Omid Jahanian

BACKGROUND Chronic pain significantly impacts physical function and quality of life. Current assessments rely on patient-reported measures or clinic-based tests, which may not accurately reflect real-world activity. OBJECTIVE To provide a preliminary evaluation of quantitative methods using wrist accelerometry data to quantify physical performance in a pilot study on individuals with chronic pain. METHODS Thirteen participants wore wrist-mounted accelerometers for seven days. The mean absolute deviation (MAD) metric was computed from raw acceleration data to classify sedentary and active behaviors. The durations and accumulation patterns of time spent in sedentary and active bouts were investigated. Activity intensity levels were also analyzed using wrist-based actigraphy cut-points previously developed for the general population. Additionally, total step counts were estimated from wrist actigraphy data. Correlations between actigraphy metrics and pain scores, age, and performance on a 6-minute walk test were examined. RESULTS The average daily percentage of time spent in sedentary and active states (light intensity and higher), based on the MAD metric, was 62% and 38%, respectively. However, the wrist-based actigraphy cut-points, previously established for the general population, tended to classify a greater proportion of time as sedentary (70%) and a smaller proportion as active (30%). Sedentary time was primarily accumulated through longer sedentary bouts. The average (SD) total daily step count was 9,344 (2,403) steps per day. Only average daily activity bout duration was associated with 6MWT (ρ = 0.56, p = 0.046). CONCLUSIONS The MAD-based metrics demonstrated feasibility for capturing light-intensity activities in individuals with chronic pain, suggesting an improved method for tracking functional outcomes. These findings should be interpreted as preliminary and hypothesis-generating, informing future studies on the integration of personalized, objective metrics into chronic pain management to better assess treatment efficacy and promote meaningful activity changes.

Objective: To evaluate the feasibility and potential efficacy of percutaneous spinal stimulation (epidural stimulation, ES) combined with task-specific training to reduce spasticity and improve gait and balance in individuals with progressive multiple sclerosis (MS). Methods: Two men with progressive MS (EDSS 6.5) underwent ES lead implantation targeting the lower spinal cord, followed by one month of rehabilitation involving 12 ES-assisted training sessions. Assessments included instrumented gait analysis, Modified Ashworth Scale (MAS), pendulum test, and static balance testing performed at baseline, and at end of the study with ES-Off and ES-On conditions. Results: Participant 1, with spastic hemiparetic gait, demonstrated improved lower extremity joint kinematics and muscle activation during gait, reduced knee extensor spasticity, and enhanced functional movement patterns with ES-On. Participant 2, with significant paraparesis and minimal spasticity, showed limited gait changes but experienced marked improvements in static balance, particularly under eyes-closed conditions. No adverse events were reported. Conclusion: This pilot study demonstrates the feasibility and tolerability of ES paired with task-specific training in progressive MS. Participant-specific responses were observed, including improvements in gait kinematics, neuromuscular activation, spasticity, or balance; however, spatiotemporal gait parameters did not improve. These preliminary findings highlight response heterogeneity and the need for individualized ES parameter tuning. Trial registry name and URL: https://clinicaltrials.gov/study/NCT06019611

Objectives: To quantify the effects of geared wheelchair wheels on energy expenditure during manual wheelchair propulsion in individuals with spinal cord injury (SCI). Methods: Eleven adult manual wheelchair users with SCI propelled their personal manual wheelchairs, which were equipped with a pair of geared wheels, on a passive wheelchair ergometer in low-gear and standard-gear conditions for six minutes. The energy cost of transport, distance traveled, rate of oxygen consumption (SCI MET), rate of perceived exertion, heart rate, and stroke cycle frequency were measured and compared across the gear conditions. Results: The distance traveled and SCI MET were significantly lower (p = 0.003) and cost of transport was significantly higher under the low-gear condition compared with the standard-gear condition. Gear condition exerted a moderate effect on the level of exertion; however, the decrease in the rate of perceived exertion under the low-gear condition was not statistically significant. Gear condition did not significantly affect heart rate and stroke cycle frequency. Conclusions: Geared manual wheelchair propulsion was significantly more energy-demanding, but less intense (easier) under the low-gear condition than the standard-gear condition. Using geared wheels may be beneficial for manual wheelchair users to independently accomplish strenuous propulsion tasks during typical activities of daily living, such as propulsion on carpeted floor. However, the small sample size and inclusion of only male participants limit the generalizability of these findings, and future studies with larger and more diverse cohorts are warranted.

