Three-dimensional reconstruction of high latitude bamboo coral via X-ray microfocus Computed Tomography.

The skeletons of long-lived bamboo coral (Family Keratoisididae) are promising archives for deep-water palaeoceanographic reconstructions as they can record environmental variation at sub-decadal resolution in locations where in-situ measurements lack temporal coverage. Yet, detailed three dimensional (3D) characterisations of bamboo coral skeletal architecture are not routinely available and non-destructive investigations into microscale variations in calcification are rare. Here, we provide high-resolution micro-focus computed tomography (µCT) data of skeletal density for two species of bamboo coral (Acanella arbuscula: 5 specimens, voxel size, 15 µm (central branch scans) and 50 µm (complete structure scan); Keratoisis sp.: 4 specimens, voxel size, 15 µm) collected from the Labrador Sea and Baffin Bay deep-water basins, Eastern Canadian Arctic. These data provide reference models useful for developing methods to assess structural integrity and other fine-scale complexities in many biological, geological, and industrial systems. This will be of wider value to those investigating structural composition, arrangement and/or composition of complex architecture within the fields and subdisciplines of biology, ecology, medicine, environmental geology, and structural engineering.

Assessment of Nucleobase Protomeric and Tautomeric States in Nucleic Acid Structures for Interaction Analysis and Structure-Based Ligand Design.

With increasing interest in RNA as a therapeutic and a potential target, the role of RNA structures has become more important. Even slight changes in nucleobases, such as modifications or protomeric and tautomeric states, can have a large impact on RNA structure and function, while local environments in turn affect protonation and tautomerization. In this work, the application of empirical tools for pKa and tautomer prediction for RNA modifications was elucidated and compared with ab initio quantum mechanics (QM) methods and expanded toward macromolecular RNA structures, where QM is no longer feasible. In this regard, the Protonate3D functionality within the molecular operating environment (MOE) was expanded for nucleobase protomer and tautomer predictions and applied to reported examples of altered protonation states depending on the local environment. Overall, observations of nonstandard protomers and tautomers were well reproduced, including structural C+G:C(A) and A+GG motifs, several mismatches, and protonation of adenosine or cytidine as the general acid in nucleolytic ribozymes. Special cases, such as cobalt hexamine-soaked complexes or the deprotonation of guanosine as the general base in nucleolytic ribozymes, proved to be challenging. The collected set of examples shall serve as a starting point for the development of further RNA protonation prediction tools, while the presented Protonate3D implementation already delivers reasonable protonation predictions for RNA and DNA macromolecules. For cases where higher accuracy is needed, like following catalytic pathways of ribozymes, incorporation of QM-based methods can build upon the Protonate3D-generated starting structures. Likewise, this protonation prediction can be used for structure-based RNA-ligand design approaches.

Seafloor primary production in a changing Arctic Ocean.

Phytoplankton and sea ice algae are traditionally considered to be the main primary producers in the Arctic Ocean. In this Perspective, we explore the importance of benthic primary producers (BPPs) encompassing microalgae, macroalgae, and seagrasses, which represent a poorly quantified source of Arctic marine primary production. Despite scarce observations, models predict that BPPs are widespread, colonizing ~3 million km2 of the extensive Arctic coastal and shelf seas. Using a synthesis of published data and a novel model, we estimate that BPPs currently contribute ~77 Tg C y-1 of primary production to the Arctic, equivalent to ~20 to 35% of annual phytoplankton production. Macroalgae contribute ~43 Tg C y-1, seagrasses contribute ~23 Tg C y-1, and microalgae-dominated shelf habitats contribute ~11 to 16 Tg C y-1. Since 2003, the Arctic seafloor area exposed to sunlight has increased by ~47,000 km2 y-1, expanding the realm of BPPs in a warming Arctic. Increased macrophyte abundance and productivity is expected along Arctic coastlines with continued ocean warming and sea ice loss. However, microalgal benthic primary production has increased in only a few shelf regions despite substantial sea ice loss over the past 20 y, as higher solar irradiance in the ice-free ocean is counterbalanced by reduced water transparency. This suggests complex impacts of climate change on Arctic light availability and marine primary production. Despite significant knowledge gaps on Arctic BPPs, their widespread presence and obvious contribution to coastal and shelf ecosystem production call for further investigation and for their inclusion in Arctic ecosystem models and carbon budgets.

