Smart home and communication technology for people with disability: a scoping review

Barriers and Facilitators to Sustainable Technology Implementation in Care for People With Disabilities-Real World Data From a Three-Year Implementation Programme

BACKGROUND

Implementation issues often impede the realisation of the potential benefits of technology in disability care organisations for people with disabilities. Therefore, we conducted a longitudinal study to gain insights into the barriers and facilitators to implementation.

METHODS

From 2019 to 2022, data were collected using questionnaires and interviews during 28 implementation projects in 26 disability care organisations.

RESULTS

Barriers and facilitators were identified using 9 themes and 26 subthemes. The main themes identified were finances, disability care organisations, internal collaborations, external collaborations, technology, care staff, project teams, people with disabilities, and context. Most factors mentioned as barriers in one organisation were mentioned as facilitators in others. This suggests that barriers can be resolved to improve implementation.

CONCLUSION

A large number of barriers and facilitators spanning the organisation suggests that the implementation of technology should be considered an organisational reform. Acting upon them is crucial for the successful implementation of technology.

Barriers and facilitators influencing implementation of care technology for people with intellectual disabilities: A cross-sectional study among care professionals

BACKGROUND

Implementation issues often hinder reaching the potential of care technology to improve daily lives of people with intellectual disabilities. We investigated barriers to and facilitators of implementing different technology modalities (app/social robot/sensor/domotics) in long-term care.

METHOD

Care professionals (N = 83) from 12 Dutch disability care organisations completed a customised measurement instrument for determinants of innovations (MIDI) questionnaire.

RESULTS

Out of 27 determinants, 20 were identified as facilitators and 16 as barriers. We highlight common barriers: few colleagues who work with the technology; no (awareness of) formal ratification of technology use; no arrangements regarding turnover of staff using the technology; unsettling organisational changes; technological defects and limited IT preconditions.

CONCLUSIONS

The results, which could be combined and compared across study sites, provide insight into which implementation determinants were already well addressed, and where there is ground to gain when implementing care technology in disability care organisations.

SMILEY-assistive application to support social and emotional skills in SPCD individuals

According to the available studies, mobile applications have provided significant support in improving the diverse skills of special individuals with social pragmatic communication disorder (SPCD). Over the last decade, SPCD has affected 8 to 11% of individuals, and therapy sessions cost between $50 and $150 per hour. This preliminary study aims to develop an interactive, user-friendly intervention to enhance social and emotional interaction skills in individuals with SPCD. The proposed intervention is an Android application that enhances social and emotional interaction skills. This pilot study involved 29 human subjects aged 7-13 years with pragmatic communication deficits. In a randomized controlled trial, the intervention was developed and implemented with consideration of caregiver and professional requirements. The improvement was analyzed using standard scales, including the Social Communication Questionnaire (SCQ) and the Social Communication Disorder Scale (SCDS). Moreover, the outcomes were examined through statistical parameters (mean, standard deviation) and tests (t-test). The intervention significantly improved the social and emotional skills of individuals with deficits. Before using the intervention, the identified statistical values for SCQ (mean = 6.48 and standard deviation = 3.37) and SCDS (mean = 8.17 and standard deviation = 4.79). However, after using the intervention, values for SCQ (mean = 8.24 and standard deviation = 3.95) and SCDS (mean = 9.48 and standard deviation = 4.72) were improved in comparison to the before-intervention outcome. The evaluation of the t-scores and p-values indicates that there has been significant improvement in the performance of individuals after the successful completion of the intervention. The proposed and applied intervention resulted in a significant impact in terms of improvement in social and emotional skills. The study concluded that it allows individuals to practice social and emotional interaction skills in a structured, controlled, and interactive environment. The proposed intervention has been found acceptable as per the reviews of caregivers and professionals, based on essential criteria including user experience, usability, interactive nature, reliability, and creditability.

Internet of things (IoT)-based assistive system for patients with spinal muscular atrophy (SMA): a case report

PURPOSE

Assistive technologies based on IoT can contribute to improve quality of living of patients with severe motor difficulties by providing partial or total independence. The aim of this work was to analyse the usability and performance of an assistive system based on the IoT when is evaluated by a child patient with spinal muscular atrophy type 1 (SMA-I).

