A new modular neuroprosthesis suitable for hybrid FES-robot applications and tailored assistance.

BACKGROUND: To overcome the application limitations of functional electrical stimulation (FES), such as fatigue or nonlinear muscle response, the combination of neuroprosthetic systems with robotic devices has been evaluated, resulting in hybrid systems that have promising potential. However, current technology shows a lack of flexibility to adapt to the needs of any application, context or individual. The main objective of this study is the development of a new modular neuroprosthetic system suitable for hybrid FES-robot applications to meet these needs. METHODS: In this study, we conducted an analysis of the requirements for developing hybrid FES-robot systems and reviewed existing literature on similar systems. Building upon these insights, we developed a novel modular neuroprosthetic system tailored for hybrid applications. The system was specifically adapted for gait assistance, and a technological personalization process based on clinical criteria was devised. This process was used to generate different system configurations adjusted to four individuals with spinal cord injury or stroke. The effect of each system configuration on gait kinematic metrics was analyzed by using repeated measures ANOVA or Friedman's test. RESULTS: A modular NP system has been developed that is distinguished by its flexibility, scalability and personalization capabilities. With excellent connection characteristics, it can be effectively integrated with robotic devices. Its 3D design facilitates fitting both as a stand-alone system and in combination with other robotic devices. In addition, it meets rigorous requirements for safe use by incorporating appropriate safety protocols, and features appropriate battery autonomy, weight and dimensions. Different technological configurations adapted to the needs of each patient were obtained, which demonstrated an impact on the kinematic gait pattern comparable to that of other devices reported in the literature. CONCLUSIONS: The system met the identified technical requirements, showcasing advancements compared to systems reported in the literature. In addition, it demonstrated its versatility and capacity to be combined with robotic devices forming hybrids, adapting well to the gait application. Moreover, the personalization procedure proved to be useful in obtaining various system configurations tailored to the diverse needs of individuals.

Evaluating AI Models: Performance Validation Using Formal Multiple-Choice Questions in Neuropsychology.

High-quality and accessible education is crucial for advancing neuropsychology. A recent study identified key barriers to board certification in clinical neuropsychology, such as time constraints and insufficient specialized knowledge. To address these challenges, this study explored the capabilities of advanced Artificial Intelligence (AI) language models, GPT-3.5 (free-version) and GPT-4.0 (under-subscription version), by evaluating their performance on 300 American Board of Professional Psychology in Clinical Neuropsychology-like questions. The results indicate that GPT-4.0 achieved a higher accuracy rate of 80.0% compared to GPT-3.5's 65.7%. In the "Assessment" category, GPT-4.0 demonstrated a notable improvement with an accuracy rate of 73.4% compared to GPT-3.5's 58.6% (p = 0.012). The "Assessment" category, which comprised 128 questions and exhibited the highest error rate by both AI models, was analyzed. A thematic analysis of the 26 incorrectly answered questions revealed 8 main themes and 17 specific codes, highlighting significant gaps in areas such as "Neurodegenerative Diseases" and "Neuropsychological Testing and Interpretation."

Correction: Developing an assistive technology usability questionnaire for people with neurological diseases.

[This corrects the article DOI: 10.1371/journal.pone.0281197.].

Community integration after spinal cord injury rehabilitation: Predictors and causal mediators.

CONTEXT/OBJECTIVE: Community integration (CI) is a crucial rehabilitation goal after spinal cord injury (SCI). There is a pressing need to enhance our understanding of the factors associated with CI for individuals with traumatic or non-traumatic etiologies, with the latter being notably understudied. Accordingly, our research explores the associations and potential mediators influencing CI across these populations. SETTING: Specialized neurological rehabilitation center. PARTICIPANTS: Community-dwelling individuals who were admitted as inpatients within 3 months post-injury (n = 431, 51.9% traumatic, 48.1% non-traumatic), assessed in relation to community integration within 1-3 years after discharge. OUTCOME MEASURE: Community Integration Questionnaire (CIQ). Covariates: American Spinal Injury Association Impairment Scale (AIS), Functional Independence Measure (FIM) and Hospital Anxiety and Depression Scale (HADS). RESULTS: Multiple linear regression yielded age, B AIS grade, educational level (< 6 years and <12 years), time since injury to admission, length of stay, HADS-depression at discharge, total FIM at discharge and three social work interventions (support in financial, legal and transportation services) as significant predictors of total CIQ score (Adjusted R2 = 41.4). Multiple logistic regression identified age, traumatic etiology, educational level (< 6 years and <12 years), length of stay, HADS depression at discharge, total FIM at discharge and one social work intervention (transportation support) as significant predictors of good community integration, AUC (95% CI): 0.82 (0.75-0.89), Sensitivity:0.76, Specificity:0.73. We identified motor FIM at discharge and motor FIM efficiency as causal mediators of total CIQ. CONCLUSIONS: We identified modifiable factors during rehabilitation-functional independence, depression, and social work interventions-that are associated with CI.

