Frame running is a sport for children and adults with mobility and balance limitations. Individuals use a three–wheeled running frame that allows them to walk and run under their own power. Frame running athletes have reported increased physical fitness, functional mobility, improved quality of life and other psychosocial outcomes. As part of World Para Athletics, Frame Running is striving to become a Paralympic sport. Unfortunately, current frame running equipment is financially costly, not readily available, and difficult to store and transport. In collaboration with Motivation Direct (UK) and Harvard Medical School, RecTech will develop and evaluate the performance of a low cost, portable, high–performance Frame Runner (D1). We selected the Frame Runner as a high priority need after consulting with Ms. Julia Ray, Programs Director of Move United, Dr. Cheri Blauwet a former Paralympic athlete, and Ms. Jen Allred, COO of Lakeshore Foundation (a Paralympic training center). We also selected this project as our top priority since the device has the potential to be used in recreational settings allowing children and adults with CP and other disabilities to participate in a recreational activity (e.g., jogging, fast walking) with family members and friends. Feedback from potential users, family members, and sport coaches will be utilized at each stage of development. This feedback will help drive iterations and guide market relevance for a product that is low–cost, easily transported, can be used recreationally, has a wide range of adjustments to accommodate varying body types and functional abilities, and can be used on varying surface types. Research (R1) will then be conducted on the newly developed pre–production prototype Frame Runner. Initial tests will assess the usability, biomechanical safety, and physiological response, followed by pilot efficacy testing to examine changes in physical function after a 12–week frame running intervention.

Over the last decade, our team has developed several telehealth projects involving synchronous and asynchronous modalities to engage PWD in physical activity. The proposed RERC will feature a national level SMART trial that will match the most appropriate intervention to each study participant targeting increased adherence and satisfaction. The project will advance the learnings (data) from its earlier trials using new artificial intelligence-driven algorithms to predict users’ behavior to tailor notifications and personalize coaching. This project results in identifying the most effective adaptive intervention towards increasing physical activity levels in the most cost-effective manner.

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National guidelines suggest that ALL children engage in at least 60 minutes of physical activity each day, yet children with disabilities receive significantly less physical activity than their peers. This has led to a higher risk of obesity in children with disabilities. Solving a complex problem such as this requires a systematic and holistic understanding of the various factors affecting the participation of children in physical activity. We propose to qualitatively perform a comprehensive exploration of the factors (i.e., barriers and facilitators) affecting the participation levels of children with disabilities in sports and recreation and map our learning to the ICF framework. These data will provide an understanding of the issues at a holistic level and allow for customized and tailored programs based on a set of algorithms derived from the study.

Frame running is a sport for children and adults with mobility and balance limitations. Individuals use a three-wheeled running frame that allows them to walk and run under their own power. Frame running athletes have reported increased physical fitness, functional mobility, improved quality of life and other psychosocial outcomes. As part of World Para Athletics, Frame Running is striving to become a Paralympic sport. Unfortunately, current frame running equipment is financially costly, not readily available, and difficult to store and transport. In collaboration with Motivation Direct (UK) and Harvard Medical School, RecTech will develop and evaluate the performance of a low cost, portable, high-performance Frame Runner (D1). We selected the Frame Runner as a high priority need after consulting with Ms. Julia Ray, Programs Director of Move United, Dr. Cheri Blauwet a former Paralympic athlete, and Ms. Jen Allred, COO of Lakeshore Foundation (a Paralympic training center). We also selected this project as our top priority since the device has the potential to be used in recreational settings allowing children and adults with CP and other disabilities to participate in a recreational activity (e.g., jogging, fast walking) with family members and friends. Feedback from potential users, family members, and sport coaches will be utilized at each stage of development. This feedback will help drive iterations and guide market relevance for a product that is low-cost, easily transported, can be used recreationally, has a wide range of adjustments to accommodate varying body types and functional abilities, and can be used on varying surface types. Research (R1) will then be conducted on the newly developed pre-production prototype Frame Runner. Initial tests will assess the usability, biomechanical safety, and physiological response, followed by pilot efficacy testing to examine changes in physical function after a 12-week frame running intervention.

Continuing our rich history creating impactful equipment/fitness industry standards, we propose three aims to introduce a set of new standards that will complement our existing published standards. The firmness and stability of indoor and outdoor play surfacing are critical to accessibility and safety for children with mobility impairments, including those who use mobility devices. Children with mobility impairments are often deprived of full participation and social inclusion in playground and sport activities as a result of poor surfacing conditions. We propose to revise draft standards for the field measurement of firmness and stability of indoor and outdoor play surfacing to allow schools and facilities hosting inclusive sports to ensure continued adherence to legal requirements for such surfacing. This standard will provide the ability to test all types of installed play surface types in indoor and outdoor settings and be able to monitor them as the surfaces age. Building from previous work, we also propose to revise and update the ASTM standards for Universal Design of Fitness Equipment based on input from the U.S. Access Board. Similarly, building on our previous work with RESNA standards for Inclusive Fitness (RESNAIF), we propose to revise and publish three additional sections of RESNAIF: (1) Specifications for Community-Based Fitness Facility Staff Training and Certification for Working with People with Disabilities; (2) Guidelines for Disclosure of Information about Adherence to Best Practices Related to Inclusive Fitness Environments for Marketing Purposes, and (3) Policy Topics for Inclusive Fitness Centers.

Inclusion of children with disabilities in physical education (PE) activities is critical for reducing social isolation, enhancing academic performance and meeting the recommended physical activity guidelines. PE classes should be stimulating, safe, and accessible for all students with diversified instruction, inclusive teaching strategies, and adapted equipment as needed. Using a valid and reliable tool (Inclusion Rating Scale For Physical Education Intervention) previously developed by our team, we will produce an online inclusion rating tool that teachers can use on mobile devices such as phones and iPads and receive instant solutions from our Adapted PE Decision Support System for the problems identified by the tool. This enables collection of national trends of PE inclusion across the country for analysis. The next phase will involve a crowdsourced technical assistance platform for user-requested PE/sports solutions, backed by a community of users that includes sport, PE, and exercise instructors, as well as researchers. Finally, we will develop and populate an online geotagged directory of adapted and/or inclusive sports and PE venues, along with equipment distributors, equipment rentals, and trainers across the country.

Data sharing is now commonplace among federally funded research to encourage transparency, widen the impact of research, improve return on resource investment, and reduce the likelihood of type II error. However, prior research and non-research data sets remain unavailable. While advancements in technology have enabled decisions made based on big data analytics, a lack of recreation, sport and exercise data have limited the advancement of successful strategies among participants, athletes, and their coaches. We propose to develop a purposeful data repository to house recreation, sport, and exercise data pertaining to people with physical disabilities, comprised of both research and non-research data sets (from athlete trainings, competitive events and more). We will also enable custom requests for data and will use our extensive network to either obtain solutions from existing data sources, or data will be obtained from our community partners.

Two major strategies will provide a comprehensive undergraduate and pre-doctoral mentorship program in exercise/recreation technology and exercise physiology to increase the number of successful independent exercise/rehabilitation/engineering researchers with advanced training in this science-based discipline:

Immersion in a mentored rehabilitation research experience
Complementary didactics to support trainees’ development as exercise/rehabilitation researchers.

To achieve our goals and objectives, we will select highly qualified undergraduate and graduate students in engineering, exercise/rehabilitation science who will work closely with faculty in RecTech’s labs, which include the following R&D: active video gaming, energy expenditure measurement, universal fitness equipment product design, and information and communication technologies. The mentorship program table is shown in Table 1.

