xv, 162 p. ; ill. (some col.) A print copy of this thesis is available through the UO Libraries. Search the library catalog for the location and call number. / Each year, over 65,000 brain injury survivors are discharged home from hospitals with ongoing rehabilitation needs due to acquired impairments, such as dysphagia. Emerging empirical evidence supports the benefits of intensive swallowing exercise programs when dysphagia results from muscle weakness. However, many of these survivors cannot complete intensive home exercise programs due to co-occurring cognitive impairments in memory or initiation. This project investigated the potential benefits of a new experimental assistive technology device, the Television Assisted Prompting (TAP) system to increase completion of home swallowing exercises. The TAP system was designed as a treatment package to provide both automated prompts and multimedia motivational instructional exercise videos via a person's home television. Three participants were recruited, all of whom had survived a hemispheric stroke and presented with neurogenic dysphagia and co-occurring cognitive impairments. Two home program delivery conditions were alternately presented on randomized days in a single-case experimental alternating treatment design: TAP delivery (e.g., TV prompting with motivational videos) or typical practice (TYP) delivery (e.g., care provider prompting as needed to follow assigned written home programs). The same exercises were presented in each condition. Measures included feasibility (e.g., reliability of the TAP system), efficacy (e.g., number of exercises completed per session), and satisfaction. Results revealed that two of three participants showed dramatic benefits from the TAP system. Participant 1 was 17 times more likely to complete exercises when prompted by the TAP system; participant 2 was six times more likely. Participant 3 completed exercises with equal likelihood on TAP or TYP days. All three participants reported preference for TAP system delivery and requested to increase the frequency of TAP delivery to every day. Care providers unanimously reported preference for the TAP system to prompt patients and reduce their burden of care. The TAP system malfunctioned during 21.70% (23/106) of scheduled sessions; two participants needed clarifications, instruction to use the system, or customized modifications in order to interact independently with the device. Recommendations for system improvements and applications to the field of assistive technology are provided. / Adviser: McKay Moore Sohlberg

O acidente vascular cerebral (AVC) é a principal causa de mortes no Brasil entre os óbitos por doenças cerebrovasculares e a principal causa de incapacidade no mundo. Este é um problema substancial de saúde pública e econômico, representa mais da metade dos pacientes neurológicos hospitalizados e muitos apresentam sequelas como hemiparesia, dependência completa ou parcial, afasias e dificuldade na deambulação. Um recurso para potencializar a reabilitação é a \"Telereabilitação\" (TR), que usa as tecnologias de informação e comunicação (TIC\'s) para acompanhamento à distância. Inúmeros benefícios da telessaúde e TR já foram descritos, incluindo um melhor acesso aos serviços de saúde, custo-eficácia, mais oportunidades educacionais, melhoria dos resultados na recuperação, melhor qualidade dos cuidados, melhor qualidade de vida e reforço dos suportes sociais. O presente trabalho realizou um levantamento da percepção dos profissionais e das ferramentas utilizadas por terapeutas ocupacionais para acompanhamento à distância de pacientes com seqüelas de AVC, assim como introduziu ferramentas de TR (mensagens de texto, telefonemas, chats online, etc) em serviços de reabilitação da cidade de Ribeirão Preto e verificou sua viabilidade de uso com estes pacientes. O estudo se desenvolveu em duas partes: 1) levantamento da percepção dos profissionais e das tecnologias usadas nos serviços de terapia ocupacional através de um questionário semi-estruturado; 2) implantação de ferramentas de acompanhamento à distância integradas ao acompanhamento convencional. A parte de implantação foi dividida em duas fases. Na primeira com o uso de somente uma ferramenta para acompanhamento do paciente (por exemplo a mensagem de texto via celular) e a segunda com o uso de duas ferramentas em conjunto (telefonemas e mensagens de texto). O acompanhamento dos pacientes em cada fase foi pelo período de no máximo dois meses. A viabilidade de uso das tecnologias foi avaliada nos aspectos de tempo dispensado para uso, facilidade, percepção de utilidade e adesão à ferramenta, que foram analisados através de questionários estruturados aplicados com o terapeuta do serviço e o paciente. Obteve-se como resultado da primeira parte do estudo um levantamento com 27 terapeutas ocupacionais. Na segunda parte as ferramentas foram introduzi das no tratamento de 9 pacientes. Foi verificado que muitos profissionais já utilizam na clínica as tecnologias de informação e comunicação para acompanhamento à distância. Pôde-se discutir sobre a importância da ética no uso de tecnologias para acompanhamento à distância, da consideração de aspectos como da confiabilidade da informação fornecida pela tecnologia, avaliação das habilidades do paciente para uso, uso de tecnologias de uso prévio do paciente, avaliação da sua rotina e hábitos de vida no momento da escolha da ferramenta. Os pacientes acompanhados não apresentaram dificuldades no uso das ferramentas introduzidas, relataram satisfação com uso e foi observado pelos terapeutas a facilitação do processo de reabilitação através da maior adesão das orientações, monitoramento do paciente e motivação na terapia. / Stroke is the leading cause of death in Brazil between deaths due to cerebrovascular disease and the leading cause of disability worldwide. This is an issue of substantial public health and economic accounts for more than half of patients hospitalized and many have neurological sequelae such as hemiparesis, partial or complete dependence, aphasia and difficulty in walking. A resource for enhancing rehabilitation is \"Telereabilitação\" (TR), which uses communication technologies for distance care. Numerous benefits of telehealth and TR have been described, including improving access to health services, cost-effective, more educational opportunities, improved results in recovery, better quality of care, better quality of life and strengthening social supports. This study conducted a survey of the perceptions of professionals and the tools used by occupational therapists for remote monitoring of patients with sequelae of stroke, as well as introduced the TR (text messages, phone calls, online chats, etc.) tools in rehabilitation services the city of Ribeirão Preto and verifted its feasibility of use with these patients. The study was conducted in two parts: 1) raising the awareness of professionals and technology used in occupational therapy services through a semi-structured questionnaire; 2) implementation of the integrated monitoring to conventional monitoring tools away. The deployment part was divided into two phases. At first only with the use of a tool for monitoring the patient (e.g. via mobile text message), and the second using two tools together (phone calls and text messages). Monitoring of patients in each phase was the period of maximum two months. The feasibility of using technology was evaluated in the aspects of time allocated for use, ease, perceived usefulness and adherence to the tool, which were analyzed using structured questionnaires with the therapist and the patient service. Obtained as a result of the first part of the study a survey of 27 occupational therapists. In the second part the tools were made in the treatment of patients 9. It was found that many professionals now use in clinical information technology and communication for remote monitoring. We can discuss about the importance of ethics in the use of technology for remete monitoring, the consideration of aspects such as the reliability of the information provided by the technology, skills assessment of the patient to use, use of prior patient use technologies, assessment of your routine and lifestyle in their choice of tool. The patients monitored had no difficulties in using the tools introduced, reported satisfaction with use and was observed by the therapists facilitating the rehabilitation process through greater adherence to the guidelines, patient monitoring and motivation in therapy.

