Mobility Aids Research Articles

Expert recommendation: treatment of nonambulatory patients with Duchenne muscular dystrophy

HintergrundDie Muskeldystrophie Duchenne (DMD) ist die häufigste genetische neuromuskuläre Krankheit im Kindesalter, bei der es meist im Alter von 9 bis 11 Jahren zum Verlust der Gehfähigkeit kommt.Ziel der Arbeit und Material und MethodenAuf der Grundlage aktueller Leitlinien und Studien erarbeiteten neuropädiatrische und neurologische Experten im Rahmen eines von der Firma PTC Therapeutics GmbH (Frankfurt am Main, Deutschland), die die Substanz Ataluren vertreibt, gesponserten Advisory Boards Empfehlungen zur Behandlung nichtgehfähiger Patienten mit DMD mit Schwerpunkt medikamentöse Therapien von Erwachsenen.Ergebnisse und DiskussionDer Verlust der Gehfähigkeit wird in Studien sehr unterschiedlich definiert und bezieht sich u. a. auf die Rollstuhlpflicht, das selbständige Gehen ohne Hilfsmittel oder die maximale Gehstrecke. Grundlage der Therapie von Patienten mit DMD in jedem Krankheitsstadium sind supportive und symptomatische Maßnahmen, die in der Regel auch nach dem Verlust der Gehfähigkeit intensiv weitergeführt werden sollten. Zusätzlich stehen den Patienten medikamentöse Therapien mit dem Ziel der Modifikation des Krankheitsverlaufes zur Verfügung. Glukokortikoide bilden den Stützpfeiler der medikamentösen Therapie auch über den Verlust der Gehfähigkeit hinaus, dann meist in reduzierter Dosis. Für Patienten mit DMD aufgrund einer Nonsense-Mutation (nmDMD), ca. 13 % aller DMD-Patienten, steht Ataluren als potenziell dystrophinwiederherstellende, krankheitsmodifizierende Therapie zur Verfügung; klinische Daten aus dem STRIDE-Register zeigen eine verzögerte Krankheitsprogression auch nach Verlust der Gehfähigkeit. Zum Exon-Skipping liegen für erwachsene Patienten derzeit noch keine belastbaren Daten vor. Das Antioxidans Idebenon kommt bei nichtgehfähigen, jugendlichen Patienten ohne therapeutische Alternative, die nicht mit Glukokortikoiden behandelt werden können, infrage. Ataluren eignet sich zur kombinierten Behandlung mit Glukokortikoiden, eine Kombination von Idebenon und Glukokortikoiden wird derzeit in einer klinischen Studie überprüft. Eine Add-on-Therapie mit Idebenon zusätzlich zu Ataluren ist bei nichtgehfähigen nmDMD-Patienten zu erwägen. Bedingt durch die Tatsache, dass sich einige der diskutierten Therapieoptionen noch in der Phase der klinischen Prüfung befinden oder noch keine oder nur begrenzte Daten für ältere Patienten mit DMD vorliegen, handelt es sich um Expertenempfehlungen entsprechend der Evidenzklasse IV.

Smartphone Applications for Otolaryngology: Head and Neck Surgery-A Recent Update.

Rise in the number of smartphone users have led to an increased development of smartphone applications. Advent of technology and increased awareness has led to an increased use of healthcare apps by both the physicians and patients. This study aims to provide an up to date review on applications related to Otolaryngology, head and neck surgery (Oto-HNS). The smartphone applications were reviewed in May 2020 in Google play store and apple app store using relevant search words. We included apps relevant for physicians, students as well as patients. Apps providing alternative therapies and home remedies were excluded. A total of 619 apps were included with 352 apps from play store and 267 apps from apple store. Number of apps have remarkably increased in the last 2years till May 2020, 63 apps were developed and last year 141 Oto-HNS apps were developed. Maximum number of apps were available in hearing aid category with 144 (23.2%) mobile hearing aids and 138 (22.2%) hearing aid control apps. 445 apps were available free of cost. Use of smartphone apps have increased dramatically in the last few years. However, their authenticity is still uncertain. Actual involvement of Otolaryngologist in app development is still rare. We recommend formation of scientific committees to regulate the apps development, to access apps quality and effectiveness before incorporated in clinical practice, medical education and patients use.

