Displaying publications 1 - 20 of 43 in total

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  1. Tan, J.H., Aishah A. Fauzi, Hasnan, N.
    JUMMEC, 2017;20(2):31-33.
    MyJurnal
    There is a high incidence of 36% to 83% of respiratory dysfunction in patients with acute cervical spinal cord
    injury. Complications arising from respiratory dysfunction remain one of the most common causes of morbidity
    and mortality in the spinal cord injured population. Specialized pulmonary care and therapy can help individuals
    with tetraplegia to maintain a stable respiratory status allowing active participation in active rehabilitation.
    This would allow them to achieve rehabilitation goals of independent function and community reintegration.
    Mechanical insufflation-exsufflation (MIE) therapy is an option for secretion management in individuals with
    acute spinal cord injury. In this paper, we present our experience using MIE as an adjunct to management of
    secretions in the spinal cord injured population at the University of Malaya Medical Centre.
  2. Julia PE, Sa'ari MY, Hasnan N
    Spinal Cord, 2011 Nov;49(11):1138-42.
    PMID: 21577218 DOI: 10.1038/sc.2011.53
    STUDY DESIGN: A cross-sectional experimental study.
    OBJECTIVE: The purpose of this study is to examine the benefit of elastic abdominal binders on voluntary cough in persons with spinal cord injury.
    SETTING: Spinal rehabilitation unit in a teaching hospital.
    METHODS: We measured voluntary cough peak expiratory flow rate (in 21 subjects with spinal cord injury, (18 tetraplegia, 3 paraplegia) under three conditions: without abdominal binder as the baseline, with single-strap abdominal binder and triple-strap abdominal binder.
    RESULTS: The results showed that the mean cough peak expiratory flow rate in all subjects without abdominal binder was 277.1 l per min. There was a significant increase in flow rate with the use of abdominal binders: 325.7 l per min with single-strap abdominal binder and 345.2 l per min with triple-strap abdominal binder (P<0.05, paired t-test). The mean cough peak expiratory flow rate in tetraplegic subjects using triple-strap abdominal binders was significantly higher compared with those using single-strap abdomina
    l binders (322.1 l per min and 299.4 l per min, respectively).
    CONCLUSION: Abdominal binders can be used as an effective method to improve cough ability in spinal cord injured patients, with triple-strap abdominal binder achieving greater cough peak expiratory flows.

    Comment in: Frisbie JH. Question of stamina for the diaphragm. Spinal Cord. 2012 Jun;50(6):480. doi: 10.1038/sc.2011.164. Epub 2012 Jan 17. PubMed PMID: 22249332.
  3. Ramakrishnan K, Chung TY, Hasnan N, Abdullah SJ
    Spinal Cord, 2011 Jul;49(7):812-6.
    PMID: 21221119 DOI: 10.1038/sc.2010.186
    STUDY DESIGN: Cross-sectional survey.
    OBJECTIVES: To determine the employment outcomes of persons with spinal cord injury (SCI) and to investigate the impact of various demographic, injury-related and work-related variables on these outcomes.
    SETTING: People living with SCI in Malaysia who are members of a disability support organization.
    METHODS: A total of 84 members of the Malaysian Spinal Injury Association, who have had traumatic SCI for at least 2 years and were between 15 and 64 years of age at the time of study, were interviewed through phone using a questionnaire to identify the association between demographic, injury-related and work-related variables and employment outcomes.
    RESULTS: The return to work rate in this study was 57.1% (employed at the time of study). The overall employment rate after SCI was 76.2% (worked at some point after injury). Those who were younger at time of injury (<20 years of age), able to drive a modified vehicle, independent in personal care and mobility were positively related to being employed. On the other hand, being hospitalized in the preceding 1 year and receiving financial incentives were negatively related to employment.
    CONCLUSION: Functional independence, especially ability to drive, was strongly associated with return to work and should be one of the priority goals of comprehensive rehabilitation of persons with SCI. The negative impact of recent hospitalization as well as financial compensation needs to be probed further.
  4. Salim MS, Mazlan M, Hasnan N
    Spinal Cord Ser Cases, 2017;3:17043.
    PMID: 28751978 DOI: 10.1038/scsandc.2017.43
    INTRODUCTION: We describe a case of intracerebral haemorrhage (ICH) following uncontrolled episodes of autonomic dysreflexia (AD) within 24 h of a minor urological procedure.

