An Evaluation of a Clinic-Based Low Vision Device Lending Library.

As the efficacy of low vision service provision is facilitated by clients' access to and proper use of low vision devices, the objective of this study was to evaluate an outpatient clinic-based low vision device lending library program and the functional and psychosocial impact that device use had upon clients. Twenty individuals borrowed portable video magnifiers during the study period. Line items from the Revised-Self-Report Assessment of Functional Visual Performance and the Reading Behavior Inventory were analyzed before and after device loan at two months. The Psychosocial Impact of Assistive Devices Scale-10 and a semi-structured interview were also completed at two months. Reported improvements in reading performance and satisfaction levels on the Reading Behavior Inventory were significant (p<.001). The Revised-Self-Report Assessment of Functional Visual Performance indicated improved independence in reading medications, bills and labels. Higher scores in happiness, independence, sense of control and adaptability on the Psychosocial Impact of Assistive Devices Scale-10 indicated device retention at two months. Qualitative themes included improved independence, time needed to acclimate to the device, personal appraisal impacting motivation and challenges specific to low vision. This article provides occupational therapists a model to facilitate access, person-device fit and successful use of low vision devices to promote therapy outcomes.

On the way home: a BCI-FES hand therapy self-managed by sub-acute SCI participants and their caregivers: a usability study.

BACKGROUND: Regaining hand function is the top priority for people with tetraplegia, however access to specialised therapy outwith clinics is limited. Here we present a system for hand therapy based on brain-computer interface (BCI) which uses a consumer grade electroencephalography (EEG) device combined with functional electrical stimulation (FES), and evaluate its usability among occupational therapists (OTs) and people with spinal cord injury (SCI) and their family members. METHODS: Users: Eight people with sub-acute SCI (6 M, 2F, age 55.4 ± 15.6) and their caregivers (3 M, 5F, age 45.3 ± 14.3); four OTs (4F, age 42.3 ± 9.8). User Activity: Researchers trained OTs; OTs subsequently taught caregivers to set up the system for the people with SCI to perform hand therapy. Hand therapy consisted of attempted movement (AM) of one hand to lower the power of EEG sensory-motor rhythm in the 8-12 Hz band and thereby activate FES which induced wrist flexion and extension. Technology: Consumer grade wearable EEG, multichannel FES, custom made BCI application. LOCATION: Research space within hospital. Evaluation: donning times, BCI accuracy, BCI and FES parameter repeatability, questionnaires, focus groups and interviews. RESULTS: Effectiveness: The BCI accuracy was 70-90%. Efficiency: Median donning times decreased from 40.5 min for initial session to 27 min during last training session (N = 7), dropping to 14 min on the last self-managed session (N = 3). BCI and FES parameters were stable from session to session. Satisfaction: Mean satisfaction with the system among SCI users and caregivers was 3.68 ± 0.81 (max 5) as measured by QUEST questionnaire. Main facilitators for implementing BCI-FES technology were "seeing hand moving", "doing something useful for the loved ones", good level of computer literacy (people with SCI and caregivers), "active engagement in therapy" (OT), while main barriers were technical complexity of setup (all groups) and "lack of clinical evidence" (OT). CONCLUSION: BCI-FES has potential to be used as at home hand therapy by people with SCI or stroke, provided it is easy to use and support is provided. Transfer of knowledge of operating BCI is possible from researchers to therapists to users and caregivers. Trial registration Registered with NHS GG&C on December 6th 2017; clinicaltrials.gov reference number NCT03257982, url: https://clinicaltrials.gov/ct2/show/NCT03257982 .

Effects of pressure garment on spasticity and function of the arm in the early stages after stroke: a randomized controlled trial.

