Perspectives of wheelchair users with chronic spinal cord injury following a walking program using a wearable robotic exoskeleton

PURPOSE

To examine the perspectives of wheelchair users with spinal cord injury (WUSCI) regarding their participation in a 16-week walking program using a wearable robotic exoskeleton (WRE); and explore concerns and expectations regarding potential use of this device and intervention in the context of a home or community-based adapted physical activity program.

METHOD

Semi-structured interviews were conducted using a narrative research, 3 weeks post-intervention. Thematic analysis resulted in 6 themes and 21 subthemes.

RESULTS

Seven men and 4 women aged between 32 and 72 years were interviewed; 8 of them had a complete SCI. After the walking program, WUSCI reported positive psychological aspects (having fun and motivation) and experiencing improvements in physical aspects (strength, endurance, balance and flexibility, blood circulation and intestinal transit). The structural aspects of the WRE device were acceptable in a lab with research personnel (appearance, size, weight, and comfort). Participants had concerns about safety on uneven surfaces, and possibility of falling. They expressed the desire to use the WRE for more life habits than just walking.

CONCLUSION

This is the first study in which WUSCI report that the WRE should be implemented in initial rehabilitation. Lack of availability for community use after rehabilitation remains a concern.

Where Are We on Proprioception Assessment Tests Among Poststroke Individuals? A Systematic Review of Psychometric Properties

BACKGROUND AND PURPOSE

Proprioception is often impaired in poststroke individuals. This is a significant issue since altered proprioception is associated with poorer physical function outcomes poststroke. However, there is limited consensus on the best tools for assessing proprioception and support for their widespread use by clinicians. The objective is to appraise the psychometric properties of each test used to assess proprioception in poststroke individuals.

METHODS

A systematic search was performed according to PRISMA guidelines using the databases MEDLINE, Cochrane Library, PEDro, DiTa, and BioMedicalCentral for articles published up to January 2021.

RESULTS

Sixteen studies of low methodological quality were included. Sixteen different proprioception assessment tests were extracted. The proprioception portion of the Fugl-Meyer Assessment Scale was found to be the most valid and reliable tool for screening patients in clinical settings. Although no real gold standard exists, the technological devices demonstrated better responsiveness and measurement accuracy than clinical tests. Technological devices might be more appropriate for assessing proprioception recovery or better suited for research purposes.

DISCUSSION AND CONCLUSIONS

This review revealed low-quality articles and a paucity of tests with good psychometric properties available to clinicians to properly screen and assess all subcomponents of proprioception. In perspective, technological devices, such as robotic orthoses or muscle vibration, may provide the best potential for assessing the different subcomponents of proprioception. Further studies should be conducted to develop and investigate such approaches.Video, Supplemental Digital Content 1, available at:http://links.lww.com/JNPT/A388.

Appropriateness of Antibiotic Prescription During Teleconsultation

Teleconsultation has become a new means of using care which has taken off significantly since the COVID crisis, The pooling of the technological environment within the TC makes it possible to set up practice reviews by reusing the data collected. Our aim was to evaluate the relevance of antibiotic therapy during teleconsultations carried out on the national teleconsultation platform "Qare" in 4 common infections. 143,428 TCs with structured prescriptions were analyzed, with an appropriate prescription in more than 82% of cases, higher than in the literature. The use of data makes it possible to quickly assess practices and inform doctors to improve their practices.

Rehabilitation supported by technology: Protocol for an international co-creation and user experience study (Preprint)

Background

Living labs in the health and well-being domain have become increasingly common over the past decade but vary in available infrastructure, implemented study designs, and outcome measures. The Horizon 2020 Project Virtual Health and Wellbeing Living Lab Infrastructure aims to harmonize living lab procedures and open living lab infrastructures to facilitate and promote research activities in the health and well-being domain in Europe and beyond. This protocol will describe the design of a joint research activity, focusing on the use of innovative technology for both rehabilitation interventions and data collection in a rehabilitation context.

Objective

With this joint research activity, this study primarily aims to gain insight into each living lab’s infrastructure and procedures to harmonize health and well-being living lab procedures and infrastructures in Europe and beyond, particularly in the context of rehabilitation. Secondarily, this study aims to investigate the potential of innovative technologies for rehabilitation through living lab methodologies.

Methods

This study has a mixed methods design comprising multiple phases. There are two main phases of data collection: cocreation (phase 1) and small-scale pilot studies (phase 2), which are preceded by a preliminary harmonization of procedures among the different international living labs. An intermediate phase further allows the implementation of minor adjustments to the intervention or protocol depending on the input that was obtained in the cocreation phase. A total of 6 small-scale pilot studies using innovative technologies for intervention or data collection will be performed across 4 countries. The target study sample comprises patients with stroke and older adults with mild cognitive impairment. The third and final phases involve Delphi procedures to reach a consensus on harmonized procedures and protocols.

Results

Phase 1 data collection will begin in March 2022, and phase 2 data collection will begin in June 2022. Results will include the output of the cocreation sessions, small-scale pilot studies, and advice on harmonizing procedures and protocols for health and well-being living labs focusing on rehabilitation.

Conclusions

The knowledge gained by the execution of this research will lead to harmonized procedures and protocols in a rehabilitation context for health and well-being living labs in Europe and beyond. In addition to the harmonized procedures and protocols in rehabilitation, we will also be able to provide new insights for improving the implementation of innovative technologies in rehabilitation.

