Rashelle M. Hoffman

Background/Objectives : Rural populations face an elevated risk of Alzheimer’s disease and related dementias partially attributed to modifiable risk factors such as physical inactivity. The study gathered key community partners’ perspectives about (a) feasibility of implementing the telerehabilitation physical activity behavioral (TPAB) intervention, a virtual program aimed at increasing daily stepping with sensor-based monitoring, and (b) necessary adaptions for implementation for rural-dwelling people with cognitive impairment and care partners (dyads). Methods : Eleven rural-dwelling individuals (three medical providers, four older adults, and four care partners of individuals with mild cognitive impairment) in Nebraska were recruited for a focus group via fliers and word of mouth. The person-based approach was used to gain the perspectives of participants during a 1-hr group discussion regarding six dimensions of feasibility. Session transcriptions were analyzed using thematic analysis. Results : Participants highlighted the need to improve physical activity in the community and supported care partners receiving TPAB alongside individuals with mild cognitive impairment. Suggested modifications to TPAB included, establishing a local champion, integrating local resources, involving primary care providers, setting recruitment deadlines, using participant testimonies for recruitment, and emphasizing program individualization. Conclusion : Overall, participants perceived TPAB was practical, feasible, and necessary for rural-dwelling participants with cognitive impairment and their care partners; however, several adaptations and the creation of the Cognitive Impairment Rural Community—TPAB are required to optimize rural implementation. Significance/Implications : There is an identified need for the TPAB intervention with outlined redesign approaches to facilitate intervention development and rural implementation.

Background: Preoperative physical activity (PA) levels persist in patients following total knee arthroscopy (TKA), despite improved function and mobility following rehabilitation. Long‐standing activity behaviors and preexisting psychosocial characteristics may explain suboptimal PA post‐TKA. Objective: To (1) confirm latent constructs from outcome measures capturing symptoms, function, psychosocial factors, and mobility and (2) examine relationships between constructs measured pre‐TKA and their influence on post‐TKA outcomes using factor analyses and structural equation modeling. Design: Secondary analysis of a randomized clinical trial. Setting: Veterans Administration medical center. Patients: U.S. military Veterans ( n = 113; age 67.3 ± 7.3; mean ± SD; body mass index 29.0 ± 3.5 kg/m ² ; 90% male) scheduled for TKA. Intervention: Participants received TKA postoperative rehabilitation and were randomized to a PA behavior‐change intervention targeting increased walking exercise or control group. Main Outcome Measures: The Western Ontario Measurement Arthritis, Falls Efficacy Scale International, Functional Comorbidity Assessment, Veterans RAND‐12 Health Survey, Multidimensional Scale for Perceived Social Support, Geriatric Depression Scale, Self‐Efficacy for Exercise scale, Timed‐Up and Go, 6‐minute walking test, and Life‐Space Assessment (LSA) score. Results: A direct relationship was observed between pre‐TKA physical characteristics and pre‐TKA psychosocial characteristics ( β = .734, z = 7.871, p < .001). Pre‐TKA psychosocial characteristics were directly associated with post‐TKA LSA scores ( β = −.627, z = 2.924, p = .003). Pre‐TKA psychosocial characteristics explained 53.8% of the variability in post‐TKA LSA scores and mediated the pre‐post relationship between physical characteristics and LSA scores ( β = −0.460, z = −2.455, p = .014). No significant relationship was observed between pre‐TKA physical characteristics and post‐TKA LSA scores. Conclusions: Latent constructs representing physical health and psychosocial traits were directly related in veterans scheduled for TKA. Elevated psychosocial characteristics observed before TKA were associated with decreased life space mobility at 12 weeks post‐TKA. Our findings support addressing psychosocial factors before and throughout TKA rehabilitation as these may have implications on postoperative life space mobility.

Background and Purpose: Patients with end-stage hip osteoarthritis typically elect total hip arthroplasty (THA) to improve life activity performance while clinical outcomes focus on physical capacity. However, it is unclear how improvements in life activity performance relate to improvements in physical capacity following THA. This study aimed to assess the longitudinal relationship between improvement in life activity performance (ie, decreases in sedentary time) and improvements in physical capacity (ie, increases in 6-Minute Walk [6MWT] distance) from before THA to a 6-month post-THA follow-up time point. Methods: This is a secondary analysis of a double-blind randomized controlled trial that enrolled individuals 50 to 85 years of age with unilateral hip osteoarthritis who underwent THA. Longitudinal variables of interest included the % of active wear time in sedentary activity using a hip-mounted wearable accelerometer-based monitor [ActiGraph wGT3X-BT] and 6MWT distance. The variables were modeled to extract predicted change scores, and simulations were used to determine if each participant had a change in sedentary time and 6MWT distance. Participants were classified on whether they improved sedentary activity time (P+: decrease in sedentary time or P−: no improvement in sedentary time) and/or 6MWT distance (C+: increased 6MWT distance or C−: no improvement in 6MWT distance). Independent sample t-tests (continuous variables) and Fisher exact tests (categorical variables) were used to compare characteristics between classification groups. Results and Discussion: All 76 participants (age: 63.9 ± 7.0 years, 64.5% male) were classified as C+, as all improved physical capacity. A majority (n = 45; 59.2%) were C+/P+, while 31 participants (40.8%) were classified as C+/ P−, and no participants were classified as C−/P+ or C−/ P−. Conclusions: There is a noted disagreement between improvements in life activity performance versus physical capacity suggesting gains in the 6MWT are not always associated with reductions in sedentary time during recovery from THA. Improving physical capacity does not equate to decreased sedentary time. Thus, different rehabilitation targets (ie, behavior change interventions) may need to be identified and explored to enhance life activity performance following THA that may better align with patient performance goals.

