PloS oneMateusz Kukla, Michał Kończak, Maciej Berdychowski, Dominik Rybarczyk, Bartosz Wieczorek, Łukasz Warguła
Manual wheelchair users may have reduced physical activity and total energy expenditure, while wearable devices may not adequately capture external mechanical demand during wheelchair propulsion. This pilot study examined whether wheel-level mechanical power combined with heart rate could estimate mass-specific oxygen uptake (V̇O2/kg) during manual wheelchair propulsion. Ten long-term manual wheelchair users aged 29-38 years completed 3-min trials under three progressively loaded conditions on a wheelchair ergometer. Wheel velocity and braking torque were measured, mechanical power was calculated from trial-mean torque and angular velocity, and metabolic variables were assessed using a wearable respiratory gas analyzer. A two-predictor linear regression model was developed, with participant-clustered standard errors and leave-one-participant-out cross-validation (LOPO-CV) for internal evaluation. V̇O2/kg increased across conditions despite lower velocity under the highest load. The final model was V̇O2/kg = 5.5738 + 0.2444P + 0.03587HR. Mechanical power (95% CI: 0.1330-0.3558) and heart rate (95% CI: 0.01342-0.05833) were significant positive predictors. The model explained 72.2% of the variance (R2 = 0.722; adjusted R2 = 0.701). LOPO-CV yielded an RMSE of 1.128 mL O2·kg-1·min-1, an MAE of 0.917 mL O2·kg-1·min-1, and R2 = 0.575. Repeated-measures Bland-Altman analysis of LOPO-CV predictions showed a mean bias of -0.156 mL O2·kg-1·min-1 (95% CI: -0.6259 to 0.2022), with limits of agreement from -2.389 (95% CI: -3.1667 to -1.7711) to 2.077 mL O2·kg-1·min-1 (95% CI: 1.6096 to 2.6636). Mechanical power and heart rate may provide complementary information for estimating metabolic demand during manual wheelchair propulsion. However, the model was developed in a small exploratory sample, was only internally evaluated, and requires external validation before practical application.
European journal of sport scienceThomas Rietveld, Rowie J F Janssen, Thomas J O'Brien, Pippa Bailey, Victoria L Goosey-Tolfrey
This study aimed to develop a standardised individualised wheelchair sprinting protocol with increasing resistances to generate linear force-velocity and parabolic power-velocity profiles, applicable across wheelchair sports with various classification levels. Twenty-seven wheelchair athletes (16 wheelchair rugby [WR] and 11 wheelchair basketball [WB]) completed six 10 s sprints on a wheelchair ergometer with 2 min rest in between. Sprint 1 was completed at the same resistance coefficient for all athletes (μ = 0.012, court resistance). For the remaining five sprints, resistances were individually increased based on predicted peak power output values. Linear regression equations were determined between forces and velocities per push for both peak and mean values. Linear relationships were more stable using the mean values compared to peak values per push (R2: 0.78 for mean power output and R2: 0.72 for peak power output). Across the six sprints, forces increased (WR: +59%, and WB: +53%), whereas velocities decreased (WR: -40% and WB: -33%). The highest mean power output per push were achieved in sprint 3 for WR and sprint 4 for WB. On average, the peak of the power parabola occurred at a mean velocity of 2.85 ms-1 and mean power output of 414 W. This wheelchair sprint protocol with individualised increases in resistance provides an applicable force-velocity relationship across sports with various classification levels when modelled using the mean force and velocity per push. Together with the subsequent power-velocity relationship, this protocol can be used to optimise power production relative to individual baselines and help work towards the most optimal force-velocity profile.
Clinical interventions in agingStephanie Zawada, Michelle Fogus, Emily Mills, Emma Fortune, Laura Cepoi
PURPOSE: With caregiver workforce shortages on the rise, devices with embedded sensors ("smart devices") hold promise for supporting older adults in community and at-home settings. The purpose of this study was to describe recent trends in coverage related to smart devices in Home and Community-Based Services (HCBS) waivers. PATIENTS AND METHODS: This analysis examined at-home services as outlined in recent Medicaid 1915(c) waivers (January 31, 2020 - May 1, 2026) offered to older adults (age 60 and older) among the 50 states and District of Columbia. Data were obtained from Medicaid waiver applications specific to older adults or including older adult populations with physical disabilities/frailty, using state and CMS repositories. Data elements extracted included waiver text and metadata, assistive technology (AT) categories, and references to smart devices. Descriptive statistics were applied. RESULTS: Thirty-nine states and D.C. (78.4%) implemented 66 waivers targeting older adults. Three states (MN, OK, and PA) offered the most smart device coverage across AT categories, with smart devices permitted most frequently in the Personal Emergency/Emergency System category (62.1%). While most waivers permit smart devices using broad device eligibility terminology, explicit references for smart devices were identified in 39.4% of waivers across 19 states concentrated in the US Rust Belt, New England, and Atlantic South, including but not limited to motion sensors, smart pens, and GPS trackers. CONCLUSION: This study outlines emerging state-by-state variability in Medicaid coverage for smart devices under HCBS waivers. Future research should assess the relationship between state waiver terminology and smart devices that receive coverage across states.
JMIR rehabilitation and assistive technologiesOskar Cvjetičanin, Ivana Marić, Nejc Šarabon
BACKGROUND: According to human-centered design principles, user experience and user satisfaction are key aspects when developing or providing patients and clients with assistive, rehabilitation, or training technologies. Existing tools for assessing user experience and satisfaction are often either too narrow (developed for specific technologies) or too broad, failing to capture all relevant aspects of the technology being evaluated. OBJECTIVE: The main objective of this study was to present the development process and content validation of a questionnaire that, following further validation steps, could be useful for researchers and developers in assessing the satisfaction of direct end users with assistive, rehabilitation, and training technologies. METHODS: The development of the User Satisfaction Questionnaire for Assistive, Rehabilitation, and Training Technologies (U-ART-Q) followed a multistep process: (1) literature review, (2) domain definition and item generation, (3) expert consultation, (4) linguistic validation, and (5) content validation. Initially, 72 items were generated and organized into 7 domains. After expert review and linguistic validation, the questionnaire underwent content validation by 8 experts in physiotherapy, kinesiology, and ergonomics. Each item was rated for relevance using a 4-point Likert-type scale. The content validity ratio (CVR) and item-level content validity index (I-CVI) were calculated, and items below the accepted thresholds were removed or further revised. RESULTS: Expert consultation resulted in the removal or merging of 20 items to improve clarity and reduce redundancy. Of the 52 items evaluated during content validation, 44 met the CVR and I-CVI criteria (CVR >0.75 and I-CVI >0.78). Eight items required additional review, and 2 items were ultimately removed. The final questionnaire comprises 10 initial screening questions and 50 content-valid items across 7 domains: design, comfort, effectiveness and usefulness, service, treatment or exercise, overall impressions, and safety. The overall average content validity index was 0.915, providing evidence of strong content validity. A macro-enabled Excel tool was developed to automate item selection and generate a PDF version of the questionnaire based on initial screening responses. CONCLUSIONS: The U-ART-Q is a newly developed instrument for assessing user satisfaction with assistive, rehabilitation, and training technologies. Further research will focus on psychometric evaluation, reliability testing, and multilingual validation to determine whether the U-ART-Q can provide a standardized method for assessing user satisfaction. Once fully evaluated, the questionnaire could support both developmental usability testing and postmarket evaluation, facilitating evidence-based decision-making and guiding future product improvement.
Acta of bioengineering and biomechanicsKajetan Ciunelis, Michalina Błażkiewicz, Elisa Digo, Jolanta Marszałek, Marie Lund Ohlsson, Anna Bjerkefors, Yves Vanlandewijck
PURPOSE: This study examined whether upper and mid trunk kinematics, measured by inertial measurement units at seventh cervical (C7) and eighth thoracic (T8) vertebral levels, distinguishes between clinically defined levels of trunk function to support classifiers' decisions in Paralympic sports. METHODS: Sixty-three wheelchair athletes with neuromusculoskeletal impairment (54 wheelchair basketball players, 7 fencers, and 2 others) were classified into four trunk-hip function groups (Very Low, Low, Moderate, and High) using hierarchical cluster analysis based on the composite score of standardised Manual Muscle Testing of trunk and hip muscles. Participants performed maximum active range of motion (Volume of Action) tasks while sitting in four conditions with progressively reduced external support (Full, Partial, No Support, and Sport Wheelchair). Two Inertial Measurement Units recorded trunk kinematics at 100 Hz. Inter-segmental peak angular differences between sensors were compared across groups using Kruskal-Wallis tests. RESULTS: Active range of motion from individual C7 and T8 sensors differentiated most trunk-hip function group pairs (88% of comparisons). Peak trunk angle differed between sensors in 66% of comparisons, particularly for rotation (8-20°) and lateral tilt (4-14°). These inter-segmental C7-T8 differences separated groups in 23% of comparisons (mean difference: 10°; range: 4-20°). CONCLUSIONS: Active range of motion from a single upper trunk (C7) sensor discriminated between most trunk function group pairs and appears sufficient for classification. Inter-segmental C7-T8 trunk peak angle differences provided limited additional classification value beyond single-sensor measurements, supporting the use of simplified field assessment protocols.
