@Article{info:doi/10.2196/67779,
author="Kanitkar, Anuprita
and Sepehri, Nariman
and Lezen, Ariel
and Parmar, Tejraj Sanjay
and Hin, Kit-Fong Cherry
and Szturm, Joseph Tony",
title="A Game-Based Mechatronic Device for Digital Rehabilitation of Hand Function After a Stroke: Design, Prototyping, and Feasibility Study",
journal="JMIR Neurotech",
year="2025",
month="Mar",
day="19",
volume="4",
pages="e67779",
keywords="stroke",
keywords="manual dexterity",
keywords="hand function",
keywords="poststroke",
keywords="fine motor",
keywords="thumb",
keywords="finger",
keywords="wrist",
keywords="movement",
keywords="motor rehabilitation",
keywords="assistive technology",
keywords="smart monitoring",
keywords="pilot",
keywords="feasibility",
keywords="prototyping",
keywords="prototype",
keywords="nervous system",
keywords="nerve",
keywords="motor neuron",
abstract="Background: This paper presents an easy-to-use, affordable robotic manipulandum device (RMD) equipped with smart monitoring and assistive technologies to engage in game-based exercise and repetitive task practice. The RMD has been designed to enhance a wide range of fine motor manual dexterity skills, including thumb, finger, and wrist movements. By focusing on finger and hand functions, it extends its utility beyond basic reaching or object transfer movements. Various interchangeable 3D-printed therapy handles of different shapes and sizes can be easily attached to the RMD drive shaft. These handle movements can be used to engage with numerous affordable, commercially available computer games, allowing patients to practice tasks that involve varying movement amplitudes, speeds, precision, and cognitive challenges. Additionally, the device is capable of automatically recording and storing the patient's real-time performance data on any given computer, integrating assessment into treatment. Objective: A pilot study was conducted with 5 patients with stroke to examine the feasibility and benefits of a 6-week game-based exercise program using the proposed device. Methods: A feasibility study was conducted with 5 participants. Data were collected using the computer game--based upper extremity assessment of manual dexterity and Wolf Motor Function Test (WMFT) before and after the intervention lasting 6 weeks. Results: The pilot study demonstrated that clients' expectations related to manual dexterity were met. The average improvement in the functional ability score of the WMFT was 14 (SD 3) points, with all participants exceeding the minimal clinically important difference. The average reduction in total time was 30 (SD 14) seconds, with 4 of 5 participants surpassing the minimal clinically important difference. For the computer game--based upper extremity assessment, the average improvement in success rate was 23\% (SD 12\%), and the average decrease in response time was 105 (SD 44) milliseconds. Conclusions: Findings revealed acceptable, engaging, game-based, and task-oriented training with a high level of compliance. Substantial improvements from pre- to postintervention were observed using the WMFT and assessments of manual dexterity. Trial Registration: ClinicalTrials.gov NCT05071885; https://clinicaltrials.gov/study/NCT05071885 ",
doi="10.2196/67779",
url="https://neuro.jmir.org/2025/1/e67779"
}


@Article{info:doi/10.2196/19792,
author="Ho, Michelle
and Goldfarb, Jared
and Moayer, Roxana
and Nwagu, Uche
and Ganti, Rohan
and Krein, Howard
and Heffelfinger, Ryan
and Hutchinson, Leigh Morgan",
title="Design and Printing of a Low-Cost 3D-Printed Nasal Osteotomy Training Model: Development and Feasibility Study",
journal="JMIR Med Educ",
year="2020",
month="Nov",
day="17",
volume="6",
number="2",
pages="e19792",
keywords="3D printing",
keywords="nasal osteotomy",
keywords="simulation",
keywords="education",
keywords="low-cost",
abstract="Background: Nasal osteotomy is a commonly performed procedure during rhinoplasty for both functional and cosmetic reasons. Teaching and learning this procedure proves difficult due to the reliance on nuanced tactile feedback. For surgical simulation, trainees are traditionally limited to cadaveric bones, which can be costly and difficult to obtain. Objective: This study aimed to design and print a low-cost midface model for nasal osteotomy simulation. Methods: A 3D reconstruction of the midface was modified using the free open-source design software Meshmixer (Autodesk Inc). The pyriform aperture was smoothed, and support rods were added to hold the fragments generated from the simulation in place. Several models with various infill densities were printed using a desktop 3D printer to determine which model best mimicked human facial bone. Results: A midface simulation set was designed using a desktop 3D printer, polylactic acid filament, and easily accessible tools. A nasal osteotomy procedure was successfully simulated using the model. Conclusions: 3D printing is a low-cost, accessible technology that can be used to create simulation models. With growing restrictions on trainee duty hours, the simulation set can be used by programs to augment surgical training. ",
