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Study Design Pilot randomized controlled trial with parallel groups. Introduction Engaging individuals with carpal tunnel syndrome (CTS) awaiting carpal tunnel decompression surgery in a preoperative rehabilitation program may mitigate pain and sensorimotor impairments, enhance functional abilities before surgery, and improve postoperative outcomes. Purpose of the Study To assess the feasibility and the efficacy of a novel preoperative neuromobilization exercise program (NEP). Methods Thirty individuals with CTS were randomly allocated into a four-week home-based neuromobilization exercise group or a standard care group while awaiting surgery. Outcome measures included feasibility (ie, recruitment, attrition, adherence, satisfaction, and safety) and efficacy metrics (ie, median nerve integrity and neurodynamics, tip pinch grip, pain, and upper limb functional abilities) collected before (ie, at the baseline and about four weeks later) and four weeks after surgery. Results Thirty individuals with CTS were recruited (recruitment rate = 11.8%) and 25 completed the study (attrition rate = 16.7%). Adherence (94%) and satisfaction with the program (eg, enjoy the exercises and likeliness to repeat the NEP (≥4.2/5) were high and no serious adverse event was reported. NEP-related immediate pre- and post-surgery beneficial effects on pain interference were documented (P = .05, η2 = .10), whereas an overall increased neurodynamics (P = .04, η2 = .11) and decreased pain severity (P = .01, η2 = .21) were observed. Discussion Engaging in the proposed NEP has limited beneficial effect as a stand-alone intervention on pre- and post-surgery outcomes for individuals with CTS. Expanding the program’s content and attribute by adding other components including desensitization maneuvers and novel therapies promoting corticospinal plasticity is recommended. Conclusion A preoperative NEP completed by individuals with CTS awaiting surgery is feasible, acceptable, and safe. However, given the limited beneficial effectsof the program, revision of its content and attributes is recommended before proceeding to large-scale trials.

Summary 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.

With low back pain (LBP), remodelling of the lumbar soft tissues involves both trunk muscles and neighbouring passive connective tissues. The aim of the present study was to compare three quantitative measures of these tissues, using ultrasound imaging (USI), among healthy controls and individuals with LBP.USI measures from 30 healthy subjects and 34 patients with non-acute LBP were compared between groups and sexes. The measures employed were (1) lumbar multifidus echogenicity (fatty/fibrosis infiltration) at three vertebral levels; (2) posterior layer thickness of the thoracolumbar fascia, and (3) thickness of the perimuscular tissues surrounding the external oblique, internal oblique and transversus abdominis (TrA).USI measures of (1) multifidus echogenicity showed statistically significant changes between vertebral levels and sexes (females males; p = 0.02); (2) differences in thoracolumbar fascia thickness approached statistical significance between groups (LBP controls; p = 0.09) and sexes (femalesmales; p = 0.07); and (3) perimuscular tissue surrounding the TrA was significantly thinner (p ≤ 0.001) in patients with LBP compared to controls.The thinner perimuscular tissues surrounding the TrA in patients with LBP is a new finding, concurring with previous findings with regard to the lower activation of this deep muscle as well as more recent findings on other perimuscular tissue.Overall, USI measures were sensitive to different potential changes (pain status, sex, vertebral level), and this is useful in studying the remodelling of various soft tissues of the trunk.

Background Many manual wheelchair users with a spinal cord injury are at risk of developing secondary upper extremity musculoskeletal impairments. The use of a mobility assistance dog may represent a way to mitigate this risk. This study aims to compare upper extremity muscular effort in this population when propelling a manual wheelchair on tiled and carpeted surfaces with and without the assistance of a dog. Method Thirteen adults with a spinal cord injury propelled their manual wheelchairs at a self-selected natural speed over a 10-meter distance on tiled abrasive and carpeted floors with and without their mobility assistance dog. Surface electromyography of the pectoralis major, anterior deltoid, biceps, and triceps was recorded and normalized against its maximal value extracted from maximal voluntary contractions. Time needed to perform each task was also computed. Findings The forward pull provided by the dog significantly and meaningfully reduced the muscular effort when propelling on the tiled floor and, even more so, on carpeted surfaces for the pectoralis major (−27.0% and −59.2%), the anterior deltoid (−54.8% and −92.4%), the biceps (−53.9% and −57.6%), and the triceps (−45.7% and −67.3%). The time needed to travel the 10-meter distance was also significantly and meaningfully reduced on the tiled and carpeted surfaces (−21.9% and −30.3%, respectively). Interpretation The provision of a mobility assistance dog represents a viable rehabilitation alternative to minimizing upper extremity muscular effort while also optimizing speed during propulsion in manual wheelchair users with a spinal cord injury.