Falls characteristics experienced by working-age adults during inpatient post-stroke rehabilitation and their impact on length of stay, discharge functional status, ambulation and destination.

BACKGROUND: In-hospital falls are frequent post-stroke medical complications and will remain of concern because it may not be possible to prevent all of them. We aimed to i) compare admission clinical and sociodemographic characteristics between fallers and non-fallers ii) determine falls characteristics iii) compare length of stay (LOS), discharge functional independence, ambulation and destination between fallers and non-fallers. METHODS: A matched case-control study, comparing individuals (n=302) who fell during inpatient post-acute rehabilitation, matched (on time to admission, age and motor Functional Independence Measure (mFIM)) to individuals (n=302) who didn´t fall, admitted within 3 months post-injury to a center between 2008 and 2023. Ambulation was assessed using the Functional Ambulation Category (FAC). RESULTS: Mean age at admission was 50±8 years. No baseline differences were seen between groups in the proportion of patients with aphasia, diabetes, dyslipidemia, hypertension, neglect, atrial fibrillation, dysphagia, dominant side affected, medication for depression, FAC assessment, body mass index and educational level. A first-fall in the first week was experienced by 22.2% and in the first three weeks by 54.3%. Most falls occurred at the patients' room (75.1%) mostly due to distractions (55.3%) and transferring without help (32.4%) with 18% occurring in the bathroom, fallers were alone in 68.6% of the cases. Fallers had an 8-day longer mean LOS compared to non-fallers, yet there were no differences in discharge mFIM or FAC scores. While non-fallers had a higher proportion of poor mFIM outcomes (28.5% vs. 17.9%) and no ambulation (20.7% vs. 12.4%), fallers showed greater mFIM gains (26 vs. 22 points). Discharge destinations were similar across both groups. CONCLUSIONS: Despite no baseline differences, fallers experienced longer stays with comparable independence and ambulation scores at discharge. Most falls occurred in patients' rooms during unsupervised activities. Preventive recommendations have been provided to address these risks and enhance patient safety.

Epidemiology of pediatric spinal trauma with neurological deficits in Catalonia: a 36-year experience.

