Institut de Readaptation Gingras Lindsay de Montreal

BACKGROUND: The immune deficiency of human immunodeficiency virus (HIV) infection is not fully corrected with ARV therapy. Interleukin-7 (IL-7) can boost CD4 T-cell counts, but optimal dosing and mechanisms of cellular increases need to be defined. METHODS: We performed a randomized placebo-controlled dose escalation (10, 20 and 30 µg/kg) trial of 3 weekly doses of recombinant human IL-7 (rhIL-7) in ARV-treated HIV-infected persons with CD4 T-cell counts between 101 and 400 cells/µL and plasma HIV levels <50 copies/mL. Toxicity, activity and the impact of rhIL-7 on immune reconstitution were monitored. RESULTS: Doses of rhIL-7 up to 20 µg/kg were well tolerated. CD4 increases of predominantly naive and central memory T cells were brisk (averaging 323 cells/µL at 12 weeks) and durable (up to 1 year). Increased cell cycling and transient increased bcl-2 expression were noted. Expanded cells did not have the characteristics of regulatory or activated T cells. Transient low-level HIV viremia was seen in 6 of 26 treated patients; modest increases in total levels of intracellular HIV DNA were proportional to CD4 T-cell expansions. IL-7 seemed to increase thymic output and tended to improve the T-cell receptor (TCR) repertoire in persons with low TCR diversity. CONCLUSIONS: Three weekly doses of rhIL-7 at 20 µg/kg are well tolerated and lead to a dose-dependent CD4 T-cell increase and the broadening of TCR diversity in some subjects. These data suggest that this rhIL-7 dose could be advanced in future rhIL-7 clinical studies. CLINICAL TRIALS REGISTRATION: NCT0047732.

BACKGROUND: Musculoskeletal rehabilitative care and research have traditionally been guided by a structural pathology paradigm and directed their resources towards the structural, functional, and biological abnormalities located locally within the musculoskeletal system to understand and treat Musculoskeletal Disorders (MSD). However the structural pathology model does not adequately explain many of the clinical and experimental findings in subjects with chronic MSD and, more importantly, treatment guided by this paradigm fails to effectively treat many of these conditions. DISCUSSION: Increasing evidence reveals structural and functional changes within the Central Nervous System (CNS) of people with chronic MSD that appear to play a prominent role in the pathophysiology of these disorders. These neuroplastic changes are reflective of adaptive neurophysiological processes occurring as the result of altered afferent stimuli including nociceptive and neuropathic transmission to spinal, subcortical and cortical areas with MSD that are initially beneficial but may persist in a chronic state, may be part and parcel in the pathophysiology of the condition and the development and maintenance of chronic signs and symptoms. Neuroplastic changes within different areas of the CNS may help to explain the transition from acute to chronic conditions, sensory-motor findings, perceptual disturbances, why some individuals continue to experience pain when no structural cause can be discerned, and why some fail to respond to conservative interventions in subjects with chronic MSD. We argue that a change in paradigm is necessary that integrates CNS changes associated with chronic MSD and that these findings are highly relevant for the design and implementation of rehabilitative interventions for this population. Recent findings suggest that a change in model and approach is required in the rehabilitation of chronic MSD that integrate the findings of neuroplastic changes across the CNS and are targeted by rehabilitative interventions. Effects of current interventions may be mediated through peripheral and central changes but may not specifically address all underlying neuroplastic changes in the CNS potentially associated with chronic MSD. Novel approaches to address these neuroplastic changes show promise and require further investigation to improve efficacy of currents approaches.

This study aimed at exploring patients' perceptions regarding telerehabilitation services received post total knee replacement. In this qualitative embedded single case study, semi-structured interviews were conducted with five patients who had previously received in-home telerehabilitation post total knee arthroplasty. Participants were asked to reflect on their 8-week rehabilitation process and on their experience with the home telerehabilitation program. Interviews were transcribed and a qualitative thematic analysis was conducted. Six overarching themes emerged from the patients' perceptions: (1) improving access to services with reduced need for transportation; (2) developing a strong therapeutic relationship with therapist while maintaining a sense of personal space; (3) complementing telerehabilitation with in-person visits; (4) providing standardized yet tailored and challenging exercise programs using telerehabilitation; (5) perceived ease-of-use of telerehabilitation equipment; and (6) feeling an ongoing sense of support. Gaining a better understating of the patient's experience in telerehabilitation will be essential as programs continue to be developed and implemented.

