Instrumented Pre-Hospital Care Simulation Mannequin for Use in Spinal Motion Restrictions Scenarios: Validation of Cervical and Lumbar Motion Assessment.

BACKGROUND: A mid-fidelity simulation mannequin, equipped with an instrumented cervical and lumbar spine, was developed to investigate best practices and train healthcare professionals in applying spinal motion restrictions (SMRs) during the early mobilization and transfer of accident victims with suspected spine injury. The study objectives are to (1) examine accuracy of the cervical and lumbar motions measured with the mannequin; and (2) confirm that the speed of motion has no bearing on this accuracy. METHODS: Accuracy was evaluated by concurrently comparing the orientation data obtained with the mannequin with that from an optoelectronic system. The mannequin's head and pelvis were moved in all anatomical planes of motion at different speeds. RESULTS: Accuracy, assessed by root-mean-square error, varied between 0.7° and 1.5° in all anatomical planes of motion. Bland-Altman analysis revealed a bias ranging from -0.7° to 0.6°, with the absolute limit of agreement remaining below 3.5°. The minimal detectable change varied between 1.3° and 2.6°. Motion speed demonstrated no impact on accuracy. CONCLUSIONS: The results of this validation study confirm the mannequin's potential to provide accurate measurements of cervical and lumbar motion during simulation scenarios for training and research on the application of SMR.

Telehealth interventions in occupational therapy with older adults: Results from a scoping review targeting better health promotion.

INTRODUCTION: Telehealth interventions have the potential to enhance access to care and improve efficiency while reducing the burden on patients. Although telehealth interventions are well accepted and adopted in physical therapy, their usage in occupational therapy for older adults is less common, and limited information exists regarding their setting and context. OBJECTIVE: To provide an inventory and synthesis of telehealth interventions in occupational therapy for older adults. METHOD: For published studies on telehealth-based occupational therapy interventions in older adults between 2000 and 2022, six databases were reviewed. Data extraction and analysis were guided by the taxonomies developed by Tulu, McColl and Law and informed by the Canadian Model of Occupational Performance and Engagement. FINDINGS: Twenty-three studies on telehealth interventions in occupational therapy for older adults were identified, mostly from North American authors (n = 11; 47.8%) and randomised clinical trials (n = 9; 39.1%). Most participants had a health problem (n = 20; 87.0%), mainly stroke (n = 9; 39.1%). Interventions focussed primarily on symptom management education (n = 12; 52.2%) of community-dwelling adults with health conditions, using videoconferencing systems or applications (n = 14; 60.7%). Interventions were delivered from the healthcare centre (n = 6; 26.1%) to the person's home (n = 18; 78.3%) synchronously (n = 19; 82.6%). About one third (n = 8; 34.8%) of the studies specified the therapist's location. CONCLUSION: Published studies on telehealth interventions in occupational therapy with older adults have mainly focussed on the synchronous training and education of participants using videoconferencing systems or applications. According to these studies, the scope of interventions is limited and could be expanded, for example, through occupational development and environmental modification. To better understand and describe best practices in the use of telehealth in occupational therapy, future studies should provide more details about the interventions performed, the technology used and the environmental settings of the therapist.

Comparison of Three Motion Capture-Based Algorithms for Spatiotemporal Gait Characteristics: How Do Algorithms Affect Accuracy and Precision of Clinical Outcomes?

