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

Virtual environment navigation with look-around mode to explore new real spaces by people who are blind

Background. This paper examines the ability of people who are blind to construct a mental map and perform orientation tasks in real space by using Nintendo Wii technologies to explore virtual environments. The participant explores new spaces through haptic and auditory feedback triggered by pointing or walking in the virtual environments and later constructs a mental map, which can be used to navigate in real space. Methods. The study included 10 participants who were congenitally or adventitiously blind, divided into experimental and control groups. The research was implemented by using virtual environments exploration and orientation tasks in real spaces, using both qualitative and quantitative methods in its methodology. Results. The results show that the mode of exploration afforded to the experimental group is radically new in orientation and mobility training; as a result 60% of the experimental participants constructed mental maps that were based on map model, compared to only 30% of the control group participants. Conclusion. Using technology that enabled them to explore and to collect spatial information in a way that does not exist in real space influenced the ability of the experimental group to construct a mental map based on the map model

Self-Confidence Levels in Sequential Learning Versus Structured Discovery Cane Travel, Post Orientation and Mobility Instruction: A Comparison Study

Sequential Learning (SL), the medical model of Orientation and Mobility (O&M)was designed for blinded WWII veterans in the 1940s. This preeminent curriculum monopolized the O&M profession, creating a paradigm paralysis, until Structured Discovery Cane Travel (SDCT) made its official debut in 1997. The conceptual framework for this study is Glasser\u27s choice theory (1998) whereby ideas or systems of belief direct or oversee behavior, and this principle holds true for both O&M professionals and individuals who are blind or visually impaired (consumers). A comparison study answered the research question; that is, at what distance and frequency do consumers travel independently post-instruction and how does this differ between the two curriculums? Data was collected through a quantitative study in which 40 participants (20 SL, 20 SDCT) voluntarily responded to an electronic survey. Because of their increased frequency and distances traveled and their decreased need for additional training, study results revealed SDCT consumers’ self-confidence is higher than SL consumers by 32%. In addition, this study discovered when sighted guide instruction commences prior to introduction of the long, white cane (as in the SL curriculum); self-confidence is hindered and leads consumers toward the Custodial Paradigm. However, when instruction of the long, white cane and problem-solving is paramount (as in the SDCT curriculum); the foundation for ongoing successful O&M post-instruction is likely whereby consumers are lead toward the Independence Paradigm

Trunk motion visual feedback during walking improves dynamic balance in older adults: Assessor blinded randomized controlled trial.

BACKGROUND: Virtual reality and augmented feedback have become more prevalent as training methods to improve balance. Few reports exist on the benefits of providing trunk motion visual feedback (VFB) during treadmill walking, and most of those reports only describe within session changes. RESEARCH QUESTION: To determine whether trunk motion VFB treadmill walking would improve over-ground balance for older adults with self-reported balance problems. METHODS: 40 adults (75.8 years (SD 6.5)) with self-reported balance difficulties or a history of falling were randomized to a control or experimental group. Everyone walked on a treadmill at a comfortable speed 3×/week for 4 weeks in 2 min bouts separated by a seated rest. The control group was instructed to look at a stationary bulls-eye target while the experimental group also saw a moving cursor superimposed on the stationary bulls-eye that represented VFB of their walking trunk motion. The experimental group was instructed to keep the cursor in the center of the bulls-eye. Somatosensory (monofilaments and joint position testing) and vestibular function (canal specific clinical head impulses) was evaluated prior to intervention. Balance and mobility were tested before and after the intervention using Berg Balance Test, BESTest, mini-BESTest, and Six Minute Walk. RESULTS: There were no significant differences between groups before the intervention. The experimental group significantly improved on the BESTest (p = 0.031) and the mini-BEST (p = 0.019). The control group did not improve significantly on any measure. Individuals with more profound sensory impairments had a larger improvement on dynamic balance subtests of the BESTest. SIGNIFICANCE: Older adults with self-reported balance problems improve their dynamic balance after training using trunk motion VFB treadmill walking. Individuals with worse sensory function may benefit more from trunk motion VFB during walking than individuals with intact sensory function

Action video game play and transfer of navigation and spatial cognition skills in adolescents who are blind

