Robot-assisted telerehabilitation (RAT) combines rehabilitation robotics with digital health workflows to extend access to upper-limb (UL) therapy after stroke. Mixed reality (MR) may support therapist-patient interaction and task visualization; however, early-stage systems require rigorous evaluation of safety and usability before deployment in the home. In a formative, mixed-methods usability study conducted in a controlled setting using a telerehabilitation workflow, six individuals post-stroke (≥3 months) and six occupational therapists (OTs) completed a single supervised session with a desktop-mounted end-effector type therapeutic robot (iTbot) integrated with Microsoft HoloLens 2. Participants performed structured passive and active UL exercises while therapists supervised and interacted with the system via the MR control interfaces. Safety was evaluated by documenting observed adverse events and safety-stop activations. Usability and user experience were assessed using the System Usability Scale (SUS), study-specific satisfaction questionnaires (reported with scale ranges), and semi-structured follow-up interviews analyzed using thematic analysis. All participants completed the session without observed adverse events or safety-stop activations. Overall usability was favorable, with a mean (SD) SUS total score of 78.3 (15.9) out of 100 (stroke: 74.2 [18.1]; occupational therapists: 82.5 [13.5]). Qualitative feedback indicated that MR was perceived as engaging and intuitive by many users, while also identifying implementation needs relevant to real-world telerehabilitation, including clearer onboarding, simplification of certain MR interactions, and improved physical interfaces (e.g., handle options). Therapists highlighted workflow considerations for remote supervision and patient independence. Together, these findings support progression to multi-session, in-home studies to quantify remote assistance needs, technical reliability, adherence, and clinical outcomes.

[Purpose] Study assessed test-retest reliability, minimal detectable change (MDC95), concurrent validity, and known-groups validity of Two Square Agility Test (TSAT) and WorkAbility Rate of Manipulation (WRM) in adults with musculoskeletal disorders. [Participants and Methods] Fifty-five participants (mean age: 61.3 ± 15.3 years) transitioning from physical therapy completed TSAT and WRM subtests for Turning (WRMT) and Placing (WRMP) in both sessions. In session 2, participants also completed Grip Strength (GS), 10-Meter Walk at usual (GSU) and fast (GSF) pace, and Grooved Pegboard Placing (GPP) and Remove (GPR). [Results] Test-retest reliability was good for TSAT (ICC=0.89) and WRMT (ICC=0.86), and excellent for WRMP (ICC=0.93). MDC95 was 0.74 steps/sec for TSAT, 13.1 parts/min for WRMT, and 6.5 parts/min for WRMP. TSAT correlated moderately with GSF (r=0.52) and GSU (r=0.50). WRMT and WRMP correlated highly (r=0.71). WRMT correlated highly with GPP (r=0.74), low with GPR (r=0.46) and negligible with GS (r=0.17). WRMP correlated highly with GPP (r=0.79), moderately with GPR (r=0.55) and negligible with GS (r=0.20). WRM differed by age and TSAT by age and body mass index. [Conclusions] Findings support reliability and validity of TSAT and WRM to assess adults with musculoskeletal disorders.

Research Objectives To identify the key factors influencing the acceptance of wheelchair-mounted robotic arms (WMRA) designed for power wheelchair users (PWU) with upper limb impairments by exploring how user, caregiver, assistive technology professional, and system-level perspectives shape their perceived value, usability, and adoption potential for supporting daily activities. Design This mixed-methods study was structured to guide the identification of factors influencing the acceptance of WMRA. The study included iterative evaluations, task-based usability trials, and qualitative consultations with key stakeholders to capture evolving user perceptions. Setting User experience evaluations were conducted in a simulated home environment at the BioRobotics Lab at the University of Wisconsin-Milwaukee. Structured stakeholder interviews were held online and in person, with additional site visits for contextual insights. Participants Data was collected from a multidisciplinary cohort of fifteen individuals to reflect the diverse factors influencing acceptance. This included eight PWU living with stroke, spinal cord injury, or multiple sclerosis; six occupational therapists with assistive technology expertise; four family caregivers; one assistive technology distributor; one device manufacturing specialist; and one policy stakeholder. Interventions Participants engaged with a WMRA, the multifunctional robotic assistive arm (mR2A), through simulated daily activities in a controlled, home-like environment. PWU performed task-based trials to evaluate usability and functionality, while other stakeholders participated through observational sessions, structured interviews, and feedback on implementation scenarios. Main Outcome Measures (a) Contextual evaluation of usability data collected through task-based trials, aimed at identifying strengths and limitations of mR2A in a simulated home setting to inform knowledge creation and adaptation to local user needs. (b) Perceived barriers and facilitators to the acceptance of mR2A across individual (user), interpersonal (caregiver/family members), and system-level (policy/reimbursement/cost) contexts. (c) Adoption Readiness Indicators, including training needs, stakeholder endorsement, and contextual fit, assessed through stakeholder feedback and KTA-informed mapping. Results Acceptance is influenced by factors at the individual level (user readiness to adopt new routines, perceived relevance to daily life), interpersonal level (clarity and consistency of communication among users, caregivers, and clinicians), and system level (alignment with clinical workflows, funding mechanisms, and organizational capacity to support change). Facilitators included stakeholder co-creation, visible clinical value, and integration into existing service delivery pathways, while barriers involved fragmented communication channels, limited contextual tailoring, and misalignment between innovation timelines and reimbursement structures. Conclusions Effective translation of wheelchair-mounted robotic arms into real-world use requires addressing multilevel factors—individual, interpersonal, and system-level—through stakeholder-driven strategies that align technological innovation with user context, communication practices, and structural readiness for adoption.

