Investigations into the potential for using reciprocal pedalling exercise to assess, measure and enhance lower limb function after stroke.

Upright Pedalling (UP) exercise offers opportunities for stroke survivors to participate in functional, repetitive lower limb activity with similarities to walking. Such functional activity is required to enhance the brain changes underlying recovery of motor function after stroke. UP might also offer opportunities for assessment and measurement of lower limb impairment during functionally-relevant activity. A systematic review using Cochrane methodology investigated effects of reciprocal pedalling (RP) on lower limb motor function after stroke. Despite some beneficial, though not definitive, effects, it was not possible to make clinical recommendations supporting or refuting RP after stroke, due to inter-study heterogeneity, wide confidence intervals around effect sizes and risks of potential biases. A feasibility study investigated participation in Upright Pedalling (UP) by people in the first month after stroke, with substantial weakness and not able to walk, and explored characterisation of lower limb movement during UP. 84.6 % (n=11) of people tested were able to participate in UP. Smooth, reciprocal pedalling was evident in stroke survivors with substantial weakness, using heterogeneous patterns. Though 84.2% (n=16) of those approached consented to participate, attrition was high due to service reorganisation, with 2.2% (n=9 of 411) of those screened actually randomised. A prospective measurement study explored the reliability and discriminative ability of impairment measures derived during instrumented UP (smoothness of pedalling, muscle activation timing, reciprocity of muscle activity). Results indicated that instrumented UP could be used to discriminate between stroke survivors and healthy age-matched volunteers for timing of onset and offset muscle activation (multi-variate ANOVA, difference in activity according to wheel position, p=0.034) and reciprocal activation (two sample t-test, difference -0.249 (CI: -0.491, -0.010; p=0.044) for quadriceps. It was not possible to establish definitive test-retest repeatability with sufficient precision to make clinical recommendations. UP is a new, promising technology for assessment, rehabilitation and measurement that is worthy of future investigation

Sampling Social Experiences in School: Feasibility of Experience Sampling Methodology on an iPlatform

This paper reports on a pilot study testing the feasibility of an app as a survey tool for exploring the social experiences of high school students who are vision impaired. The Participation in Everyday Life Survey app was designed for use with the Experience Sampling Method. This method uses in-the-moment surveys to understand individuals’ experiences of everyday activities and situations. Pilot testing shows the app to be usable and accessible for people with vision impairments and high school students who are sighted but who have other disabilities. This pilot study has also shown that the Experience Sampling Method has the potential to provide useful insights into the social experiences of high school students who are vision impaired

Recovery Assessment Scale - Domains and Stages (RAS-DS) Manual - Version 2

Manual to guide administration of the Recovery Assessment Scale - Domains and Stages (RAS-DS). The RAS-DS has 38 items or statements for the consumer to rate. It is a Likert scale with 4 rating categories for consumers to select from: “untrue”; “a bit true”; “mostly true” and “completely true”. The items have been divided into 4 recovery domains: Doing Things I Value (functional recovery); Looking Forward (personal recovery); Mastering My Illness (clinical recovery) and Connecting and Belonging (social recovery)

On the gravitational instability of a dissipative medium

This paper shows that the ordinary Jeans wave number can be obtained as a limiting case of a more general approach that includes dissipative effects. Corrections to the Jeans critical mass associated to viscosity are established. Some possible implications of the results are finally discussed.Comment: 5 pages, RevTe

CAPAbility: Comparison of the JOURNEY II Bi-Cruciate Stabilised and GENESIS II total knee arthroplasty in performance and functional ability: protocol of a randomised controlled trial

Background: Osteoarthritis of the knee is a common condition that is expected to rise in the next two decades leading to an associated increase in total knee replacement (TKR) surgery. Although there is little debate regarding the safety and efficacy of modern TKR, up to 20% of patients report poor functional outcomes following surgery. This study will investigate the functional outcome of two TKRs; the JOURNEY II Bi-Cruciate Stabilised knee arthroplasty, a newer knee prosthesis designed to provide guided motion and improve knee kinematics by more closely approximating a normal knee, and the GENESIS II, a proven existing design. Aim: To compare the change in Patient-reported Outcome Measures (PROMs) scores of the JOURNEY II BCS and the GENESIS II from pre-operation to 6 months post operation. Methods: CAPAbility is a pragmatic, blinded, two-arm parallel, randomised controlled trial recruiting patients with primary osteoarthritis due to have unilateral TKR surgery across two UK hospitals. Eligible participants (n = 80) will be randomly allocated to receive either the JOURNEY II or the GENESIS II BCS knee prosthesis. Baseline measures will be taken prior to surgery. Patients will be followed at 1 week, 6 to 8 weeks and 6 months post-operatively. The primary outcome is the Oxford Knee Score (OKS) at 6 months post-operatively. Secondary outcomes include: Other PROMs, biomechanical, radiological (computerised tomography, (CT)), clinical efficacy and safety outcomes. An embedded qualitative study will also investigate patients' perspectives via interview pre and post surgery on variables known to affect the outcome of TKR surgery. A sub-sample (n = 30) will have additional in-depth interviews to explore the themes identified. The surgeons' perspectives on the operation will be investigated by a group interview after all participants have undergone surgery. Discussion: This trial will evaluate two generations of TKR using PROMS, kinematic and radiological analyses and qualitative outcomes from the patient perspective

