The ability of a person to maintain stable posture is essential for activities of daily living. Research in this field has evolved to include sensitive assessment technology including force platforms and 3-dimensional kinematic motion analysis systems. Although many studies have investigated postural stability under the auspice of posturography and the use of force platforms, relatively few have incorporated kinematic motion analysis techniques. Furthermore, of the studies that have utilized a multivariate research model, none have sought to identify the relationship between force platform measures including both the variation of movement of the x- and y-coordinates of the center of pressure (COP), and the 3-dimensional coordinates of the total body center of mass (COM). This study used a descriptive design to evaluate the relationship between force platform measures and the kinematic measures dealing with the total body COM in 14 healthy participants (height = 1.70 ± 0.09 m, mass = 67.7 ± 9.9 kg; age = 24.9 ± 3.8 yrs). Intraclass correlations (ICC) and standard error of measurements (SEM) were determined for common variables of interest used in standard posturography models. The results suggest that the variation of the excursion of the COP coordinates best represent the variation of the total body COM in the x- and y-directions. There was a force platform measure that correlated significantly with the vertical component of total body COM in only 3 of the 8 conditions. The ICC values obtained when analyzing individual conditions revealed that the variation in the force measurements were much more reliable than those representing the variation in movement of the COP, suggesting a need for the development of higher order methods of modeling 3-dimensional COM information from force platforms.

APPLICATION OF A COMMERCIAL DATALOGGER TO ELECTRIC POWERED AND MANUAL WHEELCHAIRS OF CHILDREN Beth Ann Kaminski, BSE University of Pittsburgh, 2004 Objective: This study was conducted to investigate the usage characteristics of children wheelchair users. This was accomplished by utilizing dataloggers to quantify how far and how fast children drive or propel their wheelchairs, as well as observing the movement time data. The relationships between usage per type of wheelchair, gender, and day of the week were evaluated. Methods: 20 subjects between the ages of 6-17 years old who use a manual (n=10) or power (n=10) wheelchair for their primary source of community-based mobility were studied. The children in this study reported the disabilities of cerebral palsy (n=6), spina bifida (n=11), Duchenne muscular dystrophy (n=2), and spinal cord injury (n=1). Overall, nine females and 11 males participated in the study. All subjects, or their parents, provided demographic information and characteristics of their wheelchair. Each child¡¦s wheelchair was then instrumented with a datalogger. The datalogger was attached to wheelchair for five to seven days. During this time, the participants were instructed to go about their daily activities as usual. Results: On an average day, the manual wheelchair users traveled 1583.6 b 880.2 meters at an average speed of 0.67 b 0.16 meters/sec, while the power wheelchair users traveled 1524.5 b 1057.0 meters at 0.63 b 0.16 meters/sec. Overall, the children traveled average daily distances in the range of 8.5 meters to 3929.1 meters and at speeds between 0.39 to 1.42 meters/sec. The males in the study, on average, traveled 1910.1 b 1160.0 meters per day at 0.66 b 0.14 meters/sec while the females traveled 1118.9 b 247.9 meters at 0.60 b 0.19 meters/sec. The children were active for an average of 15 hours per day on the weekdays and 12.5 hours on the weekend days. The children traveled an average of 1738.7 b 1173.5 meters per day at 0.63 b 0.14 meters/sec on the weekdays and 1088.9 b 902.8 meters per day on the weekends. Data from nine manual wheelchair shows the subjects drove in the forward direction 93.2% of the time and backwards 6.8% of the time. Conclusions: No differences were found between the distance and speeds traveled for children manual and power wheelchair users. In comparison, the children wheelchair users show similar driving characteristics in speed and distance traveled to adult wheelchair users. The findings suggest that the male children traveled longer distances per day (P = 0.046) and at higher speeds. The children appear to be more active on weekdays as compared to the weekends. The weekday distance is significantly higher than weekend distance (P = 0.035).

