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IntroductionSeveral studies have reported impaired emotion recognition in adults with traumatic brain injury (TBI), but studies have two major design features that limit application of results to real-world contexts: (1) participants choose from among lists of basic emotions, rather than generating emotion labels, and (2) images are typically presented in isolation rather than in context. To address these limitations, we created an open-labeling task with faces shown alone or in real-life scenes, to more closely approximate how adults with TBI label facial emotions beyond the lab.MethodsParticipants were 55 adults (29 female) with moderate to severe TBI and 55 uninjured comparison peers, individually matched for race, sex, and age. Participants viewed 60 photographs of faces, either alone or in the pictured person’s real-life context, and were asked what that person was feeling. We calculated the percent of responses that were standard forced-choice-task options, and also used sentiment intensity analysis to compare verbal responses between the two groups. We tracked eye movements for a subset of participants, to explore whether gaze duration or number of fixations helped explain any group differences in labels.ResultsOver 50% of responses in both groups were words other than basic emotions on standard affect tasks, highlighting the importance of eliciting open-ended responses. Valence of labels by participants with TBI was attenuated relative to valence of Comparison group labels, i.e., TBI group responses were less positive to positive images and the same was true for negative images, although the TBI group responses had higher lexical diversity. There were no significant differences in gaze duration or number of fixations between groups.DiscussionResults revealed qualitative differences in affect labels between adults with and without TBI that would not have emerged on standard forced-choice tasks. Verbal differences did not appear to be attributable to differences in gaze patterns, leaving open the question of mechanisms of atypical affect processing in adults with TBI.

Abstract While a growing number of machine learning (ML) systems have been deployed in clinical settings with the promise of improving patient care, many have struggled to gain adoption and realize this promise. Based on a qualitative analysis of coded interviews with clinicians who use an ML-based system for sepsis, we found that, rather than viewing the system as a surrogate for their clinical judgment, clinicians perceived themselves as partnering with the technology. Our findings suggest that, even without a deep understanding of machine learning, clinicians can build trust with an ML system through experience, expert endorsement and validation, and systems designed to accommodate clinicians’ autonomy and support them across their entire workflow.

BackgroundA critical gap in our knowledge about social media is whether we can alleviate accessibility barriers and challenges for individuals with traumatic brain injury (TBI), to improve their social participation and health. To do this, we need real-time information about these barriers and challenges, to design appropriate aids. ObjectiveThe aim of this study was to characterize the ways people with TBI accessed and used social media websites and understand unique challenges they faced. MethodsWe invited 8 adults with moderate to severe TBI to log onto their own Facebook page and use it as they regularly would while thinking aloud. Their comments were recorded and transcribed for qualitative analysis. We first analyzed participants’ utterances using a priori coding based on a framework proposed by Meshi et al to classify adults’ motives for accessing social media. We next used an open coding method to understand the challenges that people with TBI faced while using Facebook. In other words, we analyzed participants’ needs for using Facebook and then identified Facebook features that made it challenging for them to meet those needs. ResultsParticipants used all categories of codes in the framework by Meshi et al and provided detailed feedback about the Facebook user interface. A priori coding revealed 2 dimensions that characterized participants’ Facebook use: whether they were active or passive about posting and self-disclosure on Facebook and their familiarity and fluency in using Facebook. The open coding analysis revealed 6 types of challenges reported by participants with TBI, including difficulty with language production and interpretation, attention and information overload, perceptions of negativity and emotional contagion, insufficient guidance to use Facebook, concerns about web-based scams and frauds, and general accessibility concerns. ConclusionsResults showed that individuals with TBI used Facebook for the same reasons typical adults do, suggesting that it can help increase social communication and reduce isolation and loneliness. Participants also identified barriers, and we propose modifications that could improve access for individuals with brain injury. On the basis of identified functions and challenges, we conclude by proposing design ideas for social media support tools that can promote more active use of social media sites by adults with TBI.

