Margherita Rampioni's research while affiliated with INRCA Istituto Nazionale di Ricovero e Cura per Anziani and other places

BACKGROUND Stroke is one of the most common cerebral vascular diseases, usually affecting people aged 60 and over, leading to a variety of disabilities requiring motor and cognitive rehabilitation. Post-stroke rehabilitation has a lead role in the recovery of the patients, and it is never too late to start. It should be implemented in a structured approach to help patients regain their physical, cognitive, and functional abilities. Technological solutions offer a beneficial and effective alternative to conventional therapy, making rehabilitation more accessible. OBJECTIVE This study maps and synthesizes the evidence from published systematic reviews that assessed the effectiveness of technology-based rehabilitation for the recovery of the upper limb in post-stroke individuals. METHODS Separate literature searches were conducted in PubMed, Web of Science, Scopus and Embase databases and Google Scholar. The PICOS was used to define inclusion criteria. There was no restriction on publication dates. The PRISMA flowchart was used in the retrieval and selection process. Then, the final articles were appraised for their methodological quality using the AMSTAR 2. RESULTS After the search process that identified 1450 records from the 4 databases and an additional 342 by Google Scholar, seven systematic reviews were included. The seven studies were published between 2019 and 2023. CONCLUSIONS This review indicated that the field of technology-based rehabilitation is still fragmented due to poor evidence of efficacy. This is probably due to the high heterogeneity of the experimental studies. When developing a technology-based rehabilitation program, it is crucial to carefully plan and link all relevant actors, user-driven design guidelines, and principles of neuroscience. There is a need for further research to understand better the impact of technology interventions on stroke deficits and recovery-related outcomes, both alone and in combination with traditional rehabilitation. This field of research could benefit from standardized rehabilitation protocols provided to patients, enabling comparison and interpretation to discover evidence currently missing.

Gerontechnology is an interdisciplinary field of research involving gerontology and technology in order to help older adults identify and slow down the effects of age-related physical and cognitive decline. It has enormous potential to allow individuals to remain in their own homes and improve their quality of life. This study aims to assess the impact of a multicomponent platform, consisting of an ambient sensor, wearable devices, and a cloud application, as an intervention in terms of usability and acceptance as primary outcomes and well-being, quality of life, and self-efficacy as secondary outcomes in a sample of 25 older adults aged over 65 after 21 days of non-supervised usage at home. This research involved the use of a mixed-methods approach, in which both qualitative and quantitative data were collected in three different measurements. Overall, the participants shared good engagement with the integrated platform. The system achieved positive results in terms of both usability and acceptance, especially the smartwatch. The state of complete well-being slightly improved over the period, whereas self-efficacy remained stable. This study demonstrates the ability of target users to use technology independently in their home environment: it strengthens the idea that this technology is ready for mainstream use and offers food for thought for developers who create products for the aging population.

The worldwide population is undergoing a fundamental change in its age structure, which challenges the health and social services system. The need to migrate towards a more person-centered and coordinated model of care that supports the optimization of abilities and capacities for older people has to be matched. In this sense, eHealth technologies can play a fundamental role. In this paper, through a questionnaire-based data collection on 30 primary (older people) and 32 secondary (informal caregivers) end-users, we share the sustainable way to develop a product optimizing the user experience and ensuring adoption. Both older adults and caregivers consider the use of smartphone and smartwatch to be very important, but also the use of digital devices for healthcare can be helpful. Seniors care about self-monitoring of health parameters using wearable devices, regardless of their health status, and would like to be included in the process of making good health decisions, because they need to feel in control of their healthcare process. Digital solutions in health and care can support the wellbeing of older adults in many areas of their daily lives at home and in their communities, but only if such innovation is designed around the natural voice of the intended target.

