AppReminders - a pilot feasibility randomized controlled trial of a memory aid app for people with acquired brain injury.

Mobile phone reminding apps can be used by people with acquired brain injury (ABI) to compensate for memory impairments. This pilot feasibility trial aimed to establish the feasibility of a randomized controlled trial comparing reminder apps in an ABI community treatment setting. Adults with ABI and memory difficulty who completed the three-week baseline were randomized (n = 29) and allocated to Google Calendar or ApplTree app. Those who attended an intervention session (n = 21) watched a 30-minute video tutorial of the app then completed reminder setting assignments to ensure they could use the app. Guidance was given if needed from a clinician or researcher. Those who passed the app assignments (n = 19) completed a three-week follow up. Recruitment was lower than target (n = 50), retention rate was 65.5%, adherence rate was 73.7%. Qualitative feedback highlighted issues that may impact usability of reminding apps introduced within community brain injury rehabilitation. Feasibility results indicate a full trial would require 72 participants to demonstrate the minimally clinically important efficacy difference between apps, should a difference exist. Most participants (19 of 21) given an app could learn to use it with the short tutorial. Design features implemented in ApplTree have potential to improve the uptake and utility of reminding apps.

The use of a smartwatch as a prompting device for people with acquired brain injury: a single case experimental design study.

Prompting-based memory compensation is a potential application for smartwatches. This study investigated the usability and efficacy of a Moto360 smartwatch as a memory aid. Four community dwelling adults with memory difficulties following acquired brain injury (ABI) were included in an A-B-A single case experimental design study. Performance of everyday memory tasks was tested over six weeks with the smartwatch and software provided during weeks three and four. Participants were asked to use their usual memory aids and strategies during the control phases (weeks 1-2, 5-6). Three participants successfully used the smartwatch throughout the intervention weeks and gave positive usability ratings. A fourth participant experienced a seizure and subsequently left the study before the intervention phase. Three participants showed improved memory performance when using the smartwatch. Nonoverlap of all pairs (NAP) analysis showed a non-significant small increase in memory performance between baseline and intervention phases (mean NAP = 0.1, p = .84). There was a larger, significant decline between the intervention and return to baseline (mean NAP = 0.58, p < .01). The use of an off-the-shelf smartwatch device and software was feasible for people with ABI in the community. It was effective compared to practice as usual, although this was only apparent on withdrawal of the device.

Technological memory aid use by people with acquired brain injury.

Evans, Wilson, Needham, and Brentnall ( 2003 ) investigated memory aid use by people with acquired brain injury (ABI) and found little use of technological memory aids. The present study aims to investigate use of technological and other memory aids and strategies 10 years on, and investigate what predicts use. People with ABI and self-reported memory impairments (n = 81) completed a survey containing a memory aid checklist, demographic questions and memory questionnaires. Chi-square analysis showed that 10 of 18 memory aids and strategies were used by significantly more people in the current sample than in Evans et al. ( 2003 ). The most commonly used strategies were leaving things in noticeable places (86%) and mental retracing of steps (77%). The most commonly used memory aids were asking someone to remind you (78%), diaries (77%), lists (78%), and calendars (79%) and the most common technologies used were mobile phone reminders (38%) and alarms/timers (38%). Younger people who used more technology prior to their injury and who use more non-technological memory aids currently were more likely to use technology. Younger people who used more memory aids and strategies prior to their injury and who rated their memory as poorer were more likely to use all types of memory aids and strategies.

Increasing physical activity in stroke survivors using STARFISH, an interactive mobile phone application: a pilot study.

