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Purpose: This study surveyed physiotherapists working at Canadian cystic fibrosis (CF) specialized centres to investigate the current practice, barriers to, and facilitators of exercise testing and training. Method: Physiotherapists were recruited from 42 Canadian CF centres. They responded to an e-questionnaire regarding their practice. The data were analyzed using descriptive statistics. Results: Eighteen physiotherapists responded (estimated response rate of 23%); median years of clinical experience was 15 (range, min-max, 3–30) years. Aerobic testing was administered by 44% of respondents, strength testing by 39%, aerobic training by 78%, and strength training by 67%. The most frequently reported barriers across all four types of exercise testing and training were insufficient funding (reported by 56%–67% of respondents), time (50%–61%) and staff availability (56%). More late career than early career physiotherapists reported utilizing aerobic testing (50% vs. 33% of respondents), strength testing (75% vs. 33%), aerobic training (100% vs. 67%), and strength training (100% vs. 33%). Conclusions: Exercise testing and training is underutilized in Canadian CF centres. Experienced physiotherapists reported utilizing exercise testing and training more than less-experienced physiotherapists. Post-graduate education and mentorship, especially for less-experienced clinicians, are recommended to emphasize the importance of exercise testing and training. Barriers of funding, time, and staff availability should be addressed to further improve quality of care.

PURPOSE This study aimed to compare muscle activation of the diaphragm (DIA), scalenes (SA), parasternal intercostals (PS), and sternomastoid (SM) during submaximal intermittent neck flexion (INF) versus submaximal inspiratory threshold loading (ITL) until task failure in healthy adults. METHODS Twelve healthy adults performed submaximal ITL or INF tests in random order for 2 d. Surface electromyography was monitored to acquire root mean square (RMS) and median power frequency (MPF) from the SA, PS, SM, and DIA. Maximal inspiratory pressures and maximal voluntary contraction for neck flexion were determined. Next, participants performed the first submaximal test-ITL or INF-targeting 50% ± 5% of the maximal inspiratory pressure or maximal voluntary contraction, respectively, until task failure. After a rest, they performed the other test until task failure. Two days later, they performed ITL and INF but in the opposite order. The Borg scale assessed breathlessness and perceived exertion. RESULTS Endurance times for ITL and INF were 38.1 and 26.3 min, respectively. INF activated three of four inspiratory muscles at higher average RMS (PS, SM, and SA) and at different MPF (PS, SM, and DIA but not SA) compared with ITL. During ITL, RMS did not change in the four inspiratory muscles over time, but MPF decreased in PS, SM, and SA (P < 0.04). In contrast, RMS increased in three of four inspiratory muscles (SM, PS, and SA) during INF, but MPF did not change throughout its duration. Borg rating was 3.9-fold greater than ITL compared with INF. CONCLUSION At a similar percentage of maximal load, INF evokes greater activation of primary muscles of inspiration (PS and SA) and a major accessory muscle of inspiration (SM) compared with ITL during a prolonged submaximal protocol.

Gait disturbances are common in individuals with Parkinson's disease (PD). Although the basic patterns of walking are thought to be controlled by the brainstem and spinal networks, recent studies have found significant corticomuscular coherence in healthy individuals during walking. However, it still remains unknown how PD affects the cortical control of muscles during walking. As PD typically develops in older adults, it is important to investigate the effects of both aging and PD when examining disorders in patients with PD. Here, we assessed the effects of PD and aging on corticomuscular communication during walking by investigating corticomuscular coherence. We recorded electroencephalographic and electromyographic signals in 10 individuals with PD, 9 healthy older individuals, and 15 healthy young individuals. We assessed the corticomuscular coherence between the motor cortex and two lower leg muscles, tibialis anterior (TA) and medial gastrocnemius, during walking. Older and young groups showed sharp peaks in muscle activation patterns at specific gait phases, whereas the PD group showed prolonged patterns. Smaller corticomuscular coherence was found in the PD group compared with the healthy older group in the α band (8-12 Hz) for both muscles, and in the β band (16-32 Hz) for TA. Older and young groups did not differ in the magnitude of corticomuscular coherence. Our results indicated that PD decreased the corticomuscular coherence during walking, whereas it was not affected by aging. This lower corticomuscular coherence in PD may indicate lower-than-normal corticomuscular communication, although direct or indirect communication is unknown, and may cause impaired muscle control during walking.NEW & NOTEWORTHY Mechanisms behind how Parkinson's disease (PD) affects cortical control of muscles during walking remain unclear. As PD typically develops in the elderly, investigation of aging effects is important to examine deficits regarding PD. Here, we demonstrated that PD causes weak corticomuscular synchronization during walking, but aging does not. This lower-than-normal corticomuscular communication may cause impaired muscle control during walking.

