In-Field Training of a Passive Back Exoskeleton Changes the Biomechanics of Logistic Workers.

OCCUPATIONAL APPLICATIONSOccupational exoskeletons receive rising interest in industry as these devices diminish the biomechanical load during manual materials handling. Still, we have limited knowledge when it comes to in-field use. This gap often contributes to failure in the implementation of exoskeleton in industry. In this study, we investigated how a training protocol consisting of in-field use of a passive back exoskeleton affected the biomechanics of logistic workers. More specifically, we focused on how the variation of the muscular and kinematic patterns of the user was altered after exoskeleton training. We found that training had a positive effect on exoskeleton use, as a relative decrease of 6-9% in peak back muscle activity was observed post-training. Additionally, training decreased knee flexion by 6°-16°, indicating a more stoop lifting technique. The findings point at the potential benefits of applying a training approach when implementing a back-supporting exoskeleton in logistics.

Background: Occupational exoskeletons are an attractive solution to reduce the prevalence of attrition and work-related musculoskeletal disorders, such as low back pain, among manual workers. However, research has mostly focused on acute effects, while the effects of in-field use, and exoskeleton training are still to be addressed. Purpose: The aim of the present paper was to investigate how in-field use and exoskeleton training affected the biomechanics, acceptance, and comfort of logistic workers when using a passive back exoskeleton. Methods: Twenty workers were randomly distributed into control and intervention group. The tests consisted of standard lifting tasks with and without exoskeleton before and after a 5-week period. The intervention group underwent a 5-week progressive training protocol aiming at increasing the duration of use of the exoskeleton. The variation in muscle activity (surface electromyography) and full-body kinematics (IMU-based motion capture) were assessed during logistic work tasks. Additionally, acceptance, comfort, and perceived effort were collected. Compliance to the training protocol reached 74%. Results: Using the exoskeleton resulted in a 13­20% reduced variation in muscle activity of the back muscles across groups and lifting conditions including trunk extension. The changes in variation were driven by a decrease in peak muscle activity, which was further lowered by 6­9% after the 5-week training. Additionally, training induced decreased knee flexion indicating a more stoop lifting technique in the intervention group. Conclusions: The present results demonstrate that exoskeleton training optimized the human-exoskeleton interaction by deriving more effects of the exoskeleton ­ in this case by lowering the peak muscle activity of the user during manual materials handling. This underlines the importance of introducing training when implementing exoskeletons in industry. Additionally, the results indicate that a progressive implementation of back supporting exoskeletons in logistics can be beneficial in terms of lowering the biomechanical load during manual materials handling.

Influence of brick laying height on biomechanical load in masons: Cross-sectional field study with technical measurements.

BACKGROUND: Work-related musculoskeletal disorders (WMSDs) located in the low back and neck/shoulder regions are major concerns for both workers, workplaces, and society. Masons are prone to WMSD, because their work is characterized by repetitive work and high physical workload. However, the knowledge on the physical workload during bricklaying is primarily based on subjective measurements. OBJECTIVE: This cross-sectional field study with technical measurements aimed to quantify physical workload in terms of muscular activity and degree of forward bending during bricklaying at different working heights among masons, i.e., knee, hip, shoulder, and above shoulder height. METHODS: Twelve male (36.1±16.1 years) experienced masons participated in a cross-sectional field study with technical measurements. Surface electromyography from erector spinae longissimus and upper trapezius muscles and an inertial measurement unit-sensor placed on the upper back were used to assess the physical workload (level of muscle activation and degree of forward bending) different bricklaying heights. Manual video analysis was used to determine duration of work tasks, frequency, type, and working height. The working heights were categorized as 'knee', 'hip', 'shoulder', and 'above shoulder'. The 95 percentiles of the normalized Root Mean Square (RMSn) values were extracted assess from erector spinae and trapezius recordings to assess strenuous level muscle of muscle activation. RESULTS: The RMSn of dominant erector spinae muscle increased from hip- to shoulder height (from 26.6 to 29.6, P <  0.0001), but not from hip to above shoulder height and decreased from hip to knee height (from 26.6 to 18.9, P <  0.0001). For the dominant trapezius muscle, the RMSn increased from hip- to shoulder- and above shoulder height (from 13.9 to 19.7 and 24.0, respectively, P <  0.0001) but decreased from hip- to knee height (from 13.9 to 11.5, P <  0.0001). Compared to hip height (27.9°), an increased forward bending was detected during bricklaying at knee height (34.5°, P <  0.0001) and a decreased degree of forward bending at shoulder- and above shoulder height (17.6° and 12.5°, P <  0.0001, respectively). CONCLUSION: Based on technical measurements, bricklaying at hip height showed the best compromise between muscular load and degree of forward bending. This study contributes to the development of the work environment for masons and can help guide preventive initiatives to reduce physical workload.

