https://rehab.jmir.org/issue/feed 2024-01-01T10:00:04-05:00 JMIR Publications editor@jmir.org Open Journal Systems Unless stated otherwise, all articles are open-access distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work ("first published in the Journal of Medical Internet Research...") is properly cited with original URL and bibliographic citation information. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included. Development and evaluation of rehabilitation, physiotherapy and assistive technologies, robotics, prosthetics and implants, mobility and communication tools, home automation, and telerehabilitation. https://rehab.jmir.org/2026/1/e86785 2026-07-02T15:30:18-04:00 Julia Mucha Rana Hamdy Melina Marini Reda Aasem Chung Duong Tai-Te Su Soo Chan Carusone Kelly K O'Brien

Background: As individuals with HIV live longer, many now face the health consequences of aging and multimorbidity, known as disability. Exercise can mitigate disability; however, engagement in exercise among adults living with HIV varies. Technology-based interventions, such as telerehabilitation, may help mitigate geographical, financial, and time barriers to community-based exercise (CBE). However, little is known about the experiences with technology uptake and usage among adults living with HIV. Understanding these experiences is essential to inform the design of inclusive, accessible, and sustainable online interventions. Objective: This study aimed to describe experiences with technology uptake and usage among adults aging with HIV participating in a 6-month online CBE intervention and explore how these experiences changed over time, from baseline to postintervention. Methods: We conducted a longitudinal qualitative descriptive study and secondary analysis using interview data from adults living with HIV who were engaged in a CBE intervention study in Toronto, Canada. Participants engaged in a 6-month online CBE intervention consisting of thrice-weekly exercise supervised biweekly through online personal coaching sessions, weekly group exercise classes, and monthly self-management education sessions (via Zoom). The technology used included Zoom software and a webcam, as well as the Sweat for Good YMCA app and the YMCA Virtuagym website; participants wore a wireless physical activity monitor (Fitbit Inspire 2) throughout. Participants completed interviews at baseline and postintervention. We conducted a group-based content analysis of interview transcripts, focusing on digital access, setup, usage, and perceptions of technology. Questionnaire data describing digital literacy and access to technology provided additional context to the interview data. Results: Eleven participants completed at least one interview. We analyzed 19 interview transcripts from 11 participants (women: n=6, 55%; men: n=5, 45%; median age 52, IQR 45-60 y). Experiences with technology uptake and usage among adults aging with HIV were characterized by four components: (1) preparations for technology (technology setup), (2) interactions with technology (preferences for different types of technology, preferences for mode of delivery, and ease of usage), (3) facilitators and satisfaction with technology (facilitators to technology uptake and usage and satisfaction with technology), and (4) challenges and frustrations with technology (barriers to technology uptake and usage and frustrations with technology). Experiences with technology across participants were influenced by intrinsic contextual factors (prior exposure to technology) and extrinsic contextual factors (COVID-19 pandemic and technological and social support). Conclusions: Experiences with technology among adults aging with HIV engaging in an online CBE intervention varied from increasing ease of use to increasingly burdensome over time. Results highlight the need to incorporate personal preferences and ongoing technological support when implementing online CBE with adults aging with HIV.

2026-07-02T15:30:18-04:00 https://rehab.jmir.org/2026/1/e81344 2026-07-02T10:30:16-04:00 María del Pilar Beristain-Colorado Patricia Batres-Mendoza Erick Israel Guerra-Hernández José Luis Cano-Pérez Christian Perezcampos-Mayoral Marciano Vargas-Treviño Jaime Gutiérrez-Gutiérrez Jorge Fernando Ambros-Antemate

