Computer and internet use among people with long-standing spinal cord injury: a cross-sectional survey in the Netherlands.

STUDY DESIGN: Cross-sectional survey OBJECTIVES: To describe computer and Internet use (other than for work or study) among people with long-standing spinal cord injury (SCI), examine associations between demographic and lesion characteristics and Internet use, and examine associations between Internet use and mental health, participation, and life satisfaction. SETTING: Community, The Netherlands METHODS: Participants were 265 individuals living with SCI for at least 10 years, who were 18-35 at the onset of SCI, aged 28-65 at the time of the study and wheelchair-user. Scales for General and Health-related Internet use were developed. RESULTS: Nearly all (97.7%) participants had Internet access and 98.4% of those used it daily or weekly. Of those with tetraplegia, 47.4% had assistive devices for computer use. General Internet use, such as following news and online banking, was very frequent. Websites with information on general health or accessibility were typically visited a few times a year. Three-quarters never visited websites of other individuals with SCI or foreign websites with information on SCI. General Internet use was associated with male gender, younger age, and higher education. Participants with tetraplegia scored higher on Health-related Internet use compared to participants with paraplegia. Health-related Internet use was associated with worse participation, but not with the other psychosocial variables. CONCLUSION: Internet has become part of daily life of people with SCI in the Netherlands. However, only one association between Internet use and indicators of psychosocial functioning was found. Possible underuse of adaptive devices and of SCI-specific websites warrant further investigation.

[Sport performance with a prosthesis]. / Sporten met een prothese.

Technology is a contributory factor to sporting success in many Paralympic sports. This article is about upper and lower limb prostheses that are used in sports. The characteristics of lower limb prosthesis can be modified to respond to predictable leg movements such as with running. Conventional mechanical lower limb prostheses do not respond well to unexpected movements. There are upper limb prostheses that have been adapted for a broad range of sports including fishing, cycling, kayaking, skiing, baseball and even mountain climbing. Techniques are being developed that enable a more natural movement of the prosthesis to occur, such as targeted muscle reinnervation. These techniques are currently still in the experimental stage. The training schedule of the sportsperson must be balanced against his or her tolerance level to avoid mechanical overstrain, not only around the stump but also on the unaffected side. Lower limb prostheses that lead to top sporting successes, such as with running, have resulted in discussions about distorted competition. No upper limb prostheses have led to similar discussions.

Underlying mechanisms of improving physical activity behavior after rehabilitation.

BACKGROUND: Regular physical activity is beneficial for the health and functioning of people with a disability. Effective components of successful physical activity promotion interventions should be identified and disseminated. PURPOSE: To study the underlying mechanisms of the combined sport stimulation program "Rehabilitation & Sports" (R&S) and daily physical activity promotion program "Active after Rehabilitation" (AaR). METHOD: Subjects in four rehabilitation centers received R&S + AaR (n = 284). Subjects in six control centers (n = 603) received usual care. Physical activity and its determinants were assessed with questionnaires at seven weeks before and nine weeks and one year after rehabilitation. RESULTS: Variables that were determinants of the intervention-induced improvement in physical activity behavior at both follow-up measurements were attitude, the perceived benefits "improved health and reduced risk of disease," "better feeling about oneself," and "improved fitness," and the barrier "limited environmental possibilities." The percentage change in the intervention coefficient caused by these determinants ranged from -35.3% to -16.3% and from -28.4% to -11.3% at nine weeks and one year after rehabilitation, respectively. CONCLUSION: Personalized tailored counseling interventions can improve physical activity behavior in people with a disability by targeting both personal and environmental determinants of physical activity behavior.

The Physical Activity Scale for Individuals with Physical Disabilities: test-retest reliability and comparison with an accelerometer.

BACKGROUND: The objective was to determine the test-retest reliability and criterion validity of the Physical Activity Scale for Individuals with Physical Disabilities (PASIPD). METHODS: Forty-five non-wheelchair dependent subjects were recruited from three Dutch rehabilitation centers. Subjects' diagnoses were: stroke, spinal cord injury, whiplash, and neurological-, orthopedic- or back disorders. The PASIPD is a 7-d recall physical activity questionnaire that was completed twice, 1 wk apart. During this week, physical activity was also measured with an Actigraph accelerometer. RESULTS: The test-retest reliability Spearman correlation of the PASIPD was 0.77. The criterion validity Spearman correlation was 0.30 when compared to the accelerometer. CONCLUSIONS: The PASIPD had test-retest reliability and criterion validity that is comparable to well established self-report physical activity questionnaires from the general population.

