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Previous studies on handrim wheelchair-specific (an)aerobic exercise capacity in wheelchair athletes have used a diversity of participants, equipment, and protocols. Therefore, test results are difficult to compare among studies. The first aim of this scoping review is to provide an overview of the populations studied, the equipment and protocols used, and the reported outcomes from all laboratory-based studies on wheelchair-specific exercise capacity in wheelchair athletes. The second aim is to synthesize these findings into a standardized, yet individualized protocol. A scoping literature search resulted in 10 anaerobic and 38 aerobic protocols. A large variety in equipment, protocol design, and reported outcomes was found. Studies that systematically investigated the influence of protocol features are lacking, which makes it difficult to interpret and compare test outcomes among the heterogeneous group of wheelchair athletes. Protocol design was often dependent on a priori participant knowledge. However, specific guidelines for individualization were missing. However, the common protocol features of the different studies were united into guidelines that could be followed when performing standardized and individualized wheelchair-specific exercise capacity tests in wheelchair athletes. Together with guidelines regarding reporting of participant characteristics, used equipment, and outcome measures, we hope to work toward more international agreement in future testing.

(1) To estimate the proportion of Dutch wheelchair users with spinal cord injury (SCI) who meet different SCI exercise guidelines; (2) to evaluate which demographic and lesion characteristics are associated with meeting these guidelines; (3) whether meeting these guidelines is associated with physical fitness and health. Based on the PASIPD questionnaire items, participants were allocated to meeting two SCI aerobic exercise guidelines, which differ in exercise load. Differences in personal, lesion, fitness, and health characteristics between groups were tested with a one-way ANOVA. Multiple regression analyses were performed to evaluate if meeting guidelines was associated with better fitness and health. Statistical significance was accepted at p < 0.05. Of the 358 included participants, 63.1% met at least one aerobic exercise guideline. Being female, older age, having tetraplegia, and lower educational level were associated with a lower likelihood to meet the aerobic exercise guidelines. Meeting aerobic exercise guidelines showed a positive association with all respiratory and exercise capacity parameters. Limited associations were found between meeting exercise guidelines and health. Meeting exercise guidelines was associated with better respiratory functions and exercise capacity with additional fitness and some body composition benefits in higher exercise activity levels.IMPLICATIONS FOR REHABILITATIONMeeting SCI exercise guidelines are associated with better respiratory functions and exercise capacity with additional fitness and body composition benefits when higher exercising at higher activity levels, emphasizing the value and importance of regular exercise in individuals with SCI. Meeting SCI exercise guidelines are associated with better respiratory functions and exercise capacity with additional fitness and body composition benefits when higher exercising at higher activity levels, emphasizing the value and importance of regular exercise in individuals with SCI.

The first (VT1) and second ventilator (VT2) (anaerobic) thresholds are used to individually prescribe exercise training programs. The purpose of this research was to analyze inter- and intraobserver reliabilities of determining VT1 and VT2 in subjects with lower limb amputation (LLA) and able-bodied (AB) subjects during a peak exercise test on the arm-leg (Cruiser) ergometer. Previously published data of exercise tests on the Cruiser ergometer of subjects with LLA (n = 17) and AB subjects (n = 30) were analyzed twice by two observers. The VT1 and VT2 were determined based on ventilation plots. Differences in determining the VT1 and VT2 between the observers for the first and second analyses were analyzed. To quantify variation in measurement a variance component analysis was performed. Bland-Altmann plots were made, and limits of agreement were calculated. The number of observations in which thresholds could not be determined differed significantly between observers and analysis. Variation in VT1 between and within observers was small (0-1.6%) compared with the total variation, for both the subjects with an LLA and AB subjects. The reliability coefficient for VT1 was more than 0.75, and the limits of agreement were good. In conclusion, based on the results of this study on a population level, VT1 can be used to prescribe exercise training programs after an LLA. In the current study, the determination of VT2 was less reliable than VT1. More research is needed into the clinical application of VT1 and VT2 during a peak exercise test on the Cruiser ergometer.

OBJECTIVE: To evaluate the external and internal work load of trained handcyclists during a mountain time trial, to compare the results with a world class (WC) handcyclist, and to identify time trial performance determinants.DESIGN: Ten trained and one WC handcyclists performed a graded exercise test to determine power output (PO) and heart rate (HR) at the ventilatory thresholds (VT1 and VT2) and exhaustion. PO and HR were continuously measured during the race.RESULTS: Absolute POmeanrace (119 ± 21 vs. 203 W, p < 0.001) was lower in the trained handcyclists compared to the WC handcyclist. Absolute and relative HRrace (86 ± 7% vs. 88%, p = 0.40) and relative POrace (66 ± 10% vs. 62%, p = 0.24) were similar. Trained handcyclists cycled significantly less time at a PO between VT1-VT2 (48% vs. 64%, p = 0.02) and more at a PO > VT2 (34% vs. 11%, p = 0.005). POVT2 showed the strongest correlation with finish time (r = -0.78) and POpeak with POmeanrace (r = 0.90).CONCLUSION: Lab outcomes POpeak and POVT2 are important performance determinants for longer time trials in handcyclists and it is, therefore, important to improve these outcomes with training. Since the trained handcyclists cycled most of the race in intensity zones 2 and 3, it is recommended to incorporate these zones also in the training.

The effect of an upper body resistance training program on maximal and submaximal handcycling performance in able-bodied males was explored. Eighteen able-bodied men were randomly assigned to a training group (TG: n=10) and a control group (CG: n=8). TG received 7 weeks of upper body resistance training (60% of 1 repetition maximum (1RM), 3×10 repetitions, 6 exercise stations, 2 times per week). CG received no training. Peak values for oxygen uptake (V˙O2peak), power output (POpeak), heart rate (HRpeak), minute ventilation (V˙OEpeak) and respiratory exchange ratio (RERpeak), submaximal values (HR, V˙O2, RER, PO, and gross mechanical efficiency (GE)), and time to exhaustion (TTE) were determined in an incremental test pre- and post-training. Maximal isokinetic arm strength and 1RM tests were conducted. Ratings of perceived exertion (RPE) were assessed. A two-way repeated measures ANOVA and post-hoc comparisons were performed to examine the effect of time, group and its interaction (p

PURPOSE/OBJECTIVE: This study aimed to (a) explore the associations between psychosocial factors and physical activity behavior in people with physical disabilities and/or chronic diseases, both between and within persons over time; and (b) examine whether these associations differ for people initiating and people maintaining physical activity behavior.RESEARCH METHOD/DESIGN: Data of 1,256 adults with physical disabilities and/or chronic diseases enrolled in the prospective cohort study Rehabilitation, Sports, and Active lifestyle (ReSpAct) were analyzed. Self-reported physical activity and four main psychosocial factors (i.e., self-efficacy, attitude, motivation, social support) were measured with questionnaires 3-6 weeks before discharge (T0) and 14 (T1), 33 (T2), and 52 (T3) weeks after discharge from rehabilitation. Hybrid multilevel regression models (corrected for age, sex, education level, diagnosis, counseling support) were used.RESULTS: Multivariable significant between-subject associations were found for self-efficacy (std β = .094; 95% CI [0.035, 0.153]) and intrinsic motivation (std β = .114; [0.036, 0.192]). Multivariable significant within-subject associations were found for identified regulation (std β = -.038; [-0.072, -0.005]) and intrinsic motivation (std β = .049; [0.016, 0.082]). Effect modification of initiating or maintaining physical activity was found for the between-subject association of attitude ( p = .035). No significant associations were found for social support, amotivation, external regulation, and introjected regulation. CONCLUSION/IMPLICATIONS: This study is the first that explored the between- and within-subject associations between psychosocial factors and physical activity over time in a large cohort of adults with physical disabilities and/or chronic diseases. The findings indicate the importance of intrinsic motivation, identified regulation, and self-efficacy in initiating and maintaining physical activity behavior. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

