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Abstract Background To overcome the application limitations of functional electrical stimulation (FES), such as fatigue or nonlinear muscle response, the combination of neuroprosthetic systems with robotic devices has been evaluated, resulting in hybrid systems that have promising potential. However, current technology shows a lack of flexibility to adapt to the needs of any application, context or individual. The main objective of this study is the development of a new modular neuroprosthetic system suitable for hybrid FES-robot applications to meet these needs. Methods In this study, we conducted an analysis of the requirements for developing hybrid FES-robot systems and reviewed existing literature on similar systems. Building upon these insights, we developed a novel modular neuroprosthetic system tailored for hybrid applications. The system was specifically adapted for gait assistance, and a technological personalization process based on clinical criteria was devised. This process was used to generate different system configurations adjusted to four individuals with spinal cord injury or stroke. The effect of each system configuration on gait kinematic metrics was analyzed by using repeated measures ANOVA or Friedman’s test. Results A modular NP system has been developed that is distinguished by its flexibility, scalability and personalization capabilities. With excellent connection characteristics, it can be effectively integrated with robotic devices. Its 3D design facilitates fitting both as a stand-alone system and in combination with other robotic devices. In addition, it meets rigorous requirements for safe use by incorporating appropriate safety protocols, and features appropriate battery autonomy, weight and dimensions. Different technological configurations adapted to the needs of each patient were obtained, which demonstrated an impact on the kinematic gait pattern comparable to that of other devices reported in the literature. Conclusions The system met the identified technical requirements, showcasing advancements compared to systems reported in the literature. In addition, it demonstrated its versatility and capacity to be combined with robotic devices forming hybrids, adapting well to the gait application. Moreover, the personalization procedure proved to be useful in obtaining various system configurations tailored to the diverse needs of individuals.

IntroductionThe ABLE Exoskeleton has been tested to be safe and feasible for persons with spinal cord injury (SCI) to complete basic skills in clinical settings but has not been tested for use in home and community environments. A user-centered design process was employed to test the feasibility of the current ABLE Exoskeleton (designed for clinical use) for persons with SCI to perform the basic and advanced skills required for home and community environments, to gain crucial feedback for the development of a novel personal-use exoskeleton.MethodsIn this prospective pretest-posttest quasi-experimental study across two SCI centers (Germany, Spain), in-and outpatients with SCI were included into a 22-session training and assessment protocol, utilizing the ABLE Exoskeleton. Feasibility and usability measures [level of assistance (LoA) for basic and advanced skills, donning/doffing-time and LoA] were recorded together with safety outcomes, and participant and therapist satisfaction with the device.Results10 participants (44.4 ± 24 years), with SCI from C5 to T11, (American Spinal Injury Association Impairment Scale A–D) completed the study. In 209 sessions, six device-related adverse events (pain and skin lesions) were reported. Average total time for don and doff was 10:23 ± 3:30 min. Eight participants were able to complete don and doff with minimal assistance or less. Independence to carry out all skills in the device increased significantly for all participants (p

[This corrects the article DOI: 10.1371/journal.pone.0281197.].

IntroductionDigital solutions for cognitive assessment are currently not only widely used in experimental contexts but can also be useful in clinical practice for efficient screening and longitudinal follow-up. The “Guttmann Cognitest”®, which includes seven computerized tasks designed to assess main cognitive functions, revealed in a previous validation study to be a potential useful tool to assess cognitive functioning in healthy middle-aged adults.MethodHere, we present results from a validation in two different populations: one consisting of older adults, and the other comprising young and middle-aged individuals, some of them affected by acquired brain injury. To perform a convergent validity test, older adults were also administered with the MOCA, while young and middle-aged individuals were administered with a short neuropsychological assessment including gold-standard neuropsychological tests. We also conducted sensitivity and specificity analysis to establish the utility of this instrument in identifying potential cognitive dysfunctions in the two groups.ResultsResults demonstrated strong convergent validity as well as good specificity and sensitivity characteristics.DiscussionThis tool is a valid and useful instrument to assess cognitive functioning and detecting potential cases of cognitive dysfunctions in older adults and clinical populations.

