Designing Game-Based Rehabilitation Experiences for People with Aphasia

2021 ◽  
Vol 5 (CHI PLAY) ◽  
pp. 1-31
Author(s):  
Kathryn Hymes ◽  
Jessica Hammer ◽  
Hakan Seyalioglu ◽  
Carol Dow-Richards ◽  
Deidra Brown ◽  
...  
Keyword(s):  
Design Process ◽  
Game Design ◽  
The United States ◽  
Population Based ◽  
Negative Consequences ◽  
Psychosocial Needs ◽  
Research Interviews ◽  
Community Data ◽  
Promising Solution

Over 2 million people across the United States are living with aphasia, the loss of language due to acquired brain injury. Aphasia is an invisible disability that may come with negative consequences for communication, community participation, and quality of life. Game-based rehabilitation is a promising solution to address unmet long-term recovery and psychosocial needs for people with aphasia. In this paper, we describe a participatory game design process that engages people with aphasia (PwA) in the creation of three hybrid digital-analog games. We detail methods for facilitating collaboration across language barriers and divergent professional expertise based on interviews and participant observations throughout our iterative design process. We also contribute a set of design principles synthesized from aphasia rehabilitation research, interviews and community data. We conclude with recommendations for pursuing community-empowered aphasia game design for this underserved population based on reflection from our co-design experience.

scholarly journals A structural equation model of cooperative member satisfaction and long-term commitment

2019 ◽  
Vol 22 (2) ◽  
pp. 247-263 ◽  
Author(s):  
Jasper Grashuis ◽  
Michael Lee Cook
Keyword(s):  
Structural Equation Model ◽  
Structural Equation ◽  
The United States ◽  
Equation Model ◽  
Negative Consequences ◽  
Term Survival ◽  
Farmer Cooperatives ◽  
Attitudes And Perceptions ◽  
Member Satisfaction

The organizational growth of farmer cooperatives is tied to increased heterogeneity in member attitudes and perceptions. To inform possible solutions, a better understanding of the complex interrelationships of member attitudes and perceptions is necessary. Using survey responses from 1,116 members of an organic marketing cooperative in the United States, this paper develops a structural equation model of six factors: organic lifestyle, mission support, participation, trust, satisfaction, and long-term commitment. The final model illustrates nine significant relationships, including satisfaction and long-term commitment. The result suggests the long-term survival or viability of farmer cooperatives is not only dependent on its financial performance but also the utility of its members. In terms of member attitudes and perceptions, trust and mission support may offer the best opportunities for farmer cooperatives to foster member satisfaction and thus address the negative consequences of heterogeneity.

scholarly journals Severity of parkinsonism associated with environmental manganese exposure

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Brad A. Racette ◽  
Gill Nelson ◽  
Wendy W. Dlamini ◽  
Pradeep Prathibha ◽  
Jay R. Turner ◽  
...  
Keyword(s):  
South Africa ◽  
Rating Scale ◽  
The United States ◽  
Population Based ◽  
Dominant Hand ◽  
Manganese Exposure ◽  
Disease Rating ◽  
The Mean ◽  
Mn Concentration

Abstract Background Exposure to occupational manganese (Mn) is associated with neurotoxic brain injury, manifesting primarily as parkinsonism. The association between environmental Mn exposure and parkinsonism is unclear. To characterize the association between environmental Mn exposure and parkinsonism, we performed population-based sampling of residents older than 40 in Meyerton, South Africa (N = 621) in residential settlements adjacent to a large Mn smelter and in a comparable non-exposed settlement in Ethembalethu, South Africa (N = 95) in 2016–2020. Methods A movement disorders specialist examined all participants using the Unified Parkinson Disease Rating Scale motor subsection part 3 (UPDRS3). Participants also completed an accelerometry-based kinematic test and a grooved pegboard test. We compared performance on the UPDRS3, grooved pegboard, and the accelerometry-based kinematic test between the settlements using linear regression, adjusting for covariates. We also measured airborne PM2.5-Mn in the study settlements. Results Mean PM2.5-Mn concentration at a long-term fixed site in Meyerton was 203 ng/m3 in 2016–2017 – approximately double that measured at two other neighborhoods in Meyerton. The mean Mn concentration in Ethembalethu was ~ 20 times lower than that of the long-term Meyerton site. UPDRS3 scores were 6.6 (CI 5.2, 7.9) points higher in Meyerton than Ethembalethu residents. Mean angular velocity for finger-tapping on the accelerometry-based kinematic test was slower in Meyerton than Ethembalethu residents [dominant hand 74.9 (CI 48.7, 101.2) and non-dominant hand 82.6 (CI 55.2, 110.1) degrees/second slower]. Similarly, Meyerton residents took longer to complete the grooved pegboard, especially for the non-dominant hand (6.9, CI -2.6, 16.3 s longer). Conclusions Environmental airborne Mn exposures at levels substantially lower than current occupational exposure thresholds in the United States may be associated with clinical parkinsonism.

