BACKGROUND:Falls represent a critical public health burden in older adults and individuals with neurological disabilities, but evidence for passive footwear-based fall prevention strategies remains limited. OBJECTIVE:To evaluate changes in fall frequency and fall-related outcomes following adoption of variable-friction (VF) footwear. METHODS:This retrospective pre-post observational study used self-reported survey data collected from community-dwelling adults aged ≥18 years who had worn VF footwear for ≥3 months. Participants were recruited from a convenience sample of 14,570 invited customers who purchased the device through an electronic survey platform. Outcomes included self-reported fall frequency, injurious falls, fall mechanisms, fall-related health care utilization (including medical visits, urgent care, and hospitalization) and assistive device use, assessed before and during VF footwear use. RESULTS:A total of 706 participants completed the survey, yielding 705 participants with usable data for analysis (4.8% response rate). Mean monthly participant-reported falls decreased from 2.4 (SD 4.3) before VF use to 0.3 (SD 1.9) during VF use (87.1% reduction; Wilcoxon signed-rank, P < .001). The proportion reporting zero falls increased from 22.7% to 84.4%. Among participants with at least 1 fall before VF use (n = 545), 95.4% reported a reduction, including 80.7% reporting zero falls during VF use. Injurious falls decreased by 93.2% (P < .001). Participants requiring medical attention decreased from 192 (27.2%) to 12 (1.7%; 93.8% reduction; P < .001), and hospital or urgent care visits decreased from 131 (18.6%) to 10 (1.4%; 92.4% reduction; P < .001). Trip-related falls decreased from 52.3% to 31.5% of reported mechanisms among participants who reported a fall mechanism in both periods (P < .001). Assistive device use decreased from 70.8% to 16.6% (P < .001). Mean annualized insurance-related fall costs decreased from $5,946.2 to $45.7 per person-year (99.2% reduction) across the full cohort. CONCLUSIONS:VF footwear use was associated with substantial reductions in self-reported falls, injurious falls, and fall-related healthcare utilization. Reductions in trip-related falls are consistent with the proposed biomechanical mechanism of the device. Given the low survey response rate and potential for self-selection bias, these findings should be considered preliminary. Prospective controlled studies are needed to confirm these findings. CLINICALTRIAL:
BackgroundThe implementation of Internet of Things (IoT) technologies to proactively monitor the functioning of assistive products remains underexplored, particularly in public assistive technology services. ObjectiveThis qualitative single-case study investigated how a public assistive technology provider in Sweden implemented IoT-equipped assistive products. MethodsThe implementation process was mapped, and a thematic analysis of interviews with 6 participants representing key organizational roles was conducted. ResultsThe process comprised 9 major events involving 4 main stakeholders. The findings included 4 themes of facilitators and 5 themes of barriers, which were synthesized into three meta-themes: (1) system-level structures that enable and constrain implementation, (2) tensions between technological potential and the challenges of realizing it, and (3) relational and cultural dynamics that balance trust with caution. ConclusionsThe findings underscore the importance of using a sociotechnical framework to guide the implementation of IoT in assistive technology services. Such a framework supports a holistic approach that integrates user needs, privacy considerations, and regulatory requirements, while drawing on leadership, technical expertise, and collaboration to address legal, organizational, technical, and user-related challenges. The implications for health care technology implementation are that organizations should adopt sociotechnical implementation strategies that account for legal, organizational, technical, and user-related considerations.
Background Digital social media aids are features that enhance accessibility to social media for users with disabilities. One group of adults with disabilities who have reported barriers to social media access is adults with traumatic brain injury (TBI). Results of previous studies showed that adults with TBI want to engage in social media but encounter significant barriers to doing so, due in large part to TBI-related cognitive and communication challenges. We previously collaborated with adults with TBI to develop 5 aids to increase social media access. Aids were implemented as Chrome extensions that modified user interface functions and visuals on Facebook. The present study was the next step: testing the use of the 5 aids by a novel group of adults with TBI longitudinally and in naturalistic settings. Objective This study aimed to determine (1) how participants perceived each aid (ie, in terms of satisfaction, usability, likes, and dislikes), (2) how aids influenced participants’ well-being, and (3) which aid features participants rated as most and least useful. Methods We recruited 39 adult Facebook users with TBI to take part in an approximately 1-month-long within-subject evaluation study of Facebook browser aids. Each aid was used for 3 days, followed by an evaluation and a subsequent 2-day no-aid use period. Participants evaluated each of the 5 unique browser aids in a randomized order. Results Users reported the aids to be beneficial, especially aids that reduced visual clutter and information overload. Users also reported increased life satisfaction after using the aids (P=.02). Conclusions These results provide proof of concept for the types of digital aids that could improve access to social media for users with TBI. We advocate including aids like these across all social media platforms so users with TBI can access the benefits of engagement in social media with fewer barriers.