OBJECTIVE: To investigate the effects of pressure (Lycra) garment on the spasticity and function of the arm in the early stages after stroke. DESIGN: A randomized controlled trial. SETTING: Occupational therapy unit of a public hospital. SUBJECTS: A total of 46 adults with stroke. INTERVENTION: After random assignment, for six weeks, both intervention group and control group received a 2 hour/week conventional occupational therapy program, with the intervention group receiving an extra 6 hour/day pressure garment application (long glove). MAIN MEASURES: Modified Modified Ashworth Scale, Disabilities of Arm, Shoulder and Hand Outcome Measure, and Jebsen-Taylor Hand Function Test. Eligibility measures: Mini Mental State Examination and Modified Modified Ashworth Scale. Assessments were performed at baseline and six weeks postintervention. RESULTS: There were 21 participants with the mean age of 51.19 (8.28) years in the intervention group and 22 participants with the mean (SD) age of 52.82 (8.71) years in the control group. The intervention group had median (interquartile range (IQR)) post-stroke duration of 1 (1) month, while for the control group, they were 2 (2) months. There was no difference in spasticity, and both perceived and actual arm functions between the groups at six weeks after baseline. CONCLUSION: Wearing a pressure garment on the arm for 6 hours daily had no effect in controlling spasticity or on improving arm function in the early stages after stroke.

Enhancing function after radial nerve injury with a high-profile orthosis and a bio-occupational orthotic framework.

STUDY DESIGN: Case report. INTRODUCTION: Radial nerve injury can cause severe functional impairment due to paralysis of wrist and digit extensors. Various orthotic designs have been described, including static, dynamic, and tenodesis. All provide wrist stabilization or extension assistance. Some, but not all, also provide extension assistance to the wrist, thumb, and fingers. PURPOSE AND METHODS: This article tells the story of Max, a 27-year-old male university student, who sustained a radial nerve injury after a left humeral shaft fracture. He was treated at a Brazilian tertiary hospital, where the choice of thermoplastics and dynamic components resulted in limited options for orthotic fabrication. Max was provided with custom-molded static wrist orthosis and a bulky, older style, high-profile dynamic forearm-based wrist-finger-thumb assistive-extension orthosis. RESULTS AND DISCUSSION: Grip strength and functional status improved, and Max was completely satisfied because with the dynamic orthosis, he could play the guitar again, which was his favorite activity. CONCLUSION: Max's story illustrates that a convenient functionally oriented orthotic intervention can be performed even in resource-limited environments by following the client-centered bio-occupational orthotic framework proposed by McKee and Rivard. This framework addresses the client's biological needs (addressing paralyzed muscles and maintaining length of soft tissues) and occupational/functional needs.

Design and development of a sensored glove for home-based rehabilitation.

STUDY DESIGN: Descriptive. INTRODUCTION: Rehabilitation programs that focus on motor recovery of the upper limb require long-term commitment from the clinicians/therapists, require one-to-one caring, and are usually labor-intensive. PURPOSE OF THE STUDY: To contribute to this area, we have developed a sensored hand glove integrated with a computer game (Flappy Bird) to engage patients playing a game where the subject's single/multiple fingers are involved, representing fine motor skill occupational therapeutic exercises. METHODS: We described the sensored rehab glove, its hardware design, electrical and electronic design and instrumentation, software design, and pilot testing results. RESULTS: Experimental results supported that the developed rehab glove system can be effectively used to engage a patient playing a computer game (or a mobile phone game) that can record the data (ie, game score, finger flexion/extension angle, time spent in a therapeutic session, etc.) and put it in a format that could be easily read by a therapist or displayed to the therapists/patients in different graph formats. CONCLUSIONS: We introduced a sensored rehab glove for home-based therapy. The exercise training using the glove is repetitious, functional, and easy to follow and comply with.

From thinking to acting: occupational self-analysis tools for use with people with intellectual disability. A pilot study.

BACKGROUND: Occupational self-analysis programmes have been developed to promote health, mainly in older adults. However, we have found no published studies dealing with this in people with intellectual disability (ID). The aim of this study was to examine the effectiveness of an occupational self-analysis programme in people with ID, focusing on the areas of subjective health perception and participation. METHODS: This study explored the benefits of the 'Occupational Self-Analysis Programme' in people with ID. The intervention group comprised 12 participants and the control group comprised 13 participants. Outcomes were measured using the SF-36 Health Survey and the Role Checklist. The contents of participants' journals and a focus group discussion were also analysed. RESULTS: Compared with the control group, the intervention group showed statistically significant improvements in role limitations because of physical health and role limitations because of emotional problems, social functioning and the cumulative scores of the mental component in the SF-36 Health Survey. The qualitative analysis revealed that participants in the intervention group increased their participation in activities related with daily living, leisure, employment seeking and acquisition, and social participation. These participants also became more aware of issues that lead to a greater engagement in meaningful occupations. CONCLUSION: This programme allowed participants to engage in meaningful activities with other people and to increase their perceived health status by raising awareness of the strengths and difficulties of participation.

