Sensorimotor and Cognitive Abilities Associated With Touchscreen Tablet App Performance to Support Self-Management of Type 2 Diabetes.

IMPORTANCE: Self-management programs (facilitated by mobile devices) may improve health and prevent secondary complications for older adults with diabetes. However, older adults may have difficulties using mobile devices because of neuropathy or cognitive dysfunction. OBJECTIVE: To identify sensorimotor and cognitive abilities associated with touchscreen tablet app performance to support self-management of diabetes in older adults. DESIGN: Cross-sectional study. SETTING: Outpatient Center for Successful Aging With Diabetes. PARTICIPANTS: Forty-five older adults with Type 2 diabetes. OUTCOMES AND MEASURES: Dexterity (Purdue Pegboard Test), touch sensation (Semmes-Weinstein monofilaments), pinch strength (pinch gauge), cognition (Montreal Cognitive Assessment), and executive functioning (Trail Making Test) were assessed. Two apps were then used: Dexteria and SuCare. Demographic data, prior mobile device use, and diabetes severity (hemoglobin A1C [HbA1C]) were collected. RESULTS: Age and HbA1C accounted for 29.8% and 9.7%, respectively, of the total variance of Dexteria performance time (dominant hand). Dexterity (dominant hand) accounted for an additional 5.4% of the total variance of 45.1%, F(4, 40) = 10.021, p < .001. Prior mobile device use, age, and diabetes severity accounted for 6.4%, 11.8%, and 26.4%, respectively, of the total variance of SuCare performance time. Executive functioning and dominant-hand dexterity accounted for an additional 9.5% and 9.4%, respectively, of the total variance of 61.0%, F(5, 39) = 14.75, p < .001. CONCLUSIONS AND RELEVANCE: Beyond age and diabetes severity, executive functioning and dominant-hand dexterity contributed to app performance, highlighting the importance of diabetes self-management. These findings may help determine suitable candidates for tablet use for self-management. WHAT THIS ARTICLE ADDS: App performance is explained by the executive functioning and dexterity of older adults with Type 2 diabetes. These factors, in addition to age and diabetes severity, should be taken into consideration by occupational therapy practitioners in future mobile self-management programs.

Self-Care Self-Efficacy Correlates with Independence in Basic Activities of Daily Living in Individuals with Chronic Stroke.

BACKGROUND: (1) To characterize the self-care self-efficacy (SCSE) of community dwelling individuals with chronic stroke and (2) to determine the contribution of SCSE to the independence in basic and instrumental activities of daily living (BADL and IADL) and the participation of individuals with chronic stroke. SCSE is the confidence in one's own ability to perform self-care activities. METHODS: This cross-sectional study included fifty community-dwelling individuals mean (SD) age 59.8 (9.3) years, mean (SD) 3.1 (1.7) years post-stroke who were able to walk at least 10 meters. SCSE was assessed using the Stroke Self-Efficacy Questionnaire (SSEQ), BADL was assessed by the Functional Independence Measure (FIM) (interview), the IADL questionnaire assessed IADL and the Physical Activity Scale for Individuals with Physical Disabilities (PASIPD) assessed participation. Correlation and regression analyses were performed after controlling for grip strength, executive functions and gait speed, factors known to influence independence in daily living. RESULTS: The mean SCSE level was moderate-high (70%). Significant moderate correlations were found between SCSE to independence in BADL (r = .596, P < .001), IADL (r = .567, P < .001) and participation (r = .340, P < .005). SCSE of our cohort explained 7.4% of the variance of the individual's independence in BADL after controlling for executive functions and gait speed, but did not contribute to their independence in IADL and participation. CONCLUSIONS: Higher SCSE of individuals with chronic stroke contributes to more independence in BADL. Additional questionnaires regarding self efficacy for IADL should be developed and investigated.

Eliciting upper extremity purposeful movements using video games: a comparison with traditional therapy for stroke rehabilitation.

BACKGROUND: Video games have become popular in stroke rehabilitation; however, the nature of this intervention is not fully understood. OBJECTIVES: To compare the number of (a) purposeful and nonpurposeful repetitions of the weaker upper extremity (UE) and (b) movement accelerations as assessed by accelerometer activity counts of the weaker and stronger UEs of individuals with chronic stroke while playing video games or participating in traditional therapy. METHODS: Twenty-nine individuals (mean age 59 years, 1-7 years poststroke) took part in a group intervention of video -games (n = 15) or traditional therapy (n = 14) as part of a randomized controlled trial. During 1-2 sessions, participants were video-taped while wearing wrist accelerometers. Assessors counted the number of repetitions and classified movements as purposeful or nonpurposeful using videotapes. The weaker UE motor impairments were correlated to movement accelerations, to determine if participants were using their potential during the sessions. RESULTS: Participants in the video game group performed a median of 271 purposeful movements and 37 970 activity counts compared to 48 purposeful movements and 14,872 activity counts in the traditional group (z = -3.0, P = .001 and z = -1.9, P = .05, respectively). Participants in the traditional group performed a median of 26 nonpurposeful (exercises) compared with 0 in the video game group (z = -4.2, P = .000). Strong significant correlations were found between the motor ability of the weak UE to repetitions of participants in both groups (r = .86, P < .01). Participants with higher motor ability performed more repetitions. CONCLUSIONS: Video games elicited more UE purposeful repetitions and higher acceleration of movement compared with traditional therapy in individuals with chronic stroke.

The use of video capture virtual reality in burn rehabilitation: the possibilities.

We independently explored the use of the Sony PlayStation II EyeToy (Sony Corporation, Foster City, CA) as a tool for use in the rehabilitation of patients with severe burns. Intensive occupational and physical therapy is crucial in minimizing and preventing long-term disability for the burn patient; however, the therapist faces a difficult challenge combating the agonizing pain experienced by the patient during therapy. The Sony PlayStation II EyeToy is a projected, video-capture system that, although initially developed as a gaming environment for children, may be a useful application in a rehabilitative context. As compared with other virtual reality systems the EyeToy is an efficient rehabilitation tool that is sold commercially at a relatively low cost. This report presents the potential advantages for use of the EyeToy as an innovative rehabilitative tool with mitigating effects on pain in burn rehabilitation. This new technology represents a challenging and motivating way for the patient to immerse himself or herself in an alternate reality while undergoing treatment, thereby reducing the pain and discomfort he or she experiences. This simple, affordable technique may prove to heighten the level of patient cooperation and therefore speed the process of rehabilitation and return of functional ability.