Ecological fallacy as a novel risk factor for poor translation in neuroscience research: A systematic review and simulation study.

BACKGROUND: Translational neuroscience is largely concerned with establishing causal links between biological processes and functional outcomes. Exciting new methods have emerged and top-tier biomedical journals are placing increasingly high demand for experiments that link outcomes. One pitfall to making these connections is the "ecological fallacy"-establishing a relationship between outcomes based on aggregate (averaged) results (a distinct issue from correlation vs causation). METHODS: To showcase the ecological fallacy, we first used simulated data to define and demonstrate the problem. Next, we performed a systematic review to determine the prevalence of the fallacy in top-tier biomedical journals (Science, Nature Medicine, Neuron, Nature, Nature Neuroscience, Cell). Based on our own research interests and specializations, we specifically focused on recent publications in the area of spinal cord injury and regenerative medicine. RESULTS: Of the articles reviewed which examined a relationship between central nervous system regeneration and a behavioural outcome, 100% (21/21) were subject to possible ecological fallacy. CONCLUSIONS: Ecological fallacy is highly prevalent in neuroscience research and could partially account for translation failures in this field. Reporting guidelines for in vivo experiments should include subject-level correlation analyses for the primary outcomes.

Seasonal Patterns of Community Participation and Mobility of Wheelchair Users Over an Entire Year.

OBJECTIVE: To describe how people who use wheelchairs participate and move at home and in the community over an entire yearlong period, including during times of inclement weather conditions. DESIGN: Longitudinal mixed-methods research study. SETTING: Urban community in Canada. PARTICIPANTS: People who use a wheelchair for home and community mobility (N=11). INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Use of a global positioning system (GPS) tracker for movement in community (number of trips per day), use of accelerometer for bouts of wheeling mobility (number of bouts per day, speed, distance, and duration), prompted recall interviews to identify supports and barriers to mobility and participation. RESULTS: More trips per day were taken during the summer (P= .03) and on days with no snow and temperatures above 0°C. Participants reliant on public transportation demonstrated more weather-specific changes in their trip patterns. The number of daily bouts of mobility remained similar across seasons; total daily distance wheeled, duration, and speed were higher on summer days, days with no snow, and days with temperatures above 0°C. A higher proportion of outdoor wheeling bouts occurred in summer (P=.02) and with temperatures above 0°C (P=.03). Inaccessible public environments were the primary barrier to community mobility and participation; access to social supports and private transportation were the primary supports. CONCLUSIONS: Objective support is provided for the influence of various seasonal weather conditions on community mobility and participation for people who use a wheelchair. Longitudinal data collection provided a detailed understanding of the patterns of, and influences on, wheelchair mobility and participation within wheelchair users' own homes and communities.

Clinicians' and Researchers' Perspectives on Manual Wheelchair Data Loggers.

Recent studies have used data loggers to record a wide range of, sometimes differing, objective outcomes associated with the use of manual wheelchairs. To identify which outcomes are broadly perceived to be the most important to measure when objectively documenting manual wheelchair use, a cross-sectional survey was conducted with groups of researchers and clinicians in the field of wheeled mobility. We also surveyed the challenges these groups experienced when using data loggers. The survey was informed by a previous scoping review of the scientific and gray literature. Seventy-four people with various academic and professional backgrounds completed the survey: 57 researchers (77.0%) and 17 clinicians (23.0%). Regarding the importance they attributed to commonly measured outcomes, the most highly rated outcome identified by both groups was "distance traveled." There were significant differences between the groups' perspectives in rating and ranking the importance of "pressure-relief activities," "seat pressure," and "acceleration." In terms of challenges or barriers associated with the use of data loggers for monitoring manual wheelchair use, it appears that researchers and clinicians have relatively similar needs and preferences. However, only clinicians reported that the time they wanted to, or could, allocate to review recorded information was a potential hardship. Our hope is that these results will help further development and increase the functionality and applicability of data loggers for manual wheelchairs in research and clinical contexts.

Neuropathic pain, depression, and cardiovascular disease: a national multicenter study.