BACKGROUND: The Lokomat, one of the most popular robotic exoskeletons, can take the asymmetry in the gait pattern of unilaterally affected patients into account with its opportunity to provide unequal levels of movement support (or 'guidance') to each of the legs. This asymmetrical guidance may be used to selectively unburden limbs with impaired voluntary control and/or to exploit the interlimb couplings for training purposes. However, there is a need to explore and understand these specific device opportunities more broadly before implementing them in training.AIM: The aim of this study was to explore the effects of (a)symmetrical guidance settings on lower limb muscle activity in persons with post stroke hemiparesis, during Lokomat guided gait.DESIGN: A single group, dependent factorial design.SETTING: Rehabilitation center; a single session of Lokomat guided walking. POPULATION: A group of ten persons with post stroke hemiparesis.METHODS: Participants walked in the Lokomat in eight conditions, consisting of symmetrical and asymmetrical guidance situations, at both 0.28 m/s and 0.56 m/s. During symmetrical conditions, both legs received 30% or 100% guidance, while during asymmetrical conditions one leg received 30% and the other leg 100% guidance. Surface electromyography was bilaterally measured from: Biceps Femoris, Rectus Femoris, Vastus Medialis, Medial Gastrocnemius and Tibialis Anterior. Statistical effects were assessed using Statistical Parametric Mapping.RESULTS: The provision of assymetrical guidance did not affect the level of lower limb muscle activity. In addition, no effect (except for Vastus Medialis in the affected leg during 1.5-2.4% of the gait cycle) of symmetrical guidance on muscle amplitude could be observed.CONCLUSIONS: The results show no evidence that either symmetrical or asymmetrical guidance settings provided by the Lokomat can be used to manipulate activity of lower limb musculature in persons with post stroke hemiparesis.CLINICAL REHABILITATION IMPACT: This study provides insights for the use of specific opportunities provided by the Lokomat for training purposes post stroke.

Background: Activity pacing is a behavioral strategy for coping with fatigue, optimizing physical activity (PA) levels, and achieving a paced approach to lifestyle and sustainable self-regulated exercise practice to optimize health and well-being. Yet little is known about how activity pacing affects PA and health-related quality of life (HRQOL) while controlling for fatigue and demographic characteristics over time in adults with multiple sclerosis (MS). This study examined the natural use of activity pacing and how it is associated with PA and HRQOL over time in adults with MS. Methods: Sixty-eight adults with MS (mean ± SD age, 45.2 ± 10.9 years) completed questionnaires on their activity pacing, fatigue, PA, and HRQOL 14, 33, and 52 weeks after rehabilitation. Associations between the variables were examined using multilevel models. Results: No associations were found between activity pacing and PA (β = −0.01, P = .89) or between activity pacing and HRQOL (β = −0.15, P = .09). Conclusions: This study provides an initial understanding of how activity pacing relates to PA and HRQOL in people with MS over time and indicates that there is no clear strategy among adults with MS that is successful in improving PA and HRQOL in the short or long term. Persons with MS may benefit from goal-directed activity pacing interventions to improve longitudinal engagement in PA, and the present study provides a foundation for further intervention development.

Purposes\ud To identify fatigue trajectories during/after stroke rehabilitation, to determine characteristics associated with trajectory membership before discharge and to investigate how these trajectories and activity pacing are associated with sustained physical activity after rehabilitation.\ud \ud Methods\ud People after stroke (n = 206) were followed from 3–6 weeks before discharge (T0) to 14 (T1), 33 (T2) and 52 (T3) weeks after discharge from rehabilitation in the ReSpAct study. Latent Class analysis was used to identify trajectories of perceived fatigue. Binomial multivariable logistic regression analyses were performed to determine characteristics associated with trajectory membership (T0). Multilevel regression analyses were used to investigate how perceived fatigue and activity pacing were associated with self-reported physical activity (T0–T3).\ud \ud Results\ud Three fatigue trajectories were identified: high (n = 163), low (n = 41) and recovery (n = 2). Compared with the high fatigue trajectory, people in the low fatigue trajectory were more likely to report higher levels of health-related quality of life (HR-QoL) (OR = 3.07, 95%CI = 1.51–6.26) and physical activity (OR = 1.93, 95%CI = 1.07–3.47). Sustained high levels of physical activity after rehabilitation were significantly associated with low perceived fatigue and high perceived risk of overactivity.\ud \ud Conclusions\ud Three fatigue trajectories after stroke rehabilitation were identified. High levels of HR-QoL and physical activity before discharge identified people in the low fatigue trajectory. A physically active lifestyle after rehabilitation was associated with low perceived fatigue and perceived risk of overactivity.\ud \ud IMPLICATIONS FOR REHABILITATION\ud Since almost 80% of people after stroke in this study perceived severe fatigue up to 1 year after stroke rehabilitation, activities focusing on the management of fatigue symptoms should be integrated in general stroke rehabilitation.\ud \ud In clinical practice, low levels of health-related quality of life and low levels of self-reported physical activity before discharge from stroke rehabilitation should be considered by rehabilitation professionals (e.g., physicians, physiotherapists, and physical activity counsellors) since these characteristics can predict chronic perceived fatigue up to 1 year after stroke rehabilitation.\ud \ud A physical activity counselling programme delivered during and after stroke rehabilitation may be improved by incorporating tailored advice regarding the management of fatigue.

Four-dimensional flow magnetic resonance imaging (i.e., 4D flow MRI) has become a valuable tool for the in vivo assessment of blood flow within large vessels and cardiac chambers. As wall shear stress (WSS) has been correlated with the development and progression of cardiovascular disease, focus has been directed at developing techniques to quantify WSS directly from 4D flow MRI data. The goal of this study was to compare the accuracy of two such techniques - termed the velocity and flow-based methods - in the setting of simplified and complex flow scenarios. Synthetic MR data were created from exact solutions to the Navier-Stokes equations for the steady and pulsatile flow of an incompressible, Newtonian fluid through a rigid cylinder. In addition, synthetic MR data were created from the predicted velocity fields derived from a fluid-structure interaction (FSI) model of pulsatile flow through a thick-walled, multi-layered model of the carotid bifurcation. Compared to the analytical solutions for steady and pulsatile flow, the flow-based method demonstrated greater accuracy than the velocity-based method in calculating WSS across all changes in fluid velocity/flow rate, tube radius, and image signal-to-noise (p 0.001). Furthermore, the velocity-based method was more sensitive to boundary segmentation than the flow-based method. When compared to results from the FSI model, the flow-based method demonstrated greater accuracy than the velocity-based method with average differences in time-averaged WSS of 0.31 ± 1.03 Pa and 0.45 ± 1.03 Pa, respectively (p 0.005). These results have implications on the utility, accuracy, and clinical translational of methods to determine WSS from 4D flow MRI.

Aim\ud In this narrative review the potential and importance of handcycling are evaluated. Four conceptual models form the framework for this review; (1) the International Classification of Functioning, Disability and Health; (2) the Stress-Strain-Capacity model; (3) the Human-Activity-Assistive Technology model; and (4) the power balance model for cyclic exercise.\ud \ud Methods\ud Based on international handcycle experience in (scientific) research and practice, evidence-based benefits of handcycling and optimization of handcycle settings are presented and discussed for rehabilitation, daily life and recreational sports.\ud \ud Results\ud As the load can be distributed over the full 360° cycle in handcycling, peak stresses in the shoulder joint and upper body muscles reduce. Moreover, by handcycling regularly, the physical capacity can be improved. The potential of handcycling as an exercise mode for a healthy lifestyle should be recognized and advocated much more widely in rehabilitation and adapted sports practice.\ud \ud The interface between handcycle and its user should be optimized by choosing a suitable person-specific handcycle, but mainly by optimizing the handcycle dimensions to one’s needs and desires. These dimensions can influence efficient handcycle use and potentially improve both endurance and speed of handcycling.\ud \ud Conclusion\ud To optimize performance in rehabilitation, daily life and recreational sports, continued and more systematic research is required.\ud \ud Implications for rehabilitation\ud Handcycling allows users to travel farther distances at higher speeds and to train outdoors. It should be recognized as an alternative exercise modality for daily outdoor use, also already in early rehabilitation, while it contributes to a healthy lifestyle.\ud \ud To individualize handcycle performance, the user-handcycle (assistive device) interface as well as the vehicle mechanics should be optimized to minimize external power and reduce friction, so that the upper body capacity can be efficiently used.\ud \ud To optimize handcycling individual performance, both the physiological and biomechanical aspects of handcycling should be considered when monitoring or testing handcycle exercise.

