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Marshall K, Patterson F, Fleming J, Gustafsson L, Atresh S. "Be ready to learn": a qualitative study of the patient perspective of falls and fall prevention following discharge from a spinal injuries unit. Disabil Rehabil 2024; 46:3108-3115. [PMID: 37559389 DOI: 10.1080/09638288.2023.2245755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 07/29/2023] [Accepted: 08/03/2023] [Indexed: 08/11/2023]
Abstract
PURPOSE Falls following a spinal cord injury (SCI) can have physical and psychological consequences, although some risk of falls may be acceptable to enable participation in meaningful activity. The study aimed to explore the patients' perspective of falls and fall prevention after discharge from a inpatient spinal injuries unit. METHODS An interpretive descriptive approach guided the study. Semi structured interviews were conducted in the 6-12 months post discharge period. Thematic analysis was used to analyze the data and identify themes. RESULTS Fifteen individuals with SCI, with a mean age of 57 years and varied fall experiences were included. Three themes were identified including: 1. Expectation of falling; 2. Learning from my own experience and the experience of others' and 3. How to prevent falls. Learning from their own experience and the experience of others was highly valued by persons with SCI and influenced expectations of falls. A variety of strategies were used to prevent falls. CONCLUSIONS Strategies that include learning from others, include activities that are individual and provide skills in self-reflection may aid to make fall prevention meaningful.
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Affiliation(s)
- Kathryn Marshall
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Department of Occupational Therapy, Princess Alexandra Hospital, Brisbane, Australia
| | - Freyr Patterson
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Louise Gustafsson
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Sridhar Atresh
- Queensland Spinal Cord Injuries Service, Division of Rehabilitation, Princess Alexandra Hospital, Brisbane, Australia
- School of Medicine, The University of Queensland, Brisbane, Australia
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Jeawon M, Hase B, Miller S, Eng JJ, Bundon A, Chaudhury H, Maffin J, Clarkson R, Wright J, Mortenson WB. Understanding the experiences, needs, and strengths of people with incomplete spinal cord injury who can ambulate. Disabil Rehabil 2024; 46:546-555. [PMID: 36740758 DOI: 10.1080/09638288.2023.2171495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 01/17/2023] [Indexed: 02/07/2023]
Abstract
PURPOSE To identify the experiences, needs, and strengths of people with incomplete spinal cord injury who can ambulate and to explore and discuss potential supports, services, and programs that would best assist them in the community. MATERIAL AND METHODS In this qualitative descriptive study, interviews were the primary means of data collection. These were supplemented with descriptive standardized measures of function and life satisfaction. Qualitative data were analyzed thematically. RESULTS Twenty-four participants were interviewed, their average age was 55 years and 46% were female. We identified three themes: 'I really couldn't go there', described the physical and social barriers experienced by participants, 'It'd be really nice to let the public know there are people out there like me' expressed the desire for greater social understanding of incomplete spinal cord injury, and 'I just don't quit', displayed the perseverance that participants demonstrated following their injury. CONCLUSION Findings indicate service providers to improve the inclusion of ambulatory individuals with incomplete spinal cord injury in their programs. Suggestions include designing programs (community, healthcare, return to work, peer support), environments using the principles of universal design for people with incomplete spinal cord injury who ambulate, and increasing consideration of their perspectives.Implication for rehabilitation:People with incomplete spinal cord injury who can ambulate live with invisible impairments, which are often not acknowledged by family, friends, health professionals, and people with complete spinal cord injuryThey may feel excluded from activities (organized by spinal cord injury associations) that were originally designed for people with complete spinal cord injuryGreater awareness among health professionals, friends, family, and people with complete spinal cord injury of the needs of people with incomplete spinal cord injury who can ambulate is needed to increase their inclusion.