Background/Objectives: Senior living communities have become a popular living arrangement for older adults seeking supportive environments for aging in place. However, older adults may enter these communities with existing health vulnerabilities. This study described the prevalence of frailty, sarcopenia risk, and cognitive risk among residents and examined their associations with relocation reasons and fitness amenity utilization. Methods: A cross-sectional survey was conducted among residents aged ≥65 years who had lived in the community for at least 3 months. Survey items included demographics, health status, living history, relocation reasons, physical activity, fitness amenity use, and screening tools for frailty, sarcopenia risk, and cognitive impairment. Descriptive statistics, Mann–Whitney U tests, and Spearman rank correlations were conducted. Results: A total of 147 residents (Mean age = 80.2 years, SD = 7.1) responded to the survey. Overall, 28.5% met criteria for frailty, 19.7% screened positive for sarcopenia risk, and 21.8% for cognitive risk. Residents who reported a health-related reason for relocation showed greater frailty (U = 410, p < 0.001), sarcopenia risk (U = 393, p < 0.001), and cognitive impairment (U = 1062, p = 0.01). More frequent fitness amenity use was associated with lower frailty and sarcopenia risk scores (Spearman’s Rho = −0.30 and −0.40, respectively, both p < 0.01), but not cognitive impairment. Conclusions: A meaningful subset of senior living residents were at risk for frailty, sarcopenia, and cognitive impairment. Routine screening and interventions promoting fitness amenity use may support healthy aging in senior living communities.

Research Objectives A bone mineral density (BMD) test measures the amount of bone minerals (mostly calcium and phosphorous) contained in a certain volume of bone. Reduced BMD is associated with an increased risk of fractures and is a recognized predictor of frailty, pre-frailty, and osteoporosis in older adults. This study examined total femur BMD in U.S. individuals aged 6 years and older using data from the National Health and Nutrition Examination Survey (NHANES) 2005–2020. The primary objective was to compare total femur BMD between individuals with and without a history of stroke. The secondary objective was to assess variations in BMD by age, sex, race/ethnicity, and survey year. Design Observational, cross-sectional study Setting Nationally representative sample of the non-institutionalized U.S. population Participants A total of 19,724 participants (aged 6 to 80+ years) with valid total femur BMD measurements were included from NHANES 2005–2020. Of these, 843 individuals reported a history of stroke. BMD values (g/cm²) were examined across subgroups defined by age, sex, survey cycle (2005–2008, 2009–2012, 2013–2016, and 2017–2020), race/ethnicity, and stroke status. Interventions N/A Main Outcome Measures Total femur BMD assessed using Dual-Energy X-ray Absorptiometry (DXA) Results Total femur BMD varied significantly by age, sex, and race/ethnicity (p < 0.001). BMD levels were lower in younger children, increased steadily throughout adolescence, peaked at approximately age 19 (0.98 g/cm² in females; 1.12 g/cm² in males), and declined gradually thereafter. Males had higher BMD than females following puberty. No significant trends in BMD were observed across survey years (p = 0.864), indicating stability over time. Racial/ethnic differences were observed, with non-Hispanic Black individuals having the highest mean BMD, followed by Hispanic, non-Hispanic White, and individuals of other races. Among males, stroke survivors had significantly lower BMD than those without stroke (p = 0.041), whereas no significant differences were found among females. Conclusions Total femur BMD is influenced by age, sex, and race/ethnicity, and remained stable between 2005 and 2020. A history of stroke was associated with reduced BMD among males but not females. These findings underscore the need for targeted education and prevention strategies, particularly among populations at greater risk for bone loss and stroke-related skeletal decline.

