Publications by authors named "Karl Zabjek"

48 Publications

Potential advantages, barriers, and facilitators of implementing a cognitive orthosis for cooking for individuals with traumatic brain injury: the healthcare providers' perspective.

Disabil Rehabil Assist Technol 2020 Nov 5:1-10. Epub 2020 Nov 5.

Occupational Therapy Program, School of Rehabilitation, Université de Montréal, Montreal, Canada.

Purpose: Considering the key role of health care providers in integrating assistive technologies into clinical settings (e.g., in/outpatient rehabilitation) and home, this study explored the care providers' perspectives on to the implementation of the Cognitive Orthosis for coOking (COOK) for adults with traumatic brain injury (TBI) within clinical contexts and homes.

Methods: Using a qualitative descriptive approach, semi-structured individual interviews and focus groups were carried out with experienced care providers of adults with TBI ( = 30) in Ontario-Canada. Qualitative analysis based on the Miles approach was used.

Results: According to the participants, COOK could potentially be used with individuals with cognitive impairments (TBI and non-TBI) to increase safety and independence in meal preparation and support healthcare providers. However, limited access to funding, clients' lack of motivation/knowledge, and the severity of their cognitive and motor impairments were perceived as potential barriers. Facilitators to the use of COOK include training sessions, availability of private/provincial financing, and comprehensive assessments by a clinical team prior to use.

Conclusions: Health care providers' perspectives will help develop implementation strategies to facilitate the adoption of COOK within homes and clinical contexts for individuals with TBI and improve the next version of this technology. IMPLICATIONS FOR REHABILITATION COOK shows a high potential for increasing independence and safety during meal preparation with its sensor-based monitoring of the environment and cognitive-based assistance, for adults with TBI. Comprehensive clinical assessments to identify individuals' therapeutic goals, clinical characteristics, and living environments are necessary to facilitate the deployment of COOK.
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http://dx.doi.org/10.1080/17483107.2020.1833093DOI Listing
November 2020

Impacts of Motion-Based Technology on Balance, Movement Confidence, and Cognitive Function Among People With Dementia or Mild Cognitive Impairment: Protocol for a Quasi-Experimental Pre- and Posttest Study.

JMIR Res Protoc 2020 Sep 18;9(9):e18209. Epub 2020 Sep 18.

Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.

Background: While exercise can benefit the health and well-being of people with dementia or mild cognitive impairment, many exercise programs offered to this population are passive, unengaging, and inaccessible, resulting in poor adherence. Motion-based technologies are increasingly being explored to encourage exercise participation among people with dementia or mild cognitive impairment. However, the impacts of using motion-based technologies with people with dementia or mild cognitive impairment on variables including balance, movement confidence, and cognitive function have yet to be determined.

Objective: The purpose of this study is to examine the impacts of a group motion-based technology intervention on balance, movement confidence, and cognitive function among people with dementia or mild cognitive impairment.

Methods: In this quasi-experimental pre- and posttest design, we will recruit 24 people with dementia or mild cognitive impairment from 4 adult day programs and invite them to play Xbox Kinect bowling in a group setting, twice weekly for 10 weeks. We will require participants to speak and understand English, be without visual impairment, and be able to stand and walk. At pretest, participants will complete the Mini-Balance Evaluation Systems Test (Mini-BESTest) and the Montreal Cognitive Assessment (MoCA). We will video record participants during weeks 1, 5, and 10 of the intervention to capture behavioral indicators of movement confidence (eg, fluency of motion) through coding. At posttest, the Mini-BESTest and MoCA will be repeated. We will analyze quantitative data collected through the Mini-BESTest and the MoCA using an intent-to-treat analysis, with study site and number of intervention sessions attended as covariates. To analyze the videos, we will extract count and percentage data from the coded recordings.

Results: This study will address the question of whether a group motion-based technology intervention, delivered in an adult day program context, has the potential to impact balance, movement confidence, and cognitive function among people with dementia or mild cognitive impairment. The project was funded in 2019 and enrollment was completed on February 28, 2020. Data analysis is underway and the first results are expected to be submitted for publication in 2021.

Conclusions: This study will assess the feasibility and potential benefits of using motion-based technology to deliver exercise interventions to people with dementia or mild cognitive impairment. This work can also be used as the basis for developing specific software and future exercise programs using motion-based technology for people with dementia or mild cognitive impairment, as well as understanding some of the conditions in which these programs can be delivered.

International Registered Report Identifier (irrid): DERR1-10.2196/18209.
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http://dx.doi.org/10.2196/18209DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7532457PMC
September 2020

Defective corticomuscular connectivity during walking in patients with Parkinson's disease.

J Neurophysiol 2020 11 16;124(5):1399-1414. Epub 2020 Sep 16.

Rehabilitation Engineering Laboratory, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.

Gait disturbances are common in individuals with Parkinson's disease (PD). Although the basic patterns of walking are thought to be controlled by the brainstem and spinal networks, recent studies have found significant corticomuscular coherence in healthy individuals during walking. However, it still remains unknown how PD affects the cortical control of muscles during walking. As PD typically develops in older adults, it is important to investigate the effects of both aging and PD when examining disorders in patients with PD. Here, we assessed the effects of PD and aging on corticomuscular communication during walking by investigating corticomuscular coherence. We recorded electroencephalographic and electromyographic signals in 10 individuals with PD, 9 healthy older individuals, and 15 healthy young individuals. We assessed the corticomuscular coherence between the motor cortex and two lower leg muscles, tibialis anterior (TA) and medial gastrocnemius, during walking. Older and young groups showed sharp peaks in muscle activation patterns at specific gait phases, whereas the PD group showed prolonged patterns. Smaller corticomuscular coherence was found in the PD group compared with the healthy older group in the α band (8-12 Hz) for both muscles, and in the β band (16-32 Hz) for TA. Older and young groups did not differ in the magnitude of corticomuscular coherence. Our results indicated that PD decreased the corticomuscular coherence during walking, whereas it was not affected by aging. This lower corticomuscular coherence in PD may indicate lower-than-normal corticomuscular communication, although direct or indirect communication is unknown, and may cause impaired muscle control during walking. Mechanisms behind how Parkinson's disease (PD) affects cortical control of muscles during walking remain unclear. As PD typically develops in the elderly, investigation of aging effects is important to examine deficits regarding PD. Here, we demonstrated that PD causes weak corticomuscular synchronization during walking, but aging does not. This lower-than-normal corticomuscular communication may cause impaired muscle control during walking.
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http://dx.doi.org/10.1152/jn.00109.2020DOI Listing
November 2020

The effects of hypoxia on muscle deoxygenation and recruitment in the flexor digitorum superficialis during submaximal intermittent handgrip exercise.