Background Characterization of ischial tissue health using a standardized diagnostic ultrasound protocol capturing thickness and gray scale analysis has not been established. Objectives This study evaluates inter-participant and inter-trial reliability of thickness and gray scale analysis of ultrasound images of tissues overlying the ischial tuberosity. It provides recommendations for the number of images required to minimize the standard error of measurement (SEM) and determines the number of images required for thickness, gray scale and contrast values that exceed an a-priori minimal detectable change (MDC) for repeated tissue assessment. Methods Brightness mode ultrasound images using a 12 MHz linear probe were collected on the dominant limb in the side lying position for ten healthy participants and partitioned into three regions of interest: skin, subcutaneous tissue and muscle. Thickness and gray scale measures of skin, muscle and subcutaneous tissue were calculated using a customized MATLAB program. Contrast of each region of interest was calculated using the Gray Scale Level Co-Occurrence Matrix. Generalizability theory was used to quantify indices of dependability and corresponding SEMs and MDCs with 90% Confidence Intervals. Results Participants accounted for most of the total variance (75.56% to 94.78%). Coefficient of dependability (ϕ) for thickness, grey scale and contrast measures was greater than 0.80 when more than two images were averaged. In order to detect a MDC of 21% in thickness and echogenicity measures, at least three images are required, while at least 5 images are required for a MDC of 25% for contrast measures. Conclusions Obtaining reliable thickness, echogenicity and contrast measures of tissue overlying the ischial tuberosity can be achieved from two ultrasound images by a single therapist on an individual participant however three and five images are required to use a MDC of 21% for thickness measures and MDC of 25% for contrast measures respectively.

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 10 m 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 O 2 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 O 2 consumption (%VO 2peak ) and respiratory exchange ratio (RER) reached 0.29 mL/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.

Objective To document the usability of psychiatric service dogs (PsySDs) as a tertiary prevention modality from the perspective of veterans who have been using a PsySD 2 to 4 years as an assistive aid for post-traumatic stress disorder symptom (PTSD) management. Method A case series study with PsySD primary users was carried out with 10 Canadian veterans recruited from 4 different dog training schools. Researchers conducted semi-structured telephone interviews and asked questions pertaining to four domains addressing the PsySD’s ‘usability’. A content and thematic analysis were realized using an inductive and deductive approach. Results Our conceptual framework proposes four main themes with their associated subthemes:: 1-Service dog’s roles and tasks (8 subthemes, e.g. acting as a socializing agent, maintaining an appropriate free space around the veteran), 2-Personal advantages and Environmental impacts (8 subthemes, e.g. alleviating symptoms; increasing outings and physical activities, enabling social interactions and relationship building), 3-Obstacles (4 subthemes, e.g. high costs of dog maintenance, dog’s presence attracted unwanted public attention, prompting intrusive questions), and 4-Recommendations for PsySD programs (16 subthemes, e.g. creating a national registry for PsySD, encouraging mental health practitioners’ involvement). Conclusions and Implications for Practice Themes 1 and 2 are positive perceptions, and theme 4 suggests relevant potential improvements. The current study offers insights into how PsySDs concretely assist primary users and can help addressing PTSD chronicity. It presents the roles professionals may play when dealing with patients using PsySDs for PTSD. The proposed conceptual framework can be useful to policy makers, dog trainers and caregivers.

Thoracic spinal cord injury (SCI) can have significant negative consequences, which can affect the ability to maintain unsupported sitting. The objectives of this study were to compare postural control of individuals with high- and low-thoracic SCI to able-bodied people and evaluate the effects of upper-limb support on postural control during quiet sitting. Twenty-five individuals were recruited into: (a) high-thoracic SCI; (b) low-thoracic SCI; and (c) able-body subgroups. Participants were seated and asked to maintain a steady balance in the following postures: (1) both hands resting on thighs; (2) both arms crossed over the chest; and (3) both arms extended. Center of pressure (COP) fluctuations were evaluated to compare postural performance between groups and different postures. Results showed that individuals with high- and low-thoracic SCI swayed more compared to the able-bodied group regardless of upper-limb support. No differences between the two SCI groups were observed, but the neurological level of injury was correlated to postural performance implying that those with higher injuries swayed more and faster. Unsupported sitting was more unstable in comparison to supported sitting posture, especially in the anterior-posterior direction. The velocity of postural sway was not different between groups, but the results suggest that postural regulation had unique effect during different postures in different groups. These results imply reduced postural stability after thoracic SCI. Overall, the way individuals with high-thoracic SCI achieved stability was different from that of individuals with low-thoracic SCI, suggesting different postural regulation strategies.