PeerJAurora Norte, María Miana, David Romero-García, Isabel Sospedra, Eva Ausó, Ana Cifuentes, Sara Perpiñá-Martínez, Sara Aprea-Moreno, Pablo Leardy Palencia, Sant…
This study evaluated dietary habits, hydration practices and adherence to nutritional recommendations in elite Spanish wheelchair basketball players, examining differences by sex and functional classification. Sixty-six athletes from first-division teams completed the validated Food4Me Food Frequency Questionnaire, and adherence was assessed using national dietary guidelines. Overall compliance with recommendations was low, the most athletes consumed fruits, vegetables, legumes, cereals and fish below recommended frequencies, while dairy, red meat and eggs generally met guidelines. Fruit intake was below recommendations in all women and in 91.2% of men, and a significant sex difference emerged only for dairy, with lower consumption in women. By functional classification, dairy intake was also lower among athletes with greater functional limitation. Most players (80.3%) did not follow any specific diet. Hydration practices were suboptimal, with 66.7% of women consuming ≤0.5 L of water during training compared with 15.8% of men, and athletes with grade 1 functionality drinking less water during matches than those with grade 4. These findings indicate limited adherence to dietary guidelines and insufficient hydration practices in this population, underscoring the need for tailored, disability-informed nutritional education strategies to support dietary adequacy and performance.
The American journal of occupational therapy : official publication of the American Occupational Therapy AssociationMadeline Runyen, Charmi Kanani, Cristin Beazley, Amol M Karmarkar
ImportanceAerobic intensity is well supported in poststroke gait rehabilitation, but its role in upper extremity rehabilitation is unclear.ObjectiveExamine whether aerobic intensity is associated with upper extremity recovery and self-care performance.DesignRetrospective observational cohort study.Participants121 individuals admitted to an inpatient rehabilitation hospital after stroke.InterventionArm therapy targeting increased cardiovascular demand using advanced arm rehabilitation technology and body weight support.OutcomesArm recovery and self-care performance were assessed using the Fugl-Meyer Assessment for the Upper Extremity and Section GG Medicare Functional Assessment.ResultsMore than half of participants reached ≥70% heart rate (HR) maximum in at least one session. Achieving ≥70% HR maximum (p = .04) and use of body weight support (p = .02) were each associated with greater improvement in self-care performance.ConclusionsAchieving ≥70% HR maximum during arm training was feasible and associated with greater self-care independence. Strategies to increase cardiovascular demand such as a more challenging body position or the use of body weight support (BWS) may support functional performance in individuals poststroke.
Forward head flexion during wheelchair propulsion has been suggested to compensate for reduced trunk muscle strength in individuals with spinal cord injury, but the influence of restricting head-neck movement on propulsion remains unclear. This study examined wheelchair propulsion under cervical fixation and non-fixation conditions. Fourteen healthy young men (20.7 ± 0.5 years) performed 5 m wheelchair propulsion under both conditions. Propulsion was recorded with a smartphone camera, and coordinates of the left ear, shoulder, elbow, and wrist were extracted using You Only Look Once version 7 (YOLO v7) to calculate upper-arm segment and elbow angles and angular accelerations. Analysis focused on the first three propulsion cycles after movement onset. Propulsion velocity showed a significant main effect of measurement point, but neither the main effect of cervical fixation nor the condition-by-point interaction was significant. Velocity increment differed significantly among measurement intervals, whereas the condition effect and interaction were not significant. Cervical fixation was associated with a smaller minimum upper-arm segment angle and greater upper-arm segment excursion, maximum elbow angle, and elbow range of motion. A significant condition-by-cycle interaction was found for minimum elbow angle, with a smaller angle under fixation during the first cycle. Minimum upper-arm segment angular acceleration in the flexion direction also differed among cycles. Thus, cervical fixation was associated with changes in upper-limb kinematics, but a statistically significant change in propulsion velocity was not demonstrated. These preliminary findings provide a basis for future studies in wheelchair users and athletes.
JMIR research protocolsLucien Coulibaly, Maude Laberge, Manon Guay, Noémie Séguin-Tremblay, Paule Langlois, Isabel Paradis, Jean Philippe Nadeau, Mireille Jobidon, René Chamard, Kari…
BACKGROUND: Aging in place is a priority for many older adults but often requires home adaptations when temporary or permanent physical disabilities arise. It reduces the risk of falls, improves health-related quality of life, and enhances social participation. Two new digital innovations aim to support home adaptation: Hygiene 2.0, which facilitates the adaptation of baths and showers, and MapIt, which provides 3D mapping of the environment. OBJECTIVE: This action study aims to cocreate and evaluate the implementation of the Hygiene 2.0 and MapIt innovations and to measure their impact on supporting older adults who experience difficulties with personal hygiene or are in the process of adapting their homes. METHODS: This study uses a multiple case study approach with a mixed convergent design, guided by the i-PARIHS (integrated-Promoting Action on Research Implementation in Health Services) framework. We will conduct semistructured interviews with 66 participants, including 8 older adults-informal caregiver dyads (or individual older adults when no informal caregiver is available) for MapIt only, 20 dyads for Hygiene 2.0 or the combined use of Hygiene 2.0 and MapIt, and 10 assistive technology advisors across all innovation scenarios. A cost analysis will be conducted from both the Quebec public system and patient perspectives. Qualitative data and mixed data integration will be analyzed using analytical questioning. RESULTS: This study was conducted within the framework of, and with financial support from, the Bien vieillir chez soi au Bas-Saint-Laurent action research program. Recruitment began in May 2024. We completed data collection in February 2026 and began data cleaning and analysis in March 2026. As of September 2025, we enrolled 1 dyad of older adults and informal caregivers using MapIt, 5 dyads using Hygiene 2.0 or the combination of Hygiene 2.0 and MapIt, and 10 assistive technology advisors. The manuscript describing the results of the study is expected to be published at the beginning of 2027. May. CONCLUSIONS: This study will provide valuable insights into how innovative digital tools can facilitate home adaptations that promote aging in place. By assessing their implementation, usability, and cost-effectiveness, the findings are expected to inform best practices, guide decision-making for health and social care stakeholders, and ultimately contribute to improving the quality of life and autonomy of older adults.
