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Background Individuals requiring greater physical assistance to practice walking complete fewer steps in physical therapy during subacute stroke rehabilitation. Powered exoskeletons have been developed to allow repetitious overground gait training for individuals with lower limb weakness. The objective of this study was to determine the efficacy of exoskeleton-based physical therapy training during subacute rehabilitation for walking recovery in non-ambulatory patients with stroke. Methods An assessor-blinded randomized controlled trial was conducted at 3 inpatient rehabilitation hospitals. Patients with subacute stroke ( Results Thirty-six patients with stroke (mean 39 days post-stroke) were randomized (Exoskeleton = 19, Usual Care = 17). On intention-to-treat analysis, no significant between-group differences were found in the primary or secondary outcomes at post-intervention or after 6 months. Five participants randomized to the Exoskeleton group did not receive the protocol as planned and thus exploratory as-treated and per-protocol analyses were undertaken. The as-treated analysis found that those adhering to exoskeleton-based physical therapy regained independent walking earlier (p = 0.03) and had greater gait speed (p = 0.04) and 6MWT (p = 0.03) at 6 months; however, these differences were not significant in the per-protocol analysis. No serious adverse events were reported. Conclusions This study found that exoskeleton-based physical therapy does not result in greater improvements in walking independence than standard care but can be safely administered at no detriment to patient outcomes. Clinical Trial Registration The Exoskeleton for post-Stroke Recovery of Ambulation (ExStRA) trial was registered at ClinicalTrials.gov (NCT02995265, first registered: December 16, 2016)

Objective To address a gap between spinal cord injury (SCI) research and practice by rigorously and systematically co-developing integrated knowledge translation (IKT) guiding principles for conducting and disseminating SCI research in partnership with research users. Design The process was guided by the internationally accepted The Appraisal of Guidelines for REsearch & Evaluation (AGREE) II Instrument for evaluating the development of clinical practice guidelines. Setting North American SCI research system (ie, SCI researchers, research users, funders). Participants The multidisciplinary expert panel (n=17) and end users (n=35) included individuals from a North American partnership of SCI researchers, research users, and funders who have expertise in research partnerships. Interventions Not applicable. Main Outcome Measures Clarity, usefulness, and appropriateness of the principles. Results Data regarding 125 principles of partnered research were systematically collected from 4 sources (review of reviews, scoping review, interviews, Delphi consensus exercise). A multidisciplinary expert panel held a 2-day meeting to establish consensus, select guiding principles, and draft the guidance. The panel reached 100% consensus on the principles and guidance document. The final document includes a preamble, 8 guiding principles, and a glossary. Survey data showed that the principles and guidance document were perceived by potential end users as clear, useful, and appropriate. Conclusions The IKT Guiding Principles represent the first rigorously co-developed, consensus-based guidance to support meaningful SCI research partnerships. The principles are a foundational tool with the potential to improve the relevance and impact of SCI research, mitigate tokenism, and advance the science of IKT.

Arm crank ergometry and adaptive rowing are existing exercise options for wheelchairs users, but not commonly available. This study was conducted to explore exercise participation of wheelchair users, as well as the usability of the adaptive rowing ergometer (aROW) and arm crank ergometer (ACE).This mixed-methods study used a concurrent triangulation design. Following completion of both exercise sessions (5 min each), participants (Wheelchair users exercised for improved physical and mental health, as well as for functional independence, and community participation; however, lack of accessible equipment was a prominent barrier. Both the aROW and ACE have high usability, but the aROW was perceived as more enjoyable and effective for cardiovascular exercise.The implementation of the aROW into community gyms has the potential to help close the existing gap in inclusive equipment and may help people with disabilities to be more fully included in their community and lead healthier lives.Implications for rehabilitationWheelchair users perceive exercise as a meaningful activity that enhances physical health and risk of disease, functional independence, community participation, and overall social and emotional health.The adapted rowing machine was perceived as highly usable and was felt to be more enjoyable and effective for cardiovascular exercise compared to traditional arm crank ergometers.The adaptive rower provides an additional accessible equipment option for wheelchair users to obtain effective cardiovascular exercise.More available equipment may increase community participation and promote inclusion for wheelchair users.

Objectives: Loneliness and depression are of increasing concern in long-term care homes made more urgent by viral outbreak isolation protocols. An innovative program called Java Mentorship was deve...

Powered wheelchairs promote participation for people with mobility limitations. For older adults with cognitive impairment, existing training methods may not address learning needs, leading to difficulty with powered wheelchair skills. Error-minimized training, facilitated by shared control technology, may provide learning opportunities more suited to this population.The objective of this study was to evaluate the feasibility of an error-minimized approach to powered wheelchair skills training using shared control in residential care. Feasibility indicators were hypothesized a priori to be feasible for use in a definitive RCT.A 2 × 2 factorial RCT compared an error-minimized powered wheelchair skills training program (Co-pilot) to a control intervention at two doses (6 sessions vs. 12 sessions). Data were collected on the feasibility of study processes (e.g., recruitment), resources (e.g., participant time), management (e.g., technology reliability), and training outcomes (e.g., adverse events, clinical outcomes).Twenty-five older adults with cognitive impairment participated in the study. Technical issues were encountered in 14.5% of training sessions. Participants receiving 6 sessions of training adhered better to the treatment than those receiving 12 sessions. All participants learned the skills required for PWC use with minor errors, regardless of the training method or dose. Co-pilot participants and trainers reported feelings of safety and training benefits with the use of shared control technology.Individuals with mild to moderate cognitive impairment are able to learn the skills required to drive a powered wheelchair in as few as six training sessions. Further evaluation of the Co-pilot training program is required.IMPLICATIONS FOR REHABILITATIONShared control teleoperation technology may be used to augment learning in older adults with cognitive impairments.Evaluation of the feasibility of use of novel rehabilitation technologies is critical prior to engaging in large-scale clinical research.Individuals with cognitive impairment are able to learn the required skills for operation of a powered wheelchair.

Powered wheelchair use promotes participation in individuals with limited mobility, however training is required for safe and effective use. There is limited evidence on the task demands of powered wheelchair use to inform an evidence-based skills training programme.To conduct a systematic exploration of the task demands of indoor powered wheelchair use to identify frequently used skills, abilities, and knowledge.We used a two-phased think aloud process to conduct a task analysis of powered wheelchair use with experienced powered wheelchair users (One-hundred and ten (110) distinct skills and abilities were identified and mapped to the ICF; 80 in the Body Structures and Functions domain, and 30 in the Activities and Participation domain. Approximately 50% of skills and abilities were mental functions. Four thematic knowledge domains were identified: knowledge of self, environment, wheelchair, and task.Powered wheelchair use is complex and requires a variety of skills and abilities from all areas of human functioning, in addition to a wide range of knowledge. Training programmes should address a range of areas of skill development.IMPLICATIONS FOR REHABILITATIONPowered wheelchair use is a complex skill; training should develop skills from all.Domains of the ICF, including mental and physical functions.A range of knowledge is used while operating a powered wheelchair; training programs.Should include the development and application of necessary knowledge.Clinicians may consider a range of factors when assessing suitability for powered.Wheelchair user, however should acknowledge that while the range of skills idenotified.May be useful, they may not be critical for success in powered wheelchair use.

