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OBJECTIVE: To compare handrim wheelchair propulsion technique between individuals with spinal cord injury (SCI) with and without shoulder pain.DESIGN: A cross-sectional study including 38 experienced handrim wheelchair users with SCI. Participants were divided in a 'shoulder pain' (n = 15) and 'no-shoulder pain' (n = 23) group using the Local Musculoskeletal Discomfort scale. Kinetic and spatiotemporal aspects of handrim wheelchair propulsion during submaximal exercise on a motor-driven treadmill were analyzed. Data were collected using a measurement wheel instrumented with 3D force sensors.RESULTS: After correction for confounders (time since injury and body height), linear regression analyses showed the pain group had a 0.30 s (95% CI, -0.5 to -0.1) shorter cycle time, 0.22 s (95% CI, -0.4 to -0.1) shorter recovery time, 15.6° (95% CI, -27.4 to -3.8) smaller contact angle and 8% (95% CI, -15 to 0) lower variability in the work per push compared to the no-pain group. Other parameters did not differ between groups.CONCLUSIONS: This study indicates that individuals with SCI who experience shoulder pain propel their handrim wheelchair kinematically different from individuals with SCI without shoulder pain. This difference in propulsion technique might be a pain-avoiding mechanism aimed at decreasing shoulder range of motion.

Millions of people around the world have difficulty hearing. Hearing aids and cochlear implants help people hear better, especially in quiet places. Unfortunately, these devices do not always help in noisy situations like busy classrooms or restaurants. This means that a person with hearing loss may struggle to follow a conversation with friends or family and may avoid going out. We used methods from the field of artificial intelligence to develop “smart” hearing aids and cochlear implants that can get rid of background noise. We play many different sounds into a computer program, which learns to pick out the speech sounds and filter out unwanted background noises. Once the computer program has been trained, it is then tested on new examples of noisy speech and can be incorporated into hearing aids or cochlear implants. These “smart” approaches can help people with hearing loss understand speech better in noisy situations.

Background: Cystic Fibrosis (CF) is one of the most common, life limiting diseases in Ireland. Physical activity (PA) is regarded as an important component in the management of CF. A Cochrane review found that there are a lack of strategies to promote PA in this population and consideration should be given to telehealth interventions (Cox et al, 2013). Improving the evidence base around PA in people with CF, and how this may impact health outcomes, could serve to inform healthcare professionals tasked with promoting PA participation in this population. Aims: This thesis aims to evaluate the following: (1) To conduct a systematic literature review on the effectiveness of exercise interventions to increase PA in CF, (2) To assess the accuracy of the ActivPAL and Fitbit Charge 2 to measure step count in CF, (3) To assess PA and sedentary behaviour in CF and determine the association with health outcomes in CF, (4) To assess the effectiveness of a pilot randomised trial which aims to increase PA levels in adults with CF using a fitness wearable, goal setting and text message feedback, (5) To qualitatively evaluate the pilot randomised trial. Methods: The research strategy undertaken involved: a systematic review on exercise interventions in CF (Chapter Two); a validation study to assess the accuracy of the ActivPAL and Fitbit Charge 2 as a measure of step count in people with CF (Chapter Three); an observational cross-sectional study of PA levels in people with CF and exploring the association with aerobic capacity, sleep, quality of life and well-being using previously validated outcome measures (Chapter Four); a pilot randomised study to explore the effectiveness of wearable technology, goal setting and text message feedback on PA and health outcomes (Chapter Five); semi-structured interviews to qualitatively evaluate the intervention (Chapter Six).

Anatomy requirements in current accreditation guidelines for allied health professions training are not comprehensive, possibly due to the lack of evidence-based research available. For health professionals to work effectively in an inter-professional relationship there needs to be evidence of acceptable education standards and the need for a standardisation of a minimum level of competency across the different health disciplines, including anatomy. Research on trends in anatomy education including teaching modalities within chiropractic programs is therefore required in order to inform a framework for standard guidelines and recommendations to assist in future refining, improving and accrediting these programs. This thesis aims to improve knowledge of the current trends and standards in anatomy education in Australian chiropractic programs. Chapter 1 provided a synopsis of the history of the chiropractic profession from its beginnings and its history in Australia. The chapter particularly focussed on the status of chiropractic in the Australian healthcare system and its involvement in the care of musculoskeletal disorders. This chapter highlighted the extensive research undertaken on anatomy in medical programs in comparison to the paucity of information on anatomy teaching in Australian chiropractic programs. Chapter 2 highlighted the strategic priority of anatomy in chiropractic programs in Australia and provided a description of the course structure, delivery methods, assessment methods, teaching resources, and anatomy academic staff profile in each of the four Australian chiropractic programs. Chapter 3 confirmed Australian chiropractors’ perceptions on the relevance and adequacy of anatomy training for clinical practice and analysed their opinion on the usefulness of the teaching resources utilized during their preprofessional training. Chapter 4 evaluated the level of knowledge of musculoskeletal anatomy in practicing chiropractors and compared this level of knowledge against that of a cohort of chiropractic students, as a measure of assessment of anatomy knowledge retention in the transition from university to clinical practice. Chapter 5 evaluated musculoskeletal items that were considered essential for inclusion in a chiropractic teaching program, as rated by anatomy and chiropractic academics to ensure adequate preparation for safe practice and to promote alignment with the standards of anatomy education delivered into the clinical professions. Conclusions, including limitations of this research are provided in Chapter 6 along with future directions.

