Functional Mobility Assessment Research Articles

Abstract PO5-11-12: The use of wearable sensors and patient-reported outcomes in breast cancer research: A literature survey

Abstract Background: Clinical outcome assessments (COAs) related to physical activity, sleep, and functional mobility (gait and balance) are common in breast cancer research as they provide insight into treatment effects and overall quality of life. Wearable sensors offer utility in supplementing traditional COAs by providing objective data by passive, continuous measurement, thereby gaining unique insight on functioning while reducing patient burden. However, a comprehensive understanding of how wearables are being used in breast cancer research and how they correlate with subjective measurement of functioning is lacking. Our aim was to identify how wearable sensors and patient-reported outcomes (PROs) are being utilized in breast cancer research, the common areas of overlap, as well as areas in which expanded use of wearable sensors may be beneficial in clinical breast cancer research. Methods: We conducted a non-systematic survey of breast cancer literature using electronic databases (PubMed, Web of Science, Elsevier and Clinicaltrials.gov) to identify oncology trials using both wearable sensors and PROs. Details such as PROs used, types of sensors used, and the data collected from these were extracted and summarized. There were no restrictions placed on the date and year of publication. Results: A total of 15 breast cancer studies, which used both wearable sensors and PROs to measure patient outcomes, were included in analysis. Accelerometers were implemented most frequently in the studies analyzed (73%) followed by pedometers (40%). The most common outcomes measured using wearable sensors were physical activity (47%) and sleep (47%), with only 1 study (7%) measuring functional mobility(gait and balance). The most common outcomes measured using PROs were sleep (47%), followed by quality of life (40%), physical activity (33%), and “other” parameters (40%; e.g., mood, fatigue, pain). Correlation between PRO and sensor metrics were sparce (20%), yet sensor measures of physical activity, sleep, and gait/balance correlated respectively with PROs of activity, sleep, and quality of life. Conclusions: Sleep, quality of life, and physical activity were the most common outcomes measured by PROs, while physical activity and sleep were the most common outcomes captured using wearable sensors. These results suggest there is alignment in outcomes gathered from wearable sensors and PROs, however additional insight may be gained by incorporating wearable sensors for assessment of functional mobility (e.g. walk or balance tests) as these areas are known to impact quality of life in cancer patients and cancer survivors. Further, few studies analyzed correlations between the two measurement systems, suggesting a greater need in understanding how objective measures via wearable sensors and subjective measurements relate. Citation Format: Kelly Dumais, Adam Jagodinsky, Saima Khakwani, Rebecca Bonaker, Bryan McDowell, Kristen Sowalsky. The use of wearable sensors and patient-reported outcomes in breast cancer research: A literature survey [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-11-12.

An integrated approach to the assessment of balance and functional mobility in individuals with history of severe traumatic brain injury

Individuals who experienced severe Traumatic Brain Injury (sTBI) are often characterized by relevant motor dysfunctions which are likely to negatively affect activities of daily living and quality of life and often persist for years. However, detailed objective information about their magnitude are scarce. The aim of this study was to quantitatively assess the extent of motor deficits in terms of postural control effectiveness under static and dynamic conditions and to investigate the existence of possible correlations between the results of clinical tests and instrumental measures. Postural sway and functional mobility (i.e., instrumented Timed Up and Go test, iTUG) were objectively measured in 18 individuals with sTBI and 18 healthy controls using a pressure plate and a wearable inertial sensor. Additionally, participants with history of sTBI completed the Rivermead Mobility Index (RMI). One-way ANOVA and Spearman's rank correlation analysis were employed to examine differences between the two groups and determine potential correlations between the instrumental tests and clinical scales.The results show that people with sTBI were characterized by larger sway area and longer iTUG walking sub-phase. Significant correlations were also detected between RMI scores and iTUG total duration, as well as the walking phase. Taken together, these findings suggest that, even years after the initial injury, individuals with sTBI appear characterized by impaired postural control and functional mobility, which appears correlated with the RMI score. The integration of instrumental measures with clinical scales in the routine assessment and treatment of individuals with sTBI would result in more comprehensive, objective, and sensitive evaluations, thus improving precision in treatment planning, enabling ongoing progress monitoring, and highlighting the presence of motor deficits even years after the initial injury. Such integration is of importance for enhancing the long-term quality of life for individuals with sTBI.

