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Introduction Motor training may improve arm-hand functioning in people with cervical spinal cord injuries. Literature advocates task-specific motor training programs with a certain amount of training to improve arm-hand functioning. Furthermore, adequate attention and motivation are essential in promoting engagement in the (re)learned arm-hand motor task. However, the optimal motor training strategies, training dosages, and optimal motivational cues are yet unknown. Methods Systematic literature research in five databases (PubMed, Cochrane, CINAHL, EMBASE, DARE) between January 1970 and May 2022, including papers on active arm-hand motor training programs. The analysis was divided into a narrative and a quantitative part. Methodological quality was assessed using the Van Tulder checklist. Effect sizes were calculated using Hedge's g; mean effect sizes were calculated to compare outcomes on the International Classification of Functioning, Disability, and Health levels of function and activity. Results Eleven studies included in the narrative analysis reported mainly on skill training alone or combined with strength and/or endurance training. Skill training programs reported on the incorporation of the following task-oriented training components: functional movements, clear functional goals, real-life object manipulation, multiple movement planes, and bimanual practice. Most of the included studies reported therapy doses ranging from 3-12 weeks and 3-7 intervention days/week. Based on seven studies, the quantitative analyses demonstrated the highest effect size on arm-hand skilled performance for skill training with additional strength and/or endurance training. The task-oriented training components with a mean effect size of more than 0.5 were: functional movements, multiple movement planes, total skill practice, real-life object manipulation, context-specific environment, clear functional goal, exercise variety, and bimanual practice. Training at least eight weeks with at least three intervention days/week resulted in the largest effect size. Using client-centered goals, resulting in high effect sizes on persons' perception of arm-hand activities. Conclusions Training to improve arm-hand functioning should include skill training with at least eight task-oriented training components with additional strength and/or endurance training. The required training dose should be at least eight weeks with at least three sessions a week. Other therapy dose dimensions were not discussed in the included studies; however, to guide clinical practice on therapy dose, more in-depth research on currently used therapy dose dimensions and how they can be objectively measured, is necessary. Client-centered goals positively impact persons' motivation, but they are still not widely used in motor training programs. Furthermore, other motivational cues were not included in the studies, although they may have an important impact on arm-hand functioning training outcomes.

Mobile health (mHealth) development has advanced rapidly, indicating promise as an effective patient intervention. mHealth has many potential benefits that could help the treatment of patients, and the development of rehabilitation in low- and middle-income countries (LMICs). mHealth is a low-cost option that does not need rapid access to healthcare clinics or employees. It increases the feasibility and rationality of clinical treatment expectations in comparison to the conventional clinical model of management by promoting patient adherence to the treatment plan. mHealth can also serve as a basis for formulating treatment plans and partially compensate for the shortcomings of the traditional model. In addition, mHealth can help achieve universal rehabilitation service coverage by overcoming geographical barriers, thereby increasing the number of ways patients can benefit from the rehabilitation service, and by providing rehabilitation to individuals in remote areas and communities with insufficient healthcare services. However, despite these positive potential aspects, there is currently only a very limited number of studies performed in LMICs using mHealth. In this study, we first reviewed the current evidence supporting the use of mHealth in rehabilitation to identify the countries where studies have been carried out. Then, we identify the current limitations of the implementation of such mHealth solutions and propose a 10-point action plan, focusing on the macro (e.g., policymakers), meso (e.g., technology and healthcare institutions), and micro (e.g., patients and relatives) levels to ease the use, validation, and implementation in LMICs and thus participate in the development and recognition of public health and rehabilitation in these countries.

Background Being able to participate fully in the community and form social networks is crucial for leading a qualitative life. To this end, transportation plays an essential role. Autistic persons often rely on public transport to fulfill their mobility needs. Nevertheless, previous research shows that it is not always easy for them to use it. What issues autistic people face while traveling with public bus transport and how to make public bus transport more autism-friendly has not been researched in-depth to date. Objectives The current case study in Flanders aimed to (1) allow autistic persons to express the issues they face while using public bus transport and (2) create awareness for more autism-friendly public transportation. Methods A qualitative hermeneutic phenomenological study was carried out. Semi-structured interviews were conducted and processed based on the interpretative phenomenological analysis method. Results The interviews were conducted with 17 autistic individuals (mean age: 23.4 years, 53% male) and 3 non-autistic employees of a public transportation company about their experiences when taking (autistic individuals) or driving (employees) the bus. After analysis, three main themes emerged: (1) creating predictability (subthemes: providing an overview, presence of consistency, and providing factual and accurate information), (2) limiting stimuli, and (3) communication tailored to autistic persons. In addition, various coping strategies were described, such as using noise-canceling headphones or using a smartphone application to follow the route. Conclusion The current study was one of the first to give an indication of how autistic persons experience public bus transportation. The results are both interesting to the autism community and public bus transportation companies. The coping strategies described are relevant for autistic persons in case they feel reluctant to use public bus transport. Furthermore, the current study’s findings could also help public bus transportation companies further develop a universal and inclusive design to provide access to public transport at the same level of service for everyone.

