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Objectives: Adults with spinal cord injury (SCI) are often sedentary, increasing their risk of cardiometabolic diseases. Leisure-time Physical Activity (LTPA) is physical activity completed during recreation time for enjoyment. We aimed to quantify LTPA in people ≥45 years with SCI and to explore its relationship with participants' characteristics. Methods: This is a secondary analysis on a subset of the Australian International SCI Survey in participants ≥45 years, at least 12 months post-injury. We described levels of LTPA and used multivariable regressions to estimate the associations between participant characteristics and LTPA. Results: Of 1,281 participants (mean age: 62.7 years, mean time since injury: 18.7 years; 74% males) 44% reported no participation in LTPA. The average LTPA participation was 197 (SD 352) minutes per week (median: 50). Females (β = -62.3, 95% CI [-112.9, -11.7]), and participants with non-traumatic injuries (β = -105.2, 95% CI [-165.9, -44.6]) performed less LTPA. Time since injury was not associated with moderate-to-heavy LTPA (LR: Probability > F = 0.785). Conclusion: LTPA promotion in the SCI population ≥45 years focusing on females and non-traumatic injuries is warranted. [ABSTRACT FROM AUTHOR]

Objective: There is a large gap between evidence-based recommendations for spatial neglect assessment and clinical practice in stroke rehabilitation. We aimed to describe factors that may contribute to this gap, clinician perceptions of an ideal assessment tool, and potential implementation strategies to change clinical practice in this area. Design: Qualitative focus group investigation. Focus group questions were mapped to the Theoretical Domains Framework and asked participants to describe their experiences and perceptions of spatial neglect assessment. Setting: Online stroke rehabilitation educational bootcamp. Participants: A sample of 23 occupational therapists, three physiotherapists, and one orthoptist that attended the bootcamp. Intervention: Prior to their focus group, participants watched an hour-long educational session about spatial neglect. Main measures: A deductive analysis with the Theoretical Domains Framework was used to describe perceived determinants of clinical spatial neglect assessment. An inductive thematic analysis was used to describe perceptions of an ideal assessment tool and practice-change strategies in this area. Results: Participants reported that their choice of spatial neglect assessment was influenced by a belief that it would positively impact the function of people with stroke. However, a lack of knowledge about spatial neglect assessment appeared to drive low clinical use of standardised functional assessments. Participants recommended open-source online education involving a multidisciplinary team, with live-skill practice for the implementation of spatial neglect assessment tools. Conclusions: Our results suggest that clinicians prefer functional assessments of spatial neglect, but multiple factors such as knowledge, training, and policy change are required to enable their translation to clinical practice. [ABSTRACT FROM AUTHOR]

