Toward Evaluation of the Subjective Experience of a General Class of User-Controlled, Robot-Mediated Rehabilitation Technologies for Children with Neuromotor Disability

Round 1

Reviewer 1 Report

The authors introduced a framework towards A/R gamebot. The framework would be beneficial for children with neuromotor disabilities.

The paper is well structured and well written.

Figure 2 is poorly visualized. The authors can capture a better angle with high pixel camera.

Moreover, labeling should be smaller than the manuscript's text.

Author Response

Dear Reviewer,

Thank you so much for taking the time to review our work. We really appreciate your encouraging feedback.

• Figure 2 was an image of the PedBotHome footplate. We replaced it with a panel of three images, higher resolution, that show more clearly both the form of the system and how a child would interact with it. This is now labeled Figure 2a-c. In addition, we expanded the description of the device to make it easier to understand what one is seeing in the picture.
• Relative to the labeling, we went through and applied the MDPI table and figure caption formats from the styles menu throughout. Hopefully this will uniformly address the problem.

Thank you again for agreeing to review our paper.

Most sincerely,

Manon Schladen and the PedBotHome research team

Reviewer 2 Report

This work is very well presented and the novelty is very clear. The system had been evaluated by actual users, which is very important.

Some minor comments the authors may need to address in the final submission: 

The abstract contains abbreviations that are not explained like CP and A/R.

Figure 2 is blurred and not very clear.

Table 1 should not be split into two pages. It is a bit confusing.

Author Response

Dear Reviewer,

Thank you for agreeing to review our work and your encouraging remarks about our study!.

• The first line of the introduction now identifies CP as the abbreviation for cerebral palsy. We also added this clarification to the abstract. A/R (assistive/rehabilitative) is now defined on first use in the introduction as well. We also added a paragraph in the introduction to clarify for the reader early on that there is a distinction to be made between “assistive” and “rehabilitative” technologies and that this distinction is ultimately essential to productive evaluation of the user experience. In addition, we re-read the manuscript with an eye to things that might not be clear to a reader outside of our rehabilitation robotics domain and inserted clarifying text.
  
  
• We have reworked Table 1 (now Table 4) and it does not seem to break across pages. It is difficult to be completely sure about this, however, since the revision file is in web layout. We will work with the journal editors to make any formatting changes they require.

Thank you again for your time and effort in help us refine our manuscript.

Most sincerely,

Manon Schladen and the A/R gamebot research team

Reviewer 3 Report

The authors propose a study with CP by intervieing 8 children that had trialed an A/R game bot for 28 days in their homes. The aim of this study concerns the evaluation of theories and instrument for measuring the subjective experience of A/R gamebots.

The proposed study is interesting but there are some points that the authors should consider.

In the Introduction section there are some points/arguments that the author(s) point as given but, it is suggested, they support them with strong references. Furthermore, the authors should better analyze the research questions (Section 1.2) by adding more details about dimension of analysis.

The authors should be better described the novelties of their study (i.e. number of patients, length of trial) with respect to existing ones.  Furthermore, the authors should provide more details and discussion about the obtained results and the used technologies.

I suggest to analyze also more recent approaches about the examined topics. In particular, I suggest to cite the following papers for further investigating community analysis for unveil similar traits among users belonging to the same community:

1) Devices and Protocols for Upper Limb Robot-Assisted Rehabilitation of Children with Neuromotor Disorders. Applied Sciences, 9(13), 2689.

2) Community detection based on game theory. Engineering Applications of Artificial Intelligence, 85, 773-782.

Finally, I suggest to perform a linguistic revision

Author Response

Dear Reviewer,

We appreciate your encouragement and your time and thoughtfulness in evaluating our manuscript. We have made revisions through based on your observations and recommendations. What follows is a point-by-point description of how we addressed your specific concerns. We are attaching a track-changes version of the manuscript so you can see all the changes made.

• In the Introduction section there are some points/arguments that the author(s) point as given but, it is suggested, they support them with strong references. Furthermore, the authors should better analyze the research questions (Section 1.2) by adding more details about dimension of analysis.

We expanded our description of cerebral palsy (CP), following the model in the Devices and Protocol paper you recommended below. We also added more citations to evidence supporting our thesis that robotics and game-based therapy have demonstrated effectiveness in improving clinical outcomes in CP.

We elaborated on our contention that A/R gamebots are a new class of technology. We grounded this perception in the rehab service delivery context experienced in the US where there currently is no classification under which systems such as A/R gamebots can be prescribed and reimbursed. We describe the indirection of their use that is the essence of their novelty.

Finally, we address the all-important distinction between rehabilitative and assistive technology up front since this differentiation drives the need for a tailored assessment measure for A/R gambot class technologies.

• The authors should be better described the novelties of their study (i.e. number of patients, length of trial) with respect to existing ones.  Furthermore, the authors should provide more details and discussion about the obtained results and the used technologies.

We added clarification to the instrument design process we are using – a figure to supplement the logic model from the original manuscript.

We also added a more in-depth description of the PedBotHome system and referred the reader to our IEEE technical paper that more fully describes the hardware and software.

We added more information about the children who participated in the trial. New Table 2 provides demographics. We also discussed the limitation of small sample size in the Limitations section. By way oof comparing our work to that of others, we noted that sample sizes in the single digits or teens are unfortunately typical of our research area. The prevalence of CP is not that large, so it is always difficult to recruit a sizeable cohort of children to studies.

Preliminary results are also part of an earlier manuscript we reference. We currently have a clinical paper nearing completion that will provide the final objectiv analysis on the impact of PedBotHome on children’s range of motion, strength and other outcomes. Our goal with this paper was to focus on the issue of subjective evaluation and acceptance. Perceived effectiveness is a part of that, predicted by both exercise adherence and exergaming theory and described in the results.

• I suggest to analyze also more recent approaches about the examined topics. In particular, I suggest to cite the following papers for further investigating community analysis for unveil similar traits among users belonging to the same community:
  • Devices and Protocols for Upper Limb Robot-Assisted Rehabilitation of Children with Neuromotor Disorders. Applied Sciences, 9(13), 2689.
  • Community detection based on game theory. Engineering Applications of Artificial Intelligence, 85, 773-782.

We appreciate the referral to the Applied Sciences paper. We incorporated citations and used it to note that, even though our focus is lower extremity, robotics and gamification have been shown to be effective generally in addressing the therapy needs of children with CP, be those needs focused on lower extremity (principally gait) or upper extremity (principally dexterity).

In reading your recommendation of the community detection paper, we realized that there was a certain lack of clarity in our writing that we set about to rectify. It is interesting to aspire to use a game theoretic approach to understand the groupings around technology acceptance, but we do not have the N and corresponding volume of data to make that happen in our rehab domain.

That said, we really appreciate your insight relative to the game theoretic mechanism underlying technology decision-making among parent-child dyads and likely, parent-child-clinician triads. We added that dimension in the final paragraph of the discussion.

• Finally, I suggest to perform a linguistic revision

Stylistic review is always in order. We closely review the entire manuscript, catching typos and non-sequiturs. We also worked to introduce greater clarity, shorten sentences and tighten up vocabulary.

Again, we really appreciate your time and thoughtfulness in helping us refine our article. Thank you so much.

Sincerely,

Manon Schladen and the PedBotHome team

Round 2

Reviewer 3 Report

I think that the authors have addressed all my concerns.