BackgroundAdults with traumatic brain injury (TBI) report significant barriers to using current social media platforms, including cognitive overload and challenges in interpreting social cues. Rehabilitation providers may be tasked with helping to address these barriers.ObjectivesTo develop technological supports to increase social media accessibility for people with TBI-related cognitive impairments and to obtain preliminary data on the perceived acceptability, ease of use, and utility of proposed technology aids.MethodsWe identified four major barriers to social media use among individuals with TBI: sensory overload, memory impairments, misreading of social cues, and a lack of confidence to actively engage on social media platforms. We describe the process of developing prototypes of support aids aimed at reducing these specific social media barriers. We created mock-ups of these prototypes and asked 46 community-dwelling adults with TBI (24 females) to rate the proposed aids in terms of their acceptability, ease of use, and utility.ResultsAcross all aids, nearly one-third of respondents agreed they would use the proposed aids frequently, and the majority of respondents rated the proposed aids as easy to use. Respondents indicated that they would be more likely to use the memory and post-writing aids than the attention and social cue interpretation aids.ConclusionsFindings provide initial support for social-media-specific technology aids to support social media access and social participation for adults with TBI. Results from this study have design implications for future development of evidence-based social media support aids. Future work should develop and deploy such aids and investigate user experience.

BackgroundVoice-controlled smart speakers and displays have a unique but unproven potential for delivering eHealth interventions. Many laptop- and smartphone-based interventions have been shown to improve multiple outcomes, but voice-controlled platforms have not been tested in large-scale rigorous trials. Older adults with multiple chronic health conditions, who need tools to help with their daily management, may be especially good candidates for interventions on voice-controlled devices because these patients often have physical limitations, such as tremors or vision problems, that make the use of laptops and smartphones challenging. ObjectiveThe aim of this study is to assess whether participants using an evidence-based intervention (ElderTree) on a smart display will experience decreased pain interference and improved quality of life and related measures in comparison with participants using ElderTree on a laptop and control participants who are given no device or access to ElderTree. MethodsA total of 291 adults aged ≥60 years with chronic pain and ≥3 additional chronic conditions will be recruited from primary care clinics and community organizations and randomized 1:1:1 to ElderTree access on a smart display along with their usual care, ElderTree access on a touch screen laptop along with usual care, or usual care alone. All patients will be followed for 8 months. The primary outcomes are differences between groups in measures of pain interference and psychosocial quality of life. The secondary outcomes are between-group differences in system use at 8 months, physical quality of life, pain intensity, hospital readmissions, communication with medical providers, health distress, well-being, loneliness, and irritability. We will also examine mediators and moderators of the effects of ElderTree on both platforms. At baseline, 4 months, and 8 months, patients will complete written surveys comprising validated scales selected for good psychometric properties with similar populations. ElderTree use data will be collected continuously in system logs. We will use linear mixed-effects models to evaluate outcomes over time, with treatment condition and time acting as between-participant factors. Separate analyses will be conducted for each outcome. ResultsRecruitment began in August 2021 and will run through April 2023. The intervention period will end in December 2023. The findings will be disseminated via peer-reviewed publications. ConclusionsTo our knowledge, this is the first study with a large sample and long time frame to examine whether a voice-controlled smart device can perform as well as or better than a laptop in implementing a health intervention for older patients with multiple chronic health conditions. As patients with multiple conditions are such a large cohort, the implications for cost as well as patient well-being are significant. Making the best use of current and developing technologies is a critical part of this effort. Trial RegistrationClinicalTrials.gov NCT04798196; https://clinicaltrials.gov/ct2/show/NCT04798196 International Registered Report Identifier (IRRID)PRR1-10.2196/37522

Remote teleoperation of robots can broaden the reach of domain specialists across a wide range of industries such as home maintenance, health care, light manufacturing, and construction. However, current direct control methods are impractical, and existing tools for programming robot remotely have focused on users with significant robotic experience. Extending robot remote programming to end users, i.e., users who are experts in a domain but novices in robotics, requires tools that balance the rich features necessary for complex teleoperation tasks with ease of use. The primary challenge to usability is that novice users are unable to specify complete and robust task plans to allow a robot to perform duties autonomously, particularly in highly variable environments. Our solution is to allow operators to specify shorter sequences of high-level commands, which we call task-level authoring, to create periods of variable robot autonomy. This approach allows inexperienced users to create robot behaviors in uncertain environments by interleaving exploration, specification of behaviors, and execution as separate steps. End users are able to break down the specification of tasks and adapt to the current needs of the interaction and environments, combining the reactivity of direct control to asynchronous operation. In this paper, we describe a prototype system contextualized in light manufacturing and its empirical validation in a user study where 18 participants with some programming experience were able to perform a variety of complex telemanipulation tasks with little training. Our results show that our approach allowed users to create flexible periods of autonomy and solve rich manipulation tasks. Furthermore, participants significantly preferred our system over comparative more direct interfaces, demonstrating the potential of our approach for enabling end users to effectively perform remote robot programming.