Objective: To investigate (1) changes in life satisfaction and mental health during 5 months of training for the HandbikeBattle and 4 months of follow-up; (2) associations between changes in handcycling cardiorespiratory fitness and changes in life satisfaction and mental health during the training period. Design: This is a multicenter prospective cohort study with the following measurements: the start of the training (T1), after the 5-month training period, before the event (T2), and after 4 months of follow-up (T3). At T1, T2, and T3, questionnaires were filled out. At T1 and T2, a graded exercise test was performed to measure cardiorespiratory fitness (peak oxygen consumption [VO2peak] and peak power output [POpeak]). Setting: Ten Dutch rehabilitation centers training for the HandbikeBattle event. Participants: Patients with a rehabilitation history (N=136) and health conditions such as spinal cord injury, amputation, or multiple trauma history. Interventions: Not applicable. Main Outcome Measure: Life satisfaction as the sum score of 2 questions (range, 2-13) and the Mental Health subscale of the 36-item Short Form Health Survey (range, 0-100). Results: Multilevel regression analyses showed that life satisfaction increased during the training period and did not significantly change during follow-up (mean ± SD, T1: 8.2±2.2; T2: 8.6±2.3; T3: 8.5±2.4). Mental health showed no change over time (T1: 77.7±14.5; T2: 77.8±14.5; T3: 75.7±16.5). An improvement in cardiorespiratory fitness was associated with an increase in life satisfaction (POpeak, ß=0.014, P=.046; VO2peak, ß=1.068, P=.04). There were no associations between improvement in cardiorespiratory fitness and an increase in mental health (POpeak, P=.66; VO2peak, P=.33). Conclusions: This study shows a positive course of life satisfaction during training for the HandbikeBattle. An improvement in cardiorespiratory fitness was longitudinally associated with an increase in life satisfaction. Mental health showed no changes over time.

Purpose: To develop and validate predictive models for peak power output to provide guidelines for individualized handcycling graded exercise test protocols for people with spinal cord injury (SCI); and to define reference values. Materials and methods: Power output was measured in 128 handcyclists with SCI during a synchronous handcycling exercise test. Eighty percent of the data was used to develop four linear regression models: two theoretical and two statistical models with peak power output (in W and W/kg) as dependent variable. The other 20% of the data was used to determine agreement between predicted versus measured power output. Reference values were based on percentiles for the whole group. Results: Lesion level, handcycling training hours and sex or body mass index were significant determinants of peak power output. Theoretical models (R2 = 42%) were superior to statistical models (R2=39% for power output in W, R2 = 30% for power output in W/kg). The intraclass correlation coefficients varied between 0.35 and 0.60, depending on the model. Absolute agreement was low. Conclusions: Both models and reference values provide insight in physical capacity of people with SCI in handcycling. However, due to the large part of unexplained variance and low absolute agreement, they should be used with caution. Implications for rehabilitation Individualization of the graded exercise test protocol is very important to attain the true peak physical capacity in individuals with spinal cord injury. The main determinants to predict peak power output during a handcycling graded exercise test for individuals with a spinal cord injury are lesion level, handcycling training hours and sex or body mass index. The predictive models for peak power output should be used with caution and should not replace a graded exercise test.

Background Hand-rim wheelchair propulsion is straining and mechanically inefficient, often leading to upper limb complaints. Previous push–pull lever propulsion mechanisms have shown to perform better or equal in efficiency and physiological strain. Propulsion biomechanics have not been evaluated thus far. A novel push–pull central-lever propulsion mechanism is compared to conventional hand-rim wheelchair propulsion, using both physiological and biomechanical outcomes under low-intensity steady-state conditions on a motor driven treadmill. Methods In this 5 day (distributed over a maximum of 21 days) between-group experiment, 30 able-bodied novices performed 60 min (5 × 3 × 4 min) of practice in either the push–pull central lever wheelchair (n = 15) or the hand-rim wheelchair (n = 15). At the first and final sessions cardiopulmonary strain, propulsion kinematics and force production were determined in both instrumented propulsion mechanisms. Repeated measures ANOVA evaluated between (propulsion mechanism type), within (over practice) and interaction effects. Results Over practice, both groups significantly improved on all outcome measures. After practice the peak forces during the push and pull phase of lever propulsion were considerably lower compared to those in the handrim push phase (42 ± 10 & 46 ± 10 vs 63 ± 21N). Concomitantly, energy expenditure was found to be lower as well (263 ± 45 vs 298 ± 59W), on the other hand gross mechanical efficiency (6.4 ± 1.5 vs 5.9 ± 1.3%), heart-rate (97 ± 10 vs 98 ± 10 bpm) and perceived exertion (9 ± 2 vs 10 ± 1) were not significantly different between modes. Conclusion The current study shows the potential benefits of the newly designed push–pull central-lever propulsion mechanism over regular hand rim wheelchair propulsion. The much lower forces and energy expenditure might help to reduce the strain on the upper extremities and thus prevent the development of overuse injury. This proof of concept in a controlled laboratory experiment warrants continued experimental research in wheelchair-users during daily life.

PURPOSE: To identify factors affecting the implementation of lifestyle interventions (LIs) in patients with hip and/or knee osteoarthritis (OA) from the perspective of primary and secondary healthcare professionals (HCPs) in the Dutch healthcare system.METHODS: Multidisciplinary focus groups were composed. Data analysis was performed following thematic analysis. The Tailored Implementation for Chronic Diseases checklist was used to guide data analysis.RESULTS: Four focus groups meetings were conducted with 38 participating HCPs (general practitioners (or in-training), orthopedic surgeons (or in-training), physiotherapists, dieticians, a general practice assistant, lifestyle counselors, and nurse practitioners). Influencing factors were grouped into nine themes: (1) intervention factors; (2) individual HCP factors; (3) patient factors; (4) professional interactions; (5) incentives and resources; (6) capacity for organizational change; (7) social, political and legal factors; (8) patient and HCP interactions; and (9) disease factors.CONCLUSIONS: A wide variety of factors affecting the implementation of LIs was identified in this study, where the importance of effective interdisciplinary collaboration was emphasized by the multidisciplinary group of participants. This thorough analysis of influencing factors is an important first step toward improved implementation of LIs within OA care. Further research is required to identify the most significant targets for change in daily practice.Implications for RehabilitationThe implementation of lifestyle interventions (LIs) by healthcare professionals (HCPs) in patients with hip and/or knee osteoarthritis (OA) is affected by both individual and environmental factors.The influencing factors identified in this study can support the development of interventions aimed at improving the implementation of LIs in OA care.A multilevel approach is required when developing interventions to improve the implementation of LIs in OA care.Continued efforts of both primary and secondary HCPs and policymakers are needed in order to promote the use of LIs within OA care.

