Gordon Tao

Objective: To determine if socket comfort predicts walking capacity, walking performance, and life-space mobility. Design: Observational exploratory study involving a secondary cross-sectional analysis using multiple regression of data collected from an exercise intervention trial. Setting: Laboratory setting for clinical assessments; community setting for walking performance. Participants: Community-dwelling lower-limb prosthesis users over 50 years old ( n = 72). Main measures: Socket Comfort Score, 2-Minute Walk Test, step count, Life Space Assessment, and control variables including demographics, Short Physical Performance Battery, Four Square Step Test, and Walking While Talking. Results: Regression modeling showed Socket Comfort Score as a statistically significant predictor of 2-Minute Walk Test ( B = 6.9 m, 95% CI [2.7, 11.1] m) alongside amputation level, Walking While Talking test, and Short Physical Performance Battery (greatest contribution to the model); the model accounted for 61% of the variance. Socket Comfort Score was not a statistically significant predictor of step count. Socket Comfort Score was the only statistically significant predictor of Life Space Assessment ( B = 4.9, 95% CI [1.1, 8.8]); the model accounted for 12% of the variance. Conclusions: Socket comfort played a notable role in predicting walking capacity and life space mobility, but not in walking performance. Improving lower extremity function may have greater impact on walking overall. While this study provides context regarding socket comfort that clinicians may consider when planning holistic prosthetic rehabilitation, mixed findings in the literature suggest that further research on how socket comfort relates to walking outcomes in the community is warranted.

Background. Physical activity (PA) is essential for maintaining well-being in adults with disabilities. This population experienced reduced PA during the COVID-19 pandemic; yet, the impact on quality of PA participation remains unclear. Purpose. This secondary analysis explored how pandemic restrictions impacted six experiential dimensions of quality of PA participation among adults with disabilities. Methods. An exploratory sequential mixed-methods design, including semi-structured interviews ( n = 10) and self-reported surveys ( n = 61), was conducted in May-2020 and February-2021. Quality of PA participation was measured using the Measure of Experiential Aspects of Participation (MeEAP). Participants included community-dwelling adults over 19 years of age (mean 59.2 ± 14.0 years) living with stroke, spinal cord injury, or other physical disabilities. Findings. Directed content analysis identified three themes related to adjusting PA participation for restrictions, motivation barriers, and valuing social support. These themes highlighted five factors, such as resilience, as potential quantitative predictors of quality of PA participation. While paired correlations with MeEAP scores were observed, these factors were not statistically predictive in multiple regression analysis (adjusted R² = −0.14, F(10,50) = 0.92, p = .53). Implications. The interplay between Meaning, Autonomy, Engagement, and Belongingness dimensions of quality of PA participation was complex, with an emphasized role for mental health, in adults with disabilities.

With increased physical restrictions during the coronavirus disease 2019 (COVID-19) pandemic, many individuals, especially older adults and individuals with disabilities, experienced increased feelings of loneliness. This study aimed to identify factors associated with loneliness among older adults and people with disabilities residing in British Columbia (BC), Canada 10 months following COVID-19 physical restrictions. Participants included a total of 70 adults consisting of older adults (>65 years of age) without any self-reported disabilities and adults (aged 19 or above) with disabilities (e.g., stroke, spinal cord injury, etc.). Participants completed standardized self-report measures of their levels of anxiety, depression, social support, mobility, and loneliness. We used hierarchical linear regression to determine the association of age, sex, disability status, anxiety, depression, social support, and mobility with loneliness. Participants reported general low levels of loneliness, anxiety, and depression and an overall high level of perceived social support. Most participants reported living with others. Our analysis showed a positive association between anxiety and loneliness (β = 0.340, p = 0.011) and a negative association between social support and loneliness (β = −0.315, p = 0.006). There was no association between depression and loneliness (β = 0.210, p = 0.116) as well as between mobility and loneliness (β = −0.005, p = 0.968). These findings suggest that anxiety and social support have been significantly associated with loneliness in older adults and people with disabilities during the COVID-19 pandemic. Increased efforts to reduce anxiety and improve social support in clinical and community settings may be helpful in reducing loneliness in older adults and people with disabilities during the COVID-19 pandemic.

