IEEE Robotics & Automation Magazine - March 2023 - 94

the flow of the exercises and the use of the interface. This
was probably due to the lack of a possibility to skip specific
exercises and being forced to finish all of the established
rehabilitation programs.
The TAM was primarily developed to understand what
factors influence the intention to use technology. It is wellknown
from other studies that perceived usefulness and ease
of use positively influence intention to use, with the first factor
contributing more than the second in
the specific case of health care [18], [19].
However, it is interesting to note the previously
observed fact by literature showing
that the actual use does not always seem
to strongly correlate with the intention to
use [18]. In our study, significant correlations
were found between perceived usefulness
and intention to use, and between
ease of use and intention to use, with a
higher score in the first case. The results
confirmed the relationships already found
in other studies in the literature among
the domains of TAM. Other close relationships
emerged from the correlation
matrix, which are useful for understanding
and interpreting how the different
aspects that characterize a technological
system and its use influence each other.
Both intentions to use and perceived usefulness
appear to be positively influenced
by aesthetics and control factors, suggesting how the graphical
user interface and user experience play a critical role in
the choice of a health-care system. When patients feel confident
handling the application commands, which is not often
possible in health care, they are more willing to use a system
and, as expected, they consider it more user-friendly (see the
significant correlation between control and ease of use, albeit
with a lower score).
It should be emphasized that personal approaches toward
"
WHEN PATIENTS FEEL
CONFIDENT HANDLING
THE APPLICATION COMMANDS,
WHICH IS NOT
OFTEN POSSIBLE IN
HEALTH CARE, THEY ARE
MORE WILLING TO USE
A SYSTEM AND, AS EXPECTED,
THEY CONSIDER
IT MORE USER-FRIENDLY.
„
treated by the TR system received a greater visual stimulus
compared to those who were treated with traditional
speech/language therapy since the performance of exercises
requires visual focus on the display. On the other hand, a
speech/language rehabilitation program was prescribed to
the participants in the EG, but they were free to use the system
as much as they preferred, and no limits were set in this
regard. Thus, the positive clinical outcomes are expected
to be related also to the high-intensity
treatment, as reported in Table 3. As the
literature suggests, high-intensity therapy
of aphasia in patients in the chronic
phase is essential for optimizing recovery
[20]. Thus, the results confirmed
that the SmartCARE system can elicit
speech/language ability improvement
as in traditional therapy. However, these
clinical outcomes need confirmation by
a large sample.
In this study, both cognitive exercises
and language-therapy exercises were proposed,
but only pre/postlanguage treatment
evaluations as clinical assessments
were considered. Although the E.N.P.A.
and B.A.D.A. are the clinical assessment
for language-specific functions concerning
the functional cognitive aspects [16],
[17], no cognitive-specific evaluation
was performed. However, given the significant
improvement achieved by individuals in the EG, it
could be assumed that some other cognitive functions may
have improved as a result. Besides, we have no details to verify
this hypothesis.
Future studies must consider a set of ad hoc assessments of
cognitive abilities, including a large sample. The small sample
in this study was limiting for highlighting the clinical efficacy
of the TR for language/speech recovery in individuals with
chronic stroke and aphasia.
technology (attitude) have an impact on perceived immediacy
of use (ease of use) and vice-versa. Moreover, trust in technology
is positively influenced and reinforced by the pleasantness of
the experience (enjoyment). Finally, the actual time spent using
the health technology proposed was conditioned positively by the
pleasantness (aesthetics and enjoyment) and trust in engineered
equipment for health management.
Despite the clinical effects in this pilot study not being
investigated as the primary outcome, the preliminary results
obtained comparing the EG and CG were encouraging. The
comprehension of the auditory words achieved a statistically
significant enhancement only in the CG, but a good recovery
of this function was also gained by the participants in the
EG, even though not statistically significant (p = 0.059). The
EG achieved a significant improvement in three of the four
considered therapeutic domains of comprehension (visual
words and auditory and visual sentences comprehension).
This positive finding may depend on the fact that patients
94 IEEE ROBOTICS & AUTOMATION MAGAZINE MARCH 2023
CONCLUSION
The SmartCARE system for speech therapy is feasible and
safe. It has been revealed to be motivating and satisfying for
patients. Its approach could be considered a valid alternative
to traditional face-to-face speech therapy in chronic stroke
subjects. This solution can therefore be considered a fundamental
instrument for the continuity of care after subacute
intensive rehabilitation therapy. Chronic patients could
receive support even if they are no longer taken in charge by
national health services or if they live in disadvantaged
areas from the digital coverage point of view. In our limited
sample, the use of the system seems to elicit clinical
improvement in chronic aphasic patients in terms of receptive
abilities. The use of TR systems is highly recommended,
especially in such a historic period, to manage as well as
possible the COVID-19-related limitations to support rehabilitation
services.
IEEE Robotics & Automation Magazine - March 2023

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