The Cochrane database of systematic reviewsChiara Arienti, Stefano Giuseppe Lazzarini, Fabio Zaina, Claudio Cordani, Fulvio Dal Farra, Silvia Minozzi, Carlotte Kiekens, Stefano Negrini
RATIONALE: Low back pain (LBP) is a major global health problem. It is the most common cause of activity limitation amongst individuals younger than 45 years, and one of the most frequent reasons for visits to a doctor. The 2019 Global Burden of Disease study named LBP as the leading cause of the need for rehabilitation, estimated to affect 568 million people. Its socioeconomic burden is substantial, with LBP-related costs from productivity loss and healthcare services utilisation making a significant impact on national gross domestic products. In particular, chronic LBP (CLBP)-defined as pain, muscle tension, or stiffness lasting longer than 12 weeks-results in long-term suffering and a considerable increase in healthcare expenditure. A wide variety of assistive technologies are utilised to manage CLBP. These aim to provide mechanical support, using diverse modalities and levels of assistance. OBJECTIVES: To assess the benefits and harms of assistive technologies (i.e. non-rigid and rigid lumbar braces, belts, supports, and devices to assist mobility and gait) in adults with chronic low back pain (CLBP). SEARCH METHODS: We searched CENTRAL, MEDLINE (PubMed), Embase, CINAHL, and trials registries up to 7 January 2025. We also searched the reference lists of included studies and any relevant systematic reviews. ELIGIBILITY CRITERIA: We included randomised controlled trials (RCTs) involving adults with CLBP comparing all types of assistive technologies versus placebo/sham, no intervention, or usual care. We planned to include non-randomised studies of interventions (NRSIs) in the absence of RCT evidence for some types of assistive devices. OUTCOMES: Our critical outcomes were pain, disability, health-related quality of life, participant-reported treatment success, falls, adverse events, and withdrawals due to any adverse events. Our important outcomes were depression, anxiety, social participation, and reduced use of painkillers. We did not assess the certainty of the evidence for important outcomes; thus, their results are not included in the abstract. RISK OF BIAS: We used the Cochrane tool RoB 1 to assess the risk of bias in the studies. SYNTHESIS METHODS: We conducted meta-analysis using the random-effects model to calculate the mean difference (MD) or standardised mean difference (SMD) with 95% confidence interval (CI) for all outcomes. We assessed the certainty of the evidence using the GRADE approach. When pooling was not possible, we calculated effect estimates for individual studies; when data were not available, we summarised the results narratively. INCLUDED STUDIES: We included eight RCTs involving a total of 501 participants. We did not identify any NRSIs meeting the inclusion criteria. Participants in the eight studies were adults of both sexes who had CLBP of at least one year's duration being treated in the outpatient rehabilitation setting. All eight studies investigated the effects of lumbar supports; no eligible studies assessed other assistive technologies, such as mobility or gait aids. Seven of the studies added lumbar supports to 'usual care'. Five of the studies were conducted in low- and middle-income countries and three in high-income countries. Most of the included studies were at high or unclear risk of bias due to lack of blinding, incomplete outcome data, and selective reporting. We judged the certainty of the evidence to be low or very low. SYNTHESIS OF RESULTS: The available evidence mainly addresses pain intensity and disability. We found some limited data on health-related quality of life. None of the included studies reported participant-reported treatment success, falls, adverse events, withdrawals due to any adverse events, or any of our other prespecified outcomes. Compared to no intervention, lumbar supports may result in little to no difference in pain intensity in the intermediate term (three months), if we consider a minimum clinically meaningful change on the 0-to-100 pain scale to be 15 points (MD -8.00, 95% CI -15.02 to -0.98; 1 study, 107 participants), and may result in little to no difference in disability (MD -0.10, 95% CI -1.11 to 0.91; 1 study, 107 participants) (both low-certainty evidence). Compared with usual care (non-steroidal anti-inflammatory drugs (NSAIDs)), lumbar supports plus usual care (NSAIDs) may result in a small reduction in short-term pain intensity (after three to four weeks), if we consider a minimum clinically meaningful change on the 0-to-100 pain scale to be 15 points (MD -17.66, 95% CI -24.22 to -11.09; I2 = 30%; 2 studies, 149 participants; low-certainty evidence). However, the effect of lumbar supports added to usual care (NSAIDs) on disability is very uncertain (SMD -0.63, 95% CI -1.43 to 0.17; I2 = 76%; 2 studies, 149 participants; very low-certainty evidence). The evidence is very uncertain about the effect of lumbar supports plus usual care (education and exercise) compared with usual care (education and exercise) on pain intensity (MD -4.50, 95% CI -20.98 to 11.98; 1 study, 25 participants), disability (MD 2.80, 95% CI -21.58 to 27.18; 1 study, 24 participants), and health-related quality of life (1 study, 25 participants) in the short term (six weeks) (all very low certainty evidence). The evidence is also very uncertain about the effect of lumbar supports plus usual care (routine physical therapy) compared with usual care (routine physical therapy) on pain intensity (MD 3.10, 95% CI -5.89 to 12.09; 1 study, 41 participants) and disability (MD -4.27, 95% CI -7.71 to -0.83; 1 study, 41 participants) in the short term (four weeks) (both very low certainty evidence). AUTHORS' CONCLUSIONS: Lumbar supports may result in a small reduction in pain intensity when provided in addition to NSAIDs, but may offer little to no benefit for pain intensity and disability when used alone. The evidence regarding health-related quality of life is very uncertain. No included studies reported on our other outcomes of interest or on adverse events, leaving uncertainty about the potential harms and broader functional impact of lumbar supports. Therefore, there is insufficient evidence to support the routine use of lumbar supports for managing CLBP. The absence of research on other assistive devices commonly used in clinical practice, particularly amongst people with disabilities or mobility limitations, is an evidence gap for future research to fill. FUNDING: This Cochrane review had no dedicated funding. REGISTRATION: Protocol (2024) DOI: 10.1002/14651858.CD015492.
Journal of athletic trainingRyan N Moran, Margaret Stran, Elizabeth E Elder, Alex C Curry
CONTEXT: The Wheelchair Error Scoring System has been developed as an alternative to quantify static balance for wheelchair sport athletes. Timed tandem gait and its progressive assessments of complex and dual-task tandem gait are not able to be administered in this population due to the inability to perform heel-to-toe walking, warranting the development of a wheelchair-specific alternative. OBJECTIVE: To quantify baseline performance, modifying factor effects, and test-retest reliability of a novel tandem gait alternative propulsion task. DESIGN: Cross-sectional, repeated measures study. SETTING: University adapted athletics facility. PATIENTS OR OTHER PARTICIPANTS: Twenty-six wheelchair-using athletes (age = 21.65 ± 2.6 years, male sex, n = 14, 53.8%) from a single institution's collegiate adapted athletics program. MAIN OUTCOME MEASURES: Participants performed a baseline wheelchair propulsion task along a straight, 9-m line, completing 3 trials of single- and dual-task propulsion, by wheeling down and back as quickly as possible while staying centered along the line and constantly feeding their wheel without power pushes or gliding. Testing was repeated 1 week and 45 days later. Performance was recorded as the average time of completion for each of the 3 trials by task. Independent variables consisted of dual task, sex, and concussion history. RESULTS: Single- to dual-task differences yielded a 1.42-second slowing (P < .001) in performance. There were no differences between sexes on single- (P = .42) and dual-task (P = .38) nor concussion history on single- (P = .74) and dual-task (P = .46) conditions. Significant test-retest reliability was observed with good (intraclass correlation coefficient [ICC] = 0.79-0.82, P < .001) to moderate (ICC = 0.50-0.56, P = .001-.003) reliability at 1 week and 45 days, respectively. CONCLUSIONS: Our findings provide context for baseline performance and reliability of a novel alternative to tandem gait for wheelchair sport athletes. Whereas sex and concussion history did not modify performance, the small difference in dual-task time yields concern over the feasibility of this task as a concussion evaluation and management tool in which upper extremity neurological assessments may be warranted.
Journal of medical Internet researchAngela Higgins, Steve Benford, Michelle Hall, Holly Blake, Kevan Murray, Praminda Caleb-Solly
BACKGROUND: Assistive technologies can support independent living among older adults, helping manage health and maintain independence, but uptake is often constrained by attitudes, confidence, and socioeconomic factors. The COVID-19 lockdowns accelerated technology use across all age groups, offering a natural experiment to examine changes in adoption. OBJECTIVE: This study aimed to examine changing patterns of technology use in older adults, to provide insight as to how service providers can support the use of technology to enhance resident independence and well-being. METHODS: Two cross-sectional surveys were conducted in United Kingdom retirement villages operated by a single housing provider, one immediately before the pandemic (2020, n=1707 across 19 sites) and one after lockdowns were lifted (2023, n=45 at one site), assessing technology confidence, device ownership, internet use, and learning pathways. Semistructured interviews with 8 participants in a technology trial scheme provided qualitative depth. Integration followed a connecting approach, with quantitative findings identifying patterns and qualitative data contextualizing them. RESULTS: Technology adoption increased significantly between 2020 and 2023, with older adults reporting greater confidence (M=2.29 to M=3.36; P<.001), higher device ownership, and increased internet use across all activities. Self-education and informal support from family or friends were the most common pathways to adoption, with 69% (31/45) of 2023 participants reporting learning from friends or family compared with 20% (44/216)-28% (416/1491) in 2020. Age-related differences in confidence observed in 2020 were no longer apparent in 2023, although gender disparities persisted across all surveys, with men reporting significantly higher confidence (P=.007, r=0.42 in 2023). No significant differences were found based on socioeconomic indicators. Qualitative findings revealed that positive technology experiences were predominantly social in nature, while health-related features such as medication reminders went largely unused. Integration of the 2 strands showed that the qualitative data expanded, confirmed, or explained the survey findings, while the gender gap remained unresolved by the qualitative strand due to the self-selected nature of the interview sample. CONCLUSIONS: Findings demonstrate that the pandemic accelerated lasting increases in technology adoption among older adults, though these changes also reflect broader societal, technological, and community-level factors. The persistent gender gap in confidence likely reflects cumulative life-course disadvantages in workplace technology exposure. Technology provision for older adults appears most effective when embedded within the social fabric of a community. These results provide evidence for housing providers and policymakers to formalize peer support pathways, introduce health-related technology through trusted social relationships, and design support that aligns with how residents are actually learning.
Disability and rehabilitationDavid Beckwée, Benjamin Filtjens, Reinhard Claeys, Chiara Lambranzi, Matthias Eggermont, Mahyar Firouzi, Louis Flynn, Jeroen Aeles, Tom Verstraten, Eva Swinnen
PURPOSE: This interdisciplinary perspective aims to identify key limitations in current Human-in-the-Loop Optimization (HILO) approaches for lower-limb exoskeletons (LLEs) and to propose a shift toward more human-centred optimization. MATERIALS AND METHODS: Drawing on literature from wearable robotics, rehabilitation science, motor learning, and clinical practice, we critically discuss three main limitations of current HILO approaches: narrow optimization scope, limited consideration of individual capabilities, and disconnection from personalized training. RESULTS: We argue that human-centered optimization should not only integrate physiotherapists' expertise but also expand their role as research partners in LLE development. Physiotherapists can contribute to adaptive control design, define user-centered outcome measures, and develop evidence-based training protocols that align human learning with technological adaptation. To support this shift, future research should prioritize: (1) using AI to interpret real-time, context-specific and user-specific data; (2) enabling physiotherapists to fine-tune device parameters based on individualized profiles; and (3) embedding structured, therapist-led training within HILO frameworks. CONCLUSION: Advancing human-centered HILO will require adaptable prototypes, multidimensional outcome measures, and sustained collaboration between engineering and rehabilitation science. This shift may help ensure that LLEs evolve into technologies that enhance mobility, autonomy, and participation in ways that are meaningful for users.
