SUMMARY: Background: Neuropathic pain after spinal cord injury (SCI) is notoriously hard to treat. Mechanisms of neuropathic pain are unclear, which makes finding effective treatments challenging. Prior studies have shown that adults with SCI have body awareness deficits. Recent imaging studies, including ours, point to the parietal operculum and insula as key areas for both pain perception and body awareness. Cognitive multisensory rehabilitation (CMR) is a physical therapy approach that helps improve body awareness for pain reduction and sensorimotor recovery. Based on our prior brain imaging work in CMR in stroke, we hypothesized that improving body awareness through restoring parietal operculum network connectivity leads to neuropathic pain relief and improved sensorimotor and daily life function in adults with SCI. Thus, the objectives of this study were to (1) determine baseline differences in resting-state and task-based functional magnetic resonance imaging (fMRI) brain function in adults with SCI compared to healthy controls and (2) identify changes in brain function and behavioral pain and pain-associated outcomes in adults with SCI after CMR. Methods: Healthy adults underwent a one-time MRI scan and completed questionnaires. We recruited community-dwelling adults with SCI-related neuropathic pain, with complete or incomplete SCI >3 months, and highest neuropathic pain intensity level of >3 on the Numeric Pain Rating Scale (NPRS). Participants with SCI were randomized into two groups, according to a delayed treatment arm phase I randomized controlled trial (RCT): Group A immediately received CMR intervention, 3x/week, 45 min/session, followed by a 6-week and 1-year follow-up. Group B started with a 6-week observation period, then 6 weeks of CMR, and a 1-year follow-up. Highest, average, and lowest neuropathic pain intensity levels were assessed weekly with the NPRS as primary outcome. Other primary outcomes (fMRI resting-state and functional tasks; sensory and motor function with the INSCI AIS exam), as well as secondary outcomes (mood, function, spasms, and other SCI secondary conditions), were assessed at baseline, after the first and second 6-week period. The INSCI AIS exam and questionnaires were repeated at the 1-year follow-up. Findings: Thirty-six healthy adults and 28 adults with SCI were recruited between September 2020 and August 2021, and of those, 31 healthy adults and 26 adults with SCI were enrolled in the study. All 26 participants with SCI completed the intervention and pre-post assessments. There were no study-related adverse events. Participants were 52±15 years of age, and 1-56 years post-SCI. During the observation period, group B did not show any reductions in neuropathic pain and did not have any changes in sensation or motor function (INSCI ASIA exam). However, both groups experienced a significant reduction in neuropathic pain after the 6-week CMR intervention. Their highest level of neuropathic pain of 7.81±1.33 on the NPRS at baseline was reduced to 2.88±2.92 after 6 weeks of CMR. Their change scores were 4.92±2.92 (large effect size Cohen’s d =1.68) for highest neuropathic pain, 4.12±2.23 ( d =1.85) for average neuropathic pain, and 2.31±2.07 ( d =1.00) for lowest neuropathic pain. Nine participants out of 26 were pain-free after the intervention (34.62%). The results of the INSCI AIS testing also showed significant improvements in sensation, muscle strength, and function after 6 weeks of CMR. Their INSCI AIS exam increased by 8.81±5.37 points ( d =1.64) for touch sensation, 7.50±4.89 points ( d =1.53) for pin prick sensation, and 3.87±2.81 ( d =1.38) for lower limb muscle strength. Functional improvements after the intervention included improvements in balance for 17 out of 18 participants with balance problems at baseline; improved transfers for all of them and a returned ability to stand upright with minimal assistance in 12 out of 20 participants who were unable to stand at baseline. Those improvements were maintained at the 1-year follow-up. With regard to brain imaging, we confirmed that the resting-state parietal operculum and insula networks had weaker connections in adults with SCI-related neuropathic pain (n=20) compared to healthy adults (n=28). After CMR, stronger resting-state parietal operculum network connectivity was found in adults with SCI. Also, at baseline, as expected, right toe sensory stimulation elicited less brain activation in adults with SCI (n=22) compared to healthy adults (n=26). However, after CMR, there was increased brain activation in relevant sensorimotor and parietal areas related to pain and mental body representations (i.e., body awareness and visuospatial body maps) during the toe stimulation fMRI task. These brain function improvements aligned with the AIS results of improved touch sensation, including in the feet. Interpretation: Adults with chronic SCI had significant neuropathic pain relief and functional improvements, attributed to the recovery of sensation and movement after CMR. The results indicate the preliminary efficacy of CMR for restoring function in adults with chronic SCI. CMR is easily implementable in current physical therapy practice. These encouraging impressive results pave the way for larger randomized clinical trials aimed at testing the efficacy of CMR to alleviate neuropathic pain in adults with SCI. Clinical Trial registration: ClinicalTrials.gov Identifier: NCT04706208 Funding: AIRP2-IND-30: Academic Investment Research Program (AIRP) University of Minnesota School of Medicine. National Center for Advancing Translational Sciences of the National Institutes of Health Award Number UL1TR002494; the Biotechnology Research Center: P41EB015894, the National Institute of Neurological Disorders & Stroke Institutional Center Core Grants to Support Neuroscience Research: P30 NS076408; and theHigh-Performancee Connectome Upgrade for Human 3T MR Scanner: 1S10OD017974.