BACKGROUND: Individuals with spinal cord injury (SCI) have a more than twofold increased risk of heart disease and stroke compared with able-bodied individuals. The increased risk appears to be in excess of the risk conferred by several well-established risk factors, including diabetes, hypertension, and sex. This raises the question whether other factors, secondary to SCI, are also contributing to the development of cardiovascular disease (CVD). Two potential factors associated with SCI and CVD are pain and depression. Both are frequently reported among individuals with SCI, develop in the acute stages of injury, and are commonly described as severe. Therefore, the primary aim of this study was to examine the relationship between pain (and types of pain) and depression with CVD among individuals with SCI. METHODS: A total of 1,493 individuals (referred sample) with chronic SCI participated in a self-report cross-sectional multicenter Canada-wide survey from 2011-2012 (mean age ± standard deviation: 49.6 ± 13.9 years). RESULTS: After adjustment for age, sex, and injury characteristics, neuropathic pain and depression were significantly and independently associated with CVD (adjusted odds ratio and 95% confidence interval: 2.27 (1.21, 4.60) for neuropathic pain; 4.07 (2.10, 7.87) for depression). In contrast to neuropathic pain, non-neuropathic pain was not significantly associated with CVD (p = 0.13). CONCLUSION: In conclusion, these data illustrate important interrelationships between secondary complications following SCI, as well as raise the possibility of neuropathic pain (versus nociceptive pain) as a novel and emerging risk factor for CVD.

Evaluation of two power assist systems for manual wheelchairs for usability, performance and mobility: a pilot study.

BACKGROUND: Power-assist devices for manual wheelchairs offer benefits, including increased community participation. Several power-assist devices are commercially available, but research on benefits and limitations of devices is limited. OBJECTIVE: To compare the usability, performance, and mobility of two power-assist device systems for manual wheelchairs in indoor and outdoor environments. METHODS: This mixed methods pilot study included 11 volunteers with limited wheelchair experience. Participants tested two different power-assist device configurations: (1) the Batec® and (2) the SmartDrive® + Freewheel®. Indoor & outdoor obstacle courses contained relevant skills from the Wheelchair Skills Test, Power Mobility Community Driving Assessment, and Power Mobility Indoor Driving Assessment. The NASA Task Load Index and System Usability Scale assessed participants' perceptions of cognitive demand and usability. A semi-structured interview was conducted to explore participants' experiences. RESULTS: Substantial differences were found in the NASA Task Load Index, and System Usability Scale scores. Participant interviews and researcher observations revealed each device performed better on some obstacle course elements. Qualitative findings showed a general preference for using the Batec® for long trips outside and off-road terrains, primarily due to the Batec's® perceived better speed control, maximum speed, and simpler braking system. Conversely, the SmartDrive® + Freewheel® was deemed most useful indoors and in tight spaces; due to a smaller wheelchair footprint, better turning radius, and increased device portability. CONCLUSION: Further studies are required to understand the usability, performance, and mobility of power-assist devices. Moving forward, these findings will inform end users and occupational therapists when procuring manual wheelchair power-assist devices.Implications for rehabilitationPower-assist devices (PADs) for manual wheelchairs increase the potential for community participation.Qualitative findings showed a general preference for using the Batec® for long trips outside and for off-road terrains, primarily due to the Batec's® perceived better speed control, maximum speed, and simpler braking system.The SmartDrive® + Freewheel® was deemed most useful indoors and in tight spaces; due to a smaller wheelchair footprint, better turning radius, and increased device portability.Increasing knowledge and research about PADs will support development of alternative options for manual or power wheelchairs users. PADs may allow manual wheelchair users (MWC) to delay moving to a power wheelchair (PWC), potentially reducing the perceived stigma associated with transitioning to a power wheelchair and impacting health outcomes.

Perception of autonomy among people who use wheeled mobility assistive devices: Dependence on the type of wheeled assistive technology.