Background As the world population continues to age, the prevalence of neurological diseases, such as dementia, poses a significant challenge to society. Detecting cognitive impairment at an early stage is vital in preserving and enhancing cognitive function. Digital tools, particularly mHealth, offer a practical solution for large-scale population screening and prompt follow-up assessments of cognitive function, thus overcoming economic and time limitations. Objective In this work, two versions of a digital solution called Guttmann Cognitest ® were tested. Methods Two hundred and one middle-aged adults used the first version (Group A), while 132 used the second one, which included improved tutorials and practice screens (Group B). This second version was also validated in an older age group (Group C). Results This digital solution was found to be highly satisfactory in terms of usability and feasibility, with good acceptability among all three groups. Specifically for Group B, the system usability scale score obtained classifies the solution as the best imaginable in terms of usability. Conclusions Guttmann Cognitest ® has been shown to be effective and well-perceived, with a high potential for sustained engagement in tracking changes in cognitive function.

Abstract Background Robotic lower-limb exoskeletons have the potential to provide additional clinical benefits for persons with spinal cord injury (SCI). However, high variability between protocols does not allow the comparison of study results on safety and feasibility between different exoskeletons. We therefore incorporated key aspects from previous studies into our study protocol and accordingly conducted a multicentre study investigating the safety, feasibility and usability of the ABLE Exoskeleton in clinical settings. Methods In this prospective pretest-posttest quasi-experimental study across two SCI centres in Germany and Spain, in- and outpatients with SCI were recruited into a 12-session training and assessment protocol, utilising the ABLE Exoskeleton. A follow-up visit after 4 weeks was included to assess after-training outcomes. Safety outcomes (device-related adverse events (AEs), number of drop-outs), feasibility and usability measures (level of assistance, donning/doffing-time) were recorded at every session together with changes in gait parameters and function. Patient-reported outcome measures including the rate of perceived exertion (RPE) and the psychosocial impact of the device were performed. Satisfaction with the device was evaluated in both participants and therapists. Results All 24 participants (45 ± 12 years), with mainly subacute SCI (

El presente artículo propone una reflexión teórico-metodológica desde la psicología social sobre los desafíos que implica el trabajo de investigación con población indígena, particularmente, con personas pertenecientes al pueblo Mapuche. Se enfatizan los desafíos éticos, teóricos y las tensiones metodológicas que emergen debido a las formas de producción de conocimiento hegemónicas de la psicología, las cuales se enmarcan dentro de lógicas poscoloniales, que privilegian la perspectiva occidental sobre la de los pueblos originarios y que, en su implementación, reproducen prácticas de dominación y racialización que tienen su origen en el pasado colonial. Finalmente, se propone una reflexión con miras a repensar las relaciones con los y las participantes y nuestras prácticas investigativas desde una perspectiva decolonial.

Este estudio tuvo por objetivo determinar si existen diferencias en el desempeño de la memoria de trabajo y representación espacial en niños y niñas mapuches rurales y no mapuche urbanos de la región de La Araucanía (Chile). Participaron 96 estudiantes entre 8 y 12 años (M = 10.33; DE = 1.02), quienes respondieron tareas de memoria de trabajo y de representación espacial en formato verbal y no verbal. Se utilizó un análisis multivariado de la covarianza (MANCOVA), controlando el efecto de la edad y el sexo. Los resultados evidencian que los participantes mapuche puntuaron más bajo que sus pares no mapuche en memoria de trabajo verbal, y se encontraron diferencias marginalmente significativas en memoria de trabajo no verbal. En la representación espacial verbal no se obtuvieron diferencias entre los grupos y en representación espacial no verbal los niños mapuches obtuvieron un desempeño significativamente más alto que sus pares no mapuche. Los niños no mapuche tienen un mayor desempeño en tareas verbales, mientras que niños mapuche obtienen desempeños similares o más altos en tareas no verbales. Se discute la relevancia de la validez ecológica desde el paradigma de la cognición situada.