Robotic-assisted therapy with bilateral practice improves task and motor performance in the upper extremities of chronic stroke patients: A randomised controlled trial.

BACKGROUND/AIM: Task-specific repetitive training, a usual care in occupational therapy practice, and robotic-aided rehabilitation with bilateral practice are used to improve upper limb motor and task performance. The difference in effects of two strategies requires exploration. This study compared the impact of robotic-assisted therapy with bilateral practice (RTBP) and usual task-specific training facilitated by therapists on task and motor performance for stroke survivors. METHODS: Forty-three community-dwelling stroke survivors (20 males; 23 females; 53.3 ± 13.1 years; post-stroke duration 14.2 ± 10.9 months) were randomised into RTBP and usual care. All participants received a 10-minute per-protocol sensorimotor stimulation session prior to interventions as part of usual care. Primary outcome was different in the amount of use (AOU) and quality of movement (QOM) on the Motor Activity Log (MAL) scale at endpoint. Secondary outcomes were AOU and QOM scores at follow-up, and pre-post and follow-up score differences on the Fugl-Meyer Assessment (FMA) and surface electromyography (sEMG). Friedman and Mann-Whitney U tests were used to calculate difference. RESULTS: There were no baseline differences between groups. Both conditions demonstrated significant within-group improvements in AOU-MAL and FMA scores following treatment (P < 0.05) and improvements in FMA scores at follow-up (P < 0.05). The training-induced improvement in AOU (30.0%) following treatment was greater than the minimal detectable change (16.8%) in the RTBP group. RTBP demonstrated better outcomes in FMA wrist score (P = 0.003) and sEMG of wrist extensor (P = 0.043) following treatment and in AOU (P < 0.001), FMA total score (P = 0.006), FMA wrist score (P < 0.001) and sEMG of wrist extensor (P = 0.017) at follow-up compared to the control group. Control group boost more beneficial effects on FMA hand score (P = 0.049) following treatment. CONCLUSIONS: RTBP demonstrated superior upper limb motor and task performance outcomes compared to therapists-facilitated task training when both were preceded by a 10-minute sensorimotor stimulation session. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03847103.

Converting the DriveSafe subtest of DriveSafe DriveAware for touchscreen administration.

BACKGROUND: DriveSafe measures awareness of the driving environment. It is one subtest of DriveSafe DriveAware, a cognitive fitness-to-drive screening instrument. We converted DriveSafe to a touchscreen format for ease of administration; this necessitated the development of an automatic data collection and scoring system to reflect the decision that would otherwise have been made by an expert rater. We applied a structured process to determine what constituted 'correct' scores. We then examined the resulting scoring parameters to determine if these discriminated at-risk drivers from a comparison sample. METHODS: Thirty at-risk older drivers and 30 younger drivers took touchscreen DriveSafe. Following presentation of images containing between one and four objects/hazards for 4 seconds, participants indicated their recall of object/hazard characteristics (type, location and direction of movement) by touching the screen. We analysed responses via descriptive statistics to compare spread, accuracy and consistency; and via a Fisher's exact test to determine whether the set scoring parameters could discriminate between at-risk and comparison drivers. RESULTS: Fisher's exact test results indicated 24 of 28 location zones and 18 of 28 direction ranges discriminated at-risk drivers from the comparison group (P < 0.05). Frequency of missed or incorrectly identified hazards was much higher for the at-risk group for all variables. At-risk drivers missed or misidentified significantly (P < 0.00) more object types (34%), directions (47%), and locations (36%) than the comparison group (≤4% for each variable). At-risk drivers entered 31 additional responses for objects/hazards not displayed; the comparison group entered no additional responses. CONCLUSION: The automatic variable data collection and scoring system reflected decisions that would have been made by an expert rater. This systematic process provided automated scoring decisions that enabled us to discriminate at-risk drivers from a comparison group. Psychometric evaluation of data gathered with touchscreen DriveSafe is required prior to use in clinical practice.

Parallel-Forms Reliability and Clinical Utility of an Application Version of the Activity Card Sort Australia (18-64).