Background: The Danish Physiotherapy Research Database for chronic patients receiving Free of Charge Physiotherapy (PhysDB-FCP) was piloted over a 1-year period. The purpose of the PhysDB-FCP is to provide a user friendly digital online structured tool that standardizes initial and follow up clinical assessments generating data that can be used for clinical decision making and support future research in physiotherapy for patients with chronic disease. Although initial assessments were completed, the attrition rate was 73% and 90% at 3- and 6- months, respectively, which suggests problems with the current tool. Objective: To evaluate the perspectives of the physiotherapists that used the PhysDB-FCP and propose changes to the tool based on this feedback. Materials and methods: Fifty of the 103 physiotherapists introduced to the PhysDB-FCP completed an anonymous online survey. Physiotherapists were asked Likert/categorical and yes/no questions on experiences with the PhysDB-FCP within their practice, perceptions of patient experiences, suitability of the resources and support provided by the PhysDB-FCP working group and the ideal administration frequency of the assessments within the PhysDB-FCP. Open ended feedback on possible improvements to the PhysDB-FCP was also collected. Results: Physiotherapists agreed that the PhysDB-FCP was useful for taking a physiotherapy assessment (74%) and the patient survey was useful for goal setting (72%). Although physiotherapists felt the PhysDB-FCP was well-defined (82%), only 36% would like to use a similar tool again. Generally, the PhysDB-FCP was too time-consuming, administered too frequently and included irrelevant items. For example, 72% of physiotherapists took >45 min to administer the assessment in the first consultation which was performed over multiple sessions. Conclusions: The perspectives of physiotherapists using The PhysDB-FCP suggest specific changes that will ensure better use of the tool in future practice. Changes will likely involve administering the assessment less frequently (every 6-months to 1-year), shortening the assessment, and using diagnosis-specific assessment items. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To investigate the completeness show a meaningful difference between years for all to guide authors to adequately describe of reporting of physical therapy interventions in interventions (+5%), controls (+6%), treatment the setting and materials used in an inrandomized controlled trials before and after publi- interventions (+6%), exercise-based interventions tervention, the intervention fidelity, and cation of the Template for Intervention Description (+9%), or musculoskeletal (+4%) or neurological the dose or duration of the intervention. and Replication (TIDieR) checklist (a reporting (+7%) physical therapy For exercise interventions, In complex interventions such as exerguideline for interventions) number of sessions was reported more (+21%) in 2018 than in 2000. For musculoskeletal trials, 2 cise-based physical therapy, the number * DESIGN: Meta-research. items were reported more completely in 2018 than of sessions, intensity, and duration of an * METHODS: Wesearched 6 journals fortrials in 2000 (materials, +29%; individual versus group, exercise intervention represent critical using physical therapy interventions that were +22%) and 3 items were reported more completely information.5 Better reporting of interpublished in 2000 and 2018. Two independent as- in neurological trials (mode of delivery, +20%, sessors scored the TIDieR checklist and extracted ventions in physical therapy research will [item 8.1] when +45%, and assessment of fidelity, descriptive information, including Physiotherapy +20%). The item "Who delivered the intervention?" help clinicians implement effective inter- Evidence Database (PEDro) scale scores. We was reported less completely (-23%) in 2018 ventions into clinical practice, ultimately identified control or treatment interventions, than in 2000 in neurological trials. We found no benefiting patient outcomes. exercise-based interventions, and area of physical correlation (r = 0.12) between PEDro scale score Meta-research using the TIDieR therapy. We performed a descriptive analysis and and TIDieR score. checklist has highlighted poor reportdefined a priori a 20% difference between studies published in 2000 and 2018 as meaningful. We *CONCLUSION: There were few meaningful ing of interventions in physical therapy assessed correlations between TIDieR and PEDro improvements in how physical therapy inter- literature.422 In 2013, physical therapy scale scores for all interventions. ventions were described after publication of trials failed to describe at least half of the * RESULTS: In total, 140 articles that met selec- the TIDieR reporting guideline. [ABSTRACT FROM AUTHOR]

Emerging technologies such as robotics and virtual reality (VR) are being trialled and implemented into physiotherapy practice. As emerging technologies compete for market share, trials on emerging technologies are at risk of spin. For consumers to make informed decisions about whether to use a new technology, trials should accurately portray the results. If spin is present, outcomes may not be comparable to the results reported when interventions are implemented clinically. To determine the amount and type of spin in abstracts of physiotherapy clinical trials that use robotic or VR interventions. A secondary objective is to determine the agreement between raters, both experienced and inexperienced, using an existing 7-item checklist with updated item definitions. We will perform two meta-research reviews on a random set of 100 robotics (study 1) and 100 VR (study 2) trials, from any year, indexed in the PEDro database. Using the updated spin checklist, the abstract of each trial will be assessed in corroboration with full-text. The total spin score and proportion of studies with spin for each item will be reported. Agreement between experienced and inexperienced raters will be determined using kappa statistics. Rater confidence in rating each item will be collected. We will identify if spin is present in robotics and VR literature and evaluate if the spin checklist can be confidently and consistently used by raters. We hope this research will facilitate best-practice reporting of research findings so emerging technologies will be implemented with realistic expectation of clinical outcome. [ABSTRACT FROM AUTHOR]