Background Grip strength is a well-established functional biomarker of musculoskeletal health and overall physiological resilience throughout the lifespan, making it a valuable indicator in aging research. Purpose This study aimed to quantify the rate of change (kg/year) and percentage change (%) in grip strength across the lifespan (ages 6-79), stratified by gender and hand dominance. Study Design Cross-sectional, observational study. Methods Data from 13,159 participants in the National Health and Nutrition Examination Survey (NHANES) study were analyzed. Grip strength was measured using a Takei Digital Handgrip Dynamometer, with the best of three trials recorded. The rate of change (kg/year) and percentage change (%) were computed for dominant and nondominant hands by gender. Results The dominant hand showed greater increases in childhood, peaking at age 14 in males (3.89 kg/year) and age 11 in females (2.37 kg/year). Growth slowed in young adulthood, stabilizing by ages 30-34, then declined. By midlife (50s), decline accelerated (−0.30 kg/year in males, −0.24 kg/year in females), reaching −0.41 kg/year (males) and −0.29 kg/year (females) by ages 69-79. For percentage change, males had 78.62% lower grip strength and females had 68.51% lower grip strength at age 6 compared with their peak (30s). By adolescence, the gap narrowed (−32.78% in males, −15.39% in females at age 14). Strength peaked at ages 32-33 in males and 32-35 in females. After age 35, percentage loss became progressively negative, reaching −7.76% in males and −4.49% in females by age 50, −11.57% and −14.48% by age 60, and nearly −29.23% and −29.04% by age 79. Conclusions This study elucidates the evolving patterns of grip strength across the lifespan, contributing valuable insights into grip strength as a potential biomarker of aging.

Objective(s) This scoping review aimed to examine demographic, occupational, lifestyle, posture/ergonomics, health history, technology use, and psychological factors linked to neck pain development, supporting the creation of preventive strategies and early intervention treatments. Data Sources Potentially relevant studies were identified via electronic searches of PubMed/Medline, Cinahl, Embase, Science Citation Index, and PsycINFO. Study Selection Studies included in this review met the following criteria: (1) published between January 2000 and January 2024, (2) involving adult human participants, and (3) designed as experimental, cross-sectional, cohort, case-control studies, or randomized controlled trials. Additionally, (4) they were disseminated in English-language journals and (5) reported data on associations or odds ratios of risk factors. Studies were excluded (1) if they lacked data or did not analyze relevant factors, (2) if full texts were unavailable, (3) if they were non-journal publications such as dissertations and conference papers, or (4) if they were review articles. Data Extraction A coding sheet was used to extract study details, sample characteristics, and risk factor data, including odds ratios. Risk factors were categorized into demographic, occupational, lifestyle, posture/ergonomics, health history, technology use, and psychological factors, with odds ratios classified as greater than 1.5 or between 0 and 1.5. Data Synthesis The results indicated that several factors were associated with a higher prevalence of neck pain. Demographic factors included being female (OR = 2.09–2.27) and prolonged sitting for work (OR = 2.68–3.50). Postural factors, such as sitting in a chair without back support (OR = 2.82) and frequently holding the neck in a forward-bent posture for extended periods (OR = 2.66), also contributed to increased risk. Technology use was a significant factor, with smartphone use exceeding six hours per day (OR = 2.78) and daily social media use (OR = 2.01) being associated with neck pain. A history of acute neck pain showed higher odds in both men (OR = 2.30) and women (OR = 3.80). Psychological and lifestyle factors, including loneliness (OR = 2.00), cigarette smoking (OR = 5.42), and emotional problems (OR = 2.09), were also identified as significant risk factors. Conclusions This review identified key risk factors associated with a higher prevalence of neck pain, including demographic, occupational, postural, lifestyle, technology use, and psychological factors. Understanding these associations can help inform preventive strategies and early interventions to reduce the burden of neck pain. Future research should focus on targeted interventions to mitigate these risks in vulnerable populations.

Research Objectives This study examined (a) rate of change, and (b) percentage change—relative to a reference age (19–20 years) across the lifespan (ages 3 to 85). Design Cross-sectional, observational study Setting General community-based sample Participants Data were drawn from 3,901 noninstitutionalized U.S. residents (ages 3–85) who participated in the NIH Toolbox study. Interventions N/A Main Outcome Measures Grip strength was assessed using a digital Jamar dynamometer (Performance Health, Warrenville, IL) in the second handle position. Each participant completed a single trial while seated upright, with arms at their sides, elbows flexed at 90°, and forearms in a neutral position. We computed (a) rate of change (kg/year) to track grip strength trajectories, and (b) percentage change (%) to quantify variation across age groups, gender, and hand dominance. Results Grip strength in both sexes increases rapidly in childhood, peaking at age 14 for males (4.58 kg/yr) and age 11 for females (2.87 kg/yr). After this peak, the rate of change declines through adolescence and young adulthood, nearing zero at age 19–20 (-0.69 kg/yr in males, -0.06 kg/yr in females). Grip strength progressively declines in adulthood, with losses accelerating after age 50 (-0.24 to -0.36 kg/yr in males, -0.26 to -0.31 kg/yr in females). By age 60, males experience a rate of change of -0.35 kg/yr and females -0.30 kg/yr, stabilizing at -0.35 to -0.37 kg/yr in males and -0.27 to -0.28 kg/yr in females from ages 66–85, reflecting a steady decline in muscle strength. Grip strength percentage change improves through childhood and adolescence, turning positive at age 18 (0.30% in males, 0.45% in females) and stabilizing in early adulthood, peaking at age 19 for males (0.60%) and age 23 for females (0.65%). Decline begins after age 26 in males (-0.09%) and age 45 in females (0.99%), becoming more pronounced after 50, reaching -7.37% in males and -3.13% in females. The decline accelerates further, with percentage losses of -22.96% in males and -25.23% in females by age 72, and -33.27% in males and -37.62% in females by age 85. These trends highlight a continuous and significant age-related reduction in muscle strength, particularly in older adults. Conclusions Knowing the reference values for the rate of grip strength decline during normal aging is essential for distinguishing healthy aging from early signs of muscle dysfunction. These values serve as benchmarks to assess whether an individual's decline is within the expected range or indicates a higher risk of frailty, sarcopenia, or other age-related conditions.