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Affiliation(s)
- Murveena Jeawon
- Department of Occupational Sciences and Occupational Therapy, University of British Columbia, Vancouver, Canada
- GF Strong Rehabilitation Centre, Vancouver, Canada
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, Canada
| | - Bethany Hase
- Department of Occupational Sciences and Occupational Therapy, University of British Columbia, Vancouver, Canada
| | - Susanna Miller
- Department of Occupational Sciences and Occupational Therapy, University of British Columbia, Vancouver, Canada
| | - Janice J Eng
- GF Strong Rehabilitation Centre, Vancouver, Canada
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Andrea Bundon
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, Canada
- School of Kinesiology, University of British Columbia, Vancouver, Canada
| | - Habib Chaudhury
- Department of Gerontology, Simon Fraser University, Vancouver, Canada
| | - Jocelyn Maffin
- Spinal Cord Injury - British Columbia, Vancouver, Canada
| | - Ryan Clarkson
- Spinal Cord Injury - British Columbia, Vancouver, Canada
| | - Jenna Wright
- Spinal Cord Injury - British Columbia, Vancouver, Canada
| | - W Ben Mortenson
- Department of Occupational Sciences and Occupational Therapy, University of British Columbia, Vancouver, Canada
- GF Strong Rehabilitation Centre, Vancouver, Canada
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, Canada
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Habib Perez O, Chan K, Martin S, Marinho-Buzelli A, Singh H, Musselman KE. The experience of falls and fall risk during the subacute phase of spinal cord injury: a mixed methods study. Disabil Rehabil 2023:1-9. [PMID: 37732508 DOI: 10.1080/09638288.2023.2259311] [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: 02/14/2023] [Accepted: 09/10/2023] [Indexed: 09/22/2023]
Abstract
Purpose: To understand the circumstances, causes and consequences of falls experienced by individuals with subacute SCI, and to explore their perspectives on how falls/fall risk impacted their transition to community living.Materials and methods: Sixty adults with subacute SCI participated. A sequential explanatory mixed methods design was adopted. In Phase I, falls were monitored for six months post-inpatient rehabilitation discharge through a survey. In Phase II, a qualitative focus group (n = 5) was held to discuss participants' perspectives on Phase I results and falls/fall risk. Descriptive statistics and thematic analysis were used to analyze Phase I and II data, respectively.Results: Falls commonly occurred in the daytime, at home and about half resulted in minor injury. Three themes reflecting participants' perspectives were identified in Phase II. 1) Lack of preparedness to manage fall risk upon returning home from inpatient rehabilitation. 2) Adjusting to increased fall risk following discharge from inpatient rehabilitation. 3) Psychological impact of the transition to living at home with an increased fall risk.Conclusions: The findings highlight the need for fall prevention initiatives during subacute SCI, when individuals are learning to manage their increased fall risk.
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Affiliation(s)
- Olinda Habib Perez
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Katherine Chan
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Samantha Martin
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Hardeep Singh
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kristin E Musselman
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Heffernan MG, Lee JW, Chan K, Unger J, Marzolini S, Welsh TN, Masani K, Musselman KE. Spatial characteristics of reactive stepping among people living with chronic incomplete spinal cord injury. J Spinal Cord Med 2023; 46:769-777. [PMID: 37037014 PMCID: PMC10446810 DOI: 10.1080/10790268.2023.2175575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2023] Open
Abstract
Objective: Compare the spatial characteristics of reactive stepping between individuals with chronic motor incomplete spinal cord injuries (iSCI) and able-bodied (AB) individuals.Design: Cross sectional.Setting: Lyndhurst Centre.Participants: Twelve individuals with iSCI (3 males, 53.6 ± 15.2 years old) and 11 age- and sex-matched AB individuals (3 males, 54.8 ± 14.0 years old).Interventions: The Lean-and-Release test was used to elicit reactive stepping. A horizontal cable, attached at waist height, was released when 8-12% body weight was supported in a forward lean position. Participants underwent up to 10 Lean-and-Release trials in a session. Kinematic and kinetic data were recorded.Outcome measures: The length, width and height of the first reactive step of each trial were calculated. Standard deviation between trials was calculated to represent the variability in step length, width and height within a participant. Among participants with iSCI, correlation coefficients were used to explore the relationship between step length and width variability and (1) Lean-and-Release test behavioral responses, (2) 3-month fall history, and (3) lower extremity strength.Results: Step length (P = 0.94), width (P = 0.52) and height (P = 0.97), normalized for participant height, did not differ between groups. Participants with iSCI showed greater variability in step length (P = 0.02) and width (P = 0.01), but not height (P = 0.32). No correlation was found between step length or width variability and behavioral responses, 3-month fall history, or lower extremity strength.Conclusions: Individuals with iSCI showed increased variability in length and width of reactive stepping compared to AB individuals, which may contribute to their impaired ability to execute single-step reactive responses.Trial registration: ClinicalTrials.gov identifier: NCT02960178.
