Perceived importance of AAC messages to support communication in rehabilitation settings.

PURPOSE: Permanent or temporary speech loss can occur due to a variety of medical conditions and often requires individuals to use augmentative and alternative communication (AAC) strategies and technologies to support communication. The use of AAC in medical and rehabilitation settings is critical to ensure the health, safety and psychological well-being of communicatively vulnerable individuals. METHOD: This study surveyed the perceived importance of communication messages within five categories (Basic Needs, Patient-Provider Specific Communication, Social, Feelings, and Messages for Young Children) by individuals with disability who have undergone recent medical care as well as by rehabilitation care providers. RESULTS: Results indicated that, with only a few exceptions, participants with disability more frequently selected all of the messages listed under the Patient-Provider Specific, Social, and Feelings categories compared to rehabilitation care providers' responses. Additionally, the individuals with disabilities selected messages that were more personalised to their specific care needs under Basic Needs. Both participant groups were asked to also suggest other messages that they perceived as important under each category. The other suggested messages demonstrated the potential need to provide personalisation to AAC displays to best meet the communication needs of individuals with disability.Implications for RehabilitationThere is a critical need for individuals who find themselves in medical settings (ICU, acute care hospital, rehabilitation hospital, etc.) to be able to communicate. This study provides preliminary information on the breadth of communication content that is perceived as relevant by individuals with disability and rehabilitation care providers. The need to provide personalized as well as a wide range of communication content options was of particular importance to individuals with disability. This information may provide specific guidance on how to best develop augmentative and alternative communication options for individuals in medical settings.

Effect of motor-assisted elliptical training speed and body weight support on center of pressure movement variability.

BACKGROUND: A motor-assisted elliptical trainer is being used clinically to help individuals with physical disabilities regain and/or retain walking ability and cardiorespiratory fitness. Unknown is how the device's training parameters can be used to optimize movement variability and regularity. This study examined the effect of motor-assisted elliptical training speed as well as body weight support (BWS) on center of pressure (CoP) movement variability and regularity during training. METHODS: CoP was recorded using in-shoe pressure insoles as participants motor-assisted elliptical trained at three speeds (20, 40 and 60 cycles per minute) each performed at four BWS levels (0 %, 20 %, 40 %, and 60 %). Separate two-way repeated measures ANOVAs (3 × 4) evaluated impact of training speed and BWS on linear variability (standard deviation) and non-linear regularity (sample entropy) of CoP excursion (anterior-posterior, medial-lateral) for 10 dominant limb strides. FINDINGS: Training speed and BWS did not significantly affect the linear variability of CoP in the anterior-posterior or medial-lateral directions. However, sample entropy in both directions revealed the main effect of training speed (p < 0.0001), and a main effect of BWS was observed in the medial-lateral direction (p = 0.004). Faster training speeds and greater levels of BWS resulted in more irregular CoP patterns. INTERPRETATION: The finding that speed and BWS can be used to manipulate CoP movement variability when using a motor-assisted elliptical has significant clinical implications for promoting/restoring walking capacity. Further research is required to determine the impact of motor-assisted elliptical speed and BWS manipulations on functional recovery of walking in individuals who have experienced a neurologic injury or illness.

Walking and Fitness Improvements in a Child With Diplegic Cerebral Palsy Following Motor-Assisted Elliptical Intervention.

PURPOSE: To quantify effects of motor-assisted elliptical (Intelligently Controlled Assistive Rehabilitation Elliptical [ICARE]) training on walking and fitness of a child with cerebral palsy (CP). KEY POINTS: A 12-year-old boy with walking limitations due to spastic diplegic CP (Gross Motor Function Classification System II) participated in 24 sessions of primarily moderate- to vigorous-intensity ICARE exercise. Fitness improvements were evidenced clinically across sessions by the child's capacity to train for longer periods, at faster speeds, and while overriding motor's assistance. Postintervention, the child walked faster with greater stability and endurance and more rapidly completed the modified Time Up and Go test. CONCLUSION: The child's fitness and gait improved following engagement in a moderate- to vigorous-intensity gait-like exercise intervention. RECOMMENDATIONS FOR CLINICAL PRACTICE: Integration of moderate- to vigorous-intensity motor-assisted elliptical training can promote simultaneous gains in fitness and function for children with CP.