    CASE PRESENTATION: A 33-year-old active paraplegic patient T1 Association Impairment Scale A underwent an elective suprapubic catheter (SPC) placement for bladder management. The surgery was done under general anaesthesia and was uneventful. Four hours after surgery, he developed haematuria and multiple blood clots in the urine, which eventually caused blockage of the SPC and resulted in symptomatic AD. The clots and blockage persisted, which continued to trigger repeated episodes of increased blood pressure (BP) and AD. Despite medical treatment with sublingual nitrate to lower the increased BP, the patient subsequently developed massive left ICH presenting with right upper limb weakness, facial asymmetry and inability to speak. He continued to have fluctuating BP measurements for 11 days post event with severe hypertensive and hypotensive episodes. This presented a challenge in the BP management as well as post-ICH management. He underwent an intensive neurorehabilitation programme as soon as the BP had stabilized.

    DISCUSSION: Severe neurological complications of AD are rare. In this case report, we highlight the importance of close monitoring of BP and AD symptoms after an SPC procedure, the challenges in BP management and the subsequent importance of an early rehabilitation programme after ICH secondary to uncontrolled AD.

  5. Aoun M, Hasnan N, Al-Aaraj H
    East Mediterr Health J, 2018 Jun 10;24(3):269-276.
    PMID: 29908022 DOI: 10.26719/2018.24.3.269
    Background: Lean practices are critical to eliminate waste and enhance the quality of healthcare services through different improvement approaches of total quality management (TQM). In particular, the soft side of TQM is used to develop the innovation skills of employees that are essential for the continuous improvement strategies of hospitals.

    Aim: The main objective was to study the relationship between lean practices, soft TQM and innovation skills in Lebanese hospitals.

    Methods: A quantitative methodology was applied by surveying 352 employees from private and public hospitals in Lebanon. The primary collected data were valid and reliable when analysed by SPSS and AMOS software as a part of structural equation modelling.

    Results: Lean practices significantly influenced the innovation skills; however, soft TQM did not mediate this relationship because it was not well implemented, especially at the level of people-based management and continuous improvement.

    Conclusion: This study has implications for healthcare practitioners to make greater efforts to implement lean practices and soft TQM. Future studies are suggested to highlight different challenges facing quality improvement in the Region.

  6. Lee RCH, Hasnan N, Engkasan JP
    Spinal Cord, 2018 04;56(4):341-346.
    PMID: 29288252 DOI: 10.1038/s41393-017-0034-2
    STUDY DESIGN: Cross sectional study.

    OBJECTIVES: To determine the prevalence, characteristics of and barriers to driving among persons with a spinal cord injury (SCI).

    SETTING: SCI Rehabilitation Clinic, University Malaya Medical Centre (UMMC).

    METHODS: This is a questionnaire-based study on persons with SCI who attended the UMMC SCI Rehabilitation Clinic between June 2015 and November 2016. The questionnaire comprised demographic data, clinical characteristics, driving variables, Spinal Cord Independence Measure III, WHOQOL-BREF, and Craig Handicap Assessment and Reporting Technique Short Form. Malaysians aged greater than 18 years old with any etiology and levels of SCI, had no other physical disabilities and not suffering from progressive illness were recruited. A single investigator administered the questionnaire via face-to-face interviews.

    RESULTS: A total of 160 participants were included in this study. Overall, 37% of persons with SCI drove and owned a modified vehicle. Almost half of persons with paraplegia (47%) drove, but only 12% of tetraplegia did. A majority (93%) of those who drove aged below 60 years, and had higher level of independence in activity of daily living. More drivers (81%) compared to non-drivers (24%) were employed; drivers also reported better community reintegration and quality of life. Three commonest barriers to driving included medical reasons (38%), fear and lack of confidence (17%), and inability to afford vehicle modifications (13%).

    CONCLUSIONS: The percentage of persons with SCI driving post injury is low. Based on the findings of this study, more efforts are needed to motivate and facilitate persons with SCI to drive.

    Study site: SCI Rehabilitation Clinic, University Malaya Medical Centre (UMMC)
  7. Hashim NM, Engkasan JP, Hasnan N
    J Spinal Cord Med, 2022 Nov;45(6):898-906.
    PMID: 33465010 DOI: 10.1080/10790268.2020.1860868
    STUDY DESIGN: Pre- and post- trial.

