Effect of Tele-exercise to Promote Empowered Movement for Individuals With Spinal Cord Injury (TEEMS) Program on Physical Activity Determinants and Behavior: A Mixed Methods Assessment.

OBJECTIVE: To assess the effects of group tele-exercise participation on physical activity (PA) determinants and behavior as identified by social cognitive theory (SCT) in individuals with spinal cord injury (SCI). DESIGN: This clinically registered non-randomized trial [NCT05360719] used a single-group parallel mixed methods design. Quantitative and qualitative primary measures were assessed at pre-program and after 8-week intervention completion (post-program), with an additional 8-week period retention to capture quantitative assessments only. SETTING: Community. PARTICIPANTS: Individuals with chronic SCI (N=22, injury duration 2-50 years) aged 26-68 years (10 male/12 female). INTERVENTION: An 8-week group tele-exercise program for individuals with SCI consisting of biweekly 60-minute classes delivered via live Web-conferencing software. MAIN OUTCOME MEASURES: Exercise self-efficacy (Exercise Self-efficacy Scale for SCI: ESES), outcome expectations for exercise (Multidimensional Outcome Expectations for Exercise: MOEES), weekly PA minutes measured through quantitative assessments (Leisure Time PA Questionnaire for SCI: LTPAQ), and parallel qualitative thematic analysis of focus group interview transcripts. RESULTS: Congruence between numeric and thematic findings was present for exercise self-efficacy and self-evaluative exercise outcome expectations. Improved exercise self-efficacy was influenced by exercise knowledge gained during program participation. Increased expectations of internal exercise outcomes, such as influence on psychological state and overall mood, occurred after program participation. Participant descriptions of the portability and sustainability of the program leading to added movement in everyday life were not reflected in the numeric scores of LTPAQ assessment. CONCLUSIONS: Participation in an 8-week group tele-exercise program positively affected personal determinants of PA behavior immediately after participation. Future investigations should include a control group and biophysical PA measures such as wearable digital health devices.

Enhancing SCI Care: Using Wearable Technologies for Physical Activity, Sleep, and Cardiovascular Health.

Wearable devices have the potential to advance healthcare by enabling real-time monitoring of biobehavioral data and facilitating the management of an individual's health conditions. Individuals living with spinal cord injury (SCI) have impaired motor function, which results in deconditioning and worsening cardiovascular health outcomes. Wearable devices may promote physical activity and allow the monitoring of secondary complications associated with SCI, potentially improving motor function, sleep, and cardiovascular health. However, several challenges remain to optimize the application of wearable technologies within this population. One is striking a balance between research-grade and consumer-grade devices in terms of cost, accessibility, and validity. Additionally, limited literature supports the validity and use of wearable technology in monitoring cardio-autonomic and sleep for individuals with SCI. Future directions include conducting performance evaluations of wearable devices to precisely capture the additional variation in movement and physiological parameters seen in those with SCI. Moreover, efforts to make the devices small, lightweight, and inexpensive for consumer ease of use may impact those with severe motor impairments. Overcoming these challenges holds the potential for wearable devices to help individuals living with SCI receive timely feedback to manage their health conditions and help clinicians gather comprehensive patient health information to aid in diagnosis and treatment.

Enhancing the Content Validity of Self-Reported Physical Activity Self-Efficacy in Adolescents: A Qualitative Study.

PURPOSE: This study's primary purpose was to enhance the content validity of a self-reported measure of self-efficacy for physical activity (PA) in adolescents. This was addressed through assessment of younger and older adolescents' understanding of the construct of self-efficacy for PA, coupled with assessment of the content coverage and comprehensibility of items derived from existing measures. METHODS: Participants completed individual semistructured and cognitive debriefing interviews as well as 3 PA self-efficacy questionnaires. RESULTS: Thematic analysis identified personal and environmental facilitators and barriers to PA self-efficacy. The major categories were physical; psychological; interaction with surroundings; support and relationships; attitudes; and services, systems, and natural environments. Cognitive interviews resulted in the retention of 52 final items: 24 for self-efficacy with perceived facilitators and 28 for self-efficacy to overcome barriers. CONCLUSIONS: This study provides a PA self-efficacy instrument with expanded content coverage that is relevant to adolescents as young as 11 years. With further validation testing in future studies, this instrument will enable pediatric physical therapists and researchers to assess PA self-efficacy and design effective intervention strategies to improve PA.

