Effectiveness of wheelchair skills training for improving manual wheelchair mobility in children and adolescents: protocol for a multicenter randomized waitlist-controlled trial.

BACKGROUND: Self-directed mobility during childhood can influence development, social participation, and independent living later in life. For children who experience challenges with walking, manual wheelchairs (MWCs) provide a means for self-directed mobility. An effective MWC skills training program exists for adults, but controlled trials have not yet been documented in children and adolescents. This paper outlines the protocol for a multi-centre randomized wait-list controlled trial. The primary objective is to test the hypothesis that children and adolescents who receive MWC skills training will have higher MWC skills capacity compared to children and adolescents in the control group who receive usual care. The secondary objectives are to explore the influence of MWC skills training in children and adolescents (MWC use self-efficacy and satisfaction with participation in meaningful activities), and parents (perceived MWC skills); and to measure retention three months later. METHODS: A multi-centre, parallel-group, single-blind randomized wait-list controlled trial will be conducted. A sample of 60 children and adolescents who use MWCs will be recruited in rehabilitation centres, specialized schools, and the communities of three Canadian cities. Participants will be randomized (1:1) to the experimental (Wheelchair Skills Training Program [WSTP]) or wait-list control group (usual care). Performance-based and self-report measures will be completed at baseline (T1), three months (post-intervention, T2), and three months post-intervention (T3). The primary outcome will be MWC skills capacity post-intervention. Secondary outcomes will be MWC use self-efficacy and satisfaction with participation of the child/adolescent, and parent-perceived MWC skills. The WSTP will consist of 12 sessions, 45-60 min each, delivered 1-2 times per week by trained personnel with health professions education. Training will be customized according to the child's baseline skills and participation goals that require the use of the MWC. The wait-list control group will receive usual care for 3 months and then receive the WSTP after completing T2 evaluations. Data will be analysed using ANCOVA (controlling for baseline scores). DISCUSSION: MWC skills training may be one way to improve self-directed mobility and related outcomes for children and adolescents. The results of this multi-centre randomized wait-list controlled trial will allow for the effectiveness of the intervention to be evaluated in a variety of clinical contexts and geographical regions. TRIAL REGISTRATION: ClinicalTrials.gov: NCT05564247, Version October 3, 2022.

The Rare Knowledge Mining Methodological Framework for the Development of Practice Guidelines and Knowledge Translation Tools for Rare Diseases.

Rare diseases bring on a heavy health, social and economic burden that impacts patients' lives and puts pressure on the healthcare system. Furthermore, they are often associated with limited published studies to inform multidisciplinary clinical practice thus limiting evidence-based practice. Moreover, the development of knowledge translation products including clinical care guidelines are often very challenging based on the current available methodological frameworks relying mostly on critical appraisal of the published research evidence where randomized clinical trial design is considered as the gold standard. To overcome this barrier, we proposed the Rare Knowledge Mining Methodological Framework (RKMMF). The RKMMF is one possible answer to improve the development of knowledge translation products for rare diseases. This framework includes other sources of evidence including registry information and qualitative studies and the involvement of expert patients. This article documents the RKMMF structure and its application is exemplified through knowledge translation products developed for a neuromuscular population.

Physical activity for individuals living with a physical disability in Quebec: Issues and opportunities of access.

BACKGROUND: Individuals living with a physical disability have reported difficulty in meeting their healthy living and leisure needs which could be a result of poor accessibility. OBJECTIVE: This qualitative study aimed to understand the relative accessibility of physical activity from the perspective of individuals living with a physical disability in Quebec, Canada. METHODS: Twenty semi-structured interviews were conducted with current, past, non-members, and staff members of an adapted physical activity program. A qualitative approach with an inductive thematic analysis was used to interpret the data. RESULTS: We identified five overarching themes focusing on participants' experiences related to access: (i) physical activity opportunities; (ii) social interactions; (iii) relationships; (iv) infrastructure; (v) policies and public services. Participants highlighted that access to physical activity programming is shaped by a complex interaction of these overarching themes and their sub-themes. CONCLUSIONS: Access to physical activity opportunities for individuals living with a physical disability cannot be understood in isolation from the broader public policies, infrastructure, social interactions, and relationships that shape their experiences. Policy makers and other health and recreational professionals must consider these broader factors when recommending or creating physical activity opportunities for individuals with physical disabilities.

Facilitators and barriers to the use of service dogs: an exploratory study using the Theoretical Domains Framework.