We evaluated perceived autonomy among users of different types of wheeled mobility assistive devices (WMADs) across five environments and identified the effect on user autonomy due to specific device characteristics. A study-specific questionnaire was used to assess satisfaction with autonomy of WMAD users in the Home, Buildings Outside of the Home, Outdoor Built, Outdoor Natural Environment, and Transportation. For each environment, 15 contextual factors were rated for their impact on participants' autonomy. Our results revealed that manual wheelchair with add-on (MWC+AO) users had higher overall satisfaction with their autonomy compared to other WMAD users. MWC+AO users reported higher satisfaction with autonomy due to their health conditions compared to other WMAD users across all environments. In Outdoor Natural Environments, MWC+AO users had the highest satisfaction with autonomy across all factors except for negotiating hills. When performing activities in Buildings, MWC users with and without add-ons reported higher satisfaction for all factors compared to power wheelchair users, except for maneuverability on different surfaces. Satisfaction with autonomy regarding contextual factors varied among WMAD users, however, MWC+AO(s) appeared to provide a more balanced sense of autonomy across most factors and environments. More in-depth investigations are required to evaluate impacts of add-on use on autonomy.

Outdoor recreation among wheeled mobility users: perceived barriers and facilitators.

PURPOSE: Participation in outdoor recreation is associated with improvements in mental, emotional, and physical health. Individuals with impairments affecting mobility, such as wheelchair users, face environmental, physical, and social barriers to participation in outdoor recreation. There is limited research on outdoor recreation participation among wheelchair users, especially concerning informal recreational opportunities. Formal programmes that offer access to outdoor recreation are often oversubscribed and also do not enable opportunities to participate more spontaneously. OBJECTIVES: (1) To explore the experiences and impact of participation in outdoor recreation activities by wheelchair users, with an emphasis on more informal activities; and (2) to identify perceived barriers and facilitators to participation in outdoor recreation activities. METHODS: Semi-structured interviews were the main means of data collection in this interpretive description study; this was supplemented by photographs of activity involvement provided by participants. These data were analysed thematically. RESULTS: Fifteen Canadian wheelchair users participated in the study. Three themes emerged following analysis: (1) Into the Woods explores participants' current outdoor recreation experiences, (2) Ain't No Mountain High Enough looks at the barriers and challenges participants face, and (3) Just Around the Riverbend discusses participants' desired changes to enable their further participation. CONCLUSIONS: The study highlighted participants' current experiences, their perceived barriers, and several ways to enhance outdoor recreation participation among wheelchair users, including: developing new adaptations, creating policies, increasing access to affordable equipment and programmes, and reducing barriers in built and natural environments.Implications for rehabilitationWheelchair users participate in a wide variety of outdoor activities.Wheelchair users experience various barriers and challenges when participating in outdoor recreation.Despite recent improvements, environmental changes are needed to allow wheelchair users to access outdoor recreation.Further development of adaptive equipment is needed in order for wheelchair users to access their desired outdoor recreation activities.

Offline and Real-Time Implementation of a Terrain Classification Pipeline for Pushrim-Activated Power-Assisted Wheelchairs.

Pushrim-activated power-assisted wheelchairs (PAPAWs) are assistive technologies that provide propulsion assist to wheelchair users and enable access to various indoor and outdoor terrains. Therefore, it is beneficial to use PAPAW controllers that adapt to different terrain conditions. To achieve this objective, terrain classification techniques can be used as an integral part of the control architecture. Previously, the feasibility of using learning-based terrain classification models was investigated for offline applications. In this paper, we examine the effects of three model parameters (i.e., feature characteristics, terrain types, and the length of data segments) on offline and real-time classification accuracy. Our findings revealed that Random Forest classifiers are computationally efficient and can be used effectively for real-time terrain classification. These classifiers have the highest performance accuracy when used with a combination of time- and frequency-domain features. Additionally, we found that increasing the number of data points used for terrain estimation improves the prediction accuracy. Finally, our results revealed that classification accuracy can be improved by considering terrains with similar characteristics under one umbrella group. These findings can contribute to the development of real-time adaptive controllers that enhance PAPAW usability on different terrains.