Movement Coordination During Humeral Elevation in Individuals With Newly Acquired Spinal Cord Injury.

Humeral elevation is a critical motion for individuals who use a manual wheelchair given that, in a typical day, wheelchair users reach overhead 5 times more often than able-bodied controls. Kinematic analyses in individuals with chronic spinal cord injury (SCI) have focused on weight-bearing tasks rather than overhead reaching. This technical report presents shoulder movement coordination during overhead reaching in individuals with newly acquired SCI. Eight volunteers with acute SCI and 8 matched, uninjured controls participated. Three-dimensional kinematics were collected during seated, humeral elevation. Scapular and thoracic rotations during humeral elevation were averaged across repetitions. The linear relationship of scapular upward rotation to humeral elevation provided movement coordination analysis. Maximal elevation was reduced in SCI with increased thoracic kyphosis. Medium to large effect sizes were found at each elevation angle, with reduced scapular external rotation, posterior tilt, and increased thoracic kyphosis for those with SCI. The linear relationship occurred later and within a significantly (P = .02) smaller range of humeral elevation in SCI. Altered movement coordination, including a diminished linear association of scapular upward rotation and humeral elevation (scapulohumeral rhythm), is found with reduced maximal elevation and increased thoracic kyphosis during overhead reaching tasks in those with acute SCI.

Longitudinal Prediction of Quality-of-Life Scores and Locomotion in Individuals With Traumatic Spinal Cord Injury.

OBJECTIVES: To examine (1) differences in quality-of-life scores for groups based on transitions in locomotion status at 1, 5, and 10 years postdischarge in a sample of people with spinal cord injury (SCI); and (2) whether demographic factors and transitions in locomotion status can predict quality-of-life measures at these time points. DESIGN: Retrospective case study of the National SCI Database. SETTING: Model SCI Systems Centers. PARTICIPANTS: Individuals with SCI (N=10,190) from 21 SCI Model Systems Centers, identified through the National SCI Model Systems Centers database between the years 1985 and 2012. Subjects had FIM (locomotion mode) data at discharge and at least 1 of the following: 1, 5, or 10 years postdischarge. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: FIM-locomotion mode; Severity of Depression Scale; Satisfaction With Life Scale; and Craig Handicap Assessment and Reporting Technique. RESULTS: Participants who transitioned from ambulation to wheelchair use reported lower participation and life satisfaction, and higher depression levels (P<.05) than those who maintained their ambulatory status. Participants who transitioned from ambulation to wheelchair use reported higher depression levels (P<.05) and no difference for participation (P>.05) or life satisfaction (P>.05) compared with those who transitioned from wheelchair to ambulation. Demographic factors and locomotion transitions predicted quality-of-life scores at all time points (P<.05). CONCLUSIONS: The results of this study indicate that transitioning from ambulation to wheelchair use can negatively impact psychosocial health 10 years after SCI. Clinicians should be aware of this when deciding on ambulation training. Further work to characterize who may be at risk for these transitions is needed.

Estimation of Energy Expenditure for Wheelchair Users Using a Physical Activity Monitoring System.

OBJECTIVE: To develop and evaluate energy expenditure (EE) estimation models for a physical activity monitoring system (PAMS) in manual wheelchair users with spinal cord injury (SCI). DESIGN: Cross-sectional study. SETTING: University-based laboratory environment, a semistructured environment at the National Veterans Wheelchair Games, and the participants' home environments. PARTICIPANTS: Volunteer sample of manual wheelchair users with SCI (N=45). INTERVENTION: Participants were asked to perform 10 physical activities (PAs) of various intensities from a list. The PAMS consists of a gyroscope-based wheel rotation monitor (G-WRM) and an accelerometer device worn on the upper arm or on the wrist. Criterion EE using a portable metabolic cart and raw sensor data from PAMS were collected during each of these activities. MAIN OUTCOME MEASURES: Estimated EE using custom models for manual wheelchair users based on either the G-WRM and arm accelerometer (PAMS-Arm) or the G-WRM and wrist accelerometer (PAMS-Wrist). RESULTS: EE estimation performance for the PAMS-Arm (average error ± SD: -9.82%±37.03%) and PAMS-Wrist (-5.65%±32.61%) on the validation dataset indicated that both PAMS-Arm and PAMS-Wrist were able to estimate EE for a range of PAs with <10% error. Moderate to high intraclass correlation coefficients (ICCs) indicated that the EE estimated by PAMS-Arm (ICC3,1=.82, P<.05) and PAMS-Wrist (ICC3,1=.89, P<.05) are consistent with the criterion EE. CONCLUSIONS: Availability of PA monitors can assist wheelchair users to track PA levels, leading toward a healthier lifestyle. The new models we developed can estimate PA levels in manual wheelchair users with SCI in laboratory and community settings.

