Complex behavioral interventions targeting physical activity and dietary behaviors in pediatric oncology: A scoping review.

As cancer and its treatment negatively impacts the long-term health and quality of life of survivors, there is a need to explore new avenues to prevent or minimize the impact of adverse effects in children with cancer and cancer survivors. Therefore, this scoping review aimed to report on the state of the evidence on the use and effects of complex behavioral interventions (CBI) targeting physical activity and/or dietary behaviors in pediatric oncology. Fourteen quantitative studies were included, evaluating interventions that used a combination of two or three different treatment modalities. Overall, studies demonstrated that it is feasible to implement CBI and that they can potentially improve physical activity and dietary behaviors as well as patient outcomes such as physical and psychological health. Unfortunately, due to a paucity of studies and the heterogeneity of the studies included in this review, no conclusive evidence favoring specific interventions were identified.

Effects of a preoperative neuromobilization program offered to individuals with carpal tunnel syndrome awaiting carpal tunnel decompression surgery: A pilot randomized controlled study.

STUDY DESIGN: Pilot randomized controlled trial with parallel groups. INTRODUCTION: Engaging individuals with carpal tunnel syndrome (CTS) awaiting carpal tunnel decompression surgery in a preoperative rehabilitation program may mitigate pain and sensorimotor impairments, enhance functional abilities before surgery, and improve postoperative outcomes. PURPOSE OF THE STUDY: To assess the feasibility and the efficacy of a novel preoperative neuromobilization exercise program (NEP). METHODS: Thirty individuals with CTS were randomly allocated into a four-week home-based neuromobilization exercise group or a standard care group while awaiting surgery. Outcome measures included feasibility (ie, recruitment, attrition, adherence, satisfaction, and safety) and efficacy metrics (ie, median nerve integrity and neurodynamics, tip pinch grip, pain, and upper limb functional abilities) collected before (ie, at the baseline and about four weeks later) and four weeks after surgery. RESULTS: Thirty individuals with CTS were recruited (recruitment rate = 11.8%) and 25 completed the study (attrition rate = 16.7%). Adherence (94%) and satisfaction with the program (eg, enjoy the exercises and likeliness to repeat the NEP (≥4.2/5) were high and no serious adverse event was reported. NEP-related immediate pre- and post-surgery beneficial effects on pain interference were documented (P = .05, η2 = .10), whereas an overall increased neurodynamics (P = .04, η2 = .11) and decreased pain severity (P = .01, η2 = .21) were observed. DISCUSSION: Engaging in the proposed NEP has limited beneficial effect as a stand-alone intervention on pre- and post-surgery outcomes for individuals with CTS. Expanding the program's content and attribute by adding other components including desensitization maneuvers and novel therapies promoting corticospinal plasticity is recommended. CONCLUSION: A preoperative NEP completed by individuals with CTS awaiting surgery is feasible, acceptable, and safe. However, given the limited beneficial effectsof the program, revision of its content and attributes is recommended before proceeding to large-scale trials.

Going beyond Activity and Participation: Development of the DIF-CHUM-A patient-reported outcome measure for individuals with Dupuytren's contracture.

STUDY DESIGN: This is a cross-sectional clinical measurement. INTRODUCTION: There are currently no Dupuytren's contracture (DC)-specific, patient-reported outcomes (PROs) that can provide a thorough clinical portrait of the patients' perceptions with regard to the execution of regular activities. PURPOSE OF THE STUDY: The purpose of this study was to present the development of the Dupuytren's contracture Impact on Function-Centre Hospitalier de l'Université de Montréal (DIF-CHUM), a DC-specific PRO. METHODS: The development process involved consultation of 45 individuals with DC and 7 health professionals, existing literature, and DC-specific PRO. RESULTS: The DIF-CHUM is composed of 2 sections: section 1, Activity and Participation includes 8 items per hand, scored on Difficulty and Change scales; section 2, General Impact includes up to 18 items, scored on Difficulty, Importance, Change and Satisfaction scales. Preliminary evidence suggests that the DIF-CHUM demonstrates good content validity. DISCUSSION: The DIF-CHUM is designed to be a patient-centered measure of Activity and Participation and Functional Competence for individuals with DC that will provide hand therapists with a unique perspective of the impact of DC on patients' lives. CONCLUSION: Further validation of the DIF-CHUM, including its scoring, is under way.

Pain interference may be an important link between pain severity, impairment, and self-reported disability in participants with wrist/hand pain.

