Study Procedure
Each participant underwent a single assessment session lasting approximately 90 minutes. During this session, the COCARE system components were presented to participants, who subsequently tried them out. Each session at each site followed a standardized protocol corresponding to the natural flow of the COCARE system.First, the participant’s functional status was assessed using 2 tests on the Senso, beginning each test with a brief warm-up for familiarization before proceeding with the main assessment.The first assessment, the Stroop Test, is based on the Color-Word Interference Test by Stroop [Color part: squares in 4 different colors are displayed in the middle, and the color of the square has to be matched with the color of the respective circle.Word part: the given stimuli are the 4 different colors written in black. The written color has to be matched with the respective circle.Inhibition part: words are written in colors (red, green, blue, and yellow). The color of the writing has to be matched with the circles.Flexibility part: colored words appear in the center. Participants have to switch between selecting the color of the writing and the color they read in case the word is enclosed within a box.The second assessment, the Coordinated Stability Test originally developed by Lord et al [HPs performed both assessments twice—first assuming the role of a patient and then acting as a therapist guiding the investigator, who simulated the role of a patient.Subsequently, the investigators demonstrated the newly adapted UI of the assessment system, which participants had the opportunity to try out. Following this, an example assessment report describing and explaining the participants’ functional status and providing derived training recommendations was presented to all participants.Afterward, participants were instructed by the investigator to set up the Senso Flex before they engaged in a selection of predetermined exergames on the Senso Flex for 80 to 150 seconds each. The games included the following:Targets (divided attention and action planning; 80 s): balls come flying simultaneously from different directions and need to be hit when reaching the middle of 1 of 4 targets displayed on the screen by stepping in the corresponding direction.Tetris (action planning, visuospatial orientation, and mental rotation; 150 s): differently shaped pieces descending from the top to the bottom have to be rotated and moved to create complete horizontal lines.Rocket (endurance; 80 s): participants control a rocket flying through space by marching on the middle plate. A green arrow and a red bar indicate the need to increase or decrease stepping frequency, respectively.Evolve (balance control, weight shifting, and action planning; 80 s): blue rings, red dots, and a yellow figure are displayed on the screen. Participants control the yellow figure by shifting their center of pressure to catch the blue rings while avoiding the red dots.Simon (short-term memory and memory span; 80 s): a given stepping sequence must be memorized and repeated.Finally, participants were introduced to the COCARE rehabilitation cockpit, which involved the following two components:A training overview for HPs to monitor adherence displaying the user’s training frequency, components, and performance (The management system, which enables HPs to create a training plan by selecting appropriate games and setting training parameters for each game, such as duration, speed, and other game-specific setting options (Participants were also informed about the concept of a communication tool integrated into the COCARE system, and their wishes and expectations regarding such a tool were elicited.Before concluding the session, participants completed questionnaires addressing various aspects of usability, acceptance, and enjoyment.The 4 levels of the Stroop Test (from top left to bottom right).Output of the Coordinated Stability Test.