Reducing fracture incidence in children with osteogenesis imperfecta: contribution of orthotics to bisphosphonates treatment.

PURPOSE: To determine whether there was a reduction in fracture incidence amongst children with OI who were treated with both bisphosphonates and orthoses. OBJECTIVE: Was there an additional reduction in fracture incidence amongst children with Osteogenesis Imperfecta (OI) treated with both bisphosphonates and Hip-Knee-Ankle-Foot-Orthosis (HKAFO)? MATERIALS AND METHODS: Of the 129 OI patients treated from 1990 to 2017, retrospective data from 48 patients who participated in the bisphosphonates-orthosis regime were analyzed including the incidence of fractures and modalities of fracture treatment. RESULTS: Bisphosphonates usage was more frequent than bracing and there were more positive changes (smaller or equal number of fractures each year) than negative changes (more fractures each year); negative changes were scarce, explained by non-compliance with the use of bracing. Poisson regression models were significant for positive changes, whereas the interaction between them was borderline significant. The main finding is that the association between bisphosphonates usage and the number of positive changes was stronger among the patients who used braces more frequently and weaker among patients who used bracing less frequently. CONCLUSIONS: Bracing of OI patients has an additive effect on bisphosphonate treatment in fracture prevention which should lead to the reconsideration of a hybrid approach to OI management.

Two key goals of treatment of Osteogenesis Imperfecta (OI) patients include decreasing fracture incidence and improving function and independence as supported by a multi-disciplinary approach that combines medical, orthopaedic and rehabilitation treatments.Although the literature provides evidence that bisphosphonates reduce the frequency of fractures, there have not been reports of its effect when used with orthoses.Orthoses for OI patients have an additive effect on bisphosphonate treatment in fracture prevention.These results contribute to making an informed decision regarding this hybrid approach to OI management.

Enhancing conflict negotiation strategies of adolescents with autism spectrum disorder using video modeling.

Adolescents with autism spectrum disorder (ASD) have particular difficulty in negotiating conflict. A randomized control trial (RCT) was carried out to determine whether the negotiation strategies of adolescents with ASD would be enhanced via a 6-week intervention based on a video modeling application. Adolescents with ASD, aged 12-18 years, were randomly divided into an intervention group (n = 36) and a non-treatment control group (n = 25). Participants' negotiating strategies prior to and following the intervention were measured using the Five Factor Negotiation Scale (FFNS; Nakkula & Nikitopoulos, 1999) and the ConflicTalk questionnaire (Kimsey & Fuller, 2003). The results suggest that video modeling is an effective intervention for improving and maintaining conflict negotiation strategies of adolescents with ASD.

Using virtual reality simulation to study navigation in a complex environment as a functional-cognitive task; A pilot study.

BACKGROUND: Navigation skills are required for performance of functional complex tasks and may decline due to aging. Investigation of navigation skills should include measurement of cognitive-executive and motor aspects, which are part of complex tasks. OBJECTIVE: to compare young and older healthy adults in navigation within a simulated environment with and without a functional-cognitive task. METHODS: Ten young adults (25.6±4.3 years) and seven community dwelling older men (69.9±3.8 years) were tested during a single session. After training on a self-paced treadmill to navigate in a non-functional simulation, they performed the Virtual Multiple Errands Test (VMET) in a mall simulation. Outcome measures included cognitive-executive aspects of performance and gait parameters. RESULTS: Younger adults' performance of the VMET was more efficient (1.8±1.0) than older adults (5.3±2.7; p < 0.05) and faster (younger 478.1±141.5 s, older 867.6±393.5 s; p < 0.05). There were no differences between groups in gait parameters. Both groups walked slower in the mall simulation. CONCLUSIONS: The shopping simulation provided a paradigm to assess the interplay between motor and cognitive aspects involved in the efficient performance of a complex task. The study emphasized the role of the cognitive-executive aspect of task performance in healthy older adults.

A narrative review of texting as a visually-dependent cognitive-motor secondary task during locomotion.

