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Objective To examine the trajectory of the Rating of Everyday Arm-use in the Community and Home (REACH) scores over the first-year post-stroke, determine if REACH scores are modified by baseline impairment level and explore the responsiveness of the REACH scale through hypothesis testing. Design Consecutive sample longitudinal study. Setting Participants were recruited from an acute stroke unit and followed up at three, six, and 12 months post-stroke. Participants Seventy-three participants with upper limb weakness (Shoulder Abduction and Finger Extension score ≤ 8). Main Measures The REACH scale is a six-level self-report classification scale that captures how the affected upper limb is being used in one's own environment. The Fugl-Meyer Upper Limb Assessment (FMA-UL), Stroke Upper Limb Capacity Scale (SULCS), accelerometer-based activity count ratio and Global Rating of Change Scale (GRCS) were used to capture upper limb impairment, capacity, and use. Results The following proportions of participants improved at least one REACH level: 64% from baseline to three months, 37% from three to six months and 13% from six to 12 months post-stroke. The trajectory of REACH scores over time was associated with baseline impairment. Change in REACH had a moderate correlation to change in SULCS and the GRCS but not FMA-UL or the activity count ratio. Conclusions Results of hypothesis testing provide preliminary evidence of the responsiveness of the REACH scale. On average, individuals with severe impairment continued to show improvement in use over the first year, while those with mild/moderate impairment plateaued and a small proportion decreased in the early chronic phase.

ObjectiveThe objective of this scoping review was to identify the modifiable factors that impact the health and quality of life (QOL) of community-dwelling people with spinal cord injury (SCI).MethodsEmpirical journal articles were identified using three academic databases: CINAHL Complete, MEDLINE with Full Text, and PsycINFO. Full-text journal articlesincluded studies of participants who were community-dwelling with traumatic or nontraumatic SCI and were over the age of 18 years without cognitive impairment; published between 2000 and 2021; focused on modifiable factors impacting health and QOL; and conducted inAustralia, Europe, orNorth America. A data table was used to extract article information including authors, year of publication, country, sample, design and methods, purpose/objectives, and main findings. Qualitative data analysis software was used to categorize major findings inductively through content analysis.ResultsThirty-one peer-reviewed articles consisting of qualitive, quantitative, and mixed-methods study design were included. This scoping review revealed modifiable factors that impact the health and QOL of community-dwelling people with SCI: sociostructural factors (social attitudes, health care access, information access, and funding and policies) and environmental factors (built environment, housing, transportation, assistive technology, and natural environment).ConclusionFuture research should examine the influence of the modifiable factors on health and QOL using qualitative inquiry, adopting a community-based participatory research approach, and considering the implications of individual characteristics and resources.

To explore the experiences of new motorised mobility scooter users from the perspectives of the assessment and training of scooter skills.Descriptive secondary analysis of qualitative data.Community.20 New users of motorised mobility scooters.Not applicable.Directed qualitative analysis of up to four semi-structured interviews over the course of the first year of scooter use, to identify themes and sub-themes that could inform recommendations regarding assessment and training protocols.We identified two themes. The first related toThe experiences of scooter users over the first year of receiving a scooter appear to be relevant to the assessment and training of scooter skills and suggest themes for further study.

Background Our research team developed a mobile application (app) to facilitate health-related self-management behaviors for secondary conditions among individuals with spinal cord injury (SCI). To facilitate mobile app adoption and ongoing use into the community, it is important to understand potential users’ expectations and needs. Objectives The primary objective of this study was to explore user expectations of a mobile app intervention designed to facilitate self-management behavior among individuals with SCI. Methods Data were collected via one-on-one, semi-structured interviews with a subsample of 20 community-dwelling participants enrolled in a larger, clinical trial. Analysis of the transcripts was undertaken using a six-phase process of thematic analysis. Results Our analysis identified three main themes for expectations of the mobile app intervention. The first theme, desiring better health outcomes, identified participants’ expectation of being able to improve their psychological, behavioral, and physical health outcomes and reduce associated secondary conditions. The second theme, wanting to learn about the mobile app’s potential, identified participants’ interest in exploring the functionality of the app and its ability to promote new experiences in health management. The third theme, desiring greater personal autonomy and social participation, identified participants’ desire to improve their understanding of their health and the expectation for the app to facilitate social engagement with others in the community. Conclusion By exploring end-users’ expectations, these findings may have short-term effects on improving continued mobile health app use among SCI populations and long-term effects on informing future development of mobile app interventions among chronic disease populations.