Assistive technology : the official journal of RESNACara E Masselink, Katie H Fitzgerald, Heidi Kohake, Erin Michael, Mary Shea, Jessica Presperin Pedersen, Jennith Bernstein
Power assist systems (PAS) on manual wheelchairs (MWC) aim to enable functional mobility and support the health of MWC users; however, current Medicare policy prohibits obtaining a PAS prior to one year of MWC use. Clinically, the authors have observed that when people needing a wheelchair have difficulty propelling at times in an MWC, they are likely to pursue a power wheelchair since PAS is not an option in the first year of use. Therefore, this scoping review aimed to explore the evidence related to PAS use through the lens of the International Classification of Functioning, Disability and Health framework. A total of 790 titles and abstracts were reviewed, with 26 articles included addressing mobility (n = 24), neuromuscular and movement (n = 10), cardiovascular and respiratory (n = 8), general tasks (n = 10), pain (n = 2) and mental functions (n = 2). Types of PAS represented included power assist push-rims (n = 23), rear-drive PAS (n = 4), and front-attached PAS (n = 1). Quantitative designs accounted for 23 studies, with 15 experimental designs. Overall, results positively supported the use of PAS across all environments, revealing reduced burden with propelling with proper training and support. The evidence did not support previous MWC experience as a factor in the user's ability to effectively use PAS.
Portable electromyography biofeedback (EMG-BFB) may support gait rehabilitation, but whole-gait responses across increasing portable auditory feedback goals are unclear. Twenty-four adults completed baseline treadmill walking and four counterbalanced right medial gastrocnemius activation-goal conditions set at 20%, 40%, 60%, and 80% above baseline; 23 contributed primary biomechanical data. Treadmill speed was adjusted within each condition to support achievement of the activation goal. Outcomes included walking speed, ground-reaction forces, force-time metrics, step length, temporal measures, and asymmetry. Repeated-measures MANOVA, outcome-specific repeated-measures ANOVAs, dose-response coefficients, bootstrap intervals, and leave-one-participant-out analyses were used. The combined gait-biomechanics outcomes differed significantly across activation-goal conditions (p < 0.001), with large condition effects for walking speed, propulsion, braking magnitude, and step length. From baseline to the highest goal, treadmill speed increased from 1.07 to 1.44 m/s, mean propulsion by 0.086 N/BW, braking magnitude by 0.109 N/BW, and mean step length by 0.150 m. Exploratory speed-adjusted models retained anterior-posterior and vertical loading-response associations but not peak propulsion; activation goal and achieved speed were strongly collinear. Unilateral feedback was not associated with systematic step-length or step-time asymmetry. Portable auditory EMG-BFB at increasing activation goals was accompanied by coordinated changes across gait mechanics.
Lower limb mobility impairments resulting from neurological diseases, trauma injuries or aging significantly impact the quality of life of individuals by limiting their autonomy. Rehabilitation plays an important role in addressing the challenges of these impairments, with early detection of changes in the functional state of individuals being essential. This enables therapies to be adjusted based on the current condition of the patient, thereby enhancing their effectiveness. Such early detection, however, requires continuous assessment by specialists, which is unfeasible given the existing limited resources. Since gait is a reflection of the physical and mental states of each individual, its continuous monitoring and subsequent data analysis can serve as a valuable tool for the aforementioned objective. This study proposes a methodology that, based on continuous gait monitoring data, detects significant changes in the functional state of patients who require an assistive device for walking. Given the variability that may exist among different individuals, this methodology tackles the issue from an individualized approach generating personalized models for each individual using the OC-SVM technique. The proposed methodology was validated in nine healthy people who had different simulated functional states, obtaining an accuracy in the range of 70-97%. In addition, a one-year longitudinal study was also carried out with three post-stroke individuals to validate the methodology in real cases, obtaining an average accuracy of 78%.
Applied ergonomicsYin Li, Michael B Gottschalk, Elizabeth Wyble, Katie Terry, W Hong Yeo, Hilarie S Warren
Nurses experience substantial physical demands that increase their risk of work-related musculoskeletal disorders. Assistive devices may mitigate this risk, yet their use remains inconsistent. This cross-sectional study examined physical workload and assistive device utilization among nurses. A total of 456 licensed nursing professionals in Florida who provide direct patient care were included. Participants reported moderate to high physical workload. Among the 390 participants with frequency-of-use data, 51.0% (n=199) reported frequent assistive device use. Frequent assistive device use was more common among nurses with higher physical workload. Each 10-point increase in physical workload was associated with 22% higher odds of frequent assistive device use, after adjusting for demographic and employment characteristics. Common barriers to the use of assistive devices included limited availability, time constraints, and patient discomfort. Participants expressed interest in lightweight, easy-to-use, patient-friendly devices. These findings underscore the need for organizational strategies and user-centered design to support the adoption of assistive technologies and reduce occupational injury risk among nurses.
Frontiers in public healthYanke Tong, Weihong Zeng, Pianpian Zhao
BACKGROUND: Against the backdrop of rapid digital technological advancement and the increasing diffusion of smart devices among older adults, understanding the implications of smart device for later-life well-being has become increasingly important. However, evidence remains limited on whether associations with depressive symptoms differ across types of smart devices and on the pathways linking smart device to depressive symptoms. METHODS: Using pooled cross-sectional data from the 2018 and 2020 waves of the China Longitudinal Aging Social Survey (CLASS), this study estimated the association between smart device ownership and depressive symptoms among older adults using OLS regression models, with a final analytical sample of 12,269 observations. Sensitivity analyses were conducted using fixed-effects models, a 2020 subsample analysis, instrumental variable estimation, and propensity score matching. Mediation effect tests examined potential mechanisms involving social networks, offline activity participation, and social adaptation, while subgroup analyses were used to assess heterogeneity. RESULTS: Smart device ownership was significantly associated with fewer depressive symptoms among older adults, with substantial variation across device functions and specific device types. Monitoring and assistive devices showed more consistent negative associations, whereas care devices showed the opposite pattern. This functional variation suggests that the association depends not only on whether older adults own smart devices, but also on the match between device functions and owners' needs. Social networks and social adaptation appeared to be relevant pathways, and the negative association was more evident among older adults without functional limitations. DISCUSSION: Functional differences across devices highlight the importance of aligning functions with older adults' needs when considering the mental health implications of smart device ownership. As population aging deepens, age-friendly digital inclusion policies should move beyond an access-oriented perspective and place greater emphasis on matching device functions with older adults' health needs, functional capacity, and social contexts.
International journal of environmental research and public healthSajay Arthanat, Jing Wang, Dain LaRoche, Heather Fritz, Rosanne DiZazzo-Miller, Mostafa Hussein, Ola Ghattas, Moniruzzaman Akash, Momotaz Begum
Artificial intelligence-enabled technologies offer new opportunities to support healthy aging and the long-term care needs of older adults. However, inclusive practices are paramount to ensuring that accessibility, usability, privacy, and equitable use are factored into the design and deployment of these emerging technologies. This article explores the role of co-design in health technology development and highlights the application of three methodological tools-the NIH Stage Model for Behavioral Intervention Development, the Unified Theory of Acceptance and Use of Technology, and Goal Attainment Scaling-to create a smart-home-based socially assistive robot (SAR) for the care of individuals living with Alzheimer's disease and related dementias (ADRD). Ten participants (five caregiver-care recipient dyads) from an ongoing mixed-methods pilot feasibility study trialed the SAR in their homes for 1-6 months, with the robot personalized to their daily functioning, home layout, and caregiving needs. Qualitative analysis of monthly interviews derived themes pertaining to technical design, care protocol design, training management, and complementary care. These themes, combined with goal attainment analysis, offered several insights that allowed us to iteratively scale and refine the technology tailored to ADRD care. The study offers a practical framework for future co-design efforts aimed at enhancing the adoption of AI-enabled health technologies among older adults.