BMC Sports Sci Med Rehabil 2020 15;12:16. Epub 2020 May 15.

1Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON M5G 1V7 Canada.

Background: Decreased oxygenation of muscle may be accentuated during exercise at high altitude. Monitoring the oxygen saturation of muscle (SmO) during hand grip exercise using near infrared spectroscopy during acute exposure to hypoxia could provide a model for a test of muscle performance without the competing cardiovascular stresses that occur during a cycle ergometer or treadmill test. The purpose of this study was to examine and compare acute exposure to normobaric hypoxia versus normoxia on deoxygenation and recruitment of the flexor digitorum superficialis (FDS) during submaximal intermittent handgrip exercise (HGE) in healthy adults.

Methods: Twenty subjects (11 M/9 F) performed HGE at 50% of maximum voluntary contraction, with a duty cycle of 2 s:1 s until task failure on two occasions one week apart, randomly assigned to normobaric hypoxia (FiO = 12%) or normoxia (FiO = 21%). Near-infrared spectroscopy monitored SmO, oxygenated (OHb), deoxygenated (HHb), and total hemoglobin (tHb) over the FDS. Surface electromyography derived root mean square and mean power frequency of the FDS.

Results: Hypoxic compared to normoxic HGE induced a lower FDS SmO (63.8 ± 2.2 vs. 69.0 ± 1.5,  = 0.001) and both protocols decreased FDS SmO from baseline to task failure. FDS mean power frequency was lower during hypoxic compared to normoxic HGE (64.0 ± 1.4 vs. 68.2 ± 2.0 Hz,  = 0.04) and both decreased mean power frequency from the first contractions to task failure ( = 0.000). Under both hypoxia and normoxia, HHb, tHb and root mean square increased from baseline to task failure whereas OHb decreased and then increased during HGE. Arterial oxygen saturation via pulse oximetry (SpO) was lower during hypoxia compared to normoxia conditions ( = 0.000) and heart rate and diastolic blood pressure only demonstrated small increases. Task durations and the tension-time index of HGE did not differ between normoxic and hypoxic trials.

Conclusion: Hypoxic compared to normoxic HGE decreased SmO and induced lower mean power frequency in the FDS, during repetitive hand grip exercise however did not result in differences in task durations or tension-time indices. The fiber type composition of FDS, and high duty cycle and intensity may have contributed greater dependence on anaerobiosis.
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http://dx.doi.org/10.1186/s13102-020-00163-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7226965PMC
May 2020

Neck and Inspiratory Muscle Recruitment during Inspiratory Loading and Neck Flexion.

Med Sci Sports Exerc 2020 07;52(7):1610-1616

Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, BRAZIL.

Purpose: This study aimed to compare muscle activation of the diaphragm (DIA), scalenes (SA), parasternal intercostals (PS), and sternomastoid (SM) during submaximal intermittent neck flexion (INF) versus submaximal inspiratory threshold loading (ITL) until task failure in healthy adults.

Methods: Twelve healthy adults performed submaximal ITL or INF tests in random order for 2 d. Surface electromyography was monitored to acquire root mean square (RMS) and median power frequency (MPF) from the SA, PS, SM, and DIA. Maximal inspiratory pressures and maximal voluntary contraction for neck flexion were determined. Next, participants performed the first submaximal test-ITL or INF-targeting 50% ± 5% of the maximal inspiratory pressure or maximal voluntary contraction, respectively, until task failure. After a rest, they performed the other test until task failure. Two days later, they performed ITL and INF but in the opposite order. The Borg scale assessed breathlessness and perceived exertion.

Results: Endurance times for ITL and INF were 38.1 and 26.3 min, respectively. INF activated three of four inspiratory muscles at higher average RMS (PS, SM, and SA) and at different MPF (PS, SM, and DIA but not SA) compared with ITL. During ITL, RMS did not change in the four inspiratory muscles over time, but MPF decreased in PS, SM, and SA (P < 0.04). In contrast, RMS increased in three of four inspiratory muscles (SM, PS, and SA) during INF, but MPF did not change throughout its duration. Borg rating was 3.9-fold greater than ITL compared with INF.

Conclusion: At a similar percentage of maximal load, INF evokes greater activation of primary muscles of inspiration (PS and SA) and a major accessory muscle of inspiration (SM) compared with ITL during a prolonged submaximal protocol.
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http://dx.doi.org/10.1249/MSS.0000000000002271DOI Listing
July 2020

The three-dimensional shoulder pain alignment (3D-SPA) mobilization improves pain-free shoulder range, functional reach and sleep following stroke: a pilot randomized control trial.

Disabil Rehabil 2020 Oct 23;42(21):3072-3083. Epub 2019 Mar 23.

Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.

Following a stroke, three-dimensional clavicular/scapular/humeral joint rotations may become restricted and contribute to post-stroke shoulder pain. This study examined whether a treatment group provided with current standard treatment plus the proposed "Three-dimensional Shoulder Pain Alignment" mobilization protocol demonstrated improved pain-free shoulder range, functional reach and sleep compared to a control group provided with standard treatment alone. In this double-blinded parallel-group randomized control trial, treatment and control subjects with moderate/severe post-stroke upper extremity impairment and shoulder pain were treated 3x/week for 4 weeks. Outcome measures included changes in pain-free three-dimensional clavicular/scapular/humeral range (using computerized digitization), pain during sleep and functional reach (using the Pain Intensity-Numerical Rating Scale), and pain location/prognostic indicators (using the Chedoke-McMaster Stroke Assessment-Shoulder Pain Inventory). Compared to controls ( = 10) the treatment group ( = 10) demonstrated significantly improved three-dimensional clavicular/scapular/humeral pain-free range during shoulder flexion and abduction ( < 0.05; Hedges  > 0.80), large effect sizes for decreased pain during sleep and functional reach to the head and back (OR range: 5.44-21.00), and moderate effect size for improved pain/prognostic indicators (OR = 3.86). The Three-Dimensional Shoulder Pain Alignment mobilization protocol significantly improved pain-free range of motion, functional reach and pain during sleep in shoulders with moderate/severe post-stroke upper-extremity impairment.Implications for rehabilitationAlthough three-dimensional clavicular/scapular/humeral rotations are an essential component of normal pain-free shoulder range of motion, current guidelines for treatment of post-stroke shoulder pain only includes uni-dimensional mobilizations for joint alignment and pain management.The Three-Dimensional Shoulder Pain Alignment (3D-SPA) mobilization protocol incorporates multi-dimensional mobilizations in various planes of shoulder movement.The current study results demonstrate proof-of-concept regarding the 3D-SPA mobilization, and this approach should be considered as an alternative to the uni-dimensional mobilizations currently used in clinical treatment guidelines for post-stroke shoulder pain.
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http://dx.doi.org/10.1080/09638288.2019.1585487DOI Listing
October 2020

Muscle architecture of vastus medialis obliquus and longus and its functional implications: A three-dimensional investigation.