Facilitators and challenges in partnership research aimed at improving social inclusion of persons with disabilities.

PURPOSE: To identify partnership research challenges and facilitators, as experienced by members of the Inclusive Society (IS) initiative. MATERIALS AND METHODS: A case study was conducted on all partnership research projects conducted between 2017 and 2019 under the IS initiative through surveys, interviews with the IS community, logbooks, and focus group. Thematic analysis and descriptive analysis were undertaken. RESULTS: To work effectively with a diversity of stakeholders, winning conditions must be created for the project from the outset. These include determining the team functioning, project objectives, the expectations of each party, and agreeing on a realistic action plan. Project implementation with concern for sustained stakeholder commitment, good working relationships, and achieving project objectives requires organizational planning that favours partner involvement, shared leadership, agreed methods for communicating, conflict resolution methods, recognition of each participant's expertise, and creating a climate of trust. Upon concluding a partnership research project, it is essential to devote time to implement project results in local environments and to ascertain their usefulness to partners.IS partnership research challenges and facilitators are similar to those identified in past research. Despite this knowledge, challenges persist. Future research could explore tools and practices from other domain to overcome partnership research challenges.

Partnership research has the potential to contribute to a more inclusive society for people with disabilities.Challenges and facilitators are identified for the stages of creating, implementing, and completing a partnership research project.Suggested solutions are offered to facilitate the conduct of a partnership research project and to increase the project's chances of success.Partnership research could benefit from using tools from other fields such as community development and social innovation to successfully implement some of the facilitators and overcome specific barriers to partnership research.

Ocean deoxygenation caused non-linear responses in the structure and functioning of benthic ecosystems.

The O2 content of the global ocean has been declining progressively over the past decades, mainly because of human activities and global warming. Nevertheless, how long-term deoxygenation affects macrobenthic communities, sediment biogeochemistry and their mutual feedback remains poorly understood. Here, we evaluate the response of the benthic assemblages and biogeochemical functioning to decreasing O2 concentrations along the persistent bottom-water dissolved O2 gradient of the Estuary and Gulf of St. Lawrence (QC, Canada). We report several of non-linear biodiversity and functional responses to decreasing O2 concentrations, and identify an O2 threshold that occurs at approximately at 63 µM. Below this threshold, macrobenthic community assemblages change, and bioturbation rates drastically decrease to near zero. Consequently, the sequence of electron acceptors used to metabolize the sedimentary organic matter is squeezed towards the sediment surface while reduced compounds accumulate closer (as much as 0.5-2.5 cm depending on the compound) to the sediment-water interface. Our results illustrate the capacity of bioturbating species to compensate for the biogeochemical consequences of hypoxia and can help to predict future changes in benthic ecosystems.

Les teneurs en O2 de l'océan mondial ont diminué progressivement au cours des dernières décennies, principalement en raison des activités humaines et du réchauffement climatique. Néanmoins, les effets à long terme de la désoxygénation sur les communautés macrobenthiques, la biogéochimie des sédiments et leurs interactions mutuelles demeurent mal compris. Dans cette étude, nous évaluons la réponse des assemblages de macrofaune benthiques et de la dynamique biogéochimique sédimentaire aux concentrations décroissantes d'O2 le long du gradient persistant d'O2 dissous dans l'eau de fond de l'estuaire et du golfe du Saint-Laurent (QC, Canada). Nous avons observé plusieurs réponses non linéaires de la biodiversité et de la dynamique biogéochimique sédimentaire face à la diminution de la concentration en O2 avec un seuil situé à environ 63 µM. En dessous de ce seuil, les assemblages de communautés macrobenthiques changent, et les taux de bioturbation diminuent drastiquement pour atteindre des niveaux presque nuls. En conséquence, la séquence des accepteurs d'électrons utilisés pour minéraliser la matière organique sédimentaire se contracte vers la surface du sédiment, tandis que les composés réduits s'accumulent plus près (jusqu'à 0.5 à 2.5 cm selon le composé) de l'interface sédiment-eau. Nos résultats illustrent la capacité des espèces bioturbatrices à compenser les conséquences biogéochimiques de la désoxygénation et peuvent contribuer à prédire les futurs changements dans les écosystèmes benthiques.

