Objective. We investigated the preliminary efficacy of cathodal transcranial direct current stimulation (tDCS) combined with bimanual training in children and young adults with unilateral cerebral palsy based on the principle of exaggerated interhemispheric inhibition (IHI). Methods. Eight participants with corticospinal tract (CST) connectivity from the lesioned hemisphere participated in an open-label study of 10 sessions of cathodal tDCS to the nonlesioned hemisphere (20 minutes) concurrently with bimanual, goal-directed training (120 minutes). We measured the frequency of adverse events and intervention efficacy with performance (bimanual—Assisting Hand Assessment (AHA)—and unimanual—Box and Blocks), self-report (Canadian Occupational Performance Measure (COPM), ABILHAND), and neurophysiologic (motor-evoked potential amplitude, cortical silent period (CSP) duration, and motor mapping) assessments. Results. All participants completed the study with no serious adverse events. Three of 8 participants showed gains on the AHA, and 4 of 8 participants showed gains in Box and Blocks (more affected hand). Nonlesioned CSP duration decreased in 6 of 6 participants with analyzable data. Cortical representation of the first dorsal interosseous expanded in the nonlesioned hemisphere in 4 of 6 participants and decreased in the lesioned hemisphere in 3 of 4 participants with analyzable data. Conclusions. While goal achievement was observed, objective measures of hand function showed inconsistent gains. Neurophysiologic data suggests nonlinear responses to cathodal stimulation of the nonlesioned hemisphere. Future studies examining the contributions of activity-dependent competition and cortical excitability imbalances are indicated.

Background: Type 2 diabetes mellitus (T2DM) is highly prevalent in the United States and represents a significant public health challenge. Telehealth interventions have shown promise for improving T2DM outcomes, but their effectiveness is often limited by disparities in digital literacy and access, especially in rural areas. To address this gap, we propose an innovative, individualized lifestyle modification intervention delivered via phone call to support glycemic control. Objective: This paper outlines the protocol for a pilot study designed to assess the feasibility and preliminary effectiveness of an artificial intelligence–assisted intervention for T2DM self-management in rural settings. Methods: The study uses the preparation phase of the MOST (Multiphase Optimization Strategy) framework to evaluate two components: (1) automated versus human health coaching and (2) fixed versus adapted gamified financial incentives, based on participants’ daily engagement with automated monitoring calls. We aim to enroll 88 adults with T2DM and hemoglobin A1c (HbA1c) levels between 6.5% and 11.5%. Participants receive daily interactive voice response calls tracking diet, physical activity, medication adherence, and blood glucose, and weekly coaching based on randomization. In the fixed-reward arm, participants earn US $0.60 per day; in the adaptive arm, rewards start at US $0.20 and increase weekly, with penalties for missed days. Primary outcomes include feasibility metrics and preliminary changes in HbA1c. Semistructured interviews will assess patient experience. Results: This study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases. As of October 2025, we have enrolled and completed data collection for 88 participants. We expect to complete the feasibility analysis by December 2025. Conclusions: This pilot and feasibility study evaluates a low-tech, artificial intelligence–assisted T2DM intervention designed to reduce digital barriers and inform a future MOST optimization trial. Trial Registration: ClinicalTrials.gov NCT05344859; https://clinicaltrials.gov/study/NCT05344859 International Registered Report Identifier (IRRID): DERR1-10.2196/70271

Background: Patients with chronic diseases often need to adhere to long-term individualized home exercise programs (HEPs). Limited adherence to long-term exercise given during physical therapy (PT) visits reduces the capacity of exercise to manage or improve symptoms related to chronic disease. In addition, a lower socioeconomic status negatively impacts exercise adherence. To mitigate this, apps that motivate people to exercise could be a viable option. Using an app through telehealth may help adults with chronic diseases to achieve long-term HEP adherence. However, because apps for rehabilitation are an emerging field, the feasibility of the app needs to be evaluated. Objective: To address HEP adherence in participants with chronic diseases who are experiencing financial distress, we aim to evaluate the feasibility of and satisfaction with the Hudl Technique app and telehealth and satisfaction with PT care and to monitor HEP adherence and compliance (ie, percentage of participant-recorded videos sent) in participants using the app with telehealth compared with those using standard HEPs on paper. Methods: We recruited patients scheduled for outpatient PT. We performed a randomized controlled trial in which the experimental group received weekly HEP demonstrations through app videos on a tablet with feedback on their self-recorded HEP video performance from the telehealth physical therapist. The control group received HEPs on paper without feedback, as is customary in PT practice. Demographic, clinical, and health coverage information was collected for screening and baseline measurements. Adherence and compliance were evaluated. Both groups completed surveys at 8 and 24 weeks on their satisfaction with PT care, and the experimental group also completed a survey on their satisfaction with the app with telehealth use. Descriptive and nonparametric statistics were used for within-group and between-group comparisons and analyzed with JMP, version 13. Results: Overall, 45 adults with chronic diseases who were experiencing financial distress were randomized into experimental (23/45, 51%) and control (22/45, 49%) groups, with 74% (17/23) and 86% (19/22) participants completing the 24-week HEP, respectively. The experimental group had an HEP adherence frequency of 4 (SD 2) to 5 (SD 2) times per week at 8 and 24 weeks (P=.14), whereas HEP adherence decreased in the control group from 4 (SD 2) to 3 (SD 2) times per week (P=.07), with a significant difference (P=.01) between groups at 24 weeks. Of the total participants, 68% (15/22) sent videos. They sent 68% (16/24) of the requested number of videos on average. The average score for PT care satisfaction was maintained at 87% in the experimental group (P=.99), whereas it decreased from 89% at 8 weeks to 74% at 24 weeks (P=.008) in the control group. App-related adverse events were not observed. Conclusions: The Hudl app/telehealth platform is feasible for delivering HEPs and maintaining HEP adherence in participants with chronic diseases who are experiencing financial distress. Trial Registration: ClinicalTrials.gov NCT02659280; https://clinicaltrials.gov/ct2/show/NCT02659280