Background: Serious games have become an alternative support for traditional physical therapy. However, many of these games do not address the emotional needs of patients. People with disabilities often experience emotions such as sadness, frustration, and even anger, which can create a barrier to their rehabilitation treatment. Objective: This review presents a comprehensive overview of technologies, techniques, and methods in affective computing as applied to serious games for physical rehabilitation and identifies key gaps to guide future research in this field. Methods: A scoping review was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, using the databases PubMed, ScienceDirect, IEEE Xplore, ACM Digital Library, PEDro, Springer, and Google Scholar. Results: The initial search yielded 5293 records, of which 9 papers met the inclusion criteria. Data were systematically extracted from these papers based on predefined research questions. Notably, engagement, tiredness, and pain were the most identified emotions, reported in 4 of 9 (50%) studies. Only 3 studies applied theoretical frameworks for emotion classification. Facial expression analysis and gesture recognition were the most frequently used affective computing techniques, yet only 2 studies implemented adaptive gameplay based on affective feedback. Conclusions: The integration of affective computing into serious games represents a promising approach for detecting affective states in patients undergoing rehabilitation. However, the limited number of primary studies, methodological limitations, and potential selection and reference-standard biases limit the reliability and generalizability of the current findings. Future research should prioritize rigorous multicenter designs, standardized evaluation protocols, and multidisciplinary collaboration. Developing these areas is essential to establishing clinical effectiveness.

2026-07-02T10:30:16-04:00 https://rehab.jmir.org/2026/1/e87471 2026-06-26T16:15:13-04:00 Nipuna Cooray Stacie Powell Mingqian Yu Michael Tim Yun Ong Julie Brown

Background: Exercise therapy is fundamental to rehabilitation for knee osteoarthritis and anterior cruciate ligament (ACL) reconstruction, yet adherence to prescribed exercise typically declines once clinical supervision ends. Digital rehabilitation platforms offer a promising means of supporting sustained exercise adherence, but qualitative evidence on how patients experience these platforms in real-world clinical practice remains limited, particularly in non-Western health care contexts. Objective: This study aimed to explore how patients with different knee conditions experienced the Healthy Knees digital rehabilitation platform in Hong Kong and to identify the factors shaping their platform engagement and exercise adherence. Methods: A qualitative design was adopted using reflexive thematic analysis. Fifteen adults (9 with ACL, 6 with osteoarthritis) who had been prescribed the Healthy Knees web-based platform at Prince of Wales Hospital participated in semistructured, in-person interviews (30‐45 min). Interviews were conducted in Cantonese or Mandarin, transcribed verbatim, translated into English, and analyzed inductively. Ethics approval was obtained from the Chinese University of Hong Kong and the University of New South Wales. Results: Participants were aged 21 to 79 years, with most being male (11/15). Younger participants were predominantly patients with postoperative ACL, while older participants were predominantly patients with preoperative osteoarthritis. Three interrelated themes were identified, collectively describing the fit between the platform and participants’ contexts. Content fit captured the alignment between exercise content and rehabilitation needs; participants across both groups perceived substantial overlap with existing physiotherapy, and content was often mismatched to their recovery stage. Motivational fit captured the alignment between platform support features and motivational needs; pain functioned as both a driver and a deterrent to exercise, and participants ranged from highly self-directed to reliant on external scaffolding, not following a simple age pattern. Access fit captured the alignment between the platform’s delivery mechanism and participants’ technological circumstances; QR code–dependent access, absence of a dedicated mobile app, and display issues created friction that led several participants to migrate to alternative resources, maintaining exercise adherence while abandoning platform engagement. Conclusions: Adherence to digital knee rehabilitation was shaped by the degree of fit between the platform and users’ contexts across content, motivational, and access dimensions. When access fit failed, participants often substituted alternative exercise resources rather than ceasing exercise entirely, highlighting a distinction between platform engagement and exercise adherence. As the sample’s clinical and demographic characteristics were closely linked, these findings should not be interpreted as diagnostic comparisons between ACL and osteoarthritis populations but as patterns shaped by the recovery phase and age. These findings suggest that digital rehabilitation platforms should incorporate adaptive content aligned with the recovery stage, integrated feedback mechanisms, and reduced access friction to sustain platform engagement within an ecosystem of competing alternatives.

