Co-creation and Evaluation of an Adapted Physical Activity Toolkit: Guidelines To Support Practice Among Rehabilitation Professionals in Community Organizations

Background: Limited knowledge and skills of health professionals is a common barrier when adapting physical activity for people with disabilities. A community organization (Adaptavie) identified the need for improved training and resources to facilitate APA prescription by their employees. The objectives of this research were to co-create an APA toolkit and evaluate implementation. Methods: A multi-method participatory research approach was used with kinesiologists who worked at Adaptavie. The project consisted of two phases: P1) co-creation of the toolkit; P2) implementation evaluation. Sociodemographic information (P1; P2), the Work self-efficacy Inventory Survey (P1; P2), the Indicators of Success Questionnaire (P2) and focus groups (P1 n = 3; P2 n = 1) were conducted with kinesiologists. Summary statistics were described (sociodemographic and questionnaires) and analysed thematically (focus groups). Results: The co-creation of an evidence-based training toolkit contained information about 45 types of disabilities. Five to eight kinesiologists (depending on the phase) reported improvements in workplace self-efficacy, skills and knowledge after using the APA toolkit for one year. Following implementation, the APA toolkit was reported to have a high level of usability and fidelity. Conclusion: A co-created APA toolkit supported kinesiologists to prescribe evidence-based APA programs by increasing their knowledge, skills and self-efficacy

Évaluation de la condition physique dans le handicap douloureux

La condition physique est un élément déterminant important de l’autonomie fonctionnelle, de la qualité de vie. Elle peut être altérée de manière non spécifique dans les douleurs chroniques. Avoir un outil pour la mesurer chez le patient douloureux chronique permet d’en avoir une estimation de base. À partir de cette donnée, le thérapeute pourra élaborer un plan de revalidation et un suivi. Dans ce but, un test d’effort sous-maximal a été conçu et validé. Ce test est simple, sécuritaire, fiable et peu onéreux. Nous le décrivons ainsi que sa mise en place en pratique.[Fitness assessment test in painful handicap] Physical fitness is non-specifically altered in chronic pain. Having a tool to measure it in the chronic pain patient allows having a basic estimate. From this data, the therapist can follow-up and develop a revalidation plan. For this purpose, a submaximal effort test has been designed and validated. This test is simple, safe, reliable, and inexpensive. The article describes it as well as about its implementation in practice

Visual feedback and age affect upper limb reaching accuracy and kinematics in immersive virtual reality among healthy adults

This cross-sectional study aimed to evaluate the effect of visual feedback, age and movement repetition on the upper limb (UL) accuracy and kinematics during a reaching task in immersive virtual reality (VR). Fifty-one healthy participants were asked to perform 25 trials of a reaching task in immersive VR with and without visual feedback of their hand. They were instructed to place, as accurately and as fast as possible, a controller held in their non-dominant hand in the centre of a virtual red cube of 3 cm side length. For each trial, the end-point error (distance between the tip of the controller and the centre of the cube), a coefficient of linearity (CL), the movement time (MT), and the spectral arc length of the velocity signal (SPARC), which is a movement smoothness index, were calculated. Multivariate analyses of variance were conducted to assess the influence of visual feedback, age and trial repetition on the average end-point error, SPARC, CL and MT, and their time course throughout the 25 trials. Providing visual feedback of the hand reduced average end-point error (P < 0.001) and MT (P = 0.044), improved SPARC (P < 0.001) but did not affect CL (P = 0.07). Younger participants obtained a lower mean end-point error (P = 0.037), a higher SPARC(P = 0.021) and CL (P = 0.013). MT was not affected by age(P = 0.671). Trial repetition increased SPARC (P < 0.001) and CL (P < 0.001), and reduced MT (P = 0.001) but did not affect end-point error (P = 0.608). In conclusion, the results of this study demonstrated that providing visual feedback of the hand and being younger improves UL accuracy and movement smoothness in immersive VR. UL kinematics but not accuracy can be improved with more trial repetitions. These findings could guide the future development of protocols in clinical rehabilitation and research

Comparison and validation of pressure and acceleration time-domain waveform models of a smart insole for accurate step count in healthy people

