence suggests that satisfaction with traditional self-management programs is low. Users with SCI have indicated preference for programs that are online (rather than in-person), that target SCI-specific concerns, and are led by peers with SCI. There is currently no program with all of these features, which addresses self-management of secondary conditions after SCI. Objective: The aim of this study was to provide details of a participatory design (PD) process for an internet-mediated self-management program for users with SCI (called SCI & U) and illustrate how it has been used to define design constraints and solutions. Methods: Users were involved in development as codesigners, codevelopers, and key informants. Codesigners and codevelopers were recruited from consumer advocacy groups and worked with a core development team. Key informants were recruited from geographically distributed advocacy groups to form a product advisory council that met regularly with the core team. During meetings, codesigners and informants walked through stages of work that typify PD processes such as exploration, discovery, and prototyping. This paper details the process by analyzing 10 meetings that took place between August 2015 and May 2016. Meetings were recorded, transcribed, and subjected to an inductive thematic analysis; resulting themes were organized according to their relationship to PD stages. Results: A total of 16 individuals participated in meeting discussions, including 7 researchers and 9 persons with SCI from 4 Canadian provinces. Themes of trust, expertise, and community emerged in every group discussion. The exploration stage revealed interest in online self-management resources coupled with concerns about information credibility. In general, participants indicated that they felt more confident with information received from trusted, in-person sources (eg, peers or health care professionals) than information found online. The discovery stage saw participants propose and discuss concepts to filter credible information and highlight community expertise, namely (1) a community-curated resource database, (2) online information navigators, and (3) group chats with peers. Several tools and techniques were collectively prototyped in an effort to foster trust and community; these are illustrated in the Results section. Conclusions: A PD process engaging users as codesigners, codevelopers, and informants can be used to identify design concerns and prototype online solutions to promote self-management after SCI. Future work will assess the usability of the collectively designed tools among a broad population of Canadians with SCI and the tools? impact on self-efficacy and health. UR - http://rehab.jmir.org/2018/1/e6/ UR - http://dx.doi.org/10.2196/rehab.8158 UR - http://www.ncbi.nlm.nih.gov/pubmed/29563075 ID - info:doi/10.2196/rehab.8158 ER - TY - JOUR AU - Välimäki, Maritta AU - Mishina, Kaisa AU - Kaakinen, K. Johanna AU - Holm, K. Suvi AU - Vahlo, Jukka AU - Kirjonen, Markus AU - Pekurinen, Virve AU - Tenovuo, Olli AU - Korkeila, Jyrki AU - Hämäläinen, Heikki AU - Sarajuuri, Jaana AU - Rantanen, Pekka AU - Orenius, Tage AU - Koponen, Aki PY - 2018/03/19 TI - Digital Gaming for Improving the Functioning of People With Traumatic Brain Injury: Randomized Clinical Feasibility Study JO - J Med Internet Res SP - e77 VL - 20 IS - 3 KW - rehabilitation KW - traumatic brain injury KW - video games N2 - Background: Traumatic brain injury (TBI) is a major health problem that often requires intensive and long-term rehabilitation. Objective: The aim of this study was to determine whether rehabilitative digital gaming facilitates cognitive functioning and general well-being in people with TBI. Methods: A total of 90 Finnish-speaking adults with TBI (18-65 years) were recruited from an outpatient neuroscience clinic. The participants were randomly allocated to one of the three groups: a rehabilitation gaming group (n=29, intervention), an entertainment gaming group (n=29, active control), or a passive control group (n=32). The gaming groups were instructed to engage in gaming for a minimum of 30 min per day for 8 weeks. Primary and secondary outcomes were measured at three time points: before the intervention, after the intervention, and 3 months following the intervention. The primary outcome was cognitive status measured by processing speed and visuomotor tasks (The Trail Making Test; Wechsler Adult Intelligence Scale-Fourth Edition, WAIS-IV, symbol search, coding, and cancellation tasks). Secondary outcomes were attention and executive functions (Simon task), working memory (WAIS-IV digit span and Paced Auditory Serial Addition Test, PASAT), depression (Patient Health Questionnaire-9), self-efficacy (General Self-efficacy Scale), and executive functions (Behavior Rating Inventory of Executive Function-Adult Version). Feasibility information was assessed (acceptability, measurement instruments filled, dropouts, adherence, usability, satisfaction, and possible future use). Cognitive measurements were conducted in face-to-face interviews by trained psychologists, and questionnaires were self-administered. Results: The effects of rehabilitation gaming did not significantly differ from the effects of entertainment gaming or being in a passive control group. For primary outcomes and PASAT tests, the participants in all three groups showed overall improvement in test scores across the three measurement points. However, depression scores increased significantly between baseline and after 8 weeks and between baseline and after 3 months in the rehabilitative gaming group. No differences were found in patients? self-efficacy between the three measuring points in any of the groups. Participants did use the games (rehabilitation group: 93%, 27/29; entertainment group 100%, 29/29). Games were seen as a usable intervention (rehabilitation group: 70%, 14/29; entertainment group: 83%, 20/29). The rehabilitation group was less satisfied with the gaming intervention (68%, 13/29 vs 83%, 20/29), but they were more willing to use the game after the intervention period (76%, 16/29 vs 63%, 15/29). Total time spent on gaming during the intervention period was low (15.22 hour rehabilitation gaming group, 19.22 hour entertainment gaming group). Conclusions: We did not find differences between the groups in improvement in the outcome measures. The improvements in test performance by all three groups may reflect rehearsal effects. Entertainment gaming had elements that could be considered when rehabilitative games are designed for, implemented in, and assessed in larger clinical trials for persons with TBI. Trial Registration: ClinicalTrials.gov NCT02425527; https://clinicaltrials.gov/ct2/show/NCT02425527 (Archived by WebCite at http://www.webcitation.org/6esKI1uDH) UR - http://www.jmir.org/2018/3/e77/ UR - http://dx.doi.org/10.2196/jmir.7618 UR - http://www.ncbi.nlm.nih.gov/pubmed/29555622 ID - info:doi/10.2196/jmir.7618 ER - TY - JOUR AU - Giunti, Guido AU - Mylonopoulou, Vasiliki AU - Rivera Romero, Octavio PY - 2018/03/02 TI - More Stamina, a Gamified mHealth Solution for Persons with Multiple Sclerosis: Research Through Design JO - JMIR Mhealth Uhealth SP - e51 VL - 6 IS - 3 KW - multiple sclerosis KW - telemedicine KW - fatigue KW - mobile applications KW - video games KW - qualitative research KW - exercise KW - chronic disease KW - user-computer interface KW - software design N2 - Background: Multiple sclerosis (MS) is one of the world?s most common neurologic disorders. Fatigue is one of most common symptoms that persons with MS experience, having significant impact on their quality of life and limiting their activity levels. Self-management strategies are used to support them in the care of their health. Mobile health (mHealth) solutions are a way to offer persons with chronic conditions tools to successfully manage their symptoms and problems. Gamification is a current trend among mHealth apps used to create engaging user experiences and is suggested to be effective for behavioral change. To be effective, mHealth solutions need to be designed to specifically meet the intended audience needs. User-centered design (UCD) is a design philosophy that proposes placing end users? needs and characteristics in the center of design and development, involving users early in the different phases of the software life cycle. There is a current gap in mHealth apps for persons with MS, which presents an interesting area to explore. Objective: The purpose of this study was to describe the design and evaluation process of a gamified mHealth solution for behavioral change in persons with MS using UCD. Methods: Building on previous work of our team where we identified needs, barriers, and facilitators for mHealth apps for persons with MS, we followed UCD to design and evaluate a mobile app prototype aimed to help persons with MS self-manage their fatigue. Design decisions were evidence-driven and guided by behavioral change models (BCM). Usability was assessed through inspection methods using Nielsen?s heuristic evaluation. Results: The mHealth solution More Stamina was designed. It is a task organization tool designed to help persons with MS manage their energy to minimize the impact of fatigue in their day-to-day life. The tool acts as a to-do list where users can input tasks in a simple manner and assign Stamina Credits, a representation of perceived effort, to the task to help energy management and energy profiling. The app also features personalization and positive feedback. The design process gave way to relevant lessons to the design of a gamified behavioral change mHealth app such as the importance of metaphors in concept design, negotiate requirements with the BCM constructs, and tailoring of gamified experiences among others. Several usability problems were discovered during heuristic evaluation and guided the iterative design of our solution. Conclusions: In this paper, we designed an app targeted for helping persons with MS in their fatigue management needs. We illustrate how UCD can help in designing mHealth apps and the benefits and challenges that designers might face when using this approach. This paper provides insight into the design process of gamified behavioral change mHealth apps and the negotiation process implied in it. UR - http://mhealth.jmir.org/2018/3/e51/ UR - http://dx.doi.org/10.2196/mhealth.9437 UR - http://www.ncbi.nlm.nih.gov/pubmed/29500159 ID - info:doi/10.2196/mhealth.9437 ER - TY - JOUR AU - Rasmussen, Skovgaard Rune AU - Schaarup, Heltoft Anne Marie AU - Overgaard, Karsten PY - 2018/02/27 TI - Therapist-Assisted Rehabilitation of Visual Function and Hemianopia after Brain Injury: Intervention Study on the Effect of the Neuro Vision Technology Rehabilitation Program JO - JMIR Res Protoc SP - e65 VL - 7 IS - 2 KW - stroke KW - vision KW - rehabilitation KW - brain injury N2 - 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) UR - http://www.researchprotocols.org/2018/2/e65/ UR - http://dx.doi.org/10.2196/resprot.8334 UR - http://www.ncbi.nlm.nih.gov/pubmed/29487042 ID - info:doi/10.2196/resprot.8334 ER - TY - JOUR AU - Cox, CM Vincent AU - Schepers, PM Vera AU - Ketelaar, Marjolijn AU - van Heugten, M. Caroline AU - Visser-Meily, MA Johanna PY - 2018/02/16 TI - Evaluating the CARE4Carer Blended Care Intervention for Partners of Patients With Acquired Brain Injury: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e60 VL - 7 IS - 2 KW - caregivers KW - brain injuries KW - internet KW - telemedicine KW - randomized controlled trial N2 - Background: Support programs for partners of patients with acquired brain injury are necessary since these partners experience several unfavorable consequences of caregiving, such as a high burden, emotional distress, and poor quality of life. Evidence-based support strategies that can be included in these support programs are psychoeducation, skill building, problem solving, and improving feelings of mastery. A promising approach would seem to be to combine web-based support with face-to-face consultations, creating a blended care intervention. Objective: This paper outlines the protocol of a randomized controlled trial to evaluate the CARE4Carer blended care intervention for partners of patients with acquired brain injury. Methods: A multicenter two-arm randomized controlled trial will be conducted. A total of 120 partners of patients with acquired brain injury will be recruited from five rehabilitation centers in the Netherlands. The blended care intervention consists of a nine-session web-based support program and two face-to-face consultations with a social worker. Themes that will be addressed are: giving partners insight into their own situation, including possible pitfalls