Introduction: Handcycling is an excellent exercise for people with spinal cord injuries. However, some users experience barriers to transferring to the handcycle. The most common barriers are the height difference between the handcycle and sitting surface and dependence on others. Purpose: This thesis aims to develop an assistive technology to help users independently transfer in and out of a handcycle. Methods: The framework for the thesis is the double-diamond, guiding the designing of the products concepts. Users, professionals, and manufacturers were interviewed regarding the facilitators and barriers while transferring in and out of the handcycle and the product needs to help prevent the barriers. A content analysis was performed to find the facilitators and barriers, and a need analysis was performed to find the needs for the product. The needs were translated into target specifications to have measurable characteristics. Benchmarking was performed, and the products were evaluated in regard to the target specifications. The market segment, personas, mood board, and design brief served to inspire and inform the specifications for the product. Brainstorming and sketching were performed to generate four concepts. The participants evaluated these concepts, and the top-ranked concept was further developed. A computer-aided model was created and rendered to better illustrate the product. A guide on how to use the product was developed based on TAI 4.0, which also was used to find limitations in the transfer technique of the new product. An evaluation regarding the target specifications was also performed. Result: The final product concept allows height transfer and can be used independently. It fulfills seven out of the seventeen target specifications in the current state. However, six target specifications cannot be defined yet as they should be developed further in other iterations. Conclusion: A lifting device concept for transferring was developed. It would still need further iterations to keep improving the product before it would be able to be released for users.

The purpose of this study was to examine the effects of song-based music therapy interventions on psychosocial factors for people who have had Acquired Brain Injuries (ABI) or Spinal Cord injuries (SCI) and their caregivers during acute rehabilitation. The psychosocial factors in this study involve mood states, caregiving experiences, and dyadic relationships. The study also examined the correlation between care recipients and caregivers on mood states and the dyadic relationship. A quasi-experimental, two-group pretest-posttest design without a control group was used to investigate the psychosocial factors. A total of 10 dyads were recruited for the study. Group A in this study were care recipients; Group B were caregivers of Group A. The dyad attended four individual music therapy sessions of approximately 45-minute duration over a period of 14 days. During the song-based music therapy protocol, the participants were empowered to choose between singing along or listening to their preferred music. Caregiver participants had the option to participate in either in-person or virtual sessions. Three measures were used to investigate psychosocial factors: Visual Analogue Mood States (VAMS), Positive Aspects of Caregiving (PAC), and Dyadic Relationship Scale (DRS). VAMS was used pre and post each intervention while PAC and DRS were only used before the first session and the last session. All statistical analyses were conducted in R, a statistical program. The Wilcoxon test and Kendall’s rank correlations were used to examine the pre- and post-intervention changes and the correlation between Group A and Group B on mood states and the dyadic relationship. The findings of the study indicated that there were significant changes in mood states for both Group A and Group B. There were four strong correlations in the dyadic relationship between caregivers and care recipients, including feeling closer to each other, feeling angry toward the other, having more patience than they have had in the past, and feeling relationships with each other were strained. Implications for music therapy practice and recommendations for the field and future research are also presented. / Music Therapy

