The objective was to explore the care experiences and service design related to rehabilitation fo... more The objective was to explore the care experiences and service design related to rehabilitation for mobility and participation in the community among individuals with acquired brain injury (ABI), as perceived by clinicians and patients. Five focus groups were held: three with clinicians and two with individuals with ABI. Focus group discussions were transcribed and analyzed using an inductive and deductive thematic content approach. Five themes were identified: Enabling continuity of care; System design; Accessibility and services in the community; Transportation services; and Uncertainty about the provided services. The results of participants’ experiences contributed to developing recommendations of service provision for mobility, leading to a patient-centered continuum of rehabilitation services. Accessibility to rehabilitation to improve the quality of care by addressing needs during transitions and mobility-related deficits, providing needed information, coordinated care, and self-management support in the community.
Background: Virtual reality (VR) is increasingly being incorporated into research and clinical pr... more Background: Virtual reality (VR) is increasingly being incorporated into research and clinical practice. Its usefulness, however, remains largely dependent on the extent to which it elicits human behaviors that are similar to those observed in the real world. Objectives: In this study, we estimated whether obstacle avoidance strategies while walking in response to pedestrians approaching from different directions differed when performed in a virtual (VE) vs. physical environment (PE). We also examined the extent to which avoidance strategies in the VE change with repeated practice. Methods: Participants (n=4) were assessed while walking overground and avoiding moving pedestrians in both a VE and a PE, in a random order. Three female collaborators acted as interferers in the PE experiment. For the VE experiment, we created avatars using full body kinematics recorded from the actors. The task consisted of walking towards a target while avoiding one of the interferers, which could approach from either the left or right side (±30°), or from the center (0°). In a fourth condition, all interferers walked away (no obstacle). Results: Delayed onset times of avoidance strategy and slower walking speeds were observed in the VE vs. PE. With practice in the VE, there was a progressive decrease in onset time of avoidance strategy and an increase in walking speed. Differences between the two environments, however, persisted by the end of the experiment. Maximal trajectory deviation and distance at onset of avoidance strategy remained comparable between the VE and PE throughout the experiment. Conclusion: Obstacle avoidance behavior in response to moving pedestrians differs in the VE vs. PE, although spatial parameters (e.g. distance at the onset and maximum lateral deviation) appear to be similar. Differences decrease but remain present despite of repeated exposure to the VE. Results should be taken into consideration when using the VR technology for assessment or training purposes.
patients with cerebral and cerebellar lesions due to stroke and degenerative diseases, gait distu... more patients with cerebral and cerebellar lesions due to stroke and degenerative diseases, gait disturbance such as hemiparetic gait and ataxic gait was characterized by the combination of asymmetrical activities in the medial motor related areas, recruitment of premotor cortex and prefrontal cortex, and abnormal time-course of oxygenated hemoglobin signals during sustained gait. Improved gait performance after rehabilitative intervention was related to improvement of these abnormal signal patterns and/or augmented signals in the motor related areas. Cortical activities during postural control were also modified by these diseases. Recent data have suggested that the prefrontal cortex plays an important role in controlling balance in healthy subjects and patients with cerebral and cerebellar lesions. Supported by Grant-in-Aid for “the Research Committee for Ataxic Diseases” of Research on Measures for Intractable Diseases & Research Grant (21B-9) for Nervous and Mental Disorders.
Background: Unilateral spatial neglect (USN), a highly prevalent post-stroke impairment, has been... more Background: Unilateral spatial neglect (USN), a highly prevalent post-stroke impairment, has been strongly associated with poor functional outcomes in self-care and instrumental activities of daily living. Hence, its sensitive detection is crucial. Yet, conventional USN assessments present with significant limitations, often leading to misdiagnosis. Virtual reality (VR) can be used to counteract those issues and increase detection sensitivity. Objective: To examine the feasibility, refine development and promote future implementation of a novel Ecological VR-based Evaluation of Neglect Symptoms (EVENS). Methods: EVENS consists of two (simple and complex) immersive, 3-D scenes, depicting grocery shopping shelves, where object-detection and navigation tasks are performed using a joystick. Through a cross-sectional study, the effects of virtual scene complexity on navigational and detection abilities in patients with (USN+) and without (USN−) post-stroke USN and in healthy controls (HC) were determined. These findings were complimented by gathering the opinion of clinicians and experts in the field as to the barriers/facilitators to the use of VR and the features for an optimal assessment. Results: Longer detection times and larger mediolateral deviations from ideal paths were found in USN+ vs. USN− and HC groups. Several barriers/facilitators for clinical VR use and features of an optimal VR-based tool were identified. Conclusion: Navigation and detection abilities are affected by environmental complexity of the VR scene in individuals with post-stroke USN and can be employed for USN assessment. The present knowledge translation initiatives can refine EVENS' design and promote its future application and adherence to its use in clinical settings.