This study employed three inertial measurement units to quantify the mobility characteristics of 12 manual wheelchair users with spinal cord injuries (SCI) over 7 consecutive days, revealing nuanced patterns of daily movement. Mobility metrics were calculated for measures of distance traveled, movement duration, and speed. A mobility profile was created to understand patterns of movement behaviors. Participants moved 65.54 ± 21.81 min daily, traveled 1488.15 ± 700.09 meters at an average speed of 0.43 ± 0.16 m/s, and executed approximately 910 turns and 428 starts/stops per day. Mobility predominantly occurred in short bouts (<215 seconds), accounting for 94% of the mobility bouts. Mean mobility characteristics remained consistent across participants despite individual variability in high-resolution metrics, including starts/stops, turns and navigated slopes exceeding the ADA recommended ratio. This methodology provides insights into real-world manual wheelchair mobility and future research could inform rehabilitation strategies and assistive technology development. These methods underscore the critical importance of personalized, high-resolution mobility assessments in understanding and optimizing manual wheelchair users’ functional independence and quality of life.

Clonus is a disabling symptom of upper motor neuron dysfunction in patients with multiple sclerosis (MS). We report immediate termination of mechanically evoked clonus by epidural lumbosacral spinal cord stimulation (ES) in a 58-year-old man with secondary progressive MS. This observation was captured during training using video and skin surface electromyography of soleus muscle activity. ES immediately reduced mechanically evoked clonus duration and cycle count compared to trials without stimulation, as determined by a Kruskal–Wallis test ( p < 0.05, n = 2–3 trials), and reverted to baseline status when stimulation was off.

Objective: To explore potential differences in physical activity and sedentary behavior volumes and patterns among postmenopausal women with and without premenopausal bilateral oophorectomy (PBO). Methods: Women with a history of PBO (n = 50) and age-matched postmenopausal referent women (n = 50) were recruited. Participants wore accelerometers on both ankles for 7 days. Volume metrics of sedentary behavior and physical activity, such as step counts, active time, and sedentary time, as well as the sedentary behavior and habitual physical activity distribution, and accumulation patterns, were quantified from the accelerometer data and compared between groups. Results: Metrics indicating volume of sedentary behavior and physical activity were not statistically different between groups. PBO was significantly associated with higher variability in stepping bout time ( P = 0.022), indicating a potentially more complex walking pattern. In addition, PBO was significantly associated with lower variability in sedentary break time ( P = 0.012), and lower activity time Gini index ( Z = −2.428, P = 0.015). This suggests that women with PBO may have broken up their sedentary time with shorter and less variable activity bouts, and because they had relatively shorter average daily active time, they might be at a higher risk of subsequent adverse health outcomes such as low bone mineral density. Conclusions: Although there were no differences in overall activity volume, some differences in activity patterns emerged between women with PBO and referent women. The study highlights the need for longitudinal research to understand how physical activity and sedentary behavior patterns evolve in postmenopausal women with a history of PBO.

Objective To evaluate the feasibility and potential efficacy of percutaneous spinal stimulation (epidural stimulation, ES) combined with task-specific training to reduce spasticity and improve gait and balance in individuals with progressive multiple sclerosis (MS). Methods Two men with progressive MS (EDSS 6.5) underwent ES lead implantation targeting the lower spinal cord, followed by one month of rehabilitation involving 12 ES-assisted training sessions. Assessments included instrumented gait analysis, Modified Ashworth Scale (MAS), pendulum test, and static balance testing performed at baseline, and at end of study with ES-Off and ES-On conditions. Results Participant 1, with spastic hemiparetic gait, demonstrated improved lower extremity joint kinematics and muscle activation during gait, reduced knee extensor spasticity, and enhanced functional movement patterns with ES-On. Participant 2, with significant paraparesis and minimal spasticity, showed limited gait changes but experienced marked improvements in static balance, particularly under eyes-closed conditions. No adverse events were reported. Conclusion This pilot study suggests that ES paired with task-specific training may enhance gait and balance in individuals with progressive MS. Responses varied based on impairment profiles, underscoring the importance of individualized ES parameter tuning. These findings warrant further investigation of ES as a therapeutic option for motor impairments in MS.

