Effect of a Wheelie Training Method With the Front Wheels on a Ramp in Novice Able-Bodied Participants: A Randomized Controlled Trial.

The objective of this study was to determine if wheelie training that begins with learning how to balance with the front wheels on a ramp would increase the success rate, reduce the training time, and improve retention rates. A randomized controlled trial design was used to evaluate the effectiveness of wheelie training on a ramp setting (ramp group, n = 26) and conventional training (conventional group, n = 26). The main outcome measures were success rates in achieving wheelie competence, training time, and the retention rate in 7 and 30 days respectively. The results showed that the success rate for each training group both reached 100%. The mean training times for the conventional group and the ramp group were 86.0 ± 35.7 and 76.0 ± 25.8 minutes. Training time was not significantly affected by the training method (p = 0.23), but it was affected by gender, with women requiring an average of 92.0 ± 31.4 minutes in comparison with 70.0 ± 27.5 minutes for men (p = 0.01). The skill retention rate after 7 and 30 days was 100% for both groups. Neither success rate nor training time for wheelie skill acquisition by learners were improved by learning wheelie balance on a ramp. However, a high retention rate of wheelie skills for both training groups was found, which implies that success can be achieved by training on a ramp used in this study.

Effect of backrest height on wheelchair propulsion biomechanics for level and uphill conditions.

OBJECTIVE: To evaluate the effect of backrest height on wheelchair propulsion kinematics and kinetics. DESIGN: An intervention study with repeated measures. SETTING: University laboratory. PARTICIPANTS: Convenience sample included manual wheelchair users (N=36; 26 men and 10 women) with spinal cord injuries ranging from T8 to L2. INTERVENTION: Participants propelled on a motor-driven treadmill for 2 conditions (level and slope of 3°) at a constant speed of 0.9 m/s while using in turn a sling backrest fixed at 40.6 cm (16 in) high (high backrest) and a lower height set at 50% trunk length (low backrest). MAIN OUTCOME MEASURES: Cadence, stroke angle, peak shoulder extension angle, shoulder flexion/extension range of motion, and mechanical effective force. RESULTS: Pushing with the low backrest height enabled greater range of shoulder motion (P<.01), increased stroke angle (P<.01), push time (P<.01), and reduced cadence (P=.01) regardless of whether the treadmill was level or sloped. CONCLUSIONS: A lower cadence can be achieved when pushing with a lower backrest, which decreases the risk of developing upper-limb overuse related injuries. However, postural support, comfort, and other activities of daily living must also be considered when selecting a backrest height for active, long-term wheelchair users. The improvements found when using the low backrest were found regardless of slope type. Pushing uphill demanded significantly higher resultant and tangential force, torque, mechanical effective force, and cadence.

Personalized Prediction of Postconcussive Working Memory Decline: A Feasibility Study.

Concussion, also known as mild traumatic brain injury (mTBI), commonly causes transient neurocognitive symptoms, but in some cases, it causes cognitive impairment, including working memory (WM) deficit, which can be long-lasting and impede a patient's return to work. The predictors of long-term cognitive outcomes following mTBI remain unclear, because abnormality is often absent in structural imaging findings. Previous studies have demonstrated that WM functional activity estimated from functional magnetic resonance imaging (fMRI) has a high sensitivity to postconcussion WM deficits and may be used to not only evaluate but guide treatment strategies, especially targeting brain areas involved in postconcussion cognitive decline. The purpose of the study was to determine whether machine learning-based models using fMRI biomarkers and demographic or neuropsychological measures at the baseline could effectively predict the 1-year cognitive outcomes of concussion. We conducted a prospective, observational study of patients with mTBI who were compared with demographically matched healthy controls enrolled between September 2015 and August 2020. Baseline assessments were collected within the first week of injury, and follow-ups were conducted at 6 weeks, 3 months, 6 months, and 1 year. Potential demographic, neuropsychological, and fMRI features were selected according to their significance of correlation with the estimated changes in WM ability. The support vector machine classifier was trained using these potential features and estimated changes in WM between the predefined time periods. Patients demonstrated significant cognitive recovery at the third month, followed by worsened performance after 6 months, which persisted until 1 year after a concussion. Approximately half of the patients experienced prolonged cognitive impairment at the 1-year follow up. Satisfactory predictions were achieved for patients whose WM function did not recover at 3 months (accuracy = 87.5%), 6 months (accuracy = 83.3%), and 1 year (accuracy = 83.3%) and performed worse at the 1-year follow-up compared to the baseline assessment (accuracy = 83.3%). This study demonstrated the feasibility of personalized prediction for long-term postconcussive WM outcomes based on baseline fMRI and demographic features, opening a new avenue for early rehabilitation intervention in selected individuals with possible poor long-term cognitive outcomes.