The Effects of Age and Height on Gait Smoothness in Adolescent Athletes.

(1) Background: Despite evidence of increased rates of sports injury during the years surrounding peak growth in adolescents, little is known regarding the relationship between adolescent growth and gait stability. The aim of this study was to gain a better understanding of how chronological age and height relate to gait stability in both male and female adolescents. (2) Methods: Participants (N = 67; females: n = 34, ages 8.7-15.9 years; males: n = 33, ages 10.0-16.7 years) completed two trials of treadmill walking at varying speeds: the preferred walking speed and 30% above and below. Trials were separated by a bout of fatiguing exercises. HarmonicRatios of the trunk, calculated from acceleration signals taken during walking, were used to quantify gait stability. Data were separated by sex and relationships between height and chronological age, and HarmonicRatios were assessed using multiple linear regression. (3) Results: Females' HarmonicRatios improved with chronological age both before and after fatigue. Males' HarmonicRatios increased with chronological age before fatigue; however, this effect was eliminated post-fatigue. Females' height was negatively associated with HarmonicRatios post-fatigue. Males' height was positively associated with HarmonicRatios pre-fatigue. (4) Conclusions: The study findings suggest sex differences in the effects of fatigue on gait stability during adolescence. In both sexes, HarmonicRatios increased with chronological age. These improvements were eliminated for males and altered for females with fatigue. The results of this study indicate the need for the reevaluation of sports progression based on chronological age in adolescents.

Differential relationships between physical activity and pain phenotypes in individuals with spinal cord injury.

BACKGROUND: Chronic pain affects 70% of individuals with spinal cord injury (SCI) and leads to declines in health and quality of life. Neuropathic and nociceptive pain are phenotypes derived from different mechanisms that contribute to pain perception. The objective of this research was to investigate differential pain responses to moderate-to-vigorous physical activity (MVPA) in two chronic pain phenotypes: neuropathic and nociceptive pain. METHODS: Community-based physical activity levels were collected for one week in 17 individuals with SCI using a wrist-worn accelerometer, and daily pain ratings were assessed and categorized by phenotype. Physical activity levels were summarized to calculate minutes of MVPA. Correlational analyses were conducted to compare relationships between pain intensity and MVPA across individual participants and between pain phenotype groups. RESULTS: The neuropathic pain group revealed significant negative correlation between MVPA and pain intensity. In the nociceptive pain group, there was no significant correlation between MVPA and pain intensity. Further analysis revealed two subgroups of positive (N = 4) and negative (N = 3) correlations between MVPA and pain intensity. Pain location differed between the subgroups of nociceptive pain. Individuals with negative correlation experienced neck and upper back pain, whereas individuals with positive correlation experienced unilateral upper extremity pain. CONCLUSION: Differential relationships exist between pain phenotypes and MVPA in individuals with SCI. Pain location differed between the subgroups of nociceptive pain, which we presume may indicate the presence of nociplastic pain in some individuals. These results may contribute to the advancement of personalized pain management by targeting non-pharmacological interventions for specific pain phenotypes.Trial registration: ClinicalTrials.gov identifier: NCT05236933..

mHealth-Based Just-in-Time Adaptive Intervention to Improve the Physical Activity Levels of Individuals With Spinal Cord Injury: Protocol for a Randomized Controlled Trial.