Abstract Background Gait impairment is a prevalent sequela of stroke. Although observational gait analysis remains a standard clinical practice for assessing neuromotor impairments in people with stroke, it is prone to subjective bias. Consequently, objective assessment is required to inform effective rehabilitation protocols. Objective This study aimed to validate a deep learning framework for automating clinical gait assessment using kinematic data. Methods This study was conducted in a university-affiliated gait analysis laboratory. Kinematic data were collected from 51 individuals with hemiparetic stroke and 18 healthy controls using wearable inertial measurement units, and video recordings were obtained for the Wisconsin Gait Scale (WGS) scoring. WGS scores, rated by 2 experienced physiotherapists, were used to establish the expert reference standard. A statistical graph convolutional network (STAT-GCN), incorporating a STAT-Attention Head module, was developed to predict WGS items 2 to 14 from kinematic data. Model evaluation was performed using a stratified, participant-level 5-fold cross-validation protocol, with all gait cycles from the same participant kept within the same fold. Model performance was assessed at the participant level using exact accuracy, mean absolute error, and weighted κ metrics. A descriptive comparison involving 4 final-year physiotherapy students was also conducted. Results Among participants with stroke, STAT-GCN achieved an overall exact accuracy of 75.42% for WGS items 2 to 14, with a mean absolute error of 0.290 score levels. Across the participant-level 5-fold cross-validation test sets, STAT-GCN achieved a mean exact accuracy of 75.64% (SD 6.58%), whereas the 4 student evaluators achieved mean accuracies ranging from 56.19% (SD 7.03%) to 67.09% (SD 4.03%). Conclusions The proposed STAT-GCN framework demonstrated reasonable preliminary performance for automated WGS item prediction in individuals with stroke. The results suggest that kinematic data–driven models may support more standardized gait assessment, but performance should be interpreted cautiously given the limited sample size, class imbalance across WGS score items, and absence of external validation. Further studies with larger and more clinically diverse stroke cohorts are needed before clinical implementation.
Background:Digital transformation in health care, including telemedicine, wearable devices, robotic process automation (RPA), and electronic medical records (EMRs), is reshaping outpatient care delivery. However, consolidated evidence on how these technologies influence patient care quality (PCQ) remains limited. Objective:This study evaluated the impact of emerging digital health technologies on PCQ dimensions in outpatient clinics through a systematic literature review combined with expert perspectives. Methods:A systematic review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines was conducted across ABI/INFORM, ScienceDirect, MEDLINE, and Google Scholar to identify studies published between 2017 and 2022. Studies examining digital technologies and their effects on outpatient PCQ were included. After screening and eligibility assessment, 53 studies were retained for synthesis. In parallel, semistructured interviews were conducted with 19 subject matter experts from public health, health informatics, and outpatient clinical practice. Findings were thematically analyzed using SERVQUAL (Service Quality Model) dimensions: responsiveness, reliability, empathy, communication, and tangibles, and triangulated across both datasets. Results:RPA led to substantial reductions in waiting times, while telemedicine improved accessibility and continuity of care, as highlighted by 14 of 19 experts. Wearable devices enhanced remote monitoring and patient engagement but required adequate digital literacy. Several studies (n=7) reported that EMR usability challenges negatively affected patient-physician communication. Overall, improvements were most evident in responsiveness and communication, while empathy and patient-centeredness remained comparatively weaker without targeted training and workflow adjustments. Conclusions:Emerging digital health technologies can enhance outpatient PCQ, particularly in operational efficiency, access to care, and communication. This review is innovative in that it integrates evidence across telemedicine, wearable monitoring, RPA, and EMRs within a unified SERVQUAL framework, offering practical guidance for implementing patient-centered digital health strategies in outpatient settings.