Spinal cord injury (SCI) can result in paralysis of trunk muscles, which can affect sitting balance. The objective of this study was to analyze trunk muscle coordination of individuals with thoracic SCI and compare it to able-body individuals. A total of 27 individuals were recruited and subdivided into: (a) high thoracic SCI; (b) low thoracic SCI; and (c) able-body groups. Participants were seated and asked to lean their trunk in eight directions while trunk muscle activity was recorded. Muscle coordination was assessed using the non-negative matrix factorization (NMF) method to extract muscle modules, which are the synergistic trunk muscle activations, and their directional activation patterns. Our results showed that individuals with SCI used less muscle modules, more co-contractions, and less directional tuning, compared to able-bodied people. These results suggest impaired and simplified muscle coordination due to the loss of supraspinal input after SCI. Observed variability in muscle coordination within SCI groups also suggests that other mechanisms such as spasticity and muscle stretch reflexes or individual factors such as experience and training contributed to the postural muscle synergies. Overall, muscle coordination deficits revealed impaired neuromuscular strategies which provide implications for rehabilitation of trunk muscles during sitting balance after SCI.

Background Cardiorespiratory fitness assessment and training among manual wheelchair (MW) users are predominantly done with an arm-crank ergometer. However, arm-crank ergometer biomechanics differ substantially from MW propulsion biomechanics. This study aimed to quantify cardiorespiratory responses resulting from speed and slope increments during MW propulsion on a motorized treadmill and to calculate a predictive equation based on speed and slope for estimating peak oxygen uptake (VO 2peak ) in MW users. Methods In total, 17 long-term MW users completed 12 MW propulsion periods (PP), each lasting 2 min, on a motorized treadmill, in a random order. Each PP was separated by a 2-min rest. PPs were characterized by a combination of 3 speeds (0.6, 0.8 and 1.0 m/s) and 4 slopes (0°, 2.7°, 3.6° and 4.8°). Six key cardiorespiratory outcome measures (VO 2 , heart rate, respiratory rate, minute ventilation and tidal volume) were recorded by using a gas-exchange analysis system. Rate of perceived exertion (RPE) was measured by using the modified 10-point Borg scale after each PP. Results For the 14 participants who completed the test, cardiorespiratory responses increased in response to speed and/or slope increments, except those recorded between the 3.6 o and 4.8 o slope, for which most outcome measures were comparable. The RPE was positively associated with cardiorespiratory response ( r s ≥ 0.85). A VO 2 predictive equation ( R 2 = 99.7%) based on speed and slope for each PP was computed. This equation informed the development of a future testing protocol to linearly increase VO 2 via 1-min stages during treadmill MW propulsion. Conclusions Increasing speed and slope while propelling a MW on a motorized treadmill increases cardiorespiratory response along with RPE. RPE can be used to easily and accurately monitor cardiorespiratory responses during MW exercise. The VO 2 can be predicted to some extent by speed and slope during MW propulsion. A testing protocol is proposed to assess cardiorespiratory fitness during motorized MW propulsion.

The objectives of the present study were to test the feasibility of measuring humeral head displacements using quantitative ultrasound imaging during the performance of two different dynamic glenohumeral neuromuscular control exercises and to investigate the influence of these exercises on the acromiohumeral distance (AHD) and anterior-posterior distance (APD). Ten individuals who have no history of shoulder injury at the non-dominant shoulder completed three repetitions of an active humeral head lowering exercise and three repetitions of a posteriorisation exercise in a random order in a seated position. The AHD and the APD of the humeral head relative to the glenoid cavity were measured continuously using an ultrasound imaging system during each exercise. Variations in AHD and APD, defined as the difference between the distance obtained before the exercise and the maximal distance reached during the exercise, were compared for each exercises. The active humeral head lowering exercise significantly increased the AHD by 0.94 ± 0.28 mm (relative: + 11.4%), but had no significant effect on the APD. The active humeral head posteriorisation exercise significantly increased the AHD by 0.65 ± 0.41 mm (relative: + 6.3%) and the APD by 1.51 ± 0.51 mm (relative: + 13.8%). The use of quantitative ultrasound imaging allows physiotherapists to quantify inferior and posterior humeral head displacements during dynamic glenohumeral neuromuscular control exercises. These measures, confirming favourable inferior and posterior humeral head displacements at the shoulder, may become useful when studying the effectiveness of rehabilitation programs incorporating dynamic glenohumeral neuromuscular control exercises.