Objective We conducted an intersectional analysis to explore how demographic characteristics and mobility device use were associated with psychological distress (depression and anxiety) and confidence negotiating physical and social environments. Design Cross-sectional data were collected using the Hospital Anxiety and Depression Scale, modified Wheelchair Use Confidence Scale and self-reported functional independence scale. Participants The sample included 105 participants. Primary mobility devices used included mobility scooters (27%), power wheelchairs (26%), manual wheelchairs (25%), walkers (11%), and cane or crutch (12%). The mean age of participants was 58 years, 53% were female, 52% lived alone and were functionally independent with the use of assistive technology. Results We were able to explain between 39% and 65% of the variance (adjusted R2) in the dependent variables with parsimonious regression models. Age was an independent predictor of all outcomes. Women were less confident negotiating the physical environment, and walker use was associated with depression and lower confidence negotiating physical environments, but increased confidence negotiating social environments. Conclusions Age is associated with psychosocial outcomes for assistive device users and those who use walkers may experience increased challenges with depression and negotiating the physical environment. Pending confirmatory research, the findings may have important implications for targeted interventions related to device provision.

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.

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.

Wheelchair users typically receive little training about wheelchair maintenance. Therefore, we developed a peer-led, manual wheelchair skills maintenance training programme, with the intention of evaluating its efficacy in a future experimental study.The purpose of this feasibility study was to examine how well we were able to implement the training programme and to evaluate the feasibility of conducting a larger scale clinical trial.Spinal cord injury research centre.Five mentors and fifteen mentees were recruited to complete this feasibility study.We collected information about recruitment capability and sample characteristics, data collection procedure, acceptability of the training programme, resources required, and participants' responses to the intervention. Participants completed all the items and we had little missing data. Participants did not face any difficulty answering the questionnaires or performing the tests. Therefore, we could conclude data collection was feasible moving forward to perform larger efficacy trials. The acceptability of the wheelchair maintenance programme was more than 90%. There was a statistically significant improvement in wheelchair maintenance knowledge test and total rolling resistance. Confidence of mentees increased significantly after the training. Improvements in the 3-cone test and the 6-min push test results were not significant.If recruitment and scheduling challenges can be overcome, our data suggested that it is feasible to conduct a larger experimental study to test the efficacy of the programme.Implications for RehabilitationWheelchair maintenance skills are important to help wheelchair users keep their wheelchairs working safely and efficiently.The findings from this study suggest that a peer-led wheelchair maintenance training programme may improve participants' wheelchair maintenance knowledge and maintenance self-confidence.The study also suggests that a peer-led wheelchair maintenance training programme may decrease the rolling resistance of participants' wheelchairs.A larger clinical trial is needed to demonstrate the efficacy of this intervention authoritatively.

Nerve transfer surgery has the potential to restore upper limb function in patients with spinal cord injury (SCI); however, there has been limited exploration of patient perception of nerve transfer.To explore the perspectives of patients with chronic SCI (2 years from injury) on nerve transfer surgery, and to determine if an educational intervention improved participants' perceived knowledge levels about the procedure.Mixed-methods study including qualitative semi-structured interviews and self-reported rating scales. Pre- and post-interviews were completed following an educational presentation.Two local SCI clinics.Ten patients with chronic traumatic SCI and neurological level of injury C3-C7 (motor complete or incomplete), recruited via snowball sampling (six male, four female).An educational slide presentation on nerve transfer concepts.The primary study outcome measure is the participants' responses to interview questions. The secondary study outcome measure is their self-reported knowledge levels of nerve transfer before and after education.Regaining upper limb function was a priority for all participants. Although most participants had heard of nerve transfer, none were offered it at the time of their SCI, and only two stated that they had any peers who had undergone the procedure. The educational module significantly increased self-rated scores on understanding of nerve transfer (p .05). Although all participants were open to nerve transfer after the educational module, they described weighing different factors, including (1) potential for loss versus gain of function, (2) inadequate knowledge about nerve transfer, (3) recovery time, and (4) determining their eligibility for the surgery.These findings suggest that people with SCI have limited understanding of nerve transfer as a potential option and would benefit from educational opportunities to help them make informed decisions. This study may inform the development of patient resources to improve pre-surgical consultation and informed decision-making.

