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2022

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An Examination Of The Relationship Between The Role Of The Chief Diversity Officer And Hospital Financial Performance And Patient Experience Measures, Kemberly L. Blackledge Jan 2022

An Examination Of The Relationship Between The Role Of The Chief Diversity Officer And Hospital Financial Performance And Patient Experience Measures, Kemberly L. Blackledge

All ETDs from UAB

Healthcare organizations drive to achieve hospital measures has much to do with strategies put in place by the executive leadership team and resources of the firm. Forces such as regulatory changes reducing hospital payments and external forces such as social injustices leave executives turning to innovative ways to improve the bottomline. This study examined the Chief Diversity Officer (CDO) and the relationship with hospitals measures of financial performance and patient experience for hospitals with a CDO and without a CDO. Hospitals with a CDO can deploy organizational strategies such as diversity management and cultural competencies. These strategies are important because …


Shared Savings Bonus In Mssp And Its Association With Length Of Participation, Terry D. Knight Jan 2022

Shared Savings Bonus In Mssp And Its Association With Length Of Participation, Terry D. Knight

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Accountable Care Organizations (ACOs) are integrated groups of providers responsible for reducing cost and improving quality for a group of individuals. Medicare began using these organizations in 2012, after the passage of the Affordable Care Act (ACA), to move away from traditional fee-for-service reimbursement. This alternative payment model is the Medicare Shared Savings Program (MSSP). MSSP affords ACOs the opportunity to receive a portion of the savings they achieve if specific cost targets and quality benchmarks are met. Length of participation time in the alternative payment model may increase the ACOs’ ability to achieve savings. The analysis of MSSP savings …


Behavioral, Environmental, Social, Psychosocial, And Physiological Factors That Impact The Relationship Between Chronic Lung Disease Status And Susceptibility To Electronic Cigarette Use Or Actual Electronic Cigarette Use, Mohammed M. Alqahtani Jan 2022

Behavioral, Environmental, Social, Psychosocial, And Physiological Factors That Impact The Relationship Between Chronic Lung Disease Status And Susceptibility To Electronic Cigarette Use Or Actual Electronic Cigarette Use, Mohammed M. Alqahtani

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There is surge increase in e-cigarettes among adult vulnerable population such as individuals with chronic lung disease (CLD). Currently, there is a lack of understanding of the factors that may lead to the increase use of e-cigarettes or susceptibility of ecigarette use among individuals who have a history of CLD. Thus, it is crucial to recognize the characteristics of the individuals with CLD and adults without CLD who are susceptible to using e-cigarettes because this may pave the way for the prevention and reduction of tobacco use by identifying the different factors and eventually targeting the related risk factors. In …


Factors Influencing Balance And Muscle Tone In Adults With Attention-Deficit/Hyperactivity Disorder, Mansour M. Alotaibi Jan 2022

Factors Influencing Balance And Muscle Tone In Adults With Attention-Deficit/Hyperactivity Disorder, Mansour M. Alotaibi

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Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental condition prevalent in children globally and continues to persist into adulthood. Executive function (EF) impairments are core ADHD deficits, specifically response inhibition, and believed to drive ADHD symptoms. Psychostimulant medications (PS) is the first line treatment to manage ADHD symptoms. Overall, individuals with ADHD are at greater risk of falls and physical injuries compared to healthy individuals. Perhaps adults with ADHD balance impairments are secondary to ankle plantarflexor (PF) spasticity. Using psychostimulant medications (PS) improves PF spasticity and postural control in children with ADHD, but the effects on adults with ADHD are unclear. Furthermore, …


The Effects Of Near Field Magnetic Induction Monitoring Of Health Care Workers' Hand Hygiene Compliance, Thomas H. Ozburn Jan 2022

The Effects Of Near Field Magnetic Induction Monitoring Of Health Care Workers' Hand Hygiene Compliance, Thomas H. Ozburn