Vertical locomotion improves horizontal locomotion: effects of climbing on gait and other mobility aspects in Parkinson’s disease. A secondary analysis from a randomized controlled trial

BackgroundIn the Climb Up! Head Up! trial, we showed that sport climbing reduces bradykinesia, tremor, and rigidity in mildly to moderately affected participants with Parkinson’s disease. This secondary analysis aimed to evaluate the effects of sport climbing on gait and functional mobility in this cohort.MethodsClimb Up! Head Up! was a 1:1 randomized controlled trial. Forty-eight PD participants (Hoehn and Yahr stage 2–3) either participated in a 12-week, 90-min-per-week sport climbing course (intervention group) or were engaged in regular unsupervised physical activity (control group). Relevant outcome measures for this analysis were extracted from six inertial measurement units placed on the extremities, chest, and lower back, that were worn during supervised gait and functional mobility assessments before and after the intervention. Assessments included normal and fast walking, dual-tasking walking, Timed Up and Go test, Instrumented Stand and Walk test, and Five Times Sit to Stand test.ResultsCompared to baseline, climbing improved gait speed during normal walking by 0.09 m/s (p = 0.005) and during fast walking by 0.1 m/s. Climbing also reduced the time spent in the stance phase during fast walking by 0.03 s. Climbing improved the walking speed in the 7-m- Timed Up and Go test by 0.1 m/s (p < 0.001) and the turning speed by 0.39 s (p = 0.052), the speed in the Instrumented Stand and Walk test by 0.1 m/s (p < 0.001), and the speed in the Five Times Sit to Stand test by 2.5 s (p = 0.014). There was no effect of sport climbing on gait speed or gait variables during dual-task walking.ConclusionsSport climbing improves gait speed during normal and fast walking, as well as functional mobility in people with Parkinson’s disease.Trial registration This study was registered within the U.S. National Library of Medicine (No: NCT04569981, date of registration September 30th, 2020)

Backwards walking speed reserve in persons with multiple sclerosis

BackgroundDecreased gait speed is common in persons with Multiple Sclerosis (PwMS) and has been associated with elevated fall risk. The walking speed reserve (WSR) indicates the ability to increase gait speed on demand and has previously been examined in PwMS. Backward walking is a sensitive measure of fall risk in PwMS; however, no studies have reported on the utility of backward walking speed reserve (BW-WSR) as a clinical assessment tool of functional mobility or fall risk in PwMS, nor have they associated this measure with cognition. Methods23 PwMS completed walking trials at their preferred walking speed (PWS) and maximal walking speed (MWS). Participants performed these walking trials in both the forward (FW) and backward direction (BW). The forward walking speed reserve (FW-WSR) was calculated as the difference between MWS and PWS in the forward direction, while the backward walking speed reserve (BW-WSR) was calculated as the difference between MWS and PWS in the back backward direction. Correlation analyses examined the relationship between the FW- and BW-WSR with clinical assessments of functional mobility (the timed up-and-go) as well as cognitive functioning (the Symbol Digit Modalities Test, the Brief Visuospatial Memory Test-Revised, the California Verbal Learning Test, and the Trail Making Test A and B). Correlations also examined the relationship between FW- and BW-WSR with prospective falls. ResultsA lower BW-WSR was associated with disease severity and poorer performance on clinical walking and balance assessment, as well as with decreased information processing speed and attentional performance. Interestingly, FW-WSR showed similar relations. Neither FW- or BW-WSR were associated with prospective risk in this small sample of PwMS. ConclusionThe BW-WSR did not offer a distinct advantage over other measures, such as the FW-WSR, PWS, or MWS, in the forward or backward direction. The selection of the most sensitive clinical measures of functional mobility and fall risk is crucial; our study holds valuable clinical implications for PwMS by providing novel insights into functional mobility assessments in PwMS.

Clinical outcomes measurement in pediatric lower limb prosthetics: A scoping review.

This study aimed to identify clinical measures that have been used to evaluate function, health related quality of life (HRQoL), and/or satisfaction in children who use lower limb prostheses (LLP). The data reported on psychometric properties for children who use LLP were collected for each measure. First, PubMed, CINAHL, and Web of Science databases were searched using broad search terms to identify standardized outcome measures of function, HRQoL, and/or satisfaction with treatment used in pediatric LLP research published in 2001 or after. For each of the eligible measures found, a second search was performed to identify psychometric properties (e.g., validity, reliability) assessed with children who use LLP. Forty-four standardized outcome measures were identified from 41 pediatric LLP research articles. Five measures (i.e., Gait Outcomes Assessment for Lower Limb Differences, Functional Mobility Assessment, Child Amputee Prosthetics Project- Prosthesis Satisfaction Inventory, Child Amputee Prosthetics Project- Functional Scale Index, and Lower Limb Function Questionnaire) had data on psychometric properties for children who use LLP. Few studies report psychometric data for assessing the overall HRQoL, function, and/or satisfaction for children who use LLP. Further research is needed to validate or create new outcome measures that assess the HRQoL, satisfaction, and/or function of children who use LLP.