PURPOSE: Existing literature on pediatric traumatic spinal cord injury (PTSCI) demonstrates large variations in characteristics, incidence, time-periods and etiology, worldwide. Epidemiological studies addressing injuries to the total spine, conducted in Southern European regions are remarkably scarce; therefore we aimed to investigate long-term trends analyzing etiology, fracture location and type, single or multiple fractures, associated lesions and neurological status in Catalonia, Spain. METHODS: We conducted a retrospective observational study. We analyzed post-acute patients after PTSCI, aged 0-17, admitted with neurological deficits between 1986 and 2022 to a specialized hospital in Catalonia. Neurological deficits were assessed using the American Spinal Injury Association Impairment Scale (AIS). RESULTS: Two hundred and forty nine children were included, 174 (69.9%) boys and 75 (30.1%) girls; mean age was 13.9 years (range, 2 months to 17 years). Two hundred and four children (82%) had ≥ 1 spinal fractures, 66 (26.5%) dislocations and 8 (3.2%) SCIWORA. Fractures were multilevel contiguous in 108 (43.4%) cases. Fracture types comprised 81 vertebral compactions (32.5%), 22 burst fractures (8.8%), 7 odontoid (2.8%) and 4 tear-drops (1.6%). There were ≥ 1 associated lesions in 112 cases (45%): in limbs in 23 cases (9.2%), thorax or abdomen in 59 (23.7%) and skull or face in 81 (32.5%). In 44 cases (39% of the 112) there were multiple lesions. Locations comprised cervical spine in 105 cases (42%), thoracic spine in 124 (49%), lumbar spine in 18 (7%), and sacrum in 2 (0.8%). Road traffic accidents (RTAs) were the main etiology (62.2%) over the whole period. However, from 2016 onwards, RTAs dropped below the rate of falls and sports injuries. The most common sites for injury in those aged 9 years or older were in the cervical (41.1%) and thoracic (50.7%) regions. Those aged 8 or under were far more likely to sustain a complete SCI (80.0%) or an accompanying traumatic brain injury (45.0%) likely due to higher numbers of pedestrian versus car RTAs. A significant peak in the occurrence of cases during 2006-2010 (20.1%) was identified with an absolute drop immediately after, during 2011-2015 (8.8%). A marked shift in trend is observed between 2016-2022 regarding age of injuries (an increase in 9 years or older), etiology (increase in falls and sports versus RTA), AIS grade (increase in incomplete lesions AIS B-D versus AIS A), severity (increase in tetraplegia versus paraplegia) and location (increase in cervical versus lumbar and thoracic injuries). CONCLUSIONS: A shift in trend is observed in the past 7 years regarding age of injuries (increase in those older than 9), etiology (increase in falls and sports versus RTA), AIS grade (increase in incomplete lesions AIS B-D versus AIS A), severity (increase in tetraplegia versus paraplegia) and location (increase in cervical). LEVEL OF EVIDENCE: IV.

Pressure ulcers acquired during inpatient rehabilitation after spinal cord injury, characterization and predictors: A 15-years' experience.

BACKGROUND: Most studies focus on the risk factors associated with the development of pressure ulcers (PUs) during acute phase or community care for individuals with spinal cord injury (SCI). OBJECTIVES: This study aimed to i) compare clinical and demographic characteristics of inpatients after SCI with PUs acquired during rehabilitation vs inpatients without PUs and ii) evaluate an existing PU risk assessment tool iii) identify first PU predictors. METHODS: Individuals (n = 1,135) admitted between 2008 and 2022 to a rehabilitation institution within 60 days after SCI were included. Admission Functional Independence Measure (FIM), American Spinal Injury Association Impairment Scale (AIS) and mEntal state, Mobility, Incontinence, Nutrition, Activity (EMINA) were assessed. Kaplan-Meier curves and Cox proportional hazards models were fitted. RESULTS: Overall incidence of PUs was 8.9%. Of these, 40.6% occurred in the first 30 days, 47.5% were sacral, 66.3% were Stage II. Patients with PUs were older, mostly with traumatic injuries (67.3%), AIS A (54.5%), lower FIM motor (mFIM) score and mechanical ventilation. We identified specific mFIM items to increase EMINA specificity. Adjusted Cox model yielded sex (male), age at injury, AIS grade, mFIM and diabetes as PUs predictors (C-Index = 0.749). CONCLUSION: Inpatients can benefit from combined assessments (EMINA + mFIM) and clinical features scarcely addressed in previous studies to prevent PUs.

Return to work within a year after first stroke: blue and white collar workers comparison, predictors and causal mediation assessed during inpatient rehabilitation.

