Search

Context/objective Functional electrical stimulation (FES) is commonly used in rehabilitation to generate electrically-induced muscle contractions. FES has been shown to assist in the recovery of voluntary motor functions after stroke or spinal cord injury. However, discomfort associated with FES can motivate patients to withdraw their participation from FES therapy despite its benefits. To address this issue, a functional electrical stimulator, called MyndMove™ (MyndTec Inc., Canada), has been developed to generate more comfortable contractions than conventional stimulators. Design Cross-sectional, interventional, with two treatment arms. Setting A laboratory within a rehabilitation center. Participants Twelve able-bodied participants. Intervention FES delivered with two different stimulators, MyndMove™ and Compex Motion (Compex, Switzerland), during muscle contractions of high, moderate and low stimulation intensity. Outcome measures Comfort-related preference to a given stimulator and the discomfort score rated through a Numeric Rating Scale (NRS-101) for both stimulators. Results Participants perceived a reduction in discomfort during high-intensity stimulation generated using MyndMove™. In addition, MyndMove™ stimulations were preferred in 60% of all contractions. The reduction in discomfort associated with MyndMove™ might be due the fact that MyndMove™ delivers less charge to generate contractions of equivalent intensity, compared to Compex Motion. Conclusion Reducing discomfort during FES may help in generating stronger and more clinically useful contractions, increasing accessibility of FES therapy to include individuals with low tolerance to FES.

Integrating brain-computer interface (BCI) technology with functional electrical stimulation therapy (FEST) is an emerging strategy for upper limb motor rehabilitation after spinal cord injury (SCI). Despite promising results, the combined use of these technologies (BCI-FEST) in clinical practice is minimal. To address this issue, we developed KITE-BCI, a BCI system specifically designed for clinical application and integration with dynamic FEST. In this paper, we report its technical features and performance. In addition, we discuss the differences in distributions of the BCI- and therapist-triggered stimulation latencies.Two single-arm 40-session interventional studies to test the feasibility of BCI-controlled FEST for upper limb motor rehabilitation in individuals with cervical SCI.Rehabilitation programs within the University and Lyndhurst Centres of the Toronto Rehabilitation Institute - University Health Network, Toronto, Canada.Five individuals with sub-acute (6 months post-injury) SCI at the C4-C5 level, AIS B-D, and three individuals with chronic (24 months post-injury) SCI at C4 level, AIS B-C.We measured BCI setup duration, and to characterize the performance of KITE-BCI, we recorded BCI sensitivity, defined as the percentage of successful BCI activations out of the total number of cued movements.The overall BCI sensitivities were 74.46% and 79.08% for the sub-acute and chronic groups, respectively. The average KITE-BCI setup duration across the two studies was 11 min and 13 s.KITE-BCI demonstrates a clinically viable single-channel BCI system for integration with FEST resulting in a versatile technology-enhanced upper limb motor rehabilitation strategy after SCI.

Major powers have long used cultural institutes to enhance their appeal in foreign countries. As aspirant powers, Russia and China have recently launched cultural institutes of their own with the a...

Functional electrical stimulation (FES), through repetitive training (FES-therapy) or continuous assistance (neuro-prosthesis), can restore motor function after paralysis due to spinal cord injury or stroke. With current technology, patients are often incapable of independently applying FES, thereby limiting its use. Novel FES-garments with embedded stimulation electrodes were developed in collaboration with Myant, Canada, to address this problem. The purpose of this study was to collect the views of future end-users to inform the refinement of the device design and to obtain insights on subsequent commercialization of this rehabilitation and assistive technology.A qualitative study was undertaken to determine the needs of potential users (patients and clinicians;The identified themes and sub-themes were: (1) User Perspectives: users' characteristics (needs, limitations), expected benefits (beliefs), and anticipated problems (fears); (2) Device Design: technical features, usability, and disadvantages of the garment, cables, stimulator, software, and interface; (3) Acquisition Process: organizational procedures (acquisition and adoption steps); and (4) Business Model: financial and strategic aspects to facilitate commercialization and support users.The insights obtained from end-users and clinicians provide guidelines to optimize the development of novel FES-garments, and strategies for bringing the device to the market. The themes identified can serve to inform other rehabilitation and assistive technology developers with processes and ideas on how to meet these groups' needs.IMPLICATIONS FOR REHABILITATIONParticipants with neurological paralysis have interest and critical views on new rehabilitation and assistive technology, and the repercussions of using new technologies to address their function, health and wellbeing.The FES-garment design presented appeared acceptable to the end-users, pending resolution of certain shortcomings (wiring, operating duration, robustness, easiness to don and doff).End-users and clinicians had specific views regarding the acquisition process of new technologies (training, customization, and follow-up/support), which are important to take into consideration to ensure broad stakeholders uptake.