Typing while walking is an example of people's ability to interact with technology while engaged in real life activities. Indeed, an increasing number of studies have investigated the typing of text messages (texting) as a dual task during locomotion. The objective of this review is to (1) describe the task requirements of texting-while-walking, (2) evaluate the measurement and psychometric properties of texting as a dual task, and (3) formulate methodological recommendations for researchers who use and report on texting-while-walking. Twenty studies which used texting as a dual task during gait were identified via a literature search. The majority of these studies examined texting among young healthy adults and showed that, like other dual tasks, texting-while-walking caused decrements in both gait and texting performance. The cause of these decrements was most likely related to increased visual task requirements, task-dependent cognitive requirements and fine motor skills. Texting-while-walking gait measures were repeatable, but texting performance showed poor reliability which further depended on skill. Preliminary results show that texting-while-walking performance may discriminate between populations (e.g., young vs. older adults) but no studies have yet examined its predictive validity (e.g., for fall risk). In conclusion, texting-while-walking is an ecologically-valid dual task for locomotion which has become much more commonly used in recent years. As opposed to other secondary tasks such as subtraction by 7 or generating words, texting may challenge various cognitive, visual and sensorimotor domains depending on its content. This imposes task-specific methodological challenges on future research, which are discussed.

Living Labs: overview of ecological approaches for health promotion and rehabilitation.

PURPOSE: The term "Living Lab" was coined to reflect the use of sensors to monitor human behavior in real life environments. Until recently such measurements had been feasible only within experimental laboratory settings. The objective of this paper is to highlight research on health care sensing and monitoring devices that enable direct, objective and accurate capture of real-world functioning. METHOD: Selected articles exemplifying the key technologies that allow monitoring of the motor-cognitive activity of persons with disabilities during naturally occurring daily experiences in real-life settings are discussed in terms of (1) the ways in which the Living Lab approach has been used to date, (2) limitations related to clinical assessment in rehabilitation settings and (3) three categories of the instruments most commonly used for this purpose: personal technologies, ambient technologies and external assistive systems. RESULTS: Technology's most important influences on clinical practice and rehabilitation are in a shift from laboratory-based to field-centered research and a transition between in-clinic performance to daily life activities. Numerous applications show its potential for real-time clinical assessment. CONCLUSIONS: Current technological solutions that may provide clinicians with objective, unobtrusive measurements of health and function, as well as tools that support rehabilitation on an individual basis in natural environments provide an important asset to standard clinical measures. IMPLICATIONS FOR REHABILITATION: Until recently objective clinical assessment could not be readily performed in a client's daily functional environment. Novel technologies enable health care sensing and monitoring devices that enable direct, objective and accurate capture of real-world functioning. Such technologies are referred to as a "Living Lab" approach since they enable the capture of objective and non-obtrusive data that clinicians can use to assess performance. Research and development in this field help clinicians support maintain independence and quality of life for people who have disabilities or who are aging, and to promote more effective methods of long-term rehabilitation and maintenance of a healthy life style.

Intervention using the VMall for improving motor and functional ability of the upper extremity in post stroke participants.

AIM: Initial studies have shown the potential of video capture virtual reality (VR) systems for rehabilitation. However, it is important to continue to investigate the utility of novel VR intervention techniques for treating motor deficits. The aim of the current study was to determine the effectiveness of the VMall, a virtual supermarket on a video capture system as an intervention tool to treat the weak upper extremity of people with stroke. METHODS: This study followed a single subject, ABA design, for six participants with stroke who live at home. Each participant received ten one-hour treatment sessions over a period of three weeks. The motor and functional abilities of the weak upper extremity of the participants were tested using standardized clinical assessments prior to and following the intervention. RESULTS: An improvement was found for all outcome measures during the intervention phase as compared to no or very little change during both baseline phases. The participants reported that the intervention helped them improve their weak upper extremity and stated that they used it more in daily life than prior to the intervention. CONCLUSIONS: The VMall appears to have great potential as an intervention tool for treating the weak upper extremity of individuals with stroke while providing opportunities for practicing functional tasks.

Interactive virtual environment training for safe street crossing of right hemisphere stroke patients with unilateral spatial neglect.