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Hospital Acquired Infections (HAIs) are among the top five leading causes of death in the United States (Scott, 2009). Estimates of the annual direct medical costs of HAIs to U.S. hospitals have ranged from $28,400,000,000 to $33,800,000,000 (Scott, 2009). Many leading health care organizations have agreed that there is a link between infection prevention and the spread of HAIs (Allegranzi, 2009). This study explored health care workers’ hand hygiene compliance and whether automated compliance reporting improved compliance. A new system powered by technology called Near Field Magnetic Induction (NFMI) found a significant increase in compliance upon introduction of an automated …


The Effects Of Charity Hospital Privitization And Medicaid Expansion On Medicaid Patient Emergency Department Utilization In Louisiana, Sean M. Prados Jan 2022

The Effects Of Charity Hospital Privitization And Medicaid Expansion On Medicaid Patient Emergency Department Utilization In Louisiana, Sean M. Prados

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Two significant events transpired in Louisiana that had sweeping changes for the healthcare system between 2013 and 2016: (1) the privatization of the nation's only stateowned Charity Hospital System via cooperative endeavor agreements with local, private hospitals known as public-private-partnerships (PPP), and (2) the implementation of Medicaid expansion, referred to as implementation of the Affordable Care Act (ACA). Either event independently could have had significant utilization and financial implications for hospitals. This retrospective, quasi-experimental research implemented a generalized estimating equation (GEE) analysis to examine the effects of PPP and ACA on Medicaid patient emergency department utilization by PPP hospital designation, …


Assessing The Impact Of The Covid-19 Pandemic On Metastatic Lung Cancer Time To Treatment Initiation, Health Care Resource Utilization, And Costs In The United States, Teresa M. Zyczynski Jan 2022

Assessing The Impact Of The Covid-19 Pandemic On Metastatic Lung Cancer Time To Treatment Initiation, Health Care Resource Utilization, And Costs In The United States, Teresa M. Zyczynski

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The COVID-19 pandemic has derailed normal operations in the health care delivery systems in the United States (US) and globally, providing prioritized care to patients seeking acute management of the novel coronavirus and its complications. Simultaneously, cancer screening tests have decreased, resulting in decreased rates of cancer diagnoses and referrals to oncologists. The purpose of this study was to assess time to treatment initiation (TTI) with systemic cancer therapy in patients with newly diagnosed metastatic lung cancer, metastatic lung cancer-related and total healthcare resource utilization (HCRU) and costs during the pandemic/post-pandemic period compared with the pre-pandemic period. The retrospective claims …


The Adoption Of New Cancer Drugs In Non-Academic Cancer Centers, Warren M. Smedley Jan 2022

The Adoption Of New Cancer Drugs In Non-Academic Cancer Centers, Warren M. Smedley

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Advancements in medical knowledge are producing significant improvements in medical technology, developing breakthrough drug therapies, advancing the practice of medicine, and improving outcomes for cancer patients. However, there are delays in getting new and improved therapies incorporated into routine clinical use, depriving cancer patients of valuable and potentially lifesaving treatments. The purpose of this study was to examine the rate of adoption of new cancer drug discoveries into routine clinical practice in non-academic cancer centers. The process of adoption takes a period of time to embrace new therapies, due in part to a prescriber’s need to gain greater comfort with …


Nutrition Practices And Body Composition In Infants Born Preterm, Maggie Jerome Jan 2022

Nutrition Practices And Body Composition In Infants Born Preterm, Maggie Jerome

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Adequate nutrition and optimal growth are critical goals of clinical care for premature infants in the NICU due to rapid brain growth and development that occur during this time. Emerging evidence suggests that body composition in preterm infants is predictive of neurodevelopmental and metabolic outcomes later in childhood. The objective of this dissertation is to investigate factors affecting premature infant growth and body composition, including high enteral protein supplementation, nutrition during the first two weeks of life, and race of infants born at 22-32 weeks gestational age admitted to the UAB NICU. In a pilot study, 56 preterm infants were …


