The Spinal Cord Injury Program in Exercise (SCIPE) study: study protocol for a randomized controlled trial evaluating teleexercise programs for people with spinal cord injury.

BACKGROUND: Many people with spinal cord injury (SCI) have limited access to tailored, readily available exercise resources. As a result, exercise remains an underutilized treatment strategy for improving health and function in people with SCI. The purpose of this study is to test the effectiveness of two remotely delivered exercise programs for people with SCI. METHODS: The Spinal Cord Injury Program in Exercise (SCIPE) study is a three-arm adaptive randomized controlled trial examining two 8-week teleexercise interventions: Movement-to-Music (M2M) and Standard Exercise Training (SET), compared to Attention Control (AC) in 327 adults with SCI. The primary outcome is change in physical activity level at post 8-week intervention. The study contains two interim analyses. The first interim analysis will assess feasibility metrics of the protocol after 36 participants complete the 8-week intervention period. The second interim analysis will examine two effectiveness comparisons: SET vs. AC and M2M vs AC, after 165 participants complete the intervention period. Early termination of the intervention arm(s) will take place when non-significant findings are found in the corresponding intervention(s). Incorporation of such interim analysis enhances trial efficiency by dropping the intervention(s) that deemed ineffective. It provides ethical benefits and allows allocation of additional resources to explore the effective intervention(s). DISCUSSION: Delivery of teleexercise programs may be an effective strategy for addressing transportation barrier to exercise resources and increasing physical activity level and quality of life in people with SCI. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT03925077 . Registered trial name: Spinal Cord Injury Program in Exercise (SCIPE). Registered on April 23rd, 2019.

Active Video Gaming Using an Adapted Gaming Mat in Youth and Adults With Physical Disabilities: Observational Study.

BACKGROUND: A common leisure-time activity amongst youth and adults in the United States is video gameplay. Playing video games is typically a sedentary endeavor; however, to encourage an increased level of physical activity in an engaging and enjoyable way, active video gaming has become popular. Unfortunately, the accessibility of gaming controllers is often an issue for persons with disabilities. A commercial off-the-shelf (OTS) gaming mat was adapted to facilitate use by individuals with mobility impairments to address this issue. OBJECTIVE: Our study aimed to examine energy expenditure, enjoyment, and gameplay experience in youth and adults with mobility impairment during active video gaming using an OTS and adapted versions of a gaming mat. METHODS: The study used an observational design. During visit 1, physical function was assessed, and participants were given a familiarization period with the gaming system. For visit 2, based on observation during the physical function tests and discussion with the participant, it was decided whether the participant would play in a standing or seated position. For standing gameplay, the mat was placed on the floor, and for seated play, the mat was placed on a height-adjustable and tilt-adjustable tabletop. Metabolic data were collected during a 20-minute baseline and four 10-minute bouts of Wii Fit Plus gameplay, with 2 bouts on each of the mats (adapted and OTS). During gameplay, the research staff observed and rated participants' ability to use the game controller (mat) and the quality of gameplay. At the end of each game set, participants reported their rating of perceived exertion on a scale from 0 to 10. During rest, participants completed the physical activity enjoyment scale. Participants also answered additional questions regarding the system's usability with each controller (adapted mat and OTS mat). Statistical analyses were computed using Stata 16 (version 16.1; StataCorp). Linear mixed-effects maximum likelihood regression was performed separately for individuals who could play standing and for those who played seated. RESULTS: A convenience sample of 78 individuals with mobility impairments between the ages of 12 and 60 years (mean 39.6, SD 15.8) participated in the study. Of the sample, 48 participants played the video games in a seated position, while 30 played the games standing. Energy expenditure and heart rate tended to be higher in the OTS mat condition for seated players, while values were similar for both conditions among standing players. However, seated participants reported greater gameplay experience, and both groups exhibited a higher quality of gameplay during the adapted mat condition. CONCLUSIONS: Active video gaming using an adapted gaming mat provided an enjoyable exercise activity for individuals with mobility impairments. The use of the adapted controller provides a means by which this population can engage in light to moderate intensity active video gaming, thereby reducing sedentary leisure time. TRIAL REGISTRATION: ClinicalTrials.gov NCT02994199; https://clinicaltrials.gov/ct2/show/NCT02994199.

Association of State Stay-at-Home Orders and State-Level African American Population With COVID-19 Case Rates.