Development, reliability and validity of the Safe Use of Mobility Aids Checklist (SUMAC) for 4-wheeled walker use in people living with dementia

BackgroundBalance and gait problems are common and progressive in dementia. Use of a mobility aid provides physical support and confidence. Yet, mobility aid use in people with dementia increases falls three-fold. An assessment tool of mobility aid safety in people with dementia does not currently exist. The objectives of this study were: 1) to develop a tool for the evaluation of physical function and safe use of a 4-wheeled walker in people with dementia, and 2) to evaluate its construct and criterion validity, inter-rater and test-retest reliability and minimal detectable change.MethodsHealthcare professionals (HCP) experienced in rehabilitation of people with dementia participated in focus groups for item generation of the new tool, The Safe Use of Mobility Aid Checklist (SUMAC). The SUMAC evaluates physical function (PF) and safe use of the equipment (EQ) on nine tasks of daily life. Reliability was evaluated by HCP (n = 5) scored participant videos of people with dementia (n = 10) using a 4-wheeled walker performing the SUMAC. Inter-rater and test-retest reliability was assessed using intra-class correlation coefficients (ICC). Construct validity evaluated scores of the HCPs to a consensus HCP panel using Spearman’s rank-order correlations. Criterion validity evaluated SUMAC-PF to the Performance-Oriented Mobility Assessment (POMA) gait subscale using Spearman’s rank-order correlations.ResultsThree focus groups (n = 17) generated a tool comprised of nine tasks and the components within each task for physical function and safe use. Inter-rater reliability was statistically significant for SUMAC-PF (ICC = 0.92, 95%CI (0.81, 0.98), p < 0.001) and SUMAC-EQ. (ICC = 0.82, 95%CI (0.54, 0.95), p < 0.001). Test-retest reliability was statistically significant for SUMAC-PF (ICC = 0.89, 95%CI (0.81, 0.94), p < 0.001) and SUMAC-EQ. (ICC = 0.88, 95%CI (0.79, 0.93), p < 0.001). As hypothesized, the POMA gait subscale correlated strongly with the SUMAC-PF (rs = 0.84), but not EQ (rs = 0.39).ConclusionsThe focus groups and research team developed a tool of nine tasks with evaluation on physical function and safe use of a 4-wheeled walker for people with dementia. The SUMAC tool has demonstrated content validity for the whole scale and good construct and criterion validity for the SUMAC-PF and SUMAC-EQ. The subscores of the SUMAC demonstrated excellent to good inter-rater and test-retest reliability.

Clockwise Torque of Sliding Hip Screws: Is There a Right Side?

This study evaluated whether patients with a left-sided femoral neck fracture (FNF) treated with a sliding hip screw (SHS) had a higher implant failure rate than patients treated for a right-sided FNF. This was performed to determine the clinical relevance of the clockwise rotational torque of the femoral neck lag screw in a SHS, in relation to the rotational stability of left and right-sided FNFs after fixation. Data were derived from the FAITH trial and Dutch Hip Fracture Audit (DHFA). Patients with a FNF, aged ≥50, treated with a SHS, with at least 3-month follow-up data available, were included. Implant failure was analyzed in a multivariable logistic regression model adjusted for age, sex, fracture displacement, prefracture living setting and functional mobility, and American Society for Anesthesiologists Class. One thousand seven hundred fifty patients were included, of which 944 (53.9%) had a left-sided and 806 (46.1%) a right-sided FNF. Implant failure occurred in 60 cases (3.4%), of which 31 were left-sided and 29 right-sided. No association between fracture side and implant failure was found [odds ratio (OR) for left vs. right 0.89, 95% confidence interval (CI) 0.52-1.52]. Female sex (OR 3.02, CI: 1.62-6.10), using a mobility aid (OR 2.02, CI 1.01-3.96) and a displaced fracture (OR 2.51, CI: 1.44-4.42), were associated with implant failure. This study could not substantiate the hypothesis that the biomechanics of the clockwise screw rotation of the SHS contributes to an increased risk of implant failure in left-sided FNFs compared with right-sided fractures. Therapeutic Level II.See Instructions for Authors for a complete description of levels of evidence.