doi="10.2196/19792",
url="http://mededu.jmir.org/2020/2/e19792/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33200998"
}


@Article{info:doi/10.2196/19582,
author="Langan, Jeanne
and Bhattacharjya, Sutanuka
and Subryan, Heamchand
and Xu, Wenyao
and Chen, Baicheng
and Li, Zhengxiong
and Cavuoto, Lora",
title="In-Home Rehabilitation Using a Smartphone App Coupled With 3D Printed Functional Objects: Single-Subject Design Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jul",
day="22",
volume="8",
number="7",
pages="e19582",
keywords="stroke",
keywords="rehabilitation",
keywords="smart technology",
keywords="3D printing",
keywords="usability",
abstract="Background: Stroke is a major cause of long-term disability. While there is potential for improvements long after stroke onset, there is little to support functional recovery across the lifespan. mHealth solutions can help fill this gap. mRehab was designed to guide individuals with stroke through a home program and provide performance feedback. Objective: To examine if individuals with chronic stroke can use mRehab at home to improve upper limb mobility. The secondary objective was to examine if changes in limb mobility transferred to standardized clinical assessments. Methods: mRehab consists of a smartphone coupled with 3D printed household items: mug, bowl, key, and doorknob. The smartphone custom app guides task-oriented activities and measures both time to complete an activity and quality of movement (smoothness/accuracy). It also provides performance-based feedback to aid the user in self-monitoring their performance. Task-oriented activities were categorized as (1) object transportation, (2) prehensile grip with supination/pronation, (3) fractionated finger movement, and (4) walking with object. A total of 18 individuals with stroke enrolled in the single-subject experimental design study consisting of pretesting, a 6-week mRehab home program, and posttesting. Pre- and posttesting included both in-laboratory clinical assessments and in-home mRehab recorded samples of task performance. During the home program, mRehab recorded performance data. A System Usability Scale assessed user's perception of mRehab. Results: A total of 16 participants completed the study and their data are presented in the results. The average days of exercise for each mRehab activity ranged from 15.93 to 21.19 days. This level of adherence was sufficient for improvements in time (t15=2.555, P=.02) and smoothness (t15=3.483, P=.003) in object transportation. Clinical assessments indicated improvements in functional performance (t15=2.675, P=.02) and hand dexterity (t15=2.629, P=.02). Participant's perception of mRehab was positive. Conclusions: Despite heterogeneity in participants' use of mRehab, there were improvements in upper limb mobility. Smartphone-based portable technology can support home rehabilitation programs in chronic conditions such as stroke. The ability to record performance data from home rehabilitation offers new insights into the impact of home programs on outcomes. Trial Registration: ClinicalTrials.gov NCT04363944; https://clinicaltrials.gov/ct2/show/NCT04363944 ",
doi="10.2196/19582",
url="http://mhealth.jmir.org/2020/7/e19582/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32706702"
}


@Article{info:doi/10.2196/16852,
author="Jiang, Taoran
and Yu, Dewang
and Wang, Yuqi
and Zan, Tao
and Wang, Shuyi
and Li, Qingfeng",
title="HoloLens-Based Vascular Localization System: Precision Evaluation Study With a Three-Dimensional Printed Model",
journal="J Med Internet Res",
year="2020",
month="Apr",
day="17",
volume="22",
number="4",
pages="e16852",
keywords="augmented reality",
keywords="HoloLens",
keywords="perforator flap",
keywords="vascular localization",
keywords="reconstructive surgery",
keywords="3D Printing",
abstract="Background: Vascular localization is crucial for perforator flap transfer. Augmented reality offers a novel method to seamlessly combine real information with virtual objects created by computed tomographic angiography to help the surgeon ``see through'' the skin and precisely localize the perforator. The head-mounted display augmented reality system HoloLens (Microsoft) could facilitate augmented reality--based perforator localization for a more convenient and safe procedure. Objective: The aim of this study was to evaluate the precision of the HoloLens-based vascular localization system, as the most important performance indicator of a new localization system. Methods: The precision of the HoloLens-based vascular localization system was tested in a simulated operating room under different conditions with a three-dimensional (3D) printed model. The coordinates of five pairs of points on the vascular map that could be easily identified on the 3D printed model and virtual model were detected by a probe, and the distance between the corresponding points was calculated as the navigation error. Results: The mean errors were determined under different conditions, with a minimum error of 1.35 mm (SD 0.43) and maximum error of 3.18 mm (SD 1.32), which were within the clinically acceptable range. There were no significant differences in the errors obtained under different visual angles, different light intensities, or different states (static or motion). However, the error was larger when tested with light compared with that tested without light. Conclusions: This precision evaluation demonstrated that the HoloLens system can precisely localize the perforator and potentially help the surgeon accomplish the operation. The authors recommend using HoloLens-based surgical navigation without light. ",