Scoping review of propelling aids for manual wheelchairs.

Manual wheelchair (MWC) users face a variety of obstacles limiting their participation. Different MWC models and new add-on components intended to improve propulsion may impact users' function and participation, although there is a lack of research on this topic. The aims of this study were to: 1) identify MWC propelling aids (PA) that are reported in the literature; 2) classify the outcomes used to evaluate the influence of PA according to the International Classification of Functioning, Disability and Health (ICF); and 3) summarize evidence for the influence of PA. A scoping review was conducted in 2017 using Pubmed, Medline, Embase, CINAHL, Compendex, IEEE Xplore, RESNA and ISS proceedings, Google, and Google Scholar. The content of each manuscript was assessed by two independent reviewers. A total of 28 PA (19 human-powered; 9 power-assisted) were identified from 163 manuscripts. The three most cited ICF subdomains were "Activity & Participation" (n = 125), "Body Function" (n = 100), and "Personal Factors" (n = 55). The findings suggest an overall positive influence of PA on various ICF domains/subdomains, but initial findings should be interpreted with caution. Confirmation of the effect and safety of PA requires higher levels of evidence.

The development of a sensory substitution system for the sexual rehabilitation of men with chronic spinal cord injury.

INTRODUCTION: Sexual health is often severely impacted after spinal cord injury (SCI). Current research has primarily addressed male erection and fertility, when in fact pleasure and orgasm are top priorities for functional recovery. Sensory substitution technology operates by communicating input from a lost sensory pathway to another intact sensory modality. It was hypothesized that through training and neuroplasticity, mapped tongue sensations would be interpreted as sensory perceptions arising from insensate genitalia, and improve the sexual experience. AIM: To report the development of a sensory substitution system for the sexual rehabilitation of men with chronic SCI. METHODS: Subjects performed sexual self-stimulation while using a novel sensory substitution device that mapped the stroking motion of the hand to a congruous flow of electrocutaneous sensations on the tongue. MAIN OUTCOME MEASURES: Three questionnaires, along with structured interviews, were used to rate the perceived sexual sensations following each training session. RESULTS: Subjects completed 20 sessions over approximately 8 weeks of training. Each subject reported an increased level of sexual pleasure soon after training with the device. Each subject also reported specific perceptions of cutaneous-like sensations below their lesion that matched their hand motion. Later sessions, while remaining pleasurable and interesting, were inconsistent, and no subject reported an orgasmic feeling during a session. The subjects were all interested in continuing training with the device at home, if possible, in the future. CONCLUSIONS: This study is the first to show that sensory substitution is a possible therapeutic avenue for sexual rehabilitation in people lacking normal genital sexual sensations. However more research, for instance on frequency and duration of training, is needed in order to induce functional lasting neuroplasticity. In the near term, SCI rehabilitation should more fully address sexuality and the role of neuroplasticity for promoting the maximal potential for sexual pleasure and orgasm.

Evaluation of the Nino® Two-Wheeled Power Mobility Device: A Pilot Study.

Novel technologies such as the Nino® two-wheeled powered mobility device are promoted as offering an intuitive improved experience compared to conventional wheelchair mobility use. The Nino® has a smaller footprint than a power wheelchair, a zero-degree turning radius, tiller-based steering, and relies on the user leaning forwards and back to move and brake. This study aimed to evaluate manual wheelchair users' ability to use the Nino® to complete a variety of wheelchair skills, and also investigated task demand, user confidence, and user perceptions. Twelve participants with a mean of 22 years of experience using a wheelchair completed the study; most had spinal cord injuries and one had multiple sclerosis. Our findings indicate that Wheelchair Skills Test scores were significantly higher for individuals in their manual wheelchair than in the Nino®. Results from the Wheelchair Use Confidence Scale showed that confidence scores increased significantly after completing Nino® training, and that participants were significantly more confident using their manual chair than the Nino®. Cognitive workload, as measured by the NASA-Task Load Index, was significantly higher in the Nino® than in participants' manual wheelchairs. Findings from qualitative interviews suggest that the Nino® is unlikely to be suitable as a functional replacement of an individual's manual wheelchair. Most participants felt unsafe during braking. Other perceptions included that the Nino may be a good alternative for use as a recreational outdoor mobility device, a powered mobility option to help prevent upper extremity overuse injuries, have a positive impact on social interactions, but that a high degree of focus was required during use. In addition to needing to address safety, usability, and functional concerns, the data suggests a clinical focus on training individuals to use these new devices may be necessary for effective community use.

