Randomized Controlled Trial of Occupational Performance Coaching for Adults With Multiple Sclerosis.

OBJECTIVE: To determine if the receipt of occupational performance coaching (OPC) by adults living with multiple sclerosis (MS) improves participants' satisfaction with performance in daily activities (primary outcome); improves perceived performance in daily activities, resilience, autonomy, and participation; and reduces illness intrusiveness and effect of MS (secondary outcomes). DESIGN: Two-group randomized clinical trial with a waitlist control. SETTING: Community. PARTICIPANTS: Convenience sample of adults with MS were recruited through a research registry. Eighty-three individuals were approached; 35 were assessed for eligibility and 31 were enrolled and 30 completed baseline assessment (Final sample size, N=30). Participants were English-speaking, were without serious cognitive impairment or severe depression, and were not receiving other coaching interventions. INTERVENTIONS: Six telephone sessions of OPC were delivered by a trained facilitator over 10 weeks. Initial sessions focused on goal setting, prioritization, and action planning. Subsequent sessions involved goal and action plan review, discussion of facilitators and barriers, and goal and plan refinement. MAIN OUTCOME MEASURES: Primary outcome was participants' satisfaction with performance in daily activities, as measured by the Canadian Occupational Performance Measure (COPM). Secondary outcome measures included the COPM performance rating, Connor-Davidson Resilience Scale, Impact on Participation and Autonomy Questionnaire, Adapted Illness Intrusiveness Rating Scale, and MS Impact Scale. Measures were administered by a blinded assessor at baseline, 10 weeks, and 2 months. RESULTS: Participants in the intervention and waitlist control groups were equivalent on demographic and outcome measures at baseline. At 10 weeks, the intervention group had significantly higher COPM ratings for both satisfaction (P<.001) and performance (P=.002). No other outcomes were significantly different. For the intervention group, the benefits of OPC were maintained at 2 months. CONCLUSIONS: OPC led to improved satisfaction with performance and performance in daily activities. Future research with a larger sample is needed to determine other effects and who benefits most from OPC.

Understanding barriers to participation in group chronic disease self-management (CDSM) programs: A scoping review.

OBJECTIVE: To identify factors that influence enrollment in and attendance of chronic disease self-management (CDSM) group programs. METHODS: A scoping review of peer-reviewed publications that reported on factors of enrollment or attendance in group CDSM programs for adults with any type of chronic condition. Screening was completed by two reviewers and data extraction was checked for accuracy. Data were summarized and key themes were identified in collaboration with the study team. RESULTS: Following screening, 52 of 2774 articles were included. Attendance rates that varied from 10.4-98.5% (mean =72.5%). There is considerable overlap between enrollment and attendance factors. These included Competing Commitments, Logistics, Personal characteristics, Perception of illness/health status, Health service provision, and Group dynamics. CONCLUSIONS: Varied and individualized factors can facilitate or impede enrollment or attendance in group CDSM programs. Consideration of these factors and tailoring of programs is needed to facilitate patient ability to take part. Participatory co-design is a growing approach to ensure programs meet individual and community needs. More research is needed to identify the specific impact of using codesign on enrollment and attendance in group CDSM programs. PRACTICE IMPLICATIONS: Including community members and service users in design and implementation may enhance CDSM program access.

Multiple sclerosis caregiving: A systematic scoping review to map current state of knowledge.

Unpaid caregivers, typically family and friends, provide significant amounts of support to people with multiple sclerosis (MS). Understanding their experiences, needs and challenges is necessary to ensure that caregivers receive the support that they require to continue in their role. Our aim was to map the current state of knowledge about unpaid caregivers of people with MS and identify gaps in knowledge to guide future research and practice. We used scoping review methodology with three major health-related databases (MEDLINE, CINAHL, APA Psychinfo), searching in September 2019, April and October 2020 and October 2021. We selected peer-reviewed scientific articles reporting on primary studies of unpaid caregivers of people with MS, regardless of topic or research design. We extracted information on study aim, participant characteristics, measures used and key findings to generate major themes and identify knowledge gaps. We identified 108 published studies between 1992 and 2021 that met our criteria. Studies of spousal caregivers were most common. Studies focused primarily on measurement of caregiver burden or other negative consequences of caregiving. Thirteen studies addressed positive consequences of caregiving. Sixteen studies reported actual tasks performed by caregivers and seven reported outcomes of caregiver support interventions. Attention to diversity issues that may influence caregiving experiences and outcomes was rare. Overall, knowledge of MS caregiving is limited, particularly with respect to tasks performed by caregivers that may contribute to negative outcomes, diversity issues and effective approaches to remediate caregiver burden. Without this knowledge, finding ways to better support MS caregivers will be difficult.

