Leveraging Emerging Technologies to Expand Accessibility and Improve Precision in Rehabilitation and Exercise for People with Disabilities.

Physical rehabilitation and exercise training have emerged as promising solutions for improving health, restoring function, and preserving quality of life in populations that face disparate health challenges related to disability. Despite the immense potential for rehabilitation and exercise to help people with disabilities live longer, healthier, and more independent lives, people with disabilities can experience physical, psychosocial, environmental, and economic barriers that limit their ability to participate in rehabilitation, exercise, and other physical activities. Together, these barriers contribute to health inequities in people with disabilities, by disproportionately limiting their ability to participate in health-promoting physical activities, relative to people without disabilities. Therefore, there is great need for research and innovation focusing on the development of strategies to expand accessibility and promote participation in rehabilitation and exercise programs for people with disabilities. Here, we discuss how cutting-edge technologies related to telecommunications, wearables, virtual and augmented reality, artificial intelligence, and cloud computing are providing new opportunities to improve accessibility in rehabilitation and exercise for people with disabilities. In addition, we highlight new frontiers in digital health technology and emerging lines of scientific research that will shape the future of precision care strategies for people with disabilities.

Using Large-Scale Sensor Data to Test Factors Predictive of Perseverance in Home Movement Rehabilitation: Optimal Challenge and Steady Engagement.

Persevering with home rehabilitation exercise is a struggle for millions of people in the US each year. A key factor that may influence motivation to engage with rehabilitation exercise is the challenge level of the assigned exercises, but this hypothesis is currently supported only by subjective, self-report. Here, we studied the relationship between challenge level and perseverance using long-term, self-determined exercise patterns of a large number of individuals (N = 2,581) engaging in home rehabilitation with a sensor-based exercise system without formal supervision. FitMi is comprised of two puck-like sensors and a library of 40 gamified exercises for the hands, arms, trunk, and legs that are designed for people recovering from a stroke. We found that individuals showed the greatest perseverance with the system over a 2-month period if they had (1) a moderate level of motor impairment and (2) high but not perfect success during the 1st week at completing the exercise game. Further, a steady usage pattern (vs. accelerating or decelerating use) was associated with more overall exercise, and declines in exercise amount over time were associated with exponentially declining session initiation probability rather than decreasing amounts of exercise once a session was initiated. These findings confirm that an optimized challenge level and regular initiation of exercise sessions predict achievement of a greater amount of overall rehabilitation exercise in a group of users of commercial home rehabilitation technology and suggest how home rehabilitation programs and exercise technologies can be optimized to promote perseverance.

Development of RehaBot-A Conversational Agent for Promoting Rewarding Activities in Users With Traumatic Brain Injury.

OBJECTIVE: In this article, we describe the development and preliminary testing of RehaBot-a chatbot that users communicate with via text messaging designed to augment behavioral activation (BA) treatment of reducing depression and increasing participation in individuals with moderate to severe traumatic brain injury (TBI). SETTING: Outpatient brain injury rehabilitation facility. PARTICIPANTS: Outpatient brain injury clinicians and individuals with moderate to severe TBI. DESIGN: Focus groups, software demonstration trials, and single-case experiments with an A-B-A design. MAIN MEASURES: System Usability Scale (SUS) and self-reported completed target activities. RESULTS: Focus group feedback guided the development of a flexible system to be used in conjunction with face-to-face therapy, designed to provide reminders, encouragement, and supportive feedback. Two of 3 participants completed all 6 RehaBot tasks independently. One completed 4 tasks independently and a fifth with assistance. Average SUS score in demonstration trials was 76.77 (SD = 21.19). In 4 single-case experiments, participants completed their highest proportion of planned activities in the RehaBot phase and the lowest proportion of planned activities in the reversal phase. They all interacted with RehaBot daily, exchanging an average of 225 messages over the 1-week period, and average SUS score was 95 (SD = 4.74). Their open-ended feedback revealed that participants found RehaBot enjoyable and easy to use. They felt it was a helpful memory aid and promoted better adherence to planned activities by providing accountability and positive reinforcement. CONCLUSIONS: This article presents a chatbot development process heavily involving consumer input, which may serve as a model for future development efforts. Our findings provide preliminary evidence suggesting that RehaBot is usable and may promote better adherence to planned target activities. However, future research is needed to establish usability and efficacy of RehaBot and to explore applications of chatbots to other domains of TBI rehabilitation.

Assessment of Prehospital Monitor/Defibrillators for Clostridioides difficile Contamination.

OBJECTIVES: The purpose of this study was to determine if Clostridioides difficile (C. diff) was present on the electrocardiogram (ECG) right arm leads, blood pressure cuffs, and fingertip pulse oximetry sensors of monitor/defibrillators used in the prehospital setting. METHODS: On March 22, 2019, a total of 20 prehospital monitor/defibrillators located at an Emergency Medical Service (EMS) station in Alabama (USA) were assessed for C. diff. The inside area of the fingertip pulse oximetry sensor, patient contact side of the blood pressure cuff, and right arm ECG lead of monitor/defibrillators (n = 60) were swabbed using a sterile cotton-tipped applicator saturated in a 0.85% Sodium Chloride solution. These cotton-tipped applicators were then inserted, scored, and released into Banana Broth vials. The vials were then sealed tightly and immediately transported to the laboratory, where they were incubated at 36°C for 72 hours. Colorimetric change from red to yellow was considered a positive indication for the presence of C. diff. RESULTS: Of 20 blood pressure cuffs, 15 had C. diff contamination (75%); C. diff was also present on 19 of 20 fingertip pulse oximeter sensors (95%) and 20 of 20 ECG right arm monitor leads (100%). CONCLUSION: Prehospital monitor/defibrillators may represent a significant reservoir of C. diff and other pathogenic bacteria. Improved disinfection protocols for reusable monitoring equipment and transition to disposable monitoring equipment used in the prehospital setting may reduce the risk of patient and EMS provider infection.