Spinal cord injury (SCI) results in persistent neurological deficits and significant long-term disability. Stimulation of peripheral afferents by epidural electrical stimulation (EES) has been reported to reduce spasticity by reorganizing spared and disrupted descending pathways and local circuits. However, a current barrier to the field is that the plasticity mechanisms that underly improved recovery is unknown. Using the power of hM3Dq Designer Receptors Exclusively Activated by Designer Drugs (DREADDs), we aim to accelerate the dissection of the mechanisms underlying enhanced recovery. In these studies, we identified the effect of clozapine-N-oxide (CNO) on the H-reflex of naïve animals; investigated the baseline influence of hM3Dq DREADDs in peripheral afferents in the intact animal using a novel behavioral tool, an addition of angled rungs to the horizontal ladder walking task; and began to uncover the neural and behavioral changes that accompany hM3Dq DREADDs activation in peripheral afferents after SCI. We observed no significant differences in the H-reflex with 4 mg/kg dosage of CNO administration (pre-CNO vs. CNO-active: p=0.82; CNO-active vs. CNO wash-out: p=0.98; n=6). On our novel ladder, we found significant differences in correct hind paw placement (p=0.0002, n=7) and incorrect placement (p=0.01) when DREADDs were activated with CNO (4 mg/kg). In our SCI study, we report that acute and chronic DREADDs activation may activate extensor muscles about the hip (32 cm/s: p=0.047; controls: n=6; DREADDs: n=8 and hereafter unless otherwise stated) as well as induce sprouting and synaptogenesis within motor pools and Clarke’s column in the lumbar spinal cord (motor pool: p=0.00053; Clarke’s column: p=0.021; controls: n=4; DREADDs: n=6). This muscle recruitment may have long-term effects such as increased hindquarter heights (e.g., 16 cm/s: p=0.017) and more frequent hindlimb coordination (p=0.002). Results from this study suggest hM3Dq DREADDs may have the potential to recapitulate EES-activation of afferents as well as provide a platform with which to functionally map changes that occur both within targeted afferents and second order neurons they effect. Future work, such as using C-Fos to examine and map changes in interneuronal networks, could seek to more directly tie changes in kinematics to observed changes in plasticity. / Bioengineering

Victims of trauma are likely to experience diverse social, psychological, and physical problems, but very little is known about how these experiences impact Vocational Rehabilitation employment outcomes and other aspects of life. This research provides detailed experiences of the impact of trauma on the lives of three young adult African American women with disabilities who live in one of the poorest states in the southern part of the country. Each participant shared their experiences of trauma and the onset of impairment early in their adult lives and the impact that it had on their employment and other aspects of life. Trauma that participants endured had a significant impact on their lives, and they experienced life after the trauma very differently than before the trauma. Their impact of trauma was categorized into 5 key experiences which shaped their experiences of life following the trauma. These 5 key experiences were concluded as final themes and included 4 additional subthemes for 2 of the major themes. The impact of trauma was expressed in terms of (a) unfavorable physical condition and pain; (b) concerns regarding employers and service providers, accommodations and accessibility, compromised immune system, and disability benefits; (c) lack of confidence surrounding employment; (d) loss of independence, leisure and social participation, relationships, and employment; and (e) new perspective in terms of attitude. Findings in this research offered insight about how experiences of trauma affect employment, health, social participation, and leisure, and other aspects of life. Practical propositions about how to better meet the needs of this group in the rehabilitation process were provided. Ensuring necessary supports, including knowledgeable employers and service providers, allow African American women with disabilities to minimize loss and concerns, increase confidence, and encourage social participation leisure, employment, good overall health, and wellbeing. Failing to address these existing experiences may result in continued disproportionately harsh employment, economic, and health consequences for African American women with disabilities including a lack of opportunity for financial stability, self-sufficiency, sustainment of mental and physical health, and overall better quality of life.

No description available.