doi="10.2196/16852",
url="http://www.jmir.org/2020/4/e16852/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32301738"
}


@Article{info:doi/10.2196/12067,
author="Crossley, Morgan Sam Graeme
and McNarry, Anne Melitta
and Eslambolchilar, Parisa
and Knowles, Zoe
and Mackintosh, Alexandra Kelly",
title="The Tangibility of Personalized 3D-Printed Feedback May Enhance Youths' Physical Activity Awareness, Goal Setting, and Motivation: Intervention Study",
journal="J Med Internet Res",
year="2019",
month="May",
day="31",
volume="21",
number="6",
pages="e12067",
keywords="behavior change",
keywords="health education",
keywords="feedback",
keywords="self-monitoring",
keywords="accelerometry",
keywords="schools",
keywords="adolescent",
keywords="child",
abstract="Background: In the United Kingdom, most youth fail to achieve the government guideline of 60 min of moderate to vigorous physical activity (MVPA) daily. Reasons that are frequently cited for the underachievement of this guideline include (1) a lack of awareness of personal physical activity levels (PALs) and (2) a lack of understanding of what activities and different intensities contribute to daily targets of physical activity (PA). Technological advances have enabled novel ways of representing PA data through personalized tangible three-dimensional (3D) models. Objective: The purpose of this study was to investigate the efficacy of 3D-printed models to enhance youth awareness and understanding of and motivation to engage in PA. Methods: A total of 39 primary school children (22 boys; mean age 7.9 [SD 0.3] years) and 58 secondary school adolescents (37 boys; mean age 13.8 [SD 0.3] years) participated in a 7-week fading intervention, whereby participants were given 3D-printed models of their previous week's objectively assessed PALs at 4 time points. Following the receipt of their 3D model, each participant completed a short semistructured video interview (children, 4.5 [SD 1.2] min; adolescents, 2.2 [SD 0.6] min) to assess their PA awareness, understanding, and motivation. Data were transcribed verbatim and thematically analyzed to enable key emergent themes to be further explored and identified. Results: Analyses revealed that the 3D models enhanced the youths' awareness of and ability to recall and self-evaluate their PA behaviors. By the end of the study, the youths, irrespective of age, were able to correctly identify and relate to the government's PA guideline represented on the models, despite their inability to articulate the government's guideline through time and intensity. Following the fourth 3D model, 72\% (71/97) of the youths used the models as a goal-setting strategy, further highlighting such models as a motivational tool to promote PA. Conclusions: The results suggest that 3D-printed models of PA enhanced the youths' awareness of their PA levels and provided a motivational tool for goal setting, potentially offering a unique strategy for future PA promotion. ",
doi="10.2196/12067",
url="https://www.jmir.org/2019/6/e12067/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31199322"
}


@Article{info:doi/10.2196/12626,
author="Park, Lily
and Price-Williams, Steven
and Jalali, Alireza
and Pirzada, Kashif",
title="Increasing Access to Medical Training With Three-Dimensional Printing: Creation of an Endotracheal Intubation Model",
journal="JMIR Med Educ",
year="2019",
month="Apr",
day="09",
volume="5",
number="1",
pages="e12626",
keywords="medical education",
keywords="printing, three-dimensional",
abstract="Background: Endotracheal intubation (ETI) is a crucial life-saving procedure, where more than 2 failed attempts can lead to further complications or even death. Like all technical skills, ETI requires sufficient practice to perform adequately. Currently, the models used to practice ETI are expensive and, therefore, difficult to access, particularly in the developing world and in settings that lack a dedicated simulation center. Objective: This study aimed to improve access to ETI training by creating a comparable yet cost-effective simulation model producible by 3-dimensional (3D) printers. Methods: Open-source mesh files of relevant anatomy from BodyParts3D were modified through the 3D modeling programs Meshlab (ISTI-CNR) and Blender (Blender Foundation). Several prototypes with varying filaments were tried to optimize the ETI simulation. Results: We have created the novel 3D-printed pediatric ETI model for learners at all levels to practice this airway management skill at negligible costs compared with current simulation models. It is an open-source design available for all medical trainees. Conclusions: Revolutions in cost and ease of use have allowed home and even desktop 3D printers to become widespread. Therefore, open-source access to the ETI model will improve accessibility to medical training in the hopes of optimizing patient care. ",