The aim was to challenge the assumptions of standard statistical analyses of average surface electromyography (sEMG) data as a measurement of response magnitudes following the generation of a reflex. The ipsilateral tibial nerve was stimulated at three stimulation intensities and the response sEMG was measured in the contralateral soleus (cSOL) muscle. The magnitude of the cSOL response was measured at a set time window following ipsilateral tibial nerve stimulation. The averaged and trial-by-trial response magnitudes were assessed and compared. The analysis of the averaged and trial-by-trial response revealed significantly different results as the trial-by trial response magnitudes were log-normally distributed with between subject variance heterogeneity violating assumptions of standard statistical analyses. A statistical model has been suggested for the analysis of the responses. By ignoring trial-by-trial response variability and distribution, erroneous results may occur. This may change the interpretation of the results in some studies. [ABSTRACT FROM AUTHOR]

Primary objective: Rehabilitation scales following neurological injury can be useful for monitoring patient progress. However, too often, rehabilitation scales are administered unnecessarily placing an extra burden on clinicians and patients. The primary objective was to reduce redundant testing by providing guidelines for the concurrent use of the Functional Independence Measure (FIM) and Early Functional Abilities (EFA) scales during rehabilitation in patients with brain injury. Methodology: In total, 3289 concurrent FIM and EFA scores from 929 patients were examined. We proposed, using clinically sound and operational criterion, that the FIM should be used throughout rehabilitation, EFA should be used as a supplement when the FIM is ≤36 and FIM should be administered before the EFA on each testing occasion. Results: Around 24% of patients should be measured with the FIM and EFA throughout rehabilitation, 35% of patients should be measured with the EFA and FIM initially but not require EFA measurements when there is an increase in function and 39% of patients should only be measured with the FIM. According to these guidelines, the EFA was administered unnecessarily 53% of the time. Conclusions and implications: These guidelines ensure that the EFA is used when it is sensitive. This will optimize clinician time and minimize redundant testing, without compromising the measurement of clinical progress. [ABSTRACT FROM AUTHOR]

The objective of the current study was to determine the test-retest reliability of heel-to-toe progression measures in the stance phase of gait using intraclass correlation coefficient (ICC) analysis. It has been proposed that heel-to-toe progression could be used as a functional measure of ankle muscle contracture/weakness in clinical populations. This was the first study to investigate the test-retest reliability of this measure. Eighteen healthy subjects walked over the GAITRite® mat three times at a comfortable speed on two sessions (≥ 48 hours apart). The reliability of the heel-to-toe progression measures; heel-contact time, mid-stance time and propulsive time were assessed. Also assessed were basic temporal-spatial parameters; velocity, cadence, stride length, step length, stride width, single and double leg support time. Reliability was determined using the ICC(3,1) model and, fixed and proportional biases, and measures of variability were assessed. Basic gait temporal-spatial parameters were not different between sessions (p > 0.05) and had excellent reliability (ICC(3,1) range: 0.871–0.953) indicating that subjects walked similarly between sessions. Measurement of heel-to-toe progression variables were not different between sessions (p > 0.05) and had excellent reliability (ICC(3,1) range: 0.845–0.926). However, these were less precise and more variable than the measurement of standard temporal-spatial gait variables. As the current study was performed on healthy populations, it represents the ‘best case’ scenario. The increased variability and reduced precision of heel-to-toe progression measurements should be considered if being used in clinical populations. [ABSTRACT FROM AUTHOR]