Lower limb exoskeletons are a recent intervention promoted to improve gait disorders. Available research has focused on clinical outcomes; however, little is known about therapists' experiences using the device in practice.We explored the implementation of an exoskeleton at a tertiary rehabilitation center.In this longitudinal qualitative study we conducted semi-structured interviews with 10 therapists. One group of therapists was formally trained using the device, whereas the other group only had clinical exposure to the device. The interviews were transcribed, coded, and analyzed for themes.Three main themes emerged: (1)The exoskeleton represents one of the most complicated and labor-intensive interventions provided by therapists. Implementation requires substantial resources, raising questions regarding its efficacy and cost-effectiveness relative to other approaches. Until more evidence becomes available around the use and effectiveness of this rapidly evolving technology, therapists must contend with a high degree of uncertainty.IMPLICATIONS FOR REHABILITATIONUsing a lower limb exoskeleton may reduce physical demands on therapists in high-intensity rehabilitation programs that involve repetitive, effortful movements.However, a number of potential barriers to implementing the exoskeleton into practice need to be taken into consideration, including calibration time, intensive training required to become qualified to administer the intervention, the cost of the device, and comfort and safety of the device affecting user acceptance and uptake.Therapists also need to manage patient expectations related to outcomes related to use of exoskeletons.

Loneliness, depression, and social isolation are common among people living in long-term care homes, despite the activities provided. We examined the impact of a new peer mentoring program called Java Mentorship on mentees’ loneliness, depression, and social engagement, and described their perceptions of the visits. We conducted a mixed-methods approach in 10 homes in Ontario, Canada, and enrolled residents as mentees ( n = 74). We used quantitative surveys and qualitative interviews to understand their experience. After 6 months, mentees ( n = 43) showed a 30% reduction in depression ( p = .02, d = .76), a 12% reduction in loneliness ( p = .02, d = .76), and a 60% increase in the number of monthly programs attended ( p = .01, d = .37), with small-to-medium effect sizes. The analysis of mentee’s interviews revealed positive perceptions. This program offers an innovative, nonpharmacological alternative to the treatment of loneliness and depression.

Pushrim-activated power-assisted wheels (PAPAWs) are assistive technologies that use force sensor data to provide on-demand propulsion assistance to manual wheelchair users. However, available data about kinetic and kinematic of PAPAW use are mainly limited to experiments performed on a treadmill or using a dynamometer. In this work, we performed experiments to gather kinetics of wheelchair propulsion and kinematics of wheelchair motion for a variety of over-ground wheelchair maneuvers with a manual wheelchair with and without PAPAWs. Our findings revealed that using PAPAWs can significantly reduce the propulsion effort and push frequency. Both linear and angular velocities of the wheelchair were significantly increased when using PAPAWs. Less force and push frequency could potentially reduce risk of chronic upper limb injury. Higher linear velocity could be desirable for various daily life activities, however, the increase in the angular velocity could lead to unintended deviations from a desired path. Future research could investigate PAPAW controllers that amplify the desired intentions of users while mitigating any unwanted behaviours.

The use of mobility scooters is becoming more common due to their effectiveness, social acceptability, and cost. A variety of benefits have been associated with scooter use, including increased mob...

This review describes recent research regarding challenges to mobility experienced by older adult mobility device users. Different elements that affect mobility in this population were highlighted using the Human Activity Assistive Technology model. Key constructs in this model include the human (personal factors); the desired activity (mobility); assistive technology (mobility devices); and context (physical and social environmental factors). Poor mobility skills and lack of mobility confidence are personal factors that can limit the places that older adults go. However, new mobility devices are being developed to facilitate independent mobility. The design of the built environment and poor signage are aspects of the physical environment that can constrain mobility and impair wayfinding. Likewise, social factors including funding and prescription policies can reduce access to devices and needed services, and stigma can cause older adults to self-limit their mobility. Addressing these challenges could reduce the difficulties that users encounter while navigating the environment and facilitate the mobility and social participation of older adults.

Introduction: Manual wheelchairs with spontaneous, user-initiated seating adjustability allow users to independently adjust both rear seat height and backrest angle on-the-fly to optimize positioni...

Introduction: Wheelchair users deploy a variety of strategies to increase their visibility to motorists. Unfortunately, there is no empirical evidence supporting the use of any of these visibility strategies with this population.Objectives: To investigate the effectiveness of four different visibility strategies (i.e., light emitting diode (LED) lighting system, reflective safety vest, orange flag, or control (i.e., black clothing)) for wheelchair users in nighttime and daytime conditions.Methods: Participants were shown videos from the driver's perspective depicting a wheelchair user waiting to cross the street while using one of the four visibility strategies in isolation during nighttime and daytime. Participants indicated when, if at all, they first saw the wheelchair user at the roadside. Results were compared to determine which strategy allowed for the longest reaction time.Results: In nighttime conditions, the most effective strategy was the LED lighting system followed by the reflective vest. Neither the orange flag nor black clothing provided an adequate stopping distance when a vehicle was traveling at 32km/h at night. During daytime conditions, all visibility strategies were effective when a vehicle was traveling at this speed.Conclusions: These results will help clinicians and enable wheelchair users to make informed choices about the best visibility strategies to use.

We evaluated perceived autonomy among users of different types of wheeled mobility assistive devices (WMADs) across five environments and identified the effect on user autonomy due to specific device characteristics. A study-specific questionnaire was used to assess satisfaction with autonomy of WMAD users in the Home, Buildings Outside of the Home, Outdoor Built, Outdoor Natural Environment, and Transportation. For each environment, 15 contextual factors were rated for their impact on participants' autonomy. Our results revealed that manual wheelchair with add-on (MWC+AO) users had higher overall satisfaction with their autonomy compared to other WMAD users. MWC+AO users reported higher satisfaction with autonomy due to their health conditions compared to other WMAD users across all environments. In Outdoor Natural Environments, MWC+AO users had the highest satisfaction with autonomy across all factors except for negotiating hills. When performing activities in Buildings, MWC users with and without add-ons reported higher satisfaction for all factors compared to power wheelchair users, except for maneuverability on different surfaces. Satisfaction with autonomy regarding contextual factors varied among WMAD users, however, MWC+AO(s) appeared to provide a more balanced sense of autonomy across most factors and environments. More in-depth investigations are required to evaluate impacts of add-on use on autonomy.