BACKGROUND: Most research focuses around impairments in body function and structure, with relatively only a small number exploring their social impact. OBJECTIVES: 1) compare characteristics for individuals who before stroke were blue collar vs. white collar workers 2) identify clinical, functional, and job-related factors associated with return to work within 1 year after discharge 3) identify specific ADL individual items (assessed at rehabilitation discharge) as return to work predictors and 4) identify return to work causal mediators. METHODS: Retrospective observational cohort study, analyzing adult patients with stroke admitted to rehabilitation between 2007 and 2021, including baseline Barthel Index (BI) and return to work assessments between 2008 and 2022. Kaplan-Meier survival curves and Cox proportional hazards were applied. Causal mediation analyses using 1000-bootstrapped simulations were performed. RESULTS: A total of 802 individuals were included (14.6% returned to work), 53.6% blue-collar and 46.4% white-collar. Blue-collar workers showed significantly higher proportion of ischemic stroke, diabetes, dyslipidemia, and hypertension.Individuals not returning to work presented a higher proportion of blue collar, dominant side affected, aphasia, lower BI scores, and larger length of stay (LOS). Multivariable Cox proportional hazards identified age at injury, aphasia, hypertension, and total discharge BI score (C-Index = 0.74). Univariable Cox models identified three independent BI items at all levels of independence: bathing (C-Index = 0.58), grooming (C-Index = 0.56) and feeding (C-Index = 0.59). BI efficiency (gain/LOS) was a causal mediator. CONCLUSION: Blue collar workers showed higher proportion of risk factors and comorbidities. Novel factors, predictors, and a return to work mediator were identified.

"Guttmann Cognitest®," a digital solution for assessing cognitive performance in adult population: A feasibility and usability pilot study.

Background: As the world population continues to age, the prevalence of neurological diseases, such as dementia, poses a significant challenge to society. Detecting cognitive impairment at an early stage is vital in preserving and enhancing cognitive function. Digital tools, particularly mHealth, offer a practical solution for large-scale population screening and prompt follow-up assessments of cognitive function, thus overcoming economic and time limitations. Objective: In this work, two versions of a digital solution called Guttmann Cognitest® were tested. Methods: Two hundred and one middle-aged adults used the first version (Group A), while 132 used the second one, which included improved tutorials and practice screens (Group B). This second version was also validated in an older age group (Group C). Results: This digital solution was found to be highly satisfactory in terms of usability and feasibility, with good acceptability among all three groups. Specifically for Group B, the system usability scale score obtained classifies the solution as the best imaginable in terms of usability. Conclusions: Guttmann Cognitest® has been shown to be effective and well-perceived, with a high potential for sustained engagement in tracking changes in cognitive function.

Effectiveness and efficiency of telerehabilitation on functionality after spinal cord injury: A matched case-control study.

BACKGROUND: Telerehabilitation in spinal cord injury (teleSCI) is a growing field that can improve access to care and health outcomes in patients with spinal cord injury (SCI). The clinical effectiveness of teleSCI is not known. OBJECTIVES: To compare independence in activities of daily living and mobility capacity in patients following teleSCI and matched controls undergoing traditional rehabilitation. DESIGN: Matched case-control study. SETTING: TeleSCI occurring in home setting (cases) versus traditional rehabilitation on inpatient unit (controls). PARTICIPANTS: Forty-two consecutive patients with SCI followed with teleSCI were compared to 42 historical rehabilitation inpatients (controls) matched for age, time since injury to rehabilitation admission, level of injury (paraplegia/tetraplegia), complete or incomplete injury, and etiology (traumatic/nontraumatic). The teleSCI group (n = 42) was also compared to the complete cohort of historical controls (n = 613). INTERVENTIONS: The teleSCI group followed home-based telerehabilitation (3.5 h/day, 5 days/week, 67 days average duration) and historical controls followed in-person rehabilitation. MAIN OUTCOME MEASURE(S): The Functional Independence Measure (FIM), the Spinal Cord Independence Measure (SCIM) and the Walking Index for Spinal Cord Injury (WISCI). We formally compared gains, efficiency and effectiveness. International Standards for Neurological Classification of Spinal Cord Injury and the American Spinal Injury Association Impairment Scale (AIS) were used. RESULTS: The teleSCI group (57.1% nontraumatic, 71.4% paraplegia, 73.8% incomplete, 52.4% AIS grade D) showed no significant differences compared with historical controls in AIS grades, neurological levels, duration, gains, efficiency and effectiveness in FIM, SCIM, or WISCI, although the teleSCI cohort had significantly higher admission FIM scores compared with the complete cohort of historical controls. CONCLUSIONS: TeleSCI may provide similar improvements in mobility and functional outcomes as traditional rehabilitation in medically stable patients (predominantly with paraplegia and motor incomplete SCI) when provided with appropriate support and equipment.

Tele-rehabilitation on independence in activities of daily living after stroke: A Matched Case-Control Study.