RecTech-III Training Mentors

Name: Specialty Area: Specific Content Area Expertise

Scott Bickel, Ph.D: PT Rehabilitation Science: Exercise training

Lloyd Cooper, M.Eng: Engineering: Graphics design and device hardware/software

Dan Ding, Ph.D: Rehabilitation Science: Energy expenditure measurement

Alan Eberhardt, Ph.D: Biomedical Engineering: Engineering design of assistive technologies

Laurie Malone, PhD: Exercise Physiology: Energy expenditure, exercise testing & prescription

Tapan Mehta, MS, E.Eng: Department of Biostatistics: Statistician II

Sangeetha Padalabalanarayanan, MS: Bioengineering: Human factors

James Rimmer, Ph.D: Exercise Physiology: Physical activity, barriers, e-health delivery systems

Mohanraj Thirumalai, MS, M.Eng: Computer Science & Operation Management Information System: Information and Communication Technology

Tim Wick, PhD: Biomedical Engineering: Engineering systems and measurements

Functional Electrical Stimulation (FES)-assisted Rowing – Susan Silverman
Mentor: C. Scott Bickel

Functional Electrical Stimulation (FES)-assisted rowing uses electrical stimulation to create muscle contractions in the legs of people with spinal cord injury (SCI) while the person rows voluntarily with their arms. This activity is very beneficial for manual wheelchair users with SCI because it helps to strengthen the muscles in the back and helps increase the intensity of the aerobic workout. This project has focused on improving the rowing machine to create a more natural rowing stroke, and allows participants to begin rowing without the need for remedial strength training in the legs. Susan Silverman, MS, ATC, CSCS, is a Ph.D. candidate and Graduate Assistant in Rehabilitation Science in the School of Health Professions at UAB.

Kinect Gestural Interface for Disability – Sean Pool
Mentor: Alan Eberhardt

People with disabilities have higher rates of physical inactivity as compared with their able-bodied peers. Integrating fitness equipment with a virtual exercise environment (VEE) shows promise for increasing physical activity level within this population. It is necessary that a universal, gestural interface be created which allows all users to interact with the VEE. This project focused on programming the Kinect to adequately sample the position of the user’s body and recognize specific gestures that identify the user’s choice in the virtual exercise environment. Performance testing of upper-body gestures was completed with individuals post-stroke and individuals with cerebral palsy. Sean Pool, BS, is a Graduate Research Assistant in Biomedical Engineering in the School of Engineering at UAB.

The design experience for engineering (EGR) students at UAB begins with participation in a Freshman Learning Community that emphasizes team design, technical communications, engineering ethics and safety.  The two-semester freshman sequence, EGR 110/111 Introduction to Engineering, culminates in a design project. Dr. Eberhardt, along with the guest client (typically a physical therapist from the participating institution), present the project by providing a background associated with the users, their physical disabilities, and the environment of the institution.

The students are given one week to brainstorm; then they must present a design proposal complete with a budget. Once the design is approved, the students must order parts, construct the device and finally present their devices at the end of the term.  The clients attend the presentations and “judge” the devices.

We feel strongly that this early exposure to the concept of engineering design of assistive technologies provides an excellent introductory training experience. Future design projects will be centered around the targeted projects in this application, including addressing issues associated with each of the laboratory projects including active video gaming, energy expenditure measurement, universal fitness equipment product design, and information and communication technologies.

Capstone Senior Design Experience

The undergraduate curriculum for each engineering program at UAB culminates with a one-year capstone design sequence. For example, the sequence in Biomedical Engineering (BME 498 Product Development and BME 499 Capstone Design), directed by co-investigator Eberhardt, begins with students shadowing clinicians and therapists to determine clinical needs and ideate potential solutions.

With regard to new RERC activities, engineering undergraduates will rotate through the RecTech labs located at Lakeshore Foundation to assist with various projects targeted in this round of funding including: adapting active video game controllers, information and telecommunication technology, exercise devices with a built-in computer system, video technology, and e-health and m-health applications. Engineering design constraints for each area of RecTech’s R&D will be formulated, and student teams will be assembled around specific R&D questions. Engineering design tools will be reviewed, including computer aided drawing (CAD) and materials selection using CES software, and finite element analysis for stress analysis and design optimization. Brainstorming and evaluation of design alternatives will culminate in the development of a formal Design Proposal, which must gain signature approval from the target client.

The students will also investigate development issues for the exercise/recreation product industry, with consideration of intellectual property, patents, business plans and economic analysis. They will justify materials selection and purchasing, and ultimately construct, test and deliver a working prototype. The Final Capstone Design Presentation will be
attended by the clients, UAB faculty and students, and members of the UAB Research Foundation.

BME Capstone Design Project Wins da Vinci Award

A project designed as part of the BME Capstone Design Course was awarded the Student da Vinci Award last week at the 2014 da Vinci Special Awards Gala at the Ford Conference and Event Center in Dearborn, Michigan. The winning team included BME students Ryan Densmore, Daniel McFalls, Shelby May, and Stephen Mehi. Their project, the Toyrota, is a powered mobility device currently in use at the Bell Center in Homewood. Developed in 2001 by the National Multiple Sclerosis Society’s Michigan Chapter, the da Vinci Awards program aims to recognize current achievements and spur future innovations to benefit all people challenged with physical limitations.

Background

The translation of evidence into practice is a key factor underlying the successful adoption and maintenance of exercise behavior in people with physical disabilities. Unfortunately, healthcare providers lack the necessary decision support tools for expeditiously recommending to their patients to ‘precision-based’ exercise/recreation programs that haves a greater likelihood for achieving the target outcomes1. For healthcare providers to play a greater role in recommending exercise/recreation to their patients, time sensitive, decision support tools that provide lead to more ‘precise’ exercise/recreation recommendations and have a greater likelihood for promoting behavior change that results in higher rates of initiation (i.e., starting a new program), adherence, and improved health outcomes, are critically needed. This is the basis of the current D1 and R1 projects – that is, we seek to develop and evaluate the Precision-based Recreation & Exercise in Community Inclusive Settings and Environments Decision Support System (PRECISE DSS) through a multi-stage project involving feasibility and efficacy testing.

The aim of this R1 study is to test the feasibility and efficacy of the PRECISE DSS developed in the D1 project (Years 1-2) on a cohort of people with physical disabilities. The recommendations will target an identified domain of reduced physical function (e.g., lower extremity strength, balance, or walking) as a system-based approach for improving mobility.

Aims

To test the feasibility and efficacy of the PRECISE DSS for developing recommendations that will increase physical function in adults with physical disabilities.

Methods

Twenty-four participants will participate in the feasibility study and 48 participants in the efficacy study. People with one of the following diagnoses will be eligible for the study: MS, stroke, or Parkinson’s disease (PD). Eligibility criteria include: (a) age 18-64 years; (b) new member of Lakeshore Foundation; (c) willing and able to participate in a 4-month center-based exercise program; (d) non-exercisers (operationally defined as a health contribution score of less than 24 on the Godin Leisure Time Exercise Questionnaire; and (e) asymptomatic (i.e., one or fewer affirmatives on the Physical Activity Readiness Questionnaire (PAR-Q) or physician approval for undertaking exercise training for those with 2 or more affirmatives on the PAR-Q. Participants who do not meet these criteria will be excluded from study participation. The sample of 24 is sufficient for providing valuable feasibility information for informing the subsequent pilot study.

The research will be conducted in Lakeshore Foundation’s health and fitness facility with newly enrolled members. The R1 project (Years 3-5) will involve two successive research phases.

