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This single-center study aimed to explore the factors associated with coronavirus disease (COVID-19) transmission in a hospital. All laboratory-confirmed COVID-19 cases among health care workers (HCWs) in a tertiary hospital in Malaysia were analyzed cross-sectionally from January 25, 2020, to September 10, 2021. A total of 897 HCWs in the hospital had laboratory-confirmed COVID-19 infection during the study period. Around 37.4% of HCWs were suspected to acquire COVID-19 infection from the hospital workplace. Factors associated with lower odds of workplace COVID-19 transmission were being females, ≥30 years old, fully vaccinated, and working as clinical support staff. Involvement in COVID-19 patient care was significantly associated with higher odds (adjusted odds ratio = 3.53) of workplace COVID-19 transmission as compared with non-workplace transmission. Most HCWs in the tertiary hospital acquired COVID-19 infection from non-workplace settings. During a pandemic, it is important to communicate with HCWs about the risk of both workplace and non-workplace COVID-19 transmission and to implement measures to reduce both workplace and non-workplace COVID-19 transmission.

Objectives: This study was conducted to investigate the effects of combined progressive resistance training (PRT) and functional electrical stimulation-evoked leg cycling exercise (FES-LCE) on isometric peak torque and muscle volume in individuals with incomplete spinal cord injury. Patients and methods: In the single-blind, randomized controlled trial performed between April 2015 and August 2016, 28 participants were randomized between two exercise interventions (FES-LCE+PRT and FES-LCE alone), and training was conducted over 12 weeks. The isometric muscle peak torque and muscle volume for both lower limbs were measured at the baseline and after 6 and 12 weeks. Linear mixed-model analysis of variance was performed to test the effects of FES-LCE+PRT versus FES-LCE on each outcome measure over time via an intention-to-treat analysis. Results: Twenty-three participants (18 males, 5 females; mean age: 33.4±9.7 years; range 21 to 50 years) completed study (10 in the FES-LCE+PRT group, and 13 in the FES-LCE group). The 12-week pre-and posttraining change for left hamstrings’ muscle peak torque in the FES-LCE+PRT group (mean difference=4.5±7.9 Nm, 45% change, p Conclusion: The combination of PRT and FES-LCE was better in improving lower limb muscle strength and volume in chronic incomplete individuals with spinal cord injury.

Repetitive electrically-evoked muscle contractions lead to the early onset of muscle fatigue. This study assessed the relationship between muscle mechanomyography (%RMS-MMG) and tissue oxygen saturation (%TSI) in extensor carpi radialis (ECR) during electrically-evoked fatiguing exercise in individuals with tetraplegia.Skin-surface mechanomyography (MMG) and near-infrared spectroscopy (NIRS) sensors were placed on the ECR of seven individuals with tetraplegia. All participants performed repetitive electrically-evoked wrist extension to fatigue while their muscle MMG and NIRS responses were monitored against their power output (PO).One out of seven participants showed no changes in %TSI throughout the repeated wrist FES-evoked contraction. The other six participants' %TSI was positively correlated with %PO before fatigue onset. At 50%POThe significant changes in muscle mechanomyography and tissue oxygenation correlations after 50%PO

Background The COVID-19 pandemic impacted healthcare systems in many aspects, with the most immediate need being the increased healthcare burden and healthcare costs. This study aimed to determine the distribution of the disease and its costs of COVID-19 management in Malaysia.Methods Data on hospital admissions related to COVID-19 were coded with ICD-10 and ICD9-CM, and the combination generated DRG codes, which were A-4-13-I, A-4-13-II and A-4-13-III for mild, moderate and severe classification of COVID-19 respectively. Simultaneously, healthcare resource utilisation and costs were estimated for the codes through clinical pathways. The distribution of COVID-19 patients based on DRG was presented as frequencies and percentages while cost data were reported in US$ with the price year 2021.Results A total of 4889 patients with COVID-19 diagnosis were admitted to the hospital. Of that, 4813/4889(98%) had a primary diagnosis of COVID-19 while the remaining patients were admitted for other medical reasons, however, were found to be positive during the admission. 3909(81%) were admitted with mild COVID-19 (A-4-13-I), 630(13%) had moderate COVID-19 (A-4-13-II) and 274(6%) were admitted for severe COVID-19 (A-4-13-III). The cumulative hospital costs for mild COVID-19 (A-4-13-I) were estimated to be USD 1,543. While the cumulative hospital costs for both moderate COVID-19 (A-4-13-II) and severe COVID-19 (A-4-13-III) were estimated at USD 23,527 and USD 26,731 respectively.Conclusions The total costs incurred by the hospital for COVID-19 were estimated to be USD 19,259,153. COVID-19 resulted in significant economic implications for the healthcare system. This study provides local data and an assessment of the economic burden of Covid-19 infection in Malaysia.