Background:Falls commonly cause injuries in older adults and can present with syncope or presyncope. Typically, frail older adults with cognitive impairment are underrepresented in research and experience difficulty tolerating conventional ECG monitoring devices. S-Patch is a novel, lightweight dual-lead device designed to provide continuous ECG monitoring for up to 72 hours with minimal interference to daily activities. Objective:This study aimed primarily to evaluate the feasibility, tolerability, and adherence of the S-Patch compared with standard 24-hour Holter monitoring in older adults (aged ≥60 years) presenting with unwitnessed falls, syncope, or near-syncope, as assessed by wear duration, completion rates, and patient-reported experience. The secondary objective of this study was to assess device usability and compare arrhythmia detection rates between the devices in a real-world setting. Methods:This prospective, single-center, randomized, open-label, crossover feasibility pilot study was conducted from March 8, 2020, to February 28, 2023. Participants were randomized 1:1 into group A (Holter followed by S-Patch) or group B (S-Patch followed by Holter), enabling up to 4 days of continuous monitoring. Results:Seventy patients were enrolled, of whom 32 (45.7%) had cognitive impairment, and the majority were frail. Group A participants were older (86.9 vs 82.9 years) with higher use of dementia medications (6/35, 17.1% vs 3/35, 8.6%). Frailty was highly prevalent across the cohort, and fear of falling was significantly greater among frail patients (P=.04). Both devices were well tolerated, with no difference in overall device preference, but S-Patch enabled substantially longer monitoring durations compared to Holter. Mean S-Patch wear time exceeded 60 hours and was significantly longer when the device was applied first (68.8 vs 62.9 h; P=.04), suggesting acceptance and adherence. Importantly, tolerability was maintained in frail patients with cognitive impairment. Arrhythmia detection rates were observed as comparable, with both devices identifying one clinically significant arrhythmia, resulting in pacemaker implantation. Conclusions:S-Patch is a feasible, well-tolerated cardiac monitoring device in frail older adults and those with cognitive impairment. Compared with Holter, S-Patch supported longer continuous monitoring without compromising patient acceptability, an important consideration in real-world clinical practice.
BackgroundPeople with severe to profound intellectual disability and visual or visual and motor impairments often experience passivity and isolation. This can lead to limited environmental stimulation, reduced physical activity, and the acquisition of incorrect body postures. Approaches to improve the situation have generally involved increasing environmental stimulation, which was regulated by the context or controlled by the people through adaptive responding and assistive technology. ObjectiveThis study assessed 2 intervention programs serving as extensions and advancements of previous approaches aimed at helping participants with intellectual and multiple disabilities control environmental stimulation through their own responses and assistive technology. The first program was designed to help 4 participants with severe intellectual disability and blindness alternate between periods of preferred music stimulation and mild physical activity. The second program was designed to help 5 participants with severe to profound intellectual disability, visual and motor impairments, and postural problems (ie, a tendency to tilt their torso and head forward). These participants were led to access preferred environmental stimulation, engage in mild physical activity, and increase correct posture. MethodsEach of the 2 programs was implemented according to a single-case research design. The technology for the first program involved (1) a smartphone with the MacroDroid app, which regulated the intervention conditions; (2) pressure sensors that allowed the participants to activate music stimulation; (3) a proximity sensor that monitored the participants’ physical activity responses (ie, placing objects in a container high up in front of them); and (4) a mini speaker. The same technology was also used for the second program. In this program, the participants’ physical activity responses consisted of arm-stretching movements, and the smartphone also served for monitoring the participants’ correct posture. Within each program, a session included 7 music periods and 6 activity periods. ResultsDuring programs 1 and 2, the mean percentage of music pieces activated independently of research assistants’ guidance was between 94.7% and 99.4%. The mean percentage of objects placed in the carton and of shelf-touching responses performed independently was between 98.7% and 99.7%. The baseline mean percentages were between 0% and 24.5%. The mean percentage of session time in a correct posture (program 2) increased to 71.1%-89.6% from baseline values of 18.8%-36.5%. A total of 8 of the 9 participants involved in the 2 programs showed higher levels of indices of happiness during program sessions than control sessions. ConclusionsThe results suggest that the programs might be a useful resource for supporting people with severe to profound intellectual disability and visual or visual and motor impairments.