Research Objectives The purpose of this study was to explore the (a) rate of change in childhood, the decline rate in older adulthood and (b) percentage change (reference age: 31 to 37 years old) in grip strength from ages 6 to 80, stratified by gender (males vs females) and hand dominance (dominant vs nondominant hand). Design This is a cross-sectional, observational study Setting General community setting Participants Data from 13,646 noninstitutionalized U.S. residents were obtained from the National Health and Nutrition Examination Survey (NHANES) study. Interventions N/A Main Outcome Measures The isometric grip strength of the dominant hand was assessed using a Takei Digital Handgrip Dynamometer (Model T.K.K.5401), with the best value determined from three trials. We computed the rate of change (kg/year) and percentage change (%) of grip strength trajectories by gender and hand dominance. Results The rate of change varied by gender and age. Grip strength of the dominant hand in both males and females increased during childhood and peaked in adolescence, with males reaching a maximum rate of change at age 14 (3.89 kg/yr) and females at age 11 (2.37 kg/yr). In young adulthood, the rate of change slowed, approaching zero by the early 30s (age 34: -0.02 kg/yr in males, age 35: 0.00 kg/yr in females), after which grip strength began a steady decline. The rate of change was -0.30 kg/yr in males and -0.24 kg/yr in females by their mid-50s and further declined to -0.41 kg/yr in males and -0.29 kg/yr in females by ages 69-79, reflecting a consistent age-related decline in muscle strength. For percentage change (compared to the reference peak grip strength at ages 31-37), males had 78.62% lower grip strength at age 6, while females had 68.51% lower grip strength at age 6, gradually improving to 32.78% and 15.39% lower by age 14, respectively, as strength developed. Peak grip strength in the dominant hand was observed at ages 32-33 in males and ages 32-35 in females. By age 79, grip strength had declined to -29.23% in males and -29.04% in females compared to the reference peak. Conclusions This study elucidates the evolving patterns of grip strength across the lifespan, contributing valuable insights into grip strength as a potential biomarker of aging.

Research Objectives This study evaluated the usability of a mixed reality (MR)-based robotic rehabilitation system utilizing Microsoft HoloLens 2 for remote therapy. The primary objective was to assess the system's usability, user experience, and potential improvements to enhance remote rehabilitation. Design Experimental study Setting In the BioRobotics Laboratory Participants Ten participants were recruited in our study: five post-stroke individuals (mean age [SD] = 60.8 [11.6], onset of stroke = 3 months; 100% female) and five occupational therapists (mean age [SD] = 31.3 [13.9], 80% female), mean clinical experience = 2 years). Each participant engaged in a one-hour session using HoloLens 2, evaluating the system’s ability to support a wide range of therapeutic exercises tailored to individual rehabilitation needs. Interventions The intervention involved two sessions with an MR-based robotic rehabilitation system. Main Outcome Measures System Usability Scale (SUS) was used to evaluate ease of use, efficiency, and overall user satisfaction with the MR-based rehabilitation system. Engagement and motivation were assessed through participant feedback and qualitative interviews to determine the impact of MR integration on therapy adherence. System performance and adaptability were measured based on response accuracy, latency, and ability to adjust resistance and task difficulty according to user needs. Safety and feasibility were evaluated by identifying risks, while user and therapist feedback helped refine the system and improve rehabilitation outcomes. Results The results showed that the HoloLens 2-based system was safe and user-friendly, with no adverse events reported, and all ten participants successfully completed the study. The usability evaluation revealed a high level of user satisfaction, with a mean SUS score of 82.4 (SD: 8.1%), indicating strong usability. Participants reported increased engagement and motivation due to the immersive and interactive nature of the MR integration. Constructive feedback suggested improvements such as enhancing adaptability, offering more personalized exercises, and improving system responsiveness to varying patient needs. The robotic system demonstrated precise and smooth performance, with velocities ranging from -10 m/s to +10 m/s, ensuring controlled and adaptive movement for rehabilitation. Participants actively engaged with the system, exerting forces between 0 N to 25 N across different axes, supporting motor recovery and strength development. Conclusions The findings suggest that an MR-based robotic rehabilitation system using HoloLens 2 is a viable and effective tool for remote therapy. Future research and development should focus on increasing system adaptability, incorporating personalized therapy plans, and refining remote therapist-patient interaction features to enhance effectiveness.

