Concussion Assessment With Smartglasses: Validation Study of Balance Measurement Toward a Lightweight, Multimodal, Field-Ready Platform

Advancing Gait Analysis: Integrating Multimodal Neuroimaging and Extended Reality Technologies

The analysis of human gait is a cornerstone in diagnosing and monitoring a variety of neuromuscular and orthopedic conditions. Recent technological advancements have paved the way for innovative methodologies that combine multimodal neuroimaging and eXtended Reality (XR) technologies to enhance the precision and applicability of gait analysis. This review explores the state-of-the-art solutions of an advanced gait analysis approach, a multidisciplinary concept that integrates neuroimaging, extended reality technologies, and sensor-based methods to study human locomotion. Several wearable neuroimaging modalities such as functional near-infrared spectroscopy (fNIRS) and electroencephalography (EEG), commonly used to monitor and analyze brain activity during walking and to explore the neural mechanisms underlying motor control, balance, and gait adaptation, were considered. XR technologies, including virtual, augmented, and mixed reality, enable the creation of immersive environments for gait analysis, real-time simulation, and movement visualization, facilitating a comprehensive assessment of locomotion and its neural and biomechanical dynamics. This advanced gait analysis approach enhances the understanding of gait by examining both cerebral and biomechanical aspects, offering insights into brain-musculoskeletal coordination. We highlight its potential to provide real-time, high-resolution data and immersive visualization, facilitating improved clinical decision-making and rehabilitation strategies. Additionally, we address the challenges of integrating these technologies, such as data fusion, computational demands, and scalability. The review concludes by proposing future research directions that leverage artificial intelligence to further optimize multimodal imaging and XR applications in gait analysis, ultimately driving their translation from laboratory settings to clinical practice. This synthesis underscores the transformative potential of these approaches for personalized medicine and patient outcomes.

Evaluation of sport-related concussion using objective eye tracking

OBJECTIVE

Evaluate EyeBOX in an adolescent sport-related concussion (SRC) population by comparing scores between concussed and non-concussed athletes, examining sensitivity/specificity, and assessing clinical recovery associations.

METHODS

A prospective, unmatched case-control study examined concussed adolescents (11-22 years) treated in a sports concussion clinic who underwent EyeBOX testing. Concussed participants completed symptom scales and follow-up assessments. Analyses included t-tests comparing groups, sensitivity/specificity analyses, and models examining relationships between BOX scores and recovery outcomes, including initial post-concussion symptom severity (PCSS) scores, return to learn (RTL), symptom resolution (SR), and return to play (RTP).

RESULTS

Participants included 36 youth athletes with SRCs and 30 non-concussed controls. BOX scores were significantly higher in concussed participants (7.9 ± 5.2) compared to controls (5.4 ± 5.1; t = 2.062, p = 0.043, Cohen's d = 0.479). Sensitivity for detecting concussion ranged from 22% (BOX>10) to 61% (BOX>5), while specificity ranged from 63%-87%. Multivariable linear regression showed that higher BOX scores predicted higher initial PCSS scores (β = 0.323, p = 0.049) but did not predict RTL, SR, or RTP.

CONCLUSION

EyeBOX demonstrated moderate specificity but limited sensitivity for identifying SRC and scores were associated with initial symptom severity. While it may not be useful as a standalone diagnostic tool, EyeBOX may serve as an adjunct for confirming concussion in youth athletes.

eHealth tools to assess the neurological function for research, in absence of the neurologist: a systematic review, part II (hardware)

BACKGROUND

Neurological disorders pose a substantial burden worldwide in healthcare and health research. eHealth has emerged as a promising field given its potential to aid research, with lower resources. With a changing eHealth landscape, identifying available tools is instrumental for informing future research. A systematic review aimed to map existing software and hardware eHealth assessing neurological signs and/or symptoms for research was conducted. In this second part, the results on hardware are presented.

METHODS

We searched for relevant literature using four search engines (PubMed, Web of Science, Scopus, & EBSCOHost). eHealth software tools have been described elsewhere, and this paper reports hardware tools only. Data extraction focused on collecting the main characteristics of each tool, including the device type and size, the tool setup, and the neurological components assessed. The data were then summarised in tables.

