How a Diverse Research Ecosystem Has Generated New Rehabilitation Technologies: Review of NIDILRR’s Rehabilitation Engineering Research Centers

Over 50 million United States citizens (1 in 6 people in the US) have a developmental, acquired, or degenerative disability. The average US citizen can expect to live 20% of his or her life with a disability. Rehabilitation technologies play a major role in improving the quality of life for people with a disability, yet widespread and highly challenging needs remain. Within the US, a major effort aimed at the creation and evaluation of rehabilitation technology has been the Rehabilitation Engineering Research Centers (RERCs) sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research. As envisioned at their conception by a panel of the National Academy of Science in 1970, these centers were intended to take a “total approach to rehabilitation”, combining medicine, engineering, and related science, to improve the quality of life of individuals with a disability. Here, we review the scope, achievements, and ongoing projects of an unbiased sample of 19 currently active or recently terminated RERCs. Specifically, for each center, we briefly explain the needs it targets, summarize key historical advances, identify emerging innovations, and consider future directions. Our assessment from this review is that the RERC program indeed involves a multidisciplinary approach, with 36 professional fields involved, although 70% of research and development staff are in engineering fields, 23% in clinical fields, and only 7% in basic science fields; significantly, 11% of the professional staff have a disability related to their research. We observe that the RERC program has substantially diversified the scope of its work since the 1970’s, addressing more types of disabilities using more technologies, and, in particular, often now focusing on information technologies. RERC work also now often views users as integrated into an interdependent society through technologies that both people with and without disabilities co-use (such as the internet, wireless communication, and architecture). In addition, RERC research has evolved to view users as able at improving outcomes through learning, exercise, and plasticity (rather than being static), which can be optimally timed. We provide examples of rehabilitation technology innovation produced by the RERCs that illustrate this increasingly diversifying scope and evolving perspective. We conclude by discussing growth opportunities and possible future directions of the RERC program

A Bespoke Kinect Stepping Exergame for Improving Physical and Cognitive Function in Older People: A Pilot Study

Background: Systematic review evidence has shown that step training reduces the number of falls in older people by half. This study investigated the feasibility and effectiveness of a bespoke Kinect stepping exergame in an unsupervised home-based setting. Materials and methods: An uncontrolled pilot trial was conducted in 12 community-dwelling older adults (mean age 79.3 ± 8.7 years, 10 females). The stepping game comprised rapid stepping, attention, and response inhibition. Participants were recommended to exercise unsupervised at home for a minimum of three 20-minute sessions per week over the 12-week study period. The outcome measures were choice stepping reaction time (CSRT) (main outcome measure), standing balance, gait speed, five-time sit-to-stand (STS), timed up and go (TUG) performance, and neuropsychological function (attention: letter-digit and executive function:Stroop tests) assessed at baseline, 4 weeks, 8 weeks, and trial end (12 weeks). Results: Ten participants (83%) completed the trial and reassessments. A median 8.2 20-minute sessions were completed and no adverse events were reported. Across the trial period, participants showed significant improvements in CSRT (11%), TUG (13%), gait speed (29%), standing balance (7%), and STS (24%) performance (all P < 0.05). There were also nonsignificant, but meaningful, improvements for the letter-digit (13%) and Stroop tests (15%). Conclusions: This study found that a bespoke Kinect step training program was safe and feasible for older people to undertake unsupervised at home and led to improvements in stepping, standing balance, gait speed, and mobility. The home-based step training program could therefore be included in exercise programs designed to prevent falls

A Bespoke Kinect Stepping Exergame for Improving Physical and Cognitive Function in Older People: A Pilot Study

