Rochelle Mendonca

Purpose: Robot-assisted therapy predominantly targets motor impairment, although post-stroke motor and cognitive impairments co-occur. We report user experience in a longitudinal deployment of a Rehab Community-based Affordable Robot Exercise System (RehabCARES) for delivering personalized motor/cognitive training. Methods: Six adults with chronic stroke (FM-UE 20-61; MoCA 22-28) completed 12 therapy visits with THEAbot, a reconfigurable 1-DoF robot. Rehab CARES also included a haptic/biometric dynamic difficulty adjustment controller and eight games characterized by cognitive processes and motor/cognitive demand. We report gaming preference, usage, and user experience (pain, exertion, usability, affect, workload) across therapy. Results: User experience varied, but generally, self-reported pain was low, perceived exertion was light to moderate, enjoyment was strong and stable, and sense of control increased while excitement plateaued. Workload showed decreasing frustration and effort. Game selection during therapy was partially consistent with motor/cognitive clinical profiles; preferences and perceptual abilities may have influenced choices. Usability scores exceeded acceptability at all time points, peaking at the final visit (86 +/- 4.5 out of 100). Conclusions: RehabCARES provided personalized motor/cognitive training to a heterogeneous cohort in a community-based setting, delivering a positive user experience. Hardware reconfigurability and motor/cognitive game variety likely enabled this success.

Background: Following stroke, motor and cognitive impairments often limit functional independence. Personalized rehabilitation requires comprehensive clinical assessments, which are costly and time-consuming. Imaging scans are routinely collected, but their predictive value in determining post-stroke function remains unclear. Objectives: To determine the ability of clinical assessments, lesion features with medical chart information, and a combined clinical and biomedical model to predict kinematic outcomes from a robot-based tracking task in chronic stroke individuals. Methods: Eighteen participants (70±6 years) completed a robot-based tracking task and a battery of motor and cognitive assessments. Three elastic net regression models were developed: 1) clinical assessments only; 2) lesion metrics and chart information only; and 3) a combined model. Models were evaluated using leave-one-subject-out cross-validation, bootstrapping, and permutation testing with false discovery rate correction. Robot-based outcomes included tracking error, normalized distance, velocity error response, and delay. Results: The clinical assessment model significantly predicted tracking error (R²=0.45), delay (R²=0.22), velocity error response (R²=0.18), and normalized distance (R²=0.12). The combined model significantly predicted tracking error (R²=0.37), delay (R²=0.19), and velocity error response (R²=0.11). The imaging model did not significantly predict any outcome. Box and Blocks Test and Color Trails 1 were stable features. The right dorsal attention network was a stable predictor in several combined models. Conclusion: Clinical assessments outperformed lesion features in predicting tracking performance after chronic stroke. Attention- and motor-related measures were the strongest predictors, highlighting the importance of cognitive-motor interactions in function. A larger sample and more granular lesion features may improve prediction from imaging biomarkers.

Background: HIV and stroke are major contributors to disability in sub-Saharan Africa, yet their combined impact on cognitive and motor functioning remains poorly understood. Botswana has a high prevalence of HIV and rising stroke incidence, underscoring the need to characterize impairment to inform neurorehabilitation. Objective: To examine differences in cognitive performance, motor function, and activities of daily living between adults living with HIV only and those living with both HIV and stroke in Botswana. Methods: Thirty-three adults (19 HIV only; 14 HIV/ stroke) completed standardized cognitive (e.g. MoCA and Digit Symbol Coding [DSC]), and motor assessments (such as Box and Block Test [BBT], Grooved Pegboard [GPB], Grip Strength [GS], 10-Meter Walk Test [10MWT], Timed Up and Go [TUG]), and ADL measures (such as Barthel Index, Lawton IADL). Group comparisons used Wilcoxon rank-sum tests. Impairment was determined using both international z-score norms and Botswana-specific cutoffs from a prior cohort study. Results: Cognitive impairment was evident in both groups, but DSC z-scores were worse in the HIV/stroke vs HIV only group (median= -2.71 vs -1.34, p=0.015). Gross motor function showed deficits in the HIV/stroke group, including lower dominant-hand BBT performance (median z-score −2.79 vs. −1.75; p=0.008). Fine motor dexterity was markedly reduced in the HIV/stroke group, with GPB dominant-hand median z-scores of −4.26 vs. −1.40 (p=0.038) and non-dominant-hand impairment rates of 100% vs. 63.2% (p=0.043). Non-dominant GS was weaker in the HIV/stroke group (100% impaired vs. 47.4%; p=0.0014). Lower-limb performance was substantially worse, including TUG (median z-score −3.63 vs. 0.10; p=0.0001) and 10MWT (median z-score −5.36 vs. −2.47; p=0.0025). ADL scores were also lower in the HIV/stroke group compared to both Barthel and Lawton (p=0.002). Conclusions: HIV alone is associated with cognitive and motor impairment, with the addition of stroke producing significantly greater deficits across all motor domains. These findings demonstrate the need to integrate structured neurorehabilitation into HIV clinical care in Botswana.