Purpose: Given the scarcity of service dogs to help individuals with mobility impairments in the community, it is crucial to identify facilitators and obstacles to the acquisition and use of service dogs in order to optimize their use and have a positive impact on the lives of individuals with disabilities. The goal of this study was to describe perceived facilitators and barriers influencing the acquisition and use of service dog by owners and rehabilitation providers, including those who had and had not recommended service dogs.Method: We conducted a phenomenological qualitative study involving in-depth interviews with nine service dog owners and 13 rehabilitation professionals in Canada. Our questionnaires were based on the Theoretical Domains Framework and the data were analyzed using a thematic content approach.Results: Knowledge, beliefs about consequences, and environmental context and resources were the domains most frequently mentioned by both dog owners and rehabilitation professionals. While service dog owners placed greater importance on their belief in their capacity to get and use service dogs, rehabilitation professionals focussed more on their role and identity within the process.Conclusion: Improving the knowledge of the availability and process of acquiring service dogs would be important for rehabilitation professions to improve the quality of life and functional capabilities of persons with disabilities.Implications for rehabilitationIdentifying determinants of service dog acquisition and use can support proposed strategies to optimize the use of this assistive technology;Determinants of service dog acquisition and use are are different for dog owners and rehabilitation professionals, which suggest the need of tailored knowledge translation strategies;Knowledge, beliefs about consequences, and environmental context and resources were the categories of determinants perceived as being more influential on the process.

Antimalarials. 12. Preparation of carbon isosteres of selected 4-pyridinemethanols as suppressive antimalarials.

Four carbon isosteres related to the highly active 4-pyridylcarbinolamines were prepared and evaluated for suppressive antimalarial activity against Plasmodium berghei in mice. Three of the four examples possessed significant activity but were approximately one dose level less active than the corresponding pyridines.

Antimalarials. 11. Synthesis of 3- and 5-aminoquinolines as potential antimalarials.

A series of 3-quinolinediamines (1g, 2c, and 3e) structurally related to primaquine and 4-methylprimaquine have been prepared and tested for antimalarial activity against Plasmodium berghei in mice and antileishmanial activity against Leishmania donovani in the hamster. All were inactive. In addition, three 5-quinolinediamines (4b, 5, and 6) were prepared. All were inactive against Leishmania donovani in hamsters. One of the examples, 6, was curative against Plasmodium cynmolgi in the rhesus monkey.

Antimalarials. 9. Methylthio- and methylsulfonyl-substituted 9-phenanthrenemethanols.

Nine di- and trisubstituted 9-phenanthrenemethanols bearing methylthio and methylfulfonyl substituents in the 2 and/or 6 positions of the phenanthrene nucleus were prepared and screened for antimalarial activity against Plasmodium berghei in mice. Six of the nine compounds were curative at or below 160 mg/kg. The most active structures contained a methylthio substituent in combination with two chlorine atoms.

Antimalarials. 14. 5-(aryloxy)-4-methylprimaquine analogues. A highly effective series of blood and tissue schizonticidal agents.

A series of five 5-(aryloxy)-4-methylprimaquine analogues has been prepared and evaluated for antimalarial activity. The compounds were tested for suppressive activity against Plasmodium berghei in mice and for radical curative activity against Plasmodium cynomolgi in the rhesus monkey. The compounds were not only significantly superior to primaquine as radical curative agents but also were suprisingly highly effective as suppressive agents.

Antimalarials. 16. Synthesis of 2-substituted analogues of 8-[(4-amino-1-methylbutyl)amino]-6-methoxy-4-methyl-5-[3- (trifluoromethyl)phenoxy]quinoline as candidate antimalarials.

A series of 2-substituted analogues of the exceptional drug 8-[(4-amino-1-methylbutyl)amino]-6-methoxy-4-methyl-5-[3- (trifluoromethyl)phenoxy]quinoline (I) were prepared and evaluated for both suppressive and prophylactic antimalarial activity. The preparation of analogues of compound I was of interest due to the high level of both blood and tissue schizonticidal activity demonstrated by this compound. One analogue, 8a, was found to be both more active and less toxic than the parent compound I. In addition, three analogues of example 8a were prepared. Although two of the three analogues showed significant antimalarial activity, both were inferior to compound 8a.

Antimalarials. 13. 5-Alkoxy analogues of 4-methylprimaquine.

A series of nuclear and side-chain analogues of 4-methylprimaquine incorporating an alkoxy group in the 5-position of the quinoline nucleus has been prepared. The compounds were tested for suppressive antimalarial activity against Plasmodium berghei in mice and for radical curative antimalarial activity against Plasmodium cynomolgi in the rhesus monkey. Although the toxicity problems characteristic of the 8-aminoquinolines were not overcome, several of the compounds, surprisingly, were highly effective as both blood and tissue schizonticidal agents.

Antimalarials. 10. Synthesis of 4-substituted primaquine analogues as candidate antimalarials.

