Mixed methods, single case design, feasibility trial of a motivational conversational agent for rehabilitation for adults with traumatic brain injury.

OBJECTIVE: Rehabilitation for adults with traumatic brain injury (TBI) incorporates client-centred goal-setting and motivational support to achieve goals. However, face-to-face rehabilitation is time-limited. New therapy approaches which leverage care are warranted. Conversational agents (CAs) offer a human-computer interface with which a person can converse. This study tested the feasibility, usability and acceptability of using a novel CA - RehabChat - alongside brain injury rehabilitation. DESIGN: Mixed methods, single case design, feasibility pilot trial. SETTING: Ambulatory and community brain injury rehabilitation. PARTICIPANTS: Adults with TBI receiving brain injury rehabilitation and clinicians providing this care. INTERVENTION: Following 1:1 training, client-clinician dyads used RehabChat for two weeks alongside usual care. MAIN MEASURES: Pre-post clinical measures (Motivation for Traumatic Brain Injury Rehabilitation Questionnaire, Rehabilitation Therapy Engagement Scale, Brain Injury Rehabilitation Trust Motivation Questionnaire-Relative, Brain Injury Rehabilitation Trust Motivation Questionnaire-Self) repeated measures (Hospital Anxiety and Depression Scale, researcher-developed wellbeing screening questions); and post-intervention (System Usability Scale (SUS), semi-structured 1:1 interview). RESULTS: Six participants (two clients and four clinicians) completed training. Two client-clinician dyads completed the intervention. Two other clinicians used RehabChat in a mock client-clinician session. SUS scores indicated good usability. Client well-being did not deteriorate. No adverse events were experienced. Interviews indicated RehabChat was feasible, acceptable and easy to use; and supported motivation, goal-setting and completing practice activities. CONCLUSIONS: RehabChat was feasible and acceptable to use alongside usual ambulatory and community brain injury rehabilitation, had good usability and supported client needs. Further testing of RehabChat with a larger cohort for longer duration is warranted.

Design, development, and use of conversational agents in rehabilitation for adults with brain-related neurological conditions: a scoping review.

OBJECTIVE: The objective of this review was to identify how conversational agents are designed and used in rehabilitation for adults with brain-related neurological conditions. INTRODUCTION: Adults with brain-related neurological conditions experience varied cognitive and functional challenges that can persist long term. However, rehabilitation services are time- and resource-limited, and novel rehabilitation approaches are warranted. Conversational agents provide a human-computer interface with which the user can converse. A conversational agent can be designed to meet specific user needs, such as rehabilitation and support. INCLUSION CRITERIA: Studies focused on the design and use of conversational agents for rehabilitation for people aged 18 years or older with brain-related neurological conditions were considered for inclusion. Eligible publication types included peer-reviewed publications (quantitative, qualitative, and/or mixed methods study designs; research protocols; peer-reviewed expert opinion papers; clinical studies, including pilot trials; systematic or scoping reviews), full conference papers, and master's or PhD theses. Eligible types of research included prototype development, feasibility testing, and clinical trials. METHODS: Online databases, including MEDLINE, Scopus, ProQuest (all databases), Web of Science, and gray literature sources were searched with no date limit. Only English publications were considered due to a lack of resourcing available for translations. Title and abstract screening and full-text review were conducted by two independent reviewers. Data extraction was shared by three independent reviewers. The data extraction instrument was iteratively refined to meet the requirements of all included papers, and covered details for technological aspects and the clinical context. Results are presented narratively and in tabular format, with emphasis on participants, concept and context, and data extraction instrument components. RESULTS: Eleven papers were included in the review, which represented seven distinct conversational agent prototypes. Methodologies included technology description (n = 9) and initial user testing (n = 6). The intended clinical cohorts for the reported conversational agents were people with dementia (n = 5), Parkinson disease (n = 2), stroke (n = 1), traumatic brain injury (n = 1), mixed dementia and mild cognitive impairment (n = 1), and mixed dementia and Parkinson disease (n = 1). Two studies included participants who were healthy or otherwise from the general community. The design of the conversational agents considered technology aspects and clinical purposes. Two conversational agent prototypes incorporated a speaking humanoid avatar as reported in five of the papers. Topics of conversation focused on subjects enjoyable to the user (life history, hobbies, where they lived). The clinical purposes reported in the 11 papers were to increase the amount of conversation the user has each day (n = 4), reminiscence (n = 2), and one study each for anxiety management and education, Parkinson disease education, to obtain and analyze a recording of the user's voice, to monitor well-being, and to build rapport before providing daily task prompts. One study reported clinician oversight of the conversational agent use. The studies had low sample sizes (range: 1-33). No studies undertook effectiveness testing. Outcome measures focused on usability, language detection and production, and technological performance. No health-related outcomes were measured. No adverse events were reported, and only two studies reported safety considerations. CONCLUSIONS: Current literature reporting the design and use of conversational agents for rehabilitation for adults with brain-related neurological conditions is heterogeneous and represents early stages of conversational agent development and testing. We recommend, as per our customized data extraction instrument, that studies of conversational agents for this population clearly define technical aspects, methodology for developing the conversation content, recruitment methods, safety issues, and requirements for clinician oversight.