Using Standardized Tools to Characterize Adult Day Program Populations: Implications for Future Research and Clinical Practice

ObjectivesTo demonstrate the usefulness of primary data collection using clinician-rated and self-rated standardized measures to describe adult day program (ADP) populations and address programming issues such as identifying members at risk of dropping out. Setting and ParticipantsOne ADP in London, Ontario, and 2 ADPs in Toronto, Ontario, Canada. A total of 223 community-dwelling older adults were recruited across the 3 different programs. MethodsThe interRAI Community Health or Home Care Assessment and self-rated psychosocial assessments were collected on program enrollment. Data analyses included descriptive statistics, comparison of the populations between ADPs, and multinomial regression models to assess reasons for program withdrawal. ResultsMean ages across the 3 programs ranged from 78.3 to 83.8 years and the proportion of women ranged from 49.3% to 56.6%. Compared with one of the ADPs, members from 2 other ADPs exhibited higher use of mobility aids (P < .001), higher levels of cognitive impairment (P < .05), increased risk for institutionalization (P < .001), lower levels of depression (P < .01), and greater need for supervision for basic and instrumental activities of daily living (P < .01). Members assessed to be at higher risk for institutionalization and have increased medical complexity showed possible association with program withdrawal at one ADP. Conclusions and ImplicationsThe tools were useful in identifying differences in physical and psychosocial characteristics of members across the 3 ADPs. Information collected from interRAI and self-rated psychosocial assessments may be helpful in the development of individualized care plans, program services, and recommendations that target transitional care. By understanding member profiles and reasons for withdrawal, ADPs may be able to develop strategies to help members stay in the program and live in the community longer.

Temporal Auditory Coding Features for Causal Speech Enhancement

Perceptually motivated audio signal processing and feature extraction have played a key role in the determination of high-level semantic processes and the development of emerging systems and applications, such as mobile phone telecommunication and hearing aids. In the era of deep learning, speech enhancement methods based on neural networks have seen great success, mainly operating on the log-power spectra. Although these approaches surpass the need for exhaustive feature extraction and selection, it is still unclear whether they target the important sound characteristics related to speech perception. In this study, we propose a novel set of auditory-motivated features for single-channel speech enhancement by fusing temporal envelope and temporal fine structure information in the context of vocoder-like processing. A causal gated recurrent unit (GRU) neural network is employed to recover the low-frequency amplitude modulations of speech. Experimental results indicate that the exploited system achieves considerable gains for normal-hearing and hearing-impaired listeners, in terms of objective intelligibility and quality metrics. The proposed auditory-motivated feature set achieved better objective intelligibility results compared to the conventional log-magnitude spectrogram features, while mixed results were observed for simulated listeners with hearing loss. Finally, we demonstrate that the proposed analysis/synthesis framework provides satisfactory reconstruction accuracy of speech signals.

Experimental Analysis of a Spatialised Audio Interface for People with Visual Impairments

Sound perception is a fundamental skill for many people with severe sight impairments. The research presented in this article is part of an ongoing project with the aim to create a mobile guidance aid to help people with vision impairments find objects within an unknown indoor environment. This system requires an effective non-visual interface and uses bone-conduction headphones to transmit audio instructions to the user. It has been implemented and tested with spatialised audio cues, which convey the direction of a predefined target in 3D space. We present an in-depth evaluation of the audio interface with several experiments that involve a large number of participants, both blindfolded and with actual visual impairments, and analyse the pros and cons of our design choices. In addition to producing results comparable to the state-of-the-art, we found that Fitts’s Law (a predictive model for human movement) provides a suitable metric that can be used to improve and refine the quality of the audio interface in future mobile navigation aids.