Background As eHealth technologies become a more prevalent means to access care and self-manage health, it is important to identify the unique facilitators and barriers to their use. Few studies have evaluated the use or potential use of eHealth technologies in spinal cord injury (SCI) populations. Objectives The primary objective of this study was to explore and identify barriers and facilitators to engagement with eHealth technologies among individuals with SCI. Methods A qualitative descriptive study was conducted. Data were collected via one-on-one, semi-structured interviews with a subsample of 20 community-dwelling participants enrolled in a larger clinical trial. Analysis of the transcripts was undertaken using a four-phase process of content analysis. Results Our analysis identified three barriers to engagement with eHealth technologies, including (1) overcoming a digital divide to comprehending and utilizing eHealth technologies, (2) navigating internet resources that provide too much information, and (3) interacting with these technologies despite having limited hand function. Our analysis also identified three facilitators to using eHealth technologies, including (1) having previous successful experiences with eHealth technologies, (2) being able to use voice activation features, and (3) being able to interact in an online community network. Conclusion By exploring barriers and facilitators to eHealth technology use, these findings may have a short-term impact on informing researchers and clinicians on important factors affecting engagement of individuals with SCI with telemedicine, mobile, and web applications (apps) and a long-term impact on informing future development of eHealth interventions and tools among chronic disease populations.

Objective The purpose of this study was to provide contemporary estimates of the prevalence of lower extremity motor impairment and walking limitation after first-ever stroke and to characterize the predictive nature of early walking ability for being discharged home after acute hospitalization. Methods In this cohort study, data were collected from a metropolitan acute care hospital in Canada at admission for 487 adults with first-ever acute ischemic or hemorrhagic stroke. Lower extremity motor impairment and walking limitation were measured using the National Institutes of Health Stroke Scale and AlphaFIM, respectively. Parallel multivariable logistic regression models were built to predict discharge home after acute hospitalization compared with further hospitalization. Results For patients surviving a first-ever stroke, 44.1% presented with some degree of lower extremity motor impairment and 46.0% were unable to walk. In a multivariable model built around a binary classification of walking (Nagelkerke R2 = 0.41), those with any ability to walk at admission (with or without therapist assistance) had 9.48 times greater odds of being discharged home (odds ratio = 9.48, 95% CI = 6.11–14.92) than those who were unable. In a parallel multivariable model built around an ordinal classification of walking (Nagelkerke R2 = 0.49), patients had 2.07 times greater odds (odds ratio = 2.07, 95% CI = 1.82–2.38) of being discharged home for each increment on a 6-point walking scale (total dependence to complete independence) assessed at acute admission. Conclusion Approximately one-half of patients with first-ever stroke present with lower extremity weakness and walking limitation. Early walking ability is a significant predictor of returning home after acute hospitalization, independent of stroke severity. Discharge planning may be facilitated early after stroke with the familiar assessment of walking ability. Impact An early assessment of walking function within days of stroke admission can help to streamline discharge planning. Lay Summary Nearly one-half of all individuals who experience a first-time stroke have walking difficulty when they arrive at the hospital. The severity of the walking limitation can predict whether a patient will eventually be discharged home or go on to further hospitalization.

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.

Objective To examine the change over 1 year in the burden, wheelchair skills, social support, social participation, and mental health of family caregivers providing assistance to older adult powered wheelchair users. Design Longitudinal study. Setting Community. Participants Participants (N=35) included family caregivers (mean age ± SD=63.7±10.2y) who provided at least 2 hours of general care per week for a powered wheelchair user. Intervention Not applicable. Main Outcome Measures The Power Mobility Caregiver Assistive Technology Outcome Measure (frequency of care and subjective burden), the Wheelchair Skills Test Questionnaire for caregivers (wheelchair skills), the Interpersonal Support Evaluation List-6 (social support), the Late-Life Function and Disability Instrument (social participation), the Hospital Anxiety and Depression Scale (mental health). Measures were taken at baseline, 1, 3, 6, and 12 months. Descriptive statistics were calculated, and a linear mixed model was used to assess changes over time in the outcomes. Results The results showed that the caregivers helped on average with 3 powered wheelchair-related activities and 10 other caregiving activities. They also experienced moderate subjective burden and social participation and were within the normal range for depression and anxiety. Moreover, those outcomes remained stable over the 1-year study period. However, the wheelchair skills scores showed significant changes over time, as the scores improved during the first 6 months of the study. Conclusion Given that previous research indicated that subjective burden tends to decline over time among caregivers, the findings of stability in this study may reflect increasing needs among this population of caregivers, who may benefit from additional support and interventions. This would need further consideration.

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.