scholarly journals A national cohort study (2000–2018) of long-term air pollution exposure and incident dementia in older adults in the United States

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Liuhua Shi ◽  
Kyle Steenland ◽  
Haomin Li ◽  
Pengfei Liu ◽  
Yuhan Zhang ◽  
...  
Keyword(s):  
Air Pollution ◽  
Fine Particulate Matter ◽  
Warm Season ◽  
The United States ◽  
Population Based ◽  
Hazard Ratios ◽  
Incident Dementia ◽  
Increase Risk ◽  
National Cohort

AbstractAir pollution may increase risk of Alzheimer’s disease and related dementias (ADRD) in the U.S., but the extent of this relationship is unclear. Here, we constructed two national U.S. population-based cohorts of those aged ≥65 from the Medicare Chronic Conditions Warehouse (2000–2018), combined with high-resolution air pollution datasets, to investigate the association of long-term exposure to ambient fine particulate matter (PM2.5), nitrogen dioxide (NO2), and ozone (O3) with dementia and AD incidence, respectively. We identified ~2.0 million incident dementia cases (N = 12,233,371; dementia cohort) and ~0.8 million incident AD cases (N = 12,456,447; AD cohort). Per interquartile range (IQR) increase in the 5-year average PM2.5 (3.2 µg/m3), NO2 (11.6 ppb), and warm-season O3 (5.3 ppb) over the past 5 years prior to diagnosis, the hazard ratios (HRs) were 1.060 (95% confidence interval [CI]: 1.054, 1.066), 1.019 (95% CI: 1.012, 1.026), and 0.990 (95% CI: 0.987, 0.993) for incident dementias, and 1.078 (95% CI: 1.070, 1.086), 1.031 (95% CI: 1.023, 1.039), and 0.982 (95%CI: 0.977, 0.986) for incident AD, respectively, for the three pollutants. For both outcomes, concentration-response relationships for PM2.5 and NO2 were approximately linear. Our study suggests that exposures to PM2.5 and NO2 are associated with incidence of dementia and AD.

Game-based design for eHealth in practice (Preprint)

2019 ◽  
Author(s):  
Frederiek de Vette ◽  
Monique Tabak ◽  
Wendy Oude Nijeweme-D'Hollosy ◽  
Hermie Hermens ◽  
Miriam Vollenbroek
Keyword(s):  
Older Adults ◽  
Design Process ◽  
Game Design ◽  
End Users ◽  
Creative Design ◽  
Motivational Strategies ◽  
End User ◽  
User Research ◽  
Training Modules

BACKGROUND Games are increasingly used in eHealth as a strategy for user engagement. While these game-based applications receive attention in literature, there is an enormous diversity of end users and objectives targeted by eHealth. Identifying game content that drives and sustains engagement is therefore challenging. Future developments would benefit from more openness on the game design process and motivational strategies applied. OBJECTIVE Our objective was to provide insight in our approach in the development of game-based eHealth in practice. By means of a case study, PERSSILAA, we elaborate the entire game design process and show the motivational strategies applied, to aid researchers and designers of future game-based applications. PERSSILAA is a self-management platform which aims to counter frailty by offering older adults training modules in the domains of healthy nutrition, physical and cognitive training to maintain a healthy lifestyle. METHODS We introduce four phases in the process towards game-based eHealth: 1) end-user research, 2) conceptualisation, 3) creative design and 4) refinement. RESULTS A total number of 168 participants participated in end-user research (1), resulting in an overview of their preferences for game content and a set of game design recommendations. We found that conventional games currently popular among older adults do not necessarily translate well into engaging concepts for eHealth. Recommendations include: focusing game concepts on thinking, problem solving, variation, discovery and achievement, using high quality aesthetics. Stakeholder sessions with developing partners resulted in strategies for long-term engagement (2), using indicators of user performance on the platform’s training modules. These performance indicators, e.g. completed training sessions or exercises, form the basis for game progression. Results from prior phases were used in creative design (3) to create the game “Stranded!”. The user plays a shipwrecked person who has to gather parts for a life raft by completing in-game objectives. Iterative prototyping (4) resulted in the final prototype of the game-based application. A total number of 35 end users participated using simulated training modules. The online game-based application was used without reported errors for a six weeks. End users scored appreciation (74/100), ease of use (73/100), expected effectivity and motivation (62/100), fun and pleasantness of using the application (75/100) and intended future use (66/100) which implicates that the application is ready for use by a larger population. CONCLUSIONS The study resulted in a game-based application for which the entire game design process within eHealth was transparently documented. We believe we have contributed to the transfer of knowledge on game design that supports engagement in eHealth applications. Our user evaluations indicate that results from end-user research and consequential strategies for long-term engagement led to game content that is engaging to the older adult end user.