FINDINGS

This review captured and described 45 relevant hardware tools. They assessed signs and/or symptoms of five neurological domains: cognitive function, cranial nerves, motor function, posture, gait & coordination, and sensation. Heterogeneity among tool types and setups was high, with most tools assessing posture, gait, & coordination. Over time, there has been an increase in the simplification and versatility of tools, with a preference for commercially available and easily accessible hardware.

INTERPRETATION

There is already a considerable number of hardware eHealth assessing neurological function that can be used for research purposes. Furthermore, commercially available tools, such as sensors, appear to be preferred due to their reduced costs, easy setup, and high portability. This opens new opportunities to extend neuroepidemiological research cost-effectively, efficiently, and adaptively.

Validity and Reliability of Methods to Assess Movement Deficiencies Following Concussion: A COSMIN Systematic Review

BACKGROUND

There is an increased risk of subsequent concussion and musculoskeletal injury upon return to play following a sports-related concussion. Whilst there are numerous assessments available for clinicians for diagnosis and during return to play following concussion, many may lack the ability to detect these subclinical changes in function. Currently, there is no consensus or collated sources on the reliability, validity and feasibility of these assessments, which makes it difficult for clinicians and practitioners to select the most appropriate assessment for their needs.

OBJECTIVES

This systematic review aims to (1) consolidate the reliability and validity of motor function assessments across the time course of concussion management and (2) summarise their feasibility for clinicians and other end-users.

METHODS

A systematic search of five databases was conducted. Eligible studies were: (1) original research; (2) full-text English language; (3) peer-reviewed with level III evidence or higher; (4) assessed the validity of lower-limb motor assessments used to diagnose or determine readiness for athletes or military personnel who had sustained a concussion or; (5) assessed the test-retest reliability of lower-limb motor assessments used for concussion management amongst healthy athletes. Acceptable lower-limb motor assessments were dichotomised into instrumented and non-instrumented and then classified into static (stable around a fixed point), dynamic (movement around a fixed point), gait, and other categories. Each study was assessed using the COSMIN checklist to establish methodological and measurement quality.

RESULTS

A total of 1270 records were identified, with 637 duplicates removed. Titles and abstracts of 633 records were analysed, with 158 being retained for full-text review. A total of 67 records were included in this review; 37 records assessed reliability, and 35 records assessed the validity of lower-limb motor assessments. There were 42 different assessments included in the review, with 43% being non-instrumented, subjective assessments. Consistent evidence supported the use of instrumented assessments over non-instrumented, with gait-based assessments demonstrating sufficient reliability and validity compared to static or dynamic assessments.

CONCLUSION

These findings suggest that instrumented, gait-based assessments should be prioritised over static or dynamic balance assessments. The use of laboratory equipment (i.e. 3D motion capture, pressure sensitive walkways) on average exhibited sufficient reliability and validity, yet demonstrate poor feasibility. Further high-quality studies evaluating the reliability and validity of more readily available devices (i.e. inertial measurement units) are needed to fill the gap in current concussion management protocols. Practitioners can use this resource to understand the accuracy and precision of the assessments they have at their disposal to make informed decisions regarding the management of concussion.

TRAIL REGISTRATION

This systematic review was registered on PROSPERO (reg no. CRD42021256298).

A scoping review of metaverse in emergency medicine

BACKGROUND

Interest in the metaverse has been growing worldwide as the virtual environment provides opportunities for highly immersive and interactive experiences. Metaverse has gradually gained acceptance in the medical field with the advancement of technologies such as big data, the Internet of Things, and 5 G mobile networks. The demand for and development of metaverse are different in diverse subspecialties owing to patients with varying degrees of clinical disease. Hence, we aim to explore the application of metaverse in acute medicine by reviewing published studies and the clinical management of patients.

METHOD

Our review examined the published articles about the concept of metaverse roadmap, and four additional domains were extracted: education, prehospital and disaster medicine, diagnosis and treatment application, and administrative affairs.

RESULTS

Augmented reality (AR) and virtual reality (VR) integration have broad applications in education and clinical training. VR-related studies surpassed AR-related studies in the emergency medicine field. The metaverse roadmap revealed that lifelogging and mirror world are still developing fields of the metaverse.

CONCLUSION

Our findings provide insight into the features, application, development, and potential of a metaverse in emergency medicine. This study will enable emergency care systems to be better equipped to face future challenges.