Purpose: Recruitment for pediatric non-invasive brain stimulation (NIBS) studies is often challenged by low enrollment. Understanding parental perceptions regarding NIBS is crucial to develop new communication strategies to increase enrollment. Design/methodology/approach: Integrating a crossed-disciplinary approach, the authors conducted a survey at the 2018 Minnesota State Fair querying the perception of risk and preferences of current and future parents associated with pediatric NIBS research. The survey consisted of 28 closed-text questions including demographics, photographs portraying NIBS, terminologies and factors related to NIBS studies. Findings: Complete surveys were analyzed from 622 parent participants. A significant number of participants (42.8%) perceived the photographs of NIBS as “risky.” Additionally, 65.43% perceived the term “Non-invasive brain therapy” as not risky, a word combination not currently being used when recruiting potential participants. Over 90% (561/622) of participants chose the photograph of child-friendly MRI suite. Research limitations/implications: Although this survey identified aspects crucial in recruitment for pediatric NIBS research, there were limitations. For example, the authors did not record the sex or demographic distribution (e.g. rural versus urban setting) of the participants. These factors may also influence recruitment messaging. Originality/value: For important medical research to impact and improve the lives of the potential remedies, participation by the public in clinical trials is necessary. Often the general public perceives the trials as risky as a result of poor marketing communication recruitment material. This study sought to be understood if how the message is encoded has an impact on the decoding by the receiver.

BACKGROUND Type 2 diabetes mellitus (T2DM) is highly prevalent in the United States and represents a significant public health challenge. Telehealth interventions have shown promise for improving T2DM outcomes, but their effectiveness is often limited by disparities in digital literacy and access, especially in rural areas. To address this gap, we propose an innovative, individualized lifestyle modification intervention delivered via phone call to support glycemic control. OBJECTIVE This paper outlines the protocol for a pilot study designed to assess the feasibility and preliminary effectiveness of an artificial intelligence–assisted intervention for T2DM self-management in rural settings. METHODS The study uses the preparation phase of the MOST (Multiphase Optimization Strategy) framework to evaluate two components: (1) automated versus human health coaching and (2) fixed versus adapted gamified financial incentives, based on participants’ daily engagement with automated monitoring calls. We aim to enroll 88 adults with T2DM and hemoglobin A1c (HbA1c) levels between 6.5% and 11.5%. Participants receive daily interactive voice response calls tracking diet, physical activity, medication adherence, and blood glucose, and weekly coaching based on randomization. In the fixed-reward arm, participants earn US $0.60 per day; in the adaptive arm, rewards start at US $0.20 and increase weekly, with penalties for missed days. Primary outcomes include feasibility metrics and preliminary changes in HbA1c. Semistructured interviews will assess patient experience. RESULTS This study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases. As of October 2025, we have enrolled and completed data collection for 88 participants. We expect to complete the feasibility analysis by December 2025. CONCLUSIONS This pilot and feasibility study evaluates a low-tech, artificial intelligence–assisted T2DM intervention designed to reduce digital barriers and inform a future MOST optimization trial. CLINICALTRIAL ClinicalTrials.gov NCT05344859; https://clinicaltrials.gov/study/NCT05344859 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/70271

Background/Objectives: To evaluate construct (convergent and divergent) validity and conduct confirmatory factor analysis (CFA) of the National Center on Health, Physical Activity and Disability (NCHPAD) Wellness Assessment (NWA) tool. Methods: A cross-sectional survey validation study utilizing secondary data. We assessed Spearman correlations between NWA and 36-Item Short Form Health Survey (SF-36), NWA and Godin Leisure-Time Exercise Questionnaire (GLTEQ) and NWA and Modified Fatigue Impact Scale (MFIS) scores to determine construct validity. A CFA was conducted to test the appropriateness of a three-factor model for NWA. Results: Data from 149 participants were used to assess construct validity and from 180 participants for CFA. Both correlations between NWA mental wellness domain and SF-36 mental component scores and between NWA emotional/spiritual wellness domain and SF-36 emotional well-being scores were 0.61 (p < 0.001 for both). The correlation between NWA physical wellness domain and SF-36 physical component score was −0.06 (p = 0.45). The correlations of NWA with GLTEQ overall and with health contribution scores were 0.26 and 0.30, respectively (p < 0.001 for both). The correlations of all NWA domain and MFIS subscale scores ranged between −0.42 and −0.25 (p < 0.05). The CFA model’s comparative fit index was 0.90. Conclusions: The NWA physical wellness domain did not demonstrate strong convergent validity, as mental and emotional/spiritual wellness domains did. All domains showed strong divergent validity, and CFA showed evidence supporting a three-factor model. Future efforts will emphasize refining and reevaluating the physical wellness domain until it achieves strong psychometric properties.