A Newly Developed Exergame-Based Telerehabilitation System for Older Adults: Usability and Technology Acceptance Study.

BACKGROUND: Telerehabilitation has gained significance as a tool to deliver and supervise therapy and training as effective as traditional rehabilitation methods yet more accessible and affordable. An exergame-based telerehabilitation system has recently been developed within the scope of the international Continuum-of-Care (COCARE) project. The system comprises training devices for use in clinics (Dividat Senso) and at home (Dividat Senso Flex), an assessment system, and a rehabilitation cockpit, and its focus lies on home-based motor-cognitive training, which is remotely managed by health care professionals (HPs). OBJECTIVE: This study aims to analyze the usability, acceptance, and enjoyment of the COCARE system from the perspective of primary (older adults [OAs]) and secondary (HPs) end users. METHODS: At 3 trial sites (located in Switzerland, Italy, and Cyprus), participants engaged in a single-session trial of the COCARE system, including testing of exergames and assessments. Mixed methods encompassing qualitative approaches (eg, think aloud) and quantitative measures (eg, Exergame Enjoyment Questionnaire [EEQ], System Usability Scale [SUS], and Unified Theory of Acceptance and Use of Technology [UTAUT] questionnaire) were used to analyze participants' perceptions of the system and identify potential barriers to its implementation in a home setting. In addition, the associations of performance during gameplay and assessments, demographics, and training motivation (Behavioral Regulation in Exercise Questionnaire-3 [BREQ-3]) with usability, acceptance, and enjoyment were explored. RESULTS: A total of 45 OAs and 15 HPs participated in this study. The COCARE system achieved good acceptance ratings (OAs: 83%, range 36%-100% and HPs: 81%, range 63.8%-93.3% of the maximum score), and OAs indicated high enjoyment (mean 73.3, SD 12.7 out of 100 points in the EEQ) during the exergame session. The system's usability, assessed with the SUS, received scores of 68.1 (SD 18.8; OAs) and 70.7 (SD 12.3; HPs) out of 100 points, with substantial differences observed between the trial sites. Several requirements for improvement were identified. Commonly mentioned barriers to adoption included the movement-recognition sensitivity of the Senso Flex, its limited markings, and difficulties in understanding certain instructions for assessments and games. Performance in games and assessments showed the highest significant correlations with the SUS (Spearman ρ=0.35, P=.02 to ρ=0.52, P<.001). The BREQ-3 had significant correlations with all usability measures, thereby even large significant correlations with enjoyment (Spearman ρ=0.58; P<.001). Age had moderately significant correlations with the SUS (Spearman ρ=-0.35; P=.02) and the UTAUT total score (ρ=-0.35; P=.02) but no significant correlation with the EEQ. Concerning sex and years of education, no significant correlations were found. CONCLUSIONS: The study's findings will inform the further development of the COCARE system toward a user-friendly and widely accepted version, enhancing cognitive and physical functions in OAs. Future randomized controlled trials should evaluate the system's feasibility and effectiveness.

Feasibility and Effectiveness of a Personalized Home-Based Motor-Cognitive Training Program in Community-Dwelling Older Adults: Protocol for a Pragmatic Pilot Randomized Controlled Trial.

BACKGROUND: Exergame-based motor-cognitive training in older adults has been associated with improvements in physical, cognitive, and psychological functioning. The novel Cocare system (Dividat GmbH), developed through a user-centered design process, allows motor-cognitive training in a telerehabilitation setting. It includes (1) a stationary stepping platform for supervised exergame training (Dividat Senso; Dividat GmbH), (2) a home-based version (Dividat Senso Flex, which is a rollable pressure-sensitive mat; Dividat GmbH), (3) an assessment system (including motor-cognitive tests), and (4) a rehabilitation cockpit for remote training supervision and management. OBJECTIVE: The aim of this study is to test the feasibility and effectiveness of this novel training system. METHODS: A total of 180 older adults from Switzerland, Italy, and Cyprus aged ≥60 years with a prescription for rehabilitation are randomly allocated to an intervention group or a control group. Both groups continue with their usual care, whereas participants in the intervention group additionally perform a 2-week supervised exergame training program at rehabilitation centers, followed by a 10-week home training program under remote supervision. The assessment system is used to indicate the start level of each participant, and, in both intervention periods, standardized progression rules are applied. The measures of feasibility include adherence, attrition, exergame enjoyment, willingness to perform such a training program, and the number and types of help requests. Effectiveness is assessed in terms of cognitive and physical functioning, balance confidence, and quality of life. RESULTS: Data collection started in February 2023 and is ongoing. Final measurements are expected to be performed in January 2024. CONCLUSIONS: Owing to the user-centered design approach, the Cocare system is expected to be user-friendly and offers several novel features to cover the whole continuum of care. This pragmatic trial will provide valuable information regarding final necessary adaptations and subsequent implementation efforts. TRIAL REGISTRATION: ClinicalTrials.gov NCT05751551; https://www.clinicaltrials.gov/study/NCT05751551. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/49377.

The Technical Ability and Performing Scale (TAPS): A newly developed patient-reported functional rating scale for Musician's focal dystonia.

BACKGROUND: Musician's Focal Dystonia (MFD) is the most common adult-onset dystonia involving the hand and can cause a professional music career to end. MFD affects about 1% of professional musicians and is a challenging clinical condition to treat. This work aimed to validate the Technical Ability and Performing Scale (TAPS), a newly-developed patient-reported functional rating scale for the clinical assessment of the MFD burden. METHODS: Seventy-seven musicians with MFD (40.84 ± 13.14 years) who accessed "Sol Diesis Service" were consecutively enrolled. Each subject filled in the TAPS after playing six technical passages of different complexity for 45 s each. The clinicians also collected the Arm Dystonia Disability Scale (ADDS) and Tubiana-Chamagne Scale (TCS). Cronbach's α coefficient was used to assess reliability; concurrent validity was measured using correlation with validated tools (ADDS and TCS). RESULTS: Our results showed that the symptoms of dystonia appeared at around 33 years of age and lasted for at least three years. The Cronbach's α displayed good internal consistency (0.817) for Technical Ability (TA). The two TAPS scores, TA and Performing Score (PS), positively correlated with TCS total score and negatively with ADDS total score (concurrent validity). CONCLUSIONS: The TAPS is a reliable and valid tool for the clinical assessment of the MFD burden. This patient-reported outcome measure may facilitate patient engagement in decision-making about their care and can help healthcare professionals to monitor the musician's change during the rehabilitative intervention.

How Do I Rehabilitate Patients with Cervical Dystonia Remotely?

In literature there is a growing evidence that in cervical dystonia (CD) rehabilitation, both in person and remotely, is an efficacious add on treatment to botulinum neurotoxins (BoNT) injections, but there is no consensus about protocols. We present here two rehabilitation programs implemented by our neuro-rehabilitative multidisciplinary team. The enclosed video clips show exercises to be performed at home as self-rehabilitation program, and exercises presented by a physiotherapist for a telerehabilitation program. These two protocols may be helpful for integrating rehabilitation with BoNT treatment in CD.