Personalized adapted locomotor training for an individual with sequelae of West Nile virus infection: a mixed-method case report.

BACKGROUND: West Nile virus (WNV) can have severe consequences, including encephalitis and paralysis. Purpose: To describe the benefits of intensive locomotor training (LT) for an individual with a previous WNV infection resulting in chronic paraplegia. Case Description: The patient, who became a wheelchair user following standard rehabilitation, began LT 3 years post infection. Her goals included standing and walking with an assistive device and transferring independently. The intervention consisted of bodyweight-supported treadmill training and overground training, which involved walking, balancing, strengthening, and transferring activities. Outcomes: Following 5 months of LT, the patient ambulated independently with a walker at a speed = 0.34m/s. She walked 110.1 metres in 6 minutes and increased her Berg Balance Scale score by 17 points. These improvements were either maintained or further increased 3 months post LT. The patient's perspectives on LT were collected through a semi-structured interview. A conventional content analysis, which uses data to drive themes, revealed three themes: (1) recalibrating goals, (2) outcomes (i.e. physical and psychological benefits, such as a sense of accomplishment), and (3) challenges of LT and effective coping strategies. Conclusions: The patient demonstrated improved balance and walking abilities. Intensive LT was feasible and effective for this individual with chronic paraplegia due to WNV infection.

Falls after spinal cord injury: a systematic review and meta-analysis of incidence proportion and contributing factors.

INTRODUCTION: Falls are detrimental to the well-being of individuals with spinal cord injury (SCI). To establish effective fall prevention initiatives, a comprehensive understanding of falls after SCI is needed. OBJECTIVES: To report the incidence proportion of falls and summarize the factors contributing to falls in individuals with SCI. STUDY DESIGN: Systematic review and meta-analysis. METHODS: Eight databases were searched. Abstracts/full articles were screened by two researchers independently. Data concerning study design, participant characteristics, and the incidence proportion, factors, and consequences of falls were extracted. Risk of bias was assessed using a domain-based approach that considered sampling and measurement bias. The incidence proportions of falls were pooled for ambulators and wheelchair users separately using random-effects meta-analyses, and compared descriptively for inpatients and community-dwelling individuals. Fall-related factors were organized according to the Biological, Behavioral, Social & Economic and Environmental Model of fall risk. RESULTS: The search resulted in 1706 articles; 24 unique studies were included. The risk of sampling bias was high. All but one study focused on community-dwelling individuals; 78% (95% confidence interval 73-83%, I2 = 0%) of ambulators and 69% (95% confidence interval 60-76%, I2 = 59%) of wheelchair users fell ≥1 over 12 months. In contrast, only 13% of inpatients fell. Most fall-related factors were categorized as biological (e.g., muscle weakness), behavioral (e.g., inattentiveness) or environmental (e.g., uneven surfaces). CONCLUSIONS: Falls are frequent among community-dwelling individuals with SCI. A variety of biological, behavioral, and environmental factors contribute to falls, some of which are modifiable and may be addressed through SCI-specific fall prevention initiatives.

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.