Creating synergies among education/research, practice, and policy environments to build capacity for the scholar role in occupational therapy and physiotherapy in the Canadian context.

Scholarly practice (SP) is considered a key competency of occupational therapy and physiotherapy. To date, the three sectors-education/research, practice, and policy/regulation-that support SP have been working relatively independently. The goals of this project were to (a) understand how representatives of the three sectors conceptualize SP; (b) define each sector's individual and collective roles in supporting SP; (c) identify factors influencing the enactment of SP and the specific needs of how best to support SP; and (d) co-develop goals and strategies to support SP across all sectors. We used interpretive description methodology. Consistent with an integrated knowledge translation approach, partners representing the three sectors across Canada recruited individuals from each sector, developed the content and questions for three focus groups, and collected and analyzed the data. Inspired by the Consolidated Framework for Implementation Research, we developed the questions for the second focus group. We analyzed the data using an inductive thematic analysis method. Thirty-nine participants from the three sectors participated. Themes related to participants' conceptualization of SP included (a) ongoing process, (b) reflective process, (c) broad concept, and (d) collective effort. Themes describing factors influencing and supporting SP were (a) recognition, (b) appropriate conceptualization, (c) social network, (d) accessibility to resources, and (e) forces outside of practitioners' effort. Goals to support SP included (a) further recognizing SP, (b) sustaining SP competency, and (c) ensuring access to information. SP requires collaborative and integrated intersectoral support and further recognition of its importance through the collaboration of multiple stakeholders.

Tipping point arises earlier under a multiple-stressor scenario.

Anthropogenic impacts and global changes have profound implications for natural ecosystems and may lead to their modification, degradation or collapse. Increases in the intensity of single stressors may create abrupt shifts in biotic responses (i.e. thresholds). The effects of multiple interacting stressors may create non-additive responses, known as synergistic or antagonistic interactions. Here we combine both concepts-ecological thresholds and interactions between multiple stressors-to understand the effects of multiple interacting stressors along environmental gradients, and how this can affect the occurrence of thresholds. Using an experimental approach to investigate the effect of nutrient enrichment and saltwater intrusion on mortality in the zebra mussel, Dreissena polymorpha, we show that multiple stressors can create thresholds at lower levels of an environmental gradient. Our results reveal a major shortcoming in how we currently investigate these two ecological concepts, as considering them separately may be causing underestimation of thresholds and stressor-interaction impacts.

Phycotoxins in bivalves from the western Canadian Arctic: The first evidence of toxigenicity.