Identification and description of telerehabilitation assessments for individuals with neurological conditions: A scoping review

Background

The clinical adoption of telerehabilitation accelerated rapidly over the last few years, creating opportunities for clinicians and researchers to explore the use of digital technologies and telerehabilitation in the assessment of deficits related to neurological conditions. The objectives of this scoping review were to identify outcome measures used to remotely assess the motor function and participation in people with neurological conditions and report, when available, the psychometric data of these remote outcome measures.

Methods

MEDLINE (Ovid), CINAHL, PubMed, PsychINFO, EMBASE, and Cochrane databases were searched between December 13, 2020, and January 4, 2021, for studies investigating the use of remote assessments to evaluate motor function and participation in people with neurological conditions. An updated search was completed on May 9, 2022, using the same databases and search terms. Two reviewers independently screened each title and abstract, followed by full-text screening. Data extraction was completed using a pre-piloted data extraction sheet where outcome measures were reported as per the International Classification of Functioning, Disability and Health.

Results

Fifty studies were included in this review. Eighteen studies targeted outcomes related to body structures and 32 targeted those related to activity limitation and participation restriction. Seventeen studies reported psychometric data; of these, most included reliability and validity data.

Conclusion

Clinical assessments of motor function of people living with neurological conditions can be completed in a telerehabilitation or remote context using validated and reliable remote assessment measures.

The effects of visual context on visual-vestibular mismatch revealed by electrodermal and postural response measures

BACKGROUND

No objective criteria exist for diagnosis and treatment of visual-vestibular mismatch (VVM).

OBJECTIVE

To determine whether measures of electrodermal activity (EDA) and trunk acceleration will identify VVM when exposed to visual-vestibular conflict.

METHODS

A modified VVM questionnaire identified the presence of VVM (+ VVM) in 13 of 23 young adults (34 ± 8 years) diagnosed with vestibular migraine. Rod and frame tests and outcome measures for dizziness and mobility were administered. Participants stood on foam while viewing two immersive virtual environments. Trunk acceleration in three planes and electrodermal activity (EDA) were assessed with wearable sensors. Linear mixed effect (LME) models were used to examine magnitude and smoothness of trunk acceleration and tonic and phasic EDA. Welch's t-test and associations between measures were assessed with a Pearson Correlation Coefficient. Effect sizes of group mean differences were calculated.

RESULTS

Greater than 80% of all participants were visually dependent. Outcome measures were significantly poorer in the + VVM group: tonic EDA was lower (p < 0.001) and phasic EDA higher (p < 0.001). Postural accelerations varied across groups; LME models indicated a relationship between visual context, postural, and ANS responses in the + VVM group.

CONCLUSIONS

Lower tonic EDA with + VVM suggests canal-otolith dysfunction. The positive association between vertical acceleration, tonic EDA, and visual dependence suggests that increased vertical segmental adjustments are used to compensate. Visual context of the spatial environment emerged as an important control variable when testing or treating VVM.

Internal Consistency of Sway Measures via Embedded Head-Mounted Accelerometers: Implications for Neuromotor Investigations

Accelerometers are being increasingly incorporated into neuroimaging devices to enable real-time filtering of movement artifacts. In this study, we evaluate the reliability of sway metrics derived from these accelerometers in a standard eyes-open balance assessment to determine their utility in multimodal study designs. Ten participants equipped with a head-mounted accelerometer performed an eyes-open standing condition on 7 consecutive days. Sway performance was quantified with 4 standard metrics: root-mean-square (RMS) acceleration, peak-to-peak (P2P) acceleration, jerk, and ellipse area. Intraclass correlation coefficients (ICC) quantified reliability. P2P in both the mediolateral (ICC = 0.65) and anteroposterior (ICC = 0.67) planes yielded the poorest reliability. Both ellipse area and RMS exhibited good reliability, ranging from 0.76 to 0.84 depending on the plane. Finally, jerk displayed the highest reliability with an ICC value of 0.95. Moderate to excellent reliability was observed in all sway metrics. These findings demonstrate that head-mounted accelerometers, commonly found in neuroimaging devices, can be used to reliably assess sway. These data validate the use of head-mounted accelerometers in the assessment of motor control alongside other measures of brain activity such as electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS).