The restrictions in 2019 due to Coronavirus impacted Canadians’ daily living, especially those at higher risk of compromised health conditions. This study aimed to describe the physical, psychological, and social well-being of adults with disabilities, and older adults from May to June 2020. Participants from the group of community-dwelling adults (≥19 years of age), who communicated in English, lived in British Columbia, and had Internet access via a computer, tablet, or smartphone with special focus on populations who had stroke, spinal cord injury and other disabilities were included. For measurement outcomes, an online survey was used to administer standardized measures of level of participation, mobility, anxiety and depression, boredom, resilience, technology readiness, social support, and social networks. Seventy-two participants were recruited, with a mean age (SD) of 61.2 (13.8). This study was comprised of two groups: the adult group consisted of individuals with disabilities under the age of 65 (48.6%) and the older adult group consisted of individuals over the age of 65 with and without self-identified disability (51.4%). There was no significant difference in the proportion of participation restriction between adult (83%) and older adult’ (81%) groups (p = 0.69). In the study population, 27.8% and 16.7% of participants exceeded the anxiety and depression cut-off scores, respectively. Boredom was experienced by 76.4% of participants. Participants’ mean (SD) resilience and life space scores were 72.4 (14.0) and 51.9 (24.0), respectively. The older adults (≥65 years) showed significantly lower depression (p = 0.012) and better resilience (p = 0.038), social support (p = 0.043), and social network (p = 0.021) than the younger adults. Issues with anxiety, boredom, participation, and life space activity were identified in both study groups. This information may provide supporting evidence when creating policies to mitigate existent health and social inequities.

Coronavirus disease 2019 restrictions impacted Canadians' daily living, especially those at higher risk of compromised health conditions. This study aimed to describe the physical, psychological, and social well-being of adults with disabilities, and older adults from May to June 2020. An online survey was used to administer standardized measures of mobility, anxiety and depression, boredom, resilience, technology readiness, social support, social networks, and participation. Seventy-two participants were recruited, with a mean age (SD) of 61.2 (13.8). 69.4% of participants had a disability, and 51.4% were older adults. 27.8% and 16.7% of participants exceeded the anxiety and depression cut-off scores, respectively. Boredom and restriction in participation were experienced by 76.4% and 80.1% of participants, respectively. Participants' mean (SD) resilience and life space scores were 72.4 (14.0) and 51.9 (24.0), respectively. Individuals with disabilities have comparatively higher mean anxiety (5.5 to 3.3), depression (4.8 to 2.9), and boredom (92.2 to 72.3) scores than those without. Individuals with a disability had lower resilience (69.9 to 78.0) and felt more life space restrictions (45.4 to 67.6). Our findings revealed issues with anxiety, boredom, participation, and life space activity. This information may provide supporting evidence when creating policies to mitigate existent health and social inequities.

Objective: Determine efficacy of the novel WiiNWalk intervention on walking-related outcomes in older adults with lower limb amputation. Design: Multi-site, parallel, evaluator-masked randomized controlled trial. Setting: Home-setting in three Canadian cities. Participants: Community-dwelling lower limb prosthesis users over 50 years of age. Interventions: The WiiNWalk group (n = 38) used modified Wii Fit activities for prosthetic rehabilitation. The attention control group (n = 33) used Big Brain Academy: Wii Degree, comprising of cognitive activities. Both groups completed a 4-week supervised phase with three 1-h sessions/week in groups of three overseen by a clinician via videoconferencing and a 4-week unstructured and unsupervised phase. Main Measures: Primary outcome was walking capacity (2 min walk test); secondary outcomes were balance confidence (activities-specific balance confidence scale), dynamic balance (four-step square test), and lower limb functioning (short physical performance battery). Outcomes were compared across time points with repeated measures analysis of covariance, adjusting for baseline and age. Results: Mean age was 65.0 (8.4) years, with 179.5 (223.5) months post-amputation and 80% transtibial amputation. No group difference in a 2 min walk test with an effect size: 1.53 95% CI [−3.17, 6.23] m. Activities balance confidence was greater in the WiiNWalk group by 5.53 [2.53, 8.52]%. No group difference in the four-step square test −0.16 [−1.25, 0.92] s, nor short physical performance battery 0.48 [−0.65, 1.61]. A post-hoc analysis showed the greatest difference in balance confidence immediately after an unsupervised phase. Conclusions: The WiiNWalk intervention improved balance confidence, but not walking-related physical function in older adult lower limb prosthesis users. Future rehabilitation games should be specific to the amputation context. Clinical Trial Registration number, NCT 01942798.

