BACKGROUND:The number of people who require a wheelchair is rising due to an increased number of injuries and the growing number of elderly. Training of new wheelchair users is mandatory to let them feel independent and safe. Virtual reality (VR)-based wheelchair simulators allow training wheelchair skills in a controlled, safe, and repeatable environment. Our group recently developed a wheelchair simulator for a motion platform in semi-immersive VR. OBJECTIVE:To assess the usability and user experience of two VR-based training environments in 20 participants considering the sense of presence, the cybersickness, the suitability of VR system, and the performance and to assess if these evaluations are influenced by the expertise in the use of a wheelchair. MATERIALS AND METHODS:The simulator was composed of a moving platform, an adaptable wheelchair, and two VR environments (one outdoor - OE, one indoor - IE) projected on a 180° screen. 10 able-bodied volunteers (wheelchair naïve-users, WNUs) and 10 expert wheelchair users (WUs) due to spinal cord injury were recruited. They performed one session during which they tested the indoor (IE) and the outdoor (OE) VR environment. Measures to assess user experience, such as the System Usability Scale, the Technological Acceptance Measure, and the Suitability Evaluation Questionnaire were administered. RESULTS:The usability of WUs was high in both environments, while WNUs had some difficulties in IE navigation. Acceptance (TAM mean score) was significantly higher for the OE (p-value = 0.017) in both groups (WNU-OE: 5.11 ± 0.44; WU-OE: 5.18 ± 0.67; WNU-IE: 4.75 ± 0.47; WU-IE: 4.85 ± 0.62). Suitability was higher for OE and generally higher for WUs. CONCLUSION:Our study focused on user experience during VR-powered wheelchair navigation in both WUs and naïve ones. The system proved to be engaging and caused low cybersickness effects. Future works will focus on longer training and will assess performance improvements longitudinally.

BACKGROUND:Employment is an essential component of life as it provides income, sense of engagement and opportunities for personal development. Unemployment due to disability following an accident may have dramatic social and psychological consequences on individuals; it is thus fundamental to foster return to work of these persons.OBJECTIVE:The present work was aimed to develop a methodology determining suitable jobs for people living with disability after a job-related accident.METHODS:The Occupational Information Network (O*NET) taxonomy was combined with the International Classification of Functioning, Disability and Health (ICF) to match individual resources with specific job requirements. ICF Linking Rules were employed by two independent groups of researchers to associate ICF codes to O*NET skill and ability descriptors.RESULTS:O*NET descriptors were linked to 92 unique ICF codes. A "Criticality score" combining ICF and O*NET features to assess suitability of selected jobs for persons with disabilities was also proposed.CONCLUSIONS:The proposed methodology represents a novel instrument to support return to work; the capability to assess specific work-related facets through the lens of both the ICF model and O*NET taxonomy would conceivably provide vocational rehabilitation specialists and occupational therapists with a useful tool fostering job placement of workers with disability.

Additive Manufacturing (AM) techniques have attracted great interest in sectors with high benefit such as the Medtech. The AM of continuous fiber reinforced composite is a technology that, although still in its initial development, appears to be very promising. The AM process could be particularly interesting for the production of prosthetic devices for sports (ESAR devices such as foot or foil). In this work, is explored the potential of additive manufacturing in the field of prosthetics of the lower limb through an multidisciplinary approach, involving several competences from the clinical evaluation, integration of biomechanics, development of new composite and hybrid materials based on polymers, carbon fibres and metal inserts, and implementation of optical sensors with their integration in the composites for the continuous monitoring of prosthetic devices and their durability.

Running is an essential activity for children with cerebral palsy (CP). This study aims to characterize the locomotor pattern of running in hemiplegic children with new generation ankle foot orthosis (AFOs) conceived to foster intense motor activities such as running. A group of 18 children with spastic hemiplegia was recruited. A biomechanical multivariable comparison was made between barefoot and with AFO running trials. The focus was devoted to bilateral sagittal plane hip, knee, ankle kinematics and kinetics, and three-dimensional ground reaction forces. Wearing the orthoses, the children were found to reduce cadence and the duration of the stance phase as well as increase the step and stride length. The new AFO resulted in significant changes in kinematics of affected ankle both at initial contact 0–3% GC (p < 0.017) and during the entire swing phase 31–100%GC (p < 0.001) being the ankle more dorsiflexed with AFO compared to barefoot condition. Ankle power was found to differ significantly both in absorption and generation 5–10%GC (p < 0.001); 21–27%GC (p < 0.001) with a reduction in both cases when the AFO was worn. No statistical differences were recorded in the GRF components, in the affected ankle torque and hip and knee kinematics and kinetics.