Successfully improving physical activity behavior after rehabilitation.

PURPOSE: To determine the effects of the physical activity promotion programs Rehabilitation & Sports (R&S) and Active after Rehabilitation (AaR) on sport and daily physical activity 1 year after in- or outpatient rehabilitation. DESIGN: Subjects in intervention rehabilitation centers were randomized into a group receiving R&S only (n = 315) and a group receiving R&S and AaR (n = 284). Subjects in six control centers (n = 603) received usual care. SETTING: Ten Dutch rehabilitation centers. SUBJECTS: Subjects consisted of 1202 rehabilitation patients. Most frequent diagnoses were stroke, neurological disorders, and back disorders. INTERVENTION: Both the sport stimulation program (R&S) and the daily physical activity promotion program (AaR) consisted of personalized tailored counseling. MEASURES: Two sport outcomes and two daily physical activity outcomes were assessed with questionnaires at baseline and 1 year after rehabilitation. ANALYSIS: Multilevel analyses comparing both intervention groups to the control group. RESULTS: The R&S program showed no significant effects. Intention-to-treat analyses in the R&S + AaR group showed borderline significant improvements in one sport (odds ratio [OR] = 1.66, p = .02) and both physical activity outcomes (OR = 1.68, p = .01 and regression coefficient = 10.78, p = .05). On-treatment analyses in the R&S + AaR group showed similar but stronger effects. CONCLUSIONS: The combination of the R&S and AaR programs improved physical activity behavior and sport participation 1 year after in- or outpatient rehabilitation. The R&S program alone did not have any effects.

Physical activity for people with a disability: a conceptual model.

The promotion of a physically active lifestyle has become an important issue in health policy in first-world countries. A physically active lifestyle is accompanied by several fitness and health benefits. Individuals with a disability can particularly benefit from an active lifestyle: not only does it reduce the risk for secondary health problems, but all levels of functioning can be influenced positively. The objective of this article is to propose a conceptual model that describes the relationships between physical activity behaviour, its determinants and functioning of people with a disability. The literature was systematically searched for articles considering physical activity and disability, and models relating both topics were looked for in particular. No models were found relating physical activity behaviour, its determinants and functioning in people with a disability. Consequently, a new model, the Physical Activity for people with a Disability (PAD) model, was constructed based on existing models of disability and models of determinants of physical activity behaviour. The starting point was the new WHO Model of Functioning and Disability, part of the International Classification of Functioning, Disability and Health (ICF), which describes the multidimensional aspects of functioning and disability. Physical activity behaviour and its determinants were integrated into the ICF model. The factors determining physical activity were based mainly on those used in the Attitude, Social influence and self-Efficacy (ASE) model. The proposed model can be used as a theoretical framework for future interventions and research on physical activity promotion in the population of people with a disability. The model currently forms the theoretical basis for a large physical activity promotion trial in ten Dutch rehabilitation centres.

Mechanical loading of the low back and shoulders during pushing and pulling activities.

The objective of this study was to quantify the mechanical load on the low back and shoulders during pushing and pulling in combination with three task constraints: the use of one or two hands, three cart weights, and two handle heights. The second objective was to explore the relation between the initial and sustained exerted forces and the mechanical load on the low back and shoulders. Detailed biomechanical models of the low back and shoulder joint were used to estimate mechanical loading. Using generalized estimating equations (GEE) the effects were quantified for exerted push/pull forces, net moments at the low back and shoulders, compressive and shear forces at the low back, and compressive forces at the glenohumeral joint. The results of this study appeared to be useful to estimate ergonomics consequences of interventions in the working constraints during pushing and pulling. Cart weight as well as handle height had a considerable effect on the mechanical load and it is recommended to maintain low cart weights and to push or pull at shoulder height. Initial and sustained exerted forces were not highly correlated with the mechanical load at the low back and shoulders within the studied range of the exerted forces.

Time course of arterial vascular adaptations to inactivity and paralyses in humans.