Functional mobility assessment in Parkinson’s: A pilot feasibility study and a new methodological approach

Background&#x0D; Parkinson’s disease (PD) is associated with motor impairments that negatively impact functional mobility (Armstrong &amp; Okun, 2020). Functional mobility is “a person’s ability to move to accomplish activities of daily living” (Bouça-Machado et al., 2020). Whilst several assessment scales exist to evaluate PD, many focus on symptom severity or use speed as a proxy for quality of movement (e.g. Timed Up and Go; Buckley et al., 2019; Mirelman et al., 2019). Here we share the development of an integrated motion capture and pressure-sensitive gait mat sequence to assess functional mobility.&#x0D; Design/Methods&#x0D; To capture aspects of functional mobility accurately, we developed a new assessment protocol (FMA-P) to measure which aspects of movement differed between people with (n = 12) and without (n = 12) PD. The sequence involved rising from a chair, locomotion, turning, bending, picking up and placing an object (keys), and returning to sit down on the chair (mean of three trials).&#x0D; Results&#x0D; The mean age of our participants was 65.25 ± 7.8 years, 46% females. We found significant differences in locomotion such as a lower step ratio (p = 0.023), stride length (p &lt; 0.001), and stride velocity (p = 0.019), as well as a higher double support time (p = 0.004), and stride length variability (p = 0.004) in people with PD (PwP) compared to aged-matched healthy participants. PwP showed a lower toe-off set angle (p = 0.042), lower foot height (p = 0.007), and a lower heel strike angle (p = 0.006) during locomotion. Further, a lower shoulder-elbow arm swing angular velocity (p=0.042), and a higher elbow-wrist arm swing angular velocity (p = 0.054) were observed in PwP compared to controls. Getting up from a chair was associated with a lower inclination amplitude in PwP compared to healthy controls (p = 0.047). In the turning section, we found a later onset of pelvis rotation in PwP (p = 0.034). More time was required for PwP to pick the keys up from the floor compared to controls (p = 0.002).&#x0D; Discussion&#x0D; The new measurement protocol could contribute to early diagnosis of PD, offering a quantitative evaluation of functional mobility. For example, reduced toe and heel offset angles may be early determinants of developing shuffling in later disease stages. Moreover, our findings provide objective and precise information about a variety of qualitative aspects of functional mobility. This approach can therefore be used to evaluate change over time thereby improving the evidence base of outcome variables for intervention studies. The FMA-P is of high clinical relevance to aid in the quantitative evaluation of clinical measures of motor impairment.&#x0D; References&#x0D; Armstrong, M. J., &amp; Okun, M. S. (2019). Diagnosis and treatment of Parkinson disease. A review. JAMA, 232(6), 548-560. https://doi.org/10.1001/jama.2019.22360&#x0D; Bouça-Machado, R., Duarte, G. S., Patriarca, M., Castro Caldas, A., Alarcão, J., Fernandes, R. M., Mestre, T. A.,, Matias, R., &amp; Ferreira, J. J. (2020). Measurement instruments to assess functional mobility in Parkinson’s disease: A systematic review. Movement Disorders Clinical Practice, 7(2), 129-139. https://doi.org/10.1002/mdc3.12874&#x0D; Buckely, C., Alcock, L., McArdle, R., Rana Zia Ur Rehman, R. Z. U., Del Din, S., Mazzà, C., Yarnall, A.J., &amp; Rochester, L. (2019). The role of movement analysis in diagnosing and monitoring neurodegenerative conditions: Insights from gait and postural control. Brain Sciences, 9(2), Article 34. https://doi.org/10.3390/brainsci9020034&#x0D; Mirelman, A., Bonato, P., Cmicioli, R., Ellis, T. D., Giladi, N., Hamilton, J. L., Hass, C. J., Hausdorff, J. M., Pelosin, E., &amp; Almeida Q. J. (2019). Gait impairments in Parkinson’s disease. The Lancet Neurology, 18(7), 697-708. https://doi.org/10.1016/s1474-4422(19)30044-4

Age and beta amyloid deposition impact gait speed, stride length, and gait smoothness while transitioning from an even to an uneven walking surface in older adults