    OBJECTIVES: To determine the changes of health belief levels after a pressure ulcer (PrU) prevention educational program based on the Health Belief Model (HBM).

    SETTING: Department of Rehabilitation Medicine, University Medical Centre, Malaysia.

    METHODS: This study was conducted between May 2016 and May 2018. We created a multidisciplinary structured PrU prevention education program based on the HBM, consisting of didactic lectures, open discussions and a practical session. The content of the program was based on several PrU prevention guidelines. The education program focused on a group of 6-10 participants, and was conducted by a multidisciplinary team; i.e. doctor, physiotherapist, occupational therapist and a nurse. The skin care belief scales (SCBS) questionnaire was administered pre, post and 8-week post intervention, which measured the 9 domains of HBM. The data from the study was analyzed using repeated measures ANOVA to assess the effectiveness of the program.

    RESULTS: Thirty spinal cord injured participants who fulfilled the inclusion and exclusion criteria completed this study. The results of the education program show statistically significant effects on Susceptibility; F (2,58) = 12.53, P < 0.05, Barriers to Skin Check Belief; F(2,58) = 5.74, P > 0.05, Benefits to Wheelchair Pressure Relief Belief; F(1.65,47.8) = 3.97, P < 0.05, Barriers to Turning and Positioning Belief; F(2,58) = 3.92, P 

  8. Abd Aziz M, Hamzaid NA, Hasnan N
    J Vis Exp, 2022 Nov 11.
    PMID: 36440840 DOI: 10.3791/63149
    Execution of Sit-to-Stand (SitTS) in incomplete spinal cord injury (SCI) patients involves motor function in both upper and lower extremities. The use of arm support, in particular, is a significant assistive factor while executing SitTS movement in SCI population. In addition, the application of functional electrical stimulation (FES) onto quadriceps and gluteus maximus muscles is one of the prescribed management for incomplete SCI to improve muscle action for simple lower limb movements. However, the relative contribution of upper and lower extremities during SitTS has not been thoroughly investigated. Two motor incomplete SCI paraplegics performed repetitive SitTS to fatigue exercise challenge. Their performance was investigated as a mixed-method case-control study comparing SitTS with and without the assistance of FES. Three sets of SitTS tests were completed with 5-min resting period allocated in between sets, with mechanomyography (MMG) sensors attached over the rectus femoris muscles bilaterally. The exercise was separated into 2 sessions; Day 1 for voluntary SitTS and Day 2 for FES-assisted SitTS. Questionnaires were conducted after every session to gather the participants' input about their repetitive SitTS experience. The analysis confirmed that a SitTS cycle could be divided into three phases; Phase 1 (Preparation to stand), Phase 2 (Seat-off), and Phase 3 (Initiation of hip extension), which contributed to 23% ± 7%, 16% ± 4% and 61% ± 6% of the SitTS cycle, respectively. The contribution of arms and legs during SitTS movement varied in different participants based on their legs' Medical Research Council (MRC) muscle grade. In particular, the applied arm forces start to increase clearly when the leg forces start to decline during standing. This finding is supported by the significantly reduced MMG signal indicating leg muscle fatigue and their reported feeling of tiredness.
  9. Hamzaid NA, Tean LT, Davis GM, Suhaimi A, Hasnan N
    Spinal Cord, 2015 May;53(5):375-9.
    PMID: 25366533 DOI: 10.1038/sc.2014.187
    STUDY DESIGN: Prospective study of two cases.

    OBJECTIVES: To describe the effects of electrical stimulation (ES) therapy in the 4-week management of two sub-acute spinal cord-injured (SCI) individuals (C7 American Spinal Injury Association Impairment Scale (AIS) B and T9 AIS (B)).

    SETTING: University Malaya Medical Centre, Kuala Lumpur, Malaysia.

    METHODS: A diagnostic tilt-table test was conducted to confirm the presence of orthostatic hypotension (OH) based on the current clinical definitions. Following initial assessment, subjects underwent 4 weeks of ES therapy 4 times weekly for 1 h per day. Post-tests tilt table challenge, both with and without ES on their rectus abdominis, quadriceps, hamstrings and gastrocnemius muscles, was conducted at the end of the study (week 5). Subjects' blood pressures (BP) and heart rates (HR) were recorded every minute during pre-test and post-tests. Orthostatic symptoms, as well as the maximum tolerance time that the subjects could withstand head up tilt at 60°, were recorded.