Development of A Learning-Based Terrain Classification Framework for Pushrim-Activated Power-Assisted Wheelchairs.

Pushrim-activated power-assisted wheels (PAPAWs) are assistive technologies that provide on-demand torque assistance to wheelchair users. Although the available power can reduce the physical load of wheelchair propulsion, it may also cause maneuverability and controllability issues. Commercially-available PAPAW controllers are insensitive to environmental changes, leading to inefficient and/or unsafe wheelchair movements. In this regard, adaptive velocity/torque control strategies could be employed to improve safety and stability. To investigate this objective, we propose a context-aware sensory framework to recognize terrain conditions. In this paper, we present a learning-based terrain classification framework for PAPAWs. Study participants performed various maneuvers consisting of common daily-life wheelchair propulsion routines on different indoor and outdoor terrains. Relevant features from wheelchair frame-mounted gyroscope and accelerometer measurements were extracted and used to train and test the proposed classifiers. Our findings revealed that a one-stage multi-label classification framework has a higher accuracy performance compared to a two-stage classification pipeline with an indoor-outdoor classification in the first stage. We also found that, on average, outdoor terrains can be classified with higher accuracy (90%) compared to indoor terrains (65%). This framework can be used for real-time terrain classification applications and provide the required information for an adaptive velocity/torque controller design.

Studies on Practical Applications of Safe-Fall Control Strategies for Lower Limb Exoskeletons.

Lower limb exoskeletons (LLEs) are susceptible to falls, and users are at risk of head and/or hip injuries. To address concerns regarding the safety of LLE users, optimization techniques were used to study safe-fall control strategies. Simulation results of these studies showed promising performance that leads to head impact avoidance and mitigation of hip impact velocity. The motivation for the current research was to extend the application of previously developed optimization techniques to study more realistic human-LLE fall conditions. We examined a range of feasible fall durations for the human-LLE model and found the optimal fall duration for which the user's safety is maximized. Next, we used a range of coefficients of friction to examine fall strategies on different ground surface conditions. We found that the effectiveness of a safe-fall strategy is higher when falling on less slippery surfaces compared to more slippery ones. The simulation results were implemented in a half-scale physical model of a three-link inverted pendulum, which represented a human-LLE model. Results of our experiments verified that the optimal safe-fall strategy could be implemented in a mechanical test setup. The hip linear velocity at impact was found to have similar values in both the experimental (2.04 m/s) and simulation results (2.09 m/s). Further studies should be conducted with appropriate software and hardware platforms to successfully implement safe-fall strategies in an actual LLE.

Data Logger Technologies for Powered Wheelchairs: A Scoping Review.

In recent years, studies increasingly employed data loggers to record the objective behaviors of powered wheelchair users. Of the data logging work reported in the literature, the technologies used offer marked differences in characteristics. In order to identify and describe the extent of published research activity that relies on data logger technologies for powered wheelchairs, we performed a scoping review of the scientific and grey literature. This scoping review, complementary to a previous one related to manual wheelchairs, is part of a process aiming to help further the development and increase the functionality of data loggers with wheelchairs. Five databases were searched: Medline, Compendex, CINAHL, EMBASE, Google Scholar. Sixty papers were retained for analysis. The most frequently used technologies were all installed on the wheelchair: 19.0% were accelerometers, 14.6% were pressure sensors or switches, 13.9% were odometers, 10.9% were global positioning systems, 9.5% were tilt sensors, and 7.3% were force-sensing technologies. The most reported outcomes were pressure-relief activities (17.3%), distance traveled (9.3%), mobility events (8.9%), acceleration (8.5%), and sitting time (6.9%). Future research may be needed to assess the usefulness of different outcomes and to develop methods more appropriate to optimize the practicality of wheelchair data loggers.