BackgroundCapturing a measure of movement quality during a complex walking task may indicate the earliest signs of detrimental changes to the brain due to beta amyloid (Aβ) deposition and be a potential differentiator of older adults at elevated and low risk of developing Alzheimer's disease. This study aimed to determine: 1) age-related differences in gait speed, stride length, and gait smoothness while transitioning from an even to an uneven walking surface, by comparing young adults (YA) and older adults (OA), and 2) if gait speed, stride length, and gait smoothness in OA while transitioning from an even to an uneven walking surface is influenced by the amount of Aβ deposition present in an OA's brain. MethodsParticipants included 56 OA (>70 years of age) and 29 YA (25–35 years of age). In OA, Aβ deposition in the brain was quantified by PET imaging. All participants completed a series of cognitive assessments, a functional mobility assessment, and self-report questionnaires. Then participants performed two sets of walking trials on a custom-built walkway containing a mixture of even and uneven surface sections, including three trials with a grass uneven surface and three trials with a rocks uneven surface. Gait data were recorded using a wireless inertial measurement unit system. Stride length, gait speed, and gait smoothness (i.e., log dimensionless lumbar jerk) in the anteroposterior (AP), mediolateral (ML), and vertical (VT) directions were calculated for each stride. Outcomes were retained for five stride locations immediately surrounding the surface transition. ResultsOA exhibited slower gait (Grass: p < 0.001; Rocks: p = 0.006), shorter strides (Grass: p < 0.001; Rocks: p = 0.008), and smoother gait (Grass AP: p < 0.001; Rocks AP: p = 0.002; Rocks ML: p = 0.02) than YA, but they also exhibited greater reductions in gait speed and stride length than YA while transitioning to the uneven grass and rocks surfaces. Within the OA group, those with greater Aβ deposition exhibited decreases in smoothness with age (Grass AP: p = 0.02; Rocks AP: p = 0.03; Grass ML: p = 0.04; Rocks ML: p = 0.03), while those with lower Aβ deposition exhibited increasing smoothness with age (Grass AP: p = 0.01; Rocks AP: p = 0.02; Grass ML: p = 0.08; Rocks ML: p = 0.07). Better functional mobility was associated with less smooth gait (Grass ML: p = 0.02; Rocks ML: p = 0.05) and with less variable gait smoothness (Grass and Rocks AP: both p = 0.04) in the OA group. ConclusionThese results suggest that, relative to YA, OA may be adopting more cautious, compensatory gait strategies to maintain smoothness when approaching surface transitions. However, OA with greater Aβ deposition may have limited ability to adopt compensatory gait strategies to increase the smoothness of their walking as they get older because of neuropathological changes altering the sensory integration process and causing worse dynamic balance (i.e., jerkier gait). Functional mobility, in addition to age and Aβ deposition, may be an important factor of whether or not an OA chooses to employ compensatory strategies to prioritize smoothness while walking and what type of compensatory strategy an OA chooses.

Automation of Functional Mobility Assessments at Home Using a Multimodal Sensor System Integrating Inertial Measurement Units and Computer Vision (IMU-Vision).

Functional movement assessments are routinely used to evaluate and track changes in mobility. The objective of this study was to evaluate a multimodal movement monitoring system developed for autonomous, home-based, functional movement assessment. Fifty frail and prefrail adults were recruited from the Brigham and Women's Hospital at Home program to evaluate the feasibility and accuracy of applying the multimodal movement monitoring system to autonomously recognize and score functional activities collected in the home. Study subjects completed sit-to-stand, standing balance (Romberg, semitandem, and tandem), and walking test activities in likeness to the Short Physical Performance Battery. Test activities were identified and scored manually and by the multimodal movement monitoring system's activity recognition and scoring algorithms, which were previously trained on lab-based biomechanical data to integrate wearable inertial measurement unit (IMU) and external red-blue-green-depth vision data. Feasibility was quantified as the proportion of completed tests that were analyzable. Accuracy was quantified as the degree of agreement between the actual and system-identified activities. In an exploratory analysis of a subset of functional activity data, the accuracy of a preliminary activity-scoring algorithm was also evaluated. Activity recognition by the IMU-vision system had good feasibility and high accuracy. Of 271 test activities collected in the home, 217 (80%) were analyzable by the activity-recognition algorithm, which overall correctly identified 206 (95%) of the analyzable activities: 100% of walking, 97% of balance, and 82% of sit-to-stand activities (χ2(2) = 19.9). In the subset of 152 tests suitable for activity scoring, automatic and manual scores showed substantial agreement (Kw = 0.76 [0.69, 0.83]). Autonomous recognition and scoring of home-based functional activities is enabled by a multimodal movement monitoring system that integrates inertial measurement unit and vision data. Further algorithm training with ecologically valid data and a kitted system that is independently usable by patients are needed before fully autonomous, functional movement assessment is realizable. Functional movement assessments that can be administered in the home without a clinician present have the potential to democratize these evaluations and improve care access.