Geriatric Risk Prediction Models for Major Gastroenterological Surgery Using the National Clinical Database in Japan: A Multicenter Prospective Cohort Study.

To investigate the effect of geriatric variables on 5 newly added outcomes and create risk models for predicting these outcomes. Because there is a current lack of geriatric research focusing on geriatric outcomes using a national surgical database in Japan, there is a need to investigate outcomes associated with major gastro-enterological surgery using these data. This multicenter prospective cohort study was conducted at 26 surgery departments across 21 institutions in Japan using the NCD surgical registry. in total, 22 new geriatric variables were imported from the ACS National Surgical Quality Improvement Program geriatric pilot study. The following 5 geriatric outcomes were defined: (1) postoperative delirium, (2) physical function on postoperative day 30, (3) fall risk on discharge, (4) discharge other than home with social service, and (5) functional decline on discharge, and geriatric risk prediction models for major gastroenterological surgery were created. Between January 2018 and December 2018, data on 3981 procedures from 7 major gastroenterological surgeries were collected and analyzed. Older age and preoperative geriatric variables (Origin status from home, History of dementia, Use of mobility aid, fall history, and not competent on admission) were strongly associated with postoperative outcomes. Geriatric risk prediction models for these outcomes were created, with C-statistic values ranging from 0.74 to 0.90, demonstrating model validity and sufficiency of fit. The risk models for the newly defined 5 geriatric outcomes that we created can be used in the decision-making process or provision of care in geriatric patients.

A qualitative study of the accessibility of a typical UK town cycle network to disabled cyclists

IntroductionCycling offers significant benefits for disabled people in the form of independent mobility and improved management of chronic health conditions, such as heart disease, diabetes and obesity through increased physical activity. However, disabled people in the UK have a lower propensity to cycle than the general population. This is often assumed to reflect lower levels of interest and reduced capability to cycle, although there is little reported evidence on the actual cycling experiences of disabled people. This study contributes to knowledge in the field by exploring the infrastructural and environmental challenges negotiated by a group of disabled people who currently cycle and utilise the cycle network in Swindon - a typical large town in the UK. MethodsFocus groups and in-depth interviews were conducted with 16 disabled cyclists and support workers from an inclusive cycling centre. Some participant also chose to take part in a ‘ride-along’ interview to complement participants' own accounts with observational data. ResultsParticipants who used adapted cycles experienced the greatest difficulties in using the cycle network and generally considered their cycles unsuitable for transportation purposes. This was due to both physical obstructions and a requirement to ‘dismount’ in pedestrianised areas where cycling is prohibited. Compared with adapted cycle-users, participants with ‘invisible disabilities’ using standard cycles experienced a greater sense of vulnerability when cycling in motor traffic, as drivers exhibited less care around them. Financial and social barriers to cycling also emerged strongly in participants' accounts. ConclusionsMany challenges faced by disabled cyclists reflect those experienced by non-disabled cyclists, but barriers are much more profound for disabled people. Public authorities need to improve the inclusivity of cycling in towns through measures such as: creating pathways to help more disabled people progress from learning to cycle to cycling independently; regular audits of the network using an adapted cycle; and legally recognising cycles as mobility aids.