Research Objectives People living with disabilities have been found to experience reduced participation during the COVID-19 pandemic. In order to inform interventions to improve physical activity and social participation in stroke survivors, we created personas to inform the design and development of products targeting stroke patients during life-changing events such as pandemics after stroke Design Persona development methodology using qualitative interview data. The personas were developed by mapping participants to behavioural variables identified from coded transcripts. After identifying behaviour patterns, characteristics and goals were synthesized. Setting Virtual-data collection via Zoom; community. Participants Community-dwelling individuals who have had a stroke (n = 26) were recruited. We included participants 19 years of age or older and if they were able to communicate in English. Participants were excluded if they had moderate or severe cognitive impairment or aphasia. Interventions N/A. Main Outcome Measures N/A. Results Our analysis identified 6 distinct personas that reflect participant behaviours and goals in regard to participation during COVID-19. 1) “The Community Provider” likes to feel involved and wants to engage in daily life. 2) “The Homebody” enjoys alone time but lacks a daily routine. This persona aims to feel motivated to accomplish personal goals. 3) “The Independent” seeks to be an active and integrated part of the community without physical or situational restrictions. 4) “The Lifestyle Person” wants to live the good life and do whatever they want, whenever they want. 5) “The Contributor” wants to feel needed and wants to be responsible for helping in the community. 6) “The Health-Literate Participator” wants to be on top of things and stay healthy for their family and themselves. Conclusions The personas highlight behaviours and goals in stroke patients towards physical activity and social participation during COVID-19. The personas will help guide the development of interventions to improve physical activity and social participation. The interventions will be developed based on the behaviours and goals of those living with stroke. Author(s) Disclosures N/A.

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.

The study had three main objectives. (1) To investigate the perceived impact of power-assist devices (PADs) on manual wheelchair (MWC) user mobility. (2) To compare perceptions about different types of PADs. (3) To identify preferred features and design characteristics of PADs. Semi-structured interviews were conducted with community-dwelling MWC users aged 31 years and older, with at least 2.5 years of experience using an MWC independently (n = 16). Data were thematically analysed using an inductive approach. Two main themes related to participants’ perceptions about the effects of PAD use were identified: (1) “Expanding my world”, which illustrated the perceived benefits of using PADs (e.g., gaining a sense of autonomy and access to new environments, maintaining physical health) and (2) “Falling short”, which described challenges with PADs (e.g., safety, reliability and portability issues). Participants also identified strengths and limitations of different types of PADs that were mainly related to specific user–device and device–environment interactions as well as various functional characteristics. Moreover, participants outlined their priorities for future PAD design, including improving controllability, customizability and affordability of these devices. Participants’ perceptions about PADs varied across different types of devices and in different contexts. However, PADs were generally perceived as enhancing the capabilities of MWCs. Our findings provide insight into the factors that can be considered when selecting a PAD and can inform the development of future PADs that are better equipped to overcome challenges that MWC users frequently encounter.Implications for RehabilitationPower-assist devices (PADs) for manual wheelchairs (MWCs) have the potential to improve the mobility, community participation and well-being of users.Some of the existing PADs have safety and reliability issues that affect their performance and limit their use by MWC users.The three types of PADs (front-mounted attachments, rear-mounted attachments, powered wheels) offer different types of assistance that can benefit users with various capabilities. Power-assist devices (PADs) for manual wheelchairs (MWCs) have the potential to improve the mobility, community participation and well-being of users. Some of the existing PADs have safety and reliability issues that affect their performance and limit their use by MWC users. The three types of PADs (front-mounted attachments, rear-mounted attachments, powered wheels) offer different types of assistance that can benefit users with various capabilities.

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).

Online decision support systems (DSS) may help older adults self-select assistive technology (AT) by offering recommendations. User interactions with DSSs may change the recommendations they receive. Objective: We evaluated recommendations stability and usability of an online DSS. Methods: Middle-aged and older adults (n = 43) were observed while using the DSS. The stability of DSS recommendations (ATs and advice) was compared between two time points, using a three-point scale: no, partial, or full agreement. Usability was coded, referencing ISO standards. Results: Half (51%) of participants received AT recommendations from the DSS in both sessions, with full (14%) or partial (12%) agreement. All but one participant received advice, and almost all of them had full (40%) or partial (56%) agreement between sessions. Many of the usability issues appear to be the result of the users inaccurately measuring their environment, challenges in understanding the questions being asked, and improperly making selections from the system. Discussion: Strict AT matching rules versus generic advice, and usability issues, likely reduced the matching rate and stability of AT recommendations. Conclusion: It appears that some users may require assistance with the system, and we suggest changes to the DSS format and content to improve stability and usability.

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.

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.

