Heidi Sveistrup

Background: Human activity recognition (HAR) is the use of technology to detect a person’s movements. Sensors can be passive like cameras monitoring an area, or active like those attached to a person’s watch. HAR is a burgeoning field whose uses span from personal health tracking to at-home physical degradation monitoring. The benefit of having sensors attached to a person for constant HAR tracking can be seen in the personal fitness field where people track their number of steps or distance ran. For older adults, HAR can be used in combination with mobility tasks like sit-to-stand, timed-up-and-go, and other tasks to monitor a person’s ability to be self-sufficient and to live alone at home. Together, HAR and mobility tasks are an effective method to measure health, especially in older adults. Consumer wearables like Fitbits and Apple watches are currently being used to measure many of these mobility tasks. The wide adoption of these devices is a result of their ease of use and simplicity. Despite this, most wearables go unused shortly after purchase. A potential solution is the use of consumer devices that are already adopted like headphones or hearing aids. These devices can perform the same measurements as the wearables but have the advantage of being used for other reasons than health monitoring. Despite this, no scoping review has summarized the current capabilities of what can be done using head-worn sensors. Objective: We aim to understand how head-worn devices have been used to monitor dynamic mobility tasks and if they have been compared to traditional methods (like smartwatches or in-sole sensors). Methods: This scoping review will be guided by the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) framework. There is no time limit to when the papers must have been published. The databases included in the search are PubMed, Engineering Village, SCOPUS, and Web of Science. Using pre-established inclusion and exclusion criteria, 2 reviewers will screen each paper. We will follow 3 stages of the screening process: abstract and title screening, full-text screening, and full-text data extraction. Results: The search will be started once this scoping review protocol is published. Conclusions: Head-mounted devices have become part of everyday life and many already contain accelerometers or inertial measurement units. This scoping review will examine how these sensors have already been used in research to measure mobility tasks, and determine how consumer devices can be adapted to improve the lives of regular people. International Registered Report Identifier (IRRID): DERR1-10.2196/67628

Background: Commercial markerless motion capture (MMC) systems show promise for use in rehabilitation and have been validated for the assessment of various parameters. However, no prior studies have evaluated MMC systems to detect stance asymmetry. Objective: The objective of this study was to assess the accuracy and variability of the Jintronix Weight Shift Tool MMC system to estimate the percentage of weight borne on each foot. Methods: Twelve healthy younger adults, 12 healthy older adults, and 12 people living with stroke were recruited for this cross-sectional study. The percentage of weight borne on each foot was simultaneously recorded by the Weight Shift Tool and a validated pressure mat during 2 series (raising the arm to capture the recording and without arm raise) with left lean, right lean, and equal stance. Agreement between the Weight Shift Tool and the pressure mat was assessed using Bland-Altman analyses. Results: Bias was greatest for older adults for all stances except for right lean without arm raise. Variability was greatest for people living with stroke for all stances except for left lean with arm raise. On average, the limits of agreement were narrower during equal stance. Although bias between the Weight Shift Tool and the pressure mat was small to moderate (0.0%-11.7%), the limits of agreement were wide (12.8%-33.6% above and below the bias). Conclusions: The Weight Shift Tool is not clinically acceptable for the estimation of the percentage of weight on each foot due to high variability. Investigation of other MMC systems is required to confirm the validity of MMC for clinical assessment.