BACKGROUND AND PURPOSE: The ability to rise from a chair to reach a standing position is impaired after stroke. This paper aims to review for the first time the factors that impact the ability to rise from a chair and identify recommendations for post-stroke rehabilitation. METHODS: In order to analyse relevant scientific publications (French and English), the search terms "stroke", "rehabilitation" and "sit-to-stand" (STS and its variations) were used. The initial literature search identified 122 titles and abstracts for full review and 46 were retained because both the junior and senior researchers agreed that they were aligned with the objectives of this review. RESULTS AND CONCLUSION: During STS, most individuals with hemiparesis able to stand independently presented several changes such as lateral deviation of the trunk towards the unaffected side (ipsilesional side), asymmetrical weight bearing (WB) and asymmetry of knee moment forces. Interestingly, the WB asymmetry was observed even before seat-off, when subjects with hemiparesis still had their thighs in contact with the chair suggesting a planned strategy. Among other interesting results, the time to execute the STS was longer than in controls and influenced by the sensorimotor deficits. A greater risk of falling was observed with a need for more time to stabilize the body during STS and especially during the extension phase. Some rehabilitation interventions may be effective in improving STS duration, WB symmetry and the ability to stand independently with repeated practice (mentally or physically) of STS tasks. However, more research is essential to further investigate effects of specific training protocols and pursue better understanding of this complex and demanding task, particularly for stroke patients who need assistance during this transfer.

PURPOSE: Knowledge translation (KT) has emerged as a concept that can lead to a greater utilization of evidence-based research in systems of care. Despite a rise in KT research, the literature on KT in relation to physical therapy practice is scarce. This article provides physical therapists (PTs) with recommendations that can support the effective implementation of new knowledge and scientific evidence in clinical practice. METHOD: Recommendations are grounded in the Ottawa Model of Research Use and in the literature in KT in the health professions. RESULTS: A well-established KT process, which is supported by a planning model, is essential to guide the implementation of scientific evidence. Consensus among all stakeholders about what evidence will be implemented must be reached. Context-related barriers and facilitators should be assessed and tailored active and multi-component interventions should be considered. Participation from individuals in intermediary positions (e.g. opinion leaders) supports implementation of KT interventions. Monitoring of the process and assessment of intended outcomes should be performed in order to assess the success of the implementation. CONCLUSION: Five major recommendations grounded in the Ottawa model are provided that can assist PTs with the complex task of implementing new knowledge in their clinical practice. IMPLICATIONS FOR REHABILITATION: In order to support EBP, knowledge translation interventions can be used to support best practice. Implementation of new knowledge should be guided by a framework or a conceptual model. Consensus on the evidence must be reached and assessment of context-related factors should be done prior to the implementation of any KT intervention. Intervention strategies should be active, multi-component and include individuals with intermediary positions that can facilitate the KT process.