This study aims to quantify the force applied during posterior-to-anterior lumbar vertebrae mobilizations of different grades (I to IV) and compare that force between experienced physiotherapists and final year physiotherapy students. Four experienced physiotherapists and four final year physiotherapy students participated in this study along with five healthy asymptomatic individuals. A manual therapy table positioned over three force plates allowed for measurements of the force oscillation frequency and intensity applied during grade I, II, III and IV posterior-to-anterior (PA) mobilizations at two lumbar vertebral levels (L2 and L4). Mixed model ANOVAs were used to compare the force applied between the experienced physiotherapists and students, and between the various grades. The results showed that the mean oscillation frequency was similar between the groups for all grades. Grade I and grade IV PA mobilizations showed similar mean oscillation frequency as did grade II and III PA mobilizations. The minimum and maximum force applied was higher for the physiotherapists than for the students for all mobilization grades (p values

Introduction Safe and efficient use of a manual wheelchair (MWC) requires appropriate training. New MWC users should learn how to maneuver in different environments (restricted spaces, uneven surfaces, etc.). Learning of appropriate balance skills is also crucial, to avoid falls when handling forward or side slopes. Moreover, long-term MWC use can lead to repetitive shoulder strain injuries, which can be avoided through adequate propulsion technique (increasing push amplitude, while decreasing cadence). We have developed a virtual reality MWC simulator for the training of MWC skills. The velocities of the rear wheels control a virtual MWC in a 3D scene presented on a computer screen in front of the participant, while force feedback simulates the effects of gravity and inertia. Our objective was to improve the realism of our existing wheelchair simulator, through the addition of upper body motion tracking that will provide feedback on trunk posture and propulsion movement. Material and methods Ten MWC users participated in the study. They propelled the virtual MWC while their trunk and arm movements were simultaneously recorded by three systems: – five inertial sensors placed on the trunk, arms and forearms; – a markerless, 3D depth camera system; – a high-precision motion capture system (gold standard). Upper body position as measured by the two low-cost approaches (inertial system and depth camera) was compared to the motion capture system. Results and conclusion Findings from this interdisciplinary study will optimize mobility of MWC users, through better MWC skills (balance and propulsion techniques), while possibly decreasing the incidence of falls and shoulder injuries.

Introduction Les modeles actuels de propulsion en fauteuil roulant manuel (FRM) considerent exclusivement les forces appliquees sur les mains courantes. Or, il est possible de diriger le FRM uniquement avec les mouvements du tronc et des membres superieurs (MS). Afin de comprendre l’effet de ces mouvements, les profils d’angle de ces articulations ont ete mesures lors d’une manœuvre d’evitement au basket-ball en fauteuil roulant (BFR). Materiel et methodes Neuf athletes de BFR, âges de 30 ± 5 ans, se dirigeaient a vitesse maximale vers un cone a 6 m et l’evitaient par la droite sans toucher aux mains courantes du FRM. Quatorze cameras optoelectroniques ont mesure la position de l’athlete et son FRM, permettant de calculer les valeurs d’angles du tronc et des MSs. Resultats Les participants ont modifie leur posture a une distance de 1,10 m ± 0,47 et a un temps de 0,47 s ± 0,20 avant l’obstacle. Une variation des angles articulaires decrite par une inclinaison laterale droite de 18,63° ± 8,41 et une torsion antihoraire de 43,79° ± 14,41 ont ete observees par anticipation a l’evitement, ainsi qu’une elevation a l’epaule droite de 56,96° ± 17,38. Aucune inclinaison sagittale du tronc n’a ete observee (−0,86° ± 3,20). Discussion/Conclusion Le mouvement du tronc et des MSs modifient le comportement de la propulsion en FRM en induisant une rotation du FRM et une augmentation du moment d’inertie, soulignant l’importance du controle de ces articulations pour modifier la trajectoire du FRM. De meilleures connaissances des interactions entre l’athlete et son fauteuil aideront a mieux adapter l’enseignement des techniques de propulsion.

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.

This study determined test–retest reliability and minimum detectable change in longitudinal median nerve excursion during upper limb neurodynamic tests (ULNTs). Seven participants with unilateral or bilateral carpal tunnel syndrome and 11 healthy participants were randomly tested with two ULNTs ( i.e ., tensioner and slider). Each ULNT was performed three times each at 45° and 90° of shoulder abduction on two separate visits. Video sequences of median nerve excursion, recorded by a physical therapist using ultrasound imaging, were quantified using computer software. The generalizability theory, encompassing a G-Study and a D-study, measured the dependability coefficient (Φ) along with standard error of measurement (SEM) accuracy and allowed various testing protocols to be proposed. The highest reliability (Φ = 0.84) and lowest minimal measurement error (SEM = 0.58 mm) of the longitudinal median nerve excursion were reached during the ULNT-slider performed with 45° of shoulder abduction and when measures obtained from three different image sequences recorded during a single visit were averaged. It is recommended that longitudinal median nerve excursion measures computed from three separate image sequences recorded during a single visit be averaged in clinical practice. Ideally, adding a second visit (six image sequences) is also suggested in research protocols.