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Affiliation(s)
- Matthew G. Heffernan
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Jae Woung Lee
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Katherine Chan
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Janelle Unger
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Susan Marzolini
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Timothy N. Welsh
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Kei Masani
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Kristin E. Musselman
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
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Marshall K, Fleming J, Atresh S, Scott JR, Gustafsson L, Patterson F. Falls on an inpatient rehabilitation spinal injuries unit: the characteristics, circumstances, and consequences. Spinal Cord 2023; 61:57-64. [PMID: 36273103 PMCID: PMC9836933 DOI: 10.1038/s41393-022-00861-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 01/17/2023]
Abstract
STUDY DESIGN Retrospective audit OBJECTIVES: To describe the nature of falls and fallers in a spinal injuries unit (SIU) and identify factors associated with having more than one fall (recurrent fallers) and falls with physical or psychological consequences (consequential falls). SETTING An Australian inpatient rehabilitation SIU. METHODS Data were retrospectively extracted from falls incident reports and electronic medical records over a 5-year period. Data were analysed descriptively to summarise participant and fall details. Univariate analyses identified candidate variables for further investigation in a multivariate model for recurrent fallers and consequential falls. RESULTS Of the 566 persons admitted to the SIU, 132 (23%) participants experienced 207 falls over the 5 years. Of the fallers, 41 (31%) were recurrent fallers experiencing between 2 and 7 falls and 78 (59%) experienced a consequential fall. No significant variables were identified for recurrent fallers. For consequential falls, older age (OR = 1.038, 95% CI, 1.012 to 1.064, p = 0.004) and female gender (OR = 3.581, 95% CI, 1.269 to 10.103, p = 0.016) were significant, as well as falls that occurred on a Sunday (OR = 0.196, 95% CI, 0.061 to 0.630, p = 0.006). Falls while transferring were less likely to be consequential (OR = 4.100, 95% CI, 1.706 to 9.856, p = 0.002). CONCLUSIONS Nearly one quarter of SIU inpatients experienced a fall with almost a third of those who fell experiencing recurrent falls. Older age, female gender, and Sundays were risk factors for falls with consequence.
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Affiliation(s)
- Kathryn Marshall
- grid.1003.20000 0000 9320 7537School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD Australia ,grid.412744.00000 0004 0380 2017Department of Occupational Therapy, Princess Alexandra Hospital, Brisbane, QLD Australia
| | - Jennifer Fleming
- grid.1003.20000 0000 9320 7537School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD Australia
| | - Sridhar Atresh
- grid.412744.00000 0004 0380 2017Queensland Spinal Cord Injuries Service, Division of Rehabilitation, Princess Alexandra Hospital, Brisbane, QLD Australia ,grid.1003.20000 0000 9320 7537School of Medicine, The University of Queensland, Brisbane, QLD Australia
| | - Justin, R. Scott
- grid.1003.20000 0000 9320 7537QCIF Bioinformatics, Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD Australia
| | - Louise Gustafsson
- grid.1003.20000 0000 9320 7537School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD Australia ,grid.1022.10000 0004 0437 5432School of Health Sciences and Social Work, Griffith University, Brisbane, QLD Australia ,grid.1022.10000 0004 0437 5432The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, QLD Australia
| | - Freyr Patterson
- grid.1003.20000 0000 9320 7537School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD Australia
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Sessford JD, Chan K, Kaiser A, Singh H, Munce S, Alavinia M, Musselman KE. Protocol for a single group, mixed methods study investigating the efficacy of photovoice to improve self-efficacy related to balance and falls for spinal cord injury. BMJ Open 2022; 12:e065684. [PMID: 36600385 PMCID: PMC9743364 DOI: 10.1136/bmjopen-2022-065684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Many individuals living with spinal cord injury (SCI) experience falls and a fear of falling, both of which can impact participation in daily activities and quality of life. A single group, convergent mixed methods study will be conducted to examine the effects of a photovoice intervention on falls self-efficacy among individuals living with chronic SCI. Secondary objectives include examining the effects of photovoice on fear of falling, participation and quality of life and exploring participants' experiences and perceptions of the photovoice intervention through qualitative interviews. METHODS AND ANALYSIS Adults with SCI (n=40) will be divided into groups according to their mobility status (ie, those who ambulate and those who primarily use a wheelchair). The study will be conducted virtually over three consecutive phases, totalling 30 weeks. Each group will self-report falls for 12 weeks prior to and following the intervention (phases 1 and 3, respectively). The 6-week photovoice intervention (phase 2) will be comprised of two photo assignments, two individual interviews with a researcher and a peer mentor, and four group meetings. Participants will discuss these photos at the interviews and group meetings. Standardised questionnaires of falls self-efficacy, fear of falling, participation and life satisfaction will be administered at four time points (ie, beginning of each phase and the end of phase 3). Questionnaire scores will be examined over time using repeated-measures analysis of variance. A semistructured interview will be completed at the end of phase 3 to gain feedback on the photovoice intervention. Qualitative data will be analysed using reflexive thematic analysis. ETHICS AND DISSEMINATION Ethics approval was obtained prior to study enrolment. Findings will be shared through peer-reviewed scientific publications and participant-directed knowledge translation activities. TRIAL REGISTRATION NUMBER NCT04864262.