PURPOSE: The goal of this study was to determine whether non immersive interactive virtual environments are an effective medium for training individuals who suffer from Unilateral Spatial Neglect (USN) as a result of a right hemisphere stroke, and to compare it to a standard computer visual scanning training. METHOD: Participants included 19 patients with right hemisphere stroke in two groups, 11 in an experimental group were given computer desktop-based Virtual Reality (VR) street crossing training and 8 in a control group who were given computer based visual scanning tasks, both for a total of twelve sessions, 9 hours total, over four weeks. Measures included: 1. Standard USN assessments, paper and pencil and ADL checklist; 2. Test on the VR street program; and 3. Actual street crossing videotaped. Testing was performed pre and post intervention. RESULTS: The VR group achieved on the USN measures results that equaled those achieved by the control group treated with conventional visual scanning tasks. They improved more on the VR test and they did better on some measures of the real street crossing. CONCLUSIONS: Despite several limitations in this study the present results support the effectiveness of the VR street program in the treatment of participants with USN, and further development of the program.

Design and development of virtual reality based perceptual-motor rehabilitation scenarios.

Virtual reality technology may provide new options for conducting perceptual-motor assessment within simulated 3D environments for persons with a wide range of disabilities. This paper outlines our work developing a series of game-like VR scenarios to assess and rehabilitate eye-hand coordination, range of motion and other relevant perceptual-motor activities. Our efforts have focused on building engaging game-based stereoscopic graphic scenarios that allow clients to participate in perceptual-motor rehabilitation by interacting with 3D stimuli within a full 360-degree space using a head mounted display or by way of a "face-forward" format using 3D projection displays. Exploratory work using multiple video sensors to detect and track 3D body motion, identify body postures and quantify motor performance is also described.

Effect of seated posture on interface pressure in children who are able-bodied and who have myelomeningocele.

PURPOSE: The objective of this study was to investigate the relationship between sitting position and interface pressure distribution in seated children. METHOD: Fifteen able-bodied children and 15 children with myelomeningocele complete paraplegia, aged 7 to 18 years were included in the study. The body-seat interface pressure was measured with the QA pressure measurement system. Four sitting positions typically used to reduce body-seat interface pressure position (recline, tilt, combined and lean forward) were compared to a neutral position. RESULTS: Test/re-test Pearson correlation coefficients were greater than 0.94 for maximum pressure and greater than 0.88 for mean pressure at all test positions (p < 0.0001) and, for the risk area (defined as the percentage of sensors which recorded pressures greater than 40 mm Hg.) varied from 0.62 to 0.85 (p < 0.0005). Maximum pressures for the myelomeningocele group were significantly higher than those recorded for able-bodied subjects in the neutral, combined and lean forward positions (p < 0.001). For the able-bodied subjects, maximum pressures at the combined (p < 0.001), tilt (p < 0.05) and lean forward (p < 0.0001) positions were significantly lower than those measured at the neutral position. For the myelomeningocele subjects, maximum pressure at all tested positions was significantly lower than at the neutral position (p < 0.05). CONCLUSIONS: The results point to the importance of measuring body-seat interface pressure for each wheelchair user and of using the information to customize wheelchair utilization.

Virtual environments in the diagnosis, prevention, and intervention of age-related diseases: a review of VR scenarios proposed in the EC VETERAN Project.

A group of worldwide virtual reality and health-care researchers have decided to combine their efforts in a multidisciplinary project titled VETERAN-virtual environments in the diagnosis, prevention and intervention of age-related diseases. The main goal of the VETERAN project is the tuning and testing of different virtual environments, designed to address the cognitive/functional impairments that may occur due to the aging process and age-related disorders. In particular the developed modules will address the problems commonly found in the following pathologies that have a strong impact on the elderly health care policy: Alzheimer's disease and other senile dementias; stroke and unilateral spatial neglect; mobility-related accidents within specific environments (e.g., falls, shocks). The project will focus on research into clinical aspects of age-related diseases and disorders of high morbidity and specifically target goals of prevention, treatment, or delay in onset. Another goal of the VETERAN project is to define and develop new protocols and tools to be used for general rehabilitation purposes. These tools will aim to provide systematic restorative training within the context of functionally relevant, ecologically valid simulated environments. This approach is hoped to optimise the degree of transfer of training and/or generalisation of learning to the person's real world environment.

Use of a computer simulator for training children with disabilities in the operation of a powered wheelchair.