Using Medical Device Standards for Design and Risk Management of Immersive Virtual Reality for At-Home Therapy and Remote Patient Monitoring

Numerous virtual reality (VR) systems have received regulatory clearance as therapeutic medical devices for in-clinic and at-home use. These systems enable remote patient monitoring of clinician-prescribed rehabilitation exercises, although most of these systems are nonimmersive. With the expanding availability of affordable and easy-to-use head-mounted display (HMD)-based VR, there is growing interest in immersive VR therapies. However, HMD-based VR presents unique risks. Following standards for medical device development, the objective of this paper is to demonstrate a risk management process for a generic immersive VR system for remote patient monitoring of at-home therapy. Regulations, standards, and guidance documents applicable to therapeutic VR design are reviewed to provide necessary background. Generic requirements for an immersive VR system for home use and remote patient monitoring are identified using predicate analysis and specified for both patients and clinicians using user stories. To analyze risk, failure modes and effects analysis, adapted for medical device risk management, is performed on the generic user stories and a set of risk control measures is proposed. Many therapeutic applications of VR would be regulated as a medical device if they were to be commercially marketed. Understanding relevant standards for design and risk management early in the development process can help expedite the availability of innovative VR therapies that are safe and effective.

Applications of Smart Glasses in Applied Sciences: A Systematic Review

The aim of this study is to review academic papers on the applications of smart glasses. Among 82 surveyed papers, 57 were selected through filtering. The papers were published from January 2014 to October 2020. Four research questions were set up using the systematic review method, and conclusions were drawn focusing on the research trends by year and application fields; product and operating system; sensors depending on the application purpose; and data visualization, processing, and transfer methods. It was found that the most popular commercial smart glass products are Android-based Google products. In addition, smart glasses are most often used in the healthcare field, particularly for clinical and surgical assistance or for assisting mentally or physically disabled persons. For visual data transfer, 90% of the studies conducted used a camera sensor. Smart glasses have mainly been used to visualize data based on augmented reality, in contrast with the use of mixed reality. The results of this review indicate that research related to smart glasses is steadily increasing, and technological research into the development of smart glasses is being actively conducted.

Technology and concussion: A scoping review

Background

Technology for concussion identification and management is rapidly expanding across the continuum of care. Although many technologies offer a range of services around concussion, there is an absence of a non-commercial online location for medical providers to access regarding the functionality of the various technologies used in concussion identification and management.

Objective

The purpose of this review is to present research findings on technology for concussion identification and management.

Methods

Searches for eligible studies were conducted using the PubMed, EMBASE, and Scopus databases with specific search criteria. Through a stepwise process, full-text articles were selected for inclusion if they described clinically useful electronic technologies (i.e. electronics able to be used in standard clinical environments including telehealth) by healthcare providers or end users (i.e. parents or athletes).

Results

A total of 29 articles were included in this review and described technology used to measure symptoms (3), neurocognitive performance (7), the visual system (4), and balance or dual task performance (18). Within the results, various technologies demonstrated increased utility for concussion identification, often detecting subtle deficits not possible with current low-tech clinical methods, differentiating those with concussion from those without concussion, with strong reliability and validity.

Conclusion

Innovative technologies included in this review demonstrate enhanced ability to identify and manage symptoms of concussion, neurocognitive deficits, visual deficits, and balance and dual-task deficits.

Sideline Concussion Assessment: The Current State of the Art

More than 200 million American adults and children participate in organized physical activity. Growing awareness has highlighted that concussion, especially when repeated, may be associated with prolonged neurological, cognitive, and/or neuropsychiatric sequelae. Objective diagnosis of concussion remains challenging. Although some concussion symptoms may be apparent even to nonmedical observers, diagnosis and removal from play for evaluation depend on validated assessment tools and trained, vigilant healthcare personnel. Over the past 2 decades, sideline concussion measures have undergone significant revision and augmentation to become more comprehensive batteries in order to detect a wide spectrum of symptomatology, eg, neurocognitive function, postconcussive symptoms, gait/balance, and saccadic eye movements. This review summarizes the current state-of-the-art concussion evaluation instruments, ranging from the Sports Concussion Assessment Tool (SCAT) and tools that may enhance concussion detection, to near-term blood-based biomarkers and emerging technology (eg, head impact sensors, vestibulo-ocular/eye-tracking, and mobile applications). Special focus is directed at feasibility, utility, generalizability, and challenges to implementation of each measure on-field and on the sidelines. This review finds that few instruments beyond the SCAT provide guidance for removal from play, and establishing thresholds for concussion detection and removal from play in qualification/validation of future instruments is of high importance. Integration of emerging sideline concussion evaluation tools should be supported by resources and education to athletes, caregivers, athletic staff, and medical professionals for standardized administration as well as triage, referral, and prevention strategies. It should be noted that concussion evaluation instruments are used to assist the clinician in sideline diagnosis, and no single test can diagnose concussion as a standalone investigation.