Background Although knee extensors are essential in daily activities (e.g. walking, climbing stairs), knee extensor strength is often not measured in clinical settings. Existing devices to test muscle strength are not always suitable to accurately measure the high forces of this muscle group. Therefore, a device to test muscle strength that is convenient, feasible, reliable, and valid in clinical settings is required. This study evaluated the reliability, responsiveness, and level of discomfort of the newly developed Q-Force ӀӀ (i.e. a portable device to measure isometric knee extensor strength) in healthy middle-aged and elderly adults. Methods Participants (n = 22) conducted two standardized test sessions on the Q-Force ӀӀ (five to ten days apart). Each session consisted of one familiarisation trial followed by three trials of peak isometric knee extension per each leg. Per trial, peak and mean knee extension force (N) and torque (Nm) were measured at 90° flexion. The level of discomfort was determined using a visual analog scale (VAS: 0-100). Intra Class Correlation (ICC, model: two-way mixed with absolute agreement), Standard Error of Measurement (SEM), and minimal detectable change (MDC) were determined. A repeated measures ANOVA was used to determine between-test variation. Results Excellent test-retest (ICC > 0.95) and inter-trial (ICC > 0.91) reliability for both legs were shown. No significant differences were found in peak and mean knee forces and torques between test and retest of both legs, indicating good test-retest reliability (P-value range: 0.360-0.538; F(1,21) range: 0.4-0.9). The SEM of the peak and mean forces and torques ranged from 28.0 to 30.4 N (6.0-6.8%) and from 9.2 to 10.4 Nm (6.4-7.7%), respectively. The MDC for these outcomes ranged respectively from 77.6 to 84.1 N (16.5-18.8%) and from 25.5 to 28.9 Nm (17.6-21.4%). The level of discomfort was low (median range: 7-10, IQR: 4-18). Conclusion The portable Q-Force ӀӀ is a comfortable, responsive, and relatively cheap device with excellent test-retest reliability. This device would be potentially suitable to measure isometric knee extensor strength in clinical settings.

Supplemental digital content is available in the text., Objective The aims of this study were (1) to compare physical capacity at 1-yr follow-up with physical capacity before and after the training period for the HandbikeBattle event and (2) to identify determinants of the course of physical capacity during follow-up. Design This was a prospective observational study. Former rehabilitation patients (N = 33) with health conditions such as spinal cord injury or amputation were included. A handcycling/arm crank graded exercise test was performed before (January, T1) and after the training period (June, T2) and at 1-yr follow-up (June, T4). Outcomes were peak power output (W) and peak oxygen uptake (L/min). Determinants were sex (male/female); age (years); classification; physical capacity, musculoskeletal pain, exercise stage of change, and exercise self-efficacy at T1; and HandbikeBattle participation at T4. Results Multilevel regression analyses showed that peak power output and peak oxygen uptake increased during the training period and did not significantly change during follow-up (T1: 112 ± 37 W, 1.70 ± 0.48 L/min; T2: 130 ± 40 W, 2.07 ± 0.59 L/min; T4: 126 ± 42 W, 2.00 ± 0.57 L/min). Participants who competed again in the HandbikeBattle showed slight improvement in physical capacity during follow-up, whereas participants who did not compete again showed a decrease. Conclusion Physical capacity showed an increase during the training period and remained stable after 1-yr follow-up. Being (repeatedly) committed to a challenge might facilitate long-term exercise maintenance.

This study evaluated the effect of a low-intensity norm duration synchronous handcycle wheelchair training in untrained able-bodied women. The training group (n = 9) received 7-weeks of low-intensity upper body training in an instrumented handcycle on a motor-driven treadmill (MDT), 3 × 30 min/week at 30% heart rate reserve. The control group (n = 10) received no training. Incremental handcycle tests on the MDT were used to determine peak values for oxygen uptake (VO2peak), power output (POpeak), heart rate (HRpeak), minute ventilation (VEpeak), and respiratory exchange ratio (RERpeak), submaximal values for heart rate (HR), oxygen uptake (VO2) and gross efficiency (GE) before and after training. Local perceived discomfort and rate of perceived exertion (RPE) were also assessed. Training significantly improved POpeak (+20%), HRpeak (+3%), RERpeak (+5%), submaximal GE (+21%), VO2 (-20%), VE (-33%), HR (-12%) and RPE was low (7.1 ± 0.5) (p < 0.05). No effects were found in VO2peak and VEpeak (p > 0.05). Though VO2peak did not improve, low-intensity norm duration handcycling training improved handcycling POpeak, while RPE was low. Also, GE increased, suggesting a motor control improvement. Handcycle training seems to be an appropriate exercise mode to improve physical capacity, and prevent early fatigue and overuse in untrained individuals.

Purpose: To investigate changes in wheelchair propulsion technique and mechanical efficiency across first five weeks of active inpatient spinal cord injury rehabilitation and to compare the outcomes at discharge with experienced wheelchair users with spinal cord injury. Methods: Eight individuals with recent spinal cord injury performed six weekly submaximal exercise tests. The first and last measurement additionally contained a wheelchair circuit and peak graded exercise test. Fifteen experienced individuals performed all above-mentioned tests on one occasion. Results: Mechanical efficiency and propulsion technique did not change during the five weeks of inpatient rehabilitation. Peak power output during peak graded test and performance time on the wheelchair circuit improved between the first and the last week. No difference in propulsion technique, peak power output, and performance time was found between the persons with a recent injury and the experienced group. Mechanical efficiency was higher after the correction for the difference in relative power output in the experienced group. Conclusion: The group with a recent injury did not improve mechanical efficiency and propulsion technique over the period of active rehabilitation, despite significant improvements on the wheelchair circuit and in work capacity. The only significant difference between the groups was found in mechanical efficiency. Implications for rehabilitation The lack of time-dependent changes in mechanical efficiency and propulsion technique in the group with a recent spinal cord injury, combined with the lack of differences in technique, work capacity and on the wheelchair circuit between the groups, suggest that important adaptations of motor learning may happen even earlier in rehabilitation and emphasize that the group in active rehabilitation was relatively skilled. Standardized observational analyses of handrim wheelchair propulsion abilities during early spinal cord injury rehabilitation provide detailed understanding of wheelchair technique, skill as well as wheelchair propulsion capacity. Measurement of external power output is critical to interpretation of gross efficiency, propulsion technique, and capacity. Wheelchair quality and body weight - next to wheelchair fitness and skill - require careful consideration both in early rehabilitation as well as in the chronic phase of spinal cord injury.

Treadmills used for gait training in clinical rehabilitation and experimental settings are commonly fitted with handrails to assist or support persons in locomotor tasks. However, the effects of balance support through handrail holding on locomotor learning are unknown. Locomotor learning can be studied on split-belt treadmills, where participants walk on two parallel belts with asymmetric left and right belt speeds, to which they adapt their stepping pattern within a few minutes. The aim of this study was to determine how handrail holding affects the walking pattern during split-belt adaptation and after-effects in able-bodied persons. Fifty healthy young participants in five experimental groups were instructed to hold handrails, swing arms freely throughout the experiment or hold handrails during adaptation and swing arms freely during after-effects. Step length asymmetry and double support asymmetry were measured to assess the spatiotemporal walking pattern. The results showed that holding handrails during split-belt adaptation reduces magnitude of initial perturbation of step length asymmetry and reduces after-effects in step length asymmetry upon return to symmetric belt speeds. The findings of this study imply that balance support during gait training reduces locomotor learning, which should be considered in daily clinical gait practice and future research on locomotor learning.

Study design Cross-sectional.Objectives Individualized training regimes are often based on ventilatory thresholds (VTs). The objectives were to study: (1) whether VTs during arm ergometry could be determined in individuals with spinal cord injury (SCI), (2) the intrarater and interrater reliability of VT determination.Setting University research laboratory.Methods Thirty graded arm crank ergometry exercise tests with 1-min increments of recreationally active individuals (tetraplegia (N = 11), paraplegia (N = 19)) were assessed. Two sports physicians assessed all tests blinded, randomly, in two sessions, for VT1 and VT2, resulting in 240 possible VTs. Power output (PO), heart rate (HR), and oxygen uptake (VO2) at each VT were compared between sessions or raters using paired samples t-tests, Wilcoxon signed-rank tests, intraclass correlation coefficients (ICC, relative agreement), and Bland-Altman plots (random error, absolute agreement).Results Of the 240 VTs, 217 (90%) could be determined. Of the 23 undetermined VTs, 2 (9%) were VT1 and 21 (91%) were VT2; 7 (30%) among individuals with paraplegia, and 16 (70%) among individuals with tetraplegia. For the successfully determined VTs, there were no systematic differences between sessions or raters. Intrarater and interrater ICCs for PO, HR, and VO2 at each VT were high to very high (0.82-1.00). Random error was small to large within raters, and large between raters.Conclusions For VTs that could be determined, relative agreement was high to very high, absolute agreement varied. For some individuals, often with tetraplegia, VT determination was not possible, thus other methods should be considered to prescribe exercise intensity.

