Trunk control and acute-phase multifactorial predictors of community mobility after stroke: a longitudinal observational study.

Introduction: Stroke is a detrimental condition associated with long-term functional impairments that restrict community reintegration, which is an indicator of successful post-stroke functional recovery and rehabilitation. Additionally, trunk control is an understudied factor that may contribute to community mobility and participation after stroke. This study aimed to identify predictors of community mobility among stroke survivors in the acute phase, with a primary focus on trunk control, in addition to exploring the mediating and moderating role of predictive factors. Methods: A longitudinal observational study included 61 participants with acute stroke. Trunk control test (TCT) during sitting, stroke severity, quality of life, fear of falls, depression, and age was assessed during the acute phase as potential predictors. The community mobility outcome measure was assessed 3 months after baseline using the Reintegration to Normal Living Index (RNLI). Statistical analyses included correlation, linear regression, mediation, and moderation analyses. Results: Trunk control test was the strongest predictor of RNLI among all factors (ß = 0.72; 95%CI = 0.004-0.007; p ≤ 0.0001). Stroke severity, quality of life, fear of falls, and age significantly predicted RNLI (p < 0.01). Higher age was a significant moderator of the relationship between TCT and RNLI (ß = 0.002; p < 0.001; 95% CI = 0.0001-0.0003). Discussion: The findings highlight sitting trunk control impairment during the acute stage as a crucial predictor of reduced community mobility after stroke, where age over 60 years can moderate this relationship. The study emphasizes that addressing trunk control during early stroke rehabilitation may enhance community reintegration prospects.

Speed- and Endurance-Based Classifications of Community Ambulation Post-Stroke Revisited: The Importance of Location in Walking Performance Measurement.

BACKGROUND: Gait speed or 6-minute walk test are frequently used to project community ambulation abilities post-stroke by categorizing individuals as household ambulators, limited, or unlimited community ambulators. However, whether improved clinically-assessed gait outcomes truly translate into enhanced real-world community ambulation remains uncertain. OBJECTIVE: This cross-sectional study aimed to examine differences in home and community ambulation between established categories of speed- and endurance-based classification systems of community ambulation post-stroke and compare these with healthy controls. METHODS: Sixty stroke survivors and 18 healthy controls participated. Stroke survivors were categorized into low-speed, medium-speed, or high-speed groups based on speed-based classifications and into low-endurance, medium-endurance, or high-endurance groups based on the endurance-based classification. Home and community steps/day were quantified using Global Positioning System and accelerometer devices over 7 days. RESULTS: The low-speed groups exhibited fewer home and community steps/day than their medium- and high-speed counterparts (P < .05). The low-endurance group took fewer community steps/day than the high-endurance group (P < .05). Despite vast differences in clinical measures of gait speed and endurance, the medium-speed/endurance groups did not differ in their home and community steps/day from the high-speed/endurance groups, respectively. Stroke survivors took 48% fewer home steps/day and 77% fewer community steps/day than healthy controls. CONCLUSIONS: Clinical classification systems may only distinguish home ambulators from community ambulators, but not between levels of community ambulation, especially beyond certain thresholds of gait speed and endurance. Clinicians should use caution when predicting community ambulation status through clinical measures, due to the limited translation of these classification systems into the real world.

A qualitative exploration of community mobility experiences of wheelchair users.

Background: Freedom of movement, which is dependent on community mobility, is a key contributor to good quality of life and important in the establishment of a person's community identity. Objective: To describe the community mobility experiences of wheelchair users who lived in a socio-economically challenged setting. Method: The study setting was Paarl, a peri-urban area of the Western Cape province of South Africa. This article reports findings from phase 1 (a reflection on past community mobility and minibus taxi use experiences) of cycle 1 of a co-operative inquiry. Nine adult wheelchair users, eight caregivers, six minibus taxi drivers, and four community stakeholders participated. Data were collected during a focus group discussion and analysed using inductive thematic analysis. Results: Four themes, 'Knowledge, attitudes, and actions', 'Natural, manmade and mechanical environmental barriers', 'Health and safety concerns' and 'Poor community participation and quality of life' were identified. The themes showed how difficult an everyday activity like moving around in the community were for wheelchair users, and how that limited their community involvement. Conclusions: Wheelchair users living in a low-income peri-urban area struggled to participate in community activities meaningful to them because various barriers hampered community wheelchair mobility and minibus taxi use. Contribution: The findings regarding community mobility struggles and specifically minibus taxi access guided specific recommendations and the further phases and cycles of the co-operative inquiry. The purpose of the co-operative inquiry was to allow co-researchers to find their voice and develop solutions to minibus taxi access for wheelchair users.