BACKGROUND While exercise can benefit the health and well-being of people with dementia or mild cognitive impairment, many exercise programs offered to this population are passive, unengaging, and inaccessible, resulting in poor adherence. Motion-based technologies are increasingly being explored to encourage exercise participation among people with dementia or mild cognitive impairment. However, the impacts of using motion-based technologies with people with dementia or mild cognitive impairment on variables including balance, movement confidence, and cognitive function have yet to be determined. OBJECTIVE The purpose of this study is to examine the impacts of a group motion-based technology intervention on balance, movement confidence, and cognitive function among people with dementia or mild cognitive impairment. METHODS In this quasi-experimental pre- and posttest design, we will recruit 24 people with dementia or mild cognitive impairment from 4 adult day programs and invite them to play Xbox Kinect bowling in a group setting, twice weekly for 10 weeks. We will require participants to speak and understand English, be without visual impairment, and be able to stand and walk. At pretest, participants will complete the Mini-Balance Evaluation Systems Test (Mini-BESTest) and the Montreal Cognitive Assessment (MoCA). We will video record participants during weeks 1, 5, and 10 of the intervention to capture behavioral indicators of movement confidence (eg, fluency of motion) through coding. At posttest, the Mini-BESTest and MoCA will be repeated. We will analyze quantitative data collected through the Mini-BESTest and the MoCA using an intent-to-treat analysis, with study site and number of intervention sessions attended as covariates. To analyze the videos, we will extract count and percentage data from the coded recordings. RESULTS This study will address the question of whether a group motion-based technology intervention, delivered in an adult day program context, has the potential to impact balance, movement confidence, and cognitive function among people with dementia or mild cognitive impairment. The project was funded in 2019 and enrollment was completed on February 28, 2020. Data analysis is underway and the first results are expected to be submitted for publication in 2021. CONCLUSIONS This study will assess the feasibility and potential benefits of using motion-based technology to deliver exercise interventions to people with dementia or mild cognitive impairment. This work can also be used as the basis for developing specific software and future exercise programs using motion-based technology for people with dementia or mild cognitive impairment, as well as understanding some of the conditions in which these programs can be delivered. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/18209

Background While exercise can benefit the health and well-being of people with dementia or mild cognitive impairment, many exercise programs offered to this population are passive, unengaging, and inaccessible, resulting in poor adherence. Motion-based technologies are increasingly being explored to encourage exercise participation among people with dementia or mild cognitive impairment. However, the impacts of using motion-based technologies with people with dementia or mild cognitive impairment on variables including balance, movement confidence, and cognitive function have yet to be determined. Objective The purpose of this study is to examine the impacts of a group motion-based technology intervention on balance, movement confidence, and cognitive function among people with dementia or mild cognitive impairment. Methods In this quasi-experimental pre- and posttest design, we will recruit 24 people with dementia or mild cognitive impairment from 4 adult day programs and invite them to play Xbox Kinect bowling in a group setting, twice weekly for 10 weeks. We will require participants to speak and understand English, be without visual impairment, and be able to stand and walk. At pretest, participants will complete the Mini-Balance Evaluation Systems Test (Mini-BESTest) and the Montreal Cognitive Assessment (MoCA). We will video record participants during weeks 1, 5, and 10 of the intervention to capture behavioral indicators of movement confidence (eg, fluency of motion) through coding. At posttest, the Mini-BESTest and MoCA will be repeated. We will analyze quantitative data collected through the Mini-BESTest and the MoCA using an intent-to-treat analysis, with study site and number of intervention sessions attended as covariates. To analyze the videos, we will extract count and percentage data from the coded recordings. Results This study will address the question of whether a group motion-based technology intervention, delivered in an adult day program context, has the potential to impact balance, movement confidence, and cognitive function among people with dementia or mild cognitive impairment. The project was funded in 2019 and enrollment was completed on February 28, 2020. Data analysis is underway and the first results are expected to be submitted for publication in 2021. Conclusions This study will assess the feasibility and potential benefits of using motion-based technology to deliver exercise interventions to people with dementia or mild cognitive impairment. This work can also be used as the basis for developing specific software and future exercise programs using motion-based technology for people with dementia or mild cognitive impairment, as well as understanding some of the conditions in which these programs can be delivered. International Registered Report Identifier (IRRID) DERR1-10.2196/18209

Highlights • The association of mouth-breathing and postural changes in children is unclear. • The terminology and bone landmarks used to evaluate posture are poorly described. • There is lack of reference values describing postural measurements. • The reliability and validity of the methods used are unclear. • The association of mouth-breathing and postural deviations in children is low., Background Mouth breathing syndrome can cause sleep disturbances that compromise the performance of children in school. It might also cause postural abnormalities involving the head and cervical spine; however, the association between postural abnormalities and mouth breathing in children is unclear. Objective To assess the methodological quality of studies and determine if there is an association between mouth breathing and postural disorders in children. Methods Databases comprised MEDLINE, CINAHL, PEDro, LILACS, EMBASE and Cochrane Central Registrar of Controlled Trials. Searches were until March 2016 and included studies that evaluated postural disorders in children diagnosed with mouth breathing. The Downs and Black checklist was used to evaluate the quality of the evidences. Results Ten studies were included totaling 417 children from 5 to 14 years. Two studies used the New York State Postural Rating Scale, seven used photography and one used motion capture to measure posture. The methods used to analyze the data included the Postural Analysis Software (SAPO), Fisiometer, ALCimagem and routines in MATLAB program. Quality assessment resulted in low scores (