Background: Avoiding collisions with other pedestrians during overground locomotion is a trivial ... more Background: Avoiding collisions with other pedestrians during overground locomotion is a trivial task for young adults, but with age or for stroke survivors it can become a daunting endeavour. Coordinated eye-head movements probably play an important role in obstacle circumvention, but unfortunately the literature on the subject is rather scarce. Objectives: The aim of this study was therefore to investigate eye-head coordination during overground locomotion, and, more specifically, during avoidance of dynamic virtual pedestrians. Methods: We recorded eye (ASL eyetracker ) and body (Vicon system) movements in five healthy young adults during overground locomotion as they navigated in a virtual environment visualized in a helmet mounted display. Medio-lateral (ML) displacements as well as the pattern of eye, head and gaze reorientation in the horizontal plane were examined. Participants were instructed to walk toward a goal represented by a blue target located 9.5m straight ahead and to avoid a non-reactive human-like avatar coming from different angles of approach. Results: We found that ML trajectory displacements were preceded by a head rotation in the direction of veering. Halfway through the ML head displacement, a head rotation in the direction opposite to that of the ML displacement was observed. Head rotations were themselves preceded by eye saccade(s) toward the side of circumvention. During the circumvention, no attempt was made to keep the head in alignment with the goal. Conclusions: Eye/gaze movements appear to play an important role during the avoidance of dynamic obstacles while walking. Eye movements are initiated ahead of the trajectory ML displacement, possibly to localize the obstacle and/or plan the future walking trajectory.
Abstract Objectives To identify factors which may influence mobility and could be considered duri... more Abstract Objectives To identify factors which may influence mobility and could be considered during the evaluation of mobility in individuals with acquired brain injury (ABI) following qualitative focus groups with both clinicians and individuals with ABI, to assess their needs and preferences in order to individualize their care management plans. Methods Five focus groups were held, three with clinicians from 3 rehabilitation sites of CRIR (CRDM: n = 4; IURDPM: n = 3; JRH: n = 10) and two with individuals with ABI from one rehabilitation site (CRDM) (individuals with stroke: n = 5; individuals with TBI: n = 5). Focus group discussions were transcribed and analyzed using inductive and deductive thematic content approaches. Results Four themes were identified: considering mobility holistically and individual needs, preferences, and unique experiences; assessment and intervention guidelines; support network; and uncertainty about symptoms and recovery. Using the ten-rule International Classification, Functioning, Disability, and Health framework linking process, codes were categorized into Body Functions Activity and Participation, and Environmental Factors exploring the prominent domains that mostly identify factors influencing mobility. Conclusions Comprehensive measurement of mobility remains an ongoing challenge owing to multiple contributing factors, ranging from personal and psychosocial factors to the influence of a myriad of environmental and community considerations. Preparing individuals with ABI for community mobility can be substantially improved if healthcare professionals employ communicative tools to facilitate shared decision making with patients and to deliver patient-centred rehabilitation care.