Biomechanical changes, acceptance, and usability of a passive shoulder exoskeleton in manual material handling. A field study.

Occupational exoskeletons contribute to diminish the biomechanical load during manual work. However, familiarization to the use of exoskeletons is rarely considered, which may lead to failure of acceptance and implementation. In this study, ten logistic workers underwent a 5-week progressive familiarization to a passive shoulder exoskeleton, while ten workers acted as controls. Tests pre and post the familiarization applied measurements of muscle activity and kinematics of back, neck, and shoulder, perceived effort, and usability-ratings of the exoskeleton. Exoskeleton use resulted in lower muscle activity of anterior deltoid (13-39%) and upper trapezius (16-60%) and reduced perceived effort. Additionally, it induced an offset in shoulder flexion and abduction during resting position (8-10°). No conclusions on familiarization could be drawn due to low adherence to the protocol. However, the emotions of the workers towards using the exoskeleton decreased making it questionable whether the shoulder exoskeleton is suitable for use in the logistics sector.

Changes in normalized mutual information in response to strength training: An ancillary analysis of a quasi-randomized controlled trial.

The aim of the present investigation was twofold. (1) to assess test-retest reliability of normalized mutual information (NMI) values extracted from the surface electromyography (sEMG) signal of muscles pairs of the upper body during dynamic bench press at a high load, and (2) to assess changes in NMI values from before to after a five-week quasi-randomized controlled bench press training intervention. For test-retest reliability, 20 strength trained males (age 25 ± 2 years, height 1.81 ± 0.07 m) performed two three-repetition maximum (3RM) tests in bench press, while sEMG was recorded from six upper body muscles. Tests were separated by 8.2 ± 2.9 days. For the training intervention, 17 male participants (age 26 ± 5 years, height 1.80 ± 0.07 m) trained bench press specific strength training for 5 weeks (TRA), while 13 male participants (age 23 ± 3 years, height 1.80 ± 0.08 m) constituted a control group (CON). 3RM bench press test and sEMG recordings were carried out before and after the intervention period. The NMI values ranged from poor to almost perfect reliability, with the majority displaying substantial reliability. TRA displayed a significant decrease in NMI values during the concentric phase for two agonist-agonist muscle pairs, while one agonist-agonist and two agonist-antagonist muscle pairs increased the NMI values during the eccentric phase. The observed changes did not exceed the minimal detectable threshold, and we therefore cannot surely ascertain that the changes observed in NMI values reflect genuine neural adaptations.

Impact of upper-body ergometer rowing exercise on aerobic fitness and cardiometabolic disease risk in individuals with spinal cord injury: A 6-month follow-up study.