BACKGROUND People living in long-term care frequently have inadequate access to properly fitted wheelchairs. This can lead to potential problems with mobility, positioning, comfort, and skin integrity. A provincial programme to provide individually fitted lightweight wheelchairs to residents started in January 2016; however, no research has evaluated programme outcomes. OBJECTIVES To identify seating needs of residents before and after implementation of a provincial wheelchair programme at two long term care facilities in Vancouver and to explore stakeholders experiences with this programme. METHODS A pre/post study design was used which involved chart reviews to collect Seating Identification Tool (SIT), and interviews with stakeholders having experience with the provincial programme to gather information on their experiences. SIT data were analysed using a Wilcoxon Signed-Rank test and interviews were analysed thematically. FINDINGS SIT scores improved by 2 (median) which was statistically significant for the 22 residents with pre/post data available. Prevalence of seating needs decreased on average by 18%. Among the six stakeholders interviewed, themes identified included: wheelchairs/cushions provided addressed many residents' needs; and saved residents and their families money and stress; and there is still ongoing need for more specialised equipment for frail residents (not covered by this programme). CONCLUSION This study provides some evidence regarding the benefits of the introduction of this programme in two care homes and identifies potential changes that might improve wheelchair seating among residents with more severe seating needs. Further research is required on how these equipment changes might affect their mobility or participation in activities. Implications for rehabilitationThese findings appear to support the provision of lightweight individually fitted wheelchairs and moderate pressure redistribution cushions by occupational therapists in long-term care through this programme.Regular use of the SIT (i.e., on admission, condition change, annual care conference, and as needed) may be beneficial to ensure residents are properly screened for seating needs.Collaboration with the resident appears to be important to ensure equipment on provision and follow-up are meeting residents' needs.Recommend future research on the use of tilt in space wheelchairs for residents' in long-term care.

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.

Objective(s) The objective of this scoping review was to explore how community-dwelling people with spinal cord injury (SCI) cope and manage their health and functioning. Data Sources Peer-reviewed journal articles were selected using the following academic databases: CINAHL Complete, Medline with Full Text, and PsycINFO. Study Selection Full-text journal articles included if they were published after 2000, included participants with traumatic or non-traumatic etiology and who were over the age 18 without cognitive impairments, focused on coping and managing of health and functioning, and were conducted in either Australia, Europe, New Zealand, and North America. Data Extraction Using the methodological process of Levac, Colquhoun & O'Brien (2010), article information was extracted and collated into a data chart with the following headings: authors & year of publication, country, purpose/objectives, design and methods, findings, limitations, and synthesis. Major findings were then extracted and categorized via inductive content analysis using qualitative software. Data Synthesis 35 peer-reviewed articles consisting of quantitative, qualitative, mixed-methods, and non-empirical study design were included. Personal strategies include cognitive behaviors, autonomy, hope, religion, spiritualty, health behaviors, and leisure, whereas external resources consist of formal healthcare support, peer support, informal support, and technology. Conclusions Community-dwelling people with SCI cope and manage their health and functioning using a wide variety of personal strategies and external resources. Future empirical research should focus on the lived experience of coping and managing of health and functioning in the community setting. Author(s) Disclosures N/A

Research Objectives To describe the self-reported scooter-skill scores of new mobility scooter users and to identify significant correlations with other characteristics and measures. Design Survey, cross-sectional. Setting General community of Greater Vancouver, British Columbia, Canada. Participants Participants were a convenience sample of 22 new scooters users (with less than one-month experience using their devices) who were able to transfer in and out of a scooter independently. Interventions Not applicable. Main Outcome Measures Participants completed the Wheelchair Skills Test Questionnaire (WST-Q) Version 4.3 [1] for scooters users. It measures the users’ perceived capacity (what they can do), performance (what they actually do), and confidence (or self-efficacy). Participants completed standardized measures of cognition [2], hearing, vision [3], life space mobility[4], visual attention and task switching [5], and confidence negotiating the social environment [6] using their scooters. Their scooter skills were also measured objectively with the Wheelchair Skills Test (WST). Results Mean total WST-Q capacity scores were 83% and performance scores were 25%. WST-Q capacity scores were significantly positively correlated with WST-Q performance (r=0.321) and confidence scores (r=0.787), WST capacity scores (r=0.488), and confidence negotiating the social environment (r=0.463). WST-Q capacity scores were significantly negatively correlated with visual attention and task switching (r=-0.591) and age (r=-0.531). Conclusions Most correlations between WST-Q scores and other variables are similar to those found in studies of experienced scooters and power mobility device users. However, the gap between capacity and performance scores highlights the potential need for additional skills training in this population, which should be evaluated in future intervention studies. Author(s) Disclosures No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

Research Objectives To explore and identify how individuals with spinal cord injury (SCI) seek and critically evaluate online health information. Design Qualitative descriptive study. Setting This study was conducted in the general community setting. Participants Community-dwelling individuals with SCI were recruited across Canada. Participants had a mean age of 48 years; 12 participants were female, 8 participants experienced non-traumatic SCI. Interventions Not applicable. Main Outcome Measures Data were collected via one-on-one, semi-structured interviews with a sub-sample of 20 participants enrolled in a larger, clinical trial. Analysis of the transcripts was undertaken using a five-step process of thematic analysis. Results Our analysis identified four main themes that described how individuals with SCI seek and critically evaluate online health information. Themes included (1) using Google's search engine, (2) using health organization websites, (3) cross-referencing information found online, and (4) matching key words. Conclusions By identifying health information seeking strategies among individuals with SCI, these findings can inform researchers and clinicians on the existing ways with which this population utilizes internet-based resources for their health information seeking needs. Long-term, these findings can help guide future health literacy and eHealth literacy programs and interventions. Author(s) Disclosures We report no real or perceived conflicts of interest.