    RESULTS: Subject A improved his orthostatic symptoms, but did not recover from clinically defined OH based on the 20-min duration requirement. With concurrent ES therapy, 60° head up tilt BP was 89/62 mm Hg compared with baseline BP of 115/71 mm Hg. Subject B fully recovered from OH demonstrated by BP of 105/71 mm Hg during the 60° head up tilt compared with baseline BP of 124/77 mm Hg. Both patients demonstrated longer tolerance time during head up tilt with concomitant ES (subject A: pre-test 4 min, post-test without ES 6 min, post-test with ES 12 min; subject B: pre-test 4 min, post-test without ES 28 min, post-test with ES 60 min).

    CONCLUSIONS: Weekly ES therapy had positive effect on OH management in sub-acute SCI individuals.

  10. Chek Siang KC, Ahmad Fauzi A, Hasnan N
    J Spinal Cord Med, 2017 01;40(1):113-117.
    PMID: 26871508 DOI: 10.1080/10790268.2015.1133016
    CONTEXT: Infection and septicaemia may clinically presented with seizure and altered conscious level. In spinal cord injury (SCI) population, they are at risk of having pressure ulcer which can be complicated further with infection and septicaemia.

    FINDINGS: A 40-year-old man with complete T4 SCI and multiple clean and non-healing pressure ulcers at sacral and bilateral ischial tuberosity regions was initially admitted for negative pressure wound therapy (NPWT) dressing. He had an episode of seizure and subsequently had fluctuating altered conscious level before the diagnosis of deep-seated sacral abscess was made and managed. Prior investigations to rule out common possible sources of infections and management did not resolve the fluctuating event of altered consciousness.

    CLINICAL RELEVANCE: We presented an unusual case presentation of septicemia in a patient with SCI with underlying chronic non-healing pressure ulcer. He presented with seizure and fluctuating altered conscious level. Even though a chronic non-healing ulcer appeared clinically clean, a high index of suspicion for deep seated abscess is warranted as one of the possible sources of infection, especially when treatment for other common sources of infections fails to result in clinical improvement.

  11. Kassim NK, Hanafi MH, Ibrahim AH, Hasnan N
    Malays Orthop J, 2021 Mar;15(1):135-137.
    PMID: 33880162 DOI: 10.5704/MOJ.2103.022
    The optimisation of blood pressure management is critical in managing hypotensive episodes in patients with spinal cord injury. Improper handling of this preventable factor will negatively impact the patient recovery prognosis. A 42-year-old man was admitted for a complete spinal cord injury after fell from height. He developed subacute neurological deterioration unrelated to the mechanical instability but due to multiple episodes of hypotension occurring one month after the initial injury. After proper management of blood pressure, his deterioration was halted and no further progression. Spinal cord haemodynamics play an important role in mediating the onset of subacute post-traumatic ascending myelopathy. Better education and awareness on Subacute Post-traumatic Ascending Myelopathy (SPAM) especially to the junior healthcare providers are important to hinder this rare but avoidable condition.
  12. Dzulkifli MA, Hamzaid NA, Davis GM, Hasnan N
    Front Neurorobot, 2018;12:50.
    PMID: 30147650 DOI: 10.3389/fnbot.2018.00050
    This study sought to design and deploy a torque monitoring system using an artificial neural network (ANN) with mechanomyography (MMG) for situations where muscle torque cannot be independently quantified. The MMG signals from the quadriceps were used to derive knee torque during prolonged functional electrical stimulation (FES)-assisted isometric knee extensions and during standing in spinal cord injured (SCI) individuals. Three individuals with motor-complete SCI performed FES-evoked isometric quadriceps contractions on a Biodex dynamometer at 30° knee angle and at a fixed stimulation current, until the torque had declined to a minimum required for ANN model development. Two ANN models were developed based on different inputs; Root mean square (RMS) MMG and RMS-Zero crossing (ZC) which were derived from MMG. The performance of the ANN was evaluated by comparing model predicted torque against the actual torque derived from the dynamometer. MMG data from 5 other individuals with SCI who performed FES-evoked standing to fatigue-failure were used to validate the RMS and RMS-ZC ANN models. RMS and RMS-ZC of the MMG obtained from the FES standing experiments were then provided as inputs to the developed ANN models to calculate the predicted torque during the FES-evoked standing. The average correlation between the knee extension-predicted torque and the actual torque outputs were 0.87 ± 0.11 for RMS and 0.84 ± 0.13 for RMS-ZC. The average accuracy was 79 ± 14% for RMS and 86 ± 11% for RMS-ZC. The two models revealed significant trends in torque decrease, both suggesting a critical point around 50% torque drop where there were significant changes observed in RMS and RMS-ZC patterns. Based on these findings, both RMS and RMS-ZC ANN models performed similarly well in predicting FES-evoked knee extension torques in this population. However, interference was observed in the RMS-ZC values at a time around knee buckling. The developed ANN models could be used to estimate muscle torque in real-time, thereby providing safer automated FES control of standing in persons with motor-complete SCI.
  13. Engkasan JP, Hasnan N, Mohd Yusuf Y, Abdul Latif L
    Am J Phys Med Rehabil, 2017 02;96(2 Suppl 1):S90-S92.
    PMID: 28059888 DOI: 10.1097/PHM.0000000000000598
  14. Hisham H, Justine M, Hussain H, Hasnan N, Manaf H
    Asian Spine J, 2019 08;13(4):577-583.
    PMID: 30866621 DOI: 10.31616/asj.2018.0172
    Study Design: A quasi-experimental single-blinded study.