Clin Anat 2019 May 19;32(4):515-523. Epub 2019 Feb 19.

Division of Anatomy, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.

Vastus medialis (VM) has two partitions, longus (VML), and obliquus (VMO), which have been implicated in knee pathologies. However, muscle architecture of VMO and VML has not been documented volumetrically. The aims of this study were to determine and compare the muscle architecture of VMO and VML in three-dimensional (3D) space, and to elucidate their relative functional capabilities. Twelve embalmed specimens were used in this study. Each specimen was serially dissected, digitized (Microscribe™ MX), and modeled in 3D (Autodesk Maya®). Architectural parameters: fiber bundle length (FBL), proximal (PPA)/distal (DPA) pennation angle, and physiological cross-sectional area (PCSA) were compared using descriptive statistics/t-tests. Sarcomere lengths (SLs) were measured and compared from six biopsy sites of VM. VMO and VML were found to have superficial and deep parts based on fiber bundle attachments to aponeuroses, medial patellar retinaculum, and adductor magnus tendon. The superficial part of VMO was further subdivided into superior and inferior partitions. Architecturally, VMO was found to have significantly shorter mean FBL, greater mean PPA and DPA, and smaller mean PCSA than VML. VML was found to be connected to the fascia lata by thin fascial bands, not present in VMO. SLs of VMO and VML were comparable. VMO and VML are architecturally and functionally distinct, as evidenced by marked differences in their musculoaponeurotic geometry, attachment sites, and architectural parameters. VMO likely contributes greater to medial patellar stabilization, whereas VML, with a larger relative excursion and force-generating capability, to the extension of the knee. Clin. Anat. 32:515-523, 2019. © 2019 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/ca.23344DOI Listing
May 2019

Important Movement Concepts: Clinical Versus Neuroscience Perspectives.

Motor Control 2019 Jul 29;23(3):273-293. Epub 2019 Jan 29.

1 University of Toronto.

Human movement is complex, presenting clinical and research challenges regarding how it is described and investigated. This paper discusses the commonalities and differences on how human movement is conceptualized from neuroscientific and clinical perspectives with respect to postural control; the limitations of linear measures; movement efficiency with respect to metabolic energy cost and selectivity; and, how muscle synergy analysis may contribute to our understanding of movement variability. We highlight the role of sensory information on motor performance with respect to the base of support and alignment, illustrating a potential disconnect between the clinical and neuroscientific perspectives. The purpose of this paper is to discuss the commonalities and differences in how movement concepts are defined and operationalized by Bobath clinicians and the neuroscientific community to facilitate a common understanding and open the dialogue on the research practice gap.
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http://dx.doi.org/10.1123/mc.2017-0085DOI Listing
July 2019

Interventions to address burden among family caregivers of persons aging with TBI: A scoping review.

Brain Inj 2019 30;33(3):255-265. Epub 2018 Nov 30.

h Occupational Therapy Program, School of Rehabilitation , Université de Montréal, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal , Montreal , Canada.

Purpose: To capture the scope of literature exploring interventions for caregivers of aging persons with TBI.

Methods: A scoping review of peer reviewed literature was conducted in two phases. Phase I: Searching seven databases, two independent raters screened articles using a set of predetermined criteria. Included articles were reviewed, and categorized according to common themes. Phase II: Five stakeholders were engaged in a consultation. A content analysis was performed by extracting statements from each interview using an inductive strategy, and organizing each into themes.

Findings: A total of 11 articles were included in the final analysis. Inter-rater reliability was assessed at both the title and abstract search [98.8% agreement; k = 0.3425 (95% CI, .246 to .439), p < .05]; and the full-text review [83% agreement; k = 0.542 (95% CI, 0.340 to 0.745), p < .05] phases. Seven articles identified potential interventions, and four identified and evaluated an intervention. Interventions targeted subjective burden (n = 4) and objective burden (n = 4), with caregiver knowledge and skill development (n = 3) classified as a sub-category of objective burden. Stakeholders overwhelmingly emphasized the need for interventions to reduce objective burden.

Implications: Included articles were primarily composed of levels six and seven evidence, suggesting that this literature is in an early stage of development. Future research should emphasize the development and evaluation of interventions to reduce objective burden.
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http://dx.doi.org/10.1080/02699052.2018.1553308DOI Listing
January 2020

Transitions sit to stand and stand to sit in persons post-stroke: Path of centre of mass, pelvic and limb loading - A pilot study.

Clin Biomech (Bristol, Avon) 2019 01 10;61:22-30. Epub 2018 Nov 10.

Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON M5G 1V7, Canada. Electronic address:

Background: To explore the movement patterns utilized by persons post stroke from the simultaneous perspective of pelvic and limb loading with the path of centre of mass during the movement transitions sit to stand and stand to sit.

Methods: A descriptive pilot study where kinetic and kinematic data were collected and compared between the contribution made by the less affected versus more affected lower limb and trunk during sit to stand and stand to sit following stroke. Movement analysis was undertaken using force-plates and a 3D VICON motion capture system.

Findings: Data were successfully collected on nine subjects of whom four presented with left side more affected and eight were male. Two patterns were demonstrated for pelvic loading, four patterns for limb loading and five patterns for deviation of centre of mass. There were no consistent patterns of movement demonstrated dependent upon the more or less affected side. There was no consistent relationship between pelvic and limb loading and deviation of centre of mass throughout the movement phases.

