This study aimed to provide preliminary evidence on whether the modified FES+VFBT was accepted by people with SCI/D and resulted in improved balance control, balance confidence, lower limb strength and sensation.
A mixed-methods exploratory study was conducted. To date, four adults, three female and one male, with chronic motor incomplete SCI/D (i.e., >1-year) completed 18 sessions of FES+VFBT (three sessions/week). Three baseline assessments, spaced two weeks apart, were completed by a physiotherapist. Assessments were repeated at mid-point, post-sessions and six and 12-weeks post. Outcomes included the Berg Balance Scale (BBS), Activity-specific Balance Confidence (ABC) Scale, lower limb and trunk muscle strength measured with hand-held dynamometry, and cutaneous pressure sensitivity and proprioception of the ankle and great toes. Data were analyzed with the two-standard deviation (2SD) band method [4]. The Technology Acceptance model-2 (TAM-2) was used to inform a questionnaire and semi-structured interview guide, which were implemented post-intervention. Deductive content analysis was used through iterative reflexivity to identify codes.
Significant improvements in BBS scores were seen in three participants (change pre-post: 8, 2, 2.3), lasting into follow-up for one, and in ABC for three participants (change pre-post: 20.8%, 15.8%, 10.2%). Strength improvements were variable across participants; however, trunk and hip muscles improved most. In all four participants, significant improvements were found in pressure sensation; however, only one improved significantly in proprioception. The TAM-2 Questionnaire results emphasized participants’ enjoyment and perceived alignment of FES+VFBT to their goals, and that it was comfortable and not risky. The qualitative results used the main TAM-2 constructs as themes: 1) Behavioral Intention: participants discussed how their perception of rehabilitation influenced their motivation for participating and found FES+VFBT to be relevant to their rehabilitation goals. 2) Perceived Ease of Use: participants highlighted the barriers, learning curve, technical difficulties encountered, and assistance required to participate in the intervention. 3) Perceived Usefulness: participants enjoyed the intervention, experiencing direct benefits that enabled them to pursue further goals. 4) Usage Behavior: participants shared system improvement ideas and how comfort was found through staff involvement and the equipment used.
FES+VFBT improved balance control, balance confidence, and sensation, and was perceived as enjoyable and relevant to the goals of persons with SCI/D.
The FES+VFBT could be an effective and end-user accepted intervention to target balance deficits after SCI/D; however, a larger clinical trial is needed.
Spinal Cord Injuries
Technology