    Purpose: To investigate the effects of 'graded exercise integrated with education' on physical fitness, exercise self-efficacy (ESE), and physical activity (PA) levels among subacute and chronic wheelchair-dependent paraplegia patients.

    Overview of Literature: Most of the chronic spinal cord injury (SCI) patients had low physical fitness due to a sedentary lifestyle and lack of ESE after discharge from a rehabilitation program. Education may encourage them to engage with exercise to regain and maintain their physical fitness. However, there is a lack of research to support the effects of exercise integrated with education after an SCI.

    Methods: A total of 44 participants will be assigned to either the experimental group (graded exercise integrated with education) or active control (conventional physical therapy). The experimental group will receive graded strength and aerobic exercise training according to their progression criteria. They will attend an education program during and after the rehabilitation program. The control group will only receive conventional physical therapy during their in-rehabilitation program. This study will be conducted during a period of 16 weeks, consisting of 8 weeks of in-rehabilitation and 8 weeks post-rehabilitation. Statistical analysis will be performed using the IBM SPSS ver. 21.0 (IBM Corp., Armonk, NY, USA) at a significance level of p≤0.05.

    Results: The primary outcome measures will be upper-limb isokinetic strength, isometric grip strength, and cardiorespiratory fitness. The secondary outcomes will be ESE and PA levels.

    Conclusions: An intervention that combines exercise training and education may be warranted to enhance the physical fitness, ESE, and PA levels in SCI patients. This trial was registered with ClinicalTrials.gov (NCT03420170).

  15. Hamdan PNF, Hamzaid NA, Abd Razak NA, Hasnan N
    J Sport Health Sci, 2022 Nov;11(6):671-680.
    PMID: 33068748 DOI: 10.1016/j.jshs.2020.10.002
    BACKGROUND: Due to its clinically proven safety and health benefits, functional electrical stimulation (FES) cycling has become a popular exercise modality for individuals with spinal cord injury (SCI). Since its inception in 2013, the Cybathlon championship has been a platform for publicizing the potential of FES cycling in rehabilitation and exercise for individuals with SCI. This study aimed to evaluate the contribution of the Cybathlon championship to the literature on FES cycling for individuals with SCI 3 years pre and post the staging of the Cybathlon championship in 2016.

    METHODS: Web of Science, Scopus, ScienceDirect, IEEE Xplore, and Google Scholar databases were searched for relevant studies published between January 2013 and July 2019. The quality of the included studies was objectively evaluated using the Downs and Black checklist.

