Assessing the reproducibility and predictive value of objective cough measurement for successful withdrawal of invasive ventilatory support in adult patients.

BACKGROUND: Utilizing clinical tests, such as objective cough measurement, can assist in predicting the success of the weaning process in critically ill patients. METHODS: A multicenter observational analytical study was conducted within a prospective cohort of patients recruited to participate in COBRE-US. We assessed the capability of objective cough measurement to predict the success of the spontaneous breathing trial (SBT) and extubation. Intra- and inter-observer reproducibility of the cough test and was evaluated using the intraclass correlation coefficient (ICC) and Cohen's weighted kappa. We used receiver operating characteristic curves (ROC-curve) to evaluate the predictive ability of objective cough measurement. RESULTS: We recruited 367 subjects who were receiving invasive mechanical ventilation. A total of 451 objective cough measurements and 456 SBTs were conducted. A significant association was found between objective cough measurement and successful SBT (OR: 1.68; 95% CI 1.48-1.90; p = 0.001). The predictive capability of the objective cough test for SBT success had a ROC-curve of 0.58 (95% CI: 0.56-0.61). Objective cough measurement to predict successful extubation had a ROC-curve of 0.61 (95% CI: 0.56-0.66). The intraobserver reproducibility exhibited an ICC of 0.94 (95% CI: 0.89-0.96; p < 0.001), while the interobserver reproducibility demonstrated an ICC of 0.72 (95% CI: 0.51-0.85; p < 0.001). The intraobserver agreement, assessed using Cohen's weighted kappa was 0.94 (95% CI: 0.93-0.99; p < 0.001), whereas the interobserver agreement was 0.84 (95% CI: 0.67 - 0.10; p < 0.001). CONCLUSIONS: The objective measurement of cough using the method employed in our study demonstrates nearly perfect intra-observer reproducibility and agreement. However, its ability to predict success or failure in the weaning process is limited.

Evaluation of the accuracy of a UWB tracker for in-home positioning for older adults.

The population of older adults is rapidly growing. In-home monitoring systems have been used to support aging-in-place. Ambient sensors or wearable localizers can be used but may be too low resolution, while camera systems are invasive to privacy. Ultra-wideband (UWB) localization offers precise positioning by placing anchors throughout the house and wearing a tag that is tracked by the anchors. In this study, the accuracy of UWB for indoor tracking was evaluated in a motion capture gait lab and in a mock condo in the Glenrose Rehabilitation Hospital. First, the configuration of UWB was tested, changing factors related to sampling time, anchor placement and line-of-sight. Comparing these factors to the configurations recommended by the manufacturer guidelines, accuracies remained within 14 cm. We then performed static and dynamic accuracy tests, with dynamic testing comprised of rolling and walking motions. In the motion capture lab, we found localization accuracies of 7.0 ± 11.1 cm while in the mock condo, we found accuracies of 27.3 ± 12.9 cm. Dynamic testing with rolling motions had an average of 19.1 ± 1.6 cm while walking was 20.5 ± 4.2 cm. The mean accuracy of UWB is within the 30 cm target for indoor localization.

Utilization of spontaneous breathing trial, objective cough test, and diaphragmatic ultrasound results to predict extubation success: COBRE-US trial.