Physiological Vibration Acceleration (Phybrata) Sensor Assessment of Multi-System Physiological Impairments and Sensory Reweighting Following Concussion

Objective

To assess the utility of a head-mounted wearable inertial motion unit (IMU)-based physiological vibration acceleration (“phybrata”) sensor to support the clinical diagnosis of concussion, classify and quantify specific concussion-induced physiological system impairments and sensory reweighting, and track individual patient recovery trajectories.

Methods

Data were analyzed from 175 patients over a 12-month period at three clinical sites. Comprehensive clinical concussion assessments were first completed for all patients, followed by testing with the phybrata sensor. Phybrata time series data and spatial scatter plots, eyes open (Eo) and eyes closed (Ec) phybrata powers, average power (Eo+Ec)/2, Ec/Eo phybrata power ratio, time-resolved phybrata spectral density (TRPSD) distributions, and receiver operating characteristic (ROC) curves are compared for individuals with no objective impairments and those clinically diagnosed with concussions and accompanying vestibular impairment, other neurological impairment, or both vestibular and neurological impairments. Finally, pre- and post-injury phybrata case report results are presented for a participant who was diagnosed with a concussion and subsequently monitored during treatment, rehabilitation, and return-to-activity clearance.

Results

Phybrata data demonstrate distinct features and patterns for individuals with no discernable clinical impairments, diagnosed vestibular pathology, and diagnosed neurological pathology. ROC curves indicate that the average power (Eo+Ec)/2 may be utilized to support clinical diagnosis of concussion, while Eo and Ec/Eo may be utilized as independent measures to confirm accompanying neurological and vestibular impairments, respectively. All 3 measures demonstrate area under the curve (AUC), sensitivity, and specificity above 90% for their respective diagnoses. Phybrata spectral analyses demonstrate utility for quantifying the severity of concussion-induced physiological impairments, sensory reweighting, and subsequent monitoring of improvements throughout treatment and rehabilitation.

Conclusion

Phybrata testing assists with objective concussion diagnosis and provides an important adjunct to standard concussion assessment tools by objectively ascertaining neurological and vestibular impairments, guiding targeted rehabilitation strategies, monitoring recovery, and assisting with return-to-sport/work/learn decision-making.

Feasibility of Mild Traumatic Brain Injury Assessment Based on Cardiovascular Response to Postural Change

OBJECTIVE

To determine the feasibility of short-term cardiovascular responses to postural change as a screening tool for mild traumatic brain injury (mTBI), using heart rate metrics that can be measured with a wearable electrocardiogram sensor.

SETTING

Military TBI clinic.

DESIGN

Data collected from active-duty service members who had sustained a medically diagnosed mTBI within the prior 72 hours and from age- and sex-matched controls. Cardiac data collected while participants performed a sequence of postural changes.

MAIN MEASURES

Model classification compared with clinical mTBI diagnosis.

RESULTS

Cardiac biomarkers of mTBI were identified and logistic regression classifiers for mTBI were developed from different subsets of biomarkers. The best model achieved 90% sensitivity and 69% specificity using data from 2 different postural changes.

CONCLUSION

Noninvasive measurement of cardiovascular response to postural change is a promising approach for field-deployable post-mTBI screening.

Reliability, Validity and Utility of Inertial Sensor Systems for Postural Control Assessment in Sport Science and Medicine Applications: A Systematic Review

BACKGROUND

Recent advances in mobile sensing and computing technology have provided a means to objectively and unobtrusively quantify postural control. This has resulted in the rapid development and evaluation of a series of wearable inertial sensor-based assessments. However, the validity, reliability and clinical utility of such systems is not fully understood.