International Registered Report Identifier (IRRID)

PRR1-10.2196/34537

Perception of gait motion during multiple lower-limb vibrations in young healthy individuals: a pilot study

In virtual reality (VR), immersion can be created through synchronous visuomotor stimulations and enhanced by adding auditory or kinesthetic stimulations. Multiple patterned vibrations applied at the lower limbs might be a way to induce kinesthetic perception of gait motion that could be combined with VR stimulations to add the perception of self-motion. However, gait motion perception using multiple vibrations has not yet been evaluated. The objective of the study was to quantify the perception of gait motion while applying multiple, patterned vibrations to the lower limbs in healthy individuals. Twenty young healthy participants (25.1 ± 4.4 years) experienced multiple vibrations in 1-min trials. Stimulation consisted of a vibration pattern based on the sequence of muscle lengthening during a 2-s gait cycle. Stimulation was applied on participants in a standing position, under 11 experimental conditions controlling visual information (eyes open/closed), vibration frequency (40-80 Hz), and number and location of the joints stimulated (hips, knees, ankles isolated or combined two by two). Perception of gait motion was quantified for each condition using a 10-point visual analog scale (VAS, 0: "no perception", 10: "Perception of gait movements"). All participants except one achieved a score higher than 5/10 in at least one condition. Great variability was found for perception of gait motion within participants and conditions (VAS ranging from 0 to 9.6/10). Differences were found between conditions (p < 0.01), with higher mean and median scores in conditions that included knee vibration. Inducing gait motion perception is possible using multiple vibrations in healthy individuals. Stimulation of the knees seems to positively influence perception of gait motion.

Clinicians' perspectives on inertial measurement units in clinical practice

Inertial measurement units (IMUs) have been increasingly popular in rehabilitation research. However, despite their accessibility and potential advantages, their uptake and acceptance by health professionals remain a big challenge. The development of an IMU-based clinical tool must bring together engineers, researchers and clinicians. This study is part of a developmental process with the investigation of clinicians’ perspectives about IMUs. Clinicians from four rehabilitation centers were invited to a 30-minute presentation on IMUs. Then, two one-hour focus groups were conducted with volunteer clinicians in each rehabilitation center on: 1) IMUs and their clinical usefulness, and 2) IMUs data analysis and visualization interface. Fifteen clinicians took part in the first focus groups. They expressed their thoughts on: 1) categories of variables that would be useful to measure with IMUs in clinical practice, and 2) desired characteristics of the IMUs. Twenty-three clinicians participated to the second focus groups, discussing: 1) functionalities, 2) display options, 3) clinical data reported and associated information, and 4) data collection duration. Potential influence of IMUs on clinical practice and added value were discussed in both focus groups. Clinicians expressed positive opinions about the use of IMUs, but their expectations were high before considering using IMUs in their practice.

Intra-operative fluorescence angiography is reproducible and reduces the rate of anastomotic leak after colorectal resection for cancer: a prospective case-matched study

AIM

Intra-operative fluorescence angiography (IOFA) with indocyanine green provides information on tissue perfusion that may help prevent an anastomotic leak (AL). The aim of this study was to assess the impact of IOFA on outcomes after left-sided colonic or low anterior resection with anastomosis for colorectal cancer.

METHODS

All patients with left-sided colonic or rectal cancer, operated between June 2017 and December 2018, were prospectively included. IOFA has been routinely implemented since May 2018. Reproducibility of IOFA, after a 1:1 matching for relevant clinical risk factors of AL, was studied in patients with IOFA (IOFA+) and without IOFA (IOFA-). Outcomes were compared in terms of postoperative events such as clinically relevant AL as the primary end-point.

RESULTS

In the IOFA+ group, changing of the initially planned colon transection due to inadequate perfusion occurred in five out of 46 patients (10.9%). Agreement between intra-operative assessment and postoperative blind review of IOFA was deemed strong (Cohen's kappa index 0.893, 95% CI 0.788-0.998, P < 0.001). Among 111 patients, 42 matched patients were included in each group. There was significantly more clinically relevant AL in the IOFA- group compared to the IOFA+ group (16.7% vs 2.4%, P = 0.026) involving significantly more anastomotic dehiscence which required re-intervention (19% vs 2.4%, P = 0.014). Additionally, more descending colon ischaemia/necrosis was observed in the IOFA- group compared with the IOFA+ group (9.5% vs 0%, P = 0.040).

CONCLUSION

In this prospective case-matched study, IOFA decreased the occurrence of clinically relevant AL due to necrosis of the descending colon or anastomosis. Upon blind review, perfusion assessment using IOFA was reproducible.

The Regenerative Effect of Trans-spinal Magnetic Stimulation After Spinal Cord Injury: Mechanisms and Pathways Underlying the Effect

Spinal cord injury (SCI) leads to a loss of sensitive and motor functions. Currently, there is no therapeutic intervention offering a complete recovery. Here, we report that repetitive trans-spinal magnetic stimulation (rTSMS) can be a noninvasive SCI treatment that enhances tissue repair and functional recovery. Several techniques including immunohistochemical, behavioral, cells cultures, and proteomics have been performed. Moreover, different lesion paradigms, such as acute and chronic phase following SCI in wild-type and transgenic animals at different ages (juvenile, adult, and aged), have been used. We demonstrate that rTSMS modulates the lesion scar by decreasing fibrosis and inflammation and increases proliferation of spinal cord stem cells. Our results demonstrate also that rTSMS decreases demyelination, which contributes to axonal regrowth, neuronal survival, and locomotor recovery after SCI. This research provides evidence that rTSMS induces therapeutic effects in a preclinical rodent model and suggests possible translation to clinical application in humans.