BACKGROUND: The lack of regular physical activity (PA) in individuals with spinal cord injury (SCI) in the United States is an ongoing health crisis. Regular PA and exercise-based interventions have been linked with improved outcomes and healthier lifestyles among those with SCI. Providing people with an accurate estimate of their everyday PA level can promote PA. Furthermore, PA tracking can be combined with mobile health technology such as smartphones and smartwatches to provide a just-in-time adaptive intervention (JITAI) for individuals with SCI as they go about everyday life. A JITAI can prompt an individual to set a PA goal or provide feedback about their PA levels. OBJECTIVE: The primary aim of this study is to investigate whether minutes of moderate-intensity PA among individuals with SCI can be increased by integrating a JITAI with a web-based PA intervention (WI) program. The WI program is a 14-week web-based PA program widely recommended for individuals with disabilities. A secondary aim is to investigate the benefit of a JITAI on proximal PA, defined as minutes of moderate-intensity PA within 120 minutes of a PA feedback prompt. METHODS: Individuals with SCI (N=196) will be randomized to a WI arm or a WI+JITAI arm. Within the WI+JITAI arm, a microrandomized trial will be used to randomize participants several times a day to different tailored feedback and PA recommendations. Participants will take part in the 24-week study from their home environment in the community. The study has three phases: (1) baseline, (2) WI program with or without JITAI, and (3) PA sustainability. Participants will provide survey-based information at the initial meeting and at the end of weeks 2, 8, 16, and 24. Participants will be asked to wear a smartwatch every day for ≥12 hours for the duration of the study. RESULTS: Recruitment and enrollment began in May 2023. Data analysis is expected to be completed within 6 months of finishing participant data collection. CONCLUSIONS: The JITAI has the potential to achieve long-term PA performance by delivering tailored, just-in-time feedback based on the person's actual PA behavior rather than a generic PA recommendation. New insights from this study may guide intervention designers to develop engaging PA interventions for individuals with disability. TRIAL REGISTRATION: ClinicalTrials.gov NCT05317832; https://clinicaltrials.gov/study/NCT05317832. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/57699.

Development and evaluation of a gyroscope-based wheel rotation monitor for manual wheelchair users.

OBJECTIVE: To develop and evaluate a wireless gyroscope-based wheel rotation monitor (G-WRM) that can estimate speeds and distances traveled by wheelchair users during regular wheelchair propulsion as well as wheelchair sports such as handcycling, and provide users with real-time feedback through a smartphone application. METHODS: The speeds and the distances estimated by the G-WRM were compared with the criterion measures by calculating absolute difference, mean difference, and percentage errors during a series of laboratory-based tests. Intraclass correlations (ICC) and the Bland-Altman plots were also used to assess the agreements between the G-WRM and the criterion measures. In addition, battery life and wireless data transmission tests under a number of usage conditions were performed. RESULTS: The percentage errors for the angular velocities, speeds, and distances obtained from three prototype G-WRMs were less than 3% for all the test trials. The high ICC values (ICC (3,1) > 0.94) and the Bland-Altman plots indicate excellent agreement between the estimated speeds and distances by the G-WRMs and the criterion measures. The battery life tests showed that the device could last for 35 hours in wireless mode and 139 hours in secure digital card mode. The wireless data transmission tests indicated less than 0.3% of data loss. CONCLUSION: The results indicate that the G-WRM is an appropriate tool for tracking a spectrum of wheelchair-related activities from regular wheelchair propulsion to wheelchair sports such as handcycling. The real-time feedback provided by the G-WRM can help wheelchair users self-monitor their everyday activities.

Potential of social engagement for overcoming barriers to physical activity in individuals with spinal cord injury.

Introduction: Many barriers to physical activity (PA) exist for individuals with spinal cord injury (SCI). Social engagement may improve motivation to perform PA, which in turn may increase PA levels. This pilot study investigates how social engagement facilitated by mobile technology may reduce lack of motivation as a barrier to PA in individuals with SCI and demonstrates design implications for future technologies. Methods: A user-needs survey was conducted with participants in the community. We recruited 26 participants (16 individuals with SCI and 10 family members or peers). A participatory design process using semi-structured interviews was used to identify themes relating to PA barriers. Results: One theme related to PA barriers was lack of PA-focused forums to connect with peers. Participants with SCI considered connecting with other individuals with SCI more motivating than connecting with their family members. Another key finding was that participants with SCI did not perceive that personal fitness trackers were targeted towards wheelchair-based activities. Conclusions: Engagement and communication with peers who have similar functional mobility levels and life experiences can potentially improve motivation for PA; however, PA-motivational platforms are not tailored towards wheelchair-users. Our preliminary findings show that some individuals with SCI are not satisfied with current mobile-technologies for wheelchair-based PA.