    RESULTS: A total of 129 articles on FES cycling were retained for analysis. A total of 51 articles related to Cybathlon were reviewed, and 14 articles were ultimately evaluated for the quality. In 2017, the year following the Cybathlon championship, Web of Science cited 23 published studies on the championship, which was almost 5-fold more than that in 2016 (n = 5). Training was most often reported as a topic of interest in these studies, which mostly (76.7%) highlighted the training parameters of interest to participating teams in their effort to maximize their FES cycling performance during the Cybathlon championship.

    CONCLUSION: The present study indicates that the Cybathlon championship in 2016 contributed to the number of literature published in 2017 on FES cycling for individuals with SCI. This finding may contribute to the lessons that can be learned from participation in the Cybathlon and potentially provide additional insights into research in the field of race-based FES cycling.

  16. Mohamad Hashim N, Yusof ANM, Engkasan JP, Hasnan N
    Spinal Cord, 2021 Jul;59(7):777-786.
    PMID: 33230272 DOI: 10.1038/s41393-020-00586-1
    STUDY DESIGN: Focus group qualitative study.

    OBJECTIVES: To explore factors affecting adherence to behaviours appropriate for the prevention of pressure injuries (PIs) in people with spinal cord injury (SCI) in Malaysia.

    SETTING: University Hospital, Malaysia METHODS: Four sets of focus group interviews were conducted, each with 5-10 participants, totalling 30 people with SCI. A trained interviewer used structured interviews designed to explore participants' experiences of complying with recommended behaviours for the prevention of PIs. All interviews were digitally recorded, transcribed, and analysed utilising thematic analysis.

    RESULTS: The factors that affected participants' adherence are classified into four main themes: (a) educational aspects, (b) internal drive, (c) social and environmental factors, and (d) post-SCI physiological changes.

    CONCLUSIONS: This qualitative study provides initial exploratory evidence regarding the thoughts, experience, and opinions pertaining to PI preventive behaviours within the Malaysian SCI population. The emerging themes contribute to an in-depth understanding of the competency of the Malaysian healthcare system in PI prevention, personal and societal factors influenced by the socio-demographic backgrounds, and disease-related factors that influence the adherence to such preventive interventions.

  17. Rosley N, Hasnan N, Hamzaid NA, Davis GM, Manaf H
    Turk J Phys Med Rehabil, 2023 Mar;69(1):23-30.
    PMID: 37201013 DOI: 10.5606/tftrd.2023.9418
    OBJECTIVES: This study was conducted to investigate the effects of combined progressive resistance training (PRT) and functional electrical stimulation-evoked leg cycling exercise (FES-LCE) on isometric peak torque and muscle volume in individuals with incomplete spinal cord injury.

    PATIENTS AND METHODS: In the single-blind, randomized controlled trial performed between April 2015 and August 2016, 28 participants were randomized between two exercise interventions (FES-LCE+PRT and FES-LCE alone), and training was conducted over 12 weeks. The isometric muscle peak torque and muscle volume for both lower limbs were measured at the baseline and after 6 and 12 weeks. Linear mixed-model analysis of variance was performed to test the effects of FES-LCE+PRT versus FES-LCE on each outcome measure over time via an intention-to-treat analysis.

    RESULTS: Twenty-three participants (18 males, 5 females; mean age: 33.4±9.7 years; range 21 to 50 years) completed study (10 in the FES-LCE+PRT group, and 13 in the FES-LCE group). The 12-week pre-and posttraining change for left hamstrings' muscle peak torque in the FES-LCE+PRT group (mean difference=4.5±7.9 Nm, 45% change, p<0.05) was consistently higher than that in the FES-LCE group (mean difference=2.4±10.3 Nm, 4% change; p<0.018). The improvement in the right quadriceps muscle's peak torque of the FES-LCE+PRT group (mean difference=19±7.6 Nm, 31% change, p<0.05) was more significant compared to the FES-LCE group. The left muscle volume showed a remarkable increase after 12 weeks in the FES-LCE+PRT group (mean difference=0.3±9.3 L, 7% change, p<0.05).

    CONCLUSION: The combination of PRT and FES-LCE was better in improving lower limb muscle strength and volume in chronic incomplete individuals with spinal cord injury.