The Relationship Between State Level Funding, Designated Trauma Centers, And Trauma Related Morbidity, Ginger Henry Jan 2022

The Relationship Between State Level Funding, Designated Trauma Centers, And Trauma Related Morbidity, Ginger Henry

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This study examined the relationship of funding and the number of designated trauma centers and age-adjusted trauma mortality across the 50 states. State level funding was defined as monies that were paid to the designated trauma hospitals in aggregate by state and by year for the years 2008 to 2017. The number of designated trauma hospitals were considered in the categories of total number of state trauma hospitals and designation levels 1 through 4. Age-adjusted mortality included the ICD-10 codes for trauma from the WISQARS database. The strategic adaptation theory was used to inform the trauma hospital manager’s need to …


Three Essays On Federally Qualified Health Centers: Competition, Patient-Centered Medical Home Adoption, Quality Quartiles Ranking And Financial Performance, Hani Al-Maliki Jan 2022

Three Essays On Federally Qualified Health Centers: Competition, Patient-Centered Medical Home Adoption, Quality Quartiles Ranking And Financial Performance, Hani Al-Maliki

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he following three essays examine the Federally Qualified Health Center (FQHC) industry. The first essay attempts to provide a description on what constitutes a competitive environment for FQHCs located in California, the second explores the impact of FQHC market competition on Patient Centered Medical Home (PCMH) adoption, and the third essay aims to test the relationship between the adoption of PCMH and FQHCs’ performance. The first essay utilizes Porter's Five Forces model to identify competitive forces in the FQHCs environment to fill a gap in the literature. Building on the first essay, the second essay using Porter’s generic strategies explores …


Mevisit: Value-Based Approach To Primary Care Delivery By Mtelemedicine Utilization Applied Through Lean Principles, Neil Coyer Thornbury Jan 2022

Mevisit: Value-Based Approach To Primary Care Delivery By Mtelemedicine Utilization Applied Through Lean Principles, Neil Coyer Thornbury

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Background: Significant issues of inconsistent patient services in the U.S. health system impact health outcomes and create high cost. Limitations of immobility, inefficiency, and accessibility sacrifice patient treatment, delay recovery, and escalate health risks from the lack of primary care physicians. The primary purpose of this study was to examine meVisit, a connective mobile technology, as a feasible primary care solution to address escalating health costs by reducing emergency room (ER) visits and inpatient admissions (IA). Methods: The feasibility study applied descriptive and inferential statistics to secondary data (n=4,024) and compared the two independent patient groups from the same large …


Applying The Hospitalist Model Of Care To Cardiovascular Acute Care Delivery, Ginger K. Biesbrock Jan 2022

Applying The Hospitalist Model Of Care To Cardiovascular Acute Care Delivery, Ginger K. Biesbrock

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The hospitalist model for managing patients in the hospital setting has been in existence for over 20 years. The hospitalist model for non-specialty care has been found to improve the efficiency of care, maintain quality of care, and support a higher degree of guideline adherence. However, there has been little research focusing on the use of the hospitalist model for specialty care. As cardiovascular programs have begun to adopt the hospitalist model, many are asking if this model is more effective than the traditional model. The main concern is the potential disruption to the patient-physician relationship that occurs with the …


Exploring The Influence Of Psychosocial Stress And Inflammatory Properties Of The Diet On Cardiometabolic Risk And Gut Microbiome Health Among Young Adult Women Of Birmingham, Alabama, Rachel Olivia Knight Jan 2022

Exploring The Influence Of Psychosocial Stress And Inflammatory Properties Of The Diet On Cardiometabolic Risk And Gut Microbiome Health Among Young Adult Women Of Birmingham, Alabama, Rachel Olivia Knight