Innovative solutions to support individuals with disabilities accessing public transportation: A case study.

Individuals with cognitive disabilities have challenges with personal navigation and wayfinding, especially when traveling on public transportation. The purpose of this case study is to describe the structure and implementation of the Personal Navigation for Individuals with Disabilities (PNID) education and training program, which is based on a socio-technical architecture for individuals with cognitive disabilities within a fixed-route public bus system. A case study methodology was used to describe preliminary findings of the skills, attributes, and experiences of three individuals with cognitive disabilities as it relates to transportation on fixed-route bus systems in a midsized urban setting. The three individuals completed five training activities: safety, public bus, smartphone, WayFinder App, and fixed-route bus system. The case study provided a preliminary mixed-methods overview of training travelers with cognitive disabilities to use the WayFinder system while accessing fixed-route public bus system. The insights and strategies identified through the case study demonstrate the potential opportunities for development, implementation, and sustainability of the PNID program in other midsized urban settings. The PNID program (i.e. AT service delivery process), in combination with the WayFinder system (i.e. assistive technology), has the potential to meet the unique needs of individuals with cognitive disabilities when accessing public transportation.

An Examination of Two Diverse Communities: Residents' Transportation Behaviors, Challenges, and Opportunities.

The Smart Cities Collaborative aims to mitigate transportation challenges and inequities with new approaches and technologies (e.g., ridesharing). Therefore, assessing community transportation needs is essential. The team explored the travel behaviors, challenges, and/or opportunities among low- and high-socioeconomic status (SES) communities. Using Community-Based Participatory Research principles, four focus groups were conducted to investigate residents' behaviors and experiences with transportation availability, accessibility, affordability, acceptability, and adaptability. Focus groups were recorded, transcribed, and verified before thematic and content data analysis. Participants with low SES (n = 11) discussed user-friendliness, uncleanliness, and bus accessibility challenges. Comparatively, the participants with high SES (n = 12) discussed traffic congestion and parking. Both communities had concerns about safety and limited bus services and routes. Alternatively, opportunities included a convenient fixed-route shuttle. All groups stated the bus fare was affordable unless multiple fares or rideshare were needed. Findings provide valuable insight when developing equitable transportation recommendations.

Initial validation of the university of Alabama Birmingham study of aging life-space assessment in older adults with multiple sclerosis.

BACKGROUND: Older adults with multiple sclerosis (OAMS) have declines in walking and physical performance that may erode community mobility defined as the spatial extent of mobility in one's daily life and environment. OBJECTIVE: This study provided the first application and validation of the University of Alabama Birmingham Study of Aging Life-Space Assessment (UAB LSA) as a measure of community mobility in OAMS. METHODS: The sample included 97 OAMS and 108 healthy controls (HCs) who completed baseline assessments as part of an ongoing, longitudinal study. The primary assessments included the UAB LSA and timed 25-foot walk (T25FW), short physical performance battery (SPPB), global health score (GHS), and geriatric depression scale (GDS) in both OAMS and HCs, and patient determined disease steps (PDDS) scale in only OAMS. RESULTS: OAMS had significantly lower UAB LSA scores than HCs (p < .001). UAB LSA scores had strong correlations with T25FW(rs = -.641) and SPPB(rs = 0.507) in OAMS, and moderate correlations in HCs (rs = -.300 & rs = 0.384). The correlations between UAB LSA and GHS and GDS scores were significant, but small in OAMS (rs = -.239 & rs = -.231), and not statistically significant in HCs (rs = -.009 & rs = -.166). There was a strong correlation between UAB LSA and PDDS scores in the OAMS sample (rs = -.605). CONCLUSION: We provided initial evidence for UAB LSA scores as a measure of community mobility in OAMS.