BACKGROUND: Pelvic floor muscle (PFM) dysfunctions are reported to be involved in provoked vestibulodynia (PVD). Although heightened PFM tone has been suggested, the relative contribution of active and passive components of tone remains misunderstood. Likewise, alterations in PFM contractility have been scarcely studied. AIMS: To compare PFM tone, including the relative contribution of its active and passive components, and muscular contractility in women with PVD and asymptomatic controls. METHODS: Fifty-six asymptomatic women and 56 women with PVD participated in the study. The PVD diagnosis was confirmed by a gynecologist based on a standardized examination. OUTCOMES: PFM function was evaluated using a dynamometric speculum combined with surface electromyography (EMG). PFM general tone was evaluated in static conditions at different vaginal apertures and during repeated dynamic cyclic stretching. The active contribution of tone was characterized using the ratio between EMG in a static position and during stretching and the proportion of women presenting PFM activation during stretching. Contribution of the passive component was evaluated using resting forces, stiffness, and hysteresis in women sustaining a negligible EMG signal during stretching. PFM contractility, such as strength, speed of contraction, coordination, and endurance, also was assessed during voluntary isometric efforts. RESULTS: Greater PFM resting forces and stiffness were found in women with PVD compared with controls, indicating an increased general tone. An increased active component also was found in women with PVD because they presented a superior EMG ratio, and a larger proportion of them presented PFM activation during stretching. Higher passive properties also were found in women with PVD. Women with PVD also showed decreased strength, speed of contraction, coordination, and endurance compared with controls. CLINICAL IMPLICATIONS: Findings provide further evidence of the contribution of PFM alterations in the etiology of PVD. These alterations should be assessed to provide patient-centered targeted treatment options. STRENGTHS AND LIMITATIONS: The use of a validated tool investigating PFM alterations constitutes a strength of this study. However, the study design does not allow the determination of the sequence of events in which these muscle alterations occurred-before or after the onset of PVD. CONCLUSION: Findings support the involvement of active and passive components of PFM tone and an altered PFM contractility in women with PVD. Morin M, Binik YM, Bourbonnais D, et al. Heightened Pelvic Floor Muscle Tone and Altered Contractility in Women With Provoked Vestibulodynia. J Sex Med 2017;14:592-600.

PURPOSE: Little is known about how spouses cope with their needs as a result of their partner's aphasia. This study described spouses' needs and identified the barriers and facilitators to satisfying them. METHODS: Four associations of people with aphasia were approached. Eleven spouses were interviewed in small groups. They described the results of their inquiries and efforts to satisfy their needs because their partner had aphasia (mean time since onset 6 years 8 months) as a result of stroke or surgery. Discussions were transcribed and coded. Excerpts were grouped into categories. RESULTS: Spouses mainly needed support and respite, and perceived their partner to need help for communication and well-being. Personal factors like the availability of close others to provide help were facilitating. However, participants encountered barriers, mainly organisational, i.e. the help needed did not exist. Some needs persisted over time. CONCLUSIONS: Results confirm the long-term needs of spouses in adjusting to the aphasia of their partner, as well as the limited services available to them. Many of the needs reflected spouses' concerns about their partner, while others were a consequence of their caregiving role as well as the unavailability of support. Spouses of people with aphasia should have access to support during and after rehabilitation.

OBJECTIVE: To examine the effect on body composition and bone mineral density of locomotor training using a robotic exoskeleton in individuals with spinal cord injury. STUDY DESIGN: Interventional study. SUBJECTS/METHODS: Five adults with a non-progressive traumatic complete sensorimotor spinal cord injury who were using a wheelchair as a primary mode of mobility. Participants performed a personalized 6-week progressive locomotor training programme using a robotic exoskeleton 3 times/week for up to 60 min. Body composition measures were determined using dual energy X-ray absorptiometry and peripheral quantitative computed tomography. RESULTS: A significant increase in leg and appendicular lean body mass and a decrease in total, leg and appendicular fat mass was observed after the intervention. Furthermore, the calf muscle cross-sectional area increased significantly after the intervention. Finally, although not statistically significant, there was an increase of 14.5% in bone mineral density of the tibia, which may be clinically significant. A decrease of > 5 % was also noted for subcutaneous adipose tissue and intramuscular adipose tissue. CONCLUSION: Locomotor training using a robotic exoskeleton appears to be associated with improvements in body composition and, potentially, bone health.

