Study protocol for a single-arm pilot trial investigating the feasibility of a multimodal digital technology for managing metabolic syndrome in patients with chronic obstructive pulmonary disease.

Individuals diagnosed with Chronic Obstructive Pulmonary Disease (COPD) are exposed to an increased risk of metabolic syndrome (MetS), which negatively affects their health outcomes and quality of life. Lifestyle interventions have shown promise in managing MetS. This study outlines the protocol for a web-based multimodal self-care program, Digital Metabolic Rehabilitation, for managing MetS in patients with COPD. The Digital Metabolic Rehabilitation is a single-arm pilot trial that integrates the Canadian Health Advanced by Nutrition and Graded Exercise (CHANGE) Program and a web-based wellness platform. The web-based wellness platform employed in this study is My Viva Plan (MVP)®, which integrates a holistic, multicomponent approach to promote wellness. The intervention will primarily focus on lifestyle changes for patients with COPD. Over 6 months, participants will use the web-based wellness platform and engage in weekly online support group sessions. Fifty patients diagnosed with stage I-II COPD and MetS will participate. Blood tests, anthropometrics, body composition, physical function, muscle strength, physical activity, energy metabolism, quality of life and mental health will be assessed at baseline, 3, and 6 months. The Digital Metabolic Rehabilitation program aims to explore whether a multimodal integrative intervention delivered through a web-based wellness platform can be implemented by patients with COPD with MetS. By combining the expertise of the CHANGE Program with the digital delivery format, the intervention seeks to enhance self-monitoring and foster better self-management practices. The protocol outlines a novel and potentially impactful intervention for managing MetS in patients with COPD.

Digital Intervention for behaviouR changE and Chronic disease prevenTION (DIRECTION): Study protocol for a randomized controlled trial of a web-based platform integrating nutrition, physical activity, and mindfulness for individuals with obesity.

Excess body weight, suboptimal diet, physical inactivity, alcohol consumption, sleep disruption, and elevated stress are modifiable risk factors associated with the development of chronic diseases. Digital behavioural interventions targeting these factors have shown promise in improving health and reducing chronic disease risk. The Digital Intervention for behaviouR changE and Chronic disease prevenTION (DIRECTION) study is a parallel group, two-arm, randomized controlled trial evaluating the effects of adding healthcare professional guidance and peer support via group-based sessions to a web-based wellness platform (experimental group, n = 90) compared to a self-guided use of the platform (active control group, n = 90) among individuals with a body mass index (BMI) of 30 to <35 kg/m2 and aged 40-65 years. Obesity is defined by a high BMI. The web-based wellness platform employed in this study is My Viva Plan (MVP)®, which holistically integrates nutrition, physical activity, and mindfulness programs. Over 16 weeks, the experimental group uses the web-based wellness platform daily and engages in weekly online support group sessions. The active control group exclusively uses the web-based wellness platform daily. Assessments are conducted at baseline and weeks 8 and 16. The primary outcome is between-group difference in weight loss (kg) at week 16, and secondary outcomes are BMI, percent weight change, proportion of participants achieving 5% or more weight loss, dietary intake, physical activity, alcohol consumption, sleep, and stress across the study. A web-based wellness platform may be a scalable approach to promote behavioural changes that positively impact health. This study will inform the development and implementation of interventions using web-based wellness platforms and personalized digital interventions to improve health outcomes and reduce chronic disease risk among individuals with obesity.

Evaluating the Efficacy of Telehealth-Based Treatments for Depression in Adults: A Rapid Review and Meta-Analysis.