PURPOSE: The aim of the present study was to assess the time course of vascular adaptations to inactivity and paralyses in humans. The spinal cord-injured (SCI) population offers a unique "human model of nature" to assess peripheral vascular adaptations and its time course to extreme inactivity and paralyses. METHODS: Arterial diameters and red blood cell velocity of the carotid artery (CA), common femoral artery (FA), and brachial artery (BA) were measured using echo Doppler ultrasound. Fifteen SCI persons with lesions varying from 6 wk to 13 months postinjury participated in a cross-sectional study (SCI-CS), 6 SCI individuals were included for longitudinal measurements (SCI-L) at weeks 6, 8, 12, 16, 20, and 24 after the trauma, and 16 able-bodied individuals served as a control group (C). RESULTS: Within 6 wk after the SCI, diameter (SCI-CS: 0.68 +/- 0.09 cm, SCI-L: 0.67 +/- 0.04 cm, C: 0.95 +/- 0.07 cm) and blood flow (SCI-CS: 299 +/- 112 mL x min(-1), SCI-L 279: +/- 52 mL x min(-1), C: 405 +/- 97 mL x min(-1)) of the femoral artery were significantly reduced (P < 0.001), and local femoral wall shear rate was almost doubled in SCI-CS and SC-L compared with C (P < 0.001). No further changes in femoral arterial properties were observed between week 6 and 13 months postinjury in SCI-L as well as SCI-CS. Carotid and brachial artery diameter and flow were similar in SCI and C and did not change between 6 wk and 13 months after the injury. CONCLUSION: We conclude that the process of vascular adaptations to inactivity and paralyses in humans seems to be largely completed within weeks.

Low-back and shoulder complaints among workers with pushing and pulling tasks.

OBJECTIVES: Low-back and shoulder complaints were examined in relation to self-reported and objectively assessed exposure to work-related pushing and pulling. METHODS: Workers from several companies (eg, nursing homes and flower auctions) with pushing and pulling tasks and, as reference, workers without physically demanding tasks were invited to participate. Altogether 829 workers initially received a questionnaire, of whom 459 responded both initially and after 1 year of follow-up. Initially, self-reported exposure to pushing and pulling was assessed by questionnaire. Furthermore, a representative sample of 131 workers was observed at work using TRAC (task recording and analysis on computer) to assess exposure to pushing and pulling objectively. For exposure to pushing and pulling, the workers were classified into a reference group and medium and high exposure groups. Initially and in the follow-up, the 12-month prevalence of low-back and shoulder complaints was assessed. Complaints reported in the follow-up were separately used as dependent variables to calculate prevalence rate ratios (PR) in a Cox's proportional hazard regression analysis. RESULTS: The adjusted PR values were not significant for low-back complaints. For shoulder complaints, both the medium and high exposure groups showed significant adjusted PR values for self-reported exposure and observed duration of pushing and pulling when compared with the reference group (PR range 2.18-4.86). For the observed frequency of pushing and pulling, only the medium exposure group showed a significant PR, of 3.95. CONCLUSIONS: The findings suggest a rather strong relationship between pushing and pulling and shoulder complaints. The evidence for a relationship between pushing and pulling and low-back complaints is limited.

Normative values and determinants of physical capacity in individuals with spinal cord injury.

We reanalyzed data from five studies with similar or identical methodology performed by our laboratory to define normative values and determinants of physical capacity in individuals with tetraplegia and paraplegia. Each study consisted of a graded wheelchair exercise test to determine peak oxygen uptake and maximal power output and could additionally include a wheelchair sprint test to determine short-term (anaerobic) power output and/or an isometric strength test. The combined subject population included 166 individuals (20 women), varying considerably for age, body mass, lesion level, time since injury, and activity level. Ranges in physical capacity parameters were extensive and normative values for individuals with tetraplegia and paraplegia were established. These physical capacity norms could be used for evaluation of fitness status and training or therapeutic interventions. Multiple regression procedures indicated that 48-80% of the variance in physical capacity could be explained by lesion level and completeness, activity level, gender, age, body mass, and time since injury. Although physical capacity is largely determined by factors that cannot be altered, such as lesion level, age, and gender, changeable factors such as activity level and body mass play an additional role.