Indiana University-Purdue University Indianapolis (IUPUI) / Background: Pulmonary rehabilitation (PR) has the potential to reduce the symptoms and complications of respiratory diseases through an interdisciplinary approach. Providing PR services to the increasing number of patients with chronic respiratory diseases challenges the current health care systems because of the shortages in health care practitioners and PR programs. Using telerehabilitation may improve patients’ participation and compliance with PR programs. The purpose of this study was to examine the applicability of the technology acceptance model (TAM) to explain telerehabilitation acceptance and to determine the demographic variables that can influence acceptance. Methods: A cross-sectional survey-based design was utilized in the data collection. The survey scales were based on the TAM. The first group of participants consisted of health care practitioners working in PR programs. The second group of participants included patients attending traditional PR programs. The data collection process started in January 2017 and lasted until May 2017. Results: A total of 222 health care practitioners and 134 patients completed the survey. The results showed that 79% of the health care practitioners and 61.2% of the patients reported positive intention to use telerehabilitation. Regression analyses showed that the TAM was good at predicting telerehabilitation acceptance. Perceived usefulness was a significant predictor of the positive intentions to use telerehabilitation for health care providers (OR: 17.81, p < .01) and for the patients (OR: 6.46, p = .04). The logistic regression outcomes showed that age, experience in rehabilitation, and type of PR increased the power of the TAM to predict the intention to use telerehabilitation among health care practitioners. Age, duration of the disease, and distance from the PR center increased the power of the TAM to predict the intention to use telerehabilitation among patients. Conclusion: This is the first study to develop and validate a psychometric instrument to measure telerehabilitation acceptance among health care practitioners and patients in PR programs. The outcomes of this study will help in understanding the telerehabilitation acceptance. It will help not only to predict future adoption but also to develop appropriate solutions to address the barriers of using telerehabilitation.

1 ABSTRACT Title: Comparing physiotherapist's functional test assessments with OpenPose kinematic data Objectives: Assess wether is OpenPose (OP) system able to detect parameters of poor performance in the Single Leg Squat Test and Step Down Test. Presence of these parameters was indicated by consensus process among 3 physiotherapists. Methods: 48 healthy volunteers participated on the research. Each volunteer demonstrated 3 repetitions of Single Leg Squat Test and Step Down Test on each leg. Repetitions were recorded on video and at the same time evaluated by 3 physiotherapists (PT) using 15 binary parameters. Consensus process indicating presence of a parameter involved agreement of at least 2 of the raters while the inter-rater reliability coeficient for all 3 raters had to be κ ≥ 0,41. Changes in angles and relative distances of observed body segments were calculated using OpenPose keypoint detection model. Therefore each execution of the functional test was described by OP data and PT data. Statistical analysis was performed to assess wether was OpenPose able to detect significant differences between poor and good execution of a functional test in the 15 rated parameters. Results: OP was able to reliably assess following parameters: Loss of balance, Excessive upper extremity movement and Lateral...

Background: People who have experienced a moderate or severe traumatic brain injury (TBI) will most likely live with motor and cognitive deficits including balance and poor mobility. These deficits may lead to limitations in activity participation, life satisfaction, and may increase the risk of falls. Improving access to rehabilitation care in the chronic phase of recovery is essential to prevent ongoing health issues. However, geographical restrictions, cost of transportation, or recently the COVID-19 pandemic restrictions may limit access to rehabilitation services. Telerehabilitation could serve as an alternative method to provide rehabilitation care while increasing access. Objectives: The overall objective of this dissertation was to understand the implementation of high-intensity telerehabilitation exercise programs for people living with a moderate or severe TBI and their family partners. This was accomplished by 1) determining the feasibility of using telerehabilitation, 2) investigating the effectiveness of high-intensity home-based telerehabilitation exercise programs on physical activity, functional mobility and dynamic balance, 3) understanding the perspectives and lived experiences of completing a telerehabilitation program, and 4) exploring how interpersonal behaviours can influence practice and be perceived in a telerehabilitation setting. Methodology: Influenced by a people-centered approach and explained by the Self-Determination Theory, this dissertation followed a mixed-method alternating single-subject design methodology. Five dyads composed of five persons living with a moderate or severe TBI and their family partners completed two high-intensity telerehabilitation programs remotely supervised, daily and weekly. The feasibility and effectiveness of the telerehabilitation programs were measured from a quantitative and qualitative perspective to replicate the clinical realities and understand all perspectives. Results: In this dissertation, the feasibility of using telerehabilitation with this population was highlighted by reporting high adherence, high usability, active engagement and safety. The effectiveness on physical activity levels, functional mobility, dynamic balance and concerns with falling was also demonstrated with no differences between the daily and weekly remote supervision schedule. The dyads described being highly satisfied, engaged, and enjoyed the remotely supervised exercise programs. The individuals with the TBI perceived more supportive behaviours than thwarting behaviours from the physiotherapist. Conclusion: This dissertation advances knowledge on telerehabilitation implementation for people living with cognitive and motor deficits following a TBI. High-intensity home-based telerehabilitation programs were shown to be feasible and effective. I introduced the importance of assessing needs-supportive and needs-thwarting interpersonal behaviours in the telerehabilitation context. Integrating these novel telerehabilitation concepts within emerging telerehabilitation models of care could significantly impact long-lasting positive health outcomes for individuals living with a moderate or severe TBI.