Convergent Validity of the Patient Reported Outcome Measurement Information System-Pediatric Physical Activity Instrument (PROMIS®-PA) with Wearable Devices in Adolescents.

The study was conducted mainly to examine the convergent validity of the Patient Reported Outcome Measurement Information System-Pediatric Physical Activity instrument (PROMIS®®®-PA) with step counts from wearable devices and another validated self-reported outcome measure. As a secondary aim, we explored the effect of different recall time frames (7-day, end-of-day [EoD], and ecological momentary assessment [EMA] time frames during the day) in terms of their feasibility and associations with each other and with step counts. This was a prospective cohort study that examined the associations between measures of PA in school-age children and adolescents (n = 84, aged 10-20). The participants wore Fitbit devices for 7 consecutive days, and then completed the 7-day-recall PROMIS-PA short form and Youth Activity Profile (YAP). Additional analyses were completed in a sub-sample (n = 25, aged 11-18 years) using the PROMIS-PA for the EMA at five intervals during the day (shorter form) and at the EoD. In the total sample, the PROMIS-PA results showed positive moderate correlations with the YAP and average daily steps (r = 0.533, p < 0.001 and r = 0.346, p = 0.002, respectively). In the sub-sample, the 7-day PROMIS-PA was highly correlated with the averaged EMA or EoD ratings for the week, and moderately correlated with the daily step counts. These findings support the validity of the PROMIS-PA as a measure of self-reported physical activity. Adolescents demonstrated higher compliance rates and preference for the 7-day recall and EoD assessments compared to more frequent EMA reporting.

Assessing functional recovery for individuals with spinal cord injury post-discharge from inpatient rehabilitation.

OBJECTIVE: To determine the associations between trauma variables, acute phase-related variables, and patient-level characteristics with functional recovery during the first-year post-discharge from inpatient rehabilitation facilities (IRF) for individuals with spinal cord injury (SCI). DESIGN: Retrospective cohort analysis. SETTING: Two SCI Model Centers in Pennsylvania, United States. METHODS: We were able to link 378 individuals with traumatic SCI between the Pennsylvania Trauma Systems Outcomes Study and the National SCI Model Systems databases. Nineteen individuals with SCI were excluded due to missing data. We estimated functional recovery based on changes in functional independence measure (FIM) total motor score during the first-year post-discharge from IRF in 359 individuals with SCI, who did not have any missing data, using ordinary least squares regression (OLS). RESULTS: After discharge from IRF the majority of individuals with SCI improved over the first-year post-injury. Individuals with cervical A-C (injury severity group) who were older had a slight decrease in motor FIM at 1-year post-injury. Regression analysis indicated that lower functional recovery was associated with being of Black and Hispanic race and ethnicity, higher injury severity group, occurrence of non-pulmonary infection during acute care, and longer length of stay at IRF (R2 = 0.36). CONCLUSIONS: Patient-level characteristics, trauma variables, and acute phase-related variables were associated with functional recovery post-discharge from IRF. Further research is necessary to collect and assess post-rehabilitation and socio-economic factors that play a critical role in continued functional recovery in the community.

Predicting energy expenditure of manual wheelchair users with spinal cord injury using a multisensor-based activity monitor.

OBJECTIVE: To develop and evaluate new energy expenditure (EE) prediction models for manual wheelchair users (MWUs) with spinal cord injury (SCI) based on a commercially available multisensor-based activity monitor. DESIGN: Cross-sectional. SETTING: Laboratory. PARTICIPANTS: Volunteer sample of MWUs with SCI (N=45). INTERVENTION: Subjects were asked to perform 4 activities including resting, wheelchair propulsion, arm-ergometer exercise, and deskwork. Criterion EE using a metabolic cart and raw sensor data from a multisensor activity monitor was collected during each of these activities. MAIN OUTCOME MEASURES: Two new EE prediction models including a general model and an activity-specific model were developed using enhanced all-possible regressions on 36 MWUs and tested on the remaining 9 MWUs. RESULTS: The activity-specific and general EE prediction models estimated the EE significantly better than the manufacturer's model. The average EE estimation error using the manufacturer's model and the new general and activity-specific models for all activities combined was -55.31% (overestimation), 2.30% (underestimation), and 4.85%, respectively. The average EE estimation error using the manufacturer's model, the new general model, and activity-specific models for various activities varied from -19.10% to -89.85%, -18.13% to 25.13%, and -4.31% to 9.93%, respectively. CONCLUSIONS: The predictors for the new models were based on accelerometer and demographic variables, indicating that movement and subject parameters were necessary in estimating the EE. The results indicate that the multisensor activity monitor with new prediction models can be used to estimate EE in MWUs with SCI during wheelchair-related activities mentioned in this study.