Background: Postural stability plays a key role in sport performance, especially after concussion. Specific to healthy child and youth athletes, little is known about the influence development and sex may have on postural stability while considering other subjective clinical measures used in baseline/preinjury concussion assessment. This study aims to describe age- and sex-based trends in postural stability in uninjured child and youth athletes at baseline while accounting for concussion-related factors. Hypotheses: (1) Postural stability performance will improve with age, (2) females will display better postural stability compared to males, and (3) concussion-like symptoms will affect postural stability performance in healthy children and youth. Study Design: Cross-sectional study. Level of Evidence: Level 3. Methods: This study comprised 889 healthy/uninjured child and youth athletes (54% female, 46% male) between the ages of 9 and 18 years old. Participants completed preseason baseline testing, which included demographic information (age, sex, concussion history), self-report of concussion-like symptoms (Post-Concussion Symptom Inventory [PCSI]–Child and PCSI-Youth), and measures of postural stability (BioSway; Biodex Medical Systems). Two versions of the PCSI were used (PCSI-C, 9- to 12-year-olds; PCSI-Y, 13- to 18-year-olds). Postural stability was assessed via sway index under 4 sway conditions of increasing difficulty by removing visual and proprioceptive cues. Results: In children aged 9 to 12 years old, there were significant age- ( P < 0.05) and sex-based effects ( P < 0.05) on postural stability. Performance improved with age, and girls performed better than boys. For youth ages 13 to 18 years old, postural stability also improved with age ( P < 0.05). In both child and youth subgroups, postural stability worsened with increasing concussion-like symptoms ( P < 0.05). Conclusion: There are developmental and baseline symptom trends regarding postural stability performance. Clinical Relevance: These findings provide a preliminary foundation for postconcussion comparisons and highlight the need for a multimodal approach in assessing and understanding physical measures such as postural stability.

Background Decreased oxygenation of muscle may be accentuated during exercise at high altitude. Monitoring the oxygen saturation of muscle (SmO2) during hand grip exercise using near infrared spectroscopy during acute exposure to hypoxia could provide a model for a test of muscle performance without the competing cardiovascular stresses that occur during a cycle ergometer or treadmill test. The purpose of this study was to examine and compare acute exposure to normobaric hypoxia versus normoxia on deoxygenation and recruitment of the flexor digitorum superficialis (FDS) during submaximal intermittent handgrip exercise (HGE) in healthy adults. Methods Twenty subjects (11 M/9 F) performed HGE at 50% of maximum voluntary contraction, with a duty cycle of 2 s:1 s until task failure on two occasions one week apart, randomly assigned to normobaric hypoxia (FiO2 = 12%) or normoxia (FiO2 = 21%). Near-infrared spectroscopy monitored SmO2, oxygenated (O2Hb), deoxygenated (HHb), and total hemoglobin (tHb) over the FDS. Surface electromyography derived root mean square and mean power frequency of the FDS. Results Hypoxic compared to normoxic HGE induced a lower FDS SmO2 (63.8 ± 2.2 vs. 69.0 ± 1.5, p = 0.001) and both protocols decreased FDS SmO2 from baseline to task failure. FDS mean power frequency was lower during hypoxic compared to normoxic HGE (64.0 ± 1.4 vs. 68.2 ± 2.0 Hz, p = 0.04) and both decreased mean power frequency from the first contractions to task failure (p = 0.000). Under both hypoxia and normoxia, HHb, tHb and root mean square increased from baseline to task failure whereas O2Hb decreased and then increased during HGE. Arterial oxygen saturation via pulse oximetry (SpO2) was lower during hypoxia compared to normoxia conditions (p = 0.000) and heart rate and diastolic blood pressure only demonstrated small increases. Task durations and the tension-time index of HGE did not differ between normoxic and hypoxic trials. Conclusion Hypoxic compared to normoxic HGE decreased SmO2 and induced lower mean power frequency in the FDS, during repetitive hand grip exercise however did not result in differences in task durations or tension-time indices. The fiber type composition of FDS, and high duty cycle and intensity may have contributed greater dependence on anaerobiosis.

Measuring the proximity of the body to the environment has the potential to provide rehabilitation health care professionals (RHCP) new, additional information to assess mobility. The aims of this study were to explore the opinions and needs of professionals to use a new device to measure such proximity, and to determine potential barriers and facilitators to implement it within the clinical setting. Four focus groups were conducted with 23 RHCP. The concept of a proximity measurement device in the early stages of development was introduced. A qualitative content analysis using a model of clinical utility as guidance for coding of the transcribed texts was used. Many potential uses were raised including: improving patient safety, motor learning, independence in tasks as gait, transfers and reaching tasks, saving time during assessment, improving follow-up with the client, data precision and objectivity to assess tasks. Barriers were related to still unclear relevance, effectiveness, the added value of such a device, and time required for use. The development of a turnkey device with support to facilitate its implementation was seen to be positive. These focus groups provided important information to further identify potential uses of such a device and to help to decrease barriers to its implementation.

ObjectiveThis paper reports on a funded summit, which convened a multidisciplinary group of experts to provide consensus on the research priorities necessary for improving long-term community integration of individuals with traumatic brain injury (TBI) and their caregivers.MethodsThe 2-day summit was directed using the World Café Methodology, to engage stakeholders and collaboratively arrive at a consensus on the problems to be targeted in research. Participants (n=54), drawn from two Canadian provinces, included an interdisciplinary group of researchers, clinicians, representatives from brain injury associations, individuals with TBI, and caregivers. In small groups, participants discussed challenges to long-term community integration and potential initiatives that would address these barriers. Field notes from the discussions were analyzed using qualitative content analysis.ResultsThe consensus on prioritized research directions included developing interventions to optimize the functioning and participation of individuals with TBI, reducing caregiver burden, and evaluating how emerging technology can facilitate delivery of care.ConclusionsThe World Café Methodology was an effective method for developing research priorities. The breadth of expertise of participants and the collegial environment allowed for the identification of a broad perspective on important future research directions with potential to enhance the long-term community integration of individuals with brain injury.