BACKGROUND: The results of clinical and weaning readiness tests and the spontaneous breathing trial (SBT) are used to predict the success of the weaning process and extubation. METHODS: We evaluated the capacity of the cuff leak test, rate of rapid and shallow breathing, cough intensity, and diaphragmatic contraction velocity (DCV) to predict the success of the SBT and extubation in a prospective, multicenter observational study with consecutive adult patients admitted to four intensive care units. We used receiver operating characteristic (ROC) curves to assess the tests' predictive capacity and built predictive models using logistic regression. RESULTS: We recruited 367 subjects who were receiving invasive mechanical ventilation and on whom 456 SBTs were performed, with a success rate of 76.5%. To predict the success of the SBT, we derived the following equation: (0.56 × Cough) - (0.13 × DCV) + 0.25. When the cutoff point was ≥ 0.83, the sensitivity was 91.5%, the specificity was 22.1%, and the overall accuracy was 76.2%. The area under the ROC curve (AUC-ROC) was 0.63. To predict extubation success, we derived the following equation: (5.7 × SBT) + (0.75 × Cough) - (0.25 × DCV) - 4.5. When the cutoff point was ≥ 1.25, the sensitivity was 96.8%, the specificity was 78.4%, and the overall accuracy was 91.5%. The AUC-ROC of this model was 0.91. CONCLUSION: Objective measurement of cough and diaphragmatic contraction velocity could be used to predict SBT success. The equation for predicting successful extubation, which includes SBT, cough, and diaphragmatic contraction velocity values, showed excellent discriminative capacity.

Challenges and promises of mixed-reality interventions in acquired brain injury rehabilitation: A scoping review.

BACKGROUND: Acquired brain injury (ABI) can lead to significant impairments and difficulties in everyday life, necessitating the need for rehabilitation. Mixed-reality (MR) technologies have revolutionized the delivery of neurorehabilitation therapies. However, inconsistencies in research methodology, diverse study populations and designs, and exaggerated claims in the research, media, and private consumer sectors have impacted the knowledge base of the field, including within the context of ABI rehabilitation. OBJECTIVE: This scoping review aims to explore MR-systems in ABI rehabilitation, while assessing the evidence base and technology readiness levels of these systems. METHODS: Seven databases were searched for studies, which were screened and analyzed by two independent raters. The types of MR systems, levels of evidence, and technology readiness levels were extracted and analyzed using descriptive analyses. RESULTS: Twenty-six studies were included in the review, all of which focused on ABI etiologies stemming from strokes. Across studies, upper-limb motor rehabilitation was the most common rehabilitation target of MR interventions, followed by gait, cognition, and lower-extremity functioning. At present, overall results indicate low evidence for MR-applications in ABI rehabilitation, with a median technology readiness level of 6, corresponding to system prototypes being tested in relevant environments. CONCLUSION: Although challenges regarding system usability and design were reported, results appear promising with ongoing research. With variability across studies, technologies, and populations, determining the effectiveness of MR interventions in ABI remains a challenge, necessitating the need for ongoing innovation, research, and development of these systems.

Technologies for monitoring activities of daily living in older adults: a systematic review.

PURPOSE: As the older adult population rise globally, technologies to monitoring activities of daily living (ADL) may have a role in supporting aging in place for older adults. The objective of this systematic literature review was to study the scope, diversity and readiness of technologies developed to monitor ADL in older adults. METHODS: We systematically searched two scientific databases (CINAHL and IEEE), following Preferred Reporting Items for Systematic reviews and Meta Analyses (PRISMA) guidelines. We included studies on technologies used to monitor older adults' ADL in the home but excluded studies focused on communication technologies (phone calls, text messages) or monitoring postures alone. The JBI checklist for case series was used for quality assessment. Extracted details included population characteristics, ADL assessment outcomes, types of monitoring technology, and technology readiness and usability. RESULTS: The search found 147 papers, with 16 papers included in the final analysis. The literature described 48 types of technologies. Of moderate quality studies, five studies used wearables at technology readiness level 4-6 to monitor basic ADL (walking, transfers and walking up stairs) and one used ambient sensors to detect urinary incontinence. CONCLUSIONS: Monitoring technologies remain at development stages. More research is needed to strengthen technologies that monitor activities of daily living.Implications for rehabilitationMonitoring activities of daily living at home remains focused on using wearables to assess in-home functional mobility to support rehabilitation.Technologies remain a 4-6 readiness level and there is a lack of evidence to recommend in-home monitoring technologies.

Emergency siren detection technology and hearing impairment: a systematized literature review.