Common reasons for non-participation during the outcome measurement process: wheeled mobility service delivery quality improvement reporting

Objective The purpose of this paper is to describe non-participation during the outcome measurement step of the wheeled mobility service delivery process (WMSDP) based on the Functional Mobility Assessment (FMA)-Uniform Dataset (UDS) Registry. Introduction The WMSDP is a standard framework for the provision of wheeled mobility devices, and several factors influence the client’s experience throughout the process. Patient-reported outcomes are one way to measure the client’s experience as part of a quality improvement program. Methods A retrospective descriptive study was conducted on the FMA-UDS Registry to measure the response rate during the outcome measurement step of the WMSDP and describe the reasons an individual did not complete the FMA-UDS. The FMA-UDS was examined at two time points: pre-delivery and post-delivery of the wheeled mobility device. Results As of September 2, 2021, 10,253 cases have been entered into the FMA-UDS Registry. 2,247 cases were no longer participating pre-delivery, and an additional 3,905 cases were no longer participating post-delivery. The most common reasons for non-participation in the FMA-UDS pre-delivery and post-delivery included: equipment not delivered; provider no longer participating in the FMA-UDS; funding issues; no new equipment; client opted out; loss in contact; deceased; returned equipment; and other. Discussion The type and frequency of non-participation in the outcome measurement step of the WMSDP is critical to understanding why individuals participate in outcome measures and provides insight into the barriers and facilitators for the implementation of quality improvement programs.

Telerehabilitation service impact on physical function and adherence compared to face-to-face rehabilitation in patients with stroke: A systematic review and meta-analysis.

The purposes of thissystematic review and meta-analysis were to (1) appraise the available evidence of telerehabilitation program effects on functional outcomes, adherence, and patient satisfaction compared to face-to-face programs after stroke; and (2) provide direction for future outcome measure selection and development for clinical research purposes. TYPE: Systematic review and meta analysis of randomized controlled trials. MEDLINE, CINAHL, Embase, Scopus, Proquest Theses and Dissertations, Physiotherapy Evidence Database (PEDro), and Clinicaltrials.gov were searched for studies published in English from 1964 to the end of April 2022. A total of 6450 studies were identified, 13 were included in the systematic review, and 10 with at least 3 reported similar outcomes were included the meta-analysis. Methodological quality of results was evaluated using the PEDro checklist. Telerehabilitation demonstrated equivalency in outcomes across several domains and was favored compared to conventional face to face alone or when paired with semisupervised physical therapy on Wolf Motor Function performance score (mean difference [MD] 1.69 points, 95% confidence interval [CI] 0.21-3.17) and time score (MD 2.07 seconds, 95% CI -4.04 to -0.10, Q test = 30.27, p < .001, I2 = 93%), and Functional Mobility Assessment in the upper extremities (MD 3.32 points, 95% CI 0.90-5.74, Q test = 5.60, p = .23, I2 = 29% alone or when paired with semisupervised physical therapy). The Barthel Index participation measures of function demonstrated improvement (MD 4.18 points, 95% CI, 1.79-6.57, Q test = 3.56, p = .31, I2 = 16%). Over half of summarized study ratings were determined to be of good to excellent quality (PEDro score 6.6 ± 2.3 points). Adherence varied in available studies from 75%-100%. Satisfaction levels of telerehabilitation were highly variable. Telerehabilitation can improve functional outcomes and promote therapy adherence after stroke. Therapy protocols and functional assessments need substantial refinement and standardization to improve interpretation and clinical outcomes.

Evalutation of the Additional Kabat’s Method Versus Conventional Physiotherapy in the Rehabilitation of Buruli Ulcer Patients (BUP), with Functional Limitations in the District Hospital of Akonolinga, Cameroon

Buruli ulcer (BU) is a chronic infection, indolent necrotizing disease of the skin and underlying tissues caused by Mycobacterium ulcerans, which may result in functional disability. This disease is the third most frequent infection after leprosy and tuberculosis caused by a mycobacterium. The main objective of this study was to determine comparative effectiveness of conventional physiotherapy alone to its association with Kabat’s method in the management of post-Buruli ulcer functional limitations. This was an interventional randomized, comparative and prospective study. It took place at the district hospital of Akonolinga from the12th June to 12th September 2016. Were included, post- Buruli ulcer patients who matched the eligibility criteria, were under treatment in the physiotherapy unit, and who accepted to participate in our study. A questionnaire on the socio-demographic profile of participants, the ulcer localization, the limitation stage, previous medical history and functional mobility assessment scale was administered to the subjects before and after the intervention, which lasted for twelve weeks. We had 2 groups: the case group received association of Kabat technique to conventional physiotherapy and the control group received conventional physiotherapy alone. We had 22 patients, 11 patients for the experimental group, 11 patients for the control group. The mean age was 26.18 years, 54.5% of female participation, 68.2% of leg localization, 59.1% patients with severe limitations of functional mobility, and preference for traditional medication 95.5%. After evaluation of efficiency we concluded that there was no statistically significant difference between the two treatment protocols. Further studies with larger sample size are recommended.