Hintergrund: Akute sowie chronische Pathologien der Aorta sind komplexe Erkrankungen mit stark risikobehafteten Interventionsmöglichkeiten. Die Wahrscheinlichkeit einer Rückenmarkschädigung und damit einhergehender Paraplegie nach umfassenden Eingriffen an thorakoabdominellen Aortenaneurysmen beträgt bis zu 20 %. Die Blutversorgung des Rückenmarks wird unter anderem durch den direkten Zufluss aus Spinalarterien sichergestellt, welche paarig aus der Aorta entspringen. Durch vorangegangene Studien weiß man, dass im Falle des Verlustes dieser direkten Zuflüsse, ein in der paraspinalen Muskulatur lokalisiertes Gefäßsystem eine alternative Blutversorgung des Rückenmarks sicherstellen kann. Dieses funktionelle System bezeichnet man als paraspinales Kollateralnetzwerk. Es konnte gezeigt werden, dass Umbauprozesse in diesem Netzwerk verzögert geschehen - in Abhängigkeit von lokaler Ischämie und Perfusionsdrücken. Mittels MISACE (minimally invasive staged segmental artery coil and plug embolization) wurde ein Verfahren entwickelt, welches es ermöglicht mittels Metallcoils- oder Plugs minimalinvasiv einzelne Segmentarterien vor dem eigentlichen Eingriff zu verschließen. Dadurch wird die Ausbildung des Kollateralnetzwerkes induziert, welches zum Zeitpunkt der definitiven therapeutischen Intervention das Risiko einer potenzielle Rückenmarkschädigung über alternative Perfusionswege mindert. Aufgabenstellung: 1. Die Etablierung eines Modells zur Vorbereitung des Kollateralnetzwerks durch minimalinvasives Coiling. Gibt es ein optimales Coilingmuster, bei welchem keine bleibenden Paraplegien auftreten? 2. Wie ändert sich die regionale Perfusion im Rückenmark in Abhängigkeit unterschiedlicher Coilingmuster? 3. Wie unterscheiden sich die einzelnen Coilingmuster im klinisch-neurologischen Outcome und besteht durch MISACE ein Risiko für iatrogene spinale Ischämien (Risikoprofil)? Methoden: Im chronischen Großtierversuch wurde an insgesamt 25 Schweinen ein umfassender Eingriff an der thorakoabdominellen Aorta mit konsekutivem Verschluss multipler Segmentarterien (T4 bis L5) durchgeführt. Mittels MISACE wurde in einem zweizeitigen Verfahren durch den selektiven Verschluss von spinalen Segmentarterien die Ausbildung des arteriellen Kollateralsystems initiiert. Im ersten Schritt erfolgte der Verschluss von einer bestimmten Anzahl und an spezifischen Punkten lokalisierten Segmentarterien. Im fünf Tage später stattfindenden zweiten Eingriff wurden nun ebenfalls durch MISACE alle verbleibenden Segmentarterien verschlossen. Durch den kompletten Verschluss aller aortalen SA wurde die anatomische Situation entsprechend eines kompletten Ersatzes (oder Stenting) der thorakoabdominellen Aorta simuliert. Drei unterschiedliche Coilingmuster wurden an jeweils sechs Schweinen untersucht. In der ersten Versuchsgruppe wurden im ersten Schritt alle lumbalen Segmentarterien und in einer weiteren Sitzung alle thorakalen Segmentarterien verschlossen (Regional-Pattern). In der zweiten Gruppe wurde zunächst, einem alternierenden Muster folgend, jede zweite Segmentarterie verschlossen. Die offen verbliebenen SA wurden anschließend in der zweiten Sitzung fünf Tage später verschlossen (Alternating-Pattern). In der dritten Gruppe wurde zuerst ein für die Blutversorgung kritischer Bereich im thorakolumbalen Übergang (Segmentebenen T12 bis L2) verschlossen. Alle übrigen Segmentarterien wurden in der zweiten Sitzung verschlossen (Watershed-Pattern). In der aus sieben Tieren bestehenden Kontrollgruppe wurden in einer offenen Operation alle Segmentarterien konsekutiv mittels Clips unter Sicht verschlossen. Das neurologische Outcome wurde alle sechs Stunden am ersten bis dritten postoperativen Tag und mindestens alle zwölf Stunden an allen weiteren Tagen evaluiert. Die regionale Perfusion des Rückenmarks wurde mittels Mikrosphärenapplikation zu insgesamt sechs Zeitpunkten vor und nach den Interventionen gemessen. Nach Abschluss der experimentellen Phase wurden alle Tiere einer Obduktion zugeführt. Hier wurden die