Background:Age-related macular degeneration (AMD) causes progressive central vision loss in older adults. Low-vision rehabilitation can improve functional vision by training the use of a preferred retinal locus, commonly through clinic-based biofeedback training (BFT). However, repeated supervised rehabilitation is burdensome, and functional gains may be difficult to sustain without home practice. Stand-alone virtual reality (VR) may enable home-based, remotely monitored visual stimulation, but feasibility, safety, and usability in older adults with AMD remain insufficiently characterized. Objective:This study aimed to evaluate the feasibility and safety of adding home-based VR 3D single-object tracking (3D-SOT-VR) to conventional BFT in older adults with dry AMD in a parallel, randomized, single-blind (to assessors), controlled, formative trial and to generate exploratory functional hypotheses for a future trial. Methods:Adults with dry AMD were recruited at the Low Vision Clinic, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada, from September 2021 to October 2023. Participants were randomized to BFT once weekly for 4 weeks (BFT group) or BFT plus home-based 3D-SOT-VR (BFT-VR group) every other day for 4 weeks. Experimental intervention consisted of tracking a single object among distractors moving at different speeds in a 3D virtual space in a VR headset. Primary feasibility and safety outcomes included recruitment, adoption, adherence, compliance, intervention completion, remote data transfer, usability, and VR-induced symptoms and effects. Secondary outcomes included visual acuity, contrast sensitivity, fixation stability, retinal sensitivity, reading speed, and low-vision quality of life. Exploratory outcomes assessed performance at 3D-SOT-VR and usage. Analyses were descriptive and exploratory, with CIs and denominators reported to reflect limited precision and missingness. Results:Fourteen individuals were randomized (BFT, n=6; BFT-VR, n=8), below the planned sample size of 32. Recruitment was not achieved because of COVID-19-related interruptions and reduced onsite access. Eleven individuals were analyzed for the primary outcome (BFT n=6, BFT-VR n=5). Intervention completion was 100% in the BFT arm and 75% in the BFT-VR arm, below the prespecified BFT-VR threshold. Among participants who used VR, adherence to scheduled home sessions was acceptable, completed VR-session files were transmitted without loss, and no participant met the predefined cybersickness stopping rule. One BFT-VR participant discontinued because headset weight caused neck fatigue. Group-level visual outcomes did not provide significant effectiveness. Reading speed showed a clinically meaningful individual-level improvement in the BFT-VR arm and correlated with VR-task performance. The findings were not clearly durable at follow-up. Conclusions:This pilot study provides formative evidence that clinic-based BFT combined with home-based, remotely monitored VR visual stimulation can be implemented safely in older adults with dry AMD, while identifying major contextual feasibility barriers. The intervention is innovative because it extends low-vision rehabilitation into the home using a connected device and objective performance monitoring. Recruitment, retention, missing data handling, and sustainability of functional gains must be addressed before effectiveness testing.
Abstract Background Indoor navigation remains a major challenge for people with visual impairments, affecting autonomy, safety, and quality of life. While navigation‑based assistive technologies leveraging artificial intelligence and mobile computing show promise, their adoption remains limited due to insufficient user-centered and context-aware design. Objective This study aimed to co-design Edge A-Eye, an inclusive artificial intelligence–powered indoor navigation platform for people with visual impairment in Canada, using a participatory and interdisciplinary approach grounded in accessibility, rehabilitation, and human-centered design principles. Methods From May 2024 to December 2025, we conducted research using an 8-step iterative co-design process. A total of 12 people with visual impairment and 2 specialists in vision rehabilitation participated in bilingual focus groups and semistructured interviews. A co-creation workshop gathered 21 stakeholders (users, clinicians, researchers, and industry partners). Successive prototypes were evaluated in controlled environments and real-world public settings. Data were analyzed thematically using an inductive-deductive approach informed by human-centered and inclusive design frameworks. Results Continuous stakeholder engagement reinforced the relevance and usability of the evolving prototypes. Participant feedback guided major design decisions, such as optimizing iPhone (Apple Inc) compatibility, excluding the gyroscope due to usability and battery constraints, and integrating hands-free navigation. The process also addressed cross-cutting issues such as digital accessibility, cybersecurity, universal design, and equitable access for users with varying technological literacy. Conclusions The Edge A-Eye project demonstrates how a sustained participatory co-design approach can meaningfully shape assistive technology innovation. By integrating the expertise of people with visual impairment, clinicians, researchers, and industry partners at every stage, the resulting platform is better aligned with real-world needs, safety considerations, and user expectations. This work provides a replicable framework for developing inclusive, context-aware indoor navigation technologies.