Background: Sufficient cardiorespiratory fitness has been regarded a prerequisite for prosthetic walking. In order to improve cardiorespiratory fitness, adequate strain ought to be placed on the system during training. Objectives: To determine cardiorespiratory fitness at the start and end of inpatient rehabilitation after lower limb amputation and determine the physical strain experienced during conventional prosthetic rehabilitation. Study design: Multicenter prospective cohort study. Methods: Cardiorespiratory fitness was assessed using a peak one-legged cycle exercise test. Physical strain was assessed during a minimum of three full rehabilitation days using heart rate recordings. Physical strain was expressed in the time per day that heart rate exceeded 40% of heart rate reserve. Results: At the start of rehabilitation, peak aerobic capacity was on average 16.9 (SD, 6.5) mL/kg/min (n = 33). Overall, peak aerobic capacity did not improve over the course of rehabilitation (n = 23, p = 0.464). Fifty percent of the patients experienced a physical strain level that satisfies minimum criteria for maintaining cardiorespiratory fitness (>40% heart rate reserve for 30 min/day). Conclusion: Cardiorespiratory fitness was low and did not increase during conventional prosthetic rehabilitation. On average, the physical strain during rehabilitation was insufficient to elicit potential improvements in aerobic capacity. Results stress the need for dedicated physical training modules at the individual level. Clinical relevance: This study shows that clinicians ought to be aware of the relatively low cardiorespiratory fitness of people who have undergone lower limb amputation and that improvements during rehabilitation are not always obtained. Results stress the need for physical training modules in which intensity is imposed at the individual level.

Purpose: To (1) investigate the association between sprint power and aerobic power output (POpeakGXT) during a graded peak exercise test (GXT); and (2) validate the prediction models of POpeakGXT based on sprint power and personal and lesion characteristics. Materials and methods: Wheelchair users with tetraplegia (N = 35) and paraplegia (N = 58) performed a 30 s-Wingate test and GXT on an asynchronous arm-crank ergometer. Data were split into samples to develop and validate the model. Sprint power (POmeanWingate and POpeakWingate, respectively) and POpeakGXT were determined. Regression analyses were performed to develop POpeakGXT prediction models. Candidate independent variables included POmeanWingate or POpeakWingate, age (years), sex, body mass (kg) or BMI (kg/m2), time since injury (TSI, years) and lesion level (tetraplegia/paraplegia). The best model was validated by comparing the predicted POpeakGXT with measured POpeakGXT. Results: The best model (R2 = 0.76) to predict POpeakGXT included POmeanWingate, BMI and all other independent variables. No significant difference was found between measured (68 ± 35 W) and predicted POpeakGXT (68 ± 30 W, p = 0.97). The ICC was excellent (0.89 with 95% confidence intervals: 0.75-0.95). The 95% limits of agreement for the Bland-Altman plots were wide (-30 to 31 W). Conclusions: Strong associations were found between POmeanWingate and POpeakGXT. Although relative agreement was excellent, absolute agreement was low. Implications for rehabilitation There is a strong relationship between peak aerobic power output and sprint power output, both tested on an arm-crank ergometer, in people with spinal cord injury. A prediction model for peak aerobic power output, based on sprint power output and personal and lesion characteristics, showed a high explained variance. The predictive model can give a guideline for choosing the right graded exercise test protocol but should be used with caution.

Purpose: The Lokomat is a commercially available robotic gait trainer, applied for gait rehabilitation in post-stroke hemiparetic patients. Selective and well-dosed clinical use of the Lokomat training parameters, i.e. guidance, speed and bodyweight support, requires a good understanding of how these parameters affect the neuromuscular control of post-stroke hemiparetic gait. Materials and methods: Ten stroke patients (unilateral paresis, 7 females, 64.5 ± 6.4 years, >3months post-stroke, FAC scores 2–4)) walked in the Lokomat under varying parameter settings: 50% or 100% guidance, 0.28 or 0.56m/s, 0% or 50% bodyweight support. Electromyography was recorded bilaterally from Gluteus Medius, Biceps Femoris, Vastus Lateralis, Medial Gastrocnemius, and Tibialis Anterior. Pressure sensors placed under the feet were used to determine the level of temporal gait symmetry. Results: Varying guidance and bodyweight support had little effect on muscle activity, but increasing treadmill speed led to increased activity in both the affected (Biceps Femoris, Medial Gastrocnemius, Tibialis Anterior) and unaffected leg (all muscles). The level of temporal symmetry was unaffected by the parameter settings. Conclusions: The Lokomat training parameters are generally ineffective in shaping short term muscle activity and step symmetry patients with hemiparetic stroke, as speed is the only parameter that significantly affects muscular amplitude. Trial Registration: d.n.a.IMPLICATIONS FOR REHABILITATIONThe Lokomat is a commercially available gait trainer that can be used for gait rehabilitation in post-stroke hemiparetic patients.This study shows that muscle amplitude is generally low during Lokomat guided walking, and that treadmill Speed is the main training parameter to influence muscular output in stroke patients during Lokomat walking.Varying Guidance and Bodyweight Support within a clinical relevant range barely affected muscle activity, and temporal step symmetry was unaffected by variation in any of the training parameters.Based on the findings it is advised to increase speed as early as possible during Lokomat therapy, or use other means (e.g. feedback or instructions) to stimulate active involvement of patients during training. The Lokomat is a commercially available gait trainer that can be used for gait rehabilitation in post-stroke hemiparetic patients. This study shows that muscle amplitude is generally low during Lokomat guided walking, and that treadmill Speed is the main training parameter to influence muscular output in stroke patients during Lokomat walking. Varying Guidance and Bodyweight Support within a clinical relevant range barely affected muscle activity, and temporal step symmetry was unaffected by variation in any of the training parameters. Based on the findings it is advised to increase speed as early as possible during Lokomat therapy, or use other means (e.g. feedback or instructions) to stimulate active involvement of patients during training.

PURPOSE: The current article provides a description of the construction process of a short questionnaire that measures patients' experiences with a motivational interviewing consultation by a (sports) counselor in rehabilitation. Subsequently, results from confirmatory factor analyses are presented to investigate a first perspective on factorial construct validity of the questionnaire.MATERIAL AND METHODS: Based on motivational interviewing literature, an initial item pool was created. All items were critically reviewed, resulting in the new "Evaluation of Motivational Interviewing Consultation on Active Lifestyle and Sports" questionnaire. The final items were determined by a confirmatory factor analysis based on 890 completed questionnaires.RESULTS: The initial 26-item questionnaire consisted of four inter-correlated subscales. Factor analyses underpinned the proposed factors: acceptance, evocation, partnership, and non-adherent. After removing six items, an alternative model remained and showed an acceptable model fit. The internal consistency of the subscales derived varied from 0.70 to 0.90.CONCLUSION: The shortened questionnaire provides a feasible and easy to administer tool and may provide a cost saving method of assessing motivational interviewing fidelity from a patient's perspective in disability and rehabilitation. Implications for rehabilitation Many persons with a physical disability do not obtain the recommended amount of physical activity in order to maintain health. Stimulation of a physically active lifestyle through motivational interviewing is promising. Measuring motivational interviewing treatment fidelity is time consuming and often from a counselor's perspective. We developed a short questionnaire facilitating the assessment of treatment fidelity at the side of the client. Our questionnaire provides a feasible and easy to administer tool for assessing MI fidelity in daily rehabilitation practice.

Objective To investigate the association between propulsion biomechanics, including variables that describe smoothness of the applied forces, and shoulder pain in individuals with spinal cord injury (SCI). Design Cross-sectional, observational study. Setting Non-university research institution. Participants Community dwelling, wheelchair dependent participants (N=30) with chronic paraplegia between T2 and L1, with and without shoulder pain (age, 48.6±9.3y; 83% men). Interventions Not applicable. Main Outcome Measures Rate of rise and jerk of applied forces during wheelchair propulsion. Participants were stratified in groups with low, moderate, and high pain based on their Wheelchair User Shoulder Pain Index score on the day of measurement. Results A mixed-effect multilevel analysis showed that wheelchair users in the high pain group propelled with a significantly greater rate of rise and jerk, measures that describe smoothness of the applied forces, compared with individuals with less or no pain, when controlling for all covariables. Conclusions Individuals with severe shoulder pain propelled with less smooth strokes compared to individuals with less or no pain. This supports a possible association between shoulder pain and rate of rise and jerk of the applied forces during wheelchair propulsion.