Background and Objectives Recent critical evaluations of age-friendly efforts have highlighted the need to prioritize the disenfranchised, including people with mobility limitations. This article examines the validity of a 13-item Stakeholders Walkability/Wheelability Audit in Neighborhoods (SWAN13) scale to measure the “walk/wheelability” of street segments from the perspectives of people with mobility limitations. Research Design and Methods Data were drawn from preliminary studies of the SWANaudit which was conducted in 2 Canadian metropolitan areas. Sixty-one participants who use mobility devices (e.g., walkers, power wheelchairs) and older adults from community organizations audited 195 street segments. We factor analyzed the data from their audits. Results SWAN13 has a 1-factor structure. 13 items were retained from 85 SWANaudit items. SWAN13 encompassed both physical and social aspects of walk/wheelability. The alpha for the scale was .79. Convergent validity was found with the University of Alabama Life-Space Assessment (ρ = .22, p = .003), especially at the neighborhood level (ρ = .23, p = .002). Significant correlation was also found with subjective assessments of a priori walk/wheelability domains (ρ = .63, p < .001). Discussion and Implications Walk/wheelability affects the life space of older adults and people with mobility limitations. It is an important latent variable that should be addressed to promote well-being and social participation. SWAN13 may be used in city-wide surveys to identify neighborhoods that may require age-friendly interventions from mobility perspectives. Detailed audits and interventions may be carried out in tandem using the paired SWANaudit instrument. Walk/wheelability is an inclusive and measurable concept that accounts for the needs of people with various mobility needs.

To describe the subjective reported scooter-skill scores of new mobility scooter users and to identify significant correlations with other characteristics and measures.This was a single-centre study using a cross-sectional design. Participants (Mean total WST-Q capacity scores were 83% and performance scores were 25%. WST-Q capacity scores had significant positive correlations with WST-Q performance (The correlations between WST-Q scores and other variables are similar to those found in other studies among users of scooters and other mobility devices. The gap between capacity and performance scores highlights the needs for additional skills training in this population of novice scooter users.IMPLICATIONS FOR REHABILITATIONIn implementing scooter training for new scooter users, attention should be paid to building community-based skills for navigating both the physical and the social environment.Scooter users' age and their driving capabilities need to be taken into account when developing and delivering the training.

Importance: Scanning the environment is critical for driving safety. The ScanCourse is a functional assessment that assesses a person’s ability to scan the environment for visual information while in motion. Measurement properties for the ScanCourse have been reported; however, its predictive validity is unknown. Objective: To determine the predictive validity of the ScanCourse for on-road driving performance and establish clinical cutoff scores. Design: Retrospective chart reviews were conducted over a 6-mo period. Setting: Four Canadian driver rehabilitation programs. Participants: Charts from patients with neurological or vision conditions were eligible if they contained ScanCourse and on-road driving evaluation results between September 1, 2008, and August 30, 2018. Three hundred twenty-five charts were included for analysis. Outcomes and Measures: Area under the curve (AUC) analysis was used to determine the predictive validity of ScanCourse scores for on-road outcomes; cutoff scores were established by optimizing sensitivity and specificity. Results: The ScanCourse had an AUC of .702. The optimal cutoff score was 18/20 with a sensitivity of 76.7% and a specificity of 47.1%. Conclusions and Relevance: Assessing the scanning abilities of at-risk drivers who intend to return to driving after sustaining an injury can help identify safety risks and inform interventions. The ScanCourse was found to have acceptable discriminatory ability for on-road driving performance. This study provides evidence supporting its continued use as a screening tool to assess driver fitness with an identified optimal cutoff score for clinical use. What This Article Adds: Measuring the predictive ability of the ScanCourse assessment in relation to on-road driving performance provides occupational therapists with an evidence-based clinical tool to assist with screening fitness to drive among at-risk people.

To evaluate and compare the perceived autonomy of people using wheeled mobility assistive devices (WMADs) in five community-based environments. To evaluate how personal, environmental, and assistive device-related factors impact the perceived autonomy of WMAD users. A study-specific questionnaire was used to evaluate perceived satisfaction of WMAD users with their autonomy in five environments: the Home Environment, Buildings Outside of the Home Environment, Outdoor Built Environment, Outdoor Natural Environment, and Transportation. For each environment, participants rated their satisfaction with autonomy about 15 personal, environmental, and assistive device-related factors. Qualitative perceptions were also collected with open-ended questions. Participants included 123 full- and part-time community-dwelling WMAD users. Participants’ overall satisfaction with autonomy in the Outdoor Natural Environment was statistically significantly lower compared to the other four environments (p WMAD users reported the greatest restriction to their autonomy in outdoor environments. Different context-specific factors were found to impact autonomy in different environments. Understanding how environment-specific contextual factors contribute to overall perception of autonomy may inform the development of future strategies to overcome identified limitations and challenges.Implications for RehabilitationWheeled mobility assistive device (WMAD) users experienced the highest autonomy in their home environments, specifically, when having access to home modification services.WMAD users had the lowest autonomy in the outdoor natural environment, with manoeuvrability on different terrains being the main predictor of the overall satisfaction with autonomy in this environment.Environment-specific contextual factors with significant impacts on perceived autonomy were identified that can inform the design and development of future WMADs (e.g., distance travelled, safety). Wheeled mobility assistive device (WMAD) users experienced the highest autonomy in their home environments, specifically, when having access to home modification services. WMAD users had the lowest autonomy in the outdoor natural environment, with manoeuvrability on different terrains being the main predictor of the overall satisfaction with autonomy in this environment. Environment-specific contextual factors with significant impacts on perceived autonomy were identified that can inform the design and development of future WMADs (e.g., distance travelled, safety).

The ability to move about the community safely and easily plays a key role in the lives of people who use mobility devices. This study explored how personal characteristics, mobility device use, transportation, and environmental factors affected the size of their activity spaces (i.e., daily path area). Seventy-eight people who used manual wheelchairs, power wheelchairs, scooters, walkers, canes, and/or crutches tracked their movements in the community using a geographical positioning system device over a 7-day period. Participating in productive activities, walkability, the interaction between access to a vehicle and walkability, seasonality, and location helped to explain 43% of the variability in daily path area. The type of mobility device used and years using a device were associated with activity space size in bivariate analysis but not significantly significant in the regression model. The findings underscore the complex challenges that people who use mobility devices face moving about the community. Implications for researchers and transportation planners are discussed.

Participation in outdoor recreation is associated with improvements in mental, emotional, and physical health. Individuals with impairments affecting mobility, such as wheelchair users, face environmental, physical, and social barriers to participation in outdoor recreation. There is limited research on outdoor recreation participation among wheelchair users, especially concerning informal recreational opportunities. Formal programmes that offer access to outdoor recreation are often oversubscribed and also do not enable opportunities to participate more spontaneously.(1) To explore the experiences and impact of participation in outdoor recreation activities by wheelchair users, with an emphasis on more informal activities; and (2) to identify perceived barriers and facilitators to participation in outdoor recreation activities.Semi-structured interviews were the main means of data collection in this interpretive description study; this was supplemented by photographs of activity involvement provided by participants. These data were analysed thematically.Fifteen Canadian wheelchair users participated in the study. Three themes emerged following analysis: (1) Into the Woods explores participants' current outdoor recreation experiences, (2) Ain't No Mountain High Enough looks at the barriers and challenges participants face, and (3) Just Around the Riverbend discusses participants' desired changes to enable their further participation.The study highlighted participants' current experiences, their perceived barriers, and several ways to enhance outdoor recreation participation among wheelchair users, including: developing new adaptations, creating policies, increasing access to affordable equipment and programmes, and reducing barriers in built and natural environments.Implications for rehabilitationWheelchair users participate in a wide variety of outdoor activities.Wheelchair users experience various barriers and challenges when participating in outdoor recreation.Despite recent improvements, environmental changes are needed to allow wheelchair users to access outdoor recreation.Further development of adaptive equipment is needed in order for wheelchair users to access their desired outdoor recreation activities.