2026-06-26T16:15:13-04:00 https://rehab.jmir.org/2026/1/e91396 2026-06-26T15:00:22-04:00 Trevor Binedell Pei Zhi Chia Ying Yi Tan Hong Yee Low

Background: Despite considerable advancements in prosthetic technology, a substantial proportion of lower limb amputees reduce or discontinue prosthesis use, with reported nonuse rates ranging from 12% to 53%. This reflects the multifactorial challenges associated with long-term prosthetic use, among which comfort and skin health are consistently identified as key determinants. More specifically, studies point toward nonbreathable silicone liners trapping heat and sweat, leading to skin and hygiene problems. These persistent limitations underscore the need for alternative interface materials that offer improved breathability, moisture management, and tunable mechanical properties. Objective: This study aimed to introduce Flexoknit, a transtibial prosthetic liner that integrates user-specific digital skin strain analysis with computer numerical control multimaterial knitting to create a mechanically tuned, breathable, and anatomically customized interface. Using digital biomechanical data as the primary design driver—rather than clinician heuristics alone—Flexoknit aims to determine the feasibility and performance of a skin strain–guided, computer numerical control–knitted prosthetic interface in terms of material function, clinical performance, and user experience. Methods: Flexoknit uses programmable multimaterial knitting, incorporating thermal-reactive yarns that stiffen when heated to create structural support zones, alongside spandex yarns that provide elastic compression and breathable zones. Uniaxial tensile tests showed that yarn and stitch combinations can generate distinct stiffness grades, with nearly order-of-magnitude differences. The spatial layout of these graded zones aligns high-stiffness regions with the lines of nonextension, and low-stiffness regions with areas of greater skin strain. With the new prosthetic interface, a series of controlled tests was conducted to compare performance against the participant’s existing prosthesis with a conventional silicone liner. User testing was organized into 3 domains (ie, mobility, suspension, and comfort) using standardized quantitative assessments and structured qualitative data collection. Results: User testing demonstrated a 22.5% improvement in total range of motion, a 37.5% reduction in interface mass, and improved thermal regulation in hot, humid environments compared to that of a conventional silicone liner. The user walked unaided and performed sit-to-stand movements, reporting positive comfort and usability feedback. Conclusions: This work establishes Flexoknit as a promising direction for future prosthetic development—one that integrates principles of biomechanics, textile engineering, and digital fabrication to create user-centered interface solutions. The findings suggest that digitally engineered knitted interfaces can provide a highly customizable, breathable, and compliant alternative to conventional silicone liners, particularly for lower-activity amputees or individuals prioritizing comfort and ease of use.

2026-06-26T15:00:22-04:00 https://rehab.jmir.org/2026/1/e81522 2026-06-26T14:45:13-04:00 Jia Min Yen Nur Shafawati Kamsani Hwa Sen Lai Ning Tang Effie Chew

Background: Various forms of electrical stimulation have been integrated into the multimodal management of spasticity. However, high-frequency electrical stimulation can potentially induce muscle fatigue. The Exopulse Mollii Suit (EMS) is a multichannel full-body garment that delivers low-frequency (20 Hz), low-amplitude (20 V), subthreshold sensory stimulation aimed at reducing spasticity. Objective: Primarily, we examined the effects of a single session of the EMS on spasticity in 7 participants with chronic stroke or cervical spinal cord injury (SCI), specifically those with upper or lower limb spasticity impacting function and gait who were able to walk with minimal or no assistance (Functional Ambulatory Category scores of 2‐5). We assessed the impact on gait and ambulatory function, as well as user perceptions of usability and acceptability. Methods: Participants wore the EMS for 60 minutes, consisting of 30 minutes of standardized goal-directed activities performed in two 15-minute blocks, interspersed with 15-minute rest breaks. Measurements included the Modified Tardieu Scale with surface electromyography for spasticity and functional mobility tests (Functional Ambulatory Category, 10-meter walk test, 5 times sit-to-stand test, and step test). Spatiotemporal gait parameters were quantified using a markerless vision-based motion capture system using the OpenPose BODY25 pose estimation model. Results: On the basis of the Modified Tardieu Scale and surface electromyography signals, improvements in spasticity were only observed in 2 participants. However, 4 participants demonstrated faster walking speeds. Improvements in the 5 times sit-to-stand test and step test were noted in 3 and 4 participants, respectively. Spatiotemporal gait parameters revealed improvements in gait symmetry in 6 participants. Qualitative feedback based on the Assistive Technology Usability Questionnaire for People With Neurological Diseases (NATU Quest) returned positive results in 3 participants. Overall outcomes, defined as meeting the individualized goals of each participant, were positive in 4 participants. Conclusions: This case series provides preliminary evidence that a single session with the EMS may offer benefits for functional mobility and gait quality for individuals with spasticity resulting from stroke or SCI. To our knowledge, this is the first report examining the effects of the EMS in participants with SCI and the first to include spatiotemporal gait parameters associated with its use. However, the small sample size, variable outcomes, and lack of a control group necessitate caution in interpreting these findings and preclude definitive conclusions regarding the efficacy of the EMS. Larger, controlled trials with repeated sessions of EMS use are required to establish the effectiveness and optimal application of the EMS for spasticity management.

