Pilot Study of Home-Based Virtual Reality Fitness Training in Post-Discharge Rehabilitation for Patients with Spinal Cord Injury: A Randomized Double-Blind Multicenter Trial.

Spinal cord injury (SCI) patients require continuous rehabilitation post-discharge to ensure optimal recovery. This study investigates the effectiveness of home-based virtual reality fitness training (VRFT) as a convenient and accessible rehabilitation method for SCI patients. This randomized, double-blind, multicenter trial will enroll 120 participants, assigning them to either an 8-week VRFT program (exercise group) or a control group engaging in regular daily activities. The outcomes measured include muscle function, cardiopulmonary fitness, body composition, and physical performance. Our study will determine the safety and feasibility of VRFT in a home setting for SCI patients and evaluate whether these patients can effectively participate in such a program post-discharge. The results of this study are expected to inform future exercise protocols for SCI rehabilitation, offering valuable insights into the utility of VRFT as a therapeutic tool.

Effectiveness of Exercise Programs for Alleviation of Upper Body Pain in Patients with Spinal Cord Injury: A Systematic Review.

(1) Background: Upper body pain, particularly in the limbs and shoulders, is a common symptom among patients with spinal cord injury (SCI) and wheelchair users. Despite the focus on resistance muscle training as a suitable intervention for SCI individuals, findings across different populations and conditions have been inconsistent. (2) Methods: We conducted a systematic review to elucidate the correlations among exercise interventions, muscle strength enhancement, and pain reduction. A comprehensive literature search was performed using the keywords "spinal cord injury," "pain," "exercise," "disability," "paraplegia," and "tetraplegia" across the DBpia, EMBASE, PubMed, and Science Direct databases. (3) Results: From 191 identified articles, 13 studies (1 from Korea and 12 from other countries) were selected for analysis. The results indicate that exercise interventions are effective in reducing pain in patients with SCI, with a particular emphasis on alleviating shoulder pain. (4) Conclusion: Exercise is essential for pain reduction in patients with SCI, especially those experiencing shoulder pain. However, there is a notable lack of experimental research focusing primarily on pain. The development of appropriate measurement instruments is crucial for the prevention and relief of pain in this patient population.

Creating a Rehabilitation Sports Public Service Information Systems Using Service Design Thinking: Physical Activity Management of the Disabled after Discharge in the Republic of Korea.

The Republic of Korea has established an institutional framework to expedite the provision of rehabilitation sports public services to individuals with disabilities post-hospital discharge (Act on Guarantee of Right to Health and Access to Health Services for People with Disabilities in December 2017). Regrettably, this service remains non-operational to date. This study employs a service design approach to identify and develop essential elements for the effective implementation of public rehabilitation sports services in Korea. Adopting the service design method, including the empathize-define-ideate-prototype phases, co-creation activities were conducted with three teams comprising people with disabilities, caregivers, rehabilitation physicians, specialized sports instructors, facility managers, and government officials, emphasizing equitable distribution. By leveraging the experiences of people with disabilities, these teams collaboratively engaged in creative activities to formulate strategies for delivering prompt and user-friendly rehabilitation sports public services post-hospital discharge. Contributions from each team were meticulously collected and organized, incorporating diverse perspectives into the development of the Korean Rehabilitation Sports Public Service Information System (KRSPSIS). Additionally, we presented a scenario illustrating the practical application of the KRSPSIS. Through this system, we anticipate providing more efficient and convenient rehabilitation sports public services to individuals with disabilities during the critical early stages following hospital discharge.

Predicting adoption of the assistive technology open platform: extended unified theory of acceptance and use of technology.