The development of mobile technology and mobile Internet offers new possibilities in rehabilitation and clinical assessment in a longitudinal perspective for multiple sclerosis management. However, because the mobile health applications (mHealth) have only been developed recently, the level of evidence supporting the use of mHealth in people with multiple sclerosis (pwMS) is currently unclear. Therefore, this review aims to list and describe the different mHealth available for rehabilitation and self-assessment of pwMS and to define the level of evidence supporting these interventions for functioning problems categorized within the International Classification of Functioning, Disability and Health (ICF). In total, 36 studies, performed with 22 different mHealth, were included in this review, 30 about rehabilitation and six for self-assessment, representing 3091 patients. For rehabilitation, most of the studies were focusing on cognitive function and fatigue. Concerning the efficacy, we found a small but significant effect of the use of mHealth for cognitive training (Standardized Mean Difference (SMD) = 0.28 [0.12; 0.45]) and moderate effect for fatigue (SMD = 0.61 [0.47; 0.76]). mHealth is a promising tool in pwMS but more studies are needed to validate these solutions in the other ICF categories. More replications studies are also needed as most of the mHealth have only been assessed in one single study.

Spooren A, Vanheel I, Geysels R, Eyckmans I The Belgian government stresses the importance of evidence based practice in occupational therapy (OT) and the need to make the evidence more demonstrable. Furthermore, the use of the ICF as a common tool within different disciplines is emphasized. Therefore, an innovative digital tool was developed that facilitates clinical reasoning in OT and facilitate evidence based practice. The Hasselt Occupational Performance Profile (H-OPP) which is currently transformed to OT-PPRO is based on the ICF and allows to register and describe the different aspects of the clients' functioning, setting goals and elaborating an intervention plan. It augments involvement of the client system. Format: demonstration of H-OPP; followed by use and application of clinical cases within small groups Participants learn how to 1)use these tools for educational purposes; 2)use the tool in clinical practice; 3)combine ICF terminology with OT terminology Description participants (max 40): OT in clinical and/or educational field

Introduction: Clinicians and rehabilitation centres are searching for affordable technology-supported systems that incorporate a client-centred task-oriented approach which increase client’s motivation and adherence without extra costs and extra individual therapy time. In order to meet these requirements, the intelligent Activity-based Client-centred Taskoriented Training (i-ACT) was developed via user-centred design. Objective: To evaluate the motivation, usability, credibility and treatment expectancy of i-ACT and treatment effect on upper limb functional ability. Method: In four rehabilitation centres, a mixed method longitudinal study was performed. Training with i-ACT was provided for 6 weeks, 3x/week, 45 min/day, additional to treatment as usual. Data collection was performed at baseline, after 2 weeks, 4 weeks and 6 weeks of training and 8-10 weeks after training completion. Semi-structured interviews were conducted with therapists and clients after 6 weeks of training. Results: Seventeen persons with central nervous system diseases participated. Motivation scores on the Intrinsic Motivation Inventory remained high on all subscales (≥ 5.2/7.0), except pressure (≤ 2.0/7.0). Similarly, high scores were seen throughout on the System Usability Scale (≥ 73.8/100) and Credibility/Expectancy Questionnaire (≥ 22.0/27.0, ≥ 15.8/27.0 respectively). Results on upper limb functioning showed a significant progress over time (p