OBJECTIVES

This systematic review aims to synthesise and evaluate studies that have investigated the ability of wearable inertial sensor systems to validly and reliably quantify postural control performance in sports science and medicine applications.

METHODS

A systematic search strategy utilising the PRISMA guidelines was employed to identify eligible articles through ScienceDirect, Embase and PubMed databases. In total, 47 articles met the inclusion criteria and were evaluated and qualitatively synthesised under two main headings: measurement validity and measurement reliability. Furthermore, studies that investigated the utility of these systems in clinical populations were summarised and discussed.

RESULTS

After duplicate removal, 4374 articles were identified with the search strategy, with 47 papers included in the final review. In total, 28 studies investigated validity in healthy populations, and 15 studies investigated validity in clinical populations; 13 investigated the measurement reliability of these sensor-based systems.

CONCLUSIONS

The application of wearable inertial sensors for sports science and medicine postural control applications is an evolving field. To date, research has primarily focused on evaluating the validity and reliability of a heterogeneous set of assessment protocols, in a laboratory environment. While researchers have begun to investigate their utility in clinical use cases such as concussion and musculoskeletal injury, most studies have leveraged small sample sizes, are of low quality and use a variety of descriptive variables, assessment protocols and sensor-mounting locations. Future research should evaluate the clinical utility of these systems in large high-quality prospective cohort studies to establish the role they may play in injury risk identification, diagnosis and management. This systematic review was registered with the International Prospective Register of Systematic Reviews on 10 August 2018 (PROSPERO registration: CRD42018106363): https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=106363 .

Digital Attention-Related Augmented-Reality Game: Significant Correlation between Student Game Performance and Validated Clinical Measures of Attention-Deficit/Hyperactivity Disorder (ADHD)

As many as half of school children with autism spectrum disorder (ASD) exhibit symptoms of attention-deficit/hyperactivity disorder (ADHD), resulting in marked negative academic, social, and behavioral outcomes. The focus of the US Food and Drug Administration (FDA) on real-world data from novel digital sources, and the emergence of Current Procedural Terminology (CPT) codes to reimburse for digital monitoring and neurobehavioral testing suggest an increasing acceptance of the role of technology in augmenting clinical care and research. Empowered Brain is an augmented reality and artificial intelligence-based social-emotional communication aid for students with ASD. In this study, student performance on Empowered Brain is correlated to validated clinical measures of ADHD. Seven high school students with a diagnosis of ASD were recruited from a public high school. All students were assessed for severity of ADHD-related symptoms via three clinical gold-standard assessments, namely the Aberrant Behavioral Checklist (ABC), Social Responsiveness Scale 2 (SRS-2), and Teacher Report Form (TRF). Students used Empowered Brain over a one-week period. We measured the correlation of student in-game performance (as measured by point- and star-based rewards) relative to the hyperactivity subscale of the ABC (ABC-H), and the ADHD-subscale of the TRF. All seven students completed the study and managed to successfully use Empowered Brain. Students received a culminative total of 32 sessions, an average of 4.6 sessions per student (range 2–8). Student in-game performance demonstrated highly significant correlation relative to ABC-H (points: p = 0.0013; stars: p = 0.0013), and significant correlation to TRF ADHD scores (points: p = 0.012; stars: p = 0.012). No adverse effects were noted among students who used Empowered Brain. New technologies may herald novel ways of identifying and characterizing symptoms of ADHD in student populations. This study provides evidence that Empowered Brain in-game performance correlates with ADHD symptom severity in students with ASD. Larger samples are required to validate these findings, with more diverse participants that can also widen the generalizability of these findings to a broader range of brain conditions that manifest with inattention, impulsivity, and hyperactivity. Through further research, we may find that such technologies can help us to identify and longitudinally monitor such symptoms, and potentially aid in severity stratification and digital phenotyping.

Usability Study of Mainstream Wearable Fitness Devices: Feature Analysis and System Usability Scale Evaluation

Background

Wearable devices have the potential to promote a healthy lifestyle because of their real-time data monitoring capabilities. However, device usability is a critical factor that determines whether they will be adopted on a large scale. Usability studies on wearable devices are still scarce.

Objective

This study aims to compare the functions and attributes of seven mainstream wearable devices and to evaluate their usability.