BACKGROUND: Implementation strategies targeting individual healthcare professionals and teams, such as audit and feedback, educational meetings, opinion leaders, and reminders, have demonstrated potential in promoting evidence-based nursing practice. This systematic review examined the effects of the 19 Cochrane Effective Practice and Organization Care (EPOC) healthcare professional-level implementation strategies on nursing practice and patient outcomes. METHODS: A systematic review was conducted following the Cochrane Handbook, with six databases searched up to February 2023 for randomized studies and non-randomized controlled studies evaluating the effects of EPOC implementation strategies on nursing practice. Study selection and data extraction were performed in Covidence. Random-effects meta-analyses were conducted in RevMan, while studies not eligible for meta-analysis were synthesized narratively based on the direction of effects. The quality of evidence was assessed using GRADE. RESULTS: Out of 21,571 unique records, 204 studies (152 randomized, 52 controlled, non-randomized) enrolling 36,544 nurses and 340,320 patients were included. Common strategies (> 10% of studies) were educational meetings, educational materials, guidelines, reminders, audit and feedback, tailored interventions, educational outreach, and opinion leaders. Implementation strategies as a whole improved clinical practice outcomes compared to no active intervention, despite high heterogeneity. Group and individual education, patient-mediated interventions, reminders, tailored interventions and opinion leaders had statistically significant effects on clinical practice outcomes. Individual education improved nurses' attitude, knowledge, perceived control, and skills, while group education also influenced perceived social norms. Although meta-analyses indicate a small, non-statistically significant effect of multifaceted versus single strategies on clinical practice, the narrative synthesis of non-meta-analyzed studies shows favorable outcomes in all studies comparing multifaceted versus single strategies. Group and individual education, as well as tailored interventions, had statistically significant effects on patient outcomes. CONCLUSIONS: Multiple types of implementation strategies may enhance evidence-based nursing practice, though effects vary due to strategy complexity, contextual factors, and variability in outcome measurement. Some evidence suggests that multifaceted strategies are more effective than single component strategies. Effects on patient outcomes are modest. Healthcare organizations and implementation practitioners may consider employing multifaceted, tailored strategies to address local barriers, expand the use of underutilized strategies, and assess the long-term impact of strategies on nursing practice and patient outcomes. TRIAL REGISTRATION: PROSPERO CRD42019130446.

Many neurons of the primary motor cortex (M1) are maximally sensitive to "preferred" hand movement directions and generate progressively less activity with movements away from these directions. M1 activity also correlates with other biomechanical variables. These findings are predominantly interpreted in a framework in which the brain preprograms and directly specifies the desired motor outcome. This approach is inconsistent with the empirically derived equilibrium-point hypothesis, in which the brain can control motor actions only indirectly, by changing neurophysiological parameters that may influence, but remain independent of, biomechanical variables. The controversy is resolved on the basis of experimental findings and theoretical analysis of how sensory and central influences are integrated in the presence of the fundamental nonlinearity of neurons: electrical thresholds. In the presence of sensory inputs, electrical thresholds are converted into spatial thresholds that predetermine the position of the body segments at which muscles begin to be activated. Such thresholds may be considered as referent points of respective spatial frames of reference (FRs) in which neurons, including motoneurons, are centrally predetermined to work. By shifting the referent points of respective FRs, the brain elicits intentional actions. Pure involuntary reactions to perturbations are accomplished in motionless FRs. Neurons are primarily sensitive to shifts in referent directions, i.e., shifts in spatial FRs, whereas emergent neural activity may or may not correlate with different biomechanical variables depending on the motor task and external conditions. Indirect, referent control of posture and movement symbolizes a departure from conventional views based on direct preprogramming of the motor outcome.

Motor actions and action verbs activate similar cortical brain regions. A functional interference can be taken as evidence that there is a parallel treatment of these two types of information and would argue for the biological grounding of language in action. A novel approach examining the relationship between language and grip force is presented. With eyes closed and arm extended, subjects listened to words relating (verbs) or not relating (nouns) to a manual action while holding a cylinder with an integrated force sensor. There was a change in grip force when subjects heard verbs that related to manual action. Grip force increased from about 100 ms following the verb presentation, peaked at 380 ms and fell abruptly after 400 ms, signalling a possible inhibition of the motor simulation evoked by these words. These observations reveal the intimate relationship that exists between language and grasp and show that it is possible to elucidate online new aspects of sensorimotor interaction.