BACKGROUND:Access to physical rehabilitation services, including orthotics and wheelchairs, is recognized as a fundamental human right but remains limited in many low- and middle-income countries due to resource constraints, fragmented care, and a shortage of trained rehabilitation professionals. In Cambodia, where the health system still faces challenges from past conflict, these services are delivered through a mix of government, international, and nongovernmental organizations. OBJECTIVE:This study investigated the pathways to obtaining orthoses and wheelchairs in Cambodia and their impact on individuals with physical impairments. METHODS:Semistructured interviews were conducted to explore experiences and the impact of accessing physical rehabilitation and assistive products for orthosis and wheelchair users. Interviews were conducted face-to-face with translation support, audio recorded, transcribed, and analyzed using thematic analysis. Interviews were conducted with participants in Phnom Penh and the Kandal province in Cambodia. In total, 17 participants aged 18 to 65 years who were current or previous patients of the Exceed Worldwide physical rehabilitation center located in Phnom Penh took part in the study. RESULTS:Three themes emerged (early experiences of illness and health care seeking, pathways to assistive products, and the impact of these assistive products). Access to orthoses and wheelchairs often involved lengthy delays and inconsistent experiences with medical care and physiotherapy. Despite these challenges, assistive products played a vital role in improving mobility, independence, and social participation, contributing to greater confidence and emotional well-being. However, issues such as poor environmental accessibility and delays in repair or replacement limited their effectiveness. CONCLUSIONS:The findings demonstrate that, while assistive products offer significant benefits, they do not fully address the systemic barriers faced by people with physical disabilities in Cambodia. Persistent challenges such as stigma, environmental constraints, and emotional strain demonstrate the need for integrated policy reforms and a robust continuum of care that ensures coordinated, ongoing support across all stages of rehabilitation.
Abstract Background Knee exoskeletons represent a significant advancement in wearable robotic technology, developed to enhance gait assistance and facilitate rehabilitation processes. These devices are increasingly used in clinical and research environments worldwide. Nonetheless, the existing empirical evidence supporting their biomechanical and functional outcomes lacks both breadth and clarity. Further investigation is essential to elucidate the specific effects of knee exoskeletons on gait dynamics and rehabilitation efficacy. Objective This study aims to systematically review the clinical and biomechanical evidence on knee exoskeletons used for gait assistance and rehabilitation. Methods A systematic search of databases—PubMed, Web of Science, IEEE Xplore, and Scopus—was conducted to identify eligible studies published between January 2015 and March 2025. Studies were included if they investigated knee exoskeleton systems in human participants for gait assistance and rehabilitation. Randomized controlled trials, observational studies, and experimental investigations were eligible. Exclusion criteria were multijoint exoskeletons, nonhuman studies, and simulation-based analyses. Two reviewers independently extracted study characteristics, participant demographics, device features, intervention protocols, and clinical and biomechanical outcomes. Risk of bias was assessed using RoB-2 (Cochrane Risk of Bias 2) for randomized controlled trials and ROBINS-I (Risk of Bias in Nonrandomized Studies of Interventions) for nonrandomized studies. Results Thirty-two studies met the inclusion criteria. Most investigations involved healthy adults in feasibility or pilot settings, while a smaller subset included individuals with stroke, spinal cord injury, or orthopedic conditions or pediatric movement disorders. Across studies, knee exoskeletons demonstrated short-term improvements in spatiotemporal gait parameters, including increased gait speed and step length, improved knee joint kinematics, and reductions in muscular effort or metabolic demand. However, substantial heterogeneity in device design, outcome metrics, and intervention duration limits comparability across studies. Sample sizes were typically small, and follow-up outcomes were rarely reported, restricting the interpretation of the long-term clinical efficacy of these devices. Conclusions Knee exoskeletons demonstrate promising short-term functional and biomechanical benefits and are increasingly feasible within structured rehabilitation settings. While current evidence is limited by small sample sizes and brief follow-up periods, emerging data suggest potential for enhancing task-specific gait training. Larger, well-designed trials are needed to determine sustained clinical impact and integration into routine rehabilitation practice.
