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Spinal cord injury (SCI) is a neurological condition that affects thousands of individuals globally each year. Among its many consequences, lower extremity impairments, including reduced walking function, balance deficits, and muscle weakness, significantly impact mobility and quality of life. Various rehabilitation approaches aim to restore function, including neuromodulation strategies, such as functional electrical stimulation (FES) cycling and repetitive transcranial magnetic stimulation (rTMS). While both interventions have shown effectiveness in improving lower extremity function following SCI, they have yet to be performed together to determine the combined effectiveness. This pilot trial will evaluate the feasibility and safety of combining rTMS and FES cycling in people with motor incomplete SCI (iSCI) and provide information to determine a sample size for a full randomized controlled trial. Secondary outcomes will explore the effectiveness of the combined intervention on lower extremity function. This is a pilot randomized controlled trial with assessor and participant blinding. Fourteen participants will be randomized to receive either active or sham rTMS prior to FES cycling for a total of 12 sessions over six weeks. Functional outcomes, including gait parameters, muscle strength, and balance tests, will be assessed at baseline, midpoint, post-intervention, and two weeks following treatment cessation and will be assessed both within and between groups to explore trends in efficacy. Feasibility and safety data will be analyzed descriptively. This study aims to establish a protocol and sample size for running a full randomized controlled trial on the effectiveness of combining rTMS and FES cycling for lower extremity rehabilitation in iSCI. The protocol is registered with ClinicalTrials.gov (ID: NCT05975606).

Background Physical rehabilitation is often prescribed immediately following a neurological event or a neurological diagnosis. However, many individuals require physical rehabilitation after hospital discharge. The purpose of this scoping review was to determine the amount of physical rehabilitation that individuals living in the community with neurological conditions receive to understand current global practices and assess gaps in research and service use. Methods This scoping review included observational studies that 1) involved adults living with a neurological condition, and 2) quantified the amount of rehabilitation being received in the community or outpatient hospital setting. Only literature published in English was considered. MEDLINE, EMBASE, AMED, CINAHL, Cochrane Library, and PEDro databases were searched from inception. Two independent reviewers screened titles and abstracts, followed by full texts, and data extraction. Mean annual hours of rehabilitation was estimated based on the amount of rehabilitation reported in the included studies. Results Overall, 18 studies were included after screen 14,698 articles. The estimated mean annual hours of rehabilitation varied greatly (4.9 to 155.1 h), with individuals with spinal cord injury and stroke receiving the greatest number of hours. Participants typically received more physical therapy than occupational therapy (difference range: 1 to 22 h/year). Lastly, only one study included individuals with progressive neurological conditions, highlighting a research gap. Discussion The amount of rehabilitation received by individuals with neurological conditions living in the community varies greatly. With such a wide range of time spent in rehabilitation, it is likely that the amount of rehabilitation being received by most individuals in the community is insufficient to improve function and quality of life. Future work should identify the barriers to accessing rehabilitation resources in the community and how much rehabilitation is needed to observe functional improvements.

Previous findings indicate that co-contractions of plantarflexors and dorsiflexors during quiet standing increase the ankle mechanical joint stiffness, resulting in increased postural sway. Balance impairments in individuals with incomplete spinal cord injury (iSCI) may be due to co-contractions like in other individuals with reduced balance ability. Here we investigated the effect of co-contraction between plantar- and dorsiflexors on postural balance in individuals with iSCI (iSCI-group) and able-bodied individuals (AB-group). Thirteen able-bodied individuals and 13 individuals with iSCI were asked to perform quiet standing with their eyes open (EO) and eyes closed (EC). Kinetics and electromyograms from the tibialis anterior (TA), soleus and medial gastrocnemius were collected bilaterally. The iSCI-group exhibited more co-contractions than the AB-group (EO: 0.208% vs. 75.163%, p = 0.004; EC: 1.767% vs. 92.373%, p = 0.016). Furthermore, postural sway was larger during co-contractions than during no co-contraction in the iSCI-group (EO: 1.405 cm/s 2 vs. 0.867 cm/s 2 , p = 0.023; EC: 1.831 cm/s 2 vs. 1.179 cm/s 2 , p = 0.030), but no differences were found for the AB-group (EO: 0.393 cm/s 2 vs. 0.499 cm/s 2 , p = 1.00; EC: 0.686 cm/s 2 vs. 0.654 cm/s 2 , p = 1.00). To investigate the mechanism, we performed a computational simulation study using an inverted pendulum model and linear controllers. An increase of mechanical stiffness in the simulated iSCI-group resulted in increased postural sway (EO: 2.520 cm/s 2 vs. 1.174 cm/s 2 , p < 0.001; EC: 4.226 cm/s 2 vs. 1.836 cm/s 2 , p < 0.001), but not for the simulated AB-group (EO: 0.658 cm/s 2 vs. 0.658 cm/s 2 , p = 1.00; EC: 0.943 cm/s 2 vs. 0.926 cm/s 2 , p = 0.190). Thus, we demonstrated that co-contractions may be a compensatory strategy for individuals with iSCI to accommodate for decreased motor function, but co-contractions may result in increased ankle mechanical joint stiffness and consequently postural sway.