OBJECTIVE: The purpose of this study was to evaluate the ability of a basic driving simulator program to evaluate and train children with disabilities in their ability to operate a powered wheelchair. METHOD: With a rating scale of skills considered essential for safe and efficient wheelchair operation, 22 children 7 to 22 years of age with either progressive muscular dystrophy or cerebral palsy were evaluated in their ability to drive a powered wheelchair through a driving course. They were divided into two groups: one without prior experience driving a powered wheelchair and the other with experience. After the driving assessment with an actual powered wheelchair, the inexperienced drivers were trained on a joystick-controlled computer game in which they navigated through labyrinths similar in layout to their own school environment. A test maze was administered before and after this training. Both groups were then evaluated on their ability to drive a powered wheelchair through the driving course. RESULTS: The inexperienced drivers significantly increased their simulator scores over the training period. Their wheelchair driving performance was significantly better after the simulator training, although their performance remained poorer than that of the experienced drivers. CONCLUSION: A simulator program can assist in the development and evaluation of the skills required to operate a powered wheelchair.

Prevalence and risk factors of upper extremity cumulative trauma disorder in dental hygienists.

Cumulative trauma disorder (CTD) refers to a number of conditions arising from overuse of joints or soft tissues. The common risk factors that contribute to the development of these disorders are related to personal and occupational variables. Job analysis of the tasks performed by the dental hygienist have shown that this occupation is particularly at risk. The objectives of this study were to determine the prevalence of CTD symptoms amongst dental hygienists in Israel and to identify which are the factors that are related to CTD. A questionnaire including items concerning demographic data, employment history, professional occupational information, use of instrumentation, and CTD symptomatology was mailed to all 530 registered dental hygienists. Two hundred forty-six hygienists (46%) returned the questionnaire; 63% of the respondents were classified as CTD 'sufferers', Age, year of graduation, hours worked per week, and frequency of changing instruments were found to be significantly related to CTD symptoms. Hygienists at high risk included those aged 50 years or more (Odds ratio, OR = 6), those who graduated before 1986 (OR = 3), those who work more than 34 h per week (OR = 2.5) and those who change two or fewer instruments per patient (OR = 2). The major recommendation resulting from this study is to make dental hygienists aware that they work in a high-risk profession. It is hoped that increased awareness of the risk will spur the hygienist to make appropriate work practice, administrative, and engineering modifications and to seek treatment at the first indication of CTD symptoms.

Virtual reality applications to work.

Virtual reality (VR) entails the use of advanced technologies, including computers and various multimedia peripherals, to produce a simulated (i.e. virtual) environment that users perceive as comparable to real world objects and events. With the aid of specially designed transducers and sensors, users interact with displayed images, moving and manipulating virtual objects, and performing other actions in a way that engenders a feeling of actual presence (immersion) in the simulated environment. The unique features and flexibility of VR give it extraordinary potential for use in work-related applications. It permits users to experience and interact with a life-like model or environment, in safety and at convenient times, while providing a degree of control over the simulation that is usually not possible in the real-life situation. The work-related applications that appear to be most promising are those that employ virtual reality for visualization and representation, distance communication and education, hands-on training, and orientation and navigation. This article presents an overview to the concepts of VR focusing on its applications in a variety of work settings. Issues related to potential difficulties in using VR including side effects and the transfer of skills learned in the virtual environment to the real world are also reviewed.

The effect of typing frequency and speed on the incidence of upper extremity cumulative trauma disorder.

Typing in the work setting, with its emphasis on speed, force and repetitive movements and its tendency to be performed under less than optimum conditions has been one of the major causes of upper extremity cumulative trauma disorder (CTD). This disorder, also known as overuse syndrome, is a chronic condition believed to result from habitual overuse of the digits, hands or arms. The objective of this study was to examine the relationship between typing habits, specifically the influence of typing frequency, speed and style, on the incidence of injury. One hundred Israeli female typists aged between 20 and 60 years with no prior history of orthopedic or neurological disease participated in the study. Data collection took place at the work setting and consisted of a clinical evaluation of the upper extremities and trunk, a typing test, and a questionnaire which included questions concerning demographic information, occupational history, and upper extremity usage in the home and at work. Subjects were asked whether they had suffered from pain or other symptoms in the upper extremity (shoulder, arm, forearm, elbow or hand) on more than three occasions in the last year or on one occasion lasting more than a week. Subjects who answered no to this question were designated as 'non-sufferers'. Those who answered yes to the question were designated 'sufferers'. The 100 women who participated in the study represented a wide range of ages and educational levels. The variables describing on-the-job performance showed a wide range of values. Similar variability was found in the anthropometric variables. On the basis of the subjective criterion, 40 of the women belonged to the group labeled 'sufferers'. The remaining 60 subjects belonged to the group of 'non-sufferers'. The Odd's ratio test (OR), a common statistical procedure for risk factor estimation, was used to determine threshold levels associated with the development of CTD. Age, hours worked per week, typing speed, and years worked as a typist were variables in which at least one cut-off value generated a significant OR. The delineation of factors associated with typists who are classified as 'sufferers' establishes a portrait of the typical worker at risk for the development of CTD and provides insight into ways in which employers, clinicians and workers themselves could reduce the risk of CTD.