scholarly journals Prostate Carcinogenesis with Diabetes and Androgen-Deprivation-Therapy-Related Diabetes: An Update

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Noboru Hara
Keyword(s):  
Prostate Cancer ◽  
Androgen Deprivation Therapy ◽  
Relevant Literature ◽  
Serum Testosterone ◽  
The United States ◽  
Population Based ◽  
Androgen Deprivation ◽  
Prostate Carcinogenesis ◽  
Increased Risk

Prostate cancer and the androgen deprivation therapy (ADT) thereof are involved in diabetes in terms of diabetes-associated carcinogenesis and ADT-related metabolic disorder, respectively. The aim of this study is to systematically review relevant literature. About 218,000 men are estimated to be newly diagnosed with prostate cancer every year in the United States. Approximately 10% of them are still found with metastasis, and in addition to them, about 30% of patients with nonmetastatic prostate cancer recently experience ADT. Population-based studies have shown that dissimilar to other malignancies, type 2 diabetes is associated with a lower incidence of prostate cancer, whereas recent large cohort studies have reported the association of diabetes with advanced high-grade prostate cancer. Although the reason for the lower prevalence of prostate cancer among diabetic men remains unknown, the lower serum testosterone and PSA levels in them can account for the increased risk of advanced disease at diagnosis. Meanwhile, insulin resistance already appears in 25–60% of the patients 3 months after the introduction of ADT, and long-term ADT leads to a higher incidence of diabetes (reported hazard ratio of 1.28–1.44). Although the possible relevance of cytokines such as Il-6 and TNF-αto ADT-related diabetes has been suggested, its mechanism is poorly understood.

scholarly journals Long-Term Neuropsychological Effects of Opioid Use in Children: A Descriptive Literature Review

2014 ◽  
Vol 2;17 (2;3) ◽  
pp. 109-118 ◽  
Author(s):  
Gaurav Jain
Keyword(s):  
Pain Management ◽  
School Readiness ◽  
Pediatric Population ◽  
The United States ◽  
Cognitive Status ◽  
Cochrane Library ◽  
Negative Consequences ◽  
Pediatric Pain ◽  
Opioid Use

Background: Use of opioids in the management of pain and its consequences in children presents a substantial challenge. A significant concern in pediatric pain management is the longterm neuropsychological consequences of opioids. Objectives: The authors aim to provide a descriptive review of the current literature surrounding the neuropsychological impact of opioid use in children, along with possible extrapolations from their use in adults and animal models. Study Design: Systematic review of published literature. Setting: Various universities in the United States. Methods: The electronic review for papers published between January 1992 and December 2012 was conducted using Medline/Pubmed, PsychInfo, CINAHL, the Cochrane Library database, and Google Scholar. Results: Findings assessing pediatric pain patients treated with opioids demonstrated no significant differences in intelligence, behavior, vocabulary, or motor skills. One study reported a decrease in a visuo-constructional ability, which measured higher order executive function. Studies from prenatal illicit opioid exposure found poorer performance on measures of language, verbal ability, mathematics, reading, impulse control, and school readiness skills. The literature from adult prescribed opioid users has mixed results. Some showed impairment in the neuropsychological domains of memory, decision-making, attention, concentration, information processing, psychomotor speed, visual special skills, and hand-eye coordination, while others found no differences or revealed improved perceptual-cognitive status, possibly due to the removal of pain as a stressor. Limitations: Very few studies looked into the long term neuropsychological and cognitive effects of the opioids in pediatric population. In an attempt to extrapolate from other groups, this review also included literature from adult patients, prenatal opioid exposure, and animal studies. Conclusion: Opioid medications have the potential to produce long-lasting neuropsychological side effects. However, given the negative consequences of untreated pain, the potential benefit may offset their risk. More studies are needed to clarify this complex interaction. Key words: Chronic pain management, infants, children, pediatrics, long term neurocognitive effects, opioid medication

scholarly journals The long-term benefits of director stock ownership

2009 ◽  
Vol 5 (3) ◽  
pp. 6-16
Author(s):  
Brian Bolton
Keyword(s):  
The United States ◽  
Stock Ownership ◽  
Governance Mechanism ◽  
Negative Consequences ◽  
United States Treasury ◽  
Managerial Entrenchment ◽  
Corporate Governance Mechanism ◽  
Dollar Amount ◽  
Director Ownership