Towards the Development of a Learning-Based Intention Classification Framework for Pushrim-Activated Power-Assisted Wheelchairs.

There has been a growth in the design and use of power assist devices for manual wheelchairs (MWCs) to alleviate the physical load of MWC use. A pushrim-activated power-assisted wheel (PAPAW) is an example of a power assist device that replaces the conventional wheel of a MWC. Although the use of PAPAWs provides some benefits to MWC users, it can also cause difficulties in maneuvering the wheelchair. In this research, we examined the characteristics of wheelchair propulsion when using manual and powered wheels. We used the left and right wheels' angular velocity to calculate the linear and angular velocity of the wheelchair. Results of this analysis revealed that the powered wheel's controller is not optimally designed to reflect the intentions of a wheelchair user. To address some of the challenges with coordinating the pushes on PAPAWs, we proposed the design of a user-intention detection framework. We used the kinematic data of MWC experiments and tested six supervised learning algorithms to classify one of four movements: "not moving", "moving straight forward", "turning left", and "turning right". We found that all the classification algorithms determined the type of movement with high accuracy and low computation time. The proposed intention detection framework can be used in the design of learning-based controllers for PAPAWs that take into account the individualized characteristics of wheelchair users. Such a system may improve the experience of PAPAW users.

Smartphone-Delivered Peer Physical Activity Counseling Program for Individuals With Spinal Cord Injury: Protocol for Development and Pilot Evaluation.

BACKGROUND: Leisure-time physical activity (LTPA) is a critical component of a healthy lifestyle for individuals with spinal cord injury (SCI). However, most individuals are not sufficiently active to accrue health benefits. The Active Living Lifestyles program for individuals with SCI who use manual wheelchairs (ALLWheel) targets important psychological factors that are associated with LTPA uptake and adherence while overcoming some barriers associated with participation restrictions. OBJECTIVE: The goal of the paper is to describe the protocol for the development and evaluation of the ALLWheel program for individuals with SCI who use manual wheelchairs. METHODS: The first three stages of the Medical Research Council framework for developing and evaluating complex interventions (ie, preclinical, modeling, exploratory) are described. The preclinical phase will consist of scoping and systematic reviews and review of theory. The intervention will be modeled by expert opinions and consensus through focus groups and Delphi surveys with individuals with SCI, clinicians, and community partners. Finally, the feasibility and potential influence of the ALLWheel program on LTPA and psychological outcomes will be evaluated. RESULTS: This project is funded by the Craig H Neilsen Foundation, the Fonds de Recherche du Québec-Santé, and the Canadian Disability Participation Project and is currently underway. CONCLUSIONS: Using peer trainers and mobile phone technology may help to cultivate autonomy-supportive environments that also enhance self-efficacy. Following a framework for developing and evaluating a novel intervention that includes input from stakeholders at all stages will ensure the final product (ie, a replicable intervention) is desirable to knowledge users and ready for evaluation in a randomized controlled trial. If effective, the ALLWheel program has the potential to reach a large number of individuals with SCI to promote LTPA uptake and adherence. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/10798.

Endogenous TrkB ligands suppress functional mechanosensory plasticity in the deafferented spinal cord.