Execution of Sit-to-Stand (SitTS) in incomplete spinal cord injury (SCI) patients involves motor function in both upper and lower extremities. The use of arm support, in particular, is a significant assistive factor while executing SitTS movement in SCI population. In addition, the application of functional electrical stimulation (FES) onto quadriceps and gluteus maximus muscles is one of the prescribed management for incomplete SCI to improve muscle action for simple lower limb movements. However, the relative contribution of upper and lower extremities during SitTS has not been thoroughly investigated. Two motor incomplete SCI paraplegics performed repetitive SitTS to fatigue exercise challenge. Their performance was investigated as a mixed-method case-control study comparing SitTS with and without the assistance of FES. Three sets of SitTS tests were completed with 5-min resting period allocated in between sets, with mechanomyography (MMG) sensors attached over the rectus femoris muscles bilaterally. The exercise was separated into 2 sessions; Day 1 for voluntary SitTS and Day 2 for FES-assisted SitTS. Questionnaires were conducted after every session to gather the participants' input about their repetitive SitTS experience. The analysis confirmed that a SitTS cycle could be divided into three phases; Phase 1 (Preparation to stand), Phase 2 (Seat-off), and Phase 3 (Initiation of hip extension), which contributed to 23% ± 7%, 16% ± 4% and 61% ± 6% of the SitTS cycle, respectively. The contribution of arms and legs during SitTS movement varied in different participants based on their legs' Medical Research Council (MRC) muscle grade. In particular, the applied arm forces start to increase clearly when the leg forces start to decline during standing. This finding is supported by the significantly reduced MMG signal indicating leg muscle fatigue and their reported feeling of tiredness.

Inactivity among patients with spinal cord injury causes further deterioration of cardiorespiratory function and muscle strength. A variety of exercise modes, including high-intensity interval trai...

Objectives: To detail the methodological features of the first International Spinal Cord Injury (InSCI) Community Survey by describing recruitment and data collection procedures, and to report on the recruitment results and basic characteristics of participants by country and income setting.Design: Cross-sectional survey.Setting: Community setting in 22 countries representing all 6 World Health Organization regions.Participants: Individuals (N = 12,591) with traumatic or non-traumatic spinal cord injury (SCI) aged over 18 years.Interventions: Not applicable.Main Outcome Measures: Recruitment and data collection procedures, recruitment results, and basic sociodemographic and lesion characteristics of participants.Results: Eight countries used predefined sampling frames and 14 countries applied convenience sampling for recruitment. Most countries recruited participants through specialized rehabilitation facilities, patient organizations, or acute and general hospitals. Modes of approaching potential participants depended on the sampling strategy and multiple response modes were offered to maximize participation. Contact rates ranged from 33% to 98%, cooperation rates ranged from 29% to 90%, and response rates ranged from 23% to 54%. The majority of participants were men (73%), the median age was 52 years (interquartile range, 40-63y), 60% had a partner, 8% reported that they were born in another country than where they were currently residing, and the median length of education was 12 years (interquartile range, 9-15y). Paraplegia was the main diagnosis (63%), traumatic etiologies were the major cause of injury (81%), and the median time since injury (TSI) was 9 years (interquartile range, 4-19y). Compared with participants from lower income settings, participants from higher income settings were over-represented and, in general, were older, more often diagnosed with tetraplegia, had a longer TSI, higher education, and were more often born in a country different than their current residence country.Conclusions: The successful implementation of the InSCI survey enables the comparison of the situation of individuals with SCI around the world and constitutes a crucial starting point for an international learning experience. (C) 2020 by the American Congress of Rehabilitation Medicine