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Affiliation(s)
- James D Sessford
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Katherine Chan
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Anita Kaiser
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Hardeep Singh
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Munce
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Mohammad Alavinia
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Kristin E Musselman
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
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Chan K, Habib Perez O, Singh H, Marinho-Buzelli AR, Hitzig SL, Musselman KE. Impact of Falls and Fear of Falling on Participation, Autonomy and Life Satisfaction in the First Year After Spinal Cord Injury. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:903097. [PMID: 36188963 PMCID: PMC9397684 DOI: 10.3389/fresc.2022.903097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022]
Abstract
IntroductionIndividuals with spinal cord injury (SCI) experience reduced participation in meaningful activities, leading to reduced social engagement and negative psychological impact. Two factors that may affect participation post-SCI are fall status (e.g., having experienced a fall) and having a fear of falling. Our objective was to examine if and how fall status and fear of falling impact participation, autonomy and life satisfaction in the first year post-injury.MethodsAdult inpatients of a SCI rehabilitation hospital were recruited. Following discharge, falls were tracked for 6 months and participants who fell at least once were categorized as “fallers”. At the end of the 6-month period, the Impact on Participation and Autonomy Questionnaire and Life Satisfaction Questionnaire 9 were administered, and participants were asked if they had a fear of falling (i.e., an ongoing concern about falling leading to the avoidance of activities they are capable of doing). Falls were reported using descriptive statistics. Ordinary least squares regression was used to evaluate the relationships between the independent variables (i.e., fall status and fear of falling) and each dependent variable (i.e., questionnaire scores).ResultsSeventy-one individuals were enrolled in the study; however, 11 participants were lost to follow-up. The included participants (n = 60) were 58.4 ± 14.6 years old and 99 ± 60.3 days post-injury. Over one third (38.3%) of participants fell over the 6-month tracking period. Twenty-seven participants (45%) reported a fear of falling and 14 (51.9%) of these participants were fallers. Fear of falling significantly predicted scores of autonomy indoors (β = 3.38, p = 0.04), autonomy outdoors (β = 2.62, p = 0.04) and family role (β = 3.52, p = 0.05).ConclusionIndividuals with subacute SCI and a fear of falling experienced reduced participation and autonomy, but with no differences in life satisfaction compared to those without a fear of falling. In contrast, having experienced a fall did not impact participation, autonomy or life satisfaction. In the first year after SCI, rehabilitation programs should place specific attention on the presence of fear of falling to help individuals with SCI prepare for everyday mobility challenges.
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Affiliation(s)
- Katherine Chan
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Olinda Habib Perez
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Hardeep Singh
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Andresa R. Marinho-Buzelli
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- St. John's Rehab Research Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Sander L. Hitzig
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- St. John's Rehab Research Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Kristin E. Musselman
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- *Correspondence: Kristin E. Musselman
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Unger J, Singh H, Mansfield A, Masani K, Mussleman KE. The experiences of people with incomplete spinal cord injury or disease during intensive balance training and the impact of the program: A qualitative study. Spinal Cord 2022; 60:1062-1068. [PMID: 35680989 DOI: 10.1038/s41393-022-00823-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 05/28/2022] [Accepted: 06/02/2022] [Indexed: 11/10/2022]
Abstract
STUDY DESIGN Qualitative descriptive study. OBJECTIVES To gain insight into if and how participation in intensive balance training impacted the daily lives and risk of falling of people living with incomplete spinal cord injury or disease (SCI/D), as well as to understand what motivated participation and what benefits and challenges, if any, they experienced while completing training. SETTING Tertiary rehabilitation hospital. METHODS Semi-structured interviews were conducted three to four months after 20 participants with incomplete SCI/D completed either Perturbation-based Balance Training or Conventional Intensive Balance Training as part of a randomized clinical trial. Interviews were transcribed verbatim and coded using conventional content analysis by two researchers. Codes were discussed for consensus, and subcategories and categories were created, which were confirmed by another two researchers. RESULTS The following categories were identified: 1) goals of balance training, 2) valuable components of balance training, 3) physical gains from balance training, 4) psychosocial gains from participating in balance training, and 5) unique aspects of Perturbation-based Balance Training. Each category consisted of several subcategories. CONCLUSIONS Collecting qualitative data facilitated the evaluation of the meaningfulness of the balance training programs to the participants. These findings demonstrate that balance training was perceived as beneficial and enjoyable for individuals with incomplete SCI/D, and that these programs provided challenge and educational opportunities for the participants while improving balance confidence and reducing perceived fall risk. These findings have implications to direct future research studies or implementation of balance training in rehabilitation.
