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Anterior cruciate ligament (ACL) injuries often require a lengthy duration of rehabilitation for patients to return to their prior level of function. Adherence to rehabilitation during this prolonged period can be subpar due to the treatment duration and poor adherence to home exercises. This work evaluates whether a smart instrumented knee brace system is capable of monitoring knee range of motion and velocity during a series of common knee rehabilitation exercises and an exergame. A total of 15 healthy participants completed a series of common knee rehabilitation exercises and played an exergame while wearing a smart instrumented knee brace. The range of motion (ROM) and velocity of the knee recorded by the knee brace was compared to a reference optoelectronic system. The results show good agreement between the knee brace system and the reference system for all exercises performed. Participants were able to quickly learn how to play the exergame and scored well within the game. The system investigated in this study has the potential to allow rehabilitation to occur outside of the clinic with the use of remote monitoring, and improve adherence and outcomes through the use of an exergame.

Proper rehabilitation following rotator cuff repair (RCR) is necessary for successful postoperative outcomes, though the average course of physical therapy (PT) is lengthy and costly. The goals of this study were to (1) develop exercise programs for the CuffLink mHealth system and (2) evaluate early prototype efforts at meeting the needs of RCR clients. A panel of 24 clinicians participated in a Delphi study to identify consensus in rehabilitation, key informatic needs, and appropriate interface modalities for client usage. Utilizing the Delphi findings, the iA CuffLink mHealth system was developed, and a pilot evaluation assessed the feasibility and usability of CuffLink through the mHealth App Usability Questionnaire (MAUQ). During the pilot evaluation, the overall MAUQ score was 6.14. All participants (n = 18) viewed messaging the care team and a real time rep counter as “important” or “very important”. All participants either agreed or strongly agreed that quantifying progress would help motivate them to be compliant, and that the app helped them achieve their recovery outcomes compared to the shoulder device alone. Participants were generally pleased with the ease of use, information arrangement, and usefulness of CuffLink. These findings can advance our understanding of the informatics and usability needs in telerehabilitation systems.

Rotator cuff tears are common in individuals over 40, and physical therapy is often prescribed post-surgery. However, access can be limited by cost, convenience, and insurance coverage. CuffLink is a telehealth rehabilitation system that integrates the Strengthening and Stabilization System mechanical exerciser with the interACTION mobile health platform. The system includes a triple-axis accelerometer (LSM6DSOX + LIS3MDL FeatherWing), a rotary encoder, a VL530X time-of-flight sensor, and two wearable BioMech Health IMUs to capture upper-limb motion. CuffLink is designed to facilitate controlled, home-based exercise while enabling clinicians to remotely monitor joint function. Concurrent validity and test–retest reliability were used to assess device accuracy and repeatability. The results showed moderate to good validity for shoulder rotation (ICC = 0.81), device rotation (ICC = 0.94), and linear tracking (from zero: ICC = 0.75 and RMSE = 2.41; from start: ICC = 0.88 and RMSE = 2.02) and good reliability (e.g., RMSEs as low as 1.66 cm), with greater consistency in linear tracking compared to angular measures. Shoulder rotation and abduction exhibited higher variability in both validity and reliability measures. Future improvements will focus on manufacturability, signal stability, and force sensing. CuffLink supports accessible, data-driven rehabilitation and holds promise for advancing digital health in orthopedic recovery.

Background: Pediatric and adolescent athletes are a large demographic undergoing anterior cruciate ligament reconstruction (ACL-R). Postoperative rehabilitation is critical, requiring patients to complete home exercise programs (HEPs). To address obstacles to HEP adherence, we developed an interactive health technology, interACTION (iA), to monitor knee-specific rehabilitation. iA is a web-based platform that incorporates wearable motion sensors and a mobile app that provides feedback and allows remote monitoring. The Wheel of Sukr is a gamification mechanism that includes numerous behavioral elements. Objective: This study aims to use a user-centered design process to incorporate behavioral change strategies derived from self-management theory into iA using the Wheel of Sukr, with the aim of influencing patient behavior. Methods: In total, 10 athletes aged 10-18 years with a history of ACL-R were included in this study. Patients were between 4 weeks and 1 year post–ACL-R. Participants underwent a 60-minute triphasic interview. Phase 1 focused on elements of gaming that led to high participation and information regarding surgery and recovery. In phase 2, participants were asked to think aloud and rank cards representing the components of the Wheel of Sukr in order of interest. In phase 3, the patients reviewed the current version of iA. Interviews were recorded, transcribed, and checked for accuracy. Qualitative content analysis segmented the data and tagged meaningful codes until descriptive redundancy was achieved; next, 2 coders independently coded the data set. These elements were categorized according to the Wheel of Sukr framework. The mean age of participants was 12.8 (SD 1.32) years, and 70% (7/10) were female. Most participants (7/10, 70%) reported attending sessions twice weekly. All patients were prescribed home exercises. Self-reported HEP compliance was 75%-100% in 40% (4/10), 50%-75% in 40% (4/10), and 25%-50% of prescribed exercises in 20% (2/10) of the participants. Results: The participants responded positively to an app that could track home exercises. Desirable features included exercise demonstrations, motivational components, and convenience. The participants listed sports specificity, competition, notifications, reminders, rewards, and social aspects of gameplay as features to incorporate. In the Wheel of Sukr card sort exercise, motivation was ranked first; self-management, second; and growth, esteem, and fun tied for the third position. The recommended gameplay components closely followed the themes from the Wheel of Sukr card sort activity. Conclusions: The participants believe iA is a helpful addition to recovery and want the app to include exercise movement tracking and encouragement. Despite the small number of participants, thematic saturation was reached, suggesting the sample was sufficient to obtain a representative range of perspectives. Future work will implement motivation; self-management; and growth, confidence, and fun in the iA user experience. Young athlete ACL-R patients will complete typical clinical scenarios using increasingly developed prototypes of the gamified iA in a controlled setting.

Following cervical spine fusion there is a reduction in maximum range of motion (ROM) but how this impacts activity of daily living (ADLs) and quality of life is unknown. This study’s purpose is to quantify maximum and functional cervical spine ROM in patients with multi-level cervical fusion (>3 levels) compared to controls during ADLs and to correlate functional range of motion with scores from patient reported outcomes measures (PROs) including the Comparative Pain Scale (CPS), Fear Avoidance Belief Questionnaire (FABQ), and Neck Disability Index (NDI). An inertial measurement unit (IMU) system quantified ROM during ADLs in the extension/flexion, lateral bending, and axial rotation directions of motion. The reliability of this system was compared to standard optical motion tracking. Fourteen participants (8 females, age = 60.0 years (18.7) (median, (interquartile range)) with a history of multi-level cervical fusion (years post-op 0.9 (0.7)) were compared to 16 controls (13 females, age = 52.1 years (15.8)). PROs were collected for each participant. Fusion participants had significantly decreased maximum ROM in all directions of motion. Fusion participants had decreased ROM for some ADLs (backing up a car, using a phone, donning socks, negotiating stairs). CPS, FABQ, and NDI scores were significantly increased in fusion participants. Reductions in two activities (backing up a car, stair negotiation) correlated with a combination of increased PRO scores. Cervical fusion decreases maximum ROM and is correlated with increased PROs in some ADLs, however there is minimal impact on functional ROM. Investigation into velocity and acceleration may yield categorization of pathologic movement.