Usability Study of a Multicomponent Exergame Training for Older Adults with Mobility Limitations

The global population aged 60 years and over rises due to increasing life expectancy. More older adults suffer from “geriatric giants”. Mobility limitations, including immobility and instability, are usually accompanied by physical and cognitive decline, and can be further associated with gait changes. Improvements in physical and cognitive functions can be achieved with virtual reality exergame environments. This study investigated the usability of the newly developed VITAAL exergame in mobility-impaired older adults aged 60 years and older. Usability was evaluated with a mixed-methods approach including a usability protocol, the System Usability Scale, and a guideline-based interview. Thirteen participants (9 female, 80.5 ± 4.9 years, range: 71–89) tested the exergame and completed the measurement. The System Usability Scale was rated in a marginal acceptability range (58.3 ± 16.5, range: 30–85). The usability protocol and the guideline-based interview revealed general positive usability. The VITAAL exergame prototype received positive feedback and can be considered usable by older adults with mobility limitations. However, minor improvements to the system in terms of design, instructions, and technical aspects should be taken into account. The results warrant testing of the feasibility of the adapted multicomponent VITAAL exergame, and its effects on physical and cognitive functions, in comparison with conventional training, should be studied.

Appliance Control with IOT-Arduino of Voice Command Detection for Mobility Impaired People

People with physical mobility disabilities experience limited ability to perform daily routine. Integration between home appliances and Internet of Thing (IoT) can be used to support these people. The technology allows tasks to be performed much more easily and enable access to applications and services that would be a challenge with existing digital user interfaces. However, the developed system that is commercially available is costly and equipped with highly specific interfaces which may require considerable technical competency to conduct system interfacing. The purpose of this study is to develop a low cost IOT system for voice-enabled lamp control by utilizing Google Assistant that is available in commercial Android based mobile devices, allowing user to operate lighting appliances without moving. Personal assistance using Google platform embedded with Arduino microcontroller, ESP8266-based NodeMCU development board and integrated Blynk application allow for remote monitoring capability. The system is remotely controlled from a tablet or smartphone to assist disabled people with restricted mobility, in particular those with lower limb disabilities. The system had been tested and demonstrated that the lamp control can be easily accessed by voice command that is then validated using voice pitch analyzer. Test result indicated that capability of the integrated voice control system is verified up to a maximum distance of 24.5 meter, making it a potential implementation in any customized smart home or room system for people with mobile disability.

Expanding Availability of Speech-Generating Device Evaluation and Treatment to People With Amyotrophic Lateral Sclerosis (pALS) Through Telepractice: Perspectives of pALS and Communication Partners

Purpose To examine the experiences of people with ALS (pALS) and their communication partners (cALS) regarding receiving speech-generating device (SGD) evaluation and treatment via telepractice. Method Eight pALS along with a primary cALS participated in telepractice SGD evaluation and treatment with an augmentative and alternative communication (AAC) specialist and representatives from multiple SGD vendors. Participants were interviewed postevaluation and post-SGD training to examine their experiences. Mixed methods data were collected through Likert scale responses and qualitative interviews. Results Telepractice SGD evaluation and training were feasible and resulted in all pALS receiving SGDs they were able to use to communicate. In both Likert rating items and qualitative interviews, participants rated the telepractice experience very highly in terms of giving them access to AAC services via an AAC specialist that they would not have otherwise been able to access, and doing so in a format that was possible given their limitations in mobility, endurance, and caregiver availability. Suggestions for improving the telepractice experience were provided. Conclusions Telepractice should be considered as an option to provide vital SGD services to patients who are geographically remote, mobility impaired, unable to leave their home, experience fatigue with travel, or otherwise would not have access to these specialized services. Telepractice allows patients to preserve their time and energy for the assessment and treatment sessions, resulting in perhaps deeper and more frequent engagement in evaluation and training. Telepractice could serve as an alternative to outpatient, in-person evaluations, or be utilized in conjunction with in-person appointments. Supplemental Material https://doi.org/10.23641/asha.15094257

Development of an Inexpensive Harnessing System Allowing Independent Gardening for Balance Training for Mobility Impaired Individuals

Balance is key to independent mobility, and poor balance leads to a risk of falling and subsequent injury that can cause self-restriction of activity for older adults. Balance and mobility can be improved through training programs, but many programs are not intensive or engaging enough to sufficiently improve balance while maintaining adherence. As an alternative to traditional balance training, harnessed gardening sessions were conducted in an urban greenhouse as an example of a community activity through which balance and mobility can be trained and/or maintained. An inexpensive multidirectional harness system was developed that can be used as an assistive or rehabilitative device in community, private, and senior center gardens to allow balance or mobility-impaired adults to participate in programming. Two wearable sensor systems were used to measure responses to the system: the Polhemus G4 system measured gardeners’ positions and center of mass relative to the base of support, and ActiGraph activity monitors measured the frequency and intensity of arm movements in garden as compared to home environments. The harnessed gardening system provides a safe environment for intense movement activity and can be used as a rehabilitation device along with wearable sensor systems to monitor ongoing changes.