Interpretation: In contrast to assumptions often made with respect to limb loading, we found large variability in movement patterns utilized by person's with a hemiparetic presentation during sit to stand and stand to sit. The findings suggest that movement problems encountered by persons post-stroke are complex and identifies limitations with respect to current measurement techniques.
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http://dx.doi.org/10.1016/j.clinbiomech.2018.11.004DOI Listing
January 2019

Research Priorities for Optimizing Long-term Community Integration after Brain Injury.

Can J Neurol Sci 2018 11;45(6):643-651

12Department of Kinesiology,University of Waterloo,Waterloo,Ontario,Canada (ENS).

Objective: This paper reports on a funded summit, which convened a multidisciplinary group of experts to provide consensus on the research priorities necessary for improving long-term community integration of individuals with traumatic brain injury (TBI) and their caregivers.

Methods: The 2-day summit was directed using the World Café Methodology, to engage stakeholders and collaboratively arrive at a consensus on the problems to be targeted in research. Participants (n=54), drawn from two Canadian provinces, included an interdisciplinary group of researchers, clinicians, representatives from brain injury associations, individuals with TBI, and caregivers. In small groups, participants discussed challenges to long-term community integration and potential initiatives that would address these barriers. Field notes from the discussions were analyzed using qualitative content analysis.

Results: The consensus on prioritized research directions included developing interventions to optimize the functioning and participation of individuals with TBI, reducing caregiver burden, and evaluating how emerging technology can facilitate delivery of care.

Conclusions: The World Café Methodology was an effective method for developing research priorities. The breadth of expertise of participants and the collegial environment allowed for the identification of a broad perspective on important future research directions with potential to enhance the long-term community integration of individuals with brain injury.
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http://dx.doi.org/10.1017/cjn.2018.334DOI Listing
November 2018

The Canadian Pediatric Mild Traumatic Brain Injury Common Data Elements Project: Harmonizing Outcomes to Increase Understanding of Pediatric Concussion.

J Neurotrauma 2018 08;35(16):1849-1857

18 Department of Educational Psychology, University of Alberta , Edmonton, Alberta, Canada .

A critical component for accelerating the clinical uptake of research data in the area of pediatric concussion or mild traumatic brain injury (MTBI) pertains to the establishment and utilization of common databases. The objective of the first phase of our CanPedCDE initiative was to agree upon pediatric common data elements (CDEs) that could best characterize children with MTBI over their recovery period. The selection of CDEs for our framework aimed to balance factors such as the comprehensiveness of outcomes collected, their applicability to diverse settings, as well as the costs associated with their use. Selection began by identifying relevant domains of functioning (e.g., post-concussion symptoms, attention, and balance). Two sources were used to make this process more efficient: 1) the World Health Organization International Classification of Functioning (ICF) Traumatic Brain Injury Core Set, and the U.S. National Institute of Neurological Disorders and Stroke Traumatic Brain Injury Common Data Elements, both of which had already suggested relevant domains to include in TBI research. The process was completed in two phases: 1) using an online survey of experts and 2) through an in-person consensus meeting. Measurement tools were also proposed that were best felt to capture these domains. Forty experts in MTBI in children from multiple health-related perspectives (e.g., emergency medicine, pediatrics, neurosurgery, nursing, physiotherapy, and neuroscience), as well as knowledge users, participated in the selection process. The final list of CDEs included 77 distinct areas of functioning, covering all categories of the ICF model. Outcome measures were attached to each element, when applicable. The CanPedCDE initiative addresses a significant limitation in MTBI research to date and may help both researchers and clinicians to organize and standardize their assessment of children and youth post-MTBI in order to move the field in promising directions.
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http://dx.doi.org/10.1089/neu.2018.5887DOI Listing
August 2018

Dynamic cortical participation during bilateral, cyclical ankle movements: Effects of Parkinson's disease.

PLoS One 2018 26;13(4):e0196177. Epub 2018 Apr 26.

Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.

Parkinson's disease (PD) is known to increase asymmetry and variability of bilateral movements. However, the mechanisms of such abnormalities are not fully understood. Here, we aimed to investigate whether kinematic abnormalities are related to cortical participation during bilateral, cyclical ankle movements, which required i) maintenance of a specific frequency and ii) bilateral coordination of the lower limbs in an anti-phasic manner. We analyzed electroencephalographic and electromyographic signals from nine men with PD and nine aged-matched healthy men while they sat and cyclically dorsi- and plantarflexed their feet. This movement was performed at a similar cadence to normal walking under two conditions: i) self-paced and ii) externally paced by a metronome. Participants with PD exhibited reduced range of motion and more variable bilateral coordination. However, participants with and without PD did not differ in the magnitude of corticomuscular coherence between the midline cortical areas and tibialis anterior and medial gastrocnemius muscles. This finding suggests that either the kinematic abnormalities were related to processes outside linear corticomuscular communication or PD-related changes in neural correlates maintained corticomuscular communication but not motor performance.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0196177PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5919457PMC
July 2018

Three-dimensional assessment of the asymptomatic and post-stroke shoulder: intra-rater test-retest reliability and within-subject repeatability of the palpation and digitization approach.

Disabil Rehabil 2019 07 23;41(15):1826-1834. Epub 2018 Mar 23.

a Rehabilitation Sciences Institute, University of Toronto , Toronto , Canada.

Altered three-dimensional (3D) joint kinematics can contribute to shoulder pathology, including post-stroke shoulder pain. Reliable assessment methods enable comparative studies between asymptomatic shoulders of healthy subjects and painful shoulders of post-stroke subjects, and could inform treatment planning for post-stroke shoulder pain. The study purpose was to establish intra-rater test-retest reliability and within-subject repeatability of a palpation/digitization protocol, which assesses 3D clavicular/scapular/humeral rotations, in asymptomatic and painful post-stroke shoulders. Repeated measurements of 3D clavicular/scapular/humeral joint/segment rotations were obtained using palpation/digitization in 32 asymptomatic and six painful post-stroke shoulders during four reaching postures (rest/flexion/abduction/external rotation). Intra-class correlation coefficients (ICCs), standard error of the measurement and 95% confidence intervals were calculated. All ICC values indicated high to very high test-retest reliability (≥0.70), with lower reliability for scapular anterior/posterior tilt during external rotation in asymptomatic subjects, and scapular medial/lateral rotation, humeral horizontal abduction/adduction and axial rotation during abduction in post-stroke subjects. All standard error of measurement values demonstrated within-subject repeatability error ≤5° for all clavicular/scapular/humeral joint/segment rotations (asymptomatic ≤3.75°; post-stroke ≤5.0°), except for humeral axial rotation (asymptomatic ≤5°; post-stroke ≤15°). This noninvasive, clinically feasible palpation/digitization protocol was reliable and repeatable in asymptomatic shoulders, and in a smaller sample of painful post-stroke shoulders. Implications for Rehabilitation In the clinical setting, a reliable and repeatable noninvasive method for assessment of three-dimensional (3D) clavicular/scapular/humeral joint orientation and range of motion (ROM) is currently required. The established reliability and repeatability of this proposed palpation/digitization protocol will enable comparative 3D ROM studies between asymptomatic and post-stroke shoulders, which will further inform treatment planning. Intra-rater test-retest repeatability, which is measured by the standard error of the measure, indicates the range of error associated with a single test measure. Therefore, clinicians can use the standard error of the measure to determine the "true" differences between pre-treatment and post-treatment test scores.
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http://dx.doi.org/10.1080/09638288.2018.1451924DOI Listing
July 2019