Gait initiation and termination are potentially challenging tasks for balance due to the transition from a quasi-static bipedal phase to a dynamic single-support phase. The purpose of this study was to compare the bipedal and single-support phases of gait initiation and termination in individuals with incomplete spinal cord injury (ISCI). Twelve individuals with ISCI were evaluated on the dynamic and postural components of balance using the stabilizing and destabilizing forces during gait initiation, termination and natural gait. Phase comparisons were made using non parametric tests. Visual inspection of the force profile of the factors explaining the forces was also conducted. Gait termination challenged more the postural control during the single-support phase than the bipedal phase for the dynamic component of the stabilizing/destabilizing forces model (p=.002). For gait initiation, the most challenging phase varied with the components analyzed (single-support phase for the dynamic component, bipedal phase for the postural component) (p⩽.008). The single support phase is more challenged during gait termination (both components) (p⩽.015) while the bipedal phase is more challenged during gait initiation (dynamic components) (p=.012). The stabilizing force and the speed of the center of mass on the one hand, and destabilizing force and the distance between the center of pressure and the base of support on the other hand, had a similar profile. The single-support phase of gait termination was the most challenging among all phases evaluated, being as challenging as the single-support phase of level natural gait. This phase should be targeted in rehabilitation in order to improve balance and decrease the risk of falling in this population.

Introduction/Background Multiple patterned vibration applied on lower limb joints in individuals after incomplete spinal cord injury (iSCI) generates gait-like movements at a cadence specific to the vibration pattern. This intervention is currently tested on individual with iSCI, who may need body weight support. The main objective of the study was to quantify perceptions associated to sensory afferents generated by multiple vibrations by iSCI participants. The second objective was to determine whether weight support and cadence of the simulated gait cycles affects perceptions before and after 15 gait-like vibrations training sessions. Material and method Six participants (21–77 years old) with an incomplete spinal cord injury (ASIA Impairment Scale grade C&D) received gait-like vibrations in a standing position, with different levels of weight relief (0%/20%/40%), and two gait cadences (60 and 120 steps/min). Perception was evaluated in each condition with a Visual Analog Scale (VAS), before and after 15 training sessions over three weeks. Results Every participant showed good perception of a gait motion (VAS score > 5/10) for 1 or more conditions in the pre- and post- training evaluation. Body weight and cycle duration had no effect on perception (less than 1 point difference). Perception increased, though not significantly by 2.2 (1.1) points after training, with the increase particularly marked in conditions with low score pre-training. Conclusion Individuals with iSCI perceived gait motion during the application of patterned gait-like vibrations, which may participate to the effect of gait vibration training individuals with iSCI in intensive rehabilitation, regardless of their need for body weight support.

1 b abstract The purpose of this study was to investigate the effects of imposing different degrees of forward trunk flexion during sitting pivot transfers on electromyographic activity at the leading and trailing upper limb muscles and on dynamic stability requirements. Thirty-two individuals with a spinal cord injury per- formed three types of sitting pivot transfers: natural technique, exaggerated forward trunk flexion and upright trunk position. Ground reaction forces, trunk kinematics, and bilateral electromyographic activity of eight upper limb muscles were recorded. Electromyographic data were analyzed using the area under the curve of the muscular utilization ratio. Dynamic stability requirements of sitting pivot transfers were assess using a dynamic equilibrium model. Compared to the natural strategy, significantly greater muscle activities were found for the forward trunk flexion condition at the anterior deltoid and both heads of the pectorialis major, whereas the upright trunk strategy yielded greater muscle activity at the latissimus dorsii and the triceps. The forward flexed condition was found to be more dynamically stable, with a lower stabilizing force, increased area of base of support and greater distance traveled. Thus, transferring with a more forward trunk inclination, even though it increases work of few muscles, may be a beneficial trade-off because increased dynamic stability of this technique and versatility in terms of potential dis- tance of the transfer.

High upper extremity (U/E) demands are required when manual wheelchair users (MWUs) with spinal cord injury (SCI) ascend curbs; this may contribute to the risk of developing U/E musculoskeletal impairments. The aim of this study was to compare movement strategies (kinematics), mechanical loads (kinetics) and muscular demand (EMG) at the non-dominant U/E among 15 MWUs with SCI when ascending curbs of 4 cm (3 trials), 8 cm (3 trials) and 12 cm high (3 trials) from a starting line set 3 m before the curb. Biomechanical data was collected during three trials for each height. The curb ascent task was divided into three adjustment phases: caster pop, rear-wheel ascent and post-ascent. The greatest effort was generated by the shoulder flexors and internal rotators as well as the elbow flexors. A significant difference (p < 0.0167) between the curb heights was found for most outcome measures studied: movement excursion, net joint moments and muscular utilization ratio (MUR) of the main muscles increased with the higher curb heights, mainly around the shoulder joint. These results provide insight that aside from adhering to a highly structured training method for wheelchair curb ascent, rehabilitation professionals need to propose task-specific strength training programs based on the demands documented in this study and continue to advocate for physically accessible environments.