A critical component for accelerating the clinical uptake of research data in the area of pediatric concussion or mild traumatic brain injury (MTBI) pertains to the establishment and utilization of common databases. The objective of the first phase of our CanPedCDE initiative was to agree upon pediatric common data elements (CDEs) that could best characterize children with MTBI over their recovery period. The selection of CDEs for our framework aimed to balance factors such as the comprehensiveness of outcomes collected, their applicability to diverse settings, as well as the costs associated with their use. Selection began by identifying relevant domains of functioning (e.g., post-concussion symptoms, attention, and balance). Two sources were used to make this process more efficient: 1) the World Health Organization International Classification of Functioning (ICF) Traumatic Brain Injury Core Set, and the U.S. National Institute of Neurological Disorders and Stroke Traumatic Brain Injury Common Data Elements, both of which had already suggested relevant domains to include in TBI research. The process was completed in two phases: 1) using an online survey of experts and 2) through an in-person consensus meeting. Measurement tools were also proposed that were best felt to capture these domains. Forty experts in MTBI in children from multiple health-related perspectives (e.g., emergency medicine, pediatrics, neurosurgery, nursing, physiotherapy, and neuroscience), as well as knowledge users, participated in the selection process. The final list of CDEs included 77 distinct areas of functioning, covering all categories of the ICF model. Outcome measures were attached to each element, when applicable. The CanPedCDE initiative addresses a significant limitation in MTBI research to date and may help both researchers and clinicians to organize and standardize their assessment of children and youth post-MTBI in order to move the field in promising directions.

Scoliosis is a sideway spinal deformity. If the curvature is measured to be more than 50\(^{\circ }\), surgery is required to straighten the spine. Pedicle screw insertion is a procedure that requires the placement of screws from the pedicle into the vertebral body. A rod is used to connect all the pedicle screws. The spine is straightened during the connection process. One of the most common techniques used for pedicle screw insertion is called the free hand technique, where the surgeon creates a screw channel by manually probing into the spine. The surgeon relies strongly on haptics feedback. However, small changes in force or direction can cause the probe to breach out of the spine. If the breach reaches the spine medial, the spinal cord could be damaged. Even experienced surgeons can not prevent breach.

The precise role of the human primary motor cortex in walking is unknown. Our previous study showed that the primary motor cortex may contribute to specific requirements of walking (i.e., maintaining a constant movement frequency and bilaterally coordinating the feet). Because aging can impair (i) the ability to fulfill the aforementioned requirements and (ii) corticomuscular communication, we hypothesized that aging would impair the motoneuronal recruitment by the primary motor cortex during bilateral cyclical movements. Here, we used corticomuscular coherence (i.e., coherence between the primary motor cortex and the active muscles) to examine whether corticomuscular communication is affected in older individuals during cyclical movements that shared some functional requirements with walking. Fifteen young men and 9 older men performed cyclical, anti-phasic dorsiflexion and plantarflexion of the feet while seated. Coherence between the midline primary motor cortex and contracting leg muscles cyclically increased in both age groups. However, the coherence of older participants was characterized by (i) lower magnitude and (ii) mediolaterally broader and more rostrally centered cortical distributions. These characteristics suggest that aging changes how the primary motor cortex participates in the cyclical movements, and such change may extend to walking.

Pedicle screw insertion is a common treatment in fixing spinal deformities in idiopathic scoliosis. This paper discusses the development of a haptic device which will aid in training for pedicle screw insertion surgery. By translating the rotational and linear effects of the surgery into tunable haptic parameters, a realistic haptic simulator is created. Over 10 surgeons of varying experience levels used the simulator, and were able to tune the device to what they felt was most realistic. They were also asked to judge the system based on its feasibility and usefulness. The results indicate the simulator is feasible for surgical education.

Stroke is one of the major causes of permanent adult disability. Stroke frequently affects motor control of the arm, leading to diffculties in doing activities of daily living. This research focuses on developing an upper limb rehabilitation robotic prototype through user-centered design to aid stroke survivors in rehabilitating their arm. To gather requirements from end users, stroke therapy sessions were observed and a survey of stroke therapists was conducted. End user requirements were evaluated to determine technical targets for the mechanical design of the prototype. Evaluation of the prototype was done with stroke therapists in a focus group and a preliminary biomechanical study. As user-centered design would require more iterations of design, testing and evaluation, this project reports a first step in developing an affordable, portable device, which could increase access to stroke rehabilitation for the arm.