Background: People who sustain a concussion and live in remote areas can experience challenges in accessing specialized assessments. In these cases, virtual approaches to assessment are of value. There is limited information on important psychometric properties of physical assessment measures used to evaluate people postconcussion virtually. Objective: The aims of this method-comparison psychometric study were to determine (1) inter- and intrarater reliability of a battery of concussion physical tests administered virtually in people with brain injury and (2) sensitivity and specificity of the virtual battery when compared to the in-person assessment. Methods: A total of 60 people living with acquired brain injuries attended an in-person and virtual assessment at the Ottawa Hospital Rehabilitation Centre. The order of the assessments, in-person and virtual, was randomized. The following physical measures were administered in-person and virtually: finger-to-nose test, vestibular ocular motor screening (VOMS), static balance testing (double leg, single leg, and tandem), saccades, cervical spine range of motion, and evaluation of effort. The virtual assessment was recorded, and a second clinician viewed and independently documented findings from the recordings twice at 1-month intervals. Results: The mean age of the participants was 45.65 (SD 16.50) years. The sensitivity metrics ranged from moderate (60%, 95% CI 30-86) to excellent (100%, 95% CI 71-100) for saccades and cervical spine right lateral flexion, respectively. Specificity ranged from 75%, 95% CI 35-95 to 100%, 95% CI 91-100 for left single leg stance eyes closed and left finger-to-nose testing, respectively. The interrater reliability ranged from poor for cervical spine extension (Cohen κ=0.20, 95% CI −0.07 to 0.47) to excellent for VOMS change in symptoms (Cohen κ=0.93, 95% CI 0.83-1). The intrarater reliability ranged from poor for cervical spine extension (Cohen κ=0.31, 95% CI 0.04-0.58) to excellent for the finger-to-nose testing on the right (Cohen κ=0.90, 95% CI 0.71-1). The wide CIs highlight variability in precision and suggest that further research with larger samples is needed before clinical use can be fully standardized. Conclusions: This study provides information on the psychometric properties associated with virtual administration of concussion measures. The VOMS change in symptoms measure appears to have the most promising properties when administered virtually when in-person visits are not possible. This is particularly relevant for patients in rural areas, for those facing access barriers, and in contexts where timely follow-up is challenging. However, caution should be maintained when administering certain concussion measures virtually. The wide CIs for some measures caution against over-reliance on single test findings, and clinicians should consider both the strengths and limitations of virtual delivery. Clinicians are encouraged to make informed decisions about which measures can be effectively used remotely, and which may still require in-person administration to maintain accuracy.

Purpose: Despite the health benefits for people with mobility limitations of participating in community-based exercise programmes (CBEPs), accessing and implementing in-person CBEPs can be challenging. We describe a theory-based approach to adapting a group task-oriented, in-person CBEP targeting balance and mobility to a virtual format. Method: We used the Knowledge-to-Action and Medical Research Council frameworks to guide adaptation of an established CBEP for virtual delivery. We undertook consultations with knowledge users (i.e., CBEP providers, health care professionals, managers, policy-makers) and researchers on adapting programme components to optimize the feasibility of virtual delivery and retain benefits of the in-person CBEP. Concurrently, we conducted three feasibility studies involving post-programme participant surveys to evaluate and refine programme components. Results: Programme components, including a pre-programme safety video and use of trained facilitators to stream exercise videos via videoconferencing and facilitate social times, met safety, feasibility, and acceptability benchmarks. In studies 1, 2, and 3, the majority of participants described benefit to physical function (59%, 64%, and 79%, respectively) and emotional well-being (64%, 62%, and 75%, respectively). Conclusions: Theoretical frameworks were useful to guide adaptation of an established in-person CBEP to a virtual format. This theoretical approach may inform virtual programme development for other populations and targeted outcomes.

Background: Poor oral health (caries and periodontal disease) in seniors is a health risk with minimal preventive care approaches evaluated. The objectives of this study were to: i) document the oral health status of a sample of Canadian seniors; and then ii) evaluate feasibility, acceptability and efficacy of non-invasive application of chlorhexidine for preventive oral health in the community. Methods: Dental examinations of 105 Ottawa seniors were followed by a randomized controlled study of 55 seniors with ³ 16 natural teeth and ³ 12 sites of bleeding on probing (BOP). Four treatments of either a chlorhexidine 10% w/v (active) or purified water (placebo) were applied over a 9-week period. Study sites included a hospital, seniors’ community centre, medical practice and long-term care facility. Treatments were applied by a hygienist or a nurse in 10-15 minutes, without dental cleaning or scaling. The primary endpoint was change in oral inflammation (BOP). Results: The sample had more decayed, missing or filled teeth (DMFT) and more periodontal disease than reported in the 2007-2009 Canada Health Measures Survey. BOP was reduced almost 2-fold more in the active group compared to placebo although significant in both groups (active: 7.91%, p<0.001; placebo: 4.1%, p=.018). The difference between groups in reducton of BOP failed to reach significance (p = 0.06) likely due to early stoppage of recruitment. Conclusion: A four-dose application of chlorhexidine significantly decreased oral inflammation as measured by BOP. The program of non-invasive preventive care in community settings is feasible, clinically impactful, and well received.