Impacto de la movilidad poblacional en el comportamiento de virus respiratorios durante la pandemia COVID-19 / Impact of population mobility on the behavior of respira tory viruses during the COVID-19 pandemic

Resumen Introducción : Durante la pandemia de SARS-CoV-2 en Argentina se implementaron intervenciones no farma cológicas que produjeron cambios en la movilidad de la población. El objetivo de este estudio fue relacionar los porcentajes de positividad y la diversidad viral con la movi lidad poblacional durante parte del período de restricciones. Métodos : Estudio retrospectivo analítico realizado en el Instituto Médico Platense durante los años 2020 a 2022 que incluyó 458 pacientes a los que se les tomó un hisopado nasofaríngeo para la búsqueda de patóge nos respiratorios por PCR multiplex. Se analizaron los cambios en la movilidad de la población utilizando los "Informes de Movilidad Local", herramienta desarrollada por Google, cuyos datos son de público acceso. Resultados : La movilidad poblacional se correlacionó significativamente con el porcentaje de positividad de las muestras (p = <0.01; R2 = 0.89) y la diversidad viral (p = 0.04; R2 = 0.78). Discusión : Las intervenciones no farmacológicas destinadas a limitar la propagación del SARS-CoV-2 tuvieron efecto en la circulación de otros virus respi ratorios, hallándose mayor porcentaje de positividad y diversidad a medida que las mismas disminuyeron su grado de restricción.

Abstract Introduction : During the SARS-CoV-2 pandemic, Ar gentina population suffered from significant changes in population mobility due to non-pharmaceutical interventions. The aim of this study was to describe the impact of the mobility restrictions to the rates of positivity and diversity among different respiratory viruses. Methods : Retrospective analytical study per formed at Instituto Médico Platense in La Plata that included 458 patients with nasopharyngeal swab to search for respiratory pathogens by multiplex PCR. Changes in mobility were studied using "Community Mobility Reports", data set developed by Google and publicly available. Results : Community mobility had significant cor relation with the percentages of viral test positiv ity (p = < 0.01; R2=0.89) and viral diversity (p = 0.04; R2 = 0.78). Discussion : Non-pharmaceutical interventions estab lished to contain SARS-CoV-2 spread had a significant impact in the circulation patterns of other respiratory viruses.

[Impact of population mobility on the behavior of respiratory viruses during the COVID-19 pandemic]. / Impacto de la movilidad poblacional en el comportamiento de virus respiratorios durante la pandemia COVID-19.

INTRODUCTION: During the SARS-CoV-2 pandemic, Argentina population suffered from significant changes in population mobility due to non-pharmaceutical interventions. The aim of this study was to describe the impact of the mobility restrictions to the rates of positivity and diversity among different respiratory viruses. METHODS: Retrospective analytical study performed at Instituto Médico Platense in La Plata that included 458 patients with nasopharyngeal swab to search for respiratory pathogens by multiplex PCR. Changes in mobility were studied using "Community Mobility Reports", data set developed by Google and publicly available. RESULTS: Community mobility had significant correlation with the percentages of viral test positivity (p = < 0.01; R2=0.89) and viral diversity (p = 0.04; R2 = 0.78). DISCUSSION: Non-pharmaceutical interventions established to contain SARS-CoV-2 spread had a significant impact in the circulation patterns of other respiratory viruses.