Aim New tools that capture hand function in everyday activities and contexts are needed for assessing children with hemiplegic cerebral palsy. This study evaluates a wearable wrist monitor and tests the hypothesis that wrist extension frequency (FreqE) is an appropriate indicator of functional hand use. Method Fifteen children (four females, 11 males; age range 6–12y; mean age 10y [SD 2y]) with hemiplegia (seven at level I and eight at level II on the Manual Ability Classification System) participated in the Assisting Hand Assessment (AHA) while wearing the wrist monitor. FreqEs were captured via the wrist monitor and validated using video analysis. Correlations between FreqE and AHA scores were calculated and a multivariate linear regression was conducted to explore other measures of wrist activity. Results Wrist extensions observed in video analyses were reliably detected by the wrist monitor (intraclass correlation coefficient, r=0.88; p

Despite widespread acceptance of clinical benefits, empirical evidence to evaluate the advantages and limitations of ambulation aids for balance control is limited. The current study investigates the upper limb biomechanical contributions to the control of frontal plane stability while using a 4-wheeled walker in quiet standing. We hypothesized that: (1) upper limb stabilizing moments would be significant, and (2) would increase under conditions of increased stability demand. Factors influencing upper limb moment generation were also examined. Specifically, the contributions of upper limb center-of-pressure ( COP hands ), vertical and horizontal loads applied to the assistive device were assessed. The results support a significant mechanical role for the upper limbs, generating 27.1% and 58.8% of overall stabilizing moments under baseline and challenged stability demand conditions, respectively. The increased moment was achieved primarily through the preferential use of phasic upper limb control, reflected by increased COP hands (baseline vs. challenged conditions: 0.29 vs. 0.72 cm). Vertical, but not horizontal, was the primary force direction contributing to stabilizing moments in quiet standing. The key finding that the upper limbs play an important role in effecting frontal plane balance control has important implications for ambulation aid users (e.g., elderly, stroke, and traumatic brain injury).

Parkinson's disease (PD) is known to increase asymmetry and variability of bilateral movements. However, the mechanisms of such abnormalities are not fully understood. Here, we aimed to investigate whether kinematic abnormalities are related to cortical participation during bilateral, cyclical ankle movements, which required i) maintenance of a specific frequency and ii) bilateral coordination of the lower limbs in an anti-phasic manner. We analyzed electroencephalographic and electromyographic signals from nine men with PD and nine aged-matched healthy men while they sat and cyclically dorsi- and plantarflexed their feet. This movement was performed at a similar cadence to normal walking under two conditions: i) self-paced and ii) externally paced by a metronome. Participants with PD exhibited reduced range of motion and more variable bilateral coordination. However, participants with and without PD did not differ in the magnitude of corticomuscular coherence between the midline cortical areas and tibialis anterior and medial gastrocnemius muscles. This finding suggests that either the kinematic abnormalities were related to processes outside linear corticomuscular communication or PD-related changes in neural correlates maintained corticomuscular communication but not motor performance.

Changes in gait parameters induced by the concomitant performance of one of two cognitive tasks activating working memory and spatial attention, was examined in healthy young adults (YA) and older adults (OA). There was a main effect of task condition on gait-speed (p = .02), stride-length (p < .001) and double-support time (p = .04) independent of the group. There were no significant differences between working memory and spatial attention associated gait changes. Working-memory and spatial-attention dual-tasking led to a decrease in gait-speed (p = .09 and 0.01) and stride-length (p = .04 and 0.01) and increase in double-support time (p = .01 and 0.03) in YA and decrease in stride-length (p = .04 and 0.01) alone in OA. Cognitive task associated changes in gait may be a function of limited attentional resources irrespective of the type of cognitive task.

The objective of the present study is to quantify the position of the Centre of Mass (COM) during quiet standing using a force plate and compare this technique to the quantification of the COM with an anthropometric model. The postural control of 18 healthy adolescents and 22 IS patients was evaluated using an Optotrak 3D kinematic system, and two AMTI force plates during quiet standing. The position of anatomical landmarks tracked by the Optotrak system served to estimate the position of the COM of both groups using an anthropometric model (COM(anth)). The force plate served to estimate the position of the COM through double integration of the horizontal ground reaction forces (COM(gl)). The mean position and root mean square (RMS) amplitude of COM(gl, )in reference to the base of support (BOS) and the first sacral prominence (S1) were quantified in the Anterior-Posterior (A/P) and Medial-Lateral (M/L) directions. There was a significant difference between the control subjects and IS patients for the displacement of the COM(gl) in reference to the BOS in both the A/P and M/L directions. There was no difference between groups for the mean position of the COM(gl), however, 63% of the IS and 43% of the controls had a lateral position of the COM(gl )in reference to S1 of greater than 5 mm. There was a significant difference between groups in the A/P and M/L directions for the amplitude of error between the COM(gl) and COM(anth) techniques.

Purpose: To explore Ontario physiotherapists' opinions on their ability to order diagnostic imaging (DI). Methods: An online questionnaire was sent to all registered members of the College of Physiotherapists of Ontario. Descriptive statistics were calculated using response frequencies. Practice characteristics were compared using χ2 tests and Wilcoxon rank–sum tests. Results: Of 1,574 respondents (21% response rate), 42% practised in orthopaedics and 53% in the public sector. Most physiotherapists were interested in ordering DI (72% MRI/diagnostic ultrasound, 78% X-rays/computed tomography scans). Respondents with an orthopaedic caseload of 50% or more (p

OBJECTIVE To develop a video-based system, mounted on a rollator to quantify the step width values of rollator users in the community. SUBJECTS A total of 5 able-bodied young adults, age range 24-28 years. METHODS A digital video camera system was mounted on the rollator frame to capture the position of the participant's feet during overground walking. A method of estimating step width from the video data was developed and evaluated against the output from a concurrently recording Vicon MX motion capture system. RESULTS Mean step widths of the rollator and motion capture systems were 14.40 cm (standard deviation (SD) 4.64) and 14.37 cm (SD 4.34), respectively, revealing a strong level of agreement; intra-class correlation coefficient 0.999 (95% confidence interval (95% CI) 0.987-1.000; and root-mean-square difference 0.70 cm. CONCLUSION The video-based system mounted on a rollator to collect foot placement data enabled accurate measurement of step width during rollator use. The ability to record foot placement measurements outside the laboratory setting, characterizing foot placement patterns occurring in the community, will enable research into how these assistive devices influence mobility during everyday use.

