Loneliness and sense of community are not two sides of the same coin: Identifying different determinants using the 2019 Nova Scotia Quality of Life data.

The purpose of this study was to explore the relative importance of lifestyle factors and living conditions when predicting loneliness and sense of community (SOC) in a representative sample of 12,871 participants from Nova Scotia collected in 2019. Using multiple regression and measures of relative importance based on the Lindeman, Merenda and Gold (lmg) method, we identified which variables are most important to predicting measures of loneliness and SOC. Twenty-two predictors accounted for 46% of the variance in SOC and the top 10 predictors accounted for 36% of the variance: satisfaction with quality of the natural environment in the neighborhood (ri = 0.09), life satisfaction (ri = 0.05), number of neighbors one can rely on (ri = 0.05), confidence in institutions (ri = 0.05), feeling better off due to government policy or programming (ri = 0.04), feeling safe walking in neighborhood after dark (ri = 0.03), mental health (ri = 0.02), number of friends one can rely on (ri = 0.02), volunteering (ri = 0.02), and perceptions of time adequacy (ri = 0.02). Only six of these variables were also the top predictors of loneliness. These results show that both community- and individual-level variables are substantial predictors of social well-being. The effect sizes differ between models, which suggests that there may be important predictors of loneliness that we have not accounted for. This study may inform community-level programming and policy that seeks to promote social well-being for individuals and their communities.

An investigation of auditory processing in relapsing-remitting multiple sclerosis.

Multiple sclerosis (MS) is one of the most common neurological diseases in North America and it is frequently associated with sensory processing difficulties, cognitive deficits, and psychiatric illness. While many studies have examined cognitive deficits in MS measured by behavioural responses and neuroimaging techniques, only a few studies have examined neurophysiological measures of auditory functioning in MS, such as the mismatch negativity (MMN). The MMN is an event-related potential that indicates automatic auditory change detection. This study examined whether MMN endpoints measured by electroencephalography (EEG) differ in individuals with relapsing-remitting MS compared to healthy controls and whether the symptomatology of MS, including symptoms of depression and fatigue, are related to MMN measures. A multi-feature MMN paradigm, which includes five distinct deviant tones, was used to assess auditory cortex function in MS. There were no significant differences in MMN amplitudes or latencies between the MS and control group (p < 0.05) and corresponding effect sizes were small. However, there was a correlation between reduced MMN amplitudes in response to an intensity deviant and physician-reported disability. The intensity MMN may be more sensitive to deterioration in this population. Ultimately, this study provides a comprehensive profile of early auditory processing abilities in MS and suggests that a reduction in the MMN response may be representative of disease severity in MS.

Clinical Outcomes Among Bullous Pemphigoid Patients-A Comparison of Urban and Rural Populations.

BACKGROUND: Bullous pemphigoid (BP) is the most common autoimmune blistering disease. It can be challenging to manage and is associated with an increased risk of mortality. Access to dermatologic care is essential for patients with BP. However, the influence of geographic residence and distance to specialty care on patient outcomes or treatment regimens is unknown. OBJECTIVE: Assess whether the rural-dwelling or urban-dwelling geographic status of our patients impacts the treatment duration of systemic corticosteroids (CS) in the management of BP. Numerous secondary outcomes were evaluated including the cumulative systemic corticosteroid dose received, steroid-sparing agent utilized, and duration and number of follow-up appointments. METHODS: Retrospective analysis of patient records from January 2013 to May 2019 seen at the university-associated clinic in Edmonton, Alberta. Patients were stratified based on their rural-dwelling or urban-dwelling status via their Forward Sortation Area. RESULTS: There were 59 patients with BP. Of these, 37 completed their systemic corticosteroid course. The time required for 51.0% of the urban group to complete their steroid course was 543 days, and for 51.5% of the rural group it was 507 days. Methotrexate and azathioprine were the most common steroid-sparing agents utilized in both groups. Rural patients were seen in follow-up significantly less often than urban patients. CONCLUSION: Our findings demonstrate that the location of a patient's geographic residence does not influence the systemic corticosteroid or steroid-sparing agent use at our center. Interestingly, rural patients are able to receive similar treatment to urban patients despite having significantly fewer follow-up appointments.