Dorsal root injury (DRI) disrupts the flow of sensory information to the spinal cord. Although primary afferents do not regenerate to their original targets, spontaneous recovery can, by unknown mechanisms, occur after DRI. Here, we show that brain-derived neurotrophic factor (BDNF) and neurotrophin-3 (NT-3), but not nerve growth factor or neurotrophin-4, are upregulated in the spinal gray matter after DRI. Because endogenous BDNF and NT-3 have well established roles in synaptic and axonal plasticity, we hypothesized that they contributed to spontaneous recovery after DRI. We first developed a model of DRI-induced mechanosensory dysfunction: rat C7/8 DRI produced a deficit in low-threshold cutaneous mechanosensation that spontaneously improved within 10 d but did not recover completely. To determine the effects of endogenous BDNF and NT-3, we administered TrkB-Fc or TrkC-Fc fusion proteins throughout the recovery period. To our surprise, TrkB-Fc stimulated complete recovery of mechanosensation by 6 d after DRI. It also stimulated mechanosensory axon sprouting but prevented deafferentation-induced serotonergic sprouting. TrkC-Fc had no effect on low-threshold mechanosensory behavior or axonal plasticity. There was no mechanosensory improvement with single-bolus TrkB-Fc infusions at 10 d after DRI (despite significantly reducing rhizotomy-induced cold pain), indicating that neuromodulatory effects of BDNF did not underlie mechanosensory recovery. Continuous infusion of the pan-neurotrophin antagonist K252a also stimulated behavioral and anatomical plasticity, indicating that these effects of TrkB-Fc treatment occurred independent of signaling by other neurotrophins. These results illustrate a novel, plasticity-suppressing effect of endogenous TrkB ligands on mechanosensation and mechanosensory primary afferent axons after spinal deafferentation.

Patterns of community participation across the seasons: A year-long case study of three Canadian wheelchair users.

PURPOSE: The aim of this study was to explore the patterns of wheelchair users' community participation across a one-year period, including periods with substantial differences in weather conditions. We sought to develop a detailed understanding of the patterns of, and influences on, wheelchair use and participation within wheelchair users' own communities. METHOD: We conducted an instrumental case study of three purposefully selected individuals who use a wheelchair. Participants' wheelchairs were instrumented with a GPS data logger and data were collected for one week per month across a year. A prompted recall interview was conducted with participants each month, in order to gain an understanding of the influences on their community participation patterns. RESULTS: For each participant, the percent of trips taken at various trip distance ranges and the mean trips/days and overall distance traveled at or above 0 °C and below 0 °C are reported. Three distinct patterns were identified in response to variations in weather conditions: (1) season and transportation options are linked: winter limits community participation; (2) winter conditions are surmountable: with the right supports year-round participation is maintained; and (3) pre-planning is the key: winter conditions affects ease, choices and options but not overall participation. CONCLUSIONS: While winter weather conditions created community participation challenges, individuals responded differently based on their unique circumstances. The findings highlight the importance of policy that addresses the dynamic nature of weather and the needs of people with disabilities as specific individuals. Implications for rehabilitation Wheelchair users experience both similar and unique challenges regarding seasonal weather conditions that influence their community participation patterns. While some individual wheelchair users effectively maintain their community participation patterns across the year, they employ their own specific strategies in response to winter weather challenges. Ready access to vehicular transportation that is accessible regardless of weather condition is a key factor in promoting community participation across the year for wheelchair users. Accessible community environments can become inaccessible with the addition of winter weather conditions and thus the changing nature of community participation across the seasons should be considered.

Data logger technologies for manual wheelchairs: A scoping review.

In recent years, studies have increasingly employed data logger technologies to record objective driving and physiological characteristics of manual wheelchair users. However, the technologies used offer significant differences in characteristics, such as measured outcomes, ease of use, and level of burden. In order to identify and describe the extent of published research activity that relies on data logger technologies for manual wheelchair users, we performed a scoping review of the scientific and gray literature. Five databases were searched: Medline, Compendex, CINAHL, EMBASE, and Google Scholar. The 119 retained papers document a wide variety of logging devices and sensing technologies measuring a range of outcomes. The most commonly used technologies were accelerometers installed on the user (18.8%), odometers installed on the wheelchair (12.4%), accelerometers installed on the wheelchair (9.7%), and heart monitors (9.7%). Not surprisingly, the most reported outcomes were distance, mobility events, heart rate, speed/velocity, acceleration, and driving time. With decreasing costs and technological improvements, data loggers are likely to have future widespread clinical (and even personal) use. Future research may be needed to assess the usefulness of different outcomes and to develop methods more appropriate to wheelchair users in order to optimize the practicality of wheelchair data loggers.