The objective of this study was to identify acute spinal and three-dimensional postural adaptations induced by a shoe lift in a population of idiopathic scoliosis (IS) patients. Forty-six IS patients (mean age: 12 +/- 2 years) were evaluated radiologically and with a stereovideographic system for pelvic obliquity. Based on the initial postural and radiological evaluation, a pertinent shoe lift height was chosen for each with the result that 12 patients were tested with 5-mm (S5) lifts, 20 patients were tested with 10-mm (S10) lifts, and 14 patients with 15-mm (S15) lifts. The posture for all 46 patients was then re-evaluated and a spinal radiograph obtained for 14 patients. The implementation of a shoe lift independent of the type of curve and amplitude significantly decreased the Cobb angle. As expected there was a change in the vertical height of the left tibial plateau and greater trochanter that induced a change in pelvic tilt. There was also a significant increase in the vertical height of S1 and T1. There was a significant change in the left and right iliac bone version, as well as a decrease in the difference in version between these two bones. The implementation of the shoe lifts also changed the lateral shift of the pelvis. A relative change between the shoulders and pelvis for tilt and anteroposterior shift was also found to be significant. In conclusion, using a shoe lift resulted in acute postural adaptations which specifically affected the spine and the three-dimensional position and orientation of the pelvis and shoulder girdle.

A small leg length inequality, either true or functional, can be implicated in the pathogenesis of numerous spinal disorders. The correction of a leg length inequality with the goal of treating a spinal pathology is often achieved with the use of a shoe lift. Little research has focused on the impact of this correction on the three-dimensional (3D) postural organisation. The goal of this study is to quantify in control subjects the 3D postural changes to the pelvis, trunk, scapular belt and head, induced by a shoe lift. The postural geometry of 20 female subjects (X = 22, sigma = 1.2) was evaluated using a motion analysis system for three randomised conditions: control, and right and left shoe lift. Acute postural adaptations were noted for all subjects, principally manifested through the tilt of the pelvis, asymmetric version of the left and right iliac bones, and a lateral shift of the pelvis and scapular belt. The difference in the version of the right and left iliac bones was positively associated with the pelvic tilt. Postural adaptations were noted to vary between subjects for rotation and postero-anterior shift of the pelvis and scapular belt. No notable differences between conditions were noted in the estimation of kyphosis and lordosis. The observed systematic and variable postural adaptations noted in the presence of a shoe lift reflects the unique constraints of the musculoskeletal system. This suggests that the global impact of a shoe lift on a patient's posture should also be considered during treatment. This study provides a basis for comparison of future research involving pathological populations.

People with lower-limb amputation have reduced mobility due to loss of sensory information, which may be restored by artificial sensory feedback systems built into pros- theses. For an effective system, it is important to understand how humans sense, interpret, and respond to the feedback that would be provided. The goal of this study was to examine sen- sorimotor responses to mobility-relevant stimuli. Three experi- ments were performed to examine the effects of location of stimuli, frequency of stimuli, and means for providing the response. Stimuli, given as vibrations, were applied to the thigh region, and responses involved leg movements. Sensorimotor reaction time (RT) was measured as the duration between appli- cation of the stimulus and initiation of the response. Accuracy of response was also measured. Overall average RTs for one response option were 0.808 +/- 0.142 s, and response accura- cies were >90%. Higher frequencies (220 vs 140 Hz) of vibra- tion stimulus provided in anterior regions of the thigh produced the fastest RTs. When participants were presented with more than one stimulus and response option, RTs increased. Findings suggest that long sensorimotor responses may be a limiting fac- tor in the development of an artificial feedback system for mobility rehabilitation applications; however, feed-forward techniques could potentially help to address these limitations.

Background: Concussion is common in the sport of ice hockey and can cause deficits in cognitive function. In most situations, ice hockey participation requires the performance of more than one skill at a time. It has been reported that following concussion in athletes, performance deficits arise when locomotor and cognitive tasks are performed concurrently that may have otherwise gone unnoticed if assessed in isolation of one another. The purpose of this pilot study was to explore the effect of concussion on cognition during concurrent ice hockey specific tasks in youth ice hockey players. Methods: This single case pilot study compared the performance of 4 male youth ice hockey players who had experienced a concussion in the previous ice hockey season (mean age=11.7 ± 0.3 years; mean time since injury=92.5 ± 49.1 days) to a group of 10 non-injured controls (mean age=11.8 ± 0.8 years). Participants completed a randomized combination of three ice hockey specific tasks while concurrently completing a visual interference task (modified Stroop task). Results: Participants who experienced a concussion within the previous ice hockey season and were ≤ 58 days post-injury demonstrated significantly poorer cognitive performance (increased cognitive dual task cost) across all conditions when completing the visual interference task concurrently with ice hockey specific skills (p ≤ 0.05). Conclusion: This study acts as an initial step towards the development of a sport-specific assessment of functional performance following concussion in youth ice hockey players to help inform safer return to play.