Methods

The wearable devices selected were the Apple Watch, Samsung Gear S, Fitbit Surge, Jawbone Up3, Mi Band, Huawei Honor B2, and Misfit Shine. A mixed method of feature comparison and a System Usability Scale (SUS) evaluation based on 388 participants was applied; the higher the SUS score, the better the usability of the product.

Results

For features, all devices had step counting, an activity timer, and distance recording functions. The Samsung Gear S had a unique sports track recording feature and the Huawei Honor B2 had a unique wireless earphone. The Apple Watch, Samsung Gear S, Jawbone Up3, and Fitbit Surge could measure heart rate. All the devices were able to monitor sleep, except the Apple Watch. For product characteristics, including attributes such as weight, battery life, price, and 22 functions such as step counting, activity time, activity type identification, sleep monitoring, and expandable new features, we found a very weak negative correlation between the SUS scores and price (r=−.10, P=.03) and devices that support expandable new features (r=−.11, P=.02), and a very weak positive correlation between the SUS scores and devices that support the activity type identification function (r=.11, P=.02). The Huawei Honor B2 received the highest score of mean 67.6 (SD 16.1); the lowest Apple Watch score was only 61.4 (SD 14.7). No significant difference was observed among brands. The SUS score had a moderate positive correlation with the user’s experience (length of time the device was used) (r=.32, P<.001); participants in the medical and health care industries gave a significantly higher score (mean 61.1, SD 17.9 vs mean 68.7, SD 14.5, P=.03).

Conclusions

The functions of wearable devices tend to be homogeneous and usability is similar across various brands. Overall, Mi Band had the lowest price and the lightest weight. Misfit Shine had the longest battery life and most functions, and participants in the medical and health care industries had the best evaluation of wearable devices. The perceived usability of mainstream wearable devices is unsatisfactory and customer loyalty is not high. A consumer’s SUS rating for a wearable device is related to their personal situation instead of the device brand. Device manufacturers should put more effort into developing innovative functions and improving the usability of their products by integrating more cognitive behavior change techniques.

Improved Socio-Emotional and Behavioral Functioning in Students with Autism Following School-Based Smartglasses Intervention: Multi-Stage Feasibility and Controlled Efficacy Study

Background: Students with Autism Spectrum Disorder (ASD) commonly demonstrate prominent social communication deficits, symptoms of attention-deficit/hyperactivity disorder, and chronic irritability. These challenges hinder academic progress and frequently persist despite educational, behavioral, and medical interventions. An assistive smartglasses technology may aid these individuals, especially if the technology is efficacious in ecologically-valid school settings. This study explored the feasibility and efficacy of Empowered Brain, a computerized smartglasses intervention designed as a socio-emotional behavioral aid for students with ASD. Methods: This two-part six-week study involved four school children with ASD from a public elementary school. The study incorporated an initial three-week feasibility stage followed by a three-week controlled longitudinal efficacy stage. Both stages involved the use of a twice-daily socio-emotional intervention with the smartglasses. Educators completed pre-intervention and post-intervention Aberrant Behavioral Checklist (ABC) ratings at the start of the feasibility stage, and weekly during the efficacy stage. Primary outcome measures were improvements in the ABC subscales of irritability, hyperactivity, and social withdrawal. Results: Students in both feasibility and efficacy stages demonstrated improvements (decreases) in irritability, hyperactivity, and social withdrawal compared to a baseline period and control periods, respectively. Participants in the controlled efficacy stage demonstrated decreased ABC subscale scores of 90% for irritability, 41.6% for hyperactivity, and 45.6% for social withdrawal. An intervention exposure-response improvement in irritability and hyperactivity was found during the efficacy stage. Educators rated the technology as superior or vastly superior compared to other assistive technologies. Conclusion: A substantial number of school children with ASD demonstrate chronic and impairing cognitive and behavioral challenges. This study provides evidence that Empowered Brain, a smartglasses-based socio-emotional aid for autism, is both feasible and efficacious in improving symptoms of social withdrawal, irritability, and hyperactivity in students with autism. The improvement is demonstrated as part of a longitudinal school-based intervention. Further studies involving larger samples and incorporation of randomized controlled trial methodology are underway to further elucidate the impact of this technology.

Applications of Augmented Reality in Otolaryngology: A Systematic Review

OBJECTIVE

Augmented reality (AR) is a rapidly developing technology. The aim of this systematic review was to (1) identify and evaluate applications of AR in otolaryngology and (2) examine trends in publication over time.