Context: Following spinal cord injury (SCI) at the cervical or upper-thoracic level, orthostatic hypotension (OH) is observed in 13–100% of patients. This study aimed to test the feasibility of conducting a randomized controlled trial combining a dynamic tilt-table (Erigo(®)) and functional electrical stimulation (FES) to mitigate OH symptoms in the subacute phase after SCI. Design: Pilot study. Setting: A tertiary rehabilitation hospital. Participants: Inpatients who had a C4-T6 SCI (AIS A-D) less than 12 weeks before recruitment, and reported symptoms of OH in their medical chart. Interventions: Screening sit-up test to determine eligibility, then 1 assessment session and 3 intervention sessions with Erigo(®) and FES for eligible participants. Outcome measures: Recruitment rate, duration of assessment and interventions, resources used, blood pressure, and Calgary Presyncope Form (OH symptoms). Results: Amongst the 232 admissions, 148 inpatient charts were reviewed, 11 inpatients met all inclusion criteria, 7 participated in a screening sit-up test, and 2 exhibited OH. Neither of the two participants recruited in the pilot study was able to fully complete the assessment and intervention sessions due to scheduling issues (i.e. limited available time). Conclusion: This pilot study evidenced the non-feasibility of the clinical trial as originally designed, due to the low recruitment rate and the lack of available time for research in participant’s weekday schedule. OH in the subacute phase after SCI was less prevalent and less incapacitating than expected. Conventional management and spontaneous resolution of symptoms appeared sufficient to mitigate OH in most patients with subacute SCI.

Objectives: To compare thickness and texture measures of tissue overlying the ischial region in able-bodied (AB) individuals vs. individuals with spinal cord injury (SCI) and to determine if there is a relationship between pressure offloading of the ischial tuberosities (IT) and tissue health in individuals with SCI. Design: Exploratory cross-sectional study. Setting: University setting and rehabilitation hospital. Outcome Measures: Thickness and texture measurements from ultrasound images of tissues overlying the IT were obtained from AB individuals (n = 10) and individuals with complete or incomplete traumatic and non-traumatic SCI American Spinal Injury Association Impairment Scale (AIS) classification A–D (n = 15). Pressure offloading was measured in individuals with SCI and correlated with tissue health measurements. Results: The area overlying the IT occupied by the muscle was significantly greater in the SCI when compared with AB cohort. The area occupied by the muscle in individuals with SCI appeared to lose the striated appearance and was more echogenic than nearby skin and subcutaneous tissue (ST). There was no correlation between offloading times and thickness, echogenicity and contrast measurements of skin, ST and muscle in individuals with SCI. Conclusion: Changes in soft tissues overlying the ischial tuberosity occur following SCI corresponding to the loss of striated appearance of muscle and increased thickness of the area occupied by the muscle. Further studies using a larger sample size are recommended to establish if thickness and tissue texture differ between individuals with SCI who sustain pressure injuries vs. those who do not.

This study aimed to explore the effect of the knee angle and loading condition on the magnitude and reliability of squat jump (SJ) performance variables. Thirteen male sport sciences students performed in a random order 4 SJ types (knee angle of 80o [SJ80], 90o [SJ90], 100o [SJ100], and self-preferred [SJ(pref)]) against 3 external loads. The push-off distance (HpO), jump height (Hmax), maximum force (Fmax) and maximum power (Pmax) were obtained from force platform recordings. The HpO during the SJ(pref) (43.4 +/- 6.4 cm) was always between SJ90 (44.3 +/- 4.8 cm) and SJ100 (40.5 +/- 4.2 cm). The magnitudes of Hmax, Fmax and Pmax were comparable or higher during the SJ(pref). The increase of the knee angle was associated with larger values of Fmax and Pmax, but no significant differences were observed for Hmax. An acceptable reliability was observed for HpO (coefficient of variation [CV] lt = 5.09% and intraclass correlation coefficient [ICC] gt = 0.78), Hmax (CV lt = 6.06% and ICC gt = 0.84), Fmax (CV lt = 3.25% and ICC gt = 0.96) and Pmax (CV lt = 2.93% and ICC gt = 0.96). Reliability did not systematically differ between the 4 SJ types. In conclusion, the higher magnitudes and comparable reliability of the performance variables obtained during the SJ(pref) support its use for testing lower-body ballistic performance against different loads.