OBJECTIVE: We recently demonstrated that upper-body rowing exercise (UBROW) improved aerobic fitness in individuals with spinal cord injury (SCI), with no effect on traditional cardiometabolic risk factors. Here, we tested the hypothesis that the exercise-induced increase in aerobic fitness was maintained at 6-month (6M) follow-up. DESIGN: Six-month follow-up. SETTING: University/hospital. PARTICIPANTS: Seventeen wheelchair-dependent participants with SCI. INTERVENTIONS: 12-week of exercise training (UBROW) or control (CON). OUTCOME MEASURES: Aerobic fitness (POpeak and V̇O2peak), body composition, blood pressure, and blood biomarkers of cardiometabolic risk were assessed at 6M follow-up and compared to baseline (BL) and immediately post-intervention (12-week). Minutes of mild, moderate, and heavy intensity leisure time physical activity (LTPA) were assessed by self-report. RESULTS: Fourteen participants returned at 6M follow-up (CON, n = 6; UBROW, n = 8). In UBROW, POpeak (median (Q1-Q3)) increased from BL (70 W (37-84)) to 12-week (77 W (58-109), P = 0.01) and 6M follow-up (81 W (51-96), P = 0.01), with no difference between 12-week and 6M follow-up (P = 0.21). Similarly, V̇O2peak increased from BL (15.4 ml/kg/min (10.5-19.4)) to 12-week (16.6 ml/kg/min (12.8-21.3), P = 0.01) with no difference between 12-week and 6M follow-up (16.3 ml/kg/min (12.9-19.7), P = 0.74). No differences were found in CON for either POpeak (P = 0.22) or V̇O2peak (P = 0.27). There were no changes over time in traditional cardiometabolic risk factors or for minutes of different LTPA intensities. CONCLUSION: We demonstrate that improvements in aerobic fitness are maintained for at least six months after completion of a 12-week exercise intervention, supporting the use of periodic exercise interventions to boost aerobic fitness level in individuals with SCI.Trial registration: ClinicalTrials.gov identifier: NCT04390087..

Augmented-reality swim goggles accurately and reliably measure swim performance metrics in recreational swimmers.

Background: Swimmers commonly access performance metrics such as lap splits, distance, and pacing information between work bouts while they rest. Recently, a new category of tracking devices for swimming was introduced with the FORM Smart Swim Goggles (FORM Goggles). The goggles have a built-in see-through display and are capable of tracking and displaying distance, time splits, stroke, and pace metrics in real time using machine learning and augmented reality through a heads-up display. The purpose of this study was to assess the validity and reliability of the FORM Goggles compared with video analysis for stroke type, pool length count, pool length time, stroke rate, and stroke count in recreational swimmers and triathletes. Method: A total of 36 participants performed mixed swimming intervals in a 25-m pool across two identical 900-m swim sessions performed at comparable intensities with 1 week interval. The participants wore FORM Goggles during their swims, which detected the following five swim metrics: stroke type, pool length time, pool length count, stroke count, and stroke rate. Four video cameras were positioned on the pool edges to capture ground truth video footage, which was then manually labeled by three trained individuals. Mean (SD) differences between FORM Goggles and ground truth were calculated for the selected metrics for both sessions. The absolute mean difference and mean absolute percentage error were used to assess the differences of the FORM Goggles relative to ground truth. The test-retest reliability of the goggles was assessed using both relative and absolute reliability metrics. Results: Compared with video analysis, the FORM Goggles identified the correct stroke type at a rate of 99.7% (N = 2,354 pool lengths, p < 0.001), pool length count accuracy of 99.8%, and mean differences (FORM Goggles-ground truth) for pool length time: -0.10 s (1.49); stroke count: -0.63 (1.82); and stroke rate: 0.19 strokes/min (3.23). The test-retest intra-class correlation coefficient (ICC) values between the two test days were 0.793 for pool length time, 0.797 for stroke count, and 0.883 for stroke rate. Overall, for pool length time, the residuals were within ±1.0s for 65.3% of the total pool lengths, for stroke count within ±1 stroke for 62.6% of the total pool lengths, and for stroke rate within ±2 strokes/min for 66.40% of the total pool lengths. Conclusion: The FORM Goggles were found valid and reliable for the tracking of pool length time, pool length count, stroke count, stroke rate, and stroke type during freestyle, backstroke, and breaststroke swimming in recreational swimmers and triathletes when compared with video analysis. This opens perspectives for receiving real-time information on performance metrics during swimming.

Prediction of movement in handball with the use of inertial measurement units and machine learning.