BackgroundIndividuals with a history of traumatic brain injury (TBI) report fewer social contacts, less social participation, and more social isolation than noninjured peers. Cognitive-communication disabilities may prevent individuals with TBI from accessing the opportunities for social connection afforded by computer-mediated communication, as individuals with TBI report lower overall usage of social media than noninjured peers and substantial challenges with accessibility and usability. Although adaptations for individuals with motor and sensory impairments exist to support social media use, there have been no parallel advances to support individuals with cognitive disabilities, such as those exhibited by some people with TBI. In this study, we take a preliminary step in the development process by learning more about patterns of social media use in individuals with TBI as well as their input and priorities for developing social media adaptations. ObjectiveThis study aims to characterize how and why adults with TBI use social media and computer-mediated communication platforms, to evaluate changes in computer-mediated communication after brain injury, and to elicit suggestions from individuals with TBI to improve access to social media after injury. MethodsWe conducted a web-based survey of 53 individuals with a chronic history of moderate-to-severe TBI and a demographically matched group of 51 noninjured comparison peers. ResultsMore than 90% of participants in both groups had an account on at least one computer-mediated communication platform, with Facebook and Facebook Messenger being the most popular platforms in both groups. Participants with and without a history of TBI reported that they use Facebook more passively than actively and reported that they most frequently maintain web-based relationships with close friends and family members. However, participants with TBI reported less frequently than noninjured comparison participants that they use synchronous videoconferencing platforms, are connected with acquaintances on the web, or use social media as a gateway for offline social connection (eg, to find events). Of the participants with TBI, 23% (12/53) reported a change in their patterns of social media use caused by brain injury and listed concerns about accessibility, safety, and usability as major barriers. ConclusionsAlthough individuals with TBI maintain social media accounts to the same extent as healthy comparisons, some may not use them in a way that promotes social connection. Thus, it is important to design social media adaptations that address the needs and priorities of individuals with TBI, so they can also reap the benefits of social connectedness offered by these platforms. By considering computer-mediated communication as part of individuals’ broader social health, we may be able to increase web-based participation in a way that is meaningful, positive, and beneficial to broader social life.

Summary: Virtual and physical embodiments of interactive artificial agents utilize similar core technologies for perception, planning, and interaction and engage with people in similar ways. Thus, designers have typically considered these embodiments to be broadly interchangeable, and the choice of embodiment primarily depends on the practical demands of an application. This paper makes the case that virtual and physical embodiments elicit fundamentally different “frames of mind” in the users of the technology and follow different metaphors for interaction, resulting in diverging expectations, forms of engagement, and eventually interaction outcomes. It illustrates these differences through the lens of five key mechanisms: “situativity, interactivity, agency, proxemics, and believability”. It also outlines the design implications of the two frames of mind, arguing for different domains of interaction serving as appropriate context for virtual and physical embodiments.

A growing body of literature has examined sex differences in a variety of outcomes from moderate-severe traumatic brain injury (TBI), including outcomes for social functioning. Social functioning is an area in which adults with TBI have significant long-term challenges (1–4), and a better understanding of sex and gender differences in this domain may have a significant clinical impact. This paper presents a brief narrative review of current evidence regarding sex differences in one aspect of social functioning in adults with TBI: social cognition, specifically affect recognition and Theory of Mind (ToM). Data from typical adults and adults with TBI are considered in the broader context of common stereotypes about social skills and behaviors in men vs. women. We then discuss considerations for future research on sex- and gender-based differences in social cognition in TBI, and in adults more generally.