Phase I will involve a feasibility study design for understanding the processes (e.g., recruitment rate), resources (e.g., retention rate), management (e.g., research site capacity), and scientific (e.g., safety and adverse events) outcomes of the PRECISE system developed in D1 when delivered through the staff at Lakeshore Foundation.

Participants will complete the items in the PRECISE DSS and receive output regarding a physiological profile, set of exercise recommendations, and strategies for exercise behavior change. Participants will then meet with a Lakeshore staff member who will assist them in undertaking the PRECISE recommendations in a 4-month exercise program.

Upon completion of the feasibility study, we will contact participants for feedback. Feedback will involve a successive two-pronged approach: a) completion of a mail-delivered survey containing questions for evaluation of the exercise program and its materials; and b) completion of a telephone interview for further evaluation of the program and its materials as well as participant experiences. The interviews will contain questions about expectations of the exercise program, perceptions of the process for enrolling in the program, actual experiences in the program (including any perceived benefits and problems experienced), and perceptions of interactions with research staff, materials, as well as any burden experienced from the PRECISE-generated exercise program.

Phase II will deploy a pilot randomized controlled trial for understanding the efficacy of the PRECISE system and refined during the feasibility phase for improving physiological function and walking outcomes in 48 participants with physical disability. Eligible participants who complete the baseline assessments will be randomly assigned to the PRECISE training program or to a usual care condition (standard membership orientation). Adherence to the PRECISE-based exercise recommendations and compliance with the exercise prescriptions will be examined.

Participants in the intervention group will receive their set of exercise recommendations from the modified (post-feasibility phase) PRECISE DSS. Participants in the usual care condition will go through the standard practice at Lakeshore Foundation, which involves an orientation of the facility, program overview, and general advice from a Lakeshore staff person. Participants in the intervention condition will then begin the PRECISE-generated exercise recommendations over the 4-month exercise period, while participants in the usual care condition will begin a 4-month, self-directed exercise program. Outcomes will be collected immediately upon completion of the 4-month period for participants in both conditions.

The primary outcome for this first phase of testing with the PRECISE DSS is physical function, which will be measured with the Short Physical Performance Battery. Walking performance will be assessed with the Timed 25-Foot Walk and the 6-Minute Walk Test.

Adherence (i.e., completion of the 4-month program) and compliance with the exercise training recommendations will be monitored based on personal logs and diaries as well as electronic records obtained when entering and leaving Lakeshore (i.e., membership card swipes).

Final Outcomes

Participants who receive the PRECISE-generated exercise recommendations will achieve greater gains in physical function (balance, strength and cardiorespiratory function) compared to a usual care group that receives a standard membership orientation upon joining a fitness center.

References

Learmonth Y, Adamson BC, Balto JM, Chiu CY, Molina-Guzam, IM, Finlayson M, Barstow E, Motl RW. Investigating the needs of healthcare providers for promoting exercise in persons with multiple sclerosis: A qualitative study. Dis Rehabil. in press.

Background

A growing body of literature indicates that increases in energy expenditure can be achieved during active video gaming (AVG) play in people with physical disabilities, including those with mobility impairments such as cerebral palsy (CP)1,2, spinal cord injury (SCI)3,4, stroke5, and other neurological conditions6,7. AVGs are particularly important for people with disabilities given the higher rate of inaccessible features in the built environment and the difficulty in finding activities they enjoy. Since AVG devices are relatively affordable, they also hold promise as a scalable product for promoting higher levels of physical activity and fitness among people with disabilities.

There continues to be a pressing need to make certain gaming controllers accessible to people who are unable to stand for long periods, cannot stand on a small platform due to poor balance or extreme obesity, or who are unable to stand and are full-time wheelchair users. The Wheelchair Accessible Active Video Gaming (W-AVG) controller that is being developed in Project D2 will be used in this study to improve health and function in ambulatory and non-ambulatory adults with physical disabilities.

Aims

To evaluate the efficacy of a 12-week (36 sessions) AVG exercise intervention using the W-AVG controller in improving cardiorespiratory endurance health, balance, balance confidence, health-related quality of life, fatigue, pain interference, and depressive symptoms in people with physical disabilities.

Methods

A randomized single-blinded 2 x 2 crossover design will be used. A total of 36 eligible participants will be recruited and randomized into one of two groups: (1) W-AVG (immediate intervention), and (2) Control (delayed intervention).

During Visit 1, following informed consent and completion of the baseline assessments, participants assigned to the W-AVG group will be familiarized with the gaming system and how to utilize weight shifting for playing the games. An appointment will be scheduled for the next visit, approximately 1 week later, when the actual intervention period will begin.

Participants in the W-AVG group will attend individual exercise visits supervised by a member of the research team three times weekly for 12 weeks for a total of 36 sessions. The intervention will be comprised of various aerobic AVG games (e.g., boxing, running, dancing, and aerobics). During each session, aerobic games will be played in bouts of 10 minutes separated by lower-intensity balance games, and finishing with 5 minutes of cool-down activities (e.g., stretching, yoga).

The training protocol will consist of repetitions of several games selected from Wii Fit Plus or other similar game packages. Each game will start at the basic/beginner level, and when a certain score is attained, will automatically advance to the next level. During the first 4 weeks of training the exercise intervention will be guided by researcher-selected games to ensure an appropriate progression and amount of aerobic activity. For weeks 5 to 8, the exercise program will be adjusted by the research team based on participant needs with continued progression and balance of activities. Progression of activities will be guided by participant safety, independence, use of appropriate movement strategies, level of engagement, and fatigue. In weeks 9 to 12 of training, participants will be free to play games that they enjoyed the most, with the goal of achieving 50 minutes of aerobic activity each session.

Final Outcomes

The W-AVG intervention will result in greater improvement in cardiorespiratory endurance, balance, and self-reported health outcomes compared to a control group.

References

Howcroft J, Klejman S, Fehlings D, et al. Active video game play in children with cerebral palsy: Potential for physical activity promotion and rehabilitation therapies. Arch Phys Med Rehabil. 2012;93(8):1448-1456.
Rowland JL, Rimmer JH. Feasibility of using active video gaming as a means for increasing energy expenditure in three nonambulatory young adults with disabilities. PM R. 2012;4(8):569-573.
Mat Rosly M, Mat Rosly H, Hasnan N, Davis GM, Husain R. Exergaming boxing versus heavy bag boxing: Are these equipotent for individuals with spinal cord injury? European journal of physical and rehabilitation medicine. 2017.
Burns P, Kressler J, Nash MS. Physiological responses to exergaming after spinal cord injury. Top Spinal Cord Inj Rehabil. 2012;18(4):331-339.
Trinh T, Scheuer SE, Thompson-Butel AG, Shiner CT, McNulty PA. Cardiovascular fitness is improved post-stroke with upper-limb Wii-based Movement Therapy but not dose-matched constraint therapy. Top Stroke Rehabil. 2016;23(3):208-216.
Malone LA, Rowland JL, Rogers R, et al. Active Videogaming in Youth with Physical Disability: Gameplay and Enjoyment. Games Health J. 2016.
Rowland J, Rimmer JH. Feasibility of using active video gaming as a means for increasing energy expenditure in three nonambulatory young adults with disabilities. Phy Med & Rehabil. 2012;4:569-573.

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Background

Physical inactivity is a serious public health issue in people with spinal cord injury (SCI)1, with less than 2% of their waking hours engaged in any type of structured exercise or leisure time physical activity as reported in the literature. People with SCI, especially those with limited access to fitness facilities, could benefit from teleexercise2, given its potential to deliver customized exercise training through a supportive online platform.