Gait assessment is of interest to clinicians and researchers because it provides information about patients' functional mobility. Optoelectronic camera-based systems with gait event detection algorithms are considered the gold standard for gait assessment. Yet, the choice of the algorithm used to process data and extract the desired parameters from those detected gait events has an impact on the validity and reliability of the gait parameters computed. There are multiple techniques documented in the literature for computing gait events, including the analysis of the minimal position of the heel and toe markers, the computation of the relative distance between sacrum and foot markers, and the assessment of the smallest distance between the heel and toe markers. Validation studies conducted on these algorithms report variations in accuracy. Yet, these studies were conducted in different conditions, at varying gait velocities, and on different populations. The purpose of this study is to compare accuracy, precision, and robustness of three algorithms using motion capture data obtained from 25 healthy persons and 21 psoriatic arthritic patients walking at three distinct speeds on an instrumented treadmill. Errors in gait events recognition (heel strike-HS and toe-off-TO) and their impact on gait metrics (stance phase and stride length) are reported and compared to ground reaction force events measured with force plates. Over the 9114 collected steps across all walking speeds, more than 99% of gait events were recognized by all algorithms. On average, HS events were detected within 1.2 ms of the reference for two algorithms, while the third one detected HS late, with an average detection error of 40.7 ms. Yet, significant variations in accuracy were noted with gait speed; the performance decreased for all algorithms at slow speed. TO events were identified early by all algorithms, with an average error ranging from 16.0 to 100.0 ms. These gait events errors lead to 2-15% inaccuracies in stance phase assessment, while the impact on stride length remains below 0.3 cm. Overall, the algorithm based on the relative distance between the sacral and foot markers stood out for its accuracy, precision, and robustness at all walking speeds.

How Long Should GPS Recording Lengths Be to Capture the Community Mobility of An Older Clinical Population? A Parkinson's Example.

Wearable global position system (GPS) technology can help those working with older populations and people living with movement disorders monitor and maintain their mobility level. Health research using GPS often employs inconsistent recording lengths due to the lack of a standard minimum GPS recording length for a clinical context. Our work aimed to recommend a GPS recording length for an older clinical population. Over 14 days, 70 older adults with Parkinson's disease wore the wireless inertial motion unit with GPS (WIMU-GPS) during waking hours to capture daily "time outside", "trip count", "hotspots count" and "area size travelled". The longest recording length accounting for weekend and weekdays was ≥7 days of ≥800 daily minutes of data (14 participants with 156, 483.9 min recorded). We compared the error rate generated when using data based on recording lengths shorter than this sample. The smallest percentage errors were observed across all outcomes, except "hotspots count", with daily recordings ≥500 min (8.3 h). Eight recording days will capture mobility variability throughout days of the week. This study adds empirical evidence to the sensor literature on the required minimum duration of GPS recording.

Transcranial direct current stimulation (a-tCDS) after subacromial injections in patients with subacromial pain syndrome: a randomized controlled pilot study.

BACKGROUND: Subacromial pain syndrome (SAPS) is a common complaint in orthopaedics. Subacromial corticosteroid injections (CSI) can relieve pain in the short term. Anodal transcranial direct current stimulation (a-tDCS) has been used for symptomatic pain relief in a variety of chronic pain conditions. The aim of this pilot study was to assess whether the application a-tDCS could enhance the symptomatic relief provided by CSI in patients affected by SAPS. METHODS: Thirty-eight participants (18 to 65-year-old) suffering from SAPS were recruited to have a CSI and randomly allocated to receive, 1 weeks post CSI, real a-tDCS (r-tDCS), sham tDCS (s-tDCS) or no intervention (Control). Upper limb function was measured 1 week prior to the CSI, at the 2- and 4-week follow-ups using self-administered questionnaires and physical measures. Self-reported pain and activity during each day were logged by the participants using visual analog scales (VAS). Differences between groups were tested using repeated-measures ANOVAs. RESULTS: Pain VAS and the Single Assessment Numeric Evaluation scale (SANE) showed significant improvement from baseline 2 weeks and 4 weeks after CSI in all groups (p < 0.05). There were no significant group X time interaction 2 weeks following tDCS treatment in any of the variables. CONCLUSION: All groups showed significant improvement in pain VAS and SANE scores following the CSI. One session of a-tDCS treatment 2 weeks following CSI did not result in any additive or potentializing effects when compared to a s-tDCS or a control group. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03967574 . Registered 30 May 2019 - Retrospectively registered.

The Accuracy and Precision of Gait Spatio-Temporal Parameters Extracted from an Instrumented Sock during Treadmill and Overground Walking in Healthy Subjects and Patients with a Foot Impairment Secondary to Psoriatic Arthritis.