HaKoll!, en arbetsterapeutisk gruppintervention för att hantera tid och organisera aktiviteter, har fått goda resultat i flera studier. Behovet att utveckla nya digitala lösningar är stort inom hälso- och sjukvård, samtidigt som initiativen till detta är begränsade inom arbetsterapi. Mot denna bakgrund blev syftet med studien att utforska och beskriva arbetsterapeuters resonemang om ett digitalt genomförande av HaKoll!. Fokusgrupp valdes som metod för datainsamling. Sex fokusgrupper genomfördes med arbetsterapeuter, tillika gruppledare för HaKoll! Data analyserades enligt analys för fokusgrupper och resulterade i ett övergripande tema, ’En digital lösning har potential om hinder kan överbryggas’ och fyra kategorier: ’Möjliggör ökad effektivitet och tillgänglighet’, ’Interaktionen i gruppen utmanas av ett digitalt format, ’Digitala möten ställer andra krav’ samt ’Behov att utveckla innehåll och upplägg’. Resultatet visade att innehållet i, formatet på och leveransen av HaKoll! behöver anpassas och utvecklas för ett digitalt genomförande, då det inte går att använda i sin nuvarande form. Idéer var bland annat att skapa ett digitalt format i form av en applikation eller att genomföra HaKoll! som videokonferens. Arbetsmiljö och organisation behöver också utvecklas för att stödja digitala lösningar. Resultaten av studien kan bidra med viktig kunskap i utvecklingen av en digital interventionsdesign för HaKoll!, men även kunskap som kan vara till nytta för utvecklandet av andra digitala interventioner inom hälso- och sjukvård. / The Let’s Get Organized (LGO) an occupational therapy group intervention to enhance time management and organize activities, has received good results in several studies. The need to develop new digital interventions in health care is great, but the initiatives for this are limited in occupational therapy. From this background, the objective of the study was to explore and describe occupational therapists' reasoning about a digital implementation of the LGO. Focus group was chosen for data collection. Six focus groups were conducted with occupational therapists, also group leaders for the LGO. Data was analyzed according to analysis for focus groups, and resulted in an overarching theme, ‘A digital implementation has potential if obstacles can be bridged’, and four categories: 'Enables increased efficiency and accessibility', 'The interaction in the group is challenged by a digital format', 'Digital meetings has other requirements', and 'A need to develop the content and arrangement'. The results showed that the content, the format and the delivery of the LGO needs to be adapted and developed for a digital implementation, as it cannot be used in its current form. Ideas included creating a digital format as an application, or implementing LGO as a video conference. The working environment and organization also need to be developed to support telerehabilitation and digital interventions. The results of the study may contribute with important knowledge in the development of a digital intervention design for the LGO, but also knowledge that might be useful for the development of other digital intervention programs in health care.

