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Kifley A, Geraghty TJ, Arora M, Bourke J, Craig A, Cameron ID, Nunn A, Marshall R, Middleton JW. Complex lived experiences and hidden disability after spinal cord injury: a latent profile analysis of the Australian arm of the International Spinal Cord Injury (Aus-InSCI) Community Survey. Disabil Rehabil 2023:1-12. [PMID: 38018422 DOI: 10.1080/09638288.2023.2283101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 11/09/2023] [Indexed: 11/30/2023]
Abstract
PURPOSE To identify and examine subgroups of people with spinal cord injury (SCI) with different patterns of lived experience, and examine hidden impairments and disability among functionally independent and ambulant people. MATERIALS AND METHODS Latent profile analysis of population-based data from the Australian arm of the International Spinal Cord Injury (InSCI) Community survey (n = 1579). RESULTS Latent subgroups reflected levels of functional independence and extent of problems with health, activity/participation, environmental barriers, and self-efficacy. Quality of life (QoL), psychological profiles, and activity/participation were often as good or better in participants who reported lower (vs. higher) functional independence alongside comparable burden of health problems and environmental barriers. QoL, mental health, and vitality reflected self-efficacy and problem burdens more closely than functional independence. Ambulant participants reported a substantial burden of underlying, potentially hidden impairments, with QoL and mental health similar to wheelchair users. CONCLUSION Hidden disability among more independent and/or ambulant people with SCI can affect well-being substantially. Early and ongoing access to support, rehabilitation, and SCI specialist services is important irrespective of cause, type, severity of injury, and level of functional independence. Improved access to SCI expertise and equity of care would help to improve early recognition and management of hidden disability. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Annette Kifley
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, Sydney, Australia
- Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Timothy J Geraghty
- Queensland Spinal Cord Injuries Service, Division of Rehabilitation, Princess Alexandra Hospital, Metro South Health, Woolloongabba, Australia
- The Hopkins Centre, Metro South Health and Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Mohit Arora
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, Sydney, Australia
- Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - John Bourke
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, Sydney, Australia
- Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Burwood Academy Trust, Christchurch, New Zealand
| | - Ashley Craig
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, Sydney, Australia
- Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, Sydney, Australia
- Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Andrew Nunn
- Victorian Spinal Cord Service, Austin Health, Heidelberg, Australia
| | - Ruth Marshall
- South Australian Spinal Cord Injury Service, Central Adelaide Local Health Network, Adelaide, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - James W Middleton
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, Sydney, Australia
- Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- State Spinal Cord Injury Service, Agency for Clinical Innovation, St Leonards, Australia
- Spinal Outreach Service, Royal Rehab, Ryde, Australia
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Arsh A, Darain H, Ullah I, Shakil-ur-Rehman S. Diagnostic tests to assess balance in patients with spinal cord injury: a systematic review of their validity and reliability. ASIAN BIOMED 2021; 15:111-118. [PMID: 37551368 PMCID: PMC10388767 DOI: 10.2478/abm-2021-0014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Sophisticated biomechanical instruments can assess balance in patients with spinal cord injury (SCI) with accuracy and precision; however, they are costly and time consuming to use. Clinical diagnostic tests to assess balance in patients with SCI are less costly and easier to use, but there is limited literature available regarding their reliability and validity. Objectives To review systematically articles reporting the validity and reliability of diagnostic tests used to assess balance function in patients with SCI. Methods We searched for articles in the English language from the earliest record to December 15, 2020, which reported validity or reliability of any clinical instrument or diagnostic test used to assess balance in patients with SCI. Articles assessing balance in paraplegic patients with causes other than SCI were excluded. Databases included MEDLINE, AMED, EMBASE, HMIC, PsycINFO, CINAHL, Scopus, and Google Scholar. The COSMIN Risk of Bias checklist was used to assess the studies included and PRISMA-DTA guidelines were applied. Results We included 16 articles that assessed the validity or reliability of 10 diagnostic tests. The Functional Reach Test (FRT), Berg Balance Scale (BBS), and Mini-Balance Evaluation Systems Test (Mini-BESTest) were assessed by more than 1 study, while the remaining 7 diagnostic tests including the Function in Sitting Test, T-Shirt Test, Motor Assessment Scale item 3, Sitting Balance Score, 5 Times Sit-to-Stand Test, Tinetti scale, and Sitting Balance Measure were assessed by 1 study each. The FRT has good-to-excellent test-retest reliability, excellent inter-rater reliability, and good construct, concurrent, and convergent validity. The BBS has excellent inter-rater and intra-rater reliability, high internal consistency, and good concurrent and construct validity. The Mini-BESTest has excellent test-retest reliability, excellent inter-rater reliability, high internal consistency, and good concurrent, convergent, and construct validity. Conclusions The FRT, BBS, and Mini-BESTest appear to be valid and reliable clinical instruments to assess balance function in patients with SCI.