Assessment of Wheelchair Propulsion Performance in an Immersive Virtual Reality Simulator.

Maneuvering a wheelchair is an important necessity for the everyday life and social activities of people with a range of physical disabilities. However, in real life, wheelchair users face several common challenges: articulate steering, spatial relationships, and negotiating obstacles. Therefore, our research group has developed a head-mounted display (HMD)-based intuitive virtual reality (VR) stimulator for wheelchair propulsion. The aim of this study was to investigate the feasibility and efficacy of this VR stimulator for wheelchair propulsion performance. Twenty manual wheelchair users (16 men and 4 women) with spinal cord injuries ranging from T8 to L2 participated in this study. The differences in wheelchair propulsion kinematics between immersive and non-immersive VR environments were assessed using a 3D motion analysis system. Subjective data of the HMD-based intuitive VR stimulator were collected with a Presence Questionnaire and individual semi-structured interview at the end of the trial. Results indicated that propulsion performance was very similar in terms of start angle (p = 0.34), end angle (p = 0.46), stroke angle (p = 0.76), and shoulder movement (p = 0.66) between immersive and non-immersive VR environments. In the VR episode featuring an uphill journey, an increase in propulsion speed (p < 0.01) and cadence (p < 0.01) were found, as well as a greater trunk forward inclination (p = 0.01). Qualitative interviews showed that this VR simulator made an attractive, novel impression and therefore demonstrated the potential as a tool for stimulating training motivation. This HMD-based intuitive VR stimulator can be an effective resource to enhance wheelchair maneuverability experiences.

Effects of audio feedback on sitting behaviors of community-dwelling manual wheelchair users with spinal cord injuries.

The purpose of this study was to investigate whether audio feedback obtained from a data logger could help community-dwelling manual wheelchair users (MWUs) to engage in pressure-relieving behaviors more frequently. Twenty community-dwelling MWUs completed the study. Data loggers with force sensors were installed on each participant's wheelchair. The frequency of pressure-relief activities and sitting time were recorded on two occasions one week apart with or without audio feedback. The results showed that MWUs spent approximately 9.2 hours per day sitting in their wheelchairs and performed an average of 5.1 transfers from their wheelchair. MWUs receiving audio feedback showed a significant increase in pressure-relieving activities, which included push-up frequency and side-to-side lean frequency with less uninterrupted sitting time. Although the audio alarm device served as a useful tool in promoting pressure-relieving behaviors, our subject population still showed low frequency of pressure-relief activities. This might indicate that other factors besides pressure may explain why our subjects are free from pressure ulcers. Educational materials should include not only information related to pressure but to other risk factors believed to contribute to the development of pressure sores.

The effect of chinese yuanji-dance on dynamic balance and the associated attentional demands in elderly adults.

Walking performance changes with age. This has implications for the problem of falls in older adults. The aim of this study was to investigate the effects of Yuanji-Dance practice on walking balance and the associated attention demand in healthy elderly. Fifteen community-dwelling elderly (comparison group, no regular exercise habit) and fifteen Yuanji- Dance elderly (exercise group, dancing experience: 5.40 ± 1.95 years), aged 60-70 years, were included in this study. The subjects in exercise group participated in a 90-minute Yuanji-Dance practice at least three times per week and the comparison group continued their normal daily physical activity. Walking balance measures (including walking velocity, step length, step width, and percentage of time spent in double limb support, COM velocity and COM-COP inclination angles) and attentional demand tests (button reaction time and accuracy) were conducted under different conditions. Our results showed that stride lengths, walking velocities, peak A/P velocities (AP V) of the COM, medial COM-COP inclination (M angle) angles, reaction time, and accuracy decrease significantly as the dual-task (walking plus hand button pressing tasks) applied for either the comparison or exercise groups. These results demonstrated that walking performance is attenuated in our elderly participants as the cognitive tasks applied. Analysis also identified a significantly faster RT for our exercise group both in standing and walking conditions. This may indicate that physical exercise (Yuanji-Dance) may have facilitating effects on general cognitive and perceptual- motor functions. This implies that Chinese Yuanji-Dance practice for elderly adults may improve their personal safety when walking especially under the condition of multiple task demand. Key pointsThe purpose of this study was to investigate the training effects of a Chinese traditional exercise, Yuanji-Dance, on walking balance and the associated attention demand in the healthy elderly.Walking performance is attenuated in elderly participants as the cognitive tasks applied.A significantly faster reaction time for our exercise group both in standing and walking conditions.Yuanji-Dance exercise training can improve the information processing speed of elderly people and has no influence of the dynamic walking balance.