Characterizing slip-like responses during gait using an entire support surface perturbation: Comparisons to previously established slip methods.

BACKGROUND: The characteristics of experimentally induced slips (low-friction surfaces and non-motorized platforms) in laboratory settings are influenced by participant gait velocity, contact surface area, and level of friction between the foot and surface. However, motorized platforms that could account for these factors during slip-like paradigms have not been extensively used. RESEARCH QUESTION: How does slip-like perturbations evoked via a motorized platform change gait characteristics and postural stability during overground walking? METHODS: Ten healthy young adults performed 4 overground, self-paced walking trials, with the 4th trial including an unexpected forward support surface translation at heel-strike during steady state walking. Kinematic and kinetic data were collected, with step characteristics (time, distance, velocity) and postural stability calculated to compare between normal gait and slip-like trials. Slip foot characteristics were also determined. RESULTS: Peak slipping foot velocity variability was considerably smaller compared to previously reported low-friction and non-motorized perturbations. The centre of mass was shifted more posteriorly (thus in a less stable location) by the end of the platform acceleration phase compared to the same time point post-heel strike during normal gait trials. Participants successfully responded to every slip-like perturbation by significantly increasing step time, decreasing step distance, and decreasing step velocity. SIGNIFICANCE: Our results demonstrate the repeatability and consistency of a motorized support surface paradigm to induce slip-like perturbations. Furthermore, stability and step characteristic results confirm posterior shifts in stability and appropriate stepping responses, mimicking how participants would react if responding to a real world slip.

Exploring the relationship between stability and variability of the centre of mass and centre of pressure.

BACKGROUND: There are competing perspectives in the literature regarding the role of movement variability in quiet standing and balance control. Some view high variability as indicative of poor balance control and a contributor to increased fall risk, whereas others view variability as beneficial in providing sensory information that aids balance control. RESEARCH QUESTION: This study aimed to help to clarify the role of variability in balance control by testing two competing hypotheses: that increased variability would lead to instability, or that increased variability would improve stability, where stability is defined as the ability to respond to a perturbation. METHODS: Fourteen healthy young adults (20-35 years old) were recruited. Participants experienced postural perturbations of varying magnitudes, delivered via sudden backward movement of the support surface. Magnitudes of postural perturbation were chosen such that both step and no-step responses could be observed at each magnitude. Variability in the centre of mass and centre of pressure movement was measured for 10 s prior to the postural perturbation. Multiple regression was used to determine if movement variability predicted step responses when controlling for perturbation magnitude, trial order, and margin of stability at perturbation onset. RESULTS: Lower variability in medio-lateral centre of mass and centre of pressure position, and lower variability in medio-lateral centre of pressure velocity were related to increased odds of stepping in response to the perturbation (p-values ≤0.001). SIGNIFICANCE: This study provides support for the hypothesis that, at least for relatively low variability values, increased centre of pressure and mass movement variability improves stability. Specifically, increasing movement of the centre of pressure and mass in the medio-lateral direction may help to preserve stability in the antero-posterior direction by providing the central nervous system with information about the antero-posterior centre of mass across a wide range of medio-lateral positions.

Atypical anticipatory postural adjustments during gait initiation among individuals with sub-acute stroke.