PURPOSE: The Assistive Technology (AT) Open Platform supports people with disabilities, older people, and developers in co-creating new assistive products outside the business realm. To address dissatisfaction with and non-adoption of commercial assistive products, the National Rehabilitation Centre in South Korea created an AT Open Platform as an open-source AT sharing platform to research and develop appropriate assistive technology suitable for users' needs. The emerging concept of AT Open Platform is new for both assistive product users and developers in South Korea. The Extended Unified Theory of Acceptance and Use of Technology (UTAUT2) was utilised to understand the factors influencing the adoption of the AT Open Platform and to gain further insights on its design and future use. MATERIALS AND METHODS: Interviews were conducted with six potential AT Open Platform users to develop a questionnaire for predicting behavioural intention. Subsequently, we surveyed 175 potential users to validate the UTAUT2. RESULTS: The results revealed that behavioural intention was significantly predicted by social influence, performance expectancy, facilitating conditions, and hedonic motivation. CONCLUSIONS: The AT Open Platform should focus on both online and offline platforms to educate and facilitate the co-creation of ATs for assistive product users and makers. This study, which targeted assistive product users and developers, has significant implications for policymakers and future research in using and adopting the AT Open Platform as it reflects the actual voices of the platform's stakeholders.

To address the issues of dissatisfaction and non-adoption of commercial assistive products, assistive technology platforms are established for the research and development of appropriate assistive technologies suitable for meeting user needs; the results are shared as open-source assistive technology.A survey was conducted with a targeted sample of assistive technology product users and developers. The study results are significant as they represent the perspectives of key stakeholders in the assistive technology platform. The study findings are expected to play an important role in the application and diffusion of the assistive technology platform in South Korea.The survey is the first to illuminate the adoption of an assistive technology platform in South Korea and is an important step towards empowering people with disabilities.

A study on the four-phase design and development process of 3D printed foot-operated safety nail clipper for people with stroke hemiplegia.

PURPOSE: Cutting nails is an essential activity of daily living. In this study, a foot-operated safety nail clipper for people with stroke hemiplegia was developed in four phases using three-dimensional (3D) printing technology. MATERIALS AND METHODS: A user was identified to develop a foot-operated, safe nail clipper for people with stroke hemiplegia (Phase 1). A single user repeatedly used the technology to determine necessary improvements (Phase 2). Then, the usability was evaluated by four people with disabilities (Phase 3) before the clipper was manufactured at multiple institutions to determine its reproducibility (Phase 4). RESULTS: The foot-operated safe nail clipper was upgraded during each phase. The Version 2.0 comprises twenty 3D printing materials and five readily-available materials. CONCLUSIONS: A foot-operated safety nail clipper was developed for people with stroke hemiplegia. The number of parts increased as the device was upgraded via the use of 3D printing and available materials. Based on a small-scale usability test, the device was best suited for people with stroke hemiplegia. The assistive device was shared with the assistive technology open platform as an open source. The four-phased process can be used to develop appropriate assistive technology devices through the Makers Movement in the future.

People with stroke hemiplegia who have limited hand movement have difficulty cutting their nails independently.The foot-operated safety nail clipper for people with stroke hemiplegia was developed using the four phases methodology to help them cutting their nails: (1) Identifying the heavy user, (2) single scale, (3) small scale, and (4) multi-site reproducibility.We hope that the four-phased process of designing and developing appropriate assistive technology (AAT) devices presents insights that can be used to develop AAT devices through the Makers Movement in the future.AAT based on digital fabrication can be released to the public based on open source for people with disability in a low resourced environment, and the 3D modelling design can be easily modified according to individual needs.

Development of a Set of Assessment Tools for Health Professionals to Design a Tailored Rehabilitation Exercise and Sports Program for People with Stroke in South Korea: A Delphi Study.

We developed a set of assessment tools for health professionals to evaluate the physical functions, mental functions, and social abilities of people with stroke (PWS) from 6 months to 3 years after stroke onset, to design a tailored "Rehabilitation Exercise and Sports" (RES) program, which the South Korean government was required to provide by the Act on Guarantee of Right to Health and Access to Health Services for people with disabilities. Since previous studies mainly dealt with the chronic stage of PWS, it would not be appropriate to apply assessment tools used in previous studies, as they are not compatible with the time window (6 months to 3 years) used to define the target population of the RES program. We reviewed the literature to identify evaluation factors and assessment tools applied in previous studies, and developed a Delphi questionnaire with closed-ended questions based on the literature review's results and supplementary open-ended questions. A 20-expert panel conducted four rounds of the Delphi survey, including two rounds to determine evaluation factors and two rounds to determine assessment tools. The Delphi survey revealed that 22 evaluation factors and 24 corresponding assessment tools reached consensus among the experts. However, no assessment tools reached consensus for three evaluation factors: muscle endurance, flexibility, and dynamic balance. A comprehensive set of assessment tools would be useful for health professionals to understand the health status of PWS from 6 months to 3 years after stroke onset, and help the design of tailored RES programs.