Client-centred task-oriented training is important in neurological rehabilitation but is time consuming and costly in clinical practice. The use of technology, especially motion capture systems (MCS) which are low cost and easy to apply in clinical practice, may be used to support this kind of training, but knowledge and evidence of their use for training is scarce. The present review aims to investigate 1) which motion capture systems are used as training devices in neurological rehabilitation, 2) how they are applied, 3) in which target population, 4) what the content of the training and 5) efficacy of training with MCS is. Methods: A computerised systematic literature review was conducted in four databases (PubMed, Cinahl, Cochrane Database and IEEE). The following MeSH terms and key words were used: Motion, Movement, Detection, Capture, Kinect, Rehabilitation, Nervous System Diseases, Multiple Sclerosis, Stroke, Spinal Cord, Parkinson Disease, Cerebral Palsy and Traumatic Brain Injury. The Van Tulder’s Quality assessment was used to score the methodological quality of the selected studies. The descriptive analysis is reported by MCS, target population, training parameters and training efficacy. Results: Eighteen studies were selected (mean Van Tulder score = 8.06 ± 3.67). Based on methodological quality, six studies were selected for analysis of training efficacy. Most commonly used MCS was Microsoft Kinect, training was mostly conducted in upper limb stroke rehabilitation. Training programs varied in intensity, frequency and content. None of the studies reported an individualised training program based on client-centred approach. Conclusion: Motion capture systems are training devices with potential in neurological rehabilitation to increase the motivation during training and may assist improvement on one or more International Classification of Functioning, Disability and Health (ICF) levels. Although client-centred task-oriented training is important in neurological rehabilitation, the client-centred approach was not included. Future technological developments should take up the challenge to combine MCS with the principles of a client-centred task-oriented approach and prove efficacy using randomised controlled trials with long-term follow-up. This work was supported in part by ‘Agentschap Innovatie door Wetenschap en Technologie’ (IWT, recently the name of IWT changed into VLAIO) IWT Tetra 140,324, research funds of PXL University College, Hasselt University and University College West Flanders.

Background: Autism Spectrum Disorders (ASD) are known to impact quality-of-life (QoL). Driving can increase autonomy and QoL by enabling maintenance of work and social contacts. Research suggests people with ASD experience difficulties in complex driving situations. These difficulties may induce increased stress, workload, and driving apprehension (i.e., fear or worry), discouraging the pursuit of licensure and potentially interfering with safely learning to drive. Driver instructors can be seen as key players in the development of safe driving skills, already during the learning phase. Internationally, attention went to the development of educational modules for driver instructors to learn how to deal with ASD learner drivers. Especially in the Netherlands, and recently in Belgium, several driving schools adopt a distinct approach for ASD learner drivers. However, effect evaluations often lack, neither has it been investigated whether these approaches lead to less stress, workload, and driving apprehension. Moreover, to avoid extra stress, too demanding research protocols are best avoided. Objectives: We conducted a feasibility study with wearable technology and questionnaires to determine levels of stress, workload, and driving apprehension during driving lessons. To this end, we developed a research protocol and asked a pilot sample to evaluate the procedure. Methods: The protocol included Q-sensor wristbands to indicate levels of stress and workload during driving lessons via measurement of electrodermal activity. We also included the Rating Scale of Mental Effort (RSME), together with the Driving Attitude Scale Parent-Report (DAS-PR) & Self-Report (DAS-SR) from Cox and colleagues as indicators for signs of apprehensive driving. Participants wore Q-sensors during each lesson and completed the RSME after each lesson, as their instructors also did. After the first, middle, and final driving lesson, participants and their parents completed the DAS questionnaires. Besides that, we included questionnaires to determine baseline levels of anxiety and ASD characteristics. We followed a similar procedure for participants that took a driving test. The pilot sample included 4 ASD diagnosed (1 male) and 2 control (1 male) learner drivers, age 18-25. Participants received the instructions once, at reception of the materials. Results: Procedures and measures were evaluated positively. However, to avoid incomplete or unusable data, special attention should go to clear enough instruction of the correct procedure. For instance, two participants wore sensors on the upper instead of the lower wrist, leading to unusable data. Furthermore, questionnaires were not always completed consistently. The non-parametric group comparison tests were not significant, probably due to the limited sample size. Only one ASD learner driver completed the driving exam during the study (i.e., one academic year). Conclusions: The developed protocol was evaluated positively and therefore can be used to investigate levels of stress, workload, and driving apprehension during driving lessons. However, sufficient attention to the instructions is warranted (e.g., inclusion of practice sessions and reminders). Finally, to include the driving exam, sufficient time allocation to the study is required.