and strengths, learning how to cope with the situation, getting a grip on thoughts and feelings, finding a better balance in the care for the patient with acquired brain injury, thinking about other possible care options, taking care of oneself, and communication. The intervention lasts 20 weeks and the control group will receive usual care. The outcome measures will be assessed at baseline and at 24- and 40-week follow-up. The primary outcome is caregiver mastery. Secondary outcome measures are strain, burden, family functioning, emotional functioning, coping, quality of life, participation, and social network. Results: The effect of the intervention on the primary and secondary outcome measures will be determined. Additional a process evaluation will be conducted. Conclusions: The findings of this study will be used to improve the care for partners of patients with acquired brain injury. Barriers and facilitators that emerge from the process evaluation will be used in the nationwide implementation of the intervention. Trial Registration: Dutch Trial Register NTR6197; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=6197 (Archived by WebCite at http://www.webcitation.org/6xHBAxx0y) UR - http://www.researchprotocols.org/2018/2/e60/ UR - http://dx.doi.org/10.2196/resprot.9108 UR - http://www.ncbi.nlm.nih.gov/pubmed/29453189 ID - info:doi/10.2196/resprot.9108 ER - TY - JOUR AU - Burton, L. Rachel AU - O'Connell, E. Megan PY - 2018/02/08 TI - Telehealth Rehabilitation for Cognitive Impairment: Randomized Controlled Feasibility Trial JO - JMIR Res Protoc SP - e43 VL - 7 IS - 2 KW - cognitive rehabilitation KW - Alzheimer disease KW - dementia KW - telehealth N2 - Background: Nonpharmacological interventions are needed to support the function of older adults struggling with subjective cognitive impairment (SCI), mild cognitive impairment (MCI), and dementia due to Alzheimer disease (AD). Telerehabilitation aims to provide rehabilitation at a distance, but cognitive rehabilitation by videoconferencing has not been explored. Objective: The objective of this study was to compare goal-oriented cognitive rehabilitation delivered in-person with videoconferencing to determine whether telehealth cognitive rehabilitation appears feasible. Methods: Random assignment to in-person or telehealth videoconferencing cognitive rehabilitation with a combined between-subjects, multiple baseline single-case experimental design, cognitive rehabilitation was delivered by a therapist to 6 participants with SCI (n=4), MCI (n=1), or dementia due to AD (n=1). Results: Two of the 6 participants randomly assigned to the telehealth condition withdrew before beginning the intervention. For those who participated in the intervention, 6 out of 6 goals measured with the Canadian Occupational Performance Measure improved for those in the in-person group, and 7 out of 9 goals improved for those in the telehealth group. Conclusions: Delivery of cognitive rehabilitation by telehealth appeared feasible but required modifications such as greater reliance on caregivers and clients for manipulating materials. UR - http://www.researchprotocols.org/2018/2/e43/ UR - http://dx.doi.org/10.2196/resprot.9420 UR - http://www.ncbi.nlm.nih.gov/pubmed/29422453 ID - info:doi/10.2196/resprot.9420 ER - TY - JOUR AU - Manor, Brad AU - Yu, Wanting AU - Zhu, Hao AU - Harrison, Rachel AU - Lo, On-Yee AU - Lipsitz, Lewis AU - Travison, Thomas AU - Pascual-Leone, Alvaro AU - Zhou, Junhong PY - 2018/01/30 TI - Smartphone App?Based Assessment of Gait During Normal and Dual-Task Walking: Demonstration of Validity and Reliability JO - JMIR Mhealth Uhealth SP - e36 VL - 6 IS - 1 KW - smartphone KW - gait assessment KW - pocket KW - dual task KW - validity KW - reliability KW - mobile applications N2 - Background: Walking is a complex cognitive motor task that is commonly completed while performing another task such as talking or making decisions. Gait assessments performed under normal and ?dual-task? walking conditions thus provide important insights into health. Such assessments, however, are limited primarily to laboratory-based settings. Objective: The objective of our study was to create and test a smartphone-based assessment of normal and dual-task walking for use in nonlaboratory settings. Methods: We created an iPhone app that used the phone?s motion sensors to record movements during walking under normal conditions and while performing a serial-subtraction dual task, with the phone placed in the user?s pants pocket. The app provided the user with multimedia instructions before and during the assessment. Acquired data were automatically uploaded to a cloud-based server for offline analyses. A total of 14 healthy adults completed 2 laboratory visits separated by 1 week. On each visit, they used the app to complete three 45-second trials each of normal and dual-task walking. Kinematic data were collected with the app and a gold-standard?instrumented GAITRite mat. Participants also used the app to complete normal and dual-task walking trials within their homes on 3 separate days. Within laboratory-based trials, GAITRite-derived heel strikes and toe-offs of the phone-side leg aligned with smartphone acceleration extrema, following filtering and rotation to the earth coordinate system. We derived stride times?a clinically meaningful metric of locomotor control?from GAITRite and app data, for all strides occurring over the GAITRite mat. We calculated stride times and the dual-task cost to the average stride time (ie, percentage change from normal to dual-task conditions) from both measurement devices. We calculated similar metrics from home-based app data. For these trials, periods of potential turning were identified via custom-developed algorithms and omitted from stride-time analyses. Results: Across all detected strides in the laboratory, stride times derived from the app and GAITRite mat were highly correlated (P<.001, r2=.98). These correlations were independent of walking condition and pocket tightness. App- and GAITRite-derived stride-time dual-task costs were also highly correlated (P<.001, r2=.95). The error of app-derived stride times (mean 16.9, SD 9.0 ms) was unaffected by the magnitude of stride time, walking condition, or pocket tightness. For both normal and dual-task trials, average stride times derived from app walking trials demonstrated excellent test-retest reliability within and between both laboratory and home-based assessments (intraclass correlation coefficient range .82-.94). Conclusions: The iPhone app we created enabled valid and reliable assessment of stride timing?with the smartphone in the pocket?during both normal and dual-task walking and within both laboratory and nonlaboratory environments. Additional work is warranted to expand the functionality of this tool to older adults and other patient populations. UR - http://mhealth.jmir.org/2018/1/e36/ UR - http://dx.doi.org/10.2196/mhealth.8815 UR - http://www.ncbi.nlm.nih.gov/pubmed/29382625 ID - info:doi/10.2196/mhealth.8815 ER - TY - JOUR AU - Lin, Hamady Susan AU - Dionne, P. Timothy PY - 2018/01/18 TI - Interventions to Improve Movement and Functional Outcomes in Adult Stroke Rehabilitation: Review and Evidence Summary JO - J Participat Med SP - e3 VL - 10 IS - 1 KW - stroke KW - evidence-based health care KW - patient-centered care KW - review N2 - Background: Patients who have had a stroke may not be familiar with the terminology nor have the resources to efficiently search for evidence-based rehabilitation therapies to restore movement and functional outcomes. Recognizing that a thorough systematic review on this topic is beyond the scope of this article, we conducted a rapid review evidence summary to determine the level of evidence for common rehabilitation interventions to improve movement/motor and functional outcomes in adults who have had a stroke. Objective: The objective of this study was to find evidence for common rehabilitation interventions to improve movement/motor and functional outcomes in adults who have had a stroke. Methods: Medline Complete, PubMed, CINAHL Complete, Cochrane Database, Rehabilitation and Sports Medicine Source, Dissertation Abstracts International, and National Guideline Clearinghouse, from 1996 to April of 2016, were searched. From 348 articles, 173 met the following inclusion criteria: (1) published systematic reviews or meta-analyses, (2) outcomes target functional movement or motor skills of the upper and lower limbs, (3) non-pharmacological interventions that are commonly delivered to post-stroke population (acute and chronic), (4) human studies, and (5) English. Evidence tables were created to analyze the findings of systematic reviews and meta-analyses by category of interventions and outcomes. Results: This rapid review found that the following interventions possess credible evidence to improve functional movement of persons with stroke: cardiorespiratory training, therapeutic exercise (ie, strengthening), task-oriented training (task-specific training), constraint-induced movement therapy (CIMT), mental practice, and mirror therapy. Neuromuscular electrical stimulation (NMES) (ie, functional electrical stimulation) shows promise as an intervention for stroke survivors. Conclusions: Most commonly delivered therapeutic interventions to improve motor recovery after a stroke possess moderate quality evidence and are effective. Future research recommendations, such as optimal timing and dosage, would help rehabilitation professionals tailor interventions to achieve the best outcomes for stroke survivors. UR - http://jopm.jmir.org/2018/1/e3/ UR - http://dx.doi.org/10.2196/jopm.8929 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/jopm.8929 ER - TY - JOUR AU - Lumsden, Jim AU - Skinner, Andy AU - Coyle, David AU - Lawrence, Natalia AU - Munafo, Marcus PY - 2017/11/22 TI - Attrition from Web-Based Cognitive Testing: A Repeated Measures Comparison of Gamification Techniques JO - J Med Internet Res SP - e395 VL - 19 IS - 11 KW - behavioral research/methods KW - games, experimental KW - computers KW - cognition KW - Internet KW - play and playthings/psychology KW - boredom KW - task performance and analysis KW - executive function KW - inhibition (psychology) N2 - Background: The prospect of assessing cognition longitudinally and remotely is attractive to researchers, health practitioners, and pharmaceutical companies alike. However, such repeated testing regimes place a considerable burden on participants, and with cognitive tasks typically being regarded as effortful and unengaging, these studies may experience high levels of participant attrition. One potential solution is to gamify these tasks to make them more engaging: increasing participant willingness to take part and reducing attrition. However, such an approach must balance task validity with the introduction of entertaining gamelike elements. Objective: This study aims to investigate the effects of gamelike features on participant attrition using a between-subjects, longitudinal Web-based testing study. Methods: We used three variants of a common cognitive task, the Stop Signal Task (SST), with a single gamelike feature in each: one variant where points were rewarded for performing optimally; another where the task was given a graphical theme; and a third variant, which was a standard SST and served as a control condition. Participants completed four compulsory test sessions over 4 consecutive days before entering a 6-day voluntary testing period where they faced a daily decision to either drop out or continue taking part. Participants were paid for each session they completed. Results: A total of 482 participants signed up to take part in the study, with 265 completing the requisite four consecutive test sessions. No evidence of an effect of gamification on attrition was observed. A log-rank test showed no evidence of a difference in dropout rates between task variants (?22=3.0, P=.22), and a one-way analysis of variance of the mean number of sessions completed per participant in each variant also showed no evidence of a difference (F2,262=1.534, P=.21, partial ?2=0.012). Conclusions: Our findings raise doubts about the ability of gamification to reduce attrition from longitudinal cognitive testing studies. UR - http://www.jmir.org/2017/11/e395/ UR - http://dx.doi.org/10.2196/jmir.8473 UR - http://www.ncbi.nlm.nih.gov/pubmed/29167090 ID - info:doi/10.2196/jmir.8473 ER - TY - JOUR AU - Bendixen, M. Roxanna AU - Fairman, D. Andrea AU - Karavolis, Meredith AU - Sullivan, Carly AU - Parmanto, Bambang PY - 2017/09/26 TI - A User-Centered Approach: Understanding Client and Caregiver Needs and Preferences in the Development of mHealth Apps for Self-Management JO - JMIR Mhealth