Markerless Kinematics of Pediatric Manual Wheelchair Mobility

Pediatric manual wheelchair users face substantial risk of orthopaedic injury to the upper extremities, particularly the shoulders, during transition to wheelchair use and during growth and development. Propulsion strategy can influence mobility efficiency, activity participation, and quality of life. The current forefront of wheelchair biomechanics research includes translating findings from adult to pediatric populations, improving the quality and efficiency of care under constrained clinical funding, and understanding injury mechanisms and risk factors. Typically, clinicians evaluate wheelchair mobility using marker-based motion capture and instrumentation systems that are precise and accurate but also time-consuming, inconvenient, and expensive for repeated assessments. There is a substantial need for technology that evaluates and improves wheelchair mobility outside of the laboratory to provide better outcomes for wheelchair users, enhancing clinical data. Advancement in this area gives physical therapists better tools and the supporting research necessary to improve treatment efficacy, mobility, and quality of life in pediatric wheelchair users. This dissertation reports on research studies that evaluate the effect of physiotherapeutic training on manual wheelchair mobility. In particular, these studies (1) develop and characterize a novel markerless motion capture-musculoskeletal model systems interface for kinematic assessment of manual wheelchair propulsion biomechanics, (2) conduct a longitudinal investigation of pediatric manual wheelchair users undergoing intensive community-based therapy to determine predictors of kinematic response, and (3) evaluate propulsion pattern-dependent training efficacy and musculoskeletal behavior using visual biofeedback.Results of the research studies show that taking a systems approach to the kinematic interface produces an effective and reliable system for kinematic assessment and training of manual wheelchair propulsion. The studies also show that the therapeutic outcomes and orthopaedic injury risk of pediatric manual wheelchair users are significantly related to the propulsion pattern employed. Further, these subjects can change their propulsion pattern in response to therapy even in the absence of wheelchair-based training, and have pattern-dependent differences in joint kinematics, musculotendon excursion, and training response. Further clinical research in this area is suggested, with a focus on refining physiotherapeutic training strategies for pediatric manual wheelchair users to develop safer and more effective propulsion patterns

Wearable Movement Sensors for Rehabilitation: From Technology to Clinical Practice

This Special Issue shows a range of potential opportunities for the application of wearable movement sensors in motor rehabilitation. However, the papers surely do not cover the whole field of physical behavior monitoring in motor rehabilitation. Most studies in this Special Issue focused on the technical validation of wearable sensors and the development of algorithms. Clinical validation studies, studies applying wearable sensors for the monitoring of physical behavior in daily life conditions, and papers about the implementation of wearable sensors in motor rehabilitation are under-represented in this Special Issue. Studies investigating the usability and feasibility of wearable movement sensors in clinical populations were lacking. We encourage researchers to investigate the usability, acceptance, feasibility, reliability, and clinical validity of wearable sensors in clinical populations to facilitate the application of wearable movement sensors in motor rehabilitation

Wounds research for patient benefit: a 5-year programme of research

Background Complex wounds are those that heal by secondary intention and include lower-limb ulcers, pressure ulcers and some surgical wounds. The care of people with complex wounds is costly, with care mainly being delivered by community nurses. There is a lack of current, high-quality data regarding the numbers and types of people affected, care received and outcomes achieved. Objectives To (1) assess how high-quality data about complex wounds can be captured effectively for use in both service planning and research while ensuring integration with current clinical data collection systems and minimal impact on staff time; (2) investigate whether or not a clinical register of people with complex wounds could give valid estimates of treatment effects, thus reducing dependence on large-scale randomised controlled trials (RCTs); (3) identify the most important research questions and outcomes for people with complex wounds from the perspectives of patients, carers and health-care professionals; (4) evaluate the potential contributions to decision-making of individual patient data meta-analysis and mixed treatment comparison meta-analysis; and (5) complete and update systematic reviews in topic areas of high priority. Methods To meet objectives 1 and 2 we conducted a prevalence survey and developed and piloted a longitudinal disease register. A consultative, deliberative method and in-depth interviews were undertaken to address objective 3. To address objectives 4 and 5 we conducted systematic reviews including mixed treatment comparison meta-analysis. Results From the prevalence survey we estimated the point prevalence of all complex wounds to be 1.47 per 1000 people (95% confidence interval 1.38 to 1.56 per 1000 people). Pressure ulcers and venous leg ulcers were the most common type of complex wound. A total of 195 people with a complex wound were recruited to a complex wounds register pilot. We established the feasibility of correctly identifying, extracting and transferring routine NHS data into the register; however, participant recruitment, data collection and tracking individual wounds in people with multiple wounds were challenging. Most patients and health professionals regarded healing of the wound as the primary treatment goal. Patients were greatly troubled by the social consequences of having a complex wound. Complex wounds are frequently a consequence of, and are themselves, a long-term condition but treatment is usually focused on healing the wound. Consultative, deliberative research agenda setting on pressure ulcer prevention and treatment with patients, carers and clinicians yielded 960 treatment uncertainties and a top 12 list of research priorities. Of 167 RCTs of complex wound treatments in a systematic review of study quality, 41% did not specify a primary outcome and the overall quality of the conduct and reporting of the research was poor. Mixed-treatment comparison meta-analysis in areas of high priority identified that matrix hydrocolloid dressings had the highest probability (70%) of being the most effective dressing for diabetic foot ulcers, whereas a hyaluronan fleece dressing had the highest probability (35%) of being the most effective dressing for venous ulcers; however, the quality of this evidence was low and uncertainty is high. Conclusions Complex wounds are common and costly with a poor evidence base for many frequent clinical decisions. There is little routine clinical data collection in community nursing. A prospective complex wounds register has the potential to both assist clinical decision-making and provide important research evidence but would be challenging to implement without investment in information technology in NHS community services. Future work should focus on developing insights into typical wound healing trajectories, identifying factors that are prognostic for healing and assessing the cost-effectiveness of selected wound treatments. Funding The National Institute for Health Research Programme Grants for Applied Research programme

