JMIR neurotechnology最新文献

{"title":"Clinical Perspectives on Using Remote Measurement Technology in Assessing Epilepsy, Multiple Sclerosis, and Depression: Delphi Study.","authors":"Jacob A Andrews, Michael P Craven, Boliang Guo, Janice Weyer, Simon Lees, Spyridon I Zormpas, Sarah E Thorpe, Julie Devonshire, Victoria San Antonio-Arce, William P Whitehouse, Jessica Julie, Sam Malins, Alexander Hammers, Andreas Reif, Henricus G Ruhe, Federico Durbano, Stefano Barlati, Arjune Sen, Jette L Frederiksen, Alessandra Martinelli, Antonio Callen, Joan Torras-Borrell, Nuria Berrocal-Izquierdo, Ana Zabalza, Richard Morriss, Chris Hollis","doi":"10.2196/41439","DOIUrl":"10.2196/41439","url":null,"abstract":"<p><strong>Background: </strong>Multiple sclerosis (MS), epilepsy, and depression are chronic central nervous system conditions in which remote measurement technology (RMT) may offer benefits compared with usual assessment. We previously worked with clinicians, patients, and researchers to develop 13 use cases for RMT: 5 in epilepsy (seizure alert, seizure counting, risk scoring, triage support, and trend analysis), 3 in MS (detecting silent progression, detecting depression in MS, and donating data to a biobank), and 5 in depression (detecting trends, reviewing treatment, self-management, comorbid monitoring, and carer alert).</p><p><strong>Objective: </strong>In this study, we aimed to evaluate the use cases and related implementation issues with an expert panel of clinicians external to our project consortium.</p><p><strong>Methods: </strong>We used a Delphi exercise to validate the use cases and suggest a prioritization among them and to ascertain the importance of a variety of implementation issues related to RMT. The expert panel included clinicians from across Europe who were external to the project consortium. The study had 2 survey rounds (n=23 and n=17) and a follow-up interview round (n=9). Data were analyzed for consensus between participants and for stability between survey rounds. The interviews explored the reasons for answers given in the survey.</p><p><strong>Results: </strong>The findings showed high stability between rounds on questions related to specific use cases but lower stability on questions relating to wider issues around the implementation of RMT. Overall, questions on wider issues also had less consensus. All 5 use cases for epilepsy (seizure alert, seizure counting, risk scoring, triage support, and trend analysis) were considered beneficial, with consensus among participants above the a priori threshold for most questions, although use case 3 (risk scoring) was considered less likely to facilitate or catalyze care. There was very little consensus on the benefits of the use cases in MS, although this may have resulted from a higher dropout rate of MS clinicians (50%). Participants agreed that there would be benefits for all 5 of the depression use cases, although fewer questions on use case 4 (triage support) reached consensus agreement than for depression use cases 1 (detecting trends), 2 (reviewing treatment), 3 (self-management), and 5 (carer alert). The qualitative analysis revealed further insights into each use case and generated 8 themes on practical issues related to implementation.</p><p><strong>Conclusions: </strong>Overall, these findings inform the prioritization of use cases for RMT that could be developed in future work, which may include clinical trials, cost-effectiveness studies, and the commercial development of RMT products and services. Priorities for further development include the use of RMT to provide more accurate records of symptoms and treatment response than is currently possible and to pro","PeriodicalId":73555,"journal":{"name":"JMIR neurotechnology","volume":"1 1","pages":"e41439"},"PeriodicalIF":0.0,"publicationDate":"2023-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12671310/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84903234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Remote Testing Apps for Multiple Sclerosis Patients: Scoping Review of Published Articles and Systematic Search and Review of Public Smartphone Apps.","authors":"Jacob B Michaud, Cameron Penny, Olivia Cull, Eric Hervet, Ludivine Chamard-Witkowski","doi":"10.2196/37944","DOIUrl":"10.2196/37944","url":null,"abstract":"<p><strong>Background: </strong>Many apps have been designed to remotely assess clinical status and monitor symptom evolution in persons with multiple sclerosis (MS). These may one day serve as an adjunct for in-person assessment of persons with MS, providing valuable insight into the disease course that is not well captured by cross-sectional snapshots obtained from clinic visits.</p><p><strong>Objective: </strong>This study sought to review the current literature surrounding apps used for remote monitoring of persons with MS.