Inertial Measurement Units (IMU) and machine learning are strong tools in quantifying physical demands in sports, such as handball. However, the detection of both locomotion and throw events simultaneously has not been a topic for much investigation. Wherefore, the aim of this study was to publicise a method for training an extreme gradient boosting model capable of identifying low intensity, dynamic, running and throw events. Twelve adults with varying experience in handball wore an IMU on the back while being video recorded during a handball match. The video recordings were used for annotating the four events. Due to the small sample size, a leave-one-subject-out (LOSO) approach was conducted for the modelling and feature selection. The model had issues identifying dynamic movements (F1-score = 0.66 ± 0.07), whereas throw (F1-score = 0.95 ± 0.05), low intensity (F1-score = 0.93 ± 0.02) and running (F1-score = 0.86 ± 0.05) were easier to identify. Features such as IQR and first zero crossing for most of the kinematic characteristics were among the most important features for the model. Therefore, it is recommended for future research to look into these two features, while also using a LOSO approach to decrease likelihood of artificially high model performance.

Rowing exercise increases cardiorespiratory fitness and brachial artery diameter but not traditional cardiometabolic risk factors in spinal cord-injured humans.

PURPOSE: This study assessed the effects of upper-body rowing exercise on cardiorespiratory fitness, traditional cardiometabolic risk factors, and vascular health in individuals with spinal cord injury (SCI). METHODS: Seventeen male and female adults with chronic (> 1 yr) motor-complete and incomplete SCI (level of injury: C4-L3) were randomized to control (CON, n = 9) or exercise (UBROW, n = 8). Participants in UBROW performed 12-week, 3 weekly sessions of 30-min upper-body ergometer rowing exercise, complying with current exercise guidelines for SCI. Cardiorespiratory fitness ([Formula: see text]O2peak), traditional risk factors (lipid profile, glycemic control) as well as inflammatory and vascular endothelium-derived biomarkers (derived from fasting blood samples) were measured before and after 6 (6W) and 12 weeks (12W). Brachial artery resting diameter and flow-mediated dilation (FMD) were determined by ultrasound as exploratory outcomes. RESULTS: UBROW increased [Formula: see text]O2peak from baseline (15.1 ± 5.1 mL/kg/min; mean ± SD) to 6W (16.5 ± 5.3; P < 0.01) and 12W (17.5 ± 6.1; P < 0.01). UBROW increased resting brachial artery diameter from baseline (4.80 ± 0.72 mm) to 12W (5.08 ± 0.91; P < 0.01), with no changes at 6W (4.96 ± 0.91), and no changes in CON. There were no significant time-by-group interactions in traditional cardiometabolic blood biomarkers, or in unadjusted or baseline diameter corrected FMD. Explorative analyses revealed inverse correlations between changes (∆12W-baseline) in endothelin-1 and changes in resting diameter (r = - 0.56) and FMD% (r = - 0.60), both P < 0.05. CONCLUSION: These results demonstrate that 12 weeks of upper-body rowing complying with current exercise guidelines for SCI improves cardiorespiratory fitness and increases resting brachial artery diameter. In contrast, the exercise intervention had no or only modest effects on traditional cardiometabolic risk factors. The study was registered at Clinicaltrials.gov (N-20190053, May 15, 2020).

Wheelchair-modified ergometer rowing exercise in individuals with spinal cord injury: a feasibility, acceptability, and preliminary efficacy study.

STUDY DESIGN: Exploratory clinical investigation. OBJECTIVES: To assess the feasibility, acceptability, and preliminary efficacy of upper-body rowing exercise adapted to wheelchair users with spinal cord injury (SCI). SETTING: University exercise laboratory. METHODS: Eight individuals with SCI exercised on a rowing ergometer modified for wheelchair users (REMW), three times weekly, for up to 30 min per session. Participants completed feasibility and acceptability questionnaire (1-5 Likert scale), and the Wheelchair Users Shoulder Pain Index (WUSPI) before and after six weeks of exercise. Average power output (POAVG), distance rowed, percent peak heart rate (%HRpeak), and rating of perceived exertion (RPE) (6-20 scale) were monitored throughout the 18 exercise sessions and analyzed to evaluate preliminary efficacy of the exercise modality. RESULTS: All eight participants completed the study (97% adherence). Participants rated the exercise high on the feasibility and acceptability scale; median (interquartile range) = 5.0 (4.0-5.0), where higher numbers indicated greater feasibility. Shoulder pain was reduced by 21% yet not significantly different from baseline (p = 0.899). Physiological measures (%HRpeak = 80-83%; RPE = 15.0-16.0) indicated a high cardiovascular training load. From week 1 to week 6, POAVG and distance rowed increased by 37 and 36%, respectively (both p ≤ 0.001). CONCLUSIONS: Data from six weeks of exercise on the REMW suggests that upper-body rowing is a feasible and acceptable exercise modality for wheelchair users with SCI. Session data on %HRpeak, RPE, and shoulder pain indicate that REMW evoked moderate to vigorous intensity exercise without exacerbation of shoulder pain. Future research is required to quantify potential training-induced changes in cardiorespiratory fitness.