Importance: To cope with the continuing coronavirus disease 2019 (COVID-19) pandemic, state and local officials need information on the effectiveness of policies aimed at curbing disease spread, as well as state-specific characteristics, like the racial mix, associated with increased risks related to the disease. Objective: To investigate whether state-imposed stay-at-home orders (SAHOs) and the proportion of African American population in a state were associated with the state-level COVID-19 cases. Design, Setting, and Participants: This cross-sectional study used daily, state-level data on COVID-19 cases, tests, and fatalities from the COVID Tracking Project. Data from March 1 to May 4, 2020, for all states (except Washington state) as well as the District of Columbia were used. Exposures: The key exposure variables were state-level SAHO (1 if in place, 0 otherwise), and proportion of state population who are African American. Main Outcomes and Measures: The primary outcome was daily cumulative COVID-19 case rates. A secondary outcome was subsequent COVID-19 fatality rates, derived using mean cumulative fatality rates 21 to 28 days after each date. Multivariate regression models were estimated. Results: The final sample included 3023 pooled state- and day-level observations. The mean (SD) cumulative positive case rate was 103.186 (200.067) cases per 100 000 state population, the mean (SD) cumulative test rate was 744.23 (894.944) tests per 100 000 state population, and the mean (SD) subsequent cumulative fatality rate was 12.923 (21.737) deaths per 100 000 state population. There was a negative association of SAHOs with cumulative case rates (ß = -1.166; 95% CI, -1.484 to -0.847; P < .001) and subsequent fatality rates (ß = -0.204; 95% CI, -0.294 to -0.113; P < .001). Estimation analyses indicated that expected cumulative case rates would have been more than 200% higher and fatality rates approximately 22% higher if there were no SAHOs, as compared with SAHOs fully in place. A higher proportion of African American population was associated with higher case rates (ß = 0.045; 95% CI, 0.014 to 0.077; P = .001) and fatality rates (ß = 0.068; 95% CI, 0.044 to 0.091; P < .001). Conclusions and Relevance: In this cross-sectional study, SAHOs were associated with reductions in COVID-19 case rates. These findings could help inform policy makers to address the continued COVID-19 pandemic in the US. The proportion of African American population was positively associated with COVID-19 case rates, and this state-level finding adds to evidence from existing ecological studies using county-level data on racial disparities in COVID-19 infection rates and underlines the urgency of better understanding and addressing these disparities.

Lessons learned from a blended telephone/e-health platform for caregivers in promoting physical activity and nutrition in children with a mobility disability.

BACKGROUND: Children with physical disabilities report higher rates of sedentary lifestyle and unhealthy dietary patterns than non-disabled peers. These behaviors can increase comorbidities, caregiver burden, and healthcare costs. Innovative interventions are needed to assist caregivers of children with physical disabilities improve health behaviors. OBJECTIVE: /Hypothesis: The purpose of this pilot study was to test the usability and preliminary efficacy of an e-health and telecoaching intervention compared to telecoaching alone. METHODS: Parent/child dyads (n = 65) were randomized into either the e-health and telephone group (e-HT) or the telephone only group (TO). All participants received regular calls from a telecoach, and the e-HT group received access to a website with personalized weekly goals for diet and physical activity, and access to resources to meet these goals. At the conclusion of the intervention, participants in the e-HT group were asked to complete a semi-structured interview to discuss the usability of the e-health platform. RESULTS: Fifty of the 65 randomized dyads (77%) completed all baseline measures and had at least one intervention call. Forty families (80% of those that started the intervention) completed the study (50% spina bifida, 24% mobility limitation, diagnosis not reported). Age of the children ranged from 6 to 17 years old. Both groups had high adherence to scheduled phone calls (e-HT (n = 17): 81%, TO (n = 23): 86%); however no significant differences in dietary intake or physical activity were seen within or between groups. Primary themes to emerge from qualitative interviewers were: the platform should target children rather than parents, parents valued the calls more than the website, and schools need to be involved in interventions. CONCLUSIONS: E-health interventions are a promising way to promote healthy behaviors in children with physical disability, but technology must be balanced with ease of use for parents while also engaging the child.

Effectiveness of the International Symbol of Access and inclusivity of other disability groups.