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Concerning trends for obesity, diabetes, heart attacks, and obesity-related cancers, or cardiometabolic disease (CMD), are developing within the emerging and young adult/adulthood (EYA) population. Evidence supports the concept that chronic stress leads to physiologic dysregulation, reduced mental health, chronic diseases, and reduced longevity; however, these are not inevitable outcomes, and resilience or vulnerability is determined by interacting environmental and biobehavioral factors. Although CMD manifests clinically in older adulthood, disease pathophysiology begins earlier, and thus, EYA is a critical time for observation and intervention. Growing evidence indicates inflammation is a major risk factor in CMD development and may be exacerbated by …


The Relationship Between Nurse And Therapy Staffing Levels And The Medicare Patient-Driven Payment Model Reimbursement During The Covid-19 Pandemic, Roland T. Shapley Jr Jan 2022

The Relationship Between Nurse And Therapy Staffing Levels And The Medicare Patient-Driven Payment Model Reimbursement During The Covid-19 Pandemic, Roland T. Shapley Jr

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The Patient Driven Payment Model (PDPM) brought about a paradigm shift in the way skilled nursing facilities are reimbursed, by linking complexity of care to beneficiary need, expanding case-mix adjusted components by including a non-therapy ancillary and speech language pathology component, and limiting the volume of therapy services provided. The COVID-19 pandemic wreaked havoc upon the nursing home industry that gave rise to high patient and staff infections and fatalities, declining occupancy rates, and nursing shortages, compelling the Department of Health and Human Services to provide $4.9 billion in CARES Funding to skilled nursing facilities (SNFs). Using Payroll Based Journal, …


Alzheimer Disease Special Care Units And Nursing Homes' Organizational Performance, Giovanna Pilonieta Ortiz Jan 2022

Alzheimer Disease Special Care Units And Nursing Homes' Organizational Performance, Giovanna Pilonieta Ortiz

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Alzheimer’s disease special care units (AD SCUs) have been adopted to provide specialized care for people with dementia in nursing homes. However, the effects of environmental and organizational factors on AD SCUs adoption by nursing homes and their influence on nursing homes' organizational performance remains unclear. Guided by Resource Dependence Theory, Donabedian’s Structure-Process-Outcome (SPO) framework and the Resource-Based View of Firms perspective, the purpose of the three papers included in this dissertation was to provide empirical evidence of the contextual and organizational factors that influence AD SCUs adoption among nursing homes and how the adoption of AD SCUs impact nursing …


Unexpected And Usual Breaks' Impact On Body Composition In College Athletes, Aston Dommel Jan 2022

Unexpected And Usual Breaks' Impact On Body Composition In College Athletes, Aston Dommel

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Body composition is an important factor that determines athletic performance. At the elite level, margins of victory are narrow, with small changes in performance making the difference between victory and defeat. Changes in body composition affect performance, in both improvements and decrements. Athletes regularly experience breaks from structured activity and resources caused by expected circumstances (school breaks, off-season) and unexpected circumstances (injury, COVID-19). Due to differences in diet, physical activity, and other factors, breaks may cause changes in body composition that can hinder or help the athlete upon return to structured resources. Currently, there is a plethora of cross-sectional research …


The Effect Of Federally Qualified Health Centers (Fqhcs) Prevalence On Uncompensated Care In Us Hospitals, Kena R. Norris Jan 2022

The Effect Of Federally Qualified Health Centers (Fqhcs) Prevalence On Uncompensated Care In Us Hospitals, Kena R. Norris

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Over the past two decades, uncompensated care in U.S. hospitals has grown at a staggering rate and reached $46.4 billion in 2013. It began to decline in 2014, due to the passage of the Patient Protection and Affordable Care Act (ACA), but is now on the rise again. Uncompensated care is typically affected by policy and market factors such as legislative changes and an increase in the number of uninsured. While hospitals continue to serve as critical safety net providers, they are often not the only or most appropriate facility to serve the indigent in U.S. communities. Instead, federally qualified …