Feasibility of encouraging participation in colorectal cancer screening campaigns by motivating people through the social network, Facebook

AIM

To describe the results of a feasibility phase and the expected results of a new approach to increase the participation rate in a Colorectal Cancer Organized Screening Program (CRCSP) through Facebook awareness messages.

METHOD

This approach targets people aged 50-74 years, who reside in an urban deprived area and regularly connect to Facebook. The feasibility phase ran over 2 months (December 2018 and January 2019) in six municipalities (Seine-Saint-Denis, France). The full provisional campaign will run over a year. The approach consists of sending electronic awareness messages on the importance of screening for colorectal cancer using a specific Facebook module. Subjects who consent to screening complete a test-kit application form. The eligibility of each subject to participate in screening is determined by a doctor before the kit is sent out.

RESULTS

A total of 39 900 people were reached by the feasibility phase campaign, and 9200 were able to watch at least one Facebook message/video. Of those, 4450 people logged to learn more about the CRCSP, 298 applied for a test kit, 160 test kit applicants were eligible to participate and the test completion rate was 41.9%. According to these feasibility results, 366 120 targeted people would connect regularly in the tested area, 141 541 of whom would be interested in a specific promotional message posted on Facebook. Requests could be made for 9770 kits, with 5246 people being eligible to participate in screening. The expected test-completion rate is estimated at 42%-89%. This would represent 5%-11% of the tests carried out in the area during the same period by 'classical' CRCSP.

CONCLUSION

Implementation of the Facebook strategy would significantly improve the rate of participation in the CRCSP by mobilizing people with no previous participation, including younger subjects.

Effects of an Overground Walking Program With a Robotic Exoskeleton on Long-Term Manual Wheelchair Users With a Chronic Spinal Cord Injury: Protocol for a Self-Controlled Interventional Study

BACKGROUND

In wheelchair users with a chronic spinal cord injury (WUSCI), prolonged nonactive sitting time and reduced physical activity-typically linked to this mode of mobility-contribute to the development or exacerbation of cardiorespiratory, musculoskeletal, and endocrine-metabolic health complications that are often linked to increased risks of chronic pain or psychological morbidity. Limited evidence suggests that engaging in a walking program with a wearable robotic exoskeleton may be a promising physical activity intervention to counter these detrimental health effects.

OBJECTIVE

This study's overall goals are as follows: (1) to determine the effects of a 16-week wearable robotic exoskeleton-assisted walking program on organic systems, functional capacities, and multifaceted psychosocial factors and (2) to determine self-reported satisfaction and perspectives with regard to the intervention and the device.

METHODS

A total of 20 WUSCI, who have had their injuries for more than 18 months, will complete an overground wearable robotic exoskeleton-assisted walking program (34 sessions; 60 min/session) supervised by a physiotherapist over a 16-week period (one to three sessions/week). Data will be collected 1 month prior to the program, at the beginning, and at the end as well as 2 months after completing the program. Assessments will characterize sociodemographic characteristics; anthropometric parameters; sensorimotor impairments; pain; lower extremity range of motion and spasticity; wheelchair abilities; cardiorespiratory fitness; upper extremity strength; bone architecture and mineral density at the femur, tibia, and radius; total and regional body composition; health-related quality of life; and psychological health. Interviews and an online questionnaire will be conducted to measure users' satisfaction levels and perspectives at the end of the program. Differences across measurement times will be verified using appropriate parametric or nonparametric analyses of variance for repeated measures.

RESULTS

This study is currently underway with active recruitment in Montréal, Québec, Canada. Results are expected in the spring of 2021.

CONCLUSIONS

The results from this study will be essential to guide the development, implementation, and evaluation of future evidence-based wearable robotic exoskeleton-assisted walking programs offered in the community, and to initiate a reflection regarding the use of wearable robotic exoskeletons during initial rehabilitation following a spinal cord injury.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03989752; https://clinicaltrials.gov/ct2/show/NCT03989752.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/19251.

Pragmatic Considerations on Clinical Decision Support from the 2019 Literature

Objectives : To summarize significant research contributions published in 2019 in the field of computerized clinical decision support and select the best papers for the Decision Support section of the International Medical Informatics Association (IMIA) Yearbook.

Methods : Two bibliographic databases were searched for papers referring to clinical decision support systems (CDSSs) and computerized provider order entry (CPOE) systems. From search results, section editors established a list of candidate best papers, which were then peer-reviewed by external reviewers. The IMIA Yearbook editorial committee finally selected the best papers on the basis of all reviews including the section editors’ evaluation.