Importance: Powered wheelchairs provide independence for people with mobility impairments; however, current training practices may not meet the needs of those with cognitive impairments. Shared-control teleoperation may have utility in a clinical setting when developing training suited to this population. Objective: To explore the clinical utility of a shared-control teleoperation device for powered wheelchair assessment and training. Design: In this qualitative study, we used two sequential semistructured interviews conducted a minimum of 2 wk apart. Thematic analyses were used with member checking, reflexive journaling, and triangulation of researchers to establish trustworthiness of the data. Setting: Rehabilitation center and residential care and community settings. Participants: Using purposive sampling, we recruited occupational therapists and physical therapists who were mostly female and who had a range of practice experience. Results: Fifteen participants were interviewed, and two primary themes were identified: (1) “A big enabler” described how shared control provides opportunities to train people who may otherwise be denied powered mobility, and (2) “changing the learner experience” described how shared control may promote success in skill development through an alternative learning experience. Conclusions and Relevance: Shared-control technology may have the potential to broaden the scope of therapeutic intervention by reducing risk to the driver and others in the environment and by facilitating alternative training approaches. What This Article Adds: Technological advances that allow more control over a powered wheelchair by a clinician, known as shared control, may provide learning opportunities for people who are otherwise denied access to powered mobility. Shared control may also allow the use of new instructional techniques, increase safety in the training process, and reduce anxiety associated with learning.

Purpose: Providing care to older adults using assistive technology can be challenging for family caregivers. To inform the development of an Internet-based intervention, this study aimed to identify older assistive technology users and family caregivers’ needs related to assistive technology procurement, and to explore how to offer remote support through an Internet-based intervention. Methods: Based on an iterative user-centered design approach, 30 semi-structured interviews were conducted with stakeholders about their experiences with assistive technology procurement/attribution and their perceptions of a proposed intervention. A modified content analysis approach was used, with a mix of emerging and a priori concepts. Results: Participants view assistive technology procurement as an ongoing cyclical process, with potential unmet needs at key moments before and after assistive technology procurement. Assistive technology user-family caregiver dyads needs focus on assistive technology information, access, assistive technology-person-context match, training and support. While participants felt there were benefits to the proposed intervention they also identified potential implementation barriers. Conclusion: Assistive technology Internet-based interventions dedicated to family caregivers should ensure systematic and tailored follow-up while integrating some form of human support. This study guides the prototype design of the proposed intervention towards a graded support approach, empowering assistive technology users and family caregivers to resolve assistive technology-related challenges.Implication for rehabilitationProviding home-based care to older adults using assistive technology (e.g., mobility aids, communication aids) can be challenging for family caregivers.Using a user-centered design approach, an Internet-based intervention is under development to support older assistive technology users and their family caregivers.Through interviews with diverse stakeholders, this study explores unmet needs related to assistive technology procurement and perceptions about the proposed intervention. Providing home-based care to older adults using assistive technology (e.g., mobility aids, communication aids) can be challenging for family caregivers. Using a user-centered design approach, an Internet-based intervention is under development to support older assistive technology users and their family caregivers. Through interviews with diverse stakeholders, this study explores unmet needs related to assistive technology procurement and perceptions about the proposed intervention.

New geared wheelchair wheels have been developed allowing the user to pull backwards on the rims to move forward. Theoretically, this utilizes larger muscle groups compared to conventional propulsion preventing repetitive stress injuries. This study compared the gross mechanical efficiency (GME), perceived effort and energy expenditure of propelling the wheelchair using two types of these geared wheels and standard forward propulsion wheels. A within participants repeated measures design was used. Participants' energy expenditure and perceived exertion were measured. GME was calculated based on power output and energy expenditure values. Ten able-bodied participants were enrolled in the study. Standard wheels required the least energy expenditure and were perceived as the lightest to propel for nine of the participants; while the low-geared wheels were perceived as the hardest to propel. Results favored the standard wheels under these conditions. Research is needed to explore the effect of training and different slope angles.

Aim The aim of this study was to gain insights, from the perspectives of both parents and pediatric therapists, into the experiences of children learning to use a power mobility device. Method The purposive sample included 33 participants: 14 parents of children who were learning, or had learned, to use a power mobility device and 19 pediatric occupational therapists or physical therapists. Data were gathered face-to-face via seven focus groups consisting of either parents or therapists, and eight one-on-one interviews. Data were analyzed using the constant comparative method. Results Three main themes were identified: (1) 'Power in mobility' described how learning to use powered mobility changed more than just a child's locomotor abilities; (2) 'There is no recipe' revealed how learning to use powered mobility occurred along an individualized continuum of skills that often unfolded over time in a cyclical process; (3) 'Emotional journey' explored how learning to use powered mobility was an emotionally charged undertaking for all those involved. Interpretation Learning to use a power mobility device is a complex process that often requires perseverance and determination on the part of the child, family, and therapist. What this paper adds Powered mobility use impacts more than just a child's locomotor abilities. Learning to use a power mobility device is a highly individualized process. Learning to use powered mobility may be an emotionally charged process.

Purpose The purpose of this study was to describe occupational therapy weight-shifting practices and explore recommended strategies for patients, healthcare staff, and family/caregivers across healthcare settings. Design Cross-sectional survey. Subjects and setting Respondents included 97 currently practicing occupational therapists working in 5 main practice settings (ie, acute care, inpatient rehabilitation, outpatient rehabilitation, home and community care, and residential) from 9 out of 10 Canadian provinces. Methods We created a 25-item questionnaire that included forced choice and open-ended queries. Items queried demographic information, weight-shifting techniques taught to patients, frequency and duration of weight shifting recommended, educational approaches used to teach weight shifting, and resources used to guide decision making. Participants were recruited via professional organizations and health authorities across Canada. Participants were excluded if they were not currently working with manual or power wheelchair users. Descriptive statistics were used to analyze quantitative data, and content analysis was used for qualitative data (responses to open-ended queries). Results The most frequently recommended weight-shifting techniques were tilt (83.3%-92.8%), leaning to one side (47.9%-87.5%), and forward leaning (46.9%-83.3%). Study findings revealed a wide range of recommendations regarding frequency (every 10 minutes or less to >2 to 3 hours) and duration (≤30 seconds to as long as tolerated) of weight shifting. Weight-shifting interventions were most commonly guided by clinical experience (81.7%), practice guidelines (62.4%), and expertise of other team members (54.8%). Conclusions Results from this study highlight the need for further research to inform weight-shifting techniques and to build a more comprehensive understanding of weight-shifting education practices.