© 2016 Mary Ann Liebert, Inc. Background: Systematic review evidence has shown that step training reduces the number of falls in older people by half. This study investigated the feasibility and effectiveness of a bespoke Kinect stepping exergame in an unsupervised home-based setting. Materials and Methods: An uncontrolled pilot trial was conducted in 12 community-dwelling older adults (mean age 79.3 ± 8.7 years, 10 females). The stepping game comprised rapid stepping, attention, and response inhibition. Participants were recommended to exercise unsupervised at home for a minimum of three 20-minute sessions per week over the 12-week study period. The outcome measures were choice stepping reaction time (CSRT) (main outcome measure), standing balance, gait speed, five-time sit-to-stand (STS), timed up and go (TUG) performance, and neuropsychological function (attention: letter-digit and executive function:Stroop tests) assessed at baseline, 4 weeks, 8 weeks, and trial end (12 weeks). Results: Ten participants (83%) completed the trial and reassessments. A median 8.2 20-minute sessions were completed and no adverse events were reported. Across the trial period, participants showed significant improvements in CSRT (11%), TUG (13%), gait speed (29%), standing balance (7%), and STS (24%) performance (all P < 0.05). There were also nonsignificant, but meaningful, improvements for the letter-digit (13%) and Stroop tests (15%). Conclusions: This study found that a bespoke Kinect step training program was safe and feasible for older people to undertake unsupervised at home and led to improvements in stepping, standing balance, gait speed, and mobility. The home-based step training program could therefore be included in exercise programs designed to prevent falls

The use of mHealth solutions in active and healthy ageing promotion: an explorative scoping review

The global population aged 60 years and over is expected to almost double between 2015 and 2050 from 12.0% to 22.0%, which will directly impact countries' labor market composition and increase the economic pressure on their healthcare systems. One way to address these challenges is to promote Active and Healthy Ageing (AHA) using mobile Health (mHealth). This research aims to provide an initial overview of the width and the depth of contemporary preventive mHealth solutions that promote AHA among healthy, independent older adults (individuals aged 60 years and over). To do so, an explorative scoping review was applied to search online databases for recent studies (March 2015 - March 2020) addressing the promotion of mHealth solutions targeting healthy and independent older adults. We identified 31 publications that met the inclusion criteria. Most of them utilized either mobile (n=25) and/or wearable (n=11) devices. mHealth solutions mostly promoted AHA by targeting older adults’ active lifestyles or independence. Most of the studies (n=27) did not apply a theoretical framework on which the mHealth promotion was based. User-experience was positive (n=12) when the solution was easy to use but negative (n=11) when the participants were resistant or faced challenges using the device and/or technology. The review concludes that mHealth offers the opportunity to combat the issues faced by an unhealthy and dependent aging population by promoting AHA through focusing on older adults’ Lifestyle, Daily functioning, and Participation. Future research should use multidisciplinary integrated approaches and strong theoretical and methodological foundations to investigate mHealth solutions' impact on AHA behavioral change

DESIGN WITH EMOTION: IMPROVING WEB SEARCH EXPERIENCE FOR OLDER ADULTS

Research indicates that older adults search for information all together about 15% less than younger adults prior to making decisions. Prior research findings associated such behavior mainly with age-related cognitive difficulties. However, recent studies indicate that emotion is linked to influence search decision quality. This research approaches questions about why older adults search less and how this search behavior could be improved. The research is motivated by the broader issues of older users\u27 search behavior, while focusing on the emotional usability of search engine user interfaces. Therefore, this research attempts to accomplish the following three objectives: a) to explore the usage of low level design elements as emotion manipulation tools b) to seamlessly integrate these design elements into currently existing search engine interfaces, and finally c) to evaluate the impact of emotional design elements on search performance and user satisfaction. To achieve these objectives, two usability studies were conducted. The aim of the first study was to explore emotion induction capabilities of colors, shapes, and combination of both. The study was required to determine if the proposed design elements have strong mood induction capabilities. The results demonstrated that low level design elements such as color and shape have high visceral effects that could be used as potentially viable alternatives to induce the emotional states of users without the users having knowledge of their presence. The purpose of the second study was to evaluate alternative search engine user interfaces, derived from this research, for search thoroughness and user preference. In general, search based performance variables showed that participants searched more thoroughly using interface types that integrate angular shape features. In addition, user preference variables also indicated that participants seemed to enjoy search tasks using search engine interfaces that used color/shape combinations. Overall, the results indicated that seamless integration of low level emotional design elements into currently existing search engine interfaces could potentially improve web search experience