The current study determined the test-retest reliability and concurrent validity of the Adapted Short QUestionnaire to ASsess Health-enhancing physical activity (Adapted-SQUASH) in adults with disabilities. Before filling in the Adapted-SQUASH twice with a recall period of two weeks, participants wore the Actiheart activity monitor up to one week. For the test-retest reliability (N = 68), Intraclass correlation coefficients (ICCs) were 0.67 (p < 0.001) for the total activity score (min x intensity/week) and 0.76 (p< 0.001) for the total minutes of activity (min/week). For the concurrent validity (N = 58), the Spearman correlation coefficient was 0.40 (p = 0.002) between the total activity score of the first administration of the Adapted-SQUASH and activity energy expenditure from the Actiheart (kcals kg−1 min−1). The ICC was 0.22 (p = 0.027) between the total minutes of activity assessed with the first administration of the Adapted-SQUASH and Actiheart. The Adapted-SQUASH is an acceptable measure to assess self-reported physical activity in large populations of adults with disabilities, but is not applicable at the individual level due to wide limits of agreement. Self-reported physical activity assessed with the Adapted-SQUASH does not accurately represent physical activity assessed with the Actiheart in adults with disabilities, as indicated with a systematic bias between both instruments in the Bland-Altman analysis.

Contains fulltext : 229915.pdf (Publisher’s version ) (Closed access) OBJECTIVES: To explore whether traditional models of cardiovascular disease (CVD) risk prediction correctly predict CVD events across a median 5.7-year follow-up period in individuals with spinal cord injury (SCI) and whether adding SCI-related characteristics (ie, lesion level) to the prediction model can improve the prognostic value. DESIGN: Retrospective analysis of patient records. SETTING: Observation at the start of active rehabilitation of participants in a multicenter cohort study, "Restoration of (Wheelchair) Mobility in SCI Rehabilitation," in the Netherlands. PARTICIPANTS: Patients with SCI (N=200) The patients were 74% men, aged 40±14 years, and with an American Spinal Injury Association (ASIA) impairment score of A through D. Forty percent had tetraplegia, and 69% were motor complete. INTERVENTIONS: Risk profiling/not applicable. MAIN OUTCOME MEASURES: Survival status and cardiovascular morbidity and mortality qwere obtained from medical records. Five-year Framingham Risk Scores (FRS) and the FRS ability to predict events assessed using receiver operating characteristic (ROC) curves with corresponding areas under the curve (AUC) and 95% confidence intervals (CI). Kaplan-Meier curves and the log-rank test were used to assess the difference in clinical outcome between participants with an FRS score lower or higher than the median FRS score for the cohort. SCI-related factors associated with CVD events, ASIA impairment, motor completeness, level of injury, and sports participation before injury were explored using univariate and multivariate Cox proportional hazard regression. RESULTS: The median 5-year FRS was 1.36%. Across a median follow-up period of 5.7 years, 39 developed a CVD event, including 10 fatalities. Although the FRS markedly underestimated the true occurrence of CVD events, the Kaplan-Meier curves and the log-rank test showed that the risk ratio for individuals with an FRS score less than the median FRS (eg, low risk) versus a score greater than the median FRS (high risk) was 3.2 (95% CI, 1.6-6.5; P=.001). Moreover, ROC with corresponding AUCs suggests acceptable accuracy of the FRS to identify individuals with increased risk for future CVD events (ROC AUC of 0.71; 95% CI, 0.62-0.82). Adding ASIA impairment (0.74; 95% CI, 0.66-0.82), motor impairment (0.74; 95% CI, 0.66-0.83), level of injury (0.72; 95% CI, 0.63-0.81), or active engagement in sport before injury (0.72; 95% CI, 0.63-0.88) to the FRS did not improve the level of discrimination. CONCLUSIONS: Our 5.7-year retrospective study reveals that cardiovascular risk factors and risk models markedly underestimate the true risk for CVD events in individuals with SCI. Nonetheless, these markers successfully distinguish between SCI individuals at high versus low risk for future CVD events. Our data may have future clinical implications, both related to (cutoff values of) CVD risk factors, but also for (earlier) prescription of (non)pharmacologic strategies against CVD in SCI individuals. 01 januari 2021

Background Handrim wheelchair propulsion is often assessed in the laboratory on treadmills (TM) or ergometers (WE), under the assumption that they relate to regular overground (OG) propulsion. However, little is known about the agreement of data obtained from TM, WE, and OG propulsion under standardized conditions. The current study aimed to standardize velocity and power output among these three modalities to consequently compare obtained physiological and biomechanical outcome parameters. Methods Seventeen able-bodied participants performed two submaximal practice sessions before taking part in a measurement session consisting of 3 × 4 min of submaximal wheelchair propulsion in each of the different modalities. Power output and speed for TM and WE propulsion were matched with OG propulsion, making them (mechanically) as equal as possible. Physiological data and propulsion kinetics were recorded with a spirometer and a 3D measurement wheel, respectively. Results Agreement among conditions was moderate to good for most outcome variables. However, heart rate was significantly higher in OG propulsion than in the TM condition. Push time and contact angle were smaller and fraction of effective force was higher on the WE when compared to OG/TM propulsion. Participants used a larger cycle time and more negative work per cycle in the OG condition. A continuous analysis using statistical parametric mapping showed a lower torque profile in the start of the push phase for TM propulsion versus OG/WE propulsion. Total force was higher during the start of the push phase for the OG conditions when compared to TM/WE propulsion. Conclusions Physiological and biomechanical outcomes in general are similar, but possible differences between modalities exist, even after controlling for power output using conventional techniques. Further efforts towards increasing the ecological validity of lab-based equipment is advised and the possible impact of these differences -if at all- in (clinical) practice should be evaluated.

BackgroundHuman movement, rehabilitation, and allied sciences have embraced their ambitions within the cycle of “RehabMove” congresses over the past 30 years. This combination of disciplines and collaborations in the Netherlands has tried to provide answers to questions in the fields of rehabilitation and adapted sports, while simultaneously generating new questions and challenges. These research questions help us to further deepen our understanding of (impaired) human movement and functioning, with and without supportive technologies, and stress the importance of continued multidisciplinary (inter)national collaboration.MethodsThis position stand provides answers that were conceived by the authors in a creative process underlining the preparation of the 6th RehabMove Congress.ResultsThe take-home message of the RehabMove2018 Congress is a plea for continued multidisciplinary research in the fields of rehabilitation and adapted sports. This should be aimed at more individualized notions of human functioning, practice, and training, but also of performance, improved supportive technology, and appropriate “human and technology asset management” at both individual and organization levels and over the lifespan.ConclusionsWith this, we anticipate to support the development of rehabilitation sciences and technology and to stimulate the use of rehabilitation notions in general health care. We also hope to help ensure a stronger embodiment of preventive and lifestyle medicine in rehabilitation practice. Indeed, general health care and rehabilitation practice require a healthy and active lifestyle management and research agenda in the context of primary, secondary, and tertiary prevention.IMPLICATIONS FOR REHABILITATIONContinued multidisciplinary (international) collaboration will stimulate the development of rehabilitation and human movement sciences.Notions from “human and technology asset management and ergonomics” are fundamental to rehabilitation practice and research.The rehabilitation concept will further merge into general health care and the quality there-off.