This study examined the effectiveness of an online interdisciplinary course in electronic health record (EHR) technology at the University of Pittsburgh for health and rehabilitation professionals. The purpose of the study was to determine how familiar participants were with EHR technology; determine if attitudes changed toward EHR technology after taking the course; and determine if the course met the needs and expectations of the participants. The goal of the project was to educate health and rehabilitation professionals about EHR technology and to identify a model interdisciplinary course for this topic. Quantitative and qualitative data was collected through questionnaires, practice module exams, and participant interviews. Participants who took the course showed significant gains in their knowledge of almost all of the content areas. The primary strength of the course was its structure, in particular, with the audio presentation. The weaknesses of the course were with regard to the quantity of and time allotted to complete assignments, as well as the desire to have more hands-on vendor component assignments. Although participant attitudes were favorable toward EHR technology before taking the course, they improved after taking the course. Overall participants believed that it is important that EHR technology is implemented in healthcare and benefited significantly from taking the course.

With modern medicine and advances in technology, people are living longer and expecting a higher quality of life. Individuals may not be receiving the ideal assistive devices because they are not sure where to obtain the proper equipment, or what is available. An increased flow of informational publications needs to reach the consumers so they are able to make better informed decisions about their quality of life. Addressing the issue of limited resources, this study places a focus on the use of service dogs as a form of assistive technology. The main objective of this study was to collect data from individuals who had wheelchair service dogs and to compare the data to individuals who did not have a wheelchair service dog. Data were collected and analyzed on variables of assistive technology use, disability, human assistance used, depression, pain, fatigue, and activities of daily living. This information was collected as a baseline, after three months and after nine months. Of the 172 individuals who participated from the beginning of this study, 117 successfully completed all three surveys. For the baseline, there were significant relationships between the dog groups and the individuals who used assistive technology (p=0.02); between the dog group and the depression (CES-D) score (p=0.047); and between the dog group and the Pain I (Total Pain Rating Index) of the McGill Pain Questionnaire (p=0.01). Individuals in the control group used less assistive technology, and individuals in the service dog and wait list groups used the most assistive technology devices. Individuals on the wait list had significantly higher CESD scores, and individuals who had recently received a service dog had lower scores than those in the pet and control groups. Overall, depression scores increased for individuals who were on the waiting list to receive a dog, although not to a significant degree. Depression scores increased (insignificantly) at the second visit for service dog owners, but decreased at the third visit. Although not to a significant degree, pain generally decreased for service dog owners. Individuals with service dogs are able to participate in more activities of daily living, although they do still need help.

Introduction: Despite being classified together as overhead athletes, the shoulders of swimmers and baseball pitchers were expected to differ in physical characteristics due to the distinctive demands placed upon their shoulders. The purpose of this study was to compare shoulder characteristics between male swimmers, pitchers, and non-overhead athletes (controls). It was hypothesized that swimmers bilateral shoulders and pitchers dominant shoulders would present adaptive changes from participation in their respective sport. Methods: Glenohumeral range of motion (ROM), posterior shoulder tightness (PST), scapular kinematics, forward shoulder posture (FSP), and shoulder strength were compared between 15 male intercollegiate swimmers, 15 intercollegiate pitchers, and 15 controls. All subjects were free of shoulder pain. ROM and PST were measured using standard goniometer/carpenters square, and FSP was assessed using a double-square device. Strength was assessed using an isokinetic dynamometer, and scapular kinematics were assessed using an electromagnetic tracking device. Results: Pitchers dominant shoulder exhibited greater external rotation ROM, compared to their non-dominant shoulder (p= 0.049) and the controls dominant shoulder (p= 0.049). No between-group differences in internal rotation ROM and total ROM were found. Glenohumeral internal rotation deficit was greater in pitchers than in swimmers (p< 0.001) and controls (p< 0.001). External rotation gain was also greater in pitchers compared to swimmers (p=0.025). Swimmers (p= 0.002~0.004) and pitchers (p= 0.015~0.047) exhibited greater bilateral flexion ROM than controls. There were no significant between-group differences in abduction and extension ROM. PST was greater in pitchers compared to controls in supine method. No between-group or between-limb differences were found in strength variables. No between-group differences in scapular kinematic variables were found. Dominant shoulders were positioned anteriorly compared to the non-dominant shoulder (p= 0.012). Conclusions: The results of the study demonstrated differences in shoulder characteristics among swimmers, pitchers, and controls. These differences may be due to the unique demands of each sport. The ROM characteristics (GIRD, ERG, and PST) were observed only in pitchers due to their dominant use of a unilateral limb. Between-group difference in strength, scapular kinematics, and FSP were not observed in this study. Further research and advancement in assessment techniques may reveal differences in these variables.