Indian journal of ophthalmologyPooja Chauhan, Suraj S Senjam, Salaj Rana, Ravinder Singh, Sandeep Singh
Assistive technology (AT) can significantly enhance functional abilities among persons with disabilities. Recently, a rapid advance in computer and Internet of Things (IoT)-based AT has been observed with the integration of Artificial Intelligence. The present scoping review explores a range of IoT-based AT for vision impairments, focusing on their functioning, reliability, and identifying the existing gaps and opportunities for future enhancement. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search was conducted for the articles published between 2020 and March 2025. After the initial screening of both titles and abstracts of 705 articles, 18 full-text articles were selected for the review. It was found that the majority of the papers (38%) are related to smart canes/sticks. The findings indicate that several studies use Raspberry Pi and Arduino platform to make products cost-effective and flexible options for real-time processing. The accuracy of these devices ranges from 87.8% in navigation to 93% in voice control and 100% in object identification. Further, challenges such as usability testing, hardware limitations, dataset constraints, and environmental adaptability remain a matter of concern which need to be addressed in future innovation. Incorporating IoT technologies into vision-assistive devices has substantially improved accessibility. Future research should focus on enhancing real-time performance, AI-driven decision-making, and user-centric designs.
European journal of trauma and emergency surgery : official publication of the European Trauma SocietyZina Stensen, Annefleur Peters, Dennis Keereweer, Inge Krul, Frits van Osch, Bas de Groot, Dennis Barten
PURPOSE: Mobility scooters are increasingly used by older individuals. The aim of this study was to assess the characteristics and temporal trends of mobility scooter accidents (MSAs) in the Netherlands over a 10-year period using a representative dataset derived from fourteen Emergency Departments (EDs). METHODS: In this retrospective multicenter cohort study, we analyzed MSA-related ED visits between January 2014 and December 2023, using the Dutch Injury Surveillance System (DISS). Information about age, sex, hospital admission, type and location of injury, mechanism of injury, and operational errors was analyzed. Injury severity was classified using the maximum abbreviated injury score (MAIS). Trend analyses were only performed for ED visits of patients with MAIS2+ injuries. RESULTS: In total, 2,702 MSA-related ED visits were identified. Forty-nine percent of patients was male and the median age was 75 years (IQR 64.0-83.0). The most common mechanism of injury was a mobility scooter rollover (34.2%). From 2014 to 2023, the number of MSA-related ED visits of patients with MAIS2+ injuries increased by 38.0%. In the 70-79 age group, this rise was 91%. The total number of traumatic brain injuries (TBI) rose steeply bij 103.0%, which includes a modest (+34.0%) increase in moderate-severe TBI. The hospital admission rate was 30.1%, with a median length of stay of 7 days (IQR 3.0-10.0). Age, sex, and mechanism of injury were independent predictors for hospital admission. CONCLUSION: In the Netherlands, there was a 38.0% increase of MSA-related ED visits of patients with MAIS2+ injuries from 2014 to 2023, with a disproportionate rise in older patients. Age, sex, and mechanism of injury were independent predictors for hospital admission. The total number of TBIs rose steeply by 103.0% which includes a modest (+34.0%) increase in moderate-severe TBI. These findings suggest that targeted preventive measures are needed in order to reduce the number and severity of MSAs.
Frontiers in rehabilitation sciencesRavi Shankar, Pei Shan Tong, Emily Yee, Poo Lee Ong
BACKGROUND: Lower limb amputation (LLA) presents significant rehabilitation challenges, with patients requiring comprehensive multidisciplinary care to achieve optimal functional outcomes. Telerehabilitation using wearable sensor technology offers a promising solution to improve therapy accessibility and exercise adherence among this population. This pilot study evaluated the feasibility, usability, and preliminary effects on hip strength, and user acceptability of a home-based telerehabilitation program using the Rebee wearable sensor system for patients with major lower extremity amputation. METHODS: A prospective single-arm feasibility study was conducted at the Foot Care and Limb Design Centre, Tan Tock Seng Hospital, Singapore. Ten participants with unilateral major amputations (5 transtibial, 5 transfemoral) were enrolled. Participants performed daily home exercises using the Rebee inertial measurement unit (IMU) sensor system for 30 days, with remote monitoring and biweekly adjustments. Primary outcomes included hip extensor and abductor strength assessed using dynamometry at baseline (Week 0), Week 4, and Week 8. Secondary outcomes included quality of life (EQ-5D-5L), exercise compliance, patient satisfaction, and system usability (System Usability Scale). RESULTS: All ten participants (80% male; median age 51.5 years, IQR 11) completed the intervention. Median hip extensor strength improved significantly from 8.43 kg at baseline to 9.87 kg at Week 4 (p < 0.05) and 10.88 kg at Week 8 (p < 0.05). Median hip abductor strength increased from 8.01 to 9.45 kg (Week 4) and 9.70 kg (Week 8), with statistically significant improvements (p < 0.05). Mean exercise compliance was 68%. The mean System Usability Scale score was 75.8, indicating favorable usability. Health-related quality of life showed mixed patterns: median self-rated health (EQ-VAS) increased from 80 at baseline to 87.5 by Week 8, whereas the proportion of participants reporting problems in several EQ-5D-5L dimensions did not improve and slightly increased. No adverse events were reported. CONCLUSIONS: Home-based telerehabilitation using the Rebee wearable sensor system is feasible, safe, and acceptable for patients with lower limb amputation, with preliminary improvements in hip strength. High user satisfaction and favorable usability support its potential. However, as a single-arm pilot without a control group, findings remain preliminary and not generalizable. Future RCTs are needed to confirm effectiveness and cost-effectiveness for clinical integration.
Sensors (Basel, Switzerland)Wataru Fujita, Ryoma Tokunaga, Ai Higuchi, Tomohiro Shibata
Evaluating wearable assistive robots in real-world caregiving is challenging because temporally aligned and repeatable A/B comparisons are rarely available. Conventional evaluations assume that assist-on and assist-off trials are comparable in task content, posture, and movement timing. However, caregivers adjust their posture and timing across human-human interactions and task sequences. This study proposes a causally inspired diagnostic framework based on DBN/SCM-inspired time-series modeling and movement-fixed counterfactual estimation. We represented the multimodal observations using intervention, robot state, movement context, EMG, and context variables. Node-specific relationships were approximated using Attention-based Sparse Variational Gaussian Process regressors. We evaluated the framework at three levels of environmental complexity. These levels comprised controlled trunk flexion, partially controlled bed-to-wheelchair transfer, and real-world caregiving. The proposed framework is intended as a diagnostic counterfactual evaluation tool rather than as a method for strict causal identification. Across experiments, one-step EMG prediction accuracy alone was insufficient to identify intervention-sensitive models. In controlled validation, the selected movement-decoupled robot-only model reproduced an EMG-reducing response consistent with the controlled A/B reference. When fitted to the partially controlled transfer data, the selected structural specification identified an EMG-increasing response in supported contexts. In the real-world caregiving case study, the global assist-mediated response (AMR) was near zero despite a positive pooled A/B difference. However, the stratified analysis identified localized supported responses. The near-zero AMR indicates that the pooled difference was not reproduced through the modeled assist intervention-robot state-EMG pathway under fixed movement context. This result should not be interpreted as evidence of overall device ineffectiveness. These findings suggest that context-fixed counterfactual diagnosis can help interpret assistive responses under increasing environmental complexity.
Background: Physical activity plays a vital role in caring for people with multiple sclerosis (MS). Yet, challenges like fatigue, mobility impairment, fall risk, symptom fluctuation, and poor access to rehabilitation often make sustained participation difficult. Adhering to physical activity programmes is tough. Artificial intelligence (AI) may transform wearable, smartphone, clinical, and patient-reported data into interpretable information for monitoring, prediction and individualized support. Objective: Building on the identified need for individualized support, this scoping review mapped original AI-based studies relevant to physical activity, gait, mobility, ambulation, fatigue, fall risk, and real-world functioning in people with MS. Methods: The review followed PRISMA-ScR principles. Search covered records published from 1 January 2016 to 14 May 2026 across biomedical, rehabilitation, technology-oriented, trial registry, and citation-searching sources. Eligible studies included MS or MS-specific data, an explicit AI/ML or model-derived predictive analytics component, and an activity-related clinical domain. Results: The search identified 332 records/reports. After removing 127 duplicates, 205 records were screened, 45 full texts were assessed, and 21 original AI studies met the eligibility criteria. These addressed inertial sensor deep learning, wearable gait speed estimation, postural sway fall risk prediction, connected device prediction of fatigue and health state, smartphone-based ambulation characterization, treadmill or walkway gait classification, chair stand fall status prediction, daily life gait/turning fall prediction, fear-of-falling detection, sensor-derived fatigue prediction, mobile/wearable modelling of MS, and physical activity prediction. Conclusions: AI can extract clinically relevant patterns from gait, wearable, smartphone, connected device, clinical, and patient-reported data in MS. However, evidence does not yet show that AI-supported systems improve physical activity, adherence, fatigue burden, fall risk, quality of life, or functional independence. AI is therefore promising but early, and prospective, externally validated, human-supervised, fatigue-aware, safety-sensitive studies are needed to support clinically meaningful, patient-centred MS rehabilitation and activity planning.