The Effect Of Integrative Medicine Interventions On Patient Activation Measure, Rochelle F. Richards Jan 2022

The Effect Of Integrative Medicine Interventions On Patient Activation Measure, Rochelle F. Richards

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Activated patients believe they have essential roles in achieving and maintaining their health. Patient activation is strongly related to improved clinical outcomes (Hibbard, 2017; Greene, 2013). The study’s primary purpose is to evaluate the use of Integrative Medicine Interventions (IMIs) and their relationship to patient activation levels; and to investigate the association between IMI protocols and patient activation levels on patient reported outcomes (PROs) for those with chronic diseases, specifically chronic fatigue and mental health-related conditions of anxiety and depression, using the principles of Integrative Medicine’s (IM) whole-person approach as the model of care in independent IM practices across the …


Exploring The Influence Of Family History Before And After Type 2 Diabetes Development Through Statistical Analysis Of Biomarkers And An Educational Intervention, Jessica Johnson Denton Jan 2022

Exploring The Influence Of Family History Before And After Type 2 Diabetes Development Through Statistical Analysis Of Biomarkers And An Educational Intervention, Jessica Johnson Denton

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The prevalence of type 2 diabetes is increasing at an alarming rate in both children and adults worldwide. Timely identification of those at risk for type 2 diabetes is essential to reduce morbidity and mortality and to mitigate the toll on families and the healthcare system. Family history is an effective, universal tool that can be used to identify individuals at risk for type 2 diabetes before they acquire additional risk factors. Understanding how family history contributes to biomarkers associated with diabetes in healthy individuals could facilitate the creation of early screening and prevention strategies designed for this specific at-risk …


The Role Of Alternative Payment Models In Pharmaceutical Services And Outcomes, Matthew G. Parker Jan 2022

The Role Of Alternative Payment Models In Pharmaceutical Services And Outcomes, Matthew G. Parker

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A persistent challenge within the healthcare sector is balancing cost containment for health services and the quality of care associated with these services. This challenge has reinvigorated interest in alternative payment models (i.e., risk-sharing, shared savings, capitation), arrangements between payers and healthcare providers that structure reimbursement for services based on health outcomes. Although much research has assessed the association between these payment models and financial outcomes for medical services, there is a paucity of research that has likewise assessed pharmaceutical outcomes (i.e., electronic prescribing, evidence-based prescribing, medication adherence). The papers comprising this dissertation contribute to this limited body of research …


Predictors Of Us Hospital Responsiveness To International Patient Inquiries, Suzanne M. Garber Jan 2022

Predictors Of Us Hospital Responsiveness To International Patient Inquiries, Suzanne M. Garber

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Medical travel has been growing at a steady rate as global travel has also increased. However, with the advent of COVID-19, all global travel came to a screeching halt, including travel intended for medical purposes across borders. Now that travel is resuming worldwide, American hospital administrators are anxious to fill their beds with more profitable, international patients to make up for revenue losses incurred during the pandemic. Existing literature on the topic of medical tourism focuses on the role of patient initiative, choice, and risk-taking behaviors with little mention of hospital leadership’s ability or desire to construct a management strategy, …


Contributions Of Off-Season Training And Food Security Status On Body Composition And Performance In Collegiate Football Players, Kathryn Lee Stowers Jan 2022

Contributions Of Off-Season Training And Food Security Status On Body Composition And Performance In Collegiate Football Players, Kathryn Lee Stowers

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Body composition measurements are collected periodically in the collegiate athletic setting to evaluate health and predict athletic performance of individual athletes. However, the effects of remote training and food insecurity on body composition have yet to be fully investigated in this population. The purpose of this research was to evaluate the influence of remote training and food security status on body composition and performance changes during off-season training. Aims 1 and 2 focus specifically on how factors affect body composition changes in collegiate football players during off-season training. Data were collected from routine body composition testing and food security screening …