PURPOSE: Major depressive disorder (MDD) is one of the leading causes of work-related disability, and accessing telehealth therapies can be a promising modality for workers with MDD. Barriers to accessing in-person mental healthcare, such as limited availability and accessibility in rural and remote communities, financial constraints, and stigma, have highlighted the need for alternative approaches like telehealth. This study investigated the efficacy of telehealth interventions including CBT for adults over 18 diagnosed with MDD. METHODS: This rapid review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to ensure a transparent methodology. Out of the 2549 studies screened, 19 were incorporated into the rapid review, and of those, 10 were included in the subsequent meta-analyses. Articles were screened independently by two reviewers, with the disagreements reconciled through discussion. A reviewer extracted data from eligible articles. Descriptive statistics and narrative syntheses were used to describe outcomes. Two meta-analyses were conducted to investigate the efficacy of cognitive behavioral therapy (CBT) delivered by telehealth (tCBT). The first compared tCBT to in-person CBT (pCBT). The second meta-analysis compared tCBT to a control group that did not receive CBT or another telehealth-based treatment. Non-CBT interventions investigated within the non-CBT group included somatic rhythm therapy, problem-solving therapy, psychiatry, behavioral activation, and interpersonal psychotherapy. RESULTS: Overall, individuals with MDD who received tCBT showed significant improvement in depression symptoms. However, the efficacy of tCBT compared to non-telehealth control groups varied across studies. The first meta-analysis indicated the magnitudes of effect were similar for both interventions in reducing depression symptoms 0.023 (95% CI - 0.120 to 0.166); p = 1.00. In the second meta-analysis, the ratio of means comparing tCBT (0.51 ± 0.14 SD) to the control group (0.68 ± 0.12 SD) exhibited a statistically significant 25% reduction with regard to depression scores (one-sided p = 0.002), favouring tCBT to non-telehealth, non-CBT study groups. CONCLUSIONS: Telehealth-based CBT demonstrated positive effects on depression symptoms; it was generally superior when compared to control groups not receiving CBT and was on par with pCBT. The growing mental health burden in the community underscores the need for accessible telehealth services like tCBT. Effective policy formulation and implementation in national health agendas are essential to meet the increasing demand for mental health support.

Identifying and Overcoming the Barriers to Virtual Electromyography Assessments: A Scoping Review.

Introduction: Electromyography (EMG) assessments have been conducted virtually more frequently in recent years, leading researchers to explore the barriers to EMG assessments in a telehealth setting and how to overcome them. Methods: A scoping review was conducted according to the methodology described by Arksey and O'Malley. A comprehensive search using controlled vocabulary and keywords for two concepts, EMG and telehealth, was conducted using Medline and EMBASE on February 7, 2022. Two independent reviewers screened titles, abstracts, and full-text articles. Two reviewers also extracted the data and described the findings in a descriptive analysis. Results: A total of 248 articles were screened during the abstract and title review, of which 64 full texts were screened for eligibility. Of these, 15 publications met the inclusion criteria. Most articles were published in 2018 or later (66.7%). The most frequently mentioned barrier to conducting a virtual EMG assessment was poor data and signal transmission (53.3%). Another frequently mentioned barrier was poor patient usability (33.3%). Solutions most frequently reported related to patient usability (33.3%). These included interactive instructions and video chat to monitor and provide the patient with technical support. Conclusion: The last 4 years have seen an increase in articles published on EMGs' use in telehealth to monitor or diagnose patients. Further research is required to determine if the proposed solutions have improved clinical outcomes for the patient.

Wheelchair propulsion fatigue thresholds in electromyographic and ventilatory testing.

STUDY DESIGN: Qualitative study. OBJECTIVE: The objective of the present study are physiological processes occurring when the intensity of manual wheelchair propulsion approaches levels causing muscular fatigue. In particular, we set out to (1) detect the electromyographic (EMG) and ventilatory fatigue threshold during a single wheelchair incremental test, (2) examine the relationship between EMG threshold (EMGT) and ventilatory threshold (VT), and (3) detect the EMG threshold differences between the propulsive and recovery muscle synergies. SETTING: Biomechanics laboratory at the University of Alberta, Canada. METHODS: Oxygen uptake and EMG signals from ten wheelchair users (seven males and three females) were recorded as they were each performing an incremental propulsion bout in their own wheelchairs on a wheelchair ergometer. The V-slope method was used to identify the VT, and the EMGT of each of the eight muscles (anterior deltoid, middle deltoid, posterior deltoid, infraspinatus, upper trapezius, sternal head of pectoralis major, biceps brachii, and triceps brachii) was determined using the bisegmental linear regression method. RESULTS: For each participant, we were able to determine the EMGT and VT from a single incremental wheelchair propulsion bout. EMGT stands in good agreement with VT, and there was a high similarity in EMGT between push and recovery muscles (intraclass correlation coefficient = 0.91). CONCLUSION: The EMG fatigue threshold method can serve as a valid and reliable tool for identifying the onset of muscular fatigue during wheelchair propulsion, thus providing a foundation for automated muscle fatigue detection/prediction in wearable technology.