Innovative technologies can support older adults with or without disabilities, allowing them to live independently in their environment whilst monitoring their health and safety conditions and thereby reducing the significant burden on caregivers, whether family or professional. This paper discusses the design of a study protocol to evaluate the acceptance, usability, and efficiency of the SAVE system, a custom-developed information technology-based elderly care system. The study will involve older adults (aged 65 or older), professional and lay caregivers, and care service decision-makers representing all types of users in a care service scenario. The SAVE environmental sensors, smartwatches, smartphones, and Web service application will be evaluated in people’s homes situated in Romania, Italy, and Hungary with a total of 165 users of the three types (cares, elderly, and admin). The study design follows the mixed method approach, using standardized tests and questionnaires with open-ended questions and logging all the data for evaluation. The trial is registered to the platform ClinicalTrials.gov with the registration number NCT05626556. This protocol not only guides the participating countries but can be a feasibility protocol suitable for evaluating the usability and quality of similar systems.

Mild cognitive impairment is frequent among people with Parkinson's disease. Cognitive training seems effective for cognitive status and for mitigating anxiety and depression. With the COVID-19 outbreak, such therapeutic interventions were delivered online. This longitudinal mixed-method study was aimed at evaluating the effectiveness of an online cognitive treatment, carried out during COVID times and based on Parkinson's-Adapted Cognitive Stimulation Therapy, on cognitive domains and mood of 18 older people with Parkinson's disease. After screening, the cognitive status and mood were assessed three times by Addenbrooke's Cognitive Examination-Revised scale and the Geriatric Depression Scale-Short Form. At the follow-up, patients were also interviewed for understanding their experience with the technology. Such treatment was effective on the participants' cognitive functions, but not on their mood. Despite some initial problems with the technology, the online intervention was experienced as a way of not being 'left behind', staying in contact with others, and being safe during the lockdown. This suggests that online cognitive treatment can be adopted to integrate face-to-face interventions by increasing their efficacy, accessibility, and long-term outcomes. Suggestions for future research are given.

The analysis of human behavior in everyday-life situations starts from the assumption that people who act on indoor devices too often are not entirely conscious of the functioning of these systems and cannot achieve well-being as intended, with non-negligible physical and cognitive efforts in weaker subjects. Is it possible to create the best comfort possible in an indoor environment with minimized activity by final users at any time? This study aims at understanding vulnerable human beings and their development through the lifespan, detecting their actions in order to design a smart indoor device able to provide seniors with the ideal comfort level, that cannot be achieved autonomously inside private and institutional environments. Five healthcare centers located in Italy took part in this project between 2016 and 2017 and a total of 75 field observations have been carried out in order to gather information about behaviors of people that live in. Findings highlighted that both men and women seem to act, physically react, and voice their discomfort more in relation to cold, and women appear extremely sensitive to the temperature and choose more carefully the right clothes based on indoor and outdoor temperatures. A huge gap seems to exist between the perceptions of senior people and those of their caregivers. This suggests that technological innovations should improve the quality of life of human beings through a process of customization to target response, especially in relation to vulnerable categories, and place themselves within an evolutionary framework all along the course of life.

It is expected that, by 2050, people aged over 60 in 65 nations will constitute 30% of the total population. Healthy aging is at the top of the world political agenda as a possible means for hindering the collapse of care systems. How can ICT/sensing technology meet older people’s needs for active and healthy aging? This qualitative study carried out in Italy and Romania in 2020 involved 30 participants: older adults, caregivers, and stakeholders. Based on a user-centered design approach, this study aimed to understand which requirements of ICT/sensing technologies could match people’s needs of active and healthy aging. Findings highlighted that ICT/sensing technology needs to focus on six major themes: (1) learnability, (2) security, (3) independence, empowerment, and coaching values, (4) social isolation, (5) impact of habit, culture, and education variables, and (6) personalized solutions. These themes are consistent with the Active Aging framework and the factors that influence perceived usefulness and potential benefits among older adults. Consequently, this study shows how well-known, but still unresolved, issues affect the field of information and communication technologies (ICTs) to promote active and healthy aging. This suggests that the reinforcement of the public health system, especially considering the pandemic effect, requires a concrete and formidable effort from an interdisciplinary research network.