doi="10.2196/12626",
url="http://mededu.jmir.org/2019/1/e12626/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30964444"
}


@Article{info:doi/10.2196/11253,
author="Crossley, Morgan Sam Graeme
and McNarry, Anne Melitta
and Rosenberg, Michael
and Knowles, R. Zoe
and Eslambolchilar, Parisa
and Mackintosh, Alexandra Kelly",
title="Understanding Youths' Ability to Interpret 3D-Printed Physical Activity Data and Identify Associated Intensity Levels: Mixed-Methods Study",
journal="J Med Internet Res",
year="2019",
month="Feb",
day="22",
volume="21",
number="2",
pages="e11253",
keywords="3D printing",
keywords="education",
keywords="adolescent",
keywords="child",
keywords="comprehension",
keywords="understanding",
keywords="mental recall",
abstract="Background: A significant proportion of youth in the United Kingdom fail to meet the recommended 60 minutes of moderate-to-vigorous physical activity every day. One of the major barriers encountered in achieving these physical activity recommendations is the perceived difficulty for youths to interpret physical activity intensity levels and apply them to everyday activities. Personalized physical activity feedback is an important method to educate youths about behaviors and associated outcomes. Recent advances in 3D printing have enabled novel ways of representing physical activity levels through personalized tangible feedback to enhance youths' understanding of concepts and make data more available in the everyday physical environment rather than on screen. Objective: The purpose of this research was to elicit youths' (children and adolescents) interpretations of two age-specific 3D models displaying physical activity and to assess their ability to appropriately align activities to the respective intensity. Methods: Twelve primary school children (9 boys; mean age 7.8 years; SD 0.4 years) and 12 secondary school adolescents (6 boys; mean age 14.1 years; SD 0.3 years) participated in individual semistructured interviews. Interview questions, in combination with two interactive tasks, focused on youths' ability to correctly identify physical activity intensities and interpret an age-specific 3D model. Interviews were transcribed verbatim, content was analyzed, and outcomes were represented via tables and diagrammatic pen profiles. Results: Youths, irrespective of age, demonstrated a poor ability to define moderate-intensity activities. Moreover, children and adolescents demonstrated difficulty in correctly identifying light- and vigorous-intensity activities, respectively. Although youths were able to correctly interpret different components of the age-specific 3D models, children struggled to differentiate physical activity intensities represented in the models. Conclusions: These findings support the potential use of age-specific 3D models of physical activity to enhance youths' understanding of the recommended guidelines and associated intensities. ",
doi="10.2196/11253",
url="http://www.jmir.org/2019/2/e11253/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30794204"
}


@Article{info:doi/10.2196/12064,
author="Crossley, Morgan Sam Graeme
and McNarry, Anne Melitta
and Hudson, Joanne
and Eslambolchilar, Parisa
and Knowles, Zoe
and Mackintosh, Alexandra Kelly",
title="Perceptions of Visualizing Physical Activity as a 3D-Printed Object: Formative Study",
journal="J Med Internet Res",
year="2019",
month="Jan",
day="30",
volume="21",
number="1",
pages="e12064",
keywords="3D printing",
keywords="feedback",
keywords="youth",
keywords="education",
keywords="school",
abstract="Background: The UK government recommends that children engage in moderate-to-vigorous physical activity for at least 60 min every day. Despite associated physiological and psychosocial benefits of physical activity, many youth fail to meet these guidelines partly due to sedentary screen-based pursuits displacing active behaviors. However, technological advances such as 3D printing have enabled innovative methods of visualizing and conceptualizing physical activity as a tangible output. Objective: The aim of this study was to elicit children's, adolescents', parents', and teachers' perceptions and understanding of 3D physical activity objects to inform the design of future 3D models of physical activity. Methods: A total of 28 primary school children (aged 8.4 [SD 0.3] years; 15 boys) and 42 secondary school adolescents (aged 14.4 [SD 0.3] years; 22 boys) participated in semistructured focus groups, with individual interviews conducted with 8 teachers (2 male) and 7 parents (2 male). Questions