Effects of Motor Skill-Based Training on Wheelchair Propulsion Biomechanics in Older Adults: A Randomized Controlled Trial.

OBJECTIVE: To identify whether motor skill-based training improves wheeling biomechanics in older adults and whether transfer or retention occurs. DESIGN: Randomized controlled trial. SETTING: Human mobility laboratory. PARTICIPANTS: Able-bodied older adults 50 years and older deemed ready to participate in physical activity (N=34). INTERVENTION: Participants were randomized to 1 of 3 groups: experimental group with 6 motor skill-based training sessions, active control group with dose-matched uninstructed practice, and the inactive control group (no training or practice). The experimental group's training sessions consisted of two 5-minute blocks of wheelchair propulsion training, separated by a 5-minute break, for a total of 60 minutes of wheeling. Breaks included education and discussion related to wheelchair propulsion. Training focused on increasing push angle, decreasing push frequency, decreasing negative braking forces, and using a circular wheeling pattern with smooth pushes. MAIN OUTCOME MEASURES: Temporal spatial and kinetic variables (ie, push angle, push frequency, total and tangential forces, negative force) were evaluated during steady-state wheeling and biomechanical variables were assessed with the SmartWheel Clinical Protocol to identify transfer. RESULTS: The training group significantly increased push angle and decreased push frequency compared with the practice (P<.05) and control groups (P<.05), which were retained over time and transferred to overground wheeling on tile (P≤.05). The dose-matched practice group did not differ from the inactive control group for any variables (P>.05). CONCLUSIONS: Older adults improve select biomechanical variables following motor skill-based training, which are retained over time and transfer to overground wheeling. Participants in the active control group did not improve with uninstructed practice compared with the inactive control group.

Patients' Perspectives on the Usability of a Mobile App for Self-Management following Spinal Cord Injury.

With decreasing inpatient lengths of stay following spinal cord injury (SCI), newly injured patients may be discharged into the community without the self-management skills needed to prevent secondary conditions. A mobile app was developed to facilitate self-management skills following SCI in the inpatient rehabilitation and early community settings. The objective of this study was to explore patients' perspectives on the usability of this self-management app. A mixed-methods study design was implemented. The app was trialed at a local rehabilitation centre with 20 inpatient participants who experienced a SCI. They received mobile app training sessions throughout their inpatient rehabilitation. A thematic analysis was performed on qualitative data from post-discharge exit questionnaires and researchers' field notes. Quantitative data (in the form of participants' tool usage data and self-reported system usability scale scores) were collected at discharge and 3 months post-discharge. Three main themes emerged from the qualitative analysis: (1) being accessible to users (i.e., being easy to adopt and compatible with assistive technologies), (2) being intuitive to navigate (i.e., incorporating a simple app layout and a system of alert notifications), and (3) offering users flexibility (i.e., providing users with control over their data). The mobile app received above average mean system usability scale scores, both at discharge (78.1/100) and 3 months post-discharge (71.6/100). Given that participants found the app acceptable for use in inpatient rehabilitation and following discharge into the community, further testing is warranted to explore its efficacy in preventing secondary complications.

Development of a Self-Management App for People with Spinal Cord Injury.

With decreasing inpatient rehabilitation lengths of stay, there may be a greater risk of spinal cord injury (SCI) populations being discharged into the community without the self-management skills needed to prevent secondary complications. Recent advancements in mobile health has made mobile apps a feasible method of delivering population-based, self-management interventions to address SCI-specific secondary complications. The objective of this study is to describe stakeholder perspectives on the development of a functional mobile app to facilitate self-management skills needed to prevent secondary complications following recent SCI during inpatient rehabilitation. A user-centered design approach was used that involved an evolving mobile app and the collection of prospective qualitative data. Stakeholders from three groups were enrolled in the study: individuals admitted for rehabilitation following SCI (n = 20) and informal (n = 7) and formal (n = 48) caregivers. Iterative feedback was gathered from rehabilitation inpatients during ongoing interactions and via post-discharge exit questionnaires, from informal caregivers via one-on-one interviews, and from formal caregivers via series of focus groups at various phases throughout the design process. Three main themes emerged from the analysis: (1) being individualized and user friendly (i.e., developing an app that is simple and easy to use to facilitate universal uptake), (2) targeting goals to promote self-management (i.e., adopting self-management skills relative to personal goals and confidence), and (3) increasing participation and support-seeking to facilitate lifestyle change (i.e., encouraging leisure activities to facilitate community integration). Key stakeholder perspectives contributed to the development of a self-management mobile app that will be evaluated in future research.