MATERIALS AND METHODS

The study involved a child with SMA-I and his caregiver. The materials used include an M5Stack Core2 kit, a mobile app, and a smart switch based on the ESP-01S card. The patient sends requests to the caregiver from the app installed on the M5Stack Core2 to a mobile app, and controls smart switches located in the rooms. The system was tested by the participants for a period of 30 days to later evaluate its usability and performance.

RESULTS

The results show that the control function of smart switches is the most used and there is no decrease in interactions over the days for the system in general. In addition, the scores obtained from both usability tests (patient and caregiver) were 87.5% and 90%, respectively. The average performance of the entire system was 93.33%.

CONCLUSION

The application of assistive technologies based on the IoT allows obtaining a practical solution that improves the development of daily activities in a patient with SMA-I.

Providing mainstream smart home technology as assistive technology for persons with disabilities: a qualitative study with professionals

PURPOSE

Mainstream smart home technology (MSHT) is becoming increasingly powerful, affordable, and relevant to improving environment control, independence, and participation of people with disabilities. This study examined how MSHT is delivered as assistive technology (AT) by practitioners of various disciplines and roles and collected their perspectives on the challenges and important considerations during the delivery process.

METHODS

Practitioners with at least 1 year of experience providing MSHT as AT were interviewed individually or in small groups of 2-3 participants. Researchers developed guiding questions based on the AT service delivery process and applied an inductive qualitative analysis to generate common themes from the data.

RESULTS

While all 15 participants confirmed the potential benefits of MSHT to people with disabilities, most followed an informal service delivery process and encountered various challenges, including challenges related to technology updates and compatibility, difficulty in keeping up with technology changes and advancement, funding for MSHT and services, client Wi-Fi/Internet access and quality, and security and privacy concerns. Participants also emphasised the importance of assessment and technology trialling during the delivery process and shared strategies for device customisation and client training.

CONCLUSIONS

This study provides first-hand information about the current practice of MSHT service delivery, as well as insights into areas where support is likely needed. The results could inform the development of new tools and resources to support MSHT service delivery. More research is required to develop and evaluate viable service delivery models for mainstream technologies to be used as AT.IMPLICATIONS FOR REHABILITATIONPractitioners who have experience delivering MSHT as AT confirmed the benefits of MSHT for improving independence, safety, and social connection of people with disabilities.Practitioners emphasised the importance of assessment prior to device selection even though MSHT can be readily purchased off the shelf.Practitioners need support for device trialling, installation, troubleshooting, and keeping up with constantly evolving MSHT.More research is needed to develop and evaluate service delivery models for mainstream technologies as AT for people with disabilities.

Hey Google! Intelligent personal assistants and well-being in the context of disability during COVID-19

BACKGROUND

Amidst the greatest technological advancement that societies have seen, the (health)care and quality of life of all, and especially of vulnerable individuals, see unprecedented improvements. Intelligent personal assistants (IPAs), such as Google Home (GH), can easily be implemented in their daily lives to facilitate routines. Technology can offer significant benefits for individuals with impairments and/or limitations in achieving greater autonomy and well-being. However, this opportunity still needs to be fully exploited, especially in long-term care facilities. Furthermore, such potential may be particularly needed during social isolation due to health concerns, such as the COVID-19 lockdowns and restrictions. We investigated the validity of implementing GH in residential care for individuals with visual impairments (VIs) and intellectual disabilities (IDs) and assessed the effects of a 10-week intervention on self-reported well-being.

METHODS

We used a mixed-methods multiple case studies approach (N = 7) and performed intensive assessments (20 weeks), including self-report well-being questionnaires and observations focusing on well-being, autonomy, social participation and GH experiences. Nonoverlap of all pairs analyses were performed for quantitative data indexing performance differences between intervention phases. Thematic analysis was performed for the qualitative data.

RESULTS

We found meaningful improvements in well-being in five clients, while all rated the experience of using GH positively.

CONCLUSIONS

Our findings from the quantitative and qualitative analyses document that individuals with VI and/or ID benefit from IPAs in fostering better autonomy by facilitating access to information and entertainment. Further implications and possible barriers to large-scale implementation of IPAs in residential care are discussed.