2026-06-26T14:45:13-04:00 https://rehab.jmir.org/2026/1/e87339 2026-06-24T17:00:24-04:00 Johannes Pohl Laura Mayrhuber Olivier Lambercy Chris Easthope Awai

Background: Digital assessment technologies, such as optical motion capture and inertial measurement units, enable detailed kinematic analysis and continuous monitoring of upper limb activity in persons with neurological conditions. While such are increasingly recognized in research, their uptake in clinical neurorehabilitation is limited. It remains unclear which clinicians perceive as most meaningful and how these are integrated into patient-centered care. Understanding clinicians’ information needs and reasoning processes is a prerequisite for implementing digital assessment technology. Objective: This study aims to characterize how rehabilitation professionals perceive, prioritize, and integrate into clinical reasoning and to identify features that would support their routine use. Methods: Three 90-minute focus groups were conducted in 3 Swiss neurorehabilitation centers, involving 11 clinicians with diverse professional backgrounds (5 physiotherapists, 4 occupational therapists, 1 movement scientist, and 1 medical practitioner). Participants discussed essential parameter domains and individually rated the relevance and meaningfulness of 17 kinematic metrics for the well-studied drinking task and 10 established arm use performance metrics. Verbatim transcripts were analyzed using reflexive thematic analysis, and rating data were summarized descriptively. Results: Five main themes were identified. (1) (active/passive range of motion, strength, selective muscle control, and grasp) form the basis for interpreting movement. (2) (smoothness, efficiency, and compensatory movement) are valued when aligned with observable task execution. (3) (hourly activity profiles, arm-use symmetry, and functional workspace) represents the reference for patient-centered reasoning. (4) , including diagnosis-specific preferences, shapes assessment selection. (5) reflects clinicians’ reliance on visual judgment complemented by normative values. Intuitive metrics such as task duration, number of movement units, and range of motion were favored, whereas confidence was lower in more complex metrics (eg, jerk and interjoint coordination). Conclusions: Clinicians value intuitive when they are clearly linked to patient-centered outcomes and supported by normative references. The findings highlight the need for targeted educational strategies and digital competency training that help clinicians interpret digital metrics and integrate them with contextual information and clinical reasoning.

2026-06-24T17:00:24-04:00 https://rehab.jmir.org/2026/1/e81667 2026-06-23T16:00:03-04:00 Keiichi Takei