Home-Based Virtual Reality Exergame Program after Stroke Rehabilitation for Patients with Stroke: A Study Protocol for a Multicenter, Randomized Controlled Trial.

It is essential for stroke patients to maintain their therapy even after discharging inpatient rehabilitation. This is because recovery is an ongoing process that requires consistent effort. Virtual reality exergame training (VRET) is becoming widely used in stroke rehabilitation to improve physical, social, and psychological outcomes. Home-based VRET may be a more convenient and accessible option for stroke rehabilitation. This study will aim to determine the effectiveness of home-based VRET for patients with stroke who have been discharged from the hospital. This trial will randomly assign 120 participants to 8 weeks of either a VRET (intervention group) or daily life (control group). The study will measure cardiopulmonary endurance, muscular strength, functional capacity, gait, activities of daily living, and quality of life. Our main objective is to determine whether it is safe for patients to undergo VRET at home after they have been discharged from the hospital with a doctor's note. Additionally, we aim to examine whether stroke patients are capable of exercising at home after being discharged from the hospital. This study's outcome could pave the way for developing more comprehensive exercise protocols for stroke patients. Our findings will provide valuable insights into the efficacy of VRET as a therapeutic tool for stroke patients.

Protocol for Community-Based Exercise Training after Discharge from Hospital-Based Stroke Rehabilitation: A Multicenter, Randomized, Parallel-Group, Double-Blind Controlled Pilot and Feasibility Trial.

Exercise training participation of patients with stroke in the community after discharge from the hospital has many benefits for physical, social, and psychological rehabilitation and improves their quality of life. However, in the Republic of Korea, studies on stroke survivors who can participate in an exercise training program have not been conducted. This trial aims to investigate the effectiveness of exercise training programs after patients with stroke are discharged from the hospital with a doctor's note and referred to a community exercise center, as there is a lack of studies on this population. This multicenter, randomized, parallel-group, double-blind controlled pilot and feasibility trial will randomly assign 120 patients with stroke to either 8 weeks of a community-based exercise training program (experimental group) or activities of daily living (control group). The primary outcomes will be muscle strength, cardiorespiratory fitness, body composition, physical performance, and gait. The secondary outcomes will be quality of life and activities of daily living. This study's results may add new insights into the effectiveness of community-based exercise training programs after patients with stroke are discharged from the hospital with a doctor's note and referred to a community exercise center. The success of the new exercise training approach could offer valuable information for developing more inclusive protocols for patients with stroke in the future if it proves to be efficacious.

The efficacy of community-based exercise programs on circulating irisin level, muscle strength, cardiorespiratory endurance, and body composition for ischemic stroke: a randomized controlled trial.

Objective: We investigated the changes in circulating irisin levels after community-based exercise and the association of these levels with improvements in muscle strength, cardiorespiratory endurance, and body composition in people with ischemic stroke. Methods: Twenty participants were randomly assigned to either a control or an exercise group. The community-based exercise program (CEP) consisted of 8 weeks of 1 h sessions for 3 days a week. Irisin levels, muscle strength, cardiorespiratory endurance, and body composition were assessed before and after the intervention. Results: Significant improvements were observed in the leg and trunk strength, peak oxygen consumption values, and body composition of the exercise group compared with the control group. In addition, circulating irisin levels were observed to have increased in the exercise group, positively correlated with muscle strength and cardiorespiratory endurance. Conclusion: CEP might be an effective intervention to increase irisin levels and prevent a stroke-related decline in muscle function.