Stereo Vision-based Path Finder for Visually Impaired

This paper introduces a novel electronic mobility aid for visually impaired users that helps them navigate in any given environment and avoid knee level to head height obstacles. The mobility aid uses stereo imaging system to capture the images of the area in front of the user. The processing unit generates a disparity map and a segmentation algorithm extracts information about the relative distance of obstacles from the user. This information is relayed to the user in simplified vibration pattern feedback to inform the user of the path to be taken to avoid collision with the obstacle. Special hardware was designed to make the system portable and cost effective.The mobility aid was validated on 55 visually impaired users. The subjects walked in a controlled test environment with a varying number of obstacles placed in their path. The accuracy of the device to help the user avoid obstacles and the average speed of walking of the user were determined. The results obtained were satisfactory and the device has the potential for use in standalone mode as well as in conjunction with a white cane and thus help visually impaired people counter mobility problems.

Eye and Voice-Controlled Human Machine Interface System for Wheelchairs Using Image Gradient Approach.

Rehabilitative mobility aids are being used extensively for physically impaired people. Efforts are being made to develop human machine interfaces (HMIs), manipulating the biosignals to better control the electromechanical mobility aids, especially the wheelchairs. Creating precise control commands such as move forward, left, right, backward and stop, via biosignals, in an appropriate HMI is the actual challenge, as the people with a high level of disability (quadriplegia and paralysis, etc.) are unable to drive conventional wheelchairs. Therefore, a novel system driven by optical signals addressing the needs of such a physically impaired population is introduced in this paper. The present system is divided into two parts: the first part comprises of detection of eyeball movements together with the processing of the optical signal, and the second part encompasses the mechanical assembly module, i.e., control of the wheelchair through motor driving circuitry. A web camera is used to capture real-time images. The processor used is Raspberry-Pi with Linux operating system. In order to make the system more congenial and reliable, the voice-controlled mode is incorporated in the wheelchair. To appraise the system’s performance, a basic wheelchair skill test (WST) is carried out. Basic skills like movement on plain and rough surfaces in forward, reverse direction and turning capability were analyzed for easier comparison with other existing wheelchair setups on the bases of controlling mechanisms, compatibility, design models, and usability in diverse conditions. System successfully operates with average response time of 3 s for eye and 3.4 s for voice control mode.

A Mobile Application Patient Decision Aid for Treatment of Overactive Bladder

The aim of this study was to develop and validate a mobile application patient decision aid (mPDA) for providing treatment options to women with overactive bladder (OAB). We performed a mixed methods study. We conducted cognitive interviews to gain insight about treatment decisions for OAB. We then developed an evidence-based mPDA and conducted a prospective cohort study to validate it. Women completed the validated Decisional Conflict Scale. Construct validity was determined by comparing Decisional Conflict Scale scores before and after use of the decision aid. Concurrent validity was assessed by determining the relationship between change in Decision Conflict Scale score and a validated Patient Satisfaction Questionnaire. Discriminant validity was assessed by comparing the change in Decision Conflict Scale score in women who had failed 2 or less versus 3 or more prior treatments. Fifteen women participated in cognitive interviews. Thematic analysis revealed that women want information about adverse events, personalization of treatment options, and supplemental interactive sources. Sixty-five women participated in the validation study. Decision Conflict Scale scores improved significantly after use of the decision aid (60.2 ± 22.3 vs 18.7 ± 19.5, P < 0.001). Change in Decision Conflict Scale score correlated moderately with Patient Satisfaction Questionnaire score (r = 0.437, P = 0.003). Women with 3 or more prior treatment failures had greater improvement in Decision Conflict Scale score than women with 2 or less prior treatment failures (P < 0.001). The mPDA is a valuable adjunct to physician counseling for treatment options in women with OAB.