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Affiliation(s)
- Aatik Arsh
- Institute of Physical Medicine and Rehabilitation, Khyber Medical University, Peshawar, Khyber Pakhtunkhwa25100, Pakistan
| | - Haider Darain
- Institute of Physical Medicine and Rehabilitation, Khyber Medical University, Peshawar, Khyber Pakhtunkhwa25100, Pakistan
| | - Irfan Ullah
- Kabir Medical College, Gandhara University, Peshawar, Khyber Pakhtunkhwa25000, Pakistan
| | - Syed Shakil-ur-Rehman
- Riphah College of Rehabilitation and Allied Health Sciences, Riphah International University Lahore, Punjab54000, Pakistan
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Mortaza N, Moussavi Z, Stecina K, Salter JE, Passmore SR, Gardiner PF, Glazebrook CM. Effects of training with a neuro-mechano stimulator rehabilitation bicycle on functional recovery and paired-reflex depression of the soleus in individuals with incomplete paralysis: a proof-of-principle study. Int J Neurosci 2019; 129:1066-1075. [PMID: 31220973 DOI: 10.1080/00207454.2019.1634068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Aim: The present study describes the training effects of a novel motorized bicycle-like device for individuals with incomplete spinal cord injury. Methods: Participants were five individuals with motor incomplete spinal cord injury (56 ± 7 years). Four of five participants received two 30-min sessions of training: one with, and one without, mechanical stimulation on the plantar surface of the foot; soleus paired H-reflex depression was examined before and after each session. Three of five participants received 24 sessions of 30-min of training (long-training). Following the long-training, balance, walking and spasticity improvements were assessed using validated clinical outcome measures, in addition to the H-reflex assessment. Results: One cycling session with mechanical stimulation yielded 14% and 32% more reflex depression in participants with moderate spasticity (n = 2/4). The same trend was not observed in non-spastic participants (n = 2/4). All participants who participated in the long-training had spasticity and showed reduced spasticity, improved walking speed, endurance and balance. Conclusions: Overall, participants with spasticity showed increased soleus H-reflex suppression after one training session with mechanical stimulation and reduced spasticity scores after long training. We interpret this as evidence that the training influenced both presynaptic and postsynaptic inhibitory mechanisms acting on soleus motoneurons. Therefore, this training has the potential to be a non-invasive complementary therapy to reduce spasticity after incomplete spinal cord injury.