A model of Multiple Resource Theory (MRT) was created to describe the influence of different conc... more A model of Multiple Resource Theory (MRT) was created to describe the influence of different concurrent tasks on driving but no such framework exists for DT walking. The objective of this study was to modify MRT model and computational DT framework to explore two task-related concepts—resource demand and resource conflict—in the context of gait and to illustrate the initial validity of the modified model. A literature search was conducted to identify DT walking-related elements related to the MRT model. An instructional guide for utilizing the computational framework was constructed using a modified e-Delphi method. Inter-rater reliability of the constructed guideline was analyzed by Kappa statistics. The initial validity of the modified model was tested using meta-regression analyses. Three new elements were included into the modified model: vestibular and somatosensory perceptions, and locomotor response. The spatial code from the original model was modified into a visuospatial domain. The computational framework was constructed, and two separate guidelines were created for walking and concurrent tasks. Using the guidelines and computational framework, task-related elements were quantified for meta-regression analysis. The analysis showed that the modified model can explain 79% of the variability in speed reduction during DT walking.
To compare results of 3 clinical vestibular tests between children with global developmental dela... more To compare results of 3 clinical vestibular tests between children with global developmental delay (GDD) and children with typical development (TD) and investigate the test-retest reliability. Twenty children with GDD (aged 4.1-12.1 years) and 11 age-matched controls with TD participated. Participants with GDD underwent 2 sessions of testing. Each session consisted of the Clinical Test of Sensory Interaction and Balance (CTSIB), Dynamic Visual Acuity (DVA) test, and the modified Emory Clinical Vestibular Chair Test (m-ECVCT). Up to 33% of the children with GDD had abnormal DVA scores. m-ECVCT results of children with GDD demonstrated larger variance than children with TD. The CTSIB score was significantly reduced in the group with GDD. The test-retest reliability varied, with good reliability for the m-ECVCT and CTSIB, and fair reliability for the DVA. Findings suggest vestibular involvement in children in GDD. The clinical tests demonstrated moderate test-retest reliability.
BACKGROUND Reading text messages is associated with accidents while walking in community places. ... more BACKGROUND Reading text messages is associated with accidents while walking in community places. RESEARCH QUESTION To what extent does reading text messages at different stages of obstacle circumvention affect avoidance strategies while walking in young vs. older adults? METHODS Sixteen healthy young and 14 older adults were assessed while walking and viewing a virtual environment (VE) simulating a subway station with three virtual pedestrians positioned 7.5 m away from the participant in the centre (0°), left and right (±40°). As participants advanced 0.5 m towards a target in the far space, a virtual pedestrian randomly approached them. Text messages were delivered at onset of pedestrian movement (0.5 m; early message) or during obstacle circumvention (2.5 m; late message). A Vicon motion capture system captured trajectory displacement while walking. RESULTS In both age groups, accuracy of message report (AMR) was reduced for early compared to late messages (p < 0.001), although older adults showed larger deterioration (p < 0.001) compared to younger participants. Locomotor outcomes (obstacle clearance, onset time of avoidance and walking speed) showed no differences between young and older participants (p > 0.05). Early messages led to slower walking speed (p < 0.001) and more frequent collisions compared to late messages and the no-message condition. Late messages yielded faster walking speed (p < 0.001) and onset time of avoidance (p < 0.02) compared to the other conditions. SIGNIFICANCE Results indicate that the stage of an avoidance strategy at which text messages are received impacts on pedestrian circumvention, with early messages posing a greater challenge to collision avoidance. In older adults, the reduced AMR suggests larger dual-task interference and prioritization of the walking task. The lack of further walking speed reduction in older vs. young adults may put them at greater risk of collisions in crowded, unpredictable community environments.
Gait asymmetry, one of the hallmarks of post-stroke locomotion, often persists despite of gait re... more Gait asymmetry, one of the hallmarks of post-stroke locomotion, often persists despite of gait rehabilitation interventions and negatively affects functional mobility. This pilot study examines the feasibility and instantaneous effects of real-time visual feedback provided in the form of a virtual avatar replicating on gait symmetry after stroke. Based on the results obtained from one chronic stroke survivor, step length and step time ratios were improved towards normal values (1.0) in presence of the avatar displayed in a third person back and paretic side view, while mixed results were observed for the front view condition. Gains were not maintained following the removal of the avatar. These preliminary results, to be confirmed in a larger sample of participants, support the feasibility of using virtual avatars as a source of visual feedback to promote gait symmetry in stroke survivors.