We are in a unique position to advance a nationwide physical activity program delivered through an eHealth platform established in 2008 in our National Center on Health, Physical Activity and Disability (NCHPAD). By revamping the eHealth platform, we are proposing to test two versions of a remotely-delivered, innovative and theory-based teleexercise program designed for adults with SCI. One of the major strengths of this project is the potential to rapidly and effectively scale our findings to people with SCI across the country through NCHPAD.

Aims

To compare the effects of two 8-week teleexercise interventions: movement-to-music (M2M) and standard exercise training (SET), delivered through the NCHPAD eHealth platform on physical activity and other related outcomes.
To evaluate the demographic (age, race, sex), clinical (level of injury, type of injury), and psychosocial (social support, outcome expectations, self-efficacy, self-regulation) variables of two participant groups: 1) compliant participants who completed ≥ 50% of the intervention; 2) noncompliant participants who completed post-testing but < 50% of the intervention or who did not complete post-testing.
Methods

The proposed three-arm randomized pragmatic trial will examine two versions of a remotely-delivered, innovative, theory-based home exercise program with 327 adults with SCI who will be randomized into one of three groups: a) M2M, b) SET, and c) Attention control (ATT). A total of 327 individuals with SCI (18 to 65 yrs) will be recruited for the study.

Participants in the M2M and SET groups will receive their assigned intervention via the NCHPAD telehealth platform. The platform will allow rolling admission so enrolled participants can register for their assigned exercise program at any time during the study period and begin the program on the following Monday. Once registered, participants will be instructed to create a profile, choose a user ID and password, and answer a set of personalization questions regarding their function, health, and exercise preferences.

The week in which a participant registers will be considered the introductory week (week 0). Throughout this week the participant will be oriented to the NCHPAD platform but access to the M2M or SET program will be restricted until the following Monday. An introductory/training video will be given to the participant with a visual demonstration of how to set up a safe environment to exercise, basic movements, use of equipment, correct exercise posture, and safety guidelines specific to the assigned intervention. Once the video is watched, the participant will then be given access to the first set of exercise routines. A brief online program evaluation form will be sent to the participant at the end each week to obtain feedback on the program.

Participants in all 3 groups will be able to access the NCHPAD website where they will have access to live chat and a toll-free hotline in case they would like to speak to an information specialist to help answer any questions regarding exercise, disability or health.

Our M2M program has been developed for onsite instruction and will be repurposed into an eHealth version. Movement and tempo-based adaptations will also be available. A typical M2M session will consist of tailored movement routines starting with a warmup using range of motion exercises, followed by muscle strengthening, cardiorespiratory, and/or balance routines, and ending with a cool down emphasizing breathing and mindfulness.

The SET intervention is based on the NCHPAD 14-Weeks to a Healthier You program launched in 2008. Exercise videos, which involve standard exercise training routines both seated and standing, have been developed and archived for use in this study. The SET intervention will be delivered through the same platform as M2M.

The ATT group will be provided with NCHPAD’s online newsletter and will have access to NCHPAD’s toll-free telephone number, email address and website.

Table 2 summarizes the variables and data collection time points corresponding to each outcome measure. All measures will be completed online. We will use participant program engagement as an indicator of exercise adherence. The platform is designed to electronically record timestamps and collect information when a participant logs into the platform, and every subsequent webpage/video being viewed.

Final Outcomes

Participants in M2M and SET groups will have significantly greater increases in physical activity, decreases in pain and fatigue, and improvements in sleep quality and quality of life compared to ATT after an 8-week intervention and at 12-week follow-up.
Participants in M2M will have significantly greater adherence and exercise enjoyment compared to SET.

References

Latimer A, Martin Ginis KA, VCraven B, Hicks A. The physical activity recall assessment for people with spinal cord injury: validity. Med Sci Sports Exerc. 2006;38:208-216.
Lai B, Rimmer J, Barstow B, Jovanov E, Bickel CS. Teleexercise for persons with spinal cord injury: A mixed-methods feasibility case series. JMIR Rehab Assist Technol. 2016;3:1-15.Charlton ME GK, Munsinger T, Schmaderer L, Healey KM. Program evaluation results of a structured group exercise program in individuals with multiple sclerosis. Int J MS Care. 2010;12:92-96.

Background

Use of health club and fitness facilities in the U.S. is rising with current membership at 55.3 million1. However, despite the number of facilities available, studies have cited their limited accessibility to people with physical disabilities2-6. A recent study by RecTech102 examined the accessibility of 227 fitness facilities across the U.S. and concluded that the majority do not fully meet standards outlined by universal design principles or the American with Disabilities Act.

Universal design (UD) is defined as the “design of products and environments to be usable by all people, to the greatest extent possible, without the need for adaptation or specialized design.”7 Sources such as Universal Design of Fitness Equipment published by the American Society for Testing Materials, and National Guidelines for Inclusive Fitness currently under development by the Rehabilitation Engineering and Assistive Technology Society of North America, could assist equipment manufacturers and facility personnel in the development of equipment, programming, services, and facility space that incorporate UD principles.8 To date, no published research is available describing why facility personnel and equipment manufacturers have not considered or adopted UD principles.

Aims

This project will explore the barriers to, and facilitators for, adopting UD principles by equipment manufacturers and public, private and recreation facilities.

To determine the barriers to and facilitators for producing accessible fitness equipment.
To determine the barriers to and facilitators for designing accessible public and private fitness facilities in the context of programming, services and environments.
To assess the relative importance of criteria and “trade-offs” individuals with disabilities would make when prioritizing UD features in public and private fitness facilities.
To compare and contrast the perceptions of equipment manufacturers and fitness facility personnel to the priorities given by individuals with disabilities regarding UD features.
Methods

This mixed methods exploratory study will use both qualitative and quantitative methods to address our 4 aims. We will use qualitative methods to 1) gather perceptions of equipment manufacturers and recreational fitness facility personnel regarding the barriers to and facilitators for applying UD principles; and 2) identify attributes and associated attribute-levels, which will guide consumer survey development. We will use quantitative methods to survey consumer preferences through discrete choice experiments, and importance of attributes by individuals with disabilities, to prioritize UD features. We will then use the results of the manufacturer and fitness personnel qualitative interviews and consumer surveys collected from the manufacturer and fitness personnel to develop a driver diagram to illustrate the collective views of these stakeholders, and to delineate processes for enhanced application of UD principles.

Phase 1/Aim 1: Manufacturer Perceptions of UDFE. We will complete one-to-one audio-recorded qualitative interviews using pilot tested interview questions. An invitation to participate will be sent to manufacturers who produce fitness equipment. Interviews will be conducted face-to-face or online.

Phase 2/Aim 2: Fitness Facility Personnel Perceptions. We will use the same methodology as described in Phase 1/Aim 1 for manufacturers. To ensure trustworthiness of the qualitative data in both Phases 1 and 2, we will apply methods of analyst triangulation and member checking. Analyst triangulation will be applied by enlisting two qualitative researchers to code all interview transcripts. Inter-coder agreement will be recorded and respondent validation will be performed.

Phase 3/Aim 3: Perceptions of Individuals with Disabilities. We will design a survey to learn the relative importance and priorities or key attributes of UD design principles from the perspective of individuals with disabilities using discrete choice experimentation (DCE). DCE is a preferred method for researchers to identify preferences and the importance of key attributes of a health service or product.

Stage 1 – Qualitative online focus group with a pilot tested script will be conducted and audio-recorded to determine the attributes and associated levels of UD application to fitness facilities. This information will be used to guide survey development in Stage 2. We will ensure trustworthiness of the focus group data through analyst triangulation as described earlier.