Postural Stability in Healthy Child and Youth Athletes: The Effect of Age, Sex, and Concussion-Related Factors on Performance.

Sports Health 2018 Mar/Apr;10(2):175-182. Epub 2017 Nov 13.

Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.

Background: Postural stability plays a key role in sport performance, especially after concussion. Specific to healthy child and youth athletes, little is known about the influence development and sex may have on postural stability while considering other subjective clinical measures used in baseline/preinjury concussion assessment. This study aims to describe age- and sex-based trends in postural stability in uninjured child and youth athletes at baseline while accounting for concussion-related factors.

Hypotheses: (1) Postural stability performance will improve with age, (2) females will display better postural stability compared to males, and (3) concussion-like symptoms will affect postural stability performance in healthy children and youth.

Study Design: Cross-sectional study.

Level Of Evidence: Level 3.

Methods: This study comprised 889 healthy/uninjured child and youth athletes (54% female, 46% male) between the ages of 9 and 18 years old. Participants completed preseason baseline testing, which included demographic information (age, sex, concussion history), self-report of concussion-like symptoms (Post-Concussion Symptom Inventory [PCSI]-Child and PCSI-Youth), and measures of postural stability (BioSway; Biodex Medical Systems). Two versions of the PCSI were used (PCSI-C, 9- to 12-year-olds; PCSI-Y, 13- to 18-year-olds). Postural stability was assessed via sway index under 4 sway conditions of increasing difficulty by removing visual and proprioceptive cues.

Results: In children aged 9 to 12 years old, there were significant age- ( P < 0.05) and sex-based effects ( P < 0.05) on postural stability. Performance improved with age, and girls performed better than boys. For youth ages 13 to 18 years old, postural stability also improved with age ( P < 0.05). In both child and youth subgroups, postural stability worsened with increasing concussion-like symptoms ( P < 0.05).

Conclusion: There are developmental and baseline symptom trends regarding postural stability performance.

Clinical Relevance: These findings provide a preliminary foundation for postconcussion comparisons and highlight the need for a multimodal approach in assessing and understanding physical measures such as postural stability.
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http://dx.doi.org/10.1177/1941738117741651DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5857732PMC
March 2018

Cardiorespiratory Responses to Short Bouts of Resistance Training Exercises in Individuals With Chronic Obstructive Pulmonary Disease: A COMPARISON OF EXERCISE INTENSITIES.

J Cardiopulm Rehabil Prev 2017 Sep;37(5):356-362

Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada (Drs Robles, Brooks, Goldstein, and Mathur and Ms Araujo,); Rehabilitation Sciences Institute (Drs Robles, Brooks, Zabjek, Goldstein, and Mathur) and Department of Physical Therapy (Drs Brooks, Zabjek, and Mathur), University of Toronto, Ontario, Canada; School of Physical & Occupational Therapy, McGill University, Montreal, Quebec, Canada (Dr Janaudis-Ferreira); and Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada (Dr Marzolini).

Purpose: Resistance training is recommended in pulmonary rehabilitation for people with chronic obstructive pulmonary disease (COPD); however, the acute cardiorespiratory responses to different intensities of resistance training are not known. We compared acute cardiorespiratory responses with high-intensity versus low-intensity resistance exercises in persons with COPD and healthy, matched controls. This research may assist in developing training parameters in COPD.

Methods: Participants (n = 10 per group) performed 1 set of 10 repetitions of leg extension and arm elevation at 2 intensities: 40% (low) and 80% (high) of 1-repetition maximum. Minute ventilation ((Equation is included in full-text article.)E), oxygen uptake ((Equation is included in full-text article.)O2), and heart rate (HR) data were collected continuously and expressed as absolute values and relative to values at (Equation is included in full-text article.)O2peak derived from a cardiopulmonary exercise test. Blood pressure, oxygen saturation, and rating of perceived exertion (RPE) were monitored before and after each set of exercises.

Results: Individuals with COPD showed similar (Equation is included in full-text article.)E, (Equation is included in full-text article.)O2, and HR with high- versus low-intensity exercises. RPE was higher after high- vs low-intensity leg extension (4 ± 1.4 vs 2 ± 1, P < .005) and arm elevation (3 ± 2 vs 1 ± 1.4, P < .005). Compared with healthy participants, relative (Equation is included in full-text article.)O2, (Equation is included in full-text article.)E, and HR were higher in COPD (≅40% vs 20% of the (Equation is included in full-text article.)O2peak; ≅60% vs 20% of (Equation is included in full-text article.)Epeak; and ≅80% vs 20% of HRpeak; all Ps ≤ .004). Absolute responses and RPE were similar between groups, irrespective of intensity and exercise.

Conclusion: Immediate cardiorespiratory responses to an acute bout of resistance exercise appear to be independent of the exercise intensity in COPD. Although people with COPD are working closer to their (Equation is included in full-text article.)O2peak, their responses and RPE are comparable with healthy controls.
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http://dx.doi.org/10.1097/HCR.0000000000000282DOI Listing
September 2017

Postural disorders in mouth breathing children: a systematic review.

Braz J Phys Ther 2018 Jan - Feb;22(1):7-19. Epub 2017 Jul 5.

University of Toronto, Department of Toronto, Toronto, Ontario, Canada.

Background: Mouth breathing syndrome can cause sleep disturbances that compromise the performance of children in school. It might also cause postural abnormalities involving the head and cervical spine; however, the association between postural abnormalities and mouth breathing in children is unclear.