Assessment of functional mobility and gait during a timed up and go test in adults with total blindness

BackgroundThe loss of vision leads to behavioral and motor adaptations that do not necessarily translate to good functioning with regards to daily tasks. AimTo investigate differences in functional mobility in adults with total blindness, and analyze differences in spatiotemporal gait variables with and without the use of a cane, and wearing shoes or barefoot. MethodsWe used an inertial measurement unit to assess the spatiotemporal parameters of the gait and functional mobility in seven subjects with total blindness and four sighted participants during the timed up and go test (TUG) test performed under conditions: barefoot/shod; and with/without a cane (blind subjects). ResultsSignificant differences between groups were found in total TUG test time and in the sub-phases when the blind subjects executed the TUG barefoot and without a cane (p < .01). Other differences were found in trunk movement during sit-to-stand, and stand-to-sit where blind subjects when without cane and barefoot, they had a greater range of motion than sighted subjects (p < .01). Also, BMI has a moderate to strong influence in the execution of the TUG in blind subjects (p < .05) ConclusionThis study showed that, when using a gait-assistance device and wearing shoes, blind subjects have similar functional mobility and gait as sighted subjects, suggesting that an external haptic reference can compensate for the lack of vision. Knowledge of these differences can provide a better understanding of the adaptive behavior in this population, thereby assisting in minimizing the occurrence of trauma and falls.

Survey of Special Education Eligibility Criteria for the Category Visual Impairment Including Blindness

Introduction: Special education eligibility criteria vary across U.S. states; this study reports a systematic analysis of interstate eligibility criteria in the Individuals with Disabilities Education Act (IDEA) category of visual impairments including blindness. Method: Eligibility criteria for all 56 U.S. states, territories, and Washington, DC, were collected and coded on 20 different variables. Variables included use of federal language, qualifying conditions, assessment components, and eligibility team member requirements. Results: Fourteen of 56 states use similar or identical eligibility criteria written in IDEA. Forty-one states (73%) included language that specified criteria or operationally defined what it meant to be a student with a visual impairment in their state. Although about half of the states included an eye report as part of the eligibility process, few specifically mentioned functional vision, learning media, and orientation and mobility assessments in their criteria. Discussion: Significant interstate variations in the interpretation of who qualifies as a student with a visual impairment exist in the United States. Some eligibility criteria were written in an unclear language, making the criteria hard to interpret. Given that identification and prevalence rates of students with disabilities, including students with visual impairments, correlate to components of eligibility criteria, future work should seek to develop an operationalized universal definition of who qualifies as a student with visual impairment in schools. Implications for Practitioners: Since significant interstate variations exist, students, families, and educators must have easy access to all states’ criteria so that families may understand how a student's eligibility for services may change if they move between states.

Music, movement and mood in Parkinson’s: A transdisciplinary study to develop a new protocol to measure functional mobility in people with Parkinson’s by integrating motion capture with a pressure sensitive gait mat

Background&#x0D; Parkinson’s disease (PD) is a neurodegenerative brain disorder associated with early-onset functional motor impairments (Rana et al., 2012). There are several assessment scales for the evaluation of PD, but many motor measurement protocols lack reference to the qualitative assessment of functional mobility in everyday life (Opara et al., 2017). Moreover, previous studies have shown that pharmaceutical treatments in combination with physical therapy play an important role in improving motor symptoms, but the benefits do not seem to extend to mental well-being (Fox et al., 2018). Growing evidence suggest that an interdisciplinary approach by integrating musical activity with exercises may have the potential to improve both functional mobility and psychological wellbeing (Barnish &amp; Barran, 2020).&#x0D; Methods&#x0D; The first phase of this mixed methods study includes a Patient and Public Involvement (PPI) consultation process (workshops and interviews; Rose et al., 2022) to develop a context-appropriate new group-based intervention program for and with PwP and health professionals. The focus will lie on music activity and the use music imagery to develop individual jukeboxes of musical cues to combat motor symptoms such as rigidity and freeze of gait. To evaluate the efficacy and the generalisability of the program, a 12-week within-subject repeated measures controlled trial will be conducted in Switzerland and the UK. An accurate and reliable quantitative measurement protocol will be developed to enable assessment of disease progression, and evaluation of interventions alongside qualitative observations of mobility in PwP. Moreover, we aim to provide fine-grained assessment of clinical measures (such as the Timed Up and Go) using an integrated motion capture (MoCap) and gait mat analysis system.&#x0D; Expected Outcomes and Perspectives&#x0D; This project lays the foundation for the development of non-pharmaceutical and low-cost intervention programs. Our PPI approach will provide better individualised and targeted prevention strategies to counteract the increasing financial and personal burden of PD worldwide. A unique aspect of the study is to develop a new quantitative functional mobility measurement protocol to assess PwP over time. This research approach will contribute to our understanding of functional mobility symptoms and the use of music in PD to reduce symptom severity and improve quality of life.&#x0D; References&#x0D; Barnish, M. S., &amp; Barran, S. M. (2020). A systematic review of active group-based dance, singing, music therapy and theatrical interventions for quality of life, functional communication, speech, motor function and cognitive status in people with Parkinson’s disease. BMC Neurology, 20(1), Article 371. https://doi.org/10.1186/s12883-020-01938-3&#x0D; Fox, S. H., Katzenschlager, R., Lim, S. Y., Barton, B., de Bie, R. M. A., Seppi, K., Coelho, M., &amp; Sampaio, C. (2018). International Parkinson and movement disorder society evidence-based medicine review: Update on treatments for the motor symptoms of Parkinson’s disease. Movement Disorders, 33(8),1248-1266. https://doi.org/10.1002/mds.27372&#x0D; Opara, J., Małecki, A., Małecka, E., &amp; Socha, T. (2017). Motor assessment in Parkinson’s disease. Annals of Agricultural and Environment Medicine, 24(3), 411-415. https://doi.org/10.5604/12321966.1232774&#x0D; Rana, A. Q., Siddiqui, I., &amp; Yousuf, M. S. (2012). Challenges in diagnosis of young onset Parkinson’s disease. Journal of the Neurological Sciences, 323(1-2), 113-116. https://doi.org/10.1016/j.jns.2012.08.029&#x0D; Rose, D. C., Poliakoff, E., Hadley, R., Guérin, S. M. R., Phillips, M., &amp; Young, W. R. (2022) Levelling the playing field: The role of workshops to explore how people with Parkinson’s use music for mood and movement management as part of a patient and public involvement strategy. Frontiers in Rehabilitation Sciences, 3, Article 873216. https://doi.org/10.3389/fresc.2022.873216