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Affiliation(s)
- Niyousha Mortaza
- Program of Biomedical Engineering, Faculty of Engineering, University of Manitoba , Winnipeg , Manitoba , Canada.,Program of Applied Health Sciences, University of Manitoba , Winnipeg , Manitoba , Canada.,Faculty of Kinesiology and Recreation Management, University of Manitoba , Winnipeg , Manitoba , Canada
| | - Zahra Moussavi
- Program of Biomedical Engineering, Faculty of Engineering, University of Manitoba , Winnipeg , Manitoba , Canada
| | - Katinka Stecina
- Program of Biomedical Engineering, Faculty of Engineering, University of Manitoba , Winnipeg , Manitoba , Canada.,Department of Physiology & Pathophysiology, University of Manitoba , Winnipeg , Manitoba , Canada.,Spinal cord Research Center, University of Manitoba , Winnipeg , Manitoba , Canada
| | - Jennifer E Salter
- Faculty of Medicine, Physical Medicine and Rehabilitation, University of Manitoba , Winnipeg , Manitoba , Canada
| | - Steven R Passmore
- Program of Applied Health Sciences, University of Manitoba , Winnipeg , Manitoba , Canada.,Faculty of Kinesiology and Recreation Management, University of Manitoba , Winnipeg , Manitoba , Canada.,Health, Leisure, and Human Performance Research Institute, University of Manitoba , Winnipeg , Manitoba , Canada
| | - Phillip F Gardiner
- Faculty of Kinesiology and Recreation Management, University of Manitoba , Winnipeg , Manitoba , Canada.,Department of Physiology & Pathophysiology, University of Manitoba , Winnipeg , Manitoba , Canada.,Spinal cord Research Center, University of Manitoba , Winnipeg , Manitoba , Canada.,Health, Leisure, and Human Performance Research Institute, University of Manitoba , Winnipeg , Manitoba , Canada
| | - Cheryl M Glazebrook
- Program of Biomedical Engineering, Faculty of Engineering, University of Manitoba , Winnipeg , Manitoba , Canada.,Program of Applied Health Sciences, University of Manitoba , Winnipeg , Manitoba , Canada.,Faculty of Kinesiology and Recreation Management, University of Manitoba , Winnipeg , Manitoba , Canada.,Health, Leisure, and Human Performance Research Institute, University of Manitoba , Winnipeg , Manitoba , Canada
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Ugurlu B, Acer M, Barkana DE, Gocek I, Kucukyilmaz A, Arslan YZ, Basturk H, Samur E, Ugur E, Unal R, Bebek O. A Soft+Rigid Hybrid Exoskeleton Concept in Scissors-Pendulum Mode: A Suit for Human State Sensing and an Exoskeleton for Assistance. IEEE Int Conf Rehabil Robot 2019; 2019:518-523. [PMID: 31374682 DOI: 10.1109/icorr.2019.8779394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In this paper, we present a novel concept that can enable the human aware control of exoskeletons through the integration of a soft suit and a robotic exoskeleton. Unlike the state-of-the-art exoskeleton controllers which mostly rely on lumped human-robot models, the proposed concept makes use of the independent state measurements concerning the human user and the robot. The ability to observe the human state independently is the key factor in this approach. In order to realize such a system from the hardware point of view, we propose a system integration frame that combines a soft suit for human state measurement and a rigid exoskeleton for human assistance. We identify the technological requirements that are necessary for the realization of such a system with a particular emphasis on soft suit integration. We also propose a template model, named scissor pendulum, that may encapsulate the dominant dynamics of the human-robot combined model to synthesize a controller for human state regulation. A series of simulation experiments were conducted to check the controller performance. As a result, satisfactory human state regulation was attained, adequately confirming that the proposed system could potentially improve exoskeleton-aided applications.
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Yuan XN, Liang WD, Zhou FH, Li HT, Zhang LX, Zhang ZQ, Li JJ. Comparison of walking quality variables between incomplete spinal cord injury patients and healthy subjects by using a footscan plantar pressure system. Neural Regen Res 2019; 14:354-360. [PMID: 30531020 PMCID: PMC6301183 DOI: 10.4103/1673-5374.244798] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The main goal of spinal cord rehabilitation is to restore walking ability and improve walking quality after spinal cord injury (SCI). The spatiotemporal parameters of walking and the parameters of plantar pressure can be obtained using a plantar pressure analysis system. Previous studies have reported step asymmetry in patients with bilateral SCI. However, the asymmetry of other parameters in patients with SCI has not been reported. This was a prospective, cross-sectional study, which included 23 patients with SCI, aged 48.1 ± 14.5 years, and 28 healthy subjects, aged 47.1 ± 9.8 years. All subjects underwent bare foot walking on a plantar pressure measurement device to measure walking speed and spatiotemporal parameters. Compared with healthy subjects, SCI patients had slower walking speed, longer stride time and stance time, larger stance phase percentage, and shorter stride length. The peak pressures under the metatarsal heads and toe were lower in SCI patients than in healthy subjects. In the heel, regional impulse and the contact area percentage in SCI patients were higher than those in healthy subjects. The symmetry indexes of stance time, step length, maximum force, impulse and contact area were increased in SCI patients, indicating a decline in symmetry. The results confirm that the gait quality, including spatiotemporal variables and plantar pressure parameters, and symmetry index were lower in SCI patients compared with healthy subjects. Plantar pressure parameters and symmetry index could be sensitive quantitative parameters to improve gait quality of SCI patients. The protocols were approved by the Clinical Research Ethics Committee of Shengjing Hospital of China Medical University (approval No. 2015PS54J) on August 13, 2015. This trial was registered in the ISRCTN Registry (ISRCTN42544587) on August 22, 2018. Protocol version 1.0.