Identification of neuromuscular targets for restoration of walking ability after stroke: precursor to precision rehabilitation

Objectives: Restoration of walking is a priority for stroke survivors and key target for physical therapies. Upright pedalling (UP) can provide functional walking-like activity using a variety of muscle synergies; it is unclear which synergies might be most useful for recovery of walking. Objectives here were as follows: to examine whether neuromuscular measures derived during UP might identify targets for walking rehabilitation after stroke and to determine test–retest repeatability and concurrent validity of the measures. Design: This was a prospective correlational study. Setting: The study was carried out in a movement science laboratory. Participants: The participants were 18 adults with stroke (StrS) and 10 healthy older adults (HOA). Intervention/measurement: StrS and HOA took part in two identical measurement sessions. During UP, surface electromyography and kinematic data were recorded and then processed to derive three measures: reciprocal activity of quadriceps and hamstrings; percentage muscle activity “on” according to crank angle; and smoothness of movement. Results: HOA and StrS demonstrated differences in reciprocal muscle activity (p =.044) and quadriceps activity according to crank angle (p =.034) but pedalled similarly smoothly (p =.367). For muscle activation according to crank angle in StrS, intraclass correlation coefficients (95% confidence interval) showing acceptable repeatability were 0.46 [0.32, 0.58] affected quadriceps; 0.43 [0.28, 0.56] affected hamstrings; and 0.67 [0.56, 0.75] unaffected quadriceps. Conclusion: Muscle activation according to crank angle is a promising measure of lower limb impairment during functional activity after stroke; subsequent investigation should determine magnitude of variance between testing sessions. Reciprocal activity of quadriceps and hamstrings muscles and quadriceps activity according to crank angle are both potential targets for physical therapies to improve motor recovery. Further investigations are warranted

‘These are not luxuries, it is essential for access to life’: Disability related out-of-pocket costs as a driver of economic vulnerability in South Africa

Background: With the dawn of the new sustainable development goals, we face not only a world that has seen great successes in alleviating poverty but also a world that has left some groups, such as persons with disabilities, behind. Middle-income countries (MICs) are home to a growing number of persons with disabilities. As these countries strive to achieve the new goals, we have ample opportunity to include persons with disabilities in the emerging poverty alleviation strategies. However, a lack of data and research on the linkages between economic vulnerability and disability in MICs hampers our understanding of the factors increasing economic vulnerability in people with disabilities. Methods: This article aims to present data related to elements of this vulnerability in one MIC, South Africa. Focusing on out-of-pocket costs, it uses focus group discussions with 73 persons with disabilities and conventional content analysis to describe these costs. Results: A complex and nuanced picture of disability-driven costs evolved on three different areas: care and support for survival and safety, accessibility of services and participation in community. Costs varied depending on care and support needs, accessibility (physical and financial), availability, and knowledge of services and assistive devices. Conclusions: The development of poverty alleviation and social protection mechanisms in MICs like South Africa needs to better consider diverse disability-related care and support needs not only to improve access to services such as education and health (National Health Insurance schemes, accessible clinics) but also to increase the effect of disability-specific benefits and employment equity policies

Perovskite-Related Oxide Fluorides: The Use of Mössbauer Spectroscopy in the Investigation of Magnetic Properties

We review here some of our recent work on the synthesis and characterisation of new perovskite-related oxide fluorides. We demonstrate the use of low temperature fluorination methods for the preparation of new phases with high fluorine contents. We also show how fluorine can be accommodated in different sites according to the structural details of the initial oxide and the fluorine content. Importantly, we describe how Mössbauer spectroscopy is a powerful technique for monitoring changes in cation oxidation state as a result of fluorination and for examining the complex magnetic interactions which result from the accommodation of fluorine within the structures and how these can be related to structural properties and changes to the superexchange pathways