STUDY DESIGN: Cross-sectional. INTRODUCTION: Pain severity, sensory and motor impairment, and psychological (distress and anxiety) and social factors have previously been related to self-reported disability in persons with wrist and hand pain. PURPOSE OF THE STUDY: The purpose of this study to determine the relative contribution of pain severity, measures of impairment (sensory and motor function), psychosocial factors, and pain interference on self-reported disability experienced by persons with heterogeneous orthopedic injuries and conditions of the wrist and hand. METHODS: Measures of disability and pain severity as well as measures of sensory (pressure pain thresholds, joint position sense), motor (grip strength, Purdue pegboard), and cognitive performance (Stroop test) and psychosocial variables related to pain and participation (West Haven-Yale Multidimensional Pain Inventory) were administered to 60 participants with wrist and hand pain. Pearson product correlations controlled for age and sex, and multiple linear regression was performed to determine the relationship between measures of impairment, pain severity, psychosocial variables, and pain interference with self-reported disability assessed with the Disability of Arm, Shoulder and Hand (DASH) questionnaire. RESULTS: The best-fitting regression model with DASH scores entered as the dependent variable (F4,50 = 28.8, P < .01) included MPI Pain Interference (ß = -0.54), Life Control (ß = -0.16), Purdue pegboard scores (ß = -0.32), and Stroop test times (ß = 0.21). Pain Interference had the strongest correlation with self-reported disability (adjusted R2 = 0.67, P < .01). CONCLUSION: Pain interference appears to be an important factor explaining the link between impairment, pain severity, and self-reported disability. Addressing pain interference may be important to improve outcomes in this population.

Peripheral and Central Adaptations After a Median Nerve Neuromobilization Program Completed by Individuals With Carpal Tunnel Syndrome: An Exploratory Mechanistic Study Using Musculoskeletal Ultrasound Imaging and Transcranial Magnetic Stimulation.

OBJECTIVE: Neuromobilization exercises are increasingly advocated in the conservative management of individuals with carpal tunnel syndrome (CTS), as they may mitigate CTS-related signs and symptoms via potential peripheral (ie, musculoskeletal) and central (ie, neurophysiological) adaptations. However, the mechanisms underlying these adaptations have not been studied extensively. Hence, this exploratory and mechanistic study aims to evaluate the potential peripheral and central adaptations that may result in individuals with CTS who have completed a neuromobilization program. METHODS: Fourteen individuals with CTS were evaluated before and 1 week after the completion of a 4-week neuromobilization program that incorporated median nerve sliding exercises. Pain and upper limb functional abilities were assessed using standardized questionnaires. The biological integrity and mechanical properties of the median nerve and the corticospinal excitability were quantified using musculoskeletal ultrasound imaging and transcranial magnetic stimulation, respectively. RESULTS: Upon completion of the program, participants reported both large and moderate improvements in pain (P ≤ .03) and upper limb functional abilities (P = .02), respectively. The biological integrity and mechanical properties of the median nerve remained unchanged (P ≥ .22), whereas a small significant increase in corticospinal excitability (P = .04) was observed. CONCLUSION: The proposed neuromobilization program appears promising to improve pain and upper limb functional abilities in individuals with CTS. These improvements may be preferentially mediated via central, rather than peripheral, adaptations. Future studies, especially with a larger sample size, longer intervention duration, and additional measurement times, are needed to strengthen current evidence.

Determining Pressure Injury Risk on Admission to Inpatient Spinal Cord Injury Rehabilitation: A Comparison of the FIM, Spinal Cord Injury Pressure Ulcer Scale, and Braden Scale.

OBJECTIVE: Assess the utility of the admission Spinal Cord Injury Pressure Ulcer Scale (SCIPUS), Braden Scale, and the FIM for identifying individuals at risk for developing pressure injury during inpatient spinal cord injury (SCI) rehabilitation. DESIGN: Retrospective cohort. SETTING: Two tertiary rehabilitation centers. PARTICIPANTS: Individuals (N=754) participating in inpatient SCI rehabilitation. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Logistic regression analysis was performed to determine the utility of the SCIPUS, Braden Scale, and FIM for identifying individuals at risk for developing pressure injury (PI) during inpatient SCI rehabilitation. Sensitivity, specificity, positive predictive value, negative predictive value, false negative rate, odds ratio, likelihood ratio, and area under the curve (AUC) are reported. RESULTS: The SCIPUS total score and its individual items did not demonstrate acceptable accuracy (AUC≥0.7) whereas the Braden Scale (0.73) and the FIM score (0.74) did. Once items were dichotomized into high and low risk categories, 1 Braden item (friction and shear), 5 FIM items (bathing, toileting, bed/chair transfer, tub/shower transfer, toilet transfer), the FIM transfers subscale, FIM Motor subscale, and the FIM instrument as a whole, maintained AUCs ≥0.7 and negative predictive values ≥0.95. The FIM bed/chair transfer score demonstrated the highest likelihood ratio (2.62) and overall was the most promising measure for determining PI risk. CONCLUSION: Study findings suggest that a simple measure of mobility, admission FIM bed/chair transfer score of 1 (total assist), can identify at-risk individuals with greater accuracy than both an SCI specific instrument (SCIPUS) and a PI specific instrument (Braden). The FIM bed/chair transfer score can be readily determined at rehabilitation admission with minimal administrative and clinical burden.