Uhealth SP - e141 VL - 5 IS - 9 KW - mobile health KW - telemedicine KW - self-care KW - adolescence KW - spina bifida KW - cerebral palsy KW - spinal cord injury N2 - Background: Many adolescents and young adults with chronic illness or disability often fail to develop the self-management skills necessary to independently handle medical and self-management routines. In light of these needs, we are developing iMHere 2.0 (Interactive Mobile Health and Rehabilitation), a mobile health (mHealth) system to support a self-management program. Objective: Our objective was to gather data from persons with brain and spinal cord anomalies (BSA) and their caregivers to better understand how mHealth would be most helpful in supporting them to proactively manage daily self-care routines and to access medical care as needed. The specific purpose was not only to gather feedback and to gain increased insight into the design of the new version of iMHere, but also to gather perspectives of new groups, namely adolescents as young as 12 years and their parents and/or caregivers. Methods: Our project employed focus group sessions and surveys to collect data from participants with BSA, as well as their caregivers. A total of six focus group sessions were conducted on four separate occasions until the data gathered reached saturation. The objectives of our focus group sessions were to better understand ways to develop mHealth systems to support self-management, to promote independence, to motivate long-term system use, and to prevent medical problems that lead to hospitalizations and emergency room visits for youth and young adults with BSA. Results: A total of 16 youth and young adults with BSA and 11 caregivers participated in the sessions. Within and among our groups, the following five overarching themes emerged from the data: (1) make it easy, (2) engage, (3) educate and prepare, (4) motivate and support, and (5) personalize. Participants shared their perspectives and detailed information about mHealth apps that would be important for independence in self-care and self-management. Conclusions: Our findings suggest that most individuals keep their mobile phones with them at all times and typically use a mobile phone for social media, music, photos, and texting. Our qualitative analysis indicates that youth and young adults with BSA, as well as their caregivers, acknowledge the importance of being actively engaged in developing and using mHealth apps that monitor and manage their health care needs. Information gleaned from these focus group sessions and surveys have provided data to refine the iMHere 2.0 mHealth prototype platform that we have developed. UR - http://mhealth.jmir.org/2017/9/e141/ UR - http://dx.doi.org/10.2196/mhealth.7136 UR - http://www.ncbi.nlm.nih.gov/pubmed/28951378 ID - info:doi/10.2196/mhealth.7136 ER - TY - JOUR AU - Harris, WF Anthony AU - Kosic, Tanya AU - Xu, Jean AU - Walker, Chris AU - Gye, William AU - Redoblado Hodge, Antoinette PY - 2017/09/20 TI - Web-Based Cognitive Remediation Improves Supported Employment Outcomes in Severe Mental Illness: Randomized Controlled Trial JO - JMIR Ment Health SP - e30 VL - 4 IS - 3 KW - severe mental disorders KW - supported employment KW - cognitive function KW - cognitive remediation KW - randomized controlled trial N2 - Background: Finding work is a top priority for most people; however, this goal remains out of reach for the majority of individuals with a severe mental illness (SMI) who remain on benefits or are unemployed. Supported employment (SE) programs aimed at returning people with a severe mental illness to work are successful; however, they still leave a significant number of people with severe mental illness unemployed. Cognitive deficits are commonly found in SMI and are a powerful predictor of poor outcome. Fortunately, these deficits are amenable to treatment with cognitive remediation therapy (CRT) that significantly improves cognition in SMI. CRT combined with SE significantly increases the likelihood of individuals with severe mental illness obtaining and staying in work. However, the availability of CRT is limited in many settings. Objective: The aim of this study was to examine whether Web-based CRT combined with a SE program can improve the rate return to work of people with severe mental illness. Methods: A total of 86 people with severe mental illness (mean age 39.6 years; male: n=55) who were unemployed and who had joined a SE program were randomized to either a Web-based CRT program (CogRem) or an Internet-based control condition (WebInfo). Primary outcome measured was hours worked over 6 months post treatment. Results: At 6 months, those participants randomized to CogRem had worked significantly more hours (P=.01) and had earned significantly more money (P=.03) than those participants randomized to the WebInfo control condition. No change was observed in cognition. Conclusions: This study corroborates other work that has found a synergistic effect of combining CRT with a SE program and extends this to the use of Web-based CRT. The lack of any improvement in cognition obscures the mechanism by which an improved wage outcome for participants randomized to the active treatment was achieved. However, the study substantially lowers the barrier to the deployment of CRT with other psychosocial interventions for severe mental illness. Trial Registration: Australian and New Zealand Clinical Trials Registry (ANZCTR) 12611000849998; http://www.anzctr.org.au/TrialSearch.aspx?searchTxt=12611000849998&isBasic=True (Archived by WebCite at http://www.webcitation.org/6sMKwpeos) UR - http://mental.jmir.org/2017/3/e30/ UR - http://dx.doi.org/10.2196/mental.6982 UR - http://www.ncbi.nlm.nih.gov/pubmed/28931500 ID - info:doi/10.2196/mental.6982 ER - TY - JOUR AU - Austin, Johanna AU - Hollingshead, Kristy AU - Kaye, Jeffrey PY - 2017/09/06 TI - Internet Searches and Their Relationship to Cognitive Function in Older Adults: Cross-Sectional Analysis JO - J Med Internet Res SP - e307 VL - 19 IS - 9 KW - Internet KW - geriatrics KW - cognition KW - executive function N2 - Background: Alzheimer disease (AD) is a very challenging experience for all those affected. Unfortunately, detection of Alzheimer disease in its early stages when clinical treatments may be most effective is challenging, as the clinical evaluations are time-consuming and costly. Recent studies have demonstrated a close relationship between cognitive function and everyday behavior, an avenue of research that holds great promise for the early detection of cognitive decline. One area of behavior that changes with cognitive decline is language use. Multiple groups have demonstrated a close relationship between cognitive function and vocabulary size, verbal fluency, and semantic ability, using conventional in-person cognitive testing. An alternative to this approach which is inherently ecologically valid may be to take advantage of automated computer monitoring software to continually capture and analyze language use while on the computer. Objective: The aim of this study was to understand the relationship between Internet searches as a measure of language and cognitive function in older adults. We hypothesize that individuals with poorer cognitive function will search using fewer unique terms, employ shorter words, and use less obscure words in their searches. Methods: Computer monitoring software (WorkTime, Nestersoft Inc) was used to continuously track the terms people entered while conducting searches in Google, Yahoo, Bing, and Ask.com. For all searches, punctuation, accents, and non-ASCII characters were removed, and the resulting search terms were spell-checked before any analysis. Cognitive function was evaluated as a z-normalized summary score capturing five unique cognitive domains. Linear regression was used to determine the relationship between cognitive function and Internet searches by controlling for variables such as age, sex, and education. Results: Over a 6-month monitoring period, 42 participants (mean age 81 years [SD 10.5], 83% [35/42] female) conducted 2915 searches using these top search engines. Participants averaged 3.08 words per search (SD 1.6) and 5.77 letters per word (SD 2.2). Individuals with higher cognitive function used more unique terms per search (beta=.39, P=.002) and employed less common terms in their searches (beta=1.39, P=.02). Cognitive function was not significantly associated with the length of the words used in the searches. Conclusions: These results suggest that early decline in cognitive function may be detected from the terms people search for when they use the Internet. By continuously tracking basic aspects of Internet search terms, it may be possible to detect cognitive decline earlier than currently possible, thereby enabling proactive treatment and intervention. UR - http://www.jmir.org/2017/9/e307/ UR - http://dx.doi.org/10.2196/jmir.7671 UR - http://www.ncbi.nlm.nih.gov/pubmed/28877864 ID - info:doi/10.2196/jmir.7671 ER - TY - JOUR AU - Bateman, R. Daniel AU - Srinivas, Bhavana AU - Emmett, W. Thomas AU - Schleyer, K. Titus AU - Holden, J. Richard AU - Hendrie, C. Hugh AU - Callahan, M. Christopher PY - 2017/08/30 TI - Categorizing Health Outcomes and Efficacy of mHealth Apps for Persons With Cognitive Impairment: A Systematic Review JO - J Med Internet Res SP - e301 VL - 19 IS - 8 KW - mHealth KW - mobile health KW - applications KW - Alzheimer disease KW - dementia KW - systematic review N2 - Background: Use of mobile health (mHealth) apps is growing at an exponential rate in the United States and around the world. Mild cognitive impairment (MCI), Alzheimer disease, and related dementias are a global health problem. Numerous mHealth interventions exist for this population, yet the effect of these interventions on health has not been systematically described. Objective: The aim of this study is to catalog the types of health outcomes used to measure effectiveness of mHealth interventions and assess which mHealth interventions have been shown to improve the health of persons with MCI, Alzheimer disease, and dementia. Methods: We searched 13 databases, including Ovid MEDLINE, PubMed, EMBASE, the full Cochrane Library, CINAHL, PsycINFO, Ei Compendex, IEEE Xplore, Applied Science & Technology Source, Scopus, Web of Science, ClinicalTrials.gov, and Google Scholar from inception through May 2017 for mHealth studies involving persons with cognitive impairment that were evaluated using at least one quantitative health outcome. Proceedings of the Annual ACM Conferences on Human Factors in Computing Systems, the ACM User Interface Software and Technology Symposium, and the IEEE International Symposium on Wearable Computers were searched in the ACM Digital Library from 2012 to 2016. A hand search of JMIR Publications journals was also completed in July 2017. Results: After removal of duplicates, our initial search returned 3955 records. Of these articles, 24 met final inclusion criteria as studies involving mHealth interventions that measured at least one quantitative health outcome for persons with MCI, Alzheimer disease, and dementia. Common quantitative health outcomes included cognition, function, mood, and quality of life. We found that 21.2% (101/476) of the fully reviewed articles were excluded because of a lack of health outcomes. The health outcomes selected were observed to be inconsistent between studies. For those studies with quantitative health outcomes, more than half (58%) reported postintervention improvements in outcomes. Conclusions: Results showed that many mHealth app interventions targeting those with cognitive impairment lack quantitative health outcomes as a part of their evaluation process and that there is a lack of consensus as to which outcomes to use. The majority of mHealth app interventions that incorporated health outcomes into their evaluation noted improvements in the health of persons with MCI, Alzheimer disease, and dementia. However, these studies were of low quality, leading to a grade C level of evidence. Clarification of the benefits of mHealth interventions for people with cognitive impairment requires more randomized controlled trials, larger numbers of participants, and trial designs that minimize bias. Trial Registration: PROSPERO Registration: PROSPERO 2016:CRD42016033846; http://www.crd.york.ac.uk/PROSPERO/ display_record.asp?ID=CRD42016033846 (Archived by WebCite at http://www.webcitation.org/6sjjwnv1M) UR - http://www.jmir.org/2017/8/e301/ UR - http://dx.doi.org/10.2196/jmir.7814 UR - http://www.ncbi.nlm.nih.gov/pubmed/28855146 ID - info:doi/10.2196/jmir.7814 ER - TY - JOUR AU - Tobler-Ammann, C. Bernadette AU - Surer, Elif AU - Knols, H. Ruud AU - Borghese, Alberto N. AU - de Bruin, D. Eling PY - 2017/08/25 TI - User Perspectives on Exergames Designed to Explore the Hemineglected Space for Stroke Patients With Visuospatial Neglect: Usability Study JO - JMIR Serious Games SP - e18 VL - 5 IS - 3 KW - usability KW - user perspective KW - mixed-methods KW - exergames KW - visuo-spatial neglect KW - stroke N2 - Background: Visuospatial neglect due to stroke is characterized by the inability to perceive stimuli emerging in the area opposite to the side of brain damage. Besides adopting conventional rehabilitation methods to treat neglect symptoms, the use of virtual reality (VR) is becoming increasingly popular. We designed a series of 9 exergames aimed to improve exploration of the neglected side of space. When new VR interventions are designed, it is important to assess the usability aspects of such management strategies within the target population. To date, most studies used questionnaires to assess user satisfaction with the intervention or product being tested. However, only a combination of both quantitative and qualitative data allows a full picture of user perspective. Objective: The purpose of this study was to quantitatively and qualitatively assess patient and therapist perspectives of a VR intervention based on the series of 9 exergames designed to explore hemineglected space. Specifically, we wanted to evaluate (1) perceived-user friendliness of the exergames, (2) attitude towards using the exergames, and (3) intention to use the exergames in the future. Methods: A total of 19 participants (7 patients, 12 therapists) evaluated the exergames they had used 5 times a week during 3 weeks. The Technology Acceptance Model (TAM) questionnaire was filled out after the intervention. Based on those responses, we conducted focus group interviews (with therapists) and individual interviews (with patients). To analyze the TAM questionnaires, we used descriptive statistics. We adopted content and comparative analysis to analyze the interviews and drew illustration maps to analyze the focus group interviews. Results: The therapists took a more critical stance with a mean TAM questionnaire total score of 48.6 (SD 4.5) compared to the patients who had a mean total score of 56.1 (SD 12.3). The perceived user-friendliness score was 5.6 (SD 1.4) for patients and 4.9 (SD 1.4) for therapists. The attitude towards using the exergames was rated 4.8 (SD 1.9) by patients and 3.6 (SD 1.4) by therapists, respectively. The intention to use the exergames in the future was rated 3.9 (SD 2.1) by patients and 3.7 (SD 1.8) by therapists. We gained information on how to improve the exergames in the interviews. Conclusions: Patients and therapists perceived the exergames as user-friendly; however, using the games further with the actual test version was not perceived as conceivable. The therapists were generally more critical towards future use than the patients. Therefore, involving both users to achieve acceptable and user-friendly versions of game-based rehabilitation for the future is deemed crucial and warranted. Trial Registration: Clinicaltrials.gov NCT02353962; https://clinicaltrials.gov/ct2/show/NCT02353962 (Archived by WebCite at http://www.webcitation.org/6soxIJlAZ) UR - http://games.jmir.org/2017/3/e18/ UR - http://dx.doi.org/10.2196/games.8013 UR - http://www.ncbi.nlm.nih.gov/pubmed/28842390 ID - info:doi/10.2196/games.8013 ER - TY - JOUR AU - Tobler-Ammann, C. Bernadette AU - Surer, Elif AU - de Bruin, D. Eling AU - Rabuffetti, Marco AU - Borghese, Alberto N. AU - Mainetti, Renato AU - Pirovano, Michele AU - Wittwer, Lia AU - Knols, H. Ruud PY - 2017/08/25 TI - Exergames Encouraging Exploration of Hemineglected Space in Stroke Patients With Visuospatial Neglect: A Feasibility Study JO - JMIR Serious Games SP - e17 VL - 5 IS - 3 KW - exergames KW - eye tracking KW - virtual reality KW - visuospatial neglect KW - feasibility N2 - 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 Zürich 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. UR - http://games.jmir.org/2017/3/e17/ UR - http://dx.doi.org/10.2196/games.7923 UR - http://www.ncbi.nlm.nih.gov/pubmed/28842388 ID - info:doi/10.2196/games.7923 ER - TY - JOUR AU - Price, Edward AU - Moore, George AU - Galway, Leo AU - Linden, Mark PY - 2017/08/17 TI - Validation of a Smartphone-Based Approach to In Situ Cognitive Fatigue Assessment JO - JMIR Mhealth Uhealth SP - e125 VL - 5 IS - 8 KW - mental fatigue KW - fatigue KW - acquired brain injury KW - cognitive tests KW - assistive technology KW - smartphone N2 - Background: Acquired Brain Injuries (ABIs) can result in multiple detrimental cognitive effects, such as reduced memory capability, concentration, and planning. These effects can lead to cognitive fatigue, which can exacerbate the symptoms of ABIs and hinder management and recovery. Assessing cognitive fatigue is difficult due to the largely subjective nature of the condition and existing assessment approaches. Traditional methods of assessment use self-assessment questionnaires delivered in a medical setting, but recent work has attempted to employ more objective cognitive tests as a way of evaluating cognitive fatigue. However, these tests are still predominantly delivered within a medical environment, limiting their utility and efficacy. Objective: The aim of this research was to investigate how cognitive fatigue can be accurately assessed in situ, during the quotidian activities of life. It was hypothesized that this assessment could be achieved through the use of mobile assistive technology to assess working memory, sustained attention, information processing speed, reaction time, and cognitive throughput. Methods: The study used a bespoke smartphone app to track daily cognitive performance, in order to assess potential levels of cognitive fatigue. Twenty-one participants with no prior reported brain injuries took place in a two-week study, resulting in 81 individual testing instances being collected. The smartphone app delivered three cognitive tests on a daily basis: (1) Spatial Span to measure visuospatial working memory; (2) Psychomotor Vigilance Task (PVT) to measure sustained attention, information processing speed, and reaction time; and (3) a Mental Arithmetic Test to measure cognitive throughput. A smartphone-optimized version of the Mental Fatigue Scale (MFS) self-assessment questionnaire was used as a baseline to assess the validity of the three cognitive tests, as the questionnaire has already been validated in multiple peer-reviewed studies. Results: The most highly correlated results were from the PVT, which showed a positive correlation with those from the prevalidated MFS, measuring 0.342 (P<.008). Scores from the cognitive tests were entered into a regression model and showed that only reaction time in the PVT was a significant predictor of fatigue (P=.016, F=2.682, 95% CI 9.0-84.2). Higher scores on the MFS were related to increases in reaction time during our mobile variant of the PVT. Conclusions: The results show that the PVT mobile cognitive test developed for this study could be used as a valid and reliable method for measuring cognitive fatigue in situ. This test would remove the subjectivity associated with established self-assessment approaches and the need for assessments to be performed in a medical setting. Based on our findings, future work could explore delivering a small set of tests with increased duration to further improve measurement reliability. Moreover, as the smartphone assessment tool can be used as part of everyday life, additional sources of data relating to physiological, psychological, and environmental context could be included within the analysis to improve the nature and precision of the assessment process. UR - http://mhealth.jmir.org/2017/8/e125/ UR - http://dx.doi.org/10.2196/mhealth.6333 UR - http://www.ncbi.nlm.nih.gov/pubmed/28818818 ID - info:doi/10.2196/mhealth.6333 ER - TY - JOUR AU - Ballester, Rubio Belén AU - Nirme, Jens AU - Camacho, Irene AU - Duarte, Esther AU - Rodríguez, Susana AU - Cuxart, Ampar AU - Duff, Armin AU - Verschure, F.M.J Paul PY - 2017/08/07 TI - Domiciliary VR-Based Therapy for Functional Recovery and Cortical Reorganization: Randomized Controlled Trial in Participants at the Chronic Stage Post Stroke JO - JMIR Serious Games SP - e15 VL - 5 IS - 3 KW - stroke KW - movement disorder KW - recovery of function, neuroplasticity KW - transcranial magnetic stimulation KW - physical therapy KW - hemiparesis KW - computer applications software N2 - Background: Most stroke survivors continue to experience motor impairments even after hospital discharge. Virtual reality-based techniques have shown potential for rehabilitative training of these motor impairments. Here we assess the impact of at-home VR-based motor training on functional motor recovery, corticospinal excitability and cortical reorganization. Objective: The aim of this study was to identify the effects of home-based VR-based motor rehabilitation on (1) cortical reorganization, (2) corticospinal tract, and (3) functional recovery after stroke in comparison to home-based occupational therapy. Methods: We conducted a parallel-group, controlled trial to compare the effectiveness of domiciliary VR-based therapy with occupational therapy in inducing motor recovery of the upper extremities. A total of 35 participants with chronic stroke underwent 3 weeks of home-based treatment. A group of subjects was trained using a VR-based system for motor rehabilitation, while the control group followed a conventional therapy. Motor function was evaluated at baseline, after the intervention, and at 12-weeks follow-up. In a subgroup of subjects, we used Navigated Brain Stimulation (NBS) procedures to measure the effect of the interventions on corticospinal excitability and cortical reorganization. Results: Results from the system?s recordings and clinical evaluation showed significantly greater functional recovery for the experimental group when compared with the control group (1.53, SD 2.4 in Chedoke Arm and Hand Activity Inventory). However, functional improvements did not reach clinical significance. After the therapy, physiological measures obtained from a subgroup of subjects revealed an increased corticospinal excitability for distal muscles driven by the pathological hemisphere, that is, abductor pollicis brevis. We also observed a displacement of the centroid of the cortical map for each tested muscle in the damaged hemisphere, which strongly correlated with improvements in clinical scales. Conclusions: These findings suggest that, in chronic stages, remote delivery of customized VR-based motor training promotes functional gains that are accompanied by neuroplastic changes. Trial Registration: International Standard Randomized Controlled Trial Number NCT02699398 (Archived by ClinicalTrials.gov at https://clinicaltrials.gov/ct2/show/NCT02699398?term=NCT02699398&rank=1) UR - http://games.jmir.org/2017/3/e15/ UR - http://dx.doi.org/10.2196/games.6773 UR - http://www.ncbi.nlm.nih.gov/pubmed/28784593 ID - info:doi/10.2196/games.6773 ER - TY - JOUR AU - Tillmann, Cristina Ana AU - Andrade, Alexandro AU - Swarowsky, Alessandra AU - Guimarães, Azevedo Adriana Coutinho De PY - 2017/07/04 TI - Brazilian Samba Protocol for Individuals With Parkinson?s Disease: A Clinical Non-Randomized Study JO - JMIR Res Protoc SP - e129 VL - 6 IS - 7 KW - Parkinson's disease KW - protocol KW - balance KW - quality of life KW - therapy N2 - Background: In the 10 most populated countries in the world, Parkinson's disease (PD) affects more than 5 million individuals. Despite optimal treatment options already developed for the disease, concomitant involvement of other areas of health care plays an important role in complementing the treatment. From this perspective, dancing can be viewed as a non-drug alternative that can reduce falls by improving some motor skills, such as mobility, balance, gait, and posture, and can also improve the overall quality of life. Brazilian samba promotes improvement in motor and non-motor symptoms in individuals with PD, providing a new treatment option for this population. Objective: The main objective of this quasi-experimental study is to provide a 12-week samba protocol (2x/week) for individuals with PD and to compare its effects with the group without intervention. The hypothesis is that the Brazilian samba protocol will promote improvement in primary (motor) and secondary (non-motor) outcomes in individuals with PD. Methods: The sample will be selected at random from individuals diagnosed with PD in the city of Florianopolis (SC, Brazil). Sample size calculation was performed with the G*Power 3.1.9.2 software, with 0.447 effect size, at 5% significance level, power of 0.9, and test and sample loss of 20%. This