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Affiliation(s)
- Xiang-Nan Yuan
- Rehabilitation Department, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Wei-Di Liang
- Rehabilitation Department, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Feng-Hua Zhou
- Rehabilitation Department, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Han-Ting Li
- Rehabilitation Department, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Li-Xin Zhang
- Rehabilitation Department, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Zhi-Qiang Zhang
- Rehabilitation Department, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Jian-Jun Li
- Department of Orthopedics, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
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Jakimovska VM, Kostovski E, Biering-Sørensen F, Lidal IB. Fractures and musculoskeletal ailments in persons 20+ years after a traumatic spinal cord injury in Norway. Spinal Cord Ser Cases 2018; 4:76. [PMID: 30131875 PMCID: PMC6092425 DOI: 10.1038/s41394-018-0102-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 06/08/2018] [Accepted: 06/17/2018] [Indexed: 01/12/2023] Open
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVES To gain insights into fracture rate and musculoskeletal ailments among Norwegians with a spinal cord injury (SCI) acquired more than 20 years ago. SETTINGS Sunnaas Hospital, Nesoddtangen, Norway. METHODS 165 persons with SCI were interviewed in 2004-2005 by questionnaires and clinical examination. Descriptive statistics and a logistic regression analysis were performed to identify variables associated with bone fractures and musculoskeletal ailments. RESULTS Around half of the participants experienced a fracture after injury and excessive use of alcohol increased the odds (OR 0.09; CI 0.01-0.74) of suffering a post-injury fracture (p = 0.03). Sixty percent experienced shoulder ailments after the SCI and the use of orthosis to the knee and hip increased the odds (OR 4.4; CI 1.4-13) of experiencing shoulder ailment (p = 0.01). CONCLUSION Around half of the 165 participants reported to have suffered a fracture and over 100 to experience musculoskeletal ailment 20 years after injury. We suggest that prevention strategies and symptom management must be embedded in follow-up visits after SCI.
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Affiliation(s)
| | - Emil Kostovski
- Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Fin Biering-Sørensen
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Clinic for Spinal Cord Injuries, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Investigating the status of using lower extremity orthoses recommended to patients with spinal cord injury. Spinal Cord 2016; 54:996-1000. [PMID: 26976531 DOI: 10.1038/sc.2016.39] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 02/08/2016] [Accepted: 02/13/2016] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Retrospective descriptive study. OBJECTIVES The present study aimed to investigate the rate of using orthosis among spinal cord injury (SCI) patients for whom orthosis was recommended for standing and walking, the relationship between the clinical and demographic characteristics of SCI and the use of orthosis and the reasons for not using orthosis. SETTING Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Turkey. METHODS The study included 62 SCI patients for whom orthosis was recommended for standing and ambulation. The patients were classified into two groups as individuals using and not using the recommended orthosis every day in order to evaluate the effect of age, gender, residence, duration of disease/recommended duration of orthosis, recommended orthosis, lesion level-degree, lower extremity tonus-range of motion and ambulation level on the frequency of orthosis use. RESULTS The orthosis most commonly recommended was hip-knee-ankle-foot orthosis with waist or pelvic belt (45.2%). Of the patients, 25.8% have never used the orthosis. The most common reason for not using the recommended orthosis was the failure to facilitate the daily life activities of the patient (30%), the difficulties in putting them on and taking them off (20%), the belief that it is unnecessary (15%) and the pressure (15%). In addition, the assessed clinical and demographic features were detected as not important risk factors for not using orthosis. CONCLUSION At least one out of four patients with SCI do not use the recommended lower extremity orthosis. Selecting eligible patients, patient training and follow-up are important for increased frequency of orthosis usage.