The Spinal Cord Injury Pressure Ulcer Scale (SCIPUS): an assessment of validity using Rasch analysis.

STUDY DESIGN: Secondary analysis of retrospective data. OBJECTIVE: The aim of this study was to further validate the Spinal Cord Injury Pressure Ulcer Scale (SCIPUS) using Rasch analysis. SETTING: Two rehabilitation centers in Canada. METHOD: Data were collected as part of the Spinal Cord Injury Knowledge Mobilization Network (SCI KMN) initiative. The SCIPUS was completed within 72 h of inpatient admission. Persons admitted for initial rehabilitation in two inpatient spinal cord rehabilitation programs were included in the project. RESULTS: Data from 886 participants were analyzed, approximately 60% of whom were males. Rasch analyses demonstrated that the SCIPUS, in its current format did not meet criteria required for true measurement. A transformed version of the SCIPUS obtained by deletion of misfitting items and modification of the response scales improved fit to the model and showed preliminary evidence of unidimensionality. The person separation index, however indicated that the scale requires further adjustments of its scoring options. CONCLUSIONS: In its original form, the SCIPUS does not meet the requirements of the Rasch model and its total score should be used cautiously. However, following some adjustments to the items such as addressing DIF between sites to insure a standardized assessment across sites and adding response options to some of the items, interval-scale measurement should be possible.

Contributions of the Left and the Right Hemispheres on Language-Induced Grip Force Modulation of the Left Hand in Unimanual Tasks.

Background andObjectives: Language-induced grip force modulation (LGFM) can be used to better understand the link between language and motor functions as an expression of embodied language. However, the contribution of each brain hemisphere to LGFM is still unclear. Using six different action verbs as stimuli, this study evaluated the grip force modulation of the left hand in a unimanual task to characterize the left and right hemispheres' contributions. Materials and Methods: Left-hand LGFM of 20 healthy and consistently right-handed subjects was evaluated using the verbs "to write", "to hold", "to pull" (left-lateralized central processing actions), "to draw", "to tie", and "to drive" (bihemispheric central processing actions) as linguistic stimuli. The time between the word onset and the first interval of statistical significance regarding the baseline (here as reaction time, RT) was also measured. Results: The six verbs produced LGFM. The modulation intensity was similar for the six verbs, but the RT was variable. The verbs "to draw", "to tie", and "to drive", whose central processing of the described action is bihemispheric, showed a longer RT compared to the other verbs. Conclusions: The possibility of a given manual action being performed by the left hand in consistent right-handers does not interfere with the occurrence of LGFM when the descriptor verb of this action is used as a linguistic stimulus, even if the possibility is remote. Therefore, LGFM seems to mainly rely on the left hemisphere, while a greater activation of the right hemisphere in action processing appears to slow the increase in LGFM intensity.

How have research questions and methods used in clinical trials published in Clinical Rehabilitation changed over the last 30 years?

Research in rehabilitation has grown from a rare phenomenon to a mature science and clinical trials are now common. The purpose of this study is to estimate the extent to which questions posed and methods applied in clinical trials published in Clinical Rehabilitation have evolved over three decades with respect to accepted standards of scientific rigour. Studies were identified by journal, database, and hand searching for the years 1986 to 2016.A total of 390 articles whose titles suggested a clinical trial of an intervention, with or without randomization to form groups, were reviewed. Questions often still focused on methods to be used (57%) rather than what knowledge was to be gained. Less than half (43%) of the studies delineated between primary and secondary outcomes; multiple outcomes were common; and sample sizes were relatively small (mean 83, range 5 to 3312). Blinding of assessors was common (72%); blinding of study subjects was rare (19%). In less than one-third of studies was intention-to-treat analysis done correctly; power was reported in 43%. There is evidence of publication bias as 83% of studies reported either a between-group or a within-group effect. Over time, there was an increase in the use of parameter estimation rather than hypothesis testing and there was evidence that methodological rigour improved.Rehabilitation trialists are answering important questions about their interventions. Outcomes need to be more patient-centred and a measurement framework needs to be explicit. More advanced statistical methods are needed as interventions are complex. Suggestions for moving forward over the next decades are given.