Background Patients who identify as 2SLGBTQIA + report negative experiences with physiotherapy. The objectives were to evaluate student attitudes, beliefs and perceptions related to 2SLGBTQIA + health education and working with individuals who identify as 2SLGBTQIA + in entry-level physiotherapy programs in Canada and to evaluate physiotherapy program inclusiveness towards 2SLGBTQIA + persons. Methods We completed a nationwide, cross-sectional survey of physiotherapy students from Canadian institutions. We recruited students via email and social media from August-December 2021. Frequency results are presented with percentages. Logistic regression models (odds ratios [OR], 95%CI) were used to evaluate associations between demographics and training hours with feelings of preparedness and perceived program 2SLGBTQIA + inclusiveness. Results We obtained 150 survey responses (mean age = 25 years [range = 20 to 37]) from students where 35 (23%) self-identified as 2SLGBTQIA + . While most students (≥ 95%) showed positive attitudes towards working with 2SLGBTQIA + patients, only 20 students (13%) believed their physiotherapy program provided sufficient knowledge about 2SLGBTQIA + health and inclusiveness. Students believed more 2SLGBTQIA + training is needed ( n  = 137; 92%), believed training should be mandatory ( n  = 141; 94%) and were willing to engage in more training ( n  = 138; 92%). Around half believed their physiotherapy program ( n  = 80, 54%) and clinical placements ( n  = 75, 50%) were 2SLGBTQIA + -inclusive and their program instructors ( n  = 69, 46%) and clinical instructors ( n  = 47, 31%) used sex/gender-inclusive language. Discrimination towards 2SLGBTQIA + persons was witnessed 56 times by students and most ( n  = 136; 91%) reported at least one barrier to confronting these behaviours. Older students (OR = 0.89 [0.79 to 0.99]), individuals assigned female at birth (OR = 0.34 [0.15 to 0.77]), and students self-identifying as 2SLGBTQIA + (OR = 0.38 [0.15 to 0.94]) were less likely to believe their program was 2SLGBTQIA + inclusive. Older students (OR = 0.85 [0.76 to 0.94]) and 2SLGBTQIA + students (OR = 0.42 [0.23 to 0.76]) felt the same about their placements. Students who reported > 10 h of 2SLGBTQIA + training were more likely to believe their program was inclusive (OR = 3.18 [1.66 to 6.09]). Conclusions Entry-level physiotherapy students in Canada show positive attitudes towards working with 2SLGBTQIA + persons but believe exposure to 2SLGBTQIA + health and inclusiveness is insufficient in their physiotherapy programs. This suggests greater attention dedicated to 2SLGBTQIA + health would be valued.

