A Context-Aware Application to Increase Elderly Users Compliance with Physical Rehabilitation Exercises at Home via Animatronic Biofeedback

Shoulder Musculoskeletal Disorder Rehabilitation Using a Robotic Device Based on Electromyography (EMG) Biofeedback: A Retrospective Cohort Study

Background and Objectives: While shoulder injuries represent the musculoskeletal disorders (MSDs) most encountered in physical therapy, there is no consensus on their management. In attempts to provide standardized and personalized treatment, a robotic-assisted device combined with EMG biofeedback specifically dedicated to shoulder MSDs was developed. This study aimed to determine the efficacy of an 8-week rehabilitation program (3 sessions a week) using a robotic-assisted device combined with EMG biofeedback (RA-EMG group) in comparison with a conventional program (CONV group) in patients presenting with shoulder MSDs. Materials and Methods: This study is a retrospective cohort study including data from 2010 to 2013 on patients initially involved in a physical rehabilitation program in a private clinic in Chicoutimi (Canada) for shoulder MSDs. Shoulder flexion strength and range of motion were collected before and after the rehabilitation program. Forty-four patients participated in a conventional program using dumbbells (CONV group), while 73 completed a program on a robot-assisted device with EMG and visual biofeedback (RA-EMG group); both programs consisted of two sets of 20 repetitions at 60% of maximal capacity. Results: We showed that the RA-EMG had significantly greater benefits than the CONV group for shoulder flexion strength (4.45 [2.6;6.15] kg vs. 2.3 [0.90;4.775] kg, U = 761, p = 0.013) and for normalized strength (77.5 [51.3;119.1] % vs. 39.1 [16.6;89.2] %, U = 755, p = 0.016). In addition, the RA-EMG group showed a trend to greater absolute gain of ROM than the CONV group (10.0 [0;24.3] degrees vs. 5.5 [0;12.0] degrees, U = 1931, p = 0.067), and a greater benefit in normalized ROM was observed for the RA-EMG (7.4. [0;17.7] %) than the CONV group (4.6 [0;10.8], U = 1907, p = 0.046). Conclusions: The current retrospective cohort study showed that a specific and tailored 8-week rehabilitation program with constant effort by automatic adjustment of the level of resistance by EMG feedback induced greater benefits for shoulder flexion strength and a trend to improve range of motion compared to conventional rehabilitation in patients with shoulder MSDs. Future research should be pursued to determine the added potential of this approach for abduction and external rotation with a randomized controlled design.

"Life has always been physical physical, now visual": an explorative study on the use of digital health technologies to promote physiotherapy home treatment programs among older people

BACKGROUND

There has been a recent rise in the use of technology for health promotional practices, which have begun to gain popularity among physiotherapists but not much research has been conducted to explore its many opportunities and challenges among older adults in developing countries.

OBJECTIVES

To explore Nigerian-based Physiotherapists' perspectives on how digital health technologies (DHT) can be utilized to promote physiotherapy home treatment programs among Nigerian older people.

METHODS

This is a one-on-one semi-structured interview of 12 geriatric physiotherapists (7 Male, 5 female) virtually in the Teams Meeting platform. Data generated were analyzed thematically using the latest version of NVivo software.

RESULTS

Three overarching themes were conceptualized including the usage of DHT in Nigeria, challenges to DHT application, and strategies to improve DHT usage. These described a low awareness and usage of DHT despite its recognized need and advantages for promoting home program. The forms of DHT commonly being used are mostly mobile-based through calls or texts, which could be due to barriers to the use of DHT including older people's declining cognition, poverty, and low interest in technology. Some external problems included the physiotherapists' attachment to hands-on practice and low commitment from the informal caregivers.

CONCLUSIONS

These findings suggested ways to utilize the DHT in promoting physiotherapy home treatment programs among older people by encouraging technological innovations and raising awareness among physiotherapists, while the physiotherapists need to patiently educate both the older people and involve their informal caregivers.

Advancing clinical understanding of surface electromyography biofeedback: bridging research, teaching, and commercial applications

INTRODUCTION

Expanding the use of surface electromyography-biofeedback (EMG-BF) devices in different therapeutic settings highlights the gradually evolving role of visualizing muscle activity in the rehabilitation process. This review evaluates their concepts, uses, and trends, combining evidence-based research.

AREAS COVERED

This review dissects the anatomy of EMG-BF systems, emphasizing their transformative integration with machine-learning (ML) and deep-learning (DL) paradigms. Advances such as the application of sophisticated DL architectures for high-density EMG data interpretation, optimization techniques for heightened DL model performance, and the fusion of EMG with electroencephalogram (EEG) signals have been spotlighted for enhancing biomechanical analyses in rehabilitation. The literature survey also categorizes EMG-BF devices based on functionality and clinical usage, supported by insights from commercial sectors.