Key points: In reduced muscle preparations, the slack length and passive stiffness of muscle fibres have been shown to be influenced by previous muscle contraction or stretch. In human muscles, such behaviours have been inferred from measures of muscle force, joint stiffness and reflex magnitudes and latencies. Using ultrasound imaging, we directly observed that isometric contraction of the vastus lateralis muscle at short lengths reduces the slack lengths of the muscle–tendon unit and muscle fascicles. The effect is apparent 60 s after the contraction. These observations imply that muscle contraction at short lengths causes the formation of bonds which reduce the effective length of structures that generate passive tension in muscles. Abstract: In reduced muscle preparations, stretch and muscle contraction change the properties of relaxed muscle fibres. In humans, effects of stretch and contraction on properties of relaxed muscles have been inferred from measurements of time taken to develop force, joint stiffness and reflex latencies. The current study used ultrasound imaging to directly observe the effects of stretch and contraction on muscle–tendon slack length and fascicle slack length of the human vastus lateralis muscle in vivo. The muscle was conditioned by (a) strong isometric contractions at long muscle–tendon lengths, (b) strong isometric contractions at short muscle–tendon lengths, (c) weak isometric contractions at long muscle–tendon lengths and (d) slow stretches. One minute after conditioning, ultrasound images were acquired from the relaxed muscle as it was slowly lengthened through its physiological range. The ultrasound image sequences were used to identify muscle–tendon slack angles and fascicle slack lengths. Contraction at short muscle–tendon lengths caused a mean 13.5 degree (95% CI 11.8–15.0 degree) shift in the muscle–tendon slack angle towards shorter muscle–tendon lengths, and a mean 5 mm (95% CI 2–8 mm) reduction in fascicle slack length, compared to the other conditions. A supplementary experiment showed the effect could be demonstrated if the muscle was conditioned by contraction at short lengths but not if the relaxed muscle was held at short lengths, confirming the role of muscle contraction. These observations imply that muscle contraction at short lengths causes the formation of bonds which reduce the effective length of structures that generate passive tension in muscles. [ABSTRACT FROM AUTHOR]

This study tested the hypothesis that the ratio of changes in muscle fascicle and tendon length that occurs with joint movement scales linearly with the ratio of the slack lengths of the muscle fascicles and tendons. We compared the contribution of muscle fascicles to passive muscle-tendon lengthening in muscles with relatively short and long fascicles. Fifteen healthy adults participated in the study. The medial gastrocnemius, tibialis anterior, and brachialis muscle-tendon units were passively lengthened by slowly rotating the ankle or elbow. Change in muscle fascicle length was measured with ultrasonography. Change in muscle-tendon length was calculated from estimated muscle moment arms. Change in tendon length was calculated by subtracting change in fascicle length from change in muscle-tendon length. The median (IQR) contribution of muscle fascicles to passive lengthening of the muscle-tendon unit, measured as the ratio of the change in fascicle length to the change in muscle-tendon unit length, was 0.39 (0.26-0.48) for the medial gastrocnemius, 0.51 (0.29-0.60) for tibialis anterior, and 0.65 (0.49-0.90) for brachialis. Brachialis muscle fascicles contributed to muscle-tendon unit lengthening significantly more than medial gastrocnemius muscle fascicles, but less than would be expected if the fascicle contribution scaled linearly with the ratio of muscle fascicle and tendon slack lengths. [ABSTRACT FROM AUTHOR]

Precise estimates of muscle architecture are necessary to understand and model muscle mechanics. The primary aim of this study was to estimate continuous changes in fascicle length and pennation angle in human gastrocnemius muscles during ramped plantar flexor contractions at two ankle angles. The secondary aim was to determine whether these changes differ between proximal and distal fascicles. Fifteen healthy subjects performed ramped contractions (0-25% MVC) as ultrasound images were recorded from the medial ( MG, eight sites) and lateral ( LG, six sites) gastrocnemius muscle with the ankle at 90° and 120° (larger angles correspond to shorter muscle lengths). In all subjects, fascicles progressively shortened with increasing torque. MG fascicles shortened 5.8 mm (11.1%) at 90° and 4.5 mm (12.1%) at 120°, whereas LG muscle fascicles shortened 5.1 mm (8.8%) at both ankle angles. MG pennation angle increased 1.4° at 90° and 4.9° at 120°, and LG pennation angle decreased 0.3° at 90° and increased 2.6° at 120°. Muscle architecture changes were similar in proximal and distal fascicles at both ankle angles. This is the first study to describe continuous changes in fascicle length and pennation angle in the human gastrocnemius muscle during ramped isometric contractions. Very similar changes occurred in proximal and distal muscle regions. These findings are relevant to studies modeling active muscle mechanics. [ABSTRACT FROM AUTHOR]