</p><p><strong>Methods: </strong>A scoping review of published articles was conducted to identify and evaluate the literature published regarding the use of apps for monitoring of persons with MS. PubMed/Medline, EMBASE, CINAHL, and Cochrane databases were searched from inception to January 2022. Cohort studies, feasibility studies, and randomized controlled trials were included in this review. All pediatric studies, single case studies, poster presentations, opinion pieces, and commentaries were excluded. Studies were assessed for risk of bias using the Scottish Intercollegiate Guidelines Network, when applicable. Key findings were grouped in categories (convergence to neurological exam, feasibility of implementation, impact of weather, and practice effect), and trends are presented. In a parallel systematic search, the Canadian Apple App Store and Google Play Store were searched to identify relevant apps that are available but have yet to be formally studied and published in peer-reviewed publications.</p><p><strong>Results: </strong>We included 18 articles and 18 apps. Although many MS-related apps exist, only 10 apps had published literature supporting their use. Convergence between app-based testing and the neurological exam was examined in 12 articles. Most app-based tests focused on physical disability and cognition, although other domains such as ambulation, balance, visual acuity, and fatigue were also evaluated. Overall, correlations between the app versions of standardized tests and their traditional counterparts were moderate to strong. Some novel app-based tests had a stronger correlation with clinician-derived outcomes than traditional testing. App-based testing correlated well with the Multiple Sclerosis Functional Composite but less so with the Expanded Disability Status Scale; the latter correlated to a greater extent with patient quality of life questionnaire scores.</p><p><strong>Conclusions: </strong>Although limited by a small number of included studies and study heterogeneity, the findings of this study suggest that app-based testing demonstrates adequate convergence to traditional in-person assessment and may be used as an adjunct to and perhaps in lieu of specific neurological exam metrics documented at clinic visits, particularly if the latter is not readily accessible for persons with MS.</p>","PeriodicalId":73555,"journal":{"name":"JMIR neurotechnology","volume":"284 1","pages":"e37944"},"PeriodicalIF":0.0,"publicationDate":"2023-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12671287/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76843481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Digital Telehealth System to Compute the Myasthenia Gravis Core Examination Metrics.","authors":"Marc Garbey, Guillaume Joerger, Quentin Lesport, Helen Girma, Sienna McNett, Mohammad Abu-Rub, Henry Kaminski","doi":"10.2196/43387","DOIUrl":"10.2196/43387","url":null,"abstract":"<p><strong>Background: </strong>Telemedicine practice for neurological diseases has grown significantly during the COVID-19 pandemic.Telemedicine offers an opportunity to assess digitalization of examinations and enhances access to modern computer vision and artificial intelligence processing to annotate and quantify examinations in a consistent and reproducible manner. The Myasthenia Gravis Core Examination (MG-CE) has been recommended for the telemedicine evaluation of patients with myasthenia gravis.</p><p><strong>Objective: </strong>We aimed to assess the ability to take accurate and robust measurements during the examination, which would allow improvement in workflow efficiency by making the data acquisition and analytics fully automatic and thereby limit the potential for observation bias.</p><p><strong>Methods: </strong>We used Zoom (Zoom Video Communications) videos of patients with myasthenia gravis undergoing the MG-CE. The core examination tests required 2 broad categories of processing. First, computer vision algorithms were used to analyze videos with a focus on eye or body motions. Second, for the assessment of examinations involving vocalization, a different category of signal processing methods was required. In this way, we provide an algorithm toolbox to assist clinicians with the MG-CE. We used a data set of 6 patients recorded during 2 sessions.</p><p><strong>Results: </strong>Digitalization and control of quality of the core examination are advantageous and let the medical examiner concentrate on the patient instead of managing the logistics of the test. This approach showed the possibility of standardized data acquisition during telehealth sessions and provided real-time feedback on the quality of the metrics the medical doctor is assessing. Overall, our new telehealth platform showed submillimeter accuracy for ptosis and eye motion. In addition, the method showed good results in monitoring muscle weakness, demonstrating that continuous analysis is likely superior to pre-exercise and post-exercise subjective assessment.