This study presents the first evidence that a diverse suite of phycotoxins is not only being actively produced by the toxigenic algal communities in the Canadian Arctic waters, but is also entering the marine food web. We detected measurable amounts of Amnesic Shellfish Toxins (ASTs) and Paralytic Shellfish Toxins (PSTs), as well as trace amounts of other lipophilic toxin groups including pectenotoxins, yessotoxins, and cyclic imines, in bivalves collected from the Canadian Beaufort Sea in 2014 and 2018. There appear to be species-specific differences in accumulation and retention of AST by Arctic bivalves, with significantly higher concentrations recorded in Nuculanidae than Propeamussiidae, likely reflecting physiological and allometric differences. We further confirm the omnipresence of potentially toxic taxonomically-versatile phytoplankton communities in the western Canadian Arctic comprising Pseudo-nitzschia delicatissima group, P. obtusa, Dinophysis acuminata, Prorocentrum minimum, Alexandrium tamarense, and Gymnodinium spp. Although measurements of actual toxicity levels and profiles of these species at the time of sampling fall outside of the scope of this study, we show that high abundance and competitive success of known AST-producers, Pseudo-nitzschia spp., are possible in Canadian Arctic waters. In 2014, a strong dominance of Pseudo-nitzschia spp. was observed at a few shallow coastal stations, representing nearly 40% of the total phytoplankton cell abundances with > 106 cells/L at the depth of maximum chlorophyll a. We further describe oceanographic conditions conducive to high abundances of toxin-producing algae, indicating that temperature is likely a key factor. Even though measured AST and PST concentrations in bivalve tissue remained well below the Health Canada's levels at which monitored fisheries would close, i.e., 5% and 4%, respectively, their presence demonstrate that phycotoxin accumulation is occurring in food webs of the Canadian Beaufort Sea. Yet, the phycotoxin production controls and trophic transfer mechanisms remain unknown. Canadian Arctic marine ecosystems are rapidly changing and temperatures are expected to continue to increase. Given that these changes simultaneously affect multiple, and often co-occurring, species of primary producers, adaptive capacity is likely to play an important role in the structure of phytoplankton communities in the Canadian Arctic.

Strengths and limitations of the Inclusive Society research model: an autoethnography.

Purpose: The Inclusive Society partnership research model aims to promote change in society for people with disabilities by supporting research teams composed of researchers and partner organizations. The objective of this article is to identify the strengths and limitations of this research model.Material and methods: An autoethnography approach was used. Thematic analysis of four methods was undertaken: semi-directed interviews with members of the research teams funded by Inclusive Society (researchers, partners), a focus group with the Inclusive Society's intersectoral collaboration agents, their logbooks, and Inclusive Society's annual reports.Results: Strengths and limitations of the Inclusive Society model were identified through their networking activities, the role and support of the intersectoral collaboration agents and the partnership research program.Conclusions: Networking activities are an essential element of Inclusive Society. They are indispensable for composing intersectoral research teams that will work on answering needs of people with disabilities. Intersectoral collaboration agents are also a strength of the model, but their role could be clarified to better frame what tasks are in their scope of practice and what the research teams could ask from them. Finally, the research program eligibility criteria could be improved to support, among others, the projects' appropriation phases.

Networking activities stimulate the creation of intersectoral research teams centered on answering the needs of people with disabilities that are identified in the fieldHired facilitators can play an important role in the emergence of research teams, merging the academic and non-academic worlds, and supporting the teams during their research projectIn participatory research projects, some funding should be reserved to support the partner organization's participation and the appropriation phase of the research projects.

Effectiveness of the miWe Simulator Training on Powered Wheelchair-driving Skills: A Randomized Controlled Trial.

OBJECTIVES: To evaluate the effectiveness of a home-based simulator training, in comparison with a videogame-based training, in terms of powered wheelchair driving skills, skills use in a real-world setting, and driving confidence. DESIGN: Single-blinded randomized controlled trial. SETTING: Community. PARTICIPANTS: New powered wheelchair users (N=47) randomly allocated to simulator group (n=24, 2 drop-out) and control group (n=23, 3 drop-out). INTERVENTIONS: The miWe wheelchair simulator (simulator group) or a kart driving videogame (control group) was setted-up at participants' homes (computer + joystick). They were instructed to use it at least 20 minutes every 2 days, during a period of 2 weeks. PRIMARY OUTCOME MEASURE(S): Assessments were done at baseline (T1) and post-training (T2) using the Wheelchair Skills Test Questionnaire (WST-Q, version 4.1), Wheelchair Confidence Scale (WheelCon), Assistive Technology Outcomes Profile for Mobility, and Life-Space Assessment (LSA). The time necessary to complete 6 WST tasks was measured with a stopwatch. RESULTS: Participants of the simulator group significantly increased their WST-Q capacity score at T2 by 7.5% (P<.05), whereas the control group remained at the same score (P=.218). Participants of both groups rolled backward and went through a door significantly faster at T2 (P=.007; P=.016), but their speed did not change for the other skills. The WheelCon score significantly increased after training (+4% for the control group and +3.5% for the simulator group, P=.001). There was no T1-T2 difference between groups for the WST-Q performance scores (P=.119), the ATOP-Activity (P=.686), the ATOP-Participation scores (P=.814), and the LSA score (P=.335). No adverse events or side effects were reported during data collection or training. CONCLUSIONS: Participants of both groups improved some skills and their wheelchair driving confidence. The simulator training group also demonstrated a modest post-training gain in their WST-Q capacity, but more studies would be needed to explore the long-term effects of the McGill immersive wheelchair simulator (miWe) simulator on driving skills.