Objectives: To describe the employment situation of individuals with spinal cord injury (SCI) in 22 countries participating in the International Spinal Cord Injury community survey, to compare observed and predicted employment rates, to estimate gaps in employment rates among people with SCI compared with the general population, and to study differences in employment between men and women.Design: Cross-sectional survey.Setting: Community.Participants: People of employable age (N=9875; 18-64 y) with traumatic or non-traumatic SCI (including cauda equina syndrome) who were at least 18 years of age at the time of the survey, living in the community, and able to respond to one of the available language versions of the questionnaire.Interventions: Not applicableMain Outcome Measures: The observed employment rate was defined as performing paid work for at least 1 hour a week, and predicted employment rate was adjusted for sample composition from mixed logistic regression analysis.Results: A total of 9875 participants were included (165-1174 per country). Considerable differences in sample composition were found. The observed worldwide employment rate was 38%. A wide variation was found across countries, ranging from 10.3% to 61.4%. Some countries showed substantially higher or lower employment rates than predicted based on the composition of their sample. Gaps between the observed employment rates among participants with SCI and the general population ranged from 14.8% to 54.8%. On average, employment rates were slightly higher among men compared with women, but with large variation across countries. Employment gaps, however, were smaller among women for most countries.Conclusions: This first worldwide survey among people with SCI shows an average employment rate of 38%. Differences between observed and predicted employment rates across countries point at country-specific factors that warrant further investigation. Gaps with employment rates in the general population were considerable and call for actions for more inclusive labor market policies in most of the countries investigated.

This study investigates whether mechanomyography (MMG) produced from contracting muscles as a measure of their performance could be a proxy of muscle fatigue during a sustained functional electrical stimulation (FES)-supported standing-to-failure task. Bilateral FES-evoked contractions of quadriceps and glutei muscles, of four adults with motor-complete spinal cord injury (SCI), were used to maintain upright stance using two different FES frequencies: high frequency (HF – 35 Hz) and low frequency (LF – 20 Hz). The time at 30° knee angle reduction was taken as the point of critical “fatigue failure”, while the generated MMG characteristics were used to track the pattern of force development during stance. Quadriceps fatigue, which was primarily responsible for the knee buckle, was characterized using MMG-root mean square (RMS) amplitude. A double exponential decay model fitted the MMG fatigue data with good accuracy [R2 = 0.85–0.99; root mean square error (RMSE) = 2.12–8.10] implying changes in the mechanical activity performance of the muscle’s motor units. Although the standing duration was generally longer for the LF strategy (31–246 s), except in one participant, when compared to the HF strategy, such differences were not significant (p > 0.05) but suggested a faster muscle fatigue onset during HF stimulation. As MMG could discriminate between different stimulation frequencies, we speculate that this signal can quantify muscle fatigue characteristics during prolonged FES applications.

Study design A quasi-experimental single-blinded study. Purpose To investigate the effects of 'graded exercise integrated with education' on physical fitness, exercise self-efficacy (ESE), and physical activity (PA) levels among subacute and chronic wheelchair-dependent paraplegia patients. Overview of literature Most of the chronic spinal cord injury (SCI) patients had low physical fitness due to a sedentary lifestyle and lack of ESE after discharge from a rehabilitation program. Education may encourage them to engage with exercise to regain and maintain their physical fitness. However, there is a lack of research to support the effects of exercise integrated with education after an SCI. Methods A total of 44 participants will be assigned to either the experimental group (graded exercise integrated with education) or active control (conventional physical therapy). The experimental group will receive graded strength and aerobic exercise training according to their progression criteria. They will attend an education program during and after the rehabilitation program. The control group will only receive conventional physical therapy during their in-rehabilitation program. This study will be conducted during a period of 16 weeks, consisting of 8 weeks of in-rehabilitation and 8 weeks post-rehabilitation. Statistical analysis will be performed using the IBM SPSS ver. 21.0 (IBM Corp., Armonk, NY, USA) at a significance level of p≤0.05. Results The primary outcome measures will be upper-limb isokinetic strength, isometric grip strength, and cardiorespiratory fitness. The secondary outcomes will be ESE and PA levels. Conclusions An intervention that combines exercise training and education may be warranted to enhance the physical fitness, ESE, and PA levels in SCI patients. This trial was registered with ClinicalTrials.gov (NCT03420170).

