Search

To measure if a knowledge-to-practice gap exists between desired practice and current practice in wheelchair assessment after the implementation of a new seating assessment tool at a university affiliated rehabilitation centre.A 6-month retrospective chart review of 61 wheelchair assessments was undertaken to determine if the assessment was consistent with a newly implemented and evidence-based seating assessment tool. Descriptive statistics were used to analyse the data to determine the degree of completion of the 69-item assessment and across 61 individual assessments.Of the 61 assessments reviewed, 69% were documented using the new seating assessment tool, 21% were documented using the previous seating assessment tool, and 10% were not documented on any seating assessment tool. Completion of the 69-item assessment tool was greater than 80% in 39% of the 61 assessments. The highest rates of completion were in the categories of patient information, clinical reasoning, and goals with an average completion of 73%, 71% and 65% respectively. The categories of linear measurements, mat assessment in supine, and postural alignment in wheelchair had the lowest average completion of 45%, 40% and 30% respectively.This chart review successfully identified and quantified areas of wheelchair assessment documented in adherence to current evidence-based guidelines, as well as gaps in assessment practice that should be addressed.Implication for rehabilitationCompletion of chart review is a simple tool to describe current practice and evaluate adherence to practice standards.Identifying practice gaps is an important first step in determining areas of focus in the improvement of clinical care.Ongoing support and monitoring is required in the development and implementation of evidence-based wheelchair assessment to ensure adoption in clinical practice.

Functional electrical stimulation therapy (FEST) is a state-of-the-art treatment for retraining motor function after neurological injuries. Recent literature suggests that FEST can be further improved with brain-computer interface (BCI) technology. In this case study, we assessed the feasibility of using BCI-triggered FEST (BCI-FEST) to restore upper limb function in a 57-yr-old man with severe left hemiplegia resulting from a stroke 6 yrs before enrollment in the study. The intervention consisted of two blocks of forty 1-hr BCI-FEST sessions, with three sessions delivered weekly. During therapy, a single-channel BCI was used to trigger the stimulation programmed to facilitate functional movements. The measure of the feasibility of the BCI-FEST included assessing the implementation and safety of the intervention. Clinical improvements were assessed using (a) Functional Independence Measure, (b) Action Research Arm Test, (c) Toronto Rehabilitation Institute - Hand Function Test, and (d) Fugl-Meyer Assessment Upper Extremity test. Upon completion of 80 therapy sessions, 14-, 17-, and 18-point changes were recorded on Action Research Arm Test, Fugl-Meyer Assessment Upper Extremity test, and Toronto Rehabilitation Institute - Hand Function Test, respectively. The participant also indicated improvement as demonstrated by his ability to perform various day-to-day tasks. The results suggest that BCI-FEST is safe and viable.

We present a case report consisting of a 64-year old man with chronic severe left hemiplegia who received an intervention to restore reaching movements using a brain-computer interface combined with functional electrical stimulation therapy. The brain-computer interface was designed to be triggered by power decreases in the beta (13 Hz to 30 Hz) frequency range of a single EEG channel at location Fz of the 10–20 electrode placement system. The electrical stimulation system was designed to facilitate reaching forward, to the opposite (right) knee, opposite shoulder, mouth, and also lateral reaching. Each phase of the movement (i.e., reaching and retrieving) was activated by the brain-computer interface. After 40 90-minute sessions, delivered three times a week, the participant's arm function showed a clinically meaningful improvement (6 points in the Fugl-Meyer Assessment Upper Extremity sub-score). No other intervention completed by the participant prior to this study had produced any functional change.