Clinical Remote Monitoring of Individuals With Spinal Cord Injury at Risk for Pressure Injury Recurrence Using mHealth: Protocol for a Pilot, Pragmatic, Hybrid Implementation Trial.

BACKGROUND: Pressure injuries are one of the most challenging secondary conditions for individuals with spinal cord injuries and related disorders (SCI/D) owing to inherent, lifelong risk factors that include a lack of sensory and motor function below the level of injury and reliance on a wheelchair for daily mobility, resulting in prolonged periods of sitting. Although many factors contribute to the development of pressure injuries, the pressure between the skin and a surface is always a factor and the development of injury is dependent on the magnitude and duration of the pressure. Clinically, broad recommendations for relieving pressure are used because we know very little about the unique day-to-day life patterns of the individual wheelchair user. Typically, it is after the occurrence of a pressure injury that the therapist will check equipment fit and the effectiveness of pressure offloading and ask about other surfaces they sit on in their home and community. This time-lapsed, largely self-reported data are fraught with recall bias and inaccuracies that the therapist incorporates into a plan of care. OBJECTIVE: This study's objective is to pilot-test the implementation and clinical effectiveness of a telehealth model of care combined with our mobile health (mHealth) Assisted Weight-Shift device for remote monitoring of factors related to maintaining skin health and wheelchair setup. Our overall hypothesis is that this study will result in an effective implementation plan, and the enhanced connected model of care using remote monitoring of pressure management will result in pilot-level, improved clinical outcomes for adults with spinal cord injury at high risk for pressure injury recurrence. METHODS: For all aims, we will use a mixed methods design using an exploratory, sequential approach to include the strengths of both qualitative and quantitative data. For aims 1 and 2, we will iteratively collect qualitative data from therapists, patients with SCI/D, and other stakeholders. For aim 3, we will perform a hybrid effectiveness-implementation randomized controlled trial to pilot-test the intervention. The projected results include an iteratively developed and tested implementation plan that meets moderate to high levels of acceptability, feasibility, and appropriateness. Additionally, the pilot trial results are expected to show positive trends in relevant clinical outcomes related to reduced pressure injury incidence, recurrence, and improved healing when compared with the standard of care. RESULTS: Currently, 6 participants have been recruited for our aim-1 qualitative study. CONCLUSIONS: This study will expand upon our previous study to move the Assisted Weight-Shift system into routine clinical care, which was a strong desire of adults with SCI/D for improved individualized care plans to prevent pressure injuries. The results of this study will guide the next steps in a full, hybrid effectiveness-implementation trial with the goal of improving care to prevent pressure injuries. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/51849.

Test-Retest Reliability of the Electronic Instrumental activities of daily living Satisfaction Assessment (EISA): A Cohort Study.

IMPORTANCE: Currently, no self-report instruments exist for assessing satisfaction with performing instrumental activities of daily living and occupations for people with disabilities using internet-connected assistive devices like accessible smartphones, tablets, laptops, and apps. OBJECTIVE: To assess the test-retest reliability and internal consistency of the Electronic Instrumental activities of daily living Satisfaction Assessment (EISA) self-report outcome tool. DESIGN: Repeated-measures cohort study with a time frame of 7 to 21 days. SETTING: Multicity online recruitment at assistive technology clinics, nongovernmental organizations, advocacy and peer support groups for people with disabilities, and higher education institutions. PARTICIPANTS: Eighty-four participants with disabilities, age 18 yr or older, with a mean age of 43.3 yr (range = 19-75 yr), and 57% female. INTERVENTION: Not applicable. OUTCOMES AND MEASURES: The a priori study hypotheses were that the EISA test-retest reliability scores would be above the minimum acceptable level (Rs > .80) and that internal consistency would be good (Cronbach's α = .70-.90). RESULTS: On the basis of the study data, the EISA, Version 1.0, demonstrated good test-retest reliability (Rs = .81) and excellent internal consistency (Cronbach's α = .88). CONCLUSIONS AND RELEVANCE: The results of the test-retest reliability and internal consistency analyses provide good support for the EISA to be used in clinical settings. What This Article Adds: This article documents the reliability and internal consistency of, to our knowledge, the first-ever self-report instrument for assessing satisfaction with performance of everyday occupations for people with disabilities using internet-connected assistive devices such as smartphones, tablets, laptops, and apps.

Development and content validation of the Electronic Instrumental activities of daily living Satisfaction Assessment (EISA) outcome tool.