Background Physical rehabilitation (PR) interventions in the intensive care unit (ICU) can improve patients’ functional outcomes, yet systematic reviews identified discordant effects and poor reporting. We conducted a scoping review to determine the extent of ICU PR interventions and how they were reported and measured. Methods We searched five databases from inception to December 2016 for prospective studies evaluating adult ICU PR interventions. Two independent reviewers screened titles, abstracts, and full texts for inclusion. We assessed completeness of reporting using the Consolidated Standards of Reporting Trials, Strengthening the Reporting of Observational Studies in Epidemiology, or Standards for Quality Improvement Reporting Excellence guidelines, as appropriate. For planned PR interventions, we evaluated reporting with the Consensus on Exercise Reporting Template (CERT) and assessed intervention and control groups separately. We calculated completeness of reporting scores for each study; scores represented the proportion of reported items. We compared reporting between groups using Kruskal-Wallis with Bonferroni corrections and t tests, α  = 0.05. Results We screened 61,774 unique citations, reviewed 1429 full-text publications, and included 117: 39 randomized trials, 30 case series, 9 two-group comparison, 14 before-after, and 25 cohort. Interventions included neuromuscular electrical stimulation (NMES) (14.5%), passive/active exercises (15.4%), cycling (6.8%), progressive mobility (32.5%), and multicomponent (29.9%). The median (first,third quartiles) study reporting score was 75.9% (62.5, 86.7) with no significant differences between reporting guidelines. Of 87 planned intervention studies, the median CERT score was 55.6%(44.7,75.0); cycling had the highest (85.0%(62.2,93.8)), and NMES and multicomponent the lowest (50.0% (39.5, 70.3) and 50.0% (41.5, 58.8), respectively) scores. Authors reported intervention groups better than controls ( p  < 0.001). Conclusions We identified important reporting deficiencies in ICU PR interventions, limiting clinical implementation and future trial development.

Study designQuantitative cross-sectional study.ObjectivesEvaluate the test–retest reliability and the construct validity of inertial measurement units (IMU) to characterize spatiotemporal gait parameters in individuals with SCI.SettingTwo SCI rehabilitation centers in Canada.MethodsEighteen individuals with SCI participated in two evaluation sessions spaced 2 weeks apart. Fifteen able-bodied individuals were also recruited. Participants walked 20 m overground under five conditions that challenged balance to varying degrees. Five IMU were attached to the lower-extremities and the sacrum to collect the mean and the coefficient of variation of five gait parameters (gait cycle time, double-support percentage, cadence, stride length, stride velocity). Intra-class correlation coefficients (ICC) were used to evaluate the test–retest reliability. Linear mixed-effects models were used to compare the five walking conditions to evaluate known-group validity while Spearman’s correlation coefficients were used to characterize the level of association between gait parameters and the Mini BESTest (MBT).ResultsCadence was reliable across all walking conditions. Reliability was higher for the mean (ICC = 0.55–0.98) of the parameters compared to their coefficient of variation (ICC = 0.16–0.97). Cadence collected with IMU had construct validity as their values differed across walking conditions and groups of participants. The coefficient of variation was generally better than the mean to show differences across the five walking conditions. The MBT was moderately to strongly associated with mean cadence (ρ ≥ 0.498) and its coefficient of variation (ρ ≤ −0.49) during most walking conditions.ConclusionsIMU provide reliable and valid measurements of gait parameters in ambulatory individuals with SCI.

Background Individuals with an incomplete spinal cord injury (iSCI) are highly susceptible to falls during periods of walking or standing. We recently reported the findings of a novel intervention combining functional electrical stimulation with visual feedback balance training (FES + VFBT) on standing balance abilities among five individuals with motor iSCI. However, the previous publication did not report the perceived impact of the intervention on the participants’ lives. In this report, the experiences of these five individuals with incomplete spinal cord injury (iSCI) who had recently completed the four-week balance training program are described. Methods Five individuals with a motor iSCI took part in this study. Each individual was at least 12 months post-injury, capable of unassisted standing for 60 s and had a Berg Balance Scale Score < 46. Participants completed twelve sessions of a novel balance intervention combining closed-loop functional electrical stimulation with visual feedback balance training (FES + VFBT). Participants received visual feedback regarding their centre of pressure position as they completed balance-training exercises while FES was applied to the ankle plantarflexors and dorsiflexors bilaterally. Semi-structured interviews were conducted after completion of the balance training intervention and eight-weeks post-training to understand participant’s experiences. Categories and themes were derived from the transcripts using conventional content analysis. Results Three themes were identified from the collected transcripts: (1) Perceived benefits across International Classification of Functioning, Disability and Health levels; (2) Change in perceived fall risk and confidence; (3) Motivation to keep going. Conclusions Participation in the FES + VFBT program resulted in perceived benefits that led to meaningful improvements in activities of daily living. Following completion of the training, individuals felt they still had the capacity to improve. Individuals felt they had increased their balance confidence, while a few participants also reported a decrease in their risk of falling. The inclusion of qualitative inquiry allows for the evaluation of the meaningfulness of an intervention and its perceived impact on the lives of the participants. Trial registration: NCT04262414 (retrospectively registered February 10, 2020)