Most falls in older adults occur when walking, specifically following a trip. This study investigated the short- and longer term responses of young (n = 24, 27.6 ± 4.5 yr) and older adults (n = 18, 69.1 ± 4.2 yr) to a trip during gait at comfortable speed and the role of interlimb coordination in recovery from tripping. Subjects walked on a self-paced treadmill when forward movement of their dominant leg was unexpectedly arrested for 250 ms. Recovery of center of mass (COM) movements and of double-support duration following perturbation was determined. In addition, the disruption and recovery of interlimb coordination of the arms and legs was evaluated. Although young and older subjects used similar lower limb strategies in response to the trip, older adults had less stable COM movement patterns before perturbation, had longer transient destabilization (>25%) after perturbation, required more gait cycles to recover double-support duration (older, 3.48 ± 0.7 cycles; young, 2.88 ± 0.4 cycles), and had larger phase shifts that persisted after perturbation (older, -83° to -90°; young, -39° to -42°). Older adults also had larger disruptions to interlimb coordination of the arms and legs. The timing of the initial disruption in coordination was correlated with the disturbance in gait stability only in young adults. In older adults, greater initial COM instability was related to greater longer term arm incoordination. These results suggest a relationship between interlimb coordination and gait stability, which may be associated with fall risk in older adults. Reduced coordination and gait stability suggest a need for stability-related functional training even in high-functioning older adults.

Body orientation with respect to the direction of gravity changes when we lean forward from upright standing. We tested the hypothesis that during upright standing, the nervous system specifies the referent body orientation that defines spatial thresholds for activation of multiple muscles across the body. To intentionally lean the body forward, the system is postulated to transfer balance and stability to the leaned position by monotonically tilting the referent orientation, thus increasing the activation thresholds of ankle extensors and decreasing their activity. Consequently, the unbalanced gravitational torque would start to lean the body forward. With restretching, ankle extensors would be reactivated and generate increasing electromyographic (EMG) activity until the enhanced gravitational torque would be balanced at a new posture. As predicted, vestibular influences on motoneurons of ankle extensors evaluated by galvanic vestibular stimulation were smaller in the leaned compared with the upright position, despite higher tonic EMG activity. Defacilitation of vestibular influences was also observed during forward leaning when the EMG levels in the upright and leaned position were equalized by compensating the gravitational torque with a load. The vestibular system is involved in the active control of body orientation without directly specifying the motor outcome. Corticospinal influences originating from the primary motor cortex evaluated by transcranial magnetic stimulation remained similar at the two body postures. Thus, in contrast to the vestibular system, the corticospinal system maintains a similar descending facilitation of motoneurons of leg muscles at different body orientations. The study advances the understanding of how body orientation is controlled. NEW & NOTEWORTHY The brain changes the referent body orientation with respect to gravity to lean the body forward. Physiologically, this is achieved by shifts in spatial thresholds for activation of ankle muscles, which involves the vestibular system. Results advance the understanding of how the brain controls body orientation in the gravitational field. The study also extends previous evidence of empirical control of motor function, i.e., without the reliance on model-based computations and direct specification of motor outcome.

BACKGROUND AND PURPOSE: It is unknown whether hemiparetic individuals are aware of their weight-bearing asymmetry during sit-to-stand tasks. This study compared the error between hemiparetic and healthy individuals' perception of weight-bearing and their actual weight-bearing distribution during the sit-to-stand task and analyzed the association between the knee extensor muscle strength and the weight-bearing distribution and perception. METHODS: Nineteen unilateral hemiparetic subjects and 15 healthy individuals participated in the study. They performed the sit-to-stand transfer on force platforms under different foot placements (spontaneous and symmetrical) and had to rate their perceived weight-bearing distribution at the lower limbs on a visual analog scale. The strength of the knee extensors was assessed with a Biodex dynamometer. RESULTS: The hemiparetic individuals presented greater weight-bearing asymmetry and errors of perception than the healthy individuals. Although no significant association was found between strength and weight-bearing perception, moderate associations were found between strength and weight-bearing distribution for both the spontaneous (r=0.75, P<0.01) and symmetrical (r=0.71, P<0.01) foot position conditions. CONCLUSIONS: This study revealed that individuals with hemiparesis after a stroke do not perceive themselves as asymmetrical when executing the sit-to-stand transfer and that the knee extensor strength is a factor linked to their weight-bearing asymmetry, not to their perception.