OP-Ergebnisse evaluiert sowie Rückenmarkproben entnommen und histologisch aufgearbeitet und bewertet. Ergebnisse: Alle Tiere der Kontrollgruppe zeigten ein neurologisches Defizit. Insgesamt waren am Ende des Beobachtungszeitraums 57 % (N=4) der Tiere dauerhaft parapleg. In der Alternating-Pattern MISACE Gruppe entwickelten 33,3 % (N=2) neurologische Störungen. Ein Tier erlitt eine dauerhafte Paraplegie, ein weiteres Tier erlitt eine temporäre Paraplegie. Kein Tier der Watershed-Pattern Gruppe hatte nach der Stage 1 MISACE Intervention neurologische Beeinträchtigungen. Allerdings kam es hier nach der zweiten MISACE Intervention zu drei temporären sowie einer permanenten Paraplegie (66,7 %, N=4), mit entsprechend histologisch nachweisbaren Schäden im Rückenmark. Damit hatte dieses MISACE Muster das schlechteste neurologische Outcome von allen MISACE Gruppen. Kein Tier aus der Regional-Pattern Gruppe erlitt eine dauerhafte Paraplegie. Weiterhin war es die einzige Gruppe, in welcher es keine histologischen Hinweise auf eine Gewebeschädigung des Rückenmarks gab (p<0,05 im Vergleich zur Kontrollgruppe) und in welcher sich die lokale Durchblutung des Rückenmarks innerhalb von drei Tagen nach dem kompletten Verschluss aller Segmentarterien wieder bis auf die Ausgangswerte erholte (von 84,4±23 % ausgehend vom Baselinewert nach der erster Sitzung auf 89,2±47 % vor Versuchsende; P=0,433). Schlussfolgerung: Ein ebenenbasiertes Verschlussmuster der Segmentarterien (Regional-Pattern), beginnend mit den lumbalen Gefäßen in einer ersten Sitzung, scheint der beste Ansatz in Hinblick auf das neurologische Outcome der Tiere und die regionale Durchblutung des Rückenmarks zu sein. Vorausgesetzt MISACE wird in nur zwei Sitzungen durchgeführt. Die Studie bestätigt, dass MISACE ischämische Schäden am Rückenmark vermindern und zu einem verbesserten neurologischen Outcome nach einem simulierten kompletten Verschluss aller Segmentarterien führen kann. Es konnte jedoch ebenfalls gezeigt werden, dass auch MISACE iatrogen zu neurologischen Schäden führen kann, was in der klinischen Praxis zu berücksichtigen ist.:1 Abkürzungsverzeichnis 2 Einführung 2.1 Erkrankungen der Aorta 2.1.1 Hintergrund 2.1.2 Das Aortenaneurysma 2.2 Das Verständnis über die Blutversorgung des Rückenmarks im Wandel der Zeit 2.2.1 Das historische Modell 2.2.2 Das zeitgenössische Modell 2.2.3 Systemumformung - Das arterielle ‚Remodeling’ 2.3 Interventionelle Therapie 2.3.1 Interventionsindikationen 2.3.2 Offen-chirurgische Interventionsmöglichkeiten 2.3.3 Endovaskuläre Interventionsmöglichkeiten 2.3.4 Interventionsassoziierte intra- und postoperative Paraplegie 2.4 Neue therapeutische Ansätze 2.4.1 Erweitertes intra- und postoperatives Monitoring 2.4.2 Neue invasive Verfahren 2.4.3 Staged Repair 2.4.4 Das MISACE-Verfahren zur Vorbereitung des Rückenmarks 2.4.5 MISACE im aktuellen klinischen Alltag 3 Fragestellung 4 Material und Methoden 4.1 Tiermodell 4.2 Periinterventioneller Ablauf, alle Gruppen 4.2.1 Präoperativer Ablauf, alle Gruppen 4.2.2 Katheterimplantation und Mikrosphären Baseline-Messung, alle Gruppen 4.2.3 Grundlagen der verwendeten Mikrosphärentechnik 4.2.4 Ablauf der Mikrosphären-Messung, alle Gruppen 4.3 Interventioneller Ablauf, Übersicht 4.3.1 Gruppenzusammensetzung und angewandte MISACE Coiling-Muster 4.3.2 Interventioneller Ablauf, Kontrollgruppe 4.3.3 Interventioneller Ablauf MISACE, alle Interventionsgruppen 4.4 Postoperative Versorgung 4.4.1 Allgemein, alle Gruppen 4.4.2 Modifizierter Tarlov-Score 4.5 Beendigung der experimentellen Phase, Gewebegewinnung 4.5.1 Vorbereitung 4.5.2 Rückenmark 4.6 Gewebeauswertung 4.6.1 Reagenzien und Geräte 4.6.2 Histologische Aufarbeitung der Rückenmarksgewebeproben 4.7 Mikrosphären 4.7.2 Probenvorbereitung und Hydrolyse 4.7.3 Filtration 4.7.4 Auswertung 4.8 Statistische Analyse 5 Ergebnisse 5.1 Tiermodell 5.2 Periinterventioneller Ablauf, alle Gruppen 5.2.1 Implantation der Katheter zur Mikrosphären-Messung 5.3 Interventioneller Ablauf, Interventionsgruppen 5.4 Postoperative