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.
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.
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.
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.
Studies in health technology and informaticsAndre W Kushniruk, Elizabeth M Borycki
In this paper we describe the development and subsequent use of a Smart Home Laboratory for health informatics education. The laboratory was designed to allow for the design and evaluation of a range of technologies that can be used to improve patient well-being and independence in home environments. The deployment of sensor-based technologies and development of use cases is being explored in the laboratory. We are exploring how the lab can be used to enhance health informatics education. Illustrative case examples are described of how the Smart Home Laboratory has been used for educational purposes to date. The paper also describes current and future research for educational and teaching applications of the laboratory, for teaching about the usability of devices and their integration for living safely at home. AI and robotic applications for the home environment are also being explored. A special focus of the work is to design, and provide training for deployment of technologies. Implications for future work and the need for innovative education in this area are explored.
Studies in health technology and informaticsArshia Khan, Hana Kabir
BACKGROUND: Addressing neuropsychiatric symptoms in Alzheimer's Disease and Related Dementias (ADRD) requires scalable, non-pharmacological interventions. This study evaluated the user experience and clinical efficacy of a humanoid Socially Assistive Robot (SAR) in an ADRD care setting. METHODS: A randomized, 8-week, baseline-controlled intervention was conducted (N=19), utilizing each participant's pre-intervention status as the control. Outcomes included acute mood change, sustained depressive symptoms via the Geriatric Depression Scale (GDS), and user acceptance via the User Experience Questionnaire (UEQ). RESULTS: The SAR achieved "Excellent" UEQ ratings (x > 2.0) across all dimensions, indicating high accessibility and engagement. Analysis revealed a significant acute positive mood boost (p < 0.001) and a sustained reduction in GDS scores over 8 weeks compared to baseline. A strong correlation existed between robotic stimulation and clinical GDS improvement (p < 0.01). CONCLUSION: Humanoid SARs are highly accepted and efficacious adjunctive tools for improving emotional health in ADRD populations, supporting their integration into formal dementia care protocols.
Studies in health technology and informaticsKymberlynn C Lee, Andre W Kushniruk, Elizabeth M Borycki
This paper describes a scoping review that explored the use and usability of wearable devices in assistive living with a focus on barriers to the real-world use of this technology in the home for the elderly. Published research was reviewed from the databases: PubMed, CINAHL, IEEE Xplore, and Web of Science. Using Arksey's et al.'s scoping review methodology relevant studies were identified, resulting in 37 reviewed for thematic analysis. The thematic analysis resulted in specific themes to barriers and facilitators in usability. Themes include privacy and security, technical challenges, providing a sense of safety and continued independence, and knowing connection to support is available if required. Wearable technology can positively contribute to elder care but a number of key issues and barriers remain.
Zhongguo gu shang = China journal of orthopaedics and traumatologyShutao Zhang, Cheng Chen, Zhongmin Shi
Foot and ankle assistive devices are a type of external apparatus that improves functional impairment or structural abnormalities of the lower limbs through biomechanics. They act on ankle and musculoskeletal system of foot through customized or standardized structural designs, aiming to alleviate patients' pain, improve gait stability, and delay progression of disease. At present, there are a wide variety of foot and ankle assistive devices in China, but their application in the field is not sufficient. Their main function still remains at long-term immobilization. For diseases such as abnormal lower limb muscle strength after stroke, congenital clubfoot, and congenital flatfoot, there are already various innovative assistive devices that could play a corrective role and improve the lower limb activity function of patients. In recent years, 3D printing technology has been able to achieve both "static" and "dynamic" correction functions, meeting the evolving process of orthopedic diseases. Meanwhile, the intelligent sensing and real-time feedback system could use algorithms to monitor abnormal gait or pressure distribution in the foot in real time, and adjust the supporting force of the auxiliary device. Based on this, through an overview of common classifications of ankle-foot assistive devices currently available, and by reviewing and summarizing the latest clinical research progress of ankle-foot assistive devices, it is hoped to provide ideas for clinical application.
Arthrogenic muscle inhibition (AMI), neurophysiological suppression of voluntary quadriceps activation triggered by joint effusion and inflammation, is consistently initiated within hours of any form of knee surgery. If not actively counteracted during the first two postoperative weeks, AMI may drive a cascade of neuromuscular, morphological, and biomechanical deficits that can persist for years, substantially increasing the risk of post-traumatic osteoarthritis, reinjury, and long-term functional disability. Emerging evidence indicates that preoperative patient-related factors, including baseline quadriceps strength, age, body mass index, and physical fitness, further modulate the rehabilitation response and should be considered in planning early postoperative protocols. This narrative review, which was not designed as a systematic review or meta-analysis and therefore does not include formal quality assessment or pooled statistical analysis, evaluates evidence for seven early-phase (0-2 weeks postoperative) knee muscle activation interventions: neuromuscular electrical stimulation (NMES), isometric quadriceps exercise, blood flow restriction (BFR) training, electromyographic (EMG) biofeedback, open and closed kinetic chain (OKC/CKC) exercise, cryotherapy, and continuous passive motion (CPM). Findings are synthesized against six clinically relevant dimensions, safety in the 0-2 week window, home-based usability, capacity to overcome AMI, requirement for volitional effort, objective monitoring capability, and progressive resistance, to characterize a consistent pattern: no single existing modality simultaneously meets all combined requirements for home deployment, volitional engagement, objective monitoring, and progressive resistance from postoperative day one. This collective unmet need provides direction for future device development and clinical research.