BACKGROUND: Following stroke, people are generally less active and more sedentary which can worsen outcomes. Mobile phone applications (apps) can support change in health behaviors. We developed STARFISH, a mobile phone app-based intervention, which incorporates evidence-based behavior change techniques (feedback, self-monitoring and social support), in which users' physical activity is visualized by fish swimming. OBJECTIVE: To evaluate the potential effectiveness of STARFISH in stroke survivors. METHOD: Twenty-three people with stroke (12 women; age: 56.0 ± 10.0 years, time since stroke: 4.2 ± 4.0 years) from support groups in Glasgow completed the study. Participants were sequentially allocated in a 2:1 ratio to intervention (n = 15) or control (n = 8) groups. The intervention group followed the STARFISH program for six weeks; the control group received usual care. Outcome measures included physical activity, sedentary time, heart rate, blood pressure, body mass index, Fatigue Severity Scale, Instrumental Activity of Daily Living Scale, Ten-Meter Walk Test, Stroke Specific Quality of Life Scale, and Psychological General Well-Being Index. RESULTS: The average daily step count increased by 39.3% (4158 to 5791 steps/day) in the intervention group and reduced by 20.2% (3694 to 2947 steps/day) in the control group (p = 0.005 for group-time interaction). Similar patterns of data and group-time interaction were seen for walking time (p = 0.002) and fatigue (p = 0.003). There were no significant group-time interactions for other outcome measures. CONCLUSION: Use of STARFISH has the potential to improve physical activity and health outcomes in people after stroke and longer term intervention trials are warranted.

The efficacy of cognitive prosthetic technology for people with memory impairments: a systematic review and meta-analysis.

Technology can compensate for memory impairment. The efficacy of assistive technology for people with memory difficulties and the methodology of selected studies are assessed. A systematic search was performed and all studies that investigated the impact of technology on memory performance for adults with impaired memory resulting from acquired brain injury (ABI) or a degenerative disease were included. Two 10-point scales were used to compare each study to an ideally reported single case experimental design (SCED) study (SCED scale; Tate et al., 2008 ) or randomised control group study (PEDro-P scale; Maher, Sherrington, Herbert, Moseley, & Elkins, 2003 ). Thirty-two SCED (mean = 5.9 on the SCED scale) and 11 group studies (mean = 4.45 on the PEDro-P scale) were found. Baseline and intervention performance for each participant in the SCED studies was re-calculated using non-overlap of all pairs (Parker & Vannest, 2009 ) giving a mean score of 0.85 on a 0 to 1 scale (17 studies, n = 36). A meta-analysis of the efficacy of technology vs. control in seven group studies gave a large effect size (d = 1.27) (n = 147). It was concluded that prosthetic technology can improve performance on everyday tasks requiring memory. There is a specific need for investigations of technology for people with degenerative diseases.

A Lack of Restraint: Comparing Virtual Reality Interaction Techniques for Constrained Transport Seating.

Standalone Virtual Reality (VR) headsets can be used when travelling in cars, trains and planes. However, the constrained spaces around transport seating can leave users with little physical space in which to interact using their hands or controllers, and can increase the risk of invading other passengers' personal space or hitting nearby objects and surfaces. This hinders transport VR users from using most commercial VR applications, which are designed for unobstructed 1-2m 360 ° home spaces. In this paper, we investigated whether three at-a-distance interaction techniques from the literature could be adapted to support common commercial VR movement inputs and so equalise the interaction capabilities of at-home and on-transport users: Linear Gain, Gaze-Supported Remote Hand, and AlphaCursor. First, we analysed commercial VR experiences to identify the most common movement inputs so that we could create gamified tasks based on them. We then investigated how well each technique could support these inputs from a constrained 50x50cm space (representative of an economy plane seat) through a user study (N=16), where participants played all three games with each technique. We measured task performance, unsafe movements (play boundary violations, total arm movement) and subjective experience and compared results to a control 'at-home' condition (with unconstrained movement) to determine how similar performance and experience were. Results showed that Linear Gain was the best technique, with similar performance and user experience to the 'at-home' condition, albeit at the expense of a high number of boundary violations and large arm movements. In contrast, AlphaCursor kept users within bounds and minimised arm movement, but suffered from poorer performance and experience. Based on the results, we provide eight guidelines for the use of, and research into, at-a-distance techniques and constrained spaces.

Designing ApplTree: usable scheduling software for people with cognitive impairments.

