Cesar Marquez-Chin

Introduction: Functional electrical stimulation (FES) can improve functional outcomes for individuals with cervical spinal cord injury (cSCI). While wearing augmented reality (AR) headsets, automated hand tracking can be leveraged to automate FES delivery and control stimulation patterns to assist independent hand exercises. The current study assessed the perceived usefulness and feasibility of using a combined AR-FES system for individuals with cSCI. Methods: 12 individuals with cSCI tried a custom AR-FES application for a single 30-minute session in a supervised clinical environment. While wearing the headset, the system compared actual to target hand postures during hand exercises with real objects, with a closed-loop linear scaling of FES amplitudes to help participants achieve correct grasping patterns. Immediately after, participants completed a custom questionnaire, the System Usability Scale (SUS), and a 30-minute semi-structured interview analyzed using a hybrid inductive-deductive thematic analysis informed by the Technology Acceptance Model. Results: Positive usability metrics (i.e., mean SUS = 75; SD = 12) were complemented by three themes: 1) Perceived Ease of Use (subthemes: perceived complexity, technological and physical limitations), 2) Perceived Usefulness (subthemes: potential impact on recovery, addressing limitations of previous therapies, person dependent), and 3) Behavioural Intention to Use (subthemes: attitudes towards use, using the system in different environments and ways). Conclusion: Individuals with cSCI perceived that the AR-FES system was useful toward recovery, potentially feasible for independent use, and provided suggestions to increase both. Thus, the study demonstrates the potential to increase the dosage of neuromodulation-based rehabilitation via independent use of an AR-FES system.

The built environment continues to become increasingly accessible to people with disabilities, yet there remains a lack of focus on how these individuals are evacuated in emergencies. The objective of this scoping review was to survey the academic literature to identify solutions for safely evacuating individuals with functional limitations from the indoor built environment (i.e., buildings). Journal articles and conference proceedings published in the year 2002 onwards were included. Two pairs of reviewers independently evaluated 3562 articles from ten databases and identified 99 articles. The results were categorized into six main evacuation solution types: notification, wayfinding, egress, building design, strategy, and training programs. Our findings highlight the importance of tailoring solutions to the needs of individuals with different functional limitations. Future work should focus on expanding the number of solutions available for (1) emergencies beyond fires (e.g., natural disasters); (2) unique building types that may require specialized engineering considerations; and (3) a greater variety of impairments (e.g., seeing, hearing, cognitive). We also emphasize the need for more interdisciplinary work and the importance of including rescuers and rescuees in emergency preparedness discussions. These collaborations will ensure that building designs, organizational procedures, and evacuation aids complement each other to maximize safety. To our knowledge, this is the first scoping review to identify solutions for evacuating individuals with functional limitations from buildings. These findings may help inform future recommendations for new evacuation guidelines around the world.

Objective. Brain-computer interface (BCI)-controlled functional electrical stimulation (FES) could excite the central nervous system to enhance upper limb motor recovery. Our current study assessed the effectiveness of motor and prefrontal cortical activity-based BCI-FES to help elucidate the underlying neuromodulation mechanisms of this neurorehabilitation approach. Approach. The primary motor cortex (M1) and prefrontal cortex (PFC) BCI-FES interventions were performed for 25 min on separate days with twelve non-disabled participants. During the interventions, a single electrode from the contralateral M1 or PFC was used to detect event-related desynchronization (ERD) in the calibrated frequency range. If the BCI system detected ERD within 15 s of motor imagery, FES activated wrist extensor muscles. Otherwise, if the BCI system did not detect ERD within 15 s, a subsequent trial was initiated without FES. To evaluate neuromodulation effects, corticospinal excitability was assessed using single-pulse transcranial magnetic stimulation, and cortical excitability was assessed by motor imagery ERD and resting-state functional connectivity before, immediately, 30 min, and 60 min after each intervention. Main results. M1 and PFC BCI-FES interventions had similar success rates of approximately 80%, while the M1 intervention was faster in detecting ERD activity. Consequently, only the M1 intervention effectively elicited corticospinal excitability changes for at least 60 min around the targeted cortical area in the M1, suggesting a degree of spatial localization. However, cortical excitability measures did not indicate changes after either M1 or PFC BCI-FES. Significance. Neural mechanisms underlying the effectiveness of BCI-FES neuromodulation may be attributed to the M1 direct corticospinal projections and/or the closer timing between ERD detection and FES, which likely enhanced Hebbian-like plasticity by synchronizing cortical activation detected by the BCI system with the sensory nerve activation and movement related reafference elicited by FES.