BACKGROUND: It is important for clinicians to rely on suitable prognosis factors after hamstring injuries because of the high incidence of these injuries and time away from athletic activities. PURPOSE: To summarize the current literature on factors that influence return to play after a hamstring injury in athletes. STUDY DESIGN: Systematic review. METHODS: A computer-assisted literature search of CINAHL, MEDLINE, Embase, and EBM Reviews databases (and a manual search of the reference lists of all selected articles) was conducted using keywords related to hamstring injuries and return to play. The literature review criteria included (1) patients with an acute hamstring or posterior thigh injury; (2) a randomized controlled trial, cohort study, case-control study, case series, or prospective or retrospective design; (3) information on rehabilitation, physical therapy, clinical assessment, imaging techniques, and return to play; and (4) studies written in English or French. RESULTS: The search strategy identified 914 potential articles, of which 24 met the inclusion criteria. In terms of the clinical assessment, the following factors were associated with a longer recovery time: stretching-type injuries, recreational-level sports, structural versus functional injuries, greater range of motion deficit with the hip flexed at 90°, time to first consultation >1 week, increased pain on the visual analog scale, and >1 day to be able to walk pain free after the injury. As for magnetic resonance imaging studies, the following factors correlated with a longer recovery time: positive findings; higher grade of injury; muscle involvement >75%; complete transection; retraction; central tendon disruption of the biceps femoris; proximal tendon involvement; shorter distance to the ischial tuberosity; length of the hamstring injury; and depth, volume, and large cross-sectional area. With respect to ultrasound studies, the following factors were associated with a poor prognosis: large cross-sectional area, injury outside the musculotendinous junction, hematoma, structural injury, and injury involving the biceps femoris. Lastly, rehabilitation approaches that included hamstring loading during extensive lengthening or 4 daily sessions of static hamstring stretching led to shorter rehabilitation times. CONCLUSION: Numerous determinants have an effect on return to play after a hamstring injury in athletes. It is important for sports professionals to be aware of those determinants to guide athletes through the rehabilitation process and refine return-to-play strategies.

BACKGROUND: Spontaneous activity originating from the spinal cord has been sporadically reported in humans. OBJECTIVES: Investigation of such rhythmic activity of the trunk and legs in a 49-year-old male patient who had a complete severance of the spinal cord at the fifth thoracic vertebra. METHODS: A multichannel electromyography (EMG) study was performed together with kinematics measurements obtained from an Optotrak system. RESULTS: Episodes of rhythmic trunk and lower limb movements started 6 to 7 years after the spinal lesion, recurred at 2 to 3 month intervals, and continued uninterrupted for 2 to 3 days despite continuous delivery of intrathecal baclofen. Several muscles discharged more or less synchronously on both sides but others clearly alternated, for instance, between hip flexors and knee or ankle extensors. Sensory stimuli (hip repositioning or skin pinch) altered significantly the baseline rhythm of about 1 Hz. The patient had both hips injected with corticosteroids and was free of these episodic rhythmic crises for more than 6 months. CONCLUSION: The rhythmic activity observed in the patient appeared related to the activation of a spinal pattern generator akin to what has been described in most animal species after complete spinal lesions.

Introduction Despite the increased interest in telerehabilitation (TR), virtual reality (VR) and outcome measures for stroke rehabilitation, surprisingly little research has been done to map and identify the most common outcome measures used in TR. For this review, we conducted a systematic search of the literature that reports outcome measures used in TR or VR for stroke rehabilitation. Our specific objectives included: 1) to identify the outcome measures used in TR and VR studies; and 2) to describe which parts of the International Classification of Functioning are measured in the studies. Methods We conducted a comprehensive search of relevant electronic databases (e.g. PubMed, the Cumulative Index to Nursing and Allied Health Literature, Embase, PSYCOINFO, The Cochrane Central Register of Controlled Trial and the Physiotherapy Evidence Database). The scoping review included all study designs. Two reviewers conducted pilot testing of the data extraction forms and independently screened all the studies and extracted the data. Disagreements about inclusion or exclusion were resolved by consensus or by consulting a third reviewer. Results In total, 28 studies were included in this scoping review. The results were synthesized and reported considering the implications of the findings within the clinical practice and policy context. Discussion This scoping review identified a wide range of outcome measures used in VR and TR studies and helped identify gaps in current use of outcome measures in the literature. The review also informs researchers and end users (i.e. clinicians, policymakers and researchers) regarding the most appropriate outcome measures for TR or VR.