Objective: To assess the methodological quality of studies and determine if there is an association between mouth breathing and postural disorders in children.

Methods: Databases comprised MEDLINE, CINAHL, PEDro, LILACS, EMBASE and Cochrane Central Registrar of Controlled Trials. Searches were until March 2016 and included studies that evaluated postural disorders in children diagnosed with mouth breathing. The Downs and Black checklist was used to evaluate the quality of the evidences.

Results: Ten studies were included totaling 417 children from 5 to 14 years. Two studies used the New York State Postural Rating Scale, seven used photography and one used motion capture to measure posture. The methods used to analyze the data included the Postural Analysis Software (SAPO), Fisiometer, ALCimagem and routines in MATLAB program. Quality assessment resulted in low scores (<14) for all the studies. The main areas of weakness were a clear description of the participants, of the methods used to access posture, of the principal confounders and lack of power analysis. External and internal validity were also threatened by the lack of a representative sample and blinding of the participants and assessors, respectively.

Conclusions: The review provides low evidence that mouth-breathing pattern in children between the ages 5-14 years is associated with postural deviations.
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http://dx.doi.org/10.1016/j.bjpt.2017.06.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5816083PMC
March 2018

Conceptualizing movement by expert Bobath instructors in neurological rehabilitation.

J Eval Clin Pract 2017 Dec 20;23(6):1153-1163. Epub 2017 Apr 20.

Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.

Rationale, Aims, And Objectives: Movement, a core aspect of physiotherapy practice, and integral to the clinical reasoning process has undergone limited theoretical development. Instead, research has focused on intervention effectiveness embedded within the positivist paradigm. The purpose of this study was to explore how expert neurorehabilitation therapists conceptualize movement as part of their clinical reasoning.

Method: A qualitative interpretive descriptive approach consisting of stimulated recall using video-recorded treatment sessions and in-depth interviews was used. Theoretical sampling was used to recruit members of the International Bobath Instructors Training Association (IBITA) who are recognized experts in neurorehabilitation. Interview transcripts were transcribed verbatim. Data analysis was progressive, iterative, and inductive.

Results: Twenty-two IBITA instructors from 7 different countries volunteered to participate. They ranged in clinical experience from 12 to 40 years and instructor experience from 1 to 35 years. The conceptualization of movement by the IBITA instructors involves the following elements: (1) movement comprises the whole person and the whole body, not just individual body segments; (2) active alignment of body segments is integral to movement performance; and (3) efficient movement requires the relative integration of postural control/stability and selective movement/mobility.

Conclusions: The IBITA instructors conceptualize movement from a person-centred perspective. The integration of postural control and selective movement, with alignment and variability as key components, forms the foundation of their understanding of movement. Further investigation into the role of postural control in movement recovery post central nervous system lesion is required. Likewise, the dimensions of movement critical to the conceptualization of movement are not well understood from the perspective of the physiotherapist or persons with neurological impairments.
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http://dx.doi.org/10.1111/jep.12742DOI Listing
December 2017

Does limb partitioning and positioning affect acute cardiorespiratory responses during strength exercises in patients with COPD?

Respirology 2017 10 19;22(7):1336-1342. Epub 2017 Apr 19.

Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada.

Background And Objective: Cardiorespiratory responses and symptoms in response to endurance exercise in patients with COPD vary with the number and position of involved limbs. Responses to such variations have never been quantified for strength exercises. We therefore assessed acute cardiorespiratory responses during brief bouts of weight lifting exercises.

Methods: We compared double- versus single-limb leg extensions and arm elevations, as well as arm elevation done above or below shoulder level in patients with moderate to severe COPD (n = 10, 6 males, 66 (8.1 years), forced expiratory volume on 1 s (FEV ) % predicted = 34% (14%)). Minute ventilation, oxygen uptake, oxygen saturation, heart rate (HR), blood pressure (BP), rate of perceived exertion (RPE) and recovery time were collected during single sets of each exercise (10 repetitions at 80% of one repetition maximum).

Results: Ventilatory and gas exchange responses were not affected by the number of exercising limbs. Changes in HR, BP and RPE scores during arm elevation above shoulder level were greater after double- compared with single-arm elevation (P ≤ 0.001) and greater when exercising above compared with below shoulder level (P ≤ 0.01). Double-arm elevation above shoulder level required 1.5 min longer HR recovery time (P ≤ 0.041) compared with other exercises.

Conclusion: Double-arm elevation above shoulder level appears to be more challenging than other strength exercise variations. Partitioning exercises and limb position may reduce perceived exertion during training.
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http://dx.doi.org/10.1111/resp.13056DOI Listing
October 2017

Dynamic Increase in Corticomuscular Coherence during Bilateral, Cyclical Ankle Movements.

Front Hum Neurosci 2017 4;11:155. Epub 2017 Apr 4.

Rehabilitation Engineering Laboratory, Toronto Rehabilitation Institute, University Health NetworkToronto, ON, Canada.

In humans, the midline primary motor cortex is active during walking. However, the exact role of such cortical participation is unknown. To delineate the role of the primary motor cortex in walking, we examined whether the primary motor cortex would activate leg muscles during movements that retained specific requirements of walking (i.e., locomotive actions). We recorded electroencephalographic and electromyographic signals from 15 healthy, young men while they sat and performed bilateral, cyclical ankle movements. During dorsiflexion, near-20-Hz coherence increased cyclically between the midline primary motor cortex and the co-contracting antagonistic pair (i.e., tibialis anterior and medial gastrocnemius muscles) in both legs. Thus, we have shown that dynamic increase in corticomuscular coherence, which has been observed during walking, also occurs during simple bilateral cyclical movements of the feet. A possible mechanism for such coherence is corticomuscular communication, in which the primary motor cortex participates in the control of movement. Furthermore, because our experimental task isolated certain locomotive actions, the observed coherence suggests that the human primary motor cortex may participate in these actions (i.e., maintaining a specified movement frequency, bilaterally coordinating the feet, and stabilizing the posture of the feet). Additional studies are needed to identify the exact cortical and subcortical interactions that cause corticomuscular coherence and to further delineate the functional role of the primary motor cortex during bilateral cyclical movements such as walking.
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http://dx.doi.org/10.3389/fnhum.2017.00155DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5378765PMC
April 2017

Dynamic cortical participation during bilateral, cyclical ankle movements: effects of aging.