Loss of sensory motor function is one of the main causes of physical and activity limitations among individual with spinal cord injury (SCI). SCI may lead to muscle paralysis, weakness and disused muscle atrophy. Evidences have shown electrical stimulation and strengthening exercise might improve lower limb muscle strength and size among individual with SCI. Functional electrical stimulation (FES) evoked cycling is one of the methods that can elicit leg muscle contractions in order to produce a cycling motion and promote the integrity of the involved muscles. Therefore, this review is to synthesize the scientific literature regarding the effects of multiple dosages of FES-evoked lower limb cycling on muscle properties. A systematic literature search from 1946 to 2016 was performed. From over 1,139 articles retrieved from the database, about 31 potentially relevant articles were retained for possible inclusion. However, only 10 articles out of 31 articles fulfilled the inclusion criteria. Although the available evidence is compelling, there is insufficient quantity and quality evidence to draw conclusions regarding the specific parameter of FES-CE that may optimally increase muscle strength, mass, and circumference. However, it can be safely concluded that an effective training session would spend for 45-60 min, 3 times a week for at least 4 weeks to see changes in muscle size and strength.

Objective To determine the effects of the Paraplegia Fitness Integrated Training (PARAFiT) program, which is an integrated graded physical exercise and health education program for individuals with spinal cord injury (SCI).Methods This nonrandomized single-blind study included 44 participants, who were assigned to either an intervention (PARAFiT) group or an active control (conventional physiotherapy) group. The intervention group underwent the PARAFiT program (8 weeks), which consisted of circuit-based interval training, progressive upper limb resistance training, and health education sessions. During the unsupervised period, the intervention group continuously underwent health education program once a month for 2 months (8 weeks). Repeated-measures analysis of variance was used for the analysis.Results The intervention group presented with a higher level of physical activity than did the control group; however, the difference was not significant (p=0.36). Additionally, the intervention group presented with better exercise self-efficacy and cardiorespiratory fitness and stronger bilateral shoulder muscle and handgrip than did the control group (all p

STUDY DESIGN: Pre- and post- trial. OBJECTIVES: To determine the changes of health belief levels after a pressure ulcer (PrU) prevention educational program based on the Health Belief Model (HBM) SETTING: Department of Rehabilitation Medicine, University Medical Centre, Malaysia. METHODS: This study was conducted between May 2016 and May 2018. We created a multidisciplinary structured PrU prevention education program based on the HBM, consisting of didactic lectures, open discussions and a practical session. The content of the program was based on several PrU prevention guidelines. The education program focused on a group of 6–10 participants, and was conducted by a multidisciplinary team; i.e. doctor, physiotherapist, occupational therapist and a nurse. The skin care belief scales (SCBS) questionnaire was administered pre, post and 8-week post intervention, which measured the 9 domains of HBM. The data from the study was analyzed using repeated measures ANOVA to assess the effectiveness of the program. RESULTS: Thirty spinal cord injured participants who fulfilled the inclusion and exclusion criteria completed this study. The results of the education program show statistically significant effects on Susceptibility; F (2,58) = 12.53, P < 0.05, Barriers to Skin Check Belief; F(2,58) = 5.74, P > 0.05, Benefits to Wheelchair Pressure Relief Belief; F(1.65,47.8) = 3.97, P < 0.05, Barriers to Turning and Positioning Belief; F(2,58) = 3.92, P