Fatigue is common in people with multiple sclerosis (MS). Activity pacing is a behavioral way to cope with fatigue and limited energy resources. However, little is known about how people with MS naturally pace activities to manage their fatigue and optimize daily activities. This study explored how activity pacing relates to fatigue and physical activity in people with MS. Participants were 80 individuals (60 females, 20 males) with a diagnosis of MS. The participants filled in questionnaires on their activity pacing, fatigue, physical activity, and health-related quality of life, 3&ndash, 6 weeks before discharge from rehabilitation. The relationships between the variables were examined using hierarchical regression. After controlling for demographics, health-related quality of life, and perceived risk of overactivity, no associations were found between activity pacing and fatigue (&beta, = 0.20, t = 1.43, p = 0.16) or between activity pacing and physical activity (&beta, = &minus, 0.24, t = &minus, 1.61, p = 0.12). The lack of significant associations between activity pacing and fatigue or physical activity suggests that without interventions, there appears to be no clear strategy amongst people with MS to manage fatigue and improve physical activity. People with MS may benefit from interventions to manage fatigue and optimize engagement in physical activity.

Background Originally, the cranks of a handcycle were mounted with a 180° phase shift (asynchronous). However, as handcycling became more popular, the crank mode switched to a parallel mounting (synchronous) over the years. Differences between both modes have been investigated, however, not into great detail for propulsion technique or practice effects. Our aim is to compare both crank modes from a biomechanical and physiological perspective, hence considering force and power production as a cause of physiological outcome measures. This is done within a practice protocol, as it is expected that motor learning takes place in the early stages of handcycling in novices. Methods Twelve able-bodied male novices volunteered to take part. The experiment consisted of a pre-test, three practice sessions and a post-test, which was subsequently repeated for both crank modes in a counterbalanced manner. In each session the participants handcycled for 3 × 4 minutes on a leveled motorized treadmill at 1.94 m/s. Inbetween sessions were 2 days of rest. 3D forces, handlebar and crank angle were measured on the left hand side. Kinematic markers were placed on the handcycle to monitor the movement on the treadmill. Lastly, breath-by-breath spirometry combined with heart-rate were continuously measured. The effects of crank mode and practice-based learning were analyzed using a two way repeated measures ANOVA, with synchronous vs asynchronous and pre-test vs post-test as within-subject factors. Results In the pre-test, asynchronous handcycling was less efficient than synchronous handcycling in terms of physiological strain, force production and timing. At the post-test, the metabolic costs were comparable for both modes. The force production was, also after practice, more efficient in the synchronous mode. External power production, crank rotation velocity and the distance travelled back and forwards on the treadmill suggest that asynchronous handcycling is more constant throughout the cycle. Conclusions As the metabolic costs were reduced in the asynchronous mode, we would advise to include a practice period, when comparing both modes in scientific experiments. For handcycle users, we would currently advise a synchronous set-up for daily use, as the force production is more effective in the synchronous mode, even after practice.

The use of a manual wheelchair is critical to 1% of the world's population. Human powered wheeled mobility research has considerably matured, which has led to improved research techniques becoming available over the last decades. To increase the understanding of wheeled mobility performance, monitoring, training, skill acquisition, and optimization of the wheelchair-user interface in rehabilitation, daily life, and sports, further standardization of measurement set-ups and analyses is required. A crucial stepping-stone is the accurate measurement and standardization of external power output (measured in Watts), which is pivotal for the interpretation and comparison of experiments aiming to improve rehabilitation practice, activities of daily living, and adaptive sports. The different methodologies and advantages of accurate power output determination during overground, treadmill, and ergometer-based testing are presented and discussed in detail. Overground propulsion provides the most externally valid mode for testing, but standardization can be troublesome. Treadmill propulsion is mechanically similar to overground propulsion, but turning and accelerating is not possible. An ergometer is the most constrained and standardization is relatively easy. The goal is to stimulate good practice and standardization to facilitate the further development of theory and its application among research facilities and applied clinical and sports sciences around the world.

BACKGROUND: Regular handrim wheelchair (RHW) propulsion is straining for the upper extremities and wheelchair users often experience overuse problems. A recent advancement in wheelchair technology that could assist users is the pushrim-activated power-assisted wheelchair (PAPAW). PAPAWs are challenging to control, yet it is unclear how people learn to use a PAPAW. The purpose of this study is to examine early skill acquisition through practice in PAPAWs and compare it with RHWs.METHODS: Twenty-four able-bodied novices were randomly allocated to either the RHW group or the PAPAW group. The experiment consisted of five sessions with three blocks of 4 min steady-state practice at 1.11 m/s and 0.21 W/kg. Finally, a transfer to the other mode was made. Data were collected with a drag-test, breath-by-breath spirometry, and a motion capture system. The last minute of each four-minute block was used for analysis. A mixed analysis of variance (ANOVA) was used to test for group, time, and interaction effects.RESULTS: Both groups improved their (assisted) mechanical efficiency, reduced their stroke rate, right-left and forward-backward deviation on the treadmill, and had a lower rate of perceived exertion (RPE) over time. (Assisted) mechanical efficiency was higher for the PAPAW group than for the RHW group and RPE was lower. However, left-right and forward-backward deviation was also found to be higher in the PAPAW group.CONCLUSIONS: At the group level the energetic cost of RHW and PAPAW propulsion can be lowered through low-intensity practice in novice users. The PAPAW is more 'efficient' than the RHW given the reduced energy requirement of the user from the motor assist, but more difficult to control. Future studies on PAPAWs should focus on the control needs of the user and their interaction with the power-assist technology.

Purpose: This study described how the Dutch and Canadian governments promote high performance sports, recreational sports, and physical activity (PA) among adults with disabilities on a national level. Methods: An internet-based study was conducted to identify and select relevant documents and websites containing information about the national approach to promote disability sports and physical activities in the Netherlands and Canada. Results: Both governments promote high performance sports in similar ways, but use different strategies to promote recreational sports and physical activities. The Dutch approach is characterized by using time-limited programs focusing on enhancement of sports infrastructure and inter-sector collaboration in which municipalities have key roles. The Canadian government promotes recreational sports in disabled populations by supporting programs via bilateral agreements with provinces and territories. Furthermore, the level of integration of disability sports into mainstream sports differs between countries. Conclusions: The findings of this study may inspire policy makers from different countries to learn from one another’s policies in order to optimize national approaches to promote disability sports and PA on all levels.Implications for rehabilitationIt is recommended for policy makers of national governments to develop and implement policy programs that promote sports and physical activities among people with disabilities because of its potential impact on functioning, participation, quality of life, and health.Insight into national approaches to promote sport and physical activities is relevant for rehabilitation practice to understand ongoing opportunities for people with disabilities to stay physically active after rehabilitation through participation in home and/or community-based sport and physical activities.It seems worthwhile to integrate activities to promote sport and physical activities in rehabilitation in such a way that it fits with the current governmental approach.It is recommended to set up international collaborations to develop and share knowledge about effective and sustainable national approaches to promote sports and physical activities among people with disabilities. It is recommended for policy makers of national governments to develop and implement policy programs that promote sports and physical activities among people with disabilities because of its potential impact on functioning, participation, quality of life, and health. Insight into national approaches to promote sport and physical activities is relevant for rehabilitation practice to understand ongoing opportunities for people with disabilities to stay physically active after rehabilitation through participation in home and/or community-based sport and physical activities. It seems worthwhile to integrate activities to promote sport and physical activities in rehabilitation in such a way that it fits with the current governmental approach. It is recommended to set up international collaborations to develop and share knowledge about effective and sustainable national approaches to promote sports and physical activities among people with disabilities.

In this study we measured the performance times on the Wheelchair Mobility Performance (WMP) test during different test conditions to see if the performance times changed when wheelchair settings were changed. The overall performance time on the WMP test increased when the tire pressure was reduced and also when extra mass was attached to the wheelchair. It can be concluded that the WMP test is sensitive to changes in wheelchair settings. It is recommended to use this field-based test in further research to investigate the effect of wheelchair settings on mobility performance time. Objective: The Wheelchair Mobility Performance (WMP) test is a reliable and valid measure to assess mobility performance in wheelchair basketball. The aim of this study was to examine the sensitivity to change of the WMP test by manipulating wheelchair configurations. Methods: Sixteen wheelchair basketball players performed the WMP test 3 times in their own wheelchair: (i) without adjustments (“control condition”); (ii) with 10 kg additional mass (“weighted condition”); and (iii) with 50% reduced tyre pressure (“tyre condition”). The outcome measure was time (s). If paired t-tests were significant (p

Contains fulltext : 244855.pdf (Publisher’s version ) (Closed access) 01 november 2021

To a certain extent, all people experience boundaries that limit the way we move through life. Figuratively, but also literally, like how we go about moving from one place to another, exercise to m...