OBJECTIVES: To compare independence in activities of daily living (ADLs) in post-acute patients with stroke following tele-rehabilitation and matched in-person controls. MATERIALS AND METHODS: Matched case-control study. A total of 35 consecutive patients with stroke who followed tele-rehabilitation were compared to 35 historical in-person patients (controls) matched for age, functional independence at admission and time since injury to rehabilitation admission (<60 days). The tele-rehabilitation group was also compared to the complete cohort of historical controls (n=990). Independence in ADLs was assessed using the Functional Independence Measure (FIM) and the Barthel Index (BI). We formally compared FIM and BI gains calculated as discharge score - admission scores, efficiency measured as gains / length of stay and effectiveness defined as (discharge score-admission score)/ (maximum score-admission score). We analyzed the minimal clinically important difference (MCID) for FIM and BI. RESULTS: The groups showed no significant differences in type of stroke (ischemic or hemorrhagic), location, severity, age at injury, length of stay, body mass index, diabetes, dyslipidemia, hypertension, aphasia, neglect, affected side of the body, dominance or educational level. The groups showed no significant differences in gains, efficiency nor effectiveness either using FIM or Barthel Index. We identified significant differences in two specific BI items (feeding and transfer) in favor of the in-person group. No differences were observed in the proportion of patients who achieved MCID. CONCLUSIONS: No significant differences were seen between total ADL scores for tele-rehabilitation and in-person rehabilitation. Future research studies should analyze a combined rehabilitation approach that utilizes both models.

Inpatient Rehabilitation Falls: Comparing Patients With Traumatic Brain Injury Versus Patients With Stroke.

BACKGROUND: Cognitively impaired neurological rehabilitation inpatients are at an increased risk for falls; yet, little is known regarding fall risk of different groups, such as stroke versus traumatic brain injury. OBJECTIVES: To determine if rehabilitation patients' fall characteristics differ for patients with stroke versus patients with traumatic brain injury. METHODS: This retrospective observational cohort study evaluates inpatients with stroke or traumatic brain injury admitted to a rehabilitation center in Barcelona, Spain, between 2005 and 2021. We assessed independence in daily activities with the Functional Independence Measure. We compared fallen versus nonfallen patients' features and examined the association between time to first fall and risk using Cox proportional hazards models. RESULTS: A total of 1,269 fall events were experienced by 898 different patients with traumatic brain injury ( n = 313; 34.9%) and stroke ( n = 585; 65.1%). A higher proportion of falls for patients with stroke occurred while performing rehabilitation activities (20.2%-9.8%), whereas falls were significantly higher for patients with traumatic brain injury during the night shift. Fall timing revealed completely different behaviors (stroke vs. traumatic brain injury), for example, an absolute peak at 6 a.m. due to young male traumatic patients. Nonfallen patients ( n = 1,363; 78.2%) were younger, with higher independence in daily activities scores, and having a larger time since injury to admission; all three were significant fall predictors. CONCLUSIONS: Patients with traumatic brain injury and stroke showed different fall behaviors. Knowledge of fall patterns and characteristics in the inpatient rehabilitation setting can help design management protocols to mitigate their risk.

Predicting models for arm impairment: External validation of the Scandinavian models and identification of new predictors in post-acute stroke settings.

BACKGROUND: Post-stroke arm impairment at rehabilitation admission as predictor of discharge arm impairment was consistently reported as extremely useful. Several models for acute prediction exist (e.g. the Scandinavian), though lacking external validation and larger time-window admission assessments. OBJECTIVES: (1) use the 33 Fugl-Meyer Assessment-Upper Extremity (FMA-UE) individual items to predict total FMA-UE score at discharge of patients with ischemic stroke admitted to rehabilitation within 90 days post-injury, (2) use eight individual items (seven from the Scandinavian study plus the top predictor item from objective 1) to predict mild impairment (FMA-UE≥48) at discharge and (3) adjust the top three models from objective 2 with known confounders. METHODS: This was an observational study including 287 patients (from eight settings) admitted to rehabilitation (2009-2020). We applied regression models to candidate predictors, reporting adjusted R2, odds ratios and ROC-AUC using 10-fold cross-validation. RESULTS: We achieved good predictive power for the eight item-level models (AUC: 0.70-0.82) and for the three adjusted models (AUC: 0.85-0.88). We identified finger mass flexion as new item-level top predictor (AUC:0.88) and time to admission (OR = 0.9(0.9;1.0)) as only common significant confounder. CONCLUSION: Scandinavian item-level predictors are valid in a different context, finger mass flexion outperformed known predictors, days-to-admission predict discharge mild arm impairment.