IMPORTANCE:Subtle, age-related declines in occupational performance among at-risk older adults may go undetected when assessed solely with self-report measures, potentially leading to missed intervention opportunities. Understanding discrepancies between self-reported and performance-based occupational performance outcomes can inform assessment selection and interpretation. OBJECTIVE:To examine the discrepancies between the two types of measure among community-dwelling older adults at risk for losing independence. DESIGN:Cross-sectional study using secondary data analysis. PARTICIPANTS:Seventy-one community-dwelling older adults (M age = 74 yr, SD = 9) who showed muscle weakness and reported difficulty with activities of daily living. OUTCOMES AND MEASURES:Canadian Occupational Performance Measure (COPM) Performance score and Assessment of Motor and Process Skills (AMPS) Motor Skills score were used as outcome measures. Participants were categorized as overestimators if they reported a higher COPM Performance score but had a relatively lower AMPS Motor Skills score and as underestimators if the reverse was true. RESULTS:Participants who overestimated their occupational performance (n = 12, M age = 79 yr, SD = 10 yr) were generally older (Z = 2.91, p = .004) and had poorer physical functioning (Zs = -2.54 to 2.42, all ps < .05) but reported higher satisfaction with their performance (Z = 4.72, p < .001) compared with those who underestimated their performance (n = 20, M age = 69 yr, SD = 7 yr). CONCLUSIONS AND RELEVANCE:Use of both self-report and performance-based assessments may be warranted to identify late-life disability, particularly among older adults of advanced age or with declined physical functioning. Plain-Language Summary: Older adults of advanced age or with poor physical functioning may rate their occupational performance differently from how they actually perform everyday activities. This study found that some older adults tend to overestimate their performance, even when their actual performance suggests otherwise. These mismatches between how older people think they are performing and how they actually perform could lead to missed chances for support or intervention if only a self-report measure is used. Using self-report followed by performance-based measures is recommended to identify late-life disability among these older adults.

Objectives To assess the ergonomics and usability of wheelchair-mounted assistive robot interfaces for improving the daily living activities of those with mobility impairments. The study evaluates interface designs through usability tests to find optimal elements that meet user needs and preferences, aiming to refine the interface for better user experience and increased autonomy. Design A mixed-method research design. Setting In the BioRobotics Lab. Participants Six healthy participants with a mean age of 30.50. Interventions Not applicable. Main Outcome Measures The study's main outcomes are the usability score from the System Usability Scale (SUS) for interface effectiveness, efficiency, and satisfaction; task completion time and error rate to measure interface efficiency and intuitiveness; and user satisfaction assessed through postinteraction feedback, emphasizing comfort, and ease of use. Results The user interface (UI) evaluation for the wheelchair-mounted assistive robot, designed to enhance the independence and quality of life for individuals with mobility impairments, yielded promising results. Participants reported high levels of satisfaction with the UIs focus on accessibility, intuitiveness, and adaptability, particularly praising its key features such as individual on/off buttons for each joint, reset functionality, and the “Home” button for returning the robotic arm to a reliable starting position. The integration of the robot with the wheelchair's control systems via a built-in joystick, operating in Cyclic Synchronous Position (CSP) mode for precise movement control, was noted as a significant advantage, alongside the comprehensive options for gripper control, and the clarity of joint status displays. The inclusion of joint-based control through a custom-made keypad, as well as alternative control methods such as chin joystick and eye gaze systems, was highly valued for accommodating a wide range of physical abilities, ensuring the robot's accessibility. The ability to adjust safety parameters directly through the UI was also a critical feature, allowing users to customize settings for a secure interaction experience. The findings indicate that the UI effectively meets user needs and preferences, significantly enhancing user experience and autonomy for individuals with mobility challenges, highlighting the impact of user-centered design in developing assistive technologies. Conclusions The study finds that user-centered UI design enhances interaction and autonomy for those with mobility impairments. Key features such as adaptive controls and customizable safety settings effectively meet varied needs. It underscores the importance of user feedback in developing assistive robots that improve quality of life, advocating for a user-focused approach in assistive technology development. Disclosures none.