Pressure changes under the ischial tuberosities during gluteal neuromuscular stimulation in spinal cord injury: a comparison of sacral nerve root stimulation with surface functional electrical stimulation.

OBJECTIVE: To compare the magnitude of interface pressure changes during gluteal maximus contraction by stimulating sacral nerve roots with surface electrical stimulations in patients with spinal cord injuries (SCIs). DESIGN: Pilot interventional study. SETTING: Spinal injury research laboratory. PARTICIPANTS: Adults (N=18) with suprasacral complete SCI. INTERVENTIONS: Sacral nerve root stimulation (SNRS) via a functional magnetic stimulator (FMS) or a sacral anterior root stimulator (SARS) implant; and surface functional electrical stimulation (FES). MAIN OUTCOME MEASURES: Interface pressure under the ischial tuberosity (IT) defined as peak pressure, gradient at peak pressure, and average pressure. RESULTS: With optimal FMS, a 29% average reduction of IT peak pressure was achieved during FMS (mean ± SD: 160.1±24.3mmHg at rest vs 114.7±18.0mmHg during FMS, t5=6.3, P=.002). A 30% average reduction of peak pressure during stimulation via an SARS implant (143.2±31.7mmHg at rest vs 98.5±21.5mmHg during SARS, t5=4.4, P=.007) and a 22% average decrease of IT peak pressure during FES stimulation (153.7±34.8mmHg at rest vs 120.5±26.1mmHg during FES, t5=5.3, P=.003) were obtained. In 4 participants who completed both the FMS and FES studies, the percentage of peak pressure reduction with FMS was slightly greater than with FES (mean difference, 7.8%; 95% confidence interval, 1.6%-14.0; P=.04). CONCLUSIONS: SNRS or surface FES can induce sufficient gluteus maximus contraction and significantly reduce ischial pressure. SNRS via an SARS implant may be more convenient and efficient for frequently activating the gluteus maximus.

Morphological characteristics of the human skin over posterior aspect of heel in the context of pressure ulcer development.

The posterior aspect of heel is known as a particularly vulnerable site for pressure ulcer development, however, it is not well understood why this is so. This study was undertaken to identify the morphological characteristics of the skin over posterior aspect of heel in the context of pressure ulcer development. Human skin tissues were obtained from four different sites of the body of 4 aged subjects postmortem: posterior aspect of heel, plantar aspect of heel, sacrum and centre of gluteus maximus. The skin samples were processed for the examination using light microscopy and scanning electron microscopy. The posterior aspect of heel was characterized by a thicker epidermis, denser distribution and larger diameter of capillaries in the papillary layer, 3-dimensional architecture of collagen fibre meshwork in the reticular layer and elliptic adipose tissues situated perpendicularly to the skin surface being surrounded by thick collagen and elastic fibre septa compared to the sacrum. Given our observations in the papillary layer of the posterior aspect of heel, we assume that the tissue of this area may be less tolerant to ischaemia since the tissue has high metabolic demand to provide oxygen and nutrients to the epidermis which protects underlying tissue from external force. In addition, elliptic configuration of adipose tissues in the posterior aspect of heel situated perpendicularly to the skin surface may result in deep lesion if the forces applied exceed the tolerable level since the forces will be concentrated within the elliptic compartments.

Microclimate impact of prophylactic dressings using in vitro body analog method.