EXPERT OPINION

The current landscape of EMG-BF is rapidly evolving, chiefly propelled by innovations in artificial intelligence (AI). The incorporation of ML and DL into EMG-BF systems augments their accuracy, reliability, and scope, marking a leap in patient care. Despite challenges in model interpretability and signal noise, ongoing research promises to address these complexities, refining biofeedback modalities. The integration of AI not only predicts patient-specific recovery timelines but also tailors therapeutic interventions, heralding a new era of personalized medicine in rehabilitation and emotional detection.

Effects of a Gamified Agent-Based System for Personalized Elderly Care: Pilot Usability Study

BACKGROUND

The global percentage of older people has increased significantly over the last decades. Information and communication technologies have become essential to develop and motivate them to pursue healthier ways of living. This paper examines a personalized coaching health care service designed to maintain living conditions and active aging among older people. Among the technologies the service includes, we highlight the use of both gamification and cognitive assistant technologies designed to support older people and an application combining a cognitive virtual assistant to directly interact with the older person and provide feedback on their current health condition and several gamification techniques to motivate the older person to stay engaged with the application and pursuit of healthier daily habits.

OBJECTIVE

This pilot study aimed to investigate the feasibility and usability of a gamified agent-based system for older people and obtain preliminary results on the effectiveness of the intervention regarding physical activity health outcomes.

METHODS

The study was designed as an intervention study comparing pre- and posttest results. The proposed gamified agent-based system was used by 12 participants over 7 days (1 week), and step count data were collected with access to the Google Fit application programming interface. Step count data after the intervention were compared with average step count data before the intervention (average daily values over a period of 4 weeks before the intervention). A　1-tailed Student t test was used to determine the relationship between the dependent and independent variables. Usability was measured using the System Usability Scale questionnaire, which was answered by 8 of the 12 participants in the study.

RESULTS

The posttest results showed significant pre- to posttest changes (P=.30; 1-tailed Student t test) with a moderate effect size (Cohen d=0.65). The application obtained an average usability score of 78.

CONCLUSIONS

The presented pilot was validated, showing the positive health effects of using gamification techniques and a virtual cognitive assistant. Additionally, usability metrics considered for this study confirmed high adherence and interest from most participants in the pilot.

Age-specific biomechanical challenges and engagement in dynamic balance training with robotic or virtual real-time visual feedback

Challenging balance training that targets age-related neuromuscular and motor coordination deficits is needed for effective fall prevention therapy. Goal-directed training can provide intrinsically motivating balance activities but may not equally challenge balance for all age groups. Therefore, the purpose of this research was to quantify age-specific effects of dynamic balance training with real-time visual feedback. Kinematics, muscle activity, and user perceptions were collected for forty healthy adults (20 younger, 18-39 years; 20 older, 58-74 years), who performed a single balance training session with or without real-time visual feedback. Feedback involved controlling either a physical mobile robot or screen-based virtual ball through a course with standing tilt motions from an instrumented wobble board. Dynamic balance training was more challenging for older compared to younger adults, as measured by significantly higher dorsiflexor and knee extensor muscle activity and ankle co-contractions (50%-80%, p<0.05). Older participants also performed more motion while training without feedback compared to younger adults (22%-65%, p<0.05). Robotic and virtual real-time visual feedback elicited similar biomechanical adaptations in older adults, reducing motions to similar levels as younger adults and increasing ankle co-contractions (p<0.05). Despite higher muscular demand, perceived physical exertion and high enjoyment levels (Intrinsic Motivation Inventory >0.80) were consistent across groups. However, robotic visual feedback may be more challenging than virtual feedback based on more frequent balance corrections, lower perceived competence, and lower game scores for older compared to younger adults. These findings collectively support the feedback system's potential to provide engaging and challenging at-home balance training across the lifespan.

Balance Therapy With Hands-Free Mobile Robotic Feedback for At-Home Training Across the Lifespan

Providing aging adults with engaging, at-home balance therapy is essential to promote long-term adherence to unsupervised training and to foster independence. We developed a portable interactive balance training system that provides real-world visual cues on balance performance using wobble board tilt angles to control the speed of a robotic car platform in a three-dimensional environment. The goal of this study was to validate this mobile balance therapy system for home use across the lifespan. Twenty younger (18-39 years) and nineteen older (58-74 years) healthy adults performed balance training with and without visual feedback while standing on a wobble board instrumented with a consumer-grade inertial measurement unit (IMU) and optical motion tracking markers. Participants performed feedback trials based on either the robotic car's movements or a commercially-available virtual game. Wobble board tilt measurements were highly correlated between IMU and optical measurement systems ( [Formula: see text]), with high agreement in outcome metrics ( [Formula: see text]) and small bias ( [Formula: see text]). Both measurement systems identified similar aging, feedback, and stance type effects including (1) altered movement control when older adults performed tilting trials with either robotic or virtual feedback compared to without feedback, (2) two-fold greater wobble board oscillations in older vs. younger adults during steady standing, (3) no difference in board oscillations during steady standing in narrow vs. wide double support, and (4) greater wobble board oscillations for single compared to double support. These findings demonstrate the feasibility of implementing goal-directed robotic balance training with mobile tracking of balance performance in home environments.