BACKGROUND: The International Symbol of Access (ISA) is recognized world-wide for designating and identifying areas which are wheelchair accessible, however its meaning has evolved to include both restricted use and universal accessibility. OBJECTIVE: This study seeks to investigate the effectiveness of the ISA in representing individuals of all impairment types. METHODS: A mixed-method survey was disseminated in the U.S. and internationally to persons without self-identified impairment and individuals of various impairment group types, including mobility, vision, hearing, and cognitive impairments, using convenience sampling (n = 981). Quantitative data was analyzed using ranking patterns and regression analysis. Qualitative data was analyzed using thematic analysis and triangulation. RESULTS: Participants with self-identified mobility impairments rated the ISA more favorably than other disability groups (p = 0.002). In addition, there is a significant correlation between age and effectiveness of the ISA, with participants rating the symbol more favorably as age increases. Common themes included association of the ISA with a mobility impairment, implications for restricted use or reserved space, and physical accessibility. CONCLUSIONS: The ISA is not effective in representing individuals with non-mobility impairments and its ambiguous nature leads to confusion for both persons with and without impairment.

Exercise Training Guidelines for Multiple Sclerosis, Stroke, and Parkinson Disease: Rapid Review and Synthesis.

The translation of knowledge from exercise training research into the clinical management of multiple sclerosis, stroke, and Parkinson disease requires evidence-based guidelines that are uniformly recognizable by healthcare practitioners and patients/clients. This article synthesized resources that reported aerobic and resistance training guidelines for people with multiple sclerosis, stroke, and Parkinson disease. Systematic searches yielded 25 eligible resources from electronic databases and Web sites or textbooks of major organizations. Data were extracted (exercise frequency, intensity, time, and type) and synthesized into three sets of recommendations. Exercise guidelines for multiple sclerosis consistently recommended 2-3 d/wk of aerobic training (10-30 mins at moderate intensity) and 2-3 d/wk of resistance training (1-3 sets between 8 and 15 repetition maximum). Exercise guidelines for stroke recommended 3-5 d/wk of aerobic training (20-40 mins at moderate intensity) and 2-3 d/wk of resistance training (1-3 sets of 8-15 repetitions between 30% and 50% 1 repetition maximum). Exercise guidelines for Parkinson disease recommended 3-5 d/wk of aerobic training (20-60 mins at moderate intensity) and 2-3 d/wk of resistance training (1-3 sets of 8-12 repetitions between 40% and 50% of 1 repetition maximum). This harmonization of exercise guidelines provides a prescriptive basis for healthcare providers, exercise professionals, and people with multiple sclerosis, stroke, and Parkinson disease regarding exercise programming.

Energy Expenditure and Enjoyment During Active Video Gaming Using an Adapted Wii Fit Balance Board in Adults with Physical Disabilities: Observational Study.

BACKGROUND: Individuals with physical disabilities have fewer opportunities to participate in enjoyable physical activity. One option for increasing physical activity is playing active video games (AVGs); however, many AVGs are inaccessible or offer limited play options. OBJECTIVE: This study aimed to examine energy expenditure and enjoyment in adults with mobility impairment during AVG play using off-the-shelf (OTS) and adapted versions of the Wii Fit balance board (Nintendo). METHODS: During visit 1, participants completed a functional assessment and the familiarization period. During visit 2, metabolic data were collected during a 20-minute baseline and four 10-minute bouts of Wii Fit Plus game play, with two bouts on each of the boards. During the resting period, participants completed the Physical Activity Enjoyment Scale (PACES). Statistical analyses were computed using SPSS software. Data were analyzed separately for individuals who were able to play while standing on both boards (StdStd); those who could not play while standing on the OTS board, but were able to play while standing on the adapted board (aStd); and those who could only play while sitting on the adapted board (aSit). RESULTS: Data were collected for 58 participants (StdStd, n=17; aStd, n=10; aSit, n=31). The sample included 31 men and 27 women with a mean age of 41.21 (SD 12.70) years. Energy expenditure (metabolic equivalent [MET]) during game play was significantly greater than that during rest for all players. Only 17 participants (StdStd group) were able to play using the OTS board. During game play on the adapted board, the average MET values for the two game sets were 2.261 (SD 0.718) kcal/kg/hour and 2.233 (SD 0.751) kcal/kg/hour for the aSit group, 3.151 (SD 1.034) and 2.990 (SD 1.121) for the aStd group, and 2.732 (SD 0.655) and 2.777 (SD 0.803) for the StdStd group. For game play on the adapted board, self-reported ratings of perceived exertion on a 0-10 scale suggested greater exercise intensity levels, with median scores ranging from moderate (3) to very hard (7). The PACES scores indicated that all players enjoyed using the adapted board, with a median score of 4 on a 5-point scale. CONCLUSIONS: The adapted Wii Fit balance board provided an opportunity for individuals with mobility impairments, including wheelchair users, to engage in AVG. All participants were able to utilize the adapted controller and enjoyed the AVG activity. Although the average MET values achieved during AVG represented light-intensity exercise (<3 METs), 16% of sitting participants and 41% of standing participants achieved moderate-intensity exercise (3-6 METs) in at least one of the games. Factors not accounted for, which may have influenced the intensity of exercise, include game selection, limited familiarization period, and discomfort wearing the COSMED portable metabolic system for measurement of oxygen consumption. Accessible AVG controllers offer an innovative approach to overcome various barriers to participation in physical activity. The next steps include assessment of an AVG intervention using an adapted board gaming controller on health and fitness outcomes. TRIAL REGISTRATION: ClinicalTrials.gov NCT02994199; https://clinicaltrials.gov/ct2/show/NCT02994199 (Archived by Webcite at http://www.webcitation.org/75fc0mN39).