UNLABELLED: Wound dressings have been successfully explored for use in prevention of pressure ulcers in individuals who are at clinical high-risk for developing ulcers. METHODS: In this study, application of a recently described body analog test fixture and method is used to evaluate performance features of 8 clinically available dressings for prophylaxis. Documenting dressing performance is essential to defining the proper use and limits to application of dressings for ulcer prevention. These in vitro studies were undertaken to characterize the impact on the microclimate generated by the application of a dressing to the surface of the skin. RESULTS: The measurement of moisture trapped next to the skin, moisture escaped from the dressing, and heat trapped by the dressing show that some dressings are more suited for skin protection. CONCLUSION: It is evident that an optimal performance band for microclimate management exists in the application of dressings for prophylaxis, and that dressings should be evaluated for proper performance prior to implementation in a pressure ulcer prevention program. .

Development of Pressure Sensors to Help Support Community Lymphedema Monitoring: A Scoping Review.

Breast cancer-related lymphedema is a condition occurring after a partial or full mastectomy, where there is a buildup of interstitial fluid in the body, particularly in the upper limb. There is a lack of at-home sensors that can help monitor the progression of lymphedema. The purpose of this scoping review is to gather relevant information on sensors for remote lymphedema monitoring. A literature search of Medline, PubMed, Scopus, Web of Science, and BMC databases yielded 96 studies. A total of six studies were selected for data extraction. Data were extracted from each study and organized into tables for analysis. A total of six different devices were mentioned in the six studies included in the scoping review, divided into wearable and nonwearable sensors. Nonwearable sensors were more likely to be adaptable for remote sensing as they were further along in development and commercially available on the market. Nonwearable sensors are more developed than wearable sensors for the purpose of remote lymphedema monitoring. This review advocates further development and validation of sensors for lymphedema management, particularly for remote monitoring and health assessments.

Assessment of remote ischemic conditioning delivery with optical sensor in acute ischemic stroke: Randomised clinical trial protocol.

BACKGROUND: Remote ischemic conditioning (RIC) is delivered by a blood pressure cuff over the limb, raising pressure 50 mmHg above the systolic blood pressure, to a maximum of 200 mmHg. The cuff is inflated for five minutes and then deflated for five minutes in a sequential ischemia-reperfusion cycle 4-5 times per session. Elevated pressure in the limb may be associated with discomfort and consequently reduced compliance. Continuous assessment of relative blood concentration and oxygenation with a tissue reflectance spectroscopy (a type of optical sensor device) placed over the forearm during the RIC sessions of the arm will allow us to observe the effect of inflation and deflation of the pressure cuff. We hypothesize, in patients with acute ischemic stroke (AIS) and small vessel disease, RIC delivered together with a tissue reflectance sensor will be feasible. METHODS: The study is a prospective, single-center, randomized control trial testing the feasibility of the device. Patients with AIS within 7 days from symptoms onset; who also have small vessel disease will be randomized 2:1 to intervention or sham control arms. All patients randomized to the intervention arm will receive 5 cycles of ischemia/reperfusion in the non-paralyzed upper limb with a tissue reflectance sensor and patients in the sham control arm will receive pressure by keeping the cuff pressure at 30 mmHg for 5 minutes. A total of 51 patients will be randomized, 17 in the sham control arm and 34 in the intervention arm. The primary outcome measure will be the feasibility of RIC delivered for 7 days or at the time of discharge. The secondary device-related outcome measures are fidelity of RIC delivery and the completion rate of intervention. The secondary clinical outcome includes a modified Rankin scale, recurrent stroke and cognitive assessment at 90 days. DISCUSSION: RIC delivery together with a tissue reflectance sensor will allow insight into the blood concentration and blood oxygenation changes in the skin. This will allow individualized delivery of the RIC and improve compliance. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05408130, June 7, 2022.

Technologies measuring manual wheelchair propulsion metrics: a scoping review.