Understanding the possibilities and limitations of assistive technology in health and welfare services for people with intellectual disabilities, staff perspectives

PURPOSE

Little is known regarding what assistive technology (AT) exists and how it is used in welfare services for people with intellectual disabilities (ID). This study aimed to explore healthcare staff's perspectives and insights regarding AT in daily support and welfare services for people with ID. We also sought to explore the associations between the use of AT and workplace-related factors and background characteristics (e.g., gender, age, and experience).

MATERIALS AND METHODS

Three focus group discussions were conducted with 11 informants (8 women, 3 men) working in home-based and day services. Also, 176 healthcare staff (43 men, 133 women) who worked in municipal home-based services and day services completed a questionnaire comprised of background questions and 14 items with a five-point answer scale.

RESULTS

Number of years using AT was positively associated with a positive attitude and use of AT among the staff. Staff were mainly positive towards AT and believed that it could represent various possibilities in the everyday lives of people with ID and their own service delivery. However, the staff expressed uncertainties and ethical concerns regarding AT, and they experienced a lack of knowledge, focus, and awareness about technology in services for this group. The quantitative results mainly showed positive associations between believing in AT's usefulness and using it in services for people with ID.

CONCLUSIONS

The findings indicate that providing equipment and resources, personal interests, and staff attitudes are essential factors in successfully implementing AT for people with ID.Implications for rehabilitationHealthcare staff have a positive attitude towards using AT for people with intellectual disabilities, but they also perceive uncertainty and ethical concerns.The staff believe that there is a broad range of AT devices and systems available that can support the independence and participation of people with intellectual disabilities.The staff need to receive more training and technical supports from their workplace and AT-related experience is associated positively with the use of assistive technology by the staff.

Technologies in Home-Based Digital Rehabilitation: Scoping Review

BACKGROUND

Due to growing pressure on the health care system, a shift in rehabilitation to home settings is essential. However, efficient support for home-based rehabilitation is lacking. The COVID-19 pandemic has further exacerbated these challenges and has affected individuals and health care professionals during rehabilitation. Digital rehabilitation (DR) could support home-based rehabilitation. To develop and implement DR solutions that meet clients' needs and ease the growing pressure on the health care system, it is necessary to provide an overview of existing, relevant, and future solutions shaping the constantly evolving market of technologies for home-based DR.

OBJECTIVE

In this scoping review, we aimed to identify digital technologies for home-based DR, predict new or emerging DR trends, and report on the influences of the COVID-19 pandemic on DR.

METHODS

The scoping review followed the framework of Arksey and O'Malley, with improvements made by Levac et al. A literature search was performed in PubMed, Embase, CINAHL, PsycINFO, and the Cochrane Library. The search spanned January 2015 to January 2022. A bibliometric analysis was performed to provide an overview of the included references, and a co-occurrence analysis identified the technologies for home-based DR. A full-text analysis of all included reviews filtered the trends for home-based DR. A gray literature search supplemented the results of the review analysis and revealed the influences of the COVID-19 pandemic on the development of DR.

RESULTS

A total of 2437 records were included in the bibliometric analysis and 95 in the full-text analysis, and 40 records were included as a result of the gray literature search. Sensors, robotic devices, gamification, virtual and augmented reality, and digital and mobile apps are already used in home-based DR; however, artificial intelligence and machine learning, exoskeletons, and digital and mobile apps represent new and emerging trends. Advantages and disadvantages were displayed for all technologies. The COVID-19 pandemic has led to an increased use of digital technologies as remote approaches but has not led to the development of new technologies.

CONCLUSIONS

Multiple tools are available and implemented for home-based DR; however, some technologies face limitations in the application of home-based rehabilitation. However, artificial intelligence and machine learning could be instrumental in redesigning rehabilitation and addressing future challenges of the health care system, and the rehabilitation sector in particular. The results show the need for feasible and effective approaches to implement DR that meet clients' needs and adhere to framework conditions, regardless of exceptional situations such as the COVID-19 pandemic.