This study describes the development and content validation of the Electronic Instrumental activities of daily living Satisfaction Assessment (EISA), a self-report outcome measure for assessing satisfaction with completing instrumental Activities of Daily Living (IADL) for People With Disabilities (PWD) using internet-Connected Assistive Devices (iCAD). For this study, an iCAD is defined as any information communication technology/electronic device or software that assists with promoting, maintaining, and/or enhancing the ability of a PWD to live independently in society. Phase 1 of development involved generating an initial item pool based on a literature review. Content validity of the EISA was computed in Phase 2 using the Qualtrics on-line research platform. Utilizing the content validity index procedure, EISA demonstrated acceptable content validity: item level (I-CVI of 0.78 or higher) and scale level (S-CVI/Ave of 0.90 or higher). EISA version 1.0 was generated in Phase 3 where it is the first of its kind outcome measure specifically designed for assessing satisfaction with completing IADL for PWD using iCAD.

Antiretroviral Therapy Adherence, Functional Independence, and Falls among People with HIV.

Chronic disease management coupled with education may improve outcomes for those with chronic disease. As Human Immunodeficiency Virus (HIV) is now a chronic disease, addressing the needs of as people living with HIV (PLWH) is essential as they experience an accelerated aging process due to the mechanisms of the disease and medications taken. Although studies exist on the management of chronic HIV, few discuss the implications of medication adherence and activities of daily living related to falls among PLWH. To inform occupational therapy services for PLWH, this case-control study used extracted data from the electronic medical records of PLWH who had received occupational therapy (OT) at a large academic hospital. Two-hundred-and-four subjects were included in the final dataset; sixty-eight were cases that reported a fall within the last 12 months, while 136 were controls which were PLWH who had not sustained a fall. The association between falls and antiretroviral therapy adherence indicated males who were ART non-adherent and had balance deficits were more likely to fall. The association between ADL dysfunction and falls among PLWH showed those more likely to fall had moderate ADL dysfunction and balance deficits. The findings suggest further examination of the person factors of PLWH who are categorized clinically as non-adherent with antiretroviral therapy and have ADL dysfunction may improve health outcomes and reduce falls when paired with occupation-based interventions.

Exploratory Review: Self-Report IADL Assessments in the age of Internet-Connected Assistive Devices.

Internet-Connected Assistive Devices (iCAD), like accessible smartphones, tablets, computers, and apps, have become an integral part of everyday functioning for people with disabilities (PWD). The objective of this article was to identify self-report assessments having the relevance and clinical applicability for assessing satisfaction with performing Instrumental Activities of Daily Living (IADL) for PWD using iCAD. An exploratory review was conducted to identify self-report assessments that were appropriate, practical, clinically fit, and psychometrically acceptable, for assessing satisfaction with performing IADLs for PWD using iCAD. Thirty-two IADL assessments were identified, of which six met inclusion criteria. Four of six assessments did not specifically address iCAD usage, while two assessments had limited relevance and clinical applicability, for assessing satisfaction with performing IADLs for PWD using iCAD. This review establishes the growing need for a self-report IADL assessment that has been specifically designed and validated for assessing satisfaction with performing IADLs for PWD using iCAD.

Information communication technology-enabled instrumental activities of daily living: a paradigm shift in functional assessment.

Purpose: Information Communication Technology, such as smartphones, apps, the internet, etc., has become all-pervasive in our society. To learn the impact of Information Communication Technology (ICT) on everyday functioning, specifically Instrumental Activities of Daily Living (IADL), an exploratory review was undertaken.Methods: We identified how many primary IADL domains were substantially influenced by ICT, by examining primary IADL domains, in terms of traditional and ICT-enabled ways of completing these common tasks. The study further explored the implications of the pervasiveness of ICT and the ICT-enabled new normal in everyday functioning that underpins the need to redefine IADLs.Results: This examination revealed that the impact of ICT on IADLs has been so profound, that it marks a paradigm shift in the way we assess IADL completion. Creation of the concept of "Electronic Instrumental Activities of Daily Living (eIADLs)" would be a first step in marking this paradigm shift, and would foster further advances for understanding the mechanisms underlying the ICT-based life style related outcome measurement in rehabilitation science.IMPLICATIONS FOR REHABILITATIONThe presence of Information Communication Technology (ICT) has substantially influenced the way we complete our Instrumental Activities of Daily Living (IADL). Indeed, the impact is so profound, that it marks a paradigm shift in the way we should assess and measure everyday functioning.Creation of the concept of eIADLs would be a first step in marking this paradigm shift, and would foster further advances for understanding the mechanisms underlying the ICT-based life style related outcome measurement in the rehabilitation sciences.