Primaquine (I) has been extensively used in combination with other drugs in the radical cure of relapsing malaria as well as for prophylaxis or the interruption of transmission. This, coupled with the activity data reported for 4-methylprimaquine (II), has led to the synthesis of a series of 14 4-substituted analogues of I. In addition, three side-chain analogues of II were prepared. The compounds were tested for suppressive antimalarial activity against Plasmodium berghei in the Rane mouse screen and for radical curative activity against Plasmodium cynomolgi in the rhesus monkey. Four of the 17 compounds prepared (1a, 9c, 15, and 17) exhibited activity in at least one of the test systems.

Analogues of 8-[[6-(diethylamino) hexyl]amino]-6-methoxy-4-methylquinoline as candidate antileishmanial agents.

8-[[6-(Diethylamino)hexyl]amino]-6-methoxy-4-methylquinoline (I) has been shown to be highly effective against Leishmania donovani in hamsters, being approximately 475 times as active as the standard meglumine antimoniate. Several nuclear and side-chain analogues of I have been prepared in an attempt to further enhance the antileishmanial activity of this class of compounds. The compounds were tested against L. donovani in the golden hamster. Although several analogues had meglumine antimoniate indexes in excess of 300, none was superior to the model compound.

Hydantoins as antitumor agents.

A series of 27 hydantoins was prepared and tested as antitumor agents. These were variously substituted in the 5 position but with special emphasis on the substituents (chloro, acetyl, chloroacetyl, and methyl) in the 1 and/or 3 positions. The most active compound was 5,5-bis(4-chlorophenyl)-1,3-dichlorohydantoin with a T/C value of 190% against P-388 lymphocytic leukemia in mice.

Antimalarials. 8. Synthesis of amino ethers as candidate antimalarials.

Based upon the antimalarial activities demonstrated by compounds I and II a series of amino ethers represented by structures III-VI was synthesized. These structures incorporated several modifications of compound II. The compounds prepared displayed no activity in either the Rane P. berghei mouse screen or the Rane P. gallinaceum sporozoite-induced chick test.

Antimalarials. 7.2,8-Bis(trifluoromethyl)-4-quinolinemethanols.

Based on the high antilalarial activity of alpha-(2-piperidyl)-2,8-bis(trifluoromethyl)-4-quinolinemethanol, ten additional 2,8-bis(trifluoromethyl)-4-quinolinemethanols were prepared in which the amino alcohol side chain was structurally varied. Synthesis of the compounds is described and antimalarial activity data against Plasmodium berghei are presented and discussed in terms of the structure variations.

Evaluation of extraction and purification methods for obtaining PCR-amplifiable DNA from compost for microbial community analysis.

Analysis of microbial community structure in complex environmental samples using nucleic acid techniques requires efficient unbiased DNA extraction procedures; however, humic acids and other contaminants complicate the isolation of PCR-amplifiable DNA from compost and other organic-rich samples. In this study, combinations of DNA extraction and purification methods were compared based on DNA yield, humic acid contamination, PCR amplifiability, and microbial community structure assessed by terminal restriction fragment length polymorphisms (TRFLP) of amplified 16S rRNA genes. DNA yield and humic acid contamination, determined by A230, varied significantly between extraction methods. Humic acid contamination of DNA obtained from compost decreased with increasing salt concentration in the lysis buffer. DNA purified by gel permeation chromatography (Sepharose 4B columns) gave satisfactory PCR amplification with universal eubacterial 16S rRNA gene primers only when A260/A280 ratios exceeded 1.5. DNA purified with affinity chromatography (hydroxyapatite columns), and showing A260/A280 ratios as high as 1.8, did not show consistently satisfactory PCR amplification using the same 16S rRNA primers. Almost all DNA samples purified by agarose gel electrophoresis showed satisfactory PCR amplification. Principal components analysis (PCA) of TRFLP patterns differentiated compost types based on the presence/absence of peaks and on the height of the peaks, but differences in TRFLP patterns were not appreciable between extraction methods that yielded relatively pure DNA. High levels of humic acid contamination in extracted DNA resulted in TRFLP patterns that were not consistent and introduced a bias towards lower estimates of diversity.

Testing the ecophysiological basis for the control of monoterpene concentrations in thinned and unthinned balsam fir stands across different drainage classes.