Purpose: In some hospitals, patients exhibit significant heterogeneity of function at admission and discharge. The current study aims to assess if concurrent usage of the Early Functional Assessment (EFA) and Functional Independence Measure (FIM®) is warranted and practical in rehabilitation centers with diverse patient groups and outcomes. Methods: This retrospective study examined a data set of all patients with concurrent EFA and FIM scores admitted to a single rehabilitation center (4076 scores from 1251 patients). The patients had acquired brain injury of multiple etiologies and a range of severities. Results: The EFA scale was more able to characterize the function of lower functioning patients according to the FIM while the FIM scale was more able to characterize the function of higher functioning patients according to the EFA. This was highlighted by 21% of assessments with the lowest FIM score (18) having corresponding EFA scores of 22-76 and 27% of assessments with the highest EFA score (>90) having corresponding FIM scores of 38-126. Conclusions: In rehabilitation centers with diverse patient groups and outcomes, the FIM and EFA scale could be used to characterize the heterogeneity of function in patients with acquired brain injury. The EFA/FIM scale could be used concurrently in certain patients providing a more complete view of patients throughout the rehabilitation process. [ABSTRACT FROM AUTHOR]

Malone L, Vasudevan E, and Bastian A (J Neurosci 31: 15136-15143, 2011) investigated the effects of different training paradigms on the day-by-day retention of learned motor patterns. In this Neuro Forum, a description and assessment of the methods used will be presented. The interpretation of the findings will be extended and the possible implications will be discussed. Finally, alternative explanations of the possible regions involved in motor pattern relearning will be provided. [ABSTRACT FROM AUTHOR]

Introduction: Validly and reliably assessing conceptual change is essential for evaluating the effectiveness of pain science education for physiotherapy students. We aimed to 1) evaluate concept of pain before and after a 14-week pain science education university subject, 2) assess structural validity of the Concept of Pain Inventory for Adults (COPI-Adult) in postgraduate entry-level physiotherapy students, and 3) explore possible relationships between baseline variables and baseline COPI-Adult scores., Review of Literature: As the COPI-Adult is a newly developed questionnaire, there is a lack of data regarding its psychometric properties., Subjects: Of 129 enrolled students at an Australian university, 124 (96%) and 114 (88%) completed the baseline and follow-up questionnaires, respectively., Methods: In this prospective cohort study, students who commenced the degree in 2020 or 2021 completed online questionnaires, including the COPI-Adult, at the start and end of their first semester. This semester included a 14-week pain science education subject and other physiotherapy-related subjects. Higher COPI-Adult scores (range = 0-52) indicate better alignment with contemporary pain science. We 1) compared differences in concept of pain before and after the semester, 2) performed a confirmatory factor analysis on the COPI-Adult, and 3) performed exploratory regression analyses., Results: Concept of Pain Inventory for Adults scores increased from baseline (median [interquartile range]: 39 [36-44]) to follow-up (48 [44-51]). The COPI-Adult retained its 1-factor structure, with acceptable internal consistency (Cronbach's alpha = 0.80). Exploratory analysis showed that previously completing a subject on pain was related to higher COPI-Adult baseline scores. Age, gender, and mental health diagnosis did not relate to baseline COPI-Adult scores., Discussion and Conclusion: Following a 14-week pain science education subject embedded within a physiotherapy degree, students improved their concept of pain. The COPI-Adult maintains a 1-factor structure in this population. Completing a previous subject on pain was associated with higher COPI-Adult scores., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2023 Academy of Physical Therapy Education, APTA.)

