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Novel and theory-based interventions promoting leisure time physical activity (LTPA) are needed for adults with spinal cord injury (SCI). The purpose of this study was to pilot test a tele-health intervention, grounded in self-determination theory, to enhance need satisfaction, motivation, physical activity, and quality of life among adults with SCI. Pilot randomized controlled trial. Participants (N = 24) were randomized to either a control or intervention group (N = 22 completed the study). The intervention group received one, 1-h counselling session per week, for eight weeks and the sessions were delivered via an online video-chat platform. The counselling sessions focused on fostering the basic psychological needs and autonomous motivation, teaching behaviour change techniques, and self-regulatory strategies. The control group was asked to continue with their regular routine. Participants responded to a questionnaire at baseline, mid-, and post-intervention. Hedge's g effect sizes were used to examine group differences and reliable change indexes to verify individual changes. Compared to the control group, the intervention group reported greater autonomous motivation (Hedge's g = 0.91) and LTPA (Hedge's g = 0.85) post-intervention. Large to moderate effects supporting the intervention group were found for health participation at six weeks (Hedge's g = 0.97), and meaningful life experiences (Hedge's g = 0.72) and social cognitive predictors of LTPA (Hedge's g > 0.76) post-intervention. This study demonstrated the preliminary effectiveness of a self-determination theory and tele-health LTPA counselling intervention for adults with SCI, which may help inform larger interventions aimed at promoting LTPA among this population. ClinicalTrials.gov NCT02833935 ; https://clinicaltrials.gov/ct2/show/NCT02833935 (Archived by WebCite at http://www.webcitation.org/6u8U9x2yt) • Physical activity motivation support can be delivered through a videoconference platform. • A trained physical activity counsellor can increase physical activity motivation. • People with spinal cord injury increased their physical activity levels after 8 weeks of coaching. • This initial physical activity intervention can now be tested among more adults with spinal cord injury. [ABSTRACT FROM AUTHOR]

Introduction/Background Individuals with traumatic brain injury often present with balance problems associated with a decrease in their social participation. An innovative approach consists in using perturbations on a split-belt treadmill to improve dynamic balance. The aim of this study is to quantify the effects of a training program including perturbations on a split-belt treadmill on dynamic balance, walking speed, balance confidence and social participation in individuals with traumatic brain injury in social integration rehabilitation phase or at a chronic stage. Material and method Seven individuals with moderate-to-severe traumatic brain injury participated in six training sessions on a split-belt treadmill with self-perturbations (head movements, turns, cognitive task) and unexpected perturbations (stop-and-go, speed increase or decrease of one treadmill belt). The Mini-BESTest, Community Balance & Mobility Scale, comfortable and fast walking speed, Reintregration to Normal Living Index and Activity-Specific Balance Confidence Scale were measured twice before and after the intervention. Results Preliminary results indicated a statistically significant improvement of 2.1 (1.5)/28 at the Mini-BESTest and 7.0 (6.9)/96 at the Community Balance and Mobility Scale. No significant change in speed, balance confidence and social participation were observed. A learning effect was observed between the two pre-intervention assessments. Conclusion This approach seems promising in balance reeducation with individuals with moderate-to-severe traumatic brain injury. [ABSTRACT FROM AUTHOR]

Introduction/Background Balance perturbation training is a promising rehabilitation approach, but limited research is available on its effectiveness for balance post-stroke. The aim of this study was to compare the effects of training with and without unpredictable gait perturbations, on dynamic balance and gait abilities in individuals post-stroke. Material and method Nineteen stroke individuals were assigned to two groups: perturbation training (PT) and no-perturbation training (nPT), and attended 9 training sessions over 3 weeks using a split-belt treadmill. For PT, perturbations were produced by changing the speed of one of the belts during stance phase every 8 to 16 steps. The intensity of the perturbations increased progressively between sessions according to participants’ tolerance. The duration of the training sessions in nPT, i.e. without perturbation, was matched with a PT subject with similar speed. The effects of the training programs on dynamic balance (Mini-BESTest), balance confidence (ABC Scale), gait speed [10-meter walk test (10MWT)], knee extensors strength (dynamometry), and reintegration into social activities [Reintegration to Normal Living Index (RNLI)] were evaluated and compared using Anovas and t -tests. Results Mini-BESTest [+4.0 (±5.2)/28 points, P = 0.005], ABC scale [+4.4% (±6.0), P = 0.026], 10MWT at faster speed [+0.17 (±0.15) m/s, P = 0.009], non-paretic knee extensors [+37.2 (±41.7) Nm, P = 0.056], and RNLI [−3.4 (±2.9)/11, P = 0.04] increased significantly with PT, with no significant changes on 10MWT at self-selected speed (0.13 (±0.19) m/s, P = 0.065) and maximum strength generation on the paretic side (+32.7 [±41.3] Nm, P = 0.081). Mini-BESTest, gait speed (self-selected and faster) and maximum knee extensors strength of paretic side in PT changed significantly in comparison to nPT which did not show any improvement. Conclusion Results support the clinical effectiveness of unpredictable gait perturbation training over walking on the treadmill in improving gait and dynamic balance after stroke. Impact on fall risk should be evaluated in a future clinical study. [ABSTRACT FROM AUTHOR]