BACKGROUND People who sustain a concussion and live in remote areas can experience challenges to accessing specialized assessments. In these cases, virtual approaches to assessment are of value. There is limited information on important psychometric properties of physical assessment measures used to evaluate people post-concussion virtually. OBJECTIVE The objectives of this method-comparison study were to determine i) inter/intra-rater reliability of a battery of concussion physical tests administered virtually in people with brain injury and ii) sensitivity and specificity of the virtual battery when compared to the in-person assessment. METHODS Sixty people living with acquired brain injuries attended an in-person and virtual assessment, at the Ottawa Hospital Rehabilitation Centre. The order of the assessments, in-person and virtual, was randomized. The following physical measures were administered in person and virtually: finger-to-nose test, Vestibular/Ocular Motor Screening (VOMS), static balance testing (double leg, single leg, tandem), saccades, cervical spine range of motion, and evaluation of effort. The virtual assessment was recorded and a second clinician viewed and independently documented findings from the recordings twice at one-month intervals. RESULTS The sensitivity metrics ranged from moderate (60%) to excellent (100%) for saccades and cervical spine lateral flexion measures, respectively. Specificity ranged from 75% to 100% for left single leg stance eyes closed and left finger-to-nose testing, respectively. The inter-rater reliability ranged from poor for cervical spine extension (Cohen’s Kappa = 0.20) to excellent for VOMS change in symptoms (Cohen’s Kappa = 0.93). The intra-rater reliability ranged from poor for cervical spine extension (Cohen’s Kappa = 0.31) to excellent for the finger-to-nose testing on the right (Cohen’s Kappa = 0.90). CONCLUSIONS This study provides information on the psychometric properties associated with virtual administration of concussion measures. The VOMS change in symptoms measure appears to have most promising properties when administered virtually. Caution should be maintained when administering certain concussion measures virtually. INTERNATIONAL REGISTERED REPORT RR2-10.2196/57663

Background: Nonimmersive virtual reality training (NIVRT) can be used to continue rehabilitative exercise for stroke recovery at home after discharge from inpatient or outpatient therapy. Objective: The objectives of this randomized controlled feasibility trial were to assess home-based NIVRT as telerehabilitation with patients living with stroke, and its potential to improve standing function and gait. Methods: Patients approaching discharge from inpatient or outpatient stroke rehabilitation were randomly allocated to NIVRT or iPad interventions. NIVRT provided interactive games and exercises designed to improve balance, stepping, and aerobic capacity. iPad apps addressed cognition and fine motor skills. Participants were visited in their homes by a physiotherapist, taught to use the program, and asked to do 30 minutes of exercise 5 days a week for 6 weeks, asynchronously. Feasibility was assessed by measuring recruitment, adherence, ability to set up and learn NIVRT, enjoyment, intent to continue, perception of impact, and safety. Participants completed assessments of standing balance, gait, and general function, before and after the intervention, by a blinded assessor. Results: NIVRT participants (n=11; 10 male participants; mean age 64, SD 12 years) did an average of 26 sessions (total 700 minutes), while iPad participants (n=9; 6 male participants; mean age 61, SD 20 years) did an average of 33 sessions (total 1241 minutes). Space was tight in 5 homes. All but 1 participant learned NIVRT and progressed. Most enjoyed it and felt that it improved their recovery. There were no serious adverse events. Most assessments showed improvement over time for both groups. Conclusions: Home-based NIVRT is safe and feasible to continue rehabilitative exercise after discharge. More research on efficacy and effectiveness in this population is required. Trial Registration: ClinicalTrials.gov NCT03261713; https://clinicaltrials.gov/study/NCT03261713 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-019-3438-9