Stage 2 – In the second stage of the DCE process, we will develop an online survey that will present attribute and attribute-levels as choice sets that capture series of sets of alternatives from among the different attribute and attribute-level combinations. The survey attributes, attribute-levels and choice sets (combinations of these attribute and attribute-levels) will be derived from the focus group results coupled with the use of a D-efficiency design. The goal of a D-efficiency design approach (also known as D-optimality) is to maintain statistical efficiency of the survey and minimize response burden as it may be impractical and unnecessary for participants to respond to all the combinations of the attribute-levels (i.e., full factorial design).

Phase 4/Aim 4: Compare and Contrast Results Obtained in Previous Phases. Integration of data derived from manufacturers and fitness personnel (Phase1 and 2) to that collected from individuals with disabilities (Phase 3) will be used to innovatively develop a driver diagram.

Final Outcomes

Appropriate instruments will be created to survey key stakeholders who represent the fitness industry to better understand the barriers to and facilitators of adoption of UD principles.

References

International Health RSA. About the Industry. http://www.ihrsa.org/about-the-industry. Accessed 07-17, 2017.
Vasudevan V, Rimmer JH, Kviz F. Development of the Barriers to Physical Activity Questionnaire for People with Mobility Impairments. Disabil Health J. 2015;8(4):547-556.
Dolbow DR, Figoni SF. Accommodation of wheelchair-reliant individuals by community fitness facilities. Spinal Cord. 2015;53(7):515-519.
Rimmer JH, Riley B, Wang E, Rauworth A. Accessibility of health clubs for people with mobility disabilities and visual impairments. Am J Public Health. 2005;95(11):2022-2028.
Rimmer JH, Riley B, Wang E, Rauworth A. Accessibility of health clubs for people with mobility disabilities and visual impairments. Am J Public Health. 2005;95:2022-2028.
Rimmer JH. The conspicuous absence of people with disabilities in public fitness and recreation facilities: lack of interest or lack of access. Am J Health Promot. 2005;19(5):327-329.
The Center for Universal Design. The Principles of Universal Design, Version 2.0. 1997; https://www.ncsu.edu/ncsu/design/cud/about_ud/udprinciplestext.htm. Accessed 07-17, 2017.
ASTM International. ASTM F3021-17 Standard Specification for Universal Design of Fitness Equipment for Inclusive Use by Persons with Functional Limitations and Impairments. https://www.astm.org/search/fullsite-search.html?query=universal design and fitness equipment&resStart=0&resLength=10&. Accessed 07-17, 2017.

Background

The development of suitable strategies for recommending appropriate exercise/recreation programs for people with disabilities is a dynamic, iterative process that involves complex decision-making between the user and the practitioner (e.g., health professional, fitness instructor)1. Despite the abundance of evidence that people with disabilities are receiving less than adequate exercise/recreation services from health care providers2, poorer quality exercise/recreation opportunities3, and have substantially greater health disparities compared to the general population4, there is currently no decision support system (DSS) that addresses their unique needs.

There is a need for a decision support tool that can guide healthcare providers and exercise/rehabilitation professionals in assisting people with disabilities to lead an active lifestyle. Today, big data technology has advanced to such a degree that abundant new data sources can be converted into smart software, thereby allowing more decisions to be made based on data and analysis rather than experience and intuition. Such DSS can also have the ability to update new data sources and over time increase its predictability for subgroups of people with similar characteristics.

Aims

To develop a health informatics infrastructure that integrates participant-specific computational models delivered through clinical decision support tools, which referred to as Precision-based Recreation, Exercise in Community Inclusive Settings and Environments Decision Support Tool (PRECISE DSS).

Methods

The PRECISE DSS will be conceptually based on the International Classification of Functioning, Disability and Health (ICF)5 and will have the capability to process the following inputs: a) clinical inputs that describe the physiological profile of a person, b) behavioral factors such as self-efficacy and motivation, c) environmental factors such as transportation and caregiver support, and d) demographics and health history. The PRECISE DSS will be developed following 3 steps.

Step 1 will focus on developing the PRECISE DSS prototype and gathering user interface requirements. A rules-based approach will be developed that accounts for person-specific inputs such as barriers and preferences, as well as clinical inputs as shown on the left side of the model in the Figure The PRECISE DSS will contain a) a module that will be used to catalog information mapping equipment, which means that the database will have the ability to provide information about the choice of exercise equipment for improving a specific physiological function and b) a home-based module that will catalog information about the different exercises and resources available to improve adherence to an exercise recommendation/prescription in a home-based or remote setting.
Additional inputs will be accounted using the American College of Sports Medicine’s guidelines, literature reviews and mining our own data sets for exercise prescription and management, issues associated with behavioral (e.g., motivation, interest, exercise self-efficacy, decisional balance) and environmental factors (e.g., social support, transportation, built environment) factors. Furthermore, we will use a) our extant data from multiple exercise training studies conducted under the UAB/Lakeshore Research Collaborative, which will include a sample size over 600 that provide information about anthropometric measures, muscular strength, aerobic capacity, functional mobility, as well as social cognitive theory constructs including self-efficacy and outcome expectations; b) the technology we created in previous grant applications, which allowed our team to design and build a health information technology platform (POWERS, Personalized Online Weight and Exercise Response System) that demonstrated success in achieving weight loss in adults with physical/mobility disability6,7 to help develop the PRECISE DSS.

An iterative usability assessment will be performed to design and develop the information display across different groups of disabilities. Twenty people with disabilities and 10 exercise trainers will respond to a series of questions using an adaptation of the System Usability Scale and the results of this scale will drive our choice of user interface.

Step 2 will involve the software development based on feedback from step 1. We will conduct a round of testing to ensure that the DSS is ready for use by other participants. This will be done side-by-side with a researcher and a developer in order to attain the richest feedback and most effective and efficient development iterations possible.
Step 3 will involve training/educational sessions for staff and people with disabilities at Lakeshore Foundation about how to use and interpret the PRECISE DSS. Detailed evaluation including testing the feasibility and efficacy of the PRECISE DSS as well as qualitative feedback.
Final Outcomes

A decision support tool that guides healthcare providers and exercise/rehabilitation professionals in assisting people with disabilities to make better choices regarding exercise/recreation programs, facilities, equipment and services will be developed.

References

Grim K, Rosenberg D, Svedberg P, Schon UK. Development and usability testing of a web-based decision suport for users and health professionals in psychiatric services. Psychiatr Rehabil J. 2017;E pub ahead of print.
Learmonth Y, Adamson BC, Balto JM, Chiu JM, Molina-Guzam, IM, Finlayson M, Riskin BJ, Motl RW. Multiple sclerosis patients need and want information on exercise promotion from healthcare providers: A qualitative study. Health Expectations,. in press,.
Martin Ginis K, Ma JK, Latimer-Cheung AE, Rimmer, JH. A systematic review of review articles addressing factors related to physical activity participation among children and adults with physical disabilities. Health Psychol Rev. 2016;10:478-494.
Carroll D, Courtney-Long EA, Stevens AC, Sloan ML, Lullo C, Visser SN, Fox MH, Armour BS, Campbell VA, Brown DR, Dorn JM. Vital signs: disability and physical activity – United States, 2009-2012. 2014;63(18):407-413.
Rimmer JH. Use of the ICF in identifying factors that impact participation in physical activity/rehabilitation among people with disabilities. Dis & Rehabil. 2006;28(17):1087-1095.
Rimmer J, Rauworth A, Wang E, Heckerling P, Gerber BS. A randomized controlled trial to increase physical activity and reduce obesity in a predominantly African American group of women with mobility disabilities and severe obesity. Prev Med. 2009;48:473-479.
Rimmer JH, Wang E, Pellegrini CA, Lullo C, Gerber B. Telehealth weight management intervention for adults with physical disabilities. A randomized controlled trial. Am J Phys Med Rehabil 2012;92:1084-1094.

