Wheelchair Mobility-Related Injuries Due to Inadvertent Lower Extremity Displacement on Footplates: Analysis of the FDA MAUDE Database From 2014 to 2018.

OBJECTIVES: The aims of the study were to assess reports of wheelchair mobility-related injuries from inadvertent lower extremity displacement (ILED) on footplates, which were submitted to the Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database during 2014-2018, characterize injury types, and evaluate MAUDE data quality. METHODS: A systematic MAUDE database review was performed. Annual reports were searched using keywords: (a) "power wheelchair" and "injury" and (b) "mechanical (also known as manual) wheelchair" and "injury." Reports related to injuries from ILED on the footplate were reviewed. RESULTS: Reports of 1075 wheelchair injuries were found across the review period. Twenty nine (3%) met our inclusion criteria. The most common source of reports was "manufacturer." The wheelchair was unavailable for evaluation in 55.17% of reports. Manufacturers' submission dates (number of days that passed after they were notified) ranged from 3 to 159. Reported injuries decreased by 60% from 2014 to 2018. The end user used a power wheelchair for all but one report. The most common injuries were single fractures, multiple fractures, wounds/cuts/infections, and amputations (in order of incidence). The most common mechanism was the foot slipping off the footplate during wheelchair mobility. CONCLUSIONS: We observed inherent weaknesses in the MAUDE database reporting process and a concerning level of reporting bias. Although there were limited reports of injuries related to ILED on the footplate during wheelchair mobility, the injuries reported were significant. More standardized reporting of the mechanism and impact of these injuries is needed to better inform wheelchair design, prescription, and patient/family education.

Effects of in home high dose accelerometer-based feedback on perceived and actual use in participants chronic post-stroke.

Purpose To explore the effects of home-based high dose accelerometer-based feedback on (1) perception of paretic upper extremity (UE) use; (2) actual amount of use (AOU); and (3) capability. The secondary purpose was to characterize paretic UE use in the home setting. Materials and Methods : Prospective experimental pre/post design (trial reg: NCT02995213). Eight participants chronic post-stroke (57.03 ± 6.64 y.o.) wore bilateral wrist accelerometers for 3 weeks during which seven sessions of accelerometer-based feedback were administered in the home. Accelerometer data (overall use, unimanual use, bimanual use, paretic/nonparetic use ratio, different intensities of use) were collected at all follow-up visits; clinical outcomes/questionnaires were collected at baseline, mid-study, and post-intervention. Results : After receiving high dose accelerometer-based feedback, participants had significant perceived gains in how much (p = 0.017) and how well (p = 0.050) they used the paretic UE. However, there were no significant group changes in actual paretic UE AOU or capability. Conclusions : In home high dose accelerometer-based feedback increased perceived paretic UE use and overall awareness of paretic UE use. Perception of use may serve as a first step to promote the behavioral change necessary to encourage actual paretic UE use, potentially decreasing the maladaptive effects of learned nonuse on participation.

Interprofessional education model for geriatric falls risk assessment and prevention.

BACKGROUND: One in three people over the age of 65 fall every year, with 1/3 sustaining at least moderate injury. Falls risk reduction requires an interprofessional health team approach. The literature is lacking in effective models to teach students how to work collaboratively in interprofessional teams for geriatric falls prevention. The purpose of this paper is to describe the development, administration and outcome measures of an education programme to teach principles of interprofessional care for older adults in the context of falls prevention. METHODS: Students from three academic institutions representing 12 health disciplines took part in the education programme over 18 months (n=237). A mixed method one-group pretest and post-test experimental design was implemented to measure the impact of a multistep education model on progression in interprofessional collaboration competencies and satisfaction. RESULTS: Paired t-tests of pre-education to posteducation measures of Interprofessional Socialization and Valuing Scale scores (n=136) demonstrated statistically significant increase in subscales and total scores (p<0.001). Qualitative satisfaction results were strongly positive. DISCUSSION: Results of this study indicate that active interprofessional education can result in positive student attitude regarding interprofessional team-based care, and satisfaction with learning. Lessons learnt in a rapid cycle plan-do-study-act approach are shared to guide replication efforts for other educators. CONCLUSION: Effective models to teach falls prevention interventions and interprofessional practice are not yet established. This education model is easily replicable and can be used to teach interprofessional teamwork competency skills in falls and other geriatric syndromes.

Interprofessional Education: Insights From a Cohort of Nursing Students.

The central research questions of this study sought to understand the experiences of nursing students participating in an interprofessional simulation experience. This study used a nonrandom, purposive sample of 75 nursing students from one Midwestern university. Conventional content analysis was used to analyze the data. Five primary themes emerged from the data: (a) benefits of interprofessional collaboration, (b) communication, (c) "real-life" learning, (d) increased self-confidence, and (e) intraprofessional collaboration. The results of this study reveal the value of participation in interprofessional simulation activities and emphasize the need for continued development and implementation of such activity into nursing education.

Efficacy and task structure of bimanual training post stroke: a systematic review.