The objectives of this study were to assess the accuracy and precision of a system combining an IMU-instrumented sock and a validated algorithm for the estimation of the spatio-temporal parameters of gait. A total of 25 healthy participants (HP) and 21 patients with foot impairments secondary to psoriatic arthritis (PsA) performed treadmill walking at three different speeds and overground walking at a comfortable speed. HP performed the assessment over two sessions. The proposed system's estimations of cadence (CAD), gait cycle duration (GCD), gait speed (GS), and stride length (SL) obtained for treadmill walking were validated versus those estimated with a motion capture system. The system was also compared with a well-established multi-IMU-based system for treadmill and overground walking. The results showed a good agreement between the motion capture system and the IMU-instrumented sock in estimating the spatio-temporal parameters during the treadmill walking at normal and fast speeds for both HP and PsA participants. The accuracy of GS and SL obtained from the IMU-instrumented sock was better compared to the established multi-IMU-based system in both groups. The precision (inter-session reliability) of the gait parameter estimations obtained from the IMU-instrumented sock was good to excellent for overground walking and treadmill walking at fast speeds, but moderate-to-good for slow and normal treadmill walking. The proposed IMU-instrumented sock offers a novel form factor addressing the wearability issues of IMUs and could potentially be used to measure spatio-temporal parameters under clinical conditions and free-living conditions.

Inertial measurement systems for segments and joints kinematics assessment: towards an understanding of the variations in sensors accuracy.

BACKGROUND: Joints kinematics assessment based on inertial measurement systems, which include attitude and heading reference system (AHRS), are quickly gaining in popularity for research and clinical applications. The variety of the tasks and contexts they are used in require a deep understanding of the AHRS accuracy for optimal data interpretation. However, published accuracy studies on AHRS are mostly limited to a single task measured on a limited number of segments and participants. This study assessed AHRS sensors kinematics accuracy at multiple segments and joints through a variety of tasks not only to characterize the system's accuracy in these specific conditions, but also to extrapolate the accuracy results to a broader range of conditions using the characteristics of the movements (i.e. velocity and type of motion). Twenty asymptomatic adults ([Formula: see text] = 49.9) performed multiple 5 m timed up and go. Participants' head, upper trunk, pelvis, thigh, shank and foot were simultaneously tracked using AHRS and an optical motion capture system (gold standard). Each trial was segmented into basic tasks (sit-to-stand, walk, turn). RESULTS: At segment level, results revealed a mean root-mean-squared-difference [Formula: see text] varying between 1.1° and 5.5° according to the segment tracked and the task performed, with a good to excellent agreement between the systems. Relative sensor kinematics accuracy (i.e. joint) varied between 1.6° and 13.6° over the same tasks. On a global scheme, analysis of the effect of velocity on sensor kinematics accuracy showed that AHRS are better adapted to motions performed between 50°/s and 75°/s (roughly thigh and shank while walking). CONCLUSION: Results confirmed that pairing of modules to obtain joint kinematics affects the accuracy compared to segment kinematics. Overall, AHRS are a suitable solution for clinical evaluation of biomechanics under the multi-segment tasks performed although the variation in accuracy should be taken into consideration when judging the clinical meaningfulness of the observed changes.

Auto detection and segmentation of daily living activities during a Timed Up and Go task in people with Parkinson's disease using multiple inertial sensors.

BACKGROUND: Wearable sensors have the potential to provide clinicians with access to motor performance of people with movement disorder as they undergo intervention. However, sensor data often have to be manually classified and segmented before they can be processed into clinical metrics. This process can be time consuming. We recently proposed detection and segmentation algorithms based on peak detection using Inertial Measurement Units (IMUs) to automatically identify and isolate common activities during daily living such as standing up, walking, turning, and sitting down. These algorithms were developed using a homogenous population of healthy older adults. The aim of this study was to investigate the transferability of these algorithms in people with Parkinson's disease (PD). METHODS: A modified Timed Up And Go task was used since it is comprised of these activities, all performed in a continuous fashion. Twelve older adults diagnosed with early PD (Hoehn & Yahr ≤ 2) were recruited for the study and performed three trials of a 10 and 5-m TUG during OFF state. They were outfitted with 17 IMUs covering each body segment. Raw data from IMUs were detrended, normalized and filtered to reveal kinematics peaks that corresponded to different activities. Segmentation was accomplished by identifying the first minimum or maximum to the right and the left of these peaks. Segmentation times were compared to results from two examiners who visually segmented the activities. Specificity and sensitivity were used to evaluate the accuracy of the detection algorithms. RESULTS: Using the same IMUs and algorithms developed in the previous study, we were able to detect these activities with 97.6% sensitivity and 92.7% specificity (n = 432) in PD population. However, with modifications to the IMUs selection, we were able to detect these activities with 100% accuracy. Similarly, applying the same segmentation to PD population, we were able to isolate these activities within ~500 ms of the visual segmentation. Re-optimizing the filtering frequencies, we were able to reduce this difference to ~400 ms. CONCLUSIONS: This study demonstrates the agility and transferability of using a system of IMUs to accurately detect and segment activities in daily living in people with movement disorders.