Flourishing in children with autism spectrum disorders.

Flourishing is an indicator of positive mental health and is important for children's development and well-being. We used variables from the National Survey of Children's Health 2016 as indicators of flourishing (difficulty making friends, is bullied, bullies others, shares ideas with family, argues, finishes tasks, does all homework, shows curiosity, stays calm, and cares about doing well in school) to compare differences in parent perceptions of their children with and without autism spectrum disorder (ASD). We anticipate that these findings will help identify intervention targets to support the well-being of individuals with ASD. Children between 6 and 17 years of age, without intellectual disability, brain injury, cerebral palsy, or Down syndrome were included. Total participants were 34,171 controls (male/female = 17,116/17,155) and 812 with ASD (male/female = 668/144). Factor analysis resulted in three-factor structures (social competence, behavioral control, and school motivation) with good model fit (root mean square error of approximation = 0.08, comparative fit index = 0.92, Tucker-Lewis index = 0.89). The multivariate regression model and propensity score with inverse probability of treatment weighting (PS-IPTW) method revealed that children with ASD had lower scores in the social competence and behavioral control factors compared to the control group (all P < 0.05). However, no significant differences were found in the school motivation factor between the two groups (P > 0.05) in both multivariate regression model and PS-IPTW method. Findings suggest that social competence and behavioral control are indicators of flourishing and are important intervention targets to increase flourishing among children with ASD. Autism Res 2019, 12: 952-966. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Flourishing is an indicator of positive mental health and is important for children's development and well-being. We used variables from The National Survey of Children's Health 2016 to examine differences in parent perceptions of the indicators of flourishing (difficulty making friends, is bullied, bullies others, shares ideas with family, argues, finishes tasks, does all homework, shows curiosity, stays calm, and cares about doing well in school) between children with and without autism spectrum disorders (ASD). We anticipate that this information will help to identify therapeutic targets to support the well-being of individuals with ASD. Children between 6 and 17 years old, without intellectual disability (ID), brain injury (BI), cerebral palsy (CP), or Down syndrome (DS) were included. From the total (N = 50,212), we excluded children under age 6 (n = 14,494), those who once, but do not currently have ASD (n = 81), and those with ID (n = 432), BI (n = 170), CP (n = 35), and DS (n = 17), resulting in 34,983 records used. Total participants, age 6-17 years, were 34,171 controls (male/female = 17,116/17,155) and 812 with ASD (male/female = 668/144). Factor analysis resulted in the identification of three flourishing categories among the indicator variables (social competence, behavioral control, and school motivation). Children with ASD had lower scores in the social competence and behavioral control factors compared to the control group. However, there were no significant differences in the school motivation factor between the two groups. Findings suggest that social competence and behavioral control are indicators of flourishing and are important intervention targets to increase flourishing among children with ASD.

Impact of Multiple Chronic Conditions on Activity Limitations Among Older Mexican-American Care Recipients.

INTRODUCTION: Older Mexican Americans are living longer with multiple chronic conditions (MCCs). This has placed greater demands on caregivers to assist with basic activities of daily living (ADL) or instrumental activities of daily living (IADL). To understand the needs of older Mexican-American care recipients, we examined the impact of MCC on ADL and IADL limitations. METHODS: We analyzed data from 485 Mexican American care-receiving/caregiving dyads. Selected MCCs in the analysis were diabetes, hypertension, stroke, heart disease, arthritis, emphysema/chronic obstructive pulmonary disease, cognitive impairment, depression, and cancer. Care recipients were dichotomized as having 3 or more conditions or as having 2 or fewer conditions. Three comorbidity clusters were established on the basis of the most prevalent health conditions among participants with comorbid arthritis and hypertension. These clusters included arthritis and hypertension plus: diabetes (cluster 1), cognitive impairment (cluster 2), and heart disease (cluster 3). RESULTS: Care recipients with 3 or more chronic conditions (n = 314) had higher odds of having mobility limitations (OR = 1.98; 95% CI, 1.34-2.94), self-care limitations (OR = 2.53; 95% CI, 1.70-3.81), >3 ADL limitations (OR = 2.00; 95% CI, 1.28-3.17), and >3 IADL limitations (OR = 1.88; 95% CI, 1.26-2.81). All clusters had increased odds of ADL and severe ADL limitations. Of care recipients in cluster 2, those with arthritis, hypertension, and cognitive impairment had significantly higher odds of mobility limitations (OR = 2.33; 95% CI, 1.05-5.24) than those with just arthritis and hypertension. CONCLUSION: MCCs were associated with more ADL and IADL limitations among care recipients, especially for those with hypertension and arthritis plus diabetes, cognitive impairment, or heart disease. These findings can assist in developing programs to meet the needs of older Mexican-American care recipients.