For individuals who are blind, navigating independently in an unfamiliar environment represents a considerable challenge. Inspired by the rising popularity of video games, we have developed a novel approach to train navigation and spatial cognition skills in adolescents who are blind. Audio-based Environment Simulator (AbES) is a software application that allows for the virtual exploration of an existing building set in an action video game metaphor. Using this ludic-based approach to learning, we investigated the ability and efficacy of adolescents with early onset blindness to acquire spatial information gained from the exploration of a target virtual indoor environment. Following game play, participants were assessed on their ability to transfer and mentally manipulate acquired spatial information on a set of navigation tasks carried out in the real environment. Success in transfer of navigation skill performance was markedly high suggesting that interacting with AbES leads to the generation of an accurate spatial mental representation. Furthermore, there was a positive correlation between success in game play and navigation task performance. The role of virtual environments and gaming in the development of mental spatial representations is also discussed. We conclude that this game based learning approach can facilitate the transfer of spatial knowledge and further, can be used by individuals who are blind for the purposes of navigation in real-world environments

Wayfinding and Navigation for People with Disabilities Using Social Navigation Networks

To achieve safe and independent mobility, people usually depend on published information, prior experience, the knowledge of others, and/or technology to navigate unfamiliar outdoor and indoor environments. Today, due to advances in various technologies, wayfinding and navigation systems and services are commonplace and are accessible on desktop, laptop, and mobile devices. However, despite their popularity and widespread use, current wayfinding and navigation solutions often fail to address the needs of people with disabilities (PWDs). We argue that these shortcomings are primarily due to the ubiquity of the compute-centric approach adopted in these systems and services, where they do not benefit from the experience-centric approach. We propose that following a hybrid approach of combining experience-centric and compute-centric methods will overcome the shortcomings of current wayfinding and navigation solutions for PWDs

INTENTIONS TO USE TELEREHABILITATION FOR COMMUNICATION AND TREATMENT FOR VISION IMPAIRMENTS

BACKGROUND: Approximately 8.1 million people in the United States 18 and older have difficulty performing one or more daily activities because of vision impairment or blindness (Erickson, Lee, & von Schrader, 2020; Taylor, 2018). If the impairments caused by vision loss are not addressed, they can result in financial difficulties, suffering, disability, loss of productivity, and decreased quality of life (National Center for Chronic Disease Prevention and Health Promotion, 2011). Currently, in-person low vision rehabilitation services are the gold standard for teaching people how to adapt to and compensate for these deficits, however, the access and utilization of these services by people with vision impairments is poor. Telerehabilitation is one service delivery option that has been used in other settings to increase access and utilization of low vision services. This study investigated the underlying factors that are related to three stakeholder groups’ behavioral intention to use telerehabilitation as a low vision rehabilitation service delivery option. METHODS: This pilot study utilized an anonymous pre-validated online survey to collect data from people with vision impairments, eye care professionals, and vision rehabilitation professionals. Participants were recruited by email or through social media. RESULTS: Fifty-two people participated in the survey – 12 males (23%) and 40 females (77%). Participants’ ages ranged from 21 to 79 years of age (M = 45.2, SD = 12.6). Twenty-two people with vision impairments (42%) participated in the survey, followed by 21 (40%) vision rehabilitation professionals, and nine (17%) eye care professionals. Most of the participants reported feeling very comfortable with using computers (85%), mobile devices (85%), and videoconferencing software (64%). More than half of the sample reported being very skilled using computers (70%), mobile devices (76%), and videoconferencing programs (59%). All participants, except for one, reported using a computer for at least 1 year. Twenty-one participants – 3 people with vision impairments, 3 eye care professionals, and 15 vision rehabilitation professionals - reported having used telerehabilitation. Twenty participants (43%) reported having the behavioral intention to use telerehabilitation in the future while 17 participants (36%) stated that they planned on using telerehabilitation in their daily lives. For this study’s adapted and extended UTAUT model, small effect size relationships were noted between behavioral intention and performance expectancy (r = .295), and behavioral intention and resistance to change (r = .254). Age, gender, and experience were not found to be confounding variables between the predictor variables and behavioral intention. The people with vision impairment group was noted to have small effect sizes for the relationships between behavioral intention and performance expectancy (r = .218), and effort expectancy (r = .271), and technology anxiety (r = -.321). Age, gender, or experience were not found to act as confounding variables in these relationships. Eye care professionals had a moderate effect size for the relationship between behavioral intention and performance expectancy (r = .414) which appeared to be confounded by gender (r = .830) and experience (r = .671). They also had a small effect size relationship between behavioral intention and technology anxiety (r = .213) which appeared to be confounded by experience (r = .515). Gender and experience were also noted to be confounding variables for the relationship between behavioral intention and resistance to change. Age, gender, or experience were not found to act as confounding variables in these relationships. For the vision rehabilitation group, there was only one small effect size found for the relationship between behavioral intention and resistance to change (r = .243) which was noted to be confounded by experience (r = .463). CONCLUSIONS: The use of telerehabilitation as a low vision service delivery option is still a new area of inquiry. This study was the first to explore the underlying factors of three stakeholder groups’ behavioral intention to use telerehabilitation as a service delivery option. Most of the participants with vision impairments reported not having difficulty accessing traditional in-person low vision rehabilitation services, or not planning on using telerehabilitation services in the future. These findings were contrary to assertions made by previous literature (Lam and Leat, 2013; Hoque and Sorwar, 2017). Eye care professionals also reported being very comfortable and skilled with various technologies, but were more open to change and accepting of new technologies, like telerehabilitation. Therefore, eye care professionals’ behavioral intention to use telerehabilitation in the future was higher than the other two groups. The vision rehabilitation group was similar to the eye care professional group in the behavioral intention to use telerehabilitation, and similar to the people with vision impairments group in their high level of resistance to change. Like the people with vision impairments group, the vision rehabilitation professional group appeared to be satisfied with the in-person low vision rehabilitation services that are already being delivered, and may not recognize the need for another service delivery option at this time. This study provides preliminary information that can be used in future studies that seek to understand why different stakeholder groups choose to accept and plan to use telerehabilitation. Once this information is better understood, researchers can build upon this information to increase the actual use of telerehabilitation among all three stakeholder groups. Limitations of this study that impact the interpretation of this study’s results and generalizability to a broader population are poor response rates, single survey response method, stringent inclusion criteria, and accessibility issues. Recommendations for future studies consist of addressing the study’s limitations as well as the intrinsic and extrinsic factors of each stakeholder group’s behavioral intention to use telerehabilitation. Overall, this study adds to the body of knowledge in the areas of telerehabilitation and low vision rehabilitation