Objectives To evaluate the effectiveness of robot-aided therapy (RAT) systems enhanced by Microsoft Azure, focusing on how interactive telerehabilitation impacts patient engagement, motivation, and therapeutic outcomes. It will also explore real-time monitoring and adaptive interventions to improve the precision of remote rehabilitation services and extend these services to underserved populations through advanced technologies and cloud computing. Design Experimental study. Setting In the BioRobotics Laboratory. Participants The study engaged 2 healthy human subjects (aged 22-32y), selected to initially evaluate the robotic system and its integration with Microsoft Azure for telerehabilitation. These participants represented a controlled group to test the system's functionality and effectiveness in delivering interactive rehabilitation exercises before broader application to diverse patient demographics with actual rehabilitation needs. Interventions The intervention featured a sophisticated telerehabilitation system combining a 3DoF robotic arm with Microsoft Azure for improved real-time data processing and responsiveness. Participants interacted through a mixed-reality interface using Unity and HoloLens 2, enabling precise control of the robot within a virtual environment. Digital twin technology mirrored the robot's actions for accurate therapy delivery, whereas Azure IoT managed data flows, adapting the system dynamically to each participant's engagement and performance during exercises. Main Outcome Measures The primary outcomes of this study evaluated the effectiveness of integrating robot-aided therapy with Microsoft Azure for telerehabilitation, focusing on real-time monitoring and precise data visualization. Participant feedback and activity metrics assessed therapeutic engagement and motivation, whereas ease of technology use highlighted patient accessibility. User satisfaction was gauged through surveys and feedback, reflecting the overall experience and perceived effectiveness of the therapy. Results The results showed that the telerehabilitation system effectively enabled remote rehabilitation through a dual-site setup, with a therapist's control panel and a patient's interaction space. Live therapy sessions via Microsoft Teams allowed therapists to monitor and visualize robot movements in real time, enhancing patient engagement in upper limb exercises. This real-time interaction facilitated various tailored rehabilitation exercises, indicating that the system significantly improves the capacity for precise and personalized remote rehabilitation. Initial findings highlight its potential for broader telerehabilitation applications. Conclusions The benefits of integrating robot-aided therapy (RAT) with Microsoft Azure for the telerehabilitation approach significantly enhance the accessibility, personalization, and engagement of rehabilitative care, demonstrating its potential to extend services to underserved populations effectively. Using advanced AI and cloud computing allows for therapy tailored to individual needs, potentially revolutionizing patient care and extending services to underserved populations. Disclosures none.

Background Robot-assisted telerehabilitation (RAT) is an emerging field that integrates digital health technologies with robotics to deliver remote therapy, offering significant potential to overcome geographical and accessibility barriers in stroke rehabilitation. This approach holds great promise for enhancing upper limb (UL) recovery in stroke survivors. This study aims to assess the safety and usability of a new tele-rehabilitation system that uses the desktop-mounted rehabilitation (DMRbotV3) device and the HoloLens 2, designed to assist stroke survivors with UL dysfunction in performing therapy. Methods Six individuals with chronic stroke (onset ≥ 3 months) and six occupational therapists (OTs) participated in a single-session usability study. They interacted with the DMRbotV3 robotic device to perform structured passive and active therapeutic exercises within mixed-reality (MR) environments powered by the HoloLens 2 platform. Safety, usability, and user experience were assessed using the System Usability Scale (SUS), a customized gamification and satisfaction questionnaire, an experience evaluation survey, and follow-up interviews. Results The DMRbotV3 system was deemed secure, as evidenced by all twelve participants successfully completing the study without any adverse events. Usability evaluations showed a high level of user satisfaction, with a mean (SD) SUS score of 86.7 (8.5)%. The participants provided positive and constructive feedback on the integration of MR with HoloLens 2, which was determined to substantially increase their engagement and motivation during the exercises. Additional feedback emphasized the system’s ease of use, the need for a variety of handle designs, and the importance of simplifying certain exercise games. Conclusion The study demonstrated that the DMRbotV3 system integrated with HoloLens 2 is a safe, feasible, and well-accepted approach for UL rehabilitation in post-stroke individuals. This approach, by enabling more frequent and comprehensive self-administered practice in-home or remote settings, has the potential to enhance telerehabilitation outcomes and support functional recovery in stroke survivors.

Each year, around 15 million people globally, including 795,000 Americans, experience a stroke. Nearly half of stroke survivors face persistent upper limb motor impairments, limiting daily activities and quality of life. This underscores the need for early, intensive, and function-focused rehabilitation. This study explores the effectiveness of integrating game-based tasks into a 3DoF end-effector robotic system to enhance upper limb rehabilitation. By incorporating an engaging "Apple Picking" game into active therapy sessions, we aim to assess improvements in motor function, reaction time, and coordination among individuals undergoing upper limb recovery. This experimental study was conducted in the BioRobotics Laboratory, involving a diverse group of participants, including post-stroke individuals (n=3) and occupational therapists (n=2). Participants engaged in active rehabilitation exercises by controlling a 3DoF robotic arm to interact with a 2D computer-based game. The robotic system, equipped with force sensors, provided adaptive guided movements, enabling participants to manipulate an on-screen basket and catch falling apples. This interactive setup was designed to enhance motor recovery by fostering active engagement and responsive control. Key outcomes included improvements in motor skills, coordination, and reaction times, as assessed through metrics like movement accuracy, response times to in-game prompts, and task completion rates. Post-session evaluations included the System Usability Scale (SUS) to gauge platform usability questionnaire to measure participant engagement and motivation. Preliminary findings suggest that the game-based rehabilitation approach significantly improves participants' motor control and coordination. The engaging nature of the apple-picking game contributed to increased motivation and participation, with participants showing enhanced ability to coordinate movements and respond promptly to game challenges.