Multicentric investigation on the safety, feasibility and usability of the ABLE lower-limb robotic exoskeleton for individuals with spinal cord injury: a framework towards the standardisation of clinical evaluations.

BACKGROUND: Robotic lower-limb exoskeletons have the potential to provide additional clinical benefits for persons with spinal cord injury (SCI). However, high variability between protocols does not allow the comparison of study results on safety and feasibility between different exoskeletons. We therefore incorporated key aspects from previous studies into our study protocol and accordingly conducted a multicentre study investigating the safety, feasibility and usability of the ABLE Exoskeleton in clinical settings. METHODS: In this prospective pretest-posttest quasi-experimental study across two SCI centres in Germany and Spain, in- and outpatients with SCI were recruited into a 12-session training and assessment protocol, utilising the ABLE Exoskeleton. A follow-up visit after 4 weeks was included to assess after-training outcomes. Safety outcomes (device-related adverse events (AEs), number of drop-outs), feasibility and usability measures (level of assistance, donning/doffing-time) were recorded at every session together with changes in gait parameters and function. Patient-reported outcome measures including the rate of perceived exertion (RPE) and the psychosocial impact of the device were performed. Satisfaction with the device was evaluated in both participants and therapists. RESULTS: All 24 participants (45 ± 12 years), with mainly subacute SCI (< 1 year after injury) from C5 to L3, (ASIA Impairment Scale A to D) completed the follow-up. In 242 training sessions, 8 device-related AEs (pain and skin lesions) were reported. Total time for don and doff was 6:50 ± 2:50 min. Improvements in level of assistance and gait parameters (time, steps, distance and speed, p < 0.05) were observed in all participants. Walking function and RPE improved in participants able to complete walking tests with (n = 9) and without (n = 6) the device at study start (p < 0.05). A positive psychosocial impact of the exoskeleton was reported and the satisfaction with the device was good, with best ratings in safety (participants), weight (therapists), durability and dimensions (both). CONCLUSIONS: Our study results prove the feasibility of safe gait training with the ABLE Exoskeleton in hospital settings for persons with SCI, with improved clinical outcomes after training. Our study protocol allowed for consistent comparison of the results with other exoskeleton trials and can serve as a future framework towards the standardisation of early clinical evaluations. Trial Registration https://trialsearch.who.int/ , DRKS00023503, retrospectively registered on November 18, 2020.

Long-term trajectories of community integration: identification, characterization, and prediction using inpatient rehabilitation variables.

BACKGROUND: Community integration (CI) is often regarded as the foundation of rehabilitation endeavors after stroke; nevertheless, few studies have investigated the relationship between inpatient rehabilitation (clinical and demographic) variables and long-term CI. OBJECTIVES: To identify novel classes of patients having similar temporal patterns in CI and relate them to baseline features. METHODS: Retrospective observational cohort study analyzing (n = 287) adult patients with stroke admitted to rehabilitation between 2003 and 2018, including baseline Functional Independence Measure (FIM) at discharge, follow-ups (m = 1264) of Community Integration Questionnaire (CIQ) between 2006 and 2022. Growth mixture models (GMMs) were fitted to identify CI trajectories, and baseline predictors were identified using multivariate logistic regression (reporting AUC) with 10-fold cross validation. RESULTS: Each patient was assessed at 2.7 (2.2-3.7), 4.4 (3.7-5.6), and 6.2 (5.4-7.4) years after injury, 66% had a fourth assessment at 7.9 (6.8-8.9) years. GMM identified three classes of trajectories.Lowest CI (n=105, 36.6%): The lowest mean total CIQ; highest proportion of dysphagia (47.6%) and aphasia (46.7%), oldest at injury, largest length of stay (LOS), largest time to admission, and lowest FIM.Highest CI (n=63, 21.9%): The highest mean total CIQ, youngest, shortest LOS, highest education (27% university) highest FIM, and Intermediate CI (n=119, 41.5%): Intermediate mean total CIQ and FIM scores. Age at injury OR: 0.89 (0.85-0.93), FIM OR: 1.04 (1.02-1.07), hypertension OR: 2.86 (1.25-6.87), LOS OR: 0.98 (0.97-0.99), and high education OR: 3.05 (1.22-7.65) predicted highest CI, and AUC was 0.84 (0.76-0.93). CONCLUSION: Novel clinical (e.g. hypertension) and demographic (e.g. education) variables characterized and predicted long-term CI trajectories.

