Development of a new scale for perceived self-efficacy in manual wheeled mobility:a pilot study

Objective: To study the psychometric qualities of a perceived self-efficacy in wheeled mobility scale. Design: Questionnaires. Subjects: Forty-seven wheelchair users with spinal cord injury (elite athletes n= 25, recreational n= 22, from 6 different countries). Method: Based on the literature, and expert's and wheelchair user's comments, a new Self-Efficacy in Wheeled Mobility Scale (SEWM(1)) was developed. Internal consistency (split-half and Cronbach's alpha) and concurrent validity (correlating the Self-Efficacy in Wheeled Mobility Scale with the Generalized Perceived Self-efficacy Scale (GSE) and the spinal cord injury Exercise Self-Efficacy Scale (ESES)) were assessed. To evaluate the construct validity, age, lesion level and completeness and time since injury between groups of participants and their total scores were compared statistically. Results: Cronbach's alpha for the SEWM was 0.91, internal consistency was r=0.90. Significant correlations between pairs of scales of the entire sample (SEWM-ESES: 0.60; SEWM-GSE: 0.50 (p <0.05; n=47, 2-tailed) and of the subgroup comparison (SEWM-ESES recreational r= 0.61; elite r=0.73), demonstrated fair construct and concurrent validity of the SEWM. Conclusion: The SEWM was found to be reliable and valid in active spinal cord injury. A larger more diverse sample is needed to support the psychometric qualities of the SEWM scale

A Scoping Review on Shoulder Injuries of Wheelchair Tennis Players: Potential Risk-Factors and Musculoskeletal Adaptations

Wheelchair tennis players are prone to develop shoulder injuries, due to the combination of wheelchair propulsion, overhead activities and daily wheelchair activities. A methodical literature search was conducted to identify articles on shoulder complaints in wheelchair tennis, wheelchair sports and tennis. The aims were to identify (1) type of shoulder complaints; (2) possible risk factors for the development of shoulder injuries; (3) musculoskeletal adaptations in the shoulder joint in wheelchair tennis players. Fifteen papers were included in this review, five on wheelchair tennis, three on wheelchair sports and seven on tennis. Type of shoulder complaints were acromioclavicular pathology, osteoarthritic changes, joint effusion and rotator cuff tears. Possible risk factors for the development of shoulder injuries in wheelchair tennis are overhead movements, repetitive activation of the anterior muscle chain and internal rotators, as well as a higher spinal cord injury level. Muscular imbalance with higher values for the internal rotators, increase in external range of motion, decrease in internal range of motion and reduced total arc of motion were the most common proposed musculoskeletal adaptations due to an unbalanced load. These presented risk factors and musculoskeletal adaptations might help researchers, coaches and wheelchair tennis players to prevent shoulder injuries

The implementation of a physical activity counseling program in rehabilitation care:findings from the ReSpAct study

Purpose: This study aimed to evaluate the implementation of a physical activity counseling program in rehabilitation and to study heterogeneity in received counseling and investigate its association with changes in patients? physical activity outcomes. Methods: This prospective cohort study was conducted in 18 rehabilitation institutions. Data were collected using surveys completed by professionals (n= ?70) and patients (n?=?1719). Implementation was evaluated using different process outcomes: reach, dosage, satisfaction, maintenance. Patients? physical activity outcomes included changes in total minutes/week of physical activity. Latent class analyses were conducted to identify profiles of received counseling characteristics and multilevel models were used to investigate associations with physical activity outcomes. Results: 5873 Patients were provided with motivational interviewing-based counseling after rehabilitation. Professionals and patients were positive about the program. Sixteen institutions (89%) formally agreed to continue the program. The four identified profiles of counseling characteristics illustrate a large variation in received counseling among patients. No substantial differences in physical activity outcomes were found between profiles. Conclusion: After a three-year program period, the physical activity counseling centers were sustainably implemented in Dutch rehabilitation care. This study illustrated an innovative approach to assess heterogeneity in implementation outcomes (e.g., counseling profiles) in relation to program outcomes (e.g., physical activity)