Use of conversational agents in rehabilitation following brain injury, disease, or stroke: a scoping review protocol.

OBJECTIVE: The objective of the review is to identify peer-reviewed literature reporting the design and use of conversational agents in rehabilitation for adults with brain injury, disease, or stroke. INTRODUCTION: Rehabilitation for adults with brain injury, disease, or stroke provides goal-directed care to overcome functional impairments and reduced independence. However, recovery can be impacted due to rehabilitation being time-limited. New therapy approaches supporting rehabilitation and self-management are warranted. Conversational agents provide personal computer-based dialogues that can be designed to meet the specific needs of clients. Interacting with a conversational agent may support rehabilitation for clients with brain injury, disease, or stroke. INCLUSION CRITERIA: Studies that report the design or use of conversational agents in rehabilitation for adults aged over 18 years with brain injury, disease, or stroke will be considered for inclusion. Research settings may include hospitals, community settings, and homes. Eligible study types are peer-reviewed research protocols, prototype development papers, and pilot and clinical trials. METHODS: Primary sourcing databases (MEDLINE [Ovid], Scopus, ProQuest [all databases], Web of Science) and gray literature sources will be searched with no date limitations. Only studies published in English will be considered due to feasibility limitations. Two independent reviewers will screen the retrieved papers by title and abstract, and the selected papers by full-text review. Any disagreements will be resolved by an objective arbitrator. Data to be extracted and analyzed from included papers will include details of participants, concept, context, and the study design. Results will be presented narratively and in tabular format.

Physical therapy interventions for gross motor skills in people with an intellectual disability aged 6 years and over: a systematic review.

AIM: The systematic review was undertaken to investigate the effectiveness of physical therapy interventions for improving gross motor skills (GMSs) in people with an intellectual disability aged 6 years and older. There is a lack of physical therapy research for GMSs in this population, and no prior systematic review. People with an intellectual disability may require specific teaching approaches within therapy interventions to accommodate their cognitive and learning needs. People with an intellectual disability who suffer from GMS deficits can benefit from physical therapy to help improve their GMSs. METHODS: Data sources were PubMed, CINAHL, Embase, and ProQuest. Reference lists of relevant identified articles were also hand searched. Papers published in English from 1 January 2008 to 22 October 2014 were considered for inclusion. This start date was chosen to reflect the tenets of the United Nations Convention on the Rights of Persons with Disabilities which was ratified in 2008.Eligible study designs for inclusion were randomized controlled trial (RCT), pseudo-RCT, repeated measures, and case report. Overall, 887 potential articles were identified, of which 42 were retrieved for full-text review, and seven were finally included. Critical appraisal was independently conducted by two reviewers using the Joanna Briggs Institute appraisal checklists; no articles were excluded following critical appraisal. Data extraction was performed using Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument data extraction instruments. RESULTS: High heterogeneity between the studies precluded meta-analysis of the results; a narrative synthesis was completed instead. Two RCTs, two pseudo-RCTs, two repeated measures studies, and one case report were included. Studies varied in regard to participants' intellectual disability, and the clinical interventions used. Interventions were well tolerated with negligible adverse effects. Significant improvements were reported for cadence and nondimensionalized gait velocity following body-weight-supported gait training; cadence following lower limb strengthening exercises; and the Gross Motor Function Measure-88 measures following adapted judo training. These results suggest that task-specific training may be useful. However, the overall quality of evidence was low. CONCLUSION: The evidence identified by this systematic review supporting physical therapy for improving GMSs in people with an intellectual disability was limited because of the low quality of studies (only two were RCTs) and only three statistically significant findings. Given the current paucity of evidence, a future systematic review, which sought to identify evidence regarding interventions used by a range of health and education professionals for improving GMSs in people with an intellectual disability, could provide a broader evidence base for clinical interventions which may be utilized by physical therapists.