Trends in hearingRonny Kurniawan Ibrahim, Kelly Miles, Lisa Maggs, Brooke Luthy, Alan Kan, Michael J Richardson, Julian Maclaren, Simon Carlile, Zachary M Smith, Joerg M Buchho…
Designing multi-sensor experiments to study interactive communication is costly, complex, and often poorly documented, particularly in terms of implementation challenges and the rationale behind decision-making. Here, we aim to demystify the process by detailing the development of a custom multi-sensor lab designed to monitor comprehensive behavioural and physiological responses during interactive communication. To illustrate the system architecture, we use an implemented paradigm as a worked example: two adults engaged in natural conversation while listening to realistic background noise scenes delivered via open Sennheiser HD-800 headphones. Multi-sensor data were collected using DPA headset microphones, Tobii Pro Glasses 3, a Vicon motion capture system (with Tobii integration), BIOPAC amplifiers (PPG, EDA, ECG, respiration, temperature), a Fitbit Sense 2 smartwatch, and six Logitech BRIO 4K ultra HD video cameras recording via Open Broadcaster Software (OBS). Due to high bandwidth demands and varying sampling rates (1 Hz to 48 kHz) among the different devices, all systems recorded independently which posed a significant synchronisation challenge. A central RME soundcard delivered trigger pulses to the Tobii, BIOPAC, OBS, and Vicon systems to mark stimulus onset/offset. Redundant synchronisation mechanisms were implemented to mitigate the risk of trigger failure and bespoke processing pipelines were developed to synchronise data streams. We share key challenges and creative solutions encountered in building such a lab, to help researchers understand and anticipate common pain points and make more informed decisions when implementing their own multi-sensor setups.
JMIR human factorsHander Wang, Jian-Jia Huang, Yu-Cheng Pei, Huey-Wen Liang
BACKGROUND: Assessing usability is important given the increasing use of technology in rehabilitation. While wearable robotic exoskeletons (WREs) are commonly incorporated into neurological rehabilitation in both clinical and community settings, there is a need to examine the applicability of different usability instruments in this context. The Assistive Technology Usability Questionnaire for People with Neurological Diseases (NATU Quest) was developed to evaluate the usability of assistive technology in individuals with neurological conditions. However, its reliability and validity have been established only for assistive devices such as wheelchairs and canes, restricting its generalizability. OBJECTIVE: This study aimed to cross-culturally adapt a Taiwan Chinese version of the NATU Quest and to preliminarily evaluate its applicability, reliability, and validity for assessing WRE use among patients who had a stroke as an expanding application context. METHODS: Cross-cultural adaptation was achieved through a structured translation from Spanish to Taiwan Chinese, followed by content validation by an expert panel of 10 raters. Following the adaptation process, psychometric testing of the NATU Quest was administered to 20 patients who had a stroke following the completion of a comprehensive course of robot-assisted gait training facilitated by a WRE. The internal consistency of the NATU Quest was evaluated using the Cronbach α coefficient. The reliability of the test-retest procedure was evaluated using the intraclass correlation coefficient (ICC). Convergent validity was ascertained by examining the correlation between the NATU Quest scores and the System Usability Scale (SUS). RESULTS: The culturally adapted NATU Quest showed acceptable content validity, with item-level content validity index (CVI) values ranging from 0.80 to 1.00 and scale-level CVI values of 0.93 for clarity and 0.97 for relevance. Cronbach α was 0.943, indicating high internal consistency. Of the 20 participants who completed all 6 rehabilitation sessions, 13 participants completed repeat testing. Preliminary test-retest reliability was acceptable (ICC=0.823; P<.001; SE of measurement=0.31). NATU Quest scores were strongly correlated with SUS scores (Spearman ρ=0.818; P<.001), providing preliminary support for convergent validity. CONCLUSIONS: The adapted NATU Quest demonstrated promising preliminary psychometric properties when applied to WRE use among individuals who had a stroke. Further studies with larger sample sizes are warranted to examine additional psychometric properties such as construct validity and responsiveness.
Annals of medicineJinglong Li, Qisen Zhu, Mohamad Nabil Mohd Noor, Chan Choong Foong
BACKGROUND: Cerebral Palsy (CP) is the main cause of motor disabilities in childhood, necessitating innovative approaches to rehabilitation and assistive technology (AT). Simultaneously, artificial intelligence (AI) is increasingly being integrated into devices to create more adaptive, personalized, and effective AT. This systematic review aimed to evaluate the effectiveness and usability of AI-powered assistive technologies designed to support daily activities and rehabilitation in children with CP. MATERIALS AND METHODS: Five databases, including Scopus, Web of Science, PubMed, Embase, and IEEE Xplore, were systematically searched, and 23 articles were included in the final analysis. Articles were identified, selected, and categorized into emerging thematic areas based on the primary function and application of the technology. RESULTS: Five key thematic topics were identified: 1) AI-driven motor rehabilitation and gait training for functional mobility; 2) intelligent assessment and monitoring systems for clinical decision support; 3) AI-supported communication, social interaction, and intention recognition tools; 4) gamified and virtual reality-based interventions to enhance engagement and usability; and 5) smart assistive systems supporting daily living and independent mobility. The findings demonstrate a strong trend toward the application of AI technologies in personalized, engaging, and data-driven interventions for children with CP. However, the field is predominantly in the proof-of-concept stage, with limitations including small sample sizes, lack of long-term clinical validation, challenges in user-centered design, and usability for children with CP. CONCLUSION: AI-powered assistive technologies hold significant potential for transforming the care of children with CP by enabling highly personalized and engaging interventions. To actualize this potential, future work must realize that practical application remains challenging owing to limited clinical validation, technological integration, and usability barriers for children with CP. Future research must prioritize user-centered design and multidisciplinary collaboration to ensure that AI and robotic advancements improve the usability and quality of life for children with CP.
Around 1.5% of the global population is suffering from speech impairments; the major causes for this are cerebral palsy and ALS, and the only way for these individuals to communicate is through Augmentative and Alternative Communication (AAC). These systems are either electronic or non-electronic. Based on new study developments, electronic methods, such as Brain-Computer Interaction (BCI) and eye-gaze-based communication, are assessed as the best choices, but they have their own limitations, incorporating limited adaptability to changing conditions, such as setup variations and user fatigue, which reduces the system's robustness. Our previous study, Netravad, shows potential for addressing these gaps, but it lacks multilingual support and will not yield the same results under changing lighting conditions. This study, Thrivaad, provides multilingual support and text prediction and integrates optimized deep learning to accurately capture eye movements even in varying environmental lighting conditions. Thrivaad uses eye movements as input from a webcam, and the Optuna-optimized YOLOv5 model is used to detect the eye direction accurately. Then communication is established in English, Malayalam, and Hindi. The text-prediction feature of this system improves communication by reducing the number of eye gestures required to form a message. This study included a total of 60 participants across three age groups with 35,263 eye-sign images collected. With this data, the YOLOv5 model is trained and then optimized by Optuna. The proposal system provides accurate eye direction, text prediction, multilingual support, and improved adaptability to changing conditions for eye-based AAC.
Medical sciences (Basel, Switzerland)Roberta Privitera, Adriana Piccolo, Carmela De Domenico, Giulia Leonardi, Angelo Alito, Angelo Quartarone, Francesca Cucinotta, Marcella Di Cara
BACKGROUND/OBJECTIVES: Minimally verbal autistic children face profound communication challenges that significantly affect daily functioning, including social interaction, behavioral regulation, and overall well-being. Identifying effective interventions is a key clinical-educational priority. This systematic review examines communication-focused interventions for these children, including both spoken language approaches and augmentative and alternative communication (AAC) strategies. METHODS: The review was registered in PROSPERO and conducted following PRISMA-S guidelines. Four electronic databases were searched, and 18 studies met the inclusion criteria. Due to heterogeneity in study designs and outcome measures, a narrative synthesis was conducted, with subgroup analyses exploring sample characteristics, intervention types, targeted outcomes, and reported effects. Methodological quality of randomized controlled trials was assessed using the Cochrane Risk of Bias tool. RESULTS: Interventions were implemented across clinical, educational, and home settings, using strategies such as Joint Attention, Symbolic Play, and Emotion Regulation, often combined with AAC technologies. Most included studies reported improvements in at least one communication outcome, although findings were heterogeneous and several studies reported mixed, subgroup-specific, or non-significant effects. The most consistent improvements were observed in spontaneous communication, particularly in interventions integrating developmental approaches with technological support. CONCLUSIONS: These findings highlight the value of individualized interventions. Future research should establish standardized definitions of "minimally verbal", assess long-term outcomes, and adopt broader measures capturing both language and social-emotional development to enhance quality of life and inclusion.