Staying active after rehab: Physical activity perspectives with a spinal cord injury beyond functional gains.

Lifestyle physical activity following spinal cord injury (SCI) is critical for functional independence, mental wellness, and social participation, yet nearly 50% of individuals with SCI report no regular exercise. The objective of this study was to better understand factors leading to this participation gap by capturing the physical activity perspectives of individuals living with SCI. We completed small group interviews with nine individuals living with SCI across the United States. Iterative thematic analysis systematically revealed meaningful core concepts related to physical activity engagement with SCI. Emergent themes revealed challenges to lifestyle physical activity behavior including gaps in physical activity education, isolation during psychological adjustment, and knowledge limitations in community exercise settings. A secondary theme related to the COVID-19 pandemic emerged, highlighting additional environmental constraints affecting participation. Our findings suggest that most physical activity education is delivered during inpatient rehabilitation and is related to physical function. Lifetime physical activity strategies are achieved through self-education and peer networking. Personal motivators for physical activity include secondary condition prevention, while social and emotional barriers prevent regular adherence. These findings can inform the development and delivery of physical activity programs to maximize physical activity engagement in individuals living with chronic SCI.

Factors associated with post-acute functional status and discharge dispositions in individuals with spinal cord injury.

BACKGROUND: Research has evaluated the effect of surgical timing on patient functional recovery in individuals with spinal cord injury (SCI); however, there is a critical need to assess how demographics, clinical characteristics, and process of care affect functional outcomes. OBJECTIVE: We examined the association between demographic, clinical, and process of care factors with post-acute functional status (locomotion and transfer mobility scores) and discharge disposition (home vs. institution) in individuals with SCI. METHODS: This study was a retrospective cohort analysis of the Pennsylvania Trauma Systems Outcomes Study (PTOS) database for individuals with traumatic SCI (N = 2223). We conducted multinomial and binomial logistic regression analyses to examine post-acute functional status and discharge disposition, respectively. RESULTS: The results indicated that older age, longer length of stay, lower Glasgow Coma Scale (GCS), higher Injury Severity Score (ISS), and individuals with tetraplegia had significantly lower motor functional score at discharge from an acute hospital. In addition, older age, individuals with public-sponsored insurance, longer length of stay, lower GCS, and higher ISS had significantly higher odds of being discharged to an institution, as compared to home. Individuals of Hispanic ethnicity, as compared to White, had lower odds of being discharged to an institution. CONCLUSIONS: The regression models developed in this study were able to better classify discharge destinations compared to the functional outcomes at discharge from the acute hospital. Further research is necessary to determine how these factors and their associations vary nationally across the US, which have the potential to inform trauma and acute care post-SCI.

Evaluating associations between trauma-related characteristics and functional recovery in individuals with spinal cord injury.

OBJECTIVE: To determine the associations between trauma variables, acute phase-related variables, and patient-level characteristics with functional recovery during inpatient rehabilitation for individuals with spinal cord injury (SCI). The associations were evaluated by linking individuals' records between the Pennsylvania Trauma Systems Outcomes Study and the National SCI Model Systems databases. DESIGN: Retrospective cohort analysis. SETTING: Two SCI Model Centers in Pennsylvania, United States. METHODS: We used a record linkage toolkit in Python to link 735 individuals with traumatic SCI between the databases. The percentage for true-match and error were 92.0% and 0.1%, respectively. The functional recovery during inpatient rehabilitation was determined in 604 individuals with SCI by ordinary least squares regression (OLS) and gradient boosting regression (GBR) analyses. RESULTS: The OLS and GBR analyses indicated older age, greater impairment (SCI level combined with American Spinal Injury Association impairment scale), presence of diabetes mellitus, pulmonary complications during acute care, and longer length of stay at an inpatient rehabilitation facility were associated with lower functional recovery (OLS R2 = 0.56 and GBR R2 = 0.58). CONCLUSIONS: Trauma and acute care variables in addition to patient characteristics were associated with functional recovery during inpatient rehabilitation in individuals with SCI. Further investigation is needed to understand the role of diabetes mellitus and pulmonary complications, which have not been previously associated with functional recovery in individuals with SCI.