Background: Older adults with lower-limb amputations (LLAs) often experience lack of confidence and poor balance, which limits their mobility. There are few validated measures for assessing these outcomes in the LLA population. Objectives: To assess the validity of the Life Space Assessment (LSA) and the Physical Activity Scale for the Elderly (PASE) for older adults with LLA. Study design: Secondary analyses of cross-sectional data. Methods: Sixty-eight older adults with LLA across Canada were recruited to complete the LSA and the PASE. Validity was assessed via correlations with the Activities-specific Balance Confidence (ABC), Four-Square Step Test (FSST), and Two-Minute Walk Test (2-MWT). Results: As hypothesized, the LSA was positively correlated with the ABC (ρ = 0.36, 95% confidence interval [CI] [0.17, 0.62]) and 2-MWT (r = 0.49, 95% CI [0.27, 0.70]) and negatively correlated with FSST (ρ = −0.39, 95% CI [−0.56, −0.10]). The PASE was positively correlated with the ABC (ρ = 0.34, 95% CI [0.10, 0.56]) and 2-MWT (ρ = 0.32, 95% CI [0.05, 0.52]), and negatively correlated with FSST (ρ = −0.36, 95% CI [−0.53, −0.07]). Conclusions: The LSA has validity in measuring life space mobility. The PASE captures the physical activity with weaker support of validity in older adults with LLA. Clinical relevance: The LSA and PASE are quick low-cost tools for clinicians to assess mobility-related functional health and physical activity, respectively, in older adults with LLA. However, the PASE may contain activities that are not common among older adults with LLA.

Background: The COVID-19 pandemic has led to wide-scale changes in societal organization. This has dramatically altered people's daily activities, especially among families with young children, those living with disabilities such as spinal cord injury (SCI), those who have experienced a stroke, and older adults. Objective: We aim to (1) investigate how COVID-19 restrictions influence daily activities, (2) track the psychosocial effects of these restrictions over time, and (3) identify strategies to mitigate the potential negative effects of these restrictions. Methods: This is a longitudinal, concurrent, mixed methods study being conducted in British Columbia (BC), Canada Data collection occurred at four time points, between April 2020 and February 2021. The first three data collection time points occurred within phases 1 to 3 of the Province of BC's Restart Plan. The final data collection coincided with the initial distribution of the COVID-19 vaccines. At each time point, data regarding participants' sociodemographics, depressive and anxiety symptoms, resilience, boredom, social support, instrumental activities of daily living, and social media and technology use were collected in an online survey. These data supplemented qualitative videoconference interviews exploring participants' COVID-19-related experiences. Participants were also asked to upload photos representing their experience during the restriction period, which facilitated discussion during the final interview. Five groups of participants were recruited: (1) families with children under the age of 18 years, (2) adults with an SCI, (3) adults who experienced a stroke, (4) adults with other types of disabilities, and (5) older adults (>64 years of age) with no self-reported disability. The number of participants we could recruit from each group was limited, which may impact the validity of some subgroup analyses. Results: This study was approved by the University of British Columbia Behavioural Research Ethics Board (Approval No. H20-01109) on April 17, 2020. A total of 81 participants were enrolled in this study and data are being analyzed. Data analyses are expected to be completed in fall 2021; submission of multiple papers for publication is expected by winter 2021. Conclusions: Findings from our study will inform the development and recommendations of a new resource guide for the post-COVID-19 period and for future public health emergencies.