Stand thinning across different soil drainage types was used to test the ecophysiological basis for the control of foliar monoterpenes in current-year foliage of balsam trees [Abies balsamea (L.) P. Mill.] the year following treatment. Photosynthetic capacity (A max) was greater on mesic sites than on sub-hygric and hydric sites (1.81, 1.33 and 0.88 µmol m-2 s-1, respectively) and greater in mid-July than at the end of June (1.86 vs 0.77 µmol m-2 s-1). Foliar N was greater on thinned plots than control plots (2.6 vs 2.2 g m-2); starch was greater on mesic control plots than mesic thinned plots (16.3 vs 10.9 g m-2); and total soluble sugars (TSS) were higher in mid-July than at the end of June (16.5 vs 12.8 g m-2). Total monoterpenes, as well as five individual monoterpenes, showed a complex interaction between site drainage class, thinning treatment and time of sampling (P<0.05). For all sites and dates combined, total monoterpenes were negatively correlated with specific leaf area (r 2=0.46), and positively but weakly correlated with A max (r 2=0.35), foliar N (r 2=0.29) and TSS (r 2=0.24). Total monoterpenes were not correlated with the different measures of carbon to nitrogen ratio as predicted by the carbon-nutrient balance hypothesis. Our results offer partial support to the different hypotheses proposing that foliage having greater resource availability, enzymatic machinery and potential for building storage structures will have greater monoterpene content. However, the strength of the relationships with monoterpenes often varied with sampling date, suggesting that phenological development may play a strong role in determining which factors control monoterpenes at a given time.

Testing the ecophysiological basis for the control of monoterpene concentrations along canopy profiles in thinned and unthinned balsam fir stands.

To determine which ecophysiological factors appear to control monoterpene concentrations in balsam fir foliage [Abies balsamea (L.) P. Mill.], the percentage of photosynthetically active radiation (%PAR), specific leaf area (SLA), light-saturated photosynthesis (A max), and concentrations per unit leaf area of foliar nitrogen (N), total soluble sugars (TSS), starch and monoterpenes were measured on current-year needles from three canopy levels (upper, middle and lower) the year following a pre-commercial thinning. The thinning only modestly changed the light profile within the canopy. %PAR was negatively correlated with SLA (r 2=0.62 in June, r 2=0.53 in July and August) and positively correlated with foliar nitrogen concentrations (r 2=0.51) within the crown profile. The positive relationship between N and A max was quite weak (r 2=0.15), suggesting significant variations in non-photosynthetic N within the canopies. Total monoterpenes were positively correlated with both %PAR (r 2=0.29) and A max (r 2=0.27), and negatively correlated with SLA (r 2=0.30). Contrary to that predicted by the carbon-nutrient balance hypothesis, total monoterpenes were negatively and only very weakly correlated with the starch/N ratio (r 2=0.06) and were not significantly correlated with either the TSS/N or the [TSS+starch]/N ratios. Monoterpenes were positively correlated with both N and TSS, although the relationship varied with the phenological state of the foliage, i.e., monoterpenes were more highly correlated with TSS (r 2=0.67) (immature foliage) in June, and in July and August with N (r 2=0.63) (mature foliage). Thus, it appears that monoterpene concentrations may be controlled primarily by carbohydrate supply in the early growing season and later by enzymatic capacity. Data expressed on a dry weight basis showed a similar pattern.

Electromyographic activity in expert downhill skiers using functional knee braces after anterior cruciate ligament injuries.

We studied six expert downhill skiers who had sustained anterior cruciate ligament injuries and had different degrees of knee instability. The aim was to measure possible changes in electromyographic activity recorded from lower extremity muscles during downhill skiing in a slalom course without and with a custom-made brace applied to the injured knee. Surface electrodes were used with an eight-channel telemetric electromyographic system to collect recordings from the vastus medialis, biceps femoris, semimembranosus, semitendinosus, and gastrocnemius medialis muscles from both legs. Without the brace, the electromyographic activity level of all muscles increased during knee flexion. The biceps femoris muscle was the most activated and reached 50% to 75% of the maximal peak amplitude. With the brace, the electromyographic activity increased in midphase during the upward push for the weight transfer and the peak activity occurred closer to knee flexion in midphase. Also, the uninjured knee was influenced by the brace on the injured leg, a decrease in electromyographic activity was seen in midphase. Spearman's rank correlation revealed a significant correlation between an increase in biceps femoris activity of the injured leg and increasing knee instability. We suggest that the brace caused an increased afferent input from proprioceptors, resulting in an adaptation of motor control patterns secondarily modifying electromyographic activity and timing.

The clinical significance of electromyography normalisation techniques in subjects with anterior cruciate ligament injury during treadmill walking.

This study investigated the clinical interpretation of three electromyographic (EMG) normalisation techniques to detect neuromuscular alterations in patients diagnosed with anterior cruciate ligament knee injury during treadmill walking. The EMG signal was normalised using the mean value during the gait cycles (MEA), the maximum value during the gait cycles (MAX), and a maximum voluntary isometric contraction (MVC) test in 16 male and female subjects. The MAX method detected an increase in total muscle activity in the injured limb rectus femoris (11.6%; P=0.02) while the MVC method detected decreased injured limb gastrocnemius medialis (GM) overall muscle activity (34.4%; P=0.02). The MAX method identified decreased GM activity in three portions of the gait cycle. This study indicates the importance of choosing the appropriate normalisation technique since its choice will change outcome measures and subsequent clinical interpretation.