Introducción: Durante la pandemia de SARS-CoV-2 en Argentina se implementaron intervenciones no farmacológicas que produjeron cambios en la movilidad de la población. El objetivo de este estudio fue relacionar los porcentajes de positividad y la diversidad viral con la movilidad poblacional durante parte del período de restricciones. Métodos: Estudio retrospectivo analítico realizado en el Instituto Médico Platense durante los años 2020 a 2022 que incluyó 458 pacientes a los que se les tomó un hisopado nasofaríngeo para la búsqueda de patógenos respiratorios por PCR multiplex. Se analizaron los cambios en la movilidad de la población utilizando los "Informes de Movilidad Local", herramienta desarrollada por Google, cuyos datos son de público acceso. Resultados: La movilidad poblacional se correlacionó significativamente con el porcentaje de positividad de las muestras (p = <0.01; R2 = 0.89) y la diversidad viral (p = 0.04; R2 = 0.78). Discusión: Las intervenciones no farmacológicas destinadas a limitar la propagación del SARS-CoV-2 tuvieron efecto en la circulación de otros virus respiratorios, hallándose mayor porcentaje de positividad y diversidad a medida que las mismas disminuyeron su grado de restricción.

Exploring the use of powered mobility devices and occupational participation for people with obesity.

BACKGROUND: The increasing prevalence of obesity is a global issue with the World Health Organization estimating that more than 650 million adults are impacted by obesity. Those living with obesity are impacted by both physical and psychological issues. The physical consequences of living with obesity can lead to decreased mobility and reduced occupational participation. The aim of this research is to understand how the use of a powered mobility device influences occupational participation and quality of life from the perspective of people with obesity. METHOD: Semi-structured qualitative interviews (n = 7) were undertaken with a phenomenological approach to gain an understanding of the lived experience of using a powered mobility device. RESULTS: Thematic analysis occurred resulting in inter-connected themes that describe the positive experiences associated with using a powered mobility device: (1) autonomous mobility; (2) enhanced occupational participation; and (3) improved self-efficacy creates increased confidence in relation to participation. In addition, two themes emerged that were barriers to usage of powered mobility devices: (4) physical environmental barriers and (5) difficulty transporting the powered mobility device. CONCLUSION: For those with obesity, a powered mobility device provided autonomous mobility allowing them to engage in an increased range of activities. This was hampered by physical environmental barriers and difficulties transporting the powered mobility device. Further research is required to verify the results of this study with a wider population and to explore the benefits and barriers to use of a powered mobility device in the home and community.

Novel automaticity index reveals a cognitive ability-related decline in gait automaticity during dual-task walking.

Gait automaticity refers to the ability to walk with minimal recruitment of attentional networks typically mediated through the prefrontal cortex (PFC). Reduced gait automaticity is common with aging, contributing to an increased risk of falls and reduced quality of life. A common assessment of gait automaticity involves examining PFC activation using near-infrared spectroscopy (fNIRS) during dual-task (DT) paradigms, such as walking while performing a cognitive task. However, neither PFC activity nor task performance in isolation measures automaticity accurately. For example, greater PFC activation could be interpreted as worse gait automaticity when accompanied by poorer DT performance, but when accompanied by better DT performance, it could be seen as successful compensation. Thus, there is a need to incorporate behavioral performance and PFC measurements for a more comprehensive evaluation of gait automaticity. To address this need, we propose a novel automaticity index as an analytical approach that combines changes in PFC activity with changes in DT performance to quantify gait automaticity. We validated the index in 173 participants (≥65 y/o) who completed DTs with two levels of difficulty while PFC activation was recorded with fNIRS. The two DTs consisted of reciting every other letter of the alphabet while walking over either an even or uneven surface. We found that as DT difficulty increases, more participants showed the anticipated decrease in automaticity as measured by the novel index compared to PFC activation. Furthermore, when comparing across individuals, lower cognitive function related to worse automaticity index, but not PFC activation or DT performance. In sum, the proposed index better quantified the differences in automaticity between tasks and individuals by providing a unified measure of gait automaticity that includes both brain activation and performance. This new approach opens exciting possibilities to assess participant-specific deficits and compare rehabilitation outcomes from gait automaticity interventions.

An Exploratory Study of Community Mobility in Adults With Multiple Sclerosis Across Different Ambulation Levels.