Background: Mindfulness-based stress reduction has demonstrated some efficacy for chronic pain management. More recently, virtual reality (VR)–guided meditation has been used to assist mindfulness-based stress reduction. Although studies have also found electroencephalograph (EEG) changes in the brain during mindfulness meditation practices, such changes have not been demonstrated during VR-guided meditation. Objective: This exploratory study is designed to explore the potential for recording and analyzing EEG during VR experiences in terms of the power of EEG waveforms, topographic mapping, and coherence. We examine how these measures changed during a VR-guided meditation experience in participants with cancer-related chronic pain. Methods: A total of 10 adult patients with chronic cancer pain underwent a VR-guided meditation experience while EEG signals were recorded during the session using a BioSemi ActiveTwo system (64 channels, standard 10-20 configuration). The EEG recording session consisted of an 8-minute resting condition (pre), a 30-minute sequence of 3 VR-guided meditation conditions (med), and a final rest condition (post). Power spectral density (PSD) was compared between each condition using a cluster-based permutation test and across conditions using multivariate analysis of variance. A topographic analysis, including coherence exploration, was performed. In addition, an exploratory repeated measures correlation was used to examine possible associations between pain scores and EEG signal power. Results: The predominant pattern was for increased β and γ bandwidth power in the meditation condition (P<.025), compared with both the baseline and postexperience conditions. Increased power in the  bandwidth was evident, although not statistically significant. The pre versus post comparison also showed changes in the θ and α bands (P=.02) located around the frontal, central, and parietal cortices. Across conditions, multivariate analysis of variance tests identified 4 clusters with significant (P<.05) PSD differences in the δ, θ, β, and γ bands located around the frontal, central, and parietal cortices. Topographically, 5 peak channels were identified: AF7, FP2, FC1, CP5, and P5, and verified the changes in power in the different brain regions. Coherence changes were observed primarily between the frontal, parietal, and occipital regions in the θ, α, and γ bands (P<.0025). No significant associations were observed between pain scores and EEG PSD. Conclusions: This study demonstrates the feasibility of EEG recording in exploring neurophysiological changes in brain activity during VR-guided meditation and its effect on pain reduction. These findings suggest that distinct altered neurophysiological brain signals are detectable during VR-guided meditation. However, these changes were not necessarily associated with pain. These exploratory findings may guide further studies to investigate the highlighted regions and EEG bands with respect to VR-guided meditation. Trial Registration: ClinicalTrials.gov NCT00102401; http://clinicaltrials.gov/ct2/show/NCT00102401

Background: High quality head-mounted display based virtual reality (HMD-VR) has become widely available, spurring greater development of HMD-VR health games. As a behavior change approach, these applications use HMD-VR and game-based formats to support long-term engagement with therapeutic interventions. While the bulk of research to date has primarily focused on the therapeutic efficacy of particular HMD-VR health games, how developers and researchers incorporate best-practices in game design to achieve engaging experiences remains underexplored. This paper presents the findings of a narrative review exploring the trends and future directions of game design for HMD-VR health games. Methods: We searched the literature on the intersection between HMD-VR, games, and health in databases including MEDLINE, Embase, CINAHL, PsycINFO, and Compendex. We identified articles describing HMD-VR games designed specifically as health applications from 2015 onwards in English. HMD-VR health games were charted and tabulated according to technology, health context, outcomes, and user engagement in game design. Findings: We identified 29 HMD-VR health games from 2015 to 2020, with the majority addressing health contexts related to physical exercise, motor rehabilitation, and pain. These games typically involved obstacle-based challenges and extrinsic reward systems to engage clients in interventions related to physical functioning and pain. Less common were games emphasizing narrative experiences and non-physical exercise interventions. However, discourse regarding game design was diverse and often lacked sufficient detail. Game experience was evaluated using primarily ad-hoc questionnaires. User engagement in the development of HMD-VR health games primarily manifested as user studies. Conclusion: HMD-VR health games are promising tools for engaging clients in highly immersive experiences designed to address diverse health contexts. However, more in-depth and structured attention to how HMD-VR health games are designed as game experiences is needed. Future development of HMD-VR health games may also benefit from greater involvement of end-users in participatory approaches.