In-Home Synchronous Telespeech Therapy to Improve Functional Communication in Chronic Poststroke Aphasia: Results from a Quasi-Experimental Study.

BACKGROUND: Although the use of telepractice in speech-language therapy for assessment purposes is well documented, its effectiveness and potential for rehabilitation in poststroke aphasia remain largely unknown. The purpose of this study was to investigate the effectiveness of a remotely delivered synchronous pragmatic telespeech language therapy for improving functional communication in aphasia. METHODS: A pre-/post-test design was chosen in which each participant was his or her own control. Using a telerehabilitation platform and software (Oralys TeleTherapy) based on the Promoting Aphasics' Communicative Effectiveness (PACE) approach, 20 participants with chronic poststroke aphasia received 9 speech therapy sessions over a 3-week period. RESULTS: Teletreatment with the PACE pragmatic rehabilitation approach led to improvements in functional communication, marked by (a) an increase in communication effectiveness, reflecting significantly improved autonomy in functional communication; (b) a decrease in communication exchange duration, meaning that the treatment made communication faster and more efficient; (c) a decrease in the number of communication acts, meaning that, after treatment, less information was needed to be efficiently understood by the communication partner; and (d) an increase in the number of different communication strategies used, meaning that the treatment fostered the use of a variety of alternative communication modes. CONCLUSIONS: This study provides additional arguments about the benefits of telerehabilitation for poststroke patients with aphasia. It showed that multimodal language therapy delivered through synchronous telerehabilitation had positive effects on functional communication in chronic aphasia.

Trueness and Minimal Detectable Change of Smartphone Inclinometer Measurements of Shoulder Range of Motion.

BACKGROUND: Digital inclinometer applications using data from embedded sensors on smartphone/multi-purpose pocket computers or "smart digital inclinometers" (SDIs) are now used to clinically assess range of motion (ROM). OBJECTIVES: The objectives of this study were to assess, compared with a biomechanical gold standard (GS), the trueness and minimal detectable change (MDC) of shoulder range of motion (SROM) measurements obtained from an SDI. METHODS: Twenty-five (n = 25) asymptomatic healthy participants performed three trials of shoulder flexion (SF), shoulder abduction (SA), and shoulder external rotation (SER) at full-range and mid-range. MAIN OUTCOME MEASURES: SROM was measured concurrently from sensor data (pitch, yaw, roll angles) from an iPod Touch installed on the posterior aspect of the humerus and 3D orientation of the upper arm obtained from an optical motion tracking system GS. RESULTS: The mean level of bias between SDI and the GS across all SROM measurements was 3.4°, with a 95% confidence interval varying between -8.9° and 15.8°. The mean and standard deviation absolute difference of SDI measurements with the GS were 5.8° ± 3.7° for SF, 8.7° ± 5.2° for SA, and 1.7° ± 1.4° for SER. The trueness of these values varied according to the movement. MDC was 1.9° for SF, 2° for SA, and 0.3° for SER. CONCLUSIONS: SROM measures in SER with an SDI seem to be accurate and robust for clinical use. However, SROM measures in other planes of motion should be interpreted with caution depending on the evaluation objective, the plane of motion assessed, and the range of ROM measured.

Patient Satisfaction with In-Home Telerehabilitation After Total Knee Arthroplasty: Results from a Randomized Controlled Trial.