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Braz GP, Russold MF, Fornusek C, Hamzaid NA, Smith RM, Davis GM. A novel motion sensor-driven control system for FES-assisted walking after spinal cord injury: A pilot study. Med Eng Phys 2016; 38:1223-1231. [DOI: 10.1016/j.medengphy.2016.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 04/24/2016] [Accepted: 06/07/2016] [Indexed: 11/25/2022]
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Braz GP, Russold MF, Fornusek C, Hamzaid NA, Smith RM, Davis GM. Cardiorespiratory and Muscle Metabolic Responses During Conventional Versus Motion Sensor-Assisted Strategies for Functional Electrical Stimulation Standing After Spinal Cord Injury. Artif Organs 2016; 39:855-62. [PMID: 26471136 DOI: 10.1111/aor.12619] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This is a case series study with the objective of comparing two motion sensor automated strategies to avert knee buckle during functional electrical stimulation (FES)-standing against a conventional hand-controlled (HC) FES approach. The research was conducted in a clinical exercise laboratory gymnasium at the University of Sydney, Australia. The automated strategies, Aut-A and Aut-B, applied fixed and variable changes of neurostimulation, respectively, in quadriceps amplitude to precisely control knee extension during standing. HC was an "on-demand" increase of stimulation amplitude to maintain stance. Finally, maximal FES amplitude (MA) was used as a control condition, whereby knee buckle was prevented by maximal isometric muscle recruitment. Four AIS-A paraplegics undertook 4 days of testing each, and each assessment day comprised three FES standing trials using the same strategy. Cardiorespiratory responses were recorded, and quadriceps muscle oxygenation was quantified using near-infrared spectroscopy. For all subjects, the longest standing times were observed during Aut-A, followed by Aut-B, and then HC and MA. The standing times of the automated strategies were superior to HC by 9-64%. Apart from a lower heart rates during standing (P = 0.034), the automation of knee extension did not promote different cardiorespiratory responses compared with HC. The standing times during MA were significantly shorter than during the automated or "on-demand" strategies (by 80-250%). In fact, the higher isometric-evoked quadriceps contraction during MA resulted in a greater oxygen demand (P < 0.0001) and wider arteriovenous oxygen extraction (P = 0.08) when compared with the other strategies. In conclusion, even though increased standing times were demonstrated using automated control of knee extension, physiological benefits compared with HC were not evident.
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Affiliation(s)
- Gustavo P Braz
- Clinical Exercise and Rehabilitation Unit, The University of Sydney, Sydney, NSW, Australia.,Discipline of Exercise and Sports Science, The University of Sydney, Sydney, NSW, Australia
| | - Michael F Russold
- Clinical Exercise and Rehabilitation Unit, The University of Sydney, Sydney, NSW, Australia
| | - Ché Fornusek
- Clinical Exercise and Rehabilitation Unit, The University of Sydney, Sydney, NSW, Australia.,Discipline of Exercise and Sports Science, The University of Sydney, Sydney, NSW, Australia
| | - Nur Azah Hamzaid
- Clinical Exercise and Rehabilitation Unit, The University of Sydney, Sydney, NSW, Australia.,Biomedical Engineering Department, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Richard M Smith
- Discipline of Exercise and Sports Science, The University of Sydney, Sydney, NSW, Australia
| | - Glen M Davis
- Clinical Exercise and Rehabilitation Unit, The University of Sydney, Sydney, NSW, Australia.,Discipline of Exercise and Sports Science, The University of Sydney, Sydney, NSW, Australia.,Biomedical Engineering Department, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
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