Research Objectives To explore the lived experiences of new mobility scooter users. Design Data were collected as part of a larger mixed-methods intervention study. Based on critical phenomenology1,2 each participant was interviewed multiple times before and after their scooter training. Examples of the questions included: What kind of problems do you have getting around currently (using manual wheelchair/walker/cane, if applicable)? How do you feel about using a manual wheelchair/power wheelchair/walker/cane? How do other people respond to you when you are using your scooter? Setting Metro Vancouver, British Columbia, Canada. Participants Participants were a convenience sample of 20 community dwelling, scooters users (with less than one-month experience using their devices) who were able to transfer in and out of a scooter independently. Interventions Not applicable. Main Outcome Measures Not applicable. Results The analysis revealed five themes. Transitioning to scooter use described how participants struggled to embrace scooters into their daily lives. Experiencing accessibility challenges revealed the challenges of navigating the outdoor and the indoor spaces in a scooter. Strategic and personalized use of devices for mobility illustrated how and why participants rely on other mobility devices. Navigating the social environment and being (un)seen demonstrated the stigma that participants experience from other people. Scooter appropriation over time revealed how participants see themselves and their use of scooters over time. Conclusions The experiences of new scooter users reflected the complexities of navigating the structural barriers and the challenges of integrating scooters into their lives3, 4, 5. The tension between the lived spaces and the scooters suggests that the design and specifications of some of these spaces do not meet the needs of modern wheeled mobility devices. Author(s) Disclosures There are no conflicts of interest for any author.

Objective(s) The objective of this scoping review was to examine the modifiable socio-structural and environmental factors that impact the health and quality of life (QoL) of community-dwelling people with spinal cord injury (SCI). Data Sources Empirical and non-empirical journal articles were identified using three academic databases: CINAHL Complete, Medline with Full Text, and PsycINFO. Study Selection Full-text journal articles were selected on four primary criteria: (i) publication date range: 2000-2020; (ii) study population: community-dwelling people with SCI with traumatic or non-traumatic etiology over the age of 18 without cognitive impairments; (iii) study focus: modifiable factors that impacted health and QoL; (iv) geographic region: Australia, Europe, and North America. Data Extraction Guided by the methodological process of Levac, Colquhoun & O'Brien (2010), a data table was used to extract article information including authors & year of publication, country, purpose/objectives, design and methods, findings, limitations, and synthesis. Qualitative data analysis software was subsequently used in the process of categorizing major findings inductively through content analysis. Data Synthesis 30 peer-reviewed articles consisting of qualitative, quantitative, and mixed method study design, as well as non-empirical studies were included. This scoping review revealed that modifiable socio-structural (social attitudes, access to healthcare, access to information, funding, and policies) and environmental factors (built-environment, housing, transportation, assistive technology, and the natural environment) impact the health and QoL of community-dwelling people with SCI. Conclusions The health and QoL of community-dwelling people with SCI is impacted by multiple modifiable socio-structural and environmental factors. Future research should examine the influence of the related regional/national policies and individual biopsychosocial characteristics and resources on modifiable factors, which impact health and QoL. Author(s) Disclosures N/A

Research Objectives To explore and identify barriers and facilitators to engagement with eHealth technologies among individuals with spinal cord injury (SCI). Design Qualitative descriptive study. Setting This study was conducted in the general community setting. Participants Community-dwelling individuals with SCI were recruited across Canada. The average age of the 20 participants was 48 years old; 8 participants were male, 12 participants experienced traumatic SCI. Interventions Not applicable. Main Outcome Measures Data were collected via one-on-one, semi-structured interviews with a sub-sample of 20 participants enrolled in a larger, clinical trial. Analysis of the transcripts was undertaken using a four-phase process of content analysis. Results Our analysis identified three main barriers and facilitators to engagement with eHealth technologies. Barriers included (1) overcoming a digital divide to comprehending and utilizing mHealth technologies, and (2) navigating internet resources that provide too much information, and (3) interacting with these technologies despite having limited hand function. Facilitators included (1) being able to use voice activation features, (2) being able to interact in an online community network, and (3) having previous successful experiences with eHealth technologies. Conclusions By identifying barriers and facilitators to eHealth technology use among people with SCIU, these findings may have short-term impacts on informing researchers and clinicians on important factors impacting engagement of individuals with SCI with telemedicine, mobile, and web apps, and long-term impacts on informing future development of eHealth interventions and tools among chronic disease populations. Author(s) Disclosures We report no real or perceived conflicts of interest.