Results : A total of 1,378 articles were retrieved. Fifteen best paper candidates were selected, the reviews of which resulted in the selection of three best papers. One paper reports on a guideline modeling approach based on clinical decision trees, both clinically interpretable and suitable for implementation in CDSSs. In another paper, authors promote the use of extended Timed Transition Diagrams in CDSSs to formalize consistently recurrent medical processes for chronic diseases management. The third paper proposes a conceptual framework and a grid for assessing the performance of predictive tools based on the critical appraisal of published evidence.

Conclusions : As showed by the number and the variety of works related to decision support, research in the field is very active. This year’s selection highlighted pragmatic works that promote transparency and trust required by decision support tools.

Intense and unpredictable perturbations during gait training improve dynamic balance abilities in chronic hemiparetic individuals: a randomized controlled pilot trial

Background

Previous studies have assessed the effects of perturbation training on balance after stroke. However, the perturbations were either applied while standing or were small in amplitude during gait, which is not representative of the most common fall conditions. The perturbations were also combined with other challenges such as progressive increases in treadmill speed.

Objective

To determine the benefit of treadmill training with intense and unpredictable perturbations compared to treadmill walking-only training for dynamic balance and gait post-stroke.

Methods

Twenty-one individuals post-stroke with reduced dynamic balance abilities, with or without a history of fall and ability to walk on a treadmill without external support or a walking aid for at least 1 min were allocated to either an unpredictable gait perturbation (Perturb) group or a walking-only (NonPerturb) group through covariate adaptive randomization. Nine training sessions were conducted over 3 weeks. NonPerturb participants only walked on the treadmill but were offered perturbation training after the control intervention. Pre- and post-training evaluations included balance and gait abilities, maximal knee strength, balance confidence and community integration. Six-week phone follow-ups were conducted for balance confidence and community integration. Satisfaction with perturbation training was also assessed.

Results

With no baseline differences between groups (p > 0.075), perturbation training yielded large improvements in most variables in the Perturb (p < 0.05, Effect Size: ES > .46) group (n = 10) and the NonPerturb (p ≤ .089, ES > .45) group (n = 7 post-crossing), except for maximal strength (p > .23) in the NonPerturb group. Walking-only training in the NonPerturb group (n = 8, pre-crossing) mostly had no effect (p > .292, ES < .26), except on balance confidence (p = .063, ES = .46). The effects of the gait training were still present on balance confidence and community integration at follow-up. Satisfaction with the training program was high.

Conclusion

Intense and unpredictable gait perturbations have the potential to be an efficient component of training to improve balance abilities and community integration in individuals with chronic stroke. Retrospective registration: ClinicalTrials.gov. March 18th, 2020. Identifier: NCT04314830.

1133 The Recovery of Sleep Oscillations in Acute to Chronic Traumatic Brain Injury

Introduction

Slow waves and spindles are essential oscillations occurring during NREM sleep that may be disrupted by moderate to severe traumatic brain injury (TBI). We investigated these oscillations in the acute and chronic trauma stage.

Methods

Four groups were tested with whole-night polysomnography: hospitalized patients with acute TBI (n=10, 29.7±13.8y) or severe orthopedic injuries (n=15, 39.9±17.1y), chronic TBI including 9 returning from the acute TBI group (n=43, 31.9±13.5y), and healthy controls (n=36, 30.5±12.7y). Characteristics for slow waves (density, amplitude, slope, frequency, duration) and spindles (density, amplitude, frequency, duration) were quantified over N2 and N3 sleep for the first three sleep cycles, and groups were compared using one-way ANOVAs.

Results

One-way ANOVAs showed group effects only for slow wave density (F=4.11 to 6.04, p=0.009 to 0.0008)) and spindle density (F=3.3 to 8.8, p=0.02 to 0.00003). These effects were present for the 2nd and 3rd sleep cycles, but not the 1st. More specifically, slow wave density in acute TBI was higher than in controls, and returned to normal levels in the chronic stage. Conversely, spindle density in acute TBI was lower than in controls and returned to normal levels in the chronic stage. No group difference was observed for the orthopedic group.

Conclusion

Our results suggest that immediately after a severely disruptive event such as a TBI, the brain needs additional deeper sleep to recover, resulting in more slow waves but also in less spindles. These changes are only present in the 2nd and 3rd sleep cycles, reflecting an absence of the expected dissipation of slow waves, which may suggest increased homeostatic sleep pressure due to the brain injury. Limits to interpretation include the hospital environment and medication, but the absence of changes in the orthopedic group under similar conditions emphasizes the effect of the brain injury itself.

Support

Canadian Institutes of Health Research (CIHR) and Fonds de Recherche Québec-Santé (FRQS)

Effects of robotic exoskeleton control options on lower limb muscle synergies during overground walking: An exploratory study among able-bodied adults

BACKGROUND

The effects of lower limb (L/L) control options, developed for overground walking with a wearable robotic exoskeleton (WRE), on the neuromotor control of L/L muscles [i.e., muscle synergies (MSs)] during walking remain uncertain.

OBJECTIVE

To gain initial insights regarding the effects of different control options on the number of MSs at the L/L and on their muscle weighting within each MS when walking with a WRE.

METHODS

Twenty able-bodied adults walked overground without and with the WRE set at two control options with a predetermined foot pathway imposed by the WRE, and at three other control options with free L/L kinematics in the sagittal plane. Surface electromyography of eight right L/L muscles was recorded. MSs were extracted using a non-negative matrix factorisation algorithm. Cosine similarity and correlation coefficients characterised similarities between the MSs characteristics.