Shoulder load during synchronous handcycling and handrim wheelchair propulsion in persons with paraplegia

Objective: To compare the shoulder load during handcycling and wheelchair propulsion under similar conditions of external power in persons with spinal cord injury. Design: Cross-sectional. Subjects: Eight men with spinal cord injury. Methods: Kinetics and kinematics were measured during handbike and wheelchair propulsion at 25, 35, 45 and 55 W on a treadmill. Shoulder load (glenohumeral contact forces, relative muscle forces) was calculated with the Delft Shoulder and Elbow Model. Results: At all power output levels, glenohumeral contact forces were significantly lower during handcycling compared with wheelchair propulsion (p < 0.001). At 55 W, the mean glenohumeral contact force was 345 N for handcycling, whereas it was 585 N for wheelchair propulsion. Also, relative muscle forces were lower during handcycling. The largest differences between handbike and wheelchair propulsion were found in the supraspinatus (4.5% vs. 20.7%), infraspinatus (3.7% vs. 16.5%) and biceps (5.0% vs. 17.7%). Conclusion: Due to continuous force application in handcycling, shoulder load was lower compared with wheelchair propulsion. Furthermore, muscles that are prone to overuse injuries were less stressed during handcycling. Therefore, handcycling may be a good alternative for outdoor mobility and may help prevent overuse injuries of the shoulder complex. © 2012 The Authors

The effect of asymmetric movement support on muscle activity during Lokomat guided gait in able-bodied individuals

BACKGROUND: To accommodate training for unilaterally affected patients (e.g. stroke), the Lokomat (a popular robotic exoskeleton-based gait trainer) provides the possibility to set the amount of movement guidance for each leg independently. Given the interlimb couplings, such asymmetrical settings may result in complex effects, in which ipsilateral activity co-depends on the amount of guidance offered to the contralateral leg. To test this idea, the effect of asymmetrical guidance on muscle activity was explored. METHODS: 15 healthy participants walked in the Lokomat at two speeds (1 and 2 km/h) and guidance levels (30% and 100%), during symmetrical (both legs receiving 30% or 100% guidance) and asymmetrical conditions (one leg receiving 30% and the other 100% guidance) resulting in eight unique conditions. Activity of the right leg was recorded from Erector Spinae, Gluteus Medius, Biceps Femoris, Semitendinosus, Vastus Medialis, Rectus Femoris, Medial Gastrocnemius and Tibialis Anterior. Statistical Parametric Mapping was used to assess whether ipsilateral muscle activity depended on guidance settings for the contralateral leg. RESULTS: Muscle output amplitude not only depended on ipsilateral guidance settings, but also on the amount of guidance provided to the contralateral leg. More specifically, when the contralateral leg received less guidance, ipsilateral activity of Gluteus Medius and Medial Gastrocnemius increased during stance. Conversely, when the contralateral leg received more guidance, ipsilateral muscle activity for these muscles decreased. These effects were specifically observed at 1 km/h, but not at 2 km/h. CONCLUSIONS: This is the first study of asymmetrical guidance on muscle activity in the Lokomat, which shows that ipsilateral activity co-depends on the amount of contralateral guidance. In therapy, these properties may be exploited e.g. to promote active contributions by the more affected leg. Therefore, the present results urge further research on the use of asymmetrical guidance in patient groups targeted by Lokomat training

Postural threat during walking:Effects on energy cost and accompanying gait changes