Psychometric Properties of the Spinal Cord Injury Pressure Ulcer Scale (SCIPUS) for Pressure Ulcer Risk Assessment During Inpatient Rehabilitation.

OBJECTIVE: To assess the psychometric properties of the Spinal Cord Injury Pressure Ulcer Scale (SCIPUS) for pressure ulcer (PU) risk assessment during inpatient rehabilitation. DESIGN: Prospective cohort. SETTING: Tertiary rehabilitation centers. PARTICIPANTS: Individuals (N=759) participating in inpatient spinal cord injury rehabilitation between January 3, 2012, and April 23, 2014. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Admission SCIPUS scores and the corresponding risk stratification, PU incidence, intraclass correlation coefficient (ICC) for interrater reliability, sensitivity, specificity, and likelihood ratios (LRs). Receiver operating characteristic analysis was performed to calculate the area under the curve (AUC). RESULTS: Mean SCIPUS scores were higher for individuals who developed PUs than for those who did not (mean SCIPUS score, 9.8±2.5 vs 8.5±2.6). Interrater reliability was excellent for SCIPUS composite scores (ICC=.91) and very good for risk stratification (ICC=.86). Using the existing cutoff value of ≥6 for "high risk" category, sensitivity and specificity were estimated to be .97 and .12, respectively, with an LR of 1.1. A cutoff value of ≥8 yielded a better balance between sensitivity and specificity (.85 and .38, respectively). The AUC equaled .64 with an LR of 1.4. Results were similar when the analysis was confined to PUs of stage II or greater. CONCLUSIONS: The psychometric properties of the SCIPUS do not currently support its routine use as a measure of PU risk in individuals with spinal cord injury undergoing inpatient rehabilitation. LRs of <2 indicate that stratification as high risk or very high risk does not substantially increase the likelihood of identifying individuals who develop PUs beyond chance alone. AUCs were also below the desired cutoff value of 0.7.

Is neuroplasticity in the central nervous system the missing link to our understanding of chronic musculoskeletal disorders?

BACKGROUND: Musculoskeletal rehabilitative care and research have traditionally been guided by a structural pathology paradigm and directed their resources towards the structural, functional, and biological abnormalities located locally within the musculoskeletal system to understand and treat Musculoskeletal Disorders (MSD). However the structural pathology model does not adequately explain many of the clinical and experimental findings in subjects with chronic MSD and, more importantly, treatment guided by this paradigm fails to effectively treat many of these conditions. DISCUSSION: Increasing evidence reveals structural and functional changes within the Central Nervous System (CNS) of people with chronic MSD that appear to play a prominent role in the pathophysiology of these disorders. These neuroplastic changes are reflective of adaptive neurophysiological processes occurring as the result of altered afferent stimuli including nociceptive and neuropathic transmission to spinal, subcortical and cortical areas with MSD that are initially beneficial but may persist in a chronic state, may be part and parcel in the pathophysiology of the condition and the development and maintenance of chronic signs and symptoms. Neuroplastic changes within different areas of the CNS may help to explain the transition from acute to chronic conditions, sensory-motor findings, perceptual disturbances, why some individuals continue to experience pain when no structural cause can be discerned, and why some fail to respond to conservative interventions in subjects with chronic MSD. We argue that a change in paradigm is necessary that integrates CNS changes associated with chronic MSD and that these findings are highly relevant for the design and implementation of rehabilitative interventions for this population. Recent findings suggest that a change in model and approach is required in the rehabilitation of chronic MSD that integrate the findings of neuroplastic changes across the CNS and are targeted by rehabilitative interventions. Effects of current interventions may be mediated through peripheral and central changes but may not specifically address all underlying neuroplastic changes in the CNS potentially associated with chronic MSD. Novel approaches to address these neuroplastic changes show promise and require further investigation to improve efficacy of currents approaches.

Psychometric evaluation of the Disabilities of the Arm, Shoulder and Hand (DASH) with Dupuytren's contracture: validity evidence using Rasch modeling.