<strong>Background:</strong> Exergames integrate motor, cognitive, and postural-control demands; however, how specific task-demand manipulations influence gaze allocation during exergame performance remains insufficiently characterized. <strong>Objective:</strong> This exploratory pilot study used a within-participant design to examine whether gaze allocation and task performance differed across baseline, concurrent cognitive-task, and unilateral-squat conditions during squat-based exergaming in healthy young adults. <strong>Methods:</strong> Eight healthy adults (mean age 20, SD 1 years; 7 men and 1 woman) used a squat-based exergame (<i>Ring Fit Adventure</i>; Nintendo) under 3 randomized conditions: baseline, concurrent cognitive task, and unilateral squats. In the concurrent cognitive task condition, participants performed serial subtraction during squatting. In the unilateral-squat condition, participants performed single-leg squats, which were intended to increase support-leg muscular demand as well as postural and motor-control requirements. Execution time, squat score, arithmetic performance, and eye-tracking metrics were recorded. Primary gaze outcomes were the proportion of fixation time and fixation counts allocated to predefined areas of interest (AOIs; command, avatar, and score) and to regions outside these areas across the entire trial. Differences from the baseline condition were examined using Dunnett tests or paired Wilcoxon signed-rank tests with Holm adjustment, and effect sizes were reported. <strong>Results:</strong> Exergame execution time increased from 31.0 (SD 3.3) seconds in the baseline condition to 38.2 (SD 6.1) seconds in the concurrent cognitive task condition and to 34.3 (SD 6.0) seconds in the unilateral-squat condition. In contrast, the squat score decreased from 98.8 (SD 2.8) in the baseline condition to 69.6 (SD 18.3) in the unilateral-squat condition. For fixation counts, allocation to the command AOI decreased from 44.8% (SD 11.4%) in the baseline condition to 32.1% (SD 8.9%) in the concurrent cognitive task condition and 36.2% (SD 8.5%) in the unilateral-squat condition. Outside AOI fixation counts increased in the concurrent cognitive task condition (55.7%, SD 8.6%) relative to the baseline condition (36%, SD 16.9%). <strong>Conclusions:</strong> In this exploratory within-participant pilot study, adding a concurrent cognitive task and performing unilateral squats resulted in different patterns of performance change and fixation count redistribution during squat-based exergaming. These preliminary findings suggest that AOI-based gaze allocation metrics may help characterize task demand–related attentional shifts in this setting. Larger confirmatory studies with more diverse samples and individual-level validation are needed before these metrics can be considered for adaptive or clinical applications.

2026-06-23T16:00:03-04:00 https://rehab.jmir.org/2026/1/e85072 2026-06-17T16:00:25-04:00 Nadine Domnik Katarzyna Krasnopolska Ramona Sylvester Jens Bansi Jaeyong Song Roman Gonzenbach Olivier Lambercy

Background: An increasing amount of digital health data are being collected across rehabilitation settings, but their integration into routine clinical practice remains limited, despite its potential to motivate patients or inform clinical decision-making. Specifically, effective visualization and communication of assessment outcomes to both patients and health care practitioners (HCPs) represent a key gap in the neurorehabilitation practice. Objective: This study describes the development and evaluation of RehaLink (author ND, ETH Zürich), a proof-of-concept mobile app that delivers structured, interpretable feedback from conventional and technology-based assessments to neurorehabilitation patients and HCPs. Methods: The app was developed through a 3-step iterative co-design process involving 17 inpatients with multiple sclerosis and 15 HCPs from a single rehabilitation center. The app integrates a full battery of conventional assessments routinely conducted at the clinic, as well as digital health metrics from the Virtual Peg Insertion Test, a validated technology-based assessment of upper limb function, as a proof of concept for integrating technology-based assessment data into clinical workflows. Three structured feedback sessions were conducted, in which participants evaluated feedback types, visualization formats, and app usability using Likert-scale ratings, preference rankings, open-ended questions, and the System Usability Scale. Data were analyzed using descriptive statistics and directed content analysis. Results: Across all 3 sessions, progress bars and color-coded indicators were consistently preferred over text-heavy or abstract formats by both patients and HCPs. A persistent set of competing demands was observed, with participants requesting both visual simplicity and access to absolute values and normative comparisons. HCPs tended to underestimate patients’ preference for informative visualizations. The perceived value of structured feedback increased over the course of the study; patients’ median ratings rose from 4.0 to 5.0 and HCPs’ from 4.0 to 4.5 on a 5-point Likert scale. The resulting mobile app prototype demonstrated high usability, with patients achieving a mean System Usability Scale score of 93.6 (mean 6.4; best imaginable) and HCPs 80.9 (SD 8.1; good), according to established benchmarks. Conclusions: These findings demonstrate the feasibility and value of a co-designed digital feedback tool for neurorehabilitation. By combining conventional and technology-based assessment outcomes in an accessible, user-centered format, the app has the potential to enhance patient engagement, support clinical decision-making, and advance the implementation of value-based, personalized care.