</p><p><strong>Conclusions: </strong>We demonstrated the ability to objectively quantitate the MG-CE. Our results indicate that the MG-CE should be revisited to consider some of the new metrics that our algorithm identified. We provide a proof of concept involving the MG-CE, but the method and tools developed can be applied to many neurological disorders and have great potential to improve clinical care.</p>","PeriodicalId":73555,"journal":{"name":"JMIR neurotechnology","volume":"2 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10334459/pdf/nihms-1900815.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9815795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Remote Consultations for People With Parkinson Disease and Cognitive Impairment: Interview Study With Patients, Caregivers, and Health Care Professionals.","authors":"Jennifer Sarah Pigott, Megan Armstrong, Elizabeth Chesterman, Joy Read, Danielle Nimmons, Kate Walters, Nathan Davies, Anette Schrag","doi":"10.2196/39974","DOIUrl":"10.2196/39974","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic led to many consultations being conducted remotely. Cognitive impairment is recognized as a potential barrier to remote health care interactions and is common and heterogeneous in Parkinson disease. Studies have shown remote consultations in Parkinson disease to be feasible, but little is known about real-life experience, especially for those with cognitive impairment. We explored the experiences and perceptions of remote consultations for people with Parkinson disease and cognitive impairment.</p><p><strong>Objective: </strong>This study aimed to explore the experiences of remote consultations for people with Parkinson disease and cognitive impairment from the perspective of service users and professionals and investigate considerations for future service delivery.</p><p><strong>Methods: </strong>Semistructured interviews were conducted remotely with 11 people with Parkinson disease and cognitive impairment, 10 family caregivers, and 24 health care professionals (HCPs) between 2020 and 2021. Purposive sampling was used. Interviews were audio-recorded, transcribed, and analyzed using reflexive thematic analysis.</p><p><strong>Results: </strong>Overall, four themes were identified: \"the nature of remote interactions,\" \"challenges exacerbated by being remote,\" \"expectation versus reality,\" and \"optimizing for the future.\" Remote consultations were considered as \"transactional\" and less personal, with difficulties in building rapport, and considered to play a different role from that of in-person consultations. The loss of nonverbal communication and ability of HCPs to sense led to remote consultations being perceived as riskier by all groups. Issues arising from communication and cognitive impairment, balancing the voices of the person with Parkinson disease and the caregiver, and discussions of the future affect this population specifically. Remote consultations were reported to have been more successful than anticipated in all 3 groups. Obstacles were not always as expected; for example, age was less of a barrier than predicted. Video consultations were perceived as being preferable to telephone consultations by many participants, but not accessible to all people with Parkinson disease. With widespread expectation of ongoing remote consultations, potential improvements for these 3 groups and health care services were identified, including practice, preparation, increased awareness of issues, expectation management by HCPs, and more time and flexibility for consultations.</p><p><strong>Conclusions: </strong>Advantages and challenges of remote consultations for this population are identified. Consultations could be improved with increased support, practice, preparation, awareness of issues, and more time and flexibility within services.