Aquatic high intensity interval training to improve aerobic capacity is feasible in adolescents with cerebral palsy: pilot randomised controlled trial

Objective: To investigate feasibility of aquatic high intensity interval training for adolescents with cerebral palsy, who can ambulate independently but may choose a mobility aid in some circumstances. Design: Pilot randomised controlled trial. Method: Following baseline assessments, participants were randomised to usual care or ten weeks of twice weekly aquatic high intensity interval training. Each class comprised 10 one-minute exercise intervals separated by one-minute rest. High intensity exercise was defined as the attainment of ⩾80% of peak heart rate measured by telemetry. Setting: Tertiary paediatric hospital. Main Measures: Primary outcomes related to the feasibility of the protocol to progress to a definitive trial. Consumer feedback was obtained. Results: Of 119 potential participants, 46 appeared eligible and 17 consented, resulting in a recruitment fraction of 37% (95% CI 23–52). Twelve completed baseline assessments and were randomised (5 males; 14 years 7 months SD 2 years 0 months). In the intervention group, of the 1190 exercise stations (across all participants and sessions), heart rate data were available for 1180 stations and high intensity exercise was achieved during 1111 stations (93%, 95% CI 92–95). All randomised participants completed the study and reported that the intervention was fun and provided friendship opportunities. There were no major adverse events or exacerbation of pain. Conclusions: Aquatic high intensity interval training in ambulant adolescents with cerebral palsy is feasible, while maintaining adherence and fidelity. Uncertainty remains on the efficacy of the intervention, highlighting the need for a large definitive trial.

Can you see frailty? An exploratory study of the use of a patient photograph in the transcatheter aortic valve implantation programme.

Frailty is an important consideration in the assessment of transcatheter aortic valve implantation patients. The documentation of a patient photograph to augment the objective measurement of frailty has been adopted by some transcatheter aortic valve implantation multidisciplinary (TAVI) programmes. We used a prospective two-part multimethod study design. In part A, we examined the concordance between the Essential Frailty Toolset (EFT) and the score attributed by healthcare professionals based on visual rating of photographs using kappa estimates and linear regression. In part B, we conducted a content analysis qualitative study to elicit information about how the TAVI multidisciplinary team used photographs to form impressions about frailty. Part A: 94 healthcare professionals (registered nurses/allied health 65%; physicians 35%) rated 40 representative photographs (women 42.5%; mean age 83.4±7.5; mobility aid 40%) between 0 (robust) and 5 (very frail). The estimate of weighted kappa was 0.2575 (95% confidence interval 0.082-0.433), indicating fair agreement between median healthcare professional visual and EFT score, especially when the EFT was 1 or 4. There was significant discordance among raters (kappa estimate 0.110, 95% confidence interval 0.079-0.141). Age, sex and mobility aid did not have a significant effect on score discordance. Part B: 12 members of the TAVI multidisciplinary team (registered nurses 27.5%; physicians 72.5%) were shown a series of six representative patient photographs. The following themes emerged from the data: (a) looking at the outside; (b) thinking about the inside; (c) use but with caution; and (d) a better approach. A patient photograph offers complementary information to the multimodality assessment of TAVI patients.