Recurrent Pityriasis Rubra Pilaris: A Case Report.

Pityriasis rubra pilaris (PRP) is an uncommon papulosquamous dermatosis characterized by follicular, erythematous, hyperkeratotic papules coalescing to salmon-coloured plaques with islands of sparing. The disease tends to be self-limited and resolves spontaneously after a few years. In some cases, the disease is persistent. However, recurrence of this disease has rarely been described. An 8-year-old male was diagnosed with type III (classic juvenile) PRP. He was treated with acitretin, and his skin was clear after 6 months. He remained disease free for 6 years. At 14 years old, he was diagnosed again with type III PRP. His cutaneous manifestations were highly similar to his initial presentation. He was treated with acitretin and methotrexate concurrently and achieved skin clearance. Recurrence of type III PRP is possible although rarely described in the literature. Acitretin ± methotrexate therapy is effective at achieving skin clearance.

Long-term functional and mobility outcomes for individuals with arthrogryposis multiplex congenita.

Arthrogryposis multiplex congenita (AMC) is a birth defect that involves congenital joint contractures in two or more joints including the limbs, spine, and jaw. The purpose of our study was to identify long-term outcomes of adults with AMC. We recruited 177 participants from over 15 countries, making this the largest international study of adults with AMC. Participants provided demographic information including living situation and mobility and completed two standardized outcome measures, of quality of life and physical activity, using an online survey format. The data were compiled and descriptive analyses were performed. The study group consisted of 72% females and a mean age of 39 years. Over 90% of participants had upper and lower limb involvement, 35% had scoliosis or lordosis while 16% had jaw problems. Participants had an average of nine (0-70) surgeries at the time of the study. The majority (75%) of respondents lived independently of family members (on their own or with a partner). Participants were nearly three times more likely to have a graduate degree than the general US population. Participants reported lower physical function scores than the general US population; however, they reported similar or higher scores for the other quality of life domains of the SF-36. They were considerably less physically active than able-bodied individuals. Half of participants experienced chronic back pain and 60% reported joint pain. Additionally, almost half of the participants took regular pain medications.

An Unanticipated Complication of Atopic Dermatitis.

An infant with a history of atopic dermatitis presented to the emergency department on 5 occasions with flulike symptoms. Eventually, this child presented with signs of infection and increased intracranial pressure: fever, bulging anterior fontanel, and leukocytosis. A computed tomography scan identified a large frontal lobe brain abscess. The abscess was surgically drained; culture was positive for Staphylococcus aureus. The initial source of the infected brain abscess was explored. Ultimately, it was thought to be secondary to impetiginized atopic dermatitis, an unusual but serious consequence of a common skin condition.

Canadian paediatric asthma action plans and their correlation with current consensus guidelines.

BACKGROUND: While written action plans are standard in the treatment and management of asthma, significant variability exists in the content and format among plans. This variability results in inconsistent educational messages that lend themselves to patient confusion and suboptimal health outcomes. OBJECTIVES: To assess the content of Canadian paediatric written action plans for consistency in format, layout, zone-defining symptoms, suggested treatment options and adherence to current Canadian asthma care guidelines. METHODS: Written action plans were sought from Canadian paediatric hospitals, major teaching hospitals associated with academic centres and three national organizations, for a total of 17 plans. An analysis was performed to assess the similarities and differences among plans. RESULTS: Of all the Canadian paediatric written action plans, 76% were found to consist of three zones and 82% incorporated a traffic light-style design. The plans were divided between symptom-based (59%) and combined symptom- and peak-flow rate approaches (41%). Nominal concordance with the 2012 Canadian Thoracic Society guidelines existed with respect to inhaled corticosteroid and oral corticosteroid therapy. Considerable variability existed among the symptom descriptors that defined each zone. Greater consistency existed among treatment strategies, although the suggested treatment was often difficult to ascertain from the plan templates. CONCLUSION: Canadian written action plans would be improved by nationally clarifying the symptom descriptors for each zone, adding asthma trigger information to the plans, increasing the emphasis of the common cold as a potential harbinger of worsening asthma symptoms and further incorporating national guideline recommendations.