La majorite des personnes touchee par un accident vasculaire cerebral ou une lesion de la moelle epiniere doit composer avec des deficiences sensorimotrices qui, malgre la readaptation fonctionnelle intensive, perturbent leur capacite locomotrice. D’une part, certaines personnes ne retrouveront aucune capacite de marche et utiliseront un fauteuil roulant manuel ou motorise a long terme comme principal mode de mobilite. D’autre part, certaines personnes recupereront une capacite de marche restreinte avec un patron de marche atypique et asymetrique, une vitesse de marche restreinte ou une endurance diminuee. Pour ces raisons, un des objectifs de readaptation les plus formules par ces personnes est de recuperer la capacite de marche. Parmi les approches therapeutiques disponibles pour cibler cet objectif, les exosquelettes robotises de marche (EXROM) sont des technologies actuellement en emergence en readaptation et en activite physique adaptee. Les EXORM produisent generalement une assistance motorisee aux membres inferieurs (MI) afin de generer des mouvements de marche. Lors de la marche, les membres superieurs (MS), en contact avec le sol via l’utilisation d’un aide technique, doivent concilier deux roles : – supporter et transferer le poids du corps et de l’EXORM vers le MI demeurant en appui au sol ; – controler l’equilibre debout afin d’eviter les chutes, particulierement lors du debut de la prise du pas avec l’autre MI. L’execution simultanee de ces tâches engendre aussi une concurrence pour les ressources attentionnelles. Somme toute, la marche reciproque et continue avec un EXORM repose grandement sur les systemes musculosquelettiques, postural et cognitif. Etonnamment, ces systemes fondamentaux et leurs interactions lors de la marche avec un EXORM n’ont pratiquement pas ete etudies. Ainsi, nous restons avec une comprehension fragmentee des determinants et predicateurs qui influencent les performances lors de l’utilisation de cette technologie. Nous demeurons egalement avec une meconnaissance des facteurs a considerer pour le developpement de programmes d’entrainement locomoteur avec l’EXORM fonde sur des preuves. Cette conference resumera des travaux de recherche elabores par notre equipe qui vise a : – quantifier les exigences musculaires, posturales, et cognitives lors des transferts assis-debout, du maintien de la position debout et de la marche au sol avec l’utilisation d’un EXORM ; – developper et tester des programmes d’entrainement locomoteur innovants concus pour optimiser la capacite locomotrice et minimiser les effets nefastes de la sedentarite.

Seated postural stability has not been studied extensively in individuals with spinal cord injury (SCI). The main purpose of this study was to compare the effects of upper limb (U/L) positions and U/L weight support roles on quasi-static postural stability between individuals with SCI and healthy controls. Fourteen individuals with SCI and 14 healthy controls sat on an instrumented seat with their feet resting on force plates and randomly maintained five short-sitting positions for 60s with or without hand support. Center-of-pressure (COP) measures based on displacement and frequency series were computed. Individuals with SCI exhibited greater mean COP displacement and velocity measures compared to healthy controls, as well as lower COP frequency measures, irrespective of the U/L positions and weight support roles, confirming reduced stability and a difference in preferential postural regulation strategies. The use of U/L support is a compensatory strategy that influences seated stability in individuals with SCI.

Dynamic stability requirements have never been quantified when long-term manual wheelchair users transfer themselves in a seated position from an initial surface to a target surface, a functional task commonly referred to as sitting pivot transfers (SPTs). Ten individuals with spinal cord injury (SCI), who rely on a manual wheelchair for mobility, underwent a comprehensive biomechanical SPT assessment. SPTs performed toward a target seat of same height (even) and a seat 10cm higher than the initial seat (uneven), repeated three times for each task, were assessed. A dynamic equilibrium model, continuously measuring the theoretical forces required to move the center of pressure to the limit of the base of support (destabilizing force) and to neutralize the kinetic energy and stop the displacement of the center of mass at the limit of the base of support (stabilizing force) at each instance during the performance of SPTs, was used to identify the phases of greatest instability during the SPT tasks. The greatest levels of instability were reached around the time the buttocks lost contact with the initial seat and around the time the buttocks landed on the target seat (pre- and post-lift transition phases). These transition periods, characterized by the lowest destabilizing force (424.7-487.1N) and the greatest stabilizing force (24.2-33.2N), confirmed the greatest level of instability. The height of the target seat had no significant effect (p=0.278-0.739) on dynamic postural stability requirements during the SPTs. During SPTs towards even and uneven target seats, the greatest postural instability occurs during the transition phases in individuals with complete motor thoracic SCI.