Evaluation of Postoperative Functional Health Status Decline Among Older Adults

Functional outcomes have value for older adults who undergo surgical procedures. Preventing postoperative functional decline in this patient population necessitates the identification of the factors associated with this outcome and minimizing their implications. To assess the prevalence of functional decline 30 days after a surgical procedure among older adults 80 years or older, examine the risk factors of this decline, and identify ways to minimize this decline by addressing its mutable factors. This retrospective cohort study used patient data from the Geriatric Surgery Pilot Project, a multi-institutional data registry of the American College of Surgeons National Surgical Quality Improvement Program. Inclusion criteria were patients 80 years or older who underwent a surgical procedure that required an inpatient stay at 1 of 23 hospitals enrolled in the Geriatric Surgery Pilot Project from January 1, 2015, to December 31, 2018, and had preoperative and postoperative functional health status data. Data analysis was performed from January 7, 2019, to December 2, 2019. Adults 80 years or older who underwent an inpatient surgical procedure. The primary outcome was 30-day postoperative functional decline defined by a change in functional health status from admission or before the surgical procedure (ie, from independent to partially or totally dependent, or from partially dependent to totally dependent). Functional health status was measured by a patient's ability to perform activities of daily living. Secondary outcomes were hospital readmission and 30-day postoperative living location. Of the 2013 patients analyzed in this study, 1128 were women (56.0%) and the mean (SD) age was 84.9 (3.9) years. Functional decline at 30 days after the surgical procedure was present in 406 patients (20.2%). Prevalence of this outcome increased with age, with 337 of 1751 patients aged 80 to 89 years (19.2%) experiencing decline compared with 69 of 262 patients 90 years or older (26.3%). In a risk-adjusted model, the geriatric-specific risk factors statistically significantly associated with this outcome included preoperative mobility aid use (odds ratio [OR] 1.76; 95% CI, 1.39-2.22; P < .001) and malnutrition (OR, 1.88; 95% CI, 1.04-3.43; P = .04) as well as postoperative delirium (OR, 2.20; 95% CI, 1.60-3.02; P < .001), pressure ulcer (OR, 1.83; 95% CI, 1.02-3.30; P = .04), and mobility aid at discharge (OR, 2.49; 95% CI, 1.72-3.59; P < .001). Among patients with a 30-day functional decline, 106 (26.1%) required hospital readmission and only 219 (53.9%) were living at home compared with 388 patients (95.6%) living at home before the procedure. In this study, 1 in 5 older adults experienced a functional decline that persisted 30 days after a surgical procedure, an outcome that appeared to be associated with several geriatric-specific risk factors. Future trials are needed to evaluate whether the prevention or mitigation of these factors can decrease the rates of postoperative functional decline in this patient population.

Structured Laser Light Improves Tripping Hazard Recognition for People with Visual Impairments.

PurposeUsing a geometrically derived model and a virtual curb simulator, we quantify the degree to which a wearable device that projects a laser line onto tripping hazards in a pedestrian's path improves visual recognition for people with visual impairments (VI). We confirm this with subjects' performance on computer simulations of low contrast curbs.MethodsWe derive geometric expressions quantifying the visual cue users perceive when a single laser line is projected from their hip onto a curb. We show how the efficacy of this cue changes with the angle of the laser line relative to the subject's walking trajectory. We confirm this result with data from three subjects with VI in a simulated curb recognition task in which subjects classified computer images as an “Ascending,” “Flat,” or “Descending” curb.ResultsThe derived model predicts that human recognition performance depends strongly on the laser line angle and the subject data confirms this (r2 = 0.86, P < 0.001). The laser line cue improved subject accuracy from a chance level of 33% to 95% for a simulated, one-inch, low-contrast curb at a distance of five feet.ConclusionsRecognition of curbs in low light can be improved by augmenting the scene with a single laser line projected from a user's hip, if the angle of laser line is appropriately selected.Translational RelevanceA majority of people with VI rely on their impaired residual vision for mobility, rather than a mobility aid, resulting in increased injury for this population. Enhancing residual vision could promote safety, increase independence, and reduce medical costs.

An examination of the nature and characteristics of patients readmitted to acute care from inpatient brain injury rehabilitation.

To describe the nature of readmission to acute care and identify patient characteristics associated with avoidable readmission to acute care from inpatient brain injury rehabilitation. A retrospective cohort design. Data prospectively documented between 1 January 2012 -31 December 2018 in local clinical and administrative database were used. Patient medical records were accessed when missing data were identified. Descriptive statistics were used to describe the nature of readmission episodes and univariate and multivariable logistic regression were used to identify patient characteristics associated with readmission to acute care. Of the 383 patients admitted for rehabilitation, 83 (22%) experienced readmission to acute care for a total of 171 episodes. Thirty-seven percent of readmission episodes were due to hospital acquired complications and therefore potentially avoidable. Infection accounted for 63% of hospital acquired complications. Patients with an avoidable readmission episode (N=38) were more likely to have a significantly lower Functional Independence Measure score, be incontinent, have a tracheostomy, require a mobility aid, and be prescribed a dysphagia diet on rehabilitation admission. Patients with a tracheostomy on rehabilitation admission had a 56% probability for an avoidable readmission to acute care. Brain injury rehabilitation patients with an avoidable readmission to acute care were more likely to have a higher burden of care on rehabilitation admission and infection was the leading cause of avoidable readmission episodes. Research into readmission to acute care in the mixed brain injury inpatient rehabilitation population is limited. In this patient population, readmission to acute care is a contemporary issue that can occur at any time during a patient's rehabilitation admission. This study provides valuable information informing practice change for preventing avoidable readmission episodes. Locally developed policy aimed at preventing readmission episodes should include proactive prevention, early recognition of complications and discrete escalation care pathways.