Examining perceptions of existing and newly created accessibility symbols.

BACKGROUND: Symbols are used to convey messages in a clear, understandable manner, without the use of written language. The most widely recognized symbol used to denote access for persons with disabilities is the International Symbol of Access. This symbol has been criticized for its inadequate representation of disability diversity poorly representing universal design of space and products. OBJECTIVE: This descriptive study explored individual comprehension and perceptions of nine existing and newly created accessibility pictograph symbols and identified one that represented universal access to fitness equipment. METHODS: A survey was disseminated electronically and face-to-face to individuals, groups and organizations affiliated with inclusive fitness equipment, space and programming. Quantitative data was analyzed for descriptive statistics, rank order of symbols and group comparisons of rankings. Thematic analysis of open-ended question results revealed themes to enhance understanding of symbol rank order. RESULTS: 981 participants completed the survey. Symbol four, shaped as a Venn diagram containing three icons representing individuals with varying ability levels, was ranked highest with no significant differences in group comparisons between participants with and without a disability and U.S. residents versus non-U.S. residents. 85.4% of participants demonstrated accurate comprehension of this symbol. Though symbol five had the same symbol rank median value, this symbol's distribution of scores was lower. CONCLUSIONS: Participants accurately comprehended symbol four and it was identified as the highest ranked symbol representing universal access to fitness equipment. Because of symbol unfamiliarity, adoption will require education and consistency of use and placement.

Adapting the Wii Fit Balance Board to Enable Active Video Game Play by Wheelchair Users: User-Centered Design and Usability Evaluation.

BACKGROUND: Active video game (AVG) playing, also known as "exergaming," is increasingly employed to promote physical activity across all age groups. The Wii Fit Balance Board is a popular gaming controller for AVGs and is used in a variety of settings. However, the commercial off-the-shelf (OTS) design poses several limitations. It is inaccessible to wheelchair users, does not support the use of stabilization assistive devices, and requires the ability to shift the center of balance (COB) in all directions to fully engage in game play. OBJECTIVE: The aim of this study was to design an adapted version of the Wii Fit Balance Board to overcome the identified limitations and to evaluate the usability of the newly designed adapted Wii Fit Balance Board in persons with mobility impairments. METHODS: In a previous study, 16 participants tried the OTS version of the Wii Fit Balance Board. On the basis of observed limitations, a team of engineers developed and adapted the design of the Wii Fit Balance Board, which was then subjected to multiple iterations of user feedback and design tweaks. On design completion, we recruited a new pool of participants with mobility impairments for a larger study. During their first visit, we assessed lower-extremity function using selected mobility tasks from the International Classification of Functioning, Disability and Health. During a subsequent session, participants played 2 sets of games on both the OTS and adapted versions of the Wii Fit Balance Board. Order of controller version played first was randomized. After participants played each version, we administered the System Usability Scale (SUS) to examine the participants' perceived usability. RESULTS: The adapted version of the Wii Fit Balance Board resulting from the user-centered design approach met the needs of a variety of users. The adapted controller (1) allowed manual wheelchair users to engage in game play, which was previously not possible; (2) included Americans with Disabilities Act-compliant handrails as part of the controller, enabling stable and safe game play; and (3) included a sensitivity control feature, allowing users to fine-tune the controller to match the users' range of COB motion. More than half the sample could not use the OTS version of the Wii Fit Balance Board, while all participants were able to use the adapted version. All participants rated the adapted Wii Fit Balance Board at a minimum as "good," while those who could not use the OTS Wii Fit Balance Board rated the adapted Wii Fit Balance Board as "excellent." We found a significant negative correlation between lower-extremity function and differences between OTS and adapted SUS scores, indicating that as lower-extremity function decreased, participants perceived the adapted Wii Fit Balance Board as more usable. CONCLUSIONS: This study demonstrated a successful adaptation of a widely used AVG controller. The adapted controller's potential to increase physical activity levels among people with mobility impairments will be evaluated in a subsequent trial. TRIAL REGISTRATION: ClinicalTrials.gov NCT02994199; https://clinicaltrials.gov/ct2/show/NCT02994199 (Archived by WebCite at http://www.webcitation.org/6xWTyiJWf).