Several studies have shown good accuracies for step count based on pressure signals of smart insoles in people walking at different speeds. Although smart insoles are often equipped with pressure sensors and accelerometer, no study has focused on comparing the accuracy of step count separately based on pressure and acceleration signals in healthy people. The objectives of this study were to design a waveform model of accelerometer and pressure sensors, and then compare with commercially well-known step count devices and validate these models using manual step counter for step count. Eight healthy participants (age: 39.8±17.56 years old) wore a pair of smart insoles, a GaitUp, and a StepWatchTM and performed the six-minute walking test at walking speeds from 1.62 to 2.22 m/s. Four pressure and one acceleration waveform models were designed and used for the detection of 341 to 412 steps. Accuracies ranged from 99.80%±0.60% to 99.97%±1.38% for right side, and from 99.67%±0.63% to 99.90%±0.05% for left side with pressure waveform models. In addition, the acceleration waveform model provided accuracies of 99.87%±2.49% and 99.84%±4.77% for right and left sides respectively. Step count accuracies using the GaitUp were 99.51%±2.06% for right side, and 99.51%±4.32% for left side. Finally, the StepWatchTM yielded step count accuracies of 99.31%±15.95% and 98.52%±28.06% for right and left sides respectively. These results suggested the smart insole with pressure and acceleration waveform models as more accurate than the StepWatchTM and the GaitUp for step count

Quantification of upper limb position sense using an exoskeleton and a virtual reality display

Abstract Background Proprioceptive sense plays a significant role in the generation and correction of skilled movements and, consequently, in most activities of daily living. We developed a new proprioception assessment protocol that enables the quantification of elbow position sense without using the opposite arm, involving active movement of the evaluated limb or relying on working memory. The aims of this descriptive study were to validate this assessment protocol by quantifying the elbow position sense of healthy adults, before using it in individuals who sustained a stroke, and to investigate its test-retest reliability. Methods Elbow joint position sense was quantified using a robotic device and a virtual reality system. Two assessments were performed, by the same evaluator, with a one-week interval. While the participant’s arms and hands were occluded from vision, the exoskeleton passively moved the dominant arm from an initial to a target position. Then, a virtual arm representation was projected on a screen placed over the participant’s arm. This virtual representation and the real arm were not perfectly superimposed, however. Participants had to indicate verbally the relative position of their arm (more flexed or more extended; two-alternative forced choice paradigm) compared to the virtual representation. Each participant completed a total of 136 trials, distributed in three phases. The angular differences between the participant’s arm and the virtual representation ranged from 1° to 27° and changed pseudo-randomly across trials. No feedback about results was provided to the participants during the task. A discrimination threshold was statistically extracted from a sigmoid curve fit representing the relationship between the angular difference and the percentage of successful trials. Test-retest reliability was evaluated with 3 different complementary approaches, i.e. a Bland-Altman analysis, an intraclass correlation coefficient (ICC) and a standard error of measurement (SEm). Results Thirty participants (24.6 years old; 17 males, 25 right-handed) completed both assessments. The mean discrimination thresholds were 7.0 ± 2.4 (mean ± standard deviation) and 5.9 ± 2.1 degrees for the first and the second assessment session, respectively. This small difference between assessments was significant (− 1.1 ± 2.2 degrees), however. The assessment protocol was characterized by a fair to good test-retest reliability (ICC = 0.47). Conclusion This study demonstrated the potential of this assessment protocol to objectively quantify elbow position sense in healthy individuals. Futures studies will validate this protocol in older adults and in individuals who sustained a stroke

Effect of an immersive virtual reality serious game to promote physical activity and cognition among older adults.

Background: To halt functional and cognitive decline that tends to augment with the age, there are increasing needs for new rehabilitation methods such as virtual reality (VR). Methods: A dozen of older adults (age>65 years) were recruited and asked to wear a fitness tracker watch for three consecutive weeks. During the first and third week, participants were instructed not to use immersive VR devices. During the second week, they were required to autonomously interact with a self-adaptive immersive VR serious game, for at least 15 minutes per day. ANOVA repeated measures tests were undertaken to compare participants’ number of steps, distance covered and number of consumed calories between week one, two and three. Older adults’ cognition and reaction time was also evaluated using the Montreal Cognitive Assessment and a smartphone application. Results: Older adults did not significantly improved their number of steps, distance covered and number of consumed calories between week one, two and three (p>0.05). Cognition was improved between baseline and week 2 (p=0.026), and between baseline and week 3 (p=0.046) whereas no between weeks difference was found for reaction time (p=0.814). Conclusion: One week of interaction with a self-adaptive serious game in immersive VR seems to enhance cognition with a retention at one-week post-intervention but does not lead to an improved activity nor reaction time among older adults

Immersive Virtual Reality to Assess Arm Kinematics among Older Adults with and without Major Neurocognitive Disorder – An Exploratory Cross-Sectional Study

