The experiences of using an anti-collision power wheelchair for three long-term care home residents with mild cognitive impairment

Purpose.?Presented are three case analyses of long-term care home residents with cognitive impairment who tested an anti-collision power wheelchair. We discuss technology design and research implications for this population.

Method.?Case studies involved 371?h of participant observation and 7?h of open-ended interview with residents (n?=?3), family members (n?=?3) and clinical staff (n?=?11). Thematic analysis generated themes related to technological, psychological and social aspects of residents' inclination and disinclination towards power mobility use.

Results.?Themes examined the discordance between others' and residents' reports of anti-collision power wheelchair use; a facet of response bias; unanticipated implications for independence and dependence; and implications of device design for self-presentation.

Conclusions.?Technology alone is insufficient to help residents to fully benefit from the autonomy that a wheelchair intervention can provide: close attention is required to the social and organisational factors of institutional life. For technology to be acceptable, the design must meet the functional and aesthetic needs of users. Considerations in the design of future power wheelchairs for residents with cognitive impairment include capabilities to drive on uneven surfaces, effort-reducing driving modes, improved user interface usability, and acceptable driving speed, size and appearance.     

Performance testing of collision-avoidance system for power wheelchairs

The Drive-Safe System (DSS) is a collision-avoidance system for power wheelchairs designed to support people with mobility impairments who also have visual, upper-limb, or cognitive impairments. The DSS uses a distributed approach to provide an add-on, shared-control, navigation-assistance solution. In this project, the DSS was tested for engineering goals such as sensor coverage, maximum safe speed, maximum detection distance, and power consumption while the wheelchair was stationary or driven by an investigator. Results indicate that the DSS provided uniform, reliable sensor coverage around the wheelchair; detected obstacles as small as 3.2 mm at distances of at least 1.6 m; and attained a maximum safe speed of 4.2 km/h. The DSS can drive reliably as close as 15.2 cm from a wall, traverse doorways as narrow as 81.3 cm without interrupting forward movement, and reduce wheelchair battery life by only 3%. These results have implications for a practical system to support safe, independent mobility for veterans who acquire multiple disabilities during Active Duty or later in life. These tests indicate that a system utilizing relatively low cost ultrasound, infrared, and force sensors can effectively detect obstacles in the vicinity of a wheelchair.     

A prototype power assist wheelchair that provides for obstacle detection and avoidance for those with visual impairments

Background

The cervical muscles are considered a potential site of whiplash injury, and there are many impact scenarios for whiplash injury. There is a need to understand the cervical muscle response under non-conventional whiplash impact scenarios, including variable head position and impact direction.

Methods

Twenty healthy volunteers underwent right anterolateral impacts of 4.0, 7.6, 10.7, and 13.0 m/s² peak acceleration, each with the head rotated to the left, then the head rotated to the right in a random order of impact severities. Bilateral electromyograms of the sternocleidomastoids, trapezii, and splenii capitis following impact were measured.

Results

At a peak acceleration of 13.0 m/s², with the head rotated to the right, the right trapezius generated 61% of its maximal voluntary contraction electromyogram (MVC EMG), while all other muscles generated 31% or less of this variable (31% for the left trapezius, 13% for the right spleinus. capitis, and 16% for the left splenius capitis). The sternocleidomastoids muscles also tended to show an asymmetric EMG response, with the left sternocleidomastoid (the one responsible for head rotation to the right) generating a higher percentage (26%) of its MVC EMG than the left sternocleidomastoid (4%) (p < 0.05). When the head is rotated to the left, under these same conditions, the results are reversed even though the impact direction remains right anterolateral.

Conclusion

The EMG response to a right anterolateral impact is highly dependent on the head position. The sternocleidomastoid responsible for the direction of head rotation and the trapezius ipsilateral to the direction of head rotation generate the most EMG activity.     

Characterization of power wheelchair use in the home and community

Sonenblum SE, Sprigle S, Harris FH, Maurer CL. Characterization of power wheelchair use in the home and community.

Objective

To characterize the use of power wheelchairs and to determine if multiple measures of mobility and occupancy jointly provide a more comprehensive picture of wheelchair usage and daily activity in full-time power wheelchair users than daily distance alone.

Design

Prospective observational study.

Setting

Subjects’ everyday mobility was measured in their homes and communities for 2 weeks, and prompted recall interviews were conducted by phone.

Participants

A convenience sample (N=25) of nonambulatory, full-time power wheelchair users.

Interventions

Not applicable.