HISTORIQUE: Les plans d'action écrits sont la norme pour traiter et prendre en charge l'asthme, mais leur contenu et leur présentation varient énormément. Cette variabilité s'associe à des messages d'éducation non uniformes qui favorisent la confusion des patients et des résultats de santé sous-optimaux. OBJECTIFS: Évaluer le contenu des plans d'action canadiens écrits en pédiatrie pour vérifier l'uniformité de la présentation, de la disposition, des symptômes définissant la zone, des possibilités thérapeutiques suggérées et de l'adhérence aux lignes directrices canadiennes à jour sur l'asthme. MÉTHODOLOGIE: Les chercheurs ont obtenu les plans d'action écrits des hôpitaux pédiatriques canadiens, des grands hôpitaux d'enseignement associés à des centres universitaires et de trois organisations internationales, pour un total de 17 plans. Ils ont effectué une analyse pour évaluer les similarités et les différences entre les plans. RÉSULTATS: Il a été établi que 76 % des plans d'action canadiens écrits en pédiatrie se divisaient en trois zones et que 82 % étaient structurés selon le principe des feux de signalisation. Ils étaient répartis entre une approche fondée sur les symptômes (59 %) et une approche combinant les symptômes et le débit de pointe (41 %). Ils présentaient une concordance nominale avec les lignes directrices de la Société canadienne de thoracologie de 2012 à l'égard des corticoïdes inhalés et des corticoïdes oraux. On constatait une importante variabilité quant aux descripteurs des symptômes qui définissaient chaque zone. Les stratégies thérapeutiques étaient plus uniformes, même si le traitement proposé était souvent difficile à déterminer d'après les modèles du plan. CONCLUSION: On améliorerait les plans d'action canadiens écrits si, sur la scène nationale, on clarifiait les descripteurs des symptômes dans chaque zone, on y ajoutait l'information sur les déclencheurs de l'asthme, on insistait davantage sur le rhume banal comme prédicteur potentiel d'aggravation des symptômes de l'asthme et on intégrait davantage les recommandations sur les lignes directrices nationales.

Prior experience does not alter modulation of cutaneous reflexes during manual wheeling and symmetrical arm cycling.

Previous research has reported that training and experience influence H-reflex amplitude during rhythmic activity; however, little research has yet examined the influence of training on cutaneous reflexes. Manual wheelchair users (MWUs) depend on their arms for locomotion. We postulated that the daily dependence and high amount of use of the arms for mobility in MWUs would show differences in cutaneous reflex modulation during upper limb cyclic movements compared with able-bodied control subjects. We hypothesized that MWUs would demonstrate increased reflex response amplitudes for both manual wheeling and symmetrical arm cycling tasks. The superficial radial nerve was stimulated randomly at different points of the movement cycle of manual wheeling and symmetrical arm cycling in MWUs and able-bodied subjects naive to wheeling. Our results showed that there were no differences in amplitude modulation of early- or middle-latency cutaneous reflexes between the able-bodied group and the MWU group. However, there were several differences in amplitude modulation of cutaneous reflexes between tasks (manual wheeling and symmetrical arm cycling). Specifically, differences were observed in early-latency responses in the anterior and posterior deltoid muscles and biceps and triceps brachii as well as in middle-latency responses in the anterior and posterior deltoid. These data suggest that manual wheeling experience does not modify the pattern of cutaneous reflex amplitude modulation during manual wheeling. The differences in amplitude modulation of cutaneous reflexes between tasks may be a result of mechanical differences (i.e., hand contact) between tasks.

Test-retest reliability and minimal detectable change of the SmartWheel clinical protocol.