yielded 60 individuals divided between the intervention and control groups. The questionnaires will be filled out before and after the dance intervention. The data collection for the control group will be held simultaneously to the intervention group. The classes will last for 1 hour, twice a week in the evening for 12 weeks, and all classes will be divided into warm-up, main part, and relaxation. Two-way analysis of variance with repeated measures and Sidak post-hoc comparison test will be used for a comparative analysis of the final results of the control group with the experimental group and of the within-group changes between pre- and postintervention period. Results: We expect to complete follow-up in September 2017. Conclusions: The major inspiration for this study was to encourage the creation of new rehabilitation programs that do not emphasize doctor involvement. This is a unique protocol for PD and we believe it can be an important tool to alleviate the motor and non-motor symptoms of individuals with PD. Dance is a simple activity depending on little equipment and few financial resources, facilitating its implementation and improving the cost-benefit relationship. In addition, activities that have a cultural aspect for the population in question, and which are pleasant, enable the participants to commit long term. This can enhance patient?s compliance with the therapy, which is often a problem for many rehabilitation programs. UR - http://www.researchprotocols.org/2017/7/e129/ UR - http://dx.doi.org/10.2196/resprot.6489 UR - http://www.ncbi.nlm.nih.gov/pubmed/28676466 ID - info:doi/10.2196/resprot.6489 ER - TY - JOUR AU - Simblett, K. Sara AU - Yates, Matthew AU - Wagner, P. Adam AU - Watson, Peter AU - Gracey, Fergus AU - Ring, Howard AU - Bateman, Andrew PY - 2017/05/31 TI - Computerized Cognitive Behavioral Therapy to Treat Emotional Distress After Stroke: A Feasibility Randomized Controlled Trial JO - JMIR Ment Health SP - e16 VL - 4 IS - 2 KW - cognitive therapy KW - technology KW - stroke KW - depression KW - anxiety N2 - Background: Depression and anxiety are common complications following stroke. Symptoms could be treatable with psychological therapy, but there is little research on its efficacy. Objectives: The aim of this study was to investigate (1) the acceptability and feasibility of computerized cognitive behavioral therapy (cCBT) to treat symptoms of depression and anxiety and (2) a trial design for comparing the efficacy of cCBT compared with an active comparator. Methods: Of the total 134 people screened for symptoms of depression and anxiety following stroke, 28 were cluster randomized in blocks with an allocation ratio 2:1 to cCBT (n=19) or an active comparator of computerized cognitive remediation therapy (cCRT, n=9). Qualitative and quantitative feedback was sought on the acceptability and feasibility of both interventions, alongside measuring levels of depression, anxiety, and activities of daily living before, immediately after, and 3 months post treatment. Results: Both cCBT and cCRT groups were rated as near equally useful (mean = 6.4 vs 6.5, d=0.05), while cCBT was somewhat less relevant (mean = 5.5 vs 6.5, d=0.45) but somewhat easier to use (mean = 7.0 vs 6.3, d=0.31). Participants tolerated randomization and dropout rates were comparable with similar trials, with only 3 participants discontinuing due to potential adverse effects; however, dropout was higher from the cCBT arm (7/19, 37% vs 1/9, 11% for cCRT). The trial design required small alterations and highlighted that future-related studies should control for participants receiving antidepressant medication, which significantly differed between groups (P=.05). Descriptive statistics of the proposed outcome measures and qualitative feedback about the cCBT intervention are reported. Conclusions: A pragmatic approach is required to deliver computerized interventions to accommodate individual needs. We report a preliminary investigation to inform the development of a full randomized controlled trial for testing the efficacy of computerized interventions for people with long-term neurological conditions such as stroke and conclude that this is a potentially promising way of improving accessibility of psychological support. UR - http://mental.jmir.org/2017/2/e16/ UR - http://dx.doi.org/10.2196/mental.6022 UR - http://www.ncbi.nlm.nih.gov/pubmed/28566265 ID - info:doi/10.2196/mental.6022 ER - TY - JOUR AU - O'Brien, K. Megan AU - Shawen, Nicholas AU - Mummidisetty, K. Chaithanya AU - Kaur, Saninder AU - Bo, Xiao AU - Poellabauer, Christian AU - Kording, Konrad AU - Jayaraman, Arun PY - 2017/05/25 TI - Activity Recognition for Persons With Stroke Using Mobile Phone Technology: Toward Improved Performance in a Home Setting JO - J Med Internet Res SP - e184 VL - 19 IS - 5 KW - smartphone KW - activities of daily living KW - ambulatory monitoring KW - machine learning KW - stroke rehabilitation N2 - Background: Smartphones contain sensors that measure movement-related data, making them promising tools for monitoring physical activity after a stroke. Activity recognition (AR) systems are typically trained on movement data from healthy individuals collected in a laboratory setting. However, movement patterns change after a stroke (eg, gait impairment), and activities may be performed differently at home than in a lab. Thus, it is important to validate AR for gait-impaired stroke patients in a home setting for accurate clinical predictions. Objective: In this study, we sought to evaluate AR performance in a home setting for individuals who had suffered a stroke, by using different sets of training activities. Specifically, we compared AR performance for persons with stroke while varying the origin of training data, based on either population (healthy persons or persons with stoke) or environment (laboratory or home setting). Methods: Thirty individuals with stroke and fifteen healthy subjects performed a series of mobility-related activities, either in a laboratory or at home, while wearing a smartphone. A custom-built app collected signals from the phone?s accelerometer, gyroscope, and barometer sensors, and subjects self-labeled the mobility activities. We trained a random forest AR model using either healthy or stroke activity data. Primary measures of AR performance were (1) the mean recall of activities and (2) the misclassification of stationary and ambulatory activities. Results: A classifier trained on stroke activity data performed better than one trained on healthy activity data, improving average recall from 53% to 75%. The healthy-trained classifier performance declined with gait impairment severity, more often misclassifying ambulatory activities as stationary ones. The classifier trained on in-lab activities had a lower average recall for at-home activities (56%) than for in-lab activities collected on a different day (77%). Conclusions: Stroke-based training data is needed for high quality AR among gait-impaired individuals with stroke. Additionally, AR systems for home and community monitoring would likely benefit from including at-home activities in the training data. UR - http://www.jmir.org/2017/5/e184/ UR - http://dx.doi.org/10.2196/jmir.7385 UR - http://www.ncbi.nlm.nih.gov/pubmed/28546137 ID - info:doi/10.2196/jmir.7385 ER - TY - JOUR AU - Jongstra, Susan AU - Wijsman, Willemijn Liselotte AU - Cachucho, Ricardo AU - Hoevenaar-Blom, Peternella Marieke AU - Mooijaart, Pieter Simon AU - Richard, Edo PY - 2017/05/25 TI - Cognitive Testing in People at Increased Risk of Dementia Using a Smartphone App: The iVitality Proof-of-Principle Study JO - JMIR Mhealth Uhealth SP - e68 VL - 5 IS - 5 KW - telemedicine KW - cognition KW - neuropsychological tests N2 - Background: Smartphone-assisted technologies potentially provide the opportunity for large-scale, long-term, repeated monitoring of cognitive functioning at home. Objective: The aim of this proof-of-principle study was to evaluate the feasibility and validity of performing cognitive tests in people at increased risk of dementia using smartphone-based technology during a 6 months follow-up period. Methods: We used the smartphone-based app iVitality to evaluate five cognitive tests based on conventional neuropsychological tests (Memory-Word, Trail Making, Stroop, Reaction Time, and Letter-N-Back) in healthy adults. Feasibility was tested by studying adherence of all participants to perform smartphone-based cognitive tests. Validity was studied by assessing the correlation between conventional neuropsychological tests and smartphone-based cognitive tests and by studying the effect of repeated testing. Results: We included 151 participants (mean age in years=57.3, standard deviation=5.3). Mean adherence to assigned smartphone tests during 6 months was 60% (SD 24.7). There was moderate correlation between the firstly made smartphone-based test and the conventional test for the Stroop test and the Trail Making test with Spearman ?=.3-.5 (P<.001). Correlation increased for both tests when comparing the conventional test with the mean score of all attempts a participant had made, with the highest correlation for Stroop panel 3 (?=.62, P<.001). Performance on the Stroop and the Trail Making tests improved over time suggesting a learning effect, but the scores on the Letter-N-back, the Memory-Word, and the Reaction Time tests remained stable. Conclusions: Repeated smartphone-assisted cognitive testing is feasible with reasonable adherence and moderate relative validity for the Stroop and the Trail Making tests compared with conventional neuropsychological tests. Smartphone-based cognitive testing seems promising for large-scale data-collection in population studies. UR - http://mhealth.jmir.org/2017/5/e68/ UR - http://dx.doi.org/10.2196/mhealth.6939 UR - http://www.ncbi.nlm.nih.gov/pubmed/28546139 ID - info:doi/10.2196/mhealth.6939 ER - TY - JOUR AU - Coffey, T. Nathan AU - Cassese, James AU - Cai, Xinsheng AU - Garfinkel, Steven AU - Patel, Drasti AU - Jones, Rebecca AU - Shaewitz, Dahlia AU - Weinstein, A. Ali PY - 2017/05/10 TI - Identifying and Understanding the Health Information Experiences and Preferences of Caregivers of Individuals With Either Traumatic Brain Injury, Spinal Cord Injury, or Burn Injury: A Qualitative Investigation JO - J Med Internet Res SP - e159 VL - 19 IS - 5 KW - traumatic brain injury KW - burns KW - spinal cord injuries KW - caregivers KW - health information, consumer KW - qualitative research N2 - Background: In order to meet the challenges of caring for an injured person, caregivers need access to health information. However, caregivers often feel that they lack adequate information. Previous studies of caregivers have primarily focused on either their time and emotional burdens or their health outcomes, but the information needs of caregivers have not been thoroughly investigated. Objective: The purpose of this investigation was to identify the preferred sources of health information for caregivers supporting individuals with injuries and to explore how access to this information could be improved. Methods: A total of 32 caregivers participated in semistructured interviews, which were used in order to develop a more in-depth understanding of these caregivers? information needs. Digital audio recordings of the interviews were used for analysis purposes. These audio recordings were analyzed using a thematic analysis or qualitative content analysis. All of participant?s interviews were then coded using the qualitative analysis program, Nvivo 10 for Mac (QSR International). Results: The caregivers endorsed similar behaviors and preferences when seeking and accessing health information. Medical professionals were the preferred source of information, while ease of access made the Internet the most common avenue to obtain information. The challenges faced by participants were frequently a result of limited support. In describing an ideal health system, participants expressed interest in a comprehensive care website offering support network resources, instructive services about the injury and caregiving, and injury-specific materials. Conclusions: According to the participants, an ideal health information system would include a comprehensive care website that offered supportive network resources, instructive services about the injury and caregiving, and materials specific to the type of patient injury. UR - http://www.jmir.org/2017/5/e159/ UR - http://dx.doi.org/10.2196/jmir.7027 UR - http://www.ncbi.nlm.nih.gov/pubmed/28490418 ID - info:doi/10.2196/jmir.7027 ER - TY - JOUR AU - Ballesteros, Soledad AU - Mayas, Julia AU - Ruiz-Marquez, Eloisa AU - Prieto, Antonio AU - Toril, Pilar AU - Ponce de Leon, Laura AU - de Ceballos, L. Maria