In October 2009, the United States Treasury Department and Congress considered new regulations requiring executives and directors to receive much of their compensation in the form of long-term stock. One concern with this is that it may have negative consequences by entrenching managers and directors over the long term. This study compares the potential benefits of long-term director ownership with the potential costs of entrenchment. Using the dollar amount of stock owned by independent directors, the results suggest that the incentive effect dominates any costs related to entrenchment: firms with greater stock ownership outperform other firms, regardless of the degree of managerial entrenchment that may be present. The implication for policy-makers is that providing directors with incentives through stock ownership can be a very effective corporate governance mechanism.

Speech-Language Pathology in the Peace Corps: Necessity and Sustainability

2012 ◽  
Vol 2 (1) ◽  
pp. 11-18
Author(s):  
Melissa A. Pierce
Keyword(s):  
United States ◽  
Special Education ◽  
Peace Corps ◽  
People With Disabilities ◽  
Communication Disorders ◽  
The United States ◽  
Speech Language Pathology ◽  
Speech Language Pathologists ◽  
Language Pathology

In countries other than the United States, the study and practice of speech-language pathology is little known or nonexistent. Recognition of professionals in the field is minimal. Speech-language pathologists in countries where speech-language pathology is a widely recognized and respected profession often seek to share their expertise in places where little support is available for individuals with communication disorders. The Peace Corps offers a unique, long-term volunteer opportunity to people with a variety of backgrounds, including speech-language pathologists. Though Peace Corps programs do not specifically focus on speech-language pathology, many are easily adapted to the profession because they support populations of people with disabilities. This article describes how the needs of local children with communication disorders are readily addressed by a Special Education Peace Corps volunteer.

Multidisciplinary Evidence to Treat Bilingual Individuals with Aphasia

2008 ◽  
Vol 15 (3) ◽  
pp. 66-72 ◽  
Author(s):  
José G. Centeno
Keyword(s):  
Stroke Rehabilitation ◽  
Culturally Diverse ◽  
Treatment Strategies ◽  
The United States ◽  
Intervention Strategies ◽  
Steady Increase ◽  
Clinical Procedures ◽  
Bilingual Speakers ◽  
Aphasic Clients

Abstract The steady increase in linguistic and cultural diversity in the country, including the number of bilingual speakers, has been predicted to continue. Minorities are expected to be the majority by 2042. Strokes, the third leading cause of death and the leading cause of long-term disability in the U.S., are quite prevalent in racial and ethnic minorities, so population estimates underscore the imperative need to develop valid clinical procedures to serve the predicted increase in linguistically and culturally diverse bilingual adults with aphasia in post-stroke rehabilitation. Bilingualism is a complex phenomenon that interconnects culture, cognition, and language; thus, as aphasia is a social phenomenon, treatment of bilingual aphasic persons would benefit from conceptual frameworks that exploit the culture-cognition-language interaction in ways that maximize both linguistic and communicative improvement leading to social re-adaptation. This paper discusses a multidisciplinary evidence-based approach to develop ecologically-valid treatment strategies for bilingual aphasic individuals. Content aims to spark practitioners' interest to explore conceptually broad intervention strategies beyond strictly linguistic domains that would facilitate linguistic gains, communicative interactions, and social functioning. This paper largely emphasizes Spanish-English individuals in the United States. Practitioners, however, are advised to adapt the proposed principles to the unique backgrounds of other bilingual aphasic clients.

Traumatic Brain Injury: A Trauma Surgeon's Perspective

2012 ◽  
Vol 22 (3) ◽  
pp. 82-89
Author(s):  
Oscar D. Guillamondegui
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Multidisciplinary Approach ◽  
Trauma Team ◽  
The United States ◽  
Long Term Outcomes ◽  
Term Care ◽  
Injured Brain ◽  
The Moment

Traumatic brain injury (TBI) is a serious epidemic in the United States. It affects patients of all ages, race, and socioeconomic status (SES). The current care of these patients typically manifests after sequelae have been identified after discharge from the hospital, long after the inciting event. The purpose of this article is to introduce the concept of identification and management of the TBI patient from the moment of injury through long-term care as a multidisciplinary approach. By promoting an awareness of the issues that develop around the acutely injured brain and linking them to long-term outcomes, the trauma team can initiate care early to alter the effect on the patient, family, and community. Hopefully, by describing the care afforded at a trauma center and by a multidisciplinary team, we can bring a better understanding to the armamentarium of methods utilized to treat the difficult population of TBI patients.

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