Objectives Bone mineral density (BMD) (gm/cm2), as measured by dual-energy x-ray absorptiometry (DXA), is used as a surrogate marker for fracture risk. This study aimed to: (1) describe the age-related change of total spine BMD across the life span in 4 distinct cross-sectional surveys by survey year 2005-2020, (2) compare the total spine BMD by age, sex, survey year, race/ethnicity, education, poverty ratio, and history of ever served on active duty, and (3) study the relationships between the total spine BMD and other BMD scans at the femoral and other spine regions (L1 to L4). Design This is an observational study. Setting General community. Participants Total spine BMD, taken from 21,570 noninstitutionalized participants, aged 8-85, were obtained from the National Health and Nutrition Examination Survey (NHANES) study. Interventions Not applicable. Main Outcome Measures Dual-energy x-ray absorptiometry—spine. Results The total spine BMD varied by sex, survey year, race/ethnicity, education, poverty level, and history of ever served on active duty (P<.001). In males, total spine BMD showed annual growth from ages 8 to 17 years (from 0.58 to 1.0 gm/cm2), stabilizing thereafter into middle and late adulthood. For females, total spine BMD increased until around 18 years old (from 0.59 to 1.0 gm/cm2), maintained stability from 18 to 47 years old, and then gradually declined as age increases. At the age of 80 years, the total spine BMD was about 0.91 gm/cm2. Although the survey year showed statistical significance, no practical differences were observed between the ages of 8 and 70 years. In general, non-Hispanic Blacks demonstrated higher total spine BMD compared with non-Hispanic Whites, while Mexican Americans tended to exhibit lower BMD levels in comparison to other groups. Overall, individuals with a background of some college education or an Associate's degree tended to display elevated levels of total spine bone mineral density (BMD), while individuals with an educational attainment of less than the 11th grade typically exhibited the lowest total spine BMD levels. Adults with incomes equal to or above the poverty level exhibited higher total spine BMD compared with those with incomes below the poverty level. The correlations between the total spine BMD and the L1 to L4 and total femur BMD were 0.958, 0.982, 0.984, 0.968, and 0.746, respectively. Conclusions This study reported the reference values of the total spine BMD among noninstitutionalized residents in the US. Targeted educational efforts are warranted to enhance knowledge of personal risk indicators. Disclosures none.

Objectives Low-density lipoprotein-cholesterol (LDL-C) remains of utmost clinical importance as a treatment target and primary cholesterol target in the primary prevention of atherosclerotic cardiovascular disease. To address the Friedewald equation measurement inadequacy, the Martin/Hopkins equation was developed to improve the LDL-C estimates. This study aimed to (1) scrutinize the factors influencing the differences between the Martin/Hopkins and Friedewald LDL-C estimates, and (2) ascertain the significant predictive factors using multiple regression and discriminant analysis. Design This is an observational study. Setting General community. Participants Blood lipid measurements were taken from 4617 noninstitutionalized participants, aged 12-80 years, with triglyceride <400 mg/dL, as obtained from the 2017-2020 National Health and Nutrition Examination Survey (NHANES) study. Interventions Not applicable. Main Outcome Measures Blood lipid measurements. The differences between the Martin/Hopkins and Friedewald LDL-C estimates were calculated as the dependent variable. The independent variables included sex, age, race/ethnicity, body mass index (BMI) category, and triglyceride levels. Results The differences between Martin/Hopkins and Friedewald LDL-C estimates varied by sex, age, race/ethnicity, BMI, and triglyceride levels (P<.001). Discrepancies were more pronounced in males compared with females, increased with age, higher BMI levels, and elevated triglyceride levels (mg/dL) (P<.001). Furthermore, disparities were greater in non-Hispanic Whites and Mexican Americans compared with non-Hispanic Blacks (P<.001). The relationship between the differences and triglyceride concentration revealed a V-shaped distribution, with the minimum turning point occurring at approximately 40 mg/dL. In comparison to the Martin/Hopkins LDL-C estimates, the Friedewald LDL-C estimates overestimated when triglyceride levels were < 100 mg/dL and underestimated when triglyceride levels were >100 mg/dL. The magnitude of differences was -3.6 mg/dL when triglyceride levels were at 20-40 mg/dL, 0.66 mg/dL when triglyceride levels were at 100-120 mg/dL, and gradually increased to 22.6 mg/dL when triglyceride levels were at 380-400 mg/dL. Results from regression analyses identified sex, age, and triglyceride levels as significant factors, with an R-squared value of 0.865. Additionally, results from discriminant analysis identified age, race/ethnicity, BMI, and triglyceride levels as significant factors, with a correct classification rate of 84.6%. Conclusions Future studies are warranted to redefine LDL-C estimation methods as our treatment targets evolve and novel therapeutics progress. Disclosures none.