Background: About 69% of Americans living with spinal cord injury (SCI) suffer from long-term debilitating neuropathic pain, interfering with the quality of daily life. Neuropathic pain is refractory to many available treatments—some carrying a risk for opioid addiction—highlighting an urgent need for new treatments. In this study, we will test our hypothesis that Spring Forest Qigong™ will reduce SCI-related neuropathic pain by improving body awareness. We will determine whether remotely delivered Qigong is feasible and we will collect data on neuropathic pain, and other reported associations with pain such as spasms frequency and/or severity, functional performance, mood, and body awareness. Methods: In this quasi-experimental pilot clinical trial study, adults with SCI will practice Qigong at home with a 45-min video, at least 3 × /week for 12 weeks. The Qigong practice includes movements with guided breathing and is individualized based on functional abilities, i.e., the participants follow along with the Qigong movements to the level of their ability, with guided breathing, and perform kinesthetic imagery by focusing on the feeling in the whole body as if doing the whole-body Qigong movement while standing. The highest, average, and lowest neuropathic pain ratings perceived in the prior week will be recorded weekly until the 6-week follow-up. The other outcomes will be collected at 5 time points: at baseline, midway during the Qigong intervention (6 weeks), after the Qigong intervention (12 weeks), after a 6-week and 1-year follow-up. Rate parameters for the feasibility markers will be estimated based on the participants who achieved each benchmark. Discussion: The University of Minnesota (UMN)’s Institutional Review Board (IRB) approved the study (IRB #STUDY00011997). All participants will sign electronic informed consent on the secure UMN REDCap platform. The results will be presented at academic conferences and published in peer-reviewed publications. Trial registration: ClinicalTrial.gov registration number: NCT04917107, (this protocol paper refers to the substudy), first registered 6/8/2021.

The Revised Body Awareness Rating Questionnaire (BARQ-R) is a self-report measure of body awareness. First aim: evaluate the structural validity of BARQ-R with Rasch analysis in community-dwelling Americans with and without musculoskeletal pain. Subaim: validate a Rasch analysis of BARQ-R done in Norwegian adults with musculoskeletal pain, through a secondary analysis in our sample of Americans with musculoskeletal pain. BARQ-R has 12 items with scores ranging from 0 (completely disagree) to 3 (completely agree), with higher total scores reflecting lower degrees of body awareness. Through Rasch analysis, we evaluated unidimensionality, item hierarchy, and structural validity with item and person fit, targeting, person separation reliability (PSR), local item dependence (LID), differential item functioning (DIF), and principal components analysis of residuals (PCAR). We recruited 623 adults with and without musculoskeletal pain (average age = 50.27 ± 17.25 years). After rescoring 1 item and deleting 3 items, the 9-item Rasch-based BARQ-R had no misfitting items, the hierarchical ordering of the items followed clinical expectations, 3 (0.48%) misfitting persons, person mean location: -0.62 ± 1.03 logits (max -0.53, min 0.72 logits), minimal floor effect (1.93%) and ceiling effect (0.48%), no DIF, and PSR = 0.72. LID was found in 5 item pairs. The PCAR’s eigenvalue was 2.18. The secondary Rasch analysis in 152 adults with musculoskeletal pain (average age = 52.26 ± 16.13 years), demonstrated that, after rescoring 2 items, BARQ-R had no misfitting items and only 2 (1.32%) misfitting persons, good targeting (person mean location: -0.36 ± 0.88 logits), minimal floor effect (0.01%), no ceiling effect (0.00%), and PSR = 0.75. LID was found in 6 item pairs. The PCAR’s eigenvalue was 2.47. BARQ-R had good item and person fit. PSR with items covering a limited logit range suggests that differing levels of body awareness are measured with only modest precision. Adding and revising items to cover a wider range of body awareness and to better address concepts of internal body awareness and body movements would improve BARQ-R’s utility. Further analyses are needed before BARQ-R’s use for research or in the clinic. In addition, future BARQ-R Rasch validation is needed in other populations with body awareness deficits, such as stroke or spinal cord injury.