Malnutrition is highly prevalent among stroke patients during post-acute rehabilitation phase and may give a negative effect on rehabilitation and impair recovery. However, to date, there is no reported study in Malaysia investigating the nutritional status of stroke patients during rehabilitation phase. Thus, this paper aims to report the preliminary results of nutritional assessment for a randomized controlled trial at baseline. All participating patients were assessed for anthropometric measurements, nutritional status using validated Mini Nutrition Assessment (MNA), 24 h diet recall, and handgrip strength. Demographic data, biochemical profiles and functional outcomes (Modified Barthel Index Score, Motor Assessment Scale) were obtained from patients’ medical record. From a total of 45 post-acute stroke patients at baseline, 24.4% of them were malnourished during admission to rehabilitation ward and 66.7% of the patients were at risk of malnutrition. Mean dietary intake and protein intake of the patients were 1489 ± 297 kcal/day and 66.1 ± 17.2 g/ day, respectively. Mean handgrip strength for the patients was 17.9 ± 8.1 kg. Weight, body mass index, serum albumin, handgrip strength, Modified Barthel Index and Motor Assessment Scale score were positively correlated with MNA score (p

Background Due to its clinically proven safety and health benefits, functional electrical stimulation (FES) cycling has become a popular exercise modality for individuals with spinal cord injury (SCI). Since its inception in 2013, the Cybathlon championship has been a platform for publicizing the potential of FES cycling in rehabilitation and exercise for individuals with SCI. This study aimed to evaluate the contribution of the Cybathlon championship to the literature on FES cycling for individuals with SCI 3 years pre and post the staging of the Cybathlon championship in 2016. Methods Web of Science, Scopus, ScienceDirect, IEEE Xplore, and Google Scholar databases were searched for relevant studies published between January 2013 and July 2019. The quality of the included studies was objectively evaluated using the Downs and Black checklist. Results A total of 129 articles on FES cycling were retained for analysis. A total of 51 articles related to Cybathlon were reviewed, and 14 articles were ultimately evaluated for the quality. In 2017, the year following the Cybathlon championship, Web of Science cited 23 published studies on the championship, which was almost 5-fold more than were published in 2016 (n = 5). Training was most often reported as a topic of interest in these studies, which mostly (76.7%) highlighted the training parameters of interest to participating teams in their effort to maximize their FES cycling performance during the Cybathlon championship. Conclusion The present study indicates that the Cybathlon championship in 2016 contributed to the number of literature published in 2017 on FES cycling for individuals with SCI. This finding may contribute to the lessons that can be learned from participation in the Cybathlon and potentially provide additional insights into research in the field of race-based FES cycling.

Previous research investigated recumbent cycle power output (PO) from the perspective of knee and hip joint biomechanics. However, ankle-foot biomechanics and, in particular, the effect of ankle-foot orthosis (AFO)-constrained movements on cycle PO has not been widely explored. Therefore, the purpose of this study was to determine whether AFOs of a fixed position (FP) and in dorsi-plantarflexion (DPF)-, dorsiflexion (DF)- and plantarflexion (PF)-constrained movements might influence PO during voluntary recumbent cycling exercises. Twenty-five healthy individuals participated in this study. All underwent 1-min cycling at a fixed cadence for each of the AFOs. The peak and average PO of each condition were analyzed. The peak and average PO were 27.2±12.0 W (range 6–60) and 17.2±9.0 W (range 2–36), respectively, during voluntary cycling. There were no significant differences in the peak PO generated by the AFOs (p=0.083). There were also no significant differences in the average PO generated using different AFOs (p=0.063). There were no significant differences in the changes of the hip and knee joint angles with different AFOs (p=0.974 and p=1.00, respectively). However, there was a significant difference in the changes of the ankle joint angle (p

Background Investigation of muscle fatigue during functional electrical stimulation (FES)-evoked exercise in individuals with spinal cord injury using dynamometry has limited capability to characterize the fatigue state of individual muscles. Mechanomyography has the potential to represent the state of muscle function at the muscle level. This study sought to investigate surface mechanomyographic responses evoked from quadriceps muscles during FES-cycling, and to quantify its changes between pre- and post-fatiguing conditions in individuals with spinal cord injury. Methods Six individuals with chronic motor-complete spinal cord injury performed 30-min of sustained FES-leg cycling exercise on two days to induce muscle fatigue. Each participant performed maximum FES-evoked isometric knee extensions before and after the 30-min cycling to determine pre- and post- extension peak torque concomitant with mechanomyography changes. Findings Similar to extension peak torque, normalized root mean squared (RMS) and mean power frequency (MPF) of the mechanomyography signal significantly differed in muscle activities between pre- and post-FES-cycling for each quadriceps muscle (extension peak torque up to 69%; RMS up to 80%, and MPF up to 19%). Mechanomyographic-RMS showed significant reduction during cycling with acceptable between-days consistency (intra-class correlation coefficients, ICC = 0.51–0.91). The normalized MPF showed a weak association with FES-cycling duration (ICC = 0.08–0.23). During FES-cycling, the mechanomyographic-RMS revealed greater fatigue rate for rectus femoris and greater fatigue resistance for vastus medialis in spinal cord injured individuals. Interpretation Mechanomyographic-RMS may be a useful tool for examining real time muscle function of specific muscles during FES-evoked cycling in individuals with spinal cord injury.