OBJECTIVES: (1) To quantify the intra- and intersession reliability and minimal detectable change (MDC) of the SmartWheel clinical protocol (SCP) and (2) to compare the reliability of the SCP between experienced and naïve wheelchair users. DESIGN: Test-retest study. SETTING: Biomechanics laboratory. PARTICIPANTS: Manual wheelchair users (WCUs) (n=10) with 1 to 32 years of wheeling experience and able-bodied (AB) naïve users (n=15). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Wheelchair propulsion parameters including average peak force, push frequency, push length, and velocity were measured according to the SCP but with 5 trials per session, for 2 sessions. WCUs and AB users were analyzed separately. Intraclass correlation coefficients ([ICC](2,1) and ICC(2,5)) were calculated to assess intrasession reliability. ICC(2,1) and MDC (with 95% confidence) were calculated for each SCP parameter using a single trial from each session and with the mean of 5 repeated measures to evaluate intersession reliability. RESULTS: Intra- and intersession reliability for WCU parameters ranged from high to very high correlation (ICC range, .70-.99). For AB parameters, intrasession ICC(2,1) ranged from moderate to very high (ICC range, .50-.92), while intersession ICC(2,1) indicated low to very high correlation (ICC range, .25-.90). Estimates of standard error of measurement and MDC were provided for each parameter. For both WCUs and AB users, using the means from 5 trials increased intra- and intersession ICC and decreased MDC values. All MDC values were lower for WCUs compared with AB users. CONCLUSIONS: The SCP is a reliable method for assessing propulsion parameters in WCUs, even if just 1 trial is taken per session. AB users showed lower intra- and intersession reliability compared with WCUs. Therefore, for AB users or individuals with minimal wheeling experience, averaging multiple trials is recommended for the SCP.

Expectations of a Health-Related Mobile Self-Management App Intervention Among Individuals With Spinal Cord Injury.

Background: Our research team developed a mobile application (app) to facilitate health-related self-management behaviors for secondary conditions among individuals with spinal cord injury (SCI). To facilitate mobile app adoption and ongoing use into the community, it is important to understand potential users' expectations and needs. Objectives: The primary objective of this study was to explore user expectations of a mobile app intervention designed to facilitate self-management behavior among individuals with SCI. Methods: Data were collected via one-on-one, semi-structured interviews with a subsample of 20 community-dwelling participants enrolled in a larger, clinical trial. Analysis of the transcripts was undertaken using a six-phase process of thematic analysis. Results: Our analysis identified three main themes for expectations of the mobile app intervention. The first theme, desiring better health outcomes, identified participants' expectation of being able to improve their psychological, behavioral, and physical health outcomes and reduce associated secondary conditions. The second theme, wanting to learn about the mobile app's potential, identified participants' interest in exploring the functionality of the app and its ability to promote new experiences in health management. The third theme, desiring greater personal autonomy and social participation, identified participants' desire to improve their understanding of their health and the expectation for the app to facilitate social engagement with others in the community. Conclusion: By exploring end-users' expectations, these findings may have short-term effects on improving continued mobile health app use among SCI populations and long-term effects on informing future development of mobile app interventions among chronic disease populations.

The Effect of External Power Output and Its Reliability on Propulsion Technique Variables in Wheelchair Users With Spinal Cord Injury.

The purpose of this study was to assess 1) how treadmill slope variance affected external power output (PO) and propulsion technique reliability; and 2) how PO is associated with propulsion technique. Eighteen individuals with spinal cord injury performed two wheelchair treadmill exercise blocks (0% and 1% treadmill slope, standardized velocity) twice on two separate days. PO, velocity, and 14 propulsion technique variables were measured. In a follow-up study, N = 29 performed wheelchair treadmill drag tests. Target and actual slope were documented and PO, intraclass correlation coefficients (ICC) and smallest detectable differences (SDD) were calculated. Within and between visits, the reliability study ICCs were perfect for velocity (1.0), weak for PO (0.33-0.46), and acceptable (>0.70) for five (0% slope) and 10 (1% slope) propulsion technique variables, resulting in SDDs of 35-196%. Measured PO explained 56-90% of the variance in key propulsion technique variables. In the follow-up, PO ICCs were weak (0.43) and SDDs high. Bias between target and actual slope appeared random. In conclusion, PO variability accounts for 50-90% of the variability in propulsion technique variables when speed and wheelchair set-up are held constant. Therefore, small differences in PO between interventions could mask the effect of the interventions on propulsion technique.