Heart rate monitoring to detect acute pain in non-verbal patients: a study protocol for a randomized controlled clinical trial

BACKGROUND

Autism entails reduced communicative abilities. Approximately 30% of individuals with autism have intellectual disability (ID). Some people with autism and ID are virtually non-communicative and unable to notify their caregivers when they are in pain. In a pilot study, we showed that heart rate (HR) monitoring may identify painful situations in this patient group, as HR increases in acutely painful situations.

OBJECTIVES

This study aims to generate knowledge to reduce the number of painful episodes in non-communicative patients' everyday lives. We will 1) assess the effectiveness of HR as a tool for identifying potentially painful care procedures, 2) test the effect of HR-informed changes in potentially painful care procedures on biomarkers of pain, and 3) assess how six weeks of communication through HR affects the quality of communication between patient and caregiver.

METHODS

We will recruit 38 non-communicative patients with autism and ID residing in care homes.

ASSESSMENTS

HR is measured continuously to identify acutely painful situations. HR variability and pain-related cytokines (MCP-1, IL-1RA, IL-8, TGFβ1, and IL-17) are collected as measures of long-term pain. Caregivers will be asked to what degree they observe pain in their patients and how well they believe they understand their patient's expressions of emotion and pain. Pre-intervention: HR is measured 8 h/day over 2 weeks to identify potentially painful situations across four settings: physiotherapy, cast use, lifting, and personal hygiene.

INTERVENTION

Changes in procedures for identified painful situations are in the form of changes in 1) physiotherapy techniques, 2) preparations for putting on casts, 3) lifting techniques or 4) personal hygiene procedures.

DESIGN

Nineteen patients will start intervention in week 3 while 19 patients will continue data collection for another 2 weeks before procedure changes are introduced. This is done to distinguish between specific effects of changes in procedures and non-specific effects, such as caregivers increased attention.

DISCUSSION

This study will advance the field of wearable physiological sensor use in patient care.

TRIAL REGISTRATION

Registered prospectively at ClinicalTrials.gov (NCT05738278).

Identification and description of telerehabilitation assessments for individuals with neurological conditions: A scoping review

Background

The clinical adoption of telerehabilitation accelerated rapidly over the last few years, creating opportunities for clinicians and researchers to explore the use of digital technologies and telerehabilitation in the assessment of deficits related to neurological conditions. The objectives of this scoping review were to identify outcome measures used to remotely assess the motor function and participation in people with neurological conditions and report, when available, the psychometric data of these remote outcome measures.

Methods

MEDLINE (Ovid), CINAHL, PubMed, PsychINFO, EMBASE, and Cochrane databases were searched between December 13, 2020, and January 4, 2021, for studies investigating the use of remote assessments to evaluate motor function and participation in people with neurological conditions. An updated search was completed on May 9, 2022, using the same databases and search terms. Two reviewers independently screened each title and abstract, followed by full-text screening. Data extraction was completed using a pre-piloted data extraction sheet where outcome measures were reported as per the International Classification of Functioning, Disability and Health.

Results

Fifty studies were included in this review. Eighteen studies targeted outcomes related to body structures and 32 targeted those related to activity limitation and participation restriction. Seventeen studies reported psychometric data; of these, most included reliability and validity data.

Conclusion

Clinical assessments of motor function of people living with neurological conditions can be completed in a telerehabilitation or remote context using validated and reliable remote assessment measures.

Home Automation for Adults With Disability Following an Injury: Protocol for a Social Return on Investment Study

BACKGROUND

People with disability following a serious injury require long-term care. The most common injuries resulting in long-term disability are spinal cord and acquired brain injuries. While the long-term effects are difficult to predict and will vary between individuals, the costs of care and recovery span well beyond the initial treatment phase and include long-term care. Long-term care is changing with the availability and advances in cost and function of technologies, such as home automation. "Home automation" refers to technology that automates or remotely controls household functions. Home automation costs vastly differ, but home automation has the potential to positively impact the lives of people with disabilities. However, there is a dearth of evidence relating to the impact of home automation for people with a disability and few rigorous evaluations about the costs and return on investment.