Psychological Adjustment to Disability: Heterogeneous Trajectories of Resilience and Depression Following Physical Impairment or Amputation

Adjustment to disability is a foundational concept within rehabilitation psychology and constitutes an important public health problem given the adverse outcomes associated with maladjustment. While the disability literature has highlighted depressive elevations in response to functional impairment, resilience and alternative patterns of psychological adjustment have received substantially less empirical inquiry. This dissertation is comprised of three papers, the first two of which are longitudinal studies utilizing distinct samples of individuals with acquired disabilities: a population-sample of physically impaired older adults, and a convenience sample of individuals with newly acquired amputations. The third paper summarizes current data science and statistical findings regarding disability adjustment for patients and their providers. The two longitudinal studies share a common statistical methodology, latent growth mixture modeling (LGMM), allowing for the identification of distinct subgroups (classes) of individuals who share similar symptom profiles over time. LGMM is well-poised to resolve fundamental questions about whether psychological functioning after disability is best described by a population-level archetypal response (i.e., distress and depression that remits over time), or alternatively, whether the data suggest a variety of definable subgroups with distinct psychological trajectories. Results of empirical papers 1 and 2 provide strong empirical evidence that the process of disability adjustment is heterogeneous, with multiple pathways of symptom development and remission. The third paper demonstrates how findings from current rehabilitation science can be utilized to inform psychoeducational materials for practitioners and their patients with recent limb loss. This chapter addresses gaps in dissemination of knowledge by describing various patterns of psychological outcomes encountered by individuals following amputation surgery, as supported by Study 2 and the broader resilience literature

Community and Family-Focused Public Health and Sustainable Development

The book “Community and Family-Focused Public Health and Sustainable Development” was originally published in the renowned International Journal of Environmental Research and Public Health. This Special Issue encompassed novel aspects of applications that are connected with sustainability issues in community and family-focused public health studies. Contributions have a significant impact on solving public health problems at the family and community levels. The Special Issue originally published scientific papers, including review articles, that fell under this Special Issue’s remit and that were relevant to audiences worldwide. Currently, the term “family health” is most commonly to describe mother and child health and reproductive health. It is rare for family health to include the family as an important context for health development and that includes all family members and the family’s social environment. Authors of scientific research covering issues related to the impact of the family and the environment in which the family lives and functions on its members’ health in the present and in the future were encouraged to contribute their work. In addition, we were especially interested in scientific reports on social, economic, and health inequalities in the context of achieving the sustainable development goals

Beyond Scalpels and Stethoscopes: A Phenomenology of Cognitive Artefacts, Classifications, and Schema Integration in Rehabilitation Medicine

Tool use is a defining capability of the human species. In the field of Health, tools are pervasive and integral to practice. Whilst the function of many tools used in Health are overt, (e.g. a scalpel), tools designed to support cognition, (i.e. cognitive artefacts), may be less so. For this reason, the description and analysis of cognitive artefacts is important. The ability to classify represents a primary cognitive skill in Healthcare practice where classifications serve to provide information infrastructures upon which practice unfolds. Formal classification systems in Health continue to evolve for which the development of cognitive artefacts can assist in their practical application. With the availability of multiple classifications in Health, practitioners concerned with holistic, person-centred approaches to care require an ability to integrate classifications when engaging in cognitive tasks such as problem solving. The cognitive task of integrating classifications introduces a framing problem for practitioners where multiple schemas, or representations of the world, require simultaneous mapping to a common global schema or framework. The design of cognitive artefacts targeting the integration of classificatory schemas in Health practice appeals to practitioners whose lived experience involves this work. To that end, this thesis provides a first-person phenomenological account of a cognitive artefact designed for the integrated application of the reference classifications of the World Health Organisation’s Family of International Classifications (WHO FIC) in the field of Rehabilitation Medicine. Using a phenomenological approach, taken-for-granted assumptions about the WHO FIC are set aside to permit reconsideration of classifications with reference to basic phenomena of time and space from which the building blocks of the cognitive artefact are constructed. Elaboration of this model occurs with the additional representation of the Body, Activities, and the Environment as dynamic interacting components within the temporospatial field. These 3 components are further represented in a 20-cell array derived using the main chapter headings from the International Classification of Functioning, Disability and Health (ICF) which is viewed as analogous to a 2-dimensional cellular automaton. Following description of the cognitive artefact design worked, examples of problems in Rehabilitation Medicine are provided that highlight the cognitive artefacts capacity to address and integrate multiple framing perspectives. Key phenomenological findings from the study include: 1) recognition of the role of artefacts in grounding a subjects temporospatial ‘lifeworld’ using visual diagrams and imagery, 2) highlighting the value of utilising a generic problem space when approaching Rehabilitation Medicine problems that demand multiple-frame perspectives, 3) using a 2-dimensional automata-like structure to appreciate the relational complexity of problems encountered in Rehabilitation Medicine, 4) appreciating the role of artefact construction for framing integration in Rehabilitation Medicine problem solving, and 5) locating the lived experience of the practitioner as a moral actor who can be positioned (alongside their patient) within the artefact frame. The study findings provide a sound basis for potential future research into the role of artefacts in Rehabilitation Medicine practice where an overarching goal is the integrated application of health classifications in the pursuit of person-centred care