</p>","PeriodicalId":73555,"journal":{"name":"JMIR neurotechnology","volume":"53 1","pages":"e39974"},"PeriodicalIF":0.0,"publicationDate":"2022-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12671285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91127508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Design Innovation for Engaging and Accessible Digital Aphasia Therapies: Framework Analysis of the iReadMore App Co-Design Process.","authors":"Tom Langford, Victoria Fleming, Emily Upton, Catherine Doogan, Alexander Leff, Daniela M Romano","doi":"10.2196/39855","DOIUrl":"10.2196/39855","url":null,"abstract":"<p><strong>Background: </strong>iReadMore is a digital therapy for people with acquired reading impairments (known as alexia) caused by brain injury or neurodegeneration. A phase II clinical trial demonstrated the efficacy of the digital therapy research prototype for improving reading speed and accuracy in people with poststroke aphasia (acquired language impairment) and alexia. However, it also highlighted the complexities and barriers to delivering self-managed therapies at home. Therefore, in order to translate the positive study results into real-world benefits, iReadMore required subsequent design innovation. Here, we present qualitative findings from the co-design process as well as the methodology.</p><p><strong>Objective: </strong>We aimed to present a methodology for inclusive co-design in the redesign of a digital therapy prototype, focusing on elements of accessibility and user engagement. We used framework analysis to explore the themes of the communications and interactions from the co-design process.</p><p><strong>Methods: </strong>This study included 2 stages. In the first stage, 5 in-person co-design sessions were held with participants living with poststroke aphasia (n=22) and their carers (n=3), and in the second stage, remote one-to-one beta-testing sessions were held with participants with aphasia (n=20) and their carers (n=5) to test and refine the final design. Data collection included video recordings of the co-design sessions in addition to participants' written notes and drawings. Framework analysis was used to identify themes within the data relevant to the design of digital aphasia therapies in general.</p><p><strong>Results: </strong>From a qualitative framework analysis of the data generated in the co-design process, 7 key areas of consideration for digital aphasia therapies have been proposed and discussed in context. The themes generated were agency, intuitive design, motivation, personal trajectory, recognizable and relatable content, social and sharing, and widening participation. This study enabled the deployment of the iReadMore app in an accessible and engaging format.</p><p><strong>Conclusions: </strong>Co-design is a valuable strategy for innovating beyond traditional therapy designs to utilize what is achievable with technology-based therapies in user-centered design. The co-designed iReadMore app has been publicly released for use in the rehabilitation of acquired reading impairments. This paper details the co-design process for the iReadMore therapy app and provides a methodology for how inclusive co-design can be conducted with people with aphasia. The findings of the framework analysis offer insights into design considerations for digital therapies that are important to people living with aphasia.</p>","PeriodicalId":73555,"journal":{"name":"JMIR neurotechnology","volume":"27 1","pages":"e39855"},"PeriodicalIF":0.0,"publicationDate":"2022-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12671282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91066817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"JMIR Neurotechnology: Connecting Clinical Neuroscience and (Information) Technology.","authors":"Pieter Kubben","doi":"10.2196/41122","DOIUrl":"10.2196/41122","url":null,"abstract":"","PeriodicalId":73555,"journal":{"name":"JMIR neurotechnology","volume":"680 1","pages":"e41122"},"PeriodicalIF":0.0,"publicationDate":"2022-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12671280/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78682903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interrater Agreement on National Institutes of Health Stroke Scale Between Paramedics and Stroke Physicians: Validation Study for the Digital Training Model in the Paramedic Norwegian Acute Stroke Prehospital Project.","authors":"Mona Guterud, Helge Fagerheim Bugge, Jo Røislien, Karianne Larsen, Erik Eriksen, Svein Håkon Ingebretsen, Martin Lerstang Mikkelsen, Jo Kramer-Johansen, Kristi G Bache, Else Charlotte Sandset, Maren Ranhoff Hov","doi":"10.2196/39444","DOIUrl":"10.2196/39444","url":null,"abstract":"<p><strong>Background: </strong>Time spent in the prehospital phase of acute stroke care is multifactorial and has an effect on the possibilities for acute treatment. Communication between paramedics and the in-hospital stroke team directly affects time to treatment. A mutual stroke scale such as the National Institutes of Health Stroke Scale (NIHSS) may improve communication quality. The Paramedic Norwegian Acute Stroke Prehospital Project (ParaNASPP) was a stepped-wedge, randomized trial of stroke screening using NIHSS in the ambulance where the intervention was training paramedics in stroke and the NIHSS, with the use of NIHSS made into a mobile app to guide the examination and facilitate communication with the in-hospital stroke team.