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Affiliation(s)
- Janelle Unger
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, M5G 1V7, Canada.,KITE, Toronto Rehabilitation Institute - University Health Network, Toronto, M4G 3V9, Canada.,School of Physical Therapy, Faculty of Health Sciences, Western University, London, N6G 1H1, Canada
| | - Hardeep Singh
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, M5G 1V7, Canada.,KITE, Toronto Rehabilitation Institute - University Health Network, Toronto, M4G 3V9, Canada.,Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, M5G 1V7, Canada
| | - Avril Mansfield
- KITE, Toronto Rehabilitation Institute - University Health Network, Toronto, M4G 3V9, Canada.,Evaluative Clinical Sciences, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, M4N 3M5, Canada.,Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, M5G 1V7, Canada
| | - Kei Masani
- KITE, Toronto Rehabilitation Institute - University Health Network, Toronto, M4G 3V9, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, M5S 3G9, Canada
| | - Kristin E Mussleman
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, M5G 1V7, Canada. .,KITE, Toronto Rehabilitation Institute - University Health Network, Toronto, M4G 3V9, Canada. .,Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, M5G 1V7, Canada.
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Habib Perez OD, Martin S, Chan K, Singh H, Yoshida KK, Musselman KE. A qualitative photo-elicitation study exploring the impact of falls and fall risk on individuals with subacute spinal cord injury. PLoS One 2022; 17:e0269660. [PMID: 35671304 PMCID: PMC9173606 DOI: 10.1371/journal.pone.0269660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 05/25/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Individuals living with chronic spinal cord injury or disease (SCI/D) are at an increased risk of falling. However, little is known about the impact of falls and fall risk in the subacute phase of SCI/D, despite this being a time when fall prevention initiatives are delivered. Hence, we explored the impact of falls and fall risk in individuals with subacute SCI/D as they transitioned from inpatient rehabilitation to community living.
Methods
This qualitative photo-elicitation study used an inductive thematic analysis. Eight individuals (7 male) undergoing inpatient rehabilitation at a Canadian tertiary rehabilitation hospital due to a new SCI/D participated. Six months following discharge, photo-elicitation interviewing was used to understand the impact of falls and fall risk. Over 7–14 days, participants completed a photo-assignment that involved taking photographs in response to questions, such as what increases/decreases your likelihood of falling? A semi-structured interview followed, in which participants described their photographs and discussed their experiences with falls, fall risk and fall prevention training.
Results
Four themes were identified. 1) Risk factors and strategies identified through lived experience. Participants discovered their fall risk factors and fall prevention strategies through “trial and error”. 2) Influences on the individual’s perception of their fall risk. Prior experience with falls, including falls experienced by themselves as well as friends and family, influenced their perception of fall risk. 3) Experiencing life differently due to increased fall risk. A high fall risk reduced participation, increased negative emotions and decreased independence and quality of life. 4) Falls training in rehabilitation can be improved. Prior experiences with falls training varied; however, participants expressed a desire for comprehensive and individualized training.
Conclusion
Although participants’ experiences with falls and fall prevention varied, falls and the risk of falling can have a significant impact on the first year of living with a SCI/D.
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Affiliation(s)
| | - Samantha Martin
- KITE, Toronto Rehab–University Health Network, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Katherine Chan
- KITE, Toronto Rehab–University Health Network, Toronto, ON, Canada
| | - Hardeep Singh
- KITE, Toronto Rehab–University Health Network, Toronto, ON, Canada
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada
| | - Karen K. Yoshida
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health (Social Science Division), University of Toronto, Toronto, ON, Canada
| | - Kristin E. Musselman
- KITE, Toronto Rehab–University Health Network, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- * E-mail:
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Singh H, Chan K, Cheung L, Hitzig SL, Musselman KE. The impact of falls and fear of falling on participation, autonomy, and life satisfaction among individuals with spinal cord injury: A brief report. J Spinal Cord Med 2021; 44:S234-S239. [PMID: 34779724 PMCID: PMC8604446 DOI: 10.1080/10790268.2021.1943251] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
CONTEXT Qualitative research suggests that falls can have a negative psychosocial impact on the lives of individuals with spinal cord injury (SCI). However, it is unclear whether these qualitative findings are supported by quantitative psychosocial metrics. This paper examines whether falling and/or having a fear of falling impacts participation, autonomy, and life satisfaction among individuals with SCI. METHODS Falls and fear of falling were tracked over six months using a survey and phone check-ins conducted approximately every three to four weeks. The Life Satisfaction 9 and Impact on Participation and Autonomy Questionnaires were administered at baseline and after six months. Responses on the questionnaires were statistically compared between fallers and non-fallers as well as participants with and without a fear of falling during the tracking period. FINDINGS Of the 65 community-dwelling adults with chronic SCI, 38 were categorized as fallers (aged 54.29 ± 13.73, 19.55 ± 14.20 years post-SCI, AIS A-D) and 27 were non-fallers (aged 57.78 ± 12.21, 17.93 ± 17.24 years post-SCI, AIS A-D). Our results revealed no significant differences between fallers and non-fallers in their perceived participation, autonomy, or life satisfaction at baseline or after six months. At the last check-in, 34 participants denied a fear of falling, while 31 had a fear of falling. Perceived autonomy outdoors (P=0.02), total life satisfaction (P=0.04), satisfaction with life as a whole (P=0.00) and self-care (P=0.01) differed between participants with and without a fear of falling after six months. CONCLUSION Fear of falling, rather than falls, may impact participation, autonomy, and life satisfaction in the SCI population.