BACKGROUND: Bimanual training has been shown to be as effective as, but not superior to, unimanual paretic upper extremity (UE) training interventions in improving paretic UE function and use post stroke. However, it is still unclear whether different training interventions or task structures within bimanual interventions may differentially affect the outcomes. OBJECTIVE: The objectives of this review were to (1) systematically determine the efficacy of bimanual training in relation to the International Classification of Functioning, Disability and Health model components and (2) explore the structure of current bimanual training interventions. METHOD: A systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eleven studies were accepted for review. RESULTS: Three main types of bimanual training emerged: functional task training (FTT), bilateral training with rhythmic auditory cues (BATRAC), and robot-assisted training (RAT). Bimanual training is generally efficacious overall in improving paretic UE movement in individuals with subacute and/or chronic stroke as compared with other interventions. FTT, BATRAC, and RAT showed no significant differences compared with conventional therapy. Bimanual training may have greater proximal control benefits but fewer benefits in terms of subjects' perceived amount and quality of use as compared with constraint-induced movement therapy. CONCLUSION: There were not enough data to draw any conclusions about the effects of bimanual task symmetry or commonality of goal.

Risk factors for first time incidence sciatica: a systematic review.

BACKGROUND AND PURPOSE: Characteristically, sciatica involves radiating leg pain that follows a dermatomal pattern along the distribution of the sciatic nerve. To our knowledge, there are no studies that have investigated risk factors associated with first time incidence sciatica. The purpose of the systematic review was to identify the longitudinal risk factors associated with first time incidence sciatica and to report incidence rates for the condition. For the purposes of this review, first time incidence sciatica was defined as either of the following: 1) no prior history of sciatica or 2) transition from a pain-free state to sciatica. Studies included subjects of any age from longitudinal, observational, cohort designs. METHODS: The study was a systematic review. Eight of the 239 articles identified by electronic search strategies met the inclusion criteria. RESULTS: Risk factors and their respective effect estimates were reported using descriptive analysis and the preferred reporting items for systematic reviews and meta-analyses guidelines. Modifiable risk factors included smoking, obesity, occupational factors and health status. Non-modifiable factors included age, gender and social class. Incidence rates varied among the included studies, in part reflecting the variability in the operationalized definition of sciatica but ranged from <1% to 37%. DISCUSSION: A majority of the identified risk factors associated with first time sciatica are modifiable, suggesting the potential benefits of primary prevention. In addition, those risk factors are also associated with unhealthy lifestyles, which may function concomitantly toward the development of sciatica. Sciatica as a diagnosis is inconsistently defined among studies.

Task-related variations in the surface EMG of the human first dorsal interosseous muscle.

Evidence from human and animal studies suggests that motor neuron pool organization is not uniform for all motor tasks. Groupings of motor units within a muscle may be recruited differentially for a given task based on principles beyond anatomical or architectural features of the muscle alone. This study aimed to determine whether: (1) there was differential activation across locations of the first dorsal interosseous (FDI) muscle during a given task, (2) the differential activation was related to directional requirements and/or end goal of the task, and (3) there was an anatomical pattern to the differential activation. Twenty-six healthy right-handed participants carried out isometric finger/hand contractions in sitting while surface EMG was collected from 4 bipolar sites on the FDI muscle simultaneously. The tasks included: abduction, flexion, diagonal, 30% abduction + 30% flexion, 30% flexion + 30% abduction, key pinch, and power grasp. Mean peak integrated EMG for each task was normalized to site and task specific mean M waves. Differential activation was evident across FDI sites based on movement direction, order of directional components within a combination condition, and end goal of the task. There was greatest activation in the distal ulnar site for all tasks. Additionally there was a trend toward an ordering effect in the amount of activation at each site: distal ulnar > distal radial > proximal radial > proximal ulnar.

6-Hz primed low-frequency rTMS to contralesional M1 in two cases with middle cerebral artery stroke.

This case study contrasted two subjects with stroke who received 6-Hz primed low-frequency repetitive transcranial magnetic stimulation (rTMS) to the contralesional primary motor area (M1) to disinhibit ipsilesional M1. Functional magnetic resonance imaging (fMRI) showed that the intervention disrupted cortical activation at contralesional M1. Subject 1 showed decreased intracortical inhibition and increased intracortical facilitation following intervention during paired-pulse TMS testing of ipsilesional M1. Subject 2, whose precentral knob was totally obliterated and who did not show an ipsilesional motor evoked potential at pretest, still did not show any at posttest; however, her fMRI did show a large increase in peri-infarct zone cortical activation. Behavioral results were mixed, indicating the need for accompanying behavioral training to capitalize on the brain organization changes induced with rTMS.

Intervention to enhance skilled arm and hand movements after stroke: A feasibility study using a new virtual reality system.

BACKGROUND: Rehabilitation programs designed to develop skill in upper extremity (UE) function after stroke require progressive practice that engage and challenge the learner. Virtual realty (VR) provides a unique environment where the presentation of stimuli can be controlled systematically for optimal challenge by adapting task difficulty as performance improves. We describe four VR tasks that were developed and tested to improve arm and hand movement skills for individuals with hemiparesis. METHODS: Two participants with chronic post-stroke paresis and different levels of motor severity attended 12 training sessions lasting 1 to 2 hours each over a 3-week period. Behavior measures and questionnaires were administered pre-, mid-, and post-training. RESULTS: Both participants improved VR task performance across sessions. The less impaired participant averaged more time on task, practiced a greater number of blocks per session, and progressed at a faster rate over sessions than the more impaired participant. Impairment level did not change but both participants improved functional ability after training. The less impaired participant increased the number of blocks moved on the Box & Blocks test while the more impaired participant achieved 4 more items on the Functional Test of the Hemiparetic UE. CONCLUSION: Two participants with differing motor severity were able to engage in VR based practice and improve performance over 12 training sessions. We were able to successfully provide individualized, progressive practice based on each participant's level of movement ability and rate of performance improvement.