Sensory Responsiveness in Siblings of Children with Autism Spectrum Disorders.

This study examined sensory responsiveness in unaffected siblings of children with autism spectrum disorder (ASD) and associations between sensory responsiveness and social severity. Sensory Profile Caregiver Questionnaires and Social Responsiveness Scales were completed by parents of 185 children between age 4 and 10.95 years. Significant differences were found between participants with ASD and controls, and between participants with ASD and unaffected siblings for all sensory quadrants and domains, but not between controls and unaffected siblings. Social responsiveness scores were significantly correlated with scores from most sensory profile categories. Sensory responsiveness as an endophenotype of ASD is not indicated from these findings; however, studies with larger numbers of unaffected siblings and controls are needed to confirm the null hypothesis.

Feasibility of Using Mobile Health to Promote Self-Management in Spina Bifida.

OBJECTIVE: To determine feasibility of using the interactive Mobile Health and Rehabilitation (iMHere) system in spina bifida and its effects on psychosocial and medical outcomes. DESIGN: In a randomized controlled trial, 13 intervention participants using the iMHere system and receiving usual care and 10 control participants receiving usual care were followed for 1 year. RESULTS: Feasibility of use of the system was demonstrated by participants using a customized smartphone system for reminders to conduct various self-care tasks, upload photos of wounds, manage medications, complete mood surveys, and for secure messaging. High usage of the system was associated with positive changes in the subscales of the Adolescent Self-Management and Independence Scale II. CONCLUSION: Use of the iMHere system in spina bifida is feasible and was associated with short-term self-reported improvements in self-management skill. This system holds promise for use in many diverse chronic care models to support and increase self-management skills.

Leisure Activity Enjoyment of Children with Autism Spectrum Disorders.

Enjoyment is a fundamental component of activity participation. This study compared leisure activity enjoyment experienced by typically developing children (TD; n = 64) and those with autism spectrum disorders (ASD; n = 67) from age 6 to 13. The TD children enjoyed formal and physical activities significantly more than the children with ASD. Symptom severity was negatively related to enjoyment of overall, formal, physical and social activities. Older children with ASD enjoyed overall, informal, recreational, and self-improvement activities significantly less than younger children, but no differences were seen across TD age groups. Children with ASD enjoyed swimming significantly more than TD children. Understanding patterns of activity enjoyment is useful for being better able to address a child's motivation to participate in various life activities.

Factors Associated with Mobility Outcomes in a National Spina Bifida Patient Registry.

OBJECTIVE: To provide descriptive data on ambulatory ability and muscle strength in a large cohort of individuals with spina bifida enrolled in a National Spina Bifida Patient Registry and to investigate factors associated with ambulatory status. DESIGN: Cross-sectional analysis of data from a multisite patient registry. RESULTS: Descriptive analysis of mobility variables for 2604 individuals with spina bifida aged 5 and older are presented from 19 sites in the United States. Analysis of a subset of National Spina Bifida Patient Registry data from 380 individuals from 3 sites accompanied by data from a specialized spina bifida electronic medical record revealed that those with no history of a shunt, lower motor level, and no history of hip or knee contracture release surgery were more likely to be ambulatory at the community level than at the household or wheelchair level. CONCLUSION: This study is the first to examine factors associated with ambulatory status in a large sample of individuals with myelomeningocele and nonmyelomeningocele subtypes of spina bifida. Results of this study delineate the breadth of strength and functional abilities within the different age groups and subtypes of spina bifida. The results may inform physicians of the characteristics of those with varying ambulatory abilities.

Depressive symptoms in adults with spina bifida.