Assessment of Active Video Gaming Using Adapted Controllers by Individuals With Physical Disabilities: A Protocol.

BACKGROUND: Individuals with disabilities are typically more sedentary and less fit compared to their peers without disabilities. Furthermore, engaging in physical activity can be extremely challenging due to physical impairments associated with disability and fewer opportunities to participate. One option for increasing physical activity is playing active video games (AVG), a category of video games that requires much more body movement for successful play than conventional push-button or joystick actions. However, many current AVGs are inaccessible or offer limited play options for individuals who are unable to stand, have balance issues, poor motor control, or cannot use their lower body to perform game activities. Making AVGs accessible to people with disabilities offers an innovative approach to overcoming various barriers to participation in physical activity. OBJECTIVE: Our aim was to compare the effect of off-the-shelf and adapted game controllers on quality of game play, enjoyment, and energy expenditure during active video gaming in persons with physical disabilities, specifically those with mobility impairments (ie, unable to stand, balance issues, poor motor control, unable to use lower extremity for gameplay). The gaming controllers to be evaluated include off-the-shelf and adapted versions of the Wii Fit balance board and gaming mat. METHODS: Participants (10-60 years old) came to the laboratory a total of three times. During the first visit, participants completed a functional assessment and became familiar with the equipment and games to be played. For the functional assessment, participants performed 18 functional movement tasks from the International Classification of Functioning, Disability, and Health. They also answered a series of questions from the Patient Reported Outcomes Measurement Information System and Quality of Life in Neurological Conditions measurement tools, to provide a personal perspective regarding their own functional ability. For Visit 2, metabolic data were collected during an initial 20-minute baseline, followed by 40 minutes of game play. The controller (balance board or gaming mat) played was randomly selected. A set of games was played for 10 minutes, followed by 5 minutes of rest, and then another set of games was played for 10 minutes, followed by rest. Quality of game play was observed and documented for each set. During rest, the participant completed questions regarding enjoyment. Following the same procedures, the participant then played the two sets of games using the other version (off-the-shelf or adapted) of the controller. The entire procedure was repeated during Visit 3 with the controller that was not played. RESULTS: Enrollment began in February 2016 and ended in September 2016. Study results will be reported in late 2017. CONCLUSIONS: We hypothesized that the adapted versions of the Wii Fit balance board and gaming mat would produce greater quality of game play, enjoyment, and energy expenditure in persons with mobility impairments compared to off-the-shelf versions. TRIAL REGISTRATION: ClinicalTrials.gov NCT02994199; https://clinicaltrials.gov/ct2/show/NCT02994199 (Archived by WebCite at http://www.webcitation.org/6qpPszPJ7).

Fitness facilities still lack accessibility for people with disabilities.