RESULTS

Freely moving the L/L in the sagittal plane (i.e., non-trajectory controlled options) during WRE walking best duplicated typical MSs extracted when walking without WRE. Conversely, WRE walking while fully controlling the L/L trajectory presented the lowest correlations to all MSs extracted when walking without WRE, especially during early swing and L/L deceleration.

CONCLUSION

Neuromotor control of L/L muscles is affected by the selected control option during WRE walking, particularly when a predetermined foot pathway is imposed.

SIGNIFICANCE

This exploratory study represents the first step in informing the decision-making process regarding the use of different L/L control options when using WRE and calls for further research among adults with sensorimotor impairments.

Wearable exoskeleton control modes selected during overground walking affect muscle synergies in adults with a chronic incomplete spinal cord injury

STUDY DESIGN

Case series.

BACKGROUND

Changes in the number of muscle synergies (MSs) and in the weighting of muscles composing each MS are typically altered following an incomplete spinal cord injury (iSCI). Wearable robotic exoskeletons (WRE) represent a promising rehabilitation option, though the effects of various WRE control modes on MSs still remain unknown.

OBJECTIVE

This case series characterizes how WRE control modes affect the number of MSs and the weighting of muscles composing each MS in individuals with iSCI.

SETTING

Pathokinesioly laboratory of a rehabilitation research center.

METHODS

Three participants with a chronic iSCI walked at a self-selected comfortable speed without and with a WRE set in two trajectory-controlled (Total Assistance, TOT; Assistance-as-Needed, ADAPT) and three non-trajectory controlled modes (High Assistance, HASSIST; High Resistance, HRESIST; NEUTRAL). Surface EMG of eight lower extremity (L/E) muscles was recorded and used to extract MSs using a nonnegative matrix factorization algorithm. Cosine similarity and weighting relative differences characterized similarities in MSs between individuals with iSCI and able-bodied controls.

RESULTS

The mode providing movement assistance within a self-selected L/E trajectory (HASSIST) best replicated MSs in able-bodied controls during overground walking. MSs extracted with the trajectory-controlled modes differed to the greatest extent from able-bodied group MSs.

CONCLUSIONS

Most WRE control modes did not replicate the motor control required for typical L/E muscle coordination during stereotypical overground walking. These results highlight the need to gain a better understanding of the effects of various control modes on L/E motor control for rehabilitation professionals to incorporate research evidence when selecting WRE control mode(s) during WRE locomotor interventions.

The effects of a strong desire to void on gait for incontinent and continent older community-dwelling women at risk of falls

AIMS

The fall rate in urgency urinary incontinence (UUI) and mixed UI (MUI) older women is higher when compared with that of continent women. One hypothesis is that a strong desire to void (SDV) could alter gait parameters and therefore increase the risk of falls. The aim of this study was to investigate and compare the effect of SDV on gait parameters in UUI/MUI and continent older women who experienced falls. The secondary aim was to determine the relationship between UI severity and gait parameters in incontinent women.

METHODS

A quasi-experimental pilot study was conducted with two groups of healthy community-dwelling women who experienced at least one fall in the last year: continent (n = 17; age: 74.1 ± 4.3) and UUI/MUI (n = 15; age: 73.5 ± 5.9). We recorded, analyzed, and compared spatiotemporal gait parameters for participants in each group with both SDV and no desire to void condition.

RESULTS

A pattern of reduced velocity (P = 0.05) and stride width (P = 0.02) was observed in both groups with SDV. Incontinence severity was correlated with reduced velocity (r_s  = -0.63, P = 0.01), increased stance time (r_s = 0.65, P = .01) and stance time variability (r_s  = 0.65, P = .01) in no desire to void condition and with reduced velocity (r_s  = -0.56, P = .03) and increased stride length variability (r_s  = 0.54, P = .04) in SDV condition.

CONCLUSIONS

SDV reduced gait velocity and stride width regardless of continence status in older women at risk of falls. Further, UI severity in the UUI/MUI women was correlated to reduced gait velocity and increased variability. Our findings could explain the higher fall rate in this population.

Cortical dynamics of sensorimotor information processing associated with balance control in adolescents with and without idiopathic scoliosis

OBJECTIVE

This study aims at examining the cortical dynamics of sensorimotor information processing related to balance control in participants with adolescent idiopathic scoliosis (AIS) and in age-matched controls (CTL).

METHODS

Cortical dynamics during standing balance control were assessed in 13 girls with AIS and 13 age-matched controls using electroencephalography. Time-frequency analysis were used to determine frequency power during ankle proprioception alteration (ankle tendons co-vibration interval) or reintegration of ankle proprioception (post-vibration interval) with or without vision.

RESULTS

Balance control did not differ between groups. In the co-vibration interval, a significant suppression in alpha (8-12 Hz) and beta (13-30 Hz) band power and a significant increase in theta (4-7 Hz) band power were found respectively in the vision and non-vision condition in the AIS group compared to the CTL group. In the post-vibration interval, significant suppressions in beta (13-30 Hz) and gamma (30-50 Hz) band power were observed in the AIS group in the non-vision condition.

CONCLUSION

Participants with AIS showed brain oscillations differences compared to CTL in the sensorimotor cortex while controlling their balance in various sensory conditions.