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Affiliation(s)
- Hardeep Singh
- KITE, Toronto Rehab-University Health Network, Toronto, Canada,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada,Bridgepoint Collaboratory for Research & Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System
| | - Katherine Chan
- KITE, Toronto Rehab-University Health Network, Toronto, Canada
| | - Lovisa Cheung
- KITE, Toronto Rehab-University Health Network, Toronto, Canada,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Sander L. Hitzig
- KITE, Toronto Rehab-University Health Network, Toronto, Canada,St. John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada,Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Kristin E. Musselman
- KITE, Toronto Rehab-University Health Network, Toronto, Canada,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada,Correspondence to: Kristin E. Musselman, SCI Mobility Lab, KITE, Toronto Rehab-University Health Network, 520 Sutherland Drive, Toronto, M4G 3V9, Canada.
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Singh H, Cheung L, Chan K, Flett HM, Hitzig SL, Kaiser A, Musselman KE. Comparing the causes, circumstances and consequences of falls across mobility statuses among individuals with spinal cord injury: A secondary analysis. J Spinal Cord Med 2021; 44:S193-S202. [PMID: 34779733 PMCID: PMC8604457 DOI: 10.1080/10790268.2021.1956252] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare the occurrence of falls and fall-related injuries, and the circumstances of falls among individuals with spinal cord injury (SCI) who ambulate full-time, use a wheelchair full-time and ambulate part-time. DESIGN A secondary analysis. SETTING Community. PARTICIPANTS Adults with SCI. INTERVENTION None. OUTCOME MEASURES The occurrence and circumstances of falls and fall-related injuries were tracked over six-months using a survey. Participants were grouped by mobility and fall status. A chi-square test compared the occurrence of falls and fall-related injuries, and the time and location of falls, and a negative binomial regression was used to predict the likelihood of falls by mobility status. Kaplan-Meier analysis was used to determine differences in the time to first fall based on mobility status. Group characteristics and causes of falls were described. RESULTS Data from individuals who ambulated full-time (n = 30), used a wheelchair full-time (n = 27) and ambulated part-time (n = 8) were analyzed. Mobility status was a significant predictor of falls (P < 0.01); individuals who used a wheelchair full-time had a third of the likelihood of falling than those who ambulated full-time (P < 0.01). Type of fall-related injuries differed by mobility status. Those who ambulated full-time fell more in the daytime (P < 0.01). Individuals who ambulated full-time and part-time commonly fell while walking due to poor balance, and their legs giving out, respectively. Those who used a wheelchair full-time typically fell while transferring when rushed. CONCLUSION Mobility status influences the likelihood and circumstances of falls. Mobility status should be considered when planning fall prevention education/training for individuals with SCI.
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Affiliation(s)
- Hardeep Singh
- KITE, Toronto Rehab-University Health Network, Toronto, Canada,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada,Bridgepoint Collaboratory for Research & Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | - Lovisa Cheung
- KITE, Toronto Rehab-University Health Network, Toronto, Canada,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Katherine Chan
- KITE, Toronto Rehab-University Health Network, Toronto, Canada
| | - Heather M. Flett
- KITE, Toronto Rehab-University Health Network, Toronto, Canada,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Sander L. Hitzig
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada,Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada,St. John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Anita Kaiser
- KITE, Toronto Rehab-University Health Network, Toronto, Canada,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada,Canadian Spinal Research Organization, Toronto, Canada
| | - Kristin E. Musselman
- KITE, Toronto Rehab-University Health Network, Toronto, Canada,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada,Correspondence to: Kristin E. Musselman, SCI Mobility Lab, KITE, Toronto Rehab-University Health Network, 520 Sutherland Drive, TorontoM4G 3V9, Canada.
