Background:Telehealth was frequently used in the provision of care and remote patient monitoring (RPM) during the COVID-19 pandemic. The Precision Recovery Program (PRP) remotely monitored and supported patients with COVID-19 in their home environment. Methods:This was a single-center retrospective cohort study reviewing data acquired from the PRP clinical initiative. Results:Of the 679 patients enrolled in the PRP, 156 patients were screened by a clinician following a deterioration in symptoms and vital signs on a total of 240 occasions, and included in the analyses. Of these 240 occasions, 162 (67%) were escalated to the PRP physician. Thirty-six patients were referred to emergency department, with 12 (7%) admitted to the hospital. The most common risk factors coinciding with hospital admissions were cardiac (67%), age >65 (42%), obesity (25%), and pulmonary (17%). The most common symptoms reported that triggered a screening event were dyspnea/tachypnea (27%), chest pain (14%), and gastrointestinal issues (8%). Vital signs that commonly triggered a screening event were pulse oximetry (15%), heart rate (11%), and temperature (9%). Discussion:Common factors (risk factors, vital signs, and symptoms) among patients requiring screening, triage, and hospitalization were identified, providing clinicians with further information to support decision making when utilizing RPM in this cohort. Conclusion:A clinician-led RPM program for patients with acute COVID-19 infection provided supportive care and screening for deterioration. Similar models should be considered for implementation in COVID-19 cohorts and other conditions at risk of rapid clinical deterioration in the home setting.

Numerosity, or the ability to understand and distinguish between discrete quantities, was first formalized for study in animals by Mechner (1958a). Rats had to press one lever (the counting lever) n times to arm food release from pressing a second lever (the reward lever). The only cue that n presses had been made to the counting lever was the animal’s representation of how many times it had pressed it. In the years that have passed since, many researchers have modified the task in meaningful ways to attempt to tease apart timing-based and count-based strategies. Strong evidence has amassed that the two are fundamentally different and separable skills but, to date, no study has effectively examined the differential contributions of the two strategies in Mechner’s original task. By examining performance mid-trial and correlating it with whole-trial performance, we were able to identify patterns of correlation consistent with counting and timing strategies. Due to the independent nature of these correlation patterns, this technique was uniquely able to provide evidence for strategies that combined both timing and counting components. The results show that most mice demonstrated this combined strategy. This provides direct evidence that mice can and do use numerosity to complete Mechner’s original task. A rational agent with fallible estimates of both counts made and time elapsed in making them should use both estimates when deciding when to switch to the second lever.

Spinal cord injury (SCI) impairs motor function and requires rigorous rehabilitative therapy, motivating the development of approaches that are engaging and customizable. Virtual reality (VR) motor training with augmented sensory feedback (ASF) offers a promising pathway to enhance functional outcomes, yet it remains unclear how ASF modalities affect performance and underlying psychophysiological states in persons with SCI. Five participants with chronic incomplete cervical-level SCI controlled a virtual robotic arm with semi-isometric upper-body contractions while undergoing ASF training with either visual feedback (VF) or combined visual plus haptic feedback (VHF). Motor performance (pathlength, completion time), psychophysiological measures (EEG, EMG, EDA, HR), and perceptual ratings (agency, motivation, utility) were assessed before and after ASF training. VF significantly reduced pathlength (−12.5%, p = 0.0011) and lowered EMG amplitude (−32.5%, p = 0.0063), suggesting the potential for improved motor performance and neuromuscular efficiency. VHF did not significantly improve performance, but trended toward higher cortical engagement. EEG analyses showed VF significantly decreased alpha and beta activity after training, whereas VHF trended toward mild increases. Regression revealed improved performance was significantly (p < 0.05) associated with changes in alpha power, EMG, EDA, and self-reported motivation. ASF type may differentially shape performance and psychophysiological responses in SCI participants. These preliminary findings suggest VR-based ASF as a potent multidimensional tool for personalizing rehabilitation.

After neurological injury, individuals often undergo physical therapy to regain motor function, which can be supplemented with use of virtual reality (VR). Rehabilitation commonly employs methods that encourage movement variability to promote functional gains, such as perturbations. Rehabilitation also commonly integrates additional sensory modalities for guidance and cognitive engagement to the protocol. In this exploratory, proof-of-concept study, neurotypical participants were trained on a custom tracing task with targeted dynamic shifting to induce movement variability, under both expected (proactive) and unexpected (reactive) conditions, with and without added auditory feedback. Participants significantly (p < 0.05) improved performance (tracing accuracy) after training with audio feedback. Participants trained without audio feedback showed decreased electrodermal activity (EDA), a measure of physiological engagement. Audio feedback during reach training with complex objectives (e.g., dynamic shifting) can promote performance improvements and cognitive engagement.

Neurological injuries and disorders affecting hand motor control can severely impair the ability to perform activities of daily living and substantially reduce quality of life. Technologies such as virtual reality (VR) are increasingly used to address fundamental challenges in therapy, including motivation and engagement; further, programmable features of digital interfaces offer additional opportunities to personalize and optimize motor training. In this proof-of-concept study, we developed and evaluated a novel VR-based training framework to support improved dexterity and hand function using physiological (sensory-driven) and cognitive (memory) cues designed to promote greater task-relevant neural engagement. The proposed approach leverages the integration of augmented sensory feedback (ASF) with memory-anchored cues for motor learning of target hand gestures. Using a within-subjects design, thirteen neurotypical adults completed four training conditions: (1) control (baseline gesture-matching in VR), (2) visual ASF (enhanced visualization and feedback of gesture accuracy), (3) memory-anchored cues (associating gestures with semantically meaningful entities, loosely analogous to American Sign Language), and (4) hybrid multimodal (visual ASF + memory-anchored cues). Training with the hybrid condition produced the fastest skill acquisition (9.3 trials to reach an 80% accuracy threshold) and the steepest initial learning slope (1.86 ± 0.12%/trial), with all conditions differing significantly in initial slope (all p < 0.002). Post-training assessment showed that the hybrid condition achieved the highest gesture accuracy (95.2%), greatest normalized post-training accuracy gain (14.3% above baseline), fastest execution time to target gesture (1.14 s), and lowest variability in gestural kinematics (SD = 3.9%). Both ASF and memory-anchored cue conditions each also independently outperformed the control condition on gesture accuracy (both p ≤ 0.002), with omnibus ANOVAs indicating significant condition effects across metrics. Together, these findings suggest that pairing ASF cues with memory-based cognitive scaffolding can yield additive benefits for motor skill acquisition and stability. Pending validation in clinical populations, such approaches may inform the design of VR-based motor training frameworks for rehabilitation.