First Place Award Submission - CA147Category: Clinical ApplicationManagement of obesity after spinal cord injury: a systematic reviewMir Hatef Shojaei1, Mohammad Alavinia1, B. Catharine Craven1,21N...

From the Patriotic Front struggle against the minority rule in Rhodesia to the seven-party mujaheddin alliance in Afghanistan, inter-rebel alliances make the armed opposition more resilient and successful in the face of government repression. Why then do some rebel groups cooperate with each other while others do not? Drawing on the principal-agent theory, I argue that the presence of foreign sponsors is likely to encourage alliance formation in civil wars especially when two rebel outfits share a state sponsor. Shared sponsors may demand cooperation between their agents and credibly threaten to punish them for non-compliance. They may also insist on the establishment of umbrella institutions to improve their monitoring and sanctioning capacity, and to increase the legitimacy of their agents. I test this argument using the UCDP Actor dataset with new data on alliances between rebel groups. I find strong evidence that shared sponsors increase the probability of inter-rebel alliance.

To determine the efficacy of functional electrical stimulation therapy assisted walking (FES-T) compared to a conventional aerobic and resistance training (CONV) with respect to bone biomarkers and lower extremity bone strength outcomes among adults with chronic motor incomplete spinal cord injury (SCI).Parallel group randomized controlled trial ( www.clinicaltrials.gov - NCT0020196819). Site: Tertiary academic rehabilitation centre in Canada.Adults with chronic (≥18 months) motor incomplete SCI (C2-T12 AIS C-D) were consented and randomized to FES-T or CONV training for 45 minutes thrice-weekly for 4 months. Osteocalcin (OC), β-cross laps (CTX) and sclerostin were assessed at baseline, and 4 months. Similarly, total hip, distal femur and proximal tibia region bone mineral density (BMD) via DXA (4500A, Hologic Inc. Waltham, MA, USA) and tibia bone quality via pQCT (Stratec XCT-2000, Mezintecknik, Pforzheim, Germany) were assessed at baseline, 4, and 12 months. Between group differences were analyzed using repeated measures general linear models.Thirty-four participants (17 FES-T, 17 CONV) consented and were randomized, 27 participants completed the 4-month intervention and 12-month outcome assessments. Participants in the FES-T arm had a decrease in CTX and a significant increase in OC at intervention completion (P0.05). Significant biomarker changes were not observed in the CONV group. No within or between group differences from baseline were observed in sclerostin or bone strength.Four months of FES-T improved bone turnover (increase in OC and decrease in CTX) but not bone strength among individuals with chronic SCI. Future, long term FES-T may augment lower extremity bone strength.

To identify specific hand movements from electroencephalographic activity.Proof of concept study.Rehabilitation hospital in Toronto, Canada.Fifteen healthy individuals with no neurological conditions.Each individual performed six different hand movements, including four grasps commonly targeted during rehabilitation. All of them used their dominant hand and four of them repeated the experiment with their non-dominant hand. EEG was acquired from 8 different locations (C1, C2, C3, C4, CZ, F3, F4 and Fz). Time-frequency distributions (spectrogram) of the pre-movement EEG activity for each electrode were generated and each of the time-resolved spectral components (1 Hz to 50 Hz) was correlated with a hyperbolic tangent function to detect power decreases. The spectral components and time ranges with the largest correlation values were identified using a threshold. The resulting features were then used to implement a distance-based classifier.Accuracy of classification.A minimum of three different dominant hand movements were classified correctly with average accuracies between 65-75% across all 15 participants. Average accuracies between 67-85% for the same three movements were achieved across four of the 15 participants who were tested with their non-dominant hand.The results suggest that it may be possible to predict specific hand movements from a small number of electroencephalographic electrodes. Further studies including members of the spinal cord injury community are necessary to verify the suitability of the proposed process.