The objective was to explore the care experiences and service design related to rehabilitation fo... more The objective was to explore the care experiences and service design related to rehabilitation for mobility and participation in the community among individuals with acquired brain injury (ABI), as perceived by clinicians and patients. Five focus groups were held: three with clinicians and two with individuals with ABI. Focus group discussions were transcribed and analyzed using an inductive and deductive thematic content approach. Five themes were identified: Enabling continuity of care; System design; Accessibility and services in the community; Transportation services; and Uncertainty about the provided services. The results of participants’ experiences contributed to developing recommendations of service provision for mobility, leading to a patient-centered continuum of rehabilitation services. Accessibility to rehabilitation to improve the quality of care by addressing needs during transitions and mobility-related deficits, providing needed information, coordinated care, and self-management support in the community.
Background: Virtual reality (VR) is increasingly being incorporated into research and clinical pr... more Background: Virtual reality (VR) is increasingly being incorporated into research and clinical practice. Its usefulness, however, remains largely dependent on the extent to which it elicits human behaviors that are similar to those observed in the real world. Objectives: In this study, we estimated whether obstacle avoidance strategies while walking in response to pedestrians approaching from different directions differed when performed in a virtual (VE) vs. physical environment (PE). We also examined the extent to which avoidance strategies in the VE change with repeated practice. Methods: Participants (n=4) were assessed while walking overground and avoiding moving pedestrians in both a VE and a PE, in a random order. Three female collaborators acted as interferers in the PE experiment. For the VE experiment, we created avatars using full body kinematics recorded from the actors. The task consisted of walking towards a target while avoiding one of the interferers, which could approach from either the left or right side (±30°), or from the center (0°). In a fourth condition, all interferers walked away (no obstacle). Results: Delayed onset times of avoidance strategy and slower walking speeds were observed in the VE vs. PE. With practice in the VE, there was a progressive decrease in onset time of avoidance strategy and an increase in walking speed. Differences between the two environments, however, persisted by the end of the experiment. Maximal trajectory deviation and distance at onset of avoidance strategy remained comparable between the VE and PE throughout the experiment. Conclusion: Obstacle avoidance behavior in response to moving pedestrians differs in the VE vs. PE, although spatial parameters (e.g. distance at the onset and maximum lateral deviation) appear to be similar. Differences decrease but remain present despite of repeated exposure to the VE. Results should be taken into consideration when using the VR technology for assessment or training purposes.
patients with cerebral and cerebellar lesions due to stroke and degenerative diseases, gait distu... more patients with cerebral and cerebellar lesions due to stroke and degenerative diseases, gait disturbance such as hemiparetic gait and ataxic gait was characterized by the combination of asymmetrical activities in the medial motor related areas, recruitment of premotor cortex and prefrontal cortex, and abnormal time-course of oxygenated hemoglobin signals during sustained gait. Improved gait performance after rehabilitative intervention was related to improvement of these abnormal signal patterns and/or augmented signals in the motor related areas. Cortical activities during postural control were also modified by these diseases. Recent data have suggested that the prefrontal cortex plays an important role in controlling balance in healthy subjects and patients with cerebral and cerebellar lesions. Supported by Grant-in-Aid for “the Research Committee for Ataxic Diseases” of Research on Measures for Intractable Diseases & Research Grant (21B-9) for Nervous and Mental Disorders.
Background: Unilateral spatial neglect (USN), a highly prevalent post-stroke impairment, has been... more Background: Unilateral spatial neglect (USN), a highly prevalent post-stroke impairment, has been strongly associated with poor functional outcomes in self-care and instrumental activities of daily living. Hence, its sensitive detection is crucial. Yet, conventional USN assessments present with significant limitations, often leading to misdiagnosis. Virtual reality (VR) can be used to counteract those issues and increase detection sensitivity. Objective: To examine the feasibility, refine development and promote future implementation of a novel Ecological VR-based Evaluation of Neglect Symptoms (EVENS). Methods: EVENS consists of two (simple and complex) immersive, 3-D scenes, depicting grocery shopping shelves, where object-detection and navigation tasks are performed using a joystick. Through a cross-sectional study, the effects of virtual scene complexity on navigational and detection abilities in patients with (USN+) and without (USN−) post-stroke USN and in healthy controls (HC) were determined. These findings were complimented by gathering the opinion of clinicians and experts in the field as to the barriers/facilitators to the use of VR and the features for an optimal assessment. Results: Longer detection times and larger mediolateral deviations from ideal paths were found in USN+ vs. USN− and HC groups. Several barriers/facilitators for clinical VR use and features of an optimal VR-based tool were identified. Conclusion: Navigation and detection abilities are affected by environmental complexity of the VR scene in individuals with post-stroke USN and can be employed for USN assessment. The present knowledge translation initiatives can refine EVENS' design and promote its future application and adherence to its use in clinical settings.