BACKGROUND: The purpose of this study was to identify differences in community mobility in adults with multiple sclerosis (MS) at various ambulation levels. METHODS: Seventy-one adults with MS completed a survey about their mobility impairment and avoidance of challenging mobility tasks. Individuals were categorized as having mild, moderate, or severe gait impairment. RESULTS: Participants across the different functional groups significantly differed in perceived ambulation disability, fatigue impact, falls efficacy, quality of life, challenges with dual-tasking, and self-efficacy for community mobility. There were no significant differences between the mild and moderate gait impairment groups in crossing a busy street or going out in different ambient conditions. Significant differences were found between those with mild impairment and those with severe impairment in avoidance of various terrain elements, heavy manual doors, postural transitions, attentional situations, and crowded places. The only environmental dimension that significantly differed across all 3 groups was carrying 2 or more items, in which avoidance increased as ambulation worsened. CONCLUSIONS: Avoidance behavior for particular environmental features can begin relatively early in the disease process. This underscores the need to further study mobility differences, community ambulation, and participation restrictions in adults with MS.

Measuring vibration and shock in power wheelchairs for clinical application.

Research evidence demonstrates the negative effects of Whole-Body Vibration (WBV) and correlation between exposure to WBV and detriment to health. ISO Standard 2631-1 (1997) is the accepted standard for human exposure to WBV in vehicle vibration, and provides vibration guidelines for health and comfort. These standards have not been applied to power wheelchairs (PWC), and no clinical tool exists that measures vibration levels during live power wheelchair driving. This study measures WBV and shock levels during PWC driving, considering the impact of terrains, base configurations, and seat cushions. A sensor tag accelerometer was used to measure vibration and shock in three different PWC configurations driven over seven different terrains. Data was collected for two runs per wheelchair, per terrain type, per cushion type. Differences were significant (p < .001) for overall mean and median peak vibration compared across the seven terrains, and for overall mean vibration for basic and enhanced cushions. Differences were also noted in mean and peak vibration in the three different base configurations (p = .0052). Results were compared with ISO 2631-1 guidelines. Mechanical shock on certain terrains created peak vibration levels with likely health risk. Results from this study can inform PWC prescription process.

The lockdown and vaccination distribution in Thailand's COVID-19 epidemic: A model study.

Background: Several countries used varied degrees of social isolation measures in response to the COVID-19 outbreak. In 2021, the lockdown in Thailand began on July 20 and lasted for the following six weeks. The lockdown has extremely detrimental effects on the economy and society, even though it may reduce the number of COVID-19 instances. Our goals are to assess the impact of the lockdown policy, the commencement time of lockdown, and the vaccination rate on the number of COVID-19 cases in Thailand in 2021. Methods: We modeled the dynamics of COVID-19 in Thailand throughout 2021 using the SEIR model. The Google Mobility Index, vaccine distribution rate, and lockdown were added to the model. The Google Mobility Index represents the movement of individuals during a pandemic and shows how people react to lockdown. The model also examines the effect of vaccination rate on the incidence of COVID-19. Results: The modeling approach demonstrates that a 6-week lockdown decreases the incidence number of COVID-19 by approximately 15.49-18.17%, depending on the timing of the lockdown compared to a non-lockdown scenario. An increasing vaccination rate potentially reduce the incidence number of COVID-19 by 5.12-18.35% without launching a lockdown. Conclusion: Lockdowns can be an effective method to slow down the spread of COVID-19 when the vaccination program is not fully functional. When the vaccines are easily accessible on a large scale, the lockdown may terminated.

Older people's out-of-home mobility and wellbeing in Australia: Personal, built environment, and transportation factors associated with unmet mobility needs.

Out-of-home mobility is fundamental to older people's wellbeing and quality of life. Understanding the unmet mobility needs of older people is a necessary starting point for determining how they can be supported to be mobile. This study estimates the extent of unmet mobility needs among older Australians and identifies the characteristics of those most likely to report unmet mobility needs. Analysis was conducted on nationally representative data of 6,685 older Australians drawn from the 2018 Survey of Disability, Aging and Carers conducted by the Australian Bureau of Statistics. Twelve predictor variables from two conceptual frameworks on older people's mobility were included in the multiple logistic regression model. Twelve percent (n = 799) of participants had unmet mobility needs, and associated factors significant in multivariable models included being among the "young-old", having a lower income, having lower levels of self-rated health, having a long-term condition, being limited in everyday physical activities, experiencing a higher level of distress, being unlicensed, having decreased public transport ability, and residing in major cities. Efforts to support older people's mobility must make equity an explicit consideration, reject a one-size-fits-all approach, and prioritize the accessibility of cities and communities.