BACKGROUND: Fitness facilities have potential to serve as places of 'health enhancement' for many underserved populations, particularly among people with physical/mobility disabilities where walking outdoors to meet recommendations for regular physical activity is not an option due to mobility or safety issues. OBJECTIVE: To examine the accessibility and usability of fitness facilities across the U.S. from a broader framework of physical and program access. METHODS: A convenience sample of 227 fitness facilities in 10 states were assessed by trained evaluators using the Accessibility Instrument Measuring Fitness and Recreation Environments (AIMFREE) tool. Non-parametric tests were performed to determine whether AIMFREE section scores were different by geographic region (urban, suburban), business type (nonprofit, for-profit), facility affiliation (fitness center/health club, park district/community center, hospital/rehabilitation facility, university/college), and facility construction date (pre/post passage of the Americans with Disabilities Act, ADA). Raw scores were converted to scaled scores with higher scores indicating better accessibility based on a criterion-referenced approach. RESULTS: Section scale scores (11/13) were low (<70) with differences found across facility affiliation. While facilities built after passage of the ADA had higher accessibility scores compared to pre-ADA facilities, only programs and water fountains had scaled scores ≥70 regardless of facility construction date. CONCLUSIONS: There exists a strong and urgent need to encourage owners and operators of fitness facilities to reach a higher level of accessibility. Until then, many people with physical/mobility disabilities will continue to have limited access to programs, equipment, and services offered at these facilities.

Active Videogaming in Youth with Physical Disability: Gameplay and Enjoyment.

OBJECTIVE: For active videogaming (AVG) to be a meaningful, health-enhancing physical activity option for youth with physical disability, factors related to game performance and enjoyment must be understood. The objective was to explore associations between quality of gameplay, controller usage, heart rate (HR), physical function, and enjoyment during AVG play in youth with physical disability. METHODS: Participants (5 girls, 11 boys, mean age 13.8 ± 2.7 years) played four AVGs on three platforms (Nintendo® Wii™, Sony PlayStation3 Move, and Microsoft Xbox® Kinect), across three sessions. Participants' primary means of mobility were manual (n = 13) and power (n = 3) wheelchairs; majority were diagnosed with cerebral palsy or spina bifida. Functional level was assessed using 17 International Classification of Functioning, Disability and Health mobility items. Participants played each AVG for 8 minutes with a 5-minute rest. Quality of gameplay and ability to use controller were recorded on a five-point Likert scale. HR was recorded immediately following each game and participants completed the Physical Activity Enjoyment Scale (PACES). PACES scores were compared across games and correlations were examined among the variables. RESULTS: PACES scores were significantly greater for Wii Punch-Out compared to Xbox Fitness, Sports Rivals, and Zumba, and for PS3 Sports Champions compared to Xbox Zumba. Higher HR was associated with higher quality of gameplay and a higher PACES score. As quality of gameplay increased, the PACES score increased. CONCLUSION: Game performance and exercise intensity were positively correlated with AVG enjoyment in youth with physical disability, specifically mobility impairments. Further research is warranted to examine the capacity of AVG play to be an enjoyable health-enhancing activity for individuals with physical disability.

Perspectives on Active Video Gaming as a New Frontier in Accessible Physical Activity for Youth With Physical Disabilities.

This perspective article explores the utility of active video gaming as a means of reducing sedentary behavior and increasing physical activity among youth with physical disabilities and limitations in lower extremity function who typically are excluded from mainstream exercise options. Youth with physical disabilities are disproportionately affected by health problems that result from sedentary behavior, lack of physical activity, and low fitness levels. Physical, programmatic, and attitudinal barriers have a synergistic and compounded impact on youths' ability to participate in physical activity. A recent health and wellness task force recommendation from the American Physical Therapy Association's Section on Pediatrics supports analyzing individualized health behaviors and preferences that are designed to improve fitness, physical activity, and participation in pediatric rehabilitation. This recommendation represents an opportunity to explore nontraditional options to maximize effectiveness and sustainability of pediatric rehabilitation techniques for youth with disabilities who could best benefit from customized programming. One new frontier in promoting physical activity and addressing common physical activity barriers for youth with physical disabilities is active video games (AVGs), which have received growing attention as a promising strategy for promoting health and fitness in children with and without disabilities. The purpose of this article is to discuss the potential for AVGs as an accessible option to increase physical activity participation for youth with physical disabilities and limitations in lower extremity function. A conceptual model on the use of AVGs to increase physical activity participation for youth with physical disabilities is introduced, and future research potential is discussed, including a development project for game controller adaptations within the Rehabilitation Engineering Research Center on Interactive Exercise Technologies and Exercise Physiology for People With Disabilities (RERC RecTech) at the University of Alabama at Birmingham (UAB)/Lakeshore Foundation Research Collaborative.