BACKGROUND: Smartphone reminding applications can help overcome memory difficulties experienced by people with acquired brain injury (ABI). Cognitive difficulties with memory and attention make entering reminders into a device, and remembering to set reminders, challenging for this group. ApplTree is a reminding app with features that aim to address challenges. One app feature was push notifications (asking "Do you need to set any reminders?") to support people to initiate use of the app to set reminders. Another app feature was a customisable user interface design to support attention and short term memory during reminder setting. METHODS: In a mixed-methods user study, five people with self or other reported memory impairment following ABI used ApplTree for at least 4 months. They received push notifications for at least 2 months and no push notifications for at least 2 months. Monthly participant interviews provided insight into user interface preference, app use, and push notification acceptability. RESULTS: Receiving four Push notifications per day doubled number of daily reminders set and four of the five participants found receiving them to be acceptable. This long-term field study uncovered issues relevant for clinicians and designers, including insights into the potential benefits of different user interface designs, the impact of family members on app use, and the importance of perceived need influencing use and acceptance. CONCLUSIONS: Feedback provided insight into future considerations when designing reminding apps and using them in neuropsychological rehabilitation. This work highlights the benefit of user-led research into accessible design and use of assistive technologies.IMPLICATIONS FOR REHABILITATION"Unsolicited" push prompts are an easy to implement feature of reminding technology that is useful and acceptable for people with ABI in community rehabilitation.Observations provide insights about how people with ABI make use of reminding apps over time. This can inform those designing apps or providing reminding technology as part of neuropsychological rehabilitation.Participants differed on their preference of the two user-interface designs available in ApplTree. This highlights an area for future research because currently available reminding apps have a broad-shallow design which may not always be appropriate for people with ABI.

Multimodal Biosensing for Vestibular Network-Based Cybersickness Detection.

Virtual reality (VR) has the potential to induce cybersickness (CS), which impedes CS-susceptible VR users from the benefit of emerging VR applications. To better detect CS, the current study investigated whether/how the newly proposed human vestibular network (HVN) is involved in flagship consumer VR-induced CS by simultaneously recording autonomic physiological signals as well as neural signals generated in sensorimotor and cognitive domains. The VR stimuli were made up of one or two moderate CS-inducing entertaining task(s) as well as a mild CS-inducing cognitive task implemented before and after the moderate CS task(s). Results not only showed that CS impaired cognitive control ability, represented by the degree of attentional engagement, but also revealed that combined indicators from all three HVN domains could together establish the best regression relationship with CS ratings. More importantly, we found that every HVN domain had its unique advantage with the dynamic changes in CS severity and time. These results provide evidence for involvement of the HVN in CS and indicate the necessity of HVN-based CS detection.

From Shielding to Avoidance: Passenger Augmented Reality and the Layout of Virtual Displays for Productivity in Shared Transit.

Passengers spend considerable periods of time in shared transit spaces, relying on smartphones and laptops for work. However, these displays are limited in size and ergonomics compared to typical multi-monitor setups used in the office, impairing productivity. Augmented Reality (AR) headsets could provide large, flexible virtual workspaces during travel, enabling passengers to work more efficiently. This paper investigates the factors affecting how passengers choose to layout virtual displays in car, train, subway and plane environments, studying the affordances of each mode of transport and the presence of others. Results from our experiment showed: significant usage of the physical environment to align displays; strong social effects meant avoiding placing displays over other passengers or their belongings; and use of displays for shielding oneself from others. Our findings show the unique challenges posed by the mode of transport and presence of others on the use of AR for mobile productivity in the future.

A Survey of Mid-Air Ultrasound Haptics and Its Applications.

Ultrasound haptics is a contactless haptic technology that enables novel mid-air interactions with rich multisensory feedback. This article surveys recent advances in ultrasound haptic technology. We discuss the fundamentals of this haptic technology, how a variety of perceptible sensations are rendered, and how it is currently being used to enable novel interaction techniques. We summarize its strengths, weaknesses, and potential applications across various domains. We conclude with our perspective on key directions for this promising haptic technology.