Main Outcome Measures

Wheelchair usage was logged electronically, and geolocation and interview data were used to isolate chair use to (1) in the home, (2) not in the home indoors, or (3) outdoors. Distance wheeled, time spent wheeling, number of bouts, time spent in the wheelchair, and the percentage of time in the wheelchair spent wheeling were measured to describe wheelchair use.

Results

The median wheelchair user spent 10.6 hours (range, 5.0-16.6h) in his/her wheelchair daily and wheeled 1.085km (range, 0.238-10.585km) over 58 minutes (range, 16-173min) and 110 bouts (range, 36-282 bouts). Wheelchair use varied across subjects, within subjects from day to day, and between environments. Mobility bouts outdoors were longer and faster than those wheeled indoors. In a regression analysis, distance wheeled explained only 33% of the variation in the number of bouts and 75% in the time spent wheeling.

Conclusions

Power wheelchair use varies widely both within and between users. Measuring distance, time, and number of bouts provides a clearer picture of mobility patterns than measuring distance alone, whereas occupancy helps to measure wheelchair function in daily activities.     

Associating the onset of motor impairments with disability progression in nursing home residents

OBJECTIVES: To evaluate the association between the onset of movement impairments and disability progression in nursing home residents. DESIGN: Retrospective cohort analysis of data from the State of New York Minimal Data Set, version 2.0, between November 1998 and October 1999. Participants were nursing home residents (n = 84,346) in the State of New York. Items defined as "functional limitation in range of motion" and "lack of voluntary movement" served as measures of movement impairments. Scores on the activities of daily living summary scale served as a measure of disability. Age, sex, measures of cognition, depression, and measures of medical stability served as adjustment variables. RESULTS: After adjusting for age, sex, cognition, depression, and measures of medical stability, the onset of either singular or combined movement impairments in voluntary movement or range of motion was associated with a concurrent step-wise loss in activities of daily living (P < 0.001). The progression in activities of daily living loss occurred regardless of location or limb type. CONCLUSION: This study directly links the onset of movement impairments with disability progression. These findings have important implications for physiatrists and other practitioners of geriatric rehabilitation.     

A comparison of pain-assessment tools for use with elderly long-term-care residents.

The purpose of this study was to examine the psychometric properties (test-retest and interrater reliability, criterion concurrent validity) of 3 verbal pain-assessment tools (Faces Pain Scale, Numerical Rating Scale, Present Pain Intensity Scale) and a behavioural pain-assessment scale for use with an elderly population. The study used a repeated-measures design to examine the reliability and validity of the tools across 4 groups of participants with varying levels of cognitive impairment using a non-random stratified sample of 130 elderly long-term-care residents. The findings support the test-retest and interrater reliability of the behavioural pain-assessment tool across all levels of cognitive impairment, whereas the same measures of reliability for the verbal-report tools decreased with increasing cognitive impairment; however, the majority of elderly with mild to moderate cognitive impairment were able to complete at least 1 of these tools. The findings are discussed in relation to their clinical and research implications.     

Prevalence of pain in nursing home residents with different cognitive and communicative abilities

OBJECTIVES: To determine the prevalence of pain and its impact among nursing homes residents with different cognitive and communication abilities. DESIGN: Cross-sectional study. SETTING: Three nursing homes in Singapore. PARTICIPANTS: Residents aged 65 years and above, without a recent change in their cognitive status. MEASUREMENTS: Self-reports were obtained whenever possible. Pain severity was measured with the Pain Assessment in Advanced Dementia scale (categorized version) among the uncommunicative. Residents were also assessed with the short-form version of the Geriatric Depression Scale, the Cornell Scale for Depression in Dementia, the state portion of the Spielberger State-Trait Anxiety Inventory, and the Human Activities Profile. RESULTS: Pain prevalence did not differ between the communicative resident with normal cognition (48.7%), mildly impaired cognition (46.5%), or severely impaired cognition (42.9%). However, the latter 2 groups reported more acute pain than those with normal cognition (7.9% to 14.1% vs. 2.5%). Those with impaired cognition reported constant pain more often, reported fewer total sites of pain, and had more frequent and more severe pain. Regardless of cognitive status, 73.3% to 100% of residents had significant scores on depression or anxiety measures when they reported pain-related mood disturbance. Pain-related reduction in activity was associated with a lower Human Activities Profile score. Sixteen of 36 uncommunicative residents had pain on the Pain Assessment in Advanced Dementia and at least 12 of them had significant mood disturbance. CONCLUSIONS: Cognitive status does not affect pain prevalence; however, it affects the chronicity and characteristics of reported pain. Self-report of pain-related mood involvement is associated with significant mood scores.     