PURPOSE: We aimed to identify evidence supporting emergency vehicle technology in out-of-vehicle systems and in-vehicle-systems that can be used by people with hearing impairment. METHODS: We conducted a systematized review to determine what technologies, at any readiness level, are currently being developed in the area of emergency vehicle detection technology. The studies and websites of technologies for emergency vehicles that are currently available to the general public were identified by searching in one electronic database, Scopus and grey literature using Google, respectively. RESULTS: A total of 359 studies were retrieved from Scopus. The grey literature search identified 189 websites related to the search terms under study. Technological devices have included satellite, out-of-vehicle and in-vehicle technology. The analysis shows that most of the technologies are at the stage of laboratory testing. Knowing the availability and the level of readiness of devices, as well as their effectiveness, provides rehabilitation professionals with tools for making evidence-based recommendations to clients with hearing impairment. Knowing which devices are available also provides information to individuals living with hearing impairment so that they can play an active role in the decision-making process of acquiring the existing technologies. CONCLUSIONS: So far, few technologies have been identified, and most of them are in the laboratory development stage (i.e., low product readiness level). These results indicate a justified need for the development of new in-vehicle technologies to detect emergency vehicles and actions to transform the new devices into products that are available for people with hearing impairment.IMPLICATIONS FOR REHABILITATIONThere is a need to design new assistive technology devices that are intended to detect emergency service vehicles, which in turn may reduce stress and anxiety related to driving for people with hearing impairment.The majority of the included articles discussed siren detection, with only three discussing the necessary next step of communication to humans.Due to the research being in its early stages, the evidence for emergency vehicle technology on health and participation-related outcomes in people living with hearing impairment is unknown.Most websites do not include information on where to purchase emergency vehicle technology or how much the devices cost, thus making it difficult for people with hearing impairment or rehabilitation professionals to make informed decisions about acquiring these technologies.

Digital Storytelling with Persons Living with Dementia: Elements of Facilitation, Communication, Building Relationships, and Using Technology.

Digital storytelling is a process that can be used to co-create multimedia stories with persons living with dementia to affirm identity, support person-centered care, and leave a legacy. Although digital storytelling typically involves a facilitator, little is known about the co-creation process between a facilitator and persons living with dementia. This study explored and described elements of digital storytelling facilitation with persons living with dementia using a secondary analysis of qualitative data from a primary study that took place across three Canadian cities. Three elements were identified during digital storytelling facilitation with persons living with dementia: communicating, building collaborative relationships, and using technology. Digital storytelling facilitators employ the three elements to weave together a person's narrative with meaning. The communication, relational, and technological elements of digital storytelling may be employed by facilitators from varying professional backgrounds and lived experiences to create meaningful digital stories for persons living with dementia.

Intentional Lung Transplantation Due to ABO Incompatibility: A Case Report.

We present a case of a 16-year-old adolescent female with blood group O+ who was diagnosed with cystic fibrosis (CF). The patient had to be hospitalized due to septic shock and respiratory failure, and extracorporeal membrane oxygenation and mechanical ventilation were applied. Faced with high urgency, she was promptly enlisted for a lung transplant, ultimately receiving a blood group A1 deceased donor lung through rescue allocation. Bilateral incompatible lung transplantation, with parental consent, was successfully performed. The postoperative course was favorable, marked by the administration of rabbit anti-thymocyte globulin, plasmapheresis, and immunosuppression (mycophenolate, steroids, and tacrolimus) as per the prescribed protocol. Notably, the patient experienced a smooth recovery without infectious complications or humoral rejection. This case highlights the viability of lung transplantation in cases of ABO incompatibility, particularly for patients in urgent need on the transplant waiting list.

Understanding the Technology Acceptance and Usability of a New Device for Hand Therapy: Qualitative Descriptive Study.