The School Attachment Monitor-A novel computational tool for assessment of attachment in middle childhood.

BACKGROUND: Attachment research has been limited by the lack of quick and easy measures. We report development and validation of the School Attachment Monitor (SAM), a novel measure for largescale assessment of attachment in children aged 5-9, in the general population. SAM offers automatic presentation, on computer, of story-stems based on the Manchester Child Attachment Story Task (MCAST), without the need for trained administrators. SAM is delivered by novel software which interacts with child participants, starting with warm-up activities to familiarise them with the task. Children's story completion is video recorded and augmented by 'smart dolls' that the child can hold and manipulate, with movement sensors for data collection. The design of SAM was informed by children of users' age range to establish their task understanding and incorporate their innovative ideas for improving SAM software. METHODS: 130 5-9 year old children were recruited from mainstream primary schools. In Phase 1, sixty-one children completed both SAM and MCAST. Inter-rater reliability and rating concordance was compared between SAM and MCAST. In Phase 2, a further 44 children completed SAM complete and, including those children completing SAM in Phase 1 (total n = 105), a machine learning algorithm was developed using a "majority vote" procedure where, for each child, 500 non-overlapping video frames contribute to the decision. RESULTS: Using manual rating, SAM-MCAST concordance was excellent (89% secure versus insecure; 97% organised versus disorganised; 86% four-way). Comparison of human ratings of SAM versus the machine learning algorithm showed over 80% concordance. CONCLUSIONS: We have developed a new tool for measuring attachment at the population level, which has good reliability compared to a validated attachment measure and has the potential for automatic rating-opening the door to measurement of attachment in large populations.

Technology to encourage meaningful activities following brain injury.

Background: Cognitive and behavioural difficulties after acquired brain injury (ABI) may lead to reduced engagement in leisure and social activities. Increasing participation is a goal of neuropsychological rehabilitation and assistive and behaviour change technology can play an important role in this. Focus groups and interviews were conductive with brain injury rehabilitation stakeholders (n = 24): people with ABI (n = 9), family members (n = 3) and care providers (n = 12) in order to understand the barriers to engaging in meaningful activities and what helps to overcome these barriers. A collaborative thematic analysis was performed by a multi-disciplinary research team using an approach based on Grounded Theory. Results: Four central, interlinked, barriers were found: Access, Cognitive Difficulties, Anticipation (of Physical or Cognitive Difficulties) and Motivation. To overcome these barriers, participants cited themes such as External Motivation from both Other People and Technology, Maintaining Momentum and different aspects of Being Planful. Conclusions: The results point to future directions for the purposeful development of effective assistive technology for this user group. Technology that is social, persuasive, adapts to individual needs and supports people to plan activities are likely to be particularly useful within neuropsychological rehabilitation.Implications For RehabilitationAdults with ABI and their carers describe problems accessing activities, cognitive difficulties, anticipationof physical or cognitive difficulties and low motivation as the key barriers to undertaking meaningfulactivities.Current solutions are external prompting, maintaining momentum and being planful.This detailed qualitative analysis of a diverse group of carers and service users allows insight into theassistive technologies that could aid rehabilitation.

Validation of smartphone step count algorithm used in STARFISH smartphone application.