BACKGROUND: Dupuytren's contracture is a progressive, fibroproliferative disorder that causes fixed finger contractures and can lead to disability. With the advances of new therapeutic interventions, the necessity to assess the functional repercussions of this condition using valid, reliable and sensitive outcome measures is of growing interest. The Disabilities of the Arm, Shoulder and Hand (DASH) is one frequently used patient-reported outcome measure but its reliability and validity have never been demonstrated specifically for a population affected with Dupuytren's contracture. The objective of this study was to evaluate the psychometric properties of the DASH, with focus on validity evidence using the Rasch measurement model. METHODS: Secondary analysis was performed on data collected as part of a randomised clinical trial. One hundred fifty-three participants diagnosed with Dupuytren's contracture completed the DASH at four time points (pre-op, 3, 6 and 12 months post-op). Baseline data were analysed using traditional analysis and to test whether they adhered to the expectations of the Rasch model. Post-intervention data were subsequently included and analyzed to determine the effect of the intervention on the items. RESULTS: DASH scores demonstrated large ceiling effects at all time points. Initial fit to the Rasch model revealed that the DASH did not adhere to the expectations of the Rasch partial credit model (χ2=119.92; p<0.05). Multiple items displayed inadequate response categories and two items displayed differential item functioning by gender. Items were transformed and one item deleted leading to an adequate fit. Remaining items fit the Rasch model but still do not target well the population under study. CONCLUSIONS: The original version of the 30-item DASH did not display adequate validity evidence for use in a population with Dupuytren's contracture. Further development is required to improve the DASH for this population.

Pediatric Performance-Based Outcome Measures for Upper Extremity Function: A Scoping Review and Linking to the International Classification of Functioning, Disability, and Health.

Background. Performance-based outcome measures (PBOMs) are objective measures that assess physical capacity or performance in specific tasks or movements. Purpose. 1) to identify which PBOMs are most frequently reported to evaluate upper extremity (UE) function in pediatric rehabilitation 2) to determine the link between constructs of the ICF and meaningful concepts extracted from each identified PBOM. Methods. Pediatric UE PBOMs were searched in four databases. The selection of outcome measures included an initial title and abstract screening, followed by full-text review of the articles to be included based on identified selection criteria. Two reviewers were appointed to link the meaningful concepts identified in the outcome measures independently and a third reviewer was consulted in case of ambiguity to make a final decision. Findings. After the initial screening, 1786 full-text articles were reviewed, 1191 met the inclusion criteria, in which 77 outcome measures were identified and 32 were included in the linking process. From the included 32 outcome measures, 538 items were extracted and linked to the ICF. The most commonly cited measures included Assisting Hand Assessment, Jebsen-Taylor Hand Function Test, Melbourne Assessment of Unilateral Upper Limb. The Activity and Participation domain represented 364 codes followed by the Body Functions domain domain which represented 174 codes. Implications. A majority of the outcome measures identified were linked with the Mobility, Fine Hand Use of the ICF. Therefore, when selecting a PBOM, careful considerations need to be made regarding which concept of health is to be assessed.

Occupational therapists' evaluation of the perceived usability and utility of wearable soft robotic exoskeleton gloves for hand function rehabilitation following a stroke.

PURPOSE: To evaluate the perceived usability and utility of using a soft robotic glove to rehabilitate hand function following a stroke. METHODS: A convergent parallel mixed-methods design was used to consult a convenience sample of 14 experienced occupational therapists (OTs) practicing within a specialised stroke rehabilitation program. All OTs participated in one 60-to-90-minute individual consultation during which the attributes of a recently-developed soft robotic glove (ExoGlove) were presented before they could test it on themselves. After this consultation, OTs completed the System Usability Scale (SUS) questionnaire and answered open-ended questions focussing on the usability and utility of soft robotic gloves framed according to the Unified Theory of Acceptance and Use of Technology (UTAUT). RESULTS: The OTs perceived the glove's usability as being moderate-to-good on the SUS (median score= 63.75 on a scale of 100). Thematic analysis revealed the importance of specifically considering elements such as ease of use (e.g. simplicity and speed), cost, movement precision, durability, and safety, when developing soft robotic gloves such as the ExoGlove. CONCLUSIONS: Engagement in a continuous improvement process is essential to maximise the perceived usability and utility of soft robotic gloves, particularly of the ExoGlove, through their final development phase before pilot testing their effects and effectiveness for post-stroke hand rehabilitation.Implications for rehabilitationAll occupational therapists anticipate that a soft robotic glove such as the ExoGlove will allow them to increase treatment intensity and best aligns with principles of neuroplasticity.The clinical judgement and guidance of OTs, developed through practice, experience, and knowledge, remain essential to safely and efficiently exercise with a soft robotic glove.Achieving a balance between effort and performance expectancies is essential in developing and improving the functionality of soft robotic gloves, as with each additional functionality comes new challenges that impact its successful transition to a clinical setting.