Commercially available exergames that are for wheelchair-bound individuals with spinal cord injury (SCI) are scarce. This study sought to identify exergames for individuals with SCI that are "dose-potent" for health benefits.Six participants with SCI were recruited for a pilot study to investigate the exercise intensity of selected exergames (Move Tennis, Move Boxing, and Move Gladiator Duel) for the potential to improve health. Issues relating to exergaming for individuals with SCI were identified, and a Move Kayaking exergame was conceived using relevant design processes in an iterative manner. These processes included the following: participant needs and requirements, system requirements (hardware), system architecture (physical and operational views), and integration and verification of the finished system. Emphasis was given to operational and physical designs of the Move Kayaking exergame.Move Boxing, Move Gladiator Duel, and Move Kayaking achieved moderate intensity exercise, while Move Tennis only achieved exercise of low intensity based on participants' metabolic equivalent. However, all four exergames achieved at least moderate intensity based on individuals' ratings of perceived exertion (RPE).The intensity classification while playing Move Boxing, Move Tennis, Move Gladiator Duel, and Move Kayaking, using RPE, reported adequate exercise intensities prescribed by exercise guidelines.

Objective To provide prevalence estimates for problems in functioning of community-dwelling persons with spinal cord injury (SCI) and to examine associations between various areas of functioning with the purpose of supporting countries in identifying targets for interventions. Design Cross-sectional survey. Setting Community, 22 countries including all World Health Organization regions. Participants Persons (N=12,591) with traumatic or nontraumatic SCI aged 18 years or older. Interventions Not applicable. Main Outcome Measures We estimated the prevalence of problems in 53 areas of functioning from the Brief International Classification of Functioning, Disability and Health (ICF) core set for SCI, long-term context, or ICF rehabilitation set covering 4 domains: impairments in body functions, impairments in mental functions, independence in performing activities, and restrictions in participation. Associations between areas of functioning were identified and visualized using conditional independence graphs. Results Participants had a median age of 52 years, 73% were male, and 63% had paraplegia. Feeling tired, bowel dysfunction, sexual functions, spasticity, pain, carrying out daily routine, doing housework, getting up off the floor from lying on the back, pushing open a heavy door, and standing unsupported had the highest prevalence of problems (>70%). Clustering of associations within the 4 functioning domains was found, with the highest numbers of associations within impairments in mental functions. For the whole International Spinal Cord Injury sample, areas with the highest numbers of associations were circulatory problems, transferring bed-wheelchair, and toileting, while for the World Health Organization European and Western Pacific regions, these were dressing upper body, transferring bed-wheelchair, handling stress, feeling downhearted and depressed, and feeling happy. Conclusions In each domain of functioning, high prevalence of problems and high connectivity of areas of functioning were identified. The understanding of problems and the identification of potential targets for intervention can inform decision makers at all levels of the health system aiming to improve the situation of people living with SCI.