BACKGROUND Commercial markerless motion capture (MMC) systems show promise for use in rehabilitation and have been validated for the assessment of various parameters. However, no prior studies have evaluated MMC systems to detect stance asymmetry. OBJECTIVE The objective of this study was to assess the accuracy and variability of the Jintronix Weight Shift Tool MMC system to estimate the percentage of weight borne on each foot. METHODS Twelve healthy younger adults, 12 healthy older adults, and 12 people living with stroke were recruited for this cross-sectional study. The percentage of weight borne on each foot was simultaneously recorded by the Weight Shift Tool and a validated pressure mat during 2 series (raising the arm to capture the recording and without arm raise) with left lean, right lean, and equal stance. Agreement between the Weight Shift Tool and the pressure mat was assessed using Bland-Altman analyses. RESULTS Bias was greatest for older adults for all stances except for right lean without arm raise. Variability was greatest for people living with stroke for all stances except for left lean with arm raise. On average, the limits of agreement were narrower during equal stance. Although bias between the Weight Shift Tool and the pressure mat was small to moderate (0.0%-11.7%), the limits of agreement were wide (12.8%-33.6% above and below the bias). CONCLUSIONS The Weight Shift Tool is not clinically acceptable for the estimation of the percentage of weight on each foot due to high variability. Investigation of other MMC systems is required to confirm the validity of MMC for clinical assessment.

Background: Remote approaches to workplace concussion assessment have demonstrated value to end users. The feasibility of administering physical concussion assessment measures in a remote context has been minimally explored, and there is limited information on important psychometric properties of physical assessment measures used in remote contexts. Objective: The objectives of this feasibility study were to determine recruitment capability for a future larger-scale study aimed at determining sensitivity and reliability of the remote assessment, time required to complete study assessments, and acceptability of remote assessment to people with brain injuries and clinicians; document preliminary results of the sensitivity of the remote assessment when compared to the in-person assessment; and estimate the preliminary interrater and intrarater reliability of the remote assessments to inform procedures of a future larger-scale study that is adequately powered to reliably estimate these parameters of interest. Methods: People living with acquired brain injury attended 2 assessments (1 in-person and 1 remote) in a randomized order. The measures administered in these assessments included the finger-to-nose test; balance testing; and the Vestibular/Ocular Motor Screening (VOMS) tool, including documentation of change in symptoms and distance for near point convergence, saccades, cervical spine range of motion, and evaluation of effort. Both assessments occurred at the Ottawa Hospital Rehabilitation Center. After the assessments, a clinician different from the person who completed the original assessments then viewed and documented findings independently on the recordings of the remote assessment. The same second clinician viewed the recording again approximately 1 month following the initial observation. Results: The rate of recruitment was 61% (20/33) of people approached, with a total of 20 patient-participants included in the feasibility study. A total of 3 clinicians participated as assessors. The length of time required to complete the in-person and remote assessment procedures averaged 9 and 13 minutes, respectively. The majority of clinicians and patient-participants agreed or strongly agreed that they were confident in the findings on both in-person and remote assessments. Feedback obtained revolved around technology (eg, screen size), lighting, and fatigue of participants in the second assessment. Preliminary estimates of sensitivity of the remote assessment ranged from poor (finger-to-nose testing: 0.0) to excellent (near point convergence: 1.0). Preliminary estimates of reliability of the remote assessment ranged from poor (balance testing, saccades, and range of motion: κ=0.38‐0.49) to excellent (VOMS change in symptoms: κ=1.0). Conclusions: The results of this feasibility study indicate that our study procedures are feasible and acceptable to participants. Certain measures show promising psychometric properties (reliability and sensitivity); however, wide CIs due to the small sample size limit the ability to draw definitive conclusions. A planned follow-up study will expand on this work and include a sufficiently large sample to estimate these important properties with acceptable precision.