Seated postural organization during bilateral upper limb symmetric and asymmetric pushing tasks in individuals after stroke compared to healthy controls.

BACKGROUND: Asymmetric weight distribution in sitting has been reported in people after stroke. However, postural strategies used during bilateral symmetric and asymmetric movements performed while seated require more evidence to inform rehabilitation strategies. RESEARCH QUESTIONS: How do symmetric and asymmetric effort levels exerted during upper limb (UL) pushing movements affect seated postural organization parameters (weight bearing (WB) between hands and hemibody sides, and forward trunk displacement) of stroke compared to healthy individuals? How are these parameters associated? METHODS: Using an instrumented exerciser, 19 post-stroke individuals were compared to 17 healthy individuals when executing four bilateral UL pushing movements in a seated position: symmetrical pushing at 30 % and 15 % of their maximal force (MF) and asymmetrical pushing with 15 % of their MF for one UL vs. 30 % of the MF for the other UL and vice versa. Anterior and vertical forces of the push, as well as vertical forces under each foot and thigh were compared between groups, sides and conditions. Forward trunk displacement was compared between groups and conditions. Correlations were used to determine the association between trunk displacement, hands and hemibody vertical forces. RESULTS: Increasing pushing effort caused increased WB on thighs and decreased on WB on feet during the 30 % MF symmetric condition compared to the 15 % MF and asymmetric conditions (p < 0.05). Individuals post-stroke showed WB asymmetry and greater forward trunk displacement when compared to healthy persons (p < 0.05). For both groups, hemibody WB and trunk displacement showed moderate association (r > - 0.5) in the asymmetric condition executed with more resistance on the paretic or non-dominant hand. SIGNIFICANCE: Individuals post-stroke presented a similar WB pattern to that of healthy persons during symmetric and asymmetric bilateral UL movements with greater forward trunk displacement and asymmetry. Increased effort and asymmetric force between both UL had effects on seated postural organization strategy.

Stakeholder engagement in the development of an upper extremity outcome measure for children with rare musculoskeletal conditions.

BACKGROUND: Upper extremity (UE) involvement is prevalent in 73% of individuals with arthrogryposis multiplex congenita (AMC), yet no AMC-specific outcome measure exists. When developing a measure specific to a population with a rare musculoskeletal condition, clinicians' and patients' perspectives and involvement is a crucial and necessary step. This study sought to determine the most clinically useful items for an outcome measure of UE function for children with AMC as defined by caregivers and clinicians. METHODS: To ensure the perspectives and needs of caregivers of children with AMC and clinicians were considered in the development of the UE measure for AMC, a Nominal Group technique (NGT) with caregivers of children with AMC (phase 1) followed by a three-round survey with clinicians (phase 2) were carried out. RESULTS: Phase 1: Eleven individuals participated in the nominal group technique and identified 32 items. The most important items were Picking up an object (n = 11), Eating (n = 10), Reaching mouth (n = 10), Getting out of bed (n = 10). Phase 2: Invitations to participate to an online survey was sent to 47 experts in the field of AMC, 20 participants completed round 1, 15 completed round 2 and 13 completed round 3. Throughout the survey, participants were asked about movement required to screen the UE, essential domains to be included in the measure, establishing a scoring guide and identifying tasks associated with joint motion and position. CONCLUSION: A preliminary version of an UE AMC-specific outcome measure was developed with the help of caregivers' perspectives and expert opinions.

Arthrogryposis multiplex congenita (AMC) is a rare musculoskeletal condition affects the joints and muscles of the body. In about 70% of the cases, it affects the upper extremities (UE). However, there is no specific outcome measure for UE function in children with AMC. An outcome measure refers to a tool or method used to assess and measure the results or effects of a particular treatment, intervention, or condition. It helps healthcare professionals and researchers understand the impact or outcome of a specific situation, such as the level of improvement or changes in a person's health or function. The goal of this study was to develop such a measure while accounting for the perspectives of youth with AMC, their caregivers and clinicians. To achieve this, a study was conducted in two phases. In the first phase, a Nominal Group technique (NGT) was used to gather input from caregivers of children with AMC. Eleven individuals participated and identified 32 items, with the most important being picking up an object, eating, reaching the mouth, and getting out of bed. In the second phase, a three-round survey was sent to 47 experts in the field of AMC, with 20 participants completing the first round, 15 completing the second round, and 13 completing the third round. The survey asked participants about screening UE movement, essential domains to include in the measure, establishing a scoring guide, and identifying tasks associated with joint motion and position. With the help of caregivers' perspectives and expert opinions, a preliminary version of an UE AMC-specific outcome measure was developed. This measure will be useful in assessing the UE function in children with AMC and will aid clinicians in developing appropriate treatment plans for this rare condition.