OBJECTIVE

The purpose of this study is to describe the impact of home automation for people with long-term disability following a serious injury (such as a motor vehicle accident) using case studies, and by conducting an evaluation of the costs and outcomes for individuals, families, and the wider community using a Social Return on Investment (SROI) approach.

METHODS

SROI is a form of economic evaluation that develops a theory of change to examine the relationship among inputs, outputs, and outcomes and, in recent years, has gained popularity internationally, including in Australia. SROI has six phases: (1) identify scope and stakeholders, (2) map outcomes, (3) evidence outcomes and give them value, (4) establish impact, (5) calculate the SROI, and (6) report findings. Individuals with a disability who use home automation and key stakeholders will be interviewed. Stakeholders will be individuals involved in home automation for people with disabilities, such as allied health professionals, medical practitioners, equipment suppliers, engineers, and maintenance professionals. Users of home automation will be people who have a disability following a serious injury, have the capacity to provide consent, and have 1 or more elements of home automation. The impact of home automation will be established with financial proxies and appropriate discounts applied to avoid overestimating the social return. The SROI ratio will be calculated, and findings will be reported.

RESULTS

The project was funded in November 2021 by the Lifetime Support Authority. Recruitment is underway, and data collection is expected to be completed by October 2022. The final results of the study will be published in March 2023.

CONCLUSIONS

To our knowledge, this study represents the first study in Australia and internationally to employ SROI to estimate the social, personal, and community outcomes of home automation for people with a disability following a serious injury. This research will provide valuable information for funders, consumers, researchers, and the public to guide and inform future decision-making.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/42493.

Wayfinding and spatial perception among adolescents with mild intellectual disability

BACKGROUND

The study's aim was to examine whether spatial orientation can be improved in students with cognitive disabilities.

METHOD

Participants were 55 boys and girls with attention deficit and mild cognitive impairment from a special education school. The procedure included an intervention for two experimental groups that studied wayfinding and orientation in the environment: group #1 learned to use a map while navigating, and group #2 learned to use a Google navigation app with voice instructions. Two pre-post tests were applied: (1) Mental folding test for children (MFTC) and (2) field test with map.

RESULTS

Both groups improved their ability in navigation and wayfinding. No advantage for one learning method over the other was demonstrated, except for shortened navigation time in the group navigating with a map, and a slight though not significant tendency of improvement in the MFTC task in the group learning navigation using a voice app.

CONCLUSION

It is worth noting that the study did not examine the students' own preferences for the way of learning, which may have implications for the degree of possible improvement. Also, a longer period of the learning process might yield a clearer understanding concerning the differences between the two teaching methods that were examined.

Usage and impact of the internet-of-things-based smart home technology: a quality-of-life perspective

The aim of this paper is to explore the usage and impact of the Internet-of-Things-based Smart Home Technology (IoT-SHT) in Malaysia. Face-to-face interviews were conducted with a total of eleven IoT-SHT users who had a minimum of 2-year usage experience. The semi-structured interview consisted of six questions which were compartmentalised into two sections. Common themes were identified through constant comparison of the inductive data in the coding process. The in-depth interview uncovered six uses of IoT-SHT. Mainly, it was used for real-time remote control, surveillance, sensing, home automation, entertainment, and family communication. It seems clear that the IoT-SHT helped people to save time, changed their lives, improved security, safety, environment condition, fun, convenience, and comfort within the home ground. It also facilitated better health tracking, family care, and energy conservation. Psychologically, the IoT-SHT also enhanced one's image, offered better companionship, and improved the sense of belongingness, and closeness within the family. This study fills the research gap by providing insights into how the IoT-SHT was used, thereby benefiting users in Malaysia. With the arrival of industrial revolution 4.0, a comprehensive knowledge on the usage of IoT is pertinent. The findings of this study may also serve as a foundation for future research in IoT-SHT adoption. Practically, this study accelerates IoT-SHT diffusion by providing insights to vendors in designing better IoT products and services, based on the popular usages and impactful benefits.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10209-022-00937-0.