Evaluation of activity monitors in manual wheelchair users with paraplegia.

OBJECTIVE: The aim of this study was to evaluate the performance of SenseWear (SW) and RT3 activity monitors (AMs) in estimating energy expenditure (EE) in manual wheelchair users (MWUs) with paraplegia for a variety of physical activities. METHODS: Twenty-four subjects completed four activities including resting, wheelchair propulsion, arm-ergometry exercise, and deskwork. The criterion EE was measured by a K4b2 portable metabolic cart. The EE estimated by the SW and RT3 were compared with the criterion EE by the absolute differences and absolute percentage errors. Intraclass correlations and the Bland and Altman plots were also used to assess the agreements between the two AMs and the metabolic cart. Correlations between the criterion EE and the estimated EE and sensors data from the AMs were evaluated. RESULTS: The EE estimation errors for the AMs varied from 24.4 to 125.8% for the SW and from 22.0 to 52.8% for the RT3. The intraclass correlation coefficients (ICCs) between the criterion EE and the EE estimated by the two AMs for each activity and all activities as a whole were considered poor with all the ICCs smaller than 0.75. Except for deskwork, the EE from the SW was more correlated to the criterion EE than the EE from the RT3. CONCLUSION: The results indicate that neither of the AMs is an appropriate tool for quantifying physical activity in MWUs with paraplegia. However, the accuracy of EE estimation could be potentially improved by building new regression models based on wheelchair-related activities.

Timing and pattern of readmission in individuals with spinal cord injury in the setting of a specialized medical home.

BACKGROUND: The rate of readmission in individuals with spinal cord injury (SCI) is known to be high (28% to 45%) during the first year post-injury and post-rehabilitation. However, there are several critical gaps in our knowledge including the timing pattern of medical complications and the pattern of health complications associated with readmissions. OBJECTIVE: To identify the timing and pattern of complications associated with hospital readmissions in individuals with traumatic SCI and non-traumatic spinal cord disorders (SCI) post-discharge from an inpatient rehabilitation facility (IRF). DESIGN: Secondary analysis of a three year prospective cohort study. SETTING: An SCI medical home. PARTICIPANTS: Individuals who were readmitted (n = 53) within the first year (N = 176) post-discharge from an IRF. INTERVENTIONS: N/A. OUTCOME MEASURES: Timing and pattern of all-cause hospital readmissions. RESULTS: Eighty one percent of the readmitted patients experienced readmission within the first six months after discharge, and 36% of the initial readmissions occurred within 30 days of discharge from an IRF. The trend line for the timing of the first readmission post-discharge from an IRF was curvilinear, with a sharp decrease in the number of new patients readmitted for months 1-7 and then a slight increase between 9 and 12 months. Urological and respiratory complications were related to repeat readmissions. CONCLUSION: The patient is at the greatest risk of readmission in the first 6 months, with a secondary increase in risk at 9 months. Possible reasons may include reduction in in-home and outpatient therapy and skilled nursing over the first year post-SCI.

Classifying and tracking rehabilitation interventions through machine-learning algorithms in individuals with stroke.

INTRODUCTION: Stroke is the leading cause of disability worldwide. It has been well-documented that rehabilitation (rehab) therapy can aid in regaining health and function for individuals with stroke. Yet, tracking in-home rehab continues to be a challenge because of a lack of resources and population-scale demands. In order to address this gap, we implemented a methodology to classify and track rehab interventions in individuals with stroke. METHODS: We developed personalized classification algorithms, including neural network-based algorithms, to classify four rehab exercises performed by two individuals with stroke who were part of a week-long therapy camp in Jamaica, a low- and middle-income country. Accelerometry-based wearable sensors were placed on each upper and lower limb to collect movement data during therapy. RESULTS: The classification accuracy for traditional and neural network-based algorithms utilizing feature data (e.g., number of peaks) from the sensors ranged from 64 to 94%, respectively. In addition, the study proposes a new method to assess change in bilateral mobility over the camp duration. CONCLUSION: The results of this pilot study indicate that personalized supervised learning algorithms can be used to classify and track rehab activities and functional outcomes in resource limited settings such as LMICs.