A preliminary study on the feasibility of community game-based respiratory muscle training for individuals with high cervical spinal cord injury levels: a novel approach.

BACKGROUND: Respiratory disorders result in rehospitalization and premature death of patients with cervical spinal cord injuries (CSCI). Community game-based respiratory muscle training (RMT) programs could reduce secondary complications. METHODS: We examined the feasibility and preliminary efficacy of RMT as a community-based exercise program. Among the 10 included participants (eight male and two female), four, one, one, and four reported C3, C4, C5, and C6 complete injuries, respectively (eight graded by American Spinal Injury Association impairment scale [ASIA] A and two by ASIA B). Their mean age was 43 ± 12.3 y. The time since injury was 10 ± 6.7 y. The participants completed an RMT program for 60 min/day, twice weekly, for 8 weeks. The participants were trained in the use of a newly developed game-based RMT device. The device provides consistent pressure for respiratory muscle strength and endurance training. Seven RMT devices were modified to allow 10 game-based RMT programs. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), peak expiratory flow (PEF), vital capacity (VC), inspiratory capacity (IC), inspiratory reserve volume (IRV), expiratory reserve volume (ERV), maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), and peak cough flow (PCF) were measured. RESULTS: There were improvements after RMT compared to pre-RMT in FVC (p = 0.027, 10.62%, 0.22 effect size [ES]), PEF (p = 0.006, 23.21%, 0.45 ES), VC (p = 0.002, 35.52%, 0.60 ES), IC (p = 0.001, 46.94%, 0.81 ES), IRV (p = 0.001, 90.53%, 1.22 ES), MIP (p = 0.002, 97.25%, 1.32 ES), MEP (p = 0.005, 141.12%, 1.07 ES), and PCF (p = 0.001, 35.60%, 0.74 ES). The participants reported a positive impact of the program. CONCLUSIONS: Community game-based RMT for individuals with CSCI appears to be safe and feasible. Community exercise with RMT use may have a positive impact on the respiratory measures for patients with CSCI who are vulnerable to respiratory compromise. TRIAL REGISTRATION: KCT0005980.

Effects of Resistance Circuit Training on Health-Related Physical Fitness in People With Paraplegia: A Pilot Randomized Controlled Trial.

OBJECTIVE: To evaluate the efficacy and safety of 8 weeks of resistance circuit training in people with paraplegia due to spinal cord injury. METHODS: Participants were randomized into experimental and control groups. Although the intensity and sequence of movements of the exercise programs were identical in both groups, the resting time between sets was limited to 1 minute in the experimental group. In the control group, the participants were allowed to rest until they were comfortable. Both groups received 8 weeks of training twice per week. Before and after the program, muscle mass, body fat percentage, fat mass, blood pressure, heart rate, muscle strength and muscular endurance were evaluated, and 6-minute propulsion test was conducted. Additionally, the safety of the program was assessed. RESULTS: Twenty-two individuals with paraplegia were enrolled (11 in each group). After the training program, the experimental group showed a significant decrease in the resting blood pressure and improvement in the upper extremity muscle mass, strength, and endurance (p<0.05). Each variable showed significant inter-group differences (p<0.05). Furthermore, none of the participants showed autonomic adverse events, musculoskeletal side effects, or discomfort. CONCLUSION: The results show that resistance circuit training programs with short resting intervals are superior to the usual resistance exercise programs in improving the blood pressure and physical strength and are safe for people with upper thoracic level injuries at T6 or higher.

Evaluation of expert views and considerations to develop rehabilitation sports public services for persons with disabilities in Republic of Korea: a Delphi study.