Brain computer interface-triggered functional electrical stimulation therapy (BCI-FEST) has shown promise as a therapy to improve upper extremity function for individuals who have had a stroke or spinal cord injury. The next step is to determine whether BCI-FEST could be used clinically as part of broader therapy practice. To do this, we need to understand therapists’ opinions on using the BCI-FEST and what limitations potentially exist. Therefore, we conducted a qualitative exploratory study to understand the perspectives of therapists on their experiences delivering BCI-FEST and the feasibility of large-scale clinical implementation. Semi-structured interviews were conducted with physical therapists (PTs) and occupational therapists (OTs) who have delivered BCI-FEST. Interview questions were developed using the COM-B (Capability, Opportunity, Motivation—Behaviour) model of behaviour change. COM-B components were used to inform deductive content analysis while other subthemes were detected using an inductive approach. We interviewed PTs (n = 3) and OTs (n = 3), with 360 combined hours of experience delivering BCI-FEST. Components and subcomponents of the COM-B determined deductively included: (1) Capability (physical, psychological), (2) Opportunity (physical, social), and (3) Motivation (automatic, reflective). Under each deductive subcomponent, one to two inductive subthemes were identified (n = 8). Capability and Motivation were perceived as strengths, and therefore supported therapists’ decisions to use BCI-FEST. Under Opportunity, for both subcomponents (physical, social), therapists recognized the need for more support to clinically implement BCI-FEST. We identified facilitating and limiting factors to BCI-FEST delivery in a clinical setting according to clinicians. These factors implied that education, training, a support network or mentors, and restructuring the physical environment (e.g., scheduling) should be targeted as interventions. The results of this study may help to inform future development of new technologies and interventions.

Study design An exploratory descriptive study was conducted. Objective To determine if and how occupational therapists (OTs) and physical therapists (PTs) in acute care hospital settings use activity-based therapy (ABT) and its associated technologies. Setting Acute care hospital settings in Canada. Methods Semi-structured interviews were conducted with physical and occupational therapists, licensed in Canada, who worked in an acute care neurological setting with individuals with spinal cord injury or disease (SCI/D). To analyze the data, interpretive description was used. NVivo 12 was used for data management. Results Five physical therapists and two occupational therapists were interviewed (n = 7). Two therapists declined after reading a description of the study. Through analysis, the following themes were identified as affecting the delivery of ABT as part of SCI/D rehabilitation in the acute care setting: (1) Impact of patient acuity on ABT participation, (2) ABT approach unique to the acute care setting, and (3) Influence of acute care work environment and therapy practice. Throughout these themes, therapists referred to dosage as a limiting factor affecting ABT delivery. Conclusions Our research reveals that implementing ABT in an acute care setting is challenging considering the high dosage of movement practice required for ABT. To increase dosage and the use of ABT in acute care, strategies could include early patient education on ABT, strategic use of social supports, and use of portable technology already incorporated in acute care.

Background: Whether due to aging, disability, injury, or other circumstances, an increasing number of Canadians experience functional limitations that reduce their ability to participate in activities of daily life. While the built environment has become increasingly accessible, existing Canadian evacuation guidelines lack comprehensive strategies for evacuating individuals with functional limitations from buildings during emergencies. To inform guideline revisions, a map of existing solutions for evacuating such individuals is required. Therefore, this scoping review aims to provide an account of solutions that have been reported to safely evacuate individuals with functional limitations from the built environment. Methods: We will conduct a scoping review using the Arksey and O’Malley methodological framework. To identify potentially relevant studies, comprehensive searches (from January 2002 onwards) of the CINAHL, Ei Compendex, Inspec, Embase, MEDLINE, KCI, RSCI, SciELO CI, Web of Science Collection, and Scopus databases will be performed. Using a set of inclusion and exclusion criteria, two reviewers will independently (1) classify identified studies as relevant, irrelevant, or maybe relevant by evaluating their titles and abstracts and (2) classify the relevant and maybe relevant studies as included or excluded by evaluating their full-text. From each included study, data on publication information, study purpose, methodological details, evacuation information, and outcomes will be extracted using a set of data extraction items. We will present a numerical summary of the key characteristics of the included studies. For each evacuation activity, reported evacuation solutions will be summarized, and citations provided for functional limitations that are targeted by a given evacuation solution. To inform Canadian evacuation guideline revisions, we will tabulate evacuation activities common to different types of buildings and emergencies. Discussion: To our knowledge, this will be the first scoping review to identify the state and use of solutions for evacuating individuals with functional limitations from the built environment. Identifying solutions that enable all individuals to safely evacuate from different types of buildings will allow us to inform recommendations for the revision of evacuation guidelines in Canada and other jurisdictions. The findings of this scoping review will be published in a peer-reviewed journal, presented at relevant conferences, and made publicly available on the internet. Systematic review registration: Open Science Framework: osf.io/jefgy

Integrating brain-computer interface (BCI) technology with functional electrical stimulation therapy (FEST) is an emerging strategy for upper limb motor rehabilitation after spinal cord injury (SCI...

The study objectives were to evaluate the inter-rater and intra-rater reliability; and criterion and construct validity of the 3D printed Toronto Rehabilitation Institute -Hand Function Test (3D TR...