The aim of this review is to investigate existing and developing technologies assessing metrics of manual wheelchair propulsion. A scoping review of scientific and gray literature was performed. Five databases were searched - Medline, Scopus, CINAHL, Institute of Electrical and Electronics Engineers (IEEE), and Embase. The 38 retained articles identified 27 devices categorized into accelerometers, wheelchair-mounted devices, instrumented wheels, and wearables. The devices included in this review can be used by manual wheelchair users to monitor propulsion effort and activity goals, by clinicians to assess rehabilitation programs, and to inform and guide future research. The findings support a need for further research into the development of custom algorithms for manual wheelchair user populations as well as further validation in broader free-living environments with equitable participant populations.

Motion sickness and sense of presence in a virtual reality environment developed for manual wheelchair users, with three different approaches.

Visually Induced Motion Sickness (VIMS) is a bothersome and sometimes unsafe experience, frequently experienced in Virtual Reality (VR) environments. In this study, the effect of up to four training sessions to decrease VIMS in the VR environment to a minimal level was tested and verified through explicit declarations of all 14 healthy participants that were recruited in this study. Additionally, the Motion Sickness Assessment Questionnaire (MSAQ) was used at the end of each training session to measure responses to different aspects of VIMS. Total, gastrointestinal, and central motion sickness were shown to decrease significantly by the last training session, compared to the first one. After acclimatizing to motion sickness, participants' sense of presence and the level of their motion sickness in the VR environment were assessed while actuating three novel and sophisticated VR systems. They performed up to four trials of the Illinois agility test in the VR systems and the real world, then completed MSAQ and Igroup Presence Questionnaire (IPQ) at the end of each session. Following acclimatization, the three VR systems generated relatively little motion sickness and high virtual presence scores, with no statistically meaningful difference among them for either MSAQ or IPQ. Also, it was shown that presence has a significant negative correlation with VIMS.

The Effect of Fatigue on Wheelchair Users' Upper Limb Muscle Coordination Patterns in Time-Frequency and Principal Component Analysis.

An assessment of shoulder muscle coordination patterns is important to gain insight into muscle fatigue during wheelchair propulsion. The objective of the present study was to quantify muscle coordination changes over time during fatiguing wheelchair propulsion, as the muscles go through distinct levels of fatigue, a) non-fatigued, b) transiting to fatigue and c) fatigued to exhaustion. We recorded surface electromyography (sEMG) signals of the anterior deltoid (AD), middle deltoid (MD), posterior deltoid (PD), infraspinatus (IS), upper trapezius (UT), sternal head of the pectoralis major (PM), biceps brachii (BB), and triceps brachii (TB) during a wheelchair incremental exercise test. Nine wheelchair users with a diagnosis of spina bifida or T6-T12 spinal cord injury volunteered for the study. Oxygen uptake and SmartWheel kinetic parameters were also recorded during the test. EMG signals were processed by wavelet and principal component analysis (PCA), allowing for an assessment of how wheelchair users modify their muscle coordination patterns over time. Analyses of covariance (ANCOVA) were conducted to identify the main effect of fatigue levels on muscle coordination patterns by controlling for the effect of increased workload as covariate. A significant effect of fatigue levels on the PC1 and PC3 loading scores was found after controlling for the effect of increasing workloads (with both cases). In addition, PC3 reflects the most dominant fatigue effect on muscle coordination patterns which are not affected by increased ergometer workload. PC3 indicates muscle imbalance when muscles are fully fatigued and muscle co-contraction when muscles are beginning to fatigue. We conclude that fatigue-related changes in neuromuscular activity during wheelchair propulsion contribute to muscle imbalance and reflect a strategy of stiffening the shoulder joint.

Balancing Access with Technology: Comparing In-Person and Telerehabilitation Berg Balance Scale Scores among Stroke Survivors.