SIGNIFICANCE

Future study using evaluation of cortical dynamics could serve documenting whether rehabilitation programs have an effect on sensorimotor function in AIS.

Slow and faster post-stroke walkers have a different trunk progression and braking impulse during gait

BACKGROUND

Braking forces absorbed by the leading paretic limb are greater than expected with regard to gait speed and not correlated with propulsive forces generated by the non-paretic limb in individuals with severe hemiparesis. Altered foot placement due to poor sensorimotor capacities may explain excessive braking forces.

RESEARCH QUESTION

The main objective of this study was to determine whether paretic foot placement was related to paretic braking forces in post-stroke individuals with various self-selected walking speeds and motor deficits.

METHODS

In this cross-sectional study, 34 chronic hemiparetic post-stroke individuals, divided into slow (< 0.7 m/s, n = 17) and faster (n = 17) subgroups, walked at their self-selected speed. Kinematic and kinetic parameters were measured. Braking impulses, peak braking forces, step characteristics and clinical status were compared between groups and limbs, and their correlations were tested using Pearson (or Spearman) correlation tests.

RESULTS

On the paretic side, braking impulses and step length were similar between groups despite the slower walking speed in the slow group. Paretic peak braking forces and step length were correlated in both groups (r = 0.5). Paretic braking forces were correlated with walking speed, foot placement ahead of the pelvis, trunk progression (TP) from non-paretic initial contact to paretic initial contact, and better motor function of the paretic limb for the faster walkers (0.6 < r < 0.7), but not for the slow walkers. Among the slow walkers, reduced TP ahead of the paretic foot was correlated with a higher paretic impulse (r =  -0.6).

SIGNIFICANCE

Better motor function likely helped the faster walkers to decelerate their center of mass appropriately relative to their walking speed. In the slow hemiparetic walkers, TP ahead of the paretic foot was perturbed. Clinicians should therefore consider vasti and plantar flexor muscle tone and activity that likely restrict TP ahead of the paretic foot and increase braking forces.

Structured Representation of Drug Indications: Lexical and Semantic Analysis and Object-Oriented Modeling

No standardized representation of drug indications is currently available that could be used in drug knowledge bases. We describe an object-oriented representation of indications that should make it possible to develop new tools for selecting drugs and checking prescriptions in computerized drug prescription systems. The model was developed using the results of a lexical and semantic analysis of drug indications, collected into a single file and processed using natural language processing software. It distinguishes both the diseases for which the drug may be given and the efficiency of the drug for a given indication. Two aspects of the model were evaluated: the differences if two independent evaluators filled the attributes independently and the loss of information induced by the use of the model. A system based on this model, making it possible for the physician to select all the drugs satisfying various criteria, is also presented.

Cardiorespiratory demand and rate of perceived exertion during overground walking with a robotic exoskeleton in long-term manual wheelchair users with chronic spinal cord injury: A cross-sectional study

BACKGROUND

Many wheelchair users adopt a sedentary lifestyle, which results in progressive physical deconditioning with increased risk of musculoskeletal, cardiovascular and endocrine/metabolic morbidity and mortality. Engaging in a walking program with an overground robotic exoskeleton may be an effective strategy for mitigating these potential negative health consequences and optimizing fitness in this population. However, additional research is warranted to inform the development of adapted physical activity programs incorporating this technology.

OBJECTIVES

To determine cardiorespiratory demands during sitting, standing and overground walking with a robotic exoskeleton and to verify whether such overground walking results in at least moderate-intensity physical exercise.

METHODS

We enrolled 13 long-term wheelchair users with complete motor spinal cord injury in a walking program with an overground robotic exoskeleton. Cardiorespiratory measures and rate of perceived exertion (RPE) were recorded by using a portable gas analyzer system during sitting, standing and four 10m walking tasks with the robotic exoskeleton. Each participant also performed an arm crank ergometer test to determine maximal cardiorespiratory ability (i.e., peak heart rate and O₂ uptake [HR_peak, VO_2peak]).

RESULTS

Cardiorespiratory measures increased by a range of 9%-35% from sitting to standing and further increased by 22%-52% from standing to walking with the robotic exoskeleton. During walking, median oxygen cost (O_2Walking), relative HR (%HR_peak), relative O₂ consumption (%VO_2peak) and respiratory exchange ratio (RER) reached 0.29mL/kg/m, 82.9%, 41.8% and 0.9, respectively, whereas median RPE reached 3.2/10. O_2Walking was moderately influenced by total number of sessions and steps taken with the robotic exoskeleton since the start of the walking program.

CONCLUSION

Overground walking with the robotic exoskeleton over a short distance allowed wheelchair users to achieve a moderate-intensity level of exercise. Hence, an overground locomotor training program with a robotic exoskeleton may have cardiorespiratory health benefits in the population studied.

Satisfaction and perceptions of long-term manual wheelchair users with a spinal cord injury upon completion of a locomotor training program with an overground robotic exoskeleton

AIM

The main objectives of this study were to quantify clients' satisfaction and perception upon completion of a locomotor training program with an overground robotic exoskeleton.