Designing Personalized Persuasive Game Elements for Older Adults in Health Apps

The use of gamification elements in health apps has been shown to promote healthy behaviors. However, one-size-fits-all gamification strategy does not have the best persuasive effect. Therefore, the aim of this paper was to determine how to select personalized game elements for older adults and use them in health education app design. Firstly, based on the DMC model, the Kano model was used to identify the demand attributes of game mechanisms, and three gamification mechanisms (winning, feedback and reward) preferred by the elderly were selected. Secondly, the corresponding gamification elements were selected by the focus group method, and nine virtual products were generated. Thirdly, the virtual products were rated and conjointly analyzed to obtain the relative importance of gamification mechanisms and the utility values of gamification elements, and a comparative analysis was conducted on four characteristics of older adults: age, gender, personal income, and education. The results obtained the best combination of gamification elements chosen by the elderly under different classifications. Finally, design guidelines on persuasive gamification elements were developed based on the characteristics of older adults, and a modified gamification model was proposed. The results of this study provide suggestions and guidelines for the design of persuasive gamification in health education apps, which will help improve the satisfaction of older adults with health apps.

Effectiveness of therapeutic electromyographic biofeedback after orthopedic knee surgeries: a systematic review

PURPOSE

To present an evidence-based overview of the current utilization and the effectiveness of therapeutic Electromyographic Biofeedback (EMG-BF) in rehabilitation after orthopedic knee surgeries.

MATERIALS AND METHODS

This systematic review was conducted according to the PRISMA statement. MEDLINE (PubMed), PEDro, The Cochrane Library, and Web of Science databases were searched from their inception to June 20, 2020.

RESULTS

Eight RCTs investigating effectiveness of the EMG-BF in rehabilitation after orthopedic knee surgeries were identified. The quality scores for included studies ranged from 6 to 8 on PEDro Scale. Most of the included studies reported that EMG-BF was more effective compared to home exercises, standard rehabilitation program or electrical stimulation for improving quadriceps strength or activation. Besides, EMG-BF was revealed positive results in functional assessments except gait velocity and IKDC. Only two studies reported knee ROMs were significantly improved in favour of EMG-BF.

CONCLUSIONS

This systematic review shows that EMG-BF seems to control pain and improve quadriceps femoris strength and functionality. However, the results are inconclusive regarding knee ROMs. Although available high-quality evidence is limited, EMG-BF might be a part of the rehabilitation after knee surgeries.Implications for rehabilitationThis paper reviews the effectiveness of the therapeutic EMG-BF as a potential option in rehabilitation after orthopedic knee surgeries.It is recommended EMG-BF can be used to control pain and to improve quadriceps strength and function.There is insufficient evidence to support EMG-BF to improve the range of motion.

A Review of Smart Design Based on Interactive Experience in Building Systems

Smart building is the result of the penetration of information technology and control technology into traditional buildings, and is the future development direction of buildings. User-centric building smart design can achieve a sustainable life, and smart technology integration based on smart design can support sustainable development and improve user satisfaction, happiness, and overall quality of life. In intelligent design, researchers focus on the “people-oriented” approach, designed to bring users the ultimate interactive experience. Based on the interactive experience principle of smart design in the smart building system, this article classifies and summarizes intelligent design from the “five senses” interaction, including visual interaction, voice interaction, tactile interaction, cognitive interaction, and emotional interaction. We analyze the application of smart design in architecture and discuss how to embody the principles of user-centered interactive experience design in the process of smart design. This article provides a comprehensive and systematic literature review, clarifies the importance of the “people-oriented” approach in the smart design of buildings, and summarizes how to improve the sustainability of intelligent buildings from the perspective of a “people-oriented” approach. This paper proposes future research suggestions and directions and promotes the sustainable development of the smart building.

Enabling Older Adults' Health Self-Management through Self-Report and Visualization-A Systematic Literature Review

Aging is associated with a progressive decline in health, resulting in increased medical care and costs. Mobile technology may facilitate health self-management, thus increasing the quality of care and reducing costs. Although the development of technology offers opportunities in monitoring the health of older adults, it is not clear whether these technologies allow older adults to manage their health data themselves. This paper presents a review of the literature on mobile health technologies for older adults, focusing on whether these technologies enable the visualization of monitored data and the self-reporting of additional information by the older adults. The systematic search considered studies published between 2009 and 2019 in five online databases. We screened 609 articles and identified 95 that met our inclusion and exclusion criteria. Smartphones and tablets are the most frequently reported technology for older adults to enter additional data to the one that is monitored automatically. The recorded information is displayed on the monitoring device and screens of external devices such as computers. Future designs of mobile health technology should allow older users to enter additional information and visualize data; this could enable them to understand their own data as well as improve their experience with technology.