OBJECTIVE: To examine the prevalence of depressive symptoms in adults with spina bifida and identify contributing factors for depressive symptomatology. METHOD: Retrospective Cohort Study. Data collection was conducted at a regional adult spina bifida clinic. A total of 190 charts from adult patients with spina bifida were included. The main outcome measures were the Beck Depression Inventory-II (BDI-II) and the mobility domain of the Craig Handicap Assessment Reporting Technique-Short Form (CHART-SF). RESULTS: Of the 190 participants, 49 (25.8%) had BDI-II scores (14+) indicative of depressive symptomatology. Sixty-nine (36.3%) were on antidepressants to treat depressive symptoms, and 31 (63.3%) of those with clinical symptoms of depression were on antidepressants. Participants with a history of depressive symptoms may be as high as 45.7% if both participants with BDI-II scores 14+ and those with antidepressant use specifically for the purposes of depression treatment are combined. In this population, lower CHART-SF mobility score, expressing "emotional concerns" as a reason for the visit on an intake sheet, and use of antidepressant medications were significantly associated with depressive symptoms. CONCLUSIONS: Depressive symptomatology appears to be common and undertreated in this cohort of adults with spina bifida, which may warrant screening for emotional concerns in routine clinic appointments. Significant depressive symptoms are associated with fewer hours out of bed and fewer days leaving the house. Additional research is needed to assess the impact of interventions directed toward mobility on depression and in the treatment of depression in this patient population.

Performance evaluation of the Personal Mobility and Manipulation Appliance (PerMMA).

The Personal Mobility and Manipulation Appliance (PerMMA) is a recently developed personal assistance robot created to provide people with severe physical disabilities enhanced assistance in both mobility and manipulation. PerMMA aims to improve functional independence when a personal care attendant is not available on site. PerMMA integrates both a smart powered wheelchair and two dexterous robotic arms to assist its users in completing essential mobility and manipulation tasks during basic and instrumental activities of daily living (ADL). Two user interfaces were developed: a local control interface and a remote operator controller. This paper reports on the evaluation of PerMMA with end users completing basic ADL tasks. Participants with both lower and upper extremity impairments (N=15) were recruited to operate PerMMA and complete up to five ADL tasks in a single session of no more than two hours (to avoid fatigue or frustration of the participants). The performance of PerMMA was evaluated by participants completing ADL tasks with two different control modes: local mode and cooperative control. The users' task completion performance and answers on pre/post-evaluation questionnaires demonstrated not only the ease in learning and usefulness of PerMMA, but also their attitudes toward assistance from advanced technology like PerMMA. As a part of the iterative development process, results of this work will serve as supporting evidence to identify design criteria and other areas for improvement of PerMMA.

Test-retest reliability of the functional mobility assessment (FMA): a pilot study.

PURPOSE: Functional mobility is necessary to perform activities of daily living and for community participation for everyone, but especially important for persons with disabilities (PWD). Therefore, functional mobility requires reliable measurement of consumer satisfaction and functional changes. The functional mobility assessment (FMA) instrument is a self-report outcomes tool designed to measure effectiveness of wheeled mobility and seating (WMS) interventions for PWD. This study examined the test-retest reliability of the FMA, and the stability of self-reported performance items. METHOD: A repeated-measures cohort study was conducted at the Center for Assistive Technology, at the University of Pittsburgh Medical Center. Participants (n = 41) completed an initial FMA questionnaire, and were re-administered the questionnaire within 7-21 days of the first questionnaire completion. The study sample included 20 participants who were non-WMS users but in the process of being evaluated for a device and 21 participants who were existing WMS users. Intra-Class Correlation coefficients (ICC) were computed to determine agreement between the two scores. RESULTS: Test-retest reliability scores for all items and participants were above the acceptable value for a clinical assessment tool (≥0.80). Responses on the FMA of Existing WMS users and non-WMS users did not differ significantly at test or retest. CONCLUSIONS: Results indicate that the FMA was a reliable and stable tool for assessing the functional performance of individuals who use or need WMS interventions.

Pilot study for quantifying driving characteristics during power wheelchair soccer.

This study determined the driving characteristics of wheelchair users during power wheelchair soccer games. Data for this study were collected at the 28th and 29th National Veterans Wheelchair Games. Nineteen veterans who were 18 years or older and power wheelchair soccer players completed a brief demographic survey and provided information about their power wheelchairs. A customized data-logging device was placed on each participant's wheelchair before power soccer game participation. The data logger was removed at the end of the final game for each participant. The average distance traveled during the games was 899.5 +/- 592.5 m, and the average maximum continuous distance traveled was 256.0 +/- 209.4 m. The average wheelchair speed was 0.8 +/- 0.2 m/s, and the average duration of driving time was 17.6 +/- 8.3 min. Average proportion of time spent at a speed >1 m/s was 30.7% +/- 33.8%, between 0.5 and 1 m/s was 16.2% +/- 34.4%, and <0.5 m/s was 21.4% +/- 24.3%. The information from this descriptive study provides insight for future research in the field of adapted sports for people with high levels of impairments who use power wheelchairs for their mobility.