Functional Mobility and postural balance in older adults with Alzheimer's disease: comparative study between mild and moderate stages

Objective: This study aimed to compare the functional mobility and postural balance of older adults among smild and moderate stages of Alzheimer's disease using the Timed Up and Go test (TUGT) and the Clinical Test of Sensory Interaction and Balance (CTSIB). Methodology: Forty elderly people were divided into two groups according to the mild (CDR1; n = 26) and moderate (CDR2; n = 14) stages of the disease. The Clinical Dementia Rating Scale (CDR) was used for staging the disease, which allows classifying the different degrees of dementia, assessing cognition and behavior. The scale allows classification into CDR 0 (normal or no alteration); 0.5 (questionable or mild cognitive impairment); 1 (mild dementia); 2 (moderate dementia) and 3 (severe dementia). In this study, only subjects classified as CDR 1 or CDR 2 were included. For the assessment of functional mobility, the Timed Up and Go Test (TUGT) was used in the conditions of single task, dual cognitive task and dual motor task, and the Clinical Test of Sensory (CTSIB) to assess postural balance. Data were compared between groups. Results: Performance on the TUGT single task, cognitive dual task, and motor dual task was significantly worse in the CDR2 group compared to the CDR1 group (p &lt; 0.05). The CTSIB was not significantly different between the groups in the four conditions. Conclusion: Functional mobility during tasks involving cognition differs between older adults with mild and moderate dementia, and this commitment is more accentuated in dual-task situations. Postural balance did not differ between the stages of the disease.

Including cognitive assessments with functional testing predicts capabilities relevant to everyday walking in older adults

BackgroundDual-task (DT) testing reflects real-world walking demands in older adults but is not always feasible to perform in clinic. Whether clinical measures that predict single-task (ST) performance also predict DT performance or dual-task effects (DTEs) has not been fully explored. Research questionWhat are the relationships between cognitive performance, functional mobility, and self-reported physical activity and balance confidence and ST and DT Gait Speed and Cognitive Reaction Time, as well as DTEs on Gait Speed (DTEGS) and Cognitive Reaction Time (DTERT), in older adults? MethodsSixty-two older adults (71.5 ± 7.1 years, 17 males) completed cognitive performance, functional mobility, and self-report physical activity and balance confidence assessments. Three 1-min trials were performed: 1) ST Cognition (clock task), 2) ST Gait and 3) DT Cognition + Gait, with Cognitive Reaction Time (recorded during clock task performance via DirectRT) and Gait Speed (measured during walking trial via APDM system) recorded, and DTEGS and DTERT calculated, as the cognitive and gait outcomes. Six multivariate regressions were conducted to test whether cognitive performance, functional mobility, and self-report assessments predicted Gait Speed and Cognitive Reaction Time in ST and DT conditions and DTEs. ResultsThe Comprehensive Trail Making Test (CTMT) predicted Reaction Time in ST cognitive (β = − 0.525, p = .003) and DT (β = − 0.510, p = .006) trials. The Physical Activity Scale for the Elderly (PASE) predicted DTERT (β = − 0.397, p = .008). The 10-Meter Walk Test (10MWT) predicted Gait Speed in ST gait (β = 0.692, p < .001) and DT (β = 0.715, p < .001) trials. The Four Square Step Test (FSST) predicted ST Gait Speed (β = − 0.233, p = .034). The Montreal Cognitive Assessment (MoCA) (β = 0.293, p = .027), 10MWT (β = 0.322, p = .046), and the FSST (β = 0.378, p = .019) predicted DTEGS. SignificanceThe 10MWT, CTMT, and MoCA can be easily implemented in the clinic and may be good choices to assess cognitive and functional abilities necessary for ambulation in older adults.

