Advances in Wireless Technologies and Telecommunication

Purpose of the research We propose a framework on how to implement exergames in the rehabilitation process. Major findings An increasing body of research is showing that exergames improve balance, motor dexterity, and cognitive functions. People suffering from stroke, Parkinson’s disease, multiple sclerosis, dementia, and many other neurological conditions may benefit from exergames. Similar to other rehabilitation strategies, playing exergames enhances neuroplasticity and facilitates functional recovery in individuals with neurological disabilities. Alongside pharmacological treatments, rehabilitation interventions, including exergames, are essential in neurological diseases to achieve functional restoration, promote independence, enhance quality of life, and prevent secondary complications. Conclusions Exergames are an emerging tool in the field of digital rehabilitation. They provide fun, engaging, and effective interventions for adaptive physical and cognitive training. The integration of exergames into a comprehensive neurorehabilitation program has stepped up considerably following the first COVID-19 pandemic wave that led to widespread disruptions in healthcare systems.

Background Assistive Technology (AT) helps individuals with multiple sclerosis (MS) to overcome limitations and enhance their social engagement by providing support in areas that would otherwise be difficult or unachievable. Objective The aim of this study is to determine the level of AT usage among individuals with MS and to address various questions related to the sociological implications of (non)use of AT devices, (un)awareness, and logistical barriers that prevent the full utilization of AT devices in the daily activities. Method 121 participants with previously diagnosed MS (26 AT users, 95 non-users), aged 18–65, were surveyed using a modified The Rapid Assistive Technology Assessment tool (rATA) covering: demographics, needs, supply, financing, satisfaction, and recommendations. Results Totally 21.5% of MS individuals used AT, dominantly mobility devices. Insecurity prevents desirable usage of AT devices. Affordability is a factor relevant for the device ownership. Both MS individuals and society lacked sufficient AT informedness. Conclusion Based on the results and current guidelines, it’s essential to improve policies, supplying, AT device enhancements, and education to fully utilize AT’s potential in people with MS.

Background People with intellectual disability and severe visual impairment or blindness tend to have low levels of functional activity engagement and low levels of mobility/ambulation. Objective The study assessed a new technology-aided program to support four adults with intellectual disability and blindness in their activity and mobility engagement. Methods The program was implemented following single-case research methodology. The activity consisted of completing object kits. The objects needed for the kits were distributed over a relatively large space and the participants moved around that space to collect them and distribute them in the kits. The program (a) was based on the use of a smartphone, tags with radio frequency identification codes, and a tag reader linked to the smartphone, and (b) ensured that the participants would receive physical support, verbal instructions, and preferred stimulation. Results During the baseline phase (without the program), the participants were unable to engage in activity and mobility. During the intervention (using the program), all participants managed to engage in activity and mobility correctly completing the object kits available during the sessions. Conclusions The results suggest that the program might be useful to support activity and mobility in people like the participants of this study.

Background Over the last 15 years, inclusive education has been formally established in Serbia as a mandatory approach for all students, ensuring equal rights and access to education without discrimination on any grounds. In addition to mainstream schools, Serbia also has special schools for students with developmental challenges and disabilities. Although some special schools in Serbia have been functioning as resource centers (RCs) for a long time now, 13 RCs have only recently been officially established, aiming to support inclusive education through assistive technology (AT) among other things. Objective The research reported in this study was conducted within a project that aims to address challenges in implementing and improving inclusive education in the Republic of Serbia, focusing on the existing capacities and difficulties in how RCs provide AT services to mainstream schools to offer a set of recommendations to inform the development of RCs in the country. Method A SWOT analysis involving 80 respondents was conducted. Fifty-three respondents completed a questionnaire online, while further 27 respondents participated in five focus groups. Groups involved experts working in the RCs, suppliers and manufacturers of AT, parents of persons with disabilities, and expert associates from mainstream schools. The data was analyzed using a SWOT framework. Results The respondents reported that human capacities (e.g., motivation and experience) were the main strength. Weaknesses included lack of specific and modern knowledge about working with children with different conditions, as well as specific knowledge about the AT itself. Intersectoral cooperation was pointed out as the main opportunity, while obstacles were recognized in almost all work segments (lack of finances, lack of staff, lack of adequate legal regulations and communication and cooperation). Conclusion Based on the results achieved, potential solutions for overcoming the existing obstacles in resource centers were proposed.