Foreign governments frequently intervene in armed conflicts by sponsoring rebels against their adversaries. A sponsorship is less costly than a direct military intervention, but rebels often defy orders, desert fighting, or turn guns against their sponsors. Under what conditions do rebels defect against their sponsors? Drawing on organizational theory, I argue that as rebel organizations become less centralized and formalized, the rebels are likely to defect against their sponsors. This occurs because non-centralized organizations have weak central leadership and allow for dispersed decision-making, both of which narrow the manipulative capacity of sponsors. Due to these disadvantages, non-centralized rebel movements are less accountable to their sponsors, cannot credibly commit to rapidly change their policies in response to changes in the sponsor’s demands, and suffer from frequent and destructive quarrels between the top and lower echelons. Using multilevel logistic models for panel data, I tes...

Why do some militant groups defect against their sponsors, while others remain loyal? Pakistan's sponsorship of Jaish-e-Mohammad and Lashkar-e-Taiba offers a controlled case comparison as the former turned its guns against Islamabad, while the latter remained obedient despite a similar strength, ethnic ties to the regime, and the presence of alternative supporters. What explains Jaish's defection and Lashkar's loyalty? Drawing on organizational and principal-agent theory, I argue that militant organizations that are more decentralized and factionalized are more likely to turn on their sponsors, because their weak command and control as well as dispersed decision making limit the militant leaders' ability to follow through on their commitments to the sponsors and makes it more difficult for the sponsors to discipline the militant organization. When a sponsor attempts to coerce such organizations into submission by detaining militant leaders, freezing or confiscating their material assets the rank-and-file ...

Improved appreciation of recovery profiles of sensory and motor function as well as complex motor functions (prehension) after cervical spinal cord injury (SCI) will be essential to inform clinical studies to consider primary and secondary outcome measures for interventions and the optimization of dosing and timing of therapies in acute and chronic SCI.(1) To define the sensory, motor, and prehension recovery profiles of the upper limb and hand in acute cervical SCI and (2) to confirm the impact of AIS severity and conversion on upper limb sensorimotor recovery.An observational longitudinal cohort study consisting of serial testing of 53 patients with acute cervical SCI was conducted. International Standards of Neurological Classification of Spinal Cord Injury, Graded Redefined Assessment of Strength Sensibility and Prehension (GRASSP), Capabilities of Upper Extremity (CUE-Q) Questionnaire, and Spinal Cord Independence Measure III (SCIM-III) were administered at 0-10 days, 1, 3, 6, and 12 months.Change over time was plotted using mean and standard deviation of the total and subgroups of the sample.Individuals with traumatic tetraplegia show distinct patterns of recovery. Factors that distinguish homogeneous subgroups of the sample are: severity of injury (level of injury, completeness) at baseline and conversion from a complete to an incomplete injury.In cervical SCI, clinical recovery can be assessed using standardized measures that distinguish levels of activity and impairment. Specific recovery profiles of the upper limb over the 1-year timecourse provide new insights and opportunity for combined analysis of recovery profiles for different clinical assessment tools of upper limb function which are meaningful to inform the design of study protocols.

Multi-channel surface functional electrical stimulation (FES) for walking has been used to improve voluntary walking and balance in individuals with spinal cord injury (SCI).To investigate short- and long-term benefits of 16 weeks of thrice-weekly FES-assisted walking program, while ambulating on a body weight support treadmill and harness system, versus a non-FES exercise program, on improvements in gait and balance in individuals with chronic incomplete traumatic SCI, in a randomized controlled trial design.Individuals with traumatic and chronic (≥18 months) motor incomplete SCI (level C2 to T12, American Spinal Cord Injury Association Impairment Scale C or D) were recruited from an outpatient SCI rehabilitation hospital, and randomized to FES-assisted walking therapy (intervention group) or aerobic and resistance training program (control group). Outcomes were assessed at baseline, and after 4, 6, and 12 months. Gait, balance, spasticity, and functional measures were collected.Spinal cord independence measure (SCIM) mobility sub-score improved over time in the intervention group compared with the control group (baseline/12 months: 17.27/21.33 vs. 19.09/17.36, respectively). On all other outcome measures the intervention and control groups had similar improvements. Irrespective of group allocation walking speed, endurance, and balance during ambulation all improved upon completion of therapy, and majority of participants retained these gains at long-term follow-ups.Task-oriented training improves walking ability in individuals with incomplete SCI, even in the chronic stage. Further randomized controlled trials, involving a large number of participants are needed, to verify if FES-assisted treadmill training is superior to aerobic and strength training.