BACKGROUND: Smartphone sensors are underutilised in rehabilitation. OBJECTIVE: To validate the step count algorithm used in the STARFISH smartphone application. METHODS: Twenty-two healthy adults (8 male, 14 female) walked on a treadmill for 5 minutes at 0.44, 0.67, 0.90 and 1.33 m⋅s-1. Each wore an activPALTM and four Samsung Galaxy S3TM smartphones, with the STARFISH application running, in: 1) a belt carrycase, 2) a trouser or skirt pocket), 3a) a handbag on shoulder for females or 3b) shirt pocket for males and 4) an upper arm strap. Step counts of the STARFISH application and the activPALTM were compared at corresponding speeds and Bland-Altman statistics used to assess level of agreement (LOA). RESULTS: The LOA between the STARFISH application and activPALTM varied across the four speeds and positions, but improved as speed increased. The LOA ranged from 105-177% at 0.44 m⋅s-1; 50-98% at 0.67 m⋅s-1; 19-67% at 0.9 m⋅s-1 and 8-53% at 1.33 m⋅s-1. The best LOAs were at 1.33 m⋅s-1 in the shirt pocket (8%) and upper arm strap (12%) positions. CONCLUSIONS: Step counts measured by the STARFISH smartphone application are valid in most body positions especially at walking speeds of 0.9 m⋅s-1 and above.

Increasing physical activity in older adults using STARFISH, an interactive smartphone application (app); a pilot study.

BACKGROUND: Increasing physical activity in older adults has preventative and therapeutic health benefits. We have developed STARFISH, a smartphone application, to increase physical activity. This paper describes the features of STARFISH, presents the views of older users on the acceptability and usability of the app and reports the results of a six week pilot study of the STARFISH app in older adults. METHODS: The operationalisation of the behaviour change techniques (BCTs) within the STARFISH app was mapped against the BCT Taxonomy of Michie et al. Sixteen healthy older adults (eight women and eight men; age 71.1 ± 5.2 years) used the app, in groups of four, for six weeks. Focus groups explored the user experience and objective measure of steps per day recorded. RESULTS: Participants were very positive about using the STARFISH app, in particular the embedded BCTs of self-monitoring, feedback and social support (in the form of group rewards). Objective step data, available for eight participants, showed that step counts increased by an average of 14% (p = 0.077, d = 0.56). CONCLUSION: The STARFISH app was acceptable and straightforward to use for older adults. STARFISH has potential to increase physical activity in older adults; however, a fully powered randomised controlled trial is required.

Physical activity profiles and sedentary behaviour in people following stroke: a cross-sectional study.

PURPOSE: To measure and compare physical activity profiles and sedentary time between community dwelling stroke survivors and healthy volunteers. METHODS: Twenty-two stroke survivors (10 men, age 55.3 ± 9.9 years; 4.2 ± 4.0 years since their stroke) were recruited from local stroke support groups, and 22 controls were matched for sex, age and body mass index (BMI). All participants wore an ActivPAL™ physical activity monitor for seven days and from these data activity profiles, including the number of steps per day, time spent sedentary and time in different cadence bands, were recorded. RESULTS: Stroke survivors took significantly fewer steps per day than the controls (4035 ± 2830 steps/day versus 8394 ± 2941 steps/day, p < 0.001) and sedentary time (including sleep time) was significantly higher for stroke participants compared to the controls (20.4 ± 2.7 h versus 17.5 ± 3.8 h, p < 0.001). People with stroke spent a significantly higher proportion of their walking time in lower self-selected cadences compared to the controls. CONCLUSIONS: Community dwelling stroke survivors spent more time sedentary, took fewer steps and walked at a slower self-selected cadence. Interventions to increase walking and reduce sedentary time following stroke are required which may have the added benefit of reducing cardiovascular risk in this group. Implications for Rehabilitation Stroke survivors are predisposed to reduced physical activity and increased cardiovascular risk. This study showed that community dwelling stroke survivors spent more time sedentary, took fewer steps and walked at a slower self-selected cadence. Interventions are required which focus on reducing sedentary time as well as increasing step counts in people following stroke.

Validation of a bovine rectal palpation simulator for training veterinary students.

Bovine rectal palpation is a necessary skill for a veterinary student to learn. However, lack of resources and welfare issues currently restrict the amount of training available to students in this procedure. Here we present a virtual reality based teaching tool -- the Bovine Rectal Palpation Simulator -- that has been developed as a supplement to existing training methods. When using the simulator, the student palpates virtual objects representing the bovine reproductive tract, receiving feedback from a PHANToM haptic device (inside a fibreglass model of a cow), while the teacher follows the student's actions on the monitor and gives instruction. We present a validation experiment that compares the performance of a group of traditionally trained students with a group whose training was supplemented with a simulator training session. The subsequent performance in the real task, when examining cows for the first time, was assessed with the results showing a significantly better performance for the simulator group.