Paediatric spinal deformities are the most prevalent musculoskeletal conditions observed in children and youth. Idiopathic Scoliosis (IS), a sub-class of these spinal deformities is commonly recognized by a lateral curvature of the spine that is of unknown cause and has the greatest risk of progression during periods of rapid growth and development.[1,2,3] The emergence of our contemporary perspective that this lateral curvature and axial rotation of the spine [4] is also accompanied by significant spatial disorientation of the spine and thoracic cage, [5,6] has motivated clinicians and scientists to develop new models of assessment for the purpose of guiding clinical decisions, orthopaedic interventions, and the evaluation of clinical outcomes.

New tools that capture hand function in everyday activities and contexts are needed for assessing children with hemiplegic cerebral palsy. This study evaluates a wearable wrist monitor and tests the hypothesis that wrist extension frequency (FreqE) is an appropriate indicator of functional hand use.Fifteen children (four females, 11 males; age range 6-12y; mean age 10y [SD 2y]) with hemiplegia (seven at level I and eight at level II on the Manual Ability Classification System) participated in the Assisting Hand Assessment (AHA) while wearing the wrist monitor. FreqEs were captured via the wrist monitor and validated using video analysis. Correlations between FreqE and AHA scores were calculated and a multivariate linear regression was conducted to explore other measures of wrist activity.Wrist extensions observed in video analyses were reliably detected by the wrist monitor (intraclass correlation coefficient, r=0.88; p0.001) and were strongly correlated with the AHA scores (r=0.93; p0.001). AHA scores were significantly correlated with FreqE (r=0.80; p=0.001) and the range of wrist extensions/flexions (r=0.70; p=0.008). The multivariate linear regression combining the FreqE and range of wrist extensions/flexions yielded a strong correlation with AHA scores (r=0.84; p=0.0043).The wearable wrist monitor may offer a convenient, valid alternative to observer reports for functional assessments of the hemiplegic hand in everyday contexts.

The recent article by Akhbari and colleagues1 is representative of a growing body of clinical research aimed at providing evidence to support the clinical uptake of biomechanical techniques that measure postural stability.2–7 Overall, this body of work has sought to better understand the measurement properties of biomechanical variables that provide insight into the fundamental mechanisms that control postural stability. Although these biomechanical variables have shown promise for measuring clinical change over time,1–7 they have not often been examined in the context of randomized controlled trials.8 In the context of upright stance, postural stability is often defined as the ability of the nervous system to control the position of the centre of mass (COM) in relation to the base of support (BOS).9 Biomechanical measurements of postural stability have traditionally been achieved by measuring the forces exerted through the base of support (kinetics), the movement of the body (kinematics), and the activation of muscle (electromyography). Analysis of the time and frequency domain characteristics of these measures has provided valuable insight into the movement of the COM in relation to the BOS and the basic strategies used to control this movement.10 Combining these biomechanical measures with variations in the task performed, the environmental context, and individual characteristics has further revealed the complexity of the strategies that the nervous system adopts to control postural stability.9 In this context, we can gain considerable insight into the underlying structural and functional determinants of postural instability, particularly where there is an underlying orthopaedic, neuromuscular, or neurological condition. However, the infrastructure and operating costs of conducting such assessments and the expertise required to interpret biomechanical measures may prohibit their application in large-scale, long-term clinical trials. The recent emergence of accessible biomechanical sensor technology has provided new opportunities to measure postural stability in a variety of contexts beyond the traditional laboratory setting. Examples of this emerging technology include force sensors embedded in active gaming platforms, shoes, and walking surfaces;11–13 wireless accelerometers and inertial measurement units;14 and balance assessment platforms.1,15 Such technologies offer clinical researchers opportunities to bridge the gap between fundamental and translational research by accessing information once exclusive to the biomechanical laboratory environment. However, advances in this emerging area of clinical research will be achieved only through significant and sustained commitment to establishing the measurement properties of the biomechanical variables and integrating these variables into long-term prospective observational and randomized controlled trials. The work of Akhbari and colleagues1 is representative of several studies in the field that have taken the first step along this continuum, providing initial evidence of the potential promise of biomechanical techniques.

The objective of this study was to quantify the relationship between gibbosity and spinal deformation expressed by the angle of Cobb before and during treatment with a brace for different classes of idiopathic scoliosis patients. As part of the standard treatment with the Dynamic Corrective Brace (SpineCor), 89 idiopathic scoliosis patients underwent an initial radiological examination and gibbosity measurement with a scoliometer wearing and not wearing the brace. The 89 patients were classified in relation to the apex of the scoliosis curves: thoracic (n = 29); thoracolumbar (n = 40); lumbar (n = 7) and double (n = 13). With the dynamic corrective brace, the patients showed a mean decrease of 8.3 degrees for the major Cobb angle, and a mean decrease of 2.3 degrees for their gibbosity. There was a significant positive relationship between gibbosity and Cobb angle with and without the brace for the thoracic and thoracolumbar curves. A linear regression analysis identified a small mean estimation error for the thoracic curves (7.4 degrees no-brace; 2.7 degrees with brace) and thoracolumbar curves (5.2 degrees no-brace; 5.3 degrees with brace), indicating a predictive potential of the scoliometer. The measure of gibbosity with the scoliometer provides a fairly reliable estimation of Cobb angle at the initial clinical examination of a scoliosis patient. However, when initial Cobb angle and gibbosity are considered, the measure of gibbosity when wearing a brace provides the clinician with a highly reliable estimation of the Cobb angle while in a brace. This relationship also exists for the follow-up with a brace, permitting a judgement of the patient's evolution under the treatment with SpineCor.