Purpose: Stroke survivors living in rural and remote communities experience challenges in accessing specialized rehabilitation services. Access to balance assessment after stroke is an essential aspect of the physiotherapy assessment. Telerehabilitation (TRH) can eliminate access disparities; however, adoption into practice has been limited. Our primary objective was to examine agreement between Berg Balance Scale (BBS) scores obtained through TRH and those obtained through traditional in-person assessment of community-dwelling individuals with stroke. Method: Two raters administered the BBS to 20 community-dwelling individuals with stroke, using both TRH and traditional in-person approaches. The order of assessments and rater assignment was randomized. Interrater reliability between the methods was assessed using Krippendorff's α reliability estimate. A survey was then administered to examine the participants' perceptions of the two means of assessment. Results: Excellent interrater agreement was found between TRH and in-person assessment (κ = 0.97; 95% CI: 0.96, 0.99), and responses regarding patients' perceived hearing and understanding of instructions as well as perceived safety were comparable. In addition, the vast majority of participants agreed or strongly agreed that they would use TRH for future physiotherapy sessions. Conclusions: The results of this study support administration of the BBS using TRH technology; this could improve access to balance assessment for stroke survivors in rural and remote communities.

Objectif : les survivants d'un accident vasculaire cérébral (AVC) qui vivent en région rurale ou éloignée éprouvent de la difficulté à accéder à des services de réadaptation spécialisés. L'accès à une évaluation de l'équilibre après un AVC est un aspect essentiel de l'évaluation physiothérapique. La téléréadaptation peut éliminer les disparités d'accès, mais sa mise en pratique est limitée. Les chercheurs se sont donné comme objectif principal d'examiner la concordance entre les scores de l'échelle d'évaluation de l'équilibre de Berg (ÉÉÉB) obtenus par transmission vidéo grâce à la téléréadaptation et ceux obtenus par les évaluations physiques habituelles chez des personnes victimes d'un AVC habitant dans la communauté. Méthodologie : deux évaluateurs ont mesuré le score de la BBS chez 20 personnes ayant subi un AVC habitant dans la communauté, à la fois par la téléréadaptation et par l'approche physique habituelle. Ils ont établi l'ordre d'évaluation et l'affectation des évaluateurs au hasard, ont déterminé la fiabilité interévaluateur des deux méthodes au moyen du coefficient alpha de Krippendorff et ont ensuite réalisé un sondage pour connaître les perceptions de participants à l'égard des deux évaluations. Résultats : les chercheurs ont constaté une excellente concordance interévaluateur entre la téléréadaptation et l'évaluation physique (κ = 0,97; IC à 95 % : 0,96, 0,99), et les patients ont entendu et compris les directives et se sont sentis en sécurité selon un ordre de perception comparable. De plus, la grande majorité d'entre eux ont convenu ou fortement convenu qu'ils utiliseraient la vidéoconférence pour leurs futures séances de physiothérapie. Conclusion : les résultats de cette étude appuient l'utilisation de l'ÉÉÉB en téléréadaptation, ce qui pourrait améliorer l'accès des survivants d'un AVC qui vivent en région rurale ou éloignée à l'évaluation de l'équilibre.

Rehabilitation in bariatrics: opportunities for practice and research.

PURPOSE: Obesity is associated with a wide range of chronic illnesses and disabilities familiar to rehabilitation researchers and practitioners. Obesity discourse in the area of rehabilitation science and practice is limited. METHOD: A meeting of rehabilitation researchers, practitioners, industry and decision makers was held for the purpose of identifying research and practice priorities in the area of bariatric rehabilitation. RESULTS: Areas of common ground in terms of the identification of gaps in research, practice and knowledge about obesity in the context of rehabilitation science were identified. Participants developed a concept for a bariatric rehabilitation treatment and research institute. A commitment to embark on priority action items was made. CONCLUSIONS: This article describes a process that successfully gathered a diverse group of researchers, clinicians, industries and decision makers for the purpose of collectively advancing the area of bariatric rehabilitation in Canada.

Investigating the test-retest reliability of Illinois Agility Test for wheelchair users.