Physiotherapy theory and practiceChelsea E Macpherson, Julie Muccini, Miguel E Blacutt, Meghan Bjalme-Evans, Mary E Lough, Lori Quinn
BACKGROUND OR INTRODUCTION: Amyotrophic lateral sclerosis (ALS) causes rapid and progressive loss of ambulation resulting in immobility. A power wheelchair (PWC) increases safety, independence, and quality of life, however, the PWC referral process is lengthy and complex. When the PWC is delayed, immobility complications can occur. One barrier is the lack of a universal predictive "gait speed threshold" to help clinicians determine when to initiate the PWC referral process. OBJECTIVE OR PURPOSE: Identify a clinically relevant gait speed threshold associated with future loss of ambulation in people with ALS. METHODS: This was a retrospective chart review of a single multidisciplinary ALS Center of Excellence from July 1, 2016 - July 1, 2019 (36-months). Participants were included in this study if they were adults (age >18 years) with clinically definite ALS who were ambulatory at baseline. The primary outcome was gait speed on the 10-meter walk test. Secondary outcomes included the ALS Functional Rating Scale-Revised, forced vital capacity, falls, and ambulation status. RESULTS: Of N = 180 people with ALS identified during the study period, n = 72 met inclusion for analysis with a mean age 66.1 ± 11.9 years, 64% male, 76% with an ALS phenotype of spinal onset, and 24% bulbar onset. A gait speed threshold of 0.79 m/s maximized the combined sensitivity and specificity for classifying ambulatory status at the subsequent 6-month visit. Faster gait speeds (>1.2-1.4 m/s) were associated with greater odds of remaining ambulatory at 6-months based on Bayesian logistic regression. CONCLUSION: A gait speed threshold of 0.79 m/s was associated with increased likelihood of subsequent loss of ambulation, though modest predictive accuracy limits its use as a stand-alone indicator. Gait speed may serve as one component of clinical decision-making regarding PWC planning and referral in people with ALS. Larger multicenter studies are needed to confirm and generalize results across ALS phenotypes.
JMIR medical informaticsJohanne Mensah Gourmel, Maxime Bourgain, Maxime Galloy, Mario Veruete, Gwenaël Cornec, Sylvain Brochard, Christelle Pons, Arriel Benis
BACKGROUND: A 2019 French national online survey explored activity limitations and participation restrictions among children and youth with disabilities for which innovative solutions could help. OBJECTIVE: The primary aim of this study was to use text mining analysis to complement previous human-led qualitative research and to uncover actionable additional knowledge related to difficult life situations that innovative solutions could help address and to compare the perspectives of children and youth with disabilities, relatives, and professionals. METHODS: This study was part of Innovation for Participation, a cross-sectional online survey, including (1) closed questions about sociodemographic characteristics, (2) closed questions about life situations that induced difficulties, and (3) open questions to explore these situations in greater depth. This study used a text mining approach designed for French data to analyze answers to open-ended questions about difficulties and desired innovative solutions. The analysis process included (1) data cleansing; (2) computing and analyzing the word frequency in the answers and their cooccurrence; (3) clustering answers using K-means algorithms; (4) analyzing the cluster words to define a title for each one and identify answers that are consistent with cluster titles, thereafter defined as well-classified; and (5) evaluating internal consistency defined as the ratio of well-classified answers to the total number of answers. RESULTS: In total, 1055 responses were received, and 962 (91.2%) were included, representing 2018 open-ended answers to questions about difficult life situations for which innovative solutions could be useful. Frequency analysis highlighted the desire for action and autonomy by children and youth with disabilities and their relatives ("do" in first position, closely followed by "by themselves" in third position). "Disability" was frequently used by professionals (third position) but did not figure among the 20 most frequently used terms by other respondents. Cooccurrences with "do" revealed a deep interest in "doing sports." Answers were gathered into 14 clusters, ranging in size from 9 to 681 answers; 5 underwent a second clustering step. Internal consistency ranged from 42% to 100%. Finally, 8 clusters were related to the difficulties linked to a desire for autonomy, and 4 highlighted difficulties related to actions within a group or community. Some clusters reinforced domains that emerged in the human-led analysis. CONCLUSIONS: Analysis of 2018 open-ended answers using a text mining approach designed for French data revealed that solutions are required to facilitate autonomy and the ability to "do it by myself (or themselves)," as well as integration into group and community life. Complementary to previous human-led analysis, the results reinforced the need for solutions to facilitate mobility, transport, and sports. They additionally highlighted differences in vocabulary used between the 3 respondent groups, suggesting that professionals may need to consider the language they use when communicating with individuals and relatives.
Expert review of medical devicesDeWet Swanepoel, Caitlin Frisby, Vinay Manchaiah
INTRODUCTION: Hearing loss affects more than 1.5 billion people globally, with nearly 80% of disabling cases in low- and middle-income countries (LMICs). Despite being the most established rehabilitation technology, fewer than 10% of those in need in LMICs possess them, with rates as low as 2% across Africa and Southeast Asia. AREAS COVERED: This review synthesizes evidence on barriers to hearing aid access in LMICs, including workforce shortages, prohibitive costs and trade barriers, geographic centralization, and stigma across internalized, social, and structural dimensions, and evaluates strategies to overcome them. These include task-sharing using community health workers (CHWs), mobile health (mHealth) and tele-audiology, preset and over-the-counter (OTC) hearing aids, rechargeable devices, mHealth adherence support, and health systems policy reforms. EXPERT OPINION: Closing this gap requires a shift toward decentralized, community-based care supported by digital technologies. Evidence supports CHW-facilitated hearing aid provision with structured counseling and mHealth acclimatization support, as a feasible, effective, and acceptable rehabilitation model. Future progress depends on embedding hearing care within universal health coverage, reforming cost-inflating trade policies, and investing in implementation science to evaluate the fidelity, scalability, and sustainability of effective models. These models also apply to underserved populations in high-income countries.
International journal of public healthBarbara Catherine Wortmann, Iris de Boer, Vanessa Grand, Heiner Baur, Anja Maria Raab
OBJECTIVES: Many people with disabilities in Switzerland face exclusion, especially in mobility, work, and leisure. Assistive technologies can support participation and wellbeing, particularly when developed with user involvement. This study explored societal perspectives on inclusion through technology using a public engagement approach. METHODS: The study took place at the Swiss Abilities Fair 2024 in Lucerne. At an interactive booth, visitors tested assistive technologies like a robotic arm and a recumbent trike. They shared their views in semi-structured interviews conducted by physiotherapists and a wheelchair-using researcher. Interviews were recorded, transcribed, and analyzed using qualitative content analysis. The sample included people with and without disabilities. RESULTS: Forty-one people participated. Non-disabled participants emphasized equality and acceptance, while those with mobility impairments focused on barriers and support. Assistive technologies were seen as key to independence, though gaps in innovation, access, and affordability remain. CONCLUSION: Inclusion is a shared societal responsibility that requires awareness, participation, and adaptable solutions. While assistive technologies support independence and participation, interviewees emphasized that true inclusion also depends on affordability, access, user involvement, and broader structural change.
Journal of primary care & community healthStephanie Decker Hurt, Jithinraj Edakkanambeth Varayil, Jon E Bowman, Karen M Fischer, Darrell R Schroeder, Ivana T Croghan
ObjectiveTo evaluate patient satisfaction with the experience of using an autonomous wheelchair to transport patients in a large outpatient clinical environment.MethodsThe autonomous wheelchair pilot was approved as a feasibility pilot by the institutional committees and deemed a quality improvement project by the Institutional Review Board (IRB). A total of 409 adult patients using an autonomous wheelchair at a large academic medical center who volunteered to complete a paper survey were included. The survey was administered immediately after autonomous wheelchair use, using a cross-sectional, anonymous survey, between 15 Oct 2025 and 14 Jan 2026. Of 409 completed surveys, six were excluded because participants did not identify their endpoint for stratification purposes. Descriptive analysis included frequencies and percentages of responses.ResultsNo collisions or adverse events were observed during the pilot, and the system operated reliably within the predefined routes. Most survey respondents were first-time users (335/402 [83.3%]). A majority reported they would use the autonomous wheelchair again (341/395 [86.3%]) and would recommend it to others (364/397 [91.7%]). Overall, the experience was rated better than expected by 293 of 393 participants (74.6%). When given a choice, 271 of 379 respondents (71.5%) preferred the autonomous wheelchair over a staff-operated wheelchair.ConclusionThese findings suggest that autonomous wheelchairs are feasible and acceptable to patients in a controlled outpatient setting and support continued piloting and prospective evaluation.