The principal aim of this study was to investigate whether a caregiver-inclusive assistive technology intervention improved older care recipients’ functional autonomy and decreased the perceived burden of their family caregivers compared to customary care. The study was a single-blind, mixed-methods, randomized controlled trial with baseline data collection and follow-ups at 6-, 22-, and 58-weeks after baseline evaluation, which was prospectively registered ( ClinicalTrials.gov Identifier: NCT01640470. Registered 11/21/2011). Dyads comprising a care recipient and family caregiver were randomly assigned to either a caregiver-inclusive experimental group (N = 44) or a customary-care comparison group (N = 46). Eligible care recipients were aged ≥55 years and had one or more limitations with mobility or daily activities, and family caregivers provided at least four hours per week of assistance. Outcome measures were administered to both groups at baseline and at the three follow-up time points. The data collectors were blinded regarding participants’ intervention group. The primary outcome measures were the Functional Autonomy Measurement System to assess care recipients’ functional performance, and the Caregiver Assistive Technology Outcome Measure to assess caregivers’ burden. Qualitative interviews examined participants’ perceptions of the caregiver-inclusive and customary care interventions. The experimental intervention addressed significantly more dyad-identified problematic activities, but caregiver involvement was evident in both groups and outcomes were not significantly different over time. In both groups, care recipients’ functional autonomy declined significantly (P

In order to promote self-determination, patients have to be actively involved with their care providers in health-care decision making, especially when such decisions involve personal preferences. Decision aids (DAs) are tools that can contribute to patient-centered decision-making processes. To benefit from previous fieldwork and avoid duplicating developmental efforts and producing many similar DAs, the adaptation of existing DAs to new cultural contexts is a resource-saving option. However, there are no guidelines on how to culturally adapt and validate DAs. This study aimed to identify and document existing procedures for the cultural adaptation and validation of patient DAs. A scoping review examined studies conducting cultural adaptation and/or validation of patient DAs. The following databases were searched in February 2016: CINAHL, EMBASE, Medline (Ovid), PASCAL, PsychINFO, and PubMed. From the 13 studies selected, 11 main procedures were identified: appraisal of the original DA, assessment of the new cultural context, translation, linguistic adaptation, cultural adaptation, usability testing, exploration of DA acceptability, test-retest reliability, content validity, construct validity, and criterion validity. A conceptual synthesis of these studies suggests there are four phases in the adaptation/validation process of DAs aimed at: 1) exploring the original DA and the new cultural context, 2) adapting the original DA to the new cultural context, 3) lab testing the preliminary version of the adapted DA, and 4) field testing the adapted DA in a real use context. By facilitating the adaptation and broader implementation of DAs, patients may ultimately be empowered in decision-making processes., Video abstract

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

A rear mounted, powered, drive wheel has been developed to assist with mobility for manual wheelchairs. The version tested operates in two modes (indoor and outdoor). To start in the indoor mode users must initiate propulsion with sufficient force to trigger the motor. To stop users must apply a braking force through the handrims. . The objectives of this study were to compare (1) the minimum force required to start a wheelchair with and without the drive, and (2) the distances and forces needed to stop a wheelchair at different treadmill speeds with and without the device. We used a crossover study design with 24 able-bodied persons. The main outcome measures were starting force single push speed, stopping distance, and stopping force. Participants did not have significantly increased starting force or single push speed using the drive. Participants had significantly shorter absolute stopping distance (p = 0.045 and reduced stopping force (p = 0.02) using the add-on at both treadmill speeds. Given the decreased stopping distances, the add-on may be a viable option for wheelchair users with limited upper limb strength.

Outdoor activities in natural settings have been found to be beneficial for overall health and well-being. However, people with disabilities may have different experiences accessing outdoor activities in natural settings. This research explored the experiences of users, volunteers, and staff, and perspectives of non-users about an adapted hiking program that uses a specialized mobility device called a TrailRider. The research had three objectives: 1. Describe the experiences of users, volunteers, and staff; 2. Identify perceived barriers to or limitations of participating for users, volunteers, staff, and non-users; and 3. Explore the impact of participation for users, volunteers, and staff.This ethnographic study used a combination of observations and in-depth interviews as a means of data collection.Researchers accompanied 38 participants on five hikes and conducted semi-structured interviews with 20 participants. Analysis identified three themes: "Let the Good Times Roll" described how TrailRider users and volunteers enjoyed the opportunity to explore the great outdoors. "An Uphill Battle" acknowledged perceived physical and psychological barriers to participation. "Clearing the Path" addressed potential areas for program improvement.This study emphasized how volunteers and users appreciated the outdoor and social opportunities the program afforded. The study identified a number of potential improvements that could be implemented to improve access to the program. Implications for Rehabilitation Outdoor recreation programs create positive experiences, as well as unique social opportunities for users and volunteers. Identifying and considering physical and psychological barriers would improve wilderness access for individuals with disabilities. Despite the fact that outdoor recreation programs, like the adaptive hiking program, are in place, deficient marketing and promotion limit users and volunteers from taking part.

Within the context of physical disability, participation has typically been conceptualized in terms of one's performance of different roles and activities. This perspective, however, ignores the meanings and satisfactions that a person derives from participating. Without an accepted conceptualization of participation that accounts for people's subjective perceptions and experiences, it is challenging for decision-makers and service providers to design meaningful participation-enhancing services, programs, and policies. Accordingly, our objectives were (1) to conduct a review of definitions and conceptualizations of participation that extend beyond performance and capture people's subjective experiences of participating and (2) to identify key experiential aspects of participation that can be used as a basis for conceptualizing and operationalizing the concept more broadly. The project involved a systematic, configurative review of relevant literature. Ten relevant articles were identified. Information on characteristics associated with experiential aspects of participation was extracted and subjected to a thematic analysis. The following 6 themes emerged: autonomy, belongingness, challenge, engagement, mastery, and meaning. Drawing on these findings, it is recommended that the individual's subjective perceptions of autonomy, belongingness, challenge, engagement, mastery, and meaning associated with participating be incorporated into conceptualizations and operationalizations of the participation construct. This recommendation provides a starting point for clinicians, researchers, and policymakers to conceptualize and measure the participation concept more consistently and more broadly.

Long-term care (LTC) residents with cognitive impairments frequently experience limited mobility and participation in preferred activities. Although a power wheelchair could mitigate some of these mobility and participation challenges, this technology is often not prescribed for this population due to safety concerns. An intelligent power wheelchair (IPW) system represents a potential intervention that could help to overcome these concerns. The purpose of this study was to explore a) how residents experienced an IPW that used three different modes of control and b) what perceived effect the IPW would have on their daily lives.We interviewed 10 LTC residents with mild or moderate cognitive impairment twice, once before and once after testing the IPW. Interviews were conducted using a semi-structured interview guide, audio recorded and transcribed verbatim for thematic analyses.Our analyses identified three overarching themes: (1) the difference an IPW would make, (2) the potential impact of the IPW on others and (3) IPW-related concerns.Findings from this study confirm the need for and potential benefits of IPW use in LTC. Future studies will involve testing IPW improvements based on feedback and insights from this study. Implications for rehabilitation Intelligent power wheelchairs may enhance participation and improve safety and feelings of well-being for long-term care residents with cognitive impairments. Intelligent power wheelchairs could potentially have an equally positive impact on facility staff, other residents, and family and friends by decreasing workload and increasing safety.