Background

Active Video Games (AVG), also known as exergames, refers to a category of video games in which game play, progress and scoring require substantially greater levels of body movement. Since their introduction, AVGs have become popular with people of all ages, with and without disabilities, and have been used in home, community, education, and rehabilitation settings to increase physical activity and other related measures1-8. There remain unresolved technical issues, however, associated with AVG access and utility in individuals with more severe physical disabilities.

To increase the level of usability for those with various forms of mobility impairments, we have developed an adapted gaming board for Wii Fit Balance designed with 3 key features: 1) a large platform area (40 inches x 38 inches), 2) built-in lateral stabilization supports (i.e., handrails), and 3) an adjustable sensitivity for making shifting of center of gravity more or less challenging. Since its development, we have received a number of purchase inquiries from visiting physical therapists who saw a demo of the adapted balance board in our lab at Lakeshore Foundation or at our exhibit booth at the annual RESNA conference and wanted to purchase one for their own practice.

Aims

To perform highly targeted proof of product activities for a Wheelchair Accessible Active Video Gaming (W-AVG) controller with an experienced team of engineers, product designers, potential customers, and other stakeholders from the research community.

Methods

The project will be conducted in 4 stages, which are described below.

Commercial Product Conceptualization: a) Perform market analysis and customer discovery activities to develop strong marketing and technology transfer strategies; b) Perform customer/user experience immersion activities to develop customer and user use scenarios to develop customer-specific (i.e., PT clinics) product requirements such as form, function, price point, and compatibility with a set of video games and gaming platforms; c) Reimagine the ideal commercial product and identify opportunities for innovation and improvements to existing adapted balance board controller proof of concept device; d) Research, identify, procure, test, down select, and validate critical technology components to enable realization of a pre-production prototype.
Pre-Production Prototype Development and Testing: a) Finalize pre-production product design based on product requirements developed in Stage 1 through modification of existing design for adapted balance board controller proof of concept device; b) Fabricate, assemble, and perform laboratory testing and validate requirement satisfaction for a single pre-production prototype; c) Revise pre-production product design as needed to include design for manufacture protocols, industrial assembly strategies, and product aesthetics and branding.
Deployment of Production Representative Systems at Multiple Customer Sites: a) Work with 2-3 potential local customers (i.e., PT clinics) to develop agreements and utilization plans for long-term deployment (>3mos) of a production representative system in their facilities for regular daily use; b) Provide responsive customer support for each deployment site and establish a pathway to obtain feedback from each site’s staff and patients on a regular basis; c) Compose summary report of findings on customer/patient/stakeholder feedback as well as any recommendations for design additions or modifications to provide improved customer and/or user experience.
Product Launch Preparation: Finalize product design based on findings from Stage 3 and finalize implementation of the technology transfer plan (TTP). This stage will aim to obtain quotes from commercial manufacturers such that a final product price point can be developed or a licensing agreement to transfer the design to an established company.
Final Outcomes

Our first-generation proof of concept gaming controller will be transitioned into a product (W-AVG) toward commercialization.

To view our current Balance Board Controller Prototype, please visit https://youtu.be/vQCTXlVV2Ls.

References

Mullins NM, Tessmer KA, McCarroll ML, Peppel BP. Physiological and perceptual responses to Nintendo Wii Fit in young and older adults. Int J Exerc Sci. 2012;5(1):79-92.
Maloney AE, Stempel A, Wood ME, Patraitis C, Beaudoin C. Can Dance Exergames Boost Physical Activity as a School-Based Intervention? Games Health J. 2012;1(6):416-421.
Christison A, Khan HA. Exergaming for health: a community-based pediatric weight management program using active video gaming. Clin Pediatr (Phila). 2012;51(4):382-388.
Vallabhajosula S, Holder JB, Bailey EK. Effect of Exergaming on Physiological Response and Enjoyment During Recess in Elementary School-Aged Children: A Pilot Study. Games Health J. 2016.
McNulty PA. Games for rehabilitation: Wii-based movement therapy improves poststroke movement ability. Games Health J. 2012;1(5):384-387.
Trinh T, Scheuer SE, Thompson-Butel AG, Shiner CT, McNulty PA. Cardiovascular fitness is improved post-stroke with upper-limb Wii-based Movement Therapy but not dose-matched constraint therapy. Top Stroke Rehabil. 2016;23(3):208-216.
Padala KP, Padala PR, Lensing SY, et al. Efficacy of Wii-Fit on Static and Dynamic Balance in Community Dwelling Older Veterans: A Randomized Controlled Pilot Trial. J Aging Res. 2017;2017:4653635.
Plow M, Finlayson M. Potential benefits of Nintendo Wii Fit among people with multiple sclerosis: A longitudinal pilot study. Int J MS Care. 2011;13(1):21-30.

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Background

RecTech has been developing a proof-of-concept advanced virtual exercise environment device (AVEED) and a utility patent has been filed. AVEED is a universal, modular exercise device that can be taken into mass production at an affordable cost, which will allow people with disabilities to participate in more enjoyable and engaging exercise experiences. The AVEED unit is unlike any other commercial product available on the market. First, the machine features a universally adaptable positioning system capable of being used from a recumbent position to a forward lean position, which allows the device to be moved into the optimal spatial orientation to meet an individual user’s needs, either sitting or standing, and also meets a range of user function, height and limb length. Secondly, AVEED uses an advanced software control system that has enabled several unique capabilities to meet the varying demands of people with physical disabilities. The latest advancements have centered around our ability to input unilimb loading resistance to both the left and right arms/legs independent of each. Since the arm/leg cranks are independent, the device is uniquely suited for allowing a training regimen to be arranged where the weakened limb(s) and the stronger limb(s) are being loaded relatively equally so that a training effect can occur for each limb. To promote socially engaging exercise, AVEED also features preliminary capabilities to interface with any virtual environment training (VET) system such as Bkool or Zwift. Although these commercial VET systems have seen promising advancements in the past few years, these systems still pose an access problem for people with physical disabilities (i.e., non-ambulatory or limited ambulation).

Aims

In order for people with physical disabilities to be able to fully participate in publicly available VET, we are proposing to add the following features to AVEED: a) Power Augmentation Capabilities: to offer smart power augmentation1-3 by adding four different motors in place of the current flywheel-based resistance system. This will allow users with uneven power on different limbs (hemiparesis)4-6 to derive maximum benefits of the cycling motion; b) Precise Measurement of Input Power: to gather real-time power output in watts from each input (left arm, right arm, left leg, right leg). This will allow accurate measurement for more realistically interfacing with virtual exercise environments and to support clinical rehabilitation applications; c) Simplified Adjustment of Upper Axes Position: to advance the portions of the frame carrying the arm axes so they will rotate electronically about their respective pivot axes similar to the way you can easily adjust a powered seat back angle in a car; and d) Refine VET Connectivity: AVEED is currently able to connect to online VET systems such as Zwift, but the connection needs to be optimized for accurate input power calibration, adjusting between upper and lower extremity input, in addition to a simplified connection methodology.

We will also conduct an exploratory study to test the enhanced AVEED device with post-stroke participants. The aims of the study are described below.