Research Objectives To understand how pandemic related restrictions and regulations have affected older adults and people with disabilities we drew on Sen's Capabilities Approach (Sen, 1985; Venkatapuram, 2011) to explore their pandemic-related experiences. Design This qualitative description study (Sandelowski, 2000;2010) used interview data that were collected as part of a larger mixed-methods study. Interviews were transcribed verbatim and inductive analysis was informed by Sen's Capabilities Approach. Setting Teleconference. Participants We recruited community dwelling participants from four groups: people with spinal cord injuries (SCI) (n = 22), people who have experienced a stroke (n = 26), people with other disabilities (n = 13), and older adults (over the age of 65) without reported disabilities (n = 10). Interventions N/A. Main Outcome Measures N/A. Results Our analysis identified one overarching theme: “navigating the new normal” described the challenges and successes participants experienced in the face of pandemic-related recommendations, restrictions and regulations. The overarching theme encapsulated three sub-themes. 1) “Trying to stay connected” explored feelings of social isolation and strategies used to reduce feelings of loneliness. 2) “Worrying about the future” described the personal and societal uncertainties participants grappled with. 3) “Exerting control” emphasized how participants tried to deal with pandemic related restrictions that affected their daily activities and health management. Conclusions As has been found in previous survey research, pandemic restrictions appear to have exacerbated previously existing inequities experienced by some older adults and people with disabilities, as those who were disadvantaged prior to the pandemic, bore the brunt of restrictions (Drum et al., 2020). Greater consultation is needed to reduce detrimental effects of pandemic restrictions on these populations and promote strengths-based approaches to deal with the current situation and potential future pandemics. Author(s) Disclosures The authors have no disclosures.

Research Objectives To (1) evaluate general health and eHealth literacy levels among individuals with spinal cord injury (SCI) and (2) identify relationships between general health literacy, eHealth literacy, and sociodemographic factors. Design Survey, cross-sectional. Setting This study was conducted in the general community setting. Participants Fifty individuals with SCI were recruited across Canada. The average age of participants was 49 years old, 50% were male and 78% experienced traumatic SCI. Interventions Not applicable. Main Outcome Measures Online survey data were collected on participants’ general health literacy (using the Brief Health Literacy Screening Tool), eHealth literacy (using the eHealth Literacy Scale), and sociodemographic characteristics (e.g., age, sex, employment status). Results Participants demonstrated moderate levels of eHealth literacy (31.6 out of 40) and general health literacy (17.6 out of 20). A significant, positive correlation (95% C.I.) was found between eHealth literacy and general health literacy (r=0.28; p=0.03). A significant association (95% C.I.) was found between participants’ employment status (i.e., employed or unemployed) and eHealth literacy (t-stat = 0.12; p=0.01). Significant, positive correlations (95% C.I.) were found between general health literacy and sociodemographic factors, including income (r =0.32; p=0.04) and education (r=0.31; p=0.03). A significant, negative correlation (95%) was found between health literacy and time since injury (r=-0.31; p=0.03). A significant association (95% C.I.) was found between participants’ living arrangement (i.e., alone or not alone) and health literacy (t-stat = -2.23; p=0.01). Conclusions This study demonstrated the diverse range of eHealth literacy levels in SCI populations and how this, and other factors, may impact an individual's ability to self-manage and adopt to eHealth technologies. This study also demonstrates the need to be mindful of individuals with SCI who may have lower levels of eHealth literacy and health literacy, and how this can impact their engagement with eHealth technologies. Author(s) Disclosures We report no real or perceived conflicts of interest.