Integrating a bovine rectal palpation simulator into an undergraduate veterinary curriculum.

There are problems associated with teaching bovine rectal palpation to undergraduate veterinary students. The students need opportunities to examine enough cows to develop the required skills, but increasing student numbers and limitations on access to cows have made this more and more difficult to achieve. A virtual reality-based teaching tool, the Bovine Rectal Palpation Simulator, has been developed as a supplement to existing training methods. The student palpates computer generated virtual models of the bovine reproductive tract while interacting with a haptic (touch feedback) device. During training sessions, the instructor follows the student's actions inside the virtual cow on the computer screen and gives instruction. A trial integration of the simulator into the fourth-year bovine reproduction course was undertaken at the University of Glasgow Veterinary School during the 2003/2004 academic year. Students were offered two training sessions, and feedback was gathered using questionnaires. In the first session, all students were taught a range of basic skills using a standardized teaching protocol. The second training session was customized to each student's learning needs and included practice in dealing with a range of on-farm scenarios. Student feedback indicated that the training had been useful for learning various aspects of bovine rectal palpation and provided information that helped in the further development of the simulator as a teaching tool.

Older users, multimodal reminders and assisted living technology.

The primary users of assisted living technology are older people who are likely to have one or more sensory impairments. Multimodal technology allows users to interact via non-impaired senses and provides alternative ways to interact if primary interaction methods fail. An empirical user study was carried out with older participants which evaluated the performance, disruptiveness and subjective workload of visual, audio, tactile and olfactory notifications then compared the results with earlier findings in younger participants. It was found that disruption and subjective workload were not affected by modality, although some modalities were more effective at delivering information accurately. It is concluded that although further studies need to be carried out in a real-world settings, the findings support the argument for multiple modalities in assisted living technology.

Evaluating an automated haptic simulator designed for veterinary students to learn bovine rectal palpation.

INTRODUCTION: Simulators provide a potential solution to some of the challenges faced when teaching internal examinations to medical or veterinary students. A virtual reality simulator, the Haptic Cow, has been developed to teach bovine rectal palpation to veterinary students, and significant training benefits have been demonstrated. However, the training needs to be delivered by an instructor, a requirement that limits availability. This article describes the development and evaluation of an automated version that students could use on their own. METHODS: An automated version was developed based on a recording of an expert's examination. The performance of two groups of eight students was compared. All students had undergone the traditional training in the course, namely lectures and laboratory practicals, and then group S used the simulator whereas group R had no additional training. The students were set the task of finding the uterus when examining cows. The simulator was then made available to students, and feedback about the "usability" was gathered with a questionnaire. RESULTS: The group whose training had been supplemented with a simulator session were significantly better at finding the uterus. The questionnaire feedback was positive and indicated that students found the simulator easy to use. CONCLUSIONS: The automated simulator equipped students with useful skills for examining cows. In addition, a simulator that does not need the presence of an instructor will increase the availability of training for students and be a more sustainable option for institutions.

Multimodal feedback for the acquisition of small targets.

This paper examines how multimodal feedback assists small-target acquisition in graphical user interfaces. All combinations of three feedback modes are analysed: non-speech audio; tactile; and pseudo-haptic "sticky" feedback. The tactile conditions used stimulation through vibration (rather than force-feedback), and the sticky conditions were implemented by dynamically reconfiguring mouse control-display gain as the cursor entered the target. Results show that for small, discretely located targets all feedback modes reduce targeting times, with stickiness providing substantial improvements. Furthermore, stickiness and tactile appear to combine well. However, the results of a more ecologically oriented menu-selection task show the need for caution, revealing that excessive feedback can damage interaction though "noise" that interferes with the acquisition of neighbouring targets.