PurposeThis study describes the development of a questionnaire for assessing the usability of assistive technologies accessible to people with neurological diseases.MethodsA Delphi study was conducted to identify relevant items for the questionnaire. After that, the content validity was addressed to identify the essential items. Once the questionnaire was designed following the results of the Delphi study and content validity, the reliability, validity, and the Rasch model of the questionnaire were examined.ResultsTwo rounds of the Delphi study were carried out. A total of 73 participants (42 experts and 31 users) participated in round 1, and 59 people (27 experts and 32 users) in round 2. A total of 53 and 29 items were identified in rounds 1 and 2, respectively. In the content validity, we found nine items above the threshold of 0.58. Finally, ten items were included in the questionnaire. Fifty-one participants participate in the reliability and validity of the questionnaire. The internal consistency reliability of the questionnaire analyzed by Cronbach's Alpha was α = 0,895. There was moderate to considerable concordance among our questionnaire items test-retest in the Kappa coefficient and a strong association between test-retest in the Spearman's coefficient ρ = 0.818 (pConclusionsThe present study suggested that the new questionnaire is a reliable 10-item usability questionnaire that allows subjective and quick assessment of the usability of assistive technologies by people with neurological diseases.

Thanks to technological advances, the administration of cognitive assessments via digital solutions continues to increase, both in research and clinical practice. “Guttmann Cognitest”°ledR is a digital solution for cognitive assessment which includes seven computerized tasks designed to assess main cognitive functions requiring approximately 20 min to be completed. The purpose of the present study was to validate it against standard and more extensive in-person neuropsychological assessments in the context of the Barcelona Brain Health Initiative (BBHI) cohort study. We studied 274 participants of the BBHI (126 women, mean age = 56.14, age range 44–69), who underwent an extensive in-person assessment, including a classical paper-and-pencil neuropsychological assessment and a cognitive assessment via the “Guttmann Cognitest”°ledR. Principal component analysis indicated that “Guttmann Cognitest”°ledR measures four main cognitive domains and convergent validity analysis demonstrated that cognitive performance was associated with gold standard paper and pencil tests. Results also showed an expected negative correlation with age, a relation with educational level as well as a gender effect. Regression-based norming equations for the sample tested are also reported. Performing a cognitive assessment with this digital solution is feasible and potentially useful to gather information about cognitive functioning in large samples and experimental settings.

Social media is a crucial communication tool (e.g., with 430 million monthly active users in online forums such as Reddit), being an objective of Natural Language Processing (NLP) techniques. One of them (word embeddings) is based on the quotation, “You shall know a word by the company it keeps,” highlighting the importance of context in NLP. Meanwhile, “Context is everything in Emotion Research.” Therefore, we aimed to train a model (W2V) for generating word associations (also known as embeddings) using a popular Coronavirus Reddit forum, validate them using public evidence and apply them to the discovery of context for specific emotions previously reported as related to psychological resilience. We used Pushshiftr, quanteda, broom, wordVectors, and superheat R packages. We collected all 374,421 posts submitted by 104,351 users to Reddit/Coronavirus forum between January 2020 and July 2021. W2V identified 64 terms representing the context for seven positive emotions (gratitude, compassion, love, relief, hope, calm, and admiration) and 52 terms for seven negative emotions (anger, loneliness, boredom, fear, anxiety, confusion, sadness) all from valid experienced situations. We clustered them visually, highlighting contextual similarity. Although trained on a “small” dataset, W2V can be used for context discovery to expand on concepts such as psychological resilience.