The influence of social context and social connection on visual perceptual processes.

The aim of this study was twofold: (1) to re-test whether a minimal social context has an influence on gaze patterns, and (2) to determine if a social connection (i.e., friendship) has a modulatory effect on gaze patterns in a minimal social context. In Experiment 1, two unacquainted participants were paired and seated at separate testing stations in the same room. At the beginning of each trial, participants were informed whether they were looking at different image sets (solo trials), or the same image set (joint trials). Image sets consisted of a positive, a negative, and two neutral images. No explicit task instructions were provided and there was no interaction between participants during the task. Experiment 2 was identical to Experiment 1, except that participants were paired with a friend. The fixation-based metrics of interest were time to first fixation (TFF) and total fixation duration (TFD). The findings revealed that social context has a modulatory effect on attentional capture (i.e., TFF) irrespective of social connection. Unexpectedly, a negativity bias was found to hold attention (i.e., TFD) regardless of social context. However, having a social connection did increase the time spent looking at positive images on the joint trials. Having a social connection with another person seems to alter looking behaviour such that more time is spent looking at positive images on the joint trials compared to the solo trials. These findings highlight the importance of evaluating both TFD and TFF to develop a better understanding of the factors underlying joint perception.

Efficiency and perceived exertion of manual wheelchair propulsion: a physiological comparison of push vs pull wheeling.

Manual wheelchair users face a high prevalence of upper extremity pain and injuries associated with poor biomechanics and the relatively low mechanical efficiency of conventional push wheeling. Recently developed geared wheels, which permit the wheelchair user to propel forwards by pulling at the handrims using a 'rowing' motion, have been speculated to improve ergonomics and reduce operational energy costs. This study compared the gross mechanical efficiency (GME) and perceived exertion (RPE) of these geared wheels to standard wheelchair wheels after a motor skill-based training session was conducted to familiarise participants with using both wheels. Fourteen able-bodied males were enrolled in the study. A within-participants, repeated-measures design was used to assess oxygen uptake (VO2), respiratory exchange ratio (RER), energy expenditure (En) and RPE during 5-minute, steady-state wheeling trials. Total external power output (Pext) was obtained using a drag test protocol for comparison over En to determine GME ratio. Stroke frequency and movement pattern were assessed through video tracking and propulsion testing. Although geared wheels required fewer strokes, standard wheels resulted in significantly lower VO2, RPE and En (p ≤ 0.001). These findings suggest overall that standard wheels were more mechanically efficient, likely due to internal energy loss of the geared wheel system.

Injuries Associated with Crutch Use: A Narrative Review.

Crutches are commonly prescribed in physiatric settings to help offload the lower extremities. Crutch use, however, results in abnormal and repetitive weight-bearing through the upper extremities that may result in secondary injury. This narrative review investigates injury types and risk factors associated with crutch use in order to guide healthcare providers on injury prevention strategies. Medline, EMBASE, CINAHL, and the Cochrane Library were systematically reviewed for publications between 1950 and 2018 on neurological, musculoskeletal, or vascular complications associated with crutch use. Titles and abstracts (n = 2395) were screened by two authors. Sixty studies were eligible. Articles were reviewed for level of evidence, crutch type, participant characteristics, and injury characteristics. There were 42 axillary crutch studies, 12 forearm crutch studies, and 6 studies that did not specify crutch type. These studies incorporated 622 individuals, and most were case series or case reports (n = 54). Axillary crutch use was most commonly associated with axillobrachial arterial complications due to pressure from the axillary bar (n = 34). Forearm crutch use was most commonly associated with compressive neuropathies due to pressure from the forearm cuff (n = 6). Improper crutch fitting and/or use were identified as contributing factors to injury in 22 cases. Duration of crutch use and medical comorbidities also influenced the types of injuries seen. There are rare but potentially serious complications associated with crutch use. When prescribing crutches, clinicians should ensure they are properly fit, engage in appropriate gait training, be aware of common crutch-related injuries, and consider potential patient-specific injury risk factors in order to minimize injury risk.