Background and Introduction: Telerehabilitation after total knee arthroplasty (TKA) is supported by strong evidence on the effectiveness of such intervention and from a cost-benefit point of view. Satisfaction of patients toward in-home telerehabilitation after TKA has not yet been examined thoroughly in large-scale clinical trials. This study aims to compare satisfaction level of patients following in-home telerehabilitation (TELE) after TKA to one of the patients following a usual face-to-face home visit (STD) rehabilitation. Secondarily, to determine if any clinical or personal variables were associated to the level of satisfaction. MATERIALS AND METHODS: This study was embedded in a multicenter randomized controlled trial with 205 patients randomized into two groups. Rehabilitation intervention was the same for both groups; only approach for service delivery differed (telerehabilitation or home visits). Participants were assessed at baseline (before TKA), at hospital discharge, and at 2 and 4 months postdischarge (E4) using functional outcomes. Patient satisfaction was measured using the validated Health Care Satisfaction Questionnaire (HCSQ) at E4. RESULTS: Characteristics of all participants were similar at baseline. Satisfaction level of both groups did not differ and was very high (over 85%). It was neither correlated to personal characteristics nor to improvements of functional level from preoperative to E4. Satisfaction was rather found associated to walking and stair-climbing performances. CONCLUSIONS: These results, in conjunction with evidences of clinical effectiveness and cost benefits demonstrated in the same sample of patients, strongly support the use of telerehabilitation to improve access to rehabilitation services and efficiency of service delivery after TKA.

Autonomous Quality Control of Joint Orientation Measured with Inertial Sensors.

Clinical mobility assessment is traditionally performed in laboratories using complex and expensive equipment. The low accessibility to such equipment, combined with the emerging trend to assess mobility in a free-living environment, creates a need for body-worn sensors (e.g., inertial measurement units-IMUs) that are capable of measuring the complexity in motor performance using meaningful measurements, such as joint orientation. However, accuracy of joint orientation estimates using IMUs may be affected by environment, the joint tracked, type of motion performed and velocity. This study investigates a quality control (QC) process to assess the quality of orientation data based on features extracted from the raw inertial sensors' signals. Joint orientation (trunk, hip, knee, ankle) of twenty participants was acquired by an optical motion capture system and IMUs during a variety of tasks (sit, sit-to-stand transition, walking, turning) performed under varying conditions (speed, environment). An artificial neural network was used to classify good and bad sequences of joint orientation with a sensitivity and a specificity above 83%. This study confirms the possibility to perform QC on IMU joint orientation data based on raw signal features. This innovative QC approach may be of particular interest in a big data context, such as for remote-monitoring of patients' mobility.

Conditions of Use, Reliability, and Quality of Audio/Video-Mediated Communications During In-Home Rehabilitation Teletreatment for Postknee Arthroplasty.

BACKGROUND: Audio/video-mediated communication between patients and clinicians using videoconferencing over telecommunication networks is a key component of providing teletreatments in rehabilitation. OBJECTIVE: The objectives of this study were to (1) document the conditions of use, performance, and reliability of videoconferencing-based communication in the context of in-home teletreatment (TELE) following total knee arthroplasty (TKA) and (2) assess from the perspective of the providers, the quality attributes of the technology used and its impact on clinical objectives. MATERIALS AND METHODS: Descriptive embedded study in a randomized controlled trial using a sample of 97 post-TKA patients, who received a total of 1,431 TELE sessions. Technical support use, service delivery reliability, performance, and use of network connection were assessed using self-report data from a costing grid and automated logs captured from videoconferencing systems. Physical therapists assessed the quality and impact of video-mediated communications after each TELE session on seven attributes. RESULTS: Installation of a new Internet connection was required in 75% of the participants and average technician's time to install test and uninstall technology (including travel time) was 308.4 min. The reliability of service delivery was 96.5% of planned sessions with 21% of TELE session requiring a reconnection during the session. Remote technical support was solicited in 43% of the sessions (interventions were less than 3-min duration). Perceived technological impacts on video-mediated communications were minimal with quality of the overall technical environment evaluated as good or acceptable in 96% of the sessions and clinical objectives reached almost completely or completely in 99% of the sessions. CONCLUSIONS: In-home rehabilitation teletreatments can be delivered reliably but requires access to technical support for the initial setup and maintenance. Optimization of the processes of reliably connecting patients to the Internet, getting the telerehabilitation platform in the patient's home, installing, configuring, and testing will be needed to generalize this approach of service delivery.