Clinical stakeholders' perspective for the integration of an immersive wheelchair simulator as a clinical tool for powered wheelchair training.

This study aimed to investigate clinical stakeholders' acceptance of an immersive wheelchair simulator as a potential powered wheelchair skills training tool. Focus groups, conducted in four rehabilitation centers, were used to obtain a rich understanding of participants' experiences and beliefs. Then, a cross-sectional survey of the simulator acceptability for clinical practice was created. Twenty-three rehabilitation therapists and clinical program directors participated in the focus groups and thirty-three responded to the survey. Participants generally expressed that use of the simulator would be complementary to training in an actual powered wheelchair, and that it could be useful for challenging situations in rehabilitation centers (e.g. anxious clients; when there is uncertainty around their potential to drive a powered wheelchair; tasks that cannot be assessed in a real-life environment). They also provided suggestions to improve the simulator (e.g. more feedback during tasks; possibility of adjusting control settings such as speed and sensitivity; possibility of adding varied control interfaces). Feedback received from key stakeholders clearly indicated that the wheelchair simulator would be complementary to training provided in a real context of use. However, some important limitations must be addressed to improve the simulator and promote its adoption by clinical programs, therapists and clients.

International research priorities on the role of cognition in power mobility device use: In pursuit of informed clinical practices and knowledge translation.

Cognition is an important factor affecting power mobility device (PMD) use. However, a gap in knowledge on the role of cognition in PMD use limits evidence of best practices for screening, assessment, and training. The overall goal of this research activity was to identify strategic research priorities to delineate the next steps in research. Following the Collaborative Prioritized Planning Process (CP3), a 1.5-day meeting was held with an interdisciplinary and international team of assistive technology users, clinicians, service providers, and researchers with expertise in PMD use and cognition. Our four-stage process included: knowledge synthesis; identification and prioritization of challenges; identification, consolidation, and prioritization of solutions; and action planning. Five of 14 challenges for research on cognition and PMD use were prioritized, and five solutions (of the 100 generated) perceived to be the most impactful were selected as the focus for the remainder of the meeting. The resulting prioritized solutions included, improving knowledge translation of existing and new evidence, profiling and addressing individualized needs, creating and evaluating training tools, development of practice guidelines, and validating and developing evaluation tools or toolkit. Preliminary action planning facilitated discussion of potential future projects, initiated new research collaborations and partnerships, and provided a foundation to build a program of research for investigating the role of cognition in PMD use.

Usability of a virtual reality manual wheelchair simulator.