Metamorphosis is a theory-driven occupational therapy program using telerehabilitation based on the concept of self-management of stroke (Warner et al., 2015), which emphasizes the crucial role of client adherence and engagement between formal therapy sessions to drive neuroplastic change. This program utilizes self-determination theory (Ryan & Deci, 2000) to cultivate the intrinsic motivation of individuals with chronic stroke to participate in evidence-based therapy from the home setting (Chemtob et al., 2019; Moore et al., 2016). Repetitious but interesting and engaging gamified therapy (Cramer et al., 2019; Proffitt & Lange, 2015; Thielbar et al., 2019) can lead to motor changes which are then translated into improvements in UL engagement during ADL guided by the Active Learning Program for Stroke (ALPS) (Fasoli & Adans-Dester, 2019), solidifying the motor changes by reducing learned non-use of the stroke-affected limb. Emotional support is provided through a moderated forum for stroke survivors (Owen et al., 2010) which can aid in continued translation of skills and motivation to participate in the program during a challenging time. / 2022-09-25T00:00:00Z

The purpose of the study was to describe the experiences and reasoning of occupational therapists' about obstacles and opportunities of implementing interventions via telerehabilitation for individuals with ADHD, Autism Spectrum Disorder or Intellectual Disability. Data were collected via semi-structured interviews with occupational therapists in psychiatric outpatient care and adult habilitation. Based on a qualitative content analysis, collected material was analysed, which resulted in an overall theme, “Commitment and embracement of a new role in the implementation of interventions is challenged by lack of conditions and four categories: New demands for ability and knowledge, Challenge in the digital environment regarding objects that constitute the environment and interaction, Changed conditions for the meeting increase accessibility for occupational interventions and New possible working method as an alternative in the near future.” Results show that the occupational therapists' reasoning is twofold where obstacles currently affect the execution and quality of the occupational therapy intervention, but where the commitment of the working method leads to a continued development of interventions via telerehabilitation. The study implies that the introduction of telerehabilitation should be implemented with regard to interventions in occupational therapy and that there is a need for coordination of working method via telerehabilitation for the occupational therapist who meets the individual. Further studies in the field focusing on the conditions for interventions through telerehabilitation and individuals ability to handle telerehabilitation are recommended.

Die technikgestützte Rehabilitation wird im Rahmen der Schlaganfallbehandlung als therapeutisches Verfahren zur Wiedererlangung der motorischen Bewegungsfähigkeit oberer Extremitäten eingesetzt. Zudem wächst durch die Digitalisierung des Alltags und den demographischen Wandel das Forschungsinteresse an telerehabilitativen Behandlungskonzepten, die die Schlaganfallversorgung durch den Einsatz von Informations- und Kommunikationstechnologien ergänzt sowie erweitert. Dabei wird das Ziel verfolgt, einen dauerhaften und nachhaltigen Therapieerfolg zu ermöglichen. Durch die Möglichkeit zur Vernetzung der stationären sowie ambulanten Rehabilitation mit der Nachsorge soll eine kontinuierliche, über die notwendigen Gesundheitssektoren der Schlaganfallbehandlung hinweg, eine Begleitung der Patient:innen durch die betreuenden Behandler:innen gewährleistet werden. Der erfolgreiche Einsatz entsprechender Therapiesysteme in der Nachsorge verlangt einen benutzerzentrierten Entwicklungsprozess. Ausgangspunkt sollten die von den beteiligten Nutzer:innengruppen gestellten Anforderungen an derartige Systeme sein. Das Ziel der vorliegenden Arbeit besteht darin, auf verschiedene Aspekte des Technikeinsatzes und die damit einhergehende Zufriedenheit sowie Akzeptanz der technikgestützten Schlaganfallrehabilitation und Nachsorge der beteiligten Nutzer:innengruppen einzugehen. Eine Kombination aus drei explorativen Untersuchungen, einer Grundlagenbefragung und zwei empirischen Feldstudien, analysieren abhängige Faktoren des Technikeinsatzes, um entsprechende Auswirkungen auf die Entwicklung und Praxis abzuleiten. Im Rahmen der Grundlagenbefragung werden das Nutzungsverhalten sowie die Nutzungsbereitschaft von Informations- und Kommunikationstechnologien von Schlaganfallpatient:innen und Behandler:innen analysiert. Daraus abgeleitet werden notwendige Ressourcen, die bereitgestellt werden müssen, um technikgestützte Verfahren sowohl in der Rehabilitation als auch Nachsorge zu ermöglichen. Die erste empirische Studie untersucht