Feasibility of the Archercise biofeedback device to strengthen foot musculature

Background

Foot muscle weakness can produce foot deformity, pain and disability. Toe flexor and foot arch exercises focused on intrinsic foot muscle strength and functional control may mitigate the progression of foot deformity and disability. Ensuring correct exercise technique is challenging due to the specificity of muscle activation required to complete some foot exercises. Biofeedback has been used to improve adherence, muscle activity and movement patterns. We investigated the feasibility of using a novel medical device, known as “Archercise”, to provide real-time biofeedback of correct arch movement via pressure change in an inflatable bladder, and foot location adherence via sensors embedded in a footplate during four-foot exercises.

Methods

Thirty adults (63% female, aged 23–68 years) performed four-foot exercises twice on the Archercise sensor footplate alone and then with biofeedback. One-way repeated measures ANOVA with pairwise comparisons were computed to assess the consistency of the exercise protocol between trial 1 and trial 2 (prior to biofeedback), and the effectiveness of the Archercise biofeedback device between trial 2 and trial 3 (with biofeedback). Outcome measures were: Arch movement exercises of arch elevation and lowering speed, controlled arch elevation, controlled arch lowering, endurance of arch elevation; Foot location adherence was determined by percentage of time the great toe, fifth toe and heel contacted footplate sensors during testing and were analysed with paired sample t-tests. Participant survey comments on the use of Archercise with biofeedback were reported thematically.

Results

Seventeen (89%) arch movement and foot location variables were collected consistently with Archercise during the foot exercises. Archercise with biofeedback improved foot location adherence for all exercises (p = 0.003–0.008), coefficient of determination for controlled arch elevation (p < 0.0001) and endurance area ratio (p = 0.001). Twenty-nine (97%) participants reported Archercise with biofeedback, helped correct exercise performance.

Conclusions

Archercise is a feasible biofeedback device to assist healthy participants without foot pathologies perform foot doming exercises.

Trial registration

Australian New Zealand Clinical Trials Registry (ANZCTR): 12616001559404. Registered 11 November 2016, http://www.ANZCTR.org.au/ACTRN12616001559404p.aspx

Connected Elbow Exoskeleton System for Rehabilitation Training Based on Virtual Reality and Context-Aware

Traditional physiotherapy rehabilitation systems are evolving into more advanced systems based on exoskeleton systems and Virtual Reality (VR) environments that enhance and improve rehabilitation techniques and physical exercise. In addition, due to current connected systems and paradigms such as the Internet of Things (IoT) or Ambient Intelligent (AmI) systems, it is possible to design and develop advanced, effective, and low-cost medical tools that patients may have in their homes. This article presents a low-cost exoskeleton for the elbow that is connected to a Context-Aware architecture and thanks to a VR system the patient can perform rehabilitation exercises in an interactive way. The integration of virtual reality technology in rehabilitation exercises provides an intensive, repetitive and task-oriented capacity to improve patient motivation and reduce work on medical professionals. One of the system highlights is the intelligent ability to generate new exercises, monitor the exercises performed by users in search of progress or possible problems and the dynamic modification of the exercises characteristics. The platform also allows the incorporation of commercial medical sensors capable of collecting valuable information for greater accuracy in the diagnosis and evolution of patients. A case study with real patients with promising results has been carried out.

A systematic review of gamification in e-Health

Gamification is a relatively new trend that focuses on applying game mechanics to non-game contexts in order to engage audiences and to inject a little fun into mundane activities besides generating motivational and cognitive benefits. While many fields such as Business, Marketing and e-Learning have taken advantage of the potential of gamification, the digital healthcare domain has also started to exploit this emerging trend. This paper aims to summarize the current knowledge regarding gamified e-Health applications. A systematic literature review was therefore conducted to explore the various gamification strategies employed in e-Health and to address the benefits and the pitfalls of this emerging discipline. A total of 46 studies from multiple sources were then considered and thoroughly investigated. The results show that the majority of the papers selected reported gamification and serious gaming in health and wellness contexts related specifically to chronic disease rehabilitation, physical activity and mental health. Although gamification in e-Health has attracted a great deal of attention during the last few years, there is still a dearth of valid empirical evidence in this field. Moreover, most of the e-Health applications and serious games investigated have been proven to yield solely short-term engagement through extrinsic rewards. For gamification to reach its full potential, it is therefore necessary to build e-Health solutions on well-founded theories that exploit the core experience and psychological effects of game mechanics.