With a U-turn on the traditional view that people need to adapt to technological innovations and their surrounding environment by merely reacting to the machines’ inputs, a new approach places the human being at the center of the picture, with technology serving humans by providing the right services for users and their environments. The exploration of the different aspects of human behavior in daily life contexts can contribute to the development of smart devices, in order to improve people's quality of life, notably non-self-sufficient senior people. Of the four sections of the research, in this paper we will concentrate on the 75 observations who took place in 5 facilities, in order to gather information about behaviors of the elderly that live in. The checklists’ analysis shows that both men and women seem to act, physically react and voice their discomfort more in relation to cold. A huge gap seem to exist between the perceptions of senior people and those of the healthcare workers that take care of them. The aim of this study is understanding human beings through the detection of their actions and physical reactions, taking their everyday-life environments into account, in order to develop smart devices that can truly ensure users’ comfort.

BACKGROUND As the world’s population rapidly ages, the number of older adults with cognitive impairment will also increase. Several studies have identified numerous complex needs of people with dementia which assistive technologies still fail to support. Recent trends have led to an increasing focus on the use of Embodied Conversational Agents (ECAs) as virtual entities able to interact with a person through natural and familiar verbal and nonverbal communication. The use of ECAs could improve the accessibility and acceptance of assistive technologies matching those high-level needs that are not well covered to date. OBJECTIVE The aim of this study is to map the current state of the art in the field of designing ECAs for patients with dementia, in order to identify current research trends and possible gaps that need to be covered in the near future. Review questions were: a) What research frameworks are used to study the interaction between PWD and ECAs, b) What are the findings and c) Limitations and problems reported? METHODS A range of electronic reference databases were searched in July 2020: Scopus, Web of Science, PubMed and Embase. Thematic analysis identified recurrent themes across the literature; narrative analyses were written for each theme, identifying concepts and discrepant issues. RESULTS The search process identified 115 records from the databases and study references. After duplicates (n=45) were removed, 70 articles remained for initial screening. A total of 7 articles were included. A thematic analysis of reviewed studies identified major themes and subthemes that led to a traversals discussion on the future steps of research and development in assistive devices. CONCLUSIONS It emerged that the field of ECAs is novel and poorly discussed in the scientific community. This study underscored the challenge of synchronizing and harmonizing knowledge, efforts and challenges with the dementia care field and its person-centered paradigm through the User Centered Design approach.

Background As the world’s population rapidly ages, the number of older adults with cognitive impairment will also increase. Several studies have identified numerous complex needs of people with dementia, which assistive technologies still fail to support. Recent trends have led to an increasing focus on the use of embodied conversational agents (ECAs) as virtual entities able to interact with a person through natural and familiar verbal and nonverbal communication. The use of ECAs could improve the accessibility and acceptance of assistive technologies matching those high-level needs that are not well covered to date. Objective The aim of this thematic literature analysis was to map current studies in the field of designing ECAs for patients with dementia in order to identify the existing research trend and possible gaps that need to be covered in the near future. The review questions in this study were as follows: (1) what research frameworks are used to study the interaction between patients with dementia and ECAs? (2) what are the findings? and (3) what are the barriers reported in these studies? Methods Separate literature searches were conducted in PubMed, Web of Science, Scopus, and Embase databases by using specific umbrella phrases to target the population (patients with dementia) and the technology-based intervention (embodied conversational agent). Studies that met the inclusion criteria were appraised through the Mixed Methods Appraisal Tool and then discussed in a thematic analysis. Results The search process identified 115 records from the databases and study references. After duplicates (n=45) were removed, 70 papers remained for the initial screening. A total of 7 studies were finally included in the qualitative synthesis. A thematic analysis of the reviewed studies identified major themes and subthemes: the research frameworks used to gather users’ perspectives on ECAs (theme 1), the insights shared by the 7 studies as well as the value of user involvement in the development phases and the challenge of matching the system functionalities with the users’ needs (theme 2), and the main methodological and technical problems faced by each study team (theme 3). Conclusions Our thematic literature analysis shows that the field of ECAs is novel and poorly discussed in the scientific community and that more sophisticated study designs and proofs of efficacy of the approach are required. Therefore, by analyzing the main topic of the narrative review, this study underscores the challenge of synchronizing and harmonizing knowledge, efforts, and challenges in the dementia care field and its person-centered paradigm through the user-centered design approach. Enabling strict collaboration between interdisciplinary research networks, medical scientists, technology developers, patients, and their formal and informal caregivers is still a great challenge in the field of technologies for older adults.