A comparison of five pain assessment scales for nursing home residents with varying degrees of cognitive impairment

The aim of the study was to compare five different pain assessment scales for use with people with different levels of cognitive impairment who resided in nursing homes. The verbal rating scale, horizontal numeric rating scale, Faces pictorial scale, color analogue scale and mechanical visual analogue scale were presented in random order to 113 residents. Cognitive impairment was assessed using the Mini-Mental State Examination. The use of the verbal rating scale was the most successful with this group, completed by 80.5% overall, and 36% of those with severe cognitive impairment. Repeated explanation improved completion rates for all the scales. Consistency between scores on the five scales was good for those with none to moderate cognitive impairment and poor for those severely impaired. This study showed no difference in pain scores according to cognitive status.     

Implementation and first experiences with a multimodal mentorship curriculum for medicine-paediatrics residents

IntroductionMentorship increases trainee productivity, promotes career satisfaction and reduces burnout. Beginning in 2016, our Medicine-Paediatrics residency program developed and implemented a longitudinal mentorship curriculum among trainees. We report initial experiences with that program and discuss potential future directions.Curriculum structure and method of implementationWe implemented and adapted a peer mentorship model and expanded it to include guest lectures and workshops centred around 13 core topics. Our expanded model included five longitudinal components: (1) peer mentorship; (2) virtual check-ins with residency leadership; (3) focussed didactics and workshops; (4) small-group dinners highlighting different career paths; and (5) dedicated faculty who pair residents with mentors based on common interests. We compared annual survey results on resident satisfaction with program mentorship, using chi-square and fisher’s exact tests to assess statistically significant differences pre- (2012–2016) and post-intervention (2016–2020).ResultsWe analysed 112 responses with annual response rate varying between 41.2% and 100%. Overall satisfaction with mentorship improved from 57.6% to 73.4% (p = .53), satisfaction with emotional support improved from 63.1% to 71.6% (p = .21), and satisfaction with career-specific mentorship improved from 48.5% to 59.5% (p = .70). Residents reported consistently high satisfaction with peer mentorship (77.8%–100%). The percent of residents reporting they had identified a career mentor increased from 60.0% in 2017 to 88.9% in 2019, which was sustained at 90.0% in 2020.ConclusionWe report our experience in implementing and adapting a mentorship curriculum for resident physicians in a single training program, including transitioning to a primarily online-based platform at the outset of the SARS-CoV-2 pandemic. Our results showed a trend towards improvement in resident satisfaction with overall and career-specific mentorship, as well as improved emotional support. Future work is needed using more objective outcome markers among a larger and more diverse group of residents.

KEY MESSAGES

• Among resident physicians in a single training program, a mix of mentor–mentee dyads, group-based peer mentoring and a structured curriculum has shown promise in improving resident-reported satisfaction with programmatic mentorship
• While we attempted to adapt the mentorship curriculum to an online platform with the development of the SARS-CoV-2 pandemic, reported satisfaction in overall mentorship and emotional support decreased in comparison to the prior year, an important focus for future work.

     

Effects of relaxing music on agitation during meals among nursing home residents with severe cognitive impairment

Relaxing music was hypothesized to buffer the general nolse level typically found in dining rooms of nursing homes, exert a calming effect, and thus reduce agitated behaviors among residents with severe cognitive impairment. Twenty-nine nursing home residents with severe cognitive deficits participated in a 4-week protocol in which, following baseline observations (week 1), relaxing music was introduced (week 2), removed (week 3), and reintroduced (week 4). Subjects were observed in terms of total number of behaviors of the Cohen-Mansfield Agitation Inventory present during a given week, and the number of behaviors present on the subscales of aggressive, physically nonaggressive, verbally agitated, and hiding/hoarding behaviors. Significant reductions were observed on the cumulative incidence of total agitated behaviors (63.4%); as well as the cumulative incidence of physically nonaggressive behaviors (56.3%) and verbally agitated behaviors (74.5%). No significant reductions were noted in terms of aggressive behaviors and hiding/hoarding behaviors. Where significant reductions were achieved, a distinct pattern was observed. Agitation decreased during week 2, increased again during week 3, only to decrease again in week 4. In addition, variance effects were noted as well, as ranges and standard deviations of agitated behaviors narrowed over time. These findings are interpreted within Hall and Buckwalter's (1988) model of a progressively lowered stress threshold among dementia patients.     