addressed understanding of the physical activity guidelines, 3D model design, and both motivation for and potential engagement with a 3D physical activity model intervention. Pupils were asked to use Play-Doh to create and describe a model that could represent their physical activity levels (PAL). Data were transcribed verbatim and thematically analyzed, and key emergent themes were represented using pen profiles. Results: Pupils understood the concept of visualizing physical activity as a 3D object, although adolescents were able to better analyze and critique differences between low and high PAL. Both youths and adults preferred a 3D model representing a week of physical activity data when compared with other temporal representations. Furthermore, all participants highlighted that 3D models could act as a motivational tool to enhance youths' physical activity. From the Play-Doh designs, 2 key themes were identified by pupils, with preferences indicated for models of abstract representations of physical activity or bar charts depicting physical activity, respectively. Conclusions: These novel findings highlight the potential utility of 3D objects of physical activity as a mechanism to enhance children's and adolescents' understanding of, and motivation to increase, their PAL. This study suggests that 3D printing may offer a unique strategy for promoting physical activity in these groups. ",
doi="10.2196/12064",
url="http://www.jmir.org/2019/1/e12064/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30698532"
}


@Article{info:doi/10.2196/jmir.6686,
author="Rouleau, Genevi{\`e}ve
and Gagnon, Marie-Pierre
and C{\^o}t{\'e}, Jos{\'e}
and Payne-Gagnon, Julie
and Hudson, Emilie
and Dubois, Carl-Ardy",
title="Impact of Information and Communication Technologies on Nursing Care: Results of an Overview of Systematic Reviews",
journal="J Med Internet Res",
year="2017",
month="Apr",
day="25",
volume="19",
number="4",
pages="e122",
keywords="information and communication technology",
keywords="eHealth",
keywords="telehealth",
keywords="nursing care",
keywords="review, overview of systematic review",
abstract="Background: Information and communication technologies (ICTs) are becoming an impetus for quality health care delivery by nurses. The use of ICTs by nurses can impact their practice, modifying the ways in which they plan, provide, document, and review clinical care. Objective: An overview of systematic reviews was conducted to develop a broad picture of the dimensions and indicators of nursing care that have the potential to be influenced by the use of ICTs. Methods: Quantitative, mixed-method, and qualitative reviews that aimed to evaluate the influence of four eHealth domains (eg, management, computerized decision support systems [CDSSs], communication, and information systems) on nursing care were included. We used the nursing care performance framework (NCPF) as an extraction grid and analytical tool. This model illustrates how the interplay between nursing resources and the nursing services can produce changes in patient conditions. The primary outcomes included nurses' practice environment, nursing processes, professional satisfaction, and nursing-sensitive outcomes. The secondary outcomes included satisfaction or dissatisfaction with ICTs according to nurses' and patients' perspectives. Reviews published in English, French, or Spanish from January 1, 1995 to January 15, 2015, were considered. Results: A total of 5515 titles or abstracts were assessed for eligibility and full-text papers of 72 articles were retrieved for detailed evaluation. It was found that 22 reviews published between 2002 and 2015 met the eligibility criteria. Many nursing care themes (ie, indicators) were influenced by the use of ICTs, including time management; time spent on patient care; documentation time; information quality and access; quality of documentation; knowledge updating and utilization; nurse autonomy; intra and interprofessional collaboration; nurses' competencies and skills; nurse-patient relationship; assessment, care planning, and evaluation; teaching of patients and families; communication and care coordination; perspectives of the quality of care provided; nurses and patients satisfaction or dissatisfaction with ICTs; patient comfort and quality of life related to care; empowerment; and functional status. Conclusions: The findings led to the identification of 19 indicators related to nursing care that are impacted by the use of ICTs. To the best of our knowledge, this was the first attempt to apply NCPF in the ICTs' context. This broad representation could be kept in mind when it will be the time to plan and to implement emerging ICTs in health care settings. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews: CRD42014014762; http://www.crd.york.ac.uk/PROSPERO/display\_record.asp?ID=CRD42014014762 (Archived by WebCite at http://www.webcitation.org/6pIhMLBZh) ",
doi="10.2196/jmir.6686",
url="http://www.jmir.org/2017/4/e122/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28442454"
}