Tablet-based Self-management Intervention for Diabetes Mellitus Type II Patients: Usability and Efficacy of The ASSISTwell Tool

Background: The usefulness of technology and the powerful capabilities of technological applications have led to a significantly increased interest in finding novel approaches to support older adults’ self-management. Self-management technological applications have been used in various contexts, and usability is key in sustainability and adoption of such technologies. Objective: The purpose of this research is to assess the usability of the ASSISTwell application in an older adult population with Diabetes Type II (DMII) and explore whether the application can effectively enhance DMII patients’ self-management. Design: Qualitative interviews, Observation, and Quasi-experimental design. Methods: Semi-structured interviews, observation, documentation, and quantitative standardized measures were used in this study. A purposive sample of 24 elderly patients with DMII was recruited for the study. Descriptive and inferential analysis were used to analyze the quantitative data. Simple content analysis was used to organize the emerging usability themes. Results: User feedback from the four-week user intervention demonstrated good usability of the ASSISTwell application. After using the ASSISTwell for 30 days, there was significant improvement in the perceived diabetes self-management skills of the intervention group (difference in mean PDSMS (F (1, 20) =5.11, p=0.035). Furthermore, those who used ASSISTwell (mean= 30.22, SD= 6.34) had higher PDSMS scores than those who received usual care without ASSISTwell (mean= 23.95, SD= 7.12). There was no significant difference in mean blood glucose levels (F (1, 20) =0.37, p=0.54) between the two groups. Those who used ASSISTwell (M=178, SD=40) had lower blood glucose levels than those who received usual care without ASSISTwell (M=185, SD=49), but the difference is not statistically significant. Conclusions: The novel ASSISTwell application presented in this paper helped participants improve their diabetes self-management skills. A well-designed application with new features has the ability to provide more promising results regarding improving perceived diabetes self-management skills. Also, examining usability is an essential step in application development to ensure that the application\u27s features match users\u27 expectations and needs and minimize the likelihood of user errors and difficulties using the system

Addressing the Health Needs of an Aging America: New Opportunities for Evidence-Based Policy Solutions

This report systematically maps research findings to policy proposals intended to improve the health of the elderly. The study identified promising evidence-based policies, like those supporting prevention and care coordination, as well as areas where the research evidence is strong but policy activity is low, such as patient self-management and palliative care. Future work of the Stern Center will focus on these topics as well as long-term care financing, the health care workforce, and the role of family caregivers

Designing Effective Interfaces for Older Users

The thesis examines the factors that need to be considered in order to undertake successful design of user interfaces for older users. The literature on aging is surveyed for age related changes that are of relevance to interface design. The findings from the literature review are extended and placed in a human context using observational studies of older people and their supporters as these older people attempted to learn about and use computers. These findings are then applied in three case studies of interface design and product development for older users. These case studies are reported and examined in depth. For each case study results are presented on the acceptance of the final product by older people. These results show that, for each case study, the interfaces used led to products that the older people evaluating them rated as unusually suitable to their needs as older users. The relationship between the case studies and the overall research aims is then examined in a discussion of the research methodology. In the case studies there is an evolving approach used in developing the interface designs. This approach includes intensive contribution by older people to the shaping of the interface design. This approach is analyzed and is presented as an approach to designing user interfaces for older people. It was found that a number of non-standard techniques were useful in order to maximize the benefit from the involvement of the older contributors and to ensure their ethical treatment. These techniques and the rationale behind them are described. Finally the interface design approach that emerged has strong links to the approach used by the UTOPIA team based at the university of Dundee. The extent to which the thesis provides support for the UTOPIA approach is discussed