Background: Avoiding collisions with other pedestrians during overground locomotion is a trivial ... more Background: Avoiding collisions with other pedestrians during overground locomotion is a trivial task for young adults, but with age or for stroke survivors it can become a daunting endeavour. Coordinated eye-head movements probably play an important role in obstacle circumvention, but unfortunately the literature on the subject is rather scarce. Objectives: The aim of this study was therefore to investigate eye-head coordination during overground locomotion, and, more specifically, during avoidance of dynamic virtual pedestrians. Methods: We recorded eye (ASL eyetracker ) and body (Vicon system) movements in five healthy young adults during overground locomotion as they navigated in a virtual environment visualized in a helmet mounted display. Medio-lateral (ML) displacements as well as the pattern of eye, head and gaze reorientation in the horizontal plane were examined. Participants were instructed to walk toward a goal represented by a blue target located 9.5m straight ahead and to avoid a non-reactive human-like avatar coming from different angles of approach. Results: We found that ML trajectory displacements were preceded by a head rotation in the direction of veering. Halfway through the ML head displacement, a head rotation in the direction opposite to that of the ML displacement was observed. Head rotations were themselves preceded by eye saccade(s) toward the side of circumvention. During the circumvention, no attempt was made to keep the head in alignment with the goal. Conclusions: Eye/gaze movements appear to play an important role during the avoidance of dynamic obstacles while walking. Eye movements are initiated ahead of the trajectory ML displacement, possibly to localize the obstacle and/or plan the future walking trajectory.
Abstract Objectives To identify factors which may influence mobility and could be considered duri... more Abstract Objectives To identify factors which may influence mobility and could be considered during the evaluation of mobility in individuals with acquired brain injury (ABI) following qualitative focus groups with both clinicians and individuals with ABI, to assess their needs and preferences in order to individualize their care management plans. Methods Five focus groups were held, three with clinicians from 3 rehabilitation sites of CRIR (CRDM: n = 4; IURDPM: n = 3; JRH: n = 10) and two with individuals with ABI from one rehabilitation site (CRDM) (individuals with stroke: n = 5; individuals with TBI: n = 5). Focus group discussions were transcribed and analyzed using inductive and deductive thematic content approaches. Results Four themes were identified: considering mobility holistically and individual needs, preferences, and unique experiences; assessment and intervention guidelines; support network; and uncertainty about symptoms and recovery. Using the ten-rule International Classification, Functioning, Disability, and Health framework linking process, codes were categorized into Body Functions Activity and Participation, and Environmental Factors exploring the prominent domains that mostly identify factors influencing mobility. Conclusions Comprehensive measurement of mobility remains an ongoing challenge owing to multiple contributing factors, ranging from personal and psychosocial factors to the influence of a myriad of environmental and community considerations. Preparing individuals with ABI for community mobility can be substantially improved if healthcare professionals employ communicative tools to facilitate shared decision making with patients and to deliver patient-centred rehabilitation care.