BACKGROUND: Upper extremity function plays a critical role in completing activities of daily living, employment, and participating in recreational activities. The FEPSim device is a medical device for hand and wrist rehabilitation that can be adjusted according to the patient's requirements in rehabilitation. Furthermore, the FEPSim can be used to assess the patient's strength and range of motion of the forearm, wrist, and hand. At present, the acceptance and usability of the FEPSim have not been tested in a clinical setting, with limited perspectives from rehabilitation-providing clinicians. OBJECTIVE: This study aims to understand the factors related to the acceptance and usability of the FEPSim device. Upper limb disorders are prevalent across populations. The impact of upper limb disorders, both acute and chronic, puts a significant burden on the Canadian health care system. METHODS: A qualitative descriptive study was conducted that involved face-to-face semistructured interviews with hand therapists from hand therapy services who used the FEPSim device. We used purposive sampling to recruit 10 participants over a period of 14 months. Semistructured interview questions (topic-guided) examined the technology acceptance and usability of the FEPSim device. RESULTS: We found 6 factors to be critical aspects of the acceptance and usability of the FEPSim device. These factors were (1) useful for therapy, (2) effortlessness, (3) environmental conditions, (4) internal encouragement, (5) technological aesthetics, and (6) use. CONCLUSIONS: The FEPSim device was widely accepted by the therapists. The use of the FEPSim device is a feasible alternative for supporting hand therapy. TRIAL REGISTRATION: ISRCTN Registry ISRCTN13656014; https://www.isrctn.com/ISRCTN13656014.

Evidence and User Considerations of Home Health Monitoring for Older Adults: Scoping Review.

BACKGROUND: Home health monitoring shows promise in improving health outcomes; however, navigating the literature remains challenging given the breadth of evidence. There is a need to summarize the effectiveness of monitoring across health domains and identify gaps in the literature. In addition, ethical and user-centered frameworks are important to maximize the acceptability of health monitoring technologies. OBJECTIVE: This review aimed to summarize the clinical evidence on home-based health monitoring through a scoping review and outline ethical and user concerns and discuss the challenges of the current user-oriented conceptual frameworks. METHODS: A total of 2 literature reviews were conducted. We conducted a scoping review of systematic reviews in Scopus, MEDLINE, Embase, and CINAHL in July 2021. We included reviews examining the effectiveness of home-based health monitoring in older adults. The exclusion criteria included reviews with no clinical outcomes and lack of monitoring interventions (mobile health, telephone, video interventions, virtual reality, and robots). We conducted a quality assessment using the Assessment of Multiple Systematic Reviews (AMSTAR-2). We organized the outcomes by disease and summarized the type of outcomes as positive, inconclusive, or negative. Second, we conducted a literature review including both systematic reviews and original articles to identify ethical concerns and user-centered frameworks for smart home technology. The search was halted after saturation of the basic themes presented. RESULTS: The scoping review found 822 systematic reviews, of which 94 (11%) were included and of those, 23 (24%) were of medium or high quality. Of these 23 studies, monitoring for heart failure or chronic obstructive pulmonary disease reduced exacerbations (4/7, 57%) and hospitalizations (5/6, 83%); improved hemoglobin A1c (1/2, 50%); improved safety for older adults at home and detected changing cognitive status (2/3, 66%) reviews; and improved physical activity, motor control in stroke, and pain in arthritis in (3/3, 100%) rehabilitation studies. The second literature review on ethics and user-centered frameworks found 19 papers focused on ethical concerns, with privacy (12/19, 63%), autonomy (12/19, 63%), and control (10/19, 53%) being the most common. An additional 7 user-centered frameworks were studied. CONCLUSIONS: Home health monitoring can improve health outcomes in heart failure, chronic obstructive pulmonary disease, and diabetes and increase physical activity, although review quality and consistency were limited. Long-term generalized monitoring has the least amount of evidence and requires further study. The concept of trade-offs between technology usefulness and acceptability is critical to consider, as older adults have a hierarchy of concerns. Implementing user-oriented frameworks can allow long-term and larger studies to be conducted to improve the evidence base for monitoring and increase the receptiveness of clinicians, policy makers, and end users.