METHODS

A group of 14 wheelchair users with a spinal cord injury, who finished a 6-8-week locomotor training program with the robotic exoskeleton (18 training sessions), were invited to complete a web-based electronic questionnaire. This questionnaire encompassed 41 statements organized around seven key domains: overall satisfaction related to the training program, satisfaction related to the overground robotic exoskeleton, satisfaction related to the program attributes, perceived learnability, perceived health benefits and risks and perceived motivation to engage in physical activity. Each statement was rated using a visual analogue scale ranging from "0 = totally disagree" to "100 = completely agree".

RESULTS

Overall, respondents unanimously considered themselves satisfied with the locomotor training program with the robotic exoskeleton (95.7 ± 0.7%) and provided positive feedback about the robotic exoskeleton itself (82.3 ± 6.9%), the attributes of the locomotor training program (84.5 ± 6.9%) and their ability to learn to perform sit-stand transfers and walk with the robotic exoskeleton (79.6 ± 17%). Respondents perceived some health benefits (67.9 ± 16.7%) and have reported no fear of developing secondary complications or of potential risk for themselves linked to the use of the robotic exoskeleton (16.7 ± 8.2%). At the end of the program, respondents felt motivated to engage in a regular physical activity program (91.3 ± 0.1%).

CONCLUSION

This study provides new insights on satisfaction and perceptions of wheelchair users while also confirming the relevance to continue to improve such technologies, and informing the development of future clinical trials. Implications for Rehabilitation All long-term manual wheelchair users with a spinal cord injury who participated in the study are unanimously satisfied upon completion of a 6-8-week locomotor training program with the robotic exoskeleton and would recommend the program to their peers. All long-term manual wheelchair users with a spinal cord injury who participated in the study offered positive feedback about the robotic exoskeleton itself and feel it is easy to learn to perform sit-stand transfers and walk with the robotic exoskeleton. All long-term manual wheelchair users with a spinal cord injury who participated in the study predominantly perceived improvements in their overall health status, upper limb strength and endurance as well as in their sleep and psychological well-being upon completion of a 6-8-week locomotor training program with the robotic exoskeleton. All long-term manual wheelchair users with a spinal cord injury who participated in the study unanimously felt motivated to engage in a regular physical activity program adapted to their condition and most of them do plan to continue to participate in moderate-to-strenuous physical exercise. Additional research on clients' perspectives, especially satisfaction with the overground exoskeleton and locomotor training program attributes, is needed.

Effect of liquid properties on swallowing and ventilation coordination in rats

BACKGROUND

One aspect of rehabilitation in swallowing disorders is to change liquid properties. The objective of our study was to test how liquid properties could improve oropharyngeal dysphagia and swallowing and ventilation coordination in an animal model.

METHODS

Forty-two healthy male rats were distributed in six groups, including a control group. Rats were deprived of water for 24 h and then each group was administered liquid with different properties: tap water, sugar water, sparkling water, salt water, cold water, and acidic water. Rats were studied without and with oropharyngeal dysphagia achieved by unilateral section of the hypoglossal nerve. Swallowing and ventilation were analyzed by barometric plethysmograph.

KEY RESULTS

In healthy rats, swallowing occurred during expiratory time for all liquid properties. Most deglutitions were during expiratory time for all liquid properties (88±12%) and were not modified. There was an increase in VT/TI during swallowing with sparkling water and cold water (P<.05). In the operated groups, rats had significantly fewer swallows with tap water (P<.05) and significantly more swallows with sparkling water (P<.001), sugar water (P<.001) and cold water (P<.001) during expiratory time. The mean inspiratory volume (VT/TI) increased with sparkling water (P<.05).

CONCLUSION AND INFERENCES

Sparkling water seemed to improve swallowing and ventilation coordination in an animal model, to be confirmed in a study including patients with oropharyngeal dysphagia.

How does wearable robotic exoskeleton affect overground walking performance measured with the 10-m and six-minute walk tests after a basic locomotor training in healthy individuals?

It is still unknown to what extent overground walking with a WRE is equivalent to natural overground walking without a WRE. Hence, the interpretability of the 10-m (10MWT) and six-minute (6MWT) walk tests during overground walking with a WRE against reference values collected during natural overground walking without a WRE is challenging. This study aimed to 1) compare walking performance across three different overground walking conditions: natural walking without a WRE, walking with a WRE providing minimal assistance (active walking), and walking with a WRE proving complete assistance (passive walking) and 2) assess the association and the agreement between the 10MWT and the 6MWT during passive and active walking with a WRE. Seventeen healthy individuals who underwent basic locomotor training with a WRE performed the 10MWT (preferred and maximal speeds) and the 6MWT under the three conditions. For the 10MWT, the speed progressively and significantly decreased from natural walking without a WRE (preferred: 1.40±0.18m/s; maximal: 2.16±0.19m/s), to active walking with a WRE (preferred: 0.48±0.10m/s; maximal: 0.61±0.14m/s), and to passive walking with a WRE (preferred: 0.38±0.09m/s; maximal: 0.42±0.10m/s). For the 6MWT, total distances decreased from walking without a WRE (609±53.9m), to active walking with a WRE (196.6±42.6m), and to passive walking with a WRE (144.3±33.3m). The 10MWT and 6MWT provide distinct information and can't be used interchangeably to document speed only during active walking with the WRE. Speed and distance drastically decrease during active and, even more so, passive walking with the WRE in comparison to walking without a WRE. Selection of walking tests should depend on the level of assistance provided by the WRE.