The psychometric properties of the cervical nonorganic signs in patients with neck pain: an assessment of pain expression.

PURPOSE: Neck pain is a common cause of disability. This study investigated the psychometric properties of the cervical nonorganic signs (CNOS), a tool for assessing abnormal illness behaviors in patients with neck pain. METHODS: The CNOS was administered on patients with neck pain. Reliability and validity analyses were used to evaluate the psychometric properties. Exploratory factor analysis was used to investigate the dimensionality. Correlations with the Short Form-36 were used to investigate the convergent validity. RESULTS: The results supported the reliability (inter-rater reliability intra-class correlation: 0.920), validity (correlated with body pain (|ρ|=0.31) and vitality (|ρ| =0.30), and two-factor dimensionality (χ2= 5.904, p= 0.66; χ2/df = 0.738; RMSEA< 0.001; CFI = 1.000; TLI = 1.024; SRMR = 0.047) of the scale. The two factors were pain (severe pain) and vitality (poor vitality) expressed by the patients. CONCLUSION: The CNOS is a reliable and valid instrument for assessing pain and vitality problems. It helps patients to express severe pain and lack of vitality. The rehabilitation discipline could use the scale to understand pain expression and to design proper rehabilitation programs. Implications for Rehabilitation The cervical nonorganic signs has two domains (pain and vitality). The scale is reliable and valid for patients with neck pain. Patients with high scores on the pain domain have severe body pain that may interfere with normal social activities. Clinicians should understand their suffering and try to help them to alleviate the pain.

Influences of Aerobic Dance on Cognitive Performance in Adults with Schizophrenia.

Cognitive impairment is one of the core features of schizophrenia. This study examined the influences of an aerobic dance programme on the cognitive functions of people with schizophrenia. A quasi-experimental matched-control design was applied. The experimental group (n = 17) participated in a 60-minute aerobic dance group class three times a week for 3 months. The control group (n = 19) participated in colouring and handwriting activities. Cognitive functions were measured before and after the interventions for both groups. The intervention group experienced significant improvements in processing speed, memory and executive function, whereas no significant changes were noted in any measures in the control group. While there were no significant between-group differences, the data showed approximately medium effect sizes that favoured the intervention group in regard to processing speed (Cohen's d = 0.51), memory (d = 0.35-0.41) and the spontaneity and fluency aspects of executive function (d = 0.51). While the small sample size and lack of randomization were the primary methodological shortcomings, this study provides preliminary results supporting aerobic dance as an adjunct activity-based intervention to improve cognitive functions in people with schizophrenia. More rigorous studies are needed to validate the findings. Copyright © 2016 John Wiley & Sons, Ltd.

Kinematical measure for spastic reaching in children with cerebral palsy.

BACKGROUND: Practitioners need more sensitive measure to quantify reaching movement for judgment of the treatment effects and reflecting the degrees of motor impairment in upper extremities. The purposes of this study were to identify the specific kinematic characteristics between normal and spastic reaching under different levels of accuracy, and to determine the most sensitive kinematic variable for quantifying the interference of spasticity on reaching. METHODS: Ten normal subjects as control group and ten subjects with spastic cerebral palsy as experimental group were studied. Participants were asked to reach, at a self-selected pace, toward two different sizes of buttons (one with accuracy constraint and the other with non-accuracy constraint) away from normalized distance. Motion analysis system was used to record the trajectory of reaching performance. Kinematic variables of reaching movement were computed and analyzed. FINDINGS: Measure for movement smoothness presented larger effect size (0.24-0.43) than other kinematic variables adopted in this study. Under high-accuracy reaching, children with spastic cerebral palsy had a prolonged movement time than normal children (P<0.05). Modified Ashworth score was significantly correlated to normalized jerk score, number of movement unit and movement time (r=0.56-0.75). Number of movement unit was the most sensitive kinematic variable to discriminate between normal and spastic reaching. INTERPRETATION: Development of reliable, valid, and sensitive multi-joint biomechanical evaluation is required, particularly for natural and goal-oriented reaching movement. It is concluded that measure of movement smoothness may be applied as valid and sensitive index to quantify the level of coordinative motor performance for subjects with spastic movement disorder.