A model of Multiple Resource Theory (MRT) was created to describe the influence of different conc... more A model of Multiple Resource Theory (MRT) was created to describe the influence of different concurrent tasks on driving but no such framework exists for DT walking. The objective of this study was to modify MRT model and computational DT framework to explore two task-related concepts—resource demand and resource conflict—in the context of gait and to illustrate the initial validity of the modified model. A literature search was conducted to identify DT walking-related elements related to the MRT model. An instructional guide for utilizing the computational framework was constructed using a modified e-Delphi method. Inter-rater reliability of the constructed guideline was analyzed by Kappa statistics. The initial validity of the modified model was tested using meta-regression analyses. Three new elements were included into the modified model: vestibular and somatosensory perceptions, and locomotor response. The spatial code from the original model was modified into a visuospatial domain. The computational framework was constructed, and two separate guidelines were created for walking and concurrent tasks. Using the guidelines and computational framework, task-related elements were quantified for meta-regression analysis. The analysis showed that the modified model can explain 79% of the variability in speed reduction during DT walking.
To compare results of 3 clinical vestibular tests between children with global developmental dela... more To compare results of 3 clinical vestibular tests between children with global developmental delay (GDD) and children with typical development (TD) and investigate the test-retest reliability. Twenty children with GDD (aged 4.1-12.1 years) and 11 age-matched controls with TD participated. Participants with GDD underwent 2 sessions of testing. Each session consisted of the Clinical Test of Sensory Interaction and Balance (CTSIB), Dynamic Visual Acuity (DVA) test, and the modified Emory Clinical Vestibular Chair Test (m-ECVCT). Up to 33% of the children with GDD had abnormal DVA scores. m-ECVCT results of children with GDD demonstrated larger variance than children with TD. The CTSIB score was significantly reduced in the group with GDD. The test-retest reliability varied, with good reliability for the m-ECVCT and CTSIB, and fair reliability for the DVA. Findings suggest vestibular involvement in children in GDD. The clinical tests demonstrated moderate test-retest reliability.
BACKGROUND Reading text messages is associated with accidents while walking in community places. ... more BACKGROUND Reading text messages is associated with accidents while walking in community places. RESEARCH QUESTION To what extent does reading text messages at different stages of obstacle circumvention affect avoidance strategies while walking in young vs. older adults? METHODS Sixteen healthy young and 14 older adults were assessed while walking and viewing a virtual environment (VE) simulating a subway station with three virtual pedestrians positioned 7.5 m away from the participant in the centre (0°), left and right (±40°). As participants advanced 0.5 m towards a target in the far space, a virtual pedestrian randomly approached them. Text messages were delivered at onset of pedestrian movement (0.5 m; early message) or during obstacle circumvention (2.5 m; late message). A Vicon motion capture system captured trajectory displacement while walking. RESULTS In both age groups, accuracy of message report (AMR) was reduced for early compared to late messages (p < 0.001), although older adults showed larger deterioration (p < 0.001) compared to younger participants. Locomotor outcomes (obstacle clearance, onset time of avoidance and walking speed) showed no differences between young and older participants (p > 0.05). Early messages led to slower walking speed (p < 0.001) and more frequent collisions compared to late messages and the no-message condition. Late messages yielded faster walking speed (p < 0.001) and onset time of avoidance (p < 0.02) compared to the other conditions. SIGNIFICANCE Results indicate that the stage of an avoidance strategy at which text messages are received impacts on pedestrian circumvention, with early messages posing a greater challenge to collision avoidance. In older adults, the reduced AMR suggests larger dual-task interference and prioritization of the walking task. The lack of further walking speed reduction in older vs. young adults may put them at greater risk of collisions in crowded, unpredictable community environments.
Gait asymmetry, one of the hallmarks of post-stroke locomotion, often persists despite of gait re... more Gait asymmetry, one of the hallmarks of post-stroke locomotion, often persists despite of gait rehabilitation interventions and negatively affects functional mobility. This pilot study examines the feasibility and instantaneous effects of real-time visual feedback provided in the form of a virtual avatar replicating on gait symmetry after stroke. Based on the results obtained from one chronic stroke survivor, step length and step time ratios were improved towards normal values (1.0) in presence of the avatar displayed in a third person back and paretic side view, while mixed results were observed for the front view condition. Gains were not maintained following the removal of the avatar. These preliminary results, to be confirmed in a larger sample of participants, support the feasibility of using virtual avatars as a source of visual feedback to promote gait symmetry in stroke survivors.
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