Background: Balance control during walking has been shown to involve a metabolic cost in healthy subjects, but it is unclear how this cost changes as a function of postural threat. The aim of the present study was to determine the influence of postural threat on the energy cost of walking, as well as on concomitant changes in spatiotemporal gait parameters, muscle activity and perturbation responses. In addition, we examined if and how these effects are dependent on walking speed. Methods: Healthy subjects walked on a treadmill under four conditions of varying postural threat. Each condition was performed at 7 walking speeds ranging from 60-140% of preferred speed. Postural threat was induced by applying unexpected sideward pulls to the pelvis and varied experimentally by manipulating the width of the path subjects had to walk on. Results: Results showed that the energy cost of walking increased by 6-13% in the two conditions with the largest postural threat. This increase in metabolic demand was accompanied by adaptations in spatiotemporal gait parameters and increases in muscle activity, which likely served to arm the participants against a potential loss of balance in the face of the postural threat. Perturbation responses exhibited a slower rate of recovery in high threat conditions, probably reflecting a change in strategy to cope with the imposed constraints. The observed changes occurred independent of changes in walking speed, suggesting that walking speed is not a major determinant influencing gait stability in healthy young adults. Conclusions: The current study shows that in healthy adults, increasing postural threat leads to a decrease in gait economy, independent of walking speed. This could be an important factor in the elevated energy costs of pathological gait

Biomechanical and physiological differences between synchronous and asynchronous low intensity handcycling during practice-based learning in able-bodied men

BACKGROUND: Originally, the cranks of a handcycle were mounted with a 180° phase shift (asynchronous). However, as handcycling became more popular, the crank mode switched to a parallel mounting (synchronous) over the years. Differences between both modes have been investigated, however, not into great detail for propulsion technique or practice effects. Our aim is to compare both crank modes from a biomechanical and physiological perspective, hence considering force and power production as a cause of physiological outcome measures. This is done within a practice protocol, as it is expected that motor learning takes place in the early stages of handcycling in novices. METHODS: Twelve able-bodied male novices volunteered to take part. The experiment consisted of a pre-test, three practice sessions and a post-test, which was subsequently repeated for both crank modes in a counterbalanced manner. In each session the participants handcycled for 3 × 4 minutes on a leveled motorized treadmill at 1.94 m/s. Inbetween sessions were 2 days of rest. 3D forces, handlebar and crank angle were measured on the left hand side. Kinematic markers were placed on the handcycle to monitor the movement on the treadmill. Lastly, breath-by-breath spirometry combined with heart-rate were continuously measured. The effects of crank mode and practice-based learning were analyzed using a two way repeated measures ANOVA, with synchronous vs asynchronous and pre-test vs post-test as within-subject factors. RESULTS: In the pre-test, asynchronous handcycling was less efficient than synchronous handcycling in terms of physiological strain, force production and timing. At the post-test, the metabolic costs were comparable for both modes. The force production was, also after practice, more efficient in the synchronous mode. External power production, crank rotation velocity and the distance travelled back and forwards on the treadmill suggest that asynchronous handcycling is more constant throughout the cycle. CONCLUSIONS: As the metabolic costs were reduced in the asynchronous mode, we would advise to include a practice period, when comparing both modes in scientific experiments. For handcycle users, we would currently advise a synchronous set-up for daily use, as the force production is more effective in the synchronous mode, even after practice

Prehabilitation to prevent complications after cardiac surgery - A retrospective study with propensity score analysis

BACKGROUND: The rising prevalence of modifiable lifestyle-related risk factors (e.g. overweight and physical inactivity) suggests the need for effective and safe preoperative interventions to improve outcomes after cardiac surgery. This retrospective study explored potential short-term postoperative benefits and unintended consequences of a multidisciplinary prehabilitation program regarding in-hospital complications. METHODS: Data on patients who underwent elective cardiac surgery between January 2014 and April 2017 were analyzed retrospectively. Pearson’s chi-squared tests were used to compare patients who followed prehabilitation (three times per week, at a minimum of three weeks) during the waiting period with patients who received no prehabilitation. Sensitivity analyses were performed using propensity-score matching, in which the propensity score was based on the baseline variables that affected the outcomes. RESULTS: Of 1201 patients referred for elective cardiac surgery, 880 patients met the inclusion criteria, of whom 91 followed prehabilitation (53.8% ≥ 65 years, 78.0% male, median Euroscore II 1.3, IQR, 0.9–2.7) and 789 received no prehabilitation (60.7% ≥ 65 years, 69.6% male, median Euroscore II 1.6, IQR, 1.0–2.8). The incidence of atrial fibrillation (AF) was significantly lower in the prehabilitation group compared to the unmatched and matched standard care group (resp. 14.3% vs. 23.8%, P = 0.040 and 14.3% vs. 25.3%, P = 0.030). For the other complications, no between-group differences were found. CONCLUSIONS: Prehabilitation might be beneficial to prevent postoperative AF. Patients participated safely in prehabilitation and were not at higher risk for postoperative complications. However, well-powered randomized controlled trials are needed to confirm and deepen these results