Investigación cuyo objetivo fue analizar la noción de gestión administrativa para determinar su relación con la calidad educativa en la formación de estudiantes de la Unidad Educativa 20 de Octubre. En cuanto a la metodología el enfoque es cuantitativo con implicaciones cualitativas puesto que se llevaron a cabo observaciones, revisión documental y entrevistas a sujetos claves para fundamentar el recorrido investigativo. Los resultados promueven una toma de conciencia en torno a la necesidad de analizar qué es lo que conduce al individuo dentro de una organización a dejar de hacer las actividades relacionadas con la calidad o cuáles son las causas de dicha apatía hacia la calidad. Se concluye que para que la escuela sea una organización de calidad, las relaciones en su interior deben orientarse con una filosofía de servicio: hacer las cosas bien.

Abstract Introduction Even in nonpandemic times, persons with disabilities experience emotional and behavioral disturbances which are distressing for them and for their close persons. We aimed at comparing the levels of stress in emotional and behavioral aspects, before and during coronavirus disease 2019 (COVID‐19), as reported by informal family caregivers of individuals with chronic traumatic brain injury (TBI) or stroke living in the community, considering two different stratifications of the recipients of care (cause and injury severity). Methods We conducted a STROBE‐compliant prospective observational study analyzing informal caregivers of individuals with stroke (IC‐STROKE) or traumatic brain injury (IC‐TBI). IC‐STROKE and IC‐TBI were assessed in‐person before and during COVID‐19 online, using the Head Injury Behavior Scale (HIBS). The HIBS comprises behavioral and emotional subtotals (10 items each) and a total‐HIBS. Comparisons were performed using the McNemar's test, Wilcoxon signed‐rank test or t‐test. Recipients of care were stratified according to their injury severity using the National Institutes of Health Stroke Scale (NIHSS) and the Glasgow Coma Scale (GCS). Results One hundred twenty‐two informal caregivers (62.3% IC‐STROKE and 37.7% IC‐TBI) were assessed online between June 2020 and April 2021 and compared to their own assessments performed in‐person 1.74 ± 0.88 years before the COVID‐19 lockdown. IC‐STROKE significantly increased their level of stress during COVID‐19 in five emotional items (impatience, frequent complaining, often disputes topics, mood change and overly sensitive) and in one behavioral item (overly dependent). IC‐TBI stress level only increased in one behavioral item (impulsivity). By injury severity, (i) mild (14.7%) showed no significant differences in emotional and behavioral either total‐HIBS (ii) moderate (28.7%) showed significant emotional differences in two items (frequent complaining and mood change) and (iii) severe (56.6%) showed significant differences in emotional (often disputes topics) and behavioral (impulsivity) items. Conclusions Our results suggest specific items in which informal caregivers could be supported considering cause or severity of the recipients of care.

BackgroundStroke is a worldwide cause of disability; 40% of stroke survivors sustain cognitive impairments, most of them following inpatient rehabilitation at specialized clinical centers. Web-based cognitive rehabilitation tasks are extensively used in clinical settings. The impact of task execution depends on the ratio between the skills of the treated patient and the challenges imposed by the task itself. Thus, treatment personalization requires a trade-off between patients’ skills and task difficulties, which is still an open issue. In this study, we propose Elo ratings to support clinicians in tasks assignations and representing patients’ skills to optimize rehabilitation outcomes. ObjectiveThis study aims to stratify patients with ischemic stroke at an early stage of rehabilitation into three levels according to their Elo rating; to show the relationships between the Elo rating levels, task difficulty levels, and rehabilitation outcomes; and to determine if the Elo rating obtained at early stages of rehabilitation is a significant predictor of rehabilitation outcomes. MethodsThe PlayerRatings R library was used to obtain the Elo rating for each patient. Working memory was assessed using the DIGITS subtest of the Barcelona test, and the Rey Auditory Verbal Memory Test (RAVLT) was used to assess verbal memory. Three subtests of RAVLT were used: RAVLT learning (RAVLT075), free-recall memory (RAVLT015), and recognition (RAVLT015R). Memory predictors were identified using forward stepwise selection to add covariates to the models, which were evaluated by assessing discrimination using the area under the receiver operating characteristic curve (AUC) for logistic regressions and adjusted R2 for linear regressions. ResultsThree Elo levels (low, middle, and high) with the same number of patients (n=96) in each Elo group were obtained using the 50 initial task executions (from a total of 38,177) for N=288 adult patients consecutively admitted for inpatient rehabilitation in a clinical setting. The mid-Elo level showed the highest proportions of patients that improved in all four memory items: 56% (54/96) of them improved in DIGITS, 67% (64/96) in RAVLT075, 58% (56/96) in RAVLT015, and 53% (51/96) in RAVLT015R (P