Versorgung 5.4.1 Modifizierter Tarlov-Score 5.5 Gewebeauswertung 5.5.1 Histologische Aufarbeitung der Rückenmarkgewebeproben 5.6 Mikrosphären 5.6.1 Auswertung der regionalen Rückenmarksperfusion 5.7 Zusammenfassung der Ergebnisse 6 Diskussion 6.1 Rückenmarkprotektion in der Aortenmedizin - Staged Repair Konzept 6.2 MISACE – Erkenntnisse und das Wirksamkeits-, Sicherheitsprofil 6.3 Das optimale MISACE-Pattern 6.4 Rückschlüsse auf die klinische Praxis 6.5 PAPAartis 6.6 Offene Fragen und künftige Forschungsansätze 6.7 Limitationen 7 Zusammenfassung der Arbeit 8 Literaturverzeichnis 9 Selbstständigkeitserklärung 10 Danksagung

No description available.

<p>The purpose of this dissertation was to use an integrative theoretical framework to examine the individual and environmental factors associated with leisure-time physical activity (LTPA) for persons living with spinal cord injury (SCI). Using a systematic approach, three studies were conducted to: (1) survey the accessibility and availability of physical activity facilities for Canadians living with mobility disabilities, (2) test an integrative, theoretical framework for understanding LTPA among people with SCI, and (3) implement a theory-based intervention that focuses on helping beginner exercisers living with SCI cope with salient individual and environmental LTPA barriers. </p> <p>Study 1 involved two sub-studies. Study lA used a modified version of the AIMFREE instrument (Rimmer et al., 2004) and provided evidence of the limited accessibility of fitness and recreational facilities (n=44) for persons with mobility disabilities. Study lB applied a geographical technique, Geographical Information Systems (GIS), to develop an objective proximity measure specific to persons with SCI. Results indicated a small, negative association between the objective presence of physical activity facilities and L TPA in a sample of persons with SCI (n=50), suggesting that living in close proximity to a facility which provides adaptive programming and equipment does not necessarily translate into greater LTPA for persons with SCI.</p> <p>As an extension of Study 1, Study 2 used structural equation modeling to conduct a cross-sectional examination of whether an environmental factor --neighbourhood perceptions--could enhance the Theory of Planned ehaviour's (TPB; Ajzen, 1985) ability to explain LTPA intentions and behaviour in persons with SCI (n=246). Results indicated a small, negative association between perceived wheeling infrastructure and LTPA intentions. However, perceptions of neighbourhood aesthetics and wheeling infrastructure did not explain significant variance in either L TPA intentions or behaviour, beyond that accounted for by the TPB constructs, suggesting that these eighbourhood factors do not enhance the TPB's ability to explain LTPA behaviour.</p> <p>Lastly, Study 3 used a randomized, controlled design to examine the effects of a 10-week action and coping planning intervention on enhancing LTPA and coping self efficacy in exercise intenders living with SCI (n=47). Results indicated greater LTPA for participants who formed action plans and coping plans (A+C condition) than for the participants who only formed action plans (A condition). Furthermore, the A+C condition had greater confidence to schedule their L TPA and overcome L TPA-related barriers than the A condition. These findings provide evidence of the benefits of supplementing action plans with coping plans for enhancing L TP A and coping self-efficacy beliefs among exercise intenders living with SCI. </p> <p>Together, these three studies provide a broader understanding of L TPA correlates and determinants in people with SCI, and provide evidence of the efficacy of multiple planning strategics for promoting L TPA in persons with SCI. The results provide an impetus for extending the scope of the research on the physical environment and LTPA towards persons with mobility disabilities. Moreover, the findings demonstrate the value of theory-based research for identifying the multidimensional correlates and determinants of LTPA, and for designing effective LTPA-enhancing interventions in persons with SCI. </p> / Thesis / Doctor of Philosophy (PhD)