Sensors (Basel, Switzerland)Leon Linder, Heiko Wagner, Klaus Peikenkamp
Air cell-based wheelchair seat cushions are widely used for pressure ulcer prevention in individuals with limited mobility. However, the influence of ambient pressure variations on the mechanical surface pressure acting on users has not been systematically investigated. This study presents a dedicated measurement concept to quantify these effects under controlled laboratory conditions. Surface pressure was quantified using a dual-range FSR sensor calibration, achieving a minimum resolution of 0.0012 N/cm2 per digit. Five representative scenarios were investigated, covering ambient pressure reductions between 30 hPa (elevator rides) and 250 hPa (aircraft takeoff). Measurements were conducted across 150 series, combining five initial internal cushion pressures and six load levels. Ambient pressure reductions led to measurable increases in surface pressure across all conditions, ranging from 11.2 ± 11.0% (30 hPa) to 62.0 ± 45.3% (250 hPa). Risk assessment based on a pressure-time cell death model revealed risk category changes in up to 66.7% of all conditions. Mean reductions in time to cell death ranged from 16 min (30 hPa) to 55 min (250 hPa), following a logarithmic relationship (adjusted R2 = 0.984). These findings highlight ambient pressure variation as a previously unrecognized influencing factor on pressure ulcer risk in wheelchair users with air cell-based seat cushions.
International journal of environmental research and public healthLibby Callaway, Natasha Layton, Phillippa Carnemolla, Lisa Licciardi, Maryam Gusheh, Em Bould
Globally, the growth of ageing populations is significant, with more people requiring supported living environments, including residential aged care (RAC). Given the influence of the environment on health outcomes, it is important to consider approaches to evaluate aged care design, including both the built environment and products and technology. With the overarching aim to identify the scope of RAC-built environment and assistive technology design interventions and the way this data is captured methodologically, this review (i) identified methods and measures used to evaluate RAC-built environment and assistive technology design, and examined populations these methods and measures were used with, and (ii) mapped identified approaches to the International Classification of Functioning, Disability and Health (ICF). An a priori review protocol was developed, and a scoping review was then conducted. Eight databases were searched for publications between January 2000 and February 2023, resulting in 81 included studies, which were then mapped to ICF activity, participation and environment domains. Twenty methods and 16 methodologies were identified. Sixty-one articles collected data directly from resident populations, primarily including older adults (n = 52). Forty-nine publications reported on the evaluation of built design, 23 reported on products and technology, and nine reported on both, but with limited inclusion of valued participation as a goal or outcome. While some participatory methods were identified, 25% of the studies did not include consumer perspectives. Analyzing aged care design can identify ways to facilitate, or remove barriers to, healthier spaces and lives in RAC. Use of internationally recognized terminology and an integrative lens on the relationship between technology and environmental design is recommended.
JMIR rehabilitation and assistive technologiesMaría Del Pilar Beristain-Colorado, Patricia Batres-Mendoza, Erick Israel Guerra-Hernández, José Luis Cano-Pérez, Christian Perezcampos-Mayoral, Marciano Varga…
BACKGROUND: Serious games have become an alternative support for traditional physical therapy. However, many of these games do not address the emotional needs of patients. People with disabilities often experience emotions such as sadness, frustration, and even anger, which can create a barrier to their rehabilitation treatment. OBJECTIVE: This review presents a comprehensive overview of technologies, techniques, and methods in affective computing as applied to serious games for physical rehabilitation and identifies key gaps to guide future research in this field. METHODS: A scoping review was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, using the databases PubMed, ScienceDirect, IEEE Xplore, ACM Digital Library, PEDro, Springer, and Google Scholar. RESULTS: The initial search yielded 5293 records, of which 9 papers met the inclusion criteria. Data were systematically extracted from these papers based on predefined research questions. Notably, engagement, tiredness, and pain were the most identified emotions, reported in 4 of 9 (50%) studies. Only 3 studies applied theoretical frameworks for emotion classification. Facial expression analysis and gesture recognition were the most frequently used affective computing techniques, yet only 2 studies implemented adaptive gameplay based on affective feedback. CONCLUSIONS: The integration of affective computing into serious games represents a promising approach for detecting affective states in patients undergoing rehabilitation. However, the limited number of primary studies, methodological limitations, and potential selection and reference-standard biases limit the reliability and generalizability of the current findings. Future research should prioritize rigorous multicenter designs, standardized evaluation protocols, and multidisciplinary collaboration. Developing these areas is essential to establishing clinical effectiveness.
Journal of neuroengineering and rehabilitationSelina Seemüller, Anne Kerstin Reimers, Benedikt Meixner, Florian Engel, Franziska Beck
BACKGROUND: The present study aimed to determine activity intensity and validate the Move4 accelerometer and derive cut-off points to accurately classify wheelchair-based physical activity (PA) in children and adolescents. METHODS: A calibration and validation study with a test-retest design was performed in 24 children and adolescents (mean age 9.9 ± 3.2 years; 50% girls) using manual wheelchairs. Participants used a manual wheelchair as their primary mode of mobility and were able propelling the wheelchair independently. Participants completed standardized activities while wearing Move4 sensors at the wrist, upper arm, and chest. In a subsample of 7 children and adolescents, energy expenditure was recorded using portable metabolic cart. Mean Amplitude Deviation (MAD) and Movement Acceleration Intensity (MAI) were processed to derive cut-off points for sedentary, light, moderate, and vigorous PA using CART models, and validity was assessed via Metabolic Equivalent (MET) and heart-rate responses. RESULTS: Both MAD and MAI values increased systematically across activity intensities, supporting good criterion validity. MET values showed progression from sedentary to vigorous tasks. Intensity-specific cut-off points were successfully established for all sensor placements, with consistently higher thresholds for MAI. Sensitivity and specificity analyses indicated the most balanced performance for the upper arm (MAD) and chest (MAI). Test-retest comparisons showed greater variability for MAD-based cut-offs, whereas MAI thresholds demonstrated higher stability, with deviations of approximately 4-5%. CONCLUSIONS: While both MAD and MAI validly reflected PA intensity, MAI showed greater temporal stability and test-retest robustness. These findings support the use of accelerometery for classifying PA in children and adolescents using wheelchairs and underscore the importance of selecting appropriate metrics and sensor positions.
Journal of Indian Prosthodontic SocietyUnnati Gedam, Uday Kiran Uppada
BACKGROUND: Loss of facial structures due to trauma, congenital anomalies, or ablative surgery induces profound psychosocial consequences that impact beyond functional impairment. While rehabilitation with advanced prosthetic materials have improved esthetics and comfort, standardized measurement of psychosocial outcomes remains limited. AIM: To assess psychosocial reintegration following maxillofacial prosthetic rehabilitation using a modified Psychosocial Impact of Assistive Devices Scale (PIADS-10) and to support the findings through a focused review of the literature. MATERIALS AND METHODS: A case series of five patients who reported with maxillofacial defects as a result of trauma and ablative surgery rehabilitated with customized orbital and ocular prosthesis were evaluated. A PIADS-10, adaptation tailored to maxillofacial prosthesis was recorded pre rehabilitation and 4 weeks postrehabilitation. The changes across competence, adaptability, and self-esteem domains were analyzed. RESULTS: The prerehabilitation PIADS scores showed substantial negative psychosocial impact particularly in self-confidence, perceived appearance, social participation, and ease of daily activities. It was observed that following prosthetic rehabilitation all the domains showed a positive shift, with greatest scores in social participation (+3), satisfaction with facial expression (+3), and overall quality of life (+3). CONCLUSION AND CLINICAL RELEVANCE: Customized maxillofacial prosthetic rehabilitation yields significant benefits as evident with the PIADS-10 noted in this study. Incorporating structured PROMs supports patient-centered care and strengthens the evidence for prosthetic interventions.
Journal of rehabilitation medicineMarthe C G Langerwerf, Karin Postma, Janneke Stolwijk-Swuste, Marga Tepper, Majanka Heijenbrok-Kal, Marcel Post, Rita J G Van den Berg-Emons, Rutger Osterthun
OBJECTIVE: Greater mobility independence after spinal cord injury is thought to lead to better long-term outcomes. However, evidence is inconclusive for ambulation compared with wheelchair dependency. This study aimed to describe and compare long-term outcomes across mobility levels in individuals with spinal cord injury. DESIGN: Cross-sectional survey. SUBJECTS: Community-dwelling individuals with spinal cord injury in the Netherlands. METHODS: Data were collected via the Dutch arm of the International Spinal Cord Injury (InSCI-NL) Survey (2018). Mobility level was assessed using the modified Spinal Cord Independence Measure-Self-Report. Long-term outcomes were compared across mobility levels, using generalised linear models. RESULTS: 253 participants were included with a mean (standard deviation) age of 58.7 (13.6) years and median [interquartile range] time since injury of 10 [5.0-22.0] years. Electric wheelchair users reported lower functional independence, and more participation problems and secondary health conditions compared with manual wheelchair users (p < 0.001). Ambulatory individuals using walking aids reported no better outcomes than manual wheelchair users, except for functional independence (p < 0.001). Ambulatory individuals without walking aids reported more paid work than those with walking aids (62.7% vs 34.3%, p < 0.001). CONCLUSION: In general, electric wheelchair users reported the least favourable long-term outcomes. Remarkably, ambulatory individuals using walking aids generally did not report better outcomes than manual wheelchair users.