Ageing, technology, and health: Advancing the concepts of autonomy and independence.

The global pandemic expedited the adoption of AgeTech solutions that aim to help older adults maintain their autonomy and independence. This article examines the negative impact of the Western worldview of autonomy and independence on older adults. Negative impact can manifest as ageism and may be compounded by intersections of identities with race, gender, and culture. We propose an inclusive framework for health leaders, one that is not binary or categorical, but instead, on a continuum: (1) relational autonomy which assumes that relationships form one's identity; therefore, no one is autonomous to the exclusion of others, and (2) interdependence which proposes that one's lifestyle choice is supported by interreliance with aspects of one's environment. We examine two examples of AgeTech from the perspective of relational autonomy and interdependence and discuss how health leaders can use this inclusive framework to ensure that their services do not discriminate against older adults.

Digital Storytelling in Older Adults With Typical Aging, and With Mild Cognitive Impairment or Dementia: A Systematic Literature Review.

The rates of dementia are on the rise as populations age. Storytelling is commonly used in therapies for persons living with dementia and can be in the form of life review, and reminiscence therapy. A systematic literature review was conducted to examine the range and extent of the use of digital technologies for facilitating storytelling in older adults and their care partners, and to identify the processes and methods, the technologies used and their readiness levels, the evidence, and the associated outcomes. Eight electronic databases were searched: Medline, EMBASE, PsycINFO, CINAHL, Abstracts in Social Gerontology, ERIC, Web of Science, and Scopus. We included 34 studies. Mild cognitive impairment or dementia represented over half of medical conditions reported in the studies. Overall, our findings indicate that the most common use of digital storytelling was to support older adults' memory, reminiscence, identity, and self-confidence; however, the level of evidence of its effectiveness was low.

Determining the Effectiveness of a New Device for Hand Therapy (The FEPSim Device): Feasibility Protocol for a Randomized Controlled Trial Study.

BACKGROUND: Impairments of the forearm, wrist, and hand affect a sizable proportion of individuals and impose a significant economic burden on health care systems. FEPSim is a medical device for hand and wrist rehabilitation. The FEPSim device could be part of the standard of care for upper extremity rehabilitation during therapeutic activities to increase range of motion, dexterity, and strength. FEPSim has not yet been tested in a health care setting; therefore, a trial of the effectiveness of FEPSim in upper extremity rehabilitation is warranted. OBJECTIVE: This study aims to assess the feasibility of conducting a definitive trial in terms of recruitment, eligibility criteria, the type and number of diagnoses included, the length and dosage of the intervention, and data collection methods. This study also aims to gather clinical and statistical information as well as information related to the cost and usability, which allows for an economic evaluation of the device. METHODS: The trial will use a randomized controlled design comprising 47 intervention participants and 47 control group participants. Participants will be adults (age≥18 years) attending outpatient rehabilitation with limitations in their forearm, wrist, or hand function due to distal radial or ulnar fractures, stroke, or osteoarthritis. This study's primary outcome variables are related to patients' range of motion and strength, specifically active and passive wrist flexion and extension range of motion; active and passive forearm pronation and supination range of motion; grip strength; and pinch strength. The secondary outcome variables are related to patients' perceived wrist pain and disability in activities of daily living. The patients' perceived wrist pain and disability in activities of daily living will be measured using the patient-rated wrist evaluation questionnaire. The control group will receive the standard of care at each of the 2 hospital facilities (Glenrose Rehabilitation and Royal Alexandra Hospitals). The intervention group will receive the same standard of care as the control group at each facility and will use the FEPSim device for therapeutic activities to increase strength, range of motion, resistance, and dexterity. All the participants will be assessed at baseline (week 0); weeks 2, 4, and 8; and postintervention (week 10). RESULTS: The FEPSim study was launched in April 2020. This study is currently on hold because of the global COVID-19 pandemic. The recruitment process is expected to resume by September 2020, and the primary impact analysis is expected to be conducted by December 2020. CONCLUSIONS: This study will provide valuable information on the measurement of comparative intervention effects, technology acceptance by hand therapists, and how associated treatment and product costs will contribute to the evidence planning process, which will be crucial for the future adoption of FEPSim. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number Registry ISRCTN13656014; https://www.isrctn.com/ISRCTN13656014. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/22145.

