Embodiment of Wearable Technology: Qualitative Longitudinal Study

Factors influencing E-pharmacy adoption in India: A study of user experiences through interpretative phenomenological analysis

The rapid growth of e-commerce has led to the emergence of e-pharmacies, which enable consumers to purchase prescription medications online. This study aims to explore the factors influencing the adoption of e-pharmacies in India through an interpretative phenomenological analysis (IPA) approach. Twelve in-depth interviews were conducted with individuals who had experience ordering prescription medicines through e-pharmacies. The findings revealed that constructs from the UTAUT2 model, including performance expectancy, effort expectancy, social influence, facilitating conditions, price value, and habit, played a significant role in the adoption of e-pharmacies. Construct hedonic motivation, from UTAUT2, was found to be weakly significant in explaining the adoption of e-pharmacy. Additionally, health literacy was identified as a key factor, with e-pharmacy users demonstrating higher levels of health literacy. However, perceived risks, such as performance, financial, privacy, and psychological risks, were found to negatively influence the adoption of e-pharmacies. The study proposes, based on findings, a research model to understand consumer behavior in the adoption of e-pharmacies. The findings suggest that the presence of favorable conditions, such as convenience, accessibility, user-friendly interfaces, social influence, internet accessibility, integrated healthcare services, diverse payment methods, and price advantages, have contributed to the widespread acceptance and adoption of e-pharmacy services in India. The study highlights the need for future research to employ quantitative or mixed methods approaches to address the limitations of the current exploratory study and to investigate the multifaceted determinants of e-pharmacy adoption in different geographical contexts.

Restoration of natural somatic sensations to the amputees: finding the right combination of neurostimulation methods

Limb amputation results in such devastating consequences as loss of motor and sensory functions and phantom limb pain (PLP). Neurostimulation-based approaches have been developed to treat this condition, which provide artificial somatosensory feedback such as peripheral nerve stimulation (PNS), spinal cord stimulation (SCS), and transcutaneous electrical nerve stimulation (TENS). Yet, the effectiveness of different neurostimulation methods has been rarely tested in the same participants. Meanwhile, such tests would help to select the most effective method or a combination of methods and could contribute to the development of multisensory limb prostheses. In this study, two transhumeral amputees were implanted with stimulating electrodes placed in the medial nerve and over the spinal cord epidurally. PNS and SCS were tested in each participant as approaches to enable tactile and proprioceptive sensations and suppress PLP. Both PNS and SCS induced sensation in different parts of the phantom hand, which correlated with cortical responses detected with electroencephalographic (EEG) recordings. The sensations produced by PNS more often felt natural compared to those produced by SCS. Еvoked response potentials (ERPs) were more lateralized and adapted faster for PNS compared to SCS. In the tasks performed with the bionic hand, neurostimulation-induced sensations enabled discrimination of object size. As the participants practiced with neurostimulation, they improved on the object-size discrimination task and their sensations became more natural. А combination of PNS and TENS enabled sensations that utilized both tactile and proprioceptive information. This combination was effective to convey the perception of object softness. In addition to enabling sensations, neurostimulation led to a decrease in PLP.

Clinical trial registration

https://clinicaltrials.gov/, identifier, #NCT05650931.

Passive shoulder exoskeleton support partially mitigates fatigue-induced effects in overhead work

BACKGROUND

Despite the potential of occupational passive shoulder exoskeletons (PSEs) to relieve overhead work, limited insights in overhead work precision performance impedes large-scale adoption in industry.

OBJECTIVE

To investigate the effect of PSE support on the reduction in task performance caused by physical fatigue.

METHODS

This experiment consisted of a randomized, counterbalanced cross-over design comparing Exo4Work PSE support and no support, in a physically fatigued state and a control condition. Precision performance was determined using execution speed and drilling errors. Muscle activity and shoulder joint kinematics were recorded.

RESULTS

Fatigue altered task performance, shoulder joint kinematics, muscle activity and subjective experience during overhead work. The PSE support mitigated the fatigue-induced changes in shoulder kinematics. Additionally, a part of the fatigue-induced co-activation of shoulder stabilizing muscles was avoided when working with the PSE. The PSE support also reduced the activity of the anterior and medial deltoid.

CONCLUSION

Physical fatigue provokes compensatory movements and increased co-contraction of muscles when executing overhead work. These fatigue-induced alterations are generally believed to increase the overall musculoskeletal load. The support provided by the PSE reduced muscle activity of muscles working to elevate the arm, but also partially mitigated those fatigue-induced effects.

SIGNIFICANCE

This study shows that the effect of PSE support on precision performance is limited, and suggested that, apart from the known effects of PSE support during overhead work, wearing the exoskeleton in a physically fatigued state may provide additional advantages.

Benefits of the Cybathlon 2020 experience for a prosthetic hand user: a case study on the Hannes system

BACKGROUND

Cybathlon championship aims at promoting the development of prosthetic and assistive devices capable to meet users' needs. This paper describes and analyses possible exploitation outcomes of our team's (REHAB TECH) experience into the Powered Arm Prosthesis Race of the Cybathlon 2020 Global Edition, with the novel prosthetic system Hannes. In detail, we present our analysis on a concurrent evaluation conducted to verify if the Cybathlon training and competition positively influenced pilot's performance and human-technology integration with Hannes, with respect to a non-runner Hannes user.