Wheelchair-mounted assistive robotic manipulators can provide reach and grasp functions for power wheelchair users. This in-lab study evaluated a vision-guided shared control (VGS) system with twelve users completing two multi-step kitchen tasks: a drinking task and a popcorn making task. Using a mixed methods approach participants compared VGS and manual joystick control, providing performance metrics, qualitative insights, and lessons learned. Data collection included demographic questionnaires, the System Usability Scale (SUS), NASA Task Load Index (NASA-TLX), and exit interviews. No significant SUS differences were found between control modes, but NASA-TLX scores revealed VGS control significantly reduced workload during the drinking task and the popcorn task. VGS control reduced operation time and improved task success but was not universally preferred. Six participants preferred VGS, five preferred manual, and one had no preference. In addition, participants expressed interest in robotic arms for daily tasks and described two main operation challenges: distinguishing wrist orientation from rotation modes and managing depth perception. They also shared perspectives on how a personal robotic arm could complement caregiver support in their home.

This paper uses mixed methods to explore the preliminary design of control authority preferences for an Assistive Robotic Manipulator (ARM). To familiarize users with an intelligent robotic arm, we perform two kitchen task iterations: one with user-initiated software autonomy (predefined autonomous actions) and one with manual control. Then, we introduce a third scenario, enabling users to choose between manual control and system delegation throughout the task. Results showed that, while manually switching modes and controlling the arm via joystick had a higher mental workload, participants still preferred full joystick control. Thematic analysis indicates manual control offered greater freedom and sense of accomplishment. Participants reacted positively to the idea of an interactive assistive system. Users did not want to ask the system to only assist, by taking over for certain actions, but also asked for situational feedback (e.g., ‘How close am I (the gripper)?’, ‘Is the lid centered over the jug?’). This speaks to a future assistive system that ensures the user feels like they drive the system for the entirety of the task and provides action collaboration in addition to more granular situational awareness feedback.

Background With the recent ongoing global COVID-19 pandemic and political divide in the United States (US), there is an urgent need to address the soaring mental well-being problems and to promote positive well-being. The Warwick-Edinburgh Mental Well-being Scale (WEMWBS) measures the positive aspects of mental health. Previous studies confirmed its construct validity, reliability, and unidimensionality with confirmatory factor analysis. Four studies have performed a Rasch analysis on the WEMWBS, but none of them tested adults in the US. The goals of our study are to use Rasch analysis to validate the WEMWBS in the general US population and in adults with stroke. Methods We recruited community-dwelling adults and adults with chronic stroke with upper limb hemiplegia or hemiparesis. We used the Rasch Unidimensional Measurement Model (RUMM) 2030 software to evaluate item and person fit, targeting, person separation reliability (PSR), and differential item functioning (DIF) for sample sizes of at least 200 persons in each subgroup. Results After deleting two items, the WEMBS analyzed in our 553 community-dwelling adults (average age 51.22±17.18 years; 358 women) showed an excellent PSR=0.91 as well as person and item fit, but the items are too easy for this population (person mean location=2.17±2.00). There was no DIF for sex, mental health, or practicing breathing exercises. In the 37 adults with chronic stroke (average age 58±13; 11 women) the WEMWBS had a good item and person fit, and PSR=0.92, but the items were too easy for this group as well (person mean location=3.13±2.00). Conclusions The WEMWBS had good item and person fit but the targeting is off when used in community-dwelling adults and adults with stroke in the US. Adding more difficult items might improve the targeting and capture a broader range of positive mental wellbeing in both populations. Our pilot data in adults with stroke needs to be confirmed in a larger sample size.