Predicting the grade of disabilty 1 year after stroke following rehabilitation.

The purpose of this study was to identify predictors of grades of disability at least 1 year after stroke rehabilitation therapy. We recruited stroke patients from the inpatient rehabilitation department of a university hospital. The degree of disability was graded using the disability evaluation at least 1 year after stroke onset. Functional ability was evaluated using the Functional Independence Measure instrument on admission, on discharge from the inpatient rehabilitation program, and at the 6-month follow-up visit after discharge. Major sociodemographic, medical, and rehabilitative factors were also collected during the hospitalization period. Of the 109 patients surveyed, 64 (58.7%) had severe or very severe grades of disability. The correlates of severe or very severe disability in logistic regression analyses were bilaterally affected (odds ratio, OR, 10.8), impaired orientation (OR, 3.6), and poorer functional ability at discharge (OR, 7.6). Based on the significant predictors identified, the logistic regression model correctly classified severe or very severe disability in 68.0% of subjects. The higher frequency of severe or very severe disability in this study may have been due to the relatively more severely affected stroke patient population in the inpatient rehabilitation service and the use of unique disability evaluation criteria. These results may provide information useful in planning continuous rehabilitation care and setting relevant socio-welfare policies for stroke victims.

Sliding and lower limb mechanics during sit-stand-sit transitions with a standing wheelchair.

PURPOSE: This study aimed to investigate the shear displacement between the body and backrest/seat, range of motion (ROM), and force acting on the lower limb joints during sit-stand-sit transitions by operating an electric-powered standing wheelchair. METHODS AND MATERIALS: The amounts of sliding along the backrest and the seat plane, ROM of lower limb joints, and force acting on the knee/foot were measured in twenty-four people with paraplegia. RESULTS: Without an antishear mechanism, the shear displacement was approximately 9 cm between the user's body and the backrest/seat surfaces. During standing up, the user's back slid down and the thigh was displaced rearward, but they moved in opposite directions when wheelchair sat back down. A minimum of 60 degrees of ROM at the hip and knee was needed during sit-stand-sit transitions. The maximal resultant forces acting on the knee restraints could reach 23.5% of body weight. CONCLUSION: Sliding between the body and backrest/seat occurred while transitioning from sitting to standing and vice versa. A certain amount of ROM at lower limb joints and force acting on the knee was necessitated during sit-stand-sit transitions. Careful consideration needs to be given to who the user of the electric powered standing wheelchair is.

Test-retest reliabilities of hand-held dynamometer for lower-limb muscle strength in intellectual disabilities.

The primary purpose of this study was to investigate the test-retest reliabilities of hand-held dynamometer (HDD) for measuring lower-limb muscle strength in intellectual disabilities (ID). The other purposes were to: (1) compare the lower-limb muscle strength between children with and without ID; (2) probe the relationship between the muscle forces and agility performance in ID; and (3) explore the factors associated with muscle strength in ID. Sixty-one participants (30 boys and 31 girls; mean age=14.1 ± 3.3 year) were assessed by the HDD using a "make" test. The comparative group consisted of 63 typically developing children (33 boys and 30 girls; mean age=14.9 ± 2.1 year). The ID group demonstrated lower muscle groups than in typically developing group. Except for the ankle plantarflexors (ICC=0.69, SEM=0.72), test-retest analysis showed good intrarater reliability with ICC ranging from 0.81 to 0.96, and intrarater SEM values ranged from 0.40 to 0.57. The HDD has the potential to be a reliable tool for strength measurement in ID. Muscle strength was positively related to agility performance. Regression analysis indicated that height, weight, BMI, and activity level were significant predictors of muscle strength in ID.

Correlations between quality of life and psychological factors in patients with chronic neck pain.

