Technologies and combination therapies for enhancing movement training for people with a disability

There has been a dramatic increase over the last decade in research on technologies for enhancing movement training and exercise for people with a disability. This paper reviews some of the recent developments in this area, using examples from a National Science Foundation initiated study of mobility research projects in Europe to illustrate important themes and key directions for future research. This paper also reviews several recent studies aimed at combining movement training with plasticity or regeneration therapies, again drawing in part from European research examples. Such combination therapies will likely involve complex interactions with motor training that must be understood in order to achieve the goal of eliminating severe motor impairment

Personalized neuromusculoskeletal modeling to improve treatment of mobility impairments: a perspective from European research sites

Mobility impairments due to injury or disease have a significant impact on quality of life. Consequently, development of effective treatments to restore or replace lost function is an important societal challenge. In current clinical practice, a treatment plan is often selected from a standard menu of options rather than customized to the unique characteristics of the patient. Furthermore, the treatment selection process is normally based on subjective clinical experience rather than objective prediction of post-treatment function. The net result is treatment methods that are less effective than desired at restoring lost function. This paper discusses the possible use of personalized neuromusculoskeletal computer models to improve customization, objectivity, and ultimately effectiveness of treatments for mobility impairments. The discussion is based on information gathered from academic and industrial research sites throughout Europe, and both clinical and technical aspects of personalized neuromusculoskeletal modeling are explored. On the clinical front, we discuss the purpose and process of personalized neuromusculoskeletal modeling, the application of personalized models to clinical problems, and gaps in clinical application. On the technical front, we discuss current capabilities of personalized neuromusculoskeletal models along with technical gaps that limit future clinical application. We conclude by summarizing recommendations for future research efforts that would allow personalized neuromusculoskeletal models to make the greatest impact possible on treatment design for mobility impairments

Structures promoting research, training, and technology transfer in mobility: lessons learned from a visit to European centers

The purpose of this paper is to describe the education, research, technology transfer, and cooperative models that appear to have the greatest likelihood of successfully tackling the issue of technology to improve mobility. Ideally better models in each of these areas will lead to an increased number of researchers who are more productive. There will be increased international collaboration that will allow for better research with small and/or disadvantaged populations, and the research completed will lead to changes in clinical care that positively impact individuals with impair mobility

UNILATERAL SHOULDER PAIN IS ASSOCIATED WITH ASYMMETRIES IN TENDON THICKNESS FOLLOWING MAXIMUM EXERTION IN AN ELITE WHEELCHAIR RUGBY ATHLETE: A CASE IN POINT TOWARDS INDIVIDUALIZED FEEDBACK

The purpose of this study was to describe changes in tendon thickness following maximum exertion in the symptomatic and asymptomatic shoulder of a highly trained wheelchair rugby athlete with tetraplegia. Tendon thickness of the biceps and supraspinatus on both sides were measured with ultrasound before any physical tests, after a treadmill test up to maximum exertion to define aerobic capacity, and after a 30s Wingate test to define anaerobic capacity. The athlete reported moderate to severe shoulder pain, quantified with the upper extremity pain symptom questionnaire (PSQ) on the left shoulder and no pain on the right shoulder. There was a meaningful reduction (i.e., \u3e 2 x SD) in biceps and supraspinatus tendon thickness after the physical tests at the asymptomatic shoulder with no meaningful changes at the symptomatic shoulder. Reduction in tendon thickness has been related to increased alignment of the collagen fibres or creep which is a typical response to tensile loading. While the symptomatic shoulder presented a higher peak power output, there was a significantly greater drop in maximum power output during the Wingate test. Subsequently, the greater decline in power output with fatigue in the symptomatic shoulder, may have increased loads on the asymptomatic shoulder and be related to the greater reduction in tendon thickness following exertion. This demonstrates the importance to monitor and reduce asymmetries to improve performance and prevent injury and pain