Importance: Self-management programs (facilitated by mobile devices) may improve health and prevent secondary complications for older adults with diabetes. However, older adults may have difficulties using mobile devices because of neuropathy or cognitive dysfunction. Objective: To identify sensorimotor and cognitive abilities associated with touchscreen tablet app performance to support self-management of diabetes in older adults. Design: Cross-sectional study. Setting: Outpatient Center for Successful Aging With Diabetes. Participants: Forty-five older adults with Type 2 diabetes. Outcomes and Measures: Dexterity (Purdue Pegboard Test), touch sensation (Semmes–Weinstein monofilaments), pinch strength (pinch gauge), cognition (Montreal Cognitive Assessment), and executive functioning (Trail Making Test) were assessed. Two apps were then used: Dexteria and SuCare. Demographic data, prior mobile device use, and diabetes severity (hemoglobin A1C [HbA1C]) were collected. Results: Age and HbA1C accounted for 29.8% and 9.7%, respectively, of the total variance of Dexteria performance time (dominant hand). Dexterity (dominant hand) accounted for an additional 5.4% of the total variance of 45.1%, F(4, 40) = 10.021, p < .001. Prior mobile device use, age, and diabetes severity accounted for 6.4%, 11.8%, and 26.4%, respectively, of the total variance of SuCare performance time. Executive functioning and dominant-hand dexterity accounted for an additional 9.5% and 9.4%, respectively, of the total variance of 61.0%, F(5, 39) = 14.75, p < .001. Conclusions and Relevance: Beyond age and diabetes severity, executive functioning and dominant-hand dexterity contributed to app performance, highlighting the importance of diabetes self-management. These findings may help determine suitable candidates for tablet use for self-management. What This Article Adds: App performance is explained by the executive functioning and dexterity of older adults with Type 2 diabetes. These factors, in addition to age and diabetes severity, should be taken into consideration by occupational therapy practitioners in future mobile self-management programs.

Date Presented 03/26/20 Weakness of the affected UE is common poststroke. However, it is important to be aware that the less-affected UE is also mildly affected poststroke. In this longitudinal study, we revealed that the motor and functional ability of the less-affected UE improved significantly during the first six months poststroke. The impact of this UE on bilateral functioning needs to be further investigated. Primary Author and Speaker: Samar Hmaied Assadi Additional Authors and Speakers: Debbie Rand Contributing Authors: Noa Doron, Shelly Peri, Haim Barel, Israel Dudkiewicz, Gabi Zeilig, Revital Gross-Nevo

Date Presented 03/27/20 Frailty is a state of vulnerability in older adults for adverse outcomes. We aimed to screen for frailty and understand its impact on daily living and participation. A cross-sectional study used a phone survey (Stage I—1,571 participants) and house visits (Stage II—120 participants). Older adults with frailty were significantly different from the nonfrail participants in all demographic and daily activities characteristics. Frailty significantly influenced instrumental activities of daily living and participation. Primary Author and Speaker: Debbie Rand Contributing Authors: Netta Bentur, Alona Baram, Reut Gasner-Winograd, Zvi Buckman, Shelley Sternberg

Date Presented 04/04/19 Executive function (EF) deficits following traumatic brain injury (TBI) negatively affect independence in daily living. The use of performance-based assessments are recommended. This cross-sectional study compared the performance of the Internet-based bill-paying task in adults with TBI to healthy adults and correlated this task to WebNeuro computerized assessment and independence in daily living. The bill-paying task has construct and initial criterion validity to assess EF deficits after TBI. Primary Author and Speaker: Yael Nadler Tzadok Additional Authors and Speakers: Rotem Eliav Contributing Authors: Sigal Portnoy, Debbie Rand

OBJECTIVE. We compared the feasibility of, adherence to, and satisfaction with a newly developed upper extremity (UE) self-training protocol using commercial video games with a traditional self-training program for people with chronic stroke. METHOD. Twenty-four participants with mild to moderate UE weakness were randomized to a video game (n = 13) or traditional (n = 11) self-training program. Participants were requested to train 60 min/day, 6×/wk. During the 5-wk self-training program and 4-wk follow-up, participants documented their self-training time and rated their perceived enjoyment and exertion. RESULTS. Eleven participants completed video game training; 9 completed traditional self-training. During the follow-up period, 8 participants (72.7%) continued the video game training, and 4 (44.4%) continued traditional training. Perceived enjoyment, satisfaction, and benefit for UE improvement were relatively high. CONCLUSIONS. Participants demonstrated high adherence to and satisfaction with both self-training programs. More participants continued to play video games after the intervention, indicating its potential to maintain ongoing activity.

OBJECTIVE. The Executive Function Performance Test (EFPT) is a reliable and valid performance-based tool to assess executive functions (EFs). This study’s objective was to develop and verify two Internet-based tasks for the EFPT. METHOD. A cross-sectional study assessed the alternate-form reliability of the Internet-based bill-paying and telephone-use tasks in healthy adults and people with subacute stroke (Study 1). It also sought to establish the tasks’ criterion reliability for assessing EF deficits by correlating performance with that on the Trail Making Test in five groups: healthy young adults, healthy older adults, people with subacute stroke, people with chronic stroke, and young adults with attention deficit hyperactivity disorder (Study 2). RESULTS. The alternative-form reliability and initial construct validity for the Internet-based bill-paying task were verified. Criterion validity was established for both tasks. CONCLUSION. The Internet-based tasks are comparable to the original EFPT tasks and can be used for assessment of EF deficits.

OBJECTIVE. Our objectives were (1) to quantify arm–hand use of older adults without a disability and to determine the effects of hand dominance, gender, and day on hand usage and (2) to determine the factors that predict arm–hand use. This information will enhance understanding of the extent of the client’s occupational performance. METHOD. Twenty men and 20 women, ages 65–85, wore wrist and hip accelerometers for 7 consecutive days. Manual dexterity and grip strength were assessed. A three-way factorial analysis of variance and multiple linear regressions were conducted. RESULTS. The activity kilocounts from both wrist accelerometers revealed a significant interaction effect between hand and gender (F[1, 190] = 24.4, p < .001). Enhanced manual dexterity of the right hand was associated with greater right-hand use. CONCLUSION. Arm–hand use is a novel dimension of hand function measuring the extent of real-life occupational performance in the client’s home.

OBJECTIVE. To explore the potential of the VMall, a virtual supermarket running on a video-capture virtual reality system, as an intervention tool for people who have multitasking deficits after stroke. METHOD. Poststroke, 4 participants received ten 60-min sessions over 3 weeks using the VMall. The intervention focused on improving multitasking while the participant was engaged in a virtual shopping task. Instruments included the Multiple Errands Test–Hospital Version (MET–HV) in a real mall and in the VMall. RESULTS. Participants achieved improvements ranging from 20.5% to 51.2% for most of the MET–HV measures performed in a real shopping mall and in the VMall. CONCLUSIONS. The data support the VMall's potential as a motivating and effective intervention tool for the rehabilitation of people poststroke who have multitasking deficits during the performance of daily tasks. However, because the sample was small, additional intervention studies with the VMall should be conducted.