Virtual Reality and Eye-Tracking Assessment, and Treatment of Unilateral Spatial Neglect: Systematic Review and Future Prospects.

Unilateral spatial neglect (USN) is a disorder characterized by the failure to report, respond to, or orient toward the contralateral side of space to a brain lesion. Current assessment methods often fail to discover milder forms, cannot differentiate between unilateral spatial neglect subtypes and lack ecological validity. There is also a need for treatment methods that target subtypes. Immersive virtual reality (VR) systems in combination with eye-tracking (ET) have the potential to overcome these shortcomings, by providing more naturalistic environments and tasks, with sensitive and detailed measures. This systematic review examines the state of the art of research on these technologies as applied in the assessment and treatment of USN. As we found no studies that combined immersive VR and ET, we reviewed these approaches individually. The review of VR included seven articles, the ET review twelve. The reviews revealed promising results. (1) All included studies found significant group-level differences for several USN measures. In addition, several studies found asymmetric behavior in VR and ET tasks for patients who did not show signs of USN in conventional tests. Particularly promising features were multitasking in complex VR environments and detailed eye-movement analysis. (2) No VR and only a few ET studies attempted to differentiate USN subtypes, although the technologies appeared appropriate. One ET study grouped USN participants using individual heatmaps, and another differentiated between subtypes on drawing tasks. Regarding (3) ecological validity, although no studies tested the prognostic validity of their assessment methods, VR and ET studies utilized naturalistic tasks and stimuli reflecting everyday situations. Technological characteristics, such as the field of view and refresh rate of the head-mounted displays, could be improved, though, to improve ecological validity. We found (4) no studies that utilized VR or ET technologies for USN treatment up until the search date of the 26th of February 2020. In conclusion, VR-ET-based systems show great potential for USN assessment. VR-ET holds great promise for treatment, for example, by monitoring behavior and adapting and tailoring to the individual person's needs and abilities. Future research should consider developing methods for individual subtypes and differential diagnostics to inform individual treatment programs.

Sociodemographic characteristics associated with physical activity barrier perception among manual wheelchair users.

BACKGROUND: Individuals with disabilities are sub-optimally active and at increased risk for chronic diseases. Limited knowledge exists about how differences among wheelchair-dependent individuals may affect their perception of physical activity barriers. OBJECTIVE: We examined whether the perception of physical activity barriers are associated with wheelchair user sociodemographic characteristics. METHODS: Danish manual wheelchair users (MWCUs) (N = 181; 52.5% females, mean ± SD: age 48 ± 14 yrs) completed the 'Barriers to Physical Activity Questionnaire for People with Mobility Impairments' (BPAQ-MI) online. The BPAQ-MI queries physical activity barriers in four domains (intrapersonal, interpersonal, organizational, and community) and eight subdomains. Participant characteristics evaluated as potentially associated with physical activity barriers included age, sex, years in chair, body mass index (BMI), spinal cord injury (SCI) (if any), education, employment, and resident city size. Simple linear regression (step 1) and multiple regression models (step 2) were created to assess associations between MWCU characteristics and barriers. RESULTS: Multiple regression models revealed that MWCUs who were obese, who did not complete high school, or were unemployed rated physical activity barriers higher across several subdomains (all r2≤0.226, p<0.05). Resident city size was associated with safety subdomain barrier impact (r2=0.039, p<0.05). Sex, age, years in chair and SCI were not associated with any barrier domains (all p ≥ 0.064). CONCLUSIONS: Our results provide new evidence that MWCUs with BMI ≥30; who are not employed; or who only have completed high school, may need special consideration and resources to overcome distinct physical activity barriers. Behavioral strategies and interventions focusing on reducing physical activity barriers should be tailored to the individuals above.