PURPOSE: Individuals with impaired mobility often require assistance for getting around. The skilled use of a manual wheelchair (MW) is required in order to gain independence while preventing injuries. Training in a virtual reality (VR) setting allows for safe practice of MW skills in a wide range of environments. We developed a low-cost MW simulator which includes visual and haptic feedback. Our objectives were to assess the usability and fidelity of the VR simulator, by clinicians and expert MW users, and to determine whether the addition of haptic feedback would positively improve the user's experience. MATERIALS AND METHODS: This mixed method study investigated the sense of presence, overall experience and ease of use of the experience in six MW users, as well as five clinicians (wheeled mobility experts) who practiced in the simulator. RESULTS: Participants reported a positive perception of usefulness, sense of presence, and immersion during the MiWe simulator experience. The addition of haptic feedback to the simulator significantly enhanced fidelity of the overall experience, compared to the no-feedback condition. CONCLUSION: Our low-cost simulator was well perceived by clinicians and MW users and was considered as a potentially useful tool to complement MW skill training.IMPLICATIONS FOR REHABILITATIONWe developed a low-cost, virtual reality simulator with visual and haptic feedback, for the practice of manual wheelchair skills.Expert clinicians and wheelchair users reported a positive experience after practicing in the wheelchair simulator, in terms of presence, realism and usability.Participants highlighted the potential usefulness of our low-cost simulator in the training of manual wheelchair skills.

Pediatric powered mobility training: powered wheelchair versus simulator-based practice.

METHOD: Participants included 30 children and adolescents (23 males, 13 females) with cerebral palsy and other neuromuscular diseases, aged 6-18. Data were collected and compared at baseline and after 12 weeks of home-based practice via a powered wheelchair or a simulator. Powered mobility ability was determined by the Powered Mobility Program (PMP), the Israel Ministry of Health's Powered Mobility Proficiency Test (PM-PT) and the Assessment of Learning Powered Mobility (ALP). RESULTS: All participants practiced for the required amount of time and both groups reported a similar user experience. Both groups achieved significant improvement following the practice period as assessed by the PMP and PM-PT assessments, with no significant differences between them. A significant improvement was found in the ALP assessment outcomes for the powered wheelchair group only. CONCLUSIONS: This is the first study, to our knowledge, that compares two different wheelchair training methods. Simulator-based practice is an effective training option for powered mobility for children with physical disabilities aged 6-18 years old, demonstrating that it is possible to provide driving skill practice opportunities safe, controlled environments.

Top predator sea stars are the benthic equivalent to polar bears of the pelagic realm.

The marine pelagic compartment spans numerous trophic levels and consists of numerous reticulate connections between species from primary producers to iconic apex predators, while the benthic compartment is perceived to be simpler in structure and comprised of only low trophic level species. Here, we challenge this paradigm by illustrating that the benthic compartment is home to a subweb of similar structure and complexity to that of the pelagic realm, including the benthic equivalent to iconic polar bears: megafaunal-predatory sea stars.

Consensus for a power wheelchair training approach for people with cognitive impairments.

PURPOSE: Power wheelchairs (PWCs) can enhance independent mobility. The World Health Organization recommends training PWC users. However, current PWC training approaches do not always meet the needs of PWC users with complex mobility and cognitive impairment. The aim was to co-develop an innovative approach to PWC training for individuals with complex mobility and cognitive impairments. MATERIALS AND METHODS: A two-phase mixed method research, involving PWC users, clinicians and researchers throughout all aspects of the research, was realized. (1) Interviews and focus groups were used. (2) The Delphi method was followed to refine the PWC training approach. RESULTS: Phase 1: Twenty-six stakeholders indicated that PWC training should consider the client as a partner, the learning environment, the proposed activities, interactions with the trainer and intervention format. Phase 2: two hundred and seven participants agreed that the PWC training should be goal directed, should be client-centred and occupation-based, should enhance client-therapist relationships and should be realized in a safe and adapted environment. CONCLUSIONS: Stakeholders on PWC use came to agreement on key components that should be applied when training people with cognitive impairments.

Stakeholders on power wheelchair (PWC) use came to agreement on key components that should be applied when training people with cognitive impairments.Power wheelchair training should be goal directed, should be client-centred and occupation-based, should enhance client­therapist relationships and should be realized in a safe and adapted environment.Results of this study may contribute to best practices for PWC training and may empower occupational therapists providing PWC in their clinical decision-making.

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.

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.

Feasibility and clinical applicability of a novel power wheelchair training approach.