To use AVEED to discover the optimal resistance/power augmentation settings that will enable people post-stroke to generate the greatest arm and leg pedaling work values during exercise with the device.
To use these optimal parameters obtained from Aim 1to inform a 12-week pilot and feasibility study.
Methods

Twenty-four individuals with chronic hemiparetic stroke will be recruited. Inclusion criteria are: (1) age 18 years or older; (2) >5 months post-stroke; (3) able to ambulate at least 14 m with an assistive device or assistance of one person; (4) approval of primary care physician. Exclusion criteria are: (1) Mini-Mental State Exam score <24; (2) currently receiving lower extremity strengthening exercises or gait training.

For Aim 1, individuals will participate in a 60-minute session where we will ask them to pedal with their arms, legs, and then both arms/legs using AVEED against different levels of resistance/power augmentation and with different left/right leg speeds. We will collect data on heart rate, perceived exertion, and any challenges associated with the single session training protocol. This optimization protocol will allow us to calculate the relative differences in pedaling work generated by each limb. After safety and optimal parameters are ascertained, VET capabilities will be initiated. We will collect feedback about their experience using the AVEED device while generating the greatest possible symmetry of work done by the paretic versus non-paretic limbs. These generated optimal settings will be used in Aim 2.

For Aim 2, we will conduct a randomized crossover trial (12 participants per arm) with a 4-week washout period. Participants will be randomized to start with 30 minutes of AVEED multi-limb exercise training, three days per week, over a 12-week period, or be instructed on a daily walking regimen for the same time frame. With respect to AVEED training, the participants will pedal for 30 minutes at a pace and against resistance levels that elicit the greatest symmetry of pedal work with each limb and a heart rate response between 50% and 80% of their heart rate reserve. The walking group will be asked to walk around Lakeshore’s indoor track for 30 minutes continuously, three days a week, at their own comfortable pace. Process feasibility outcomes will include recruitment, refusal, retention and adherence. Clinical outcomes of interest will be assessed pre and post intervention. Measures will include:

10-meter timed walk: Gait speed (m/sec) = distance covered (10 m)/time (sec)
6-minute walk test: Distance covered to the nearest meter in 6 min
Berg Balance Scale: 14 items (1 sitting, 13 standing) related to balance function
We will also collect biomechanical muscle performance data to explore possible mechanistic underpinnings of the changes that are observed pre- versus post-training. Changes to peak ankle plantarflexor and peak hip flexor torque will be assessed using a multi-joint dynamometer (Biodex System 3, Shirley, NY).

Final Outcomes

The enhanced AVEED will allow users with hemiparesis to generate the greatest arm and leg pedaling work during exercise with the device, which will be supported by the 12-week pilot and feasibility study. The device will be prepared for commercialization.

References

Kazerooni H. Exoskeletons for human power augmentation. Paper presented at: Intelligent Robots and Systems, 2005.(IROS 2005). 2005 IEEE/RSJ International Conference on2005.
Marcheschi S, Salsedo F, Fontana M, Bergamasco M. Body extender: whole body exoskeleton for human power augmentation. Paper presented at: Robotics and Automation (ICRA), 2011 IEEE International Conference on2011
Yang C-J, Niu B, Chen Y. Adaptive neuro-fuzzy control based development of a wearable exoskeleton leg for human walking power augmentation. Paper presented at: Advanced Intelligent Mechatronics. Proceedings, 2005 IEEE/ASME International Conference on2005.
Chen G, Patten C, Kothari DH, Zajac FE. Gait differences between individuals with post-stroke hemiparesis and non-disabled controls at matched speeds. Gait & posture. 2005;22(1):51-56
Levin MF, Cirstea MC, Michaelsen SM, Roby-Brami A. Use of trunk for reaching targets placed within and beyond the reach in adult hemiparesis. Exp Brain Res. 2002;143.
Stevens JA, Stoykov MEP. Using motor imagery in the rehabilitation of hemiparesis. Archives of physical medicine and rehabilitation. 2003;84(7):1090-1092

Background

The multilevel socio-ecological barriers to physical activity experienced by people with physical disabilities cut across structures and systems, community, institutions and organizations, interpersonal, and individual levels1-5. Several studies have attempted to understand these barriers and facilitators, but to date, no study or system has attempted to systematically resolve these multilevel barriers and capitalize on the potential facilitators that can increase access to exercise and recreation programs, services and facilities for people with disabilities6.

In our previous cycle of funding, RecTech addressed this gap in a Proof of Concept product called the Activity Inclusion Mapping System (AIMS). AIMS (See Figure to the right or visit http://aims.rectech.org) enabled people with disabilities to quickly and precisely identify accessible and usable community-based physical activity resources and services. We aim to further develop an innovative person-centered geotagged Social Networking System based on the social-ecological model of health6,7 to address multilevel barriers and facilitators associated with community-based leisure time physical activity (LTPA) experienced by all people with physical disabilities.

Aims

To develop an information and communication technology solution named RecTechMatch.com to systematically resolve barriers and capitalize on facilitators for increasing LTPA participation by people with physical disabilities.
To evaluate the usability and feasibility of RecTechMatch.com towards increasing LTPA minutes, reducing barriers to LTPA, and increasing social support.
To complete mass deployment of the system at a national level through our National Center on Health, Physical Activity and Disability (nchpad.org).
Methods

The project will be conducted in 3 stages corresponding to our 3 specific aims.

Stage 1: Development of the RecTechMatch.com will use a five-phase iterative approach. The first phase will involve a baseline needs assessment of five trainers through a focus group that will be conducted at Lakeshore Foundation. Data will be recorded, transcribed and coded to identify what professionals would like to see the system perform. The second phase will be a needs assessment from the users’ perspective using the same methods as with the trainers. Ten individuals with physical disabilities, ages 18 and above, will be invited to participate. A detailed design and development sprint will take place to create the first fully functional prototype (websites and mobile applications) following the focus groups. The third phase will involve a detailed heuristic evaluation by faculty/staff/students who are trained in human factors and information design in the Usability Track of the UAB Master’s degree program in Health Informatics. Based on the heuristic evaluation feedback, the prototype will be refined according to the comments received by this group. The fourth phase will feature first-level usability testing of the prototype by 5 potential trainers following a “think aloud” cognitive walk-through protocol. Following a redesign iteration, the fifth and final phase will feature second-level usability testing of the prototype by 10 users with physical disabilities using the same procedures as the trainers.

During testing, observations will be made about usability issues such as how participants chose to perform the tasks, their reactions, etc. The usability testing phases will also include quantitative usability measures such as the System Usability Scale8 and the (health specific) Mobile Application Rating Scale9.

Stage 2: Pilot Feasibility Study: Thirty users with physical disabilities, ages 18 to 64, will participate in a 12-wk two-arm parallel randomized control trial (15 per group) aimed at reducing barriers to physical activity, increasing social support and increasing LTPA minutes. The control arm will have access to generic information available on the NCHPAD website, which includes the same information but is not delivered through RecTechMatch.com. All users will be recruited online. Fitbit sensors will be provided to participants to objectively measure physical activity minutes one week before the intervention and continue for one week post-intervention. Process feasibility outcome measures will include recruitment, retention and adherence, and Intervention efficacy outcomes will include the Godin-Shephard Leisure-Time Physical Activity Questionnaire, the Barriers to Physical Activity Questionnaire for People with Mobility Impairments (BPAQ-MI), and Chogahara’s Social Influence on Physical Activity questionnaire.

Stage 3: Once successful feasibility testing is completed, we will work with nchpad.org, the #1 Google search result for “physical activity and disability” to seed information and launch nationally.

Final Outcomes

The RecTechMatch.com will be developed to address multilevel barriers and facilitators associated with community-based LTPA using crowdsourcing principles for gathering data.