Objectives To (1) quantify the age-associated rate of decline in grip strength in adults aged ≥30 years (∆kg/y, ∆kg/5-y, ∆kg/10-y), (2) examine sex differences in the rate of decline, and (3) explore differences in the rate of decline among different racial/ethnic groups. Design This is a cross-sectional, observational study. Setting General community. Participants Observed hand grip strength data for both hands were extracted from the National Health and Nutrition Examination Survey (NHANES) 2011-2014 database, comprising 7328 noninstitutionalized participants aged 30-80 years. Interventions Not applicable. Main Outcome Measures The muscle strength/grip test component measured isometric grip strength using a Takei Digital handgrip dynamometer. Best values (best from 3 trials) of the dominant hand were determined. The “Y2-Y1 rate of change” (in kg/y) was the grip strength difference between consecutive observations. Multiple regression analysis was used to estimate the constant rate of decline. Results The decline in handgrip strength varied by sex, with a consistent rate of decline observed as age increased. In male adults, the annual decline rate of the handgrip strength was estimated at 0.353 kg/year, 1.742 kg/5 years, and 3.620 kg/10 years. Conversely, in female adults, the annual decline rate of the handgrip strength was 0.221 kg/year, 1.095 kg/5 years, and 2.243 kg/10 years. Among males, handgrip strength declined 0.353 kg/year for Mexican Americans, 0.358 kg/year for Other Hispanic, 0.377 kg/year for non-Hispanic Whites, and 0.390 kg/year for non-Hispanic Blacks. Similarly, among females, handgrip strength declined at the rate of 0.205 kg/year for Mexican Americans, 0.216 kg/year for Other Hispanic, 0.248 kg/year for non-Hispanic Whites, and 0.244 kg/year for non-Hispanic Blacks. Conclusions Grip strength declines at a systematic and predictable rate as the population ages. Here, we estimated the age-associated rate of decline in grip strength. Disclosures none.

Objectives Bone mineral density (BMD), as measured by dual-energy x-ray absorptiometry, is used as a surrogate marker for fracture risk. This study aimed to: (1) describe the age-related change of total femur BMD across the life span in 4 distinct cross-sectional surveys by survey year 2005-2020, (2) compare the total femur BMD by age, sex, survey year, race/ethnicity, education, poverty level, and history of ever served on active duty, (3) study the relationships between the total femur BMD and other BMD scans at the femoral (femoral neck, trochanter, intertrochanter, Ward's triangle) and spine regions, and (4) explore the relationships between the grip strength and the total femur BMD. Design This is an observational study. Setting General community. Participants Total femur BMD, taken from 26,228 noninstitutionalized participants, aged 8-85, were obtained from the National Health and Nutrition Examination Survey (NHANES) study. Interventions Not applicable. Main Outcome Measures Dual-energy x-ray absorptiometry—femur, spine. Results The mean total femur bone mineral density (BMD) was lower for younger children, gradually increased to reach a plateau in early adult life, peaked around 18-19 years old (BMD, 1.12gm/cm2 for males and 0.99gm/cm2 for females), and then gradually declined thereafter. Males exhibited higher total femur BMD than females after puberty. In middle adulthood, the mean total femur BMD in females was 92% of that in males, decreasing to 81% in individuals near 80 years old. Being female, non-Hispanic white, and having an income below the poverty level were associated with lower total femur BMD levels (P<.001). From 2005 to 2020, stable trends in total femur BMD were observed (P=.994). Although individuals who served on active duty in the US armed forces had a slightly higher mean total femur BMD than those who did not, the difference was not significant (P=.173). Total femur BMD showed a very high correlation with BMD scans at the femoral sites (femoral neck, trochanter, intertrochanter, Ward's triangle) with r=0.89, 0.94, 0.98, and 0.70, respectively. Total femur BMD exhibited a high correlation with BMD scans at the spine (total spine, L1 to L4) with r=0.75, 0.73, 0.73, 0.70, and 0.69, respectively. However, the correlation between total femur BMD and handgrip strength at the dominant hand was low with r=0.47. Conclusions This study reported the reference values of the BMD. Targeted educational efforts are warranted to enhance knowledge of personal risk indicators. Disclosures none.