Bilateral motor coordination during upper limb symmetric pushing movements at two levels of force resistance in healthy and post-stroke individuals.

BACKGROUND: Impairments of the upper limb (UL) are common after a stroke and may affect bilateral coordination. A better understanding of UL bilateral coordination is required for designing innovative rehabilitation strategies. OBJECTIVE: To assess bilateral coordination after stroke using time-distance, velocity and force parameters during an UL bilateral task performed by simultaneously pushing handles on a bilateral exerciser at two levels of force. METHODS: Two groups were included to assess bilateral coordination on a newly designed bimanual exerciser- One group of individuals at least 3 months post-stroke (n = 19) with moderate impairment and one group of healthy individuals (n = 20). Participants performed linear movements by pushing simultaneously with both hands on instrumented handles. The task consisted of two one-minute trials performed in sitting at two levels of participants' maximum force (MF): 30% and 15%, with visual feedback. Time-distance parameters, spatial, velocity and force profiles were compared between groups, between levels of resistance and the first part (0-50%) and entire duration of the pushing cycles (0-100%). RESULTS: The mean pushing time was longer at 30% MF compared to 15% MF in the stroke group. Spatial profiles, represented by hand positions on the rail, revealed that the paretic hand lagged slightly behind throughout the cycle. For velocity, both groups displayed good coordination. It was less coupled at 30% than 15% MF and a trend was observed toward more lag occurrence in the stroke group. Except for lower forces on the paretic side in the stroke group, the shape of the force profiles was similar between groups, sides and levels of resistance. For all parameters, the coordination was good up to 75% of the pushing cycle and decreased toward the end of the cycle. CONCLUSIONS: Individuals after stroke presented with overall spatial and temporal coupling of the UL during bilateral pushing movements. The relay of information at different levels of the nervous system might explain the coordinated pushing movements and might be interesting for training UL coordination.

Virtual Reality-Based Rehabilitation as a Feasible and Engaging Tool for the Management of Chronic Poststroke Upper-Extremity Function Recovery: Randomized Controlled Trial.

BACKGROUND: A growing number of stroke survivors are left with little to no rehabilitation services upon discharge from stroke rehabilitation, although arm deficits may persist or develop from disuse once rehabilitation services have ceased. Virtual reality (VR)-based rehabilitation, combined with new technologies such as telerehabilitation, including serious games using VR environments that encourage users to practice functional movements from home with minimal supervision, may have an important role to play in optimizing and maintaining upper extremity (UE) function. OBJECTIVE: The primary objective of this study is to determine the extent to which a 1-month intervention using a VR-based serious game is effective in improving UE function compared with an evidence-based home exercise program. A secondary objective is to assess the feasibility of implementing the intervention for chronic stroke rehabilitation in participants' homes. METHODS: A total of 51 chronic stroke participants were randomized to treatment (n=26, 51%; Jintronix system) or standard care (n=25, 49%; standardized Graded Repetitive Arm Supplementary Program kit home program) groups. The participants were evaluated at baseline (before), immediately after the intervention (after), and at follow-up (4 weeks). The primary outcome measure was the Fugl-Meyer Assessment for UE (FMA-UE). Secondary outcome measures included the Stroke Impact Scale and an abridged version of the Motor Activity Log-14. Self-reported number of sessions was logged for the standard care group. RESULTS: No statistically significant differences between groups were found across measures. Overall time effects were found for the FMA-UE (P=.045), specifically between preintervention and postintervention time points for both groups (P=.03). A total of 9 participants in the treatment group reached or surpassed the minimal clinically important difference in scores for the FMA-UE, with 7 (78%) of them having baseline low or moderate arm function, compared with 3 (33%) participants in the standard care group. Furthermore, 56% (9/16) of the participants in the treatment group who actively engaged with the system reached the minimal clinically important difference for the FMA-UE, compared with none for the 0% (0/10) less-active participants. CONCLUSIONS: These findings suggest that UE training for chronic stroke survivors using virtual rehabilitation in their home may be as effective as a gold standard home exercise program and that those who used the system the most achieved the greatest improvement in UE function, indicating its relevance to being included as part of ongoing rehabilitation services. TRIAL REGISTRATION: ClinicalTrials.gov NCT02491203; https://clinicaltrials.gov/ct2/show/NCT02491203. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1016/j.cct.2015.12.006.