References

Rimmer JH, Riley B, Wang E, Rauworth A. Accessibility of health clubs for people with mobility disabilities and visual impairments. American journal of public health. 2005;95(11):2022-2028.
Rimmer JH, Riley B, Wang E, Rauworth A, Jurkowski J. Physical activity participation among persons with disabilities: barriers and facilitators. American journal of preventive medicine. 2004;26(5):419-425.
Rimmer JH, Rubin SS, Braddock D. Barriers to exercise in African American women with physical disabilities. Archives of physical medicine and rehabilitation. 2000;81(2):182-188.
Rimmer JH, Wang E, Smith D. Barriers associated with exercise and community access for individuals with stroke. Journal of rehabilitation research and development. 2008;45(2):315.
Vissers M, Van den Berg-Emons R, Sluis T, Bergen M, Stam H, Bussmann H. Barriers to and facilitators of everyday physical activity in persons with a spinal cord injury after discharge from the rehabilitation centre. Journal of Rehabilitation Medicine. 2008;40(6):461-467
Martin Ginis KA, Ma JK, Latimer-Cheung AE, Rimmer JH. A systematic review of review articles addressing factors related to physical activity participation among children and adults with physical disabilities. Health psychology review. 2016;10(4):478-494.
McLeroy KR, Bibeau D, Steckler A, Glanz K. An ecological perspective on health promotion programs. Health education quarterly. 1988;15(4):351-377.
Brooke J. SUS-A quick and dirty usability scale. Usability evaluation in industry. 1996;189(194):4-7.
Stoyanov SR, Hides L, Kavanagh DJ, Zelenko O, Tjondronegoro D, Mani M. Mobile app rating scale: a new tool for assessing the quality of health mobile apps. JMIR mHealth and uHealth. 2015;3(1):e27.

Two major strategies will provide a comprehensive undergraduate and pre-doctoral mentorship program in exercise/recreation technology and exercise physiology to increase the number of successful independent exercise/rehabilitation/engineering researchers with advanced training in this science-based discipline:

Immersion in a mentored rehabilitation research experience
Complementary didactics to support trainees’ development as exercise/rehabilitation researchers.

To achieve our goals and objectives, we will select highly qualified undergraduate and graduate students in engineering, exercise/rehabilitation science who will work closely with faculty in RecTech’s labs, which include the following R&D: active video gaming, energy expenditure measurement, universal fitness equipment product design, and information and communication technologies. The mentorship program table is shown in Table 1.

RecTech-III Training Mentors

Name: Specialty Area: Specific Content Area Expertise

Scott Bickel, Ph.D: PT Rehabilitation Science: Exercise training

Lloyd Cooper, M.Eng: Engineering: Graphics design and device hardware/software

Dan Ding, Ph.D: Rehabilitation Science: Energy expenditure measurement

Alan Eberhardt, Ph.D: Biomedical Engineering: Engineering design of assistive technologies

Laurie Malone, PhD: Exercise Physiology: Energy expenditure, exercise testing & prescription

Tapan Mehta, MS, E.Eng: Department of Biostatistics: Statistician II

Sangeetha Padalabalanarayanan, MS: Bioengineering: Human factors

James Rimmer, Ph.D: Exercise Physiology: Physical activity, barriers, e-health delivery systems

Mohanraj Thirumalai, MS, M.Eng: Computer Science & Operation Management Information System: Information and Communication Technology

Tim Wick, PhD: Biomedical Engineering: Engineering systems and measurements

Functional Electrical Stimulation (FES)-assisted Rowing – Susan Silverman
Mentor: C. Scott Bickel

Functional Electrical Stimulation (FES)-assisted rowing uses electrical stimulation to create muscle contractions in the legs of people with spinal cord injury (SCI) while the person rows voluntarily with their arms. This activity is very beneficial for manual wheelchair users with SCI because it helps to strengthen the muscles in the back and helps increase the intensity of the aerobic workout. This project has focused on improving the rowing machine to create a more natural rowing stroke, and allows participants to begin rowing without the need for remedial strength training in the legs. Susan Silverman, MS, ATC, CSCS, is a Ph.D. candidate and Graduate Assistant in Rehabilitation Science in the School of Health Professions at UAB.

Kinect Gestural Interface for Disability – Sean Pool
Mentor: Alan Eberhardt

People with disabilities have higher rates of physical inactivity as compared with their able-bodied peers. Integrating fitness equipment with a virtual exercise environment (VEE) shows promise for increasing physical activity level within this population. It is necessary that a universal, gestural interface be created which allows all users to interact with the VEE. This project focused on programming the Kinect to adequately sample the position of the user’s body and recognize specific gestures that identify the user’s choice in the virtual exercise environment. Performance testing of upper-body gestures was completed with individuals post-stroke and individuals with cerebral palsy. Sean Pool, BS, is a Graduate Research Assistant in Biomedical Engineering in the School of Engineering at UAB.

The design experience for engineering (EGR) students at UAB begins with participation in a Freshman Learning Community that emphasizes team design, technical communications, engineering ethics and safety.  The two-semester freshman sequence, EGR 110/111 Introduction to Engineering, culminates in a design project. Dr. Eberhardt, along with the guest client (typically a physical therapist from the participating institution), present the project by providing a background associated with the users, their physical disabilities, and the environment of the institution.

The students are given one week to brainstorm; then they must present a design proposal complete with a budget. Once the design is approved, the students must order parts, construct the device and finally present their devices at the end of the term.  The clients attend the presentations and “judge” the devices.

We feel strongly that this early exposure to the concept of engineering design of assistive technologies provides an excellent introductory training experience. Future design projects will be centered around the targeted projects in this application, including addressing issues associated with each of the laboratory projects including active video gaming, energy expenditure measurement, universal fitness equipment product design, and information and communication technologies.

Capstone Senior Design Experience

The undergraduate curriculum for each engineering program at UAB culminates with a one-year capstone design sequence. For example, the sequence in Biomedical Engineering (BME 498 Product Development and BME 499 Capstone Design), directed by co-investigator Eberhardt, begins with students shadowing clinicians and therapists to determine clinical needs and ideate potential solutions.

With regard to new RERC activities, engineering undergraduates will rotate through the RecTech labs located at Lakeshore Foundation to assist with various projects targeted in this round of funding including: adapting active video game controllers, information and telecommunication technology, exercise devices with a built-in computer system, video technology, and e-health and m-health applications. Engineering design constraints for each area of RecTech’s R&D will be formulated, and student teams will be assembled around specific R&D questions. Engineering design tools will be reviewed, including computer aided drawing (CAD) and materials selection using CES software, and finite element analysis for stress analysis and design optimization. Brainstorming and evaluation of design alternatives will culminate in the development of a formal Design Proposal, which must gain signature approval from the target client.

The students will also investigate development issues for the exercise/recreation product industry, with consideration of intellectual property, patents, business plans and economic analysis. They will justify materials selection and purchasing, and ultimately construct, test and deliver a working prototype. The Final Capstone Design Presentation will be
attended by the clients, UAB faculty and students, and members of the UAB Research Foundation.

BME Capstone Design Project Wins da Vinci Award

A project designed as part of the BME Capstone Design Course was awarded the Student da Vinci Award last week at the 2014 da Vinci Special Awards Gala at the Ford Conference and Event Center in Dearborn, Michigan. The winning team included BME students Ryan Densmore, Daniel McFalls, Shelby May, and Stephen Mehi. Their project, the Toyrota, is a powered mobility device currently in use at the Bell Center in Homewood. Developed in 2001 by the National Multiple Sclerosis Society’s Michigan Chapter, the da Vinci Awards program aims to recognize current achievements and spur future innovations to benefit all people challenged with physical limitations.