Determining the usability and technology acceptance of a powered and automated cargo management system during ladder lifting tasks: A pilot study.

BACKGROUND: Evidence for the adoption and acceptance of assistive devices for ladder lifting tasks by workers is scarce. OBJECTIVE: This study aims to investigate the technology acceptance and usability of a powered and automated cargo management system (RazerLift®) used by workers who need to lift ladders as part of their daily duties, as compared to mechanical cargo management systems (traditional). METHODS: We used a one-way repeated measures design in this study. Our primary outcome variable was a usability performance measurement measured as time (in seconds) for unloading and loading ladders using both systems. Our secondary outcome was technology acceptance, measured using questionnaires with a 5-point Likert scale: "strongly disagree (1)" to "strongly agree (5)". RESULTS: The participants conducted the combined unloading and loading time using the powered and automated system (RazerLift®) 20.85 seconds faster than the traditional system (p-value = 0.000, t-value (df) = -5.730 (6), d = 2.713). Overall, the RazerLift® system (mean = 44.28, SD 5.58) had a higher technology acceptance compared to the traditional system (mean = 30.00, SD 7.91), (p = 0.041, t-value (df) = 6.589 (6), d = 4.60). CONCLUSIONS: The RazerLift® was more time efficient compared with the traditional system, and (2) the RazerLift® was superior in terms of technology acceptance compared to the traditional system.

What do we know about technologies for dementia-related wandering? A scoping review: Examen de la portée : Que savons-nous à propos des technologies de gestion de l'errance liée à la démence?

BACKGROUND: Occupational therapists use technologies to manage wandering-related risks to promote safety and independence among individuals with dementia living in the community. PURPOSE: The purpose of this review was to examine types of technologies used to manage wandering behaviour. METHOD: Using a modification of Arksey and O'Malley's methodology, we systematically searched peer-reviewed and grey literature on technologies used in home or supportive care environments for persons with dementia at risk for wandering. Data from the studies were analyzed descriptively. FINDINGS: The literature described 83 technologies. Nineteen devices were clinically tested. Interventions ranged from alarm products to mobile locator devices. Benefits included reductions in risk and caregiver burden. IMPLICATIONS: Occupational therapy strategies include technologies to enhance function in persons with dementia. Technologies can also reduce risks of wandering and should be affordable. Ethical issues of the use of technology must be addressed. More research is needed to increase levels of evidence.

Will artificial intelligence be a blessing or concern in assistive robots for play? / A inteligência artificial será uma bênção ou preocupação em robôs assistivos para brincar?

The recent advances and popularity of artificial intelligence (AI) offer exciting possibilities to improve technology but they also raise concerns. In this paper, we use our research to present the potential benefits of using AI in assistive technology for children with disabilities to access play, and examine potential ethical concerns surrounding data required by AI algorithms. Since play is a key factor in child well-being and cognitive development, secondary disabilities may arise as a consequence of motor impairments. Assistive robots for augmentative manipulation can be instrumental in providing children with physical disabilities play opportunities, but we need to take a principled and user-centered approach to technical innovations.

Os avanços recentes e popularidade da Inteligência Artificial (IA) oferecem possibilidades animadoras para melhorar a tecnologia, mas, também, trazem preocupação. Neste artigo, usamos nossa pesquisa para apresentar os benefícios potenciais do uso da IA em tecnologia assistiva para crianças com deficiências brincarem e examinar possíveis preocupações éticas em torno dos dados exigidos pelos algoritmos de IA. Uma vez que o brincar é um fator chave no bem-estar infantil e no desenvolvimento cognitivo, as incapacidades secundárias podem surgir como consequência de deficiências motoras. Robôs assistivos para manipulação aumentativa podem ser fundamentais para proporcionar às crianças com deficiência física oportunidades de brincar, mas precisamos adotar uma abordagem baseada em princípios e centrada no usuário para inovações técnicas.