Background Sensory impairments, such as visual impairment, deafblindness, deaf or hard of hearing (DHH), muteness, and Sensory Processing Disorder, present significant challenges for students in higher education. These challenges include difficulties in accessing information, participating in discussions, and adapting to academic environments. Objective This review aims to explore advancements in assistive technology that support sensory-impaired individuals in higher education and identify existing gaps in accessibility, usability, and educator preparedness, aligning with (UNSDG) (United Nations Sustainable Development Goals) 4’s goal of inclusive lifelong education by 2030. Methods We conducted a systematic literature review of 68 studies focussing on technological solutions such as assistive devices, adaptive learning platforms, and communication tools designed to enhance accessibility and inclusion in academic settings. Results While various assistive technologies have improved access, disparities in resource availability across institutions persist. Many educators lack adequate training to effectively integrate these technologies, and infrastructure limitations further hinder their use. Conclusions The findings underscore the need for further research to address accessibility gaps and improve educator training. By enhancing the adoption of assistive technologies, higher education institutions can create more inclusive learning environments, ensuring equal opportunities for all students, regardless of sensory impairments.

Objectives This study evaluated intra-rater (IR), test-retest reliability (TR), and concurrent validity of 10-m walk test (10mWT), a timed motor function test (TMFT) using video- (VBO) and online-based (OBO) observation with direct observation (DO). Methods Seventy five (n = 75) middle school going typically developing children performed repeated sessions of 10mWT to determine validity and reliability of VBO and OBO with DO. IR and TR reliability were calculated using the intraclass correlation coefficient (ICC). The correlation between sessions of VBO, OBO methods, and DO method were evaluated to estimate the concurrent validity. Results Good IR and TR reliability of VBO and OBO methods were observed (IR: ICC = 0.90 [VBO], 0.78 [OBO]; TR: 0.84 [VBO], 0.85 [OBO]). Correlations between VBO (rs = 0.86; p<0.001) and OBO (rs = 0.85; p<0.001) methods with DO method demonstrated good concurrent validity. Conclusions VBO and OBO methods can be used in clinical settings where DO method is not feasible.

Background Extended reality (XR) has previously been used to train control of upper limb prostheses. It is however unclear what characteristics an XR environment should have in order to become a usable and effective training tool. Objective The objective was to develop a framework describing the most important factors to be incorporated when designing an XR environment to train prosthesis control. Methods A mixed method approach was used. A narrative review was conducted to explore factors that should be considered when designing an XR environment for prosthesis control. Subsequently, a preliminary framework, based on these factors, was rated by prosthesis users and therapists and discussed during focus groups. Results Fifty out of 489 articles were included. The preliminary framework comprised 62 factors in four domains: feedback, control, exercise and environment. Five prosthesis users and eight therapists participated in three focus groups. A final framework was developed which contained 46 factors in the four domains. End-users considered all domains to be equally important, since domains and factors influence each other. Conclusions The developed framework can be used to guide the design of an XR environment to train prosthesis control.

Background The eye-tracking-based communication systems open up opportunities for interaction in the lives of many patients with severe motor impairments. In these systems, users need to focus their gaze on a key until it is fully entered. However, these systems are not truly refined in terms of design and interaction efficiency, and they may still cause discomfort for users, such as eye strain or typing errors. Some solutions have been proposed to address this issue, but so far, no comprehensive solution has been found. Objective In this research, we have proposed a novel method to adjust data inputting speed in human-computer interfaces controlled by eye gaze and electroencephalography (EEG) data. Methods It combines EEG data to extract the user’s attention level. We then flexibly adjust the time users need to keep their gaze on a key on the system and personalize the user experience using their own data. This approach aims to enhance interaction efficiency by increasing interaction speed while maintaining accuracy. We evaluated this method on an eye-tracking-based spelling communication system for Vietnamese people, proposed by our team, involving 20 healthy individuals and 4 people with motor function impairments. Results The results indicated that communication speed through the system increased by 20–80% for participants, and not only did the time improve, but the communication effectiveness also increased linearly. This outcome was achieved for both healthy individuals and patients. Conclusions Through experimentation, we have demonstrated the feasibility and effectiveness of our approach, showing improvements in typing speed over successive trials. This result is highly meaningful as it optimizes dwell time and interaction efficiency in the ET-based system without having to compromise by increasing the error rate when directly reducing dwell time.