</p><p><strong>Objective: </strong>The aim of this study was to validate the digital training model from the ParaNASPP clinical trial.</p><p><strong>Methods: </strong>In total, 24 paramedics were recruited from Oslo University Hospital in Norway to complete the ParaNASPP training model; 20 exclusive videos with predefined NIHSS scores were recorded; and 4 stroke physicians from Oslo University Hospital were included for reference. Bland-Altman plots with 95% limits of agreement (LoA) were calculated-first comparing paramedics and stroke physicians to the predefined scores and then with each other. The predefined LoA were set to 3 points. To align with clinical practice, NIHSS scores were also dichotomized into 2 categories: from 0-5 (minor stroke) or ≥6 (moderate and major stroke), and agreement was calculated using Cohen <i>κ</i>.</p><p><strong>Results: </strong>The videos (n=20) had a median (range) NIHSS score of 7 (0-31). The paramedics' scores were slightly higher than the predefined scores with a mean difference of -0.38 and the LoA ranging from -4.04 to 3.29. The paramedics scored higher than the stroke physicians with a mean difference of -0.39, with the LoA ranging from -4.58 to 3.80. When the NIHSS scores were dichotomized, Cohen <i>κ</i> was 0.89 between the predefined scores and paramedics, 0.92 between the predefined scores and stroke physicians, and 0.81 between the paramedics and stroke physicians, all indicating very good agreement.</p><p><strong>Conclusions: </strong>The paramedics scored higher than both the predefined scores and stroke physicians' scores, hence the predefined LoA were not met. However, the width of the LoA was smaller than seen when experienced neurologists are compared. When the NIHSS scores were dichotomized, the paramedics achieved very good agreement with both the predefined scores and stroke physicians' scores. This study demonstrates the possibilities for the transfer of clinical competence in digital simulation training.</p>","PeriodicalId":73555,"journal":{"name":"JMIR neurotechnology","volume":"99 27 1","pages":"e39444"},"PeriodicalIF":0.0,"publicationDate":"2022-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12671290/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83681410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Potential for Using Extended Reality Technology in Interdisciplinary Case Discussions and Case Planning in Stereotactic Radiosurgery: Proof-of-Concept Usability Study","authors":"S. Chidambaram, M. Palumbo, V. Stifano, John McKenna, A. Redaelli, A. Olivi, M. Apuzzo, S. Pannullo","doi":"10.2196/36960","DOIUrl":"https://doi.org/10.2196/36960","url":null,"abstract":"\u0000 \u0000 Extended reality (XR) is a term that captures a variety of techniques, such as augmented reality (AR) and mixed reality (MR), which allow users to interact with virtual models in real time. This technology has an emerging role in several applications within neurosurgery. XR can be useful in enhancing how radiosurgical cases are planned. Multidisciplinary team (MDT) review is an essential part of the radiosurgery case planning process; during case discussions, patient images are reviewed, usually in 2D or 3D modifications. The current commercially available platforms for this review need improvement.\u0000 \u0000 \u0000 \u0000 We describe a novel visualization application, titled “NeuroVis” by our development team, which uses an XR Microsoft HoloLens headset to provide an interactive 3D visualization of a patient’s neuroanatomy in stereotactic surgery (SRS) case planning discussions.\u0000 \u0000 \u0000 \u0000 We present examples of 6 common radiosurgery indications to demonstrate the utility of NeuroVis to solve common visualization hurdles in MDTs.\u0000 \u0000 \u0000 \u0000 The utility of NeuroVis is demonstrated through 6 common brain tumor SRS cases as a proof-of-concept illustration of the utility of NeuroVis to enhance radiosurgery case discussion by improving visualization of the standard neuroimaging used in radiosurgery treatment planning by MDTs.\u0000 \u0000 \u0000 \u0000 The NeuroVis application provides several interactive features that produce an enhanced ability to place participating members of an interdisciplinary treatment team on the same visualization plane. This technology, by facilitating team discussions and case review, has the potential to improve the efficiency, efficacy, and safety of radiosurgery treatment planning and, as a result, to optimize patient care.\u0000","PeriodicalId":73555,"journal":{"name":"JMIR neurotechnology","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88676772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}