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What about Using Photovoice for Health and Safety? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211985. [PMID: 34831740 PMCID: PMC8620590 DOI: 10.3390/ijerph182211985] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/03/2021] [Accepted: 11/05/2021] [Indexed: 11/17/2022]
Abstract
The positive reception of Wang and Burris' photovoice method, published in 1997, has led to a proliferation of ways in which professionals deploy photovoice in a widening range of application fields, e.g., public health, social development and phenomenological research of human experiences. A scoping review method is used to obtain an overview of current photovoice designs and of application examples in the health and safety domain. The results show a variety of method designs. Our findings indicate that all of the photovoice designs are composed from different combinations of eleven process steps. Five generic objectives cover the range of application examples found in our literature study. We therefore condensed the variety into five generic photovoice designs for: (a) communication, (b) education, (c) exploration, (d) awareness, and (e) empowerment purposes. We propose this for use in a classification system. The potential for application of these photovoice designs in safety management is illustrated by the existence of various safety related application examples. We argue that the five generic designs will facilitate the implementation and usage of photovoice as a tool. We recommend that both a theoretical framework and guidance are further developed. We conclude that photovoice holds potential for application in health and safety management.
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Habib Perez O, Chan K, Unger J, Lee JW, Masani K, Musselman KE. Characterizing inter-limb synchronization after incomplete spinal cord injury: A cross-sectional study. Gait Posture 2021; 85:191-197. [PMID: 33610130 DOI: 10.1016/j.gaitpost.2021.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 01/14/2021] [Accepted: 02/08/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Individuals with incomplete spinal cord injury (iSCI) demonstrate greater postural sway and increased dependency on vision to maintain balance compared to able-bodied individuals. Research on standing balance after iSCI has focused on the joint contribution of the lower limbs; however, inter-limb synchrony in quiet standing is a sensitive measure of individual limb contributions to standing balance control in other neurological populations. It is unknown if and how reduced inter-limb synchrony contributes to the poor standing balance of individuals with iSCI. RESEARCH QUESTION How does an iSCI affect inter-limb synchrony and weight-bearing symmetry in standing? METHODS Eighteen individuals with non-progressive motor iSCI and 15 age- and sex-matched able-bodied individuals (M-AB) were included in the study. Participants stood in a standardized position on two adjacent force plates in eyes open and closed conditions for 70 s per condition. Net centre-of-pressure (COP) root mean square (RMS), net COP velocity, COP inter-limb synchrony (i.e. cross-correlation between left and right COP), and weight-bearing asymmetry (i.e. vertical force from each limb over total vertical force) were calculated. Muscle strength of the lower limbs was assessed with manual muscle testing. RESULTS Individuals with iSCI demonstrated reduced inter-limb synchrony when standing with eyes open and eyes closed, but did not differ to M-AB with respect to weight-bearing asymmetry. They also produced greater net COP RMS and velocity when compared to M-AB. Muscle strength of the two lower limbs demonstrated an overall asymmetry in individuals with iSCI. SIGNIFICANCE Individuals with iSCI demonstrated impaired balance control as evidenced by reduced inter-limb synchrony and greater COP RMS and velocity compared to M-AB individuals. This increased understanding of how balance control is impaired following iSCI may inform balance assessment and intervention for this population. Future work examining the association between inter-limb synchrony and the occurrence of falls in iSCI is warranted.
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Affiliation(s)
- Olinda Habib Perez
- KITE, Toronto Rehab - University Health Network, 520 Sutherland Dr., M4G 3V9, Canada
| | - Katherine Chan
- KITE, Toronto Rehab - University Health Network, 520 Sutherland Dr., M4G 3V9, Canada
| | - Janelle Unger
- KITE, Toronto Rehab - University Health Network, 520 Sutherland Dr., M4G 3V9, Canada; Rehabilitation Sciences Institute, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada
| | - Jae W Lee
- KITE, Toronto Rehab - University Health Network, 520 Sutherland Dr., M4G 3V9, Canada; Institute of Biomaterials & Biomedical Engineering, University of Toronto, 164 College Street, Toronto, ON, M5S 3G9, Canada
| | - Kei Masani
- KITE, Toronto Rehab - University Health Network, 520 Sutherland Dr., M4G 3V9, Canada; Institute of Biomaterials & Biomedical Engineering, University of Toronto, 164 College Street, Toronto, ON, M5S 3G9, Canada
| | - Kristin E Musselman
- KITE, Toronto Rehab - University Health Network, 520 Sutherland Dr., M4G 3V9, Canada; Rehabilitation Sciences Institute, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada; Department of Physical Therapy, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada.