Parent And Healthcare Provider Beliefs About Chlamydia Adolescent Vaccine, Alison P. Footman Jan 2022

Parent And Healthcare Provider Beliefs About Chlamydia Adolescent Vaccine, Alison P. Footman

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Introduction: Chlamydia is the most common bacterial sexually transmitted infection (STI) worldwide and it disproportionally affects young people and those living in the Southern United States. If left untreated chlamydia infections can lead to complications such as infertility and pelvic inflammatory disease. Currently, chlamydia vaccines are being development. A successful chlamydia immunization program would require adolescents to be vaccinated before engagement in sexual activity and would require parental approval and recommendations from healthcare providers. Therefore, this project aims to explore parent and healthcare provider opinions about chlamydia vaccines to identify potential barriers and facilitators to uptake. Because the COVID-19 pandemic …


Oxygen Cost Of Walking And Its Correlates In Multiple Sclerosis, Brenda Jeng Jan 2022

Oxygen Cost Of Walking And Its Correlates In Multiple Sclerosis, Brenda Jeng

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Multiple sclerosis (MS) is a chronic, neurological disease characterized by demyelination and transection of axons as well as loss of neurons in the central nervous system that may result in poor walking efficiency, indicated by an increase in the oxygen cost of walking (Cw). The Cw is defined as the amount of oxygen consumed per kilogram of body weight per unit distance walked and reflects disability-related gait abnormalities and manifestations and its interaction with the environment. This dissertation involved four research projects. The first project provided an overview of existing research on the Cw in MS and established a research …


Strategic Balance In Healthcare Organizations, Corey Spraberry Jan 2022

Strategic Balance In Healthcare Organizations, Corey Spraberry

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The purpose of this dissertation was to assess the relationship between service mix offerings relative to competitors and firm performance. Specifically, this study explores if an optimal point of service offerings in the competitive market is associated with financial performance. This study is important to both researchers and healthcare leaders as it helps understand the relationship between optimal service mix and firm performance. The results find a relationship that suggests a differentiated service mix compared to a generalized service mix is associated with financial performance. Additionally, hospital characteristics are associated with service duplication and differentiation. The findings of this research …


Health Disparities In Cardiometabolic Risk Among African American And European American Adults, Catharine A. Couch Jan 2022

Health Disparities In Cardiometabolic Risk Among African American And European American Adults, Catharine A. Couch

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African American (AA) individuals are disproportionately burdened by cardiometabolic disease, including type 2 diabetes (T2D) and cardiovascular disease (CVD), and associated risk factors. The objective of this dissertation research was to investigate pathophysiological and lifestyle contributors to racial disparities in cardiometabolic disease including beta-cell dysfunction, ectopic fat, the natriuretic peptide system, and diet. These first three risk factors, beta-cell dysfunction, ectopic fat, and the natriuretic peptide system, were explored in a cross-sectional study of young AA and European American (EA) adults. The fourth risk factor, diet, was explored in a large, national cohort of black and white adults. First, we …


Effects Of Different Types Of Augmented Feedback On Spatiotemporal Gait Performance And Intrinsic Motivation With Individuals Post Stroke, Saleh M. Alhirsan Jan 2022

Effects Of Different Types Of Augmented Feedback On Spatiotemporal Gait Performance And Intrinsic Motivation With Individuals Post Stroke, Saleh M. Alhirsan

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After a stroke, an individual can be left with physical and psychological deficits, including decreased walking speed, reduced step length, and reduced intrinsic motivation. These deficits affect their performance during rehabilitation sessions, limit daily activities such as walking and stepping, and restrict participation in social roles that involve mobility. Current clinical practice guidelines recommend providing augmented feedback using virtual reality (VR) to enhance walking outcomes after six months of stroke onset. This dissertation shows two novel VR applications designed, especially for individuals’ post-stroke, to induce their fast-walking speed and maximum step length performance, and intrinsic motivation. Three performance conditions were …