Sitting dynamics during computer work are age-dependent.

This laboratory study aimed to characterize the dynamics of sitting during a 40 min computer task in 20 younger (YG) and 18 older (OG) computer users. The position of the center of pressure (COP) in anterior-posterior (AP) and medial-lateral (ML) direction was computed. The range, velocity, area, standard deviation (SD) and sample entropy (SaEn) values were extracted. The range, velocity and area of the COP displacement were larger in the AP while the SD and SaEn were respectively larger and smaller in both AP and ML for the OG than the YG. The findings revealed altered dynamics of sitting among older computer users.

The effects of walking speed and mobile phone use on the walking dynamics of young adults.

Walking while using a mobile phone has been shown to affect the walking dynamics of young adults. However, this has only been investigated using treadmill walking at a fixed walking speed. In this study, the dynamics of over ground walking were investigated using lower trunk acceleration measured over 12 consecutive trials, following differing walking speed and mobile phone use instructions. Higher walking speed significantly increased the proportion of acceleration along the vertical measurement axis, while decreasing the proportion of acceleration along the anteroposterior axis (p < 0.001). Moreover, higher walking speed also resulted in increased sample entropy along all measurement axes (p < 0.05). When walking while texting, the maximum Lyapunov exponent increased along the anteroposterior and vertical measurement axes (p < 0.05), while sample entropy decreased significantly along the vertical axis (p < 0.001). Walking speed and mobile phone use both affect the walking dynamics of young adults. Walking while texting appears to produce a reduction in local dynamic stability and an increase in regularity, however, caution is required when interpreting the extent of this task effect, since walking speed also affected walking dynamics.

The effects of age on response time, accuracy, and shoulder/arm kinematics during hammering.

The aim of this study was to investigate the effects of age on response time and accuracy during a hammering task. Older male workers aged 51-69 years (older group: OG, n = 23) and younger male reference individuals aged 25-36 years (younger group: YG, n = 16) performed the experiment. Response time, accuracy, and 3D shoulder/arm kinematics were acquired using motion capture. The effects of age were investigated using linear mixed model analysis. Response times were significantly longer for OG compared with YG (P < 0.001) while no marked differences in the accuracy was observed (P = 0.729). OG showed less hammer displacement and smaller range of motion in the shoulder. Although older workers seemed to use a less biomechanical demanding motor strategy, their response times during hammering were about twice that of younger individuals.

Physical Activity Barriers in Danish Manual Wheelchair Users: A Cross-sectional Study.

OBJECTIVE: To identify physical activity barrier prevalence and severity among manual wheelchair users (MWCUs) and test whether barrier impact is associated with self-reported physical activity level (PAL). DESIGN: Cross-sectional survey. The Barriers to Physical Activity Questionnaire for People with Mobility Impairments (BPAQ-MI) was translated from English to Danish and administered online. The BPAQ-MI includes barriers within 4 domains and 8 subdomains and queries if an item hindered physical activity participation in the last 3 months (yes/no). If "yes," participants graded barrier severity from very small (1) to very big (5). Barrier impact scores were summed within and across domains. SETTING: General community. PARTICIPANTS: Danish MWCUs (N=181; 52.5% female, mean age, 48±14y.). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: PAL was rated from not active (1) to extremely active (10). Individual barrier prevalence (frequency, %) and severity (median [interquartile range]) was computed. Unadjusted (Spearman rank correlations, domains, subdomains) and adjusted (multivariate linear regression, subdomains) associations between PAL and barrier impact were computed. RESULTS: The 5 most prevalent barriers were reported by ≥49.6% of participants (2 intrapersonal and 3 community). The 5 most severe barriers all had a median of 5 (1 organizational and 4 community). Unadjusted analysis showed that PAL was inversely associated with total intrapersonal (r=-0.487, P<.01) and overall (r=-0.241, P<.01) impact and the intrapersonal "health" (r=-0.477, P<.01) and "beliefs/attitudes"(r=-0.307, P<.01) subdomains. Adjustment for shared variance revealed only the "health" subdomain impact score was independently associated with PAL (P<.001). CONCLUSIONS: Intrapersonal barriers were highly prevalent. Health-related barriers were inversely related to PAL. When organizational and community barriers were present, they were rated as particularly severe. These results provide novel information that can guide the design of future interventions aiming to increase MWCUs PALs.