  18. Ibitoye MO, Hamzaid NA, Zuniga JM, Hasnan N, Wahab AK
    Sensors (Basel), 2014;14(12):22940-70.
    PMID: 25479326 DOI: 10.3390/s141222940
    The research conducted in the last three decades has collectively demonstrated that the skeletal muscle performance can be alternatively assessed by mechanomyographic signal (MMG) parameters. Indices of muscle performance, not limited to force, power, work, endurance and the related physiological processes underlying muscle activities during contraction have been evaluated in the light of the signal features. As a non-stationary signal that reflects several distinctive patterns of muscle actions, the illustrations obtained from the literature support the reliability of MMG in the analysis of muscles under voluntary and stimulus evoked contractions. An appraisal of the standard practice including the measurement theories of the methods used to extract parameters of the signal is vital to the application of the signal during experimental and clinical practices, especially in areas where electromyograms are contraindicated or have limited application. As we highlight the underpinning technical guidelines and domains where each method is well-suited, the limitations of the methods are also presented to position the state of the art in MMG parameters extraction, thus providing the theoretical framework for improvement on the current practices to widen the opportunity for new insights and discoveries. Since the signal modality has not been widely deployed due partly to the limited information extractable from the signals when compared with other classical techniques used to assess muscle performance, this survey is particularly relevant to the projected future of MMG applications in the realm of musculoskeletal assessments and in the real time detection of muscle activity.
  19. Khoo TB, Kassim AB, Omar MA, Hasnan N, Amin RM, Omar Z, et al.
    Disabil Rehabil, 2009;31(21):1753-61.
    PMID: 19479558 DOI: 10.1080/09638280902751964
    To determine the magnitude and impact of physical disability on Malaysian school-aged children between 7 and less than 18 years old.
  20. Mat Rosly M, Mat Rosly H, Davis Oam GM, Husain R, Hasnan N
    Disabil Rehabil, 2017 04;39(8):727-735.
    PMID: 27108475 DOI: 10.3109/09638288.2016.1161086
    INTRODUCTION: Exergames have the potential to enable persons with disabilities to take part in physical activities that are of appropriate "dose-potency" and enjoyable within a relatively safe home environment. It overcomes some of the challenges regarding transportation difficulties in getting to commercial gymnasium facilities, reducing physical activities perceived as "boring" or getting access into the built environment that may be "wheelchair unfriendly".

    OBJECTIVE: This systematic review assessed available evidence whether "exergaming" could be a feasible modality for contributing to a recommended exercise prescription according to current ACSM™ or WHO guidelines for physical activity.

    METHODS: Strategies used to search for published articles were conducted using separate search engines (Google Scholar™, PubMed™ and Web of Science™) on cardiometabolic responses and perceived exertion during exergaming among neurologically-disabled populations possessing similar physical disabilities. Each study was categorized using the SCIRE-Pedro evidence scale.

    RESULTS: Ten of the 144 articles assessed were identified and met specific inclusion criteria. Key outcome measures included responses, such as energy expenditure, heart rate and perceived exertion. Twelve out of the 17 types of exergaming interventions met the ACSM™ or WHO recommendations of "moderate intensity" physical activity. Exergames such as Wii Jogging, Bicycling, Boxing, DDR and GameCycle reported moderate physical activity intensities. While Wii Snowboarding, Skiing and Bowling only produced light intensities.

    CONCLUSION: Preliminary cross-sectional evidence in this review suggested that exergames have the potential to provide moderate intensity physical activity as recommended by ACSM™ or WHO in populations with neurological disabilities. However, more research is needed to document exergaming's efficacy from longitudinal observations before definitive conclusions can be drawn. Implications for Rehabilitation Exergaming can be deployed as physical activity or exercise using commercially available game consoles for neurologically disabled individuals in the convenience of their home environment and at a relatively inexpensive cost Moderate-to-vigorous intensity exercises can be achieved during exergaming in this population of persons with neurological disabilities. Exergaming can also be engaging and enjoyable, yet achieve the recommended physical activity guidelines proposed by ACSM™ or WHO for health and fitness benefits. Exergaming as physical activity in this population is feasible for individuals with profound disabilities, since it can be used even in sitting position for wheelchair-dependent users, thus providing variability in terms of exercise options. In the context of comprehensive rehabilitation, exergaming should be viewed by the clinician as "at least as good as" (and likely more enjoyable) than traditional arm-exercise modalities, with equivalent aerobic dose-potency as "traditional" exercise in clinic or home environments.

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