Shoulder Pain Is Associated With Rate of Rise and Jerk of the Applied Forces During Wheelchair Propulsion in Individuals With Paraplegic Spinal Cord Injury

OBJECTIVE: To investigate the association between propulsion biomechanics, including variables that describe smoothness of the applied forces, and shoulder pain in persons with SCI. DESIGN: Cross-sectional, observational study. SETTING: Non-university research institution. PARTICIPANTS: 30 (age: 48.6±9.3 years, 83% males) community dwelling, wheelchair dependent participants with a chronic paraplegia between T2 and L1, with and without shoulder pain. INTERVENTIONS: Not applicable MAIN OUTCOME MEASURE: Rate of rise and jerk of applied forces during wheelchair propulsion. Participants were stratified in low, moderate and high pain groups based on their Wheelchair User Shoulder Pain Index (WUSPI) score at the day of measurement. RESULTS: A mixed-effect multilevel analysis showed that wheelchair users in the high pain group propelled with significantly greater rate of rise and jerk - measures that describe smoothness of the applied forces - as compared to persons with less or no pain, when controlling for all co-variables. CONCLUSIONS: Persons with severe shoulder pain propelled with less smooth strokes as compared to persons with less or no pain. This supports a possible association between shoulder pain and rate of rise and jerk of the applied forces during wheelchair propulsion

Unravelling perceived fatigue and activity pacing in maintaining a physically active lifestyle after stroke rehabilitation:a longitudinal cohort study

Purposes To identify fatigue trajectories during/after stroke rehabilitation, to determine characteristics associated with trajectory membership before discharge and to investigate how these trajectories and activity pacing are associated with sustained physical activity after rehabilitation. Methods People after stroke (n = 206) were followed from 3–6 weeks before discharge (T0) to 14 (T1), 33 (T2) and 52 (T3) weeks after discharge from rehabilitation in the ReSpAct study. Latent Class analysis was used to identify trajectories of perceived fatigue. Binomial multivariable logistic regression analyses were performed to determine characteristics associated with trajectory membership (T0). Multilevel regression analyses were used to investigate how perceived fatigue and activity pacing were associated with self-reported physical activity (T0–T3). Results Three fatigue trajectories were identified: high (n = 163), low (n = 41) and recovery (n = 2). Compared with the high fatigue trajectory, people in the low fatigue trajectory were more likely to report higher levels of health-related quality of life (HR-QoL) (OR = 3.07, 95%CI = 1.51–6.26) and physical activity (OR = 1.93, 95%CI = 1.07–3.47). Sustained high levels of physical activity after rehabilitation were significantly associated with low perceived fatigue and high perceived risk of overactivity. Conclusions Three fatigue trajectories after stroke rehabilitation were identified. High levels of HR-QoL and physical activity before discharge identified people in the low fatigue trajectory. A physically active lifestyle after rehabilitation was associated with low perceived fatigue and perceived risk of overactivity. IMPLICATIONS FOR REHABILITATION Since almost 80% of people after stroke in this study perceived severe fatigue up to 1 year after stroke rehabilitation, activities focusing on the management of fatigue symptoms should be integrated in general stroke rehabilitation. In clinical practice, low levels of health-related quality of life and low levels of self-reported physical activity before discharge from stroke rehabilitation should be considered by rehabilitation professionals (e.g., physicians, physiotherapists, and physical activity counsellors) since these characteristics can predict chronic perceived fatigue up to 1 year after stroke rehabilitation. A physical activity counselling programme delivered during and after stroke rehabilitation may be improved by incorporating tailored advice regarding the management of fatigue