Background. Powered-wheelchair use improves participation for people with mobility limitations; however, many individuals do not receive powered-wheelchair skills training that meets their learning needs. Purpose. The aim of this work is to evaluate the feasibility of a powered-wheelchair training program for older adults with cognitive impairment, using errorless learning strategies facilitated by shared control technology. Method. A feasibility 2 × 2 factorial randomized controlled trial will recruit 32 older adults in residential care with mild to moderate cognitive impairment who are new powered-wheelchair use. The intervention consists of six or 12 training sessions, facilitated by shared control technology, using errorless learning techniques. Control participants will receive six or 12 training sessions using trial-and-error methods. Feasibility and clinical outcomes data (primary outcome: powered-wheelchair skills) will be collected. Implications. Errorless learning facilitated by shared control technology may be an alternative to meet the powered-wheelchair learning needs of older adults with cognitive impairments.

This paper presents a systematic literature review on the impact of the neighborhood physical environment on mobility and social participation among people using mobility assistive technology (MAT). Peer-reviewed articles from eight databases published in French or English from 1990 to 2016 were searched. Thirty studies were included in this review. Factors related to neighborhood environmental features, mobility in transit, and accessibility of homes and public buildings influenced mobility and social participation of MAT users. The majority of reviewed studies combined different types of MAT, which made the interpretation of the results challenging. Few studies included walker, cane, and crutch users. Definitions of mobility and social participation lacked consistency and were often simplistic. Future empirical research needs to examine the impact of neighborhood physical environment factors separately for different MAT users. Causality and links between mobility and social participation of different MAT users at the neighborhood level should be further explored.

Background Mobility impairments are the third leading cause of disability for community-dwelling Canadians. Wheelchairs and scooters help compensate for these challenges. There are limited data within the last decade estimating the prevalence of wheelchair and scooter use in Canada. Objective The aims of this study were: (1) to estimate the prevalence of wheelchair and scooter use in Canada and (2) to explore relevant demographic characteristics of wheelchair and scooter users. Design This study was a secondary analysis of a cross-sectional national survey. Methods The Canadian Survey on Disability (2012) collected data on wheelchair and scooter use from community-dwelling individuals aged 15 years and over with a self-identified activity limitation on the National Household Survey. Prevalence estimates were calculated as weighted frequencies, with cross-tabulations to determine the number of wheelchair and scooter users in Canada, by province, and demographic characteristics (ie, age, sex) and bootstrapping to estimate the variance of all point estimates. Results There were approximately 288,800 community-dwelling wheelchair and scooter users aged 15 years and over, representing 1.0% of the Canadian population. The sample included 197,560 manual wheelchair users, 42,360 powered wheelchair users, and 108,550 scooter users. Wheelchair and scooter users were predominantly women, with a mean age of 65 years. Approximately 50,620 individuals used a combination of 2 different types of devices. Limitations The results are representative of individuals living in the community in Canada and exclude individuals in residential or group-based settings; estimates do not represent the true population prevalence. Conclusion This analysis is the first in more than 10 years to provide a prevalence estimate and description of wheelchair and scooter users in Canada. Since 2004, there has been an increase in the proportion of the population who use wheelchairs and scooters, likely related to an aging Canadian population. These new prevalence data have potential to inform policy, research, and clinical practice.

RÉSUMÉLes technologies de surveillance nouvelles, telles que celles inclus dans le logement avec assistance ambiante—les capteurs environnementaux portés sur le corps, les interfaces intelligentes, et les réseaux de communication—sont en cours d'élaboration afin d'améliorer la sécurité et la sûreté des personnes âgées qui sont à risque, mais des questions éthiques ont été soulevées quant à dans quelle mesure ils compromettraient les droits et la vie privée des personnes à surveiller. L'étude qualitative que nous avons mené a été conçu pour nous aider à comprendre les façons dont ces technologies de surveillance nouvelles seraient influencer les expériences quotidiennes des individus de leur maison. Les participants ont estimé que de nouvelles formes de surveillance auraient une influence sur leur sentiment de sécurité, de l'autonomie et de la confiance en soi, et modifieraient leurs perceptions chez soi. Les résultats soulignent la nécessité d'améliorer notre compréhension de la façon dont le logement assisté ambiant affectera la vie des personnes à surveiller.

Loneliness and depression are serious mental health concerns across the spectrum of residential care, from nursing homes to assisted and retirement living. Psychosocial care provided to residents to address these concerns is typically based on a long-standing tradition of ‘light’ social events, such as games, trips, and social gatherings, planned and implemented by staff. Although these activities provide enjoyment for some, loneliness and depression persist and the lack of resident input perpetuates the stereotype of residents as passive recipients of care. Residents continue to report lack of meaning in their lives, limited opportunities for contribution and frustration with paternalistic communication with staff. Those living with dementia face additional discrimination resulting in a range of unmet needs including lack of autonomy and belonging—both of which are linked with interpersonal violence. Research suggests, however, that programs fostering engagement and peer support provide opportunities for residents to be socially productive and to develop a valued social identity. The purpose of this paper is to offer a re-conceptualization of current practices. We argue that residents represent a largely untapped resource in our attempts to advance the quality of psychosocial care. We propose overturning practices that focus on entertainment and distraction by introducing a new approach that centers on resident contributions and peer support. We offer a model—Resident Engagement and Peer Support (REAP)—for designing interventions that advance residents' social identity, enhance reciprocal relationships and increase social productivity. This model has the potential to revolutionize current psychosocial practice by moving from resident care to resident engagement.

Background One in five men will experience an osteoporosis-related fracture in their lifetime. However, osteoporosis is widely perceived as a women's disease and few studies focus specifically on men. Our objective was to identify qualitative evidence to understand men's perceptions of osteoporosis and fracture. Methods We conducted a systematic review following standardized guidelines. We identified qualitative studies that included men aged 18 years and over using the terms: osteoporosis, fragility or low-trauma fracture, bone health; and perceptions or experiences with osteoporosis and fractures. We appraised the quality of data and used a meta-aggregative approach to synthesize findings. Results We identified four publications, based on three studies (n = 61 participants); one of the publications was a secondary analysis. The following themes were developed from the literature: (1) perceived healthcare gap for men; (2) strong focus on women, with a need for support from spouses and health professionals; and (3) three general responses to men's osteoporosis self-management: limiting lifestyle, minimizing importance of diagnosis, and risk taking. Conclusions The most striking finding from this review was the lack of available qualitative evidence. However, it emerged that the present focus of osteoporosis as a women's disease may influence how men develop self-management strategies. These data highlight the need to include men in future osteoporosis health-related conversations and interventions. Systematic review registration CRD42018093999.