Pediatric OTs’ Experience in Using Mobile Applications in Practice

Abstract Date Presented 03/26/20 The study’s findings highlight common themes that emerged from pediatric OTs’ experiences using mobile apps for promoting children’s developmental skills. The findings are important to the science of mobile technology development and aid in understanding the ways in which mobile technology can be designed and used to support OTs to better enhance children’s development. Primary Author and Speaker: Supawadee Lee Contributing Authors: Zhan Zhang

Preoperative Risk Factors for Nonhome Discharge of Home-Dwelling Geriatric Patients Following Elective Surgery.

To identify patient risk factors for nonhome discharge (NHD) for home-dwelling older patients undergoing surgery, we performed a retrospective cohort study of patients aged ≥65 years undergoing elective surgery between 2014 and 2016 using the geriatric research file from the National Surgical Quality Improvement Program (NSQIP). Multivariable logistic regression examined the association between preoperative demographics, comorbidities, and functional status and NHD to determine which factors are most strongly predictive of NHD. Risk of NHD was higher among those of age >85 years, age 75 to 85 years, Black race, with body mass index (BMI) >30, dyspnea with exertion or at rest, partially or totally dependent in activities of daily living (ADLs), preoperative steroid use, preoperative wound infection, use of a mobility aid, fall within 3 months, or living alone at home without support. NHDs were statistically more likely among orthopedic, neurosurgery, or cardiac surgery interventions. Understanding individual patient's risks and setting expectations for likely postoperative course is integral to appropriate preoperative counseling and preoperative optimization.

Predicting ambulatory function at skeletal maturity in children with moderate to severe osteogenesis imperfecta.

Maximizing ambulation is a key treatment aim in moderate to severe osteogenesis imperfecta (OI). Here we investigated which early clinical characteristics predicted ambulation function at skeletal maturity. We assessed Bleck ambulation scores in 88 individuals with OI at 5 to 6 years of age and again at final height (at 15 to 24 years of age). At 5 to 6 years of age, 33 (38%) children were non-ambulators, 32 (36%) were fully independent ambulators, and 23 (26%) had intermediate ambulation skills. At skeletal maturity, 58% of the study participants had the same mobility level as at first assessment. The ability to ambulate independently at skeletal maturity was predicted by independent ambulation at 5 to 6 years (odds ratio [OR] 22.6, 95% confidence interval [CI] 4.9-105; P < 0.001), height z score at 5 to 6 years (OR 3.1, CI 1.6-6.3; P = 0.001) and weight z score at 5 to 6 years (OR 0.44, CI 0.19-0.99; P = 0.04).Conclusion: Independent ambulation at 5 to 6 years was the main determinant of independent ambulation at skeletal maturity. This highlights the importance of maximizing ambulation in children below 5 years of age. What is Known: •walking ability varies markedly between OI types. The highest level of mobility was found in OI type I, the lowest in OI type III who require mobility aids; intermediate levels were reported for OI type IV. • OI type is a key predictor of ultimate ability to ambulate, whereas the timing of developmental milestones was not associated with walking ability What is New: • overall key predictors of mobility function at skeletal maturity were mobility status and height z-score at 5-6 years of age • Childrenwho were non-ambulators at 5 to 6 years of age had a higher chance of having better mobility at skeletal maturity if they had good upper extremity function, as expressed in the PEDI Self Care Score.