Corrigendum to "Emergency Medical Services resource capacity and competency amid COVID-19 in the United States: preliminary findings from a national survey" [Heliyon 6 (5) (May 2020) e03900].

[This corrects the article DOI: 10.1016/j.heliyon.2020.e03900.].

Erratum to "Emergency Medical Services resource capacity and competency amid COVID-19 in the United States: preliminary findings from a national survey" [Heliyon 6 (5) (May 2020) Article e03900].

[This corrects the article DOI: 10.1016/j.heliyon.2020.e03900.].

Emergency Medical Services resource capacity and competency amid COVID-19 in the United States: preliminary findings from a national survey.

OBJECTIVE: This study aimed to investigate available resources, Personal Protective Equipment (PPE) availability, sanitation practices, institutional policies, and opinions among EMS professionals in the United States amid the COVID-19 pandemic using a self-report survey questionnaire. METHODS: An online 42-question multiple choice survey was randomly distributed between April 1, 2020, and April 16, 2020 to various active Emergency Medical Services (EMS) paid personnel in all 50 U.S. states including the District of Columbia (n = 192). We approximate a 95% confidence interval (±0.07). RESULTS: An overwhelming number of EMS providers report having limited access to N95 respirators, receiving little or no benefits from COVID-19 related work, and report no institutional policy on social distancing practices despite CDC recommendations. For providers who do have access to N95 respirators, 31% report having to use the same mask for 1 week or longer. Approximately ⅓ of the surveyed participants were unsure of when a COVID-19 patient is infectious. The data suggests regular decontamination of EMS equipment after each patient contact is not a regular practice. DISCUSSION: Current practices to educate EMS providers on appropriate response to the novel coronavirus may not be sufficient, and future patients may benefit from a nationally established COVID-19 EMS response protocol. Further investigation on whether current EMS practices are contributing to the spread of infection is warranted. The data reveals concerning deficits in COVID-19 related education and administrative protocols which pose as a serious public health concern that should be urgently addressed.

Big Data Analytics and Sensor-Enhanced Activity Management to Improve Effectiveness and Efficiency of Outpatient Medical Rehabilitation.

Numerous societal trends are compelling a transition from inpatient to outpatient venues of care for medical rehabilitation. While there are advantages to outpatient rehabilitation (e.g., lower cost, more relevant to home and community function), there are also challenges including lack of information about how patient progress observed in the outpatient clinic translates into improved functional performance at home. At present, outpatient providers must rely on patient-reported information about functional progress (or lack thereof) at home and in the community. Information and communication technologies (ICT) offer another option-data collected about the patient's adherence, performance and progress made on home exercises could be used to help guide course corrections between clinic visits, enhancing effectiveness and efficiency of outpatient care. In this article, we describe our efforts to explore use of sensor-enhanced home exercise and big data analytics in medical rehabilitation. The goal of this work is to demonstrate how sensor-enhanced exercise can improve rehabilitation outcomes for patients with significant neurological impairment (e.g., from stroke, traumatic brain injury, and spinal cord injury). We provide an overview of big data analysis and explain how it may be used to optimize outpatient rehabilitation, creating a more efficient model of care. We describe our planned development efforts to build advanced analytic tools to guide home-based rehabilitation and our proposed randomized trial to evaluate effectiveness and implementation of this approach.

Promoting mental health in traumatic brain injury using single-session Behavioural Activation and SMS messaging: A randomized controlled trial.

We compared two treatments for depression and/ or anxiety in chronic moderate to severe traumatic brain injury (TBI) (Clinicaltrials.gov NCT02061553). Fifty-nine participants were randomized 2:1 to a single session of Behavioural Activation followed by 8 weeks of daily SMS (text) messages in the form of implementation intentions supporting individualized goals for increased rewarding/ meaningful activities (INT), or a single (attention control) session focused on the importance of motivation followed by 8 weeks of motivational SMS messages (MOT). Both conditions resulted in modestly improved emotional status. The INT condition led to more exposure to environmental reward and greater productivity. Gains in both conditions were of questionable clinical significance but suggested different mechanisms of action, which should be confirmed by further research. The delivery of frequent text messages proved to be a very feasible means of supporting treatment in this population.

The paradox of satiation.

Animals behave in bouts, and the process that causes feeding bouts to end is called satiation. Bout size or, in the case of feeding, meal size is the result both of the costs of food resources and the consequences of consuming a particular resource. Meal size increases as a function of increasing resource access cost; in this way, meal size is part of a strategy that economizes on time and energy spent acquiring food resources, thereby making time and effort available for competing activities. Meal size also varies as a function of the amount of the resource consumed and the animal's requirements for that resource. The paradox of satiation is that it is both a tool for economizing and a consequence of feeding.

The currency of procurement cost.

As the number of instrtumental responses required to procure access to food is increased, animals decrease the frequency of initiating meals and increase meal size, conserving total intake while limiting the increase in the overall cost of feeding. In two studies, one using wheel turns and one using bar presses as the instrumental response, we asked whether freely feeding laboratory rats measure cost according to the energy or the time they expend. In each study we varied both the price (i.e., number of wheel turns or bar presses) and the force required to make a response (i.e., torque on the wheel or weight of the bar). Price affected both procurement time (from the first to the last procurement response) and procurement work, whereas torque and bar weight affected work without altering time in most cases. Meal patterns were altered by all manipulations of price, but changes in torque and bar weight had little effect on meal patterns, except in the conditions in which they altered procurement time. These results suggest that time is a critical currency of procurement cost in rats.