Background Individuals who identify as 2SLGBTQIA+ report worse health outcomes than heterosexual/cisgender counterparts, in part due to poor experiences with healthcare professionals. This may stem from inadequate 2SLGBTQIA+ health and inclusiveness training in health professional student education. The purpose of the study was to evaluate knowledge, behaviours, and training related to 2SLGBTQIA+ health education and inclusiveness for entry-level physiotherapy students in Canada. Methods We conducted a nationwide, cross-sectional survey with physiotherapy students from accredited Canadian physiotherapy programs. We administered the survey through Qualtrics and recruited students through targeted recruitment emails and social media posts on Twitter and Instagram between August and December 2021. Survey responses are reported as frequencies (percentage). We also completed multivariable logistic regressions to evaluate associations among question responses related to working with 2SLGBTQIA+ individuals (i.e., communication, feeling prepared and assessment competency). Covariates included training hours (< 10/10 + hours) and 2SLGBTQIA+ identity (yes/no). Results A total of 150 students responded to the survey, with 35 (23%) identifying as 2SLGBTQIA+ . Many students felt confident in communicating effectively with clients who identify as 2SLGBTQIA+ (69%). However, only half (47%) felt comfortable assessing clients who identify as 2SLGBTQIA+ . Routine practice of inclusive behaviours such as using pronouns, considering identities are fluid and a patient’s gender identity and/or sexual orientation may shift from one visit to the next, and considering trauma-informed care practices were reported from less than half of the students (< 45%). Around 29% of students reported no 2SLGBTQIA+ training in their physiotherapy program, while 47% reported 0–10 hours, and 24% reported 10 + hours of training. Students with 10 + hours of training had 92% higher odds of feeling competent in assessing 2SLGBTQIA+ clients, compared to those with < 10 hours of training. Conclusions Entry-level physiotherapy students in Canada show a lack of understanding and awareness for 2SLGBTQIA+ health and inclusive behaviours which can meaningfully impact patient experience. Students report feeling incompetent when working with 2SLGBTQIA+ patients, which may be associated with lack of 2SLGBTQIA+ training in their programs. Greater efforts and attention towards increasing 2SLGBTQIA+ health education and inclusivity in Canadian entry-level physiotherapy programs is critically needed.

BackgroundThe foremost reported unmet health need for Canadians with chronic neurological conditions is linked to physical maintenance. One way to address this issue is through activity programing offered through public institutions, where rehabilitation can be integrated into secondary health care settings. Parkwood Institute in London, Ontario has developed several programs, including virtual exercise classes, day programs, and a community fitness center. People who have participated in these initiatives can provide insights that could be used to create more robust person-centered rehabilitation physical activity programing.ObjectivesTo explore the lived experiences of individuals participating in activity programs offered through Parkwood Institute to develop recommendations for future program development.MethodsUsing purposive sampling of individuals with a chronic neurological health condition who have participated in a physical activity program offered through Parkwood, we will use a grounded theory methodology to explore individual perspectives. Data will be collected using semi-structured interviews to gather critical perspectives and data will be analyzed using constant comparative analysis. Data collection and analysis will be an iterative process, meaning codes and categories will be developed from initial interviews, with subsequent data being continuously compared to identify similarities and differences.ResultsThe findings of this research will, once completed, describe the impact of various physical activity programs, including benefits, challenges, and recommendations for future development.ConclusionsThe theoretical interpretations of the findings will be presented as a list of recommendations for activity programs offered through rehabilitation centers to assist researchers, clinicians, and policy makers in decision-making.