Primary somatosensory cortex (SI) is an important cortical structure involved in receiving and relaying sensory inputs to condition primary motor cortex (M1). The functional interaction between SI and M1 is important for motor control by providing surround inhibition, which is the inhibition of muscles not involved in the movement and in learning new motor skills. This interconnection is known as short-latency afferent inhibition (SAI) and may be probed using Transcranial magnetic stimulation and peripheral nerve stimulation. SAI is dependent on the afferent volley as increasing the nerve stimulation intensity increases the depth of SAI. Individuals with spinal cord injury show reductions in SAI evoked in lower limb and this may be a contributing factor to the impairments in motor control seen within this population. SAI has yet to be investigated in the upper limb in individuals with chronic cervical SCI and this thesis examines these alterations. Two experiments were performed examining M1 excitability (motor evoked potentials), SI excitability (somatosensory evoked potentials) and the interconnection between SI and M1 (SAI). The first Experiment investigated alterations in these measures in individuals with SCI while the second Experiment investigated these measures as a function of the afferent volley. The collective results from Experiment 1 indicate that motor evoked potentials and SAI are reduced but somatosensory evoked potentials are similar to controls. Further data from Experiment 2 indicate that SAI and SEPs increase as a function of the afferent volley and indicate that alterations seen in individuals with SCI may be due to cortical plasticity in the synapses from SI to M1 or within M1. The novel findings of this thesis have indicated aberrant cortical circuits in individuals with SCI and have indicated potential synapses that may be targets for TMS plasticity protocols to alter and restore function to these circuits. / Thesis / Master of Science (MSc)

Spinal cord injury causes the partial or total loss of the anatomical and functional continuity of the spinal cord tissue, leading to the damage of the organs controlled by nerves that branch off downstream the injury. This thesis analyses the mechanics of two possible treatments based on two different approaches: intraspinal microstimulation (ISMS) and tissue engineering. These two approaches have a common rationale, the delivery of electrical stimuli to the injured spinal cord. In the literature, the feasibility of the electrodes for ISMS is often limited to the analysis of stiffness. The mechanical validation of the device is then focused on the step after the in vivo implantation, considering the interplay with the surrounding tissue. In this work, the mechanical performance of an innovative intraspinal microstimulation device is evaluated thoroughly before the in vivo step, to avoid the waste of material, animals, and time. The study involves the characterisation of the single components (electrodes), prototypes, and possible failure mechanisms. A work on silk fibroin hydrogels for the regeneration of the spinal cord is also presented. Silk fibroin is a highly versatile material for biomedical purposes, and thus largely used in tissue engineering. Moreover, it has piezolectric properties subjected to micro and nanostructure. Given the proven benefits of electrical stimulation in the regeneration of the spinal cord after injury, different approaches studied in literature often require the use of external devices to generate electrical stimuli. This thesis aims to study the mechanical properties of silk fibroin hydrogels obtained by applying an electric field to silk fibroin solutions, to investigate the eventual increase of the microstructure orientation and consequent improvement of the piezoelectric effects of fibroin.