Funder: W D Armstrong Trust; the Macao Postgraduate Scholarship Fund, Funder: UM Macao Fellowship; the Clarendon Scholarship Fund, Funder: Baroness de Turckheim Fund, Trinity College Cambridge, Funder: the Cambridge Hearing Trust; the Evelyn Trust, Cochlear implants restore hearing in patients with severe to profound deafness by delivering electrical stimuli inside the cochlea. Understanding stimulus current spread, and how it correlates to patient-dependent factors, is hampered by the poor accessibility of the inner ear and by the lack of clinically-relevant in vitro, in vivo or in silico models. Here, we present 3D printing-neural network co-modelling for interpreting electric field imaging profiles of cochlear implant patients. With tuneable electro-anatomy, the 3D printed cochleae can replicate clinical scenarios of electric field imaging profiles at the off-stimuli positions. The co-modelling framework demonstrated autonomous and robust predictions of patient profiles or cochlear geometry, unfolded the electro-anatomical factors causing current spread, assisted on-demand printing for implant testing, and inferred patients' in vivo cochlear tissue resistivity (estimated mean = 6.6 k��cm). We anticipate our framework will facilitate physical modelling and digital twin innovations for neuromodulation implants.

Speech-in-noise perception is a major problem for users of cochlear implants (CIs), especially with non-stationary background noise such as competing talkers or traffic. Algorithms that facilitate speech perception by attenuating background noise have produced benefits but relied on a priori information about the target speaker and/or background noise. We developed a recurrent neural network (RNN) algorithm for enhancing speech in non-stationary noise and evaluated its benefits for speech perception, using objective measures, experiments with normal-hearing (NH) subjects listening to CI simulations and experiments with CI users. The RNN was trained using a data set that included speech from many talkers mixed with a set of real-world multi-talker or traffic noise recordings. Its performance was evaluated using speech from a novel talker mixed with novel noise recordings of the same class, either babble or traffic noise. The signal-to-noise ratios also differed from those used for training. Objective measures indicated benefits of using a recurrent architecture over a simpler feed-forward architecture and predicted better speech intelligibility than for the unprocessed speech in noise. The experimental results showed significant improvements in speech intelligibility for the speech in babble for both CI simulations and CI subjects; speech reception thresholds were improved by 1.4 to 3.4 dB. There was no significant improvement for the traffic noise. CI subjects rated stimuli processed using the RNN algorithm as significantly better in terms of speech distortions, noise intrusiveness and overall quality than unprocessed stimuli for both babble and traffic noise, with larger improvements for the former. These results extend previous findings and indicate benefits in speech-in-noise performance by CI listeners for mostly unseen acoustic conditions when using a speaker-independent algorithm that was optimized for non-stationary noises.

We read with interest the article entitled “Impaired hip muscle strength in patients with femoroacetabular impingement syndrome” Kierkegaard et al. It is certainly an interesting article and shows reduced muscle strength in the affected as well as the unaffected hips in those suffering with femoroacetabular impingement (FAI).

In New Zealand (NZ), 88% of health loss is now caused by non-communicable diseases, in part attributed to low levels of physical activity (PA) and high levels of inactivity, and the downstream impacts of these, including suboptimal blood glucose profiles, body size, and blood pressure.1 While the NZ 2016 PA Report Card on Physical Activity for Children and Youth2 revealed relatively high levels of PA, approximately one-third of NZ children and youth did not meet PA recommendations of ≥60 minutes of moderate-to-vigorous physical activity (MVPA) per day. The purpose of this paper is to summarize the methods for grade calculation and results of the 2018 update of the PA Report Card for NZ.