Veränderungen im Nutzer:innenerleben, der Zufriedenheit und Technikakzeptanz, zwischen zwei Therapiegeräten in der klassischen Versorgung mit zwei experimentellen Therapiesystemen mit visuellem und zum Teil haptischem Feedback. In einer zweiten Feldstudie werden zeitbezogene Veränderungen untersucht, die bei längerfristiger Nutzung über zehn Behandlungseinheiten mit dem Bi-Manu-Interact auftreten können. / Using technically assisted rehabilitation in stroke treatment as a therapeutic procedure to regain motor mobility of upper extremities. In addition, the digitalisation of everyday life and demographic change are increasing research interest in telerehabilitative treatment concepts, which supplement and expand stroke care by using information and communication technologies. The aim is to achieve lasting and sustainable therapeutic success. The possibility of integrating in-patient and out-patient rehabilitation with aftercare is intended to ensure that patients are continuously accompanied by the attending physicians across the necessary health sectors of stroke treatment. The successful use of appropriate therapy systems in aftercare requires a user-centered development process. The starting point should be the requirements placed on such systems by the user groups involved. The aim of the present study is to deal with different aspects of the use of technology and the associated satisfaction as well as acceptance of the technology-supported stroke rehabilitation and aftercare of the participating user groups. A combination of three explorative studies, a basic survey and two empirical field studies analyse dependent factors of the use of technology in order to determine corresponding effects on development and practice. The basic survey analyses the usage behaviour and readiness of stroke patients and therapists to use information and communication technologies. From this, resources are derived to enable technology-supported procedures in rehabilitation and aftercare. The first empirical field study investigates changes in user experience, satisfaction and technology acceptance between two therapy devices in classical care with two experimental therapy systems with visual and partly haptic feedback. The second field study investigates time-related changes that can occur with long-term use of more than ten therapy units with the therapy system "Bi-Manu-Interact".

Problem: The Centers for Disease Control and Prevention indicates that falls are the “leading cause of injury death and the most common cause of nonfatal injuries and hospital admission for trauma among people ages 65 and older.”1 Falls can have significant economic consequences to the individual and payer sources. To address these consequences, telerehabilitation was hypothesized to be a suitable supplement for fall screening efforts. Several sources concluded that support for synchronous telerehab was underdeveloped in the literature. Purpose: The purpose of this study was to explore the acceptability, feasibility, reliability, and validity of telehealth-delivered fall screening among community-dwelling older adults. Procedures: This investigation implemented an experimental, quantitative, cross-sectional design employing both pretest-posttest control group and quasi-experimental static group comparisons using non-probability sampling. This study assembled a panel of experts to provide content validation for a survey tool developed to quantify an older adult’s behavioral intension to use and attitudes towards a telerehabilitation delivery system. Seven fall screening tools were investigated for agreement among remote and face-to-face raters, and for comparison with the face-to-face reference standard (Mini-BEST). Results: All three null hypotheses were rejected. Results indicate that a telerehabilitation delivery system is a reliable and valid method of screening and determining fall risk in community-dwelling older adults. This study produced a content validated, internally consistent survey instrument designed to determine attitudes and beliefs about telerehabilitation. An experimental design was able to demonstrate a positive significant change in 4 of 7 survey constructs among the intervention group after exposure to telerehabilitation as compared to post-test controls. Overall, no significant difference was calculated between face-to-face or telerehab raters, and both environments produced equivalency with scoring, fall risk classification, and ability to discern fallers from non-fallers. Results from the telerehab STEADI fall risk conclusions were calculated to be concurrently valid with the face-to-face reference standard screening tool, the Mini-BEST. Conclusions: This investigation expanded the array of remote healthcare delivery options for clinicians and clients. Further investigation in residential and community settings are recommended.