OBJECTIVE: This study examined the parallel-forms reliability of a web application (app) of the Activity Card Sort Australia for adults ages 18-64 and assessed its clinical utility. METHOD: Forty-eight participants completed the app and card versions of the tool within a 2- to 3-wk interval and provided feedback via a purpose-designed survey. Intraclass correlation analysis tested parallel-forms reliability. RESULTS: The app demonstrated acceptable parallel-forms reliability for overall retained activity level (r = .75, p < .001), the daily life domain (r = .77, p < .001), and the recreation and relaxation domain (r = .74, p < .001), but not for the physical activity domain (r = .59, p < .001). Clinical utility responses suggested good acceptance of both versions. CONCLUSION: The results suggest that further studies are required before the app version can be used for research or in clinical settings.

Measuring Social Communication in the Community: Novel Tools for Advancing Family Participation.

Natural contexts and family involvement are key features of effective intervention approaches. However, the measurement of community participation and parent engagement with children remains complex. Therefore, we examined the feasibility of combining use of the Language ENvironment Analysis (LENA®) system and a global positioning system (GPS; i.e., Qstarz® BT-Q1000XT). The LENA is a small speech recognition device that captures and quantifies full-day recordings of the natural language environment. The Qstarz BT-Q1000XT is a wearable GPS data logger that allows identification of the locations a person visits. The marrying of these measures allows for an accurate representation of community settings that afford children greater social communication opportunities. Our results show that the combination of measures provides meaningful social communication location data. Also, the participating caregiver reported that the collection of measures was feasible across community settings.

Open-source 3D printed sensors for hand strength assessment: Validation of low-cost load cell and fabric sensor-based systems.

BACKGROUND/AIM: Pinch and grip strength assessment is commonly performed in occupational therapy practice. However, the typically utilised methods are limited to pinch or grip dynamometers and do not readily translate to handling everyday objects. With the advent of consumer-grade 3D printing and low-cost sensor systems, the possibilities for creating customised assessment devices are expanding. As a first step in determining the validity of low-cost sensor systems, their data must be compared to a gold standard. Consequently, this study examined the criterion validity of two such systems for measuring pinch strength, specifically a small load cell and pressure-sensing fabric, with a mechanical pinch gauge. METHODS: A total of 33 participants performed strength tests using a mechanical pinch grip device, which had a plastic 3D printed cover with a pressure-sensing fabric overlaid on it to allow for simultaneous criterion validation, and a small load cell with a plastic 3D printed casing designed for comfortable pinch grip assessment. RESULTS: The simultaneously assessed fabric sensor and mechanical pinch grip device showed excellent absolute (ICC2,k  = 0.94) and relative (Pearson's R = 0.90) agreement. Both devices showed similar excellent relative (R > 0.75) agreement with the load cell despite non-simultaneous assessment. These findings indicate that 3D printed sensors incorporating a load cell and a pressure-sensing fabric can be used to replicate a pinch grip assessment performed with a mechanical pinch gauge. CONCLUSIONS: This study lays the foundation for these sensor systems to be modified for use as assessment tools during the performance of functional tasks using everyday objects. Additionally, because both systems generate real-time force data they could be used for biofeedback as part of rehabilitation and strengthening programs. To aid uptake and future research using these systems, the 3D print models, step-by-step hardware design and software programs used are provided in an open-source format at www.rehabtools.org/otsensors.html.

Fidget spinners: Purported benefits, adverse effects and accepted alternatives.

PURPOSE OF REVIEW: In the span of a few months, fidget spinners have caught the eyes of millions of children, parents, educators and paediatricians. Fidget spinners, hand-held toys designed to spin freely in your grasp, have become a source of entertainment for consumers of all ages. Despite a lack of scientific evidence, toy marketers have advertised the benefits of fidget spinners for children with attention-deficit/hyperactivity disorder and other disorders (e.g. autism, anxiety, sensory issues). Parents are incentivized by these purported benefits to purchase fidget spinners to improve their child's concentration and decrease stress. RECENT FINDINGS: While fidget spinners are a new phenomenon, existing therapy toys (e.g. sensory putty) have been used by occupational therapists for similar reasons, with comparably little research supporting these claims. The purpose of this review is to explore literature regarding sensory toys and examine educator/professional-reported concerns and medical adverse effects of using fidget spinners. SUMMARY: Due to a recent surge in popularity, fidget spinners and other self-regulatory occupational therapy toys have yet to be subjected to rigorous scientific research. Thus, their alleged benefits remain scientifically unfounded. Paediatricians should be aware of potential choking hazards with this new fad, and inform parents that peer-reviewed studies do not support the beneficial claims.