Research Objectives To explore psychosocial and quality of life outcomes between those injured early versus later in life. Design This study used a concurrent triangulation mixed-methods design. We collected quantitative data about participants’ sociodemographics and participants completed standardised questionnaires assessing personal factors, environmental factors, life habits, and quality of life. The transcripts were analysed thematically. Setting Community-based study. Participants We recruited individuals with SCI (> 55 years of age) who were either injured between the ages of 15 to 30 (n = 15) or after the age of 50 (n = 15). Interventions N/A. Main Outcome Measures Spinal Cord Independence Measure, Hospital Anxiety and Depression Scale, Late Life Disability Index, Craig Hospital Inventory of Environmental Factors, Life Space Assessment, World Health Organization Quality of Life-BRIEF version. Results We found no statistically significant differences between the two groups on any of the psychosocial outcomes. However, those injured later in life were significantly more likely to be female, have a higher income, and live in residential care. We identified three main qualitative themes that were consistent across the two groups: ‘dealing with health and changes in occupation’, ‘enacting independence’, and ‘living in the community’. Some sub-themes varied between groups. Conclusions To facilitate better rehabilitation, clinicians need to be aware of disparities among people with SCI relating to age of injury. Across age cohorts, it is important to increase independence, provide greater support when entering or returning to the workforce, and reduce societal stigma. Author(s) Disclosures The authors declare no conflicts of interest.

Research Objectives To explore what experiences individuals with spinal cord injury (SCI) have with internet-based health resources. Design Qualitative descriptive study. Setting This study was conducted in the general community setting. Participants Community-dwelling individuals with SCI were recruited across Canada. The average age of the 20 participants was 48 years old; 8 participants were male, 12 participants experienced traumatic SCI. Interventions Not applicable. Main Outcome Measures Data were collected via one-on-one, semi-structured interviews with a sub-sample of 20 participants enrolled in a larger, clinical trial. Analysis of the transcripts was undertaken using a five-step process of thematic analysis. Results Three overarching themes were identified regarding the experiences of individuals with SCI with internet-based resources. These themes included: (1) mistrusting health information available online, (2) filtering internet resources with help from others, and (3) connecting with others to promote social interaction. Conclusions By exploring the experiences individuals with SCI have with internet-based health resources, these findings can inform researchers and clinicians on how this population engages with telemedicine, mobile app, and web apps, while also guiding the development of future eHealth resources and technologies. Author(s) Disclosures We report no real or perceived conflicts of interest.

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.

Qualitative data from a mixed-methods clinical trial are used to examine caregivers' experiences with the selection and use of assistive technology to facilitate care recipients' independence. Through a thematic analysis of interviews from 27 caregivers, three broad themes were identified. "A partial peace of mind" described the generally positive psychological impacts from assistive technology, mainly reduced stress and a shift in caregiving labour from physical tasks to a monitoring role. "Working together" explored the caregivers' experiences of receiving assistive technology and the sense of collaboration felt by caregivers during the intervention process. Finally, "Overcoming barriers" addressed two impediments to accessing assistive technology: lack of funding and appointment wait times for service providers. The findings suggest that assistive technology provision by prescribers plays a beneficial role in the lives of caregivers, but access to such benefits can be hampered by contextual constraints. Implications for rehabilitation The study findings have a number of implications for rehabilitation practice: Family caregivers can be instrumental in determining what assistive technology is needed and then procured. Their involvement in the selection process is desirable because assistive technology may have both positive and negative impacts on them, and they themselves may use the devices chosen. Involving family caregivers as more active partners in the process of assistive technology provision may represent a greater time investment in the short term, but may contribute to better long-term outcomes for care recipients and caregivers as well. Limited access to funding and long appointment wait times are potential barriers to obtaining necessary assistive technologies.

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 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.

To evaluate the relation among the measures in a power wheelchair outcomes toolkit.We performed path analysis of cross-sectional data from self-report questionnaires and 1 objective measure.Six sites.A convenience sample of power wheelchair users (N=128). Most (n=69; 53.9%) participants were women. Multiple sclerosis and spinal cord injury/disease were the most common diagnoses.Not applicable.The power wheelchair version of the Wheelchair Skills Test version 4.1 was used to carry out an objective evaluation of capacity to perform 32 wheelchair skills. The Late-Life Disability Index measured frequency of participation in 16 life activities. The Life-Space Assessment measured independence, extent, and frequency of mobility. The Assistive Technology Outcomes Profile for Mobility was used to assess perceived difficulty performing activity and participation using assistive technology. The Wheelchair Use Confidence Scale for powered wheelchair users captured users' self-efficacy with wheelchair use.Wheelchair confidence was independently associated with less difficulty with activity (β=.028, P=.002) and participation (β=.225, P.001), increased life space (β=.095, P.003), and greater wheelchair skills (β=.30, P.001). Less perceived difficulty with activity was independently associated with increased frequency of participation (β=.55, P.001). Life-space mobility was independently associated with increased frequency of participation (β=.167, P.001). Less difficulty with participation was independently associated with greater life-space mobility (β=.59, P.001) and greater frequency of participation (β=.13, P.001).This study provides empirical support for the measures included as part of the power wheelchair outcomes toolkit. They appear to provide complementary information on a variety of constructs related to power wheelchair use.

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.

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.