Fear of Falling Avoidance Behavior in Parkinson's Disease: Most Frequently Avoided Activities.

BACKGROUND: Fear of falling avoidance behavior (FFAB) is common in Parkinson's disease (PD). OBJECTIVES: The objectives of the study are to determine what activities are most avoided due to FFAB among people with PD and whether any associations exist with demographic factors or fall history. METHOD: Cross-sectional analysis of 174 individuals with PD using the Modified FFAB Questionnaire. RESULTS: Walking in dimly lit, unfamiliar places, and different surfaces, lifting and carrying objects, walking in crowded places, recreational/leisure activities, and going up/downstairs were most avoided. Fallers reported more FFAB (ps < .029). FFAB for certain activities was associated with increased or decreased odds of falling. CONCLUSION: Individuals with PD avoid walking in compromised situations and engaging in recreational/leisure activities due to FFAB. While excessive FFAB may increase the odds of falling, protective forms may be associated with decreased odds. Targeting FFAB among individuals with PD may increase safe participation in meaningful occupations in the home and community.

Efficacy of the Stroll Safe Outdoor Fall Prevention Program: A Randomized Controlled Trial.

BACKGROUND AND OBJECTIVES: Outdoor falls can negatively affect the independence and well-being of community-dwelling older adults. Although there is some overlap, there are also differences in risk factors for indoor and outdoor falls. There are no existing community-based fall prevention programs that specifically target outdoor fall prevention. To fill this gap, the Stroll Safe program was developed. RESEARCH DESIGN AND METHODS: A cluster-randomized controlled trial design was used with randomization at the site level. Participants (N = 86) were aged 60 and older, with a history of an outdoor fall or who had a fear of falling outdoors. Eight naturally occurring retirement community program sites were randomly assigned to the treatment or wait list control group. Outcome measures included the Outdoor Falls Questionnaire, the Falls Behavioral Scale for the Older Person, and the Falls Efficacy Scale-International to examine knowledge of risks, safe strategy use, protective behaviors, and fear of falling. An Analysis of Covariance (ANCOVA) was used to compare change scores between groups with covariates included for any initial differences between groups. A linear mixed model was also conducted to account for any clustering effects. RESULTS: Significant differences (ps < .05) were found between groups for knowledge of outdoor fall risks and safe strategy use. Effect sizes were large (Cohen's d = 1.2-1.9). Results were retained at 6-week follow-up. DISCUSSION AND IMPLICATIONS: Stroll Safe is effective in improving knowledge of outdoor fall risks and increasing safe strategy use for community mobility. Stroll Safe fills a gap in outdoor fall prevention programs. Clinical Trials Registration Number: NCT03624777.

Community mobility and participation assessment of manual wheelchair users: a review of current techniques and challenges.

According to the World Health Organization, hundreds of individuals commence wheelchair use daily, often due to an injury such as spinal cord injury or through a condition such as a stroke. However, manual wheelchair users typically experience reductions in individual community mobility and participation. In this review, articles from 2017 to 2023 were reviewed to identify means of measuring community mobility and participation of manual wheelchair users, factors that can impact these aspects, and current rehabilitation techniques for improving them. The selected articles document current best practices utilizing self-surveys, in-clinic assessments, and remote tracking through GPS and accelerometer data, which rehabilitation specialists can apply to track their patients' community mobility and participation accurately. Furthermore, rehabilitation methods such as wheelchair training programs, brain-computer interface triggered functional electric stimulation therapy, and community-based rehabilitation programs show potential to improve the community mobility and participation of manual wheelchair users. Recommendations were made to highlight potential avenues for future research.

Novel attentional gait index reveals a cognitive ability-related decline in gait automaticity during dual-task walking.