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Unger J, Chan K, Lee JW, Craven BC, Mansfield A, Alavinia M, Masani K, Musselman KE. The Effect of Perturbation-Based Balance Training and Conventional Intensive Balance Training on Reactive Stepping Ability in Individuals With Incomplete Spinal Cord Injury or Disease: A Randomized Clinical Trial. Front Neurol 2021; 12:620367. [PMID: 33603710 PMCID: PMC7884853 DOI: 10.3389/fneur.2021.620367] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/11/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Impaired balance leads to falls in individuals with motor incomplete spinal cord injury or disease (iSCI/D). Reactive stepping is a strategy used to prevent falls and Perturbation-based Balance Training (PBT) can improve this ability. Objective: The objective of this study was to determine if PBT results in greater improvements in reactive stepping ability than frequency-matched Conventional Intensive Balance Training (CIBT) in adults with iSCI/D. Design: Randomized clinical trial. Setting: Tertiary SCI/D rehabilitation center. Participants: Twenty-one adults with chronic (>1 year) iSCI/D were randomized. Due to one drop out 20 participants completed the study. Methods: Participants were randomly allocated to complete either PBT or CIBT three times per week for 8 weeks. Both programs included challenging static and dynamic balance tasks, but the PBT group also experienced manual external balance perturbations. Main Outcome Measures: Assessments of reactive stepping ability using the Lean-and-Release test were completed at baseline, and after 4 and 8 weeks of training, and 3 and 6 months after training completion. A blinded assessor evaluated secondary outcomes. Results: Twenty-five participants were screened and 21 consented; one withdrew. Ten PBT and 10 CIBT participants were included in analyses. Across all participants there were improvements in reactive stepping ability (p = 0.049), with retention of improvements at follow up assessments. There were no differences in reactive stepping ability between groups [median (interquartile range): PBT 0.08 (0.68); CIBT 0.00 (0.22)]. One participant in the PBT group experienced a non-injurious fall during training. Conclusions: Balance training is beneficial for individuals with iSCI/D, but the addition of manual perturbations (i.e., PBT) did not prove advantageous for performance on a measure of reactive stepping ability. Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT02960178.
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Affiliation(s)
- Janelle Unger
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,KITE at Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
| | - Katherine Chan
- KITE at Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
| | - Jae W Lee
- KITE at Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - B Catharine Craven
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,KITE at Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.,Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Avril Mansfield
- KITE at Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.,Evaluative Clinical Sciences, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Mohammad Alavinia
- KITE at Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
| | - Kei Masani
- KITE at Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Kristin E Musselman
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,KITE at Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
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Musselman KE, Arora T, Chan K, Alavinia M, Bone M, Unger J, Lanovaz J, Oates A. Evaluating Intrinsic Fall Risk Factors After Incomplete Spinal Cord Injury: Distinguishing Fallers From Nonfallers. Arch Rehabil Res Clin Transl 2020; 3:100096. [PMID: 33778471 PMCID: PMC7984974 DOI: 10.1016/j.arrct.2020.100096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To determine whether performance on measures of lower extremity muscle strength, sensory function, postural control, gait speed, and balance self-efficacy could distinguish fallers from nonfallers among ambulatory individuals with spinal cord injury or disease (SCI/D). Design Prospective cohort study. Setting Community. Participants Individuals (N=26; 6 female, aged 58.9±18.2y) with motor incomplete SCI/D (American Spinal Injury Association Impairment Scale rating C [n=5] or D [n=21]) participated. Participants were 7.5±9.1 years post injury. Seventeen participants experienced traumatic causes of spinal cord injury. Main Outcome Measures Participants completed laboratory-based and clinical measures of postural control, gait speed, balance self-efficacy, and lower extremity strength, as well as proprioception and cutaneous pressure sensitivity. Participants were then followed for up to 1 year to track falls using a survey. The survey queried the circumstances and consequences of each fall. If a participant's number of falls equaled or exceeded the median number of falls experience by all participants, they were classified a faller. Results Median follow-up duration was 362 days and median time to first fall was 60.5 days. Fifteen participants were classified as fallers. Most falls occurred during the morning or afternoon (81%), at home (75%), and while walking (47%). The following laboratory-based and clinical measures distinguished fallers from nonfallers (P<.05): measures of lower extremity strength, cutaneous pressure sensitivity, walking speed, and center of pressure velocity in the mediolateral direction. Conclusions There are laboratory-based and clinical measures that can prospectively distinguish fallers from nonfallers among ambulatory individuals with spinal cord injury. These findings may assist clinicians when evaluating their patients' fall risk.
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Affiliation(s)
- Kristin E Musselman
- KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Tarun Arora
- School of Rehabilitation Science, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.,Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Katherine Chan
- KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
| | - Mohammad Alavinia
- KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
| | - Mackenzie Bone
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Janelle Unger
- KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada.,College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Joel Lanovaz
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Alison Oates
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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