Background: Most people with spinal cord injury will develop secondary complications with potentially devastating consequences. Self-management is a key prevention strategy for averting the development of secondary complications and their recurrence. Several studies have shown that self-management programs improve self-management behaviors and health outcomes in individuals living with chronic conditions such as asthma, diabetes, hypertension, and arthritis. Given the burgeoning health care costs related to secondary complications, we developed an alternative electronic health–based implementation to facilitate the development of self-management skills among people with spinal cord injury. Objective: This study aims to evaluate the efficacy of a self-management app in spinal cord injury populations. The primary outcome is attainment of self-selected, self-management goals. Secondary outcomes include increases in general and self-management self-efficacy and reductions in self-reported health events, health care utilization, and secondary complications related to spinal cord injury. This study also aims to explore how the intervention was implemented and how the app was experienced by end users. Methods: This study will employ a mix of qualitative and quantitative methods. The quantitative portion of our study will involve a rater-blinded, randomized controlled trial with a stepped wedge design (ie, delayed intervention control group). The primary outcome is successful goal attainment, and secondary outcomes include increases in self-efficacy and reductions in self-reported health events, health care utilization, and secondary conditions related to spinal cord injury. The qualitative portion will consist of semistructured interviews with a subsample of the participants. Results: We expect that the mobile self-management app will help people with spinal cord injury to attain their self-management goals, improve their self-efficacy, reduce secondary complications, and decrease health care utilization. Conclusions: If the results are positive, this study will produce credible new knowledge describing multiple outcomes that people with spinal cord injury realize from an app-based self-management intervention and support its implementation in clinical practice. Trial Registration: ClinicalTrials.gov NCT03140501; http://clinicaltrials.gov/ct2/show/NCT03140501 (Archived by WebCite at http://www.webcitation.org/73Gw0ZlWZ) International Registered Report Identifier (IRRID): PRR1-10.2196/11069

Background: Advances in wearable robotic technologies have increased the potential of these devices for rehabilitation and as assistive devices. However, the utilization of these devices is still limited and there are questions regarding how well these devices address users’ (therapists and patients) needs. Objective: The aims of this study were to (1) describe users’ perceptions about existing wearable robotic devices for the upper extremity; (2) identify if there is a need to develop new devices for the upper extremity and the desired features; and (3) explore obstacles that would influence the utilization of these new devices. Methods: Focus groups were held to collect data. Data were analyzed thematically. Results: A total of 16 participants took part in the focus group discussions. Our analysis identified three main themes: (1) “They exist, but...” described participants’ perceptions about existing devices for upper extremity; (2) “Indeed, we need more, can we have it all?” reflected participants’ desire to have new devices for the upper extremity and revealed heterogeneity among different participants; and (3) “Bumps on the road” identified challenges that the participants felt needed to be taken into consideration during the development of these devices. Conclusions: This study resonates with previous research that has highlighted the importance of involving end users in the design process. The study suggests that having a single solution for stroke rehabilitation or assistance could be challenging or even impossible, and thus, engineers should clearly identify the targeted stroke population needs before the design of any device for the upper extremity. [JMIR Rehabil Assist Technol 2018;5(1):e12]

1) To investigate how much training manual wheelchair users perceive is required to learn to use a rear-mounted power assist safely and confidently. 2) To evaluate how the power assist affected wheelchair users' ability to negotiate a standardized obstacle course, wheelchair skills capacity and wheelchair mobility confidence.This study used a pre- versus post-test intervention design. Outcome measures included a standardized obstacle course, and modified versions of the Wheelchair Skills Test 4.2 (WST) and the Wheelchair Confidence Measure.The 11 participants felt safe and confident using the power assist within one to two training sessions. However, some potential safety concerns were noted. Participants performed two obstacle course tasks significantly more quickly with the power assist.Participants felt safe using the device with limited training and the device facilitated some mobility task performance. Further research is needed to understand the outcomes of long-term, community use. Implications for Rehabilitation Most experienced wheelchair users wanted only one or two training sessions with a new rear mounted power assist device; however, some safety concerns were noted. The device did not appear to affect user's confidence. The device enabled users to perform some mobility tasks more quickly and allowed some users to perform some mobility tasks they were unable to perform in their regular MWC.

Background Mobility scooters can facilitate community participation among individuals with mobility limitations. However, accidents are a serious concern with scooter use. Scooter training has been recommended to improve safety, but there are currently few validated programs available. Therefore, we developed a Systematic, Comprehensive, One-to-One Training (SCOOT) program for scooter users. We will conduct a study to evaluate the outcomes produced by the provision SCOOT. Methods This feasibility study will use a mixed-methods, rater-blinded, randomized control trial, with a two-step wedge design. The study has two arms: an immediate intervention group, which will receive the intervention directly after baseline assessments, and a delayed intervention group, which will receive the intervention after a 6-week period. Forty participants, who will be stratified based on whether or not participants have previously held a driver’s license, will be randomly assigned to each arm. The intervention for this study consists of 6 weeks of one-to-one scooter training by an experienced occupational therapist, who will provide training once or twice per week over the 6 weeks. The primary outcome measure is subjective scooter skills, measured using the Wheelchair Skills Test for scooters. Secondary outcomes include objective scooter skills, confidence, mobility, and satisfaction with selected participation activities. Descriptive measures include cognitive status, functional status, hearing, vision, physical accessibility of the home and community, and visual attention and task switching. Qualitative interviews will be conducted with the first ten willing participants from each group to learn about their scooter use and experiences with SCOOT. Discussion The results of this study will inform a larger randomized control trial. If the intervention is proven to be effective in this larger study, it may have important implications for policy and practice. Trial registration ClinicalTrials.gov identifier: NCT02696213. Registered on 23 February 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1963-y) contains supplementary material, which is available to authorized users.

(1) Describe trends in time to rehabilitation admission and rehabilitation length of stay (LOS), (2) compare functional independence at discharge from rehabilitation between patients who arrived directly from acute care versus those from elsewhere and (3) identify independent predictors of functional outcomes following rehabilitation.Traumatic brain injuries rehabilitation unit of King Fahad Medical City, Riyadh, Saudi Arabia.We collected information on time from injury to rehabilitation admission, rehabilitation LOS, functional independence measure (FIM) score (admission and discharge) and demographic variables for 66 patients who arrived to rehabilitation from acute care and 142 patients who arrived from elsewhere. A mixed model analysis of variance measured change in FIM score between groups. Hierarchical regression was employed to investigate variables associated with FIM score at rehabilitation discharge.Patients arriving directly from acute care had a time from injury to rehabilitation admission 1/3 that of, and a higher discharge FIM score than, patients arriving from elsewhere. For the latter group, increasing time from injury to rehabilitation admission was associated with lower rehabilitation discharge FIM score.Reducing time from injury to rehabilitation admission and promoting enrolment to inpatient traumatic brain injury rehabilitation directly from acute care may improve functional outcome at discharge from rehabilitation.