Introduction: Gait automaticity refers to the ability to walk with minimal recruitment of attentional networks typically mediated through the prefrontal cortex (PFC). Reduced gait automaticity (i.e., greater use of attentional resources during walking) is common with aging, contributing to an increased risk of falls and reduced quality of life. A common assessment of gait automaticity involves examining PFC activation using near-infrared spectroscopy (fNIRS) during dual-task (DT) paradigms, such as walking while performing a cognitive task. However, neither PFC activity nor task performance in isolation measures automaticity accurately. For example, greater PFC activation could be interpreted as worse gait automaticity when accompanied by poorer DT performance, but when accompanied by better DT performance, it could be seen as successful compensation. Thus, there is a need to incorporate behavioral performance and PFC measurements for a more comprehensive evaluation of gait automaticity. To address this need, we propose a novel attentional gait index as an analytical approach that combines changes in PFC activity with changes in DT performance to quantify automaticity, where a reduction in automaticity will be reflected as an increased need for attentional gait control (i.e., larger index). Methods: The index was validated in 173 participants (≥65 y/o) who completed DTs with two levels of difficulty while PFC activation was recorded with fNIRS. The two DTs consisted of reciting every other letter of the alphabet while walking over either an even or uneven surface. Results: As DT difficulty increases, more participants showed the anticipated increase in the attentional control of gait (i.e., less automaticity) as measured by the novel index compared to PFC activation. Furthermore, when comparing across individuals, lower cognitive function was related to higher attentional gait index, but not PFC activation or DT performance. Conclusion: The proposed index better quantified the differences in attentional control of gait between tasks and individuals by providing a unified measure that includes both brain activation and performance. This new approach opens exciting possibilities to assess participant-specific deficits and compare rehabilitation outcomes from gait automaticity interventions.

Autonomous Shuttle Operating on Highways and Gravel Roads in Rural America: A Demonstration Study.

The safe integration of Automated Driving Systems (ADS) into the nation's on-road transportation system, particularly in rural areas, could vastly improve overall quality of life for a rapidly growing segment of the US population. This paper describes findings from the first half (i.e., three of six phases) of a demonstration project called "ADS for Rural America". The goal of this project is to conduct a series of demonstrations that utilizes an autonomous shuttle to show how older adults (≥65 years old) could be transported from their rural homes to other locations in rural areas, as well as an urban center. This paper examines older adults' perceptions of automation before and after riding in an autonomous shuttle and their ratings of anxiety throughout the ride as they experience particular road types and maneuvers. After riding in the shuttle, older adults expressed decreased suspicion, increased trust, and increased reliability of ADS compared to baseline. Older adults reported low levels of anxiety during the 90 min ride in the shuttle. To promote the adoption and acceptance of ADS, older adults should be exposed to this technology.

Reliability and Validity of the Japanese Version of the Assessment of Readiness for Mobility Transition (ARMT-J) for Japanese Elderly.

The Assessment of Readiness for Mobility Transition (ARMT) questionnaire assesses individuals' emotional and attitudinal readiness related to mobility as they age. This study aimed to examine the reliability and validity of the Japanese version of the ARMT (ARMT-J). The ARMT-J and related variables were administered to 173 patients and staff members undergoing rehabilitation at hospitals in Japan. Construct validity was first examined using confirmatory factor analysis (CFA) to confirm cross-cultural validity. For structural validity, the optimal number of factors was confirmed using a Velicer's minimum average partial test and parallel analysis, followed by exploratory factor analysis (EFA). Finally, a CFA was performed using the most appropriate model. Internal consistency, test-retest reliability, standard error of measurement (SEM), and smallest detectable change (SDC) were assessed for reliability. The CFA fit for the factor structure of the original ARMT was low. Therefore, the EFA was conducted with two to four factors. The optimal factor structure was three factors, with a Cronbach's alpha coefficient and Cohen's weighted kappa coefficient of 0.85 and 0.76, respectively. The intraclass correlation coefficient (ICC) of the test-retest was 0.93, the SEM was 0.72, and the SDC was 2.00. The model fit was good for the ARMT-J, with a three-factor structure.