What does the literature say about using robots on children with disabilities?

PURPOSE: The purpose of this study is to examine the extent and type of robots used for the rehabilitation and education of children and young people with CP and ASD and the associated outcomes. METHODS: The scholarly literature was systematically searched and analyzed. Articles were included if they reported the results of robots used or intended to be used for the rehabilitation and education of children and young people with CP and ASD during play and educative and social interaction activities. RESULTS: We found 15 robotic systems reported in 34 studies that provided a low level of evidence. The outcomes were mainly for children with ASD interaction and who had a reduction in autistic behaviour, and for CP cognitive development, learning, and play. CONCLUSION: More research is needed in this area using designs that provide higher validity. A centred design approach is needed for developing new low-cost robots for this population. Implications for rehabilitation In spite of the potential of robots to promote development in children with ASD and CP, the limited available evidence requires researchers to conduct studies with higher validity. The low level of evidence plus the need for specialized technical support should be considered critical factors before making the decision to purchase robots for use in treatment for children with CP and ASD. A user-entered design approach would increase the chances of success for robots to improve functional, learning, and educative outcomes in children with ASD and CP. We recommend that developers use this approach. The participation of interdisciplinary teams in the design, development, and implementation of new robotic systems is of extra value. We recommend the design and development of low-cost robotic systems to make robots more affordable.

Smart homes and home health monitoring technologies for older adults: A systematic review.

BACKGROUND: Around the world, populations are aging and there is a growing concern about ways that older adults can maintain their health and well-being while living in their homes. OBJECTIVES: The aim of this paper was to conduct a systematic literature review to determine: (1) the levels of technology readiness among older adults and, (2) evidence for smart homes and home-based health-monitoring technologies that support aging in place for older adults who have complex needs. RESULTS: We identified and analyzed 48 of 1863 relevant papers. Our analyses found that: (1) technology-readiness level for smart homes and home health monitoring technologies is low; (2) the highest level of evidence is 1b (i.e., one randomized controlled trial with a PEDro score ≥6); smart homes and home health monitoring technologies are used to monitor activities of daily living, cognitive decline and mental health, and heart conditions in older adults with complex needs; (3) there is no evidence that smart homes and home health monitoring technologies help address disability prediction and health-related quality of life, or fall prevention; and (4) there is conflicting evidence that smart homes and home health monitoring technologies help address chronic obstructive pulmonary disease. CONCLUSIONS: The level of technology readiness for smart homes and home health monitoring technologies is still low. The highest level of evidence found was in a study that supported home health technologies for use in monitoring activities of daily living, cognitive decline, mental health, and heart conditions in older adults with complex needs.

Playfulness in Children with Limited Motor Abilities When Using a Robot.

AIMS: Children with limited gross motor and manual abilities have fewer opportunities to engage in free play. We investigated the effect of a robotic intervention on the playfulness of children with cerebral palsy (CP). METHODS: We used a partially nonconcurrent multiple baseline design with four children and their mothers. Children were classified in level IV or V on the Gross Motor Function and Manual Ability Classification Systems. The intervention was the availability of an adapted Lego robot during a 15-min free play session between the child and mother. There were two sessions per week for about 14 weeks. Playfulness was measured using the Test of Playfulness. RESULTS: Statistical comparisons using the 2 SD band and X-moving range chart methods revealed that all the children's levels of playfulness increased significantly while they played with the robot. Comparison of baseline and follow-up phase indicated that three children had retention of improved level of playfulness. CONCLUSION: Play with adapted Lego robots increased the level of playfulness in all four children during free play with their mothers. The findings have implications for providing children with limitations in motor abilities opportunities for free play with family and friends.