A lack of access to learning opportunities is among the main reasons for social exclusion of people with cognitive disabilities in the professional field. It has been accentuated in the last few ...years by the rapid development of online learning strategies that limit the physical presence of students and instructors. Personalized systems can help overcome access barriers in learning for people with disabilities by helping them learn autonomously without the direct intervention of tutors. However, despite the wide range of research initiatives in this area to deal with individual differences, learners with cognitive disabilities still suffer from a lack of consideration of their conditions. Indeed, most e-learning platforms have been designed without taking into account users with multiple profiles and impairments. This paper systematically reviewed papers to provide insights about personalization within e-learning systems. We highlight personalization goals and approaches and review whether they improve learning accessibility and outcomes. The objective is to discuss the strengths and weaknesses of current research and suggest some opportunities to improve research in personalized e-learning systems for people with cognitive disabilities.
Acute gastrointestinal bleeding (AGIB) is common in older patients but the use of iron in this context remains understudied.
This study aimed to evaluate prospectively the efficacy of ferric ...carboxymaltose to treat anaemia in older patients after AGIB.
This randomised double-blinded placebo-controlled clinical trial was conducted in 10 French centres. Eligible patients were 65 years or more, had controlled upper or lower gastrointestinal bleeding and a haemoglobin level of 9-11 g/dl. Patients were randomly assigned, in a 1:1 ratio, to receive either one intravenous iron injection of ferric carboxymaltose or one injection of saline solution. The primary endpoint was the difference in haemoglobin level between day 0 and day 42. Secondary endpoints were treatment-emergent adverse events, serious adverse events, rehospitalisation and improvement of quality of life (QOL) at day 180.
From January 2013 to January 2017, 59 patients were included. The median age of patients was 81.9 75.8, 87.3 years. At day 42, a significant difference in haemoglobin level increase was observed (2.49 g/dl in the ferric carboxymaltose group vs. 1.56 g/dl in the placebo group, P = 0.02). At day 180, QOL, measured on European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30, improved by 10.5 points in the ferric carboxymaltose group and by 8.2 points in the placebo group (P = 0.56). Rates of adverse events and rehospitalisation were similar in the two groups.
Intravenous iron seems safe and effective to treat anaemia in older patients after AGIB and should be considered as a standard-of-care treatment. ClinicalTrials.gov (NCT01690585).
In this paper, we propose a game adaptation technique that seeks to improve the training outcomes of stroke patients during a therapeutic session. This technique involves the generation of customized ...game levels, which difficulty is dynamically adjusted to the patients’ abilities and performance. Our goal was to evaluate the effect of this adaptation strategy on the training outcomes of post-stroke patients during a therapeutic session. We hypothesized that a dynamic difficulty adaptation strategy would have a more positive effect on the training outcomes of patients than two control strategies, incremental difficulty adaptation and random difficulty adaptation. To test these strategies, we developed three versions of PRehab, a serious game for upper-limb rehabilitation. Seven stroke patients and three therapists participated in the experiment, and played all three versions of the game on a graphics tablet. The results of the experiment show that our dynamic adaptation technique increases movement amplitude during a therapeutic session. This finding may serve as a basis to improve patient recovery.
L'accident vasculaire cérébral (AVC) est une des principales causes de handicap et de décès chez les adultes dans le monde. Un nombre important de travaux de recherche ont été émergés afin ...d'améliorer les stratégies de rééducation en incluant les jeux sérieux dans le processus thérapeutique. L'avantage des jeux sérieux consiste à fournir aux patients un environnement d'entraînement personnalisé et immersive. La thèse se focalise sur une technique d'adaptation qui vise à améliorer les résultats de l'entrainement des patients tout en maintenant leur motivation durant une session thérapeutique. La technique est basée sur l'évaluation des capacités motrices des patients hémiplégiques pour adapter dynamiquement la difficulté de jeu. Elle a été évaluée via des expérimentations avec des joueurs sains, des thérapeutes et des patients atteints d'AVC. Les résultats de l'évaluation montrent que la technique d'adaptation permet d'augmenter le nombre de tâches, le nombre de tâches réussies ainsi que l'amplitude du mouvement. En outre, elle permet également de maintenir la motivation des joueurs en la comparant aux stratégies de contrôle. Cela peut être donc prometteur pour améliorer la récupération de patients qui ont subi un AVC.
A stroke is among the major causes of adults' disability and death worldwide. To date, a growing amount of research studies have been devoted to improve rehabilitation strategies by including serious games in the therapeutic process. The benefit of serious games lies in providing patients with a customized and immersive training environment. The thesis focuses on an adaptation technique that seeks to enhance the patients' training outcomes while maintaining their motivation. It is based on the assessment of the patient's motor abilities to dynamically adapt the game difficulty. The technique has been evaluated through experiments with healthy players, therapists and stroke patients. The results of the evaluation show that the adaptive technique has increased the training outcomes in terms of the number of tasks, number of successful tasks as well as the movement amplitude. In addition, it has also maintained the players' motivation compared with the control strategies. This can therefore be promising to enhance stroke patients' recovery.
Partnership working between Health and Social Care is the Scottish Government’s strategy to affect major policy and practice level changes within public services in order to meet the fiscal ...challenges arising from the ageing demographic profile within our society. The Joint Future Group Report, published by the Scottish Government in 2002, specifically identified the profession of occupational therapy as central to the strategy for public service reform and inspired an inter-organisational occupational therapy service redesign within Lanarkshire. The practice and system service redesign transcended Acute, Primary Care and Local Authority care of the elderly occupational therapy services, introducing measures to promote patient continuity of care at an informational, management and relational level. The aim was to promote longitudinal models of patient care that minimised the incidence of patients being transitioned between occupational therapy services. This PhD adopted a critical realism research approach with a mixed method sequential explanatory research design. The aim was to develop a theoretical understanding of the structural and agential influences at the macro meso and micro levels that gave rise to the service redesign outcomes. The results provided illuminating insights as to the agential and structural barriers to partnership working. Service specific patterns emerged that suggested structural and cultural influences on occupational therapy practice resulted in service specific variation in the ability to deliver on the continuity of care service redesign intentions. The agency of the occupational therapists was explored through mechanism based theorising in order to identify morphogenetic influences (facilitators to change) and morphostatic influences (barriers to change) in engaging in the service redesign measures in practice. The results reflect that the occupational therapists within all three service sectors enacted their agency to preserve their respective pre-existing organisational service structures. These results suggest that the learning strategies and associated behaviours of the participating occupational therapists were not conducive to transformational change. The practical insights of the conditioning power of structure vis a vis the discrete reflexive power of agency outlined within this thesis offers the profession of occupational therapy within public services the means of exploring and conceptualising the complex implications of partnership working.
In this paper, we propose a dynamic difficulty adaptation approach for serious games dedicated to upper-limb rehabilitation after stroke. The proposed approach aims to provide a personalized ...rehabilitation session in which the training intensity and challenges can be adapted to patient's abilities and training needs. The objective is to increase the rehabilitation volume by getting the patient engaged to the therapy session. This approach has been implemented and tested through a point and click game. Finally, we present a pilot experiment that we have conducted with healthy people in order to explain how this approach has been implemented and integrated to post-stroke therapeutic games.
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