Background and objective Using traditional regression modelling, we have previously demonstrated a positive and strong relationship between paralyzed knee extensors' mechanomyographic (MMG) signals and neuromuscular electrical stimulation (NMES)-assisted knee torque in persons with spinal cord injuries. In the present study, a method of estimating NMES-evoked knee torque from the knee extensors’ MMG signals using support vector regression (SVR) modelling is introduced and performed in eight persons with chronic and motor complete spinal lesions. Methods The model was developed to estimate knee torque from experimentally derived MMG signals and other parameters related to torque production, including the knee angle and stimulation intensity, during NMES-assisted knee extension. Results When the relationship between the actual and predicted torques was quantified using the coefficient of determination (R2), with a Gaussian support vector kernel, the R2 value indicated an estimation accuracy of 95% for the training subset and 94% for the testing subset while the polynomial support vector kernel indicated an accuracy of 92% for the training subset and 91% for the testing subset. For the Gaussian kernel, the root mean square error of the model was 6.28 for the training set and 8.19 for testing set, while the polynomial kernels for the training and testing sets were 7.99 and 9.82, respectively. Conclusions These results showed good predictive accuracy for SVR modelling, which can be generalized, and suggested that the MMG signals from paralyzed knee extensors are a suitable proxy for the NMES-assisted torque produced during repeated bouts of isometric knee extension tasks. This finding has potential implications for using MMG signals as torque sensors in NMES closed-loop systems and provides valuable information for implementing this method in research and clinical settings.

This article reviews the epidemiology, rehabilitation intervention strategies, and rehabilitation resources for persons with disabilities (PWD) in Malaysia. Currently, the registered number of PWD is 409,269 individuals, 1.3% of the total population, which is far less than the World Health Organization estimation of 10%. The rehabilitation implementation strategies include health policies, health promotion, and prevention programs. Health-related services for PWD are provided by many government agencies, including health, welfare, education, manpower, housing, and the private sector and nongovernment organizations. It is hoped national health programs can ensure special care and rehabilitation for PWD, optimizing self-reliance and social integration.

Background: Upper body exercise for individuals with spinal cord injury (SCI) is essential for improving health and fitness but is often constrained to conventional arm crank ergometer (ACE). Exergaming, a form of active video gaming, can provide an alternative upper body exercise that is dose-potent (moderate-vigorous intensity). Objective: This cross-sectional study sought to assess Ratings of Perceived Exertion (RPE) and Physical Activity Enjoyment Scale (PACES) for three types of exercise, Move Boxing (MB), Move Kayaking (MK) and ACE, when conducted within similar heart rate (HR) training zones. Methods: Biomechanical descriptions, RPE and PACES scores were taken for each session. Analyses of variance with Hedge’s g were used for significant differences and effect sizes in HR, RPE and PACES scores between the three types of exercises and injury category. Results: The average HR was not different (p=0.489) between exercises (ACE: 110±15, MB: 114±19; MK: 115±17). Tetraplegia (ACE: 95±6, MB: 100±8, MK: 97±12) had lower (p=0.005) average HR than paraplegia (ACE: 117±12, MB: 121±18, MK: 123±13) but when normalised to peak HR was not different (p=0.098). The RPE and PACES were significantly different (p=0.022) between the three types of exercises. ACE produced a lower RPE than both exergames (p=0.002) while Move Boxing was more enjoyable than both ACE (p=0.001) and Move Kayaking (p=0.003). Conclusion: All three exercises achieved vigorous intensity (70–80% of peak HR) for individuals with tetraplegia and paraplegia. Move Boxing was found to be difficult but more enjoyable than conventional ACE when done within similar HR training intensities.

