Current state of balance assessment during transferring, sitting, standing and walking activities for the spinal cord injured population: A systematic review.

CONTEXT: Comprehensive balance measures with high clinical utility and sound psychometric properties are needed to inform the rehabilitation of individuals with spinal cord injury (SCI). OBJECTIVE: To identify the balance measures used in the SCI population, and to evaluate their clinical utility, psychometric properties and comprehensiveness. METHODS: Medline, PubMed, Embase, Scopus, Web of Science, and the Allied and Complementary Medicine Database were searched from the earliest record to October 19/16. Two researchers independently screened abstracts for articles including a balance measure and adults with SCI. Extracted data included participant characteristics and descriptions of balance measures. Quality was evaluated by considering study design, sampling method and adequacy of description of research participants. Clinical utility of all balance measures was evaluated. Comprehensiveness was evaluated using the modified Systems Framework for Postural Control. RESULTS: 2820 abstracts were returned and 127 articles included. Thirty-one balance measures were identified; 11 evaluated a biomechanical construct and 20 were balance scales. All balance scales had high clinical utility. The Berg Balance Scale and Functional Reach Test were valid and reliable, while the mini-BESTest was the most comprehensive. CONCLUSION: No single measure had high clinical utility, strong psychometric properties and comprehensiveness. The mini-BESTest and/or Activity-based Balance Level Evaluation may fill this gap with further testing of their psychometric properties.

Falls, mobility, and physical activity after spinal cord injury: an exploratory study using photo-elicitation interviewing.

STUDY DESIGN: Exploratory qualitative study using photo-elicitation interviews. OBJECTIVES: To identify contributors to falls, as perceived by individuals with incomplete spinal cord injury, and describe the impact of perceived fall risk on mobility and physical activity. SETTING: Participants' home and community environments. METHODS: Eight individuals with chronic motor incomplete spinal cord injury participated. Participants took photographs of situations that increased/decreased their risk of falling, or depicted how this risk impacted mobility and physical activity. Photographs were discussed in semi-structured interviews. Inductive thematic analysis was used to describe participants' perceptions and experiences. RESULTS: Photo-elicitation interviews identified four themes: (1) Perceived challenges were primarily environmental with biological (e.g., reduced strength) and behavioral (e.g., risk-taking) factors also identified. (2) Impact of perceived fall risk included moving slowly, avoiding balance-provoking activities, and feelings of frustration and/or fear. (3) Prevent falls: learn through experience included strategies used to avoid falls, which were learnt experientially and consisted of changes to behavior. (4) Factors mitigating impact of perceived fall risk included character traits (i.e., perseverance, optimism) and a desire for independence. CONCLUSIONS: Primarily environmental factors were perceived to contribute to fall risk and mainly behavioral strategies were adopted to mitigate the risk. SPONSORSHIP: Physiotherapy Foundation of Canada.

Physical Therapists' Use of Functional Electrical Stimulation for Clients With Stroke: Frequency, Barriers, and Facilitators.

BACKGROUND: Best practice guidelines for stroke rehabilitation recommend functional electrical stimulation (FES) to improve gait and upper extremity function. Whether these guidelines have been implemented in practice is unknown. OBJECTIVE: The purposes of this study were: (1) to determine the frequency with which physical therapists use FES to address common therapeutic goals poststroke and (2) to identify the barriers to and facilitators of FES use. DESIGN: This was a cross-sectional, survey study. METHODS: A valid and reliable online survey was sent to Canadian physical therapists. Questions about demographic characteristics, FES use, knowledge of FES literature, and barriers and facilitators were posed. Closed-ended questions were analyzed with descriptive statistics and index scoring to produce summary scores. Pearson or point-biserial correlation coefficients correlated FES use with demographic variables. Open-ended questions about barriers and facilitators were analyzed by 3 researchers using a conventional content analysis. RESULTS: Two hundred ninety-eight physical therapists responded. Use of FES for clients with stroke was low for all therapeutic goals queried (improve walking, arm function, muscle strength and endurance, and sensation; prevent shoulder subluxation; and decrease spasticity). However, 52.6% of the respondents stated that they would like to increase their use of FES. More than 40% of the respondents were unsure of the strength of the evidence supporting FES for stroke care. Physical therapists with postgraduate FES training were more likely to use FES (r=.471, P<.001). A lack of access to resources, such as time, equipment, and training, was the most frequently cited barrier to FES use. LIMITATIONS: As an observational study, cause-and-effect relationships for FES use cannot be identified. CONCLUSIONS: Functional electrical stimulation is not widely used by physical therapists in stroke rehabilitation. Improving access to resources-in particular, continuing education-may facilitate the implementation of FES into clinical practice.

Integration of taste and calorie sensing in Drosophila.

Animals use gustatory information to assess the suitability of potential food sources and make critical decisions on what to consume. For example, the taste of sugar generally signals a potent dietary source of carbohydrates. However, the intensity of the sensory response to a particular sugar, or "sweetness," is not always a faithful reporter of its nutritional value, and recent evidence suggests that animals can sense the caloric content of food independently of taste. Here, we demonstrate that the vinegar fly Drosophila melanogaster uses both taste and calorie sensing to determine feeding choices, and that the relative contribution of each changes over time. Using the capillary feeder assay, we allowed flies to choose between sources of sugars that varied in their ratio of sweetness to caloric value. We found that flies initially consume sugars according to taste. However, over several hours their preference shifts toward the food source with higher caloric content. This behavioral shift occurs more rapidly following food deprivation and is modulated by cAMP and insulin signaling within neurons. Our results are consistent with the existence of a taste-independent calorie sensor in flies, and suggest that calorie-based reward modifies long-term feeding preferences.