Bilateral robotic priming before task-oriented approach in subacute stroke rehabilitation: a pilot randomized controlled trial.

OBJECTIVES: To investigate the treatment effects of bilateral robotic priming combined with the task-oriented approach on motor impairment, disability, daily function, and quality of life in patients with subacute stroke. DESIGN: A randomized controlled trial. SETTING: Occupational therapy clinics in medical centers. SUBJECTS: Thirty-one subacute stroke patients were recruited. INTERVENTIONS: Participants were randomly assigned to receive bilateral priming combined with the task-oriented approach (i.e., primed group) or to the task-oriented approach alone (i.e., unprimed group) for 90 minutes/day, 5 days/week for 4 weeks. The primed group began with the bilateral priming technique by using a bimanual robot-aided device. MAIN MEASURES: Motor impairments were assessed by the Fugal-Meyer Assessment, grip strength, and the Box and Block Test. Disability and daily function were measured by the modified Rankin Scale, the Functional Independence Measure, and actigraphy. Quality of life was examined by the Stroke Impact Scale. RESULTS: The primed and unprimed groups improved significantly on most outcomes over time. The primed group demonstrated significantly better improvement on the Stroke Impact Scale strength subscale ( p = 0.012) and a trend for greater improvement on the modified Rankin Scale ( p = 0.065) than the unprimed group. CONCLUSION: Bilateral priming combined with the task-oriented approach elicited more improvements in self-reported strength and disability degrees than the task-oriented approach by itself. Further large-scale research with at least 31 participants in each intervention group is suggested to confirm the study findings.

Does occupational therapy reduce the need for surgery in carpometacarpal osteoarthritis? Protocol for a randomized controlled trial.

BACKGROUND: In the absence of disease-modifying interventions for hand osteoarthritis (OA), occupational therapy (OT) comprising patient education, hand exercises, assistive devices and orthoses are considered as core treatments, whereas surgery are recommended for those with severe carpometacarpal (CMC1) OA. However, even though CMC1 surgery may reduce pain and improve function, the risk of adverse effects is high, and randomized controlled trials comparing surgery with non-surgical interventions are warranted. This multicentre randomized controlled trial aims to address the following questions: Does OT in the period before surgical consultation reduce the need for surgery in CMC1-OA? What are patients' motivation and reasons for wanting CMC1-surgery? Are there differences between departments of rheumatology concerning the degree of CMC1-OA, pain and functional limitations in patients who are referred for surgical consultation for CMC1 surgery? Is the Measure of Activity Performance of the Hand a reliable measure in patients with CMC1-OA? Do patients with CMC1-OA with and without affection of the distal and proximal interphalangeal finger joints differ with regard to symptoms and function? Do the degree of CMC1-OA, symptoms and functional limitations significantly predict improvement after 2 years following OT or CMC1-surgery? Is OT more cost-effective than surgery in the management of CMC1-OA? METHODS/DESIGN: All persons referred for surgical consultation due to their CMC1-OA at one of three Norwegian departments of rheumatology are invited to participate. Those who agree attend a clinical assessment and report their symptoms, function and motivation for surgery in validated outcome measures, before they are randomly selected to receive OT in the period before surgical consultation (estimated n = 180). The primary outcome will be the number of participants in each group who have received surgical treatment after 2 years. Secondary and tertiary outcomes are pain, function and satisfaction with care over the 2-year trial period. Outcomes will be collected at baseline, 4, 18 and 24 months. The main analysis will be on an intention-to-treat basis, using logistic regression, comparing the number of participants in each group who have received surgical treatment after 2 years. DISCUSSION: The findings will improve the evidence-based management of HOA. TRIAL REGISTRATION IDENTIFIER: NCT01794754 . First registrated February 15th 2013.