Abstract Background Rehabilitation frequently extends beyond supervised clinical settings, creating a demand for scalable digital tools to support structured follow-up. We propose a novel open-source telerehabilitation platform. Objective We describe the iterative, user-centered development of an open-source rehabilitation follow-up platform and report findings from an initial formative usability evaluation with patients, health care professionals, and additional end users. Methods The platform was developed through repeated cycles of stakeholder engagement, prototyping, and evaluation within the rehabilitation department of Insel Group, University of Bern. A formative usability evaluation was conducted with 24 participants (8 health care professionals, 9 patients, and 7 additional participants; mean age 41.1, SD 12.9 y) using a task-based protocol. Perceived usability was assessed with the System Usability Scale (scored 0‐100) and the Post-Study System Usability Questionnaire (scored 1‐7; higher is better). Open-ended written responses were processed by one researcher using rapid content analysis. Results A web-based telerehabilitation platform enables therapists to manage patient caseloads, assign and track personalized rehabilitation interventions, and monitor patient progress through Fitbit activity data and rehabilitation plan adherence. It supports multiclinic workflows with role-based access, REDCap patient importing (Vanderbilt University), automated background processing via Celery, and multilingual content. Its mean System Usability Scale score was 82.8 (SD 14.1), placing the platform in the “excellent” usability range. The mean Post-Study System Usability Questionnaire overall score was 6.02 (SD 0.77), with all 3 subscales scoring above 5.7. Most participants (20/24, 83%) rated the task set as easy or very easy; no participant rated any task as difficult. Among health care professionals, 7 out of 8 (88%) reported an intention to use the platform in practice. Qualitative themes highlighted the value of a rehabilitation plan overview, structured intervention scheduling, and progress tracking. Conclusions The platform, released as open-source (Massachusetts Institute of Technology [MIT] License), demonstrated promising perceived usability across both patient and clinician user groups in a formative evaluation. These findings provide preliminary support for the platform’s perceived usability and justify further evaluation in real-world rehabilitation settings. Future work will evaluate deployment in real-world outpatient settings and assess clinical effectiveness.
Background:Indonesia has the second-highest prevalence of stroke in Southeast Asia, with 4,918,487 people (1.7% of the population) living with this condition as of 2025. This is attributable to the living conditions in Indonesia, where limited health care workers and facilities are available to assist with stroke rehabilitation via mobile health (mHealth) interventions. Objective:This study designed an mHealth app to facilitate stroke rehabilitation in Indonesia. Methods:In this mixed methods study, interviews were conducted with 10 experts (doctors, therapists, and medical students) and 8 patients who have experienced a stroke to explore the need for stroke rehabilitation management apps. Using a design science research approach, we conducted 3 iterative design cycles, each comprising design, development, and evaluation, to construct an mHealth app for stroke rehabilitation. The first iteration produced a low-fidelity app prototype informed by intervention theory. The prototype, which comprised 13 features for patients and 12 for medical personnel, was evaluated through interviews with medical personnel. The second iteration produced a design for a high-fidelity app prototype based on feedback from the first iteration. The third iteration yielded an improved app based on feedback from the second iteration. Results:This study identified app features that support patient rehabilitation, including patient training programs with progress monitoring in functional, speech, and occupational therapy, along with consultations and home visits to connect rehabilitating patients with medical personnel. Other features of the app include onboarding, gamification, users' authentication, user profile management, schedule reminders, activity targets, therapeutic progress reports, and educational materials and videos. The prototypes received a System Usability Scale score of 71.83 ("good") and average scores of 2.32 (system usefulness), 2.39 (information quality), 2.42 (interface quality), and 2.35 (overall). Conclusions:This study provides guidance for health care facilities and regulators to improve the quality of rehabilitation services for patients with stroke in Indonesia.
Background:Task-oriented rehabilitation supported by exoskeletons has the potential to increase therapy intensity, personalization, and accessibility. However, to achieve fully automatic treatment, robotized systems need to analyze therapy in a more complex way than only based on reference trajectories following. Objective:This study aimed to investigate the effects of an intelligent, context-aware control algorithm for an upper limb rehabilitation exoskeleton on patients' musculoskeletal engagement, compared with constant-admittance robot-assisted therapy, and conventional physiotherapist-guided treatment. Methods:A single-session experimental study was conducted with 34 adult participants performing 6 activities of daily living under 3 therapy modes: robot-assisted therapy with constant admittance, robot-assisted therapy with an intelligent assist-as-needed algorithm, and physiotherapist-guided therapy. Muscle activity was assessed using surface electromyography of 8 upper limb muscle groups, while joint kinematics were recorded using inertial measurement units. Metrics included electromyography power, muscle activation time, joint range of motion, and Burst Duration Similarity Indices. Statistical comparisons were performed using the t test and the Mann-Whitney U test depending on data normality. Results:Results indicate that the intelligent control strategy engages the musculoskeletal system at least as effectively as constant-admittance control across all exercises. At the same time, more motion control is given to the patient, which is consistent with the principles of neuroplastic motor learning. Compared with physiotherapist-guided therapy, robot-assisted treatment with intelligent control elicited significantly higher and more consistent muscular engagement. Intelligent assistance also modified joint-level motion patterns by reducing compensatory movements, particularly in shoulder-elbow coupling, while maintaining functional task execution. Muscle activation timing patterns during intelligent robot-assisted therapy were more consistent with robotic control than with manual therapy, reflecting altered movement strategies. Conclusions:These findings demonstrate that context-aware, intelligent control in rehabilitation exoskeletons can promote active patient participation, reduce compensatory behaviors, and maintain physiologically meaningful muscle engagement. The proposed approach exceeds the results of recent similar studies, being a promising step toward effective, minimally supervised, and task-oriented rehabilitation.