Traumatic spinal cord injury (SCI) results in substantial reductions in lower extremity muscle mass and bone mineral density below the level of the lesion. Whole-body vibration (WBV) has been proposed as a means of counteracting or treating musculoskeletal degradation after chronic motor complete SCI. To ascertain how WBV might be used to augment muscle and bone mass, we investigated whether WBV could evoke lower extremity electromyography (EMG) activity in able-bodied individuals and individuals with SCI, and which vibration parameters produced the largest magnitude of effect.Ten male subjects participated in the study, six able-bodied and four with chronic SCI. Two different manufacturers' vibration platforms (WAVE(®) and Juvent™) were evaluated. The effects of vibration amplitude (0.2, 0.6 or 1.2 mm), vibration frequency (25, 35, or 45 Hz), and subject posture (knee angle of 140°, 160°, or 180°) on lower extremity EMG activation were determined (not all combinations of parameters were possible on both platforms). A novel signal processing technique was proposed to estimate the power of the EMG waveform while minimizing interference and artifacts from the plate vibration.WBV can elicit EMG activity among subjects with chronic SCI, if appropriate vibration parameters are employed. The amplitude of vibration had the greatest influence on EMG activation, while the frequency of vibration had lesser but statistically significant impact on the measured lower extremity EMG activity.These findings suggest that WBV with appropriate parameters may constitute a promising intervention to treat musculoskeletal degradation after chronic SCI.

The primary objective was to compare the benefits of single (COT1) versus double (COT2) dose of conventional occupational therapy (COT) in improving voluntary hand function in individuals with incomplete, sub-acute C3-C7 spinal cord injury (SCI). The secondary objective was to compare these two interventions versus functional electrical stimulation therapy plus COT (FES + COT).Retrospective analysis. Setting Inpatient spinal cord rehabilitation center, Toronto.Individuals with traumatic incomplete sub-acute SCI.Data from Phases I and II (ClinicalTrials.gov ID NCT00221117) randomized control trials were pooled together for the purpose of this study. Participants in the COT1 group received 45 hours of therapy, the COT2 group received 80 hours of therapy, and the FES + COT group received 40 hours of COT therapy +40 hours of FES therapy.We analyzed the functional independence measure (FIM) and the spinal cord independence measure (SCIM) self-care sub-scores. Results The mean change scores on the FIM self-care sub-score for the COT1, COT2, and FES + COT groups were 12.8, 10, and 20.1 points, respectively. Similarly, the mean change scores on the SCIM self-care sub-score for the COT1, COT2, and FES + COT groups were, 2.6, 3.16, and 10.2 points, respectively.Increased rehabilitation intensity alone may not always be beneficial. The type of intervention plays a significant role in determining functional changes. In this instance, receiving one (COT1) or two (COT2) doses of COT resulted in similar outcomes, however, FES + COT therapy yielded much better outcomes compared to COT1 and COT2 interventions.

To test the feasibility of controlling a computer cursor asynchronously in two dimensions using one subdural electrode.Proof of concept study.Acute care hospital in Toronto, Canada.A 68-year-old woman with a subdural electrode implanted for the treatment of essential tremor (ET) using direct brain stimulation of the primary motor cortex (MI).Power changes in the electrocorticography signals were used to implement a "brain switch". To activate the switch the subject had to decrease the power in the 7-13 Hz frequency range using motor imagery of the left hand. The brain switch was connected to a system for asynchronous control of movement in two dimensions. Each time the user reduced the amplitude in the 7-13 Hz frequency band below an experimentally defined threshold the direction of cursor changed randomly. The new direction was always different from those previously rejected ensuring the convergence of the system on the desired direction.Training time, time and number of switch activations required to reach specific targets, information transfer rate.The user was able to control the cursor to specific targets on the screen after only 15 minutes of training. Each target was reached in 51.7 ± 40.2 seconds (mean ± SD) and after 9.4 ± 6.8 switch activations. Information transfer rate of the system was estimated to be 0.11 bit/second.A novel brain-machine interface for asynchronous two-dimensional control using one subdural electrode was developed.