2026-06-17T16:00:25-04:00 https://rehab.jmir.org/2026/1/e85066 2026-06-16T17:00:21-04:00 Amarria Dila Sari Abdullah Al Mahmud Johanna Renny Octavia Shivani Tyagi

Background: Children with hearing impairments (HIs) have traditionally faced difficulties with language acquisition due to various factors, such as difficulties in accessing early intervention and therapy, among others. There is an opportunity for digital technology to address this problem; however, how different technologies can facilitate language acquisition, as well as the level of evidence, is not well understood. Objective: This study aimed to explore the types, roles, and outcomes of different digital technologies in supporting language development in children with HIs. Methods: Following Arksey and O’Malley’s framework for conducting a scoping review and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews), we systematically searched 6 online databases from 2014 to September 2024 for relevant studies on the role of digital technologies in supporting language learning among children with HIs (aged <18 years). Results: A total of 45 studies met the inclusion criteria. Mobile apps were the most frequently reported technologies, followed by digital books, extended reality, computer-based programs, and tangible or robotic tools. The most commonly used signed-language apps focus on vocabulary development and visual communication. Spoken language tools were less common but included augmentative and alternative communication (AAC) systems and auditory training apps. The efficacy outcomes of 12 studies included in this review showed that AAC-based apps had stronger effects on expressive language, pragmatic communication skills, and vocabulary development. These outcomes occurred when AAC-based apps were used in structured contexts with a therapist or parent. In contrast, signed language apps often reported narrower, word-level outcomes. Notably, relatively few interventions targeted early spoken language development, despite early childhood being a critical period for language acquisition. In addition, limited attention was given to visual design considerations related to user comfort, cultural relevance, and contextual adaptation. Conclusions: The evidence base reveals 3 structural patterns: the dominance of accessibility-driven mobile technologies; an imbalance between signed and spoken-language interventions, characterized by a greater number of signed-language tools but stronger and more consistent evidence for spoken-language outcomes, particularly in AAC-based interventions; and limited integration of digital technologies across home, school, and clinical contexts. Future research should prioritize the co-design and evaluation of culturally responsive, integrated, developmentally appropriate digital systems that support early spoken-language development and sustained, family-mediated language learning across contexts.

2026-06-16T17:00:21-04:00 https://rehab.jmir.org/2026/1/e83081 2026-06-15T15:15:11-04:00 Marina B Wasilewski Shaghayegh Mirbaha Karl Wong Gary Siu Siobhan Donaghy Justin Huynh Sarmiya Uruthiralingam Michelle L A Nelson Elizabeth Linkewich Ron Lacombe Matthew Godleski

Background: Although patient outcomes are improved by stroke rehabilitation, the suggested amount of therapy is rarely maintained. The COVID-19 pandemic aggravated this situation further due to disruptions in health care. One solution was the rapid and extensive transition to virtual care. A hybrid outpatient stroke telerehabilitation program (HOSTP) was introduced by St John’s Rehab—a tertiary rehabilitation hospital in Toronto, Ontario. The HOSTP integrated in-person and virtual care in an effort to alleviate long-standing obstacles that challenge stroke rehabilitation. Objective: This study explored health care providers’ (HCPs) experiences with the HOSTP and their perspectives on its implementation, quality, and impact to determine the modifications needed to optimize its delivery and sustainability. Methods: A qualitative implementation study was conducted, with semistructured interviews conducted among HCPs involved in the HOSTP. The interview guide was informed by the CFIR (Consolidated Framework for Implementation Research). In total, 14 HCPs were recruited and interviewed from St John’s Rehab outpatient program. Interview transcripts were analyzed using a 2-stage analytic approach involving inductive thematic analysis, followed by deductive categorization using CFIR. Results: Four main themes were identified across CFIR domains: (1) adaptability and flexibility of the hybrid care model (intervention characteristics), (2) alignment with patient needs and resources (outer setting), (3) the impact of organizational resources and infrastructure (inner setting), and (4) variability in provider confidence and perceptions of virtual care (characteristics of individuals). Key determinants were identified as adaptability, patient-related factors, resource availability, and provider beliefs about virtual care. Conclusions: Our findings suggest that, from HCPs’ viewpoints, optimizing virtual care processes and resources may support access and care quality within hybrid outpatient stroke rehabilitation. HCPs viewed maintaining virtual care as important for supporting ongoing access and patient-centered care. Lastly, optimizing the benefits and mitigating the drawbacks of hybrid care can ensure future integration of virtual care into standard outpatient stroke rehabilitation.

2026-06-15T15:15:11-04:00