AU - Reales Avilés, Manuel José PY - 2017/01/24 TI - Effects of Video Game Training on Behavioral and Electrophysiological Measures of Attention and Memory: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e8 VL - 6 IS - 1 KW - attention KW - C-reactive protein KW - cognitive training KW - healthy aging KW - inflammation KW - electrophysiology KW - video games KW - working memory N2 - Background: Neuroplasticity-based approaches seem to offer promising ways of maintaining cognitive health in older adults and postponing the onset of cognitive decline symptoms. Although previous research suggests that training can produce transfer effects, this study was designed to overcome some limitations of previous studies by incorporating an active control group and the assessment of training expectations. Objective: The main objectives of this study are (1) to evaluate the effects of a randomized computer-based intervention consisting of training older adults with nonaction video games on brain and cognitive functions that decline with age, including attention and spatial working memory, using behavioral measures and electrophysiological recordings (event-related potentials [ERPs]) just after training and after a 6-month no-contact period; (2) to explore whether motivation, engagement, or expectations might account for possible training-related improvements; and (3) to examine whether inflammatory mechanisms assessed with noninvasive measurement of C-reactive protein in saliva impair cognitive training-induced effects. A better understanding of these mechanisms could elucidate pathways that could be targeted in the future by either behavioral or neuropsychological interventions. Methods: A single-blinded randomized controlled trial with an experimental group and an active control group, pretest, posttest, and 6-month follow-up repeated measures design is used in this study. A total of 75 cognitively healthy older adults were randomly distributed into experimental and active control groups. Participants in the experimental group received 16 1-hour training sessions with cognitive nonaction video games selected from Lumosity, a commercial brain training package. The active control group received the same number of training sessions with The Sims and SimCity, a simulation strategy game. Results: We have recruited participants, have conducted the training protocol and pretest assessments, and are currently conducting posttest evaluations. The study will conclude in the first semester of 2017. Data analysis will take place during 2017. The primary outcome is transfer of benefit from training to attention and working memory functions and the neural mechanisms underlying possible cognitive improvements. Conclusions: We expect that mental stimulation with video games will improve attention and memory both at the behavioral level and in ERP components promoting brain and mental health and extending independence among elderly people by avoiding the negative personal and economic consequences of long-term care. Trial Registration: Clinicaltrials.gov NCT02796508; https://clinicaltrials.gov/ct2/show/NCT02796508 (archived by WebCite at http://www.webcitation.org/6nFeKeFNB) UR - http://www.researchprotocols.org/2017/1/e8/ UR - http://dx.doi.org/10.2196/resprot.6570 UR - http://www.ncbi.nlm.nih.gov/pubmed/28119279 ID - info:doi/10.2196/resprot.6570 ER - TY - JOUR AU - Dove, Erica AU - Astell, J. Arlene PY - 2017/01/11 TI - The Use of Motion-Based Technology for People Living With Dementia or Mild Cognitive Impairment: A Literature Review JO - J Med Internet Res SP - e3 VL - 19 IS - 1 KW - dementia KW - mild cognitive impairment KW - technology KW - review N2 - Background: The number of people living with dementia and mild cognitive impairment (MCI) is increasing substantially. Although there are many research efforts directed toward the prevention and treatment of dementia and MCI, it is also important to learn more about supporting people to live well with dementia or MCI through cognitive, physical, and leisure means. While past research suggests that technology can be used to support positive aging for people with dementia or MCI, the use of motion-based technology has not been thoroughly explored with this population. Objective: The aim of this study was to identify and synthesize the current literature involving the use of motion-based technology for people living with dementia or MCI by identifying themes while noting areas requiring further research. Methods: A systematic review of studies involving the use of motion-based technology for human participants living with dementia or MCI was conducted. Results: A total of 31 articles met the inclusion criteria. Five questions are addressed concerning (1) context of use; (2) population included (ie, dementia, MCI, or both); (3) hardware and software selection; (4) use of motion-based technology in a group or individual setting; and (5) details about the introduction, teaching, and support methods applied when using the motion-based technology with people living with dementia or MCI. Conclusions: The findings of this review confirm the potential of motion-based technology to improve the lives of people living with dementia or MCI. The use of this technology also spans across several contexts including cognitive, physical, and leisure; all of which support multidimensional well-being. The literature provides evidence that people living with dementia or MCI can learn how to use this technology and that they enjoy doing so. However, there is a lack of information provided in the literature regarding the introduction, training, and support methods applied when using this form of technology with this population. Future research should address the appropriate introduction, teaching, and support required for people living with dementia or MCI to use the motion-based technology. In addition, it is recommended that the diverse needs of these specific end-users be considered in the design and development of this technology. UR - http://www.jmir.org/2017/1/e3/ UR - http://dx.doi.org/10.2196/jmir.6518 UR - http://www.ncbi.nlm.nih.gov/pubmed/28077346 ID - info:doi/10.2196/jmir.6518 ER - TY - JOUR AU - Kumar, Ramesh AU - Htwe, Ohnmar AU - Baharudin, Azmi AU - Ariffin, Hisam Mohammad AU - Abdul Rhani, Shaharuddin AU - Ibrahim, Kamalnizat AU - Rustam, Aishah AU - Gan, Robert PY - 2016/12/05 TI - Spinal Cord Injury?Assessing Tolerability and Use of Combined Rehabilitation and NeuroAiD (SATURN Study): Protocol of An Exploratory Study In Assessing the Safety and Efficacy of NeuroAiD Amongst People Who Sustain Severe Spinal Cord Injury JO - JMIR Res Protoc SP - e230 VL - 5 IS - 4 KW - spinal cord injury KW - NeuroAiD KW - MLC601 KW - MLC901 KW - safety KW - recovery KW - efficacy N2 - Background: Spinal cord injury (SCI) is a devastating condition with limited therapeutic options despite decades of research. Current treatment options include use of steroids, surgery, and rehabilitation. Nevertheless, many patients with SCI remain disabled. MLC601 (NeuroAiD), a combination of natural products, has been shown to be safe and to aid neurological recovery after brain injuries and may have a potential role in improving recovery after SCI. Objective: The aim of this study is to evaluate the safety and efficacy of NeuroAiD amongst people who sustain SCI in the study setting. Methods: Spinal Cord Injury?Assessing Tolerability and Use of Combined Rehabilitation and NeuroAiD (SATURN) is a prospective cohort study of patients with moderately severe to severe SCI, defined as American Spinal Injury Association (ASIA) Impairment Scale (AIS) A and B. These patients will be treated with open-label NeuroAiD for 6 months in addition to standard care and followed for 24 months. Anonymized data will be prospectively collected at baseline and months 1, 3, 6, 12, 18, and 24 and will include information on demographics; main diagnostics; and neurological and functional state assessed by the Spinal Cord Independence Measure, ASIA?International Standard for Neurological Classification Spinal Cord Injury, and Short Form (SF-8) Health Survey. In addition, NeuroAiD treatment, compliance, concomitant therapies, and side effects, if any, will be collected. Investigators will use a secured online system for data entry. The study is approved by the ethics committee of Hospital University Kebangsaan Malaysia. Results: The coprimary endpoints are safety, AIS grade, and improvement in ASIA motor score at 6 months. Secondary endpoints are AIS grade, ASIA motor scores and sensory scores, Spinal Cord Independence Measure (SCIM), SF-8 Health Survey, and compliance at other time points. Conclusions: SATURN investigates the promising role of NeuroAiD in SCI especially given its excellent safety profile. We described here the protocol and online data collection tool we will use for this prospective cohort study. The selection of moderately severe to severe SCI provides an opportunity to investigate the role of NeuroAiD in addition to standard rehabilitation in patients with poor prognosis. The results will provide important information on the feasibility of conducting larger controlled trials to improve long-term outcome of patients with SCI. Trial Registration: Clinicaltrials.gov NCT02537899; https://clinicaltrials.gov/ct2/show/NCT02537899 (Archived by WebCite at http://www.webcitation.org/6m2pncVTG) UR - http://www.researchprotocols.org/2016/4/e230/ UR - http://dx.doi.org/10.2196/resprot.6275 UR - http://www.ncbi.nlm.nih.gov/pubmed/27919862 ID - info:doi/10.2196/resprot.6275 ER - TY - JOUR AU - Joddrell, Phil AU - Astell, J. Arlene PY - 2016/11/04 TI - Studies Involving People With Dementia and Touchscreen Technology: A Literature Review JO - JMIR Rehabil Assist Technol SP - e10 VL - 3 IS - 2 KW - dementia KW - technology KW - literature review N2 - Background: Devices using touchscreen interfaces such as tablets and smartphones have been highlighted as potentially suitable for people with dementia due to their intuitive and simple control method. This population experience a lack of meaningful, engaging activities, yet the potential use of the touchscreen format to address this issue has not been fully realized. Objective: To identify and synthesize the existing body of literature involving the use of touchscreen technology and people with dementia in order to guide future research in this area. Methods: A systematized review of studies in the English language was conducted, where a touchscreen interface was used with human participants with dementia. Results: A total of 45 articles met the inclusion criteria. Four questions were addressed concerning (1) the context of use, (2) reasons behind the selection of the technology, (3) details of the hardware and software, and (4) whether independent use by people with dementia was evidenced. Conclusions: This review presents an emerging body of evidence demonstrating that people with dementia are able to independently use touchscreen technology. The intuitive control method and adaptability of modern devices has driven the selection of this technology in studies. However, its primary use to date has been as a method to deliver assessments and screening tests or to provide an assistive function or cognitive rehabilitation. Building on the finding that people with dementia are able to use touchscreen technology and which design features facilitate this, more use could be made to deliver independent activities for meaningful occupation, entertainment, and fun. UR - http://rehab.jmir.org/2016/2/e10/ UR - http://dx.doi.org/10.2196/rehab.5788 UR - http://www.ncbi.nlm.nih.gov/pubmed/28582254 ID - info:doi/10.2196/rehab.5788 ER - TY - JOUR AU - Lumsden, Jim AU - Edwards, A. Elizabeth AU - Lawrence, S. Natalia AU - Coyle, David AU - Munafò, R. Marcus PY - 2016/07/15 TI - Gamification of Cognitive Assessment and Cognitive Training: A Systematic Review of Applications and Efficacy JO - JMIR Serious Games SP - e11 VL - 4 IS - 2 KW - gamification KW - gamelike KW - cognition KW - computer games KW - review N2 - Background: Cognitive tasks are typically viewed as effortful, frustrating, and repetitive, which often leads to participant disengagement. This, in turn, may negatively impact data quality and/or reduce intervention effects. However, gamification may provide a possible solution. If game design features can be incorporated into cognitive tasks without undermining their scientific value, then data quality, intervention effects, and participant engagement may be improved. Objectives: This systematic review aims to explore and evaluate the ways in which gamification has already been used for cognitive training and assessment purposes. We hope to answer 3 questions: (1) Why have researchers