This study aims to research whether there is a difference in cardiorespiratory variables and gross mechanical efficiency (GE) in healthy individuals during low-intensity one-legged and two-legged exercise on the combined arm-leg (Cruiser) ergometer and whether motor learning occurs. The outcome of this study will support the use of the Cruiser ergometer in future as a testing and training instrument in the rehabilitation of patients with a lower limb amputation. Twenty-eight healthy men participated in this randomized-controlled trial. One group (n=14) used one leg and both arms during the exercise and the other group (n=14) used both legs and both arms. All participants performed a 1-day low-intensity exercise protocol. This included a standardized pretest and post-test of three bouts of 4min exercise at 40W and an exercise intervention of seven bouts of 2x4min exercise at 40W. The one-legged and two-legged group differed significantly in the heart rate and GE between the pretest and post-test. At the post-test, the one-legged group showed motor learning. GE improved significantly in both groups over the duration of the three exercise bouts of the pretest, but it did not improve during the post-test. There are differences in cardiorespiratory variables and GE between one-legged and two-legged exercise on the Cruiser ergometer. When using this ergometer in the rehabilitation of patients with a lower limb amputation, it is important to consider these differences and the occurrence of motor learning.

A distal femoral extension osteotomy with patellar tendon advancement (DFEO+PTA) is a common treatment for individuals with cerebral palsy (CP) who walk in crouch. Musculoskeletal modeling suggests that the typical patella baja position post-DFEO+PTA may limit one's abilities to perform sit-to-stand (STS) tasks; however, STS function has not been assessed. Our purpose was to compare how well individuals who received a DFEO+PTA can perform a 5-times STS test (FTSST) eight or more years after surgery compared to their peers who did not receive a DFEO+PTA (non-DFEO+PTA group). Twenty-one participants completed the task (12 DFEO+PTA, 9 non-DFEO+PTA). Three-dimensional kinematics and kinetics were captured. Kinetics were non-dimensionalized to facilitate group comparisons. Non-DFEO+PTA participants performed the FTSST moderately faster than the DFEO+PTA group (median(IQR), 14.6(9.3) seconds vs. 20.3(10.1) seconds, non-parametric effect size ɣ=0.97, p=0.241). Peak negative knee power was larger for the non-DFEO+PTA group (Mean±SD, -0.063±0.025 vs. -0.048± 0.020, Cohen's d=0.66, p=0.165). A similar but weaker trend was observed for negative hip power (median(IQR) -0.120(0.066) vs. -0.105(0.044), ɣ=0.43, p=0.671). Both groups used their hips approximately twice as much as their knees to perform the task. The functional deficit among DFEO+PTA participants may be due to patella baja decreasing the knee extensor moment arm, which concurs with the modeling prediction. The group differences may also be due to the non-DFEO+PTA group being slightly higher functioning. Future research is warranted to determine if optimizing patella position during a DFEO+PTA may improve unaided STS function without compromising gait improvements.

Active lifestyle and physical exercise are considered crucial to people with a disability both for fruitful functioning and participation in society as for long-term health reasons.Restoration of m...

PURPOSE: To describe the current status of the nationwide implementation process of a sports and physical activity stimulation programme to gain insight into how sports and physical activity were integrated into Dutch rehabilitation care.METHODS: The current implementation status of a sports and physical activity stimulation programme in 12 rehabilitation centres and 5 hospitals with a rehabilitation department was described by scoring fidelity and satisfaction. Seventy-one rehabilitation professionals filled out a questionnaire on how sports and physical activity, including stimulation activities, were implemented into rehabilitation care. Total fidelity scores (in %) were calculated for each organization. Professionals' satisfaction was rated on a scale from 1 to 10.RESULTS: In most organizations sports and physical activity were to some extent integrated during and after rehabilitation (fidelity scores: median = 54%, IQR = 23%). Physical activity stimulation was not always embedded as standard component of a rehabilitation treatment. Professionals' satisfaction rated a median value of 8.0 (IQR = 0.0) indicating high satisfaction rates.CONCLUSIONS: The fidelity outcome showed that activities to stimulate sports and physical activity during and after rehabilitation were integrated into rehabilitation care, but not always delivered as standardized component. These findings have emphasized the importance to focus on integrating these activities into routines of organizations. Implications for Rehabilitation Components of an evidence-based programme to stimulate sports and physical activity during and after rehabilitation can be used to measure the current status of the integration of sports and physical activity in rehabilitation care in a structural and effective way. The method described in the current study can be used to compare the content of the rehabilitation care regarding the integration of sports and physical activity among organizations both on a national and international level. Sports and physical activity are seen as important ingredients for successful rehabilitation care in The Netherlands.

IntroductionThe rising prevalence of modifiable risk factors (eg, obesity, hypertension and physical inactivity) is causing an increase in possible avoidable complications in patients undergoing cardiac surgery. This study aims to assess whether a combined preoperative and postoperative multidisciplinary cardiac rehabilitation (CR) programme (Heart-ROCQ programme) can improve functional status and reduce surgical complications, readmissions and major adverse cardiac events (MACE) as compared with standard care.Methods and analysisPatients (n=350) are randomised to the Heart-ROCQ programme or standard care. The Heart-ROCQ programme consists of a preoperative optimisation phase while waiting for surgery (three times per week, minimum of 3 weeks), a postoperative inpatient phase (3 weeks) and an outpatient CR phase (two times per week, 4 weeks). Patients receive multidisciplinary treatment (eg, physical therapy, dietary advice, psychological sessions and smoking cessation). Standard care consists of 6 weeks of postsurgery outpatient CR with education and physical therapy (two times per week). The primary outcome is a composite weighted score of functional status, surgical complications, readmissions and MACE, and is evaluated by a blinded endpoint committee. The secondary outcomes are length of stay, physical and psychological functioning, lifestyle risk factors, and work participation. Finally, an economic evaluation is performed. Data are collected at six time points: at baseline (start of the waiting period), the day before surgery, at discharge from the hospital, and at 3, 7 and 12 months postsurgery.Ethics and disseminationThis study will be conducted according to the principles of the Declaration of Helsinki (V.8, October 2013). The protocol has been approved by the Medical Ethical Review Board of the UMCG (no 2016/464). Results of this study will be submitted to a peer-reviewed scientific journal and can be presented at national and international conferences.Trial registration numberNCT02984449.

This study investigated (i) the prevalence of the metabolic syndrome (MetS) in people with a long-standing spinal cord injury (SCI); (ii) whether personal or lesion characteristics are determinants of the MetS; and (iii) the association with physical activity or peak aerobic capacity on the MetS. In a cross-sectional study, persons with SCI (N = 223; time since injury of ≥10 years) were tested. The individual components of the MetS were assessed together with the physical activity measured by the Physical Activity Scale for Individuals with Physical Disabilities (PASIPD), while peak aerobic capacity was tested during a graded wheelchair exercise test on a treadmill. Thirty-nine percent of the participants had MetS. In a multivariate logistic regression analyses and after performing a backward regression analysis, only age and education were significant determinants of the MetS. A 10-year increase in age leads to a 1.5 times more chance to have the MetS. Furthermore, people with a low education will multiply the relative risk of MetS compared with people with high education by almost 2. With and without correcting for confounders, no significant relationship was found between PASIPD or peak aerobic capacity and the MetS. It can be concluded that the prevalence of the MetS is high (39%) in people with a long-standing SCI but is comparable to the general Dutch population. Older people and those with a lower education level are most at risk for the MetS. Physical activity and peak aerobic fitness were not related to the MetS in this group with a long-standing SCI.