Long-term prediction of functional independence using adjusted and unadjusted single items of the functional independence measure (FIM) at discharge from rehabilitation.

CONTEXT: Being able to survive in the long-term independently is of concern to patients with spinal cord injury (SCI), their relatives, and to those providing or planning health care, especially at rehabilitation discharge. Most previous studies have attempted to predict functional dependency in activities of daily living within one year after injury. OBJECTIVES: (1) build 18 different predictive models, each model using one FIM (Functional Independence Measure) item, assessed at discharge, as independent predictor of total FIM score at chronic phase (3-6 years post-injury) (2) build three different predictive models, using in each model an item from a different FIM domain with the highest predictive power obtained in objective (1) to predict "good" functional independence at chronic phase and (3) adjust the 3 models from objective (2) with known confounding factors. METHODS: This observational study included 461 patients admitted to rehabilitation between 2009 and 2019. We applied regression models to predict total FIM score and "good" functional independence (FIM motor score ≥ 65) reporting adjusted R2, odds ratios, ROC-AUC (95% CI) tested using 10-fold cross-validation. RESULTS: The top three predictors, each from a different FIM domain, were Toilet (adjusted R2 = 0.53, Transfers domain), Toileting (adjusted R2 = 0.46, Self-care domain), and Bowel (adjusted R2 = 0.35, Sphincter control domain). These three items were also predictors of "good" functional independence (AUC: 0.84-0.87) and their predictive power increased (AUC: 0.88-0.93) when adjusted by age, paraplegia, time since injury, and length of stay. CONCLUSIONS: Discharge FIM items accurately predict long-term functional independence.

Falls During Inpatient Rehabilitation After Spinal Cord Injury: Characterization, Clock-Hour Visualization, and Time to Event Predictors.

OBJECTIVES: To (1) determine fall characteristics (eg, cause, location, witnesses) of inpatients with spinal cord injury (SCI) and whether they were different for ambulatory persons vs wheelchair users; (2) visualize the total number of daily falls per clock-hour for different inpatients' features (eg, cause of injury, age); (3) compare clinical and demographic characteristics of inpatients who experienced a first fall event vs inpatients who did not experience such event; and (4) identify first fall event predictors. DESIGN: Retrospective observational cohort study. SETTING: Institution for inpatient neurologic rehabilitation. PARTICIPANTS: Persons with SCI (N=1294) admitted to a rehabilitation facility between 2005 and 2022. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Functional independence measure (FIM), Hospital Anxiety and Depression Scale (HADS), American Spinal Injury Association Impairment Scale (AIS), and Spinal Cord Independence Measure (SCIM) at admission. Kaplan-Meier survival curves and Cox proportional hazards models were used. RESULTS: A total of 502 fall events were experienced by 369 ambulatory inpatients (19.8%) and wheelchair users (80.2%) in 63.9% of cases being alone, with cause, situation, and location significantly different in both groups. Clock-hour visualizations revealed an absolute peak at 12 AM (complete or incomplete injuries, with paraplegia or tetraplegia) but a relative peak at 9 AM mainly including incomplete patients with paraplegia. Of the (n=1294) included patients, 16.8% experienced at least 1 fall. Fallen patients reported higher levels of HADS depression, lower total SCIM, and longer time since injury to admission, with no differences in age, sex, educational level, FIM (quasi-significant), and AIS grade. Multivariable Cox proportional hazards identified time since injury to admission and AIS grade D as significant predictors of first fall event. CONCLUSIONS: Falls identification, characterization, and clock-hour visualization can support decisions for mitigation strategies specifically addressed to inpatients with SCI. Fall predictors were identified as a first step for future research.