Anticipatory postural adjustments, executed prior to gait initiation, help preserve lateral stability when stepping. Atypical patterns of anticipatory activity prior to gait initiation may occur in individuals with unilateral impairment (e.g., stroke). This study aimed to determine the prevalence, correlates, and consequences of atypical anticipatory postural adjustment patterns prior to gait initiation in a sub-acute stroke population. Forty independently-ambulatory individuals with sub-acute stroke stood on two force plates and initiated gait at a self-selected speed. Medio-lateral centre of pressure displacement was calculated and used to define anticipatory postural adjustments (shift in medio-lateral centre of pressure >10mm from baseline). Stroke severity, motor recovery, and functional balance and mobility status were also obtained. Three patterns were identified: single (typical), absent (atypical), and multiple (atypical) anticipatory postural adjustments. Thirty-five percent of trials had atypical anticipatory postural adjustments (absent and multiple). Frequency of absent anticipatory postural adjustments was negatively correlated with walking speed. Multiple anticipatory postural adjustments were more prevalent when leading with the non-paretic than the paretic limb. Trials with multiple anticipatory postural adjustments had longer duration of anticipatory postural adjustment and time to foot-off, and shorter unloading time than trials with single anticipatory postural adjustments. A high prevalence of atypical anticipatory control prior to gait initiation was found in individuals with stroke. Temporal differences were identified with multiple anticipatory postural adjustments, indicating altered gait initiation. These findings provide insight into postural control during gait initiation in individuals with sub-acute stroke, and may inform interventions to improve ambulation in this population.

Can augmented feedback facilitate learning a reactive balance task among older adults?

While concurrent augmented visual feedback of the center of pressure (COP) or center of gravity (COG) can improve quiet standing balance control, it is not known whether such feedback improves reactive balance control. Additionally, it is not known whether feedback of the COP or COG is superior. This study aimed to determine whether (1) concurrent augmented feedback can improve reactive balance control, and (2) feedback of the COP or COG is more effective. Forty-eight healthy older adults (60-75 years old) were randomly allocated to one of three groups: feedback of the COP, feedback of the COG, or no feedback. The task was to maintain standing while experiencing 30 s of continuous pseudo-random perturbations delivered by a moving platform. Participants completed 25 trials with or without feedback (acquisition), immediately followed by 5 trials without feedback (immediate transfer); 5 trials without feedback were completed after a 24-h delay (delayed transfer). The root mean square error (RMSE) of COP-COG, electrodermal level, and co-contraction index were compared between the groups and over time. All three groups reduced RMSE and co-contraction index from the start of the acquisition to the transfer tests, and there were no significant between-group differences in RMSE or co-contraction on the transfer tests. Therefore, all three groups learned the task equally well, and improved balance was achieved with practice via a more efficient control strategy. The two feedback groups reduced electrodermal level with practice, but the no-feedback group did not, suggesting that feedback may help to reduce anxiety.

Is perception of vertical impaired in individuals with chronic stroke with a history of 'pushing'?

Post-stroke 'pushing' behaviour appears to be caused by impaired perception of vertical in the roll plane. While pushing behaviour typically resolves with stroke recovery, it is not known if misperception of vertical persists. The purpose of this study was to determine if perception of vertical is impaired amongst stroke survivors with a history of pushing behaviour. Fourteen individuals with chronic stroke (7 with history of pushing) and 10 age-matched healthy controls participated. Participants sat upright on a chair surrounded by a curved projection screen in a laboratory mounted on a motion base. Subjective visual vertical (SVV) was assessed using a 30 trial, forced-choice protocol. For each trial participants viewed a line projected on the screen and indicated if the line was tilted to the right or the left. For the subjective postural vertical (SPV), participants wore a blindfold and the motion base was tilted to the left or right by 10-20°. Participants were asked to adjust the angular movements of the motion base until they felt upright. SPV was not different between groups. SVV was significantly more biased towards the contralesional side for participants with history of pushing (-3.6 ± 4.1°) than those without (-0.1 ± 1.4°). Two individuals with history of pushing had SVV or SPV outside the maximum for healthy controls. Impaired vertical perception may persist in some individuals with prior post-stroke pushing, despite resolution of pushing behaviours, which could have consequences for functional mobility and falls.