Introduction/Background Power wheelchair (PW) skills training is generally seen as insufficient by both clinicians and PW users. A virtual reality (VR) simulator may be helpful in improving PW driving skills, when used in addition to regular training. In previous work, challenging PW driving activities have been identified through interviews with expert clinicians and PW users and were then integrated in the McGill Immersive Wheelchair simulator (miWe). Our objective was to evaluate the effectiveness of VR simulator training on real PW driving skills. Material and method The miWe simulator included six PW driving activities (bathroom, shopping center, supermarket, elevator, street crossing and adapted transport vehicle). A computer with a joystick was installed in the participant's home. Participants (new PW users) were randomly allocated to the simulator or control group. Participants in the control group were asked to practice on a racing videogame (also using a joystick). Participants in both groups were asked to practice for at least 20 minutes every two days, over a two-week period. We compared real wheelchair driving skills as measured by the wheelchair skills test (WST), before and after the intervention. Results A total of 43 participants completed the study. All practiced on the simulator or computer game at least twice as much as what was minimally required. Results indicate that the WST scores in the experimental group increased by 7% on average, compared to 2% in the control group. Feedback regarding ease of use and potential usefulness of the PW simulator was very positive. Conclusion Our preliminary results show that miWe simulator training may lead to improved wheelchair skills as compared to training with a racing videogame. A PW simulator may be helpful to new users if it promotes the practice of activities in specific environmental contexts to complement the basic skills training received in the clinic.

Introduction/Background Gait training is a key element of intensive functional rehabilitation to improve mobility and participation after an incomplete spinal cord injury (iSCI). Gait-like vibration training is an emerging approach that may improve intralimb coordination as shown by preliminary data gathered in a person with a chronic iSCI. The effects of gait training on intralimb coordination have not been studied extensively. This study aimed to analyse the effects of gait-like vibration training on intralimb coordination in individuals with iSCI. Material and method Six participants with iSCI were evaluated pre- (n = 4/6; missing data for 2 participants) and post–intervention (n = 6). The intervention consisted of a gait-like vibration program encompassing 15 training sessions during which multiple vibrators reproduced typical sensory activity associated with gait movements in standing ( Fig. 1 ). During pre-intervention evaluation, participants received twelve minutes of vibrations whereas they received 27 minutes of vibrations during the post-intervention evaluation. During these two evaluations, lower limb kinematics during gait was recorded in standing without vibration before and after the vibrations with a three-dimensional motion analysis system. Intralimb coordination, characterized using hip-knee cyclograms, was compared between the beginning and the end of each evaluation conducted pre and post-intervention, respectively, using a qualitative gait classification. Results Gait cycles variability and cyclograms shape improved mostly at weight acceptance after heel strike (n = 6) and for knee excursion during swing phase (n = 5). Knee extension at heel strike was also greater in participants with a crouched gait pattern after one pre-intervention evaluation. One participant changed from the resilient to the regular gait pattern. Conclusion Gait-like vibration training seems to be beneficial and could improve gait quality through a facilitation of gait movements and a better intralimb coordination. These preliminary results support the potential of gait-like vibration training to improve gait performance after iSCI.

Ultrasound is a proven method for examining soft tissue structures, including tendons, and recently quantitative ultrasound has become more prevalent in research settings. However, limited reliability data have been published for these new quantitative ultrasound measures. The main objective of this study was to quantify the reliability and measurement error of multiple quantitative ultrasound imaging protocols for the biceps and supraspinatus tendons.Two examiners captured ultrasound images of the non-dominant long head of the biceps tendon and supraspinatus tendon from 15 able-bodied participants and five manual wheelchair users. Each examiner captured two images per subject under two different preparations, which included subject positioning and reference marker placement. Image processing (reading) was performed twice to compute nine quantitative ultrasound measures of grayscale tendon appearance using first-order statistics and texture analysis. Generalizability theory was applied to compute interrater and intrarater reliability using the coefficient of dependability (Phi) for multiple study design protocols.Interrater reliability was generally low (0.26Phi0.82), and it is recommended that a single evaluator capture all images for quantitative ultrasound protocols. Most of the quantitative ultrasound measures (n = 14 of 18) exhibited at least moderate (Phi0.50) intrarater reliability for a single image captured under one preparation and read once.By following a protocol designed to minimize measurement error, one can increase the reliability of quantitative ultrasound measures. An appropriately designed protocol will allow quantitative ultrasound to be used as an outcome measure to identify structural changes within tendons.