Introduction/Background Gait perturbation training for fall prevention is gaining recognition over regular strength and balance exercises. Difficulty of perturbations chosen varies between interventions and the most effective intensity is unknown. Some physiotherapists already use perturbations in clinical settings. Our objective was to quantify the changes in balance parameters during gait perturbations selected by an experienced physiotherapist. Material and method Seven subjects with moderate to severe traumatic brain injury and deficits in dynamic balance participated. Three-dimensional whole-body motion and kinetics analysis was performed, after one habituation session. Self-imposed (head rotations) or physiotherapist-imposed (repeated or random slips and trips induced by changes in belt speed) perturbations were applied while walking on a split-belt treadmill. Relative anteroposterior position (APP) and velocity of the center of mass (COM) and center of pressure (COP) were compared between perturbations and natural and fast gait speed. Results No differences were found in relative APP of COM and COP for physiotherapist-imposed slip-like or self-imposed perturbations compared to natural gait ( P > 0.134). Physiotherapist-imposed trip-like perturbations caused significantly more forward relative APP of COM and COP than during fast gait ( P ≤ 0.05). Velocity of COM and COP was significantly greater during physiotherapist-imposed ( P ≤ 0.001), but not self-imposed ( P > 0.106), perturbations than at natural gait speed. COM velocity remained lower than during fast gait for all perturbations ( P ≤ 0.05), but COP velocity in physiotherapist-induced perturbations reached fast gait COP velocity ( P > 0.279). Conclusion Balance-related gait parameters were not affected during self-imposed perturbations, while physiotherapist-imposed trip-like perturbations altered parameters the most. During physiotherapist-imposed perturbations, balance control (COP-related) parameters reached values equal or greater than at fast gait speed. Meanwhile, the level of balance quantified by COM-related parameters, reached levels similar to fast gait for relative APP but not velocity. Future research should examine the possibility of personalizing perturbations to train specific balance parameters based on patient needs. [ABSTRACT FROM AUTHOR]

Introduction/Background Spinal cord injury (SCI) is a life-changing event as it incurs primary impairment (e.g., paralysis, bladder dysfunction), as well as secondary health conditions (e.g., spasticity, pressure sores), and impacts on life domains (e.g., housing, transportation). As a result, assessing quality of life (QoL) post-SCI is challenging since QoL can be impacted in various ways depending on specific (or a combination of) health conditions and life domains. To address these challenges, the Participation and Quality of Life (PAR-QoL) website, an online knowledge mobilization tool, was developed to aid clinicians and researchers in the selection of QoL outcome tools specific to SCI. The aim of this study was to evaluate the usability and use of the website. Material and method Using a technology acceptance framework, an online usability survey was developed and employed to gain information about how the website was used, perceived ease of use, and improvement recommendations. The actual use was assessed through a 26-item survey and through Google analytics. Recruitment targeted researchers and clinicians who worked with individuals with SCI. Survey and web data were analyzed using descriptive statistics. Results Forty-six individuals responded. More than 60% used the website to find tools for work. The website was perceived as easy to use by 80% of respondents. To improve the website, respondent suggested rearranging classification, developing a French version, and adding more up-to-date evidence. There were a total of 181.179 users who made 303.810 visits to the website between April 2012 and November 2017. Returning visitors comprised 13% of the total visits. Conclusion The PAR-QoL website was perceived to be an important and useful knowledge mobilization tool with QoL outcome tools for SCI that are easy to find. Usability may be improved through modification of navigation processes and improved organization of content, which may facilitate greater uptake. [ABSTRACT FROM AUTHOR]

Introduction Virtual reality (VR) can promote functional rehabilitation of arm movements through environments allowing the practice of a variety of tasks while providing feedback [1] . We evaluated an affordable VR system for arm rehabilitation, developed by Jintronix Inc and based on the Microsoft Kinect, that provides three unilateral and two bilateral activities, each with ten difficulty levels. Objectives Our objectives were to (1) determine which activities and levels of difficulty are appropriate for rehabilitation of arm movements in stroke patients with different degrees of motor impairment; and (2) determine the ease of use and subjective experience of patients using the VR arm rehabilitation system. Methods Clinicians each supervised two to four stroke patients who participated in three 20-minute sessions with the Jintronix system. We determined the highest level of difficulty attained by patients in each activity with a performance score of at least 50%. Arm impairment was assessed using the upper extremity section of the Chedoke-McMaster Scale (CM) [2] . Patients and clinicians completed a questionnaire on the usability of the Jintronix system, based on the technology acceptance model (FD Davis [3] ). Results Fifteen clinicians supervised a total of 40 stroke patients. Over 80% of the clinicians and patients provided positive feedback in terms of ease of use and VR experience. For each activity of the Jintronix system, results indicated a positive correlation between the CM score and the maximal difficulty level reached by stroke patients. Discussion Our data demonstrate the feasibility of using an affordable VR arm rehabilitation system in a clinical setting and provide clinical guidelines for the selection of impairment-specific difficulty levels. [ABSTRACT FROM AUTHOR]