Effect of maintained stretch on the range of motion of the human ankle joint.

The effectiveness of maintained stretch in expanding the range of motion of the human ankle joint was assessed in a population of normal adults. Controlled movements were imposed upon the ankle, and triceps surae and tibialis anterior electromyograms were monitored to ensure that only passive joint properties generated ankle torque. We found that a majority of subjects (7 of 12) showed evidence of muscle activity sufficient to distort a subjective assessment of changes in range of motion. For the remaining five subjects, a 60-s maintained stretch produced a small decrease in the torque subsequently generated by an imposed dorsiflexing movement, but this effect was transient and largely disappeared following 300 s of rest at a neutral position. This short-term effect is consistent with the viscoelastic properties of collagenous material stretched during such treatment and is unlikely to lead to long-term increases in range of motion. RELEVANCE: The results of these experiments indicate that subjective assessments of changes in joint range of motion may be distorted by voluntary and reflexive muscle activation. Moreover the presumed increases in range of motion produced by maintained stretch in our normal subjects were small and transient. These results suggest that future assessments of the long-term efficacy of this treatment must monitor muscle activity and take into account known viscoelastic properties of collagenous materials.

Using the Exos Handmaster to measure digital range of motion: reliability and validity.

Traditional assessment of digital range of motion via a standard goniometer is a weak correlate of hand function and task performance. Yet it remains one of the primary, quantitative methods of hand assessment used to determine an individual's ability to return to work or to assess his or her permanent functional impairment. Another technique more representative of functional performance would be immensely useful for clinicians, patients, employers and third-party payers. The objective of this research was to investigate the clinical feasibility of using the Exos Handmaster, a Hall-effect instrumented exoskeleton, to measure angular joint rotation of the metacarpophalangeal and interphalangeal joints. The work reported in this paper includes a description of modifications to the fixation technique and calibration procedures of the Handmaster and the results of an investigation of the unit's reliability and validity.

Objective and subjective approaches to the force and displacement characteristics of input devices used by the disabled.

This study was designed to determine how well therapists were able to estimate the mechanical characteristics of adapted switches. This was accomplished using two related experiments. In the first experiment, objective data characterizing the activation force-displacement trajectories for eight commonly used adapted switches were collected. In the second experiment, subjective data identifying the relative ranking of activation force as well as activation displacement by experienced and novice therapists were compiled. The major finding was that although therapists' subjective estimates of activation force and displacement were reasonably good there were specific areas of weakness that should be rectified with quantitative, objective data. In particular, subjective estimates of the mechanical properties appeared to be inadequate when used to evaluate switches separated by only small differences in force or displacement and for those whose properties were larger or smaller than their expected values. Possible difficulties in dissociating activation force and displacement were also noted. The technical and clinical implications of these results are discussed.

A human factors approach to adapted access device prescription and customization.

Adapted access device prescription and customization is often a lengthy and cumbersome process. To date, few objective procedures are available to assist in the prescription process. Rather, clinician and client rely on a trial-and-error approach that is often severely constrained by the size of their adaptive device collection as well as the extent of clinical expertise. Furthermore, the large number of available options and lack of information delineating the mechanical and physical characteristics of these devices means that therapists must take time away from direct clinical contact to probe each adaptation in detail. There is available in the human factors domain a body of literature that is highly relevant to adapted access. Of particular interest are the studies that have addressed issues related to the suitability of standard and alternative input devices in terms of task productivity (via improvements in input speed, accuracy, and endurance), and their ability to minimize the risk of acute and chronic work-related dysfunction. This paper aims to consider the relevance of human factors research for physically disabled individuals. Three human factors issues--digit travel, digit loading, and device positioning--have been selected as representative of factors important in the configuration of adapted access devices.