The objective of this study was to assess the success of treatment during the follow-up of a group of 195 idiopathic scoliosis (IS) patients consecutively treated with the SpineCor system. A survival analysis was performed to estimate the cumulative probability of success during treatment, at follow-up and for the combined treatment and follow-up period. Success was defined as either a correction or stabilization of +/-5 degrees or more, and failure as a worsening of more than 5 degrees. The patient cohort was categorized before treatment into curves less than 30 degrees (group 1), and curves greater than 30 degrees (group 2). The survival analysis indicated a cumulative probability of success that increased during treatment with the patient wearing the brace (Year 1: 0.30, 0.39; Year 2: 0.62, 0.79; Year 3: 0.92, 0.89, for groups 1 and 2 respectively). During the post-treatment follow-up period, there was a stabilization (Year 1 post-treatment: 0.94, 0.89; Year 2 post-treatment: 0.85, 0.81), with an overall probability of success of 0.92 and 0.88 after 4 years of combined treatment and post-treatment follow-up. For the 29 patients who had a minimum follow-up of 2 years (initial Cobb angle: 30 degrees +/-9 degrees ), the trend during treatment was a decrease in spinal curvature at 3 months, with a mean difference of 10 degrees (SD 5 degrees ); at termination of treatment a mean difference of 7 degrees (SD 7 degrees ); and at the time of the 1- and 2-year follow-ups there was a difference of 4 degrees (SD 7 degrees ) and 5 degrees (SD 7 degrees ) respectively, with reference to the initial out of brace condition. At 2 years follow-up there was an overall correction of greater than 5 degrees for 55% of the patients, 38% had a stabilisation and 7% had worsened by more than 5 degrees. This initial cohort of patients demonstrated a general trend of initial decrease in spinal curvature in brace, followed by a correction and/or stabilisation at the end of treatment, which was maintained through 1, and 2 years' follow-up.

Background There is an important need to better understand the activities of individual patients with stroke outside of structured therapy since this activity is likely to have a profound influence on recovery. A case-study approach was used to examine the activity levels and associated physiological load of patients with stroke throughout a day. Methods Activities and physiologic measures were recorded during a continuous 8 hour period from 4 individuals in the sub-acute stage following stroke (ranging from 49 to 80 years old; 4 to 8 weeks post-stroke) in an in-patient rehabilitation hospital. Results Both heart rate (p = 0.0207) and ventilation rate (p < 0.0001) increased as intensity of activity increased. Results revealed individual differences in physiological response to daily activities, and large ranges in physiological response measures during 'moderately' and 'highly' therapeutic activities. Conclusion Activity levels of individuals with stroke during the day were generally low, though task-related changes in physiologic measures were observed. Large variability in the physiological response to even the activities deemed to be greatest intensity suggests that inclusion of such extended measurement of physiologic measures may improve understanding of physiological profile that could guide elements of the physical therapy prescription.

Idiopathic scoliosis (IS) is a class of paediatric spinal deformities that has historically posed a significant challenge to the orthopaedic and scientific community. Our understanding of the underlying mechanisms associated with the early progression to advanced stages that require surgical intervention is limited. Current clinical models of assessment provide limited insight into the biomechanical and neuromuscular factors that contribute to the alignment and stability of the spine. There is an emerging recognition that new insight into the factors that affect spinal stability and the progression of a spinal deformity may be gained by expanding current observational techniques beyond the clinic. Technological innovations and advancements in analytical techniques have provided a unique opportunity to develop measurements of neuromuscular function and spinal stability. The overall aim of our present work is to develop new biomechanical measures that will provide insight into the factors that contribute to the early progression of IS. The first specific aim of this pilot project is to further develop a technique that will provide a localized estimate of the asymmetric positioning of the Centre of Mass (COM) in relation to the underlying skeletal structures of the pelvis (sacrum) and spine (apex of spinal curvature). The second specific aim is to determine the association between these measures with persistent asymmetric posture and muscle activation patterns during the performance of dynamic activities that are typical of every day life. To achieve these objectives we are currently developing a mixed methods approach that includes the coupling of a radiological, biomechanical and ambulatory monitoring assessment. This includes a 3D assessment of the spine utilizing EOS to characterize the spinal deformity, and a dynamic assessment that is focused on characterizing the dynamic patterns of muscle activity and movement. This latter component of the project involves an in laboratory biomechanical assessment with a multiple camera Vicon and 16 channel EMG system, and an out of lab ambulatory monitoring assessment. This initial study will provide the foundation to conduct future work focused on identifying new biomechanical factors that are positively associated with the early progression of IS.