脑机接口联合多模态感知反馈训练对脑卒中后上肢功能恢复的探索性研究

摘要 目的：探究基于运动想象的脑机接口技术联合多模态感知反馈训练对脑卒中后严重偏瘫患者上肢运动功能恢复的临床可行性及有效性。 方法：本研究纳入在院康复脑卒中慢性期患者12例,在常规康复训练基础上,增加基于运动想象的脑机接口联合多模态感知反馈训练。在干预前后评估患者的上肢运动功能及日常生活活动能力,包括简化Fugl-Meyer量表上肢部分（FMA-UE）、腕关节主动活动度、手臂动作调查测试（action research arm test, ARAT）和Barthel指数（Barthel index, BI）。同时测量每位患者干预前后双侧M1区的运动诱发电位（motor evoked potentials, MEP）,探讨脑机接口训练对脑重塑的影响。 结果：所有患者均完成了治疗和评估,其中,FMA-UE及ARAT评分较干预前显著改善（P<0.05）,FMA-UE从基线的（13.50±8.20）分提高到（15.92±9.28）分,ARAT评分从基线的（3.08±5.96）分提高到（4.75±7.52）分;所有患者在干预前均不能主动伸展腕关节,2例受试者有小范围的主动屈腕,而在干预后,4例患者出现了较为明显的患侧腕关节自主伸展,6例患者出现显著的腕关节主动屈曲;所有患者的BI评分均未显示出显著变化。在治疗过程中未观察到不良事件。 结论：基于运动想象的脑机接口联合多模态感知反馈训练或能有效改善脑卒中严重偏瘫患者的上肢运动功能恢复。     

Music listening for maintaining attention of older adults with cognitive impairments

Twelve older adults with cognitive impairments who were participants in weekly community-based group music therapy sessions, 6 older adults in an Alzheimer's caregivers' group, and 6 college student volunteers listened to a 3.5 minute prepared audiotape of instrumental excerpts of patriotic selections. The tape consisted of 7 excerpts ranging from 18 s to 34 s in duration. Each music excerpt was followed by a 7-9 s period of silence, a "wait" excerpt. Listeners were instructed to move a Continuous Response Digital Interface (CRDI) to the name of the music excerpt depicted on the CRDI overlay when they heard a music excerpt. Likewise, they were instructed to move the dial to the word "WAIT" when there was no music. They were also instructed to maintain the dial position for the duration of each music or silence excerpt. Statistical analysis indicated no significant differences between the caregivers' and the college students' group means for total dial changes, correct and incorrect recognitions, correct and incorrect responses to silence excerpts, and reaction times. The mean scores of these 2 groups were combined and compared with the mean scores of the group of elderly adults with cognitive impairments. The mean total dial changes were significantly lower for the listeners with cognitive impairments, resulting in significant differences in all of the other response categories except incorrect recognitions. In addition, their mean absence of response to silence excerpts was significantly higher than their mean absence of responding to music excerpts. Their mean reaction time was significantly slower than the comparison group's reaction time. To evaluate training effects, 10 of the original 12 music therapy participants repeated the listening task with assistance from the therapist (treatment) immediately following the first listening (baseline). A week later the order was reversed for the 2 listening trials. Statistical and graphic analysis of responses between first and second baseline responses indicate significant improvement in responses to silence and music excerpts over the 2 sessions. Applications of the findings to music listening interventions for maintaining attention, eliciting social interaction between clients or caregivers and their patients, and evaluating this population's affective responses to music are discussed.     

Interrater and intrarater reliability of the wheelchair skills test version 4.2 for power wheelchair users

Purpose: The purpose of this study is to estimate the interrater and intrarater reliability of the Wheelchair Skills Test (WST) Version 4.2 for powered wheelchairs operated by adult users.

Materials and methods: Cohort study with a convenience sample of occupational therapists (n?=?10). For the main outcome measure, participants viewed and scored eight videos of adult power wheelchair users completing the 30 skills of the WST Version 4.2 on two occasions, a minimum of two weeks apart. Using these scores, we calculated intraclass correlation coefficients to estimate interrater and intrarater reliability.

Results: The interrater reliability intraclass correlation coefficient was 0.940 (95%CI 0.862–0.985). Intrarater reliability intraclass correlation coefficients ranged from 0.923 to 0.998.

Conclusions: The WST Version 4.2 has excellent interrater and intrarater reliability and is a reliable tool for use in clinical and research practice to evaluate a power wheelchair user’s skill capacity.

• Implications for Rehabilitation

• The Wheelchair Skills Test for Powered Wheelchair Users (WST-P 4.2) is a useful addition to the clinical tools available for clinicians who assess and train for powered wheelchair use.

• The WST-P 4.2 has excellent reliability and potential for clinical use as a pre-post measure of powered wheelchair skills.

• Clinicians using the WST-P 4.2 should attempt to maintain consistent scoring procedures, particularly for those skills that may require subjective assessment of skill safety.