Robot assisted gait training (RAGT) and virtual reality plus treadmill training (VRTT) are two technologies that can support locomotion rehabilitation in children and adolescents affected by acquired brain injury (ABI). The literature provides evidence of their effectiveness in this population. However, a comparison between these methods is not available. This study aims at comparing the effectiveness of RAGT and VRTT for the gait rehabilitation of children and adolescents suffering from ABI. This is a prospective cohort study with propensity score matching. Between October 2016 and September 2018, all patients undergoing an intensive gait rehabilitation treatment based on RAGT or VRTT were prospectively observed. To minimize selection bias associated with the study design, patients who underwent RAGT or VRTT were retrospectively matched for age, gender, time elapsed from injury, level of impairment, and motor impairment using propensity score in a matching ratio of 1:1. Outcome measures were Gross Motor Function Mesure-88 (GMFM-88), six-min walking test (6MWT), Gillette Functional Assessment Questionnaire (FAQ), and three-dimensional gait analysis (GA). The FAQ and the GMFM-88 had a statistically significant increase in both groups while the 6MWT improved in the RAGT group only. GA highlighted changes at the proximal level in the RAGT group, and at the distal district in the VRTT group. Although preliminary, this work suggests that RAGT and VRTT protocols foster different motor improvements, thus recommending to couple the two therapies in the paediatric population with ABI.

Objective . The minimum clinically important difference (MCID) is a standard way of measuring clinical relevance. The objective of this work was to establish the MCID for the 6-minute walking test (6minWT) and the Gross Motor Function Measure (GMFM-88) in pediatric gait disorders. Methods . A cohort, pretest-posttest study was conducted in a hospitalized care setting. A total of 182 patients with acquired brain injury (ABI) or cerebral palsy (CP) performed 20 robot-assisted gait training sessions complemented with 20 sessions of physical therapy over 4 weeks. Separate MCIDs were calculated using 5 distribution-based approaches, complemented with an anonymized survey completed by clinical professionals. Results . The MCID range for the 6minWT was 20-38 m in the ABI cohort, with subgroup ranges of 20-36 m for GMFCS I-II, 23-46 m for GMFCS III, and 24-46 m for GMFCS IV. MCIDs for the CP population were 6-23 m, with subgroup ranges of 4-28 m for GMFCS I-II, 9-19 m for GMFCS III, and 10-27 m for GMFCS IV. For GMFM-88 total score, MCID values were 1.1%-5.3% for the ABI cohort and 0.1%-3.0% for the CP population. For dimension “D” of the GMFM, MCID ranges were 2.3%-6.5% and 0.8%-5.2% for ABI and CP populations, respectively. For dimension “E,” MCID ranges were 2.8%-6.5% and 0.3%-4.9% for ABI and CP cohorts, respectively. The survey showed a large interquartile range, but the results well mimicked the distribution-based methods. Conclusions . This study identified for the first time MCID ranges for 6minWT and GMFM-88 in pediatric patients with neurological impairments, offering useful insights for clinicians to evaluate the impact of treatments. Distribution-based methods should be used with caution: methods based on pre-post correlation may underestimate MCID when applied to patients with small improvements over the treatment period. Our results should be complemented with estimates obtained using consensus- and anchor-based approaches.

Maintenance of stability for children in a wheelchair, particularly for those with spasticity, can be achieved through external stabilization components, such as pelvic positioning belts. Different kinds of pelvic belts exist on the market and one of the main characteristics is the different number of attachment points between the seat and the belt. As literature on this topic is limited to qualitative assessments, this study compared quantitatively 4-point versus 2-point pelvic positioning belts for the trunk fixation in 20 young patients with spasticity. Our data showed that 70% of the children required the use of pelvic belts on wheelchairs for stability and a better stability was observed with the 4-point belts than compared to the 2-point. Data generally showed in fact a higher percent of variation in terms of trunk flexion angle and knee joint angle with the 2-point belt than the 4-point belt, indicating increased submarining with the 2-point belt during sitting maintenance if compared to the 4-point belt (p < 0.05). According to our results, the 4-point belts seem to be the most effective configuration for patient stabilization, suggesting that its use prevents the thigh from submarining.

This study compared the effects of solid and hinged ankle-foot orthoses (AFOs) on the gait of children with spastic diplegic cerebral palsy (CP) who ambulate with excessive ankle plantar flexion during stance. Twelve children with spastic diplegic CP wore no AFOs for an initial 2-week period, solid AFOs for 1 month, no AFOs for 2 weeks, and hinged AFOs for 1 month. Lower extremity muscle timing, knee and ankle joint motions, moments and powers, and temporal-distance characteristics were measured during ambulation for an initial barefoot baseline test, and with solid and hinged AFOs for the other two tests. Both orthoses increased stride length, reduced abnormal ankle plantar flexion during initial contact, midstance and terminal stance (TST), and increased ankle plantar flexor moments closer to normal during TST. Hinged AFOs increased ankle dorsiflexion at TST and increased ankle power generation during preswing (PSW) as compared to solid AFOs, and increased ankle dorsiflexion at loading compared to no AFOs. No other significant differences were found for the gait variables when comparing these orthoses. Either AFO could be used to reduce the excessive ankle plantar flexion without affecting the knee position during stance. The hinged AFO would be recommended to produce more normal dorsiflexion during TST and increased ankle power generation during PSW in children with spastic diplegic CP.