This study investigates the reproducibility and concurrent validity of the Rate of Perceived Stability (RPS) Scale in people with stroke.On two separate days (2–10 days apart), participants provide...

Objective: Successful stepping reactions, led by either the paretic or nonparetic leg, in response to a loss of balance are critical to safe mobility poststroke. The purpose of this study was to measure sagittal plane hip, knee, ankle, and trunk kinematics during 2-step stepping reactions initiated by paretic and nonparetic legs of people who had stroke and members of a control group. Methods: Principal component analysis (PCA) was used to reduce the data into movement patterns explaining interlimb coordination of the stepping and stance legs. Correlations among principal components loading scores and clinical measures of balance ability (as measured on the Community Balance and Mobility scale), motor impairment (as measured on the foot and leg sections of the Chedoke-McMaster Stroke Assessment), and step characteristics (length and velocity) were used to examine the effect of stroke on stepping reaction movement patterns. Results: The first 5 principal components explained 95.9% of the movement pattern of stepping reactions and differentiated between stepping reactions initiated by paretic legs, nonparetic legs, or the legs of controls. Moderate-strong associations (ρ/r > 0.50) between specific principal component loading scores and clinical measures and step characteristics were dependent on the initiating leg. Lower levels of motor impairment, higher levels of balance ability, and faster and longer steps were associated with stepping reactions initiated by the paretic leg that comprised paretic leg flexion and nonparetic leg extension. Step initiation with the nonparetic leg showed associations between higher scores on clinical measures and movement patterns of flexion in both paretic and nonparetic legs. Conclusions: Movement patterns of stepping reactions poststroke were influenced by the initiating leg. After stroke, specific movement patterns showed associations with clinical measures depending on the initiating leg, suggesting that these movement patterns are important to retraining of stepping reactions. Specifically, use of flexion patterning and assessment of between-leg pattern differentiation may be important aspects to consider during retraining of stepping reactions poststroke. Impact: Evidence-based interventions targeting balance reactions are still in their infancy. This investigation of stepping reactions poststroke addresses a major gap in research.

Background: Encouraging upper limb use and increasing intensity of practice in rehabilitation are two important goals for optimizing upper limb recovery post stroke. Feedback from novel wearable sensors may influence practice behaviour to promote achieving these goals. A wearable sensor can potentially be used in conjunction with a virtually monitored home program for greater patient convenience, or due to restrictions that preclude in-person visits, such as COVID-19. This trial aims to (1) determine the efficacy of a virtual behaviour change program that relies on feedback from a custom wearable sensor to increase use and function of the upper limb post stroke; and (2) explore the experiences and perceptions of using a program coupled with wearable sensors to increase arm use from the perspective of people with stroke. Methods: This mixed-methods study will utilize a prospective controlled trial with random allocation to immediate or 3-week delayed entry to determine the efficacy of a 3-week behaviour change program with a nested qualitative description study. The intervention, the Virtual Arm Boot Camp (V-ABC) features feedback from a wearable device, which is intended to increase upper limb use post stroke, as well as 6 virtual sessions with a therapist. Sixty-four adults within 1-year post stroke onset will be recruited from seven rehabilitation centres. All outcomes will be collected virtually. The primary outcome measure is upper limb use measured by grasp counts over 3 days from the wearable sensor (TENZR) after the 3-week intervention. Secondary outcomes include upper limb function (Arm Capacity and Movement Test) and self-reported function (Hand Function and Strength subscale from the Stroke Impact Scale). Outcome data will be collected at baseline, post-intervention and at 2 months retention. The qualitative component will explore the experiences and acceptability of using a home program with a wearable sensor for increasing arm use from the point of view of individuals with stroke. Semi-structured interviews will be conducted with participants after they have experienced the intervention. Qualitative data will be analysed using content analysis. Discussion: This study will provide novel information regarding the efficacy and acceptability of virtually delivered programs to improve upper extremity recovery, and the use of wearable sensors to assist with behaviour change. Trial registration: ClinicalTrials.govNCT04232163. January 18, 2020.