Clinimetric properties of the Turkish version of the De-Morton Mobility Index (DEMMI) in intensive care unit survivors – a cross-sectional observational study

Purpose To investigate the intra-rater reliability and the construct validity of the Turkish version of the De-Morton Mobility Index (DEMMI) in intensive care unit (ICU) survivors. Methods Construct validity of the DEMMI was measured by correlating it with physical functioning scales. Known group comparison was made according to the Medical Research Council Sum Score (MRC-SS). Internal consistency was determined by measuring Cronbach α coefficient. Test-retest reliability was assessed by performing the DEMMI by the same researcher after 24 h and calculating the intraclass correlation coefficient (ICC). The minimal detectable change (MDC) value was calculated. Results One hundred and two patients discharged from the ICU were included. The ICC for intra-reliability was 0.972. The internal consistency was excellent (Cronbach = 0.991). The DEMMI total score was correlated with the Barthel Index (r = 0.791), Katz Index of Independence in Activities of Daily Living (r = 0.722), MRC-SS (0.614), ICU length of stay (r = –0.515), and total mechanical ventilation duration (r = –0.488). The DEMMI was able to differentiate between MRC-SS subgroups (p < 0.001), whereby higher strength was associated with higher DEMMI scores. The MDC was determined to be 6.82 out of 100 points. Conclusion The Turkish version of the DEMMI is reliable and valid for measuring mobility in ICU survivors. Trial registration number NCT05196997 Implications for Rehabilitation The Turkish version of the de-Morton Mobility Index (DEMMI) is a reliable and valid outcome measure for the assessment of functional mobility in intensive care unit survivors. The Turkish version of the DEMMI could guide clinicians working in the field of intensive care in the planning of rehabilitation programs after discharge.

Validation of an Arabic translation of the Functional Mobility Assessment (FMA) tool for assistive mobility device users

BackgroundFunctional mobility assessment (FMA) tool is a self-report questionnaire developed to measure users’ satisfaction with assistive mobility devices while performing activities of daily living.PurposeTo validate an Arabic translation of the FMA tool for Arabic-speaking assistive mobility devices users.MethodsA committee of 2 bilingual qualified occupational therapists translated the English version into Arabic which was verified by back translation. The final versions were administered to bilingual assistive mobility devices users. The participants were randomly assigned to answer either the English or Arabic version of the FMA first, followed by answering the FMA in the other language. The scores obtained were tested for agreement using the kappa statistic.ResultsParticipants’ (n=52), 28 were males and 24 were females, average participant age was 39.4 years old and had used an assistive mobility device for 6.4 years. We found a significant moderate agreement between the scores obtained from the two versions (p<0.000). The kappa measurement of agreement was 0.59 (95% confidence interval, 0.48–0.70).ConclusionThe FMA is now available in Arabic, and it is an appropriate measure for use in research and clinical practice to quantify satisfaction with a functional mobility among assistive mobility device users. Further studies should test its psychometric properties.

Functional mobility, employment and safety benefits of seat elevating devices

ABSTRACT Seat-elevating devices (SEDs) allow vertical movement of the seat of a power wheelchair (PWC), so users can perform activities of daily living including transferring and reaching. RESNA’s position papers on SEDs and the wheelchair provision process highlight the benefits of SEDs and the need for outcome measurement. The Functional Mobility Assessment (FMA) is a satisfaction measure to carry out specific tasks including transferring and reaching. The purpose of this retrospective study was to evaluate the relationship between the use of SEDs on the FMA and uniform dataset (UDS) with a sample of 1,733 PWC users. Independent-samples t-tests and Mann–Whitney U tests were used to compare total FMA and individual FMA item scores between those with and without an SED. A univariate linear regression model was used to control for confounding variables and determine if SEDs were a predictor of variance in FMA. Those with SEDs had significantly higher total FMA percentage score (mean = 76.7 ± 20.9) than those without SEDs (mean = 59.6 ± 24.7; t = 11.9, p < 0.001). Those with SEDs had significantly higher reach (U = 99849.0, p < 0.001) and transfer (U = 140587.0, p < 0.001) scores. The functional, vocational, and safety benefits of SEDs should be considered when determining coverage for SEDs. Status of Research Process Study completed. Involvement of Assistive Technology Users Participants were power wheelchair users.

Assessment of functional mobility in a child with total blindness and another with low vision using an inertial sensor: Case report

Assessment of functional mobility in a child with total blindness and another with low vision using an inertial sensor: Case report