The aim was to investigate trial-by-trial response characteristics in the short-latency stretch reflex (SSR). Fourteen dorsiflexion stretches were applied to the ankle joint with a pre-contracted soleus muscle on two days. The magnitude and variability of trial-by-trial responses of the SSR were assessed. The SSR was log-normally distributed and variance heterogeneous between subjects. For some subjects, the magnitude and variance differed between days and stretches. As velocity increased, variance heterogeneity tended to decrease and response magnitude increased. The current study demonstrates the need to assess trial-by-trial response characteristics and not averaged curves. Moreover, it provides an analysis of SSR characteristics accounting for log-normally distributed and variance heterogeneous trial-by-trial responses.

Short-latency spinally mediated interlimb reflex pathways were recently reported between the left and right soleus muscles in the human lower-limb during sitting. The aim of the current study was to establish if these pathways were observed during a functional motor task such as human gait and modulated by the gait cycle phase and/or electrical stimulation intensity. The second aim was to elucidate on the afferents involved. Two interventions were investigated. First was ipsilateral tibial nerve (iTN) stimulation at motor threshold (MT), 35% of the maximal peak-to-peak M-wave(M-Max) and 85% M-Max (85M-Max) with stimuli applied at 60%, 70%, 80%, 90%, and 100%of the gait cycle of the ipsilateral leg. Second was ipsilateral sural nerve (SuN) and medial plantar nerve (MpN) stimulation at 1, 2, and 3X perceptual threshold at 90% of the gait cycle [corrected]. The root mean squared (RMS) of the contralateral soleus (cSOL) responses were analyzed in a time window, 40-55 ms (or 45-60 ms for subjects >50 y/o) following iTN stimulation. The most consistent responses occurred at 90 and 100% of the gait cycle at higher stimulation intensities of the iTN. Significantly inhibitory responses (P = 0.006) were reported at 60 versus 80% (P = 0.03), 90% (P = 0.006), and 100% (P = 0.002) and 70 versus 90% (P = 0.02) and 100% (P = 0.009) of the gait cycle at 85M-Max. The responses became more inhibitory with increasing stimulation intensities at 80% (P = 0.01), 90% (P = 0.001), and 100% (P = 0.004) of the gait cycle. Stimulation of the MpN and SuN at all stimulation intensities demonstrated no short-latency responses. Therefore, it is unlikely that afferents within these nerves contribute to the response. This is the first study to show short-latency spinally mediated responses in the cSOL following iTN stimulation, during walking. It provides evidence for a new spinal pathway contributing to motor control and demonstrates that the response likely has functional relevance.

Even though interlimb coordination is critical in bipedal locomotion, the role of muscle afferent mediated feedback is unknown. The aim of this study was to establish if ipsilateral muscle generated afferent feedback can influence contralateral muscle activation patterns in the human lower limb and to elucidate the mechanisms involved. The effect of ipsilateral tibial nerve stimulation on contralateral soleus (cSOL) responses were quantified. Three interventions were investigated, 1) electrical stimulation applied to the tibial nerve at stimulation intensities from 0 to 100% of maximal M-wave (M-max) with the cSOL contracted from 5 to 15% of maximal voluntary contraction (MVC) and 15 to 30% MVC, 2) ispsilateral tibial nerve stimulation at 75% M-max prior to, during, and following the application of ischemia to the ipsilateral thigh. 3) Electrical stimulation applied to the ipsilateral sural (SuN) and medial plantar nerves at stimulation intensities from 1 to 3 times perceptual threshold. A short-latency depression in the cSOL electromyogram (EMG; onset: 37-41 ms) was observed following ipsilateral tibial nerve stimulation. The magnitude of this depression increased (P = 0.0005 and P = 0.000001) with increasing stimulus intensities. Ischemia delayed the time of the minimum of the cSOL depression (P = 0.04). SuN and medial plantar nerve stimulation evoked a longer latency depression [average; 91.2 ms (SuN); 142 ms (medial plantar nerve)] and therefore do not contribute to the response. This is the first study to demonstrate a short-latency depression in the cSOL following ipsilateral tibial nerve stimulation. Due to its short latency, the response is spinally mediated. The involvement of crossed spinal interneurons receiving input from low-threshold muscle afferents is discussed.