Introducing a psychological postural threat alters gait and balance parameters among young participants but not among most older participants

The fear of falling can be manipulated by introducing a postural threat (e.g., an elevated support surface) during stance and gait. Under these conditions, balance parameters are altered in both young and elderly individuals. This study aimed to dissociate the physical and psychological aspects of the threat and show the impact of a verbal warning cue of imminent perturbation during gait among young and elderly healthy participants. Ten young subjects (29.4 ± 3.9 years) and ten subjects aged over 65 years (72.9 ± 3.5) participated in the study. Spatiotemporal and balance parameters were quantified during eight consecutive gait cycles using a motion analysis system and an instrumented treadmill. These parameters were compared twice in the control trial and before/after a verbal warning cue of imminent perturbation during gait ("postural threat") in perturbation trials and between groups using repeated measure ANOVAs.

RESULTS

The verbal cue yielded reduced step length (p = 0.008), increased step width (p = 0.049), advanced relative position of the center of mass (p = 0.016), increased stabilizing force (p = 0.003), and decreased destabilizing force (p = 0.002). This warning effect was not observed in the older participant group analyses but was found for three participants based on individual data analyses. The warning effect in younger participants was not specific to impending perturbation conditions. Most gait and balance parameters were altered in the older group (p < 0.05) versus the younger group in each condition, regardless of the warning cue. A psychological threat affects gait and balance similarly to a physical threat among young participants but not among most older participants.

Do Performance-Based Wheelchair Propulsion Tests Detect Changes Among Manual Wheelchair Users With Spinal Cord Injury During Inpatient Rehabilitation in Quebec?

OBJECTIVE

To quantify and compare the responsiveness and concurrent validity of 3 performance-based manual wheelchair propulsion tests among manual wheelchair users with subacute spinal cord injury (SCI) undergoing inpatient rehabilitation.

DESIGN

Quasi-experimental repeated-measures design.

SETTING

Publicly funded comprehensive inpatient SCI rehabilitation program.

PARTICIPANTS

Consenting adult manual wheelchair users with a subacute SCI admitted and discharged from inpatient rehabilitation (N=14).

INTERVENTION

Participants performed 20-m propulsion at both self-selected natural and maximal speeds, the slalom, and the 6-minute propulsion tests at rehabilitation admission and discharge.

MAIN OUTCOME MEASURES

Time required to complete the performance-based wheelchair propulsion tests. Standardized response means (SRMs) were computed for each performance test and Pearson correlation coefficients (r) were calculated to explore the associations between performance tests.

RESULTS

The slalom (SRM=1.24), 20-m propulsion at maximum speed (SRM=.99), and 6-minute propulsion tests (SRM=.84) were the most responsive. The slalom and 20-m propulsion at maximum speed were strongly correlated at both admission (r=.93) and discharge (r=.92).

CONCLUSIONS

The slalom and 6-minute propulsion tests best document wheelchair propulsion performance change over the course of inpatient rehabilitation. Adding the 20-m propulsion test performed at maximal speed provides a complementary description of performance change.

The Total Work Measured During a High Intensity Isokinetic Fatigue Test Is Associated With Anaerobic Work Capacity

The purpose of the study was to determine whether total work measured during a high intensity isokinetic fatigue test (TWFAT) could be considered as a valid measure of anaerobic work capacity (AWC), such as determined by total work measured during a Wingate Anaerobic Test (TWWAnT). Twenty well-trained cyclists performed 2 randomly ordered sessions involving a high intensity isokinetic fatigue test consisting in 30 reciprocal maximal concentric contractions of knee flexors and extensors at 180°·s(-1), and a Wingate Anaerobic Test. We found that TWFAT of knee extensors was largely lower than TWWAnT (4151 ± 691 vs 22313 ± 2901 J, respectively, p < 0.05, Hedge's g = 4.27). Both measures were highly associated (r = 0.83), and the 95% limits of agreement (LoA) represented 24.5% of TWWAnT. TWFAT of knee flexors (2151 ± 540 J) was largely lower than TWWAnT (p < 0.05, g = 9.52). By contrast, both measures were not associated (r = 0.09), and the 95% LoA represented 31.1% of TWWAnT. Combining TWFAT of knee flexors and knee extensors into a single measure (6302 ± 818 J) did not changed neither improved these observations. We still found a large difference with TWWAnT (p < 0.05, g = 5.26), a moderate association (r = 0.65) and 95% LoA representing 25.5% of TWWAnT. We concluded that TWFAT of knee extensors could be considered as a valid measure of AWC, since both measure were highly associated. However, the mean difference between both measures and their 95% LoA were too large to warrant interchangeability. Key pointsTotal work performed during a high intensity isokinetic fatigue test can be considered as a valid measure of anaerobic work capacity (as determined by total work performance during a 30-s Wingate anaerobic test).The 95% limits of agreement are two large to allow a direct comparison between both measures. In other words, it is not possible to estimate the magnitude of performance improvement during a 30-s Wingate anaerobic test from that observed during a high intensity isokinetic fatigue test.In addition to provide sport scientists and coaches with measures of peak torque and ratios between agonists and antagonists muscles in a perspective of injury prevention, isokinetic dynamometry can also be used in the physiological assessment of athletes. However, some precautions should be taken in the interpretation of data.