For individuals living with spinal cord injury (SCI), a deep understanding of their shoulder pain experience is crucial to guide equipment prescription/design, mobility training, exercise, recreation, and pain education. Standardization in pain assessment methods is necessary for cross-study comparisons and meta-analyses. No previous studies describe the spectrum of shoulder pain assessment measures applied to adults with SCI who use MWCs for mobility. This scoping review aimed to determine the measurement instruments and methods of shoulder pain assessment used in peer-reviewed, published literature in studies focused on individuals with SCI who use MWCs. A literature search was performed using multiple databases on February 23, 2023. Data extraction elements included study design type, inclusion/exclusion criteria, sample size, and pain measurement instrument. Participant characteristics were also extracted including age, sex, time since SCI, level of SCI, and MWC use. This scoping review identified over 20 instruments used in 133 studies that focused on reported shoulder pain in studies of this population. Thirty percent of the studies performed shoulder pain assessment for more than one purpose (screening, baseline, outcome), and 56% used more than one assessment measurement. The Wheelchair Users Shoulder Pain Index was the most commonly used instrument. An in-depth understanding of pain requires measurement within a biopsychosocial framework and likely involves multiple instruments. Overall, investigators are challenged to select valid, reliable instruments that fulfill the demands of study design and questions of interest. Guiding questions are provided to assist investigators in their choice of pain instruments.

Background: Falls in people with multiple sclerosis (pwMS) lead to morbidity and expense. Objective: Identify clinical metrics associated with falls. Methods: Eighty-six pwMS completed fall surveys, timed 25-foot walk (T25FW), and motion analysis with Clario Opal devices. Logistic regression models were created. Results: Median age was 54.5 years (range 21–73), 62% (53) were female. The cohort included 58% with relapsing (50) and 42% with progressive MS (36). Those who reported falling in the last year were older (median age 58 vs 52.5, p = .03) and had a higher Patient Determined Disease Step (PDDS) score (median 3 vs 1, p < .0001). Falls were associated with worse balance metrics including sway area (median 2.3 degrees ² vs 1.2, p = .01), jerk (median 3.3 m ² /s ⁵ vs 1.6, p = .005), and slower T25FW (median 11.5 s vs 8; p < .0001). A multivariable regression model based on gait aid use and T25FW time >10.8 s (c = 0.80) was derived. Having both features portended a probability of falling of 0.97, while having neither, a probability of 0.26. Conclusions: Falls in pwMS are more frequent in patients who are older, have higher PDDS, slower walking, and worse balance. Gait aid use and T25FW >10.8 s were strongly associated with falls in the past year.

This study employed three inertial measurement units to quantify the mobility characteristics of 12 manual wheelchair users with spinal cord injuries (SCI) over 7 consecutive days, revealing nuanced patterns of daily movement. Mobility metrics were calculated for measures of distance traveled, movement duration, and speed. A mobility profile was created to understand patterns of movement behaviors. Participants moved 65.54 ± 21.81 min daily, traveled 1488.15 ± 700.09 meters at an average speed of 0.43 ± 0.16 m/s, and executed approximately 910 turns and 428 starts/stops per day. Mobility predominantly occurred in short bouts (<215 seconds), accounting for 94% of the mobility bouts. Mean mobility characteristics remained consistent across participants despite individual variability in high-resolution metrics, including starts/stops, turns and navigated slopes exceeding the ADA recommended ratio. This methodology provides insights into real-world manual wheelchair mobility and future research could inform rehabilitation strategies and assistive technology development. These methods underscore the critical importance of personalized, high-resolution mobility assessments in understanding and optimizing manual wheelchair users’ functional independence and quality of life.