DATA SOURCES

PubMed and EMBASE.

REVIEW METHODS

A systematic review was performed according to PRISMA guidelines without temporal limits. Studies were included if they reported otolaryngology-related applications of AR. Exclusion criteria included non-English articles, abstracts, letters/commentaries, and reviews. A linear regression model was used to compare publication trends over time.

RESULTS

Twenty-three articles representing 18 AR platforms were included. Publications increased between 1997 and 2018 ( P < .05). Twelve studies were level 5 evidence; 9 studies, level 4; 1 study, level 2; and 1 study, level 1. There was no trend toward increased level of evidence over time. The most common subspecialties represented were rhinology (52.2%), head and neck (30.4%), and neurotology (26%). The most common purpose of AR was intraoperative guidance (54.5%), followed by surgical planning (24.2%) and procedural simulations (9.1%). The most common source of visual inputs was endoscopes (50%), followed by eyewear (22.2%) and microscopes (4.5%). Computed tomography was the most common virtual input (83.3%). Optical trackers and fiducial markers were the most common forms of tracking and registration, respectively (38.9% and 44.4%). Mean registration error was 2.48 mm.

CONCLUSION

AR holds promise in simulation, surgical planning, and perioperative navigation. Although level of evidence remains modest, the role of AR in otolaryngology has grown rapidly and continues to expand.

Safety and Lack of Negative Effects of Wearable Augmented-Reality Social Communication Aid for Children and Adults with Autism

There is a growing interest in the use of augmented reality (AR) to assist children and adults with autism spectrum disorders (ASD); however, little investigation has been conducted into the safety of AR devices, such as smartglasses. The objective of this report was to assess the safety and potential negative effects of the Empowered Brain system, a novel AR smartglasses-based social communication aid for people with ASD. The version of the Empowered Brain in this report utilized Google Glass (Google, Mountain View, CA, USA) as its hardware platform. A sequential series of 18 children and adults, aged 4.4 to 21.5 years (mean 12.2 years), with clinically diagnosed ASD of varying severity used the system. Users and caregivers were interviewed about the perceived negative effects and design concerns. Most users were able to wear and use the Empowered Brain (n = 16/18, 89%), with most of them reporting no negative effects (n = 14/16, 87.5%). Caregivers observed no negative effects in users (n = 16/16, 100%). Most users (77.8%) and caregivers (88.9%) had no design concerns. This report found no major negative effects in using an AR smartglasses-based social communication aid across a wide age and severity range of people with ASD. Further research is needed to explore longer-term effects of using AR smartglasses in this population.

Longitudinal Socio-Emotional Learning Intervention for Autism via Smartglasses: Qualitative School Teacher Descriptions of Practicality, Usability, and Efficacy in General and Special Education Classroom Settings

There is considerable demand for special education services for the over half a million students with autism in the United States. While assistive technology may augment educational services, its implementation is often prevented by a number of practical and attitudinal barriers. These barriers are especially pertinent for the newest and thus least familiar digital systems, such as computerized smartglasses loaded with specialized software modules. Computerized smartglasses are a technology that has already been shown to have an ability to deliver educational interventions through augmented reality. With this in mind, we sought to understand how school educators received and assessed the practicality of a smartglasses-based educational intervention in a single-subject study. The intervention was designed to aid with attention and social educational learning in autism. The intervention was delivered twice a day during a two-week study on a 13-year-old student with autism who was attending a mainstream middle school in Massachusetts. Three different school educators delivered the intervention: the student’s general education teacher, special education teacher, and paraprofessional. Educators recorded their attitudes, the practicality of the technology, and its impact on the student and their classroom through the use of a digital log and a series of in-person interviews. Overall, the school educators experienced a positive view of the smartglasses. The smartglasses intervention was found to be logistically practical to implement, easily usable by both the educator and student, and not time-consuming to learn or implement. Educators also identified the experience as being fun for the student, and felt that the student demonstrated improvement in his verbal and non-verbal skills. There were no adverse effects on the other students or the classroom, and the technology did not result in a distraction. These findings suggest that social skills interventions delivered by smartglasses may be practical, useful, and may lead to improvements in social communication skills. Further research on smartglasses may help to clarify the future role for augmenting special education in students with autism.