Sci Rep 2017 03 16;7:44658. Epub 2017 Mar 16.

Rehabilitation Engineering Laboratory, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.

The precise role of the human primary motor cortex in walking is unknown. Our previous study showed that the primary motor cortex may contribute to specific requirements of walking (i.e., maintaining a constant movement frequency and bilaterally coordinating the feet). Because aging can impair (i) the ability to fulfill the aforementioned requirements and (ii) corticomuscular communication, we hypothesized that aging would impair the motoneuronal recruitment by the primary motor cortex during bilateral cyclical movements. Here, we used corticomuscular coherence (i.e., coherence between the primary motor cortex and the active muscles) to examine whether corticomuscular communication is affected in older individuals during cyclical movements that shared some functional requirements with walking. Fifteen young men and 9 older men performed cyclical, anti-phasic dorsiflexion and plantarflexion of the feet while seated. Coherence between the midline primary motor cortex and contracting leg muscles cyclically increased in both age groups. However, the coherence of older participants was characterized by (i) lower magnitude and (ii) mediolaterally broader and more rostrally centered cortical distributions. These characteristics suggest that aging changes how the primary motor cortex participates in the cyclical movements, and such change may extend to walking.
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http://dx.doi.org/10.1038/srep44658DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5353607PMC
March 2017

Systematic Review of Postural Assessment in Individuals With Obstructive Respiratory Conditions: MEASUREMENT AND CLINICAL ASSOCIATIONS.

J Cardiopulm Rehabil Prev 2017 Mar;37(2):90-102

Department of Respiratory Medicine, West Park Healthcare Centre (Drs Lee, Brooks, and Goldstein), Department of Physical Therapy, University of Toronto (Drs Lee, Brooks, and Goldstein), and Department of Medicine, University of Toronto (Dr Goldstein), Toronto, Ontario, Canada.

Purpose: Changes in posture in individuals with an obstructive respiratory disease have been reported, but the extent of these deviations and their clinical significance is not well understood. This study aimed to systematically review the literature of the skeletal structural alignment in children and adults with an obstructive respiratory disease, describe the measurement techniques used, and determine the clinical relevance of any alternations.

Methods: Observational cohort or cross-sectional studies of postural assessment were identified, with 2 reviewers independently assessing study quality.

Results: A total of 18 studies were included, 12 in cystic fibrosis (CF), 5 in asthma, and 1 in chronic obstructive pulmonary disease (COPD). The overall quality assessment rating was 12.6 out of 16. Increased thoracic kyphosis or scoliosis was found in both children and adults with CF. Increased shoulder protraction and elevation were evident in asthma and COPD, although changes in spinal curvature were variable. The clinical impact of postural changes was diverse, with an inconsistent influence on lung function. A mix of methods was applied for postural assessment.

Conclusions: Skeletal structural malalignment appears to be present in some individuals with an obstructive respiratory disease, although the extent of alterations and its clinical impact is variable. Photogrammetry is used to provide a comprehensive assessment of posture in these populations.
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http://dx.doi.org/10.1097/HCR.0000000000000207DOI Listing
March 2017

The Effects of Acute Intense Physical Exercise on Postural Stability in Children With Cerebral Palsy.

Adapt Phys Activ Q 2016 Jul;33(3):271-82

Bloorview Research Inst., Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.

This study evaluated the effects of intense physical exercise on postural stability of children with cerebral palsy (CP). Center of pressure (CoP) was measured in 9 typically developing (TD) children and 8 with CP before and after a maximal aerobic shuttle-run test (SRT) using a single force plate. Anteroposterior and mediolateral sway velocities, sway area, and sway regularity were calculated from the CoP data and compared between pre- and postexercise levels and between groups. Children with CP demonstrated significantly higher pre-SRT CoP velocities than TD children in the sagittal (18.6 ± 7.6 vs. 6.75 1.78 m/s) and frontal planes (15.4 ± 5.3 vs. 8.04 ± 1.51 m/s). Post-SRT, CoP velocities significantly increased for children with CP in the sagittal plane (27.0 ± 1.2 m/s), with near-significant increases in the frontal plane (25.0 ± 1.5m/s). Similarly, children with CP evidenced larger sway areas than the TD children both pre- and postexercise. The diminished postural stability in children with CP after short but intense physical exercise may have important implications including increased risk of falls and injury.
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http://dx.doi.org/10.1123/APAQ.2015-0115DOI Listing
July 2016

Clinician's Commentary on Akhbari et al.(1).

Authors:
Karl Zabjek

Physiother Can 2015 Aug;67(3):254

Department of Physical Therapy, University of Toronto.

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http://dx.doi.org/10.3138/ptc.2014-51-CCDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4594818PMC
August 2015

Acute Physical Exercise Affects Cognitive Functioning in Children With Cerebral Palsy.

Pediatr Exerc Sci 2016 05 23;28(2):304-11. Epub 2015 Oct 23.

Interdisciplinary Research in Rehabilitation and Social Integration Center, Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Quebec, Canada.

Little is known about the effects of acute exercise on the cognitive functioning of children with cerebral palsy (CP). Selected cognitive functions were thus measured using a pediatric version of the Stroop test before and after maximal, locomotor based aerobic exercise in 16 independently ambulatory children (8 children with CP), 6-15 years old. Intense exercise had: 1) a significant, large, positive effect on reaction time (RT) for the CP group (preexercise: 892 ± 56.5 ms vs. postexercise: 798 ± 45.6 ms, p < .002, d = 1.87) with a trend for a similar but smaller response for the typically developing (TD) group (preexercise: 855 ± 56.5 ms vs. postexercise: 822 ± 45.6 ms, p < .08, d = 0.59), and 2) a significant, medium, negative effect on the interference effect for the CP group (preexercise: 4.5 ± 2.5%RT vs. postexercise: 13 ± 2.9%RT, p < .04, d = 0.77) with no significant effect for the TD group (preexercise: 7.2 ± 2.5%RT vs. postexercise: 6.9 ± 2.9%RT, p > .4, d = 0.03). Response accuracy was high in both groups pre- and postexercise (>96%). In conclusion, intense exercise impacts cognitive functioning in children with CP, both by increasing processing speed and decreasing executive function.
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http://dx.doi.org/10.1123/pes.2015-0110DOI Listing
May 2016

Ordering diagnostic imaging: a survey of ontario physiotherapists' opinions on an expanded scope of practice.