Systematic Review of the Effectiveness of Frequency Modulation Devices in Improving Academic Outcomes in Children With Auditory Processing Difficulties.

This systematic review describes the published evidence related to the effectiveness of frequency modulation (FM) devices in improving academic outcomes in children with auditory processing difficulties. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards were used to identify articles published between January 2003 and March 2014. The Cochrane Population, Intervention, Control, Outcome, Study Design approach and the American Occupational Therapy Association process forms were used to guide the article selection and evaluation process. Of the 83 articles screened, 7 matched the systematic review inclusion criteria. Findings were consistently positive, although limitations were identified. Results of this review indicate moderate support for the use of FM devices to improve children's ability to listen and attend in the classroom and mixed evidence to improve specific academic performance areas. FM technology should be considered for school-age children with auditory processing impairments who are receiving occupational therapy services to improve functioning in the school setting.

Upper limb motor training using a Saebo™ orthosis is feasible for increasing task-specific practice in hospital after stroke.

BACKGROUND/AIM: Assistive technologies have the potential to increase the amount of movement practice provided during inpatient stroke rehabilitation. The primary aim of this study was to investigate the feasibility of using the Saebo-Flex™ device in a subacute stroke setting to increase task-specific practice for people with little or no active hand movement. The secondary aim was to collect preliminary data comparing hand/upper limb function between a control group that received usual rehabilitation and an intervention group that used, in addition, the Saebo-Flex™ device. METHODS: Nine inpatients (mean three months (median six weeks) post-stroke) participated in this feasibility study conducted in an Australian rehabilitation setting, using a randomised pre-test and post-test design with concealed allocation and blinded outcome assessment. In addition to usual rehabilitation, the intervention group received eight weeks of daily motor training using the Saebo-Flex™ device. The control group received usual rehabilitation (task-specific motor training) only. Participants were assessed at baseline (pre-randomisation) and at the end of the eight-week study period. Feasibility was assessed with respect to ease of recruitment, application of the device, compliance with the treatment programme and safety. Secondary outcome measures included the Motor Assessment Scale (upper limb items), Box and Block Test, grip strength and the Stroke Impact Scale. RESULTS: Recruitment to the study was very slow because of the low number of patients with little or no active hand movement. Otherwise, the study was feasible in terms of being able to apply the Saebo-Flex™ device and compliance with the treatment programme. There were no adverse events, and a greater amount of upper limb rehabilitation was provided to the intervention group. While there were trends in favour of the intervention group, particularly for dexterity, no between-group differences were seen for any of the secondary outcomes. CONCLUSIONS: This pilot feasibility study showed that the use of assistive technology, specifically the Saebo-Flex™ device, could be successfully used in a sample of stroke patients with little or no active hand movement. However, recruitment to the trial was very slow. The use of the Saebo-FlexTM device had variable results on outcomes, with some positive trends seen in hand function, particularly dexterity.

The aesthetic appeal of assistive technology and the economic value baby boomers place on it: A pilot study.

BACKGROUND: This pilot study aimed to understand the importance of assistive technology (AT) aesthetics on the intention to purchase, using grab rails as the example. Furthermore, the study explored the economic value consumers placed on aesthetic appeal. METHOD: Structured interviews were conducted with 25 participants, nine female, mean age 59; where seven grab rails were presented and feedback obtained on the level of appeal and 'willingness to pay'. Responses to open-ended and fixed response questions were transcribed by the interviewer during the interview and a qualitative content analysis conducted. RESULTS: Positive and negative terms in relation to aesthetics were used to describe appealing and unappealing grab rails; however, all grab rails were felt to have negative aesthetic aspects by at least five participants. Physical design and finish emerged as the two main themes regarding the appeal of the grab rail designs. Participants' 'willingness-to-pay' for appealing options was mixed, with both over and under valuations. The most likely grab rails to be purchased were considered both appealing and cost effective by participants. CONCLUSION: Aesthetic appeal plays an important role in acceptance and uptake of AT. Designers and manufacturers should be encouraged to provide appealing options as the study has shown consumers prefer aesthetically appealing grab rails. However, the challenge is creating more appealing designs, without increasing cost as consumers seem to not want to pay more for them. Furthermore, clinicians need to acknowledge the importance of aesthetics when recommending interventions and be familiar with a range of options to provide clients with more choice.