Cervical Spine Motion during Transfer and Stabilization Techniques.

Abstract Objectives. To compare paramedics' ability to minimize cervical spine motion during patient transfer onto a vacuum mattress with two stabilization techniques (head squeeze vs. trap squeeze) and two transfer methods (log roll with one assistant (LR2) vs. 3 assistants (LR4)). Methods. We used a crossover design to minimize bias. Each lead paramedic performed 10 LR2 transfers and 10 LR4 transfers. For each of the 10 LR2 and 10 LR4 transfers, the lead paramedic stabilized the cervical spine using the head squeeze technique five times and the trap squeeze technique five times. We randomized the order of the stabilization techniques and LR2/LR4 across lead paramedics to avoid a practice or fatigue effect with repeated trials. We measured relative cervical spine motion between the head and trunk using inertial measurement units placed on the forehead and sternum. Results. On average, total motion was 3.9° less with three assistants compared to one assistant (p = 0.0002), and 2.8° less with the trap squeeze compared to the head squeeze (p = 0.002). There was no interaction between the transfer method and stabilization technique. When examining specific motions in the six directions, the trap squeeze generally produced less lateral flexion and rotation motion but allowed more extension. Examining within paramedic differences, some paramedics were clearly more proficient with the trap squeeze technique and others were clearly more proficient with the head squeeze technique. Conclusion. Paramedics performing a log roll with three assistants created less motion compared to a log roll with only one assistant, and using the trap squeeze stabilization technique resulted in less motion than the head squeeze technique but the clinical relevance of the magnitude remains unclear. However, large individual differences suggest future paramedic training should incorporate both best evidence practice as well as recognition that there may be individual differences between paramedics.

Cost analysis of in-home telerehabilitation for post-knee arthroplasty.

BACKGROUND: Rehabilitation provided through home visits is part of the continuum of care after discharge from hospital following total knee arthroplasty (TKA). As demands for rehabilitation at home are growing and becoming more difficult to meet, in-home telerehabilitation has been proposed as an alternate service delivery method. However, there is a need for robust data concerning both the effectiveness and the cost of dispensing in-home telerehabilitation. OBJECTIVE: The objective of this study was to document, analyze, and compare real costs of two service delivery methods: in-home telerehabilitation and conventional home visits. METHODS: The economic analysis was conducted as part of a multicenter randomized controlled trial (RCT) on telerehabilitation for TKA, and involved data from 197 patients, post-TKA. Twice a week for 8 weeks, participants received supervised physiotherapy via two delivery methods, depending on their study group allocation: in-home telerehabilitation (TELE) and home-visit rehabilitation (VISIT). Patients were recruited from eight hospitals in the province of Quebec, Canada. The TELE group intervention was delivered by videoconferencing over high-speed Internet. The VISIT group received the same intervention at home. Costs related to the delivery of the two services (TELE and VISIT) were calculated. Student's t tests were used to compare costs per treatment between the two groups. To take distance into account, the two treatment groups were compared within distance strata using two-way analyses of variance (ANOVAs). RESULTS: The mean cost of a single session was Can $93.08 for the VISIT group (SD $35.70) and $80.99 for the TELE group (SD $26.60). When comparing both groups, real total cost analysis showed a cost differential in favor of the TELE group (TELE minus VISIT: -$263, 95% CI -$382 to -$143). However, when the patient's home was located less than 30 km round-trip from the health care center, the difference in costs between TELE and VISIT treatments was not significant (P=.25, .26, and .11 for the <10, 10-19, and 20-29 km strata, respectively). The cost of TELE treatments was lower than VISIT treatments when the distance was 30 km or more (30-49 km: $81<$103, P=.002; ≥50 km: $90<$152, P<.001). CONCLUSIONS: To our knowledge, this is the first study of the actual costs of in-home telerehabilitation covering all subcosts of telerehabilitation and distance between the health care center and the patient's home. The cost for a single session of in-home telerehabilitation compared to conventional home-visit rehabilitation was lower or about the same, depending on the distance between the patient's home and health care center. Under the controlled conditions of an RCT, a favorable cost differential was observed when the patient was more than 30 km from the provider. Stakeholders and program planners can use these data to guide decisions regarding introducing telerehabilitation as a new service in their clinic. TRIAL REGISTRATION: International Standard Registered Clinical Study Number (ISRCTN): 66285945; http://www.isrctn.com/ISRCTN66285945 (Archived by WebCite at http://www.webcitation.org/6WlT2nuX4).