Physiother Can 2015 ;67(2):144-56

Department of Physical Therapy, University of Toronto, Toronto, Ont.

Purpose: To explore Ontario physiotherapists' opinions on their ability to order diagnostic imaging (DI).

Methods: An online questionnaire was sent to all registered members of the College of Physiotherapists of Ontario. Descriptive statistics were calculated using response frequencies. Practice characteristics were compared using χ(2) tests and Wilcoxon rank-sum tests.

Results: Of 1,574 respondents (21% response rate), 42% practised in orthopaedics and 53% in the public sector. Most physiotherapists were interested in ordering DI (72% MRI/diagnostic ultrasound, 78% X-rays/computed tomography scans). Respondents with an orthopaedic caseload of 50% or more (p<0.001) and those in the private sector (p<0.001) were more interested in ordering DI. Respondents preferred a DI course that combined face-to-face and Web-based components and one that was specific to their area of practice. Most respondents perceived minimal barriers to the uptake of ordering DI, and most agreed that support from other health care professionals would facilitate uptake.

Conclusion: The majority of Ontario physiotherapists are interested in ordering DI. For successful implementation of a health care change, such as physiotherapists' ability to order DI, educational needs and barriers to and facilitators of the uptake of the authorized activity should be considered.
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http://dx.doi.org/10.3138/ptc.2014-09DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4407136PMC
May 2015

Development of a video-based technique for ambulatory monitoring of foot placement with an instrumented rollator.

J Rehabil Med 2015 Mar;47(3):273-7

Graduate Department of Rehabilitation Science,, University of Toronto, M5G 1V7 Toronto, Canada .

Objective: To develop a video-based system, mounted on a rollator to quantify the step width values of rollator users in the community.

Subjects: A total of 5 able-bodied young adults, age range 24-28 years.

Methods: A digital video camera system was mounted on the rollator frame to capture the position of the participant's feet during overground walking. A method of estimating step width from the video data was developed and evaluated against the output from a concurrently recording Vicon MX motion capture system.

Results: Mean step widths of the rollator and motion capture systems were 14.40 cm (standard deviation (SD) 4.64) and 14.37 cm (SD 4.34), respectively, revealing a strong level of agreement; intra-class correlation coefficient 0.999 (95% confidence interval (95% CI) 0.987-1.000; and root-mean-square difference 0.70 cm.

Conclusion: The video-based system mounted on a rollator to collect foot placement data enabled accurate measurement of step width during rollator use. The ability to record foot placement measurements outside the laboratory setting, characterizing foot placement patterns occurring in the community, will enable research into how these assistive devices influence mobility during everyday use.
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http://dx.doi.org/10.2340/16501977-1907DOI Listing
March 2015

Toward an artificial sensory feedback system for prosthetic mobility rehabilitation: examination of sensorimotor responses.

J Rehabil Res Dev 2014 ;51(6):907-17

Institute for Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada;

People with lower-limb amputation have reduced mobility due to loss of sensory information, which may be restored by artificial sensory feedback systems built into prostheses. For an effective system, it is important to understand how humans sense, interpret, and respond to the feedback that would be provided. The goal of this study was to examine sensorimotor responses to mobility-relevant stimuli. Three experiments were performed to examine the effects of location of stimuli, frequency of stimuli, and means for providing the response. Stimuli, given as vibrations, were applied to the thigh region, and responses involved leg movements. Sensorimotor reaction time (RT) was measured as the duration between application of the stimulus and initiation of the response. Accuracy of response was also measured. Overall average RTs for one response option were 0.808 +/- 0.142 s, and response accuracies were >90%. Higher frequencies (220 vs 140 Hz) of vibration stimulus provided in anterior regions of the thigh produced the fastest RTs. When participants were presented with more than one stimulus and response option, RTs increased. Findings suggest that long sensorimotor responses may be a limiting factor in the development of an artificial feedback system for mobility rehabilitation applications; however, feed-forward techniques could potentially help to address these limitations.
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http://dx.doi.org/10.1682/JRRD.2013.07.0164DOI Listing
July 2015

Emerging technology within the field of active gaming: towards the establishment of evidence.

Authors:
Karl Zabjek

Gait Posture 2014 Apr;39(4):1157-8; discussion 1158-61

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http://dx.doi.org/10.1016/j.gaitpost.2013.12.018DOI Listing
April 2014

Combining ambulatory and laboratory assessment of rollator use for balance and mobility in neurologic rehabilitation in-patients.

Disabil Rehabil Assist Technol 2015 15;10(5):407-14. Epub 2014 Apr 15.

Department of Kinesiology, University of Waterloo , Waterloo , Canada .

Purpose: Despite the common use of rollators (four-wheeled walkers), understanding their effects on gait and balance is limited to laboratory testing rather than everyday use. This study evaluated the utility of an ambulatory assessment approach to examine balance and mobility in everyday conditions compared to a laboratory assessment.

Methods: Standing and walking with a rollator was assessed in three neurological rehabilitation in-patients under two conditions: (1) in laboratory (i.e. forceplate, GaitRite), and (2) while performing a natural walking course within and outside of the institution. An instrumented rollator (iWalker) was used to measure variables related to the balance control (e.g. upper limb kinetics), destabilizing events (e.g. stumbling), and environmental context.

Results: Two of three patients demonstrated greater reliance on the rollator for standing balance (2.3-5.9 times higher vertical loading, 72-206% increase in COP excursion) and 29-42% faster gait during the walking course compared to the laboratory. Importantly, destabilizing events (collisions, stumbling) were recorded during the walking course. Such events were not observed in the laboratory.

Conclusion: This study illustrated a greater reliance on the rollator during challenges in everyday use compared to laboratory assessment and provided evidence of specific circumstances associated with destabilizing events that may precipitate falls in non-laboratory settings. Implications for Rehabilitation The value of combining laboratory and ambulatory assessment approaches to provide a more comprehensive profile of the risks and benefits of rollator use to prevent falling was studied. Patients demonstrated greater reliance on rollator assistive devices for standing balance and exhibited higher gait speeds during ambulatory assessment, compared to standard laboratory protocols. Repeated instances of events that may precipitate falls (e.g. collisions, stumbling, and unloading behaviors) were observed only during the ambulatory assessment. Individual challenges to balance can be used to identify specific training targets, assess suitability for assistive devices, and recommend rehabilitation goals.
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http://dx.doi.org/10.3109/17483107.2014.908243DOI Listing
April 2016