BACKGROUND:Brain-computer interface (BCI) technology is undergoing rapid translation from laboratory research to clinical applications, heralding a fundamental restructuring of human-machine relationships with profound societal implications. Existing bibliometric analyses of this domain have exclusively relied on scholarly article databases, critically overlooking patent data that is essential for capturing the full spectrum of technological innovation in this highly translational field. OBJECTIVE:This study aims to investigate the overall scientific and technological trajectories, key research drivers (journals, institutions, countries, and funding agencies), as well as research topics and trends in the BCI field through a comprehensive analysis of scientific and technical literature (articles and patents). METHODS:BCI-related articles (11,346) and granted patents (1,551) published from 2015 to 2025 were retrieved from the Web of Science (WOS) and the incoPat database, respectively. VOSviewer, CiteSpace, Microsoft Excel and InCites were used to summarize bibliometric features. Additionally, the Disruptive Index was calculated to characterize the developmental trajectory of scientific and technological advancements in BCI field. RESULTS:The number of BCI articles and patents has been continuously increasing over the past decade. JOURNAL OF NEURAL ENGINEERING published the largest number of BCI articles. The Chinese Academy of Sciences ranked first in article output, while the University of California System achieved the greatest citation impact; Tianjin University from China led in patent filings. At the country level, China dominated article output and patent filings, whereas the United States attained the highest article citation impact and the most extensive international patent portfolios. The National Natural Science Foundation of China (NSFC) was the most prolific funding agency for BCI articles. Disruptive Index analysis revealed that BCI scientific research (article-based) maintained sustained growth in disruptiveness, whereas technological development (patent-based) demonstrated a pattern of fluctuation rather than consistent growth during the observation period. Five major research topics were identified, with Neural Interfaces and Motor Control attracting the greatest attention. In parallel, the leading technology categories were computer input/output interface devices (IPC: G06F3) and diagnostic measurement and human identification (IPC: A61B5). Citation analysis revealed an average knowledge transfer lag of 8.8 years, alongside limited bidirectional article-patent linkages. CONCLUSIONS:This study reveals a rapidly expanding yet strategically differentiated global BCI landscape dominated by China and the United States, with the former leading in output volume and the latter achieving highest citation impact and international patent portfolios. BCI scientific research maintains active disruptive potential, whereas technological development lacks a commensurate upward trajectory; this asynchrony, compounded by prolonged knowledge transfer lag and weak article-patent linkages, points to translational challenges that require strengthened mechanisms for converting scientific discovery into technical innovations. CLINICALTRIAL:
Abstract BackgroundRehabilitation health care providers (HCPs) report high levels of burnout. Self-compassion interventions have shown beneficial effects on HCP burnout, but they have never been explored in specialist rehabilitation settings where challenges may differ. ObjectiveThis study aimed to explore the experiences of specialist rehabilitation HCPs with an online Self-Compassion for Healthcare Communities (SCHC) course aimed at providing tools to regulate emotional well-being, including burnout. MethodsSemistructured qualitative interviews (n=20) with specialist rehabilitation HCPs were used to explore experiences with the SCHC course. A reflexive thematic analysis study design was chosen to highlight participants’ insights, and inductive coding was undertaken to analyze data and organize findings into themes. ResultsSix themes that reflected HCPs’ experiences with the course were constructed: (1) the nature of working in rehabilitation; (2) different perspectives on burnout in specialist rehabilitation; (3) a new perspective, less self-criticism, more self-compassion; (4) growing recognition of the importance of compassion for oneself and others; (5) challenges engaging with the SCHC course; and (6) challenges to sustaining self-compassion in specialist rehabilitation. ConclusionsSpecialist rehabilitation HCPs who participated in the SCHC course developed a new understanding of the importance of fostering self-compassion and compassion for others. This shift may have supported HCPs in navigating workplace challenges, and HCPs described experiencing changes that could help with burnout, improve their care of patients and relationships with colleagues.