Effects of sensory cueing in virtual motor rehabilitation. A review.

Objectives To critically identify studies that evaluate the effects of cueing in virtual motor rehabilitation in patients having different neurological disorders and to make recommendations for future studies. Methods Data from MEDLINE®, IEEExplore, Science Direct, Cochrane library and Web of Science was searched until February 2015. We included studies that investigate the effects of cueing in virtual motor rehabilitation related to interventions for upper or lower extremities using auditory, visual, and tactile cues on motor performance in non-immersive, semi-immersive, or fully immersive virtual environments. These studies compared virtual cueing with an alternative or no intervention. Results Ten studies with a total number of 153 patients were included in the review. All of them refer to the impact of cueing in virtual motor rehabilitation, regardless of the pathological condition. After selecting the articles, the following variables were extracted: year of publication, sample size, study design, type of cueing, intervention procedures, outcome measures, and main findings. The outcome evaluation was done at baseline and end of the treatment in most of the studies. All of studies except one showed improvements in some or all outcomes after intervention, or, in some cases, in favor of the virtual rehabilitation group compared to the control group. Conclusions Virtual cueing seems to be a promising approach to improve motor learning, providing a channel for non-pharmacological therapeutic intervention in different neurological disorders. However, further studies using larger and more homogeneous groups of patients are required to confirm these findings

Teaching the Blind to Find Their Way by Playing Video Games

Computer based video games are receiving great interest as a means to learn and acquire new skills. As a novel approach to teaching navigation skills in the blind, we have developed Audio-based Environment Simulator (AbES); a virtual reality environment set within the context of a video game metaphor. Despite the fact that participants were naïve to the overall purpose of the software, we found that early blind users were able to acquire relevant information regarding the spatial layout of a previously unfamiliar building using audio based cues alone. This was confirmed by a series of behavioral performance tests designed to assess the transfer of acquired spatial information to a large-scale, real-world indoor navigation task. Furthermore, learning the spatial layout through a goal directed gaming strategy allowed for the mental manipulation of spatial information as evidenced by enhanced navigation performance when compared to an explicit route learning strategy. We conclude that the immersive and highly interactive nature of the software greatly engages the blind user to actively explore the virtual environment. This in turn generates an accurate sense of a large-scale three-dimensional space and facilitates the learning and transfer of navigation skills to the physical world