opted to use gamification? (2) What domains has gamification been applied in? (3) How successful has gamification been in cognitive research thus far? Methods: We systematically searched several Web-based databases, searching the titles, abstracts, and keywords of database entries using the search strategy (gamif* OR game OR games) AND (cognit* OR engag* OR behavi* OR health* OR attention OR motiv*). Searches included papers published in English between January 2007 and October 2015. Results: Our review identified 33 relevant studies, covering 31 gamified cognitive tasks used across a range of disorders and cognitive domains. We identified 7 reasons for researchers opting to gamify their cognitive training and testing. We found that working memory and general executive functions were common targets for both gamified assessment and training. Gamified tests were typically validated successfully, although mixed-domain measurement was a problem. Gamified training appears to be highly engaging and does boost participant motivation, but mixed effects of gamification on task performance were reported. Conclusions: Heterogeneous study designs and typically small sample sizes highlight the need for further research in both gamified training and testing. Nevertheless, careful application of gamification can provide a way to develop engaging and yet scientifically valid cognitive assessments, and it is likely worthwhile to continue to develop gamified cognitive tasks in the future. UR - http://games.jmir.org/2016/2/e11/ UR - http://dx.doi.org/10.2196/games.5888 UR - http://www.ncbi.nlm.nih.gov/pubmed/27421244 ID - info:doi/10.2196/games.5888 ER - TY - JOUR AU - Martínez-Alcalá, I. Claudia AU - Pliego-Pastrana, Patricia AU - Rosales-Lagarde, Alejandra AU - Lopez-Noguerola, JS AU - Molina-Trinidad, M. Eva PY - 2016/05/02 TI - Information and Communication Technologies in the Care of the Elderly: Systematic Review of Applications Aimed at Patients With Dementia and Caregivers JO - JMIR Rehabil Assist Technol SP - e6 VL - 3 IS - 1 KW - information and communication technologies KW - eHealth KW - elderly KW - caregiver KW - Alzheimer's disease KW - systematic review N2 - Background: The interest in applying information and communications technology (ICT) in older adult health care is frequently promoted by the increasing and unsustainable costs of health care services. In turn, the unprecedented growth of the elderly population around the globe has urged institutions, companies, industries, and governments to respond to older adults? medical needs. Objective: The aim of this review is to systematically identify the opportunities that ICT offers to health services, specifically for patients with dementia and their families. Methods: A systematic review of the literature about ICT applications that have been developed to assist patients with Alzheimer?s disease (AD) and their primary caregivers was conducted. The bibliographic search included works published between January 2005 and July 2015 in the databases Springer Link, Scopus, and Google Scholar. Of the published papers, 902 were obtained in the initial search, of which 214 were potentially relevant. Included studies fulfilled the following inclusion criteria: (1) studies carried out between the years of 2005 and 2015, (2) studies were published in English or Spanish, (3) studies with titles containing the keywords, (4) studies with abstracts containing information on ICT applications and AD, and (5) studies published in indexed journals, proceedings, and book chapters. Results: A total of 26 studies satisfied the inclusion criteria for the current review. Among them, 16 were aimed at the patient with AD and 10 at the primary caregivers and/or family members. The studies targeted applications that included assistive technology (44%, 7/16), telecare (37%, 6/16), and telemedicine (31%, 5/16). The information systems (56%, 9/16) and Internet (44%, 7/16) were the most commonly used enabling technologies for the studies. Finally, areas of attention more covered by the studies were care (56%, 9/16), treatment (56%, 9/16), and management (50%, 8/16). Furthermore, it was found that 20 studies (77%, 8/26) evaluated their ICT applications through carrying out tests with patients with dementia and caregivers. Conclusions: The key finding of this systematic review revealed that the use of ICT tools can be strongly recommended to be used as a lifestyle in the elderly in order to improve the quality of life for the elderly and their primary caregivers. Since patients with AD are completely dependent in most activities, it is necessary to give attention to their primary caregivers to avoid stress and depression. In addition, the use of ICT in the daily life of caregivers can help them understand the disease process and manage situations in a way that is beneficial for both parties. It is expected that future developments concerning technological projects can support this group of people. UR - http://rehab.jmir.org/2016/1/e6/ UR - http://dx.doi.org/10.2196/rehab.5226 UR - http://www.ncbi.nlm.nih.gov/pubmed/28582258 ID - info:doi/10.2196/rehab.5226 ER - TY - JOUR AU - Välimäki, Maritta AU - Korkeila, Jyrki AU - Kauppi, Kaisa AU - Kaakinen, K. Johanna AU - Holm, Suvi AU - Vahlo, Jukka AU - Tenovuo, Olli AU - Hämäläinen, Heikki AU - Sarajuuri, Jaana AU - Rantanen, Pekka AU - Orenius, Tage AU - Koponen, Aki PY - 2016/02/09 TI - Digital Gaming for Improving the Functioning of People With Traumatic Brain Injury: Protocol of a Feasibility Study JO - JMIR Res Protoc SP - e6 VL - 5 IS - 1 KW - digital games KW - brain injury KW - cognitive rehabilitation N2 - Background: Traumatic brain injury (TBI) is a critical public health problem. The recovery process for people with TBI is typically slow and dependent on complex and intensive assisted rehabilitation programs. Objective: To evaluate the effects and feasibility of digital games for cognitive functioning and general well-being among people with traumatic brain injury. Methods: This is a single-site feasibility study conducted in Finland, which uses a pragmatic, randomized controlled trial with three arms, and will recruit patients from the Turku University Hospital, Division of Clinical Neurosciences in Finland. Participants must meet the following inclusion criteria: (1) a Finnish speaking adult, aged 18-65 years; (2) diagnosed with a traumatic brain injury (diagnostic criteria ICD-10, S06.X, T90.5) in the University Hospital; (3) access to a TV, a computer, and the Internet at home; (4) not an active digital gamer (5 hours or less a week); (5) willing to participate in the study. Participants must have been discharged from the neurologic treatment period for traumatic brain injury for over 12 months before the commencement of the trial, and they may not have actively participated in cognitive rehabilitation during the 3 months prior to the trial. Written informed consent will be mandatory for acceptance into the trial. Exclusion criteria are as follows: (1) sensory, cognitive, or physical impairment (eg, severe cognitive impairment); (2) a deficiency restricting the use of computers or computer game control system unaided (eg, impairment in vision, severe astigmatism, hemiplegia, disorder in visuospatial perception, dysfunction of the central vestibular system); (3) apathy identified in previous neuropsychological evaluations; (4) diagnosed severe mental disorders (eg, schizophrenia or severe depressive disorders to be identified in medical records as the secondary diagnosis). Results: The preparatory phase for the study is fulfilled. Recruitment started in June 2015 and finished November 2015. Results will be reported in 2016. Conclusions: The specific outcomes such as primary outcome measures were selected because they are widely used psychological tests and thought to be sensitive to changes in the cognitive functions related to TBI. Trial Registration: Clinicaltrials.gov NCT02425527; https://clinicaltrials.gov/ct2/show/NCT02425527 (Archived by WebCite at http://www.webcitation.org/6esKI1uDH) UR - http://www.researchprotocols.org/2016/1/e6/ UR - http://dx.doi.org/10.2196/resprot.4841 UR - http://www.ncbi.nlm.nih.gov/pubmed/26860741 ID - info:doi/10.2196/resprot.4841 ER - TY - JOUR AU - Mawson, Susan AU - Nasr, Nasrin AU - Parker, Jack AU - Davies, Richard AU - Zheng, Huiru AU - Mountain, Gail PY - 2016/01/07 TI - A Personalized Self-Management Rehabilitation System with an Intelligent Shoe for Stroke Survivors: A Realist Evaluation JO - JMIR Rehabil Assist Technol SP - e1 VL - 3 IS - 1 KW - stroke KW - self-management KW - design KW - realist evaluation KW - sensor technology KW - equipment design KW - telehealth KW - self-care N2 - Background: In the United Kingdom, stroke is the most significant cause of adult disability. Stroke survivors are frequently left with physical and psychological changes that can profoundly affect their functional ability, independence, and social participation. Research suggests that long-term, intense, task- and context-specific rehabilitation that is goal-oriented and environmentally enriched improves function, independence, and quality of life after a stroke. It is recommended that rehabilitation should continue until maximum recovery has been achieved. However, the increasing demand on services and financial constraints means that needs cannot be met through traditional face-to-face delivery of rehabilitation. Using a participatory design methodology, we developed an information communication technology?enhanced Personalized Self-Managed rehabilitation System (PSMrS) for stroke survivors with integrated insole sensor technology within an ?intelligent shoe.?. The intervention model was based around a rehabilitation paradigm underpinned by theories of motor relearning and neuroplastic adaptation, motivational feedback, self-efficacy, and knowledge transfer. Objective: To understand the conditions under which this technology-based rehabilitation solution would most likely have an impact on the motor behavior of the user, what would work for whom, in what context, and how. We were interested in what aspects of the system would work best to facilitate the motor behavior change associated with self-managed rehabilitation and which user characteristics and circumstances of use could promote improved functional outcomes. Methods: We used a Realist Evaluation (RE) framework to evaluate the final prototype PSMrS with the assumption that the intervention consists of a series of configurations that include the Context of use, the underlying Mechanisms of change and the potential Outcomes or impacts (CMOs). We developed the CMOs from literature reviews and engagement with clinicians, users, and caregivers during a series of focus groups and home visits. These CMOs were then tested in five in-depth case studies with stroke survivors and their caregivers. Results: While two new propositions emerged, the second importantly related to the self-management aspects of the system. The study revealed that the system should also encourage independent use and the setting of personalized goals or activities. Conclusions: Information communication technology that purports to support the self-management of stroke rehabilitation should give significant consideration to the need for motivational feedback that provides quantitative, reliable, accurate, context-specific, and culturally sensitive information about the achievement of personalized goal-based activities. UR - http://rehab.jmir.org/2016/1/e1/ UR - http://dx.doi.org/10.2196/rehab.5079 UR - http://www.ncbi.nlm.nih.gov/pubmed/28582250 ID - info:doi/10.2196/rehab.5079 ER - TY - JOUR AU - Tacchino, Andrea AU - Pedullà, Ludovico AU - Bonzano, Laura AU - Vassallo, Claudio AU - Battaglia, Alberto Mario AU - Mancardi, Gianluigi AU - Bove, Marco AU - Brichetto, Giampaolo PY - 2015/08/31 TI - A New App for At-Home Cognitive Training: Description and Pilot Testing on Patients with Multiple Sclerosis JO - JMIR mHealth uHealth SP - e85 VL - 3 IS - 3 KW - tablet KW - mobile phone KW - mobile device KW - cognitive rehabilitation KW - cognitive impairment KW - working memory KW - self-management KW - adaptive working load algorithms KW - usability N2 - Background: Cognitive impairment is common in people with neurological diseases and severely affects their social and professional life. It has been shown that intensive and personalized cognitive rehabilitation (CR), based on working memory exercises, leads to improved cognitive status of healthy and cognitive-impaired subjects. New technologies would help to promote accessible, at-home, and self-managed CR interventions. Objective: The aim of this paper is to describe the design of Cognitive Training Kit (COGNI-TRAcK), an app for