Somesthetic, Visual, and Auditory Feedback and Their Interactions Applied to Upper Limb Neurorehabilitation Technology: A Narrative Review to Facilitate Contextualization of Knowledge.

Reduced hand dexterity is a common component of sensorimotor impairments for individuals after stroke. To improve hand function, innovative rehabilitation interventions are constantly developed and tested. In this context, technology-based interventions for hand rehabilitation have been emerging rapidly. This paper offers an overview of basic knowledge on post lesion plasticity and sensorimotor integration processes in the context of augmented feedback and new rehabilitation technologies, in particular virtual reality and soft robotic gloves. We also discuss some factors to consider related to the incorporation of augmented feedback in the development of technology-based interventions in rehabilitation. This includes factors related to feedback delivery parameter design, task complexity and heterogeneity of sensory deficits in individuals affected by a stroke. In spite of the current limitations in our understanding of the mechanisms involved when using new rehabilitation technologies, the multimodal augmented feedback approach appears promising and may provide meaningful ways to optimize recovery after stroke. Moving forward, we argue that comparative studies allowing stratification of the augmented feedback delivery parameters based upon different biomarkers, lesion characteristics or impairments should be advocated (e.g., injured hemisphere, lesion location, lesion volume, sensorimotor impairments). Ultimately, we envision that treatment design should combine augmented feedback of multiple modalities, carefully adapted to the specific condition of the individuals affected by a stroke and that evolves along with recovery. This would better align with the new trend in stroke rehabilitation which challenges the popular idea of the existence of an ultimate good-for-all intervention.

Lessons Learned From Clinicians and Stroke Survivors About Using Telerehabilitation Combined With Exergames: Multiple Case Study.

BACKGROUND: In Canada, stroke survivors have difficulty accessing community-based rehabilitation services because of a lack of resources. VirTele, a personalized remote rehabilitation program combining virtual reality exergames and telerehabilitation, was developed to provide stroke survivors an opportunity to pursue rehabilitation of their chronic upper extremity (UE) deficits at home while receiving ongoing follow-up from a clinician. OBJECTIVE: We aimed to identify the behavioral and motivational techniques used by clinicians during the VirTele intervention, explore the indicators of empowerment among stroke survivors, and investigate the determinants of VirTele use among stroke survivors and clinicians. METHODS: This multiple case study involved 3 stroke survivors with chronic UE deficits and their respective clinicians (physiotherapists) who participated in the VirTele intervention, a 2-month remote rehabilitation intervention that uses nonimmersive virtual reality exergames and telerehabilitation aimed at improving UE deficits in stroke survivors. Study participants had autonomous access to Jintronix exergames and were asked to use them for 30 minutes, 5 times a week. The VirTele intervention included 1-hour videoconference sessions with a clinician 1 to 3 times a week, during which the clinician engaged in motivational interviewing, supervised the stroke survivors' use of the exergames, and monitored their use of the affected UE through activities of daily living. Semidirected interviews were conducted with the clinicians and stroke survivors 4 to 5 weeks after the end of the VirTele intervention. All interviews were audiorecorded and transcribed verbatim. An abductive thematic analysis was conducted to generate new ideas through a dynamic interaction between data and theory. RESULTS: Three stroke survivors (n=2, 67%, women and n=1, 33%, man), with a mean age of 58.8 (SD 19.4) years, and 2 physiotherapists participated in the study. Five major determinants of VirTele use emerged from the qualitative analyses, namely technology performance (usefulness and perception of exergames), effort (ease of use), family support (encouragement), facilitators (considerations of the stroke survivors' safety as well as trust and understanding of instructions), and challenges (miscommunication and exergame limits). During the VirTele intervention, both clinicians used motivational and behavioral techniques to support autonomy, competence, and connectivity. All these attributes were reflected as empowerment indicators in the stroke survivors. Lessons learned from using telerehabilitation combined with exergames are provided, which will be relevant to other researchers and contexts. CONCLUSIONS: This multiple case study provides a first glimpse into the impact that motivational interviewing can have on adherence to exergames and changes in behavior in the use of the affected UE in stroke survivors. Lessons learned regarding the supportive role caregivers play and the new responsibilities clinicians have when using the VirTele intervention may inform the use of exergames via telerehabilitation. These lessons will also serve as a model to guide the implementation of similar interventions. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/14629.