BACKGROUND:Stroke is a leading cause of disability and death, resulting in a clinical, social, and economic burden upon families and the health system worldwide. OBJECTIVE:This study aimed to introduce nurse-led rehabilitation services for patients after stroke to improve functional independence for self-care management. METHODS:A pilot, open-label, 2-arm (1:1), randomized controlled trial was conducted at the National Institute of Neuroscience & Hospital in Bangladesh between March and August 2025. A total of 64 patients with stroke were enrolled using simple randomization. In the intervention group (IG), patients received rehabilitation education and assistive devices to improve activities of daily living. The control group (CG) received usual hospital care for stroke. Data were collected through a structured questionnaire. After discharge from the hospital, study nurses enrolled patients after stroke after a face-to-face assessment and provided rehabilitation education at the hospital and monthly rehabilitative education at home for 3 months. The study outcomes were improvement of functional independence, self-efficacy, social participation and reduction of caregivers' burden. RESULTS:Among 64 participants, 47 (73%) completed the study. Results depict an increase in self-care capacity, self-efficacy, social involvement and a decrease in care burden in both groups from baseline to end line; nevertheless, there was no statistically significant difference between IG and CG (F2, 44=0.113; P=.74). Functional Independence Measure mean scores (IG: mean 78.4, SD 37.6; CG: mean 74.3, SD 35.4; P=.70; 95% CI -25.16 to 18.14), self-efficacy (IG: mean 27.0, SD 6.9; CG: mean 26.6, SD 7.1; P=.83; 95% CI -3.6 to 4.6), social participation (IG: mean 30.4, SD 21.4; CG: mean 28.2, SD 17.2; P=.61; 95% CI -9.33 to 13.61), and care burden (IG: mean 24.9, SD 13.6; CG: mean 25.2, SD 12.6; P=.83; 95% CI -8 to 7). In qualitative analysis, we noticed enhanced self-care capacities of patients with poststroke disabilities after rehabilitative intervention, as indicated by participants' perceptions. CONCLUSIONS:In this study, patients' self-care capability was improved after the intervention from baseline, and improvements were noted by using assistive devices based on patients' perceptions and responses. The study findings demonstrated the importance of early self-care management for patients with poststroke disabilities. Future research should focus on long-term, community-integrated strategies that involve primary care, enhanced technological support, and caregiver-focused disability adjustment programs to achieve better outcomes. TRIAL REGISTRATION:ClinicalTrials.gov NCT06786559; https://clinicaltrials.gov/search?id=NCT06786559.
Accurate motor assessment is crucial for diagnosing and monitoring neurological and musculoskeletal disorders. However, traditional manual and semiautomated methods can be subjective, time-consuming, or expensive. Realtime 3D Human Pose Estimation (HPE) is emerging as a lowcost, noninvasive alternative. However, its clinical adoption is limited due to a lack of thorough, standardized evaluation of its accuracy and robustness in realworld clinical settings. This study introduces a technical pipeline for evaluating the applicability of realtime 3D HPE in simulated clinical rehabilitation settings. The framework facilitates the evaluation of an HPE model's spatial and spatiotemporal accuracy, realtime capability, and robustness against simulated common setup errors and camera position variations, using a marker-based motion capture system as a gold-standard baseline. To address the technical challenge of inter-dataset comparison, the framework includes a morphing model that harmonizes differing joint definitions. Applying the framework to an exemplary state-of-the-art algorithm (Mediapipe) demonstrated the pipeline's sensitivity to image distortions. The metrics showed that simulated underexposure and blur had negligible effects, whereas body segment occlusion and insufficient multiocular calibration significantly degraded tracking accuracy. Additionally, the framework showed significant sensitivity to specific camera placements (sagittal views), in contrast to more stable frontal views. This study establishes a technical foundation for the standardized evaluation of markerless tracking for clinical applications, like motor rehabilitation. The morphing model enables inter-dataset comparison, and the proposed framework facilitates domain-specific interpretation of HPE performance. While further validation on pathological populations is required, this work provides the necessary engineering foundation for future validation studies.