mobile devices, to self-administer an at-home, intensive, and personalized CR intervention based on working memory exercises, and test its disposability-to-use (usability, motivation to use, compliance to treatment) on cognitive-impaired patients with multiple sclerosis (MS). Methods: COGNI-TRAcK includes user-friendly interfaces for personal data input and management and for CR intervention configurations. Inner routines automatically implement adaptive working load algorithms and allow data processing and analysis. A dedicated team developed COGNI-TRAcK with C# programming language, by using the platform Xamarin Studio 4.0.10 for Android (API level 15 and following). Three exercises based on working memory are now available. To assess the disposability-to-use of the system, patients with MS were selected as likely users due to the young age of disease onset. Cognitive-impaired patients with MS (N=16) with a mean age of 49.06 years (SD 9.10) and a mean score of 3.75 (SD 1.92) on the Expanded Disability Status Scale (EDSS) were submitted to an 8-week at-home intervention administered by the app. The intervention consisted of 5 daily scheduled 30-minute sessions per week. Disposability-to-use of COGNI-TRAcK was investigated by means of a questionnaire administered to patients at the end of the training. Results: The adherence to the treatment was 84% (33.4/40). Of the patients with MS, 94% (15/16) understood the instructions given, 100% (16/16) felt independent to use COGNI-TRAcK at home, 75% (12/16) found the exercises interesting, and 81% (13/16) found the exercises useful and were motivated to use the app again. Moreover, during the exercises, patients with MS were highly motivated to perform well (mean score 3.19/4, SE 0.16), experienced rather low levels of stress (mean score 2.19/4, SE 0.26), were not bored (mean score 1.81/4, SE 0.30), and felt amusement (mean score 2.25/4, SE 0.23). Conclusions: As COGNI-TRAcK is highly usable, motivating, and well-accepted by patients with MS, its effectiveness can now be investigated. To improve COGNI-TRAcK, new releases should contain more working memory exercises, have enhanced perceived amusement, and promote Internet communication procedures for data transfer and fostering remote control of the intervention. UR - http://mhealth.jmir.org/2015/3/e85/ UR - http://dx.doi.org/10.2196/mhealth.4269 UR - http://www.ncbi.nlm.nih.gov/pubmed/26323749 ID - info:doi/10.2196/mhealth.4269 ER - TY - JOUR AU - Tatla, K. Sandy AU - Shirzad, Navid AU - Lohse, R. Keith AU - Virji-Babul, Naznin AU - Hoens, M. Alison AU - Holsti, Liisa AU - Li, C. Linda AU - Miller, J. Kimberly AU - Lam, Y. Melanie AU - Van der Loos, Machiel H. F. PY - 2015/03/10 TI - Therapists? Perceptions of Social Media and Video Game Technologies in Upper Limb Rehabilitation JO - JMIR Serious Games SP - e2 VL - 3 IS - 1 KW - virtual reality KW - technology adoption KW - rehabilitation KW - therapy KW - social media KW - gaming KW - stroke KW - cerebral palsy KW - hemiplegia N2 - Background: The application of technologies, such as video gaming and social media for rehabilitation, is garnering interest in the medical field. However, little research has examined clinicians? perspectives regarding technology adoption by their clients. Objective: The objective of our study was to explore therapists? perceptions of how young people and adults with hemiplegia use gaming and social media technologies in daily life and in rehabilitation, and to identify barriers to using these technologies in rehabilitation. Methods: We conducted two focus groups comprised of ten occupational therapists/physiotherapists who provide neurorehabilitation to individuals with hemiplegia secondary to stroke or cerebral palsy. Data was analyzed using inductive thematic analysis. The diffusion of innovations theory provided a framework to interpret emerging themes. Results: Therapists were using technology in a limited capacity. They identified barriers to using social media and gaming technology with their clients, including a lack of age appropriateness, privacy issues with social media, limited transfer of training, and a lack of accessibility of current systems. Therapists also questioned their role in the context of technology-based interventions. The opportunity for social interaction was perceived as a major benefit of integrated gaming and social media. Conclusions: This study reveals the complexities associated with adopting new technologies in clinical practice, including the need to consider both client and clinician factors. Despite reporting several challenges with applying gaming and social media technology with clinical populations, therapists identified opportunities for increased social interactions and were willing to help shape the development of an upper limb training system that could more readily meet the needs of clients with hemiplegia. By considering the needs of both therapists and clients, technology developers may increase the likelihood that clinicians will adopt innovative technologies. UR - http://games.jmir.org/2015/1/e2/ UR - http://dx.doi.org/10.2196/games.3401 UR - http://www.ncbi.nlm.nih.gov/pubmed/25759148 ID - info:doi/10.2196/games.3401 ER - TY - JOUR AU - Merchán-Baeza, Antonio Jose AU - Gonzalez-Sanchez, Manuel AU - Cuesta-Vargas, Antonio PY - 2015/03/10 TI - Clinical Effect Size of an Educational Intervention in the Home and Compliance With Mobile Phone-Based Reminders for People Who Suffer From Stroke: Protocol of a Randomized Controlled Trial JO - JMIR Res Protoc SP - e33 VL - 4 IS - 1 KW - stroke KW - ADL KW - environment KW - patient adherence KW - mobile apps KW - mobile health N2 - Background: Stroke is the third-leading cause of death and the leading cause of long-term neurological disability in the world. Cognitive, communication, and physical weakness combined with environmental changes frequently cause changes in the roles, routines, and daily occupations of stroke sufferers. Educational intervention combines didactic and interactive intervention, which combines the best choices for teaching new behaviors since it involves the active participation of the patient in learning. Nowadays, there are many types of interventions or means to increase adherence to treatment. Objective: The aim of this study is to enable patients who have suffered stroke and been discharged to their homes to improve the performance of the activities of daily living (ADL) in their home environment, based on advice given by the therapist. A secondary aim is that these patients continue the treatment through a reminder app installed on their mobile phones. Methods: This study is a clinical randomized controlled trial. The total sample will consist of 80 adults who have suffered a stroke with moderate severity and who have been discharged to their homes in the 3 months prior to recruitment to the study. The following tests and scales will be used to measure the outcome variables: Barthel Index, the Functional Independence Measure, the Mini-Mental State Examination, the Canadian Neurological Scale, the Stroke Impact Scale-16, the Trunk Control Test, the Modified Rankin Scale, the Multidimensional Scale of Perceived Social Support, the Quality of Life Scale for Stroke, the Functional Reach Test, the Romberg Test, the Time Up and Go test, the Timed-Stands Test, a portable dynamometer, and a sociodemographic questionnaire. Descriptive analyses will include mean, standard deviation, and 95% confidence intervals of the values for each variable. The Kolmogov-Smirnov (KS) test and a 2x2 mixed-model analysis of variance (ANOVA) will be used. Intergroup effect sizes will be calculated (Cohen?s d). Results: Currently, the study is in the recruitment phase and implementation of the intervention has begun. The authors anticipate that during 2015 the following processes should be completed: recruitment, intervention, and data collection. It is expected that the analysis of all data and the first results should be available in early-to-mid 2016. Conclusions: An educational intervention based on therapeutic home advice and a reminder app has been developed by the authors with the intention that patients who have suffered stroke perform the ADL more easily and use their affected limbs more actively in the ADL. The use of reminders via mobile phone is proposed as an innovative tool to increase treatment adherence in this population. Trial Registration: ClinicalTrials.gov NCT01980641; https://clinicaltrials.gov/ct2/show/NCT01980641 (Archived by WebCite at http://www.webcitation.org/6WRWFmY6U). UR - http://www.researchprotocols.org/2015/1/e33/ UR - http://dx.doi.org/10.2196/resprot.4034 UR - http://www.ncbi.nlm.nih.gov/pubmed/25757808 ID - info:doi/10.2196/resprot.4034 ER - TY - JOUR AU - Calderita, Vicente Luis AU - Manso, J. Luis AU - Bustos, Pablo AU - Suárez-Mejías, Cristina AU - Fernández, Fernando AU - Bandera, Antonio PY - 2014/10/07 TI - THERAPIST: Towards an Autonomous Socially Interactive Robot for Motor and Neurorehabilitation Therapies for Children JO - JMIR Rehabil Assist Technol SP - e1 VL - 1 IS - 1 KW - rehabilitation KW - cognitive robotics KW - interactive games N2 - Background: Neurorehabilitation therapies exploiting the use-dependent plasticity of our neuromuscular system are devised to help patients who suffer from injuries or diseases of this system. These therapies take advantage of the fact that the motor activity alters the properties of our neurons and muscles, including the pattern of their connectivity, and thus their functionality. Hence, a sensor-motor treatment where patients makes certain movements will help them (re)learn how to move the affected body parts. But these traditional rehabilitation processes are usually repetitive and lengthy, reducing motivation and adherence to the treatment, and thus limiting the benefits for the patients. Objective: Our goal was to create innovative neurorehabilitation therapies based on THERAPIST, a socially assistive robot. THERAPIST is an autonomous robot that is able to find and execute plans and adapt them to new situations in real-time. The software architecture of THERAPIST monitors and determines the course of action, learns from previous experiences, and interacts with people using verbal and non-verbal channels. THERAPIST can increase the adherence of the patient to the sessions using serious games. Data are recorded and can be used to tailor patient sessions. Methods: We hypothesized that pediatric patients would engage better in a therapeutic non-physical interaction with a robot, facilitating the design of new therapies to improve patient motivation. We propose RoboCog, a novel cognitive architecture. This architecture will enhance the effectiveness and time-of-response of complex multi-degree-of-freedom robots designed to collaborate with humans, combining two core elements: a deep and hybrid representation of the current state, own, and observed; and a set of task-dependent planners, working at different levels of abstraction but connected to this central representation through a common interface. Using RoboCog, THERAPIST engages the human partner in an active interactive process. But RoboCog also endows the robot with abilities for high-level planning, monitoring, and learning. Thus, THERAPIST engages the patient through different games or activities, and adapts the session to each individual. Results: RoboCog successfully integrates a deliberative planner with a set of modules working at situational or sensorimotor levels. This architecture also allows THERAPIST to deliver responses at a human rate. The synchronization of the multiple interaction modalities results from a unique scene representation or model. THERAPIST is now a socially interactive robot that, instead of reproducing the phrases or gestures that the developers decide, maintains a dialogue and autonomously generate gestures or expressions. THERAPIST is able to play simple games with human partners, which requires humans to perform certain movements, and also to capture the human motion, for later analysis by clinic specialists. Conclusions: The initial hypothesis was validated by our experimental studies showing that interaction with the robot results in highly attentive and collaborative attitudes in pediatric patients. We also verified that RoboCog allows the robot to interact with patients at human rates. However, there remain many issues to overcome. The development of novel hands-off rehabilitation therapies will require the intersection of multiple challenging directions of research that we are currently exploring. UR - http://rehab.jmir.org/2014/1/e1/ UR - http://dx.doi.org/10.2196/rehab.3151 UR - http://www.ncbi.nlm.nih.gov/pubmed/28582242 ID - info:doi/10.2196/rehab.3151 ER -