Despite the recommendation of improving assessment objectivity and frequency, the use of immersive virtual reality to measure and quantify movement quality remains underexplored. In this study, we aimed to evaluate the reliability, validity and usability of an immersive virtual reality application, KinematicsVR, to assess upper limb kinematics among older adults with and without major neurocognitive disorder. The KinematicsVR involves the drawing of three-dimensional straight lines, circles and squares using a controller in a virtual environment. Twenty-eight older adults with or without major neurocognitive disorder were recruited. Reliability was evaluated through correlations on test–retest and validity through correlations between KinematicsVR variables and other functional tests (TEMPA, BBT-VR and Finger-Nose Test). The usability of the KinematicsVR was assessed with the System Usability Scale questionnaire. Kinematic indexes were compared between eight adults with major neurocognitive disorder and eight matched controls. Results indicated that most variables provided by the KinematicsVR had excellent reliability for tasks involving the drawing of straight lines and circles, but moderate reliability for tasks involving the drawing of squares. Secondary analyses showed that the usability of the application was excellent but few significant and strong correlations were observed between variables of the KinematicsVR and the scores of the TEMPA scale, Finger-Nose Test and BBT-VR. Adults with major neurocognitive disorder, when compared to other older adults, made larger and less linear hand movements. These findings provide perspectives for the use of immersive virtual reality to improve assessment frequency and objectivity through the autonomous measure of upper limb kinematics in older adults

Measuring global activity performance in children with cerebral palsy in West Africa: validation of an adapted version of the ACTIVLIM-CP questionnaire.

PURPOSE: To calibrate a West-African version of the ACTIVLIM-CP questionnaire (ACTIVLIM-CP-WA) for children with cerebral palsy (CP). MATERIALS AND METHODS: We recruited 287 children with CP of various age range: 2-6 years (n = 117, preschoolers), 6-12 years (n = 96, children) and 12-19 years (n = 74, adolescents). Caregivers of children of each age range completed the experimental version of the ACTIVLIM-CP-WA including 76 (preschoolers), 78 (children) and 76 (adolescents) global daily life activities. Responses were analyzed using the Rasch RUMM2030 software. RESULTS: The final West-African version of ACTIVLIM-CP including 31 items (both common and age-specific items) defined a unidimensional, linear scale with well-discriminated response categories. It presented a high internal consistency (R = 0.94). Moreover, all items were locally independent and the item difficulty hierarchy was invariant regarding caregivers' education, children's age and gender, MACS and GMFCS levels. The ACTIVLIM-CP-WA measures were significantly correlated (p < 0.05) with Gross Motor Function Classification System (ρ = -0.77), Manual Ability Classification System (ρ = -0.75), Box and Block test (dominant hand r = 0.51; non-dominant hand r = 0.49), One-minute walking test (r = 0.28), and Timed up and Go test (r = -0.40). CONCLUSIONS: The ACTIVLIM-CP-WA questionnaire provides a valid and reliable tool that has the potential to follow children's evolution and quantify changes consecutive to neurorehabilitation in Sub-Saharan Africa.IMPLICATIONS FOR REHABILITATIONThe West-African version of the ACTIVLIM-CP questionnaire (ACTIVLIM-CP-WA) measures global activities requiring a combination of lower and upper extremities in children with cerebral palsy.As a Rasch-built scale, measures are unidimensional and linear to document changes in children with cerebral palsy from 2 to 19 years in Sub-Saharan Africa.Rehabilitation professionals are encouraged to use the ACTIVLIM-CP-WA questionnaire as a psychometrically robust assessment tool measuring the global performance in daily life activities in children with cerebral palsy in Sub-Saharan Africa

Acceptability, Feasibility, and Effectiveness of Immersive Virtual Technologies to Promote Exercise in Older Adults: A Systematic Review and Meta-Analysis

Context: This review aimed to synthesize the literature on the acceptability, feasibility, and effectiveness of immersive virtual technologies to promote physical exercise in older people. Method: We performed a literature review, based on four databases (PubMed, CINAHL, Embase, and Scopus; last search: 30 January 2023). Eligible studies had to use immersive technology with participants aged 60 years and over. The results regarding acceptability, feasibility, and effectiveness of immersive technology-based interventions in older people were extracted. The standardized mean differences were then computed using a random model effect. Results: In total, 54 relevant studies (1853 participants) were identified through search strategies. Concerning the acceptability, most participants reported a pleasant experience and a desire to use the technology again. The average increase in the pre/post Simulator Sickness Questionnaire score was 0.43 in healthy subjects and 3.23 in subjects with neurological disorders, demonstrating this technology’s feasibility. Regarding the effectiveness, our meta-analysis showed a positive effect of the use of virtual reality technology on balance (SMD = 1.05; 95% CI: 0.75–1.36; p < 0.001) and gait outcomes (SMD = 0.7; 95% CI: 0.14–0.80; p < 0.001). However, these results suffered from inconsistency and the number of trials dealing with these outcomes remains low, calling for further studies. Conclusions: Virtual reality seems to be well accepted by older people and its use with this population is feasible. However, more studies are needed to conclude its effectiveness in promoting exercise in older people

Validity of the Walked Distance Estimated by Wearable Devices in Stroke Individuals

International audienceHealth professionals need valid devices to assess a stroke individual's ability to walk. The aim was to evaluate the validity of the estimation of the walked distance by wearable devices and the impact of the sensor's position in stroke individuals