Developing an assistive technology usability questionnaire for people with neurological diseases.

PURPOSE: This study describes the development of a questionnaire for assessing the usability of assistive technologies accessible to people with neurological diseases. METHODS: A Delphi study was conducted to identify relevant items for the questionnaire. After that, the content validity was addressed to identify the essential items. Once the questionnaire was designed following the results of the Delphi study and content validity, the reliability, validity, and the Rasch model of the questionnaire were examined. RESULTS: Two rounds of the Delphi study were carried out. A total of 73 participants (42 experts and 31 users) participated in round 1, and 59 people (27 experts and 32 users) in round 2. A total of 53 and 29 items were identified in rounds 1 and 2, respectively. In the content validity, we found nine items above the threshold of 0.58. Finally, ten items were included in the questionnaire. Fifty-one participants participate in the reliability and validity of the questionnaire. The internal consistency reliability of the questionnaire analyzed by Cronbach's Alpha was α = 0,895. There was moderate to considerable concordance among our questionnaire items test-retest in the Kappa coefficient and a strong association between test-retest in the Spearman's coefficient ρ = 0.818 (p<0,001). The intraclass correlation coefficient was 0,869 with a 95% confidence interval (0,781;0,923). There was a strong correlation between the total scores of the new questionnaire and other validated questionnaires analyzed with Spearman's coefficient ρ = 0.756 (p<0,001). The ten items demonstrated a satisfactory fit to the Rasch model. CONCLUSIONS: The present study suggested that the new questionnaire is a reliable 10-item usability questionnaire that allows subjective and quick assessment of the usability of assistive technologies by people with neurological diseases.

Investigating the application of "Guttmann Cognitest"® in older adults and people with acquired brain injury.

Introduction: Digital solutions for cognitive assessment are currently not only widely used in experimental contexts but can also be useful in clinical practice for efficient screening and longitudinal follow-up. The "Guttmann Cognitest"®, which includes seven computerized tasks designed to assess main cognitive functions, revealed in a previous validation study to be a potential useful tool to assess cognitive functioning in healthy middle-aged adults. Method: Here, we present results from a validation in two different populations: one consisting of older adults, and the other comprising young and middle-aged individuals, some of them affected by acquired brain injury. To perform a convergent validity test, older adults were also administered with the MOCA, while young and middle-aged individuals were administered with a short neuropsychological assessment including gold-standard neuropsychological tests. We also conducted sensitivity and specificity analysis to establish the utility of this instrument in identifying potential cognitive dysfunctions in the two groups. Results: Results demonstrated strong convergent validity as well as good specificity and sensitivity characteristics. Discussion: This tool is a valid and useful instrument to assess cognitive functioning and detecting potential cases of cognitive dysfunctions in older adults and clinical populations.

"Guttmann Cognitest"®, preliminary validation of a digital solution to test cognitive performance.

Thanks to technological advances, the administration of cognitive assessments via digital solutions continues to increase, both in research and clinical practice. "Guttmann Cognitest"°ledR is a digital solution for cognitive assessment which includes seven computerized tasks designed to assess main cognitive functions requiring approximately 20 min to be completed. The purpose of the present study was to validate it against standard and more extensive in-person neuropsychological assessments in the context of the Barcelona Brain Health Initiative (BBHI) cohort study. We studied 274 participants of the BBHI (126 women, mean age = 56.14, age range 44-69), who underwent an extensive in-person assessment, including a classical paper-and-pencil neuropsychological assessment and a cognitive assessment via the "Guttmann Cognitest"°ledR. Principal component analysis indicated that "Guttmann Cognitest"°ledR measures four main cognitive domains and convergent validity analysis demonstrated that cognitive performance was associated with gold standard paper and pencil tests. Results also showed an expected negative correlation with age, a relation with educational level as well as a gender effect. Regression-based norming equations for the sample tested are also reported. Performing a cognitive assessment with this digital solution is feasible and potentially useful to gather information about cognitive functioning in large samples and experimental settings.