We aimed to (1) apply cluster analysis techniques to mixed-type data (numerical and categorical) from baseline neuropsychological standard and widely used assessments of patients with acquired brain injury (ABI) (2) apply state-of-the-art cluster validity indexes (CVI) to assess their internal validity (3) study their external validity considering relevant aspects of ABI rehabilitation such as functional independence measure (FIM) in activities of daily life assessment (4) characterize the identified profiles by using demographic and clinically relevant variables and (5) extend the external validation of the obtained clusters to all cognitive rehabilitation tasks executed by the participants in a web-based cognitive rehabilitation platform (GNPT). We analyzed 1,107 patients with ABI, 58.1% traumatic brain injury (TBI), 21.8% stroke and 20.1% other ABIs (e.g., brain tumors, anoxia, infections) that have undergone inpatient GNPT cognitive rehabilitation from September 2008 to January 2021. We applied the k-prototypes algorithm from the clustMixType R package. We optimized seven CVIs and applied bootstrap resampling to assess clusters stability (fpc R package). Clusters' post hoc comparisons were performed using the Wilcoxon ranked test, paired t-test or Chi-square test when appropriate. We identified a three-clusters optimal solution, with strong stability (>0.85) and structure (e.g., Silhouette > 0.60, Gamma > 0.83), characterized by distinctive level of performance in all neuropsychological tests, demographics, FIM, response to GNPT tasks and tests normative data (e.g., the 3 min cut-off in Trail Making Test-B). Cluster 1 was characterized by severe cognitive impairment (N = 254, 22.9%) the mean age was 47 years, 68.5% patients with TBI and 22% with stroke. Cluster 2 was characterized by mild cognitive impairment (N = 376, 33.9%) mean age 54 years, 53.5% patients with stroke and 27% other ABI. Cluster 3, moderate cognitive impairment (N = 477, 43.2%) mean age 33 years, 83% patients with TBI and 14% other ABI. Post hoc analysis on cognitive FIM supported a significant higher performance of Cluster 2 vs. Cluster 3 (p < 0.001), Cluster 2 vs. Cluster 1 (p < 0.001) and Cluster 3 vs. Cluster 1 (p < 0.001). All patients executed 286,798 GNPT tasks, with performance significantly higher in Cluster 2 and 3 vs. Cluster 1 (p < 0.001).

ObjectiveTo evaluate whether introducing gamification in BCI rehabilitation of the upper limbs of post-stroke patients has a positive impact on their experience without altering their efficacy in creating motor mental images (MI).DesignA game was designed purposely adapted to the pace and goals of an established BCI-rehabilitation protocol. Rehabilitation was based on a double feedback: functional electrostimulation and animation of a virtual avatar of the patient’s limbs. The game introduced a narrative on top of this visual feedback with an external goal to achieve (protecting bits of cheese from a rat character). A pilot study was performed with 10 patients and a control group of six volunteers. Two rehabilitation sessions were done, each made up of one stage of calibration and two training stages, some stages with the game and others without. The accuracy of the classification computed was taken as a measure to compare the efficacy of MI. Users’ opinions were gathered through a questionnaire. No potentially identifiable human images or data are presented in this study.ResultsThe gamified rehabilitation presented in the pilot study does not impact on the efficacy of MI, but it improves users experience making it more fun.ConclusionThese preliminary results are encouraging to continue investigating how game narratives can be introduced in BCI rehabilitation to make it more gratifying and engaging.

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