BACKGROUND: Physical activity is required to maintain health; however, resources needed for physical activity (e.g. facilities, instructors, and programmes) are scarce for persons with disabilities (PWD), particularly those who require rehabilitation following hospital discharge and those with severe disabilities. The Republic of Korea presently lacks a legal and administrative framework that supports the implementation of health services for PWD. Therefore, it is necessary to develop such a framework based on the perspectives of PWD, medical and physical education experts, facility managers, and government organisations. Thus, this study aimed to establish expert consensus on the development of rehabilitation sports public services (RSPS) in the Republic of Korea by reviewing previous studies and expert statements. METHODS: Using the Delphi method, we reviewed the literature to identify the critical roles and factors required for planning efficient RSPS programmes, including coordinators, physicians, facility managers, rehabilitation exercise and physical education instructors, and integrated information systems for facilities, instructors, and programmes. We developed a Delphi questionnaire with closed-ended questions, based on the factors derived from the literature review and supplementary open-ended questions, which was administered to a panel of 26 experts. RESULTS: The panel reached a consensus on most factors (i.e. coordinators, physicians, facility managers, rehabilitation exercise and physical education instructors, and integrated information systems for facilities, instructors, and programmes). However, no consensus was reached regarding 'when an applicant can continue/discontinue an RSPS programme', 'establishing information systems to manage physical fitness of PWD', and 'joint operation of the to-be-established system by the Ministry of Health and Welfare and Ministry of Culture, Sports, and Tourism', leaving room for further debate. CONCLUSIONS: By identifying the factors and roles necessary for RSPS, this study is expected to offer valuable information for state-led pilot projects and contribute to promoting physical activity and quality of life among PWD.

Comparing the effects of multicomponent exercise with or without power training on the cardiorespiratory fitness, physical function, and muscular strength of patients with stroke: a randomized controlled trial.

BACKGROUND: Literature studies concerning the effect of implementing a multicomponent program with different individual exercise intensities are insufficient. This study aimed to examine the effects of performing a multicomponent exercise program incorporating high-speed power training on cardiorespiratory fitness, physical function, and muscular strength in poststroke patients. We compared the results of two different exercise regimens: high-speed power training and traditional low-speed strength training. METHODS: Forty-five poststroke patients were randomly assigned to the high-speed, low-speed, and control groups. A 60-min multicomponent exercise program was conducted three times per week for 8 weeks in the two exercise groups, whereas static stretching was performed in the control group. Cardiorespiratory fitness, physical function, and muscular strength were assessed before and after the intervention. RESULTS: Significant improvements were observed in the peak oxygen consumption values and results of the Berg balance scale, Korean version of the Trunk Impairment Scale, and Timed Up-and-Go test. The aforementioned were evaluated as a measure of cardiorespiratory function and functional ability in the exercise groups and compared to those obtained in the control group. High-speed power training led to greater improvement in patients compared with low-speed strength training. CONCLUSIONS: Multicomponent exercise involving high-speed power training was beneficial in helping patients with stroke regain cardiorespiratory fitness, physical function, and muscular strength.

Development and pilot testing of novel game-based respiratory rehabilitation exercise devices for patients with tetraplegia.

BACKGROUND: Individuals with spinal cord injuries (SCI) show restricted breathing patterns with reduced lung volumes and capacities. OBJECTIVE: To improve breathing in such individuals, we aimed to develop breathing exercise devices using a user-centered design (UCD) and then assess the effects of these devices on breathing. METHODS: Patients with SCI were involved in the device development. Preliminary online survey participants were recruited from the community, and interview and pilot test participants were recruited from a patient self-help group. The four UCD phases were repeatedly performed. Users required fun, easy, multi-player, and safe exercise devices. RESULTS: Seven breathing exercise devices were developed, and 10 different game-based exercises were performed. Two individuals participated in a pilot test involving a respiratory rehabilitation exercise program conducted twice weekly for 60 min/session over 8 weeks. Lung function was assessed using a spirometer. Forced vital capacity, forced expiratory volume in 1 s, and vital capacity showed minimal changes, whereas maximum inspiratory and expiratory pressures improved. Participants reported that the exercises were entertaining and that the competitive nature of the game-like exercises encouraged further participation. CONCLUSION: Breathing exercise programs using our developed devices can improve breathing and positively affect the psychological states and sociability of users.

Development and Evaluation of a Classified and Tailored Community-Based Exercise Program According to the Mobility Level of People with Stroke Using the Knowledge to Action Framework.