Sensors (Basel, Switzerland)Bilie Hu, Peishen Gao, Yan Liu, Xi Xia, Guoping Huo
Traditional white canes offer a limited perception range, whereas end-to-end visual models face challenges in real-time deployment on edge devices. To address these limitations, this paper proposes a lightweight real-time assistive system that integrates geometric topology reconstruction with state-adaptive warning logic. The system utilizes YOLOv9 to extract discrete semantic primitives of tactile paving. It constructs a dual-branch perception framework based on Median Absolute Deviation and the Minimum Spanning Tree algorithm to analyze the topological structure of tactile paving. For complex intersections characterized by warning indicators, a one-dimensional connectivity clustering algorithm based on longitudinal topology is proposed. It generates accurate macroscopic feasible directional prompts under field-of-view boundary constraints. Additionally, a hierarchical scheduling framework dynamically orchestrates scenario-specific finite state machines to enable continuous dynamic interaction across typical high-risk scenarios. Evaluated on a custom real-world dataset, the system achieves a 95.21% frame-level comprehensive accuracy for straight-path deviation correction and intersection directional prompting. Dynamic temporal stress tests confirm the temporal stability and logical coherence of state transitions. Furthermore, latency evaluations demonstrate the logic layer's minimal computational overhead, proving its theoretical feasibility for real-time edge deployment. This approach provides an effective, low-latency solution for delivering directional prompts and hazard warnings to visually impaired users.
Frontiers in public healthVicente Martín Moreno, Elena Pérez Rico, Amanda Martín Fernández, Jorge Hurtado Gallar, Irene Sánchez González, Elena Sánchez Rodríguez, María Inmaculada Martí…
INTRODUCTION: The Barthel index has designed to assess functional capacity to perform basic activities of daily living. This study analyzes the association between each of these activities and community living, the use of mobility aids, and various socioeconomic factors, as well as survival associated with each activity at 5 years. METHODS: Study conducted between 2020 and 2025 in the functionally dependent population (Barthel ≤60) of the Orcasitas neighborhood in Madrid (Spain). A total of 127 people participated, with a mean age of 86 ± 6.3 years. Barthel index activities were classified into three groups, and the relationship between community living and the use of mobility aids with the level of dependency and survival was analyzed. RESULTS: One in four people in this cohort was dependent for activities included in group 2 (dressing-undressing, grooming, bathing), but only one in ten was dependent for activities in group 1 (walking independently, chair-to-bed transfers, going up-down stairs, and toilet use) and group 3 (feeding or maintaining bladder and bowel control). Dependence on others on feeding, toilet use, chair-to-bed transfers, and bathing, as well as fecal incontinence, were associated with the need to live with other people. Chair-to-bed transfers, up-down stairs, and urinary incontinence were associated with living homebound. Feeding, toileting, bathing, dressing-undressing, and urinary or fecal incontinence were associated with the need for a hired caregiver. Only bathing was not associated with the use of mobility aids. The activities that showed the strongest association with mortality risk were using the toilet, dressing-undressing, and chair-to-bed transfers. CONCLUSION: Dependence on others to perform each of the activities on the Barthel index follows a different pattern with respect to the interrelationships established with dependence on other activities and the personal and social adaptations that this dependence imposes. These characteristics must take account when designing population studies and planning social and health care services.
IEEE transactions on neural systems and rehabilitation engineering : a publication of the IEEE Engineering in Medicine and Biology SocietyMonika K Buczak, Joseph Brignone, W Caden Hamrick, Kiley M Cole, Mark B Bromberg, Haohan Zhang, Jacob A George
Neck weakness limits head control and quality of life for individuals with Amyotrophic Lateral Sclerosis (ALS). The Utah Neck Exoskeleton can restore neck motion, but current control methods-joystick and gaze tracking-have limited accessibility and reliability. These preliminary offline analyses investigate neck electromyography (EMG) as an alternative control modality from ALS patients. EMG signals were recorded from four male participants with ALS while performing neck flexion/extension, axial rotation, and lateral deviation. The resulting dataset was used to train convolutional neural networks (CNNs) per patient to classify either head position or movement direction from EMG features offline. Position classification significantly outperformed direction classification, with a mean accuracy of 82.5% $\pm ~0.010$ across participants. Performance was consistent when controlling one, two, or all three neck degrees of freedom. A subset of participants with sufficient residual motor function also completed neck movements while talking or chewing. Classification accuracy decreased during talking and chewing, although these effects were not statistically significant. Importantly however, training CNNs with diverse data that included periods of talking and chewing improved algorithm robustness across all conditions. These findings suggest that neck EMG signals can reliably predict intended head movements in ALS, even in the presence of weak and often confounding muscle activity. Offline accuracy and real-time computational speed suggest the approach is feasible for future online user-in-the-loop studies. Altogether, this pilot work advances EMG-based assistive technology for individuals with severe motor impairments, laying the groundwork for clinically viable, intuitive control systems.