Background: Functional cognitive impairments caused by acquired brain injury (ABI) negatively impact an individual’s daily functioning. Impaired self-awareness can pose obstacles to task execution and participation. Traditional assessment methods for self-awareness lack a functional approach, highlighting the need for performance-based assessments such as the Occupational Therapy Anticipatory Awareness Test (OTAAT). The purpose of this study was to establish the interrater reliability of the OTAAT in adults with ABI. Methods: This was a two-phase study. Phase One involved the recruitment of three participants with ABI, who then underwent OTAAT administration within a setting of their choosing. OTAAT performances were recorded. In Phase Two, ten occupational therapists assessed the Phase One participants’ performances using the OTAAT. Phase Two’s raters’ outcomes were obtained by research personnel. These data were then collected and analyzed by research staff to measure interrater reliability using the Intraclass Correlation Coefficient (ICC) via IBM Statistical Package for the Social Sciences (SPSS) software. A two-way random effect, absolute agreement, multiple-rater/measurement ICC was adopted for this study. Results: Data analysis demonstrated strong interrater reliability for the OTAAT, demonstrating its consistency to measure self-awareness in individuals with ABI across different raters. Specifically, the ICC values indicated strong agreement among raters in their assessment of participants’ self-awareness performance using the OTAAT. Conclusions: The OTAAT has strong interrater reliability and holds promise as a valuable addition to neurorehabilitation practice. This study demonstrates the reliability of the OTAAT as a tool for assessing self-awareness in the ABI population.

MyAccessibleHome is a home safety screening and intervention app developed to be used by PwD, aging adults, support persons, and stakeholders vested in facilitating improved community living outcomes in home-dwellers desiring to age-in-place. This study describes the iterative development process and content validation of myAccessibleHome. App development involved participatory action research (PAR) methodology and engaged PwD, caregivers, and contractors (N = 6) as part of the core research and development team. For content validity, an expert panel (N = 7) and target population end-users (N = 15) completed a web-based survey which evaluated relevance and clarity. Item and scale content validity (I-CVI, S-CVI) indices were calculated. The PAR team and content validation process contributed to iterative and ongoing refinement of content, design, and features of myAccessibleHome. For the expert panel, mean I-CVI was 0.96 [0.57-1.00] for relevance and 0.89 [0.29-1.00] for clarity. The S-CVI was 0.93. For target population end-users, mean I-CVI was 0.64 [0.40-0.87] for relevance and 0.82 [0.53-0.93] for clarity. Items were removed and revised based on respondent feedback. Engaging potential end-users in PAR and content validation studies contributed to myAccessibleHome matching wants and needs of targeted end-users.

Wearable robotic devices are currently being developed to improve upper limb function for individuals with hemiparesis after stroke. Incorporating the views of clinicians during the development of new technologies can help ensure that end products meet clinical needs and can be adopted for patient care. In this cross-sectional mixed-methods study, an anonymous online survey was used to gather clinicians' perceptions of a wearable robotic hand orthosis for post-stroke hemiparesis. Participants were asked about their clinical experience and provided feedback on the prototype device after viewing a video. 154 participants completed the survey. Only 18.8% had previous experience with robotic technology. The majority of participants (64.9%) reported that they would use the device for both rehabilitative and assistive purposes. Participants perceived that the device could be used in supervised clinical settings with all phases of stroke. Participants also indicated a need for insurance coverage and quick setup time. Engaging clinicians early in the design process can help guide the development of wearable robotic devices. Both rehabilitative and assistive functions are valued by clinicians and should be considered during device development. Future research is needed to understand a broader set of stakeholders' perspectives on utility and design.