The interaction between muscle contractions and joint loading produces torques necessary for movements during activities of daily living. However, during neuromuscular electrical stimulation (NMES)-evoked contractions in persons with spinal cord injury (SCI), a simple and reliable proxy of torque at the muscle level has been minimally investigated. Thus, the purpose of this study was to investigate the relationships between muscle mechanomyographic (MMG) characteristics and NMES-evoked isometric quadriceps torques in persons with motor complete SCI. Six SCI participants with lesion levels below C4 [(mean (SD) age, 39.2 (7.9) year; stature, 1.71 (0.05) m; and body mass, 69.3 (12.9) kg)] performed randomly ordered NMES-evoked isometric leg muscle contractions at 30°, 60° and 90° knee flexion angles on an isokinetic dynamometer. MMG signals were detected by an accelerometer-based vibromyographic sensor placed over the belly of rectus femoris muscle. The relationship between MMG root mean square (MMG-RMS) and NMES-evoked torque revealed a very high association (R2 = 0.91 at 30°; R2 = 0.98 at 60°; and R2 = 0.97 at 90° knee angles; P < 0.001). MMG peak-to-peak (MMG-PTP) and stimulation intensity were less well related (R2 = 0.63 at 30°; R2 = 0.67 at 60°; and R2 = 0.45 at 90° knee angles), although were still significantly associated (P ≤ 0.006). Test-retest interclass correlation coefficients (ICC) for the dependent variables ranged from 0.82 to 0.97 for NMES-evoked torque, between 0.65 and 0.79 for MMG-RMS, and from 0.67 to 0.73 for MMG-PTP. Their standard error of measurements (SEM) ranged between 10.1% and 31.6% (of mean values) for torque, MMG-RMS and MMG-PTP. The MMG peak frequency (MMG-PF) of 30 Hz approximated the stimulation frequency, indicating NMES-evoked motor unit firing rate. The results demonstrated knee angle differences in the MMG-RMS versus NMES-isometric torque relationship, but a similar torque related pattern for MMG-PF. These findings suggested that MMG was well associated with torque production, reliably tracking the motor unit recruitment pattern during NMES-evoked muscle contractions. The strong positive relationship between MMG signal and NMES-evoked torque production suggested that the MMG might be deployed as a direct proxy for muscle torque or fatigue measurement during leg exercise and functional movements in the SCI population.

Infection and septicaemia may clinically presented with seizure and altered conscious level. In spinal cord injury (SCI) population, they are at risk of having pressure ulcer which can be complicated further with infection and septicaemia.A 40-year-old man with complete T4 SCI and multiple clean and non-healing pressure ulcers at sacral and bilateral ischial tuberosity regions was initially admitted for negative pressure wound therapy (NPWT) dressing. He had an episode of seizure and subsequently had fluctuating altered conscious level before the diagnosis of deep-seated sacral abscess was made and managed. Prior investigations to rule out common possible sources of infections and management did not resolve the fluctuating event of altered consciousness.We presented an unusual case presentation of septicemia in a patient with SCI with underlying chronic non-healing pressure ulcer. He presented with seizure and fluctuating altered conscious level. Even though a chronic non-healing ulcer appeared clinically clean, a high index of suspicion for deep seated abscess is warranted as one of the possible sources of infection, especially when treatment for other common sources of infections fails to result in clinical improvement.

Purpose The Physical Activity Scale for Individuals with Physical Disabilities questionnaire provides an assessment of physical activity after spinal cord injury. This study sought to adapt, with cultural competence, the English questionnaire and translate it into Bahasa Malaysia, including evaluation of content and face validity, internal consistency and test-retest reliability, and completion of a factor analysis in order to validate the Malaysian version. Materials and methods A total of 250 participants completed the questionnaire that was distributed via email, postal mail, the internet, physically and by word of mouth. Sixty-eight respondents were re-contacted to complete the questionnaire again. Results The adapted PASIPD demonstrated adequate internal consistency Cronbach's α = 0.68 and acceptable test-retest reliability, intraclass correlation = 0.87. Factor analysis extracted four main dimensions for physical activity; factor 1 (heavy housework, home repair, lawn work and gardening), factor 2 (sports and recreation), factor 3 (light housework and caring for another person) and factor 4 (leisure and occupational activities) that accounted for 64% of the physical activities' total variance. Conclusion The Malaysian-adapted English and translated Bahasa Malaysia versions of the questionnaires intended to measure physical activity levels in individuals with spinal cord injury, demonstrated good to acceptable validity and reliability. However, some individual items revealed weak reliability measures. Further work is needed to validate the questionnaire's criterion validity against other physical activity measures. Implications for rehabilitation The Malaysian adaptation of the Physical Activity Scale for Individuals with Physical Disabilities questionnaire provided preliminary support for its use since it has demonstrated adequate construct validity and reliability. The Malaysian adaptation of the Physical Activity Scale for Individuals with Physical Disabilities questionnaire can quantify the physical activity level of community-dwelling individuals with spinal cord injury, whilst deriving descriptive information on their physical activities. Deploying the Physical Activity Scale for Individuals with Physical Disabilities questionnaire to a spinal cord injury population in Malaysia may provide the first data on activities of daily living in an Asian developing country.