Introduction: Previous research has stereotyped many overhead athletes as baseball pitchers. Due to the different physiological stresses in each overhead sport, it may not be appropriate to group all overhead athletes together. The objective of this study was to show sport specific physical adaptations in common overhead sports. Methods: Forty-three healthy, male athletes participated in this cross-sectional study; fifteen baseball pitchers, fifteen volleyball athletes, thirteen tennis athletes and fifteen control athletes. Internal rotation (IR) and external rotation (ER) shoulder range of motion (ROM), glenohumeral internal rotation deficit (GIRD), external rotation gain (ERG), posterior shoulder tightness (PST) (supine and side-lying methods), shoulder strength and scapular kinematics were assessed in a neuromuscular research laboratory. ROM was assessed with a goniometer while PST was assessed with a goniometer (supine) and carpenters square (side-lying). Strength was assessed with an isokinetic dynamometer and scapular kinematics with an electromagnetic tracking device. Results: Pitchers had more dominant IR ROM than tennis athletes and less dominant IR ROM than control athletes. Tennis athletes had the lowest IR ROM of all groups included in this study. Volleyball athletes had less dominant IR ROM than control athletes. Pitchers and tennis athletes had more GIRD than control athletes had. Pitchers and tennis athletes had higher between limb differences with the supine method of assessing PST. With the supine assessment, tennis athletes had increased dominant PST compared to control athletes; additionally, all overhead athletes had decreased non-dominant PST. At 90° and 120° humeral elevation, pitchers had the most scapular elevation, volleyball athletes had more elevation than tennis athletes did, and tennis athletes had less elevation than control athletes did. There were no differences in external rotation ROM, total rotation ROM, or strength measures. Conclusion: Not all overhead athletes had the same physical characteristics. The differences between sports in each of the variables could be due to the different amount of physiologic stress on the shoulder in each sport. These results may help to show healthy, sport specific adaptations in each sport. Clinicians should develop sport specific rehabilitation protocols and return to play criteria for athletes to return to play earlier and stronger.

This study examined how adults use power wheelchair seat features such as seat tilt, backrest recline, and seat elevation, during typical daily activities. A Seat Feature Data Logger (SFDL) was attached to 11 subjects wheelchairs for 10-14 days to gather data regarding daily usage of the wheelchair and these features. Subjects occupied their wheelchairs for 12.0 ± 3.0 hours per day and transferred in/out of their wheelchairs 5.0 ± 5.3 times per day. An average of 0.7 ± 1.5 hours per day was spent in an upright position. The tilt feature was accessed 18.4 ± 14.4 times per day for 8.5 ± 5.2 hours per day, and recline was accessed 11.5 ± 8.4 times per day for 8.6 ± 4.6 hours per day. Tilt and recline were used in combination for a total of 4.8 ± 4.6 hours per day. Subjects accessed the seat elevation feature 4.3 ± 4.1 times per day on average for 2.8 ± 4.6 hours day. Based on these data it was found that subjects spent significantly more time in a tilted versus an upright position (p<0.025), but that tilt was not used significantly more than recline (p=0.155) or seat elevation (p=0.046). In addition, comparison of SFDL data with pressuremapping data revealed that subjects were more likely to use small and intermediate amplitude tilt and recline angles, and positions known to result in low peak pressure were accessed more frequently and for longer durations than intermediate and high pressure positions. While subjects did not always use large angles of tilt and recline as many clinicians recommend these features were used frequently and their use resulted in lower peak pressures.

Medical advances are constantly increasing survival rates of individuals experiencing traumatic accidents and infants born with disabilities. Medical advances have also significantly increased the life expectancy of individuals living with disabilities as well as the general population. Along with these factors, baby boomers are growing the elderly population. All of this will cause the number of individuals with disabilities to increase exponentially over the next several decades. Many of these individuals will need assistance to complete their daily activities. Research has shown that when applicable, assistive technology by itself is more beneficial than human assistance or a combination of both human assistance and assistive technology. Dogs are a form of technology humans have been developing for thousands of years. Also, they have lived so closely with humans for so long, they have evolved an ability to understand human cues, gestures, facial expressions, etc. Because of this, their immense loyalty, desire to please, and ability to overcome social barriers, dogs are an ideal assistive technology for some individuals with disabilities. It was hypothesized that wheelchair users partnered with service dogs would score higher on quality of life indicators than wheelchair users not partnered with service dogs. Two hundred and fourteen individuals were included in a cross-sectional study. To be included in the study, subjects had to be 18 years of age or older and use a wheelchair for 75 percent of their mobility needs. Ninety-nine subjects partnered with service dogs for at least 14 months but less than 8.5 years were compared to one hundred fifteen subjects not partnered with service dogs. Quality of life indicators were number of hours of paid and unpaid assistance, mobility, physical independence, social integration, occupation, economic self-sufficiency, self-esteem, depression, and loneliness. The service dog group scored significantly higher on mobility although this group was comprised of significantly more individuals with severe disabilities and used almost significantly more hours of paid assistance. The service dog group outperformed the comparison group on nearly every other indicator although not to a significant degree. These results are similar to those in previous studies on the service dogs.