Auto detection and segmentation of physical activities during a Timed-Up-and-Go (TUG) task in healthy older adults using multiple inertial sensors.

BACKGROUND: Recently, much attention has been given to the use of inertial sensors for remote monitoring of individuals with limited mobility. However, the focus has been mostly on the detection of symptoms, not specific activities. The objective of the present study was to develop an automated recognition and segmentation algorithm based on inertial sensor data to identify common gross motor patterns during activity of daily living. METHOD: A modified Time-Up-And-Go (TUG) task was used since it is comprised of four common daily living activities; Standing, Walking, Turning, and Sitting, all performed in a continuous fashion resulting in six different segments during the task. Sixteen healthy older adults performed two trials of a 5 and 10 meter TUG task. They were outfitted with 17 inertial motion sensors covering each body segment. Data from the 10 meter TUG were used to identify pertinent sensors on the trunk, head, hip, knee, and thigh that provided suitable data for detecting and segmenting activities associated with the TUG. Raw data from sensors were detrended to remove sensor drift, normalized, and band pass filtered with optimal frequencies to reveal kinematic peaks that corresponded to different activities. Segmentation was accomplished by identifying the time stamps of the first minimum or maximum to the right and the left of these peaks. Segmentation time stamps were compared to results from two examiners visually segmenting the activities of the TUG. RESULTS: We were able to detect these activities in a TUG with 100% sensitivity and specificity (n = 192) during the 10 meter TUG. The rate of success was subsequently confirmed in the 5 meter TUG (n = 192) without altering the parameters of the algorithm. When applying the segmentation algorithms to the 10 meter TUG, we were able to parse 100% of the transition points (n = 224) between different segments that were as reliable and less variable than visual segmentation performed by two independent examiners. CONCLUSIONS: The present study lays the foundation for the development of a comprehensive algorithm to detect and segment naturalistic activities using inertial sensors, in hope of evaluating automatically motor performance within the detected tasks.

Framework for the analysis of nanotechnologies' impacts and ethical acceptability: basis of an interdisciplinary approach to assessing novel technologies.

The genetically manipulated organism (GMO) crisis demonstrated that technological development based solely on the law of the marketplace and State protection against serious risks to health and safety is no longer a warrant of ethical acceptability. In the first part of our paper, we critique the implicitly individualist social-acceptance model for State regulation of technology and recommend an interdisciplinary approach for comprehensive analysis of the impacts and ethical acceptability of technologies. In the second part, we present a framework for the analysis of impacts and acceptability, devised-with the goal of supporting the development of specific nanotechnological applications-by a team of researchers from various disciplines. At the conceptual level, this analytic framework is intended to make explicit those various operations required in preparing a judgement about the acceptability of technologies that have been implicit in the classical analysis of toxicological risk. On a practical level, we present a reflective tool that makes it possible to take into account all the dimensions involved and understand the reasons invoked in determining impacts, assessing them, and arriving at a judgement about acceptability.

Translation and validation of the contact lens dry eye questionnaire 8 (CLDEQ-8) in Canadian French.

PURPOSE: To present the process that led to the creation of the French Canadian translated version of the Contact Lens Dry Eye Questionnaire-8 (which allows for an assessment of symptoms while wearing soft contact lenses) as well as the validation data of the f-CLDEQ-8. METHODS: The CLDEQ-8 went through the process of reverse translation, which was then reviewed and improved by an experts' committee to create a first version of the French questionnaire. Cognitive interviews were conducted to pretest the tool and ensure content validity. After a review of the pretest, the f-CLDEQ-8 was created. A web-based version of this questionnaire was sent to contact lens wearers (CLW) recruited out of a clinical setting for completion at two different endpoints interspaced by 7 days. Internal consistency and test-reliability were calculated using Cronbach's alpha and Intra-class Correlation coefficient (ICC), respectively. Convergent validity between the f-CLDEQ-8 score and overall opinion of the contact lenses was evaluated with a correlation. RESULTS: 9 CLW with different socio-economic statuses and education levels went through a cognitive interview with the back-translated version of the f-CLDEQ-8 to improve the questionnaire wording and enhance its comprehension. 63 CLW (34.2 ± 10.1 years old and 2/3 of them women) completed the f-CLDEQ-8 twice. An average Cronbach alpha of 0.928 was found and an ICC of 0.944 (CI at 95 % 0.905;0.966). A moderately strong correlation of -0.714 (CI at 95 % -0.817;-0.566) was found between the overall opinion of the contact lenses and the total score to the f-CLDEQ-8. CONCLUSION: The French language version (f-CLDEQ-8) generated from the original CLDEQ -8 was shown to be easy to use, reliable and culturally adapted to French spoken in Canada.