Mobility-Related Behavioral Flexibility and Routines

Few empirical studies have explored psychological attitudes toward out-of-home mobility in old age. We aimed to validate an instrument to assess mobility-related behavioral flexibility and routines in the context of everyday mobility and successful aging. Data were gathered from face-to-face interviews and travel diaries of 211 community-dwelling older adults (aged 65–92) in Germany. Analysis revealed sufficient reliability and confirmed the factorial and convergent validity of the instrument. Mobility-related behavioral flexibility predicted the number of daily trips, particularly by mobility-impaired participants, and was strongly linked to autonomy and to psychological well-being. However, a preference for routines predicted neither out-of-home mobility nor further outcomes. The results demonstrate the importance of mobility-related flexibility in maintaining an active and independent life in old age.

Users’ Experience in Digital Architectural Design: Combining Qualitative Research Methods with a Generative Model

This paper presents the development of a digital generative design tool for residential building that integrates qualitative data from potential users of buildings. The central aim is to understand and challenge the inherent biases in the design process of architecture for mobility impaired users, whose experiences might be difficult to understand for designers who often move around and use buildings without any difficulty. Although Universal Design promotes designed environments that are more sensitized with the diverse difference of individuals, the most of design generating tools are based on empirically deducted human needs, objectifying the people or seeing them as useful in simply validating design ideas. There is a clear distance in between the real needs and wishes of wheelchair users and what architects imagine when designing. Mixed-methods – expert interview, literature review and data analysis of disability blogs – are used to collect and analyse wheelchair users’ experience. Accumulated qualitative data is, then, used as guiding input for the development of an explorative generative model that effectively produces large number of floor plans for residential architecture. The developed generative model effectively selects floor plans that correspond with challenges described by the wheelchair users. The selected floor plans become informed starting points for spatial planning, which can guide architects to produce new and unexpected design solutions that are more sensitised to wheelchair users’ experience. The application of generative design tools in early stages of design tasks can help architects to understand users’ needs and wishes, and thus challenge biased assumptions about wheelchair users’ experiences. And yet, further research needs to be conducted in order to progress the system: additional user data and new design objectives can give rise to new hypothesis and allow the system to be more precise, responding to the complex reality of disabled people in their everyday lives.

The Prevalence and Burden of Hypophosphatasia in an Ambulatory Endocrinology Practice

Introduction: Hypophosphatasia (HPP) is an autosomal disease resulting from loss-of-function mutations in the ALPL gene encoding tissue-nonspecific alkaline phosphatase (TNSALP). The presentation and severity of the disease is highly variable ranging from perinatal-onset HPP with mortality rates as high as 100%, to adult onset with little mortality but with high disease-burden. Overall estimated prevalence of HPP in the general population is 1:100,000 though it may be significantly higher in specific populations. Hypophosphatasia is a heterogeneous disease that can reveal itself at any age, presenting within a wide range of symptoms. Adult HPP typically presents during middle age and is often misdiagnosed or missed in practice. The objective of this study was to determine the prevalence and burden of hypophosphatasia in an ambulatory care endocrinology practice. Methods: Potential subjects were identified via a computerized text search of the laboratory fields of patient electronic medical records (EMR). Search terms included serum ALP levels of less than or equal to 40 mg/dL. Records of patients with at least two low ALP levels were reviewed manually to identify potential patients with a history consistent with HPP. Results: A total of 315 patients with ALP levels < 40 mg/dL were identified via text search from an estimated 20,000 patient records. Fifty-six patients with a single low level were not considered for further review. The remaining 259 patients were reviewed for histories consistent with hypophosphatasia. These patients were predominantly white (64.9%), with an average age of 55 (+ 15) years, and an average BMI of 28 (+ 7) kg/m2. Ten of these patients had histories consistent with hypophosphatasia including musculoskeletal pain requiring scheduled use of pain medications, polyarthropathy, chondrocalcinosis, deformity secondary to fractures, low BMD, a history of nontraumatic fracture, delayed or incomplete fracture healing, a history of multiple orthopedic surgeries, fatigue, impaired mobility, impaired gait, impairment of daily activities, a history of renal stones or nephrocalcinosis, and/or high serum B6 levels. None of the identified ten patients were currently being treated or had previously been treated for hypophosphatasia and have subsequently been recommended for genetic testing. Conclusions: Hypophosphatasia is an uncommon condition with a highly variable presentation often resulting in a missed diagnosis. Surveillance of practices by identifying patients with low ALP levels is a reasonable screening approach to identifying potential patients with hypophosphatasia.