A controlled pilot trial of two commercial video games for rehabilitation of arm function after stroke.

OBJECTIVES: To investigate the acceptability and potential efficacy of two commercial video games for improving upper extremity function after stroke in order to inform future sample size and study design. DESIGN: A controlled clinical trial design using sequential allocation into groups. SETTING: A clinical occupational therapy department. SUBJECTS: Twenty-four first-stroke patients. INTERVENTIONS: Patients were assigned to one of three groups: conventional group, Wii group, and XaviX group. In addition to regular one-hour conventional rehabilitation, each group received an additional half-hour of upper extremity exercises via conventional devices, Wii games, or XaviX games, for eight weeks. MAIN MEASURES: The Fugl-Meyer Assessment of motor function, Box and Block Test of Manual Dexterity, Functional Independence Measure, and upper extremity range of motion were used at baseline and postintervention. Also, a questionnaire was used to assess motivation and enjoyment. RESULTS: The effect size of differences in change scores between the Wii and conventional groups ranged from 0.71 (SD 0.59) to 0.28 (SD 0.58), on the Fugl-Meyer Assessment of motor function (d = 0.74) was larger than that between the XaviX and conventional groups, ranged from 0.44 (SD 0.49) to 0.28 (SD 0.58) (d = 0.30). Patient enjoyment was significantly greater in the video game groups (Wii mean 4.25, SD 0.89; XaviX mean 4.38, SD 0.52) than in the conventional group (mean 2.25, SD 0.89, F = 18.55, p < 0.001), but motivation was not significantly different across groups. CONCLUSION: Patients were positive to using video games in rehabilitation. A sample size of 72 patients (24 per group) would be appropriate for a full study.

TagTrainer: supporting exercise variability and tailoring in technology supported upper limb training.

BACKGROUND: Rehabilitation technology for upper limb training can potentially increase the amount, duration, and quality of therapy offered to patients by targeting the needs of individual patients. Empirical evaluations of such technologies focus on clinical effectiveness; however, little is known regarding the implications of their implementation in daily practice. Tailoring training content to patients requires active participation by therapists, and requires an extension of their role to include authoring and modifying exercises. It is not yet known whether this is feasible, and the socio-technical requirements that will make it successful in practice have not yet been explored. The current study investigates the extent to which therapists can take the role of authoring patient-specific training content and whether effort savings can be achieved by sharing the created content. METHOD: We present TagTrainer: an interactive tabletop system for rehabilitation that can be operated by manipulating every day physical objects in order to carry out exercises that simulate daily living tasks. TagTrainer supports therapists in creating their own exercises that fit individual patient needs, in adjusting existing exercises, and in putting together personalized exercise programs for and with patients. Four therapists in stroke- and paraplegia-rehabilitation have used TagTrainer for three weeks. Semi-structured interviews were conducted with the therapists, questionnaires were administered to them, and observation notes and usage logs were collected. RESULTS: A total of 20 exercises were created from scratch, while another three exercises were created as variations of the existing ones. Importantly, all these exercises were created to address specific needs that patients expressed. The patients found the exercises motivating and these exercises were integrated into their regular training. CONCLUSIONS: TagTrainer can support arm-hand rehabilitation training by increasing therapy variability and tailoring. Therapists consider TagTrainer most suited for group sessions where they supervise many patients at once. Therapists are motivated and are able to, with minimal training, create and tailor exercises for patients fitting individual needs and capabilities. Future research will examine the socio-technical conditions that will encourage therapists to contribute and share training content, and provide the peer support needed for the adoption of a new technology.

Use of computer access technology as an alternative to writing for a pre-school child with athetoid cerebral palsy--a case report.

The purpose of this study was to demonstrate the use of an outcome-driven model of decision-making in the implementation of computer access technology (CAT) for a pre-school child with athetoid cerebral palsy. The child did not have the fine motor skills required to hold a pencil but had the cognitive abilities to learn to write; therefore, we explored the use of a CAT device to enable written communication. Case study methodology was used to describe the selection process, child-level outcomes, and clinical challenges faced by the therapist in the use of a consortium model that was designed for an outcome-driven model of decision-making. The critical role of an occupational therapist in this process using a family-centered approach is discussed.