Attempts to classify the mobility levels of people with stroke (PWS) for a tailored exercise program in community settings have been few. We developed and evaluated a classified and tailored community-based (CTC) exercise program according to the mobility level of PWS. Forty-two PWS were classified into the Supine and Sitting, Sitting and Standing, and Standing and Gait groups, based on a newly developed classification model and participated in a group-based CTC exercise program for 1 h/day twice/week for 10 weeks. The health outcome measures were blood pressure, lipid profile, glucose control, body composition, ventilatory capacity, and physical and psychological function. The rate of agreement on classification results among the physiotherapists was analysed. For all participants, significant improvements were noted in the blood pressure, lipid profile, body composition, ventilatory capacity, and physical and psychological function. The lower mobility groups showed significant improvements in a greater number of health outcomes than the higher mobility group. The physiotherapists' agreement regarding the classification results was 91.16 ± 5.14%, verifying the model's possible high relevance to the community. The effective improvement in participant health implied that the CTC exercise program was well tailored to the participants' mobility levels, particularly the lower mobility groups.

Patient perspectives on virtual reality-based rehabilitation after knee surgery: Importance of level of difficulty.

This article explored the perspectives of 25 patients regarding virtual reality (VR)-based rehabilitation following knee surgery and identified the important factors that allowed patients to immerse themselves in rehabilitation. Qualitative analysis of data collected via open-ended questionnaire and quantitative analysis of data from physical assessments and surveys were conducted. In the open-ended questionnaire, the majority of participants mentioned level of difficulty as the most common reason for selecting both the most and the least immersive exercise programs. Quantitative analysis showed that participants experienced a high level of flow (3.9 +/- 0.3 out of 5.0) and a high rate of expectation of therapeutic effect (96%) and intention of exercise adherence (96%). Further, participants with more severe pain or physical dysfunction tended to have more positive experiences (e.g., Difficulty-Skill Balance, Clear Goals, and Transformation of Time), leading to high levels of flow during VR-based rehabilitation. In conclusion, VR-based games are potentially acceptable as a motivational rehabilitation tool for patients following knee surgery. However, to best meet patients' needs, it might be useful to equip a VR program with varied levels of difficulty, taking into account the severity of the individual's knee injury. Additionally, severe pain or physical dysfunction might act as an indication rather than a contraindication for VR-based rehabilitation.

A Further Step to Develop Patient-Friendly Implementation Strategies for Virtual Reality-Based Rehabilitation in Patients With Acute Stroke.

BACKGROUND: Virtual reality (VR)-based rehabilitation is gaining attention as a way to promote early mobilization in patients with acute stroke. However, given the motor weakness and cognitive impairment associated with acute stroke, implementation strategies for overcoming patient-perceived difficulty need to be developed to enhance their motivation for training. OBJECTIVE: The purpose of this study was to explore patient-perceived difficulty and enjoyment during VR-based rehabilitation and the factors affecting those experiences. DESIGN: An exploratory mixed-method design was used in this study. METHODS: Eight individuals with acute stroke participated in 2 training modes of VR-based rehabilitation (ie, workout and game modes) 20 to 30 minutes per day for 5 to 8 sessions. A visual analog scale was used to assess patient-perceived difficulty and enjoyment at every session. Then semistructured interviews were conducted to explore the factors affecting those experiences. RESULTS: Levels of difficulty and enjoyment varied depending on the training mode and participants' phases of recovery. Five major factors were identified as affecting those varied experiences: (1) ease of following the directions, (2) experience of pain, (3) scores achieved, (4) novelty and immediate feedback, and (5) self-perceived effectiveness. CONCLUSIONS: Levels of difficulty and enjoyment during VR-based rehabilitation differed depending on the phases of recovery and training mode. Therefore, graded implementation strategies for VR-based rehabilitation are necessary for overcoming patient-perceived difficulty and enhancing enjoyment. Ease of following the directions might be best considered in the very early stage, whereas multisensory feedback may be more necessary in the later stage. Health professionals also should find a way for patients to avoid pain during training. Feedback, such as knowledge of results and performance, should be used appropriately.