The Illinois Agility Test (IAT) is a standard agility course used to assess and train able-bodied athletes as well as wheelchair-sport athletes and rehabilitation of wheelchair users. It has been shown to be a reliable and valid tool to assess the able-bodied population, but the reliability of this test for assessing wheelchair propulsion has never been shown. The purpose of this study is to investigate the test-retest reliability of IAT to assess wheelchair propulsion. In this paper, the test-retest reliability of using IAT for wheelchair users is found for peak and average velocity, acceleration, tangential and total force of the push, each for the left and the right wheel. Each of these variables was found for thirty-two decisive points throughout the IAT path. The Intra-class Correlation Coefficient (ICC) was found to be very strong for 15 out of 16 variables. The average ICC was 89% and the average 95% confidence interval was [44% 96%]. In addition, thirty-seven other significant propulsion parameters were found that are clinically important, such as the number of pushes participants take to go around cones on the right, relative to turning around the cones on the left. Also, all thirty-seven variables were compared between the two sessions using four separate MANOVAs; the results showed no significant difference between IAT performed in the two sessions which were at least one week apart. This, in turn, backs the reliability of IAT for wheelchair users. These results are sufficient evidence to show that IAT is a reliable tool to test wheelchair agility for fifteen variables tested for non-wheelchair users. Since experienced wheelchair users are much more consistent in wheelchair propulsion compared to non-wheelchair-users, the results of this study show that IAT can be used as a reliable tool to assess and train wheelchair users, both for clinical and athletic applications.

Virtual Trauma-Focused Therapy for Military Members, Veterans, and Public Safety Personnel With Posttraumatic Stress Injury: Systematic Scoping Review.

BACKGROUND: A necessary shift from in-person to remote delivery of psychotherapy (eg, teletherapy, eHealth, videoconferencing) has occurred because of the COVID-19 pandemic. A corollary benefit is a potential fit in terms of the need for equitable and timely access to mental health services in remote and rural locations. Owing to COVID-19, there may be an increase in the demand for timely, virtual delivery of services among trauma-affected populations, including public safety personnel (PSP; eg, paramedics, police, fire, correctional officers), military members, and veterans. There is a lack of evidence on the question of whether digital delivery of trauma-therapies for military members, veterans, and PSP leads to similar outcomes to in-person delivery. Information on barriers and facilitators and recommendations regarding digital-delivery is also scarce. OBJECTIVE: This study aims to evaluate the scope and quality of peer-reviewed literature on psychotherapeutic digital health interventions delivered remotely to military members, veterans, and PSP and synthesize the knowledge of needs, gaps, barriers to, and facilitators for virtual assessment of and virtual interventions for posttraumatic stress injury. METHODS: Relevant studies were identified using MEDLINE (Medical Literature Analysis and Retrieval System Online), EMBASE (Excerpta Medica dataBASE), APA (American Psychological Association) PsycINFO, CINAHL (Cumulative Index of Nursing and Allied Health Literature) Plus with Full Text, and Military & Government Collection. For collation, analysis, summarizing, and reporting of results, we used the CASP (Critical Skills Appraisal Program) qualitative checklist, PEDro (Physiotherapy Evidence Database) scale, level of evidence hierarchy, PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews), and narrative synthesis. RESULTS: A total of 38 studies were included in this review. Evidence for the effectiveness of digital delivery of prolonged exposure therapy, cognitive processing therapy, behavioral activation treatment with therapeutic exposure to military members, veterans, and PSP was rated level 1a, whereas evidence for cognitive behavioral therapy was conflicting. The narrative synthesis indicated that virtual delivery of these therapies can be as effective as in-person delivery but may reduce stigma and cost while increasing access to therapy. Issues of risk, safety, potential harm (ie, suicidality, enabling avoidance), privacy, security, and the match among the therapist, modality, and patient warrant further consideration. There is a lack of studies on the influences of gender, racial, and cultural factors that may result in differential outcomes, preferences, and/or needs. An investigation into other therapies that may be suitable for digital delivery is needed. CONCLUSIONS: Digital delivery of trauma therapies for military members, veterans, and PSP is a critical area for further research. Although promising evidence exists regarding the effectiveness of digital health within these populations, many questions remain, and a cautious approach to more widespread implementation is warranted.