INTRODUCTION: This study aimed at exploring the perceived benefits and drawbacks of practicing tai chi, an alternative therapy that can be implemented in the community, as part of upper-limb rehabilitation following stroke. METHODOLOGY: Semistructured interviews were carried out with participants with chronic stroke (>6 months). The participants took part in 16 tai chi sessions over 8 weeks. Interviews were conducted in person using an interview guide based on the theory of planned behavior (TPB), and a thematic analysis was conducted. RESULTS: Eight interviews were carried out with participants at various stages of motor recovery. Participants perceived a number of physical, functional, and psychological benefits. They found tai chi to be a global exercise, including both physical and mental aspects, and suggested that it can be included as part of rehabilitation for stroke patients. Many participants expressed a desire to continue practicing tai chi after completion of the study because it exceeded their expectations, among other reasons. CONCLUSION: This study can serve to guide future tai chi interventions and research on tai chi for rehabilitation in terms of the characteristics of the intervention and the various areas to assess in order to measure the overall benefits. IMPLICATIONS FOR REHABILITATION Tai chi was perceived as a good way of integrating various skills learned during rehabilitation. Despite having different functional abilities, all the participants noted various physical, functional, and psychological benefits from participating in the tai chi sessions. Tai chi seems to be a form of exercise that stroke patients would perform more long-term since all the participants in this study expressed the desire to continue practicing tai chi.

Power wheelchairs (PWCs) can have a positive impact on user well-being, self-esteem, pain, activity and participation. Newly developed intelligent power wheelchairs (IPWs), allowing autonomous or collaboratively-controlled navigation, could enhance mobility of individuals not able to use, or having difficulty using, standard PWCs. The objective of this study was to explore the perspectives of PWC users (PWUs) and their caregivers regarding if and how IPWs could impact on current challenges faced by PWUs, as well as inform current development of IPWs. A qualitative exploratory study using individual interviews was conducted with PWUs (n = 12) and caregivers (n = 4). A semi-structured interview guide and video were used to facilitate informed discussion regarding IPWs. Thematic analysis revealed three main themes: (1) "challenging situations that may be overcome by an IPW" described how the IPW features of obstacle avoidance, path following, and target following could alleviate PWUs' identified mobility difficulties; (2) "cautious optimism concerning IPW use revealed participants" addresses concerns regarding using an IPW as well as technological suggestions; (3) "defining the potential IPW user" revealed characteristics of PWUs that would benefit from IPW use. Findings indicate how IPW use may help overcome PWC difficulties and confirm the importance of user input in the ongoing development of IPWs.

PURPOSE: To compare stroke subjects with different levels of functional mobility, as determined by the Timed "Up and Go" (TUG) test, with controls and outline which clinical functional measures could be combined to predict functional mobility. METHOD: Twenty-two chronic stroke (54.7 ± 15.4 years) and 22 healthy subjects (54.7 ± 15.4 years) performed the TUG and were assessed regarding the paretic or non-dominant quadriceps strength, maximal gait speed, and quality of life (QL). Each group was divided into fast, intermediate, and slow sub-groups regarding their TUG performances. ANOVAs were employed to investigate the main and interaction effects between the groups and sub-groups and discriminant analyses to predict group membership. RESULTS: For both groups, the three sub-groups were significantly different regarding their TUG scores (26.21 < F < 32.73; p < 0.006). The significant interactions indicated that faster stroke subjects demonstrated similar TUG scores, compared to those of all the healthy sub-groups. Maximal gait speed and QL showed significant discriminant functions and correctly classified 86.4% of the original grouped cases. CONCLUSIONS: Fast stroke subjects demonstrated similar TUG performances compared to those of healthy subjects. Group membership was correctly classified for the majority of subjects, except for the fast stroke sub-group, but only for the variables related to gait speed and QL.