The number of neuropsychological tests and functional assessments that claim to have a relationship between the patients testing performance and behavior in real-world settings is limited. Additionally, there is a growing concern among testing professionals that most, if not all, psychological tests and standardized assessments introduce environments and stimuli that people never encounter and tasks that often do not emulate life situations or vocational requirements. In order to address the current issues surrounding the ecological validity of psychometric tests, this pilot study introduced a hands-on assessment using a simulated real-world vocational task. Twenty-three subjects between the ages of 18-26, with varying cognitive disabilities, completed a vocational simulation task, the Hamburger Turning Task (HTT), and the results were compared to their scores on a battery of commonly used neuropsychological tests (Wisconsin Card Sorting Test, Finger Tapping test, Controlled Oral Word Association Test, Trailmaking Test, Stroop Color-Word test) that purport to measure aspects of executive functioning analogous to those measured by the HTT. A Pearson-product correlation was run to compare the relationship between the scores from the HTT and the psychometric tests, as well as the relationship between both psychometric tests and HTT scores and daily behavioral observations of executive functioning related performance over a 7 week period. The results of the study found a significant correlation between the HTT and behavioral data, leading us to believe that the HTT can be used to evaluate real-world aspects of executive functioning. It was also found that there was a high level of interrater reliability on the scoring of the HTT, allowing future researchers to use this as a standardized tool.

Introduction: Shoulder musculoskeletal adaptations commonly occur in baseball pitchers due to repetitive throwing and extremely high shoulder velocities. Some observed adaptations include posterior shoulder tightness (PST) and glenohumeral internal rotation deficit (GIRD). The static capsular structures and dynamic muscles of the shoulder that are responsible for controlling normal glenohumeral arthrokinematics, must be properly stretched for normal shoulder movement. It is speculated that appropriate posterior shoulder stretching of the glenohumeral joint can decrease the amount of PST in an overhead athlete, help minimize the risk of developing shoulder pathologies, and increase the ability of the overhead athlete to perform. The purpose of this study was to evaluate three on-the-field posterior shoulder stretches among collegiate baseball pitchers. It was hypothesized that the standing sleeper stretch at 90º, sleeper stretch at 45º, and the horizontal cross arm stretch would create acute ROM differences and provide scapular stabilization for increasing shoulder IR ROM and decreasing PST. Methods: Glenohumeral ROM, PST, and scapular kinematics were measured in 15 male collegiate pitchers. All subjects were free of shoulder pain. Each subject performed one posterior shoulder stretch during 3 individual sessions. Glenohumeral ROM and PST were measured using an inclinometer/anthropometer, pre and post stretch while scapular kinematics were assessed using an electromagnetic tracking device during each stretch. Results: The results of this study show that stretching created significant acute increases in glenohumeral IR (p<.0001) and decreases in supine PST (p<.0001) and side-lying PST (p=.012). There were no significant differences between stretches for IR (p=.919), ER (p=.494), Supine PST (p=.536), and Side-lying PST (p=.177). The five scapular kinematic values showed no significant differences among stretches when compared for scapular upward rotation (p=0.066), external rotation (p=0.077), posterior tilting (p=0.101), protraction (p=0.221), and elevation (p=0.228). Conclusions: This study has demonstrated that performing a posterior shoulder stretch for a single session of 3 repeated 30 seconds is adequate to significantly increase acute GH IR ROM and decrease PST. Sufficient scapular stabilization can be achieved when the standing sleeper stretch at 90º, standing sleeper stretch at 45º, and the standing horizontal cross arm stretch are performed correctly.