Background Controlling a myoelectric arm prosthesis after amputation is a skill that is difficult to master and requires extensive training since muscles need to be activated in a specific manner. One novel type of training places the prosthesis user in a virtual reality environment (VRE) to train; however, it is not yet clear if skill transfer occurs from the training to actual prosthesis use. Objective The aim of the current study is to examine skill transfer of VRE training. Methods A total of 20 able-bodied participants were divided into two training groups. One group trained with a newly developed VRE system and the other trained using a prosthesis simulator. Both groups performed five training sessions in a pre-test/post-test design where functional control, motivation and perceived workload were measured. Results The results showed that both groups improved from pre-test to post-test on functional control and motivation but not on the workload. Interestingly, almost no differences in improvements between groups were found indicating that there was no difference in effectiveness between training methods. Conclusion Based on these results, we can conclude that we found skill transfer of VRE training. Therefore, VRE training is an effective training method for arm prosthesis control and has valuable potential for implementation in a rehabilitation setting.

Background Technology-based aphasia rehabilitation has witnessed steep growth over the past decades with the availability of several commercial apps. While such apps facilitate the intensity of rehabilitation, certain limitations including low multi-language capabilities and/or task-customization (for client-specific needs) result in lower uptake in multilingual countries like India. Aim We describe the development and pilot-testing of the Smartphone- assisted Language Training (SaLT) app – a new application for both mono- and multilingual people with aphasia that facilitates cross-lingual and cross-national sharing of intervention resources. Methods SaLT is a novel, clinician-prescribed, android-based therapy application for mono- and multilingual people with aphasia (SaLT-Home). It can be personalized and customized for individual clients through the clinician-operated web application (SaLT-SLP). Further, it permits asynchronous remote monitoring of therapy progress and sharing of therapy resources with other clinicians across the globe. We present details of the development and structure of the app. We also present pilot testing with four multilingual people with aphasia who undertook clinician-delivered therapy and SaLT-based home therapy. The clinician uploaded personalized tasks and training materials for practice into the SaLT app. Participants with aphasia and their caregivers were asked to practice tasks at home. The focus of this study was not on effectiveness but rather on usage and feasibility. We collected both quantitative and qualitative data regarding the use of the app. After the intervention, participants rated the user experience using the User Mobile Rating Scale. Outcomes & Results Three of the four participants with aphasia across two different languages were motivated to practice and used SaLT-Home. These participants were generally positive about the app. They provided useful insights regarding training in the use of app-delivered therapy, the transition to independent use of such apps and need for support during practice. Conclusions The SaLT application, with its customization and multi-language capabilities, hopes to redefine technology-based intervention in aphasia. Further, it provides the scope for collating and sharing therapy resources by clinicians around the world which could foster the rehabilitation of aphasia, globally. The data from pilot testing also provide insights into the prescription and use of mobile-based home therapy applications which is of general applicability to app-based therapy. The results of this study suggest that future exploration of the use of SaLT is warranted in experimentally controlled treatment studies.

BACKGROUND While it has been broadly agreed that there is a need for consolidated information about assistive technology, previous attempts have not been sufficient for detailed consumer demands. OBJECTIVE Researchers sought consumer feedback to determine what should be included in a comprehensive, accessible database of AT. METHODS We conducted focus groups with different stakeholder groups (people with diverse disabilities, practitioners, and circles of support). We used a framework analysis to map participant responses to the research questions using focus group transcripts and notes. RESULTS AT users are looking for quick access to certain information such as the cost versus benefit, reliability, funding, and compatibility. They expect to find this in a variety of formats (video, audio, text) with a collaborative element (reviews and recommendations) from other users. CONCLUSIONS In an AT product database, users want the option to search by activity rather than only disability category, as disability can fluctuate. Accessibility of the database is key, with people preferring modifiable and flexible formats for both adding and consuming information. A community of practice will foster the connections people require to confirm their decisions prior to purchase.

BACKGROUND Non-verbal persons with intellectual disabilities (ID) may suffer from pain or discomfort, but caregivers may not notice this because of the communication difficulties. Previously, we conducted a study in which professional caregivers used heart rate (HR) monitoring to identify situations that cause acute pain or distress in the everyday life of non-verbal persons with ID. OBJECTIVE To explore professional caregivers’ experience with using HR monitors to better understand non-verbal persons with ID. METHODS Fifteen professional caregivers and 30 final-year students of social education were recruited as informants based on their experience with HR monitoring in non-verbal persons. The informants were interviewed, and they responded to a questionnaire with open-ended questions. The qualitative data were analysed thematically. RESULTS Caregivers reported that HR monitoring provided information about acute pain, acute or prolonged distress, occurrence of epileptic seizures, and the non-verbal persons’ preferences and dislikes. HR data had to be interpreted contextually to be meaningful. Some informants found HR monitoring time-consuming or the interpretation of HR data challenging due to multiple possible causes of increased HR. CONCLUSIONS Caregivers experience HR monitoring as a potentially important source of information that may help them better understand non-verbal persons with ID.