Investigating the Reliability and Validity of Three Novel Virtual Reality Environments With Different Approaches to Simulate Wheelchair Maneuvers.

Wheelchair manoeuvring has received little attention in the literature despite its importance in mobility and performing activities of daily living and its role in developing secondary injuries for wheelchair users. The focus in this paper was technology development with iterative and proof-of-concept testing. Three versions of a wheelchair simulator that were designed and developed for simulating curvilinear wheelchair propulsion in virtual reality were tested for their validity and reliability. The wheelchair simulators comprise a sophisticated wheelchair ergometer in an immersive virtual reality environment and are developed for manual wheelchair propulsion. These simulators all replicate inertia in translation, in addition to taking three approaches for simulating turning. The three systems were then tested and compared with the real world to see how reliable and valid they are; 15 healthy participants were recruited to perform the Illinois Agility Test (IAT) in two sessions that were at least one week apart. The intraclass correlation coefficient and the Pearson correlation coefficient were found for 16 variables to find the test-retest reliability and convergent construct validity of the systems, respectively. Overall, the three systems showed good validity and reliability with the VR_system 2 (mechanical compensation for rotational inertia) having the best scores and the VR_system 3 (software compensation for rotational inertia) having the lowest scores. Also, it was observed that performing IAT in the real world needed fewer pushes and often accompanied more negative pushes. Participants also used longer strokes in the real world compared to virtual reality environment.

Blood perfusion changes during sacral nerve root stimulation versus surface gluteus electrical stimulation on in seated spinal cord injury.

The objective of this article is to examine dynamic changes of ischial blood perfusion during sacral nerve root stimulation against surface functional electrical stimulation (FES). Fourteen adults with suprasacral spinal cord injury (SCI) were recruited. The gluteal maximus was activated by surface FES or stimulating sacral nerve roots by functional magnetic stimulation (FMS) or a sacral anterior root stimulator implant (SARS). Ischial skin index of hemoglobin (IHB) and oxygenation (IOX) was measured.Skin blood perfusion was significantly higher during FMS than the baseline (IHB 1.05 ± 0.21 before vs.1.08 ± 0.02 during stimulation, p = 0.03; IOX 0.18 ± 0.21 before vs. 0.46 ± 0.30, p = 0.01 during stimulation). Similarly, when using the SARS implant, we also observed blood perfusion significantly increased (IHB 1.01 ± 0.02 before vs.1.07 ± 0.02 during stimulation, p = 0.003; IOX 0.79 ± 0.81 before vs. 2.2 ± 1.21 during stimulation, p = 0.036). Among four participants who completed both the FMS and FES studies, the magnitude of increase in both parameters was significantly higher during FMS. This study demonstrates sacral nerve root stimulation confer better benefit on blood perfusion than applying traditional FES in SCI population.

The Effect of Manual Wheelchair Propulsion Speed on Users' Shoulder Muscle Coordination Patterns in Time-Frequency and Principal Component Analysis.

A rehabilitation program for wheelchair users should be based on a thorough understanding of shoulder muscle coordination patterns. The objective of the study was to quantify the extent to which the muscle electromyographic (EMG) patterns vary with propulsion speed. A total of 11 wheelchair-dependent participants with a diagnosis of spina bifida or T6-T12 spinal cord injury volunteered for the study. Each participant performed a series of wheelchair propulsion bouts at 1m/s, 1.3 m/s, and 1.6m/s. EMG signals of 8 shoulder muscles as well as the physiological and kinetic variables were recorded. Propulsion at 1.6m/s generated significantly higher EMG intensities in biceps brachii, anterior deltoid, pectoralis major, and middle deltoid than at 1m/s and 1.3m/s. The combined wavelet and principal component analysis showed that the faster propulsion speed requires higher push muscle activity in the early push phase and in the phase transitions between alternating push and recovery. Training to strengthen the shoulder flexors to achieve smoother phase transitions could improve rehabilitation outcomes by increasing functional speed while lessening shoulder strain.