Introduction: Physiotherapy services have been typically provided in-person since the profession usually involves a therapist providing hands-on assessment and treatments. The COVID-19 pandemic provided an opportunity to study physiotherapists’ adaptation to telerehabilitation (phone or videoconference).Objective: This study aimed: (1) to explore how physiotherapists adapted to the transition to delivering telerehabilitation, (2) to assess physiotherapists’ perceptions of implementing telerehabilitation, and (3) to identify the challenges and facilitators of delivering telerehabilitation.Methods: This study used an online survey distributed to physiotherapists within a large Canadian health authority. Closed-ended questions were analyzed with descriptive statistics.Results: Seventy-five physiotherapists responded and data were collected. Compared prior to the pandemic to time during the pandemic, the use of a phone for delivering physiotherapy increased from 24.0% to 73.3% of physiotherapists while videoconference increased from 5.3% to 77.3%. Overall, the physiotherapists found videoconference to be a more effective delivery method than phone. Less than half felt that they could use videoconference to effectively treat pain (49.3%), upper extremity function (40.0%) or strength/range of motion (48.0%). Only 29.3% felt that they could effectively treat walking balance or mobility by videoconference. Technical barriers were identified with client comfort with the equipment reported by 90.7% of physiotherapists and positioning of the webcam by 76.0% of physiotherapists. A large proportion of physiotherapists agreed that they would continue the practice of telerehabilitation via phone (54.7%) and videoconference (68.0%).Conclusion: The pandemic resulted in a dramatic shift to telerehabilitation for a profession that typically provides hands-on assessments and treatments. While there was increased uptake of telerehabilitation, many physiotherapists questioned their effectiveness using telerehabilitation to undertake activities that traditionally involve manual treatments or hands-on guidance/supervision. However, physiotherapists were committed to continuing telerehabilitation to meet patients’ needs after the pandemic.

Investigating the relationship between the movement patterns of multiple limb segments during the rowing stroke on the resulting force production in elite rowers can provide foundational insight into optimal technique. It can also highlight potential mechanisms of injury and performance improvement. The purpose of this study was to conduct a kinematic analysis of the rowing stroke together with force production during a step test in elite national-team heavyweight men to evaluate the fundamental patterns that contribute to expert performance. Twelve elite heavyweight male rowers performed a step test on a row-perfect sliding ergometer [5 × 1 min with 1 min rest at set stroke rates (20, 24, 28, 32, 36)]. Joint angle displacement and velocity of the hip, knee and elbow were measured with electrogoniometers, and force was measured with a tension/compression force transducer in line with the handle. To explore interactions between kinematic patterns and stroke performance variables, joint angular velocities of the hip, knee and elbow were entered into principal component analysis (PCA) and separate ANCOVAs were run for each performance variable (peak force, impulse, split time) with dependent variables, and the kinematic loading scores (Kpc,_ls) as covariates with athlete/stroke rate as fixed factors. The results suggested that rowers’ kinematic patterns respond differently across varying stroke rates. The first seven PCs accounted for 79.5% (PC1 [26.4%], PC2 [14.6%], PC3 [11.3%], PC4 [8.4%], PC5 [7.5%], PC6 [6.5%], PC7 [4.8%]) of the variances in the signal. The PCs contributing significantly (p ≤ 0.05) to performance metrics based on PC loading scores from an ANCOVA were (PC1, PC2, PC6) for split time, (PC3, PC4, PC5, PC6) for impulse, and (PC1, PC6, PC7) for peak force. The significant PCs for each performance measure were used to reconstruct the kinematic patterns for split time, impulse and peak force separately. Overall, PCA was able to differentiate between rowers and stroke rates, and revealed features of the rowing-stroke technique correlated with measures of performance that may highlight meaningful technique-optimization strategies. PCA could be used to provide insight into differences in kinematic strategies that could result in suboptimal performance, potential asymmetries or to determine how well a desired technique change has been accomplished by group and/or individual athletes.

Introduction: Balance confidence and perception of task challenge is an important construct to measure in rehabilitation of people with lower-limb amputation (LLA). Measurement of electrodermal activity (EDA) captures physiological arousal responses reflecting an individual’s perceived challenge in a task. This study explores the feasibility of the use of EDA during outdoor walking tasks to capture task-specific physiological arousal changes associated with perception of challenge in people with amputation. Objective: To develop and demonstrate feasibility of a portable EDA/GPS system mapping physiological arousal while challenging walking balance outdoors in individuals with LLA and controls. Methods: Sixteen people (eight with LLA and eight age-/sex-matched controls) completed an outdoor walking course in the community (3 laps). A battery-powered portable device was developed containing EDA/GPS sensors with data logged on a microcontroller. Phasic EDA response was extracted from EDA signal to explore the physiological arousal response to walking tasks. Results: Physiological arousal demonstrated task-specific modulation with ascending stairs without a handrail showing higher levels of phasic EDA than walking on a paved incline (p = 0.01) or a gravel decline (p = 0.01) in people with LLA. While evidence of habituation over repeated trials was shown in controls with lap 1 of walking down a gravel decline showing higher levels of phasic EDA than lap 3 (p = 0.01). Phasic EDA maps, representative of arousal levels throughout the walking course, showed individual-specific response. Conclusion: Mapping of EDA during outdoor walking is feasible. Modulation of physiological arousal between outdoor walking tasks and over repeated trials is suggestive of clinical utility. Further research is warranted to explore how EDA may be incorporated into assessment of response to outdoor walking amongst individuals following LLA.