Gagnon D, Nadeau S, Gravel D, Robert J, Belanger D, Hilsenrath M. Reliability and validity of static knee strength measurements obtained with a chair-fixed dynamometer in subjects with hip or knee arthroplasty. Objectives To evaluate the reliability (intertrial, interevaluator) and the concurrent validity of strength measurements obtained with a chair-fixed dynamometer and to recommend a clinical protocol that minimizes standard error of measurement (SEM). Design Within-session repeated measures of maximal static strength of knee flexors and extensors at 30° and 60° of flexion on the chair-fixed and Cybex dynamometers. Setting Ambulatory physiotherapy department of a rehabilitation hospital. Participants Convenience sample of 50 subjects with total hip (n=25) or knee (n=25) arthroplasty. Interventions Not applicable. Main Outcome Measures Reliability was quantified by indices of dependability and corresponding SEMs estimated with the generalizability theory, whereas coefficients of correlation were used to assess the validity. Results Indices of dependability confirmed excellent intertrial (0.98–1.00) and a very good interevaluator (.92–.99) reliability for the strength measures obtained for different movements and positions. An average of 3 trials minimized the magnitude of the SEMs (>2Nm for all measurements). When comparing the strength values obtained with the Cybex dynamometer to those measured with the chair-fixed dynamometer, strongest relations were attained when the tested knee was positioned at 60° compared with 30° for subjects with a total knee (.78–.92 vs .87–.93) or hip (.73–.85 vs .86–.91) arthroplasty. Conclusions A clinical protocol averaging 3 trials with the knee positioned at 60° after a familiarization period, both for knee flexors and extensors, performed by a trained therapist is recommended to minimize measurement errors on strength values measured with the chair-fixed dynamometer.

Objective Use of a power wheelchair (PW) can improve quality of life and participation in individuals with mobility impairments. PW skills training is generally seen as insufficient by both clinicians and PW users. A virtual reality (VR) simulator may be helpful in improving PW driving skills, when used in addition to regular training. In previous work, challenging PW driving activities have been identified through interviews with expert clinicians and PW users and were then integrated in the McGill immersive wheelchair simulator (miWe). Our objective was to evaluate the effectiveness of VR simulator training, delivered through a home program on real PW driving skills. Materials/patients and methods The miWe simulator included six PW driving activities (adapted bathroom, shopping center, supermarket, elevator, street crossing and adapted transport vehicle). A computer with a joystick was installed in the participant's home. Participants (new PW users) were randomly allocated to the experimental or control group. Those in the experimental group were asked to practice all six-simulator activities for at least 20 minutes every two days, over a two-week period. Participants in the control group were asked to practice on a racing videogame, for an equivalent amount of time as the experimental group. We compared wheelchair-driving skills as measured by the wheelchair skills test (WST), before and after the intervention. Results Preliminary analyses were made on the 35 participants who completed the study. All practiced on the simulator or computer game at least twice as much as what was minimally required. Results indicate that the WST scores in the experimental group increased by 6% on average, compared to 3% in the control group. Feedback regarding ease of use and potential usefulness of the PW simulator was very positive. Discussion/conclusion Our preliminary results show that miWe simulator training may slightly improve wheelchair skills as compared to training with a racing videogame. A PW simulator may be helpful to new users if it promotes the practice of activities in specific environmental contexts to complement the basic skills training received in the clinic.

The purpose of this study was to assess different measurement strategies to increase the reliability of different electromyographic (EMG) indices developed for the assessment of back muscle impairments. Forty male volunteers (20 controls and 20 chronic low back pain patients) were assessed on three sessions at least 2 days apart within 2 weeks. Surface EMG signals were recorded from four pairs (bilaterally) of back muscles (multifidus at the L5 level, iliocostalis lumborum at L3, and longissimus at L1 and T10) while the subjects performed, in a static dynamometer, two static trunk extension tasks at 75% of the maximal voluntary contraction separated by a 60 s rest period: (1) a 30 s fatigue task and (2) a 5 s recovery task. Different EMG indices (based on individual muscles or averaged across bilateral homologous muscles or across all muscles) were computed to evaluate muscular fatigue and recovery. Intra-class correlation coefficient (ICC) and standard error of measurement (SEM) in percentage of the grand mean were calculated for each EMG variable. Reliable EMG indices are achieved for both healthy and chronic low back pain subjects when (1) electrodes are positioned on medial back muscles (multifidus at the L5 level and longissimus at L1) and (2) measures are averaged across bilateral muscles and/or across two fatigue tests performed within a session. The most reliable EMG indices were the bilateral average of medial back muscles (ICC range: 0.68-0.91; SEM range: 5-35%) and the average of all back muscles (ICC range: 0.77-0.91; SEM range: 5-30%). The averaging of measures across two fatigue tests is predicted to increase the reliability by about 13%. With regards to EMG indices of fatigue, the identification of the most fatigable muscle also lead to satisfactory results (ICC range: 0.74-0.79; SEM range: 21-26%). The assessment of back muscle impairments through EMG analysis necessitates the use of multiple electrodes to achieve reliable results.