To investigate the score distribution, reliability, and validity of the objective Wheelchair Skills Test (WST) for scooter users.A study using a test-retest design was conducted with 20 people who had mobility limitations that prevented them from ambulating more than one city block without a mobility aid, and who had owned a scooter for ≥3 months. Objective scooter skills, confidence, and physical accessibility were measured at both time points, while anxiety, depression, visual attention and task switching, functional independence, and visual acuity were measured only at baseline.The mean total WST scores at Time 1 and Time 2 were 86.3% and 87.5%. The WST ICC was 0.889. The WST had a SEM of 2.50 and a Cronbach's alpha of 0.74. The total WST scores were significantly correlated with total subjective WST-Q scores (r = 0.547, p = 0.013), scooter confidence (r = 0.466, p = 0.038), and were affected by gender (p = 0.005).The WST for scooters has good test-retest reliability and generally varies as anticipated with other measures. Although further study is needed, the WST for scooters appears to have promise for use in research and clinical practice. Implications for Rehabilitation It is important to understand the measurement properties of the tools we use in rehabilitation so the results can be interpreted correctly. As scooter use increases, better measurement of skills is required.

Caregiver burnout is a serious concern among informal caregivers, especially for those who provide care to individuals with more severe limitations such as power mobility users. The Power Wheelchair Caregiver Assistive Technology Outcome Measure tool measures device specific and overall burden experienced by informal caregivers of power mobility users. A one-month, test-retest study was conducted to examine the reliability, internal consistency, and construct validity of the Power Wheelchair Caregiver Assistive Technology Outcome Measure. Two construct validity measures were administered: the Hospital Anxiety and Depression Scale and the Late Life Disability Index. The test-retest-reliabilities of part 1 (power wheelchair specific burden) and part 2 (general caregiving burden) were 0.769 and 0.843 respectively. Scores on part 1 were moderately and positively correlated with part 2 and with frequency of participation. Scores on part 2 were moderately and negatively correlated with anxiety, depression, and positively with perceived limitation of participation. The strength and direction of these correlations provide support for the construct validity of the measure and suggest part 1 and part 2 provide complementary information. Further testing is needed to assess the clinical utility and responsiveness of the measure.

Importance: The ScanCourse is used by occupational therapists to evaluate visual scanning ability during locomotion. Its measurement properties have not been examined. Objective: To assess the interrater reliability, test–retest reliability, and construct validity of the ScanCourse. Design: This study involved data collection at two time points. To assess test–retest reliability, the ScanCourse was administered twice within a 2-week period. To assess interrater reliability, a second rater was present for one session. To assess level of agreement, a Bland–Altman plot was created. To assess absolute reliability, the standard error of measurement was calculated. To evaluate construct validity, the results of the ScanCourse were compared with results of the Bells Test and Trail Making Test A and B. Setting: Rehabilitation hospital. Participants: Forty-one patients with neurological impairments. Outcomes and Measures: The ScanCourse (participants identify numbered cards placed on both sides of a hallway at various heights during locomotion). Results: The ScanCourse was found to have excellent interrater reliability (intraclass correlation coefficient [ICC] [1,1] = .998; 95% confidence interval [CI] [.996–.999]), test–retest reliability (ICC [1,1] = .912; 95% CI [.811–.959]), a high level of agreement, and a low standard error of measurement (.503), and it was found to be significantly correlated with Trails A (rs = −.436, p = .009) and B (rs = −.364, p = .029). Conclusions and Relevance: The assessment was found to have strong measurement properties, and it is therefore an appropriate tool for assessing dual-task visual scanning among those with neurological impairments. What This Article Adds: This research demonstrates that the ScanCourse is reliable between raters and over time and that scores on the measure vary as anticipated with scores on a related measure, which provides evidence of its validity. These findings support its use in practice.

Importance: Occupational therapists frequently assess the fitness to drive of people with visual field impairment, but the relationship between these assessments and driving performance over time is not well understood. Objective: To determine traffic violation and crash incidence over a 1-yr period for drivers with visual field impairment. Design: Retrospective review of medical and driving records. Setting: British Columbia, Canada. Participants: Participants (N = 445) were ages 26–74 yr with binocular, corrected visual acuity of ≥20/50. Goldmann visual field tests were reviewed to stratify participants on the basis of visual field impairment and whether impairments exceeded licensing standards. Outcome and Measures: Traffic records were reviewed to determine group-specific traffic violations and crash incidence during the year after the visual field test. Results: Of 445 participants, 292 held a valid driver’s license during the designated period. Participants not meeting the licensing standards were less likely to become licensed than participants who met the standards. The results indicate that drivers with visual field impairment did not have a higher probability of crashes or violations than drivers without visual field impairment. Conclusion: Drivers with visual field impairment who retained a driver’s license did not have an increased probability of crashes in the following year. A larger, prospective, mixed methods study of long-term driving behaviors among people with visual field impairment is recommended. What This Article Adds: This study provides preliminary data on the 1-yr incidence of traffic violations and crashes among people with visual field impairment.

Background: Many community-dwelling individuals living with a disability use mobility assistive technologies (MATs). MAT devices are generally beneficial for individuals with mobility impairments. However, less is known about the specific factors that may foster or deter mobility and community participation. Objective: The purpose of this protocol is to describe the methodology for a study including three main objectives: (1) to understand the places people using MAT go and the things they do, (2) to identify perceived barriers and facilitators as well as users’ desired environmental modifications, and (3) to understand subjective and objective issues related to environmental accessibility. Methods: A mixed-methods study was conducted in Vancouver and in Quebec City. Qualitative interviews were conducted to address all three objectives. In addition, Objective 1 was achieved through collection of global positioning system (GPS) data and activity diaries with 36 participants per site who represented six types of MAT users (ie, cane, walker, crutches, manual wheelchair, power wheelchair, and scooter). All participants were invited to take part in all aspects of data collection. PhotoVoice was used to address Objectives 2 and 3. Two environmental audits were used to address Objective 2. The Stakeholders’ Walkability/Wheelability Audit in Neighbourhood (SWAN) measured perceptions related to a variety of community environmental features associated with mobility and participation. A total of 24 participants were recruited to each study site for SWAN data collection. The Measure of Environmental Accessibility (MEA) was also used to objectively measure access to exterior and interior environments selected earlier in the project by the participants that could benefit from improvements. Results: Funding for this study was obtained from the Social Sciences and Humanities Research Council of Canada. Approval was obtained from the University of British Columbia Research Ethics Board and the Centre integre universitaire de sante et de services sociaux de la Capitale-Nationale Research Ethics Board. Regarding the MEA evaluations, 19 locations (ie, buildings and exterior spaces) where obstacles have been identified by the participants of the PhotoVoice focus groups have been evaluated in Quebec City and 20 locations have been identified in the Vancouver region by the participants of the community forums. Data collection for this project was completed in December 2018. Analysis and writing of manuscripts are underway. Conclusions: The use of a variety of methods to gather data on participation and mobility will allow a more holistic consideration of factors influencing mobility with a MAT device. This study will provide objective information about the mobility of participants and identify barriers and facilitators that impact their mobility and community participation. Through the mixed-methods approach employed in this study, we will gain a subjective evaluation of the participants’ neighborhoods, including personally meaningful information on environmental features that influence participants' everyday mobility and participation. We will also gain an objective evaluation of particular obstacles that community users of MAT identify as significant barriers to their ability to access public environments. We anticipate that these findings will help to identify a broad spectrum of solutions to improve the mobility and community participation of MAT users. International Registered Report Identifier (IRRID): DERR1-10.2196/12089