BACKGROUND A better understanding of the relationship between eye movements required for reading and central visual field loss may facilitate the design of more effective personalized visual rehabilitation programs to improve access to information and quality of life. OBJECTIVE To determine the impact of central vision loss due to maculopathy on the oculomotor skills required for reading and tasks of varying complexity, eye-tracking technology was used. METHODS Case-control study. Participants were 17 cases (61.7 years (SD [Formula: see text] 8.8), 12 females and 5 males) and 17 controls, matched for age and sex. Three computer-based tests were administered, analyzing eye fixations, saccadic movements, and visual search, measured with a 60 Hz eye-tracking device. RESULTS Central vision loss due to maculopathy increases the number of fixations and saccadic movements, indicating more instability in and out of the region of interest. Visual search required more fixations (16.2 [Formula: see text] 10.2 vs. 6.7 [Formula: see text] 1.9), more saccades (11.7 [Formula: see text] 6.4 vs. 3.3 [Formula: see text] 1.9), longer latency (701.3 [Formula: see text] 191.4 ms vs. 315.9 [Formula: see text] 56.0 ms), and longer time to find the target (113.1 [Formula: see text] 76.6 s vs. 18.5 [Formula: see text] 10.1 s). All comparisons between the two groups showed a statistically significant difference ([Formula: see text] 0.05). CONCLUSIONS The results revealed the significant impact of central vision loss due to maculopathy on reading by increasing patterns of eye fixations, saccadic movements, and visual search strategies, as measured by eye-tracking technology. This technology may have high potential to improve the assessment and rehabilitation of people with maculopathy, and this may become key information for designing personalized interventions to improve the quality of life and autonomy of individuals with central vision loss.

BACKGROUND Studies reveal healthcare disparities for people with disabilities (PwD) due to various barriers. Digital health offers promise but raises concerns about the digital divide. To address that, health Information and Communication Technologies (ICTs) should follow inclusive design principles for accessibility to all, including PwD. OBJECTIVE We examine the design of ICTs in healthcare to address the needs of people with disabilities. Three research questions guide the study: (i) how health technologies contribute to healthcare accessibility and inclusion; (ii) what the main challenges are in implementing these technologies; (iii) how health ICTs are structured to meet users’ limitations and enhance performance. METHODS Research questions are addressed through a scoping review and critical literature analysis, drawing from seven databases and grey literature. The analysis of research question (iii) uses the accessibility fundamentals recommended by the Web Accessibility Initiative as starting point. RESULTS Our research reveals a predominant focus on the elderly, with cognitive impairment as the most studied limitation, followed by mobility, reach and dexterity, vision, and hearing. CONCLUSIONS We emphasize the need for inclusive design for all health technologies and investigate their potential to improve user and healthcare system performance. We also propose four promising research directions for further investigation.

BACKGROUND Work-related musculoskeletal disorders are common among care professionals in elderly care. Exoskeletons showed effectiveness in preventing and reducing low back pain in other sectors. However, the potential of using an exoskeleton in elderly care is unclear. OBJECTIVE To document the experiences of care professionals using an exoskeleton in elderly care. METHODS A descriptive qualitative study with individual semi-structured interviews among professionals from two elderly care institutes, facing low back pain. RESULTS Twenty-two care professionals used the exoskeleton mainly at peak loads during morning and evening care. Their experiences were described in four main themes: wearing and adjusting, movement and comfort, appearance, integration into work, and perceived effects. Those who experienced (predominantly) positive effects reported having less or even no back pain, partly due to the relief of the lower back, but also to a more conscious posture and attention to ergonomically sound movement. CONCLUSIONS This study led to valuable insights into experiences of using an exoskeleton in elderly care, such as the potential of mitigating and preventing low back pain, and suggestions for further development of exoskeletons to improve their usability in the context of elderly care. The latter should be followed by studies into long-term effects.