PURPOSE: To evaluate the feasibility and the clinical applicability of administering the COMET (cognition, occupation, mobility, evaluation and training) intervention. MATERIALS AND METHODS: A pilot research was conducted with adults who were being considered for power wheelchair (PWC) provision, or who were recently provided a PWC, and who had been identified to benefit from a PWC training. The COMET intervention applies a goal directed, client-centred and occupation-based approach. Feasibility and applicability indicators were collected for: process, resources, management and treatment. Indicators were evaluated as "successful/unsuccessful". Clinical outcomes included the Goal Attainment Scale (GAS), the Canadian Occupational Performance Measure (COPM), the Power mobility Indoor Driving Assessment (PIDA) and the Wheelchair Skills Test (WST). RESULTS: Four females (62.5 ± 3.5 years) with cognitive impairment participated in the study. Among the 13 indicators, 10 were successfully achieved. Indicators that did not meet the criteria for success were adherence rate, safety and treatment for the PIDA. Two adverse events were reported, with one minor injury. Participants demonstrated better than expected results on the GAS, the COPM scores and the WST. However, only two reported an improvement beyond 4% of the PIDA. CONCLUSIONS: With few modifications, the COMET intervention and the study protocol will be feasible and applicable in clinical practice. Individuals with complex cognitive and mobility impairment demonstrated abilities to learn PWC use. Further investigation of the COMET intervention is required to evaluate its efficacy.Implications for rehabilitationA novel power wheelchair (PWC) training approach adapted to individual with complex mobility and cognitive impairments was developed: the COMET (cognition, occupation, mobility, evaluation and training) intervention.The COMET intervention applies a goal directed, client-centred and occupation-based approach.With minor modifications, the COMET intervention may be feasible and clinically applicable to train individuals with complex motor and cognitive impairments how to use a PWC.Further evaluation of the COMET intervention and lager control trialsare suggested.

Biomedical Research and Informatics Living Laboratory for Innovative Advances of New Technologies in Community Mobility Rehabilitation: Protocol for Evaluation and Rehabilitation of Mobility Across Continuums of Care.

BACKGROUND: Rapid advances in technologies over the past 10 years have enabled large-scale biomedical and psychosocial rehabilitation research to improve the function and social integration of persons with physical impairments across the lifespan. The Biomedical Research and Informatics Living Laboratory for Innovative Advances of New Technologies (BRILLIANT) in community mobility rehabilitation aims to generate evidence-based research to improve rehabilitation for individuals with acquired brain injury (ABI). OBJECTIVE: This study aims to (1) identify the factors limiting or enhancing mobility in real-world community environments (public spaces, including the mall, home, and outdoors) and understand their complex interplay in individuals of all ages with ABI and (2) customize community environment mobility training by identifying, on a continuous basis, the specific rehabilitation strategies and interventions that patient subgroups benefit from most. Here, we present the research and technology plan for the BRILLIANT initiative. METHODS: A cohort of individuals, adults and children, with ABI (N=1500) will be recruited. Patients will be recruited from the acute care and rehabilitation partner centers within 4 health regions (living labs) and followed throughout the continuum of rehabilitation. Participants will also be recruited from the community. Biomedical, clinician-reported, patient-reported, and brain imaging data will be collected. Theme 1 will implement and evaluate the feasibility of collecting data across BRILLIANT living labs and conduct predictive analyses and artificial intelligence (AI) to identify mobility subgroups. Theme 2 will implement, evaluate, and identify community mobility interventions that optimize outcomes for mobility subgroups of patients with ABI. RESULTS: The biomedical infrastructure and equipment have been established across the living labs, and development of the clinician- and patient-reported outcome digital solutions is underway. Recruitment is expected to begin in May 2022. CONCLUSIONS: The program will develop and deploy a comprehensive clinical and community-based mobility-monitoring system to evaluate the factors that result in poor mobility, and develop personalized mobility interventions that are optimized for specific patient subgroups. Technology solutions will be designed to support clinicians and patients to deliver cost-effective care and the right intervention to the right person at the right time to optimize long-term functional potential and meaningful participation in the community. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/12506.