METHODS

Two transradial amputees were recruited as pilots (Pilot 1 and Pilot 2) for the Cybathlon competition and were given the polyarticulated myoelectric prosthetic hand Hannes. Due to COVID-19 emergency, only Pilot 1 was trained for the race. However, both pilots kept Hannes for Home Use for seven weeks. Before this period, they both participated to the evaluation of functionality, embodiment, and user experience (UX) related to Hannes, which they repeated at the end of the Home Use and right after the competition. We analysed Pilot 1's training and race outcomes, as well as changes in the concurrent evaluation, and compared these results with Pilot 2's ones.

RESULTS

The Cybathlon training gradually improved Pilot 1's performances, leading to the sixth place with a single error in task 5. In the parallel evaluation, both pilots had an overall improvement over time, whereas Pilot 2 experienced a deterioration of embodiment. In detail, Pilot 1, who followed the training and raced the Cybathlon, improved in greater way.

CONCLUSION

Hannes demonstrated to be a valuable competitor and to perform grasps with human-like behaviors. The higher improvements of Pilot 1, who actively participated in the Cybathlon, in terms of functionality, embodiment and UX, may depend on his training and engagement in the effort of achieving a successful user-prosthesis interaction during the competition. Tasks based on Cybathlon's ones could improve the training phase of a prosthetic user, stimulating dexterity, prosthetic integration, and user perception towards the prosthesis. Likewise, timed races or competitions could facilitate and accelerate the learning phase, improving the efficiency and efficacy of the process.

Development of a Wearable Biocueing App (Sense-IT) Among Forensic Psychiatric Outpatients With Aggressive Behavior: Design and Evaluation Study

Background

The ability to regulate anger is often impaired in forensic psychiatric patients, frequently resulting in aggressive behavior. Although some treatment programs are partially successful in enhancing aggression regulation and reducing recidivism among specific subgroups, generalizable conclusions on the effectiveness of these interventions cannot be drawn to date. In forensic outpatient care, low treatment adherence and a predominant focus on cognitive control in most treatment programs may entail some of the factors impeding treatment. Technology-based interventions may address some of these treatment challenges.

Objective

The aim of this study is to explore whether a new technology-based biocueing intervention, the Sense-IT app, can be a valuable addition to aggression regulation treatment programs in forensic outpatient care. The Sense-IT app, which provides the user with real-time physiological feedback and behavioral support, is developed to strengthen emotional awareness and facilitate real-life practice. In this study, we aim to develop and evaluate an updated version of the Sense-IT app that is suitable for forensic outpatients with aggressive behavior.

Methods

First, we conducted a design study to assess the attitudes of forensic professionals and patients toward biocueing and to collect requirements for a biocueing app for this specific population. On the basis of this information, we developed an updated version of the Sense-IT app. In an evaluation study, 10 forensic outpatients used the app for 2 weeks. The app’s acceptability, usability, and clinical outcomes (aggression, anger, and recognition of bodily signals related to anger) were measured before and after the intervention using both quantitative and qualitative measures.

Results

The design study revealed a cautiously positive attitude toward the use of biocueing as an addition to aggression regulation therapy. The evaluation study among forensic outpatients demonstrated moderate acceptability and adequate usability for the new version of the Sense-IT app. Exploratory analysis revealed a significant decrease in trait aggression postintervention; no significant changes were found in other anger-related clinical outcomes. To further increase acceptability and usability, a stable functioning app with self-adjustable settings, the use of smartwatches with a longer battery life, and the use of the patient’s own smartphone devices were recommended.

Conclusions

This study, which is one of the first attempts to enroll and evaluate the real-life use of a biocueing intervention among forensic outpatients, emphasized the importance of involving both patients and therapists throughout the development and implementation process. In the future, experimental studies, including single-case experimental designs using ecological momentary assessment, should be performed to evaluate the effectiveness of the Sense-IT intervention on clinical outcomes. An open attitude toward new technology, allowing exploration of the potential benefits of the Sense-IT app case-by-case, and training of therapists in using the app are expected to facilitate its integration in therapy.

Exploring the Embodiment of a Virtual Hand in a Spatially Augmented Respiratory Biofeedback Setting

Enhancing the embodiment of artificial limbs-the individuals' feeling that a virtual or robotic limb is integrated in their own body scheme-is an impactful strategy for improving prosthetic technology acceptance and human-machine interaction. Most studies so far focused on visuo-tactile strategies to empower the embodiment processes. However, novel approaches could emerge from self-regulation techniques able to change the psychophysiological conditions of an individual. Accordingly, this pilot study investigates the effects of a self-regulated breathing exercise on the processes of body ownership underlying the embodiment of a virtual right hand within a Spatially Augmented Respiratory Biofeedback (SARB) setting. This investigation also aims at evaluating the feasibility of the breathing exercise enabled by a low-cost SARB implementation designed for upcoming remote studies (a need emerged during the COVID-19 pandemic). Twenty-two subjects without impairments, and two transradial prosthesis users for a preparatory test, were asked (in each condition of a within-group design) to maintain a normal (about 14 breaths/min) or slow (about 6 breaths/min) respiratory rate to keep a static virtual right hand "visible" on a screen. Meanwhile, a computer-generated sphere moved from left to right toward the virtual hand during each trial (1 min) of 16. If the participant's breathing rate was within the target (slow or normal) range, a visuo-tactile event was triggered by the sphere passing under the virtual hand (the subjects observed it shaking while they perceived a vibratory feedback generated by a smartphone). Our results-mainly based on questionnaire scores and proprioceptive drift-highlight that the slow breathing condition induced higher embodiment than the normal one. This preliminary study reveals the feasibility and potential of a novel psychophysiological training strategy to enhance the embodiment of artificial limbs. Future studies are needed to further investigate mechanisms, efficacy and generalizability of the SARB techniques in training a bionic limb embodiment.