Comparison of virtual wheelchair driving performance of people with traumatic brain injury using an isometric and a conventional joystick.

UNLABELLED: Cooper RA. Comparison of virtual wheelchair driving performance of people with traumatic brain injury using an isometric and a conventional joystick. OBJECTIVE: To compare wheelchair driving performance in a driving simulator using a conventional joystick and an isometric joystick. DESIGN: Randomized, cohort study. SETTING: A research facility based in a hospital or in an independent living center. PARTICIPANTS: Participants (N=20; 12 men, 8 women; mean age ± SD, 30.62±10.91 y) who were at least 1 year post-TBI. INTERVENTIONS: Driving performance using an isometric joystick compared with a conventional movement joystick. MAIN OUTCOME MEASURES: Average trial completion time, and trajectory-specific measures measured orthogonal to the center of driving tasks: root mean squared error, movement offset, movement error, and number of significant changes in heading. RESULTS: After statistically controlling for driving speed, participants were able to complete the driving tasks faster with an isometric joystick than while using a conventional movement joystick. Compared with the conventional joystick, an isometric joystick used for driving forward demonstrated fewer driving errors. During reverse driving the conventional joystick performed better. CONCLUSIONS: The customizable isometric joystick seems to be a promising interface for driving a powered wheelchair for individuals with TBI.

Demographic profile of older adults using wheeled mobility devices.

The purpose of this study was to determine whether the use of wheeled mobility devices differed with respect to age, gender, residential setting, and health-related factors among older adults. A total of 723 adults ageing 60 and older are representing three cohorts, from nursing homes, the Center for Assistive Technology, and the wheelchair registry from the Human Engineering Research Laboratories. Wheeled mobility devices were classified into three main groups: manual wheelchairs, power wheelchairs, and scooters. Our results found factors including age, gender, diagnosis, and living settings to be associated with differences in use of manual versus powered mobility devices. Differences in use were also noted for subtypes of manual (depot, standard, and customized) and powered (scooter, standard, and customized) mobility devices, on demographic, living arrangements, and health-related factors. Consideration of demographic, health-related, and environmental factors during the prescription process may help clinicians identify the most appropriate mobility device for the user.

Manual wheelchair-related mobility characteristics of older adults in nursing homes.

AIM: Manual wheelchairs are commonly prescribed for older adults in nursing homes (NH). The extent of their utilisation being unknown may result in the prescription of standard wheelchairs. The purpose of this study was to quantify manual wheelchair use by nursing home residents. METHODS: Seventy-two independent wheelchair users were recruited from four NH (two VA-affiliated and two private). A customised wheelchair data logger was attached to each participant's wheelchair for 1 month. Data were reduced and compared separately for VA- affiliated and private facilities by types of propulsion pattern (arms versus legs and the combination of arms and legs) using MANOVA. RESULTS: Participants from the VA-affiliated facilities who used their arms were covering more distance (1451 m versus 806 m), with greater endurance (73 m versus 60 m) as compared to participants who used combination of arms and legs. However, no difference was observed between velocity of wheelchair propulsion between groups (0.48 m/s versus 0.58 m/s). For private facilities no notable difference was observed between the groups. CONCLUSION: Older adults who live in NH and use of wheelchairs represent a diverse cohort. The efficacy of using an objective assessment method to measure the extent of use of wheelchairs was demonstrated in this study.

Multiple sclerosis and mobility-related assistive technology: systematic review of literature.

Multiple sclerosis (MS) causes a wide variety of neurological deficits, with ambulatory impairment the most obvious cause of disability. Within 10 to 15 years of disease onset, 80% of persons with MS experience gait problems due to muscle weakness or spasticity, fatigue, and loss of balance. To facilitate mobility, persons with MS frequently use mobility assistive technology (MAT), such as canes, crutches, walkers, wheelchairs, and scooters. We systematically reviewed the published literature on MAT use among persons with MS. We used electronic reference lists such as Ovid MEDLINE and PubMed to search the literature. We located 50 articles that met the initial criteria of providing good evidence of the types of MAT devices and their benefits for individuals with MS. A limited number of articles with higher levels of evidence was found regarding benefits of MAT use specifically for persons with MS. Evidence-based literature provides the basis for the strongest method of measurable clinical performance; therefore, having a strong research study design is vital to the justification of MAT prescription and reimbursement decisions. However, a paucity of studies with higher levels of evidence-based practice exists.