Experiences of Persons With Executive Dysfunction in Disability Care Using a Social Robot to Execute Daily Tasks and Increase the Feeling of Independence: Multiple-Case Study

Background

Executive functions are essential for independently navigating nearly all of our daily activities. Executive dysfunction often occurs as a result of a neurodevelopmental disorder. Persons with executive dysfunction experience challenges regarding independent execution of daily tasks. Social robots might support persons with executive dysfunction to execute daily tasks and promote their feeling of independence.

Objective

This study aimed to study the impact of interacting with social robot Tessa on goal attainment in the execution of daily tasks and perceived independence of persons with executive dysfunction.

Methods

In this multiple-case study, 18 participant–caregiver couples were followed up while using Tessa in the home environment for 3 months. Goal attainment on independently performing a self-determined goal was measured by the Goal Attainment Scale, and participant–caregiver couples were interviewed about their experience with their interaction with Tessa and how they perceived Tessa’s impact on their independence.

Results

In total, 11 (61%) participants reached their goal after 6 weeks and maintained their goal after 3 months. During the study period, 2 participant–caregiver couples withdrew because of mismatch with Tessa. Participants set goals in the following domains: execution of household tasks; intake of food, water, or medication; being ready in time for an appointment; going to bed or getting out of bed on time; personal care; and exercise. Participants perceived that Tessa increased the feeling of independence by generating more structure, stimulation, and self-direction. Participant–caregiver couples reported that the auditive information provided by Tessa was more effective in coping with executive dysfunction compared to their initial approaches using visual information, and the use of Tessa had a positive impact on their relationship.

Conclusions

This study paid ample time and attention to the implementation of a social robot in daily care practice. The encouraging findings support the use of social robot Tessa for the execution of daily tasks and increasing independence of persons with executive dysfunction in disability care.

Chinese adult segmentation according to health skills and analysis of their use for smart home: a cross-sectional national survey

BACKGROUND

Digital health has become a heated topic today and smart homes have received much attention as an important area of digital health. Smart home is a device that enables automation and remote control in a home environment via the internet. However, most of the existing studies have focused on discussing the impact of smart home on people. Only few studies have focused on relationship between health skills and use of smart home.

AIMS

To analyze the health skills of Chinese adults and segment them to compare and analyze the use of smart home for each group.

METHODS

We used data from 11,031 participants aged 18 and above. The population was clustered based on five health skills factors: perceived social support, family health, health literacy, media use, and chronic diseases self-behavioral management. A total of 23 smart homes were categorized into three sub-categories based on their functions: entertainment smart home, functional smart home, and health smart home. We analyzed demographic characteristics and utilization rate of smart home across different cluster. Each groups' features and the differences in their needs for smart home functions were compared and analyzed.

RESULTS

As a result of the survey on health skills, three groups with different characteristics were clustered: good health skills, middle health skills, and poor health skills. The utilization rate of smart home was the highest was good health skills group (total smart home: 92.7%; entertainment smart home: 61.1%, functional smart home: 77.4%, and health smart home: 75.3%; P < 0.001). For entertainment smart home, smart TV had the highest utilization rate (good health skills: 45.7%; middle health skills: 43.5%, poor health skills: 33.4%, P < 0.001). For functional smart home, smart washing machine (good health skills: 37.7%, middle health skills: 35.11%, poor health skills: 26.5%; P < 0.001) and smart air conditioner (good health skills: 36.0%, middle health skills: 29.1%, poor health skills: 24.6%) were higher than other of this category. For health smart home, sports bracelet has the highest utilization rate (good health skills: 37.3%, middle health skills: 24.5%, poor health skills: 22.8%).

CONCLUSION

People can be divided into different categories based on health skill profiles, those with good health skills had a better utilization rate of smart home. The government and smart home companies need to focus on people with poor smart home use in various ways to promote their use of smart homes for personal health management.