[Se familiariser au transport en commun par l'apprentissage d'outils de planification technologiques : effets d'un programme co-construit avec des partenaires de la communauté auprès d'aînés vivant avec des incapacités].

Cette étude visait à documenter comment un programme de familiarisation à l'utilisation du transport en commun influence l'expérience de mobilité des aînés. Ce programme a été co-construit avec des partenaires clés afin d'y inclure l'usage d'outils de planification technologiques et un accompagnement personnalisé tenant compte des incapacités des participants. Une étude de cas multiples (n = 7) a été menée selon une approche mixte convergente, combinant des méthodes qualitatives (p. ex., entrevues) et quantitatives (p. ex., cartes à puces). Les participants qui ont bénéficié davantage de la formation ont rapporté une meilleure connaissance du transport en commun et une plus grande confiance à utiliser l'autobus. Ils ont aussi effectué plus de sorties. Nos résultats suggèrent d'intégrer une destination « signifiante ¼ et l'apprentissage d'outils de planification non technologiques à la formation pour en assurer la compatibilité avec les besoins et le niveau de littératie numérique des aînés. De futures études aideront à favoriser cette option de transport en amont de la perte du permis de conduire.

Spatiotemporal parameters and gait variability in people with psoriatic arthritis (PsA): a cross-sectional study.

BACKGROUND: Foot involvement is a major manifestation of psoriatic arthritis (PsA) and can lead to severe levels of foot pain and disability and impaired functional mobility and quality of life. Gait spatiotemporal parameters (STPs) and gait variability, used as a clinical index of gait stability, have been associated with several adverse health outcomes, including risk of falling, functional decline, and mortality in a wide range of populations. Previous studies showed some alterations in STPs in people with PsA. However, gait variability and the relationships between STPs, gait variability and self-reported foot pain and disability have never been studied in these populations. Body-worn inertial measurement units (IMUs) are gaining interest in measuring gait parameters in clinical settings. OBJECTIVES: To assess STPs and gait variability in people with PsA using IMUs, to explore their relationship with self-reported foot pain and function and to investigate the feasibility of using IMUs to discriminate patient groups based on gait speed-critical values. METHODS: Twenty-one participants with PsA (age: 53.9 ± 8.9 yrs.; median disease duration: 6 yrs) and 21 age- and sex-matched healthy participants (age 54.23 ± 9.3 yrs) were recruited. All the participants performed three 10-m walk test trials at their comfortable speed. STPs and gait variability were recorded and calculated using six body-worn IMUs and Mobility Lab software (APDM®). Foot pain and disability were assessed in participants with PsA using the foot function index (FFI). RESULTS: Cadence, gait speed, stride length, and swing phase were significantly lower, while double support was significantly higher, in the PsA group (p < 0.006). Strong correlations between STPs and the FFI total score were demonstrated (|r| > 0.57, p < 0.006). Gait variability was significantly increased in the PsA group, but it was not correlated with foot pain or function (p < 0.006). Using the IMUs, three subgroups of participants with PsA with clinically meaningful differences in self-reported foot pain and disability were discriminated. CONCLUSION: STPs were significantly altered in participants with PsA, which could be associated with self-reported foot pain and disability. Future studies are required to confirm the increased gait variability highlighted in this study and its potential underlying causes. Using IMUs has been useful to objectively assess foot function in people with PsA. TRIAL REGISTRATION: ClinicalTrials.gov , NCT05075343 , Retrospectively registered on 29 September 2021.