Implementing a self-management mobile app for spinal cord injury during inpatient rehabilitation and following community discharge: A feasibility study.

Objective: To determine the feasibility of implementing and evaluating a self-management mobile app for spinal cord injury (SCI) during inpatient rehabilitation and following community discharge. Design: Pilot feasibility study. Setting: Rehabilitation hospital and community. Participants: Inpatients from rehabilitation hospital following admission for their first SCI. Intervention: A mobile app was developed to facilitate self-management following SCI. The app consisted of 18 tools focusing on goal setting, tracking various health aspects, and identifying confidence regarding components of self-management. In-person training and follow-up sessions were conducted during inpatient rehabilitation and follow-up calls were provided after participants were discharged into the community. Main outcome measures: Participants completed outcome measures at baseline, community discharge, and 3-months post discharge. This study focused on feasibility indicators including recruitment, retention, respondent characteristics, adherence, and app usage. Additionally, participants' self-management confidence relating to SCI (e.g. medication, skin, bladder, pain) was evaluated over time. Results: Twenty participants (median age 39, IQR: 31 years, 85% male) enrolled in the study. Participants' Spinal Cord Injury Independence Measure (SCIM-III) median score was 23 and IQR was 33 (range: 7-84), which did not correlate with app usage. Retention from admission to discharge was 85% and 70% from discharge to 3-months post discharge. Individuals in the study who used the app entered data an average of 1.7x/day in rehabilitation (n = 17), and 0.5x/day in the community (n = 7). Participants' bowel self-management confidence improved between admission and discharge (P < 0.01). Conclusions: Feasibility indicators support a larger clinical trial during inpatient rehabilitation; however, there were challenges with retention and adherence following community discharge.

Porphyria Cutanea Tarda Presenting with Scleroderma, Ichthyosis, Alopecia, and Vitiligo.

Porphyria cutanea tarda (PCT) is a cutaneous porphyria that presents later in life with cutaneous findings in sun-exposed sites. We report a complex case of PCT in a 67-year-old woman with an unusual constellation of cutaneous findings: scleroderma, acquired ichthyosis, and nonscarring alopecia. Possible triggers for her PCT include tamoxifen treatment for breast cancer and carrier status of the hemochromatosis gene. High-dose chloroquine was used to successfully achieve clinical remission and normalize her uroporphyrins. While on chloroquine she developed extensive classic vitiligo. It is not clear if this is another feature of her complex and unusual PCT, or a consequence of her antimalarial therapy.

Exploring the ecological validity and variability of a 10-min bout of wheeling.

PURPOSE: To determine the ecological validity of using able-bodied participants to perform a 10-min wheeling trial by (1) evaluating changes in biomechanics over the trial in manual wheelchair users and able-bodied participants naïve to wheeling and (2) describing differences in changes and variability between groups. MATERIALS AND METHODS: Manual wheelchair users (n = 7, 2-27 years' experience) and able-bodied participants (n = 11) wheeled for 10 min. Kinetic and temporal variables were collected and averaged over each minute, while wheeling strategy (movement pattern) was categorized at minutes 1 and 10. RESULTS: There was a main effect of time for push angle, and a main effect of group for average push angle, tangential force and total force. Manual wheelchair users used larger push angles and forces compared to able-bodied participants. Surprisingly, intercycle variability did not differ between groups. CONCLUSION: Using able-bodied participants to represent manual wheelchair users performing a 10-min wheeling trial is not ecologically valid and caution should be used when interpreting push angle and forces applied to the pushrim. Considering that push angle was the only variable that demonstrated a main effect of time, long durations (e.g., 10 min) of wheeling may be appropriate for use in study designs acknowledging potential changes in wheeling strategy and push angle. Implications for Rehabilitation Some experienced wheelchair users and non-wheelchair users modify their movement pattern from an arc to a circular pattern within a 10-min wheeling trial. There are clear biomechanical differences in push angle and forces applied to the pushrim between wheelchair users with experience and able-bodied non-wheelchair users. Able-bodied participants who have no prior manual wheeling experience are no more variable than long-term wheelchair users. Variability may play an important role in wheelchair propulsion.