Impairment and Compensation in Dexterous Upper-Limb Function After Stroke. From the Direct Consequences of Pyramidal Tract Lesions to Behavioral Involvement of Both Upper-Limbs in Daily Activities

Impairments in dexterous upper limb function are a significant cause of disability following stroke. While the physiological basis of movement deficits consequent to a lesion in the pyramidal tract is well demonstrated, specific mechanisms contributing to optimal recovery are less apparent. Various upper limb interventions (motor learning methods, neurostimulation techniques, robotics, virtual reality, and serious games) are associated with improvements in motor performance, but many patients continue to experience significant limitations with object handling in everyday activities. Exactly how we go about consolidating adaptive motor behaviors through the rehabilitation process thus remains a considerable challenge. An important part of this problem is the ability to successfully distinguish the extent to which a given gesture is determined by the neuromotor impairment and that which is determined by a compensatory mechanism. This question is particularly complicated in tasks involving manual dexterity where prehensile movements are contingent upon the task (individual digit movement, grasping, and manipulation…) and its objective (placing, two step actions…), as well as personal factors (motivation, acquired skills, and life habits…) and contextual cues related to the environment (presence of tools or assistive devices…). Presently, there remains a lack of integrative studies which differentiate processes related to structural changes associated with the neurological lesion and those related to behavioral change in response to situational constraints. In this text, we shall question the link between impairments, motor strategies and individual performance in object handling tasks. This scoping review will be based on clinical studies, and discussed in relation to more general findings about hand and upper limb function (manipulation of objects, tool use in daily life activity). We shall discuss how further quantitative studies on human manipulation in ecological contexts may provide greater insight into compensatory motor behavior in patients with a neurological impairment of dexterous upper-limb function.

Brain-Computer Interface (BCI) Control of a Virtual Assistant in a Smartphone to Manage Messaging Applications

Brain-computer interfaces (BCI) are a type of assistive technology that uses the brain signals of users to establish a communication and control channel between them and an external device. BCI systems may be a suitable tool to restore communication skills in severely motor-disabled patients, as BCI do not rely on muscular control. The loss of communication is one of the most negative consequences reported by such patients. This paper presents a BCI system focused on the control of four mainstream messaging applications running in a smartphone: WhatsApp, Telegram, e-mail and short message service (SMS). The control of the BCI is achieved through the well-known visual P300 row-column paradigm (RCP), allowing the user to select control commands as well as spelling characters. For the control of the smartphone, the system sends synthesized voice commands that are interpreted by a virtual assistant running in the smartphone. Four tasks related to the four mentioned messaging services were tested with 15 healthy volunteers, most of whom were able to accomplish the tasks, which included sending free text e-mails to an address proposed by the subjects themselves. The online performance results obtained, as well as the results of subjective questionnaires, support the viability of the proposed system.

Smart-speaker technology and intellectual disabilities: agency and wellbeing

PURPOSE

Mainstream intelligent personal assistants (IPAs, e.g., Amazon Echo and Google Home) offer an unprecedented opportunity to enhance agency and wellbeing among vulnerable groups across health and social care. However, unintended consequences and barriers to use are possible.

MATERIALS AND METHODS

We conducted a mixed-methods semi-randomized controlled trial among individuals with intellectual disability (ID), providing IPAs to an intervention group (N = 22), but not a control group (N = 22). Semi-structured interviews on device use and daily life were conducted with individuals with ID. Observation surveys were also collected from support staff. Key themes were identified using thematic analysis. We also collected quantitative agency and wellbeing data. A separate group of 40 individuals who had already received IPAs were additionally assessed, as well as their support staff.

RESULTS

Four themes were identified: (1) social value, (2) entertainment, (3) perceived agency, (4) challenges, perseverance, training/support needs. Opinions regarding IPAs were overwhelmingly positive. Most individuals qualitatively reported improved sense of agency and IPAs enabled many individuals to access features associated with wellbeing, but there was no significant change in the quantitative measure. Some individuals experienced challenges related to pronouncing and remembering IPA phrases; however, perseverance was common.

CONCLUSIONS

This study increases our understanding of the ways smart speakers can be used to enhance life quality among individuals with ID, and the nature of barriers faced. In conclusion, IPAs are cost-effective complementary support for vulnerable populations, but additional training is required to realize all potential benefits.Implications for rehabilitationIndividuals with intellectual disability (ID) in supported living are able to use mainstream smart-speakers to access features associated with supporting wellbeing and social communication.They also reported that smart speakers made them feel better able to do things for themselves.A number of individuals with ID and their support staff identified a need for training and support to get the most out of smart speakers in future.