Effect of wheelchair-modified rowing exercise on cardiometabolic risk factors in spinal cord injured wheelchair users: protocol for a randomised controlled trial.

INTRODUCTION: Cardiovascular and metabolic diseases are a growing concern for individuals with spinal cord injury (SCI). Physical inactivity contributes to cardiometabolic morbidity and mortality in the SCI population. However, previous studies have shown mixed results regarding the effects of exercise on cardiometabolic risk factors in individuals with SCI. This discrepancy could be influenced by insufficient exercise stimuli. Recent guidelines recommend 30 min of moderate-to-vigorous intensity aerobic exercise, three times per week, for improvement in cardiometabolic health in individuals with SCI. However, to date, no studies have implemented an exercise intervention matching the new recommendations to examine the effects on cardiometabolic risk factors. Therefore, the primary objective of this study is to determine the effects of 12 weeks of wheelchair user-modified upper-body rowing exercise on both traditional (constituents of the metabolic syndrome) and novel (eg, vascular structure and function) cardiometabolic risk factors in manual wheelchair users with SCI. METHODS AND ANALYSIS: A randomised controlled trial will compare 12 weeks of upper-body rowing exercise, 30 min three times per week, with a control group continuing their normal lifestyle. Outcome measurements will be performed immediately before (baseline), after 6 weeks (halfway), 12 weeks of training (post) and 6 months after the termination of the intervention period (follow-up). Outcomes will include inflammatory (eg, C reactive protein) and metabolic biomarkers determined from venous blood (with serum fasting insulin as primary outcome), body composition, arterial blood pressure, cardiorespiratory fitness level, brachial artery vascular structure and function and autonomic nervous system function. ETHICS AND DISSEMINATION: This trial is reported to the Danish Data Protection Agency (J.nr. 2019-899/10-0406) and approved by the Committees on Health Research Ethics in The North Denmark Region on 12 December 2019 (J.nr. N-20190053). The principal investigator will collect written informed consent from all participants prior to inclusion. Irrespective of study outcomes, the results will be submitted to peer-reviewed scientific journals for publication. TRIAL REGISTRATION NUMBER: NCT04390087.

Functional Connectivity Analysis on Resting-State Electroencephalography Signals Following Chiropractic Spinal Manipulation in Stroke Patients.

Stroke impairments often present as cognitive and motor deficits, leading to a decline in quality of life. Recovery strategy and mechanisms, such as neuroplasticity, are important factors, as these can help improve the effectiveness of rehabilitation. The present study investigated chiropractic spinal manipulation (SM) and its effects on resting-state functional connectivity in 24 subacute to chronic stroke patients monitored by electroencephalography (EEG). Functional connectivity of both linear and non-linear coupling was estimated by coherence and phase lag index (PLI), respectively. Non-parametric cluster-based permutation tests were used to assess the statistical significance of the changes in functional connectivity following SM. Results showed a significant increase in functional connectivity from the PLI metric in the alpha band within the default mode network (DMN). The functional connectivity between the posterior cingulate cortex and parahippocampal regions increased following SM, t (23) = 10.45, p = 0.005. No significant changes occurred following the sham control procedure. These findings suggest that SM may alter functional connectivity in the brain of stroke patients and highlights the potential of EEG for monitoring neuroplastic changes following SM. Furthermore, the altered connectivity was observed between areas which may be affected by factors such as decreased pain perception, episodic memory, navigation, and space representation in the brain. However, these factors were not directly monitored in this study. Therefore, further research is needed to elucidate the underlying mechanisms and clinical significance of the observed changes.