Background: Resistance training with real-time movement velocity feedback enhances power training. Linear position transducers (LPTs) provide visual biofeedback and are commonly used to measure movement velocities in performance and research settings. However, the agreement between some commonly used LPTs, such as the Humac360, is unknown. Objective: The purpose of this study was to determine the agreement of the Humac360 LPT between the Tendo Power Analyzer and the GymAware PowerTool. Methods: Thirty participants (23.0 ± 5.6 years) completed 7 sets of 3 repetitions of the belt squat movement with loads ranging from 0–120% of their body weight. Mean velocity (MV) and peak velocity (PV) were collected and recorded simultaneously on all three LPTs. Agreement between devices was assessed using the ratio of half the limits of agreement and the mean of pairwise measurements, and the correlation between devices was determined using Pearson's r. Results: Moderate agreement was seen at PV between the Humac360 and Tendo (0.5 LOA/MPM = 0.12–0.21), and between the Humac360 and GymAware (0.5 LOA/MPM = 0.16–0.27). Low agreement was observed when measuring MV between the Humac360 and Tendo (0.5 LOA/MPM = 0.23–0.31), and between the Humac360 and GymAware (0.5 LOA/MPM = 0.18–0.27). High to very high correlations were observed between the Humac360 and both the Tendo (r = 0.87–0.99) and GymAware (r = 0.87–0.96) at MV and PV. Conclusion: The moderate agreement and high to very high positive correlations demonstrated by the Humac360 was comparable to the Tendo and GymAware devices, specifically at peak velocities, supporting its use by clinicians, therapists, and trainers, for the particular use of measuring peak velocity.

Background: Individuals with end‐stage knee osteoarthritis (OA) walk at a lower intensity (ie, slower step cadence) contributing to worse physical function. Previous literature reports daily step counts and sedentary time, with little information regarding stepping bouts or cadence. Determining relationships between daily higher stepping cadence duration and clinical outcomes can move the field toward optimal daily stepping prescription.Objective: To quantify daily physical activity patterns of individuals with end‐stage knee OA and determine the contribution of high stepping cadence to explain functional capacity variability.Design: Cross‐sectional analysis.Setting: Veterans Administration medical center.Participants: U.S. military veterans (n = 104; age: 67.1 years [7.2]; mean [SD]; male [89.3%]) with end‐stage knee OA were enrolled.Intervention: Not applicable.Main outcome measure: Functional capacity (6‐Minute Walk Test [6MWT]). Physical activity (activPAL wearable sensor; cadence and time sitting, standing, and stepping), pain (Western Ontario and McMaster Universities Osteoarthritis Index‐pain subscale) sociodemographic variables, and comorbidities (body mass index and Functional Comorbidity Index) are the main explanatory variables.Results: Participants' wake time was mainly sitting (11.0 h/day) in ≥60‐minute bouts (29.7% ± 12.7 of sitting time). Standing (3.4 hours/day) and stepping (1.4 h/day) primarily occurred in 0–5 minute bouts (standing: 87.7% ± 14.4 of standing time, stepping: 98.7% ± 12.7 of stepping time) and stepping cadence was predominantly incidental (1–19 spm; 52.9% ± 9.6 of total stepping time). Backward elimination model results indicated shorter medium‐to‐brisk cadence bout duration, older age, and higher pain significantly explained shorter 6MWT distance (_AdjR²=0.24, p < .01).Conclusions: Individuals with knee OA spend most of their waking hours sitting, while standing and stepping occurs in short bouts at very low stepping cadence. Decreased time in high stepping cadence is associated with lower functional capacity. Future studies should explore if increasing the daily time spent in higher step cadence can improve functional capacity in this population.

Somatosensory cortical activity is altered in individuals with cerebral palsy (CP). However, previous studies have focused on the lower extremities in children with CP and have given less attention to structural changes that may contribute to these alterations. We used a multimodal neuroimaging approach to investigate the relationship between somatosensory cortical activity and cortical thickness in 17 adults with CP (age = 32.8 ± 9.3 years) and 18 healthy adult controls (age = 30.7 ± 9.8 years). Participants performed a median nerve paired-pulse stimulation paradigm while undergoing magnetoencephalography (MEG) to investigate somatosensory cortical activity and sensory gating. Participants also underwent magnetic resonance imaging to evaluate cortical thickness within the area of the somatosensory cortex that generated the MEG response. We found that the somatosensory responses were attenuated in the adults with CP (P = 0.004). The adults with CP also hypergated the second stimulation (P = 0.030) and had decreased cortical thickness in the somatosensory cortex (P = 0.015). Finally, the strength of the somatosensory response was significantly correlated with the cortical thickness (P = 0.023). These findings demonstrate that the aberrant somatosensory cortical activity in adults with CP extends to the upper extremities and appears to be related to cortical thickness.

Neurophotonics covers advances in optical technology applicable to study of the brain and their impact on the basic and clinical neuroscience applications.