The purpose of this study was to investigate health-related quality of life (HRQOL) and associated factors in patients with chronic neck pain (CNP). The HRQOL of patients with CNP was assessed by the Short Form-36 questionnaire in this cross-sectional study. To evaluate the psychological factors related to HRQOL, the Eysenck Personality Questionnaire, Chinese Health Questionnaire, and Beck Anxiety Inventory were used. The scores for the eight subscales of Short Form-36 were all lower than the Taiwanese age-matched normative values (p < 0.001). The two most strongly affected subscales were the role-physical subscale and the bodily pain subscale; both scores were below half the score of the age-/sex-matched normative values. The physical components summary score, a summary measure, was moderately correlated with age (rho = -0.43), education level (rho = 0.37) and Beck Anxiety Inventory score (rho = -0.36). The mental components summary score was moderately to highly correlated with the Chinese Health Questionnaire score (rho = -0.72), the neuroticism domain of Eysenck Personality Questionnaire (rho = -0.52) and Beck Anxiety Inventory score (rho = -0.41). The HRQOL of patients with CNP was worse than that of normal subjects across all domains. Furthermore, patients with a neurotic personality, minor psychiatric morbidity and higher anxiety status showed poor mental health, as measured by the Short Form-36. We found that patients with CNP had multiple physical and mental health problems in terms of. The mental health of patients with CNP was strongly associated with various psychological factors. Comprehensive assessment of the physical and mental functioning of patients with CNP can improve the management and care of these patients.

An investigation of rugby scrimmaging posture and individual maximum pushing force.

Although rugby is a popular contact sport and the isokinetic muscle torque assessment has recently found widespread application in the field of sports medicine, little research has examined the factors associated with the performance of game-specific skills directly by using the isokinetic-type rugby scrimmaging machine. This study is designed to (a) measure and observe the differences in the maximum individual pushing forward force produced by scrimmaging in different body postures (3 body heights x 2 foot positions) with a self-developed rugby scrimmaging machine and (b) observe the variations in hip, knee, and ankle angles at different body postures and explore the relationship between these angle values and the individual maximum pushing force. Ten national rugby players were invited to participate in the examination. The experimental equipment included a self-developed rugby scrimmaging machine and a 3-dimensional motion analysis system. Our results showed that the foot positions (parallel and nonparallel foot positions) do not affect the maximum pushing force; however, the maximum pushing force was significantly lower in posture I (36% body height) than in posture II (38%) and posture III (40%). The maximum forward force in posture III (40% body height) was also slightly greater than for the scrum in posture II (38% body height). In addition, it was determined that hip, knee, and ankle angles under parallel feet positioning are factors that are closely negatively related in terms of affecting maximum pushing force in scrimmaging. In cross-feet postures, there was a positive correlation between individual forward force and hip angle of the rear leg. From our results, we can conclude that if the player stands in an appropriate starting position at the early stage of scrimmaging, it will benefit the forward force production.

Effects of robot-aided bilateral force-induced isokinetic arm training combined with conventional rehabilitation on arm motor function in patients with chronic stroke.

OBJECTIVE: To analyze the effects of conventional rehabilitation combined with bilateral force-induced isokinetic arm movement training on paretic upper-limb motor recovery in patients with chronic stroke. DESIGN: Single-cohort, pre- and postretention design. SETTING: Rehabilitation department at a medical university. PARTICIPANTS: Twenty subjects who had unilateral strokes at least 6 months before enrolling in the study. INTERVENTION: A training program (40min/session, 3 sessions/wk for 8wk) consisting of 10 minutes of conventional rehabilitation and 30 minutes of robot-aided, bilateral force-induced, isokinetic arm movement training to improve paretic upper-limb motor function. MAIN OUTCOME MEASURES: The interval of pretest, post-test, and retention test was set at 8 weeks. Clinical arm motor function (Fugl-Meyer Assessment [FMA], upper-limb motor function, Frenchay Arm Test, Modified Ashworth Scale), paretic upper-limb strength (grip strength, arm push and pull strength), and reaching kinematics analysis (peak velocity, percentage of time to peak velocity, movement time, normalized jerk score) were used as outcome measures. RESULTS: After comparing the sets of scores, we found that the post-test and retention test in arm motor function significantly improved in terms of grip (P=.009), push (P=.001), and pull (P=.001) strengths, and FMA upper-limb scale (P<.001). Reaching kinematics significantly improved in terms of movement time (P=.015), peak velocity (P=.035), percentage of time to peak velocity (P=.004), and normalized jerk score (P=.008). Improvement in reaching ability was not sustained in the retention test. CONCLUSIONS: Preliminary results showed that conventional rehabilitation combined with robot-aided, bilateral force-induced, isokinetic arm training might enhance the recovery of strength and motor control ability in the paretic upper limb of patients with chronic stroke.